It all began with Seishu Hanaoka, a surgeon who successfully administered general anesthesia and removed a breast cancer tumor for the first time in the world on October 13, 1804. This was accomplished about 40 years before the widely known public demonstration of ether anesthesia performed by William T. G. Morton at Massachusetts General Hospital.

Hanaoka invented a new drug he called Mafutsusan, which consisted of 6 medicinal herbs, mainly Mandarage (Datura alba Nees) and Uzu (Aconitum japonicum) which are now known to contain scopolamine and aconitine. This blend formed the anesthetic which he used to remove the tumor, in the first known successful case of general anesthesia in the world.

Hanaoka knew about Hua Tuo’s use of an anesthetic called Mafeisan in the 3rd century in China. It was a surprising invention because it was in an era in Japan with no concept of anesthesia, when enduring pain was thought to be a virtue. He repeated his experiments many times. His achievement was introduced to the International College of Surgeons in 1954, and documents on Hanaoka have been exhibited in the Japanese Hall of Fame of the International Museum of Surgical Science in Chicago. The Japanese Society of Anesthesiologists (JSA) uses a Datura flower for its symbol to honor his historic achievement.
It was a revolutionary invention, but its use declined, especially during wartime. Its use was hampered by its slow induction speed and difficulty in anesthesia depth control due to oral administration and rather complex preparations.

Japan was isolated from the world during a period between 1639 and 1853, but knowledge of ether came to Japan in 1850 through contact with the Netherlands. Seikei Sugita, who studied Dutch medicine, translated a Dutch edition of Schlesinger’s textbook on ether anesthesia in 1850 and tried to use ether clinically in 1855. However, he failed, most likely due to the impurity of the ether used.

Unlike Europe and the US which experienced wars during the 1800s and thus faced demand for fast-acting general anesthesia and antiseptic procedures for war casualties, a peaceful, but isolated, Japan was left out of the need for trauma surgery.

During the civil wars in Japan after the Meiji Restoration in 1868, William Willis, a young British surgeon utilized chloroform anesthesia for war casualties and briefly brought attention to the British Medical system, but the new government of Japan preferred that of Germany. They invited surgeons from Germany to train Japanese surgeons and implemented the authoritarian surgeon-based model used in Germany.

Academism was given priority over practice in the German model, and authority was concentrated in the hands of professors. Surgeons were evaluated on how fast they could operate, as infections were considered to be reduced with shorter operating times. The suffering of patients continued to be ignored. In 1898, the Japanese Surgical Society was established, and their power was officially endorsed. Most surgery at the time was performed with local anesthesia (local infiltration anesthesia and nerve blocks), but chloroform and ether were also used.

There was a period during the 1920s when a series of disputes over the use of general anesthesia and positive pressure ventilation erupted within members of the Japanese Surgical Society. The issue was settled via suppression of subsequent use of inhaled anesthesia. Interestingly, general anesthesia techniques rapidly advanced during the same period in the US.

In the 1930s, surgeons such as Hayao Nakatani of the University of Tokyo and Daisuke Nagae of the Imperial Army Medical School visited the Mayo Clinic to study surgery and anesthesiology, separately. Nagae was especially impressed by advances in endotracheal anesthesia and reported this in detail after returning to Japan, but his report was neglected due to pre-war circumstances. Diplomatic relations were truncated and thus the development and benefits of anesthesiology were never recognized until 1950, five years after the war.

During World War II, the Japanese health care system was completely demolished and medical science was isolated from the rest of the world. The Allied Powers (mainly US forces) realized the importance of restoring social welfare to peacefully demilitarize Japan.
Crawford Sams, Chief Public Health Officer of the Allied Powers (led by General MacArthur), was very successful in improving nutritional and sanitary conditions, and in establishing the basis for current universal health insurance coverage. He also realized the importance of medical education reform as the traditionally rigid departmental caste-like system and lack of structured teaching and postgraduate education in medical schools prevented Japan from entering modern interdisciplinary specialties such as anesthesiology.

As of 1950, medical or scientific textbooks, contemporary literature in English and essential anesthetic equipment was scarce or even absent. Japan lacked medical knowledge and technology in anesthesia and the words anesthesiology and anesthesiologist were non-existent. Sams decided to hold a mission, “Institutes on Medical Education for Japan” with the assistance of the Unitarian Service Committee Medical Mission. It was called ”The Japanese-American Joint Conference on Medical Education.”

Meyer Saklad, Director of Anesthesiology at Rhode Island Hospital, represented anesthesiology. He was immensely impressive for an audience that consisted of professors of surgery, as he introduced the scientific basis for anesthesiology and practical knowledge related to general anesthesia. He talked about the use of endotracheal intubation, anesthesia devices, spinal anesthesia, anesthesia for thoracic surgery, as well as the education of anesthesiologists. He presented the use of anesthesia for successful heart and lung surgery, which was considered impossible in Japan at that time. He also participated in inter-disciplinary sessions with a pharmacologist, a physiologist, and a surgeon, which were shockingly eye-opening experiences for the Japanese professors.

The attendee surgeons returned to their medical schools with a strong passion for establishing anesthesia departments. In fact, this conference motivated some 50 doctors to study anesthesiology in the US over the following 10 years. Most of them became founders of anesthesia departments at their respective medical schools. Among them was Professor Hideo Yamamura of the University of Tokyo. He and Professor Michinosuke Amano of Keio University subsequently led the Japanese anesthesia community.

Professor Amano had a unique career, having graduated from the University of Philippines in 1943, and had some anesthesia exposure at an American army hospital in Manila earlier in his career. He returned to Japan, was subsequently selected as a GARIOA fellow in 1950, and studied anesthesiology at the University of Chicago. He returned to Keio University in 1952 and organized multiple training sessions to promote clinical anesthesia. These were open to physicians outside of Keio and motivated many young doctors to specialize in anesthesia.

In 1952, just 2 years after the Unitarian mission, the first academic journal “Masui” which specialized in anesthesia and related topics, was launched by Kokuseido Publishing. Soon after this, the first academic anesthesia department was established in 1952 at the University of Tokyo by Associate professor Hideo Yamamura, who also took on the role of chief physician. This was followed at Tohoku University in 1953 by Professor Kenichi Iwatsuki, at Keio University in 1955 by Associate Professor Michinosuke Amano, at Kyoto University in 1956 by Professor Akira Inamoto, and at Sapporo Medical University by Professor Takeo Takahashi in 1957.

In 1957, St. Luke’s International Hospital in Tokyo established an anesthesia department independent of surgery. It was groundbreaking, as most anesthesia in hospitals at the time was delivered by physicians who belonged to the surgery department. The first local gathering of fulltime anesthesiologists, “The Tokyo Society of Anesthesiologists,” was established in 1958 and the Japanese Ministry of Health officially approved of the specialty of anesthesia in1960.
The Japanese Society of Anesthesiologists (JSA), (formerly the Japan Society of Anesthesiology), was founded in 1954. The first 5 annual meetings were organized by prominent surgeons, but anesthesia professors led the organization after 1959.The JSA established the specialty board system in 1963, which was the first

such system in the Japanese medical community. The first exam produced 44 board certified specialists, but exceeded 7,000 after 65 years. As of early 2019, JSA membership was about 14,000.

The JSA organized the 5th World Congress of Anaesthesiologists in Kyoto in 1972, attracting 67 national societies and 3000 attendees. Crown Prince Akihito and Princess Michiko opened the conference and many prominent clinicians and scientists from overseas dispatched fascinating information on anesthesiology from Kyoto. This conference generated major momentum to spread the word anesthesiology to the medical community and general public in Japan.
The JSA has published the official peer-reviewed Journal of Anesthesia since 1987. The society organizes an annual scientific meeting which attracts well over 10,000 attendees, as well as 6 district scientific meetings.

Anesthesia safety is the main mission of the JSA. It mandates that certified training hospitals must report annually on incidental adverse events during anesthesia. This figure shows constant yearly improvement. The JSA is now collaborating with the Anesthesia Patient Safety Foundation (APSF) and publishes some of their newsletter articles in Japanese as well as contributing articles on the Japanese experience to the APSF newsletter.

The JSA has made contributions to the academic and cultural development of Japan. It is officially recognized as the representative organization in Japan for anesthesia. It belongs to the Japanese Association of Medical Sciences (JAMS), which belongs to the Japan Medical Association (JMA), Japan’s largest professional medical organization. JAMS is the section of the JMA responsible for academic improvement and medical education. The JSA is also recognized as a specialist group of anesthesiologists by the Science Council of Japan, which was itself established in the Prime Minister’s Office under the direct control of the Prime Minister, in order to obtain reports from specialists for the effective social application of science. The JSA is often consulted for specialized knowledge regarding anesthesia and scientific evaluation.

The JSA has special annual awards to honor the best scientific contribution (the Yamamura Award), the best study of anesthesia history (the Matsuki Award), and the most outstanding social contribution (the Social Award) related to anesthesiology. The JSA organizes sessions for the general public at every scientific meeting to promote knowledge of anesthesia. The JSA has also set the date of October 13th as Anesthesia Day to honor Seishu Hanaoka’s great achievement in 1804.

Internationally, the JSA belongs to the Asian/Australasian (Australia and Oceania) region of the World Federation of Societies of Anaesthesiologists (WFSA), and plays a leading role in education and technical improvement of anesthesia in Asia. The JSA accepts anesthesia trainees from abroad, especially from developing countries.

The demands on anesthesiologists are constantly expanding in our rapidly aging society, and include work in the OR, ICU, pain medicine, palliative care, and home care for technology-dependent patients living at home. Anesthesiology must reach out to patients who need anesthetic care outside the OR such as epidural analgesia for labor, and various diagnostic or therapeutic procedures. These services are for the most part not available in Japan at the present time.

The JSA is constantly discussing ways to increase the number of anesthesiologists and how to best utilize the chronically scarce supply of anesthesia manpower. Several ways are being explored to mobilize allied healthcare workers to help and support anesthesiologists. It is, however, especially important to let anesthesiologists direct the system to protect patient safety.

Advances over a wide area of anesthesia technology, including the use of AI and gene control, bring us to a new era of ELSI (Ethical, Legal, and Social Implication) oriented medicine where the opinions of specialists can be easily ignored. Anesthesiology involves very distinctive, constant, ultra-acute decision-making processes which often are not appreciated by the lay public or even other health care professionals. The JSA, as the official professional organization of anesthesiologists in Japan, must ensure that our voices are heard by the general public as well as regulatory and legislative bodies.

The JSA feels it important to promote advanced clinical research and utilization of the advanced industrial technologies of Japan. We are facing multiple everyday clinical questions such as the effect of anesthesia on developing brains, cancer metastasis, organ/tissue protection, and more. The JSA is promoting inter-disciplinary and multi-institutional studies on this front.

Japan enjoys peace and a high standard of medical care which is apparent from its position in having one of the highest life expectancies and the lowest infant mortality in the world. The JSA feels it is important to reciprocate the extensive support we received from the world after World War II. The language barrier is a frequently-overlooked obstacle, and this English-language website is one of our efforts to introduce the JSA to the world.

Yamamura, H: History of anesthesia in Japan. J Clin Anesth 2: 369–72,1990.


Ikeda, S: The Unitarian Service Committee Medical Mission: Contribution by the United States to Post– World War II Japanese Anesthesiology. Anesthesiology 106: 178-185, 2007.


Matsuki, A: The Development of Anesthesiology in Japan. —200— year History—. Shinko-Koheki Medical Publisher, 2019