19th C. Breast Cancer Lithograph Makes Surgery Look Beautiful

by Stephen J. Gertz

A copy of the first edition of the most complete anatomical atlas and arguably the most beautiful of the nineteenth century, Jean Baptiste Marc Bourgery's Traité complet de l’anatomie de l’homme, comprenant la médecine opératoire (1831-1854), is being offered by Christie's-Paris in its Importants Livres  Ancienes, Livres d'Artistes, et Manuscrits sale November 6, 2013.

Amongst the 726 beautifully designed lithographed plates within its sixteen books in eight folio volumes is Fonctionnant sur une tumeur cancéreuse (Operating on a Cancerous Tumor), which depicts a neat and bloodless breast ablation upon a beautiful woman in calm repose as two sets of hands perform the surgery as if the horror was Photoshopped out leaving only the sheen of precision and 19th century state-of-the-art medicine.

How 'bout those clean, well-manicured, bare hands so gracefully intruding into the patient's flesh as if dancing a finger ballet? The two inset images show the successful result of the surgeons' efforts, and the whole presents a procedure sterile of reality if not of pathogens. The blood-curdling screams have been excised for your comfort; surgical anesthesia was in its infancy and ether and chloroform were not yet standard. This is an artistic exercise in medical aesthetics.

Bourgery studied medicine in Paris with René Laennec, inventor of the stethoscope, and Guillaume Dupuytren, the French anatomist and military surgeon who won fame treating Napoleon's hemorrhoids as the imperial proctologist, before Bourgery continued his work his work at Romilly. 

Published over a period of twenty-three years, this atlas was the result of titanic work by Bourgery, who died before the last volume's publication. This huge artistic work was supervised by Nicholas-Henri Jacob (1782-1871), student of Jacques-Louis David. 

"Without issue one of the most beautifully illustrated anatomical and surgical treatises ever published in any language" (Heirs of Hippocrates).

We post this today to remind all that breast cancer needs to be early detected and treated. Despite Bourgery's neat and tidy depiction scrubbed of life and death, breast cancer surgery is not pretty. National Breast Cancer Awareness Month ends tomorrow.

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BOURGERY, Jean Baptiste Marc (1797-1849). Traité complet de l’anatomie de l’homme, comprenant la médecine opératoire. Paris: C.-A. Delaunay, 1831-1854. First edition. Sixteen tomes in eight folio volumes (425 x 310 mm). Eight lithographed title pages, 724 plates (of 726, lacks vol. V plate 5 and vol. VII plate 36). Lacks the frontispiece. Some foxing, a few tears. Contemporary half black morocco, smooth spine.

Heirs of Hippocrates 1569. Waller 1342. Wellcome II, p. 214.

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Image courtesy of Christie's, with our thanks.
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An Inside Look At Tonsils, Or A Medical Instrument From Hell

By Stephen J. Gertz

From: Leçons sur l'hypertrophie des amygdales et sur
une nouvelle méthode opératoire pour leur ablation
by Edouard Chassaignac.
Paris: Jean-Baptiste Baillière, 1854.
First (only) edition. Octavo. 120 pp.

Just the other day I received a letter from a medical student in Guatemala,   a chronically unemployed chimney sweep from Papua, New Guinea with higher ambitions and one of my protegés. Aware that I once practiced occupational therapy in hospitals and sub-acute facilities and that when I put on my white, crisply pressed lab coat I transmogrified onto a brilliant, sage physician possessing all the medical knowledge in the world, he asked me, "Doc Gertz,  do you have any lessons on the hypertrophy of tonsils and a new method for their ablation? I've a test coming up."

After performing my ablutions I should have told him to go look it up, I wasn't going to be around forever. I  am, after all, mortal and not the God-like medico I actually am but play-down, yet I couldn't resist the opp to, once again, have the ans immediately and inflate my vainglorious ego to its proper psi.

"Okay," I wrote back, "here's what you do. When those almond-shaped babies swell up like my vainglorious ego at its proper psi, yank 'em out. But not with the standard wire-cutter, apple-corer or strawberry-top remover. My old buddy, Edouard Chassaignac, has a new gizmo from 1857; he wrote a book about it. He took a couple of dinner forks, wrapped 'em around a couple of soap bubble-blowers. The bubble-blowers isolate the swollen tonsils, and the forks, when stuck into them, tell you they're done and ready to be served to the pathologist. It's also great for tumors, piles, and polypi, your basic weed-whacker for bad growths. Best part, no blood."

I couldn't resist spritzing one last factoid at him to push him over the top and into perpetual awe. "The procedure is called 'écrasement.' It means 'crushing.'"

Hell, Ed could've used a nutcracker to similar, albeit messier, effect but he's got the "M.D." after his name and I don't, like that should make any difference.

Need I add that Yauwii aced the exam? I'm feeling pumped.
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Image courtesy of Libraire Alain Brieux, currently offering this item, with our thanks.
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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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