The story is a tragic melodrama about the family conflict that ensues when Namiko, a young wife, contracts tuberculosis.

[1] Namiko, the daughter of a general, and Takeo, a naval officer and son of a deceased baron, begin the story happily married.

His mother, encouraged by the vengeful Taneo, sends Namiko back to her family, effectively dissolving her son's marriage.

Namiko considers throwing herself into the sea, but is stopped by an old woman who brings her a copy of the Christian Bible, which they discuss.

Tokutomi was a staff journalist for his brother's publishing company, Min'yusha, when he began writing the novel, and was not yet a particularly successful or well-known writer.

[1] At the time of its first publication, the novel was appreciated for its flowery language and emotional scenes, with many readers describing crying while reading.

"[3] The novel was also read by female factory workers, which Takateru Teru observed set it apart from the other major hit at the time, Ozaki Kōyō's Konjiki yasha (The Usurer, also known as The Golden Demon).

Namiko's dying words have been described as "without a doubt among the most famous lines of Meiji popular fiction"[1] and "penetrated into the Japanese collective memory.

"[3] William Johnston, however, has recently suggested that there was a sharp decline in the novel's cultural prevalence after the 1950s, as tuberculosis disappeared from Japan.

And having grown up in the healthiest period in their nation's history, they find it hard to believe that their parents lived through Japan's worst epidemic ever of an infectious disease.

Nobuko's stepmother, Ōyama Sutematsu, was the subject of unsympathetic gossip for isolating her stepdaughter, which was seen as a punishing exile.

[7] The novel's romantic tragedy captured important cultural changes in the Meiji period regarding marriage and family, gender roles, and modern wars and diseases.

[1] Namiko's tragic suffering from tuberculosis makes her an example of the late nineteenth romantic stereotype of "the languid and sickly but passionate and loving beauty".

[1] Non-Japanese audiences often compared her to the character in Pierre Loti's novel Madame Chrysanthème, which formed the basis for the opera Madama Butterfly.

[1] Takeo's mother reflects established and conservative views of tuberculosis as hereditary, infectious, and inevitably fatal.

Takeo presents a more modern view by seeing its transmission as not clearly hereditary or infectious, and by suggesting that proper treatment could eventually restore Namiko's health.

Among the factory workers who learned the story through a popular song, for example, those who became more aware of tuberculosis through The Cuckoo also became more likely to shun those who were ill.[5] Within Japan, the novel inspired a volume of poetry, Katei shinshi: Hototogisu no uta (Tokyodo, 1905) by Mizoguchi Hakuyō, which was also successful, with twenty-nine printings in its first two years.

The second translation, into French as Plutôt la Mort ("Rather Death"),[a] was based on the original Japanese, and attributed to Olivier Le Paladin.

Other translations, into German, Spanish, Portuguese, Italian, Swedish, and Finnish, may have been based on the 1904 English version.

In 1918, a newer English translation by Isaac Goldberg was published, titled The Heart of Nami-San: A Story of War, Intrigue and Love, which was dedicated to the feminist Alice Stone Blackwell.

All of these translations leave out Namiko's plea not to be reborn as a woman, which was considered a strong condemnation of the position of women in Japanese society.