In 1809, Kihan Akaishi (1785-1847), one of the disciples of Seishu Hanaoka who ran a private medical school "Shunrinken," planed to publish an illustrated brochure, on breast cancer surgery by Hanaoka. It was only two months after he enrolled at the school. Although details remain unknown as to why Akaishi was so active in publishing the brochure, it is likely that he was impressed by the skillful breast cancer surgeries done by Hanaoka and determined to prevail upon him to share information about them among his colleagues. On the request of Akaishi, however, Hanaoka responded with neither "Yes" nor "No" because Hanaoka thought that it was impossible to accurately describe his diverse medical practices. Although Akaishi failed to obtain Hanaoka's permission to publish it, he tried to move further for the publication. He showed a manuscript containing Akaishi's preface and illustrations of 13 cases of breast cancer surgery to Yuya Kishi (1734-1813), asking him to write a foreword to the manuscript. Kishi was a scholar of Chinese literature of the Wakayama domain and a close friend of Hanaoka. A manuscript tentatively titled "Nyugan Zufu" is most likely the manuscript that Akaishi showed to Kishi, and the preface by Akaishi and the foreword by Kishi from other manuscripts elucidated the situation of the unirealized publication of the brochure.