Red Beard: a master clinician in nineteenth century Japan

Howard Fischer
Uppsala, Sweden

 

A Meeting of Japan, China, and the West, late 18th – early 19th century. Shiba Kōkan. late 18th – early 19th century. Minneapolis Institute of Art.

One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.

—Francis W. Peabody, M.D.1

Red Beard (or Akahige) is a film about an arrogant, inexperienced doctor who learns about caring and compassion from his chief, a physician of great character and kindness. It was directed by Akira Kurosawa (1910-1988), the giant of Japanese cinema, who wrote or co-wrote every script for his thirty movies. Red Beard (1965) has been called the “last film of Kurosawa’s golden age.”2

The story takes place in a small Japanese town in about 1860. Dr. Kyojo Niide, known as Red Beard (played by Toshiro Mifune), runs the government-financed Koshikawa clinic, which is really a hospital that also has an outpatient clinic. Newly qualified Dr. Noboru Yasumoto (the actor Yuzo Kayama) visits Red Beard at his father’s request. He is shocked to learn that he is to become Red Beard’s intern for the year. Dr. Yasumoto learns what the place is like from the intern he is replacing: the clinic is terrible. The patients smell. They all have lice. They would be better off dead. Red Beard works the doctors too hard. Yasumoto does not want to stay there. His plan was to become the shogun’s doctor. (The shogun was the military dictator of Japan, appointed by the emperor. The shogunate system ended in 1868.)

Dr. Yasumoto does everything he can to get Red Beard to throw him out. He refuses to eat, does not work, will not wear the hospital uniform, and drinks sake during the day. He boasts that with his education from the Dutch medical school at Nagasaki (established 1838), he “knows more than Red Beard.”

Red Beard calls Yasumoto to the ward to the bedside of a dying man, gives him the patient’s history, and asks him to examine the patient and propose a diagnosis. His diagnosis is wrong because the patient has a rare disease. Red Beard tells Yasumoto to remember this patient and states a basic principle: “We can only fight poverty and ignorance. Half of our patients are sick because of poverty.” He tells Yasumoto to stay with the dying man. Yasumoto finds the experience dreadful and is shaken to be in the presence of death.

Red Beard gives some money to the daughter of the dead man so that she can continue to pay her rent and care for her three children. He says that the money was with her father’s possessions, but Yasumoto knows the money is actually Red Beard’s.

Yasumoto starts to realize that the patients, without exception, have lives of sadness and sacrifice. One inpatient, a wheelwright, works while ill to earn money to buy food for the other patients. The next day, Yasumoto faints while holding a patient as Red Beard sutures her penetrating abdominal wound.

The young doctor begins to realize that his feelings of superiority are misplaced, and that there is much that Red Beard can teach him. He puts on his hospital uniform and jokes with the hospital’s overworked washerwomen-cooks. He accompanies Red Beard on a house call to see a rich man, where Red Beard tells the man that his rich lifestyle is making him sick and recommends a restricted diet. He charges a large fee for the visit; he uses his few wealthy patients to subsidize the treatment of the poor.

Red Beard is called to a brothel to treat a prostitute with syphilis. While there, he hears a child being beaten. She is Otoyo, the twelve-year-old daughter of a prostitute who has recently died. She is being beaten because she refuses to become a prostitute herself. When she is agitated she ceaselessly scrubs floors. Red Beard stops the beating and discovers that the child has a high fever. He decides to take her to the hospital. The brothel’s madam calls on some thugs to stop him. Red Beard handles the six thugs with some economical karate moves, breaking some long bones and dislocating one jaw. He turns to Yasumoto and says, quite seriously, “Such violence is terrible. A doctor mustn’t do such things.”

Japan’s first treatise on Western anatomy, 1774. National Science Museum, Tokyo. Photograph by PHG, 2004. Via Wikimedia.

He and Yasumoto take the girl to the hospital, where Red Beard tells Yasumoto that the girl is his (Yasumoto’s) patient and he must cure her. She will not let Yasumoto examine her. He thinks she is “insolent and lonely.” She starts scrubbing floors again. He tries to give her some medicine by spoon. She pushes it away. Red Beard enters the room and says simply, “I’ll try.” She pushes his spoon of medicine away, and he tries a second, third, and fourth time. Each time she pushes the spoon away and the medicine lands on his beard. On the fifth try, she accepts it.

Yasumoto gives her some food. She asks why she did not get hit for pushing the medicine away. Yasumoto: “There are kind people in the world.” Otoyo: “Mother says to trust no one.” Yasumoto: “Your body and mind have been hurt by cruelty.” Testing him, she throws a bowl of food, breaking the bowl. Yasumoto sees how disturbed she is and says, “You poor girl.”

She later runs away from the clinic. Yasumoto finds her begging in the street. She uses the money she collected to buy a bowl to replace the one she broke. He tells her that he was not angry that she broke the bowl and apologizes if she thought so. She cries broken-heartedly.

Yasumoto realizes that he has complained too much, has been vain, and thought himself “too good for the clinic.” He falls ill and is tended by Otoyo. As he improves, Yasumoto smiles at Otoyo. She smiles back at him. Otoyo gets well by caring for Yasumoto. The madam comes to take Otoyo back. Red Beard refuses, and the washerwomen-cooks beat the madam and she flees. Red Beard’s diagnosis of Yasumoto: “[He] saw too much of the world at once.”

Later, Otoyo lets a seven-year-old thief steal cooked rice from the kitchen. He and his whole family are starving. She later brings rice to the family and finds that the whole family has taken poison because of the shame of having a thief in the family.

The internship year is now over. Yasumoto has been offered the position of doctor to the shogun, but he stays at the clinic with Red Beard, having understood that he can do some good working with the poor and can continue learning from a masterful physician.

The movie shows that “acts of love can travel,”3 and that kindness begets kindness. This is clearly illustrated by Otoyo being shown kindness and then showing kindness to the starving family. The sick get better by helping others.

“Niide is a paradigm of the good physician. He is a complex man who is cherished for his compassion and admired for his relentless advocacy . . . He is gruff, yet caring, stubborn and resourceful . . . He is an expert listener and problem solver. Red Beard proposes that an ideal physician does not have to be . . . perfect. Physicians’ own character flaws and setbacks facilitate their connection to, and communication with, patients.”4

Kurosawa had several medical problems, and the film “may have been his mark of respect for the profession.”5 Red Beard won six film awards in Japan, plus international film awards in Venice and Moscow.6 Flores’ “Top Ten List of Doctor Movies” places Red Beard at number one.7 It has been stated that Red Beard should be seen by every medical student,8 and that the film “should stand as a cornerstone of medical education.”9 There is a good thirty-minute online summary of the three-hour film with a discussion of Red Beard’s major themes.10 As a pediatrician, medical educator, and child protection doctor, I was impressed by Yasumoto’s evolution and his thoughtful care of Otoyo.

 

References

  1. Frances Peabody. “The Care of the Patient,” JAMA, 88;877-882, 1927.
  2. Peter Wild. Akira Kurosawa. London: Reaktion Books, 2014.
  3. Baradwaj Rangan. “Red Beard, the Last Kurosawa-Mifune Collaboration, is a Film for These Times—It’s about Healing and Hope” firstpost.com, April 3, 2020.
  4. Roger Ebert. “Treating Souls along with Bodies.” Rogerebert.com, November 18, 2010.
  5. Tony Miksanek. “Red Beard (1965), Commentary,” Academic Med, 87, no. 4, 2012.
  6. John Launer. “Red Beard:Kurosawa’s Medical Masterpiece,” Postgrad Med J, 96(1140) 2020.
  7. Glen Flores. “Doctors in the Movies,” Arch Dis Child, 89(12) 2004.
  8. Ebert, “Treating.”
  9. Mohsin Badat. “Medical Classics: Red Beard,” BMJ, 342, 2011.
  10. NA. “Healing both heart and body. Discussing therapy in Kurosawa’s Red Beard.” ND. akirakurosawa.info.

 


 

HOWARD FISCHER, MD, was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.

 

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