Irako Mitsuosa (伊良子光順)

Mitsuosa IRAKO (October 7, 1823-September 23, 1881) was a Japanese medical doctor from the end of Edo period to the early Meiji period. He called himself Mugo. He was from present-day Nara City, Nara Prefecture and belonged to Tenyakuryo (the Department of Drugs and Medical Care in Imperial Household Agency), and he served the Emperor Komei and the Emperor Meiji.

Achievements
Backgrounds
He was born in Nara in 1823 as a son of a doctor Yukihiro WASUMI who served a chief priest of Ensho-ji Temple. Later, he moved to Kyoto to learn things and became a disciple of a goteni (doctor who is hired by bakufu [Japanese feudal government headed by a shogun] or daimyo [feudal lord]) Mitsumichi IRAKO.

Mitsumichi was adopted into his wife's family as a son-in-law of a surgeon Mitsuaki IRAKO, and permitted to establish another new school (Sennodo Irako school) separated from Soke (the head family) (Kendosai Irako school) taken over by Mitsuaki's biological child. At the same time, Mitsumichi was a known doctor who was appointed to conduct actual medical examinations of the Emperor Ninko, with the official court rank of Jushiinoge (Junior Fourth Rank, Lower Grade), Assistant Director of the Bureau of Taxation, but he has lost his successor since his biological son Mitsutaka passed away in 1844. Then, a disciple Mitsuosa married Iwao, who was a Kokei's daughter, to become an adopted son of Mitsumichi. Additionally, since Mitsuosa's successor Mitsutsugu was also an adopted son-in-law, the maternal line of inheritance continued in Sennodo Irako school over three generations.

On January 14, 1846, assisted by a doctor from Tenyakuryo, Mitsuosa was given the court rank of Jurokui (Junior Sixth Rank) and the government post of Bizen no suke (Assistant Governor of Bizen Province). In 1849, his foster father Mitsumichi passed away and Mitsuosa became the family head of Sennodo Irako school at the age of 26.

Medical examination of an emperor
At that time, there were 20 doctors in total with or without the post in the government belonging to Tenyakuryo, but in reality, only several of them were allowed to conduct medical examinations of an emperor and Imperial Princes and Princesses while the remaining doctors were engaged in that of court ladies in Empress' residence, regents to Emperor, and members of Imperial families. Mitsuosa was not entitled to conduct that examinations at that time when he succeeded the family, so he examined mainly court nobles and ladies.

In 1851, he was appointed to provide medical treatments for hemorrhoid of the Emperor Komei. The Emperor Komei had suffered from hemorrhoid since around 1849 and other several doctors from Tenyakuryo provided medical care using Chinese herbal drugs, which, however, had no effect and indicated the limitations of internal treatment for his condition. Then, Irako school came to draw the attention suddenly since they had been a family of surgeons that had certain achievements in the medical care for hemorrhoid. Since he received the official appointment, he started keeping a record in a journal of his detailed medical examinations.

On November 21, 1851, he examined the affected part for the first time, while serving the Emperor Komei at his bedside. At this time, because the Emperor's condition had already progressed to prolapsed hemorrhoid, he diagnosed the Emperor with no-cure hemorrhoid unless the prolapsed part would be removed by surgery, however, following an opinion from Kanpaku (chief adviser to the Emperor) Masamichi TAKATSUKASA saying 'it was too august to cut the body of Emperor with knife', he decided to give up surgical operation and to employ supportive measures using medical pad and other things. In fact, it was 136 years later that the first surgical operation on an emperor was performed (an abdominal surgery on Emperor Showa).

Fortunately, his treatments paid off and relieved the Emperor. As a result of this success, he was given the court rank of Jugoi (Junior Fifth Rank)and appointed to be the Mutsu no kami (Governor of Mutsu Province) in 1855 when he was only 32 years old. Since his foster father Mitsumichi was given the same rank at the age of 47, it seemed that the Emperor Komei had much confidence in Mitsuosa. Moreover, in 1857, he received an incentive award especially for the effectiveness of his medical treatment and was given the government post of the Oribe no kami (Governor of Oribe Province) as well as the Mutsu no kami concurrently.

Emperor's illness
On December 11, 1866 (in old lunar calendar), the Emperor Komei, who had a touch of cold, push himself to a Shinto ritual held in the Imperial Court and on the next day, December 12, he developed a fever. Mitsuosa kept taking notes on the Emperor's medical conditions from his onset of fever to death, describing them in a journal in detail.

According to the descriptions from the journal on December 12, 1866 (in old lunar calendar), when the Emperor developed a fever, Tsuneyoshi TAKASHINA, who was in the rank of Emperor's attending doctor (to manage Emperor's daily health), conducted examinations and dispensed drugs for the Emperor but even the next day the Emperor had never got better. On December 14 (in old lunar calendar), one of the top-ranked doctors from Tenyakuryo Zui YAMAMOTO took part in the medical treatment, and on December 15, Mitsuosa was also summoned and thorough clinical examinations night and day started.

On December 16 (in old lunar calendar), four doctors, Zui, Tsuneyoshi, Mitsuosa and Tsuneyoshi's son Tsunenori, all together, reexamined the Emperor and they found out that there was a strong possibility that he had been affected with smallpox. On December 17 (in old lunar calendar), the official announcement regarding the name of the Emperor's disease was made to bukedenso (Imperial official in charge of communication between the shogunate and the court) and others, and after that, 15 qualified doctors for Emperor's examination were divided into three groups and around-the-clock medical treatment started.

The first group
The head: Atsuhira FUJIKI (Jushiinojo [Junior Fourth Rank, Upper Grade], tenyaku no gon no suke [Tenyaku Assistant Director] and Ise no kami [Governor of Ise Province] concurrently)
Emperor's attending doctor: Tsuneyoshi TAKASHINA (Jushiinoge [Junior Fourth Rank, Lower Grade], Tenyaku shojo [Tenyaku Junior Bureau Secretary] and Aki no kami [Governor of Aki Province] concurrently)
Masafumi YAMAMOTO (Jugoinojo [Junior Fifth Rank, Upper Grade], Zusho no kami [Chief of the Bureau of Drawings and Books] and Awa no kami [Governor of Awa Province] concurrently)
Tsuneshi TAKASHINA (Jugoinoge [Junior Fifth Rank, Lower Grade], Tango no kami [Governor of Tango Province])
Tsunenori TAKASHINA (Shorokuinoge [Senior Sixth Rank, Lower Grade], Chikuzen no suke [Assistant Governor of Chikuzen Province])
The second group
The head: Zui YAMAMOTO (Jushiinoge [Junior Fourth Rank, Lower Grade], Tenyaku taijo [Tenyaku Senior Bureau Secretary], Daigaku no suke [Assistant Director of the Bureau of Education] and Yamato no kami [Governor of Yamato Province] concurrently, later his name changed to Kyozui)
Sanenori KAWARA (Jugoinoge, tenyaku sho sakan [Tenyaku Junior Officer] and Iyo no kami [Governor of Iyo Province] concurrently)
Kanemichi NISHIO (Jugoinojo, Tosa no kami [Governor of Tosa Province])
Atsunobu OMACHI (Jugoinoge, Danjo Daisho [Assistant of Board of Censors] and Suo no kami [Governor of Suo Province] concurrently)
Kyo KUNO (Shorokuinoge, Dewa no suke [Assistant Governor of Dewa Province])
The third group
The head: Seiken FUJIKI (Jugoinojo, Omi no kami [Governor of Omi Province])
Mitsuosa IRAKO (Jugoinojo, Oribe no kami [Governor of Oribe Province] and Mutsu no kami [Governor of Mutsu Province] concurrently)
Noboru FUKUI (Jugoinojo, Kazuenosuke [Assistant Director of Bureau of Statistics] and Bungo no kami [Governor of Bungo Province] concurrently, later his name changed to Sadanori)
Arinori MISUMI (Shorokuinoge, Settsu no suke [Assistant Governor of Settsu Province])
Mitsunobu IRAKO (Jurokuinojo [Junior Sixth Rank, Upper Grade], Awa no suke [Assistant Governor of Awa Province], the family head of Kendosai Irako School)
Because generally, a patient with smallpox showed a certain process of medical conditions to heal, doctors from Tenyakuryo had planned the treatments for the Emperor, anticipating roughly how the disease would progress. In fact, up to December 23 which was the 11th day after the onset of symptoms, the condition was improved as they anticipated, which they called it 'gojunsho' (the condition shows the patient is in the process of recovery). However, according to the record of the following day, December 25, the Emperor suffered from sputum, and Atsuhira and Seiken FUJIKI rubbed his body while Mitsuosa plastered him. Regardless of which group one belonged to, doctors attended on him at his bedside night and day, however, he passed away past 11:00 p.m. of the same day.

Several days after the Emperor's demise, the doctors were ordered to take turns to serve his dead body standing by his bedside. In the meantime, on December 30, Mitsuosa noted 'a so-called ofune (coffin) was lighted by the moon' in his examination journal, most contents of which were almost medical-records-like, business-like descriptions. Ofune refers to a coffin and his note provides lyrical depiction on the night deep in winter silence, where the Emperor's coffin was lighted by the moon. Though it was just an only 10-letter short line, it is almost impossible to imagine Mitsuosa's feeling to lose the lord whom he had served for many years.

The doctors from Tenyakuryo including Mitsuosa were thanked for their medical service to the Emperor during the Emperor's life and were permitted to worship the deceased placed in a coffin in Seiryoden (Emperor's residence). Moreover, Mitsuosa was ordered to participate in the funeral in Senyu-ji Temple. Additionally, after the funeral service, the doctors were given a reward as an Imperial gift and Mitsuosa was exclusively given the deceased's watch since he had long been engaged in the medical care of the Emperor's hemorrhoid.

Meiji period
Due to the demise of Emperor Komei, Imperial Prince Mutsuhito (Emperor Meiji) of Crown Prince ascended to the throne, and Mitsuosa still remained as a medical doctor for Emperor. In 1869, he was given the title of Shogoinoge; however, because of the governmental reform of the same year due to the Meiji Restoration, Tenyakuryo was abolished and he came to lose the official ranks of Oribe no kami and Mutsu no kami. Moreover, the following year, he was forced to return the court rank of Shogoi (Senior Fifth Rank).

According to a new system, Emperor's court physicians were divided into three ranks such as Senior, Middle and Junior Tenyaku physicians, and Mitsuosa was appointed as Junior Tenyaku physician. When the capital was moved to Tokyo, he followed the Emperor to go east but in 1871, as he lost the post, he returned to Kyoto.

On September 23, 1881, Mitsuosa passed away in Kyoto, and was buried in Hoto-ji Temple in Kii County, Fukakusa-mura (the present Fushimi Ward, Kyoto City). He died at the age of 59.

Record of court ranks and government posts
*The dates shown are according to the old lunar calendar.

December 17, 1845: Given the title of Kurokuinojo and appointed as Bizen no suke (Assistant Governor of Bizen Province).

January 17, 1852: Given the title of Shorokuinoge

September 23, 1855: Given the title of Jugoinoge and transferred to Mutsu no kami

Date unknown in 1857: Appointed as Oribe no kami (retained his position as Mutsu no kami)

In 1869

February 23: Given the title of Shogoinoge

July 7: All officials and provincial governors abolished by executive officers as well as court ranks and upper and lower grades abolished

September 3: Appointed as Junior Tenyaku Physician

November 19, 1870: Court ranks abolished by the decree of Grand Council of State and reappointed as Shoshichi (Senior Seventh Rank)

August 17, 1871: Dismissed as Junior Tenyaku Physician

January 18, 1872: Court ranks returned

Journal of Medical Examination of Emperor' and a theory on the assassination of Emperor Komei
Refer to the argumentation on the demise of Emperor Komei