The Great White Tower (白い巨塔, Satsuo Yamamoto, 1966)

“It’s about the right thing to do, it’s about conscience, and Prof. Zaizen lacks conscience” according to a star witness at the conclusion of a medical malpractice trial in Satsuo Yamamoto’s adaptation of the novel by Toyoko Yamasaki, The Great White Tower (白い巨塔, Shiroi Kyoto). One of a series of films heavily critical of the medical system in the midst of rising economic prosperity, Yamamoto’s tense political drama presents the succession intrigue at a university hospital as an allegory for the nation as a whole implying that lingering feudalistic and authoritarian thinking has poisoned the contemporary society. 

This is in part reflected in the way in which major hospitals are often run as large family businesses where succession is a dynastic matter. In this case, however, the scene is a prominent university hospital in Osaka at which the head of the surgical department, Azuma (Eijiro Tono), is about to retire. Generally, one of his assistant professors would simply move up after being approved by a board comprised of other department heads but the problem is no one, and especially not Azuma, is particularly happy with the most likely candidate, Zaizen (Jiro Tamiya). The issue between them seems to be one of ambition and authority. Zaizen is regarded by all as an excellent doctor with a stellar track record but he is also cold and arrogant with no regard for departmental protocol all of which of course offends Azuma as does his background and person. The son of a country teacher, Zaizen prospered through the dedicated labour of his widowed mother along with family connections before marrying into the extraordinarily wealthy and influential Zaizen family who run a large obstetrics clinic. Consequently, he is free to pursue his interests and lacks the economic anxiety that might make another employee wary of pushing his luck. 

His humble background might have placed a chip on Zaizen’s shoulder but it’s also clear he’s part of a new generation that does things differently from the last, apparently keen to build a public media brand appearing in a glossy magazine which brands him “the magic scalpel” thanks to his success in treating pancreatic cancer. While they might not be able to argue with his track record, other doctors worry that Zaizen has developed a god complex and is slapdash with his practice often timing his operations and smugly pleased with himself when hitting a new record. Azuma first picks him up on this in the case of elderly patient, questioning his treatment decisions in accusing him of neglecting to fully consider the patient’s post-op wellbeing. This then becomes something of a recurring theme as good doctor Satomi (Takahiro Tamura) is minded to bring Zaizen in on the tricky case of a man, Sasaki (Nobuo Minamikata), he suspects may have pancreatic cancer but has been repeatedly diagnosed with chronic gastritis. 

Though it’s political intrigue that in some senses leads him to Zaizen, Satomi is otherwise depicted as the responsible physician who deeply cares for his patients’ wellbeing and not much at all for interoffice politics. Thus he continues to investigate Sasaki’s case even when other doctors tell him he’s wasting too much time on one patient and should just leave it at gastritis. Zaizen, meanwhile, is the exact opposite taking one look at the X-rays and deciding it is pancreatic cancer after all but thereafter ignoring Satomi’s advice after taking over the case refusing to run a CT scan to verify that the cancer hasn’t spread to the lungs as Satomi fears it might have. 

For Zaizen Sasaki ceases to matter, to him the human body is no different to a machine and he perhaps more engineer than doctor even as he proclaims medicine more art than science in insisting that he just knows the early signs of pancreatic cancer while others are unable to detect them. After the first operation we see him perform, a grateful wife stops to thank him profusely for saving her husband’s life though he treats her coldly and implies it’s all part of the job before going outside to celebrate his private glory in his record-breaking feat. It’s then a minor irony that he finds himself later slapped with a malpractice suit by Sasaki’s wife upset that he was unavailable as her husband was dying because he was preoccupied with the ongoing elections for Azuma’s successor.

The implication is that the dehumanisation of the health industry has reduced it to the status of any other company, the head doctors no better than ambitious salarymen whose lives are defined by their job titles. The various department heads eventually descend into factions with Azuma plumping for an external candidate, Kikukawa (Eiji Funakoshi), while others line up behind Zaizen or his internal rival Kasai (Koichi Ito). Influence is brokered largely by outright bribery or industry manipulation by external influential players including Zaizen’s wealthy father-in-law and a professor in Tokyo who can offer monetary perks, access to funding, and potential promotions to those willing to vote for their chosen candidate. The main argument against Zaizen is his bad character, yet the fact he has been carrying on an affair with a bar hostess is never used against him even as they prepare to smear a rival candidate with his mistress even suggesting they hire a hitman to take him out completely. Zaizen’s minions meanwhile make an ill-advised visit to Kikukawa to ask him to withdraw bizarrely stating the importance of maintaining “democracy” even as they themselves deliberately undermine it for their own gain.  

It’s this sense of feudalistic, fascistic authoritarian chumminess that Azuma’s daughter Saeko (Shiho Fujimura) later decries in asking her father why he did nothing to change such a destructive system while he himself had the power to do so the implication being that he saw no need because he continued benefit from it. Only she and Satomi present any kind of challenge to the hypocrisy that pervades the medical system but eventually discover that there is no place for integrity in the contemporary society. Zaizen miraculously falls upwards every time because his success is more expedient that his failure. Even the Tokyo professor brought in as an expert witness during the malpractice suit declares that Zaizen is unfit to be a physician because of his arrogance and total lack of human feeling but pulls back from testifying that he caused the death of his patient through negligence later explaining to a colleague that if a university professor were to be found guilty of malpractice it would undermine public faith in the medical system. 

If can’t they can’t have faith in the medical system, the very people who are supposed to care for them when they are most in need, how can they have faith in anything else? As the rather bleak conclusion makes clear, the entire system is rotten to the core and no longer has any place for idealists like Satomi who are continually pushed to the margins by those jockeying for power in this infinitely corrupt society defined by hierarchy and cronyism while ordinary people, like Sasaki, continue to pay the price. Just as in his opening sequence, Yamamoto takes a scalpel to the operations of the medical industry to expose the messy viscera below but ultimately can offer no real cure in the face of such an overwhelming systemic failure. 


Original trailer (no subtitles)

The Dawning Sky (明け行く空, Torajiro Saito, 1929)

A family broken by economic shock and destructive male pride is eventually mended through Christian faith in Torajiro Saito’s 1929 silent melodrama The Dawning Sky (明け行く空, Akeyuku Sora). Though most of his work is currently presumed lost, Saito became known as the “god of comedy” while working at Shochiku’s Kamata studios yet Dawning Sky while affecting a cheerful tone is marked by a sense of sadness and anxiety that perhaps reflects the precarities of the world of 1929.

Recently widowed Kyoko (Yoshiko Kawada) has learned to bear her grief by doting on her newborn daughter Reiko, though her world is about to implode as the bank operated by her previously wealthy father-in-law Junzo (Reikichi Kawamura) has collapsed leaving the family in financial ruin. Kyoko’s parents approach Junzo offering to take her back, but the idea provokes only intense resentment in Junzo’s wounded pride as he takes it that they no longer feel his family is good enough for their daughter now that he is no longer rich. A traditionally minded woman Kyoko pleads with him to stay but he will have none of it, throwing her out but insisting on keeping Reiko with him. Out of old-fashioned ideas of loyalty, Kyoko decides that she will not return to her parents nor marry again but is at a loss for what to do sadly wandering about ominously near a bridge before catching sight of the cross on a Christian church and feeling herself saved. Some years later, Kyoko is sent to a small town as a female pastor where, by total coincidence, Junzo is also living with Reiko (Mitsuko Takao) and now working as a lowly coachman. 

The cause of Kyoko’s forced dislocation is located directly in the economic shock of the late 1920s which causes Junzo to lose his family bank and with it the social status which gives his life meaning, but it’s also implicitly the demands growing consumerist capitalism which have already undermined traditional familial bonds and responsibilities. Junzo is so consumed by resentment towards Kyoko’s family, who may have made the offer for pure-hearted reasons rather than snobbish disdain for Junzo’s ruined state, that he coldly separates a mother from her child and thinks nothing of the consequences seeing only red in his internalised shame in having failed in business. Yet true happiness is evidently not possible until he finally learns to abandon his lust for material success. “I’m poor, I know, but life is nice and carefree because I have my granddaughter” he explains to one of his passengers having reconsidered his priorities and come to realise it’s familial bonds which are most important after all. 

Nevertheless, he continues to hide the truth from Reiko having told her that both her parents are dead while she continues to pine for a mother she’s never known. Her little friend Koichi meanwhile is the only son of his widowed mother who is bedridden and unable to work. As the family is poor Koichi is responsible not only for her care, they’ve rigged up a kind of machine which automatically dispenses her medicine while he isn’t there to administer it, but for the cooking and cleaning too. The two children first bond when Reiko discovers a wounded pigeon shot by Koichi and scolds him that he has no right to kill living things though he only wanted to feed his sick mother, the pair of them deciding to bury the pigeon and give it a proper funeral. This brings her to the attention of the pastor, Kyoko, who is proving especially popular in the local community because of her innate kindness and compassion. But in suspecting that Reiko may be her daughter, Kyoko is at a loss as to how to move forward unwilling to disrupt her life with Junzo by telling her the truth while torn apart inside by her wounded maternity and new duties to her Christian faith. 

The film’s overt religious overtones are perhaps surprising for the world of 1929 as is the near universal approval with which the church is viewed in the local community with only the strange and bookish Hide refusing to attend on the grounds that he hates Christians while all of the other children begin hanging out inside largely because of Kyoko’s warmth and kindness. It is finally Christian virtues which allow the family to be repaired, Junzo overcoming his sense of wounded male pride when faced with Reiko’s constant pining as the pair eventually make a mad dash towards the station on learning that Kyoko has decided to leave town rather than risk causing Reiko further pain by disrupting her new life. “God’s grace brought them together” as the benshi intones, yet as much as Kyoko’s maternity is restored she remains a liminal figure returning not to Junzo’s house but only to the church as its pastor recommitting herself to her religious duties while looking out sadly as Reiko plays with the other children in the beautiful countryside suggesting that the ruptured bonds of the traditional family cannot ever be fully repaired. 

Saito’s elegant mise-en-scène has its moments of poignancy in the expressionist angles of Kyoko’s walk into darkness or frequent employment of superimposition, not to mention the intensity of its climactic storm scene intercut the with the spiritual ferocity of Kyoko’s desperate praying surrounded by candles in the dark and empty church, but the film is first and foremost a melancholy tale of familial reunion which, while in some senses incomplete, nevertheless suggests that true happiness exists only in simplicity, the family repairing itself through jettisoning contemporary ideas of capitalistic success and social hierarchy in order to embrace their natural affection for each other.