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dressed and refuses to put on plain clinical younger doctor is suspicious and believes Red Beard: garments. He shows contempt for his older colleague only wants to plagiarise Dr Niide and disgust with the patients these. Later he comes to understand that it Kurosawa’s and their relatives (see figure 1). was the older man’s humility and commit- Dr Yasumoto is played by the young heart- ment to learning that led him to want medical throb Yuzo Kamaya, and Dr Niide by them. He also discovers that it was Toshiro Mifune, the greatest Japanese Dr Niide who requested his placement in masterpiece film actor of his age, so their interaction the clinic in the first place, presumably in on the screen is doubly charged. order to acquire this knowledge. This fits with the circumstances of the period. In John Launer EVERY ASPECT OF MEDICINE the early 1800s, Japan was almost entirely Kurosawa’s plot takes viewers through five closed to western influence, and books The Japanese movie maker Akira interwoven episodes related to patients of from the west were banned. An exception Kurosawa is considered by many to have the clinic. They cover just about every was only made for a Dutch trading post in been one of the world’s greatest film direc- aspect of medicine you could imagine: Nagasaki Bay. Through contact with the tors. His friend and colleague Steven madness, death and dying, operative sur- settlers there, Japanese scholars developed Spielberg described him as ‘the visual gery, infectious diseases, the effects of nat- traditions of science, medicine and tech- Shakespeare of our time’. Kurosawa is ural disasters like earthquakes, but above nology known as Rangaku, or ‘Dutch probably best known for his movies of all the consequences of poverty and social learning’ that enabled them to adopt samurai life, including Rashomon, injustice. Kurosawa even manages to incor- some of the discoveries of the European Yojimbo and the most famous of all, porate a scene of martial arts, when Enlightenment into Japan, in advance of Seven Samurai. These had a great influence ‘Dr Redbeard’ fights off assailants who the enforced opening of the country by in Hollywood, and many westerns imi- are trying to prevent him rescuing the the USA in 1853.3 tated them. Some of his films were them- young girl Otoyo from the brothel. In The movie also includes a scene where selves adaptations of Shakespeare: Throne doing so, the doctor applies his knowledge ‘Dr Redbeard’ carries out an operation on of Blood was a version of Macbeth, and of anatomy to break a few bones, but then a woman who has suffered a serious injury Ran was based on King Lear. His 30 self-effacingly apologises for his use of on a building site, and he does so under movies ranged over many genres, includ- violence. anaesthesia or very deep sedation (see ing love stories and psychological dramas. The last episode of the film is the most figure 3). This is also historically accurate. One of his finest movies is a portrait of moving. We see how Dr Yasumoto has The first use of general anaesthesia in two doctors and a tribute to compassionate evolved from a narcissist into a selfless Japan took place in 1804, predating its medicine. Its title is Red Beard, after the individual who has absorbed the values use in Europe. A doctor named Seishu nickname of one of the doctors.1 The plot that motivate the clinic director. He takes Hanaoka, who had studied both Japanese comes mainly from a set of tales by the over the care of Otoyo and nurtures her so medicine and Dutch surgery, administered Japanese writer Shugoro Yamamoto, she can recover from the psychological it when removing a breast tumour from although the final section brings in a story damage and fever she acquired in the a 60-year-old woman.4 Hanaoka gave her taken from the great Russian novelist brothel. Ironically, he then catches the an oral anaesthetic made from herbs, fever himself and she nurses him back to Dostoyevsky about an underage girl who which he had previously tested on animals. http://pmj.bmj.com/ is rescued from enforced work in a brothel. health. In the process, we also observe He later used it in a total of 156 operations Kurosawa made three films about compas- Otoyo grow from being a traumatised on humans, including his wife and sionate medical care. He suffered from sig- orphan into a loving and much loved mem- daughter. nificant medical problems for much of his ber of the clinic community—a result of 2 the humanising effect of ‘Dr Redbeard’s’ life, including alcoholism and depression, EXQUISITE VISUALLY philosophy on physicians and patients so the film may be his mark of respect to Like other movies directed by Kurosawa.

alike. This episode alone would make per- on September 24, 2021 by guest. Protected copyright. the profession. Red Beard is exquisite visually, with many Red Beard fect material for a session on cinema in is set in a poor district of Edo frames seeming like works of art in their a medical humanities course. The movie (now Tokyo) in the first half of the nine- own right (see figure 4). It is gripping both ends with Dr Yasumoto’s wedding to the teenth century. Dr Kyojo Niide is a red- as a cinematic masterpiece and an unsenti- sister of his original fiancée, when he bearded physician who runs a clinic and mental portrayal of medicine. In his review explains that his future will not be as phy- cottage hospital for poor and indigent of the movie, the Pulitzer prize-winning sician to the Shogun, but to the poor (see patients. He is rather gruff and uncompro- critic Roger Ebert has written mising, but his patients adore him. The figure 2). start of the movie shows the arrival of Red Beard is a long and deliberate film, as a newly qualified doctor, Noboru it must be, because the lessons of the Yasumoto, who has been sent there in JAPANESE AND WESTERN MEDICINE great doctor cannot be ticked off in vign- order to escape embarrassment after his Kurosawa always paid close attention to ettes. Doctors need to watch awhile at deathbeds, and learn to know the fiancée ran off with another man. He is historical detail. He demonstrates this in Red Beard with his depiction of Japanese patients. We need to observe how a man proud, ambitious and in line to become who thinks of himself as flawed can be ‘ ’ medicine and its emerging relationship a physician to the Shogun or de facto wholly good. And how a man who has an ruler of Japan. When he arrives, he is well with western medicine. We learn from the unearned high opinion of himself can beginning that Dr Yasumoto has been learn goodness through humility. trained by Dutch doctors in Nagasaki. As Correspondence to Dr John Launer, Associate I believe this film should be seen by Editor, Postgraduate Medical Journal, London WC1H soon as he arrives, Dr Niide wants him to every medical student .. It fearlessly 5 9JP, UK; [email protected] share his medical school notes, but the regards the meanings of life, and death.

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Figure 1 Dr Niide and Dr Yasumoto attend a dying patient. http://pmj.bmj.com/ on September 24, 2021 by guest. Protected copyright.

Figure 2 Dr Niide attends Yasumoto’s wedding.

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Figure 3 Dr Niide conducts an operation under anaesthetic while Dr Yasumoto looks on. http://pmj.bmj.com/ on September 24, 2021 by guest. Protected copyright.

Figure 4 Dr Niide and a nurse observe Otoyo taking care of a hungry child.

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Twitter John Launer @JohnLauner. 2 Kurosawa A. Something like an autobiography. Funding The authors have not declared a specific grant New York, NY: Vintage Books, 1983. 3 Jansen MB. Rangaku and westernisation. Mod Asian for this research from any funding agency in the public, To cite Launer J. Postgrad Med J 2020;96:641–644. commercial or not-for-profit sectors. Stud 1984;18:541–53. Postgrad Med J 2020;96:641–644. 4 Izuo M. Medical history: Seishu Hanaoka and his Competing interests None declared. doi:10.1136/postgradmedj-2020-138828 success in breast cancer surgery under general Patient consent for publication Not required. anaesthesia two hundred years ago. Breast Cancer Provenance and peer review Not commissioned; REFERENCES 2004;11:319–24. internally peer reviewed. 5 Ebert R. Treating bodies along with souls. 18 1 Reineke R. Kurosawa, in order #23: Red Beard. 7 © Author(s) (or their employer(s)) 2020. No August 2013. Available http://wherethelongtailends. November 2010. Available https://www.rogerebert. commercial re-use. See rights and permissions. com/kurosawa-in-order-23-red-beard/ (accessed 23 com/reviews/great-movie-red-beard-1965 (accessed Published by BMJ. Jul 2020) 23 Jul 2020) http://pmj.bmj.com/ on September 24, 2021 by guest. Protected copyright.

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