Shigeaki Hinohara

2.1. Birth and Family Background

Shigeaki Hinohara was born on October 4, 1911, in Yoshiki District, Yamaguchi Prefecture, in his mother's hometown, now part of Yamaguchi City. Both of his parents were devout Christians, and his father, Hinohara Zensuke, was a minister who had studied at the Union Theological Seminary. Hinohara was baptized at the age of seven, influenced by his father's deep faith. He was the second of nine children in his family, which included six siblings. All of his siblings' names included the Japanese character "明" (read as *aki* or *mei*), which means "bright" or "clear," reflecting the Meiji era in which they were born. In 1913, his family relocated to Ōita when his father became a pastor at the Oita Methodist Church (now Japan Christian Church Oita Church). Two years later, in 1915, they moved to Kobe as his father transferred to the Kobe Central Methodist Church (now Japan Christian Church Kobe Eiko Church).

2.2. Education and Early Career

Hinohara began his schooling at Suwayama Elementary School in Kobe in 1918. During his fourth year of elementary school in 1921, he was forced to take a leave of absence due to acute nephritis. During his recovery, he began taking piano lessons from the wife of an American missionary. In 1924, he passed the entrance examination for Kobe First Middle School but decided to withdraw on the day of enrollment to attend Kwansei Gakuin Middle School instead. To overcome a severe blushing phobia, he joined the debate club, a challenge that helped him develop his public speaking skills. Later, in 1929, he entered the science department of the former Third Higher School. There, he was active in both the debate and literature clubs, where he cultivated his writing skills, producing poetry and essay collections.

In 1930, his father assumed the position of president at Hiroshima Jogakuin, an educational institution. Hinohara himself entered the Kyoto Imperial University School of Medicine in 1932, with his tuition fees supported by donations from various church affiliations. His medical studies were interrupted in 1933 when he contracted tuberculosis and had to take a leave of absence. He spent approximately one year convalescing at his father's residence at Hiroshima Jogakuin and in Nijigahama, Hikari City, Yamaguchi Prefecture. This experience led him to abandon his initial dream of becoming an internal medicine professor and to briefly consider pursuing a career in music, a passion that was ultimately discouraged by his parents. Due to his weakened health, he also contemplated becoming a psychiatrist, as he perceived it to be a less physically demanding medical specialty. He resumed his studies at Kyoto Imperial University School of Medicine in 1934. Upon graduating in 1937, he was appointed as an unpaid assistant in the Third Department of Internal Medicine (Cardiology) under Professor Shunichi Mashita, serving until 1939. During this period, he also worked at Kitano Hospital and Kyoto Hospital (now the National Hospital Organization Kyoto Medical Center) in 1938. In 1939, he advanced to the doctoral program in cardiology at Kyoto Imperial University, focusing on heart disease.

2.3. Wartime Service and Early Professional Roles

In 1941, Hinohara embarked on a long and significant association with St. Luke's International Hospital in central Tokyo, accepting a position as an internal medicine physician. This move was made despite objections from those who cited the strong academic cliques prevalent in Tokyo's medical community, though St. Luke's was notable for not adhering to such a system, appealing to Hinohara's desire for an environment where merit prevailed. His initial assignment was at St. Luke's Karuizawa Clinic, where he worked from July to September of that year, a role he continued to fulfill every summer until 1944.

In 1942, he married a woman he had met through his father's church in Den-en-chōfu, where she taught Sunday school. The following year, in 1943, he earned his PhD in Medicine from Kyoto Imperial University. Reflecting his passion for music, his doctoral dissertation focused on "heart sound research," through which he discovered that the heart produced low-frequency sounds during contraction, a finding he published in a notable American medical journal.

As World War II intensified, Hinohara volunteered for military service and was commissioned as an Imperial Japanese Navy medical sub-lieutenant in 1945. He underwent training at Totsuka Naval Hospital and the Naval Medical School in Totsuka, Yokohama. However, his military service was brief, as he was hospitalized due to a recurrence of acute nephritis and subsequently discharged. He returned to St. Luke's, where he worked throughout the devastating wartime firebombing of the city in 1945, providing medical care amidst widespread destruction.

3.1. Work at St. Luke's International Hospital

Hinohara's professional life was deeply intertwined with St. Luke's International Hospital for over seven decades, starting in 1941. In 1951, he was appointed Chief of Internal Medicine. His pursuit of advanced medical knowledge led him to spend a year studying at Emory University School of Medicine in the United States, where he was mentored by Professor Paul Beeson. During this time, he also visited the Mayo Clinic, an experience that exposed him to the principles of holistic medicine and significantly influenced his approach to patient care.

Upon his return in 1952, he assumed the role of Assistant Hospital Director, overseeing research and education until 1972. During this period, he declined an offer for a professorship at Kyoto University, prioritizing his work at St. Luke's. He also served as a lecturer at institutions such as the Tokyo Nursing Education Model Institute (now Japanese Red Cross College of Nursing) and Tokyo Bunka Gakuen (now Nitobe Bunka College), and contributed as an examiner for the national medical licensure exam and a member of the Physician Training Council. From 1953, he served as a professor at International Christian University for four years, teaching "Social Health" and acting as an advisor for the university clinic.

In 1974, Hinohara retired from St. Luke's International Hospital after reaching the mandatory retirement age. Despite being nominated to succeed the late Director Hirotoshi Hashimoto, he declined the position. He then became the fourth president of St. Luke's College of Nursing (1974-1998), where he made a groundbreaking contribution by establishing the first doctoral program for nursing in Japan. In 1992, at the age of 80, he returned to St. Luke's as Hospital Director, a position he held without pay until 1996, at which point he became the hospital's honorary director.

3.2. Response to Medical Emergencies

Dr. Hinohara's career was marked by his decisive leadership during major medical emergencies, demonstrating his unwavering commitment to patients and public safety. During the Tokyo firebombing in 1945, he remained at St. Luke's International Hospital, providing essential medical care amidst the widespread devastation. This experience instilled in him a profound understanding of the need for robust disaster preparedness in medical facilities.

His foresight proved critical during the Tokyo subway sarin attack on March 20, 1995. As hospital director, Hinohara made the immediate and bold decision to open St. Luke's International Hospital to all victims, halting all regular outpatient services to prioritize emergency care. At 83 years old, he personally led the medical response, directing the treatment of 640 victims. This swift and comprehensive action was made possible by the hospital's unique design, which Hinohara had conceptualized three years prior after observing hospitals in Scandinavia. He had advocated for the installation of approximately 2,000 oxygen pipes along the walls of corridors and waiting areas, as well as the creation of spacious lobbies and a large chapel. These areas, initially criticized by some as "excessive investment" for their size in a normal hospital setting, functioned perfectly as emergency triage and treatment centers for mass casualties, enabling the hospital to manage the crisis efficiently and minimize fatalities. The incident and Hinohara's crucial role were later featured in the NHK documentary series "Project X: Challengers", with crisis management expert Sassa Atsuyuki stating that Hinohara's actions, including the decision to release all available PAM antidotes, were worthy of the People's Honor Award.

3.3. Pioneering Preventative Medicine

Dr. Shigeaki Hinohara was a staunch advocate for preventative medicine, pioneering practices that fundamentally reshaped public health in Japan. He is widely credited with establishing and popularizing the nation's practice of annual medical checkups, famously known as 人間ドック_{Ningen Dock}^Japanese (literally "human dock"). He introduced this concept as the first of its kind in Japan, emphasizing proactive health management rather than merely treating illness after its onset. His vision for Ningen Dock was to create a comprehensive system that allowed for early detection of diseases and health issues, thereby enabling timely intervention and promoting overall well-being. This innovative approach became a cornerstone of Japanese healthcare, shifting the focus towards maintaining health and preventing disease before it became severe.

3.4. Introducing "Lifestyle Diseases"

One of Dr. Hinohara's most significant contributions to public health awareness was his conceptualization and popularization of the term "lifestyle diseases" (生活習慣病_{Seikatsu Shūkanbyō}^Japanese). Prior to his advocacy, these conditions were typically referred to as "habitual diseases" (習慣病_Shūkanbyō^Japanese). Beginning in the 1970s, Hinohara championed the change in terminology to more accurately reflect the strong link between common illnesses, such as thrombosis, heart disease, and stroke, and an individual's daily habits and choices.

His rationale was that by calling them "lifestyle diseases," people would better understand their role in both developing and preventing these conditions, thus empowering them to make healthier choices. This concept was eventually adopted by the former Ministry of Health and Welfare in 1996 and subsequently gained widespread acceptance throughout Japan. The shift in terminology had a profound impact on public health awareness campaigns, medical education, and policy-making, fostering a greater emphasis on lifestyle modifications as a primary means of disease prevention.

3.5. Hospital Design for Disaster Preparedness

Dr. Hinohara's experiences during the Tokyo firebombing in World War II, where adequate medical care was severely hampered, left an indelible impression on him. This experience fueled his foresight and determination to design medical facilities that could effectively withstand and respond to large-scale emergencies and mass casualties. His vision culminated in the construction of the new wing of St. Luke's International Hospital in 1992.

Despite initial criticism from some who perceived his plans for large lobbies and a chapel as "excessive investment" for a hospital, Hinohara steadfastly pressed forward, drawing inspiration from his observations of hospitals in Scandinavia. He incorporated features such as approximately 2,000 oxygen pipes installed along the walls of corridors and waiting areas, ensuring that these seemingly superfluous spaces could be rapidly converted into emergency treatment areas. The effectiveness of this forward-thinking design was dramatically demonstrated during the Tokyo subway sarin attack in 1995. The spacious lobbies and chapel, which had been designed with disaster response in mind, functioned precisely as intended, serving as crucial triage and treatment centers for the hundreds of victims. Hinohara's decision to open the hospital immediately and suspend all other operations allowed St. Luke's to become a central hub for victim treatment, a move widely credited with minimizing fatalities in the wake of the terror attack. This innovative approach to hospital design became a significant part of his legacy in disaster medicine.

4.1. University Roles and Teaching

Throughout his extensive career, Dr. Shigeaki Hinohara held various influential roles at numerous academic institutions, profoundly shaping medical and nursing education in Japan. After serving as an assistant at Kyoto Imperial University's School of Medicine, he later became a professor at International Christian University from 1953. He also held visiting professorships at prestigious institutions such as Jichi Medical University (from 1982 to 1998) and Harvard University's School of Public Health. Notably, he was appointed the first Asian President of the International Society of Internal Medicine, serving from 1984 to 1986.

In 1971, he became the Vice President and Professor at St. Luke's College of Nursing, later serving as its fourth president from 1974 to 1998. During his tenure, he pioneered the establishment of a graduate school for nursing at St. Luke's, creating the first doctoral program in nursing in Japan. From 2008, he served as a visiting professor at Hiroshima Jogakuin University, an institution where his father had previously held the position of president. He also took on the role of special advisor for education at Kwansei Gakuin Elementary School in 2008, where he conducted special classes. In 2009, he became the honorary director of the Japan Grief Care Institute at St. Thomas University, and from 2010, he held the same position at Sophia University's Japan Grief Care Institute. Hinohara was also instrumental in promoting the integration of music into therapy, serving as the first chairman of the Japanese Bio-Music Research Society (later the Japanese Music Therapy Association) from 1986, and subsequently becoming the first president of the Japanese Music Therapy Association in 2001.

A significant part of his educational legacy was his "Classes on Life" (いのちの授業_{Inochi no Jugyō}^Japanese), which he began in 1987. Through these classes, he visited over 200 elementary schools across Japan, including his alma mater Kobe Municipal Suwayama Elementary School, to impart lessons on the preciousness of life. These impactful sessions were also featured in an NHK educational television series titled "Series Classes."

4.2. Awards and Honors

Dr. Shigeaki Hinohara received numerous accolades and honors throughout his long and impactful career, recognizing his extensive contributions to medicine, education, and society. He was made an Honorary Member of the Japanese Circulation Society. In 1993, he was awarded the Order of the Sacred Treasure, Second Class, a significant national honor. His profound influence on Japanese culture and public health was further recognized when he was designated a Person of Cultural Merit in 1999 and subsequently awarded the prestigious Order of Culture in 2005.

Academic institutions also acknowledged his scholarly and humanitarian efforts by conferring upon him several honorary doctorates, including from Kyoto Imperial University, Thomas Jefferson University (Honorary Doctor of Humane Letters in 1998), McMaster University (in 2002), and Kwansei Gakuin University (in 2006). Beyond these, he received the highest merit award from the Japan Medical Association in 1982. His deep Christian faith and service were recognized with the Christian Contributor Award in 1989. The city of Tokyo honored him with the Tokyo Metropolitan Cultural Award in 1992, and he was named an Honorary Citizen of Tokyo in 1998, followed by Honorary Citizen of Chuo Ward, Tokyo, in 1999.

Further distinctions include the Academia Award from the Gakushikai in 1999, the Japan PR Grand Prix Social Category Award from the Japan Public Relations Association in 2000, and the Keizaikai Grand Prize Special Award in 2002. In 2003, he received the NHK Broadcasting Culture Award, the Asahi Social Welfare Award from the Asahi Shimbun, and the Kameoka City Lifelong Learning Grand Prize, also known as the Ishida Baigan Award. His international recognition extended to the Albert Schweitzer Award from the Albert Schweitzer Association in Austria in 2013. In 2011, he received the Japanese Society for Tobacco Control Award for his efforts in public health. Reflecting his commitment to global welfare, he was appointed Ambassador for UNICEF Japan in 2007.

5.1. Christian Faith and Life Philosophy

Shigeaki Hinohara's deeply held Christian faith formed the bedrock of his life philosophy and significantly influenced his approach to medicine and his views on life, aging, and death. Born to Christian parents, he was baptized at the age of seven, and his father, a minister, was a profound influence. Although St. Luke's International Hospital is affiliated with the Anglican Christian denomination, Hinohara himself was a member of the United Church of Christ in Japan.

His philosophical outlook emphasized a holistic view of well-being, encompassing not only physical health but also spiritual and mental aspects. He famously championed the concept of "Vessel of Life" (いのちの器_{Inochi no Utsuwa}^Japanese), which posited that life is a finite amount of time given to each individual, and the purpose of one's existence is how that time is utilized, especially in service to others. He believed that dedicating oneself to helping those in need sets an example for future generations.

Hinohara also held a progressive view on aging, advocating for its embrace as a period of continued growth and contribution rather than decline. His highly influential book, "Living a Good Life" (生きかた上手_{Ikikata Jōzu}^Japanese), which sold over 1.2 million copies, encouraged readers to view their later years as a "second coming of age," a time for new beginnings and self-development. His personal motto, borrowed from the renowned physician William Osler, was: "Medicine is an art based on science," reflecting his belief in combining scientific rigor with compassionate, human-centered care. Hinohara was also involved in the planning and original concept of a musical adaptation of Leo Buscaglia's picture book "The Fall of Freddie the Leaf", which explores themes of life, death, and renewal, further reflecting his profound interest in life's ultimate questions.

5.2. Social and Political Views

Dr. Hinohara held distinct views on various societal matters, encompassing his respect for the Imperial family, his thoughts on national symbols, and his strong advocacy for peace, shaped by his personal experiences of war. He maintained a conservative ideology and deeply revered the Imperial family, often being invited to Imperial events. He even suggested that the Constitution of Japan should explicitly state the duty of loyalty and service to the Emperor. In a column he penned for the Asahi Shimbun, titled "My 95 Years, Going As I Am," he proposed the creation of a new national anthem to replace "Kimigayo".

On medical policy, Hinohara openly challenged the stance of the Japan Medical Association, which traditionally advocated that only physicians should perform medical procedures. He argued that some nurses possessed more extensive therapeutic knowledge than newly qualified doctors, and thus, medical procedures should be broadly permitted for qualified healthcare professionals, irrespective of their specific designation. He also criticized Japan's mandatory retirement age for university professors, noting that in the United States, professors were often allowed to continue teaching based on their performance, regardless of age, a practice he believed Japan should emulate.

His experiences during World War II profoundly influenced his views on peace and violence. He expressed that during the war, St. Luke's Hospital was renamed "Greater East Asia Central Hospital" by the government, and the Special Higher Police (Tokkō) harassed and interrogated him and his colleagues under suspicion of espionage. The hospital's cross atop its tall tower was forcibly removed by military police, and a stone monument inscribed with the hospital's founding philosophy, "For the glory of God and service to humanity," had to be covered with granite slabs, the nail marks from which remained visible as a stark reminder. After Japan's defeat and the hospital's requisition by GHQ, Hinohara immersed himself in American medical literature, becoming a devoted follower of William Osler, whose emphasis on prevention and lifestyle improvement resonated deeply with him.

Hinohara passionately engaged in activities to pass on the lessons of war to younger generations. In lectures and forums for the elderly, he stressed the importance of cherishing life and working towards a peaceful society. In his book, "War, Life, and the Story of St. Luke's International Hospital," he advocated for breaking the cycle of violence by resolving conflicts through dialogue rather than force, asserting that "intellect is humanity's most precious treasure." He frequently stated that "war is the same as bullying," a message also prominently featured on the obi (book band) of his 2015 book. In his children's book, written at age 95, he advised that individuals are solely responsible for controlling feelings of resentment, that the courage to forgive can end conflict, and that "knowing" is paramount. His long-running "Classes on Life" consistently condemned bullying as a form of violence.

6.1. Personal Interests and Hobbies

Dr. Hinohara harbored a lifelong passion for piano playing, which he began learning as a child during his recovery from acute nephritis. During his battle with tuberculosis, he composed a piece titled "Nocturne," a portion of which was publicly performed by Shin-ichiro Ikebe during Hinohara's guest appearance on NHK Educational TV's "N-Kyo Hour" in 2008. His musical talents extended to lyric writing, as he penned the lyrics for "A Song That Embraces the Earth" (地球をつつむ歌声_{Chikyū o Tsutsumu Utagoe}^Japanese), the assigned song for the elementary school division of the 2015 NHK National School Music Competition.

He was also a prolific writer, enjoying authorship from his elementary school days, contributing to literary magazines and publishing numerous books. He sometimes used pseudonyms such as 日野原重秋_{Hinohara Shūaki}^Japanese and 日野原詩郷明_{Hinohara Shigōmei}^Japanese. His literary output included over 200 books, encompassing solo works, co-authored titles, and translations.

In terms of sports, Hinohara was an avid fan of the Hakone Ekiden (a university relay marathon) and football (soccer). In 2015, he was a particularly enthusiastic supporter of the Nadeshiko Japan and expressed great admiration for goalkeeper Ayumi Kaihori. His personal style reflected his attention to detail; he viewed dressing elegantly, especially selecting jackets, ties, and pocket squares to suit the season, as a "talisman" before public appearances. He meticulously chose one pocket square from several options his wife presented daily, especially after receiving a compliment from television personality Kazushige Nagashima.

Regarding his daily habits, Hinohara's diet primarily centered around dinner. For breakfast, he would drink juice with olive oil, and for lunch, he consumed only milk, germ cookies, and an apple. Dinner, consumed in a slightly larger portion, consisted of meat twice a week and fish on other days, adjusted according to his physical condition. He often stated that he did not feel hungry when he was highly focused on his work. He also had a fondness for "peanut miso" (ピーナッツ味噌_{Pīnattsu Miso}^Japanese), a spread made by his mother from ground peanuts, sugar, and miso, resembling peanut butter, and cherished memories of eating peanut butter sandwiches during his financially constrained student days studying in the United States in 1951.

6.2. The Yodo-go Hijacking Incident

A profoundly life-altering experience for Dr. Hinohara occurred on March 31, 1970, when he was a hostage aboard Japan Airlines Flight 351, en route to the Japanese Society of Internal Medicine general conference in Fukuoka. This incident, known as the Yodo-go hijacking incident, was Japan's first commercial airline hijacking. When the hijackers, members of the Japanese Red Army Faction, announced the hijacking, many Japanese passengers were unfamiliar with the term. Hinohara raised his hand and calmly explained, "Hijacking means taking over an airplane and holding the passengers hostage." He was notably the only hostage who accepted a book offered by the hijackers, choosing to read "The Brothers Karamazov" during his captivity.

He was held hostage for four days, during which he prepared himself for death, describing the experience later as a significant physical and mental trauma. While other older passengers, such as Shigeo Okinaka, the director of Toranomon Hospital, were released in Fukuoka, Hinohara was eventually freed at Gimpo International Airport in South Korea. Following his release, he and Kazuwa Yoshitoshi, a professor at the University of Tokyo Faculty of Medicine (one of whose students was among the hijackers), conducted health examinations for the other passengers.

The hijacking marked a pivotal turning point in Hinohara's life. He came to believe that the life he lived after the incident was a gift, and he resolved to shift his focus from pursuing personal fame as a physician to dedicating himself to serving others. He often spoke of how this experience fundamentally changed his outlook on life, transforming his priorities and deepening his commitment to humanitarian efforts.

7.1. Continued Professional Engagement

Even in his advanced years, well into his second century, Dr. Hinohara maintained an extraordinarily active professional and public life. His schedule was often booked two to three years in advance, reflecting the high demand for his insights and presence. He continued to write prolifically, utilizing even brief travel times to draft manuscripts. For much of his life, he was known for his rigorous routine, sleeping only about 4.5 hours a night and pulling an all-nighter once a week. However, at the age of 96, he adjusted his habits, giving up the all-nighters and increasing his sleep to five hours. Until his very last months, he expressed a clear ambition to remain professionally active until at least 110 years old, a testament to his belief in lifelong engagement.

He continued to appear on various television and radio programs, sharing his wisdom and experiences. These included two appearances on NHK's "Studio Park Kara Konnichiwa" in 2009 and 2012, even after reaching 100 years old. In May 2014, at 102, he was hospitalized due to E. coli in his bloodstream. Although he recovered in four days, subsequent tests revealed aortic valve stenosis. Due to his advanced age, surgery was deemed too risky, leading him to begin using a wheelchair for mobility as a preventative measure. In 2015, at 103, he experienced atrial fibrillation while watching a women's football match. Following this, he chose to watch recordings of intense matches after learning the results to avoid excessive excitement.

7.2. Death and Public Recognition

Dr. Shigeaki Hinohara passed away on July 18, 2017, at his home in Setagaya, Tokyo, at the remarkable age of 105. His cause of death was attributed to respiratory failure. His passing marked the end of an era for Japanese medicine and was met with widespread public tributes and recognition across the nation.

In acknowledgment of his lifelong contributions and distinguished service, the Japanese government posthumously conferred upon him the Junior Third Rank (従三位_Jusan'i^Japanese) on the same day he died. He was laid to rest at the Tama Cemetery, specifically within the St. Luke's International Hospital Chapel Annex, reflecting his profound and lasting connection to the institution he had served for so many decades. His death prompted numerous reflections on his impactful life and enduring legacy from various sectors of Japanese society.

7.3. Enduring Impact on Healthcare and Society

Dr. Shigeaki Hinohara's enduring influence on Japanese medicine and public health is profound, establishing him as a beloved cultural icon and a source of inspiration for generations. He is widely celebrated for establishing the first Ningen Dock (comprehensive annual medical checkup) in Japan and for consistently advocating for the critical importance of preventative medicine and end-of-life care. These pioneering contributions were explicitly cited as key reasons for his recognition as a Person of Cultural Merit and the conferment of the Order of Culture. His innovative recoining of "adult diseases" as "lifestyle diseases" significantly shifted public perception and policy towards proactive health management.

His 2001 book, "Living a Good Life" (生きかた上手_{Ikikata Jōzu}^Japanese), became a national bestseller, selling over 1.2 million copies and solidifying his status as a "star of hope" for the elderly, offering guidance on healthy and purposeful aging. Hinohara's dedication to humanitarian causes extended to his involvement as a planner and original concept contributor for the musical adaptation of Leo Buscaglia's picture book, "The Fall of Freddie the Leaf", which explores themes of life and death, further demonstrating his commitment to broader societal well-being.

His legacy is further cemented by his visionary approach to hospital design. The strategic construction of St. Luke's International Hospital's new wing, with its spacious, multi-functional areas, proved invaluable during the Tokyo subway sarin attack in 1995, transforming the hospital into an efficient mass-casualty treatment center. His decisive leadership in that crisis is still lauded, with some critics suggesting his actions warranted the People's Honor Award. Hinohara's philosophy, emphasizing the interconnectedness of physical, mental, and spiritual health, along with his tireless advocacy for living a life of contribution, continue to inspire individuals across Japan to pursue meaningful lives and embrace the journey of aging with vitality and purpose.