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Brief reports received from governments on the progress of their health activities

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WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTt

REGIONAL OFFICE FOR

THE WESTERN PACIFIC

BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMI'lTEE:

•

Nineteenth Session Manila 1-8 October 1968 Provisional agenda item 10

8 October 1968 ORIGINAL: ENGLISH

BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF HEALTH ACTIVITIES

Attached are brief reports received from governments on the progress of health activities in tr~

following countries and territories: (English only) (English only) (French only)

*Austral1a Cambodia China Hong Kong Japan Laos Macao

*Malaysia (English only) New Caledonia and its Dependencies New Zealand (English only) Philippines (English only) Republic of Korea (English only) Singapore Timor (French only) Viet-Nam (English only) Western Samoa

*Distributed

to Chief Representatives only.

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Commonwealth Department of Health ~ • 1967-68 , -to

The Annual Report of the Director-General of Health

COMMONWEALTH OF AUSTRALIA

With the Compliments of the Director-General of Health

COMMONWEALTH DEPARTMENT OF HEALTH

Annual Report Director-General of Health

1967-68

CANBERRA, 1968

Contents

5 12 24 26 29

Introduction National Health Benefits Planning and Legislation Establishments and Finance Quarantine Tuberculosis Northern Territory Health Australian Capital Territory Health Public Health Therapeutic Substances National Biological Standards Laboratory Commonwealth Health Laboratories Commonwealth Acoustic Laboratories Commonwealth X-Ray and Radium Laboratory Commonwealth Bureau of Dental Standards School of Public Health and Tropical Medicine Institute of Child Health Institute of Anatomy National Health and Medical Research Council World Health Organisation Commonwealth Grants National Fitness Appendix 1Appendix 2Directory of Senior Officers

--<'

37 40 46 52 55 57 60 62 66 70 73 79 83 84 88

91 94 97

.... 3

129 135

The Honourable A. J. Forbes, M.C., M.P., Minister for Health, Commonwealth of Austmlia I present herewith my report of the activities of the Commonwealth Department of Health for the year ended 30 June 1968

W. D. Refshauge, Director-Geneml of Health, 81 August 1968 Canberra, A.C.T.

Introduction

The year 1967-68 was one of steady progress and achievement and more noticeable public interest which promises to lead to further improvements in health services. Public interest in new medical methods and the means of applying health services is a great stimulus to progress but, at the same time, the need to maintain the efficiency of existing programmes must never be overlooked. Advances in chemotherapy do not remove the need for constant checks within the community against tuberculosis; the availability of vaccines as yet gives no real cause for the relaxation of exacting quarantine control; surgical ability to replace complete organs, although exciting and often lifesaving, would not always be necessary if early preventive medicine had kept these organs healthy. Much of the work of the Commonwealth Department of Health is concerned with services which, because they are effective and have become routine, are taken for granted. The routine checking of drug potency and the preparation of standards by the National Biological Standards Laboratory, the checking of levels of radio-activity and the maintenance and distribution of supplies of radio-isotopes by the Commonwealth X-Ray and Radium Laboratory and the work to improve the standards of dental equipment and materials carried out by the Bureau of Dental Standards are all functions of vital importance to the health of the community. It is also, of course, vital that the methods by which people pay for their health services should operate smoothly, and, in administering the National Health Benefits Schemes, the Commonwealth Department of Health carries out one of the major managerial operations in the country. In 1967-68 the Department supervised the expenditure of $298.2 million. In the field of pharmaceutical benefits alone it checked and paid chemists for some 55 million prescriptions. Such managerial operations are carried out as a matter of routine and the systems used are regularly reviewed in an endeavour to provide the most efficient possible service to the public. In addition to such important functions, the Department is constantly involved in a process of investigation and planning to keep abreast of changes in the pattern of public health. The provision of public health services is no longer a matter of finding methods and applying them with the public following professional advice because of the self evident advantages. The technical and social capabilities of modern society make it possible to achieve progress in almost any given direction. The big problem now in public health planning is the definition of priorities and the allocation of resources. It is now necessary to measure quite precisely the gains in human welfare available from alternative public health projects. At some stage we must begin to answer questions such as what standards of 5

health should be sought for the various age groups? Are we interested mainly in mortality-in keeping people alive~and do we care enough about morbidity-about how well they are from day to ~ay? How much further should we go in attempting to eradicate, as distinct from controlling, communicable diseases, and at what stage should we begin to divert resources to other areas? An increasing part of the Central Office functions o~ the Department is being devoted to the process of investigation and discussion necessary to present the Government with information on which decisions a,bout health matters can be made. Bodies such as the National Health and Medical Research Council and its committees, the Australian Drug Evaluation Committee and the Pharmaceutical Benefits Advisory Committee are supplied with information and the executive part of' their activity is carried out by the Department. Close and continuous liaison is maintained with State Health authorities, with professional bodies and with the World Health Organisation. It is only by the pooling of information and opinions from all such sources that the best sets of alternatives may be presented for decision. Australia is one of the fortunate countries in the world with well established public health services. But the health se~vices available to the majority of the world's population are still governed not so much by choice as by dire necessity. In April this year the World Health Organisation reached its 20th anniversary. In reviewing 20 years of endeavour, the Organisation concluded that while crash programmes against particular diseases could sow the seeds of better health, ~he most effective approach is still by way of developing indigenous,permanent health services geared to improving local environments. The World Health Organisation is, accordingly, continuing its policy of directing most of its energies towards these long-term unspectacular t~sks. In the long term, as the efforts to raise health standards throughout the world succeed in bringing more of the communicable diseases under control, the risks of international transmission of diseases should be very greatly reduced. In Australia we have reached a stage of medical sophistication in which renal transplant operations have become a normal surgical procedure and in which we have the skills and resources to attempt even more complicated organ transplants. There are, of course, many questions still to be resolved on this advanced frontier of medicIne. The National Health and Medical Research Council is at present studying some of these aspects, including the question of rationalisation of the facilities available for this type of su'rgery. But, dramatic as are the implications of this subject, the most immediate interest of the Australian population is still undoubtedly the efficient , operation and improvement of existing health services and benefits and the means by which they are provided. The problems posed by the mounting costs of health services and questions of financial responsibility are the matter~ which now seem in most urgent need of resolution. Two committees have been set up to investigate these problems. An independent committee appointed by the " Government and comprising Mr Justice Nimmo, Sir Leslie Melville and

Mr N. H. McIntosh, is enquiring into the health insurance aspects of the National Health Benefits Scheme. A Select Committee of the Senate is investigating medical and hospital costs. Preparation of the information required by the Committee of Enquiry and the Senate Select Committee has already called for a major effort on the part of the Department. In addition, studies are being made of various aspects of the provision of health services, including the particular needs of people suffering from chronic and long continued illnesses, and a review of the Pensioner Medical Service, which was requested by the Australian Medical Association, is being carried out. Health services in Australia are, of course, provided through a complex integration of local authority, State, Commonwealth and private interests. Another important area of discussion and liaison is therefore that which takes place between the Commonwealth and States and in June 1968 the annual meeting of the Commonwealth and State Ministers for Health took place in Darwin with the Commonwealth acting as host and providing the secretariat.

Management The volume and range of services provided through the Department involves it in an intensive managerial task. A highlight of management operations during the year was the completion of the programme of conversion rrom manual to computer processing of pharmaceutical benefit claims. The computer system was introduced initially to a small group of chemists in Queensland in July 1965, and progressively extended to all chemists in Australia. The conversion process was completed when prescriptions from the last group of chemists in Victoria were switched to the computer system in September 1967. The introduction of the computer system was a managerial project of considerable magnitude. The essential tasks of staff recruitment, training and re-training, informing chemists in detail of new procedures, installation and testing of data preparation equipment and procurement and fitting out of suitable accommodation had to be co-ordinated and carried out without disruption to the manual system of processing claims during the changeover period.

National Health Benefits Total expenditure on national health benefits, which comprise hospital, medical and pharmaceutical benefits and payments under the Pensioner Medical Service was $242.4 million in 1967-68. This was 6.8 per cent higher than in the previous year. The increase in hospital benefits was $7.4 million, or 10.9 per cent. This was mainly due to the increase from $3.60 to $5.00 in the payment to public hospitals for pensioners and the rise in the standard rate fund benefit for hospital fund special account contributors from $1.60 to $3.00 from 1 January 1967. The full effect of these increases was felt in the current year, when hospital benefits for pensioner patients rose from $18.7 million to $23.7 million and special account deficits from $3.8 to $4.5 million.

Payments made to doctors under the Pensioner Medical Service rose by 12.3 per cent to $16.1 million. The average number of services per enrolJed person fell from 8.0 in 1966-67 to 7.9 in 1967-68, and the increase in payments was due partly to the normal growth in the number of pensioners and their dependants for whom services are provided and partly to the higher fees payable to doctors as from 1 May 1967. Commonwealth payments for pharmaceutical benefits to the general public, pensioners and to hospitals were $105.1 millibn. In 1967-68, however, there was a substantial reduction in the rate of increase in Commonwealth expenditure for pharmaceutical prescriptions. For prescriptions for non-pensioners the increase was only $144,000 compared with $3.6 million in 1966-67 and for pensioners the increase was $2.8 million compared with $5.2 million in 1966-67. The to14l Commonwealth expenditure on pharmaceutical benefit prescriptions of $88.9 million in 1967-68 was thus only some $3 million more than the total for the previous year. This compares with increases of $8.8 million for 1966-67 and of $6.7 million for 1965-66. The increase in the numbe'r of prescriptions per heaq of population in 1967-68 was less than one per cent. Previously the smallest percentage increase since the broadening of the Pharmaceutical Benefits Scheme in 1960-61 had been 3.1 per cent and the average annual increase between 1960-61 and 1966-67 was 7.4 per cent. While the major factor in this reduction in the rate of increase was the absence of seasonal illnesses

COMMONWEALTH EXPENDITURE ON NATIONAL HEALTH BENEFITS

1967-68

Pharmaceutical Benefits

$105.1m

Hospital Benefits $74.8m

during the winter of 1967, I would like to point out that the growth rate for pharmaceutical benefits in 1967-68 was not significantly more than the percentage increase which could result from population growth, ageing patterns and other demographic and social factors.

Hearing Aids for Pensioners A new service introduced during 1967-68 was the prOVISIOn of hearing aids for pensioners. Under the scheme, announced in the 1967 Budget, hearing aids are provided by the Commonwealth Acoustic Laboratories for a hiring charge of $10. The scheme came into operation on a limited basis on 1 April 1968 in the metropolitan areas of Adelaide and Newcastle for pensioners in the 65 to 69 years age group. Subsequently, as laboratory facilities became available, the service was extended to the other State capitals and to some provincial cities. The testing of pensioners for hearing aids was initially limited to the 65-69 years age group to enable the Laboratories to deal swiftly with applications from individual pensioners. The service is now being progressively extended to all eligible pensioners and their dependants. In the period 1 April to 30 June 1968, a total of 1,190 pensioners had been tested for hearing aids and 978 had been issued with aids.

Quarantine Again during 1967-68 our quarantine defences were proved effective in keeping the country free of exotic diseases. The year, however, was marked by two situations which demonstrate the ever-present threat which diseases such as foot and mouth disease pose to our animal population. In the United Kingdom, an outbreak of foot and mouth disease which continued to spread, despite a well-planned and intensive campaign against it, caused very severe livestock losses. In May 1968 New Zealand authorities advised this Department that an unidentified disease had been reported among pigs on a farm near Auckland and that foot and mouth disease was a possibility. In accordance with contingency planning, it was necessary to act as if foot and mouth disease did exist in New Zealand. Immediate precautions on the movement of livestock, animal products and travellers were applied. Fortunately, the New Zealand authorities were soon able to confirm that the condition which had caused concern was not foot and mouth disease and the restrictions on trade and travel were 'removed. During the United Kingdom epidemic of foot and mouth disease, the Department arranged for twenty-two Australian veterinary officers to go to England to assist the Ministry of Agriculture, Fisheries and Food in its eradication campaign or to act as observers and study the procedures used. As a result, the pool of knowledge in Australia about foot and month disease has been greatly expanded. An aspect of quarantine planning which is now becoming important is the question of quarantine control methods for container handling of cargo. Speed in handling is vital to the full success of container cargo operations and methods of quarantine control must be devised which will 9

not interfere with loading and unloading cycles. During the year an officer of the Department visited overseas container terminals and had discussions with container operators. It is clear that accurate prior documentation of container contents will he fundamental to the intention to provide streamlined quarantine procedures which will both protect Australia from the introduction of diseases and, at the same time, avoid any unnecessary delay in the flow of goods. The use of computer data by the operators to provide a ready check on the history of each container will also be an important element in the quarantine control procedures. Meanwhile alterations to procedures to expedite the general quarantine clearance of ships and aircraft from overseas have already been made. On 1 June 1968 the hours of quarantine inspection for ships arriving from overseas were extended. Previously, except i~ emergencies or special circumstances, ships had been inspected only bet~veen sunrise and sunset. The hours have been extended and now are from 6 a.m. to 10 p.m. At the same time the radio pratique system was extended. Under this system a vessel's passengers and crew are not now subject to routine quarantine inspection if the vessel carries a qualified doctor who can advise by radio, before the ship berths, that all passengers and crew are healthy and that all vaccination certificates are in order. Previously this concession had been confined to certain large passenger liiners. As a check, unscheduled inspections will be made to ensure that this privilege is respected. Arrangements have also been made to speed up the quarantine clearance of aircraft passengers arriving in Australia. To eliminate the need for passengers on incoming aircraft to have their Australian addresses documented, arrangements have been made to obtain passengers' addresses, if necessary, from information in the possession of the Department of Immigration. Another new procedure is that International Vaccination Certificates are now being checked by trained quarantine assistants instead of, as in the past, personally by the attending quarantine doctor. These new procedures, which are carried out under the supervision of specially trained' medical officers, will allow the rapid clearance of passengers from new and larger jet aircraft expected in Australia in the . early 1970's. Under the old system long delays in passenger clearance would have been inevitable with aircraft carrying up tb 400 passengers. The vaccination of travellers against such diseases as smallpox is fundamental to international quarantine. In the calendar year 1967 there were 115,202 cases of smallpox notified to WHO-the highest figure since 1963. The greatest incidence of this disease was in South-East Asia, where a total of 86,288 cases were notified, and there were also high incidence rates in the African, Eastern Mediterranean anp, South American regions. Yet, all too frequently, travellers who had not been vaccinated arrived in Australia. It was necessary to quarantine 100 people who had not been vaccinated against smallpox and to vaccinate, immediately on their arrival, 2,748 more people whose vaccination certificates were not in order. Many other travellers who had not been vaccinated against such diseases as cholera, plague and yellow fever, or 'Yhose vaccination certificates were invalid, were also either quarantined pr vaccinated. 10

}II

It is vital to the health of Australia that all persons who are not properly vaccinated should be subjected to quarantine precautions and the utmost vigilance will be maintained to detect such potential disease carriers.

Territory Health Services Planning The planning, development and operation of health services in the Northern Territory and the Australian Capital Territory is becoming an increasingly complex function. In both territories the emerging needs of rapidly growing populations which are changing in social structure have to be met. In the Northern Territory the project to complete and equip stage one of the new Darwin Hospital was completed during the year. At the same time the planned development of the Katherine and Tennant Creek hospitals was continued and planning for major extensions at Alice Springs was carried further. At Gove, in north-eastern Arnhem Land, an entireJy new town of 3,000 people is to be built, in what is at present virgin bushland, as an aluminium ore mining industry is developed. This will involve the planning, construction and operation of a complete new hospital and the setting up of infant health, dental, district nursing and public health nursing services as well as the establishment of an aerial medical base. The provision of such services in the Northern Territory is a major task, but the biggest challenge for the Department is still the health of the Aboriginals. There has also been intensive planning for new health services for the Australian Capital Territory. Planning for a 600-bed hospital to be located in the Woden district of Canberra has been a major task. This will be one of the largest general hospitals to be planned and built as a single project for many years in Australia. Special care has therefore been taken to obtain the best possible balance between new concepts in hospital planning, proven needs and the necessity for flexibility to accommodate new needs and methods which may emerge in the future. A significant achievement in hospital planning for the A.C.T. has been adoption of the concept of integrated services for the existing and future hospitals.

Tuberculos,is Control There was further steady progress in 1967 in the campaign against tuberculosis. The number of notifications of new cases of the disease was 2,293, a fall of 256 on the previous year and an encouraging continuation of the downward trend evident in recent years. The total incidence rate also fell and, at 19.2 per 100,000, was, for the first time in Australia, below 20 per 100,000. At the same time the 2,293 new cases diagnosed in 1967 show that there is no reason for complacency, especially when it is realised that the majority of these patients will need treatment extending for from two to three years. The figures also show that there are 204 patients in Australia whose infectiousness has continued for more than twelve months. This very important group of patients is now receiving special attention in the campaign. 11

National Health Benefits

Hospital Benefits In 1967-68 Commonwealth benefits paid towards meeting the cost of hospital and nursing home treatment amounted to $74,750,000.

An important development in the hospital insurance scheme during the year was the introduction by the maj or registered hospital benefit organisations of increased fund benefits for long-term patients contributing to the higher benefit tables. These increased benefits were made available without an increase in contributions. In many instances the new benefits, when added to the Commonwealth Special Account benefit of $5.00 a day, are comparable with public ward charges even after the contributor has 'reached the limit of the maximum benefit. During 1967-68 the hospital funds paid a total of $81,787,000 as benefits to their contributors. This represented an increase of $12,776,000 or 18.5 per cent over the previous year. Statistics relating to hospital benefits are set out it Tables 2 to 9 on pages 101 to 104.

Pensioners in Public Hospitals Payments to public hospitals in respect of pensioners accommodated in public wards totalled $23,665,000 in 1967-68, compared with $18,731,000 in the previous year. The increase was due to two factors. There was a rise in the number of pensioners eligible for the ber).efit and 1967-68 was the first full year in which the rate of hospital behefit paid by the Commonwealth for pensioners in public wards was $5' a day compared with $3.60 a day previously.

Uninsured Patients in Approved Hospitals Expenditure on Commonwealth hospital benefits for uninsured patients fell from :j;2,376,000 in 1966-67 to $2,298,000 in 1967-68.1 It is considered that this slight decrease resulted from the increases I in the membership of health insurance organisations and in the numbers of pensioners who became eligible for free public ward treatment in public hospitals.

Nursing Home Patients The number of approved nursing homes and beds available for nursing home patients again rose during 1967-68. As a result of the increased number of nursing home beds and the continued increase in the aged sector of the population, Commonwealth nursing home benefits paid during the year totalled $24,486,000, an increase of $1,719,000 over the previous year. 12

Approval of Hospitals and Nursing Homes Details of new premises approved in 1967-68 as hospitals or nursing homes for the purpose of payment of Commonwealth benefits under the National Health Act are as follows:No. Beds No. Beds

HospitalsPublic .. Private. Totals

9 5 14

301 123 424

Nursing HomesPublic .. 2 47 Private. Totals 49

121 1,140 1,261

After allowing for variations arising from revocation of approvals and adjustment of bed capacities, the number of approved premises and beds at 30 June 1967 and 30 June 1968 were:30.6.1967 30.6.1968

Approved HospitalsNumber Beds Approved Nursing HomesNumber Beds

1,098 73,644 1,098 35,537

1,093 74,112 1,122 37,883

Medical Benefits A revised Medical Benefits Schedule was introduced in 1967 by an amendment to the First Schedule of the National Health Act and came into operation on 1 March 1968. The schedule, which sets out the medical services in respect of which Commonwealth medical benefits are payable and the amount of Commonwealth benefit for each service, is revised periodically to enable anomalies that may develop to be corrected and to include benefit amounts for new medical procedures. The revised schedule was the result of the work of a committee consisting of representatives of the Australian Medical Association and Departmental officers. For several years this committee has been engaged in examining the schedule with a view to the elimination of anomalies. The new schedule incorporates certain new items for which Commonwealth benefits are payable. Determinations made by the Minister since 1964 under Section 15A of the Act have also been included. Most funds revised their medical benefit tables to bring them in line with the new schedule. A further development during the year was the introduction by the registered medical benefit funds in all States except Western Australia of an increase in benefits in relation to some 128 surgical procedures. This was done without any increase in contribution rates. The increased 13

payments by the funds apply only to the top tables and range from $10 to $30 for major operations which attract Commonwealth ·benefit of $40, $50 and $60. As a result of these changes contributors to top medical benefit tables are eligible for insurance benefits totalling $180 against the cost of certain major operations. Most funds applied the increase to operations performed after 1 March 1968. Commonwealth medical benefits expenditure in 1967-68 amounted to $46,431,000 compared with $43,841,000 in 1966-67. The rhedical benefits funds paid out $52,576,000 to contributors compared with $48,941,000 in 1966-67. Of the total cost of medical services subject to Commonwealth benefit during 1967-68, 32.0 percent was borne by the Commonwealth, 35.4 per cent by the funds, and the remainder by contributors. In 1966-67 the comparative percentages were 32.2 per cent, 35.5 per cent and 32.3 per cent respectively. Statistics relating to medical benefits are set out at Tables 10 to 17 on pages 104 to 107.

Special Accounts-Hospital and Medical Benefits There were no changes to the Special Account system during 1967-68. The system enables registered hospital and medical benefit organisations to provide assured rates of fund benefit, known as 'standard rate', to contributors who otherwise would have been excluded from fund benefits because the pre-existing ailment, chronic illness or maximum fund benefit rules. Commonwealth expenditure on advances to hospital benefit organisations for Special Account purposes and on reimbursement of deficits incurred in hospital fund Special Accounts totalled $4,494,000 in 1967-68. The corresponding amount in respect of medical fUl;Jd benefits was $956,000. At 30 June 1968 the membership of the hospital fund Special Accounts was 32,558. The membership of the medical fund Spedal Accounts was 33,650.

Registration Committee The functions of the Registration Committee are to examine, and to make recommendations to the Minister for Health in regard to, applications for registration as medical and/or hospital benefits organisations and proposed changes to the rules of organisations. The Committee met 35 times in 1967-68 and made recommendations on 369 proposals submitted by organisations. The Committee also considered an application by one organisation for cancellation of registration under the Act. The Minister approved the application on the recommendation of the Committee. 14

Commonwealth Health Insurance Council The Commonwealth Health Insurance Council met in Canberra from 28-30 November 1967. At this meeting the Council discussed a wide range of matters concerning the hospital and medical benefit schemes. The matters discussed included investments of fund reserves and the granting of hospital benefits for non-chronic, pre-existing ailments after three years' continuous membership. The functions of the Council are to advise the Minister for Health on matters relating to the hospital and medical benefits schemes and to recommend means by which improvements in methods and standards may be effected.

Committee of Enquiry into Health Insurance In April 1968 the Government appointed an independent Committee of Enquiry into Health Insurance and preliminary meetings were held in May and June prior to the holding of formal meetings in each State Capital commencing in July. The terms of reference of the Committee are:(A) To enquire into-

The types of and amounts of benefit provided by benefit tables offered by organisations registered under Part VI of the National Health Act 1953-1967, and the numbers of such tables. The extent to which the fund benefits available provide coverage against the cost to contributors of medical and hospital treatment. The rates of contributions payable by contributors to registered organisations, having regard to the financial needs of the organisations and the effect of these contribution rates on the willingness of individuals to insure. The limitations imposed by the rules (including the Special Account rules) of registered organisations in respect of benefit payments. The limitations imposed on individuals by the rules of registered organisations on becoming a contributor to an organisation or transferring to a different benefit table in the same organisation. The policies pursued by registered organisations in the application of their rules relating to the transfer of contributors to Special Accounts. The methods used by registered organisations in paying benefits. The methods used and costs incurred by registered organisations in collecting contributions including the rates of commissions and fees paid to collecting agencies.

7 8

The expenses incurred in administration and management, including the payment of benefits. 10 The level of reserves maintained by registered organisations for hospital and medical insurance purposes. 11 The policies followed in the investment of such reserves and of other monies arising f'rom contributions to hospital and medical benefit funds. 12 The overall management, administration and financial operations of the registered organisations. 13 The extent to which there is effective contributor representation in the administration and policy making of registered organisations. 14 The effects of activities pursued by registered organisations in competing for members. 15 The extent and form of competition that is desirable between registered organisations. 16 Whether the interests of contributors would be better served if there was a greater or a lesser number of registered organisations. (B) To make such recommendations to the Minister in relation to the above matters as the Committee deems necessary. (C) To make such other recommendations to the Minister as the Committee deems necessary in relation to the provision of adequate financial protection against the cost of illness in the context of both a voluntary health insurance scheme, and the obligations at present accepted by the State Governments.

-. ~-.

Pensioner Medical Service In the previous report it was mentioned that the Australian Medical Association had deferred a decision on the admission into the Service of those persons who, as a result of the relaxation of the pensions means test and a corresponding amendment, effective from 21 April 1967, to the definition of 'pensioner' in the National Health Act, became eligible for the benefits of the Pensioner Medical Service. In November 1967, the Australian Medical Association agreed to the enrolment of those persons in the Service, subject to an assurance that a full scale review of the Pensioner Medical Service would be in progress before the next Federal Assembly of A.M.A. This condition was agreed to and the review is at present being undertaken. The Pensioner Medical Service is now available to those persons, and their dependants, who are in receipt of an age, invalid or widow's pension or a sheltered employment allowance under the Social Services Act, a pension under the Repatriation Act, or an allowance under the Tuberculosis Act. At 30 June 1968 the number of pensioners and dependants enrolled in the Service was 1,115,000, an increase of 72,000 over the number enrolled at the end of the previous financial year. The number of doctors participating in the Service increased during the year to 6,333 at 30 June 1968, compared with 6,175 at 30 June 1967. 16

Payments to Doctors

otal payments during the year to doctors amounted to $16,115,000, an :r Increase of $1,764,000 over the figure for 1966-67. As stated in the introductory chapter of this Report, the increase in total payments was due partly to the normal annual increase in the numbers of pensioners and their dependants and partly to the higher fees payable to doctors from 1 May 1967.

Committees oj Inquiry In accordance with the provisions of Section 110 of the National Health Act, Medical Services Committees of Inquiry have been established in each State. The functions of these committees are, among other things, to inquire into matters in respect of the services or conduct of medical practitioners in connection with the provision of medical services under the Pensioner Medical Service. In 1967-68, forty-three references to these committees concerning the provision of medical services to pensioners were considered. In twenty-two of these cases a total reduction of $25,842 was made to doctors' claims. In two cases the medical practitioners also were reprimanded by the Minister. In twenty-one cases no recovery action or reprimand was recommended by the committees.

Pharmaceutical Benefits A feature of the year's operations was a sharp reduction in the annual rate of increase in the volume of pharmaceutical benefit prescriptions. An overall increase of 1.7 million benefit prescriptions or 3.2 per cent, was recorded compared with an increase of 3.7 million, or 7.4 per cent, in 1966-67 over 1965-66. This represents the lowest annual increase in benefit prescription volume since the inception of the broadened Pharmaceutical Benefits Scheme in 1960-61. The major factor contributing to this result was that during the colder months of 1967 there was little evidence of widespread outbreaks of seasonal ailments. For the months Df July, August, September and October there were 800,000 fewer pharmaceutical benefit prescriptions passed for payment than for the same months of 1966. Prescribing of pharmaceutical benefits for pensioners increased to a greater extent than that of benefits for non-pensioners. In 1967-68 the number of prescriptions provided for pensioners totalled 18.37 million and for non-pensioners the total was 37.05 million. This represented a rise over the 1966-67 figures of 1.43 million prescriptions for pensioners and of 300,000 prescriptions for non-pensioners. When the population increase factor is taken into account this meant that the number of prescriptions per head for non-pensioners during 1967-68 was actually lower than in the previous year. This was the first time since the inception of the Pharmaceutical Benefits Scheme that the number of prescriptions per head for the general public had fallen. The rise in the volume of prescribing for pensioners was partly due to pensioner benefits becoming available to enrolled persons who were formerly provided for under the general benefits scheme and partly to the easing of restrictions on the prescribing for pensioners of drugs in the anti-depressant group. 17

PHARMACEUTICAL BENEFITS 1960-61 to 1967-68 NUMBER OF PRESCRIPTIONS

IiliillI •

Pensioners

Excluding Pensioners

1960-61

1961-62

1962-63 1963-64

1964-65 1965-66

1966-67

1967-68

PHARMACEUTICAL BENEFITS 1960-61 to 1967-68 EXPENDITURE

[]ill

Patient Contribution Hospitals

~ Pensioners

liliiii

Excluding Pensioners

<:: '"

°E '" 50

1960-61 18

1961-62 1962-63 1963-64 1964-65 1~o5-oo 1966-67 1807-00

The number of prescriptions per head of population for the combined pensioner and non-pensioner groupings rose to 4.65 compared with 4.61 in 1966-67. The average cost per prescription remained unchanged at $1.94 and the cost per head of population rose by only 6 cents, or 0.7 per cent, compared with 70 cents, or 8.5 per cent, in 1966-67 over 1965-66. Details of relevant statistics are shown in Tables 27 to 30 on pages 111 to 112. The volume of prescribing for drugs in the high and relatively high cost groups-for example diuretics, drugs acting on blood vessels, tranquillisers and anti-depressants and erythromycin-continued to increase in 1967-68. The following comparative table shows prescribing volume and costs for benefits provided in the more frequently prescribed therapeutic groups in 1966-67 and in 1967-68:Year Ended 30 June 1967 1968

Therapeutic Category ~'.

Prescrip- Expenditions ture OOO's SOOO's 4,564 4,216 2,868 2,242 4,286 6,792 2,974 1,087 813 803 1,538 1,207 553 1,048 74 353 869 966 598 920 1,167 13,872 9,500 9,278 7,512 8,729 6,893 5,223 2,663 2,871 2,339 1,856 2,263 2,038 1,663 324 1,338 1,403 1,307 1,102 1,025 973

Prescrip- Expenditions ture $OOO's OOO's 5,049 4,353 3,040 2,515 4,362 6,651 3,342 1,246 907 899 1,896 1,259 605 1,152 411 387 934 1,078 665 1,027 1,072 13,619 9,338 10,427 8,647 8,448 6,476 5,828 3,201 3,178 2,673 2,429 2,338 2,222 1,823 1,524 1,504 1,459 1,422 1,212 1,151 898

Broad Spectrum Antibiotics . Penicillins Blood Vessels-Drugs Acting On Diuretics Analgesics Sedatives and Hypnotics Anti-Histamines Genito-Urinary Infections-Drugs Acting On Anti-Cholinergics Tranquillisers Antacids Heart-Drugs Acting On Anti-Diabetic Eye Drops Anti-Depressants Anti-Convulsants Bronchial Spasm-Preparations. Sulphonamides . Gastro-Intestinal Sedatives Iron Preparations Expectorants and Cough Suppressants

Cost of the Scheme The total cost of pharmaceutical benefits, including patients' contributions on prescriptions for benefits available to the general public, amounted to $123,638,789. This was an increase of $4,010,954, or 3.4 per cent, over the amount of $119,627,835 recorded in 1966-67 and is considerably less than the $10,362,933, or 9.5 per cent, increase in 1966-67 over 1965-66. Va"iation from 1966-67

$ The increased costs were distributed as follows:Increased Commonwealth expenditure onBenefits available to the general public. Benefits provided in public hospitals and miscellaneous services Pensioner Pharmaceutical Benefits Total increased Commonwealth expenditure Increased patient contribution on prescriptions available to the general public. 144,310 874,267 2,835,068 3,853,645 157,309 $4,010,954 As the average cost per benefit prescription remained the same as the 1966-67 figure, the increase in the cost of prescription benefits was due to an increased prescription volume which, as previously stated, was not as great as in previous years. Overall prescription volume increased to 55,422,846, compared with 53,687,342 in 1966-67. The increase in payments for drugs used in hospitals was due mainly to the addition of new drugs to the list of benefits available to patients in hospital, an overall increase in hospital prescribing and to an acceleration in the settlement of payment claims by hospital authorities. Details of related statistics are shown in Table 24 on page 110. As a service to doctors, Departmental pharmacists for some years past have been visiting doctors to discuss matters associated with the Pharmaceutical Benefits Scheme. To increase the value of this service more information on their prescribing will now be available to doctors. This information has become available from the computer system following the changeover to automatic processing of chemists' claims.

Changes of Listing An important administrative change was made during the year to amend the list of benefits more frequently than in the past. This was done with the agreement of the Australian Medical Association and the Federated Pharmaceutical Service Guild of Australia. Previously it has been the practice to add new drugs to the list at six monthly intervals. However, during 1967-68, arrangements were made for changes in the list to be 20

made three times a year, following each meeting of the Pharmaceutical Benefits Advisory Committee. At the same time, the books which the Department sends to doctors and chemists and which include the Schedule of Benefits, are now being published three times a year. From the point of view of doctors and chemists, the new arrangements mean that there is a lesser number of changes to be assimilated on each occasion. The most important feature of the change, however, is that new drugs are made available at more frequent intervals than in the past and this undoubtedly improves the service provided under the Pharmaceutical Benefits Scheme. As a result of recommendations by the Pharmaceutical Benefits Advisory Committee, twenty-eight new drugs, including two new antibiotics and a new anti-diabetic preparation, were added to the list of pharmaceutical benefits in 1967-68. Another twenty-eight new forms and strengths of existing benefits were also added to the list. In addition to those new items, a further four preparations have been made available as pharmaceutical benefits under special arrangements because of their specialised nature and because the supply of them is limited. The most interesting of these are two hormones extracted from human pituitary glands at the Commonwealth Serum Laboratories, namely human growth hormone and human follicle stimulating hormone. The growth hormone is used for long-term treatment of children who are dwarfed because their own pituitary glands do not naturally produce sufficient of this hormone. The follicle stimulating hormone is restricted as a benefit to particular cases of infertility in women where the natural production of this hormone is defective. Both hormones are in extremely short supply and it has been necessary to restrict their availability as benefits to individual cases. The supply of the hormones is being authorised by special expert committees which have been established to screen all applications for their use. The third of the new special benefits is an anti-haemophilic factor of animal origin which is used in the treatment of particular cases of haemophilia (a disease cha'racterised by uncontrollable bleeding) where the human anti-haemophilic factor is not suitable. This new benefit can be obtained through the Director of the Red Cross Blood Bank in each State who, after consideration of the case, may arrange supplies from stocks held by the Commonwealth Serum Laboratories. The fourth special benefit is a new antivenene against the sting of the stonefish. Supplies of this antivenene have been placed in hospitals in the areas of Northern Australia where stonefish are found. During the year a large number of changes were made to the restrictions applying to the prescribing of preparations as pharmaceutical benefits. Most of these changes were to make drugs available for the treatment of a wider range of diseases and conditions. One example of this was in regard to quinine tablets. Because of a world-wide shortage of this drug it had become necessary to restrict its availability as a pharmaceutical benefit to the treatment of malaria only. However, when further supplies became available it was then possible to ease the restrictions to make quinine available to pensioners for any disease or purpose.

As a result of the regular review of the list of benefits by the Pharmaceutical Benefits Advisory Committee, thirty-three preparations were deleted from the list of ready prepared pharmaceutical benefits and twenty-seven items from the list of drugs available for use as ingredients of preparations compounded by chemists from doctors' directions. Most of the items deleted had fallen into disuse because they had been superseded by more effective preparations.

Price Negotiations During 1967-68, as in previous years, negotiations regarding the prices of pharmaceutical benefits were conducted with manufacturers. These resulted in reductions in prices of preparations which would save the Pharmaceutical Benefits Scheme approximately $1,400,000 in a full financial year if the rate of prescribing remained constant. The most significant price reductions were in respect of tetracyclines and penicillins, which are among the most widely prescribed of the drugs listed as pharmaceutical benefits. The total savings from price negotiations was much less than in 1966-67 and reflects the effect of substantial price reductions negotiated in previous years for frequently prescribed drugs. For example, tetracycline capsules, which cost $23.31 per 100 wholesale in 1963, now cost $8.81. As stated earlier there were increases in prescription volumes in the high and relatively high cost groups of drugs and this tended to offset the effect of price reductions in the final level of pharmaceutical benefits expenditure.

Joint Committee on Pricing Arrangements The activities of the Joint Committee on Pharmaceutical Benefits Pricing Arrangements during the year included the revision of purchase units for drugs used in extemporaneous preparations and the revision of purchase units for containers. The survey of pharmacy earnings, costs and profits continued to be the Joint Committee's major concern during 1967-68. Constant liaison regarding the progress and conduct of the survey was maintained with the independent firm of consultants engaged to carry out the survey. Last year's Annual Report noted that, at the close of 1966-67, the survey was still in progress. The year 1967-68 saw the presentation of the consultants' report on the survey and acceptance of the report by the Joint Committee. At the close of 1967-68 both the Department and the Guild were analysing the survey results.

Committees of Inquiry The Pharmaceutical Services Committees of Inquiry considered forty-two references in 1967-68 concerning the services or conduct of pharmacists approved to supply pharmaceutical benefits. The references mainly concerned the supply of pharmaceutical benefits which failed to meet the required standards. 22

These cases of faulty dispensing were revealed by the Department's continuous programme of sampling of chemists' dispensing of pharmaceutical benefits. It is pleasing to note that there has been a significant reduction in the number of references of this type to the Committees of Inquiry during the past year. The actual number of references was less than half the number in 1966-67. Following the Committees' recommendations on these references, nineteen chemists were warned to exercise greater care in dispensing, three were reprimanded with the reprimand appearing in the Commonwealth Gazette, four were reprimanded without gazettal and the approvals of two chemists were suspended for one month. There were fourteen cases not finalised at 30 June 1968. The Medical Services Committees of Inquiry considered three references during the year involving the prescribing of pharmaceutical benefits. As a result of the Committees' 'reports and recommendations, amounts of $694.54 and $33.10 respectively were recovered from two doctors for irregular prescribing .of benefits. No action was taken in the third case as the Committee was satisfied with the explanations placed before it.

Overseas Visits The Assistant Director-General and the Director of the Pharmaceutical Services Branch visited New Zealand during the year and made an examination of the New Zealand Pharmaceutical Benefits Scheme with particular reference to the various points of difference between the two schemes.

Planning and Legislation

The Planning and Legislation Branch of the Management Services and Benefits Division is responsible for the administration and co-ordination of the policy, legislation and research functions of the Department, for ministerial and Parliamentary liaison and for public relations.

Policy and Legislation During the year, the Policy and Legislation Section of the Branch continued to investigate, advise and prepare papers on changes in policy and the development of new policies. The Policy and Legislation Section is also responsible for the drafting, development and processing of draft legislation at both the Commonwealth and Territory levels. In the field of Commonwealth legislation, work proceeded in three important areas. The first concerns measures for the control of drugs imported into Australia that have not been proved therapeutically. The second concerns revisions to the Quarantine Act, including review of all the penalty provisions of the Act. The third concerns the preparation of draft regulations to the Therapeutic Goods Act 1966. Work on Territories legislation in ,the past year was directed mainly towards a major review of legislation for the control of poisons, dangerous drugs and narcotics, for the control of radioactive sUbstances and irradiating apparatus, and for the control of private hospitals and nursing homes. Four amending ordinances and regulations were made during the year for the Australian Capital Territory and five for the Northern Territory. The Policy and Legislation Section was also responsible for the organisation of the Commonwealth-State Health Ministers' Conference in Darwin in June 1968.

Research The Research Section has continued and, in some cases, enlarged the scope of projects which were begun last year, and has undertaken investigations into aspects of health services which have not been previously explored. The main effort has been concentrated on analysis of the operating costs and incomes of hospitals and nursing homes. Details of the incomes of approved public hospitals, similar to those published for earlier years in the September 1967 edition of • Health', will shortly be available for 1966-67. Some dissection of expenditure has also been undertaken for this year. A survey of uninsured patients in private hospitals has also been completed for 1966-67, and currently a sample survey of charges for all patients is being conducted. A new project undertaken was a survey of operating income and expenditure during 1966-67 of home nursing organisations receiving a subsidy under the Commonwealth Home 24

Nursing Subsidy Scheme It is dt . with r.equests for ~urthe~ .pertin~~l~!~ail~ ~~~~nt~~ t;~:e~~~~::'a~~s~~7s DetaIls publIshed in the statistical supplement to the 46th Report of the Commissioner of Taxation provided an opportunity to analyse the range of incomes of the medical and related professions and to observe the effect on income of allowable tax deductions related to medical expenses. Statistics and comments were published in the March 1968 issue of 'Health '. One of the functions of the Research Section is to service the National Medical War Planning Committee and its Standing Committee. The National Medical War Planning Committee, its Standing Committee, the nine sub-committees and the State Medical Planning Committees met on a number of occasions during the year. Considerable progress was made in the compilation of lists of essential instruments and drugs and trade surveys of some essential items were commenced to assess what reserve stocks could be relied upon in an emergency. In addition, it has been decided to produce a model plan for the utilisation of medical resources and manpower under emergency conditions. The purpose of the model plan is to ensure that emergency medical planning throughout Australia will be uniform and it is proposed to give the model plan to the States as guide in the development of operational plans to meet each State's needs. In some instances the representation of State authorities on State Medical Planning Committees has been increased to enable greater co-ordination of Commonwealth and State facilities and planning. In the past the work of the National Medical War Planning Committee and its supporting committees had not been publicised. As the medical profession would playa vital role in the event of a disaster, arrangements are being made for a series of articles, dealing with the various medical and para-medical responsibilities and activities in a disaster, to be prepared in a form suitable for publishing in medical journals. This will enable the medical profession to be aware of the plans and afford an opportunity to contribute to them. The National Medical War Planning Committee recommended submission of an item to the 1968 Conference of the Commonwealth and State Health Ministers proposing the extension of the teaching of first aid. The Ministers agreed that training in first aid, with a view to having a trained person in each home, was desirable on a national basis and that the teaching of first aid should be encouraged.

of patIents.

Public Relations A Public Relations Section was established within the Branch during the year to co-ordinate the publishing and information activities of the Department. The volume of published material from the Department has increased markedly in recent years and there has been a similar increase in the general public interest in the activities of the Department. The Public Relations Section is now planning, editing and distributing the Department's publications and providing a general information service to the Press and public.

Establishments and Finance

The Establishments and Finance Branch of the Management Services and Benefits Division provides the management services to the Central Office of the Department and, in some specialised areas, to the State and Territorial offices. It is made up of four sections :-Establishments, Organisation and Methods, Finance and Automatic Data Processing. The Management Services group have been giving particular attention to the requirements involved in the proposed re-location of the Central Office of the Department in a new building at present under construction at the Woden District Centre in Canberra, some four miles from the Parliamentary Triangle. The building will be of nine storeys, with a threestorey annexe, and is expected to be ready for occupation early in 1969. A considerable amount of work has been involved in planning the layout of the accommodation and in planning communications and other facilities in the new building.

Establishments Major reviews of the Finance Section, the Medical and Hospital Branch and the Planning and Legislation Branch were completed during the year as well as many minor variations to the establishments of the various other Branches of Central Office and the States. The A.C.T. Health Services Branch has been considerably expanded. A position of Senior Specialist has been created in the Branch to control psychiatric services. A position of specialist (child psychiatry) has also been created to direct the activities of the Child Guidance Clinic. An immunisation team, consisting of a Medical Officer and Nursing Sister, has been formed to undertake the immunisation of pre-school and school children in the A.C.T. Schools. The Commonwealth Health La,boratory Service is at present being completely re-organised and schemes are in operation to train medical laboratory technologists and technical officers for duty in the laboratories. This is a long range plan and will take some years to fully implement. The necessary establishment was created to enable the recently introduced Pensioner Hearing Aid Service to commence operation.

Organisation and Methods The work of the Organisation and Methods Section of the Department falls into several categories. It undertakes cyclical reviews of sections and establishments within the Department to ensure that organisational structures are adequate and that work methods are modern and efficient. It examines those problems which arise from time to time outside the pattern of cyclical reviews but which involve questions of organisation and/or methods.

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During the year reviews were carried out in the Pharmaceutical-A.D.P. areas in Sydney and Hobart, the Administration and Finance area in Sydney, the Tuberculosis Division, the Office Registry and the International Health Section. A methods review was carried out in the Uninsured Benefits and Review Sections of the Medical and Hospital Branch, Central Office and a major review of the National Health Division is in progress. Office communications systems were improved during the year. Telex installations now exist in Central Office, the seven divisional offices, the Alice Springs Hospital and the four Health Laboratories in Queensland. An offset duplicating machine and a centralised dictation service were installed in Central Office.

Finance The Finance Section of the Department is responsible for the overall supervision and co-ordination of the expenditure and revenue of the Department. The accounting arrangements cover a widely diversified field of activity involving, for example, payments from the National Welfare Fund to such groups as registered hospital and medical benefit organisations, doctors, chemists, State governments, hospitals and bush nursing organisations. During the year, a comprehensive review of the organisation of the Finance Section in Central Office was undertaken and approval has been given to strengthen the organisation. The new organisation provides for four groups within the Section, namely, Central Office-A.C.T. Accounts and Funds and Estimates; Procedures Investigation; Revenue Review and Commonwealth Serum Laboratories. Action is in hand to fill the new positions stemming from the re-organisation .

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Automatic Data Processing Automatic Data Processing was extended during the year to cover all chemists dispensing pharmaceutical benefit prescriptions. In addition, information systems supporting the managerial and administrative aspects of the Pharmaceutical Benefits Scheme were further developed and implemented. The new system has provided the Department with the capacity to accommodate increasing prescription volumes without reduction in processing efficiency, for more satisfactory methods of internal control and for more effective managerial control of the scheme in general. It has also relieved the chemist of much of the clerical burden which he was required to bear under the former processing method. A considerable amount of effort during the year was directed towards programme reviews and systems re-design to take advantage of the additional computing facilities provided at the Computer Service Centre during 1967 and to increase the flexibility and strength of the Department's computing systems. Difficulties were, however, experienced in meeting the Department's increasing computing demands within the time available at the Computer Service Centre. As delays in the processing of chemists' claims must always be kept to a minimum, backlogs in the area of management infor27

mation processing were unavoidable. This had a significant effect on pharmaceutical benefits administrative processes and cost control measures, which are now largely dependent upon the computer for information and on the rate of data processing development achieved throughout the year. Some assistance was provided by ad hoc allocations at the C.S.I.R.O. Computer Centre. The question of meeting the future computing requirements in other functional areas of the Department and of maintaining and further developing existing computing systems is currently under close consideration.

Tape being prepared at the Melbourne office of the Commonwealth Depa;rtment of Health for data processing of chemist.' cla·ims

Quarantine

Human Quarantine Australia was again kept free from human quarantinable diseases in 1967-68 despite the ever-increasing volume of international travel and a world disease picture in which smallpox and cholem continued to take a heavy toll. Quarantine stations in each State were kept in constant readiness to receive any case, 'Or potential case, of quarantinable disease which may have occurred 'Or been imported 'On an incoming vessel or aircraft. The human quarantinable diseases are plague, smallp'Ox, cholera, yell 'OW fever, typhus fever, lepr'Osy and any 'Other disease declared by pr'Ociamati'On. To prepare f'Or the advent 'Of new and larger aircraft, the planned introduction of container handling of cargo, the c'Onstruction 'Of new ports in Australia for bulk-l'Oading cargo vessels and increased activity in the shipping trade, procedures f'Or the quarantine clearance of vessels and examination 'Of inc'Oming passengers were reviewed during the year. The alterations to procedures are outlined on page 10 of this report. The number 'Of vessels and persons being cleared through quarantine increases each year. In 1967-68 4,440 ships and 4,968 aircraft, carrying a t'Otal 'Of 873,734 pers'Ons, passed thr'Ough quarantine. This c'Ompares with 4,040 ships and 3,918 aircraft carrying a t'Otal of 781,756 pers'Ons in 1966-67.

Smallpox Smallpox has never been introduced by air into Australia. Very few countries, if any, can claim this record. The careful medical inspection of all incoming passengers and examination 'Of their vaccination certificates t'Ogether with close attenti'On t'O every 'Other detail 'Of quarantine procedures have contributed c'Onsiderably towards keeping Australia free fr'Om quarantinable diseases. The disease threat posed by smallpox is, h'Owever, an ever-present one. As previously menti'Oned, in 1967 smallpox outbreaks 'Occurred in several African and South American countries and, in Asia, there were epidemics in Ind'Onesia, Afghanistan, India and Pakistan. Australia's quarantine requirements are notified in 'Official publications on international quarantine. Shipping and airline companies are informed 'Of these requirements and of any amendments which may be made. Despite this, unvaccinated travellers continue t'O arrive in Australia and during 1967-68 it was necessary to quarantine 100 people wh'O, for various reasons, were n'Ot vaccinated against smallpox. This figure compares with 71 cases in 1966-67. Some travellers arrived without vaccination certificates 'Or with certificates which were invalid. For these reasons it was necessary to vaccinate 2,748 persons against smallpox on their arrival iby air. 29

Cholera Cholera occurred in India, Indonesia, Malaysia, Pakistan, the Philippines, Thailand and Vietnam. Isolated cases were also reported from Cambodia and Singapore. However, despite the proximity of these countries, and the increasing air traffic, Australia remained free from this disease. To ensure that travellers are adequately protected against cholera, Australia's requirements are that all persons over the age of 12 months arriving from proclaimed cholera areas must possess valid vaccination certificates. During 1967-68 it was necessary to vaccinate 919 travellers who arrived by air without satisfactory vaccination certificates for cholera.

Yellow Fever The principal mosquito vector of yellow fever, Aedes negypti, is widely distributed in Australia, a fact which makes this country vulnerable to the disease unless adequate precautions are taken. Accordingly, all travellers arriving in Australia from endemic areas in the African and American continents must be currently vaccinated against yellow fever. The routine spraying of aircraft on arrival ensures that infected mosquitoes are not introduced. In the past year two persons who arrived in Australia by air in an unvaccinated state or with invalid or immature certificates for yellow fever were quarantined.

Plague One of the main factors in guarding against the introduction of plague is the regular inspection of ships to ensure freedom from rodents. This is carried out by officers of the Quarantine Service, who also undertake the fumigation of ships and trapping of rats where necessary. Particular vigilance is necessary at present due to the prevalence of this disease in South Viet Nam. The disease has also been reported in the Congo and Madagascar, in Brazil, Ecuador and Peru, in four States of the United States of America and in Burma, Nepal and Indonesia. The reports received do not differentiate between human and rodent plague and it is therefore not known in how many of these countries human plague actually occurred. It is known, however, that plague in human beings did occur in South Viet Nam and Madagascar. All sea vessels arriving in Australia must be in possession of a current de-ratting -certificate or an exemption certificate in the form prescribed by the World Health Organisation.

Control oj Imports The quarantine service administers controls over importations of viral and bacterial cultures, pathology and animal specimens, and any substances which may carry disease. Applications for the importation of medical appliances are also examined by medical officers of the Quarantine and Laboratories Division. This is done in close liaison with the Department of Customs and Excise.

Facilitation in Quarantine Quarantine activities concern people, commercial interests, ships, airRepresentatives of the various b~dles c?ncerne~ v.:it? t?e transport of people and goods confer regularly wIth a VIeW to dlmlnIshmg delays and generally to facilitating the passage of travellers and merchandise requiring quarantine and other necessary formalities. This work is also carried out at international levels. In addition to representation on local and national facilitation committees, the Department was represented in May 1968 by a senior medical officer at the Seventh Session of the Facilities Division of the International Civil Aviation Organisation which was held in Montreal.

cra~t, and Government departments.

Animal Quarantine The animal disease which has perhaps exercised the minds of veterinarians and Animal Quarantine authorities most during the past year has been foot and mouth disease. The epidemic in the United Kingdom once again demonstrated the drastic stamp-out measures that have to be taken by any country intent on preventing this disease from becoming endemic. This epidemic, and the suspected outbreak in New Zealand in May 1968, which fortunately proved negative, focussed considerable public interest on Australia's existing quarantine defences. The New Zealand incident indicates Australia's careful attitude towards possible new avenues of risk. Australia immediately imposed stringent precautions on the importation of meat, meat products and livestock and controls on travellers from that country and maintained these restrictions until it was finally determined that New Zealand did not have foot and mouth disease. The precautions taken in this case indicate what are considered to be the most likely means of virus importation-meat, meat products and live animals. The importation of the virus of a disease such as foot and mouth disease has traditionally been associated with uncanned meat and livestock. The virus cannot be effectively detected in consignments of meat, and like most other animal disease viruses, can survive for a long time in frozen or chilled meat. Hence Australian legislation regarding the importation of meat and meat products is explicit and strictly controls their importation. At present, and for several disease reasons, the importation of animals susceptible to foot and mouth disease is prohibited. Hence there is no avenue for the introduction of this disease with living animals. However, it is possible for diseases of animals to enter a country in many ways and our quarantine defences are designed to cover all areas of risk. In addition to the prohibition on the importation of susceptible animals and the controls on meat and meat products, the Quarantine Service exercises equal vigilance where such things as hides and skins, various hormone preparations and biological products, animal semen, eggs and milk are concerned. Among the possible means of entry of foot and mouth disease virus is the soiled footwear and clothing of incoming passengers from an

endemic area who have had contact with farm animals or meatworks. Not all countries agree that this possible avenue of transmitting infection is significant, but Australia, like New Zealand and the Repuhlic of Ireland, does not neglect even this aspect of quarantine.

A Quarantine Officer prepares to disinsect the cargo hold of an overseas airliner

Publicity More attention is now being devoted to the public relations aspect of Animal Quarantine and the Department has embarked on a programme involving several publications and a film. Early in the year a leaflet outlining Animal Quarantine requirements was published for distribution to Service personnel serving in Asian areas. A foot and mouth disease information pamphlet has been distributed throughout Australia, with the help of the State Departments of Agriculture. This pamphlet was designed for stockowners and describes the disease in simple terms to enable a quick report of suspicious symptoms of the disease if it should break out in this country. The Animal Quarantine Branch has also produced a general information pamphlet on the various activities of Animal Quarantine for distribution to the travelling public. A separate programme has been planned to impress on migrants from Southern European countries the danger of importing certain foodstuffs of animal origin. Printed material and a short cartoon film will be used in this campaign. The Department has also begun the publication of a quarterly Animal Quarantine Newsletter. This pUblication is now being distributed to veterinarians, universities, primary producer organisations, other groups and individuals interested in veterinary hygiene. Arrangements have also been made for the publication and distribution of a booklet providing information on Animal Quarantine for the guidance of importers of animals and animal products.

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Training of Veterinarians As mentioned in the introductory section of this report, twenty-two Australian veterinary officers were sent to England during the 1967-68 epidemic of foot and mouth disease in that country to assist in thE eradication of the disease and to observe at first hand the course of the disease and the methods used to combat it. Fourteen of these veterinary officers worked in the field during the eradication campaign and eight senior officers made studies of the campaign methods. As in past years arrangements were made for two veterinarians, one from the Victorian Department of Agriculture and one from the South Australian Department of Agriculture, both of whom are Quarantine Officers, to attend the Canadian Department of Agriculture's exotic diseases course at the Grosse lie Experiment Station, Quebec.

Overseas Visits The Director of Veterinary Hygiene attended the Australian-New Zealand Technical Committee on Animal and Plant Quarantine and the inaugural meeting of the Animal Health Advisory Group of the South Pacific Commission, which were held in Wellington, New Zealand, in March 1968. In May 1968 he attended the annual meeting in Paris of the Office International des Epizooties, as the Australian delegate.

Two Senior Veterinary Officers from the Animal Quarantine Branch were among those who visited the United Kingdom in November and December 1967 to study the methods used in the campaign there against the foot and mouth disease outbreak. One of these officers also investigated the operation of the proposed container freight service from London to Australia. In February 1968 a Senior Veterinary Officer went to Norfolk Island, at the request of the Department of Territories, to investigate cattle deaths there. A report of the findings of this investigation, and recommendations for improving animal husbandry practices on the island, has been made to the Department of External Territories.

Imports Subject to Quarantine The number of animals subject to quarantine imported in 1967-68 was 3,767, compared with 2,797 in the previou'S year. Detailed statistics for 1967-68 are given in Table 44 on page 118. The standard form of application to import biological materials which was introduced last year has resulted in a greater degree of control over the importation and use of such materials. It has also facilitated the clearance of theBe products with the Department of Customs and Excise. ~,..-

Plant Quarantine Activities aimed at preventing the introduction of plant pests and diseases were maintained during the year. These included the inspection of any material of plant origin arriving by sea or air and the close supervision of plants and seeds imported for propagation in Australia. The'Se activities were carried out with the full co-operation of the State Departments of Agriculture, whose officers supervise plant quarantine in the States on behalf of the Commonwealth.

The Drought The severe drought in Southern Australia resulted in a need to import bulk quantities of linseed, safflower and malting barley to offset, in part, the short-fall in local production. Linseed and safflower shipments came from Canada and the United States and consignments of linseed from New Zealand and Ethiopia. Special precautions were taken with a shipment of bagged linseed from Ethiopia to guard against any animal disease risk. Malting barley in bag'S was imported from New Zealand. Strict quarantine conditions were imposed for these importations, which were made only for processing in the metropolitan areas of Sydney and _. Melbourne.

Nursery Stock The importation of nursery stock is at a manageable level from the quarantine point of view. Representations were made by the Dutch flower bulb industry for a liberalisation of the quantities of hyacinth ' .... bulbs imported each year, but these were rejected. The quantities 34

suggested could not be handled in post-entry quarantine and, therefore, would be in conflict with the general policy for vegatatively propagated material. Thorough and detailed screening of fruit varieties such as stone fruit, grape vines, berry and pome fruits are undertaken at the few centres in Australia where facilities and staff are available to carry out the specialised virus testing of imported varieties. The Department is most grateful to the State Departments of Agriculture and the Waite Agricultural Research Institute, where this work is undertaken.

Timbe1' Large quantities of timber continue to be imported into Australia, mainly from Malayasia, New Zealand and the United States. The close vigilance maintained by plant quarantine inspectors resulted in the interception of timber and crates infested with live borers. In New Zealand damage has been caused in pine forests by Dothistroma Needle Caste and special precautions have been taken to prevent its introduction into Australia by means of pine seed or other plant material.

Plant Culture Committee A Plant Culture Committee has been established to give advice on the importation of cultures of pathogens which can attack plants. The first meeting was held in Canberra in February 1968. The Committee comprises the Director of Plant Quarantine, a representative of research esta;blishments and a representative of State Departments of Agriculture.

Post-Entry Facilities Progress was made in extending the facilities for post-entry quarantine. A quarantine screenhouse, designed for tropical regions, was erected at Darwin and is now in use. The propagation of several types of rice has been the main activity so far. A second screenhou8e for post-entry quarantine was completed in Brisbane during the year and a combined quarantine screenhouse-glasshouse was erected in Adelaide to handle plant material requiring postentry quarantine for observation on disease status.

Plant Quarantine Laboratory

...

Problems peculiar to plant quarantine are under investigation at the Department's Plant Quarantine Laboratory in Canberra. The subjects being studied include fumigation techniques, seed treatments for seedborne diseases, seed devitalisation, virus screening, nematodes and glasshouse and screenhouse procedures and construction. During the year a heat therapy cabinet was installed to enable investigations into plant establishment from virus-free tip growth. Vacuum fumigators were also in3talled for the study of complex fumigation methods. 35

Container Handling Several meetings were held during the year with officers of the Department of Customs and Excise and representatives of container cargo firms. A working party of quarantine officers is preparing an outline of plant quarantine procedures for container handling of cargo, and when finalised, this will be circulated to interested parties in Australia and overseas.

Sirex Wasp The Department continues to participate in the activities of the National Sirex Fund Committee. A survey carried out by the Department indicates that the incidence of Sirex in Tasmania remains unchanged, but that in Victoria the area where Sirex has been found has extended and now covers a third of the State. Parasites which attack the Sirex wasp and which were originally imported under Plant Quarantine control have been multiplied in special cages at Melbourne and at a newly estlliblished unit at Traralgon and are now being released.

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Officers' Course The second course for Plant Quarantine officers was held in Sydney in May 1968, and was attended by officers from all States and the Northern " Territory. Subjects covered included the principles and systems of plant quarantine, legislation, seeds and seed-borne diseases, weeds, timber inspection, plant treatment procedures, publicity, nursery stock, soil, bags and packing materials and a review of plant quarantine entomology and plant pathology.

International Liaison In July 1967, Australia was represented by the Principal Plant Quarantine Officer at the South Pacific Commission Technical Meeting on Plant Protection held at Pago Pago. A number of items directly related to plant quarantine were discussed, including exclusion and control of pests and diseases, post-entry quarantine stations, disinfection and disinfe3tation of imported plant material and improvement in plant quarantine operations.

Publicity The Plant Quarantine Publicity Campaign, which is sponsored by the Australian Agricultural Council and operated from funds contributed ". by the Commonwealth and the States, continued for the sixteenth succes- . sive year. The object of the campaign is to assist in keeping Australia free of further invasions of plant pests and diseases and to keep down the spread of pests and diseases already here. Emphasis has been placed on the revision and production of plant quarantine literature, which has been distributed by airline, shipping, ~ motoring, tourist and government organisations.

Tuberculosis

Overall indications point to further progress in the past year in Australia's national campaign against tuberculosis. Compared with the figures for the 1966 calendar year there were reductions in 1967 in the total of new cases discovered (from 2,549 to 2,293) ; in the number of persons needing to be paid a tuberculosis allowance (from 1,177 to 1,009); and in the beds required throughout Australia for the treatment of patients (from 2,558 to 2,350). But into this total picture of steady hard-won progress, there has appeared in two states in 1967 an increase in the number of new cases of tuberculosis discovered. The increases have been from 131 to 141 in South Australia and from 134 to 142 in West Australia. Although these increases are small and therefore should not be overemphasised, they have reversed the consistent downward trend maintained over many years and have taken the place of expected decreases in this important notification index. They indicate the need for all aspects of the control programme to be examined and for any weaknesses to be eliminated. In addition, they give point to the warnings which

There are many problems other than medical ones in ca1'rying out tuberculosis surveys in the outback of Queensland

have been given to earlier reports against complacency in dealing with tuberculosis. The accompanying graph demonstrates the downward trend in notifications of all forms of tuberculosis but indicates also that there was still a significant level of new infectious cases of tuberculosis discovered in 1967. The disease therefore still presents a major public health problem despite the progress made in control. In addition to the new cases notified, 239 persons with known old treated or untreated lesions broke down with active tuberculosis in 1967. This reactivation of the disease accounts for approximately ten per cent of the infectious cases of tub.erculosis occurring each year and demonstrates the importance of keeping patients with known pulmonary abnormalities under regular supervision indefinitely. Particulars of notifications are given in Tables 33 and 34 on pages 113 and 114.

Chest Clinics As the pool of knowledge of patients with pulmonary abnormalities builds up, the task of the chest clinics in maintaining close supervision increases. The clinics maintain comprehensive records and are centres for community control work. They are destined to play an even more important role as the emphasis in treatment moves further from hospitalisation to treatment in the patient's home under clinic supervision. TUBERCULOSIS-ALL FORMS Incidence of notifications per 100,000 population 1949 to 1967 60 ~-----------------r------------------'-----------------~

oL-____________ 1~

______________

____________

1955

1961

Disco very of Cases Mass X-ray survey s during 1967 resulte d in the radiolo gical examin ation of the chests of nearly 2,000,000 adults and in the discov ery initiall y of 531 active cases of tuberc ulosis and 296 cases suspec ted of being active. Follow ing subseq uent investi gation s, 652 new cases were credite d to mass X-ray survey s in 1967. Other benefits of these survey s to the individ ual are reflected in the discov ery of 19,393 non-tu bercul ous condit ions of sufficient significance to warra nt furthe r investi gation . Chest clinics were respon sible for 430 new cases being notified in while 460 of the total of 2,293 new cases notified were discov 1967, ered by privat e medica l practit ioners and the remain der mostly from hospit als and other institu tions and by way of death certific ates. These discov ery figures point very clearly to the impor tant place by privat e medical practit ioners in the nation al tuberc ulosis contro held l programm e. As the empha sis in contro l moves gradua lly back to genera l medicine, as inevita bly it must do, the role of the privat e practit ioner in close co-ope ration with the chest clinic will become more and more import ant.

Confe rence The second Austra lian Clinical Tuberc ulosis Confer ence was held in Melbo urne from 1 to 5 April 1968. In additio n to delega tes from all States , Dr B. W. Christ mas, Assist ant Direct or, Divisio n of Public Health , New Zealan d Depar tment of Health , and Dr I. D. Bobrow itz, AS30ciate Profes sor of Medicine, Yeshiv a Unive rsity, New York, presen ted papers and contrib uted to the discussions. There were twenty scientific session s at which twenty -one papers were presen ted. The confer ence was highly succes sful and achieved its main aim of provid ing a forum for the exchan ge of ideas among st full-tim e medical officers in the State tuberculosis service s.

Great distance s are covered by mobile X-ray unit. in the Queens land outback .

Northern Territory Health

The theme in 1967-68 for the Northern Territory Medical Service was one of expansion of activities to meet the fast growing needs of the Territory. Forward planning for new and expanded health services was a major activity in itself. Detailed planning for the development of the inland hospitals at Katherine and Tennant Creek and for major extensions at the Alice Springs Hospital was carried further and basic planning was undertaken towards the establishment of a complete hospital and the setting up of infant health, dental, district and public nursing services and an aerial medical base at Gove, in north-eastern Arnhem Land. At Gove, a town of some 3,000 people is being planned to serve an aluminium ore mining project. In spite of development such as this, the Department's biggest challenge, and its greatest problems in the Northern Territory, are still those connected with the health of the Aboriginals. The health problems of the Aboriginals are being accentuated by the social changes which are occurring in the Territory and the rapidity with which they are becoming involved in the cultural and technological complexities of modern urban and industrial life. To help combat the existing public health problems of the Aboriginals, and to ensure that new ones are not created, expanded effort:3 by public health nursing teams are being planned to safeguard vulnerable groups, particularly mothers and children.

Quarantine A change in the pattern of quarantine activities in the Northern Territory is occurring as the development of the region proceeds. The need for overseas vessels to call at areas remote from Darwin has meant the provision of quarantine staff to clear ships at Groote Eylandt and will require similar arrangements to serve the port at Gove when the aluminium ore mining project there gets under way. The increasing use of the Alice Springs airport, particularly by Service aircraft, has also meant an extension of responsibilities and quarantine outports are now situated 500 miles to the east and 1,000 miles to the south of Darwin. The introduction of regular and frequent rest and recreation flights from Viet Nam has resulted in a sudden, substantial increase in the work at the Darwin airport. The importation of goods subject to quarantine continues to increase and the rapid rate of building development in the Territory is being reflected in the large quantities of timber entering the port of Darwin.

Constant use was made throughout the year of the quarantine station to accommodate persons with vaccination problems. Two groups of Indonesian seamen were quarantined at the station following their arrival ~ in the wake of storms which had blown them far from their homelands. 40

Communicable and Tropical Diseases The maintenance of constant, routine inspection visits and intensive activity by immunisation teams has continued to play a major role in the control and eradication campaigns against communicable and tropical diseases. The most difficult task is in combatting those diseases where immunisation is not possible or effective. The infectious bowel disorders of childhood, hookworm disease, shigellosis and salmonella infections continue as major communicable disease problems. An outbreak of typhoid in east Arnhem Land during the year was brought under control by the use of public health teams and at 30 June 1968 the infection appeared to have been eradicated from the two communities involved and no spread to neighbouring areas had occurred. This was gratifying considering the pattern of family and community life in the area, which presented conditions ideal for a rapid and uncontrolled dissemination of the infection. During the campaign 1,000 blood samples and more than 2,000 faecal specimens were collected and screened by the reference laboratory. Follow-up testing will entail the handling of further large numbers of specimens during the early part of 1968-69. The year again passed without any indigenous cases of malaria, although the continuing occurrence of imported cases highlights the danger to the Northern Territory of the re-introduction of this disease. A close watch is being kept on mining developments in eastern Arnhem Land and mosquito control measures are being applied at the start of all projects. Tuberculosis activities were continued and are being combined in mining areas with the screening of workers for silicosis. Although the general trends are favourable, the thorough follow-up of old cases is essential to prevent infection spreading, particularly in rural communities. Venereal disease continued to increase, especially in the urban communities, in spite of every effort to educate the public to the dangers of the situation. The indications of progress in the work against leprosy are encouraging but it is difficult to draw conclusions in the short term about a disease of such a chronic nature and slow development. The E.C.G. vaccination campaign has been continued and over 8,000 vaccinations have been performed following the Mantoux testing of over 12,000 people. Although the results of this mass vaccination campaign will not become apparent for some years it should, in the long term, materially assist in the effort being made to eradicate leprosy.

School Health Increasing population pressure on the School Health Section has continued. In addition to the usual examinations of school children, the School Health Section i3 responsible for supervision of audiometric examinations, assistance to the visiting otologist and team from the Commonwealth Acoustic Laboratories, follow-up clinics for patients seen by these specialists, and for combatting the general problem of chronic ear infection and hearing loss, which is so prevalent in the rural areas. The Section is 41

also responsible for the organisation of the Sabin oral vaccine campaign, which this year has been extended to rural areas following the successful urban campaign last year. In spite of these heavy pressures, the Section has commenced health education lectures to seventh and higher grades in the important subject of sexual development and its problems. With the co-operation and approval of teachers and parents, these lectures were well attended and received and a pleasing maturity of approach on the part of the pupils was evident.

Infant Health Services Activity has continued to increase at all Infant Health Service centres and additional staff has been provided in the northern areas since October 1967. Home visiting, in particular, has increased and early visits are being undertaken to new mothers on their discharge from hospital. Toddlers' clinics have been introduced and are extremely popular. Ante-natal baby care lectures have continued to be well attended and lectures on mothercraft, which are also given to Aboriginal mothers at Bagot, have proved popular. Generally speaking, infant health in the major centres is of a reasonable standard but gastro-enteritis and skin infection remain frequent, particularly in the Top End during the wet season and among the less fortunate socio-economic groups.

District Nursing Services Home nursing was of particular value in the past year in Darwin because of a shortage of hospital beds due to construction work in the new areas of the Darwin hospital. With the greatly increased usage of the Alice Springs Hospital in 1967-68 the activities of the District Nursing Service also proved invaluable. The District Nursing Service also helped greatly to relieve pressure on the outpatient departments of hospitals. In the Darwin area the District Nurses gave some 35,000 treatments, dressings, and injections and in Alice Springs some 12,000 treatments, dressings and injections.

Aerial Medical The demands on the Aerial Medical Service continue to increase and a fifth aircraft was added to the fleet during the year. Apart from the evacuation of seriously ill and injured people from remote areas, this Service operates an essential transport link for the rural health teams and was also useful in maintaining quarantine surveillance over Indonesian seamen brought to the Australian coastline by monsoonal storms. The figures for both hours and miles flown and for patients and staff carried showed an upward trend. With development proceeding in areas far distant from Darwin, this increase may be expected to show an even faster rate of growth. 42

Rural Public Health The public health problems of the rural areas of the Territory continue to cause concern. Because of the difference in conditions between those in modern uI1ban communities and the transitional stage through which the Aboriginals are passing on settlements and missions, the public health approach used in such localities must be adapted to the particular problems of the individual communities. The use of public health teams to tackle rural problems continues :to be the most effective approach. The efforts to communicate to the Aboriginals the importance of basic hygiene and sanitation, and to induce in them the motivation towards personal cleanliness, have been assisted by the recent provision in some communities of housing equipped with basic sanitation facilities. The increasing ease of communication between the Rural Health teams and the indigenous population-exemplified by the excellent co-operation received in the campaign to control the outbreak of typhoid in Arnhem Land-has been one of the most encouraging features of the past year. By further developing this aspect of the approach to community health problems, and by the involvement of the people in the health work in their own communities, it is hoped to bring about those changes in community thinking which are essential before the desired health standards can be achieved. Major developments in the mining industry in remote areas have been closely watched by the Rural Health staff and it is pleasing to record the high level of co-operation received from the companies concerned. This has enabled health needs to be considered throughout planning, development and construction stages.

Urban Public Health The encouraging trend in the urban areas of the Territory towards the building of modern, well equipped premises for the handling of food and the construction of up-to-date motel accommodation continues. By contrast some of the older buildings, which date from an era of lower standards, have required increasing attention to ensure that a satisfactory upgrading is being undertaken. Because of the long supply lines to the Territory, the transport of perishable foodstuffs needs to be closely watched. However, the improvement in refrigerated transport is lessening the problems. The quality of milk supplies was satisfactory during the year and handling and transport conditions showed an improvement. However, the water supplies in town areas caused some concern and the iU3tallation of water treatment plants has been recommended in some cases.

Dental SeTvices Work was begun during the year on the construction of a new dental clinic at Darwin. This will greatly extend and improve the facilities available for the major population centre of the Northern Territory and the modern conditions should prove an added incentive in staff recruitment. 43

Work at the beginning of the year was handicapped by staff shortages but the use of short term locums helped until a more stable staffing situation was achieved. The return of a staff dentist from the two years' post-graduate course in orthodontics made possible the full-time provision of this specialist service in Darwin. In spite of the staffing difficulties in the early part of the year the mobile services were maintained and, as the staff situation became more stable, a long range mobile programme was begun.

•/

Pharmaceutical Section There was a continuing shortage of trained pharmaceutical staff during the year and difficulties were experienced in meeting the increasing need for pharmaceutical services to the smaller hospitals at Katherine and Tennant Creek. Pharmaceutical services to these hospitals were, however, provided by visits from pharmacists stationed at Darwin and Alice Springs.

Health Laboratories The Health laboratories of Darwin and Alice Springs were subjected to increasing work loads during the year. Demands on the bacteriological section in Darwin were particularly heavy as a result of the typhoid outbreak in Arnhem Land. This section of the Darwin Laboratory is always a busy one because of the shigellosis and salmonellosis problems. The increase in specialist staff at the Darwin Hospital meant requests for more sophisticated tests and many new procedures became incorporated in the laboratory's routine.

Hospitals Major additions to the Darwin Hospital were opened by the Minister for Health, the Honourable A. J. Forbes, in November 1967. The new buildings brought the total number of beds available at the hospital to 317 and also provided the most modern standards of accommooation and equipment. The completion of the hospital swimming pool and the new staff quarters for nurses has added considerably to the standard of accommodation and amenities available to nursing staff and should be of great assistance in the recruitment and retention of staff. The medical staffing position was very satisfactory during the year and the specialist body now includes all the major specialties. In spite of major disruption to the building programmes by the heavy rains of the past year, several building projects at Alice Springs Hospital were completed. The new professional officers' quarters was a welcome addition to staff accommodation and has provided conditions comparable with those in any other area. The work of the Alice Springs Hospital increased sharply during the year and the recruitment of medical staff specialIy trained in paediatric problems enabled a very high standard of treatment to be provided for children from rural areas.

There was heavy pressure on the Katherine Hospital during the year and it handled the maximum number of cases the existing accommodation would permit. Near the end of the year tenders were let for de-mountable ward space and staff quarters. These will permit the demolition of the remaining old, sub-standard accommodation and open the way for new building construction. The hospital continued to function during the year as a centre for the surrounding district and regular visits were made to rural centres. The appointment of a second medical officer to the Tennant Creek Hospital in 1967-68 placed this institution on the same medical staffing level a's the Katherine Hospital. The presence of a second doctor has enabled visiting to surrounding rural districts to be re-instituted. Already a reduction in the number of evacuations from the area has been evident and the potential now exists for regular specialist visits to be more easily handled and for follow-up action to be more readily carried out. There was a sharp increase in the activity in the X-ray department during the year because of work involved in the screening of mine workers for silicosis and tuberculosis.

A patient receives ea"pert care in the Darwin Hospital

Australian Capital Territory Health

The population of the Australian Capital Territory passed the 100,000 mark during the year and it is eatimated it will reach 250,000 by about 1978. The year has been another of rapid growth in all A.C.T. health services and it is apparent that increasing demands are going to be made for new services as well as the expansion of the established ones. Co-ordination and integration of these services, together with planning for the future health needs of the community, is the main task of the A.C.T. Health Services Branch.

Hospital Planning A Hospital Planning Group was established within the Branch during the year and considerable progress was made in the planning for the Woden Valley Hospital. The Department of Works and its consultant architects have developed preliminary sketch plans and estimates of cost for this 600-bed general hospital project. In accordance with Commonwealth Civil Works Procedure the project was the subject of a public enquiry by the Parliamentary Standing Committee on Public Works. The report of this Committee endorsed the principles proposed for the construction of the hospital. A 200-bed general hospital is also currently being planned by a consortium of private architects for the Little Company of Mary, an order of nursing nuns. Commonwealth assistance is being provided for the construction and operation of this hospital, which will be erected on a site in the Belconnen di3trict of Canberra. Final sketch plans have been received and work is proceeding on the final working drawings. A system of integrated hospital services for the A.C.T. is being planned and each hospital will co-operate in its operation. The services which are being developed for this purpose initially include laundry, linen and sterile supplies. Hospital planning activities were reinforced during the year by the appointment by the Minister for Health of the Australian Capital Territory Hospitals Advisory Committee.

---

Child Dental Services As in previous years, dental examination and treatment was provided for children attending infant's and primary schools in the Australian Capital Territory, including Jervis Bay and Wreck Bay and the rural schools at Hall, Tharwa and Uriarra. In 1967-68, 12,129 children were examined by the Child Dental Service compared with 12,844 in 1966-67. Details regarding the training and employment of dental therapists were finalised during the year. These dental auxiliaries will, under the supervision of dentists, carry out the simpler types of filIings and extractions for children. To qualify as a dental therapist, suitable applicants of matriculation standard will be trained in Hobart for a two-year period. 46

~ ... ~

The first four students began their training in January 1968. The training school in Hobart is under the control of the Tasmanian Department of Health Services, with whom agreement was reached regarding the training of Commonwealth students. The survey to assess the value of fluoridation in Canberra was continued. During the 1967 calendar year there were 8,203 dental examinations of children aged six to twelve years inclusive, who had lived continuously in Canberra since fluoridation began in 1964. These children had 25.4 per cent less decayed permanent teeth than children in the comparative age groups who were examined in 1964 prior to the commencement of fluoridation. This survey also showed that there has been no change in the prevalence of mottled teeth since fluoridation was begun.

Health Laboratory The volume of work performed by the Commonwealth Health Laboratory again increased significantly in the past year. The work load of laboratory testing increased by twenty-six per cent in 1966-67 and it increased by a further twenty-five per cent in 1967-68. The Health Laboratory is situated in the Canberra Community Hospital and serves both the hospital and local medical practitioners. It also carries out pathology tests for the Commonwealth Public Service, the Armed Forces and the Australian National University. During the past year specimens were obtained from some eighty to one hundred patients each morning in the laboratory. These patients were mainly those referred by doctors in the Canberra area. Other general pathology services carried out included post-mortem examinations, both for the hO'3pital and the police, and examination of various types of smears for the early detection of cancer.

Public Health Laboratory The Public Health Laboratory, located in the Institute of Anatomy, carried out a steady volume of tests of water and food samples, blood alcohol estimations and toxicological investigations. In addition preliminary work was started on the estimation of pesticide residues in food samples. The total number of water and food samples, chemical analysis and sewerage and effluent tests during the year was 6,706. Among work done for police, and coronial inquiries, there was a marked increase in the number of samples received for blood alcohol testing.

School Medical Service Medical examinations of children at both public and private schoolsincluding Jervis Bay and Wreck Bay-were continued during the year. The number of children examined by the School Medical Service and defects noted are given in Table 50 on page 120. There was an increase of approximately one hundred per cent in the number examined when compared with the previous year, while the estimated school population increased by nearly fifteen per cent to approximately 28,000. 47

Defects of eyesight have been found in a significantly higher proportion of high school children (8.45 per cent of 4,605 children) than in primary school children (5.54 per cent of 10,732 children) during the past fifteen months.

Immunisation The School Medical Officers undertook all immunisation work for the major part of the year. This WR3 taken over by a full time Immunisation Officer who was employed in May 1968. A total of 11,316 injections of either Triple Antigen or combined diptheria and tetanus vaccine were administered, compared with 10,311 the previous year. Regular clinics were also held at Jervis Bay and Wreck Bay. Immunisation against poliomyelitis using the Sabin vaccine was also continued at several clinics. In all 26,644 doses of this were issued, thirty per cent of the recipients being adults. In 1966-67, 80,815 doses were administered but this figure included the vaccine used in the original campaign in the schools.

Amb1tlance Service The administration of the A.C.T. Ambulance Service was transferred from the Canberra Community H03pital to the A.C.T. Health Services Branch in February 1968. The staff of five Station Officers and twenty-one Ambulance Officers, under the control of a Superintendent, operate seven ambulance vehicles from a central station in the suburb of Dickson and two vehicles from a sub-station in the suburb of Griffith. Further substations are planned for the Woden and Belconnen districts. The central station provides the control centre for all future sub-stations. It is equipped with six incoming telephone lines, a radio control network to all vehicles and direct telephone lines to emergency numbers.

Health Inspectors A feature of the Health Inspection Section',s activities in the past year was work connected with sampling and testing of the water supply. As a result of drought conditions, turbidity of the water supply became a frequent source of complaint. This involved the Section in a heavy programme of inspection, sampling and testing. The continual sampling and testing, and the control measures which followed, helped ensure that no problems ar03e due to bacteriological contamination of the water supply during the drought period. The drought conditions and the consequent planning for emergency water supplies also necessitated the analysis of samples from all water sources which seemed likely to be required for domestic purposes. The programme of daily water sampling to ensure that fluoride and chlorination treatments were kept at the proper levels was maintained. Apart from watching over the water supply, the Section maintained a close watch on the manufacture. transport, storage and sale conditions of all foodstuffs. 48

Canberra Mothercraft Society Two new Mothercraft centres were opened in the past year and there are now twenty-two mothercraft centres and sub-centres operating in the A.C.T. These are administered by the Canberra Mothercraft Society-a voluntary organisation subsidised by the Commonwealth-and are staffed by a total of ten triple-certificated nursing sisters. Attendances at the centres totalled 53,688 for the year. The Society's nursing sisters also make an initial home visit to mothers following their discharge from hospital, and 2,200 of these visits were made during the year. The Queen Elizabeth II Coronation Home for Mothers and Babies, also operated by the Canberra Mothercraft Society, provides. post-natal care for mothers and babies following their discharge from hospital. During the year 236 mothers and 356 babies were admitted to the home.

Child Guidance Clinic The Child Guidance Clinic worked actively during the year on the diagnosis and treatment of disturbed children and about seven new patients each week are now being referred to the Clinic. As far as possible, the working time is divided equally between diagnosis and treatment. Psychotherapy is the basic treatment given by the Clinic. Where drug administration is required in the management of a patient, it is carried out by a consulting p'3ychiatrist. Although the child is the main patient it is policy to involve the family in therapy, and counselling with parents is carried out wherever possible. Speech therapy has become an important part of the Clinic's activities as defects occur in a large number of children. It has been the Clinic's aim to see all speech cases without necessarily distinguishing them from other forms of behaviour disturbances.

National Fitness National Fitness grants totalling $5,302 were distributed to forty-six sporting and youth organisations in the A.C.T. during 1967-68. Pilot projects in leadership training were related to the development of leaders for vacation swimming schools, youth organisations and sporting bodies. Two scholarships to the Australian Recreation Leadership Course were awarded and programme aid services were also provided. Vacation programmes were conducted in co-operation with the Department of the Interior and the Physical Education Branch of the N.S.W. Department of Education. A total of 3,393 children enrolled in three vacation swimming schools were taught by sixty-three teachers. Play centres catered for about 1,300 children per day during a three-week season in January.

District Nursing Service Increased public health nursing duties were undertaken in 1967-68 by thll District NUf:sing Service. The Service also assisted in influenza and Sabin vaccination campaigns, at the Immunisation Clinic and in industrial

nursing. District nurses continued to give assistance at the Rehabilitation Centre of the Canberra Community Hospital and to co-operate with general practitioners, hospital and departmental and voluntary agencies. The number of patients referred to the District Nursing Service increased during 1967-68 and many people who would otherwise have been admitted to hospital were able to remain in their own homes. The expanding area of the Woden Valley and Belconnen districts caused a considerable increase in the mileage travelled by the nurses in the course of their duties.

Nursing Home Accommodation The first nursing home in the A.C.T. was opened in February 1968 on the completion of stage one of the project. The home, known as Morling Lodge, was built by the New South Wales Baptist Homes Trust with financial assistance from the Commonwealth. Beds are now available for thirty-four patients and the second stage is expected to be completed during the forthcoming year. This will increase the number of beds available to seventy-one.

Professional Boards The secretariat to the various professional Boards established under the A.C.T. ordinances had a busy year in 1967-68. The Medical Board of the A.C.T. held twelve meetings and regi3tered forty-five medical practitioners. The Dental Board met eight times and registered four dental practitioners. The Nurses Registration Board held twelve meetings and registered 241 nurses and thirty-nine nursing aides. The Pharmacy Board met four times and registered twenty-five pharmacists and the Veterinary Surgeons' Board held three meetings and registered three veterinary surgeons. The Optometrists Board did not meet during the year and no optometrists were registered. Five final examinations for nurses were held during the year at the Canberra Technical College on behalf of the New South Wales Nurses Registration Board, which continued to set and mark the examination papers. -'~'

Chest Clinic Nineteen new cases of pulmonary tuberculosis and one relapsed case were notified in the A.C.T. in 1967-68. This compared with six new cases in 1966-67. At present 800 persons are under regular supervision at the Chest Clinic, which is located in the Canberra Community Hospital and is responsible for tuberculosis control in the A.C.T. and nearby areas. Another 200 persons are under surveillance by the Clinic. A total of 11,489 miniature X-ray films were taken during the year as part of the routine case-finding programme. The recent emphasis on the need to record, and follow-up regularly, persons with pulmonary abnormalities, who constitute a high risk group, is increasing the work load of the Clinic. 50

Acoustic Service Visiting Commonwealth Acoustic Laboratories officers in 1967-6~ tested 140 children for the first time and re-tested 100 children. Eighteen Repatriation patients were tested for hearing problems and twenty were re-tested. All children examined by the School Medical Services in the A.C.T. undergo testing by audiometry in order to assess any partial loss of hearing. If necessary, these children are referred to the Commonwealth Acou3tic Laboratories for further investigation. This is performed by an officer from the central laboratory in Sydney who comes to Canberra for two days every three weeks. During his visit he also examines children referred by local medical practitioners or consultants. Any child requiring a hearing aid has it provided and 3erviced by the Acoustic Laboratories. A similar service is provided for Repatriation pensioners. The Acoustic Laboratories have now begun a hearing aid service for pensioners and planning i3 proceeding for the establishment of a permanent clinic in Canberra.

Pharmaceutical Section A Pharmaceutical Section has been e3tablished within the Branch and a pharmacist has been appointed. The pharmacist will inspect pharmacies and supervise the supply of drugs, narcotics and poisonous substances, and will also inspect, periodically, the relevant registers and records which must be maintained by pharmacists. He will issue licences for the 3ale of certain poisonous substances in 'shops and will be available to give advice to professional and business people regarding the interpretation of Ordinances and to advise members of the public, where necessary, on pharmaceutical problems.

Public Health

The past year brought a noticeable expansion in the activities of the Public Health Branch. Staff was increased and a new Epidemiology Section was created. The Branch continues to provide information on a wide range of general public health matters. This include;;; advice on subjects such as immunisation programmes and other methods of controlling infectious disea;;;es, fluoridation of public water supplies, atmospheric pollution, tropical diseases, traffic injuries, alcoholism and zoonoses.

National Poisons Register In an effort to overcome delays in the work associated with the National Poisons Register project, additional staff was recruited to the Toxicology Section. Encouraging progress has since been made and the first instalment of the revised National Poisons Register Manual, which now lists 'some 15,000 possibly hazardous products, is being prepared for printing. The States have co-operated in providing poison case reports and an examination of these has been made prior to coding for computer analysis and subsequent publication of the findings.

Food Standards Programme The Department became more involved in the proceedings of the joint FAO/WHO Codex Alimentarius Commission during 1966-67. Some standards have reached the stage of being forwarded to Governments for acceptance and di;;;cussions have been held with State Government authorities to determine an Australian approach. Senior officers of the Public Health Branch were included in the Australian delegations to the committees on food additives, pesticide residues in food and food hygiene as well as the fifth session of the Codex Alimentarius Commission, held in Rome during February 1968. The work in connection with the Commission and its subsidiary bodie;;; is undertaken in collaboration with the Department of Primary Industry.

Communicable Diseases Australia has for many years been free from quarantinable disease;;;, such as smallpox and cholera. There are, however, non-quarantinable diseases which also might be introduced to AU3tralia and a careful watch must be kept on communicable diseases overseas. Because of the continuing problem of haemorrhagic fever in South-East Asia it was considered that control mea'sures against the vector, a mosquito called Aedes aegypti, should be encouraged over that part of Northern and Eastern Australia in which this mosquito is found. As a result of evidence submitted to the National Health and Medical Research Council, the Council has recommended that a continuing effort 3hould be made by State and local authorities to eliminate Aedes aegypti. 52

In 1967-68, 173 cases of malaria were notified to health authorities in Australia. These infections were acquired overseas. Through the National Health and Medical Research Council, the attention of the medical profe3sion in Australia has been drawn to the need for epidemiological investigation and adequate treatment of all cases of malaria. Attention has also been drawn to the need for proper briefing of travellers going to malarious areas in the use of prophylactic drugs and to the need for radical treatment of such per30ns if, on return, they wish to enter an area where the mosquitoes are likely to transmit malaria. The control of leprosy in Australia is still an important part of public health administration. Fifty-one new cases of this disease were notified in 1967. There does, however, appear to be a falling off in the number of cases notified, the total having been higher than this in fourteen out of the previous fifteen years. A report on leprosy control in Australia, endor3ed by the National Health and Medical Research Council, has been given publicity among the medical profession. This report draws attention to the fact that, under adequate drug treatment, and with proper facilities for regular out-patient follow-up, it is possible to avoid the prolonged isolation of patients, which has been a feature of treatment in the pa3t. The infectious diseases which have been of major importance of recent years have been poliomyelitis, influenza and infective hepatitis. During the year only five suspected cases of poliomyeliti3 were referrea to the Poliomyelitis Sub-Committee of the National Health and Medical Research Council and none of these were confirmed. This successful reduction of poliomyeliti3 to a place of minor importance has been achieved by the use of first Salk and now Sabin vaccine throughout the Australian States and Territories. No major epidemic of influenza occurred in Australia during 1967-68, but the progress of epidemics in other part;;; of the world were closely watched. It has been noted that the A2 virus strain of influenza which has been responsible for recent Northern Hemisphere epidemics is practically identical antigenically with the A2 strain in the pre;;;ent Commonwealth Serum Laboratories vaccine. The number of notifications of infective hepatitis rose in 1967 as in 1966. Total notifications between 1961 and 1965 had shown a decline. Hepatitis nevertheless remains a matter of concern to public health authorities and has been the subject of continuing health education campaigns.

Epidemiology and Medical Statistics An Epidemiology and Medical Statistic3 Section has now been established within the Public Health Branch. Previously only a very limited volume of work was possible in these fields and this was dealt with in the various divisions as the need arose. The growing interest in studies such as the National Morbidity Survey, the results of which were published in 1966, and the Smoking Attitudes Survey, which began during 1967, has produced the need for a central section to advise on matters of a statistical or 53

epidemiological nature. The Section h now assisting in the Smoking Attitudes Survey and in preparation of epidemiological commentaries on the National Morbidity Survey. The Section's work is expected to increase the use which can be made of health statistics available in Australia. These at present include statistics on infectious diseases and mortality. During the year collection of uniform hospital morbidity and of mental health statistics was begun in some States. When this system is developed throughout the Commonwealth, important new information relative to health and disease will be available for future investigation. Officers of the Section will work closely with the National Health and Medical Research Council and with those of its committees and sub-committees which have responsibilities in these fields.

Nursing A variety of courses for nurses from overseas countries under government sponsored 'schemes was arranged during the year by the Nursing Section. At the end of 1967, twenty-six overseas nurses successfully completed post-graduate courses at colleges of nursing in Australia. The nurses came from Afghanistan, Burma, Indonesia, Korea, Kenya, Malaysia, the Maldive Islands, Nigeria, the Philippines, South Viet Nam and Thailand. The Nursing Section is working closely with the Departments of Immigration and External Affairs in order to improve and clarify arrangements for the entry of private nursing students from overseas and to provide them with a choice of useful and satisfying training programmes.

Therapeutic Substances

The Therapeutic Substances Branch has been particularly active over the past year in endeavouring to increase the level of reporting of adverse drug reactions. Commonwealth activities in the drug control field in Australia are co-ordinated by the Branch, which incorporates the Registry of Adverse Drug Reactions and provides the secretariat of the Australian Drug Evaluation Committee. With the assistance of the State health authorities, medical faculties and medical superintendents of hospitals, the Registry of Adverse Drug Reactions has distributed pads of report forms throughout the larger hospitals. A total of 450 reports were received in 1967-68, bringing the total number received since August 1964, to 1,320. The number of reports received last year represented an increase of fifty-five per cent over the level of reporting in the preceding three years. Seventy-two per cent of the reports last year were received from doctors in private practice and twenty-one per cent from hospitals. The remaining seven per cent of reports were received from the pharmaceutical industry. Support from the pharmaceutical industry continued during the year. In the last few months of the year report forms were distributed to investigators conducting clinical trials. It is hoped that much valuable information on the adverse effects of drugs will be obtained through these channels before drugs are released on the general market. Another major achievement during the year was the distribution of the ' Report of Adverse Drug Reactions " in booklet form, to all registered medical practitioners in Australia. The response to the distribution of the report was most enthusiastic. Feedback of information to the reporting clinician is considered to be an important function of the Registry and, apart from its intrinsic value to clinicians, it is hoped that the' Report of Adverse Drug Reactions' will stimulate the medical profession to more active participation in the reporting scheme. Australia is now participating in the WHO pilot research project for international drug monitoring and details of reports received by the Registry are forwarded, as a matter of routine, to WHO on a report form specially designed to facilitate computer processing. With a world-wide accumulation of data on the adverse effects of drugs and sophisticated data processing facilities, it will be possible to determine more readily than in the past the statistical significance of reported adverse drug reactions.

Australian Drug Evaluation Committee The Australian Drug Evaluation Committee was established in 1963 to provide expert advice on the assessment of new drugs and on reports of adverse reactions and, to 30 June 1968, had made 178 resolutions relating to therapeutic substances. 55

The question of adverse effects of oral contraceptives has continued to be the subject of close scrutiny. From time to time the Committee has indicated the need for a special study on this question in Australia and the Australian College of General Practitioners is now carrying out such a survey. The Committee has also made arrangements with the H03pital Morbidity Statistics Sub-Committee of the National Health and Medical Research Council for inclusion of information on the usage of oral contraceptives, in cases of thrombo-embolic episodes, in the collection of data for h03pital morbidity statistics. Close liaison with the drug control authorities in a number of overseas countries has continued to prove most beneficial to the work of the Committee. This collaboration, coupled with careful study of the medical literature, and investigations instituted locally, provides the Committee with reliable and up to date information.

Standard of Therapeutic Substances A number of controlled therapeutic '3ubstances are subjected to examination in respect of packaging, labelling and conformity to standard on importation into Australia. To avoid undue delays to importers, the analyses are conducted by the Department of Customs and Excise Laboratories in the various States. The following table indicates the number of samples assayed by the Customs' Laiboratories for the year ended 30 June 1968. Examination of the other categories of therapeutic substances is conducted by the National Biological Standards Laboratory and details of these examinations are outlined in the section of the report relating to that Laboratory-

State New South Wales Victoria Queensland South Australia Western Australia Tasmania

Number of Samples Passed Failed 93 3 81 2 18 1 1

National Biological Standards Laboratory

The National Biological Standards Laboratory'S drug testing programme was maintained during 1967-68 at previously established levels but was made more effective by selecting samples, as far as possible, from those products and sources most likely to be at fault. The Laboratory's activities in the control of therapeutic standards were also made more efficient during the year by the development of better liaison arrangements with other Commonwealth and State authorities and with international bodies such as the World Health Organisation and the British Pharmacopoeia Commission. A number of Laboratory 'Officers are now members of technical and expert advisory committees of WHO. Contacts with the British Pharmacopoeia Commission were maintained and extended through the visit to AustraJia during the year of Professor F. Hartley, a member of the Commission and Dean of the School of Pharmacy 'Of the University of London, Valuable exchanges were also made possible through a visit by Dr A. S. Outschoorn, Chief of Biological Standardisation, WHO, particularly in relation to the international certification of vaccines. Planning for a proposeu National Biological Standards Laboratory building proceeded during the year. Following a feasibility study by the Department of Works and joint consultations with that Department, the National Capital Development Commission and this Department, it was considered that a site at Deakin, near the Royal Australian Mint, which had been originally allocated for the building, did not allow sufficient area for possible development. Subsequently a 50-acre site in the Narra;bundah area of Canberra was set aside for this purpose. This area will permit more flexibility in laboratory design and the grazing of sheep and cattle used in the testing of veterinary products. A feasibility study of the new site has been completed by the Department of Works and preliminary plans are now being costed. The Director of the Laboratory spent a month in India during the year as a short-term consultant for the World Health Organisation to report on measures which would strengthen drug quality control in that country The major part of the assignment consisted of an evaluation of laboratory facilities already available and advice concerning the direction 'Of future developments. In addition to the sampling and testing of therapeutic products, the Laboratory during the year assisted other Commonwealth Departments and authorities by providing specifications for tenders for pharmaceutical products and surgical dressings and by the subsequent analysis of products against the specifications. The following is a summary of the activities of the various sections of the Laboratory, and statistics relating to analyses performed are in Tables 57 to 59 on pages 122 and 123. 57

Antibiotic Products The prDgramme fDr testing antibiDtic products was brDadened during the year tD include antibiotic preparatiDns which are not available as pharmaceutical benefits, veterinary antibiDtics and prDducts cDntaining mDre than 'One antibiDtic. There was alSD a greater concentratiDn on the testing 'Of gDDds supplied tD various CDmmonwealth Departments and to territories of the CDmmonwealth. The testing of many of these products has required the laboratories tD evaluate new variations of methDds 'Of analysis and this has been a time consuming prDcess. Work was continued during the year 'On the calibration 'Of reference standards both fDr use in Australia and in cDnnectiDn with internatiDnal standards being established by the World Health Organisation for certain antibiotics. A systematic examination of each consignment of pre-sterilised, disposable hYPDdermic equipment imported into Australia from Japan has been carried out. Shortcomings were fDund in the packaging and labelling of certain brands 'Of this equipment. One brand did not appear in fact to have been sterilised and its impDrtatiDn was subsequently prDhibited.

Bacterial Products Staff fDr the new microbial and immunological unit was recruited and work was begun 'On the purification of bacterial toxins. Developmental work on 'in vitro' tests for bacterial vaccines was also begun. The programme of testing veterinary vaccines gathered momentum during the year. It is noteworthy that 'Of thirtY-Dne veterinary preparations purpDrting to vaccinate against tetanus, thirty-nine per eent failed. Pulpy kidney (enterotoxaemia) vaccines gave much better results and only fifteen per cent failed tD meet requirements. The manufacturers 'Offered various explanations for the failure 'Of their products but did not cDntest the LabDratDry's results, which revealed a real deficiency in veterinary clDstridial vaccines. The industry has been most cD-Dperative in implementing suggested quality contrDI prDcedures and it is evident that manufacturers are now exercising tighter quality control. Samples recently taken from manufacturers, whose prDducts had previDusly failed, have shown a marked improvement.

Endocrine Products WDrk in the EndDcrine PrDducts Section has been sDmewhat hampered by the inability tD recruit a chief endocrinologist to take charge 'Of this laboratory but the testing of prDducts has cDntinued. CDllabDrative studies with scientific staff of the Garvan Institute, in Sydney, were undertaken tD develop a radio immuno-assay fDr secretin. This work has been published.

Viral Products The routine testing 'Of viral vaccines continued during the year and a total 'Of twelve batches 'Of Salk and Sabin vaccines were cleared fDr use in Australia. In additiDn, five batches 'Of canine distemper vaccine were _. cleared as satisfying requirements for pDtency. A preliminary draft 'Of the proposed Australian minimum requirements fDr smallpox vaccine was 58

prepared and preliminary work has been carried out on similar requirements for influenza sub-unit vaccine. Studies have been made of the effectiveness of living and inactivated vaccines in inducing immunity to respiratory viruses. Infectious laryngotracheitis of fowls, important in the poultry industry, has been used as the model and a close parallelism has been demonstrated with human para-influenza infections. It has been found that resi'3tance to challenge with virulent virus does not correlate with circulating antibody titre. Live vaccines, despite low circulating antibodies, protect whereas killed vaccines with high levels of antibody confer little protection.

Pharmaceutical Chemistry Because of accommodation problems, testing of products by the Pharmaceutical Chemistry Section was largely restricted to products which were pharmaceutical benefits or the subject of tenders to government authorities. The surgical dressing unit was not affected by the accommodation problems and the investigation of products available on the market continued in order to develop new standards. A considerable amount of testing of cotton wool, dressings and bandages was undertaken for the Department of Repatriation. A project on the development of automated spectrophotometric analysis of single tablets was begun. Very small amounts of active materials are contained in some tablets and there is a need to know that there is a uniform distribution of such materials. Traditional methods are too laborious for such work and automation appears to offer the only chance of carrying it out. Preliminary work was begun on the use of a differential scanning calorimeter which provides a method for the determination of absolute purity of materials used as reference standard substances. A study of the use of data retrieval systems for handling the records of samples tested and filing data on physical and chemical properties of drugs is continuing.

Pharmacology The pre-clinical evaluation of new drugs has continued to be a major function of the Pharmacology Section and the number of drugs to be evaluated is increasing. A considerable amount of work was undertaken on parenteral iron preparations following the introduction of a toxicity test in the 1966 Addendum to the British Pharmacopoeia. A number of failures to meet this test were found, but the significance of these failures is not clear since the range of products to which it can be applied is uncertain, as is the validity of the test, since it is an intravenous test applied to intramuscular injections. Products were examined following complaints by medical practitioners that the expected pharmacological response had not been obtained from the products, or that unexpected side effects had occurred. The most frequent complaint was of eye drops producing unexpected pupillary dilation. In only one case could contamination with an atropine-like substance be demonstrated. The manufacturer in this instance also found contamination and promptly withdrew the product from sale. The considerable attention being given by the pharmaceutical industry to drugs acting on the cardiovascular system prompted a research programme on factors affecting catecholamine uptake and release with a view to applying the knowledge gained to the assessment of new and existing drugs.

Commonwealth Health Laboratories

Clinical pathology is a rapidly expanding field in Australia, and throughout the world, fulfilling an important role in the complex diagnostic and research procedures of current medical practice. The laboratory services provided by the fifteen Commonwealth Health Laboratories located at regional centres throughout Australia-at Albury, Alice Springs, Bendigo, Canberra, Cairns, Darwin, Hobart, Kalgoorlie, Launceston, Lismore, Port Pirie, Rockhampton, Tamworth, Toowoomba and Townsville-are being developed in line with the requirements of modern medical methods. The Health Laboratories are, in most cases, attached to a base hospital and provide a clinical pathology service to the base hospital, to district hospitals and to the medical profession in the area. The work undertaken by the laboratories includes histo-pathology, morbid anatomy, biochemistry, microbiology, haematology, serology and cytology. Some of the laboratories also perform work of a public health nature such as bacteriological and chemical examinations of food, milk and water and the investigation of outbreaks of disease. The application of radio-isotope techniques to clinical diagnosis was introduced to the Health Laboratories. with the recent establishment of a radio-isotopes section at the Canberra Health Laboratory. The many advances in scientific knowledge and technology in recent years have stimulated a quite dramatic expan3ion in the range of pathology tests and procedures and the development of a great deal of new and sophisticated instrumentation. These factors have led to an accelerated requirement for scientific and technical staff for the Health Laboratories and have accentuated the Department's difficult and long-standing problem of recruitment of qualified persons to serve in country laboratories. A significant advance towards a solution to this problem has been made during the past year with the introduction of a new scheme to train laboratory technologists and technical officers. The training scheme became a reality following the establishment of Institutes of Technology by the various State Departments of Education to provide tertiary-level education in technological and technical fields, and also the furthering of new concepts of professional and sub-professional employment in technical areas of the Public Service. Following discussions between this Department and the Public Service Board, cadetships in medical technology and traineeships in biological techniques were established and the first group of these cadets and trainees commenced their studies at the beginning of 1968. Fifteen cadets commenced full-time study at the Queensland Institute of Technology, Brisbane, and a total of fifty trainee technical officers were appointed to the laboratories at Townsville, Rockhampton, Toowoomba and Canberra and began part-time study in Technical College certificate courses at those

centres. It is considered that the continuation of this training scheme offers a long-term, practical solution to some of the staffing problems of the Health Laboratories. There is still, however, an urgent need for more pathologists in the Health Laboratories, and, in association with the Public Service Board, the Department is actively seeking a scheme for post-graduate pathology training which will be appropriate to the needs of the Health Laboratories. In the meantime, a further two scholarships have been provided to allow selected medical officers to proceed overseas in 1968 to undertake studies for the Diploma of Clinical Pathology at the Post-Graduate Medical School, London. Two medical officers are at present undertaking studies for the Diploma of Clinical Pathology in London, one having been awarded a Public Service Scholarship and the other a WHO Fellowship in 1967. Both officers are due to complete the diploma courses and return to duty in the Health Laboratories in late 1968. Building work to provide extra laboratory space at the Port Pirie Laboratory is due to begin during the latter part of 1968 and plans for the building of a new laboratory at Tamworth are being finalised. The Department has begun an investigation of the overall requirements of the Health Laboratories Service in terms of staffing, instrumentation and accommodation with a view to formulating a co-ordinated plan of development. Statistics of tests performed and the number of patients who attended the Laboratories during the year are given in Table 56 on page 122.

Commonwealth Acoustic Laboratories

There was a marked expansion of the Commonwealth Acoustic Laboratories clinical services in 1967-68 due to the introduction of the pensioner hearing aid service. To introduce this service the staff of the Laboratories was built up, special training programmes were undertaken and new laboratory accommodation was provided and equipped. Further work was carried out on the development of hearing aids and a record number of aids was produced. There was also a change in the directorship during the year. Mr R. A. Piesse, formerly physicist in charge of the Acoustics and Electroacoustics Research Section, was promoted to the position of Director to replace Mr N. E. Murray, O.B.E., who died in August 1967 after a long illness. Mr Murray had been Director of the Laboratories since their inception in January 1947.

Services Clinical Audiology aM Psychology The scheme to provide pensioners and their dependants with hearing aids commenced on 1 April 1968 in Adelaide and Newcastle and was later extended to other State capitals and Canberra and Townsville. To 30 June

Testing a child's hearing at the Commonwealth A coustic Laboratories

1968 a total of 2,505 applications for hearing aids had been received, 1,504 being from pensioners in the eligible age groups. (At 30 June 1968 services were available to pensioners as follows :-65-74 yearsSydney, Melbourne, Brisbane, Hobart, and Perth; all age groupsAdelaide, Newcastle, Canberra and Townsville.) In all, 1,190 pensioners were examined and 978 were fitted with hearing aids. A programme has been drawn up for the extension of the pensioner hearing aid service to other age groups and to country areas in 1968-69. A new, permanently staffed laboratory was opened at Townsville in June 1968 and arrangements are proceeding to open new, full-time laboratories at Parramatta and Launceston. The increase in the staff has meant much effort with training schemes, the most notable being the training programme undertaken in Sydney early in 1968 for psychologists, assistants (audiometry) and technical staff for the pensioner scheme. Members of the new categDry of sub-professional staff-assistants (audiometry)-are dDing useful wDrk in assisting psych 01'0 gists with hearing tests, the fitting 'Of hearing aids and taking ear-impressions. Further explDratory work in the guidance of parents and pre-schDol aged deaf children shows promise 'Of leading to the better use 'Of hearing aids and hearing skills for these very young children. Other programmes for children and ex-servicemen continue to operate at a greater level of efficiency due to improved methDds of testing and SDme extra case-work time.

Engineering The pensiDner hearing aid service dominated the resources 'Of the Engineering Section in 1967-68. Assistance was given with the planning 'Of accommDdation and in supervising technical installations. The Engineering Section also contributed to the training programme for the new technicians and psychologists appointed fDr the pensioner service and prepared an instruction manual for the technicians em pI Dyed 'On maintenance and servicing 'Of hearing aids. Equipment for calibrating and testing hearing aids was developed for use in the clinical labDratDries and a record number of hearing aids was produced during the year. NDise measurements were undertaken for the Quarantine Divi3ion of the Department at the international terminal, KingsfDrd Smith AirpDrt, and fDr the Overseas Telecommunications Commission, the Department of the Navy and the Department of Customs and Excise. Visits were made to various Commonwealth Government Departments and instrumentalities such as the Commonwealth Serum LabDratories, Department of Supply, PDstmaster-General's and Army Design establishments tD assist with the introductiDn 'Of hearing conservation programmes and give advice on noise problems.

Research

Acoustics and Electroacoustics The work of the ACDustics and ElectroacDustics SectiDn was curtailed during the year as the staff members wDrked with the Engineering Section 'On various technical matters relating to the implementatiDn of the pen-

A pension.er being fitted with a hearin.g aid

sioner hearing aid service. Despite these commitments, the Section designed a calibrator for an artificial mastoid and an audio switch with a fast rise time of signal for the evoked response audiometer. Further work was done on the development of hearing aids.

I I

Audiology-Psychology The Audiology-Psychology Section developed and standardised speechhearing tests, using recorded sentences, for use in the pensioner hearing aid service. The standardisation showed a high degree of agreement with pure tone test results, and the sentence tests are now being used to supplement existing diagnostic speech tests. The technique of cortical evoked response audiometry has been developed further. A series of experiments exploring the relations between stimulus and response is nearing completion. The results obtained to date have indicated an optimum strategy for detecting the pattern of response and this has been used in the design and development of a simple, selfcontained evoked re3ponse audiometer, which has been undertaken in conjunction with staff from the Electroacoustics Section. Further research has been done on the effects of powerful hearing aids on the residual hearing of children with sensorineural deafness. It has been found that short-term use of powerful aids can cause temporary deterioration in children's hearing and that recovery from the deteriora64

tion, when the aid is removed, proceeds at a very slow rate. A further analysis of data on the permanent effects of powerful aids has revealed that most of the damage effect probably occurs in the first four to five years of aid use and is added to any deterioration in hearing due to other causes.

Medical Ultrasonics The clinical trials of the a;bdominal echoscope at the Royal Hospital for Women, Sydney, have been carried further and the results are being prepared for computer analysis. It is hoped in this way to determine the accuracy of diagnosis of various conditions of pregnancy and the accuracy of prediction of foetal size and growth rate. The standard of pictures has continued to improve and such structures as the heart, kidney and bladder of the foetus are now regularly seen. A further improvement should follow the installation of a new scanner early in the new financial year. An echo-encephaloscope is undergoing continuing clinical trials at the Royal Newcastle Hospital. The improved system used in the instrument has allowed a significant improvement in the detection of mid-line shifts in the brain. Previously a shift of up to three milIimeteres was regarded as normal due to random errors in the technique. It has been shown that with the Commonwealth Acoustics Laboratories' instrument, indicated shifts of only one millimeter are clinically significant. After some set-backs due to staff changes, the eye echoscope installed at the Royal Prince Alfred Hospital, Sydney, is now producing high quality echograms and will be used for clinical trials to determine the appearances of normal and pathological eyes. Work is continuing on clinical assessment of the breast echoscope at the Royal North Shore Hospital, Sydney, and on the study of the biological effects of ultrasound in conjunction with the School of Pathology, University of New South Wales.

Psychoacoustics The main activities of the Psychoacoustics Section have concerned the investigation of the determinants of the loudness, detectability and annoyance of impulse noise. The final experiment on the loudness of pulses is under way but the acquisition of data and its evaluation will continue for some time before the project is complete.

Standards Staff members of the Laboratories were actively engaged in work connected with Australian standards during the year. Two representatives of the Laboratories attended a meeting of the Standards Association of Australia at which it was decided that work in acoustics should be placed on a more formal basis by the establishment of an Acoustics Standards Committee. The Laboratories co-operated in the publication of a standard entitled' Preferred Frequencies for Acoustical Measurements' and in the drafting of an Australian standard for the standard reference zero of the calibration of pure tone audiometers.

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Commonwealth X-Ray and Radium Laboratory ~:

The Commonwealth X-Ray and Radium Laboratory, established in 1929, is the Commonwealth centre for radiological physics and one of it3 important present day functions is the monitoring of the environment for radioactivity.

Radiochemistry and' Low-Level' Measurements Significant quantities of man-made radioactive materials may be contributed to the environment from two sources: the testing of nuclear weapons and the release of radioactive materials which have been used for peaceful purposes. In Australia, interest in the fall-out from nuclear weapons was revived when France began a series of tests in Polynesia in July 1966. A second series followed in June 1967, and a further series is planned for July 1968. A continuing programme of monitoring the environment for radioactive materials is 'supplemented during actual testing of nuclear weapons in the atmosphere. The Laboratory makes relevant measurements for the Atomic Weapons Test Safety Committee and, through it, for the National Radiation Advisory Committee. The methods used for collecting, treating and measuring samples are frequently reviewed to ensure their efficiency. The complex calculations necessary are made by computer, using data programmed by the staff of the Laboratory. A whole-body monitor, a device designed by the Laboratory for the detection and measurement of traces of radioactive materials present in the human body, is being imltalled at the La:boratory. A steel-walled room has been built, ancillary equipment installed and preliminary tests made. A dosimetry system, to measure radiation in the environment, has also been constructed and tested at the Laboratory. A Commonwealth Standard for the measurement of X-rays is maintained at the Laboratory and other related standards for the accurate measurement of X-rays are being developed. Equipment for the accurate measurem~nt of radioactive materials has been developed and this equipment WIll be certified as providing working standards for the measurement of particular radio-nuclides.

Commonwealth Radium The Laboratory continued to discharge its responsibility for the care and maintenance of the Commonwealth radium issued on loan to approved hospitals and research centres and the radon services to approved hospitals and private practitioners in Australia and New Zealand have been maintained. An interesting development in recent years has been the increasing use of radon by approved veterinary surgeons. All the radon issued is sealed in gold capillary tubing made in the Laboratory.

Diagnostic Radiology The Laboratory ha3 continued its service to orthodontists of maintaining specially-designed equipment for taking skull radiographs. The same equipment has also been made available to the Growth Unit of the Anatomy Department, University of Melbourne, in a co-operative, !ongterm investigation on the sequential developments of skull growth. Assistance to government instrumentalities, hospitals and universities has included advice in the planning of X-ray departments and in the specification of equipment.

A • plastic phantom' filled with liquid of low radioactive content being positioned for the calibration of the Whole Body Monitor at the Commonwealth X-Ray and Radium Laboratory, Melbourne

Radiation Dosimetry In association with the National Health and Medical Research Council planning has been carried out for a survey to assess the geneticallysignificant dose to the Australian population arising from the use of ionising radiations. The Laboratory has maintained its routine services relating to the measurement of radiation output and the associated characteristics of X-ray equipment used for therapeutic purposes in hospitals and in private medical practices.

Radio-isotopes During the year 2,625 shipments of radio-isotopes were procured by the Laboratory for medical use. The Laboratory is the central procurement agency for purchasing and distributing radio-isotopes used in Australia for medical diagnosis, treatment and research. The number of radioisotopes procured in the past year increased by nine per cent over the number for the previous twelve months. Of the total, 370 shipments were procured from the Australian Atomic Energy Commission, compared with 266 shipments in 1966-67. The remainder of the 'shipments were from overseas spurces which include the United Kingdom, the United States, Holland, India, France, Italy and West Germany. The total shipments included forty-eight different radio-isotopes in many different forms. A total of 64,237 individual issues of radio-isotopes were made in 1967-68, an increase of 172 per cent over the number for the previous year. These doses are made available without charge to all classes of patients through the National Welfare Fund. The increase in expenditure from the National Welfare Fund for radio-isotopes procured by the Laboratory for medical purposes since 1956 is shown in Table 63 on page 124. An interesting development has been the increasing use of special , generators' from which radio-isotopes of short life can be extracted periodically. These short-lived materials are used on patients in special diagnostic techniques. As part of the programme relating to the provision of national standards, equipment for the accurate measurements of certain radio-isotopes in terms of the Curie has been installed and tested.

Protection Against Ionising Radiation The legislative control in Australia of the use of ionising radiations from irradiating apparatus and radioactive substances is mainly the responsibility of the States. The Laboratory co-operates with State authorities in this work but maintains its own advisory services. Technical assistance given by the Laboratory ranges from the detailed design of protective shielding in X-ray departments and radio-isotope laboratories to the monitoring of radiation levels and the assessment of proposed safety procedures. 68

During the year aS3istance was provided to Government departments in matters relating to the safe transport, storage and diSlposal of radioactive materials, and in framing the procedures to be followed during the entry of nuclear-powered vessels into Australian ports. A review has been made of the pre3ent uses of radioactive luminous compounds and of the associated hazards. Investigation into the possible danger to those operating powerful radar installations from exposure to microwaves of high power density have been continued and an assessment is being made of the possible risks arising from the production of X-rays in colour-television receivers.

Film Badge Service The Laboratory film badge service, under which film badges are issued to people to ensure that they are not exposed to unacceptably high levels of radiation in the course of their work continue3 to expand. In 1967-68, 77,301 individual monitoring films were assessed and reported on. The number of centres registered with the service is at present 1,186. The increasing demand for the service has made it necessary to employ automatic techniques, including an analogue computer, for asse3sing the films and recording the results.

Commonwealth Bureau of Dental Standards

The past year has seen active participation overseas in the work on international dental standards, greater assistance interstate in training dental personnel in materials and the installation at the Bureau of special equipment to assist in programmes of investigation and testing. The investigation, teaching and standards programmes of the Bureau have been maintained with particular emphasis being placed on recently introduced products. Several Asian and Pacific fellows and scholars in Australia have attended the laboratory during the year for instruction and training.

A ustralian Standards Further assistance in the preparation of specifications for medical and dental items has been given through committees of the Standards Association of Australia, especially in regard to hypodermic syringes and needles, both of the re-usable and single-use types. The Bureau has been investigating test methods and requirements for local anaesthetic solutions, elastomeric impression materials, dental X-ray film, denture repair resins, various orthodontic items of metal and rubber, gold and cobalt-chromium alloys, casting waxes, investments and amalgam alloys.

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Testing The testing programme for local and overseas dental manufacturers, distributors and for Government and other bodies has continued. Of the total of 200 samples tested, there were forty-eight cements and mineral products, twenty-five waxes and impression materials, thirty-four synthetic resins, fifty-two metals and alloys, twenty-five instruments and sixteen therapeutic materials. Some of these samples were related to the check-testing of products included in the list of certified products prepared by the Australian Dental Association.

Investigational Projects Silicate cements, used for what is loosely called' porcelain fillings', have some serious disabilities which shorten their useful life as restorative materials. One of these disabilities is the tendency to dissolve or disintegrate in the mouth and a study has been made of the substances leached out of silicate cement over a period of twelve months. Fluoride, one of these substances, assists in preventing further decay at the margins of the filling, but its loss together with other constituents gives rise to ultimate breakdown of the restoration itself. One manufacturer has devised a product claimed to have greatly enhanced resistance to breakdown and dissolution and this is under close examination. 70

Among recent developments being investigated are a new type of elastomeric impression material, zinc oxide eugenol cement;; modified with ethoxybenzoic acid-which is claimed to improve their propertiesand some novel methods of dispensing and mixing cements and amalgams.

Equipment Some new types of equipment have been installed at the Bureau to assist in its investigation and testing. These include an atomic absorption spectrophotometer, to be used for simplified analytical techniques not previously available, and an automatic induction casting machine for cobalt-chromium and other high-melting alloys. A new versatile universal testing machine, which can handle by electronic devices specimens with breaking loads ranging from a few grams to ten tons, has proved very useful and further studies of its performance and application are being undertaken.

International Standards The Bureau was repre3ented by its Director at the Fourteenth World Dental Congress held in Paris in July 1967. Prior to and during the Congress, he attended meetings of the International Standardisation Organisation and its various working groups in particular dental fields, and of the Federation Dentaire International (Commission on Dental Materials, Instruments, Equipment, and Therapeutic Materials). In the meetings of the International Standardisation Organisation particular attention was given to zinc oxide eugenol cements, synthetic resin teeth, elastomeric impression materials, tolerance for rotary dental instruments and dental nomenclature. Programmes of work on root canal instruments and dental radiographic film were arranged through appropriate secretariats. The FDI Commission discussed with the ISO the co-ordination of its dental standardisation work, a code for radiation hygiene in dentistry, rules for the acceptance of dental therapeutic products by national as'3ociations and standards for various dental materials. The Director of the Bureau also attended the annual conference of the British Dental Association, held in Birmingham at the end of July 1967, and visited a number of dental materials research and standards centres. It was noted that a much more vital interest in dental standardisation and product accreditation programme3 has been stimulated in the United Kingdom over the past year or two and that there is close colJaboration between the dental profession, manufacturers, government laboratories and the Ministry of Health.

Meetings and Lectures Members of the staff have presented papers, clinics or exhibits at various meeting3 and have assisted in the training of dentists, dental therapists, nurses and technicians from South Australia, Tasmania and Victoria. Lectures to groups of practising or undergraduate dentists have been given in Tasmania, New South Wales, Queensland and Victoria. Several overseas denti3ts on fellowships or scholarships have been instructed at the Bureau on the properties and testing of dental materials. The dentists came from India, Tonga, Taiwan and the Philippines. 71

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A iilaTiasis investigation patrol from the School of Public Health and Tropical Medicine climbs to a mountain village in Papua-New Guine!t

School of Public Health and Tropical Medicine

The School of Public Health and Tropical Medicine maintained a busy and satisfying programme of research, teaching and consultative activities during 1967-68. The School is conducted by the Commonwealth Department of Health in association with the University of Sydney and its work comprises teaching and investigation and consultation in subjects relating to public health, social and preventive medicine and tropical medicine and hygiene.

Teaching Courses at undergraduate, postgraduate and extra-mural levels were maintained and in case3 extended. Full-time courses were provided for graduates in medicine for the Diploma of Public Health and the Diploma of Tropical Medicine and Hygiene. Courses were also provided for various subjects of the postgraduate diploma courses in Public Health Dentistry, Clinical Pathology and Social Work and for a three-weeks course in Occupational Health for medical practitioners. Undergraduate courses were given for medical students in preventive medicine (fifth year) and parasitology and malaria (fourth year) and in hygiene, industrial hygiene and safety, and in protozoology for students of architecture, engineering and sdence respectively. Various extra-mural courses were undertaken for the Australian School of Pacific Administration, the University of New South Wales and the New South Wales College of Nursing and instruction W33 arranged for personnel of Commonwealth departments and organisations, the Armed Forces, and various institutions. A seminar on rabies was held in February 1968 and attended by senior representatives of public health authorities and from medical and veterinary schools. The lectures in the seminar covered the epidemiology, symptomatology, diagnosis and prevention of the disease and were accompanied by practical demonstrations and film sessions.

Research Entomology The detailed investigation of unsolved problems concerned with populations of filth-ftie3 in urban areas has continued. Statistical analysis of the extensive survey data has now revealed or substantiated the following points: 1. Within the complex of fly species of domestic importance some are

almost entirely dependent on human activities for their existence whereas others attain significant population densities unaided by man. 2. Fluctuations in population densities of considerable magnitude can occur in a wide variety of environments at the same time, indicating dependence on general factors which are either climatic or dependent on climate.

3. Extremely rapid increases in fly population densities which could justly be termed explosions, occur from time to ti~e and cannot be interpreted as due to population build-up but only as due to release from normally effective controls almost certainly of a natural character. At times fly population can increase from c1o'se to minimal to maximal within the space of two to three weeks. 4.

Si~oc:v:~~~niie~~sc~~~r~f ~~~~i~r ;::~:a;:-~st~es~:: ~~a~zt~=~~~

of individual species and on an evaluation of the real contribution if any, of methods of control now commonly employed. Observa~ tions ancillary to the fly survey itself have emphfrsised the local importance of aggregation of animals, poultry, pigs and cattle especially. Reports of bush fly (Musca vetustissima) abundance in the Sydney area over past years have now revealed two distinct problems, one occurring in early November and the other throughout the summer. The November problem only affects suburbs immediately adjacent to the coastline and at times the city itself and the elevated country to the north, but not necessarily the valleys in this area. It is now clear that this is a windborne invasion following a particular wind sequence commonly experienced in the first week of November-that of westerly winds from the interior of the State converting suddenly to southerlies. Although dramatic, this invasion is of brief duration and western metropolitan areas, to which the southerlies do not penetrate, are free of bush flies at this time. The source of the invasion, although not known, would certainly be west of the Dividing Range. The summer problem is a feature of the rural and semi-rural areas peripheral to Sydney and is of local origin derived at least in part from breeding occurring in fresh cattle dung. Work relating to mosquitoes has been dominated by the problems arising in an attempt to establish a laboratory colony of Anopheles annulipes. Although all previous attempts to colonise this species have failed, the introduction of an artificial mating technique has resulted in success so far to the sixth generation.

Environmental Health Anti-malarial drugs are commonly administered to unacclimatised men and women as they enter, or are about to enter, a tropical area. If such drugs had a deleterious effect on heat tolerance this could be of material importance, especially in the military situation of unacclimatised troops from a temperate climate entering a war zone in the tropics. An experiment was therefore conducted to determine if either proguanil or chloroquine, the two most commonly used anti-malarials, produced any such effect. The work was carried out in association with 1 Malaria Research Laboratory, Royal Australian Army Medical Corp's, and was made possible by the collaboration of 1 Battalion, Royal Australian Regiment, which provided thirty-two volunteers to act as subjects. A ' double-blind' trial was performed under the most rigid precautions, in which a subject was exposed twice to work in a hot environment and received on one occasion the active drug and on the other a placebo. The results, which have been submitted for publication, conclusively showed 74

that neither proguanil nor chloroquine, when administered in the dosage prescribed for the suppression of malaria, has any effect on heat tolerance. Provision was made in the experiment on the effect of anti-malarials on heat tolerance for the results of the physiological measurements to be used in an assessment of the heat tolerance of the participating subjects. It was shown that the heat tolerance of these young soldiers in Australia lies almost exactly midway between that of two other groups with whom they were carefully matched for age and physical characteristics-one a group of sailors serving in England and the other a group of sailors serving in Singapore who were well acclimatised to a tropical climate. A paper to this effect is in course of preparation. Information gained from routine observations of thermal comfort and of the inter-relations of blood pressure, skinfold thickness, body weight and oral temperature in Antarctica has been collected over the past seven years in collaboration with the medical officers of the Australian National Antarctic Research Expedition. Analysis has been made of the data so far collected. Only tentative conclusions can be drawn at this stage, but the results confirm the findings in a previous investigation in showing that discomfort due to heat as well as discomfort due to cold occurs in men living in Antarctica.

Biochemistry An investigation of techniques for the estimation of quinoline derivatives, with the object of providing a suitable means of rapid anti-malarial drug assay, is proceeding. A study has been commenced of changes in serum and plasma held at varying temperatures with reference to both enzyme decay and differential pattern with standard and borate media, especially in relation to lipoprotein, glycoprotein and mucoprotein quantitation. Work on copper metabolism and abnormal globulin patterns, to establish the nature of possible disturbances in copper metabolism occurring in leprosy and chronic liver damage, is proceeding.

Genetics Linkage analyses for genetic markers and the beta-thalassaemia locus were completed. No evidence of close linkage was obtained for any loci. Techniques have been established for short term tissue culture of human lymphocytes and for study of human immunoglobulins by fluorescent antibody and autoradiographic technique. Before embarking on pathological human material, immunological methods for determining reactivity of ' in vitro' immune systems are being developed.

Microbiology Work on infection with Mycoplasma pneumoniae was continued. In throat specimens examined for the presence of the organism from sixtytwo inmates of an institution for retarded children, none were isolated, although six Mycoplasma hominis and two yet unidentified Mycoplasmas were found. No significant advance has been made in the development of procedures for the immunological diagnosis of Histoplasma capsulatum infections. Work in this field is proceeding.

Occupational Health A survey was completed of all common loads and handling practices in Repatriation hospitals from the point of view of strain hazard to staff. The major emphasis was placed on the handling of patients, but loads in kitchens, stores, laundries and e13ewhere were also studied. Strain injury reports of recent years were also analysed. The findings support the belief that handling-strain injuries are the greatest cause of time loss at work and that these constitute a greater proportion of all time loss than in the average type of employment. The sources of hazard, and their relative importance, were more clearly defined, and ways of lessening the hazards indicated. These have possible applications in all hospitals. A report on this survey is being printed. A survey, undertaken to determine the amount of ink and paper dust in the air of rotary printing departments, and whether such dust is injurious to health, is nearing completion. It appears at the present stage that exposures to such dust in rotary printing has little adver3e effect on lung infection. An investigation was made into possible hazards associated with the transport of benzene in tankera on the Australian coast. This entailed work in the ships while at sea and in port, and the development of a sampling and analytical method for the estimation of benzene and other hydrocarbons in the breathing zone of workers. This method allows a large number of samples to be taken in inaccessible place3 prior to analysis by gas chromatography in the laboratory. A serious benzene hazard was discovered in the course of the work, which resulted in the iS3ue of a directive to ship-owners by the Department of Shipping and Transport on the subject of the carriage of benzene and petroleum products containing benzene. An investigation into a hazard from ethyl alcohol at a pharmaceutical works resulted in the development of a sampling method which recorded on a paper chart the exposure of a workman during his working day. The method can be modified for a number of other industrial contaminants and, unlike most other industrial hygiene '3ampling techniques, allows the determination of instantaneous values of contaminant to which a workman is exposed. "

Parasitology Assessment of the results of long-term study of the epidemiology and control of filaria3is in New Guinea, undertaken in collaboration with the Department of Public Health of Papua and New Guinea, is proceeding. A report on ' Recommendations on the Control of Bancroftian Filariasis in the Territory of Papua and New Guinea' was submitted to the Medical Research Advisory Committee of the Territory. Alimentary parasite surveys were continued in an effort to obtain a better understanding of the incidence and distribution of such infestation and an assessment of methodology. Five hundred and eighty-nine specimens, obtained from an infants' home and an Aboriginal children's home in New South Wales, and from native people in North Australia and New Guinea, were examined. A parasite survey, arranged at the request of the Director of Medical Service'3, Fiji, is proceeding.

Preventive and Social Medicine A pilot-study of twenty persons with inherited forms of severe visual handicap yielded strong indications for further study of associated individual and social problems. This is now under way. The aim of thh study is to define problems relevant to blindness in New South Wales and to recommend methods of assistance and guidance for the individual. A study of the employment problem3 of 166 asthmatics was undertaken to determine whether agencies providing vocational guidance and employment to asthmatics were meeting the needs of asthmatics in this area. This study was conducted in collaboration with the Asthma Welfare Society of New South Wales and a paper has been submitted for publication. The long-term inve3tigation of the efficacy of BCG vaccination in the prevention of leprosy, which has been conducted in an area of high leprosy incidence at Karamui, in New Guinea, in collaboration with the Papua-New Guinea Department of Health, was extended for an additional year because of the considerable bearing its results could have on the final evaluation of BCG as a prophylactic. In a further visit to the area, data relating to the neurological assessment of all ca3es were collected and a study was made of the social structure covering the whole local population of 5,000, for use in the development of indices of exposure to infection.

Preparing to examine village?'s during the Karamui lepro.y project, Territory of Papua and New Guinea [Photogmph by Dept, Medical Illustrations, Unive'rsity of New South Wales]

An evaluated control programme using a depot sulphone, which was enthusiastically accepted by the people, was also commenced. From the results to date, BCG appears to have protective efficacy of forty-six per cent where the vaccine is given prior to invasion by the leprosy bacillus. In situations where the disease is endemic and a large proportion of the population can be assumed to have been exposed to infection and probably invaded by the organism prior to vaccination, BCG offers no protection. This result is in accord with experimental studies in mice, and may explain the widely conflicting results reported from similar trials in Uganda and Burma. The phenomenon of self-healing in leprosy and the importance of lepromatous cases as sources of infection were conclusively confirmed.

Radiation Bi~logy Further work was done in the cytogenetic characterisation of experimental leukaemia. Within the confines imposed by the morphology of mouse chromosbmes, chromo'some analysis was made of forty-three radiation induced leukaemias. Cytogenetic variability of the leukaemias appears to lie abuIj-dantly outside the normal variation of non-malignant tissues. Inspection of the aberrations of chromosome number and form seen within the thymus and the distribution of distinctive clones and classes within aggrega~ed tissues is consistent with an origin of the radiation induced neoplasm within the thymus. Twenty patients treated by radiophosphorous for polycythaemia were examine(i by one or more cytogenetic means. It was found that the level of chromosome breakage was comparable with that found in two overseas studies but the number of stable and unstable aberrations were not as extensivll as previously reported. A pilot study has been commenced of the atjerrations induced in the bone marrow of some patients undergoing radiotherapy in order to correlate cytogenetic aberrations with radiation dosage. It is anticipated that the correlation should add to the information required!to enable assessment of absorbed dose in radiation accidents.

Tropical Medicine Very gqod progress was made in the continuing health study of an Aborigirlal community in New South Wales. The good progress being made is attributed to the careful individual contact employed in the method pf approach. Among these people economic hardship is related to the low educational level of most workers, the large number of children in some househol-ds and the apparent lack of motivation of many to spend availablEl funds in the way which middle class people consider to be proper. The sUrvey made of their children shows that they have had their major medical problems attended to. At the same time the majority of the children suffer from complaints which may be ' minor' in the strictly medical Isense but which are major social handicaps, being a barrier to social integration and equal opportunity at 'school and in employment. Others have less obvious 'minor' disabilities which produce persistently suboptinltal health and indicate insufficient use of the medical services which are available. Psychological problema are evident among the older children. It is planned to explore ways and means by which the health status o~ these people can be improved by the use of a public health nurse working 'as a member of the study team.

Institute of Child Health ,

The Institute of Child Health moved into its new building in November 1967 and this event and the facilities now available have given impetus to many of the Institute's activities. The new building was made possible by a grant from the Australian Universities Commission to the University of Sydney, the funds being provided partly by the Commonwealth and partly by the State of New South Wales. Much of the equipment was provided by the Commonwealth. The building has two floors, each of 6,000 sq ft. On the ground floor there are three clinical rooms, two rooms for social workers, five rooms for the child psychiatry section, a common room for secretarial staff, a large laboratory with two adjoining smaller laboratorie3, a balance room and an area yet to be completed as additional laboratories. On the first floor, there are offices for the medical staff, a seminar room for medical students, a meeting room for the medical and technical staff, a laboratory and a conference room. The Institute is located partly in the School of Public Health and Tropical Medicine, in the grounds of the University of Sydney, and partly at the Royal Alexandra Hospital for Children. The staff of the Institute conduct research and also co-operate in both undergraduate and post-graduate teaching. An important part of the duties of the staff is as advisers to the Commonwealth on matters relating to child health.

Scope of Work The work of the Institute is developing in three general directions: an increa'3ing involvement in national and international advisory services related to child health and disease; a demonstration of the ways in which psychological adjustment to modern life can be assisted both individually by the medical profession and generally by society; and attention to problems of certain specific illnesses ill childhood. Fruitful international co-operation was a feature of the year's activities. Three Indonesian paediatricians worked at the Institute during the year. Special programmes were arranged for Dr Moeljono Trastotenojo, Head of the Department of Paediatrics of the University of Diponegoro, Semarang, Central Java, and for Dr Sutedjo, Head of the Department of Paediatrics of the University of Indonesia, Djakarta, and a member of the Advisory Board of the International Paediatric Association. Also from Indonesia, Dr Jan Mangiwa of the Department of Paediatrics, Macassar, Sulawesi, joined the staff as a Colombo Plan Fellow for both general paediatric training and special training in gastroenterology. As in the previous year special advice was given, on request, to the Administration of Nauru and arrangements have been made for a member of the Institute staff to carry out a survey of genetic problems in Nauru. At the request of the World Health Organisation, Dr G. M. Alino, from the Philippines, spent two months at the Institute while making a special study of child health services ill New South Wale-a. 79

Advisory Services Dr F. W. Clements undertook an assignment for the World Health Organisation in the Philippines on a project for the coptrol of endemic goitre by the use of iodized oil. He also went to India! as a short term consultant to WHO during a seminar on the use of iodized salt in the prevention of goitre. The Director has continued as Chairman of the Child Welfare Advisory Council of New South Wales. Thi3 is a statutory boqy which advises the State Government on Child Welfare matters. The pouncil has prepared a detailed report on the problems of hooliganism in New South Wales for submission to the relevant Ministries in the State. During the year consultations were held with a number of hospital authorities on the planning of accommodation for children. Expert opinion wa3 given in relation to the treatment of juventle offenders and discussions continued with the New South Wales Child :Welfare Department on the care of children in institutions. "

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His Royal Highness the Duke of Edinburgh visits the Institute of Child Health. Sydney

Educational Activities Since 1961 a number of booklets have been produced on paediatric sUbjects. These hll;v~ been set up and I;1rinted by the University of Sydney. They were orIgmally planned mamly as aids in the medical education of ~ndergr~dw:te ;at?dents in th~ Un~versity. 'A Students' Guide to Dosage m PaedIatrICS, A Students GUIde to Infant Feeding' , A Students' Guide to Fluid and Electrolyte Therapy', 'A Students' Guide to Fibrocystic Disease of the Pancreas' and ' A Students' Guide to Some Immunising Procedures' fall into this category. Two books, however, have been recently produced mainly to as'aist parents of patients attending the Institute to understand some of the complexities and problems which arise in dealing with their children's illness. 'Fibrocystic Diaease of the Pancreas: Some answers to Parents' Questions' and' A Guide for Parents Whose Children have Thalassaemia' have been written in dialogue-form in the hope that a simple manual may assist understanding among affected familiea. The Cystic Fibrosis Association of New South Wales has been distributing the relevant booklets to medical practitioners on request. The publication on Thalassaemia i3 being issued in Greek, Italian and English versions.

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Child Psychiatry Active development of the Child Psychiatry Section has been made possible by the improved facilities available in the new building. In addition to the teaching of child psychiatry to undergraduates by lecture, seminar and case discussion, lectures and demonstrations have been given to candidatea for the Diploma in Psychological Medicine and candidates for the entrance examination to the Australian and New Zealand College of Psychiatry and to students of the Department of Social Welfare. Formal training of psychiatrists wishing to specialise in child psychiatry has been developed.

~ I

Research A gastroenterology laboratory has been €atablished within the Institute and equipped initially for morphological studies and enzyme assay of small bowel mucosa. The main interests of the unit are morphology of small bowel mucosa in childhood, the diagnosis and the long-term foHow-up of children with coeliac di3ease and the investigation of sugar intolerance in childhood and children who have had infective gastroenteritis. Sugar intolerance is being studied in the Laboratory by performing enzyme assay of mucosal specimens and clinically by an evaluation of bariumlactose meals as an aid to diagnosis. Ten children with coeliac diaease are being followed clinically with particular reference to the effect of a gluten free diet on their serum immunoglobulins. Five children who have had gastroenteritis are also being followed-up to assess the long-term effecta on growth and development. A metabolic laboratory has been established in the Institute to investigate disorders of carbohydrate and amino acid metabolism. The initial projects commenced include the investigation and long-term management of infants and children with inborn errors of metabolism such a3 phenylketonuria. Many such infants are now being diagnosed early in life by 81

routine ;screening surveys such as that performed by the New South Wales Bureau' of Maternal and Infant Welfare. The projects are important becau3e prophylactic care can prevent mental retardation in phenylketonuria and renal calculi in cystinuria. About sixty children are now attending thel special metabolic clinic. The long-term study of rheumatic fever and chorea, begun in 1952, has been cQntinued. The main aims of this study are to determine the effectiveness of penicillin prophylaxis in preventing rheumatic recurrence and ultimate cardiac damage and to study the history of the disea'3e in as large a group of Australian children as possible. Since the beginning of the study, 284 children have received regular oral penicillin prophylaxis, but thirty-six have been lost from the group during sixteen years, including five who have died. More than seventy of tho'at remaining in the study are now over twenty years of age and are stiJI attending for assessment at regular intervals. In addition to the 284 patients receiving penicillin, a large number of other rheumatic patients are reviewed annually. A paper, entitled 'Tonsillectomy and Rheumatic Fever' was published in the Medical Journal of Australia on 16 December 1967. Six hundred and sixty patients were reviewed to ascertair the effects of tonsillectomy on the disease. It was concluded that the occurrence of rheumatic fever is not an indication for the removal of tonsils when prophylaxis is given. The lnstitute has also continued its study of chronic urinary tract infections in childhood. A simplified technique for bacterial colony counts as part of the routine urine culture introduced laat year by the Bacteriology Departl11ent of the Royal Alexandra Hospital for Children, has been of great value in this study. The number of children now included in the Institute's long-term study o~ cretinism is fifteen. In this study the main criteria of progress are mea3urements of height, span, weight and developmental quotient. An initial assessment of osseous age, cholesterol and protein bound iodine concentl(ation of the serum is made. The latter test is repeated at twelve-monthly intervals, or more often if indicated by the clinical condition. Activ~ co-operation with the Australian Cancer Society and the Tumour Study Group of the Royal Alexandra H03pital for Children has continued. The Institute is the allocation centre for the treatment of patients with leukaemia in South Australia, Western Australia, Queensland and New South wlales.

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Institute of Anatomy

The Nutrition Section of the Institute of Anatomy carried out during the year an interesting study of metabolic rates in New Guinea. At the request of the South Pacific Commission, and with the co-operation of the Dean of the Papuan Medical College, Port Moresby, and the Baptist Missionaries at Baiyer River, near Mt Hagen, a study was made of the metabolic rates, under standard fasting, resting and exercising conditions, of healthy indigenous medical students who were consuming European~ type diets compared with the rates of healthy New Guinea Highlanders whose diets were composed predominantly of sweet potatoes. Contrary to the expectations which prompted the study, it was found that the fasting, rllsting metabolic rates, and the extra metabolism needed to perform a standard exercise, were considerably higher in the Highlanders than in the Port Moresby students. A parallel study of diets and nitrogen balances carried out by Miss Margaret Corden in collaboration with Professor H. A. P. C. Domen, of Amsterdam, confirmed a low protein consumption by the Highlanders, whose diet i3 based on sweet potatoes, compared with the students, whose diets were based on cereals plus meat. Final conclusions from this study must await the completion of the analysis of the collected samples. It is, however, considered likely that the results of the metabolic study were due to the difference in protein consumption by the two groups.

Museum Work in the Museum Section of the Institute on the display dealing with the brain and nervous system is continuing. A revision of the display dealing with the reproduction of life has begun. Experimental work is being carried out on an exhibit designed to portray a concept of health and disease based on an analysis of basic needs of people and the ways in which these needs are satisfied. All the Australian material of the ethnographic collections at present on hand has been catalogued and accessioned. New material is constantly being added through the activities of the Australian Institute of Aboriginal Studies. Work has begun on similar records for the Melanesian collections.

National Health and Medical Research

Council

Two sessions of the National Health and Medical Research Council were held in 1967-68. The Sixty-fifth Session was held in Canberra on 27 October 1967 an-d the Sixty-sixth Session in Melbourne on 31 May 1968. Committees and sub-committees reporting to the Council held over ninety meetings. The membership of these committees and sub-committees includes recognised authorities in all fields of medicine and allied disciplines.

Medical Research The Council continued to make important advances towards establishing a planned programme for financing the future medical research needs of Australia. During the year some three hundred applications were received from research workers ';seeking project and scholarship support. Grants totalling over $1,200,000 were divided between 140 research projects. This amount was thirty-two per cent more than the total approved in 1966-67. As the number an-d scope of research programmes expands there is a developing need for more trained workers in the fields of medicine and dentistry. The Council has recognised this need and, through its postgraduate research training scheme, is endeavouring to keep pace with the expansion in particular areas of research. At present thirty-five scholarships are held by medical and dental graduates engaged in research training. Each scholarship has a normal tenure of three years. An indication of the importance which the Council places on the scheme was the formation during the year of a standing committee, comprised mainly of experts in the field of medical education, to advise the Council on suitable applicants to receive the scholarships.

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Mosquito Control Recommendations have been made concerning the eradication of the Aedes aegypti mosquito in Australia. It is a potential vector of haemorrhagic fever, which is a problem in South-East Asia, and there is a risk of introduction of the disease into this country. The Council has recommended, as an objective, that Aedes aegypti be eradicated and that a study should be made of a programme to achieve this. This study would cover the practicability of an eradication campaign and the methods, costs and co-ordination involved.

Antibiotics in Stock Feeds A special ad hoc committee has been formed to consider the question of antibiotics commonly used ail additives to feed for livestock. The additives are used to promote growth in the animals. The Council has produced a list of antibiotics approved for this purpose and has specified the amounts and concentrations recommended. A list of antibiotics not approved a's /additives for livestock has also been prepared. 84

Codex Alimentarius Work on the preparation of food standards is to be integrated more closely with that of the FAO/WHO Codex Alimentarius Commission. Acceptance of these standards by Australia requires enabling legislation in the various States. The Council has recommended that the acceptance procedure for standards be simplified by arranging representation from all States in the committee work.

Dental Health The Council has recommended the intake of fluoride during pregnancy, since it considers the effectiveness of fluoride in the reduction of dental caries is now a proven fact and that there is no evidence that the ingestion of fluoride in normal amounts is harmful either to an expectant mother or to the foetus. However, the combination of fluoride with vitamin and mineral supplements can lead to uncontrolled dosage of certain of the ingredients and the Council believes that the use of such combined preparations should be discouraged.

Diabetes Surveys The results of survey's conducted on the incidence of diabetes mellitus in country towns in Queensland and New South Wales have been studied by the Council, which has concluded that the organisation, planning and methods used in these 'surveys provides a useful model for future work on comparable diseases.

Epilepsy The Council has pointed out the need for health education of the public in order to change attitudes towards persons suffering from epilepsy. Such people may be of normal, or above normal, intelligence and capacity, and even those with some handicap can do useful work. The report of the 65th Session of the Council contains a report on the management and care of patients with epilepsy. The Council has drawn the attention of State authorities, rehabilitation 'services, the medical profession, employers, insurance underwriters and lay organisations to this problem.

Food Additives and Food Standards The Council has undertaken further review of permissible additives to foods and a further list of recommendations has been made. Modifications have been made to the suggested allowable tolerances for residues of agricultural chemicals in foodstuffs. Changes have been made in the food standards for fish and fish products and for imitation cream and ice cream. New standards have been recommended for liquid egg, for edible fats and oils and for the sale, service, storage, display and transportation of frozen foods.

---Malaria Although malaria is no longer endemic in Australia, there is a continuing danger that infections acquired abroad may become established in the Northern Territory and Queensland, parts of which are receptive to the foci of infection. The Council has set out detailed recommendations covering suggested procedure for treating malaria sufferers in both southern and northern parts of Australia. 85

Measles Difficulties have arisen in various countries in the use of measles vaccine for mass campaigns amongst children. Inactivated vaccines were used, but it was found that the immunity they gave was of short duration and that, in some children, they produced severe reactions. This often occurred when an immunised child contracted natural measles. The Council has investigated this problem and has recommended that live attenuated vaccine should be used in Australia, instead of inactivated vaccine. It is considered that measles vaccine should be given as a routine to young Aboriginal children, amongst whom a serious epidemic of measles was successfully controlled in the Northern Territory in 1966 following mass adminiistration of the vaccine.

Medical Statistics A report has been prepared on the use of computers in hospital management. There is wide scope for advance in the medical use of computers and tl)ey are already being employed to analyse data collected on cervical _ , . cytology. Further work was done in the field of hospital morbidity statistics and the Council produced a basic document for hospital statistics recording, an outline of hospital morbidity statistic3 available in Australia and recommendations on possibilities and priorities for further development and use of hospital medical records staff and morbidity statistics.

M ental Health The glossary of mental disorders produced for use with Section Five of the Eighth Revision of the International Classification of Diseases has been reviewed and amended and an index of mental disorders has been produced for USie in the coding of such diseases untilauch time as the WHO Index becoIDies available.

Nurses' Training The Council has pointed out the need for post-graduate training of nurses in the basic principles of research and survey methods, and that such training should be incorporated in the appropriate courses. Training of nu*es in psychiatric wards was considered to be of limited value unless preliminary theoretical training in psychology and the study of human relatidnship8 had been given.

Pesticides The Council has considered the dangers involved in the handling of pe3ticjdes. Draft uniform regulations have been prepared as a guide for the s~atutory control of the hazards arising from the commercial use of these substances.

Radiation Health The Council has prepared a code of practice for the control and safe handl~ng of sealed radioactive sources used in industrial radiography. A comprehemlive set of notes has been prepared indicating recommended . ~ medical procedure for radiation accidents and radioactive contamination.

These notes are a guide for personnel in industry who may be called on to handle persons or environments contaminated with radioactive materials and they give detailed instructions for first aid and the organisation of decontamination procedures. A code of practice on radiation hygiene in dentistry has also been produced for distribution to the dental profession and university dental schools.

Smallpox Vaccination A detailed recommendation was made setting out a list of disorders which the Council considers are contraindications to vaccination against smallpox. These include pregnancy and a number of skin and systemic conditions. The Council also prepared a list of recommended precautions in giving smallpox vaccinations.

Smoking Attitudes in Australia The first phase of a survey of the attitudes of Australian children towards smoking is in progress. A preliminary report on the survey was considered at the conference of Commonwealth and State Ministers for Health in June 1968. The survey is designed to show how children acquire the habit of smoking.

Transplantation oj Human Organs An ad hoc committee has been set up to consider a wide range of problems raised by organ transplantation and renal dialysis. The committee includes in its membership representatives of the various specialities involved and representatives of hospital administration from three States. Through the work of this committee the Council hopes to be able to produce a plan for rationalisation of the facilities for transplantation and to make recommendations which will clarify the complex medico-legal difficulties.

Typhoid Vaccine Typhoid vaccine has long been unpopular with Australians who have had courses of it in preparation for overseas travel and this has been because feverish reactions have been common. The Council has sought to minimise this by recommending the use of a modified vaccine which will give protection against typhoid fever but which should not produce reactions. This can be achieved by removing the paratyphoid A and B components from the vaccine. A WHO report indicates that these components do not give any added protection.

-..

Veterinary Public Health The Council examined the implications of the possible administration of radioactive isotopes to animals which are subsequently slaught~red for human consumption. It has recommended that an expert commIttee be available in each State to ensure that there is no risk to human health by consumption of meat from such animals. 87

World Health Organisation ,

The 21st World Health A3sembly was held at Geneva from 6 to 24 May 1968 al'fd, during the Assembly, the Organisation celebrated its Twentieth Anniversary. At the Assembly South Yemen was admitted to membership and Bahrain to associate membership. One hundred and twenty-one member Nations and two Associate Member Nations were represented out of a total membership of 127 and an associate membership of four. The re~iring Director-General of WHO, Dr M. G. Candau, was re-elected at the Assembly for a further five-year term. The Australian Delegation was led by the Director-General of Health. At a meeting of the Programme and Budget Committee the DirectorGeneral was appointed chairman of a special sub-committee on international quarantine. The Director-General, who is a '3erving member of the Executive Board, was also elected to the Standing Committee on Administration and Finance at the 42nd Session of the Executive Board, which was held immediately after the Assembly. I

Budget An effeCtive working budget for 1969 was accepted unanimously at the level o~ $U.S.60,749,800. This represents an increase of 8.1 per cent over the 1967 level and is within the previously agreed order of magnitude.

A field public health clinic in Africa

It was agreed to plan for a 9 per cent increase in expenditure in 1970. This will give a budget figure of about $U.S.66,000,000. The health needs in many countries call for a tremendous expenditure of effort and funds. The role of WHO is, however, primarily to advise, co-ordinate and promote health mea'3ures, rather than serve as a channel for funds.

International Sanitary Regulations The Committee on International Quarantine, at its meeting in December 1967, made a detailed review of the International Sanitary Regulations. It was proposed that these Regulations should be revised and be known as International Health Regulations. This was the first review for fifteen year3 and in that time many changes have occurred in the speed and volume of international traffic as well as in the knowledge and control of disease. In view of the details and volume of the Committee's report, a special sub-committee on International Quarantine was set up and as a result of its deliberation3, a resolution was adopted recommending the U3e of an approved method of vapour disinfection of aircraft as from 31 December 1970. It was not possible at the Assembly to deal with all the proposed amendments to the Regulations and Member States have been asked to send their comments to WHO by 31 October 1968, so that the matter can be taken up again at the 22nd World Health Assembly.

.- .

Malaria Eradication The campaign to eradicate malaria is the largest and most widespread activity of the World Health Organisation. In 1967-68 expenditure of $U.S.16,000,000 was directed towards the eradication of malaria and, in addition, many countries devoted much effort and money to their national campaigns against malaria. WHO has decided to set up four high level consultant teams to study the problems and advise countries concerned on the best method3 of carrying out eradication campaigns. One of the tasks of the consultant teams will be to bring home to affected countries the socio-economic advantages of malaria eradication. The Director of Tropical Medicine of the School of Public Health and Tropical Medicine, Sydney, Professor R. H. Black, has been appointed malariologist of one of the teams to study the problems. Professor Black spent three months with the Malaria Eradication Division of WHO at Geneva early in 1968, during which he compiled a handbook on the epidemiology of malaria.

Smallpox Eradication Smallpox is stilI endemic in South East Asia, India and part'3 of Africa and South America. The ten-year eradication campaign, started in 1967. is considered by WHO to be capable of completely eradicating this disease which is not dependent on an intermediate host for transmission amongst humans. The United States has announced the formation of a reserve of twenty million doses of freeze dried vaccine for emergency use against smallpox. 89

--~'I

Quality Control of Drugs The quality control of drugs had been discussed at 'the 20th World Health Assembly, and particularly the question of controls in international commerce. A proposal to draft international regulatioD!s was con3idered at the 21st Assembly but it was decided to formulate instead, suitable requirements for good manufacturing practice; to consider a possible certification scheme for drugs in international commerj2e; and to assist in the development of central control laboratories. The advertising of pharmaceutical preparations was also discussed and' principles were enumerated requiring adherence to truth, a statement' of toxic effects, designation, and dosage, and prohibition of advertising of prescription drugs to the public. Implementation of these principles is to be left to the individual countries. .

Surveillance of Communicable Diseases In conjunction with the 21st World Health Assembly a technical discussion was held on the question of national and international surveillance of communicable diseases. It was considered there are three main features of surveillance :-the systematic collection of pertinent data; the orderly consolidation and evaluation of data; and the prompt di3semination of the results to those who need to know, particularlr those who are in a position to take action. WHO has a distinct role in the surveillance of communicable disease. Initially this role was limited to quarantinable diseases. In recent years surveillance has been extended to several other diseases of international importance. These include influenza, endemic trepon~matoses, malaria, tuberculosis, dengue, haemorrhagic fever, salmonellosis and wildlife rabies. Surveillance is also applied to vector populations with regard to their distribution, density, resistance to insecticides and ecological factors. Perhaps the most important aspect of the future role of WHO in surveillance is to help governments in formulating a r~tional approach to better utilisation of existing facilities and resources. '

-'.

The Regional Committee for the Western Pacific Regio'1,L The 18th Session of the Regional Committee for t~e Western Pacific Region of WHO was held in Taiwan from 13 to 19 September 1967 and the Australian Delegation was led by Dr H. E. Downes. The work of WHO in the Western Pacific Region [ncludes a number of important programmes. The malaria eradicatioB programme now extends to fifty million people in malarious areas, a~d only 3.5 million are still unprotected in the Western Pacific Region. Campaigns against tuberculosis are now being carried out in almost every country or territory in the region. ApprotXimately four million BCG vaccinations are giveneach year under WHO/UNICEF programmes. Howfver, this coverage is still only twenty to thirty per cent of the total population. Many countries in the Region are now operating campaigns against poliomyelitis. Other fields of endeavour include healtll education, nursing training, environmental health protection by the provlision of safe water 3upplies and adequate sanitation systems, materna~ and child health ' measures and studies on nutrition. 90

Commonwealth Grants

The Commonwealth Government, through the Department of Health, made grants totalling $15.8 million in 1967-68 to State Governments and nonprofit making organisations to subsidise various schemes for the promotion and maintenance of certain health services for the community.

Blood Transfusion Service The Australian Red CrD'SS Society operates a nation-wide blood transfusion service from blood banks situated in each capital city. Blood transfusions and other treatments are provided free of charge. Since 1954 the Commonwealth has made an annual grant to each State Government equal to 30 per cent of the operating costs of the Blood Transfusion Service incurred by the Society in each State, provided that 60 per cent of the operating wsts are paid by the State concerned. This has left 10 per cent of the operating costs to be met by the Society. Grants to the States for 1967-68 amounted to $631,996. Tables 65 and 66 on page 125 show the grants made since 1953-54. The Society also operates blood transfusion services in the Australian Capital Territory and Northern Territory and the Commonwealth makea grants to the Society equal to 90 per cent of the operating expenses. Grants during 1967-68 were $4,180 for the Australian Capital Territory and $19,389 for the Northern Territory. The figure for the Northern Territory represents an increase of $17,000 compared with the previous year and reflects the greatly expanded service being provided from the new Red Cross headquarters in the Territory.

Royal Flying Doctor Service An important development in recent years in the services provided by the Royal Flying Doctor Service to people living in sparsely settled areas has been the introduction of regular field clinics. The number of consultations conducted by flying doctors, dentists and eye speciali3ts at these clinics now exceeds radio consultations. During the three-year period to 30 June 1968, the Commonwealth provided financial assistance to the Service in the form of annual subsidies for operational expenditure amounting to $450,000 and capital grants on a $1 for $1 basis of $390,000.

- Free Milk for School Children Commonwealth grants to the States under the States Grants (Milk for School Children) Act during 1967-68 amounted to $9,649,802 and a further $181,415 was paid for the provision of milk in the Northern Territory and the Australian Capital Territory. Under the Free Milk Scheme one-third of a pint of milk is distributed each school day to some 1,819,000 school children under thirteen years of age. 91

Expenditure by the Commonwealth on the Free Milk Scheme since its cqmmencement is shown in Table 69 on page 126 These figures do not include amounts reimbursed to the States for half the cost of • capital, .administrative and incidental expenditure, which was $29,937 for 1967-68.

Mental Health Institutions Following the introduction of Commonwealth capital grants for mental health I institutions, annual expenditure by the States on the provision of buildiI1gs and equipment for such institutions has risen from $4,639,000] in 195p-56 to $12,728,000 in 1967-68. Under the States Grants (Mental j Health Institutiom) Act the Commonwealth pays one-third of the capital expenc\iture incurred by the States for and on approved institutions. Details of the total expenditure each year since the inception of the capital' grants scheme in 1955-56, together with amounts contributed by the Commonwealth and the States, are shown in Table 71 on page 127.

Home Nursing Subsidy Scheme Duringl 1967-68 subsidies totalling $764,959 were paid to sixty-five home nursing organisations employing approximately 675 nurses. This was an increase in subsidies of $101,000 compared with the previou3 year and refiects, the steady growth which is occurring in both the number of organisations and the number of nurses engaged in this work. Details of the annual isubsidies paid Iby the Commonwealth since the inception of the Scheme are given in Tables 67 and 68 on page 126. To bJ eligible for subsidy, an organisation must provide a home nursing service" be non-profit making, employ registered nurses and receive assi3tance from a State Government or a local governing body established under a State; Act. Subs¥y payments are based on the number of nurses employed over and above the number employed during September 1956, in the case of exis~ing organisations, and on the total number of registered nurses employed by organisations formed after that date.

Lady Gowrie Child Centres The Commonwealth subsidises the activities of the Australian Pre-School Association, which administers the Lady Gowrie Centres, and in 1967-68 the grarlt was $120,000. This was divided equally among the six Centres. In addition, a grant of $14,800 was made to the Australian Pre-School A3socia~ion.

The o;ommonwealth established a Lady Gowrie Child Centre in each State c~pital in 1940 and made provision towards the cost of their operatioh. The Centres carry out specialised demonstrations and research work in; the problems of physical growth, nutrition and development and test and! demonstrate methods for the care and instruction of the young child. 111 more recent years the activities have included the mental development of children. 92

Children receive expert advice at a N atwnal Fitness tennis coaching camp at HO'lOman's Gap, Victoria

National Fitness

The stimulus of the increase in Commonwealth assist~nce to the National Fitness Movement in the past two years continues to have a significant influence on the range and extent of activities undertaken in the community by State National Fitness Councils. All States have taken advantage of the Commonwealth's offer of capital assistance on the basis of $1 Commonwealth to $2 State for national fitness capital projects. National fitness camps have been enlarged to provide additional accommodation and, in Victoria and Tasmania, new camps have been purchased to cater for the increased demand for a wider variety of activities. These increased facilities have also been widely used by youth and sporting groups in order to operate their own training programmes. There has been a general increase in the number of staff employed by State Councils to meet the demand for professional advice in the field of community recreation. In Queensland, numerous regional national fitness officera have been appointed following the offer of fiI).ancial support for such officers by local government authorities. There has been emphasis in each State's programme on camping activities. Most States are catering for the growing intereat in outdoor activities such as bush walking, rock climbing and canoeing.

State Education Departments The Commonwealth grant to State Education Departments during the year was $34,000. Assistance was given for training of teachers in physical education and for publications, films and equipment. School camping has also been developed in most States as an integral part of the general education programme. .

Universities Grants totalling $24,800 were made during the year to universities to assist in the training of specialist physical education teachers. Physical education department;, of the universities concerned also provided physical recreation activities for the general student body. The Universities of Melbourne, Queensland, Adelaide and Western Australia each received $4,200 and the Universities of Sydney and Tasmania ea¢h received $4,000.

'Keeping Fit' Following the offer of the AMP Society to provide financial assistance to enable the printing and distribution of the booklet' Keeping Fit', 800,000 copie3 were distributed between August and December 1967. The booklet received wide acceptance throughout Australia and had the effect of stimulating a greater awareness of the need for fitn,ess. Some State Councils have established permanent committees which· are continuing to promote fitness activities in industry and in the commulllity generally. 94

, "

The Commonwealth Council for National Fitness is investigating the possibility of developing a broad national campaign which will aim at encouraging public participation in a wide variety of recreational activities.

Duke of Edinburgh's Award The Duke of Edinburgh's Award Scheme was actively promoted in Australia by Award Committees in each State in association with the State National Fitness Councils. More than 5,000 young people are currently participating in the scheme within Australia through '3ome 700 individual groups. During May 1968, His Royal Highne3s, the Duke of Edinburgh, presented 121 gold awards to recipients in Sydney, Brisbane and Adelaide. The A ward Scheme is being recognised by an increasing number of youth groups as a valuable aspect of their training programmes . .

Contents

Appendix 1-Statistics Table No. NATIONAL HEALTH.

Pllge. No.

Departmental Expenditure-1963-64 to 1967-68 HOSPITAL BENEFITS.

101

Number of registered organisations, membership and coverage-1952-53 to 1967-68 3. Number of registered organisations, membership and coverage-by States-30 June 1968 4. Benefits paid to contributors by registered organisations-1952-53 to 1967-68 5. Benefits paid to contributors by registered organisations-by States-1967-68 6. Amount of Commonwealth and fund benefits paid-1962-63 to 1967-68 . . . . . . .... .... 7. Amount of Commonwealth and fund benefits paid~by States1967-68 .... .... 8. Amount of Commonwealth nursing home benefits paid-1962-63 to 1967-68 .... .... .... 9. Amount of Commonwealth nursing home benefit paid-by States1967-68 MEDICAL BENEFITS.

101 102 102 102 103 103 103 104

10. 11. 12. 13. 14. 15. 16. 17.

Number of registered organisations, membership and coverage-1953-54 to 1967-68 . .. Number of registered organisations, membership and coverage-by States-30 June 1968 .... .... Medical services receive-d by contributors to registered organisations-fee-for-service only-1953-54 to 1967-68 Medical services received by contributors to registered organisations-fee for service only-by States-1967-68 .... Cost of medical services to contributors to registered organisations-1953-54 to 1967-68 Cost of medical services to contributors to registered organisations-by States-1967-68 Amount of Commonwealth and fund benefits paid-1953-64 to 1967-68 Amount of Commonwealth and fund benefits paid-by States1967-68 PENSIONER MEDICAL SERVICE.

104 104 105 105 106 106 107 107

18. 19. 20. 21. 97

Number enrolled, number of services received and average attendances per enrolled person per annum-1951-52 to 1967-68 Number enrolled, number of services received and average attendances per enrolled person per annum-by States-1967-68 Number of participating doctors, payments received and average annual payment per doctor-195l-52 to 1967-68 Number of participating doctors, payments received and average annual payment per doctor-by States-1967-68

108 108 109 109

CONTENTS-Appendix I-continued Table No. Page. No.

PHARMACEUTICAL BENEFITS.

22. 23. 24. 25.

26. Digg8etion of 27. 28. 29. 30. 31. 32.

Cost of prescriptions-1960-61 to 1967-68 Cost of prescriptions-by States-1967-68 Payments to hospitals and miscellaneous services Dissection of benefit prescription costs into chemists' remuneration-1960-61 to 1967-68 .... .... .... .... .... b(mefit prescription costs Into Ingredient cost and chemists' remuneration-by States-1967-68 Number of prescriptions and average cost per prescription1960-61 to 1967-68 Number of prescriptions and average cost per prescriptionby States-1967-68 Number of prescriptions per head of population and average cost per head of population-1960-61 to 1967-68 Number of prescriptions per head of population and average cost per head of population-by States-1967-68 Drugs dispensed by chemists-1967-68 Number of pharmaceutical chemists and medical practitioners dispensing pharmaceutical benefits prescriptions-1949-50 to 1967-68

ingredient cost and

109 110 110

110 111 111 111 112 112 112 113

TUBERCULOSIS.

33. 34. 35. 36. 37.

Number of allowances, notifications and mortality-1952 to 1967 Number of allowances, notifications and mortality-by Statesyear ended 31 December 1967 Expenditure under the Tuberculosis Act-1949-50 to 1967-68 Expenditure under the Tuberculosis Act-by States-1967-68 Results of mass X-ray surveys-by States-year ended 31 December 1967 PUBLIC HEALTH.

113 114 114 115 115

38. 39. 40. 41.

Notifiable diseases in the States of Australia-1967-68 Poliomyelitis-number of confirmed cases-by States-1957-58 to 1967-68 Infectious hepatitis-cases notified-by States-1961 to 1967 Radio and television scripts on medical matters examined-1967-68 QUARANTINE.

116 116 117 117

42. 43. 44.

Vessels boarded and cleared-by States-1967-68 Infectious diseases on overseas vessels arriving in Australia1967-68 Animal importations subject to quarantine-1967-68 NORTHERN TERRITORY HEALTH.

117 118 118

45. 46. 47. 98

Aerial Medical Service-1967-68 Health services provided at main Northern Territory hospitals1967-68 ... Dental services provided in the Northern Territory-1967-68

118 119 119

CONTENTS-Appendix I-continued

· "

Table No. AUSTRALIAN CAPITAL TERRITORY HEALTH.

Page. No.

48. 49. 50. 51.

Licences issued under the public health ordinance-I967 Samples collected by health inspection section-1967-68 School medical service examinations-1967-68 Registrations granted-1967-68 NATIONAL FITNESS.

120 120 120 120

52. 53.

Allocation of annual grant to State National Fitness Councils196~68

121 121

Allocation of annual grants to State Education Departments1967-68 COMMONWEALTH MEDICAL OFFICERS.

54. 55.

Number of clinical examinations by Commonwealth Medical Officers-by States-1967-68 Number of vaccinations by Commonwealth Medical Officers-by States-1967 -68 COMMONWEALTH HEALTH LABORATORIES.

121 121

56.

Number of pathological examinations and laboratory tests performed and number of patients-1967-68 NATIONAL BIOLOGICAL STANDARDS LABORATORY.

122

57. 58. 59.

Summary of all samples examined-1967-68 Reasons for failure as percentage of total failures-1967-68 Safety tests performed-1967-68 COMMONWEALTH ACOUSTIC LABORATORIES.

122 123 123

60. 61. 62. 63.

Cases examined-1967-68 Calaid hearing aids fitted-1967-68 Cal aid hearing aids maintained-1967-68 COMMONWEALTH X-RAY AND RADIVM LABORATORY.

123 124 124

Expenditure under the National Welfare Fund on radio-isotopes for medical purposes-1955-56 to 1967-68 NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL.

124

64.

Grants made from the Medical Research Endowment Fund1967-68 COMMONWEALTH GRANTS.

125 125 125 126 126 126 126 127

65. 66. 67. 68. 69. " 70. 71. 99

Red Cross Blood Transfusion Service-1953-54 to 1967-68 Red Cross Blood Transfusion Service-by States-1967-68 Home Nursing Subsidy Scheme-1956-57 to 1967-68 Home Nursing Subsidy Scheme-by States-1967-68 Free Milk for School Children-1950-51 to 1967-68 Free Milk for School Children-by States-1967-68 Mental health institutions-by States-1955-56 to 1967-68

Appendix 2-Publications Page

No.

School of Public Health and Tropical Medicine Institute of Child Health Commonwealth Acoustic Laboratories National Biological Standards Laboratory Commonwealth X-Ray and Radium Laboratories Commonwealth Bureau of Dental Standards Institute of Anatomy Central and Divisional Offices National Health and Medical Research Council

129

130 131 131 131 132 132 132 133

100

Appendix 1 STATISTICS Table I

Departmental Expenditure 1963-64 to 1967-68 Year ended 30 June

1964 $'000

1965 $'000 58,791 35,277 82,203 9,320 8,059 10,146 2,859 206,655 696 2,087} 1,078 4,817 2,152 3,136 1,916 869 16,751 2,504 225,909

1966 $'000 60,743 41,282 91,784 13,365 8,493 13,379 3,453 232,500 696 8,836t 2,256 3,682* 2,388 1,105 18,962 4,539 256,001

1967 $'000 67,398 43,841 101,281 14,351 9,021 10,983 3,947 250,821 499 IO,677t 2,363 4,420* 3,291 1,096 22,346 4,973 278,141

1968

National Welfare Fund Hospital Benefits .' Medical Benefits Pharmaceutical Benefits Pensioner Medical Service

$'000 74,750 46,431 105,134 16,116 9,831 11,269 4,349 267,881 780 1I,706t 3,161 5,102* 3,805 1,545 26,099 4,243 298,222

Free Milk for School Children Tuberculosis* . Miscellaneous Total National Welfare Fund Consolidated Revenue Fund T u bercu losis Capital Reim bursement or

56,216 24,848 78,839 9,531 7,775 10,473 1,785 189,467 598 1,762 908 4,943 1,989 2,732 1,451 242 14,625 1,595 205,687

Administration

Quarantine .. Health Services Subsidies and Grants Northern Territory Australian Capital Territory Capital Works and Services

Total Consolidated Revenue Fund, .

Special Capital Grants to States for Mental Health Institutions Total Expenditure

Apparent minor errors in totals are due to 'rounding off'. *In addition to the amounts shown. allowances are paid by the Department of Social Services-see Table 35, page 114. tUnder the division of expenditure introduced by the Department of the Treasury, it is not now possible to derive separate figures (or these three items. :J:Certain expenditure preViously included in Administration is now included in this item.

Table 2

Hospital Benefits Number of registered organisations, membership and coverage-1952-53 to 1967-68 No. of registered organisations 139 127 128 124 122 119 116 115 115 113 110 112 III III 109 109

As at 30 June

Membership' ODD's 1,500 1,865 2.111 2,247 2,373 2,514 2,749 2,908 3,044 3,130 3,176 3,286 3,407 3,489 3,657 3,680

Estimated coverage ODD's 3.413 4,601 5.121 5,499 5.878 6,195 6,774 7,208 7,500 7,738 7,895 8,194 8,732 8,915 9,342 9,254t

Percentage of population covered

'1953 1954 1955 1956 . 1957 1958 1959

,1$0. 1961 1962 1963 1964 1965 1966 1967 1968

39 51 56 59 61 63 68 72 72 73 73 74 77 78 80 77t

"As advised by the organisations. tDecrease due to reassessment of coverage by a major organisation.

101

Table

Hospital Benefits Number of registered organisations, membership and coverage-by States-

30 June 1968 Stote No.o( registered organisations 32 42 4 13 9 9 109

"'- .

Membership' ODD's 1,449t 1.092 317 411 293 118 3,680

Estimated

coverage OOO's 3, 525t 2,926 812 997 699 295 9,254

Percentage o( population covered

New South Wales Victoria . .

Queensland South Australia Western Australia Tasmania . . Commonwealth

79t 88 47 84 78 77 77

'As advised by the organisations. tMembership and coverage in a major organisation reassessed.

Table 'I

Hospital Benefits Benefits paid to contributors by registered organisations-I 952-53 to 1967-68

Year ended 30 june 1953 1954 19S5 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968

No. o(doys (und benefit paid ooo's 1,874 3,413 4,642 4,808 5,492 6,215 7,049

Average doily benefit 1.03 1,40 1.58 1.81 2.32 2.62 2.75 2.68 2.88 3,17 3.43 4.40 4.83 5.40 6.61 7,46

No. o( claims per 100 members 13,4 19.9 23.5 20.8 23.3 25.6 26.9 29,4 29.7 30.9 32.1 30.7 32.5 32.8 33.4 34,1

Average stay in hospital per claim days 10,98 10.17 9,92 10.60 10.30 9.96 9,74 10.81 11,02 10.78 10.29 9,39 9.23 9.05 8,72 8.47

8,937 9,740 10,341 10,419 9,576 9,988 10,252 10,444 10,572

Table 5

Hospital Benefits Benefits paid to contributors by registered organisations-by States-1967-68

State New South Wales Victoria . .

No. o(days fund benefit paid OOO's

Average daily benefit 7.94 7.93 4.45 6.53 8,32 8.60 7.46

No. of claims per 100 members 35.6 27.2 40.3 38.3 39.4 35.2 34.1

Averofe stay in hospita per claim days 8.82 8.85 8.74 7.41 7,10 8.18 8.47

Queensland South Australia Western Australia

Tasmania . . Commonwealth

4,578 2,593 1,120 1,138 811 332 10,572

102

Table 6

Hospital Benefits Amount of Commonwealth and fund benefits paid-1962-63 to 1967-68 Commonwealth ---_._--------

Fund

Year ended 30 June

Uninsured patients $'000 1,028 2,578 2,614 2,464 2,376 2,298

Insured patients $'000 6,636 18,657 19,221 19,616 19,740 19,807

Pensioner palients $'000 4,731 13,354 13,585 14,665 18,731 23,665

Special account deficit $'000 4,246 3,749 3,576 2,873 3,784 4,494

Total $'000 40,681 ' 33,338 38,995 39,619 44,631 50,264

Excluding ancillary $'000 35,783 42,120 48,282 55,330 66,379 78,903

Ancillary $'000 944 1,162 1,537 2,232 2,632 2,879

Total

$'000 36,727 43,282 49,819 57,562 69,011 81,782

1963 1964 1965 1966 1967 1~68

Apparent minor errors in totals are due to 'rounding off',

'Includes Commonwealth ordinary benefit of $10,953,000 and additional benefit of $13,088,000.

Table 7

Hospital Benefits Amount of Commonwealth and fund benefits paid-by States-I 967-68 Commonwealth State Uninsured patients

Fund Special account deficits $'000 2,600 1,002 213 367 287 24

Insured patients $'000 8,477 4,872 2,176 1,998 1,620 664

Pensioner

Total $'000 20,568 11,551 7,527 4,437 4,376 1,5/8 168 120 50,264

patients $'000 8,871 5,272 4,259 1,969 2,316 783 156 40 23,665

Excluding ancillary $'000 36,326 20,557 4,988 7,425 6,749 2,858

Ancillary $'000 1,027 795 208 497 284 67

Total $'000 37,352 21,353 5,197 7,921 7,033 2,925

New South Wales Victoria ..

Queensland South Australia Western Australia Tasmania ..

Australian Capital Territory Northern Territory Overseas .. Commonwealth

$'000 620 405 879 103 153 47 12 80

* 2,298

t t t 19,807

t t t 78,903

t t t 2,879

t t t 81,782

4,494

Apparent minor errors in totals are due to 'rounding off'.

tA.C.T. included with N.S.W., N.T. with S.A., Overseas with State in which contributor is insured. *Commonwealth payment to uninsured patients overseas was $6.40.

Table 8

Hospital Benefits Amount of Commonwealth nursing home benefits paid-I 962-63 to 1967-68 Public nursing

Year ended 30 June 1963* 1964 1965 1966 1967 1968 ~ Apparent minor errors in totals are due to 'rounding off'. 'Six months 1/1/63 to 30/6/63.

homes $'000 2,513 6,503 6,773 6,970 7,249 7,694

Private nursing homes $'000 4,133 11,377 13,023 14,253 15,518 16,792

Total $'000 6,646 17,880 19,796 21,223 22,767 24,486

103

Table 9

Hospital Benefits Amount of Commonwealth nursing home benefit paid-by States-I 967-68 State Public nursing homes $'000 1,773 2,+16 1,819 452 855 349 7,694

Private nursing homes $'000 8,616 2,676 1,933 1,750 1,367 450 16,792

Total $'000 10,388 5,122 3,752 2,202 2,222 800 24,486

New South Wales Victoria

Queensland South Australia .. Western Australia Tasmania .. Commonwealth Apparent minor errors in totals are due to 'rounding off',

Table 10

Medical Benefits Number of registered organisations, membership and coverage-I 953-54 to 1967-"68'

As at 30 June

No. of registered organisations 79 80 82 81 81 82 83 83 82 78 81 80 80 78 78

Membership' ODD's 1,358 1,666 1,901 2,229 2,422 2,667 2,908 2,850t 2,846 2,952 3,095 3,217 3,313 3,418 3,456

Estimated coverage OOO's 3,502 4,154 4,806 5,715 6,148 6,713 7,311 7,173t 7,275 7,686 8,058 8,462 8,679 8,846 8,817t

Percentage of population covered

1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 *As advised by the organisations.

39 45 51 60 63 67 72 68t 68 71 73 75 76 76 74

tVariations from previous year result from revision of membership figures in one of the major organisations.

Table I I

Medical Benefits Number of registered organisations, membership and coverage-by States30 June 1968 State No. of registered organisations 28 19 6 8 8 9 78

Membership' ODD's

Estimated coverage

Percentage of population covered

OOO's 3,317 2,750 822 952 687 289 8,817

New South Wales Victoria ..

Queensland South Australia Western Australia Tasmania .. Commonwealth • As advised by the organisations.

1,350 1,010 316 381 284 115 3,456

74 83 48 80 76 76 74

104

Table 12

Medical Benefits

Medical services received by contributors to registered organisations-fee-for-service only-I 953-54 to 1967-68 Average No. Year ended 3D June No. of services received

Percentage of G.P. to Total 74 70 71 75 75 75 75 73 72 72 71 70 69 68 63

per contributor 3.4 6.2 6.8 6.6 6.7 6.5 7.1 7.3 7.7 8.0 7.8 8.3 8.7 8.7 9.4

of services

Average No. of services per person covered 1.3 2.5 2.7 2.6 2.6 2.5 2.8 2.8 3.0 3.1 3.1 3.2 3.3 3.4 3.7

Average cost

per service S 2.85 2.91 2.91 3.10 3.24 3.28 3.30 3.56 3.64 3.69 3.85 4.02 4.20 4.48 4.67

1954 1955 1956 1957 1958 1959 1.960 1961 1962 1963 1964 1965 • _)966 1967 1968

ODD's 3,284 9,453 12,259 13,668 15,582 16,819 19,625 20,123 21,669 23,431 24,308 25,847 28,210 29,269 31,991

Table 13

Medical Benefits

Medical services received by contributors to registered organisations-fee-for-service only-by States-I 967-68 State No. of services received ODD's 12,527 8,602 3,382 3,923 2,595 962

Percentage of G.P. to Total

Average No. of services per contributor 9.2 8.8 10.6 10.6 9.5 8.8 9.4

Average No. of services per

persons covered 3.7 3.2 4.1 4.2 3.8 3.5 3.7

Average cost

per service 5.04 4.63 4.23 4.30 4.18 4.49 4.67

New South Wales Victoria . .

% 62 65 64 62 61 63

Queensland South Australia Western Australia Tasmania . . Commonwealth

31,991

105

Table 14

Medical Benefits

Cost of medical services to contributors to registered organisations-1953-54 1967-68

tIL..

Year ended 30 June

of services (fee-far-service and contract) 9,112 27,169 35,276 42,003 49,625 54,619 64,203 71,242 78,499 86,213 93.313 104,624 119,021 131,770 141,982

Total cost

Percentage Fund

of total cost met by-(fee-for-service only) Commonwealth 31.4 30.9 30.6 29.3 28.3 28.5 28.2 27.4 27.0 26.6 25.9 32.9 33.9 32.2 32.0

1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968

-----------------------$'000 31.7 33.9 35.0 34.1 33.9 34.4 35.4 36.0 36.9 37.1 36.8 35.2 35.7 35.5 35.4

Contributor 36.9 35.2 34.4 36.6 37.8 37.1 36.4 36.6 36.1 36.3 37.3 31.9 30.4 32.3 32.6

Table 15

Medical Benefits

Cost of medical services to contributors to registered organisations-by States1967-68 Total cost of services (fee-for-service and contract) $'000

Percentage of totol cost met by(fee-for-service only) Fund 35.7 33.1 35.9 37.3 37.9 36.4 35.4 Commonwealth 29.4 31.6 33_0 37.8 37.2 36.9 32.0 Contributor 34.9 35.3 31.1 24.9 24_9 26.7 32.6

State

New South Wales Victoria ..

Queensland South Australia Western Australia Tasmania .. Commonwealth

59.902 38,580 13,696 15,041 10,852 3,911 141,982

Apparent minor errors in totals are due to 'rounding off'.

106

Table 16 .A

Medical Benefits

Amount of Commonwealth and fund benefits paid-I 953-54 to 1967-68 Commonwealth Year ended 30 June Benefits $'000 1954 .. 1955. 1956 .. 1957 .. 1958 .. 1959 .. 1960 .. 1961 .. 1962 .. 1963 .. 1964 .. 1965 .. 1966 .. 1967 .. 1968 .. 2,868 8,420 10,827 12,292 14,171 15,559 18,410 19,567 21,291 22,982 24,232 34,594 40.507 42,884 45,475

Fund Total $'000 2,868 8,420 10,827 12,292 14,171 15,559 18,583 19,952 21,823 23,474 24,847 35,276 41,282 43,841 46,431

Special account deficits $'000

Excluding ancillary $'000 2,929 9,296 12,408 14,414 16,953 18,821 22,790 25,794 29,062 32,042 34,442 36,880 42,560 46,898 50,332

Ancillary $'000

Total $'000 2,929 9,296 12,408 14,922 17,589 19,602 23,787 27,132 30,806 33,606 36.150 38.876 44,502 48,940 52,576

.. 508 636 781 997 1,338 1,744 1,564 1,708 1.996 1.942 2,Q42 2,244

M-

---,

173 385 532 492 615 682 775 956 956

Apparent minor errors in totals due to jrounding off' .

. .., Table 17 Medical Benefits

Amount of Commonwealth and fund benefits paid-by States-1967-68 Commonwealth Year ended 30 June Benefits $'000 New South Wales Victoria

Fund Total $'000 18,315 12.301 4.499 5.773 4,093 1,450 46,431

Special account deficits $'000 702 118 53 80 4 956

Excluding ancillary $'000 21,434 12,794 4,916 5,608 4,144 1,436 50,332

Ancillary $'000 1,168 373 235 261 124 83 2.244

Total $'000 22,602 13.167 5.151 5.869 4.268 1,519 52.576

Queensland South Australia Western Australia

17.613 12.183 4,499

5,120 4.013 1,446 45,475

Tasmania

Commonwealth

Apparent minor errors in totals are due to 'rounding off'.

107

Table 18

Pensioner Medical Service Number enrolled, number of services received and average attendances per enrolled ~ . person per annum-1951-52 to 1967-68 No. of pensioners and dependants enrolled at 30 June ODD's No.

of services ODD's

received

Average No. of services Tataf ODD's per enrolled person

Year ended 30 June'

Surgery ODD's

Domiciliary

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968

501 558 597 640 668 684 697 720 740 766 810 831 844 849 1,006 1,043 1,115

1,228 1,671 2,076 2,375 2,669 2,778 2,992 3,462 3,763 3,866 4,139 4,278 4,406 4,389 4,670 5,215 5,757

1,105 1,651 2,092 2,346 2,514 2,603 2,774 2,980 3076 3,131 3,223 3,111 3,020 2,859 2,824 2,972 2,898

2,334 3,322 4,168 4,721 5,183 5,381 5,766 6,441 6,"39 6,996 7,363 7,389 7,426 7,248 7,494 8,187 8,655

5.0 6.2 7.2 7.6 7.9 8.0 8.3 9.0 9.4 9.4 9.3 9.0 8.9 8.6 8.4 8.0 7.9

Apparent minor errors in totals are due to 'rounding off',

Table 19

Pensioner Medical Service Number enrolled, number of services received and average attendances per enrolled person per annum-by States-I 967-68 No. of pensioners and dependants enroffed at 30 June f968 OOO's No.

of services received Domiciliary 000', Total ODD's

State

Surgery OOO's

Average No. of services per enrolled person

New South Wales Victoria ..

Queensland South Australia Western Australia Tasmania .. Commonwealth

425 282 183 108 81 36 1,115

2,295 1,380 942 511 464 166 5,757

1,084 870 346 338 184 76 2,898

3,379 2,2S0 1,288 849 647 242 8,655

8.0 8,2 7.2 8.1 8.2 6.9 7.9

Apparent minor errors in totals are due to 'rounding off'.

108

Table 20

Pensioner Medical Service Number of participating doctors, payments received and average annual payment per doctor-I 95 I-52 to 1967-68 Year ended 30 June No. of participating doctors at 30 June 3,502 3,898 4,239 4,567 4,730 4,990 5,243 5,531 5,685 5,861 6,012 6,025 5,899 5,896 6,034 6,175 6,333

Payments to doctors $'000 2,070 3,480 4,231 5,032 5,749 5,998 6,398 7,613 8,225 8,401 8,796 9,146 9,531 9,320 13,365 14,351 16,115

Average receipts

per annum $ 620 928 1,024 1,132 1,236 1,234 1,250 1,376 1,466 1,456 1,476 1,520 1,598 1,578 2,246 2,360 2,573

1952. , 1953 .. 1954 .. 1955 .. 1956 .. 1957 .. 1958 .. 1959 .. 1960 .. 1961 .. 1962 .. 1963 .. 1964 .. f r

!$5 .. 1966 .. 1967 .. 1968 ..

Table 21

Pensioner Medical Service Number of participating doctors, payments received and average annual payment per doctor-by States-I 967-68 State No. of participating doctors at 30 June 1968 2,439 1,767 845 609 476 197 6,333

Payments to doctors

Average receipts

per annum $ 2,600 2,411 2,842 2,673 2,503 2,406 2,573

New South Wales Victoria

Queensland .. South Australia .. Western Australia Tasmania Commonwealth

$'000 6,267 4,241 2,364 1,611 1,172 460 16,115

Table 22

Pharmaceutical Benefits Cost of prescri ptions-I 960-6 I to 1967-68 Payments by Commonwealth

Year ended 30 June '~.

Excluding

Patient contribution

pensioners 1961 1962 1963 1964 1965 1966 1967

Pensioners $'000 14,677 18,195 19,831 20,602 21.564 24,071 29,280 32,115

Total cost $'000 59,284 75,835 81,666 82.637 87,336 94,630 104,283 107,420

Total $'000 48,959 62,827 66,924 67,063 70,494 77,149 85,936 88,916 $'000 10,325 13,008 14,742 15,574 16,841 17,481 18,347 18,504

•

1'968

$'000 34,282 44,632 47,093 46,461 48,930 53.078 56,656 56,800

Apparent minor errors in totals are due to 'rounding off'.

109

Table 23

Pharmaceutical Benefits CO$t of prescriptions-by States-I 967-68 Payments by Commonwealth -----

State

Excluding pensioners

Patient

Pensioners S'OOO 13,563 7,505 5,016 3,038 2,143 850 32,115

contribution Total $'000 36,396 23,326 12,806 8,294 5,806 2,288 88,916

Total cost

New South Wales Victoria ..

Queensland South Australia Western Australia Tasmania . . Commonwealth

S'OOO 22,833 15,821 7,790 5,256 3,663 1,438 56,800

$'000 7,441 5,045 2,665 1,699 1,185 470 18,504

S'OOO 43,836 28,371 15,471 9,992 6,991 2,758 107,420

Apparent minor errors in totals are due to 'rounding off'.

Table 24

Pharmaceutical Benefits Payments to hospitals and miscellaneous services

Year ended 30 June 1961 .. 1962 .. 1963 .. 1964 .. 1965 .. 1966 .. 1967 .. 1968 ..

N.S.W. $'000 1,785 2,454 2,890 3,341 3,039 6,692 5,233 6,222

Victoria $'000 2,620 2,536 3,360 4,300 4,396 4,000 5,000 4,103

Queensland

South Aust. $'000 511 417 597 712 738 607 1,110 1,416

Western Aust. $'000 415 652 822 892 764 700 1,100 1,286

Tasmania $'000 172 170 247 75 414 713 538 602

Miscellaneous

Total $'000 6,803 7,712 9,986 11,776 11,708 14,635 15,344 16,219 $'000 239 16 138 392

S'OOO I, 190

S'OOO 110 71 214 256 243 309 322 392'

1,413 1,856 2,200 2,114 1,613 2,041 2,198

*Miscellaneous services expenditure consisted of-

Biological products and prophylactic materials Commonwealth Medical Officers and Immigration Service . . Miscellaneous (including bush nursing and testing expenses) Apparent minor errors in totals are due to 'rounding off'.

Table 25

Pharmaceutical Benefits Dissection of benefit prescription costs into ingredient cost and chemists' remuneration-1960-61 to 1967-68 Year ended 30 June Cost of ingredients and containers $'000 35,629 46,714 49,113 49,398 52,139 57,293 63,676 66,662

Chemists' remuneration

Total cost $'000 59,284 75,835 8/,666 82,637 87,336 94,630 104,284 107,420

1961. . 1962 .. 1963 .• 1964 .. 1965 .. 1966 .. 1967 .. 1968 .• Apparent minor errors in totals are due to 'rounding off',

$'000 23,655 29,121 32,553 33,239 35,197 37,337 40,608

40,758

110

Table 26

Pharmaceutical Benefits Dissection of benefit prescription costs into ingredient cost and chemists' remuneration-by States-I 967-68 State

--------New South Wales Victoria

Cost of ingredients and containers $'000 27,197 17,697 9,496 6,210 4,342 1,719 66,662

Chemists' remuneration $'000 16,639 10,674 5,975 3,782 2,649 1,039 40,758

Total cost $'000 43,836 28,371 15,471 9,992 6,991 2,758 107,420

Queensland South Australia Western Australia

Tasmania

Commonwealth

Cost of ingredients and containers includes payments to chemists for wastages on broken quantities of ready-prepared, items. Chemists' remuneration includes mark up on wholesale price and professional fees. but does not include discount allowed

to chemists by wholesalers and manufacturers.

Table 27

Pharmaceutical Benefits Number of prescriptions and average cost per prescription-I 960-6 I to 1967-68 No. of benefit prescriptions Average cost per benefit prescription*

Year ended 30 June

Papulation Total papulation excluding Pensioner

pensioners OOO's 20,489 26,050 29,518 31,040 33,715 35,085 36,751 37,053

papulation OOO's 10,728 11,664 12,674 13,317 13,841 14,908 16,936 18,370

Total population $ 1.90 2.01 I. 93 1.86 1.83 1.89 1.94 1.94

Papulation excluding pensioners $ 2.18 2.22 2.09 2.00 1.95 2.01 2.04 2.03

Pensioner

population $ 1.37 1.56 1.57 1.55 1.56 1.61 1.73 1.75

1961 .. 1962 .. 1963 .. 1964 .. 1965 .. 1966 .. 1967 .. 1968 ..

OOO's 31,217 37,714 42,192 44,357 47,556 49,993 53,687 55,423

* Includes

patient contribution where applicable.

Table 28

Pharmaceutical Benefits Number of prescriptions and average cost per prescription-by States-1967-68 No. of benefit prescriptions State Total papulation Papulation excluding pensioners OOO's 14,897 10,113 5,331 3.398 2,374 941 37,053

Average cost per benefit prescription*

Pensioner population OOO's 7,801 4,184 3,020 1,693 1,215 457

Total population $ 1.93 1.98 1.85 1.96 1.95 1.97 1.94

Papulation excluding pensioners $ 2.03 2.06 1.96 2.05 2.04 2.03 2.03

Pensioner population

New South Wales Victoria Queensland South Australia Western Australia Tasmania .. Commonwealth

OOO's 22.698 14,296 8,351 5,092 3,588 1,397

S 1.74 1.79 1.66 1.79 1.76 1.86 1.75

55,423

18,370

* Includes

patient contribution where applicable.

111

Table 29

Pharmaceutical Benefits Nu~ber

of prescriptions per head of population and average cost per head of poplulation-I 960-6 I to 1967-68 Number of prescriptions per head of population Average cost per head of population' Total population Population excluding pensioners $ 4.62 5.92 6.12 6.10 6.47 6.68 7.06 6.95

Yeor ended 30 June

Total Population 3.00 3.56 3.90 4.02 4.23 4.36 4.61 4.65

Population excluding pensioners

Pensioner

population 14.25 14.80 15.45 15.91 16.35 16.38 16.59 16.82

Pensioner population 19.86 23.08 23.95 24.38 25.88 26.45 28.68 29.'10

S 1961. . 1962 .. 1963 .. 1964 .. 1965 .. 1966 •. 1967 •. 1968 .• 2.13 2.65 2.95 3.05 3.24 3.32 3.46 3.42 5.70 7.20 7.48 7.51 7.93 8.25 8.95 9.01

* Includes patient contribution Table 30

where applicable.

Pharmaceutical Benefits Number of prescriptions per head of population and average cost per head of population-by States-I 967-68 Number of prescriptions per head of population State

Average cost per head of population' Total population $

Total Population New South Wales Victoria Queensland South Australia Western Australia Tasmania .. Commonwealth 5.10 4.33 4.86 4.31 4.03 3.68 4.65

Population excluding

Pensioners 3.69 3.34 3.46 3.16 2.93 2.73 3.42

Pensioner Population 18.56 15.36 16.87 16.08 15.20 12.97 16.82

Population excluding pensioners

Pensioner population

(

9.84 8.59 9.00 8.47 7.84 7.27 9.01

S 7.51 6.88 6.79 6.47 5.98 5.55 6.95

32.26 27.55 28.03 28.85 26.82 24.13 29.40

* Includes Table 31

patient contribution where applicable.

Pharmaceutical Benefits DrMs dispensed by chemists-I 967-68 (Benefits dispensed in hospitals are excluded)

Therapeutic category

Percentage of total

expenditure prescriptions

Therapeutic category

Percentage Percentage of total of total expenditure prescriptions 2.5 2.3 2.2 2.1 1.7 1.4 1.4 1.3 1.1 1.1 0.8 17.B

Broad Spectrum Antibiotics Penicillins .. Blood Vessels-Drugs Acting On Diuretics .. Analgesics Sedative and Hypnotic Drugs Anti-Histamines .. Anti·Cholinergics Genito-Urlnary Infections-Drugs Acting On

12.7 8.7 9.7 8.0 7.9 6.0 5.4 3.0 2.9

9.1 7.9 5.5 4.5 7.9 12.1 6.0 1.6 2.3

Tranquillisers Antacids Heart-Drugs Acting On Anti-Diabetics .. .. Eye Drops Bronchial Spasm .. Anti-Convulsants Sulphonamides Iron Preparations. . .. Gastro Intestinal Sedatives Expectorants and Cough Suppressants .. Other Drugs

1.6 3.4 2.3 1.1 2.1 1.7 0.7 1.9 1.9 1.2 1.9 23.3

112

Table 32

Pharmaceutical Benefits Number of Pharmaceutical Chemists and Medical Practitioners dispensing pharmaceutical benefits prescriptions-I 949-50 to 1967-68

A. Pharmaceutical Chemists

approved under Section 90 of the National Health Act 1953-1967 for the purpose of supplying pharmaceutical benefits. B. Medical Practitioners approved under Section 92 of the National Health Act 1953-1967 for the purpose of supplying pharmaceutical benefits in areas in which there are no other pharmaceutical services available. New South

As at 30 June 1950 1951 1952 1953 1954 1955 1956 .1957 >-, 1958 1959 1960 1961 1962 1963 1964 1965

Wales

Victoria B 2 25 26 29 31 32 31 27 28 30 29 34 36 32 31 32

Queensland

South Australia

Western Australia

Common-

Tasmania

wealth

A 1,200 1,252 1,323 1,368 1,452 1,519 1,574 1,615 1,681 1,763 1,818 1,877 1,933 2,008 2,065 2,101

A 1,038 1,054 1,070 1,102 1,170 1.206 1,245 1,284 1.299 1,348 1,383 1,402 1,414 1,445 1,482 1,520

B 6 6 7 8 8 5 6 7 7 6 6 6 6 6 7 7

A 285 332 348 388 437 476 520 554 571 603 645 676 696 721 750 775 805 818 843

B 3 4 5 5 6 7 8 8 8 9 9 7 6 7 6 5

A 265 292 305 329 368 384 396 403 424 433 436 449 459 470 474 487 507 520 527

B 27 30 29 24 25 20 20 19 18 16 17 14 13 14 12 10 9 9 9

A 202 208 212 221 232 243 261 270 282 292 296 311 312 325 338 354 363 370 382

B 12 12 12 10 II 12 II 12 12 II 10 7 6 7 8 8 5 5 5

A 90 93 95 94 95 95 97 101 III 113 118 123 127 131 134 138 141 143 146

B 7 8 10 II 12 II II II 12 12 12 II 10 12 12 12 13 14

A 3,080 3,231 3,353 3,502 3,754 3,923 4,093 4,227 4,368 4,552 4,696 4,838 4,941 5,100 5,243 5,375 5,501 5.638 5.728

8 50 84 87

86 92 88 87 84 84 84 83 80 78 76 76 74 71 70 66

1966 1'J67 1968

2,140 2.204 2,228

33 34 30

/,545 1.583 1,602

6 5 3

6 4 5

Table 33

Tuberculosis Number of allowances, notifications and mortality-1952 to 1967 ---No. of Allowances Current No. pulmonary 6,127 5,696 5,742 5,029 4,182 3,326 2,750 2,503 2,235 2,017 1,845 1,796 1,573 1,378 1,177 1,009 4,761 4,787 4,650 4,360 4,169 3,762 3,632 3,160 3,556 3,239 3,503 3,574 3,113 2,624 2,276 2,005 Notifications ---Deaths

Year ended 31 December

Incidence No. all forms 4,786 4,979 4,952 4,602 4,419 4,035 3,708 3.582 4,084 3,570 3,825 3,883 3.446 2,903 2,549 2,293 per 100,000 all forms 54.8 55,9 54,5 49.4 46.4 41.4 37.2 35.2 39.2 34.0 35.3 35.2 30.6 25.3 21.8 19.2 No. pulmonary 1,165 879 823 672 663 543 501 509 447 412 448 410 388 259 303 249 No. all forms 1,290 974 897 729 724 585 538 549 489 447 475 440 413 294 321 275 Per 100,000 all forms 14.8 10.9 9.9 7,8 7.6 6,0 5.4 5.4 4.7 4.3 4.4 4.0 3.7 2.6 2.8 2.3

1952 .. 1953 .. 1954, . 1955 .. 1956. , 1957 .. 1958 .. 1959, .

1960 .. 1961 .. 1962 .. n63 .. 1964 .. 1965 .. 1967 ..

~'~

113

Table 34

Tuberculosis I

Number of allowances, notifications and mortality-by States-year ended 31 December 1967 Notifications State

"-'--<

Deaths Incidence

No. of Allowances current 298 241 293 86 51 40

No. pulmonory 778 495 415 120 109 47 7 34 2.005

No. all forms 853 599 454 141 142 50 9 45 2,293

per 100,000 all forms 19.6 18.1 26.4 12.6 15.9 1M 8.3 74.2 19.2

No. pulmonary 67 80 56 23 10 6 7 249

No. all forms 72

Per 100,000 all forms 1.7 2.8 3.4 2.3 1.1 1.8 14.8 .----~

New South Wales .. Victoria

Queensland South Australia Western Australia

Tasmania Aust. Capital Territory Northern Territory Commonwealth

93 58 26 10 7 9 275

* t 1,009

2.3

* Included t Included

in New South Wales figure. in South Australian figure.

Table 35

Tuberculosis Expenditure under the Tuberculosis Act-I 949-50 to 1967-68 Capital

Year ended 30 june

Maintenance reimbursements

reimbursements

to States $'000 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 472

to States $'000 692 1,887 4,229 5,965 7,478 7,601 8,101 9,610 9,138 9,688 8,753 8,473 8,800 9,932 10,669 10,337 13,577 11,238 11,508 157,677

Allowances paid to sufferers $'000 2,690 3,555 3,816 3,753 3,809 3,380 2,921 2,509 2,125 2,051 1,893 1,746 1,607 1,593 1,458 1,286 1,193 1,091 42,476

Total -------~-.--

809 1,290 2,327 2,591 3,422 3,495 4,757 4,257 2,822 1,458 776 756 984 598 703 689 499 780 33,487

Total

$'000 1,165 5,386 9,074 12,107 13,822 14,832 14,976 17,289 15,905 14,636 12,262 11,142 11,302 12,523 12,861 12,497 15,552 12,930 13,380 -----233,640

•

Apparent minor errors in totals are due to 'rounding off'.

114

Table 36

Tuberculosis Expenditure under the Tuberculosis Act-by States-1967-68 State Capital $'000 591 10 136 31 10 3 780

• Victoria ..

Maintenance $'000 3,864 3,395 2,394 651 844 360 11,508

Allowances $'000 366' 251 285 97t 55 38 1,091

Total $'000 4,821 3,656 2,815 779 909 401 13,380

New South Wales Queensland South Australia Western Australia Tasmania . . Commonwealth

Apparent minor errors in totals are due to 'rounding off'. * Includes the Australian Capital Territory. t Includes the Northern Territory.

Table 37

Tuberculosis Resu Its of mass X-ray su rveys-by States-year ended 31 December 1967 No. State examined

No. active T.B. 156 235 81 31 12 8 8 531

Rate per 1,000

No. inactive T.B. 4,173 1,755 1,434 1,136 71 221 120 8,910

Rate per 1,000

Suspect active T.B. at 31.12.66

Rate per 1,000

New South Wales Queensland .. South Australia Western Australia Tasmania Australian Capital Territory

Victoria

772,739 641.974 293,255 112,475 62,993 79,883 10,823 . .1,974,142

0.20 0.37 0.28 0.27 0.19 0.10 0.74 0.27

5.40 1.37 4.89 10.10 1.13 2.77 11.09 3.41

44 151 9 7 6 79 296

0.06 0.51 0.08 0.11 0.08 7.30 0,11

Northern Territory . . Commonwealth . .

115

Table 38

Public Health Notifiable diseases in the States of Australia-1967-68t Disease N.S.W.

, Tas. A.C.T. N.T. Aust.

--'

Vic.

Qld

S.A.

W.A.

Acute Encephalitis Acute Rheumatism Amoebiasis

Ancylostomiasis

Anthrax Bilharziasis Breast Abscess Brucellosis . .

* • *

3 4 13 36 731 33 43 7 23 2 /I

3 29

2 I

998

121 7 1.032 5 25 65 2

Chorea (St. Vitus Dance) Dengue Diarrhoea, Infantile Diphtheria Dysentery, Bacillary Erythema Nodosum Encephalitis Filariasis Homologous S. Jaundice .. Hydatid Infective Hepatitis

* 499 29 20

" 246 89 15 I

4 I

* I

* 16

5 96 8 15

* * I

* * *

188

180 5 14

* 17 570

1,682 68 435 16 73 I

* *

22 3,307 8 36

* 2,281 4 /17 56 160 I

3,100

Lead Poisoning Leprosy Leptospirosis Leukaemia .. Malaria Meningococcal Infection

2 2 27 31

•

1,103 I

169 6 2

• • *

213

126 I

26 4 17 9 9

Ophthalmia Ornithosis ..

5 I

• • 9

• •

Paratyphoid Puerperal Fever Q. Fever Rubella Salmonella Infection Scarlet Fever

2 3 1,225 484

2 7

•

4 7

* 6 4

* I

• 73 41

Staph Disease Infantile Tetanus . Trachoma .. Trichinosis Tuberculosis

8 436 /I

• • • • * *

/12 29 160 7 9

2 962 164 49

* I

* * *

5 3

•

/15 26

Typhoid Fever Typhus (flea, mite or tick borne)

293 7

•

• •

• • •

8 15 6

42 29 2

* 7 5 33

2 50' 10.869 2 38 127 2 150 212 9 7 5 13 121 2,339 323 768 12 21 8 /,191 66 4

276 8 4

26 /I

97 2

No cases. * Not notifiable. t The figures shown in this table are the number of cases notified by individual medical practitioners to State Health Departments. No case of cholera. plaguei smallpox, epidemic typhus or yellow fever.

Table 39

Public Health Poliomyelitis-number of confirmed cases-by States-I 957-58 to 1967-68

Year ended 30 June

N.S.W.

Vic.

Qld

S.A.

W.A.

Tas.

A.c. T.

N.T.

------~---

1958 .. 1959 .. 1960. 1961 .. 1962 .. 1963. 1964 .. 1965 .. 1966 .. 1967 .. 1968 ..

21 18 17 II 367 5 2 4

3 78 10 80 21

3 3 4 19 157

5 I

2 I

3 I

Cwlth -----37

19 "

7 22 19 17 2

6 6 2 2

2 46

14 3 2

102 60 178 572 35 25 4

2 I

116

Table 40 ~

Public Health Infectious Hepatitis-cases notified-by States-1961 to 1967 State 1961 6,025 3,515 1,022 1,406 262 304 281 61 12,876 1962 3,358 3,533 885 504 117 630 88 100 9,215 1963 2,822 3,840 1,433 293 145 856 20 104 9,513 1964 2,667 2,705 1,148 277 101 638 12 57 7,605 1965 3,299 1,988 511 413 86 199 51 128 6,675 1966 4,191 2,142 843 978 31 202 125 83 8,595 1967 4,015 3,017 1,972 1,295 160 423 248 166 11,296

New South Wales Victoria

Queensland South Australia Tasmania .. Au.t. Capital Territory Northern Territory Commonwealth

Western Australia

,---'fable 41

Public Health Radio and television scripts on medical matters examined-1967-68

Type ..Radio Television

of script

Approved Number examined 893 277 1,170

Approved as amended Number 349 102 451

Rejected

Number 513 168 681

Per cent 57.4 60.7 58.2

Per cent 39.1 36.8 38.6

Number 31 7 38

Per cent 3.5 2.5 3.2

Total

Table 42

Quarantine Vessels boarded and cleared-by States-I 967-68 Surface State

Air Passengers 49,870 27,769 12,504 6,650 116,421 81 226 213,521

Vessels New South Wales 'Victoria

Crew 66,903 26,914 44,732 14,067 84,313 4,674 3,703 245,306

Vessels 2,576 23 379 5 723 3 1,259 4,968

Crew 28,283 222 3,561 50 8,114 8 10,912 51,150

Passengers 190,743 169 22104 54 61,039 89,648 363,757

Queensland Tasmania .. Northern Territory .,.- ~ __ Commonwealth South Australia Western Australia

1,172 433 922 280 1,310 158 165 4,440

117

Table 43

Quarantine In~ctious

diseases on overseas vessels arriving in Australia-1967-68 No. of cases 64 2 3 6 195 15 I

Disease Chickenpox .. Glandular Fever Infectious Hepatitis Influenza

Disease Salmonella Infection Scarlet Fever Typhoid Fever Venereal Disease

No. of cases I I

2 280

Measles Mumps Paratyphoid Rubella

Total ..

601

Table 44

Quarantine

Animal importations subject to quarantine-I 967-1 968 Type Horses-from United Kingdom

Number

from New Zealand Dogs and cats-from United Kingdom from New Zealand Small laboratory animals for scientific institutions Monkeys from Malaysia and U.S.A. for Commonwealth Serum Laboratories Animals for permanent quarantine in registered zoological gardens and circuses ..

112 793 720 657 662 306 517 3.767

Total ..

1 Table 45 Northern Territory Health

Aerial Medical Service-1967-68 Darwin

Alice Springs 2

Emergency flights Routine flights Hours flown .. Miles flown .. Patients carried Patients carried by charter and commercial services Radio medical consultations

206 205 1.645 216.739 771 1.722 2.433

217 724 101.020 391 387 2.391

118

I, r

Table 46

Northern Territory Health Health services provided at main Northern Territory hospitals-I 967-68 Darwin

Alice Springs 42,063 3,199 115.4 305 73 40 203 962 34,490

Tennant

Creek 5,548 810 15.1 70 6 18 2 319 12,289

Katherine 14,911 1,527 40.7 136 13 19 5 209 10,706

Batchelor

-"------- --Total No. of daily occupied beds Total No. of admissions Average daily No. of patients Total No. of births .. Total No. of deaths in hospital Total No. of post mortem examinations . . Total No. of major operations Total No. of minor operations Total No. of outpatients treated

83,383 7,553 227.5 907 98 115 893 2,333 81,544

{',513* 6,I70t "--------

DispensariesPrescriptions dispensed Average No. of prescriptions dispensed per working d.y .~--

113,911 464.3 44,163 2,377 3,265 28,827 1,379 7,152

68,931 282.9 10,428 489 568 27,843 1,284 6,819

5,768 22.5 2,260 125 157 16,341

10,230 31.9 2,743 285 304 14,980 ""------"----

, X-ray Department-t No. of exposures Ambulance ServicesNo,oftrips No. of patients carried No. of miles travelled r-

Physiotherapy Department-:j: ~-- No. of patients No. of treatments . .

* t

* Doctor's clinic. Daily clinic. Inpatients and outpatients.

Table 47

Northern Territory Health Dental services provided in the Northern Territory-I 967-68 Darwin Dental Clinic Aerial Mobile (operating from Darwin) Overland Mobile (operating from Darwin) 1,215 475 137 416 II 47 36 2 II Darwin

Schools

Alice Springs (including Mobiles and Schools) 1,414 1,060 297 1,885 '37 12 5 838 575 13 69 4 17 33

Nightcliff Clinic

"':

--------------------------5,509 1,870 Examinations 731 3,172 Extractions .. 91 534 Porcelain restoration 2,778 440 Amalgam restoration 50 Inlay. 16 Crowns Bridges 42 1.684 Dressings 1,242 X-rays 26 G,A.'. hospital 16 Root treatment 86 33 S~'!le and clean " I Infective Gingivitis 1,003 Orthodontist 77 Or.1 surgery 16 Jaw fracture 83 1,313 Other treatment .. 158 Dentures-Full 121 Partial 525 Repair .. 34 Remodel 601 Impressions

941 98 80 457 I 29 1,693

1,668 2,009 505 3,078 42 14 918 921 30 12 91 64 4 2 1.248 95 112 377 36 378

150 33 18 33 4 93

84 3 6 12

939 60 41 82 8 164

119

Table 48

Australian Capital Territory Health licences issued under the Public Health Ordinance-I 967

Barber shops E.ting houses Boarding houses

Ice cream vendors

78 67 •• 1

Meat vendors

Milk distributors Milk vendors

68 ..

Prepared meat vendors

201 233

Table 49

Australian Capital Territory Health Samples collected by Health Inspection Section-I 967-68 For bacteriological

examination Milk Cream Meat Other foods Water-City supply Swimming pools

For chemical examination 474

769 99 16 1,090 104

105 20 10 151 21 936 52

Picnic resorts and, other supplies Fluoride .. Sewerage .. .. .. .. .. Lake Burley Griffin and M1olongo River

206 29 544

Table 50

Aus~ralian

Capital Territory Health

School medical service examinations-I967-68 Defects as Percentage of Children examined

No. of children examined Defects notifiedEye .. .. Nose and throat Hearing loss ..

13,679 1,090 38 8.0

0.3 2.4

Speech .. .. Cardiac abnormality Hernia . . Orthopaedic Miscellaneous . .

335 67 25 II

25 264

0.5 0.2 0.1 0.2 1.9

Table 51

Australian Capital Territory Health Registrations granted-I 967-68 Type Number Number

Medical Practitioners

45 4

Dental Practitioners

Nurses Nursing Aides

241 39

Pharmacists .. Optometrists Veterinary Surgeons

o 3

120

Table 52 <

National Fitness Allocation of annual grant to State National Fitness Councils-1967-68 Item

N.S.W.

Vic.

Qld

S.A.

W.A.

Tos. S 9,124 9,124 1,564 2,356 610 9,124 31,902

Cwlth

11 Wages. salaries, allowances, overtime and services not otherwise provided for ., Services to associated groups, including leader training

11 10,646 12,178 3,034 4,572 1,476 12,178 44,084

11 9,124 9,124 2,680 3,986 908 9,124 34,946

3 9,124 9,124 2,680 3,986 908 9,124 34,946

11 9,124 9,124 2,680 3,986 908 9,124 34,946

11 57,788 60,852 15,672 23,458 6,286 60,852 224,908

10,646 12,178 3,034 4,572 1,476 12,178 44,084

Grants to voluntary youth organisations . . Subsidies to local national fitness com~ mittees Services to sports organisations ..

Development of camps and hostels Total

,Table 53

National Fitness Allocation of annual grants to State Education Departments-1967-68 Item N.S.W.

Vic. $

Qld

S.A. S 600 1,000 1,200

W.A. 11 600 1,000 1,200

Tos.

Cwlth

Training of general teachers in physical education(a) Short courses (b) Residential courses Provision of bursaries to enable selected

11 1,000 1,000

/I 1,000 1,000

S 600 1,000 1,200

S 4,800 6,000 3,600

1,000 1,000

teachers to undertake university courses

Development of health and physical education in practising schools and teachers colleges(0) Equipment .. (b) Camps for teachers college students .. .. .. .. Publications. firms. records, etc. Development of school camping and hostelling(0) Equipment of camps and schools .. (b) School camping and hostelling Total

600 500 968 1,000 600 5,668

600 500 966 1,000 600 5,666

400 300 966 800 400 5,666

3,000 2.400 5,800 5,400 3,000 34,000

. Table 54

Commonwealth Medical Officers Number of clinical examinations by Commonwealth Medical Officers-by States1967-68

,........,.. New South Wales Victoria

State

Departments 26,430 15,783 6,116 3,894 2,913 1,163 6,288 1,377 63,964

Seamen 1,151 228 139 78 355 2

Pensioners 6,016 3,846 1,991 2,450 1,604 422 116 66 16,511

Others 4 12 3 156 1,806 1,284 3,265

Total 33,601 19,869 8,246 6,422 4,875 1,743 8,210 2,727 85,693

Queensland South Australia Western Australia Tasmania ~Northern

Australian Capital Territory Territory Commonwealth ..

1,953

121

Table 55

Commonwealth Medical Officers Number of vaccinations by Commonwealth Medical Officers-by States-1967-68 State Smallpox 30,088 3,284 5,226 3,117 2,742 1,484 3,199 2,371 51,511

Yellow Fever 1,344 753 237 180 231 67 147 39 2,998

Cholera 25,944 3.292 4,565 1,564 2,650 1,279 4.548 2.825 46,667

T.A.B.

Tetanus

Plogue 176 24 68 3 6 4 161 30 473

Total

New South Wales Victoria

Queensland 50uth Australia Western Australia Tasmania Australian Capital Territory

Northern Territory

1,760 1,079 338 211 106 141 4,540 421 8,596

207 298 261 2.186 90 24 116 739 4,031

59,519 8,730 10,695 7,261 5.825 2,999 /1,812 6.425 114,276

Commonwealth ..

Table S6

Commonwealth Health Laboratories Number of pathological examinations and laboratory tests performed and number of patients-I 967-68 Health laboratory Examinations and tests* 146,821 64,035 204,462 393.761 707,928 209,641 234.021 49,991 62.814 320,649 64,236 319.252 260,393 291,280 431,682 3,760,966

No. of potients 22,489 12,591 31,051 52,070 124,456 45,162 22,453 9,778 16,107 43,219 12,606 70,488 42,892 42,029 56,233 603,624

~-~--~~~~---~----~~-~.-------.--------

Albury Alice Springs Bendigo Cairns Canberra Darwin "

Hobart Kalgoorlie Launceston Lismore

Port Pirie Rockhampton Tamworth Toowoomba Townsville . . Total .'

* Nuffield Table 57

points score.

National Biological Standards Laboratory Summary of all samples examined-I 967-68 Type No. examined

Failures

Percentage o( (ailures

For Department of HealthProducts for human use

% 1,003 141 214 39 91 133 1,621 291 92 37 17 24 15 476 29 65 17 44 26 II 29

Products for veterinary use For other Commonwealth Departments and Authorities Miscellaneous drug samples* .. Dressings tested .. Surgical equipment testedt

Total .. *E!~g.

Samples tested at the request of hospitals and other authorities. samples of products about which complaints have been received, samples taken prior to granting authority to import products subject to Item 28A-Customs (Pro-_ hibited Imports) Regulations. tNumber of batches of needles tested.

122

Table 58

National Biological Standards Laboratory Reasons for failure as percentage of total failures-1967-68 Reoson*

Products for HUman Uset

Products for Veterinary Use

---------Safety. contamination or misidentification

% 2 31 26

Sterility Potency Disintegration Uniformity of weight

Acidity or alkalinity Loss on drying Container content Miscellaneous (e.g. colouring, physical appearance. moisture content. grading, etc.) Particulate matter Labelling

2 I 31 12 4 4 5 3

4 6 7 78

10 45

*These reasons are listed in order of seriousness. tThis figure represents the percentage of total failures due to the specific cause. Where a product has failed for more ~ than one reason it is included in more than one category.

J<tl:>le 59

National Biological Standards Laboratory Safety tests performed-I 967-68 Type No. examined 387 47 33 56 63

Passed 327 47 33 53 61

Failed ~-~-------

Suspect failures not confirmed -------~--

SterilityStandard test technique Millipore technique Histamine·like substances Toxicity

60 3 I

3 I

Pyrogens

Table 60

Commonwealth Acoustic Laboratories Cases examined-I 967-68

New cases attending laboratories

N.S.W. 287 2,396 2,479 439 300 133 6,034 358

Vic. 191 755 1,362 348 194 86 2,936 491

Qld 207 746 1,857 68 50 134 S61 3,623 198

S.A. 444 428 975 142 93

W.A. 47 367 751 69 31 I 88 1,354 210

Tas. 14 80 332 186 5 38 655 19

Cwlth

P.ensioners Repatriation ..

Persons under 21 years Armed Forces (Serving) Commonwealth Departments State Departments Miscellaneous .. Total Civil Aviation referrals

162 2,244 149

1.190 4,772 7,756 1,252 673 135 1,068 16,846 1,425

123

Table 61

Commonwealth Acoustic Laboratories Calaid hearing aids fitted-I 967-68 Calaids fitted

, Qld 164 631 183 2 20 1,000

N.S.W. 278 1,558 457 9 25 2,327

Vic.

S.A. 359 433 171 31 994

W.A. 39 358 103

To,. II 174 65

Cwlth

Pensioners Repatriation ..

Persons under 21

ye~~s

Armed Forces (Serving) .. Commonwealth Departments Total

127 996 343 3 37 1,506

18 501 268

978 4,150 1,322 14 132

'--6,596

Table 62

Commonwealth Acoustic Laboratories Calaid hearing aids maintained-1967-68 Calaids Maintained

N.S.W. 278 5,404 2,208 42 1,235 9,167

Vic.

Qld

S.A.

Pensioners

Repatriation ..

Persons under 21 years Armed Forces (Serving) Commonwealth Departments Total

127 4,964 2,095 25 691 7,902

164 2,065 1,048 II 543 3,831

359 1,896 932 10 392 3,589

Tos. Cwlth - - - - - - - - - - _.. 39 II 978 1,586 16,492 577 268 7,043 492 2 I 91 3,226 270 95 W.A.

2,389

952

27,830

Table 63

Commonwealth X-Ray and Radium Laboratory Expenditure under the National Welfare Fund on radio-isotopes for medical purposes1955-56 to 1967-68

Year ended 30 June

Expenditure 6,172

Year ended 30 June

Expenditure

I 1963 1964 1965 1966 1967 1968 35,936 55,874 67,942 81,755 132,201 154,764

1956 1957 1958 1959 1960 1961 1962

13,900 15,954 21,382 19,368 27,736 28,988

124

Table 64 <

National Health and Medical Research Council Grants made from the Medical Research Endowment Fund-1967-68

Universities, institutions and hospitals -_._-----

Research workers $

Scholarships $

Technical assistance maintenance and equipment

Total $

Universities University of Adelaide University of Melbourne Monash University .. ,. University of New South Wales University of Queensland .. .. University of Sydney University of Western Australia

! 70,332 168,750 50,049 52,218 36,410 91,348 49,398 23,289 59,639 21,809 6,300 3,465 633,007

28,535 125,475 29,373 33,518 20,395 47,930 34.760 100.070 240,782 2,415 23,230 686,483

42,147 35,493 5,230 7.694 3.370 41,500 9,530 4,730 9,100

141,014 329,718 84,652 93.430 60,175 180.778 93,688 128,089 309,521 24,224 6,300 3,465 23,230 1,478,284

•

~iscellaneous

Institutions and hospitals New South Wales .. Victoria Queensland South Australia ..

Travelling Fellowships Total

158,794

-rTable __

Commonwealth Grants Red Cross Blood Transfusion Service-I 953-54 to 1967-68

Year ended 30 June 1954 1955 1956 1957 1958 1959 1960 1961

Commonwealth grant $'000

Year ended 30 June 1962 1963 1964 1965 1966 1967' 1968

Commonwealth grant $'000 349 369 402 435 490 974 656

88 138 172 214 251 263 282 315

* The

figure for this year reflects an alteration in accounting procedures during 1966-67, when annual payments were replaced by quarterly payments. The grant relates to expenditure incurred by the Society during the period I July 1965 to 31 March 1967.

Table 66

Commonwealth Grants Red Cross Blood TransfUSion SerVice-by States-I 967-68 Payments Payments State Tasmania Australian Capital Territory

State New South Wales Victoria Queensland .. South Australia Western Australia

1967-68

$'000 168 176 119 76

$'000 14 19 4

Northern Territory Commonwealth ..

656

125

Table 67

Commonwealth Grants Home Nursing Subsidy Scheme-1956-57 to 1967-68

Year ended 30 June

Annual subsidy

Year ended 30 June ------------

Annual subsidy $'000

1957 1958 1959 1960 1961 1962

$'000 4

36 69 107 156 215

1963 1964 1965 1966 1967 1968

289 372 465

546 664 765

Table 68

Commonwealth Grants HO"1e Nursing Subsidy Scheme-by States-I 967-68 Payments State

Payments State Western Australia .. Tasmania

1967-68 $'000

New South Wales Victoria

Queensland .. South Australia

209 288 95 32

131 10 765

Commonwealth ..

Table 69

Commonwealth Grants Free Milk for School Children-1950-51 to 1967-68 Year ended 30 June Commonwealth Grant $'000 72 Year ended 30 June Commonwealth Grant

1951 1952 1953 1954 1955 1956 1957 1958 1959

S'ooo

1,630 3,Q43 3,999 4,475 4,811 5,214 5,511 6,137

1960 1961 1962 1963 1964 1965 1966 1967 1968

6,719 7,120 7,483 7.454 7,775 8,059 8,493 9,021 9,831

Table 70

Commonwealth Grants Free Milk for School Children-by States-I 967-68 No. State

of children' 000'5

Payments 1967-68

As at 31 Dec. 1967 New South Wales Victoria

Queensland .. South Australia Western Australia

633 500 266 184 144

3,350 2,623

S'ooO

1.372

Tasmania Australian Capit,,1 Territory Northern Territory Commonwealth . .

61 18 13

952 850 503 106 75 9,831

1.819

*These figures represent the approximate number of school children eligible to participate in the free milk scheme.

126

Table 71 f

Commonwealth Grants Mental health institutions-by States-I 955-56 to 1967-68 N.S.W.

Vic.

Qld $'000 133 266 400 176 352 528 228 456 685 237

S.A. $'000 24 49 73 257 514 771 304 609 913 245 489 734 184 367 551 91 183 274 56 III 167 104 208 313 173 345 518 265 530 794 242 484 726 193 385 578 64 127 190 2,201 4,402 6,602

W.A.

Ta,. $'000 59 119 179 138 276 414 183 366 548 92 184 275 134 268 402 104 208 312

Cwlth $'000 1,546 3,093 4,639 2,496 4,993 7,489 2,513 5,026 7,538 2,241 4,482 6,722 2,295 4,590 6,885 1,454 2,909 4,363 1,648 3,297 4,945 1,590 3,181 4,711 1,595 3,189 4,784

1955-56 Com monwealth grant Net State expenditure

$'000 418 835 1,253 767 1,534 2,301 648 1,297 1,945 394 787 1,181 718 1,436 2,154 866 1,732 2,597 1,297 2,595 3,892 1,295 2,590 3,885 982 1,964 2,947 659 1,319 1,978 1,717 3,434 5,151 2,217 4,434 6,652 2,095 4,/91 6,256 14,074 28,148 42,222

$'000 892 1,783 2,674 1,054 2,109 3,163 1,091 2,181 3,272 1,239 2,478 3,718 1,036 2,073 3,109 168 335 503

$'000 20 40 60 104 207 311 58 117 175 34 69 103 74 147 221 31 61

Total expenditure .. 1956-57 Commonwealth grant

Net State expenditure Total expenditure . .

1957-58

Commonwealth grant Net State expenditure Total expenditure .. 1958-59 Commonwealth grant

Net State expenditure Total expenditure . . ~·1959-60

474 711 149 298 448 195 391

Commonwealth grant Net State expenditure Total expenditure . . I 960-!> I Commonwealth grant

Net State expenditure Total expenditure .. 1961-62 -:- Commonwealth grant

586 141 283 424 75 150 226 108 216 324

92 154 308 462 116 232 347 332 663 995 447 893 1,340 338 675 1,013 260 521 781 148 297 445

Net State expenditure Total expenditure .. 1962-63

Commonwealth grant Net State expenditure

Total expenditure .. 1963-64 Commonwealth grant

Net State expenditure Total expenditure .. I964-!>5 Commonwealth grant

Net State expenditure

Total expenditure .. 1965-66

711 1,423 2,134 1,567 3,134 4,700 1,192 2,385 3,577 1,382 2,763 4,144 10,333 20,664 30,996

225 449 674 146 293 439 288 576 863 196 391 587 2,299 4,596 6,895

197 394 591 529 1,058 1,586 823 .,646 2,469 358 717 1,075 2,617 5,235 7,851

2,504 5,007 7,511 4,539 9,078 13,617 4,973 9,947 14,920 4,243 8,485 12,728 33,638 67,275 100,912

Commonwealth grant ,Net State expenditure ,~Total

expenditure . .

1966-67 Commonwealth grant

Net State expenditure Total expenditure .. 1967-68 Commonwealth grant

Net State expenditure

Total expenditure .. Total i"-Commonwealth grant

2.1/5 4,230 6,345

Net State expenditure Total expenditure ..

Apparent minor errors in totals are due to 'rounding off'.

Appendix 2-Publications 3CHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE Adams, A. 1.-' Death and Injury on Country Roads-A Study of 816 Persons Involved in Rural Traffic Accidents', (1967), Med. J. Aust., 2, 799. Adams, A. I.-' Exposing the Medical Student to Community Health Problems', (1968), Med. J. Augt., I, 912. . Adams, A. I.-' Accidents on Country Roads', (in press). Adams, A. 1.--' Accident Morbidity in Australia', chapter in National Health and Medical Research Council-Medical Morbidity Survey, Report, part 2, (in press). Adams, A. 1.-' Employment Problems of Asthmatics', (in press). Adams, A. I.-' Who is Worth Screening for What', (in press). Atkinson, L., Booth, Kathleen, Cooke, Robin and Scott, G. C.-' Cancer in the Territory of PapuaNew Guinea 1958-65', East African med. J., (in press). Black, R. H.-' Malaria in Medical Practice in Australia', (1967), Med. J. Aust., 2, 36. Black, R. H.-' Health Notes for Australians Visiting Papua-New Guinea', (1968), in: Booth N. (Ed.), NUAUS. Handbook of Papua-New Guinea. 1968, 2nd ed., pp. 21-23. Black, R. H.-' The Fruits of Malaria Control', (1967), Papua and New Guinea med J., 10, 142, correspondence. Black, R. H.-' Cbemoprophylaxis of Malaria', Mod"'n Medicine in Pakistan, (in press). Black, R. H. et al.-' Prevention of the Re-Introduction of Malaria Report of a WHO Meeting', (1967), Wid HUh Org. techno Rep. Series, No. 374, pp. 1-32. Black, R. H. et al.-' Chemotherapy of Malaria Report of a WHO Scientific Group', (1967), Wid Hlth O'·g. techno Rep. Series, No. 375, pp. 1-91. Booth, Kathleen, Cooke, Robin, Scott, G. C. and Atkinson, L.-' Carcinoma of the Nasopharynx and Oesophagus in Australian New Guinea 1958-1965 " (in press). Briscoe, O. V., lIbery, P. L. T., and Wood, Olive--' The Legality of Eugenic Sterilization in Australia', (1967), Med. J. Aust., 2, 185. Budd, G. M.-' PopUlation Increase in the King Penguin, Aptenodytes patagonica, at Heard Island, (in press). Campbell, C. H.-' Antivenine in the Treatment of Australian and Papuan Snake Bite', (1967), M ed. J. A u8t., 2, 106. Campbell, C. H.-' The Use of Antibiotics in Tropical Medicine', (1967), Medicine Today, I, 35. Campbell, C. H.-' The Papuan Black Snake (Pscudechis Papuanus) and the Effect of its Bite', (1967), Papua and New Guinea med. J., 10, 117. Clements, F. W. and Rogers, Josephine, F.-'You and Your Food', (1967), Sydney: A. H. & A. W. Reed, pp. 1-219. Elkington, E. J.-' Finger Blood Flow in Antarctica " (in press). Ferguson, D. A.-' Better Seating Means Better Health', (1967), Factory and Plant, 55, 37. Ferguson, D. A.-' Ergonomics-Human Aspects', (1967), 11th New South Wales Industrial Safety Convention, Pro c., (Broken Hill, Oct. 17-19), pp. I1-14, mimeographed. Findlay, A. W.-' Occupational Health by Numbers: Threshold Limit Values and Their Interpretation', (1968), Roy. Augt. ehem. In8t., Proe., 38, 37. Ford, E.-' William Redfern " Australian Dictiona,'y of Bio.graphy, (1967), 2, 1788-1850. l-Z, 368. Ford, E.-' Three Australian Medical Historians: Leslie Cowlishaw, John Lidgett Cumpston and William Stewart McKay', (1967), Med J. Anst., 2, 927. Hicks, K. E.-' Changes in the Blood-clotting Mechanism, Serum Lipids, and Basal Blood Pressure in Antarctica', (1967), Clin. Sci., 33,527. Howell, M. J. and Bearup, A. J.-' The Life Histories of Two Bird Trematodes of the Family Philophthalmidae', (1967), Linn. Soc. New South Wales, Proc., 92, 182. Ilbery, P. L. T.-' Prevention of Radioleukaemia by Lymph Node Shielding', (1967), Nature, 215, 655. Ilbery, P. L. T. and Alexander, J. M.-' Unbalanced C/E Translocation Exhibiting Some Clinical Features of Trisomy E', (1967), A/asian Ann. Med., 16, 215. IIbery, P. L. T., Alexander, G., and Williams D.-' The Chromosomes of Sheep X Goat Hybrids', (1967). Aust. J. bioi. Sci., 20, 1245. Kerr, C. B.-' Introduction to Medical Genetics: I. Molecular and Chromosomal Aspects', (1967), Post-Graduate Committee in Medicine, University of Sydney, Bull., 23, 78. Kerr, C. B.-' Introduction to Medical Genetics: 2. Mendelian Genetics: Theory and Application " (1967), Post-Graduate Committee in Medicine, University 0/ Sydney, Bull., 23, 105. Kerr, C. B.-' Introduction to Medical Genetics: 3. Population Genetics: Environmental and Genetic Interactions', (1967), Post-Graduate Committee in Medicine, University of Sydney, Bull., 23, 133. Kerr, C. B.-' Legality of Eugenic Sterilisation', (1967), Med. J. Aust., 2, 421. Kerr, C. B.-' Mutational Load in Man: Visible X-linked Traits', (1967), Aust. Soc. med. Res., Proc., 2, 104. Kerr, C. B.-' Discrimination in Phenotype Heterogeneity', (1967), Aust. Soc. med. Res., Proc., 2, 104. Kerr, C. B.-' Genetic Counselling in Hereditary Disorders of Blood Coagulation', (1968), Modern Treatment,S, 125.

129

Ken, C. B.-' Studies on X-linked Human Variation', London: Oxford University Press, (in press) . Kerr, C. B.-' Inactive X-chromosome Hypothesis " Ann. hum. Genet., (in press). Kerr, C. B.-' Genetic Counselling in Mental Retardation', 6th ann. Can!. Aust. Group sci. Studl1 _ ment. Dej., Proc., (in press). Kerr, 9.. B. ~ndDavidson, Eileen M.-' Individual Problems and Social Adaptation of Haemophlhacs III New South Wales', Canberra: Australian National University Press, (in press). Lee, D. J.-' Human Myiasis', (1968), Med. J. Aust., I, 170. Lee, D. J. and Reye, E. J.-' The Control of Biting Midges', (1967), Health, 17, 15. Lee, D. J. and Waterhouse, D. F.-' Anthony Reeve Woodhill', (1968), Linn. Soc. New South Wales, Proe., 92, 285. McGarrity, K. A. and Scott, G. C.-' A Review of Cancer of the corpus ute1'i in New South Wales', (1968), J. Obstet. Gynaec. Brit. Cwlth, 75, 14. McMillan, B.-' <Dbservations on Strongyloidiasis in Australia and New Guinea', (1967), South Pacific Commission, Seminar on Helminthiases and Eosinophilia 1Vleningitis, (Noumea, New Caledonia), Working Paper No. 24. McMillan, B.-' Is Filariasis Endemic in the Northern Territory of Australia?', (1967), Med. J. Aust., 2, 243. McMillan, B.-' Lawang Bark as a Rubefacient in the Treatment of Filarial Lymphangitis in New 1 Guinea', (in-press). '__ 1 McMillan, B.-' Further Observations on Ovale Malaria in New Guinea " submitted for publication. McMillan, B. and Kelly, A.-' Ovale Malaria in Eastern New Guinea', (1967), Trop. geog. Med., 19, 172. .., McMillan, B. and Boulger, L. R.-' Squirrel Bite Fever', submitted for publication. Macpherson, R. K.-' Temperature Regulation in Elderly Men in Bed', (1967), Med. J. Aust., 2, 4771 correspondence. Macpherson, R. K. (1968)-' American Scientific Research in Antarctica', The Gazette, University of Sydney, 2, 227. Macpherson, R. K.-' Environmental Problems in New Guinea', Encyclopaedia of Papua and New Guinea, (in press). Macpherson, R. K.-' Session "G"-Tropical Building. Rapporteur's Statement' in relation tl) Third Australian Building Research Congress Melbourne, 14-17 August 1967, Arch,tecture in Australia, (in press). Merrett, J. D., WelIs, R. S., Kerr, C. B. and Barr, A.-' Discriminant Function Analysis of Phenotype Varieties in Ichthyosis', (1967), Am. J. hum. Genet., 19, 575. . Merrett, J. D., Wells, R. S., Kerr, C. B. and Barr, A.-' Linear Discriminant F~nction. Anal:(sls of Phenotype Variation in Ichthyosis', The Biometrteal Society VI Internatwnal Bwmetnc Conference, Sydney. Conference Handbook. Sections 4-6, pp. 4-117. Moodie P. M.-' The Invisible Aborigines', submitted for publication. Occup;tion Health Unit-' Report on Health Survey of Telegraph Officers', (1967), pp. i-vi + 302, mimeographed. Welch, J. P., Wells, R. S. and Kerr, C. B.-' Ancell-Spiegler Cylindromas (Turban Tumours) and Brooke-Fordyce Tricoepitheliomas: Evidence for a Single Genetic Entity', (1968), J. Med. Genet., 5, 29. 1

INSTITUTE OF CHILD HEALTH Clements, F. W. (with Josephine F. Rogers)-' You and Your Food', (1967), A. H. & A. W. Reed, Sydney. Clements, F. W.-' The Need for Day Nurseries', Proceedings of the 11th Australian Pre-School Association COnference, Canberra, May 1968. Aust. Pre-School Ass. Canberra. Clements, F. W.-' Health Services for Young Children, Yesterday, Today and Tomorrow', (1967), Med. J. Aust., I, 831. Dintenfass, L. and Yu, J. S.-' Changes in the Blood Viscosity and the Consistency of Artificial Thrombi in 17.year-old Girls During the Menstrual Cycle', (1968), Med. J. Aust., I, 181. Stapleton, T.-' Health Services for Children in Isolated Areas', (in press). Stapleton, T.-' Some Applications of Psychiatric Knowledge', (in press). Walker-Smith, J. A. and Wyndham, N.-' Total Loss of Mid-Gut', (1967), Med. J. Augt., 1, 857. Walker-Smith, J. ~., Skyring, A. P. and Mistilis, S. P.-' Use of "CrCI. in the Diagnosis of Protein-losing Enteropathy', (1967), Gut, 8, 166. Walker-Smith, J. f\..-' Dissecting Microscope Appearance of Small Bowel Mucosa in Children', (1967), Arch. Dis. Ch-ildh., 4Z, 626. Walker-Smith, J: A.-' Dissecting Microscope Appearances of Small Bowel Mucosa in Childhood', (1967), Ped!at~ Res., I, 412. Walsh, Helen and Dowd, Bryan-' Tonsillectomy and Rheumatic Fever', Med. J. Aust., 1967--:i,1121. '

130

COMMONWEALTH ACOUSTIC LABORATORIES Carter, N. L.-' Hearing Damage Risk Criteria and Impulse Noise', (1967), Paper presented at 4th Annual Conference of Ergonomics Soc. Aust. N.Z., Brisbane. Kossoff, G. and Robinson, D. E.-' Basic Physics of Diagnostic Ultrasound " in Goldberg, R. E. and Sarin, L. K., Ultmsonws in Ophthalmology; Diagnostic and Therapeutic Applications, Philadelphia, W. B. Saunders, (1967), pp. 23-44. Kossoff, G., Wadsworth, J. H. and Dudley, P. F.-' Further Experience with the Round Window Ultrasonic Technique, (1968), Arch. Otolaryngol, (in press). Kossoff, G., Wadsworth, J. H. and Dudley, P. F.-' The Round Window Ultrasonic Technique for Treatment of Menier's Disease', (1967), Arch. Otolaryngol., 86, 535-554. Kossoff, G., Wadsworth, J. H. and Dudley, P. F.-' Ultrasonic Treatment of Meniere's Disease Using the Round Window Approach', (1968), E.E.N.T. Monthly Digest, 30, 55-57. Macrae, J. H.-' Deterioration of the Residual Hearing of children with Sensorineural Deafness', (1968), Acta Oto-Laryngol., (in press). Macrae, J. H.-' TTS and Recovery from TTS After Use of Powerful Hearing Aids', (1968), J. Acoust. Soc. Amer., (in press). Robinson, D. E.-' Application of Ultrasound in Medicine', (1968), Aust. Electron. Eng., (in press) . Robinson, D. E., Dadd, M. and Kossoff, G.-' Two Dimensional Ultrasonography in the Eye', (1968), Paper presented at 1968 Internat. Congo of U1trason. in Ophthalmol., Philadelphia, Pa., May 1968. Robinson, D. E., Garrett, W. J. and Kossoff, G.-' The Diagnosis of Hydatidiform Mole by Ultrasound', (1968), Aust. N.Z. J. Obstet. Gynaecol., 8, 74-78. Robinson, D. E., Garrett, W. J. and Kossoff. G.-' Foetal Anatomy Displayed by Ultrasound', (1968) Investigat. Radiol., (in press). Rose, J. A.-' Development of Hearing Damage Risk Criteria and Their International Standards', (1968), Paper No.5 presented at Symposium on Noise in Industry, Adelaide. Stranger, J. H., O'Dell, D. A., Robinson, D. E. and Kossoff, G.-' The Routine Use of Echography in an X-ray Department as an Adjunct to Routine Skull Radiology', (1968), Australas. Radiol .• 12, 12-17. Tonkin, E. J .-' Changes and Expansions in the Scope and Services of the Commonwealth Acoustic Laboratories', (1968), Proc. 10th Triennial Conference of Aust. Assoc. of Teachers of Deaf. Upfold, L. J.-' The Use of Audiological Techniques in Otoneurological Assessment', (1967), Paper presented to Otolaryngol. Soc. Aust .. Queensland Branch. REPORTS Brigden, D.-' Observer Variability and Inaccuracy in Measuring Noise in Octave and ThirdOctave Bands', (1967), CAL Report No. 45, 20 pp. Dudley, P. F.-' The Development of a Speech Hearing Testing Using Recorded Sentences', (1968), CAL International Report No.5, 14 pp. Dudley, P. F.-' Evoked Response Audiometry and Individual Loudness Functions', (1967), CAL Report No. 43, 14 pp. Dudley, P. F. and Macrae, J. M.-' The Measurement of Improvement in Speech Hearing and Its Relation to Hearing Aid Use', (1968), CAL Internal Report No.4, 9 pp.

NATIONAL BIOLOGICAL STANDARDS LABORATORY Howes, D. W.-' The Theory and Practice of Plague Counting in the Bioassay of Virus Infectivity', (1968). PrWl"csS in Immunbiological Standardisation, 3, (in press).

COMMONWEALTH X-RAY AND RADIUM LABORATORIES Alsop, R. J.-' Procurement and Distribution, in Australia, of Radio-isotopes for Medical and Medical Research Purposes', Aust. Bull. of Med. Phys. and Biophys., No. 34, December 1967, 14*. Bonnyman, J. and Duggleby, J. C.-' Iodine-131 Concentrations in Australian Milk Resulting from the 1967 French Nuclear Weapon Tests in Polynesia " Aust. J. Sci., 30, No.6, December 1967, 223. Bonnyman, J., Duggleby, J. C., Molina-Ramos, J. and Paterson, I. C.-' Concentrations of Caesium137 in Rainwater and Milk in Australia During 1966', Aust. J. Sci., 30, No.8, February 1968, 313. Bonnyman, J. and Molina-Ramos. J.-' Strontium-90 and Caesium-137 in Some Australian Drinking Water Supplies 1961-1965', Aust. J. Sci., 30, No.5, November 1967, 171. Duggleby, J. C., Saddlier, L. J. and Stevens, D. J.-' Design and Construction of Whole-Body Monitor', (in press). Duggleby, J. C. and Seebeck, R. M.-' Potassium and Caesium-137 Distributions in Angus Steer Carcasses '. J. Agric. Sci., Camb., 69, 1967, 149.

131

Sofer(,. D. F., S)tevens, D. J. and Swindon, T. N., with Holman, W. P.-' Radon Services in Australia' In press. , ' Stevens, D ..J.-'!pvolution of X-ray Equipment for Tuberculosis Case F· d· P . AustralIa', (In press). In Ing rogrammes In Stevens, D. J.-';Deve}ol?ments i,; Radia!i0n Protection', (in press). ' Stevens, D. J.- Rad!o-!sotopes !n Med!cal Diagnosis and Treatment', (in press). Stevens, D. J.--;I RadIO-Isotopes In. MedIcal Diagnosis and Treatment', Health, 18, No.2. Stev~ns, D. J. wIth.Fletche~, W., GIbbs, W. J., Moroney, J. R. and Titterton, E. W.-' Strontium-90 In the Aust~l'han. EnVlronment During 1966', Au.t. J. Sci., 30, No.8, February 1968, 307. Stevens, D. J. WIth GIbbs, W. J., Moroney, J. R. and Titterton, E. W.-' Fallout over Australia from. Nuclear Weapons Tested by France in Polynesia During June and July 1967' Au.t. J. Sm., 30, NO.6, December 1967, 217. ' • This paper was read at the Seventh Annual Meeting of Physics in Medicine and Biology, held in Adelaide from 22 to 27 May, 1967. REPORTS Bonnyman, J.-' Determination of Strontium-90 and Caesium-137 in Drinking Water', Tech. Rep. CXRL/3 (Published 1 November 1967). Bonnyman, J.-' The Determination of Strontium in Calcium Oxalate by Atomic Absorption Spectrometry " Tech Rep. CXRL/4 (Published 5 April 1968). Bonnyman, J.-' Radio-assay of Strontium-89, Strontium-gO, Caesium-137 and Radium-D in Fl\llout Ion Exchange Collectors', Tech. Rep. CXRL/6 (Published 23 October 1967). Ubrary Information: Library Accession List-Issues of September 1967, December 1967 and March 1968, and June 1968.

COMMONWEALTH BUREAU OF DENTAL STANDARDS de Freitas, J. F.-' The Long-term Solubility of Silicate Cement', (1968), Aust. Dent. J., 13, 129- ,134. de Freitas, J. F.-' The Rapid Determination of Cross-linking in dental monomer', The Analyst. (in press). Docking, A. R.-' New Horizons in Dental Filling Materials', (1967), Au.t. Dent. J., 12,317-322. Also (1968), Oral Res. Ab8., 3, 303.

INSTITUTE OF ANATOMY Food and Nutrition Notes and Reviews-Vol. 24, Nos. 7-12, Vol. 25, Nos. 1-6. CaRDEN, MARGARET W.-' Obesity and Nutrition', Food and Nutrition Notes and Reviews, 25:51. HIPSLEY, E. H.-' !!,utrition Education and Ecological Awareness', Food and Nutriton Notes and Reviews, 24: 129. ENGLISH RUTH M., HITCHCOCK, NANCY E.-' Nutrient Intakes during Pregnancy, Lactation and afte; the Cessation of Lactation in a Group of Australian Women', British Journal of Nutritioo (in press).

CENTRAL AND DIVISIONAL OFFICES BYRNES P., and GERRARD, B. W.-' Determination of Glucose in Blood with reference to the Survey of Diabetes in Toowoomba' (1967), Proceedings of the Australian A.sociation of Clinical Biochemists, 1, 251. EDMONDSON, K. W.-' Lost Years-a further consideration, (1967), Med. J. Au.t., 2, 786. EDMONDSON, K. W.-' Medical Library System' (1967), Health, 17, No.2. HERSFALL, W. R.-' Pathology Tests in Remote Areas, (1967), Med. J. Au.t., 2, 554. HOWELLS, GWYN, ABRAHAMS, E. W., EDWARDS, F. G. B., HARRIS, K. W. H., MARSHMAN, R. S .. PEARSON, 1. R. and YOUNG, L. F.-' Minor Epidemics of Tuberculosis', (1967), Med. J. Au.t .. 2, 1115. ROFE, R. B.-' Hospital Beds and Finance', HeaUh, 17, No.2. RoPE, R. B.-' The Financing of Public Hospitals " Health, 17, No.3, ROFE, R. B.-' Hosllital Insurance in Canada', HeaUh, 11, No.4. ROFE, R. B.-' Dissections of Health Spending', Health 18, No. 1. WELLS, R. H. C.-' Medical Research in Australia', (1968), Med. J. Aust., 1, 1140.

132

NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL 'Dietary Allowances for Australians '. Reprinted from Report of 60th Session, October 1965. 'Dental Auxiliary Personnel '. Reprinted from Report of 60th Session, October 1965. 'Code of Practice for the Safe Handling of Corpses Containing Radioactive Substances '. Reprinted from Report of 62nd Session, May 1966. , Principles to be Applied in Minimising Radiological Hazards to Patients from the Diagnostic Use of X-Rays in Medical Practice '. Reprinted from Report of 62nd Session, May 1966. 'Poisoning by Organo-Phosphorus Compounds '. Reprinted from Report of 62nd Session, May 1966. Jamieson, K. G. and Tait, 1. A.-' Traffic Injury in Brisbane '. Special Report Series No. 13, 1966. Report on a National Morbidity Survey, February 1962-January 1963, Part 1. , A Guide On School Tuck Shops '. Reprinted from Report of 59th Session, May 1965. 'Atmospheric Contaminants '. Reprinted from Report of 57th Session, 1964. 'Radiation Protection Standards '. Reprinted from Report of 57th Session, 1964. 'Nursing Staff Exposed to Ionizing Radiations '. Reprinted from Report of 59th Session, May 1965. 'Ionizing Radiations In Secondary Schools '. Reprinted from Report of 59th Session, May 1965.

133

Commonwealth Department of Health

Central Office Director-General Sir William Refshauge, C.B.E., E.D., M.B., B.S., F.R.C.O.G., F.R.A.C.S., F.R.A.C.P., HON.F.R.S.H. Deputy Directors-General Dr G. M. Redshaw, O.B.E., M.B., B.S., D.P.H. Dr L. J. Wienholt, M.B., B.S. Management Services and Benefits Division FIRST ASSISTANT DIRECTOR-GENERAL D. G. Dunlop, B.COM., D.P.A., F.A.S.A., F.C.LS., F.C.A.A. r -

ESTABLISHMENTS AND FINANCE BRANCH ASSISTANT DIRECTOR-GENERAL M. Carroll, B.COM., A.A.U.Q. FINANCE SECTION Director: L. B. Holgate, B.COM., A.A.S.A. A.D.P. SECTION Director: R. H. Searle, B.EC., DlP.COM., A.A.U.Q., A.A.S.A. ESTABLISHMENTS SECTION Director: H. W. Fan O. AND M. SECTION Director: A. D. Morgan PLANNING AND LEGISLATION BRANCH ASSISTANT DIRECTOR-GENERAL D. Corrigan (Acting)

POLICY AND LEGISLATION SECTION Director: W. F. Armstrong, B.COM., A.A.S.A. RESEARCH SECTION Director: R. B. Rofe, B.EC. PUBLIC RELATIONS SECTION (Acting)

Director: J. B. Lleonart 135

MEDICAL AND HOSPITAL BRANCH ASSISTANT DIRECTOR-GENERAL

a. A.

M. Kelly, D.P.A., A.A.S.A.

INSURED BENEFITS AND INSPECTIONS SECTION Director:

J. L.

Hayes, DIP.COM., F.A.S.A.

UNINSURED BENEFITS AND REVIEW SECTION Director: L. W. Lane, A.A.S.A.

Management Services Division Senior Project Officers A. E. Shields, PH.C. O. Fenwick, LL.B., A.A.S.A.

National Health Division FIRST ASSISTANT DIRECTOR-GENERAL Dr R. H. C. Wells, M.D., B.S., B.SC., M.R.C.P., M.R.A.C.P., D.T.M. & H., D.C.T.M., F.R.I.P.H. PHARMACEUTICAL SERVICES BRANCH ASSISTANT DIRECTOR-GENERAL

R. M. W. Directors

Cunningham, O.B.E., PH.C., M.P.S.

J. G. G. Kelleher, M.B.E., M.P.S. H. West, B.COM., A.A.S.A., A.C.I.S. THERAPEUTIC SUBSTANCES BRANCH ASSISTANT DIRECTOR-GENERAL Dr A. M. Walshe, M.B., B.S., B.SC. (Acting)

Medical Officer Dr G. E. E. White,

M.B., B.S., PH.C.

PUBLIC HEALTH BRANCH ASSISTANT DIRECTOR-GENERAL Dr A. D. Spears, M.B., B.S., D.T.M. & H. TOXICOLOGY SECTION Dr D. B. Travers, M.B., B.S., D.P.H. Dr R. A. J. McGregor, M.B., B.S. GENERAL SECTION Dr Dr

R. J.

H. C. Fleming, M.B., B.CH. G. Fairbrother, B.SC., PH.D.

EPIDEMIOLOGY SECTION Dr

K. W. Edmondson, M.B., CH.B., D.P.H.

NURSING SECTION Principal: Miss 1. M. Copley, DIP.N.AD., F.C.N.A.

136

Laboratory Services and Quarantine Division FIRST ASSISTANT DIRECTOR-GENERAL ;

J. B.

Mathieson, M.B., B.S., D.T.M.

GENERAL QUARANTINE AND HEALTH STANDARDS BRANCH ASSISTANT DIRECTOR-GENERAL Dr A. C. Green, M.B., B.S., D.D.M., D.T.M. & H., D.P.H.

Afedical otncers Dr F. S. D. Thompson, M.R.C.S., L.R.C.P., D.P.H. Dr E. J. Fitzsimons, M.B., B.S., D.P.H. Senior Project Otncer J. Cockburn, B.A. (Acting) r ~

INTERNATIONAL HEALTH SECTION Dr J. S. Boxall, M.B., B.S., M.R.A.C.P. ANIMAL QUARANTINE BRANCH ASSISTANT DIRECTOR-GENERAL (DIRECTOR OF VETERINARY HYGIENE)

K. S. McIntosh, B.V.SC., H.D.A.

Senior Veterinary Officers H. R. Peisley, B.V.SC., D.P.A. I. D. Cameron-Stephen, M.R.C.V.S. PLANT QUARANTINE BRANCH ASSISTANT DIRECTOR-GENERAL (DIRECTOR OF PLANT QUARANTINE)

J. R.

G. Morschel, B.SC.AGR., H.D.A. Principal Plant Quarantine Officer:

J. O. Smith, B.SC.AGR., H.D.A.

National Health and Medical Research Council Division FIRST ASSISTANT DIRECTOR-GENERAL Dr R.

GreviIIe, M.B., B.S., B.V.SC., F.F.A.R.A.C.S., D.A.

Medical Otncer Dr N. R. D. Higham, M.B., B.S.

Tuberculosis Division FIRST ASSISTANT DIRECTOR-GENERAL Dr G. Howells, M.D., B.S., M.R.C.P., M.R.A.C.P. Specialist: Dr A. J. Proust, M.B., B.S., M.R.C.P., M.R.C.P.E. Administrative Officer: T. C. Boag (Acting)

137

State Offices

Sydney..... COMMONWEALTH DIRECTOR OF HEALTH Dr. H. M. Franklands, M.B., B.S., D.T.M.

Assistant Directors Medical: Dr B. E. Welton, M.R.C.S., L.R.C.P., D.T.M. & H. Administration and Finance: C. A. Dixon (Acting) General Benefits: N. S. Flint (Acting) Pharmaceutical: K. J. Kelly, PH.C., M.P.S.

MelbourneCOMMONWEALTH DIRECTOR OF HEALTH Dr R. C. Webb, M.B., B.S., D.T.M. & H.

.4ssistant Directors Medical: Dr A. V. M. Cocks, M.B., B.S., M.P.S. Administration and Finance: K. F. Delaney, F.A.S.A. General Benefits: M. J. Carlson Pharmaceutical: L. L. Lock, PH.C., D.P.A.

BrisbaneCOMMONWEALTH DIRECTOR OF HEALTH Dr A. H. Humphry, M.B., B.s., D.T.M. &

Assistant Directors Medical: Dr H. B. Cumpston, M.B., B.S., D.T.M. & H. Administration and Finance: A. J. Lavercombe, M.B.E., A.A.S.A. General Benefits: A. E. Garske, A.A.U.Q. Pharmaceutical: K. L. Bate, PH.C.

AdelaideCOMMONWEALTH DIRECTOR OF HEALTH Dr C. S. Barbour, M.B., B.S.

Assistant Directors Medical: Dr R. B. Lapedus, M.B., B.CH., B.A.O., B.A. (T.C.D.) Administration and Finance: A. S. W. Arnold, O.B.E., E.D., A.A.S.A. General Benefits: N. J. Gluyas, A.U.A.(COM.) Pharmaceutical: A. P. Brammall, PH.C., M.P.S.

PerthCOMMONWEALTH DIRECTOR OF HEALTH Dr W. H. Young, M.B., CH.B. (Acting) 138

, i I

Assistant Directors Medical: Dr W. G. Smart, M.B., CR.B. (Acting) Administration and Finance: F. G. Dienhoff General Benefits: A. J. Wilson, A.A.S.A. Pharmaceutical: A. T. Stocker, PH.C., M.P.S.

HobartCOMMONWEALTH DIRECTOR OF HEALTH Dr C. W. Phillips, M.B., B.S., D.T.M. &

Assistant Director's Administration, Finance and General Benefits: R. J. Boxhall Pharmaceutical: K. R. Heferen, PH.C., M.P.S. ,

DarwinCOMMONWEALTH DIRECTOR OF HEALTH Dr W. A. Langsford, O. ST. J., M.B., B.S., D.T.M. &

Assistant Directors Medical: Dr C. W. Ramsay, M.B., B.S., D.P.R., D.P.A. Public Health: Dr B. L. Kirkup, M.B., B.S. Tuberculosis: Dr E. G. Wilson, M.B., B.S., D.A. Public Health & Medical Services (Southern): Dr N. D. Vawser, M.B., B.S., D.T.M. & H. Administration and Finance: H. C. Harrison

Darwin Hospital: Medical Superintendent: Dr A. H. Dunnet, M.B., CH.B., D.T.M. & R., D.P.H. Matron: Miss A. K. L. Brennan, DIP.N.AD. Secretary: D. A. Hyde, L.H.A.

Alice Springs Hospital Medical Superintendent: Dr B. M. Wittenbury, M.B., B.S. (Acting) Acting Matron: Miss L. R. Johnston Secretary: E. C. Milgate

Tennant Creek Hospital Medical Superintendent: Dr M. M. De Burgh, M.B., B.S. Acting Matron: Mrs Z. Thyer Secretary: R. S. Lisson

Katherine Hospital Medical Superintendent: Dr P. D. Short, M.B., B.S. Acting Matron: Miss M. A. McShane, DIP.N.AD. Secretary: S. Davies

East Ann Leprosy Hospital Dr J. C. Hargrave, M.B.E., M.B., B.S., D.T.M. & H.

Dental Services Senior Dental Officer: S. Paul, B.D.S., M.D.S.

139

CanberraCOMMONWEALTH DIRECTOR OF HEALTH Dr A. Johnson, M.B., B.CH., B.A.O., B.A. (ECON.), D.P.H., M.A.C.G.P. MEDICAL OFFICER OF HEALTH Dr M. Ryan, L.R.C.P. & s.l., D.P.H. HQSPITAL PLANNING Dr A. S. Cumming-Thorn, M.B., B.S., D.T.M. & H. SCHOOL MEDICAL SERVICE Senior Medical Officer: Dr B. H. S. Dixon, M.B., B.CH., M.R.C.S., L.R.C.P,. D.P.H.

- i

Assistant Director (General Services) : K. W. Arscott, A.A.S.A., A.C.I.S. SCHOOL DENTAL SERVICE Senior Dental Officer: L. M. Carr, M.D.S., D.P.D., F.A.C.D.S. AMBULANCE SERVICE Superintendent: A. W. Grant -~

Laboratories and Research Organisations School of Public Health and Tropical MedicinePRINdIPAL Sir Edward Ford, O.B.E., M.D., D.P.H., D.T.M., F.R.C.P., F.R.A.C.P., F.Z.S.

Tropical Medicine Director: Professor R. H. Black, M.D., B.S., D.T.M. & H., F.R.A.C.P., DIP.ANTHROP. Associate Professor C. H. Campbell, M.B., B.S., D.T.M. & H., M.R.C.P., M.R.C.P.E., F.R.A.C.P.

Preventive and Social Medicine Director: Profe3sor C. B. Kerr, M.B., B.S., D.PHIL. Envir{J)nmental Health Director: Professor R. K. Macpherson, M.D., B.S., M.SC., M.R.A.C.P.

•

Industrial Health Principal Medical Officer: Dr G. C. Smith, M.B., B.S., D.P.H., M.R.A.C.P.

Bacteriology and Pathology Senior Medical Officer: Dr L. C. Rowan, M.B., B.S., M.C.P.A., B.SC.

Biochemistry Senior Medical Officer: Dr D. C. Torpy, M.B., B.S., D.T.M. &

H., B.A.

140

r Parasitology Senior Medical Officer: Dr B. McMillan, M.B., B.S., D.T.M. & H., D.A.P. & c. Entomology Chief Entomologist: Associate Professor D. J. Lee, B.SC. Administration Registrar: J. E. Claffey, M.B.E., B.A., B.EC. Institute of Child HeaIthDIRECTOR: Professor Thomas Stapleton, M.A., D.M., M.R.C.P., D.C.H. R.C.P. &S. Associate Professor of Child Psychiatry: J. Katz, M.B., B.CH., D.P.M., R.C.P. & s., M.A.N.L.C.P. Principal Medical Officer: Dr F. W. A. Clements, O.B.E., M.D., B.S., D.T.M. & H. National Biological Standards LaboratoryDIRECTOR Dr L. F. Dodson, M.B., B.S., DIP.CLIN.PATH., D.PHIL.

Assistant Dit'ectors Bacterial Products: Dr V. P. Ackerman, M.B., B.S., B.A., PH.D. Endocrine Products: F. F. Atkinson, B.S.C., (Acting) Viral Products: Dr D. W. Howes, M.SC., PH.D. Pharmaceutical Chemistry: Dr F. E. Peters, M.SC., PH.D. Pharmacology: Dr C. G. Haining, B.PHARM., PH.D. Antibiotics: N. M. Semple, B.SC. Medical Administration: Dr J. Raby, M.B., B.S., B.SC. (MED.), M.C.P.A. Commonwealth Acoustic LaboratoriesDIRECTOR R. A. Piesse, B.SC., A.A.I.P. Chief Physicist (Ultrasonics) : G. Kossoff, M.E., B.SC. Principal Physicist (Acoustics and Electroacoustics): Vacant Principal Psychologist (Clinical Audiology and Psychology Services) : E. J. Tonkin, B.A. Commonwealth X-Ray and Radium LaboratoryDIRECTOR' D. J. Stevens, O.B.E., B.SC., F.C.R.A., HON.F.I.R.

Assistant Directors Principal Physicist (X-Rays): J. F. Richardson, M.SC., F.INST.P., F.A.I.P., HON.M.I.R. Principal Physicist (Radioactivity): D. W. Kearn, M.SC. 141

Bureau of Dental StandardsDIRECTOR A. R. Docking, M.B.E., M.SC., F.R.A.C.l. Institute of AnatomyMEDICAL OFFICER-IN-CHARGE: Dr E. H. Hipsley, M.B., B.S. Oommoq.wealth Health Laboratories TOWNSVILLE Dr R. A. Rimington, M.B., B.S., D.T.M. M.C.P.A. CAIRNS Dr R. M. Symes, M.B., B.S., D.T.M. & &

H., D.C.P., D.PATH., R.C.P.

S.,

H., D.C.P.

ROCK HAMPTON Dr F. S. Hansman, M.B., F.R.A.C.P., M.R.C.P., M.C.P.A. TOOWOOMBA Dr W. R. Horsfall, M.R.C.S., L.R.C.P., M.B., B.CH., M.C.P.A. LISMORE Dr M. A. Bundock, M.B., B.S., D.T.M. TAMWORTH Dr B. H. Murphy, M.B., B.S. ALBURY Dr E. D. Lyons, M.B., B.CH., D.T.M.

•

H., M.C.P.A.

LAUNCESTON Dr R. E. Richards, M.B., B.S., M.C.P.A. HOBART Dr A. L. Lyons, M.B., B.S., M.C.C.P., D.T.M. KALGOORLIE Dr S. O. M. Were, M.B., B.S., D.T.M. DARWIN Dr W. J. Wilmot, L.R.C.P. CANBERRA Dr E. J. F. De Salis, M.B., B.S., D.P.H., M.C.P.A. &

H., M.C.P.A., M.C.PATH.

142

Overseas Posts London CHIEF MEDICAL OFFICER: Dr M. A. Walker, L.R.C.P., L.R.C.S., L.R.F.P. & s.

The Hague MEDICAL DIRECTOR: Dr J. M. Thompson, M.B., B.S., M.R.C.S., L.R.C.P .. M.C.P.A.

Athens MEDICAL DIRECTOR: Dr

R. W. Cumming, M.B., B.S.

Cologne MEDICAL DIRECTOR: Dr B. H. Hartshorne, M.B., B.S.

Rome MEDICAL DIRECTOR: Dr

P. Dawes, M.R.C.S., L.R.C.P.

Malta MEDICAL DIRECTOR: Dr J. Boyd, L.R.C.P. & S.

Beirut MEDICAL DIRECTOR: Dr C.

E. A. Mason, M.R.C.S., L.R.C.P.

Secretariat Commonwealth Committee of Enquiry into Health Insurance SECRETARY: L. J. Daniels, B.EC., A.A.S.A. SENIOR EXECUTIVE OFFICER: A. B. McDonald, A.A.S.A.

143

'.1

D. E. WILKINSON. Government Printer, Tasmania.

ORIGINAL: CAMBODIA BRIEF REPORl' ON THE PROGRESS OF HEAIJrH ACTIVlTIES l

FRENCH

, ~-

Thanks to a well-designed medical and health policy, much progress has been made in the field of public health. Development is well co-ordinated in all sectors. In the field of preventive medicine, current public health programmes were strengthened, in particular those related to the control of communicable diseases, maternal and child health, environmental health and health education. The problem of maternal and child health has been solved to a great extent through an increase in the number of midwives and rural midwives on the one hand, and in the number of pre-natal and postnatal clinics on the other hand.

1-------+··----- .- . I Pre_natal and I post_natal clinics I I j

I I

~ar

1~7

1~8

i i

._1

1,8

Rural midwives' I stations 677 819 , _______-1___....._ ...L ___ ....._ ..

In addition to these permanent centres, rural midwives are assigned to all parts of the Kingdom. They assist in home deliveries. They follow-up pregnant WOOlen and mothers and give them advice on health matters. Since 1958, no case of plaGUe and smallpox has been reported. Isolated cases of cholera appeared around April 1968. However, thanks to quick and efficient action, no epidemic occurred. y--

In order to improve the quality of patient care, we have strengthened and streamlined the medical infrastructure of the country. Many improvements and new constructions and facilities have resulted in better treatment for the patients. The number of beds increased from 6433 in 1967 to 6525 in 1~8.

~-----------------

Year :L~7 Hospita1.s--:n-;;.-------r----

health centres Dispensaries, infirmaries Hlarmacies and drugstores

86 470

500

lSubndtted by the Minister of Health d

As regards manpower, all our efforts are aimed at constant improvements in the quality of teaching in our faculties ;and paramedical training schools. Teachers and :professors were sent abroad for further training. The table below shows the increased number of staff.

I ,

Year Physicians Pharmacists Dentists Nurses Midwives Rural midwives Sanitary agents

1967 360 64 35 2330 246 677 409

1968 403 77 40 2380 286

I i

819 442

ENGLISH ONLY

CHINA (TAII'lAN) REPORT ON THE PROGRESS OF HEALTH ACTIVITIES 19671

COMMUNITY DEVELOPMENT PROGRAMME AND IMPROVEMEN'r OF ENVIRONMENTAL SANITATION

Several moves to improve environmental sanitation were made during the past year. The significant impro\~ent was that every level of government began to realize that environmental sanitation is one of its important activities and that every department of the Government shares the responsibility for improving sanitation.

•

Perhaps, the most significant change i.n policy is the development of the concept and plan of community devel~. This plan is based on the idea that, to improve environmental sanitation, we must develop a community as a whole, with environmental sanitation first. This involves close interlocking of urban and rural plans, with the efforts of all departments in the Government integrated into one plan. ~~e

••

'l'hanks to the World Food Programme, the first successful effort was possible by the approval, in December 1966, of the project "Community Development-Improvement of Sanitation", as a three-year programme. Through this, US$l 887 830 was granted in the form of food. According to the plan, during 1966 to 1968, every township of the 330 in Taiwan must select one or more villages as a community for demonstration and must cornplet~ construction of necessary sanitation facilities including water supply, latrines 1 drainage, paved village roads. and public baths. The President instructed the Army in July 1966 t~ help local government and the public in construction of sanitary facilities for the first 17 communities. This gave impetus to the programme, and by the end of 1967, 110 communities had completed the necessary construction •

The UNICEF programme for construction of simple water supply systems in rural areas b,as been going well. In the past two years, 150 simple water supply systems were added. This brought the total figure to 240 since the programme started in 1962. To facilitate construction in poor villages by lessening the local matching fund we have a subsidy of NT$2.4 million in our budget. beginning 1967. In larger Cities, our efforts to mechanize transport for garbage collection got under way in 1967, with a loan of NT$29 million from the Committee for International Economic Co-operation and Development (CIECD). With this loan, Taipei a.~d Keelung purchased 65 garbage trucks and 64 nightsoil trucks. In 1967, CIEeD has approved another loan of NT$23.7 million to Taichung, Tainan, Kaohsiung Cities and Taipei County for this purpose.

ISubmitted by the Director, Department of Hea,lth Administration, Ministry of Interior, Taipei, 1 October 1968.

- 2 To solve the problem of garbage disposal, we decided to adopt the method of composting plants, and completed planning for con$truetion of 17 of them. in 71 cities and townships within the next five years. This plan requires NT$120 million, one-third of which will be met from local government budgets and two thirds .through the loan from CIECD.

POPULATION CONTROL

The fourth year of the family planning program had gone very well. In the past year, almost 130 nco of fertile women have had intra-uterine devices inserted, bringing the figure since Janaury 1963 up to August 1968 to 440 000 women, or one of four wives 20-44 years. For the many women who could not wear the loop com:f'ortably J oral pills were introduced from January 1967. The success of the program has begun to show in the reduction of the birth rate. The crude birth rat~: was 28.5 per thousand! for 1967 compared with 32.7 in 1965 and 36.3 in 1963, the 374 282 total live births in 1967 compared with 424 250 in 1963 and 406 6r4 in 1965. The population growth rate has dr~ped fram3.2 in 1963 to 2.34% at the end of 1967. This programme is making a major contribution to the education, food, and economic development program. The attitudes of government high officia.ls, legislators, as well as the public toward the activity of family planning had been becoming steadily more favourable. This led to the creation of a Population policy for our country and the legalization of family planning as a government program was announced in May 1968. The recognition by international organizations of our family planning work was reflected in the increase of visitors to our program. More than 1000 international visitors have come to Taiwan and visited the family planning pro~ In 1967 alone, there were 308 foreign visitors. In May 1968 we had the East Asian Population Workshop held in Taiwan, to which about representatives from eleven neighbouring countries and many international agencies had came. Taiwan now is beginning to show that rapid population growth can be checked by organized effort. '

•

INIlOSTRIAL HEALTH

The increase of industrial growth in 1967 was reported to have reached an all-time high of 17% as compared with 15~ in 1966. However, due to the ineffective control of factories, the public hazards from air and stream pollution in industry are grOwing rapidly. The safety problem in fa.ctories is also getting worse. The industrial health program mUst therefore receiTe priority above other health programs. The recruitment and the training of staff are considered most important at the p~esent stage, and, through WHO and Japanese aid, four key persons were sent to the United States and Japan :t'or advanced training. Dr. Yamaguchi, WHO consultant, visited Taiwan again in 1967 to check how far we had folJ,owed his recommendations. .

- 3 The strengthening of our three industrial health centers did not make much progress. The set-up of an industrial health services station in every industrial district is not in sight yet. Industrial health requires much more effort in the coming years, including more of our personal attention.

HOSPITAL PROJECT

•

Compared with some other health programs. the project for rehabilitation of -the government hospitals has not been going very well. In our prev~ous report, we stated that construction of the buildings for the Taitung Hospital, Yuli Mental Hospital, Taipei Tuberculosis Center and Taichung Tuberculosis Center had been completed during 1964-l96~and predicted that in 1966-1967 we should cO!lJ±llete construction of the Children 's Hospita~, the Tainan Hospital, the Taichung Hospital, and the Changhua Hospital. In fact, we completed only Taichung (NT$6 million) and Changhua (NT$7 million). The delalf was due to too much official red tape in selling hospital land and to the shift of the administrative jurisdiction of Taipei from the Provincial Government. However, in order to achieve the rehabilitation of government hospitals as set forth in the ten-year plan, we have received the approval of appropriation for the contruction of other five hespi tals •

POLIO CONTROL

•• -,.,..--

The donation of 2.6 million doses of Salk vaccine had been received and immunizations to ene million children under three years old had been performed in 1964 and 1965. UNICEF had provided Sabin vaccine to immunize another million children under three years old in the winter of 1966 and to 400 000 newborns every year thereafter • The program was carried out completely in accordance with t he plan. to UNICEF and WHO, 950 388 children below three years old were given two doses of oral vaccine from December 1966 to March 1967. This covered 92% (two doses) or 95% (one dose) of the population below three years. Then, in December 1967, we gave immunization of the 318 704 (one dose) infants born during the year with oral vaccine. By now, we can safely ass"lmle that most of our children below five years old are immunized against polio. Thant~

What was the result? During 1967 only 46 cases were reported with 27 deaths, compared with 392 reported cases with 249 deaths in 1966 , and 563 cases with 255 deaths in 1965. The real effect of this progrwa was even greater. Since the cases had not usually been well reported in the past. t he local experts through their surveys estimated th~t there might have been three to seven thousand cases of polio a year before our mass immunizatj.on campaign. Few other health programs could give greater benefits.

- 4 -

JAP.ANE3E ENCEPHALITIS

Japanese B. EncephaJ.itis is taking its place year after year as the most important and difficult epidemic disease in Taivan. 14 1967, 1024 cases (206 deaths) were reported and 819 (157) in 1966 and a majoxr1ty of the cases was confirmed in the laboratory. This was a big increase oVer the 444 cases in 1964 and the 377 in 1965. Nothing could be done to combat this disease. Our field study on the effect of mouse-brain vaccine in 1965, however, proved that two doses of immunization could give 81% protection. We, therefore, asked 1-1H0 to help start local production of vaccine. 7. SOME IMPORCANT PROORAMB

The tuberculosis control program continued to make good progress under the four-year accelerated control plan. Two hundred full-time tuberculosis workers were added in the local townships, and the simultaneous vaccinations of BOO and smallpox vaccine to newbel'ns reached 801> of the the infant population. Free domiciliary chemotherapy to aJ.l active cases bad aJ.so been started during this period. The third prevalence survey assisted by WHO has been under way since October 1967. The maintenance phase of the malaria project has been tioing reasonably well since November 1965, when Taiwan's malaria eradication was officially registered by WHO. There were outbreal~s of a few cases in 1966, but these were immediately brought under control. The trachoma control in schools ,(as continued and brought down the prevalence rate to 8.81> (2.2 million examinations) in 1961 from 12.31> in 1965. The six years' trachoma community mass campaign vrasclose to the end, and, after the interim assessment of this project, Dr Assaad, the WHO consultant, reported that the operation .1aS excellent.

Also during the reporting period, some improvements v19re made in other health programs. Bicillin was substituted for PAM in the treatment o f " syphilis in our V.D. control program in order to simplify the treatment and to increase the treatment rate. The K:H program was able to set up 127 midwifery stations in remote villages in order to reduce the deliveries attended by unqualified persons. The iodated salt program 'for goiter control vras extended to the whole country resulting in a sUbstantial decline of cases in endemic areas. These programs are certainly of benefit to the health of mothers and children. Regrettably, almost no organized programs were implemented against parasitic diseases and for dental health. For out future efforts, two other fields of health activities are our concern and must receive attention: development of laboratory services and iDg;>rovement of training and research institutions. These are the weakest parts of our health program. If we are to lay a sound and steady foundation for the future health program, the strengthening of these two basic problems is essential. .

e, .

.. - 5 .•

ASSIgrANCE FROM EAST-WEST CENTER

OF HAlJJ'UI

During the years that the USAID was assisting our country, more tb:m one hundred :public health :personnel ,;ere sent to the United states for :public health training. These included medical doctors, nm'ses, engineers and health educators. After USAID was 1fi.tbdraw. in 1965, there was only WEO to train our :public health leaders abroad. Thanks to the East-West Center of Hawaii and particularly, to Dr Baron Goto and Dr Richard K.C. Lee, four teams consisting of six members for each team had received six months' training in Hawaii through provision of the East-Hest Center's fellowshi:ps in 1967. These teams covered sanitation, hos:pital administration, health education and hospital nursing.

•

The other assistance from the East-Hest Center was to send a team on s83.litation to visit Taiwan and to hel:p us conduct two in-service train:l.ng courses for local sanitarians. This yea.r we shall be able to send a :public health nursing team and others, and also received the East-Hest Center's team on hospital management in August •

•• -

ORIGINAL:

EmLISR

HONG KONG BRIE:F BEFOre.: ON THE

PROGREsr. 1967

OF HEAl]:H PaarIV'l!rJES

GENERAL HEAIJrH

••

The general health of the population continued to be good during No case of cholera 'Was reported during the year and apart from one isolated case in 1966, there has been no visitation of this disease for over three and a half years. Diphtheria and poliomyelitis are under coIltrol, but measles in receIlt years has emerged as a major cause of death in young children, due primarily to complications associated 'With the disease •

1967.

\'Ihile tuberculosis remains the major community health problem, the Colony is facing increasing problems due to diseases of later life. Deaths from cancer, diseases of the heart and cerebra-vascular lesions 'Were the leading causes of death followed by pneumonia and tuberculosis. 2. mAL Sl!ATISUCS

The estimated mid-year population in 1967 was 3 834 000, approximately 4cY{o being below the age of 15 years and only 6% over the age of 60. The general state of health of the population continued to be satisfactorily reflected by the Colony's vital statistics. The crude death rate in 1967 was 5.1 per thousand population, and the crude birth rate fell further from 24.8 in the previous year to 23.0 per thousand in the year under revie,1 • The steady decline in infant mortality has been due to improvement in environmeIltal conditions, development of maternal and child health services and increasing public appreciation of the value of these services in the maintenance of health amongst infants and mothers. The infant mortality rate in 1967 was 25.6 per thousand live births. During the last two years, there has been a slight up'Ward trend in infant mortality. This is attributed to fluctuations in mortality trends especially when the fall in mortality has reached a low level. The maternal mortality continued to show a reduction and the rate in 1967 was 0.30 per thousand total births. During recent years, there have been coIltinuing reductions in deaths from toxaemia, haemorrhage and puerperal sepsis. 1

••

Submitted by the Colonial secretary, Hong Kong, 27 August 1968.

_ 2 -

3. COMMUNICABLE DISEASES 3.1 Cholera Hong Kong was last declared free from cholera infection on

5 December 1966 and since then no further case of the disease was reported. In view of the continuing prevalence of the disease in nearby countries, special preventive measures were continued and strict quarantine restrictions were maintained in respect of neighbouring countries declared infected. As 'l-lith previous years, a mass immunization campaign against cholera was started in April 1967. 3.2 Smallpox "•

The disease has been absent from Hong Kong since 1952 but vaccina.. tion campaigns against the disease have been conducted each year. The increasing importance of Hong Kong in international travel by sea and air and the prevalence of smallpox in nearby countries un~erline the need to maintain a high level of community protection against the disease.

3.3 Tuberculosis Tuberculosis remains the major health problem of Hong Kong although considerable progress is now being made. The policy for control of the disease has been to protect, by vaccination with BeG, the new-borns, who are particularly vulnerable to the fulminating forms of the disease, and the primary school-entrants who may develop active disease later in life. For actual cases of the disease, it has now been shown that in a large proportion of cases, out-patient therapy is at least as good as institutional treatment. The not inconsiderable institutional resources are reserved for those not responding to out-patient therapy, i for acutely ill cases, for those whose diagnosis is doubtful and for those in need of surgical intervention. In executing this policy, there continues to be a high degree of co_operation between Government and voluntary agencies concerned with the problem, particularly the Hong Kong Anti.tuberculosis and Thoracic Diseases Association. The Government Chest Service maintains the BeG vaccination and out-patient treatment programmes, while the voluntary agencies aided by substantial Government subventions, maintain most of the hospitals. During the year, a biostatistician was aSSigned to the Government Chest Service to advise on development of statistical procedures for the evaluation of the tuberculosis progranme in Hong Kong. In conjunction with the Medical Research Council of the United Kingpom and the Hong Kong Anti-tuberculosis and Thoracic Diseases Association, a trial started in l.farch 1967 to evaluate the most effective policy of treat. ment for tuberculosis patients in Hong Kong and to invest,igate the use of a rapid.slide-culture sensitivity test. This chemotherapy trial should yield extremely valuable results in the treatment of patients suffering from tuberculosis in Hong Kong.

- 3 -

The number of deaths from tuberculosis in 1967 fell slightly. Ev'j. dence of progress against the disease in the young is shown by a further appreciable fall in the infant mortality rate for tuberculosis. '!he level of BCG coverage of new-born infants remains high at 95.4%. Notification of tuberculosis during 1967 showed a very considerable increase over the previous years. 'lhis is attributed to a thorough re-organization of statistics dUring the year and the intensified casefinding programme.

3.4 Diphtheria

•

As a result of annual immunization campaigns which have been in progress since 1959, the incidence of the disease has shown a continuous and steady decline falling from 73.0 per 100 000 population in 1959 to 5.8 in 1967.

3.5 Poliomyelitis A further fall in the incidence of the disease was observed and a report of five cases during the year was the lowest recorded since 1949. '!he success in the control of the disease has been due to the continuing vaccination programme, consisting of giving one dose of TYpe I poliovaccine, soon after birth, followed by two doses of trivalent vaccine at three and five months of age. Approximately, 77% of infants received one dose of. TYpe I pol1ovaccine soon after birth and more than half of these children subsequently received two doses of the trivalent vaccine at maternal and child health centres. A general campaign is mounted annually in an attempt to immunize the remainder.

.•

3.6 Enteric fever There was a slight increase in incidence in August and September. The disease in Hong Kong is generally mild.

3.7 Malaria The incidence of malaria continued to decline, the disease being restricted mainly to certain parts of the rural areas in the new territories. Plasmodium vivax remained the predominant parasite responsible for the infection.

3.8 Measles The disease in Hong Kong has shown a distinct biennial pattern with an increase in the number of cases every alte:ma.te winter and spring. '!he high mortality associated with the disease during each outbreak has been due mainly to complications, particularly broncho-pneumonia,

- 4 -

developing as a result of delay in seeking early medical attention. Health education efforts were continued throughout the outbreak to encourage parents to bring their children for early medical advice. At the end of December 1967, measles vaccine was made available at all government maternal and child health centres to children aged between six and forty-eight months. The drive is still being continued.

3.9 Venereal diseases The incidence of early infectious syphilis showed a further decrease in 1967, marking the fourth consecutive year of ~eduction. This is mainly due to energetic epidemic control by contact tracing, follow-up of defaulters and routine free antenatal blood tests. The number of latent syphilitic cases "/as about the same as in the previous year \-,hile the incidence of gonorrhoea shol'led a slight indrease. It is encouraging to note that the incidence of syphUis in the teenage group of the population has not risen in the manner experienced in many parts of the world. This is no doubt attributable to the old Chinese custom of strong family ties and parental authority "lhich still prevails in Hong Kong in spite of western influence.

•

3.10 Leprosy The incidence of this disease in 1967 fell further t~ 3.9 per 100 000 population. Tuberculoid manifestations predominated. During recent ;years, there has been some advance in overcoming thte prejudice against employment of cured leprosy patients and, to this end, great attention is paid by the Social Hygiene Service towards the prevention of disabilities in tuberculoid cases. 4. MATERNAL AND CHILD HEALTH SERVICES

•

The maternal and child health services offer free maternal and child care at 30 centres, 17 of which are full-time and 22 of them are provided with maternity beds. 78.8% of children born attended a maternal and child health centre on at least one occasion; this compares with a figure of 75.5% in 1966. Approximately, 99%, of births took place in institutions, either maternity homes or hospitals, and 38 maternity beds were provided following the opening of the new Lion's Club Maternity Home and the Castle Peak Clinic.

• - 5 -

ME!NrAL HEALTH SERVICES

Continued efforts to turn the Castle Peak Hospital for psychiatric patients into a modern therapeutic community have resulted in a judi.. cious liberalization of control over patients. Increasing efforts were made to rehabilitate the long_stay and grossly mentally handicapped patients, the aim being to make them fit to earn their living. Plan.ning is in progress for another mental hospital in North-West KOwloon which will have approximately 1000 beds. Out-patient treatment continued to be provided by the psychiatric centres. The newly_opened Yau Mo. Tei psychiatric centre provides day_ treatment services and also special facilities for the observation of disturbed children • The Drug Addiction Treatment Centre at Shek Kwu Chau, maintained by the Society for the Aid and Rehabilitation of Drug Addicts and aided by government subvention, continued to provide treatment for male drug addicts. In November 1967, a Co10ny..wide anti-narcotic health education campaign, was organized by the Medical and Health Department in conjunction with the Action Committee Against Narcotics (ACAN). The emphasis of the campaign was on the preventive aspect of drug addiction and publicity was directed primarily towards education of the young.

•

6 • HOSPIrALS At the end of 1967, there was a total of 13 273 beds available in all hospitals in Hong Kong including those hospitals maintained by Her Majesty's Armed Forces; in addition, there were 484 beds in government maternity hcmes and 498 beds in private maternity and nursing homes and the total of 14 255 beds represents 3.7 beds per thousand of the population. The development programme of the Medical and Health Department has been making steady progress. Altogether, there were twenty-five building projects being planned or built for the improvement and expansion of the medical facilities in the urban and rural areas. The first of the five phases of the alteration programme of Queen Mary Hospital to provide more acute beds commenced in July 1967. up_to_date facilities for the professorial staff of the University of Hong Kong in the hospital were completed and commissioned. Other works in progress ,~ere the new Lai Chi Kok Hospital, the Chai Wan Urban Clinic and Maternity Home, the Tang Shiu Kin Hospital and the Nental Defective Hospital at Siu Lam. The Castle Peak Clinic was opened in the beginning of 1968.

- 6 -

Work in the government hospitals continued. The number of patients admitted and treated in government hospitals dur:ifng the year have shown an increase compared with the previous years. The Tung Wah Group of Hospitals, aided by substantial government subventions, continued its programme of modernization and expansion. During the year, work on Wong Tai Sin Infirmal!'y' s phases II and III continued. On completion of the 'Ilhole project, it will give an overall total of 800 beds.

OlJr-PATmNl'S SERVICES

There has been increasing use of the Department's sell'vices by public and attendances at general out_patients and specialist outpatients departments continued to increase, a total of 7 348 621 attendances being recorded during 1967. The Government now maintains 43 out-patient clinics as well as mobile dispensaries, floating clinics and a flying doctor service. In addition, the Government also provides evening and public holiday out_patient sessions at seven clinics in the more densely_populated areas.

•

...

ORIGINAL; JAPAN

ENGLISH

REPOID!

THE PROGRF.sS OF HEALTH ACTIVITIES' FOR THE: FISCAL YEAR 1967 {April 1967 - March 1968)1 L

ORGANIZATION OF NATIONAL AND LOCAL HEAILL'H ADMINISTRATION

In order to meet the increased problem of public nuisance and environmental pollution, the Environmental Control Division was created in the Environmental Sanitation Bureau of the Ministry of Health and Welfare on 20 June 1>67, and no other changes were made during the period under review. The prefectural and municipaJ. health centres continued to carry out their routine fUnctions as local community health service agencies. There were 832 health centres throughout Japan at the end of March 1968, an increase of 3 centres over the previous year.

2 • H:EAI1rH BUDGEr

The total national health budget for the fiscal year 1967 was ;{.U7 133 million, vlhereas it was nl2 281 million for the fiscal year 1966.

mAL ffl'ATISl'ICS

The estimated population as of 1 October 1967 was 100 243 000. The following table gives some of the vital statistics data for the calendar year 1967 with a comparison with 1966. '-

Births: Number 1 934 958 Rate (per 1000 population) 19.3

1 360 974 13.7 670

'-~

Deaths: Number Rate (per 1000 population) Infant deaths: Number Rate (per 1000 total live births)

674 909 6.7 28 935 15.0

342 6.8

26 217

19.3

ISubmitted by the Second Secretary, Embassy of Japan, Manila, 2 september 1968.

- 2 -

Maternal deaths: Nwnber Rate (per 10 000 total live births) still-births: Nwnber Rate (per 1000 total 11ve births)

1 351 6.4 149 304 71.6

1 266 8.4 11:8 248

98.2

The average life expectancy at birth for the Japan~se people, prepared on the basis of the 1967 data, indicates 68.91 years for males and 74.15 years for females; the comparable figures for the previous year being 68.35 years for males and 73.61 years for females. 4 • MATERNAL.AND CHILD HEAID'!H

During the calendar year 1967, 1 040 866 visits 'lel'e made to the clinics by mothers, and 5 204 747 by children. Public health nurses paid 307 057 home visits on mothers and 854 412 on children. At the em of March 1968, there were 501 maternal and child health centres in the rural areas (459 centres in 196'7). Duri,!)g the calendar year 1967, 73 116 low weight babies were reported, indica.ting an increase of 14 459 over that of 1966. 5. TUBERCULOSIS CONl'ROL

In the calendar ~~ar 1967, the number of deaths from tubercu_ losis decreased further, there being only 17 675 deaths, a rate of 17.6 per 100000 population (20 064 deaths, a rate of 20.2 for 1966). During 1967, 42 555 000 persons (42 822 000 persons for 1966 ) received health examinations for case-finding purposes. Among them, 37 229 000 (37 381 000 for 1966) were examined by photoUuorography. The case-finding rate for 1967 was 0.12% (0.15% for 1966). Among those tuberculin negative, 4 524 000 were vaccinated wi~h BeG.

The total number of registered tuberculosis patients as of the end of 1967 was 1 339 460 (1 405 289 for 1966), 62.9% of which were active caseSj 21.1% of the, active cases were hospitalized, 62.2% were under domiciliary treatment, 14.9% did not receive 'complete medical treatment and the ren~ining 1.8% could not be traced. During the same period, 253 781 cases were newly registered. In 1966, the total expenditure on tuberculosis treatment was estimated to be 112 billion yen (111 billion yen for 1965). This is eq~ivalent to

- 3-

8.6% (9.4% for 1965) of the total expenditure on medical care for all kinds of illness. At the end of 1967, there 'Iere 204 945 beds allocated to tuberculosis patients and the bed occupancy rate was 72.CJ/o (211 527 beds and 73.8% for 1966).

6. LEPROOY CONl'ROL The number of newly reported cases of leprosy has been decreasing yearly. In the calendar year 1967, 120 were reported (las for 1966). The total number of reported leprosy patients at the end of 1967 was 10 220 (10 404 for 1966) with a prevalence loate of 1.0 per 10 000 population (same for 1966); 9537 patients (9715 patients for 1966) were institutionalized at 11 national and 3 private leprosaria. The total number of beds available in those 1e;.-,rosaria 'Here 12 950 and 280, respectively.

COMMUNIClIBLE DISEASES CONrROL

The total number of persons who received immunization during the calendar year 1967 was as follows: 3 047 000 for smallpox; 14 727 000 for typhoid and paratyphoid fever; 1 910 000 for diphtheria; 3 290 000 for diphtheria-whooping COU@1 combined, and 2 238 000 for poliomyelitis (attenuated vaccine). In 1967, there was a marked decrease in most of the acute communicable diseases. The incidence of poliomyelitis was dramatically reduced after the successful. oral administration of Sabin-type poliomyelitis vaccine. In 1967, only 24 eases were report€d. The decrease in poliomyelitis eases during the past several. years is as follows: 5606 :ror the year 1960, 2436 for 1961, 289 for 1962, 131 for 1963, 86 for 1964, 76 for 1965 and 38 for 1966. The number of Japanese encephalitis cases decreased compared with 1966, and 1ee8 cases includinG 659 deaths were reported. The number of persons who received voluntary immunization against Japanese encephalitis during 1967 is estimated to be about 28 million. Except for a small increase in 1966, the number of cases of dysentery has yearly decreased since 1960, and 30 097 cases were reported in 1967. 8.

FOREIGN QUARAN.rINE SERVICES

During the calendar year 1967, 30 964 vessels (1 348 342 persons) and 18 310 aircraits (1 176 180 persons) received health inspection at the time of arrival from abroad j 157 795 persons were vaccinated against quarantinable diseases before going abroad (this number excluded those vaccinated at places other than the quarantine stations): 991 ships i~ere granted de ratting certificates and 5936 ships received deratting exemption certificates. No case of quarantinable diseases was introduced during the year 1967.

_4_

ENVIRONMENrAL SA;NJ::rATION

As of the end of March 1957, a population of 71 519 025 (about 72.2% of the total population) 1laS covered by some kind of public i~ater supply. At the end of Harch 1967, there were 142 cities operating sewage treatment plants and a population of 16 $31 000 benefitted from these services. At the end of March 1967, there were 958 nightsoll disposal plants. At the end of March 1967, a population of 62 677 000 'las covered by the garbage disposal pro-

gramme, either by incineration or composting methods. The insect and rodent control prograuune, SU1)ported by the couununity organizations, has been continued, and routine sanitary inspections have been carried out continuously. In order to cope with the air pollution problem, so far 20 large or ne'vlly industrialized areas have been desisnated as specific smol.e control areas under the Smoke Control Law. A study on the effect of polluted air on human health couunenced in several industrialized cities. Twenty_three rivers ilere deSignated as the control basin under the Water Pollution Control Law. In the past, the administrative responsibility for sel,age disposal and its facilities was jointly in the hands of the Ministry of Health and Helfare and the Ministry of Construction, i.e., operation of sewage treatment plants was under the jurisdiction of the former and main~ tenance and construction of sewerage pipes of the latter. Hovlever, with a view to simplifying administration, the Ministry ott' Construction became the single agency responsible for sewage disposal work as to its budget and operation as from 21 June 1967, although it still requires to obtain the consent of the Ninister of Health and lfelfare when approving the construction of new sewerage facilities and: their e:x:tension. 10. FOOD SANJ::rATION

During the year 1967, 5058 food inspectors wel'e statlioned in 832 health centres to deal with 2 552 694 food_handling establishments. For the ::lame year, the total number of food poisoning cases reported vIas 1565, involving 31 204 patients and resulting in 120 deaths. Chemical synthetics to be used as food additives are fully controlled under an mrthorization system by the Government. At the lend of 1907, a total of 349 chemical synthetic food additives were inclUded in the list of the authorized synthetic food additives. At the end of 1967 there 'Iere 781 slaughter-houses and 11 286 122 food anioals were slaughtered and inspected, during the same year. j

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ll.

NUrRll'ION

During the calendar year 1967, 1 423 146 cases of individual nutrition guidance and 86 162 group sessions, including demonstrations by kitchen cars, were given by the nutrition staff of the health centres. As of the end of March 1968, there were 213 authorized nutritionist training schools and 116 318 licensed nutritionists. 12 • DENTAL llEAILrH

One hundred and twenty of the 832 health centres were equipped with dental facilities and dentists, and continued to play an important role in the preventive dental health programme. During the year 1967 J 151 213 dental health guidance consultations were given to pregnant women and 1 325 306 to children. 13 • MIOO.'AL HEAIrrH Continuous efforts were made to improve the mental health programme during the year 1967, including care of the mental cases. The number of mental hospitals, mental beds, etc., at the end of June 1967 as compared with the same data in 1964, 1965 and 1966 is shown below:

~ Mental hospitals Units in general hospitals Mental beds 649 329 144 823

!2§2 705 363 163 910

.!2§£

12§1

746 399 181 709

797 429 201 823

'Y--

There are many governmental facilities carrying out the programme for the promotion of mental health guidance for the public as well as for the mentally retarded children and adults. The Government received the services of a 1'lli0 short-term consultant in the field of community merrtal health care for a period of three months in 1967. 14 • MEDICAL SERVICE At the end of the (7308 for 19(6) with a showing an increase of available in 1966. At calendar year 1967, there were 7505 hospitals total bed capacity of 963 113 (918 233 for 1966), 197 hospitals and 44 890 peds against those the end of the calendar year 1966, there were

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65 679 general clinics (64 524 for 1965) and 28 893 dental clinics (28 602 for 1965), showing an increase of 1155 general clinics and 291 dental clinics. (Data for 1967 are not yet available.) At the end of the calendar year 1966, there were 110 759 physicians (11.2 per 10 000 population), 36 022 dentists (3.6 p~r 10 000 population), 70810 pharmacists (7.1 per 10 000 population) and 265 230 nurses (26.8 per 10 000 population). This means an increase of 1390 physicians, 464 dentists, 2137 pharmacists and 20 019 nurses. (Data for 1967 are not yet available) In order to cope with the increase in traffic and other accidents, the ambulance medical care system was revised in February 1964. As a result, a network of ambulance medical cal~ has been established throughout the country; at the end of March 1967, the number of such faCilities, either public or private, reached 3892. 15. MEDICAL REHABIIJTATIOli

The School of Rehabilitation attached to the National Tokyo Chest Hospital and established in 1963 for the purpose of training and educa. ting physical therapists and occupational therapists, has d:ontinued successfully its teaching activities under WHO's expert assistance. There are now a total of 721 phYSical therapists and 130 occupational therapists who have passed the national examination for th~ir respective professions under the Law for Physical Therapists and'Occupational Therapists.

l6.

PIiARMACEtTl'ICAL CONTROL

During the calendar year 1967, 2002 pharmaceutical inspectors visited 205 860 pharmaceutical facilities (out of a total of 260 729 such facilities), such as drug and medical supply manufacturers, pharma. cies and blood banks. The control of amphetamine preparations and narcotics was also maintained, and the measures for narcotic addicts were also carried out. The blood supply service had in the past depended chiefly on the so-called "professional blood donors". This practice had caused not only social evils but had also increased the risk of serU!l1 hepatitis among the population. The Government, recognizing the seviousness of the above situation, made a decision in August 1964 to develop voluntary blood donations further to normalize the blood supply service programme. Under the nation-wide campaign for voluntary blood donation, the ratio of voluntary donation to the total donations increased to reach 68.7% during the year 1967, while it was 48.5% in 1966 (in 1964, only 7.7%).

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The first edition of the Official Book on Japanese standard of Cosmetic Ingredient 'Was published in August 1967. The monitoring system for adverse drug reaction established in March 1907 continued its activities in order to ensure safety of drugs. 17. MEBNMIONAL CO-OPERATION IN THE! IlEAIlrH PROGRAMME

During the calendar year 1967, the Government extended its services and co-operation in connection 'With the international health programme, and received and trained 77 WHO fellows, J2 trainees under the Colombo Plan, and 6 trainees under other schemes. It also arranged for 2 long-term experts and 6 short_term consultants to work 'With WHO, 19 with the Colombo Plan and 7 with other schemes.

A Brief Report on Public Health Administration in Japan 1968 (January 1967 ~

August 1968)

====r======~=~~

_____

'vVith Pertinent Infmmations oa Social Welfare and Insurance Programme

Ministry of Health and Welfare Japanese Government

31 August 1968

CONTENTS Chapter Page 1, Organization of National Health Administration"""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1 2,

Main Laws under the Jurisdiction of the Ministry of Health & Welfare···,,·········· 3 Finance of the Ministry of Health & Welfare ................................................... 5 Organization of Local Health Administration ........... " ................ " .... " ............ " 5 Health Center ............................................................ , .. ,................................ 6 Population ......... , .............. " ....... , ........ ' ........................................................ , .. 8 Vital Statistics ................................................................................ , ............ ". 9 Life Tables ...... , .... , ......... , .......................... " ..... ········,···································13 Deaths by Leading Causes ..................... '" ........................................... ···········16 Maternal and Child Health .. "" ... " .... "" .. "" .. """"""""" .. """,,,,"",,.,,,,""""" IS Family Planning "."., .. " .. " ... ". " .. "."." ". ".".," " .... " ..... " .... " ............ ".", "." ... ·20 Health Education·· .. ··"·····"····,, ".", ...... , ........................... " """"'''''''''' ", .... " .. ·21 Tuberculosis Control ....... " .... "" .... "." ..... "" ........ "" .... "." .. "" .. ""." ................ 22 Leprosy Control ". ". ". ". " .... ". ". '" "." .. " ... " .. ,. " ........ "". ". ,,,.,, ". ". ". ". '" "'''''''24 Adult Disease Control "."""."" .. """"" ..... " ... "."." ........ "."" ..... ""." ..... ,,,,,," 26 Communicable Disease Control " ..... "."' ... ,, ...................... ,.,., ............. ·,·,·······,,,27 Foreign Quarantine Service"""'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 34 Environmental Sanitation·······" " ..................... , ...... ,., ... ". ". ". ". " .... " .............. "35 Environmental Pollution Control .. ,," """",,",, ... ,," ..... """""""" ... """"""""" 37 Food and Veterinary Sanitation """"""" .. """·"""""""" .. "· .. ·" .. """" .. ",,,, .... ·40 Nutrition", " .... " .............. " ...... "" ...... " .. , "'''' ". " ..... "." .... " .................. " ... ,," ,,·42 Dental Health ...... , ................... , ........................... , ............. ·····"··· .. · .. ····· .. ,,,···44 Mental Health ................................. " ........... " ....................... ··············,,··· .. · .. ·45 Medical and Social Rehabilitation Service" ........ "" ............................ " .... "" .... ·49 Radioactive Isotope and Peaceful Use of Atomic Energy .. ·"· .... "·""""""",, .... ,,·50 Occupational Health ............ ". " .. "" .. ", .... ,,"". ". ".". " .......... """ " .... " ...... ,," .. ·51 Medical Service .... " " ............... " .. " ............. " .... " .. " ..................... " .............. ,,52 Pharmaceutical Affairs ................................ " ............................. , ...... , ............. 60 Major Research and Training Institutes in Public Health Programme"''''''''''''''''63 International Cooperation on Health Programmes .... "" .. " .... ·" .... "· ...... ", .. ,, .. · ...... 64 Public Assistance, Child Welfare and Social Insurances""""""'''''''''''''''''''''''''''66

) -J '/

4. 5. 6. 7. S. 9. 10. 11, 12. 13. 14. 15. 16. 17. IS. 19. 20. 21, 22. 23. 24. 25. 26. 27. 28. 29. 30. 31,

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Organization of National Health Administration

The chart below shows the organizational structure of the national health and welfare administration in Japan as of 1 August 1968. On 20 June 1967, the Environmental Control Division was created in the Environmental Sanitation Bureau in order to meet the increased problems on public nuisance and environmental pollution. On 10 May 1968, the Handicapped Children Welfare Section was created in the Children & Families Bureau to deal with the increased problem on the health and welfare service and rehabilitation for the physically and mentally handicapped children. The idea of close coordination among the fields of preventive medicine, medical care, social welfare and social insurance is maintained. The Public Health Bureau, Environmental Sanitation Bureau.. Environmental Control Division, Medical Affairs Bureau, Pharmaceutical and Supply Bureau, Maternal and Child Health Section of the Children and Families Bureau, Rehabilitation Section of the Social Affairs Bureau, and the Health and Welfare Statistics Division, of the Ministry of Health and Welfare, share responsibilities on planning national health policy and programmes in the field of preventive medicine, environmental sanitation, control of public nuisance and environmental pollution, medical care, pharmaceutical control, maternal and child health, and rehabilitation, respectively. These Bureaus direct the health programmes by giving orders to 46 Prefectural Governments and 29 larger Municipal Governments. --Personnel Affairs Section General Affairs Section Accoun ts Section Office of the Personnel Welfare Officer Office of the Programme Evaluation and Planning Office of the Counsellor for International Liaison Affairs -Office of the Counsellor for Scientific and Technical Affairs

Minister's secretariat-I

-Administration Section Vital Statistics Section Health Statistics Section i Health & Welfare 1-Statistics Division-- Social Statistics Section Mechanical Counting Section -Office of the Statistical Investigator :-Administration Section I

I--National Parks Division--I Planning Section

-Recreation Facilities Section -Planning Section Nutrition Section Health Center Section - - - - Tuberculosis Prevention Section I Communicable Disease Control Section Mental Health Section I-Quarantine Section

I-public Health Bureau-----··-

-."-

-Environmental Sanitation Section W ater-Works Section -Environmental Sanitation Bureau - - - - - - Food Sanitation Section Veterinary Sanitation Section -Food Chemistry Section

. y

Environmental Control Division - - - - - - ! -

--General Affairs Section Environmental Pollution Control Section -Sanitation Facilities Section

--General Affairs Section Medical Affairs Section Hospital Guidance Section Administration Section -Medical Affairs Bureau - - - - -_ _ _ _ __ National Hospital Section National Sanatorium Section

~2~

Supply and Equipment Section Nursing Section I~Dental Health Section !

Pharmaceutical & Supply Bureau

I Enterprise Section I P harmaceu tical Affairs Section Drug Manufacturing Section II

~ Tec.hnical

Counsellor for Pharmaceutical Affairs

Inspection SectIOn Biologics and Antibiotics Section Fust Narcottc Section

- Second Narcotic Section

~Social

Affairs Bureau

-General Affairs Section PU blie Assistance Section Rehabilitation Section Life Improvement Section Institution Section Public Assistance Programme

Office of the Counsellor for the Investigation on

Section for the Welfare of the Aged

~Planning

Children & Families Bureau--

Section Child Care Section Handicapped Children Welfare Section Maternal and Child Welfare Section ' -Maternal and Child Health Section

-Insurance Bureau

- Planning Section Health Insurance Section - - National Health Insurance Section

Medical Care Section I-Acturial Research Affairs -Pension Bureau

Section

-Planning Section Pension Section - - Pension Fund Operation Section Acturial Affairs Section

-General Affairs Section Bereaved Families Relief Section Demobilization Section <-Repatriation Bureau - First Pension Affairs Section

First Allowance Screening Section Second Pension Affairs Section Second Allowance Screening Section -Investigation Section

-General Affairs Section -Director's Secretariat -

I-Inspection Section

Accounts Section

Social Insurance Medical Care I-Health ,Insurance Sectio~ Agency -Insurance Division-Seamen s Ins~rance SectIon . -Welfare PenSIon Insurance SectIOn Pension Insurance Division --

-National Pension Section Welfare Pension Section -Accounting Section

-Institute Institute National National National National National National National Affiliated Institutions

of Population Problems of Public Health Institute of Mental Health Institute of Nutrition Institute of Health Hospitals Sanatoria Institute of Hospital Administration Institute of Leprosy Researob.

Port Quarantine Offices

--.

National Cancer Center

National Institute of Hygienic Sciences National Homes for the Blind National Rehabilitation Center for the Physically Handicapped

National Rehahilitation Center for the Deaf and Mute National Recuperation Homes National Homes for the Juvenile Training and Education National Home for Mentally Retarded Social Insurance Appeals Committee

-Social Insurance Service Training Institute Local Branch Offices _ _ I-Reg~onal Branch. Offices .of Medical Affairs Bureau -ReglOnal NarcotIc Investigators' Offices

2. 1.

Main Laws under the Jurisdiction of the Ministry of Health and Welfare Health Center Law (1947)

Laws on Administration: Ministry of Health and Welfare Establishment Law (1949) Laws on Preventive Medicine: Infectious Disease Prevention Law (1897) Leprosy Prevention Law (1907) Trachoma Prevention Law (1919) Parasitosis Prevention Law (1931) Venereal Disease Prevention Law (1948) Preventive Vaccination Law (1948) Rabies Prevention Law (1950) Quarantine Law (1951) Tuberculosis Control Law (1951)

Laws on Environmental Sanitation: Natural Park Law (1931) Friseur Artists Law (1947) Food Sanitation Law (1947) Entertainment Facilities Law (1948) Public Bath House Law (1948) Hotel Business Law (1948) Law Relating to Processing Plants of Dead Animals and Others (1948) Law Regarding Graveyards, Burial and Others (1948) Hot Spring Law (1948) Cleaning Business Law (1950) Slaughter House Law (1953) Wastes Disposal Law (1954) Beauty Artists Law (1957) Water-Works Law (1957) Law Concerning Improved Management of Business Dealing with Sanitation (1957) Sewerages Law (1958) Water Pollution Control Law (1958) Law for Cooks (1958) Environmental Pollution Control Service Corporation Law (1965) Law for Confectioners (1966)

-4 Fundamental Law for Environmental Pollution Control (1967) Law for Finance Corporation of Business Dealing with Sanitation (19617) Air Pollution Control Law (1968) Noise Regulation Law (1968) 4. Laws on Health Statistics: Regulations Regarding Declaration of Still· birth (1946) Ordinance Regarding Vital Statistics (1946) 5. Other Laws on Public Health: Nutritionists Law (1948) Eugenics and Maternal Protection Law (1948) Mental Health Law (1950) Nutrition Improvement Law (1952) Law for Loan of Scholarship for Studies in Public Health (1957) Law for Health Protection and Medical Care for A-Bomb Explosion Sufferers (1957) Maternal and Child Health Law (1955) 6. Laws on Medical Care: Law for Masseurs, Acupuncturists, Moxa·cauterists and Judo-orthopaedists (1947) Medical Service Law (1948) Medical Practitioners Law (1948) Dentists Law (1948) Dental Hygienists Law (1948) Public Health Nurse, Midwife and Nurse Law (1948) Law for Dissection and Preservation of Dead Body (1949) Law for Medical X-Ray Technicians (1951) Law for Dental Technique (1955) Cornea Transplantation Law (1958) Law for Health Laboratory Technicians (1958) Law for Medical Care Facilities Finance Corporation (1960) Law for Physical Therapists and Occupational Therapists (1965) 7. Laws on Pharmaceutical Affairs: Poisonous and Deleterious Substances Control Law (1950) Awakening Drug Control Law (1951) Narcotic Control Law (1953) Taima (Marihuana) Control Law (1953) Opium Law (1954) Bleeding and Blood Donor Supply Service Control Law (1956) Pharmaceutical Affairs Law (1960) Pharmacists Law (1960) 8. Laws on Social Welfare: Child Welfare Law (1947) Disaster Relief Law (1947) Welfare Commissioners Law (1948) Consumers' Livelihood Cooperative Association Law (1948)

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Law for the Welfare of Disabled Persons (1949) Daily Life Security Law (1950) Social Welfare Service Law (1951) Law for the Welfare of Mentally Retarded Persons (1960) Law for the Welfare of the Aged (1963) Widowed Mother and Child Welfare Law (1964) 9. Special Child Allowance Law (1966) Laws on Social Insurance: Health Insurance Law (1922) National Health Insurance Law (1938) Seamens' Insurance Law (1939) Employee's Pension Insurance Law (1941) Social Insurance Medical Fee Payment Fund Law (1948) Health Insurance Law for Daily Workers (1953) National Pension Law (1959)

3. Finance of the Ministry of Health & Welfare Annual budget of the Ministry of Health and Welfare and its health budget for the past several years is shown in the following table as compared with the total National Government expenditures. This budget includes those subsidy granted to the Local Governments. Our fiscal ~

year covers the period of 1 April

31 March.

Table 1. Budgetary Expenditure of the Ministry of Health and Welfare and its Health Budget. Expenditure of All Fiscal Year National Government

I 1962 1963 1964 1965 19116 1%7 19G8

Agencies Million Yen

i ,

Total Expenditure of Ministry of Health & Welfare Million Yen

Amount of Health Budget Million Yen

__ 1

2 2 3 3 4 4 5

426 850 255 658 314 950 818

801 008 438 080 Z71 910 598

Z72 331 398 481 580 671 768

316 313 980 942 241 098 675

55 72 86 100 112 117 113

675 230 108 286 281 133 493

4. Organization of Local Health Administration Each Prefectural Government and larger Municipal Government have their own Health Department in order to carry out their health programmes in compliance with the national policies and programmes directed by the Ministry of Health and Welfare. These Prefectural and Municipal Governments divide their administrative boundaries into several" health center districts "which covers cities, towns and villages, and the Health Center is established in each one of those districts. For the reason of geographical conditions, mo~t

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of the Health Centus have their branch health units within their health cetJter districts. Further details on the Health Center are described in the following chapter.

'5. Health Center Outline The first Health Center in Japan was established in Tokyo III

1935.

Then, in 1937, the

original Health Center Law was enacted, and the lO-year programme for health center construction started, which resulted in bringing the total number of health centers up to 306 in 1943. The number had further increased to 770 in 1944 as a result of amalgamation of all governmental health consultation agencies. pre-service men. The Health Center in pre-war days had only health consultation in tuberculosis control, maternal and child health, and maintenance of health of However, in 1947, public health programme in this country was reorganized, and the Health Center Law was completely revised, whereby the new health center programme had started.

Legal Basis According to the Health Center Law, the Local Government is required to establish the Health Center, and the National Government is responsible to share the cost. 46 Prefectures, and those 29 larger Municipalities specially designated, have their own Health Centers. Director of Health Center is specified to be the medical doctor by law. The role of Health Center as defined by law is primarily to function as the community health service agency, and secondarily as the health administration supervising agency based on the authority delegated by the Governor or Mayor. The

Number, Standard Scale and Organization As of the end of March 1968, there was a total of 832 Health Centers in all. All Health Centers are classified by the size of health center district, its population, extent of urbanization, and its industrial component. There are 4 basic types, i.e., Urban Health Center, Rural Health Center, Urban-Rural Health Center, and Health Center with small population in big area. These are abbreviated as U, R, UR, L type. As the health center of exceptional type, the Health Center with small population in small area is classified as S type. Health Centers. It was reported that the total number of health center personnel subsidized under the health center grants was 22,458. This includes, as the main technical personnel, 1,739 physicians and dentists, 4,751 of nutritionists, X-ray technicians, laboratory technicians, pharmacists, veterinarians and dental hygienists, 4,660 of public health nurses, midwives and nurses, 9,501 of health statisticians, health educators, social case workers, and mental health counsellors. In addition to those, there are also the food inspectors, sanitary inspectors and veterinariains for veterinary sanitation work. According to this classification, there are 224 U type, 79 UR type, 386 R type, 121 L type, and 22 S type

Function and Programme The function and programme of Health Center include activities in the different fields. Thus, all community health programmes have been integrated into the health, center activities.

-7Followings are the basic functions defined by the law: Health educatien, vital and health statistics, improvement of nutrition and food sanitation, environmental sanitation, public health nursing, medical social service, laboratory service, mental health, prevention of tuberculosis, control of venereal diseases and other com· municable diseases, maternal and child health, dental hygiene, and other local health programmes as required, such as endemic disease control, etc. As a routine programme, the health consultation clinic, well· baby conference, mass chest survey, heme visit, community health education, inspection and field supervision on sanitary operation are carried out. The health education is integrated into every phase of routine prog· ramme. TB control, insect and rodent control, and maternal and child health promotion are highlight programmes. Recently, the community organization process has been extensively The following table shows the main developed for performance of all health programmes. health center activities during the year 1967. Main Health Centee Activities. (Jan. Total number of health consultation session Inside of health center At district Activities of sanitary inspectors Total number of sanitary establishments Total labour used for environmental sanitation field work (person x O. 5 day) Total number of food establishments inspected by food inspectors Total number of inspection days by food inspectors (person x O. 5 day) Carrier investigation in dysentery control Prevention of tuberculosis X-ray examination 35mm and 6x6 large film Parasite examination Total number of venereal disease examination Maternal and child health Care of expectant and nursing mothers Actual number of attendances at health clinic Total number of attendances at health clinic Care of infants and children, 1~5 years of age Actual number of attendances at health clinic Total number of attendances at health clinic Care of physically handicapped children Actual number of attendances at health center Total number of dental examination Nutrition consultation Total number of attendances to individual nutrition consultation Total number of attendances to mass nutrition consultation session Total number of health education session Total number of visits by social case workers Total number of household visited by public health nurses Actual number Accumulated number Laboratory examination Bacteriological examination Clinical examination Water examination ~Dec.

Table 2.

1967)

207 742 189 199 18 543 8tili 750

449 818 2 051 163 506 440 6 599678

38 329 37 229 1 099 3 043 914

029 352

677 528

076

480696 653 615

2 607 485 3 635 474 102 890

1 721 327 1 423 146

2 435 760 157 343 58 384 1 206 414 1 660 965 7 097 944 8 077 656 G38 988

Finance The Health Center IS

financed by Local and National Governments. The item of national

i nt er sed! on H ea lth Ce -8ce nt er subsidy ba th al he d. e th ne er is n co nc s, cn e spective legislatio d into 2 categorie re de e vi th di is on y d id se bs su ar e th e subsidy ba responsible to sh th e pr og ra m m e is is t r en he nm ot er e th ov G d na l La w an La w, th e N at io ones. e H ea lth Ce nt er d no n- re cu rre nt an t Ac co rd in g to th lf of th re cu rr en bo re itu nd en t sh ar es on e ha pe ex nt er Na tio na l G ov er nm e th , ed co st of he al th ce of ish bl ird ta es es on e th Ce nt er is newly d it also subsidiz an ts, en pm W he n th e H ea lth ui eq year, th e necessary Fo r 1968 fiscal ns tru ct io n an d . co es r ns fo pe ex re of itu nd st e re th e ex pe er nm en t pays th fiscal year, it nses. Lo ca l G ov yen. Fo r 1967 n io ill m 2 21 6, th e ru nn in g expe nt er subsidy is na tio na l health ce to ta l am ou nt of n yen. wa s 5, 511 millio lae. estimated popu pa n, in cl ud in g th Ja in n tio d la an pu of po of H ea lth ow s the tre nd s lems of Mini$try ob Pr n tio la Fi g. 1 below sh pu laIn sti tu te of Po d th at th e popu calculated by th e Oct. 1965 reveale 1 of as tion in th e fu tu re d te th uc co nd n, an d e po pu la tio n census yond 100 millio st be te d la se e ea Th cr in . re it W el fa n. ,961. In 1967, e to ta l po pu la tio ou nt ed to 98,274 pr op or tio n of th er rg la a tion of Ja pa n am ed ut pu la tio n. er co ns tit in th e aged po 65 years an d ov rm of fo n r tio de la oa pu br po g ap in ag ed an d 1967. fu tu re will be sh py ra m id in th e py ra m id s fo r 1935 n tio la pu po of Th e po pu la tio n e co m pa ris on xt pa ge sh ow s th Fi g. 2 in th e ne ion in Japan. Tr en ds of Po pu lat

Population

Fig. 1.

~-Year

-9Fig. 2. Population Pyramids for 1935 and 1907. Age

Male

F~male

r"-----j30i----......,<----"r r"------j25i------''o r'-----i20i-------', .-L-------1 i+ ------jIO 600 500 400 300 200 100 0

t=====:u f--------', 100 200 300 0 400

~~~~~~-~~O~~~~,_~J,-r_ 500 600

10 thousands

Vital Statistics

The nation·wide vital statistics survey has been yearly carried out since 1899 in Japan, except for the period between 1944 and 1946, during which no reliable data were available due to the confusion resulting from the last World War.

_.-

Live Births Annual Change of Birth Rate. highest rate since 1900. Between 1900 and 1919, the birth rate in Japan was be· tween 32 and 35 per 1,000 population, but it rapidly rose to 36.2 in 1920, which was the But after this peak, it started to decrease and kept declining every year until 1939 when the rate reached the lowest point (26.6), and from about 1940 it again started to rise. This rise was considered to be due to the pro-natalist policy supported by the Government at that time. During 3 years from 1944 to 1946, the birth rate seems to be conFig. 3. Annual Change of Live Birth Rate. (per 1,000 population)

siderably low, judged from various rea· sons, although no accurate data were available becaues of the confusion caused by the war. The rate lly In

1947 was

abnorma-

high, showing 34.3, but such an

extraordinary rise was considered to be due to a sudden increase of postponed marriages and reunited couples of demobilized or repatriated families of the °o=-~~~~=--:~~-=-~~~-LLL-L

~ ~

__ __ ~~

people after the termination of the war. After such extraordinary rise, the birth rate started to decline rapidly, and rea· ched 17.2 in 1957. This rapid decrease

-L__L--L

Year

seems to be due to the decrease of marriage, the extensive use of contraceptivB measures, and the prevalence of artificially induced abortions as well as the changing attitude of people toward family size. However, in 1958, the rate was recorded as 18.0, indicating the first sign of halting its declining in the postwar years. However, it again started to decrease since then and reached

-10Table 3. 1

Vital Statistics in Japan. (Numbe") I • ' Infant Neo- 1 I Mater- , StillNatural I Deaths natal Deaths nal b' tho Increase (under (under Deaths Ir 1 yr.) 28 days)

Year

i I i

Populadon

Live I Births

Deaths

Marria- Divorges ces 63 828 59432 55 511 51 259 48 556 49 424 46 268 49705

I 43 847 000' 1 420 534 910 744 49 184 000 1 712857 1 064 234 55 963 053 2025 564 1 422 096 64 4SO 005 2085 101 1 170 867 71 71 72 72 73 71 73 78 80 81 83 84 85 87 88 89 90 91 92 99 ~

1990

509 790 220 211 112 259 648 623 276 136 126 910 603 468 335 613 139 681' 914 234 258 703 104101 190 191 190 195 509 420 897 219 81 77 76 76 869 829 177 588, .. ·1

6 ZOO! 137 987 346 528 6 228 157 392 441 222 7158 144 038 546 207 5681 111 730 506 674 5 070 102 034 666 4 929 103400 791 4586 95 448 679 4 542 92 889 743 575 625 044 842

1910 1 1920

1930 1940 41 42 43 44

933 680 384 883 998 114 101 002 772 199 573 852 033 293 275 259 088 010 971

000 200 SOO 100 064 300

2 2 2 2

115 277 233 253

867 283 660 535

...

1 1 1 1

186 149 166 219

595 929 272 559 1 127 724 630 1 067 030 073 1 034 462

...

1945 46 47, 48 . 49 19SO 51 52 53 54 , 1955 56 57 58 59 1960 61 62 63 64 1965 66 67

... ... ... ... I 100 ..·1 ... .··1 1001 ... "'1 473 2 678 792 1 138 238 1 540 554 205 360 83 047 SOO 2 681 624 9SO 610 1 731 014 165 406' 72 907 600, 2 696 638 945 444 1 751 194 168 46i 71 485

.-.

... ... ! ~~ ~~~ ~~~, ~~ ~~3 4 :\ 3 3 3 1171 691 417 373 262 216 217 203 193 187 9741715 231 671 824 676 374 683 119 697 365 007 353 148 8J, 281 895 363 424 046 714 715 773 826 847 866 890 928 937 963

... ... ._.

"'1

...

.. . ._ .

...

4 6011192 677' 842 170 081 905 995 077 809 861; 934 362' 902 1351 115 158 341 516 130

79 551 79 032 82 575 83 689 82 331 79 0211 75255 76 759 , 75 267 72 040 71 651 740041 72 455 69410 69 323 71 394 69996 72 306 77 195 79 432 83 242

6371 000 000 000 000 529 000 000 000, 000 SOl 000 000 000 000

2 2 2 1 1 1 1 1 1 1 1 1 1 1 1

337 137 005 868 769 730 665 566 653 626 606 589 618 659 716

S071 689, 162 040 580 692 278 713 469, 088 041' 372 616 521 761

904 838 765 772 721

876 998 068, 547 491

1 1 1 1 1

432 298 240 095 048

631 140 5151 691' 122 869 094 99114 493 91 424 089 78 944

64 142 58 686 51 015 47 580 42726 646, 232 847, 237'

693 523 1 037 169 724 460 940 818 752 445 814 268 684 189 969 280 6899591 936 129 706 695 710 670 673 599. 644' 265 770 067 1

93 418 94285 95 178 96 156 97 186

68 801 38 67 691 38 62 678 33 57052, 32 54 768, 30 49 45 42 38 34 293 465 797 442 967 27 26 24 22 21

235 362 255 7771 965 343,

3 095 183 2 838 179 2 677 176 2560 185 2 381 181 2097 1 914 1 813 1 701 1 699 179 179 177 175 168

899 893 908 988 043

442, 728' 351 751 694

98 274 961 1 823 697 99 056 000 1 360 974 100 243 000 1 934 958 I

700 438 1 123 259 670 342 690 632 674 909 , 1 260 049

33 742 26 217 28 935

21260 16296' 19 246i

1 597 161 6117 954 852 1 2661148 2~8 940 120 1 351 149 304 953 097

Nole: Figures for 1967 are provisional.

16.9 in 1961, showing the lowest rate ever experienced by that time. Since 1962, the rate again started to increase, and it reached 18. 5 in 1965. However, in 1966, the births were noticeably decreased to about 1,360 thousand and the birth rate became 13.7, showing the lowest one ever recorded. This was judged to be due to the fact that the married couples avoided giving birth to children in the year 1966, which happened to be the year called <'Hinoe-Uma" ("CHorse"). This comes round every 60 years under sexagenary cycle with Zodiac Calendar and has been traditionally believed to bring a bad luck to female babies, because they may face difficulty in finding husbands when they grow up. In 1967, on the contrary, the birth rate went up to 19.3, showing about 1,935 thousand births.

Deaths Annual Change of Death Rate. From 1900 to about 1930, the annual death rate had been around 20 per 1,000 population, excepting the high rates of 27.3 in 1918.and 25.4 in 1920,

-11-

Table 4. Live Birth Rate Year Death Rate Natural Increase Rate

Vital Statistics in Japan. (Rates) Infant Death Rate Neo-natal Death I Maternal Death Rate 'Rate Still-birth Rate 'I

(1900~1967)

Marriage Rate

Divorce Rate

Per 10,000 Per 1,000 total total P er 1,000 Per 1,000 Per 1,000 P er, 1 000 P er 1,000 b' tb btb popuIpopupopulive I live I . It.s . II.S lation, lation lation births births (ltve blrtb (ltve buth ~ and ~ and ____:_____ -+1_ _ _ _ _ _-+-___ still-birth) still-birth,

I----I---+---!,----

I 'I

Per 1,000 Per 1,000 popu popu

l~tion 7.9 9.0 9.8

l~tion 1. 46

1900 1910 1920 1930 1940 41 42 43 44 1945 46 ' 47 48

32.4

20.8 21. 6

11. 6

155.01---79.0 ,

39.8 33.3 33.0

88.5

34.8 36.2 32.4 29.4 31. 8 30.9 30.9

13.2

161. 2 165. 7

74. 1 69.0 49.9 I

84.2

1. 21 0.99 0.80

25.4

18.2 ' 16.5 16.0 16. 1 16.7

10.81 14.2 , 12.9 15. 7 14.7 14.2

66.4 53.4

124. 1 90.0 84. 1 85.5 86.6

25.8 22.9 20.7 19.7 19.4

7.9 I 9.3 11.0 9.4 10.2

38.7 ! 34.2 : 34.1 33.8

46.0 43.4

i~:~ 44.2 50.9 66.7

0.68 0.69 0.64 0.68

49 1950 51 52 53 54 1955 56 57 5R

34.3 33.5 33.0

14.6 11. 9 11.6

19.7 21. 6 21. 4 17.2 15.4 14.4 12.6 11. 9 11. 6

76.7 (i1. 7

62.5

31.0 27.2 26.5 :

16.0 15.7 15.9 16. 1 15.7 15.5 16.4 16.2 15.4 15.4 13.9

10.3 8.6 7.9 7.9 7.8 7.9

12.0 11. 9

1. 02 0.99 1.01

28. 1 25.3 23.4 21. 5

20.0 19.4 18.4 17.2 18.0 17.5 ! 17.2 16.9

10.9 9.9 8.9 8.9 8.2 7.8 8.0 8.3, 7.4 7.4 7.6 ' 7.4 7.5 7.0: 6.91

60.1 57.5 49.4 I

48.9 44.6

27.4 27.5 25.4 25.5 24.1 22.3 23.0 21. 6 19.5 18.6 17.0 16.5 15.3 13.8 12.4

i I

16.7 ,

84.9 92.2 92.3 93.8 95.6 95.8 97.1 101. 2

1. 01 0.97 0.92 0.86 0.87

59 1960 61

10.4 I 8.9 , 10.5 10.1 1

39.8 40.6 40.0

34.5 33.7

13.2

100.7 100.6

8.0 7.9 8.5 9.0 9.1 9.3 9.4 9.8 9. 7 9.9

0.84 0.80 0.79 0.80 O. 78 0.74 0.74 I 0.75, 0.73 i 0.74 0.79 0.80 0.83

62 63 64

17.0 17.3 17.7 I

9.6 9.5 9.5 10.3

30. 7 28.6 26.4 23.2 20.4

11. 6 10.8 10.0

100.4 98.8 95.6 89.2

101. 7 '

10.7

9.2 9.0 8.0 8.4 6.5

-----.----~----~--~----~----~----~----~----~----~

19~~ 67

i~:~ 19. 3

U I 1i:tl 6. 7 12. 6

iU 15. 0

g:6 9. 9 I

~~:: I 71.6

9.7 9.5, 9.5 I

~ote: Figures for 1967 are provisional.

Fig. 4.

Annual Change of Death Rate. (per 1,000 population)

respectively, because of the world·wide pandemic of influenza. It kept decreas· ing in the following years until 1941, showing 16.0, in spite of the war. In 1948, just 3 years after the ending of war, the deaths decreased under 1 million and its rate dropped to 11.9, In

O.:--:::--:::-_:~~_:~~-L....l_...lLl....J..-L....J..-..L.....I. ~ :E ~ ~ tg ~ ...-4 0'1 ~ ::! 0"1 0'> -Year

spite of the fact that considerable num· ber of deaths must have occurred during the war and immediately after the end·

-12 -

ing of war. It further continued to decrease as low as to 7.8 in 1955.

However, in 1957, beThen, it again .~.

cause of the A2 Influenza epidemic, it became 8.3, showing a slight increase.

decreased in 1958 and kept on the same level of approximately 7.5 until 1962. In 1964, the death rate of 6.9 was recorded, which was the lowest one ever recorded: in our history of vital statiscs. However, in 1965, it increased slightly, showing 7.1, resulting from the influenza epidemic which affected the adult-age groups. On the contrary, the mortality revealed 6.8 in 1966 and 6.7 in 1967. (Refer Fig. 4, page 11)

Infant Deaths Annual Change of Infant Death Rate. The changes of infant death rate have been almost the same as the death rates for all ages. Before 1925, the yearly infant death rate had heen around 160 per 1,000 live births excepting the high rate in 1918 (188.6) d* to the pandemic of influenza. It declined in the course of the years after 1925 until it became helow 100 in 1940, and reached 39.8 in 1955. The decreasing tendency halted somewhat in 1956 and 1957, III

but in 1960, it remarkably decreased to 30.7, and went down further, reaching 18.5 In 1966, it again increased to 19.3, but dropped to 15.0 in 1967. (Refer Fig. ,5, below)

1965.

Maternal Deaths Annual Change of Maternal Death Rate. The maternal death rate around 1900 was approximately 40 per 10,000 total births (live births and still-births), but it decreased every year until it reached the low rate in 1943, showing 19.4. Although some sharp increase of mao ternal death rate was expected after the war due to the increase of artificially induced abortions, it remained at the level of 16.0 in 1947. Thereafter, it kept a decreasing trend, reaching 8.4 in 1966. and 6.5 in 1967. -

Fig. 5.

Annual Change of Infant Death Rate. (per 1.000 live births)

Year

Foetal Deaths Annual Change of Still-birth Rate. In the vital statistics of Japan, a still-birth is defined as a foetal death in the fourth or more later month of gestation. The still· birth rate in Japan in early 1900's was around 90 per 1,000 total births (live births and still-births), and it kept decreasing until it became about 40 in 1943. following years, and became 101.2 in 1957. 100 or so. After the end~-

ing of war, it again started to show the high rate of 44.2 in 1947, and rapidly increased in the Since then, it kept on almost the same level of In 1961, it increased suddenly to 101.7, showing the highest rate ever recorded.

However, it dropped to 98.8 in 1962, keeping a decreasing trend and reached 81.4 in 1965, and 71.6 in 1967, after the disturbed rate of 98.3 in 1966.

-13 The increasing trend seen before 1955 was believed to be due to the influence of enforce-

ment of Eugenics and Maternal Protection Law_

This was proved by the fact that the proporSince then, it began to decrease to This was due to both an increase of

tion of artificially induced abortion to the total still-births had increased to 53A% in 1954 and 53.5% in 1955, respectively, from 21.6% in 1948.

47JJ% in 1960, 41.5% in 1965 and 39.1% in 1967.

spontaneous foetal death and also was attributed to the use of safer method of contraception.

Marriages Annual Change of Marriage Rate. before and after 1920. year. .:.The marriage rate smce 1900 up to about 1935 had been approximately between 7 and 8 per 1,000 population, excepting some slight fluctuations It went up to 9.5 in 1937 due to the war which started in the same Although the marriage rate went down rapidly, it again rose to 9~ 11 after 1940, as the

marriage was encouraged by the Government in the course of development of war. Then, in

1947, it became 12.0, showing the highest rate since 1900, which was considered to be a temporary state caused by family reunion and increase of postponed marriages after the war.

started to decrease in 1949, showing 10.3, and went further down to 8.0 in 1955, and 7.9 in

1956, respectively, to the normal level recorded in the pre-war days. and reached 9.5 in 1967.

However, after 1957, it

kept an increasing trend, reaching 9.9 in 1964, although it again started to decrease from 1965

Divorces Annual Change of Divorce Rate. The divorce rate in 1900 was 1A6 per 1,000 population, But after the war, it suddenly and since then it kept decreasing until it became 0.63 in 1938.

rose again, showing about 1.0. This was partly because of the increase of marriages after the war, and partly because of the new attitude of the people toward divorce. After 1959, however, the rate had been slightly decresing year after year, and it reached 0.73 in 1963. From

1965, it again started to increase and reached 0.83 in 1967.

Life Tables

Average life expectancy at birth for the Japanese people, according to the Abridged Life Tables prepared on the basis of 1967 data, indicates 68.91 years for male and 74.15 years for female, sbowing a slight increase compared with that of 1966. According to the l1th Life Tables (complete) based on the population census and vital statistics for the period of calendar year 1960, it was 65.32 years for male and 70.19 years for female, showing a slight difference from the data by the Abridged Life Tables. _~<

The prolon.

gation of average life expectancy at birth for both men and women has been remarkable in the recent years. population. This particularly due to the sharp decrease of mortality rates of younger

-14 Table 5 Year *1891~1898 *1899~1903 *1909~1913 *1921~1925 *1926~1930

I I

Expectation of life (eo) Age

(a)

Male

*1935-1936 1945 1946 *1947 1948 1949 1

*1950~1952

1950 1951 1952 1953 1954 *1955 1955 1956 1957 1958 1959 *1960 1960 1961 1962 1963 1964 1965 1966 1967 * Note: Complete life tables.

1 I 49.2 51. 11 51.61 49.14 51.07 51.95 23.9 ! 28.8 42.6 I 47.7 50.06 53.74 I 58.4 55·6 56.2 59.2 59. 57 62. 14 58.0 60.6 60.8 63.5 61. 9 64.2 , 61. 9 64.3 63.41 65.45 63. 60 65.37 ! 63.88 65.64 63.59 65. 28 1 63.24 65.01 64. 98 66.51 I 65.21 66.66 65.32 66.56 I 65.37 66.62. 66.03 67.18 66.23 67.21 67.21 67.97 67. 67 68.25 67. 73 68. 16 68.35 68.78 0 42.8 43.97 44.25 42.06 44.82 46.92

5 10 50.7 I 47.5 51. 90 48. 23 52.57 48.82 50.35 46.53 51. 85 47.93 52.22 48.25 28.5 25.0 47. 1 43.1 53.61 49.49 56.8 52.5 57. 7 53.4 60.10 55.68 58.7 54.4 61. 7 57.2 61. 8 57.3 61. 8 57.3 62.80 58.23 62. 45 57.89 62.73 58.19 62.28 57.67 61. 96 57.32 63.32 58.68 63.45 58.81 63.26 58.57 63.32 58.64 63.78 59.08 63. 75 59.00 64.45 59. 70 64.68 59.93 64.58 59.80 65.16 60.38

20 I 39.8 II 40.35 i 41.06 39.10 40. 18 40.41 18.5 34.8 40.89, 43.6 44.3 46.43 45.3 47.9 48.0 48.0 48.87 48.47 i 48.77 I 48.21 47.87 49.19 49.31 49.08 49.13 49. 58 49. 44 50.10 50.33 50. 17 50.78

30 I 40 33.0 I 25. 7 33.44 26.03 34.31 I 26. 82 32.59 ' 25. 13 33. 43 25.74 33. 89 26.22 20.7 18.7 29. 5 23. 1 34.23 26.88 36.6 29. 1 2).2 37.0 38.10 23.65 29. 4 37.4 31. 4 39.8 39.5 30.9 39.3 30.6 40.20 31.45 39.70 30. 85 40.00 31. 15 39.37 30.45 38.98 30.04 40.26 31. 29 40.31 31.30 31. 02 40.07 40. 10 31.05 40.52 : 31. 44 40.30 I 31. 19 40.90. 31. 79 31. 95 41. 10 40.88 31. 72 41. 49 32.33 1

50 I 60 12.8 18.8 18. 97 12.76 19. 61i I 13. 28 18.02 11.87 18.49 12.23 18.851 i 12.55 8.7 13.6 16.4 I 10.4 19.44' 12.83 21. 5 14.8 21. 5 14.6 21. 54 14. 36 21. 4 14.4 23.4 , 16.6 22.7' 15.5 22.2 15.0 23.08 15.88 22.4V 14.97 22. 72 15.33 21. 96 14.55 21. 53 14. 14 22. 74 15.29 22.69 15. 16 22.39 14.84 22.42 14.87 22. 77 15. 17 22. 51 14.85 23.10 15.40 23.25 15.51 22. 99 15.19 15.74 23.57

I I 1

'. I I

70 8.0 7.89 8.26 7.11 7.43 7.62 5.0 5. 9 7.93 9.7 9.4 8.82 9.3 10.1 9.4 10. 14 9.13 9.56 8. 58 8.31 9.41 9.10

1 '

8. 85 8.86 9.05 8. 72 9.22 9.30 8.97 9.51 9.56

Table 5 Year *1891~1898 *1899~1903 *1909~1913

Expectation of life (~) Age

(b) Female

*1926~1930 *1935~1936

*1921-1925 1945 1946 *1947 1948 1949 1950 1951 1952 1953 1954 *1955 1955 1956 1957 1958 1959 *1960 1960 1961 1962 1963 1964 1965 1966 1967

*1950~1952

, 0 1 1 I 44.3 50. 1 44. 85 51. 17 44.73 51. 24 43.20 49.42 46.54 52.10 , 49.63 54.07 37.5 43.4 51.1 55.5 53. 95 57.40 59.4 61. 9 59.8 62.5 62.97 65.25 61.5 63.9 64.9 67.3 I 65.5 67.6 65. 7 67. 7 67.69 69. 52 67. 75 69.34 68.41 69.99 67.54 69. 13 67. 70 68.75, 69.61 70.99. 69.88 71. 05 70. 19 71. 17 70.26 71.25 70. 79 71. 63 71. 16 1 71. 89 72. 34 , 72.87 72.87 i 73.22 95 73.16 72. 1 73.61 73.82 74. 15 74.17

5 51. 5 51. 97 52. 16 50. 71 53.00 54.40 43.6 54.7 57.45 60.3 61. 1 63.28 62. 1 65. 6 65. 3 65.3 66.92 66.41 67.09 66.15 65.69 67.80 67.78 67.79 67.88 68.17 68. 37 69.28 69.59 69.51 70. 15 70.47

' . ' : 1

30 I 40 1 50 I 20 , 48. 1 27.8 20.8 40.8 34.4 48.34 . 41. 06 34.84 I 28. 19 21.11 48.51 41. 67 35.72 i 29.03 21. 84 47.00 40.38 34.69 28.09 20.95 49.18 42. 12 35.98 29.01 21. 61 50.47 43.22 36.88 29.65 22.15 40.5 34.8 29.9 24.0 17.7 50. 7 42.6 36.0 28.8 21. 4 53. 31 44.87 37.95 30.39 I 22.64 56.0 47.3 40.2 24.7 32.5 40. 5 56.8 47.9 32.6 24.6 58.82 49. 58 41.20 32.77 24.47 57.8 48. 7 40.8 32. 7 24.6 , 61. 1 43. 6 51. 9 , 35. 4 27.3 60.8 42. 8 51. 4 34.2 25.9 60.8 42. 6 51. 4 33.9 25.4 62.31 52.86 44.0~ 35.22 26.58 61. 78 52.25 43.25 34. 34 25.70 62.47 52.95 44.01 35.11 26.49 61.49 51. 92 42.84 33.85 25. 14 61. 02 51. 48 42.39 33.39 24.6$ 63.08 53.48 44.33 35.23 26.44 63.06 53.45 44.21 35.08 26.24 63.04 53.39 44. 10 34.90 26.03 63. 13 53.48 44. 19 34.98 26.11 63.39 53.72 44.35 35. 10 26. 16 63. 56 53.85 44. 44 35.15 26. 1$ 64.45 54. 70 45.23 35.89 26.89 64. 76 54.99 45.48 36.11 27.09 64.66 54.88 45. 34 35.94 26.8$\ 65.30 55.53 45. 97 36.55 1 27. 4$ 65. 60' 55. 82 46.24 36.79 i 27. 66 10

, I

14.2 14.32 14.99 14.12 14.68 15.07 11.8 14.6 15.39 17.4 17.2 16.81 17.1 20.0 18.3 17.7 18.54 17.72 18.59 17.12 16.59 , 18.38 i 18. 10 17.83 , 17.91 17.90 17.90 18. 54 18.69 18.45 18. 99 19.15 1 r

70 8.8 8.77 9.28 8.44 8.83 9.04 6.8 9.0 9. 41 11. 5 11. 2 10.34 11. 1 12.0 11.3 ll.82 10. 95 12.05 10.34 9.65 11. 48 11.05 10. 78 10.85 69 10. 10. 67 11. 26 11. 35 11. 10 11. 61 11.72

-15 Table 6 Year *1891~1898 *1899~1903 *1909~1913 *1921~1925 *1926~1930 *1935~1936

1100 0001 100000 i 100 000, ' 100 000 i 100 000 1 100 000 1945 100000 1946 100 000 *1947 100000 1948 100 000 1949 100 0001 *1950~1952 100000 1950 100 000 1951 100 000 1952 100 000 1953 100 000 100 000 1954 *1955 100000 1955 100000 1956 100 0001 100 000, 1957 100 0001 1958 1959 100 0001 *1960 100000 1960 100 0001 1961 100 000, 1962 100000 1963 100000 100 000 1964 1965 100 000 100 000 1966 1967 100 0001 * Note: Complete lIfe

1 1 85 1051 84 314 83950 83 796 85990 88 697 80 130 87 530 91 402 93 5001 93 370 94 331 94 100 94240 94 950 94 890' 95 380 95 817 95 830 95 918 95 767 96 216 96354 1 96 667 96 637 96 826 97 086 97 440 97719 97 918 97 948i 98 263 tables.

Number of Living (Ix) (a) Male Age 5 1 10 1 20 1 30 1 40 1 50 1 76 2391 73 6551 69716 63 917 58 178 50 534 76 887 74 891. 71 310 65 596 60 101 52 629 76410 74 564 70 846 65 020 59 889 52 999 75 567' 73749 69 336 62950 57618 50 267 78 457 76 786 72 845, 66 721 61 693 54 349 81 788' 80 141 76 189' 69 441 64 242 57 034 70674 66377 55 709, 29 841 19 997 14 782 81477 79 668 76 1161 65 705, 57410 48 596 85 120 83 694 81 067 74 152 67 997 60 804 89 747 88 589 86 395 80 187, 74 432 67 648 89 514 88 449 86609 81 079, 75 902 69 331 91 3821 90 481 89 132 85 65.'1 81802 75 859 90 773, 89 784 88 138 83 631 78 964 72 702 91 056, 90 236 88887 85 236' 81 401 75 479 92 505: 91672 90 465 87 540 84 1421 78 515 92 604, 91 817 90 709 87 964 84 834' 79 546' 93 4111 92 776 91 637 88 945 85 841' 80 765 94 215' 93 537 92 499 89 938 87 047 81 963 94 230! 93 533 92 498 89972 87080 82 032 94 437, 93 818 92 847 90 423 87 628 82603 94355 93 766 92 781 90 437 87 6771 82 624 95 030' 94 494 93586 91 364 88 751 83 991 95 183 94650 93760 91 683 89 156 84589 95 643 95 154 94 249 92 172 89 709 85 108 95 616 95 130 94 238 92 217 89750 85 168 95 936 95 481 94 590 92640 90 285 85 836 96 287 95 896 95 110 93 303 90 983 86 516 96 732 96350 95 632 93 959 91 664 87 285 97 082 96 710, 95 992 94 384 92 151 87858 97 313 96 9671 96 293 94 812 92 598 88 319 97 392 97 0471 96 347 94 8621 92 698 88 579 97 749 97 446 96 766 95 327 93290 89 2471 (b)

60 1 390731 41 160 42 136 38 5171 42 283 44712 9253 35 499 48903 56111 58 026 64481 61300 64 018 67 269 68 218 69 658 71 115 71 193 71 319 70 947 73 095 73 837 74 207 74280 75 257 75 929 77 110 77813 78 330 78972 79 869

70 23 149 24 519 26014 21 591 24 306 26 434 3572 17 481 29 230 36 686 38 110 42 997 39 544 46 031 46 446 49 870, 49 434' 49 823, 49 384: 47872 51 4481 52 4291 51 942 52 114 53 647 53657 55 577 56404 56 251 57720 58 904

Table 6 Year *1891~1898 *1899~1903 *1909~1913 *1921~1925 '1926~1930 *1935~1936

Number of Living (lx) Age

Female.

*1950~1952

1945 1946 *1947 1948 1949

1950 1951 1952 1953 1954 *1955 1955 1956 1957 1958 1959 *1960 1960 1961 1962 1963 1964 1965 1966 1967

0 1 100000 100 000 100 000 100 000 100000 100 000 100 000 100 000 100 000 100 000 100 000 100000 100 000 100 000 100 000 , 100 000 ' 100 000 100 000 ' 100 000 100000 : 100 000 ' 100 000 100 000 100 000 100 000 100 000 100 000 100 000 100 000 100 0001 , 100 OOO! , 100 000

1 86 620 85908 85 496 85 600 87 586 90083 84310 90 350 92 336 94360 94 110 95 027 94 740 94 910 95580 95510 95 950 96 311 96 340 96 278 96 895 96 6751 96 969 97 261 97 238 97 456 97 618 97 919 98 175 98 357 98 378 98 638

5 780281 78 339 77 818 77 110 79 8661 83229 76 731 1 85 189' 86101 90 664 90 304 92079 91 382 91 759 93 119 93 237 94016 , 94 BOO' 94 817 94 849 95 556 95 566 95 969 96 394 96 366 96707 96 955 97 363 97 663, 97 880 97 9361 98 229,

10 1 75 4821 76 245 75 770 75 102 78 053 81 564 73 278 83 630 84 793 89 676 89 320 91 275 90 477, 90 979' 92 402 92 547 93 461 94271 94271, 94 346 95 076 95 163 95 562 96 029 96000 96 395 96 673 97 117 97 423 97 661 97 724 98 044

20 1 71 073! 71 652: 70 540 69 379 73 069 76 792 65 266 80 346 82 067 87367 87 329 89 978 88 819 89 664 91 315 91 596 92 556 93473 93477 93 621 94 315 94507 94925 95 448 95 416 95852 96 198 96 708 97 041 97 298 97346 97 687

30 1 64 479 64 874 63 555 61 885 66 215 70 130 55 703 73 608 76 195 81704 82 329 86 813 84 737 86 411 88 686 89 257 90 412 91 525 91 451 91 799 92 503 92 874 93 450 , 94 0581 94 045 94 607 95 0381 95 677 96 087 96 3931 96 490 96 874

40 1 57 773[ 58 308 57 373 55 536 60 312 64 515 47893 67 513 70945 76717 77728 83 189 80 528 82 736 85426 86 319 87 648 88 969 88 917 89 405 90 077 90 777 91 410 92 152 92 151 92 820 93 342 94 117 94596 94 964 95 138 95 581

50 1 51006 51794 51 352 49411 54 285 58 537 39 959 60 781 65 129 71100 72 359 78 325 75 347 77 765' 80 857 81 921 83 833 84 968 84 959 85 518 86 153 87 196 87949 88 741 88 750 89 621 90 206 91 105 91 649 92 104 92 433 92 976

60 1 41 826 42 998 43 113 41055 45 819 49 862 30113 50 825 56 170 62 163 63 746 69 713 66 639 69099 72 345 73 5291 76 599; 77 213' 77 219' 77 641 78 208 79 777 "2 80 67 81 533 81567 82 607 83 256 84 544

70 27 594 28 745 29 783 27 465 31 544 35 328 17 204 34 258 40 014 46348 47 799 53 063 49 317 55734 56 525 61 115 60 960 60 937 60 683j 51 110 64 165 "I I 65 16 65 624 65 761 67246 67 823 69717 70 761 70 968 72 088 73104 1

85 308 85789 86 359 87091

-16-

Deaths by Leading Causes

As a recent trend, the deaths from those infectious diseases such as tuberculosis, pneu monia and bronchitis, etc. have decreased greatly, whereas the deaths from malignant neoplasms and other degenerative diseases have been gradually increasing, comprisin" more important proportion in the total deaths, particularly, the so·called adult diseases such been increasing. Table 7. Aunal Change of Deaths and Death Rates by Leading Causes. (Rate per 100,000 population) @ Lesions I

~s vascular lesions

affecting central nervous system, malignant neoplasms, heart diseases, and some others have

(1900~ 1967)

(Con'd ~o the next page)

ICD Vascular Year ---

. affecting Central Nervous System

Malignant Neoplasms B18 , ,

® Heart Diseases B25~B27

'CD Senility B45a R I

Accidental Deaths BE47, BE48 N

B22 I I

., R •

N 1900 1910 1920 1930 1940 41 42 43 44 1945 46 47 48 49 1950 51 52 53 54 1955 56 57 58 59 1960 61 62 63 64 69 64 88 104 127 125 125 120 799 888 186 942 847 124 349 985

N 21 31 35 41 107 976 540 138

N 57 442 59117 73468 76 591 89540 89673 95 998 99162

I I

159.2 131. 9 157.6 162.8 177.7 174.6 173.2 166.0

20 334 32 998 40648 45488 51 879 52 949 53 897 53580

46.41 67.1 72.6: 70.6, 72. 1 73.9 74.5 73.5

48. 1 65.0 63.5 63.8 63.3 59.2 60. 1 62.3

131. () 120_2 131. 3 118.8 124·5 125. ~ 132. 136. I

19 874 21800 26 198 26 295 28 28 31 33 408 808 134 519

45.3 44.3 46.8 40.8 39.5 40.2 43. 1 46.0

...

45 542 42 543 43 487 45428

... ... I

...

... ... 53886 56 633 59 889 64 428 66354 69488 71 578 75 309 77721 81879 83 155 87 895 91286 93773 96 442 98 224 101 426 104 324 106536 109805 112450

... ... 69.0 70.8 73.2 77.4 78.5 80.9 82.2 85.3 87. 1 90.7 91. 3 95.5 98_2 100.4 102.3 103.2 105.5 107.3 108.4 110_9 112.2

... ... .. .

...

... ... 62.2 61. 3 64.5 64.2 63.6 61. 3 64.9 60.2 60.9 66.0 73. 1 64.8 67.7 73.2 72.1 76.2 70.4 70.3 77.0 71. 9 74.5

... ... ...

...

... 100.3 79.$ 80.~

.. . ... .. .

...

... .. .

101 0951 129.4 94 329 117.9 100 278 122.6 105 728 105 858 110359 116 351 116 925 121 504 133 931 138 181 136 767 142858 150 155 161 164 166 109 966 228 818 901 127. 1 125_2 128.5 133.7 132.4 136. 1 148.4 151. 7 148_ 6 153.7 160.7 165.4 169.4 171. 4 171.7 175.8 173. 8 171. 7

48 575 49046 52763 53 377 53750 52603 56477 53 128 54 351 59543 66571 59603 62954 68400 68 017 72 493 67 672 68 328 75672 71188 74720

78 342 63 639 65 574 58 59 59 67 61 59 68 73 51 52 412 796 514 514 334 932 414 283 046 687

38533 38975 34 277 32850 31 968 31 215 34236 34 812 33265 33 258 34 528 35785 41662 38 41 38 39 40 964 614 393 698 437

49.3 48.7 41. 9 39.5 37_8 36_4 39.3 39.4 37.3 36.8 37.9 38.9 44.8 41. 7 44. 1 40.3 41. 3 41. 6 40.9 43.0 41. 4

70.2 70.7 69.3 77.6 69.$ 67. 1 75. $ 80.$ 55.5 56.7 58.0 58.2 57.$ 50.<),

54 139 54880 54 738 48 466 46 995 49 092 44209 43122

48.4 50.0 44.6 43.0 !

1965 , 172 773 172 186 66 172 129 67 1 Note: 1)

40188 42 547 41 514

In the upper column, "N" and "R" stand for "number" and "rates," r~spectively.

2) Figures for 1967 are provisional. 3) The encirled figure in the upper column as CD, @, etc. indicates the rank among leading causes of deaths.

•

__ 1900 1905 1910

Year

® Pneumonia 'and Bronchitis

-17 -

Hypertensive Diseases

® Tuberculosis Call forms)

Suicide

Gastritis, Duodenitis, Enteritis

B31, B32, B43a B28, B29 Bl, B2 ~-=-N- ~I-R---N-~ I-R-~-N~I-R-~ 99 115 128 137 228 164 128 129 133 126 128 139 130 :!26 877

BE49

and Colitis B36, B43b

N 5863 8 089 9372 10 153 10 630 12 249 13 942 14 172 9 877 9713 9 393 8 784

I I !

N ,

R 133.8 137.2 213.4 223. 7 254.2 238.2 221. 4 173.2 159. 2 142. 8 142.0 153.2

1915 1920 1925 1930 1935 1940 41 42 43 44 I 1945 46 47 48 49 1950 51 52

730 330 649 970 318 649 120 438

226. 1 247.4 262.0 261. 1 408. 0 275.6 200. 1

"'1

...

71 96 113 115 125 115 119

7~.~

186. 7 185. 8 175.9 177. 4 191. 8

...

, :

132 153 154 161 171

163.71 771 030 I 206.0 203 230.2 913 ' 219.7 165 223.7 956 194. 1 635 185.6 151 190.8 154 ::m.9 344 215.3 484 223. 1 473 235.3

13.4 58 664 17.4 63 979 19.1 104 950 19.2 117 988 19.0 142 278 20.5 142 288 21. 6 142 673 20.5 119 931 13. 7 ' 114 538 13.6 102 387 13.0 102 784 12.1 111 688

53 54 1955 56 57 58 59 1960 61 62 63 64 1965 66 67 1

136 78 81 77 69 57 62 48 43

524 911 812 565 555 586 091 256 154

43 683 53 923

43 832 42018 46 045 39 245 42 B61

31899 31 212 36 663 27 942 28 487

174.8 98. 6 100.0 93.2 82.2 67.1 I 71. 3 , 54.7' 48.3 48.4 59.2 47.6 45.2 49.3 41. fi 45.0 33.2 32. 1 37.3

9 935 B 865

8 950 9 343 9 100 9073 ID 371

11. 9 10.5 10.4 10 7 10.3 10.2 11.5

146 143 138 121 93 70

, 1

28. 2 28.41

11 12 13 15 16 17 17 18 18 18 18

158 565 503

115 083 547 469 . 207

987 405 175

12.2 13.7 14.5 16. 2 17. 1 18.4 18.2 18. 7 19.3 18. 6 18. 1 1

241 909 113 769 307 558 57 849 55 124 46735 43874 42718 36 274 32 992 31 959 27916

187.2 179.9 168. 8 146. 4 110.3

82.2 66 5 62.4 52.3 48.6 46.9 39.4 35.5 34.2

27 852 23 302 22 929 22366 20 064 17 675

29.6 29.3 24.2 23.6 22.8 20.3 17.6

12 262 12 753 14 201 16 311 15 415 . 15 776 17 731 20 635 22477 22 107 22 136 23 641 21 090 20 143 18 446 16724 15490 14 707 14 444 15 050 13 955

136.8 105 838 109.9 87 890 92.6 75 748 82.4 68540 67. 7 57 214 53. 1 45 552 46. 1 40 139 39.0 34 436 31. 7 28 289 30.0 27 077 25.7 24.3 23 425 15. 1 25. 7 23 128 23.3 22. 7 21 674 21. 2 21.6 19 791 19.5 19.6 18 383 18.0 J7,6 17 143 16. 1 16.1 . 15 449 14.6 14 180 15.1 14.7 12 705 , 12. 9 15.2 11 161 ' 11. 3 13.9 10 5841 10.6 15.7 15.9 17. 4 19.6 18.2 18.4 20.4 23.4 25.2 24.5

Table 8. Percentage of the Selected Causes to the Total Deaths. Int'l Abbreviated List Number B1,2 B18 B22 B25~27

Causes of Death Tuberculosis (all forms) Malignant neoplasms

1950 ! 1960 1196511966[1967 4.5 13.3 21.2 9.7 2.1 6.5 2.8 2.2 I I

13.5 7.1 Vasular lesions affecting central nervous system 11.7 Heart diseases 5.9 Hypertensive diseases Pneumonia and bronchitis Gastritis, duodenitis, enteritis, and colitis Nephritis and nephrosis

B28~29

Bel, 32, 43a B36, 43b B38

B45a BE47, 48

Senility . Accidents II,

8.6 7.6 3.0 6.5 3.6

7.7 5.5

3.2 3.0 2.6 15.2 16.4 16.7 24.7 25.6 25.5 10.8 10.5 11.1 2.7 2.7 2.7 4.2 4.2 5.2 1. 8 1. 7 11.6 1.6 1.5 1.5 7.0 6.6 6.4 5.7 6.3 6.2 2. 2 19. 3 2. 1 19.4

___ B=Suicide ____Others Note: The total deaths of each year are calculated as 100%.

1. 81 2. 9 2. 1 30.8 21. 6 i 20. 0

-18-

10.

Maternal and Child Health

Statistics As stated in Chapter 7, "Vital Statistics" (page 9) of this report, there has been a steady decline in the numbers and rates of neo-natal and infant deaths in the recent years, while the figures for still-birth have remained considerably high_ Maternal deaths also have been gradually decreasing in numbers and rates, but still it should be noted that there is a great deal to be done to improve maternal health in Japan. Of a total of 1,823,697 live births reported during 1965, number of live births which took place in hospitals, clinics or maternity homes, was 1,531,812, representing a percentage of 84.0 to the total. This is a remarkable rise in the rate of institutional delivery for those 15 years; the figuer being 4.6 for 1950. Analysis of maternal and infant deaths by leading causes of death for the year 1967 with the comparison for the past several years is shown in the following tables. Table 9. Infant Deaths and Death Rates by Leading Causes of Death. Infant Deaths (1955-1967)

---.-.----------,--~---------,-----------;

Infant Death Rates (per 1.000 live births)

.... ·------------:,-----'---';---L.--..J'-----'----';----'---'-----!---I All Causes 168 801149 293133 737126 217128 9351 39.81 30. Vi 18.5 19.31 15.0 Infectious and parasitic 1

11~ll~I~11611~ ~1~ll~11611~ I 2 491 1 396 ,

diseases Pneumonia and bronchitis Gastro-enteritis Congenital malformations Birth injuries, post-natal

582

552

297 1

1. 4 1

0.9 8.6 2. 3 1. 9 1. 6

0.31 3.6 1. 0 2. 0 1. 8

0.4 3.4 1. 0 2. 3 2. 0

0.2 2.4 O. 7 1. 9 1. 7

i16 32513 761 6 615 4 669 4 549 ,

9.4' 3. 41 2. 1 O. 8

5 821 3 772 1 912 1 440'11 277'

3 564 3 056 3 587 3 082 3 712 1

asphyxia and atelectasis Other diseases peculiar to early infancy and immaturity

1 325 2 494 3 256 2 7471 3 356 , :,28 037117 27912 65319 866 .,11 375 11 238 7 535 5 1321 3 861: 4 368 I

unqualified Others

16.2 6.5

10.8 4.7

6.9 2.8

5.9 2.3

1 I

Table 10. Maternal Deaths and Death Rates by Leading Causes of Death. Maternal Deaths 1 1 I

(1955-1966)

I ,

Maternal Death Rates (per 10,000 live births) , 8.8, ! 0.3 I

~1~1~IIBI~I~I~I~ll~l~ 1

All Causes Puerperal fever Toxaemias of pregnancy Haemorrhages I

3 095 2 09711 699 1 597 12661 141 1 124 831 373 121 505 108 809 507 232 63 378 1

17.9 0.8 6.5 4.8

13. 1 0.7 5.0 3.2' 1.4 0.4

9.9 0.4 3.5 ., 5 -' 1 ]. 0: 0.4 2.1

9.3 0.3 3.5 2.1 1.1 0.6 1.7

68 608 423

41 471 281 146 1

628 387 145 64, 321 1

3.4: 2. 1 0.8 0.4 1.8

Ectopic pregnancy Abortion without sepsis

ISO 62 358,

2.2

•

Others

2::1

:: :1

2.4

-19 -

Clinics for Mothers and Children Every expectant woman is required to report on her pregnancy to the local authority in accordance with the Maternal and Child Health Law. All expectant and nursing mothers and guardians of young children are encouraged to receive health guidance concerning pregnancy, child·bearing and child care from the medical, dental and nursing staff. To this effect, the Prefectural and Municipal Health Centers regularly provide the ante-natal, post-natal and child health clinics, where mothers and young children can obtain advice and preventive treatment. In addition, an increasing number of local government authorities is providing such clinics for mothers and children living in their areas. The reports indicated that these health clinics had been mostly attended by the infants under 1 year of age, while attendances at clinics were falling off as the chid grew older. To cope with such situation, a special programme has been in operation since 1961 for all 3-yearJ

old children to attend clinical sessions arranged by the Prefectural Government.

The main

purpose of those special clinics is not only to give routine medical examinations and advices on the general health of children, but also to find the children with physical and/or mental defects which require medical or protective treatments. During the calendar year 1967, 1,440,866 mothers and 5,204,747 children visited clinics, respectively_

Home Visiting Activities In addition to the provision of clinical services at the Health Centers, the home visiting for mothers and children is generally conducted by the nursing staff of the Health Centers and of other health agencies. The number of home visiting conducted by the public health nurses was 307,057 for mothers, and 964,180 for children during the calendar year 1967. As it seems to be of a great importance to provide more sufficient care for the newborn infants in order to reduce the high neo-natal death rates, the Health Centers have been making special arrangements for midwives in private practice and public health nurses to pay frequent home visits to the newborn infants since 1961. The number of visiting cases was 854,412 during the calendar year 1967. A special project to provide the home visiting services to the pregnant mothers has been in operation since 1962_ Because of a lack of nursing staff in the Health Centers, the midwives in private practice are employed on a part-time basis for these home visiting. 307,057 cases were visited during the calendar year 1967 under this service. A new programme was commenced from 1963 in order that the patients of serious toxaemias of pregnancy could receive medical treatment in hospital mostly through the public expense.

Voluntary Activities The voluntary community activities have been encouraged for maternal and child health

.r.

programme in rural as well as in urban areas.

A large number of community organizations

have been working in close co-operation with the local health authorities, and have been taking part in mothercraft training and in other various services.

-20-

MCH Centers in Rural Areas In the rural areas, where mothers and children had to travel their long! way for receiving health guidances and consultations at Health Centers, the provision of rbaternal and child health services presented great difficulties. In order to relieve the problems and to meet the needs of mothers and children in such areas, the Maternal and Child Health Centers have been established in the rural villages and towns since 1958. Though it is small, the building includes rooms for ante-natal and post-natal clinics, class-room, demonstration room for nutrition guidance, and accommodations and facilities for child-bearing mothers. 1968. Now!, the total number of M CH Centers reached 501, and additional 42 centers will be constructed during the year

Premature Births Every infant born with the weight of 2,500 grammes or less has to lDe reported to the respective Health Center immediately after its birth. Public health nurses obr midwives of the Health Center may visit the families with premature infant to advise them on the proper care of such infant at home, and if necessary, the baby-incubators of open type are lent to the family. The premature infants requiring more complicated care are treated in hospitals designated for this purpose, and the costs of hospitalization are mostly supported by the national and local authorities' subsidy. During the calendar year 1967, 73,116 low-weight birth babies were reported, (58,657 for 1966). Public health nurses paid visits for 71,956 cases (55,019 for 1966) of premature infants during the same period.

Tuberculous Children Children staying in tuberculosis sanatoria for a long-term treatment ~f bone and joint tuberculosis as well as other tuberculosis may receive financial aids from national and prefectural authorities for all expenses for medical treatment, school education and other daily living costs required for the children. Approximately, 2,200 children were aided under this scheme during the year 1967.

Other Services In order to improve the condition of nutrition of expectant and nursing mothers and infants, a special programme started from 1965, enabling mothers and infants in indigent families to receive milk free of charge every day. As for the informations regarding rehabilitation of the physically handicapped children, they can be found in Chapter 24, page 49 of this report.

11.

Family Planning

Under the general social confusion and economic distress followed after termination of the last World War, there was unbalanced situation between the population and national economy. People paid special attention to the over-population, and the need for limiting family-size was

21-

recognized among the people, thus the induced abortion became prevalent among the people, and undesirable effects were caused by the obstetric operation. In such days in 1948, a law was carried into effect, the provisions of which made the induced abortion legal under certain conditions, i. e., the qualification of doctor in charge, medical and social indications of the women to undergo operation, etc. The reported number of induced abortion was increasing up to the year 1955, when it reached 1.17 million. In 1952, the Government decided to provide the movement for the promotion of conception control instead of induced abortion. In the beginning of the movement thus resumed, the voluntary organizations performed introductory work to the general public, and in 1955, the Ministry of Health and Welfare launched a special programme to disseminate the practice of contraception among the indigent families. The Prefectural and Municipal Governments have been playing leading and supervising parts in family planning services under public and voluntary basis in the areas. The Health Center not only routinely provides consultation clinics, but also frequently organizes mother's class, discussion group, newly married couple class, and other group meetings on the subject of family planning. Personal guidance is conducted by the doctors and those "contraception instructors," who are the qualified midwives, puhlic health nurses, and clinical nurses who were specially trained through attendance at formal course given by the Government. In the above· stated special programme for tbe indigent families, who desire to practice contraception, the costs needed for personal guidance, the contraceptive appliances and drugs are aided through the expenditures of the Central and Local Governments. Besides the services provided through governmental scheme, some of the enterprises have been taking up the guidance on family planning as one of the welfare measures for their workers. The yearly reported number of induced abortion has been decreasing after the promotion of those measures, and in 1967, it was 747,490 cases. According to the sampling survey carried out by the Government and some press authorities, it is estimated that the current users of contraceptives reached more than 53% of the total couples, and more than 90% of couples have the knowlege of contraception. The economic and social situation of Japan has been improved, and there is a fundamental idea that the problem of health and family planning should be the first one to be solved as personal aspects, and Government prepares several facilities for the people. health and children's welfare in Japan. Thus the meaning of family planning is understood as a way to build up a happy family by keeping mothers'

12.

Health Education

The Health Centers perform extensive health education programme m the field of com· municable disease prevention, care of infants, insect and rodent control and improvement of environmental sanitation. In addition, the school health education is performed by the school authorities under the direction of the local Education Board, whereas the industrial hygiene education is conducted by the local Labor Standards Offices. In the rural area, agricultural extension service is carried out under :the ~direction of Ministry of Agriculture and Forestry

-22-

which includes health education programme for the farmers. Radio and TV broadcast, movies, slides and exhibits are employed extensively, National congress on health education has been held annually for training and for cfmference, and the regional discussion groups on health education meet often for the exchange of views and ideas.

13.

Tuberculosis Control

Tuberculosis Control Programme in General The tuberculosis control programme is completely defined in the Tuberctilosis Control Law, covering the responsibility of national and prefectural health authorities on the expenses for prevention of diseases and medical treatment of the patients. This law also provides for the health examination for case· finding, BCG immunization, reporting and registration of new cases. The voluntary activities for tuberculosis control has assisted the Government for carrying out the programme a great deal. Because of development of chemotherapy and technique of surgical operation during the last 19 years, a good result has been obtained in slowing down the tuberculosis death rate yearly as shown in Fig. 6, which gives the comparison with the death rates of vascular lesions affecting central nervous system and malignant neoplasms during the years 1948-1967. Further· more, the decrease of tuberculosis death rate is remarkable among younger age· group compared with the older age·group as shown in Fig. 7. There were 17,675 deaths (17.2 per 100,000 population), during the calendar year 1967. among prefectures. Although the tuberculosis death rate for whole Japan has been gradually decreasing, we have noted an indication of difference of death rates

Fig. 6.

Annual Death Rate of Tuberculosis. • - -... Vascular lesions affecting central nervous system - - - Malignant neoplasms

Fig. 7.

Annual Change of 'Iiuberculosis Death Rate by Age·groups .

200

- - Tuberculosis

,..........., ...--'"

...... - - - - - -

.... ~_../

300

250 200

10 20 30 40 Age-

Death Rate (per 100.000 population)

I948 1950

1955

1960

1967 year-

Death Rate (per 100,000 population)

We conducted three tuberculosis prevalence surveys, i. e., in 1953, 1958 >lnd 1963, to obtain the nation·wide information on the existing status of tuberculosis, and the valuable data were

23-

obtained on a statistical sampling basis. According to the 3rd tuberculosis prevalence survey, it was revealed that there were 2.03 million active cases and 1.41 million inactive cases. When we compare the decrease of tuberculosis cases during the period of of 1958~ 1963, 1953~ 1958

with the period

the decrease of tuberculosis cases during the latter 5·year period is larger than

that of the former one.

Early Case Finding and Preventive Vaccination The health examination for case·finding consists of routine and extraordinary examination; the former is applied to all the people above 6 years old once a year free of charge, and the latter is applied to some professional groups such as barbers, food· handlers, and family member of patients, etc. During the calendar year 1967, 42,555,000 persons (42,822,000 persons for 1966) received the health examination for case-finding purpose. for 1966) were examined by photofluorography. (0.15% for 1966). Among them 37,229,000 persons (37,381,000 The case finding rate for 1967 was 0.12%

Among those negative reactors against tuberculin, 4,524,000· persons (4,081,

000 for 1966) were immunized with BCG vaccine during the same period. The statistical figures for various health examination and BCG vaccination for the past several years are shown in the following table. Table 11. Tuberculosis Health Examination and Preventive Vaccination. (1955~ 1967)

(in thousand persons) No. of Tuberculin Test --.------~,-

I Year

Persons

Examined

Examined Persons

Positive Reactors

Examined with Photofluorography

Examined with Radiography

Rersons diagnosed as TB Case

Rersons I received BCG Vacci-

natIOn

I I

i 1955 I

57 59 60 61 62 63 64 65 66 67 Note:

26 531 33 152 35714 38 838 37 165 39380 42 621 38 876 42 709 42 822 42 555

20 24 21 21 19 19 18 15 16 16 15

439 889 120 411 140 216 574 i 807 I 405 246 I 731

13117 16 280 13 896 13 346 12607 12 866 12 055 10 409 10 758 10 821 10 443

17 923 i 24 29 32 31 34 33 33 37 37 37 589 I 679 625 837 070 699 I 678 269 381 229

755 1000 1 205 1 269 1 180 1 211 I 1 315 i I 1 207 , 1 172 I 1 174 1 100

130 108 I I 132 I 142 I 117 106 97

77 69 62 52

I I

6 094 6690 6 279 6 346 5 590 5 412 5 061 4605 4 829 4 681 4524

A year stands for the calendar year period.

Reporting and Registration The law requires the physicians to report to the respective Health Center when they detect tuberculous patients. These reported cases are registered in the Health Centers. The total number of registered patients as of the end of 1967 was 1,339,460 (1,405,289 for 1966), and 62.9% (63.1% for 1966) of which were active cases. 21.1% of active cases were hospitalized, The number 62.2% were under domiciliary treatment, 49% did not receive complete medical treatment, and the remaining 1.8% (same for 1966) was unknown of any disposition.

-24-

of newly registered cases during the calendar year 1967 was 253,781 (253.2 per 100,000 population), 18.6% (47,273 cases) of those were infectious. (Refer Table 12).

Table 12. Rate of Newly Reported Tuberculosis Cases. Year Rate of Newly Registered Tuberculosis Cases (per 100,001l population)

Medical Treatment The law specifies that a half of the treatment expense of patients requmng chemotherapy and surgical operation is to be paid out of the local government fund, a half of which is subsidized The rest The law through the national treasury. insurance or public assistance.

1950 51 52 53 54 55 56 57

of the expense may be covered by social requires that, in the case when a person engaging in certain occupation such as barber, food· handler, etc, is found to have infectious case, he may be prohibited to continue his work, and in the case where there is a danger of infecting his family, he may be compulsorily hospita· lized. In these cases, the expenses of medical treatment will be born by the Government. The total amount of expenses for the treatment of tuberculous patients in the country is estimated to be about 112 billion yen in 1966 (111 billion yen in 1965), which is equivalent to 8.6% (9.4% for 1965) of the total amount of expenses spent f or medical care of all kinds of illness. 1951 52 53 54 55 56

58 59 60 61 62 63 64 65 66 67

636 698 683 583 593 580 574 572 542 538 524 446 407 387 356 310 283 253

Table 13. Number of TB Beds and Occupancy Rates. Year

I Number of TB Bed. 125 204 153 861 178424 210 062 236 183 252 803 261 375 263 235 260 124 252 208 245 975 241 305 235 150 227 454 220 757 211 527 204945

I I ! I , I , 1

Occupancy Rate (%)

96 96 96

i ; , !

Facilities As of the end of 1967, total number of tuberculosis beds amounted to 204,945 and the occupancy rate (Refer Table 13). was 72.0%.

57 58 59 60 61 62 63 64 65 66 67

i I

95 91 86 83 82 77 76 78 80 80 78 75 74 72

14.

Leprosy Control In

Basic policy on leprosy control is completely defined

the Leprosy I Prevention Law.

The original Leprosy Prevention Law was promulgated in 1907 and was amended twice

25-

thereafter.

New, the current Leprcsy Prevention Law provides not only the prevention of

leprosy, medical care and promoticn of welfare of the leprosy patients, but also the financial assistance to the needy families of the institutionalized patients. In addition to these provisions, the programme fcr leprosy has been greatly promoted by the patronage of the Imperial Family and the activities of religious and voluntary groups. The decrease of number of leprosy patients in our country by means of a half century's efferts for the leprosy control programme has been remarkable, and the gradual decrease of the number has been well proven by the fact that, according to the first nation-wide prevalence survey in 1900, there were 30,359 leprosy patients identified, whereas the present number of leprosy patients decreased to abcut 1/3, and the prevalence rate became about 1/6. In the calendar year 1967, the number of newly reported cases of leprosy was 120 (106 for 1966). The total number of reperted leprosy patients as of the end of 1967 was 10,220 (10,404 for 1966) with a prevalence rate of 10 per 100,000 population, 9,537 patients of which were institutionalized at 11 national and 3 private leprosaria. changes of leprosy patients and newly reported cases. Table 14. Number of Leprosy Patients and Newly Reported Cases. ,

The following table indicates the yearly

Number of Patients Year

Total 1940 50 60 61 62 63 64 65 66 11 326 11 094 11 587 11 414 11 215

Hospitali.ed 8855 8325 10 645 10 492 10 339 10 163 9 994 9 874 9715 9 537

Not-hospitafued 2471 2 769 988 922 876 820 754 733 689 683

Prevalence Rate per 100,000 Population 21 18 12 12 12 11 11

Newly Reported Cases

257 235 211

10 10 10 10 10

983 748 607 404 220

10 10 10

175 135 125 106

120

The total number of beds available in those leprosaria were 12,950 and 280 beds, respectively. ment. As for the type of leprosy, 7,107 (47.5%) patients in leprosaria were lepromatous type, 1,354 (14.2%) tuberculoid neural, 966 (10.1%) tuberculoid macular, and other 110 atypical type, as of the end of 1967. In speaking of geographical and age distribution of leprosy patients, more patients are found in southern part of Japan than in northern part, and the average age of those institutionalized patients is about over 50 years old and the one for those uninstitutionalized patients is about 10 years older than the former. getting older year by year. Besides, the average age of leprosy patients has been All expenses necessary for those patients III

leprosaria are wholely met by the Govern-

-26 -

15.

Adult Disease Control

Because of decrease of infections diseases and aging of population, ~he death rate of vascular lesions affecting central nervous system, malignant neoplasms, alid heart diseases have been increasing in the recent years, and they have been occupying a leading position among various causes of death, and they are now coming up to 60% of all deaths. They are treated as "adult diseases," and in 1958, the Government established the "Anti-Adult Disease Council" in order to set up the plans for preventing and controlling these adult diseases.

Surveys The Government carried out a survey on malignant neoplasms in 1958 on nation-wide scale for a total of 13,127 patients discharged from 4,594 general hospitals for the period of September~October

1958.

By this survey, we found that, out of all patients received operation,

70.6% of them were able to be radically operated and tbat 70.8% of them were discharged successfully. There were big differences among live discharge rates according to organs affect·

ed with cancer. We found that the live discharge rate of uterus cancer was high, inspite of the low rate of stomach cancer. After this survey, the similar surveys were made in 1960 and 1963, and we found new characteristics on cancer, for example, regional and age-group differences, relation between stomach cancer and the feeding habit of people and so on. As to hypertension, the Government carried out, in 1961 and 1962, a nation-wide sampling survey of population of 30 years old and over on the distribution of blood pressure, the situation of medical treatment, the incidence of stroke, and etc. higher than that of other nations. Some of the findings of this survey are as follows: 1) 2) 3) 25%of those who were examined showed 150 mmHg or over in systolic blood pressure 13% of 8,600 examinees in electro-cardiography showed abnormal findings of heart; 35% of 8,400 examinees in ophthalmoscopic observation of ocular fundi showed abo (160 mmHg or over in case of the age-group of 60 years and over); It has been well known that the death rate of vascular lesions affecting central nervous system in Japan is remarkably

normal changes of retinae (3% of them were in higher grades). 4) It was estimated that the number of those suffering from the vascular lesions affecti· ng central nervous system was about 310,000 persons in the whole country.

Cancer Control Activity 1. Equipment of Medical Facilities In order to improve the function of medical facilities, the Government started to facilitate cancer treatment centers in national hospitals in 1954, which was a part of the programme for establishing a network of cancer hospitals throughout the country, and in 1956, the National Cancer Center was established, which consists of three major parts, i.e., hospital, research institute and administrative department, as a central facilities in Tokyo. Following this, the local cancer centers in nine bloc of whole country and cancer departments in other main hospitals

-2:1-

at prefectural level are being established. 2. Training of Specialists and Research Training of doctors, nurses and X·ray technicians specialized in cancer, improvement of fundamental and applied research are another important programmes which are being promoted by the Government. 3. Cancer Finding Mass·examination In order to control stomach cancer and uterus cancer which are characteristically high in incidence among our nations, the Government started the mass·examination campaign by using stmach cancer mass examination car equipped with indirect photofluorography and uterus cancer mass examination car. During 1967 fiscal year, more than 1.3 million population who were mostly 40 years old and over were examined by the mass·examination for stomach, and 170,000 women of 35 years old and over were examined for uterus cancer. 4. Voluntary Activity The Japanese Foundation for Cancer Research (Gan-Kenkyu-Kai) established in 1908, is serving for the investigation, medical treatment and health education of people for cancer, and the Japan Cancer Society (Taigan Kyokai) organized in 1958, is serving for improving the people's defence for cancer by the education, practising mass screening examination and training of specialized personnel, in good cooperation with governmental activity.

Activities for Stroke and Heart Disease Hypertension is the widely spread disease among adult population, and the general practitioners play an important part for the prevention of stroke and heart disease. On the other hand, the Government has organized and established the hypertension and heart disease centers in the several national hospitals for improving diagnostic and treatment facilities in the regions. Training of health workers for the purpose of improving ability for the rehabilitation of apoplectic person is another important government programme, which was started in 1965.

16. Communicable Disease Control Communicable Disease Control Programme 1. Legal Aspect The communicable disease control programme is based on the Infectious Disease Prevention Law, Preventive Vaccination Law, Venereal Disease Prevention Law, Trachoma Prevention Law, and Parasitosis Prevention Law. been treated in Chapters 13 and 14. The Infectious Disease Prevention Law provides, in detail, diseases with reporting obligation by the physicians, and those measures such as isolation of patients, disinfection of the infected places, and other specific obligation of the nationa and local health authorities for controling the spread of specific communicable disease. At present, the following 12 diseases are specified by this law, i.e., cholera, dysentery, typhoid fever, paratyphoid fever, smallpox, The account for tuberculosis and leprosy, they have

-28-

epidemic typhus, scarlet fever, diphtheria, epidemic meningitis, plague, Japanese encephalitis, and acute poliomyelitis. In addition, the following 12 diseases are required to be reported of

their occurrence by physicians, i. e., influenza, rabies, infectious diarrhea, Iwhooping cough, measles, malaria, tsutsugamushi disease, filariasis, yellow fever, anthrax, tetallUs, and relapsing fever. The total number of beds available for accommodating those patients with reportable diseases were 32,739 as of the end of 1967. 2. Preventive Vaccination The Preventive Vaccination Law provides enforcing of both regular ,and emergent im· munization.

Regular immunization: (1) (2) Smallpox-3 times; during 2~12 months after birth, during 6 months before enterDiphtheria-4 times; during 3~6 months after birth, during 12~ 18 months after the ing primary school, and during 6 months before graduating from primary school. fiist immunization, during 6 months before entering primary sch()ol, and during 6 months before graduating from primary school. (3) Typhoid Fever and Paratyphoid Fever-during 36~48 months after birth, and thereafter, once a year up to 60 years of age. (4) Whooping Cough-twice; during 3~6 months after birth, and during 12~18 months after the first vaccination.

(5) Poliomyelitis-twice (by attenuated live vaccine); during 3~18 months after birth. Emergent immunization:

Besides the regular vaccination programme, the law provides immunization for epidemic typhus, cholera, plague, influenza, and Wei!'s disease in case of their epidemics. Table 15. ----------

Number of Persons who received Immunization.

(1962~1967)

(in thousand) ---------------- -

Vaccination

---------

Year

1962 3 702 20

1963

1964 3 321 17 811 2128 108 3 325 10 2249

1965 3 304 16 971 2 040 76 3 561 11 2487

1966

1967 3 047 14 727

Smallpox vaccination

4 130 19 032 2288 98 3718 3 14 473

3 155 16 252 1 951 47 3 459 5 2 519

Typhoid & paratyphoid vaccination Diphtheria vaccination Pertussis vaccination

184

2 483 100 3 670

I I

1 910 54 3 290 12 2'238

Diphtheria-Pertussis combined vaccination Epidemic typhus vaccination Poliomyelitis vaccination (attenuated live vaccine)

11 23 375

Forecasting of Outbreak of Communicable Diseases It is very important to forecast outbreak of communicable disease in order to plan the This prograII1l!lle has, therefore,

essential measures for the successful control of its epidemic.

been operated for several diseases in order to forecast the possibility of their outbreak by investigating various epidemiological factors such as susceptibility, source of infection, environ-

-29-

mental conditions, and etc. The forecasting method for each com:nunicable disease is differe:Jt from each other, because of its different epidemiological character. The brief account of forecasting method being applied for poliomyelitis, diphtheria, Japanese encephalitis and influ-

enza

as follows:

Poliomyelitis: (1) Susceptibility study, neutral antibody titer survey by age-group for 80 persons in

each area (2 areas in 15 prefectures). (2) Isolation and identification survey for foci of infection of such entero-viruses as polio-virus in stool for 40 persons in each area (2 or 3 areas each in 18 prefectures). b. Diphtheria: Susceptibility study by age-group for 180 persons in each area (2 areas each in 6 prefectures). c. Japanese encephalitis. (1) Susceptibility study, neutral and HI antibody titer survey in blood by age-group for

180 persons in eacb area (2 areas each in 6 prefectures). (2) HI antibody titer survey in blood for about 20 pigs collected at one or two slaughter houses each in 45 prefectures. d. Influenza: HI antibody titer survey m blood for the influenza-like patients and virus isolation m

each hospital (2 hospitals each in 10 prefectures).

Prevalence of Major Communicable Diseases During the period of January 1967~August 1968, Japan was free from the quar"ntinable diseases. The occurrence of two cholera cases, one was the non-imported (3 August 1964) and the other was the imported case (11 October 1964), was the last incidence. Most of other acute communicable diseases remarkably decreased and were well under control during the same period. The highlights of some communicable disease are shown as follows.

Poliomyelitis As shown in the following Fig. 8, the incidence of poliomyelitis was dramatically reduced Fig. 8. Incidence of Poliomyelitis. Cases

after the successful oral administration of Sabin type virus vaccine since 1962. Weare convinced, however, that we should continue surveillance of immunity among the inhabitants as well as proper immunization, and try to make close examination for the differentiation with other similar diseases in character.

1200 100 800 Live Oral Poliomyelitis Vaccine

Influenza Japan suffered, to varIOus extent, from influenza epidemics in the past. Last year, the first

30-

influenza epidemic started to occur from the end of January and prevailed until latter March all over Japan, which ended in April. The epidemic was mainly due to type B, but type A, in Tokyo area. The second epidemic started from the end of November ip. 1967, and lasted until latter March in 1968. The number of cases was 55,321 in 1967. It is very difficult for us to set up rational counter·measures for influenza, because of its character of rapid world· wide spread and of many changeable variation of virus strain. However, it is noteworthy that we are carrying out intensive immunization programme on the planned basis through the epidemic forecasting method.

3. Japanese Encephalitis The number of cases, case rate, number of deaths and death rate of Japanese encephalitis since 1956 are shown in the following table, and the number of weekly inc1dence is shown in Fig. 9. Table 16. Annual Change of No. of Cases, Case Rate, Deaths and Death Rate of Japanese Encephalitis. Fig. 9. Weekly No. of Reported Cases of Japanese Encephalitis for the Last 3 Years.

I~ Year

-r

No . of Cases

Case

Rate

No. of Deaths

Death Rate

Yearly Total Casl's 600

--1967(1,028) --1966(2, 301) -- ---1965(1, 179)

1956

4 538 1 793 3900 1 979

5. 0

1 600 744 1 349

1.8 500 •

2.0 4.2 2. 1

0.8

58 59

1.5 0.8

400 -

723 650

60 61

1607 2 053

1.7 2.2

O. 7 0.9

300

825

200

1 363 1 205

1.4 1.3 2.8

568 566

0.6 0.6 IOn

f ........

I !

. I .

ii ! I i. i \

63 64

2683 1 179 2301 1028

1 365 656

1.4 O. 7 1.5

65 66 67

1.2 2.3

24 26 28 30 32 34 36 6umulative number of

" ~

_!.

-\\ r

\.-\ i \1...., i

\ ~

,/ !

,V\, ......~~~"-.. [ ::..;;p.1

38 40 42 44 Week

1 442 659

cues for first 24weekilil

1.0

O. 7

The Japanese encephalitis presents peculiar epidemiological characteristics, i. e., seasonal characteristics, regional characteristics and mode of infection, that is by the 'bite of mosquitoes. The number of persons who received immunization during 1967 is estimated to be about 28 million. 4. Dysentery The number of cases of dysentery had yearly decreased since 1960, except 1966, and it reached to 30,097 in 1967. The incidence rate and death rate of dysentery reported during Almost all of the the period of 1967 were 30.0 and 0.1 per 100,000 population, respectively.

31-

cases were due to bacillary dysentery and only 12 were amoebic dysentery. Some of the recent trends which should be noted are that the occurrence during summer month has shown a smaller proportion to the total cases compared with those of the previous years, clinical symptoms have become milder and milder, and the number of cases by Shigella sonnei has been increasing; it was about 90 % of the total cases in 1967. rest 11.2% was not known. Out of 447 epidemics in 1967, 13.0% was classified as water· borne, 10.2% as food· borne, 65.6% as direct contact, and the More intensive effort is being made for the periodic examination and health education of food· handlers, workers in water· supply work and other people dealing with food for public consumption. 5. Venereal Diseases In Japan, the reported venereal disease cases had yearly decreased since 1950, and reached its lowest level in 1964. However, the increase of early infectious syphilis has been observed smoe 1962, and the number of 'III venereal disease cases have increased since 1965. 1967, 11,755 syphilis cases and 11,874 gonorrhea cases were reported. venereal disease control programme. During We presume that the

change of attitude of the younger· aged for sex is now constituting a very difficult problem for In order to cope with the problem, a partial amendment The main points of of the Venereal Dise'lse Prevention Law was made on July 26, 1966.

amendments are 1) to simplify the reporting method and the content of the report on patients to be given by the physician, 2) to make obligatory for any man and woman entering into matrimony to receive STS by a physician, and 3) to make such expense free of charge, in case of above STS and the one for pregnant woman. entering into matrimony in 1967 was 172,000. 6. Parasitosis The parasitosis control programme in Japan is being carried out under the provisions of Parasitosis Prevention Law, and the mass examination and treatment for hookworm disease, filariasis and Japanese Schistosomiasis are being carried out particularly. In the endemic area of filariasis, south· west part of Japan, the blood examination for about 128,000 persons, mass treatment for more than 1,500 carriers, and mosquito control with residual spray were simultaneously carried out during the year 1967. As the control programme for hook·worm disease, the stool examination for 490,000 persons and over, and mass treatment for carriers, were carried out in the 7 endemic prefectures during the same period. As for Japanese Schistosomiasis, the intensive molluscicide operation and construction of cemented irrigation ditches have been carried out in the 5 endemic prefectures as the special control programme since 1957, which has resulted in the gradual decrease of the cases. The number of STS for men and women

"li-

Table 17.

Annual Change of No. of Cases, Deaths, Case Rate and Death Rate for Communicahle Diseases. Cholera

(Rate per 100,000 population) ..'

(1930-1967)

I Year

I Cases [Rate Case IDeaths IDeath Case [D eat h s [Death Cas es Rate 1-Cases [ Rate Rate 1 , 29672 29 655 32249 38040 42 939 48 964 52 053 0.0 , 78 283 0.0 ' 80 221 0.0 97249 0.0 83 689 58 803 55 785 50 188 55196 96462 O. 7 88 214 39219 14665 23 961 49 780 93 039 - III 709 - 1108 009 - i 98810 -180654 84 437 74780 81 577 85 695 93 971 91538 73 999 46.5 45. 7 49.0 56.9 63.4 71. 3 74.9 111.8 113.9 137.3 117.3 82. 7 77. 7 69.4 76.2 134.0 120. 7 50.2 18.3 29.3 59.8 110.0 130. 1 124.1 111.9 90.3 93.6 82.1 88. 7 92.2 100.6

._1.

Dysentery

Typhoid Fever

1_ IDeath Rate

Paratyphoid Fever

I Case [D eath s . Rate 64.81 58. 9 53. 8 57.5 I 62. 6 i 55.3 52. 9 54.4 59. 7 53.4 57.0 57. 1 49.6 72.6 79.3 80.5 61. 1 22.8 11. 9 7.8 5. 9 4.6 3.4 2.9 2. 9 2.2 2.4 2.3 2. 1 1.7 1.7 1.1 1.0 1.0 O. 9 0.8 0.9' 0.5·

I Cases

_I _

Smallpox

'" '"

-[ Case I D - Death [ I Rate Case I 1 eaths Rate Death s IOeath Rate [-Cases Rilte ,

,1930 -, 1931 41 0.0 19321 1933 1934 1935 1936 57 0.1 1937 18 0.0 1938 1939 1940 11941 1942 1943 1944 1945 19461 1 245 1 1.7 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 .1962 1963 11 0.0 2 0.0 11964 1 1965 1966 1967

11 10 1 5

560

i3- 014 20.4 31 367 13 002 20, 1 38 202 13 547 20. 6 35 437 14 874 22.3 38 408 15 484 22. 9 42 420 15 915 23.2137 980 16710 24.0 36 799 19712 28.0 38 124 21955 31. 1 42074 24 890 35. 1 37 837 22 02.~ 30.8 40706 16 295 22.4 40 595 14 268 19.4 35 589 10 208 13.8 52 519 11 208 15.2 57 448 20 107 27.8 57 933 13 409 17.6 44658 9573 12.3 17 809 5 157 6.4 9486 7 765 9.5 6391 11 968 14.4 4 883 3 878 14 814 17.5 2898 13 585 15.8 10 851 12.5 2521 9341 10.5 2567 1 939 6 042 6.8 5 165 5. 7 2 123 3 763 4. 1 2113 3176 3.5 1 901 1546 2 457 2.6 1572 2 048 2.2 1 646 1.7 1001 97.1 910 77. 7 1 109 1.2 995 757 0.8 I 72.6 0.5 ! 890 471 53. 9 789 270 0.3 49.5 893 265 0.3 65.8 511, 0.1 I 300 _97-,-1_30_._0-,-I_ 148 _-"----_

8 34013. 4467 7.0 4 042 6.2 8 163 12. 4 694 7. 1 6 936 10. 5279 6. 9 7 632 11. 4 462 6.6 8 129 12. 4 173 6. 1 7 912 10. 4 747 6.8 6 847 9. 4 439 6.3 7062 10. 6100 8. 7 7 803 II. 5 227 7.4 6954 9. 6 251 8.8 9. 7 106 6 233 8.8 9. 6 904 6428 8.8 6218 8. 7 6925 9.4 12382 17. 1 7 844 10.6 14 819 20.4 7990 11. 0 10 059 14.0 5446 7. 2 9 154 12.5 4728 6. 1 2926 3.7 1 443 1.8 2 917 3.6 2189 2. 7 936 1. 1 711 2. 1 630 ' 0.8 1 302 1.5 351 I 0.4 835 1.0 189 , 0.2 1 098 1.3 157 0.2 124 I O. 1 760 O. 9 590 O. 7 105 O. 1 509 0.6 80 0.1 344 0.4 76 O. 1 54 O. 1 1 149 1.2 411 0.4 37 0.0 319 0.3 39 O. ( 2-13 0.2 34 it. {} 203 0.2 14 0.0 148 0.2 16 0.0 148 O. 2 20 0.0 71 O. 1 9 0.0 119 O. 1 13 0.0 10 0.0 138 1 O. 1

372 308 368 333 319 279 276 263 295 293 312 308 281 564 526 466 316 170 116 80 49 32 16 24 13 19 7 8 8 6 3

508

3 3

1 6

0.6 7 0.0 23 0.0 0.5 0.6 305 0.5 0.5 375 0.6 0.5 320 0.5 113 0.2 0.4 0.4 178 0.3 O. 1 0.4 90 0.4 60 O. 1 0.4 287 0.4 0.4 575 0.8 0.4 654 0.9 0.4 381 0.5 546 0.8 O. 7 0.8 311 0.4 O. 7 1 614 2.2 0.6 17 954 24.6 0.5 0.4 386 0.2 29 0.0 124 0.2 0.1 O. 1 5 0.0 86 O. 1 O. 1 2 0.0 0.0 0.0 6 0.0 2 0.0 0.0 1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0- 0.0 0.0 0.0 0.0 0.0 0.0

4 8 44 55

o o 1 1

35 16 20 8 6 33 60 62 61 73 44 319 3 029 85 3

o o o o o 1

1 1 1 1

14 2 12

o 1 o o o o

-I

Note:

One case of cholera in 1963 is the imported case.

One of the 2 cholera cases in 1964 is also the same.

(Con'd to the next page)

I '

(Rate per 100,000 population) I I

Year

1_ --

--. 1930 ! 1 1931 1932 i 19331 1934 1935 . 1936 19371 1938 1939 I 'I

~:s.es

- ---~p~emic Typhus Scarlet Fever Case' Death Case ! Rate IDeaths I Rate I Cases 'Date 1 1_ _ _ _

---------1

DeathsJR.it~L~ases 3031 327 336 401 1 505 i 488 467 454 398 475 0.51 0.5 O. 5 O. 6 I 0.7 18 21 21 28 29

..... I Death'

Japanese Encephalitis \ Diphtheria . I Epidemie Meningitis I Case Deathl Case Death Ca scs 1 Case Rate 1D eaths 1Deathl Rate Date .1 Deaths 1 Rate i Cases 1 Rate 1 Deaths 1 Rate I Ii. 4 7. 1 Ii. 9 8. 1 7.7 275 280 238 359. 1 186: 1 304 1 003 839 995 1 632 1 160

1 1 0.0 3 O. 0 3 O. 0 4 O. 0 26 0.0 18 1 17 5 0 0 O. 0 O. 0 0.0 0.0

1 3 1 1 5 1 3 1 2 3 14 23 129 622

0.0 0.0 O. 0 O. 0 0.0

6 6 8 12 16

0251 480 257 631 688 506 707 602 002 907

9. 4 10.!) 12. 5 18. 9 24.6 24. 0 24. 0 25. 1 27.0 28. 1 27. 1 21. 1 17.7 13.7 8. 8 3. 3 3.0 3.4 3. 7 5.6 6.2 6. 0 7. 2 14. 5 22. 5 15. 1 13.5 15. 9 14.9 10. G 9. 41 6. 6 12.31 10.9 8. 9 I 6. 9 I

522 , 29.0 1 4 069 048132.4 4 582 811 33. 1 4 509 500 , 42. Ii i 5 418 '. 992 I 44.3 I 5 215, 4 4 4 4 5 432' 321 236 118 255

0.4 0.4 O. 4 O. 5 1. 8 1. 9 1. 4 1. 2 1. 4 2.3 1.6 1.1 1.5 2.0 6. 1 2.0 4.3 2.6 1.8

168 165 165 239 599

O. 3 O. 3 O. 3 O. 4 0.9

O. 0 O. 0 O. 0 0.0 0.0 0.0 0.0 0.2 0.8 0.4 4.4

Hi 16 17 19 19

3 , 1940 : 1941 87 1942 100 1943 1374 1944 3 941 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 19641 1965 i 1966 , 19671 1

O. 1 0.1 1.9 5. 4

19 325 14 997 12 688 9891 6 354 2 2 2 2

2 461 306 1 106 475 111 938 3 16 'I·

3.·1, 260 44.3 'I 3 351 1. 4 135 O. () 47 0.1·1 18 1. 1 68 0.0 Z O. 0 1

O. 0

'-I I -

405 208 O. Z 635 O. 1 982 0.0 4 602 O. 1 5 149 0.0 5 096 6 168 12 619 O. 0 19 861 13 486 12 172 14 499 13734 9 882 8 786 6 251

-I -I -:

-I -

-1 12 907 10 735 8 827 6 933

O. 7 28 054 ' 40. 9 O. 7 28 117 40. 4 O. 6 28 003 40. 0 0.6 28 323 40. 2 0.7 35 803 50.6 3RR 0.5 18 303 53. 7 268 1 O. 41' [0442 56.9 2171 0.3 4 4 431 61. 91 165 0.2 6 3 756 8H.2 114 0.2 9 4 274 1130.1 1 ; 833 1119.2 82 O. 1 100 O. 1 9864 1 68.21 \ 307 36.2 71 O. 1 42 O. 1 j 377120.5 58 0.1 14555 17.8 33 0.0 11 2 621 15. 2 34 0.0 10749 12. 7 9.8 48 O. 1 I 8 381 9 5H9 11. 0 56 O. 1 0490 11. 9 87 O. 1 1 17.4 5 557 62 O. 1 1 63 0.1 18 395 20.4 44 O. 0 15 423 16.9 31 0.0 15641 17.0 38 O. 0 17 936 19.3 23 0.0 14 921 16.0 231 114 9 790 10.4 32 0.0 7 451 7. H 18 0.0 4866 5.1 20 0.0 19 1 0.0 1 2774 2. 9 2 774 I 2.9 14 0.0 15 1 0.0 8 O. 0

G. 5 6. 2 6. 0 5.8 7.4 6.6 6.9 7.0 7.3 8.4 10.8 5.0 4.3 2. 4 2. 0 1.4 1.1 O. 7 O. 9 O. 9 1.0 1.1 1.0 O. 7 0.8

699, 1. 0 601 O. 9 479 O. 7 580 0.8 886 1. 2

823 1 113 1 468 4384 1 435 3373 2052 1 446 1 193 1 111 912 859 676 630 610

443 398 396 1 072

263 4 757 1 284 5196 2188 3 545 1 729 1 758 3 699 4 538 1 793 3900 1 979 112 96 73 79 59 \

2O~

I 0.3 0.3 5. 9 1.6 6.2 2.6

99 228 2620 1177 2430 956 1 437 720 732 1373 1 600 744 1 349 723 650 825

1.4 1.3 1.1 1.0 0.8

4. 1 2.0 2.0 4.1 5.0 2.0 4.2

0.1 0.3 3.3 1.4 2. 9 1.1 1.7 0.8 0.8 1.5 1.8 0.8 1.5 0.8

O. 7 O. 7

2. 1 1. 7 2.2 1.4 1.3 2.8

497 286 206 76 42

0.5 O. 3 II. 2 0.1 0.0

526 504 390 320 249 2141 144 117

0.6 0.5 0.4 0.3 0.3

O. 1 O. 1 O. 1 0.1 0.1

1 607 2 053 1 363 1205 2 673

568 566 1 365

O. 7 O. 9 0.6 0.6 0.4

2 159\ 2.2 i 1 520 1. 51 1 207 1. 2

39 \ 0.0 \ 22 0.0 17 O. 0

o. 2

0.1 O. 1

50 \ O. 1: 33 0.0 33 O. 0

1 17911. 21 2 301 2 3 1 028 1. 0

658 1 0.7 1 500 1. 5 696 O. 7

: Note: The population t;~ed as the basis for -~omputing these rates is th~--';;timated population excluding· Okinawa. The-'numbcr of deaths for years bei~~ 1942 is only for Japan Proper, exclusive of Okinawa, but the numher of cases and deaths for 1943-1945 includes Okinawa. The number of cases were taken from the Morhidity Statistics, while deaths were from Cause-of-Death Statistics and Vital Statistics. (Numher of deaths in 1967 is provisional).

1;3

-34Table 18. No. of Cases and Case Rate for Reportable Diseases. 1962 (Other than those in Table 17) [ 1966 [ 1967 r

1963

1964

Cases IRate I Cases IRate I Cases IRate Malaria I

I-Cas~ IRateh::~sesIRate I Cas~ 6 O. 0

1965

[ Rate!

181 O. 0' 63 809 67.0 11 552 12 1

16[ O. 0[1 38 141 39.7 4 132 774' 131 667 4.3

O. 0

15; O. 0 !

I O. 0

Measles Whooping Cough Influenza

52 494 54.0 1 167 1 2

37 789138.5 2 362 2 4'

52 991 53. 5 3 136 3. 2,

21 157 21. 1 820 O. 8!

474723498.8/ 289 707 0.3;

0.8 110204113.4 4093911416:6 O. 1

41 437 41. 8 1

Poliomyelitis Tetanus Rabies Anthrax Tuberculosis

841

o. 1

O. 7

6~ O. 7, 1

5~1 0.6 22

~' o. ~I ~ 01 211 0.2' 175 1

01 0.1 1

o~ 0.0 0.0

1:~ ,~:j 106 O. I,

55 321 55 2

387 767407.4 380 603395.8 355 500365.8 315 0061320.5 286 568 0.2. 135 1251 0.1 21 792, 22. 2 3 H

Leprosy Trachoma Infectious

289~1258 93:11~: 116 O. 11

23 476 24. 7 58 72 O. Ii

27 522 28. 61 2 39 270 126 5761 4166 221 6

24 147 24. HI 1 19 446

12 994 13. 1 21 0.0 13 211 14 1

11 539 11. 5 10 6 1

Diarrhea Tsutsugamushi

o.o[ 0.0/ O. 3 ,

0.0 00, 0: 51 1

0.0 0.0 1

Disease Schistosomiasis Japonica

0.11 O. 4 I

O. 0

359 1 536 6 301 5125 256

228j 118 6 000

o. 2 O. 1

O. 21 0.0

1871 o. 2 19

Filariasis

1. 6 6.6 5.4 0.3

O. I'

639

0.7;

O. 01

Syphilis Gonorrhea

6.0 4.3 0.2 0.0

5 326, 5.5 4 041

6. 1

10 821 10. 9'

11 755 11. 7, 11 874 11.8 490 0.5

4.2 0.2 0.0

46634.7 179 0.2

6951 288

7.0 0.3

, LymphogranuI lomatosis Inguinale

Chancroid

169 4

6, 0.0 I ,

17.

Foreign Quarantine Service

The foreign quarantine services for health are under the management of the Quarantine Section, Public Health Bureau, Ministry of Health and Welfare, and are being carried out hy 70 Quarantine Stations which are shown in Table 20, page 35.

During the year 1967, 30,964 vessels (1,348,342 persons) and 18,310 aircrafts (1,176,180 persons) passed health inspection at the time of arrival from abroad, 157,795 persons going abroad were vaccinated against quarantinable diseases (this number excludes cases vaccinated at such facilities other than quarantine stations), 991 ships were granted deratting certificates and 5,936 ships received deratting exemption certificates. No quarantinable diseases, including imported ones, occurred in Japan during the reporting period. Four detached offices were established newly in view of developing of international traffic and trade and coping with new trends in certain communicable diseases.

Table 19. Names of Quarantine Stations. II

35-

Seaport Stations

Main Offices

Hakodate, Kobe, Moj~ Nagasaki, Nogoya, Sasebo, Yokohama Hakata, Hiroshima, Kagoshima, Niigata, Osaka, Otaru, Shi-

I 1

*** ** *** ** * **

mizu, Tokyo Branch Oflices Izuhara Chiba, Fushiki-Toyama, Iwakuni, Kamaishi, Kure, Muroran,

8 1

-----+---~I

Niihama, Tokuyama·Kudamatsu, Wakayama·Shimotsu, Yokk· aiehi, Y okosuka

11 -~"

---I

Naze Detached Offices Fukuyama, Gamagori, Hososhima, Koehi, Kushiro, Maizuru, makomai, Tsukumi, Ube, Wakamatsu, Yaizu Aomori, China, Funakawa. Hachinoe, Hagi, Karatsu, Matsuyama, Misumi, Miyako, Nanao, Naoetsu, Owase, Onahama,

I !

Miike, Misaki, Mizushima, Ofuna to, Saganoseki, Saiki, To· i 17

Rumoi, Sakai, Sakaide, Sakata, Shiogama, Tsuruga, ,Vakka·

nai, Yoron - - - - - - -.--c-----------------~---------·--_i_----I

Airport Stations

I M~in Office I Tokyo Airport 1 - .-....--.. --... - . - - - - ----- . ! Detached Office I Itazuke, Kagoshima, Osaka De~i;~~~d~~

I I ------

Total 66 1

----~---.-----------~~~~~~----

I I

3 2

quarantine

Amami, Iwakuni _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

airport only J_ _ _ _ ·~_~

_ I+----I

I Remarks: isolation of infected cases.

Total 6

*** 1) Offices equipped with special facilities for disinfecting, detention of suspected cases, 2) Granted the authority for issuing of both the deratting certificate and deratting exemption certificate.

** *

Granted the authority for issuing of both the deratting certificate and deratting exemption certificate. Granted the authority for issuing of the deratting exemption certificate only.

18. Sanitation Facilities L Water·Works

Environmental Sanitation

It is indicated, as of the end of March 1967, there were 71,519,025 population served by the water supply systems in a total of 19,192, which represented 72.2% of the total population. For further details, (1) 59,774,036 population by 1,489 urban systems, (2) 9,273,436 population by 14,174 rural systems, and (3) 2,471,553 population by 3,535 private systems. Under the provisions of Water-Works Law, the water supply installation can be provided by cities, towns, villages, syndicate, corporations, and other communities so as to elevate the standard of public health and improve environmental sanitation by supplying safe drinking water. As far as financing is concerned, the self·supporting system is the main principle in the

-36-

water·works. However, the cost for construction is provided by the National Government as the national loan (annual interest 6.5%, reimbursement period 30 years). Also, tbe Ministry of Health and Welfare may subsidize for the undertakings for the development of water reo sources, and the large development plans of water supply systems including regrouping or integration. Besides, the National Government subsidizes villages, towns and cities for the establishment of small·scale water supply system (covering less than 5,000 population), with one third or one fourth of the total expenses, depending upon the financial conditions of those local municipalities. Sewage Treatment As of the end of March 1967, there were 85 cities operating sewage treatment plants, and 11,341,000 population was covered by those services. 67 cities have been ccpnstructing sewage treatment plants. Under the provisions of Sewerage Law, the sewerage installation can be provided by public expenses of cities, towns and villages, and its construction is limited on public land. In the past, the administrative responsibility for sewage disposal and its facilities had been jointly in the hands of Ministry of Health and WeHare, and Ministry of Construction, i. e., construction and operation of Sewage treatment plants was under the former's jurisdiction

and construction and maintenance of sewerage pipes under the latter's.

However, in view of

simplification of administration, the Ministry of Construction became the single agency reo sponsible for sewage disposal work as to its budget and operation as from 21 June 1967, although it still requires to obtain the consent of the Minister of Health and Welfare from the stand· point of public health when approving the new construction and extension of sewerage facilities. 3. Nightsoil Disposal The difficulty for proper nights oil disposal is still one of the important environmental sanitation problems. According to the result of special survey made in 1967, 55.4% was disposed by digestion plants and sewerage systems; 4.6% was used for fertilizer in rural farm, though this has been decreasing year by year since the chemical fertilizer !Jas been replacing the role of nightsoil, and 19.1% was dumped into ocean. At the end of March 1967, there were 891 communities operating nightsoil disposal plants. According to the 5·year national programme, it is planned that 32,950,000 population will be covered by flush·toilet system by the end of March 1972. 4. Garbage and Trash Disposal Incineration is the most basic principle for disposal of garbage and trash. According to

the result of special survey in 1967, 45.2% of garbage and trash in the designated public clean· ing districts was incinerated. As of the end of March 1967, the number of population benefited either through garbage incineration and composting or other sanitary disposal reached 67,855,000.

Insect and Rodent Control Under the present provisions of Infectious Diesease Prevention Law, the !Cities, Towns, and Villages are responsible for the control of insects and rodents under the technical guidance of the Prefectural Governments, with financial assistance of the Ministry of Health and Welfare.

, 37-

At present each of the local Health Centers have full-time staff to perform technical guidance for such operation in its own district_ The model districts have been established since 1950 in many parts of the country in order to demonstrate insect and rodent control programme under the active participation of organized community people, and it has been quite successful not only in the control of insects and the prevention of insect-borne diseases but also in popularizing the basic understanding and public consciousness on hygiene, and thus in the general development of community social life_ The nation-wide movement of establishing "life free from mosquitoes and flies" initiated by the Government in 1955 lasted for 3 years. This movement was widely supported by positive understanding and cooperation of general public as proper movement for the improvement of people's daily living through eradication of insects. Since the favorable results were obtained by this movement, the movement is still being carried on even at present under the supervision of each Prefectural Government. In view of the fact that this kind of organized community activities is essential for various health and welfare programmes, the Government established the National Council for the Promotion of Community Health & Welfare Programmes (juridical person) in 1959, for the purpose of developing organized projects in the communities.

Sanitary Inspection and Supervision During the year 1967, there were 4,917 sanitary inspectors (including both full-time and part-time) who made a total of 17,341 inspections for 7,909 entertainment facilities, 121,518 for 89,005 hotels and inns, 47,145 for 24,825 public bath-houses, 179,294 for 129,492 barber shops, 158,571 for lO3,429 beauty parlors, and 88,520 for 67,953 laundries_

They also inspected water

supply facilities, sewage treatment plants, nightsoil disposal plants and garbage disposal plants in order to maintain good sanitary conditions.

Administrative Regulation Under the provisions of the Law concerning Improved Management. of Business Dealing with Sanitation, the Central Council is provided in the Ministry of Health and Welfare to review the operational and trade standard whether it is satisfactory to maintain good sanitary condition or not, in order to improve management of commercial establishments under the jurisdiction of sanitary regulations. Regulating the tariff of the charges of such business as The Local barber-shop, laundry, public bath-house, etc., is always on the subject for review. of the standard settled by the Central Council.

Council is also provided in each prefecture to settle local standard which is based on principle

19.

Environmental Pollution Control

Along with a rapid industrial development and increase of transportation as well as the heavy concentration of population in the larger cities, the environmental pollution problem has become more and more aggravated. To cope with such situation, the Government has estabMoreover, Air Pollulished Basic Law for Environmental Pollution Control in August 1967.

38-

tion Control Law and Noise Regulation Law, in addition to the existing Water Pollution Control Law, have been established in order to facilitate implementation of the Basic Law in May 1968. The former Smoke Control Law was abolished. 1. Air Pollution Under the remarkably rapid growth of industrial production and change of energy policy from coal to petroleum because of heavy industrialization policy, the quality and quantity of air pollution problems have changed their magnitude. Especially, petrochemical combinative development and operation of huge power plants generated by heavy fuel have produced complex air pollution problems, as nuisance or public health hazard in the surrounding com· munity. Throughout the country, there are 409 monitoring spots equipped with deposit gauge, 635 monitoring spots for SO, to be measured by PbO, candle methods, and about 103 automatic monitoring instruments for SO, and particulated matters run by the local governments at present. The amount of deposit matters in the main area is more or less 20 tons per sq. km. per month in average, and roughly speaking, monthly average of SO" as SO, is in-between, 1.0 mg/100 sq. cm/day to 0.5 mg/sq. cm/day in urban area. The major districts where the air pollution is a big community health problem are Sapporo, Tokyo-Kawasaki-Yokohama, Yokkaichi, Osaka-Amagasaki-Kobe, Ube, and Northern Kyushu districts. Since 1964, active approach to the study on the effect of air pollution to the health has been started by Ministry of Health and Welfare, in Osaka, Y okkaichi, and Ichihara as a long-range project; not only the epidemiological studies but also the elinical approaches have been made by the team with various professional research staff. Those Prefectural Governments, having the smoke area under their jurisdiction, are required under the law to operate continuous monitoring survey for air pollution. In certain larger municipalities, those administrative functions are delegated by the prefectural authority to those municipalities. Concerning the control of noxIOUS gases, vapour and fume, the lawi provides special provision for accident handling procedure, and those substances such as HF, H,S, SeO" HCI, NO" SO" CI" SiF" COCI" CS" HCN, NH" Pel" Pels, P, HclSO" HCHO, PH, and C,H,O are designated as the specific noxious substances. Recently, auto-exhaust control has been getting social concern in larger urban areas, and Ministry of Transportation started to regulate CO in auto-exhaust gas to be less than 3% by volume as for the new cars to be produced since September 1967. The Environmental Pollution Control Service Corporation was established in 1965 by the government fund in order that the industry obtains the loan with low ,interest from the Corporation for the purpose of installing necessary facilities required under the Air Pollution Control Law for enforcing rigid emission standard. Needless to say, prevention is the most important approach in the air pollution controL Since the fiscal year 1965, pre-siting studies have been conducted in 8 districts by Ministry of Health and Welfare. Among them, the field surveys of atmospheric diffusion, using Huorescent Because of the enactment of the new Air Polluparticles, have been conducted in 7 districts.

tion Control Law which abolished the former Smoke Control Law, tbe emission standards of sulfur dioxides and dust will be changed, and the auto-exhaust gas will be: regulated under

39-

the new law after December 1968. During the last few years, scientific research on air pollution has heen rapidly expanding year by year. tion. Ministry of Health and Welfare shared the efforts, from the stand-point of environmental analysis and evaluation, on effect study and also source study under its jurisdicNational Air Monitoring Network project, equipped with high level automatic air moniThey will toring machines in the small stations was started in 1965, and has 7 spots in 1968_ be expanded to 20 spots in a few years. 9 local governments have adopted the automatic monitoring network by tele·meter system_ The data of SO, concentration, particulated matters, wind direction and velocity, etc_ are sent from each monitoring station to the central stations by the wire or wireless system. Some of the larger local governments are using electronic calculators in order to supervise the data_ Ministry of Health and Welfare has been subsidizing the local governments for the system_ .2. Water Pollution Control The Economic Planning Board of the Prime Minister's Office has primary power and responsibilities for execution of the "Water Pollution Control Law," and Ministry of Health and Welfare shares the responsibility from the view-point of protection of public health_ specifically designated by the law. 128 public water areas were investigated in these 9 years, and 23 public water areas have been Standards of the qualities of water of those 23 public water areas have been also provided, and natures and characters of the waste-water to be discharged into those public water areas from the factories are regulated under the "Industrial Wastes Law" which is enforced by Ministry of International Trade and Industry. 3. Noise Control In order to cope with noise problems, a number of prefectures and cities have already As the noise has become a nation-wide problem, however, the The Law regulates noises

enacted their own regulations_

Government has established Noise Regulation Law in May 1968_

coming from industrial and construction work by way of the notification and advice for the improvement in case that the noise from sources does not accord with the noise regulation standards_ As for the studies of nOIse problems, the Ministry has made the studies on the actual status of noise in Metropolitan area, on the legislation of noise regulation and on the physiological and social effects of noise since 1965. 4. Others There have been 4 big accidents due to trace metal poisoning smce 1953. As for one of

them, the so-called "Itai-itai-byo" (Japanese word for "severely painful disease"), the Ministry has revealed in May 1968 that its main cause is the chronic cadmium poisoning, and the patients have taken water and food (mainly rice) polluted by the cadmium which has been discharged chiefly from a mine. The accident involved 73 patients, 150 people required observation, and perhaps .-~

more than 100, at least 56 death toll. The Ministry intends to investigate the environs of other mines which produce cadmium and also conditions of the environmental pollution due to mercury discharged from factories using it this year.

40-

20. Food Sanitation 1.

Food and Veterinary Sanitation

Food Inspection 5,058 food inspectors (including 4,211 inspectors holding an additional post) were stationed They performed inspection on the

in 832 Health Centers to work on 2,652,694 food-handling establishments including 1,272,715 establishments which are not required to be licensed)_ establishments and supplies of food and drinks as to their sanitary handling. 2. Food Poisoning During the year 1967, the reported food poisoning cases were food poisoning cases). The details are shown in the following table. Table 20. ~--

total 1,565, involving

39,760 patients and 120 deaths (for 1966, 31,204 patients and 117 deaths in a total of 1,400

Analysis of Food Poisoning.

i - _________+-'_ _ _ _ _ _ _ _ _ _ _ _ _

Causes of food poisoning

i Bacterial infection and

!I:-P_O_iS_O~~gOLses -+1____r_a_~_l:e_~_~___I'---__ ~_~_·_t'h_f_ __ , 666 21 157

l-c-b~ee-n_m-te-i:-:-~t-:-:-i:-o-n-in~---! Poisonous plants and animals

- - ---

--13-- --_-_-_-__ _ 264

-1-7-~_--_-_-1--~-__

3 975

- - - - - - - - - - 1 - - - - - - - 1 - - --622 Causes unknown ---------+-------------~--- Type of food ! Fish, shellfish and their 659 9 438 I products causing ',-- - - - - - - - - - - - 1 - - - - - - - - 1 - - - - poisoning I Cereals, vegetables and 215 5246 their products 97

1 - - - - - - - - - - - 1 - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - -, Milk, egg, meat and their products 56 122

6 286 4 196

o 1

, II

---------------------1--- .--------I----------~I--------------I I---~---~---------~-----~-------L---------I 94 Kind of places I 750 6 890 I Home ----------1---------1-------where the I Mass-feeding establishment I I 1

Other food

Other unknown food

513

14 594

14·

causative

food was taken

of business place, school,

389

23 941

hospital, etc. Hotel

_____

1 _ _ _. _ _ _ _ _ _ _

___________

-+1

_ _ _ _ _ _ _ _ _ __

,100 III

2 601 1 612

1 7

Restaurants Other places

133

3 500 _L_ _ _ 1_2_16 ___

I 1

I L.______~_O_th_e_r_un_k_n_o_w_n~p_la_c_es _ _~_______8_2___

~______7___

41-

Food Additives Chemical synthetics used as food additives are fully controlled by authorization system by

the Government, and they are listed in the Enforcement Regulation of Food Sanitation Law. Approximately, 363 chemical synthetic food additives are authorized for use at present. The manufacturers or processors of synthetic food additives or their preparations are required to have a qualified self· inspector by the law. In addition, the additional certification system is applied to coal·tar colours and several other food additives. These specified additives are required to be tested for each lot and to be certified by the Minister of Health and Welfare or the Prefectural Governor concerned before sale. 1968. 4. Pesticide Residue in Food Pesticide residues in some fruits and vegetables have been investigated from 1964 to establish the tolerance in food. In 1965, apples, pears, grapes, strawberries, cucumbers, In 1966, pears, strawberries, tomatoes, green tea, radishes, cabbages, and rice were examined for pesticide residues. Long·term toxicity test of some pesticides was also carried out for animals. tangerines, green tea, cabbages, radishes, peaches, potatoes, spinach and rice were investigated. In 1967, mandarin oranges, peaches, potatoes, spinach, egg· plants, Chinese cabbages, Welsh onions, onions, carrots and rice were investigated. In 1968, rice, egg· plants, Chinese cabbages, \Velsh onions, onions, carrots, turnips, pumpkins, Spanish paprikas, and burdocks are being investigated. In March 1968, tolerances for r-BHC, DDT, parathion, arsenic and lead in some fruits and vegetables were established as follows. Table 21. ---~~---

The use of dulcin was forbidden in July

Established Tolerances for Pesticide Residues in Some Fruits and Vegetables. (ppm)

---

r- BHC Apple Grape Cucumber Tomato

DDT

Parathion

Arsenic (as As,O,)

Lead (as Pb)

0.5 0.5 0.5 0.5

1.0 0.5 0.5 0.5

0.3 0.3 0.3 O. 3

3.5 1.0 1.0 1.0 --~~---

5.0 1.0 1.0 1.0 ----~~-

Inspection of Imported Foodstuff The imported food is inspected by the inspectors of Ministry of Health and Welfare who During the year 1967, 15,185,000 tons of food·

are placed at the main ports in this country.

were imported, and approximately 510,000 tons of food were either rejected or ordered to give additional process to make them safe for human consumption as the result of inspections. These were soyabeans containing morning glory seeds, milk products contaminated with bacteria and mould, confectioneries coloured with unauthorized coal-tar colour, and other food decomposed due to mishandling.

Veterinary Sanitation About 2,500 veterinarians engaged in the work for meat inspection. There are 781 slaughter-houses; 18 of them are operated by the prefectural authorities, 325 by cities, 206 by towns or villages, 107 by associations, and 125 by private individuals. The following table

42-

shows the number of food animals slaughtered and of carcasses condemned during the year 1967. Table 22. 1 _

No. of Animals Slaughtered and Carcasses Condemned. Cattle

(1967) Total 11 286 122 1 345 3:1 4545 5 033 190

I Calves I Sheep 150 3971 17 1 179 7538, 15 1041 0

Goats

I Swine 1: 1 294 3 841 ,

Horses

Total No. slaughtered No. prohibited from slaughtering No. of condemned carcasses No. of condemned parts

598 2091 30, 4661 166 839:

137 005110 329 376

56 0311

4 I 1310 1

3 661 4 846 204: I

8367 ,

The rabies control programme is also under the veterinary sanitation programme in Japan. During the year 1967, under the provisions of Rabies Prevention Law, 2,693,209 dogs were registered, 4,364,560 were immunized, and 676,262 stray dogs were caught. cases of rabies in dogs after 1956, and in humans after 1955. There has been no

21. Intake of Nutrients The food consumption the years 1950~ 1960 In

Nutrition

Japan has been increasing recently, and the Table 23 below However, it should be noted that the data for For are not comparable, because of the following reasons.

indicates yearly increase of essential nutrients. and 1964~ 1966

the years between 1950~ 1963, the nutrition survey was conducted 4 times a year, but it became only once a year after 1964 since the survey method was changed then. The data for the former periods were obtained based on the survey made in May and the latter on the survey made in November. Besides, the change of survey method involved the revision of "standard table of food composition," some food composition for the former year period and the one for the latter differ each other.

1---Calories Protein (g) Animal protein (g) Fat (g) Carbohydrate (g) Ca. (mg) Vitamin A (1. U.) E, (mg)

Table 23.

Annual Change of Nutrients (per capita per day) 1950 2 098 68 17 18 418 270 1955 2104 69. 7 22.3 20.3 411 338 1 084 1. 16 0.07 76 1960 2096 69. 7 24. 7 24. 7 399 389 1 180 1. 05 1964 2 223 74.4 28. 7 34.3 398 476 1 492 1'-00;-'1 2 206 74. 9 29.3 39. 7 380 499 1 600 1. 03

1. 52

LOS 0.82 114

E, (mg) C (mg)

O. 72 107

O. 72 75

O. 90 118

Nutrition Guidance 1.

Nutrition Guidance at Health Center The nutrition guidance programmes are prepared by the Ministry of Health and ,Velfare,

-43-

and are transmitted to the prefectural and municipal authorities, which then give instruction to the Health Centers for the actual performance of the services to be rendered directly to the people in the districts. The Health Center usually has one or more qualified nutritionists to run its nutrition consultation office. The main duties of health center nutritionists are: (1) give consultation for those who visit Health Center; (2) hold educational sessions for nutrition improvement in the districts; and, (3) look after the nutritional needs of the institutional people or group of people who are fed by group-feeding programmes. The number of such nutritional guidance given by the nutritionists of the Health Centers in each year between 1960 to 1967 are shown in Table 24, below. 2. Demonstration Kitchen Car The mobile nutrition demonstration services have been continuously being operated. type They are called "Demonstration Kitchen Cars," which are the busmobile kitchen cars, completely I I

Table 24.

Annual Change of Number of Guidance given by Health Center Nutritionist. (196~1967)

equipped with necessary cooking utensils, supply of water and gas fuel, for nutrition ~--

Total No. of Persons received Individual Guidance 1960 61 62 63 64 65 66 67 1 1 1 1 1 1 1 1 269 363 397 400 431 378 361 423 059 043 642 954 074 229 396 146

Total No. of Sessions held in Group Guidance Programme 71 709 69 445 74671 77 591 81 494

demonstration,

and

the

trained

nutritionists are using them for lecture demonstration on preparation and cooking method for the balanced diet for the house-wives and women's group. At present each prefecture has at least one such car for that purpose. , I I

80 467 85 702 86162

Mass Feeding Many mass feeding facilities in those places such as hospitals, schools, working places, etc. have been organized after the last World War from the view-point of nutrition improvement_ Particularly, the school feeding has spread throughout the country, and at present over a half of the children of primary schools benefit from complete school lunch programme.

National Nutrition Survey Since 1946, the national nutrition survey has been conducted four times every year order to determine the condition of nutrition of the entire population. and also blood pressure are surveyed. In

In the survey, intake

of nutrients, physical measurements, physical symptoms probably due to nutritional deficiency, However, in 1964, the procedure of nutrition survey was revised for the purpose of preparing more clear information on the actual nutrition status of people which has been remarkably changed due to the improvement of mode of living, and it is now carried out only once a year.

Nutritionist The license of nutritionist is given to those graduating from the training school of 2 to 4 years authorized by the Minister of Health and Welfare or to those successfully passing the national examination for nutritionist. There are 213 authorized nutritionists training schools and about 116,000 licensed nutritionists at the end of March 1968.

44-

Cook The Cooks Law stipulates the authorization of training institutions for! cooks and their supervision, and examination for qualifying cooks. There are 101 authorized training schools and approximately 600,000 licensed cooks at the end of March 1968.

Enriched Food The taking of enriched food has been strongly advocated by the Ministry of Health and Welfare, and at the end of March 1968, the number of enriched food perIlilitted by the Ministry in accordance with the provisions of Nutrition Improvement Law amounted to 1,541. Those food such as the rice, flour, bread, noodle, bean'paste, jam, soft drinks, canned fruit, biscuit, etc. are enriched with vitamin A, thiamine (vitamin B,), riboflavin (vitamin B,), vitamin C, calcium, iron, lisin, etc. Particularly, the enriched rice has been encouragfd. When enriching rice, 1 gram of rice containing 1.2~ 1.5 mg. thiamine and a bit of riboflavin will be mixed in the polished rice at the ratio of 1 to 200.

Health Promotion In the recent years, the necessity of promoting positive health which is not merely directed to the prevention of any particular disease or disorder but rather to serve for further improvement of general health and well· being of the people has been emphasized. Through vanous information media and active participation of civic and voluntary organizations, health promotion campaign and movement are actively carried out to disseminate idea on healthy living with good standard of nutrition, exercise, rest and recreation. Because of having high tem· perature and high humidity in summer season, we have particularly an active campaign during summer, called "health promtion in summer time."

22. Prevalence of Dental Caries

Dental Health

The latest dental survey in our country is the one made in 1963, which revealed that existence of high percentage of prevalence of dental caries in all age-groups; ,it was 69.1% In

male and 73.6% in female, 71.6% in average. According to the results of the recent school health survey, it seems that the increasing trend of prevalence rate of dental caries among school children has been continued.

Dental Health Activities At 120 Health Centers out of a total of 832 Health Centers, 68 dedtists and 90 dental hygienists are engaged in dental health work, and the schools are playing important role in carrying out preventive programme on dental health among school childtten through dental examination and health guidance. Each school has the school dentist in accordance with the School Health Law. Dental examination, health guidance and advictl are being given effectively in these facilities, and particularly many schools have been taking proper preventive measures in their own facilities.

-- 45--

Since 1952, in accordance with the Maternal and Child Health Law, the dental examination and health guidance for pregnant women and infants have been carried out in the Health Centers or by guidance dentists designated by the Law; 227,080 dental health guidance for pregnant women and 1,701,190 for infants were given during the year 1967. During the same year, 1,760 pregnant women received oral prophylactic treatment, and 264,004 infants received topical application of fluoride and oral prophylactic treatment, as the preventive treatment programme. Based on the same law, the programme of dental examination and dental health guidance for 3 year-old children was carried out, and 1,031,570 infants were covered by the programme during the year 1967 as shown in the following table. Table 25. Results of Examination for 3-year-old Children. Number of Children Total Dental caries 1 031 570

(1967)

------------------------------~---------------------,---------------------

I I

Percentage of Children 100_ 0

805 536 ---

Malocclusion ______

'-1 ______

---=--==:...J__ ~_:_:_~e~se:a~i~y'Oft ~I--tis::,':_____

-1--------

-----78_-1- ---

= +::: 40765

- ---I----------~-----I

!_ _ . :: j

The Department of Dental Health Research of National Institute of Health has been conducting many researches on the prevention and treatment of dental disease and dental health. The information on the number of dental clinics, dentists. etc. can be found in Chapter 27 (pages 52 and 56).

23. Legislation

Mental Health

The mental health programme has increasingly attracted public and professional attention in these years. accelerated. Under the Mental Health Law, in addition to the provisions of institutional care for the patients, the communiy care and the preventive work in mental health services are Services for the mentally retarded children and child guidance activities are In order to extend service for the mentally retarded provided under the Child Welfare Law.

people in general, the Law for the Welfare of Mentally Retarded Persons was also enacted. In order to promote the welfare of severely-feeble-minded children as well as severely physically handicapped children, the special child allowance is granted under the Special Child Allowance Law.

Surveys Since 1954, four special statistical surveys on mental health were carried out by means of stratified sampling on a nation-wide scale, summaries of which are as follows: (1) mental health survey in 1954, the purpose of which was to clarify prevalence of mental disorders, (2) statistical survey in 1956, for hospitalized mental disorders, the purpose of which was to know actual

-46-

status of hospitalized cases from the medical and social view·points, (3) statistical survey in 1960, for attitudes of the mental disorderd persons or their families toward medical treatment, a part of which cases was placed under observation for follow.up survey in 1961, and (4) mental health survey in 1963, the purpose of which was the same as that of 1954 survey. According to the survey in 1954, the estimated prevalence rates of mental disorders were fond to be 1.55% in male, 1.41% in female and 1.48% in total, respectiviely, and the per· centage distribution by sex of cases was 50.7% in male and 49.3% in female, respectively. While the same survey of 1963 revealed that the prevalence rates were 1.4~% in male, 1.18% in female, and 1.29% in total, and the percentage distribution by sex of Cases was 53.6% in male and 46.4% in female. The followings were, on the other hand, revealed by the survey in 195$. 61.4% of a total was the male patients and remaining 38.6% was female, which showed a comparatively higher proneness of hospitalization of patients as much as the sex distribution of morbid cases in the community is concerned. 70.0% of a total was schizophrenia; while, 15.$% of a total was schizophrenia, according to the percentage distribution by diagnosis of mental disorders in the prevalence survey in 1954. Percentage distribution by duration of stay in hospital at the time of survey of the hospitalized mental disorder was broken down as follows; less than 3 months 20.9%, 3~6

months 13.5%, 6

months~l

year 13.6%,

1~2

years 16.5%,

2~5

years 22.4%, and

over 5 years 13.0%. According to the survey in 1960, the estimated number of newly att~nding cases to the mental hospital in a year was approximately 254,000. The percentage distribution by diagnosis of cases in 4 surveys are shown in the following table. Table 26. Percentage Distribution by Diagnosis of Mental Cases. ----

Morbid Cases in the I Inpatients in Community in General Mental Hospital

1954 Total Sch izophrenia Manic depressive psychosis Epil epsia Mental disorder due to intoxication Oth er psychoses such as those due to brain i~juries Mental deficlency Other types of mental disorder (including neurosis) I

I 1.lj 9.6 7.01 8.71

1956

I (survey in 1956D 100.0 70.0 3.7 3.8 2.3 12.6 3.0 4.8

Newly attending Cases to Mental Hospital (survey in 1960)

100.0, 15.51

100.0' 17.8[ 1.6

100.0 24.1 8.4

8.11 5.5 1 18.6 ?

9.9 4.3 10.8 3.5 38.0

44.5

13.51

Hospitalization Expense Since 1961, the hospitalization expenses for mental cases to be paid by Prefectural Gover. nment for compulsory hospitalization has been subsidized by the National Government with the ratio of eight tenth. Since 1965, one half of the total expenses to be born by the Prefec· tural Government for daily clinic attendance by patient has been subsidized by the National Government. The hospitalization expense for mental cases is paid out from the public fund obtainable under Mental Health Law, Daily Life Security Law, Social and Medical Insurance,

-47-

or self-payment.

Mental Hospitals The latest figures of hospital accommodation for mental patients are shown in Table 27, below_ The latest figures of mental hospitals (excluding the psychiatric units in the general hospitals), their beds, hospitalized patients, bed occupancy, and monthly outpatients, are shown in Table 28. Table 27. Psychiatric Beds. Total

~~Beds I Year ~

National, Prefectural and Municipal ,

.: .!

1955 56 57 58 59 60 61 62 63 64 65 66 67 Note: (1) (2)

982 502 542 658 953 354 182 22 075 23 492 25 842 27760 30 769 33 475

10 12 14 15 16 18 20

27.3 25.7 24. 1 22.5 21. 2 20.5 20.3 19.6 18.2 17.8 16.9 16.9 16.6

I I

Private, Juridical Persons and Others

29 254 36106 45840 53 814 62 831 70960 79 150 90 674 105 357 118981 136 150 150 940 168 348

72.3 74.3 75.8 77.5 78.8 79.5 79.7 80.4 81. 8 82.2 83. 1 83. 1 83.4

I I I 40 236 48 608 60 382 69472 79 784 89 314 99 332 112749 128 849 144 823 163 910 181 709 201 823

100 100 100 100 100 100 100 100 100 100 100 100 100

All psychiatric beds include beds in the mental hospitals and general hospitals. Data are as of the end of June. Table 28. Mental Hospitals, their Beds and Patients. , 1

(end of Dec.)

, Mental hospitals Mental beds Inpatients Bed occupancy Monthly out·patients Monthly out·patients per 1 hospital

1960

1961

I 1962

1 1963 I

1964

1965

1966

1967

54..1 506 583 6291 676 7251 769 818 1 73 839 81 960 92 317 105 046, 117 758 130 113 142 938 157 498 75 669 83728 95 592 110 050 124 191 136 708 151 956 166 592 110.5 Ill. 1 109.8 110.8 105.8 108.1 108.4 110.6 116 172 135 002 157 219 185 520 209 307 230 088 261 4951335 876

230 1

249 1

270

295 1

310

317 1

340 1

411

Note: Figures for 1967 are provisional.

Health Centers and Mental Health Centers The service for consulation, counselling and home visit guidance on mend health are being given at 832 Health Centers under the provisions of Mental Health Law, while the research and study, dissemination of correct information of knowledge on mental health, counselling and ./... guidance, and technical guidance to the health center staff, etc. are being done at 18 local Mental Health Centers, the number of which will be increased to 28 by the end of March 1969, and it is expected to be increased to 46 by the end of March 1972 so that we could have at least one Mental Health Center in each prefecture.

48I

Child Guidance Centers Under the provisions of Child Welfare Law, each prefectural and larger municipal authorities are required to establish the Child Guidance Centers which provide ti)e child guidance and counselling service, and at present a total of 138 centers is functioning. The main work of the center includes: 1) such administrative service on placement and accommodating those children with problems at various types of child welfare institutions (now, 14 types), like homes for dependent, neglected and abused children, etc., and 2) such guidance service for the childrens with problems as diagnosis, counselling and guidance from medical, psychological, pedagogical, sociological and psychiatrical standpoints. The yearly number of cases handled at the centers reaches almost 300,000 as in particular, many cases require counselling relating to sound development of children, such as problem of aptitude, adaptability, breeding, long absence from school, school phobia, etc. Table 29. Intake Case Load in Child Guidance Centers. (1 May 1967 and 1968) Intake case

Figures

% 1968 258783 95 749 43486 32 377 35 976 28911 22284 1967 I

1967

1968

Total Problem of aptitude, breeding or character Mentally retarded Health, physical handicap, speech, visual or hearing disorder Delinquency and pre-delinquency Protective measures

265 277 92 605 43 774 33 089 41 925 32 816 21068

100.0 35.0 16.5 12.5 15.8 12.4 7.8

roo. 0 37.0 16.8 12.5 13.9 11. 2 8.6

Others

Care for the Mentally Retarded The number of those mentally retarded children who were under the care of Homes for Mentally Retarded Children (267 homes in all) reached 17,412 at the end df December 1967, and the number of those children who were attending Mentally Retarded Children Day Care Centers (70 centers in all) reached 2,509. The National Home for Mentally Retarded Children has been operated particulary for the severe cases of mentally retarded children. All of them are now operated under the Child Welfare Law. Under the provisions of the Law for the Welfare of Mentally Retarded Persons, each prefecture has the Prefectural Mentally Retarded Persons Consultation Center, and besides, 6,680 persons were under the care of lO2 Homes for Mentally Retarded Persons .as of the end of December 1967.

Training and Education of Juvenile Delinquents The children commiting or liable to commit delinquent acts are admitted to the Home for Training and Education of Juvenile Delinquents where they are giving traiming and education

-49-

under the Child Welfare Law. As of 1 March 1968, there were 4,462 juvenile delinquents who were accommodated in 56 homes, two national homes, one for boys and the other for girls.

24. Medical and Social Rehabilitation Service

Statutory Provisions and Organization for the Service As for the rehabilitation services for the physically handicapped persons, it is provided under the Law for the Welfare of Disabled Persons that it is the duty of the Prefectural Go· vernors to establish and operate the Consultation Centers (53 centers in 1968), where the adults of the blind, deaf, crippled, and cardiac or pulmonary function insufficiency could be examined and receive the guidance from the medical, psychological and vocational standpoints, and to provide the Prefectural and Municipal Social Welfare Offices (1,052 offices in 1968) with the staff specialized in the services for the welfare of physically handicapped persons. The provisions of the services for the physically handicapped children under 18 years of age are included in the Child Welfare Law. the Health Centers. In this case, Consultation Clinics are provided at

New Rehabilitation Staff In June 1964, the Law for Physical Therapists and Occupational Therapists was enacted III

order to establish legal system for qualification and licensing for physical therapists and

occupational therapist in order to develop and strengthen the medical rehabilitation programme. Under the law, the license for those profession can be given to those who successfully pass the respective national examination. As of April 1968, there were 6 physical therapist training schools, and 2 occupational therapist training schools. Among those schools, the School of Rehabilitation attached to the Tokyo National Chest Hospital established in 1963 for training both of the professional workers has been receiving WHO assistance in the form of fellowships and experts from 1964 to strengthen the education programme for PT and OT. There are now a total of 721 physical therapists and 130 occupational therapists who have passed the national examination for their respective professions under the above-mentioned Law.

Blind Persons Blind persons and persons with defective vision are provided under the laws with walkingsticks, artificial eyes, pairs of glasses, etc., and if necessary, with the medical treatment for the recovery of vision. require. There are 5 national, 3 prefectural and 2 private Homes for Blind Adults where the blind adults are given vocational guidance and medico-psychological treatments they The blind and partially sighted children are received in 32 Homes for Blind Children Blind Children. There are several publishers who are and are educated at 75 Schools for

publishing books in braille points, and 32 libraries for the use of the blind.

50-

Deaf Persons Persons with deafness or defective hearing are provided with various hearing aids and medical treatments for the recovery of hearing. The National Rehabilitatio'!- Center for the Deaf and Mute is giving the comprehensive medico-psychological treatments and vocational guidance to the persons with deafness or defective hearing. There are 2 Homes for Deaf Adults, 37 Homes for Deaf Children and 107 Schools for Deaf Children. Crippled Persons The crippled adults and children are provided under the law with pro$thetic appliances, wheel-chairs, etc., and medical treatments, in case of need. The National Rehabilitation Center for the Physically Handicapped in Tokyo and 45 Prefectural and one private Rehabilitation Centers provide the crippled adl,llts with medical treatments, physiotherapy and vocational guidance. In addition, there are 2 National and 11 Prefectural Rehabilitation Centers for the Severely Crippled Adults. The Bospital-Homes for Crippled Children provide integrated services of medical care and rehabilitation for the severely crippled children. As of 1 April 1968, there were 7,209 accommodations for children at 71 Hospital-Homes for Crippled Children all over Japan. As of 1 May 1967, in addition to the hospital-homes, there were 63 special schools and 215 special classes for the crippled children for their school education. There were 23 hospital-homes for severely multiple-handicapped children for their medical care. As for the adults of cardiac or pulmonary function insufficiency, there are 22 public and 7 juridical rehabilitation facilities for the disabled of internal organs, where the medical care and the guidance and training necessary for rehabilitation are given.

25. Radioactive Isotope and Peaceful Use of Atomic Energy

The use of radioactive isotope (RI.) commenced from 1950 is now extended to more than 1,500 institutions in Japan. It is mostly used in medicine in the field of research, diagnosis, and treatment, which is about 35% of the total institutions. The government organizations responsible for the development of peaceful use of atomic energy in Japan are the Atomic Energy Commission and the Atomic Energy Bureau, Science and Technology Agency of the Prime Minister's Office. While the Promotion Section of the said Bureau is the main body among national government agencies dealing with the production of R.I., planning and execution of its use, the prevention of hazard that may occur through the use of RI. is in the hand of Radiation Safety Section of the same Bureau. The necessary measures for radioactive fall-out are to be carried out by the Environmenta! Radioactivity Section of above Bureau under the decision of the Headquarters of Counter-Measures for Radioactive Fall-Out established within the Cabinet. The various Ministries are sharing the respective responsiblities in the research work and the use of RI. in the field of their own concern. Various research work <1m the use of R.I. in the field of public health is being carried out at various research institutes attached to the

-51 -

Ministry of Health and Welfare, and particularly, the Department of Radiological Health of Institute of Public Health is the main one. The laboratory facilities for RL at those institutions are being strengthened and expanded under the current year to carry out more intensive research work. The use of RI. in the field of medicine for diagnosis and treatment is also being done at the National Cancer Center and some of the National Hospitals. The National Institute of Radiological Sciences established in 1957 under the jurisdiction of the Science and Technology Agency is dealing with coordination of research work on the medical use of RI. and prevention of radiological hazard. For the purpose of preventing possible health hazards from radiation that may occur along the development of peaceful use of RI., the Law concerning Prevention of Radiation Hazards due to Radioactive Isotopes and Others is enforced. While, in order to prevent possible bazard that may occur at the medical institutions and drug manufacturing factories, the neccessary requirements are provided in the Enforcement Regulations for Medical Service Law and tbe Enforcement Regulations for Pharmaceutical Affairs Law. Those law and regulations related to radiation hazard are in comformity with almost all the principles of the Recommendations of the International Commissions on Radiological Protection, for which acceptance was advised to the Prime Minister after study made by the Radiation Council. As to atomic reactors in Japan, there are now 21 reactors, 11 of them are for physical research purpose in some of the universities and the private research institutions, and 2 of them are the power reactors. Other 5 power reactors are now under construction. The Atomic Energy Commission worked out a Long-Range Programme on Development and Utilization of Atomic Energy in April 1967. The new programme aims at an effective stepping up effort for the development of power reactors, an efficient use and stable supply of nuclear fuels, the development of a nuclear ship and the utilization of radiation which includes radiation chemistry and food irradiation. In accordance with the utilization and development of atomic energy, the greater efforts for such safety measures as safety standard in and around the institute sites, counter-measures for radiation hazards and treatment or disposal of radioactive wastes, are required.

26. Occupational Health The occupational health programme in Japan, where the term "industrial hygiene" is used, is based on Labor Standards Law, Pneumoconiosis Law, Ordinance on Protection of Ionizing Radiation Injuries and other concerned regulations, and is carried out by the Ministry of Labor through the inspection system by more than 2,000 labour standard inspectors who inspect the health condition of the facilities. ssary preventive measures have been taken. , ~. compensation scheme for their treatment. Pneumoconiosis, organic solvent poisoning, caisson The patients are given benefits out of workmen's diseases, and ionizing radiation injury are the major occupational disease problems, and neceUnder the Labor Safety and Hygiene Regulations,

the enterprise engaging in manufacturing business which have more than 50 workers and those non-manufacturing enterprise having more than 100 workers are required to appoint the health supervisors duly licensed by the Government.

52-

27. Medical Service Hospitals and Clinics Medical Service Law provides the detailed qualification for hospitals (medical care facilities having 20 or more beds), while the law does not provide such detailed requirements in case of clinics (medical care facilities having no bed or with less than 19 beds) imd the administrator of such clinic is required not to keep their patients for more than 48 hours except when inevitable circumstances occur. The hospitals are inspected yearly by the medical inspectors as to their physical facilities, professional staff, and hospital management. This inspection system contributes greatly for the improvement of hospital services to the patients. It is true that the number of hospitals and their beds has increased rapidly in the recent years as far as ratio per population is concerned. However, we confronted with the problem of inadequate > •

hospital planning and distribution which resulted in receiving complaints of scarcity of medical facilities in rural or mountainous districts. In order to relieve the problem, the Medical Service Law was amended, and since 1963 it became possible for the Government to exercise its authority in controlling planning and distributing public and non-profit hospitals_ Because of the progress of medical science, it is neccessary to improve the service of medical institution as well as to increase the number of hospitals and clinics in order to meet the increasing demand for medical care followed after expansion of health insurance system. F or that purpose, in addition to the specific subsidy or financial aid given t<D the national and public hospitals by the National Government, the provisions have been made by the Law for Medical Care Facilities Finance Corporation to enable the private hospitals and clinics to receive low-interest and long-term loan for their facilities since 1960. Because of the increase of road traffic accidents in these years, the system for emergency medical care was revised in Februry 1964, and the network of emergency medical care was estabushed. AB of 31 March 1968, the number of those facilities, either public or private, During the same year, a nation-wide survey on the actual condition of ambureached 3,892.

lance medical care facilities and their services was carried out under the joint sponsorship of Japan Medical Association for the purpose of obtaining data which are necessary to make further improvement of the system. The following tables show the number of hospitals and their beds. Table 30. Annual Change of Number of Hospitals, General Clinics and Dental Clinics. (as of the end of Dec.) Hospitals General Clinics 60 301 61 366 62 363 63296 64 524

Year 1961 1962 1963 1964 1965 1966 1967

Dental Clinics

6 229 6428 6 621 6838 7 047 7308 7505

65 679

27 263 27 488 27 869 28150 28 602 28 893

-53Table 31. 1

Number of Hospitals by Type and Kind.

(1965 and 1966) General Hospitals

Total

. CommunicaMental I Tuberculosis l L Hospitals Sanatoria eprosarla ble Disease Hospitals

196511966

1965 11966

1965

i 1966 76 (65)1 1

144814461 National . (268)1 (266) Prefectural and municipal 154 11 154 1 1 Semi· public 3121 312 SOCIal Insurance Private ? 16_1 1631 4 97115 233 i 6 047 7 308 I 1

(~)I

d)1 411 11 724

97 (86) 50 4 1

196511966 196511966 11 111 (11) (11)

3~1 6821

43. 41 ,

=1 1 3

Grand total Note: 1)

~ m

!--~

~ ~ ~

13 176

12 1481 ~

1 3

~ ~

f" "" 1 1

196511966 1(68)' (187)

41 1 02011 029 307. 307,

I __ ~

1491 __

151 1

11' ~

-'14 109 4 358,

___

415~6~1 L-~

Those figures in the brackets are those directly under the jurisdiction of the Ministry of Health and Welfare. 2) Those semi·public facilities include hospitals operated by the Japan Red Cross Society, etc. Table 32. Number of Hospitals, Beds, and Bed Occupancy Rate.

(1966 and 1967)

Number of Hospitals. 11

(as of the end of Dec.)

Mental L . Communicable I General u b erc Iosis 1-____ K. ind.o ..f ..H ... O.s-----.pital .. Year lT i T tal a S · H ' eprosana 1I DIsease . . . anatona ospltals HospItals HospItals I____________ ____ _______- L_______ Number of hospitals 19661 7 308 283 7691 14 41 6 201 1967 7 505 250 818 14 39 6 384 ~~~~~ ~

1------·---------- - - - . 1966 918 233 Number of bed 1 1967 963 113

13 230 713 173 2 968 13 230 2 914 749 107 1 1 Note: Those mental, TB, leprosy and commulllcable dIsease beds at general hospItals are counted as the beds of general hospitals. 45 924 40 208 142 938 157 654 b. Number of Beds and Bed Occupancy Rate. -. .

------------

1 Kind of' I bed for 1--1 Total I " ______ I Year 1 1 Number of bed 1 19661918 2331 1967 963 113

1Mental case I Leprosy 191 597 1 210 6271

Communicable

I General

Disease

case

211 5271 204 945

13 230 13 230

23872 23 789

478 007 510 522

74.2 20.0 79.8 73.81 108.81 72.0 106.6 72.8 81. 2 11.41 1 I .. Note: "Bed Occupancy rate" refers to the number of m'patIents per 100 beds of the offICIal rated Bed occupancy rate

I 19661 1967,

82.51 82.71

capacity.

Medical Care Personnel Better standard of qualification for medical care personnel and their number have always been the matter of great concern for the Government. Table 33, next page, illustrates the educational qualification requirements for various personnel as of August 1968. As to medical doctor, under the revision of Medical Practitioners Law effected on 15 May 1968, one year internship compulsorily required for the medical school graduates before receiving national

<"'-

examination is now abolished, so that they can obtain the license to practice after successfully

passing the national examination, although 2·year residency training is still recommended. Table 34, page 55 shows the numher of training institutions for medical care personnel and students entering annually.

Table 33.

Standard of Qualification Requirements for Medical Care Personnel. ~

General Education Primary SCh~IJuniOr hig~1 S~nior;'igh (6 years). school (3 years) school (3 years) -Medical --Professional Education

Examination

Licensed by

d~ctor ~__ :x.~_ _ XXXX .

_ _ _XX-XX-_1 Pre.med(2

yrs.)~nivfr~gssiOnal(4 y~s.) Umverslty

National __ 1/

illi~alt~i;~~eW~[fare. II 1/

Dentist _ _. _ _ ---

~XX _ _ _ . XXXX_ _ _ XXXX_Pre-phall11~J'Ts.) X X

1_,_" __(4 1

PharmaCIst

._ _ _ _~_~CX~ __ XXXX _ _ _ ~ _ _ Pre-pharm(2yrs.)

UnIversIty

Veterinary doctor . Public health nurse -Public

W--;zxU- -

XXXX

XXXX X X :x.x -

XXXX

Pre· vet (2 yrs.)

I~_ ,___ . ___ ~. _____.__ I___ .-.---_-'UnIversIty 1----, Mmlster of Agn,,(2 yrs.) (4

1------

yrs.)_

_j _ _ _ _ _ _ _ _ 1/.

~ .___ " _ _ i~lture & Forestry_ "

Xx~-X-- - - -U~iversity

yrs.)---I-"~

Heal~i~~erW~lfare "

he.uth~urse(b)

--:x.XXX . ---------;z-XXX

~;zx- --7;~.tclL-1 pn~/)h'I~= ~ ~nXXXX

MidwifeW

------XXXX--~XXX XXXX----XXXX-

University (4 yrs.) I

1------------.

" ______ " ___"_"_

Midwif;(bj - - .

--:x.XX:x.---XXXX-~XXX

~s~~~.)sch. -.

s~t1t~:.) I~I----;;yr~ I~c

Clinical nurse (a) . .-_.-

University (4

._1___._"_____ I

Clini~al nurse (b) . - . -.-.-- . - - - - ~limcal nurs:...(e_)__ Chmcal nurse (d) . .

-X;Z-XXXXXX

XXXX XXXX Nursing sch. (3 ~rs.) - - - - - - ---- - Assistant nurse --P- . (3 ) XX~._XXXX __ training sch(2yr~_ raet!ce. yrs. XXXX Health nurse

1------------------___._,,___ I-NurSing I~ " sch.(2yrs.)___ ~ _" 1/

" _______ 1

course(3 yrs.)

Nursmg sch.

(2 yrs.)

I -- --

--.-. - - - - - - - - . - - - - - - - - - - - - - - Assistant nurse - -

Ass!stant nurse (a) XXX X XXXX - ---- - , - - - . .- - - _ . 1 . b Ass!stant nurse ( ) XXXX X XXX ---. - - - - - - - - - - -Radiology technici~_ XXXX ____ X_XXX

_X-ray~echnieian _ _ _ XXXX _ _ _ XXXX Health1ahoratory technICIan XXXX XXXX - - -----. - - XXXX XXXX Dental hygienist

Prefectural Pref. Exam. train. seh.(2yrs.) Gonernor -Health nurs"---course(3 yrs.) ___ ___ _ _ _" _ _____ .-. ____ _ - - - - - School or trainingl--IN' I MID!ster of XXXX _ _. ,"sch.(3 yrs.).. _ _ _ _ _ _____ atlOna _ftealth and Welfare School or tram-j-· P f E Prefectural __ XXXX _ _ ing 8ch.(2 yrs-L-==c_ __-___ - _~ xam./ Governor

XXXX X}{XX XXXX

(ditto)

- __ _

. . National /,

-_XXXX_,XXXX

~~~~.(~Iy~~tainingl--_==________.- ~___ I/ j (ditto)

JHeal~i~~~erW~lfare

- - - ---

-1Dental technician Nutritionist

XXXX -

XXXX --.--

~;zx-;~~. (1~~a;:~r XXXX XXX X

1-·--- --- ------,;-- --PG~~~~'::;; c Pref. Exam. ' - - - -~ 1 . NatlOnal

1--------------1

. __"_' _ _ _

XXXX XXX X

XXX X XXXX

S<:h. or training I- ---- - -- -- -__ sch. (2 yrs.) Training seh. (2,3,4 yrs.)

Minister of Health and Welfare

,.,

-55Table 34. Number of Training Institutions for Medical Care Personnel and

of Students Entering Annually. (as of July 1968) Number of Training Institutions Physician Dentist Pharmacist Veterinarian Public health nurse University Junior college Others Mid-wife University Junior college Others Clinical nurse University Junior college Others Assistant nurse High school (nursing course) Others X-ray technician Laboratory technician Dental hygienist Dental technician Physical therapist Occupational therapist Number of Students Entering Annually

46 15 34

16 41

U 34

U 344

3 10

{311

767 83 684 21 64 49 25 6 2

3980 1 240 5 853 680 1 170 100 20 1050 835 40 20 775 30 241 100 460 29681 64 067 13 245 50 822 1 015 2310

1 591 920 100

Under the requirement of various Japanese laws, such as Medical Practitioner's Law etc., the person, regardless of his nationality, who is holding a license to practice as the respe· ctive medical care personnel in a foreign country is allowed to practice in such capacity of the respective medical care personnel in Japan only when he obtains the Japanese license concerned after successfully passing the national or prefectural examination. Also, the law does not allow any reciprocal arrangement between the countries concerned as regards qualification for pra· cticing referred to above. The following tables show the number of medical personnel. Although statistically speak· ing, the number of physicians, dentists and pharmacists is about the same as those in European countries on a per.population basis, the Government has been confronted with the difficulties of excessive concentration of those personnel in the urban areas and of lack of qualified personnel in the field of public health work.

-56Table 35. Physician Year

Number of Medical Care Personnel. Public Health Dentist Pharmacist Nurse

Midwif~

Clinical Nurse

Per Total 10,000 No. Pop. IThou" sand, 85 90 92 95,

Total I No.

IThou-) 9.9 10.3 10.5 10.6 10. 7 10.8, 10.9: 10.9 11. 0 11. 0, 11. 11 11. Ii 11. 1 11. 11 11. 2

1952 53 54 55 56 57 58 59 60 61 62 63 64 65 66 Note: 1)

96\ 98 1001 101 103 104 105 107 108

sand' 29 30 31' 31! 32 32 32 33 33 33 34\ 34 35 35 36 1 1

pe;;Pet Per Per Per I 10,000 Total I 10,000 Totall 10,000 Total I 10,000 10,000 Total No. No. No. No. P<Jp. Pop. , Pop. Pop. Pop. 'ThouThou\ ThouThoU-I sand sand sand sand 1. 41 55 6.4 12 12.2 5.B 3.4: 50 105 12.9 6.5 3.5 51 12' 1. 4' 56 112 5.9 6.31 119 51 1.4 56 13.5 5.8 12 3.5'1 1.4 6.2 14.6 3.5 52 12 5.9 55 130 I 1.4 12 6.0 3.5 53 54 5.9 137 15. 2 1.3 6.0 145 15.9 3.5 55 12 S. 7 52i 52' 1. 3; 3.5 57 6. 1 17.4 12: 5.71 160 13; 6.3 3.5 58 1.3 52 5.6 170 18.3 1 4: 3.6 60 6.5 52 5.6! 19.9 13 186 3.5, 62 6.5 51 5.4 195 13 20. 7 1: 41 62 6.6 14 1.4 4.8 50 204 21. 5, 3.61 3.6 65 4.8 14 1.5 46 216 6.8' ~2. 5 3.6 67 6.9' 14 1.4 44 4.5 230 3.8 245 15 24.9 7. OJ 3.61 4.31 1 1. 51 421 3.6 7.2; 14 1.4 46 4. 7 246 24.9i

The number of clinical nurses include assistant clinical nurses.

Data for 1967 are not available yet. Table 36. Number of Physicians and Dentists by Type of Work. No. of Physicians & Dentists - ------- - -

'~-

Physician ---Number

Type of Work

- - - __ ~, -

--I

(1965 and 1966) (as of the end of Dec.) Dentist

Number

1965 55 217 37049 9 749 2 165 226O 2 929

1966 56 5521 36 874' 10 530 1 966 2 368 2469

1965

Owner of hospital or clinic Employed in hospital or clinic Teacher and research worker of clinical medicine Teacher and research "yorker of medicine other than clinical medicine

1 26 9181 6263 1 946' 183 163 1 085

1966 27 167

6 309 1071 184 133 1 158 36 022

Engaged in other public health Others Total

109 3691 1107591 1 Table 37. Number of Nurses and Midwives Actually Engaged in the Work. Type of Work 1

35 558

(1966 and 1967) Clinical Nurses 1)

Public Health Nurse 1 1966 1 1967 ,

1966

Midwives , 1967

1966

19671 643 106 240 323

Nursing school Hospitals and clinics

Health centers Industries

90 544 6 012 911

415i 5994, 804

37\ 7310: 156 -:

Schools Cities, towns and villages

6171 -

- i 6090 I 1

-, _I

51 7694 154

1 341\ 254 423, 312'

23 592 453 2)'

J -

1 101

2 534 5 386 1 234 265 2301

2115 1 559 2)

Private duty Others Total

447

2171 13

35 843! 1 364 I

14 1751

6061

43 7101

31 944!

112 981

Noter 1) The number of clinical nurses include assistant clinical nurses. 2) After 1967, even the one possesses more than 2 licenses for different nursing profession, only one kind of her main profession is counted for the total number of respective profession, whereas each kind of her profession was counted for the total number of each profession before 1967.

57-

Medical Care Statistical Survey 1.

National Health Survey The Government has been conducting National Health Survey (Family Sickness Survey)

and Patient Survey scince 1948, on a nation-wide scale based on the sampling method.

this survey, about 20,000 households or 80,000 people in about 400 areas have been sampled in the recent years, and the incidence and prevalence of diseases and injuries among the people are enumerated by the type of diseases or injuries, geographical area, occupation, economic status, sex, age, etc., and also by the mode of treatment of those diseases and injuries, and by amount of payment by the patients for the treatment. 2. Patient Survey

In the Patient Survey, 732 hospitals

(1~ of the total hospitals), 656 general clinics ( 1~0

of the total general clinics) and 289 dental clinics

(l~oof

the total dental clinics), are sampled,

and to enumerate the number of in·and-out patients who visit those institutions, by type of deseases or injury, sex, age, and by the method of paying charge for treatment, together with the length of hospital in-patients.

Table 38-

How the Diseases and Injuries are Treated. (Based on the National Health Survey in Oct.) I

1961 100.0% 99.3 O. 7 50.4 5.8 3.6 38.7 1.5

1962 100.0% 98.01 1.9 50.5 5.9

1963 100.0% 98.2 1.2 47. 9 7.0 3.3 40.3 1.5

1964 100.0% 98. 2 1.8 48.8 6.8 3.4 39.9 1.2

1965 100.0% 97.8 2.2 53.3 8.4 3. 7 33.2 1.5

Total number of diseases and injures Treated

Not treated Consulted physician Consulted dentist Consulted {acupuncturist, moxa-cauterist massagist or Judo-orthopaedist

Treated by home drug Others ---~-

3.5 ! 38. 7 I 1.4 : I

Note: When disease or injury is treated by two or more kinds of treatment, each of them is counted as one.

Table :l9. Incidence of Diseases and Injuries, and Sick Days among the People.

?Jl Incidence Rate Disease and Injuries

Sick Day ~--~--

1961 1 1962 1 1963 Total I. Infective and parasitic diseases 2 10.

1964 268.11 3.4 0.2 0.4 3.0

1965 239.

1961

1962

1963

1964 I 1965 64. 21 2 924. 8

201.51 5. 1

232.11 3.3 0.3 0.4 2.9 0.4 0.4 14.6 5. 1 95.4 88.2 41. 8 21. 8 1.8 0.4 8. 7 14.4 0.2 20. 1 21. 1.3

4\2 109. 41 2 420. 5 185. 7 127.5 28.6 81. 5 17.8 19.6 286.5

II. III. IV. V. VI.

(s.m.) Tuberculosis Neopla,ms Allergic endocrine system, metabolic and nutritional disease Diseases of the blood and blood· forming organs Mental, psychoneurotic and personality disorders Diseases of the nervous system and sense organs

VII. VIII.

Diseases of the circulatory system Diseases of the respiratory system Acute nasopharyngitis (common cold) (s.m.) IX. Diseases of the digestive system Diseases of teeth and teeth-supporting structure (s.m.) X. Diseases of the genito-urinary system XI. Deliveries and complications of pregnancy, childbirth and puerperium XII. Diseases of the skin and cellular tissue

5.5 0.4 0.6 2.5 O. 7 0.2 12. 7 4.2 83.0 74. 3 39. 7 17. 1 1.8 0.4 9.0 12.0 0.8 19. 7 17.6 1.2

0.3 0.4 2. 1 0.4 O. 2 12.0 3.0 90.2 83.6 35.2 16.6 1.5

3.31 0.2i 0.31 3.01 0.6 O. 1 15.81 5.41

O. 7 0.4 15.6 6.3 118.2 111.3 44. 1 22.6 1.7 0.4 8.4 16.1 0.0 O. 1 24. 1 23.8 1.

95.31 87.2 44.9 25.31 2.0 1

239.0 425.9 325.61 555.2 165. 7 60.6 9.6 104. 7 114.9 5. 9 1.5 83.4 171.9 17.5

196.1 137.6 20.8 78.5 14. 2 20.1 325.8 238. 5 448.6 366.8 545.8 178. 2 57.5 6.0 95.8 113.5 4.2 81. 0 157.4 Hi.

143.0 97.8 25.1 96.4 13.3 35.0 356.4 299.2 488.3 399.1 569.3 206.0 62.4 5.5 95. 7 125. 7 9.3 1.9 83.9 180:

49.1 14.91 27.2 91. 8 23.8 29.5 02.7 38.7

134.3 90.1

m.9 06.8 ,89.9 201. 8 52.5 5.5 80.91 56.5 1.7 98. 9 91. 5 18.8

28.8 96. 1 20.2 34.7 382. S 377.3 538.1 410.3 657.4 275.0 61. 1 9.3 89.6 177.6 5. 2 4. 7

XIII. Diseases of the bones and organs of movement XIV. Congenital malformations XV. Certain diseases of early infancy XVI. Symptoms, senility and ill-defined conditions XVII. Acciden ts, poisoning and violence YI. Convalescent care, plastic treatment and fitting of prosthetic devices

0.3 7.9 10.6 0.0 16.5 14.9

0.4 8.4 15.8 0.0 0.2 19.3 ZI. )

3.41

78. 7 221:6 17.9

1.0

:lj

1.2

Note:

Incidence Rate: per 100 population a year. Sick Day: per 1,000 population a month. These are obtained from National Health Survey.

l ..

., 'I

Table 40.

Number of Patients visited Hospitals and Clinics. (per 100,000 population a day) Total No. of Patients

I-i.I. II. III.

I 6691 2401' 223 8 281 1 181 9

Inpatients

I 8201 233 205 71 40 26 16 4

---O~~~atients

Disease and Injury 1 I 1961 /1962

196311964/1965i19hlfl9n2f1963/19641196S(19nl/19nZi 19631 1964/-19n5 1

Total Infective and parasitic diseases Tuberculosis Venereal diseases

~~~~~-~- 5 05415 260] 5 70415 673 (s.m.) (s,m.)

5 7101 510 301 20, 1 63 38' 200 25 2fJ7 801 400 696 571 184 83 360 260

719

763 247 218 7 30 19 12 4

8281 4 38614 5411 4 221 193 8 341 22 151 4' 1691 511 298 1 96 11 28 16, 1851 18 24 653 314 82 14 26 14 195'1 16 26

94~ 4 85~ -5 0821 338 93 10 29 15 200

538; 319,

564 315 22 54 32 2ml 20 1421 648, 2601 5771

586; 332' 17 59 34 212 29 157 8001 313 634

561 310 19 72 441 2151 25 178

2501 233 8, 281 18 11 3 1

328 85 11 32 18 199 21 31 785

289 89 12 29 16 184 21 38

Neoplasms Malignant neoplasms (s.m.) Allergic endocrine system, metabolic and

56~ 1941 21

19i

35;

nutritional diseases IV, V.

Diseases of the blood-forming organs Mental, psychoneurotic and personality disorders

4 103 31 27 16 86 22 19 5 15 4

1271 683 246 527

16 37i I 34 19 1

131

147 53, 39 1

25 26 757

VI. VII. VIII.

Diseases of the nervous system and sense organs Diseases of the circulatory system Diseases of the respiratory system

IX. X.

Diseases of the digestive system Diseases of the genito-urinary system

III

839'1 353 627 3531 1 43311 477 1 36911 178 152\ 173 183 62 4441 163 15 7,1 33

44 37

611'

90/ 23

Deliveries and complications of pregnancy. child·birth and puerperium

:1 25 ,

~I 4i

44, 2191 226\ 171 507 558 1 103 1 267: 1 342 1 28 1301 150!

276 615 38311 155, 38 436

750 356 313 679 609 271 1 468 151 156 46 382 48 357 236 19 121 33 294

64 462 184 15

63 4401 206'1 17 13 38] 367 35 75 1 1

XII. Diseases of the skin and the cellular tissue XIII. Diseases of the bones and organs of movement XIV. Congenital malformations

79 387 217 211 15 40

22 5 171

4' 181 41 3 4

351 3

43 439:

XV, XVI.

Certain diseases of earIy infancy Symptoms, senility and ill defined conditions Accidents, poisoning and violence Special conditions and examinations without sickness Convalescent care, plastic treatment and fitting of prosthetic devices

3~1' 328 23 65

~I I

XVII, YO. YI.

340

390

38 357

21 3 51 4

:I 4

491 2

551 3

20i 24\ 148'1 81 7 11 434 31 41 4 68 6a 289,

42 457 , 1671

188 13 101' 34 312' 32 751

197 13 11

111 5

29 279 21

36 322, 33

34!

::1

11 1

23 1

33 7~

79\

-I

68 1

651

731

Note: The number of patients are obtained from the Patient Survey.

iil

-60-

28.

Pharmaceutical Affairs

Inspection of Drugs, Devices, and Cosmetics Under the Pharmaceutical Affairs Law, the licensing system is adopted for all manufacturers of drugs, quasi-drugs, cosmetics and devices for the sake of quality control. established by the Law. During the calendar year 1967, the Ministry of Health and Welfare provided 2,002 inspectors all over the country, who made a total of 205,861 inspections (including 23,522 for manufacturers, 30,026 pharmacies and others) for a total of 260,729 places (24,738 manufacturers, 22,331 pharmacies and others) in order to prevent adulterated, misbranded or exaggeratedly advertised pharmaceutical merchandises to be sold to the public. Besides, the facilities of every manufacturing factory have been improved in accordance with the standards

Japanese Pharmacopoeia and Others The latest edition of Japanese pharmacopoeia is its 7th edition, which is ~omposed of Parts I and II. The 8th edition is now in progress for publication on 1 April 197d. The Minimum Requirements for Biological and Antibiotic Preparations and Radio-active Preparations have been revised annually. The first Edition of Official Book on Japanese Standard of Cosmetic Ingredient was published in Japanese in August 1967. This Official Book includes the specification for identity and purity of 114 chemicals used to produce cosmetics.

Poisonous and Deleterious Substances Control The chemical substances having toxic properties other than drugs and quasi-drugs are regulated by Poisonous and Deleterious Substance Control Law. They are divided into poisonous substances and deleterious substances according to their toxicities. Some poisonous substances whose toxicities are extremely great and handlings are very hard, such as Tetra alkyl lead, parathion, etc., are designated as specified poisonous substances and controlled! more strictly.

Monitoring Adverse Drug Reaction A programme for monitoring and studying on adverse reaction of drug commenced from 1 March 1967 continued its activites. ter of Health and Welfare. In order to develop this programme, a' special sub-committee on adverse drug reaction composed of respective specialists was established by the MinisUnder this programme, the information on adverse drug reaction is to be collected from 40 university hospitals and 88 national hospitals for evaluation by the sub-committee in request of the Minister of Health and Welfare.

Control of Awakening Drugs There has been no violation of Awakening Drug Controal Law by the authorized dealers. However, 710 persons were arrested in 1967 (722 persons in 1966), because of Illicit manufacturing, sale or possession of those amphetamine preparations and the like. By this law, the raw materials (1-phenyl-2-methylaminopropanol-l, I-phenyl-2-dimethyl-aminopropanol-l, phenylacetic acid, and etc.) are controlled as nearly the same as the awakening drugs.

61-

Narcotic Contiol During the period from April 1967 to March 1968, the second year programme of USJapan Cooperative Reseach on Drug Abuse was successfully carried out under US-Japan Scientific Cooperative Programme. For exchange of information in this research programme, the American principal researchers met with the Japanese research group in Tokyo in June 1967. During the year 1967, the narcotic control conducted by the law enforcement agencies resulted in sending 1,595 cases (1,661 persons) of violations to the Public Prosecutor·s Offices, which included 592 cases (685 persons) of violation of the Narcotic Control Law; Cannabis Control Law. -6-0-methyl-6, 702 cases (705 persons) of violation of the Opium Law; and 301 cases (298 persons) of violation of the The following items were newly designated as the narcotic drugs under the Cabinet Order No. 25 of 2 March 1967; 7,8-dihydro-7a (1 (R)-hydroxy-1-mcthylbutyl) 14-endo-ethenomorphine, 3-0-acetyl-7, 8-dihydro-7a- (1 (R)-hydroxy-1-methylbutyl) -6-0-methyl-6, 14-endo-ethenomorphine and their salts. ~-

Blood Transfusion Service Blood collection services III

Japan are being rigidly controlled by two laws, one of them is

the Pharmaceutical Affairs Law aiming at maintenance of the quality of human whole blood and its derivatives, and, of the standard structure of the manufacturing premises for these preparations, and the other is the Bleeding and Blood Doner Supply Service Control Law aiming at prevention of health hazard which may accompany with bleeding intended to manufacture human whole blood and its derivatives. On this basis, our blood supply service programme However, because of undue dependence has developed remarkably because of the increased demand for human whole blood and its derivatives along with progress of modern medicine. on "professional blood donors" and commercial blood banks, our blood supply service programme had faced with very unfavorable situation, such as dreadful increase of "professional blood donors" suffering from anemia, and the risk of serum hepatitis, etc., which had constituted a great threat to the public health. Therefore, the Government, recognizing seriousness of the blood supply situation, made a decision on 21 August 1964 to develop voluntary blood donation campaign to normalize the sound hlood supply service programme. The table below indicates the good result obtained by the nation-wide campaign for voluntary blood donors' recruitment carried out to increase the number of voluntary blood donors and quantity of blood collected. Year

Number of Voluntary I Ratio of Voluntary Donationsl Donations to Total Donation (%) 55 166 425 983 1 536 950 660 930 460 188 1.9 7. 7 19.6 48.5 fi8. 7

1963 1964 1965 1966 _i_

1967

There are 62 organizations engaged in the bleeding of voluntary blood donors, 52 of them ,-,-~

are operated by the Japan Red Cross and 10 are by Prefectural Offices. collection units are operated by these organizations.

121 mobile blood

The Ministry of Health and \Velfare is

now considering to promote the establishment of the system to recruit more voluntary blood donors.

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Production of Drugs and Devices The production amount of medical supplies such as drugs, quasi·drugs, $nitary materials, medical apparatus and devices have been increasing yearly, as shown in Table 41, below. While, as for export of those medical supplies, it has been increasing in parallel with the increase of their production. In particular, those vitamin drugs such as vitaJin Bl, vitamin C, other vitamin preparations, amino acids and their salts, household medicine, and those antibi· otics of our originality such as kanamycin, leucomycin, colistin, and dental aIlparatus, and those precision medical apparatus such as detailed diagnostic instruments and measuring apparatus, have been widely exported to the countries in Southeast Asia, Europe and USA. Table 41. I

(a). !

Production of Main Drugs and Medical Devices. Kinds Vitamin preparations Antibiotic preparations Agents affecting central nervous system

(in thousand dollars, Jan. ~ Dec.)

. Drugs

I I

1965

I 1

1966

1967 230 673 202756 198 321 149 3091 143 594 118213[ 103 789 64 125[ 45 183 43224 41 674 38721 31619 30 275 27 961 95174 564 602 71 469

Miscellaneous agents affecting metabolism Agents affecting digestive organs Cardiovascular agents Agents for epidermis Nutrients, tonics and alteratives

2328751 162 650 170 889 104 783 103 394 69722 81 578 71 125 29 7721 37 153. 27381 37958 25 861 22 531 24 869 68 678 1 271 219 47983 28 306 13 156 89 447

Agents affecting peripheral nervous system Hormone preparations Biological preparations Chemotherapeutics

Agen ts affecting respiratory organs

Agents for public health Agen ts affecting sensory organs

Others Total Quasi·Drugs Agents for epidermis I Agents for public health I I Agents affecting digestive organs Tatal

251 4221 179 180, 1808421 125 190 121 534 94 222 88 942 62 940 37 081 41 420 31763 32544 32042 27 601 21960 79948 1 408 634 1 54 774 33105 20 534 108 413 32 26Z!

I Sanitary Materials Medical Devices

43 813 33 233 148 515 45 667 32 280 'w'~

I Medical instruments and apparatus

I Dental instruments, apparatus and materials Medical supplies Total (b). Export and Import of Drugs.

35 6311 88 25 42 155 057 732 021 811

i 90 27 42 160 833 117 408 357

51754 193 9

(in thousand dollars, Import

Jan.~Dec.)

Export

-, 1967 103 313

1965 38 375

1966 40 652

1967 45 893

1965 63 383

1966 84 159

-63-

29.

Major Research and Training Institutes in Public Health Programmes

F or the purpose of performing research work on technical problems as well as training and educating public health technicians of various categories which are necessary for promoting public health programme in Japan, those major research or training institutes illustrated in the following table are established and are functioning as the affiliated institutes of the Ministry of Health and Welfare. Table 42. Kind and Organization of Public Health Research and Training Institutes. (as of 1 April 1968) Name of the Institute

Date of INo. ofl I Establishment Staff 1 .

0 " I L l' I rgamzatlO~ ____ oca Ity I ,

National Institute of Hygienic Sciences National Institute of Nutrition

1 Mar. 1874 17 Sept. 1920

Institute of Public Health National Institute of Health National Institute of Hospital Administration Institute of Population Problems

29 Mar. 1938' 21 May 1947 1 June 1949 14 Aug. 1950 1

311115 departments, 1 library, 1 branch ll i 5 experimental stations 62 7 departments, 1 section 226 17 departments, 1 library 560 17 departments, 1 library, 1 branch2 ) 17 3 departments, 1 section 47. 3 departments, 2 sections

Tokyo Tokyo Tokyo Tokyo

National Institute of Mental Health National Institute of Leprosy Research N.ltional Cancer Center

Jan. 1952 1 July 1955 1 Feb. 1962·

Tokyo Tokyo I 42; 7 departments, 1 section Chiba 34 2 departments, 1 section Tokyo 614 1 hospital, 1 institute (12 de· Tokyo partments, 2 sections) 1

department, 1 library

Note: 1) The branch is in Osaka. 2) One branch is in Nagasaki and the other in Hiroshima.

National Institute of Hygienic Sciences This institute is performing test and assay of drugs (excluding biologics and anti-biotics for which the tests are given at the National Institute of Health), food, food additivies, cosmetics and devices_ It also performs cultivation and research of medicinal plants, and research on drug manufacturing, and other test, investigation and research on those which are necessary from the standpoint of hygiene and sanitation_

National Institute of Nutrition This institute is performing survey and research on people's nutrition condition, eating habit, physiological and otber assay on nutrients of food, and analysis of certain specified food and enriched food based on the Nutrition Improvement Law_

Institute of Public Health This institute is performing training of public health personnel as well as study and research on the application of basic theory in medicine and public health which is necessary for such training programme_ The training programmes consist of 6 regular courses, 2 preliminary ,A..

courses and 13 short courses. ted in 1967. them being programme

The course for environmental pollution control was newly crea-

The graduates of those courses up to March 1968 totaled 13,516; the majority of 111 111

government service, both national and local, actively participating in the health the different fields. It is to be mentioned that the Rockefeller Foundation of

-64-

U.S.A. had rendered a great deal of financial contribution particulary in its foundation. sent under WHO fellowship programme, Colombo Plan training programme, or others.

The

institute has also extended its service to tbe foreign trainees in the recent years, who have been

National Institute of Health This institute is performing study and research on the infectious diseases and other specified diseases, and food sanitation. It is also giving training course, performing national assay of antibiotics and biobgical preparations and th~ir experimental production. Because of the particular work of the institute, it is designated as the various WHO Wester:n Pacific Regional Centers and Reference Laboratories, i.e., for influenza, entro-virus diseases, ltptospira, Shigella, respiratory virus diseases, arthropod-borne virus diseases and Salmonella.

National Institute of Hospital Administration This institute is performing study and research on hospital administration and giving training for hospital administration. -

.-'

Institute of Population Problems This institute is performing research and survey on demography and population problem.

National Institute of Mental Health This institute is performing study and research on mental health as well as rendering consultation service on mental health by its mental health clinics and training of mental health workers as a national training center in mental health programme. It has been closely associ· ated with the Koonodai National Hospital.

National Institute of Leprosy Research This institute is performing study and research on the prevention and treatment of leprosy. It is closely associated with the National Leprosarium" Tama Zensho-en."

National Cancer Center This center consists of hospital, research institute, and administration department. ments of the highest quality and efficiency. The hospital is giving the best diagnosis and treatment to the cancer patients by using the equipThe major projects of the research institute are to make original research in the biochemical, chemotherapeutic and pathological aspects of cancer. The function of administration department is not only to administer general services of whole center but is to perform the fundamental anti-cancer programme throughout the country.

30. International Cooperation on Health Programmes Health and Medical Technical Cooperation The Ministry of Health and WeHare participated in the international technical cooperation in the health, medical and social service fields under the various schemes through the service of Overseas Technical Cooperation Agency of Ministry of Foreign Affaih;. countries in South-east Asia, Middle and Near East and Africa. During the calendar year 1967, the Government received and trained 77 WHO fellows, As far as our Ministry is concerned, the emphasis was placed on the medical technical cooperation for the

65-

(number was trebled from 1965), 12 Colombo Plan trainees and 6 trainees under other scheme, and also, arranged for 2 long-term experts and 6 short-term consultants to work with WHO, 19 with the Colombo Plan, and 7 with other scheme in medical and public heatlh fields_ A total of 80 experts from Japan selected from their technical competence in the various fields, such as public health, environmental sanitation, etc_ have been serving for a total of 35 panels out of a total of 43 WHO Expert Advisory Panels_ In order to disseminate correct information on the medical and public health situation in our country to the neighboring countries and other interested countries, the Ministry prepared sound movie films in technicolor entitled "Medical Electronics in Japan," in 1967_ This is a sequence of those previously prepared films, i.e., "A Report of Medical Services in ]apan," "TB Control in Japan," "Maternal and Child Health Programme in Japan," "Communicable Disease Control in Japan," "Cancer Control in Japan," and "Medical Training in Japan." These films have been already circulated among the countries concerned through the overseas Japanese legations.

WHO Assistance Under 1967 year WHO fellowship programme, a total of 26 WHO fellowships were awarded to our country and WHO experts both on physical therapy and occupational therapy continued training programme from previous years.

Special International Studies L Joint Japan-Philippines-WHO Cholera EI Tor Study

In view of terrific spread of Cholera EI Tor in the Western Pacific Area and urgency of finding out many unknown factors on this new cholera in order to obtain best weapon to tackle with this disease, the authorized representatives of Japan, Philippines and WHO, agreed in F ebmary 1964 to undertake collaborative studies on the efficacy of different cholera vaccines, the role of cholera carrier in disease transmission and the viability of cholera EI Tor vibrio_ This excellent sample of what can be accomplished when different people work together in harmony and understanding to achieve their common objective showed fmitful results in the interim reports. At the time of the third technical conference held in Tokyo in May 1967, the parties agreed that the project be expanded to study and practice the measures to control the invasion of diseases. 2_ Japan-US Cooperative Medical Science Programme In January 1965, the summits of Japan and the United States, mindful of many areas of human health which are of great concern to all the people of Asia, agreed to undertake the expanded programme of cooperation in medical science. The Panels of Cholera, Tuherculosis, Leprosy, Certain Viral Diseases, Parasitic Diseases (Schistosomiasis and Filariasis) and Malnutrition are established under its Joint Committee. The Joint Committee so far has met 4 times, first in Hawaii in October 1965, then in Tokyo in August 1966, San Francisco in August 1967, and the 4th in Tokyo in August 1968 to report the progress of reseasch in each field and to plan out future programme.

66-

31.

Public Assistance, Child Welfare and Social Insurances

For the reference of readers, some of the informations on the programmr of public assistance, child welfare, and social insurances are given as follows. Public assistance is provided under the Daily Life Security Law to fill persons under certified cases of need after means test. Programmes consist of 1) livelihood laid, 2) educational aid, 3) housing aid, 4) medical aid, 5) maternity aid, 6) occupational aid and, 7) funeral aid. Assistance is provided in principle as an out-door care, while some cases may be institutional. All aids except medical care are provided by cash. There are 1,052 Welfare Offices in Japan (approximately one per 100,000 population), and their Welfare Officials as case workers are providing services assisted by 129,793 volunteer workers, who are called Welfare Commissioners. 80% of the aids are financed by the National Government and Governments.

20%

by the Local

The following tables show some of the statistical data on public assistance. ,-------Fiscal Year

1956 57 58 59 60 61 62 63 64 65 66 67 Note:

Table 43. Number of Recipients and Amount of Payments. No. of Recipients Ratio of Recipients to Amount of Payment (Mon thly A '!.::.er::a",gc:ce)'------,--'t:.::h:::e_T:..o::.:t:=al:...:.P..::o"pu::.l:::a::::ti::oon=--_+---'(=Monthly Average) Thousand Y·~en~-1 775 970 1. 97% 3 647 312 1 623 744 1. 79 3 728 648 1 627 571 1. 77 4 089 055 1 669 180 1. 80 4 645 422 1 627 508 1. 74 5 101 038 1 643 445 1. 74 6 227 962 1 674 001 1. 74 7 075 142 1 744 639 1. 81 8 322 346 1 674 661 1. 75 9 616 351 1 598 786 1. 63 11 337 148 1 570 054 1. 57 13 109 381 1 535 065 1. 54 14 969 366

1) Figures for 1967 are provisional. Table 44.

Number of Recipients and Amount of Payments by Type of Aids. (Monthly average •.fiscal year 1967) o-n-al"I-HT'<0-u-Si~n-g'I--'M7e-d"ic-a'I-I"M~atc-e-rn'iC""tY-'1'O'c-c1ll-pational I Funeraf Livelihood I Educall·~· Item Aid Aid Aid I Aid Aid Aid Aid I I-R-eC-iP-ien-ts---i--, 1 346 360 720 683 0.4 2 7 I (in thousand) I Amount 5 493 620 8 298 4 20 371 51 (in million yen)

Child Welfare Child Welfare Law provides for a comprehensive programme of care for children aged up to 18 years, and welfare of mothers. Programmes consist of 1) a net-work of Child Guidance Centers, 2) foster parents. 3) vocational foster parents, 4) homes for dependent, neglected and abused children, 5) homes for training and education of juvenile delinquents (aged up to 14 years), 6) homes for mentally retarded children, 7) homes for physically weak children, 8) hospital-homes for crippled children. 9) hospital-homes for severely ~ultiple-h'1ndicapped chidren, 10) homes for blind. deaf and dumb chidren, 11) homes for mothers with children, 12) baby homes, 13) day nurseries, 14) children's recreation centers, 15) maternity homes, 16) mentally retarded children's day care centers, and 17) residential treatment centers f,or emotionally dis, turbed children.

-07-

Social Insurance Japan is the first Asian country to have introduced social insurance measures, and it has developed them steadily during the last few decades. The first social insurance law was passed in 1922, dealing with workers' health insurance in general. Thereafter, it was succeeded by many branches of social insurances as shown in Table 45, below, whkh illustrates a bird's-eye view of all kinds of social insurances, giving some informations about the pertinent laws with their dates of promulgation, responsible government agencies, the coverage of insurer and the insured people, etc. Table 45. Law

Classification of Social Insurances. ----,--------,

I Date i 1922 1 1

Responsible Ministry 1

Insurer

Insured

Health Insurance Law Employee's Pension Insurance

---·G vernment, and Health .& Welfare 1 H0 ealth Insurance Mmlstry U ilIOn !

Law Unemployment Insurance Law -------

I 1

1941 1947

" Ministry of Labor

Government II

I 1

Employees in the working places (compulsory or voluntary)

Workmen's Accident Compensation Insurance Law 1

1947 1 1

" Health & Welfare MInIstry

" Other persons besides those insured 1

National Health Insurance Law National Public Service Mutual Aid Associatio n Law Seamen's Insurance Law

1938 I , 1948 1939 1953

-Ci ty:'rown-V,llage Government, d Union 1 an Association

Ministry of Finance M utual Aid

Government employees 1 1

Health & Welfare Ministry /I

" Govemmen

Seamen ------1

Health Insurance Law for

Daily Workers

I Dail; workers 1

Mutual Aid.-A'C--S-S-o-c~ia""t~io-n"""L-a-w--+I---,!-i-M-i-n-i-s-tr-y-o-f----+I-M--utual Aid Teachers and workers for the Teachers and Wor1953 Education Association of private schools kers of Private Schools ,_ _ _ _ _ _ _ _ ~I_ _ _ _ _ _ _ _ _ _ _ 1 Mutual Aid Association Law 1 1 1 1 Employees in the for the Employees in the 1956 Ministry of _Finance " public enterprises I Public Ente~PEi_s~_._ !-Mutual Aid Association Law I I Ministry of I Employees in the for the Employees in the 1958 _.' Agriculture & /I agriculture & fishery Agriculture & Fishery Forestry organization Organization . I Whole population, those 20~59 years Health & Welfare National Pension Law Government old, except those 1959 Ministry covered by other ) pension schemes 1 - - - - - - - - - - - - - - + - - + - - - - - - - - - + - - - - - - - - + r O " f f i c i a l s of cities, ,i

-~~ Local Public Service Mutual 1962 Minffistr y of Home MAutual Aid teachers and workers Aid Association Law A airs ssociation of public schools, l. I __________________________.L____.L________________.L______________.L__~an~d_p~o~lice officials Following is the summary of those social insurance schemes operated under the direct jurisdiction of the Ministy of Health and Welfare. 1. Health Insurance (compulsory for employed person) Established by basic Law No. 70 of April 1922, the scheme is covering approximately 20 million insured persons as of the end of the year 1967. The insurance carriers are the Govern-

68-

ment and the Health Insurance Societies (approved societies).

Benefits in kind include all types

of medical care, hospitalization, dental care and pharmaceutical medicine in respect of the non· occupational risks of the insured persons and their dependents. Cash benefits include sickness and injury allowance, delivery expense, maternity allowance, child nursing allowance and funeral expense_ The scheme is financed from contributions paid by the insured person and the employer in equal proportion. 2. National Health Insurance Established by basic Law No. 60 of April 1938, the scheme applies to persons not covered under the Health Insurance Scheme. It now covers approximately 43 million insured persons including householders and their dependents. nity, funeral and other expenses. The insurance carrier is City,' Town or Village, Benefits include medical care in kind, materv-',

and the National Health Insurance Organization. insured persons and the national subsidies.

The scheme is financed from contributions paid by the

This law has been wholly amended by the Law No. 192 of December 1958, whereby every city, town and village were given the responsibility to enforce the National Health Insurance. Consequently, "Sickness Insurance for Whole National Programme" has been achieved. 3. Seamen's Insurance (compulsory for seamen) The scheme is a comprehensive insurance Established by basic Law No. 73 of April 1939, the scheme covers approximately 250,000 seamen. Tbe insurance carrier is the Government. injury, unemployment, invalidity, old age and death. 4. persons. Daily Worker's Health Insurance (compulsory for daily workers) The insurance carrier is the Government. Benefits in kind are almost the same as The Established by basic Law No. 207 of August 1953, the scheme covers 1,018,000 insured those under the Health Insurance Scheme, and there are various benefits in cash, too. subsidy. 5. Employee's Pension Insurance (compulsory for employed persons) The insurance carrier is the Government. Benefits include old age Established by basic Law No. 60 of March 1941, the scheme covers approximately 19 million insured persons. allowance. 6. pension, co-ordination old age pension, invalidity pension, survivor's pension and withdrawal The scheme is financed from contributions paid by the insured persons, the employer and national subsidy. National Pension The insurance carrier is the Government. This Benefit Establishe by the Law No. 141 of April 1959, the scheme applies to persons not covered under any other public pension system. scheme includes the contributory programme and the non-contributory programme. scheme for seamen, covering occupational as well as non-occupational risks of sickness and

scheme is financed from contributions paid by the insured persons and employers, and national

includes old age pension, co-ordination old age pension, invalidity pension, widowed mother's pension, guardians pension, orphan's pension, widow's pension and lump-sum death grant. The contributory programme is financed from contributions paid by the insured persons (approximately 21 million) and national subsidy, while the non-contributory programma is financed by the government contribution.

•

"The health of all peoples is

fundamental to the attainment of peace and security"

"Health is a state of complete physical, mental, and social well· being and not merely the absence of disease or infirmity" (From the Preamble of the Constitution of the World Health Organization)

Compiled by the Office of the Counsellor for International Liaison Affairs, Minister's Secretariat,

Ministry of Health & Welfare Japanese Government

Tokyo, Japan ---,._---

FRANCAIS IAOS EXPOSE SUCCINCT SUR I.E PIDGRES DES ACTIVITES SANITAIRES El' IES OEUVRES DE L' OMS AU IAOS

SEULEMENT

Ie Royaume du laos est un petit pays completement separe de la mer, borde au nord par la Republique populaire de Chine et la Birmanie, a l'ouest par la ThaIlande, au sud par Ie Cambodge et a l'est par Ie Viet-Nam (NOrd et Sud). II a une superficie de 214 000 km2 et loge environ 3 millions d'habitants. Ie taux de natalite du peuple lao est de 4,7%, celui de sa mortalite de 2,3% et celui de sa croissance est de 2,4%. La scolarite est assez repandue dans Ie pays. Son taux au premier cycle est de 49% et de 3,6% dans l'enseignement du second degre. Celui du 3e degre c'est-a.-dire au niveau universitaire est seulement de 0,6%. L'economie du Laos est modeste. Elle est paralysee par une guerre interieure qui a dure plus de vingt ans bien avant son accession a l'independance. Cette guerre absorbe la moitie de son budget qui est la cause de son sous-developpement economique et la raison pour laquelle Ie Laos continue de dependre dans oe domaine de l'aide des pays amis. Voila Ie pays dans son aspect geographique. Je vais maintenant vous entretenir des problemes sanitaires. Historigue : Au moment de l'independance, en 1949, Ie service sanitaire du Laos etait tras rudimentaire et sa penetration dans la masse de ses habitants etait presque insignifiante. Quelques h8pitaux d'une centaine de lits situes dans les grands centres urbains Ie long du Mekong avec quelques dispensaires ruraux eparpilles dans les grosses bourgades de nos campagnes forment l'essentiel de ce service. Depuis l'independanoe les gouvernements successifs se sont efforces d'ameliorer l'infrastructure sanitaire du pays qui a alors evolue assez rapidement. Depuis les dix dernieres annees principalement, les services sanitaires laotiens ont connu un effort tres appreciable tant par les facilites offertes aux malades que par la qualite des so ins gr~ce aux aides des pays amis et des organismes specialises des Nations Unies. Ie Laos est membre de I' OMS depuis Ie 17 mai 1950. Ies oeuvres de l'OMS au Laos Nous allons aborder maintenant l'etude des aides et de leurs rendements dans notre pays depuis son admission comme membre depuis 1950 jusqu'a. present.

'. Laos page 2 1. La lutte contre le pian

Dans les quatre provinces du Sud Laos le tauxde la prevalence du pian s'elevait parrois jusqu'a 4 a 5% et dans certaines regions constituait une des principales causes d'incapacite de travail saisonniere et parfois m~me permanente. La lutte contre le pian commen~ait par une premiere periode de sondage et de statistique sui vie immediatement de periode de traitement intensif a laquelle succede une periode de surveillance et de contrale des cas eteints, des cas rebelles ou de la recrudescence de nouveaux cas. Le programme a dure quatre ans. Il etait elabore et execute par les techniciens de l'OMS et etait strictement finance par l'aide economique americaine. Les resultats obtenus sont plus que satisfaisants. Le taux de prevalence du pian n'est plus que de 0,5%, encore qulil n'est pas signale des cas nou~eaux. 2.

La lutte

c~ntre

le paludisme

Ce programme etait apparu peu apres celui de la lutte contre le pian. Les etudes entomologiques des vecteurs etaient tras rapidement menees et Ie plan de campagne presque immediatement adopte et s'inspirait en grande partie de celui pratique dans les pays voisins en particulier en Tharlande. lei encore, il etait egalement finance par l'aide economique americaine. Ce programme entrepris avec beaucoup d'enthousiasme et d'energie, par des pulverisations regulieres des maisons et desdistributionsde grande quantite d'antimalariques,a vu brusquement sa lancee brisee par des troubles violents internes qui ont supprime pratiquement la tranquiD..i te et la securi te dans certaines regions. La lutte contre le paludisme reste ainsi en veilleuse depuis six ans.

L'eradication de la variole (Laos 0514)

Ce programme vient de debuter et il est finance presque entierement par l'Organisation mondiale de la Sante. Les dernieres statistiques ont montre que malgre les vaccinations systematiques entreprises par le Gouvernement, les nourrissons et les enfants de moins de six anssont en general negliges et echappent aux campagnes de Vaccinations. Ce qui represente un pourcentage tres appreciable d'elements qui peuvent ~tre contamines par la variole. Le plan d'operations~Q~e vaccination plus generalisee est done elabore et adopte avec l'aide de l'OI~. Le service de la sante publique mettra a la disposition de ce programme tout le personnel necessaire pour que toute la population du Laos soit immunisee contre la variole. 4. Lutte contre la tuberculose

Une etude tres poussee a deja ete faite gr~ce a 1 'aide de l'OMS pour etablir la prevalence de la tuberculose au Laos. On a constate que le taux des cas contagieux ne doit pas ~tre neglige et que Ie probleme doit ~tre pose

•

laos page 3 serieusement et des mesures de prevention et de traitement doivent ~tre envisagees rapidement. Seul le manque de moyens techniques et financiers ne permet pas au service de la sa..Ylte publique d' etablir un programme d'action de grande envergure.

Developpement rural (laos 0010)

Un programme etabli par les Nations Unies sur les fonds de l'assistance technique a ete tres serieusement execute dans une zone pilote de la region de Vientiane qui consiste a etudier les habitudes sanitaires et d'hygiene de la population, de leur nutrition, les cas de maladies endemiques et epidemiques. L'equipe responsable entreprendra une education sanitaire de base a la population et l'aidera a entre prendre pour la proprete du village, du logement, l'ecoulement des eaux, la destruction des ordures menageres, les soins a donner dans les cas d'urgence, a mieux se nourrir, etc. Malheureusement, suite a la penurie financiere, ce programme qui est provisoirement sera repris bient8t. Le Gouvernement royal y attache une grande importance car la majorite de notre population est rurale. arr~te

Protection de la mere et de l'enfant (laos 0513)

II existe un service national de la protection maternelle et infantile, organisme nouvellement cree il y a six ans selon la recommandation de l'OMS. Ce service est tres rentable, realise grace a l'aide de l'OMS et du FISE. Il s'occupe de la femme parturiente, la suit pendant toute sa grossesse, la delivre et la suit dans les suites de couche et l'aide a s'occuper de ses enfants en bas age. II existe actuellement des sous-centres prov1nciaux dans toutes les grandes villes et aussi dans plusieurs centres ruraux.

L' Ecole royale de Medecine (laos 0015)

Cette ecole creee en 1956 sous Ie patronage de la Faculte de Medec1ne de Paris, recrute les etudiants sur la base du dip18me d'etudesprimaires complementaires,quatre annees d'etudes apres Ie certificat d'etudes et sur concours. Elle dispense quatre annees d'etudes de medecine et sanctionne les dip16mes par un examen de sortie. Elle fournit une dizaine de medecinsassistants par an. A l'heure actuelle, la question majeure qui nous importe est la penurie des medecins professeurs. Par 1 'accord bilateral entre Ie Gouvernement rOyal et la France, la mission d'aide technique fran~aise au laos nous a procure les medecins consultants et experts de toutes branches pour les h8pitaux de Vientiane remplissant en m~me temps la fonction du corps enseignant de cet ecole. Dans ce domaine l'OMS va nous envoyer trois medecins professeurs (biologie, anatomo-pathologie et medecine preventive) a court terme pour la prochaine annee scolaire.

Iaos page

4 L' Ecole d' Infirmiers et d' Infirmieres (Iaos 0012)

•

Ce programme consiste a. former du personnel auxiliaire de sante, a partir des eleves possedant Ie certificat d'etudes primaires(six annees) par concours. I.e Ministere de la Sante vient de creer un service de formation pour Ie porsonnel auxiliaire a part au sein du Ministere de la Sante la Direction de l'Ecole de Sante publique. Ce service reunit toutes les ecoles des auxiliaires medicals et paramedicals. II planifie en m~me temps sur Ie recrutement de ces personnels en vue de satisfaire les be so ins du service de sante sur la realisation des divers projets. I.es programmes de ces ecoles ont ete aussi elaborespar l'assistance du personnel technicien et infirmier de l' OMS et sont fWs pour deux annees pour n' importe quelle ecole pour l'etude theorique et pratique. II compte a. present 11 ecoles : 4 ecoles d 'infirmiers et ct1nfirmieres auxiliaires (8. Vientiane, wang-Prabang, Savannakhet et Palese), 4 ecoles de sages-femmes auxiliaires (a. Vientiane, wang-Prabang, Savannakhet et Palese), 1 ecole d'aides-preparateurs de pharmacie, 1 ecole d'aides-techniciens de laboratoire, 1 ecole de mecaniciens dentaires, etc.). Ce projet a ete debute depuis mars 1962 qui jusqu'a present pourrait fournir plus de 500 aides-techniciens et infirmiersinfirmieres auxiliaires au service des h8pitaux et de la sante publique. En plus, dans l' avenir Ie plus proche, Ie Gouvernement possede egalement un projet de rehausser Ie niveau de cette formation, c'est-a.-dire de former de vrais infirmiers et infirmieres dip18mes d'Etat et de vrais techniciens ou technologistes medicals. Ia realisation de ce projet est financee en grande partie par Ie budget national d'une part et des aides bilaterales (aides economiques americaines) d'autre part.

Readaptation des personnes physiquement diminues (Iaos 0018)

I.e service de sante avec la cooperation du Ministere des Anciens Combattants,a cree un centre de readaptation des personnas physiquement diminues a. Vientiane depuis 1960. Au debut, 11 s 'agissait seulement d 'un petit embr,yon de service orthopedique et de prothese qui jusqu'a present (apres six annaes de creation) ont vu adhere les services de physiotherapie, d'ergotherapie ,de la readaptation, etc. En ootobre 1967, l'OOIS intervient dans ce programme. II nous aide a. organiser des installations de readaptation, d'assurer leur fonotionnement,de former Ie personnel nacessaire et aussi a revoir tous les lois et reglements relatifs aux personnes p~~siquement diminuees. 10. Iaboratoire central de sante publique, Vientiane (Iaos 0509)

.. - -

I.e projet de reorganisation d'un laboratoire central de sante publique capitale consiste a centraliser tous les services de diagnostics et de technologie medlcale en un seul centre des servant les travaux de routine des services hospitaliers et Ie programme d'enseignement de l'Ecole royale de Medecine. II sera aussi un centre de recherche et d'identification de toutes les maladies en vue d'avoir un vrai chiffre de statistique de toutes maladies. Ce projet a ete aussi entrepris par l'OMS.

a la

11.

statistigues demographiques et sanitaires (Iaos 0512)

Ce proJet vient de debuter cette annee (mars 1968). L'OOIS DOUS envoie un medecin-statisticien pour aider a. creer un service de statistiquesdemographiques et sanitaires au Ministere de la Sante et a former du personnel.

•

OlUGDiAL: SUMMARY REPORl' ON THE HEALTH PlWGRESS ACHIEVED IN 1967 IN MACA<r-

ENGLISH

POPULATION

The mid-year 1967 population has been estim«Geu by us as

290 850. This figure has been calculated on the basis of the 1960 census, death registration and migration data, and on OU1' om) estimate of the number of births which have occurred each successive year after 1950. General mortality Death figures after 1960 have been as follo1lS:

'-E-

1961 1962 1963 1964 1965 1956 1967

.................. 175'( .................... 1732 .................... 1802 .................... 1606 .................... 1550 .................... 1538 .................... 1576

deaths II II II II II

The increase shown in the 1%7 fieure has been oninly due to "malignant neoplasms ", "hich caused 174 deaths in 1966 and 215 in 1967, that is 41 more deaths than in the previous year. Referring mortality to crude death rates (ca1culat.ed on the basis of our oVln estimates of the mid-year population) the evolution has -ueen as shown in the folloYling table: ~lortality

in l\facao

from

1$61 to 1961

I~: !'1 1 953

TNo .~-f T fu~Ul~tio:r--+deaths_4 __~stinates.L

-Crt:d~ '~e~~hl ___~'~t~_,=---~

111961 1757 I, 181 130 I: 1962 \ 1732 I 236 041 ;11965 111966 \k_~

I I I

111964

,1802

111957 -

L--

1606 1550 1538 1576

285 434

292 295 296 290

861 377 561f 850

9.7/1000 pop. i! 7.3/1000"!; 6.3/1000 JI !' 5.5/1000 JI :1 5.311000 JI !1 5.2{1000 II :: 5 .4/1000 " " ___

Submitted by the Director of Health and v!eli'Gre Eer"lices,

1 July 1968.

_2 _

TEE TEN LEADING CAUSES OF DEATH

In the last three_year period, the ten leading causes of' death have been as follows: --

Categories of disease

1965

1 ---;-66 ~

J I I

196'i

Diseases of the heart (B24 to B28)

2. Tuberculosis (Bl and B2) ...... 3. Vascular lesions affecting the central nervous system (B22) 4. 11alignant neoplasms (B1S) ..• 5. Influenza and pneumonia (B30 and B31) 6. All accidents (BE47 and BE4S) 7. Cirrhosis of the liver (B37) S. Nephritis and neophrosis (B3S) 9. Gastric and duodenal ulcer (B33) 10. Congenital malformations (B41) Gastritis, duodenitis, enteritis colitis, except ne\~bcrn diarrhoea (B36) .••.•.•....•....• Hypertension, vlithout mention of djsease of the heart (B29)

..........................

(1) (2) (3) 'h) I..

282 221 189 lS0

(2 )

(1) (3) (1· ) \ '

228 1(1)

233 1(3) 174 1(1)) 164 (2)

2L>5 211

_ --

-.'

170 215 .49 96 2!f

.....................

1(6 ) -

60 56 (7) 35 (8) 33 25 (9) (lO)(EA) 13 (5)

(6 ) - 65 (6 ) (5) 67 1(5 ) 1(7 ) - 27 i (9) (9) (EA) 20 ! (8) (8) 21 1(10)

28 16

(lO)(EA) 13

Measles (B14)

Suicide and self-inflicted lesion (BE49)

'O., ••••••• -

•••••

................

I I

(9) (TIJA) 20

(EA) 13

It7) !

I I I I

(EA) 13 i

I Note: EA means "Ex-aequo".

I I

As one can see, diseases of the heart (B24 to B28) changed their position to become in 1967 the first leading cause of death, malignant neoplasms (B18) becoming the second and showing a great increase in incidence as compared to the previous J~ars. Tuberculos5.s (Bl and B2) left first :place to become the third leading cause of death, shmling a noticeable absolute decrease in the number of regi.stered deaths.

- 3 -

Meamlhile, In 1967. the t~lo-yearly epidemic of measles stroke ,Macao severely. so that the disease becP.Jlle in that year the seventh \greatest killer.

3. TUBERCULOSIS Despite the fact that it is now only the third leadinG cause of death, tuberculosis, in viel'i of its prevalence, incidei1ce and infectious character; undoubtedly constitutes the majol' or, at least, the most pressing public health problem in the pro'lince. Its mortality, based on absolute figures or proportional morta_ lity rates) apparently shows a general regressive trend. Hmvever) its incidence, on the basis of diagnosed clinical c~cses mainly of the respiratory type, is apparentl~' increasinG. Corresponding figures are shown in the t,IO follmlinG tables: Clinical or dia~~o~e~es of tu~~~~~psis during the last six 'JretXFS

rForras of tuberculosis I -- , ITuberculosis z all forms 1

T1962 -

1563 I 1964 --

- T

--r

-t I I

1 I

- ----f'--T

':.-y --

1>65

1~966

1967 I ----r

", I

no. of cases i no. of deaths

1522 351

13891 1028 223 25Jl'

n04

219

I I

1267 1 I

, I , I

i, , i I I j

1368 211

233

l!-

of the resIi 12iratory system It

Ii Tuberculosis

~..============1---

No. of cases No. of deaths

1439 1345 32 7 L __281 __

970

211

I , I lol+4 I 1211> 106 i

I I , 1 ! t

214

1328 1 93 --

i.,l I,

_~.i

Proporj;ional mortal..1ty from tuberc:..u1<;?sis ::lurine the 1as~ six years

I 1962 i

! ...-

-r'

t~tj _

1963 , 1964 I 1965 I

_4 _

4 • !J:RANSMISSIBLE DISEASES Viith the exception of tuberculosis, aJ.ready commented upon, 1967, from the transmissible diseases point of viev/, has been mainly characterized by the follOiJing tiW events: (a) (b) t,~enty

an epidemic outbreak of meningitis in J\pril and Hay, cases having been registered;

particular intensity and lethality of the epi~emic of measles during 1>67; the fatality rnte reached was 7 .3~j, a rate only comparable to the one registered in 1963.

Infectious hepatitis apparently shows an increasing incidence. Available data show that about 50% of the registered cases of tetanus occurred in infants born out of hospitals and maternities. Meanwhile, it is of interest to report that: (a) (b) (c) (d) typhoid and paratyphoid fevers regressive trend; sho'~

a general

the incidence of diphtheria is declining; no cases of cholera have been registered since

1964 ; since 1962) the problem of malaria in the area of l.liacao peninsula and town is merely to prevent the re-introduction of the vector; smallpox has been absent for years.

(e)

The incidence of the main transmissible diseases and their mortality for the last five yeul'S is given on page 5.

In 1957, 3691 children were born alive in 11o.cao s hospitals end maternities, i.e., 51.6~~ of the children who, according to our own estimate, were born alive in the province in that part ic ulal' year. I

Of the children born i:1 1967 j.n 1>18'::0.0 I S matel'nitie!s, 1408, i.e., 38.1~G, were born in maternities run by the Govenment Health and HeJi'are Services. I'filen all the births in the prcvince are tal~en into consideration, the Governinent Health and Welfare Services assisted is

19.7%.

'; l' ,I

o:rhe__Jnc).~~~!Fe !?! the r.min t.l'onsm~sl'~_L:..2:L d'iteaseG arid til eil' raortali ty for the last-!.i ve ;years

"..

I',

• ,

~ ....

1963 ---

1964 cases deaths cases

1965 deaths cases

1966 deaths cases

1967

cases

Tuberculosis of the respiratory system .. Tuberculosis: all other forms .................. S;vphills and sequelas •.......•.........• Gonococcal infection and other venereal diseases .............................................................. Typhoid fever ..........•••.....•....••.. Paratyphoid fever ...................•... Cholera .................................................................. Bacillary dysentery ....•..•......••..... Amoebiasis ............................................................ other forms and non_specified forms of dysentery .......................................................... Scarlet fever .....•...•...••............ Diphtheria ..........................•... Pertussis .............................................................. Meningococcal infection •.•.••......••... Plague .................................................................... I..eprosy ..............................................................

131f3 41, 1 ',)

. deaths 281 13

deaths

1: I

970 53 2 2

211

1044 60

2 6

196 23

38 5

1 1

111 13 1 2 1 1 53 8'7

96 2 37 2

22 1

J214 53

214 19

1328 40 2 2 , 103

193 8

1 90

7 1 413 7

1 1 2

18 9

2 3 1 1

lt9 2

Tetanus ................................. e" . . . . . . . . . . . . . . . . . . Acute poliomyelitiS ..•....•..•..•.•..••• Acute infectious encephalitis ...•.•..•.. Smallpox ........................... e .. .. .. • .. .. .. .. .. .. .. .. .. .. .. .. Measles ................................................................ Rubella ............................................................... Chicken pox .......................................................... He.rpes zoste r ................................................... Epidemic parotitis ...................................... Yellow fever ...................................................... Infectious hepatitis ..•..•.•...•....•.•. Rabies ........................................................... Trachoma ........................................................... Typhus and ot~er rickettsial diseases ••.. ~aria

42 10 2

21 1 1 21

2 1

1 -'

2 ~

45 63 1 34 7

1 -

1 31 6

1 28 lt7

6 3

1 6

20 20

I I

18 8

7 2lt 5 36

267

9 ,

136 3

8 7

175 22

133 -

1 I,

7 -

523

...........................................................

169 3 !

34 31* -

2 1

\J1

38 -

218

*Only referring to the f'igures registered in the Government Hospitals - "Hospital central Conde de S. Jnnuario" and "Hospital de Santa In1'!lncia" and in the Health Department of the Islands District.

- 6 -

The still.-births ,lhich took place in the hospi tala in 1967, amounted to twenty-three still-births related to a tota! of 3714 children born alive and dead, i.e., 6.2/1000. The still-birth rate in the Government Health and llelfare Services was 4.2/1000 (6 late foetal deaths in a total of 1414 births of children alive and dead in maternity wards of these services). J:.Iaternal mortality anlounted to two deaths, one due to "haemorrhage due to pregnancy or labourll (All7), which occurred in Hospital central Conde de S. Januario (Government Central Hospital), and another one due to "other complications of pl'egnancy, labour and puerperal status II (A120) which occm'red in a private hospital. Prenatal and child health services, as ore;anized services of preventive medicine and health promotion, are only run, in Macao, by the Government Heait.l.l and .}lelfare Services. The follm,ing taule relates to the yearly operatioms of these services since 1964:

service and :: nature of the register

i, Type of

: !

j I

Ii prenat::;:- cases

I , ;

1~4 I 1965 = ! 1

1-1966 I

=1' -

i""-4 . .

' ,

;~9~7 ~:1 45611 17051 21611

Ii No.

of expectant rJothers " registered for the first I time during the year .... 1 I Total No. of assisted Ii expectant mothers ..... . [Total No. of consultations

933 1778 2711

764 2127 2891 ''''j'-1

541 2119 2660 --_.1..'.

i I

I Child

I j

health--~:.vices

-----'-1 -" J

-r-''

, I

. !

"-,

of children reGistered for the first time, during !: the year ...•....•...... )!Total No. of assisted ,: ,: children ............... I, Total No. of consultations ,j

INo.

" ,

107

1037

779 1131; 4102

6-==-=--=-==""--~'--=========i==dL 6 • SANITATION

117 1 1143 172 i 4164

,- - - - --, ---

In 1967, work in connexion 'lith the construction of a se-werage systera for the city of Macao continued; 8153 collection meters were installed. This means that 33 500 meters, i.e., 83.:;1' of the vlhole planned system, have been already installed.

- 7-

The construction of a vlater supply plant planned in 1967 for the population of the Islands of Taipa and Coloane, Vlill begin this year. The cost of this enterprise, which includes a Vlater reservoir, pumping and treatment stations, aud a distributing plant, is estimated to be Bscudos 2 500 000$00, equivalent to us$83 534.22. The United Nations High Commissioner for Refugees has contributed $575 000.00 patacas (that is US$93 238.21) and an investment of Escudos 560 000$00, that is US$19 117.03, has been provided through the "Intercalar Development Program" ("Plano Intercalar de Fomento"). In Taipa Island, an economic housing estate (with 102 low_cost houses) has been built at a cost of US$112 355.23. Plans for a new abattoir for the city of Macao ,Iere made in 1957 and construction is to begin in 1968. Its cost is estimated roughly at $600 000.00 to $700 000.00 patacas, i.e., US$113 507.37. 7. HEAIJrH COVERAGE AND COllPARTICIPATION OF GOVERNMEI'lT HEALTH AND WELFAP,E SERVICES

Health coverage of the '-Ihole province by Dedical and paramedical personnel has shown a noticeable increase in 1967, thanl~s to the promulgation of legislation giving due recognition to the professional training of Chinese nationals and of people born in Vmcao. This provision resulted in 1967, ina considerable increase in the number of registered doctors and paramedical professionals. Physicians and paramedical professionals registered in ~~cao in 1966 and 1967 ii I I,

~--

1966 ------- -- ....li---i Ratio to the ;i No. of reProfessional ! population \1 gistered I , categories (estimated as I prof'esI I I !, sionals 296 564 ) I -- ---- ~t=-, i :! i 11 Phy~icians 53 1/5595.5 II i 1/5931.3 \\ Dentists 35 " I 1,8473.3 Nurses 66 i I I 1/11 862.6 Auxiliary nurses II 25 Midwives 19 I 1/15 608.6 ,1 n 3 __.L '" 1/98 85"'. ( ,

~ 11

!I :1

1567 --'"" --- I .. - --No. of re- , Ratio to the ; population gistered \ (estimated as ;1 pl'ofesi: 850) sionals 290 I il ....,.__..._ . --... -- '-'-'.-'-- --1-------, 152 ;"0 , I I

i( ;1

27 Ii, 22 " 1___ . __ _ 3

12 7

1/1913.5 1/5817.0 1/2290.2 1/10

i ~ i

7'n .. 2

1/2290.1

1/96 949.7

iI.l

- 8 -

In 1967, the follo,ling categories of staf'r were in. the Government Health and Helfare Services: Phys ic ians ••...•••.•.•..•...• 28 !'tlarmac ists ........................... 2 Social vlorkers •.•..•.....•... 2 Clerk personnel ••.•.•.••.•... 24 Nursing personnel ..•......... 75 Nurs ing nuns ....•...........• 20 Technologists for the dia,gnostic and therapeutic auxiliary services ..••••••• 16 Sanitary agents ..•.••.••.•••• 11 Skilled 'l'lorkers .............. 26 Non.skilled workers and servants ...................................... Total ........••.. Compared to the previous year, there has been an increase of manpower in 1967 through the addition of the following: Psychiatric nurse ••.••.••.••• Auxiliary nurses .•.•......... Clerk official •.•••••..••..•• list. 8.

4 1

Meanwhile, three sanitary agents have been eliminated from the COVERAGE BY MEDIC()",SANrrARY ESTABLISHNE!¢

Plans are being completed for the construction of a new psychiatric pavilion for the Hospital Central Conde de S. Januario (Government Central Hospital), and for a ne1'1 building in iihich the out. patient services of the hospital and the preventive medicine and health promotion services will be integrated. The Provincial Health and Welfare Office and the Macao City Health ./luthority De,partment '1'1111 also be installed in this building. l-Ieam,hile, vlOrk in connexion with the psychiatl'ic pavilion has already began. In the 1968-1973 "Develonment Program" ("Plano de Flbmento"), plans are made for the enlargement and in~rovement of the building for the Taipa Island Health Center and Rural Hospital.

EXPENDrrURE ON GOVERNMEl'l'I' HEAIlI'H AND UEr.FARE SERVICES

The expenditure on Government Health and Helfare S¢rvices in 1967 is shown in the follo1~ing table, in 1~hich for cow.parative purposes, figures for the last three years are also included: ."

1, ,

t, -lr---

1 I, I I

t --,=" I

, .. I

:E;x:pe'l.<li t llF.!3. 2E.. Qavernment r I c -.-----

Health..aJl.(Lll~.J!~~_ SeJ_vj.9_e:.~ from 1565 to 195'{ -----

-.-'-

OriGin of funds

Currency -~:-~~~-~~-

1965 ,

J I

-------=, .1966 1967

~==-~=~~~'==-=-==-~~'~

i Provincial Ordinary Budget

- -"="-"-='-~====="=~-r--' '

--#-:==-=----.=>,==~~~-=.--~~-.

PatacaE Dollars

$3 292 diG .69

03 243 262.81

I j

f;3 1:.84 644. Tr

r-.. i

'i II

i i

I II

(US )"

$ 533 e:u;. 55

525 9<f, .24

$ 565 046.99

-.~-.-------J Dollars (US)*

Program I Development (nplano de Foment o")

i II

33669.96

65 931.52

! :; '

\,')

73687.03

Donatio", of th: Assistance Board

Pu~l:~

Putaoaa~-r$~- l00.:;~ 2 ' Dollars

49 033.05

·~-$-2l $ .......

950.30·'-'"

I! II ;:: ........ =

(us)* =-.--

340.52

b ..,

7 950.88

3 560·94

II II

Patacas

$3 50::' 789·53

$3 698 895.55

TOTAL Dollars (US)*

I i I ~

$3 5X)1 033.01

$ 56'7 827·07

$ 599 788.48

$ 642 294.96

II *US$l

= $6 .167

patacas.

- 10 -

•

The appropriations in Macao I s Provincial Ordinary Budget for the Health and Welf'are Services and the corresponding proportion (as a percentage) in relation to total budget expenditure in li967 are shown on page ll, in 'which, also for comparative purposes, figures are included covering the last three years.

'.1

:!.

-. /

1, \ ~

,A.,

, 1 -. -.. ·--~-~~--u

•

Appropriations attributed ts> the Macao Health and \Jelfure Services from 1965 to 1967, 1~ith estirnat~oportion..? in Eelation with the whole bUdG£t spendin~

~-==:=

t" I

'I currencY~'!. 196;; --.!I=~=-~=-=. --=~~~-=-===--

. ~=t=-

-===~='F=

1966

I '======~'='=f 1967 ! I

Grand Total of tile whole bud.geted spending in the Provincial Ordinary Budget

I I

I Patacas Dollars

I I

I " $lfl 088

905.11

$46 068 429.h8

$46

677 390·77

(US)* f-----------·---------·II

6 662 706.03

$ 7 470 152.34 --+

$ 7 568 897 .48 1-'

----H-------Patacas

Total appropriations in favour of the Health and Helfare Services in the Provincial Ordinary Budget H II

$ 2 993 416.00 I $ 3 143 756.00

$ 3 369 734.00

!-'

Dollars

(US)* H

485 392.57 I $

509 770.71

54·6 559.75

Proportion of appropriations in favour of the Health and \{elf'are servicel as a whole, in relation to grand total budgeted spending II II II

7.310

6.8</0

7.610

J'!

-1.==

...

*US$l = $6.167 patacas.

PORTUGAL

PROVINCE OF MACAU

MACAU AND ITS PUBLIC HEALTH 1968

Brief monograph prepared by the Health & Welfare Department and the Information and Tourism Centre of Macau.

PORTUGAL

•

PROVINCE OF MACAU

MACAU AND ITS PUBLIC HEALTH 1968

Brief monograph prepared by the Health & Welfare Department and the Information and Tourism Centre of Macau.

GENERAL 11J'FOR,flATION Geography

The territory of the Portuguese Overseas Province of Macau is formed by a small peninsula on the southern coast of China, in the delta formed by two big riversCanton (or Pearl) River and the West River - and wholly occupied by the city of Macau, and by the islands of Taipa and Coloane, lying to the south, quite close the peninsula. The situation on the geographical chart, referring to the Guia Lighthouse, is pointed out by the co-ordinates of 22 0 11' 51" North latitude and 113 0 32' 48" East longitude. Macau is 15,515 sq. kilometers in area, distributed as follows: Peninsula of Macau ............ ..... 5,422 sq. km. » Island of Taipa ..................... 3,478 Island of Coloane ................... 6,615 » The climate is hot - with a mean annual temperature of over 20oC, moderate - and a range of yearly mean variation of temperature between 100 and 200 C -, humid - with an average yearly humidity between 75% and 90% - and rainy - and with a yearly precipitation between 1,000 and 2,000 millimetres. The hottest month is July - with an average temperature of 28.3 0 C - and the coldest is January - with an average of temperature of 14.6°C. Generally the month with the

-3-

greatest humidity is April and the dryest are October and November. The rainy season extends from April to September, when 82% of the annual rain falls, this season being the typhoon season. Typhoons, however, seldom strike Macau. History

Macau has been a Portuguese territory for over four centuries. Beginning as a trading entrepot - the first to be established in Asia between West and Far East - in the course of years, it assumed an important cultural and religious role. Portugal's political and administrative standing in Macau came, not by conquest, but by pure and spontaneous assent and donation by the Chinese. It was Jorge Alvares, the first Portuguese navigator to reach China, who in 1513 anchored his ship in the port of Tun-Moon, known among the Portuguese by the name Tamang, and lying between the island of Lin Tin and the city of Nam Tau. It was at this point that Portugal's relations wi~h China began. Other Portuguese traders followed Jorge Alvares. For several years, the Portuguese tried to get permission from the Government of China to establish themselves on Chinese territory, aiming at bigger trade development with this country. Not always have the Portuguese been successful in their efforts, but from their persistance some results have been achieved towards their desired aim.

-4-

r~ I

In fact, at a certain time, the Portuguese were authorised to establish a trading post im Liampo, close to the mouth of the river Ian Tse-Kiang, on the coast of the Chekiang Province. Trade here prospered until 1548, when a viceroy of this province ordered its abandonment. In spite of this, in 1553, Leonel de Sousa managed to get permission to trade on the coast of Kwangtung, mainly in Sangschuang and Lau Pak Kau, which met the wishes of the traders of Canton in attracting Europeans to trade in those places. One of the first consequences of that permission was the use of Macau by the Portuguese. This place, which had an excellent port, was known by the Chinese as Ho Keng or Hoi Kiang, but the Portuguese adopted the name of the temple of the Goddess Liang Ma or A-Ma, as the Chinese seamen called her. And so the place became known as A-Ma-Gau, which means A-Ma's harbour, from which was derived Macau, the name used by Europeans to identify the place and the port. Traditionally, however, the European occupation of Macau dates from the year 1557 when, according to some documents, a well known pirate named Chang-Tse-Lao was defeated and expelled from these seas, with the help of Portuguese forces. In 1568, Dom Belchior Carneiro arrived in Macau as Vicar of China and of Japan - a man of unusual culture and energy to whom Macau owes the establishment of the Holy House of Mercy, a Brotherhood of mercy inspired by the brotherhoods of mercy in the Portuguese Homeland. He also established the hospital os St. Lazarus for

-5-

lepers and the hospital originally called "Hospital of the Poor", and later renamed "St. Raphael's" - the first European hospital established in the Far East. According to an historian, "these charitable works award Dom Belchior Carneiro first place in the gallery of those who introduced European medicine to China". The Diocese of Macau was created in 1575. With the support of the Diocese of Macau, other dioceses were established into the territory of Continental China. Through these dioceses and their missionaries, not only was the Christian religion preached, but also European culture and science, above all mathematics, flourished on the Continent. Meanwhile, several European surgeons, including Portuguese from Macau, praticed in the Imperial Court in Peking. Through the years, relations between Macau and China progressed, generally guided by a spirit of understanding and natural agreement, from which resulted a situation of good neighbourhood. There have, of course, been disputes, at times brought on by circumstances of the moment. Nevertheless, the traditional good harmony and friendship which exists between these two peoples have never been interrupted for too long. For a very long time, Macau has been a point of liaison between China and other countries. Thus, on the 3rd July 1844, the first trade treaty between the United States of America and China was signed in the small garden of the temple of the goddess "Kun Ian".

-6-

On the 26th March 1887, The Treaty of Friendship and Trade between Portugal and China was signed. In 1844, the Health Services in Macau were established as part of a bigger scheme of the Portuguese Overseas Health Services.

Populatio1l The last census was that of 1960 when the population was 169,299, made up of: 7,974 Portuguese ., .......... , .......... ........ Chinese .. , .......... , ..................... 160,764 561 Foreigners.. .............. ....... ... ....... The estimated population for 1967 is as follows: Areas (sq.km)

--f-

1----Thewholeprovince ..................... I lVlaritime population , ...... ,............. Are.a o~ Yvlacau peninsula and munir

. 1

- - - -

~.. -

15,515 -

290850 8 871

cIpalIty ................................... Island of Taipa ........................... Island of Coloane ................. .......

5,422 3,478 6,615

272 640 6136 3203

50283,9 1764,2 484,2

1}C01l()my With the business competitIOn aroused by other European powers specially since 1841, when the English established themselves in Hongkong, the prosperity of Macau was deeply affected, falling into a subordinate situation particularly as it depended on the trade between the Far East and the West.

-7-

Because of this, many Portuguese from Macap, by the end of XIX century, began to emigrate to H01;lg Kong, Shanghai and to some cities in Japan, where the trade activities offered better means of earning a living. The economy of Macau, however, adapted itself to the new circumstances, although on a more modest scale than before, continuing to maintain with China quite a considerable volume of trade which remains one of its main economic supports. The deflagration of the hostilities in the Pacific in the last W odd War and later the changing of the continental Chinese Government (which greatly restricted the importation of foreign products) and, on the other hand, the restrictions imposed by the U. S. A. concerning goods from China, stopped the import and re-export flow through the entrepot of Macau to the big China market. These facts created a real economic crisis, which had to be settled urgently, as indeed it has been solved. The industrial development of Macau was the new path chosen for the Province in order to overq)me this new situation. Free trade between Overseas Provinces having been decreed, legislation was passed to open the way for industrial development. In this way, without neglecting the improvement of the traditional industries, namely firecrackers, matches, incence sticks, Chinese wines and fishing products, other more advanced industries were introduced, attracting more

-8-

capital investment, offering more jobs and usmg more sophisticated equipment. Among the various industries which appeared were: textiles including the manufacture of garments, the stamping of cloth and weaving; and the industries of leather, fiber and plastic cloths; beading arts and plastic goods. Recently, another plant was established for the manufacture of binoculars and other optical goods. Export results from this industry are good and prospect for the future are excellent. The manufacture of toys is another aspect of Macau's industry which is developing with prospects for expansion into new foreign markets. Meanwhile, weaving and stamping of natural silks, artificial or synthetic fibers and eventualy cotton weaving are industries whose establishment and improvement are being studied. More than 16,000 persons are directly employed in these developing industries not to mention those employed in handiwork in the "cottage industries". The trade balance of Macau is negative, its difference being covered by the entry of invisibles, specially through tourism which can be considered as a healthy, flourishing industry. Government and Administration The territory of Macau, which comprises the city of the Name of God of Macau and its dependencies, constitutes an overseas Province of Portugal.

-9-

As such it is a collective, public utility and by virtue of the Portuguese Constitution, the Organic Law allld the respective Political and Administrative Statutes, enjoys administrative and financial autonomy. For Macau, as well as for the other Overseas Provinces, besides the organs of the Central Government, whose Legislative power covers matters concerning all overseas territories, there exist Government organs of its own. These organs are: The Governor, The Legislative Council and the Government Council. The Government of Macau operates under the dependency of the Central Government, through the Overseas Ministry.

PlJBLIC HEALTH Mortality Mortality, evaluated through the gross mortality rates (calculated on the basis of population estimates) has evolved in Macau as shown in the following table:

[ ! Population estimate ..............

~~~~~t%:~t~Ii~~h:at~... :::::::::::::

1963 1964! 1965 i 1966 I 1967 1[-~~~34 -;92 8611'-;5~~1296 564!-;~~~ . 6.3M~. 5.5Mg~, 5.3Jl~~gl 5.2Jlg~gl 5,4MZg

[

Considered with reference to the causes, the ten leading causes of death in: 1967 and their position in the whole obituary are shown in the following table:

-10 -

Rate of Causes of Death Number of (classification according to the registered I international list of the W.H.O. deaths of 50 leading causes) I __________________________ !__________ All the causes ............................. I The ten leading causes: mortality

% of each cause in

I__ I

per 100 000 relation of with all estimated causes of PO_p_u_la_t_io_n_I ____ d_e_~_h___ 541,9 79,8 73,9 72,5 58,4 33,0 16,8 13,1 9,6 8,2 5,5 371,0 170,9 100,0 14,7 13,6 13,4 10,8 6,1 3,1 2,4 1,8 1,5 1,0 68,5 31,5

1 576 232 215 211 170 96 49 38 28 24 16 1 079

1) Diseases of the heart (B24 to B28) .............................. 2) Malignant tumours (B18) ...... 3) Tuberculosis (Bl and B2) ..... 4) Vascular lesions affecting the

central nervous system (B22) 5) All accidents (BE47 and BE48) 6) Influenza and Pneumonia (B30 and B31) ........................ 7) Measles (B14) ..................... 8) Nephritis and nephrosis (B38) 9) Cirrhosis of liver (B37) .. ....... 10) Ulcer of the stomach and doudenum (B33) ................... Total of the «ten leading causes»). ..... All other causes ...........................

497

Communicable diseases Malaria is today eradicated from the peninsula of Macau not only as a clinical entity, but also as a point of fact; Malaria is extinct in this area. Tuberculosis was in 1967 the third cause of death, its contribution to the obituary being steadily diminishing. There was, in March and April 1967, an outbreak of "epidemic meningitis", introduced from outside Macau, followed in May by one sole case - obviously sporadic. Diphtheria is declining. Meanwhile smallpox has not been recorded for many years and cholera, has not seen seen since an epidemic outbreak of cholera EL TOR in 1961 - 1964. The following list shows the main communicable diseases as recorded during the years 1963 - 1967:

-11-

1963 Diseases

1964

1965

I I

1966

1967

I I cases deaths 1 i cases Ideaths cases Ideaths I cases Ideaths I cases I deaths

--I--175 4 1 5 3 39 2 49 10 267 32 91 44 283 1 13 11 l' 1 9

I 1 345 1

- 531 111 13 1 2 1 53 3 87 5 8 8 7 3

9701

211 12

'''' -;;:1-;~;;f~I~'1 '" 60 23: 53 19 40 I -

96 2 2 37 5 1 2 2 45 1 63 6

21 -

90 1 7

103 11

...... t-v

Meningococcal infections ............... I lXTl-. ............. ; .................. , ...... '1-.

1 21

dl 22[ 31

1 4

719 48 2 6 28 6 31 20 47 6 7 7 2 5231 34

1~1

2 1 3 1

3~1 3

\ .. \J

HEALTH SERVICES COVERAGE The general health care coverage of the Province evaluated in terms of medical and paramedical registered manpower, refering to December 31, 1967, is as follows: Number of units