Leprosy looms large in this story about transformation and loss set in post World War II Japan. A nineteen-year-old pearl diver notices a numb red spot on her forearm. Later on, another blemish appears on her lower back. These two lesions are manifestations of a mild case of leprosy. Her infection will be arrested by medication and never get any worse. The girl is forcibly transported to the Nagashima Leprosarium, an island where she will spend the rest of her life except for a few brief excursions and one extended "escape" at the age of sixty-four.

Despite the introduction of new and effective drugs--Promin (sulphone) and dapsone--authorities still fear allowing the leprous patients to return to society. Inhabitants of the sanatorium are admonished on arrival that their past is erased. Each individual must begin a new life and select a new name. The protagonist chooses the moniker Miss Fuji. She is a kind and sensitive young woman who eventually functions as a nurse and caregiver for the other patients incarcerated in the sanatorium. As a punishment, Miss Fuji is required to attend abortions and dispose of the dead fetuses.

As the decades pass, conditions on the island improve. The number of residents with leprosy still living there dwindles from about two thousand people to six hundred. Even a bridge connecting Nagashima to the mainland is constructed. It no longer matters. Emotional and psychological barriers remain. When Miss Fuji has an opportunity to create a new life for herself away from the sanatorium, she still returns to the place and the people that have been her home and family for so many years.


The story is primarily told via artifacts from the leprosarium--an urn, a badge, photographs, a treatment schedule, a scrub brush, black paint, rubber boots. Memories provide sustenance but also generate grief. Despite the disfiguring nature of the disease, leprosy is generally painless. Yet the suffering it spawns is immense. Guilt, shame, and a sense of burden plague many of these characters.

Although the novel contains frequent descriptions of useless limbs, collapsed noses, and shriveled digits, the most severe form of mutilation and subsequent scarring is internal. Loss of the past and any hope for the future threatens to suffocate this society of the sick. Some cannot cope with their fate. Many patients commit suicide by jumping off a cliff. One man severs his own left hand to rid himself of the leprous lesions but bleeds to death.

Most of the residents of the sanatorium somehow endure. Through a combination of benevolence, tenacity, and patience, they create a culture of compassion where small victories are cherished. Although leprosy is an ancient disease, it shares much in common with a contemporary one--AIDS. One thoughtful character in the novel remarks, "Words are the most important thing we have." A single word can alter history or at least the lives of many people. For the characters in The Pearl Diver, a few words stand above the rest--leprosy, fear, survival, compassion, grace.


Nan A. Talese/Doubleday

Place Published

New York



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