Alexander von Kumberg

In 1972 sculptor Tadao Koga unveiled his monument to the introduction of Western medicine to Japan in Ōita, a city on the northeastern coastline of Kyushu, Japan. The bronze statue depicts a Japanese patient preparing for his surgery, flanked by a surgeon and his assistant. The surgeon, dressed in Nanban clothes, is Luis de Almeida. But who is this giant of old, seemingly ignored in Western history of medicine circles, but evidently exalted in Japan since the latter part of the Muromachi Period?

Almeida was born in Lisbon in 1525 to a family labeled “New Christian,” having descended from a lineage of Sephardic Jews. This religious and legal designation in the Kingdoms of Portugal and Spain originated from the 1492 Alhambra Decree and marked the designee and his family as recent Christian converts following the Reconquista. Unfortunately, not much is known about Almeida’s childhood; however, it is evident that his New Christian status did not thwart his ascent into prominence. Rather, the young Almeida studied the humanities, and his ensuing medical studies were endorsed by King João III. Consequently, Almeida attended the renowned Hospital Real de Todos os Santos (All Saints Royal Hospital). 

Following two years of surgical training at the royal hospital, Almeida received a surgical license in 1546. His daring and enterprise shifted his attention eastwards. Almeida finished his studies during Portugal’s golden age, when the great minds of the kingdom looked to the Orient for opportunity and renown. The first half of the 16^th century was an era of Portuguese naval supremacy which ensured a monopoly on Europe’s spice trade. Moreover, Portuguese colonies littered the Asian coastline from Muscat to Ternate. Hence, a thirst for adventure and unrivaled economic prospects compelled Almeida to leave Portugal and set sail for the colony of Goa. In March of 1548, Almeida cast his last glance at the wondrous Belém Tower and its white Madonna as his vessel left port for India. 

During the tiresome voyage, which persisted for half a year, Almeida tended to his fellow seafarers. While caring for patients on board, Almeida witnessed the great care with which Jesuits ministered. Their example lit a flame of vocation in Almeida’s heart. There is little preserved information of Almeida’s experiences in India prior to his arrival to Japan. However, after landfall, he partook in intra-Asian trade and traveled to Macau. Portugal had been trading with China since 1513, but it was only in 1543 that the first Portuguese ship moored on Japan’s Tanegashima island, opening up trade relations with Westerners and fulfilling demand for cotton, silk, and other luxuries. Indeed, the mid-16^th century marked the aperture of Japanese ports and thus the unveiling of the mysterious Japanese archipelago. 

Hence, Almeida’s Asian mercantile endeavors naturally led him to Japan as the era of Nanban trade had commenced. He made landfall in 1552, and swiftly traveled to Yamaguchi, a safe haven for Christian missionaries and the center of the Kirishitan faith. 

By winter, however, despite notable economic gains, Almeida’s vocation grew in magnitude, as seen from his correspondence with a Portuguese Jesuit: “I requested help from He who could give it to me, Christ our Saviour and I decided to stay here [Japan] in the company of Father Balthezar Gago so that I could determine the path our Lord was showing me which was his holy service and my salvation.” By 1555 Almeida gave his accumulated wealth to the charitable endeavors of the Jesuit order and became a member of the community. That same year, Almeida began to open orphanages for abandoned children in Kyushu. These were of vital importance due to the ongoing turmoil of the Sengoku period, which had led to mass migrations across Japan. 

The rejection of the material life not only instigated Almedia’s clerical beginnings, it revived his physicianship. Letters indicate that Almeida asked for drugs and ointments to be sent for the children in his care, marking the commencement of his renewed medical passion. The center of his early work was Funai, the capital of Bungo, where he was given permission by Ōtomo Sōrin, the daimyo of the Ōtomo clan, to build a hospital in 1557. The hospital primarily cared for lepers, syphilitics, and orphans. Almeida’s hospital was the first western-style medical center in Japan, and thus internal medicine and surgery were introduced and practiced. Furthermore, Almeida introduced hitherto unknown procedures such as cauterization and the use of olive oil and alcohol on wounds. By 1562, the hospital held over 100 patients. With time, the hospital, and Almeida himself, began to attract patients from across Japan. Daily contact with local Japanese patients had a tremendous effect on Almeida, who learned Japanese and rigorously studied local customs and etiquette. Almeida’s medical practice was of great note, as Father Torres states, “We have received a brother [Almeida] who has the gift of curing and who knows how to do so full well.” Critically, Almeida did not solely practice medicine; he also taught it to his fellow Jesuit brothers and local Japanese students. Thus, Almeida is accredited for opening the first medical school in Japan. 

As Almeida cared for patients, opened pharmacies, taught students, and administered hospitals, his prominence grew, and Japanese doctors traveled to visit him and learn from him. Almeida did not leave Funai nor his hospital work until 1561, when he was ordered by the Jesuits to travel to Kyushu, as the Otomo clan had won a series of military victories, making the region conducive to missionary work. Indeed, Ōtomo Sōrin was a recent convert to Catholicism. There, Almeida worked as a doctor and a preacher, caring for the physical and spiritual needs of his patients. His work brought him to Hakata, Hirado, and ultimately Kagoshima, the first city in Japan to hear the words of the renowned St. Francis Xavier. During his latter ventures Almeida served as an accountant for the society and founded small churches as he traveled, baptizing and utilizing his medical knowledge wherever appropriate. His interest and respect for local customs can be seen in 1565, when he witnessed and  left a detailed description of a tea ceremony, or sadō, while in Sakai. In 1580, following an incident in which chrism was fortuitously delivered by some Franciscans, Almeida was ordained a priest by the Bishop of Macau, Monsignor Melchior Carneiro. Subsequently, Almeida was directed to Amakusa and began to celebrate mass and administer the sacraments as the district’s superior. 

Almeida continued his medical vocation until his death in 1583. While the exact reason and date of his death is unknown, there is no doubt that Almeida was widely respected among his Jesuit brothers and the local inhabitants of the land he had worked so hard for and where he had suffered so much. As stated by fellow Portuguese Jesuit Father Luis Froi: “Father Luiz de Almeida… was exceptionally well-liked by the Japanese lords, both Christian and heathen, for he was most familiar with their ways and strange manner of conversing… Even when he was in the final stages of illness, as death was approaching, his simple house was filled with Christians who came to kiss his feet and lament at his passing away.”

Almeida’s hospital outlived him. Indeed, the great care and the minds he fostered there continued to manage the institution after his departure. While the Funai hospital was destroyed in 1587 by armies of the Satsuma domain, his medical teachings persisted in Japan’s medical sphere. Despite Japan’s declaration of isolation in the early 17^th century, Almedia’s medical and surgical novelties were so embedded in Japan’s medical practice that they had become internalized. To this day, Japan’s medical sphere exalts Almeida, as embodied by the very sculptures and medical namesakes that honor his legacy.  

Image: Kyushu Regional Land Sustainability Plan Promotion Office, Luis de Almeida: Founder of Western Surgery, 2019.

Alexander von Kumberg is a premed student at the University of Chicago who plans on majoring in Neuroscience. He has a deep passion for history, a result of growing up in the Eternal City itself, Rome. His dual interests in medicine and history have led him to be an avid reader of the history of medicine. He is a writer for the University of Chicago’s Pre-Medical Students Association and concurrently assists in oncology research.