Hayari Miyake - A surgeon who built the bridge between Japan and Germany

At the end of nineteenth century several Japanese surgeons studied in Germany and opened a friendly communication between Germany and Japan. Professor Hayari Miyake was one of them (Fig. [1]). This report is on his life.

Fig. 1 The portrait of Professor Hayari Miyake (by courtesy of Professor and Mrs. Y. Hiki)

He was born in 1867 in Tokushima prefecture in Japan, which is located on the island of Shikoku. This area is not far from Naruto, where the second Joint Meeting of the Japan and German Neurosurgical Societies was held four years ago. At the age of twelve he went to Tokyo and in 1881 at the age of fourteen he entered the German Language School in Tokyo. In 1887 he commenced medicine at the Tokyo Imperial University School. The Professor of Surgery was J. Scriba and that of Internal Medicine E. Bälz; both of them came from Germany. The lectures by Professors Scriba and Bälz were all written in German on Hayari's notebooks. After graduation from the Tokyo Imperial University in 1891 he became assistant to Professor Scriba. 1n 1893 he reported a surgical case of depressed skull fracture operated on by Professor Scriba. This was the first report of a successful craniotomy in Japan (the paper is in Japanese).

In 1889 he went up to Breslau, Germany, to study surgery of the highest level. His teacher was Professor J. von Mikulicz (Fig. [2]). The Figure [3] shows the surgical tree in Germany drawn by Emeritus Professor Y. Hiki, Department of Surgery, Kitasato University, Japan. This tree shows the pedigree of the surgeons in Germany. The root is Professor Langenbeck, Berlin, and the lower stem is Professor Billroth, Wien. Three large branches extend from Professor Billroth: Professor Mikulicz, Breslau, Professor Eiselberg, Wien and Professor Gussenbauer, Wien. From Professor Mikulicz's branch three further branches come out, namely Professor Sauerbruch, Berlin, Professor Anschütz, Kiel and Professor Hayari Miyake (written in Japanese). From the branch of Professor Anschütz a further Japanese branch extends. This is Professor Hiroshi Miyake (written in Japanese). However, this branch has an anastomosis with the branch of Hayari Miyake, because Hiroshi Miyake was the son of Hayari Miyake. Prof. K. Kitamura, my teacher, and myself studied under Professor Hiroshi Miyake at the first Department of Surgery of Kyushu University before the Department of Neurosurgery was established. Therefore, Prof. Kitamura and myself also belonged to this Japanese branch.

Fig. 2 The portrait of Professor L. von Mikulicz (by courtesy of Professor and Mrs. Y. Hiki)

Fig. 3 The surgical tree of the surgeons in Germany drawn by Professor Y. Hiki

Hayari Miyake remained for two years, from 1898 to 1900 in Breslau and again for a further year and eight months from 1903. During his stay in Breslau he studied surgery, particularly gastric surgery together with Professor Sauerbruch. Later Professor Sauerbruch sent his portrait with a short message to Miyake (Fig. [4]). Miyake must have observed some neurosurgical procedures in Breslau because it is known that Professor Mikulicz and Professor Sauerbruch contributed to neurosurgery. In 1899 Miyake bought a book “Geschwülste des Gehirns” written by Oppenheim in 1896. This book bears his signature “Berlin, den 14/9,1899 Dr. H. Miyake.” This is the first book in the world describing brain tumors. In this book there are notations made by Miyake. This book has been handed down to his son Professor Hiroshi Miyake, then to Prof. Kitamura and later on to myself. Miyake returned to Japan with a sound knowledge of surgery and neurosurgery. On returning to Japan Professor Mikulicz wrote a certificate for Hayari Miyake's outlining his distinguished activities in Breslau and recommending him as a future leader of surgery in Japan.

Fig. 4 The portrait of Professor Sauerbruch with a short message to Professor Hayari Miyake (by courtesy of Professor and Mrs. Y. Hiki)

In 1904, Professor Hayari Miyake was elected as the chairman of the Surgery of Kyoto Imperial University Fukuoka Medical School. This is now the Graduate School of Medicine, Kyushu University. In 1905 he succeeded in removing a glioma in the motor area of the brain and reported this in Langenbeck's Archiv für Klinische Chirurgie in 1909 [[1]]. This is the first successfully reported removal of an intracranial tumour in Japan, and is noted in the book “History of Neurosurgery” written by Dr. Earl Walker. The patient was a 27 year old male who had a Jacksonian seizure. On his discharge he had mild weakness and hypaesthesia of the right lower limb but was able to walk.

[Table 1] shows the neurosurgical achievements of Professor Hayari Miyake. In 1906 he repaired a depressed fracture of the left temporal region causing crossed aphasia, which means motor aphasia in a left handed patient. After the surgery was performed the patient, a four year old boy, regained his speech [[2]]. In 1907 he removed a cerebral gumma (the paper is in Japanese), and in 1911, successfully for the first time he removed a spinal neurinoma at C5-6 (the paper is in Japanese). At that time there were no modern diagnostic techniques or instruments. Diagnosis was made solely by the neurological symptoms and signs. The detailed neurological observations before and after surgery were clearly described by Professor Hayari Miyake.

Table 1 Neurosurgical achievements by Professor Hayari Miyake 1905 removal of cerebral glioma 1906 repair of depressed fracture causing aphasia 1907 removal of cerebral gumma 1911 removal of spinal neurinoma at C5-6

In the autumn of 1922 Professor Hayari Miyake was on a ship from Europe to Japan. It was his third visit to Europe inspecting the European countries as ordered by the Japanese Government. On the same ship was Professor Albert Einstein, who had just been given the Nobel prize for his work. Miyake did not know Einstein then. When the ship was in the Indian Sea, Einstein commenced hemorrhaging on defecation, and had a fever. His symptoms persisted, and Einstein became alarmed and depressed thinking he had a rectal cancer. Einstein's wife, Elsa, visited Miyake and asked to visit Einstein. Miyake saw Einstein and said this is not to be a rectal cancer, but some kind of tropical fever. Miyake gave him treatment for the infectious disease and Einstein soon recovered. Thereafter Einstein had absolute trust in Miyake (Fig. [5]). After arriving in Japan Einstein and his wife visited Miyake's house in Fukuoka City.

Fig. 5 With Professor Einstein on a ship from Europe to Japan (by courtesy of Professor and Mrs. Y. Hiki)

In 1926 Professor Miyake attended the 7th International Surgical Meeting in Rome as the representative of the Japanese Surgical Society. This was the first time the Japanese Surgical Society was included in the International Surgical Association. After this meeting Miyake visited Einstein's house in Berlin. Miyake enjoyed the reunion with Einstein and his wife. However, this was the last occasion that they saw each other. Three years after Miyake's visit, Einstein and his wife had to move to the United States, because the rise of German Nazism. Einstein was Jewish.

Though Professor Hayari Miyake left several distinguished achievements in neurosurgery, his main achievements were in abdominal surgery for stomach cancer and cholelithiasis. He retired as the Chairman of Surgery Kyushu University in 1927.

I must also introduce Professor Hiroshi Miyake, the son of Professor Hayari Miyake. He had the opportunity to study in Kiel under Professor Anschütz from 1934, for two years. In 1947 he became the Chairman of the first Department of Surgery, Kyushu University. His main achievement was in Cholelithiasis. Later on he was elected as an honorary member of the Surgical Society of the Northern Germany.

After retirement Professor Hayari Miyake and his wife remained in Okayama City, where his son, Hiroshi, was the Chairman of the Surgical Department of Okayama University. On June 27th, 1945 an air raid by the American Air Force killed Professor Hayari Miyake and his wife Miho. Upon learning of Professor Hayari Miyake's death, Professor Einstein in the United States sent a letter of condolence. His epitaph was inscribed on the tombstone at Hayari's birth place (Fig. [6]). “Hier ruhen Dr. Hayari Myake und dessen Frau Miho. Sie wirkten vereint für das Wohl der Menschen und schieden vereint als Opfer von deren Verirrungen. Albert Einstein.”

Fig. 6 The tombstone of Professor Hayari Miyake with the epitaph sent by Professor Einstein and the epitaph in print

Figure [7] shows the death mask of Professor Mikulicz, who died in 1905 at the age of 55 years. One death mask was sent to Professor Hayari Miyake, probably because he was one of the most talented and beloved pupils of Professor Mikulicz. A copy of the death mask remains in the Chairman's room in the Department of Neurosurgery in Kyushu University.

Fig. 7 The death mask of Professor J. von Mikulicz

Professor Hayari Miyake opened a scientific and friendly communication between the surgeons of Germany and Japan. It is with honour and pleasure that we continue to maintain the link to the present time.

Acknowledgement: I would like to wholeheartedly thank the following three people for providing the data and photographs of Professor Hayari Miyake. Mrs. Sumiko Hiki, a grand-daughter of Professor Hayari Miyake, Professor emeritus Yoshiki Hiki, Department of Surgery, Kitasato University and the husband of Mrs.Sumiko Hiki, and Professor emeritus Katsutoshi Kitamura, Department of Neurosurgery, Kyushu University. Also I would like to thank Dr. A. P. Poulgrain, Southport, Australia for correction of English.

References

• 1 Miyake H. Zur Exstirpation der Gehirntumoren in den motorischen Rindencentren.  Langenbeck's Archiv für Klinische Chirurgie. 1909;  88 811-833
• 2 Miyake H. Ein Fall von traumatischer Aphasie mit rechtsseitiger Hemiplegie bei Linkshändigen. Trepanation. Heilung.  Langenbeck's Archiv für Klinische Chirurgie. 1909;  88 800-810