Orito thinks of her own childhood amongst scholars and books.

‘Yôben dreamt of audiences at palaces, and we spent a year in Edo, but he smelt too much of the showman… of hunger… and, simply, he smelt too much. During our six or seven years on the road, the quality of our inns never improved. All his misfortunes, of course, were my fault, especially when he was drunk. One day, near the end, after we’d been chased out of a town, a fellow healing-trickster told him that where a magical fox girl could squeeze money from the desperate and dying, a magical fox woman was another matter. That got Yôben to thinking, and within the month he sold me to a brothel in Osaka.’ Yayoi looks at her hand. ‘My life there, I try hard to forget. Yôben didn’t even say goodbye. Perhaps he couldn’t face me. Perhaps he was my father.’

Orito wonders at Yayoi’s apparent lack of rancour.

‘When the Sisters tell you, “The House is far, far better than a brothel,” they don’t mean to be cruel. Well, one or two may, but not the others. For every successful geisha with wealthy patrons vying for her favours, there are five hundred chewed-up, spat-out girls dying of brothel diseases. This must be cold comfort for a woman of your rank, and I know you’ve lost a better life than the rest of us, but the House of Sisters is only a Hell, a prison, if you think it is. The masters and acolytes treat us kindly. Engiftment is an unusual duty, but is it so different from the duty any husband demands from his wife? The duty is certainly paid less often – much less.’

Orito is frightened by Yayoi’s logic. ‘But twenty years!’

‘Time passes. Sister Hatsune is leaving in two years. She can settle in the same town as one of her Gifts, with a stipend. Departed Sisters write to Abbess Izu, and they are fond and grateful letters.’

Shadows sway and coagulate amongst the low rafters.

‘Why did the last Newest Sister hang herself?’

‘Because being parted from her Gift broke her mind.’

Orito lets time pass. ‘And it’s not too much for you?’

‘Of course it hurt. But they haven’t died. They are in the World Below, well fed and cared-for, and thinking about us. After our Descent we can even meet them, if we wish it. It’s a… strange life, I don’t deny it, but earn Master Genmu’s trust, earn the Abbess’s trust, and it needn’t be a harsh life, or a wasted one…’

The day I believe this, Orito thinks, is the day Shiranui Shrine owns me.

‘… and you have me here,’ says Yayoi, ‘whatever this is worth.’

XVIII The Surgery on Dejima

An hour before dinner on the Twenty-ninth Day of the Eleventh Month

‘Lithotomy: from the Greek lithos for “stone”; and tomos, for “cut”.’ Marinus addresses his four pupils. ‘Remind us, Mr Muramoto.’

‘Remove stone from bladder, kidneys, gall-bladder, Doctor.’

‘ “Till Kingdom Come…” ’ Wybo Gerritszoon is drunk, senseless, naked between his nipples and his socks, and trussed on the backward-slanting operating table like a frog on a dissection board. ‘ “Who Art Unleavened Bread…” ’

Uzaemon takes the patient’s words to be a Christian mantra.

Charcoal in the brazier rumbles; snow fell last night.

Marinus rubs his hands. ‘Symptoms of bladder stones, Mr Kajiwaki?’

‘Blood in urine, Doctor, pain to urine, and wants to urine but cannot.’

‘Indeed. A further symptom is fear of surgery, delaying the sufferer’s decision to undergo his stone’s removal until he can no longer lie down without aching to piss, notwithstanding that these few…’ Marinus peers at Gerritszoon’s dribble of pink urine in its specimen dish ‘… drops are all he can muster. Implying that the stone is now positioned… where, Mr Yano?’

‘ “Hello’ed be thy Daily Heaven…” ’ Gerritszoon belches. ‘Howz’ fockit go?’

Yano mimes a constriction with his fist. ‘Stone… stop… water.’

‘So,’ Marinus sniffs, ‘the stone is blocking the urethra. What fate awaits the patient who cannot pass urine, Mr Ikematsu?’

Uzaemon watches Ikematsu deduce the whole from the parts, ‘cannot’, ‘urine’ and ‘fate’. ‘Body who cannot pass urine cannot make blood pure, Doctor. Body die of dirty blood.’

‘It dies.’ Marinus nods. ‘The Great Hippocrates warned the phys-’

‘Will yer cork yer quack’n’ an’ do thef’ckin’t’doit yer f’ck’r…’

Jacob de Zoet and Con Twomey, here to assist the doctor, exchange glances.

Marinus takes a length of cotton dressing from Eelattu; tells Gerritszoon, ‘Open, please’, and gags his mouth. ‘The Great Hippocrates warned the physician to “cut no stones” and leave the job to lowly surgeons; the Roman Ammonius Lithotomus, the Hindoo Susruta and the Arab Abu al-Qasim al-Zahrawi – who, en passant, invented the ancestor of this -’ Marinus wiggles his blood-encrusted double-sided scalpel ‘- would cut the perineum’ – the doctor lifts the outraged Dutchman’s penis and indicates between its root and the anus – ‘here, by the pubic symphysis.’ Marinus drops the penis. ‘Rather more than half the patients in those bad old days died… in agonies.’

Gerritszoon abruptly stops struggling.

‘Frère Jacques, a gifted French quack, proposed a suprapubic incision, above the corpus ossis pubis,’ Marinus traces an arc with his fingernail to the left of Gerritszoon’s navel, ‘and entering the bladder sideways. Cheselden, an Englishman, combined Jacques le Quack with the ancients to pioneer the lateral perineal lithotomy, losing less than one patient in ten. I have performed upwards of fifty lithotomies and lost four. Two were not my fault. The two were… Well, we live and learn, even if our dead patients cannot say the same, eh, Gerritszoon? Cheselden’s fee was five hundred pounds for two or three minutes’ work. But luckily,’ the doctor slaps the trussed patient’s buttock, ‘Cheselden taught a student named John Hunter. Hunter’s students included a Dutchman, Hardwijke, and Hardwijke taught Marinus, who today performs this operation gratis. So. Shall we begin?’

The rectum of Wybo Gerritszoon releases a hot fart of horror.

‘View halloo.’ Marinus nods at de Zoet and Twomey; they secure a thigh each. ‘The less movement, the less the accidental damage.’ Uzaemon sees the seminarians are uncertain of this pronouncement, so he translates it for them. Eelattu kneels a-straddle the patient’s midriff, holding Gerritszoon’s flaccid penis back and blocking his view of the knives. Marinus asks Dr Maeno to hold the lamp close to the patient’s groin and takes up his scalpel. His face becomes the face of a swordsman.

Marinus sinks the scalpel into Gerritszoon’s perineum.

The patient’s entire body tenses like a single muscle; Uzaemon shudders.

The four seminarians, peer, transfixed.

‘Fat and muscle thickness vary,’ says Marinus, ‘but the bladder-’

Still gagged, Gerritszoon releases a loud noise not unlike a man in orgasm.

‘- the bladder,’ continues Marinus, ‘is about a thumb’s length in.’

The doctor lengthens the bloody incision with his scalpel: Gerritszoon shrieks.

Uzaemon forces himself to watch: lithotomies are unknown outside Dejima, and he has agreed to supplement Maeno’s report to the Academy.

Gerritszoon snorts like a bull, his eyes water and he groans.

Marinus dips his left forefinger into rape-seed oil and inserts it into Gerritszoon’s anus up to its knuckle. ‘Thus the patient should void his bowels beforehand.’ There is the smell of rotting meat and sweet apples. ‘One locates the stone through the rectal ampulla…’ with his right hand Marinus inserts the tweezers into the blood-brimming incision ‘… and pushes it from the fundus up towards the incision.’ Liquid faeces ooze out of the patient’s rectum around the doctor’s hand. ‘The less one pokes around with the tweezers, the better… One puncture is quite enough, and – ah! Almost had it… and – aha! Ecco siamo!’ He takes out the stone, retrieves his finger from Gerritszoon’s anus and wipes both on his apron. The stone is as big as an acorn and the yellow of a diseased tooth. ‘The gash must be staunched before our patient dies of blood loss. Domburger, Corkonian, pray stand aside.’ Marinus pours another oil over the incision and Eelattu covers it with a scab-crusty bandage.