Seishu Hanaoka: The Japanese Doctor Who Bridged the Gap Between Eastern and Western Medicine

"Surgical Casebook" (Kishitsu geryō zukan) by Hanaoka Seishu

Hanaoka Seishū (華岡青洲) was a prominent surgeon of the Edo period in Japan. He was born on November 30, 1760, in Kii Province, Japan, and died on November 21, 1835. His real name was Furuu, but he was commonly known as Unpei. Seishū is recognized for being the first person in the world to perform surgery using full-body anesthesia. This achievement predates the first use of anesthesia in the West by approximately 40 years.

Seishū was born as the eldest son of Hanaoka Naomichi. He moved to Kyoto in 1782, where he studied traditional medicine under Yoshimasu Sanga for three months. He then studied Western-style surgery under Yamato Misui for a year, followed by the study of the Iriko-style surgery established by Misui's teacher, Iriko Dōgyū. In 1785, Seishū returned home and took over his father's medical practice. He began to develop an anesthetic drug to alleviate the suffering of patients during surgery. In 1804, Seishū successfully performed a breast cancer surgery under full-body anesthesia on a 60-year-old woman named Aoya Kan from Gojo Village in Yamato Province. He was appointed as a "small construction doctor" of Kishu Domain in 1813 and was promoted to a small construction royal doctor in 1819. He became a royal doctor in 1833.

Seishū died on November 21, 1835, at the age of 76, surrounded by his family and many disciples. His second son, Sagishū (Shūhei), succeeded him. In 1919, he was posthumously awarded the rank of Senior Fifth Rank for his lifetime achievements. In 1952, he was enshrined in the Hall of Honor of the International College of Surgeons in Chicago, USA, as one of the doctors who contributed to humanity through surgery.

Hanaoka Seishū invented these two formulas for skin disease. He was a Japanese doctor who knew Chinese herbal medicine in the Edo period. Hanaoka developed the famous formula, Jumihaidoku-to(Shi Wei Bai Du Tang) and Shiunko (purple cloud ointment). Both are still widely used for skin diseases.

Shiunko

Hanaoka Seishū and Surgery

While Hanaoka Seishū was a traditional Japanese medicine doctor, he also studied Dutch-style surgery, equipping himself with the most advanced medical knowledge of the time. However, this experience also made him acutely aware of the limitations of the medical techniques available. For instance, breast cancer was not considered suitable for surgical treatment at the time, as it was believed that surgery would put the patient's life at risk.

Major surgeries, such as the removal of breast cancer, were unbearable for patients without general anesthesia. This led Seishū to begin his research into anesthesia. He improved upon the anesthetic prescriptions used by his predecessors and, with the cooperation of a number of volunteers, confirmed their effectiveness and safety. It is said that both his mother and wife participated in the administration trials.

Finally, in October 1804, Seishū undertook the surgical treatment of breast cancer in a 60-year-old patient. As the patient had beriberi and asthma, Seishū spent over 40 days treating these conditions in preparation for the surgery. The anesthesia, known as Mafutsusan, with its main ingredient being Datura, worked well. The surgery to remove only the cancer from the breast was a resounding success.

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Seishū read numerous books and realized that Chosen asagao (Korean morning glory, Datura metel) and Aconitum, which were used as analgesics in China from the Song Dynasty, had the greatest potential ‘Korean morning glory, a species of datura, is poisonous. It belongs to the large Solanum family of plants, which includes tomatoes and the deadly nightshade. Originally from India, it arrived in Japan during the Edo Period (1603-1867) and was used to treat asthma.

It is said that he also conducted animal experiments to examine the effects of the drugs, but the details are not clear. According to recent research, when the drugs were administered to animals such as mice, rats, rabbits, and dogs, the effects varied greatly depending on the species, raising questions about the usefulness of animal experiments in determining doses for humans. Therefore, it is believed that human administration trials with volunteers were extremely important. There are stories that Seishū's mother and wife also participated in the administration trials, but no documents have been found to substantiate this.

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.

Tsūsensan (also known as mafutsu-san)

8 parts yang jin hua (Korean morning glory); 2 parts bai zhi (Angelica dahurica); 2 parts cao wu (Aconitum sp., monkshood or wolfsbane); 2 parts chuān ban xia (Pinellia ternata); 2 parts chuān xiōng (Ligusticum wallichii, Cnidium rhizome, Cnidium ofﬁcinale or Szechuan lovage); 2 parts dong quai (Angelica sinensis or female ginseng); 1 part tian nan xing (Arisaema rhizomatum or cobra lily).

Outstanding treatment results for breast cancer

On October 13, 1804, surgery was performed on Kan. The surgery was successful. However, Kan died four and a half months after the surgery. The cause of death is believed to have been a recurrence of breast cancer.

However, if we only count those among the 143 breast cancer patients who underwent surgery at Shunrinken under Seishū, for whom postoperative survival periods are known, the shortest is 8 days, the longest is 41 years, and on average it is about 3 years and 7 months. Considering that this was more than 200 years ago, and that the majority of the cases were advanced breast cancer that was clearly visible from the outside, these can be said to be commendable treatment results.

Following this, many young doctors gathered at Seishū's place to learn about anesthesia and surgical methods. Seishū carefully selected doctors with a strong desire to learn, and taught them the techniques of anesthesia, along with the spirit of constant effort that characterized a physician. This marked the beginning of the advancement of surgical procedures in Japan

THE DOCTOR'S WIFE By Sawako Ariyoshi **Mint Condition** - Picture 1 of 1

"The Doctor's Wife" by Sawako Ariyoshi

"The Doctor's Wife" by Sawako Ariyoshi is a semi-historical novel set in 18th-century Japan. It follows the life of a woman named Kae, who marries into the family of Hanaoka Seishū.

Ariyoshi’s compelling novel is based on the true story of a Japanese doctor who created one of the ﬁrst general anesthetics using potentially deadly herbs.

“Kae stretched out her hands and snatched the cold, wet ﬂowers. She picked them in deﬁance, one after the other, as she was too upset merely to contemplate their rapaciousness and beauty. ‘Do you know the name of that ﬂower?’ inquired a voice overhead. Kae had been too engrossed to hear footsteps. Clutching the ﬂowers, the frightened girl stiffened, looked up at her husband, and tried to concentrate on the question.” - 189 From “The Doctor’s Wife” by Sawako Ariyoshi, translated by Wakako Hironaka and Ann Siller Kostant (Kodansha International)

From the age of eight, Kae admires a beautiful and clever woman named Otsugi, who later requests Kae to marry her son, Seishū. Despite Kae's father's initial hesitation due to the age difference, the marriage is arranged with Seishū absent, as he is attending medical school. Kae eagerly adapts to her new family, joining her sisters-in-law in weaving cloth, the proceeds of which are sent to Seishū in Kyoto. She develops a deep affection for her unseen husband and a reverence for her mother-in-law, Otsugi.

Upon Seishū's return, Kae feels alienated. She becomes envious of Otsugi, and the once harmonious relationship between the two women deteriorates as they compete for Seishū's attention. Seishū, however, is engrossed in his medical research, particularly his pursuit of developing an anesthetic for surgery.

After succeeding in creating the anesthetic through experiments on animals, Seishū faces the challenge of determining the correct dosage for humans. Both Otsugi and Kae insist on being his test subjects. He first administers the anesthetic on his mother, using a weakened form and omitting the poisonous part of the substance. Encouraged by Kae, he later uses a stronger dosage on his wife, which includes the poison. This results in Kae suffering from headaches and eye problems after the first experiment, and she completely loses her eyesight after the second. Despite these sacrifices, Seishū remains consumed by his medical interests, failing to acknowledge the competition for his affection between Otsugi and Kae.

In the end, both Otsugi and Kae, having "risked their lives to help the doctor achieve his dreams," die. They are buried alongside Seishū, whose tombstone is larger than theirs. From a certain perspective, their tombstones are obscured by Seishū's, symbolizing the overlooked sacrifices of the women and Ariyoshi's critique of the condition of Japanese women at the time.

https://literariness.org/2022/10/11/analysis-of-sawako-ariyoshis-the-doctors-wife/

Conclusion

Seishū Hanaoka was a pioneer in his era, seamlessly blending traditional and Western medical practices. His profound knowledge of herbal medicine played a pivotal role in his groundbreaking invention of a general anesthetic, a feat that revolutionized surgical procedures. His repertoire of surgeries was diverse, ranging from bladder stones and gangrene to hemorrhoids and tumor removal, with a particular emphasis on breast cancer.

In addition to his surgical accomplishments, Seishū also developed several medicinal prescriptions that remain in use today, including Jūmi-haitō, and Shiyūngō. He was a staunch advocate for the integration of traditional Japanese medicine and the newly introduced Dutch medicine, placing a strong emphasis on practical experimentation and empirical verification rather than relying solely on theoretical knowledge.

Seishū's life and work serve as a testament to the potential of integrating traditional medicine and biomedicine, demonstrating how medical advancements can be driven by a patient-centered approach. His legacy continues to inspire the evolution of medical practices, underscoring the importance of bridging the gap between different medical paradigms for the benefit of patient care.

Further reading

https://anesth.or.jp/users/english/general_public/history