diagnosed the examinee as patient, or after examining or performing autopsy on the dead body of the patient, the physician must, as stipulated by the ministry of health and welfare ordinance, instruct the method of disinfection and other preventive measures to the patient, his guardian, those living with the patient, those in charge of the premises where the dead body is or was found, and shall also notify within 7 days the particulars stipulated by that ordinance to the prefectural governor of the place of residence of the patient, or the premises where the dead body was found. article 5. when the prefectural governor finds it necessary, he may ask a designated physician to examine a patient or one who is, with sufficient reasons, suspected of being patient. 2. the physician indicated in the preceding paragraph shall be selected from among those with more than three years' experience in leprosy work and after obtaining consent of the said physician. article 6. when the prefectural governor finds that a patient may communicate leprosy, the governor may encourage the patient or his guardian that the patient be hospitalized in a national leprosarium established by the national government. 2. if the patient or his guardian does not follow this encouragement, as stipulated in the above paragraph, the prefectural governor may order the patient or his guardian to be hospitalized for a fixed period of time. 3. when one who has been ordered to be hospitalized fail to comply with this disorder, or when there is no time to follow the necessary procedures for hospitalizing the patient in a leprosarium in the interest of public health, as stipulated in the preceding paragraph, the governor may send the patient directly to a national leprosarium. article 15. the in-patients may not leave the national leprosarium and may be allowed to leave only in the following instances. (1) that there is a special condition such as the death, serious illness, or afflictions of relatives, and when the director grants permission in the view that the patient's going out does not affect the prevention of spread of leprosy seriously. (2) omitted. article 16. the in-patients shall devote themselves to the treatment and abide by the rules of the leprosarium. 2. when an in-patient violates the rules of the leprosarium, the director may impose the following punishments on the patient concerned, in order to maintain order within the leprosarium. (1) to give a warning to the patient; (2) to confine the patient for a term not exceeding 30 days. laws repealed all these laws were repealed in 1996. the japanese sanatoriums 13 national sanatoriums matsugaoka hoyoen. aomori-ken aomori-shi ishie, 1909- tohoku shinseien. miyagiken tobe-shi, sako-machi, 1939- kuryu rakusen-en. gunma-ken azuma-gun kusatsu-cho, 1932- tama zenshoen. tokyo-to higashimurayama-shi, 1909- suruga ryoyosho. shizuoka-ken getenba-shi, 1944- nagashima aiseien. okayama-ken, setouchi-shi, 1930- oku komyoen. okayama-ken, setouchi-shi, 1938 (as sotojima hoyoen, 1909–1934) ooshima seishoen. kagawa-ken kida-gun aji-cho, 1909- kikuchi keifuen. kumamoto-ken koushi-shi, 1909- hoshizuka keiaien. kagoshima-ken kanoya-shi, 1935- amami wakoen. kagoshima-ken amami-shi, 1944- okinawa airakuen. okinawa-ken nago-shi, 1938- miyako nanseien. okinawa-ken miyakojima-shi, 1931- private sanatoriums kouyama fukusei byoin. shizuoka-ken getenba-shi, 1889- tairoin shinryosho. kumamoto-ken kumamoto-shi, 1898- previous sanatoriums name place founder (or related persons) years kihai byoin (hospital) tokyo masafumi goto 1875–1907? yoikuin tokyo kensuke mitsuda (kaishun ward) 1901–1904 ihaien tokyo kate m. youngman 1894–1942 kaishun byoin (hospital) kumamoto hannah riddell 1895–1941 jinkeien yamanashi-ken ryumyo tsunawaki 1906–1992 st. barnabas home gunma-ken cornwall legh 1916–1941 suzuranen gunma-ken kesako hattori 1926–1931 manchuria sanatorium doukouin tetsurei-ken, manchuria shunzo sugimura 1939–1945 other facilities national hansen's disease museum tokyo-to higashi-murayama-shi. national infection research center. leprosy research center. tokyo-to higashi-murayama-shi. okinawa-ken. yuuna kyokai okinawa-ken naha-shi. life in the sanatoriums the present situation there are about 2600 ex-patients in 13 national hansen's disease sanatoriums and 2 private hospitals as of may 1, 2009. there are no active leprosy patients, and all are recovered or have after-effects of leprosy. their mean age is 80. because of sterilization and abortion, they do not have children. many of them have diseases of advanced ages or handicaps and aids are necessary. some earnestly hope for social rehabilitation, but there are very few who are active in society. those in the sanatoriums enjoy life in or out of the sanatoriums; medical and living care are helped by doctors and health workers. their families visit them in sanatoriums and vice versa. they may be treated in other medical facilities, if necessary. religions every leprosy sanatorium in japan has churches and buddhist temples (there are no temples attached to sanatoria in okinawa prefecture), and it is true that patients had faith, though some patients stated that deciding on religion was in preparation for their death in the leprosaria. in days gone by, they could not share the family graves, an instance of leprosy stigma. in kikuchi keifuen leprosarium, statistics showed buddhism a 757, b 85, c 89, d (sokagakkai) 51, shintoism a 11, shintoism b 9, catholic 51, christianity 95, as of 1979. abortions and sterilization since 1915, sterilization had been performed in public sanatoriums in japan. married life was permitted. abortions were performed. because of this, patients did not have children. the leprosy prevention laws of 1907, 1931 and 1953, the last one only repealed in 1996, permitted the segregation of patients in sanitariums where forced abortions and sterilization were common, (even if the laws did not refer to it), and authorized punishment of patients "disturbing peace". literature some patients wrote novels, and many patients composed tanka and haiku, a short poem. education education in prewar days was unsatisfactory. educated patients taught patients who needed education. in postwar days, branch schools of primary schools and secondary schools were made within the leprosariums. a high school was made for some time starting in 1955; 369 patients were enrolled and 307 patients graduated from the school. education of children born of patients was insufficient. in kumamoto, the enrollment of them into a primary school met social stigma or leprosy stigma in 1954 which was called the tatsudaryo incident or kurokamikou incident. leprosy stigma main article: leprosy stigma leprosy in japan is characterized by considerable leprosy stigma, by the buddhistic concept of leprosy that leprosy is punishment and in modern times by three leprosy prevention laws requesting segregation. personalities empress teimei empress teimei (貞明皇后, teimei kōgō, 25 june 1884 – 17 may 1951), also known as empress dowager teimei (貞明皇太后, teimei-kōtaigō), was empress consort of emperor taishō of japan. she was the mother of emperor shōwa. her posthumous name, teimei, means "enlightened constancy". she was interested in leprosy problems and donated money to hannah riddell in financial distress since 1915, and other foreigners. she donated money with which a leprosy prevention foundation was established in 1931 and left money upon her death which became the basis of the tofu organization for leprosy, in 1951. kensuke mitsuda kensuke mitsuda (1876–1964) the most influential leader both in the administration of leprosy policy and the academic circle. he stated that all leprosy patients be hospitalized before the upper house in 1951, and led to the 1953 leprosy prevention law. as a scholar, he found a lepromin reaction called mitsuda reaction or mitsuda test. this is very important in the classification of leprosy. hannah riddell hannah riddell (1855–1932) was an english woman who devoted her life to the salvation of hansen's disease patients in japan. she not only established "kaishun hospital", the first leprosy hospital in kumamoto, but also inspired the conscience of the japanese people on this problem. mary cornwall-legh mary cornwall-legh (may 20, 1857 – december 18, 1941) was a highly educated english woman who devoted herself, after age 50, to missionary work in japan and especially to the welfare, education and medical care of leprosy patients in kusatsu, gunma prefecture, japan. keisai aoki keisai aoki (april 8, 1893 – march 6, 1969). a japanese missionary who virtually paved the way to the establishment of hansen's disease sanatorium kunigami-airakuen, okinawa, with extraordinary difficulties. at age 16, he developed leprosy and later, under the leadership of hannah riddell, he helped people with leprosy in okinawa. matsuki miyazaki matsuki miyazaki (1900–1970) the director of the kyushu sanatorium (1934–1958). he studied the war and leprosy and by his efforts, soldiers who developed leprosy could receive the same treatment as those who developed tuberculosis. he was a segregationalist. after retiring from the kikuchi keifuen sanatorium (kyushu sanatorium), he established a leprosy facility in india. he died in an airplane accident in india. isamu masuda isamu masuda (1872–1945) was a japanese doctor, known for writing "leprosy and social problems" in 1907, the year of the promulgation of the first leprosy law, and openly criticized the crucial segregation policy. he advocated the nation's involvement in the discovery of treatments of leprosy, since he believed that it was curable. masako ogawa masako ogawa (1902–1943) was a female japanese doctor who worked at the nagashima aiseien sanatorium. she wrote a book, "spring in a small island" in 1938, about her experiences in persuading leprosy patients in remote areas of japan into hospitalization. it created a sensation in japan, and was made into a film. on the other hand, she was criticized for accelerating the "no leprosy patients in prefecture" movement and giving the impression that leprosy is to be feared. masasue suho masasue suho (october 8, 1885 – june 20, 1942) was a japanese physician, the director of the sorok island sanatorium in korea. he completed the world's biggest leprosy facility sorok island sanatorium hospitalizing 6000 patients. he was assassinated by a patient while rushing to a morning ceremony. forced segregation of leprosy patients, the worsening of treatment of patients and antipathy against colonial rule were behind the assassination. ryumyo tsunawaki ryumyo tsunawaki (january 24, 1876 – december 5, 1970, was a buddhist priest who established a leprosy hospital minobu jinkyo-en, in minobu-cho, yamanashi-ken, japan in 1906. noboru ogasawara noboru ogasawara (1888–1970) was a japanese physician specializing in leprosy. he was an assistant professor at the department of kyoto imperial university. he insisted that leprosy was not incurable and diathesis was an important factor in the development of leprosy. he was against strict segregation of leprosy patients and met strong opposition at a congress of leprosy. masanao goto masanao goto (1857–1908), was a japanese leprologist. he was the son of first shobun goto and called as the second shobun goto. he devoted his life to leprosy patients in japan and on the island of molokai in the kingdom of hawaii. father damien had trust in goto's therapy, and he left the message, "i have not the slightest confidence in our american and european doctors to stay my leprosy, i wish to be treated by dr. masanao goto." mosuke murata mosuke murata was a japanese dermatologist who was the designator of erythema nodosum leprosum (enl) in 1912. mieko kamiya mieko kamiya (1914–1979) was a psychiatrist who treated leprosy patients at nagashima aiseien sanatorium. she was known for the translation of books on philosophy. she was said to be "one of doctors of the department of psychiatry of tokyo university soon after the war", who "greatly helped the ministry of education and the general headquarters as english-speaking secretary", and to be "an adviser to empress michiko". she wrote many books as a highly educated, multi-lingual person; one of her books titled on the meaning of life (ikigai in japanese) based on her experiences with leprosy patients attracted many readers. kazuo saikawa kazuo saikawa (1918–2007) was a japanese physician, who contributed to the treatment of leprosy and to the administration of leprosy policy in japan. he was against kensuke mitsuda and worked in taiwan and okinawa. heibei okamura heibei okamura (1852–1934) produced japan's finest "okamura's" chaulmoogra oil, between about 1892 and 1944 at sakai, osaka, japan. the chaulmoogra oil had been the only one remedy in wide use before guy henry faget proved the efficacy of promin in 1943. promin started the era of sulfur chemicals and revolutionalized the treatment of leprosy. okamura was also known for caring for more than 1,000 leprosy patients between 1888 and 1901 in his house. suketoshi chujo suketoshi chujo (中條資俊 1872–1947) was a japanese physician, a hansen's disease researcher, the first director of matsugaoka hoyoen sanatorium (1909–1947). he repeatedly reported turpentine spirit preparation he named tr as effective for leprosy. isamu tajiri isamu tajiri (1902–1966) was