Nihon ishigaku zasshi. [Journal of Japanese history of medicine]最新文献

Seishu Hanaoka's greatest achievement was the anesthetic Mafutsusan. He developed it and then used it successfully for various operations, primarily breast cancer tumor excisions. The developmental process can be traced in Mayaku Ko, a memorandum written and edited in 1796 by Hanaoka's close friend Shutei Nakagawa. Contained in this document is a list of fourteen prescriptions for earlier attempts by other doctors to create-a general anesthetic. These prescriptions, which Nakagawa had passed along to Hanaoka, were the foundation for the scientific breakthrough. The preface suggests that Hanaoka had nearly perfected Mafutsusan by 1796. Nakagawa's original manuscript has been lost, but copies of it are extant. Until recently, we knew of four, all of them in Japan. I have discovered three more: one in the University of Tokyo Library (Gakken Collection), another in the Keio University Shinanomachi Media Center, and the third in the Asahikawa Medical University Library (Sekiba-Samejima Collection). After carefully examiiing the new ones, I put the seven known copies of Mayaku Ko into four groups, A to D, according to the order in which they were likely transcribed. One of the copies in Group A, which is from the Matsuki Collection, appears to have been the first.

Dutch researcher Christiaan Eijkman realized that a form of Polyneuritis closely resembling Beriberi occurred among chickens that were fed with cooked, instead of raw rice. He found that the cause of this illness lay in the nutritional differences between rice that still had its bran layer, and polished white rice. He also found that this bran layer had a therapeutic effect. He decided to investigate the incidence of Beriberi among humans by comparing a diet based on white rice with one based on unpolished, full-grain rice. In 1898, he published 'Beri-Beri en Voeding, Een Kritisch-Historische Studie' (Beri-beri and Feeding, An Important Historical Study), in which he discussed the diet reforms of Van Leent in the Dutch East Indian Navy, and of Kanehiro Takaki in the Japanese Navy. Notwithstanding the fact that Takaki's research was highly praised by the Lancet, Eijkman was very critical of his research methods. He was conscious, however, that a shift had occurred in the research of Beriberi from bacteria-based research to nutritional deficiencies, and discussed Takaki's findings insofar as he could.

Nyugan-jun is a manual that was used at Hanaoka's school, Shunrinken, describing two oral medicines and three ointments routinely administered after breast cancer surgery. Nyugan-jun Furoku is also a manual that was used at the school, depicting a variety of diseases of the breast, and oral concoctions to be administered. The earliest manuscript of both manuals was transcribed in February 1812. A manuscript of Ben-nyugansho narabini Chiho Soko, written by Ryozo Chiba in 1811, includes descriptions of an oral medicine and four ointments routinely given after breast cancer surgery. Although Choeito was only a common oral concoction in Nyugan-jun and Chiba's manuscript, the latter bears an original trace of Nyugan-jun. This indicates that Nyugan-jun and Nyugan-jun Furoku were completed by the end of February 1812, and their completion dates were not before August 1811.

The study of artistic anatomy was established in the 17th century, and its education techniques were developed in the 19th century and brought to Japan in the Meiji era. Books of artistic anatomy published in the 19th century have been collected and classified into three periods. In the early period before 1828, education of artistic anatomy proper was preliminarily tried, and in the middle period before 1869, new educational methods were invented to adapt the education in the curriculum of the artistic academy. In the late period, various educational methods of artistic anatomy were combined and systematized to provide modem educational materials which are still in use. Medical illustration was developed in the 20th century, and is clearly distinguished from artistic anatomy. The present study reveals the genealogy of Western artistic anatomy as well as the historical background of artistic anatomy in Japan.

In 1811, Ryozo Chiba (1789-1861) from Sendai Province enrolled in a private school of Shunrinken, presided by Seishu Hanaoka and wrote up a manuscript titled Nanki Seishu Sensei Nyugan Chyutu Koju (the title on the first page is Ben-nyugansho narabini Chiho Soko) in August 1811, only 6 months after enrollment. The manuscript describes Hanaoka's teachings about breast cancer surgery; signs and symptoms of breast cancer, differential diagnosis, preoperative care, administration of Mafutsusan, operative procedures, hemostatic techniques, wound suture; wound dressing, recovery from anesthesia with Mafutsusan, postoperative care, and prescriptions of drugs for internal and external use. After repeated transcriptions and the addition of various papers on other subjects, the title of the manuscript changed to Nyuganbenshio or Nyuganben. Chiba's original manuscript is considered important because the transcriber and the year of transcription of the manuscript are identified, and it unfolds the practice of Hanaoka's breast canicer surgery as of 1811.

The Taisho-Era (1912 to 1926) was a period during which Japanese women increasingly took part in various social activities and employment. The author surveyed the registered woman-doctors listed in the official gazette and the journal of the Japanese Society of Woman Doctors from the first to the 10th years of the Taisho-Era (1912 to 1921) and investigated their medical life-times, including with regard to their husbands and family surroundings, hobbies, and so on. According to the author, there were 467 woman doctors during the first 10 years of the Taisho-Era, far more than the 239 during the Meiji-Era (1886 to 1912). Immediately after medical registration they had a tendency to choose employment in large cities such as Tokyo because there were many medical facilities suitable' for clinical training there. After several years of this training, some of them moved their activities to the countryside. The 1923 Great Kanto Earthquake caused tremendous damagp,to people, including the woman doctors, who were affected by the collapse of buildings and fires (this subject is developed in a separate paper).

We examined the change in the self-recognition about the accuracy of data on Okinawa in the Mizushima Prefectural Life Table, and discussed:its relationship to the "Okinawa Is a Traditional Longevity Prefecture" theory. In the Prefectural Life Table made before WWII, Mizushima had suspended his judgment as to the reliability of infant mortality data in Okinawa. However, after the production of the "Proto-'1921-25' Life Table" in 1952-1954, Mizushima asserted that infant mortality data in Okinawa was incomplete and unreliable, and excluded Okinawa in his analysis in two times of the life table. On the other hand, the "Pre-publication of the 1921-25 Prefectural Life Table" was, in a way that ignores Mizushima's own interpretation, used as the basis of the "Okinawa Is a Traditional Longevity Prefecture" thesis used by the Ryukyu government in its occupation era, and in recent years by other commentators.

Koko Niida composed an epitaph for Seishu Hanaoka in 1836 and in it he employed a phrase consisting of eight Chinese characters to describe Hanaoka's medicine. The phrase reads Naigai Goitsu Katsubutsu Kyuri. Since then, the phrase has prevailed as Hanaoka's motto, even among lay people as well as medical historians. Although there are scrolls written by Hanaoka showing the four Chinese characters of Katsubutsu Kyuri, no calligraphy including the four Chinese characters of Naigai Goitsu is extant. Gencho Honma, one of the leading disciples of Hanaoka and who published Zoku Yoka Hiroku in 1859, mentioned in the preface that the phrase Katsubutsu Kyuri was the maxim that Hanaoka proposed. Considering these facts, the phrase Katsubutsu Kyuri is the very maxim chosen by Hanaoka. He appreciated the significance of skillfulness in the practice of surgery, which was difficult to acquire by reading books and listening to lectures. One of his important phrases, which reads Toku to Futoku wa Sonohito ni Ari in seven Chinese characters, is discussed, regarding how to be adept at technical skills in the practice of surgery.

Seishu Hanaoka's medicine is famed for its breast cancer surgery. Hanaoka, who,was motivated by Dokushoan Nagatomi's Man-yu zakki, published in 1771, had the idea to excise a breast cancer tumor and not to perform a breast amputation. Because he recognized that general anesthesia was indispensable for performing a surgical operation of the breast, he developed a general anesthetic and surmounted various difficulties: selection of an anesthetic method, anesthetic ingredients, determination of the opti- mal dosage, administration methods, indications and contra-indications, evaluation of the depth of anesthesia, facilitation of the smooth emergence from anesthesia, and postoperative care. I reviewed previous articles on these subjects and, using several unpublished manuscripts, provided new information on disseminated general anesthetics in Japan during the decade after the first general anesthesia for Kan Aiya in 1804.

Four illustrations of a breast cancer operation of Kan Aiya in 1804 are referred to as Figures 2 to 5 in the manuscript Nyugan Chiken Roku. One of Hanaoka's disciples depicted them, standing at the patient's feet, in order not to block the sunlight. Thus, the drawings may have been illustrated as viewed from the front. Because the manuscript lacks the original illustrations, Kure transcribed them from other unidenti- fied manuscripts to reproduce them in his monograph Seishu Hanaoka and His Surgery, but they were illustrations viewed from the side, suggesting that they were different from the original figures. A manuscript in the Kyou Library titled Nyuganzu is considered to convey the original style because its illustrations are presented from a front view. Sixteen sheets of drawing, which are in the possession of the Flower Hill Museum, are considered rough sketches for the original illustrations because they are of Hanaoka's family provenance. Careful examination of these manuscripts and the rough sketches leads to further elucidation of the mysteries of Nyugan Chiken Roku.