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The Dawn of Bronchoscopy: The Biography of Ino Kubo, the Japanese Pioneer of Bronchoscopy

Shirakawa, Taeko M.D.*; Becker, Heinrich D. M.D., F.C.C.P.

History
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*Pulmonary Division of Internal Medicine, National Saishunso Hospital, Kumamoto, Japan; †Department of Interdisciplinary Endoscopy, Thoraxklinik–Heidelberg, Germany

Address reprint requests to Dr. Taeko Shirakawa, Pulmonary Division of Internal Medicine, National Saishunso Hospital, 2659, Suya, Nishigoshi-machi, Kikuchi-gun, Kumamoto, Japan 861-1196; e-mail: taeko@aminet.or.jp

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CHILDHOOD AND YOUTH

ENT, ear-nose-throat

InokichiI Kubo (Fig. 1), known as Ino Kubo, was born on December 26, 1874, in a small village called Nihonmatsu in Aizu, Japan (currently the Fukushima prefecture located in the northern part of Japan). It was shortly after the Meiji Restoration (1868)—the period of dramatic change in the political and social systems in Japanese history, from the federalism of the Edo period to the modern nation. Only 7 days after his birth, Kubo's mother was forced to divorce her husband and was sent back to her parents by her husband while Ino stayed with his father. Later, Ino would blame his small stature and insufficient physical strength on physical and emotional deprivation. His father, Tsuneyasu, who used to be a Samurai during the federal period, became a government official in the area after the Meiji Restoration. However, his income was never sufficient, so they were always poor. Soon thereafter, Tsuneyasu got married for the second time, and Ino's half-brother and -sister were born. Ino was a very diligent boy, willingly helped with housework, and nursed his small brother and sister. It is reported that Ino frequently carried them on his back. At the same time, he held a textbook in his left hand and a writing brush in his right hand. After graduating from primary school, he entered Fukushima Junior High School, the only junior high school in the Fukushima prefecture at that time. He had to walk all the way to the junior high school—approximately 10 km each way—which was almost too hard for a small and comparatively weak 12-year-old boy. Nevertheless, he used to wake up at three o'clock every morning, prepare his lunch by himself, and leave home at half past five. During his second year, he became a boarding student so that he could reduce his burden.

FIG. 1.

FIG. 1.

After graduation, he passed the difficult entrance examination of the most prestigious First National Senior High School in Tokyo. At that time (1891), Ino left his hometown to go to Tokyo to begin a new life at the age of 16. School life in Tokyo was enjoyable indeed. However, his financial situation was extremely difficult. He began to write “Tanka Poems”—a still-popular, special kind of Japanese verse of 31 one syllables (five lines with a rhythm of 5-7-5-7-7 syllables, which sounds very pleasant in the Japanese language). He devoted himself to his writing, probably to comfort himself while suffering from poverty. He soon was recognized as one of the most excellent young poets. In his second year at Tokyo University Medical School, he organized a new Tanka group called “Ikazuchi-kai” (group of thunder and lightning). This was a revolutionary group that ushered in a new phase in this field of poetry. 1

If after my death, really I would be destined to go to heaven, I would choose that Hesperus to be my eternal home. (composed around 1898–99)

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STARTING HIS CAREER AS AN OTORHINOLARYNGOLOGIST

In 1900, Kubo graduated from Tokyo University Medical School at the age of 26, and began working as an otorhinolaryngologist with Prof. Okada, Ear–Nose–Throat (ENT) Department, Tokyo University, Japan. The specialty was very new and was represented at only a few institutions. Soon he became editor of the Journal of the Society of Great Japanese Otorhinolaryngology (Fig. 2). 2 One of his coworkers wrote about his daily life:

FIG. 2.

FIG. 2.

Working not only as a chief of the ENT department but also as an editor of the journal, he got up early in the morning to study Spanish language by himself. Until 10 o'clock he treated outpatients in his private office at home. In the evening he gave lectures to a private study group on ENT. We all respected him very much as an exceptional hardworking person. But I never heard him complaining “I am busy” or “I am tired.”3

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IN GERMANY (1903–1907)

In 1903, Kubo was awarded a grant by the Japanese government to go to Germany. 4 He first went to Freiburg, which had become “the Mecca of Bronchoscopy” because of Killian's good reputation. Hundreds of physicians came from all over the world 5 (Fig. 3). Kubo soon became “Killian's most faithful student,” because of his intelligence and amiable personality. Working at Freiburg University, Kubo acquired the most advanced knowledge and techniques of the time. 6 When he left Freiburg in 1906, Killian presented him with an ink pot for memory (Fig. 4).

FIG. 3.

FIG. 3.

FIG. 4.

FIG. 4.

In foggy morning of the southern Germany on the window pane I see vaguely reflected the mountains of my home land.(composed in Freiburg)7

After Freiburg, before leaving for home, he stayed several months in Vienna and Utrecht to extend his knowledge of otology and physiology, especially caloric nystagmus. 1,8

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THE PIONEER OF JAPANESE BRONCHOSCOPY

In January 1907, Kubo returned to Japan to become professor of otorhinolaryngology at Fukuoka University (now Kyushu University), where he stayed until 1934. 4 In September 1907, he performed the first bronchoscopy in Japan using the Killian-type bronchoscope, removing a foreign body (a drum tack) from the left main bronchus of a 14-year-old boy 9,10 (Fig. 5). This procedure was performed as an official demonstration at Tokyo University. At that time, the common method for removing a foreign body from an airway was to stimulate the airway membrane with a feather through a tracheotomy. Therefore, the bronchoscopic method, which did not require tracheotomy, astonished the audience. Some criticized the method as dangerous; however, Kubo promoted the new method and encouraged the use of the new instruments 1 (Fig. 6). In fact, the bronchoscopic method was very efficient for retrieving foreign bodies: More than 2,000 foreign bodies were removed from the airways as well as from the esophagus using the endoscope in the ENT department of Kyushu University during his service. 8 Furthermore, Kubo explored the frontiers of this field and established new methods, one after another. Among his many achievements, the following stand out: diagnosis of aortic aneurysm, enlarged lymph nodes, and diphtheria of the deeper airways, and treatment by removal of pseudomembranes. Detection of the mechanism of hoarseness in infantile Beriberi (Fig. 7) shows the successful treatment of life-threatening compression of the trachea by a tuberculous gravitation abscess in spinal caries. The endoscopic incision and drainage of the peritracheo-esophageal abscess saved the 17-year-old boy's life. 11 Kubo's first steps as the Japanese pioneer of bronchoscopy were exceptionally great.

FIG. 5.

FIG. 5.

FIG. 6.

FIG. 6.

FIG. 7.

FIG. 7.

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KUBO'S ROLE FOR BRONCHOSCOPY IN JAPAN

Soon, other doctors took up the new technique: Dr. Shin-ichi Chiba introduced Brünings' bronchoscope in 1910 11 and Dr. Jo Ono returned to Japan in 1934 after training with Chevalier Jackson in America. Kubo invited Ono to Kyushu to give a lecture and demonstration of Jackson's bronchoscope. 12 Ono's work in bronchoscopy was also important for the development and spread of this new technology. In 1949, Ono established the Japan Broncho-esophagological Society. 10,11,13

Kubo continued his career as a professor at Kyushu University until the age of 60 in 1934. At that time he was the leader who established modern bronchoesophagology and otorhinolaryngology in Japan. He also developed several instruments and devices: Kubo-type forceps for crushing artificial teeth and dentures, Kubo-type forceps for tonsillectomy, Kubo-type device for suturing, Kubo-type mouth-opening device, a device to measure the thickness of the nasal septum, and many other original instruments.

These inventions are now exhibited in the Kubo Museum in Fukuoka (Fig. 8). This museum was founded in 1927, on the occasion of the 20th anniversary of the ENT department of Kyushu University as the scientific documentation and research center 7 (Fig. 9). Kubo's motto was Hippocrates' “ars longa, vita brevis.” Kubo wrote 530 articles in Japanese as well as 42 articles in German. 1 His main themes were physiology of the vestibular apparatus, antero-and sphenochoanal polyp, and the treatment of postoperative maxillary cysts. His brother Morimi Kubo, who became the professor of the ENT department of Chiba University, introduced Kubo's work in necrology in the German language.

FIG. 8.

FIG. 8.

FIG. 9.

FIG. 9.

[By animal experiments he correctly observed the effect of thermal excitation on the vestibular apparatus and thus verified Baran's hypothesis of caloric nystagmus. At a time when Killian's claim—based on rhinoscopic observations—that the so-called solitary choanal polyps were originating from the maxillary sinuses was still doubted by many specialists, Kubo could prove his mentor's statement as correct by the results of surgery. Whereby, he was also lucky to detect the sphenochoanal polyps.]8

Kubo also became editor of several textbooks and journals. Among them, Otorhinolaryngologia was started as the monthly journal that offered (1) the opportunity to present articles for otorhinolaryngologists and (2) up-to-date information in this field not only to the specialists but also to clinicians of other specialties. 14 Kubo devoted himself to this journal for more than 12 years. But we should not forget his wife, Yorie, who had been participating and supporting Kubo throughout all his miscellaneous activities. 12,15 Because of his work and participation at international meetings he was so well-known in Europe that he was elected the corresponding member of societies in Germany in 1914, Great Britain in 1917, and Austria in 1925. 8 In 1928, the German Scientific Academy “Leopoldina” elected him a regular member, and in 1934 the French government awarded him the Legion d'Honeur. 4

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THE LAST YEARS IN TOKYO

Kubo was a dedicated teacher (Fig. 10). Among his pupils, 15 doctors later became professors, including his own brother, Morimi Kubo, at Chiba University. 8 After his retirement, Ino Kubo moved to Tokyo. Besides serving as an advisor to St. Lucas Hospital, he spent his time as a dedicated collector of butterflies. 1 On November 12, 1939, he died at the age of 65. At the time of his death, the Japanese government gave him an official award in recognition of his great achievements. Inokichi Kubo is buried at the famous Aoyama cemetery in Tokyo. 4 In the obituary his brother Morimi wrote:

FIG. 10.

FIG. 10.

[Called by the early morning star on his quiet death at dawn, he found his last resting place there. In starlight blessed Ino Kubo is gliding down on giant wings from the heights of Hesperus passing by in all his splendor.]8

His memory is preserved in the Kubo Museum at Kyushu University, Fukuoka, Japan.

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Acknowledgment:

The authors are greatly indebted to the generous support of the following: Prof. Sohtaro Komiyama, Department of Otorhinolaryngology, Kyushu University; former Prof. Toyoji Soda, Department of Otorhinolaryngology, Fukuoka University; former Prof. Masaaki Ohata, 1st Department of Surgery, Nihon University, Tokyo; Prof. Takayuki Shirakusa, 2nd Department of Surgery, Fukuoka University; and Prof. Hirokuni Yoshimura, current President of the World Association for Bronchology.

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REFERENCES

1. Ofuji T. The vicissitude of my respected teacher Inokichi Kubo and his Tanka group “Ikazuchi-kai.” Fifty years of Musashino. Nagai H, ed. Tokyo: Osada Print Co., Ltd. Kikkyo-kai, 1987:188–210.
2. Asai K. Memory of Prof. Kubo. Otorhinolaryngologia 1940; 11:800–2.
Koike J. Mourning over the passing away of Prof. Inokichi Kubo. Otorhinolaryngologia 1940; 11:802–5.
4. Historical documents. A brief history of the late Prof. Inokichi Kubo. Otorhinolaryngologia 1940;11:945–8.
5. Becker HD. Gustav Killian: a biographical sketch. J Bronchol 1995; 2:77–83.
6. Killian H. Gustav Killian, -Sein Leben—Sein Werk. Remscheid—Lennep, Dustri-Verlag, 1958.
7. The Department of Otorhinolaryngology, Faculty of Medicine, Kyushu University. Inventory of Kubo Museum. 1985.
8. Kubo M. Ino Kubo-Sein Nekrolog. Otorhinolaryngologia 1940; 11:47–52.
9. Takasaki F. The history of endoscopic examination in Japan. J Soc Jpn Otorhinolaryngol 1919; 26:353–62.
10. Soda T. Several related scientific associations and the broncho-esophagology–oto-rhino-laryngology. J Jpn Bronchoesophagol Soc 1999; 50:156–7.
11. Ohata M. History and progress of the Japan Society for Bronchology. J Jpn Soc Bronchol 1997; 19:611–20.
12. Ono J. Mourning for the late Prof. Inokichi Kubo—memory of the first meeting with him. Otorhinolaryngologia 1940; 11:805–7.
13. Ono J. Looking back to 20 years of Japan Broncho-esophagological Society. The memorial index of the 20th anniversary of the Japan Broncho-esophagological Society. Tokyo: , 1968.
14. Kubo I. Geleitwort von Dr. Ino Kubo. Otorhinolaryngologia 1927; 1:2–4.
15. Hirose W. Mourning for the death of the chief editor Kubo. Otorhinolaryngologia 1940; 11:809–10.
Keywords:

Ino Kubo; Japanese pioneer of bronchoscopy; Killian

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