Medical Policies and Facilities in the Shogun’s Capital: The Koishikawa Hospital

In 1722, under the eighth shōgun Tokugawa Yoshimune (1684-1751, r. 1716-1745), a free hospital for impoverished commoners was established in the Koishikawa district, in the northern part of Edo. Prompted by a petition submitted by a local physician to the military government (bakufu), the Koishikawa Yōjōsho represented an unprecedented initiative in a city where no system of public medical care existed and access to treatment was largely determined by social status and economic means. The creation of the hospital must be understood within the broader context of the Tokugawa regime’s financial and socio-political challenges, which Yoshimune sought to address through a programme of reforms grounded in Confucian ideals of benevolent governance. These reforms included new medical policies aimed at reducing reliance on costly imported medicinal herbs and promoting domestic cultivation. The hospital’s location within the Koishikawa Medicinal Herb Garden directly reflected these objectives, linking medical care to economic self-sufficiency and broader strategies of urban management. This article examines the Koishikawa Yōjōsho as both an institutional and spatial intervention, analysing its establishment, location, and early operation within the fabric of Edo. It argues that, although limited in scale, the hospital played a significant role in the early articulation of healthcare within the city’s administrative and spatial framework, shaped by the interaction between shogunal authority and local actors.