‘Perfectly,’ Jacob assures her. ‘Every word.’

‘Nowdays, in Japan, when mother, or baby, or mother and baby die in childbirth, people say, “Ah… they die because gods decide so.” Or, “They die because bad karma.” Or, “They die because o-mamori – magic from temple – too cheap.” Mr de Zoet understand, it is same as bridge. True reason of many, many death of ignoration. I wish to build bridge from ignoration,’ her tapering hands form the bridge, ‘to knowledge. This,’ she lifts, with reverence, Dr Smellie’s text, ‘is piece of bridge. One day, I teach this knowledge… make school… students who teach other students… and in future, in Japan, many less mothers die of ignoration.’ She surveys her daydream for just a moment before lowering her eyes. ‘A foolish plan.’

‘No, no, no. I cannot imagine a nobler aspiration.’

‘Sorry…’ she frowns ‘… what is “noble respiration”?’

‘Aspiration, miss: a plan, I mean to say. A goal in life.’

‘Ah…’ a white butterfly lands on her hand ‘… a goal in life.’

She puffs it away; it flies up to a bronze candle on a shelf.

The butterfly closes and opens and closes and opens its wings.

‘Name is monshiro,’ she says, ‘in Japanese.’

‘In Zeeland, we call the same butterfly Cabbage-white. My uncle-’

‘ “Life is short; the art, long.” ’ Dr Marinus enters the Sick Room like a limping, grey-haired comet. ‘ “Opportunity is fleeting; experience-” and, Miss Aibagawa? To conclude our first Hippocratic Aphorism?’

‘ “Experience is fallacious,” ’ she stands and bows, ‘ “judgement difficult.” ’

‘All too true.’ He beckons in his other students, whom Jacob half recognises from Warehouse Doorn. ‘Domburger, behold my seminarians: Mr Muramoto of Edo…’ the eldest and dourest, bows ‘… Mr Kajiwaki, sent by the Chôshu Court of Hagi…’ A smiling youth not yet grown into his ropy body bows. ‘Next is Mr Yano of Osaka…’ Yano peers at Jacob’s green eyes ‘… and, lastly, Mr Ikematsu, native son of Satsuma.’ Ikematsu, pocked by childhood scrofula, gives a cheerful bow. ‘Seminarians: Domburger is our brave volunteer today; please greet him.’

A chorus of ‘Good day, Domburger’ fills the whitewashed Sick Room.

Jacob cannot believe his allotted minutes have passed so soon.

Marinus produces a metal cylinder about eight inches in length.

It has a plunger at one end and a nozzle at the other. ‘This is, Mr Muramoto?’

The elderly-looking youth replies, ‘It is call glister, Doctor.’

‘A glister.’ Marinus grips Jacob’s shoulder. ‘Mr Kajiwaki: to apply our glister?’

‘Insert to rectum, and in-jure… no, in-pact… no, aaa nan’dattaka? In-…’

‘-ject,’ prompts Ikematsu, in a comic stage-whisper.

‘- inject medicine for constipation, or pain of gut, or many other ailment.’

‘So we do, so we do; and, Mr Yano, where lies the advantage in anally ministered medicines over their orally ministered counterparts?’

After the male students have distinguished ‘anal’ from ‘oral’, Yano responds, ‘Body more quick absorb medicine.’

‘Good.’ Marinus’s slight smile is menacing. ‘Now. Who knows the smoke glister?’

The male seminarians confer without including Miss Aibagawa. At length, Muramoto says, ‘We do not know, Doctor.’

‘Nor could you, gentlemen: the smoke glister has never been seen in Japan until this hour. Eelattu, if you please!’ Marinus’s assistant enters, carrying a leather tube as long as a forearm and a deep-bellied, lit pipe. The tube he hands to his master, who flourishes it like a wayside performer. ‘Our smoke glister, gentlemen, possesses a valve in its midriff, here, into which the leather tube is inserted, here, via which the cylinder can be filled with smoke. Please, Eelattu…’ The Ceylonese inhales smoke from the pipe and exhales it into the leather tube. ‘ “Intussusception” is the ailment for which this instrument is the cure. Let us speak its name together, seminarians, for who can cure what he cannot pronounce? “In-tus-sus-cep-tion!” ’ He waves one finger like a conductor’s baton. ‘A-one, a-two, a-three…’

‘ “In-tus-sus-cep-tion,” ’ the students falter. ‘ “Intus-sus-cep-tion.” ’

‘A terminal condition where an upper portion of the intestine passes into a lower, thusly…’ The doctor holds up a piece of sailcloth, stitched like a trouser leg. ‘This is the colon.’ He narrows one end in his fist, and feeds it backwards inside the cloth tube towards the other end. ‘Ouch and itai. Diagnosis is difficult: its symptoms being the classic alimentary triad, namely, Mr Ikematsu?’

‘Abdomen pain, groin swelling…’ He massages his temples to loosen the third. ‘Ah! Blood in faeces.’

‘Good: death by intussusception or,’ he looks at Jacob, ‘in the vernacular, “shitting out your own intestines” is, as you would expect, a laborious affair. Its Latin name is “miserere mei ”, translatable as “Lord Have Mercy.” The smoke glister, however, can reverse this wrong,’ he pulls the knotted end of the sailcloth tube out again, ‘by puffing in such a density of smoke that the “slippage” is reversed; and the intestine restored to its natural state. Domburger: in guerno for favours granted, shall loan his gluteus maximus to medical science that I may demonstrate the passage of smoke “through caverns measureless to man” from anus to oesophagus, whence smoke trickles through his nostrils like incense from a stone dragon, though not, alas, so sweet-scented, given its malodorous voyage…’

Jacob begins to understand. ‘Surely, you don’t intend-’

‘Remove your breeches. We are all men – plus one lady – of medicine.’

‘Doctor.’ The Sick Room is disagreeably cool. ‘I never consented to this.’

‘To treat nerves,’ Marinus flips Jacob over with an agility belying the doctor’s partial lameness, ‘ignore them. Eelattu: let the seminarians inspect the apparatus. Then we begin.’

‘A fine joke,’ wheezes Jacob, under fourteen stone of Dutch physician, ‘but-’

Marinus unhooks the now-squirming clerk’s braces.

‘No, Doctor! No! Your little joke has gone far enough…’

VII Tall House on Dejima

Early on Tuesday the 27th August, 1799

The bed shakes its sleeper awake; two of its legs snap, tipping Jacob on to the floor, whacking his jaw and knee. Merciful Christ is his first thought. The Shenandoah’s magazine is exploded. But the spasm seizing Tall House grows stronger and faster. Joists groan; plaster patters like grapeshot; a window casement flies from its mount and the lurching room is lit apricot; the mosquito net enwraps Jacob’s face and the unappeasable violence is magnified threefold, fivefold, tenfold, and the bed drags itself across the room like a wounded beast. A frigate is unloosing a broadside, Jacob thinks, or a man-o’-war. A candlestick hops in dithyrambic circles; sheaves of paper from high shelves swoop in loops. Don’t let me die here, Jacob prays, seeing his skull smashed under beams and yolky brains dashed in Dejima’s dust. Prayer grips the pastor’s son: raw-throated prayer, to the Jehovah of the early Psalms, O God, thou hast cast us off, thou hast scattered us, thou hast been displeased; O turn Thyself to us again! Jacob is answered by roof-tiles smashing on Long Street and cows lowing and goats bleating. Thou hast made the earth to tremble; thou hast broken it; heal the breaches thereof; for it shaketh. Glass panes shatter into false diamonds, timber cracks like bones, Jacob’s sea-chest is tossed by undulating planks, the water jug spills and the chamber pot is upended and Creation herself is being undone and God God God, he implores, bid it cease bid it cease bid it cease!

The Lord of hosts is with us; the God of Jacob is our refuge. Selah. Jacob shuts his eyes. Silence is peace. He thanks Providence for subduing the earthquake and thinks, Dear Christ, the warehouses! My mercury calomel! He snatches his clothes, steps over the flattened door and meets Hanzaburo emerging from his nest. Jacob barks, ‘Guard my room!’ but the boy does not understand. The Dutchman stands in the doorway and makes the shape of an X with his arms and legs. ‘Nobody enter! Understand?’