Hanaoka Seishu
Encyclopedia
was a Japan
ese surgeon
of the Edo period
with a knowledge of Chinese herbal medicine
, as well as Western surgical techniques he had learned through Rangaku
(literally "Dutch learning", and by extension "Western learning"). Hanaoka is said to have been the first to perform surgery
using general anesthesia.
European surgery. Due to the nation's self-imposed isolation policy of Sakoku
, few foreign medical texts were permitted into Japan at that time. This limited the exposure of Hanaoka and other Japanese physicians to Western medical developments.
Perhaps the most notable Japanese surgeon of the Edo period, Hanaoka was famous for combining Dutch and Japanese surgery and introducing modern surgical techniques to Japan. Hanaoka successfully operated for hydrocele
, anal fistula
, and even performed certain kinds of plastic surgery
. He was the first surgeon in the world who used the general anaesthesia in surgery and who dared to operate on cancers of the breast
and oropharynx
, to remove necrotic
bone, and to perform amputation
s of the extremities in Japan.
Hua Tuo
(華, ca. AD 145-220) was a Chinese surgeon
of the 2nd century AD. According to the Records of Three Kingdoms
(ca. AD 270) and the Book of the Later Han (ca. AD 430), Hua Tuo performed surgery under general anesthesia using a formula he had developed by mixing wine with a mixture of herbal extract
s he called mafeisan (麻沸散). Hua Tuo reportedly used mafeisan to perform even major operations such as resection
of gangrenous
intestines. Before the surgery, he administered an oral anesthetic potion
, probably dissolved in wine, in order to induce a state of unconsciousness
and partial neuromuscular blockade
.
The exact composition of mafeisan, similar to all of Hua Tuo's clinical knowledge, was lost when he burned his manuscripts, just before his death. The composition of the anesthetic powder was not mentioned in either the Records of Three Kingdoms or the Book of the Later Han. Because Confucian
teachings regarded the body as sacred
and surgery was considered a form of body mutilation, surgery was strongly discouraged in ancient China. Because of this, despite Hua Tuo's reported success with general anesthesia, the practice of surgery in ancient China ended with his death.
The name mafeisan combines ma (麻, meaning "cannabis, hemp
, numbed
or tingling
"), fei (沸, meaning "boiling
or bubbling"), and san (散, meaning "to break up or scatter", or "medicine in powder form"). Therefore, the word mafeisan probably means something like "cannabis boil powder". Many sinologist
s and scholars of traditional Chinese medicine
have guessed at the composition of Hua Tuo's mafeisan powder, but the exact components still remain unclear. His formula is believed to have contained some combination of:
Others have suggested the potion may have also contained hashish
, bhang
, shang-luh, or opium. Victor H. Mair
wrote that mafei "appears to be a transcription of some Indo-European
word related to "morphine"." Some authors believe that Hua Tuo may have discovered surgical analgesia by acupuncture
, and that mafeisan either had nothing to do with or was simply an adjunct to his strategy for anesthesia. Many physicians have attempted to re-create the same formulation based on historical records but none have achieved the same clinical efficacy as Hua Tuo's. In any event, Hua Tuo's formula did not appear to be effective for major operations.
Hanaoka was intrigued when he learned about Hua Tuo's mafeisan potion. Beginning in about 1785, Hanaoka embarked on a quest to re-create a compound that would have pharmacologic properties similar to Hua Tuo's mafeisan. His wife, who participated in his experiments as a volunteer, lost her sight due to adverse side effects. After years of research and experimentation, he finally developed a formula which he named tsūsensan (also known as mafutsu-san). Like that of Hua Tuo, this compound was composed of extracts of several different plants, including:
Some sources claim that Angelica archangelica
(often referred to as garden angelica, holy ghost, or wild celery) was also an ingredient.
Reportedly the mixture was ground to a paste, boiled in water, and administered as a drink. After 2 to 4 hours the patient would become insensitive to pain and then lapse into unconsciousness. Depending on the dosage, they might remain unconscious for 6–24 hours. The active ingredients in tsūsensan were scopolamine
, hyoscyamine
, atropine
, aconitine
and angelicotoxin. When consumed in sufficient quantity, tsūsensan produced a state of general anesthesia and skeletal muscle
paralysis
.
Shutei Nakagawa (1773–1850), a close friend of Hanaoka, wrote a small pamphlet entitled "Mayaku-ko" ("narcotic powder") in 1796. Although the original manuscript was lost in a fire in 1867, this brochure described the current state of Hanaoka's research on general anesthesia.
for breast cancer
on Kan Aiya, using tsūsensan as a general anesthetic. This is regarded today by some as the first reliable documentation of an operation to be performed under general anesthesia. Nearly forty years would pass before Crawford Long
used general anesthesia in Danielsville, Georgia
.
Hanaoka's success in performing this painless operation soon became widely known, and patients began to arrive from all parts of Japan. Hanaoka went on to perform many operations using tsūsensan, including resection of malignant tumor
s, extraction of bladder stones
, and extremity amputations. Before his death in 1835, Hanaoka performed more than 150 operations for breast cancer. He also devised and modified surgical instruments, and trained and educated many students, using his own philosophy for medical management. Hanaoka attracted many students, and his surgical techniques became known as the Hanaoka method.
The surgical teachings of Hanaoka were also preserved in a series of eight handwritten books by unnamed pupils, but known to us by the following titles: Shoka shinsho, Shoka sagen, Kinso yojutsu, Kinso kuju, Geka chakuyo, Choso benmei, Nyuiganben, and Koho benran. No dates are known for any of these writings. Since Hanaoka himself made only manuscript copies and none were ever published, it is doubtful if many copies of his surgical writings are now extant.
of the Tokugawa shogunate
prevented Hanaoka's achievements from being publicized until after the isolation ended in 1854. By that time, different techniques for general anesthesia had already been independently developed by American and European scientists and physicians. The Japan Society of Anesthesiologists however has incorporated a representation of the Korean morning glory
flower in their logo
in honor of Hanaoka's pioneering work.
Hanaoka's house has been preserved in his hometown (Naga-cho, Kinokawa, Wakayama
). It has various interactive exhibits in both Japanese and English. It is adjacent to a nursing college, and many locally trained doctors and nurses pay homage to Hanaoka and his works.
wrote a novel entitled, The Doctor's Wife
(Japanese
華岡青洲の妻), based on the actual life of Hanaoka Seishū mixed with a fictional conflict between his mother and his wife. The novel was subsequently filmed as a 1967 movie directed by Yasuzo Masumura
, Hanaoka Seishū no tsuma (aka "The Wife of Seishu Hanaoka").
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
ese surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
of the Edo period
Edo period
The , or , is a division of Japanese history which was ruled by the shoguns of the Tokugawa family, running from 1603 to 1868. The political entity of this period was the Tokugawa shogunate....
with a knowledge of Chinese herbal medicine
Chinese herbology
Chinese Herbology is the theory of Traditional Chinese herbal therapy, which accounts for the majority of treatments in Traditional Chinese medicine ....
, as well as Western surgical techniques he had learned through Rangaku
Rangaku
Rangaku is a body of knowledge developed by Japan through its contacts with the Dutch enclave of Dejima, which allowed Japan to keep abreast of Western technology and medicine in the period when the country was closed to foreigners, 1641–1853, because of the Tokugawa shogunate’s policy of national...
(literally "Dutch learning", and by extension "Western learning"). Hanaoka is said to have been the first to perform surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
using general anesthesia.
History
Hanaoka studied medicine in Kyoto, and became a medical practitioner in Wakayama prefecture, located near Osaka, where he was born. Seishū Hanaoka learned traditional Japanese medicine as well as Dutch-importedRangaku
Rangaku is a body of knowledge developed by Japan through its contacts with the Dutch enclave of Dejima, which allowed Japan to keep abreast of Western technology and medicine in the period when the country was closed to foreigners, 1641–1853, because of the Tokugawa shogunate’s policy of national...
European surgery. Due to the nation's self-imposed isolation policy of Sakoku
Sakoku
was the foreign relations policy of Japan under which no foreigner could enter nor could any Japanese leave the country on penalty of death. The policy was enacted by the Tokugawa shogunate under Tokugawa Iemitsu through a number of edicts and policies from 1633–39 and remained in effect until...
, few foreign medical texts were permitted into Japan at that time. This limited the exposure of Hanaoka and other Japanese physicians to Western medical developments.
Perhaps the most notable Japanese surgeon of the Edo period, Hanaoka was famous for combining Dutch and Japanese surgery and introducing modern surgical techniques to Japan. Hanaoka successfully operated for hydrocele
Hydrocele
A hydrocoele denotes a pathological accumulation of serous fluid in a body cavity. It can also be noted as a minor malformation of newborns due to high levels of lead in the mother's blood during pregnancy....
, anal fistula
Anal fistula
Anal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and the perianal skin....
, and even performed certain kinds of plastic surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
. He was the first surgeon in the world who used the general anaesthesia in surgery and who dared to operate on cancers of the breast
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
and oropharynx
Oral cancer
Oral cancer is a subtype of head and neck cancer, is any cancerous tissue growth located in the oral cavity. It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the...
, to remove necrotic
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
bone, and to perform amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
s of the extremities in Japan.
Hua Tuo and mafeisan
Hua Tuo
Hua Tuo was an ancient Chinese physician who lived during the late Han Dynasty and Three Kingdoms era of Chinese history. The Records of Three Kingdoms and Book of Later Han record Hua as the first person in China to use anesthesia during surgery. He used a general anesthetic combining wine with a...
(華, ca. AD 145-220) was a Chinese surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
of the 2nd century AD. According to the Records of Three Kingdoms
Records of Three Kingdoms
Records of Three Kingdoms , is regarded as the official and authoritative historical text on the Three Kingdoms period of Chinese history covering the years 184-280 CE. Written by Chen Shou in the 3rd century, the work combines the smaller histories of the rival states of Cao Wei , Shu Han and...
(ca. AD 270) and the Book of the Later Han (ca. AD 430), Hua Tuo performed surgery under general anesthesia using a formula he had developed by mixing wine with a mixture of herbal extract
Herbal extract
Tincture is a liquid solution of herbs and a fluid menstruum, usually ethanol. The dried or fresh herbs are combined with alcohol, then the solid matter is removed leaving only the oils of the herbs mixed with the alcohol...
s he called mafeisan (麻沸散). Hua Tuo reportedly used mafeisan to perform even major operations such as resection
Segmental resection
Segmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
of gangrenous
Gangrene
Gangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
intestines. Before the surgery, he administered an oral anesthetic potion
Potion
A potion is a consumable medicine or poison.In mythology and literature, a potion is usually made by a magician, sorcerer, dragon, fairy or witch and has magical properties. It might be used to heal, bewitch or poison people...
, probably dissolved in wine, in order to induce a state of unconsciousness
Unconsciousness
Unconsciousness is the condition of being not conscious—in a mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli. Being in a comatose state or coma is a type of unconsciousness. Fainting due to a drop in blood pressure and a...
and partial neuromuscular blockade
Neuromuscular-blocking drug
Neuromuscular-blocking drugs block neuromuscular transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles. This is accomplished either by acting presynaptically via the inhibition of acetylcholine synthesis or release or by acting postsynaptically at the...
.
The exact composition of mafeisan, similar to all of Hua Tuo's clinical knowledge, was lost when he burned his manuscripts, just before his death. The composition of the anesthetic powder was not mentioned in either the Records of Three Kingdoms or the Book of the Later Han. Because Confucian
Confucianism
Confucianism is a Chinese ethical and philosophical system developed from the teachings of the Chinese philosopher Confucius . Confucianism originated as an "ethical-sociopolitical teaching" during the Spring and Autumn Period, but later developed metaphysical and cosmological elements in the Han...
teachings regarded the body as sacred
Sacred
Holiness, or sanctity, is in general the state of being holy or sacred...
and surgery was considered a form of body mutilation, surgery was strongly discouraged in ancient China. Because of this, despite Hua Tuo's reported success with general anesthesia, the practice of surgery in ancient China ended with his death.
The name mafeisan combines ma (麻, meaning "cannabis, hemp
Hemp
Hemp is mostly used as a name for low tetrahydrocannabinol strains of the plant Cannabis sativa, of fiber and/or oilseed varieties. In modern times, hemp has been used for industrial purposes including paper, textiles, biodegradable plastics, construction, health food and fuel with modest...
, numbed
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
or tingling
Paresthesia
Paresthesia , spelled "paraesthesia" in British English, is a sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep"...
"), fei (沸, meaning "boiling
Boiling
Boiling is the rapid vaporization of a liquid, which occurs when a liquid is heated to its boiling point, the temperature at which the vapor pressure of the liquid is equal to the pressure exerted on the liquid by the surrounding environmental pressure. While below the boiling point a liquid...
or bubbling"), and san (散, meaning "to break up or scatter", or "medicine in powder form"). Therefore, the word mafeisan probably means something like "cannabis boil powder". Many sinologist
Sinology
Sinology in general use is the study of China and things related to China, but, especially in the American academic context, refers more strictly to the study of classical language and literature, and the philological approach...
s and scholars of traditional Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
have guessed at the composition of Hua Tuo's mafeisan powder, but the exact components still remain unclear. His formula is believed to have contained some combination of:
- bai zhi (Angelica dahuricaAngelicaAngelica is a genus of about 60 species of tall biennial and perennial herbs in the family Apiaceae, native to temperate and subarctic regions of the Northern Hemisphere, reaching as far North as Iceland and Lapland...
), - cao wu (草烏, Aconitum kusnezoffii, Aconitum kusnezoffiiAconitumAconitum , known as aconite, monkshood, wolfsbane, leopard's bane, women's bane, Devil's helmet or blue rocket, is a genus of over 250 species of flowering plants belonging to the buttercup family .-Overview:These herbaceous perennial plants are chiefly natives of the mountainous parts of the...
, Kusnezoff's monkshood, or wolfsbane root), - chuān xiōng (Ligusticum wallichiiLigusticum wallichiiLigusticum wallichii is a flowering plant in the carrot family best known for its use in traditional Chinese medicine where it is considered one of the 50 fundamental herbs. It is known by the common names chuānxiōng and Szechuan lovage....
, or Szechuan lovage), - dong quai (Angelica sinensisAngelica sinensisAngelica sinensis, commonly known as "dong quai" or "female ginseng" is a herb from the family Apiaceae, indigenous to China.-Chinese:...
, or "female ginsengGinsengGinseng is any one of eleven species of slow-growing perennial plants with fleshy roots, belonging to the genus Panax of the family Araliaceae....
"), - wu tou (烏頭, Aconitum carmichaeliiAconitum carmichaeliiAconitum carmichaelii is a flowering plant species native to East Asia, particularly in China and Japan. It is commonly known as Chinese Aconite, Carmichael's Monkshood and Chinese Wolfsbane...
, rhizome of Aconitum, or Chinese monkshood"), - yang jin hua (洋金花, Flos Daturae metelis, or Datura stramoniumDatura stramoniumDatura stramonium, known by the common names Jimson weed, devil's trumpet, devil's weed, thorn apple, tolguacha, Jamestown weed, stinkweed, locoweed, datura, pricklyburr, devil's cucumber, Hell's Bells, moonflower and, in South Africa, malpitte and mad seeds, is a common weed in the...
, jimson weed, devil's trumpet, thorn apple, locoweed, moonflower), - ya pu lu (Mandragora officinarumMandragora officinarumMandragora officinarum is a species of the plant genus mandrake. It has a variety of medicinal uses, especially anodyne and soporific, though in the past much of the use was due to superstition.-Physical characteristics:...
) - rhododendronRhododendronRhododendron is a genus of over 1 000 species of woody plants in the heath family, most with showy flowers...
flower, and - jasmineJasmineJasminum , commonly known as jasmines, is a genus of shrubs and vines in the olive family . It contains around 200 species native to tropical and warm temperate regions of the Old World...
root.
Others have suggested the potion may have also contained hashish
Hashish
Hashish is a cannabis preparation composed of compressed stalked resin glands, called trichomes, collected from the unfertilized buds of the cannabis plant. It contains the same active ingredients but in higher concentrations than unsifted buds or leaves...
, bhang
Bhang
Bhang is a preparation from the leaves and flowers of the female cannabis plant, smoked or consumed as a beverage in the Indian subcontinent.- India:...
, shang-luh, or opium. Victor H. Mair
Victor H. Mair
Victor Henry Mair is a Philologist specializing in Sinitic and Indo-European languages, and holds the position of Professor of Chinese Language and Literature in the Department of East Asian Languages and Civilizations at the University of Pennsylvania, Philadelphia, United States...
wrote that mafei "appears to be a transcription of some Indo-European
Indo-European languages
The Indo-European languages are a family of several hundred related languages and dialects, including most major current languages of Europe, the Iranian plateau, and South Asia and also historically predominant in Anatolia...
word related to "morphine"." Some authors believe that Hua Tuo may have discovered surgical analgesia by acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
, and that mafeisan either had nothing to do with or was simply an adjunct to his strategy for anesthesia. Many physicians have attempted to re-create the same formulation based on historical records but none have achieved the same clinical efficacy as Hua Tuo's. In any event, Hua Tuo's formula did not appear to be effective for major operations.
Formulation of tsūsensan
- 8 parts yang jin hua (Datura stramoniumDatura stramoniumDatura stramonium, known by the common names Jimson weed, devil's trumpet, devil's weed, thorn apple, tolguacha, Jamestown weed, stinkweed, locoweed, datura, pricklyburr, devil's cucumber, Hell's Bells, moonflower and, in South Africa, malpitte and mad seeds, is a common weed in the...
, Korean morning glory, thorn apple, jimson weed, devil's trumpet, stinkweed, or locoweed); - 2 parts bai zhi (Angelica dahuricaAngelicaAngelica is a genus of about 60 species of tall biennial and perennial herbs in the family Apiaceae, native to temperate and subarctic regions of the Northern Hemisphere, reaching as far North as Iceland and Lapland...
); - 2 parts cao wu (Aconitum sp.AconitumAconitum , known as aconite, monkshood, wolfsbane, leopard's bane, women's bane, Devil's helmet or blue rocket, is a genus of over 250 species of flowering plants belonging to the buttercup family .-Overview:These herbaceous perennial plants are chiefly natives of the mountainous parts of the...
, monkshood or wolfsbane); - 2 parts chuān ban xia (Pinellia ternataPinellia ternataPinellia ternata , crow-dipper, is a plant native to China, but also grows as an invasive weed in parts of North America. The leaves are trifoliate, while the flowers are of the spathe and spadix form typical of plants in Araceae.-Characteristics:The plant spreads by rhizomes, and there are also...
); - 2 parts chuān xiōng (Ligusticum wallichiiLigusticum wallichiiLigusticum wallichii is a flowering plant in the carrot family best known for its use in traditional Chinese medicine where it is considered one of the 50 fundamental herbs. It is known by the common names chuānxiōng and Szechuan lovage....
, Cnidium rhizome, Cnidium officinale or Szechuan lovage); - 2 parts dong quai (Angelica sinensisAngelica sinensisAngelica sinensis, commonly known as "dong quai" or "female ginseng" is a herb from the family Apiaceae, indigenous to China.-Chinese:...
or female ginsengGinsengGinseng is any one of eleven species of slow-growing perennial plants with fleshy roots, belonging to the genus Panax of the family Araliaceae....
); - 1 part tian nan xing (Arisaema rhizomatumArisaemaArisaema is a genus of about 150 species in the flowering plant family Araceae, native to eastern and central Africa, Asia and eastern North America. Its species are often called Cobra lilies, particularly the Asiatic species...
or cobra lily).
Some sources claim that Angelica archangelica
Garden Angelica
Angelica archangelica, commonly known as Garden Angelica, Holy Ghost, Wild Celery, and Norwegian angelica, is a biennial plant from the Apiaceae family Apiaceae family, formerly known as Umbelleferae...
(often referred to as garden angelica, holy ghost, or wild celery) was also an ingredient.
Reportedly the mixture was ground to a paste, boiled in water, and administered as a drink. After 2 to 4 hours the patient would become insensitive to pain and then lapse into unconsciousness. Depending on the dosage, they might remain unconscious for 6–24 hours. The active ingredients in tsūsensan were scopolamine
Scopolamine
Scopolamine, also known as levo-duboisine, and hyoscine, is a tropane alkaloid drug with muscarinic antagonist effects. It is among the secondary metabolites of plants from Solanaceae family of plants, such as henbane, jimson weed and Angel's Trumpets , and corkwood...
, hyoscyamine
Hyoscyamine
Hyoscyamine is a tropane alkaloid. It is a secondary metabolite found in certain plants of the Solanaceae family, including henbane , mandrake , jimsonweed , tomato and deadly nightshade...
, atropine
Atropine
Atropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...
, aconitine
Aconitine
Aconitine is a highly poisonous alkaloid derived from various aconite species.-Uses:...
and angelicotoxin. When consumed in sufficient quantity, tsūsensan produced a state of general anesthesia and skeletal muscle
Skeletal muscle
Skeletal muscle is a form of striated muscle tissue existing under control of the somatic nervous system- i.e. it is voluntarily controlled. It is one of three major muscle types, the others being cardiac and smooth muscle...
paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
.
Shutei Nakagawa (1773–1850), a close friend of Hanaoka, wrote a small pamphlet entitled "Mayaku-ko" ("narcotic powder") in 1796. Although the original manuscript was lost in a fire in 1867, this brochure described the current state of Hanaoka's research on general anesthesia.
Use of tsūsensan as a general anesthetic
Once perfected, Hanaoka began to administer his new sedative drink to induce a state of consciousness equivalent to or approximating that of modern general anesthesia to his patients. Kan Aiya (藍屋勘) was a 60 year old woman whose family was beset by breast cancer - Kan being the last of her kin alive. On 13 October 1804, Hanaoka performed a partial mastectomyMastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
for breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
on Kan Aiya, using tsūsensan as a general anesthetic. This is regarded today by some as the first reliable documentation of an operation to be performed under general anesthesia. Nearly forty years would pass before Crawford Long
Crawford Long
Crawford Williamson Long was an American surgeon and pharmacist best known for his first use of inhaled diethyl ether as an anesthetic...
used general anesthesia in Danielsville, Georgia
Danielsville, Georgia
Danielsville is a city in Madison County, Georgia, United States. The population was 457 at the 2000 census. The city is the county seat of Madison County...
.
Hanaoka's success in performing this painless operation soon became widely known, and patients began to arrive from all parts of Japan. Hanaoka went on to perform many operations using tsūsensan, including resection of malignant tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s, extraction of bladder stones
Urolithiasis
A bladder stone is a solid concretion or crystal aggregation found in the urinary bladder...
, and extremity amputations. Before his death in 1835, Hanaoka performed more than 150 operations for breast cancer. He also devised and modified surgical instruments, and trained and educated many students, using his own philosophy for medical management. Hanaoka attracted many students, and his surgical techniques became known as the Hanaoka method.
Publications
Hanaoka wrote the following works. It should be noted that none of these were printed books. Rather (as was the custom in Japan at that time), they were all handwritten manuscripts which were later reproduced by his students for their personal use.- 1805: Nyuigan chiken-roku, a one-volume book that provides a detailed description of Hanaoka's first operation for mammary carcinoma.
- 1805: Nyugan saijo shujutsu-zu, a one-volume book that provides a detailed description of Hanaoka's first operation for mammary carcinoma.
- 1809: Nyuigan zufu, an illustrated emakimonoEmakimono, often simply called , is a horizontal, illustrated narrative form created during the 11th to 16th centuries in Japan. Emakimono combines both text and pictures, and is drawn, painted, or stamped on a handscroll...
in one roll which also pictured breast cancer. - 1820: Geka tekiyio, a one volume text.
- 1838: Hanaoka-ke chiken zumaki, an illustrated emakimono scroll depicting 86 different cases, including surgical resection of fibromas and elephantiasisElephantiasisElephantiasis is a disease that is characterized by the thickening of the skin and underlying tissues, especially in the legs and male genitals. In some cases the disease can cause certain body parts, such as the scrotum, to swell to the size of a softball or basketball. It is caused by...
of the genitalia.). - Date unknown: Hanaoka-shi chijitsu zushiki, a one-volume illustrated book that depicts his operations for the treatment of conditions such as phimosisPhimosisPhimosis , from the Greek phimos ), is a condition where, in men, the foreskin cannot be fully retracted over the glans penis...
, arthritisArthritisArthritis is a form of joint disorder that involves inflammation of one or more joints....
, necrosis, choanal atresiaChoanal atresiaChoanal atresia is a congenital disorder where the back of the nasal passage is blocked, usually by abnormal bony or soft tissue formed during fetal development.-Presentation:It can be unilateral or bilateral....
, and hemorrhoidHemorrhoidHemorrhoids or haemorrhoids , are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of...
s. - Date unknown: Seishuiidan, a series of essays on Hanaoka's medical and surgical experiences.
- Date unknown: Yoka hosen, a one volume text.
- Date unknown: Yoka shinsho, a one volume text on surgery.
- Date unknown: Yoka sagen, a two volume text on surgery.
The surgical teachings of Hanaoka were also preserved in a series of eight handwritten books by unnamed pupils, but known to us by the following titles: Shoka shinsho, Shoka sagen, Kinso yojutsu, Kinso kuju, Geka chakuyo, Choso benmei, Nyuiganben, and Koho benran. No dates are known for any of these writings. Since Hanaoka himself made only manuscript copies and none were ever published, it is doubtful if many copies of his surgical writings are now extant.
Legacy
Though some of his patients are said to have benefited from Hanaoka's work, it apparently had no impact upon the development of general anesthesia in the rest of the world. The national isolation policySakoku
was the foreign relations policy of Japan under which no foreigner could enter nor could any Japanese leave the country on penalty of death. The policy was enacted by the Tokugawa shogunate under Tokugawa Iemitsu through a number of edicts and policies from 1633–39 and remained in effect until...
of the Tokugawa shogunate
Tokugawa shogunate
The Tokugawa shogunate, also known as the and the , was a feudal regime of Japan established by Tokugawa Ieyasu and ruled by the shoguns of the Tokugawa family. This period is known as the Edo period and gets its name from the capital city, Edo, which is now called Tokyo, after the name was...
prevented Hanaoka's achievements from being publicized until after the isolation ended in 1854. By that time, different techniques for general anesthesia had already been independently developed by American and European scientists and physicians. The Japan Society of Anesthesiologists however has incorporated a representation of the Korean morning glory
Datura stramonium
Datura stramonium, known by the common names Jimson weed, devil's trumpet, devil's weed, thorn apple, tolguacha, Jamestown weed, stinkweed, locoweed, datura, pricklyburr, devil's cucumber, Hell's Bells, moonflower and, in South Africa, malpitte and mad seeds, is a common weed in the...
flower in their logo
Logo
A logo is a graphic mark or emblem commonly used by commercial enterprises, organizations and even individuals to aid and promote instant public recognition...
in honor of Hanaoka's pioneering work.
Hanaoka's house has been preserved in his hometown (Naga-cho, Kinokawa, Wakayama
Kinokawa, Wakayama
is a city located in Wakayama Prefecture, Japan.As of April 30, 2011, the city has an estimated population of 67,835 with 25,607 households and a population density of 297.21 persons per km²...
). It has various interactive exhibits in both Japanese and English. It is adjacent to a nursing college, and many locally trained doctors and nurses pay homage to Hanaoka and his works.
Popular culture
The Japanese author Sawako AriyoshiSawako Ariyoshi
was a Japanese writer and novelist.-Biography:Born in Wakayama City and a graduate of Tokyo Women's Christian College, Sawako Ariyoshi spent part of her childhood in Java...
wrote a novel entitled, The Doctor's Wife
The Doctor's Wife
The Doctor's Wife, known in Japanese as , is a noted novel by Sawako Ariyoshi written in 1966.The partly historical novel is based on the life of noted male physician Hanaoka Seishū. Though much is based on fact, many events were added for dramatic purposes. The novel follows the protagonist, here...
(Japanese
Japanese language
is a language spoken by over 130 million people in Japan and in Japanese emigrant communities. It is a member of the Japonic language family, which has a number of proposed relationships with other languages, none of which has gained wide acceptance among historical linguists .Japanese is an...
華岡青洲の妻), based on the actual life of Hanaoka Seishū mixed with a fictional conflict between his mother and his wife. The novel was subsequently filmed as a 1967 movie directed by Yasuzo Masumura
Yasuzo Masumura
was a Japanese film director.Masumura was born in Kōfu on Honshū. After dropping out of a law course at the University of Tokyo he worked as an assistant director at the Daiei studio, later returning to university to study philosophy; he graduated in 1949...
, Hanaoka Seishū no tsuma (aka "The Wife of Seishu Hanaoka").
External links
- Turning the Pages: a virtual reconstruction of Hanaoka's Surgical Casebook, ca. 1825. From the U.S. National Library of Medicine.