Hospital Regulations.

Various regulations exist, but those of the great Yoshiwara Lock Hospital are typical of the others. They were revised in March 1900, and provide substantially as follows:—

Object of the Hospital.—The hospital is established for the purpose of treating prostitutes who are suffering from venereal diseases, consumption, and other contagious maladies contracted or developed in the Yoshiwara brothel-quarters.

Staff.—The permanent staff consists of about fifty people, including several surgeons, a secretary, four pharmacists, nurses, clerks, servants, etc., and is presided over by a chief doctor. The hospital arrangements are subject to Police supervision.

Medical Staff.—The patients must be visited at least twice a day, and on each occasion details of their condition and treatment entered in a report sheet (by�sh� nis-shi) for the information of the President. In case of serious illness or slow recovery the matter must be reported to the President, and should the symptoms denote immediate danger, the brothel-keeper of the woman’s house must be notified forthwith. Upon recovery, the report sheet has to be signed by the attendant physician, after which the President himself has to examine the patient. It is the duty of the doctors to prescribe the diet of patients, to instruct and supervise the nurse to see that all necessary instruments are provided and kept in proper condition; and each of the doctors are bound to take night-duty alternately. To prevent scandal and collusion, the doctors are prohibited from entering the wards unless accompanied by a nurse, and, as a precaution against incurring unnecessary risks in treatment, surgical operations can only be performed with the approval of the President. When not otherwise engaged, the hospital doctors may employ their leisure time in making medical investigations, and may, subject to the permission of the President, publish the results of their labours in this direction.

Records, Accounts, Statistics and Reports.—Proper records must be kept of the work and accounts of the hospital, the admissions and discharges, and a monthly and yearly report prepared containing detailed statistics. Monthly reports must be prepared by the 5th of the following month, and the annual report by the 10th of January of the following year. The chief pharmacist is also bound to prepare a daily report of all drugs dispensed and to submit same to the President.

Sundry.—Detailed rules are laid down for keeping the bedding and premises in a clean and sanitary condition, for disinfection, etc.; and for the control of the nurses.

Salaries.—That the staff of the hospital is very much underpaid will be recognized upon perusal of the following scale of monthly salaries:

Yen. U.S. $ £ Sterling.
President 80 to 150 40 to 75 8 to 15
Vice-President 50 “ 80 25 “ 40 5 “  8
Physicians 25 “ 50 12-1�2 “ 25 2.10/- “  5
Secretary 20 “ 30 10 “ 15 2 “  3
Chief Pharmacist 25 “ 50 12-1�2 “ 25 2.10/- “  5
Pharmacist 10 “ 25  5 “ 12-1�2 1 “  2.10/-
Clerks 10 “ 25  5 “ 12-1�2 1 “  2.10/-
Chief Nurse 10 “ 20  5 “ 10 1 “  2
Nurses 3 “ 10  1-1�2 “ 5 0.6/- “  1
Servants 4 “ 10  2 “ 5 0.8/- “  1

P.S.—If absent for upwards of two weeks, no salary is paid for the current month, and if absent for upwards of one month they may be discharged from the service. The rules do not, however, apply in cases of sickness.

Financial.—Funds for the support of the hospital are raised by way of forced contributions from the brothel-keepers of the Yoshiwara, and the basis of the annual expenditure is a written estimate prepared prior to the 20th March every year by the President of the institution and the Director of the Brothel-keepers Guild, and approved by the Police authorities. In case of a deficiency occurring, steps may be taken to make good the same by the President and Director acting in concert.

Alteration of Hospital Regulations.—When necessary, the regulations may be altered by the President of the hospital and the Director and Vice-Director of the Guild acting in concert, provided that the consent of the Police authorities has been obtained to the proposed changes.

Sick-Rooms and Sanitary Precautions.—The regulations require that separate wards[67] be provided for various classes of patients, and that contagious cases be properly segregated; also that the premises be kept swept and clean, and all infected matter be destroyed by fire. Bedding and towels are not to be used promiscuously, sheets are to be disinfected by means of hot steam, spittoons containing a 5% solution of carbolic acid are to be provided, table utensils are to be washed in hot water containing corrosive sublimate (1 in a 1000), infected waste paper must be burnt, and even waste paper which is not infected must not be sold until properly disinfected. Patients who have obtained permission from the physicians are bound to take a bath every morning before the periodical examination.

Visitors.—Are not allowed in the wards or rooms unless the patient is unable to move and special permission has been obtained from the physician in attendance. Visitors may, however, under certain conditions, see patients between 9 a.m. and 3 p.m. in a room (�setsu-jo) set apart for that purpose.

Rules for Patients.—While under treatment, patients are required to be civil and respectful in their language and demeanour towards the members of the hospital staff, to wear the regular cotton dresses worn by all inmates, and to observe the regulations governing the institution. No patient is allowed to leave the hospital while under treatment. Patients are required to do their hair up in a simple style, to refrain from entering other wards or rooms except for proper reasons, to refrain from wearing the thick-soled high sandals (takaz�ri) ordinarily worn in brothels, to carefully place all waste-paper in the receptacles provided, to refrain from creating noise or disorder, singing, quarreling, and scribbling nonsense on the walls or furniture. They are also prohibited from lending or borrowing money, gambling, etc.; and (except with the permission of the physicians) from taking food and drugs brought in from outside. In case of wishing to make purchases outside the hospital, permission must be obtained from the physicians through the nurses.

Exercise.—Exercise may be taken daily in the hospital gardens within prescribed hours.

Complaints.—Complaints against the nurses or other persons must be made direct to the physicians in attendance.

As to the actual working of the Yoshiwara Hospital, some caustic remarks, contained in a book entitled Yūkiwaku no Rimen (�廓��� “Behind the scenes in the brothel-quarters�) published in T�ky� in 1903, are appended. In the course of an exceedingly severe arraignment, the author says substantially as follows:—

“The filthy state of the Yoshiwara Hospital, and its utter lack of proper appointments, is so notorious that it is hardly necessary for us to dwell upon this particular phase of the subject; but we propose to enquire into some of the details of the institution. When we try to picture to ourselves what a hospital is, or should be like, we naturally imagine a fine lofty building surrounded by beautiful green trees, grateful shrubs and flowering plants, containing well-ventilated wards kept scrupulously neat and clean and furnished with beds covered with snowy-white counterpanes free from even a suspicion of stain or dirt; but the Yoshiwara Hospital is indeed far from being like that. We are tempted to compare it to a prison, but, as a matter of fact, a prison like the Sugamo Gaol is far more clean and complete, so from the point of general dirtiness and disorder the comparison would be quite inappropriate! The sick rooms have an area of from about 144 to 180 square feet, and as many as twelve or thirteen people are sometimes collected together in such stuffy chambers. The inmates often sleep two in a bed, and women belonging to different brothels, who are indeed entire strangers to each other, share the same couch. As to their treatment, they are medically examined twice a day, they have to pay for their own food, and although attendance and medicine is supposed to be supplied by the brothel-keepers, the patients have to get the money from their masters in the form of a loan and repay it in due course. Even in these expensive times, when living is far dearer than formerly, it appears that the cost of the regular hospital food is only estimated at from 7 to 8 sen (3-1�2 to 4 cents U.S. money or say 2d in sterling), so that for the women to be supplied with appetizing or nourishing food is simply impossible. The food they actually get three times a day is far worse than good prison fare, and consists of:—

(1)In morning: boiled barley and rice mixed (baku-han).
(2)At noon: boiled barley and rice mixed (baku-han), some vegetables or a small fish.
(3)In the evening: boiled barley and rice mixed (baku-han) and some indigestible malodorous pickled vegetables (k�-no-mono).

“Periodical examination of all prostitutes takes place once a week, the different streets each having special days. For instance if Edo-ch� It-ch�-me has its inspection on Friday, the inspection of Ageya-machi will be on a Wednesday. When the inspection time arrives, the name of each prostitute is called by turn, and one by one each undergoes a local examination. If a woman is visibly infected, the doctor orders her into hospital, but prior to her entering the establishment she is permitted to temporarily return to her brothel, where she makes up a bundle of such little things as she needs and, accompanied by a servant of the house, proceeds to the hospital and applies for admission. In the hospital several nurses are in attendance, but while the name ‘nurse’ sounds fine enough in itself, the women who bear this title are terrible females, something like the old brothel hags (yarite) themselves, and are ready to do anything for a consideration. For this reason, the prostitutes need some pocket-money when entering the hospital, and if they only are provided with this they have very little trouble in getting their whims gratified in every respect. After a prostitute has been in the hospital three or four days, if she happens to be a popular woman, the brothel-keeper, and others who lose by her absence, do their best, by judicious presents, to get her discharged as soon as possible, so she is not put to any great inconvenience. On the other hand, if the woman is an unknown new comer, or unpopular, she is treated in a manner painful to witness, only getting what may be given to her out of sheer pity by one of the senior prostitutes of the brothel to which she belongs. The moment they hear the signal for dinner, these wretched girls rush into the dining hall, and scrambling for food devour it in the same greedy wolfish manner as we can imagine the hungry spirits doing in the Buddhist hell! As to the condition of the inmates of the hospital, most of them spend their time in reading obscene novels and stories, but this does not last long, and they begin to discuss their guests and the men they know, to talk about their lovers, to sing, and to make abusive remarks about their masters and the servants in their respective brothels. Or they dance and skip about, play cards, write begging letters, and generally raise a pandemonium as if the institution was a low-class boarding-house. Such being the conditions of this horrible place, with the exception perhaps of a few disappointed women, or women who get on badly with the brothel-keeper, the prostitutes regard with dread the ordeal of entering the hospital. The majority of the public place considerable faith in the efficacy of the medical examination, but they are woefully mistaken in thinking that immunity from disease is secured by such inspection, because many of the doctors of the prostitute quarters are miserable quacks, apparently regardless of their conduct, and so venal that they receive bribes from the brothel-keepers to deliberately pass unchallenged women who are plainly affected with venereal diseases—an act as dangerous as letting loose wild tigers to prey upon the public! Not only that, but some of the youngster assistant doctors who, though of course licensed, are still in the course of perfecting their medical knowledge by practical training, often intentionally overlook serious cases which, unless treated in the hospital, are incurable and likely to spread infection. This is done partly out of sympathy and partly for the sake of winning popularity with some of these ill-famed wenches who know so well exactly how to bewitch the impressionable young men with their sidelong looks and amorous glances. No doubt it is very wrong, but then what a potent influence for good or bad there is in the eye of a young and pretty woman! Moreover, many of the girls are in collusion with their masters for the purpose of hoodwinking the examiners. These girls employ some of the low quacks who haunt the quarters to make preliminary inspections, and if they are found infected and likely to be ordered into hospital on the examination day, they get ‘fixed up’ for the official inspection by having the inflamed parts treated with medicinal applications which temporarily, but effectually, conceal all visible symptoms of disease. For those reasons, it is by no means safe to put one’s trust in the medical inspection. But these are not the only tricks of the trade. It sometimes happens that the quacks discover cases which it is impossible to conceal from the examiners by any known method of ‘fixing,’ and when this happens, the brothel-keepers often request the mercenary charlatans to prepare false certificates stating that a change of air is necessary. Armed with these certificates, keepers pretend that the patient has gone into the country, whereas she is carefully hidden in the house and secretly treated by the quacks. The consequence of this is that many women who are actually in attendance on guests, and apparently healthy, are a frightful menace to society and dangerous as the sharp points of poisoned needles concealed in a bag, whose awful pricks spread death and desolation in the paths of those with whom they come into contact. As to the sanitary conditions of the quarters, the laws of hygiene are utterly defied, for notwithstanding the exterior splendour of the palaces of vice in the Yoshiwara, filthiness is the order of the day, and in unseen corners, and dirty yards and alleys, lie heaps of festering garbage containing the germs of every imaginable form of virulent disease. While some attempt is made to detect venereal maladies by means of periodical inspections, internal diseases are practically left uncared for, therefore the callous and selfish brothel-keepers, taking advantage of this fact, are apt to force girls (who are really ill and ought to be inmates of a hospital ward) to wait on guests, and allow women suffering from such sicknesses as consumption and syphilitic eye diseases to continue their calling. Partly owing to the heartlessness of the masters, and partly owing to their carelessness in matters of sanitation, many instances have occurred where women have not only communicated to their guests the most loathsome diseases, but actually died from illness while sleeping beside their patrons. Decency forbids a too close description of all the horrors of these brothels, but one or two more instances of the terrible inattention to sanitary precautions may be pardoned. In some of the smaller houses the keepers are too mean to provide daily baths, so it often happens that the women appear before their guests innocent of the use of soap and water. In these houses the girls are treated like veritable dogs and cats, and remain year in and year out in cramped unclean chambers, known as kwambeya, furnished with dirty ragged bedding which is so filthy that it gives off a strong sweaty effluvium! In these dens, owing to the absence of hot water, the inmates are supposed to wash in cold water, but in the winter-time the low temperature causes them to dread their ablutions, and so the risk of infection to themselves and guests is materially increased. On the other hand, when they do cleanse themselves as expected, the frequent application of cold water results in bringing on various forms of uterine affections and dooming the unfortunate wretches to life-long misery. In the alleys where the restaurants (daiya) stand, lie piles of mouldy fish-bones, rejected articles of food in a high state of putrefaction, and even heaps of excrement, all vieing with each other in the exhalation of offensive and poisonous odours, and advertising far and wide the ‘sanitary’ ideas of the charming residents of this sink of corruption. Thus are the laws of hygiene observed in the great Yoshiwara of T�ky�!�

Whether the author’s scathing denunciations of the medical staff of the Yoshiwara are justified or otherwise is not known, but, collating the results of enquiries instituted, the writer is of the opinion that the allegations are somewhat sensational, although of course scandals may occasionally arise, and it must be remembered that the miserable salaries paid are not likely to tempt high-class practitioners to remain in the service for any great length of time. That a host of shady quacks haunt the quarters and assist the brothel-keepers to enable the women to hoodwink the regular examiners is, the writer is informed on reliable authority, a sober fact, and it is probable that in some cases the official doctors have to bear the opprobium of sins committed by these unscrupulous outside charlatans.

As to the gross inattention to sanitary methods charged against the denizens of this immense social sewer, it is probably impossible to exaggerate the mephitic abominations of the disgusting place, or to overestimate the danger of infection run by its thoughtless frequenters in consequence of the virulent disease-germs which are incubated in and infest every hole and corner of the unclean stews, vitiating the atmosphere and spreading the seeds of sickness and death far and near.

The monthly report sheets of the hospital contain blanks analysing the various forms of disease as follows:—

INFECTIOUS DISEASES.

Syphilis:

1Primary sclerosis and ulcers.
2Painless buboes.
3Disease of the lymphatic glands.
4Skin diseases.
5Diseases of the mucous membranes.
6Opthalmia.
7Diseases of the bones and periosts.
8Diseases of the joints.
9Diseases of the muscles.
10Diseases of the viscera and brain.
11Soft chancres.
12Acute buboes.
13Gonorrhœa.
14Itch.
15Tuberculosis.
16Unenumerated.

NON-INFECTIOUS DISEASES.

17Diseases of the digestive organs.
18Diseases of the respiratory organs.
19Diseases of the circulatory organs.
20Diseases of the urinary organs.
21Diseases of the generative organs.
22Diseases of the nerves and sensitive organs.
23Diseases affecting the general development and nutrition of the body.
24Diseases of the skin and muscles.
25Diseases of the bones and joints.
26Surgical diseases.
27Unenumerated.