Chapter 1.1

The formerly independent village of Sotoba was now annexed into the town of Mizobe. That town of Mizobe had a Health Department in place but Sotoba's own health department was in the public office---that is, the public office bore the Sotoba branch of the city Health Department. Each community had an official who served at the public office as the health official as well. That said, the only one in charge of it all was Ishida. Basically Ishida worked according to instruction from Mizobe, dolling out orders to each community health official, nothing more than a messenger from the governing to the governed; with no particular specialized knowledge, he was an office worker through and through. On the one in a thousand chance that an epidemic was starting to spread, of course it would be too much for Ishida alone.

On the night of August the twenty third, Seishin and Toshio called Ishida to the temple and explained the situation. At first Ishida seemed to be in half doubt but upon receiving Toshio's explanation, his pallor changed.

"Last summer, four people died. Two in June, one in August and September each. To be precise, those are all the dead that I personally oversaw. The death in August was from a heart attack. For a year, well, that's about normal. On the other hand this year all at once, seven. August isn't even over yet but a in simple comparison of the dead up until now with last year's one, we have a surplus of seven or six people."

"Surplus..."

Toshio nodded.

"Not the best wording but the numbers are clearly too high for a normal death toll is what I'm saying. Now, looking at the raw numbers of the situation and that we have six more than last year wouldn't be anything to make a fuss over. Without a statistical analysis there's no way I can say anything definitive but all the same six people is enough to certainly call abnormal."

That's right, said Ishida with a dumbfounded nod.

"This August, it's certain something's happening in the village. It's causing the abnormal surplus of deaths. Sotoba's an incredibly tiny place, but just the same in one season alone there've been seven. On top of that, most of them were unexpected sudden death by some internal cause. Since it's come to this, it shouldn't be by any means unreasonable to suspect we have a mass outbreak of some kind of disease or another."

Yes, said Ishida wiping at his sweat with his handkerchief. It was an abnormally sultry night. The air was thick and stagnant, the tepid humidity rising. The glass of beer sat in front of Ishida was beaded with drops of water, the foam completely gone.

"But at the same time we're far off from being anywhere near knowing what's actually happening. All I can say about where we are now is that it starts with trivial symptoms, symptoms that while they aren't even aware of it themselves takes a dramatic turn for the worst into sudden death, is what it comes down to. And that it has a trend of spreading like fire to those nearby. If nothing else, I think it's certain it's spreading."

Ishida stared at Toshio with dependent eyes.

"It isn't yet a certainty that it's an epidemic, right?"

"I can't say anything definitive. But, if we cling to wishful thinking, then in the one in a million chance it is an epidemic, we won't get that lost time back. I think it's better to be vigilant as if assuming it is an epidemic."

"But, you know." Ishida patted his forehead with his handkerchief. "If you carelessly throw around the word epidemic..."

"That's the problem," Toshio sighed. "It's gonna be the worst. If rumor of a contagion spreads there the village there'll be a panic. The initial symptoms are too trivial and common, if they lose their cool, then the hospital's functionally paralyzed. It's not definitely a contagious disease but in the case that it is, if the patients march in on the hospital when we don't know the illness or the infection route, it's not just a bother it's a danger. I'd like to minimize that possibility as much as we can, if possible."

Ishida nodded.

Sotoba was dependent on the Ozaki Hospital. In a mountain village of merely 1,319 people, having a proper hospital at all in itself was a rarity. Sotoba had been blessed with such all this time, so that was all the more reason that their faith in the Ozaki Hospital was so high. The people in the village had a certain sense of duty practically taken on through osmosis that they wouldn't go to another hospital without a referral by Ozaki, so all the more reason that if rumors started of a plague, the villagers would mostly flood the Ozaki Hospital without a doubt.

"But.... But then, what should we...."

Seeing Ishida's dismay, Seishin explained.

"Could not a notice be passed about through you, Ishida-san, as the public health official? Phrased as if lately there have been many suffering summer fatigue and to be cautious."

"Circulating a notice is simple enough but..."

"If you think that someone has become fatigued, do not rely on a layperson's judgement and go to the doctor, it would say."

Toshio nodded.

"In the first place in the summer there're plenty who just take in drinks and lose their appetites. Couldn't you say the summer heat's still pretty stringent, so for the time being take in three square meals a day, don't diet excessively? Even a simple 'mind your health''ll be fine. If we do that then at least as much as it'll actually protect against simple ailments, it'll be useful in sieving out a few patients."

"Yes, yes, ---that's true." Ishida wiped at his sun burnt neck. "But, will just that be enough? If we don't take some concrete measures to stop the spread of the infection..."

"Even if we try to take some concrete measures at our current level we don't have any measures to take. At best, all we'd have is don't drink well water, try to bring a canteen with you when going into the mountains, and mind what you're washing your hands and gargling with. Make too loud of a fuss and that'll just be poking the bush with a stick."

"Haa..."

"That's why for the time being the only way we can start is with gathering data. The bunch in the village won't let you touch a corpse. Forget doing a pathological autopsy, they disapprove of even drawing blood after death. If they don't come into the hospital before they become a corpse, we can't even get a grasp on what's happening in the village."

"Yes--yes, that's right."

"There's no choice but to collect the data this way, compile it, then have the administration act on it. It's true enough that if it really does turn out to be an epidemic, it's going to be too much for us."

"Wouldn't it be better for me to pass this report up to the prefecture health department or the city health center?"

"You can try it I guess. But right now without a name to put to the disease, the government won't move. What those guys call an epidemic isn't something spreading around to the people; for them it's a word for an existing contagious disease written into the protocol or manuals. Unless the situation really gets huge, we probably can't count on any support. They can't do anything themselves. If you wanted to hurry it, there's the possibility of saying for example that food poisoning or hepatitis is spreading, but if I get an inquiry from the public office, I can't exactly give fake disease report."

"Th, that's indeed true."

"Anyway I'll collect the data. All we can do is get solid proof if something is spreading, then leave it to Kanemasa to get things moving," Toshio said, his face scrunching. "So I say but while the predecessor was one thing, I dunno if it's all right to rely on that old guy that much or not, but...."

Ishida nodded without really thinking. The previous generation of the Kanemasas, as well as the one before that had served as the village headmen and had been experienced, influential people. That predecessor died last year, and now his son was a member of the Diet but compared to the vigor of his predecessor, he was hopelessly flaky.

"It'd have been better if the predecessor were alive for us." Ishida murmured, then suddenly: "Come to think of it, the Kanemasa predecessor also died suddenly, didn't it?"

Toshio suddenly made a complicated expression as if something bitter had been tossed into his mouth.

"Yeah, but----. No matter how you stretch it, that's probably not related, right? We're talking last July, I'm sure. That was a year ago."

"There is that but. Well, I mean, you know."

"Anyway, in order to collect data first we need patients to come to the hospital."

"Yes, indeed. I understand."

"In the mean time, Ishida-san, this summer's---yeah, since July, I want the list of those who've died since then. There might've been deaths amongst those who weren't my patients, too. If there were, I'd like copies of their death certificates too, but."

Ishida nodded.

"I'll see what I can do tomorrow. At the latest I will have them prepared by the day after tomorrow. My jurisdiction is over demographics but I'll see what I can do about compiling them quickly for that period."

"The day after tomorrow's fine. But, definitely by the day after tomorrow."

"Yes, sir."

[TL/N: But right now without a name to put to the disease, the government won't move. What those guys call an epidemic isn't something spreading around to the people; for them it's a word for an existing contagious disease written into the protocol or manuals.

Epidemics and Japanese Health Laws

Epidemic, densenbyou, literally translates to contagious disease. However not all contagious diseases are legally classified as densenbyou (epidemics) in Japanese. Lay people may use the word translated as "epidemic" to refer to a massively destructive and spreading malady. Medical professionals however would only refer to an "epidemic" as those outlined by the government in the Epidemic Disease Prevention Act, as the word implies specific legal duties on their part. The Epidemic Disease Prevention Act was repealed in 1999 and replaced by the reformed Infectious Disease Control Law. A doctor in the 1990s could accurately declare a contagious disease was not an epidemic (legally), which linguistically would be saying that it was not a contagious disease.

Epidemic Disease Prevention Act

Legal Epidemic Diseases: (cholera, dysentery, typhoid fever, paratyphoid A, smallpox, typhus, scarlet fever, diphtheria, epidemic cerebrospinal meningitis, bubonic plague, Japanese encephalitis). These were reported to the health and town officials, and the patient is to be quarantined for treatment at a cost paid by the government.

Specified epidemic diseases: (polio, Lassa fever). These were diseases designated for treatment identical to the above 11 in the original law.

Required reporting diseases: (influenza, rabies, anthrax, epidemic diarrhea, pertussis (whooping cough), lock jaw, malaria, scub/Bush typhus, filaria, yellow fever, recurrent fever). These were diseases that physicians were required to report within 24 hours to health officials, and treatment could take place either at home or in an ordinary hospital ward.

The Venereal Disease Prevention Law: (syphilis, gonorrhea, chancroid, lymphogranuloma urethritis). These are to be reported to health officials who passed the numbers to national officials.

The Tuberculosis Control Law: A physician must report diagnosis of tuberculosis within two days and their treatment bill will be paid by the government.

Leprosy Prevention Law: A doctor who diagnoses leprosy must report it within 7 days and the potentially effected patients will be put in a sanatorium at the government's cost. This law was also repealed in 1996, designating leprosy as a Legal Epidemic Disease.

The Parasitic Disease Prevention Law was not a part of the Epidemic Disease Prevention Act but is a law stating that the government may spend funds investigating by means of physical examinations or feces exams for signs of parasitic diseases (Roundworm, hookworm, liver flukes, blood flukes (Schistosoma japonicum)) and also in providing treatment for them. This law was repealed in November of 1994.

Without counting parasites as a disease (The Parasitic Disease Prevention Law is actually separate from the Epidemic Disease Prevention Law) that leaves 32 diseases that the government required and took action (read: spent money) on. As the government also does spend money on parasite control Ozaki also mentions that, highlighting the limited expectations had for government intervention on any health matter]