Swollen lower leg, 19th-century Japan. Illustration of a large venous swelling of the lower leg, from 'A Surgical Casebook', a 19th-century manuscript of hand-painted pictures commissioned by Japanese surgeon Hanaoka Seishu (1760-1835). Diagnosed at the time as a bone tumour, this could be a disorder of the veins or lymphatic system, such as elephantiasis. Hanaoka pioneered the use of general anaesthesia to remove tumours from cancer patients. His book illustrated the cancers and other conditions that he treated, and the patients that came to him for treatment. The illustrations were by an artist named Tangetsu.