조선시대 지방의료의 성장 : 관 주도에서 사족 주도로, 사족 주도에서 시장 주도로 = Three Great Phases in the Development of the Local Medical System of the Joseon Dynasty

다국어 초록 (Multilingual Abstract)

The present paper elucidates the three phases in the local medical system of the Joseon Dynasty by examining the process through whicha medical mutual assistance association in Gangneung (1603～1642) emerged, saw changes in its management methods, and disappeared.
In 1603, twenty-five aristocrats in Gangneung created an informal mutual assistance association, thus establishing an unprecedented and stable local medical supply system. Although it did receive support from the magistracy of Gangneung, this medical mutual assistance association was privately organized and led by the aristocrats. The system was organized so that the aristocrats lent rice at interest, which in turn was used to procure medicine and to hire physicians.
Up to the 17th century, Joseon society provided medicine to the provinces through a gift economy where a system based on three central medical organs(which also included the Palace Medical Office and the Office for Relief Works), at the top of which was the Palace Pharmacy in Seoul, and pharmacies attached to regional magistracies, which catered to those of high ranks and social class. Based on personal connections, it was a makeshift and unstable system.
With the rise of medical mutual assistance associations, however, this medical structure came to be replaced by a medical system centered on aristocrats. From 1603 and onwards, the aristocrats in Gangneung took care of their health by organizing a medical mutual assistance association, which indeed was the sole medical system in the region. Although it required a considerable amount of operating funds, this new system secured and provided medication in a stable manner. The aristocrats in Gangneung organized this medical mutual assistance association in an effort to practice the Confucian values of “filial piety” and “benevolent art”, and the organization also contributed to these aristocrats’ rule over local society because it was the only medical organ throughout Gangneung.
This aristocrat-centered medical system was in complete disuse by the early 19th century, however, a phenomenon that actually began to occur much earlier. What destroyed the Gangneung aristocrats’ medical mutual assistance association was the emergence of pharmacies pursuing profit. With the rise of numerous pharmacies, the Gangneung aristocrats’ medical mutual assistance association lost its monopoly. This signifies the transition of the “qualification” for the use of the medical system from ideology and social class to economic purchasing power.
In fact, such commercial medical mutual assistance associations were predominant in both Seoul and the provinces and eventually came to take root even in the relatively isolated Gangneung area. Implemented since the early 17th century, the Uniform Land Tax Law generated a large amount of surplus medical supplies besides those presented to the king as tribute, which in turn seem to have affected the commercialization of medicine considerably.
In sum, the local medical system in Gangneung during the Joseon Dynasty changed from a makeshift gift economy based on official rank and social class in the early 17th century to a medical mutual assistance association managed by aristocrats, then to a commercial medical system around the early 19th century. Such changes were caused by the emergence of social organizations called mutual assistance associations following the mid-Joseon Dynasty, Confucian values of “filial piety” and “benevolent art”, and the growth of commerce during the late Joseon Dynasty. Indeed, the case of the medical mutual assistance association was not limited solely to Gangneung but a phenomenon observable in the entire Joseon society including both the capital and the provinces. key

목차 (Table of Contents)

• Ⅰ. 머리말
• Ⅱ. 강릉 약계의 등장과 소멸
• Ⅲ. 강릉 약계의 성격-사족 중심의 지방 의료시스템
• Ⅳ. 강릉 약계를 통해본 서울-지방의 의학과 의료
• Ⅴ. 17세기 이후 조선 약계의 두 경향
• Ⅵ. 에필로그
• 〈ABSTRACT〉