Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
The Japanese movie maker Akira Kurosawa is considered by many to have been one of the world’s greatest film directors. His friend and colleague Steven Spielberg described him as ‘the visual Shakespeare of our time’. Kurosawa is probably best known for his movies of samurai life, including Rashomon, Yojimbo and the most famous of all, Seven Samurai. These had a great influence in Hollywood, and many westerns imitated them. Some of his films were themselves adaptations of Shakespeare: Throne of Blood was a version of Macbeth, and Ran was based on King Lear. His 30 movies ranged over many genres, including love stories and psychological dramas.
One of his finest movies is a portrait of two doctors and a tribute to compassionate medicine. Its title is Red Beard, after the nickname of one of the doctors.1 The plot comes mainly from a set of tales by the Japanese writer Shugoro Yamamoto, although the final section brings in a story taken from the great Russian novelist Dostoyevsky about an underage girl who is rescued from enforced work in a brothel. Kurosawa made three films about compassionate medical care. He suffered from significant medical problems for much of his life, including alcoholism and depression,2 so the film may be his mark of respect to the profession.
Red Beard is set in a poor district of Edo (now Tokyo) in the first half of the nineteenth century. Dr Kyojo Niide is a red-bearded physician who runs a clinic and cottage hospital for poor and indigent patients. He is rather gruff and uncompromising, but his patients adore him. The start of the movie shows the arrival of a newly qualified doctor, Noboru Yasumoto, who has been sent there in order to escape embarrassment after his fiancée ran off with another man. He is proud, ambitious and in line to become a physician to the Shogun or ‘de facto’ ruler of Japan. When he arrives, he is well dressed and refuses to put on plain clinical garments. He shows contempt for Dr Niide and disgust with the patients and their relatives (see figure 1). Dr Yasumoto is played by the young heartthrob Yuzo Kamaya, and Dr Niide by Toshiro Mifune, the greatest Japanese film actor of his age, so their interaction on the screen is doubly charged.
EVERY ASPECT OF MEDICINE
Kurosawa’s plot takes viewers through five interwoven episodes related to patients of the clinic. They cover just about every aspect of medicine you could imagine: madness, death and dying, operative surgery, infectious diseases, the effects of natural disasters like earthquakes, but above all the consequences of poverty and social injustice. Kurosawa even manages to incorporate a scene of martial arts, when ‘Dr Redbeard’ fights off assailants who are trying to prevent him rescuing the young girl Otoyo from the brothel. In doing so, the doctor applies his knowledge of anatomy to break a few bones, but then self-effacingly apologises for his use of violence.
The last episode of the film is the most moving. We see how Dr Yasumoto has evolved from a narcissist into a selfless individual who has absorbed the values that motivate the clinic director. He takes over the care of Otoyo and nurtures her so she can recover from the psychological damage and fever she acquired in the brothel. Ironically, he then catches the fever himself and she nurses him back to health. In the process, we also observe Otoyo grow from being a traumatised orphan into a loving and much loved member of the clinic community—a result of the humanising effect of ‘Dr Redbeard’s’ philosophy on physicians and patients alike. This episode alone would make perfect material for a session on cinema in a medical humanities course. The movie ends with Dr Yasumoto’s wedding to the sister of his original fiancée, when he explains that his future will not be as physician to the Shogun, but to the poor (see figure 2).
JAPANESE AND WESTERN MEDICINE
Kurosawa always paid close attention to historical detail. He demonstrates this in Red Beard with his depiction of Japanese medicine and its emerging relationship with western medicine. We learn from the beginning that Dr Yasumoto has been trained by Dutch doctors in Nagasaki. As soon as he arrives, Dr Niide wants him to share his medical school notes, but the younger doctor is suspicious and believes his older colleague only wants to plagiarise these. Later he comes to understand that it was the older man’s humility and commitment to learning that led him to want them. He also discovers that it was Dr Niide who requested his placement in the clinic in the first place, presumably in order to acquire this knowledge. This fits with the circumstances of the period. In the early 1800s, Japan was almost entirely closed to western influence, and books from the west were banned. An exception was only made for a Dutch trading post in Nagasaki Bay. Through contact with the settlers there, Japanese scholars developed traditions of science, medicine and technology known as Rangaku, or ‘Dutch learning’ that enabled them to adopt some of the discoveries of the European Enlightenment into Japan, in advance of the enforced opening of the country by the USA in 1853.3
The movie also includes a scene where ‘Dr Redbeard’ carries out an operation on a woman who has suffered a serious injury on a building site, and he does so under anaesthesia or very deep sedation (see figure 3). This is also historically accurate. The first use of general anaesthesia in Japan took place in 1804, predating its use in Europe. A doctor named Seishu Hanaoka, who had studied both Japanese medicine and Dutch surgery, administered it when removing a breast tumour from a 60-year-old woman.4 Hanaoka gave her an oral anaesthetic made from herbs, which he had previously tested on animals. He later used it in a total of 156 operations on humans, including his wife and daughter.
Like other movies directed by Kurosawa. Red Beard is exquisite visually, with many frames seeming like works of art in their own right (see figure 4). It is gripping both as a cinematic masterpiece and an unsentimental portrayal of medicine. In his review of the movie, the Pulitzer prize-winning critic Roger Ebert has written
Red Beard is a long and deliberate film, as it must be, because the lessons of the great doctor cannot be ticked off in vignettes. Doctors need to watch awhile at deathbeds, and learn to know the patients. We need to observe how a man who thinks of himself as flawed can be wholly good. And how a man who has an unearned high opinion of himself can learn goodness through humility. I believe this film should be seen by every medical student .. It fearlessly regards the meanings of life, and death.5
Twitter John Launer @JohnLauner.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.