FEATURE ARTICLES
The Creation of Nursing Professionals:
Why Did Japanese Management Engage in the Training of Nurses?
2025 年 42 巻 p. 6-22
詳細
2025 年 42 巻 p. 6-22
This article takes up the example of Gunze Silk Manufacturing Co., Ltd. (present-day Gunze, Ltd.), which handled everything from the training of nurses to the establishment of hospitals. Focusing on nurses assigned to factories, the article sheds light on the creation of nursing professionals and their working conditions in interwar Japan. Japan in 1909 became the largest exporter of raw silk in the world, with Gunze becoming the second largest company in the industry after Katakura. The nurses who worked at Gunze were, while being repeatedly transferred from location to location, able to remain continuously employed and acquire midwifery certifications for the future. However, by the 1930s, quitting jobs to get married had become commonplace, and nursing had become a temporary occupation until marriage. The Taishō period (1912–1926) was an era that saw nursing and those involved with it establish a new place for nursing in society, in keeping with the establishment of provisional occupational qualifications and the rapid increase in practitioners. However, during this period, it may also be said that among those companies that embarked on training nurses, a human resources management strategy was brought to fruition such that, even among female employees, young girls were educated as they were made to take up labor-intensive jobs.
This article focuses on nurses who were assigned to factories. Using individual data, it sheds light on the process by which nursing professionals were created in interwar Japan. By focusing on silk manufacturing businesses that embarked on training nurses on their own, it asks the question: in light of the existence of “female employees,” how exactly did Japanese management utilize women?1
The history of modern nursing in Japan begins in the 1880s when it was “imported” as a gendered occupation and the focus was mainly on training nurses to work in hospitals. The tendency had been to present the history of nursing as part of the movement to elevate the profession’s social status. However, in recent years, research in this area has deepened and the perspectives have grown more varied. Works have taken up such topics as the history of various nursing professions (Yamashita 2016), the formation of the profession and gender (Hirakawa 2019), and public health nursing in the interwar period (Takahashi 2004). Be that as it may, the presence of nurses in factories has not been seen as an element essential to production organizations. Nurses have been slighted when talking about factory work, and even in the history of nursing they have not been fully discussed owing to the limitations of the available source materials.
The origins of industrial nursing in Japan can be found in the middle years of the Taishō period (Shiki 1983, 244). We know this because efforts were being made to establish medical facilities mainly at large factories, and we can confirm that nurses were present there. Naturally, this was not unrelated to the fact that certifications for nurses had become standardized nationwide. The Nursing Regulation (Ministry of Home Affairs Ordinance issued June 30, 1915, in effect from October 1) stipulated that nursing certification required nurses to be at least 18 years old and be licensed by the local governor (Article 2). Under this regulation whose intention was to establish controls, the requirements for obtaining a certification were to either study nursing for at least one year and pass a nursing examination, or graduate from a designated school. However, nurses who had certifications previously received through prefectural ordinances and were currently engaged in the practice could obtain a license without an examination by applying for one within three months after the regulation came into force. Consequently, the number of nurses nearly doubled from 14,707 at the end of 1914 to 27,714 by the end of 1916 (Naimushō Eiseikyoku 1914, 1916).
The assigning of nurses mainly to large factories also continued during this period, but the details are unclear. The Shokugyō fujin chōsa [Survey of working women] (1927) classifies nurses into “hospital nurses” (byōin kangofu), “nursing association nurses” (i.e., “dispatch nurses,” hashutsu kangofu), and other nurses (specifically, “nurses attached to company factories,” “nurses involved with social welfare projects,” “school nurses,” and “nurses at private practices”). The survey also notes that medical facilities of various sorts were established in large factories during the late Taishō period with some number of nurses posted in those locations, though how many were actually posted remains unknown (Chūō Shokugyō Shōkai Jimukyoku 1927, 88).
Incidentally, we start to see nurses being assigned to production sites in the United States in the 19th century. Visiting nurses went on to establish themselves in the 1910s as “female professionals”—that is to say, industrial nurses—beneficial to companies while also promoting the Americanization of immigrants (Ueno 2017, 2019). Distinctive to Japan at the same time is the fact companies there began their own training efforts. In the text that follows, we will clarify the process of appointing nurses and the work that they actually did based on examples of silk-manufacturing management that demonstrate a certain degree of initiative with respect to “industrial hygiene.”
Gunze Silk Manufacturing Co., Ltd. was a silk-manufacturing enterprise established as “Gunze” in the Ikaruga District of Kyoto Prefecture in 1896 with 168 basins with the goal of promoting sericulture within that district. However, from 1906 onward, the company began to increase its factories through acquisitions, and expanded the areas in which it had factories to include Kyoto and Hyōgo, and subsequently to Okayama, Gifu, Yamagata, Miyazaki, and Shimane. By 1920, the company had more than 20 factories and had more than 10,000 employees (Enoki 2008).
The question here is what sorts of initiatives regarding industrial hygiene were pursued at these late-entry silk manufacturing enterprises that had expanded so quickly like this. To begin with, in the Suwa region of Nagano Prefecture—a leading center of silk manufacturing—examples of medical wards having been established in factory dormitories and patients receiving treatment from physicians have been affirmed since the Meiji period (Shimizu 1981). According to a study conducted on Nagano Prefecture, starting from 1910 one after another private hospital attached to silk-manufacturing facilities—focused primarily on large-scale operations—was established, leading to the development of various medical facilities.
Meanwhile, Gunze Silk Manufacturing was attacked in public opinion for the high disease rate among its workers and the rampant spread among them of tuberculosis. According to the recollections of Ono Kurazō, who joined the company in 1910 and very soon thereafter became the head of its main mill, it was only natural to see people become ill under the harsh working conditions. Many of them contracted tuberculosis, and most who contracted it died (Ono 1973). Starting in autumn 1910, the company began to implement a breathing exercise known as sokushin chōwa-jutsu (“breath-mind harmony technique”) before bedtime, and in 1913 it revised the practice of two people sleeping on a single futon to one person per mattress. Furthermore, the company shortened daily working hours from 13 hours to 12 hours, and adopted measures that gave attention to meals and so forth (Chūō Shokugyō Shōkai Jimukyoku 1928, 166). Ono also participated in the first meeting of the “Industrial Hygiene Study Group” [Kōjo Eisei Kenkyūkai] (July 1913), held by the Industrial Education Association (Kōgyō Kyōikukai) having called out to factories in the Kansai region, and is thought to have participated in similar initiatives at his company (Uno 1913). The Hyōgo branch of Kanebō had newly established the function of public health nurse, and at the Study Group this was introduced as a forward-thinking experiment (Uno 1914). At Kanebō, beginning around 1912 experimental attempts were made at hiring nurses with licenses to serve as public health nurses with their focus being on hygienics rather than treatment. That function entailed making rounds of the dormitories to detect individuals with health problems. Nurses in those positions were to prevent persons in ill health from working and prevent sick individuals from mixing in regular living quarters. Furthermore, they were also engaged in discharging health-related duties ordered by physicians, specifically including physical examinations and medical checkups for new workers and raising awareness about hygiene. From the perspective of epidemic prevention, factories at this time put concentrating their energies solely on discovering sick people at the center of their measures for maintaining workers’ health.
The annual number of sick persons (per thousand) at Gunze Silk Manufacturing fell from 2,426 persons on average from 1911 to 1915 to 1,657 in 1916. During this period, cases of the common cold or flu—the most common illness—fell from 611 to 378, instances of stomach and other abdominal pains fell from 510 to 387, and trachoma cases also decreased from 121 to 22. While cases of skin diseases increased from 433 to 438 persons and suitable countermeasures appeared to be unavailable, suppressing the spread of trachoma and colds and flus led to a sharp decline in the number of sick persons. The ratio of people suffering from problematic lung issues fell dramatically from 16 persons for every 1,000 to two. The number of people who took leave due to illness fell from 947 to 908 per thousand, and the total number of leave days fell from 6,162 to 5,196 (Chūō Shokugyō Shōkai Jimukyoku 1928, 167-169). Assuming 320 working days per year, the average annual number of sick days per person fell from 6.5 to 5.7, meaning the average annual sick day rate fell from 1.92% to 1.62%. Gunze’s initiatives were counted among the examples of successes at a time when the “evils” (heigai) of factory labor were being viewed as a problem.
Noteworthy here is the fact that Gunze began on its own to Eisei-kakari [train health] workers (later, “nurses”) to be assigned to each of its factories. For example, even in Nagano Prefecture, it took measures to employ nurses at those of its relatively large factories in the silk manufacturing business that did not have hospitals (Government of Japan, Ministry of Agriculture and Commerce, Factory Section 1918, 124-125). That said, it was not until after World War II that an occupation dedicated exclusively to assisting with providing assistance and treatment in the course of medical care of a sort that “only nurses can provide” (Yamashita, 2001). At the time of the Spanish flu epidemic, for example, we see it was ordered that, “Workers who engage in nursing on the occasion of this illness will be compensated at approximately thirty sen per day (Jōchō-kai rokuji [Plant manager meeting minutes], December 1918 [from the Gunze collection]. It appears that during epidemics, workers at times did the work of nursing. Under these circumstances, the company began training health workers as specialized nursing professionals, and later embarked on training nurses. To explore this situation, I want to analyze the written reports regarding personnel created by Shimizu Shigeharu and collected in Gunze Silk Manufacturing’s Ninmen jōshinsho [Appointment and dismissal documents] (July 1917 to May 1924, in the collection of Gunze Silk Manufacturing). Shimizu served as head of the Hygiene Section from April 1917 to September 1924, and also served as the headmaster of the Gunze Midwifery and Nursing School following its establishment. During his tenure, 154 written reports (involving 415 persons) were submitted to Shimizu regarding such matters as student employment, staff appointments, promotions, pay raises, transfers, leaves of absence, and resignations. Based on this data, I will attempt to examine the formation of Gunze’s nurse training system and the actual working conditions of those nurses.
2. The Start of Nurse TrainingFrom the time of its founding, Gunze Silk Manufacturing counted one nurse among its standard staffing of 242 personnel. However, no mention was made of nurses in 1909 when the company’s administrative executive bodies were established, opting instead for the creation of health workers in the General Affairs section. Furthermore, when the company laid out a departments-and-sections system in 1917 to clarify the division between headquarters and the factories, a hygiene section was created in the headquarters’ General Affairs Department, with health workers assigned to the medical facilities (“health care institutes,” yōjou’in) attached to each mill. Under the new company regulations of that same year, employees were classified by title and grade into “councilor” (sanji) (grades 1–4), “secretary” (shoki) (grades 5–10), “engineer” (gishi) (grades 2–4), “assistant engineer” (gishu) (grades 5–10), “instructor” (kyōyu), “assistant instructor” (jokyōyu), “assistant” (ko’in) (grades 7–10), and “trainee” (minarai) (grades 7–10); health workers followed the same system (Murashima 1936, 52-57). In 1917, the Hygiene Section including mill health workers comprised 21 girls (one assistant specialist, three assistants, 15 trainees, and two students), section chief Shimizu, and two men (both assistants). Most in the section were females. The health worker training course (eisei-gakari yōsei-ka) at Gunze Women’s School (Gunze Jogakkō) was established specifically to train these female health workers. Before this school was established in March 1917, health workers appear to have been appointed after going through a training period of about six months. According to the Ninmen jōshinsho, five girls joined the company by the end of 1916. These girls received a uniform three-yen monthly allowance. Two became trainees by July 1917, and another three achieved the same status by that October.
According to the school regulations, the health worker training course at the Gunze Women’s School had 10 students. The course of study was two years. There were 324 hours of instruction every month, with classes held daily from 6 a.m. to 6 p.m. and very few days off (Gunze Kabushiki Gaisha Shashi Hensanshitsu 1978, 198-201). Course subjects included moral education, hygienics, bacteriology, physiology, anatomy, nursing science, nursing practice, bandaging techniques, first aid training, pharmaceutical dispensing methods, microscopy, reaction testing methods, physical examination methods, and health laws. The course provided specialized training for nursing personnel. Naturally, however, 250 of the monthly hours of instruction were devoted to nursing practice (Uno 1917, 12-13). As Table 1 shows, the six students who enrolled in 1917 were mostly around 14 years of age, but the age range among the 13 who enrolled in 1918 was considerable broader. They were paid a monthly student allowance of 3 to 4 yen. The monthly salary after appointment as a trainee was uniformly set at 5 yen. Following the standard practice, new appointments were made after six months or so; two were appointed in August 1918, eight in September 1918, and three in April 1919.
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Source: Shimizu, Shigeharu. Ninmen jōshinsho [Appointment and dismissal documents]. July 1917–May 1925.
NOTE: “OG,”“HG,”and“H1”refer respectively to graduates of an“ordinary elementary school”(jinjō shōgakkō), graduates of a“higher elementary school”(kōtō shōgakkō), or an individual who completed the first year of a higher elementary school.
According to the Ninmen jōshinsho, the students in the health worker training course came from only three prefectures: eight from Hyōgo, five from Kyoto, and three from Okayama. Each of the districts in Hyōgo and Kyoto from which the students came had factories, while Maniwa District from which the three Okayama students came was a community in which a mill would later be built. Whatever the case, the criteria on educational background and age criteria appears to have been vague, with students being pulled together based on connections. Under these circumstances, the difference with students in the training courses for factory girls is noteworthy. According to school regulations, no students in either course were charged tuition. However, the regulations do explicitly state that only those in the factory girl course were provided loans and grants for school supplies.
The health worker training course at the Gunze Women’s School was soon succeeded by the Gunze School for Midwifery and Nursing (established December 1918) (Gunze Kabushiki Gaisha Shashi Hensanshitsu 1978, 198-201).2 Hygiene Section Chief Shimizu Shigeharu was appointed the school’s principal. Hamuro Kotoe and one other person were assigned as assistant teachers, and three physicians contracted by the company were appointed to teach specialized subjects. According to the school regulations, the school had two courses. One was a two-year nursing course (enrollment quota of 30) that would train “individuals who are physically sound and possess the learning and virtue of a higher elementary school graduate” to become nurses. The other was a two-year midwifery course (enrollment quota of 10) that would train “individuals who have graduated from the nursing course, are currently engaged in nursing at this company, and possess excellent character and scholastic abilities” to become midwives.
However, as a closer look at the nursing students from the first through fifth cohorts (1919–1923) shown on Table 1 reveals, the actual situation was slightly different. First, with regard to student numbers, despite an enrollment quota of 30 the actual number ranged around 10 per year. Furthermore, the hiring in 1919 of graduates from ordinary elementary schools and those students who had completed one year at a higher elementary school is particularly noticeable. Among the latter group, three were students with birthdates in January, February, or March and hence had just turned 13.
In order to secure the required number of students, it seems there was no choice but to lower the age requirement. Subsequently, the age for enrollment was gradually restricted to 14. The educational background requirement was also strictly enforced, suggesting that enrollees had gone on to higher elementary school. At the time, the enrollment requirement for entering the factory girls’ training course was being an ordinary elementary school graduate. Hence, a clear distinction between the two courses based on educational background at the time of enrollment had been established.3 Unquestionably, there was little difference when it came to their allowances during training. Specifically, the monthly student allowance during the 2nd, 3rd, and 4th nursing program cohorts was 6 yen, while the allowance for factory girl students was 20 sen per day. If we exclude days off, this means they were at roughly the same level. However, while students going through factory girl training had every day that ended in “5” off, this provision did not apply to nursing program students (Chūō Shokugyō Shōkai Jimukyoku 1928, 73). Furthermore, nursing program students were appointed “trainees” after one year. From the 3rd cohort onward, this changed to being appointed as “Assistant, 10th Grade,” and they received a monthly salary of 10 yen or higher.
According to the Ninmen jōshinsho, more than half (26 of 45) of the individuals who enrolled in the nursing training course from 1919 to 1923 came from Kyoto Prefecture. Most were from either Ikaruga District (10), where Gunze’s headquarters was located, or Amada District (10). That said, the places of origin for the remainder were scattered across many other prefectures, including Hyōgo (8), Okayama (3), Shiga (2), Gifu (2), Fukui (1), Kōchi (1), Saitama (1), and Miyazaki (1). This suggests how spread out the company’s mill sites were. However, it should be noted that these girls were not hired by each mill to work in their respective places of origin, but rather were relocated on countless occasions to other locations. This is because the transfer system was unique to nurses assigned to factories and moved set out to their new posts as employees of the same company. Next, let us move on with an examination of the actual conditions of mill work.
There are records available from 1918 that inform us of trends among health workers at factories.4 In these, Hygiene Section Chief Shimizu describes bringing a trainee health worker (15) to the Kumohara Mill in Amata District, Kyoto Prefecture, and in her place bringing back to the headquarters office another health worker who had completed a three-week nursing shift. At the time, Gunze Silk Manufacturing had 15 factories. Consequently, health workers went back and forth between headquarters and the factories, providing nursing care at the factories. This was referred to as “outside duty.” It was similar to being a visiting nurse in the sense that they would be dispatched for a fixed period based on how many patients there were.5 Understandably, with the workers lacking nursing certifications, the matter was thought of as their being dispatched for “outside duty” as the company’s health workers. However, publicly, the emphasis came to be placed on nursing certifications.
Responding in 1920 to questions regarding its “medical affairs offices or infirmaries,” the company said that its facilities included “one building that contains a doctor’s office, a general internal medicine office, a surgical and ophthalmological examination office, a nursing business office, a disinfecting room, a medical staff office, a health worker manager’s office, a laboratory, and a nursing classroom, and another ward building (with beds) capable of accommodating 100 patients. There is also a cafeteria for patients and an isolation ward.” Going on, the company said, “We have assigned three contract physicians, seven nurses, and five hygiene officers.6 Furthermore, at our headquarters we have a school for midwifery and nursing, where we work to train nurses so they can be dispatched to our factories” (Kyoto Prefecture 1921, 14).
Gunze had more than 1,000 factory girls alone working at its headquarters mill. Yet, even at its Hagiwara Mill with only about 280 factory girls, the company said it “had established a medical office in one room of the dormitory. One Hygiene Department worker and one nurse were permanently staffed there. A contract physician is employed to visit there every day. They provide medical treatment for patients, treat those with minor illnesses, and dispense medicines, which are distributed to them at cost. However, the cost for consultations is free. For patients with more serious conditions, we have established a convalescent ward in a separate single-story, four-room building. They are accommodated here and treated by nurses for comforting recuperation.” This indicates that nurses were regularly on station (Kyoto Prefecture 1921, 16). It can also be inferred that the nurses’ task was to look after patients in medical wards that were separate from the dormitory. In the case of the Kuchikanbayashi Mill with about 50 factory girls, the company “established a convalescent hospital with one contracted physician assigned to provide medical treatment, while the girls’ dormitory director concurrently handled health-related and preventive nursing.” Thus, it was the dormitory director rather than a nurse who oversaw industrial hygiene (Kyoto Prefecture 1921, 20). This sort of setup was perhaps the initial approach to addressing industrial hygiene, but the assigning of nurses became a foregone conclusion. Immediately after the company began training its own nurses, it hired a succession of experienced personnel.
Five experienced nurses were hired between October 1918 and March 1920. Nurse 1 (age 22, from Yosa District, Kyoto Prefecture), hired October 1918, received a diploma in midwifery and nursing from Kyoto’s Saeki Hospital. After working at the hospital, she began doing business as a midwife in her home. Nurse 2 (age 19, from Asago District, Hyōgo Prefecture), hired May 1919, passed the midwifery and nursing examination in Osaka Prefecture, and had experience working at Ogata Hospital. Nurse 3 (age 19, from Ikaruga District, Kyoto Prefecture), hired June 1919, graduated from an ordinary elementary school and then went to work as a factory girl at one of Gunze Silk Manufacturing’s dupion silk factories. After quitting in 1915, she studied nursing under a physician. Nurse 4 (age 24, from Oku District, Okayama Prefecture), hired February 1920, had been with the Japan Red Cross. Finally, Nurse 5 (age 21, from Amada District, Kyoto Prefecture), hired March 1920, had experience as a nurse trainee at Fukuchiyama Hospital from April 1916 to March 1920. All had the experience of working at a hospital in an urban area, but just like the nursing school students they all came from regions where Gunze had factories. While the health worker including these experienced nurses worked at the company’s factories as nurses, their working patterns differed from those of nurses at regular hospitals. One of the distinctive features was the frequency of transfers that came with changing the locations of their employment.
2. Some Aspects of Transfers and ResignationsAccording to Ninmen jōshinsho, in October 1920 13 persons were appointed to work as health workers at factories in Kyoto and Hyōgo prefectures. This provides the first confirmed instance of a job transfer. Table 2 tracks the movements of those 13 persons (A to M).
Individual D in Table 2 represents a trainee health worker assigned to “outside duty” at the aforementioned Kumahara Mill. Appointed Assistant, 9th Grade, this worker was assigned to the Yanase Mill. Other than the individual in row C, everyone else had either enrolled in Gunze Women’s School after working two or more years with the company or had been working with the company even longer than that. Whatever the case, two or more years of experience working in a mill was required. The individual in row C corresponds to Nurse 2 mentioned above. She was treated as being an Assistant, 8th Grade. After training for a short period, she was assigned to the Ehara Mill, but what happened afterward is unknown. Since the individual in row H was transferred to that same mill in August 1921, it seems that Nurse 2 from row C resigned.
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Source: Shimizu, Shigeharu. Ninmen jōshinsho [Appointment and dismissal documents]. July 1917–May 1925.
NOTES: Regarding column “I,” the numbers in the upper row indicate the individual’s year of birth, while the numbers in the lower row indicate the individual’s year when they joined the company.
Regarding column “II,” the numbers in the upper row indicate the individual’s age at the time, while the numbers in the lower row indicate the individual’s length of service.
Incidentally, the monthly salaries of health workers who transferred to the mill ranged from 14 yen to 20 yen. Around this time, the wages for the company’s mill girls were adjusted at each mill to be around 55 sen per day (including seniority bonuses), so on a monthly basis it amount to slightly less than 15 yen.7 While the wages for health workers were not conspicuously higher than those of the average factory girl, it appears there were increases in their monthly salaries based to some degree on seniority or experience. With the inclusion of bonuses and so forth, the differences became more conspicuous. Since the allowances during training remained at basically the same level, differences in monthly wages seem to have expanded based on length of employment.
Tracking the movements of these 13 individuals, between February 1921 and June 1922 nine were transferred to different factories, two resigned, and two were unaccounted for. These reassignments were carried out irregularly at first, but eventually they were mainly carried out twice a year, in spring and autumn. For example, in the case of one student (born in 1905) from the first cohort of Midwifery and Nursing School graduates, she was posted to the Hagiwara Mill (Amada District, Kyoto Prefecture) in June 1921, followed by the Nagai Mill (Nishi-Okitama District, Yamagata Prefecture) in April 1922. She then returned to the Hygiene Section in October 1923 before being posted the following month to the Yanase Mill (Asago District, Hyōgo Prefecture). The number of reassignments confirmed from 1920 to 1924 mainly at factories in Kyoto and Hyōgo totaled 75.
There were particular reasons for the reassignments to the main mill. As to the individual in row A, it was decided that they would be transferred to the mill concerned “in connection with having contracted an infectious disease while working at the mill [and] requiring further monitoring of their health.” As a result, the individual in row F was assigned as their replacement. There were instances in which a nurse who was exposed to an infectious disease actually injured their health would be taken in by the Hygiene Section or the mill in question at the request of the mill manager. Furthermore, when the company returned individuals D and E to the main mill, it was noted that they should be reassigned to the main mill since they had already obtained “the qualifications to teach midwifery.” The training of midwives became a reality from around the mid-1920s when the number of nurses had reached a certain level. It was once again proposed at a meeting that “for the future happiness of [our] nurses, and in order to prolong their service, we shall choose based on seniority those who wish to participate and begin midwife training.”8 Midwife training was a benefit policy of sorts for the company’s nurses who had endured mill work, including transfers. The standard employment pattern for nurses at the company had taken shape, in that after going through training they would work at a mill and then return to the headquarters as “midwife students.” However, in the early 1920s, not all nurses aimed at obtaining a midwife’s certification.
When someone from the Hygiene Section resigned, Hygiene Section Chief Shimizu would review the request from the person in question. If it was deemed appropriate, the matter would be reported to the president. As an example, let’s review the cases of five male section members who left the company. First, we find that of the three who were charged with cleaning duties, one (employed for three months) was dismissed due to being a drinker, one died (employed eight months), and one (also employed three months) resigned for personal reasons. As to the other two assistants, they were dismissed. One was for being repeatedly absent from work and engaging in his family’s sericulture business, which was deemed as having a bad influence on others. The other was a “reserve navy medical corpsman 1st class” trained by the Navy who was released due to “conduct unbecoming of a service member.” All had served for less than a year. Meanwhile, from 1920 to 1923, 28 female Hygiene Section employees or nurses (including nursing students)—excluding the one individual who was responsible for handling bedding for patients—left the company. The most common reason was “family reasons” (12), followed by marriage (6), illness (5), “unknown” (2), expelled from school (2), and dismissed (1). This trend is similar to that of the reasons why factory girls at the same company resigned (Enoki 2008). However, there were no instances of job changes like those seen among the factory girls. It seems that being nurses who had been trained at the company, they did not utilize those vocational qualifications elsewhere.
That said, there was a tendency for resignations due to “family reasons” to be seen as appropriate. Here are three examples of workers who resignations were allowed: (1) an employee from April 1919 to February 1920, age unknown: “Due to my father’s illness, I was absent from work to nurse him. After he passed away, I assisted my brother with his work. However, the situation has now produced a manpower shortage among my relatives, making it absolutely impossible for me to continue working at the company.” (2) an employee from March 1918 to April 1920, age 19: “After my elder brother joined the army last autumn, there has been no one to tend our farm. My parents have become frail, especially my mother who has recently lost the ability to get up on her own. Household arrangements are in disarray, causing considerable distress.” (3) an employee from April 1918 to March 1922: “My elder brother who had been residing at home for reasons beyond his control found he had given up caring for our mother after recently expressing his desire to become a police officer and enrolling in the Kyoto training institute.” Also, (4) an employee from February to May 1920, it was deemed that there was no escaping the pressure from close relatives on the issue of marriage since the employee was 24 years old. This was the aforementioned Red Cross nurse. She could have made contributions right away, but due to her age she couldn’t have expected continued employment.
We may presume that Gunze subsequently eschewed hiring personnel with experience. This can also be inferred from the company subsequently noting upon hiring a 19-year-old woman who had passed the nursing examination in Okayama Prefecture in November 1922 that “she possesses the spirit to work for the company for a long time.” Like this, in those cases where a nurse was called home due to such family circumstances as an illness at home or a brother getting work, they were allowed to resign regardless of how long they had been working for the company. This fact vividly demonstrates that nursing was not thought of as a “special occupation that called for a lifetime commitment.”9
At the same time, even though there were instances of requesting a worker to continue in their position for whatever reason, it was not possible to enforce the request. (5) an employee from April 1917–October 1921 age 19, the record states: “Since this petition for resignation was submitted without sufficient reason, we have earnestly remonstrated with her father. However, as she has missed the proper time for marriage, she insists that unless she remains at home to seek a match, she will ultimately be unable to marry. She therefore presses her wish to resign. The person in question was born in the 35th year of Meiji (1902) and has not yet passed the proper age for marriage. She obtained her qualification as a nurse the year before last, and only recently has she at last begun to show improvement in efficiency. Yet, since there is no remedy in forcibly detaining her against her will, I must permit her resignation.” And so, she was allowed to resign. Without any specific marriage proposal, we can see that the company was reluctant when it came to the resignation of individuals who had just obtained their nursing certifications. There were six resignations, including this one, that were due to marriage. What’s especially interesting is that three of the other five who resigned after their marriages were finalized were hired for reasons such as “marriage cancelled.” In the early 1920s, “resigning after getting married” was not yet a common practice. Given the demand that nurses continue to work, one can also see this as being linked to the company’s policy that nurses should acquire midwifery certifications “for the future happiness of the nurses.”
That said, marriage-related resignations were growing more commonplace. According to Ninmen jōshinsho, one of the students who enrolled in the health worker training course at Gunze Women’s School in April 1918 was appointed to be a sewing instructor at the school. Hired effective July 1921 as an “extra-departmental faculty member” (kagai saiyō kyōin), this individual taught sewing and other subjects to the nurses. Furthermore, of the 17 nurses who left the company in 1934 for whom details can be confirmed, as many as 13 gave marriage or marriage preparations as their reason for quitting. Regarding these recent developments, it was noted, “These ladies who have left the company for marriage seem to be leading lives as steady housewives. Regardless of whether conditions are adverse or favorable, as girls who worked at Gunze we believe that through it all they will show themselves to be examples of splendid housewives and we pray for their happiness.” Incidentally, other reasons given for leaving included illness (2 persons), childbirth (1), and death (1) with no mention of “family reasons” (Shukujo no tomo, May 1935). Nursing had come to be seen as an occupation that should take precedence over “family reasons,” but its standing was that of “a temporary occupation for women prior to marriage.” This was in line with the “worker reforms” implemented at the company with respect to its workers in the 1920s that required employees to work as the company directed until marriage regardless of family circumstances (Enoki 2008).
Having reached a certain number, in 1926 the company’s nurses formed the Shukujokai (“Ladies’ Association”) with Hamuro Kotomi as its chair.10 The association had originally been a self-improvement group formed in 1910 by the then-girls’ dormitory director Shimizu Shigeharu. The group had only five members at first, but it later grew into an organization in which nearly all of the female teachers who served as technical instructors in the mill, the room monitors who managed things at the dormitory, and the nurses joined. It became “an influential, autonomous self-improvement group that held sway over the atmosphere of the dormitory itself and was filled with the spirit of devotion to the company.” For example, the group held “Tuesday meetings” to guide and protect newly hired factory girls. It taught them hymns and the rules of dormitory life, and engaged in service-related work. However, due to such factors as the growth of the company’s educational organization and Shimizu Shigeharu becoming chief of the Hygiene Section, the Shukujokai temporarily stopped accepting new members. Education in the dormitory came to be carried out by the company’s formal organization centered on its education division; having turned those activities over, the Shukujokai wound up continuing private self-improvement activities.11
The role of nurses in the early years who had been dispatched to the factories as members of the Shukujokai went far beyond just nursing. In particular, at those factories that had been picked up from other businesses, the nurses who had been dispatched from headquarters were called upon as some of the company’s few female employees to serve as role models for the factory girls. For example, there is the case of the Yanase Mill (Asago District, Hyōgo Prefecture, began operations 1917) that became a Gunze facility when it acquired Kusaka Silk Mill (established 1882). It was “a place where many people experienced great difficulties since even after becoming part of Gunze they did not understand the Gunze spirit.” The nurses who were dispatched here are said to have had a positive influence on the factory girls. Shimizu wrote that “after the nurses went to Yanase, the Yanase factory girls finally understood the Gunze spirit. They became obedient women and factory girls in the Gunze style…… The Gunze nurses in fact forgot about their own appearances, devoted themselves spiritually to kindness, and made the Gunze name an honored one.”12 In this way, the nurses assigned to the factories were given the standing of individuals who embodied “the Gunze spirit.” Gunze had rapidly expanded the number of factories it operated, and it is likely that one of the reasons why it began to train was that it expected the nurses to play such a role. This was also a reason for their frequent reassignment.
However, there was the factor that the company in reality could not secure suitable personnel for its factories situated in rural areas. In fact, although the company had 1,450 nurses in Kyoto Prefecture at the end of 1917, as many as 1,277 of them had received their licenses in Kyoto City itself. The regional imbalance was considerable. Furthermore, although this is from a different period of time, according to Kyoto City’s 1926 survey of working women 75% of the 663 nurses surveyed had officially registered domiciles outside of Kyoto Prefecture.13 The influx of persons from other prefectures was striking (Kyoto-shi Shakai-ka 1927, 22-23). Also, 80% of the nurses had never had the experience of shifting their workplaces, and if we are to include those who changed workplaces only once the figure grows to 90% (Kyoto-shi Shakai-ka 1927, 25). We can see from this a tendency for nurses to move from other prefectures, and for them to either not change their places of work or to work at the places where they were trained. In a labor market that it would be hard to describe as fluid, it is not hard to imagine the difficulties of enticing nurses to work at factories in rural locations. The fact that the experienced nurses that Gunze hired were all originally from the locations of the factories where they worked attests to this. On the other hand, if the company provided training, it would also be possible to have them perform nursing duties in the name of “engaging in practice.” In that sense, starting to train nurses was a rational choice for the company. However, the objective went beyond merely securing the human resources it lacked; it was also a program for improving the nurses. Ten years after the company had begun the full-blown training of nurses, Shimizu—who had been the first president of the Gunze Midwifery and Nursing School—wrote the following. It shows the pride he had of being a pioneer.
The very fact that the changes in the world in recent times have necessitated bettering our nurses must be seen as an auspicious development…… Looking back, it may be said with pride that Gunze, having begun ten years ago to work toward the improvement of our nurses, has transformed their status from being merely the servants or attendants of physicians into collaborators and colleagues in the practice of medicine, thus setting something of a precedent for today’s society Hence, as a pioneer, Gunze now bears the responsibility of advancing the curriculum of its nursing school another step forward to satisfy the requirements of the present age.14
In 1927, the company established Gunze Hospital. With 75 beds, the facility was the largest general hospital in the prefecture’s rural areas.15 The Gunze Midwifery and Nursing School was absorbed into the hospital, with goal of making further improvements in nurse training (Shashi Hensan Iinkai 1960, 117).16
To shed light on the process of assigning nurses to factories and their actual working conditions, we have looked an example from a silk manufacturing business that led from the training of nurses to the establishment of a hospital. Although we can see the title of “nurse” dating back to the company’s founding in 1896, it is unclear as to whether these individuals were certified or not. Nursing professionals were called “Eisei-kakari [health workers].” After going through about six months of training and being appointed to that position, they would leave for “outside duty” at various factories depending on where there were patients. As interest in industrial hygiene grew, systematic training was begun to ensure the permanent placement of health workers at each of the factories. This developed into full-fledged nurse training at a school for midwifery and nursing. By the mid-1920s, a career track had developed whereby a woman would go through training at the school to become nurse. After getting experience working at a mill, they would return to headquarters and then obtain a midwife’s certification. We saw that throughout this, the company’s nurses not only performed their duties as nurses, but also been given the standing important female employees who had a leadership role with respect to the factory girls. This fact likely was one factor behind the company doing its own training.
Such corporate initiatives have been drawing attention as private sector-specific ways of handling public health nursing. Even without mentioning the example of Gunze Silk Manufacturing, we can find in various places examples of other companies creating their own hospitals (Enoki 2022). However, not infrequently, what those companies put together were medical facilities that were the most advanced ones in the region. Considering that “factories” were one source of the “hygiene” problems in the first place this can be seen as a natural development, but in any event, there are numerous instances of companies having pushed the development of modern medical facilities. In the case taken up this article, a company satisfied its own demand by training personnel itself to be pillars of modern nursing. There is also the aspect of companies pursuing the development of medical facilities heading into the 1920s in particular of this being a response to the “socialization of health care” that was being demanded surrounding the Health Insurance Act (promulgated 1922) coming into force. At this time, companies found there was unique value to providing high-quality medical services. Katsura Takashi, a secretary for the Kyōchōkai (“Harmonization Society”) who observed silk manufacturing factories, wrote: “It has almost become a fashion of sorts in recent times to construct a fine infirmary. Since in many cases they have a far greater capacity than needed for the number of patients in normal times, part of the space is frequently used for sewing classrooms and the like. When the parents and older siblings of the factory girls come to visit, the first thing they show them are these splendid infirmaries!!!” (Chūō Shokugyō Shōkai Jimukyoku 1928, 158). It may be inferred that the very fact of building a medical facility was highly valued as a requirement for attracting workers. In that sense, there were quite a few instances of nurses being trained by large textile companies.
For example, at Kurashiki Spinning Works, they established the Kurabō Central Hospital in 1923 and, attached to the hospital, opened an affiliated nurses’ training center (two-year program). In September 1922, Toyobo opened an affiliated nursing school on the grounds of its Shikanjima Mill, producing its first graduates on August 31, 1924. According to its company history, “a nursing school was established for female workers” with the “purpose of training the nurses who will work at the factory hospitals” that were being set up at the company’s hospitals around this time (Tōyō Bōseki Kabushiki Gaisha Tōyō Bōseki Shichijū-nenshi Henshū Iinkai 1953, 242). For companies that operated multiple factories, training their own nurses was a means for them to provide uniform medical services at those factories while at the same time straightforwardly pointing out that these were being built “for female workers.” We can also see in this matter of companies starting to train nurses an aspect that is unique to the textile industry, which provide dormitories and employed many female workers. Putting in terms so there will be no misunderstanding, there also seems to have been aspect to this such that, during the process through which persons who engaged in medical care and nursing came to recognized societally as certified professionals, factory nurses were reorganized so as to differentiate the functions of female workers in the “mill.” It is also for this reason that this article has paid attention to the relationship between factory nurses and factory girls while shedding light on the working patterns of the nurses. The Taishō period was an era that saw nursing and those involved with it establish a new place for nursing in society, in keeping with the establishment of provisional occupational qualifications and the rapid increase in practitioners. Still, it may also be said that the human resource management strategy of Japanese companies, which entailed educating young girls while also assigning them to labor-intensive work, was thoroughly applied to these positions as well.
1 This article is based on Enoki 2005 with additions and revisions. The “Introduction” was substantially rewritten, the citations were also simplified.
2 The school was not a designated institution under the Nurse Regulations, so students obtained their nursing qualifications by passing the Kyoto Prefecture nursing examination. The school became the private Gunze Associate Nursing School, accredited in 1952, and closed in 1959.
3 For discussions on the company's hiring standards for workers, see Enoki 2008.
4 Hakuro 1918. “Kumohara kikō [A trip to Kumohara],” Shukujo no tomo [The lady's friend]. This publication is the official journal of the Ladies' Association, formed primarily by instructors, female educators, and nurses employed at the Gunze Silk. The year of publication was estimated based on the content.
5 For information on dispatched nursing during this period, see Endō 1976.
6 The hygiene officers refer to male employee of hygiene section included clerical staff handling tasks such as dispensing medications and laborers engaged in auxiliary work like cleaning.
7 Jōchō-kai rokuji [Mill manager meeting minutes]. September 1920.
8 Matter Concerning the Request for a Midwife from the Hygiene Section, Jōchō-kai rokuji [Mill manager meeting minutes]. August 1925.
9 From the mid-Taisho period onward, as nurses became incorporated into the category of “working women,” they shed the image of a “specialized career requiring lifelong dedication” and instead came to be seen as “a temporary occupation for women until marriage.” (Endō 1980)
10 The passage that follows regarding the history of the Shukujokai is based on “Shukujokai no enkaku [A history of the Women’s Society]” Shukujo no tomo, May 1935.
11 Regarding education at this company, see Enoki 2008.
12 “Nurses and the character of nurses [Kangofu to kangofu no hinsei],” Shukujo no tomo, October 1927.
13 Kyoto Prefecture. Kyōto-fu tōkeisho, Dai-4-hen [Kyōto Prefecture statistical book, no. 4]. 1919, p. 103.
14 Shukujo no tomo, May 1927.
15 Kyoto Prefecture. Kyōto-fu tōkeisho, Dai-4-hen [Kyōto Prefecture statistical book, no. 4]. 1929, p. 161. The number of in-house patients this year stood at 2,074, with another 6,522 outpatients.
16 The Shukujokai, including students, had more than 120 members in 1933. Subsequently, after suspending student enrollments in 1935 and an increase the numbers of individuals resigning from their companies, the number of members fell to 98. However, it would to on to maintain around 100 members [Shukujo no tomo, May 1935].
