Japanese
pioneer developed first general anaesthetic
" 06 March 2009 by Stephanie
Pain
" Magazine issue 2698.
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Topic Guide
Pioneering Japanese surgeon Seishu Hanaoka,
with his mother (left) and wife (Image: International Museum
of Surgical Science)
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a gallery of bizarre medical devices
"When the dreadful steel was plunged into my breast...
I began a scream that lasted unintermittingly during the
whole time of the incision. I almost marvel that it rings
not in my ears still, so excruciating was the agony."
When English writer Fanny Burney had surgery for breast
cancer in 1811, she felt every move of the knife as the
surgeon cut through her all too resistant flesh. The introduction
of ether and chloroform as general anaesthetics was still
35 years away. Yet, unknown to doctors in the west, Japanese
surgeon Seishu Hanaoka had performed the same operation
several years earlier - and his patient hadn't felt a thing.
IT WAS nine months before Fanny Burney could
bring herself to write about the operation to remove her
breast. In a letter to her sister Esther, she described
in harrowing detail what she had felt as the surgeon cut
and scraped and cut some more. By the early 19th century,
Europe's surgeons had the knowledge and skills to perform
major operations. What they didn't have was an effective
anaesthetic. Opium or copious amounts of cognac could help
dull the pain, but no one had yet found a reliable way to
render a patient unconscious during surgery - or so European
surgeons thought.
Unknown to the rest of the world, on 13 October
1804, Japanese surgeon Seishu Hanaoka had put 60-year-old
Kan Aiya under with a general anaesthetic in order to remove
her cancerous breast. While Hanaoka's surgical technique
owed much to western medicine, his anaesthetic was rooted
firmly in the tradition of Chinese medicine that prevailed
in Japan at the time. By combining the two, Hanaoka was
able to perform surgery other Japanese doctors dared not
try - and Europe's surgeons could perform only after tying
down the patient and blocking out their screams.
Hanaoka was born in the small town of Hirayama
in 1760, possibly the perfect time for a pioneering doctor.
Worried by the spread of Christianity and angered by the
activities of Portugal's Jesuit priests, Japan had expelled
all Europeans in 1639. An exception was made for the Dutch,
who were tolerated because they stuck to business and kept
their religion to themselves. Even so, Dutch traders were
confined to the tiny walled
settlement of Dejima, an artificial island in Nagasaki
Bay. Their activities were strictly controlled and their
movements closely watched. All communication was through
official Japanese interpreters, who ensured that foreign
ideas did not slip in among the Dutch imports, but here
too there was an exception.
Japan's doctors had always been curious about
the medicine practised by the Jesuits. After they were expelled,
the one window onto western medicine was at Dejima, and
Dutch medical books were allowed to trickle into the country.
Better still, the Dutch East India Company sent a succession
of surgeons to Dejima. The interpreters watched them at
work, took notes, and reported what they had seen. A few
even took lessons. Soon, Japanese doctors began to try some
of the simple surgery picked up from the Dutch, and schools
of "Dutch-style surgery" began to spring up.
Despite its name, Dutch-style surgery bore
only a passing resemblance to that practised in Europe.
It was based on a handful of badly translated books and
sketchy accounts of operations performed by a string of
Dutch surgeons, some no more than ship's doctors. Japan's
doctors were also highly selective in what they chose to
adopt. One of the main tenets of Chinese medicine was to
avoid harming the body, so while Japan's doctors followed
Dutch advice on treating wounds and fractures, they rejected
invasive surgical procedures. European doctors routinely
amputated limbs, removed cataracts and extracted bladder
stones. In Japan, even bloodletting was regarded as abhorrent.
In the 1740s, however, there was a big push
to find out more about western science and medicine. The
authorities actively encouraged "Dutch learning",
and while earlier interpreters had learned just enough Dutch
to do business, scholars were now exhorted to learn the
language fluently enough to read and translate Dutch books.
By the time Hanaoka was beginning his medical
studies in the 1780s, attitudes towards surgery were changing.
What prompted the change was a book of anatomy. In Europe,
anatomy was the foundation stone of medicine and its medical
students pored over anatomy texts and dissected bodies.
In Japan, students learned about the body from stylised
drawings in ancient Chinese texts. Dissection of human bodies
was forbidden.
In 1771, the revered doctor Genpaku Sugita,
a proponent of Dutch learning, acquired a Dutch edition
of Johann Kulmus's Anatomical Plates. Curious to find out
how Kulmus's drawings compared with Chinese ideas of the
body, Sugita and fellow doctor Ryotaku Maeno bribed an executioner
to allow them to watch the dissection of a criminal - and
took the book along with them. They were so impressed by
the book's accuracy they spent the next four years translating
it. Its appearance marked a turning point in Japanese medicine.
No one could deny that Dutch surgery was based on sound
knowledge of the body.
Following in his father's footsteps, Hanaoka
left Hirayama in 1782 to study medicine in Kyoto. After
studying traditional Chinese medicine, he took lessons in
Dutch-style surgery, which by then was far more advanced
than in his father's day. At 25 he took over his father's
practice in Hirayama and immediately began work on his anaesthetic.
Hanaoka's great ambition was to save women from breast cancer
by surgically removing their tumours, an operation he had
seen in "a foreign book". But he also considered
it his duty to prevent pain, and there the Dutch were no
help at all. He could find no mention of anaesthesia in
their books. Chinese medicine, by contrast, was well endowed
with drugs that deadened pain, numbed sensation and induced
sleep. Hanaoka wanted something that did all these things
without killing the patient in the process.
That was a tall order. All these drugs came
from extremely poisonous plants, and while some could safely
be smeared onto skin to numb a small area before minor surgery,
for more serious operations the drug would have to work
on the whole body, which meant it would have to be swallowed.
It took 20 years of experiment before Hanaoka
found the right formula. He started by combining different
herbs at different doses, testing his draughts on cats and
dogs. The difficulties were all too evident: if the drug
wasn't powerful enough, the animals still felt pain; if
it was too strong they suffered nerve damage or died. When
he thought he had arrived at a safe dose, he tried it on
his wife. She went blind, transforming a story of wifely
devotion into one of medical heroism.
It took almost 20 years of experiment before Hanaoka found
the right formula
Hanaoka persisted and eventually found a formula that worked
without inflicting terrible after-effects. He called it
tsusensan. The key ingredients were Angel's trumpet (Datura
metel) and monkshood (Aconitum japonicum). The first contains
scopolamine, hyoscyamine and atropine, which are still used
as sedatives and muscle relaxants, while monkshood contains
aconitine, a powerful neurotoxin. To bolster the analgesic
and sedative effects he added angelica, Szechuan lovage
(Ligusticum wallichii) and the arum Arisaema serratum.
News of the experiments spread, and in 1804
Hanaoka finally achieved his ambition of performing cancer
surgery under anaesthetic. Aiya, his first patient, had
a large tumour in her left breast and had turned to Hanaoka
in desperation. The anaesthetic worked, the operation was
a success and Aiya went home. Sadly it came too late. Her
cancer had spread and she died six months later.
Hanaoka went on to perform more than 150 similar
operations and other procedures deemed too difficult by
his contemporaries. Patients and students eager to learn
his techniques flocked to Hirayama, and Hanaoka's place
in Japanese history was assured. Yet Japan's policy of isolation
meant the world outside remained ignorant of Hanaoka's anaesthetic.
By the time Japan reopened its doors to foreigners, in 1853,
they had no interest in it: they had finally found anaesthetics
of their own.
See
a gallery of bizarre medical devices
Bibliography
1. Find out more about the history of surgery and anaesthesia
at www.sciencemuseum.org/uk/broughttolife,
the London Science Museum's new multimedia website. Brought
to Life explores centuries of medical history through 2500
objects from the Wellcome Trust collection held at the museum,
many of which are on display for the first time.