This Rare Medical Book Is A Real Knockout

By Nancy Mattoon

This famous painting of Hanaoka Seishu shows him removing
a tumor from the chest of a fully anesthetized male patient.
From: Hanaoka Seishu's Surgical Casebook, ca. 1825.
(All Images Courtesy of The National Library Of Medicine.)

Imagine the absolute horror of having major operation, say the removal of a cancerous tumor of the breast, without anesthesia. A state of blissful unconsciousness during surgery is taken for granted now, but the drugs which gave patients the miraculous ability to "sleep" (relatively) safely through invasive procedures have only been in common use for about 150 years.

The Regal Daughter of A Samurai,

Who Came To Hanaoka For Removal
Of A "Blood Tumor" From Her Jaw.

The American National Library of Medicine (NLM) has recently digitized a book recording what is generally believed to be the very first use of general anesthesia during a surgery to remove a cancerous tumor. It is a manuscript containing hand-painted pictures, commissioned by Hanaoka Seishu, a Japanese physician who perfected an herbal formula to induce unconsciousness in 1804. (By contrast, ether was not used as a general anesthetic in the West until 1842.) The text is known simply as Hanaoka Seishu's Surgical Casebook (Japan, ca. 1825).

A Patient Points To A Growth,
Which Appears To Be A Cancer Of The Ear.

Hanaoka was born in what was then the completely closed society of Japan in 1760. Japanese rulers had expelled nearly all Westerners, and Western books, from their island nation in 1639, fearing the spread of European culture and religion. But Japan's ban on outside influences would not be completely successful. A few Dutch traders in isolated settlements remained, and they insisted on bringing in their own medical men.

A Merchant's Wife With An External Tumor On Her Back.

Japan's doctors had always been curious about the medical and surgical practices of the West. (Japanese medicine of the time was based on the Chinese model, in which surgery was banned as "body mutilation," and anatomical dissection of any kind was strictly prohibited.) Hanaoka was one of a new breed of Japanese practitioners who managed to be educated in both the herbal medicine of the East, and the "Dutch-style" surgery of the West.

An Elderly Patient,
Who Appears To Have Cancer Of The Tongue.

Japanese attitudes towards surgery had changed by the time Hanaoka started his practice in about 1785. Translations of Dutch anatomy books into Japanese had begun to appear, and clandestine dissections of executed criminals confirmed their accuracy in depicting the internal workings of the human body. But in Japan, as in the West, surgical practice remained horrifically painful. Patients had to be physically restrained during operations, as alcohol, cocaine, and even morphine could not completely block the pain of the knife without resulting in a fatal overdose.

A Patient In A Lovely Kimono
Seeks Help For A Facial Tumor.

Almost immediately upon finishing his studies, Hanaoka began experimenting with a formula for an herbal anesthesia. He found no mention of pain killers in his Western medical texts, and his Chinese texts included many concoctions made from poisonous plants which could be topically applied to the skin to numb a small area, but which would prove fatal if swallowed. What he sought was a medicine which could deaden pain in the entire body, and induce unconsciousness, without resulting in the death of his patient.

A 56-year-old Woman With An
Undiagnosed Facial Malformation.

Twenty years of experimentation followed. Hanaoka combined various herbs, at various doses, and proceeded to study their effects on cats and dogs. Repeatedly, the drugs were either too weak to mask the pain, or so strong they caused permanent nerve damage or death. Ultimately, he believed he had a workable formula, but needed a human "guinea pig" to test for the proper dose.

Breast Cancer Patient Kan Aiya,
Whose Surgery Was The First Ever
Performed Under General Anesthesia.

It is said that both Hanaoka's devoted wife and his aged mother volunteered to be his test subjects. In the end, Hanaoka chose to experiment on his wife, reasoning (rather chillingly) that he could always remarry if he lost her, but he only had one mother. Tragically, after one too-large dose of anesthesia, Hanaoka's wife became totally and permanently blind. (These events were later fictionalized by Japanese writer Sawako Ariyoshi, in her 1966 novel, The Doctor's Wife. The novel became the basis for Yasuzo Masumura's 1967 film, The Wife of Seishu Hanaoka .)

The Surgeon Locates the Tumor With His Left Hand,
and Uses the Scalpel In His Right
To Separate the Tumor From the Surrounding Tissues.

Finally on October 13, 1804, Seishu Hanaoka successfully anesthetized 60-year-old Kan Aiya with his herbal formula before removing a cancerous tumor in her breast. She survived the surgery, and noted that she had felt no pain, and had no memory of the procedure. Sadly, she died six months later, as the cancer had been removed too late to prevent its spread to the rest of her body.

The Surgeon Completes The Lumpectomy,
By Lifting And Removing The Tumor.

Hanaoka went on to perform at least a 150 operations of a similar nature, and taught thousands of Japanese students his techniques. The surgical casebook digitized by the NLM is a documentary record of those operations drawn by an unknown but highly skilled artist, possibly with medical training himself. Interestingly, some of the active ingredients of Hanaoka's formula, such as scopolamine, hyoscyamine and atropine, are still used in medicine today. His actual formula, which he called Tsusensan, remained unknown in the West until after the development of synthetic anesthetics, such as ether and chloroform. At that point, his herbal concoction was seen as inferior, and was totally ignored.
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Enduring Power Of Frankenstein Inspires Two Monstrous Exhibitions

By Nancy Mattoon

An 1857 Portrait of Mary Shelley
By Reginald Easton,
Allegedly Based On Her Death Mask.
(Image Courtesy of National Library of Medicine.)

It seems impossible that a single exhibit could appeal to fans of science fiction, Gothic novels, Romantic poetry, radical philosophies, horror movies, monsters and early feminism. But the announcement of the opening on December 3, 2010 of a new show at the Bodleian Library of the University of Oxford, Shelley’s Ghost: Reshaping the Image of a Literary Family, will have them all lining up for a chance to learn more about one of Britain's most renowned clan of writers.

A Page From Mary Shelley's
Original Manuscript Of Frankenstein.
(Image Courtesy of Wikipedia Commons.)

The writings of Romantic poet Percy Bysshe Shelley; his wife, pioneering science fiction and Gothic novelist Mary Shelley; and Mary’s parents, radical philosopher William Godwin; and early feminist Mary Wollstonecraft will all be on display. But the most talked about piece in the show is the original manuscript of Mary Shelley's Frankenstein; or, The Modern Prometheus (1818).

An 1819 Portrait of Percy Shelley
By Alfred Clint.
(Image Courtesy of National Library of Medicine.)

The handwritten notebook containing Mary Shelley's classic tale of scientist Victor Frankenstein and his monstrous creation is one of the great treasures of the Bodleian's collections, and has never before been on display in Great Britain. It contains not only Mary's first draft of the novel, but also many handwritten corrections, suggestions, and other marginalia from her first reader, her poet husband, Percy. After the display at Oxford closes on March 27, 2011, it will travel to New York City. The New York Public Library is a co-sponsor of the show, which includes many artifacts from its The Carl H. Pforzheimer Collection of Shelley and His Circle.

Frontispiece And Title Page
From The Third Edition of Frankenstein;
Or The Modern Prometheus, 1831.
(Image Courtesy of The National Library of Medicine.)

A virtual version of the Shelley’s Ghost exhibition will also be made available on December 3. It promises to include digitized leaves from the Frankenstein manuscript, along with pages from the three-volume, first edition of the novel, and an image of the frontispiece of the novel's third edition, which marked the first time that Dr. Frankenstein and his creature were ever depicted visually.

Poster For The Classic 1931
Film Version of Frankenstein,
Directed By James Whale.
(Image Courtesy of The National Library of Medicine.)

Oxford's virtual exhibition was not online as this piece was written, so the images here are from an earlier, but no less interesting, Frankenstein-inspired exhibit from the American National Library of Medicine (NLM). Frankenstein: Penetrating The Secrets of Nature "looks at the world from which Mary Shelley came, at how popular culture has embraced the Frankenstein story, and at how Shelley's creation continues to illuminate the blurred, uncertain boundaries of what we consider 'acceptable' science." It includes a detailed exploration of the ways in which well-intentioned men of science have unwittingly developed technology which, in the wrong hands, leads to "monstrous" creations. The exhibit connects Frankenstein, both in Shelley's novel and in popular culture offshoots, with genetic engineering, human-animal organ transplantation, eugenics, cloning, and other bioethical issues.

A 1935 Article From Popular Science Magazine,
Clearly Influenced By Images
From The Film Version Of Frankenstein.
(Image Courtesy of The National Library of Medicine.)

The combination of the new Oxford exhibit and the previous NLM exhibit reinforce the brilliance and continued relevance of Mary Shelley's tale of "the modern Prometheus." In Greek mythology Prometheus, one of the Titans vanquished by the Olympian Gods, stole fire from Zeus with the best of intentions, and returned it to mere mortals. But ultimately the well-meaning deeds of Prometheus led to the opening of Pandora's box, and the unleashing of all of the troubles of the world. Dr. Frankenstein also maintains that his attempts at reanimating the dead are motivated by "benevolent intentions" and an unquenchable thirst "for the moment when I should put them in practice." But the ultimate result of the scientist's attempt to "mock the stupendous Creator of the world," is an endless spiral of misunderstandings, cruelty,violence, savagery, and death.

Actor Boris Karloff Transformed By Make-Up Artists
Into The 1931 Film Version Of Dr. Frankenstein's Creature.
(Image Courtesy of The National Library of Medicine.)

The unceasing echoes of the timeless themes of Frankenstein through nearly two centuries are all the more remarkable when one considers the age of its author. Mary Shelley began writing the story as a teenager, age 18, and published it just as she reached her twenties.

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Got The Blues, The Mean Reds, Or The Evil Yellows?

Holly Golightly Battles "The Mean Reds" At Tiffany's

Truman Capote's Breakfast At Tiffany's should be required reading for psychiatrists. Nobody ever painted a more terse and pithy picture of clinical depression than Holly Golightly: "You know those days when you've got the mean reds... the blues are because you're getting fat or maybe it's been raining too long. You're sad, that's all. But the mean reds are horrible. You're afraid and you sweat like hell, but you don't know what you're afraid of. Except something bad is going to happen, only you don't know what it is." The National Library Of Medicine has created an exhibit that adds the third primary color to Capote's mental health palette. It's an investigation of what could be called "the evil yellows."

This exhibit, The Literature of Prescription, describes the birth of Charlotte Perkins Gilman's 1892 short story, The Yellow Wallpaper. This literary creation is the world's finest illustration of the old bromide: "the cure is worse than the disease." And the illness was bad enough: a crushing case of post-partum depression.

Charlotte Anna Perkins was born on July 3, 1860 in Hartford, Connecticut. She was a poor relation of the illustrious Beecher Family, including Uncle Tom's Cabin author Harriet Beecher Stowe. Soon after her birth, her father Frederick left the family. Charlotte, her mother Mary, and brother Thomas were forced to live on the handouts of various aunts and uncles, shuttling from relative to relative seeking charity. Her mother was an emotionally cold, sickly woman who forbade her children to make friends or read fiction. Predictably, the lonely Charlotte began stealing away to the public library, and reading voraciously. She also showed a natural talent for writing and drawing.

Writer And Reader Charlotte Perkins Gilman.

At 18, Charlotte enrolled at the prestigious Rhode Island School of Design. She was a talented commercial artist, and for a time made a living designing trade cards. Here she met her first husband, fellow artist Walter Stetson. They married in 1884, and had their only child, Katharine Beecher Stetson, a year later.

Almost immediately after the birth, Charlotte became despondent. She found no joy in motherhood, and felt it did not suit her. She wanted nothing more than to return to her work as an artist. This attitude was considered unwholesome, unladylike, and unacceptable. Walter Stetson wanted a wife, not a business partner. Charlotte's mental frailty became so acute she sought help from the nation's leading specialist in "nervous diseases," Dr. Silas Weir Mitchell.

Rest Cure Proponent Dr. Silas Weir Mitchell.

Dr. Mitchell specialized in treating women suffering from "nervous exhaustion." He believed that the cause of an epidemic of neurasthenia among upper class women was an overdose of education. Women who participated in intellectual activities were "exceeding their natural limits." The cure: an intense period of isolation, total bed rest, deliberate overfeeding of fatty foods like butter and cream, and a complete elimination of reading, writing, drawing, conversation, or any other mental activity.

Charlotte took the rest cure and got well fast. At least well enough to escape Dr. Mitchell's "care" in a month, with the following prescription: "Live as domestic a life as possible...And never touch pen, brush, or pencil as long as you live." The beaten-down patient tried to follow Weir's advice: "I went home and obeyed those directions for some three months, and came so near the borderline of utter mental ruin that I could see over. Then, using the remnants of intelligence that remained... I cast the noted specialist's advice to the winds and went to work again."

An 1892 Illustration From The Yellow Wallpaper.

That work became Charlotte Perkins Gilman's Gothic horror classic: The Yellow Wallpaper. It is the tale of young woman driven mad by the rest cure. The nameless narrator is confined to a locked room with barred windows. In her forced isolation she defies her doctor-husband by secretly writing in a diary. As weeks go by she becomes obsessed with the garish colors and serpentine patterns of the room's wallpaper. She begins to see shapes behind the paper, and eventually becomes convinced there is a woman entrapped beneath it. Hoping to free the imprisoned woman, the narrator begins tearing the paper from the wall. In the end she surrenders completely to her visions, and is last seen compulsively circling the room amidst a sea of tattered paper. Her husband is so shocked by her maniacal behavior that he faints dead away.

Despite having the backing of author and literary critic William Dean Howells, The Yellow Wallpaper was rejected outright by the editor of The Atlantic Monthly. Horace E. Scudder's rejection letter read, in its entirety, "Mr. Howells has handed me this story. I could not forgive myself if I made others as miserable as I have made myself." The story was ultimately published in the January 1892 issue of The New England Magazine. Public reaction was swift, and not positive. A letter to the editor called the story "perilous stuff," and the writer found it so morbidly fascinating and sensational that he wondered if such literature might better remain unpublished. Gilman replied that the story "was not intended to drive people crazy but to save people from being driven crazy."

The Shocking Finale Of The Story, As Illustrated In 1892.

After the story's publication, Charlotte Perkins Gilman divorced her first husband, and in a move shocking for the times, gave him custody of their daughter. She later married a cousin, George Houghton Gilman. The marriage was a happy one, and Charlotte spent the remainder of her life as a writer and crusader for women's rights. She penned both fiction and nonfiction books, as well as essays and poetry, and published her own monthly magazine, The Forerunner, from 1909 through 1916. Most of this work is forgotten today, but The Yellow Wallpaper was rediscovered by feminists in the 1970's, and is now a standard text in Women's Studies classes.

Charlotte Perkins Gilman ended her own life in 1935. Her suicide was NOT a result of depression. A firm believer in euthanasia, she chose to inhale chloroform when diagnosed with inoperable breast cancer. Thanks to her harrowing story, the "Three Color Literary Diagnostic Test for Depression" is complete: the blues are manageable, the mean reds borderline, but evil yellows? See your mental health professional, stat!

Posted by Nancy Mattoon

Medical Library's Contagious Exhibit Sure To Go Viral

She may be…a bag of TROUBLE. Syphilis – Gonorrhea.

U.S. Public Health Service,United States, 1940s.
Photomechanical print: color; 41 x 51 cm. Artist: "Christian."
A sultry, heavily-made-up woman squints provocatively, while smoking a cigarette. WWII posters usually addressed men, and fingered promiscuous women as the source of contagion.

They are an unholy alliance of science, art, medicine, politics, history, advertising, and propaganda. Dramatic images use visual shorthand to convey danger, disease, and death. Shadows, crowds, skeletons, vermin, blob-like micro-organisms, and sinister sick-o's threaten innocent men, women, and children. But these aren't posters for grindhouse horror flicks from the fabulous 50's. They're government issue placards pleading for public health.

Chinese Anti-Tuberculosis Society, 1935.
Translation: "Mistakes are difficult to avoid. Mistakes can be corrected once people realize their errors; and people can be forgiven, if the mistake is not committed again. In spite of government efforts, the average person still does not think spitting is wrong. Any time, any place. Spit once, spit again. Not only does this lack public morality, but, if the phlegm contains the TB bacillus, this can spread thousands upon thousands of bacilli. Spit, on the ground, or on common tools, is inhaled into the lungs. People next to you don't know or feel it, but can catch the disease. TB is rampant in our country because of the error of spitting anywhere. This is unforgivable! If you have the habit, please stop doing it. Spit into a handkerchief and boil it, or spit into paper and burn it. This not only ensures virtue but is a gift to mankind."

The Cultural Programs of the National Academy of Sciences (CPNAS) and the National Library of Medicine (NLM) of the National Institutes of Health have teamed up to create an exhibit of 22 posters from around the globe, the creme de contagion culled from a collection of hundreds of compelling commercials created to curtail communicable killers. An Iconography of Contagion proves that every trick in Madison Avenue's persuasive playbook was purloined by medical professionals to stem the tide of spitting, sneezing, screwing around, smoking, and other socially suspect steps certain to spread sickness.

Rotten er en Landeplage. (Rats are a plague on the land.)
Statens Annonce & Reklamebureau, Denmark, 1946.
Color lithograph; 54 x 86 cm.
Artist: Aage Rasmussen (1913-1975).
A rat crawls over a map of Denmark. The caption reads "Anmeld straks Rottebesog paa kommunekontoret-og Bekæmp selv med alle midler." ("Immediately tell the city authorities if you have rats in your house, and use all possible means to exterminate them").

The first goal of the health poster is to attract the viewer’s attention. Through seduction, entertainment, annoyance, or fear, the images and words on the poster must capture the intended audience. Once heeded, it is hoped the message of the campaign will exert a powerful effect on behavior. Through a combination of argument and imagery, the content will persuade the populace to carry a handkerchief, see a doctor, get an x-ray, practice safer sex, drink only clean water, destroy disease-carrying vermin, get vaccinated, stop smoking, exercise, and practice good nutrition.

She may look clean, but…pick-ups, "good time" girls, prostitutes spread syphilis and gonorrhea.
U.S. Public Health Service,United States, 1940s.
Photomechanical print: color; 37 x 51 cm.
An appealing, seemingly innocent, young woman smiles. Three men, a sailor, a civilian and a soldier, look toward her.

Despite depicting the most dangerous and dire consequences of dreaded diseases, the posters were not without a certain sense of positivity. NLM exhibit curator Michael Sappol says the exhibit reflects a time when medical professionals believed that the creation of compelling images would be "the scientific and modern way to conquer disease and build a better society." Public-health art exploded during World War II, when governments poured money into campaigns designed to defeat the enemy as well as disease, often combining the two until they were indistinguishable. The tagline of one poster, produced by the U.S. Public Health Service in the 1940s, reads: "You can't beat the Axis if you get VD." The posters also reveal the twisted sexual politics of the era: susceptible soldiers are seduced by sirens serving sex with a side of syphilis.

Man-Made Malaria. 6 mosquitoes in 10 breed in water in unnecessary ruts, abandoned roads, blocked ditches, fox and shell holes.
U.S. Navy, Bureau of Medicine & Surgery, U.S. Government Printing Office, 1945.
Photomechanical print: color; 21 x 23 cm.
War-time U.S. military health campaigns often conflated the Japanese enemy with disease-carrying flies and mosquitoes. Here, an anopheles mosquito is given the stereotypical features of the Japanese enemy and has the rising sun of the Japanese imperial flag on his wings.

Scientific advances in the 1950s, antibiotics, the polio vaccine, made public health posters seem passe. The general populace believed drugs and technology would quickly eradicate all the plagues of humankind. Then, in the 1980s, a new incurable killer came knocking. "AIDS blew a giant hole in that belief," says Sappol. HIV/AIDS posters took advantage of the more liberal social climate, and selected salty language and saucy images to sell safe sex. They took a stab at soothing irrational fears, too, assuring a panicked public that casual contact couldn't cause contamination. "Don't worry about what you'll pick up at work," says the text of a poster showing a hand touching a coffee cup, and reaching for a towel and a wrench.

Don’t worry about what you’ll pick up at work.
Health Education Authority, Great Britain, 1980s.
Photomechanical print: color; 60 x 42 cm.A series of ominous photos of darkly-lit human hands touching or grasping for objects commonly used in the workplace. The caption reassures the public that hands and the objects they touch are not carriers of the AIDS contagion.

Discover safer sex.
Terrence Higgins Trust, London, mid-1980s.
Photomechanical print: color; 42 x 60 cm.
This poster, from the Love Sexy, Love Safe campaign, shows an intimate scene of a couple in bed. A tattooed man places his head between the legs of a sexually indeterminate partner. The precise nature of the activity is playfully obscured. Against the stigmatization of gay sex and AIDS sufferers as a source of contagion, and a larger atmosphere of panic, the poster presents sexual activity in a positive light and urges the use of reasonable measures to make sex safe.

Infectious diseases form a chain that links not just all of humanity, but all living things. They do not discriminate, they affect every individual and every population. They have shattered societies and eliminated entire economies. They have changed history by determining the outcome of warfare, destroying the demography of nations, and creating social unrest. They still make headlines every day, and remain mysterious despite scientific breakthroughs. We remain vulnerable to new illnesses in spite of all of our education and technology. Malaria still kills more than 1 million people a year; AIDS has taken more than 25 million lives. Little has changed since 1934, when Hans Zinsser wrote in his classic study, Rats, Lice and History: "Infectious disease is one of the great tragedies of living things – the struggle for existence between different forms of life."

Tuberkulose undersogelse –en borgerpligt (Tuberculosis examination – a citizen’s duty.)
Copenhagen, Denmark, 1947.
Color lithograph; 62 x 85 cm.
Designer/artist: : Henry Thelander (fl. 1902-1986).
Lithographers: Andreasen & Lachmann.
A shadow couple happily walks arm in arm. In the background, the abstract form of a modernist building, looking like an arrow and suggesting a statistical increase, is labeled Folke-tuberkulose undersogelse.

La course a la mort. (The race with death.)
Ligue Nationale Française contre le Peril Venerien, France, ca. 1926.
Color lithograph; reproduction of a pastel drawing; 69 x 88 cm.
Artist: Charles Emmanuel Jodelet (1883-1969).
Death watches a thoroughbred race of deadly diseases. The statistics below compare the annual mortality rates of tuberculosis, syphilis
and cancer.

"An Iconography of Contagion," began life as a short term exhibition in Washington, D.C. Now in a trend that appears to be infectious, the National Library of Medicine has made the exhibit a permanent online feature of its website. The posters served a deadly serious purpose, but have an artistic legacy, as well. As curator Michael Sappol puts it: "they're also about the pleasure of the image. There have been some very sexy, colorful, playful posters about some very serious diseases."

Posted by Nancy Mattoon