BOOK REVIEW | 'Tales of Plague and Pestilence: A History of Disease in Japan'
Robert D Eldridge, PhD 
From the book cover of "Tales of Plagues and Pestilence" by Shizu Sakai, translated by Marie Speed (2025)
In Tales of Plague and Pestilence: A History of Disease in Japan, Professor Sakai Shizu delivers a haunting yet deeply human meditation on illness, survival, and the ways societies confront invisible threats. Drawing from Japan's rich folklore tradition and interweaving it with historical episodes of disease outbreaks — from smallpox to the Spanish flu, syphilis, and tuberculosis, among many others — Sakai constructs a tapestry of stories in her book that are as imaginative as they are historically grounded.
The book is a collection of interconnected short stories, each centered around a specific epidemic. However, rather than offering a dry chronicle of events, Sakai uses myth, legend, and intimate character vignettes to explore the psychological and emotional impact of disease. Ghosts of the sick wander between villages. Monks chant prayers that carry the weight of collective despair. Midwives, mothers, and medicine men each take turns navigating the blurred boundaries between the natural and supernatural.
Sakai, a professor emerita at Juntendo University and former president of the Japanese Society for the History of Medicine, has produced one of the best books I have ever read about Japanese history and society.
Born in 1935, she has lived much of the recent medical history she has written about. Yet, even the earlier periods she did not personally experience are written with such detail and authenticity, it seems as if she was there documenting events as they unfolded, and assuming the role of the doctors, scientists, or public health officials at that moment, trying to deal with the problem.
Weaving the Horrors of Pestilence
One of the book's greatest strengths is Sakai's ability to weave together the tangible horrors of pestilence with intangible cultural memory. In the opening story, set in the Heian period, a noblewoman hides in a remote mountain retreat while smallpox ravages the capital. Her journal entries — fragmented, poetic, increasingly fevered — are discovered centuries later by a modern epidemiologist. Thus, they create a mysterious and poignant bridge between past and present.
This dual temporality is a recurring device throughout the collection. The author invites the reader to consider how societies remember (or forget) the trauma of disease.
Sakai's language is elegant and occasionally lyrical, even when describing grotesque or terrifying moments. She has a remarkable talent for evoking atmosphere — thick fogs rolling through abandoned villages, eerie silences broken by the cough of an unseen sufferer, and the oppressive weight of physical, mental, and emotional uncertainty.
Her writing invites comparison to classic Japanese ghost stories. Yet, her focus is never on mere horror. Instead, she offers a compassionate gaze on those left behind, those burdened with caring for the sick, and those who attempt to make sense of the senseless.
Elegant Translation
Dr Marie Speed, as well, must be given credit for the elegant translation she provides for this very difficult subject matter. In particular, the text includes medical terminology from centuries past. This may be one of her best translations to date. Thanks to her, Professor Sakai's important work, originally published in Japanese in 2008 as Yamai ga Kataru Nihonshi, is available to an international audience.
An example of the depth of insight of the original text and the eloquence of the translation can be seen in one of the most poignant passages of the book. It is found in the Afterword (p. 217):
"Medicine now belongs to natural science, but the history of disease and treatment remains less a scientific history than a cultural one. Medicine is effectively a cultural history of the body. Even the most powerful people cannot conquer the agony of illness. In that fact, we can observe the anguish and naked truth of the very human yearning to be spared from disease."
That this civilizational history is told in a mere 221 pages, divided into three main parts (with 26 chapters in total), is awe-inspiring.
Tales of Plague and Pestilence is timely, especially in the aftermath of the COVID-19 pandemic. However, it is also timeless. It reminds us that every age has its own plagues, literal or metaphorical, and that the human response to fear, isolation, and grief often remains unchanged.
Sakai Shizu has written a book that lingers in the mind long after the final page. It is as much a work of literary art as a mirror to our collective vulnerabilities.
About the Book:
Title: Tales of Plague and Pestilence: A History of Disease in Japan
Written by: Shizu Sakai
Translated by: Marie Speed
Publisher: Japan Publishing Industry Foundation for Culture (2025)
ISBN Hardcover: 9784866582566 OPEN ACCESS / NOT FOR SALE
For more information, see the publisher's webpage on the book.
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Reviewed by: Robert D Eldridge, PhD
Dr Eldridge is a former political advisor to the US Marine Corps in Japan, author of numerous books on Japanese political and diplomatic history, and a 2024 Taiwan Ministry of Foreign Affairs Fellow at Tamkang University.
