outstanding contributions by japanese dermatologists

II I III III I IIII I II

Outstanding contributions by Japanese dermatologists Kimie Fukuyama, M.D., Ph.D., and Toshiaki Yasuda, M.D., Ph.D. San Francisco, CA, and Tokyo, Japan

The International Congress will be held in Tokyo this year. In this article, we have reviewed the progress and contributions of Japanese dermatologists over the last eighty years. (J AM ACAD DERMATOL 6:173-178, 1982.)

There was a period of over 200 years in Japanese history when scholars were forbidden to read European books (Sakoku-period). Toyo Ya- mawaki (1705-1762) was one of the most outstanding anatomists of that time, and his book, Zo-shi (Anatomical Sketch of the Human Body), was published in 1759 (Fig. 1). Only the Dutch settlement of Dejima, on the outskirts of Naga- saki, Kyushu, was allowed then to have any con- tact with the Japanese. It was the door for physicians who sought educational experiences in medicine different from those obtainable from China. Therefore, it must have been a great sur- prise to the Japanese when four battleships sailed into Tokyo Bay in 1853. Commodore M. G. Perry, who represented President Fillmore, requested the Tokugawa-Shogun to engage in trade with the western world. A waka, a Japanese style poem with thirty-one syllables, describes the situ- ation well:

Taihei no nemuri o samasu jokisen Tatta shi*-hai? de yoru mo nemurezu (Perry awakened the Japanese from a peaceful sleep, come in 4 steamships Japanese not able to sleep after 4 cups of tea)

Reprint requests to: Dr. Kimie Fukuyama, University of California School of Medicine, Department of Dermatology, Dermatology Research, 1092, HSE, San Francisco, CA 94143.

*Shi means 4.

thai is a numerical term used not only for counting ships but also for counting cups of tea.

0190-9622/82/020173+06500.60/0 © 1982 Am Acad Dermatol

This period marked the beginning of the mod- ernization of Japan, and indeed an educational rev- olution occurred in Japanese medicine. When the Tokugawa period came to an end by the Meiji Restoration in 1867, many of the projects in progress were continued and strengthened with gov- ernmental support. Physicians were sent to west- em countries, and the educational system in Japan quickly became modified accordingly. Dr. M. Takahashi translated an American surgery text- book into Japanese, and this was published in 1874. Although some historical evidence suggests that dermatology was taught by Dr. Takahashi in Osaka, the first formal course in dermatology was presented as part of the surgery curriculum at the school which later became the University of To- kyo. Between 1890 and 1892, Dr. K. Murata, who studied dermatology in Germany, also taught courses in dermatology and syphilology in Tokyo, but this was an exception.

Establishment of a dermatology department at medical schools in Tokyo became an issue in 1894, and Dr. Dohi (Fig. 2) in Heidelberg, Ger- many, was requested to go to Professor Kaposi's department at the University of Vienna to study dermatology. He then moved to Professor Neis- ser's department in Breslau, and, after spending an additional 5 months in Paris mastering urology, he returned to Tokyo in 1898. A new era in Japanese dermatology had commenced. In 1901, the Japanese Dermatology Association was organized and published its official journal, making

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174 Fukuyama and Yasuda Journal of the

American Academy of Dermatology

Fig. 1. A figure from Zo-shi.

1901 the most memorable year in dermatologlc history in Japan.

The past eighty years have been a time of strug- gle and challenge for Japanese dermatologists and scientists, We have "come a long w a y , " and it is a privilege for us to reflect on our contributions in the dermatologic field. In this article, we will dis- cuss the Japanese contributions from the stand- point of: (1) education and academic activities in Japan, (2) participation of the Japanese in Ameri- can and European dermatology, and (3) cooperative efforts between Japanese dermatologists and dermatologists of other countries. We realize that a very large number of scientists have contributed to these exciting events and regret that we are unable to acknowledge all of their names in the space allotted to us.

Fig. 2. Dr. Keizo Dohi,

CONTRIBUTIONS IN JAPAN

Dr. Dohi and others brought back an increased knowledge of dermatology and syphilology to Japan which was integrated with Japanese tradi- tion and culture. Japanese names were given to the diseases observed in Europe in order to classify them more systematically, and efforts were made to find out whether the same or different diseases existed among the Japanese population. In particu- lar, advances in mycology were made by students of Dr. Dohi. Dr. M. Ohta, one of Dr. Dohi's students, studied under Dr. Maurice in Langeron, France, and later established the Japan Mycology Association. Dr. Dohi's encouragement for inves- tigating the possibility of unique entities occurring in the Japanese resulted in the description of many clinical syndromes. In Table I, we list examples of dermatologic conditions first claimed to be reported by Japanese, although some of them may not be separate entities as initially believed. Dr. Ohta and his student, Dr. H. Tanino, described nevus fuscoceruleus ophthalmomaxillaris (Jpn J

Volume 6 Number 2 February, 1982

Japanese dermatologists 175

Dermatol-Urol 40:107, 1939), and Dr. Ito reported on nevus fuscoceruleus acromiodeltoideus (Tohoku J Exp Med 60:10, 1954). Dr. K. Kita- mura and co-workers reported on acropigmentatio reticularis (Hautarzt 4:152, 1953). Another group of diseases are keratinization abnormalities. Japa- nese dermatologists plan to exhibit patients with these diseases for participants of the X VI Interna- tional Congress of Dermatology.

At present, dermatology is taught in all medical schools in Japan, and many graduates select this field for their specialty. Local and regional meetings are held in order for dermatologists to com- municate with each other. Once a year, in the spring, a national meeting is organized and three (East, Middle, and West) regional meetings are held in the fall. Findings are presented and discussed at these meetings. In 1956, the Dohi Memorial International Exchange Lectureship of Dermatology of Japan was established by the Jap- anese Dermatological Association. Distinguished scientists have been selected as speakers. In recent years, an ever-increasing number of visiting dermatologists from foreign countries have come to Japan. All of them have brought excellent ideas and have been witness to the growth and development of Japanese dermatology in both clinical and investigative fields. In Japan, dermatology is no longer culturally and educationally isolated; it will continue to progress while maintaining its own unique- ness, as written by the Meiji Emperor:

Yokiotori ashikio sutete totsukunini otoranu kunito nasu yoshimogana (By absorbing the good and leaving the un- wanted, we wish to make progress to the levels of other countries.)

In 1982, we expect to have the most broad rep- resentation of foreign dermatologists ever to visit Japan. We believe that holding the Congress in Japan will add another dimension to our ability to contribute to international dermatology.

CONTRIBUTIONS ABROAD

The number of Japanese dermatologists who have been abroad has increased steadily. While comparative data among different nations have not been obtained, it seems that the United States,

Table I. Dermatologic conditions first claimed to be reported by Japanese

Erythema annulare angioneuroticum Dohi Keratosis foilicularis squamosa Dohi Phlebitis tuberculosa nodosa Dohi-Hashimoto Acropigmentatio symmetrica Dohi-Komaya Keratodermia tylodes palmaris progressiva Dohi-Mi-

yake Nevus fuscoceruleus ophthalmomaxillaris Ota Phacomatosis pigmento-vascularis Ota Nevus fuscoceruleus acromiodelto[deus Ito Incontinentia pigmenti achromians Ito Dyschromatosis symmetriea hereditaria Toyama Dyschromatosis universalis hereditaria Toyama-lchi-

kawa-Hiraga Pityriasis circinata Toyama Pityriasis rotunda Matsuura Acropigmentatio reticularis Kitamura Erythromelanosis follicularis faciei Kitamura Photoleucomelanodermia Kobori Eosinophilic pustular folliculitis Ofuji Lypodystrophia centrifugalis abdominalis infantilis

Imamura Eosinophilic lymphoid granuloma (Kimura's disease) Aurantiasis cutis Baelz

United Kingdom, and Germany have been the most popular locations. However, Japanese dermatologists have also gone to France, Italy, Den- mark, and other countries. Wherever they have traveled, the purpose of their stay abroad has changed gradually from a total learning experience (as during Dr. Dohi's period) to a more collabora- tive relationship between the host scientists and the Japanese dermatologists. This change is not sur- prising. Due to the increased knowledge and im- proved technology of dermatologic education in Japan, scientists have better preparation now in order to participate in the activities of foreign institutions.

The Journal of Dermatology (Tokyo) which is the official publication of the Japanese Der- matological Association, publishes in English the contributions of many Japanese dermatologists and has a wide distribution. In addition, large numbers of scientific papers written by Japanese dermatologists can now be found in a variety of refereed journals published in the United States and other countries. We have calculated the percent of papers that were written by Japanese der-



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Fig, 3. Percent of papers written in Japanese and published during 1970-1980 in Ac ta Dermato -Venereo -

logica (Stockholm) (o . . . . o), Journal of Investigative Dermatology (X X), Archives of Dermatology (r:~---~), and British Journal of Dermatology ( • . . . . e).

matologists which appeared in four representa- tive dermatologic journals. These calculations excluded papers of Japanese dermatologists who have a permanent position abroad. Fig. 3 depicts the percent of total papers published in each journal, comparatively. In 1970, all the journals con- tained a very limited number of Japanese papers. There were, however, more papers in the Journal of Investigative Dermatology and Acta Dermato- Venereologica (Stockholm) than in Archives of Dermatology and the British Journal of Dermatol- ogy. Interestingly, we noted that Japanese dermatologists having a more or less permanent ap- pointment in the United States and Denmark also had papers published in the Journal of Investiga- tive Dermatology and Acta Dermato-Venereo- logica (Stockholm) but not in Archives of Derma- tology or the British Journal o f Dermatology for the same year and approximately the same period. In the following years, an increase in the number of papers accepted in the Journal of Investigative Dermatology and Acta Dermato-Venereologica (Stockhohn) reflected an increase in percent of published papers. The percent showed some rise

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70 72 74 76 78 80

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Fig. 4. Percent of papers published in Journal oflnves- tigative Dermatology during 1970-1980. Total papers written by Japanese (X X) and the papers reporting the studies from Japanese institutions (e . . . . e).

in papers published in Archives of Dermatology during 1974 to 1978, and then fell to the lowest percent in 1980. All papers published in the Brit- ish Journal of Dermatology and in Acta Der- mato-Venereologiea (Stockhohn) in 1980 were written by Japanese investigators presently affili- ated with Japanese institutions. We also noted a sudden increase in the percentage in the British Journal of Dermatology and a decrease of almost the same degree in Acta Dermato-Venereologica (Stockholm). It is highly speculative, but the shift during 1978 to 1980 might represent a shift in foreign publication preferences of Japanese dermatologists during that time. Nevertheless, the overall percent of increase seen in these journals is remarkable and emphasizes that findings from academic studies in Japan are being well intro- duced into other countries.

We have further analyzed the percent of papers written by Japanese authors working in Japanese institutions and published in the Journal ofhn, es- tigative Dermatology (Fig. 4). In 1970, a total of about 4% of the papers were written by Japanese authors, but only one paper (0.7%) was submitted from a Japanese institution and the rest reported investigative finding obtained in laboratories out- side of Japan. The papers from Japanese institutions increased after 1972, and by 1980 about 5.5% of the papers in the Journal of Investigative

Volume 6 Number 2 February, 1982

Japanese dermatologists 177

Dermatology were from Japan. The percent of papers written by Japanese abroad is also about 5.5%. Thus, a total of 1I% of the papers published in the Journal of h~ vestigative Dermatology 1980 were written by Japanese. From the authors' names, we surmised that many of the dermatologists in foreign laboratories from 1970 to 1976 account for the increased number of publications submitted fi'om Japanese institutions in 1978 to 1980.

Scientific quality of these publications is diffi- cult to monitor, and we have not attempted to search for citation indices for these papers. How- ever, we are certain that a large number of these findings have contributed to progress made in the field of dermatology. We believe that much of the work that Japanese dermatologists have done will be remembered as part of the total progress of dermatology.

CONTRIBUTIONS IN INTERNATIONAL COOPERATION

It is clear that no nation can afford to remain isolated from the scientific developments of the rest of the world. International cooperation in science is essential for advances in knowledge and technology. Japanese dermatologists have participated in many cooperative programs with dermatologists from both Asia and the western countries in a variety of forms. Some are small discussion groups, and others are more organized international sym- posia and conferences. They are sponsored by in- dividuals, societies, and government agencies. In- ternational program activities also include bilateral cooperation between Japan and other countries. The Japan Society for the Promotion of Science has supported a symposium on the biology of normal and abnormal melanocytes and seminars on the biochemistry of cutaneous epidermal dif- ferentiation. The Japan Medical Research Founda- tion has been holding an annual international symposium, and sarcoidosis has been one of the topics selected. The Ministry of Education and the Min- istry of Health and Welfare subsidize and promote research activities of Japanese scientists in order that they may participate in international programs. The National Science Foundation of the

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Fig. 5. Chinese poem written by Dr. Dohi in Kanji.

United States recognized the importance of such exchanges, and a bilateral cooperation program in science between Japan and the United States began in 1966, preceding programs with other countries.

Cooperative programs foster sharing of experiences with others. They open the opportunity for many future events to take place with Japanese dermatologists as partners. In reality, true cooperative arrangements have become possible only after World War II, but the idea was conceived in the mind of a Japanese dermatologist, Dr. Dohi. Fig. 5 is a poem written by Dr. Dohi. It is written



Fig. 6. This poem written in Hiragana. The writing was kindly done for this manuscript by Mrs. Ryo Saito in San Francisco.

in Chinese and in Kan-ji (one of the three types of Japanese characters used). It can be translated as follows:

The origins of the culture between the east and the west are very different,

It is my hope that both cultures can be combined,

If someone can achieve this union, The people of the world and I will thank them

for many hundreds of years.

CONCLUSION

The International Congress of Dermatology will be held in Tokyo in May, 1982. It is just one of the

many steps that Japanese have taken to contribute to world dermatology in the future. However, we realize that languages and traditions are different among all the countries and nations involved. The differences must be kept, cherished, and valued, but we must work out some common standards. Many approaches must be discussed and tested. For example, it is important to translate clinical and laboratory observations alone without discussion comparatively into other languages because some of the implications behind the facts, and particularly the way of thinking, often prove diffi- cult to express adequately in foreign languages. Japanese will continue to be a part of development in dermatology because we share common ground, namely, our specialty "Dermatology." To end, we would like to introduce a beautiful poem written in Hiragana, one of three Japanese writing forms, which may be the backbone of all Japanese culture (Fig. 6).

Naseba naru, nasaneba naranu nanigotomo, naranu wa hito no nasanu narikeri (Anything may be done if you try, nothing is done if you don't do it. If it is not done, perhaps, you have not tried.)

We thank Mrs. Atsumi Minami for providing valuable literature resources from the University of California, San Francisco library; Deborah Carlson and Elizabeth Samit for their special editorial assistance; and Dr. William L. Epstein for his special consultant work.

outstanding contributions by japanese dermatologists

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