leprosy in japan leprosy in japan as of 2009, 2,600 former leprosy patients were living in 13 national sanatoriums and 2 private hospitals in japan. their mean age is 80. there were no newly diagnosed japanese leprosy patients in 2005, but one in 2006, and one in 2007. history ancient and medieval ages the route of leprosy into japan has not been settled but the presence of leprosy in japan at least in the nara era (710-784) and the earliest record of leprosy in korea at cheju island in 1445 suggests that leprosy came from the south. in a collection of government documents titled "ryounogige", written in 833, leprosy was described as the following: "it is caused by a parasite which eats five organs of the body. the eyebrows and eyelashes come off, and the nose is deformed. the disease brings hoarseness and necessitates amputations of the fingers and toes. do not sleep with the patients, as the disease is transmittable to those nearby." this is the first document in the world that identifies leprosy as transmissible since there had been no such documents in china. kensuke mitsuda thought that this was because of the frequent complication of scabies with leprosy since scabies is easily transmitted. according to a legend, empress komyo washed a leprosy patient in the 8th century. in medieval times, people with leprosy were discriminated against and lived separately from the main dwelling areas of the villages. this discrimination was bolstered by religion — one of the sutras of the nichiren sect stated that "those who do not respect this sutra will get leprosy in the next stage of life." during the short period (1549–1611) when catholic priests were allowed to preach christianity, they built special hospitals where they treated leprosy patients. this came to an end when the tokugawa government enacted the death penalty for the crime of being a catholic. otani yoshitsugu a famous samurai of the sengoku era also suffered from leprosy. it was said to be one of the factors that led to his defeat at the battle of sekigahara in 1600. the meiji era (1868–1912) japan reopened its doors to foreign countries in 1868, and the power went to the emperor and the democratic government. checkpoints between provinces were abolished in 1871, and leprosy patients could also freely travel in the country. in the same year, leprosy patients began to line up on the road to honmyoji, a noted temple in kumamoto, kyushu, japan, for mercy. the first national survey conducted in 1904 indicated that there were 30,359 patients, but because of the methodology, this figure may be vastly underestimated. christian missionaries and japanese savers japanese people were accustomed to seeing people with leprosy begging for money at temples and shrines or wherever people gathered, but this was a shocking event to europeans. upon seeing a miserable 30-year-old woman abandoned near a watermill, father testevuide became determined to establish a facility for such people. in 1889, he started the kohyama fukusei hospital. his example was followed by kate youngman in tokyo, and by miss hannah riddell and father corre in kumamoto. in 1875, dr. masafumi goto founded the kihai hospital in tokyo which was specially designed to treat leprosy patients. dr. goto and his son, dr. masanao goto, became widely known for their balneotherapy for leprosy patients. at the request of the king of the hawaiian kingdom, dr. masasao goto visited hawaii and introduced their method. most of the japanese doctors who established these facilities discontinued their activities after the start of public leprosy sanatoriums. 1905 epoch-making meeting hannah riddell established the kaishun hospital in 1895 in kumamoto and her activities are mentioned elsewhere. because of the russo-japanese war, she was in desperate financial straits because english people stopped sending money to her because of the risks that could occur during the sending process. an important meeting was held at the banker's club in tokyo, both to save her and to discuss leprosy problems facing japan. various leaders, including those representing the government, statesmen, and journalists, attended the meeting. the timing was good. the japanese government had begun to take an interest in leprosy problems since they found many patients in the drafts for military service. to become strong militarily was their biggest concern at the time. the meeting was chaired by viscount shibuzawa, who was a leading businessman. at the meeting kensuke mitsuda stressed that leprosy was infectious. finally, the japanese government, spurred by the events of the 1905 meeting, promulgated the first leprosy prevention law in 1907 and started five public sanatoriums in 1909. "no leprosy patients in prefecture" movement main article: no leprosy patients in our prefecture movement further information: forced hospitalization at honmyoji at the start of public sanatoriums, only the wandering patients were hospitalized. however, as time went, people wanted their prefectures to be "purified," and the belief began that there should be no leprosy patients in their prefectures. this movement started around 1930 and it naturally worsened leprosy stigma. in kumamoto, 157 patients living near honmyoji were "arrested" and transferred to other sanatoriums. a patient received unjust procedures and was sentenced to the death penalty. war and leprosy in japanese sanatoriums, in 1945, because of food shortage, many patients died of tuberculosis in mainland japan with a rate of 20% at the worst leprosaria. in okinawa, more than 25% of patients died in the sanatorium in the same year. in the miyako nanseien, okinawa, the death rate was over 40% in 1945 and the cause of death was almost always malaria. it was reported that in a psychiatric hospital in tokyo (tokyo metropolitan matsuzawa boi), the death rate in 1945 was 40% *the rate of death of inpatients at 10 national sanatoriums in 1945 and 1946, excluding suruga sanatorium in other years, including all sanatoriums. amami wakoen sanatorium, okinawa airakuen sanatorium and miyako nanseien sanatorium are excluded. the mean rate of death of patients at japanese sanatoriums yearmean rate of death 194514.8 19468.8 19476.6 19484.7 19494.1 19502.8 19512.2 19521.6 19531.3 19541.5 19551.6 the 1953 leprosy prevention law and patients' struggle kensuke mitsuda stated before the upper house in 1951 that all patients be hospitalized. this was a segregation policy and all patients were against it. some of them staged even hunger strikes, but the 1953 leprosy prevention law was passed; there were practically no changes from the strict 1931 leprosy prevention law. the expressed view of the japan leprosy association hiroshi shima, fujio otani, minoru narita and kunio murakami were primary movers in the abolition of japan's leprosy prevention law. it was delayed because the opinions of patient autonomy associations differed. the statement of the japanese leprosy association on the leprosy prevention law it is said that the leprosy control method in japan was greatly influenced by the first international congress of leprosy in 1897, at which it was concluded that isolation of patients was the best method of leprosy control. however, this did not mean indiscriminate isolation of patients. the interior ministry of japan replied to a question that "the salvation of wandering patients" be given priority, above that of prevention. absolute isolation has been based on two views; 1) that leprosy occurs through intimate contact within the families in which any patients would be the source of infection, and 2) leprosy would be incurable for the rest of life. absolute isolation was supported by the social belief of that day; leprosy is a shameful disease and the purity (absence of leprosy patients) of the nation should be maintained, thus justifying isolation. complete isolation was given priority rather than salvation of patients. in japan, not a small number of patients had been found during the draft for military service. between 1897 and 1937, leprosy patients found at the draft kept decreasing. there were major national censuses between 1919 and 1935, during which the number of leprosy patients kept decreasing. epidemiologically speaking, improvement in the living conditions has been given credit for this decrease, rather than the results of isolation. japan was on its way to elimination of leprosy patients, irrespective of enforced isolation. in other words, statistically speaking, the present leprosy prevention law had not been necessary. nevertheless, the 1953 revision of the leprosy prevention law was passed and enforced. at that time, the effects of chemotherapy were apparent, and internationally, isolation has not been supported at the rome conference on rehabilitation. dapsone and rifampicin were put into service. in 1982, the infectivity of mycobacterium leprae was found to disappear within several doses of rifampicin, and a multidrug therapeutic regimen (mdt) was proposed. this has become the standard regimen for leprosy control. recently new quinolones were added. outpatient treatment has become possible even at the onset of the disease, and now we can treat patients with erythema nodosum leprosum and leprous neuritis without much difficulty. although there have been mysteries left unsolved concerning leprosy, such as the mode of transmission or the relationship between infection and development of symptoms, there have been no reports suggesting leprosy is beyond the concept of ordinary infections. therefore, the present law lost its basis for existence; medically speaking, the law deserved to be abrogated. as late as 1955, 91 percent of leprosy patients were hospitalized in leprosaria. outpatient treatment did become popular, but management of patients continued to be leprosarium-centered. this does not go hand in hand with who, which aims at the coexistence of patients and society. therefore, we have been left far from the remainder of the world. *it cannot be denied that the isolation within the leprosaria has made those working at hospitals and universities lose interest in the treatment of leprosy. the japanese leprosy association deeply reflected on these matters. however, they did not lead toward an abrogation of the outdated law, they did not point out this failure of leprosy control, because those working in leprosaria occupied the central part of the association, and they let the law to exist to the present time. new leprosy patients should be treated on an outpatient basis, within the framework of the health insurance system. hansen's disease centers should be established and specialists be trained. we have no right to condemn our senior leprologists who advocated isolation under the banner of "salvation" of the patients. however, we must listen to and hear the pitiful cries of those who have been separated from their families because of leprosy stigma. reflections and self-criticisms are urgently needed. leprosy control should be nothing but medical control. it was our failure that we advocated isolation with a view to arousing public opinion, thereby stirring up the fear of leprosy in this country. the japanese leprosy association and japanese medical world need to reflect on this and recognize this fact again. the trials the zenkankyo (patients' union) staged a number of struggles against the ministry of welfare and they finally won the abolishment of the 1953 leprosy prevention law in 1996. it was ruled that the law was unconstitutional between 1960 and 1996. during this period, the law should have not been present. in 1998, many patients sued the government for compensation and they won it in 2001. leprosy prevention law leprosy prevention law of 1907 the patients who do not have supporting men and women shall be treated in public leprosaria. those who have supporters shall be cared for by them. leprosy prevention law of 1931 patients with leprosy shall be hospitalized in leprosaria. (however, it is not compulsory at the start.) patients should not be engaged in works which may transmit leprosy. the families of patients shall be given some financial aids. the privacy of patients should be respected by physicians and related workers. leprosy prevention law of 1953 article 1. the aim of the law is to prevent the spread of leprosy, to provide medical care and to promote the welfare of leprosy patients, thus contributing to the general public health. article 2. the national government and local public bodies shall, at all times, strive to prevent leprosy, to provide medical care for leprosy patients and to promote the welfare of the patients. these bodies shall also try to disseminate accurate knowledge of leprosy. article 3. no one shall discriminate the patients or those related to the patients because of this disease. article 4. after a physician has