Pathway to Japanese Literature

Therefore, when these attendants—officially designated attendants—developed neuralgia or fell ill with pleurisy, temporary attendants had to be dispatched from the health ward. This counted among two or three obligatory duties, though even here a work wage of ten sen was provided. The isolation wards and men’s/women’s disability wards operated identically; these temporary attendants rotated through assignments following iroha order, ensuring everyone took their turn once a year. Naturally, this rule did not apply to those with physical impairments or other unavoidable circumstances—barring such exceptions, all were required to abandon their regular work and report for duty. Temporary attendant assignments were limited to fifteen days and required no extension beyond that period unless personally requested.

The five attendants took turns being on duty; those not on shift went to the distribution center to fetch meals and other supplies, ran errands to the shop at patients’ requests—the attendants referred to those confined to bed as ‘patients’—and each took charge of various small tasks. Additionally, each on-duty shift had one assistant, whom they referred to as “Suke.” Those on duty got a full day off the following day, free to nap or visit other wards as they pleased.

Since coming here, I had only been dispatched three times as a temporary attendant, but I will now excerpt parts of my diary from those periods.

September 3, 1934.

Today’s shift. I was extremely busy from morning onward. It is now 11:15 at night. Being my first time on duty, I found myself confused about various matters—mentally exhausted and utterly drained—but I suppose recording this may yet serve some purpose.

Wake-up at 5:30. Rain. Around noon, it stopped, and through thin clouds, the sun began to shine. In the evening, it began to rain again, but by night, it stopped.

6:15. I went to the distribution center to get miso soup. Today’s menu—Lunch (Tofu). Dinner (Simmered Potatoes). I returned and wrote it on the blackboard.

6:30. Breakfast.

7:00. I exchanged with yesterday’s on-duty person and was handed over the room. “Hōjō-san, please take over,” said Mr. M. It felt somewhat ritualistic. Mr. M’s face was tense.

7:30. Cleaning the room. I sweated from using a dust cloth for the first time.

8:00. I had several blind patients smoke. I wrote a postcard for one of them. 9:00. Tea time arrived. I poured tea for the patients. I let them smoke cigarettes.

9:30. A surgical assignment came up. Removing the patients’ bandages was part of my duty shift tasks. Mr. Suke also helped out. The room was filled with gauze and bandages soiled with pus. The stench was overwhelming. Someone urged me to put on a mask. Masks were such a bother.

10:00. Cleaned the room. Sweated. 10:30. Lunch. However, regarding the patients. I let them smoke cigarettes.

A little past eleven. Attendants’ lunch.

11:30. The patients’ nutritious items—“eggs” and “milk”—arrived. It was tea time. I prepared warm water for each patient.

Twelve o'clock. Cleaning. However, only a broom.

Two o’clock. I was made to peel garlic. On top of the stench, my eyes ached. There were also two or three simmered dishes. This was quite trying.

3:30. Dinner.

6:00.

I pulled out the cannula from Patient S's throat and administered inhalation. The cannula cleaning. As it was my first time, I was instructed by Mr. T. It was unbearable to look at. They called this "throat cleaning."

Seven o'clock. I went around asking the patients if there was any need from the medical office. “Those with neuralgia: ‘We’d like injections，please.’” “There，there，” I said.

7:30. I finished giving bedpans to the patients. I sighed in relief.

8:00. The nurse making rounds in the ward brought a syringe. “You’ve done well.” And then I crawled into bed. But I couldn’t fall asleep at all.

September 4.

Five o'clock. Awakened by a patient. I opened the curtains wide and breathed. Cleaning the room. Handling bedpans. Stench. Stench.

Seven o'clock. I finished breakfast and entrusted the room to the next attendant.

The above were mostly fixed tasks repeated daily; unless there was a patient on the verge of death, the daytime work of an attendant on duty generally consisted of such things as described. Admittedly, there were a few points I had omitted in writing—of course there were variations from day to day, and differences depending on each ward—but they were all more or less similar. During my shifts, I fortunately never encountered a death all three times, but even so, it was not uncommon to be awakened in the middle of the night.

×

As I was drifting off to sleep from the day’s exhaustion, a hoarse voice called out, “Attendant-san... Attendaant-saan...” Startled, I leapt up—though veteran staff members who’d been doing this for years would rise calmly—and there was the patient tormented by insomnia,

“Mr. Yamada is calling.”

They informed me. The person himself calling out naturally lacked the vigor to raise his voice, gasping and clenching his teeth. “Injection...” the patient said, then hissed through clenched jaws. Needless to say, he was being ravaged by neuralgia. Then the attendant would rush to the medical office in his nightclothes and summon the on-duty nurse. In the deep night when every blade of grass and every tree lay still, the feeling I had as I ran down the silent corridor, listening to my own footsteps—this was not something that could be easily expressed.

The medical office stood at the western end of the hospital; the long corridor connecting each ward lay dim and shadowy, and through the glass of every room could be seen half-rotted figures lined up in rows. As those half-rotted figures flickered into the corner of my vision while I ran, I was made acutely aware—as if realizing it anew—that I was in a leprosarium. When I returned from the medical office, I stood motionless in the ward until the nurse arrived, waiting while watching the patient streaming with sweat. For attendants, this must have been the most trying time. For whether they were drenched in sweat or not, there was simply nothing to be done but stand there blankly watching—

"Behold." Behold the state of this ward. Is there even one living, breathing human being here? All are dead—everything gray with death's hue. Here flows no resilient vitality, no whispered breath of hope. No—rather, not a single human soul remains here. They are not human. Something wholly other—creatures undeniably distinct from any human I had ever witnessed—were emitting death-throe moans. I too was among their number. I am dead, dead—.

In my diary, there remains a passage I wrote about the impressions from when I served as an attendant in the tuberculosis ward. Even now, I can vividly recall the feelings I had while writing it—and that too had been in the deepest hours of night.

When I was called and opened my eyes, the man in the next bed informed me that Mr. Yamada seemed to be suffering. I was terribly sleepy, so when I staggered over to the man’s side, I found him lying facedown, his upper body hanging over the pillow, clutching a dark red blood-soaked gauze in one hand as he gasped for breath. “What is it?” I was a bit irritated at being awakened in the middle of the night. “Guh… guh… blood…”

“What?”

“Guh... guh... guh... guh...”

He stuttered, unable to speak, but after a moment I jolted awake to realization. It was a careless oversight on my part, but I finally understood that he had coughed up blood. "Hemoptysis? That's bad."

I hurriedly made him drink saline solution, wiped the blood from around his mouth, and then rushed out to the medical office. Having only recently arrived here at the time, I was utterly terrified. When I returned from the medical office, I promptly cleaned his bedside, washed the spittoon, and waited for the nurse to arrive. As I scanned the dimly lit room—the numerous beds looming in the gloom, the white futons lined up in two rows, the procession of bandage-patched heads peering out from them—I suddenly felt a strange anger and loneliness. Before long, the nurse came, administered an injection, and then left. I crawled into bed and wrote the aforementioned diary entry.

This man who had suffered hemoptysis had apparently emigrated to Brazil and developed leprosy there; he was forty-five or forty-six years old. He died this early spring, but I remember his leprosy had not been particularly severe.

×

In the severe illness ward, there were patients of a kind that healthy people could not even imagine. Furthermore, there were bizarre things there that one could search the entire earth and never find the likes of. The first thing that shocked me when I came here—as I had written about in my novel The First Night of Life (いのちの初夜)—was when I saw a man ravaged by laryngeal leprosy with a hole in his throat. But next, what struck me as utterly strange was the sight of a blind woman—her eyeballs melted into a viscous mass, her hair fallen out—breathing through a black rubber tube inserted into her nearly collapsed nasal cavity. And with both ends of that rubber tube protruding about six millimeters outward in parallel, it made them look all the more eerie.

However, this spring when I performed attendant duties, I was shown something even stranger—or rather, more bizarre. It was another woman—aged thirty-seven or thirty-eight, perhaps around forty—with quite severe symptoms: her face, of course nodular in type, was eroded by advanced ulcers, and she was blind. In the evening while I was on duty, she called me and said there was a tobacco pipe mouthpiece in the cabinet, so please take it out. Since each bed had a cabinet attached to it, when I opened the door, just as she had said, several wax-coated mouthpieces formed into long sticks were lying there. When I asked what she intended to do, she said to push one of them into her nose. “Huh,” I blurted out without thinking, but she explained that this was better than the rubber tube—with this, she could replace it daily with ease. And while letting the end of the mouthpiece peek out from the tip of her nearly collapsed nose, she took two or three experimental breaths,

“Hmm, hmmph.” “It works perfectly well.” Speaking of tobacco pipe mouthpieces—I, who had never used them except for smoking—I felt I had witnessed something truly novel. Yet I couldn’t dismiss the possibility that the time might come when I too would have to use them as she did. I laughed and shuddered.

In Ward 6, there was a Mr.Y who had been transferred between wards for several years.

When it comes to Mr. Y, I find myself unable to muster the energy to write about him in detail—or rather, whenever I try to write about him, I somehow begin to feel suffocated myself.

A person’s age can generally be inferred from facial contours, expressions, and bodily gestures; indeed, it is through these very mannerisms that the concept of age gains its precise linguistic fit. Yet when confronted with a human stripped of all such attributes, even contemplating their age feels fundamentally discordant. Mr.Y remains technically forty-seven or forty-eight this year, but his appearance compels observers to recognize he has transcended ordinary human conventions like age. Just as none would examine a skeleton—save perhaps an archaeologist—and ponder its years, so too does Mr.Y’s form render age both unquantifiable and unworthy of curiosity. For he exists as precisely what the words denote: a “living skeleton.”

The eyeballs that had fallen out, leaving two cavernous eye sockets; the sunken cheeks with protruding cheekbones above them; the head devoid of even a single hair; and the fissure-like creases etched into it—this was Mr. Y’s neck. Even at a glance, it seemed almost strange that ears remained attached. Both upper arms had been amputated beyond the wrists, and with the elbow joints serving no function whatsoever, they dangled limply from his shoulders as if two round sticks were attached there. Moreover, both legs had been amputated at the knees. And then the lower part had been cut off. In short, he was reduced to just a neck and torso. I marveled that he could still live in such a state, but considering that hanging oneself required limbs, even the act of suicide had become impossible for Mr. Y—no, he could not even swat away the fleas scurrying over his back when they irritated him.

When mealtime came, he would still get up and sit before the cabinet. When the attendant ladled gruel into a bowl for him, he would flick out his tongue like a dog to feel around the area, locate the bowl, then plunge his head into it and begin slurping noisily. It was no metaphor—he looked exactly like a dog or a cat. By the time he finished eating, gruel clung thickly to his collapsed nose, forehead, and cheeks, while miso soup had splattered and stuck everywhere as if smeared on. This needed to be wiped off, but of course, performing the human-like act of wiping it with a hand towel was impossible. For this, proper preparations had been made, with layers of gauze spread out beside the futon. Mr.Y would promptly lie down, turn face down, and wipe his face by rubbing it against the gauze. The gauze, already used to wipe him many times over, had turned yellow—though of course the attendants periodically replaced it—but rather than wiping, it merely smeared the caked-on mess from one spot to another. Oblivious to this futility, Mr.Y would burrow back into his futon, convinced his face had been properly cleaned.

Last night, I again had business in the ward where this man was and went to check, but Mr.Y was still alive. However, his loss of strength was strikingly apparent, and I thought he would likely die before long. But what astonished me was that despite being in such a state, he maintained remarkably bright spirits—a mentality where he carefully avoided drinking even water beyond necessity, since even going to the bathroom required the attendant’s assistance. And when they let him smoke or helped him with the toilet, he expressed his gratitude in a very clear tone with a single “Thank you.” Moreover, he was quite knowledgeable about haiku; when someone read them aloud to him, he would sometimes offer critiques so astute they startled listeners. When I looked at him, I felt a tightness in my chest—for here was a man who, having been oppressed beyond endurance and confronted only with reality’s most dire circumstances, desperately continued to protect his life. Whether one views this as noble or despicable—that remains people’s prerogative. But the fact that there exist humans fighting to protect their lives and surviving—this truth remains absolutely unshakable, no matter what anyone may say.

× In leprosariums, across any treatment ward, it was not uncommon to find parent-child pairs or siblings admitted together. More precisely, over half had parents or siblings likewise afflicted—a stark testament to the severity of familial transmission. Though medical doctrine held leprosy bacilli to be significantly less infectious than tuberculosis or other chronic diseases—a fact corroborated by the absence of epidemic-scale outbreaks—transmission within families nevertheless remained alarmingly feasible through prolonged contact and exposure to infected parents during childhood’s most vulnerable years.

“[...] Around the fifth day of the New Year, a New Year’s letter arrived from Father at Aiseien (Note: National Nagashima Aiseien). When Mother opened the envelope, there was also a letter addressed to Yōko and Kiyohiko. Mother handed me the letter, so I read it immediately. Congratulations, Yōko dear, Kiyo dear. Did everyone have a safe New Year? Father spent this New Year apart from you all, and it was a somewhat lonely New Year for me. Let’s have this father heal from his illness soon, return home, and enjoy a happy New Year with the whole family together. By now, there must be a great deal of snow piled up there, I suppose. But here it is quite warm, and the plum blossoms are in bloom. (Omission)”

From then on, I could hardly wait for Father’s letters. Whenever the postman came by, I would rush out to see if there was one for us. Then I fell ill during that time. Before becoming sick, I had been unbearably sleepy for some reason. During school lessons, I kept nodding off repeatedly. (Omission) Amidst all this, Father returned home. That day, I had been following Mother to the vegetable garden. My little sister Etsu-chan and brother Kiyo-chan were away at school. When I came back calling, “Mother! Sis! I’m home!”, there sat Father in the living room—I just stood staring at him in wonder. We asked, “Do you know who this is?” He shook his head and said, “No, I don’t.” Then Father laughed and said, “You must’ve forgotten—it’s been so long since we last met.”

That night, our whole family gathered together and shared a joyful evening meal. Then Father examined our bodies like a doctor would. It turned out that besides me, Mother and my younger brother were ill. “Your elder sister, elder brother, and younger sister don’t seem to show signs of illness,” Father said, “but since their constitutions are weak, they’ll need to be examined over there eventually.” I told only Hikaru next door about coming here. “(The rest is omitted.)” — Published in *Aisei Children’s Literature*, Volume 6, Number 6.

Jinroku, by Yōko――

This is but one example, yet there are truly many similar facts.

At my hospital there were now over a hundred children; most of these children were hospitalized together with a parent or an older brother or sister—among them were even siblings who were still young children not yet ten years old. The siblings—the elder sister being ten and her younger brother eight—had entered school this year; yet in terms of their illness they were far more senior than someone like me; they had already been hospitalized for five or six years. As for the younger brother his was a case of such rare early onset that he had already become a patient and been hospitalized from around age three.

In early March, when cold winds still blew, an eleven- or twelve-year-old boy was admitted. His illness was mild, his eyebrows thick, and his large, round eyes shone with a wild intensity befitting a child of the countryside. However, his right leg was afflicted, the joints had deteriorated, and when he walked, he dragged his leg with a limp. This child had been brought by his uncle, but when it came time to part, he clung to the pillar in the medical office and cried loudly; that night too, he cried straight through until morning. It seemed he had been separated from his real father eight years prior and had been raised by his uncle.

However, that father—whom this boy must have found utterly impossible to even imagine—was indeed hospitalized here as well, groaning in the severe illness ward as his condition worsened. Of course, it was not long before the boy too was informed of his father’s presence. However, when this critically ill father was identified to him with “This is your father,” how his nerves must have quivered. The father’s body was swollen livid from severe infiltration, his entire frame bloated like that of a kidney disease patient. Moreover, a hole gaped in his throat ravaged by laryngeal leprosy; he managed to breathe through a cannula, his voice hoarse—each word he uttered provoking three or four coughs through that hole. The truth is, I first became aware of this parent and child when asked to serve as an attendant in the ward where the father lay; though I had known of the boy’s hospitalization beforehand, never had I imagined the father’s presence. The boy came to his father’s side every night to tend to him. On nights when I kept watch, he would appear shuffling unsteadily down the corridor, and upon seeing me reading atop the duty bed, would bow his head once with a faint smile before approaching his father’s pillow. When he came while I cleaned cannulas under Mr.T’s instruction, he would alternate his gaze between the six-millimeter hole in his father’s throat and my hands working gauze strips into the extracted tube—his expression torn between dread and fascination.

×

Here, I felt the need to provide a brief explanation regarding cannulas and laryngeal leprosy. Laryngeal leprosy might seem to refer to a special disease type—one that affects only the larynx. But no—it describes cases where ordinary nodular leprosy progresses until finally reaching the larynx. The primary laryngeal symptoms consist of leprous infiltration and nodules accompanied by swelling and ulcers in the airway, resulting in respiratory distress. Of course, being a chronic disease of this nature, there was no instance of someone breathing normally until yesterday suddenly falling into respiratory distress today; rather, as the disease advanced, swelling and ulcers gradually developed until eventually there became insufficient respiratory volume to adequately sustain lung function.

So even if affected by laryngeal leprosy, this did not mean their airway became completely blocked. Of course left untreated it would eventually become fully obstructed; however patients would complain of pain and have a hole created before reaching that stage—even after this procedure they could still breathe through their mouth and manage hoarse vocalization. Naturally should the disease progress further from that point they would lose their voice entirely and even struggle to breathe through that opening; though in other cases after creating the hole progression might cease with infiltrations and ulcers healing until that artificial passage became unnecessary. Such cases were rare yet there existed such a man two wards over from mine who had wrapped bandages around his neck now that his hole served no purpose. Let me clarify—this bandage did not constitute medical treatment to seal the opening but merely covered it since leaving it exposed would let air leak through.

The hole is made between the first and second rings of the trachea, far below the vocal cords. Therefore, it may seem puzzling at first glance that those who have had such a hole made can still speak or chant Buddhist prayers. However, I believe the preceding explanation has made the circumstances sufficiently clear. However, when speaking, these perforated ones skillfully raise their hands to briefly press the holes, ensuring air flows into the oral cavity.

On this point, I deeply regret that my previous writings provided insufficient explanation, but I must beg your kind understanding, as this stems from my own inexperience.

At my hospital, we used double-lumen tracheal tubes for cannulas—Numbers 5, 6, 7, and 8. Namely, those with diameters of 7⅔—8½—9—9⅔ mm. (Refer to the Iwashiya Medical Equipment Catalog)

The above constitutes my response to the short review column in *Bungakukai*, but as there may be others who harbor similar questions, I will record it here.

×

There are times when parent and child are admitted together.

About half a year after the aforementioned boy, a girl named Haru-chan entered with her father. She was only nine years old, but her large build and worldly-wise demeanor made her appear twelve or thirteen; combined with her strikingly beautiful face, whenever this child arrived, the entire hospital would buzz with talk of her for a time. Her illness was mild and, being of the neural type, there was nothing about her outward appearance that suggested she was a patient. Jet-black, vivid eyebrows and clear, large eyes were set close together like those of a Western child; if only her cheeks hadn’t been so sunken, she would have reminded one of Shirley Temple. Admittedly, having lived for many years in such a world where all they saw were decaying flesh, sunken noses, and lividly discolored skin, the patients harbored an endlessly persistent hunger for beautiful girls and boys—so it could not be said that she did not appear all the more beautiful for it. However, this child’s father was in critical condition; moreover, he was suffering from tuberculosis or something of the sort, and unable to move from the general ward to the residential building, he was placed in the severe illness ward, where he died not long after. The parent and child had brought with them a large, well-trained dog that seemed powerfully built, and for a time, they formed a peculiar family within the general ward that unnerved people.

When I consider this parent and child, I am led to think that this must be what a typical tragedy of leprosy looks like; in truth, however, they had been what people call leprosy beggars until coming here. In other words, this Miss Leprosy—who had just turned nine—would place her father, deprived of the freedom to walk, into a wheeled cart, have that powerful dog pull it, and go about begging. And her mother too was ill; by that time already lacking the strength to stand, she lay at home awaiting their return—it was a literal human tragedy. The mother had died a little before they were hospitalized.

So when they were hospitalized, their entire bodies were covered in lice, and apparently even the attendants couldn't get too close. Their hair was wildly disheveled, and their hands and feet were caked with thick grime, emitting a foul odor—this went without saying. However, the attendants said that once they had bathed, gone to the barber, and returned with their hair cut into bobs, they became almost unrecognizable.

“This child’s mother was truly beautiful.” “This child is the spitting image of her mother.”

Such were the reminiscences of the ailing father.

However, one morning, as I was walking around the field as usual, I encountered a group of people emerging from the crematory. When I looked, there at the very front was the child, walking while holding the cremation urn.

“What’s wrong? Who died?” I asked, and she said, “Papa,” with a laugh. She did not appear particularly sad; if anything, she looked positively cheerful as she held the urn. ×

In the dim light of early dawn, or in the fading glow of dusk, the clang, clang of a bell would sometimes resonate throughout the hospital grounds. Then the people in the ward,

“Someone’s died.” “Who could it be?” “It must be Mr. Saitō from Room Nine—he’d had auxiliary nursing for over ten years now.” “When I went to see him last night, he was already on death’s doorstep.”

And then those of the same religion to which the deceased had belonged, or those who had been closely involved, would troop into the sickroom one after another. When there was a dead person, the attendants would come out in front of the room, ring the bell, and notify the entire institution of the death. Within the hospital grounds, there existed religious groups such as the Shingon sect, Shin sect, Nichiren sect, and Old and New Christian denominations, and the deceased were buried by these groups. Auxiliary nursing referred to cases where patients became critically ill and attendants alone could no longer manage, at which point members from those groups would take turns assisting the attendants. Of course, the system was designed so that patients’ close relatives and friends also took turns coming to provide nursing care.

However，there were often those who did not join any of these religious groups；while it was acceptable for friends to handle auxiliary nursing，when death occurred，there might be no one at all to conduct the burial． Since that would not do，due to such stubborn individuals，it had been arranged for each sect to take turns being on duty． To be sure，such cases were exceedingly rare—among over twelve hundred patients，one would likely have found no more than a little over ten．Moreover，when death truly approached and fear set in，they suddenly adopted a pious frame of mind and clung tearfully to some group，making such cases exceedingly rare． I myself was one of those constitutionally incapable of trusting religion，yet when my breath grew short，some desperate piety might suddenly surge forth． I was now developing an intense interest in this question，but in any case，human psychology toward death appeared to expose nothing but weaknesses．

The corpse was placed on a stretcher, and the attendants carried it to the dissection room. Next to the dissection room was another small room; people came to this room to chant Buddhist prayers, or a service began. In that room, flowers and such were enshrined, giving it a somewhat makeshift temple-like feel, but the partition at the far end could be removed, allowing a view of bodies laid out on the platform in the dissection room’s corridor through this arrangement. During times of intense heat or severe winter cold, there were many dead, and sometimes the corpses of those who had died in quick succession piled up on that platform, three or even four deep.

Once the autopsy was completed and the necessary parts had been taken as specimens, the patients streamed in to gather there, and soon began a funeral procession. The corpse was placed into a plain wooden box, and as they pulled the cart bearing it, a strange procession made its way toward the crematory. A completely hairless man, a woman with a twisted mouth, faces and hands lividly swollen, an old man leaning on a crutch, a boy with a prosthetic leg—such an eerie crowd gathered around the cart at its center, forming a line as they moved through the fields—a sight that seemed scarcely of this world. In the distance gleamed the white dome of the ossuary.

When we reached the crematory, Buddhist prayers were chanted there once more, and Christian believers sang hymns with trembling voices thick with sentiment. From the slender chimney rose wisps of smoke, carrying the stench of death throughout the hospital grounds. Thus ended a life steeped in anguish—two or three bone fragments placed in a teacup-shaped urn fashioned by patients themselves, then arrayed on ossuary shelves just as Haru had carried hers. “That one’s gone and we’re all better for it now, ain’t we?”

“Well, I never—is this really what they call the world?” The old women, having finished their Buddhist prayers, discussed such things and left that place. And thus they returned to the world of illness and suffering.