September, 2023. I can't remember the exact date, though. Mornings would find me on the 3rd floor of the public library near my house. There's an English section there that offers a wide variety of books and novels too. I spend an hour or so just browsing titles to see if any pique my interest. My ritual includes touching each book and then opening it to a random page to see if it sparks any curiosity. If it does, that's a winner and if not, it means I have to spend more time until I find the right one. So, my eyes caught 'The Doctor's Wife' by Sawako Ariyoshi - naturally, I thought it was about the wife of a doctor. My fingers stumbled upon a page detailing a poignant moment: the older sister lay on her deathbed. From what I recall, she expressed a sense of relief, remarking, "At least I was spared the ordeal of vying for our brother's affection, unlike you and mother. That was a bitter rivalry..."

I took it home and began reading, quickly becoming engrossed in the narrative—a complex battle between two women: the mother and wife of the doctor. The more I read, the more I uncovered about this doctor, a legendary figure who made history not only in Japan but worldwide. His name was Hanaoka Seishu, and he was a pioneering Japanese surgeon, the first in the world to use general anesthesia, which he called "tsusensa," for surgery in 1804.

Although the book is a novel, it delves deeply into the historical context, focusing particularly on the lives of the women behind him: his wife, Kae, and his mother, Otsugi. In essence, it explores the complexities of the human condition, touching on themes of sacrifice, jealousy, and the pursuit of knowledge against the backdrop of 19th-century Japan. Both of the woman, are deeply committed to supporting Hanaoka's medical research, even to the extent of enduring painful experiments. So today's newsletter aims to explore who Hanaoka was as a doctor, independent of the novel.

You might wonder how he managed to create an anesthesia in the 1800s. Tsūsensan, also referred to as "Mafutsusan" in some texts, was the formulation he used. This complex mixture of several herbs marks a historically significant milestone as one of the first documented uses of general anesthesia in surgery. Hanaoka's anesthesia, inspired by traditional Chinese medicine, included ingredients like the Datura plant, known for its analgesic and anesthetic properties, among others.

Even though opium has been, and continues to be, one of the most potent herbal medicines aka morphine for alleviating pain, it is believed that the Greeks used it by boiling poppy seeds in milk. Interestingly, in my country(Albania), there were many instances where women discovered a remarkable 'medicine' by boiling milk with poppy seeds to calm crying infants, working like a miracle, though they were unaware of its full implications.

Upon further research, it becomes clear that Hanaoka Seishu was not the first to perform surgery under general anesthesia; this milestone was actually achieved 115 years earlier. Takamine Ueekata Tokumei (高嶺 親方 徳明, February 15, 1653 – 1738), an Okinawan interpreter proficient in Chinese-Okinawan languages, was tasked with learning the technique for cleft lip surgery. He successfully carried out this surgery on Shō Eki, the grandson of King Shō Tei, using general anesthesia. Remarkably, the procedure left no visible scar, marking a significant achievement in surgical history. This operation, conducted 115 years before Hanaoka Seishu's famed removal of a mammary cancer under general anesthesia (recognized as the first of its kind in Japan), illustrates an earlier application of general anesthesia in surgical practice.

Before his groundbreaking surgery, Hanaoka Seishu was dedicated to discovering the perfect combination of drugs to use for anesthesia. This led him to conduct numerous experiments on cats and dogs before advancing to human trials. In the novel, it is mentioned that their garden turned into a graveyard for these test subjects. His wife, while pregnant with their second child, was plagued by nightmares of witnessing the deaths of these animals. Distressed by these visions, she visited the temple to offer prayers for peace.

He tried various drug combinations, meticulously noting which ones succeeded and which failed. His venture into human experimentation began unintentionally, with his mother volunteering herself, followed by his wife, who tragically lost her eyesight due to these dangerous trials. Kae's loss of eyesight is symbolic of the extreme sacrifices made by those closest to pioneers and innovators, highlighting the often unseen and personal costs of progress. Hanaoka's wife passed away before he did, and her sacrifice was widely acknowledged. In recognition of her contributions, a substantial tomb was built in her honor.

However, these experiments with herbal anesthesia were crucial for Hanaoka's pioneering achievements in surgery, particularly in developing an effective method for performing operations without pain, marking a significant advancement in the medical field.

After perfecting his formulation, Hanaoka began using his new sedative, tsūsensan, to achieve a state in his patients that was similar to modern general anesthesia. His first documented use of this anesthetic was on Kan Aiya, a 60-year-old woman from a family plagued by breast cancer, with Kan being the last surviving member. On October 13, 1804, Hanaoka performed a partial mastectomy on Kan Aiya under general anesthesia with tsūsensan, marking what some consider the first reliably documented operation performed under general anesthesia.

Following this successful painless operation, Hanaoka's fame spread, attracting patients from all over Japan. He continued to perform numerous operations, including tumor resections, bladder stone extractions, and amputations, using tsūsensan. Before his death in 1835, Hanaoka had conducted over 150 breast cancer operations, innovated surgical instruments, and imparted his medical philosophy to many students, thus establishing the Hanaoka method.

References:

"The Doctor's Wife" - Sawako Ariyoshi

Japan Society of Anesthetic Medicine

National Library of Medicine - Historical Anatomies