日大医誌 74 (6): 292–294 (2015) 292

Original Article

Surgery for Peripheral Nerve Sheath Tumors during the “Early Meiji Period” in 19th Century Japan

Shunzo Osaka and Satoshi Hayakawa Division of , Department of and Microbiology, Nihon University School of

Background: This classic article is a translation with commentary of a seminal treatise on the status of for peripheral nerve sheath tumors in the “early Meiji period” of Japan. It was during the Meiji period in the 19th century that modern medicine, even surgery for the nerve tumors, was introduced to our country. This allowed differences between Japanese and Western medicine to be investigated. Methods: “Geka setsuyaku” (Surgery Theory) was published as a textbook by Tadanori Ishiguro in 1873. This surgical text was written with reference to the works of Heschl, Gross, Stromeyer and Roser. “Shinkei ryu” (nerve mass) was described as being derived from a nerve sheath, with illustration of the resected nerve mass. We have researched the background factors contributing to understanding of such nerve masses during historical times. Results: The neuromatous tumor described in Gross’s surgery text corresponded to the nerve mass illustrations presented in Surgery Theory here in Japan. Tumor resection included a portion of the nervous system, based on medical practices available during the time period that this classic text was in use. Conclusion: This textbook has been key to the development of modern medicine. Our country was greatly influenced, particularly by Western medical theory and practice, during the “early Meiji period”. Key words: peripheral nerve sheath tumor, surgery, early Meiji period of Japan, 19th century, historical medicine (J. Nihon Univ. Med. Ass., 2015; 74 (6): 292–294)

Wien, and his textbook (1860–1889: editions 1–9) was Introduction translated into “Geka tsuron” (Surgery Discussion) As for the history of Western surgery in Japan, (1876), as German medicine then gradually became Portugal and Spain disseminated their medical texts the mainstream practice. widely. The Portuguese surgeon Luis de Almeida We have reviewed the medical history of nerve (1525–1583) treated patients and taught medicine sheath tumor during the “early Meiji period” in the in Kyushu (southern Japan), from the “Muromachi 19th century of Japan. Especially, we compared the period” to the “Azuchimomoyama period” of the 16th surgical treatment of “shinkei ryu” (nerve mass) found century1). From the “early Edo period” through the in “Geka setsuyaku” (Surgery Theory)6) (1873) with “early Meiji period”, Western surgery established that in Western medicine. by Chinzan Narabayashi (1648–1711) was based on Methods the herbal “Koi geka soden” (1706) (Red-head-style surgery text) of Ambroise Pare’s (1510–1590) surgery Surgery Theory written by Tadanori Ishiguro textbook in France that had been translated into Dutch. (1845–1941) was promulgated in 1873 (the 6th year of Then, surgeons such as Engelbert Kaempfer (1651– the “Meiji period”) (Fig. 1A). The preface of Surgery 1716) (German), Carl Peter Thunberg (1743–1828) Theory was written by referring to the surgical texts of (Swedish), and Philipp Franz von Siebold (1796–1866) Heschl, Gross, Stromeyer and Roser. (German), working in the Netherlands, provided a firm The nerve mass developed from nervous system basis for the study and practice of medicine2). For a tissue, and it was resected with this contiguous tissue. short time, the British surgeon William Willis (1837– The resected tumor with the nerve is illustrated, and 1894) served as a professor at Tokyo Medical School the nerve funiculus is recognizable in the stump (University of Tokyo), in the “early Meiji period”, portion (Fig. 1B). The peripheral nerve tumor is which also promoted the spread of the English described as being from a nerve sheath, but whether language3). German medicine gained popularity due it is benign or malignant in nature is unknown, to the research of Rudolf Virchow (1821–1902) and though the explanation provided suggests that it was Robert Koch (1843–1910). Furthermore, Susumu resected because of intense . A clear pathological Sato4) (1845–1921) studied abroad under Billroth5) in differentiation of peripheral nerve sheath tumors was

Received: July 30, 2015 Accepted: August 31, 2015 74 (6) 2015 Surgery of Nerve Tumor in early Meiji Japan 293

Fig. 1A and B A, A title cover of the “Geka setsuyaku” (Surgery Theory) surgical text is shown. B, A mass grows in a nerve sheath: the “shinkei ryu” (nerve mass) does not exclude nervous system involvement, and such a mass is described when it occurs either distally or centrally. not described. We have studied this textbook in detail by Western medical theory and practice, in the “early to identify the background factors pertaining to nerve Meiji period”. Japan approached and even overtook masses. Western medicine at that time. Surgery Theory was not, however, a translated text. Results Discussion Pathological anatomy was reflected by the progres­ sive development of theories at the time in Surgery Nerve tumors in Japan Theory by Ishiguro, before the discovery of X-rays, Before Surgery Theory became available in our based on the aforementioned surgical texts such country, a peripheral nerve mass was reported by as “Compendium der Allgemeinen und Speciellen Gencho Honma7) (1804–1872), a disciple of Seishu Pathologischen Anatomie, Wien, 1855” by Heschl, “A Hanaoka (1760–1835). This text departs from the book System of Surgery, Philadelphia, 1859” by Gross, the by the Hanaoka-ryu (Hanaoka-school), and although military medicine and surgery text entitled “Maximen there is a mention, the illustration is not shown in the der Kriegsheilkunst, Hannover, 1861” by Stromeyer, “Yoka hitsuroku; Sequel” (1859) published in Japan. and the surgery book “Handbuch der Anatomischen In Surgery Theory (1873), Ishiguro6) described Chirurgie, Tubingen, 1844” by Roser. a nerve mass. Surgery Theory by Heschl8), Gross9), Knowledge of pathological anatomy appears to Stromeyer10) and Roser11) is based on the pathological have been disseminated in our country during the anatomy derived from adopting various opinions and same period. The surgical book by Gross serves as the pathology theory of Virchow12) which was the the foundation of pathological anatomy, presenting most recent and up-to-date at that time, as well as the many illustrations of resected specimens and antisepsis theory and practices of Lister13) in 1867, as histology. These are found in “A system of surgery; described in 19 volumes. pathological, diagnostic, therapeutic, and operative “Geka tsuron; last volume” was then followed by (first of editions 1–7, 1859–1882)”. “Neuromatous the classification of neuromas by Haga14) in 1890. tumors were described in CHAPTER VII. TUMORS Neuromas are classified into genuine character, OR MORBID GROWTHS (pp288–291, ed 1, 1859)”. pseudo, and plexiform, based on the report stating that Furthermore,“Figure 32” which had been quoted in intense pain necessitates that neuromatous tumors be this surgery book was the same as an illustration of resected. Surgery Theory in Japan. The neuromatous tumor Nerve tumors in Western surgical practice resection included a portion of the nervous system, As for the history of Western neurological tumor based on medical practices available during the time surgery, according to Browne15) and Powers et al.16), period that this classic text was in use. most operations were carried out with bulging of Our country was greatly influenced, particularly the nervous system stump (neuroma) due to the type 294 Shunzo OSAKA et al. 日大医誌 of noted by Lower17) in 1669. Furthermore, 18) References Cheselden reported a tumor site thought to be the median nerve of the elbow in 1741, which was 1) Kimura S. Ancestral initiation of western medicine; Luis resected as a peripheral nerve tumor together with a de Almeida. Clin Orthop Surg 2005; 40: 282–286. portion of the contiguous nervous system. Home19) 2) Ishida J. Duch doctors of Edo. Tokyo: Sanseido, 1988: 50–56. also resected a tumor with a portion of the contiguous 3) Achiwa G. The influence of European medicine on nervous system in 1800, and he recognized that Japanese surgery. Tokyo: Jpn Soc Hist Med, 1967: 148– it could easily be peeled off the peripheral nerve 157. tumor and the adjacent nervous tissue in a resected 4) Sato S. Geka tsuron. Tokyo: Eirando, 1876. specimen. A portion of the contiguous nervous system 5) Billroth T. Die Allgemeine Chirurgische Pathologie und did not necessarily have to be resected. 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