Pathway to Japanese Literature

When these caretaker patients—referred to as "official caretakers"—developed neuralgia or were struck by pleurisy, temporary caretakers had to be dispatched from the healthy ward. This was one of several mandatory duties, and even in such cases, a work wage of ten sen was provided. The isolation wards and male/female disability wards followed the same system; these temporary caretaker assignments rotated in iroha order, ensuring everyone took a turn once a year. Of course, this did not apply if one developed physical impairments or other unavoidable circumstances, but barring such cases, everyone had to abandon their own work and report for duty. Temporary caretaker assignments were limited to fifteen days, and there was no need to extend them beyond that unless requested by the individual.

The five caretaker patients took turns serving night duty, while those off-duty went to the distribution center to fetch meals and other supplies, ran errands to the shop at the patients’ request—the caretakers referred to those confined to bed as “patients”—and handled various minor tasks assigned to each. Additionally, night duty was assigned one assistant, whom they called “Jo” (Assistant). Night duty personnel had the entire next day off and were free to nap or visit other wards as they pleased.

Since coming here，I had only been temporarily assigned as a caretaker patient three times，but I would try to excerpt some passages from my diary during those periods.

September 3, 1934.

Night duty today. I was extremely busy from morning. It was now 11:15 at night. As this was my first night duty, I had been at a loss in various ways and was utterly exhausted from the mental fatigue, but I thought writing it down might prove useful someday.

Woke at 5:30 AM. Rain. Around noon, the rain stopped, and sunlight began filtering through thin clouds. In the evening it began raining again, but by nightfall it stopped. 6:15 AM. I headed out to the distribution center to get miso soup. Today’s menu—Lunch (tofu). Dinner (simmered potatoes). I returned and noted it on the blackboard.

6:30 AM. Breakfast.

7:00 AM. Taking over from yesterday’s night duty person, I was handed the room. “I leave it to you, Mr. Hōjō,” said Mr. M. There was a somewhat ceremonial air to it. Mr. M’s face was tense.

7:30 AM. Indoor cleaning. I sweated onto the dust cloth I used for the first time.

8:00 AM. I had several blind patients smoke. I wrote a postcard for one of them.

9:00 AM. Tea time. I poured tea for the patients. I had them smoke.

9:30 AM. There was a surgical dispatch. My night duty work was removing the patients' bandages. Mr. Jo helped out too. The room brimmed with pus-stained gauze and bandages. The stench overwhelmed. Someone urged me to wear a mask. Masks were such a nuisance.

10:00. Indoor cleaning. Sweat.

10:30. Lunch. But this concerned the patients. I had them smoke cigarettes.

A little past eleven. Caretaker patients’ lunch.

11:30. The patients’ nutritional supplements—“eggs” “milk”—arrived. 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 skins. On top of the stench, my eyes stung. There were also two or three simmered dishes. I found this quite unpalatable.

3:30.

Dinner.

6:00. I pulled out the cannula from patient Mr. S’s throat and administered inhalation therapy. Cannula cleaning. As it was my first time, I was instructed by Mr. T. Unbearable to look at. They called this "throat cleaning."

7:00 PM.

I went around asking the patients whether there was any need from the medical office. The neuralgia patients: “Please give us injections.” “There, there,” I said.

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

8:00 PM. The ward nurse brought a syringe. “Thank you for your hard work.” And then I slipped into bed. But I couldn’t fall asleep.

September 4.

5:00. I was awakened by the patients. I threw open the curtains and breathed. Indoor cleaning. Handling bedpans. Stench. Stench. Seven o'clock. I finished breakfast and entrusted the room to the next person on duty.

The above constituted the fixed routine repeated nearly every day; only when there was a dying patient did it differ—otherwise, this was essentially what comprised a night-duty caretaker’s daytime work. Admittedly, there were a few points I had neglected to record; while there were naturally variations from day to day and differences between each ward, on the whole, things remained more or less the same. During my shifts, I fortunately never encountered a dead person in all three instances, but even so, being woken in the middle of the night was hardly uncommon.

×

Drowsy from the day’s exhaustion, I was just drifting off when a hoarse voice called out, “Night-duty caretaker… Night-duty caretakeeer…” Startled, I would leap up—though of course, the veterans who’d been doing this for years would rise with ease—only to find a patient tormented by insomnia,

“Mr. Yamada is calling for you.” They informed me. The man himself naturally lacked strength to raise his voice; he was gasping and grinding his teeth. “The injection…” “The injection…,” the patient said, then hissed through clenched teeth in pain. Needless to say, neuralgia had him in its grip. Then the caretaker would rush to the medical office in nightclothes and summon the night-duty nurse. In the deep night when even plants lay still, that feeling one gets while running down hushed corridors, listening to one’s own footsteps—it defies description. The medical office stood at the hospital’s western end; the long corridor connecting all wards lay dimly shadowed, glass-paned doors revealing rows of half-decomposed figures. As those shapes flickered into my peripheral vision while running, I became acutely aware—as if anew—that this was a leprosarium. Returning from the medical office, I stood motionless in the ward until the nurse arrived, waiting while watching sweat cascade down the patient. For caretakers, this must be their most helpless moment. Whether drenched in sweat or otherwise, there was nothing to do but stare vacantly—

"Look upon this," I thought. The state of this ward— Was there even a single living, breathing human being here? Everyone was dead—everything gray, death's own hue. Here flowed no resilient motion, no whispered breath of hope. No—worse still—not one human soul remained here. They were not human. Something else entirely—beings unlike any I'd ever known—now groaned in death throes. I too was among them. "I'm dead... dead—"

As an impression from my time performing caretaking duties in the tuberculosis ward, there exists a passage in my diary where I wrote these words. I can still vividly recall the feelings I had when writing this—though that too had occurred in the dead of night. When roused awake by the summons, the man in the neighboring bed informed me that Mr. Yamada appeared to be in distress. Still heavy with sleep, I staggered unsteadily to where he lay and found him facedown, his torso hanging over the pillow as he clutched a piece of dark red blood-soaked gauze in one hand and gasped for breath.

“What’s wrong?”

I was slightly irritated at having been woken in the middle of the night. “G-gak… blood…” “What?” “G-g-g-g…” He stammered, unable to speak, but then I suddenly realized. It was a careless oversight, but I finally understood he had coughed up blood. "Hemoptysis? That’s bad news." I hurriedly made him drink saline solution, wiped the blood from around his mouth, then dashed to the medical office. Having only recently arrived here, I was utterly shaken. When I returned from the medical office, I promptly cleaned around his bedside, washed out the spittoon, and waited for the nurse. As I surveyed the beds looming in the dim room—the white futons lined in two rows and the procession of bandaged heads peering out from beneath them—I was struck by a peculiar fury and loneliness. Soon the nurse came, administered the injection, and left. Then I crawled into bed and wrote down that diary entry.

This man who had suffered hemoptysis had apparently emigrated to Brazil and contracted leprosy there, and was forty-five or forty-six years old. He died earlier this spring, but I remember his leprosy wasn’t particularly severe.

×

In the critical care wards dwelled patients of a kind that healthy people could never even imagine. Moreover, there existed grotesque sights unlike anything found elsewhere on Earth.

The very first thing that shocked me upon arriving here—though I had written about it in my novel *The First Night of Life*—was when I saw a man with a hole in his throat ravaged by laryngeal leprosy. But what struck me next as utterly bizarre was the sight of a blind woman—her eyeballs reduced to viscous sludge, her scalp completely bald—breathing through a black rubber tube inserted into her partially collapsed nostrils. And with both ends of that rubber tube protruding about half a centimeter outward in parallel, it appeared all the more eerie.

However, when I performed caretaking duties this spring, I was shown something even stranger—or rather, utterly bizarre.

She was also a woman—thirty-seven or thirty-eight, perhaps forty years old—with a severe case of nodular leprosy; her face was ravaged by advanced ulcers, and she was blind. During my night duty that evening, she called me over and said there was a bat-shaped mouthpiece in her bedside cupboard that I should retrieve. Each bed had its own cupboard attached, and when I opened hers, there indeed lay several wax-coated mouthpieces elongated into rods, scattered haphazardly inside. When I asked what she meant to do, she told me to insert one into her nose. “Hah!” I exclaimed despite myself, but she insisted this was better than a rubber tube—you could replace it daily with ease. Then, with the mouthpiece’s tip protruding from her partially collapsed nostrils, she drew breath two or three times,

“Hmm, hmm.” “It works perfectly.” Speaking of bat-shaped mouthpieces—I, who had only ever used them for smoking—felt I had witnessed something truly bizarre, but it wasn’t impossible that I too might one day come to use them as she did. I laughed even as I shuddered.

In Ward 6 there was Mr. Y, who had been moved from ward to ward over several years.

As for matters concerning Mr. Y, I found myself scarcely able to muster the energy to write in detail; or rather, whenever I attempted to write about him, I somehow began to feel suffocated myself.

A person’s age can generally be inferred from the shape of their face, their expressions, and the movements of their body; moreover, it is precisely through such gestures and expressions that the very word “age” comes to fit naturally into place. However, when it comes to a person who has lost all such attributes entirely, even contemplating the very notion of age feels somehow mismatched and incongruous. Mr. Y was still only about forty-seven or forty-eight that year, but when one looked at him, one felt he had already transcended such human conventions as age. Just as no one—unless they’re an archaeologist—would look at a skeleton and wonder how old it might be, when observing Mr. Y, not only was discerning his age impossible, but no such curiosity even arose. This was because Mr. Y was quite literally a “living skeleton.”

Two eye sockets where eyeballs had escaped, leaving cavernous hollows; sunken cheeks with cheekbones jutting upward; a head devoid of even a single hair and crisscrossed with fissure-like creases—this was Mr. Y’s head. At first glance, it seemed almost miraculous that ears remained attached at all. Both upper arms had been amputated beyond the wrists; moreover, his elbow joints served no purpose whatsoever, dangling from his shoulders like two rounded rods. Furthermore, both legs were severed at the kneecaps. The lower portions had been entirely cut away. In short—to put it plainly—he was reduced to nothing more than a head and torso. I marveled that he remained alive in such a state, but considering one needed limbs even to hang oneself, Mr. Y could no longer perform even the motions required for suicide—let alone chase away the fleas crawling restlessly across his back when they vexed him.

When mealtime came, Mr. Y would nevertheless get up and sit before the cupboard. When the caretaker patients served him rice gruel in a bowl, he would flick out his tongue like a dog to probe the area, and upon locating the bowl, thrust his head into it to begin noisily lapping it up. It was no metaphor—he looked precisely like a dog or 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 wiping off, but of course he couldn't manage the human-like feat of using a hand towel properly. For this purpose, preparations had been made: several layers of gauze were spread out beside the futon. Mr. Y would flop down sideways, then press his face against the gauze to wipe it by rubbing. The gauze—already yellowed from repeated use, though the caretaker patients occasionally replaced it—didn't so much clean as redistribute clumps from one spot to another. Oblivious to this, Mr. Y would burrow back into his futon convinced his face had been properly cleansed.

Last night I went to the ward where this man was staying on some business, and Mr. Y was still alive. But his strength had visibly diminished, making me think he might die soon. What astonished me was how he maintained such an extraordinarily bright disposition despite his condition—exercising meticulous restraint by never drinking more water than absolutely necessary, reasoning that even using the toilet required the caretakers' assistance. And when we let him smoke or helped him relieve himself, he would state his gratitude in a perfectly clear tone with a single "Thank you kindly." Moreover, he showed considerable knowledge of haiku, sometimes offering critiques so astute they took one's breath away when someone read poems aloud to him. Whenever I saw him, I couldn't help thinking: here was a man mercilessly oppressed beyond endurance and confronted solely with reality's worst possibilities, yet desperately continuing to guard his life. Whether one views this as noble or despicable is entirely their prerogative. But the fact remains unshakably certain—no matter what anyone says—that there exist humans who keep fighting to protect their lives.

×

In leprosariums, it was not uncommon for parents and children or siblings to be hospitalized together. Or rather, more than half had parents and siblings there, compelling one to realize how severe familial transmission was. Indeed, while medical science acknowledged that the leprosy bacillus had far weaker infectious power compared to tuberculosis and other chronic diseases—a fact corroborated by the absence of explosive patient increases—within families transmission nevertheless became easily possible through prolonged contact and exposure to infected parents during childhood's most susceptible period.

"(Omitted) Around the fifth day of the New Year, a New Year’s greeting card arrived from Father at Aiseien (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. Yōko, Kiyohiko, Happy New Year. Did everyone have a safe New Year? Dad had a somewhat lonely New Year, separated from all of you. May this father soon recover from his illness, return home, and let us all have a joyful New Year together as a family. By now, there must be a great deal of snow piled up there. But here it is quite warm, and the plum blossoms are blooming. (Omitted)"

From then on, we could hardly wait for Dad’s letters. Whenever the postman came by, I would rush outside to see if one had arrived. I fell ill around that time. Before getting sick, I’d been unbearably sleepy for some reason. Even during school lessons, I kept dozing off, my head nodding again and again. (Omitted) Then Father came home too. That day, I’d followed Mother to the fields. My little sister Etsu-chan and brother Kiyo-chan were still at school. They came back shouting “Mom! Sis! We’re home!” but froze when they saw Father in the living room, staring at him curiously. When we asked, “Do you know who this is?” “Hmm… no,” they replied, shaking their heads. “You’ve forgotten me, haven’t you? It’s been so long,” Dad said with a laugh.

That night, we had a joyful and happy dinner together as a family. After that, Father examined our bodies like a doctor. Then, besides me, Mother and my younger brother were also ill. “Your older sister, older brother, and younger sister don’t seem to have the disease,” Father said, “but since their bodies were weak, they’ll need to be examined over there once.” I informed only Hikari-chan next door about coming here. “(Omitted)” — Published in *Aisei Jidō Bungei* (Children’s Literary Arts), Volume 6, Issue 6. *Jinroku*, by Yōko—

This is but one example, yet facts of this kind are indeed numerous.

My hospital housed over a hundred children at the time, and nearly all of them had been admitted alongside a parent, older brother, or sister; among them were even siblings not yet ten years old. The siblings were ten and eight years old and had entered school that year, yet in terms of their illness, they were far more experienced than someone like me, having already been hospitalized for five or six years. As for the younger brother, his case was one of such rare early onset that he had already become a patient and been hospitalized from around the age of three.

In early March, when cold winds still blew, an eleven- or twelve-year-old boy was admitted. His illness was mild; his eyebrows were thick; and his large, round eyes shone with a wild intensity typical of a country child. However, his right leg had been affected, the joint ruined, and when he walked, he dragged his leg with a pronounced limp. The boy had been brought by his uncle, but when parting came, he clung to a pillar in the clinic and wailed loudly; that night too, he cried straight through until morning. It was said he had been separated from his biological father eight years prior and raised by this uncle.

Yet the father whom this boy must have found utterly impossible to imagine was indeed hospitalized in this very institution, groaning in critical condition within the intensive care ward. Of course, it was not long before the boy too was informed of his father’s presence, but when they showed him his critically ill father with the words, "This is your father," how his nerves must have quivered. The father’s body had swollen livid from severe infiltration, his entire form bloated and flabby like a nephritis patient’s; worse still, a hole gaped in his throat ravaged by laryngeal leprosy, through which he barely breathed via a cannula. His voice rasped hoarsely—every word he uttered provoked three or four coughs through that ghastly aperture. ――The truth is, I first became aware of this father and son when I was asked to take up caretaker duty in the ward where the father was admitted. I had known of the boy’s hospitalization prior to this, but never in my wildest dreams had I imagined his father was here too. The boy came to his father every night and would care for him in various ways. On nights when I was on night duty, he would appear shuffling down the corridor, and upon seeing me reading a book atop the night-duty cot, he would bow his head once with a soft smile before approaching his father’s bedside. Moreover, when I would come to clean the cannula under Mr. T’s instruction, the boy would arrive and, with an expression tangled between terror and curiosity, compare the roughly two-bu-diameter hole gaping in his father’s throat to my hands working to thread slender strips of gauze into and out of the tube extracted from that very aperture.

×

Here, I feel compelled to offer a brief preliminary explanation concerning cannulas and laryngeal leprosy.

When one spoke of laryngeal leprosy, it was often thought to be a special pathological form—a type affecting only the larynx. However, this was not the case; rather, it referred to instances where ordinary nodular leprosy had progressed and finally come to affect the larynx. The primary laryngeal manifestations of leprosy—infiltration by leprous nodules accompanied by swelling, ulcers, and similar lesions in the airway—ultimately led to respiratory distress. Of course, being a chronic disease of this nature, there was no such abrupt onset where someone who could breathe normally until yesterday suddenly fell into respiratory distress today. Rather, as the disease progressed, swelling and ulcers gradually developed until eventually there was no longer sufficient respiratory volume to sustain lung function.

So even if one was afflicted with laryngeal leprosy, it did not mean the airway became entirely obstructed. Of course, if left untreated, it would eventually become completely blocked, but before reaching that point, patients would complain of pain and have a hole opened; thus, even after the hole was made, they could still breathe through their mouth and manage to produce a hoarse voice. Naturally, if the condition progressed further from that point, they would lose their voice entirely, and even breathing through that hole would become difficult; however, in other cases, after the hole was made, the progression halted, the infiltration and ulcers healed, rendering the created hole unnecessary. Such cases were rare, but there actually existed one such case in a ward about two buildings away from mine—a man who now wore a bandage around his neck since the hole had become unnecessary. Let me clarify: This bandage was not applied as medical treatment to seal the hole; it merely covered it because leaving it open would have allowed air to leak out.

The hole is made between the first and second rings of the trachea, far below the vocal cords; thus, that those who have had this hole made can still speak or chant Buddhist prayers may seem a puzzling phenomenon at first glance. However, I believe the preceding explanation has made the circumstances largely clear. When speaking, those with tracheostomies skillfully raise their hands to briefly press the hole, ensuring air flows into their oral cavity.

On this point, I deeply regret that my previous writings provided insufficient explanation, but I must beg your pardon for this inadequacy. In my hospital, we use tracheal double-tube cannulas numbered 5, 6, 7, and 8. Namely, those with diameters of 7⅔ – 8½ – 9 – 9⅔ mm. (Refer to the Iwashiya Medical Equipment Catalog.)

The above was my response to the short review column in *Bungeikai*, but as there might be others harboring similar questions, I decided to record it here.

× At times, parent and child would be hospitalized together. About half a year after the aforementioned boy’s admission came a girl named Haru-chan with her father. Though only nine years old, her large build and worldly manner made her appear twelve or thirteen—combined with an exceptionally beautiful face that set the entire hospital abuzz with talk whenever she appeared. Her illness being mild and of the neural type left no outward trace suggesting she was a patient. Jet-black eyebrows and limpid eyes set close like a Western child’s would have recalled Shirley Temple herself had her cheeks not been so gaunt. Yet considering how these patients—having dwelled for years among decaying flesh, sunken noses, and livid skin—harbored an insatiable hunger for beauty, one couldn’t deny she appeared all the more radiant through their starved gaze.

However, this child’s father was in critical condition—moreover suffering from tuberculosis or something akin to it—and unable to be transferred from the general ward to regular housing, he was admitted to the critical care ward, where he died not long after. This parent and child had brought with them a large, well-trained dog that seemed strong, and for a time, they formed a peculiar family unit within the general ward that unsettled people.

When I consider this parent and child, I find myself thinking this must represent leprosy's quintessential tragedy—yet in truth, they had been what society calls leprosy beggars before coming here. This Miss Leprosy, having just turned nine, would walk about begging after placing her father—whose freedom to walk had been stolen—in a wheeled box pulled by their powerful dog. Her mother too lay ill at home by then, already bereft of strength to stand, waiting for their return—a human drama tragic in the most literal sense. The mother had died shortly before their hospitalization.

So when they were admitted, they were covered in lice from head to toe, and apparently even the caretaker patients couldn’t approach them closely. Their hair was wildly disheveled, and their hands and feet were thickly caked with grime, emitting a foul odor—this went without saying. However, once they had bathed, gone to the bedding area, and returned with their hair cut into bob styles, they were utterly transformed, the caretaker patients said.

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

This was the ailing father’s reminiscence.

However, one morning, as I was walking through the fields as usual, I came upon a group of people emerging from the crematorium. When I looked, there at the very front walked that child, cradling the funerary urn.

“What happened? Who died?” I asked. “Dad,” she said with a laugh. She showed no particular sign of sorrow; rather, she appeared almost cheerful as she cradled the urn.

×

In the dim light of early dawn, or in the fading light of dusk, the *clang, clang* of bells would sometimes echo throughout the hospital grounds. Then the ward residents would, “Someone’s dead.” “Who could it be?” “It must be Mr. Saitō from Ward 9—he’s had auxiliary nursing for over ten years now.” “When I went to check last night, he was already on the verge of death.”

And then those who belonged to the same sect as the deceased’s religion, or those who had been closely acquainted with them, would troop into the sickroom one after another. In other words, when there was a dead person, the caretaker patients came out in front of the room and struck a bell to announce the death throughout the institution.

Within the hospital grounds existed religious groups such as Shingon Buddhism, Jōdo Shinshū Buddhism, Nichiren Buddhism, and Christian denominations (Protestant and Catholic), through which the deceased were buried. Supplemental care referred to a system where, when a patient’s condition became critical and caretaker patients could no longer manage alone, members from these groups would take turns assisting them. Of course, it was structured so that close relatives and friends of the patients would also alternate in providing care. Yet there were often those who joined none of these religious groups. While friends might handle supplemental care adequately, when death came, there would be no one to conduct the funeral rites. Deeming this unacceptable, arrangements were made for each sect to take turns being responsible for such obstinate cases. To be sure, these were exceedingly few—amounting to just over ten among more than twelve hundred patients—and moreover, when death actually approached, they seemed to grow fearful, suddenly adopting a pious disposition to cling to some sect or another. Thus such cases remained profoundly rare. I myself am one of those constitutionally incapable of trusting religion, yet perhaps when my breath grows short, faith might abruptly surface. Though I now find myself intensely curious about this question, human psychology facing death appears to lay bare nothing but vulnerabilities.

The corpse was placed on a stretcher, and the caretaker patients carried it to the dissection room. Adjacent to the dissection room stood another small chamber where people would come to chant Buddhist sutras or begin their prayers. Flowers had been enshrined in that room, giving it the air of a makeshift temple, but at its far end lay a removable partition panel designed to allow viewing of corpses laid out on a table in the dissection corridor. During sweltering summers or bitter winters when deaths multiplied, bodies of those who had perished in quick succession sometimes lay piled three or four deep upon that platform.

Once the autopsy concluded and the necessary parts had been taken as specimens, the patients would gather there again, and soon a funeral procession would begin. The corpse was placed in a plain wooden box, and as they pulled the handcart bearing it, a bizarre procession continued toward the crematorium. A man without a single hair on his head; a woman with a twisted mouth; faces and hands swollen lividly dark; an old man leaning on crutches; a boy with a prosthetic leg—such grotesque figures clustered around the handcart at the center, forming a spectral procession that wound through the fields—a sight unearthly enough to seem scarcely of this world. In the distance, the ossuary’s white domed roof came into view.

When we reached the crematorium, Buddhist invocations were chanted there once more, and the Christians sang hymns with voices trembling sentimentally. From the thin, small chimney, smoke billowed out, and the stench of corpses permeated the entire hospital grounds. Thus ended a life filled with suffering. A few bone fragments were placed into a hospital-made ossuary jar—shaped like a teacup, crafted by patients—and arranged on the ossuary shelves, just as Haru-chan had carried them. “That person’s dead and we’re relieved now, aren’t we?”

“Is this truly what passes for our world?”

The elderly women, having finished their Buddhist invocations, talked about such matters as they left the place. And so they returned once more to the world of illness and suffering.