Woman identified as the wife of Chubei, a retail merchant in Edo, with an external tumor on her back. "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 successfully operated for hydrocele, anal fistula, and even performed certain kinds of plastic surgery. 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 also devised and modified surgical instruments, and trained and educated many students, using his own philosophy for medical management. He died in 1835 at the age of 75.