Kensuke Mitsuda
Encyclopedia
was a Japanese leprologist and director of the Tama Zenshoen Sanatorium
(1914–1931) and the National Sanatorum Nagashima Aiseien(1931–1957). He had been at the frontier of leprosy
policy of Japan. He was given the Order of Cultural Merits (1951) and Damien-Dutton Award(1961). He has been the target of admiration from one corner, and also the target of criticism from another.
National Hansen's Disease Museum (Japan)
The ' is a museum in Higashimurayama, Tokyo, Japan that is dedicated to education about Hansen's disease and to eliminate discriminatory practices against its sufferers...
(1914–1931) and the National Sanatorum Nagashima Aiseien(1931–1957). He had been at the frontier of leprosy
Leprosy
Leprosy or Hansen's disease is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions...
policy of Japan. He was given the Order of Cultural Merits (1951) and Damien-Dutton Award(1961). He has been the target of admiration from one corner, and also the target of criticism from another.
Early life
- He was born in Yamaguchi PrefectureYamaguchi Prefectureis a prefecture of Japan in the Chūgoku region on Honshū island. The capital is the city of Yamaguchi, in the center of the prefecture. The largest city, however, is Shimonoseki.- History :...
in 1876 and studied medicine at a private doctor's office in YamaguchiYamaguchi, Yamaguchiis the capital city of Yamaguchi Prefecture, Japan.As of February 1, 2010, the city has an estimated population of 198,971 and a population density of 194.44 persons per km²...
city. He went up to Tokyo in 1894 and studied medicine at a doctor's office and passed the First Stage Doctors' Practice Examination in 1895. Later he studied at a Private schoolPrivate schoolPrivate schools, also known as independent schools or nonstate schools, are not administered by local, state or national governments; thus, they retain the right to select their students and are funded in whole or in part by charging their students' tuition, rather than relying on mandatory...
Saisei Gakusha. He passed the final qualification examination in 1896. He then studied pathologyPathologyPathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
at the University of TokyoUniversity of Tokyo, abbreviated as , is a major research university located in Tokyo, Japan. The University has 10 faculties with a total of around 30,000 students, 2,100 of whom are foreign. Its five campuses are in Hongō, Komaba, Kashiwa, Shirokane and Nakano. It is considered to be the most prestigious university...
for two years. In 1897, he worked at the Tokyo Metropolitan Yoikuen Hospital where he met leprosy patients. In 1899, he isolated leprosy patients within the hospital and created a ward "Kaishun Ward" , named after Kaishun Hospital of KumamotoKumamoto, Kumamotois the capital city of Kumamoto Prefecture on the island of Kyushu, Japan. Greater Kumamoto has a population of 1,460,000, as of the 2000 census...
. This was the first case of leprosy care in Japanese public hospitalPublic hospitalA public hospital or government hospital is a hospital which is owned by a government and receives government funding. This type of hospital provides medical care free of charge, the cost of which is covered by the funding the hospital receives....
s. Later he lectured many times on the need of public leprosy policy.
Tama Zenshoen Hospital
- In 1909, he became the chief doctor at the newly established Tama Zenshoen Hospital and then in 1914 he became the director of the Hospital. He made a world trip to study leprosy abroad.
National Sanatorium Nagashima Aiseien
- Following the examples of HawaiiHawaiiHawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...
and the PhilippinesPhilippinesThe Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
, remote islands were considered as possible sites of sanatoriumSanatoriumA sanatorium is a medical facility for long-term illness, most typically associated with treatment of tuberculosis before antibiotics...
s, and a national sanatorium was established in the Inland Sea of Okayama PrefectureOkayama Prefectureis a prefecture of Japan located in the Chūgoku region on Honshū island. The capital is the city of Okayama.- History :During the Meiji Restoration, the area of Okayama Prefecture was known as Bitchū Province, Bizen Province and Mimasaka Province.- Geography :...
, and he became the first director in 1931.
Criticisms
- He started vasectomyVasectomyVasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
in order to cope with the children born of patients. Originally, it was due to difficulties to bring up the children within the hospital, and later, the worsening of leprosy in pregnancy. The Interior Ministry was consulted, but did not give any response. Later he was bitterly criticized. - Kensuke Mitsuda was also known as the strict segregationalist and in 1951 he testified at the Japanese Upper House that all Hansen's disease patients be hospitalized. Although the value of Promin was being established later, he did not change his principle and contributed to the 1953 leprosy prevention law, which retained the principle of segregation.
- His testimony on November 8, 1951. "The statistics of the Ministry of Welfare say that 2000 patients are not in the sanatoriums, but there may be more patients. The patients out of the sanatoriums should be hospitalized, and many patients refuse our requests. Familial infection continues if forced hospitalization is not introduced. Handcuffs may be necessary, but intellectuals do not enter sanatoriums with excuses. The law should be powerful." On October 2, 1952. "On on the testimony last year, I did not have enough time for preparation. There was no time. The people I want to hospitalize with power are exceptionally violent patients. I am afraid of familial infection. "
Pathology
- As a leprologist, he was essentially a pathologist. He first discovered the coexistence of tuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
and leprosy in a lymph nodeLymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
. The number of autopsies he conducted is the largest in the world, when the cases performed later were added.
Immunology
- Although he did not regard himself an immunologistImmunologyImmunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...
, his discovery of the leprominLeprominThe lepromin skin test is used to determine what type of leprosy a person has. It involves the injection of a standardized extract of the inactivated "leprosy bacillus", under the skin...
test is his most important achievement. It proved very useful in the classification of leprosy. However, the original idea was to distinguish leprosy patients and persons with normal blood, and he invented a skin test using the killed bacilliBacillusBacillus is a genus of Gram-positive, rod-shaped bacteria and a member of the division Firmicutes. Bacillus species can be obligate aerobes or facultative anaerobes, and test positive for the enzyme catalase. Ubiquitous in nature, Bacillus includes both free-living and pathogenic species...
, the original Mitsuda reaction. He reported it at the 3rd International Leprosy Congress in 1923 but received little attention. Mitsuda stored the necessary materials in a refrigerator and tried to persuade many doctors who came under him to study them, and finally found Fumio Hayashi. The Mitsuda Test was at last completed by Fumio Hayashi.
Importance of the Mitsuda (lepromin) Reaction
- The importance of the Mitsuda (lepromin) reaction may be confirmed by the fact that it is the axis of the Ridley-Jopling classification of leprosy. Four papers related to the Mitsuda reaction in the Year Book of Dermatology follow.
- Histologic study of the Mitsuda reaction in patients with lepromatous leprosy and its prognostic value in bacteriologically negative cases. Oscar Reyes. Med cutanea 3:1139,1968.
- Comparison in leprosy patients of Fernandez and Mitsuda reactions using human and armadillo antigens: double-blind study. Millar JW, Gannon C, Chan CSP. Int J Lepr 43:226-233, 1975.
- The Mitsuda lepromin reaction in long-term treated lepromatous leprosy. Waters MFR, Ridley DS, Lucas SB. Lepr Rev 61,347-352,1990.
- Lepromin skin testing in the classification of Hansen's disease in the United States. Krotoski WA, et al. Am J Med Scie 305:18-24,1993.
Representative Papers of Mitsuda
-
- His name Mitsuda K is omitted
- On the lymphadenitis leprosa, Tokyo Igakkai Zasshi, 13, 1899
- Pathological changes in the peripheral nerves and blood vessels, Tokyo Igakkai Zasshi 14,15,1900
- On the lymphnode affected with leprosy and tuberculosis, Tokyo Igakkai Zasshi 15,9,1901
- On the leprosy of internal organs, Nihon Rengo Igakkaishi 1902
- Pathological changes in the blood vessels and their significance, Nihon Igaku 15,1906
- Pathological changes in the central nervous system in leprosy, Shinkeigaku Zasshi, 6,6 and 7, 1906
- On the serum reactions in leprosy, Jpn J Dermatol Urol 11,7,1910
- On the therapeutic value of Gynocardia ( Chaulmoogra) oil in leprosy, Jpn J Dermatol Urol 12,12,1912
- On the value of skin reaction with emulsion of leproma, Jpn J Dermatol Urol 19,8,1919 (The first paper leading to the Mitsuda reaction)
- On the relation between tattoo and Mycobacterium leprae, Jpn J Dermatol Urol 27,8,1927
- Coexistence of leprosy and scabies, Nihon Kohshuuhokenkyoukai Zasshi, 10,11,1934
- On the Langhans giant cell in leprosy and the stellate body in nodular leprosy, Int J Lepr 3,3,1935
- A study of 150 autopsies on cases of leprosy, Int J Lepr 5,1,1937
- On alopecia leprosa, Int J Lepr 5,3,1937
- On the classification of leprosy, Repura 15,2,1943
- Treatment of leprosy with cepharanthin, Nihon Igaku 3389,1944
- The southernmore, the milder leprosy becomes, Repura 15,3,1944
- Pathological studies of leprosy treated with Promin, Repura 20,5,1951
- Atlas of leprosy (book), 1952