Chapter 2.5

That night after the all night vigil at the Yasumori house had ended, Seishin visited Toshio. At that time, Toshio was in his private room just looking over Nao's test results. 

"Yo."

Toshio motioned Seishin who came through the rear courtyard as usual to come inside. 

"Was Nao-san----as expected?"

To Seishin's question, Toshio nodded. 

"Most likely, yeah. Nao-san came into the hospital on the 24th, and died this morning on the 27th. She was sick from the 23rd it seems, which would made it four days until she died. Overall no subjective symptoms but she got tired easily, her head was heavy, and she said she was spacing out. Anyway, as far as the exam went, it was thought to be anemia, and the test results said anemia. Other than the anemia there was nothing particularly wrong."

"That is like Megumi-chan was...."

"Right, the same pattern," Toshio nodded. "Really seemed spaced out, no matter what you asked, she didn't give any answers that hit on anything. Even using her mouth seemed troublesome, or maybe there was more the impression her attentions were diffused and she couldn't get her thoughts in order. This is like Megumi-chan's case, too."

"I see...."

"The blood tests on the 24th didn't show anything out of the ordinary besides the anemia. In normocytic normochromic anemia, all types of blood cells are fewer, looking at the net red blood cell counts. All kidney and liver functions were within normal ranges; we looked for internal bleeding but we didn't find any of that either. On the other hand," Toshio motioned to the results pinned to the medical record. "These are the results from when she came into the hospital on the 26th. They came in today. Looking at this, everything's wrong all over. The kidney and liver functions are hugely out of normal ranges. Her anemia improved some but just the opposite everything but that got worse in exchange, it's like. And this morning she died. Looking at the corpse, she was slightly jaundiced, dropsy, ascites, and had other trends towards blood loss, with signs of liver and renal failure. She presented as if she'd been choking; in truth, when suctioning her respiratory tract, there was a froth of blood frmo the lungs in her airways. Respiratory failure due to a pulmonary edema due to heart failure. But, we took a EKG of this before too. At least the first time she came into the hospital, there was nothing to show signs of heart failure. There were no problems aside from the anemia, as few as three days before. From there she had a full body breakdown. The cause of death was suffocation from heart failure but, the heart failure itself was just what happened to become the trigger. Looking at the way it progressed, it wouldn't be strange if the liver or kidney or something else became the trigger. Rather than heart failure, it's like MOF---Multiple Organ Failure."

"....The chances of it being an epidemic are?"

"None. At least, according to the test results, they all turn up negative."

"It's that, then, huh...."

"More than likely, yeah. The first problems with her condition were ones you couldn't help but think were her suffering from the summer heat or a summer cold. From there it took a sudden, fatal turn for death but, its transition is obvious. From the time until it turns deadly to the first signs being anemia, it's incredibly similar to Megumi-chan's case."

"It begins with anemia?"

"The odds of that are high, I think. It might've been better to tell Ishida to rewrite the leaflets to say that anemia is common and to be careful. To list anemia's objective symptoms and what it feels like, and to come to the hospital right away if it looks like that."

Seishin nodded. 

"I was barely able to ask her, and after asking Mikiyasu and putting it together, it doesn't seem like her original family had any chronic illnesses that fit the bill. Nao-san's real father was a deadbeat, and the ones who raised Nao-san were her uncle and his wife, but anyway as far as what I could get from Mikiyasu, I don't think there were any hereditary problems. I can't think of any particular lifestyle habits she'd had that would be a problem. She was a social drinker, and didn't smoke. She basically stayed in the village during her daily life, and aside from when she might have gone to Yamairi, she didn't go into the mountains. At most she'd go to Mizobe to do some shopping."

Seishin looked at the notebook page where Toshio had written 'Yasumori Nao.' As a doctor he'd asked all he could of the person and the family, and indeed nothing was left unchecked. 

"The contractors don't use well water. It's not all from the above ground lines but only the air conditioner in the office uses ground water. It's the same as at the Maruyasu sawmill."

Seishin took notes while nodding. Yamairi didn't have waterworks. Gigorou and the Murasakos both used well water. At the Gotouda household, the drinking water was from the waterworks, but the bath water and laundry used well water. In Shimo-Sotoba where Megumi lived, most houses used waterworks but for farm works ground water was used, and just before Megumi had died she had been seen climbing the western mountains. If she had a normal habit of going into the mountains like that, she might have drank water from the swamp there. Putting those lines of thought together, it was possible to think that the source was in the water, but.

".....Wouldn't it be the water?"

"If you think about the contracting firm and Maruyasu, the odds are probably pretty low. The odds of it being something or another polluting the water or some kind of poisoning or contagion have pretty much been whittled down I think. There's still a chance that it might have first gotten to the person through water but water isn't the source of the contamination."

"So for example, the water in Yamairi may have been contaminated, and from there the three in Yamairi were infected, and after that, direct transmission?"

Toshio nodded. "If we say water was the cause, that's what it'd come to but Megumi-chan and Giichi-san are the bottleneck. Thinking of the obvious, I can't think of how Megumi-chan would make contact with Yamairi or the three from there or Shuuji-san. It's just I can't say that for certain."

Seishin nodded. Megumi lived in Shimo-Sotoba but, as they knew from the day she had gone missing, here sphere of activity spanned the upper communities.  It wasn't impossible that she met with the three from Yamairi or Shuuji by chance.

"Moreover the one who becomes a problem is Giichi-san. If Nao-san's case is the same thing, I can't think the source was anyone other than Giichi-san. If she was infected in the middle of august, this is right during the time when Giichi-san had died. According to Mikiyasu, Nao-san was always coming and going from the Maruyasu sawmill. She visited Giichi-san for a get-well visit three times or so, and on Bon the whole family was gathered at Maruyasu. Indeed smack in the middle of August. It wouldn't be strange at all for her to have caught it from Giichi-san. But, where Giichi-san would have caught it from I don't know. Giichi-san's sphere pf activity was just about nonexistent. He was totally bed ridden, after all. All I can think of is that it's possible one of the three from Yamairi or Shuuji-san had come to meet with Giichi-san but---"

"It doesn't seem so," Seishin shook his head and turned his eye to his notes. "I tried asking Atsuko-san from Maruyasu but it seems Shuuji-san and Giichi-san had no relations whatsoever. It seems he never set food in Maruyasu. It wasn't as if the three from Yamairi had no connection to Yamairi at all. Giichi-san did know them but, they weren't especially close. It seems they didn't take the trouble to come visit Giichi-san. If they had business with Maruyasu, they would incidentally pay Giichi-san a sick visit, incidents like that may have happened before, but Giichi-san was sick for a long time. Before, there had been customers who would visit Giichi-san but lately that had petered out, in current times, it seems."

"Seems so. That person'd been stuck in bed for six years or so now. When I came back, he was already bedridden and all."

Seishin nodded. "So, the ones who met with Giichi-san were largely only family members. Particularly the people from the contractors. Also, people from the main Tamo family. Sadaichi-san seemed particularly close to Giichi-san. Then there were a few people he in his inner circle."

"No connection point then.... Is it impossible that it spreads directly after all?" Toshio sighed as if fed up. "---And the others?"

As he was being urged, Seishin opened the folded up notes and presented them. 

"For the three in Yamairi and the Gotouda household, their families are spread out and I don't know the specifics. .... But." Seishin repeated the story he'd heard at Chigusa. That the day before Shuuji fell ill, he'd gone to Yamairi and Gigorou had left Sotoba, that when he'd come back he'd seemed off. 

"Shuuji-san went to Yamairi on the second, huh..." Toshio made a sullen face. "That's certainly something. If it was the second, Hidemasa-san should have been dead. Shuuji-san shouldn't have seen a dead body, if he did, he would have called somebody. That he didn't means he visited but didn't see them, but."

"That's right."

"But Mieko-san was there wasn't she? She wasn't doing well and her husband was dead next to her. If she was having a lapse in consciousness due to liver failure, she might have ignored that someone came to visit. It's possible she might have just been asleep, and not noticed that Shuuji-san had come but..."

"Then there's Gigorou-san. ---Say, couldn't we think that Gigorou-san brought something in from outside of Sotoba? And then it was something that Shuuji-san caught in Yamairi."

"I wonder." Toshio twisted his neck. "Of course, there's the incubation period to consider too. For influenza the average time is two days, for cholera, it usually breaks out in a day or two too but. Still, thinking of it like that, where Fuki-san caught it, I wouldn't know."

"That's true. Did Fuki-san catch it from Shuuji-san...."

"I can't say for sure, but. it might be like Japanese encephalitis." When Seishin tilted his head, he continued. "Japanese encephalitis is carried by mosquitoes. It doesn't spread from person to person. If that's the case, there might be that possibility, too."

"Actually," Toshio said poking a finger down on the medical records. "Thinking about it from the end, when the organs all start to break down, it's like something starts in the blood and effects all the other organs. If it comes in through the digestive tracts or the respiratory system, it wouldn't be impossible for the pathogen to invade through the blood, and if that's the case, then at first it may seem to appear as a response to something foreign in the digestive or respiratory systems. But, there's no symptoms of vomiting or diarrhea. If we think of it like this, we can reason that it's a point blank blood-based infection."

"From a wound?"

"Right. Actually, when Megumi-chan fell in the mountains, she had countless little scrapes and scratches. Nao-san didn't have any particular injuries but she had countless mosquito bites. I think there's a possibility it spreads through an animal as an intermediary like Japanese encephalitis. Not person to person, but moquitos or fleas, or ticks as intermediaries. If we consider that, it explains the lack of contact between Megumi-chan and Giichi-san."

That said, Toshio pointed at Seishin. "I can't deny that possibility. You be careful."

"Why?"

"Why?" Toshio said eyes wide in frustration. "Yamairi, right? Megumi-chan was found around the mountains in the Maruyasu back yard. Nao-san's house is a little separated from there but she came and went from the Maruyasu Sawmill. The Maruyasu Sawmill is at the foot of your guys' mountain."

"That.... is true, but?"

"It's all around the northern mountain. There's a chance the intermediary carriers are coming from the northern mountain and spreading out. Yamairi's on the other side of the northern mountain, and Megumi-chan was found just at the place where the northern mountain and western mountain meet up."

Seishin nodded. Certainly in that area the mountain stream flowed towards Yamairi in a loophole shape. When Seishin was small, there was a direct wire line down between the Maruyasu sawmill from Yamairi, a lumber path. As forestry declined, now there wasn't anybody elft who used it, and already the path was grown over with underbrush but that path that followed the mountain stream was still plenty cleared enough for animals to use it. ---For example, wild dogs and the like.

Seishin remembered the disastrous scene at Yamairi. "Wild dogs?"

"We could think that way. The dead didn't have any bite wounds while they were alive, so it can't be that the wild dogs are transmitting it but it is possible that the wild dogs have fleas or ticks that do. Just earlier, the Ohkawa Liquor shop's son was bitten by a wild dog. Before that, the Inoda's Motosaburou-san I think it was was attacked by a wild dog. It is true that the wild dogs in the surrounding mountains are multiplying. Those who go into the mountains seem to be tremblingly afraid of it. From the gossip the people who come in for exams say, they've been multiplying in Yamairi and coming down south, it sounds like. There was a patient just recently who mentioned seeing three wild dogs just above the shrine area and all."

"Do you think there's a need to hunt for wild dogs?"

Toshio pondered. "There is a chance the wild dogs are carrying a disease. I'd need to do research..." That said, Toshio let out a huge sigh. "But, the hell'm I supposed to research? If I'm supposed to catch a wild dog and see if it's housing a pathogen or not, then not even knowing what that pathogen is is kinda, well."

"That's true."

"Well, rounding up the wild dogs in the area just in case wouldn't hurt anything but the problem's what kind of reason to give. If we do it carelessly, we might just be stirring the pot but the cause isn't limited to dogs. It's pretty risky."

Seishin nodded. He couldn't deny that the chance to use Ohkawa Atsushi and Inoda Motosaburou's cases as an impetus was long passed. Using those as the reason would seem out of place more than likely.

"This isn't something we can push using the next time someone's attacked as a chance, either."

"But..."

"This isn't just about exposing that there's an plague. It's easy for you to say wild dog hunting but how do you assure the safety of the people actually doing it? The people who go out to round the wild dogs up might be prepared for their teeth but they're not going to be ready for the ticks and fleas are they? If we're going to have them doing that, then we'd need to give them detailed instructions about the plague from the start."

"What about poison bait?"

"That's just changing which part's risky. Let's say the intermediary's fleas. But, once the dog dies, they'll leave its corpse. While we're doing that kind of extermination, unless we have a way to wipe them out too, then instead we won't be able to stop the spread of fleas."

"Is that right," said Seishin, biting his lip. 

"Well... the wild dogs might be the ones carrying the disease but, there's the possibility that it's not just them, too. Rats and rabbits, maybe even wild birds. And the fleas and ticks attached to them.

If that's the case," said Toshio, his voice low, "we're going to have a hard time."