1. Introduction
The Prison Law of the People’s Republic of China, revised on October 26, 2012, deals with the correction and medical care of prisoners. This modern law stipulates that those imprisoned for committing crimes must also be protected under the national medical system. There are two reasons for this. First, the PRC’s Constitution stipulates the right to medical and health services for all citizens (Article 45). Second, medical care is considered the minimum necessary measure to achieve the basic purpose of correction (Lee et al., 2009: 122).
Given the above reasons, how did premodern China perceive the medical treatment of criminals? Premodern China differed from how the modern state looks at people, but all citizens, including criminals, were under the emperor’s protection because they were considered his children (chizi 赤子). However, the argument behind the second reason, the idea of medical care as a prerequisite for correction, was not prevalent. This is because punishment in premodern China had a strong purpose of retributivism or general prevention, and the idea of correction as punishment was not very prominent (Kim, 2020: 339–344).
Moreover, there is a need to consider the perception of the emperor’s role and the differences in punishment with reference to the medical treatment of criminals. In premodern China, unlike today, there were no legislative or judicial institutions independent of the supreme power, and the origin and operation of all laws were dependent on the emperor’s will (Shiga, 2003: 19). In other words, the power to define crime and punishment by enacting laws or granting amnesty to criminals was concentrated in the emperor. Therefore, when a punishment second to the death penalty was awarded or when the death penalty was commuted, even if the emperor’s leniency regarding pardons was progressively narrowed after the Ming dynasty (McKnight, 1981: 108–111), it was commonly described as “a criminal generously spared by the grace of the emperor.” The perpetrator was not sentenced to death even after committing a crime because the emperor distinguished that crime from other crimes punishable by death. From this point of view, if a criminal not sentenced to death was treated improperly and died, it meant that the emperor’s favor went in vain, and the balance between the death penalty and non-death penalty was lost.
Under this concept of punishment, the perception that criminals should be punished only as much as prescribed was already reflected in the law from the Tang Code. If the criminal was punished more severely or lightly by applying the wrong provisions of the law in the process of determining the crime, and if the criminal died due to an incorrect execution, the relevant government official or yamen runners were ordered to be punished.1) In addition, the standards of the instruments used for corporal punishment were set, and medical treatments were provided to the prisoners to prevent any unintentional death. These legal measures were intended not only to impose appropriate and standardized punishment on criminals but also to exercise the emperor’s will.
This study examines the medical treatment that was delivered to the criminals managed by local governments during the Qing era and the role that was expected of the government doctor in charge of medical care. There are two reasons for paying particular attention to the Qing era. First, the Qing Dynasty was a turning point in many ways. Emperor rule reached its peak in the Qing era, but as the shock from Western influences and the accumulated contradictions emerged, the old system began to disintegrate. This trend is evident in the medical history of the period as well. While the traditional medical system was developed and compiled, Western medical knowledge spread around the treaty ports.2) By the end of the Qing era, Western medicine gathered support, Western surgery methods were welcomed, and some traditional Chinese doctors began to be labeled “quack” doctors by people (Choi, 2019).
The second reason is the peculiarity of the punishment system in the Qing era. The Qing Dynasty differed from the previous Ming Dynasty in that it adhered to a system based on “actual punishment,” that means that the punishment was actually executed. This made the local officials in Qing China responsible for managing a large number of criminals. Penal servitude (tu 徒), ordinary exile (liu 流), and military exile (chongjun 充軍) coexisted as punishments. In addition, imprisoned criminals waited long for sentences and judgments and, since the middle of the Qing era, new punishments based on bondage were introduced. To ensure that these criminals did not die due to internal causes resulting from the mentioned punishment, because the emperor had not yet ordered the death penalty, the officials had to guarantee medical treatment.
In addition, the abundance of historical sources during the Qing era reveal how the above-mentioned measures actually worked to punish criminals to the prescribed extent. Examining the extant research on medical care for criminals in premodern China, we find that it mostly focused on those in prison. Two main strands of research exist: studies emphasizing prison regulations, such as the placement of medical personnel and provision of clothing, and those focusing on poor sanitation and medical care in prisons based on reports from local officials.3) However, compared to the topics of interest above, there is a tendency to not deal with how the medical care was actually provided, mainly because of the lack of historical materials. None of the institutional regulations found in the central historical records, local gazettes dealing with some famous doctors’ specific activities, or medical books of the time focused on the medical treatment of criminals.
Against this backdrop, what must be the research approach toward medical care practices for criminals under local government control, including those in prison? Local archives in the Qing era can be a powerful source for tracing the medical practices of government doctors at the time. In this study, I pay special attention to the local archives of Ba County (巴縣) in Sichuan Province, located in present-day Chongqing. First, I explain the characteristics of the punishment system in the Qing era, particularly because a large number of criminals were placed under the management of the local governments. Next, I compare the medical practices laid down in the central government regulations and the primary records of the county and try to reconstruct the actual medical practices at the time by examining the government doctors’ diagnoses and prescriptions for prisoner patients.
2. Criminals under local government control and government doctors
Before examining the medical treatment provided to criminals by the local government in the Qing era, it is important to confirm the types of the criminals who were subjected to the treatment and the government doctors in charge of their medical care. Unlike previous dynasties, the basic direction of the Qing era in terms of jurisdiction was to use “five punishments (wuxing 五刑)” as actual punishments, and the amends fine was limited to older adults, youth, people living with disabilities, and women. Thus, the number of criminals the government had to manage was bound to increase compared to that in the previous era.
In the above judicial context, the local governments had to manage three categories of criminals. The first and the largest group was criminals in prison.4) Historically, Chinese prisons accommodated various types of criminals, which continued in the Qing era. There were criminals under trial, such as those involved in human life cases, or those judged to be guilty of more than penal servitude, who had to await judgment of higher authority after the trial and were kept in prison for a specific period. There were also people waiting for the final verdict on the death penalty, held once a year, where one of the following three judgments was made: execution, commutation, or adjourned for a year.5) Some prisoners continued to be in prison for years after repeated adjournments (Shiga, 2003: 19).
The second group comprised exiled prisoners, who were a problem because, unlike in the past when only frontier areas were used as places of exile, post-stations or counties in China proper were supposed to house the criminals. The exiles sent to China proper had to be self-supporting, but their status as criminals did not change, and the local government was obliged to manage them to prevent trouble (Kim, 2016: 250–257).
The third group comprised criminals sentenced to fettering punishments. In the Qing era, a cangue—a 15 kg wooden collar, 89 cm long and 85 cm wide—was put on some criminals in front of the public.6) After the 19th century, cases involving new forms of fettering were introduced for some crimes. For example, criminals were tied to an iron pillar or a large stone (Suzuki, 2012) or housed in a concentration camp (Ōta, 2015: 265–364). These punishments were usually executed at the local level, and approval was obtained from the central government.
For these types of criminals, respective regulations were prepared by the central government, and in 1740, the following medical treatments were prescribed in Da Qing lüli.
Article 1
Central and local prisons select two doctors each to treat prisoners and evaluate their competency at the end of each year. If many people have been cured and healed in a six-year term, according to the statute, the central government appoints the doctor for limu (吏目), and the local provinces appoint him for dianke (典科) and xunke (訓科). If there are many criminals who die because they cannot be treated, the doctors should be dismissed and replaced (Vol. 26, “Prisoners’ Food and Clothing”).
Article 2
If a prisoner on the road to exile falls ill, the transporting person immediately reports this to the local government official, who submits an official document after an inspection in person so that the local government can stop the exile and treat the criminal (Vol. 26, “Abuse of and Cruelty to Prisoners”).
Article 3
If the criminal subjected to cangue is sick, they are bailed immediately to receive treatment, and as soon as they get better, they have to make up for the number of days of cangue they missed. If, after executing the blow first, a cangue is imposed, or if the person becomes ill and is not immediately bailed and cured, resulting in death, the official shall be reprimanded by the Ministry of Personnel (Vol. 26, “Prisoners Who should be Incarcerated and Who are Not”).
Article 1 specifies that two doctors should be assigned to prison to treat the criminal, and the promotion and dismissal of doctors are stipulated according to the success or failure of the treatment.7) Article 2 provides that if a criminal on the way to exile falls ill, the person must be stopped immediately and treated. Since the criminals arriving at the place of exile had to make a living on their own, the stipulation of medical support was limited to those on the way to exile. For this reason, in Zhejiang Province, if the exiled person could not support themselves in the place of exile, provincial rules dictated that the government had to send a doctor.8)
Article 3 describes the medical regulation for cangue criminals, for whom treatment was ordered if they fell ill, and the punishment stopped immediately. Since the mid-Qing era, as other types of fettering punishments were expanded, provincial governments made a provision to temporarily release these criminals in case of illness, treat them, and then fetter them back.9) This was because the criminals sentenced to fettering could easily die if they got sick because of a drop in immunity. In one case from the Dan Xin Archives, three criminals, ordered to be fettered for the same crime, died in succession in about three months in summer (DXDA 33402). In addition to the central regulations, the local rules on medical treatment for criminals took the actual requirements of each region into consideration.
Who, then, were the government doctors in charge of medical care for these criminals? There were clear operating regulations for doctors in the Directorate of Imperial Medicine, which was authorized to hire doctors who had been selected after passing relevant tests (Kug, 2021). However, there were no clear regulations for government doctors in the local prisons, and the local officials could select people knowledgeable in medicine and then notify the Ministry of Rites.10) In principle, these government doctors were to be placed in each prefecture, department, and county, and the case of government doctors in Nanbu County shows they played a role in hygiene and medical disputes (Liu, 2020: 45).
The title of a government doctor, yixue (醫學), was originally given to the head of a medical educational institution, but it seems that the function of medical education was rarely performed in the Qing era. Governmental medical educational institutions have been in decline since the Ming Dynasty, and during the Qing era, most medical education paths were in the private sector, mostly as a family tradition (Huang, 2017: 99–100).
Judging from the regulations regarding the placement of government doctors in Article 1 and examples such as Ba County, Danshui Subprefecture (淡水廳) and Nanbu County, it seems certain that each local government agency was in charge of medical treatment for criminals by arranging government doctors.11) However, it is not easy to trace the activities of these doctors because, among the authors of medical books or doctors named in local gazettes, there are hardly any who have worked as government doctors.
In fact, there did not seem to be enough incentives for doctors with high social status or medical achievements to serve as government doctors. One reason was the low salary. According to the salary records of several government doctors, it was around 2 taels of silver per month.12) Considering a magistrate’s salary of about 400–600 taels per year with only the “silver to nourish his virtue (yanglian yin 養廉銀)”13) and livelihood assistance for the poor of 3.6 taels per year (Kim, 2022: 144), the government doctor’s salary was not high. Another factor was the resistance to providing medical care to criminals. The following paragraph from the medical book written by Chen Shiduo (陳士鐸) provides a good example.
Although most punishments for transgression are due to wrongdoing, how can we guarantee that no one has been punished even when there is no wrongdoing? When there is a resentful qi (氣) in the heart, the liver lobes open and the qi in the liver contracts, making it easier for blood to enter the xin (心), so innocent people die overnight. Even if you try to cure it, there is no way, so whose fault is it? I requested a special prescription from a stranger (yiren 異人);14) when you are punished by an official, if you decoct it and take it immediately, you will never lose your life (Bianzheng lu, Vol.13, “Stroke Punishments”).
This instruction refers to the treatment of an individual who received the stroke punishment and demonstrates that a criminal could lose their life without proper treatment. However, I want to draw attention not to the treatment but to the point that treatment became necessary because there were the victims punished without their offense being proven. Thus, treating criminals was considered justified only if there was a possibility of them being subjected to false charges and severe punishments, which also confirms that the practice of doctors treating real criminals was not preferred.
In addition, a local gazette in the Qing era featured a biography of a government doctor named Meng Dongyang (孟東暘), as follows:
Meng did not discriminate between the rich and the poor upon seeing the diseased. Even on a snowy night, he paid visits and gave medicine to the poor without receiving payment. When the women belonging to ethnic group came carrying their children on their backs and sought treatment, he gave them medicine and sent them off. On one occasion, Meng realized that he had forgotten the supplementary medicine; he became anxious, picked it up, and chased after them, finally giving it to them. Later, Meng became a government doctor, and when there was an epidemic in prison, he tried to examine the prisoners. His family advised him not to enter the prison for fear of contagion, to which Meng got angry and said, “The prisoner is also a human being. Unfortunately, they fell into crime, but how can there be no one to forgive? The disease is critical now, if I get afraid of contagion, it is the same as me killing them (Dongchuan fu xuzhi, Vol.3, “Skills”).”
Meng Dongyang’s anecdote shows similarities with that of Chen. Meng was not wealthy, but he treated ethnic groups and criminals with a humanistic attitude. He mentions that he should treat criminals because there is someone to forgive, demonstrating his resistance to treating veritable criminals. This story shows that not only low wages but also psychological resistance made people not want to be government doctors.
Based on the above evidence, the social status of the government doctors in charge of the medical care of criminals was not high, and they did not actively record their own medical practices. For this reason, historical sources for examining the medical treatment of criminals by government doctors are limited. However, from the local governments’ perspective, it is possible to trace the history because some judicial process involved government doctors. Therefore, using an example from the Ba County Archives, I provide an account of the government doctors’ medical practice of treating criminals.
3. Procedures for medical practices for criminals
Ba County, Sichuan Province, was a commercial center located in the upper reaches of the Yangtze River. Its population had declined greatly during the wars of the late Ming and early Qing eras, but it established itself as a large city with a population of over 200,000 in the 18th century (Ling, 2020: 45). Because of this immigrant society and high population pressure, there are many litigation-related documents in Ba County Archives. Therefore, research on it has tended to focus mainly on the aspects of commercial disputes and the extent to which state power permeated the private sector.15)
Since the Ba County Archives is an administrative document of the government, it also comprises many documents about the judiciary, one of the main tasks of the local county. Among these were many reports on the deaths of criminals, which confirmed that the government had dispatched a doctor, but this was ineffective and resulted in deaths. In this section, using the reports of the criminals’ illnesses, the government doctors’ dispatch, and the criminals’ deaths in the Ba County Archives, I examine how the medical practice of the government doctor was carried out at that time.
The first is the case of the death of Hu Junmei (胡君美), a criminal imprisoned in Ba County in 1757. On July 11, Ba County’s prison guard Xu Pengzhu (徐鵬著) reported Hu’s death as follows:
On March 20 of this year, Hu Junmei, a criminal who committed theft, was imprisoned. On April 4, he caught an epidemic, which was reported on April 6. I asked a doctor to visit, but his condition did not improve. On May 20, his symptom metastasized to diarrheal disease, and on May 29, I reported again. His treatment did not work, and he died on the evening of July 11. I report on this (BXDA 6-1-245).
Upon receiving the report of Hu Junmei’s death, the magistrate of the Ba County accompanied the coroner to the prison, placed the body on a flat surface, and conducted an autopsy in front of the prison guards and other prisoners. The coroner conducted an autopsy on the spot and said:
The face is yellow and emaciated, and both eyes are sunken and slightly open. His mouth is slightly open, and his hands are lightly clasped. His stomach is down, his legs are straight, and feces are coming out of his anus. The whole body is yellow and emaciated, so there is no reason other than death from disease (BXDA 6-1-245).
The magistrate, who checked the body in person, did not find any other injuries and immediately began interrogating the persons involved. The interrogation subjects were Xu Pengzhu, a prison guard who first reported the death, Li Xiaozu (李效祖), a government doctor, and prisoners Liang Shigang (梁仕剛) and Chen Shifeng (陳世俸). First, Xu stated that Hu fell ill in prison and asked for a doctor to treat him, and swore that he would never mistreat a criminal. Liang and Chen, who had been imprisoned together, also made the same statement and swore that Hu was not abused. The government doctor Li stated the following:
Hu Junmei, who died, fell ill in prison on July 6, and I was ordered to treat him. I judged the cause of his illness as an epidemic because he was feeling breathless. At this time, I first used shengma gegen tang (升麻葛根湯) to feed him two packs, but it did not work, and later, he developed a diarrheal disease. I adjusted the huanglian jiedu tang (黃連解毒湯) again and fed it to him, but it did not work, and he died unexpectedly on the evening of July 11. He really died of an illness, and there is no other reason. I swear (BXDA 6-1-245).
Here, the prison guard (Xu) and the government doctor (Li)’s focus of the descriptions vary. Xu said that Hu fell ill on April 4, about 15 days after he entered prison, and that he called a doctor to treat him and on May 29, Xu reported that Hu’s sickness had metastasized to diarrheal disease. This was probably because Xu wanted to claim that Hu was already weak and that he had not abused Hu. However, Li’s statement focuses on his medical practice after July 6, which is directly related to his death. Either way, the gist of the statement and the answer the magistrate wanted to hear was the conclusion that “the prisoner died of an illness, and there is no other reason.” This is because if a criminal died due to being abuse by the prison guard, not only the prison guard but also the officer in charge who failed to detect it would be punished.16) The magistrate of Ba County, who received the statements, reported it to the superior office, attaching the autopsy documents and the pledges of the concerned.
Based on the above case, the prisoners’ medical treatment procedure can be summarized as follows. First, the prison guard or others report the occurrence of the disease. After that, the magistrate gives the order to dispatch a doctor. The dispatched doctor makes a diagnosis, prescribes medication, and gives medicines to the prisoner. If the treatment does not work, the government doctor visits again and prescribes another medication. When a criminal dies, the prison guard reports the death. Then, the magistrate, accompanied by a coroner, conducts an autopsy to ensure there was no injury, and interrogates the doctor, the prison guard, and other prisoners. If it is judged that “the criminal died of an illness and there is no other reason,” the case is closed, and a letter is written confirming that there is no lie in the statement. The procedure of Ba County’s medical treatment and death administration is almost the same as in the description of the official manual, Fuhui quanshu, widely referenced during the Qing era.17)
The circumstances of criminals’ death outside the prison were not much different. Following is the case of Tian Wensheng (田文盛), who died in 1774. Tian was from Jintang County (金堂縣) and was sentenced to “90 strokes and two and a half years of penal servitude” for taking money and valuables by intimidation, and was sent to Baishi Station (白市驛) in Ba County on August 17, 1774. The rule was that a criminal sentenced to penal servitude was sent to a post station to engage in forced labor. Huang Rong (黃榮), a horsekeeper, was supposed to take responsibility for managing the criminal. When Tian was struck by shanghan (傷寒) disease, Huang requested for a doctor on November 25, who happened to be Li Xiaozu again. However, there was no improvement, and on December 4, Tian passed away. After inspecting the site, the magistrate posted the following report:
(Receiving the death report of the criminal) I took the coroner to the place where the body was laid, moved the body to a flat and bright place, and conducted an autopsy in front of many people according to the law. Coroner Ren Shixue (任世學) dictated, “…Indeed, he died of an illness.” After putting the body in the coffin and cleaning it, I received the coroner’s confirmation that there were no hidden injuries. Then, I interrogated the people available at the spot. When I asked Huang Rong, the horsekeeper, he said that “dead Tian … on November 25, contracted shanghan disease. I reported and received medicinal materials, and the government doctor, Li, was dispatched to treat him. I gave Tian a decoction of medicine every day, but it did not work, and he died on December 4. Tian indeed died from the disease, and I did not abuse him at all.” When I asked the government doctor Li, he said that “On November 25, I was selected and sent to treat Tian Wensheng, who had been sentenced to penal servitude. He was suffering from shanghan disease, and I tried to cure him by adjusting mahuang tang (麻黃湯). However, even after feeding him several packs, he did not show any improvement, and Tian died on December 4. He really died from the disease, and there is no other reason.” After receiving the above description, the coffin containing the body was temporarily buried in a high place, and I notified Jintang County so that the deceased’s relatives could come and receive it (BXDA 6-1-411).
The procedure’s description is not much different from that of the previous example. Except for the differences in the criminal’s diagnosis and the medicine used, the same phrases are used. Both the magistrate’s reports focused on avoidance of blame for the death of a criminal.
Among other cases is the death of Zhang Yongming (張永明), who had been sentenced to penal servitude and was first sent to Baishi Station but later moved to the Location of the Community Compact (xiangyue suo 鄕約所), where he received treatment after falling ill (BXDA 6-1-306). However, the doctor sent to the Location was the same government doctor Li Xiaozu, and the progress of this case was not much different from that of the others.
In another case from Ba County Archives, a criminal, Chen Xuebao (陳學寶), who was exiled to Xingzi County (星子縣) in Jiangxi Province, died of an illness. He had arrived in Xingzi County, the place of exile, on July 24, 1781, for robbery in broad daylight. However, on March 17 of the following year, he was suddenly taken ill from shanghan disease. The magistrate of Xingzi County sent a doctor, but the treatment did not work, and he died on March 24. The magistrate sent the autopsy results and the statement of the village representative in charge of Chen’s management to Ba County, saying that he died from the disease and there was no other reason. At the same time, the magistrate requested that the dead criminal’s family be sent to recover the body (BXDA 6-1-506).
As described above, if a criminal under government control became ill, regardless of whether they were in prison, a government doctor was dispatched to treat them. Thus, a government doctor was required to play two main roles. The primary role, of course, was to heal criminals. However, if the criminal died, they had another role, to testify that there was no other cause of death than the disease. In this way, the government doctor played a role in determining whether the death was related to a crime. This begs the question: what medical practice did the government doctor perform to treat the patient?
4. Examples of prescriptions by government doctors
Based on Li Xiaozu’s statement in the case of Hu Junmei, Li used shengma gegen tang and huanglian jiedu tang. In this section, I examine the medical case of a criminal in Ba County during 1757–1781, in which the disease and prescription are confirmed. The symptoms and prescriptions are summarized in chronological order in Table 1.
All the criminals in Table 1 were treated by Li Xiaozu, except Liu Jiyi, in whose case the name of the doctor appeared as Sun Lanping (孫闌平). Li appears in most of the criminal death cases of Ba County during the Qianlong years, described as a doctor or government doctor. Eight of the medicines prescribed by Li were identified. Among them, seven prescriptions are found in Waitai miyao (外台祕要) of the Tang era, and Taiping huimin heji ju fang (太平惠民和劑局方) and Renzhai zhi zhi (仁齋直指) of the Song era. In addition, the uses of the medicine are also not markedly different from those of the Tang and Song eras.
Based on the above, Li’s prescription can be seen as quite conservative. Although there were new and commercialized medicines in the Qing era,18) he still adhered to the Tang and Song era prescriptions. There could be two reasons for this conservatism. First, Li had no economic incentive to use new medicines and prescriptions. Unlike the private market, patients under the care of government doctors did not directly pay them for medical services. Rather, if criminals could afford it financially, they sought bail to receive medical treatment outside.19) In addition, the medicinal materials used were not stored in the yamen and used, but were refunded by claiming the cost of the medicinal materials used by the government doctor.20) In Ba County, in particular, only 80% of the price of used medicinal materials was refunded (BXDA 6-1-153). It is unknown whether the refund of 80% was to prevent the use of overly expensive medicines or because of the local government’s temporary financial problems, but it is certain that there was no incentive for Li to use expensive new medicines.
The second reason was the fear of being punished for a criminal’s death. In the Qing Code, there was a rule called “Incompetent Doctors Who Kill or Injure Others” that punished medical practitioners in case of death due to malpractice.21) The corpus delict of the rule is the phrase “someone who does not follow the pharmacopeia leads patients to death.” Prescribing medicine following the pharmacopeia could be a basis for a doctor to defend the legitimacy of their medical practice, in case of a death or trial, and claim that they did not cause the criminal’s death.
What does the pharmacopeia refer to? One possibility is Yuzuan yizong jinjian (御纂醫宗金鑑), a medical series published during the Qianlong period and an official textbook of the Directorate of Imperial Medicine (Kug, 2021). It was so widely distributed that it had 53 editions until the end of the Qing era (Wang, 2014). However, in the case related to the rule of “Incompetent Doctors Who Kill or Injure Others” in the Xing’an huilan, there is no specific mention regarding the origin of pharmacopeia. Moreover, considering that the doctors involved in the case never clarified which book they relied on for the prescriptions, it is reasonable to assume that these illustrate a general prescription rather than a specific pharmacopeia, such as those found in Yuzuan yizhong jinjian.
Li’s statement above verifies the patient’s symptoms and prescription, but confirming the treatment and changes in the patient’s prognosis is difficult. This is because most of the examples in this study were statements made after the death of the criminal, and the main purpose of the depiction was to make sure that medical treatment was performed according to regulations and that no other circumstances were involved in the death.
For this reason, BXDA 6-2-3948, containing 13 prescriptions served to Mou Dashun (牟大順) is a very valuable piece of medical history. The circumstances of the case are as follows. At some point in the Qianlong period (1736–1795), the magistrate of Bishan County (璧山縣) caught three criminals, including Mou who had stabbed three people to death. They were sent to Ba County, which was the seat of Chongqing Prefecture, because, cases dealing with human life were not handled at the county level and they had to wait for the provincial governor’s response through the prefecture. The criminals had killed three people and were most likely facing the death penalty unless significant mitigating factors existed.22)
However, one of them, Mou, fell ill. The prescription dated February 28, the earliest confirmed prescription, is presented in Figure 1.
In this prescription, Li Chunwu (李純武), a government doctor, specifies the prescription of dayuan yin (達原飲) and lists the medical ingredients used for it. Dayuan yin, which appears in Wenyi lun, a medical book of the Ming era, is prescribed for treating warm diseases.23) In here, Li faithfully followed the prescription, with some additional medical materials. Three pieces of ginger were prescribed as a supplementary medicine.24) However, Mou’s health did not improve, and Li continued to treat the patient while revising the prescriptions, summarized in Table 2.
It is not possible to ascertain what happened to Mou after he received treatment because his whereabouts could not be confirmed. Perhaps he died from an aggravation of his illness, or he could have recovered and then put on trial and sentenced to death, or his sentence could have been commuted to exile. However, considering only the changes in the prognosis recorded by Li, one can infer that Mou did not die immediately. The most difficult period seems to have been March 2–3, when Mou had a fever and was semi-conscious. A recuperating medicine called bazhen tang appears to have been prescribed on March 11 and Mou seems to have recovered, though with some difficulty.
Several facts can be verified through the above prescriptions. First, Li prescribed medicines while adjusting a part of the prescription in the medical books. He added some herbs or removed some from the most basic prescription, as illustrated by the adjustment of dayuan yin. Second, even considering the possibility of lost prescriptions, one prescription was made at least once every two days. Judging from the changes in the symptoms and prescription, it is highly likely that the government doctor visited in person. Subsequently, regardless of whether an effective prescription was provided, the effort to prevent the death of the criminal was not limited to a nominal one, and even though Mou was almost certain to be sentenced to death, Li tried to save his life as far as possible. Third, the use of acupuncture is not confirmed, and this is similar to Li Xiaozu’s statement reviewed earlier. It seems that the government doctors of Ba County in 18th century depended mainly on decoctions.
Almost all of Li Chunwu’s prescriptions were traditional prescriptions related to the Tang and Song eras, except for dayuan yin and chaihu yangrong tang, which only appeared in the Ming era. The conservatism of this prescription is also valid in the data of Dan Xin Archives in a later period. A report made in 1883 listed several prescriptions. The government doctors were prescribing shensu yin (參蘇飲), da chaihu tang (大柴胡湯), and xiao chaihu tang (小柴胡湯) (DXDA 33319), which too were traditional prescriptions from the Tang and Song eras. More than 20 years have passed since Tamsui Port was opened under the Treaty of Tianjin, but the new medical knowledge has not yet led to medical care for criminals.
5. Conclusion
During the Qing era, there were three possible reasons for prisoner deaths. The first was abuse by management personnel; Fuhui quanshu said that the life of a prisoner depends on the prison guard.25) Second, the prison management was not well-executed; as a magistrate from the Danshui Subprefecture said, “If a criminal dies of disease or cold and hunger, how can the official be blameless (DXDA 31801-1)?” The third was death from disease. Many of the illnesses could have been caused by the first or the second reason, but more importantly, no officer in charge was held accountable unless there were direct injuries or evidence.
It was a major task for the local official to prevent these three types of death of the criminals kept alive by the emperor. This is why, for the first two reasons, the disposition of local government officials and yamen runners who failed to prevent the deaths was stipulated by statutes. However, in case of death from disease, there was a minimum regulation for the arrangement of government doctors, but it was rare to demand responsibility for frequent diseases or deaths of criminals. This reflects high possibility of death due to mistreatment by prison guards or prison mismanagement and the traditional Chinese view of life and death,26) that a person’s fate determines disease and death. Under these circumstances, the possibility of the criminal dying due to wrong treatment by the doctor was not considered, and the possibility of saving the criminal was not highly accepted. Even if three prisoners died in succession, the punishment of the doctor was not considered. Rather, it seems that the biggest role of the doctor requested by the government was to testify that a criminal’s death did not occur due to abuse or illegality.
From the point of view of criminals’ medical care, the right to medical care was secured, but the government doctors dispatched to patients were not selected based on their medical competency, and adequate incentives for quality medical care were also not provided. Moreover, although the judicial system in the Qing dynasty increased the number of criminals to be managed by local governments, no reform measures related to their medical care were implemented. Even in such a situation, there were government doctors like Li Chunwu, who tried to save patients by visiting them every day and changing prescriptions, or Meng Dongyang, who went to prison and treated the patients even during an epidemic. Despite their limited role, they made an effort to provide medical care. However, this also meant that the quality of medical care was not institutionally guaranteed and depended on the personality and skills of individual doctors, thus providing evidence of the poor medical environment in which the criminals in government control were placed.27)
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