Agenda Item 7 - ACknowledgement by the Chairman of brief reports received _ from governments on the progress of their health activities.
Attached are brief reports received from the follOwing governments in the Region on the progress of their health activities:
1. 2.
American Samoa British Solomon Islands Protectorate Cambodia China Hong Kong Macau Netherlands New Guinea North Borneo Philippines Singapore Trust Territory of the Pacific Islands Viet Nam
;. 4. 5. 6.
7. 8. 9. 10.
11. 12.
BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN AMERICAN SAMOA DURING THE PERIOD 1956/1957
Advancements and Improvements in the Department of Med..i.cal Services during fiscal year 1957 1. A tuberculosis building was opened and tuberculosis patients were transferred from the General Hospital Where they occupied two wards. Extensive repairs were made to the main hospital and the student nurses' building.
2. During November the Watson-V:"ctor Photofluorogram (lOOmm), which required English film, was converted into a 70 rom chest photofluorogram machine. With this conversion it is now possible to talre routine X-rays at a total cost of .05 per patient, as compar:cd. to .83 per patient. This equipment may also be utilized in conducting a tuberculosis survey •
.3. . A tubercu.losis survey "TaS con0.ucted on all Samoan graduate and student nurses beginning April 2, 1957. ~le total number of nurses X-rayed was 127. A chest survey on all Samoan hi&~ school students was begun April 22. Three Samoan young men, hig..~ school graduates, were appointed to attend the Central Medical School at Suva, Fiji, malting a total of six students from American Samoa presently attending.
4.
5. One Samoan X-ray trainee from the hospital was sent to Honolulu for further X-ray training in the St. Franci s lio spi tal d"..U'ing the year. Hi s training will be completed in Augt.~.st 1958. He is expected to return to work in the X-ray service of this department, and should be able to replace a stateside employee. 6. Dr. Julia T. Lagarejos) first Samoan Doctor of MediCine, was appointed Chief of the Paediatric Service. 7. Smallpox vaccination and typhoid imrmmization programmes continued from December 1956 to the present. The Central district has already been covered. This immunization is expected to cover the Eastern district, Western district, and all the islands of the lhnu'a group during the fiscal year 1958.
8.
An increase in the complement of medical doctors from four to five enabled the Department to render additional services.
9. A building next to the hospital was re~ovated for the purpose of providing office space and headquarters for the public-health officer and his staff. This • congested condition of the hospital and enabled two divisions action reduced the of this department (hospital and p~blic health) to operate more efficiently. 10. A programme was initiate~ for the rehabilitation and health education of tuberculosis patients as reco~mend8d by WHO.
BRIEF REPORT ON THE PROGRESS OF HFALTH ACTIVITIES IN THE BRITISH SOLOMON ISLANDS PROTECTORATE DURING THE PERIOD 1956/1957 1. Hospitals
A new lOO-bed hospital was recently completed at Honiara with facilities for the treatment of tuberculosis, general medical and surgical cases, and a small maternity unit. The three government district hospitals are working to capaci ty and it is hoped to reconstruct the hospitals at Gizo and Kira Kira. . next year. 2. There are fifty government rural dispensaries. Twelve child welfare and materni ty centres have been opened in the past eighteen months and have proved of gre~t value. This service will be expanded as more trained nurses become available. ,. Training of Medical Assistants and Nurses
Thirty-six students are being trained at the Central Hospital. They a three-year tra1nin~ in general nursing, diagnosis and treatment and public health. Most, on qualifying, will be posted to the districts in rural dispensa.ries. A nurses school 'Was opened in December 1956 and the first batch of girls connnenced training in February this year. They will do a three-year course similar to the boys with emphasis on child welfare and maternity work. There is total accommodation for thirty girls. The loan of a tutor sister has been requested from WHO to assist in training. rece~ve
4.
Public Health 4.1 Yaws cam;pai~
A yaws eradication campaign 'Was commenced in July 1956 with the assistance of WHO and UNICEF. In the first year just over half the ;po;pula.tion have been covered and the initial treatment survey should be completed about mid.-1958. The results so far have been most encouraging. 4.2 Leprosy campaign, a leprosy survey is being WHO, will visit the Protectorate in visit and advice, it is hoped that extended.
In conjunction with the yaws conducted. A leprologist, sponsored by September/October this year. After his the control of leprosy will be actively
4., 4.4
Malaria
It is hoped to start a pilot project in malaria control with the advice and assistance of WHO in the near future. Malaria remains our major endemic disease. Tuberculosis
Two tuberculosis surveys have been undertaken and a modest BOO vaccination campaign was planned in some of the more remote islands for the latter part of this year.
/4.5
Special training •••
Page 2
4.5 Special training overseas Assistant Medical Practitioner Dawea attended a course in village hygiene in Samoa sponsored by WHO. Assistant Medical Practitioner Fakaamea is at present attending a course in health education in Noumea sponsored by the South Pacific Commission.
ORIGINAL: FRENCH BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN CAMBODIA DURING 1956 1 General
Cambodia has an estimated area of 180 000 square kilometres and an estimated population of !~ 360 000 inhabitants (based on the 1955 figures). The birth rate is estimated to be 125 000 per year, or 31 births per 1000 inhabitants. The mortality figure is estimated to reach 44 000 per year or 11 per 1000 inhabitants. The ratio of birth to mortality is 31:11 per 1000 inhabitants. The infantile mortality rate appears high. As a result of not having a statistical service and consequently a shortage of personnel, none of these figures can be accepted as ~ompletely accurate. 2 Progress made in 1956
Efforts have been made by the Government to continue and expand existing programmes and to establish new ones. However, the progress made has not been as great as in 1955 for it has been limited as a result of insufficient funds and personnel or because certain programmes (in particular those related to training of personnel) require more time before producing results. 2.1 Training of personnel The number and calibre of personnel, despite every effort, remain insufficient for the needs of the country and this is the principal problem of the Government. At the Royal School of Medicine, the section of health officers (officiers de sante) which has existed since 1945, has had added to it a section "Doctorat en Medecine" which has been functioning since the 1955-1956 academic year. Professors of the Faculty of Medicine of Paris, who have come on short-term assignoents, lecturers recruited with WHO funds and doctors of the various health organs in Phnom-Penh carry out teaching duties in the two sections. An agreement has been concluded with the Faculty of Medicine of Paris to permit capable and deserving officers of health to continue their studies in the French Faculty up to a degree in medicine. The question of turning the present School of Medicine into a true Faculty of Medicine is under consideration. With the assistance of four nursing educators from WHO, the training of nursing personnel and midwives has not been forgotten by the Government. The study programme is progressively being modified, and the selection of candidates increasingly emphasized. The establishment of a new statute to raise the School of Nursing and Midwives to a professional level is under consideration. The construction of the new school is alJnost finished. To counterbalance the lack of midwives due less to an insufficient budget than to lack of candidates (for very few Cambodian girls take up administrative careers and less still work in the health field) the training of rural midwives is being carried out. /2.2 Campaigns against •••
Page 2 2.2 Campaigns against control of communicable diseases
The antimalaria service made considerable progress during the year. The objective of this campaign, which is directed to eradication, is becoming more and more precise. In 1956, 1216 villages have been treated with DDT and 412 000 inhabitants directly protected, compared with 180 000 inhabitants and 556 villages in 1955. The antimalaria campaign is receiving technical assistance from WHO and Cambodia is a member of the Antimalaria Co-ordination Board of 'Which the other members are Burma, Laos, Thailand and Viet Nam. The number of BeG vaccinations 'Which remains much the same as in the past year shows that here too certain progress has been made. The teams, 'Whose number has been increased from three to four, are going further into the field after having visited the main centres. As the distance to cover becomes greater and the area less and less populated the further away it is from the fertile areas and the towns, the figure which remains unchanged or which tends to become lo-wer is no evidence of neglected or failing work. The results for the year were as follows: test 262 716, positive 126 883, negative vaccinated vaccinated 1511. 1~4
tested 296 784, completed 322 and negative non-
2.3 Maternal and child health and school health The expansion of the two projects to the provinces, the opening of new pre- and post-natal consultations are planned. The distribution of milk, supplied by UNICEF, to needy children in the town of Phnom-Penh has been started. A wider distribution (in the provinces and schools) is planned in 1957. A programme of UNICEF assistance amounting to $54 000 (28 000 for equipment and 26 000 for milk) has been established. A course in home economics for teachers is being given during the school summer vacation. 2.4 Health education The 38 national" health educators provided this year with improved and more efficient propaganda (pamphlets, films ••• ) are continuing their work further and further in the provinces, often in collaboration with the antimalaria and BCG vaccination teams. 2.5 Consultation and hospitalization services
The number of consultations and hospitalizations in the provinces has considerably increased (32 706 hospitalizations and 2 358 628 consultations against 17 471 and 1 906 259 in 1955). This increase does not signify an increase in the number of patients in the country; it is rather proof of ·the efforts made by the Administration to increase the number of assistant nurses, thus permitting many people to benefit from modern methods of , medicine. Reference is also made to the fact that several new buildings have been erected from funds resulting from voluntary gifts from the population. In this category there is mentioned, amongst others, the Hospital for Buddhist Priests 'Which has 130 beds and 'Which represents an achievement never before known in this little country, conceived and realized almost without any help from the Administration. /At the Preah •••
Page 3 At the Preah Ket Mealea Hospital in Phno~Penh a second ward for older children has been opened, in addition to the existing hospital ward for children. A supplementary pavilion for the hospitalization of infants is in the course of construction and will take the name of Kantha Bopha Paediatric Centre (after the name of the Princess, daughter of His Royal Highness Prince Norodom Sibanouk who died at an early age). It has also a consultation service f.or children. The Prince has contributed a very large part of the money for this work. An operating block, whose construction is almost finished, will be in operation in 1957.
2.6 Rural health Quite large sums of money have been assigned to the Department of Social Welfare to increase the number of sanitary wells and pit privies. The Fundamental Education Project (which comes under the Department of National Education), while trying to raise the social and intellectual level of the people, is also trying to raise their sanitary level. A praiseworthy effort has been made with encouraging results; many villages are moderniZing, improving and embellishing themselves. The construction of a health centre is almost finished: ,its opening is planned for the end of 1957. This is the beginning of a service which little by little will be extended throughout the whole country. 2.7 Other work in the health field Only programmes ~riting special attention in 1956 have been mentioned above. Others which are not reported on here (health service, campaigns against yaws, venereal diseases, scabies, trachoma, drug addicti()n ••• ) are not lagging behind; everything which was started in 1955 is continuing in 1956. In summarizing, during 1956, the progress made, although little, is not to be ignored. The Goverrunent owes this' to a great extent to the generosity of foreign and international assistance through which it has received money, supplies, or experts.
BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN TAIWAN DURING THE PERIOD 1956/1957
Taiwan, one of the provinces of the Republic of China, ba.s a total :population of 9 473 511. The birth and death rates for the last three years are as follows:
1954 Population Birth rate Crude death rate Infant death rate
1955 9 077 643 44.6 8.5 33.9
122§.
8 749 151 43.8 8.0 30.1
9 473 511 44.1 7.9
The density of :population is
180 in 1947.
263 per square kilometre this year as against
During 1950-1953 effort bas been concentrated in setting up local health agencies. There are now 22 health centres (one in each :perfecture) and 368 health stations. Each of these health stations serves about a total :population of 20 000 to 30 • 000. Health services ba.ve been developed gradually since these local health agencies were set up. The process of the main public-health activities are given as follows: 1. Ma.tarnal and chili health
The majority of the births are delivered at home. There are about 401> of deliveries attended by unlicensed midwives. This year refresher courses to train unlicensed m:idwives were offered by maternal and child health centres and other health centres. The nutrition programme for the antenatal cases is also emphasized. Another activity in maternal and child health is nutrition education, especially for those infants during weaning period. 2.
Tuberculosis control
In order to strengthen the tuberculosis control programme, it is planned to establish a local tuberculosis centre in each :perfecture. Up to the present, tuberculosis clinics attached to local health centres have been organized in nine out of the total twenty-two prefectures. Within three years, it is expected that a tuberculosis clinic will be established in each health centre of the other thirteen prefectures. This year the BeG programme continued as in the previous year. Among the
711 419 people tested, 668 193 or 84.1i completed the test, and 381 666 or 98.41> of 387 773 non-reactors were vaccinated. The death rates from pulmonary tuberculosis were 8.51> and 7.91> of the total deaths in 1954 and 1955, respectively. In 1954 and 1955, the number of deaths :per 100 000 were 56 and 55 respectively. The figu,rea for 1956 are not yet available.
/3.
Environmental. .....
Page 2
3.
Environmental sanita. tion
Environmental sanitation is another main activity this year. Since the establishment of the Institute of Environmental Sanitation, same experimental 'WOrk has been done. Recently, a new sewage disposal system -was put into operation. In Taipei City a complete sewage disposal system is under pl..anning. WHO has a.ssigned one sanitary engineer to assist in this project. To solve the housing problem, a national committee was organized. From 1953 to 1956, a sum of NT$66 160 000 has been loaned and 3899 units -of house s have been built for the people. In addition, activities in connection with water pollution,- air pollution and other vector control have been carried out.
4.
Malaria control
The control of malaria has been a great success. A. min1mus, the chief vector in Taiwan has been effectively controlled by nm-spray1ng. From 1952 to 1956, residual DDr spraying of houses covered 7 500 000 people. The incidences of clinical cases of malaria were 1 200 000 and 486 in 1946 and 1956 respectively.
5.
Venereal disease control
Diagnostic facilities for venereal disease control have been set up in each of the twenty-two health centres.
6.
Other communicable diseases
Other communicable diseases have been effectively controlled by either mass vaccination or strengthening the reporting system.
7.
Nutri tion
Although there is no independent institute of nutrition, some work such as a nutrition survey, food analysis and processing, and nutrition education have been carried on in health education and agricultural institutions. In order to create better co-operation and co-ordination, a three-day national nutrition conference was held 16-18 July 1956. This conference has given impetus to the public-health nutrition work. Several resolutions for nutrition improvement have been obtained.
8.
Training
In 1956 the Institute of Public Health of Taiwan University continued to conduct two-month in-service courses for public-health officers. A one-year post-graduate cour~e in public health is being planned. The training for public-health nurses was conducted in Tao-yuan Health Centre with technical assistance by the National Institute of Health. Finally, two organizations related to public healtb are bei1 planned. One is the Na.tional Atomic Medical Institute. Its functions are 1) clinica.l applica~ion of radioactive isotopes for diagnosis and treatment, 2) training of personnel in atomic med.1c:J..ne and (3) international co-operation on the peaceful uses of atomic energy in medicine. The other organization is the National Food and Drug Control Bureau. Both will be functioning in 1957.
BRIEF REPORT ON THE PROGRESS OF HFALTH ACTIVITIES IN HONG KONG FQR THE YElJ~ E:NDED 31 M/'..JWII 1957 (Statistical data refer to the Calendar Year 1956) The responsibility f~r the administration of the services safeguarding the public health in H~ng Kong is shared mainly between the Department of Medical and Health Services, the Urban Services Department, the New Territories Administration (for the rural area of the Colony), and the Labour Department. The Medical Department is responsible for the administration of all government hospitals, clinics, maternal and child health centres, etc.; for the study and control of communicable diseases; for port health, and international health matters, vaccination campaigns, etc. The Urban Services Department is concerned wi th questions of hygiene and sanitation. It administers the public-health laws relating to environmental sanitation, food inspection, etc.; and in addition is responsible for such matters as the control of hawkers, disposal of the dead, public beaches and parks and playgrounds. The main work of this department centres on cleanliness and hygiene; the majority of the staff is engaged on street cleaning, removal of refuse and allied duties. The New Territories Administration is responsible for public health in the New Territories, with the assistance of a medical officer seconded from the Medical Department, 'Who also supervises generally all the clinics, maternity homes and government medical services in the New Territories. The Commissioner of Labour is responsible for health and hygiene in factories. The Industrial Health Officer advises him in this, and particularly on the prevention of hazards that may endanger the health of the industrial workers and give rise to industrial diseases. There are voluntary organizations working in the fields of tuberculosis control, blindness, deafness, leprosy, family welfare, family planning, etc. The Department of Medical and Health Services, under the Director and his Deputy, is divided into two main divisions - the Medical and the Health Divisions, each under an Assistant Director. Its expenditure for the year ended 31st March, 1957, "Was some HK$30m. In addition, HK$7.5m. "Was paid by "Way of subvention to voluntary organizations providing hospitals and other medical and health services in the Colony. The total of these sums "Was approximately 8% of the Government's total expenditure for the year, although this does not, of course, include the spending on health services of the other departments mentioned. In 1956, as in the three previous years, the Colony remained entirely free from the six quarantinable diseases, nor were there any noteworthy outbreaks of any other notifiable communicable diseases. The incidence of, and mortality from, notifiable diseases in general decreased from 18 142 cases with 3095 deaths in 1955 to 16 071 cases with 2870 deaths in 1956. During the year, 96 746 births were registered (an increase of 6235 over 1955) and 19 295 deaths (an increase of 215). The estimated crude birth rate was 39.7 per thousand and the death rate 7.9 per thousand. There "WaS a further drop in the infant mortality rate from 66.4 per thousand live births in 1955 to 60.9 in 1956. There "Was, however, an increase in the neo-natal mortality rate from 23.1 per thousand live births in 1955 to 24.2 in 1956. Deaths under one year of age in 1956 constituted 30.6% of all deaths from all causes as compared with 31.5% in 1955. /The incidence rate •••
Page 2 The incidence rate of notifiable diseases was 658.6 and the mortality rate 117.6 per 100 000. Excluding tuberculosis (see table) the incidence and mortality rates were 160.5 and 9.9. 1. Tuberculosis
The enormous increase of population since 1945 (including some 700 000 refugees) and the resulting appalling overcrowding have produced probably the highest tuberculosis infection rate in the world. However, excluding the immediate post-war years, when statistics could not be regarded as reliable, the mortality rate for 1956 was the lowest on record. Estimated Mid-Year Population 1 1 2 2 2 2 2 2 2 800 857 265 013 250 250 277 340 440 000 000 000 000 000 000 000 000 000 Death-rate per 100 000 108.9 140.6 144.0 208.0 158.8 130.6 126.3 120.0 107.0 TUBERCULOSIS Percentage of Percentage of tuberculosis total deaths deaths below 5 years 14.6 16.0 17.7 20.0 18.4 16.0 14.9 14.7 13.6
Year
1948 1949 1950 1951 1952 1953 1954 1955 1956
34.8 38.3 34.0 34.3 36.2 31.2 28.0 25.0
1.1 Ambulatory treatment of tuberculosis: Ambulatory chemotherapy was started in the chest clinics in an experimental way in 1950, has steadily increased in scope and magnitude since that time, and has now become the spearhead in the therapeutic attack against the tuberculosis problem. The advantages of this method of treatment in Hong Kong are as follows: (i) The available beds are totally inadequate to deal with the tuberculosis problem using orthodox hospital treatment; (ii) many patients prefer ambulatory treotoent as it enables them to retain their Job and maintain their families; (iii) it is 90% as effective as hospital treatment, although 10-15~ of patients require subsequent admission to hospital; (iv) using combined ambulatory and hospital treatment, nine times the number of patients can be treated at the same cost as by orthodox hospital treatment. In addition, the Hong Kong Anti-Tuberculosis Association (in its RuttonJee Sanatorium) and the Tung Wah Group of Hospitals maintain beds for conventional treatment. The BCG vaccination campaign, started in 1952 under the sponsorship of UN;tCEF and WHO, continues with emphasis on the vaccination of new~born children.
INo general X-ray
...
Page 3
No general X-ray surveys are carried out since facilities for treatment are already overstrained, but all civil servants are X-rayed annually, all teaChers are X-rayed before taking up their posts, and arrangements are made to X-ray the employees of any employer prepared to guarantee paid sick leave to those with active disease. 2. Malaria
Control relies mainly on anti-larval measures. The areas at present under active control consist of the populated portions of Hong Kong Island( Kowloon and New Kowloon, in which the main bulk of the population (about 90%) is concentrated. Certain areas in the New Territories are similarly protected. The disease is not a public-health problem in Hong Kong.
3.
Leprosy
The vast majority of patients with this disease continued to be treated at out-patient clinics with the object of rendering them non-infective as quickly as possible by modern treatment. This is justified by the proved fact that infectivity of leprosy is extremely low. Infectious cases were sent to Hay Ling Chau Leprosarium, most of the non-infectious were accommodated in multi-storied resettlement estates in Kowloon and the remainder, who were physically disabled, were cared for by the Social Welfare Office. Rehabilitation of cured cases, however, continues to be difficult since the progress of re-acceptance into the community is slow.
4.
Social Hygiene
The incidence of venereal diseases continuesto show a satisfactory decline. Ante-natal blood tests for expectant mothers showed a lower positive rate than has previously been recorded. Special services for seamen and for cases referred by the sterility clinics of the Family Planning Association continue to be provided on an increasing scale. Several new investigative procedures were introduced during the year.
5.
Ma ternal and Child Health' Services The government midwifery service has 37 district midwives working from
19 widely scattered centres in the urban areas and New Territories.
Twelve centres, all in the more rural areas, have maternity homes attached, with a total of 105 beds. The remaining centres provide a domiciliary service only. A total of 11 013 deliveries were conducted during 1956 by the government midwifery service, 7660 in the maternity homes and 3353 in private houses. Maternal and child health clinics provide the public with free ante-natal, post-natal, infant and child welfare services. Their aim is to promote and maintain the health of expectant mothers, of all infants and young Children, but no therapeutic treatment of sick cases is undertaken. During the year, / five full-time •••
Page 4 five full-time centres and fourteen subsidiary centres holding clinic sessions provided these services. In addition, sessions providing maternal care only were provided in five other centres. Ante-natal attendance figures again show an improvement over the previous year. Over two-thirds of all cases delivered received some pre~t~l care. Considerable increases were also possible in the number of post-natal sessions provided. 6. School Health
In 1956, the School Health Service has continued to be limited owing to lack of premises and staff. No new entrants, except those to existing government schools, have been accepted during the year. The number of pupils participating in the Service in December 1956, was 36 196 fram 400 schools (including 43 government schools, 86 subsidized schools and 268 private and grant-in-aid schools). . Prophylactic immunizations were arranged for all school children irrespective of participation in the Service. Particular ~pbasis is laid on measures against diphtheria, typhoid, smallpox and tuberculosis. Two thousand six hundred fortyeight sanitary examinations of school premises were carried out. 7. Health Education
There was a considerable increase of work in this field, through the School Health Service, school nurses, health visitors, the maternal and child health centres, and tuberculosis visitors, in addition to the annual vaccination campaigns. 8. Hospital Facilities
Apart from nursing homes and the Armed Services' hospitals, there are 28 hospitals in the Colony. Eleven of these are the responsibility of the Medical Department and the other 17 are run by various private organizations. Treatment in government hospitals is generally free. Seven of the private institutions receive sUbstantial assistance from the government for the charitable service Which they offer. The 11 government hospitals provide a total of 1999 beds, the government-assisted hospitals 2477 beds and private hospitals 1172 beds. In addition, various government dispensaries provide a further 98 beds, mainly in the New Territories'and practically all for maternity cases, and there are 520 beds in private maternity and nursing homes. There is therefore in the Colony a total of 6266 beds for all purposes. The Anti-Tuberculosis Association I s new 540.bed Grantham Hospital was due to be opened soon after the end of the year. Planning continued on the new 1300-bed government hospital in Kowloon, which it is estimated will cost HK$52m. 9. Technical Training
M.R.C~O.G~,
Candidates for higher qualifications such as the M.R.C.P., F.R.C.S., F.F.A.R.C.S. and other diplomas receive their preliminary training in the Queen Mary and the Tsan Yuk. Hospitals. The University of Hong Kong also assists in the training of future specialists. IAn ~Fortant part •••
Page 5 An important part of the work of the Medical Department is the training of male and female nurses, and midwives.
The second health visitor course with ten specially selected students was successfully completed in September 1956, .and the third course with the same number of students commenced on 1 October 1956. The Medical Department also trains technical assistants in pharmacy, radiography, laboratory techniques and in medico-social work. Candidates are also sent to the United Kingdom, Canada and the united States for courses in the following subjects: public health, oesophageal surgery, diagnostic radiology, anaesthetics, orthopaedic surgery, psychiatry, public dentistry, conservative dental surgery, plastic surgical nursing, physiotherapy and midwifery and premature baby nursing, and also for courses leading to the Licentiateship of the Medical Council of Canada and Sister Tutors Diplomas. 10. International Liaison
Experts in various fields connected with the World Health Organization visited the Colony to advise the Department on various problems, amongst 'Which were malaria, environmental sanitation, leprosy, tuberculosis, resistance of insects to insecticides, and maternal and child health. In turn, the Department offered facilities to WHO fellows to study problems which are of special importance and significance in the Western Pacific area.
The above summary deals only with the principal aspects of health activities in Hong Kong. There has not been space for detailed reference to, for instance, the work done in the Medical Department in radiology, medicosocial work, the dental, ophthalmic and pathological services, physiotherapy, occupational therapy, etc., and the detailed activities of the Labour and Urban Services Departments, and the New Territories Administration.
ORIGINAL: PORTUGUESE BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN MACAU DURING"THE PERIOD 1956/1957 1.
Population
Based on the census of 1950 the population of Macau was 187 772 inhabitants, about 92% of whom were Chinese. No other census has been made but since then, the demographic balance resulting from the difference between births and deaths, the accumulated surplus and the intense movement of entries and exits of Chinese allow us to compute the present population at 450 000. In spite of reasons, too well known, Which have placed the province of Macau in a difficult situation in this respect, and in spite of the precarious conditions of the general population Which overcrowds the territory, notable progress has been made in the field of health as a result of intensive action developed in the sectors of hygiene, in the fight against insects, the prophylaxis of infectious diseases and medical assistance to the population. 2.
Hygiene
The supply of drinking water and the removal and destruction of excreta and garbage - basic factors of all hygiene - have received the most constant attention. Water, supplied by the enterprise that assumed this responsibility, is bacteriologically pure and there are no restrictions on its consumption either during any period of the year or of the day. The removal of excreta and garbage in the city zones without sewage is now done in an almost perfect way by properly trained personnel. The excreta is also used as fertilizer, especially on the Chinese Continent to Which it is shipped by adequate transportation; the garbage residues of domestic and industrial life are burned. Due to the care and attention given to all aspects of this work and to the improvement in installation and working conditions, the incidence of diseases related to the quality of water and to excreta has diminished considerably.
3.
Fight against
insects
The fight against insect carriers of diseases - namely, the anopheles is carried on by a health brigade especially trained and maintained by the Health Services and using the insecticides with residual action - DDT and BHC. All collections of water are under control and are periodically sprayed, as well as the living quarters near them. Due to the intense action developed in this field the cases of malaria among the inhabitants of Macau registered in 1956 were very few and almost all the cases came from outside of the province (Macau); only a few collections of water in a district of the city were found to be positive during periodical collections made to find out larvae of the anopheles; no adult insect has been caught in traps periodically laid in different places. It may be stated, therefore, that malaria eradication is on its way in the city of Macau; and the filling up and levelling of all existing depressions, as provided for in the health projects under study, will contribute fundamentally towards the achievement of this goal.
/4.
Prophylaxis of' •••
Page 2
4.
Prophylaxis of infectious diseases
Prophylaxis of infectious diseases, namely: cholera, typhoid and paratyphoid, diphtheria and smallpox, was made by vaccination which abnormal condi tions existing in nearly all parts of the East have made necessary, even· compu.lsory. Conditions having been greatly improved by the constructive action developed in the field of sanitation, the practice of mass vaccination was abandoned, only the numerous population who live by the hundred in boats anchored at the docks, being submitted to periodic vaccination as it is impossible to control this population because of the constant movements. It was in this group that the outbreak of diphtheria and typhoid cases occurred in 1956.
5.
Medical assistance
The Province disposes of numerous diagnostic and treatment centres Wbere medical consultation, nursing care and medical supplies are given free of charge.
The working conditions, Where intense action has been developed with all the beneficial effects in the health field, have been improved. In the five hospitals in the city, administered or subsidized by the Government, many important improvements were made during the last year. In the Central Hospital - built on the same site Where the Hospital of the Count of San Januario stood for one century - a second wing vas constructed Which, in addition to a laboratory, out-patient services and a surgical block, will have over 125 beds. In the "Hospital de San Rafael" - built four centuries ago and since then transformed, enlarged and modernized in successive periods - the maternity ward has been enlarged to 12 beds and has been endowed with an incubator for premature babies. In the "Hospital de Santa Infancia" (Holy Infancy Hospital) capacity has been increased by 10 beds. In the Military Hospital a new infirmary with 30 beds and a new surgical ward, with all its necessary supplies, have been constructed. In the Anti-Cancer Clinic, Which has already disposed of 450 milligrams of radium element, a deep radio therapy apparatus was installed. In the islands of Taipa and Coloane two maternity centres were constructed with the number of beds in proportion to the population of these islands.
6.
Mortality rate
Due to the progress made in the field of health, the mortality from infectious diseases decreased from 1196 deaths in 1950 to 474 in 1956; the total mortality from 2939 to 1787 including the still-born.
7.
Expenses of the Health Services
The Government spent in 1956, with its own health services and with subsidies, $2 482 737.10, or about 13% of its budget.
BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN NETHERLANDS NEW GUINEA DURING THE PERIOD 1956/1957 Population estimated Population under govermnent administration Area
700 000
• .
373 000
• .
416 000 square kilometres
1.
Organization of the Department of Health
No essential changes have taken place in the organization. Further extension of the number of specialized division is in preparation. These concern environmental sanitation and nutrition. By ordinance of His Excellency the Governor a nutrition board insti tuted. 2. Health Staff 'WaS
The number of medical officers (dental surgeons included) amounts to 70. Forty-nine are in government service. This comes to one medical officer in every 10 000 people.
92 3.
The number of nurses (Netb.erlands certificate) amounts to 104 of which are in government service. Expendi ture on public health
In the calendar year 1956 the cost of operations and capital expenditure amounted to Fl.Ned.crt. 6 452 000 (fl.5 890 000 the previous year), 'Which is 6% of the total government budget. 4. Curative medical services
The new central hospital for Netherlands New Guinea at Hollandia is under construction. Specialists in the terri tory are one general surgeon, one orthoJ;6E!dic surgeon and one specialist physician. 5. Awdliary ;personnel
The number of qua.J.ified Papua.n nurses amounts to 109 (81 in government service); malaria control assistants 29; pharmacy sub-assistants 12; l6boratory assistants 8; smallpox and BCG vaccinators 14; infant welfare nurses 40.
6.
Vital statistics The general mortality rate covering a population of 19 400 'Was 241>.
In a population of 26 700, the infant mortality rate varied between 167 and. 500 per 1000 live births. The mortality rate of infants under maternal and child health control varied between 47 and. 95. Birth rate 511>, covering a population of 26 700. /7. Activities of •••
Page 2
7.
Activities ot WHO/UNICEF-aided projects
7.1 Malaria In the yea:r under discuss:i:on consultati·~n with WHO/UNICEF resulted in finding new ways to achieve mala.ria eradication. The original plan of action for 1957 'WaS reconsidered. The indoor-spraying campaign will be extended more selectively to those areas Where greater results can be expected. This means that in 1957 the aim is to have a total population of 120 000 persons protected. The original plan consisting of an expansion of the campaign in 1956 to a total of 100 000 persons was considerably surpassed. The results on the island of Biak go in the direction of total interruption of malaria transmission. A combination with mass-chemoprophylaxis is scheduled for 1957.
7.2 Yaws With the assistance of WHO/UNICEF a yaws control campaign was inaugurated in 1955. The system of total mass treatment was adopted. At the end of 1956, 276 571 persons were treated. The attendance was 9710. The ini tial clinical index was 5 - 1010. ']he clinical index after one yea:r was O.l&{o.
7.3 Tuberculosis In 1956 a second medical officer was put at the disposal of the tuberculosis control division. In a basic agreement with Wlro7UNICEF and the Government, a programme for BCG vaccination for the coming three years was laid down. In the first year of execution the agreed number of 25 000 tests was considerably surpassed. Six thousand persons submitted to fluoroscopy. Similar to the yaws campaign programme, local teams of the health centres will be trained in order to participate in the campaign. The tuberculosis registers of the territory record 559 cases.
7.4 Maternal and child welfare In 1955 discussions were held with representatives of UNICEF, Which resulted in a "plan of Operations for a Maternal. and Child Health Programme" in the course of 1956. The agreement envisages the continuation of a training course for village nurses during the coming years. Yearly, twenty-five trainees will conclude their studies. Periodic reschooling is a part of the training scheme. The training staff consists of one paediatrician, six domiciliary nurses, three qualified midwives and one general nurse. At the end of 1956, thirty-two native village nurses were stationed and fifty-two were in training. The activities were as follows: Control of infants Control of children Control of pregnant mothers Deliveries assisted Home visits Families under supervision Feeding demonstrations Population covered • • •
· :
25 078 22 807 5 229 1 146 4 782 1 884 41 000 8 Other activities
/8.
Page 3
8.
Other activities 8.1 Leprosy
At the end of 1956 the number of registered patients amounted to 1811 (previous year 1475), corresponding with a prevalence of 216 pro mille for the entire territory. The type-index amounts to 30%. There are three leprosaria in the terri tory. The management of the leprosarium at Mieu (160 patients) was transferred to the Protestant Mission. The number of infectious patients treated in leprosaria amounts to 291. One new leprosarium is under construction, the erection of another is planned. The leprosy control programme is directed to the isolation and treatment of infectious cases in leprosaria. In areas "Where this is not feasible, it will be tried to effect isolation in special villages at the border of main centres, 'Where medical treatment is within reach. Patients are tracked down by regular surveys. A central laboratory was established with facilities for histo-pathological examination. 8.2 Nutrition A two-year milk-feeding prograrmne is in operation in various villages where infant welfare nurses are stationed. The number of beneficiaries is 4000. They consist of toddlers, children, nursing and pregnant mothers.
8.3 Environmental sanitation Waste disposal systems Water supply systems in urban centres only only in urban areas covering a population of 40 000.
WHO granted a fellowship to a government medical officer for studies in environmental sanitation.
d
";'.
ORIGINAL: BRIE]' REPORi.l ON THE PROGRESS OF HEALTH ACTIVITIES TI,/" N1:\7 C}.LEJX)NIA AND DEPENDMTCES
FRENCH
DURnfG THE PERIOD 1956 Durin,r; 195G, the medical care service in New Caledonia continued to progress. days, The number of patients amounted, to 7565, i.e. 273 936 hospitalization belll~ a l~spective increase of 1782 persons and 9445 days compared to
1955. There is no special comment to make on the fUnctioning of the various hospitalization services. As concerns surgery, 1899 operations were performed, out of which there were 790 major and minor ones. In radiology, 14 868 X",ra,ys v!ere carried out compared with 9290 in 1955; to which 16 494treatments must be added. The Radiological Service has been completed with the addition of tomography equipment; antl'a new installation for radiotherD.py l-u::.s supplemented the existing apparatus. The Hospital has performed 503 deliveries.
As far as the rebuililing programme is concerned a pavilion containing
98 beds for TB pD.tieni;s is being builtin addition to the remodelling of the radiology pavilion alrea~- mentioned. It is expected to be finished at the end of 1957. This pavilion will be used for phthsiology, enabling the implementa tion of certain additional services. The building improvements which have been earried out at the Hospital are the follo'Win~:: construction of' a sanitary block, two storeys high with baths, showers, ~"i.C. t s. An elevator specially designed for patients has been ordered from Fr~ce. From the point of view of the administration, a new medical district has been established fc'C the Loyal t-y Isla.nda, at Mare, making a total of 12 districts. Tribal visits are c.?rried out refPllarly. Several dispensaJ.~ies have been constructed or are being plannecl. 1232 The mobile dental service has received the same success as before~ patientsvdth 2230 treatments (fillings and extractions).
As far us com~unicable diseases are concerned a slight epidemic of l)oliomyeli tir; vas. reported during the cool season, 14- cases being detected. 1800 vaccinations of Lepine vaccine from the Pasteur Insti-i;ute were s1.1.ccessfully l)erformed. The most important public health problems are still leprosy and tuberculosis. The control of Hansen disease is being taken care of with encoura~ing results - 4-6 new cases have been recorded. Due to the excellent results of tl~a·tmel1.t yrl th sulfone, the number of specialized institutions has been reduced Jeo two: the Ducos and Chila Hospitals.
IOn the other
- 2 -
On the 0 ther hmd, in 1956 more liberal reQliG. tions based on the proposals of the Congresz for the rehabilitation of lepers were established and put into force at the begirming of 1957. As concerns tuberculosis, case-finding has been carried out regularly as well as ·~he BCG vaccination campaisn. Almost the whole island has been covered. 276 nei7 patients have been recorded. The p~cventive medicine services have examined 53 645 persons, out of which 1760 showed v8.rious diseases. Finally in 1956, various constructions in,teQhnical improvements were added. to ·the hospitalization service of New Caledonia. ·The output of the various services, hospital centres or mobile, being higher than those of
1955.
BRIEF REPORT OF THE PROGRESS OF HEA.LTH ACTIVITIES IN NORTH BORNEO DURING THE PERIOD 1956/1957 1. General Health
There were no cases of any of the major epidemic diseases in the Colony in 1956. For many years now there has been no reported case of smallpox, cholera, plague or ty:phus. However, certain diseases causing chronic ill-health and diminished economic efficiency continue to be widespread. These are primarily malaria, tuberculosis and intestinal infestations. As experience grows in the control of malaria, there is considerable hope that this disease may be very largely controlled, if indeed not eradicated, within the foreseeable future by the use of residual insecticides. Tuberculosis, on the other hand, presents at the moment a far more intractable problem requiring prolonged treatment. As the hopes of controlling malaria increase, tuberculosis begins to move to the forefront and becomes the most serious health problem in the Colony today. During the year 42 087 cases of malaria were treated as against 2317 of tuber... culosis. Fortunately there is an increasing public awareness of the problem of tuberculosis and it is becoming appreciated that its control is a matter of improvement in general social and economic conditions, and of prevention, rather than purely of medical treatment. One-third of the total budget allocated to the Medical Department tor medica.l stores is expended on drugs and X-ray films used in the treatment and control of tuberculosis. With improving sanitation consequent upon the rebuilding of many of the larger population centres throughout the Colony and the extension and improvement of piped water supplies in urban areas, it is reasonable to expect a steady improvement in public health so far as intestinal diseases are concerned in these places. 2. Malaria Control
Malaria is endemic in many parts of the Colony, but fortunately most of the larger towns are comparatively free. A pilot scheme for the control of malaria sponsored jOintly by the Government, the World Health Organization and the United Nations Children's Fund began in July 1955. The project aims to produce a malaria map of the Colony and to ascertain whether control of-the disease can be effected by means of spraying with residual insecticides. The malaria map is now complete. An estimate of the incidence of the disease indicates that some 200 000 people out of a population of approximately 389 000 have a spleen rate greater than 20%. An assessment of the pilot project made in June 1957 by the WHO Regional Malaria. Adviser shows that residual spraying has not succeeded in interrupting the transmission of malaria completely, but it has succeeded in reducing the rate of transmission some'What in the sprayed areas. The results are sufficiently satisfactory to justify embarking on an expansion of the scheme for the control of malaria.
3.
Tuberculosis
Pulmonary tuberculosis is a cause of much prolonged ill-health in the Colony. Whereas the malaria sufferer, if treated, is likely to recover comparatively quickly, it is sometimes very difficult to persuade tuberculosis /patients to continue •••
Page 2 patients to continue with the long course of treatment necessary. The reports of med1.ce.l officers, the results of routine examinations, and the investi€11tions undertaken by voluntary social workers all indicate toot the incidence of the diseas is high. Figures for 1956 show a further increase over those for 1955, but the rate of increase was somewhat less than in previous years. To assist in devising a plan for the control of tuberculosis, North Borneo has recently had the advantage of a visit and the advice of Sir Harry W. Wunderly, M.D., F.R.C.P., of the Tuberculosis Division, Department of Health, Connnonwealth of Australia. The North Borneo Anti-Tuberculosis Association (NOBATA), originally formed in 1953, continued its good work in 1956. The Association is active in propaganda designed to prevent tuberculosis and carries out relief and 'Welfare work among sufferers from the disease and their dependants. Special wards for the treatment of tuberculosis patients have been built in Tawau and others are in the course of construction in Keningau and Jesse1ton.
Wards are also planned for Sandakan, Kudat and Beaufort. These special wards are designed to be airy, well.ventilated and of light construction, and will provide, in addition to sanatorium treatment, an element of rehabilitation. They will have the added advantage of relieving the strain on the general hospitals.
4.
Intestinal Disorders
As in all tropical countries Where standards of hygiene and sanitation are low, bowel infections :brm a high proportion of the diseases encountered. How. ever, improved sanitation both as regards disposal of night. soil and refuse, and improved water supplies, as now being planned, will reduce substantially the incidence of' bowel disease in urban areas. The rural community still relies on mlprotected wells and polluted rivers and streams as sources of water, and the disposal of excreta in most rural areas is unsatisfactory. A large proportion of the general population harbours more than one kind of intestinal parasite, although serious epidemics of bowel infections are remarkably rare. Typhoid fever is uncommon. 5. General Sanitation and Preventive Measures
There are now fourteen health inspectors posted at various stations in the Colony. Two of these inspectors undertook a course of training in Singapore under the auspices of the Royal Society of Health from February to November, 1956. The posting of health inspectors to various districts and population centres should result in greatly improving general sanitation and preventive health measures in years to come. Two sanitary engineers provided by WHO toO advise the Public Works and Medical Departments on environmental sanitation completed their work during t he year, and the planning of modern sanitation for the main towns is now finished. 6. Nutrition
Starvation as such is almost unknown in the Colony, but many of the rural inha.bi tants fail to appreciate the importance of including fruit and vegetables in their diet, and as a result cases of avitaminosis are-met with ii'om time to time. It is hoped that with increasing health education through the medium of the schools, governme~t health centres and dispensaries, the /health inspectors, •••
Page 3 health inspectors, the press and radio, the public will become more aware of the importance of a properly balanced and adequate diet. During the year generous assistance from UNICEF enabled additional supplies of drug and diet supplements to be given out at maternal and child welfare clinics and health centres throughout the Colony.
7.
?¥e
Diseases
The ophthalmologist appointed for the three British Borneo territories visited North Borneo from April to June, and again in October, November and December. He reported having seen 1959 patients and having performed 365 operations. One hundred and four of the operations were for the relief of cataract. Four hundred patients had glasses prescribed. During these visits sixty-two incurably blind persons were seen, twenty per cent of Whom suffered blindness as a result of measles during childhood. The Chinese readily came forward for operations on the eye and for advice on the early treatment of eye troubles. Unfortunately the natives, vmo stand most in need ·of this form of treatment, often present themselves too late for effective treatment. This is partly due to the fact that a great proportion of the native population lives in places remote from hospitals and clinics and is inaccessible even to travelling dispensaries. Out of 1400 schoolchildren examined, over seven per cent were found to suffer from trachoma.
8.
Travelling DiSpensaries
Motor ambulance dispensaries especially designed for the purpose have continued to serve a number of small to'WIlS and villages for distances of up to twenty miles and more from Jesselton, Kota Belud and Keningau. On the East Coast regular visits are made to the more remote stations by launch. A railway travelling dispensary operates between Jesselton and Beaufort on a weekly schedule with night stops at Kinarut, Papar, Membakut and Bongawan. It is in the charge of a senior hospital assistant, vmo is assisted by one attendant. The dispensary is attached to a train and is shunted to the siding at its stopping point Where attention is given to those in need of it until the next train comes along Which brings the dispensary to the next succeeding station. It has proved to be a great success and in 1956 treated 14 893 patients.
9.
Acknowle~ent
Lastly the Government of North Borneo wishes to express its thanks for the practical interest Which WHO continues to take in its medical and health problems, and for the visits of WHO officials in connection with various projects.
BRIEF REPORT ON THE PROORFSS OF HEA.LTH J...CTIVITmB IN THE TERRITORY CF RPUA. MID NEW GUINEA. DURUJG THE ~::IERIOD 1956/1957
1
General. "
Pupun nod New Guinon is still n country 1-1ith n scnttered, nod by modern stnndnrds, inaccessible populntion. Thore arc now ostimated to be 1 750 000 people in tho Territory. Nortnlity nnd fortility rntos nrc still only •• nod it will be soveral years bofo~e progress in hoalth nctivities cnn be measured with these acceptod yardsticks. The health services nre made up of govornment nnd Christian mission personnel. In tho Public Health Department there are . 66 modical officers, 135 medicnl nssistnnts, 117 nurses. nnd 150 other stnff. The Christinn missions, who are given finnncinl subsidies by the Government .. emPloy'12 modicnl officors, 7 medicnl nssistants and 138 nurSes. The number of staff avnilable for medicnl work is increasing ro.pidly and there a re more than 100 more people in tho }'ladicd DeJXlrtment thnn wore in it one yonr ngo.
,.tee
ThePnpuan' and New Guinean staff now totnls 4500 but at present only a small pOrtion of these nro engaged in sldlled medicnl work. Tho majority are semi-skilled orderlies. ~
The Delk"1.rtment of Public Health is split into five divisions, which, by their names, indiccte tho main fiolds of activ1\7.
2.
l1edical Serv100s
During tho last year we have openod three new hospitals nnd now have eighty-eight hospitals. Hospital accommodation is improving, and on 13 October a 316-bed base hospital will be opened at Port Moresby. A similar hospital is being constructed at Rabaul and a third one will shortly start at Madnng. Specialist medical. services arc becoming available and we now have five specialist surgeons, three ophthalmologists, one physician, two radiologists and three pathologists. There are now eighteen X~ray diagnostic units, one in each of the districts of the Territory, and other mnjor centres. An X-ray thernpw unit for deep and superficinl therapw is operating in Port MOresby. A survey of mental henl th is being llndertnken by u psychiatrist and a.
yho vUli adviDa.'onth,', future" prcgrrwn&'ito be .toUo.d development of mental hcnlth, and ~ontnl institutic~B. p87ch~lo81e15~
~
·the"
A new disease" cnlled by the people "Kuru" and clinicnlly aldn in some ways to parldnsonism and in others to chorea, has been found in the Central Highlands in the Okapa region. One per cent of the population is affected and to date there have been no rocorded rocoveries from the condition. This disease is being investigated by a group of specinlists and at present appears to be hereditary in origin. Consideration is being given to tho creation of a division to overseas medical research in the Territory. One of the problems to be dealt with by this division will be the investigotion of infnnt mcrtllity azxl morbidity in particular relation to virus disease. /A stuctr of •••
Page 2 A study of dentru.. conditions and the formulation of a programme for a dental honI th service is to be undertaken by the New Zealnnd Depnrtment of Dentnl Hygieno. I~dicnl ctficers are becoming freely available and in the next year it is hoped to station a further twenty-five medical officers in the field and to open a similar number of hospitals to be staffed by medienI assistants.
3
Preventive Medicine
Disease control in the Territory depends nlmost entirely on patrolling and getting advice and trontment to the people in the villages and hamlets where they live and die. Health education is one of the most important means available for this purpose. Tho Territory has one henIth oducator and with the assistance of WHO" two further members of our staff aro being trained. With the return of these officers" all divisions and sections of tho Health Department" and in particular the Preventive Medicine Division, will have the: advantage of their assistance and become more health education conscious in their work and field activitios.
3.1 Tuberculosis A specialist medicnI officor has beon appointed and at this moment a general campaign, with BeG Taooinat£on of negative reactors and X-ray of· positive reactors, is being undertaken in three districts of the Territory. It is hoped in the near future" to start a fourth team and to cover the entire Territory within three yenrs. Five ~acic surgery teams have visited the Territory from Australia and have opernted on 100 cases of tuberculosis with excellent results.. These visits are being continued. We have now only 320 beds specially reserved for tuberculosis patients and the majority arc patients in general hospitals. Hospitals for 1000 beds are being constructed and these will be taken care of by tho ~istian miSSions. 3.2 Leprosy
We now have 1160 beds for patients with this disease and are establishing further colonies at ;l.itape and 1l/abag. t. survey has just boen completed in Western Papua and indicates that the o~ndition there, while important" is minor compared with other areas. It is hoped to d0velop a systGm of village control and to avoid the construction of further major institutions.
In areas such as New Iroland whore leprosy colonies have been opernting for twenty or more years, the incidence of the disease has shown a marked decline associated with'tho continuous hospitalization of infected cases and no doubt dependent on the far more rapid control obtained b,y modem drugs. 3 .3 11aJ.aria
A malariologist is now on our staff and he is developing atMaprik in the Sar.1k district, a resoarch project to determine the best means to be used to control malaria in this territory. \trile the aim is eradication of
/malaria, the •••
Page .3 malaria~ the malariologist is endeavouring to determine the required"-balance'
and relationship between residual spraying, ground contro~and antimalarf~8. From this rose arch and with the appointment of malaria control assistants for all districts it is hoped during 1958/1959, to initiate a major control progr~ A yaws campaign is now
50t
complete.
4
Infant, Child and Maternal Health
The infant mortaJ.1tt in the Territory~is still in the region of 250 per 1000 and it is estimated that in most aroas, one third of children born alive die before they reach tbo1r fifth birthday. Maternal mortality is also at a commensurate level. This division has the problem of ondeavOUring to reduce this mortality. At present its services extend from at least one centre in all but two of the districts of the Territory. From the seventeen government centras now operating, the nurses of the $ervice 10 by ship and by road to villages covering approximately l~ of tho territory population. These government ceDtros are a ssisted by 120 stationary centres operated by Christian missions and the total population covered by both services is approximately 5~. The extension of this service is limited by the means of communication and the number of staff available. Fapuan and New Guinean girls are being trained as infant welfare and maternity assistance and from this training it is planned to extend the service year b.Y year to cover the entire territory. The approach to infant welfare is entirely preventive. Its main activity is advice in relation to feeding and other problems during the first two years of life. ~
, Triple vaccine is used against whooping coughs diphtheria and tetanus, and malaria and other acute conditions are dealt with as they occur.
5
l1edical Training
The health service is geared to train the native people of Fapua and New Guinea so that they thomselves may; at an early date" take over zz.ajcJ' poriiol18' of their medical care. The rate of development of training depends on the supply of sufficient trainees from the education services. ht present there are eight nurses at the Central Nursing School, Fiji, twenty~two stUdents at the Central Medical School there, training to bo assistant medical practitioners and four training to be assistant dental practitioners. Construction of dormitories for a Central Nursing andGentral Medical School will be commondod during 1958/1959 and it is hoped to commence training nurses in January 1959. Assistant medical practitioners will commJnce training in 1961. Training of nursing assistants is established and it is hoped to switch at an early da~e from orderly to tho more advanced assistant tratning. /6 hdministration
Page 4 .
6
Administration
With tho growth .. during the last few years, in tho number and size of hospitnls and their problems" it 1).&8 become necesSary to divide the adminis,/' tration of the Territory Public Health Department into four major regionsl These four regions have autonomous control except in regard to polic.y. The generaJ. administration Th'lS been strenthonedby the formation at an administrative division within tho headquartors of the Dopartmunt.
In conclusion, the progress of health activities in tho Territory is hampered by the inaccessibility of tho people to whom we are endeavouring to give these sorvices. Medical staff, when avoraged over the entire population, allows for one trained European for every four thousand persons •. This average, if it were spread evenly aver tho Territory, would bo ideal .. but centrifugal developnent has concentrated this staff in certain areas and it will be several yearB before a figure of this nature will be roached on an even basis in all areas.
•
•
BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN THE PHILIPPINES DURING THE PERIOD 1956/1957 1.
General remarks
The fiscal year just ended carried the country to another milestone of progress regarding health and sanitary activities performed by the different units under the Department of Health. Except for the occurrence of a mild country-wide influenza epidemic towards the later period of the fiscal year, the country strode to better health. Both the general death and infant mortality rates are on the downward trend in comparison with the previous fiveyear period depicting decided improvement in matters of disease prevention and improved sanitation for the 22 million Filipinos, especially in the rural areas. Hospital, laboratory, tuberculosis, health education and personnel training, research and nutrition services were being constantly boosted as a result of continued multilateral and government assistance. 2. Bureau of Health
A new Acting Director of Health to devote full-time service was given Presidential appointment during the period under review. Vital statistics recorded 10.05, 83.91 and 2.69 respectively for general death rate, infant mortality rate and maternal mortality rate per 1000.A total of about 2 000 000 anti-smallpox vaccinations, about 7 000 000 CDT inoculations and more than 1 000 000 DPT injections constituted the bulk of preventive measures performed. As regards environmental sanitation, one third of the entire population has been provided with potable water. Better facilities for the sanitary waste disposal were introduced with the co-ordination of the community development workers. Rural health units performed most of the curative phase of health work throughout the country served by ll34 doctors, 162 dentists, 1018 nurses, 101.8 midwives as comprised in 1200 units. A pilot project for the ~rovement of the methods of collection and analysis of vi tal statistics has been launched in the province of Nueva Ecija. Health education and epidemiological research on obscure fevers received top priorities in the regular activities of the Bureau of Health. 3. Bureau of Hospitals
As of date there are 84 public hospitals and 188 private hospitals with a total of 18 981 hospital beds operating throughout the country. These hospitals fall under the over-all supervision of the Bureau of Hospitals. In the field of leprosy control, travelling skin clinics operated since 1955 for the early detection and treatment of leprosy cases in rural areas. The WHO/ UNICEF-assisted programme on midwifery training continued to give assistance to the Philippine Government giving in-service training for six weeks and improvement of tea.ching methods and techniques in private and government schools of midwifery. Forty-six out of 53 provinces are now participating in hilot training. Organization of mothers' or parents' classes was done in 14 provinces. As of now there are 506 operating puericulture centres reporting more than 4 million units of work for the year. As added activities, the Bureau of Hospitals maintains a medico-social and referral services. /4. Public-health
4.
Public-health research laboratories
A total production of 18 776 138 cc of vaccines sera and toxoids have been produced by the Alabang Laboratory sufficient to supply local needs as well as the BCG vaccination programme in East Asian countries. The pilot Influenza Centre functioning under this institution was able to identify the influenza virus which caused the recent epidemic in the Philippines, the type being Type A. The venereal diseases in the country are well Ullder control. Malaria is fast approaching eradication with the total launching of the house spraying campaign with powerful insecticides such as DIYI' and dieldrin. To date no less than 8 ·017 150 Filipinos living in 1 519 847 houses located in malarious regions are already protected from malaria. The problem of schistosomiasis, 'an endemic disease in certain sections of the country, is likewise nearing solution with encouraging results on the methods of control as studied at the pilot project in Palo, Leyte. Studies and research on the biology and bionomics of the parasite, host-parasite relationship, epidemiological characteristics, the biology of the host are currently going on in this pilot project.
5.
Institute of Nutrition
Research projects were undertaken by this unit. The most important of which are: (1) composition of Filipino foods; (2) vitamin levels in the blood of Filipinos; (3) reCipe and menu standardization; (4) dietary evaluations. Services rendered by the Institute consisted of: (1) training of public-health workers, teachers and other health workers: (2) information services; (3) implementation of rice enrichment law; (4) quality control of pre-mixed rice; and (5) consultant and co-operative services. Nutrition surveys were made in the Bicol and Central Luz·on regions covering the dietary, clinical, and biochemical phases. During February to March 1957, a United States nutrition team in collaboration with the Institute of Nutrition and the Armed Forces of the Philippines also performed a similar nutrition survey.
6.
Division of Tuberculosis
On prevention the)O BCG teams performed 955 000 tuberculin tests and 368 331 BCG vaccinations this year bringing to a cumulative total of 8 311 253 and 3 491 573 respectively covering 52 provinces. Other important accomplishments of the Division consisted of (1) case-findings in the rural areas made possible with the operation of nine chest mobile clinics, (2) treatment and care with the extensive use of anti-microbials and regular check-ups, (3) health education, (4) research and special studies, (5) training of technical personnel (6) public-health nursing by household supervision of contacts. Atehabilitation service is yet to be developed 'With the forthcoming establishment of a village rest settlement in Silay, Occidental Negros.
7.
Personnel training and health education
The five regional training centres have given the corresponding training to the different categories of health personnel divided into pre-service with a total of 806; in-service, 475 for local health workers and 42 foreign nationals. Projects assisted and strengthened: tuberculosis control, maternal and child health, rural health units, nursing supervision, malaria, schistosomiasis, cOIIIDlunity development workers and cOIIIDlunity education. In health education, 311 cOIIIDlunity group classes were conducted with an enrolment of 12 369. Also 2337 meetings and conferences were conducted and 4 health educators took post-graduate training at the University of the Philippines Institute of Hygiene. On public-health information there were 215 press released, 25 radio programmes, 12)0 film showings, 7 pamphlets published with 146 000 printed copies. There were 5000 official publication copies and 436 017 educational materials circulated.
BRIEF REPORT ON THE PROGRESS OF HFALTH ACTIVITIE3 IN SINGAPORE DURING THE PERIOD 1956/1957
1.
Population (estimated)
The preliminary count of the census carried out in June 1957 showed that Singapore has a population of 1 464 200. Of this'; 6500 were wi thin port l1m1ts and 1300 were wayfarers. 2.
-
Area The area of Singapore is 224 square miles.
3.
Organization - Structure of the Ministry of Health. Minister for Health Permanent Secretary and D.M.S. Deputy Secretary and D.D.M.S.
·---------1 I I
I I
• I
I t I
I
I
A.D.M.S. (Health) The following hospitals exist in Singapore:
Dental Service: C.D.O.
Nursing Service: Principal Matron
Number of Beds General Hospital Kerbau Hospital Tan Tock Seng Hospital Orthopaedic Hospital Prisons Social Hygiene Infectious Diseases Trafalgar Home Police Woodbridge Hospital Kandang
1199 316 980 120
160 65 250 1000 20
2000
/There are in •••
Page 2 There are in addition four private hospitals: Number of Beds Kwong Wai Siu Free Hospital Youngberg Memorial Hospital UIlder the Malayan Union Mission St. Andrew's Mission Hospital Red Cross Cripples Home 400
68 30 40
4. •••
Health Staff
The attached table gives the total number of officers authorized and available as at 1st January 1957 in the Ministry of Health. Expenditure on Public Health
•••
Please see attached statement •
6.
Curative and preventive medical services
The following types of :medical facilities are available to the public of Singapore: (i) General Practitioner Service: consultation and treatment Clinic and dom1ciliary
(ii) General Outpatient Service: operated by the Government for the poorer sections of the public and for its own employees. (iii) Specialist Outpatient Clinics: at the main hospitals for consultation and follow-up of specific types of cases. (iv) Personal Health Services: operated by Government and the City Council and include the school health and maternal and child health services. (v) Hospital Services:
provided by Government, voluntary agenCies
and nursing homes. (vi) Dental Service. (vii) Teaching Service.
7.
Trainin6 of Auxiliary Personnel
Training of nurses, male nurses, assistant nurses and mental nurses is carried out under the authority of the Nursing Board of Singapore. Training of sanitary inspectors has been in operation since early 1920. The Central Midwives Board of Singapore undertakes training of midwives. Assistant health visitor training and training of health visitors will be commenced as soon as' the urban Health Centre now nearing completion is ready. Training of pharmacists and almoner training are carried out by the University of Malaya. Scholarships and training courses for overseas training of personnel in occupational therapy, physiotherapy, dietetics, radiographers and many other fields are increasingly provided by the Government. .
/8.
WHO assistance
Page 3
8.
WHO assistance (past and proposed) (a) Experts - 4 Senior Nurse Educator (General) Two Nurse Educators (General) Nurse Educator (Mental Health) (b) Experts - 2 Senior Nurse Educator (Public Health) Nurse Educator (Midwifery) (c) Fellowships -
4
Child Psychiatry Child Psychology Psychiatric Social Worker Health Visitor Tutor (d) Expert - 1
Lecturer in public-health administration (e) Fellowship - 1 (f) Expert - 1 Hospital Records Officer (g) Fellowship - 1
Medical Statistics (h) Expert - 1
Aedes control
9.
Demographi c De.ta
Fifty per cent of the population is under the age of 21 years and extrapolations indicate that 50% of the population will be under the age of 15 years by 1962. For the year 1956 the birth-rate was 48.26 per 1000, the death-rate 8.11 per 1000 and the infant mortality-rate 42.66 per 1000 live births. 10. Communicable diseases
Tuberculosis is the major communicable disease prevalent in Singapore. Malaria has been eradicated. Mild occasional outbreaks of diarrhea and food poisoning occur. There has been no major infectious disease during the last nine years. 11. Nutri tion On the Whole very good. /12. Environmental •••
Page 4 12. Environmental sanitation
Water-borne system of night soil disposal and piped water supplies are not available in all areas of the rural country of Singapore although much has been done in these directions. About 150 000-200 000 of the population depend for their water supply on wells. In the rural areas the main system of night soil disposal is by the bucket system, although large housing estates Which have been appearing in recent years in the rural country have water borne sewerage disposal. 13. Maternal and child health
Extensive. There are eighth maternity and child health centres in the town provided by the City Council. There are nearly fifty such centres in the rural areas. The maternal mortality-rate foz: the year 1956 was 0.7 per 1000 live births.
PUBLIC MEDICAL FINANCE RECEIPI'S
1956 BXPENDITURE
Colony Government Fees from patients Balance of cost borne by public revenue
Rtmninei Costs
Ca,Eital Works
$ 1 196 409
Administration and overheads General Hospital Tuberculosis Hospital Maternity Hospital Other Medical Institutions Public· Health and Quarantine City Council
$
650 476
$
61 442
30 862 656
10 111 178 3 365 763 2 927 878 6 684 246 4 161 ~~4 27 901 95
1 212 620 1 279 933 507 556 664 011 4~2
4 157 570
008
. Fees from patients
Administration and overheads Infectious disease hospital Anti-mosquito measures Other public-health measures
764 748 625 913 1 338 329 202 021 37 401
2 891 720 -$33 522 205
$4
223 239 620 231
Balance of cost borne by City Council Consolidated Rate Fund Total
6 083 371
_.........
Total
......-_.
• (For medical finance purposes the Rural Board is treated as part of Government)
TOTAL NUMBER OF OFFICERS AUTHORIZED AND AVAILABLE 1st January, 1957 Total Estimates Available 1957 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
A.
ADMINISTRATION Director Deputy Director Deputy Secretary (Administration) A.D.M.S. Hospital) A.D.M.S. Tuberculosis) Medical Superintendent, G.H. Medical Superintendent, K.K.M.H. Medical Superintendent, T.T.S.H. Medical Superintendent, W.H. Medical Superintendent, Trafalgar Home Chief Dental Officer Senior Medical Officer Social Hygiene Superintendent Pharmaceutical Chemist Senior Pathologist Senior Health Officer Deputy Medical Superintendent, W.H. Medical Officer in-Charge, Out-patients Department Medical Health Officer in-Charge School Health Officer in-Charge Maternal and Child Health Services (Rural) Principal Matron
A.D.M.S. !Health)
B.
HOSPITAL DIVISION Specialist Officers, Grade "E" Specialist Officers, Grade "G" Medical Officers including Senior Registrars (excluding Housemen) Housemen Matrons Sisters Expatriate ) Sisters Locally Appointed ) *Nurses Hospitals Assistants ) Dispensing Assistants ) *Qualified Midwives Dental Officers (including Housemen) Pharmaceutical Chemists Pharmaci sts Laboratory Assistants Male Nurses
6 26 170
5 13
155
13 198 894 224
50
50 11
131 764 222
180
180
36 2
34 1
16
16
80
13
62 7
*
Ic. excludes Assistant Nurses.
HEALTH DIVISION
Page 2 Estimates Total Available
1957 C. HEALTH DIVISION Health Officers Health Education Officers Supervisor of Public-Health Works Chief Sanitary Inspector Sanitary Inspectors Matrons Health Sisters Health Nurses Hospital Assistants Qualified Midwives
35 2 1 1
28 2 1
20 2
1 20 2
17 83 23 70 50
14 59 23 6f:;
Assistant Health Nurses
17
BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN THE TRUST TERRITORY OF THE PACIFIC ISLANDS DURING THE PERIOD 1956/1957
1.
Education
In 1956 entrance examinations for tbe Centrul-Medical Scho~l at Suvn, Fiji were offered to twenty candidates. Of these twenty candidates, nine were . qualified for entrance. Because of budgetary limitations only seven were able to attend school. At the time of entry of these students, two graduates were returned to employment in the Trust Territory. The Trust Territory School of Nursing graduated seven stUdents. The usual complement at this school is twenty students in a two-year course. A six-week Sanitation Refresher Course was held in the Trust Territory for a total of thirty-one stUdents. Special advanced dental laboratory training for eight graduate dentists was accomplished at the Navy installation on Guam. Advanced training in nursing and medicine was accomplished in the Hawaiian Islands for six students. One laboratory technician completed advanced training in the Hawaiian Islands. Three students began a course in health education in New Caledonia. 2. Tuberculosis
Special interest is accorded this disease because of its prevalence in the Micronesian people. Their manner of living facilitates the transmission of the disease from the active carrier. During the past year a programme has begun.in Which testing for the existence of the disease and vaccination of the non-reactors is carried out. The programme has started in a small way in each district because of the limitation of the trained group to implement the programme. Some domiciliary treatr.Jent of tuberculosis has been started in all districts. This is materially limited to those patients Who do not have positive sputa. This has relieved the pressure on hospital beds, but it is too soon to draw a conclusion as to its success in the field. Intensive use of isoniazid has markedly reduced surgical interference in this disease.
3.
Hospital Services
All district hospitals have made a concerted effort to utilize more completely and efficiently the existing available facilities. Out-island services have been increased in both oedical and dental care in two locations; namely, the Marshall Islands and the Eastern Caroline Islands. Definite plans for new construction are in existence for two more units to offer both medical and dental services. These are located in the Marshall Islands and the Western Caroline Islands. Lack of trained personnel prevents a more rapid programme.
ORIGINAL: FRENCH BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN VIEr NAM FROM JULy 1956 TO JULy 1957
From July 1956 to July 1957 (third year of office of President Ngo-Dinh-Diem) the health services in Viet Nam, remodelled according to democratic principles, developed to a considerable extent. Activities in the health field were carried out according to the following principles: (a) democratization of health services: absolute equality between the patients, no social discrimination (b) concentration of a large part of the activities on preventive medicine (c) placing of health services at the disposal of the population, especially in rural areas. The following progress was made in the fields of preventive medicine, curative medicine and public health. 1 PREVENTIVE MEDICINE
1.1 SmallpoX, cholera and BCG vaccinations No. Vaccination Smallpox Cholera BeG Of~OPle
I
vaccinated
1955-19 1 016 189 679 279 39 454*
1956-1957 3 62~
669
1 613 298 191 266**
Note:
* from 0-6 years ** from 7-14 years
1.2 Malaria eradication A project has already been established for the control of malaria in all malarious areas of Viet Nam (3 million inhabitants). The methods used are the following: DDI' spraying and distribution of anti-malarial drugs. The project is supposed to last for fo,ur years with United States of America Operations Mission (USOM) assistance. In 1956-1957, during the peri od in vlbich a simplified malaria control campaign was launched 57 322 people were tested, 32 925 blood smears taken and 592 292 houses were sprayed with DDT. 1.3 Medical assistance to rural areas Priority is given to preventive medicine without neglecting the treatment of patients in rural areas. Out of more than 6000 villages in /Viet Nam, 2684 •••
Page 2 Viet Nam, 2684 first aid posts have been set up in 2684 villages. These posts are headed by rural health workers assisted by a "communal committee for health protection". Decree No. 59, signed on 25 October 1956,; provides rules for the organization of this programme. Rural First Aid Posts No. of posts No. of patients No~
1955-1956 2 449 4 964 223 8 753 499
1956.1957 2 684 6 571 354 9 783 667
of consultations su~rvision
1.4 Laboratorl
On 7 January 1957, a refresher course was started at the National School for Medical Biology (Saigon) for technicians working at present in provincial hospitals. One hundred Wld twellty 1D.boratory teclmicill1l9 are being trained this year (1956.1957). 1.5 ?pidemioloSl Very recently, the Secretariat of State for Health had to face a fairly serious influenza epidemic. All urgent prophylactic measures were taken to control the disease. No death was recorded. 1.6 In the framework of preventive medicine, the following endeavours should also be stressed: intensification of measures against prostitution, opium addiction and alcoholism.
2
CURATIVE MEDICINE 2.1 Number of hos~itals
and clinics in the cities: 1955-1956 No. Beds 1956-1957 No. Beds 44 80 1 2 1 2 6 120 8557 554 700 179 22 381 396 ll64
Hospitals Maternity wards Psychiatric hospital Venereal disease control clinics Hospital for contagious diseases Tuberculosis dispensaries Leprosaria Rural maternity hospitals
40 53 1 2 1 2 4 ll6
7919 286 700 179 22 237' 135 878
19~~-1956
19~6-19~1
No. No. No. No.
of of of of
patients consultations hospitalizations deliveries
1 842 047 4 224 ll8 207 597 77 368
2 072 720 5 572 014 3ll 169 91 608 /2.2 National Cancer •••
Page 3 2.2 National Cancer Institute Decree No. 273-YT of 17 June 1957 created a national cancer institute with a view t~ treating cancer patients with modern methods. The Institute will include a 150-bed hospital and various research laboratories and treatment services. 2.3 Supply and pharmaceutical products
The National Supplying Pharmacy was set up in 1956 in order to supply all public hospital institutions with drugs and medical equipment. Funds amounting to 100 million piastres were earmarked in 1956.
Furthermore, the Government revised certain rules concerning drug dispensaries in order to give them more facilities for the sale of normal drugs to the rural population. After a selection, 484 licences were issued. 2.4 Hospital. Child welfare Eighty out of a total of 280 beds are being used at the Chi1dren ' s The following results were recorded: 1955-1956 Consultation service (No~ of patients) (No. of consultations) Hospitalizations No. of treatment days ~
1956-1957 15 63 1 5 178 694 076 784
6 053 21 305
2.5
SUpervision of pharmacies and narcotics The aims- of this Qervice are the following:
(a) (b)
Supervision of pharmacies and drug dispensaries (206 pharmacies and 723 dispensaries are supervised) Supervision of the Chinese-Vietnamese pharmacies Supervision of import and use of narcotics Supervision of import and distribution of pharmaceutical products.
(c) (d) 2.6
Blood banks
Two blood banks are operating, one at the Cho-Ray (Saigon) Hospital and the other in Hue. They keep a deposit of blood Which is sufficient to meet the needs of hospitals. The results obtained are mainly due to the enthusiasm of blood donors, both foreigners and Vietnamese Who answered the call made by the Department of Health with a view to assisting severely ill patients. I
/2.7 Training •••
Page 4
2.7 Training At present there are two national nursing sChools, one in Saigon with 109 students (57 first year and 52 second year students) and the other in Hue with 41 students (23 first year and 18 second year). arts: Then the nurses attend a three-month refresher course in nursing five courses were organized in 1956-1957.
Six-month training courses for rural midwives continued to be organized in provincial hospitals. Finally fellowships for study abroad are being granted by the Government, USOM, WHO, the Colombo Plan and the French Technical Aid.
3
ENVIRONMENTAL SANITATION
The press, radio, public speeches, distribution of leaflets and pamphlets and film projections contribute to popularize health and health education. Sanitary wells or pit privies have been installed in several villa~s.
Through training courses for health workers (6 months) 172 people have been trained. The sanitary code is being revised and the sanitary conditions in the rural areas and the cities are being studied, with particular emphasis on the question of drinking water and control of foodstuff. Technical advice is being given to the various local environmental sanitation services and to special projects in this field. CONCLUSION In spite of the shortage of means, the results obtained in 1956-1957 are quite considerable. Nevertheless, much remains to be done. In the framework of the social policy, launched by the Government, the Department of Health continues its vigorous efforts towards the development of rural health services, the reorganization and modernization of hospitals. Thanks to the financial and technical assistance of friendly nations, particularly to the United States of America, of international agencies such as WHO, UNICEF', and the Colombo Plan, and to the professional integrity and devotion of its staff, it is to be hoped that once :peace and liberty will be established, the Department of Public Health of Viet Nam will reach its aims within a short time •
A Brief Report on Public Health Administration in Japan
1957
- .. ~
Ministry of Health and Welfare Japanese Government I
1 September I ~)57
CORRIGENDA Page 7. Page 10. Pllge 12. Page 15. Pagel6. Page 17. Page 18. Page 23. 14 from bottom: "Ths .... " read "The.••. " 5 from bottom: ...... is enongh to..•. " read " ..•. is enough to•.. ". line: " .... and so no." read ...... and so on." 16 from bottom: " .••. progarmmes...... read " .... programmes" 8 from bottom: " ..•. local la or" read " .••. local labor" 2 above Table 12: ...... rate ther of...... read " .•.. rate there of.... .. 6 of paragraph 4. "Medical Care": " .... the otal. ••. " read ...... the total. ..• " Title of Cha.pter 15: "Environmental Sanitaion" read "Enviro.nmental Sanitation" •. Line 3 of paragraph, "Insect and Rodent Control": " ..•. finacial. ..." read " .... financial. ..•" Line 14 from bottom: " .•••riboflavin, and will be...•" read ......riboflavin, will be ..•. " Line 10 from bottom: "Mend deficiency" read "Mental deficiencY" Top column of Table 25: "Jnpatients" read "Inpatients" Line 1 of paragraph, "Mental Deficiency": ...... Feedle-minded.... " read . " •... Feeble-minded.... " Line 4 of same paragraph: "the Feeble-mindedis also to de set up .•••" read "the Feeble-minded is also to be set up•••. " Line 6 of Chapter 21: "Under the tho Labour.... " read "Under the Labour.... " Line 3 from bottom: "20 or mor beds)," read "20 or more beds)," Top column of Table 27 ~: "Gereral Hospital" read "C.eneral Hosp~tal" Top column of Table 27 b: "Geneoral bed" read "General bed" Foot note of Table 28: ".--: •• include male clinical nursea ..•. " read " .... include 1,683 male clinical nurses...• " Table 32: "VII. Diseasea of the circulat ry system" read "VII. Diseases . of the circulatory system" Line 18 from bottom: " ...•Devices and Cosmctics...." read " ...•Deviee, and Cosmetics.... " Line 16 from: " .... cosmetics f r .... " read " .... cosmetics for .... " Line 8 from bottom: " .... assaing...... read " .... assaying...... Line 4 of paragraph. "The National Institute of Leprosy": " .... form tion .... " read " .... formation .... ., Line 9 from bottom: ...... the anitary .•.. " read ...... the sanitary.... " Title of Table 37: "Nnmber of.... " read "Number of.... " Line 1: " .... informtion" read " .... information" Title of Table 40: "Health Insurance Managed Association" read "Ht'81th , Insurance Managed by Asaooiation" Line Line Last Line Line Line Line
Page 27. Page 28. Page 29.
.
" Page 30. Page 31. Page 33Page 34.
" Page 37.
"
Page 38. Page 39. Page 40.
CONTENTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Organization of National Health Administration ..............................................~~ge1 Laws under the Jurisdiction of the Ministry of Health & Welfare·.. .................. 2 Finance of the Ministry of Health & Welfare··· ......................... ,...................... 3 Organization of Local Health Administration.. ....... ........................... ............... 4 Health Center ............................................. ~ .. ~ ..... : ................ :.:: ......... ,.. ~ ..... :.... 4 Population········ .. ···· .. ············· .. ········· .. ·········· .. ···· .. ····· ........... :...... ...... ............ 6 Vital Statistics··· .. ···· .. ···· .. · ...... ..................... ...... ...... ..................... .................. 7 Life Tables in Japan················ .... · .... ··· .. ··· .. ······ .. ··· .. ······· .... · ........................... 11 Deaths by Leading Causes ........................ ... ...... ...... .................. ............... ...... 12 Maternal and Child Health ............ ..................... ...... ...... ...... ...... ...... ............... 15 Health Education··············· ............ ...... ...... ... ...... ....................................... ...... 16 Tuberculosis································· .. ············ .................................................... 17 Communicable Diseases····· ........... ...... ...... ... ... ... ... ... ............ ...... ...... ...... ............ 19 Port Quarantine ... ...... ...... ... ... ... ...... ...... ... ... ... ... ... ... ............ ............ ...... ......... 22 Environmental Sanitation················································ ................................. 23 Water-Works and Sewage Treatment··············································· ................ 24
17. Food and Veterinary Sanitation··············································· ......................... 24 18. Nutrition··············· ......... .............. ..... ... ............ ... ........................ ... ... ......... 26 19. Dental Health ................................................................................................ 27 20. 21. 22. 23. 24. 25. 26. 27. Mental Health·················································· .............................................. 28 Occupational Health ...... ......... ............ ............ ............ ..................... ... ............ 29 Hospitals and Clinics······················································································· 29 Medical Care Personnel········· .................................................. :...... .................. 30 Medical Care Statistical Survey············ ......... ... ...... ... .................. ......... ... ... ...... 32 Pharmaceutical Affairs··· ... ......... ... ...... ......... ... ......... ... ...... ... ......... ... ... ... ...... ... 34 Major Research and Training Institutes in Public Health ......... ... ... ...... ... ... ... ... 36 Public Assistance and Social Insurances .. ···· .. ···· .. · .. ·········· .. ·························· ..... 38
-1-
1. Organization of National Health Administration The Fig. 1 below shows the organizational structure of the national health and welfare administration _in Japan. The idea of close cooperation among the fields of preventive medicine, medical care, social welfare and social insurance are being maintained. The Public Health Bureau, Medical Affairs Bureau, and Pharmaceutical and Supply Bureau, together with the Children's Bureau share responsibilities on health administration in the field of preventive medicine, medical care, pharmaceutical supplies. and maternal and child hygiene, respectively. With the assistance of statistical services rendered by the Health and Welfare Statistics Division of the Ministry, these Bureaus direct the health programmes by giving orders to the 46 local prefectural governments. -The follGwing is the organi-wtional chart as of 1 August 195t
Fig. 1. Organization of the Ministry of Health & Welfare. -Personnel Affairs Section General Affairs Section : Accounts Section ,-, Ofl:ice of Programme Evaluation i '-Office of Chief Liaison Officer, International Affairs
I
I !
-
Minister's Health & Welfare j-General Affairs and. Field ~taff Section Secretariat - - , - Statistics Division-I Reports. and An~ysls SectIOn i-TabulatIon SectIon
I ,
I
'
I __PubliC Health Bureau 1
National Parks Division
I-Administration Section -,-Planning Section -I-Planning Section Nutrition Section Health Center Section Tuberculosis Prevention Section Acute Communicable Disease Prevention Section Mental Health Section !-Quarantine Section
1- -
---I !
nVlronmenta aDltahon ectIon Food Sanitation Section Environmental -- Sanitation Division-: Water-Works and Sewerage Section I--Office of Veterinary Sanitaion
1-E ' I
IS"
S
.
!-Medical Affairs Bureau
I I I
I I-Enterprise Section \ Pharmaceutical Affairs Section I '-Pharmaceutical & Supply Bureau---'I- D~ug !'danufactl;lring Section 1
-General Affairs Section Medical Affairs Section Management Section National Hospital Section National Sanatorium Section Arrangement Section , Office of Nursing Affairs .-Office of Dental Affairs
-
I
I ~-Social Affairs Bureau - -
BiologIcals SectIon Narcotic Section I-Office of Pharmaceutical Inspection I-Geneal Affairs Section Protection Section Rehabilitation Section Life Improvement Section -Institution Section
I Ch Idr B -. i en's ureau_---·_------
- Planing Section Child Protection Section Maternal & Child Welfare Section 1 -Maternal & Child Health Section
(Con'd)
-2-General Affairs Section Health Insurance Section National Health Insurance Section Welfare Pension Insurance Section Seamen's Insurance Section Medical Care Section -.office of Acturial & Statistic~ Affairs
'-Repatriation Relief Bureau
i -I
General Affairs Section Repatriation Section Bereaved's Pension Planning Section Liquidation Section (Ex-Army) Demobilization Section (" ) Pension BusIness Section (" ) First Pension-Screening Section (,,) I Demobilization & Liquidation Section (Ex-Navy) (,,) -Second Pension-Screening Set ion -Institute of Population Problems Institute of Punlic Health National Institute of Nutrition National Institute of Health National Institute of Leprosy Port Quarantine Offices National Hospitals National Sanatoria National Institute of Hospital Administration National lIygienic Laboratories National Home for the Blind National Institution of Vocational f Rehabilitation for the Physically Handicapped National Home for the luvenile Training and Education -National Institute of Mental Health ,-Regional Branches of Medical Affairs Bureau -Local Repatriation Offices
Affiliated Institutions
Local Branch Offices -\ Re~ional Narcotic Investigators' Offices
2_ Laws under the Jurisdiction of the Ministry of Health & Welfare 1. Laws on Administration: Ministry of Health & Welfare Establishment Law (1949) Health Center Law (1947) 2. Laws on Preventive Medicine: Communicable Disease Prevention Law (1897) Preventive Vaccination Law (1948) Tuberculosis Control Law (1951) Leprosy Prevention Law (1907) Trachoma Prevention Law (1919) Parasitosis Prevention Law (1931) Venereal Disease Prevention Law (1948) Quarantine Law (1951) 3. Laws on Environmental Sanitation: Entertainment Facilites Law (1948) Public Bath· House Law (1948) Hotel Business Law (1948) Friseur Artist Law (1947) Beauty Artist Law (1957) Cleaning Business Law (1950) Water-Works Law (1957)
-3Sewerages Law (1900) Waste Disposal Law (1954) Food Sanitation Law (1947) Slaughter House Law (1906) Law Relating to Processing Plants of Dead Animals and Others (1948) National Park Law (1931) Law Regarding Graveyards, Burial and Others (1948) Rabies Prevention Law (1950) 4. Laws on Health Statistics: Regulations Pertaining to Report of Still·birth (1946) Ordinance Regarding Vital Statistics (1946) Regulations on Reporting of Infectious Diseases (1947) Other Laws on Public Health: Mental HygIene Law (1950) Eugenic Protection Law (1948) Nutritionist Law (1947) Nutrition Improvement Law (1952) Laws on Medical Care: Medical Service Law (1948) Medical Practitioners Law (1948) Dentists Law (1948) Dental Hygienists Law (1948) Law for Dental Technique (1955) Public Health Nurse, Midwife and Nurse Law (1948) Law for Medical X-Ray Technicians (1951) Law for Masseurs, Acupuncturists, Moxa-cauterists and Judo-orthopaedists (1947) Law for Dissection and Preservation of Dead Body (1949) Laws on Pharmaceutical Affairs: Pharmaceutical Affairs Law (1948) Law for the Control of Poisonous and Powerful Agents· (1950) Narcotic Control Law (1953) Opium Law (1954) Taima (Marihuana) Control Law (1953) Awakening Drug Control Law (1951) Laws on Social Welfare: Social Welfare Service Law (1951) Daily Life Security Law (1950) Law for the Welfare of Disabled Persons (1949) Child Welfare Law (1947) Disaster Relief Law (1947) Law for the Loan etc. of Welfare Funds for Mothers. and Children (1952) Welfare Commissioner Law (1948) Consumers' Livelihood Cooperative Association Law (1948) Laws on Social Insurance: Heslth Insurance Law (1922) National Health Insurance Law (1938) Welfare Pension Insurance Law (1941) Sesmens' Insurance Law (1539) Health Insurance Law for Daily Workers (1953) Social Insurance Medical Fee Payment Fund Law (1948)
5.
6.
7.
8.
9.
3. Finance of the Ministry of Health & Welfare Annual budget of the Ministry with the comparison to the total national expenditures is shown in Table 1 in the next page.
Tahle 1. ExpendituN of the Mbiatrr with the Compms311 of Expendituree of All Govenuaent Apacies.
Fileal Year
Expenditure of All Apncies JWJIoe y ...:
L ,-
ExpenditllN
~ Mbrimy of- ~1th & W~are Pm:eatage 60 187 188 In : 187 289 466 612 1,928 7,561 . 13,413 24,773 28, 182 ~6,018 IIIIIiDa Yea
Amount
1937-38 1938-39
193&-40
3, 288
2, 709
I : " .
....:.....---,.,.·-1 *.
2.2 5.7 4.2 2.9 2.3
1940--41 1941-42
4.49! 5,860 8, IS& 8,276 12,552 19,872 21,496
1942-43 1943-44 19#-45 1945-46 1946-47 1947-48 1948-49 1949-50 1930-51 1931-32 I'
I
119,087
3.5 3.7 3.4 9.0 6.4
214.256 473,146 741,047 661,406 793,7fY1
as, 314
5.2 3.8 5.3 5.8 7.8 8.4 8.7 7.1 8.4
6.3
L!~
1953-54 1954-55
1952-53
1,017,251
925,5S6
1,013,300 1,034,900
999,880
.---~
I
I
73,176 83,816 84,613 90,317
72,128
Each prefeetura1 ~t and Iarpr municipal perumenb have their own hnlth depsrtment
in order to carry out their health
prosraDUIIH
in
~imee
with the uti,.} policies and prosrammM
dincted by the Mbrimy of Health & Welfare. .. 1'heIe prefeetura1 aad mODicipal pemmeab divide their political bndaries into _era! "health eenter districts," and the local health eeoter ia eltallli.hed in each one of thole districts. At preMOt 'there are 783 health eeoten in tlda COWllfJ'. FOl' the reuoa of .....phical CGDditiona, IIlOIt of t~ health eeoteis have their branch health waib withia their health eeoter districta.
.,
. of all pemmeotal health CGDnltatiOD apciea. The health eeo~ in
:
The 6nt h.ealth eeoter in Japan wu eatahliahd in Tokyo in 19S Thea, in the folloWiJis year, the Health Center Law wu eoacted and the lo-year ~ for health eeoter CODatnlctiOll wu atarted.
There were 306 health eeoten in 1943. and bad ioereued to 770 in 19« due to the amalpmatiOD days bad OD1y health eouwtatiOD in tubercubis CGDtrol and materoal and child health, and maintell&D. 0(. health of preeerviee
.-war
mea. la 1947. pohlic health work in tlda COWllfJ' wu reatpnbecI. AcaordinPy. wu rni8ed, and the new health eeoter ~ started.
* Health Ceater Law
Aecordins to the Health Center Law, the local pemmeot ia requind to eltalllUh health eenter, and the utiooa1 perameat ia reijIoosillle' to share the· COlt. 46 prefectUrei, and 3CJ municipalities, desipated by the Cahinet Order, provide their health eeoten. Director of hnltli eeoter is
"""BaN
IJ*ified
to
-5be the medical doctor by law. The character of health center is defined by law primarily as community health service agency, and secondarily as administrative supervisor based on the power, delegated by the governer or mayor.
Number, Standard Seale and Organization As of the end of 1956 fiscal year, there are 783 health. centers in Japan, and 5 more health centers are expected to be built by the end of 1957. One health center is expected. to cover 100,000 population, but actually it covers about 115,000 at present. There are three types of health centers, namely A-class, B-class and C-class. At present, A-class health Cf'nter is expected to be .staffed with 57, and has the building of 1,800 sq. feet, and also covers more than 160,000 population. B-class health center is expected to have staff of 47, and building of 1,350 sq. feet and covers population of 160,000 to 110,000. C.class h~th center is ex~ted to hav«( staff of 31, building of 900 sq. feet, covers less than 110,000 population. '.
Function and Programme The function and programme of health center iuclude activities in the different field. All community health programmes have been integrated into health center activities. Following are the basic functions, defined by law: Health education; vital and health statistics: improvement of nutrition and food sanitation; environmental sanitation; public health nursing; medical social service; laboratory service; prevention of tuberculosis; venereal disease and other communicable diseases; maternal aud child health; dental hygiene, and other needed local health programme. (such as endemic disease control etc.) As the routine programme, the health consultation clinic, well baby conference, mass chest survey. home visit, community health education, inspection and field supervision of sanitary operation are carried on. The health education is integrated into every phase of routine process. T~berculosis control, insect and rodent control, birth control are highlight Jlrogramine. Recently. community organization process has been extensively developed for performance of all health programmes. Table 2. Main Health Center Activities in 1956 (from monthly health center service reports.) (per health center per month) 794.6 173.7 2,061. 5
Tuberculin test BCG inoculation Miniature X·ray examination Large film X·ray examination Culture of tuberculous bacili Culture for fastness test of tuberculous bacili Maternity health examination Well baby conference individual mass examination Health examination for V. D. Immunization Home visit by p'ublic health nurse Nutrition consultation Food inspection Bacteriological stool culture
88.4 22.9 7.1 52.3 134.1 87.0 125.0 513.3 453.4 195.1 314.9 242.7
I
I .._ _1_..
Finance Health center.is financed by local and national government. The item of national subsidy is divided into 2 categlries; that is, health center subsidy and programme subsidy. According to the Health enter Law, national government is responsible to share the cost of health center expenditure both ecurrent and non-recurrent. At the time of new establishment of health center, national government shares 1/2 of expenditure construction and needed equipments, and it also subsidizes 1'3 for running expenses. Local govern-
f
-6ment pays rest of expenses. In the national budget in 1957 fiscal year, health center sudsidy amounts to ¥ 2,134,845,000.
6. Population Table 3 below, shows the estimated population of Japan, as of Oct. 1, 1956. based on the latest census taken on October 1, 1955. (Includjng Japanese nationals and foreigners in Japan).
· · · __·--····r --...
Table 3. Population by Age Groups and Sex for All Japan. Total 90,253 8,805 11,636 9,141 8,737 8,463 7,736 6,481 5,205 5,006 4,522 3,815 3,301 2,583 1,992 1,383 903 408 138
Thou.ud
All Japan
o to 4 5 to 9 10 to 14 15 to 19 20 25 30 35 40 45 50 55 60 65 70 75 80 85 to to to to to to to to to to 24 29 34 39 44 49 54 59 64 69
.1 I I
.--_. . _ -.. _.
Male -Thou.ad
,
Female Tbou. .d
44,352 4,514 5,929 4,631 4,400 4,236 3,845 3,028 2,335 2,342 2,188 1,911 1,656 1,269 934 590 354 146 43
45,901 4,291 5,706 4,509 4,337 4,226 3,890 3,453 2,870 2,663 2,334 1,905 1,646 1,314 1,058 793 549 262 95
to 74 to 79 to 84 years old and over ..... - _ .
Fi~. 2.
Population by Age Groups in 1956 (Estimated on Oct. 1, 1956)
Ags 8580-84 15-19
F~
....._--1 55 - 591 - - _......... ...-1-_ _-150- 54 1--_--1...... ........_ _--1 45- 49 1--_ _...1...,
~--I60-G41---iL...,
70-74 85 .........---1 ....69 1----'-0
r-.----I - 1 - - - - -..... 3S 39 r-I-_ _ _ _ _--I25 - Z91__-----....1-, r'-_ _ _ _ _--I ZO- l41 _ _ - - - - - - ' . ,...&-_ _ _ _ _ _-1 15 - 191--_ _ _ _ _---1, r--_L..-_ _ _ _ _ _-I 10- 14 1--_ _ _ _ _ _.L.-.........
40-44
~-'--------130-341__------L"""
____~----~_,--~~ -4~~--~~--~~~__ 5,000 Thou sandO 0 Thousami· 5,000
L....-r------I
5- 91----_-,.-----1 . ~ 0
~7-
7. Vital Statistics Inspite of the fact that the nation·wide vital statistics survey has been carried out since 1899 in Japan, no reliable data were available for the years 1944 to 1946 due to the confusion of the last World War.
Birth Annual Change of Birth Rate. Between 1900 and 1919, the Lirth rate in Japan was between
29 and 34 per 1,000 population, but it rapidly rose to 36.3 in 1920, which was the highest rate since 1900. But after this peak, it had been declining as the years advanced until 1939 when the rate reached the 19west one 40
Fig. 3. Annual Change 'Of Live Birth Rate. (per 1,000 population)
RdL
(26.6), and from about
1940 it again started to rise. This increase considered to be due to the fact that the policy of the government at that time was to encourage the increase of .birth. During 10 ZO
\ 1910 1920
3 years from 1944 to 1946, the birth rate seems to have been considerably low judg· ed from various reasons, although no accu· rate data were available because of the confusion caused by war• .Ths birth rate in 1947 was abnor· mally high, showing 34.3, but such an ex· traordinary rise of birth rate is considered to be due to the repatriation or restoration of normal family life of the people after the termination of the war. After such an extraordinary rise, the birth rate started to decline rapidly, and became 19.4 and 20 30 40 0
1900
F
1930
1940
1950
1~~
Fig. 4. Annual Change of Death Rate. (per 1,000 population) Ro.Q
18.4 in 1955 and 1956, respectively, and this rapid decrease of the birth rate may be due to the decrease of the marriage, encouragement of birth control and the pro . 0
10
evalence of artificially induced abortions. (Refer Table 5 and Fig. 3)
1900
1910
19Za
1930
Y-
19'0
,.
1950
1960
-8Table 4. Vital Statistics in Japan (Number).
Year
I' P opu atlon
L i v e !De 1'th Births. a S
I~~~h!
(1900-1956' I
(under 1 yr.)
NO:~h~al Maternal', 8t;I-I- . ... Mar- -- r~-. 1 (under 28 Deaths births riages 1 Ivorces days)· .
-
1900 19()5 1910 1915 1920 1921 1922 1923 1924 1925 1926 1927 ]928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 , 1952 1953 1954 1955 1956
I ~~~:1'409'1 47,160,400, 1,442, 0041
9O~06,r : •.~ :::.; .~~ 137"1 343.•1J ~:88 997,065 1
219, S071 I
103,340 126, 8231 125,293 139,571' 136,267, 132,757 135,4231 126,2991 121,1541 119,566 116, 160 115,609 114,906! 104,203 108,740 104,483: 102,8301 103,309 97,930 100,9701 95,397' 89,092 84,129 81,785 77,751 76,090: 76,590
6,185!. 142,092 6, 228 6,452 7,158 7,181 6,565 6,8991 6, 273, 157,388I· 141,300 144,0351 138,294' 132, 230 133,8551 125,831,
347, 5181 433,9461 438,708 541,542 514,823 510,385 508,100 508,660 516,6391 497,959 482,907 494,345, 491,988; 501.8311. 492,094 510, 603 481,012 506,937 551,032/ 543. 5181 668,336 532, 103 548,118 660,184, 783,858' 671,680 736, 18 ..3.1 !
59,4601 58,394,1 59,050 . 54,6711 52,643 52.082 50,314 50,9041 1
' 055, 3541 I... 49, 998, 600I 1, 699, 698!1, 53,902, 3OOI l ,788,521 1,03,42U 1
275,396 • 287,955' 334,3811 334,352. 326, 684 333,120, 311,3571 295,888 288,301 291, 209 293,026. 294,0571 257,846 275,644 255,701 256,395,' 254,213, 232,821 244,558 229,911 219,9431 201,291
I
55, 391, 2,011,63411,409,3711 56,120,000 .1, 976, 055 1,279,219 56.830.000 1.953.560 1, 278, 120 57,550,000 2,028,955' 1,323.648 58,300,000!, 1,984,326 1, 245, 3431 59,179,200' 2,071,5601 1,199,936 50, 180,00012,089,937 1,151,163 61, 110.000 2, 045, 828 1, 204, 847 62,050,000j 2,120,493, 1,227,570, 62, 930,000! 2,061,72011,251,0411 63,872,49612,070,765 1,161,504' 64,820,000 2,088,608 1,231,154. 65, SOO, 000 2, 168,026 1, 166, 167 66,790,000 2, 106, 260 1, 184, 5461 67,680,000. 2,028,289 1,225,402 1 68,661,65412,174,291 '1,152,371 69,590,000 2,086,355 1, 220, 023j 70,360,000 2, 164, 949 1, 198, 4001 70,590,0001' 1,911, 9661 1, 250, 093 70,930,000 1,885,957: 1,258,514' 72,539,729 2,100,164, 72,750,000, 2,260,270\· 73,450,0001 2,216. 271 73, 9SO, 000 2, 235, 431' 73,865,000,1 '''1
~811
1
6,3091124,394 5,721 124,036 5,765 116. 916, 5,997: 120, 1861 5,86i 116,967 1 5,6811' 117,729 5,667 116,5051 5,530, 119,575, 5,763' 114, 135 5,709 113,039 5,693' 115,592 5,3841 111,050 5,444' 111,481 4,877 99, 527 4,818 98,347; 5,0701. 102,033.1 4,929 103,393 4,586' 95,446 4, 542' 92,882 ....
50,741 49,224; 49,689: 48,235 50,310 1 50,516,· 49,887 50,728 48,546 47,806 47,7211 45,399 45,719 43, 832 45,178/ . 47, 80~,1 48,605' 45, 529 4S,832
1,176,5171189, S09 1,140,428 190,7SO 1, 157,845 190, 162 1, 204, 802 194,55 ..1.' .,.
72,410,000' ..• . .. 1 76,155,000 78, 101, 473, 2, 673, 792 1, 138, 238j 205,360i 80,000,000 2,681,624 950,610 165, 4061 81,800,000 2,696,638 945,444 168,467 83, 199,637 84,573,000: 85,852,000i 87,033,000 88, 293, 000 2,337, 507 2,137,689 2,005, 162 1,858,040 1, 769, 580! 904,876 838,998 765,068 772,547 721,491 693.523 724,028, 140, 515! 122,869 99,114j 91,424 944 78, 1 68, SOl 67, 6691
'''i 83,047 72,907 71,485 64,142 58,686, 51,015j 47,58O i 42,726 38,646, 38, 2211 4,4881 123,837 934,170; 4,4371 143,963 953, 999~ 601 192, 6771 842, 1701 4, 1 4,117 3,691 3,417 373 3, 3,2621 216,974 217,231 203,824 274 193, 187,1191 715,081 671,905: 676.995 682,077 69i,8091 714,861: 715,947i I 79,551 79,032 82,575 83,689 82,331, 79,021 75,255 76. 759 1 75,267i 71,767
89,275,529 1,730,692 9O,253,0~ 1,661,615
, ·. ___ i ,
,
3,0941 183,265' 2,792 178,926
Figures of vital statistics and· the population for the years before 19(-3 were shown excluding Okinawa Prefecture. except neo-natal death. and maternal death. Figures of vital statistics in
1956 are provisionL
-9Table 5. Vital Statistics in Japan (Rates).
-II Live Birth
-I 1
D~th
~I~.~ 1 1
1Increase Natural 1
I II
~
Infant Death
I Neo-natal Death I~ 1
Maternal -)-St'll b' th Death I . Ir
~,~J~ (live birth
1-;; .--1-;· I _._.
(1900-1956)
arrlage
~,
Ivorce·
Year
I Pe;-},ooo I Per 1,000 \ Pe~-~,OOO ;er 1,000 r;,~r 1,000 . !:; l~~ I·t<>:i t~ . popuI popupo}>ulive live i I lation lation lation! births: births! i Ilili.i.~rth) (live birth
lliU"."':rth)
Per 1,000 - Pet: popupopu· i lation lation [ 1
1'~ ~
1900 1905 1910 1915 1920 1921 1922 1923 1924
I·
-31.~ 30. 3... 33,2,1 36.3 35.2 34.4· 35.3 34. OJ1 35.01 34.7 33.5; 34.2 32.8 32.4 32.2 32.9 31. 5 30.0 31. 71 30.0 30.81 27.1 26.6.
1
""
11.' -
155.6
19.~ 71. 74. 70. 1 69.4 69.0 68.0 66.7 63.6 58.5 57.2 56.8 54.5 55.7 50.2 52.1 48.2 48.8 50.9 45.0 48.4 44.11 46.6 44.6 38.9 34.4 34•• 3
39.8
21.1 21. 11 20. 11 25.41 22.8 22.5 23.0 21. 4!1 20.31 19. 1 19.7 19.8' 19.9: 18.21 19.0, 17.7, 17.71 18. 11 16.8 17.51 17.0 17.7'1 17.7 16.21 15.7 15.8,
9. • 12.9 13. 1 10.9 12.4 11.9 12.3 12.7 14.7 15.6 13.8 14.4 12.9 14.2 13.2 15.2 13.8 11. 9 14.9 12.4 13.7 9.4 8.8 12.7 15.4 14.4
l53.'
162.0 161. 0 166.2 169.2 .167.2 164.2 156.9 142.8 138.0 142.3 138.2 J.42.6 124.5 132.0 117.9 121. 7 125.3 107.1 117.2 106.2 115.01 106.7 90.41 84.4 85.8
'I i
.91! 89.
,.8
38.8: 33.' 33.
~
1 ..,1 1. 26
,.. 8. , 8. 1 9.8 9.2 9.0 8.8 8.7 8.7 8.3 7.9 8.0 7.8 7.9 7.6 7.8 7.2 7.5 1 8.01 7.8 9.5 1 7.5 7.7) 9. 1: 10.8; 9.1 ~O1
1
~
54. " 73. 2: 66.8' 65.4 63.41 61.9j 59.6' 56.6! 56.°' 54.1 53.61 53.71 53.8! 52.8 52.3' 51.41 52.8i 50.5' 50.5 1 49.0, 49.5! 4.9.6j 46.3, 43.71 41. 31
1.171 1.101 O.99 0.94 0.92 0.87 0.871
33.01 33.7 31. 2 31. 71 29.51 28.51 25.7 26.5 26.6. 26.71 25. 25.51 24.0 25.8 26.5 24•• 7,' 24.3 23.7 24,.11 24•• 1
)
t
1925 1926 1927 , 1928 1929 1930 1931 1932 1933 1934 1935
~
0.861 O. 82~ 0.8H 0.78! 0.80, 0.79'f' 0.77, 0.77f 0.73\ 0.71[ 0.70/ 0.65! 0.62) 0.64f 0.66! 0.671 O.62
1936 1937 1938 1939 1940
O. 65~
1941 19!2 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954
29.0 31. 1 30.2
~2
~~
~9
~O
~3
23.0 20.7 19.71
~~
~~
~~
f
34:31 33.5 33.0. 28.1 25.31 23.4 21. 5 20.0 19.4 18.4
11. 9 11.6
14:~1 7. 8.0
19.7 21. 6 21. 4 17.2 15.4 14.4 12.6 11.9 11.61 10.4j
76.71 61. 7 62.5 60.1 57.5
31j 27.2 26.5 27.4 27.5 25.4 25.51 24•. 1
16] 15.7 15.9' 16.1 15.71 15.5 16.41 16.8 1
1 I'.
49.~,
48.91 44.6
44J 50.9. 66.7 1 84,.91 92.21 92.3' 93.8: 95.6 1
12.0 11.9 10.3 8.6 7.9, 7.9' 7.81 7.9, 8.01 7.
1. 0.99; 1. 01 1 1.01 1 0.97) 0.92\ 0.86! 0.87/ 0. 841 0. 801
~~I
1956 1955 "
. - ._.. - -
.-
1 ---_.--------
_
39.8 22.31' 16.2' 95.81 40.7 23.0 15.2 97.21 1 .._---_ ..__._- - - .. -
_
.1__
Vital statistics rates for the years before ,1943 were recomputed excluding Okinawa Prefecture, for the convenience of comparison :with the post· war data. The computed rates were based on the population shown in the Table 4.
-10Death Annual Change of Death Rate. In· 1955, the death rate in Japan was 7.8 per 1,000 population, which was the lowest one ever recorded in the history of vital statistics in this country. In other words, from 1900 to about 1930, the death rate was around 20 every year, except the high ratf!S in 1918 and 1920, because of world-wide pandemic of influenza, showing 26.9 and 25.4, respectively. It kept decreasing in the following years until it became below 16 in 1941 despite of the war. Mter the war, the number of deaths in 1948 was under 1 million and the death rate decreased to 11.9, inspite of the fact that the considerable incidences of death must have happened during and directly after the war period. It further continued to·decrease as low as to 7.8 in 1955. In 1956, it was 8.0. showing slight increasf!. Although there may be many factors contributing to this decrease, it is safe to say that it is mainly because of the progress of the science of medicine and of public health. (Refer Table 5 and Fig. 4). Fig. 5. Annual Change of Infant Death Rate. (per 1, 000 live births) R.t.. ZOO
Infant Death Annual Change of Infant Death Rate. The changes of infant death rates have been almost same as the death rates for all ages. Before 1925, the infant death rate was around 160 per 1,000 live births every year except thf! high rate in 1918 (189.7), because of the pandemic of influenza. It declined in the course of the years after 1925 until it became below 100 in 1940, and reached the lowest rate of 39.8 in 1955. In 1956, it was 40.7, showing a little increase. (Refer Table 5 and Fig. 5).
O,LI~------19~10--~~1~9Z-0~--~193~O--~-19T40~~~19~~~O V"""
Maternal Death Annual Chang.e 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 19.2. Even though some sharp increase of maternal death rate was expected after the war due to the increase of artificially induced abortions, it was 16.1 in 1947, and in 1956, it was 15.2. (Refer Table 5).
Still·birth Annual Change of Still-birth Rate. In the vital statistics in Japan, the still-birth after 3 months of gestation are registered. The still-birth rate in Japan was around 90 per 1,000 total births (live births and still-births) about in 1900, and kept decreasing until it became about 40 in 1943. Mter the war, in 1947, it again started to show the high rate of 44. 2, and rapidly increased in the following years and became 97. 2 in 1956. Such increase is considered to be due to the Eugenic Protection Law of 1948This is proved by the fact that the proportion of artificially induced abortion to the total stillbirths increased from 21. 6% in 1948 to 53.5% and 51. 7% in 1955 and 1956, respectively. This is enongh to prove how widely the artificial· abortions have been carried out in Japan, and this fact explains that the increasing number of population are becoming aware of the heavy burden of big family. As the increase of artificially induced abortions is not desirous from the viewpoint of the maternal health. the government is making efforts to educate the people for safer methods of contraception.
~11-
Marriage Annual Change of Marriage Rate. The marriage' rate in this country since 1900 up to about
1935. had been approximately between 7 and 8 per 1,000 population. except some slight irregular changes before and after 1920. It went up to 9.5 in 1937 due to the war which started in the same year. 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 the war. The marriage rate in 1947 after the war was 12.0, which was the highest rate since 1900, but this is considered to be a temporary state caused by the repatriation after the war. It decreased to 10.3 in 1949. and as a result of further decresae. it went down to 8.0 and 7.9 in 1955 and 1956, respectively. to the same level before the war. (Refer Table 5).
Divorce Annual Change of Divorce Rate. The divorce rate in 1900 was 1. 42 per 1,000 population, and
since then it kept decresaing until it became 0.62 in 1938. But after the war. it suddenly rose again showing about 1. O. This is partly because of the increase of marriages after the war. and partly because of the new concept of the people towards divorce. In 1956, however, the rate dec~eased to 0.80. (Refer Table 5).
8. Life Tables in Japan
Expectation of life at birth was 63.9 and 68.4 years for male and female respectively in 1955. according to the abridged life table. As it was 50.06 and 53.96 years for male and female respectively in 1947, the length of life has become extraordinarily longer than in 1947. The improvement is largely due to the death rates in younger ages than in older ages.
Table 6.
Mortality Rate (qx). (a). Male (Per 10,000 Population) __________ 70
Year
--i- __ " I0 II! 2 ! 3
I4
____ i
Age----·-·
J
5
10! 15
I20 I 25 I 30 : 35 I40 • 45 I 50 I55 I 60 !65 1 11211411186 256 365 51ii 104, 133 17812451 351 51 96 122 164 229 328 47 105 137 186 263 392 571! 96, 1271175 250 36715491 240, 460! 312' 2121 1871 355 648, 461 333 281
I
1 1891-1898 1,490 4471296: 1899-1903 1,569' 369, 259 1 .1909-1913 1,6051 4411236 1921-1925 :1, 620 485 261 ,1926-1930 1,4011431 224 ; 1935-193611,130 ! 1945 I, 989, 1946 ,1,247 1947 ,860 550i 1 1948 3701205 56~6 295 2 195 332 192 182, 98
2~~138 1~~51 5z"~~11- -8~---~~1-- 93 170 147 166j 150: 112 79 103 71 105 70 981 64 33 32 32 26
651 24 l00! 101 57' 23 511 201 36 13 1 1949 1 663' 1] 111 74' 50 34, 11' ',1950-1952 56711151 89 66 46 31'\' 111 , 1950 '5901 143 100 671 48 35 10 1951 576 1311 921 71 48132 7 1 1952 5051 90 74, 571 39 271 9\ 1 1953 511 87! 66' 531 37 26'1 81 135, 91. 2281142 130 85 110 70 75: 521
48 83' 84 79 87 50 89 85 77 81 60 108 951 82 87 50 98 86 74 77 48 100:1 921 77 76, 89 119 173 158 474 664' 90 376' 307 2871 350, 42. 114 154 142 1321 135 166 222 261 771 96 84 85 91 111' 148 231 58 781 76 73 79j 94, 128! 19 12 17 141 121 11 50 31 39, 311 25. 1 24 69 42! 55: 44 341 66 44 55\ 44. 361 65 45 57 45, 39 1
74. 745 69 848 ,.804
519 767 920:1,291 690 1,04 511 751! 423 623 1
I I
73, 56 65 571 49
~~~~
_ I!~~l ~~i .~~I. ~~i ~~; ~~I
~I ~~i ~~: ~~: ~~: ~~; !~! ~gl :: ~5 ~~: ~~I_ ~~tl
321 33' 36
1
178 272: 419. 161 248,,' 406\' 170 272. 438 1641 259 156 2361 379 1 1 1 1 45 65, 99 157 245 397,
90 75. 821 75' 691
121' 107,\' 113 108 101
1 62W 617[ 665~ -[ 594\
64~
-12(b). Female
I :1'
Year
11909.-,191311,450 437, : 1921....;.1925 1,440 476 : 1926-1930 1,2411421 11935-1936 992' : 1945 1 1,5691 ' 1946 ' 965'1 i 1947 766 1 1948 564 'I'
i 1899-1903 1 1, 4091 360, 2601 17 353 428 244 325 176
1891~1&98'1, 3381 416! 28~ 195
I
0
,1
I2 I3 136~
4
I5
' 10
136' 1171 239 147 104 1 26~ 17 115 227; 156 1O6' 1 200: 93 222 17 10 1611107 71 190 1091 68, 99: 7i?l 50,
i
981 81'1 76 78, 71 1 66 74; 481 48, 34,
H 38 40 37 30 25; 78; 21 18 11
i 15 ,_20 I-.:~ l~O 60: 64, 76' 90: 73,
Age
35 1 40. 451 1 90: '981102' 110! 118'1 121: 96 99 100 1071114, 115, 1081 103 98 102 1071 108; 121 112 1051107 113! 113' 106 96 89' 93: 101 102, i
~~J~~,~60 ~5 , 146 138 130 138j 126' 197! 185 175: 1!W-, 169; 121 159' 22011 280: 137 1491 111' 144 97 13~ 92 80 88 84 227, 385! 253" 221 193"
' 70 : 615' 607 566 6161 577! 533i 8121 582 520 449
283,,' 410, 265 3991 2461365'1 264 398 242 371 341 548 390, 335 293
70 120:' 40, 311 25 221 13, 18, 14 10 9 8'
91 811 82 9 1 184 143 1501 7 90 851 861 69 77 73 70 56 70 64 62 62 38 49 39 30 27 24 23 59 40 49 45 1 34 301 27 251 1 571! 42 51 43' 37j 331 32 28
90, 95' 1601 179, 90 104! 75 82 671 75 61'1 71 50 59: 561 6626: 50: 431' 40 36\ 34 55 531 45 46
1
1949 1950-19521 ' , 1950 1951 1952 1953 1954 1955
589 497, 9' 5526 0
184' 108\ 70 116 8S: 65 146 999 669, 129 11 55' 442 90, 75 449 87' 511 405 69! 5 46, 366 56 34'
48' 331 11 45 29 10 4478 34 ~I 31 ~ 40 36' 341 271 28 25 24 21
~
.6~__1_1.'1 I
1261 186', 1151 169 12~i 189; 111S1 181:
2871445 275 435 301 465' 424 453i 367' 392
I
,_I_ 1
77 99' 162 261 75 110' 165i 268; 56 91 1471 223i 66 96 1431 236: _.__ 1
II.
Table 7.
Expectation of Life at Birth. ..
(eoo ) .
.. , - - ! -
__
..
__
.-...
Year The The The The The lst 2nd 3rd 4th 5th Life Life Life Life Life Table Table Table Table Table 1891-1898 1899-1903 1909-1913 1921-1925 1926-1930 1935-1936 1945 1946 1947 1948 1949 1950-1952 1950 1951 1952 1953 1954 1955 ..
Male 42.8 43.97 44.25 42.06 44.82 46.92 23.9 42.6 50.06 55.6 56.2 59.57 58.0 60.8 61.9 61.9 63.4 63.9
._-----44.3 44.85 44.73 43.2 46.54 49.63 37.5 51.1 53.96 59.4 59.8 62.97 61. 5 64.9 65.5 65.7 67.7 68.4
Female
The 6th Life Table Abridged Life Table The 8th Life Table Abridged Life Table
"
The 9th Life Table' Abridged Life Table
" " " p
" ----- -------,
"
,
..
__
9. Deaths by Leading Causes The leading causes of deaths in 1956 were vascular lesions affecting central nervous system, malignant neoplasms, senility, heart diseases. tuberculosis, and pneumonia and bronchitis etc. Causes of deaths increased from the previous year were vas~la;' lesions affecting central nerVous system, malignant 1Ie(}/Jlasms, heart diseases. senility etc, whereas those decreased were tuberculosis, pneumonia and so no.
~
13-
Table 8. Vascular Lesions i affecting Central I Nervous System ' 822 !
! 'I
Year ,
I Nu~r L~te L 1900 1905 1910 1915 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1 1949 1950 1951 1952 1953 1954 1955 1956 I
-- --
--I
69, 498; 75, 946 62, 845i 67, 480 j 87, 860 I
156. 6 161. 01 125. 7 125.2 158.61 160.7 ! 160. 3 163. 81 175. 7 162. 11 163.4i 165.8 165.3 j 171.6 163.7
20,242 1 26,527 32,5601 37,296 1 40,102 1 40,351 40, 5781 41,587 62.0; i 63.9, 66.4' 65.4
90, 194 91, 0871 94, 258 102, 440 95,9481 98,315 101, 3001 102,547 108,014 1 104,540 106, 976 106,9471 110,441 114, 192, 114,2681 117,847' 118, 456 126, 5401 130, 496
nOrI 1
69.4: 67.1j 62.81I 63.51 64.01 65.7 64.11 45,030 46, 6061 47,732 48,856 48,989 50,419 50, 2181 50,898 50,676 51,6881 52,693, 1
165.0i 162.5 165.4 168.7I 166.4 169.3 168. 41 179. 3 184. 0
64.3 58.9: 59.7! 62.5 57.7[1 61.3' 60.5! 66.9: 66.5; 62.4: 58.t 58.9
;
127, 523j 175.8 124, 786 171. 5i 125,001 170.2 I
45,275, 42,2801
···1 ••• 1
···1 ..., 53,047 55,6771 58,769j 64,428 66, 3541 69,4881 71,578 1 75,309; 77,721 1 81, 7101 67.9: 69.61 71.8 77.4! 78.4! 80.9, 82.2 1 85.3 87.1 90.5 1 ... 1
... , ... , ... 1
43'2~.~1 ..•!
···r 62.Z;
••• 1
···1 78,953, 64, 0741 66,191, 58,412 59,796 1 59,514 67,5141 61,3341 59,9321 68,3551 101.1 so. 11 80.9 70.2 1
···f "
101,0951 94,329, 100,2781 105, 7281 105, 8581 110,359 1 116,351 116,9251 121, 5041
I I
129.41 117.9 122.61 127.1 1 125.2 1 128.5 133.71 132.41 136. 11
I
I
133, 729! 148. 2i
i
-(Note~The 'figures for 1956 are pr~i;i~nal. The international abbreviated list number of cause of death is respectively shown together with each cause of death)
_
.._.
--,
70.7 1 69.3 77.61 69.51 67.1' 75.71
1
136, 5241 174J 98.6' 78,911 1 81, 8121 100.0 93.2; 77,565 I 1 69,5551 82. 21 67.1 57, 586j 62,091 71. 3! 1 54. 71 48,256 1 48. 3' 43,154 43, 5611 1
48,
5;~1
49, 0461 52,763 53, 3771 53, 7501 52,603 56,4771 53, 1281 54, 3511
61. 31 64.5\
64.~ 63. 61. 3
5
48!.1_
~9~O~~ ~. 4!
64. ~ 60. 2] 60. 9
-14-
i Year
, !-
.. ~ , I_R_I 1900 1905 1910 1915 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 I
-'---1
Tuberculosis (all forms) Bl,2
,
-'--,N
Accidental Deaths BE47,48 'R ···1
Gastritis, Duodenitis, Enteritis i and Colitis ' 836,43b
Suicide
BE49 R 'i
Nephritis and Nephrosis B38
_~ ~_i-'N 58,012. 63,2751 102,983 116, 474j 141,992 153, 126 151, 990j 163,660' 150,134 140,3851 139, 4781 148,171 144,962. 154,993 140,946 138,409; 135,761 129,202. 126,357 110,599 130,7 134.21 206.0 216.1 256.3 272.9, 267.4 284.4' 257.5 237.21 231. 8 242.5 233.61 246.3 220.7j 213.5 206.31 193.4 186.7 161.1 5,85t
N 12,979' 19,931 26,347 38,693; 54,941 59,320 60,409 62,046 61, 657! 59,353 59,110. 59, 554i 62,421 64, 930! 62,910 63,790: 60,899' 59,538 59,059 55,510 57,239 55,843: 61,535 58,314 54,1421 49,425 50, 5981
70,872 95,171 1 112,0811 114,770 1 123,988 , 119,526; 124,328 I 117,036; 112,938; 114,650 1
159.7 201.81 224.2 ! 212.91 223.8 1 213.0 218.8 203.41 193.7 193.71
13.2 17.11 18.718.8 19.21 20.2 20.3 19.9: 19.3' 20.71 20.7 21. 01' 21. 0 20.2 21. 81 22.1 22.41 22.1 21.5 20.61 22.1 20.31' 17.3 15.2 13.6j 13.3 12.1-
-I 29.3 42.31 52.7
R
21,870, 24,1901 25,944
43.7 44.9 46.81
8,085, 9,3621 10,137 10, 6141 11,337 11,520 1 11, 467! 11,244 12,229 12, 461i 12,817 13,0121 12,718: 13,919 i 14, 322i 14,725 14,780. 14, 525i 14,141' 15,394; 14, 270! 12,190 10,7661 9,851 9,6881 9,363'
71.81 99.2 105.7 106,31 107.8 105.8 100.31 98.2 97.5' 100.61 103.2 98.51 98.4 92.61 89.1 87.3
111,728 185.7 118,112 193.3j 118,377-1 190.8 122,221 194.2 118,3451 185.31 120, 629 118,0231 125,492 130, 262. 130,7631 143, 855 143, 4241 147, 685 153, 209 152, 019i 153, 250 186. 1; 179.41 187. 9, 192. 5 190.4 206. 1203.81 209.2 216. 0 209. 6 1 210. 7
24, 29 I! 43. 3 25, 338 44. 61 71, 1661 123. 7 25, 557 43. 81 24, 779j 41. 9 1 25,414 42.2 29, 1021' 47. 6 25, 824 41. 61 26,412 42.0 26, 0541 40. 81 38.7 26, 53zi 40. 3 29,817 44.61 31, 6801 46. 8 28, 721 '41. 81 29,928 29,951 1 31,483' 29,109 28, 1471 28,573. 30,959 43.0 42.6' 44.61 41.0 38.9 39.3'1 42.1 ;
1931 . 1932 1933 1 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 i 1952 1953 1954 1955 1956
25,055
i
80.S!, 82.3 79:41 87.2 82.2 74.61 67.9 68.9,1 ···1
119,343 1 118,460 115,455 111,232. 106, 8891 95,353 95, 6481
171. 5 168.4 163.6, 156.8 147.4 131.1. 130.2
160, 3~.~1 218J
···1
···1 ···1
···1
···1 146, 241 1 143,909 1 138,113 121,7691 93,3071
···1 •.• 1
···1 129.9 104.11 87.5 82.41 67.7 i 53. Ii 46.11 39.0 31. 7: 29.9, 12,262 12,7531 14,201 16,3111 15,4151 15, 776j 17,731 1 20,635 22,477j 21,777\ 18.2' 18.4 1 20.4 1 23.4 25.21 24. Ii
···1
... i' ,
187.21 179.9 1 168.8 146.41 110.31
38, 471 1 38,960 34,259' 32,850: 31,968; 31,215 34,2361 34,812' 33, 2651 33,1331
49.3 48.1-1 41.91 39.51 37.8, 36.4 39.31 39.4, 37.31 36.71
70,5581 .82.21 57,8491 66.5i 62.4, 55,124 1 46,735 52.3j I
101,4541 83,264; 71, 546i 68,540 1 57,214, 45, 552 1 40,139 34,436' 28,289; 27,006' ._. -
45,0171 36,561, 33,707 26, 9781 24,701 22, 1081 20,160, 19,511 19, 122: 19,439'
57.6
1
45.71 41. 2 32.41 29.2 1 25.8 23.21 22. 11 21.4 21. 5' 1
43,782,
48.5 1
- - _ . _ . _ - - _ .. -
_.-!
-15 Table 9. Percentage Increase or Decrease in Death Rates by Selected Causes International abbreviated list number 1 - ,- -
C-au-se-s-o~-Dea-~h-
-l'-I
Year-19-4-7- " , --Y-ear-~9-56- -
------------~-----------------~~------------~-----------
B12 B18 B45a B31, 4&, 32 B25-27 B12 BE47, 48 836, 43b BE49 B39
Vascular Lesions affecting Central Nervous System Mali~nant Neoplasms SenilIty Pneumonia and Bronchitis Heart Diseases Tuberculosis (all forms) Accidental Deaths Gastritis, Duodenitis, Enteritis and Colitis Suicide Nephritis and Nephrosis
11_5
+ + + + + +
8.6 0.7 6.6 22.6 11.8 33.9 8.3 13.3 18.9
+
+
10.9 27.1 33.7 74.1 13.3 74.5 12.2 81.4
+ g:~J
(Note: The rate for 1935 was supposed as 100) Fig. 6. Death Rates by Leading Causes in 1956.
Ra1:e Vascular lesions affecting central nervoue system ...........................................•• Malignant neopla.m•.•.•••••••••••••••••••.••.••••••••.••••••••••••••••••••••••••••••••••••••••••••••••••••
~~~~~~~~~~~;---....,:.i. ~~~;;;;b~
100
~
Seuility••.••.•..•.••..•••••••••••••••••••••••••••••••••••••••••••••••••••••.••••••••••••••.•••••••.••••••••••••• "-
Heart dl ...................................................................................................... Tuberculosis of aU form •••.••.•••••.•••....•••••••••.........••••.••.•..•.....••.••••••••••••••••••••• Pueumonia aDd Immchltlo iDcludiug pneumcmia of the newhorn •••••••••••••••••••••••• Accidents, including IDOtor vehicle accidents .................................................. .
f;;;;;;;;;;;t':<::I ~;;;;;;;~
Certoin dloeo... of eorly infancy, n:cludiug pneumonia of the Dewhom and diarrheo of the newhorn .•.•.••. '" •••.•..•....••••••••••••.••••••••••••••••• '" ..•••••••••• , •••••• Gastritie, duodenitis, enteritis and colitis9 including diarrhea of the newborn ••••••
~ 1951>
Suicide and oelf·infUcted Injnty•••••.•••••••••.•..••••••••••..••••••••.•..••.••••••••••••.••••••••••
10. Maternal & Child Health Maternal and Child Health Programme Recently there has been a steady decline in the maternal and child deaths. It is generally considered· that this decline is due to the progress of ~eneral public health programme, especially the expansion of the programmes for maternal and child health, environmental sanitation, and wide use of modern medicine. The government activities for maternal and child health progarmmes are run by the local health centers, which include the following services: 1) Mother and child clinic twice or four times a week and the travelling clinic twice a year (mothers' cases about 965,000: children's cases about 2,765,000 in 1955). 2) Visit to mothers' homes by public health nurses (about 1,449,000 cases in 1955). 3) Opening of mothers' classes (7,659 cases in 1955). Parallel with the government activities, the voluntary community activities have been encouraged since 1954, and the community organizations for maternal and child health were set up in abDut 1,50() cities and villages. For the purpose of furthering maternal and child health programme, the national government felt neceasity for carrying out measures for the special diseases in mothers and children, and therefore, the government has planned the system for early diagnosis. and treatment of pregnant intoxication, rickets. and conttenital dislocation of coxal joints in children, in addition to the discovery ami care for premature infants; this programme has been already carried out locally.
Physically Handicapped Children's Programme The programme for the crippled children has ~own rapidly since 1948. The programme is run on. a national-prefectural basis and includes the following four kinds of services.
-16 1) 2)
Consultation clinic is run by 135 health centers. 25, 783 children received this service in 1956Short-term treatment by the designated general hospitals is purehased by the government under this programme. This is aimed at the early treatment of the diseases which may develop to physical disabilities. 2,451 children were given this treatment in 1955. (Figures for 1956 are not available -yet) 3) Hospital-and-homes for crippled children, which provide integrated services of rehabilitation, are being established by 50.-50. national-prefectural fund. 21(1,515 beds) are now established. 4) Prosthetic appliances are provided under the programme. 3, 60.7 appliances were provided and 457 cases received repair service in 1955. (Figures for 1956 are not available yet) Table 10.. Annual Change of Maternal Deaths by Leading Causes (1951 ......1955). Year Number Rates(Per 10.,0.00 live births), 1951 [195211953 18.1 3. 3 4. 8 1.0, 6.91
,... - ' - - - - _ . _ - _ . _ - - - ..,----------.......,...._-_ ....__ . Causes of Deaths"--
J ,-1
I
ToW, .. ' ...i 3~691i 3,4i7j 3,373! 3, 262i' 3:;;4117.3117.0. Accidental di8tur~nce ?f p~egnancy 652 588 625 5361 569 3. 1, 2.9' 1 Haemorr~e dunng child-birth . I, 0.24. 931 896 893 831 4. 8' 4. 6, 1391 1.2i 1.1 Childbed fever ; 263'1 213, 194 179 Toxaemias of pregnancy ; 1,285 1,29111,286 1,261 1,116 6. O. 6.4 ~her diseases during child-bir~!. 467 _394 . 372, 393,440.1 __ 2.2j 2.0, 1
-------J
1951 ,1952
1953 11954 : 1955
195411~~~ I 17.71 3.3; 4. 8 0.8 6.51 2.5:
-
18.5' 3.0. 5. 1 1.0 7.11 2.~,_. 2.2_
Table 11.
Annual Change of Infant Deaths by Leading Causes (1951-1955). -._. ._-_. -- - - - - . . . Year 1 Number' _ I,QQQ_live
1951 1 1952 ~ 1953 ; 195411955 195~1~95~;1953Ii954119551 1 ...-T-otal- . - . _ . '--,-122, 868 99'114~191' 424~-78'944i68' 8011~7. 51 49.4:48.91 44.6 39.8 , Tuberculosis, all forms 872 I, 31 48 _ 3611 2991 Q. 4: Q. 3 o. 3 O. 2~ O. 2 Syphilis and its sequelae 478 298 20') 126' 94 0.21 0.1 0.1 O.l j 0.1 Dysentery. 145 176 121 104,1 85 0..1: 0..1 1 0..1 0..11 0..1 Diphtheria 82: 481 50. 24 36 Q. 0. O. 0., O. 0 o. 0. O. 01 Whooping cough 2, 0.22 I, 385: 825' I, 06!: 252 O. 9i Q. 7j Q. 4 Q. 6 Q. 21 Measres 3, 403 I, 0.88 2, 341 I, 179 922. 1. 6 Q. 51 1. 3 Q. 71 Q. 5 Tetanus 497 481: 4461 3411 315\' 0.2. 0.0.: 0.2,1 0..2 0..2 Mali~nant neoplasm 86 731 641 85, 87 0..0.1 O. ~ 0.0 Q. 1 Q. 11 Menmgitis, except meningococcal and I, 30.6 893., 775 6491 453 ' 0..6 0..4 0.4 0.4' Q. 3; tuberculous . Influenza 178 73 396 84 10.9,1 0.11 Q. 0..2, 0.0. 0.1' Pneumonia 22, 796118, 537118, 35~16' 52814, 50.6'10. 7 9. 3 9.81 9. 3 8.41 Bronchitis 5,474 4,0.74 3,21 2, 60.111, 819 2.6: 2.0.: 1. 7 1. 5 1. 1 Intestinal obstruction and hernia 840. 692 898 8171 858 0..4 0..3 0..4 0..5 0.5 Gastritis, duodenitis, enteritis and colitis 14,17810,342' 8,557 6,968 5,821 6.71. 5.214.61' 3.9 3.4! and diarrhea of newborn 1 Nephritis and nephrosis ! 194 176 116 80: _55 Q. I, 0.1 0..1 0..11 0..0.: 1 Congenital malformations 4,854 4, 146 3,937 3,466 3,064 2. 2! 2. 11 2. I,1 2·Qi 2.11
~~er
'Ra~--
b~_~) HI
----.._1-
Iii
2'239r," I, 21~ 1'~ 905 I, 771 1,825 1. 0.; O. 9! 0.611. 0. 1. 1 1 1 1 Other diseases r.ecnliar to early infancy , .47,'331 ,611,36, 31,984,28,0.37,22. 1'120. 3 L9. 6 18. 1[1(;,' a!. 1 and immaturJty unqualified 1 1 Beriberi 2,0.51 I, 51~ I, 154 844 6161 1. 0.' 0..81 O. 61 Q. 5 O. 4, ,_A~!~en~ __________ .._ _ 2,0.661 ~,Q8~ 1,855,1,713j 1,739, 1.0., ~ 1.0:~~~.O
Bi~!~e!~isisies,
I
postnatal asphexia and
I'
I
11. Health Edueation The local health centers perform extensive health education programme in the field of communicable disease prevention, care for infants, and insect and rodent control, and promotion of environmental sanitation. In addition, school health education is performed by school authorities under the direction of the local education board, whereas the industrial hygiene education is conducted by local la' or standard offices. In the rural area, agricnltural extension service under the direction of the Ministry of Agricultur.e-and~ includes substantial health education programme to the farmers. . Radio broadcast, movies, slides and exhibits are employed extensively. Summer seminars are held annually for training and for conference, and the regional discussion groups meet often for the exchange of views and ideas. The production of health films and slides are increasing rapidly for the use at health centers and for women's and young people's meetings. .
-17-
12. Tuberculosis The deaths from tuberculosis continues to decrease. In 1956, there were 43,782 deaths, the ratio of which was 48. 5 per 100, 000 population, and it was the 5th one in the leading causes of death. As was in the previous years, the decrease was remarkable among younger age group compared to the older and productive age group. In order to ascertain the actual condition of the tuberculosis prevalence in the country, the were selected by the stratified random sampling method, and ,99. 3% of the ~otal ~ove
rnment conducted the nation-wide survey in 1953. In this survey, 211 areas with 51,011 population popuJati. ., of the areas were examined with radiograph to get informations on the number of tuberculosis patients, type of tuberculosis, kind of treatment required, and the consequent requirement of the medical facilities. As a result of the survey, it was estimated that thrre were 2,920,000 patients, 3. 4% of the total population. who needed medical care. In addition to this group, it was also estimated that there were 2.610,000 persons who needed rest or care but not medical care. Based on the result of the survey mentioned above, the Tuberculosis Control Law (Law No. 962 of 1951) was amended on August 1955, which now requires health examination for all population adove 6 years of age.
Tuberculosis Control Programme The tuberculosis control programme as provided for in the Tuberculosis Control Law has been carried on throughout the country as the years passed. The brief summary thereof is stated below. 1. Budget The budget for the tuberculosis control programme amounts to 14.9 billion yen in 1957 fiscal year_ This, however, is only the national expenses and does not include the expenses by the prefectures, cites. towns and villages. 0.7 billion yen for health examination and vaccination, 12.5 billion yen for management of public sanatoria, and 1. 7 billion yen for grants to tuberculosis patients are provided in the national budget. 2. Health Examination and Preventive Vaccbation According to the Tuberculosis Control Law, the teachers and pupils in schools, employees of factories. and offices, inmates of certain institutions, and residents in the cities, towns and villages receive the free health examination, except those' under 6 years of age. In 1956. 29.888.493 persons, 1/3 of the total population, received the examination. The case finding rate ther of was 0.35%, which was 0.14% less than that in 1955. Among the negative reactors. against tuberculin, 6.433.455 persons were innoculated with BeG vaccine in 1956. (Refer Table 12}
Table 12.
Tuberculosis Health Examination and Preventive Vaccination (1951-1956). [' Tuberculin Test ., . Exammed I POSitive Persons Reactors With -I' . Mmlature
Year 1951 1952 1953 1954 1955 1956
of INo. Persons Examined
I Exal!lined
1 :
Exal!lined I Persons With di d RadiOasagnose 'CB case I Radi~~~graphy , II
.
I
jl
received ' . BeG VaccInation
Pe~ns
I t
~2! 426. 290 19.754.843.10.696.729 ",1.921.8421 18.546,913 11.322,059
~~~~~~I~~~I~~~ 12.419.467, 1 ~_~I.~m,~~~~~~
14,295.449
606.6951 638.630
~~ m~
143.320, 10.387. 504f 142,073 8.126.176,.
~~~m~ ~~~~~ ~~~~~
~~m._m~m~~_~
.-~~-~~~~~~~
~~
-~
~~~-~
(Note: A year stands for the calendar year period, except 1951, which covers the period April·Decem er.}
~18-
3.
ReJl«lrting and Registration
The reported cases by the practicing medical doctors to health authorities are shown in Table 134. Medical Care The expenses for the medical care of tuberculosis patients are provided, besides with the private expenses, with the grants by various types of ~ocial insurance, public assistance programme, and also by the governmental grants under the Tuberculosis Control Law. It is estillllrted that the lotal expenses for medical care of ail kinds of illness by all kinds of sources, both private and public in 1955, were 271 billion yen, and among them 63 billion yen, nearly a quarter of tbe total amount, was for tuberculosis. The Tuberculosis Control Law provides the 1/2 grant to chemo-therapy, surgical treatments of all cases. 5. Beds for Tuberculosis Patients The beds for tuberculosis patients continue to increase as shown in Table 15. The average length of stay of tuberculosis in-patients became shorter 85 shown in Table 16. Table 15. Number of TB Beds by Year and Manager
- - ____ --I Reported N-umber oC - -I ,- --- Year --=Tuberculosis Cases I I 1947 1948 1949 1950 1951 1952 1953 19541955 1956 Table 14.
Table 13.
Reporting of Tuberculosis Cases.
"1 " 7,397 382,810 464,903 528,829 590,662 586,651 507,244 523,556 517,477 518,142 Expenses for Medical Care in 1955 Fiscal Year (in Billion yen)
i
1
-
-
0
Fund -
---I ~lJIlf~:!s - 1TUberc~iosisl 0
I
L _
Total - - - - - - -1--- 271.0-1 --63.0-' IPublic Assistance Law 24.4 15.2 TB Control Law i 3. 1 3. 1 Health Insurances i 118. 5 31. 3 Patien~ _ 1 125.1 13~~ 0 ____
Table 16.
Average Length of Stay of Tuberculosis In·Patients
r
Year
i
To<aI
'N'~\ ~!';""I~:'"OO! Printel r;~;1 . To~a;~~~~oria I~~£~~73, 0421 76,751 77,342 81, 565 84,248 83,932 11, 5861 19,2261 28,458 39, 368 46,846 52,361i 25, 488! 15, 088, 1-~51 35,876' 32,008 I 1952 1953 44,9881 27,636 53, 187 35, 942 1954 59,515 45,574 1955 _ 63~ 989 .. 52, 521 1956 1 1
1951 1952 1953 1954 1955 1956
125, 204! _ 153, 861 1178,'424 : 210, 062 236,183 252, 803 1
-~- 269 T
292 361 402 383 1 35~_..__
I
369 - - - 1S;-353 223 510 257 550 316 I' 478 313 426 304" __ 0
Annual Change of Death Rate from Tuberculosis The death rate from tuberculosis was 253.2 per 100,000 population in 1918, which was the highest rate since 1900. It decreased in the course of years until it became 179.4 in 1932. But it again started to rise and became extremely high in 1943, showing 230. 9. No accurate data were available for the succeeding three years. However, in 1947, the death rate was reduced to 187.2 and still continued to decrease year after year, and in 1956 it became 48.5. It will be also noted from the chart illustrated below that the decrease of death rate in the past 10 years are remarkable in the younger age group. Fig. 7. Death Rates from Tuberculosis by Year and Age Groups• Fig. 8. Annual Change of Death Rates from Tuberculosis by Age Groups.
.lOll
100
~ Death 1930 - Year 1940 Rot. (Per lIIO.ooof'1ll>ulotion)
------------(0-4)
-19-
13. Communicable Diseases Communicable Disease Control Programme The communicable disease control programme is based on the Communicable Disease Prevention Law (1897), Preventive Vaccination Law (1948), Venereal Disease Prevention Law (1948), Tuberculosis Control Law (1951), Leprosy Prevention Law (1907), Trachoma Prevention Law (1919), and Parasitosis Prevention Law (1931). Particularly, the Communicable Disease Prevention Law provides, in detail, diseases with reporting obligation, isolation of patients, disinfection of the places, and the specific obligation of the local and national health authorities. The diseases designated by the Law are, cholera, dysentery, typhoid fever. paratyphoid fever, smallpox, epidemic typhus, scarlet fever, diphtheria, epidemic meningitis, Japanese "B" encephalitis, and plague. In addition, the following 13 diseases are also required ~ be reported of their occurrence by the physicians: influenza, rabies, tetanus, infectious diarrhea, whooping cough. measles, acute poliomyelitis, malaria, filariasis, yellow fever, anthrax, tsutsugamushi disease, and relapsing fever. Preventivc Vaccination Law was put int:> effect in 1948, and the programmes have been carried out for the following diseases: a. Periodical vaccination: 1. Smallpox-3 times: 2--12 months after birth, during 6 months before entering primary school. and during 6 months before graduating from primay school. 2. Diphtheria-3 times: during 6--12 months after birth, during 6 months before entering primary school, 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: durng 3--6 months after birth, and during 12--18 montha after the first immunization. b. Extraordinary vaccination: Besides the periodic immunization, the law provides immunization for epidemic typhus, cholera. scarlet fever, influenza, and Weil's disease at the time of their epidemics. Table 17. Number of Persons received Immunization. 1951 1952 ___ . . Thnuland
~ ---:--._DIsease
Year jApr. 1950--1 ------I Dec~19~~I. TboU8Olldl
I
1953
!
I
1954 Thn~laDdl 5•. 21(? 32,976'
1955 -:"----c::::---
1956 Tbouoand
Thouland
Thnulandi
Thnuoandl'
i I
Smallp1x Typhoid & Paratyphoid
Diphtheria . Whooping Cough . Epidemic Typhus
fu~
26,867, 43,676 3, 646, 266' 1, 1551
13,654 35,498 3, 770 1, 656
4,471 30,975 3, 789 1, 615
4,716; 30,1641 4, 048 1, 598
' I 4, 665 1, 939 4, 848i 1, 419,
5, 212, 29,380 '
~~_I_ _ !7~L
4,31l i 26,907l I 4, 603i 1, 4441
_1_34-'--_ _ 89 _ _ _ 61...:..1_ _ _ 31
Prevalence of Major Communicable Diseases Due to the confusion soon after the World War II, dysentery, typhoid fever, paratyphoid fever. and diphtheria, together with cholera, smallpox, and epidemic typhus were prevalent. Most of them, however, decreased rapidly and are now well under control, except dysentery and diphtheria started to increase in recent years and is still increasing.
Dysentery Survey Because of the increase of dysentery since 1949, the ~overnment conducted nation-wide survey as to the epidemiological as well as social factors of dysentery prevalence in 1953. Again in 1954. epidemiological 8urv£y was done of "Ekiri" (Serious brain symptom cf dysentery with vascular lesion). Their results are as follows: 1) Dysentery survey 805 areas with 187,024 population were selected by the stratified random sampling method. This. revealed: a) rate of response was 94.45% and rate of reservoir was 0.57%, b) Shigella were isolated in 4.3% of diarrhea-patients, c) distribution of isolated strain was Flexner 2a 35.4, 2b 27.0, 3a 12.6. and Sonnei 12. 6, and d) majority of the cases was very mild. 2) Ekiri survey Survey revealed: a) around 70% of patients were children, who were at the age of 1--6 years, and. b) . fatality rate of Ekiri was 18.6% in male and 19.3% in female.
Table 18.
Annual Change of Cases, Deaths, CaJe Rate and Death Rates for Communicable Diseases. (Rate per 100,000 population) (1920-1956)
1:5
Cholera Year 1 •
Case ' Death Cases I Rate Deaths 1 Rate 1920 1921 1922 1923 1924 1925 1926 1627 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956
1--' - i I
Dysentery
Case Death Cases ,Rate I Deaths Rate! Cases
-, !
Typhoid Fever
I
Paratyphoid Fever!
Smallpox
!
'_-_00" . "1i " ---' 1·_· Case Death ! Case Death . Case Death Rate I Deaths 1 Rate Case3: Rate 1 Deaths I Rate 1 Cases ,Rate' Deaths I Rate
1_
-4.969-1-' 9.0~,417-"6.2 ; 12:723123.0 8,148 14.7 ' 53,'7561'97'.-0 12,0731 ;1~--7,697' 13.9T ·783 1.4-! -;:166 5.7' "7291.3 29 0.1 35 0.1' 12,443 22.2 7,872 14.0, 49,916 88.9 11,948 21.3 6,286. 11.2 702 1. 3 889 1. 6 203 0.4 743 1.3 542 1. 0 15,101 26.6 I 9,110 16.0' 52,287 92.0 12,351 21. 7 7,108: 12.5 , 767 1. 3 679 1. 2 120 0.2 4. 0.0 31 0.1 20,266 1 35.2' 9,397 16.3 52, 588 91. 4 12, 933 22.5 5, 288, 9.2: 676 1. 2 1,921 3.3 399 0.7 - ! - 18,726132.1' 8,652 14.8 58,356 100.1 14,059 24.1 5,330, 9.1 I 597 1. 0 1,703 2.9 294 0.5 624 1.1· 363 0.7 1.14,720 24.9 7,514 12.7 45,768 77.3 10,468 17.7 5,052 8.5 442 0.7 430 0.7 69 0.1 250.0, 13 0.0.17,135 28.5 8,528 14.2 43,938 73.0 9,774 16.2 4,4511 7.41 431 0.7 1,256 2.1 '158 0.3 2 0.0 3 0.0121,396'35.010,211 16.7,37,50361.4 7,83412.8]' 4,736, 7.71 490 0.8 352 0.6 90 0.1 10.0 1 0.0 25,196 40.6 12,033 19.4 41,996 67.7 i 8,767 14.1 4,887; 7.9! 451. 0.7 723 1.2 100, 0.2 205 0.3 114 0.2, 30, 230 48.0: 13,421 21. 3 37,262 59.2 1 8,015 12.7, 4,189 6.7: 349 i 0.6 114 0.2 11 0.0 21 0.01 29,672 46.5 13,014 20.4! 41,367 164.8 8,340 13.1; 4,467 7.0 372 i 0.6 7 0.0 4, 0.0 - 1 29,655! 45.7 ' 13,002 20.1 I 38,202 58.9,1 8, 163 12.6 4,OiZ 6.2, 308: 0.5 23 0.0,1 8 0.0 4 I 0.0 I 1 0.0 1 32,249 ' 49.0 113,547 20.6: 35,43? 9 6,936 10.51 4,694 I 7.1 368 0.6 305, 0.5: 44 0.1 - , 38,040 57.0 14,874 22.3 38, {03 ,)7.5 7,632 11.4 5,279 7.9 333 I 0.5 375 0.6 55 0.1 - : 42, 939 63.4: 15, 484 22. 9 42, 420 , 62.7 8, 129 12.0 4, 462: 6.6 319 I 0.5 320, O. SI 35 o. 1 -148,964 71.3,15,915 23.2 3'(,9CO 55.3; 7,192 10.5 4,173 6.1; 279 I 0.4 113; 0.2, 16 0.0 -152,053! 74.8; 16,710 24.0 I 36,799,52.91 6,847 . 9.8 4,747 6.8: 276, 0.4 178: 0.3' 20 0.0 57 I 0.1 i 11 0.0 78,283 i111. 3 119,712 28.0 1 38,124 54.2 7,062 10.0 4,439 6.3, 26~, 0.4 90: 0.1; 8 0.0 113. 6 21,955 31.1 1 42,074 59.6 18 10 0.0 1 SO,221 1 7,803 11.1 6,100 8.6 29., 1 0.4 60 0.1 i 6 0.0 1 0.0: 97,249 137.1 124,890 35.1' 37,837 53.3' 6,954 9.8 5,227 i 7.4 293, 0.4 287 0.4! 33 0.0 5 0.0 83,689 117.0 22,02~ 130.8 i 40,706 56.9, 7,106, 9.9 6,251 ~ 8.7 3121 0.4 575 0.81, 60 0.1 ! -158, 803 ; 80.8 16, 290 22.4' 40, 595 55.8' 6,904 9.5. 6,233 1 ,8.6 308 0.4 654 0.9 92 0.1 - 55, 785 75.9 I 14, 268 19.4 35, 589 48.5 6,428 8.8 6, 218, 8.5 1 281 0.4 381 0.5 61 0.1 - 50,188 67.8 10,203 13.8152,519, 71. 0 6,925 ' 9.4 12,382! 16.71' 503' 0.7 546 0.7 73 0.1 - 55,196 74.7 11,203 15.2 57,448 77. 8 7,844 10.6 14,819 20.1 564 0.8 311 0.4 44 0.1 -196,4621133.2 20,107 27.8' 57, 0 '7,999, 11.? 10,059 13.9 526 0.7 1,6!4, 2.2. 319; 0.4 560 I 0.7 88,214 115.8 13,409 17.6 44,608 i 58.6, 5,446 7.2 9,154,12.0 466 0.6 17,9.,4 23.6 2,029 4.0 1,245 -: 39,219 50.2, 9,573 12.3 17,£09; 22.8 i 2.926, 3.7 4,728 6.1 316 0.4 386 0.5 85 0.1 1 - 14,665, 18.31 5,157 6.4 9,486111. 91 1,433 1. 8 2, 917, 3.6 I' 170 1 0.2 29 0.0 3 0.0 - 23,991129.3 7,765 9.5,1 6,391 7.8 936 1.1 2,189 2.7 116 0.1 124 0.2 14 0.0 1 1 0.0 I' 49,780 59.8' 11,968 14.4. 4,883 5.9: 630! 0.8 I 1, 711 2.1! 80 I' O. 1 5 0.0 2 i 0.0 1 0.0 93,039 110.0 14,814 !7. 5 3,878 I 4.6 351 ~ 0.4 1,302 1. 5 ! 49 O. 1 86 0.1 12' 0.0 111,709 130.0 , 13,585 15.8 2,893, 3.4 189' 0.2 835 1. 0 32 0.0 2 0.0 - '108,009 124.1! 10,851 12.5 2,521: 2.9 1571 0.2 1,093 1.3 16: 0.0 1 61 0.0, 98,810 !111. 9! 9,311, 10.5! 2, 567 1 2.9 124: O. 1 760 0.9, 2: 1 0.0 1 2, O. Q i £0, 654 , 90.3, 6,0421 6.8' ~, 939 2.2 105 0.1 590 0.71 13 0.0 1 0.0 I - i 84, 437 93. 6 5, 145 5.7 2, 123: 2.4 1 80 0.1 509 0.6 19: o. 0 - 1 , i ' -----,--- (con'dfu'th--;-~~~t-page)'
I
~
I~3.
i
0.= I
I
j
9~3180.
=1
I
~I :
I
(Rate per 100,000 population)
I. ,
Year
1-.
Epidemic ___ _ __Diphtheria.·- _. Epidemic 1 Case 1 Dea h ' Death! C : Case 1 D h ' Death C Case 1 • Death I Case 1 Death Ca I Case I Dea h Death I • Cases Rate' t s , Rate i ases Rate I eat s • Rate: ases Rate Deaths i Rate Cases; Rate' Deaths • Rate . ses i~te, ~s . .!ta~
Typh~~
._1
~c~~et Fe~
I
I
Meningit~ ._II-Ja;an~se"B"-E.ncep~I~_1
.!
1920 1 --' 661'-0:1. 3 1 1,368! 1921 171 0.3· 24 0.0' 1,589 2.8 1 '1922 23. 0.0 4 0.0 1,656 2.9 1923 14 i 0.0 3, O. 0 ~ 1, 562 2.7 1924 14· 0.0 i 3 i 0.0 1, 843 i 3.2' 28 O. 0 2, 573 4. 3 1925 36., 0.1 i 4 0.0' 3, 319 5.5 1926 7 0.0, 1 i 0.0 4,1481 6.8 1927 23 0.0 3 I 0.0. 5,727 9.2: 1928 15, 0.0 3 0.0 5,663 9.0 1929 . . 1930 1 1 0.0, 1 0.0· 6,025 1 9.4 1931 3 O.O! 3 0.0 6,480 1~.0; 1932 3 0.0 1 0.0 8,257 1u.5 1933 4. 0.0 1; 0.0. 12,631 18.9· 1934 .261 0.0 5 0.0 116,688 ~4.7 1935 18, 0.0· 1 0.0 16,506 24.0 1936 1 i 0.0, 3 0.0 16,707 24.0 1937 17 I 0.0 1 0.0 17,602,25.0, 1938 - ; 19, 002 26. 9 ' 1939 5 0.0 21 0.0·19,907 28.1 1940 3. O. 0 3 O. 0 i 19, 325 27. 0 1941 871 0.1 1 14, 0.0 '14, 997 . 20.6 i 1942 100 0.1 23, 0.0 12,688·17.3 1943 1,374: 1.9 129' 0.2 9,891 13.4 1944 'I 3,9411 5.3 622 'I 0.8 6, 354 1' 8.6 i 1945 2,461 3.4 260 0.4 2,405 3.3 I 1946 . 32,366 42.5 3,35! 4.4 2, 2.9 1947 1, 106 1.4. 13:> 0.2 2, 63;> 3.4 1948 475 0.6 .47 0.1 1 2, 982 3.7 1949 111 0.1. 18! 0.0 4,602! 5.6, 1 1950 938 1. 1 68 0.1, 5,149 6.2: 1951 3 ~ 0.0 i 2 0.0' 5,096 6.0 19~2 16. 0.0; 6,168 i 7.2 19:>3 _. 12, 619 , 14.5 1954 1 0.0. 19, 861 22.5;
0.0
2.5; '102 i 93. 107 104 128: 284 300
20~
i
161, 3,699 'I 4.1' 1,373 i 1.5\ 1461 0.2! 4,538. 5.0 1,593 1 1.8 ~(Note: ~ The popui~tio;t used' as the hasis of computa'ti~ ~(the~' rates is ih~'-'~timated population excl~ding oki~~wa. The n~~her 'ofdeath~ior1920·':-1912 is only for Japan Proper, exclusive of Okinawa Prefecture, hut the number of cases and deaths for 1943-1945 includes Okinawa Prefecture. Consequently, there is some inconsistency in this tahle; the number of cases were taken from our Morhidity Statistics, and deaths from Cause-of-Death Statistics and Vital Statistics; deaths from smallpox in 1950 includes one death which actually occurred in 1949 and was rep:lrted in 1950; one death from cholera in 1950 and 1951 shown in tahle actually occurred ill 1949 and was reported in 1950 and 1951; all 15 cases of epidemic typhus, reported and tahulated in 1952, actually occurred in 1951.) . I
1955 1956
=, I =j =i 12,172 1~,48? I
220 248 303: 327 336 401 505 I 488 467 454 398 475 388 268 217 165 1141 82 100 71 42 58. 33 34 48. 56: 87 1 62 63
~19
I
0.'2 i 27.313:801 1 11.'9 -'-949-1 1.7 111.0! - 0.2 14,449.25.7 3,851 6.9! 772 1.4 i 464 0.8! 0.2, 13, 696 '24.1 3, 530 6.2 939, 1. 6 592 1. 0 0.2! 12,729 . 22.1 3, 378 i 5.9 708 1. 2 1 394 0.7 -I 0.2 13,081! 22.4 I 3, 546 .. 6.1! 1,348: 2.3 1, 333 1 2.3! . . . 1 . . O. 5 13, 775 23. 3 3, 595 6. 1 445· O. 8 . 275 0.7 0.5 .113, 621 22.6, 3, 625 'I 6.0 408 0.7 236 0.4, 0.4 15,172 24.8 i 3,913 6.4 \ ~30 I 0.5 2121 0.3. 0.4 17,526 28.2 4,401 7.1 294 0.5 171 0.3· ('.4 19,674 31.3 4,703 7.5 352 0.6' 208. 0.3 , . 1 0.5 '118, 522 i 29.0 4,069, 6.4! 275 0.4 168. 0.3 0.5 21,048! 32.5 I 4,582 I 7.1· 280 I 0.4 165· 0.3! -I 0.5· 21, 811 33. l ' 4, 509 6.9 238 0.4 165 0.3 0.6 28, 500 42.7 5,418. 8.1 359· 0.5. 239 0.4 0.7 i 29,992144.3. 5,2151 7.7! 1,186 1. 8 1 599 0.9 0.7' 28,054 40.9 4',432 I 6.5, 1,304 1. 9 699. 1. 0 0.7 28,117 40.4. 4321 6.2 1,003 1 1.4 601 0.9 0.6 28,003 39.8: 4,236 I 6.0 8391 1.2 479 0.7 O. 6. 28, 323 40. 1 I 4, 118; 5. 8 995 1 1. 4 580 i O. 8 0.7 35,803 50.5! 5,255 7.4 1,632 2.3: 886 I 1.2. O. 5 38, 303 53. 5; 4, 728' 6. 6, 1, 350 1. 91 707 I 1. 0 . - , 0.4. 40,442 55.6 . 4, 985 I 6.9 1 1, 160 1 1. 6 524, 0.7 - 1 0.3 1 44,431 60.5 5,134 7.0 823 1.1. 443 0.6 0.2·63,756 86.2 5,419 ~ 7.3 1,113 1.5 393 0.5 -; 396 1 0.5 i 0.2,94,274127.61 6,192 8.4 1, 463 1 2.0. O. 1 85, 833 118.5' 7, 826 ~ 10.8 4, 384 6. 1 1 1, 072 '1. 5 O. 1 49, 864 65.5 3,825; 5.0, 1, 436 1. 9 ! 455 0.6 201, 0.1 28, 307 36.2 3, 390 4.3 1 3, 373 4.3 1 1, 187· 1. 5 ' 263 1 0.1, 16,377 , 20.51 1, 903 2.4, 2,052 2.6· 650 I 0.8 4, 757 0.1 114,555 : 17.8 1,635 2.0· 1,446.1 1.8, 492 0.6 i 1,284. 0.0' 12,621 ,15.2 I 1,182 1. 4 1,193 1. 4 336: 0.4' 5,196 0.0 10,749 12.7! 895 1.1 1,11111.3, 302' 0.4 2,1881. 0.1 8,381 9.8· 639 0.7.1 912 1.1 227 0.3! 3,545 0.1 9,589 11.0 773 1 0.9 859 1. 0 196, 0.2 1, 729 O. 1 i 10, 490 11. 9 i 794, 0.9. 676 0.8! 153' 0.2 1,758 i
15,1~i
~o
~I
-;' -
_I
-
i
-
1
-I
-I
I
-I
=1 =1 -! -! ,
=1 -I
i
-,
-I
=1 =1 -I I
=! =1
I
=1
-I. I
I
·1'
15.1 I' 13.5,
0.1' 117.41 0.1 18,39:> 20.4
15,55~
91311.0 978. 1.1
630 0.7 610 i 0.7.1
I
O.~
0.3 0.3 5.9 1.6 6.2 2.61 4.1 2.0 1 2.0 I
I I
99 1 228 2,620 'I 1,177 2,430 1 956 1,437 1 720, 731
-1 - . 0.1 I 0.3 3.3 1 1.4 2.9 1.1 1.71 0.8 0.8
I
I
.... N
-
22Table 19. Cases and Case Rates for Reportable Diseases. (Other than those in Table 19)
:_. _ 'I
_
I 1955 I 1956 ! ,NUmber! Rate ~u~rl Rat~l~um~1 R~e Nu~~1 Rate l~~~r: Rate INumber Rat~J l 1951 I'
1952
!
1953
1954
I 'I'
i 1 1 476 0.6 263 0.3 1681 0.2\ 3371 0.41 661 0.1 471 O.l 181,861215.01 57,502166.91127,723146.81 71. 605 81.1 60,271 1 67.51 68,153 75.5! 1 78,606: 92.9 56,868 66.2 45,2621 52.0 67,028 75.91 14,134 15.8 18,5241 20.51 5,958 7.°, 1,634 1.9 89,942103.41 4,444' 5.0, 18,639' 20.9 ' 24,991, '/.7.7' 4,230 5.0, 2,317 2.7\ 2,286\ 2.6 1,921, 2.2 1,314; 1. 5, 1,497 1. 7\ 1 j j Tetanus I 1,724 2.0, 1,4381 1.7. 1,243 1.41 1,044 1. 2 960 1.1 998i 1. If t~~~:x 13i 0.0 5, O. OJ 3 0.0 11 O. OJ -: I, 0.0; 2 O. 0 -I 31 o. 01 3 O. 0 6 0.0 1 O. 0 Tuberculosis 507,244583.0523,556593. 0517, 477 579. 6 518, 142574. I! . I590,662698.2'586,651682.91 Leprosy 485j O. 6' 3261 O. 4 3151 O. 4 333' O. 4 3311 O. 41 283i o. 3: 1 i Trachoma 1165,708,195.9:149,0671173. 51130, 223149. 7j123, 460 139. 8 102, 215114. 51 91, 684101. Infectious Dia~rh~ 1, 520, 1. 8 147 0.2 59 0.1 1091 0.1 81i O. I' 424 0.5: 97 O.lj 1041 0.1 74 O. r 43 0.0 381 0.0 : Tsutsugamushi DI-! 100 0.1 , sease 'i I I Schistosomiasis Ja6971 0.8; 9481 1.1 1, 200 1. 4 1,537, 1. 7; 1,349. 1.5 1,442 1.6
Malaria Measles : Whooping Cough ; Influenza I Poliomyelitis
I
,
-!
~
I
! I,lOlan~ca . I Fill r18SIS
i GOnorrhea
, Syphilis
.
,Chancroid : Lty~phlograJ?ulolma: OSIS nguma e ~.-----
55 O. 1I 187 0.2 61 0.1, 98 0.1; 1 1 , 1 77,081 91.1 50,528 58.8 38,7211 44.5j 33,829 38.3 28,673 32.1' 24,3231 26.9i 1 142, 458 161. 4141, 416.160. 2134, 571150. 7116, 842 129. 5 179, 116211. 7i158, 670!184. 71 15,953 18.9 14,909 17.4 1",5141 14.4, 8,745' 9.9 4,636, 5.2 3,068,1 3.4 3031 0.4 208 0.2i 163, 0.2 125' 0.1' 70 0.1 40' 0.0, i : - - - - . ----~--- .. - - - - - . - - - - " 71
I'
O. 1:
40
0.0
I
I :
14. Port Quarantine The port quarantine service in this country is bein~ carried out, in accordance with the Quarantine Law of 1951 (partially amended in July 1956) and the Law concerning Special Instances of the Quarantine Law relating to Military Vessels, etc., by the Quarantine Stations, Branch Quarantine Offices and Detached Quarantine Offices located at 34 seaports and 3 airports. The set-up of those quarantine stations as of Dec. 31, 1956 are as follows: Table 20. (1)
Quarantine Facilities at Seaports and Airports.
a) Ha-k-oda-te; Hiroshima; Kobe; Moji; Nagasaki; Nagoya; Sasebo; Yokohama' b) Hakata; Kagoshima; Miike; Osaka; Otaru; Shimizu; Tokyo'.
--I .
j 1
"~'Kamaishi ; "Kure; Maizuru; Muroran; Tokuyama-Kudsmatsu; Wakamatsu; I
I I
Seaport . Stations
(2)
I b) Naze; Niihama
Wakayama-Shimotsu; Yokkaichi; Yokosuka ____ .
. 1
• !
(3)
IYoron
Fushiki-Toyama; Izuhara; Kushiro; Misumi; Niigata; Shiogama; Tsukumi;! ___ Iwakuni; Tokyo
\
~::fi:~s --"1(4) \ Itazuke;
(~-~i.d~)',-~
...
. _____J
I
1. Those 8 quarantine stations, shown in the column (1) a) of Table 20, are equipped with the quarantine hospital, detention house, and deratting facility.
-23 2. Those 15 quarantine stations, shown in the column (1) and 9 branch quarantine offices, shown in the column (2) a) have the equipment and personnel necessary for deratting. 3. Those 2 branch quarantine offices, shown in the column (2) b) and 8 detached quarantine offices, shown in the column (3), have no such facility mentioned above, but are able to perform routine <{Uarantine business. 4. Every station or office is able to issue the deratting exemption certificate. 5. The airport quarantine service is being carried out at 3 airports shown in the column (4), and Tokyo International Airport (Haneda Airport) is designated as the Sanitary Airport in Japan. During the year 1956, 11,846 vessels and 3,612 aircraft, involving 708,842 and 125,298 persons, respectively, received quarantine inspection, and those vessels received deratting work amounted to 1,225, and those received deratting exemption certificate amounted to 1,378. respectively. During thl> same periOd, there was no case of quarantinable disease as a result of quarantine inspection.
15. Environmental Sanitaion Inse::t and Rodent Control Under the present provision of Communicable Disease 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 finacial assistance of the national government. At present each one of the local health centers have full·time staff to perform technical guidance for their own districts. Ever since 1950, the model districts have heen established in various parts of the country in order to demonstrate insect and rodent control programme, and are quite successful not only in preventing insect·borne diseases for human-beings but also in improving the community life through better understanding and organized co-operation of the people for health problems. These model districts are also used for the rodent control programme, which, with enthusiasm of the community, are showing good result. The following table shows yearly increase of the model districts. Year No. of Districts
1950 1951 1952 1553 1054 1955 1956
150 660 1,481 2,842 6,493 15,243 32,086
Being encouraged by the result in model districts, the national government has started since 1955 three year plan of eradication of mosquitoes and flies throughout the country.
Nightsoil, Trash, and Garbage Disposal Nightsoil Flush-toilet system is not yet widely developed due to the insufficient sewerage system. Nightsoil collected are mostly carried to the farms for use as fertilizer. However, such need is decreasing" because of the increase in using chemical fertilizer. In spite of that, quantity of nightsoil in urban area is increasing because of the rapid increase of the popubtion. Consequently. majority of cities are facin~ today increasing difficulty for disposal of nightsoil. Since 1953, nightsoil digestion plants have been constructed in 26 cities, and 16 more are under construction in the other cities. Trash and Garbages Difficulties are felt for employing the method of burnin~ and burying of trash and garbages, because of the urbanization in many area of the country. In 1956, the prototype plant for composting of nightsoil and garbages was constructed in Kobe City under the assistance of WHO and is in operation at present. 2. 1.
-24-
16. Water-Works and Sewage Treatment Water-Works 1. Population served with water supply system as of October 1955. Number Population served 637 27,770,568 4,011 3,145,198 3, 528 2, 761, 549 8,176--- - - - - 33, 677t 315
~~~i: Privates -Total- - -
(Note: "Rurals" means those so-called "small·scale water supply systems," and "Privates" means those belong to other than municipalities) 2. Legal provisions to de:Vl'lop water supply facilities. Under the provisions of Water·Works Law of 1957, which superseded the old Water·Works Regulation of 1890, water supply installation can be provided by cities, towns, villages, sindications. privates. provinces, and other communities so as to elevate the standard of public health, to improve the environmental sanitation and to supply safe drinking water. 3. Subsidies. The Minister of Health & Welfare may sudsidize as for the establishment of water supply system. and so-called small·scale water supply system. within one fourth of the total expense.
Sewage Treatment 1. Number of sewage treatment facilities 7 (Oct., 1955) 2. Amount of total flow treated 1,621,800 m8/day 3. Number of populati(ln covered 5,406,000 4. Sewerages Law (Law No. 32 of December, 1900). By this law sewerage installation can be provided by the public expenSll of cities, towns and villages, and its construction is limited on the public land. 5. Administration according to the Cabinet Decision made on 1 July 1957. The administration of sewerages has become separated as follows: a) Ministry of Health & Welfare is responsible for the sewage treatment, and b) Ministry of Construction for the sewers.
17. Food and Veterinary Sanitation Food Sanitation Food Inspection 3,913 food inspectors (including 1,933 inspectors holding an additional post) are stationed in the local health centers to work on 1, 535, 453 food-handling establishments (including 919, 513 establishments which do not need to be licensed). They perform inspection on establishments and supplies of food and drinks. 2. Food Poisoning During the year 1956, the reported food poisoning cases are in total 1, 665 involving 28, 286 patients and 271 deaths. As .regards the causes of food poisoning, 152 cases with 6,914 patients are due to bacterial infection and entro-toxin, 9 cases with 240 patients are due to chemical poisoning, 226 Cf8eS with 752 patients are due to poisonous plants and animals, and others. are unknown. As regards the type of food caused these poisoning, mostly they are fish, shell·fish and their products, amounting to 51. 4%, and cereals, vegetables and their products, amounting to 15.6%, whereas only 3.3% are by milk, meat and their products. In 1956, there occurred very noticiable food poisonin~ cases, of which brief summary is stated below. 1) A mystery disease at Minamata City, Kumamato Prefecture, Kyushu, occurred. This can be a kind of "intoxicating brain symptom" and it occurred among the people who ate too much fish and shell-fish caught in the Minamata Bay, and the poisonous substance is considered to be Se. or Mn. or other chemical substance. But it has not been cleared as to the reason why fish and shell-fish in the Minamata Bay only became poisonous, and actual causative agent, and the treatment method for this disease. 2) In Yamaguchl Prefecture, poisoning cases· due to soy-bean sauce was occurred, which was caused by the arsenic compound happened to be contained in the sauce. 3) In Tokyo, a food poisoning due to Stereolepis Ischinagi was occurred; the cause is considered to be over-taking of vitamin A. 4) As to the new causative agents for recent food poisoning cases, pathogenic coli and halophile bacterien have appeared. 1,
- 25-
3.
Food Additives Chemical synthetics to be used as food additives are fully controlled by autho.izatio:t system by
the Government, and they are listed up in the Enforcement Regulation of Food Sanitation Law_ Approximstely, 150 synthetic food additives are authorized for use at present. The msnufacturers or processors of synthetic food additives or its preparation are required to have a qualified self-inspector by the law. In addition to the ahove mentioned control, the additional certification system is applied to coal-tar colours and other several food additives. These specified additives are required to be tested by each lot and to be certified by the Minister of Health and Welfare or the prefectural governor concerned before sale. 4. Food Preservation Recently msny attempts have been done to utilize antibiotic to preserve food. especially fish. However. it is necessary to have further investigation on the allergic conditions to which antibiotics msy give rise. the creation of microbial resistance to antibiotics, and the effects on the intestinal flora. Under these circumstances, antibiotics have been prohibited to be used in or on food as preservatives since July 23. 1956. 5. Inspection for Imported Foodstuff The yearly amount of foodstuff imported in our country is about 5,881,080,000 tons and it is about 17% of whole imports. Since the Ministry of Health and Welfare is responsible to prevent possible occurrence of health hazard due to imported foodstuff of inferior quality, the food sanitation inspectors have been specially stationed in the msin sea-ports in the country to perform inspection and teSting of imported foodstuff. During the year 1956. as a result of these inspections and testing, amClng all foodstuff imported, total of 280 cases (56,000 tons) were either not permitted for import, or destroyed, or ordered to be used for other purpose than as food. The msin items of those inferior foodstuff are, the deteriorated rice, milk products contaminated with bacteria. confectionery containing poisonous food colour, and spoiled canned goods and milk products. In order that the inspection for imported foodstuff be carried out more effectively, the Food Sanitation Law has been recently amended to require, in each case when the particular food is to be imported, sending in notification to that effect to the Minister of Health and Welfare through the stationed inspector.
Veterinary Sanitation The following table shows the number of food animals slaughtered and of carcases condemned during the yesr 1956. Table 21. No. of Food Animials slaughtered and of Carcasses Condemned (1955) I
I I !
Cattle -
I- T~~al ~o.~laug~teredJ ,
680,726
---,, -, 1
Calves 191, 7741
Sheep
., 1 1
, 4
Gost
Swine
_
Horses
Total
33, 8761
53, 44~ 2: 149, 675: --1-j95
1 145,615 3,255, ;08
I I
1_~s~intestines)
No. prohibited from i-slaughtering No. of condemned carcasses No. of condemned I parts (meat) , No. of condemned
r9, 132, 3, 6321
I
, 128[
15,
5, 106' 1,463 8,057'
,
343, 9909' , 1
5
1
j
491,
1,0851 25, 69° -
871 3,416 1
202,9021
2,4061
978,032!
32,
502~ !
I
I, 227, 3151 i
-26-
Rabies Control The rabies control programme is also under the veterinary sanitation p~ramme in our country. and the incidence of rabies and casualties therefrom during the yesr 1945 to 1956 are shown in the following table. Table 22. I 1 i
Incidence of Rabies and Casualties therefrom.
(1945-1956)
Year 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 94 24 37 141 614 867 319 232 176 98 23 1
I I
1,158 86 129 387 1,617 1,866 677 389 316 178 41 10 1 1 17 46 74 57 13 5 3 1 0 0
I 1
I , I I
1
!
6
L 18. N:utrition Nutritionist Licensing of nutritionist is made by graduating the training school of 2 to 4 yesrs authorized by the Minister of lIeslth & Welfare, or by successfully passing national examination for nutritionist. There are 110 authorized training schools and approximately 20,684 licensed nutritionists.
National Nutrition Survey The national nutrition survey, has been conducted four times every yesr since 1946 in order to determine the condition of nutrition of the entire populstion. The following tables show some of the results of the survey. Table 23. 1 Symptoms Appesrance of Physical Symptoms (%) j
Whole Country
1--'-1954 2.3, !
Cities
~
Rural Districts
1-,Anaemia
1"--1-1 2.3 2.7 5.4 I
I 1955 i -1956"jl954'! -1'-1 , 2.71 3.11 4.9 9.4 1
1955
I 1956 1
i
11954-I-i9sSI1956-; '-2.6; 3.1 7) 8.3 1.9 4.9 1 1
1.9 2.0
i Hyperkeratosis 1 Cheilosis Loss of knee jerk reflex Edema , Chronic digestion , disorder Bradycardia 1 Delayed menstruation ! and amenorrhaes i Deficiency of lactation i Pressure-pain on calf i
1
2.6 1
2.0 1 1.9 2.9' 1 5.9 1
2.4 1 2.91 2.41 8.91
2.6:'---3.~t 3.31 7.6 1 7.6 1. 71 1
3.3; 7.6 9.9! 3.1
5.4 1
7.5 1.8 4.8 1
I 7.8 1.51 4.41 3.0 1
2.2
1 1
6.6
! I
3.11
1 1
-I -I
1. 71 4.71 2.3' 9.81 26.91
,
I
2.8 10.21 25.21 I ! 1
9.7 26.8
j
1.4'3.11 1 4.4 -j 1 2. 3 9.01
4.4' 3. 7 10.51 1
-I
-I
3. 21 10.4 1
-' 1
29.21
-I
24.21
' 25.2 I
5.4i 77.5, 77.6,1 i
Non·symptoma
75.9
81.
4
~
3.~ 81. 4 , 18.6:
~ 72. ~ 27.81
~ 74.11 25.9 1
7.d 73.51 26.5:
i One or morE' symptoms
22:5,
22.41
18.6 j
Table 24. Intake of Nutrients (Per capita per day).
27-
I
r- -'y~~-'-
District
,
Whole Country
--:-1954 T1955 0.895
~~i:1:: P~~ei~-_: l~dult J
:
r
1
1956\-:-1954
~ i
Cities
i_O. 90~:
0.901: 0.877:
-~ -1955T1956--\ 0.888 1 0.888 I O. 902 ~..~914·.1 O. 9~4 " 1955 : 19561 1954 1
Rural Districts
;
1 Calories Animal Vegetable Total
I
0.853; 0.861 22
i 0.863 1 0.841
~845 _ 0.844 1_ 0~_86~.!_ O.!~: 0.885
i
·IProtein . (g.)
.1- -
I I Fat (g)
I 1_
22 1 23 I 24 . 25 25 1 20 20 ' 20 1 -1--·-'----·..._.,-- - - - - ....-.. - - - - ---: 1 I ' 47 I 471~ _._~I _45 f_ ~ 'i~1 50 : 48
~i 21
t·c:.arboh;dra;e
(g~=II"403'1 2,074
I
69, 20 411 2,104
691_~,~1 __ 7~1_~:~1~.__~~1 22
i
I
24 .
I I
405 1--=-'381- 1 _ 2,092, 2,010
~5 1._384-:_ I
23
24
19 ; 420 ,.
435~1- 4~?' 2,176
18
19 .
I Calories
~?a~
i
2,025
2,034 _L 2,122
-=,152.-!
School Lunch Programme School lunch programme in Japan began in 1946, and at present about 12, 982, 000 primary school children (59% of all children) are fed, supplying about 600 calories and 25 g. of protein in schools. The school lunch feeding for the middle school students has been commenced since 1956, and as for the evening high school studentes since 1957.
Enriched Food The Enriched food has been strongly advocated by the government in Japan, and at the end of July 1957, the number of enriched food permitted by the Ministry of Health and Welfare in accordance with the provisions of "Nutrition Improvement Law", amounted to 1,240. Vitamin A, thiamine(vitamin Bt). riboflavin (vitamin B2), vitamin C, calcium, iron etc., are enriched in the following foods: rice, flour, bread, noodle, bean-paste, jam, soft drinks, canned fruit, biscuit etc. In particular, enriched rice has been encouraged for use in order to prevent malnutrition caused by the use of polished rice. 1 gram of the rice contains 1.2-1.5 mg. thiamine and a bit of riboflavin, and will be mixed in polished rice at the ratio of 1 to 200 in case of use. Approximately 100 tons of enriched rice is now consumed every month.
19.· Dental Health 1)
As of December 31, 1955, there are 31,109 dentists, of which 29,422 engaged in dental practice, t:Jf
196 engaged in dental education, training and researches, 258 engaged in government administration, and 1, 233 engaged in other types 2) work. There are 485 dental hygienists as of December 31, 1955, and 12,444 dental technicians as of January 15,1955. 1,195 (25%) hospitals out of the total 5, 119 hospitals in our country have dental facilities as of December 31, 1955. Among 24,773 dental clinics throughout the country, 24,409 (about 99%) are private ones; others are natioual, municipal and juridical 3) Preventive programme is carried out by 300 health centers out of the total of 783. For the school children, each school is required to appoint a school dentist for the care and protection of the children in schools.
-28 -
20. Mental Health Legislations The mental health programme has increasingly attracted public and professional attention in these years. In accordance with the recent developments in a concept of mental disorder. the new Mental HY$iene Law was put into force in 1950. repealing all the previous legislations which had main~ posed the safe custody of mental patients. Under the new Law. in addition to the provisions of insti~utional care for the mental patients. the community care and the preventive work in mental health services are accelerated. Services for the mentally deficient children and child guidance activi. ties are provided under the Child Welfare Law of 1947.
Surveys In July 1954. a statistical survey was carried out on a nation·wide scale to obtain the basic data on mental patients. A group of psychiatrists, who had been specially appointed for the survey. examined all cases of mental disorder in the selected areas. althou~h the negligibly mild cases were excluded from the calculation. Thus the survey clearly reveale.d that the estimated number of mental cases was 660,000 in male (1. 55%) and 650,000 in female (1. 41%), totaling 1,300,000(1. 48%) in the whole population. Roughly
15.5% of these cases were found suffering from schizophrenia, 1.1% manic·depressive illness, 9.6% convulsive psychoses, 1.4% psychoses due to syphilis, 7.3% mental disorders due to alcoholism and drug addictions, 44.5% mental deficiency and 13.5% other types of mental disorder. The survey also revealed that about 430,000 patients (excluding those who were under institutional care at the time of the survey) require institutional care, 46.2% of them suffering from mental illness, 31. 6% men' tal deficiency, 22.2% other mental disorders. In the Mental Hospital Inpatient Survey of July, 1956, about one fifth of all the mental hospital inpatients and the ex·patients who had been discharged during the preceeding 6 months of the date of the survey were statistically analysed, mainly on diagnosis. clinical pictures, treatmentes, etc. The fi~ures in the following tables show the percentage distribution of the inpatients and the discharged ex·patients.
rI
1.
Age and sex Age Sex Total 19 6.3 3.5 2.8 10.9 5.9 5.0 20 59 60 and over 7.3 4.9 2.4 5.8 3.1 2.7 Dischar~ed
1--I 2.
I .-._,
Jnpatients
.--.--.-
Both sex Discharged patient~ I Male Female ..
-_ ..
, Both sex Male I Female
86.4 53.0 33.4
100 61.-1 38.6 '100 60.4 39.6
83.3 51.4 31.9
-
I
Diagnosis Schizophrenia Manic·depressive illness Epilepsy Psychoses due to syphilis Psychoses with alcoholism & drug addicticn Other ty~s of psychoses Psychopathic personalities Psychoneuroses Ment! deficiency Other types of mental disorder (Total) Inpatients 70.0%
3.7 3.8 8.3 2.3
4.2
Patients 44.2% 10.1. 2.9 5.9 6.2
l00~-
0.5
1.4 2.9 3.0
7.3
1.5
11.8
·100:
1.8 0.8
3.
Source of the payments of lnpatents. All paid by patient Health and social insurances Daily Life Security Law Mental Hygiene Law Others (Total) 8-5% 31. 2 14.6 1.7
44.0
·100. -
-29 4. Duration of stay in mental hospital (Discharged patients) Less than 3 months 3 months-6 months - 1 year-2 years-5 years and over (Total) 46.2% 26.3 14.5 7.3 4.8 0.9
ioo~
Mental Hospitals The latest figures of the hospital accomm:>dations available for mental patients are shown in the following table. It implies that there are approximately 6.3 mental beds for each 10,000 inhabitants. Table 25. Psychiatric beds and Inpatients Hospitals Capacity 9,414 36,331 4,064 7,411 334
Jnpatients 9,475 38,285 3,616 7,813 59,189
(March, 1957) -BedOcc~~ncy
_
i Mental j
. Hospitals
National & Prefectural ••• Private, Juridical Persons ( and others ••••••••••••••
39 295
100.6 108.1 89.0 105.4 103,4
• I I Beds In '" genera h ·tal
: OSpl
s
( National & PrefecturaL •• P rtvate, . Jun·d·cal Persons 1 and others •••••••••••••• (Total)
57,220
Mental Hygiene Clinics and Child Guidance There are 40 mental hygiene clinics in this country, which are provided by local health authorities for persons in psychological difficulties under the Mental Hygiene Law. Child guidance services are also provided at the child welfare centers by local child welfare authorities under the Child Welfare Law.
Mental Deficiency The number of the mentally deficient children in care in 86 Homes for the Feedle-minded Children amounted to 4,838 at the end of March, 1957. One of the recent developments in the services for the mentally deficients is the opening of 6 Occupation Centers in the large cities. National Home for the Feeble-mindedis also to de set up in 1957 by the hand of the Children's Bureau of the Ministry.
21. Oecupational Health The occupational health programme in this country is based on Labor Standards Law and is implemented by the Ministry of Labor. 2,350 labor standards inspectors work for the inspection of the 1,038,248 fa!tories which include the inspection of the health cDndition of the facilitities and workers. Silicosis is the major problem and the special compulsory health examination is performed. Thepatients are given benefits out of workmen's compensation scheme for their treatment. Under the the Labour Safety and Hygiene Regulation, larger type factories are required to appoint the health supervisors duly licensed by the government.
22. Hospisals and Clinics Medical Service Law provides the detailed qualification for hospitals (medical care facilities having 20 or mor beds), while the Law does not provide such detailed requirements in case of clinics (medical care facilities without or with less than 19 beds) and the administrator of these clinics shall endeavor not to keep their patients more than 48 hours except when inevitable circumstance exists. The hospit-
-30 als are inspeeted and graded yearly by the medical inspectors on the basis of physical facilities. professional stair, and hospital management The inspeetion system contributes greatly for the improvement of hospital services to the patients. Inspite of the increase of hospitals and beds, the demand for more beds espeeially for tuberculosis and mental patients are acute. The following tables show the statistics on hospitals aud their deds.
Table 26. Number of Hospitals and Clinics. T
I I I. r
Hospital
General Clinic
Dental Clininic
I
5,418 (as of 1956)
51,349 (as of 1955)
24,773 (as of 1955)
-I
I
Table 27.
Number of Hospitals, Beds, Ilnd Bed Occupancy Rate. (Based on the Hospital Monthly Report)
(1956)
a.
Number of Hospitals. - --- Kind ofT __ )l~pital I Ttl oa
(1956)
ITu~rculosis iMe~taljSanatoria
---------- -- -=; Number of Hospltals (at the end of year) I of Beds l Number (at the end of_ year),
5,:18-'559, ~9 _
~'3-' -
I Hospitals _ - :
-, I.e ~I~m~~nicable--I Ger~al-prosana jDisease Hospital Hospital
1- -':1 14,260
--
n
-
~~ -j
I
!
127, 184.L (-3, 8881.
5,856
368,061
b.
N umber of Beds and Bed Occupancy Rate.
(1956) -
-Kind of \Bed 1 Total ··~·-I
I T B Bed ~e~~a 1 _ 252,803 I 85.7
-
I-bed! -I.e 1__
p:y
~ IdiS~se_bed__ IGen:ra I 20, 602 25.1
-d 'Com~nicable --i - - I -be- -d __
Number of beds Bed Occupancy Rate,
559,249 80.7
54, 866 1~.7
14, 260' 75.8
216, 718 74.9
Note: "Bed Occupancy Rate" refers to the number of in-patients per 100 beds of the official rated capacity.
23. Medical Care Personnel Better standard of qualification for the medical care personnel has always been the matter of great concern for the government. The Fig. 9 shows the qualifications of various personnel as of
1957. Tables 28, 29 and 30 show -the number of personnel.
The difficulties confronting with the G0-
vernment at present are the concentration of medical doctors and dentists in the urban areas, lack of qualified personnel in the field of public health work, and the scarceness of public health nurses.
Fig. 9. Standard of Qualification for Medical Care Personnel.
31-
'fable 28. Number of Medical Care Personnel.
f- -
. t-i-Public Health 1 M~·f -.- -Ciinicali armacls ,Nurse I 1 WI e , Nurse y - - ' - ' _.- - - - - ._- ---,----, ear 'Total !f;r0001 Total ,r;r0001 Total li;r Total 'Ii;r 0001 Total Ir;r000 Total Ir;r000 Number lP ' Number p' Number P' Number P' Numberl'p' Number P' • • • I • • • Dentist' Ph
- ~. . YSlclan
I
1935 1936 1937 , , 1938 1 1939 : 1940 1941 , !
I j
. Thounndl
! Tho......d- . -, 20 2J
ThoUoOiid
oooi -I
Thou-if
- IThO......dl
58 60! 62, 63 6t, 65 68 1
8.41 8. 6 8.8 8.9 9.11 9. 1" 9.3
2~I
231 23 23: 25 26 27'1 29 29 30 311 31
2.9 3.0 3.11 3.2 3.3· 3. 2j 3.4 3.1 3.0 3.31 3.4 3.4. 3.41 3.5 3. S: 1
25 27 28 29,' 30
l
3.61 3.8 3.9i 4.1 4.2
-I -
-
-I
-I -I
-
_ 19~
1948 1949 ! 1950 i 1951 , 1952 1953 1954 I'
I
31 32.1 44 1 46 471 49 50 511 51 52
9.01 73 8.9 761 9.11 84 9.9 85, 9.9 901 10.3, 92 10. Sj ._ .9:__10J
ni
251
4. 3 4.3 5.41 5.5 5.61 5.8 5.81 5.8' 5.81 5.9.
i
62 621 62
-I
-
'1
I
ThoulIIUld
8.8 8.8 ItS1 8. & 8.6.
-!
-
124 17.7 120 17.0' 1231 17.91 135 150 1591 147 149! 154 207i 272 284 3061 18. 8: 20.6' 19.91 16.7, 17.8'1 18.2 24. l' 31.3' 32.11 34.3.
-I -
.
-I 241 23
611 63'
251 27 30' 361 40 411
3. o. 2.9 3.01 3.2, 3.5 4.21 4.5 4.6!
701 8.81 77 9.4 751 9.0 78, 9.21 99 11.6' 1271 14.6 134 15.21 133_1.4.9'.
Note: The figures of clinical nurses as of the end of 1955 include male clinical nurses and 18, 781 assistant clinical nurs~s. . Table 29. Number of Physicians and Dentists by Type of Work.
t, . :::::::. . i Type of Work
(as of the end of 1955) No. of Physicians & Dentist
----
...
j..
Physician Number 44,642 32,539 9,063 3,004 2,622 2,693 94,563 1_.
Dentist Number 23,541 5,344 537 196 258 1,233 31,109
I
Owner of hospital or clinic Employed in hospital or clinic Teacher and research worker of clinical medicine Teacher and research worker of medicine other than clinical medicine Engaged in other public health service Otliers
J -I -'
..
_
Total .... - - - - - -
-
32Table 30. - . _.. and Midwives Actually engaged in the Work in 1956 __. Number of Nurses -,-'._-- .. _. -_. --
Type of Work Administration and Teaching Hospitals and Clinics Health Centers Industries Schools Cities, Towns and Villages Private Duty Others Total Note: T~e
I I I
Public Health Nurses
I I
229 175 5,245 766 4,936 805 12,156
I
I
I
Midwives
Clinical Nurses
.J 40 4,236 182 905 122,420 316 4,312 48,951 334 53,743 7,022 1,990 136,965
I
figures of clinical nurses include 1, 021 male clinical nurses and 17, 370 _ assistant clinical
nurses
24. Medical Care Statistical- Survey The government has been Cjonducting National Health SurVey (Family Sickness Survey) and Patient Survey since 1948, on a nation-wide scale based on the sampling method. In the National Health Survey, we sample about 10, 000 households or 50,000 people in 200 areas in this country, and enumerate the incidence and prevalence of disesses and iiijuries among the nation by the type of disease or injury, geographic area, occupation, economic statu~;- sex, age, etc, and also how those diseases and injuries are treated, and how much the patients pay for the treatments. In the Patient Survey, we sample about 500 hospitals (1/10 of the nation's hospitals), 1; 000 general clinics (1/50 of the nation's general clinics) and 100 dental clinics (11200 of the nation's dental clinics), and enumerate number of in-and-out patients who visit those institutions by type of disease or injury, sex, age, and the method of paying the charge for treatment. together with the length of stay of hospital in-patients.
Table 31. haeidenco of DUeue. and IDjuries, and
,- ... - -- - - - h-ci I
the Peop!e. (per 100 PopUJahoG a TNt) ~; ~-IDj~- - - - - - - - - - -, Dce l'S~~';
Si4 Days aJDODg
lt
-
1----- -- -'. - - --'-- - - - - - - - - - - - - - , - - - - , - - --Total
!
1 I. I.
1 1
I X '4. ~DlfItoms. leDility and ill-defined CODditiODl , X W. .!coiaeDb, poisoDin.s ~ violence 1 YI.
I
D. DiIeI~i: skiD and celluJar tissue X I. DieeueI of the hones and orpDI of movement I X If. X V • ~Dital mdformations and certaiD diIeMeI of early iDfa~
I. ~c eDdocrioe sptem. .ubolic and DUtritioDll dUeue If. DiIeUes of the blood and bJoocl.formiag ~DI V. Mental, paychooeUNtic and ~ty cIiaiiirden '4. DieeueI or the DenODI syltem and MIlle orpDI Diaeue of eye DiIeue of ear 1I. Diaeues of the circulatory IJItem •• 01.... of the ~~ IJItem ACllte ~etii (commOD cold) 1ll. Diseues of the di ve ~ Dian. . an eoteritii Diseues of teeth and teet....upportiag IttUctue X. Diseases of the .Di~ ~ Diseues of the feJDlle ~taI Oipnl ][. D.iliveries and compliCltiODi of prepaney. child-birth, and
Tahetcaloiia Neopl... neoplasms Mali~t
IDfective and euasitic diaeases
(......).
(......).
i i
1 1
1
(s.m.) 1 (......), 1
1
178.3,' 6.2 0.4 0.6 0.1 2.1 0.2 I O. 2 10.2 4.1 2.2 2.1
2,
090. 5 283.5 220.0 20.2 11.8 79.0 8.6 18.5
245.8 62.1 37.1
(......)1
( __ ) i __ (s.m.) 1 1 (......). .,
72.7 63.2
27'.6 4.4 12.6 1.4
388. 5 277.4 395. 1 41.6 128.7 37.9
115.7
g: ~ 9.3
0.8 I
14. 7 9.4
122.9 84.5
"0. 1
6. 3
16.4 157.1 CODvaIelCeDt Cat ~ treatment and fittiag of proathetic devices : 0.6 19.7 i____ Fi~ns __de~_~~._. _ _ _ _ _ _ _ _ _ ._~ ......),_ _~•.5_,___ 18.~.
1
18.9
97.8
Note: The IDcidence Rate and Sick Days ate derived fl'OlD the NatioDII Suvey in New.. 1955. Table 32. The Number of PatieDts visited Hospitals and CliDi~ (per 100.000' PcipuJatiOil a cia ) - -Na~-of-01Iel~ ;-nd -l=:~-:'ients
"
-
-
1~ ~nf~ve~n: ~t: 1. TuhetcuJOIia Veoenal diseues Neap......
=---.-.------ -I 3,:;--:: Inj;; - ----- (......)1 (...... )1
a:ie":]
2,3 1591 ~i
I. I
'f.
W. V.
~t neopIums Allerpc eadocrioe IJIteJD, metabolic and nlltritioDll diseues Di.ue. of the blood and bloocl-f~ ~ MentaI. paychonemotic and ~l'IOIIIlity diiOrdera O1Iellel or the Del'VOUI syltem and MIlle 01pDI DiIeIIeI of the eircu1at ry syltem Diatuet of the respira~ system ACllte ~~:tetil (COllllDDD cold) ~ of the' •~
(......)1 1 1
4571 29! 36' 211 1571
2981 17 1~ ~
11. ... I
= :: ~ pu~um
~=~I (s.m.)
sa&.
9 68'
I I 1 1
11. X.
117 3040 78'
t~
4: Ii 52i 1~
1521
191 Iii
10! .• 1071 91 .:.
~
16, ~I
!I
t:lr 741
][. 1 1
I>iarrt-a a ententia DiIeIIeI of teeth and teeth-supporting IttUctUre O1seues of the pDi..an~ IIJS!eIIl DiIeIIeI of the female pmtaI orpDI Deliveries and compliCltioDl of prepancy. chilcl-hitth. and
( ...... ) . ( ...... )\ 426 0.
8601 1~ 62 ' 48'
49t.' SUi 12' 4
4!
2951
( ..m.) I
D. DiIeUes Gl the skin aud celluJar tissue 1 I X I. DiIeIIeI of the b3D8I and ~s of monDeDt 1 1 XIf. X V. Coapital mdfCll'IDItiODI and certain dilellel of early infancy I X 1[. ~~ RDili~ and tll-def"med CODditiODl I 1
278' 73· 9'
141
,
I
I
X W. YO.
: n. ,
, _______ -
without licbeu 1 PreaatIl cares and poetpartum obeervatioDl (s.m.) 1 . eoavaleaceDt Cat ~ treatmeDt and fittilll of proetheaic devices I' Fittiag of dental devices (......) - __ - ___ - -
Acca_ts.~. and violence S~ con4litioDi and .esamiaatioDl
I
23' 182, 17' 43. 40 21.
2: 2 191 3j 3 0..!
31 6.
~ 211
351
1m 40\
1- _ _ _ _ _
Note: The Dumber of pat!eots are from the Hoepital Patient Suvey on the July 13. 1955.
-34 Table 33. H'.w the Diseasea and Injuries are Treated.
---
(Based on the National Health Survey in Nov., 1955) _.._---------_._-------- _.- I
-
- - -- - - - 100.0%
Total Number of Diseases and Injuries
Tr~t:i-----
-- --- - - - -- -- -- - -, - -- --97.;%----1 ~
I I
--- ------ --- - -- -- ----3.7% --I ----------- - --------- -- -- ------ ------------1 Consulted Physician : 40.9% _ J -Consulted ~ntist- -~~ =~=-~~~~===-----I-4.9%-~ ____ --N~t T~~-- ~--
Consulted
----------- ----- - - - _------- -;---- -------1 Treated by Home Drug : 53.7% I - - _ . _ . _ - - - - - - - - - - - - - - - -- -._--...,.- - - ' - - - ._.-. Others 1.7% I I _._-._-. - - - - _._------_._-------_.-~.---
Acupun.cturist, Moxa-cauter~st Massaglst or JudooOrthopaedlst
==
- - -
--I -I
--_-_ -
1 I
' "
4 1%
Note:
when disease or injury is treated by two or more kind of treatments. each of them is counted one.
Table 34. .- . -
Paying Method for the Cost of Treatment in Hcspitals and Clinics. (Base.:! on the Hospital Patient Survey on July 13, 1955) -- -_. ·1-- -
I 1
--- -
-
-
_.
-
_.- -
~ - -
- --
-
---
-
- -
-
Self'paying - - - - - - - - - - - - - - ----- - - - - - --- -
Social Insurance --- - - - - - --- --- --- ----- -
I -~-I ----,---
I -: -
-
-
-
~~
-
_.
--
18.0% ------ - - - ------
71. 0% 6.9% 3.3%
1
~ Oth~s-
Benefit through the Daily Life Security Law (Public Assistance)
- - ----- - -- - - --- -- - - ---r-25. Pharmaceutical Affairs
I
_
-I J
-I
Inspeetion of Drugs, Devices and Cosmetics The licensing system is adopted, according to the Pharmaceutial Affairs Law, for all manu' facturers of drugs, devices and cosmetics f r the sake of quality control. established by the Law. During the past year, the Ministry provided 1.900 inspectors all over the country, who inspected about 246,211 places out of 321.359 places (15,967 manufacturers. 19.563 pharmacies. 215.755 importers or selJers. and others) under their supervision. in order to prevent adulterated or misbranded pharmaceutial merchandises to be sold to the public. The National Institute of Health is conducting national assay on biological products and antibiotic preparations. while the National Hygienic Laboratory is assain~
Besides, the installation
of every injection manufacturing factolY has been improved, in accordance with the standard newly
or testing sulfa drugs. anti·tuberculosis
preparations. contraceptives. and some of the medical devices.
Japanese Pharmacopoeia, National Formulary and Others The fourth supplement edition of Japanese Pharmacopoeia VI and the second edition of National Formulary was published in March 1955. and its English edition in March 1956, while the Minimum Requirements for Biclogical and Antibiotic Preparations have been revised.
Poisoning by Organic Phosphorons Preparations The organo·phosphorous preparations have been used for agricultural insecticides since 1952. As
-35above all parathion and methylparathion are especially danl;erOus, this Ministry established the technical standards concerning the method of their manufacture, storage, use and etc. by the Cabinet Order. However, in spite of strenuous effort of the government, there have been many poisoning cases and fatal cases, of which figures are shown in the following table.
No. 35.
Number of p ••isoning Cases and Fatal Cases by Parathion.
Year 1952 1953 1954
· I I I
Number of Poisoning Cases 111 1,564 1. 887
.__
(1952-1156) .-!---'Number
of Fatal Cases
Operatives 70 70
I
Amoun' of eoalomption of Parathion
Suicides
Dust
'-'---;1'
I I
Emulsion 38.095 L 449. 954 ~ 481. 293 ~
_ ~:~___,__ .~~gL ___ J~ ._.._~__~~:~~~::: ; I Control of Awakenine Drug ~w,
397,922 kg. I 121 ' 7. 126. 669 Q 237 15. 164. 691 Q
~~:~~ ~
There has been no violation of the authorized dealers based on the Awakening Drug Control but 5.232 persons were arrested because of illicit manufacturing, sale or possession of those amphetamine preparations and the like, in 1956. And also, by this law, the raw materials (l-phenyl2-methylaminopropanol-l, I-phenyl-2-dimethylaminopropanol-l, phenylacetic acid and others) are controlled as nearly same as the awakening drugs. Number of addicts is estimated about 150,000.
Narcotic Control During the year 1956. the narcotic control conducted by the law enforcement agencies resulted in sending 1,748 persons as violators to the Prosecutors Office, which includes: 1,060 cases (1.575 persons) of violation of the Narcotic Control Law; 128 cases (140 persons) of violation of the Opium Law; and 27 cases (33 persons) of violation of the Cannabis Control Law. The following items have been designated as narcotic drugs, under Cabinet Order No. 100. of April 18. 1956; 1.3-dimethyl-4-phenyl';'4-propinoxy hexamethyleneimin and its salts, 3-hydroxy -N-phenethy lmorphinan and its salts, 4-morpholino-2,2-diphenyl ethyl butyrate and its salts, 4-dimethyl-amino -1.2-diphenyl-3-methyl-2-propinoxybutane and its salt••
Blood Transfusion Service Blood transfusion service is being controlled by two laws. One of them is "Pharmaceutical Mfairs Law"aiming at the maintenance of the quality of blood products such as the citrated whole blood, unfiltered normal human plasma, etc. and the other is "Bleeding and Blood Donor Supply Service Control Law" aiming at the protection of the doners' health from the ill effect which may be caused by improper bleeding. Thus, since 1951, there have been 30 liceused blood banks and 33 hospitals such as Japan Red Cross Hospitals or national hospitals which are rendering such services within the respecti~e hospital.
Production of Drugs and Devices The supplies of drugs and devices are not only sufficient for the domestic consumption but enough to
export with the exception of only a very few items. The yearly production amount of main drugs and devices are shown in Table 36.
-
36 ,..Table 36. Items
, - - - - - - - - - - , - - - - - - - - - - - - - - - - - - - - _ . --._-_._---.
(Jan.-Dec., 1956)
- ' - r - - --- . - . -
PfC!duction Quantity
Antibiotics
Penicillin Dihydro-Streptomycin Chloramphenicol Chlortetracyclin Salkomycin Trichomycin ~ents
I I
Anti-tuberculosis Sulfa~drugs
Vitamin Preparations Insecticides Anthelmintics Biologics
Medical Instruments
Dental Instruments Dental Materials
Sanitary Materials
Calcium-p-Aminosalicilate Sulfadiazine Sulfaguanidin Sulfathiazol Sulfaisoxazole Sulfaisomidin Vitamin Bl . Vitamin C Dichlorophenotan Benzenhexachloride(99%r,Lindane) Santonin Cholera Vaccine Dried BCG vaccine Diphtheria Antitoxin Diphtheria Toxoid Influenza Virus Vaccine Pertussis Vaccine Rabies vaccine for Human Use Small-pox Vaccine Tetanus Antitoxin Tetanus Toxoid Tubercnlin Typhoid and Paratyphoid Vaccine TYllhus Vaccine Ul!nltered No~ Human Plasma.' Microscope X-Ray Film 12 X 10 X-Ray Apparatus Centrifuge Lamps for Operation Sterilizer Apparatus Forceps Scissors Operating Table Injection Syringe Injection Needle Dental Equipment Handpiece Forceps Acrylic Resin Impression Material Dental Cement Dental Wax Porcelain Tooth and Acrylic Resin Tooth Absorbent Cetton Cauze
Sodium-p-Am~osalici1ate
I I I
I
34,416 Billion I.U. 37,566 kg. 9, 868 II 1, 408 II 366 " 1,429 Billion I.U. 278,631 kg_ 1,689,008 " 107,970 . " 27, 997 " 81, 412 " 77, 072 0 83, 269 0 54, 737 " 195,994 " 1,227,362 0 259,511 " 4,204 831 I. 27,117,800 doses 676 t. 7,789 .Il, r.. i 117 0 ,. .4,923."0. ... 28 .. :i0, 546, 800 doses': 679 1. '.". 0 5,398 H 10,336 689 27,397 'I 27,600 pieces 1,331,000 dozens 9,200 pieces 35,000 8,900 132,500 828,000 409,000 21,000 12,000,000 46,750,000 20,400 70,000 43,000 23,000 kg. 22,000 27,000 20,700 "\ 22,900,000 pieces
"
~
"
,,~·t
"
" "
" " " " " " " " " " " " " "
39,037,709 pound 112,854,000 meter
I
J
26. Major Research & Training Institutes in Public Health The Institute of Public Health The Institute of Public Health was estallished in Tokyo by the donation of the Rockefeller Foundation, and commenced its wOlk in March, 1938, under the management of the Ministry of Heslth and
-37 Welfare for the purpose of training public health personnel. 10 regular courses and 13 short courses have been offered and the graduaies of those courses totaled 8,154 lip '·to July, 1957, the mlj.>city of them being in governmental service, both national and local, actively puticipating in the health progr· amme of different field3. Thcf Institute is also extending its service to the' Japanese-speaking foreign health personnel for their post·graduate work in recent years.
The National Institute of Nutrition The National Institute of Nutrition was founded in Sept. 1920, in Tokyo. The Institute makes investigation and research on the nutrition of food in Japan or eating habit of the people. It also performs
as~ay and analysis of enriched food.
The National Institute of Health The National Instituie of Health was founded in Tokyo in May, 1947, for the purpose of giving scientific background to public health administration. Its main tasks are in assaying biological preparations, and in carrying out the study in the field of applied researches which have direct bearing on public health programme of the Government. The.impnrtance of the Institute has increased much as it was desi![nated as the various WHO Regional Centers such as on influenza and poliomyeliiis. The present are ~orking. or~anization
consists of twelve departments and one section, and over 400 persons
The National Institute of Leprosy The National Institute of Leprosy was established in July, 1950, in Tokyo far the purpooe of research work on prophylactics and treatment of leprosy. The main activities are as follows: (1) Studies on the culture of leprae bacilli and the inoculation in animals. (2) Studies 0 I
serum
reaction in leprosy. (3) Histopathological studies in the function of form tion of hum ID leprous info ection. (4) Stadies on improvement and synthesis of agents aglinst leprosy, and the omervatbn for reading the anti·leprous effect. (5) Studies on the metabolism in leprosy patients.
The National Institute of Hospital Administration The National Institute of Hospital Administration was established in June, 1949, in Tokyo to carry out the following works. (1)
The education of the hospital administrator. (3)
(2)
The survey and study on the hospital
administration. tion.
The collection of materials and the c:)Dsulhtbn ablut the h!l8pital admini ..tra·
The National Hygienie Laboratories The laboratories at Tokyo and Osaka are conducting the following: (except biologicals and antibiotics), devices, cosmetics and food. blishing their test standards. (4) (3) (1)
Test of all drugs necessary for esta-
(2)
R~earche3
Research and guidance in the cultivation of medicinal plants.
Other tests and researches necessary from the anitary point of view.
The National Institute of Mental Health The National Institu!e of Menta~ H~th
was founded
~n
1952 in Chiba. as
~
rese'rch and training
center in mental health. The IlllItitute
con~ists
of the Departments of Psychology, Physiology and Mo-
rphology, Eugenics, Child Psychiatry, and Sociology, and its staff includes psychiatrists, psychologists, and sociologists. For the purpose of clinical work and investigation, the Institute has opened the "mental hygiene clinic" in its building to deal with the adults and children suffering from mental disor· ders, and has been closely associated with the Konodai Natonal Hospital, which is adjacent to the Institute.
-38 Or~anized training course has not been provided yet because of the present financial difficulty, but
a number of voluntary trainees have been lJuided and instructed by the professional staff of the Institute. The .Institute'lS Library has received a great deal of financial assistance from the W. H. O. in purchasing the books and other publications on mental health.
'lf1. Public Assistance & Soeial Insurances For the reference of are shown below. rea~
some of the statistical data on public assistance and social insurances
Table 37. Nnmber of Persons received Public Assistance and Amount of Payments.
(1950-1956)
Year 1950 1951 1952 1953 1954 1955 1956
I I
Annual Total Amount of Payment Tho....d Yea
I
Monthly Average No. of Persons Amount of Payment received Payment
I
IDO_dY..
14,090,868 21,933,363 28,858,015 34,863,637 37,181,231 42,571,156 41,308,749
2,050,050 2,033,085 ·2,066,835 1,933,480 1,886,540 1,928,410 1 825,009
i
i
1,166,739 1,827,780 2,404,835 2,905,303 3,098,436 3,547,596 3 442--,-396
Fig. 10. Recipients and Payments under Public Assistance.
Billion Yen 5 '
Number of Retipieftts
oJan
195 I JCl~ 1952
k
1953 ~A 1954 ~ 1955
"
.Lm
1956
o
AIRount of Payment
-39 The following table shows a :bird-eye view of all kind of social insurances, giving some informtion about the concerned laws with their dates of promulgation. responsible agencies, the insurer and the
,_ 1
insured people, etc. Table 38. CI8ssification of Social Insurances. Law - - ""nate , Res~'Ministry
..
-1--' 'j---
Insurer
Insured
Ministry I ,Welfare Pent:: Insurance : 194~- j,,' --I I-I . Unemployment Insurance 1947 : Ministry of Labor : Law 1
H:lt..h Insur.a ....nce La,W
-·1.19~2·1
Health & Welfare
--I-Gover~ment, Union Government 1
"
--I --I
Employees in the working place (compulsory or voluntary)
j
INati~nal :
--_.--
Workmen~-pensation Accident Insurance Com· Law Seamen's Insurance Law
1'1947 "1'.. , ,., ____ ",. 1
,,'-1; I,' I "
Public Mu-I' 194-8' M'- '-t- f F' tual Aid Association Law 1 Inls ry 0 lnance
Servi~~-
;
1939
HealM!h. & Welfare Inlstry
Seamen
M'utual Aid -+I--Gov--ernment Association e:nployees
!__ . I '1
r
'-I~th & welf~~--I-Seif-0>verrmii'-.n_-i I. Other---· National Health insura~ce-ILaw '1938 Ministry Union! Other persons besides BodIes those insured Health Insuran~ Law ior-'-'-'I'9~'3' , 1 I Daily workers Daily Workers__ . () " I Government Mutual Aid Association Law for the Teachers and Wor- 1953 kers of Private Scho Is
I
" - MinIstry ~-.' .of
1
Edu('atlon
I
i 1954 \ - - ' '1' " Officials of cities, , . Vil!age OffIcials . I ,Agency towns and. v._i_llages_' I Mutual Aid Association Law-I- - . - ' - - - .. _-." - - - - - . . . - - - ~ for in the 11956 1 Ministry of Finance Employees in the 1 . PublIc Enterp~~s _ _ . _ _ _ _ _ _ _ _ ..._ _ . _ _ _......!..._p_u_bl_ic_e.~_erprises.
Mf!~ih~~itf.~:;~o:~rw
Lo~l Aut~nomy
Mutual Aid AssoCiation'i
Teachers and workers schools of private
. "
t~e Employ~
II'
"
I
In following table, figures in "Coverage" and in "Pension" refers the data as of March.
Table 39. Health Insurance Managed by Government. I . Fiscal 1 Year - -Coverage . - , - - . ' Benefit - - ---- - - - - -.. (in kind) I
I I
1._ _ , _ _Ce8
Wp~ing ~ Insured Thouoani
No. of ''T.No.
. ~ . ·_..--Others Cases : Amount . -L_ _ _ _ Cases__ :_Amoun.t.~.~_-1 Amount_,______i_ _ _ _ _ . II
0~1~ -=~ Med~ill~C.are Thouoand' Million Yen!
~.or. Primary Insure,U_ .!~: Depen~n~ .. Thouoand'
'-'-=-'1
Thouoa1
Million Yenl
Thouoaudl
Million Yenl
1946 I 86 2. 270 1, 462 119 450 1947 93 2, 484 2, 715; 402 650 1948 I 129 3, 279 4, 128,' 2, 754 1, 581 1949 141 3,268', 8,491 7,227 6, 163 1950 157 3, 580 10, 150' 8, 638 8, 407 1651 175 4,018 12,398 10,766 10,831 1952 193 4, 399 ,. 14,995 15, 284 13, 220 1953 224 4,988 17,869 20,585 15,669 1954 236 4,941' 20,928 27,900 17; 605 1955 244 5,242 22,589 30,345 18,623 1956 .L_.2~J ~~, 991_ .~, ~ ._1_33. 32L_21, 3~ ....._
I
25. 382' 42 65 603 233 473 892 957 1,985 1,404 2, 521 2, 553 1, 434 3, 453 3,421 1,564 I 4,329 4,791 1,733 5,473 6,058 1,886 6,656 7,211 2,043 8,068 7,609 2,111 8,553 .. 8, 62'1:-' _2, 125_i,!,353
-40 -
Table 40. Health Insurance Managed Association.
I Fiscal Year
~-~~--
I I
Coverage ~
-
-
Benefit
-
I f~1!-: ~:~ hon 627 695 775 761 759 779 820 873 894 907 924
I
I--For ,Cases
Pri~~:t;:-!I~(inFl~:::-=---~-otIller~~=-: L Amount Milil.;n Yenl
--------J I
Cases
I Amount!
1-- 1946 - HH7 19~8
I -I
1949 1 I 1950 1951 1552 1953 1554 : 1955 i 19561) '1
2,088 2, 287 2,670 2, 827 2,950 3,036 3,105 3,314 3,220 3,313 3,516
ThoulaDdl
..• 4, 771 7,313' 10, 989 12,131 12,830 13,461 14,707 16,021 16,591 18, 165 i
- ThoUlIlIldl
I I
103, 472 I 2,691 6, 624 'I 7,977 8,892 10,761 13,292 17,252 17,837 18, 843
I
... 23 ' 2, 692 156 -I 4,160 - 777 8, 521 1 2,355 11,280 3,054 12,669 - 3,441 14,732 4,734 17,655 6,177 19,159 7,187 20,740 7,720 23,051 _8, 485 -I
Thouaandl Million Yen
I
I
Thou~Ddl MlllioD Yen I 91, I, 632 499 1,896 1,483 4,015 4,102 6,789 5,133 7,575 6,569 8,686 8,172 8,804 9,309 9,157 10,619 9,625 10,553 9, 73~_ _!O, 43~_:
I
Note:
1)
Figures for Benefit are estimate.
Table 41. Health Insurance for Daily Workers. --senefit' - - - - _ .._~~rage - - - - Medical-Care(iIi kind)---- --:---'-~Ot~h~e-r8 Fiscal No. of For Pri Year Insured Cases I (estimates) --Cases ----;
Thouoand
1953 563 1954 573 1955 670 -~---.- 748
Thou.udi
m8~7n~ -I" ~nef~t~i MiIli0'2;enl ThOioDdl- Million :en - 23 ~_;__
Tho~.":",~llion Yen 21 52 77
Amoun~
794 1,422 1,759
904 2, 050 ~
391 641 938 _
I
12 30 _.~ _ _ _4_6,_,_i__
241 372
Table 42. Welfare Pension Insurance.
Fi~- -:'-~Cov~o.- of
- ---1Year 1946
i I 1949 149 5,738 ' 1950 167 6,113 1951 186 6,613 1952 205 7, 034 1953 239 7, 790 , 1954 254' 7,883 1955 265 8, '(.27 -1.!!5_6____ ~8_5_,_~J72
~~!~
Working place, -ThoouaDd - I 94
'1-- --Pensi~- Benjfit LUmp-8UiIl"-.- Ins~~~;:_or Pe"'i~--r-xmount-~--Cues- J Amount Thouoandl Thoueend!
I
!
i~~
4,543
~:~~~
11.3
I
I
32.8 49.0 70.4 95.8: 119. 2 I 132.5 163.4 191.8,
i~:~
I I I
Mi1lioD Yen!
Thou....d
Million Yeo
394 ' 87 330 724 97 770 1,293 95 1,281 I, 917 99 1,806 2, 483 117 2, 616 3,446 163 2,719 4, 340 207 2,716 I 3,127, _ _ _ _ 19.!L.,, ___ 2~...J
1~~ I I I
8
617
~~~
118
i~:
-
Table 43. Unemployment Insurance. -" --( , CoVeragel ) - ' - - , ' - - -----senefit l ) Fiscal Year I--No. of Working 1 N -f I -ed----Weeks - P--=-d'__ ' _ _ , _ , ~aces ,0. 0 nsur Unemployed , __ : _Amount ,a_l_
!
--1--- I
'--I J i
1948 1949
I I'
Thoulaad
~
139 154 '208 230
~,
1952 1953,
I
m m
I
ThoDllllld
Thoumd-
Mlllioa Yen_
~~ ~ru
5,486 5,703
790 10,854 ~m
~rul
~m, ~~'
385 9,170
I
1956 261 Note! 1) Excluding daily laborers.
~ ~
I
~ ~
8, 987
~m &~
6,849 7,695
14,931 16,153 13.421
~~I ~~
20,669 25;404
,, _ _ 24. 362:-
~~I .~
-41-
1--- --I,' , Fiscal Year
Table 44. Workmen's Accident Compensation Insurance.
._-..
Coverage
Benefit-----··
No. P{a!orking-- -I-No.-of insu""re ..... d_+.-_ _ _ Cases_ _ ..-,--. -
1- -1948 1949
-T~;nf 278 i.
--....
.1
'-Am-o-u-n-t-P-ai-d--
I
~7d 6,969
~7d 1,204
~~~:-D 5,512
1953 1954
t!i~' Ordinary Insurance. '---'-~~e
~~g
I'
I
~~~~. _1_. __ ..__ ;~_I_. I
454 491 .
i: ~~
__ ~g; ~~. _,
9,363 9,679
1,572. 1,721
t!t~ ~; ~~~
__.__. ~~; ~~~.___ ___ ._..._ 'I
13,928 16,111
~~: ~H
Table 45. Seamen's Insurance. (II)
1 Fiscal Year 'I;' ._H_·
,ShiPowners :oner , I
i No: of
I i - unt
1-- Pens!on_1 Lons-term Benefit .HJ _ _ Short-te!_m Bene~. - - -·'1 ; HLump-Sum I Medical Care (in kind) Others._ , No. of ~ I I IFor PriJ.D8.l'Y1 For Depen. I Insured pNeo~if AIIlO" C AIIlO" Insured "dant i Case ,AmOo' ases : ,unt
_J_ . H=:":.
._B~~iefit::':'_~-=-:-.
"
., ThoUi8n~d Thou ....d' ThoU., Million' Thou- I Million
I , · I
1946
I
1949 5. 3 1241 15 83 1950 5. 8, 1241 16 139 1951 ' 6.71 141 18 168 1952 1 7.3 144, 19 205 1953 7.9 154', 201 244 1954 'I 8. O~ 162 211 467 1955 8.1 165 22 519 . L .._1956 _ _ .. _~ _ _ 1!!~! ~ _ _ _ _ • _ _ _ _
~~~
I ~: gl I
,1.
~ 1~~'
~
~
~
~
I
ICases'lAIIlO" ~
ThoU~
,unt
Million I Thou- I-Million! ThOu- 1Million'l ~ ~ ~ .~ .~
I
'A' Cases, mOo ; ,unt i
s: t " un
' "
~~' 1~ ~: ~
7
4
5. 51
10
111 4911 464 4. 51 63 154, 1. 4 82 5~ 486 257 2.5' 1 6 5= 36~ 1. 91 132 726 6 47 2.3 189 770'1 783 574 1. 81 192 901 1; 032, 681' 1. 4: 20 1,006, 1, 115 7~1 .1~:U 1,05S: 1,1_~~. 1 H _ _ _ . . _ __
~ ~. 1~~1
71
-
-
5! 57! 85 116 173 220 272 321
353,
56 61 68 82: 80' 1121 135, 139
~~. ~~i
71
31
216 288 3591 505 6141 785. 898' 9481
(b)
Unemployment Insurance. • _ _ ._ •
_ _ _ _ _• _ _ •
Coverage Fiscal Year . - . - - ._- - . : No. of Ship-owners No. of Insured
I
- -... Cases
1·-
.- ' -
_. -Thouaandl--'
-"'Thouaarur-'
-=-_.CA~~~ Thouaand
Benefit
II
Million Yen
1947 1948 1949 1950 1951 1952 1953 1954 1955 1956
1.9! 3.8 4.3 4.6 5.3 5.6 5.9 6.0 6.0 6.2
79 103 92 88 97 92 93 93 93 103
!
5 73 200
4
145 137 139 132 107 90
95 290 255
265 303 292
241
224
Table 46. National Public Service Mutual Aid Association.
i ( -
195~' 1952 1953 1954 1955 1956
-42 Table 47. National Health Insurance. Coverage
Fiscal Year
No. of Unions
I I'
No.
0;- -. - .I C
I
Benefit
Medical
eare.
Others
I .~78
_ _ _--;-__
..- ~mount-~I· aBeS I _ Amount _ _______ ___ _ _ _ _ ..L.. Cases Thou....d Million Yen I Thouoand Thouoandl Million Yenl Insured
I
1952 4,990 23,089 1953 5, 131; 24, 906 1954 3,669' 26,633 :;,:19=55::"'-----L .. __3, 1701~8, 7!.L, _ 1 Note: Figures for 1956 are not available yet.
29,271 34, 147 41,231 49, 158,1 .
18,134 23,7341 31,g08 ___ 37, 388
542 604 .~01_
259 341[
-.' .