Painting of Hanaoka Seishu removing a tumor from the chest of a fully anesthetized male patient. An assistant applies traction to the tumor which is draining into a bowl beside the patient, while Hanaoka applies counter tension with his left hand. He uses his right hand to direct the blade of the scalpel to excise and extract the tumor. This picture seems designed to portray both the comfort of the patient under anesthesia and the supreme confidence of the surgeon. "A Surgical Casebook" is a manuscript of hand-painted pictures commissioned by Hanaoka Seishu. The colorful, often charming, pictures in this casebook capture the likenesses of the men and women who came to Hanaoka for treatment, and they depict graphically the medical and surgical problem to be treated. Hanaoka Seishu (October 23, 1760 - November 21, 1835) was a Japanese surgeon with a knowledge of Chinese herbal medicine, as well as Western surgical techniques. He was the first surgeon in the world who used the general anesthesia in surgery and who dared to operate on cancers of the breast and oropharynx, to remove necrotic bone, and to perform amputations of the extremities in Japan. He died in 1835 at the age of 75.