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been a better treatment and would consider how to improve his techniques.There are separate records of Taizen directing the first orchiectomy in Japan. The patient was the samurai Toyoki Yamauchi; he was Taizen’s close friend and the husband of Taizen’s younger sister. Toyoki’s operation was performed in 1849 by Seikai Totsuka, Dokai Hayashi, and Gonsai Miyake. Totsuka was a pupil of Siebold and, like Taizen, an Edo physician who had made a name by performing Western surgeries. Dokai Hayashi was Taizen’s brother-in-law and the physician who had taken up Wadajuku. Gonsai Miyake was Taizen’s appren-tice. The surgery was performed without anes-thesia following the protocol of the Dutch text. In the same year, Dokai Hayashi had translated the section of Chelius’ surgical text on orchiectomies into Japanese15). This surgery is also an example of treatments based on Western medical texts. Toyoki Yamauchi himself left preoperative and postopera-tive records of the surgery16). It is recorded that he received an explanation before the operation about the surgery, which he could understand and agree with. Although it had never been performed in Japan before, the patient accepted the treatment to ensure that the treatment would benefit others like him.Taizen’s surgeries were not ones performed autocratically; surgery was only performed after the patients provided their consent. There are a few examples of written consent for surgery that had been addressed and sent to relatives or local friends by patients before undergoing surgery by Taizen. There are no records of such consent in surgery other than Juntendo during the Edo period, and it is considered to be a pioneering example of a modern contractual relationship between physi-cians and patients. In addition, there is a table listing the surgical fees for Juntendo. During the Edo period, it was typical for physicians to not charge for treatment; they would only charge for the medication and adjust the cost as per the patient’s financial situation. Taizen placed a mone-tary value on treatment and charged everyone an equal amount that was made publicly available. This demonstrates a modern way of thinking about medical fees that continues to date.The immunization of smallpox by cowpox vaccine brought by Dutch ships was successful for the first time in Japan in Nagasaki in 1849, and then smallpox vaccination rapidly spread throughout Japan. The Sakura han conducted smallpox vacci-nation for all residents, and Taizen contributed to this effort. He had previously collected information about cowpox vaccines, translated sections on cowpox vaccines from Dutch texts, and passed on the information to Sakura han physicians. In this way, Taizen contributed toward the public health administration of Sakura han. In 1853, he became a Sakura han physician and taught Western medi-cine at a medical school established by the Sakura han.In addition to working as a physician , Taizen was deeply involved in the education of students. He taught Dutch and medicine using Dutch texts. Students would gain experience by assisting surgeries and examining patients in place of the instructing physician. Many medical students who came to Edo from across Japan visited Juntendo.［Medical treatment at the end of the Tokugawa shogunate and early Meiji period］In 1854, the Tokugawa shogunate entered into a treaty with the USA, UK, France, the Netherlands, and Russia, to end the long-standing national isola-tion policy. Subsequently, travel between Japan and Western countries considerably increased.The Tokugawa shogunate requested the Dutch government to send personnel to learn coastal defense and military medicine for the Japanese people’s education. Johannes Lijdius Catharinus Pompe van Meerdervoort arrived in Japan in 1857 and taught Western medicine to the Japanese physicians in Nagasaki. Pompe van Meerdervoort conducted the first systematic education in science and basic and clinical medicine as well as leading dissections and bedside education in Japan, with the help of the shogunate physician Ryojun Matsu-moto (son of Taizen Sato, adopted into the Matsu-moto family who served a hereditary position of shogunate physician ), who mediated communica-tion between Pompe and the Japanese physicians. Further, Pompe van Meerdvoort built a West-ern-style hospital in Nagasaki (Nagasaki Hospital, 1861) to treat patients and provide on-the-job practical training. Pompe van Meerdvoort also worked hard during the 1858 cholera outbreak, thereby improving the public perception of Western 467