Breast cancer surgery, 19th-century Japan. Illustration of the main lumpectomy stage (scalpel in surgeon's right hand) of a breast cancer operation carried out on 13 October 1804 by Japanese surgeon Hanaoka Seishu (1760-1835). Hanaoka pioneered the use of general anaesthesia in cancer surgery. He used mafutsusan to anaesthetize this patient (60-year-old Kan Aiya), in what is recognised as the world's first surgical procedure under general anaesthesia. Illustration by Tangetsu from 'A Surgical Casebook', a manuscript commissioned by Hanaoka. This illustration is part of a sequence showing the breast cancer surgery and tumour.