M »i ERVICE «ES MANUAL CIVIL AFFAIRS HANDBOOK JAPAN SECTION 13: PUBLIC HEALTH AND SANITATION e m i n a t i o n of The information con- tained in restri documents and tlT6 essential chaj«rcte r i st i cs of ijwst rioted material may be to any person known to be yr the service United States and to jaTr sons of undoubted loyalty and who &rjf coope rat i ng in Gove rfc. but will be commun i cat.t o the public jyr to the press except ho r i zed m i 1 i tati' pu b 1 i c relation# agencies. par. |8b, AR Sep i 91+2.) JF Jf HEADQUARTERS, ARMY SERVICE FORCES,18 DECEMBER 1943 ARMY SERVICE FORCES MANUAL M 354-13 Civil Affairs CIVIL AFFAIRS HANDBOOK JAPAN SECTION 13 : PUBLIC HEALTH AND SANITATION HEADQUARTERS, ARMY SERVICE FORCES,18 DECEMBER 1943 UNCLASSIFIED emination of tricted matter. - Tinformation con- tained in rest documents and Jpe essential characteristics of restricted material may be given to any known to be in th of the United States and to rsons of undo uto$* d loyalty and discr n on who are cooperating in Gove rnmeg.#work, but will be communicated iojJnie public or to the press except i zed militaap public relations (See also par. 18b, AR 38028 Sep I 942-) NUMBERING SYSTEM OF ARMY SERVICE FORCES MANUALS The main subject matter of each Army Service Forces Manual Is Indicated by consecutive numbering within the following categories: Ml - M99 Basic and Advanced Training MlOO - M199 Army Specialized Training Program and Pre- inductlon Training M200 - M299 Personnel and Morale*-* M300 - M399 Civil Affairs M400 - M499 Supply and Transportation M500 - M599 Fiscal M600 - M699 Procurement and Production M700 - M700 Administration M800 - M899 Miscellaneous M900 up Equipment, Materiel, Housing and Construction HEADQUARTERS, ARMY SERVICE FORCES Washington 25, D. C., 18 Dec 1943. Army Service Forces Manual 354-13 Civil Affairs Handbook; Japan, Section 13: Public Health and Sanitation has been prepared under the supervision of the Provost Marshal General, and Is published for the Information and guidance of all concerned. [SPX 461 (21 Sep 43).] By command of Lieutenant General SOMERVELL; W. D. STYER, Major General, General staff corps. Chief of Staff. OFFICIAL; J. A. ULI0, Major General, Adjutant General. S4-6302HBCD CIVIL affairs handbooks TOPICAL OUTLINE 1. Geographical and Social Background 2, Government and Administration A 3 • Legal Affairs !;• Government Finance 5. Money and Banking 6. Natural Resources 7. Agriculture 8. Industry and Commerce 9. Labor 10. Public Works and Utilities 11. Transportation Systems 12. Communications 13* Public Health and Sanitation liu Public Safety l£. Education 16. Public Welfare 17* Cultural Institutions a4'02621ABCD This preliminary study on Public Health and Sanitation in Japan was prepared by the LIAISON AND STUDIES BRANCH OF THE MILITARY GOVERNMENT DIVISION, OFFICE OF THE PROVOST MARSHAL GENERAL. INTRODUCTION Purposes of the Civil Affairs Handbooks, The basic purposes of civil affairs officers are (1) to assist the Commanding General by quickly establishing those orderly conditions which will contribute most effectively to the conduct of military operations, (2) to reduce to a minimum the human suffering and the material damage resulting from disorder and (3) to create the conditions which will make it possible for civilian agencies to function effectively. The preparation of Civil Affairs Handbooks is a part of the effort to carry out these responsibilities as efficiently and humanely as is possible* The Handbooks do not deal with plans or policies (which will depend upon changing and unpredictable developments). It should be clearly understood that they do not imply any given official program of action. They are rather ready reference source books containing the basic factual information needed for planning and policy making. Revision for Final Publication. This section on Public Health and Sanitation in Japan should be considered as a preliminary draft. It will be revised preparatory to its incorporation in the Civil Affairs Handbook on the whole. The following topical outline indicates the subject matter covered by the Handbook series. This preliminary study on Public Health and Sanita- tion in Japan was prepared in the LIAISON AND STUDIES BRANCH OF THE MILITARY GOVERNMENT DIVISION, OFFICE OF THE PROVOST MARSHAL GENERAL. OFFICERS USING THIS MATERIAL ARE REQUESTED TO MAKE SUGGESTIONS INDICATING THE REVISIONS OR ADDITIONS WHICH WOULD MAKE THIS MATERIAL MORE USEFUL FOR THEIR PURPOSES. THESE CRITICISMS SHOULD BE SENT TO THE CHIEF OF THE LIAISON AND STUDIES BRANCH, MILITARY GOVERNMENT DIVISION, PMGO, 2807 MUNITIONS BUILDING, WASHINGTON, D. C. i>4 -easai abcd CIVIL AFFAIRS handbooks TOPICAL OUTLINE 1* Geographical and Social Background 2, Government and Administration 3. Legal Affairs li. Government Finance 5>. Money and Banking 6. Natural Resources 7. Agriculture 8. Industry and Commerce 9. Labor 10* Public Y/orks and Utilities 11. Transportation Systems 12. Communications 13. Public Health and Sanitation llu Public Safety l£. Education 16. Public Welfare 17• Cultural Institutions This preliminary study on Public Health and Sanitation in Japan was prepared by the LIAISON AND STUDIES BRANCH OF THE MILITARY GOVERNMENT DIVISION, OFFICE OF THE PROVOST MARSHAL GENERAL. 34-S36aiABCD INTRODUCTION purposes of the Civil Affairs Handbooks. The basic purposes of civil affairs officers are (1) to assist the Commanding General by quickly establishing those orderly conditions which will contribute most effectively to the conduct of military operations, (2) to reduce to a minimum the human suffering and the material damage resulting from disorder and (3) to create the conditions which will make it possible for civilian agencies to function effectively. The preparation of Civil Affairs Handbooks is a part of the effort to carry out these responsibilities as efficiently and humanely as is possible* The Handbooks do not deal with plans or policies (which will depend upon changing and unpredictable developments). It should be clearly understood that they do not imply any given official program of action. They are rather ready reference source books containing the basic factual information needed for planning and policy making. Revision for Final Publication. This section on Public Health and Sanitation in Japan should be considered as a preliminary draft. It will be revised preparatory to its incorporation in the Civil Affairs Handbook on the whole* The following topical outline indicates the subject matter covered by the Handbook series. This preliminary study on Public Health and Sanita- tion in Japan was prepared in the LIAISON AND STUDIES BRANCH OF THE MILITARY GOVERNMENT DIVISION, OFFICE OF THE PROVOST MARSHAL GENERAL. OFFICERS USING THIS MATERIAL ARE REQUESTED TO MAKE SUGGESTIONS INDICATING THE REVISIONS OR ADDITIONS WHICH WOULD MAKE THIS MATERIAL MORE USEFUL FOR THEIR PURPOSES. THESE CRITICISMS SHOULD BE SENT TO THE CHIEF OF THE LIAISON AND STUDIES BRANCH, MILITARY GOVERNMENT DIVISION, PMGO, 280? MUNITIONS BUILDING, WASHINGTON, D. C. 24-eaoaiABCD RESTRICTED Table of Contents Page I• General 1 a. Geography 1 b. Prefectural Governments 1 II. Vital Statistics 4 a. Population 4 b. Birth Rate 4 c. Legitimacy and Illegitimacy 5 d. Marriages and Divorces 5 e• Deaths 6 f. Poisonings 8 g. Burials and Cremations 9 III. Ministry of Public Health and Welfare 10 a. Historical 10 b. Organizational Outline of the Ministry 12-a IV. Central Sanitary Administration 15 a. Central Administration Proper 15 1* Health Preservation Section 14 2. Chronic Diseases Section 14 5. Acute Infectious Diseases Section 14 4. Medical Matters 14 a4-02eaiiBco i RESTRICTED RESTRICTED ii Page b. Advisory Councils 15 1. Central Board of Health Council 15 2. Council for Investigation of Japanese Pharmacopoeia 15 3. Council for Investigation of National Hygiene 16 4. National Parks Council 16 5* Opium Commission Council 16 c* Laboratories 16 1. Government hygienic Institute Laboratories 17 2* Government Institute for Infectious Diseases 18 5* Government Research Institute of Nutrition 18 d. Examining Bodies 19 e« Medical Relief 20 1. Policy 20 2« Medical Relief Establishments 21 a. National Leprosaria 21 b* Prefectural Leprosaria 22 c* National Tuberculosis Sanitarium 22 S4-6aestABCD RESTRICTED RESTRICTED ill Page V. Health Functions in the Other Departments 24 a. Department of Home Affairs 24 b« Department of Education 24 c. Departments of War and Navy 24 d. Railway and Prison Sanitation 24 VI. Public Health Institute 26 VII. Physical Education 26 VIII• Provincial Organizations for Public Health Administration 26 a. Local Governors 27 b. Chief of the Police Station 27 c. Cities, Towns, Villages and their Heads 27 IX. Quarantine Organizations 27 X. Medical Personnel 50 a. Doctors 50 b. Dentists 52 c. Pharmacists 54 d. Auxiliary Staff 56 1. Midwives 56 2. Nurses 55 5, Public Health Nurses , 55 4. Miscellaneous 56 24-O3021ABCD RESTRICTED RESTRICTED iv Page e. Veterinarians 36 XI. Hospitals 37 XII. X-Ray Apparatus 41 XIII. Drugs 42 i a. Control 42 1. Pharmacists 42 2. Druggists 42 3. Drug Manufacturers 42 b. Handling of Drugs 43 XIV. Medicines 45 a. Medicines not mentioned in any Pharmacopoeia b. Inspection of Medicines 45 c. Patent Medicines 45 XV. Budgets 46 24-fl2«21lBCD XVI. Rural Sanitation and Collaboration of the Population 47 XVII. Housing 48 RESTRICTED RESTRICTED V Page XVIII. , Water Works and Drinking Water 60 a. Water Supply 50 b. Existing Waterworks 61 c. Methods of Purification 52 d. Water Supply Fees 52 e. Waterworks Consultation Society 55 XIX, Sewage Waste and Garbage Disposal 54 XX, Foods, Beverages and Other Articles 67 a. Early Laws 57 b. Principal Laws and Regulations 58 c. Control of General Foods and Drinks 58 d. Control of Special Foods and Beverages 59 XXI, Composition of Food and Method of Preparation - 60 a. Rice 60 b. Milk 61 c. Meat Hygiene 65 XXII, Mineral Springs 66 XXIII, Opium and its Control $7 XXIV, Health Examination of Prostitutes 69 •4-02S81ABCD RESTRICTED RESTRICTED vi Page XXV. Venereal Diseases 71 XXVI. Health Centers 74 XXVII. Infectious Diseases (Reportable) 75 a. Cholera 75 b. Dysentery and "Ekirl" 76 c. Typhoid Fever, Paratyphoid Fever 78 d. Smallpox 79 e. Scarlet Fever 80 f. Diphtheria 80 g. Typhus Fever 80 h. Plague 81 1. Trachoma 85 j. Cerebrospinal Meningitis 85 k. Notification of Acute Infectious Diseases 85 l. Detection and Disposal of Bacilli Carriers 86 XXVIII. Port Quarantine 88 XXIX. Rabies 91 24 ~6a031ABCD XXX. Vaccination 91 mi. Parasites 95 BEBPiCffiP RESTRICTED vii Page a. Common types 95 b. Geographical Distribution of Parasites 95 c. Preventive Measures Employed 94 d. Worms 95 XXXII. Tuberculosis 95 a. History 96 b. Statistics 97 c. Duties of Administration Authorities 98 XXXIII. Mental Disorders mi XXXIV• Cancer 105 XXXV. Bacteriological Laboratories 106 a. Number 106 b. Vaccines, Sera, etc. 106 c. Vaccines 107 XXXVI. Disease Information 109 a. Malaria 109 b. Dengue Fever 10$ 34-9B«aiABCD RESTRICTED RESTRICTED viii ° Page c. Pappataci or Sandfly Fever 110 d. Influenza 110 e. Pneumonia 110 f • Relapsing Fever 111 g« Schistosomiasis 111 h. Filariasls 111 i. Other Worm Infestations 111 j. Epidemic fhcephalitis 112 k. Dermatological Conditions 112 l. fieri beri 112 in* Leptospirosis 113 n. Leprosy 113 o. Tetanus 114 p. Kala Azar 114 q. Anthrax 114 r. Actinomycosis 114 XXXVII. Insects and Animals of Importance to Man 115 a. Mosquitoes 115 b. Flies 115 c. Sandflies 116 d. Other Flies 117 e. Fleas 117 34-62031*800 RESTRICTED RESTRICTED ix Page f. Lice 118 g. Mites 118 h. Hats 118 i. Poisonous Snakes 119 j. Pests 119 XXXVIII. Diseases of Cattle 120 XXXIX. Maternity and Child Welfare 120 XL. Organization of School Hygiene 122 XLI. Mutual Relief Organizations 123 XLII, Health Insurance Act 123 XLIII. Industrial Hygiene 124 XLIV. Red Cross Activities 126 List of Illustrations 1, Sports Center of Tokyo 28 2. Tokyo Municipal Sanatorium 65 3* St. Luke's International Medical Center 108 Appendices A. Tables Table 1. Number of Deaths Caused by Disease in Japan Proper in 1938 133 S4-03681ABCD RESTRICTED RESTRICTED X Page Table II, Municipal Hospitals, Convalescent Homes, Clinics, and Health Advice Offices 169 Table III* Notifiable Infectious Diseases 175 Table IV, Number of Water Works 176 Table V, List of Approved Biologicals 178 Tables VI. & VII, Number of Officials in Department of Health and Sanitation 179 Table VIII. Administration of School fyglene 181 Table IX. Ministry of Public Health and Welfare 182 B, Maos Japan xil Cholera 183 Dengue 184 Filariasis 185 Malaria 186 Plague 187 Schistosomiasis 188 Tetanus 189 Typhus Fever 190 34-O30S1ABCD RESTRICTED RESTRICTED XI Page £• A Method of Obtaining a Japanese Medical History Outline 191 List of References 215 B3S STRICTER) XII JAPAN RESTRICTED JAP4N PUBLIC HEALTH AND SANITATION I. Senegal a. Geography. A proper understanding of the functioning of any governmental agency of Japan requires the possession of certain funda- mental facts about the geography of Japan. For purposes of government the Japanese Empire is divided into two main divisions: (1) Japan Proper and (2) her possessions and Mandated Islands. The possessions are Korea, Formosa, Karafuto and Kwantung. The Mandated Islands are the Marianas, Marshalls and the Carolines: these three groups cf islands lie in the North- west Pacific Ocean between 150 degrees and 175 degrees east longitude and between one degree and twenty one degrees north latitude. They form a great maritime triangle; the base of 2700 miles is formed east to west by the Caroline and Marshall Islands, the apex 1200 miles north of the base is formed by the Marianas. Japan Proper, geographically, is a long and narrow group of islands lying between north latitude 50 degrees and 25 degrees. In the northern part of these islands the winters are extremely cold with a great deal df snow, and in the southern part, especially in Okinawa prefecture, the climate is always warm, like that of the subtrop- ical zone. There are four main islands in the group: Hokkaido, Shikoku, Honshu and Kyushu. b. Prefectural Governments. For administrative purposes, however, Japan Proper is divided into "Kenn or Prefectures, of which there are 47, 24-62621ABCD RESTRICTED 1 RESTRICTED 2 each* serving as a centralized unit* They are grouped geographically as follows: Northeastern Group of Prefectures: Hokkaido Aomori Iwate Uiyagi Akita Yamagata Fukushima Eastern Group of Prefectures: Ibaraki Tochigi Gumma Saitama Chiba Tokyo (City Government) Kanagawa Northern Group of Prefectures: Nigata Toyama Ishikawa Pukui Tosando Group of Prefectures: Yamanashi Nagano Gifu Tokaldo Group of Prefectures: Shizuoka Aichi Miye Klnkl Group of Prefectures: 34*0>631iBCDil Shiga Kyoto (City Government) RESTRICTED RESTRICTED 3 Hiogo a Wakayama Osaka (Gity Government) Dhugoku Group of Prefectures: Tottori Shimane Okayama Hiroshima Yamaguchi Shikoku Group of Prefectures: Tokushima Kagawa Kochi Kyushu Group of Prefectures: Fukuoka Saga Nagasaki Kumamoto Oita Miyazaki Kagoshima Okinawa It should be noted that Tokyo, Kyoto and Osaka are administered as City Governments rather than prefectur&l governments* 24-fl2«21*BCD RESTRICTED RESTRICTED 4 II. Vital Statistics a. Population. According to the national census of Japan taken in 1939, the actual population was 72,222,700. The sex ratio shows 100.62 males to 100 females. The males slightly exceed the females, a condition diamet- rically opposite to practically all European and American countries. 1935 1232 Total 69,254,148 72,222,700 Male 34,734,133 36,182,700 Female 34,520,015 36,040,000 Number of households 13,499,483 13,704,364 Average number in household 5.13 5.13 The density of the population, as based on the census of 1935, was 181 persons per square kilometer, an increase of 12 over the corresponding figures of the previous census. Density according to locality shows Tokyo prefecture to be most densely settled, with a figure of 2,970 persons per square kilometer. Osaka has 2,369# Kanagawa 782, while the most sparsely settled locality was Hokkaido with a density of 35. Dividing the population into two categories, urban and rural, shows urban to be 22,666,037 or 32.73*, and rural 46,587,841 or 67.27*. Considering the ages from 15 to 60 to be industrially productive, on the basis of productivity the 1935 figures indicate the following: Male and female Total 69,254,148 100* Under 15 25,545,167 36.89* From 15-59 38,553,411 55.67* 60 and over 5,155,570 7.44* b. Birth Hate. The total number of live births in Japan Proper in 1937 was 2,180,734 and its ratio to the actual population was 30.61 births per 1,000 inhabitants. This figure represents; 34-6302 lABCJD Male 1,116,154 Female 1,064,580 RESTRICTED RESTRICTED 5 Total 1958 live births was 1,928,551, which shows a decline. This represents a ratio of live births to population in 1958 of 26.70 per 1000 births, or 104,8 males to every 100 females. The highest birth rate was in Aomori with 41.76 and the lowest in Osaka with 23.06. Osaka is the center of the industrial area of Japaq. Still births in Japan Proper in 1957 were 111,485; males 60,578, females 50,214, giving a rate of 1.56 per 1000. In 1939 the still births were 99,528, a decline from the previous year. The ratio of still births of 1.56 per 1000 is considered high for a civilized country. Most European and American Nations have a still birth rate of under 1. c. Legitimacy and illegitimacy. The ratio of illegitimacy in Japan is high; per 100 births in general legitimate 95.8 illegitimate 6.2 per 100 still births legitimate 80,9 illegitimate 19.1 per 100 legitimate births live births 95.7 still births 4.3 per 100 illegitimate births live births 84.6 still births 15.4 d. Marriages and Divorces* The total number of marriages among the actual population in Japan Proper in 1957 was 674,680 and the ratio per 100 of the actual population as of that year was 9.47* The highest ratios were found in Toyama prefecture with 12,30, Kagawa 11,80 and the lowest ratios were Tokyo 7,58, and bsaka 7,65. 24-82621ABCD RESTRICTED RESTRICTED 6 The number of divorces in 1957 was 46,600 or 0.65 per 1000 population. Compared to the marriages of that year the divorces were 6.9 percent of the marriages. Compare this figure to those of 1890 when the divorce rate was 55.6 for every 100 marriages. This rate has been steadily declining except for a brief period around 1915, a phenomenon attributed to the greater importance played by women in the econony of Japan. e. Deaths* The total number of deaths in Japan Proper in 1959 was 1,259,806 of which 662,926 males and 606,809 were females, giving a V rate of 17.52 per 1000 for males and 16.58 for females. The highest rate was in Ishikawa with 25.70 and lowest in Tokyo with 12.91 per 1000. January, February and march show the highest death rates. May, and June the lowest. Life expectancy as calculated at the Bureau of Statistics of the Cabinet was as follows; Age male female under 1 year 44.82 years 46.54 years 2 years 51.07 62.10 5 51.85 65.00 10 47.95 49.18 20 40.18 42.12 50 33.45 56.98 40 25.74 29.01 50 18.49 21.07 60 12.25 14.68 70 7.45 8.88 24-eaeaiABCD RESTRICTED RESTRICTED 7 Comparison bj Years: Year Total number of deaths Death per 1000 Deaths of children under one year per 1000 births 1954 1,234,634 18.1 125 1955 1,161,956 16.8 107 1956 1,250,278 17.5 117 1957 1,207,899 17.0 106 Principal causes of death, with their ratio per 10,000 population, as of 1958: Males Females Total Typhoid and paratyphoid fever 1.00 1.00 1.00 Measles 0.7 0.8 0.8 Whooping cough 1.2 1.6 1.4 Diphtheria 0.7 0.6 0.6 Influenza 1.2 1.2 1.2 Dysentery 2.5 2.6 2.4 Tuberculosis of Respiratory System 16.1 14.4 16.3 Other Tuberculosis 4.7 6.1 5.4 Syphilis 1.0 0.6 0.8 Septicemia 1.5 1.2 1.5 Cancer and other malignant tumors 7.1 6.9 7.0 Meningitis, except tuberculous 6.6 6.0 5.5 Cerebral hemorrhage, embolism, thrombosis 18.6 15.1 16.8 24-82621ABCD RESTRICTED RESTRICTED 8 Chronic Endocarditis & Valvular disease 2.9 5.6 5.3 Diseases of coronary arteries 0.9 0.6 0.7 Arteriosclerosis 0.9 0.0 0.7 Bronchitis 5.9 5.6 5.7 Pneumonia 17.1 14.9 16.0 Pleurisy 2.7 2.4 2.6 Ulcer of stomach and duodenum 2.3 1.1 1.7 Enteritis and diarrhea (under two years of age) 10.7 9.4 10.0 Enteritis over 2 years of age 6.4 8.0 7.2 Cirrhosis of liver .9 • 5 .7 Nephritis 8.0 8.5 8.5 Suicide 2.8 1.6 2.2 Accidents 0.5 2.5 4.2 Attention is called to the high death rate from tuberculosis, enteritis and cerebral accidents and pneumonia. f. Poisonings. The total number of persons poisoned in 1957 was 12,000. Of these 7,410, or 58.50$, were poisoned intentionally; 5,215, or 41.16$, accidentally. Of poisonous substances employed the ones most frequently used in intentional poisoning were ’'calmotlve" and those containing phosphorous, cyanide, and patent medicines. Accidental poisoning was due mostly to eating poisonous fish, or a food widely eaten in Japan called kamaboku, and poisonous mushrooms• 24-82621ABCD RESTRICTED RESTRICTED 9 g. Burials and Cremations* Burial grounds total 975,682, crematories total 54,534. Total number cremated in 1937 was 707,164, or 55.76%. Total number buried 608,329, or 46.24%. In some areas, such as Toyama, Ishikawa, Osaka, Tokyo, Hiroshima the percentage of cremations run over 90% of the dead. The low percentage cremations were in Southern Japan as in Kagoshima where the cremations ran as low as 4.68% of the dead. 24-62021AB CD RESTRICTED RESTRICTED 10 Ill* Ministry of Public Health and Welfare a. Historical. For centuries the chief health problem of the Japanese has been the pandemics — the vast epidemics that swept the whole country, with cholera, plague, smallpox, dysentery, influenza and typhoid — and the chief effort of the authorities has been toward combatting these pandemics that decimated the population and caused panic among the people. Though great strides have been made and certain epidemics, such as cholera and plague and smallpox, have been blotted out, it was after the restoration of the Meiji (1868-1873) that a sanitary commission was established in Japan. This was modelled after those in existence in the United States and countries of Europe. In the beginning, the Toko (the East College) of the Imperial Uni- versity controlled sanitary administration, in addition to medical education. But in 1872 a Medical Section was set up in the Department of Education and the year following the Medical Bureau in the Department of Education was established. This was the first body ever created in Japan for sanitary administration. At that time there was little legislation concerning sani- tary administration and the Medical Bureau began the investigation and drafting of regulations, and in 1874 published the so called “Medical Code.” This was the first unified statute to be published in Japan. The Medical Bureau of the Educational Department had under its control not only sanitary administration but medical education as well. It was trans ferred to the Home Department in 1875 and a body for the exclusive management of sanitary affairs came into existence for the first time in Japan. At that time the organization was called the "Seventh Bureau,” but soon after it was 34'63«aiABC0 RESTRICTED RESTRICTED 11 renamed "The Sanitary Bureau" and has continued to function under that name ever since. Until 1937 the entire organization of Health and Sanitary Services func- tioned under the Ministry of Home Affairs. However, at a meeting of the Konoye Cabinet on June 9, 1937, it was decided to create a new ministry — the Ministry of Public Health and Welfare. This was offically organized in 1933 and has since taken over the business of the Ministry of Home Affairs as far as Sanitary and Health matters are concerned. This move was prompted by the great number of rural inhabitants being brought into the factories in the cities. Japan was changing from an agricultural to an industrial nation. The Ministry of Welfare was created by Ordinance Number 7 of the 10th of January, 1933. Article 1, No. 1, states that the Minister of Public Health and Welfare shall be in control of administration connected with the national health, social undertakings, and labor. Article 2 divides the Ministry of Public Health and Welfare into Departments of Physique, Sanitation, Prevention of Disease, Social Affairs, and Labor. The Department of Physique, in addition to matters of physique and physical training, is responsible for the health of pregnant women, in- fants, and children. The Department of Sanitation, among other functions, is concerned with education in hygiene, medical affairs, and pharmacy, and other departments. The branches specified for the Department of Prevention of Disease are the prevention of infectious, local and other disease, quar- antine administration, mental diseases, and racial health. The Department of Social Affairs is responsible for functions which are in the main similar 24-62621ABCD RESTRICTED RESTRICTED 12 to those of the former boards of guardians in this country. The Department of Labor explains itself, its functions including the supervision of inter- national labor matters. Councillors up to fifteen in number are attached to the Department of Labor, these being selected from among higher Civil Servants and economic experts. Officials for the supervision of factories and mines and for arbitration in labor disputes are selected from among the permanent staff. The Public Health Service and Sanitary Bureaus of Japan are modern, efficient and compare favorably with those of the Western Hemisphere. The Public Health Services are administered under four main branches: (1) Gen- eral Public Health by the Central Sanitary Bureau of the Ministry of Public Health; (2) Industrial Hygiene by the Bureau of Social Affairs; (3) School Hygiene by the Department of Education; (4) Military Hygiene by the Ariny and Navy Ministries. Officials of Ministry of Public Health and Welfare. January 1. 1941» Minister of Health - Yasui Eiji Secretary to Ministry of Health - Irie Seiichiro Director; Sanitation Bureau - Kato Otomaro Director of Preventive Medicine Section - Takano Hokuro Director Bureau of Social Welfare - Kumagae Kenichi Director Labour Bureau - Mochinaga Gifu Director Occupational Bureau - Naito Kanichi Director Unemployment Bureau - Naito Kanichi Director General Affairs Bureau - Kawamura Hidefumi Director Bureau of Social Welfare - Shimidzu Ken Director Post Office Insurance Bureau - Maeda Jo 24-82621ABCD RESTRICTED RESTRICTED 12-a Table A b. Organ1gatlonal Outline of the Ministry of Public Health and Welfare Minister of health - Member of Cabinet I. Bureau of Physical Training Minister's Secretariat Confidential Secretary Filing & Correspondence Accounting Improvement of Physique Physical Measurements Miscellaneous Section of Planning Physical culture exercise Training of Phy. culture instructors Mass exercise in cadence Miscellaneous Physical culture Parks Other Equipment Physical training of midwives, infants and children Section of Equipment II. Bureau of Health Water works 8c Sewers Food, beverages Animal husbandry Public sanitation Natural spring, beaches, etc. Training of Sanitation Specialist Section of Health Maintenance Section of Education Improvement of Health Methods Clothing, Housing conditions Doctors, dentists, nurses, raidwives Pharmacist & Manufacturers of drugs, medical societies; Dentist and Pharmacist societies. Medical, dental, pharmacist examination clinics — medical and dental; control of opium and narcotics, poisons Cultivation of medicinal plants 24-62021&BCD Medical Section RESTRICTED RESTRICTED 12-b III. Bureau for Prevention of Diseases 1. Section on chronic infectious endemic diseases such as tuber- culosis , leprosy etc. 2. Section on acute contagious diseases, small-pox, trachoma, varicella, rubiola. 5. Section on quarantine of epidemic contagious disease. IV. Bureau of Social Affairs V. Bureau of Labor VI. Bureau of Occupations VII. Bureau of Unemployment Board of Insurance Board for Protection of Wounded Veterans 34-ea«aii*CD RESTRICTED RESTRICTED 13 IV. Central Sanitary Administration The Staff of the Central Sanitary Bureau is usually composed of the following members; an Administration Official, a Director, 6 experts and 13 assistant experts and clerks,. In addition to this the Bureau has in its service as temporary members nine medical experts and three assistant experts who are employed in the prevention of infectious diseases; two experts, two clerks and three assistant experts who are enployed in public health inquiries. The Central Sanitary Administration is composed of five divisions, and these in turn, in typical Japanese fashion, are sub-divided into various operating units. The five major divisions consist of: a. Central Administration Proper b. Advisory Councils c. Laboratories d. Examining bodies e. Medical Relief Establishments a. Central Administration Proper. This is presided over by a Board of Health which holds four regular meetings a year, frequent committee meetings, and have among their duties the imposing of penalties on medical practitioners, dental surgeons and pharmacists. The board consists of: of Public Health and Welfare Secretary—Secretary of the Ministry Members—26 Temporary Members—10 Three Clerks Central Administration Proper organization is divided into the four following sections: 1. Health Preservation 2. Chronic diseases prevention 3. Acute infectious diseases prevention 4. Medical matters 24-02031ABCD RES TRIG TEE RESTRICTED 14 1. Health Preservation Section is concerned with: (i) Drinking water and waterworks. (ii) Foods, beverages and nutrition. (iii) Sewage, removal of wastes, and other means of maintaining cleanliness. (iv) Public parks, mineral spring resorts, sea bathing places and other health resorts. (v) Sanitation of factories, theaters, and other gathering places. (vi) General hygiene of children and women. (vii) Encouragement of physical exercise. (viii) Health statistics. (ix) Diffusion of the knowledge of hygiene, (x) Other matters relating to public health which do not come under the control of other sections. 2, Chronic Diseases. The section for the prevention of chronic diseases is concerned with: (i) Tuberculosis, trachoma, leprosy, veneral diseases, and other chronic infectious diseases. (ii) Parasitic, protozoal and local diseases* (iii) Mental diseases. (iv) The Saiseki (medical charity association), a foundation originating from an Imperial Donation, as well as other measures of free medical treatment. 3. Acute Infectious Diseases. The section for the prevention of acute in- fectious diseases is concerned with: (i) Acute infectious diseases. (ii) Port quarantine. (iii) Vaccines, sera, and other article# of bacteriological prevention and treatment. 4* Medical Matters. This section is concerned with: (i) Medical practitioners, dentists, surgeons, midwives, and other practitioners. (ii) Pharmacists, drug manufacturers and druggists. (iii) Association of medical practitioners, dental surgeons and pharmacists. (iv) Medicines and patent medicines. (v) Poisonious or potent drugs and other injurious substances, (vi) Non-therapeutic chemical substances requiring control by the public health unit officer. (vii) The cultivation of medicinal plants and the expanding of drug manufacture. (viii) Hospitals in general. 34-03831ABCD RESTRICTED RESTRICTED 15 b. Advisory Councils* The advisory councils operate under the super- visibn of the Ministry of Health, and consist of five units. 1. The Central Board of Health Council. 2. Council for Investigation of the Japanese Pharmacopoeia 3. Council for the Investigation of National Hygiene. 4. National Parks Commission. 5. Opium Commission. 1. The Central Board of Health Council was first established in 1877 when cholera was prevalent, in order to investigate and consult in the measures to be taken in connection with sanitary inspection, detention of vessels and other matters. It was made a permanent institution empowered to act as an advisory body in regard to affairs of sanitary administration in general. The board is under the direct supervision of the Minister of Health and is authorized to ex- press its views in answer to inquiries made by the competent Ministers of State regarding matters relating to Public Health as well as to the health of animals. It is composed of a chairman and not more than thirty members; in case of ne- cessity additional temporary members may be appointed. The Board has a secretary who must be a high official of the Home Department and who is in charge of the Board's general business. 2. Council for the investigation of the Japanese Pharmacopoeia was first es- tablished as a temporary body in 1900 for the purpose of investigating matters relating to the revision of the "Second Revised Edition of the Japanese Pharm- acopoeia" such revision being of urgent necessity at the time. It was revised in 1906, and as these matters require constant revision, the Council was trans- ferred into a permanent organization. It investigates under the supervision of the Minister of Health matters relating to the revising of the Japanese Pharm- acopoeia and is composed of one chairman and not more than sixteen members; in case of necessity, additional temporary members may be appointed. The Council Q u CQ *5 (N <0 CJ «0 I * o RESTRICTED RESTRICTED 16 has in its service a secretary who must be a high official in the Ministry of Health and who is in charge of the Board's general business. 5. The Council for the Investigation of National hygiene is under the Supervision of the Minister of Health and investigates and advises in matters relating to preservation of national health and hygiene. It is composed of a chairman and not more than 40 members; in case of necessity additional temporary members may be appointed. Its chairman is the Minister of Health. The Secretary must be a high official of the Ministry of Health and is responsible for the management of its general business. 4. National Parks Council is an advisory board on matters concerning National Parks. Chairman, 13 Secretaries, 39 Members, 5 temporary members, 3 Clerks. 5. The Opium Commission Council is an advisory board on opium and other dangerous drugs. It consists of a chairman, eleven secretaries which includes: Secretary of Foreign Office, Secretary of Home Department, Expert of Home Department, Secretary of Finance Department, Secretary of Department of Justice, Secretary of Communications Department, Secretary of Overseas, Secretary of Manchukuo Affairs, 19 members of the Commission and 5 clerks. In 1937 two meetings were held to (1) Report on the progress of International Conference for Control of illicit traffic in Narcotic Drugs. (2) Meeting in regard to disposal of crude morphine by the monopoly bureau of the Taiwan Government General. Q O OQ ◄ Cl CO Cl CO I * 0) c. Laboratories. The Laboratories include: 1* Government Hygienic Institute RESTRICTED RESTRICTED 17 2* Government Institute for Infectious Deseases* 5. Government Institute of Nutrition. 1. The government Hygienic Institute Laboratories had their origin in the Tokyo Medicine Examination Institute in 1878, founded by the Education Department for the purpose of examining medicines* When work of the Sani- tary Administration was transferred from the Education Department to the Home Office the Institute came under the control of the latter and finally under the Ministry of Public Health in 1958. In 1897 it was named hygienic Institute Laboratory and was made responsible for the business relating to medicinal opium which had hitherto been a responsibility of the Sanitary Bureau. At present the two main laboratories are in Tokyo and Osaka. Both are under the control of the Ministry of Health and deal with the examination of specimens and with research. The Tokyo laboratory consists of four sections? (i) Examination section: scientific examinations arising out of legal, civil and criminal cases* (ii) Medicine section: requests made for examinations by government and private parties. (iii) Research on Drugs: methods of use and purity of drugs etc. (iv) Section of general affairs: Accounts and Administration* The Osaka Laboratory has no research section* Staffs appointed for these laboratories are: 8 experts, 19 technicians and 5 clerks; for each laboratory a superintendent is appointed who is selected from the experts* During the World War the importation of medicines from abroad became difficult, and pressed by the urgency of the situation at home the laboratories undertook the manufacture of certain drugs, and the cultivation of plants* During 1937 the number of non-medical examinations made were 2,056. 2 4 ~02 6 2 1AB CD RESTRICTED RESTRICTED 18 Examinations of medicines were 620,447. Special examinations were 9,874. Applications to purchase opium were 9,874 for a total weight of 21,123,626 grammes, an increase of 3,887,942 grammes over the preceding year. 2. The government Institute for Infectious Diseases was first establi- shed as an annex to the Health Society of Japan in 1892. In 1899 it was made a Government Institution under the control of the Home Department and in 1905 it took charge of the vaccine and serum production managed by the Educational Department and was attached to the Imperial University. How- ever, it is still under the supervision of the Ministry of Health so far as matters pertaining to Sanitary Administration are concerned. The Institute investigates infectious diseases and sources of infect- ion; investigation of methods of prevention and treatment; examination of materials in connection with prevention, disinfection and treatment; the study of the methods of investigation of infectious diseases, and the manufacture and examination of vaccines, sera and other bacteriological prevention and therapeutic products. The Superintendent of the Institute is appointed by the Minister of Education and he may be either a professor of the Imperial University or an independent expert. The Staff consists of 10 experts, 26 technical assistants, 3 pharmacists, 5 clerks and 5 chief nurses. In addition not more than 20 unpaid technical assistants may be employed. 24-62621ABCD 5. The Government Research Institute of Nutrition was founded in 1902 > RESTRICTED RESTRICTED 19 under the control of the Home Affairs Bureau, for the purpose of research and investigations on the subject of national nutrition. The Japanese believe that the increase of fertility and of human stature is closely related to food, and the work of the Institute is largely to that end. It is divided into four departments: Basis Research Department, Applied Research Department, Depart- ment for Investigation and Department for General Affairs, Six experts, nine technical assistants and two clerks from the personnel of the Institute and the superintendent appointed from among the experts. In addition to the staff, not more than 10 unpaid assistant experts may be engaged. Among 57 subjects in- vestigated in 1937, the following will serve to indicate the type of work: Digestibility of maize. Biochemical studies of soy beans. Energy requirement in pregnancy. Storage of sardines. Vitamin D in vegetable oils. Studies in the energy requirement of Japanese, studies in famine relief foods. On the food of Java and Bali. Effect of nutrition on the reproduction of animals. 177 lectures and courses were given at the Institute. 5,668 persons attended the Institute during the year 1937* Its most important contribution ha* been the standardization of rice by the "carbolfuchsin" dye method, setting 70$ as the standard of polish. d. Examining Bodies. These include commissions for the examination of medical practitioners, dental surgeons and pharmacists. The Committee for the Examination of Medical Practitioners is composed of a Chairman, Vice Minister of Health, Secretary of Ministry of Health, nineteen members all of whom are professors at the Tokyo Imperial University, and three clerks. 24-63621ABCD RESTRICTED RESTRICTED 20 The Committee for the Examination of Dental Hygiene is composed of a Chairman, Vice Minister of Health, a Secretary and sixteen professors at the Tokyo Imperial University, Tokyo Higher Dental College, and four clerks. The Committee for the Examination of Pharmacists is composed of: Vice Minister of Health, a Chairman, two secretaries, twenty-eight members and four clerks. The "Chuoeiseikai" is the disciplinary body for doctors, dentists and pharmacists. The Ministry of Health refers all pertinent matters to the board for investigation and suggestion of disciplinary action. e. Medical Relief 1. Policy, In Japan medical practice and public services are not generally carried out by the same personnel. Private medical practice forms the basis of the Japanese Medical System. In order to supplement the system of private practice> Japanese laws sanction the establishment of institutions for medical treat- ment by agents other than individual physicians. There are a number of governmental and public organizations for medical treatment and non-profit making dispensaries open for medical relief work. There are sanatoria, as well as dispensaries, for specific purposes such as infectious diseases, tuberculosis, leprosy, venereal d:i-seases and mental diseases, as well as dispensaries attached to certain industries. 24-62621ABCD Prefectures, cities, towns and villages also establish hospitals, sanatoria, and dispensaries for the treatment and prevention of trachoma. RESTRICTED RESTfllCFED 21 venereal disease, mental disease, acute; infectious diseases, leprosy and tuberculosis. In response to tne demands of the time, medical treatment unions have been favored in corrective, cooperative societies and other roedlcal aid associations. The government has to a certain extent adopted a system of sickness insurance and compulsory health insurance. Legislation for workmen has subsequently been introduced together with health centers for those insured through postal life insurance. 2. Medical Relief Establishments. a. National leprosaria—There are four main national leprosaria for the treatment of and assisting leprosy patients. Besides these there are four prefectural leprosaria and seven privately owned leprosaria. The national leprosaria are located at; Nagashima Aisei-en Leprosarium, Mokake Village, Oku District capacity of 1,200 beds. This Leprosarium is administered by a medical superintendent and staffed by a secretary and 7 physicians, 7 clerks, 3 chemists, 2 head nurses, 8 Shokutaku experts and 8 employees in leprosy. (iij Kokusen En Leprosarium, Kusatsu, Azuma District, Gumma ken 300 beds. This Leprosarium is administered by a Medical-Superintendent and staffed with 3 medical officers, 3 clerks, and 1 chemist, 1 head nurse, 13 Shokutaku Experts and 8 employees in that field. 24-62621ABCD (iii) Hoshizuka, Keiai in Leprosarium at uera Village, himotsuki oistrict Kagoshima Ken 300 beds. RESTRICTED RESTRICTED po K< This Leprosarium is administered by a medical officer with a staff of 2 physicians, 1 assistant medical officer, 1 chemist, 2 Shokutaku and 8 employees. (iv) Miyako Leprosarium Bishara, Miyako Districts, Okinawa Ken 100 beds. It should be noted here that a "Shokutaku" is an expert in any given field according to government standards. He is employed by the government but is not a civil service employee. b. Prefectual Leprosaria are: (i) First District Zensei (ii) Second District (iii) Fourth District (iv) Fifth District Kyushu at Higashinmrayama Kitatama District Tokyo Fu Sinjo Village Kigashitsugaru District Aomori Ken Aji Village, Kida District Kagawa Ken Aishi Village Kikuchi District Kumamota Ken 1E00 beds 500 beds 510 beds 1000 beds The seven private leprosaria have a total bed capacity of _ 777 beds Total 6,887 c. National Tuberculosis Sanitarium. Prior to 1958, there was only one goverftment national sanitarium. This was located at Muramatsu village, Naka District, Ibaraki Prefecture, and had a bed capacity of 500, This was officially known as Muramatsu Seiranso Sanitarium. This Sanitarium was organized in 1937 and takes charge of matters concerning the treatment of tuberculosis of non- RESTRICTED RESTRICTED 23 commissioned or warrant officers and men in the Army and Navy who have been exempted from service of more than one kind because of tuberculosis. It is administered by a Superintendenty 6 Medical officers 1 Chemist 1 Secretary 2 Assistant Medical officers 2 Assistant Chemists 4 Clerks 1 Head nurse In 1957 under article 6 of the Law for the Prevention of Tuberculosis fifteen prefectural Tuberculosis Sanitaria and four City Government Tuberculosis Sanitaria were ordered to be erected at: Prefecture Bed Capacity Osaka 502 Hyogo 500 Gumma 100 Chiba 100 Tochigi 160 Mie 160 Aichi 500 Gifu 100 Yamagata 100 Fukui 100 Ishikawa 157 Okayama 256 Yamaguchi 500 Oita 70 Kumamoto 100 The City Government Sanitaria were erected at: Bed Capacity Tokyo City 700 Osaka 1200 Yokohoma 100 Nogoya 750 24-62621ABCD These hospitals were all in operation March 51st, 1959, RESTRICTED RESTRICTED 24 V. Health Functions in the Other Departments. a* Department of Home Affairs: Bureau .for social work. Although labor sanitation comes under the control of the Minister of Public Health and Wel- fare, its business is not conducted by the Sanitary Bureau but by the Bureau of Social Work, where the Superintendence Section of the First Division is in direct charge of it, supervising Industrial Itygiene in general. b. Department of Education: Section for School Hygiene. School Hygiene is under the control of the Minister of Education. The section for School ifygiene in the Ministers* Secretariat takes charge of its affairs. c. Departments of War and Navy: Medical Bureau Military Sanitation is in charge of the Ministers of War and Navy respectively. The Medical Bureau of the Department concerned takes charge of its affairs. d. Besides the above, railway and prison sanitation are in charge of the Departments of Railways and of Justice respectively. 2 4-6292 «li»CD RESTRICTED RESTRICTED 25 Vi. Public Health Institute The Public Health Institute was organized March, 1938, as a result of a survey made by the Rockefeller Foundation Institute, A building erected in Tokyo, with a Rockefeller Foundation grant, was formally turned over to the Japanese government May 9th, 1938, The principal functions of the Institute are training and education, and its general purpose is the investigation of factors contributing to national health and the prevention of disease. In training and education there are three sections; First Section Medicine Second Section Drugs and pharmaceuticals Third Section Veterinary and animal husbandry. The period of instruction is one year each for medicine and drugs and pharmaceuticals—one month for veterinary training. At the end of 1939 there were 50 students in the medical department, 20 Students in Pharmacy, 25 Students in veterinary medicine. Also, provisions are made for visiting students and helpers who receive instruction in the lab- oratories, Lectures are given to the public at frequent intervals on matters pertaining to public health. The Institute maintains a program of study and research for which they have established two laboratories: in Tokyo for stud- ying the health problems of urban districts, in Saitama Prefecture at Tokur- azawa for rural health problems. The general purposes of the Institute are the following: To investigate the effect on physique of the people of the phenom- enon of movement of population toward the cities. Investigation of health conditions on the Continent of Asia, 24 ~S2 021ABCD Statistical studies in regard to Eugenics and National Health, RESTRICTED RESTRICTED 26 Study of methods of national prevention of infectious diseases of the digestive tract. Studies in the cause of death of infants. Studies with regard to the fate of bacteria causing diseases of the digestive organs by various methods of sanitary disposal of execretion. Study into the effects of excessively long labors of child birth. Studies on the effect of occupational diseases. VII. Physical Education In 1952 a General Physical Advisory Council for Physical Culture was created* This council is not an initiative council. It merely studies and deliberates on matters and procedures submitted to it by the Minister of Health. It is composed of 40 members who serve upon it on invitation from the Minister of Health. Personnel of the Bureau of Physical training: Chief of the Bureau 21 Members of the highest score service grade 12 Non-civil service experts 4 Civil service experts. 4 Physical instructors 45 Additional employees For the past ten years Japan has strongly emphasized the importance of physical culture and mass cadence exercise. To this end there fcas been de- £* veloped a very complete physical culture organization and program. VIII. Provincial Organizations for Public Health Administration Provincial bodies for sanitary administration consist of local governors, chiefs of police stations and chiefs of towns and villages. In addition, in small sea-port towns, custom houses and temporary port quarantine officers also help supervise sanitary administration. 24-620214BCD RESTRICTED RESTRICTED 27 a. Local Governors. Inspector General of the Metropolitan Police. Since local governors are the highest of the Provincial administration officials, sanitary administration comes naturally under their control. Under the gover- nors, there are police departments at which are established sanitary sections which take charge of Health Affairs. To each sanitary section experts of various kinds and a laboratory are attached. In the Tokyo prefecture the responsibility for sanitary administration is divided between the Prefectural Governor and the Inspector General of the Metropolitan Police Board, which deals with matters relating to public health. b. Chief of the Police Station. Intermediate provincial administration bodies in Japan consist of heads of sub-prefectures and chiefs of police sta- tions. As a rule, however, sanitary affairs are supervised ty the chiefs of police stations who generally have jurisdiction over sub-prefectures and cities and look after the health conditions. c. Cities. Towns. Villages, and their Heads. Cities, towns, villages and their heads also have public health responsibilities of their own. Most civies and towns have a sanitary department and a hygeinic laboratory, but in villages certain officials represent the whole health organization. IX. Quarantine Organizations:- There are 11 ports in Japan with a permanent health quarantine organi- zation at each ports Yokohoma Osaka Tsuruga 24-62821ABCD RESTRICTED 28 AREA 11. JAPAN - HONSHU - TOKYO. (App. Lat. 35° AO* N, - Long. 139° A5' E.) Air view of outer garden of Meiji Shrine with baseball stadium0 ONI #98119. RESTRICTED 29 Kobe Moji Wakamatsu Nagasaki Mi ike Kuchinotsu Matsushima Sakito In these ports the Customs authorities take charge of quarantine pro- cedure. For that purpose a office is established in each of these Custom Houses, in which are stationed harbor officers and medical officers. In case temporary quarantine is found necessary a provisional quaran- tine station may be established. Such stations come under the supervision of the chief of the police department of the prefecture concerned. The total number of vessels inspected in the year 1957 by harbor offices of the Custom Houses and by temporary port quarantine stations was 24,281 Japanese vessels, and 5,978 foreign vessels. The total number of crew and passengers inspected was 2,877,586. By these inspections 5 cholera, 9 small-pox and 81 other con- tagious disease patients were discovered. 2 4 ~02021ABC0 RESTRICTED RESTRICTED 30 X. Medical Personnel a. Doctors. In order to become a practitioner of medicine# a physician must obtain a license from the Ministry of Public Health and Welfare after having qualified in one of three ways: studied medicine at a University established under the Universities Ordinance and have acquired the title of "Gakushi," or have completed a course in a higher medical school either governmental, public or private, recognized by the Minister of Education; passed the Medical Practitioner's examination; or obtained a diploma in a medical school in a foreign country and be deemed to have qualified for the profession by the Minister of Public Health and Welfare, The Training Centers for Medical Practitioners are as follows: 1, Universities under the Universities Ordinance Governmental 13 Prefectural 3 Private 3 2, Medical Colleges Private 9 The physicians associations require membership in the Medical Practit- ioner's Association of Japan for all licensed physicians. The Association meets in its general conference once each year to investigate and study for presentation to the Government advanced methods and knowledge of medical ser- vice and hygienic regulations. Physicians associations are public cooperations established under the laws for practitioners, and aim at the improvement and development of medicine and public health. They consist of three classes: the Nihon Ishikai (Association of Japanese Physicians), the Prefectural Association of Physicians, and the Country, City or Ward Association of Physicians, The 24-eaeaiABCD RESTRICTED RESTRICTED 31 Nihon Ishikai has as members all the prefectural medical associations of the country. The Prefectural Association of Physicians is composed of country, city or ward associations of Physicians engaged in Medical practice at public or private institutions in the district concerned. Number and Distribution of Medical Practitioners. 1957. Total No. of phys. Pop. per No. of Med. Aver. No. Number engaged in medical pract. per of Medicical of medical practit. 10,000 pract. Ptysicians practice pop. per Municip. City districts 54,254 50,878 754 15.62 259.0C Rural Districts Towns 11,785 10,748 1295 7.72 6.29 Villages 12,494 11,750 2780 5.59 1.21 24,279 22,498 2057 6.66 3.75 Grand Total 68,511 55,576 1585 8.64 Distribution of Practitioners in Remote Districts. In those localities where there is a dearth of medical practitioners the government has organized a service whereby doctors may be sent to such districts both in times of emergency and on regular visits. The government has also adopted a policy of subsidizing practitioners in towns and villages and of encouraging independent medical institutions in towns and villages as well as medical dispensaries attached to cooperative societies. Physicians at the end of 1958;- 24-62621ABCD Graduates of Imperial Universities 22,952 Graduates of Recognized Schools 26,602 Women Graduates 5,961 RESTRICTED RESTRICTED 32 Graduates of Foreign Universities 74 Women graduates of Foreign Universities 7 Doctors passing examinations but not graduates of recoganized medical colleges 8554 Total 62,250 b. Dentists. In the dental profession the system is to license dental surgeons for the treatment of dental diseases and mouth diseases arising there- from, and for the practice of dental surgery. Their system on the whole is similar to that for medical practitioners. The Dental Associations of Japan are on a very similar basis as the Medical Societies. In the prefectures are Prefectural Dental Societies in which membership is compulsory and members are not permitted to withdraw from the Societies. These prefectural Societies are combined to form the Japanese Dental Association. The number of Dental Schools is as follows* Governmental dental colleges 1 Private dental colleges 7 Dentists at the end of 1958 Graduates of Imperial University and Dental Colleges 12,692 Women graduates 1,519 Graduates of foreign dental colleges Passed examinations without having 79 graduated from colleges. 8.525 22,513 Number and Distribution of Dental Surgeons at the end of 1957 TOTAL No. of Dental surgeons engaged in private practice No.of Dental surgeons per 10.000 pop. Cities wITw 10,982 4.85 Rural Dlst. 1.60 Towns W MW 5,052 Villages |fWW 2.594 Total 20,010 18,428 5.22 2 4 “62 62 1 A. BCD RESTRICTED RESTRICTED 33 Medical and Dental Schools The Medical Universities and Colleges of Japan Imperial University Medical Schools: Number of Students Tokyo 662 Kyoto 612 Kyushu 640 Tohoku 426 Hokkaido 280 Osaka 412 Keiogijuku 528 Medical Colleges Chiba 329 Okayama 528 Kanagawa 609 Nagasaki 515 Niigata 208 Nagoya 520 Kyoto 520 Kumamoto 466 Keio 1120 Japan 1120 Tokyo Charity 680 Medical Schools Tokyo 740 Shoira 672 Tokyo womens 856 Osaka 816 Osaka womens 1230 Teikoku womens medical 656 and Pharmaceutical School 625 Kyshu 569 Iwate 616 Dental College^ Tokyo 800 Japan 800 Osaka 666 Tokyo womens 511 Kyushu 616 Total 10,478 24 “62 82 IABCD RESTRICTS RESTRICTED 34 c. Pharmacists. The total number of licensed pharmacists in Japan Proper in 1959 was 28,766, classified as follows: Graduates of Imperial University 565 1.29% Completed course in government, private or public colleges 17,212 61.15% Completed course in foreign schools 55 0.12% Passed examinations 11,158 57.46% Of these 18,214 dispensed medicines in pharmacies, 5,152 worked in hospitals and 1,712 devoted full time to the sale of patent medicines. The proportion of pharmacists was 5.24 per 10,000 Inhabitants. The number of pharmacies in 1958 was 15,066 of which 12,769 were run by phar- macists and 507 by non-pharmacists. In 1957 sixteen pharmacists were suspended from business as a result of penalties inflicted for unprofessional conduct. Medicine manufacturers totalled 4,074. The largest number of these were in Osaka, 905} followed by Tokyo with 884. The examinations for medical practitioners, dental surgeons and pharmacists are divided into two sections: theory and practice. The medical examinations take place once yearly, and are held in Tokyo, where both theory and practice are given, and in Hiroshima where only theory is given. The Dental Surgeons examinations take place twice yearly. The examinations of pharmacists take place twice yearly} theory at Tokyo, Shiguoka and Aichi, and practice at Tokyo. The results of these examinations indicated that the percentage of those passing the medical examinations Is as high as 96%. Those taking the Dental examinations do not fare so well— averaging 50% successful. Pharmacists average 50% successful in the theory examination and 80% successful in the practice examination. 24-62621ABCD RESTRICT) RESTRICTED 35 d. Auxiliary Staff: 1. Midwives. A midwife in Japan must be over 20 years of age and must have passed the usual examinations for midwives or completed a course at a school or training institute recognized by the Ministry of Health. Number and distribution of Midwives Total No. of midwives No. of midwives oer 10,000 pop. Cities 25,981 11.46 Rural districts 7.21 Towns 12,355 Villages tsum Total 59,560 9.55 2. Nurses. A nurse must be a woman over 13 years of age and must have passed the usual examination for nurses or completed a course in a school or training institute recognized by the local Governor. The total number of nurses in whole of the country in 1957 was 124,402 or a ratio of 17.46 per 10,000 population. The male nurses totalled 296. 5. Public Health Nurses. Public Health nurses require a special course of training. About 5,000 are engaged in schools, factories and child welfare centers. 4. Persons engaged in massage, acupuncture and moxacauterlzatlon. A special license is required for the practice of massage, acupuncture and moxa-cauterization. 24-62621A BCD RESTRICTED RESTRICTED 36 Number and distribution of each of the foregoing Divisions: Practitioners engaged in Acu- Acupuncture Moxa- acupuncture puncture & and cauteriza- moxacauteri- moxacau- Massage tion and zation and terization Massage Massage Persons engaged in acupuncture 5,005 10,542 4,418 11,595 Persons engaged in moxa- cauterization 4,950 10,542 1,190 11,595 Persons engaged in Massage 56,210 4,413 Total 1,190 11,595 Persons engaged in acupuncture 51,558 Persons engaged in moxacauterization 28,055 Persons engaged in Massage 52,211 e. Veterinarians. Prior to 1909 the veterinary service and veterinary surgeons were under the control of the Department of Agriculture and Forrestry, In 1909 the affairs of this department were transferred to the Sanitary Bureau of the Ministry of Home Affairs. The licensing of Veterinarians is under the control of the Commission for the examination of Veterinary Surgeons. There were in Japan at the end of 1958 the following number of Licensed Veterinarians: 24-4S0S14BCD Graduates of national and prefectural veterinary schools 7,515 Graduates of recognized veterinary schools 6,614 Veterinarians qualified by examinations 1.741 Total Veterinarians licensed 15,768 RESTRICTED RESTRICTED 37 XI. Hospitals In 751 A. D. a dispensary called a "Seyakuin” was established and this became the first hospital built in Japan. This was followed by dispensaries in Nara, Kamakura, Kyoto. In 1860 the first hospital, as we know hospitals, was built in Nagasaki. In 1869 the Shitaya of Tokyo was built. This was a larger hospital, with medical school attached to it. Since then, with the development of medical schools, many hospitals have been built. Each local prefecture determines whether a hospital is to be built in its confines. The site must be a reasonable distance from temple, school, park, and public garden; it must not be close to a factozy or a restaurant. A hospital for respiratory diseases must be provided with recreation grounds. The distance between each ward building and between ward buildings and other buildings is required to be one-third or more of the height of the highest building. The dimensions of the sickroom are required to be 9 feet by 9 feet or more. The height of the first floor must be at least 9 feet from the ground; the height of the celling must be from 8 to 9 feet; when a sickroom is to be built above the first storey, 2 or more stair cases oust be provided in each ward building and the width of such must be from 4j to 6 feet wide and its slope 55 to 45 degrees or less. All of the stair cases must have hand rails. A certain minimum number of fire extinguishers, stretchers and emergency alarms are required, and in some prefectures the number of physicians and other personnel is fixed. Special regulations exist for asylums for the insane. a4-*a*ai*BCD RESTRICTED RESTRICTED 38 It should be noted that in stating the bed capacity of a western world hospital the definition of "bed" is used to designate what is familiarly known as a "hospital bed or cot". In Japan, however, where sleeping on the floor is still the prevalent mode of sleeping, the term "bed capacity" is actually a misnomer, for in many instances floor space for spreading their comforters is counted as "bed capacity." It is, therefore, impossible to determine an accurate figure on the "bed capacity" of the hospitals of Japan, as we under- stand the term "bed". In 1958 there were 125 public hospitals distributed as follows: Hokkaido 19 Ryogo 8 Tokyo 7 Fukuoka * .7 Aomori, Okayama, Kogoshima 15-5 each Osake, Miyagi, Akita, Aichi, and Ehime 20-4 each Iwate, Yamagata, Fukushima, Kanagawa Fukui, Nagato, Gifu, Hiroshima, Nagasaki 27-5 each Kyoto, Tochigi, Yamanashi, Mie, Shiga Kumamoto 12-2 each Skizuoka, Wakayama, Tottori Shimane, Saga, Tokushima, Kagawa Saga, Oita, Miyazaki, Okinawa 10-1 each Patients admitting capacity 11,548 Aggregate number of patients treated each day 2,852,178 Admitted through year 119,612 Average capacity per hospital 92.58 Average number of in-patients per hospital (total) 996.59 Average number of days patient stays in hospital 22.76 Private hospitals (Charity hospitals, Insane Asylums, Tuberculosis Hospitals and Leprosaria excluded) 34-fla«21ABCD Total 2,907 Bed Capacity 8£,£01 Admitted 1937 672,71*2 Aggregate number of in-patients 12,^32,111* Average Bed Capacity 29.1*1 Average No* of Days in Hospital 17.17 RESTRICTED 39 Charity Hospitals (Tuberculosis Hospitals, Insane Asylums and Leprosaria excluded). Total 46 Bed capacity 7,314 Admitted in 1937 29,604 Aggregate days 1,124,787 Average bed capacity 80.74 Average number days in hospital 31.74 In 1937 in Japan there were the following number of Clinics: In cities with accommodation for admitting patients 4,973 without accommodations for admitting patients 11,531 In towns for admitting patients 3,264 without accommodations for admitting patients 5,118 In villages for admitting patients 2,301 without accommodations for admitting patients 10.538 57,725 Insane Asylums Total number 151 (a) Public 12 (b) Private 139 Admitting capacity 21,525 Admitted in 1937 15,960 Agg. no. of patients Districts 3,237,544 Average capacity of Asylum 141.23 Average number of days in asylum 172.71 daya Tuberculosis Hospitals Government 30 Private 85 115 Admitting capacity 10,607 Admitted 1937 11,974 34-63621ABCD RESTRICTED RESTRICTED 40 Average number of patients treated 1,641,124 Average capacity per hospital 91.44 Average number of days in hospital 113.37 Leprosaria: Three are in Kumamoto, two in Gumma, two in Tokyo, one in Aomori, Yamanashi, Shizuoka, Okayama, Kogawa, Fukuoka, Kagoshima and Okinawa. Total number 1 15 Government 4 Public 4 Private 7 Average capacity per leprosaria 392 Average number of days in 306.92 Admitting capacity 5,887 Admitted in 1937 1,536 Aggregate number of in-patients 2,345,683 Infectious Diseases Hospitals, Isolation Wards and Isolation Houses: the total number of Infectious Diseases Hospitals in 1938 was 1,010, Towns 726 Cities 119 Villages and various associations 165 Bed capacity 23,255 Isolation wards 7,044 Bed capacity of isolation wards 69,246 Isolation houses 66 Bed capacity 1,699 Average bed capacity of each isolation house 25.7 Disinfecting Stations 47, 24-62821ABCD RESTRICTED mimm 41 Total Numbers of Practitioners and Institutes Medical practi tloners 62,250 Dental surgeons 22,215 Midwives ; 69,746 Pharmacists 28,766 Public Health nurses 5,000 Masseurs, acupuncturists Moxacauterists 56,210 Clinics for treating out patients 56,858 Dental clinics for treating out patients 19,586 Beds Public Hospitals 125 11,548 Private Hospitals 2,907 85,501 Charity Hospitals 46 7,314 Insane Asylums 151 21,525 Tuberculosis Hospitals 116 10,607 Leprosaria 16 5,887 Hospitals for prostitutes 117 4,935 Infectious Disease Hospital 1,610 25,265 Isolation wards and houses 7,100 94,200 XII* X-Ray Apparatus Regulations for the control of X-ray apparatus intended for diagnosis and treatment of disease: The X-ray ordinance applies to X-ray apparatus up to 20,000 volts in the circuit of its x-ray tube. Any medical or dental surgeon shall within ten days after installing an X-ray apparatus, report it to the local governor giving make and capacity of machine and detail precautions taken to prevent injury to patients. Standards required to be observed for the prevention of danger from X-ray. Standards to be followed in rendering the X-ray room free from danger. Frequent checks, at least every six months with the skiameter to see that the maximal volts specified for that particular machine are within these limits. Penalties for violations of the above ordinances. 3 4“82 8 21 ABCD RESTRICTED RESTRICTED 4£ XIII. Drugs a. Control. The control of drugs comes under the medical section of the Bureau of Health. The basis of the drug industry of Japan is the Japanese Pharmacopoeia which is under continual revision by the Board for the Investi- gation of the Japanese Pharmacopoeia. This board consists of a chairman, 12 secretaries, 16 members, 4 temporary members, 4 clerks and 1 "shokutaku", The government Issued the first Japanese Pharmacopoeia in 1886 in order to verity the character and quality of drugs and to test the genuineness of the chemicals. It has been revised a number of times since and in now in its seventh revised edition. The actual control of drugs is by means of the "Regulation for the Trading and Handling thereof of Drugs." Those dealing in drugs are classified as follows: 1. Pharmacists—"A pharmacist is a person who compounds the pre- scriptions of medical practitioner and who sells and manufactures drugs". He must be either a graduate of the Department of Pharmacy of the Imperial College of medicine or of a recognized college of pharmacy or have passed the examina- tion for pharmacists and obtained a pharmacists license from the Minister of Health. 2. Druggists—A druggist is allowed only to sell drugs. He must obtain a license from the local governor. 5. Drug Manufacturers—A drug manufacturer is permitted to sell drugs of his own manufacture only* and must procure a license from the local governor. Q u A ◄ A « « ® I * A RESTRICTED RESTRICTED 45 b. Handling of drugs: !• Ho person other than a licensed pharmacist who has opened a pharmacy is allowed to compound drugs at the request of people in general except physicians and dentists who may prepare drugs to be sold to their patients. In Japan most patients secure their drugs from the physicians who treat them. 2. Sale of Drugs; The regulations for the handling of drugs divide them into three classes: Poisonous drugs—they must be stored and locked in separate places. Powerful drugs—treated as poisonous drugs. "Common drugs". The principal markets of the drug trade are in Osaka and Tokyo. Almost all of the drugs imported into Japan are collected at these markets and dis- tributed to the different districts throughout the country. The main coun- tries exporting medicines to Japan were the United States, Switzerland, Great Britain, and Germany. Drugs that are generally used for the treatment of disease are described in the Japanese Pharmacopoeia, with specifications as to character, quality, and method of testing. Their names are published by the Department of Health, The sale of drugs is prohibited unless they possess the character and quality specified in the Japanese Pharmacopoeia. Drugs which are not included in the Japanese Pharmacopoeia are not permitted to be sold unless the names of the foreign pharmacopoeia in which they appear are given. a « M M • a < ♦ m RESTRICTED RESTRICTED 44 A drug which does not appear in any pharmacopoea can only be sold with the permission of the local governor. In each prefectural office there is a drug inspector. His duty is to visit dealers in drugs. He is authorized to prosecute any offenders and to carry away any drugs to be examined at the inspection room of the prefectural office and to forward them to the National Governmental Hygienic Laboratories. In addition to generalized control of drugs special regulations control the sale of opium and its alkaloids, cocaine and its alkaloids, the manufac- ture of vaccines,sera, and other biologicals. 24~62631ABCD RESTRICTED RESTRICTED 45 XIV, Medicines a• Medicines and preparations not mentioned in any pharmacopoeia. The total number of persons who reported in 1937, the manufacture and sale of medicines not to be found in the pharmacopoeia was 687 and the number of medi- cines was 2,630. b. Inspection of Medicines; In the tours of inspection made in 1957, 19,954 pharmacies and other places were visited as follows: Pharmacists 5,895 Non Pharmacists 47 Drugstores 4,847 Medicine Manufactures 505 Hospitals 704 Medical practitioners 6,954 Dental Surgeons 2,008 Veterinary Surgeons 362 c. Patent medicines« The total number of traders in patent medicines at the end of 1937 was 43,427. Of this number 12,617 were pharmacists, 5,370 medical practitioners, and 3,010 veterinary surgeons who employ pharmacists. Number of permits for the manufacture and importation of patent medicines; At the end of 1958 the total number of patent medicines for which permission of manufacture and importation was given was 387,510 of which 171 were imported. The patent medicine manufacturing business totaled 108,150,609 yen or 1.52 yen per person per annum. The total number of retailers of patent medicines was 217,490 and the number of pedlers of patent medicines was 167,260, 24-O2021ABCS RESTRICTED RESTRICTED 46 XV,. Budgets Summary of expenditure for health services incurred by the Central prefect- ural, city, town and village authorities. In the case of the Central health organisations acting as a principal organ of public health, the figures represent the expenditure of the Central Sanitary Bureau of the Health Ministry only. Central-(1954) Budget for health services Percentage of the health budget of the Central Sanitary Bureau against the budget of the entire Ministry Budget for health services per capita 29,660,860 yen 15.64$ 0.454 yen 1 len quoted as $0,287. In the fiscal year of 1958 the amount of money defrayed for expenses relating to Infectious disease prevention vas 1,594,184 yen. In addition the prefectural governments spent in this work: For notifiable diseases 556,059 yen For other infectious diseases 1,490,000 yen The last available figure for the appropriation for the prevention of leprosy for the year 1930 were; running expenses 675,000 yen extra expenses 5,000 310,000 yen to prefectures for enlarging leprosaria reserved in the National Treasury for special grants 150,000 yen 84-MCS1ABCD RESTRICTED RESTRICTED 47 IVT. Rural Sanltatiop and Collaboration of the Population The rural population of Japan concerned with agriculture is 48% of the total population. In addition there are many persons not engaged in farming who are living in rural districts. Including these the total reaches 63% of the total population for the country. In 1916 the Board for the Investigation of National hygiene was inaugurated at the Department of Home Affairs and a section was formed to deal with rural sanitation. On the basis of investi- gations made by this section the Department of Home Affairs devised and en- forced a plan to correct unsanitary conditions in rural districts. In cities, towns and villages there are health unions which work in cooperation with the authorities, but on their own initiative in health matters, in addition to their usual work of medical relief and prevention of infectious disease. At present these unions number 64,960. These cooperative societies are economic bodies established in a spirit of mutual aid. The town and village authorities collaborate with agricultural associations and industrial bodies, schools, shrines, temples, youths associations, women*s clubs and other educational bodies as well as health groups such as physicians associations. These cooperative bodies exert considerable influence on rural rehabilitation. 24-«3621ABCn RESTRICTED RESTRICTED XVII. Housing 48 The extreme variations of temperature and climate in Japan require local adaptable methods of housing. In the northern districts rural housing requires measures of protection from cold, while in the south protection from heat is needed. Rural housing in Japan has followed the customs and living conditions of ancient times and there have been no radical changes. This fact has been the most difficult obstacle to improvement work from the hygienic and practical points of view. At present, the Tohoku Koshinkai (Society for the rehabilitation of North Eastern Territories) representing the government supervises the improvement in rural housing in these territories with the help of an annual subsidy of 50,000 yen from the Central Government. In addition the Nihon Sakujitsu Shlnkokai (The Japanese Society for the encour- agement of acts and licenses) founded with imperial donations has been endeavor- ing in cooperation with the Dojunkai (an agency for housing points) to study rural housing conditions in those districts where winter is severe. The pre- fectural authorities are taking similar steps with the cooperation of the health and social sections of the prefectural governments. In order to educate the inhabitants in housing matters model houses have been set up in the rural high schools as well as agricultural schools. Prize competitions for the construction of model houses are held under the auspices of the health and social section of the prefecture and the plans selected are submitted to the authorities of towns and villages, contractors for their use. Low interest loans by prefectural authorities for building funds are granted inhabitants. Great stress has been placed on the improve- ment in kitchens. As in the past, the kitchens have been inadequate in light and ventilation. 24-62621ABCD RESTRICTED RESTRICTED 49 Although sanitation in Japan proper is much better than in most other parts of the Japanese Empire, it in no way compares with that of the United States. The Japanese are a clean people but modern facilities, for the treat- ment of water and disposal of sewage, are found only in metropolitan areas. Even the newer parts of Japanese cities, which are well planned, are all sur- rounded by large slum areas, crowded, filthy and vermin infested. In rural districts, the results of the investigation of 3,310 houses were as follows: directions: Houses facing south 85.5$, north 9*7$, northeast 3.1*, west 1.8$. Construction: Bungalow types 78.3$, two stories 21.5$. Roofs thatched with straw and tiles 11.5$; tiled roofs 26.2$ Ventilation and lighting in houses: good 31.5$, moderate 46.3*, imperfect 22,H. Average area of the lots in which the houses were erected was 792 square feet; the average floor space was 180 square feet. Drainage in rural districts is most imperfect, only 30$ of the farm houses being provided with any arrangements. Of principal foods, the results of investigations conducted in 2195 households in rural districts show: Those eating rice 23,63?' Those eating barley ,7$ Those eating rice and barley mixed 75.7$ Supplementary foods are mostly vegetables. Meats are rarely consumed. The drinking water in rural districts is generally obtained from wells. Investigations made by the Home Office showed that 45.5$ of the drinking water is chemically wholesome. 24-62621ABCD RESTRICTED RESTRICTED 50 ■X.VIII. Water Works and Drinking Y.'ater a. hater Supply. Although water is found in ample quantities in most parts of Japan, there are likely to be shortages in certain areas during the latter part of the summer months. The majority of the existing waterworks obtain their supply of water from rivers, but some also obtain water from springs, wells, lakes, and reservoirs containing collections of ground water. The Tokyo V/aterworks date back to the 18th year of Teusho Era (ad 1590) when Tokugawa lyeyasu—the founder of the Tokugawa Shogunate—gave an order to construct the Kanda waterworks. In 1652, the Shogunate government seeing the necessity of building waterworks on a larger scale, succeeded in divert- ing the water of the Taraagawa to the Yedogawa, cutting the waterway from that river at a point about 27 miles from the capitol. This is what is known as the Tamagawa Waterworks and was used by the residents of Tokyo until 1900. In the larger cities adequate facilities for filtering (usually slow sand filter) and chlorination are found. Bacteriological examinations are made at regular intervals, as evidenced by the report of the central bureau laboratories, but the high rate of intestinal diseases indicates that in many instances the water supplies are not as efficient as government reports would seem to indicate. 24-6262 1ABCD The present laws concerning waterworks are the "Waterworks Law" and its regulations, 1890. According to this law, waterworks are constructed and RESTRICTED hssx&sim 51 maintained at the public expense of the cities, towns or villages concerned. In the event the cities, towns or villages are unable to bear the expense, permission to construct the works is given to others than such cities, towns or villages on the condition that when the term of permission or lease expires, if the cities, towns or villages concerned deem it necessary they may purchase the said works and the land required for the proper operation. Further, the Ministry of Health has the power to order the cities, towns or villages to construct such works when he deems it necessary. The plans for new waterworks must be submitted to the Minister of Health for approval or to the local gover- nor in case the works to be constructed are for use of a population under 16,000. As waterworks are closely affiliated with general sanitation the state makes grants from the National Treasury with a view to encourage their construction. The amount of such grants has been averaging about 2,500,000 yen per year. In rural districts the quality of drinking water is generally good and the supply abundant. In the mountainous districts good drinking water may be ob- tained from the mountain streams by a simple filter equipment so that reform of the "sanitary well" has been encouraged in those rural districts where no waterworks are available. The adoption of the filter equipment in the home is also encouraged. b. Existing waterworks* The first waterworks built in Japan, after the pattern of modern systems, was in 1885 at Yokohama. 1957 1958 Cities 117 119 Towns and villages 568 587 Town or village association 7 7 Prefecture 4 5 24-62621ABCD RESTRICTED RESTRICTED 62 Private enterprise m m Total 60S 655 The sources of the water for these waterworks were: Rivers 467 Springs 82 Reservoirs 36 Wells 16 Lakes 12 Total 603 c. Methods of Purification. Except for a few waterworks which need no filtering because the water is in no danger of contamination and some others which are equipped with rapid sand filters most of the waterworks have filteringbeds and carry on "slow filtration." The cities, towns and villages have the equipment needed for the examination of the quality and purity of the water. As a result of examinations made in cities and towns the highest hard- ness was found to be 4.978 (German hardness) and the lowest 0.5. Quantities of chlorine contained in one litre of unfiltered water was: largest 18 miHigrammes, smallest 0.668. Consumption of potassium permanganate, largest 14.164 milli- grammes, smallest 0.601 milligrammes. Number of bacteria, largest 6,374 per 1 cc, smallest 2 per 1 cc. Further examination of these waterworks after filtration showed that only one contained more than 50 bacteria per 1 cc. d. Water Supply Fees. Two methods for supplying water have been adopted. One is to collect a fixed amount from the customers and let them use the water freely; the other to install water meters and charge for the actual amount used. 2 4-6 26 81ABC D RESTRICTED RESTRICTED 65 The latter method is on the increase. According to statistics the largest quantity supplied per capita per diem was 6.10 cubic feet and the smallest 0.18 cubic feet. Generally in cities and towns 2.684 cubic feet is the common figure. e. Waterworks Consultation Society. A society called "Waterworks Consult- ation Society" founded in 1904 has contributed much toward improvement of the public utility. The Society's membership consists of those who are operating waterworks. The society holds an annual meeting for the study and discussion of waterworks and frequently publishes the results of its study to its members. Among the methods for testing water adopted by the society the standards for drinking water are as follows: Waters enumerated below are not fit for drinking. Immediate improvement shall be carried out. In the meantime the water must be boiled before drinkings Water that has a strange appearance* Water that has a strange smell. Water that reacts for nitrite ammonia. Water of which the quantity of potassium permanganate consumed is over 10 milligrammes. Water that reacts for chlorine, sulphuric acid or nitrate or water the quantity of solid articles contained therein or its hardness is abnormal or water in which lead is contained will be carefully examined and special examinations shall be made. Water the bacteria content of which is more than 101. This figure may be raised to 151 or 201 according to the condition of the location. Most of the prefectures have their own regulations concerning grants in and for the purpose of the improvement of drinking water and encourage boring of new wells giving monetary aid for that purpose* 24-62621ABCD RESTRICTED RESTRICTED 54 XIX. Sewage Waste and Garbage Disposal The present system for the disposal of waste garbage and sewage is en- forced according to the "Law for the Removal of ffaste Garbage and Sewage** of 1900, The law requires cities, as well as towns and villages, designated by local governors, to remove and dispose of such waste in order to maintain clean- liness of the land and of the dwellings. Most of the refuse in rural districts is used as fertilizer or fuel by the farmers. Human night soil is also used for fertilization, and this practice has made the consumption of raw fruits and vegetables a dangerous procedure in Japan. To eliminate this danger, the “San- itary Privy" has been adopted to destroy the eggs of intestinal parasites—such as hookworms, amoeba and the bacteria of enteric fever—so that the effluent is practically free from danger of both parasites and infectious diseases. As the efficiency of their "sanitary privy" has undoubtedly been demonstrated, it has been urged upon the farmers. The Bureau has definitely proved that decom- position of human excreta after 3 months destroys practically all pathogenic bacteria and parasites. Water-borne sewage systems are found only in the large cities. The col- lection of night soil, for sale to farmers, is the usual method of sewage dis- posal. At the end of 1938 there were 49 cities, towns and villages equipped with sewage disposal systems, but no information is given on the methods employed to dispose of the sewage. This low figure is attributed to the fact that most of the cities or towns in Japan formerly had gutters which, though not entirely satisfactory, served fairly well for the drawing off of liquid wastes; also the farmer could not give up the use of human night soil for fertilization. Moreover, whereas the operation of water works is a source 24-8 38 31 ABC D RESTRICTED RESTRICTED 55 of income, sewage lacks such remunerations* Of late with the rapid rise in farmers incomes, farmers near cities have refused to remove the night soil and city residents are now compelled to pay for its removal* Sewage systems are operated in the following centers: City at Hakodate Sapporo Sendai Akita Sakata Fukushima Takasaki Kawagae Chiba Tokyo Yokohama Kawasaki Nagaoka Gifu Shizuoka Okazaki Nagoya Osaka Kobe Akashl Nishinomiya Tottori Okayama Hiroshima Tamaguchl Shimonoseki Takamatsu Osu Wakamatsu Toyohashi Ichinomiya Isu Kyoto Seto Kokura Yawata S4-6S6S1ABCD RESTRICTED RESTRICTED 56 Oita Miyazaki Nara Towns Miyazu Key a Iwakuni Fukuoka Towns Fusuhara Meno Viliams Seido Sumiyoshi Prefecture Aichi For the disposal of rubbish and garbage in localities where the law applies, tenants are required to place collected rubbish into a receptacle prepared for this purpose. In turn, the city, town or village must trans- port it to a fixed place and dispose of it by burning, burial, or by other methods deemed not injurious to health. Among the cities, towns, or villages to which the law applies 8 cities and 5 towns have facilities for burning rubbish and 5 cities and 12 towns and villages burn it in the open. The remainder resort to various methods of dis- posal such as using the garbage for fertilizer, employing it for reclaiming foreshore, river and swamp lands throwing it in the fields by using it as food for fowls and pigs. In the 146 cities of Japan in 1957 under the provision of the Law for Removal of Foul Matters 34-S3021ABCD RESTRICTED RESTRICTED 57 Number of houses within the districts 4,795,227 Removal from above houses: refuse Dirt Nightsoil 5,590,450,442 kilogrames 645,449,155 " 14,027,561 " Number of houses from which owner was required to remove foul matter 2,755,858 Number of incinerator plants 152 Running water flushing toilets 68,877 Toilets with purifying equipment 17,817 In 1958 452,520 yen granted by National government for subsidizing erection of new sewage systems. Needing no comment is the statement of the number of toilets connected with sewers. At the end of the year 1958 there were 68,817 toilets in Japan Proper connected with sewer systems; further, there were only 17,877 toilets not connect- ed with a sewage plant, which had their own purification system. XX, Foods. Beverages and other Articles a. Early laws. The "Nihon Shokai," a history of Japan written in 726 A. D., stated that in the mythical ages there existed in Japan such cereals as millet, wheat, rice and peas and that in the month of April of 675 A. D. by Imperial decree it was prohibited to eat meat of cow, horse, dog, monkey or chicken. In 926 A. D. reference is made to radish, melon, boar meat, fish and milk. Thus , it appears that the food in those ancient days differed but little from those in use today. With the growth of Buddhism in Japan,proclamations were issued pro- hibiting the eating of meat and the custom of abstinence from eating meat continued until 1868. Restrictions for the use of alcoholic drinks were often published by the government from the year 1595. In 1855 an order prohibiting the use of chemi- cals in refining rice was enacted on the ground that the use of such chemicals *was 2 4-62821ABC D RESTRICTED RESTRICTED 58 injurious to health - the loss of vitamins was recognized* In 1900 the present laws and regulations for the control of foods and beverages was enacted. b. Principal laws and regulations* Law for the control of Foods, Beverages and other articles. Regulations for the control of trade in: cow*s and goat’s milk refreshing drinks snow and ice saccharine use of pigments in foods preservatives for foods utensils for foods and beverages trade in tea alcohol Regulations for the control of trade in artificial butter. Regulations for the control of use of salycilyc acid in the manufacture of sake (Japan*s National drink). c. The Control of General Foods and Drinks. Restriction relating to general foods and beverages, have undergone frequent revisions. By these laws it is unlawful to mix certain specified foods, to sell unripe fruit, tainted meat or any food or beverage which may be injurious to health or to display without covers such foods as are edible without cooking or peeling. Prohibition of sale, or the addition of certain articles to food stuffs. The use of benzoic and other food preservatives (14 in number) is prohibited. The use of arsenic and 14 other substances prescribed in the regulations for coloring food and beverages is prohibited. The addition of sacchrlne in foods and beverages is prohibited. The sale of food containing wood alcohol is prohibited. 34-02621ABCD RESTRICTED RESTRICTED 59 d. Control of Special foods and beverages* A person who proposes to manu- facture or sell refreshing drinks is required to obtain the permission of the local governor* Traders in drinks and food must not be suffering from tubercu- losis, leprosy, syphilis or any other infectious or contagious diseases* Ice and snow* A person who collects snow and manufactures ice must obtain the permission of the local governor. The melted snow and ice must be color- less and odorless, without foreign matter and must conform to the standards of water for drinking purposes* All vessels containing artificial butter must be inscribed* Tea must not be colored or mixed with impure matter* There are no special regulations for the control of alcoholic drinks except with regard to taxations* Very rigid laws exist preventing sale of alcoholic beverages to minors. Tobacco—a similar restriction regarding the use of tobacco by minors is enforced. Control of Articles* In the interest of public health, utensils for foods and beverages, vessels, containers and wrappers for food are rigidly controlled. The provincial governors are directly responsible for enforcing all laws relating to food and beverages* The governors, therefore, issue their own regu- lations using sanitary experts and police officers as their supervising agencies* 24-aajaiABcn RESTRICTED RESTRICTED 60 XXI. Composition of Food and Method of Preparation. a. Diet. In the Japanese diet, rice is the most important item, and of this Japan produces 90$ and the remaining 10$ is imported from Korea, no more than fifty miles across the Straits, Other items in the diet include wheat, barley, corn, sweet potato, and Irish potato. In wheat and barley, in certain vegetables and fruit, Japan produces a self-sufficiency. At one time Japan was a heavy iii£>orter of dairy products, but, though still requiring im- ports, in recent years there has been a great development of dairy products in the prefecture of Hokkaido* Even today Japan imports from Manchuria all of its soy beans, the bulk of protein in their diet. With vegetables and fruits, all must be thoroughly washed and cooked before eating, because the common practice of fertilizing farms and gardens with night soil offers a great danger of contracting the enteric diseases (typhoid, paratyphoid, dysentery, amoebic dysentery and cholera) or one of the many intestinal parasites that exist in Japan. Excess supplies of fish are frequently infected with flukes and other parasites and worms. The custom of eating raw fish is responsible for the spread of the fish tapeworm diphyllobothrium latum. With the basic item of rice, the Japanese serve vegetables and fruits, meat and fish, and various sea foods. Sea products are relatively more plentiful in Japan than in other countries. Formerly the hulling and polish- ing of rice reduced the food and vitamin value, and the heavy dependence on rice in the Japanese diet caused the prevalence of beri-beri, always a terrific problem for the Japanese, However, the present tendency is to hull and wash rice only to the extent of seven-tenths, the "seven-tenths pounded and 24-8 26 21ABCD RESTRICTED 61 without the use of sand" method of polishing rice has been adopted, beri-beri has greatly decreased in the past four years. Rickets, scurvy, eye diseases, underweight, as well as beri-beri, are due to malnutrition in the Japanese diet. But statistics show a general in- crease in the well-being of the population since the Institute of Nutrition (page 18 ) was established in 1902. The average Japanese family of the agricultural population allots l+B% of its budget to food. b. Milk# Regulations governing the milk supply include the followings whole milk, skim milk, milk products and condensed milk, condensed skim milk, powdered milk. Whole milk must contain at least 5 percent fat and condensed milk must contain not less than 8 percent, while specific gravity of whole milk must be from 10.28 to 10.54, and that of skim milk from 10.52 to 10.58. Spoiled milk, milk containing foreign matter or showing deficiencies, and milk from cows suffer- ing from certain chronic and acute infectious diseases are not allowed to be sold. miv containers must state whether they contain whole, skim milk or milk products. Handlers of milk must obtain permission and permits from the local governor, first satisfying the governor they are not suffering from tuberculosis, leprosy, syphilis or any other infectious or contagious diseases. Goat»s Milkx The same regulation that apply to cowfs milk apply to goat’s nil*. There is a law for the control of bovine tuberculosis. This law is under the jurisdiction of the Minister for Agriculture and Commerce and provides for the examination ty the authorities of milk cows, cattle of foreign breed and bulls of mixed breed to ascertain whether tuberculosis is present. The examination is made at a : 24~fl8621ABCD RESTRICTED RESTRICTED 62 designated place on a fixed day. Clinical examinations and the tuberculin test are made once a year. Cattle showing clinical tuberculosis on positive tubercu- lin tests are destroyed and the carcasses except skin, horns and hoofs are burned. Cattle suffering from mild tuberculosis are Isolated and their milk is pasteurized Inspection of Farms: Milk cows are inspected before their milk may be sold and they are Inspected thereafter at regular intervals* Inspection of the milk is made either during delivery or at dairies. Dairies are inspected at least once each month when samples of milk are examined for variation, color, odor, density, specific gravity, fat content, bacterial count* The dairy industry is confined largely to the environs of the larger towns and cities and pasteurizations at its best must be considered uncertain and inadequate* Despite the recent develop- ment in Hokkaida, the importation of dairy products of each type was consid- erably greater than that produced. Statistics. 1958 Persons engaged in milking, handling, selling milk 4,799 • " " milking and selling milk 25,111 * • " selling milk 6,600 Dairy farms 50,422 Milk plants 6,445 Number of milk cows 107,878 Milk produced 262,514,995 litres Hokkaido prefecture, produced of the total amount 78,725,065 Okinawa produced the least* Goat's milk: Persons engaged in production and sale of goat milk 709 24-62821ABCD RESTRICTED RESTRICTED 63 Number of goat dairies 614 Number of goats 6,482 Quantity of goat milk produced 1,575,766 litres Milk products: Amount of condensed milk produced 25,733,458 Kilo. Condensed skim milk 2,657,680 " Powdered milk 894,646 " Butter 698,706 " A business in Japan which was once large is the melting of snow for sale as water* This melted snow was required to pass all the tests of other water. Now this business is considerably smaller, and exists only in the northern prefectures of Aomori and Toyama, and Shiga in the center. Selling ice is another business greatly reduced in scale. As of 1937, the figures are as follows s Snow and Ice: 1937 Traders in snow and ice 1,636 Artificial ice produced 2,699,939,119 Kgs. Natural ice 52,291,065 ** Snow 154,7B2 Refreshing drinks in 1938 had 3,347 manufacturers, and their products consisted of: Mineral and Plain soda 8,291,727 litres Lemonade 52,177,373 n Cider 53,744,847 » This industry has been rapidly increasing in Japan showing a consumption of 2.01 litres per inhabitant. c. Meat Hygiene. Sanitary control of meat was first adopted by the government in the 1870's when regulations for the control of slaughter houses S4-62681ABCD RESTRICTED RESTRICTED 64 were issued to prohibit the slaughter and sale of cattle suffering or dying from disease. The present laws for meat hygiene were adopted in 1906 and are under the administration of the local governor. Permits to establish abattoirs must be obtained from the governors. Site, facilities and equipment must be approved. The control of cattle for slaughter is exercised by 625 sanitary inspectors devoting their full time for this work. In case an animal is found to be suf- fering from a disease the slaughter of the animal is prohibited and the word "prohibited” is branded on Its horn, fore hoofs and rump. After an animal is slaughtered examination of the blood, viscera and lymphatic glands and flesh is made. Disease of any of these organs is cause for rejection of the carcass. The number of slaughter houses in 1938 was 728, Hokkaido, with 77 slaugh- ter houses, has the greatest number. Slaughtering: Head: Yielding in Kilogrammes: Cattle 345,385 64,523,122 Calves 43,661 2,647,629 Sheep 2,534 46,927 Goats 4,207 46,654 Pigs 1,222,249 60,042,749 Horses 7,427 10,497,131 Number Prohibited 91 9 ~ _ 281 128 Destroyed after slaughter 166 31 1 — 271 66 Partly Destroyed 1,789 263 3 1 1,152 3,599 Viscera only destroyed 78,785 2,015 727 192 579,913 9,831 Cattle Calves Sheep Goats Pigs Horses In addition to the meat produced in 1937 Japan imported 13,086,484 kilo- grammes • 24-62621ABCD RESTRICTED 66 AREA 11. JAPAN - HONSHU - TOKYO. (App. Lat. 35° 40* N. - Long. 139° 45‘ E.) Tokyo Municipal Sanatorium, Opened in 1920 and successively enlarged. Prior to 1936. ONI #98110. a*-«aa2iiBCD RESTRICTED 66 UII. Mineral Springs In Japan there are several chains of volcanoes stretching throughout the country and as a consequence many mineral springs, especially hot springs, are found in groups along these volcanic chains. The Sasu volcanic chain which runs southward thru the northern part of Honshu from the western part of Kara- futo and Hokkaido has many such springs. Yunokawa, Kaborietsu, and Jozankei in Hokkaido; Owani, Naruko, Kaminoyama, Oene, etc. in the northern part of Honshu. In the Fuji volcanic chain that traverses the middle of Honshu and extends over to the Seven Islands of Izu, hot springs are found at Akakura, Betsho, Swa, Hakone, Atami. In the Hakusan volcanic chain in the center of Honshu are found Kamikochi, lamanaka, Misasa. The cities, towns, and villages which have mineral springs within their jurisdiction number 680 while the total number of Mineral springs numbering about 1000 are classified as follows: Simple cold 161 Simple hot 231 Simple carbonated 23 Earthy carbonated 18 Alkaline carbonated 153 Common salt 187 Bitter 79 Iron 36 Sulphur 142 Rydrogen sulphide 11 Acid sulphates 7 Alkaline sulphates 11 Miscellaneous 136 Mineral springs are generally utilized for the purpose of recuperation and are used in the following manner: The most commonly used method is bathing. Most of the public bathing houses are open to the public without charge. The indoor bath is generally installed in 2 4-02031ABC D RESTRICTED RESTRICTED 67 hotels and restaurants for the convenience of guests. In Beppu Shima there are steam baths so arranged as to fill a room with the natural vapor which emanates with the mineral springs. Hot water falls is a method peculiar to Japan. It combines massaging effect with the effect of the hot mineral water. The water from many mineral springs is drunk with a supposed salutary effect on many ills. ✓ Hot sand and mud baths—the bather covers himself with the sand and is warmed by the hot spring as in resorts like Beppu and Ibusuki. The mineral salts obtained from the springs consisting of sulphur and iron alkaline salts are used in baths. These springs as health resorts are under the control of the Governor of the prefecture who presides over enforcement of Regulations for the Control of General Bath Houses. The accessibility of these springs has made bathing of this type a great national institution in Japan. The average annual visithrs to these springs number about 17,000,000 persons. XXIII, Opium and its Control Very little opium has been produced in Japan, and since no opium was imported from China the people did not contract the habit of opium smoking. In fact, recognizing the evils of opium the government placed a very strict bar on its import. As opium became of great medicinal value, the government created an opium monopoly and has adopted very strict regulations for the 24-92621A.BCD RESTRICTED RESTRICTED 68 control of opium. In 1868 a trade treaty was signed with Great Britain prohibiting Import of opium. In 1880 the penal code came into effect. In it, provisions were made for the punishment of offenses against the violation of the opium law. As insufficient opium was grown in Japan to take care of its medicinal requirements, the government decided to purchase the deficiency and create a monopoly. Opium is sold only through drug stores on prescriptions by medical officers. All the opium grown in Japan is under the direct supervision of the government. All the powder produced from the plants is sent to the authori- ties. In 1919 the opium law was revised to abolish wholesale dealers of opium, and the governor appointed an official dealer in each prefecture. The governor iras authorized to sell directly to consumers. The government alone may import opium. The export of opium to countries is prohibited except to Japanese physicians practicing in foreign countries, provided their applications are enforced by the Japanese authority in these countries. The opium committee is composed of The Minister of Health, who is Chairman, 12 Secretaries and 19 members besides 5 clerks. During the year 1958 the following quantities were sold: 5,884 bottles containing 5 grains of opium 256 ■ • 25 • ■ » 210 " " 460 ■ " " 1,297 " ■ 500 ■ • " Drug Addicts in Japan: Opium addiction has been done away with entirely, both in rural and city districts. Nor is the use of medicinal opium abused RESTRICTED RESTRICTED 69 as measures regulating its purchase and the control of its use are strictly enforced. In recent years addicts have been found in the cities among Koreans and Japanese who have lived in Korea. Medical practitioners who treat such pati- ents must report the cases to the authorities. In 1955 the number of addicts throughout Japan was about 5000. The prefectural authorities endeavor to admit as many addicts as possible to mental institutions and to give them proper treatment. XXIV, Health Examination of Prostitutes The prostitute quarters actually existing in 1958 numbered 592. The term "prostitute quarters" includes all places where licensed prostitutes axe per- mitted to carry on their trade. The daily average during the year of licensed prostitutes in these quarters was 44,908. For the examination of these prostitutes 568 health examination stations were maintained. The total number of examinations made in these sta- tions was 2,770,427 and in 59,454 cases the prostitutes were found to be dis- eased. The number of hospitals for admitting these diseased prostitutes was 158 and the average number of times a prostitute was admitted into the hospital during the year was 1.52 times. The following table gives the number, classified according to diseases, of prostitutes in the whole country who were found to be diseased during the year upon examination; when two or more diseases are found in the same person 24-62621ABCD RESTRICTED RESTRICTED 70 the one which appears first in the table is taken to be the principle diseasej thus if a prostitute is suffering both from syphilis and gonorrhea she is taken to be infected with syphilis and the latter is added to the number under gono-r rrhea. Cases Ratio in percentage to the no. of cases of deseases Syphilis 3,715 6.25 Gonorrhea 50,144 60.70 Chancroid 19,635 53.02 Ulceration 4,941 8.51 Infectious skin diseases 188 .52 Tuberculosis 51 .06 Leprosy — — Trachoma 594 100 Other diseases 6,164 10.57 Hospitals for Prostitutes: Total number of hospitals for prostitutes 158 Total bed capacity 4,935 Total entered into hospitals 54,984 Average capacity per hospital 42,16 patients Average number of days in hospital 17.51 days The average number of days a clandestine prostitute remains hospitalized is 26.74 days. The average number of days in hospital of the clandestine prostitute is some 9 to 15 days longer than that of the licensed prostitute which would in- dicate that the health examination of prostitutes is of decided importance. Regulations for the control of licensed prostitutes provide that a woman desiring to become a licensed prostitute must be above 18 years of age, must obtain permission from the police and must have her name entered on the offi- cial list of prostitutes. First she must undergo a physical examination. A licensed prostitute must live within a certain designated area and cannot 24-6 2 6 21ABC D RESTRICTED RESTRICTED 71 carry on her trade except in officially sanctioned brothels. Each licensed area has a medical Institution for prostitutes and medical examinations are required of each prostitute once every 5 to 7 days. In case a prostitute is found to be suffering from a venereal disease she is sent to a lock-up hospital and is required to undergo treatment. Her license is withdrawn until she is cured. IT ben found clandestine prostitutes are punished hy 30 days jail sen- tences. If she is found to be suffering from a venereal disease she is sent to the lock-up hospital for treatment. In certain prefectures "geisha girls" (dancing girls) waitresses, and other women of related occupations must undergo periodic examinations. These are made at so-called "health preservation guilds" once every month or two. The expense is borne by the employer. XXV. Venereal Diseases Syphilis, gonorrhea and chancroid are the only reportable venereal dis- eases in Japan« The first case of syphilis was reported in Japan in 1512 and seems to have been imported from the Loochoo Islands being known as "Loochoo Pox." Fifty years later a physician reported a series of cases and treatment of bubo and syphilis stating that syphilis was more prevalent in cities than villages. The present system of licensed prostitution dates to 1881 when the Metropolitan Police Board of Tokyo required prostitutes in Tokyo to live in 2 4-6 26 31ABC D RESTRICTED RESTRICTED 72 brothels, stating as a reason that venereal diseases could be more easily controlled, and ordered compulsory examination of all licensed prostitutes. This law underwent certain changes until 1900, when the prostitution law as it stands today was adopted. This law provides for the licensing, frequent examinations and free treatment of all Infected prostitutes. The number of cases of venereal diseases discovered in the examination of young men for conscription, which is carried on throughout the country yearly, may be taken as an accurate index of the incidence of venereal diseases. Year Syphilis Soft Chancroid Gonorrhea Total Rate per 1000 1914 2,542 2,162 8,136 12,640 26.57 1920 2,196 2,454 6,975 11,605 21.87 1925 1,216 1,601 6,171 7,888 14.27 1950 942 1,116 4,862 6,920 12.69 Based upon this evidence, an intense venereal disease campaign has caused a decrease of these diseases, though in the present war the prevalence of vene- real diseases among conscripts was stated to be in the region of 1,18 percent. For opthalmia neonatorum there are no general statistics available, but from investigations of the Tokyo School for the Blind it was found that 2,56$ of its pupils lost their eyesight because of gonorrhea. Though the regula- tions concerning the prevention of venereal disease applicable to the public are only general, any person suffering from a venereal disease may seek relief 24-62621ABCD RESTRICTED RESTRICTED 73 at public or private hospitals or by physicians in practice. If unable to pay for their treatments, payment is provided for by the Saisei Kal, a philan- thropic association endowed by the Imperial Family, by the Red Cross, and by the Association for the Prevention of Venereal Diseases. Sero diagnosis tests for syphilis are given on application by the general public at government and private hospitals free of charge. The Ministry of Public Health and Welfare since 1916 has been maintaining classes in Tokyo, Osaka and Kyoto for sanitary officers, training them to dis- seminate information in venereal diseases to the general public. The Japanese Association for Prevention of Venereal Diseases has been the most active of the anti venereal agencies, providing for public lectures, distribution of pam- phlets to the public, etc. At the end of 1937, 179 venereal disease clinics handled the following: Syphilis Gonorrhea Chancroid Total 467 ) 1,166 )in patients iuiz) 2,950 1,349 ) 5,356 )out patients 1i&l ) 8,240 In 1939 deaths were listed as: From syphilis: male 2,791, female 1,021, total 4,412. From chancroid: male 35, female 12, total 47. Though lymphogranuloma inguinale and granuloma venereum are found in Japan, no statistical information is available. Prevalence of venereal diseases in licensed protitutes is 1,8$; in un- licensed and clandestine prostitutes, 3.44$. Routine blood tests have shown the following positive percentages: 84-92621ABCD Admissions to the Dermatological Department of Tokyo University: 5.9$. Admissions to the Izuraibashi Hospital: 10.6$. Admissions to the Kyomido Hospital: 9.4$. RESTRICT]*!) HESTRIG TED 74 AXVI. Health Centers As a result of the promulgation of the Health Center Law of April 1957 health centers were established in 49 different areas throughout Japan; generally speaking one for each prefecture of Japan. Names of Health Center Location Names of Health Center Location Asahlgawa Hokkaido Nishitama Tokyo Fukuchiyama Kyoto Tomldabayshi Osaka Odawara Kanagawa Himeji Ifrogo Omura Nagasaki Niitsu Niigata Oshi Saitama Ota Gumma Kisarazu Chiba Ohta Ibaraki Ota bar a Tochigi Nara Nara Iga-Ueno Mie Ichinomiya Alchi Shimizu Shizuoka Kusakabe Yamanashl Nagahama Shiga Ohta Gifu Ueda Nagamo Furukawa Miyagi Taira Fukushima Morioka Iwate Aomori Aomori Sakata lamagata Ohdate Akita Asahl Fukui Nanao Ishikawa Mlkkalchi Toy ana Chigashira Tottori Kawamoto Shlma Okayama Okayama Bofu Yamaguchi Fukuyama Hiroslma Gobo Wakayama Muya Tokushima Kotohlra Kagawa Uwajima Ehime Aki Kochi lizuka Fukuoka Nakatsu Oita Karatsu Saga Yatsushiro Kumamoto Nobeoka Miyazaki Sendai Kagoshima Nijo Kagoshima Aberno Kyoto Ikuno Osaka The Health Center Act further provides that within a period of 10 years 665 new health centers and 1,100 substations be erected throughout the country. Further, that urban and rural health centers be held responsible for providing intensive training courses for public health personnel needed for the program. 34-62621ABCD RESTRICTED RESTRICTED 75 XXVII. Infectious Diseases (Reportable) a. Cholera♦ The first introduction of cholera to the interior of Japan occurred, it is stated, in 1822, when a Dutch ship carried the disease from Java to Nagasaki. But previous to this many cases of cholera were reported in Java, and were followed by outbreaks in Canton, Ningpo, and Peking. When the disease appeared first in Japan, it was in Kyushu. In 1858 between 2,500,000 and 3,500,000 people were stricken by cholera in all parts of the country. The disease raged with special violence in Osaka and Tokyo. During the days between July and September in 1860, 286.000 bodies were cremated in the Tokyo area alone. Then in 1877 a British merchant ship brought a sailor, suffering from cholera, to Nagasaki. The disease spread from there to other districts. From September to October 14,000 cases occurred and the next year 175,000 cases were reported. Since that time there have been six definite epidemics ranging from 10.000 to 155,000 cases. The outbreaks occur at irregular intervals, and invariably the epidemic seems to be traceable to the entry of a single case through a port. The port of entry is often in the South of Japan, most commonly Nagasaki. The authorities carefully watch the prevalence of the disease in foreign countries, and whenever unusual prevalence is reported a bacteriological exam- ination of the excreta of passengers and crews of ships from infected ports is S4-«8«811BCD RESTRICTED RESTRICTED 76 carried out. This results in detecting a large number of cholera patients and carriers. The two most important anti-cholera measures adopted in Japan are: search for cholera carriers, and cholera vaccination. For preventive inoculation either a heated cholera vaccine or a sensitized vaccine is used. In time of cholera prevalence those whose occupations make them more liable than others to contract the disease are vaccinated. Of late years the people have begun to demand vaccinations. The disease is spread through contaminated water and food, commonly fish. No cholera cases were reported in 1936. The total number of cases in 1959 was 57, with 20 deaths. The 57 cases were distributed over: Hiroshima 40 15 deaths Yamaguchl 10 5 Okayama 5 1 Tokyo 1 — Hyogo 1 1 b. Dysentery and n£kirif1. Dysentery has existed in Japan from the earliest times. The first authentic record of its prevalence in Japan is dated A.D.861, and between that year and 1829 there were 19 severe recorded epidemics. The number of cases in these epidemics varied from 12,000 to 267,000. The case fatality has been between 20% and 25%. The seasonal prevalence of dysentery starts in May or June and reaches its peak in August or September. 24-88821ABCD RESTRICTED RESTRICTED 77 Dysentery in Japan is mostly of the bacillary type. Ekiri, a disease resembling infantile dysentery, id often confused with similar diseases; and has persistently prevailed in various parts of the coun- try from ancient times. Victims of Ekiri are principally children from 2 to 6 years of age. Epidemics are frequent in summer and autumn. Though similar in symptoms to adult dysentery there is sufficient evidence to classify it sepa- rately. The number of cases of dysentery in 1957 was 78,284 with a death toted of 18,427. Of these the number of cases which broke out in urban districts was 72.50£ or 66,696. Of these there were 10,622 deaths. The rate of cases and deaths per 10,000 urban population was 22.54 and 4.19 respectively. Compared with 1956 there wan an over-all increase of 26,209. Figures are not available on the incidence of amoebic dysentery, though the statement is found that very few cases of amoebic dysentery occur in Japan Proper. However the general use of night soil in fertilizing, to which the high incidence of dysentery is attributed, tend to spread amoebic dysentery also. The areas of Japan where dysentery frequently breaksout are: Cases Deaths No. cases per 10,000 Fukuoka 16,214 1,656 66.87 Tokyo 20,550 4,575 50.77 Osaka 7,954 1,704 17.20 Ityogo 5,468 662 11.58 These are of course, the areas of greatest population density in Japan. Carriers either by direct or by indirect contact Spread bacillary dysen- tery by contaminating the food and water. S4-0seaiABCD RESTRICTED* RESTRICTED 78 c. Typhoid Fever. Paratyphoid Fever* Typhoid and paratyphoid fever are extremely common throughout Japan. Although cases occur throughout the year they have their greatest prevalence In the late summer and early fall* The earliest report of an acute type of fever, undoubtly typhoid fever as we know It, vas reported In Japan In 1674* In 1886 Japan*s most serious outbreak of typhoid fever occurred when over 65,000 cases of typhoid or 17 per 10,000 popu- lation were actually registered* The case fatality was about 26%. Averaging about 50,000 cases yearly the case mortality rate has been about 21% to 50% depending on the locality* A study of the origin of the Infection over a long period of years Showed that: 20.77% were Infected thru drinking water, 18.11% thru eating Infected food, 59*56% thru direct contact with a known case* The total cases of typhoid fever in 1957 vas 58,542 with 6,617 deaths showing an Increase over the previous year of 1,604 cases and 150 deaths. The ratios were 5.41 cases and 0.95 deaths per 10,000 Inhabitants* Cases Deaths Number of cases per 10,000 pop. Hiroshima 2,458 418 15.27 Hyogo 5,400 676 11.19 Iwate 1,200 165 9.50 Miyogi 1,160 151 S.ll Akita 957 117 8.86 Osaka 5,455 724 7.44 Kyoto 1,026 177 6.81 Fukuoka 1,028 285 6.68 24-62821ABCD Paratyphoid fever was first considered an entity by Itself In 1900 when a typical bacillus vas found In the stools of patients suspected of having typhoid restricted RESTRICTED 79 fever. Like typhoid fever it is usually prevalent in the summer and early fall and the same preventive measures are required* The number of cases in 1937 was 4,430 with 292 deaths, showing 0.65 cases and 0.04 deaths per 10,000 population. Usually a higher rate of incidence of typhoid and paratyphoid is reported from the cities and towns than from the rural districts, the ratio being 10 to 7* Both the Japanese Navy and Arny submit their entire strength to vacci- nation once each year. A mixed typhoid—paratyphoid vaccine is used. Once again it may be repeated that the general use of night soil as a fertiliser is the cause of the prevalence of intestinal diseases in Japan. With the development of the fertilizer industry in the mandated Islands it is the hope of the Japanese government that the use of "night soil" for fertilizer will be sharply curtailed. The ultimate goal, of course, is that of eliminating intestinal bacterial diseases and parasitism, conditions well nurtured by the present practices. d. Smallpox. The first historical notice of small-pox in Japan was in 735 A. D. Originating in a corner of Kyushu, Fukuoka it spread to many other prefectures. Two years later it again invaded the same territory thus point- ing to Korea as a source of its disease. From 735 A. D. to 1833 small*pox is said to have ravaged Japan 56 times. From 1833 to 1920 there have been six severe epidemics varying from 3000 to 113,000 cases for each epidemic. The case fatality of small-pox varies greatly, but it has never exceeded 50% nor fallen below 10%. February and March have been the most common months for epidemics. 24-62021ABCD RESTRICTED RESTRICTED 80 spread of the epidemics is promoted ty the fact that Japan has a great many fishermen leading nomadic lives, and individuals who fail to be vaccinated• In 1957 there were 90 cases of small-pox with 6 deaths. e. Scarlet Fever. Total number cases in 1957 was 17,605 with 480 deaths, showing an increase of 896 cases and a decrease of 7 deaths. The ratios of these cases and deaths to the population were 2.47 cases and .07 deaths per 10,000 inhabitants. f. Diphtheria. Since the discovery of diphtheria antitoxin by Park 0f the United States in 1899, diphtheria has not played the important role it had prior to that time, when the average yearly number of cases was between 56,000 and 60,000 cases. In 1957 the number of cases reported were 28,111, with 4,069 deaths. Ratios were 5.95 cases and 0.57 deaths per 10,000 inhabitants. Toxin-anti- toxin and toxoid are used in schools. g. Typhus Fever. It is characteristic of typhus fever to prevail with great violence in times of war or famine. It was regarded as a malignant type of adult measles and in the epidemic following the famine of 1859 over fifty deaths per day occurred while the epidemic lasted. The principal areas affec- ted were Tokyo, and the prefectures of Kanagawa, Saitama, Chiba, Gumma. In recent years, however,only sporadic cases of typhus fever have occurred and they have been in Yamagata, Aomori and Akita prefectures. 17 cases of typhus fever were reported in 1957 with no deaths,compared with 16 cases and one death the previous year. 24-83821ABCD RESTRICTED RESTRICTED 81 Various forms of typhus and typhus-like fevers are found in Japan, (l) The epidemic or louse borne typhus fever is a rickettsial disease transmitted by the common body louse. (2) Endemic typhus fever (murine typhus) is spread by the rat fleas. This type- is found usually at the sea*ports around docks and warehouses. (3) Tsutsugamushi fever, or Japanese river fever, is a rick- ettsial disease carried by trombicula akamushi. These mites are usually found in infested voles and other rodents. The mortality rates from tsutsuga- mushi fever are high, around 6C$. It prevails during the summer and autumn in parts of the mountainous districts of Niigata, Akita and lamagata prefec- tures. That tsutsugamushi fever is an old disease in Japan, is evidenced by the ancient proverb "Safe as a person without the tsutsuga." However, it is confined to a limited area of three prefectures. In 1937 the 59 deaths attri- buted to the disease were confined to the above mentioned prefectures. h. Plague. In 1896 a Chinese passenger on a steamer that arrived at Yokahama and another on one that arrived at Nagasaki were found to be suffer- ing from plague. This marked the first inroad of plague into Japan. In 1897 fot'r* more cases of plague were found in the same ports. In 1899 the first indigenous case of plague in Japan occurred in Kobe. During this year there were 23 cases, 42 infested rats found in Hyogo prefecture. Thus it spread to Osaka, Hyogo and Wakayama causing 220 cases. Since this period there have been a number of periods when the disease has waxed and waned, but each year there have been sporadic cases in the port cities. The death rate has varied from 75/6 to 88%. Although no recent epidemics have been reported, a few cases are reported annually. The prevalence of the flea infested rats makes epidemic S4-«S«aiABGD RESTRICTED RESTRICTED 82 outbreaks a potential hazard. Rats are found especially in the seaports, around wharves and warehouses. In rural areas most houses are rat infested. The plague bacillus is called Pasteurella pestis and is carried by the Oriental rat flea Xenopsylla cheopis. The finding of dead rats and other rodents frequently indicates that plague is prevalent among the local rodents. The importance of avoiding these dead animals cannot be over- emphasized, As the fleas leave the dying or dead rodent they seek new animal hosts, including man. Thus, by infesting humans, they transmit the disease to man. Investigations made in Kobe showed that of 470,846 rats examined: Rattus rattus norveglcus. made up 45$ Rattus rattus tanezumi 56$ All others 17,9$ Thirty-two species of rats have been identified in Japan. Below are given the percentages of plague infested rats according to species: In Tokyo Rattus rattus alexandrinus made up of total 90,4$ Rattus rattus rattus 5.57$ Rattus norvegicus 5,95$ In Miye Prefecture: Rattus rattus alexandrinus 22,9$ Rattus rattus rattus 55.68$ Rattus norvegicus 5.95$ In Aichi prefecture: Rattus rattus alexandrinus 86.9$ Rattus rattus rattus 5.5$ Rattus norvegicus 9,7$ The foregoing table indicates the great predominance of infection in the Rattus rattus alexandrinus and rattus. They are found to be infected the year around. The Rattus norvegicus, however, is Infected only in the winter months. 24~62621ABCD RESTRICTED RESTRICTED 85 Areas of Japan where the Rattus rattus alexandrinus and rattus are found to predominate are the areas in which epidemics of plague have been most persistent. Only the most extreme vigilance on the part of port authorities has kept the incidence of plague within bounds. Its terrific infectiousness and high mortality have been sources of fear to the Japanese. The presence of one case is sufficient to cause terror among the people. The history of the epidemics of Japan Shows that the years from 1906 to 1910 were the moat severe during which time 2,200 cases of plague occurred in Japan. Since this time there have been no epidemics, but sporadic cases occur almost yearly. Plague in Japan has been almost entirely bubonic in type, except for a small outbreak of pulmonary plague of 11 cases in Chiba prefecture. Sea-port prefectures have been the prevailing places for plague, Osaka, Hyogo, Kagawa, Nagasaki and Tokyo being the most commonly affected. i. Trachoma. Records show that in the Heroic period (the ninth century) a certain violent eye disease spread rapidly throughout Japan. Whether it was trachoma or not is unknown. However about 1800 an eye disease resembling tra- choma was described in some medical books, but it was not until 1880 that the people began to appreciate the gravity of trachoma and the necessity of a stamp- ing it out. In 1916 there was established in Tokyo the Association for the Prevention of Trachoma which studied preventive methods and educated the public concerning the disease. And in 1919 the "Trachoma Act" was passed to help prevent the disease. Physical examination of the conscripts showed that in 1925 14.68% of them 24*82821ABCD RESTRICTED RESTRICTED 84 had trachoma. Examinations of factory workers showed that 10.84% of them had trachoma. Examination of students showed that in primary schools as high as 16.69% of the children were afflicted with this disease. The distribution of trachoma is not uniform throughout the country. Conscripts from Aomori showed the highest percentage with 59.8% of conscripts afflicted with the disease, while Nagarro was lowest with 6.65%. According to the investigations of the Tokyo School for the Blind, 2.69% of blindness is said to be due to the disease while the Nagasaki prefectural hospital attributed 18% of blindness in one eye and 20% of total blindness to trachoma. In order to educate the public concerning trachoma The Home Affairs Burea arranged for lectures to be given by experts to the general public. This work has since been taken up by the Association for the Prevention of Trachoma, a voluntary organization set up by physicians. Cities, towns and villages re- ceive financial aid for all expenditures involved in trachoma treatment and prevention. The following table shows the result of examinations conducted by the prefectural government in accordance with The Law for Prevention of Trachoma. Number of persons examined 6,522,554 Number of trachoma patients Severe cases 59,455 Mild cases 409,495 Suspected cases 125.549 672,497 Ratio of patients per 100 persons examined 7.92 24-02621ABCD RESTRICTED RESTRICTED 85 In 1958 from a selected group (origin or qualifications of this group not given) 790,094 who were examined for trachoma 546,555 were found to be suffering from the disease. At the end of 1958 there were for the exclusive treatment of trachoma: Prefectural clinics 29 Municipal clinics 266 Towns and village clinics 1080 Total 1,506 j. Cerebrospinal Meningitis. It is only in recent times that any mention has been made of this disease in Japan. It was first found in Nara and Shiga prefectures in 1871 and subsequently spread to Kyoto and Osaka. Since the Chino- Japanese war of 1894 the disease has prevailed in epidemic form at various places in the country. Osaka has been attacked with particular violence. It was first put on the reportable list of diseases in 1918. In the following year 2,400 cases were reported— an unprecedented number. Kyushu Island, Oita and Miyazaki prefectures seem to be immune from the disease. The case mortality has averaged 60%. The disease is usually most prevalent in March, April and May. Young children are the most frequent victims. The total number of cases of epidemic cerebrospinal meningitis in 1957 was 2,859 of which 841 died showing a decrease of 764 cases and 155 deaths under the previous year. 65% of the cases, or 464 in number, occurred in the cities, of these cases, 577 died. 24-62621ABCD Most of these cases occurred in Fukuoka, Osaka and Tokyo, k. Notification of acute infectious diseases. Although most cases of RESTRICTED RESTRICTED 86 infectious diseases are reported to the authorities by attendant physicians, in times of epidemic prevalence police officers endeavor to find patients in the early stages of infection or those who do not have physicians in attend- ance by carrying out house to house inspection. Investigations to determine the efficiency of the various methods of discovering contagious disease were made: Cases found in household ins pec tloh 480 3.66% Cases found around persons medically examined 1.25 0.95% Cases found by postmortem examination 12 0.0956 Reported by Physicians 12,248 93.52% Notified by patients family 16 0.12% No. of patients Secretly Reported 62 0.40% Others 192 1.46 Total Cases 15,125 100% 1. Detection and Disposal of bacilli carriers: It is the responsi- bility of prefectural authorities to carry out different measures to control bacilli carriers. Cholera and typhoid fever and paratyphoid fever carriers have been the main problems. If cholera breaks out, the excreta of all members of the patients house- hold, all fellow passengers on ship board and all persons who have been in communication with the patient and those who use the same well and toilet faci- lities are bacteriologically examined. These same investigations are made of typhoid and paratyphoid fever patients. Two negative reports at intervals of 24-62831ABCD RESTRICTED RESTRICTED 87 not less than 24 hours are required before the patient is released. Disinfection of patients* houses is carried out as a routine procedure. Patients suffering from cholera, small-pox, typhus and plague are with- out exception removed to isolation houses or hospitals. More than 80£ of patients suffering from dysentery, typhoid fever, paratyphoid fever, scarlet fever and cerebrospinal menigitis are treated in isolation hospitals. Most diphtheria patients are treated in their homes. For the treatment of infectious diseases at the end of 1933 there were 1,010 isolation hospitals with a capacity 23,255 beds—there were 7,044 isolation wards with 69,246 beds, 66 isolation houses with 1,699 beds. 24-83621AflCD RESTRICTED RESTRICTED 66 XXVIII. Port Quarantine In an island country it is well nigh impossible to keep the country safe unless the incoming diseases are detected at the sea ports. Especially is this so when there ere frequent outbreaks of infectious and contagious dis- v eases in the neighboring countries and when no adequate measures for prevent- ion are taken at ports of these neighboring countries. Port quarantine was first carried out in Japan because of the necessity of checking the spread of cholera when patients with this disease frequently arrived in Japanese ports from abroad. In 1&79 regulations for the prevent- ion of cholera at sea ports were first issued as No. 26 of the Supreme Councils Notifications. The regulations'consisted of 22 articles and provided fairly thoroughly for quarantine measures for ships arriving from abroad or from in- land ports. In 1S93 it was decreed that the quarantine regulations of lf§97 were to be applied in the case of plague also, and accordingly vessels coming from or by way of the Chinese Coast or Hong Kong were quarantined at Nagasaki, Kobe, Yokahama, and Shimonoseki, Since these quarantine laws were enforced only when epidemics prevailed in neighboring countries, when an endemic case of cholera slipped in and started a serious epidemic of cholera in Japan the authorities realized more stringent regulations were necessary. The present quarantine law was adopted in 1^99> though it has been revised twice since then. The infectious diseases for which quarantine is enforced are cholera, smallpox, scarlet fever, plague, and yellow fever* Carriers of bacteria of these diseases are regarded as actual cases for the purpose of quarantine. Vessels running from foreign ports to a port where sanitary inspection is carried out are not permitted to enter the harbor, nor communicate with the 34-82821ABCD RESTRICTED RESTRICTED 89 shore or other vessels, nor land crew or passengers or unload the cargo until they have been inspected and granted pratique. A vessel which comes from a foreign port to where sanitary inspection is carried out must hoist the quarantine signal if any of the following has occurred during the voyage: A case of an infectious disease or a death therefrom. The vessel has left an infected district, has passed such a district or has communicated with an infected vessel or is itself infected. The quarantine officer possesses the authority to take these measures: (1) If there is a person suffering from an infectious disease on board, to detain such vessel. Give directions for the disposal of such person and his belongings. Carry out dis- infection of the vessel for the destruction of rats and insects and, if necessary, detain the passengers and crew in the quarantine station or in the vessel for a prescribed period. This period will be 10 days for a plague, 5 days for cholera and yellow fever. (2) If there is a patient on board who is suspected to be suf- fering from an infectious disease, to detain the vessel for a period not exceeding 2 days. (3) According to the condition of the port of departure or ports of call, or the state of the vessel, disinfections or the destruction of rats and insects may be carried out. When the disinfection or destruction of rats or insects is carried out, the captains and crew are required to assist. The quarantine laws do not apply to vessels of less than 20 tons or to vessels the loading capacity of which is less than 200 Kaku, unless such vessels have arrived by way of an infected district. The permanent quarantine stations are under the control of the Harbor Master*s Office of the Custom House that supervises the port. In every station S4-8383 14BCD RESTRICTED RESTRICTED 90 there are harbor officers, medical officers and other necessary personnel and adjutants such as a disinfection house, isolation house, hospital and crematory. As a rule the quarantine officers order the vessels to stop outside of the harbor and board the vessel for Inspection. Except for vessels coming from plague infested districts, or from districts where plague has broken out, ell vessels coming from places where there is danger of plague are ordered to destroy rats and insects on board every 3 months. A gas generator especially made for the purpose is available at the quaran- tine ports. The composition of the gas isj Carbon Monoxide CO 3*3 — 6.6* Carbonic Acid gas 1J»0 — 19% Nitrogen gas N 76.-4 — 77* Though recent figures are not available, the figures of Osaka may be taken as an example. In the year 1931s 93 cases of plague and 372 infested rats were found in the ships arriving at Osaka. Ratio of infested rats per 1000 inspedted rats me8 Rattus rattus norvegicus 44,0. Fleas examined on these rats were Xenopsylla cheopis ceratopyllus, end Ctenopsyllus segnis. In the ports where plague cases were discovered the species Xenopsylla cheopis was hy far the most predominant flea. The total number pf vessels inspected in 1937 by harbor offices of the Custom Houses and by temporary port quarantine stations was 24,261 Japanese vessels and 5*973 foreign vessels. The total number of persons inspected was 2,377,566 of which the shipfs crew numbered 1,657,126 and passengers 1,220,460. By these examinations 3 persons were found suffering from cholera, 9 from small- pox and 61 from other notifiable diseases. »4-eaesi4BCD RESTRICTED RESTRICTED 91 XXIX. Rabies In 1756 the first case of rabies was reported in Japan. There was a severe outbreak in Tokyo prefecture in 1870 and soon after it made its appearance in all parts of Japan. In the five years, 1935 - 1938, there was only one case of rabies in man reported. The number of rabid dogs reported in 1937 was 5, all in Tokyo. Persons bitten by rabid dogs reported in 1937 was 3, all in Tokyo. Persons given preventive antirabic serum 5,748. No. of cases of No. of persons bit- No of cases of rabies in animals: Year rabies in man ten bv rabid docs Dogs Cattle Horses Sheen Others 1955 1 20 21 0 0 0 1 1956 0 55 11 0 0 0 0 1957 0 S 6 0 0 0 0 The extremely rigid quarantine regulations and anti-rabic inoculations of dogs have kept the incidence of rabies to a remarkably low number. XXX. Vaccination It is believed that inoculation with smallpox virus was first practiced several centuries ago at the small seaside village of Awa in the prefecture of Chiba. But the first case of this form of preventive inoculation was at Nagasaki and was performed by a Chinese from Hankow in 1745. In 1849 Kanso Nabeshima head of Saga Clan, had his physician import bovine virus from Holland. This virus was kept alive by transmission from child to child and gradually vaccination spread from prefecture to prefecture. The general public did not seem to recognize the value of vaccination. In 1867 a private enterprise 34*82821ABCD RESTRICTED RESTRICTED 92 opened a house for vaccination in Tokyo. Only arm to arm vaccination was practiced until Dr. Nagayo returned from Europe in 1373 and innoculated a calf with humanized lymph and manufactured calf lymph for the first time. Since 1900 vaccine calf lymph has been used, prepared by the methods of Kitasato and Umeno. Vaccination is compulsory and must be affected in two periods, the first between 6 months after birth and, in case of a negative, taken again before the following June. The second in the 10th year after birth. The total number of period vaccinations against smallpox in 1937 was 2,031,232, of which 1,903,237 proved positive and 66,372 negative. The total number of second period vaccinations was 2,011,374-, of which 1,215,149 proved positive and 765,439 negative, making a total positive takes for the year of 1937 of vaccinations. Percentage in positive cases 1937 Adults 1st time 97.43% 2nd time 73.46% Children 1st time 70.01% 2nd time 25.01% 96.6476 of all adults supposed to be vaccinated were vaccinated, 95»4l£ of all children supposed to be vaccinated were vaccinated. 24-62031ABCD RESTRICTED T C. TF.D 95 XXXI. Parasites a. Common Types* Intestinal parasitism is extremely common throughout Japan, and the prime cause may be considered the universal practice of using human night soil as a fertilizer. The need of fertilizer, and the availability of human night soil, have created a strong block against the installation of wide-spread sewage systems, and as long as this condition persists, intestinal parasites will remain a serious problem. Flatworms: Schistosoma Fasciola Opisthorchis Metagonimus Paragonimus Trematodes (flukes) Dipfcy Hobo thrium Dipylidium Hymenolepis Taenia Echinococcus Cestodes (tapeworms) Acanthocephala (thorny-headed worms) Roundworms: Trie hocephalus Strongyloides Ancylostoma Ascaria Wuchereria Onchocerca Nematodes (roundworms) Gordiacea (hair-worms) In 1937, 581,809 persons were examined under the provision of Act 2 of the Law for the Prevention of Parasitic Disease. Of these 282,004, or 48%, were found to carry eggs. Roundworm egg carriers represented 83% of this total. The next largest was hookworm carriers with 22%. b. Geographical distribution of Parasites. Thread worms and tapeworms are found distributed throughout the country* 8«~eaflaiiBCD RESTRICTED RESTRICTED 94 Roundworms affect on an average 50% of the population. Old world hookworms are particularly prevalent in agricultural villages due to the lack of protect- ion of the feet. In Saitama, for example, the percentage is about 56% of the population and the disease is serious. Diseases caused by flukes occur mostly in low-lying damp places. Parts of Yamanashi, Hiroshima, Okayama, Saga, Ibaraki and Shizuoka prefectures are affected. Lung flukes are found in persons living along streams running from mountain ranges forming the backbone of the main island of the country while liver flukes prevail wherever fresh water fish is eaten uncooked. c. Preventive measures employed. Finding that human parasites were more prevalent than was thought, the Central Government issued in 1920 mwnoranda to the local governments to the effect that it would make grants to the extent of one-third of the cost of measures for the extermination of parasites and for the prevention and suppression of malaria undertaken by local governments. The government has also sent specialists to districts particularly affected to assist in the campaign of prevention. The local governments make grants to guilds, cities, towns, villages where such diseases are particularly prevalent to carry on the campaign. In Saitama prefecture,, where hookworm is most prevalent, the local govern- ment treated over 400,000 people for the extermination of the parasite. In parts of Yamanashi, Hiroshima and Okayama prefectures where there are a great number of persons afflicted with flukes, fire is used to destroy Blanfordia, nosophora katayama by means of which the parasite enters the body. 24-02621ABCD RESTRICTED RESTRICTED 96 Ditches also are covered with lime for the purpose of destroying it. As the eggs of roundworms and hookworms are discharged from the body in the excreta, proper measures must be taken to improve the sanitary con- ditions of toilets and for the safe disposal of faeces. The government’s answer has been the subsidizing of adequate sewage systems, as yet still highly inadequate, and the so-called "sanitary privy" by means of which the eggs of the parasites are almost completely destroyed prior to the collection and spreading of the night soil. The government urges the public to use care in the selection of food and drink which may contain eggs of the parasites. The first principle in the prevention of these diseases is the extermi- nation of the adult worm in the human body. For this purpose various anthelmin- tics are used such as santonin, thymol, oil of chenopodium, oil of eucalyptus, carbon tetrachloride, etc. As purgatives magnesium sulfate and castor oil are the favorites. These drugs should be given by a physician only because fatal- ities may result. d. Worms» Infestatiott with filarial worm is common in Japan. The filarial larvae on entering the body migrate to the lymph channels and block these, tending to produce a swelling of the scrotum and legs, commonly called "elephantiasis.” The principal filarial parasites are the Filaria bancrofti which is spread chiefly by the mosquito, Culex quinquifasciatus (fatigans), and Microfilaria malayi which is spread by the Mansanoides annulatus and A. hyrcanus sinensis. 34-03031ABCD RESTRICTED RESTRICTED 96 Infestation with the liver fluke follows ingestion of raw fish harboring the cercariae. Snails of the species Bithynia are the primary host. Infestation with the liver fluke follows ingestion of vegetables or water polluted with cysts of the fluke. The intestinal fluke is contracted by man through the ingestion of un- cooked or improperly prepared water chestnuts and water plants. Paragoni- miasis follows ingestion of uncooked infested crabs and crayfish. The primary host for this lung fluke are snails of the species Melania. The broad fish tapeworm may be transmitted to man when he eats raw fish a universal custom in Japan. Practically all types of fish in the Far East are infested, but the Japanese limit their raw fish ingested to practically three types of fish, red snapper or "tai", striped bass, and tuna, erroneously believing they do not harbor the infesting organism. Schistosomiasis. Infestation with Schistosoma japonicum, a liver fluke, is common in certain regions of Japan. This is a chronic disease acquired by man by drinking and swimming in waters infested with the cercariae. Snails which are known to serve as the intermediate host Schistosoma japonicum are various species of Oncomelania, Katayama and Schistosomophora. XXXII. Tuberculosis a. History* The history of tuberculosis in Japan dates from early times. In the most ancient Japanese medical book "Ishinho" written in 984 A. D, there is a very complete description of the symptoms of pulmonary tuberculosis. In 1805 in another medical book, the author contended that tuberculosis was an infectious disease and contagious through the media of various utensils. 24-62621ABCD RESTRICTED RESTRICTED 97 clothes and other things used by patients with tuberculosis. In April 1904 the government promulgated, for the first time, ordinances concerning the prevention of pulmonary tuberculosis. According to this ordinance, spittoons were provided in schools, factories, theatres and other places designated by local governors. Spitting, other than in spittoons was strictly forbidden. Besides this, a long list of rules was adopted for the hospitals, hotels, prisons, railway stations, etc. In 1914 the first national sanitorium was established for pulmonary tuberculosis, and grants were made by the Treasury to cities containing more than 300,000 inhabitants for establishing adequate sanatoria for the treat- I ment of tuberculosis. Private enterprise started, in 1911, the Japanese White Cross Society for the prevention of tuberculosis, and in 1913 the Japanese Association for the Prevention of Tuberculosis was organized. b. Statistics. The first statistical study of tuberculosis in Japan was made in 1899, and judging from the present death rates from tuberculosis, the spread of the disease has not yet abated. The situation does not differ materially in different parts of the country, but the death rate is higher in cities than in rural districts. From 1915 - 1920 the average tuberculosis death rate for the entire country was 25.1 per 10,000 population. The average death rate for 40 cities of over 50,000 population was 36.09 per 10,000 pop- ulation. Death rate from pulmonary tuberculosis in females is higher than in males. The death rate is highest among men between the ages of 20 and 25 and among women between 15 and 20 years of age. 24-62621ABCD RESTRICTED RESTRICTED 98 By virtue of the present law, physicians are charged with the duty of in- structing tuberculosis patients in methods of disinfection and other prevent- ive measures, which the patients, or other persons to whom such instruction is given, are required to follow. c. Duties of Administration Authorities. The Authorities are required to disinfect the building Mid articles therein and take other necessary meas- ures of prevention in case patients with tuberculosis have occupied it, or a death from tuberculosis has occurred. The administrative authorities carry out the health examinations of persons who are engaged in an occupation which is conducive to the spread of the disease, or those who live in places where the spread of the disease is feared. Persons suffering from tuberculosis are prohibited from engaging in occupations which are conducive to the spread of the disease. The adminis- trative authorities must take special precautions with respect to schools, hospitals, factories, inns, restaurants, barbershops and similar places. The National Treasury allows grants to cities and prefectures erecting sanatoria in the amount of one-half of the sums expended for this purpose and one quarter of the sum required for maintenance. Other agencies helping in this work are the following: The Salvation Army The Japanese Red Cross Society The Sai Sei Kai The White Cross Society of Japan The Japanese Association for the Prevention of Tuberculosis. 24-82«21*bcd RESTRICTED RESTRICTED 99 The Japan White Cross Society began, years ago, the work of diagnosing tuberculosis at an early stage and treating them either gratuitously or for a very moderate fee* In the early 1950's, as Japan began its industrial development, the many workers required for this induetrillnation were recruited from the rural districts* One of the early developments of the distribution of the popula- tion from rural life to city life was a sudden increase in the incidence of tbs cause of tuberculosis* The increase in numbers was so disturbing the Konoye Cabinet created the new cabinet office of the Ministry of Public Health and Welfare thus removing health matters from the hands of the Bureau of Home Affairs* The Ministry of Welfare recognised this menace to the health of the people of Japan and one of its first steps was, by Imperial Ordinance, to plan the erection of a number of national sanatoria for the treatment of cases of tuberculosis* These sanatoria were still in the course of construct- ion in 1940* Clause I of Article IV of the Law for the Prevention of Tubercu- losis provides for the complete physical examination of those who by their occupation render them susceptible to this disease* In 1957 orders were issued to the following prefectures for the establi- shment of sanatoria* Osaka Htyogo Gumma Chiba Tochigl Mie Alchi Gifu Yamagata S4-8*«81ABCD RESTRICTED RESTRICTED 100 Fukui Ishikawa Okayama Yamaguchi Oita Kummamoto With a total capacity of 5,654 beds these hospitals are now In full operation. There are now 116 hospitals with a total of 10,607 beds available, private, prefectural and governmental. during 1957 11,974 males and 6,797 females were admitted to these hospi- tals. Of these 5,053 males and 2,856 females died in hospital. Statistics of 1959 — Death from Tuberculosis Total male female rate per 10,000 rate of death per 10,000 Pulmonary Tuberculosis 107,442 57,147 50,295 85.5 14.88 Tuberculosis of meninges and CNS 8,754 4,692 4,042 6.9 1.21 Tuberculosis of Intestines & peritoneum 26,595 10,102 16,295 21.0 5.66 Tuberculosis of Spinal Column 2,770 1,555 1,217 2.2 0.58 Tuberculosis of bones and joints 655 396 259 .5 .09 Tuberculosis of skin & subcutan- eous tissues 52 12 20 .00 .001 Tuberculosis of genital organs 1,505 847 656 1.2 .21 Tuberculous granuloma _ 700 409 491 . 7 .12 Total 148,441 75,158 85,275 24-02621ABCD RESTRICTED RESTRICTED 101 XXXIII. Mental Disorders In contrast to ancient European thought, which considered mental dis- orders as a punishment for sins or as works of the devil, in Japan there existed from very early times the conception that they were manifestations of disease. In the 11th Century a system of Home nursing for the insane was started at Iwakura a suburban village of Kyoto, and it is still being carried on. In a law enacted in the 18th Century lunacy was called a serious disease. The first public asylum for the insane in Japan was established on Kyoto in 1871. It was followed by a second asylum in 1879 at Tokyo. At this time the Civil Code provided for the protection and civil rights of insane persons. The present day regulations of the insane were enacted in 1900 which provided for the prevention and treatment of insanity. The present laws enforced are: Law concerning custody of the insane: The object or the law is to prevent the unlawful confinement of the insane as well as to prevent danger to society. Guardians, husbands or wives, fathers or mothers, heads of houses or blood relatives are responsible for the custody of the insane. Expenses Incident to the custody of the Insane are borne by the patient. In the case of indigent people, persons responsible for their support must bear the expense; where there are no such persons the prefectural govern- ment is responsible. , < 24-620214BCD RESTRICTED RESTRICTED 102 Laws concerning Asylums for the Insane s1 The object of the law is to provide for the protection and treat- ment of patients as well as to increase the number of hospitals and asylums for the insane. The Minister of Home Affairs may order prefectures to establish asylums for the insane. The local governor may order heads of cities, towns or villages to keep in custody insane persons who have committed an offense and are deemed by the authorities to be especially dangerous. There are three kinds of asylums in Japans Those established by prefectures; those established by prefectures and approved by the Minister of Home Affairs; public or private hospitals established as a temporary measure pending the establishment of asylums for the insane by all the prefectures throughout the country. The National Treasury makes grants to prefectural hospitals to the ex- tent of one half of their cost and one sixth of their maintenance. The hospital expenses of indigent patients are paid by the prefectures. The total number of insane persons at the end of 1957 was 90,755 showing an increase of 4,706 for the year. Its ratio to the population of the country was 12,74 per 10,000 population. 24-62821ABCD RESTRICTED RESTRICTED 103 Admitted into Insane asylums Admitted into Substitute Asylums Under Custody in the asylums Under custody in other places Under temporary custody Not requiring admission to hospital or custody Males 1,667 4,127 4,341 5,858 94 41.066 57,153 Females Total 883 2,550 2,420 6,547 2,329 6,670 1,550 7,280 28 122 26.590 67.656 33,600 90,753 Classified according to the form of insanity the percentages of the various diseases are as follows: 1. Insanity resulting from somatic causes especially from infectious diseases 0.11 2. General paralysis 19.81 3. Intoxication psychosis Alcoholism 2.15) £#3Q Drug addiction 0.21) 4. Female dementia 3.0.7 5. Insanity of unknown etiology Dementia praecox 36.41) Paranoia 1.53)40.44 Idiocy, imbecility and %ilepay 2.50) 6. Hereditary insanity, chiefly resulting from constitutional causes Hysteria 2.41 Manic depressive insanity 26.41 Insanity of degeneracy 0.77 7. Other forms of insanity 4.21 100.00 Predominating forms of insanity in Japan are therefore dementia praecox 36.41$, manic depressive insanity 26.41$, and general paralysis 19.81$. Alco- holism and morphinism ere infrequent in Japan. In this connection it should be noted that "Sake”, the national alcoholic drink of Japan, contains only 14$ to 18$ alcohol and stronger alcoholic drinks'are infrequently used. Of the 24-82621ABCD RESTRICTED RESTRICTED 104 oatients discharged from asylums 20.64$ were cured, 59.65% were still insane and 19.71% died while still insane. Prefectural asylums for the insane are built on extensive grounds on the cottage system. This applies also to some private asylums. Patients are gen- erally treated on the "non restraint method" rest treatment, continuous bath and occupational therapy. The Tokyo prefectural asylum at Matsugawa and the clinics at Kyushu Imperial University and the Osaka Medical College have specialized in the malaria therapy for general paresis. The Japanese are great believers in courses in psychiatry to prevent mental breakdowns And in all colleges, universities and medical schools in- tensive courses in psychiatry are given. As early as 1875 all police officers at the Tokyo Metropolitan Police were given lectures in psychiatry. The following are associations dealing with mental disorders: The Society of Social Medicine The Japan Neurological Society The Tokyo Psychiatral Society The Japan Criminological Society The Japan Society of Psychiatrists The Aid for the Insane Association. To take care of the insane there are 151 hospitals for the Insane under govern- mental, prefectural and private auspices with a total bed capacity of 21,525 beds. To these 15,960 patients were admitted in 1959. Of these 15,752 were discharged and 1,588 died while in the hospital. For the protection of feeble-minded persons there are six private asylums, and two private schools for feeble-minded children. The percentage of feeble-minded children according to investigation carried out by the Municipal Office of Tokyo on 10,000 pupils of the primary grade 24-aaeaiabcd RESTRICTED RESTRICTED 105 school in Kongo Ward was 2.4%, and of 65,000 pupils examined in Kyoto 2.7% were feeble-minded. Juvenile criminals are not necessarily of abnormal mentality, however there are among them many feeble-minded or mentally deranged boys and girls. Investigations made by the State Reformatory of its inmates showed that 59.8% were feeble-minded, 14.1% defectives and 26.1% mentally normal. To care for these, there are in Japan one National Government Reformatory, twenty-nine prefectural; 22 substitute prefectural and four private reformatories, all under the supervision of the Ministry of Health. XXXIV. Cancer The incidence of cancer in Japan shows a slightly lower rate than most European countries. Its annual death rate from cancer is about 680 per million of population, showing an equal rate for both sexes Of interesting note is the apparently complete absence of "occupational cancer" By that type of cancer is meant cancers of the skin among workers engaged in such occupations as chimney sweeping, local tar industries, spinning mills, etc., where the skin is constantly exposed to the action of coal, tars, machine oil, etc. The Japanese explanation of this phenomenon is the habit of frequent washing of hands and bathing indulged in by the Japanese as a race. The Japanese Foundation for Cancer Research was founded for the purpose of encouraging and stimulating cancer research. It fostered the erection of the Koraku Hospital for Cancer in Tokyo which was completed in 1954. Here cancer patients are given treatment under the appropriate Divisions of Radiology, Surgery, Internal Medicine, Radium and Qynecology. 24-eaoaiA£Go RESTRICTED RESTRICTED 106 XXXV. Bacteriological Laboratories a. Number* The number of bacteriological laboratories at the end of 1957 was 195 consisting of 145 established by prefectural governments; 24 by cities, 1 ty towns and villages and 25 by private individuals, showing an increase of two over the preceding year. Shizuoka prefecture had the largest number of laboratories with 13, Hyogo 12, Osaka and Nagasaki 9 each, Hokkaido, Miyagi and Hiroshima 7 each, Ibaraki, Yamaguchi, Fukuoka and Kumraamoto 6 each. The number of bacteriological examinations made by these laboratories in 1957 was 4,446,593, of which those connected with notifiable infectious diseases were 5,859,920 and those not connected with infectious diseases were 586,473, showing an increase of 878,998 in the total examinations over the preceding year. b. Vaccines. Sera and other Bacteriological Products for Preventive and Therapeutic Cases. In 1908 the Department of Home Affairs issued the Regulations for the control of Manufacture of Vaccines, Sera and other Bacteriological Prevent- ive and Therapeutic articles. These articles have been amended but once since then, in 1914. It provided that any person who proposes to manufac- ture or import and sell vaccine, serum or any other bacteriological pre* ventive and therapeutic articles must obtain the sanction of the local governor and present a detailed statement giving the name and situation of the plant, description of article produced, method of production, period of efficacy, as well as the names and qualifications of the director and the 24-82821ABCD RESTRICTED RESTRICTED 107 chief expert of the establishments. Before making a decision, the local gov- ernor refers the matters to the Ministry of Welfare and procures the opinion of the Infectious Diseases Investigation Institute. The local governor is charged with the duty of supervising the preparation of such products in the districts under his control. If any of the provisions of the ordinance are infringed upon he is authorized to impose a fine or rescind the license. Anti-diphtheritic serum and anti-tetanus serum cannot be sold until ex- amined and judged to be efficient by the government laboratories. bera, vaccines and other similar articles for sale by the general public are subjected to control, together with all drugs in accordance with the pro- visioning of the Regulations for the Trade and Handling of the Drugs. Sera are considered to retain their potency for a period of one year and vaccines for a period of one month after manufacture. The preparations approved are: Sera: Anti-diphtheritic serum, in liquid or dry form. Anti-tetanic serum, liquid and dry form. Typhoid serum. Shiga anti-dysentery serum, polyvalent anti-dysentery serum, anthrax, influenza, anti-pneumococcal, anti-meningococcal, anti-plague, anti-cholera, anti- spirochaeta, anti-ictero hemorrhgicae. c. Vaccines. Vaccine lymph, typhoid vaccine, paratyphoid, dysenteric, cold, influenza, whooping cough, streptococcal, erysipelas, gonococcus, staphylococus, plague, cholera, spirochaete ictero hemorrhagicum, seven day fever, glanders, old tuberculw, neotuberculin, tuberculo-toxodin, rabies, Ducrey's, rabies vaccine for dogs, diagnostic preparation for typhoid fever, paratyphoid and syphilis, and a large number of sensitized bacterial vaccines are prepared. 34-830211BC0 RESTRICTED 108 Area 11 — Japan • Tokyo Lat. N 35 40* Long* E 138 45* St. Luke’s International Medical Center. Suraida River Source: MID 201 Kibby, Sydney Date: 6/12/42 24-82821ABCD RESTRICTED 109 XXXVI. Disease Information a< Malaria. Malaria in Japan Proper is of the tertian type. Plasmodium falciparum is found in Okinawa prefecture* Cases of the quartan type are found only in Yaeyama Islands, Okinawa prefecture. The number of deaths from malaria in Japan Proper in 1938 was 76 j of these 45 were in Okinawa prefecture and the balance was scattered in lots of one or two over the rest 6f the country. This compares with 51 deaths the previous year. The chief malaria carrying anophelines in Japan are A. maculipennis, A. elictio, A. sergenti, A. fluviatlis, A. minimus, A. maculatus, A. ludlowi and A. umbrosus. That the anti-malarial campaign in Japan is being successfully carried out is evidenced by the decline in the number of average annual deaths of 350-400 down to 50-75. In Japan Proper, malaria occurs in practically all sections. It is most common in the low-lying districts and shady lowlands of Kyoto, Nigata, Gumma, Okinawa, Tochigi, Miye, Aichi, Shizuoka, Shiga, Gifu, Aomori, Fukui. A. sinensis is said to be the most important vector and to have the widest distribution. b. Dengue Fever. Dengue or break back fever is a disease conveyed by Aedes aegypti and Aedes albopictus. This disease occurs throughout the Japanese empire and is most prevalent in the coastal areas. Although the disease is rarely fatal the fact that it frequently occurs in epidemic proportions may be the cause of considerable Morbidity among troops* 34-8202IABCO c, Pappataci or Sandfly Fever. This disease is spread by sandflies, Phlebotomus pappataci. It is similar to dengue fever in that it produces no RESTRICTED RESTRICTED no fatality and in its tendency to occur in sudden sharp outbreaks involving numbers of persons at one time. The long period of convalescence during which the patient complains of extreme weakness makes it of particular importance among troops. d. Influenza. The first epidemic on record in Japan was reported in 860 A. D. Since this time many epidemics have been reported. In 1890 an epi- demic of great violence prevailed. Though there is no record of the number of t cases which occurred at that time the records of the Japanese Army show that 17% of the whole army strength was affected. No death rate is given. In the great world epidemic of 1918, 21,168,398 cases of influenza were reported with the total deaths 257,565 or 1,22 percent of the population. e. Pneumonia. Though there were 58,051 deaths in Japan from pneumonia in the year 1958 giving a death ratio of 8.04 per 10,000, no particular stress seems to be placed on combating the disease. Hokkaido in the north of Japan rates first in the number of deaths, there having been 2,592 deaths during the year. f. Relapsing Fever. This condition, caused by the splroehaete Borrellia recurrentis, is spread chiefly by the louse, and its distribution corresponds to that of epidemic fever. Cases of relapsing fever were found during the Chino-Japanese War of 1894 during which time the Infection was introduced into Japan by way of Korea. Many cases wore observed in 1902 - 1910 in Osaka prefecture. In 1958 there were two deaths in Japan due to relapsing fever. g. Schistosomiasis. Infestation with Schistosoma japonicum, a liver 34-«3«aiABCD RESTRICTED RESTRICTED Ill fluke, is common in certain regions of the Japanese Empire, This chronic disease is acquired by man by drinking, and bathing in waters infested with cercariae. Snails which are known to serve as the intermediary host of schis- tosoma Japonicum are various species of Oncomelania, Katsuyama and Schistomo- phora. Thi Japanese have discovered that snails live only in acid reacting water; they, therefore, destroy these snails by adding enough lime to the water to alkalinize it, h, Filarlasis. Infestation with filarial worms is common in the coun- tries of the Japanese Empire, The filariae migrate to the lymph channels, blocking these, and thus causing a swelling of the scrotum and the legs, known as ,1elephantiasis.w The principal filarial parasites are Filaria bancrofti which is spread chiefly by the mosquito Culex quinquifasciatus (fatigansj and Microfilaria malayi which is spread by Mansonoides annulstus, M. annulifera , A. barbirostris and A, hyrcanus sinensis, Filaria bancrofti is the only type reported from Japan Proper. Culex quinquifasciatus (fatigans) is the only vector reported from this area. The disease is found most commonly in the province of Nagasaki, Shizuoka, Kochi, Saga, Kummamoto, Kagoshima and Okinawa, In 1939 there were 129 deaths in Japan Proper from filaria, 74 males, 55 females. These deaths were well scattered throughout Japan, i. Other worm infestations. Diseases caused by flukes occur mostly in low lying damp places. Parts of Yamanashi, Hiroshima, Okayama, Saga, Ibaraki and Shizuoka, are affected. Lung flukes are found in persons living along streams running from mountain ranges forming on the backbone of the main island of the country, while liver flukes prevail wherever freshwater fish is eaten uncooked. Infestation with the liver fluke Clonorchis sinensis follows ingestion of 24-82621ABCD RESTRICTED RESTRICTED 112 raw fish harboring the cercarise* Snails of the species Bithynia are the primary host. Infestation with the liver fluke Fasciola hepatica follows ingestion of, vegetables or water polluted with the cysts of fluke. The in- testinal fluke Fasciolopsis buski is contracted by man through the ingestion of uncooked or improperly prepared water plants, water chestnuts, etc. Paragonimiasis follows the ingestion of uncooked Infested crabs or crayfish. The primary host for the lung fluke are snails of the species Melania. Flukes of the species Metagonimus yokogawai infest man when he consumes their host, fresh water fish, usually gold fish. These various fluke infestations are reported all through Japan. The broad fish tapeworm, Diphyllobothrium latum may be transmitted to man when he eats raw fish. Practically all types of fish in the East are infested. j. Epidemic Encephalitis. No cases of this disease were reported in Japan prior to the influenza epidemic of 1918. 'In 1924 there were a number of people in the prefectures of Okayama, Kagawal, Tokushima who were affected by a strange epidemic which was diagnosed as epidemic encephalitis. In nine months of 1924, 6,547 cases were reported. The case fatality was 60%. In 1958 there were 1,088 deaths, 567 males and 521 females. k. Dermatological Conditions. Skin diseases including the various fungus infections are common throughout the empire. l. Beri-beri. Beri-beri first made its appearance in Japan during the Komakura period 1186-1555. In modern times outbreaks of beri-beri have been very frequent in the Army and in overcrowded prisons. In 1874, one-third of 24-02631ABCD RESTRICTED RESTRICTED 115 the Japanese arny was affected with beri-beri. A board was established to study the disease to find the cause of it. The number of deaths attributed to beri-beri showed a great increase from 1912 to 1922. The Navy also had its difficulties with the disease and at one time the rate of beri-beri in the Navy was about 400 cases out of every 1,000 sailors. Changing the diet from rice to a mixture of rice and barley ameliorated the disease. Since the discovery that beri-beri is a deficiency disease, the disease incidence has diminished considerablyj but in 1938 there were 12,712 deaths in Japan as a result of beri-beri. Of these 7,753 Hrere in males and 4,979 in females. In infants under one year of age there were 6,430 deaths. This number compares with 11,097, 10,062, and 15,828 for previous years. m. Leptospirosis. Various forms of leptospirosis, especially Weil*s disease, are reported for all parts of the Japanese Empire. These diseases are spread in food or water contaminated by the urine of infected rats. Man con- tracts the disease by eating or drinking contaminated food or water and by swimming or wading in water contaminated by rat urine. n. Leprosy. In the 12th and 13th centuries leper houses were established in Japan, and in the 16th century missionaries established further leprosaria in Bungo and Kyoto. But as leprosy was considered a visitation of a punishment from Budda, the people refused to present themselves for treatment. This con- tributed to the spread of the disease. In 1906 the number of lepers in Japan was; male 16,607, and female 7,208. In 1919 the number had dropped to 16,261, but in 1956 it was estimated there were 35,000 .to 50,000 lepers in Japan. No figures are available for the number of lepers in Japan at present, but there are 15 leprosaria with 5,887 beds. Of these, 8 were established with private 24-62621ABCD REgmCIEB RESTRICTED 114 funds, the balance are government or prefectural supported. 1,636 new patients were admitted during the year; 6,549 lepers were in the leprosaria at the end of the year; 412 deaths in the hospitals. o. Tetanus. In the year 1938 there were 1,775 deaths from tetanus report- ed from Japan Proper. Of these 1,069 were males and 706 females. Though these were fairly well distributed throughout the country, the prefectures of Ibaraki with 169 deaths, Tochigi with 60> Chiba with 185 and Gumma with 71 were out- standing. These are all adjoining prefectures. Rate per 10,000 was 0.25 and rate of death per 1000 inhabitants was 1.4. p. Kala Azar. This condition is thought to be spread by the sandfly, phlebotomus sp. and caused by the parasite Leishmania donovani. It is very rare in Japan. q. Anthrax. A few cases of anthrax are reported sporadically through- out Japan each year. r. Actinomycosis. From eight to twelve cases of actinonycosis cases are reported from Japan Proper each year. RESTRICTED 24-03«21ABCD RESTRICTED 116 XXXVII. Insects and Animals of Importance to Man a. . Mosquitoes. Malaria, filariasis and dengue fever are the mosquito- borne diseases found in Japan, Malaria is scattered over the country and occure principally in low lying damp districts and shady woodlands favoring Anopheles fcyrcanus sinensis, which is by far the most important mosquito vector of malaria in Japan. In addition to A, hyrcanus sinensis malaria in Japan is carried by A. aconitus. They are found chiefly ih Hiroshima, Saga, Okayama, Ibaraki, Shizuoka, Kyoto, Niigata, Gumma, Tochigi, Miye, Aichi, Shiga, Gifu, Aomori, Fukui, Kochi, and Okinawa prefectures. Phsraodium falciparum is found in the Loochoo Islands. Other anophelines reported to be carriers of malaria in Japan are A. aconitus, A. subpictus and A. umbrosus. Culex quinquifasciatus(fatigans)is the vector for Wuchereria bancrofti and is most commonly found in parts of Nagasaki, Shizuoka, Kochi, Saga, Kummamoto, Kagoshima and Okinawa prefectures (Loochoo Islands). Dengue fever is carried by both Aedes aegypti and Aedes albopictus. Aedes aegypti also carries yellow fever. No case of yellow fever has ever been discovered in Japan although Aedes mosquitoes are found. b. Flies. The common house fly, Musca domestics, by purely mechanical means carries the causative organisms of the intestinal diseases, typhoid fever. RESTRICTED 24*02021ABCD RESTRICTED > 116 paratyphoid fever, amoebic dysentery, bacillary dysentery and cholera from fecal matter to food consumed ty man. It is also believed that flies may spread the cholera organisms through their excreta. There are no specific regulations regarding the combating of flies in Japan but such general laws as the Sewage Law, the Law for the Disposal of Refuse and the Law for the Prevention of Acute Infectious Diseases contribute indirectly to the prevention of flies and considerable results are obtained through the rigid operation of these laws. Local governments have provisions not only for the protection of food displayed in the windows but also for the equipment of food plants, commercial kitchens, and the like. In towns and villages measures for destroying breed- ing places and for catching flies have been taken by the prefectural authori- ties officially in cooperation with the health unions. At present the chief measures taken for the prevention of flies in towns and villages are as follows: (l) General cleansing of houses both outside and inside. (2j Reconstruction of storehouses for manure, night soil, tanks and cess pools. (5) Reconstruction and cleansing of privies, stables, and live stock pens. (4) Encouragement in fly catching. Various fly traps. (5) Distribution of larvicides. (6) Anti-fly propaganda leaflets. c. The Sandflies. The sandfly (phlebotomus) transmits a virus disease known as pappataci or sandfly fever. This disease is prevalent over practi- cally all of the southern part of the Japanese Empire. Evidence indicates 24-8aaa xabcd RESTRICTED RESTRICTED 117 that sandflies are capable of transmitting the organism causing oriental sore (dermal leishmaniasis) and may be responsible for the spread of Kala Azar. d. Other Flies. Other species of flies especially Ohrysomla bezziania are found in great numbers in Southern Asia and may cause deep seated abscesses. In the process of biting or alighting the flies deposit their eggs in or on the skin*s open wounds, and in the nostrils or ear canals. The eggs of some of these flies may be carried by other insects, for example mosquitoes. The development of the maggots in these locations is accompanied by bacterial in- fection with subsequent abscess formation. e. Fleas. Fleas (Xenopsylla cheopis) are vectors of at least two serious diseases affecting man, namely, plague and the murine (rat) type of typhus fever. Fleas found on rats commonly carry these diseases. The finding of dead rats or other rodents frequently indicates that these diseases are prevalent among local animals. This is of importance because the fleas leave the dying rodent and seek new animal hosts, including man. Thus, by infest- ing man they may transmit plague and murine typhus. In China, it is believed that the plague organism may also be carried by the dog flea. Canlsus fleas are distributed throughout the Japanese Empire. The plague infected fleas in the time of the large plague epidemics of Japan showed them to be of: X, cheopis, cenopaylla rausculi arid CeratophyllusFor killing fleas a soap emulsion of kerosene oil is used, hydrogen sulphide is found to be partic- ularly effective for the destruction of fleas. 24-®a62lfcBCD RESTRICTED RESTRICTED 118 f. Lice. The body louse, PtdiculuB humanuBj carries the epidemic form of typhus fever, a disease that is found in every part of the Japanese Empire. They are most frequently found in China and Manchuria. Lice also carry the spirochete Borrelia recurrentis) causing louse-borne relapsing fever which has the same geographical distribution as epidemic typhus fever. They also carry the microorganism (rickettsia quintana) the causative organism of trench fever. This latter disease has not been reported from Asia for many years but it is a potential hazard, especially in wartime. g. Mites. Mites (trombidium) are the vectors of several different typhus- like diseases in the Orient and are found in association with rodents, partic- ularly rats; with birds5 and possibly in the flowers of certain palm trees. They are most commonly found in areas that are subject to flood and are most numerous in the late spring and early summer. Tropical scrub typhus is found on the southern coast of Indo-China and on the Malay Peninsula. Japanese river fever or tsutsugamushl fever occurs in Japan, and Formosa, and is transmitted by the mite Trombicula akainushi • h. Rats. Rats are important in the spread of several of the typhus fevers and of plague, in that they are hosts to mites and fleas which are the respective vectors of these diseases. The most frequently encountered rats are the common black house rat (Eattus rattus) and the sewer rat (Batons nor- vegicus). In certain areas the vole and bandicoot are common and like rats are responsible for the spread of some of the forms of typhus fever. Some 52 different species of rats are found in Japan. 24 -6282 1 i.BCD RESTRICTED RESTRICTED 119 i. Poisonous Snakes. The most important poisonous snakes of the Japanese Empire are found outside of Japan Proper, and are the King cobras, kraits and the russel viper. Poisonous sea snakes are common but the major- ity of fresh water snakes are non-poisonous. Persons who have been in the Southern region indicate that the russel viper causes more deaths than either the kraits or the cobra. On Japan Proper the "mamushi" or form of viper is the only poisonous snake encountered. Its bit© may be fatal. The,"mannish!" is a species of ancistrodon Blombofiij its maximum length extends to about 2 feet. The body is short and it has a triangular head. The color of the body is usually dark brown or earth color and blackish brown spots appear on both sides of its back. It usually lives in damp mud. Stay- ing under cover during the daytime, it operates after dark. Its motions are slovenly, and although its poison will cause the blood to flow (hemolytic) its poisonous qualities are not too potent. It is found in Hokkaido, Kyushu, Sado, Samuki, Tsushima, On Hachigo Shima there are Aka-maraushi or red vipers and Kuro-mamushi black vipers. The meat of the viper is considered a delicacy, j. Pests, Leeches are common in the jungle areas of Eastern Asia, especially in the south. They attach themselves to the skin for blood sucking, and if carelessly removed with retention of the proboscis in the skin, a furuncle or abscess often results. It is said if the body of a leech is touched with a lighted cigarette the insect will withdraw its proboscis and fall off the skin. There is a wide distribution of gnats and various itch mites in the Orient important only as annoying pests. Insect control measures, particularly in the urban areas of Japan Proper, 24-62621ABCD RESTRICTED RESTRICTED 120 have been instituted by the various local governors. Rats and mosquitoes have received particular attention along these lines. XXXVIII. Diseases of Cattle Cattle diseases that occur in Japan are rinderpest? epidemic hoof and mouth disease, Siberian cattle plague, glanders, swine cholera, hydrophobia and bovine tuberculosis. For the prevention of bovine tuberculosis regular teamed sanitary experts make semi-annual inspections of all cattle and give the tuberculin tests once yearly. Cattle found to give positive tests are killed, and their carcasses, except for skin, horns, and hoofs, are burned or buried. Those found to be only mildly suffering from the disease are segregated and their milk pasteruized. The results of the tuberculin tests over a period of years indicate that between 30 and 37 percent are infected. No figures are available on the number of cases or geographical preva- lence of these animal diseases. XXXIX. Maternity and Child Welfare The following are the general rules followed by the Minister of Health in guiding their maternity and child welfare work. 1. Erection of maternity houses and hospitals in cities for ex- pectant mothers in needy circumstances* 2* Visiting midwives and health nurses are attached to these homes and are sent to attend poor mothers who cannot be sent to hospitals. 3, Courses for training midwives in maternity homes and hospitals. 24-62621ABCD RESTRICTED RESTRICTED 121 4. Maternity welfare centers attached to maternity homes and hospitals to examine and give advice to expectant mothers* 5. In cities, child welfare centers for the care of infants. 6. Health visitors attached to these centers to visit the homes of poor people and give instructions. 7. Milk stations in maternity homes and hospitals and in welfare centers to distribute milk free or at nominal cost. 8. Babies homes established in cities where babies who are under no motherly protection may be cared for. 9. Infant welfare nurses trained at babies homes and hospitals. 10. Playgrounds for children in cities. 11. In areas where there are no midwives, authorities engage train- ed nurses. 12. Pamphlets and posters issued to expectant mothers. 15. Aid from National treasury. The special committee for reducing infant and child mortality was estab- lished in 1921. Provincial Institutions for maternal and child welfare consist of: Special institutions relating to midwives 197 Maternity homes and hospitals 122 Health Centers (maternity and child welfare) 214 Milk stations 1,146 Day Nurseries and babies, homes 667 Special Institutions for the care of delicate children 42 24-02821&BCD RESTRICTED RESTRICTED 122 XL. Organization of School Hygiene The section of school hygiene in the secretariat of the Education Department deals with the following subjects: 1. Sanitary questions relating to building sites, buildings, fixtures and other equipment of public and private schools* 2. Instruction of hygiene* 3* Physical training* 4. Physical examination of teachers students and pupils. 5. Prevention and treatment of disease in schools* 6. Supervision aqq protection of physically or mentally abnormal pupils and children. 7* Drinking water and food in schools. 8. Statistics relating to school hygiene. 9. Miscellaneous matters relating to school hygiene. Prevention of Infectious Disease in Schools. These regulations include the following: 1. Specific contagious diseases. 2. Whooping cough, measles, influenza, mumps, rubeola and chicken pox. 5. Pulmonary tuberculosis, laryngeal tuberculosis, other forms of tuberculosis and leprosy. 4. Trachoma and other infectious diseases of the eye. 5. Scabies and other skin diseases. p u A ◄ 01 <0 PJ A i I * N I RESTRICTED RESTRICTED 125 Trachoma is relatively common among school children, particularly among the children in the lower grades. Tuberculosis is a serious problem. Routine X-ray examinations are given all school children. Distribution of School lunches is encouraged and the cost is borne by the local prefectural governments. XLI. Mutual Relief Organizations These may be divided into two classes: Those existing among workers employed in Government Industries, and those of workers in private industries. These associations insure their members against accidents ana illnesses not included in the provisions of the Factory Law and the Mining Law relating to the relief of employees. Members are also insured against accidents not connected with their employment. Regulations relating to the associations of governmental workers were enacted by Imperial ordinance and most of them provide for a system of dis- ablement pensions. XLII, Health Insurance Act Risks insureds Sickness and accident either in connection with work or otherwise; death and childbirth. Persons insured: (a) Those insured by compulsion: Persons employed in a factory or industry to which the factory act or the mining act apply, (b) Those insured voluntarily. 2 4“82 821ABC D RESTRICTED RESTRICTED 124 Insurer: The state shall insure persons who are not members of societies mentioned under Article XXII. Health insurance Societies: (a) Societies established voluntarily. (b) Societies established by compulsion. An employer of 500 persons or more will establish a health insurance society. XLI1I. Industrial Hygiene Ai'fairs relating to factory sanitation are under the jurisdiction of the Director of the Sanitary Bureau of the Ministry of Health* In 1910 the Department of Agriculture and Commerce appointed medical experts to report on the sanitary state of factories, and allowed them to have a voice in framing the law, which was promulgated in 1911 and known as the "Factory Law." Medical Inspectors were appointed as permanent sanitary inspectors. In 1922 the enforcement was transferred to the Home Minister and finally to the Minis- try of Health. Under rules respecting industrial hygiene, the Factory Law applies to two varieties of factories, and has as its object the safeguarding of them from dangers attendant upon overcrowding and dangers to which particular industries are liable: Factories where ten or more hands are regularly employed. Factories carring on operations of a dangerous nature, or injurious to health. 24-63621ABCD RESTRICTED RESTRICTED 125 Age limit of factory workers: A minimum age limit of 14 years has been adopted in conformity with the restrictions of the International Labor Conference. Limits to working hours: The maximum working hours for females, and for males below 16 years of age, is 11 hours. Prohibition of night labor: The employment of females and of males below 16 years of age is prohibited between 10 p, m. and 5 a. m. Prohibition of Employment of sick persons . Pregnant or parturient women: No limitation has been set regarding the employment of preg- nant women. However, women are prohibited from taking up for 5 weeks following childbirths. Medical attention must be provided for workers becoming ill in the performance of duty. The various laws for the prevention for disease, such as "The Law for Prevention of Epidemics”, "The Law for the Prevention of Tuberculosis and Trachoma", also apply. Supervision of Industrial Sanitation: For medical inspections, as the Factory Law is concerned essentially with sanitary affairs and requires the services of medical experts for en- forcement, each administrative body charged with the execution of this law has one or more medical inspectors attached to it. 0 u m < , H CM CD CM CD 1 * Cf RESTRICTED RESTRICTED ■326 Present Organizations: The local governor is charged with the super- vision of sanitation in factories. They appoint experts who act as sani- tary inspectors attached to the central organization. These inspectors inspect the factories at stated intervals, see that the sick absentees are cared for, that the injured are properly attended to, that factory infirm- aries are adequately manned by professional help. XLIV. Red Cross Activities As a supplement to the Japanese Arny, the Japanese Red Cross Society plays a very important part in war time. In its report to the International Red Cross Conference the opening sentence reads "It is already well known to the public that the Japanese Red Cross Society is closely connected with the Army, as is clearly shown by the Society*s remarkable activities during the Manchurian Incident and in the post wars through which Japan went." "The object of the Japanese Red Cross Society, in accordance with the principles of the International Treaties, and in conformity with those of the Red Cross Societies of the Power, is to care for the sick and wounded of both beligerents in time of war and in time of peace, relief service in cases of natural calamity and to carry on activities related to public health for the prevention of disease and to the alleviation of suffering." The Japanese Red Cross Society originated in the voluntary relief ser- vice under the name of "Hakuaisha" and administered to the sick and wounded at the seat of hostilities during the Kagoshima Civil War in 1877. In 1886 the government adopted the name "Japanese Red Cross Society", joined in the 34-e2fl21ABCD RESTRICTED RESTRICTED 127 Geneva Convention, and became a member of the International Red Cross Union, and finally in 1919 it affiliated with the League of Red Cross Societies. In 1901, having become a corporate body by Imperial Ordinance, it was required to assist in the health service of the Army and Navy under the supervision of the respective Ministers. The president and vice-presi- dent of the Red Cross Society therefore, must be commissioned by the Emperor upon the recommendation of the Ministers of the Army and Navy. The presi- dent of the Society is always a prince of the Imperial Family. The general affairs of the Society are administered by ten directors and three auditors who supervise the financial affairs. The headquarters of the society are located in Tokyo and local branches are established in each prefecture. In each branch there is a committee which administers the activities of the Red Cross Society in that prefecture. In time of war, under the direction of the Ministers of the Array and Navy its activities are carried on by four departments which are directly under The Department of Relief Service and Relief Personnels Relief units Hospital ships Hospital trains Relief motor cars or ambulances. The Relief Personnel consists of managers, medical officers, pharmacists, nurses and attendants. In times of peace the personnel is formed into a res- erve and are distributed throughout the Red Cross Hospitals of Japan, and upon the outbreak of war or incidents are immediately mobilized. The trained Red Cross nurses or graduates of Red Cross hospitals now number over 50,000. 24"62 621ABCD RESTRICTED RESTRICTED 128 Hospital supplies for relief either in time of war or of natural calamity are always in readiness at the National Headquarters and at the Local Branches. The Japanese Red Cross Society administered relief to the prisoners of war during the wars with China, Russia and the World War with the Central Powers. In the anti-tuberculosis campaign the Red Crpss has maintained clinics, dispensaries, and sanatoria throughout Japan—clinics for prenatal and post- natal care, infants and childrens health work. All the local branches provide for courses in hygiene available to the public• For the training of nurses, schools in the Red Cross Hospitals have been established, and the more promising graduates are sent to the Central Red Cross Hospital in Tokyo, for courses as "head nurses." Midwives are trained in the Central Maternity Hospital in Tokyo, in a course lasting two years. Ary Japanese woman may apply for a training in this course. In times of war the inadequacy of the Medical Corp of the Amy is met by the augumentation of Red Cross Relief Units which have been held in re- serve during peace time for war time emergency. The Red Cross Hospitals are taken over by the Amy, as are the hospital ships and hospital trains and ambulances. The Red Cross therefore becomes an integral part of the Army. public• a4"83®21ABCD RESTRICTED RESTRICTED 129 Since in peace most Red Cross trained nurses seek work outside of Red Cross Hospitals, it becomes necessary to hold periodic mobilizations. These mobilizations are roll calls, and take place every three years, and last three days, and are usually carried out in connection with manoeu- veurs of the Medical Corps of the Army or Navy. At these times all of the Red Cross Hospitals of Japan, numbering 28, surgeons, nurses and pharmacists of the reserve, conduct relief work in a mock battle or imaginary disaster. These last usually for a period of ten days, during which time the entire personnel is administered by the Army or Navy. 24-A2821ABCD RESTRICTED 151 Page Appendices A. Tables Table I. Number of Deaths Caused by Disease in Japan Proper in 1938 135 Table II. Municipal Hospitals, Convalescent Homes, Clinics, and Health Advice Offices 169 Table III. Notifiable Infectious Diseases 175 Table IV. Number of Water Works 176 Table V. List of Approved Biologicals 178 Table VI & VII. Number of Officials in Department of Health and Sanitation 179 Table VIII. Administration of School Hygiene 181 Table IX. Ministry of Public Health and Welfare 182 B. Maps Cholera 185 Dengue 184 Filariasis 186 Malaria 186 Plague 187 Schistosomiasis 188 Tetanus 189 Typhus Fever 190 C. A Method of Obtaining a Japanese Medical History Outline 191 List of References 215 9 24"62621ABCD RESTRICTED RESTRICTED 133 Entire Country Rate per Ho- l.OOQ Iraldo Aomori Ivate Miyagi Akita lama- «ata Fuku- shima Ibar aki Tochigl Population 72,222,700 Total Deaths 1,269,806 1.000 52,077 19,415 21,576 20,826 19,580 20,675 28,549 29,725 21,316 Epidemic, Infectious & Parasitic Diseases, 229,708 182.5 11,514 2,897 2,710 5,274 2,454 2,571 5,784 5,711 2,875 (1 - 44) 1. Intestinal typhoid 7,819 6.2 205 94 221 289 111 98 200 105 107 fever 2. Paratyphoid fever 297 6.2 12 7 5 4 5 5 7 9 9 5. Exanthematous typhus fever - - - - - - - - - - — 4. Relapsing fever 2 0.0 - - - - - - - - - 5. Undulating fever 1 0.0 - - - - - - - - - 6. Smallpox 6 0.0 - - - - - - - - - 7* Measles 4,997 4.0 294 108 157 162 65 100 202 91 54 8, Scarlet fever 398 0.5 54 10 7 9 4 1 5 8 6 9. Whooping cough 8,871 7.0 481 121 154 215 90 146 224 179 160 10. Diphtheria 4,156 3.5 321 121 128 91 121 65 124 62 58 11. Influenza 7,646 6.1 214 65 82 51 60 69 62 101 75 12. Cholera 10 0.0 — - - - - - 1 - - 13. a. Dysentery 5,560 4.4 14 9 37 21 4 4 11 86 34 b. Ekiri 16,416 15.0 47 12 75 45 23 25 174 581 527 14. Pestis-plague - - - - - - - - - - — 15. Erysipelas 3,409 2.7 151 59 42 66 45 53 81 81 62 16. Cerebrospinal meningitis Epidemic 715 0.6 28 14 12 16 7 7 17 16 11 17. Sleeping sickness 1.088 0.9 - 5 9 8 51 34 11 6 10 18. Cerebrospinal meningitis 580 0.5 58 17 4 2 6 5 11 5 - 19. Furunculosis - — — - - — - - - - — 20. Carbuncle 10 0.0 - - 1 - - 1 - 1 - 21. Rabies 5 0.0 - - - - - - - - - 22. Tetanus 1,775 1.4 16 22 15 20 21 10 16 169 60 Table I. Number of Deaths Caused by Disease in Japan Proper in 1958* 84-«S«81ABCD RESTRICTED 134 Entire Country Rate per Ho- 1.000 kaldo Aomori Iwate Miyagi Akita Yama- sata Fuku- shima Ibar- aki Toehi si 23. Tuberculosis of Res- piratory organs (a)Lungs 104,995 83.3 5,871 1,343 980 1,238 1,052 1,019 1,498 1,291 1,163 (b) Throat 2,081 1.7 121 29 24 41 25 29 42 29 35 (c) Others 366 0,3 28 6 1 4 1 1 2 2 2 24. Tuberculosis of Men- inges and central nervous system 8,754 6.9 850 ISO -95 162 87 63 126 53 57 25. Tuberculosis of In- testines & Peritoneum 26,395 21.0 1,201 351 299 344 246 301 489 578 345 26, Tuberculosis of spinal column 2,770 2.2 271 59 60 66 40 42 86 51 42 27. Tuberculosis of bones and joints 655 0.6 60 13 12 15 19 10 20 10 7 28. Tuberculosis of skin & subcutaneous tissues 32 0.0 1 — — — 2 1 — 29. Tuberculosis of lymph- 533 0.3 atic glands (excluding those about the 14 1 bronchial tubes, 5 4 intestines and 6 5 1 retroperitoneuo)• 5 2 30. Tuberculosis of the genitals 1,603 1.2 194 29 58 58 52 26 38 14 14 31. Tuberculosis of other organs 63 0.0 5 *• 1 4 2 ““ * 2 32. Tuberculosis of miliary type , 900 0.7 138 51 9 16 15 7 13 6 2 33. Leprosy 537 0.3 4 21 11 3 11 4 2 4 6 34. Syphilis 4,412 3.5 275 79 50 98 126 80 95 121 76 35. Soft chancre 47 0.0 4 1 1 2 2 - - 1 — 36. Sepsis (except puerperal sepsis) 9,203 7.3 363 161 148 221 156 142 183 174 no 37. Yellow fever - - - - - - - - — — — 38. Malaria 207 0.2 — - - 1 - — — _ 39. Other diseases due to protazoa, helminths and 1,545 1.2 hemorrhagic 6 3 3 23 jaundice due to spirochaete 7 8 12 49 29 40. Bacterial diseases of the duodenum 280 0.2 4 — 2 3 1 1 6 8 6 41. Amoebic cyst of the liver 4 0.0 — — ** — — — — - — 24-02021ABCD restricted 135 Rate Entire per Ho- Aomori Iwate Miyagi Akita Yeraa- Fuku- Ibar- Tochigi Country 1.000 kaido jgata. shima aki 42. Other diseases of helminths (e)Round worm 277 0.2 14 9 5 5 7 5 8 2 - (b)Distoraa of liver- 14 0.0 - - - 1 - - - 1 - fluke-trematode (c)Distoma of lungs 21 0.0 - - - - - - - - 1 (d)Animal that sucks blood (indigenous to Japan) 57 0.1 - - - - - - - - (e)Filariasis 129 0.1 - - - - - - - - - (f)Tape worm 2 0.0 - - - - - - - - — (g)Miscellaneous 15 0.0 - - - 1 - 1 1 - - 45. Mycosis 418 0.5 16 8 14 10 10 5 14 18 9 44. Other epidemic or 58 0.1 - 2 1 - - - 1 2 — parasitic diseases (a )Epidemic lymphadenitis, subclavian (b)Tsutsugamushi 59 0.0 - - - - 8 - - - - (c)Others 110 0.1 2 1 6 1 1 4 - 2 4 Tumors (44 - 65) 46. Cancer of throat, 820 0.6 58 8 10 15 11 17 20 25 7 mouth and other malignancies of the throat 46. Cancer and other malignancies of the digestive tract and peritoneum. (a)Oesophagus 2,605 2.1 76 9 22 46 15 55 59 61 48 (b)Stomach St Duodenum 24,752 19.6 840 257 225 448 571 475 559 652 470 (c) Small St large intestines 1.706 1.5 55 26 14 29 15 24 52 60 55 (d)Liver Sc gall bladder 5,749 4.6 180 40 58 117 48 88 150 1S7 117 (e)Pancreas 212 0.2 7 1 1 1 - 4 1 4 1 (f)Peritoneum 426 0.5 18 6 5 9 9 7 8 8 14 (g)Miscellaneous 1,555 1.1 47 15 14 50 19 27 21 46 14 47. Cancer and other 1,456 1.1 50 12 25 25 17 21 52 57 54 malignancies of the respiratory organs 48. Cancer and other 259 0.2 6 6 5 4 1 5 5 7 - malignancies of the female reproductive organs 49, Cancer and other 7,145 5.7 240 85 100 151 95 97 175 186 151 malignancies of the female organs 50. Cancer and other 919 0.8 41 9 21 15 8 12 18 16 9 malignancies of the breast 24* 62621ABCD RESTRICTED Rate Entire per Ho- Aomori Iwate Miyagi Akita Yama- Fuku- Ibar- Tochigi Country 1.000 kaido gata . shima aki 51. Cancer of male urethra - and genital organs 401 0.3 10 3 2 13 1 3 5 10 3 52. Cancer of the skin 457 0.5 12 3 10 9 2 3 6 14 7 63. Cancer of other miscellaneous organs 2,228 1.8 83 55 57 41 34 57 53 52 45 64. Tumors of female 1,000 0.8 54 13 13 16 25 16 15 17 15 organs 55. Growths, undeter- 2,032 1.6 92 27 28 35 26 33 56 45 28 mined as to malignancy, of female organs 56.-69.: Constitutional diseases affecting the body as a whole • 56. Acute rheumatism of the joints 614 0.5 22 4 8 8 4 5 14 18 14 57. Chronic rheumatism 1,139 0.9 27 8 11 18 15 11 23 20 18 and inflammation of the joints 58. Arthritis 15 0.0 6 1 - - — 1 — — 59. Diabetes 3,043 2.4 94 38 30 52 30 29 23 57 43 60. Scurvy 199 0.1 10 1 - - 4 3 3 12 6 61. Beri-beri 12,712 10.1 461 340 145 169 122 108 107 130 106 62. Pelagra 25 0.0 4 3 - - - - - - — 63. Diseases of the spine I causing kyphosis 149 0.1 30 1 7 4 5 1 4 1 — 64. Osteomalacia 28 0.0 2 2 1 1 - - 1 2 _ 65. Disease of pituitary gland 8 0.0 1 - - - - 1 - — — 66. Disease of thyroid i and parathyroid (a)Exophthalmic goitre 322 0.5 12 4 4 1 8 2 3 7 5 (b)Tetany 45 0.0 4 6 - - - 1 — 6 1 (c)Others 97 0,1 4 2 - 2 5 4 1 2 1 67. Disease of thymus 108 0.1 8 2 8 1 3 - 4 3 1 68. 69. Other miscellaneous diseases 2,497 2.0 62 18 38 7 15 13 27 51 11 70. - 74.; Diseases of blood and blood-forming organs• 70. Purpura Hemorrhogica 928 0.7 31 16 21 14 11 11 24 24 17 71. Anemia 843 0.7 28 6 14 8 20 12 19 16 15 72. Leukemia 911 0.7 32 11 18 19 14 16 21 27 21 RESTRICTED 137 Rate Entire per Ho- Country 1.000 Kaido Aomori Iwate Mlyagi Akita Yama- J?ata Fuku Ibar- shima aki Tochigi 73. Diseases of the spleen 246 0.2 1 5 5 2 5 2 5 5 2 74. Other diseases of 16 0.0 1 - - - - - — - — blood and blood-forming organs (75 - 77; Alcoholism and chronic toxicosis) 75. Alcoholism 257 0.2 11 5 2 4 1 5 6 1 76. Toxic conditions 50 0.1 1 1 - - - — 1 2 1 brought about by occupation contacts 77. Toxic conditions 15 0.0 . . brought about by intangible occupational contacts (78 - 89: Diseases of nerves and sensory organs) 78. Inf lama tion of the brain 4,861 3.8 139 51 78 62 76 92 122 155 85 79. Meningitis, 36,748 29.2 2,107 636 634 657 498 555 1,096 880 672 other than tuberculous meningitis 80. Locomotor ataxia - tabes dorsalis 1,029 0.8 45 11 15 15 25 26 26 31 9 81. Other diseases of this type - 2,415 1.9 96 48 47 33 26 32 62 71 42 82. Hemiplegia: cerebral hemorrhage, thrombosis and embolism, a)Cerebral hemorrhage 125,598 98.1 5,660 1,806 2,586 2,310 5,134 2,692 5,442 5,584 2,451 b)Thrombosis & embolism 3,185 2.5 103 48 35 92 57 92 102 79 72 c)0hknovn types 80 0.1 2 2 2 1 - — 5 2 — 85. Dementia Paralytica 2,926 2.5 108 34 25 49 26 49 43 57 47 84. Dementia Praecox 4,107 3.5 129 55 27 58 42 87 56 89 69 85. Epilepsy 1,264 1.0 45 5 26 29 39 21 44 44 40 86. Epilepsy of childrens, 159 2.5 551 265 77 30 254 17 24 57 58 87. Other diseases (a) Chorea 70 0.1 4 1 2 2 1 1 2 5 2 (b) Inflamation of nerves 559 0.4 16 5 8 12 9 11 9 9 18 (c) Others 2,091 1.7 60 28 22 28 57 51 59 58 26 88. Diseases of the eye and appendages 74 0.1 2 1 3 4 1 2 5 4 5 restricted 138 Entire Country Rate per lr000 Ho- kaido Aomori Iwate Miyagi Akita Yame- gata Fuku- shima Ibar- aki Tochigi 89. Diseases of the Ear 501 0.4 26 7 11 5 5 6 9 10 10 (90 - 105; Diseases of the circulatory system.) 90* Pericarditis 888 0.7 49 8 14 18 17 7 17 28 16 91. Acute endocarditis 618 0.5 20 16 6 18 5 8 14 21 6 92. Chronic endocar- 24,744 10.6 • 908 271 597 594 564 408 549 497 598 ditis and valvular disease 95. Diseases of 5,288 2.6 120 47 60 82 56 49 82 76 44 ngrocardium including aneurism 94. Diseases of 6,059 4.8 256 48 55 86 64 98 105 164 127 -coronary artery; angina pectoris 95. Other diseases of the heart 11,884 9.4 559 128 192 200 184 262 *529 585 267 96. Aneurisms other than that of the heart 582 0.5 16 5 2 4 8 5 8 5 5 97. Arterio sclerosis 5,100 4.1 185 55 82 75 61 64 84 122 51 except of the coronary arteries 98. Aneurism of the aorta 422 0.5 10 7 6 11 5 11 15 5 6 99. Other diseases of the arteries 106 0.1 5 1 5 2 5 4 5 1 100. Diseases of the veins 89 0.1 1 - 1 - 1 5 1 - 1 101. Diseases of the lymphatic vessels 550 0.5 16 9 9 6 5 10 14 7 6 102. Disturbances of blood pressure 558 0.5 15 9 8 10 10 7 7 6 2 105. Other miscellaneous 574 0.5 15 2 7 12 5 8 12 12 15 diseases of the circulatory system 104. - 114.: Diseases of the respiratory organs 104. Diseases of the nose and adnexa 97 0.1 7 • 2 6 2 4 4 2 1 105. Diseases of the throat 722 0.6 58 12 9 9 8 9 15 14 14 106, Bronchitis (a)Acute5,288 4.2 211 145 146 69 67 78 124 145 49 (b)Chronic 11,515 9.1 552 191 165 160 125 161 270 256 229 (c)Unclassified 9,576 7.5 525 149 169 106 89 205 186 258 255 24-03S3HBCD RESTRICTED 139 Entire Country Rate per 1.000 Ho- kaido Aomori Iwete Miyagi Akita Yama- eata Fuku- shima Ibaraki Tochigi 107. Inflammation of the bronchial tubes St lungs 55,557 28.2 1,489 440 606 656 590 444 814 1,012 606 108. Pneumonia 58,051 109. Unclassified lobar 46.1 2,592 1,012 975 957 819 848 1,565 1,249 704 & broncho pneumonia 24,585 19.6 704 400 550 588 502 520 647 646 671 110. Pleurisy 20,980 16.6 1,265 281 508 282 259 259 482 456 585 111. Hemothorax 1,291 1.0 48 11 18 18 22 22 59 19 11 112. Asthma 9,648 7.7 294 92 129 112 74 151 259 400 250 115. Bronchiectasis 1,155 0.9 26 15 8 10 8 11 24 25 15 114. Other miscellaneous 5,287 2.6 197 diseases of the respiratory organs (115 - 129: Diseases of the digestive organs.) 115. Diseases of the 58 45 70 48 60 75 56 50 oral cavity St adnexa 1,917 116. Diseases of the 1.6 91 50 52 19 24 54 46 57 48 oesophagus 521 117. Ulcer of the 0.4 17 2 8 15 6 9 25 12 9 stomach and duodenum 15,279 118. Other diseases of 10.6 596 129 166 225 174 259 554 504 220 the stomach and duodenumlS,856 15.4 695 564 506 587 258 518 581 456 521 119. Diarrhea and 58,465 enteritis (less than one year of 46,4 age) 4,540 2,182 2,201 1,757 1,511 1,855 1,622 1,504 1,545 120. Diarrhea and 68,491 enteritis (over one year of age) 46.4 1,808 686 762 556 624 1,140 1,516 1,692 1,758 121. Appendicitis 2,672 2.1 128 51 57 65 52 52 49 51 58 122. Hernia and 5,585 intestinal obstruction 4.4 247 92 92 96 105 86 110 118 95 125. Other diseases 890 of the intestines 0.7 55 27 18 9 11 25 15 21 19 124. Cirrhosis of 4,942 the liver 5.9 124 25 46 42 51 41 56 95 67 125. Diseases of the 5,758 liver including biliary calculi 5.0 121 40 58 66 44 48 64 85 46 126. Gall stones 2,500 2.0 57 3ft 25 41 56 29 55 49 54 127. Other diseases of 2,587 the gall bladder and gall ducts 128. 1.9 75 40 25 56 52 55 57 54 54 24-62621ABCD RESTRICTED 140 Rate Entire per Country 1.000 Ho- kaido Aomori Iwate Miyegi Akita Yama- ha ta Fuku- shima Ibar- aki Tochici 129. Peritonitis due to unknown causes 20,584 16.2 1,015 261 150. - 159.: Diseases of the genito-urinary system. 279 286 254 258 571 559 284 150. Acute nephritis 11,222 8.9 451 175 175 224 207 251 274 281 202 151. Chronic nephritis 29,590 25.5 784 292 596 524 471 507 512 778 441 152. Unclas siftable 21,184 16.8 nephritis, acute or chronic 608 259 257 512 264 585 596 442 526 155. Other diseases of 5.477 2.8 162 the renal pelvis and urethra except those due 154. Calculi of to 65 56 pregnancy. 52 45 61 51 70 55 urinary passages 172 0.1 5 4 1 2 5 1 5 _ 1 155. Diseases of the 1,268 1.0 bladder other than tumors 76 16 54 24 15 21 28 29 20 156. Diseases of the 160 0.1 urethra 9 1 5 1 2 2 5 5 - 157. Diseases of the 101 0.1 prostate gland 5 2 1 — — — — - - 158. Diseases of the 58 0.1 male genital organs other than venereal 5 diseases. • 1 1 1 - 1 — 2 159. Diseases of the 596 0.5 26 14 female genital organs other than venereal diseases. (140 - 150: Diseases of childbirth and pregnancy) 140. Abortions accompanying puerperal 16 7 9 12 16 17 12 sepsis 50 0.0 141. Abortions not accompanying — 1 — — — — — 1 1 puerperal sepsis 181 0.2 15 4 5 2 7 5 7 5 6 142, Extra-uterine 245 0.2 pregnancy 10 1 6 4 6 6 5 4 — 145. Other accidents 15 0.0 in pregnancy 1 2 • • 1 1 ~ — — 144. Hemorrhage 1,186 1.0 accompanying birth 76 11 20 25 19 25 59 25 26 145. Puerperal sepsis 1,021 0.8 146. Toxemia of 57 25 56 15 54 12 25 26 14 pregnancy & convulsions 1,401 1.1 61 20 27 16 16 18 51 28 20 147. Other toxic 205 0.2 conditions during pregnancy 5 4 5 — 5 4 5 5 5 34'eaOSIABCD RESTRICTED 141 Rate Entire per Country 1.000 Ho- kaido Aomori Iwate Miyagi Akita lama— £ata Fuku- shlma Ibaraki Tochigi 148. Sudden death due to, childbirth 14 0.0„ 1 149. Complications 666 0.4 61 4 16 15 11 9 16 16 10 arising from other causes during birth 150. Miscellaneous 25 0.0 2 1 conditions due to childbirth 161. - 165.! Diseases of the skin and subcutaneous tissues. 151. Furunculosis 647 0.5 25 8 5 6 12 4 6 11 n 152. Urticaria 1,854 1.6 74 55 54 24 25 20 44 40 54 165. Other conditions 650 0.5 27 6 10 8 8 8 11 12 9 (154 - 156: Miscellaneous conditions of 154. Acute inflammation 10 0.0 the bones and skeletal structure.) 2 1 1 of bones and marrow of contagious character 155. Other diseases 1,179 0.9 74 28 17 25 18 54 58 51 52 of the bone including tuberculosis 156. Diseases of 887 0.7 55 n 9 8 16 15 24 16 16 articulations excluding tuberculosis 167. Congenital malformations 5,916 5.1 199 66 66 64 73 79 108 ns 54 158. Congenital 60,568 48.1 2,559 1,526 1,515 1,291 1,685 1,545 1,659 1,882 900 weakness of infants less than one year 159. Premature births 6,410 4.5 of age. 252 81 122 in 158 150 96 198 56 160. Injury at birth 581 0.5 19 4 9 6 7 15 4 6 2 and death within three months of birth. ,161. Death from other 8,971 7.1 369 154 196 112 185 164 180 587 156 causes within three months of birth. 162. Senility 98,772 78.4 2,574 1,214 i,sn 1,112 1,282 1,445 2,580 2,642 1,545 (165 - 198j Deaths due to other causes. 165. Suicide by poisoning2,408 1.9 ) no 29 27 21 27 26 48 50 46 164. Suicide by toxic gases 74 0.1 2 _ _ 1 165. Suicide by chemicals5,884 4.7 206 66 106 71 119 144 no 84 115 166. Suicide by drowning 2,095 1.7 59 15 19 19 16 25 25 49 55 167. Suicide by pistol 62 0.0 1 - - — — 1 2 2 1 168. Suicide by knife 440 0.4 25 5 3 8 4 8 7 n 5 84-03621ABCD RESTRICTED 142 Entire Country Rate per . 1,0.00. Ho- kaido Aomori Iwate Miyagi Akita Yama- cata Fuku- shima Ibar- aki Tochlgi 169. Suicide by jumping off high places 77 0,1 4 1 - 1 - - - 2 - 170. Suicide by being i run over by a train 1,020 0.8 55 7 6 15 12 15 26 12 19 171. Other suicides 165 0.1 '10 - - 1 * 5 7 1 2 172. Infanticide 45 0.0 2 - 1 1 — 1 2 2 1 17-6. Wurder by shooting 41 0.0 - - 1 — - - - - — 174. Murder by knife 105 0.1 6 1 1 — - — 2 6 7 175. Other murders 246 0.2 8 1 1 11 2 5 2 7 2 ly76 • Toxemia by poisonous food 107 0.1 2 1 - 1 1 - 1 — — 177. Toxemia by spoiled food 272 0.2 4 - 1 3 2 1 « 7 5 178. Toxic conditions 565 0.5 151 5 5 5 — 5 6 1 * 1 by accidental poisonous gases 179. Toxic conditions 1.106 0.9 48 12 15 S 17 19 11 24 9 by unknown accidental causes 180. Death by fires 421 0.5 64 10 8 10 15 2 18 11 5 181. Decth from wounds from fires 2,774 2.2 151 55 98 66 65 42 111 74 76 182. Accidental suffocation 1,584 1.1 150 15 57 16 26 30 53 34 27 185. Accidental drowning 10,505 8.5 618 185 215 195 196 222 268 267 168 184. Accidental shooting 56 0.0 5 1 1 1 - 1 - 1 — 185. Accidental stabbing 295 0.2 7 1 2 2 1 2 3 5 2 186. Accidental 4,020 5.2 255 24 69 66 59 58 122 80 104 falling, being run over , or by landslides 187. Natural calamity such as earthquakes - - - - - - - - - - 188. Accidentally killed by animals 55 0.0 11 - - 1 - 1 — - 2 189. Starvation 87 0.1 8 1 1 1 1 * 5 1 1 190. Freezing 488 0.4 59 10 12 11 17 9 17 18 11 24-62021ABCD RESTRICTED 143 Entire Country Rate per 1.000 Ho- kaido Aomori Iwate Miyagi Akita Yama- Fuku- shima Ibaraki Tochigi 191. Heat prostration 205 0.2 5 1 7 1 5 5 1 12 18 192. Lightning 24 0.0 - - 1 - 2 2 - - - 193. Other electrical 456 causes 0.4 16 6 7 5 10 4 12 11 2 194. Other accidental 8,924 causes 7,1 .615 115 157 92 115 104 211 125 81 195. Suicides, 96 0.1 murders, accidents: unknown causes. 4 5 1 2 1 2 1 1 196. Military casualties - - - - - - - * - - - - 197. Execution - of civilians by armed forces. — — — * 198. Executions 16 0,0 1 - - - - - - - - 199. Sudden death 28 due to unknown causes. o.o 2 — — 1 1 ** ““ 200. Death due 56,255 28.8 to causes undeterminable at autopsy. 1,586 669 854 509 570 590 968 889 £86 34-62021ABCD J RESTRICTED 144 Disease No. Gumma Sai- tamma Chiba Tokio Kana- zawa Nigata Toyama Ishi- kawa Fukui Yara- anashi Nagano Gifu Total Deaths 22,465 31,027 31,697 94,202 50,776 38,299 18,487 18,168 14,722 11,330 28,552 25,099 Epidemic,3,642 4,496 4,302 27,182 7.052 5,560 2,781 3,201 1,939 1,522 3,877 4,519 Infectious and 1. 130 Parasitic Diseases, (1 - 159 143 503 44). 205 195 20l 135 50 42 105 110 2. 12 15 2 29 6 10 - 8 3 8 4 6 3. - - - - - — — — - - - - 4. - - - — — - 1 T - - - - 5.. - - - - - - - — - - - - 6. — _ - — - - - - — — — — 7. 11 90 66 163 82 108 13 48 24 66 39 63 8. 8 14 4 116 22 4 - - - 5 9 10 9. 175 215 198 1,228 552 192 177 41 59 89 181 162 10. 107 81 68 469 143 124 7 35 12 45 154 71 11. 141 262 275 871 193 233 106 81 59 77 208 141 12. — - - - - - - - - - - - 15a. 82 172 149 1,526 272 19 4 4 8 14 22 60 b. 379 631 502 2,928 558 90 18 19 23 44 62 444 14. — - - - - - - - - - - - 15. 66 83 78 245 86 92 35 24 54 44 72 67 16. 9 16 18 56 29 11 12 7 9 5 19 20 17. 10 9 14 128 31 39 12 12 - 8 8 7 18. 2 2 2 49 14 1 4 3 2 1 1 2 19. - — — — — — — — — — - 20. — — - - - - - - - - - - 21. - — - 1 - - — — - - - - 22. 71 63 185 62 38 21 16 14 4 30 56 27 23a. 1,505 1,593 1,484 12,857 3,468 2,628 1,351 1,647 1,102 492 1,661 2,010 b. 31 26 22 160 38 54 14 21 19 14 32 65 c. 3 11 6 52 7 13 6 1 2 2 5 5 24. 83 78 93 1,384 321 156 80 119 40 28 195 148 25. 480 589 434 2,625 665 700 509 717 346 208 677 561 i 24-82821ABCD RESTRICTED 145 Disease No. Gumma Sal- ta mma Chiba Tokio Kana- zawa Nigata Toy ama Ishi- kawa Fukui Yam- anas hi Nagano Gifu 26. 58 65 59 202 55 89 40 45 27 58 87 51 27. 16 16 15 45 16 25 5 9 8 9 19 19 28. - 1 - 2 1 - - 1 - - - — 29. 6 1 8 14 4 20 4 2 2 2 4 14 50. 25 28 20 188 57 52 29 55 14 15 41 56 51. — 1 - 6 - 5 3 1 4? 1 1 52. 7 7 19 155 52 11 10 3 5 1 7 18 55. 5 5 5 5 C\ & 5 - 4 4 2 2 12 54. 71 75 145 508 115 86 27 21 17 42 64 51 55. — 2 2 r» <2 1 - - - — 1 1 1 56. •z 7 127 152 197 598 259 282 104 119 95 115 249 112 s • 58. 1 1 5 — — — — 1 1 , 59. 26 55 71 195 EC 25 6 6 5 17 4 5 40. A 1 5 4 9 6 4 7 5 1 11 7 5 42a. — 5 7 4 5 10 1 2 3 2 4 b. - - 2 - - 1 - - - 1 - c. - - - 5 - - - - - - - - d. - - - - - - - - - 55 — _ e. f — — — 2 — 1 - - - 4 - 1 g* 1 _ — — — 1 . 2 45. 8 12 21 15 9 10 4 8 5 2 11 16 44a. 2 1 2 5 1 4 - 2 - 2 1 2 b. - - - - - 51 - - — _ _ — c. 5 1 1 4 2 9 5 - — 2 6 3 24-62621ABCD RESTRICTED 146 Disease No. Gumma Sai- tarama Chiba Tokio Kana- £awa Nigata Toyama Ishi- kawa Fukui Yam- anashi Nagano Gifu 45. 11 15 10 75 16 14 4 7 6 7 17 16 46a. 64 92 59 258 62 69 16 19 9 50 80 50 b. 555 715 750 1,985 676 992 569 554 250 261 714 440 c. 26 51 37 171 52 48 9 20 19 16 56 28 d. 109 182 129 454 129 254 45 51 55 100 171 80 s • 2 5 7 26 7 4 2 4 1 2 7 2 f. 5 9 10 47 9 17 5 5 6 4 19 7 g« 25 21 52 91 29 58 18 16 11 21 69 24 47. 51 55 59 174 50 47 19 10 9 9 55 12 48. 5 8 7 25 7 15 5 4 1 5 5 2 49. 112 172 204 501 168 152 86 64 56 50 168 116 50. 19 22 16 78 25 29 9 15 7 5 26 7 51, 12 7 14 51 5 9 6 4 6 1 5 9 52. 7 5 8 25 15 15 5 9 5 5 14 6 55. 29 57 60 188 46 68 20 29 25 26 51 45 54. 9 10 22 84 29 58 15 8 10 10 25 19 55. 26 28 49 257 44 55 20 21 15 11 62 50 56. 9 20 15 51 15 18 6 6 9 10 15 7 57. 25 55 51 49 11 45 25 14 16 21 24 21 58. — — - 1 - - - - — — — 1 59. 50 54 77 208 56 88 47 56 51 25 54 58 60. 5 4 4 11 6 9 5 5 4 2 4 6 61. 88 147 457 998 514 371 178 205 147 55 66 205 62. - 5 — - — 5 — — — 1 65. 1 - 2 4 1 6 10 25 2 1 — 4 64. 1 - 1 1 - — — 4 1 1 _ 65. - - - 2 - - - - - - 1 1 66a. 4 1 10 55 9 6 2 5 2 2 9 5 b. 2 4 1 1 - 1 — 1 — 1 1 c. - 1 - 4 2 5 4 1 5 — 1 2 1 a4-e«eaiABCD | RESTRICTED 147 Disease No. Gumma Sal- tamma Chiba Tokio_ Kana- zawa Nisata Toyama Ishi- kawa Fukui Yam- anashi Nacano Gifu 67. 1 5 4 4 6 4 1 2 5 5 68. 69. 41 51 57 152 129 50 7 7 4 25 36 22 70. 14 20 22 61 25 26 11 6 7 15 25 15 71. 7 11 27 65 11 28 15 5 7 16 19 11 72. 6 18 19 79 24 52 6 19- 2 16 27 4 75. — 8 5 18 5 8 1 4 2 5 4 4 74. — — — 2 2 2 1 - — - — — 75. 1 4 5 51 14 2 1 2 1 1 4 5 76. — 2 — 4 - X 1 - 1 1 5 1 77. — — 1 5 — — — 1 — — — 2 78. 87 108 121 271 72 256 91 79 60 42 108 96 79. 586 1,018 1,116 1,958 956 1,295 512 675 568 519 702 975 80. 19 25 55 95 57 28 9 18 14 7 29 16 81. 41 65 86 155 51 69 29 56 20 28 79 35 32a. 2,287 2,165 5,482 9,255 5,006 4,647 1,615 1,627 1,060 1,167 5,822 2,142 b. 49 74 87 288 82 99 29 50 20 25 85 58 c. 1 2 1 6 1 - 1 2 1 - 1 - 85. 44 105 72 444 106 62 50 46 27 22 44 52 84. 65 ’ 142 117 485 149 106 68 47 32 24 154 98 35. 26 42 50 87 25 19 11 20 7 18 27 34 86. 18 50 80 19 15 90 681 374 73 20 57 54 87 .a. 2 — 1 6 — 1 1 1 - 1 5 5 b. 5 17 17 24 5 17 12 10 12 4 14 10 c. 55 67 49 99 56 65 56 51 55 18 76 39 88. 1 2 5 5 1 1 1 5 - 2 1 2 89. 6 8 11 42 10 n 9 7 7 11 6 9 90. 8 25 27 96 28 20 15 15 9 4 21 12 91. 15 9 25 52 9 20 14 15 12 5 12 11 92. 476 518 759 1,644 546 726 596 571 318 285 709 645 93. 57 70 151 205 70 86 52 69 47 55 71 76 94. 120 160 168 711 211 148 71 70 49 68 174 81 24*0262lABCfi RESTRICTED 148 Disease No. Gumma Sai- tamma Chiba Tokio Kana- zawa Niftata Tovama Ishi- kawa Fukui lam- ana shi Nagano Gifu 96. 287 559 582 958 268 550 169 162 108 109 512 2*0 96. 4 5 4 48 14 7 5 7 2 5 8 4 97. 67 155 189 570 71 555 104 495 79 45 152 94 98. 3 7 11 19 8 15 5 2 2 6 7 11 99. 3 5 5 6 5 2 - 2 1 2 2 - 100. , 2 2 4 2 — _ 1 5 4 1 101. 3 10 8 11 6 5 7 7 6 5 10 6 102. 2 8 12 21 10 15 3 2 5 1 2 9 105. 3 18 15 15 11 11 5 5 7 7 8 8 104. 5 1 7 3 - 4 - - - 1 5 5 105. 25 17 20 20 9 12 4 12 7 9 9 16 106a. 109 166 159 162 87 222 85 68 111 67 138 189 b. 257 466 556 565 242 409 157 162 17$ 170 251 240 c. 149 265 246 444 147 551 191 95 225 100 141 294 107. 709 967 901 5,265 889 1,032 560 648 565 376 780 647 108. 864 1.194 1,205 4,624 1,569 1,489 902 854 717 561 1,471 1,020 109. 528 497 678 2,207 617 571 357 191 221 152 259 592 no. 362 412 546 1,685 558 466 464 596 323 170 464 340 111. 19 22 64 149 45 48 10 50 16 16 50 11 112. 217 295 259 699 225 282 69 120 106 95 185 192 115. 20 20 22 85 31 25 7 6 8 19 50 22 114. 68 59 60 289 65 128 67 76 60 29 63 44 115. 48 46 42 72 45 82 52 58 19 28 33 58 116. 12 21 10 46 15 9 4 4 3 14 20 6 117. 237 530 408 1,115 377 382 194 187 121 154 336 215 118. 590 638 419 584 316 507 314 550 522 158 530 357 119. 1,118 1,471 1,157 2,349 1,043 2,634 1,602 1,000 1,044 617 1,217 1,517 120. 1,892 2,620 1,451 1,445 965 2,562 1,152 767 1,050 715 1,540 1,472 121. 38 55 61 294 80 88 47 55 28 50 40 45 122. 71 129 154 461 129 185 65 64 65 68 111 91 125. 12 17 25 47 15 16 17 15 14 10 22 13 124. 79 98 75 268 99 122 47 59 57 66 56 69 24-82621ABCD RESTRICTED 149 Disease No. Gumma Sai- tamma Chiba Tokio Kana- zawa Nisata Toyama Ishi- kawa Fukui Yam- anas hi Nazano Gifu 125. 49 62 58 184 62 84 55 42 40 54 68 77 126. 52 41 50 128 55 70 17 16 21 22 54 25 127. 58 59 44 155 61 57 21 54 22 14 45 41 128. 129. 516 581 424 1,559 409 562 467 457 421 162 517 488 150. 259 282 258 771 297 545 181 164 102 151 219 178 151. 426 899 897 2,997 892 1,024 410 524 276 510 805 522 152. 515 411 451 1,958 585 597 297 191 284 155 589 592 155. 44 68 60 285 78 107 55 55 60 59 57 52 154. 2 - 6 14 — 6 2 2 1 1 5 1 155. 18 20 21 62 26 24 14 22 14 10 55 21 156. 2 6 2 12 1 6 1 5 1 5 157. 5 5 4 12 4 5 1 1 1 — 5 _ 158. - 2 1 2 1 2 - - — 2 _ 1 159. 9 16 12 16 6 6 6 9 9 7 9 20 140. 4 - - - 1 2 - - - 1 - 1 141. 4 5 4 8 2 4 2 5 1 5 5 5 142. 4 5 5 25 4 2 2 4 1 1 6 2 145. 1 - 1 5 - - — — - — — _ 144. 52 51 21 107 42 40 14 11 5 21 52 14 145. 26 27 21 75 14 25 15 9 12 14 18 19 146. 25 55 55 166 46 55 19 25 5 9 27 22 147. 1 5 6 19 4 - 1 2 1 1 1 5 148. - - 1 1 - - 1 — 2 — — z. 149. 5 18 20 21 5 18 4 6 1 11 12 6 150. 1 4 1 2 — 1 — 151. 7 10 17 65 9 19 6 5 6 2 15 10 152. 55 84 45 118 40 62 50 26 25 15 55 28 155. 7 7 16 54 12 54 4 7 7 9 12 10 154. — — — 1 - - - — - — — — 155. 19 22 27 68 11 52 18 18 12 12 59 25 24- O o « o Nurses « as E L (0 1 w -H cd o X) cd Oh S 3 a 0) •H +> cd Ou i 3 O ) ; Admissions 5atients Discharged Tokyo Hospitals of all types 14 4,077 207 828 62 159,829 47,048 41,620 Convalescent Homes 1 1,170 26 199 7 - 1,608 857 Clinics 22 - 53 54 6 120,857 - - Health Advice Offices 17 - 58 124 15 506,681 - - Osaka Hospitals of all types 6 2,452 105 452 54 198,108 798,485 21,899 Clinics 25 - 8 55 - 280,989 - - Health Advice Offices 18 - 29 58 - 220,142 - - Nagoya Hospitals of all types 5 448 65 196 19 555,145 115,126 4,151 Convalescent Homes 1 224 5 25 2 - 80,550 462 Clinics 4 - 5 8 4 117,552 - - Sfcgte Hospitals of all types 1 559 10 94 5 - 104,800 - Clinics 7 - 7 14 - 425,717 - - Convalescent Homes Health Advice 1 550 8 45 5 112,278 Offices 1 - 2 7 - 5,709 - - 24-63«21ABCD 169 170 MUNICIPAL HOSPITALS, CONVALESCENT HOMES, CLINICS, AND HEALTH ADVICE OFFICES (1958) coat'd. m a o No. of Beds P E R S 0 N N w E* L£ 01 Patients Discharged CITY TYPE , 2 •H O *H -P • to o fl z; m to u o -p o 02 M •P P P tj 02 .P •H O -P 02 to Oh Q Omits Clinics 1 4 6 1 17,480 - - Hime.ii Clinics y 5 6 10 3 49,793 - - Kofu Hospitals 1 20 5 5 2 32,579 2,475 1,250 of all types Clinics 1 — 2 2 ” • _ Kochi Hospitals 1 96 5 6 1 _ 12,260 481 of all types Clinics 1 3 6 1 19,854 «• Health Advice Offices 1 - 3 6 1 7,544 - — Nishinomiva Clinics 2 - 8 12 4 152,312 - — Aomori of Hospitals all types 1 24 7 22 1 93,901 6,801 6,791 175 Disease: cholera dysentery typhoid fever paratyphoid fever cases deaths cases deaths cases deaths cases deaths 1956 - 48,968 15,066 58,557 6,845 4,207 270 1957 - - 52,075 15,740 56,958 6,467 4,778 295 1958 57 20 78,284 18,427 58,542 6,617 4,480 292 Disease: smallpox ■typhus fever scarlet fever diphtheria 1956 155 16 17 1 15,071 560 15,695 1,951 1957 68 15 - - 15,462 557 15,868 1,848 1958 52 2 2 — 15,948 552 15,749 1,748 Table III. Notifiable Infectious Diseases plague epidemic cerebro. meningitis 566 541 277 629 516 464 24-«»«814BCD Disease: 1956 1957 1958 176 Prefectures Cities Towns & Villages _ Towns & Village Unions Prefc- tures Private Ind« Total Number of houses sup- plied Number of houses by 100 houses Hokkaido 5 20 . 5 30 100,041 18.54 Aomori 2 1 - -- 1 4 21,332 13.18 Iwate 1 6 — - 7 14 9,877 5.64 Mlyage 2 18 - - 3 23 59,000 19.75 Akita 1 — - - - 1 9,166 6.23 Yamagata 4 14 - - - 18 19,583 10.60 Fukushima 4 9 — - - 13 51,182 11.44 Ibaraki 1 1 — 3 5 5 8,357 2.90 Tochigi 2 4 - - - 6 14,576 6.84 Gumma 5 1 - - - 4 22,830 10.14 Saitama — 5 1 - - 6 10,197 3.67 Chiba 1 2 — 1 6 10 15,772 4.69 Tokyo 2 6 — - 4 12 970,725 75.39 Kanagawa 3 10 1 1 1 16 220,551 61.55 Niigita 4 11 - - - 15 48,077 13.51 Toyama 2 3 - - - 5 7,676 4.96 Ishikava 1 4 — - - 5 16,942 10.72 Fukui 1 2 - — - 3 20,808 15.68 Yamanashi I 10 1 - 2 14 24,375 19.64 Nagano 5 28 1 - - 14 49,219 14.79 Gifu 2 15 — - 5 20 19,253 7.86 Shizuoka 4 20 - 1 - 25 57,136 10.67 Aichi 6 1 2 - - 9 234,079 41.09 lile 5 4 - - - 7 19,020 7.93 Shiga 1 - - - - 1 5,855 3.87 Number of Water Works Established in Japan Table IV. 34-62021ABCD 177 Prefectures Cities Towns & Villages Towns & Village Unions Prefc- tures Private Ind. Total Number of bouses supplied Number of houses by 100 houses Kyoto 5 23 2 28 167,973 47.51 Osaka 4 18 1 - 4 27 661,511 75.66 Hyogo 5 13 - - 7 25 271,581 44.41 Nara 1 6 — - 2 9 11,074 8.94 Wakayama 2 4 - - 9 15 25,637 15.88 Tottori 2 8 - 1 - 11 14,529 15.28 Shi mane 1 7 - - 7 15 15,858 10.05 Okayama 5 15 1 - - 17 48,062 17.06 Hiroshima 6 7 - - 16 28 115,010 29.66 Yamaguchi 4 7 - 1 9 21 42,104 16.26 Tokushima 1 3 - - - 4 16,769 11.60 Kagawa 2 4 1 - 6 13 16,798 11.04 Ehime 5 21 - - 1 25 15,295 6.29 Kochi 1 7 - - 3 11 15,068 9.65 Fukuoka 10 7 — — 1 18 144,500 27.03 Saga 2 4 — - 1 7 12,120 9.49 Nagasaki 2 9 - - 5 16 71,337 28.20 Kumamoto 1 7 • - - ' - 8 25,677 9.05 Oita 3 4 — - 1 8 20,177 10.35 Miyazaki 1 5 - - 2 8 6,890 4.55 Kagoshima 1 8 1 - 2 12 24,455 7.55 Okinawa 1 - - - - 1 5,551 2.80 - — — —- — Total 119 380 7 5 117 627 3,716,626 27.51 Number of Water Works Established in Japai Table IV. contd. 84-fl2«a1ABCD 178 Table V. List of Biologicals Approved by Ministry of Welfare Vaccine Lymph Anti-diphtheric serum 1. liquid form 2. dried form Liquid anti-tetanic serum Anti-dysenteric serum Serum against dysentery and Chara bacillus Anti-typhoid serum Anti-paratyphoid serum Anti-cholera serum Anti-tubercle bacilli serum Anti-pneumococcic serum Anti-meningococcic serum Anti-streptococcic serum Anti-anthrax serum Serum against ictero-hemorrhagic spirochaete Normal horse serum Old tuberculin New tuberculin Diphtheria preventitives Scarlet fever preventitives Dysentery bacilli vaccine Typhoid bacilli vaccine Para-typhoid mixed vaccine Mixed typhoid-paratyphoid vaccine Cholera vaccine Colon bacilli vaccine Tubercle bacilli! vaccine Pneumococci vaccine Pfeiffers bacilli vaccine Pertussis vaccine Meningococci vaccine Streptococci vaccine Staphylococci vaccine Chancroid bacilli vaccine Gonococci vaccine Ictero-hemorrhagic spirochaete vaccine Anti-rabic vaccine for dogs Anti-rabic vaccine for man Typhoid bacilli-oral vaccine Dysentery bacilli-oral vaccine Typhoid diagnosticum Para-typhoid diagnosticum Plague serum Anti-snake venom • ♦“02 021ABCD 179 Number of Officials in Department of Health and Sanitation assistant p p p p infectious 9 ® (O M § m a n (3H P «JQ) WOO 1 r~f CO clerks assistant diaease P P W u •P P m u w p w CO o p m experts prevention •H 4) 2 B* U ® •H (D to a, rl *H CQ D Vi *4 0) •H tH CO 'O s. 0) officials 5 x 03 SECTION DRAwfnf^H^E0SAWYT!v!sl8N7l8??— MAP NO 625, JUNE 20, 1942 O 0 03 ◄ 01 <0 01 <0 I <9 189 ii< EDiTiON RESTRICTED TETANUS PREVALENT THtsC FOUR PREFECTURES ACCOUNT TON 33 OF ALL CASES Of JAPAN INDEX TO MARINE PREFECTURES OF JAPAN HONSHU I AOMORI I AKITA 3 IWATE 4 YAM AG AT A 3 MIYAGI 6 NIIGATA 7. FUKUSHIMA 8 ISHIKAWA 9 TOYAMA 10 IBARAKI II FUKUI 12 TOKYO • 3 CHIBA 14 KANAGAWA 13 AlCHI 18 SHIZUOKA 17 KYOTO 18 MIE 19 OSAKA 20 WAKAYAMA 21 .HYOOO 22-TOTTOR1 21.OKAYAMA 24 SHIMANE 25 HIROSHIMA 26 YAMAGUCHI i SHIKOKU 27 KA6AWA 26.EHIME 29.KOCHI 10 TOKUSHIMA KYUSHU 31 .FUKUOK A 12 NAGASAKI 33 SAGA 14.KUMAM0T0 35 .01 T A 36.MIYAZAKI 37 KAGOSHIMA WAP NO JUNE 2'). Bfpsonucio BY THI OSS RIPRO SICHON DRAWN IN THE GEOGRAPHY DIVISION, OSS 3 4“® 3 S31ABC® 190 PROVISIONAL EDITION K( ') 1 KU, I LI) TYPHUS FEVER MITt BORNE LOOSE BONNE INDEX TO MARINE PREFECTURES OF JAPAN HONSHU 1 AOMOR' 2 AkiTa 3 HR ATE 4 YAMAGATA 5 MiYAGi 6 NIIGATA 7 FUKUSHlMA 8 iSHIKAWA 9 TOYAMA 10 'BARAKI 11 FUKUt 12 TOKYO 13 Chiba 14 KANAGAWA 15 A (CHI 16 SHIZUOKA f7 KYOTO I8MIE 19 OSAKA 20 WAKAYAMA 21 HYOCC 22 TOT TORI 23 OKAYAMA 24 Shim ANE 25 HIROSHIMA 26 YAMAGUCMI SHIKOKU 27 KAGAWA 28 t HI ME 29 KOC Ml 30 TOKUSHIMA KYUSHU 31 FUKUOKA 32 NAGASAKI 33 SAG A 34.KUMAM0T0 35 01 T A 36 MIYAZAKI 37 KAGOSHIMA MAP NO , *25. JUNE 20, 1942 HMOOUCB) tY THE OSS HNO. SICTION "DRAWfTlN^H^EoSS^r'olviSBR^??" S4-aaflaiABCD A METHOD OB OBTAINING A JAPANESE MEDICAL HISTORY OUTLINE if la #, I. Explanation II. Introductory Remarks III. Medical History 1. Specific Diseases including Venereal 2. Injuries and Operations 3. History by Systems - Present and Past 4. Immunizations IV. Examination Commands and Directions V. Time Determination and Additional Vocabulary 191 GENERAL This outline Is prepared as a practical Instrument which a medical officer In the field may use to obtain case histories from non-English speaking Japanese under his care. It does not cover the field exhaustively or technically but Is designed so that by use of relatively few words and phrases a medical officer may obtain Important diagnostic facts In the absence of an Interpreter, The outline allows tne medical officer two methods of approach. He may read aloud the appropriate Anglicized questions which appear below or opposite their English equivalents. If this proves Impractical he may, by pointing at the appropriate Japanese text, have the patient himself read the selected questions. To either of the above, the response will be "hal" (yes), "llye" (no), or "shlrlmasen" (I don't know;. In order to confine the patient's verbal responses to these three expressions, sentence #3 on page #4 should be Impressed upon hinf at the outset. Note also the questions In Section III (pages 5 to 9) can be framed In either the 2nd or 3rd person. The information may thus be obtained through a third party when the patient Is Incapable of Intelligent response. It Is suggested that before a medical officer attempts to use this outline, he thoroughly familiarize him- self with the plan of its contents. It Is not Intended that words or phrases herein be memorized, but rather that emphasis be placed upon proper pronunciation in reading the questions aloud. To this end, the vowels are pronounced as follows: a - "ah", e - "eh", 1 - "ee", o - "oh", and u - "oo". Consonants are pronounced as In English. SECTION III The sentences In Section II are to be used as an approach to the patient and at the same time Instruct him that he Is to answer only "yes'*, "no", or "I don't know". It will be necessary for the medical officer to learn to recognize by sound no more than the three Japanese expressions: "hal" - pronounced "hah-ee" - (yes) "llye" - pronounced "ee-eh" - (no) "shlrlmasen" - pronounced " shl-rl-ma-sen" - (I don't know) 24-82621ABCDj 192 SECTION III In Section III-l on page #5 are listed four key sentences. Two of these are In the 2nd person and two are In the 3rd person. By selecting the desired word from the list of diseases and Inserting It In the blank space of the key sentence, the past medical history may be obtained. Section III-2 contains English questions and their Japanese equivalents which are Individually complete In themselves. Questions 1 to 6 (page #8) Inclusive will elicit only the responses "yes", "no", or "I don't know". The responses to sentences ? and 8 are merely physical indications. The purpose of Section III-3 Is to obtain the medical history by 8ystems--either present or past. To determine the presence of disease or abnormality use suc- cessively In key question (1), (2), (3), or (4) the names of the organs In the extreme left column. To determine the nature of symptoms, use successively In key question (5) the symptoms listed In the middle and right columns. For the amplification of symptoms in certain Important organs, several questions complete In themselves have been added under the heading "Additional". They are self explanatory with the exception of question #3 on page #14. This question is used to determine which of two symptoms occurred first. Section III-4 Is used to obtain Immunization data by Inserting the desired words In the proper key sentence. These questions will be answered only "yes11, "no", or "I don’t know" SECTION IV Section IV consists of a series of simple self- explanatory commands and questions to be used at the time of physical examination. SECTION V Section V-l Is used to determine approximate dura- tion or time of occurrence without using the complicated Japanese numerical system. Section V-2 Is an additional list of less Important or more uncommon diseases or conditions. Tnese words are to be used with the key questions of Section III-l, page #5. 24-62621ABCD IQ* II INTRODUCTORY REMARKS 1. I am a medical officer. -kk\i %%t'-f 0 Watakushl wa gunl desu. 2. I want to Inquire about your health. it'7T 9 t 'j c \ 9 r -h Anata no kenko Jotal wo shlrltal no desu. 3. Answer questions only "yes", "no", or "I don*t know11 rli Uj *V U jCii rl V u. "Hal" ka "llye" matawa "shlrlmasen" to dake kotayete kudasai. 4. Do you understand? Wakarl masu ka? 5. Do you smoke? 1 # i -f . Tabako wo noml masu ka? 0. Are you married? Anata wa kekkon shite Imasuka? 7. Is your wife well? i-l JlMr r Okusan wa tassha desu ka? 24-62821ABCD INTRODUCTORY REMARKS II (Cont'd) 8. Are you well? %ri*. Anata wa taasha deeu ka? III-l SPECIFIC DISEASES INCLUDING VENEREAL 1. Did you ever have ? i i fifty# i Anata wa nl kakarl mashlta ka? 2. Were you treated for ? <9## t%nfi vtz*'. Anata wa no chlryo wo uke mashlta ka? 3. Did he ever have ? /fij? A Ano hi to wa nl kakarl mashlta ka? 4. Was he treated for ? 9 A li 9 tft&i I Ano hi to wa no chlryo wo uke mashlta ka? 24-62621ABCD 195 SPECIFIC DISEASES INCLUDING VENEREAL III-l (Contfd) ENGLISH JAPANESE ROMAJI ANEMIA ARTHRITIS ASTHMA ‘ CANCER CHOLERA CHRONIC RESPIRATORY DISEASE DIABETES DIPHTHERIA DYSENTERY EPILEPSY (Fite) INFLAMMATORY RHEUMATISM INSANITY LEPROSY MALARIA NEURITIS PARALYSIS (Stroke) PLEURISY PNEUMONIA SCARLET FEVER SMALLPOX TUBERCULOSIS GENERAL Iwj MM tm Sl HINKET3U KANSETSUEN ZEN30KU GAN KOKERA KIK AN SHI-K ATARI! TONYOBYS JIFUTERIYA 3EKIRI TENKAN EN3H03EI-RYUMACHI 3EI3HINBY0 RAIBYO MARARIYA 3HINKEIT3U CHUKI ROKUMAKUEN HAIEN 3H0K0-NET3U TENNENTO KEKKAKU 196 SPECIFIC DISEASES INCLUDING VENEREAL III-l (Cont»d) ENGLISH JAPANESE ROHAJI SIW Mm TUBERCULOSIS APICAL MINIMAL TYPHOID FEVER TYPHUS WHOOPING COUGH YELLOW FEVER HAI3EN-KATARU CHO-CHIBU3U CHIBU3U HYAKU-NICHI-3EKI 0NETSUBY3 BLADDER DISEASE BONE DISEASE HEART DISEASE JOINT DISEASE KIDNEY DISEASE LIVER DISEASE NERVOUS OR MENTAL DISEASE RECTAL DISEASE SKIN DISEASE STOMACH DISEASE VENEREAL DISEASE GONORRHEA SYPHILLI3 CHANCROID Bnm it? Wffc f 9^^ BOKOBYO HONE NO BYOKI SHINZOBYO KAN3ET3U NO BY^KI JINZOBYO KANZOBY^ 3HINKEI-SUIJAKU KOMON NO BYOKI HIFU3Y0 I NO BYOKI karytjbyS RIMBYO BAIDOKU YOKONE HI-2 INJURIES AND OPERATIONS 1, Did you ever have a fracture? A % ')i~f A, Hone vo otta koto ga arimasuka? 2. Did he ever have a fracture? ii iiff A V i A A,. Ano hlto wa hone wo otta koto ga arimasuka? 3. Did you ever have a wound? tlt'f tz %■*)<% Maye nl fusho wo uketa koto ga arimasuka? 4. Did he ever have a wound? f} k * m M Jr Kslk TOOTHACHE NECK PAIN SWELLING STIFFNESS CHEST PAIN PALPITATION HEART MISSED BEATS (Irregularity) SHORTNESS OF BREATH FLUSHING OF THE FACE BLUENESS OF NAILS SWELLING OF THE ANKLES HA-ITAMI KUBI IT AMI KUBI NO HARE KOWABARI MUNE ITAMI DOKI 3HINZ0 KODO NQ HENCHO IKI-GIRE KAO GA AKAKU NARU T3UME GA AOJIROKU NARU A3HI KUBI NO MUKUMI 24-828211BCD 202 HISTORY BY SYSTEMS HI-3 (Cont'd) ADDITIONAL 1. Is It made worse by exercise? iim tc * & < ti y t -t *. Undo shltara yoku narlmasu ka? 2. Is It Improved by rest? k fe" 3 & < 4 'j i i * . Yasundara yoku narimasu ka? ENGLISH JAPANESE ROMAJI LUNGS PAIN COUGH EXPECTORATION SPITTING OF BLOOD SHORTNESS OF BREATH ABDOMEN Stomach Liver Instestine Rectum Gall Bladder PAIN at $1 < ti?L< ti- W HI HxPI Hit HAI ITAMI SEKI TAN WO HAKU CHI WO HAKU IKI-GIRE KARA I Kanz*o Cho Korn on Tan no ITAMI 24 "6262 1ABCI) 205 HISTORY BY SYSTEMS III-3 (Coat'd) ENGLISH JAPANESE ROMAJI CRAMPY DULL ACHING THROBBING KNIFE-LIKE PAIN DIARRHEA CONSTIPATION BLOATED BELCHING PILES 4% -7 * -9* * r»i /SL*S13 v%k- 4 KElREN OMOGURUSHII ITAMI ZUKI-ZUKI EGDRU YO NX ITAX GERI BEMPI KARA GA HARD AIKI (OKUBI, GEPPU) JI ADDITIONAL 1. Is there nausea? fli-jlM' L t "t Hakike ga shimasu ha? 2. Is there vomiting? $ i -i Jh, Hakimasu ka? 3. Did the X come before the Y ? X Y 9 f= 1 I . X ga Y no maye nl klmashlta ka? 4. Is your appetite good? \i i' I'T -f *. 24-82821ABCD Shokuyoku wa ii deeu ka? 204- HISTORY BY SYSTEMS III-3 (Cont'd) ADDITIONAL 5. Was there blood when you vomited? ti v \ t- iz is. x< ') i 17= . Haita tokl ni cni ga arimasnita ka? 6. Are the stools bloody? H-f!? i7 k & ** afc 9 S T *. Funben no naka ni chi ga arimasu ka? 7. Are the stools black? Iv't^n* Funben ga kuroi desu ka? 8. Are the stools gray? IN*. i 4'. Funben ga haiiro desu ka? 9. How many time a? f-t o Nando gural desu ka? 10. If you eat, does it get worse? ') 'k'c tz bg < tt *, Tabetara varuku narimasu ka? 11. Do greasy foods bother you most? Abura mono ga ichlban varui desu ka? 12. Was it bitter when you vomited? T'i tz Haita tokl ni nigai deshita ka? 205 HISTORY BY SYSTEMS I1I-3 (Cont'd) 13. Was It sour when you vomited? i- r l iz j\o Halta tokl nl sull deshlta ka? ENGLISH JAPANESE ROMAJI KIDNEYS BLADDER PENIS TESTICLES 5W NT I. f A. JINZO BOKO INKEI KOGAN (Kintama) 1. Is there pain In the kidneys? 5/1 Jingo no Itami desu ka? 2, Is there pain In the groin? v M &t f Homone no Itami desu ka? 3. Is there smarting of urination? 'Is ft r -j Shoben no Itami desu ka? 4. Is there pain in the testicles? A> 9 «9- r -f jj", Kintama no itami desu ka? 6, Is there frequent urination? 'J'ft 24“6 2 821 ABC D Shoben ga hlnpan desu ka? HISTORY BY SYSTEMS III-3 (Cont'd) 6. Is there urethral discharge of pus? t i 4% Uml no shoben desu ka? 7. Is there chills? H r i . Samuke desu ka? 8, Is there scanty urine? ft ’Y I' T , Shoben ga sukunal desu ka? 9, Is there blood In the urine? jk v']' fit r -j ■t}'- „ Chi no shoben desu ka? 10, Is there inability to urinate? aN 4ft Wife i~k A Shoben ga deklmasu ka? ADDITIONAL 1. Have you had sexual Intercourse lately? tin*'. Salkin nikutal kankel wo shlmashlta ka? 2. Have you been treated for syphlUls? fc't i I* Baidoku no chlryo wo uke mashlta ka? 207 III-4 IMMUNIZATION 1. Were you immunized against ? itt ti <0 % t $tjf tltz^o Anata wa no menyeki chlryo wo uke mashlta kat 2. Was he immunized against ht 9 1 i 11. . Ano hi to wa _____ no menyeki chlryo wo uke mashlta ka? ENGLISH JAPANESE ROMAJI fa?]*] A°Xh • flfeflai m CHOLERA PLAGUE SMALLPOX TETANUS TYPHOID FEVER TYPHUS YELLOW FEVER KORERA PE3UTO (Kokushl-byo) TENNEN-TO HA3HOPU CHS CHIBU3U CHIBDSU 3NET3U-BY0 IV EXAMINATION COMMAND AND DIRECTIONS 1. Take your clothes off. 24-82621ABCD M i if • Kimono vo nuge. 208 EXAMINATION COMMAND AND DIRECTIONS IV (Cont'd) 2. Get dressed. Kimono vo kiro. 3. Turn around. ?€4l. Mavare. 4• Stand up• it . Tate 5. Sit dovn. o Suvare. 6* Open your mouth. -V t TtH if. Kuehi wo ake. 7. Put out your tongue. •£1 ft “t. Shita wo dase. 6. Put out your arm Dde vo dase* 9. Put out your hand. 4t A-t. Te wo dase. 209 EXAMINATION COMMAND AND DIRECTIONS IV (Cont'd) 10, Take a deep breath. i $. Shin kokyu ehlro. 11. Cough. Vt t l 6 o Sekl wo ehlro. 12. Hold your breath. %t± ft 5, Ikl wo tomero. 13, Look up. Jti . Uye wo mlro. 14. Look down. r±Jb*>. Shlta wo mlro. 15. Bend over. S'] k|>!). Mae nl kagame. 16. Lie down. lz & At o Yoko ni nare. 17, Do as I do. ik. Watashi no mane wo shlro. 210 EXAMINATION COMMAND AND DIRECTIONS IV (Cont'd) 18. Take this. 4 Sk . Kore wo nome. 19. Urinate In this. i lb - Kore nl shoben wo shlro. 20. Shut up. Damare. 21. Does this hurt? 4k u ti'' o Ital ka? 22. Does this hurt more than this? )tb 'i 11> "? t' o Kore wa motto Ital ka? 23. Relax. Rakunl shiro. V TIME DETERMINATION AND ADDITIONAL VOCABULARY HOW TO DETERMINE ECUOH DURATION OR TIME 6F OCCURRANCE 1* Has It been within the past day? 4l }i 'Q T i /z „ Sore wa saku-Jltsu deshlta ka? 2. Has It been within the past week? $*.ii Sore wa senshu deshlta ka? 3. Has It been within the past month? % rfil-i$ 1" I « Sore wa sengetsu deshlta ka? 4. Has it been within the past year? t)1 li — vA fa T I fc c Sore wa ichlnen inai deshita ka? 5. Show by holding up your fingers how many hours ago. $1 T fa f] * t V T T * tx. Yubl de nan jlkan maye ka Itte kudasai. 6. Show by holding up your fingers how many days ago. t1 $b T fa H ff] ~f tr v ' . Yubl de nan nlchl maye ka Itte kudasai. 7, Show by holding up your fingers how many weeks ago. ftr-toia# t t o. Yubi de nan shu maye ka itte kudasai. 1 “8262 t A BCD TIME DETERMINATION AND ADDITIONAL VOCABULARY V (Cont'd) 8. Show by holding up your fingers how many months ago T'M & Bf} * t X T * u. Yubl de nan kagetsu maye ka Itte kudasal. 9. Show by holding up your fingers how many years ago. ta Tfaifirj 4'T^- Yubi de nan nen maye ka itte kud&sai. ADDITIONAL VOCABULARY ENOLI3H ASTIGMATISM BERI-BERI CHICKENPOX FEBRILE DISEASE (Type not specified) FOOD POISONING HAY FEVER HIGH BLOOD PRESSURE HOOKWORM JAUNDICE MEASLES MUMPS PEDICULOSIS PEPTIC ULCER POISON IVY JAPANESE &#■& fjj III ROMAJI RAN 31 KAKKE MIZU-BOSO NETSU-BYO SHOKUATARI KAREKU3 A-B YO K0-KET3UATSU JUNISHICHO-BYO ODAN HASHIKA OTAFUKU-KAZE SHI RAMI IKAIYO KABURE 24-62021ABCD 215 TIME DETERMINATION AND ADDITIONAL VOCABULARY V (Cont'd) ROMAJI CHIKUN0-3H0 TORAHOMU TSUTSUOAMUSHI-BYS Z0HI-BY3 muso Eosra enolish SINUSITIS TRACHOMA T8UTSUOAMU3HI DISEASE ELEPHANTIASIS X - SAT JAPANESE h 7— A £ &&& X/o DISEASE 214 2 4-02621 AB C D 215 REFERENCES Koseisho Eisei Nempo Imperial Japanese Government (1935—59) Takumu Tokei Imperial Japanese Government (1938) Taiwan Igakkai Zasshi Formosa Medical Association (1955-40) Report of XVth International Red Cross Convention Horei Zenshu Tokyo (1935-1941) Reports to League of Nations by Imperial Japanese Government Bulletin of Hygiene London (1955-1942) Juiko Tokei Imperial Japanese Government (1959) Shokuiin Roku Imperial Japanese Government (1940) Note: In the Sections on tropical diseases and parasites the nomenclature used has been directly translated from the Japanese text. Variations from terminology used in American texts may, therefore, be expected* For complete information on parasites the reader is referred to the "Laboratory Guide to Medical Protozoology and Helminthology” Naval Medical School, National Naval Medical Center, Bethesda, Maryland. 24-62«31ABCD