A review of Through the Hospital Gates: Hansen’s Disease and Modern Japanese Literature, by Kathryn Tanaka.
Kathryn Tanaka’s dissertation examines the rise of “leprosy literature” in modern Japan, a body of literature written by patients diagnosed with what is now known as Hansen’s Disease. Her work is a welcome addition to studies of modern literary expression in the twentieth century for the ways it links literary production with the history of modern medical policy. While the dissertation as a whole provides a helpful overview of patient writing from the early twentieth century to the present, her dissertation is primarily concerned with “leprosy literature,” written under a public health regime existing prior to the introduction of the curative drug Promin in 1946, when treatment was primarily palliative rather than curative and diagnosis often meant a lifetime of confinement within the hospital system. Tanaka is thus careful to maintain the crucial difference between the two terms, “leprosy literature” and “Hansen’s Disease literature,” retaining the context of stigma and prejudice associated with the former term. Through close readings and translations of patient writings including short stories, free verse, and tanka, her study takes up three writers who represent the rise and range of leprosy literature from the 1910s through the 1940s, to explore the ways that patient communities used writing to give an account of their illness and quarantine experience in the public hospital system.
Despite the policy of compulsory lifetime confinement that was mandated under the 1931 Leprosy Prevention Law, Tanaka invites reconsideration of leprosy literature’s characterization as a “literature of quarantine” (kakuri bungaku), and instead suggests that the production of such writing was employed by patients as a connective activity: within, across, and beyond the hospitals. As she puts it, rather than writing a history of “leprosy literature” as a literature of quarantine, her project “investigates the ways in which patient writing was fundamentally connective on a multiplicity of levels: among patients as well as between patients and different groups outside the hospital” (p. 3). Her title, “Through the Hospital Gates” underscores the boundary as well as the permeability of those boundaries: that confinement was never complete, and patients represented and shared the experience of their illness and hospital life on their own terms. The focus on its connective effect thus allows her to highlight the productive nature of patient’s confinement experiences, and furthermore suggests that interpretations of patient writings require more nuanced approaches rather than interpreting them simply as the propaganda of the hospitals or expressions of a single author’s struggle with illness. With care, she provides ways of understanding patients’ differing views on hospitalization as benevolence or coercion.
In her introduction, she describes the etiology and history of Hansen’s Disease in Japan, including a survey of historical representations of what was thought to be Hansen’s Disease in historical records from the Nara period (710-784) to the modern era. This history provides a context for understanding the importance of the emergence of patient writing in twentieth-century Japan, against a long history of popular understandings that attributed a variety of moral and karmic sins to sufferers of the disease. The emergence of patient writing thus opened a space for self-representation and nurtured new ways of social engagement. But as she reveals, this facet of self-representation was always in danger of being used to different ends by doctors of Hansen’s Disease relief organizations, such as the Leprosy Prevention Association, who sought not only to encourage patient writing as therapeutic, but encouraged it as a means to correct popular representations of the disease or to encourage compliance with government quarantine policies (p. 76). Thus, patient writing was never fully independent of the intervention of relief workers, hospital administrators, and doctors.
The first chapter discusses Shimada Shakusō, a patient who admitted himself into the Kyushu prefectural hospital in 1924 before the compulsory confinement law, upon failed attempts at a cure and recognition of the negative ramifications that his contraction of the disease had upon the family. Shakusō, who was a founding member of the first literary magazine by patients in the Kyushu Hospital, broke new ground in bearing public witness to the disease, but also embraced the connective bonds made between writers by the discussion of shared experiences as well as the practices of reading and composing poetry in circles. In this chapter, Tanaka reveals the breadth of patient writing activities, showing its circulation within and beyond hospitals, reading practices among patients, and involvement of doctors and medical staff. Her first chapter also engaged with a fascinating case of a journal published out of the colonial hospital in Taiwan, and examines the tighter controls over patient writing that were in place in the colonial peripheries.
It is to Tanaka’s credit that she also tackles the thorny and at times uncomfortable figures that have since been marginalized within the genre, such as those who took up their pen to defend hospitals as utopian places in support of government policies. Her example here is Nagata Honami, the subject of the second chapter, whose case allows her to “restore some of the plural, conflicted nature of leprosy literature and the multiplicity of purposes that patient writing served” (p. 112). Indeed, she approaches anew his Christian and nationalistic poetics that endorsed the government’s confinement policy, and re-reads his writing as part of an effort to make his suffering meaningful on a national and religious level. In doing so, she reconstructs the prevalence and pervasiveness of stigma toward those who contracted the disease, and recognizes the motivations of patients to protect their families from discrimination as well as the salvation offered by the idea of sacrificing oneself for the nation. The chapter also includes a fascinating discussion of the wide circulation of his writings through the early English language translations by Christian missionaries that took an interest in his works.
In the third and final chapters, she takes up the most famous figure of “leprosy literature,” Hōjō Tamio. His appearance signals a new stage of visibility of “leprosy literature” within the late 1930s literary scene beyond the hospital walls, as Hōjō’s stories were published in mainstream literary publications ぷbりcあちおnsuch as Bugakkai through the mentorship of writer Kawabata Yasunari. Unlike the other writers she examines, Hōjō wrote without support of hospital administrators, and she convincingly reads his writings as contesting hospital control over the representation of patient experience and the hospitals as a utopian space. Rather than rehash the common interpretation of Hōjō’s most famous story, Life’s First Night (Inochi no shoya), as a means of acceptance of a new life, she draws attention to the resistance his fiction expresses towards the notion of the hospital as utopia or as a space completely under the control of medical authorities. Instead, by foregrounding his depiction of a hospital life including births, suicides, and permeable boundaries between the hospital and the outside world, she shows that Hōjō’s writings undermine the image of the hospital as a space of total quarantine.
Tanaka’s study will no doubt be embraced for its contribution to studies of medicine, disease, and the body in Japan. But what makes her project fresh and exciting to those who work in Japanese literary studies is its translations, close readings, and the careful historical contextualization of the ways that non-professional writers engaged with literature, showing us the shared value placed upon creative expression and its wide circulation as a communal activity. She presents patient writing with the dignity and richness for which it is rarely acknowledged, and paints a picture of the myriad literary coteries that developed beyond the hospital walls and which encouraged such writing by non-professionals. Through her study, we receive a detailed picture of a body of literature that still remains in relative obscurity, especially as it pertains to the realities of what contracting the disease meant for individuals, such as the separation from family, the accompanying change in name, physical symptoms as the disease progressed, and the vicissitudes of daily life in the hospital. And finally, her close attention to tanka and poetry should be applauded, especially when one considers the dearth of studies that examine modern poetic production as social and political matter. Tanaka’s project is a crucial addition to studies of literary history within the context of disease and government control over patient life, and deserves to be read by any scholar interested in the history of medicine and modern literature in twentieth-century Japan.
Mika Endo
Assistant Professor of Japanese
Bard College
Primary Sources
Archives of Kikuchi Keifuen, Kuriu Rakusen-en, Tamazensho-en, Oshima Seisho-en, and Nagashima Aisei-en
Patient magazines (Hinoki no kage, Yamazakura, Papaya)
Shimada Shakuso Zenshu, works by Nagata Honami, Hojo Tamio Zenshu
Publications by the Rai yobo kyokai
Patient and missionary family interviews
Dissertation Information
The University of Chicago. 2012. 241 pp. Primary Advisor: Norma Field.
Image: Dock where patients would arrive at Nagashima Aisei-en, the first national Hansen’s Disease hospital. Photo by author.
