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l

WORLD HEALTH ORGANISATION HONDIALE DE LA SANT~ ORGANIZATION

REG IONAL COMMrr'l'EE

Eleventh Session :t.t:I.nila 12-17 August 1960

Agenda Item 8

REGIONAL OFFICE FOR THE WESTERN PACIFIC

BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL

P.O. Box. 2932, MANILA

18 August 1960

ORIGINAL: ENGLISH

BRlEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGREBS OF THEm HEALTH ACTIVITlES

Attached are brief reports received from the following governments

in the Region on the progress of their health activities:

AustraJ.ia Brunei China (Taiwan) Fiji Guam Hong Kong

*Japa.n lecao lelaya. Netherlands New Guinea North Borneo Papua and New Guinea Philippines Singapore Timor Trust Territory of the Pacific Islands Viet Nam

* Available in English only.

...

AUSTRALIA.

In addition to the attached report of the Forty Ninth Session of the National Health and ~iedical Research Council, the Government of Australia has submitted a copy of the ItReport of the D~rector General of Health" for the period 1 July 1956 -30 June 1958.

Representatives wishing to review this report are referred to the Enquiry Desk.

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NATIONAL HEALTH AND MEDICAL RESEARCH C(lulTCIL

FORTY NINTH SESSION, MkY 1960

CCJI4:ONWEllTIrH 1959

Immigration !1edical Service - Annual Report 1959

The Department continued to conduct the Hospitals o'f the Immigration Medical Service in Migrant Reception Centres controlled by the Department of Immigration.

Six hospitals with 348 beds, cots and bassinettes were in use at the beginning of the period under review. The bed complement was reduced to 281 at the end of the year •.

The migrant intake decreased during 1959. In January 4 789 were accalllloda ted in the various Centres, whereas in December the number was 3 414 • •

No babies were born in the Centre Hospitals, but 11.4 were born, in local hospitals, to Centre residents.

A total of 3 552 in-patients were hospitalised for a total of 21 923 bed days. 59 097 out-patient treatments were given and a totalo! 838 infectious cases were treated, either as in or out-patients. 3 581 immunizations were effected.

SUrgery was carried out in four Centres where 111 minor operations took place.

gUARAIiTIliE 1959

1st January 1959 to 31st December, 1959

The Quarantine Service authorised under the Quarantine Act 1908-1950 was maintained during the year ended 31st December, 1959.

There were no cases of quarantinable cliGet.::w dincovt;rcd by Quarantine examinations during 1959.

Cases of non-quarantinable infectious diseases continued to arrive regularly on passenger vessels from Europe. The figures for the year were _

Chicken pox 73 German measles 1 Infectious

Hepatitis 1 Influenza 4 Measles 143 HorbUli 10 Mumps 21 PolioJl\Yelitis 1 Rubella 2 Scarlet Fever 3 Syphilis 2 Varicella 7

268

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Membership

REVIEW OF PUBLIC HEAI1I'H DEVEIDPNENT DURING 1959

International - The World Health Organisation

During the year, Colombia and the Republic of Guinea were admitted as members. There are now 87 Hember states and :3 Associate Members.

Constitution

There are three organos of 'YlHO - the World Health Assembly, the Executive Board, and the Secretariat. World Health Assemblies are held annually, where decisions are taken on policy programme and budget. The twelfth Assembly was held in Geneva in 1959. The Executive Board, a third of which is elected each year, consists of eighteen persons, and it meets twice a year. The Australian representative on the Board is Dr. A.J. Metoal.1'e.

Regions of the World Health Organisation

There is a central Secretariat, and smaller regional staffs far each of the six regions. Australia belongs to the Western Pacifio region, the headquarters of' which a re in Manila. Countries of the region meet annually and consider regional programme and budgets for subw.ission to the subsequent meeting of the World Health Assembly., The last meeting ot the Western Pacific Region took place in Taipei in September, 1959.

Australia was represented at this meeting by Dr. G. M. Redshaw.

Financing of International Health Projects

The regular budget of WHO is decided by the Assembly, the member nations contributing on a fixed scale. Other funds available to vlHO are the Malaria Eradication Special Account, United Nations Technical Assistance Funds and Other Extra-budgetary Furlds. The sources of such other extra­budgetary :funds include the United nations Children'sFund and the Pan American Health Organization.

The estimated eJq>enditure under these headings in 1959 is as follows:-

Regular Budget ~uuaria Eradication Account Technical Assistance Other Extra-budgetar,y funds

Total

~ 15 482 000 4 238 000 4 991 000

22 477 000

!jp 47 188 000

/Field Projects •••

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Field Proj cts

During 1959 Expert Committees met on addiction producing drugs, biological standardisation, cancer, insecticides, leprosy, mental health, organisation of medical care, public health administration, rabies, radia­tion, specifications for phannaceutical preparations, non-proprietary names, tuberculosis, venereal infections and treponematoses, food additives, milk hl'giene, teacher preparation for health.education. The Committee on International quarantine and the Advisory Canmittee on medical research also met.

Malarial Eradication Programme

WHO during the year gave considerable emphasis to malarial eradica­tion campaigns in an endeavour to encourage countries to eradicate the diseu as speedily as possible before the mosquito vector becomes resist­ant to the new insecticides.

During 1959 eradication was in progress in 61 countries, pre­eradication in 9 countries and pilot projects in 14 countries.

CCH1ONWEAI:rH 1959 IEGISIATIal

The National Health Act was amended in 1959 so as to increase Canmonweal th medical beneli t tor maj or surgery and certain other medical services. As a result of this legislation, the maxillllll1 combined Govermnant and fund benelit . payable tor a major operation is now £60 by comparison with the Jrevious max1DUlIl of £:30.

The pharmaceutical benefits provisions of the National Health Act were also amended so as to extend co~iderably the list of drugs which IftB¥

be pr scribed under the scheme and at the same time to provide tor a charge of 5/- to be paid by the patient to chemist tor each prescription received.

A minor amendment was also made to the Thera~utio Substances Act so as to provide that, in future, amendments to the British Pharmacopoeia will not take elfect for the purposes of the Therapeutic Substances legis­lation until such time as a date is fixed by the Minister by proclamation in the Gazette.

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BRUIEI

Report on the FrogI' ss of Health Activities during 196C*

1 A GENERAL SURVEY

There has been a stea~ development in most branches of the health work conducted within the state of Brunei where well-established facilities and modern aspects have been added to meet the clearly defined needs of the people.

The rapid develO}Dent in the government, education, comrmmications and buildings throughout the state have been going on hand in hand with the development of environmental health services designed to provide the basic conditions of health¥ living.

The rural health services are being improved tremendously with the vigorous support of fund and staff in an endeavour to slash down the high infant mortality rate in the State. The improved rural health services have shown reflection in the vital statistics. The activities of the maternal and child health clinics have been expanded in 1959.

There is an acceleration in the development of buUding, equipment and staffing. ReDDVat10n and re-equipping of less modern bU'jJd 1ngs are cont1 .. nuing with the object of providing a higher stamard of working cond1t1ons for staff and the patients.

Two IIII1lti-m1lJ.1on dollar hospi tala are being planned for the state. More health clinics have been cons tructed for the rural areas. HabU and static dispensaries are being increased.

In the field of communicable diseases vaccination against po~eliti8 is a welcomed duty following the recent epidemic of poliolYW'el1t1s in th State.

A vigorous campaign against tuberculosis, using mass miniature radio­graphy has been prosecuted since 1959.

Malaria has been almost entirely eliminated in 1959, -there being only 66 cases in the whole State.

2 S<l4E SPECIAL -FEATURES

2.1 Population

The estimated population in 1959 was 85 227 persons, representing

/ an :1ncrease of •••

* Prepared by Dr. Abdul Wahab Bin Mohamed Arift, L.M.S., (S'par ), D.C.H., R.F.P.S. (Glas.), D.P.H. (London), L.N .. (Rotunda), MeR.S.H., F.R.I.P.H.H., State Medical Officer, Brunei.

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an increase of 4 950 on the total populaUon of SO 277 for 1958. This inorease was made up by a natural increase of population of 3 267 persons, and an excess of immigrants aver emigrants at 1 683 persons. The last census was taken in 1947 and revealed a countec;' population of 40 670 persons. A census is due to be ~en this year.

2.2 Vital statistics: Please refer sWl'llllary of vital statistics (See Annex 1).

2.3 Maternal and Child Care . The int'ant mortality rate of 93.29 for 1959 is stUl high. The neonatal

rate of 24.51 for the same year compares Wlfavourably with the figures of 16.5 for the United Kingdan.. Out of 4 201 babies born in the State 1 614 (3$) births were attended by unqualified ~1dwive8.

A.mcmg the ...". births conducted by Government midwives the baby was born b fore the arrival of the midwife. This was not due to the delay on the part of the m1d.wife, for whom in most cases there was departmental river aM land transport ava1l.able, both by day and night; it was due to the fa.mil3' of the mother who was to be confined deliberately refraining from summoning the midwife until the baby was born, so that traditional practices of midwifery might proceed without interference.

With a constant supervision during pregnancy, confinement and the period of lactation, the women and children attexxling the clinics conducted by six Health Sisters in the state have shown improved standard of health.

2.4 M1dwif~ Services

The midwitery training school has continued to turn out trained mid­wiv s and has enabled more nursing staff to qualify in midwifery.

The spreading network of midwives, and the improved attendance at ante-aatal clinics together with the generally improved standard of health in the state have between them brought about a most welcome reduction in th number of obstetric emergencies which are brought to the hospitals.

2.5 The School Health Services

These services have not been carried out satisfactorily through lack ot staff. However, the school dental services are expanding satisfactorily. A mobil dental clinic is reaqy to serve the school children.

2.6 Malnutrition

A valuable 1nDovation has been the distribution to pre-school children.

lot vitamin nAn •••

t vita.'1lin "A" fortified, flavoured skim-milk. This is an effort to attack the problem of malnutrition at an early ag , b fore irremediabl damage has been done to the child.

,2.7 Health Education

More attention is being paid to health education. Wax models are exhibited in every clinic. Health exhibitions are arranged periodical~.

2.8 Communicable Diseases

2.8.1 Poliomrelitis

In March 1960 an epidemic of infantUe poliom.relitis broke out in all parts of the State victimising 36 children of the State mostly those under 2 years. There was no death. The victims showed EPIII8 paralysis of the Itmbs and the recovery from the paralysis has been satisfactory. The epidemic was under control by the middle of May 1960, Vaccination agains. pollom.relltis among the children of susceptible age i1 being pursued Tige­rously using Quadrigen.

2.8.2 Tuberculosi!

The campaign against tuberculosis, which was started in 1958, has achieved a notable success. The object of this campaign was to detect and treat all cases of tuberculosis and also using preventive methods such as BCG vaccination and INH propqylaxis of selected groups of the population. The campaign has outgrown the organisation originallY planned for it. Mor staff are being recruited to pursue the campaign with increasing vigour,

MMR X-ray unit was used to intensify the campaign. Seventeen thousand two hundred eilhty-seven X-r~ examinations were conducted in 1959 (5 052 X-r~ examinations were done in 1957). Out of 11 695 X-r~ films, 483 new cases were discovered (i.e. 4%). .

In August 1959 a thoracio surgical team, which came from Australia performed 25 major operations and 30 minor operations in Brunei.

Allowances are paid to the families of tuberculosis patients who are temporarily unable to work. A SUlIl of $300 000 has been allocated to the Department for such tuberculosis allowances.

2.8.3 Influenza

/At the end of •••

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At the end of 1959 influenza reappeared in epidemic form and a total of 1 981 cases have been recorded.

The incidence of this disease has been reduced to insignificant proportions in Brunei 'as the result of the residual insecticide house spr~ing programme which has been in progress since 1953. There were only 66 cases of malaria in the State in 1959.

2.10 Medical and Health Facilities

No. of hospitals

No. of doctors

No. of static dispensaries

No. of riverine dispensaries

No. of travelling dispensavies

No. of maternity and child welfare centres

2.11 ExJ>enditure

• •• 3 (375 beds)

• •• 14 (no private doctor)

• •• 3 (Government)

... 3

••• 2

••• 9

The approved estimates for 1960 is ~ 089 130. A sum of ;:?1S 000 000 bas been earmarked for two new multi-million dollar hospitals for the State.

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StllWRY OF VITAL STATISTICS FOIl. 1959 (figures in trackets are for 1958)

Area of State of Brunei • • • • • • • • • • •

Population (Census 1947) · . . . . . . . .~ . . Population (Estimated ) · . . . . • • •

Births:-

Males

Females • • • • • • • • 2(117)

2 104 ~ • • • • • • • • • • •

Still births • • • • • • • • • • •

Live birth rate per 1 000 population

Still birth rate per 1 000 population

Deaths:-

Males

Females • • • • • • • • I. • • • · . . • •

Death rate per 1 000 population ••

• • • • • • •

• I. • • • • •

;20)

415) • • • • •

• • • • • • • •

Infant mortalHty rate (per 1 000 live births) • • • • • • • • e· • • • •

Neo-natal mortality rate (per 1 000 live births)

Maternal mortality •••

• • • • • • • • • • • • •

• • • • • • • • • • • • •

ANNEX 1

2 226 square milfl s

40 670

85 2'Z7 (80 277)

4 201

not availabl

50.78 (56 • .79)

not available

93S

11.30 (11.76)

(88,88)

(20.00)

not available

CHINA (TAIWAN)

Report on the Progress of Health Activities during the Fiscal Year 1960

1 T1JDillCULOSIS COrITROJJ PROJi:;CT

1.1 BCG vaccination

During the period 836 509 tuberculin tests were completed, of which 556 588 or 66.5% were initial tests ~ 588 ')13 or '70~4 of all children completing tuberculin tests were vaccinated with the locally produced liquid vaccine. 329 048 or 39.3% of the total completing tests, were pre-school children while the rest were school entrants and school leavers.

1.2 l':lass chest surveys

Using the mobile 70mm. photofluorographic units, 364 470 persons were examined during the year comprising 128 704 persons voluntarily joining in community surveys. Of the total number examined, 13 831 (3.8%) were suspect as having active tuberculosis. All suspect cases are referred to the health agencies for sputum examination and necessary treatment.

1.3 Mass sputum oxaminations I

Sputum exami:~tions are carried out free of charge at health stations, heaH.h centres, and at some special institutions. During the period, 111 678 persons received free sputum examinations on one or more occa­sions. Those persons found to have positive sputum are eligible for free drug treatment, and during the period, 6 797 new open cases were found and brought under treatment on free basis.

1.4 Domicilia~ chemotherapy

Domiciliary chemotherapy is provided thr(lugh the existing health agencies near the patients' residences with regular follow-up from the health centres and the tuberculosis centres. Under several progTammes, about 20 000 persons are currently receiving free drugs --- this includes school teachers, persons under aboriginal programme and some other

/special group •••

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special group.

2. MATERNAL AND CHlm HEALTH (MCH) PROJECT

2.1 Tra1n:tng

Training of the medical officers and nurses or l.1lidl-ri ves from health stations 1 and refresher training for private midwives have been continued. By trle end of June 1960 tL.e following personnel had been trained.

Medical officer Nurse or midwife Private midwife Health station covered by MCH

2.2 SUpervision:

1960 -59 48

162 47

1953 - 1960

301 427

1 021 332

Supervision of health stations covered by tlie MOM training is being carried out as follows:

Number of stations visited: Number of visits to these stations

1960

136

140

2.3 Institute of Maternal and Child Health

1953 - 1960

283

895

Institute of MCH was established in September 1959. A study am survey on the practical problems of NCH services in Taiwan are being carried out.

3 DIPHTImRJA-PERTUSSIS IHHUNIZATIOH PROJECT

3.1 New plan of Operations

Under the new Plan of Operations amended at the later part of 1958, childr n between 6 to 24 months of age are to be immunized with DP com­bined vaccine and Children bctl'leen 2 to 6 yoars of age nrc to be imrllWlized l-lith cllp!ltheria. toxoid.

3.2 Production of vaccine

During this fiscal year, 1 294 500 cc of diphtheria-pertussis

/combined vaccine •••

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combined vaccine and 799 000 cc of diphtheria toxoid have been produced and distributed to health centres. •

3.3 Hass immunization project

3.3.1 Diphtheria-pertussis combined vaccine immunization

This project has been carried out on a campaign basis with six months for each campaign since 1955. During the fiscal year 1960, the 6th and 7th campaigns have been completed and the 8th and 9th campaigns are being carried out. The numbers of children who have received DP combined vaccine during this fiscal year are tabled as follows:

N~ .of Nos. received NQ!I rueived No.ll received No!. receiv:d R mark cam:~J.gn 1.s" J.nJec't.J.on 21lU ~ec't.J.on 3ru J.nJec't.J.on oOvs't.er l.n.J. e s

6th 16 127 Continued from last FY

7th 25 594 46 757 76 275 4 006 ditto

8th 361 103 327 692 318 952 63 879 still going on

9th 188 233 122 016 57 823 29 185 ditto ",.., t.a.:J. . . J 01 . n .~g __ "_====~:u. ... ~g======::4~g~======.J..~d.2:1:========';[J:l..JQ=

Cumula.-tive 1.839 369 1 340 308 1 025 662 135 832 total

(Dec. 1954-June 1960)

Diphtheria toxoid immunization

All children between 2 to 6 years of age are to be immunized with diphtheria toxoid. This mass campaign started from October 1959 and is to be finished at the end of 1960. The numbers of children immunized under this campaign are as follows:

No received 1st injection

No received 2nd injection

680 079

4. VENEREhL DISEASE CONTROL PR.OJECT

Remarks

Oct. 1959 - June 1960

4.1 Case finding and treatment performed by health centres.

No. of STS (Nes cases) : 605 958 No. of reactors : 23 373 (3.~) No. of cases requiring treatment: 17 937 (3.0%) No. of cases transferred 668 No. of cases treated 14 778 (85.~)

Icase finding •••

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Case finding and treatment performed by hospitals.

No. of STS (New cases) : No. or reactors : No. of cases requiring treatment: No. of cases transferred : No. of cases treated :

37 79~ 3 866 (10.~) 2 132 (5.~)

78 486 (23.'7,1:)

Beside these new cases of STS collected by government health and medical B Nice units" 6 323 blood specimens which are collected by private doctors and are transferred to local laboratories through health stations are not included in the figure shown above.

There are 26 057 cases of periodic re-examination and 9 391 cases of post-treatment follow-up re-examination.

The cumulative total number of STS of new cases which were collected by government health and medical agencies from September 1953 when the project was initiated to June 1960 is 2 903 241.

7 088 cases of gonorrhea were diagnosed and treated" and 1 288 cases of other venereal d1senee 1f'~re t.re~ted at government service units.

4.2 The Venereal Disease Demonstration Clinic.

3 999 new cases were seen at the venereal disease Demonstration Cl1n1c and 677 cases (16.~) were diagnosed as syphilis" 598 cases as gonorrhea and 456 cases as other venereal disease. The re-visi ts numbered 6 268 times.

4.3 The Reference Laboratory

The major activities were as fo~ows:

(l) Routine performance of STS

New cases Re-test Ar1Jl1'

• • :

· •

8 961 (10.)% positive reactive) 9 723 (O.~ positive reactive) 1 993 (4.~ positive reactive)

(2) Training the local laboratory technicians •

. (3) Supervision of 22 local laboratories.

(4) Co-operation with the Venereal Disease Demonstration Clinic in making G-<} Culture.

(5) Continuously making tissue culture of treponema. pallidum in rabbit testicles. '

. (6) study on the contamination of cord-blood specimens.

(7) Making survey of private laboratories.

/Environmental •••

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5 ENVmONl'lENTAL SA.NITATION PROJECT

5.1 Demonstration of rural sanitation i%Provement

In addition to eleven rural Demonstration areas set up in the past three years, five other areas have been added this year. The, improved items are: (1) water supp~, (2) drainage, (3) latrine, (4) house I (5) pigpen, (6) re~lse disposal and (7) nightsoil disposal.

5 •. 2 Refuse and nightsoil disposal

Beside the 25-ton compost plant at Ping tung city, the compost plants at Lotung and TflitWlg" have been completed. The constr\lction of 2CO-ton compost plant in Kaohsiung City is under way and design ot 30-ton compost plant at Taoyuan Hsien has been completed.

5.3 Construction of rural water su~

(1) Continuing the previous proGramme, 693 public wells have been constructed in this year.

(2) With JCRRls cooperation, eight rural water supplies have been completed in this year.

5.4 Food Sanitation

(1) Food handler training has been conducted this year in four hsiens, with a total of 2 355 trainees.

(2) A total of 324 restaurants in Keelung City, Kaohsiung City Taipei City, Taoyuan Hsien and I-lan Hsien have been reviewed and inspected.

(3) Assist Kaohsiung UUllicipal Government to set up a modern abattoir.

(4) The construction of a demonstration market at Touliu of Yunlin Hsieh, has been started. The purpose of this is to improve the existing market practice and control in Taiwan •

5. 5 Environmental Sanitation Personnel Training

Four sanitarians classes, one water chemists class and one environ­mental radiation sanitation class have been completed now with a total of 121 graduates.

5.6 water Laboratory

(1) Established 12 water laboratories in 12 health centres respect­ive~ to examine the water samples from the public wells and individual water system of public school.

/(2) Strean pollution

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(2) stream pollution survey of Hsintien creek of Taipei City and Mellung river of Hualien Hsien hav been completed.

(3) A study on the use of anion detergent as a substitute for bUe salt in the confirmation test for B. Coli in water analysiS has been made.

5.7 Industrial H,ygiene

(1) 215 industrial plants have been reviewed in this year.

(2) A special investigation of liver disease and hydrogen sulfide pOisoning in Taiwan Alwninium plant has been made.

(3) Having' started the Coal Mine Sanitation'Demonstration in January' 1960, the works of survey, health education, stool eXamination and survey­of water source in the selected coal mine have been completed. The design of a water supply and. standard latrine has been approved, and its COl'US­truction will be started soon.

(4) A radiological fall out survey has been established and works efficiently.

(5) The air pollution investigation in Taipei and Kaohsiung Cities are going on steadily as routine work.

5. 8 Vector Control

(1) To pr.-omote the rodent control Programme for the purpose of demons­tration inLotung and Keelung. The rat poisoning campaign in Lotung had killed 14 663 rats in 520 families.

, (2) The study on the seasonal distribution of housetl,y in the pigperla has been continued and wUl be ended in December 1960.

(3) A. survey of intestinal helminths infection on rural demonstra­tion area at Chuch1 Village cf I-lan Hsien yielded the following results:

The total of infection rate was 86.7~. The rate for ascaris was 76.~ and hookworm 33.~.

(4) The laboratory study of the effect of the fertilizer, calcium cyanamide, on the hookworm ova in nightsoU has been made and it was found that there was hundred percent killing of OIia with ~ calciWll cyanamide after 24 hours.

6 MENTAL HEALTH PROJECT

6.1 Hospital Services

/ a) Kaohsiung •••

I .,..

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a) Kaohsiung Mental Hospital

The cons truction of the hospital has almost been completed, and the training programmes for the doctor, psychologist, nurses and nursing aids have been proceeding with the assistance and co~operation of the Dept. of Neurology and Psychiatry National Taiwan University Hospital (NTUH) and Taipei Children's Mental Health Centres. It is expected that the hospital will begin to accept the patient for admission around September 1960 as soon as the present training programmes are completed.

b) Taipei Children's Henta.l-:Hea:ltb 0efitre

The new modern building for the centre under lCA aid was completed a.t the end of February 1960. As the second step of the project, the cons­truction of the ward for 5 boys and 5 girls is in progress. On completion of the ward, which is expected to be around the end of 1960, together with better teaching facilities and more qualified personnel, the centre will be able adequately to meet with the rapidly increasing demands of commun1~ in child guidance work, t~ching and public education.

6.2 COmmunity Mental Health

a) Men tal Health Mobile Clinic

In order to integrate mental health into public health the mental health team, consisting of psychiatrists, psychologist and social workers from the Departlnent of Neurology and Psychiatry, National Taiwan University Hospital and the Taipei Children Mental Health Centre has regularly visited the Health Centre, Public Health Nurse Training Centre and Reformatory in Taoyuan every week to provide consultation service for the public health nurses and primary school teachers since August 1959. The results have clearly indicated the success of this project and necessity of extension to the other areas of the is land.

b) School Consultation for Mental Health Prohlems

A pilot study have been done with a close group of teachers in Fu-Bhin Primary School in Taipei City by the staff of the Department of Neurology and Psychiatry, NTUH and Taipei Children's Mental Health Centre last year.

7 TRACHOHA CONTROL PROJECT

7.1 Trachoma control among school-children

All the children entering to the primary schools were examined and two months treatment were applied to the positive cases. The first, second and third re~xamination had been carried out to the second, third and fourth graders previously found positive trachoma. All the sixth graders

Iwere re-examined ....

.• ~. ..... .

wer re-examined before leaving from the schools. The figures of the activities are as follows:

Result ot exam1na tion

No. of exam. *Conj. **Tr. Mo. treated

Category No. of Child Ho. % No. % No. % No.

New entrants 342 068 326 324 95.40 52 C112 15.96 71 563 21.93 123 635

School leavers 210 800 203 343 96.~ 25 578 12.58 43 510 21.40 69088

Re-eJCall1ination (positive cases treated last year):

2nd graders 116148 104098 89.63 16824 16.16

3m grader 58 947 54002 91.61 7796 14.44

4th graders 27848 25 787 92.60 :3 625 14.06

* Including conjunctivitie " doubtful trachoma. ** Including Tr I, II Be In stage.

7.2 Blanket treataent of the fa.mil.y contacta

34 447 33.cY1 51 271

21 722 40.22 29 518

11 699 45.37 15 324

%

37.89

33.98

49.25

54.66

59.43

During the period from July 1959 to June 1960, 308 954 persons were coa­pletaly treated.

7.3 . Refresher training of doctors, nurses and school teachers

One thousand tour hundred n1n6ty-three school teachers were trained on treatment method and dosage of ointment application; forty-one doctors and 332 nurses were trained on standardization of their techniques, diagnosis or reoord.

7.4 . Therapeutic Trials

. ~

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The new entrants to 40 primary schools in areas wi til high prevalence of trachoma were examined late in 1959 and cases diagnosed trachomatous sub- / 1

jected to a controlled study in an attempt to evaluate the relative merits of, the continuous 48 cl.a¥s, the continuous .60 cl.a¥s and the intermittent tiv da,ys a month (for six months), ophthalmic eye ointment application wice daily. The continuous treatment has been completed and the intermediate examination immediately after the completion of the course has been conducted. The intermittent treatment will be completed by the end of the first week of July. Due to the short time-interval, between the completion of the treat-ment and 8U1111lOl" leave,. only halt the number of children 10 this sroup will

/be examined •••

..~

•

• ••

1;' J

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be examined.

7.5 Epidemio10gica1"Studies

A stratified mu1ti-stage sample has been designed covering tile who1 island. The sample size is estimated to be approximate~ 40 000 individuals. S parate intensive sampling procedures have been developed for the three . groups presumably suffering the highest prevalence rate of trachone.: the fishing and salt minil1g communities and the aborigines. A provisional house­hold recording card has been designed to be subjected to a pilot study. Standardization of clinical criteria has been provisionally set aln field trials have been initiated.

8 MAIARIA ERADICATION PROJECT

8.1 Malaria case detection

A little mare than 760 000 bloodfilms were collected, and 122 positives (2 p.f., 78 E.:!. end 42 E:!!:.) including 60 with presence of gametocyt&s*among 698 423 smears so far examined. Only 17 positives were found in area I , 45 in area II" 31 in area III" none in area IV and 29 in area V; or 49 detected by mass blood survey in areas I & II, 7 by active fever case survey at area II III & V" 2 by clinic visitation" 18 by follow-up survey of cases and their associates" but as many as 40 by spontaneous reporting and 3 by other measures.

The 122 positives represent 105 individual cases distributed in 97 tamilies (93 with one case each, 2 with two cases each" 1 with three cases am 1 with more than three cases)" located in 88 sub-villages or 65 villages in 50 towns~P1 of 17 counties or cities. Of which" 53 were proved or unable to be disproved indigenous" 13 sporadic, 9 :tmuced, 5 imported from outsid Taiwan, 24 imported from known foci within the island and one unknown.

8.2 Malaria toci

An additional newly created focus of malaria transmission was detected around the end of 1959 involving nine groups of charcoal-burners temporarily s tt1ed in previously unsprayed area. Transmission of the disease in th four foci existing during the year was successfully interrupted by emergency spraying and mass drug treatment.

8.3 Radical treatment of cases confirmed

As many as 671 cases, including those confirmed so far during the year" and those treated with only amodiaguine or chloroquine during p::i e lious year underwent domiciliar,y treatment under strict supervision with combination of primaquine and chloroquine.

/8.4 Entomological •••

* Area I = active malaria foci, II = potentially malarious areas" ~ III • formerlY ~rendemic areas" IV • formerly meso- and hypo-endemic areas, i V = non-malarious ar as.

l~

- 10 -

8.4 Entomological vigilance

In the course of ,many years' house-spraying, Anopheles minimus, the sole and most effioient vector of malaria so far conf~ed has shown its predestined vulnerability to residual insecticide. In FY 1958 the first year following the withdrawal of spraying from large part of the formerly ~perendemic area, the species was found in 43 out of 169 townships in the endemic area. Routine collections at 132 fixed stations and non­routine surveys during the season of possible peak breeding of the species 'in ~as where there were no fixed stations demonstrated slow but steady come-back of A. minimus as regards both population density and geographical dlstribution.- The majority of spraying-discontinued townships still remain fr e from the species or have a density below that of precontrol d~s.

Tests on susceptibility of anopheline mosquitoes to DDT conducteQ in 1956 indicated 0.2(7.1: DIYr as LC50 for A. min1m.us and 2.45% for A. sinensis,. Up to date results showed 0.2~ DDT as tC50 for the former and 1375% tor the latter and conttr.med that the main vector was in general still very sens1tlv ·to DI1l'.

8.5 Residual-insecticide house-spr!ylng

The spr~1ng was applied on a limited scale, ~lY one. or twice in Area II and three times in Area I. Cumulative number of structures and population directlY covered by spraying was 55 822 and 4CT1 323 respective1¥'.

1-

,

~;

F I J I

Report on the Progress of Hea1thActivit1es

1 VITAL STATISTICS

The estimated population at the end of 1959 (derived from the 1956 census figures) was:-

Fijians •• • • • • • • 162 483

Indians • • • • • • 191 328

Others • • • • • • •• 33 835

The birth rate for the last three years has been:-

19;7. . 1958 1959 - -Fijians •••• • • • • 38.68 35.40 36.36

Indians •••• • • • • 44.73 44.52 46.46

Whole Population • • • • 41.12 39.57 41.07

The crude death rate for the last three "years has been:-

· 19~7 1958 1959 -Fijians • • • • • • • • 8.54 7.56 ?61

Indians • • • • • • • • 6.29 6.54 7.70 Whole Population • •• •• 7.34 6.90 ?44

The infant mortality rate for the last three years has beem-

1957 1958 1959 -Fijians ••••• .. • • 42.31 3fJ.?7 38.25

Indians ••••••• • 35.57 42.09 46.68

Whole Population" • • • 38.94 39.37 42.59

2 TUBERCUIOOIS COlll'ROL

The BCG campaign, which was commenced in 1958, but temporarily

/halted owing •••

- 2 -

halted owing to an outbreak of poliolD¥slltis, was re-commenced. Up to the end of 1959, a total of 50 373 persons received Heat tests, and ot thes 38 874 received BOG vaccination. Th:1.s campaign continues.

3 YAWS CAMPAIGN

The general follow-up of the 'WHO/UNICEF yaws campaign has been carried out by the medical department r s staff. A total of 82 cases were notified - a great improvement on previous years - and both the cases and their contacts were treated with pen1cUlin. The follow-up continues.

4 FIIARIASIS

The research conducted by H.M. Overseas Research Unit came to a conclusion during the year, and arrangements were made for following-up the results obtained.

The Fiji School of l-ledicine continued the training of assistant _dioal officers. Courses for assistant health inspeotors, pharmacists# laboratorr technicians and radiographers were also given. Continued assistance from WHO was received by the presenoe of & pilysiolo8f lecturer and a biology lecturer.

With the completion of the Nutfield Department of Social aad Pre­ventive Medicine, it was possible to increase this aspeot of training, and preparat10ns were made for the first post-graduate course 111 Public Health to caaence in March 1960 •.

An aspect ot training which proved very successful. was the series of week1.y broadcasts to assistant medical officers. The talks by specialist officers during these broadcasts were later mimeographed, and have proved very popular in other territories 111 the South Pacific.

6 DENTAL SliRVICE

A new dental centre was opened at Ba during the year. The mobile dental clinic completed its first year's work, and has p."OVed of great value to the school dental service in areas away from the fixed clinics.

7 FAMIz;r PWlBlIIG

A familJ' planning service was started during the year with the opening of five cl1D1cs. Sutticient experienoe baa been ga1ned to prove

/their value •••

1

;~ I

io ,.

-3-

their value, and the number of patients is increasing steadil"y.

8 mvmoNMSi~TAL liYGIEHE

Further efforts were made in +ne process of the integration of this aspect Qf public health work with the other duties of assistant medical officers, and some progress resulted.

9 CURATIVE SmVICES

The scope and extent of curative services continues to incr ase with the increasing population and with the raising of the standards of training of assistant medical officers.

A

GUAM

Report on the Progress of Health Activities

Fiscal Year - 1960

DIVISION OF ~JBLIC HEALTH

The year was notable because of the expansion and reorganization of the Public Health Division. Personnel were added to meet the demands of the Division. Dr. W.l'1. Peck 'l-TaS appointed Chief of the Division; Dr. Robert E. O'Connor was appointed Chief of Maternal and Child Health and Crippled Children's Services. Four nurses and a Chief Sanitarian were added to the Public Health Staff.

The Sanitation Section began an island-wide programme of paraSite elimination by means of intensive diagnostic procedures and treatment, as well as correcting sanitation. Health education and food inspection continued.

The Section of Tuberculosis Control acquired a mobile chest x-r~ machine. This will be used for island-wide survey in the fall.

The Section of Vital Statistics completed an intensive review of procedures and a study of infant and maternal mortality for the years 1956 to 1959.

The Section of Public Health Nursing increased its educational and nursing programme almost 20afo. This increase was shown by an immediate imprOVelllent in general health.

The l~ternal and Child Health Division began its activities in November 1959. Attendance at well-baby conferences increased over 300%. A drop of almost 30% was noted in morbidity and mortality of cnildr n 0-6 years. The immunization programme increased 250%. Plans were made for a comprehensive school health programme.

Crippled Children's Services began on December 1959. Since that date, 402 children were aided by the programme. A classification and survey of children with crippling defects was completed. Thirteen (13) children were sent to more specialized hospitals for care.

Three clinics were started iQ the villages for care of the aged. Th response was immediate; it is expected that hospitalization will drop.

• •

HONG KONG

Report on the Progress of Health Activities during 1959/1960

(statistical data refer -to the calendar year 1959)

1 INTRODUCTION

1.1 Public Health Administration

statutory responsibility for administering the services which safe­guard publj.c heal tl: in Hong Kong l:J..ts jointly v:i tL the Director of Uedical and Health Services, the Urban Council, tne District CO!1»llissioner, Hew Territories and the Commissioner of Labour. The Medical and Health Deoartment has the executive resool1sibility of providing the Government ho~pi tal and clinic services thr~ughout both urban and rural areas. In addition the epidemic and endemic disease control, maternal and child health, school health and port health services are maintained by the Departmen t.

The Urban Council, tP~ou~~ the Urban Services Department, is concerned with environmental sanitation, including food hygiene, in the urban areas of Hong l~ong and Kowloon and has recently taken over these functions from the District COIIIIlissioner, New Territories in respect of the larger towns in the Uew Territories. The Industrial Iiealth Section of the Labour Department is respol~ible for the assessment and control of occupational diseases, for accident prevention in work places, for tl~ medical aspects of workmen's compensation and for environmental health conditions in factories. Doctors from the liedical and Health Department are seconded to the Urban Services Department, to the Industrial Health Section, Police Department am to the Prisons Medical Service.

1.2 Finance

Recurrent expenditure on the services maintained by the Hedical and Health Department d.uring 1959-60 was estimated to be ~7 806 000. A further ~?l9 324 200 was disbursed as recurrent or special grants-in-aid to fJec1ical work maintained by welfare and missionary agencies.

Estima teo. capital expenditure on t<iedical and Health Department projects was ~pl8 706 200, in add.ition to this the Hong Kong Jockey Club during the year undertook to provide buildings to the value of 98 025 000, which when complete will be handed over to Government and maintained by the l>Iedical and Health Department.

The estimated recurrent expenditure, inclucling subventiolls, repr -sents 9.6~ of Government's total estimated recurrent expenditure. This does not include the expenditure on environmental sanitation by the

/Urban Services •••

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Urban Services Department.

2 PRO<:.RESS DURING 1959/1960

2.1 General Health

Against the background of overcrowding, a limited water supply and lack of adequate housing and modern sanitation the general level of health was remarkably well maintained, but the rising incidence of diph­theria and the enteric diseases gave cause for concern, particular~ as protective inoculations were widelY available, at no cost, to all who Bought them.

For the seventh year in succession there were no cases of the six quarantinable diseases which are the subject of control under Interna­tional Sanitary Regulations. OUtbreaks of cholera and smallpox in nearby countries on the main air and sea routes to Hong Kong made special vigilanc necessary. A.s smallpox was still pr'evalent in the nearby countries additional facilities for vaccination were made available and the response resulted in some 1 034 138 vaccinations being performed, as compared with S64 244 during 1958. For the fourth year in succession tho Colon1 was free of animal and human rabies.

Tub rculosia continued to be the major health problem, blt the results of the control measures applied were encouraging. Accidents inside and outsid the home continued to cause much disability, death and loss of working time. Education in the prevention of accidents, particular13 those due to fire and traffic was greatly intensified. The toll, however, re­ma1nedvery high on account of the density of the population, overcrowded living conditiOns and the phenomenal increase in vehicles.

2.2 Vital statistics

Until the population census has been taken in 1961 the .precise age structure ot the population will not be known. It is estimated, however, from data accumulated in surveys of limited scope, that one-third of the population is aged 14 years ar under and that there is a predominance of males in the young adult age groups. The estimated mid-year popula­tion was 2 857 000.

For the first time since recards were re-established after World War II there was a decline over the previous year both in the total number of births registered and in the birth rate. The natural in­areas of 84 329 persons was 1 741 less than for 1958 and the birth rate als declined to 36.6 per 1 000. The crude death rate of 7.1 per 1 000 was. again the lowest on record.

The Want mortality rate dropped to 48.3 per 1 000 liv births;

/tlI.e neonatal •••

-:3 -

the neonatal mortality rate was 21.3 per 1 000 live births and the still birth rate was 13.1 per 1 000 live births. There were only 77 maternal deaths and the lnaternal mortality rate further declined to 0.73 per 1 000 total births.

2.3 Communicable Diseases ruld Epidemiol~~

The total of 20 241 cases of l1:>tifiable diseases represented an increase of 7.~ over the 1958 total. The increase was due largely to a rise in the number of reported cases of diph~leria, enteric fever, bacil12ry d;,'sentery and tuberculosis. There wel'C fewer deaths, hmlever, from notifiable comnnmicab1e diseases, the total of 25~ being less by 173 than that for the previous year. There were fewer deaths from tuber­culosis, enteric fever and diphtheria.

2.4 Tuberculosis

Progress in control was encouraging during 1959 when the death rate per 100 000 fell to 76.2 compared with 83.8 in 1958. Deaths from th disease however still accounted for some 10), of all deaths register d in the Colony.

Vaccination with 'BCG was offered free am was particularly directed towards the new born of whom almost 60% received this protection in 1959.

Ambulatory chemotherapy of known cases was carried out by 3 fu1l­time and 6 part-time chest clinics; during the year over 20 000 cases were receiving continuous therapy involving some 1 400 000 attendances at these clinics.

One thousand eight-hundred and forty-six hospital beels were available for the medical and surgical treatment of tuberculosis.

2.5 Diphtheria

Though a considerable increase in the number of notified cases was r corded the case fatality rate fell by 3Q% to 5.6% compared to the figures for 1958.

"'!!~ Immuni~tion campaigns with APT produced only fairly satisfactory respol~es, a total of 207 700 persons receiving protection either by full or "booster" doses of toxoid.

2.6 Enteric Fevers

The case fatality rate was reduced to 3.~ in the 997 cases notified. Control measures during the year were intensified with inoculation and health education campaigns and the detection aild supervision of carriers.

/The majority of •••

-4-

The majaritq ot cases occurred in areas ot high population density associa­ted with lower standards at hygiene and sanitation.

2.7 Poli~litis

Sporadic cases ot pol~elitis were notified throughout the year am there was not the marl,ed seasonal increase during the summer months

which marked the previous years. A total of 86 cases was recorded ot which 57 occurred in Chinese children under 3 years ot age. There were 20 deaths.

A virus laboratory, tor the investigation of enteroviruses only at pr sent, was completed early in 1960.

2.8 Malaria

Despite one of the longest wet seasons on record the number of o&ses t malaria notified was onl.,Y 442, as against 659 during 1958. Hot1t1catiODS,

as usual, reached a peak during the last quarter at the year.

In the urban areas, consisting ot Hong Kong Island, Kowloon and New Kowloon and certain limited areas in the New TerritorieS, anti-larval operatiOns directed againet anopheline breeding were maintained cont1nuoualJ'. The major part of the New Territories, where the wet cultivation ot rice is practised, was not controlled.

There was a continuing influx of large numbers of infected individuals into the unprotected areas as a result of the traffic beween China and the New Territories. The nwnbers, estimated at one million persons annuall,y, mad surveillance as a quarantine measure impractical; nor was interruption ot transmission or eradication of malaria by either anti-adult or anti­larval measures yet a practicable proposition.

The cost of control by anti-larval methods was 37 cents (approximate­q tivepence-haltpenny) per capita per annWll.

Information on tests for insecticide resistance in adult mosquitoes and larvae was forwarded to the World Health Organisation.

2.9 Venereal Diseases

Qen rally speaking, the decline in the incidence of venereal diseasea continued with certain exceptions which were not significant in relation to the whole problem. There was an increase in the nuqiber of cases of pr1nll.l7 and secondary syphilis, and the figures for early latent syphilis also rose, though the llUJI'ber of cases ot late latent syphilis dropped considerably. The incidence of gonorrhoea remained the same J but surprisingly there vaa a decl'8ase. of some 160 cases of non-gonococcal urethritis; chancroid 111oi-d nce increased but ly.mpho-granuloma decreased considerablJ'.

/2 10 Leprosy •••

·f ... : ... I11 • ., ....... I11111"-""'."'" ------•.. ~"-'-" .

- 5 -

2.10 Leprosy

Two hundred ninety-seven new cases were diagnosed compared to 379 in 1958. One hundred thirty-eight infecticus cases were admitted to the Lepro­sarium at Hay Ling Chau.

A total of 2 732 cases of the disease was receiving treatment at out­patient clinics at the end of the year.

The use of diamino-diphenyl-sulphoxide for treatment of selected cases was discontinued and a clinical trial of "ditopha1" by inunction was introduced.

3 OTHER HEALTH SERVICES

3.1 The Haternal and Child Health Centres continued to increase their work. Antenatal attendances reached 61 891 and infants and toddler attendances totalled 327 898.

3~2 Midwife;y Services

Fifty-three government employed midwives operated from 23 centres and undertook 13 427 deliveries about 10% of which were domiciliary. Private midwives maintained 122 small maternity homes and delivered 34 496 babies during the year.

3.3 The Port Health Office carried out routine measures to prevent tPe importation of quarantinable disease by sea, air and land, rodent control" and h1"giene and sanitation of the dock and airport areas. With the incr as in air traffic and the speed of international air travel, greater vigilance is exercised by the Port Health Service.

4 HOSPITAIS AIID CLnrrCS

Total hospital beds available for all purposes numbered ? 702, an increase of 102 over the previous year's figures. The foundation stone of a new 1 320-bed hospital in Kowloon was laid in March 1959, and this is expected to be ready by the end of 1962.

Forty-two Government clinics and dispensaries throughout the Colony recorded a total of over 5 million attendances during the year, an increas of near~ 20% compared to 1958.

5 STAFF

Medical and auxiliary staff registered in Hong Kong at the end of

/the year was •••

-6-

the Tear was as follows.-

Registered i'fed1caJ, Personnel

Registered medical practitioners (excluding Government personnel) ••••••••••••••••••••• 691

Provisionally registered medical practitioners internes •• 70

Government medical officers •••••••••••••••••••••••••• 320

: f1j.fe~·· "Ii -.-

R gistered dentists (excluding Government ""-dental surgeons) ••••••••••••••••••••••••••••••••••••• 353

Government dental surgeons ••••••••••••••••••••••••••• 't1:I •

Registered pharmacists (excluding Government pharmacists) ••••••••••••••••••••••••••••••••••••••••• 68

Government pharmacists ••••••••••••••••••••••••••••••• 8

Registered. nurses (excluding Govel'llJ1ent nurses) •••••• 995

Government nurses ••••••••••••••••• -••••••••••••••••••• 1073

R gistered dressers (excluding Governraent dressers)... 10

Government dressers •••••••••••••••••••••••••••••••••• 137

Registered midwives (excluding Oovernnent midwives)... 970

Government midwives •••••••••••••••••••••••••••••••••• 161

A White Paper on "The Problem of Harcotic Drugs in Haag Kong" was pubJJ.shed in November 1959 and followed by a w1descale anti-narcotic drive includirll amending legislation to control the use of dangerous drugs.

· A' Brief, ,Report

on.

Public Health Administration

in Japan'

1960

•••••

With Pcrlment Informations on S!>::ial Welfare

and Insurance Program

Ministry of Health and Welfare Japanese Government

1 August 1960

f?i-

CONTENTS

Chapter Page 1. Organization of National Health Administration·· .. ······ ...................................... 1

2. Main Laws under the Jurisdiction of the Ministry of Health & Welfare .. · .... · .. ·· 3

3. Finance of the Ministry of Health & Welfare .... ·· .... · ........ · .... · .... · .. · .... ·· .. · .. · .. · .. · 4

4. Organization of Local Health Administration·· ...... ···· .. ·· .. ···· .. ············ .... · .... · .... · 5

5. Health Center································································································ 5

6. Population· . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . .. . . .. . . . . .. . . .. .. . . . . .. . . . .. . . . . . . . .. . . .. .. . . . . .. . . . . . . . . .. . . . . .. . . . .. 7

7. Vital Statistics···· .. ······················································································· .. · 9

8. Life Tables in Japan .......... ·· ...... · .... · .. · .. ·· .... · .......... · .. ··· .. ·· .... ·· .. · .. · .... · .............. 13

9. Deaths by Leading Causes· .. ·· .. · .... ·· .... · ...... · .. · .... · .. ·· .... · .. ·· .. · .. ·· .... ···· .... · .......... ·15

10. Maternal and Child Health .................. · ...... · .. · .... · .. ··· ...... · .. ·· .. · .. · ................ · .... ·18

11. Health Education ......................................................................................... ·20

12. Tuberculosis································································ .. ···················· .. ···········2O

13. Communicable Diseases· ...... · ........ · ........ · .. · .... ·· .. ···· .... ·· ...... ··· ...... · ...... · .... · ...... · .. 23

14. Port Quarantine .......................................................................................... ···26

15. Environmental Sanitation·················································································27

16. Water-Works and Sewage Treatment· .... ·· .. ·· .... ·· .. ····················· .. ·· .. · .... · .. ···· .. ···28

17. Food and Veterinary Sanitation .... ·· .... · .................... · .. ··· .. · .... ·· .... ·· .... · .. · .. · .... · .... 29

18. Nutrition· .. ·· .. ·· ...... · .. ·· .. · .......... · ........... ···.· .. · .. ··· ...... ··· ................... ·· .... ·· .... ·· .. 31

19. Dental Health ................................................................................................ 33

20. Mental Health· .................... ·· .. · .......... · .. · .. · .. · .. · .. · .. ······· .. ··· .. ··· .... ···· .. ····· .... ····· ·34

21. Care and Rehabilitation of the Physically Handicapped· ........ · .. · .... · .... · .... · ...... · .... 36

22. Radioactive Isotope and Peaceful Uses of Atomic Energy ...... · .... · ............ · .... · .... ··37

23. Occupational Health · .. ····· .. ········ .. ················· .. ·· .. ···· .. ··· .. ······· .. ···;······ .. · .. · .. · .. ···38

24. Hospitals and Clinics ...... · ................................................................................ 39

25. Medical Care Personnel ................................................................ · .. ···· .... ·· .... 40

26. Medical Care Statistical Survey·········· ...................................................... · .. ·· .. ·42

27. Pharmaceutical Affairs·· ........ ··· .. ·· .. ···· .... · .. · .. · .. ·· .... · ...... · .......... ·· .. ····· .. ·· .. ·· ...... ·44

28 Major Research and Training Institutes in Public Health Program···················· ·46

29. International Cooperation on Health Programs················· .. ···· .. · .. ······ .. ··· .. ·· .. ·· .. ··48

30, Public Assistance, Child Welfare and Social IuslJran.ces .. ·· .... · .. · .. · .. " " ............... .w

I

~ -1--1. Organization of National Health Administration

The chart below shows the organizational structure of the natIOnal health and welfare

administration in Japan as of 1 August 1960. The idea of close coordination among the

fields of preventive medicine, medical care, social welfare and social insurance is maintained.

The Public Health Bureau, Medical Affairs Bureau, and Pharmaceutical and Supply Bureau,

together with a part of the Children's Bureau and Social Affairs Bureau share responsibilities

on health administration in the field of preventive medicine, medical care, pharmaceutical

supplies, maternal and child health, and social health respectively. With the assistance of

statistical services rendered by the Health and Welfare Statistics Division of the Ministry,

these Bureaus direct the health programs by giving orders to the 46 local prefectural

governments. In May 1959, the Pension Bureau was newly established in the Ministry to

be in charge of pension programs for the general public. In April 1960, Sanitation

Facilities Section was established in the Environmental Sanitation Division, taking over

the work on insect and rodent control, disposal of nightsoil, trash and garbage, and sewage

treatment, some of which were previously carried out in the Environmental Sanitation

Section and Water-Works Section.

Minister's - Secretariat

-Personnel Affairs Section General Affairs Section Accounts Section Office of Personnel Welfare Officer I-

I Office of Program Evaluation and Planning Office of Chief Liaison Officer, International Affairs

-Office of Councillor for Scientific and Technical Affairs

Health & Welfare - Statistics Division

I National Parks '- Division

I

-General Affairs and Field Staff Reports and Analysis Section

- Tabulation Section -Mechanical Counting Section

_I-Administration Section :-Planning Section

-Planning Section Nutrition Section Health Center Section

Section

-Public Health Bureau Tuberculosis Prevention Section Communicable Disease Control Section Mental Health Section

'f;r -Quarantine Section

-Environmental Sanitation Section Environmental Sanitation Facilities Section

Sanitation Division Water-Works Section Food Sanitation Section

-Veterinary Sanitation Section

I-General Affairs Section

Medical Affairs Section I Management Section

-Medical Affairs Bureau : National Hospital Section ----------.1 ~::!c:g:~~:~a;~~t~: Section

Office of Nursing Affairs i-Office of Dental Affairs (Con'd)

-2-

I-Enterprise Section

Pharmaceutical Affairs Section

-Pharmaceutical & S~pply Bureau-----Drug Manufacturing Section Inspection Section Biologics and Antibiotics Section

-Narcotic Section

-Social Affairs Bureau----------:

-General Affairs Section Protection Section Rehabilitation Section Life Improvement Section

-Institution Section

I-Planning Section

Child Protection Section -Children's Bureaul---------- Maternal & Child Welfare Section

-Maternal & Child Health Section

-General Affairs Section Health Insurance Section

-Insurance Bureau-----------National Health Insurance Section Welfare Pension Insurance Section Seamen's Insurance Section Medical Care Section

-Pension Bureau ----

-Acturial & Statitstical Affairs Section

'

-General Affairs Section National Pension Section

---- Security Pension Section -Office of Planning and Acturial Affairs

.-General Affairs Section Bereaved's Families Relief Section Demobilization Section First Pension Affairs Section

-Repatriation Bureau -----------[ First Allowance Screening Section Second Pension Affairs Section

I Second Allowance Screening Section

-Unrepatriates Investigation Division

-Institute of Population Problems National Institute of Public Health National Institute of Nutrition National Institute of Health National Institute of Leprosy Research Port Quarantine Offices National Hospitals National Sanatoria National Institute of Hospital Administration

Affiliated Institutions- National Institute of Hygienic Sciences" National Home for the Blind

Local Branch

National Rehabilitation Center for the Handicapped

National Home for the Juvenile Training and Education

National Institute of Mental Health National Home for Mentally Retarded Children

-National Rehabilitation Center for the Deaf and Mute

I-Regional Branch Offices of Medical Affairs

Offices- Regional Narcotic Investigators' Offices I-Local Repatriation Offices

Bureau

(Note "This institute was formerly called as the National Hygienic Laboratory in its English name i nQw it~ En~li8h n(l.lII~ il! «<hanged ~Q the present Qne)

\ ,

-,..-;'l-

.~/

,j;

~ 'fi

, .,

';7-

',/

~-

-3-

2. Main Laws under the Jurisdiction of the Ministry of Health & Welfare

1. Laws on Administration:

2.

3.

Health Center Law (1947)

Ministry of Health & Welfare Establishment Law (1949) Laws on Preventive Medicine:

Communicable Disease Prevenion Law (1897)

Leprosy Prevention Law (1907)

Trachoma Prevention Law (1919)

Parasitosis Prevention Law (1931)

Venereal Disease Prevention Law (1948)

Preventive Vaccination Law (1948)

Rabies Prevention Law (1950)

Quarantine Law (1951)

Tuberculosis Control Law (1951)

Laws on Environmental Sanitation:

National Park Law (1931)

Friseur Artists Law (1947)

Food Sanitation Law (1947)

Entertainment Facilities Law (1948) Public Bath House Law (1948)

Hotel Business Law (1948)

Law Relating to Processing Plants of Dead Animals and Others (1948)

Law Regarding Graveyards, Burial and Others (1948)

Cleaning Business Law (1950)

Slaughter House Law (1953) Wastes Disposal Law (1954)

Beauty Artists Law (1957)

Water-Works Law (1957) Law Concerning Improved Management of Business Dealing with Sanitation (1957)

Sewerages Law (1958)

Law for Cooks (1958)

4. Laws on Health Statistics:

Regulations Pertaining to Report of Still-birth (1946) Ordinance Regarding Vital Statistics (1946)

5. Other Laws on Public Health: Nutritionists Law (1948)

Eugenics and Maternal Protection Law (1948)

Mental Health Law (1950)

Nutrition Improvement Law (1952)

Law for Loan of Scholarship for Studies in Public Health (1957)

Law for Health Protection and Medical Security for A-Bomb Explosion Sufferers (1957)

Law for Health Laboratory Technicians (1958)

6. Laws on Medical Care:

Law for Masseurs, Acupuncturists, Moxa-cauterists and Judo·orthopaedists (1947)

Medical Service Law (1948)

Medical Practitioners Law (1948)

Dentists Law (1948)

Dental Hygienists Law (1948)

Public Health Nurse, Midwife and Nurse Law (1948)

Law for Dissection and Preservation of Dead Body (1949)

Law for Medical X-Ray Technicians (1951)

Law for Dental Technique (1955)

Cornea Transplantation Law (1958)

Law for Medical Care Facilities Finance Corporation (1960)

7. Laws on Pharmaceutical Affairs:

Pharmaceutical Affairs Law (1948)

Law for the Control of Poisonous and Powerful Agents (1950)

Awakening Drug Control Law (1951)

Narcotic Control Law (1953)

Taima (Marihuana) Control Law (1953)

Opium Law (1954)

Bleeding and Blood Donor Supply Service Control Law (1956)

Pharmacists Law (1960)

8. Laws on Social Welfare: Child Welfare Law (1947)

Disaster Relief Law (1947)

Welfare Commissioners Law (1948)

Consumers' Livelihood Cooperative Association Law (1948)

Law for the Welfare of Disabled Persons (1949)

Daily Life Security Law (1950)

Social Welfare Service Law (1951)

Law for the Loan etc. of Welfare Funds for Mothers and Children (1952)

Law for the Welfare of Mentally Retarded Persons (1960)

9. Laws on Social Insurance:

Health Insurance Law (1922)

National Health Insurance Law (1938)

Seamens' Insurance Law (1939)

Welfare Pension Insurance Law (1941)

Social Insurance Medical Fee Payment Fund Law (1948)

Health Insurance Law for Daily Workers (1953)

National Pension Law (1959)

3. Finance of the Ministry of Health & Welfare

Annual budget of the Ministry is shown in Table 1 in the next page as compared with the total national government expenditures. Our fiscal year covers the period from

April 1 through March 31 the following year.

,,-;;"'--

-;< ..

Fiscal Year

1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960

Table 1. Budgetary Expenditure of the Ministry as Compared with the Total Expenditures of All National Government Agencies.

-5-

Expenditure of All Natioual Government

Expenditure of Ministry of Health & Welfare

Agencies Amount I Percentage

Million Yen Million Yen % 2, 709 60 2.2 3,288 187 5.7 4,494 188 4.2 5,860 171 2.9 8,134 187 2.3 8,276 289 3.5

12,552 466 3.7 19,872 672 3.4 21,496 1, 928 9.0

119,087 7,561 6.4 214,256 13,413 6.3 473,146 24,773 5.2 741, 047 28,182 3.8 661, 406 35,314 5.3 793,707 46,018 5.8 925,536 72,128 7.8

1, 027,251 73,176 7.1 999,880 83,816 8.4

1,013,300 84,613 8.4 1,034,900 90,317 8. 7 1,137,465 101,462 8.9 1,312,131 107,258 8.2 1,419,248 130,543 9.2 1,569,675 164,715 10.5

4. Organization of Local Health Administration

Each prefectural government and larger municipal government have their own health

departments in order to carry out their health programs in compliance with the national

policies and programs directed by the Ministry of Health & Welfare. These prefectural and municipal governments . divide their political boundaries into

several" health center districts," and the local health center is established in each one of

those districts. At present there are 790 health centers in this country.

For the reason of geographical conditions, most of the health centers have their

branch health units within their health center districts. Further details on the health

center are described in the following chapter.

5. Health Center

Outline The first health center in Japan was establishd in Tokyo in 1935. Then, in the

following year, the Health Center Law was enacted and the lO-year program for health center construction was started.

There were 306 health centers in 1943, which increased in number to 770 in 1944

due to the amalgamation of all governmental health consultation agencies. The health

center in pre-war days had only health consulation in tuberculosis control, and maternal and child health, and maintenance of health of pre-service men. However, in 1947, public health program in this country was reorganized. Accordingly, the Health Center Law

was revised, and the new health center program started.

-6-

Legal Basis According to the Health Center Law, the local government is required to establish

the health center, and the national government is responsible to share the cost. 46 pre­

fectures, and 30 municipalities, designated by the Cabinet Order, have their health centers.

The director of health center is specIfied to be the medical doctor by law.

The character of health center is defined by law primarily as the community health

service agency, and secondarily as the administrative supervising agency based on the

power, delegated by the governor or mayor.

Number, Standard Scale and Organization

As of the end of 1959 fiscal year, there were 790 active health centers in Japan, and

construction of 4 new health centers is carrying on at this time.

According to the changing need for public health administration, the organizational

standard of health center was re-examined in 1959. It was decided then that former standards

as A, B, C were to be abolished and new standard would be effected from 1960 fiscal year.

Now all health centers are classified by the size of area of health center district and

its population. 4 basic types have been settled, i. e., urban health center, rural health , center, urban-rural health center, and health center with small population in big area.

These are abbreviated as U,R, UR,L type. As the exceptional type health center, the health

center with small population in small area has been classified S type. Depending upon new

classification, there are 174 U type health centers, 73 UR type health centers, 428 R type

health centers, 106 L type health centerS and 13 S type health centers. In addition to the

typing, establishment of branch health center will be approved from the next fiscal year.

It was reported that the total number of health center personnel subsidized under

health center grants was 21,225. This includes 1,814 physicians, 122 dentists, 5,427 public

health nurses, 798 nutritionists, 1,377 X-ray technicians, 1,004 laboratory technicians as

the main technical personnel. In addition to them, there are also 1,626 food inspectors,

1,352 sanitary inspectors, 807 veterinarians for rabies and slaughtering control. Therefore,

25,009 staff are now working in all the health centers. It is about 31.4 per health center

and 26.7 per 100,000 population.

Function and Program

The function and program of health center include activities in the different fields.

Thus, all community health programs have been integrated into the health center activities

Followings are the basic functions defined by the 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; control of venereal disease

and other communicable diseases; maternal and child health; dental hygiene,

and other local health program as required, such as endemic disease control, etc.

The Table 2 in the next page shows the main health center activities during the year 1959.

As the routine program, the health consultation clinic, well baby conference, mass

chest survey, home visit, community health education, inspection and field supervision on sanitary operation are carried out.

The health education is integrated .intoevery phase of routine process.

-y-,

Table 2. Main Health Center Activities in 1959 (Jan.~Dec.)

Total number of health consultation session

X-ray examination

Laboratory examination

Health education session

Prenatal examination

Inside of health center At district

TB control; 35 mm & 6x6 large film

Crippled children; 6 x 6 large film

Bacteriological culture for acute notifiable C. O. Wasserman test Precipitation test (VORL) TB bacilli culture TB fastness test

Total number of educational session

Actual number of examinee Total number of examinee

Well baby examination (under 12 M) Actual number "f examinee Total number of examinee

Total number of dental examination Total number of nutrition consultation Immunization Carrier investigation in dysentery control Parasite examination Total number of food establishments inspected by food inspector Total labour used for environmental sanitation field work

(person-days) Total number of household visited by public health nurse

Actual number Accumulated number

-7-

321. 383 28.299

27.394.422 1. 630. 211

70.106 59.176

3.106.148 131. 854 809.772 208.761

83.909

159.959

349.149 457.431

1. 296.371 2.438.648 1. 083. 231 1.289.352 8.730.361 3,759.579 6.414.732 2.775.810

197.637

979.222 1. 499. 577

Tuberculosis control. the insect and rodent control, and birth control are highlight

programs. Recently, the community oganization process has been extensively developed

for performance of all health programs.

Finance

The health center is financed by local and national government. The item of national

subsidy is divided into 2 categories; that is health center subsidy based on Health Center

Law and program subsidy based on the respective legislation concerned. According to the

Health Center Law, national government is responsible to share the cost of health center

expenditure both recurrent and non-recurrent.

When the health center is newly established. the national government shares one half

of the expenditure for construction and necessary equipments. and it also subsidizes one

third of running expenses. Local government pays the rest of expenses. In 1960 fiscal year,

total amount of national health center subsidy is 2,252 million yen. It was studied that

total cost of health center expenditure in 1958 was about 13,174 million yen. The percen­

tage of personnel expenses was about 59%.

6. Population

Table 3 in the next page shows the estimated population of Japan, as of Oct. 1, 1959,

based on the latest census taken on October 1, 1955 and vital changes thereafter. (Including

-8-

Japanese nationals and foreigners in Japan).

Age Groups

All Ages 0 1 2 3 4

O~ 4 5~ 9 1O~14 15~19

20~24 25~29 30~34 35~39

40~44 45~4.9 50~54 55~59

60~64 65~69 70~74 75~79

80~84 85~

0~14 15~64 65~

15~49

Table 3. Population by Age Groups and Sex for All Japan. (Estimated on Oct. 1, 1959)

I Total I Male I I

Thousand

I Thousand

92,971 45,707 1.616 828 1. 570 803 1. 529 783 1. 614 826 1. 676 858 8,005 4,099 9,702 4,952

10,398 5,298 9,634 4,874 8,497 4,262 8,171 4,072 7,350 3,623 5,813 2,602

4,884 2,237 4,786 2,255 -4,087 1. 999 3,589 1,784

2,845 1,398 2,107 997 1. 510 667

939 368

474 166 179 53

28,105 14,350 59,657 29,106 5,209 2,251

Female

Thousand 47,264

788 766 746 788 818

3,905 4,750 5,100 4,760 4,235 4,099 3,727 3,211 2,648 2,530 2,088 1. 805 1, 447 1. 110

843 571 308 126

13,756 30,551

2,957 25,211

Fig. 1. Population by Age Groups in 1958. (Estimated on Oct. 1, 1958)

Male

I J 1

I J ,

1 r I

I I r

I 1

5.000

) .~ Aije 85 &. OVer aN4 'l5~'l

'10-'14 fi5-6'1 60-64 r5-rq 5(}-v54 45-49 40-44 3 3

I

5-3'1 0~J4

25'ZQ 10-24-5-lq

~ 0-14 5-.9 0-4 o 0

-,

TiIOl.[sand fer.sonl:i

, 1

Female

-, , 1

I , 1 ,

I , I

, •

'i

-9-

7. Vital Statistics

The nation-wide vital statistics survey has been carried out every year constantly

since 1899 in Japan. However, no reliable data were available for the years from 1944 to

1946 due to the confusion resulted from the last World War.

Birth

Annual Change of Birth Rate. Between 1900 and 1919, the birth rate in Japan was

between 39 and 35 per 1,000 population, but it rapidly rose to 36.2 in 1920, which was the

highest rate since 1900. But after this peak, it had been declining as the years advanced

until in 1939 when the rate reached the lowest point (26.6), and from about 1940 on it

Fig. 2. Annual Change of Live Birth Rate.

(per 1.000 population)

10

0= l.O t::> ~ t::> '-0 <:> lO c:::, ll) <::) lO c:::, <::) -- '" C'.J <T:> m ~ ""'" l.O lO 0':>Cl:)0) ~ a;, 0':> 0':> 0':> 0':> 0'>

~yt?r ..... -... --- --- --- --- --- -... ---

<:> '0 a;, .....

again started to rise. This increase is

considered to be due to the fact that the

policy of the government at that time

was to encourage the increase of birth.

During 3 years from 1944 to 1946, the

birth rate seems to have been consider­

ably low judged from various reasons,

although no accurate data were avail­

able because of the confusion caused by

war.

The birth rate in 1947 was abnor­

mally high, showing 34.3, but such an

extraordinary rise of birth rate is con­

sidered to be due to the repatriation

and 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

reached 17.2 in 1957, the lowest level in the vital record of Japan. This rapid decrease of

the birth rate may be attributable to the decrease of the marriage, the wide spread of

contraceptive measures, and the prevalence of artificially induced abortions. However, the

rate for _~958 'Yas 18:9, which showed a slight increase from the previous year. It decreased slightly again in 1959, represen­

ting 17.4. (Refer Table 5 and Fig. 2).

Death

Annual Change of Death Rate. From

1900 to about 1930, the death rate was

around 20 per 1,000 population every

year, excepting the high rates of 27.3

and 25.4 in 1918 and 1920 because of the

world-wide pandemic of influenza. It kept

decreasing in the following years untill

it became just 16 in 1941 despite the

war. After the war, the number of deaths

in 1948 was under 1 million and the

Fig. 3. Annual Change of Death Rate.

(per 1,000 population)

10 ~~ 5

0t::> lo eo. ~ t::> LO CO> lr) eo. 1O eo. lo eo. eo. eo. --- N N ~ 0') "'I- "'I- l..t) lr) ..., ") 0:> 0:> 0) 0, 0) 0:> C') 0:> 0:> 0:> a;, 0:>

--- --- --- ..... ~- --- --- --- --- --- --- '- -----Yeal'

- 10.-

Table 4. Vital Statistic8 in Japan. (Number).

(19DO~ 1959)

I Infant Neo-natal Mater· I Year Population Live

Deaths Natural Deaths Deaths nal Still- I Mar- . Births Increase (under (under births riages DIvorces

1 yr.) 28 days) Deaths I __

11900 43.847. 000 1, 420., 534 910.,744 I 509,790. 220.,211 112,259 6,20.0. 137,987 346,528 63,828

190.5 46,620.,0.0.0. 1. 452, 770. 1, 0.0.4, 661 448,10.9 220.,450. 10.3,382 6,185 142,0.92 350.,898 60.,0.61 \

1910. 49,184,0.0.0. 1,712,857 1,0.64,234 648,623 276,136 126,910. 6,228 157,392 441, 222 59,432 11 49,852,0.0.0. 1. 747, 80.3 1,0.43,90.6 70.3,897 276,798 127,30.2 6,192 155,319 433,117 58,0.67 12 50.,577,0.0.0. 1. 737,674 1,0.37,0.16 700,658 268,0.25 123,90.2 5, 770. 147,545 430.,422 59,143 13 51,30.5,0.0.0. 1. 757, 441 1,0.27,257 730.,184 267,281 124,213 5,90.0. 147, 769 431,287 59,536 14 52,0.39,00.0. 1,80.8,40.2 1,10.1,815 70.6,587 286,678 125,745 6,418 145,692 452,932 59,992

1915 52,752,0.0.0. 1,799,326 1,0.93,793 70.5,533 288,634 125,337 6,452 141, 30.1 445,210. 59,943 16 53,496,0.0.0. 1.80.4,822 1,187,832 616,990. 30.7,283 132,0.0.0. 6,337 139,998 433,680. 60.,254 17 54,134,0.0.0. 1. 812, 413 1, 199, 669 612,744 313,872 139,717 6,368 140.,328 447,970. 55,812 18 54,739,0.0.0. 1. 791,992 1,493,162 298,830. 337,919 145, 710. 6,812 142,50.7 50.0.,580. 56,474 19 55,0.33,0.0.0. 1. 778,685 1,281,965 496,720. 30.3,20.2 129,0.72 5,910. 132,939 480.,136 56,812

1920. 55,963,0.53 2,0.25,564 1, 422, 0.96 60.3,468 335,613 139,681 7,158 144,0.38 546,20.7 55,511 21 56,665,90.0. 1,990.,876 1,288,570. 70.2,30.6 335,143 136,342 7,181 138,30.1 519,217 53,40.2 22 57,390.,100 1, 969, 314 1,286,941 682,373 327,60.4 132,856 6,565 132,244 515,916 53,0.53 23 58,119,20.0. 2,0.43,297 1,332,485 710.,812 333,930. 135,50.4 6,897 133,863 512,689 51, 212 24 58,875,600. 1, 998, 520. 1,254,946 743,574 312,267 126,385 6,273 125,839 513,130. 51, 770.

1925 59,736,822 2,0.86,0.91 1, 210., 70.6 875,385 297,0.0.8 121. 238 6,30.9 124,40.3 521. 438 51,687 26 60.,740.,900 2,10.4,40.5 1, 160.,734 943,671 289,275 119,642 5, 721 124,0.38 50.2,847 50.,119 27 61,659,30.0. 2,0.60.,737 1,214,323 846,414 292.0.84 116.240. 5, 765 116,922 487.850. 50.,626 28 62,595,30.0. 2,135,852 1,236.711 899,141 293,881 115,682 5,997 120.,191 499,555 49.119 29 63,460.,600 2,0.77,0.26 1.261,228 815. 798 295,178 U5.DD9 5,867 116,971 497,410. 51, 222

1930. 64,450.,005 2,0.85.10.1 1,170.,867 914,234 258,70.3 10.4.101 5,681 117,730. 50.6,674 51, 259 31 65,457,50.0. 2,10.2,784 1,240.,891 861, 893 276.584 108.812 5.667 U6,5D9 496,574 50.,60.9 32 66,433,80.0. 2,182,742 1,175,344 1,0.0.7.398 256,50.5 10.4,573 5,530. 119,579 515,270. 51,437 33 67,431.600 2,121. 253 1, 193, 987 927,266 257,251 10.2,887 5,763 114,138 486.0.58 49,282 34 68,30.8.90.0. 2,0.43,783 1.234,684 80.9,0.99 255,0.63 10.3,40.8 5, 70.9 113,0.43 512,654 48,610.

1935 69,254,148 2,190.,70.4 1,161,936 1,0.28,768 233,70.6 97.994 5,698 115,593 556,730. 48,528 36 70.,113,600. 2,101,969 1.230.,278 871,691 245,357 101,043 5,384 111,056 549,116 46,167 37 70.,630..40.0. 2,180.,734 1,20.7,899 972,835 230.,70.1 95,465 5,444 111,485 674,50.0. 46,500. 38 71,0.12,600 1,928,321 1,259,805 668,5H 220,695 89,159 4,877 99,528 538,831 44,656 39 71,379,700 1,90.1,573 1,268,760. 632,813 20.2,0.18 84.20.4 4,818 98,349 554,321 45,970.

1940. 71,933,0.0.0. 2,115,867 1,186,595 929,272 190.,50.9 81,869 5,0.70. 10.2,0.34 666,575 48,556 41 71,680.,20.0. 2,277,283 1,149,559 1,127,724 191, 420. 77,829 4,929 10.3,40.0. 791, 625 49,424 42 72,384,50.0. 2,233,660 1,166,630. 1,0.67,0.30. 190.,897 76,177 4,586 95,448 679,0.44 46,268 43 72,883,10.0. 2,253,535 1,219,0.73 1,0.34,462 195,219 76,588 4,542 92,889 743,842 49,70.5 44 73,0.64,30.0. ... ... ... . .. ... ... .. . ... .. .

1945 71,998,10.0. ... .... ... ... .. . ... ... ... ... 46 73,114,10.0. .. , ... ... ... .. . ... .. . ... ... 47 78,10.1,473 2,678,792 1,138,238 1,540.,554 20.5,360. 83,0.47 4,488 123,837 934,170. 79,551 48 80.,002,500 2,681. 624 950.,610. 1,731. 0.14 165,40.6 72,90.7 4,437 143,963 953,999 79,0.32 49 81,772,600. 2,696,638 945,444 1,751,194 168.467 71,485 . 4,60.1 192,677 842,170. 82,575

1950. 83,199,637 2,337,50.7 90.4,876 1. 432,631 140.,515 64,142 4,117 216,974 715,0.81 83,689 51 84,573,0.0.0. 2,137,689 838,998 1,298,691 122,869' 58,686 3,691 217,231 671,90.5 82,331 52 85,852,0.0.0. 2,0.0.5,162 765,0.68 1,240.,0.94 99,114 51.0.15 3,417 20.3,824 676,995 79,021 53 87,0.33,0.0.0. 1.868,0.40. 772,547 1, 0.95, 493 91. 424 47.580. 3,373 193.274 682,0.77 75,255 54 88,293,000. 1. 769, 580. 721.491 1.0.48.0.89 78,944 42,726 3,362 187.119 697,80.9 76,759

1955 89,275,529 1,730.,692 693,523 1,0.37.169 68,80.1 38.646 3,0.95 183,265 714,861 75,267 56 90.,259,0.0.0. 1,665,278 724,460. 940.,818 67,691 38,232 2,838 179,0.0.7 715,934 72,0.40. 57 91,0.88,0.0.0. 1,566,713 752,445 814,268 62,678 33,847 2,677 176,353 773,362 71,651 58 92,0.0.7,000. 1, 653,469 684,189 969,280. 57,0.52 32,237 2,560. 185,148 826,90.2 74,0.0.4 59 92,971,0.0.0. 1, 622, 819 689,578 933,241 54, 754 30.,20.9 2,359 181, 795 847,137 72,158

Note: Figures for 1959 are provisional.

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Table 5. Vital Statistics in Japan. (Rates) (1900~1959)

Live Death Natural Infant Nee-natal Maternal Still-birth Marriage Divorce Birth Increase Death Death Death Rate Rate Rate Rate Rate Rate Rate Rate Rate

Year Per 10.000 Per 1.000 Per 1,000 Per 1,000 Per 1,000 Per 1,000 Per 1,000 total births lota I births Per 1,000 Per 1,000 popu- popu· pepu- live live (live birth (live birth POPU- POPU-

I lation lation lation births births and and lation lation 11m-birth) 8Iill-birth)

I

1900 32.4 20.8 11. 6 155.0 79.0 39.8 88.5 7.9 1. 46

1905 31. 2 21. 6 9.6 151. 7 71. 2 38.8 89.1 7.5 1. 29

1910 34.8 21. 6 13.2 161. 2 74.1 33.3 84.2 9.0 1. 21 11 35.1 20.9 14.1 158.4 72.8 32.5 81. 6 8. 7 1. 16 12 34.4 20.5 13.9 154.2 71. 3 30.6 78.3 8.5 1. 17 13 34.3 20.0 14.2 152.1 70.7 31.0 77.6 8.4 1.16 14 34.8 21. 2 13.6 158.5 69.5 32.8 74.6 8.7 1.15

1915 34.1 20.7 13.4 160.4 69.7 33.2 72.8 8.4 1. 14 16 33.7 22.2 11.5 170.3 73.1 32.6 72.0 8.1 1.13 17 33.5 22.2 11. 3 173.2 77.1 32.6 71. 9 8.3 1.03 18 32.7 27.3 5.5 188.6 81. 3 35.2 73.7 9.1 1. 03 19 32.3 23.3 9.0 170.5 72.6 30.9 69.5 8.7 1. 03

1920 36.2 25.4 10.8 165.7 69.0 33.0 66.4 9.8 0.99 21 35.1 22. 7 12.4 168.3 68.5 33. 7 65.0 9.2 0.94 22 34.3 22.4 11. 9 166.4 67.5 31. 2 62.9 9.0 0.92 23 35.2 22.9 12.2 163.4 66.3 31. 7 61. 5 8.8 0.88 24 33.9 21. 3 12.6 156.2 63.2 29.5 59.2 8.7 0.88

1925 34.9 20.3 14.7 142.4 58.1 28.5 56.3 8.7 0.87 26 34.6 19.1 15.5 137.5 56.9 25.7 55.7 8.3 0.83 27 33.4 19.7 13.7 141. 7 56.4 26.5 53.7 7.9 0.82 28 34.1 19.8 14.4 137.6 54.2 26.6 53.3 8.0 0.78 29 32.7 19.9 12.9 142.1 55.4 26.7 53.3 7.8 0.81

1930 32.4 18.2 14.2 124.1 49.9 25.8 53.4 7.9 0.80 31 32.1 19.0 13.2 131. 5 51. 7 25.5 52.5 7.6 O. 77 32 32.9 17.7 15.2 117.5 47.9 24.0 51. 9 7.8 0.77 33 31. 5 17.7 13.8 121. 3 48.5 25.8 51.1 7.2 0.73 34 29.9 18.3 11.8 124.8 50.6 26.5 52.4 7.5 0.71

1935 31. 6 16.8 14.9 106.7 44.7 24.7 50.1 8.0 0.70 36 30.0 17.5 12.4 116.7 48.1 24.3 50.2 7.8 0.66 37 30.9 17.1 13.8 105.8 43.8 23.7 48.6 9.5 0.66 38 27.2 17.7 9.4 114.4 46.2 24. 1 49.1 7.6 0.63 39 26.6 17.8 8.9 106.2 44.3 24.1 49.2 7.8 0.64

1940 29.4 16.5 12.9 90.0 38. 7 22.9 46.0 9.3 0.68 41 31. 8 16.0 15.7 84.1 34.2 20.7 43.4 11. 0 0.69 42 30.9 16.1 14.7 85.5 34.1 19.7 41. 0 9.4 0.64 43 30.9 16. 7 14.2 86~6 33.8 19.4 39.6 10.2 0.68 44 ... ... '" ... ... ... ... ... .. .

1945 ... '" '" ... ... ... ... ... ... 46 ... ... '" ... ... ... .. . ... ... 47 . 34.3 14.6 19.7 76. 7 31. 0 16.0 44.2 12.0 1. 02 48 33.5 11. 9 21. 6 61. 7 27.2 15.7 50.9 11. 9 0.99 49 33.0 11. 6 21. 4 62.5 26.5 15.9 66.7 10.3 1. 01

1950 28.1 10.9 17.2 60.1 27.4 16.1 84.9 8.6 1.01 51 25.3 9.9 15.4 57.5 27.5 15. 7 92.2 7.9 0.97 52 23.4 8.9 14.4 49.4 25.4 15.5 92.3 7.9 0.92 53 21. 5 8.9 12.6 48.9 25.5 16.4 93.8 7.8 0.86 54 20.0 8.2 11. 9 44.6 24.1 16.7 95.6 7.9 0.87

1955 19.4 7.8 11. 6 39.8 22.3 16.2 95.8 8.0 0.84 56 18.4 8.0 10.4 40.6 23.0 15.4 97.1 7.9 0.80 57 17.2 8.3 8.9 40.0 21. 6 15.4 101. 2 8.5 0.79 58 18.0 7.4 10.5 34.5 19.5 13.1 100.7 9.0 0.80 59 17.5 7.4 10.0 33. 7 18.6 13.1 100.7 9.1 0.78

. . Note. FIgures for 1959 are proVIsIOnal .

- 12 ~

death rate decreased to 11.9, in spite of the fact that considerable incidences of deaths

must have occurred during and directly after the war period. It further continued to decrease as low as to 7.8 in 1955. It was 8.0 in 1956, and 8.3 in 1957, respectively,

showing a slight increase. However, it again decreased to 7.4 in 1958, and was kept on ~---

the same level in 1959, showing the lowest rate ever recorded in the history of vital

statistics in our country. Although there may be many factors causing this decrease,

it is safe to say that it is mainly because of the progress of medical science and public

health. The recent increase is considered to be due to the world-wide prevalence of

influenza. (Refer Table 5 and Fig. 3).

Infant Death Annual Change of Infant Death

Rate. The changes of infant death rate

have been almost the same as the death

rates for all ages. Before 1925, the

infant death rate was around 160 per 1,000 live births every year excepting

the high rate in 1918 (188.6) due to the

pandemic of influenza. It declined in the

course of the years after 1925 until it

became below 100 in 1940, and reached

39.8 in 1955. Both in 1956 and 1957,

it did not decrease, but in 1958, it

remarkably decreased to 34.5, and further -..,. to 33.7 in 1959. (Refer Table 5 and

Fig. 4).

~atertUl] Death

zoo

Fig. 4. Annual Change of Infant Death Rate.

(Per 1,000 live hirths)

so ~

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

-Yeal"

Annual Change of Maternal Death Rate. The maternal death rate around 1900 was

approximately 40 per 10,000 total births (live births and still-births), but it decreased

every year until it reached the low rate in 1943, showing 19.4. Even though some sharp increase of maternal death rate was expected after the war due to the increase

of artificially induced abortions, it was 16.0 in 1947, 15.4 in 1957, and 13.1 (provisional) in 1959. (Refer Table 5).

Still-birth

Annual Change of Still-birth Rate. In the vital statistics in Japan, the still-births

of 3 completed months and over 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. After

the war, in 1947, it again started to show the high rate of 44.2, and rapidly increased

in the following years and became 101.2 in 1957. In 1959, it was 100.7, showing the

same rate as the previous year and a slight decrease from that of 1957.

\

r r

. ,-f ,..,.., . ... - 13-

Above-mentioned increase is considered to be affected by the enforcement of Eugenics

and Maternal Protection Law of 1948. This is proved by the fact that the proportion of

artificially induced abortion to the total still-births increased from 21.6% in 1948 to 51.6%

and 50.2% in 1956 and 1958, respectively, though it decreased to 49.0% in 1959. This is

enough 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 people to use safer methods of contraception.

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, excepting

some slight fluctuations 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 to 9~ 11 after 1940, as the marriage was encouraged by thEj 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 decrease, it went down to 8.0 in 1955. and 7.9 in 1956, respectively, to the

same level before the war. It was 9.0 in 1958 and 9.1 in 1959, showing a slight increase

from the previous years. (Refer Table 5).

Divorce

Annual Change of Divorce Rate. The divorce rate in 1900 was 1.46 per 1,000

population, and since then it kept decreasing until it became 0.63 in 1938. But after

the war, it suddenly rose again showing about 1.0. This is partly because of the increase

of marriages after the war, and partly because of the new attitude of the people towards

divorce. In 1959, however, the rate was 0.78, being at the same level as in the several

previous years around 1930. (Refer Table 5).

8. Life Tables in Japan

Expectation of life at birth showed a slight rise to 65.2 and 69.9 years for male and

female respectively in 1959, as compared with 65.0 and 69.6 years for male and female

respectively in 1958. The rise was relatively small in contrast with a sharp increase

recorded in the previous year. The prolongation of the average life expectancy at birth

for both men and women has been remarkable in recent years. This is particularly resulted

from a sharp decrease of mortality rates for younger population and partly from an

increase of older popUlation.

- 14-

Year

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 1956 1957 1958 1959

Table 6. Mortality Rate (qx).

(a). Male. (per 10,000 population)

I Age --~~~~~~~~-~~-~~~~~~~--I

1 0 11 I 2 I 3 I 4 I 5 110 115 120 125 \30 \35 140 145 150 155 160 165 I 70 I 75

1,490 447\296 201 138 100 45 52 82 88 86\1 93 112 141 18612561 3651 514i 745!1. 0741 1,569 369 259 170 112 79 33 48 83 84 79 87 104 133 178 245 351 5d 7451. 075: 1,605441 236 147 103 71 32 50 89 85 771 81 96122 164 229 328476 6981,013 1,620485 261 166 105 70 32 60 108 95 82 87 105 137 186 263 3921571 9491,245 1,401431 224150 98 64 26 50- 98 86 741 77 96 127 175 250 367 549 8041,175

1,130 370 205 135 91 65 24 48)100 92 77 76 89 119 173 240 355 519 7671,1321

1,989566295228 142 100 101 158474664 4903763072873504606489201,291, 1,2471299 195 130 85 57 23 42 114 154 142 132 136 166 222 312 461 6901,047'

86°1

332 192 110 70 51 20 26 77 96 84 85 91 111 148212333511 7511,160 550 182 98 75 52 36 13 23 58 78 76 73 79 94 128 187 281 423 623

6631184, 111 74 50 34 11 19 50 69 66 65 73 90 121 178 272 419 629 888 567 115' 89 66 46 31 11 12 31 42 44 45 56 75 107 161 248 40~61 617 920 590 143 100 67 48 35 10 17 39 55 55 57 65 82 113 170 272 43 665 576 131 92 71 48 32 7 14 31 44 44 45 57 75 108 164 259 - -505 90 74 57 39 27 9 12 25 34 36 39 49 69 101 156 236 379 594 807

511 87 66 53 37 261 8 11 24 32 33 36 45 651

99 157 245 397 6461,033 462

1

i 70 56 47 351 25 851 12 25 31 29 36 46 60 96 149 226 328 514

I 417 58 46 36 28 32 10 22 29 29 32 41 60 93 142 224 355 561 408 54 43 33 261 191 7 9 23 27 27 321 41 60 92 146 237 363 580 932

I illl ~Il! ~ !!I!l ! 'I II 1: ~ ¥'I ~ ~ II m ~l ~!. ~," !ill ------.

Year

98 1891~18 1899~19 1909~19 1921~19 1926~19

03

1935-19 1945 1946 1947 1948

1949 1950~19

1950 1951 1952

1953 1954 1955 1956 1957 1958 1959

13 25 30

36

52

(b). Female.

Age

o \ 1 \ 2 I 3 \ 4 \ 5 \ 10 115120 125 \ 30 \35 \ 40 \45\ 50 I 55 \ 60 \65 \ 70 I 75 ,

416\2821

195 136 1, 338 98 44 60 1,409 360 260 173 117 81 38 64 1, 450 437 239 147 104 76 40 76 1,440 476 263 174 115 78 37 90 1,241 421 227 156 106 71 30 73

992 3531

200 136 93 66 25 70 1, 569 428 222 172 106 74 78 120

965 244 161 107 71 48 21 40 766 325 190 109 68 48 18 31 564 176 99 72 50 34 11 25

589 184 108 70 48 33 11 22 497 116 88 65 45 29 10 13 526 146 99 66 48 34 9 18 509 129 91 69 47 31 6 14 442 90 75 55 40 28 6 11

449 87 66 51 36 25 6 10 405 69 54 46 34 24 4 9 366 56 42 34 27 21 5 8 372 51 40 34 24 18 6 7 311 51 36 29 22 17 5 8 333 42 30 25 18 13

§\ ~I 303 39 27 21 171 13 _L _ 1

90 98 102 qo 118 96 99 100 107 114

108 103 98 102 107 121 112 105 107 113 106 96 89 93 101

96 91 81 82 90 166 184 143 150 160 76 90 85 86 90 69 77 73 70 75 56 70 64 62 67

48 62 59 57 61 28 38 40 42 50 37 49 49 51 56 27 39 45 43 50 22 30 34 37 43

20 27 30 33 40 19 24 27 32 36 16 23 25 28 34 16 20 23 27 32 15 20 23 27 33 14 18 19 23 28 12 16 19 22 28

121 146 115 138 108 130 113

1

138 102 126

95, 121 179 220 104 137 82 111 75 97

71 92 59 80 66 88 62 84 55 77

53 75 45 56 46 66 45 67 45 65 40 61 39 58

1

197 185 175 184 169

159 280 149 144 134

126 115 122 118 99

110 91 96 96 97 89 87

2831410 615 928 265, 399 607 926 246 365 566 845 264 398 616

1

959 242 371 577 889

227 341 533 853 3851 548 812 253, 390 582 221 335 520 812 193 293 449

186 287 445 724 169 275 435 691 189 301 465 -181 162 261 424 642

165 268 453 788 147 223 367 -143 236 392 -153 245 404 673 150 244 428 732 135 215 377 630 130, 2121 365 6171

1;'

'~

- 15-

Table 7. Expectation of Life at Birth. (~o)

Year I Male I Female i i

1891~1898 42.8 44.3 I The 1st Life Table

1899~1903 44.0 44.9 The 2nd Life Table 1909~1913 44.3 44.7 The 3rd Life Table 1921~1925 42.1 43.2 The 4th Life Table 1926~1930 44.8 46.5 The 5th Life Table

1935~1936 46.9 49.6 The 6th Life Table 1945 23.9 37.5 Abridged Life Table 1946 42.6 51.1 h

1947 50.1 54.0 The 8th Life Table 1948 55.6 59.4 Abridged Life Table

1949 56.2 59.8 h

1950~1952 59.6 63.0 The 9th Life Table 1950 58.0 61. 5 Abridged Life Table 1951 60.8 64.9 h

1952 61. 9 65.5 • 1953 61. 9 65.7 h

1954 63.4 67.7 • 1955 63.9 68.4 • 1956 63.6 67.5 h

1957 63.2 67.6 • 1958 65.0 69.6 h

1959 65.2 69.9 h

9. Deaths by Leading Causes

The leading causes of death in 1959 were vascular lesions affecting central nervous

system, malignant neoplasms, heart diseases, senility, pneumonia and bronchitis, accidents,

tuberculosis, and etc. Causes of death which increased from the previous year were

accidents, heart diseases, hypertension, malignant neoplasms, senility, etc., whereas

those which decreased were suicide, tuberculosis, gastritis, duodenitis, enteritis, and colitis, nephritis and nephrosis, pneumonia and bronchitis, etc.

As a recent trend, deaths from the infectious diseases such as tuberculosis, pneumonia

and bronchitis and etc. have decreased greatly, and deaths from malignant neoplasms and

other degenerative diseases are gradually increasing, comprising more important proportion

in the total deaths.

Table 8. Percentage Increase or Decreasp, in Death Rates by Selected Causes.

International Abbreviated Causes of Death 1947 1958 1959 List Number

B22 Vascular Lesions affecting -21.81 -10.2 - 7.2 Central Nervous System

B18 Malignant Neoplasms - 4.6 +32.1 +35.4 B25-27 Heart Diseases + 8.0 +12.5 +16.7 B45a Senility -12.0 -61. 3 , -50.3 B,31 43a, 32 Pneumonia and Bronchitis - 6.4 -84.5 I -75.8 BE47, 48 Accidental Deaths + 17.7 - 7.2 ' + 6.4 Bl, 2 Tuberculosis (all forms) - 1.9 -89.41 -81.4 B36, 43b Gastritis, Duodenitis, Enteri· -21.0 -95.5 I -86.5

tis and Colitis !

BE49 Suicide -23.4 +25.4 I + 8.8 B39 Nephritis and Nephrosis -28.8 -76.5 ! -78.2

Note: The rates for the year 1935 are taken as the base, 100.

-16 -

Table 9. Annual Change of Deaths and Death Rates hy Leading Causes (l900~1959).

(Rate per 100,000 population) (Con'd to the next page)

Vascular Lesions Malignant i I Pneumonia I affecting Central I and Nervous System Neoplasms I Heart Diseases

i Senility Bronchitis

Year I

I 822 BI8 I 825·27 B45a B31, 43a, 32

N I R N I R I N I R I N I R I N I R

1900 69,799 159.2 20,334 46.4 21,107 48.1 57,442 131. 0 99, 130 226.1

1905 76,169 163.4 26,668 57.2 25,888 55.5 65,233 139.9 115,426 247.6

1910 64,888 131. 9 32,998 67.1 31,976 65.0 59,117 120.2 128,877 262.0 11 65, 731 131. 9 34,219 68.6 31,555 63.3 56, 792 113.9 124,345 249.4 12 67,489 133.4 34,444 68.1 31,223 61. 7 57, 765 114.2 128,056 253.2 13 66,771 130.1 35,712 69.6 31,092 60.6 56,791 110.7 132,370 258.0 14 68,571 131. 8 36,931 71.0 32,476 62.4 61,574 118.3 136,365 262.0

1915 67,921 128.8 37, 789 71.6 33,586 63. 7 59,346 112.5 137, 730 261.1 16 73,912 138.2 39,410 73.7 37,022 69.2 68,370 127.8 158,549 296.4 17 77,999 144.1 39,365 72.7 37,862 69.9 71,628 132.3 156,298 288. 7 18 86,262 157.6 40,560 74. 1 44,760 81. 8 82,073 149.9 270,620 494.4 19 84,382 153.3 38,670 70.3 34,426 62.6

I 69,431 126.2 203,113 369.1

1920 88,186 157·6 40.648 72.6 35,540 63.5 73,468 131. 3 228,330 408.0 21 90,523 159.7 40,877 72.1 37,420 66.0 75,654 133.5 165, 758 292.5 22 91, 433 159.3 41, 116 71. 6 37,312 65.0 75,957 132.4 164,401 286.5 23 94,615 162.8 42,231 72.7 42, 184 72.6 76,579 131. 8 155,451 267.5 24 102,810 174.6 41,671 70.8 40,676 69.1 74,003 125.7 159,200 270.4

1925 96,293 161.2 42.177 70.6 39,895 66.8 70,065 117.3 164,649 275.6 26 98,688 162.5 43,119 71. 0 37,949 62.5 67,576 111.3 139,447 229.6 27 101, 705 164.9 43,351 70.3 38,971 63.2 74,664 121.1 153,268 248.6 28 102,985 164.5 45,086 72.0 39,908 63.8 77,251 123.4 158,459 253.1 29 108,439 170.9 44,299 69.8 41,532 65.4 79,181 124.8 153.056 241. 2

1930 104.942 162.8 45,488 70.6 41, 138 63.8 76.591 118.8 128,976 200.1 31 107,352 164.0 45, 164 69.0 41,867 64.0 85,650 130.8 159.744 244.0 32 107,328 161.6 45,883 69.1 38,973 58.7 77,529 116.7 140,309 211. 2 33 110,719 164·2 47,705 70.7 40,111 59.5 82,932 123.0 131, 644 195.2 34 114,447 167.5 48;822 71. 5 42,519 62.2 87,045 127.4 151, 141 221. 3

1935 114,554 165.4 50,080 72.3 39,902 57.6 78,972 114.0 129,318 186.7 i 36 118,152 168.5 50,203 71. 6 42,910 61. 2 91,672 130.7 138.324 197.3 37 118, 761 168.1 51, 578 73.0 42,822 60.6 84,478 119.6 132,286 187.3 38 126.861 178.6 51, 358 72.3 47,461 66.8 98,451 138.6 144,331 203.2 39 130,826 183.3 52,059 72.9 47.442 66.5 95,173 133.3 156,657 219.5

1940 127,847 177.7 51,879 72.1 45,542 63.3 89,540 124.5 133,649 185.8 41 125,124 174.6 52,949 73.9 42,543 59.2 89,673 125.1 126, 120 175.9 42 125,349 173.2 53,897 74.5 43,487 60.1 95,998 132.6 128,438 177.4 43 120,985 166.0 53,580 73.5 45,428 62.3 99,162 136.1 139, 762 191. 8 44 ... ... ... ... ... .. . .. . ... ... . ..

1945 ... ... ... ... ... ... .. . ... ... .. . 46 ... ... ... ... .., .. . .. . .. , ... ... 47 101,095 129.4 53,886 69.0 48,575 62.2 78,342 100.3 136,524 174.8 48 94,329 117.9 56,633 70.8 49,046 61. 3 63,639 79.5 78,911 98.6 49 100,278 122.6 59,889 73.2 52, 763 64.5 65,574 80.2 81,812 100.0

1950 105,728 127.1 64,428 77.4 53,377 64.2 58,412 70.2 77,565 93.2 51 105,858 125.2 66,354 78.5 53,750 63.6 59, 796 70.7 69,555 82.2 52 110,359 128.5 69,488 80.9 52,603 61. 3 59,514 69.3 57,586 67.1 53 116,351 133.7 71,578 82.2 56,477 64.9 67,514 77.6 62,091 71. 3 54 116,925 132.4 75,309 85.3 53,128 60.2 61.334 66.5 48,256 54.7

1955 121,504 136.1 77,721 87.1 54,351 60.9 59,932 67.1 43, 154 48.3 56 133,931 148.4 81.879 90. 7 59,543 66.0 68,414 75.8 43,683 48.4 57 138,181 151. 7 83. 155 91. 3 66,571 73.1 73,283 80.5 53.923 59.2 58 136,767 148.6 87,895 95.5 59,603 64.8 51,046 55.5 43,832 47.6 59 142,678 153.5 90.993 97.9 62,508 67.2 52,678 56.7 41,938 45.1

I I

Note: Figures for 1959 are provisional,

· --;;-

/ !

-17 -

I

Accidental Tuberculosis I Gastritis,Duo- 1 II Nephritis Deaths (all forms) denitis, Enteritis i Suicide and

and Colitis l Nephrosis Year , ',

1'_--=Bc::E:.:,47:2.'...:c4B~_, ___ -,B_l;'_ 2'---___ i B36, 43b 1 __ --'B=--:E::;.:4:.:.9 __ ! __ ---=B::.;3:c:::8 ___ 1

I N [R N [ R IN --I R I N I_R _I,--N-,--I_R_, 1900

1905

1910 11 12 13 14

1915 16 17 18 19

1920 21 22 23 24

1925 26 27 28 29

1930 31 32 33 34

1935 36 37 38 39

1940 41 42 43 44

1945 46 47 48 49

1950 51 52 53 54

19,874

20,469

21, 800 22,781 23,877 22,335 25,524

24,321 23,914 26,892 27,160 25,165

26,198 24,558 25,500 71,322 25, 739

24,982 25,627 29,327 26,040 26,634

26,295 25,270 26,734 30,220 32,029

29,023 30,193 30,205 31, 700 29,328

28,408 28,808 31, 134 33,519

38,533 38,975 34,277

32,850 31, 968 31, 215 34,236 34,812

45.3 71,771 163.7 58,664 133.8 5,863

43.9 96,030

44.3 113,203 45.7 110,722 47.2 114,197 43.5 110,753 49.0 113,341

46.1 115,913 44.7 121,810 49.7 124,787 49.6 140,747 45.7 132,565

46.8 125,165 43.3 120,719 44.4 125,506

122.7 118,216 43.7 114,229

41. 8 115, 956 42.2 113,045 47.6 119,439 41. 6 119,632 42.0 123,490

40.8 119,635 38.6 121,875 40.2 119,196 44.8 126,703 46.9 131,525

41. 9 132, 151 43. 1 145, 160 42.8 144,620 44.6 148,827 41. 1 154, 371

39.5 153,154 40.2 154,344 43.1 161,484 46.0 171,473

49.3 146,241 48.7 143,909 41. 9 138, 113

39.5 121, 769 37.8 93,307 36.4 70,558 39.3 57,849 39.4 55,124

206.0

230.2 222.1 225.8 215.9 217.8

219.7 227.7 230.5 257.1 240.9

63,979

104,950 104,964 101,323 99,657

118,308

156,903 126,078 129,869 145,667 136,829

223.7 142,278 213.0 154,912 718.7 153,528 203.4 165,199 194.0 151.874

194.1 142,288 186.1 141,327 193.7 149,920 191.1 146,517 194.6 156,903

185.6 142,673 186.2 140,152 179.4 137,426 187.9 139,974 192.5 136,771

190.8 119,931 207.0 129,028 204.8 127,325 209.6 124,744 216.3 119,835

212.9 114,538 215.3 102,387 223.1 102,784 233.3 111,688

187.2 106,838 179.9 87,890 168.8 75,748

146.4 110.3 82.2 66.5 62.4

68,540 57,214 45,552 40,139 34,436

137.2

213.4 210.6 200.3 194.2 227.3

247.2 235.7 239.9 266.1 248.6

254.2 273.4 267.5 284.2 258.0

238.2 232. 7 243.1 234.1 247.2

221. 4 214.1 206.9 207.6 200.2

173.2 184.0 180.3 175.7 167.9

159.2 142.8 142.0 153.2

8,089

9,372 9,373 9,475

10,367 10,902

10,153 9,599 9,254

10,101 9,924

10,630 11, 358

1 11,546 11,488 11,261

12,249 12,484 12,845 13,032 12,740

13,942 14,353 14,746 14,805 14,554

14, 172 15,423 14,295 12,223 10, 785

9,877 9, 713 9,393 8,784

136.8 12,262 109.9 12,753 92.6 14,201

82.4 16,311 67.7 15,415 53.1 15,776 46.1 17,731 39.0 20,635

1955 33,265 'I 37.3 46,735 52.3 28,289 31. 7 22,477 56 33,258 36.8 43,874 48.6 27,077 30.0 22,107 57 34,528

1

37.9 42,718 46.9 23,425 25.7 22,136/

I~_ ~~_._ ~f: ~~~ I ~_ ~~: ~ _' ~~~_~i~ ____ ~~:_~ __ ~_~~~~ ___ ~~~3:_~ _~6: ~~

13.4 13,259

17.4

19.1 18.8 18.7 20.2 20.9

19.2 17.9 17.1 18.5 18.0

10,129

26,603 28,918 30,897 32,654 38,288

39,064 44,485 47,997 57,473 52,077

19.0 55,546 20.0 59,788 20.1 60,870 19.8 62,574 19.1 62,227

20.5 59,873 20.6 59,581 20.8 60,034 20.8 62,884 20.1 65,391

21. 6 63,435 21. 9 64,241 22.2 61, 360 22.0 59,986 21. 3 59,553

20.5 56,026 22.0 57,771 20.2 56,285 17.2 61,996 15.1 58,799

13.7 54,703 13.6 49,900 13.0 51,108 12.1 49,708

15.7 45,017 15.9 36,561 17.4 33,707

30.2

21. 7

54.1 58.0 61.1 63.6 73.6

74.1 83.2 88.7

105.0 94.6

99.3 105.5 106.1 107.7 105.7

100.2 98.1 97.4

100.5 103.0

98.4 98.1 92.4 89.0 87.2

80.9 82.4 79.7 87.3 82.4

76.0 69.6 70.6 68.2

57.6 45.7 41. 2

19.6 26,978 32.4 18.2 24,701 29.2 18.4 22,108 25.8 20.4 20,160 23.2 23.4 19,511 22.1

25.2 19,122 21.4 24.5 19,459 21.6 24.3 19,509 21.4 25.7 17,440 19.0 22.3 16,372 17.6,

__ ,,_ ~_,--___ l

- 18-

Fig. 5. Death Rates by Leading Causes in 1959.

o 50 100 150 200 Vascular Lesions affecting central Nervous System .............. .

Malignant Neoplasms···················· .... ········ .. ·· .. ····· ............. . Heart Diseases ................................................................. .

Senility·· .. ····.· ........................ '" ..................................... . rv;5 /959

Pneumonia and bronchitis including pneumonia of the new born Accident .......................................................................... .

Tuberculosis. all forms ..................................................... .

Gastritis. duodenitis. entertis, and colitis· .......................... . Suicide .......................................................................... .

Nephritis and Nephrosis················· ...................... · ............. .

10. Maternal and Child Health Statistics

As for the general aspect of vital statistics in Japan, please refer Chapter 7, "Vital

Statistics" of this report. Generally speaking, there has been a steady decline in the

numbers and rates of maternal and infant deaths in the recent years, while the figures

for foetal deaths have remained considerably high. Of 1,653,469 live births in 1958,

578,802 confinements took place in the hospital, clinic or maternity home. representing a

percentage of 35.0 to the total. This is a remarkable rise in the rate of institutional

confinements for these 10 years, the figure being 3.1 for 1948. Tables 10 and 11 in the

next page show the break-down of maternal and infant deaths by the causes of death

from 1940 through 1959.

Pre-natal and Post-natal Cares

All expectant and nursing mothers and guardians of young children are encouraged

to receive health guidance concerning pregnancy, child-bearing and child care from medical,

dental and nursing professions. To this effect, the prefectural and municipal health

centers regularly provide the ante-natal and post-natal clinics and child health clinics

where mothers and young children could obtain advice and preventive treatment.

In 1959, there were 656,847 attendances at clinics for mothers, and 3,257,008 attendances

at clinics for children. The number of home visiting conducted by the public health

nurses was 244,129 for mothers, and 1,076,964 for children in 1959.

In addition to the services provided at the health centers, the voluntary community

activities have been encouraged for maternal and child health program in rural as well

as in urban areas. A larger number of community organizations act in close co-operation

with local health authorities, and take part in mothercraft training and in distributing

UNICEF-donated skim milk and in other various services.

MCH Center in Rural Areas

In the rural areas, where the mothers and children have to travel a long way for

receiving medical examination and treatment because of lack of medical and nursing

personnel and facilities, the provision of maternal and child health services presents great

difficulties. Therefore, the establishment of MCH centers surely meets to a great extent

the needs of mothers and children in such areas. Though it is small, the building includes

rooms for pre-natal and post-natal clinics. class-room, demonstration :room in nutrition.

and accommodation~ and facilities for child-bearin~ mothers,

-.".-.;" 1

-19 -

MCR c('nters have come in operation in 98 remote villages since 1958, and additional

45 centers will be constructed in 1960.

Premature Births

Provisions for the care of premature infants have been introduced into maternal and

child health services since the middle of the year 1958. Every infant born with the

weight of 2,500 grammes or less has to be reported to the respective health center

immediately after its birth.

Public health nurses or midwives of the health center may visit the families with

premature infant to advise them in regard to the proper care of such infant at home,

and, in case of need, incubators of simple type are lent out to the family. The premature

infants in need of more complicated care are received into the hospitals which have been

designated for this purpose, and the costs of hospitalization are mostly supported by the

national and local authorities' grants-in-aid.

The number of the premature infants treated in the hospital during 1959 was nearly

2,000, of which about 1,300 cases came under the subsidiary scheme.

Tuberculous Children

Financial aids for those children hospitalized for the long-term treatment of bone and

ioint tuberculosis have been started from 1959; these aids cover all expenses for medical

treatment, school education and other daily living costs the children require.

Other Services

As for the informations regarding care and rehabilitation of the physically handicapped

children, they can be found in Chapter 21 of this report.

Table 10. Infant Deaths and Death Rates by Leading Causes. (1940-1958) 1 Infant'Death Rates I

I Infant Deaths (Per 1,000 live born) 1

Causes of Deaths -~------

I 1940 1 1950 11955 [1957 11958 1940119501195511957i19581 ! All Causes 189.8091140.515 68,801162,67857,052190.460.1 39.8 40.0 34.5

Tuberculosis, all forms 965 1.182 2991 206 166 0.5 0.5 0.2 O. 1 O. 1 Syphilis and its sequelae 1, 069 854 94 47 32 0.5 0.4 0.1 0.0 0.0 Whooping cough 4.849 4,421 252 235 320 2.3 1.9 0.2 0.2 0.2 Measles 1, 632 1,315 922 1,176 413 0.8 0.6 0.5 0.8 0.3 Pneumonia 36.258 23.996 14,506 15,145 14,134 17.3 10.3 8.4 9.7 8.5 Bronchitis 6,559 7,519 1,819 1,541 1,321 3.1 3.1 1.1 1.0 0.8 Castro-enteritis 30,279 19,366 5,821 4,495 4,433 14.4 8.3 3.4 2.9 2.7

I Congenital malformations 2,833 5,540 3,564 2,961 3,217 1.3 2.9 2. 1 1.9 1.9 I Birth injuries, post·natal asphyxia and 291 2.462 1,825 1,858 2,229 0.1. 1. 0 1.1 1.2 1.3 I atelectasis

I Other diseases peculiar to f'arly infancy ... 39,39428,037 24,042 21,499 "'16.9 16.2 15.3 13.0

[

and immaturity unqualified 2, 18911,739 Accidents 1, 135 1,400 1,377 0.5 0.9 1.0 0.9 0.8 I

1 .~-- .. -- ---.--.-.~

Table 11. Maternal Deaths and Death Rates by Leading Causes. (1940-1958) .. ~~.----

I M"".,I D""h, I Maternal Death Rates

1 Causes of Deaths 11940 11950 11955 11957 1 1958

(Per 10,000 live born)

1940 11950 11955 11957 1 1958

All Causes 5,070[ 4,117 3, 0951 2, 677 2,560 24.01 17.6 17.9 17.11 15.5 Puerperal fever 868 351 1411 130 138 4.1 1.5 0.8 0.8 0.8 Toxaemias of pregnancy 1,693 1,396 1, 124 1, 055 982 8.0 6.0 6.5 6.8 5.9 Haemorrhages 1, 402 1,147 831 671 649 6.6 4.9 4.8 4.3 3.9 Ectopic pregnancy 321 474 373 297 283 1.5 2.0 2.2 1.9 1.7 Abortion without sepsis 186 261 121 99 99 0.9 1.1 0.7 0.6 0.6 Others 600 488 505 425 409 2.8 2.1 2.9 2. 7 2.5

- 20-

11. Health Education

The local health centers perform extensive health education program in the field of

communicable disease prevention, care for infants, insect and rodent control, and improve­

ment of environmental sanitation. In addition, the school health education IS performed

by the school authorities under the direction of the local Education Board, whereas the

industrial hygiene education is conducted by the local Labor Standards Offices. In the

rural area, agricultural extension service under the direction of the Ministry of Agriculture

and Forestry includes health education program for the farmers.

Radio broadcast, movies. slides and exhibits are employed extensively. Summer

seminars have been held annually for training and for conference, and the regional

discussion groups on health education 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 peoples' meetings.

12. Tuberculosis

Death Rates from Tuberculosis The deaths from tuberculosis continue to decrease. In 1959, there were 32,914 deaths,

the ratio of which was 35.4 per 100,000 population, and it was the 7th 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. The death rate from tuberculosis was 253.2 per 100,000 populaton in 1918, which was

the highest rate since 1900. It decresed 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 acurate data were available for the succeeding three years. However, in 1947,

the death rate was recorded as reduced to 187.2 and still continued to decrease year after

year, and in 1959 it became 35.4 as stated already. 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. 6. Death Rates from Tuberculosis by Year and Age Groups.

'iOO

Fig. 7. Annual Change of Death Rates from Tuberculosis by Age Groups.

:./UJ

JOO

100

l " ..... ; /VS9

°0 10 -ZO 30 40 to-lJ A e Group ----oerlA Rales (P,,/IJO.OOO Populalion)

./ .;:,

,"

- 21-

Tuberculosis Prevalence

In order to ascertain the actual condition of the tuberculosis prevalence in the

country, the government conducted the nation-wide surveys in 1953 and 1958. In these

surveys, 211 areas with 51,011 population in 1953 and 301 areas with 68,269 population

in 1958 were selected by the stratified random sampling method, and both in 1953 and

in 1958, above 98% of the total population were examined with radiograph to obtain

informations on the number of tuberculosis patients, type of tuberculosis, kind of

treatment required, and the consequent requirement of the medical facilities. Comparing

the results of the surveys in 1953 and 1958, the estimated number of patients who

needed medical care, was 2,920,000 in 1953, and 3,040,000 in 1958, and the prevalence

rate was 3.4% in 1953, and 3.3% in 1958. Although the total number of patients was

almost the same, the number of patients in the younger age group remarkably decreased,

while in the age group of above 40 years somewhat increased, and the number. of

severe cases requiring hospitalization evidently decreased from 1,370,000 to 860,000, and

those with cavity from 540,000 to 410,000.

According to the follow-up survey of above surveys, conducted in 1954 and 1959,

the incidence rate of pulmonary tuberculosis in one year was 0.37% in 1954 and 0.23%

in 1959.

Tuberculosis Control Program

The tuberculosis control program as provided for in the Tuberculosis Control Law

(Law No. 962 of 1951; amendments were made in line with the result of surveys) 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 program amounts to 16.4 billion yen in

1960 fiscal year. This, however, is only the national expenses and does not include the

expenses by the prefectures, cities, towns and villages. Provided in the national budget

are 0.6 billion yen for health examination and vaccination, 0.1 billion yen for reporting

and registration, 13.1 billlon yen for management of public sanatoria, and 2.6 billion yen for grants to tuberculosis patients.

2. Health Examination and Preventive Vaccination

According to the Tuberculosis Control Law, all population above 6 years of age is

required to receive free health examination, i.e., the teachers and pupils of schools,

employees of factories and offices, inmates of certain institutions, and residents in the cities, towns and villages.

In 1959, 35,714 thousand persons, above } of the total population, received the

examination. The case finding rate thereof was 0.37%, which was 0.03% more than

that in 1958. Among the negative reactors against tuberculin, 6,279 thousand persons

were inoculated with BCG vaccine during the year 1959. (Refer Table 12).

Table 12. Tuberculosis Health Examination and Preventive Vaccination (l951~1959).

(in thousand persons) -----I

! 1

I I

No. of Tuberculin Test Examined Examined Persons Persons Year Persons with with diagnosed received

Examined Examined I Positive Miniature BCG Vacci-Persons Reactors Radiography Radiography as TB Case nation

1951 17,421 15,441 I 6,644 7,691 450 132

I

14,214 1952 22,426 19,754 10,696 12,419 606 143 10,387 1953 21, 921 18,546 11,322 14,295 638 142 8,126 1954 27,325 20,933 12,931 17,020 720 151 6,619 1955 26,531 20,459 13, 127 17,922 755 130 6,095 1956 29,888 23,169 15, OlD 21,136 890 103 6,433 1957

I

33, 152 24,880 16,280 24,589 1,000 109 6,949 1958 37,103 24,085 15,733 29,124 1,204 127 6,697 1959 35, 714 21,120 13,896 29,679 1,205 132

I 6,279

I

(Note: A year stands for the calender year period, except 1951, which covers the period April~ December).

3. Reporting and Registration Table 13. Reporting of Tuberculosis Cases.

I

I

The practicing medicel doctors are requ­

ired to report to the health authorities, when

they find the tuberculosis patients. The

reported cases are registered in the health

centers in the same form. The number of

the reported ca~es are shown in Table 13.

Year I Reported Number of _____________ Tuberculosis.~C=a~se~s _____ 1

4. Medical Care

The expenses for the medical care of

tuberculosis patients are provided, besides

the private expenses, with the grants by

various types of social insurance, public assi­

stance program, and also by the governmen­

tal grants under the Tuberculosis Control

Law. It is estimated that the total expenses

for medical care of all kinds of illness by

all kinds of sources, both private and public

1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959

317,397 382,810 464,903 528,829 590,662 586.651 507.244 523.556 517,477 518, 142 520,899 598, 779 499,873

Tble 14. Expensel for Medical Care in 1956 Fiscai Year.

(in billion yen)

I All Kinds I Tuber-

Source of Fund of Illness culosis

Total Public Assistance Law TB Control Law Health Insurances Patients

325.8 26.6 3.7

148.9 146.6

63.3 I

14.3 I 3.7 ,

30.7 i 14.7 i

in 1957, were 325.8 billion yen, and among them 63.3 billion yen, nearly a quarter of the

total amount, was for tuberculosis. The Tuberculosis Control Law provides ~- grant to

chemotherapy and 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 as shown in Table 16. Table 15. Number of TB Beds by Year.

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

I I I Local I Puhlic I Private Year Total National Govern- ~.ssocia-

ment hon

1951 125,204 73,042 11,586 25,488 15,088 1952 153,861 76,751 19,226 35,876 32,008 1953 178,424 77,342 28,458 44,988 27,636 1954 210,062 81,565 39,368 53,187 35,942 1955 236, 183 84,248 46,846 59,515 45,574 1956 252,803 83,932 52,361 63,989 52,521 1957 261,375 85,592 54,188 65,875 55,820 1958 263.235 85,451 55,824 64,713 57,247 1959 260,124 83,563 55,352 63,521 57,688 I

Table 16. Average Length of Stay of Tuberculosis In-Patients.

I I TB I TB War.C,

Year Total St' in General ana ona Hospitals

I

1951 269 369 182 1952 292 353 223 1953 361 5lD 257 1954 402 550 316 1955 383 478 313 1956 357 426 304 1957 341 404 293 1958 341 406 294 1959 335 394 292

---j

-~-.

r,

/

- 23-

13. Commun.icable Diseases

Communicable Disease Control Program

The communicable disease control program 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 by the physicians, isolation of patients, disinfection of the places,

and the specific obligation of the local and national health authorities. At present the

following 11 diseases are specified by this law, i.e., cholera, dysentery, typhoid fever,

paratyphoid fever, smallpox, epidemic typhus, scarlet fever, diphtheria, epidemic meningitis,

plague, and Japanese "B', encephalitis. In addition, the following 13 diseases are also requ­

ired to be reported of their occurrence by the physicians, i.e., influenza, rabies, infectious

diarrhea, whooping cough, measles, acute poliomyelitis, malaria, tsutsugamushi disease,

filariasis, yellow fever, anthrax, tetanus, and relapsing fever. Among these notifiable di­

seases, the acute poliomyelitis was designated by the regulation in June, 1959 as the

disease for which the same legal control measures as in the case of those 11 diseases

mentioned above are to be enforced by the health authorities.

Preventive Vaccination Law was put into effect in 1948. and the programs have been

carried out for the following diseases:

a. Regular immunization: 1. Smallpox-3 times: during 2~12 months after birth, during 6 months before

entering primary school, and during 6 months before graduating from primary

school.

2. Diphtheria-4 times: during 3~6 months after birth, during 12~18 months after

the first vaccination, 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: during 3~6 months after birth, and during 12~ 18

months after the first vaccination.

b. Emergent immunization:

Besides the regular vaccination program, the law provides immunization for epidemic

typhus, cholera, plague, influenza, and Weil's disease at the time of their epidemics.

Table 17. Number of Persons who received Immunization. (1953~1959)

I Vacciuation ____ year_ 1953 1954 _1_19~J __ 1956 l~I_~58 _L~! i I Thousand[ ThOUSandl Thou8and~ Thousandl' Thousandl Thousand Thousand]

I Smallpox Vaccination 4,716 I 5,215 5, 212 1 4,311 3, 916 1 3,753 4,262 TYJ>hoid & Paratyphoid ! 30, 164, 32,976 29,380 29,908 I 24,611 23,893 23,082

, Vaccination I

I

Diphtheria Vaccination I 4,048 4,665 I! 4, 848 1 4,6031 3,861 i 3,811 4,696 Pertusis Vaccination '1,598 I 1. 939 1,419 1, 444 1,466 I 1, 391 1,914

I Diphtheria-Pertusis Combined I - I - I -I I - I, 1,358 , Vaccination I I I Epidemic Typhus Vaccination' 134 I 89 i 61 i 31 I 25 I 23 23 ___ ~ ____ ~ _____ ~ ______ c _____ ~ ____ ~ ____ ~ ____ ~

~' ,

Table 18. Annual Change of Cases, Deaths, Case Rate and Death Rate for Communicable Diseases. (Rate per 100,000 population) (1920~1959)

Cholera Dysentery I Typhoid Fever Paratyphoid Fever 1 Smallpox 1

Year I--~I ~C~a-s-e~I-----\l)eath I Case \ \ l)eath I I Case \ \ Death \ Case I I Death- I Case \ \ De h Cases Rate Deaths Rate Cases Rate Deaths Rate Cases Rate Deaths Rate Cases Rate Deaths Rate Cases Rate l)eaths R::e·

1920 4.969 9.0· 3.417 6.2 112.723 23.0 I 8.148 14.7 53.756 67.0 12.073 21. 8 7.697 13.91 783 1. 4 I 166 5.7 729 1. 3 I

1925 625 1.1 363 0.7 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 I 1926 25 0.0 13 0.0 17.135 28.5 8.528 14.2 43.938 73.0 9.774 16.2 4.451 7.4, 431 0.7 1.256 2.1 158 0.3 1927 2 0.0 3 0.0 21.396 35.0 10.211 16.7 37.503 61.4 7.834 12.8 4.736 7.7 490 0.8 352 0.6 90 0.1, 1928 1 0.0 1 0.0 25.196 40.6 12.033 19.4 41, 996 67.7 8.767 14.1 4.887 7.9 451 0.7 723 1. 2 100 0.2

1

1929 205 0.3 114 0.2 30.230 48.0 13.421 21. 3 37.262 59.2 8.015 12.7 4.1891 6.7 349 0.6 114 0.2 11 0.0 1930 - - 2 0.0 29.672 46.5 13.014 20.4 41,367 64.8 8.340 13.1 4.467 7.0 372 0.6 7 0.0 4 0.0 1931 - - - - 29.655 45.7 13.002 20.1 38.202 58.9 8.163 12.6 4.042 6.2 308 0.5 23 0.0 8 0.0 1932 4 0.0 1 0.0 32.249 49.0 13.547 20.6' 35.437 53.9 6.936 10.5 4.694 7.1 368 0.6 305 0.51 44 0.1 1933 - - - - 38.040 57.0 14.874 22.3 38.408 57.5 7.632 11.4 5.279 7.9 333 0.5 375 0.6 55 0.1

1934 - - - - 42.939 63.4 15.484 22.9 42.420 62.7 8.129 12.0 4.462 6.6 319 0.5 I 320 0.5 35 0.1 1935 - - - -- 48.964 71.3 15.915 23.2 37.980 55.3 7.192 10.5 4.173 6.1 279 0.4 113 0.2 16 0.0 1936 - - -I - 52.053 74.8 16.710 24.0 36.799 52.9 6.847 9.8 4.747 6.8 276 0.4 178 I 0.3 20 0.0 1937 57 0.1 11 0.0 78.283 111. 3 19.712 28.0 38.124 54.2 7.062 10.0 4.439 6.3 263 0.4 90 0.1 8 0.0 1938 18 0.0 10 0.0 80.221 113.6 21.955 31.1 42,074 59.6 7.803 11.1 n.l00 8.6 2% 0.4 60 0.1 6 0.0

1939 - - 1 0.0 97.249 137.1 24.890 35.1 37.837 53.3 6.954 9.8 5.227 7.4 293 0.4 287 0.4 33 0.0 1940 - - 5 0.0 83.689 117.0 22.025 30.8 40,706 56.9 7.106 9.9 6.251 8.7 312 0.4 575 0.8 60 0.1 1941 - - - - 58.803 80.8 16.295 22.4 40.595 55.8 6.904 9.5 6.233 8.6 308 0.4 n54 0.9 92 0.1 1942 - - - - 55,785 75.9 1 14.268 19.4 35,589 48.5 6,428 8.8 6.218 8.5 281 0.4 331 0.5 61 0.1 1943 - -I - - 50.188 67.8110.208 13.8 52.519 71.0 6,925 9.4 12,382 16.7' 508 0.7 546 0.7 73 0.1 1944 - - - - 55.196 74.7 11,208 15.2 57,448 77.8 7.844 10.6 14,819 20.1 564 0.8 311 0.4 44 0.1 1945 - - - - 96.462 133.2 20.107 27.8 57,933 80.0 7.999 11.0 10.059 13.9 526 0.7 1,614 2.2 319 0.4 1946 1.245 1.6 560 0.7 88.214 115.8 13.409 17.6 44.658 58.6 5,446 7.2 9,154 12.0 466 0.6 17.956 23.6 2.029 4.0 1947 - - - - 39,219 50.2 9.573 12.3 17.809 22.8 2.926 3.7 4,728 6.1 316 0.4 386 0.5 85 0.1 1948 - - - - 14.665 18.3 5.157 6.4 9.486 11.9 1.433 1.8 2,917 3.6 170 0.2 29 0.0 3 0.0

1949 - - - - 23.991 29.3 7.765 9.5 6.391 7.8 936 1.1 2,189 2.7 116 0.1 124 0.2 14 0.0 1950 - - 1 0.0 49.780 59.8 11.968 14.4 4.883 5.9 630 0.8 1,711 2.1 80 0.1 5 0.0 2 0.0 1951 - - 1 0.0

1

93.039 110.0 14.814 17.5 3.878 4.6 351 0.4 1,302 1.5 49 0.1 86 0.1 12 0.0 1952 - - - - 111.709 130.0 13.585 15.8 2.898 3.4 189 0.2 835 1.0 32 0.0 2 0.0 - -1953 - - - -1108.009 124.1 10.851 12.5 2.521 2.9 157 I 0.2 1,093 1. 3 16 0.0 6 0.0 - -1954 - - - - 98.810 111.9 9.311 10.5 2,567 2.9 124 0.1 760 0.9 24 0.0 2 0.01 - -1955 - - - - 80.654190.3 6.042 6.8 1.939 2.2 105 0.1 590 0.7 13 0.0 1 0.0 - -1956 - - - -1 84,43793.6 5.165 5.7 2.12312.4 80 0.1' 509 0.6 19 0.0 - -I - -1957 - -, - - 74.780 82.1 3.763 4.1 2.113 2.3 76 0.1\ 344 0.4 7 0.0 --- - - -1958 - -181.577188.7 3.1471 3.4 1.901 2.1 55 0.1 1.149 1.2 8 0.0 - - - -1959 ___ ~_1_- - - 85.695 92.2 2.350,2.5,1.546 1.7 3610.0 411 0.4 7 0.0 -, - - -

(Continupd to the next page)

, ~ \ ' 1.; ., f' • /i' , I(

~

\ ~ 1'\

~

Year

1920

1925 1926 1927 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 1957 1958 1959

'!,~

~'7\ . ~ . , . \. ( \

Epidemic Typhus Scarlet Fever Diphtheria

I Case -I h 1 Death I -I- Case I - I Death I C I Case I De-h-I Death Cases Rate Deat S Rate Cases Rate Deaths Rate ases Rate at s Rate

661 0.1 3 0.0 \1,368 2.5 102 0.2 15,113 27.3 3,801 6.9 28

1

0.0 - - 2,573 4.3 284 0.5 13,775 23.3 3,595 6. 1 36 O. 1 4 0.0 I 3,319 5.5 300 0.5 13,621 22.6 3,625 6.0 7 0.0 1 0.0, 4,148 6.8 219 0.4 15,172 24.8 3,913 6.4

23 0.0 I 3 0.0 II 5,727 9.2 I 220 0.4 17,526 28.2 4,401 7.1

15 0.0 31/ 0.0 5,663 2.0 248 0.4 19,674 31.3 4,703 7.5

1 0.0 1 0.0· 6,025 9.4 303 0.5 18,522 29.0 4,069 6.4 3 0.0 3 0.0 I 6,480 10.0 327 0.5 21,048 32.5 4,582 7.1 3 0.0 1 0.0 I 8,257 12.5 336 0.5 21,811 33. 1 4,509 6.9 4 0.0 1 0.0 12,631 18.9 401 0.6

1

" 28,500 42.7 5,418 8.1

26 0.0 5 0.0 16,688 24.7 505 0.7 29,992 44.3 5,215' 7.7 18 0.0 1 0.0 16,506 24.0 488 0.7 28,054 40.9 4,432 6.5 1 0.0 3 0.0 16,707 i 24.0 467 0.7 28,117 40.4 4,321 6.2

17 0.0 1 0.0 \17,602 25.0 454 0.6 28,003 39.8 4,236 6.0 - - - 19,002 26.9 398 0.6 28,323 40.1 4,118 5.8

5 0.0 2 0.0 19,907 28.1 475 0.7 35,803 50.5 5,255 7.4 3 0.0 3 0.0 19,325 27.0 388 0.5 38,303 53.5 4,728 6.6

87 0.1 14 0.0 14,997 20.6 268 0.4 40,442 55.6 4,985 6.9 100 0.1 23 0.0 12,688 17.3 217 0.3 44,431 60.5 5,134 7.0

1,374 1. 9 129 0.2 9,891 13.4 165 0.2 I 63,756 86.2 5,419 7.3

3,941 5.3 622 0.8 6,354 8.6 114 0.2 94,274 127.6 6,192 8.4 2,461 3.4 260 0.4 2,405 3.3 82 0.1 85,833 118.5 7,826 10.8

32,366 42.5 3,351 4.4 2,208 2.9 100 0.1 49,864 65.5 3,825 5.0 1, 106 1. 4 135 0.2 2,635 3.4 71 O. 1 28,307 36.2 3,390 4.3

475 0.6 47 0.1 2,982 3.7 42 0.1 16,377 20.5 1,903 2.4

111 0.1 18 0.0 4,602 5.6 58 0.1 14,555 17.8 1,635 2.0 938 1. 1 68 0.1 5,149 6.2 33 0.0 12,621 15.2 1, 182 1. 4

3 0.0 2 0.0 5,096 6.0 34 0.0 10,749 12.7 895 1. 1 16 I 0.0 - - 6,168 7.2 48 0.1 8,381 9.8 639 0.7

- - - 12,619 14.5 56 0.1 9,589 11. 0 773 0.9

- 1 0.0 19,861 22.5 87 0.1 10,490 11.9 794 0.9 - - - 13,486 15.1 62 0.115,55717.4 913 1.0 - - - 12,172 13.5 63 0.118,39520.4 978 1.1

1 1. 0 - - 14,499 15.9 44 0.0 15,423 16.9 887 1. 0 - - - 13,734 14.9 31 0.015,64117.0 618 0.7 - I - - 9,882 10.6 32 0.0 17,936 19.3 628 0.7 I

~ h, e ' 0; '. ' I<

0· ,;

(Rate per 100,000 populatIOn)

Epidemic Meningitis

C 1

Case I De h I Death ases Rate at s Rate

949 I 1. 7 I 530 1-~ I 445 I 0.8' 275 1. 7 ' 408 0.7 236 0.4 303 0.5 212 0.3 294 0.5 171 0.3

352 0.6 208 0.3 275 0.4 168 0.3 280 0.4 165 0.3 238 0.4 165 0.3 359 O. 5 239 O. 4

1. 186 1. 8 599 O. 9 1, 304 1. 9 699 1. 0 1,003 1. 4 601 0.9

839 1.2 479 0.7 995 1.4 580 0.8

1,632 2.3 886 1. 2 1, 350 1. 9 707 1. 0 1, 160 1. 6 524 0.7

823 I 1. 1 443 0.6 1,113 I 1.5 398 0.5

1,468 2.0 396 0.5 4, 384 6. 1 1, 072 1. 5 1,436 1.9 455 0.6 3, 373 I 4. 3 1, 187 1. 5 2,052 2.6 650 0.8

1,446 1. 8 1, 193 1. 4 1,1111.3

912 1. 1 859 1. 0

676 0.8 630 0.7 610 0.7 780 0.8 638 0.7 573 I 0.6

492 0.6 336 0.4 302 0.4 227 0.3 196 0.2

153 0.2 161 0.2 146 0.2 155 0.2 134 0.1 105 I 0.1

Japanese "B" Encephalitis

C I Case I De h IDeath ases Rate at 5 Rate

I : I I

• i . '

, I

• I

201 0.3 263 0.3

4,757 5.9

1,284 1. 6 5,196 6.2 2,188 2.6 3,545 4.1 1, 729 2.0

1,758 2.0 3,699 4.1 4,538 5.0 1,793 2.0 3,900 4.2 1,979 2.1

• I

99 228

2, 120

1,177 2,430

956 1, 437

720

731 1,373 1,598

744 1, 347

716

0.1 0.3 3.3

1.4 2.9 1.1 1.7 0.8

0.8 1.5 1.8 0.8 1.5 0.8

Note: The population used as the basis of computation o( these rates is the estimated population excluding Okinawa. The number of deaths for 1925~1942 IS

only for Japan Proper, exclusive of Okinawa Prefecture, but the number of cases and deaths for 1943~ 1945 includes Okinawa Prefecture. Consequently, there is some inconsistency in this table; the number of cases were taken from our Morbidity Statistics, and deaths from Cause-of·Death Statistcs and Vital Statistics; deaths from smallpox in 1950 includes one death which actually occurred in 1949 and was reported in 1950; one death from cholera in 1950 and 1951 shown in table actually occurred in 1949 and was reported in 1950 and 1951. (number of deaths in 1959 is provisional).

<"b_~

tl

.., (]l

Prevalence of Major Communicable Diseases

Due to the confusion soon after the World War II, dysentery, typhoid fever, paraty­

phoid fever, and diphtheria, together with cholera, smallpox, and epidemic typhus were

prevalent. Most of them, however, decreased rapidly and are now well under control.

I

Table 19. Cases and Case Rate for Reportable Diseases. (Other than those in Table 18)

(1954'"'" 1959)

1954 1955 1956 1957 1958 1959 1

Number I Rate Number I Rate Number I Rate Number I Rate Number I Rate Number I Rate I Malaria 337 0.4 66 O. 1 47 0.1 33 0.0 281 0.0 16 0.0 Measles 71,605 81. 1 60,271 67.5 68, 153 75.5 65,886 72.3 29,351 31. 9 75,417 81. 1 Whooping 67,028 75.9 14,134 15.8 18,524 20.5 20,112 22.1 29,948 32.6 9,742 10.5

Cough Influenza 4,444 5.0 18,639 20.9 24,991 27.7 983, 105 1,079.3 32,944 35.8 19,401 20.9 Poliomyeli tis 1. 921 2.2 1,314 1.5 1,497 1.7 1, 718 1.9 2,610 2.8 2.917 3. Ii Tetanus 1,044 1.2 960 1.1 998 1.1 945 1.0 853 0.9 853 0.91 Rabies 1 0.0 - - 1 0.0 - - - - ---- -I Anthrax 3 0.0 6 0.0 1 0.0 -- - 3 0.0 5 0.01 Tuberculosis 523,556 593.0 517.477 579.6 518. 142 574. 1 520,899 571. 9 498.779 542. 1 499,873 537.7[ Leprosy 333 0.4 331 0.4 283 0.3 361 0.4 362 0.4 295 0.3

Trachoma 123.460 139.8 102.215 114.5 91,684 101. 6 77,922 85.5 63.404 68.9 54.992 59.21 Infectious 109 O. 1 81 O. 1 424 0.5 37 0.0 45 0.0 131 0.11 Diarrhea Tsutsugamushi 74 0.1 43 0.0 38 0.0 41 0.0 35 0.0 40 0.0, Disease

Schistosomiasis 1. 537 1.7 1.349 1.5 1,442 1.6 664 0.7 1,983 2.2 936 1.0 Japonica

Filariasis 187 0.2 61 O. 1 98 0.1 61 0.1 122 O. 1 39 0.0

Syphilis 33.829 38.3 28.673 32. 1 24,323 26.9 18,011 19.8 13,211 14.4 11,468 12.3 Gonorrhea 141. 416 160.2 434.571 150. 7 116.842 129.5 86.195 94.6 24.367 26.5 9.970 10.7 Chancroid 8,745 9.9 4.636 5.2 3.068 3.4 2.216 2.4 733 0.8 266 0.3 Lymphogranu- 125 O. 1 70 O. 1 40 0.0 25 0,0 31 0.0 6 0.0 lomatosis

I 1 [ Inguinale

14. Port Quarantine

The port quarantine service in this country is being carried out, in accordance with the

Quarantine Law of 1951 (partially amended in April 1956) and the Law concerning Special

Instances of the Quarantine Law relating to Military Vessels, etc., by the Quarantine Stat­

ions, Branch Quarantine Offices and Detached Quarantine Offices located at 40 seaports (2

quarantine stations at Keihin Port and 1 quarantine station and 1 branch office at Kanmon

Port) and 4 airports. The set-up of those quarantine stations as of Dec. 1959 are as follows:

Seaport

Stations

Airport Stations

Table 20. Quarantine Facilities at Seaports and Airports. -----------------------

( \ a) Hakodate; Kobe; Moji; Nagasaki; Nagoya: Sasebo; Yokohama 1) b) Hakata; Hiroshima; Kagoshima; Miike; O~~ka; Otam; Shimizu; Tokyo

a) Kamaishi; Kure; Maizuru; Muroran; Tokuyama-Kudamatsu; Wakamatsu; e 2) Wakayama-Shimotsu; Yokkaichi; Yokosuka; Niihama

b) Naze

I Aomori; Funakawa; Fushiki-Toyama; Hachinoe; Hososhima; Izuhara; Kushiro;

e 3) Misumi; Nanao; Niigata; Onahama; Sakaide; Shiogama; Tsukumi; Tsuruga; Yoron

Ie 4)1 Itazuke; Iwakuni; Osaka; Tokyo--Airport

r

. ,

- 27-

L Those 7 quarantine stations shown in the column (1) a) of Table 20 are equipped

with the quarantine hospital, detention house, disinfecting room and deratting facility.

2 Those 15 quarantine stations shown in the column (1), and 10 branch quarantine

offices shown in the column (2) a), and 2 detached quarantine offices shown in the column

(3) have the equipment and personnel necessary for deratting.

3. Those 1 branch quarantine office shown in the column (2) b), and 14 detached

quarantine offices shown in the column (3), have no such facility mentioned above, but

are able to perform routine quarantine business.

4. Every station or office attached to the seaport is able to issue the deratting

exemption certificate.

5. The airport quarantine service is being carried out at 4 airports shown in the

column (4), and the Tokyo International Airport which is designated as the Sanitary

Airport is equipped with the disinfecting room.

During the year 1959, 13,705 vessels and 5,058 aircrafts, involving 757,622 and 211,239

persons, respectively, received quarantine inspection. and the vessels which re::eived derat­

ting service amounted to 1,144, and those which received deratting exemption certificate

amounted to 2,282, respectively.

15. Environmental Sanitation

Insect 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 financial assistance of the Ministry

of Health and Welfare. At present each of the local health centers have the full-time

staff to perform technical guidance for its district.

Ever since 1950, the model districts have been established in various parts of the

country in order to demonstrate insect and rodent control program under the initiative

participation of organized community people, and this has been quite successful not only

in the control of insects and the prevention of insect-borne diseases but also in popularising

the basic hygienic understanding and public consciousness, and thus in the general deve­

lopment of community social life. In 1955, the government initiated the three-year project

for the movement of establishing "the life free from mosquitoes and flies", by which the

eradication of insects was promoted. This movement was widely supported by positive

understanding and cooperation of general public as a proper movement for the improvement

of people's every-day living, and the nation-wide effort was put into action. As the result,

although this three-year project was over, even at present the movement is continuing

under the supervision of each prefectural government, increasing the number of organized

communities for this purpose yearly to the total of 64,462 communities at the end of

March, 1959.

In view of the fact that this kind of organized activities of community is needed in

various aspects of health and welfare, the government took the special budgetary measure

in 1959 in inaugurating the National Council for the Promotion of Community Health and

Welfare Programs (juridical person), for the purpose of development of organized projects

in the communities.

-- 28 -

Kightsoil, Trash, and garbage Disposal

1. Nightsoil

Flush-toilet system is not yet widely developed due to the insufficient sewerage

system in our country_ Nightsoil collected are mostly carried to the farms for use as

fertilizer. However, such need is decreasing because of the increase in the use of chemical

fertilizer. In spite of that, quantity of nightsoil in urban area is increasing because of the

rapid increase of the population. Consequently, majority of cities are faced with increasing

difficulty for disposal of nightsoil recently.

Since 1953, nightsoil digestion plants have been constructed and operating in 80 cities.

2. Trash and Garbages

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. The composting

plants of other types were constructed in 6 cities, and the similar plans are being

made in other cities. Incineration is the main method in trash and garbage disposal, and

approximately 250 incinerators are operating in municipalities.

16. Water-Works and Sewage Treatment

Water-Works

1. Population served with water supply system as of April 1958 is shown below:

Number Population served --_.

Urban 821 32,276,447

Rural 9.411 5,763,178 I

Private 7,686 2,678,137 I Total 17,918 40,717,762 -I

(Note; "Rural" means those so-called "small-scale water supply system", covering less than 5,000 population and "Private" means those belong to other than municipalities. Data for 1959 is not available yet.

2. Legal provisions to develop water supply facilities:

Under the provisions of Water-Works Law of 1957, which superseded the old Water­

Works Regulation of 1890, the water supply installation can be provided by cities, towns.

villages, syndicates, privates, provinces, and other communities so as to elevate the standard

of public health by improving the environmental sanitation and by supplying safe drin­

king water.

3. Subsidies:

The Minister of Health & Welfare may subsidize for the establishment of water

supply system and so-called small-scale water supply system. with one forth of the total

expenses.

Sewage Treatment

1. Number of cities .... ··················· .. ··· .. ······21 (April 1960)

2. Amount of total flow treated ·········· .. ······1,146.578 m3/day 3. Number of population treated ............. ··4,586.271

4. Sewerage Law (Law No. 79 of 1958). By this law the sewerage installation can

, , ..... -.. -

'.

i

- 29-

be provided by the public expense of cities, towns and villages, and its construction is

limited on the public land.

5. The Cabinet Decision made on 1 July 1957 had devided the administration of

sewerages as the following: 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

1. Food Inspection

4,210 food inspectors (including 2,282 inspectors holding an additional post) are stat­

ioned in 790 local health centers to work on 1,907,899 food-handling establishments

(including 1,039,935 establishments which are not required to be licensed). They perform

inspection on the establishments and supplies of food and drinks.

2. Food Poisoning

During the year 1959, the reported food poisoning cases were in total 2,468, involving

39,899 patients and 318 deaths.

As regards the causes of food poisoning, 303 cases with 11,617 patients were due to

bacterial infection and entero-toxin; 3 cases with 16 patients were due to chemical

poisoning; 266 cases with 1,077 patients were due to poisonous plants and animals; and

others were unknown.

As regards the type of food causing these poisoning, 1,376 cases with 15,427 patients

involving 217 deaths were by fish, shellfish and their products; 281 cases with 4,881

patients involving 24 deaths were by cereals, vegetables and their products; 71 cases with

4,229 patients involving 3 deaths were by milk, egg, meat and their products; 227 cases

with 7,640 patients involving 17 deaths were by other food, and 513 cases with 7,722

patients involving 57 deaths were by unknown food.

As regards the kind of places where the causative food was taken, 1,626 cases with

13,121 patients involving 274 deaths were at home; 378 cases with 16,881 patients involving

9 deaths were at the establishments for mass feeding such as ia the business place,

school, hospital and so on; 150 cases with 3,321 patients involving 3 deaths were at

hotels; 88 cases with 1,131 patients involving 6 deaths were at restaurants; 179 cases

with 5,211 patients involving 13 deaths were at other places and 47 cases with 234 patients

involving 13 deaths were at other unknown places.

3. Food Additives

Chemical synthetics to be used as food additives are fully controlled by authorization

system. by . the government, and they are listed in the Enforcement Regulation of Food Sa­

nitation Law. Approximately, 230 synthetic food additives are authorized for use at present.

The manufacturers or processors of synthetic food additives or their preparations are

required to have a qualified self-inspector by the law. In addition to the above mentioned control, the additional certification system is applied

to coal-tar colours and several other food additives. These specified additives are required

to be tested for each lot and to be certified by the Minister of Health and Welfare or the

prefectual governor concerned before sale.

- 30-

The Official Book on Japanese Standard of Food Additives was published on March

15th, 1960. This Official Book prescribes the standard of 230 food additives, containing

definitions and standards of identity, specified use or restrictions, etc. This book was

made by the sub-committee of Food Sanitation Investigation Council which is provided by

the Food Sanitation Law.

4. Food Preservatives

Recently many attempts have been made to utilize antibiotics to preserve food, espe­

cially fish. However, it is necessary to have further investigation on the allergic conditions

which antibiotics may give rise, or the creation of microbial resistance to antibiotics, and

the effects on the intestinal flora. Under these circumstances, the use of chlortetracycline

was widened on 10th of May, 1960 and is only permitted in case of using it in the icc

which is used for preserving such fish to be used as the raw material for such product

as "fish-cake, canned fish, salted fish and drycured fish." In this case, the amount is restr­

icted to less than 5 p.p.m., and its possible residue in/on fish is restricted to less than 0.1

p.p.m.

5. Inspection of Imported Foodstuff

The imported foods are inspected by the inspectors of the Ministry of Health and

Welfare at the main ports in our country.

During the year 1959, 6,500,000 tons of foods were imported to our country, and

approximately 578,000 tons of foods were rejected as the results of inspections. These

rejected foods were soya-beans containing morning glory seeds, milk products contaminated

with bacteria and mould, confectioneries coloured by unauthorized coal-tar color, and other

decomposed foods.

In view of the importance of soya-bean as a food in Japan, the soya-bean which con­

tains morning glory seeds has been strictly controlled by the Ministry of Health and

Welfare.

Veterinary Sanitation

The following table shows the number of food animals slaughtered and of carcasses

condemned during the year 1959.

Table 21. No. of AnimialR Slaughtered and of Carrasses Condemned.

(1959)

Cattle Calves Sheep I Goat Swine Horses Total Total No. Slaughtered

696,667 181, 051 114,712 , 120,273 3,562,160 134,264 4,809,127

No. prohibited from 14 5 2 1 321 14 357 slaughtering

No. of condemned carcasses 422 132 21 14 686 81 1,356

No. of condemned parts (meat) 9,120 1, 506 229 64 141, 110 3,069 155,098

No. of condemned 1,876,2d parts (intestines) 223,521 7,694 10,052 5,054 1,608,035 21, 889

--

Rabies Control

The rabies control program is also under the veterinary sanitation program in our

, .. • • ~

f f

.. ,;

- 31-

country, and the incidence of rabies and casualties therefrom during the year 1945 to 1959

are shown in Table 22 below.

Table 22. Incidence of Rabies and Casualties therefrom. (l945~1959)

Year I No. of Cases of Rabies in lJQgs

I No. of Persons bitten by Rabid Dogs

I No. of Cases of Rabies in Men

1945 94 159 1 1946 24 86 1 1947 37 129 17 1948 141 387 46 1949 614 1, 617 74

1950 867 1,866 57 1951 319 677 13 1952 232 389 5 1953 176 316 3 1954 98 178 1

1955 23 41 0 1956 6 10 0 1957 0 0 0 1958 0 0 0 1959 0 0 0

18. Nutrition

Nutritionist

Licensing of nutritionist is given to those graduating the training school of 2 to 4

years authorized by the Minister of Health & Welfare, or to those successfully passing

national examinati.on for nutritionist. There are 113 authorized training schools and 41,752

licensed nutritionists as of the end of December 1959.

National Nutrition Survey

The national nutrition survey has been conducted four times every year since 1946

in order to determine the condition of nutrition of the entire population. The following

tables show some of the result of the survey.

Table 23. Appearance of Physical Symptoms C%).

0950-1959 )

Symptoms J 19501195111952\1953\1954\195511956119571195811959

No symptoms 76.3 78.4 77.1 77.4 75.9 77.5 77.4 74.1 75.6 75.6 One or more symptoms 23. 7 21. 6 22.9 22.6 24.1 22.5 22.6 25.9 24.4 24.4 Anemia 3.3 2.8 3.4 2.5 2.3 2.3 2.6 2.6 2.7 2.4 Hyperkeratosis 1.7 1.8 2.2 2.4 2.6 2. 7 3.1 3.5 3.5 2.9 Xerophtalmia and keratomalacia 0.1 0.1 - - - - .- - - -Cheilosis 7.4 7.1 4.5 4.7 5.4 5.4 5.4 6.3 6.3 5.7 Glossitis 1.6 1.1 - - - - - - - -Loss of knee ier k reflex 8.0 7.0 7.3 7.4 7.5 6.8 9.1 10.5 9.5 10.9 Edema 1.2 1.1 2.0 1.7 1.8 1.5 2.8 2.6 2.8 2. 7 Chronic diarrhea 0.6 0.5 - - - - - - - -Chronic disorder of stomach and intestine - -- 4.01 4.1 4.8 4.4 - - - -Bradycardia 3.0 2.8 3.4 3. 1 2.8 3.0 - -- - -Delayed menstruation or amenorrhea 9.6 9.3 11. 0 10.0 10.2 9. 7 - -- - -Deficiency of lactation 22.4 23.4 21. 7 19.6 25.2 26.8 - - - -Pain in calves - - - - - - 5.3 6.5 5.5 6.2

- 32-

Table 24. Intake of Nutrients (per capita per day). (1950~1959)

Year I 1950 I 1951 I 1952 I 1953 I 1954 I 1955 I 1956 I 1957 I 1958 I 19591

Cal. 2,098 2,125 2,109 2,068 2,074 2,104 2.092 2,089 2,118 2,117 Proteins

Total (g) 68 68 70 69 69 69.7 69.1 69.6 70.1 69.3 Animal (g) 17 19 23 22 22 22.3 22.6 23.2 23.8 23.5 Vegetable (g) 51 49 47 47 47 47.4 46.5 46.5 46.4 45.8

Fat (g) 18 18 20 20 21 20.3 21. 8 21. 9 23.7 23.8 Carbohydrate (g) 418 424 412 403 403 411 405 404 406 406 Minerals

Ca. (mg) 270 270 373 370 362 338 379 384 388 385 Phos. (mg) 1,820 1, 820 1, 790 1,840 1, 820 1,370 1, 350 1,351 1. 369 1,359 Iron. (mg) 46 49 65 61 60 14 16 14 15 14

Vitamins A (I.U.) 2,459 2,262 2,700 2,721 2,814 2,889 3,175 3,374 3,282 3,202 Bl (mg) 1. 52 1. 58 1. 14 1. 07 1.12 1. 16 1. 13 1. 09 1. 07 1. 05 B2 (mg) 0.72 O. 76 0.66 0.65 0.66 0.67 0.70[ 0.71 0.73 0.74 C (mg) [ 107 99 77 72 75 76 77 77 77 78

School Lunch Program

School lunch program in Japan began in 1946, and at present about 9,420,000 primary

school children (68% 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 commenced

in 1956, and as for the evening high school students in 1957.

Demonstration Kitchen Car

Since July 1954, several prefectures have initiated mobile nutrition demonstration

service. They built the bus-type mobile-kitchen car, completely equipped with necessary

cooking utensils, supply of water, and gas fuel for nutrition demonstration. They are called

"Demonstration Kitchen Cars," and the trained nutritionists used the cars for lecture

demonstration on preparation and cooking method for balanced diet for the house-wives

and women groups. These mobile nutrition demonstration is now very popular and is

receiving warm welcome from the house-wives wherever they go.

Enriched Food

The enriched food has been strongly advocated by the government in Japan, and at

the end of May 1960, the number of enriched food permitted by the Ministry of Health

and Welfare in accordance with the provisions of "Nutrition Improvement Law," amounted

to 1,285. Those food such as the rice, flour, bread, noodle, bean-paste, jam, soft drinks,

canned fruit, biscuit, etc., are enriched with vitamin A, thiamine (vitamin B\), riboflavin

(vitamin B2), vitamin C, calcium, iron, 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 rice containing 1.2~ 1.5 mg. thiamine and a bit of riboflavin will be mixed in

the polished rice at the ratio of 1 to 200 when enriching rice. Approximately 160 tons of

enriched rice is now consumed every month.

The Cooks Law was enacted in May 1958, which stipulates the authorization on and

supervision of the training institutions of cooks and the examination for qualifying cooks.

There are 22 authorized training schools and approximately 61,570 licensed cooks as of

the end of 1959.

-?

19. Dental Health

Prevalence of Dental Caries

The high percentage of prevalence of dental caries at all ages was revealed by the

dental survey carried out in November 1957. It was 84.1% in male and 86.0% in female,

85.1% in average. The survey also revealed that the number of DMF permanent teeth

per capita was those as follows:

Number of DMF Teeth (per capita, permanent teeth)

Ii ---~------ Age I Sex~

Male

Female

Preventive Program

6

0.5

0.7

10 15

2.1 3.1

2.4 4.0

20

4.3

5.0 I I

About 300 health centers out of a total of 790 health centers which are equipped

with dental facilities and dentists, and the schools, are playing important role in carrying

out the preventive program on dental health. Each school has the school dentist in

accordance with the School Health Law. Dental examination, health guidance and advice

are being given effectively in those facilities, and particularly many schools have been

taking proper preventive measures in their own facilities.

Since 1952, the dental examination and health guidance for pregnant women and

infants have been put into practice, in accordance with the Child Welfare Law, in the

health centers or by guidance dentists designated by the Law. Consequently, 179,638

dental health guidance for pregnant women were given in 1959; for infants it was 465.50l.

Fluoridation of water has been put into practice in Yamashina disirict, Kyoto, since

1952, and the prevalence of dental caries in that area has been reduced by 30% com­

paring with other areas of the country; the fluorine content in the water in that area

was 0.6 ppm. The Department of Dental Health Research created in the National Institute

of Health of the Ministry of Health and Welfare in 1958, has been conducting many research on the prevention and treatment of oral diseases.

Dental Personnel

As of Decemper 31, 1958, there were 32,484 dentists, of which 31,032 engaged in

practice (about 90%). The number of dental hygienists as of December 31, 1959 was

1,156 and the number of registered dental technicians as of December 31, 1959 was 7,218.

Dental Clinic

As of December 31, 1957, there were 26,028 dental clinics, of which 25,645 were

private ones (about 98.5%), and the number of general hospitals and general clinics

which have dental facilities were 910 out of 5,833 hospitals, and 1,528 out of 56,048 clinics.

/'

- 34 - ,,...,,,

20. Mental Health Legislations

The mental health program has increasingly attracted public and professional at­tention in these years. In accordance with the recent developments in the concept of mental disorder, the Mental Health Law was put into force in 1950, repealing all the previous legislations which had the main objective in the safe custody of mental patients. Under this Law, in addition to the provisions of institutional care for the patients, the community care and the preventive work in mental health services are accelerated. Services for the mentally retarded children and child guidance activities are provided under the Child Welfare Law of 1947. In order to extend service for the mentally retarded people in general, the Law for the Welfare of Mentally Retarded Persons was enacted in March 1960.

Surveys According to the statistical survey carried out in 1954 on a nation-wide scale, the

estimated number of mental cases was found to be 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% manic­depressive illness, 9.6% convulsive psychoses, 44.5% mental deficiency and 13.5% other types of mental disorder. Out of these cases, 90.9% of the schizophrenic, 75.0% of the manic-depressive, 67.6% of the convulsive psychotic and 64.6% of the mentally retarded were already known as the abnormal by the relatives or the other lay people, and the rest had been the unknown cases untill the psychiatrists engaged in the survey saw them and gave the correct diagnosis at the time of survey.

In the Mental Hospital Inpatients Survey of July, 1956, about one fifth of all the mental hospital inpatients and the ex-patients who had been discharged during the preceding 6 months of the date of the survey were statistically analysed, mainly on their diagnosis, clinical pictures, treatments, etc. The figures in the following tables show the percentage distribution of the inpatients and the discharged ex-patients.

1. Age and sex

I Age I I

Sex Total ~ 19 20 ~ 59 60 and ove.r

I

-------Both sex 6,3 86,4 7,3 100,0

Inpatients Male 3.5 53.0 4.9 61.4 Female 2.8 33.4 2.4 38.6

Both sex 10.0 83.3 5.8 100.0 I Discharged Patients Male 5.9 51.4 3.1 60.4 Female 5.0 31.9 2. 7 39.6 I

2. Diagnosis

I Inpatients I Discharged Patients

Schizophrenia 70.0% 51.5% Manic·depressive illness 3. 7 10.1 Epilepsy 3.8 2.9 Psyclioses due to syphilis 8.3 5.9 Psychoses with alcoholism and drug addiction 2.3 6.2 Other types of psychoses 4.2 7.5 Psychopathic personalities 1.4 1.5 Psychoneuroses 2.8 11.8 Mental deficiency 3.0 1.8

I Other types of mental disorder 0.5 0.8

Total I 100.0 \

100.0 I ~ -- •... ~'-" ~ -

3. Sourcc of the Payments of Inpatients.

All paid by patients Heal th and social insurances Daily Life Security Law Mental Hygiene Law Others

Total

8.5% 31. 2 44.0 14.6 1.7

100.0

4. Duration of Stay in Mental Hospital. 5. Waiting Period from Outbreak to Hosp­

italization of Those who are Hospitalized for the First Time

Duration I Dischargedl I l' t Patients npa len s Period I Those hospitalized for the first time

Lcss than 3 months 46.2% 20.9% 3 months -- 26.3 13.5 6 months -- 14.5 13.6 1 year-- 7.3 16.5 2 years -- 4.8 22.4 5 years and over 0.9 13.0

Less than 3 months 22.8% 3 months 9.3 6 months 11..2 1 year 13.4 2 years 16. :1 5 years and over 17.9 unknown 9.1

Total I 100.0 I 100.0 I , Total I 100.0

Mental Hospitals

The latest figures of hospital accommodations available for mental patients are shown

in Table 25 below. The .latest figures of mental hospitals (excluding the psychiatric

untis in' the general hospitals), their beds, hospitalized patients, bed occupancy, and

monthly out-patients are shown in Table 26. The mental hospitals and psychiatric

units in the general hospitals as classified by the bed-capacity are shown in Table

27. The mean capacity is calculated to be 145 in the former, 47 in the latter, and the

median capacity is 109 in the former and 50 in the latter (1959).

Table 25. Psychiatric Beds* (March, every year)

I National & Prefectural

I Private, Juridical Persons

I Total & Others

1953 7,268 27.0 19,622 73.0 26,890 100.0 1954 8,419 25.6 24,415 74.4 32,834 100.0 1955 9,722 24.9 29,388 75.1 39,110 100.0 1956 10,744 23.5 34,905 76.5 45,649 100.0 1957 12,175 21. 3 45,045 78.7 57,220 100.0 1958 13,508 20.4 57,857 79.6 66,365 100.0 1959 14,800 19.4 61,333 80.6 76,133 100.0 1960** 16,931 19.8 68,541 80.2 85,472 100.0

I I

Note '" All psychiatric beds including beds in the mental hospitals and general hospitals. ** As of the end of Jannary 1960.

Table 26. Mental Hospitals (average, every year) -----------------------------,-----

I 1953 I 1954 I 1955 I If56 I 1957 I 1958 I 1959 I - -

348 I Mental Hospitals 182 206 241 291 391 438 ~ Mental Beds 24,500 27,700 33,100 39,500 48,000 55,500 63,401 I Inpatients 27,600 30,900 36,200 42,400 50,500 59,400 67,261 I

Bed Occubtncy 112 112 111 107 105 107 106 Monthly ut-patients 33,700 36, 700 43,400 51,800 63,800 71,600 90,091 I Monthly Out-patients per ,I Hospital 185 178 188 178 183 183 206 j

- 36-

Table 27. Capacity of Mental Hospitals & Psychiatric Units in the Geneneral Hospitals.

(end of March, 1959) r

I Mental Hospitals Psychiatric Unit Total

Figures % Figures % Figures %

Bed Capacity i 195811959 1958 11959 1958 11959 1958 11959 1958 11959 195811959 -

~I o[ 51 Less than 10 0 0 8 5 4. 7 2. 7 8 1.4 0.8 10 ~

01 0 0 15 17 8.8 9.2 15 17 2.6 2. 7

20 ~ 57' 61 14.1 13.6 63 58 37.1 31. 4 120 119 20.9 18.8 50 ~ III 112 27.5 24.9 51 67 30.0 36.2 162 179 28.2 28.2

100 ~ 110 132 27.2 29.4 20 23 11.8 12.4 130 155 22.6 24.4 150 ~ 50 55 12.4 12.2 -1 -1 2.4 2.2 54 59 9.4 9.3 200 ~ 38 46 9.4 10.2 3 5; 1.8 2.71 41 511 7.1 8.0 300 ~ 14 17 3.5 3.8 3 3 1.8 1. 61 17 20

1

3.0 3.2 400 ~ 15 15 3. 7 3.3 3 2 1. 8i

1.1 18 17 3.1 2.7 500 ~ 5 6 1.2 1.3 0 1 . 0 0.5' 5

~I 0.9 1.1

600 ~ 1 2 0.2 0.4 0 0 0 0 1 0.2 0.3 700 ~ 2 2 0.5 0.4 0 0 0 0 2 21 0.3 0.3

I

800 ~ 0 0 0 0 0 0 0 0 0 0 0 0 900 ~ 1 1 0.2 0.2 0 0 0 0 1 1 0.2 0.2

1000 and over 0 0 0 0 0 0 0 0 0 0 0 0

I Total 404 449 100.0 100.0 170 185 100.0 100.0 574 634 100.0 100.0

Mental Health Clinics and Child Guidance There are 42 prefectural and 6 municipal mental health clinics in this country operated

under the Mental Health Law, through which local health authorities provide services for

persons in psychological difficulties as well as mental disorders. Child guidance services

are also provided at 123 child welfare centers by the local welfare authorities under the

Child Welfare Law.

Care for Mentally Retarded Children

As of the first of March, 1960, 6,913 mentally retarded children were under the care

of 115 Homes for Mentally Retarded Children, and 644 children were attending 21

Mentally Retarded Children Day Care Centers. The National Home for Mentally Retarded

Children was established in April 1958 and has been operating particularly for the severe

cases of mentally retarded chldiren. All of them are now operated under the Child

Welfare Law.

Training and Education of Juvenile Delinquents

The children committing or liable to commit delinquent acts are admitted to the Home

for Training and Education of Juvenile Delinquents where they are given training and

education under the Child Welfare Law. As of the end of March, 1960, there were 5,128

iuvenile delinquents who were institutionalized in 56 homes. There is one national home

for delinquent boys, and another one for girls will be established in 1960.

21. Care and Rehabilitation of the Physically Handicapped

Statutory Provisions and Organization for the Services Under the Law for the Welfare of Disabled Persons of 1949, it is the duty of the

prefectural governors to establish and operate the consultation centers (49 centers in 1958)

where the blind, deaf and crippled adults could be examined and receive the guidance

from the medical, psychological and vocational standpoints, and to provide the prefectural

- 37~

social welfare offices (1,010 offices in 1958) with the staff specialized in the services for

the welfare of physically handicapped persons.

Provisions of the services for physically handicapped children under 18 years of age

are included in the Child Welfare Law of 1947. In this case, consultation clinics are

provided at the health centers.

The Blinds

Blind persons and persons with defective vision are provided under the Laws with

walking-sticks, artificial eyes, pairs of glasses etc., and if necessary, with the medical

treatment for the recovery of vision.

There are 3 national and 2 prefectural Homes for Blind Adults where the blind adults

are given the vocational guidance and medico-psychological treatments they need. Blind

and partially sighted children are received in 34 Homes for Blind Children and are

educated in 73 Schools for Blind Children.

There are several publishers who are publishing books in braille points, and also

several libraries for the use of the blinds.

Deaf Persons

Persons with deafness or defective hearing are provided with various hearing aids

and medical treatments for the recovery of hearing.

The National Rehabilitation Center for the Deaf and Mute was established to give

the persons with deafness or defective hearing the comprehensive medico-psychological

treatments and vocational guidance. There are 41 Homes for Deaf Children and 92

Schools for Deaf Children.

Crippled Persons

Crippled adults and children have been provided under the Laws with prosthetic

appliances, wheel chairs etc., and, in case of need, medical treatments.

The National Rehabilitation Center for the Handicapped in Tokyo and 41 prefectural

rehabilitation centers provide crippled adults with medical treatments, physiotherapy and

vocational guidance. The Hospital-Homes for Crippled Children provide integrated services

of medical care and rehabilition for the seriously crippled children. As of the end of

December, 1959, there were 3,206 accommodations for children in 41 Hospital-Homes for

Crippled Children all over Japan. In addition to the hospital-homes, there are 14 special

schools where the crippled children are receiving school education.

22. Radioactive Isotope and Peaceful Uses of Atomic Energy

The use of radioactive isotope CR. I.) in our country has been commenced since 1950,

and now it is being used at more than 1,000 institutions. It is mostly used in medicine

in the field of research, diagnosis, and treatment, which is about 60% of the total R. 1.,

while 20% is for agricultural and biological research, 10% is for industrial research and

production, and the remainder is for basic research in physics and chemistry.

The organization of the government responsible for the development of the peaceful

uses of atomic energy in our country is the Atomic Energy Commission and the

Atomic Energy Bureau of the Science and Technics Agency of the Prime Minister's

Office. Particularly, the Isotopes Section of the said Bureau of the Agency is the main

-38-

body in the national government in dealing with the production of R. 1., planning and

execution of its uses, and the prevention of hazard that may occur through use of R. I.

is dealt by the Radiation Safaty, Section of the same Bureau.

The various Ministries are sharing the respective responsibilities in the research work

and the uses of R. I. in the field of their own concern. Various research work on the uses

of R. I. in the field of public health is being carried out at the National Institute of Health,

Instituteof Public Health, National Institute of Hygienic Sciences, National Institute of

Nutrition, and National Institute of Leprosy Research, all of which belong to the Ministry

of Health and Welfare, and the laboratory facilities for R. I. at those institutions are

being strengthened and expanded under the current year in order to carry out more

intensive research work. The uses of R. I. in the field of medicine for diagnosis and trea­

tment is also being done at the National Hospitals, among which the First National

Hospital of Tokyo, Second National Hospital of Tokyo, Osaka National Hospital, National

Sanatorium Kiyose Hospital and National Sanatorium Toneyama Hospital are the main

ones.

In order to perform coordination of the research work on the medical uses of R. 1.

and the prevention of radiological hazard, the National Institute of Radiological Sciences

was created in 1957 under jurisdiction of the Science and Technics Agency, and the main

buildings were completed in April 1959.

For the purpose of preventing possible health hazards from radiation that may arise along the development of peaceful uses of R. I., "Law concerning Prevention of Radiation

Hazards due to Radioactive Isotopes and Others" was enacted in June, 1957. While, for

the purpose of preventing possible hazard that may occur at the medical institutions

and drug manufacturing factories, the Ministry of Health and Welfare found the necessity

of providing legal measures, and, consequently, the Enforcement Regulations for Medical

Service Law and the Enforcement Regulations for the Pharmaceutical Affairs Law were

revised in May and August, 1959, respectively. In addition, the Radiation Council of the

government has been studying about the Recommendations of the International Com­

missions on Radiological Protection (9 Sept. 1958) since August last year, and in March this year they reached the conclusion that in principle the said recommendation should

be accepted in our country also. Therefore, necessary amendment of relevant laws and

regulations is expected to be made in the near future.

As to atomic reactors in our country, one JRR-1 type reactor was built in the Japan

Atomic Energy Research Institute at Tokai Village, Ibaragi Prefecture, and JRR -2 and

JRR -3 are being built at present. At some of the universities, establishing of small type

atomic reactors for physical research purpose is being planned. The atomic reactor for

the medical use has been contemplated, but no definite plan has been made yet.

23. Occupational Health

The occupational health program in this country is based on Labor Standards Law

and is implemented by the Ministry of Labor. As of the end of December, 1959, there

were 2,350 labor standards inspectors, who made the inspection of 243,653 factories out

of the total of 1,367,953 factories including inspection of the health condition of the facilities

---

- 3.9 -

and workers. Silicosis is the major problem and the special compulsory health examination

is performed. The patients are given benefits out of workmen's compensation scheme

for their treatment.

Under the Labor Safety and Hygiene Regulations, larger type factories are required

to appoint the health supervisors duly licensed by the government.

24. Hospitals and Clinics

Medical Service Law provides the detailed qualification for hospitals (medical care

facilities having 20 or more beds), while the Law does not provide such detailed

requirements in case of clinics (medical care facilities without or with less than 19

beds) and the administrator of these clinics must endeavor not to keep their patients for

more than 48 hours except when inevitable circumstances exist. The hospitals are inspected

and graded yearly by the medical inspectors on the basis of physical facilities, professional

staff, and hospital management. This inspection system contributes greatly for the

improvement of hospital services to the patients.

It is true that the number of hospitals as well as their beds in our country has

been increased rapidly in recent years, and they are thought to be quite sufficient in

number as far as per population ratio is concerned. However, we are now confronting

with the problem of inadequate hospital planning and distribution, which resulted in rece­

iving complaints of scarcity of medical facilities in some areas.

In order to relieve the problem. the government has been preparing revision of the

Medical Service Law, by which the government can exercise its authority in controlling

their planning and distribution.

As for function of medical facility, because of the progress of medical science, it is

necessary to improve function as well as to increase the number of hospitals and clinics.

In order to meet these demand, government has established "The Law for Medical Care

Facilities Finance Corporation" in June, 1960. By this regulation, the Corporation, will lend

low-interest and long-term loan to the private hospitals and clinics. The original funds of

this Corporation are about 3,000 million yen.

the following tables show the statistics of hospitals and their beds.

Table 28. Number of Hospitals and Clinics.

Hospital General Clinic Dental Clinic

6.002 (as of the end of 1959) I 56,048 (as of the end of 1958) I 26.367 (as of the end of 1958)

Table 29. Number of Hospitals, Beds, and Bed Occupancy Rate. (Based on the Hospital Monthly Report)

a. Number of Hospitals. (as of the end of 1959)

I--~~ Kind of I I Tuberculosis I Mental I ~ ___ -----':: _______ ~=i~alj Total Sanatoria Hospitals

Number of Hospitals --~--6~-~~~1 655 476 ! (at the end of year)

1 Number of Bed . (at the end of year) L-_~ ______ ._. ___ ~_

662.273 121.721

L . I Communicable I General eprosana Disease Hospital I Hospital

631

5.0241 453.934

141

14. 260 1

4. 794

67.319

~ 40-

b. Number of Beds and Bed Occupancy Rate. (1959)

Kind of I I TB Bed I M I B d I L B d I Communicable

I General - Bed Total enta e eprosy e D· B d Bed .. __ ._---- lsease e

Num ber of Beds

I

662,273 260,082 84,97l 14,260 I 22,220 280,660

Occupancy Rate 80.4 79.4 104.7 76.1 24.6 78.9 Bed

Note: "Bed Occupancy Rate" refers to the number of in-patients per 100 beds of the official rated capacity.

25. Medical Care Personnel

Qualification of Medical Care Personnel

J

Better standard of qualification for the medical care personnel has always been the

matter of great concern for the government. The Fig. 8 shows the qualifications of various

personnel as of 1960. Table 30 shows the number of training institutions for personnel

and of students graduating annually.

Fig. 8. Standard of Qualification for Medical Care Personnel.

Table 30. Number of Training Institutions for Personnel and of Students Graduating Annually.

(as of June, 1960)

I

Number of Training

I Number of Students

Institutions Graduating Annually

Physician 46 I

2,860 Dentist 7 650 Pharmacist 31 2,510 Public Health Nurse 33 980

University 2 Junior college ! 1 Others 30

Mid-wife 23 485 Clinical Nurse 187 5,215

University 2 Junicr College 5 Others 180

X-ray Technican 17 755 Dental Hygienist 13 420 Dental Technician 5 145 Assistant Nurse 524 13,222

-f ..

- 41-

Under the requirement of various Japanese laws, such as Medical Practitioners' Law,

etc., the person holding a license to practice as the respective medical care personnel in a

foreign country is allowed to practice in such capacity of the respective medical care

personnel in our country only when he obtains the Japanese license concerned after passing

successfully the national or prefectural examination. Also, the law does not allow any

reciprocal arrangement between the countries concerned as regards qualification for practi­

cing referred to above.

Number of Medical Care Personnel Tables 31, 32 and 33 show the number of personnel. Although statistically speaking,

the number of physicians, dentists and pharmacists is about the same as those in European'

countries on a per-population basis, the government has been confronted with the

difficulties of excessive concentration of those personnel in the urban areas and of lack of

qualified personnel in the field of public health work.

Table 31. Number of Medical Care Personnel.

I Physician Dentist Ph . t I Public Health Midwife Clinical Nurse armaClS ,Nurse

I Year T II Per TIl Per 1 I Per I Tllrer-- TIl Per T I I Per I ota 1 10,000 ota . 10,000 Tota 10,000 Iota 10,000 ota 10,000 ota 10,000

No. P No, ! P No. P No. P No. P No. P i I op. I op" i op. op. .op. I lOP·

I 1952 I 85\ 9.9\ ~I 3.4\ 50 5.8 I 12 1.4 55 6.4 105 12.2

I 1953 90 10.3 3.5 51 5.9 12 1.4 56 6.5 112 12.9 ! 1954 92 10.5 31 3.5 51 5.8 12 1.4 56 6.3 119 13.5

1955 95 10.6 31 \

3.5 52 5.9 12 1.4 55 6.2 130 14.6 1956 96 10. 7 32 3.5 53 5.9 12 1.4 54 6.0 137 15.2

I 1957

\

98\ 10.8

32\ 3.5 55 6.0 12 1.3 52 5. 7 145 15.9

I 1958 100 10.9 32 3.5 57 6.1 12 I 1.3 52 5. 7 160 17.4

Table 32. Number of Physicians and Dentists by Type of Work.

Cas of the end of 1958) ..

---------------- '- No. of Physicians & Dentists Physician Dentist ----- '" '. ----Type of Work

--------------.------- Number Number

Owner of hospital or clinic 47,907 24,798 Employed in hospital or clinic 35,042 5.621 Teacher and research worker of clinical medicine 9,421 613 Teacher and research worker of medicine other than 2,515 184

clinical medicine Engaged in other public health service 2,415 218 Others 2.576 1,050

Total I 99,876 I 32.484

- 42-

Table 33. Number of Nurses and Midwives Actually Engaged in the

Type of Work

Administration and Teaching Hospitals and Clinics Health Centers Industries Schools Cities, Towns and Villages Private Duty Others

Total

I I

I

Public Health Nurses

55 401

5,323 809

5,253

360

12,201 ".-------~

Midwives

24 3,473

172

48,360 150

52,179

Work in 1958.

Clinical Nurses

750 149,181

311

2,420

9,348 1,167

160,177

Note: The figures of clinical nurses include 1,039 male clinical nurses and 39,149 assistant clinical nurses.

26. Medical Care Statistical Survey

National Health Survey

The government has been conducting 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. about 10,000 households or 50,000 people in 200 areas

in this country are sampled, and enumerate the incidence and prevalence of diseases and

injuries among the people by the type of disease or injury, geographic area, occupation,

economic status, sex, age, etc., and also by how those diseases and injuries are treated,

and how much the patients pay for the treatments.

Table 34. Incidence of Diseases and Injuries, and Sick Days among the People.

(per 100 population a year)

Name of Disease and Injury I Incidence

I Sick Days Rate

Total 204.1 2.501. 0

I. Infective and parasitic diseases (s.m.) 5.9 277.0 Tuberculosis 0.4 198.4

II. Neoplasms 0.6 24.3 Ill. Allergic endocrine system, metabolic and nutritional disease 2.0 77.0 IV. Diseases of the blood and blood-forming organs 0.3 10.4 V. Mental, psychoneurotic and personality disorders 0.2 22.3

VI. Diseases of the nervous system and sense organs 11.1 288.8 Disease of eye (s.m.) 4.0 65.3 Disease of ear (s.m.) 2.7 52.5

VII. Diseases of the circulatory system 2.7 181. 7 VIII. Diseases of the respiratory system 83.1 474.8

Acute nesopharyngitis (common cold) (s.m.) 74.9 378.6 IX. Diseases of the digestive system 33.1 540.7

Diseases of teeth and teeth'supporting structure (s.m.) 14.8 164.4 X. Diseases of the geni to-urinary system 2.1 58.5

XI. Deliveries and complications of pregnancy, child-birth, and puerperium 0.3 8.9

XII. Diseases of the skin and cellular tissue 9.8 129.2 XIII. Diseases of the bones and organs of movemen t 10.8 107.5 XIV. Congenital malformations 0.0 3.5 XV. Certain diseases of early inf an cy 0.0 0.6

XVI. Symptoms. senility and ill·defined conditions 21. 3 98.2 XVII. Accidents. poisoning and violence 20.1 183.0 I

YI. Convalescent cares, plastic treatment and fitting of prosthetic devices 0.8 14.7

Note: The Incidence Rate and Sick Days are derived from the National Health Survey in Oct., 1958.

- 43-

Table 35. How the Diseases and Injuries are Treated.

Total Number of Diseases and Injuries

Treated

Not Treated

Consulted Physician

Consulted Dentist

C It d{Acupuncturist, Moxa-cauterist onsu e Massagist or Judo-orthopaedist

Treated by Home Drug

Others

(Based on the National Health Survey in Oct., 1958)

100.0% 98.7% 1.3%

46.2% 5.6%

3.5%

50.1% 1.9%

Note: When disease or injury is treated by two or more kind of treatments, each of them is count­

ed one.

Patient Survey

In the Patient Survey, 558 hospitals (1/10 of the nation's hospitals), 499 general clinics

(1/100 of the nation's general clinics) are sampled, and 244 dental clinics (1/100 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 36. Number of PatientR visited Hospitals and Clinics.

(per 100,000 population a day)

Name of Diseast> and Injury I Total I In- I Out-Patients Patients Patients

Total 4,036 610 3,426

I. Infective and parasitic di seases 628 306 321 Tuberculosis (s.m.) 409 288 121 Venereal diseases (s.m.) 20 7 13

II. Neoplasms 38 18 20 Malignant neoplasms (s.m.) 22 11 11

III. Allergic endocrine system, metabolic and nu tri tional diseases 156 6 149 IV. Diseases of the blood-forming organs 14 2 12 V. Mental, psychoneurotic and personality disorders 92 74 17

VI. Diseases of the nervous system and sense organs 504 21 483 Diseases of eye (s.m.) 222 5 217 Diseases of ear (s.m.) 148 2 146

VII. Diseases of the circulatory system 177 16 161 VIII. Diseases of the respiratory system 401 12 389

Acute nesopharyngitis (common cold) (s.m.) 105 0 105 IX. Diseases of the digestive system 1. 039 63 976

Diarrhea and en teri tis (s.m.) 141 2 140 Diseases of teeth and teeth·supporting structure (s.m.) 555 0 555

X. Diseases of the genito-urinary system 148 17 130 Diseases of the female genital organs (s.m.) 69 3 66

XI. Deliveries and complications of pregnancy. child·birth and puerperium 61 17 44

XII. Diseases of the skin and the cellular tissue 320 4 316 XIII. Diseases of the bones and organs of movement 99 10 88 XIV. Congenital malformations 10 2 8 XV. Certain diseases of early infancy 4 1 3

XVI. Symptoms, senility and ill-defind conditions 21 2 19 XVII. Accidents, poisvning and violence 254 35 218

YO. Special conditions and examinations without sickness 20 2 18 Prenatal cares and postpartum observations (s.m.) 20 2 18

YI. Convalescent cares, plastic treatment and fitting of prosthetic devices 53 0 53 Fitting of dental devices (s.m.) 53 0 53

Note: The number of patients are derived from the Patient Survey in July 16, 1958.

- 44-

Table 37. Paying Method for the Cost of Treatment in Hospitals and Clinics. (Based on the Patient Survey on July 16, 1958)

Total I 100.0%

Self·paying 14.3% .--.-~-

Social Insurance 76.1% --

Benefit through the Daily Life Security Law (Public Assistance) 6.1%

I Others 3.4%

27. Pharmaceutical Affairs

Inspection of Drugs, Devices and Cosmetics

The licensing system is adopted. under the Pharmaceutical Affairs Law, for all manu­

facturers of drugs, devices and cosmetics for the sake of quality control. Besides, the

installation of every injection manufacturing factory has been improved, in accordance

with the standards newly established by the Law.

During the past year, the Ministry provided for 1.937 inspectors all over the country,

who inspected 235,452 places out of about 350,315 places (21,028 manufacturers, 20,917

pharmacies, and others) in order to prevent adulterated, misbranded, or exaggeratedly

advertised pharmaceutical 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 Institute of Hygienic Sciences is assaying

or testing sulfa drugs. anti-tuberculosis preparations, contraceptives, and some of the

medical devices.

Japanese Pharmacopoeia, Japanese National Formulary and Others

The 8th supplement to the Japanese Pharmacopoeia VI and the 4th supplement to

the Japanese National Formulary II were published in November 1959, while the Minimum

Requirements for Biological and Antibiotic Preparations have been revised.

Poisoning by Organic Phosphorous Preparations

The organic phosphorous preparations have been used for agricultural insecticides

since 1952. As parathion and methylparathion are especially dangerous, this Ministry

established the technical standards concerning the method of their manufacture, storage,

use, etc., by the Cabinet Order. However, in spite of strenuous effort of the government,

there have been many poisoning and fatal cases, of which figures are shown in the

following table.

Table 38. Number of Poisoning Cases and Fatal Cases by Parathion. (1952~1959)

I Number of Po-Number of Fatal Cases Amount of Consumption of

Year Parathion isoning Cases

Operatives I Suicides Dust I Emulsion

1952 III - I 5 397. 922kg. 38.095 L. 1953 1,564 70 121 7,126.669 h 449,954 h

1954 1,887 70 237 15,164,691 h 481,293 h

1955 1,409 48 462 14. 714. 000 h 682,463 h

1956 561 86 900 15.010.000 h 527.667 h

1957 570 29 519 15.200.000 h 728.512 h

1958 816 35 515 16, 379. 000 h 873,000 h

1959 484 26 453 17,789.000 h 1, 093. 000 q

, . '

\,"r- - 45-

Tablp 39. (1an.~Dec., 1959) - --._-------

Kinds hems Production Quantity

---------_ ..

An tibioti,'s Penicillin 29,667 Billion LU. Dihydro·Streptomyein Sulfate 48, 729 kg. Chloramphenicol 7,300 Chlortetracyc Ii n 803 Salkomycin 125 Trichomycin 2, 104 Billion LU.

f- Anti-!ubl'rculosis Agl'n!,; Sodium-p-Aminosalieilak 105,493 kg. ~ Calcium-p·Aminosali"ilalc 1,492,857

SnlLl·drugs Sulfadiazine 61, 394 Sulfaguanidin,· :i2,772 Sulfathiazalf' 52, 78:i Sulfisoxazole 178,207 Sulfisomidiw' 192,614

Vitamin Preparations Vitamin ill 74,999 Vitamin C 449,695

Insecticides Dichlorophenotan 1,092,780 Benzenhexaellinrirle (99%r, Lindam') 278, 385

Antht>lminlil's Santonin 2,S76

Riolo~i('" ChohTa Vacei nl' 27(; t. Dried BC<: V,u'j·iIll' 1H,HRO,HO() do~('",

Diphtheria Antitoxin 199 t. Dip!.theri" Toxoid 3,816 Influenza Virus Vac('inf' 733 Pertussis V .. lfTinl' ;\,0,11 Plague Va'Tin,' 23 Habies Vaccine for Hum"n list" 10 Small-pox Vaccine 8, on GOO doses Tetanus Antitoxin 738 t, Tetanus Toxoid 18 Tuberculin 4,S58 Typhoid and PuratypllOid Va('C'ine 6,978 Typhus Vaccine 108 Unfilterf'rI Normal Human Pla,ana 18,383

y

M,,<1i"ul Instruments Microscope 39,490 pieces X·R"y Film 12>; 10 18,498,000 dozens X-Ray Apparatus 10,630 pi!"c('s Centrifuge 66,400 Lamps for 0r"ra tion 11, 820 Sterilizer Arpa ra tm; 173,720 Forceps 851,340 " Scissors 501,200 " Operating Table 26,200 ,.,.. Injection Syring" 11,609,700 Injection Needl" 80,673,200

D"ntal I nstrumen ts Dental Equipnwnt 22,490 Handpiece 57,260 Forceps 47,410 "

D,>ntal Mal<'rials Acrylic Resin 2:i,150 kg.

Impression Material 24,260 Dental Cement 56,560 Dental Wax 22,820 Porcelain Tooth and Acrvlic Resin 21,980,870 pieces

Tooth

Sanitary Materials Absorbent Cotton 47,459,212 pounds

Gauze 180,949,360 meters

- 46-

Control of Awakening Drug

There has been no violation of the Awakening Drug Control Law of 1951 by the

authorized dealers. However, 372 persons were arrested because of illicit manufacturing,

sale or possession of those amphetamine preparations and the like, in 1959. And also,

by this law, the raw materials (l·phenyl-2-methylaminopropanol-l, I-phenyl-2-dimethyl­

aminopropanol·l, phenylacetic acid and others) are controlled as nearly the same as the

awakening drugs. Number of addicts is estimated to be below 40,000.

Narcotic Control

During the year 1959, the narcotic control conducted by the law enforcement agencies

resulted in sending 1,891 persons as violators to the Prosecutors Office, which includes

1,394 cases (1,714 persons) of violation of the Narcotic Control Law; 137 cases (147

persons) of violation of the Opium Law; and 28 cases (30 persons) of violation of the

Cannabis Control Law.

The following items have been newly designated as narcotic drugs, under Cabinet

Order No. 170 of May 12, 1959; normorphine and its salts; and dimethylaminoethyl-l­

ethoxy-l, I-diphenylacetate and its salts.

Blood Transfusion Service

Blood transfusion service is being controlled by two laws. One of them is "Phar­

maceutical Affairs 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 donors' health from the ill effect which may be caused by improper bleeding. Thus.

since 1951, there have been 37 licensed blood banks and 33 hospitals such as Japan Red

Cross Hospitals or national hospitals which are rendering such services within the respective hospitals.

Production of Drugs and Devices

The supplies of drugs and devices are not only sufficient for the domestic consump­

tion 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 39 In

the preceding page.

28. Major Research & Training Institutes in Public Health Program

For the purpose of performing research work on technical problems as well as

training and educating public health technicians of. various categories which are necessary

for promoting public health program in our country, the following major research or

training institutes are established and are functioning as the affiliated institutes of the Ministry of Health and Welfare.

II ;,.,

J

j J 1 "'~1

1

i " < >

~ t'1 <

" " .' ,f)

~ JI f' Iw

l

;;; ..

Table 40. Kind and Organization of Public Health Research and Training Institues.

Name of the Institute I Date of I No. of \ Establishment Staff

- 47-

(as of March 1959)

Organization \ Locality

National Institute of Public Health Mar. 1938

I 218115 departments, I Tokyo

1 library

National Institute of Mental Health Jan. 1952 36 I 5 departments, Chiba 1 sestion

National Institute of Nutrition Sept. 1920 62 6 departments, Tokyo 1 section

National Institute of Health May 1947 4M 14 departments, Tokyo 1 library, 2 branches 1)

National Institute of Leprosy Research July 1955 19 1 department, Tokyo 1 section

National Institute of Hospital Administration June 1949 9 Tokyo

National Institute of Hygienic Sciences 2) Mar. 1932 250 11 departments, Tokyo 1 library, 1 branch, 3)

4 experimental stations

Note: 1) One branch is in Nagasaki and the other in Hiroshima. 2) This institute's English name was given as "National Hygienic Laboratory" previously.

Only English translation was changed to the present orie. 3) One branch is in Osaka.

National Institute of Public Health This institute is performing training of public health technicians as well as study

and research on the application of basic theory in medicine and public health which is

necessary for such training program. The training programs consist of 3 regular courses

and 13 short courses, and the graduates of those courses totaled 9,358 up to March 1960;

the majority of them being in government service, both national and local, actively parti­

cipating in the health program in the different fields. It is to be mentioned that the

Rockefeller Foundation of U.S.A. had rendered a great deal of economic contribution par­

ticularly in its foundation. The institute has been also extending its service to the foreign

trainees in recent years, who have been sent under UN-WHO or US-leA training programs.

National Institute of Mental Health

This institute is performing study and research on mental health as well as rendering

consultation service on mental health by its mental health clinic and training of mental

health workers as a national training center in mental health program. It has been closely associated with the Konodai National Mental Hospital.

National Institute of Nutrition

This institute is performing survey and research on nation's nutrition condition and eating habit, physiological assay on nutrients of food, and other assay and analysis of

certain specified food and enriched food based on the Nutrition Improvement Law.

National Institute of Health

This institute is performing study and research on the infectious diseases and other

specified diseases, and food sanitation. It is also giving training course, performing of

- 48-

national assay of antibiotics and biological preparations and their experimental production.

Because of the particular work of the institute, it is designated as the various WHO

Western Pacific Regional Centers, i.e., for influenza, poliomyelitis, leptospira and Shigella.

National Institute of Leprosy Research

This institute is performing study and research on the prevention and treatment of

leprosy. It has been closely associated with the National Leprosarium "Tama Zenshoen".

National Institute of Hospital Administration

This institute is performing study and research on hospital administration. and giving

education of hospital administrators.

National Institute of Hygienic Sciences This institute is performing test and assay of drugs (excluding biologics and antibio­

tics for which the tests are given at the National Institute of Health), food, food additives,

cosmetics and devices. It also performes cultivation and research of medicinal plants, and

research on drug manufacturing, and other test, investigation and research on those

matters necessary from the standpoint of hygiene and sanitation.

29. International Cooperation in Health Programs

During the period from January through December 1959, the government received 54

foreign trainees and fellows from, and dispatched the experts to, the countries in south­

east Asia and western Pacific region under UN-WHO, ICA and Colombo Plan programs.

They were 26 WHO fellows mostly from China, 22 ICA trainees from China, Indonesia

and Viet Nam, and 6 Colombo Plan fellows from Thailand and North Borneo. During

the same period, one team consisting of 6 members, including physicians, X-ray technicians

and nurses, was sent to Laos under Colombo Plan for ambulatory medical service, which

worked with one ambulatory medical service car donated by our government.

During the same period, the government was able to send 11 Japanese fellows, mostly

working in the Ministry of Health and Welfare, to USA, UK, and other European

countries to acquire advanced technique and practical experiences for the purpose of

improving our national health administration.

In 1959, the government assisted WHO by acting as the host to two WHO seminars,

i.e., one for Veterinary Public Health Seminar in April and the other for Seminar on

Education and Training of Sanitation Personnel in November.

30. Public Assistance, Child Welfare & Social Insurances

For the reference of readers, some of the informations on the programs of public

assistance, child welfare, and social insurances are given below.

Public Assistance

Public assistance is provided under the Daily Life Security Law (Law No. 144 of

1950) to all persons under certified cases of need after means test. Programs consist of,

.. ",

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-49 -

1) Livelihood Aid, 2) Educational Aid, 3) Housing Aid. 4) Medical Aid, 5) Maternity Aid,

6) Occupational Aid, and 7) Funeral Aid. Assistance is provided in principle as an outdoor

care, while some cases may be institutional. All aids except medical care are provided by

cash. There are 1,010 Welfare Offices (approximately one for a population of 100,000)

from which welfare officials as case workers provide services assisted by 125,000 volunteer

workers who are called welfare commissioners. The aids are financed 80% by the national

government and 20% by the local governments.

The following tables show some of the statistical data on public assistance.

Table 41. Number of Recipients and Amount of Payments.

Fiscal No. of Recipients Rate of Recipients to Amount of Payment

Year (Monthly Average) the Total Population (Monthly Average)

\ (Annual Total)

% Thousand yen Thousand yen 1955 1,929,408 2.16 3,600,122 43,201, 463 1956 1, 775, 970 1. 97 3,554.277 42.651, 329 1957 1.623,744 1. 78 3,625,116 43,501,395 1958 1, 627, 571 1. 77 3,973,416 47,680,990 1959 1,669,186 1. 80 4,517,353 54,208,232

Table 42. Number of Recipients and Amount of Payments by Type of Aids

Item I Livelihood II Educational I Housing 'A'd A'd A'd I I I

I

Recipients (in thousands) 1, 470 510 663

Amount 1,535 170 103 (in million yen)

Child Welfare

(monthly average, fiscal year 1959)

1\1 d· 1 1M' 10 'II F I e Ica I atermty I ccupatlOna I unera A'd A'd A'd A'd I I 1 I

--I

433 1 7 3

2,694 1 5 8

Child welfare Law (Law No. 164 of 1947) provides for a comprehensiye program of

care for children ages up to 18 years, and health and welfare of mothers. Programs

consist of, 1) a net-work of child guidance clinics, 2) maternal and child health, 3)

orphanages, 4) training homes for juvenile delinquents (ages up to 14 years), 5)' homes

for mentally retarded children, 6) homes for physically weak children, 7) homes for

physically handicapped children, 8) homes for deaf and mute children, 9) homes for blind

children, 10) mothers homes, and 11) infants homes.

Social Insurances The following table shows a bird's-eye view of all kind of social insurances, giving

some information about the pertinent laws with dates of promulgation, responsible agencies,

the coverage of insurer and the insured people, etc.

-50-

Table 43. Classification of Social Insurances.

I-~ Law I Date I Responsible I

I Ministry I Insurer Insured

Health & Welfare Government, Health Insurance Law 1922 Ministry Union

Welfare Pension Insurance 1941 • Government Employees in the

Law working place

Unemployment Insurance 1947 Ministry of Labor ( compulsory or

Law • voluntary)

Workmen's Accident Com· 1947 • " pensation Insurance Law

I Seamen's Insurance Law 1939 Health & Welfare • Seamen Ministry I

National Public Service Mu· 1948 Ministry of Finance Mutual Aid Government

tual Aid Association Law Association employees -----

Self-Government

I National Health Insurance 1938 Health & Welfare Union, Other Other persons besides

Law Ministry Bodies those insured ._--- -----------

Health Insurance Law for 1953 Government Daily workers Dail y Workers • --- .---

Mutual Aid Association Law for the Teachers and Wor- 1953 Ministry of Mutual Aid Teachers and workers

kers of private Schools Education Association of private schools

MutualAid Association Law Local Autonomy Officials of cities, for the City, Town and 1954 • V illage Officials Agency towns and villages

Mutual Aid Association Law Employees in the for the Employees in the 1956 Ministry of Finance • public enterprises Public Enterprises

I Mutual Aid Association Law Ministry of Employees in the for the Employees in the Agriculture & Fishery 1958 Agriculture & • agriculture & fishe-

Organization Forestry ry organization

Whole population of

i Health & Welfare those 20~59 years

I National Pension Law 1959 Ministry Government old, except those co-

vered by other pen-sion schemes

In the following tables, figures in "Coverage" and in "Pension" refers the data as

of March.

Table 44. Health Insurance Managed by Government.

Coverage Benefit Fiscal

No. of I No. of Medical Care (in kind) I Others

Year Working Insured For Primary Insured I For Dependant

I Cases I Amount Places Cases I Amount I Cases I Amount

Thou88ndj Thousand ThoWland Million Yen Thousand' Million Yen Thousand Million Yen

1948 129 3,279 4,128 2,754 1,581 473 892 957 1949 141 3,268 8,491 7,227 6,163 1,985 1,404 2,521 1950 157 3,580 10,150 8,638 8,407 2,553 1,434 3,453 1951 175 4,018 12,398 10,766 10,831 3,421 1,564 4.329 1952 193 4,399 14,995 15,284 13,220 4,791 1,733 5,473 1953 224 4,988 17,869 20,585 15,669 6,058 1,886 6,656 1954 236 4,941 20,928 27,900 17,605 7,211 2,043 8,068 1955 244 5,242 22,589 30,345 18,623 7,609 2,111 8,553 1956 267. 5,991 25,906 33,321 21,328 8,627 2,125 8,353 1957 298 6,631 29,065 37,728 24,672 10,072 2,341 9,420 1958

I 317 7,037 29,294 42,957 24,481 • 11,133 2,419 10,404

1959 348 7,961 34,380 51,897 27,558 13,210 2,582 10,935 -

, •

i

,J-. -"

- 51-

Table 45. Health Insurance Managed by Assoiation.

Coverage Benefit Fiscal No. of

I

Medical Care (in kind)

I

Others

Year Associa-No. of For Primary Insured ! For Dependant I

Insured Cases I

Amount tion Cases I Amount I Cases I Amount

1948 I ThOU .. ndl Thousand Million Yen Thousand I Million Yen Thouaand Million Yen

775 2,670 7,313 2,691 4,160 777 1,896 1,483 1949 761 2,827 I 10,989 6,624 8,521 2,355 4,015 4,102 1950 759 2,950 12,131 7,977 11,280 3,054 6, 789 5,133 1951 779 3,036 12,830 8,892 12,669 3,441 7,575 6,569 1952 820 3,105 13,461 10,761 14, 732 4,734 8,686 8,172 1953 873 3,314 14, 707 13,292 17,655 6,177 8,804 9,309 1954 894 3,220 16,021 17,252 19,159 7,187 9,157 10,619 1955 907 3,313 16,591 17,837 20,740 7,720 9,625 10,553 1956 924 3,516 18,104 18,865 22,957 8,465 9,973 10,483 1957 968 3, 752

I

19,794 20,619 25,862 9,832 11,766 11,616 1958 1,010

I 4,003 19,631 22,827

I 25,479 10,817

I 12,127 12,581

[1959 I 1,047 4,496 ... ... ... .. , ... ...

Table 46. Health Insurance for Daily Workers.

Coverage Benefit Fiscal No. of Medical Care (in kind)

I Others

Year Insured For Primary Insured I For Dependant Cases I

Amount (estimates) Cases I Amount I Cases I Amount

Thousand Thousand Million Yen Thousand Million Yen Thousand Million Yen

1953 563 23 22 10 6 ... ... 1954 573 794 904 391 241 12 21 1955 670 1,422 2,050 641 372 30 52 1956 748 1,759 2,563 938 569 46 77

i.1957 802 2,000 3,015 1,149 676 50 79

1958 1,032 2,327 3, 768 1,531 891 78 123 1959 1,162 2,849 4, 737 2,062 1, 156 128 208

Table 47. Welfare Pension Insurance.

C overage B f' ene It

i

Fiscal Year No. of I No. of Pension

I Lump-sum

Working Places

I

I

Insured No. of Pensionerl Amount Cases I Amount Thou.andl Thou.andl Thousandl Million Yen Thousand . Million Yen

1948 138 5,713 17.9 I 133 216 154 1949 149 5,738 32.8 394 87 330 1950 167 - 6,113 49.0 724 97 770 1951 186 I 6,613 70.4 1,293 95 1,281 1952 205 7,034 95.8 1,917 99 1, 806 1953 239 7,790 119.2 2,483 117 2,616 1954

I 254 7,883 132.5 3,446 163 2,719

1955 265 8,227 163.4 4,340 207 2, 716 1956 285 9,172 191. 8 3,127 190 2,343 1957 322 10,023 218.3 5,856 216 2,691 1958

I 327 10,393 242.4 6,514 247 3,231

1959 361 11,746 272.5 7,413 I 245 3,162

Table 48. Unemployment Insurance.

Fiscal Year

1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959

1____ _ Coverage

II No. of Working I No. of Insured Places

I Thousand Thousand'

139 5,486 154 5, 703 167 5,898 187 6,314 208 6,849 230 7,695 235 7,921 242 8,064 261 8,987 284 9,776 308 10,410 342 11,669

Note: 1) Excluding daily laborers.

Benefitl )

Weeks I Unemployed

Thousand

790 10,854 15,716 10.518 14,931 16.153 22,028 19,038 13.421 14,824 20,546 17,138

Amount Paid

Million Yen

385 9.170

14,728 12,524 20,669 25,404 35,552 30,834 24,362 27,952 40,383 35,201

- 52-

Table 49. Workmen's Accident Compensation Insurance.

I Coverage Benefit

I Fiscal Year No. of Working

I No. of Insured Cases I Amount Paid Places i Thousand Thouland Thousand Million Yen"

1948 225 6,268 839 2,458 1949 278 6,969 1, 204 5,512 1950 316 7,196 1,517 8,297 1951 340 7,559 1,547 10,763 1952 372 8,057 1,419 11,746 1953 454 9,363 1,572 13,928 1954 491 9,679 I, 721 16,111 1955 559 10,244 1,693 16,187 1956 586 10,725 1,937 18,387 1957 658 12,207 2,163 21,242 1958 700 13,012 2,225 22,373 1959 751 14,500 2,426 24,433

Table 50. Seamen's Insurance.

(a) Ordinary Insurance.

Coverage I Benefit Long-term Benefit Short-term Benefit

Fiscal No. of Pension Lump-sum Medical Care (in kind) I Otli~

Ship- No. of For Primary For Depen-Year Insured No_ of owners Pensi- Amo- Cases Amo- Insured dant Cases Amo-

unt unt C lAma- Cases I ~:a- unt oner ases unt

Thousand Thouland Thou.and/ Million Thousand Million Thou8and Million Thousand Million Thou.andl Million D

Yen Yen Yen Yen Ye

1948 4.3 122 15 10 8. 7 25 230 192 11 5 38 90 1949 5.3 124 15 83 4.5 63 491 464 154 57 56 216 1950 5.8 124 16 139 1.4 82 575 486 257 85 61 288 1951 6.7 141 18 168 2.5 130 634 516 361 116 68 359 1952 7.3 144 19 205 1.9 132 726 655 475 173 82 505 1953 7.9 154 20 244 2.3 189 770 783 574 220 80 614 1954 8.0 162 21 467 1.8 192 901 1,032 681 272 112 785 1955 8.1 165 22 519 1.4 205 1,006 1,115 766 301 135 898 1956 8.4 177 21 544 1.5 231 1,058 1,194 905 353 139 948 1957 8.9 189 22 587 1.6 224 979 1,232 1,070 429 150 1,054 1958 9.3 199 23 662 1.8 319 915 1, 410 1,094 491 169 1,314 1959 9. 7 206 24 747 1.9 342 1,015 1,658 1,247 583 188 1,493

(b) Unemployment Insurance.

I Coverage Benefit

Fiscal Year No. of Ship-owners I No. of Insured Cases I Amount

Thousand] Thousand Thousand Million Yen

1948 3.8 103 5 4 1949 4.3 92 73 95 1950 4.6 88 200 290 1951 5.3 97 145 255 1952 5.6 92 137 265 1953 5.9 93 139 303 1954 6.0 93 132 292 1955 6.0 93 107 241 1956 6.2 103 90 224 1957 6.6 113 81 221 1958 6.8 115 124 342 1959 7.2 120 115 322

....;;--

,,/. r:'j"t;

.. , r

':"

I I

I

I

I

- 53-

Table 51. National Public Service Mutual Aid Association.

Coverage Benefit ---

Long-term Benefit Short-term -Benefit

Fiscal Pension Lump-sum Medical Care (in kind) Others

No. of No. of For Primary For Year Ass'n Insured No. of Amo- Amo- Insured Dependant Amo-

Pensi- Cases Cases unt- unt-

Cases I ~o- Cases I ~~o- unt oner

Thousand Thousand Million Thousand Million Thousand Million Thousand Million Thouland Million Yen Yen Yen Yen

1951 31 2,426 184 6,326 192 3,199 10,629 7,105 8,177 2,087 1952 30 2,531 188 6,735 153 2,778 10,872 9,443 8,984 2,945 1953 29 2,590 188 8,274 102 2,380 11,336 11,024 10,857 3,797 1954 29 2,634 191 8,398 102 3,204 11,887 12,843 12,112 4,552 1955 29 2,695 193 8,473 80 2,875 13,284 14,159 14,462 5,340 1956 26 2,040 30 1,569 72 2,637 9,596 11,189 12,322 4,899 1957 27 2,069 31 1,646 80 3,733 10,470 11, 763 14,024 5,548 1958 27 2,129 22 I, 128 85 4, 703 10,035 12,062 13,864 6,012

Note: Figures for the years after 1956 do not cover those coming under the Public Enterprise Organization, and those for 1959 are not available yet.

Table 52. National Health Insurance.

Coverage Benefit

Yen

2,929 3,297 3,061 4,083 3,315 5,236 3,675 5,192 2,442 4,238 1,100 2,590 1,053 2,654 1,062 2, 771

I Fiscal Medical Care Others

Year No. of No. of Unions Insured Cases I Amount Cases I Amount

Thousand Thousand Million Yen Thousand Million Yen

1952 4,990 23,089 29,271 18,134 ... . .. 1953 5,131 24,906 34,147 23,734 542 259 1954 3,669 26,633 41, 231 31,308 604 341 1955 3,169 28,711 49,158 37,388 701 478 1956 2,870 30,582 58,245 45,326 756 551 1957 2,941 33,576 68,945 54,819 784 613 1958 3,167 37,239 74,947 67,125 876 757

Note: Figures for 1959 are not available yet.

Compiled by the Office of

Chief Liaison Officer,

International Affairs,

Minister's Secretariat,

Ministry of Health & Welfare

Japanese Government

Tokyo, Japan

1 J

ORIGINAL: PORrUGUES!

MACAO

Report on the Progress of Health Activities for 1959 - 1960

1 BUILDINGS AND EQUIPMENT

The project for the construction of a pavilion for female mental patients has been concluded and the plan for equiping the pavilion for male mental patients has been made.

The project for permanent residences of the personnel employed in the Ka-Ho Leprosarium and the equiping of new pavilions built in the same Leprosarium have been completed.

The Thermic Centre of the "Hospital . Central " has been equipped 8D.Cl has started to function, operating the laundry, kitchen and sl.q)ply1ng hot water to the wole hospital and steam for the steam-pots and bed .. pan steri­lizers and other existing materials in the various departments of the s.e building.

A micro-radiography apparatus for films of 70 mm in the Anti-Tuberculosis Dispensary was purchased, installe~ and is now operatirig.

2 MEDICAL AND MATERNAL-CHILD CARE

Atter the neces~ary installation was made, consultations began in the hospital and in the various assistance centres in the city. A pre-natal consultation section was also established in the Hospital Central.

3 PROPHYLAXIS OF IHFEarIOUS DISEASES

Due to the great continuous rotation in popUlation" because of the ret\1gee movement wich has created delicate economiC, social and health situations to the entire province, re-doubled attention and care have .been given to the prevention of these diseases by trying to vacCinate, preventively, the greatest number of persons against smallpox, cholera, typhoid and diphtb ria.

Though Macao has been tree from. smallpox and cholera since many yeaH ago, yet a recurrence of endemic diphtheria has been verified. It continues to be very difficult to convince the population to get vaccinated when more than one inoculation is required. However, mortality by diphtheria has . decreased.

4 SANITATION

The overcrowding of the City and the occupation by the people in the areas reserved for parks and gardens brought about iDiK>rtant health problems, especiall.y those related to the disposal of garbage and xcreta. In normal. situations it bas been possible during the year to maintain supplies of drinking water. New projects for the disposal of excr ta and garbage have

been ex cuted by using more personnel and more conveni nt material. Also, under cons1deration is the purchase of new vehicles which will render this work more rapid and e:f':ricient.

At the same time.. the sewage system of a vast section ot the city ha$ b n supplied with bigger pipes. A new sewage system has also been cons­truct d in another area, all the works costing approximately five hundred thousand Ma.eao dollars (M/>5OQ,OOO.OO). An additional project which will complete this system is under consideration but is of'tering certain technical difficulties. This project is estimated at one and a halt million Macao dollars (M$l,500,OOO.OO).

5 FlOHr AGAIHBr VEm'OR INSEarS AND MALARIA

The fight against vector insects has been carried on with the same intensity either through water collection or residual pulverizations ot dwellings. The recent occupation ot further Chinese refugees of the free areas a the city and the excavations in those areas to store water for garden use have rendered more arduous th1s work in which groups of skilled p rsonnel are employed daily.

However, no recurrence ot malaria has been verified althougb vector 1nsects abound in the neighbouring regions.

6 TRAIHING OF PERSONNEL

The reg1stration in the Nursina SChool has increased. The present attendanc is of sixty-two students.. in whose professional tra1nina the great st care 1s being given.

J.

•

-.

fP ;:os #$ /

j'

r'

I ."

MAlAYA

Report on the Progress of Health Activities during 1959/1960

The Ministry of Health and Social Helf'are faces the problem of catering for the medical and health needs of an increasing population which is becoming increasingly aware of the value of modem medical treatment. A heavy strain is placed on the facill ties 'Which are being steadily expanded, particularly into the rural areas. Despite limitations in the resources available and other difficulties, statistics show an overall picture of steady improvement of the health of the country. Ther has been no case of dangerous infectious diseases such as cholera, plague, typhus or yellow fever in the Federation for many years. Enteric fever and diphtheria are endemic and the incidence of malaria, judged by notified cases and deaths, continues to be low.

A pilot project aimed at discovering a practical and economiC method of eradication commenced in early 1960.

During the latter part of 1959 an epidemic of smallpox occurred in the states of Kelentan and Trengganu and lasted till February 1960. Forty-nine eases were reported with nine deaths. The entire population in both the states "ere vaccinated during the mass campaign.

POisoning by Parathion was reported in different localities in the Federation and the Ministry of Health issued a warning to the public against the insecticides containing parathion. Action was also taken to trace these insecticides and destroy them werever found.

During the penod under review, though no new haspi tals have been built, rehabilitation and re-conditioning of various hospitals have satisfactOrily progressed.

The Ministry has instituted an air-11ft service to convey serious17 ill patients from remote areas to main hospitals in the Federation for necessary treatment.

A new nurses hostel costing $500 000 was constructed at Alor.star, Kedah and was opened on 24 September 1959.

In accordance 'With the declared policy of Government and to rat,e the 11ving standard of rural population, the expansion of health centres and midWife centres has been given hiBb priority in the plann1ng of itds M1n1stry's Medical Services. ODe of the main views of the development of the service is the reduction of the infantile mortality rate existing in rural. areas as compared to urban areas. With the opening of these midWife centres an ~reciable decrease in the infantile mortality l'ate has been noted.

Research activities are centered in the Institute for Medical Research I K'Uala Lumpur. Its studies, t1 ld experiments and publications have pl.tqed

/ a vital role •••

I ~

a vi tal role in the development of the Medical and Health Services in Malaya besides ma1d.ng valuable contributions to th control of tropical diseases throU8hout the world. It is hoped to establish an additional division for the study of virus diseases with particular emphasis on poliomyelitis. In a.dd:1tion to its research activities the Institute tor Medical Research also trains laboratory assistants tor laboratory work in the various hospitals of the Federation.

A Snake Research Station has been established in Penang ~d its activities are confined to the study of the various types of venomous reptiles tound in the Federation of Mal~ and the production of anti­venom s rums.

SUlphone continues to be the drug of choice in the treatment of leprosy. Elrperiments on a new drug for the treatment of leprosy are being oarried out at Sungei Buloh Leprosarium in conJunction w:lth the Research Council of Great Britain which prov1desthe services of a Research Officer. There msts also a scheme whereby discharged patients are referred to their home town cl.1n1os for follow-up treatment. outdoor olinics have also been set up in PenaD8 and KUala Lumpur for treatment ot suspected aDd arq cases.

Psychiatric out-patient units have been established at certa1n horrpi tals tor the treatment of oases which do not require treatment at mental institutions.

Tuberculosis is still considered a maJor public health probl_ in th Federation. A national programme for the el1m1nation of tuberculosis as a public health problem is being p1aImed follow1ng the recoamendations ot Sir Barry WUn<1erly, a 'WHO Consultant.

As a result ot a full scale yaws control campaign started in the Stat s ot Kelllltlll and Trengganu in 1954 w:l th the assistance ot WHO and UNICEF the incidence of yaws in these areas has been reduced to a m:1n1mum and th disease is nOli under control.

With the success in this campaign it is now proposed to extend the yen rad1cation projects to the states of Pahang, Kedab and Perlis. Sample surveys in these States have been cOllWleted and a progrEllDlJJe has been mapped out to c01lllllellce early 1961.

Pilariasis research still continues at the Institute for Medical Res arch and at K.Uantan. In certain localities filariasis control pro. gr8i1W18 has b~en in progress for many years. This is to be accel.erated. and it poss1ble standardised.

The Federal Nursing School has been elq)lIlded by the establishment of a Burses Training School in Kuala LuJr.\pur and Johore Bahru. l-Tith this upanalon it is hoped that the output from these tra:1.n1ng schools will be increased. in the near future. This move will alleviate the acute shortage of trained nurses and provide sufficient personnel to staff the expanding hospital and rural health semces. In addition, &8sistaDce is being reo ived under the Colombo Plan to send local girls tor basic nurse tra1D1ng in Australia. In order to maintain a hiBb standard of

lnursing .....

I • -~.-

- 3 -

nursing in the country, a number of post-graduate training awards are offered under the training scheme of this Ministry for various post­graduate courses. Colombo Plan assistance as well as assistance from the World Health Organization in this direction is also being received from time to time.

A PUblic Health Inspectors' Training School has been established in KUala Lurru>ur since 1958 and it is affiliated to, and recognized by, the Royal SoCiety for the Promotion of Health, London. The intake of the School is 25 candidates per academic year. Assistance by way of reference books, microscopes, teaching aids and a bus for the conveyance of students for practical field studies was given to the School by UNICEF.

....... :1

-~'--t: w

NETHERLANDS NEW GUINEA

Report on the Progress of Health Activities during 1959

1. INTRODUCTION

1.1 Organization of the Department of Health

The Director of Health is responsible for the administration of all medical and PQblic health services in the territory.

The Director, his depQty and the chiefs of divisions for preventive medicine constitQte a Territorial Board of Health. This bo~ meets regQlarl1 to review concQrrent health projects, and to plan, organize and co-ordinate field activities.

One senior district medical officer is also a permanent member of this body.

1.2 Staff

The total number of medical and dental officers increased from 80 to 85; 61 are employed by the Government.

A comparativeetatemant on" the-medica1 and para-medical personnel employed by the Government is given below:

Neth. Certificate New GQinea Cert.

-57 '58 '59 '57 '58 '59

A. 1) Nurses 1(12 99 1<1> 100 95 117

2) Midwives 4 4 6

3) l.fedical orderlies l14x 145x -107x

4) Infant welfare nurses (MCH) 50 61 69 5) Laboratory technicians 7 8 8 29 33 33 6) Malar La technidans 10 10 10 8 10

7) Smallpox vaccinators 10 14 14

8) Dispensary assistants 9 11 11 16 23 23 x • unqualified personnel.

!B. Trainee's •••

-2-

(I.G. Certificate~ 1959

B. Traineets nursing course \I 152 n " aids course " 163 II Infant welfare nurses

course (iifCH) " SO

" malaiia technicians " 7 It laboratory technician It .3

" dispensary assistarte " 4

1.3 Finance and budiet

For 1959 the government budget~r health was 7-1/2 million guilders (appr. 1.88 mill. US dollars) as compared to 7 million in the prevlGM year. Index figure 23:3 (1954 • 100)

In addition 2.4 mill. (appr. 0.6 mill. US dolla rs) were spent on the construction and maintenance of buildings.

UNICEF assisted materially to a value of 126.000 guilders.

Finally contributions to the national health programme were obtained from a nWllber ot voluntary organizations to a tct al value ,of appr. r 260 000.

2 VITAL STATISTICS

During the last years the registration of births and deaths has become a routine procedure in the Sentani district.

In other areas data have beeri collected on an anamnestic basis.

Sentan1

Ajamaroe

Tanah-t"'4erah

Ballem

Birthrate

57 0/00

40 " 46 If

40 rt

Deathrate

17 0/00

32 tt

41

40

It

Infant-mortality rate -.

125 0/00

.300 " 280 tt

300 "

/3 HEALTH ACTIVITIES •••

-'

../"

F i"

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3 HEALTH ACTIVITIES

3.1 Medical services

'rhe new Central Hospit al at Hollandia was completed and officially opened 011 the 3rd of' July 1959.

The nlunber of patient d~s in the 24 hospitals amounted to 278 199. Five new out-patient departments were opened, bringing the total of these to 84.

Medical consultations rendered at these out-patient clinics amounted to 1 020 174.

Specific treatments, vaccinations etc. given under special p~ogramm s are not included in this number.

3.2 Public Health Services

3.2.1 Public Health Laboratory Service

The starf of the Central Public Health Laboratory consists of one ful~ qualified bacteriologist, who is assisted by eight qualified laboratory technicians and a number of local auxiliary personnel.

The Central Laboratory assists with preventive and curative work.

The workload has increased considerably in recent years.

Number of examinations in 1959

Bacteriology::

Serology:

Clinical:

General Tuberculosis

General Yaws

Drinking water:

other investigations:

1 553 11 406

71 4 467

12 959

4 538

635

82

91

18 305

/3.2.2 WHO/UNICEF •••

- 4 -

3.2.2 WHO/UNICEF assisted projects

3.2.2.1 Malaria Control Project

The policy of the division for malaria control remained unchanged. The DDT residual spr~ing project has been extended to include a total population of 178 000. In addition 8S 000 people received single dose treatment of chloroquine and daraprim one or two times a year.

There can be little doubt, that the addition of chemoprophylaxis has made a considerable contribution to the overall reduction in the parasite index, Particularly in the islands districts favourable results have been obtained, whereas complete interruption of malarial transmission has been achieved on Biak island.

In other coastal areas the reduction in parasite rates was less dramatic. Therefore a pilot study, using pyremethaminized salt, was st&rted in three different coastal areas. A marked initial reduction of the par.site load 1n the population was counteracted by the rapid emergence of Falciparwm strains r s1.stant to pyremethamine. ..

Therefore chloroquine was added to the pyremethaminized salt, with which, it i8 expected, more favourable result s will be achieved.

3.2.~.2 !!!!,control project

At the end of 1959 381 000 persons had been treated with PAM in the initial survey. In all 26 000 cases were diagnosed (index 5.4%)._

Durine resurveys, 250 000 persons were seen and 1 020 cases of clinical yaws found, giving a prevalence of 4 per 1 000.

Research in field-serology using the Chediak VDRt slide test WBS continued.

3.2.2.3 Maternal and Child Health

The Division employees one medical officer, eight nurses and four midwives, all with European certificates. A number of medical officers and nurses in the Territory are part time engaged in this programme.

One senior nurse went to the UD1ted States ot America on a WHO­fellowship in public health nursing.

Sixty-nine native infant welfare nurses are now working in the Ii ld, ighty being under training in four MCB centres.

/Stationary c11nic8 •••

- 5 -

Stationary clinics were made mobile with the aim to cover 1 000 people per I.H.F .-nurse. Fifty-five thousand people are receiving regula r ;·1CH services.

The number of schoolchildren benefitting from the UiUCEF milk-feeding project, totals 6 000.

3.2.2.4 Nutrition

The creation of a special division for tf1e stady of the many nutri­tional disorders in the terri.tory, ,,1nich had been provided for in the budget for health, has been delayed due to difficulties in the recruitment of suit~ able staff. It is hoped tha t a.Jpropriate personnel can be found in the near future.

3.2.2.5 Environmental Sanitation

With the establishment of a separate division for environmental sanitation a fruitful co-operation between the Depar~~ent of Public Works and the Department of Health is being maintained. Regular consult. at Lon in all matters related to environmental sanitation problems, takes p~ce.

A fellowship has been requested from WHO for an engineer from th Department of Public Works to undergo special training in environmental sanitation.

3.2.3 Other Government activities without international aid

3.2.3.1 Tuberculosis control project

By the end of 1959, 38 026 persons had been submitted to mass radio­grap~. All cases found during this survey have been referred to local t~bercu1osis clinics and brought under ~roper control.

To facilitate diagnosis on out-stations, the number of small fluoroscopy units was increased.. Fifteen machines are now in use as compared to 12 in the previous year. The number of tuberculosis clinics increased !Dom 4 to ?

The plan of operations fur a ~mO/UNICEF assisted BCG vaccination project expired in the first half of 1959, The scheme is continued at government expense.

In agreement with the plan of operations, same observations made in the course of the campaign were published in the WHO Bulletin, and a final report has been submitted to the UNICEF Thai Area Mission in Bangkok.

/At the end •••

- 6 -

At the end of June 1960 136 367 persons had been covered in the initial campaLgn, and 141 305 retest. had been giyen.

Due to the difficulty of access of the remainder part of the terr itory, the use of Japanese g1utamite dried BOG vaccine is under active consideration, and a pilot stu~on this vaccine will be implemented in the latter part of 1960.

3.2.3.2 ~prosy control proj~

Two full-time and four part~time medical officers are working in the lield of leprosy control.

Surveys, with the aim to find all infectious cases of leprosy, were continued. The total coverage of the territory will be completed in the latter part ot 1960.

It has been possible in most afflicted areas to segregate all infectious cases on a voluntary basis. The scheme has been extremelY popular, and receives great cooperation of the local population.

A limited number of cases is treated on an ambulatory basiS.

The total number of known cases of leprosy increased to 3 954 (1957 - 2 317). Leprosy index is 9.? per 1 000. Six hundred fifty-five of these are of the lepromatous-borderline type.

3.2.3.3 Smallpox prevention

Although smallpox has been eradicated from the territoryJbr more than 25 years, a smallpox vaccination scheme is in effect with the objeot to cover all coastal districts once in three years. Under this scheme 80 455 vaocina­tions war given during this period, 24.6% of which were primar,r vaccinations.

Smallpox vaccinators are also engaged in other vaccination schemes, .g. tuberculin testing and BeG vaccination.

3.2.3.4 Filariasis control project

The investigations tor vectors of filariasis and their relative importanoe were continued.

In oollaboration with an expert from the spe (Dr. M.OS. Iyengar) a special survey was conducted in the IUmboran district, were residual spraying with D~ has been in progress ever since 1955. The findings obtained in this particular survey suggested a complete interruption of

/filariasi8 transmission •••

- ? -

filariasis transmission.

In the 1fCstern part of New Guinea, where culicines are the major· vectors, a pilot study with hetrazan has been started.

On the island of PAM, also in the western part of New Guinea, the effect of indoor spraying on the transmission of filariasis by Aedes Kochi is being investigated.

3.2.3.5 other infectious diseases

i:~o cases of quarantinable diseases occurred.

Sporadic cases of poliomyelitis (2~; meningitis (14); encephalitis (4); typhoid (6); and typhus mite born (],.) were reported.

A mild influenza-epidemic was diagnosed during the months of M~ until August in the coastal areas of Netherlands New Guinea.

3.2.3.6 Health Education

The Division of Health Education and the Division of Public Informa­tion of the Department of Cultural Affairs, assisted all divisions tor diseases control with education material, such as slides and posters.

Radio talks and articles in the press were also produced.

.~ j

."'t

NORTH BORNEO

Report on the Progress of Health Activities during 1959

1 GENERAL HEALTH

During the past twelve months the Colony recorded its first sizeable outbreak of enteric fever. The disease was confined to the town and envi­rons of Tenom in the Interior; 117 cases being diagnosed between mid-August and early October. The clinical type was relatively mild and there were no fatalities. Influenza was mildly prevalent over most of the Uolony through­out the year, but a sharp outbreak of the Asian Type 2 extending from Drunei affected Labuan Island during February 1960. Some sixty soldiers carrying out a training exercise in uninhabited territory 60 miles north of Jeaselton developed scrub typhus - clinical~ mild. Measles and chickenpox have been prevalent during the past few months. None ef the six quarantinable diseases were notified.

In the calendar year 1959 36 085 cases of malaria 2 422 new cases of tuberculosis and 23 558 cases of intestinal infections were diagnosed at government medical institutions. On the whole the health of the colony can be considered good and even after substantial allowance for under-registra­tion of births and deaths, it is clear that the death rate is falling -particular~ in areas where malaria control operations are being done. Even more interesting is the lowered infant mortality rate in these areas.

With eradication of malaria and control of tuberculosis already planned, the other two major fields of health improvement are coming into sharper focus - maternal and child health and environmental hygiene.

Yaws still occurs but epidemiologically the condition is in the so called "Receding state".

2 MA.IARIA COr.'"TROL

The combined Government/WHO/UNICEF malaria control project was reviewed in September 1959 and it was considered that Colony-wide eradication in a territory which is virtually an island was feasible. Acccrdingly plans have been made to convert the control project to one of eradication in 1961 and a staff supplement of over one-third is already in the lield. J.i.esults of aC'(,ive surveillance to date confirm the assessment ma~ in September last that transmission can be interrupted. Hospitals and ~ispensaries are assist­ing in preliminary surveys of areas not yet under control measures and a propaganda campaign is being planned. It is estima-red that the government

• • • contribution to/

- 2 -

contribution to eradication over the period 1961-65 inclusive will be about u.S • .$ 930 000 less the hoped for J.IEStr. allocation of US $ 180 000.

3 TUBERCUIDSIS CONTROL

During the past twelve months the Government recruited a tuberuculosis control medical officer (project leader) two expatriate health visitors (tuberculosis), local nursing; laboratory and X-ray personnel and purchased much additional equipment. Recently a Colombo Plan (Australia) team of two health visitors, a laboratory technician, and a radiographer/electronic engineer joined the project and a chest physician/radiologist is expected shortly. The project began to get underway in March following a policy for operations drawn up at Jesselton with Sir Harry Wunderly in February. The work and documentation done from hospital and dispensaries over the past few years has given SUbstantial impetus to this.

The keynote of the control policy is prevention, the main steps being case finding and treatment, contact examination BCG where applicable, and some chemopropQylaxis.

The voluntary organisation NOBATA (North Borneo Anti-Tuberculosis Association) continues to assist the Medical Department in the field of propaganda and by providing relief and welfare to sufferers and deperdants.

4 INTESTINAL DISORDERS

Apart fram the outbreak of enteric fever already mentioned, infesta­tions by intestinal nematodes (especially ascaris) remain cormton especially in the rural areas there were the usual outbreaks of diarrhoea, probably caus d by salmonella infections, and a moderate amount of bacillary and protozoal dysentery.

standards of sanitation continue to improve in the larger urban areas controlled by fairly well endowed municipal authorities, but the trend towards "minor urbanisationlt particularly along communications, presents problems. fhe typhoid fever outbreak occured at such a minor town.

A composite Public Health Ordinance was approved by the Legislative CounCil at the end of March. This repeals most previous health legi~la­tion, consolidating it into one Act which gives central control to the Director of Medical Services, and much local control to the local autho­rities and health officers.

5 NUTRITION

The nutritional status of the ColonY as a whole is good judged by

••• South-East Asian/

--

,

. ""'-

r'

.'

- 3-

South~East Asian standards but cases of malnutrition come to light from time to tilll€, notably beri-beri. The importation of rice mills is strictly controlled but there has recently been considerable public pressure for greater polishing of locally grown rice.

Since the thiamin content of the local diet barely exceeds the mini­mum, further polishing would be dangerous unless the expensive process of adding the vitamin to the polished grain is also instituted.

UHICEF continued to give generous vitamin and diet supplements for maternal and child health clinics and the Government has now begun to take over the responsibility for providing whole mili{ to these institutions.

6 MllTERNAL AND CHIlD HEALTH SERVICE

Considerable progress has been made towards the provision of MCH services and currently clinics are operated at 40 places in the Colony. This service is so popular that attendances have almost outstripped the Colony's resources in staff and finance available for the work.

7 EYEDISFASES

Surveys by the Visiting Ophthalmologist have shown that a substantial amount of blindness in the rural areas is due to infection which if prompt­ly and adequately treated could be much reduced. A campaign conducted from rural dispensaries was therefore commenced at the end of last year.

8 GOVERNMENT HOSPITAIS & DISPENSARIES

During the past year one new hospital of 56 beds was completed at Tenom in the Interior Residency. In addition, tuberculosis wards were completed at Sandakan, (70 beds) Labuan (28 beds) and Kudat (28 beds) hospitals.

9 THE CENSUS, 1960

Work has started on a decennial census. It is expected that the population will exceed 420 000 an increase of over twenty-five percent on the previous count in 1951.

~ I

TERRIT<RY OF PAPUA AND lID-I GUINEA

Report on the Progress of Health Activities (31 July, 1959 - 30 June, 1960

The following is a resume of progress made in public health activities in the Territory of Papua and New Guinea for the period 31 Ju~, 1959 - 30 June, 1960. It will be appreciated that many statistics, particular~ in regard to mission medical services, are unavailable at present as these are in the course of preparation for the Annual ;'ceport to the United Nations Trusteeship Council and the Commonwealth Government ani are not expected to be completed before 31 August, 1960.

1 STAFF

There was a net increase in European staff of 89 officers up to the beginning of June and this staff now comprises 83 medical officers, 139 medical assistants, 164 nurses, 11 dental surgeons, 98 clerical 'p~rsonnel and 118 technical officers. Thirty-one cadet medical officers are at various stages of qualification at universities in Australia. The total European staff is 644.

Among the indigenous staff are ? assistant medical officers and the Auxiliary Division of the service includes ? clerical officers and 25 technical officers. Mixed race and Asian employees number 51.

There are now 3 ??O indigenous Administration Servants employed in maqy categories; approximately one-third of these operate village aid-posts. It is anticipated that a satisfactory level of recruitment will be maintained during the next twelve months.

2 BUILDINGS

Considerable progress has been made on the new hospitals at Madang and Wewak and a Mental Block was completed at Nonga Hospital, Rabaul. The new Base 11edical Store at Port Moresby has been brought a stage nearer to completion and will shortly go into operation. Building programmes hav been continued at Ubuia Hansenide Coloqy, Finschhafen (Butaweng) Tubercu­losis Hospital and, in the Northern District of Papua, Embogo Tuberculosis Hospital staffed by the Anglican Mission has been completed and is now operating. For the eleven months to the end of May, £465 000 had b n spent on new buildings.

/3 PREVENTIVE MEDICINE •••

-2-

3 ffiEVENTIVE MEDICINE

3.1 Health Centre Pilot Project

A health centre pilot project has been commenced in an area near Rabaul in conjunction with the Local Government scheme. The centre is staffed by a qualified indigenous assistant medical officer, an assistant health inspector, and an infant child and maternal health nurse. The a1m of this team is the prevention of illness by·education and practical de­monstration and early detection of disease - which will be referred to existing hospitals. An extension of the health centre programme is proposed for 0 ther areas. '

3.2 Malaria Control

FollOWing encouraging results obtained from two malaria control pilot projeots (at Maprilc and in the D'entrecasteaux), the Department extended its activiti s in malaria oontrol to the New Guinea Islands Region, c01lll1enclng spraying operations in the New Ireland District in 1959. Spraying of houses 1s now b ingconducted in this di.strict and also in the Bouga1nviUe Dist~ict, and it is estimated that approximate13 90 000 people aM 'be1Dg .proteoted. 1n these regions. Spraying ~perations will shortly be commenced in the Manus and New Britain Districts.

An assessment laboratory has been established at i,ahaul, New Br~tain, and through clinical and entomological surveys, wnder the direction or a specialist medical officer (assistant malariologist), is continua~ examining the effectiveness of the campaign in the New Guinea Islancia region, The village aid-post network is being used to its fullest advantage to cbtain the co-operation and enthusiasm of the people in all districts. This work in health education is progressing well under the guidance of an officer who was prEfY'iously awarded a fellowship from the World H~alth organiZation to enable htm to stu~ health education at the London University. The malariologist in charge of the campaign is currently making a tour of various cowntries to stuq, malaria control and eradication methods also under a fellowship trom the WHO. It is expected that much valuable 1nlorma­tion will be gained by this officer with regard to the problems encountered in other areas and that this knowledge will be applied here when determining th future course of the Territory Eradication plan.

An inter-territory Malaria Co-ordination Conference was held in Pert Moresby in October" 19'59, and a WHO observer was among those attending.

Malaria control in urban areas continued during the year wi th routine measures of mechanical fogging, oiling and drainage.

3.3 Tuberculosis Control

/The anti-tUberculosis •••

J-

... 3 -

The anti-tu~erculosis campaign, primarily preventive but curative in so far 8S prevention includes case finding and treatment, has be n continued in the rural and urban areas throughout th Territory. This· campaign will shortly be a"gmented by the formation and equipment of an additional field team.

3.4 Infant, Maternal and Child Health

The use of the Infant, Child and Mother Care Services. in all stablished centres and clinics has increased giving a tru~ preventive

service to more childr.n and mothers at the time when health care is mast needed and when the mother is mo~t receptive to education.

" DENTAL SERVICES

The Dental Section approached closer to its aim of becoming primarily a preventive service rather than a relief-of-pain service during the year. Successful recruitment of trained staff has allowed the service to expand rapidly and dental sections were tpened at Samarai and Kavieng and the Maxillo/Facial Unit was established on a full-time basis at P~t Moresby where~8 surgical cases were treated during the year.

4.1 The School Dental Service progressed to include children undergoing Standard 111 education so that the scheme now applies to all school chlldren accessible from main 4&Jltreu·,up to and including this standard. Already the value of this 'service in maintaining school chili ren in a stat of dental health has been ver.y clearly shown in inspection of treated groups by the senior dental officer. Five thousand four hundred ninety-three school-children were treated by this e~rvice during the year.

The general service has continued to expand and a total of 16 560 patients were treated during the 'last twelve months.

The survey of dental disease patterns in relation to dietary patt :ns has continued and is now nearing completion. A new survey on eruption t~es has been initiated in the Samarai area and this wi~l.be extended to other areas of the Territory after examination of the in~t~al data.

Three students were sent to Suva during the year to commence assistant dental officer training, and even though the Territory training course for assistant dental officers is due to commence in March, 1961, it is intended to make use of the Dental School, Suv~, for selected students far some time to come.

5 MENTAL HEALTH

of Territory mental health proulems was conduct d by A further survey /the Specialist ••••

- 4 -

the Speoialist Psychiatrist, Dr. A. Sinclair, earl1 in the year and policy in relation to prevention of mental 1Une.s will shortly be implemented. The Assistant Director (Mental Health) is \ presentl1 undertaldng a pes t­graduate course in Australia in Social Anthropology. Preliminary cons­truction ot the newt~ntal Hospital at Leloki (Port Moresby) is due to commenc within the next six months.

6 MEDICAL RESEARCH ,

An investigation commenced during the year in the Sepik District into the demography, mortality and morbidity of the people and into their customs and beliefs so far as these attect health. A study is being made of th problems of maternal morbidity and mortality, with special attention~ to failure ot lactation and neo-natal tetanus, in the Maprik area.

Dr. B. MaoMlllan of the Sydney SChool of Public Health and TroPical MediciDacondUcted further surveys in the course ot investigations into the control of filariasis. .'

The Acb11'l1stration ·ls continuing to provide assistance to resear6\"t workers from the Adelaide University and the United States of America National Inst1tu.te8 ot Health who are looldng into the causes of the Kuru d1seaae.

. . Departmental medical offioers are engaged on reaearOb into the epi~

deIIl101~,, and oontrol of goitre, the masculinity ratio ot birth ot dU"tere.nt racial groups, and the control of tinea imbricata, A nutrition research unit wUl be estab11ahed at Kundiawa this financial year to stucJ.y kwa8hiorkor, protein malnutrition generallf, the aet1ology or cirrhosis ot the liver and other probleIu.

7 MEDICAL smVIOES

There haa been considerable consol~~t1on and expansion ot curative servic s. the Administration now conductis 106 hospitals in the Territor 1nc~d1ng 9 Hansenlde and tuberc~losis hospitals stafted for it by the r~li-11ou. mis810ns. One new chest hospital at Embogo was opened durl the Domiciliary oare tor non-infectious tUberculosis and Hansenlde s~erersyear. hal been expanded bT the I1se of mod.ern drugs and frequent surveillance Aid-posta have inoreased from 1 159 to 1 267 over the year and the tun~tion of these aid-poets is not onl,y curative b~t also concerned witb enviror:aantal lanitation. Three specialist thoraoio teams from Australia operated. in the Territory during the year. The Artificial Limb Factory oontinlled its prosthe­tic .ervices.

/8 MEDICAL TRAINING •••

/

-r'.

• .. 5 ..

8 MEDICAL TRAINING

Steady progress was made throughout the year. The newly-established Papuan Medical College and the Rabaul Hursing College increased the nwnber of nurses in training from 129 to 178. Eighteen assistant medical officers lolere in training in the Territory at the end of the year. A further sixteen continued their courses at the Central Medical School, Suva. Those attending various medical auxiliary courses numbered 48 in the Territory and 9 at Suva_

9 FINANCE

The following table compares expenditure between 1958-59 and 1959-60 on all public health activities (other than buildings).

Hospital and medical services

Medical training and health education

Preventive medicine

Mission medical services sub­sidized by the Administration

1958-59

£ 1 913 827

99 165

162 209

267 061

Tot~l £2 442 262 . _._ as:_=====

1959-60

£ 2 147 550

146 650

261 350

271 200'"

4

. ."",

PHILIPPINES

Report en the Progress of Health Activities

(Fiscal Year 1 Ju~ 1959 to 30 June 1960)

1 PUBLIC HEALTH ADMINISTRATION

1.1 Organization

Consolidation of the decentralized scheme of operating the health services oontinued. Eaoh of the health and medical services of the eight health districts are administered by a regional health director. The latter has under his supervision a regional training centre for public health personnel and a regional public health laboratory where laboratory samples are examined direct~ or referred from the hospital and health services •. Each regional health district is comprised of contiguous provinces and cities whose health services are headed by a provincial and a city health officer, respective~. The provinoial health offic r, in turn, has supervision over the local health service of a municipality (rural health unit). A provincial hospital is normallY situated in the capital of the province and its chief falls under the administrative supervision of the provincial health officer.

The responsibility for the country's health is ultimately vested in the Secretar,y of Health who sits in the Presidentts Cabinet. He is assisted administrative~ by two undersecretaries (viz., an Unders cr ~ar,y for Health and Medical Services who has direct charge of the regional health directors and an Undersecretary of Special Health Services who haa responsibility for laboratory activities and international quarantine), and technical~ by directors of bureaus and heads of divisions at the national level. The latter two are responsible for developing and evaluating programmes, establishing standards and procedures, and assist­ing in implementing programmes through technical assistance extended to lower levels.

l.~ Launching and Expansion of New Aotivities

Congress provided for Fiscal Year 1961 funds for 200 units in addition to the 1 300 rural health units to meet needs in terms of population density; special geographical looation of oommunities and to aSSist ohartered oities with rural environment,

The puericulture centres are increasingly being co-ordinated in their aotivities with the regular local health services.

/The filariasis control •••

-

- 2 -

The filariasis control projeot was launched with ICA and WHO assistance to determine the magnitude or the problem in ndemic areas as well as its prevalence in the still unsurveyed areas.

The bilharziasis control pilot projeot, whith liSO assistance, has introduced an integrated plan of control in three municipalities under the leadership of the local health services and seeks to establish inter­agency collaboration and community support for the control measures wtich consist of snail control, environmental sanitation, health education, and a limited amount of,medical treatment.

The Disease Intelligence Centre was formally organized with lCA assistanc • Its funotion is to collect, interpret, and disseminate, to '. ' health agencies data and information concerning oocurrenoe, spread and control against the oauses of epidemio diseases.

"Projeot Helping Hand" was inaugurated with the financial support of private oOlllQ.ero1al firms to supplement medical services being given bT the rural health units. Young medical graduates are given nominal pay for a period of one year to establieh themselves in a ranote cOlllllunit,y which haa no resi"dent ph¥.ici~n. TheT are provided 'with medioines from private and public sources and must render free medical servioe to the poor. When their, contract is terminated it ia hoped that theT wUl have at.blished themselves lQCall,y to want to continue theLrpractice in

the ar a. . '

2 BU'DGET

Financing of the health services from appropriation of the national, provincial, oity and municipal governments. Provincial and municipal governments contribute at least S% of their general revenue to a special acooWlt, the "Health Fund", from. which salaries of local and provinoial health personnel as well as expenses for medical and' health eupplies mq be obta1nedJ annual savings do not revert to the general fund. Chartered oiti s finance their health services exclusivel3' from the general fund. Provincial hospitals are financed from provincial, municipal and citT contributions but a substantial amount come from the national fund. The national appropriation tor health is theretore very essential at all levels and in undeveloped and remote communities, health servioes are maintained exc1:usively from this souroe.

The appr~iation tor fiscal year 1961 shows an increase ot 1 4 l22 ass over the preoeding year, or an increment ot rough17 ~. Although all health activities received increased allotments, the most substantial were tor the rural health services, the general hospitals and the special hospitals amounting oorrespondingly to )'2.38, 11.16 and

ilO.S3 millions •••

,!

It 3 -

;0.53 millions. The outl~ for FY 1961 is 161 370 040 which represents approximately 8% of the national budget.

, VITAL AND HEALTH STATISTICS

Improvement in the general health condition of the country was indicated by the decline in the mortality rate and the increase in the birth tat,e. With the mid-year estimated population of 123 562 905 in 1959 there were 909 086 registered births as against 197 423 deaths.

Comparative rates in 1959 as against the average for the past five years (i.e., 1954-1958) are: birth rate, 34.34 per 1 000 against 33.77; death rate, 8.38, per 1 000 against 10.10,; and infant mortality rate, 72.44 per 1 000 live births against En .08.

The ten leading causes of deaths in 1959 were tile following:

Disease or Condition Number RatoL1OO 000 • I 0

1. Pnewnonias • • • • • • • • • • 25 840 .109.66

2. Tuberculosis :. • .. • • • • • • 22 169 94.08

3 .. Bronchitis • • • · .. • • • 0 • 15 676 66.53

4. Beri-beri • · • • • • • • • • 15 617 66.28

5. Gastro-enteritis • • • • o. 0 • 14 880 63.15

6. Cardiovascular diseases · .. '. 11 982 50.85

7. Accidents. • . • • • • • • • 4604 19.54

8. Cancer • • • • • • • • • • • 4 C176 17.W

9. Tetanus • • • • • • • • • • • 2 278 9.67

10. Malaria • • • • • • • • • • • 1 768 7.50

From the above it will be seen that almost three-fourths or the deaths are due to infections with the broncho-pulmonary diseases accounted for almost one-third of the above list. The ten leading causes of deaths represented 60% of all deaths. It is significant to note that tub rculosis and malaria which during 1926-1954 ranked first and second in tne list now place second and tenth, respective~, during 1959.

4 SUMMARY ($ PROGRESS (J' ACTIVITIES

/4.1 Communicable Diseas •••

- 4 -

4.1 Communicable Dis ase Control

4.1.1 General

Immunization campaigns continued against cholera, diphtheria, pertussis, rabies, tetanus, tuberculosiS, typhoid and smallpox. Epidemio-10glO81 tindings show that 62% ot diphtheria cases occur in the ages 1-4 years and concerted preventive measure. tor this group have been adopted. "H-tever" continued to erupt in widel,y separate communities; control measures are directed towards mosquito control.

4.1.2 Malaria Eradicatio~

Th re were 41 506 blood positive cases during the year; 515 675 indLviduals received anti-malarial treatment in the control areas. Spray1n& of hous s increased trom 467 692 in 1958 to 840 041 in 1959 (continuation ar as, 828 680 houses and surveillance areas, 11 369 houses). Population prot cted in 1959 was 8 ~4 761 (against 7 785 969 in 1958) conaisting of J 433 088 people in the continuation areas and 2 621 673 in the survell­lance areas.

Medicated salt was introduced among the Mangy-an tribe in Mindoro; it sucoe •• rut this approach will be applied to the non-Christian groups in othel-' &reas.

The Division ot Malaria collaborated with WHO staff in the train1ng at malaria workers from other countries at the Tala Malaria Institute.

4.1.3 Tuberculosis Control

A 10% deoline against the previous year in tuberculosis mortality was registered in 1959 in contrast to 3.8% average annual decline in the immediatelY preceding decade and O.~ in the decade preceding the Second World war.

BOG vaccination was given to 609 lS8·individuals during the year resulting in a cumulative total of 4 603 751 vaccinated since 1952. The en st clinics (mobile and static) reported 565 077 examinations with 64 511 positives of whom 40 171 were new cases. About 2 000 patients were hospitalized· in twelve government h~spitals, excluding admissions at the Quezon Institute and the provincial pavillions ot the Phllippine Tuberculosi. Society.

Local health personnel received training in BeG Vaccination resulting in 804 individuals trained from 268 rural health units or a oumulative total from the previous year ot 1 912 personnel of 653 rural health units.

/4.1.4 u.p'oq •••

.~.

'-..< 1 ,t-

4.l.~ Leprosy Control

The total number at the beginning of 1959 of individuals in th sanitaria of different categories was? 304; towards the end this was reduced to 6 106 or a difference of 1 198 individuals. There were 963 admissions and 433 discharges.

The static skin clinics examined 36 992 individuals of whom 649 or 13.5% were clinical Hansen cases with 496 bacteriological~ positiv •

The travelling skin clinics examined 114 571 school children, 9 883 house contacts, and 30 518 individuals in clinics. The findings revealed 1 567 Hansen cases (1 053 new and 514 old cases) and 5 637 OUler skin conditions. The contacts gave positives of 4.2% skin clinics 1.3a% and school children, 0.m5'/.. .

Sulfone treatment in the sanitaria and skin clinics covering a mini­mum period of six months gave bhese results: conversion to negative, 6-9%; improvement, 78-81%; stationary, 17-19%; and worse, 2.5 to 9%.

4.1.5 Social aygiene

Reports from the Manila and provincial clinics revealed that syphi­lis continued to decline (95 cases) while gonorrhoea increased over the past year (3 899 cases). Other iiseases were: Chancroid, 8: lymphogranuloma venereum, 2; granuloma inguinale, OJ non-specific urethritis, 999.

4.1.6 Treponematosis

or the 2 116 913 individuals examined, 11 114 were diagnosen and treated as yaws while 14 114 were tropical ulcers.

4.2 Maternal and Child Health

This continued to be an important activity of the rural health units and the puericulture centres. Five maternity hospitals and 15 emergency hospitals were designated to receive .UNICEF supplies and equipmeht in addition to other units already provided previously. There were registered increases in the number of municipalities establishing domiciliary obs~­trical service.

4.3 Environmental Sanitation

Continuation of the campaigns for toilet construction and improvement of local water supplies characterized the year. Increasing requests were received for technical assistance in the construction of composting plants from the larger municipalities. The advanced training course for sanitary inspectors continued to operate with WHO assistance.

/4.4 International •••

.. 6 -

4.4 International QuarantLne

Timely discovery and isolation of 'a smallpox case in an incoming foreign vessel prevented outbreak of secondar.y cases. Sanitary improve­ments are underway to prepare the Manlla International Airport for jet­travel. The new standard for disinsectization has been adopted. A request to India has been made to rescind the bilateral agreement on yellow fever control in preparation for introducing the new.

4.5 Laboratories

Examination of pathological and bacteriological specimens totalled ?9 307; proceSSing and production of 4 069 130 cc. of blood products (whole blood, dried plasma, concentrated red oell reSidue, eto.); conduct­ing 2 791 sanitary chemical examinations; production of 14 (111 364 cc. of vaccine sera, etc. (human and veterinary rabies vaccine, vaccine virus, eDT, anti-tetanic serum, anti-cobra venom, BCG vaccine, tuberculin dilution, diphtheria,toxoid); ana~zing 9 670 samples of foods and drugs.

4.6 Health Education and Training

Assistance was rendered in the special health programmes (e.g. bilhar­ziasis control pilot project, MCH-dental health programme, malaria eradica­tion), training facilities provided for public health personnel, assisted in the placement and organization of training for the medical specialties, training of third country nationals and other health department personnel.

4.7 Medical Services

Continued rendering technical guidance to the 104 general and 5 special government hospitals with respective capacities of 6 600 and 5 950 beds and rendered inspectorial duties to 209 private hospitals with a total bed capa­city of 9 204 beds.

5 RESOURCES IN HEALTH PERSONNEL

EJccluding national, regional, provincial and city health staff, health ' and medical personnel before the end of 1959 were as follows:

Rural Health Units -

Munioipal health ot.ricers • • • • • • • • • 1 242

Public health nurses

Public health lJidw1ves • • • • • • • • • • • . . . .. . . . ",. . ..

1 296

1 524

/Sanitary inspectors •••

- ,

- 7 -

Sanitary inspectors • • • • • • • • • 1 ,564

Public health dentists • • • • • • • 283

Senior pharmacists • • • • • • •

Public Hospitals -

Chiefs of hospitals (medical) • • •• 101

Resident physicians (senior & junior). 801

Nurses • • • • • • • • • • • • • • • .2109

other {including pharmacists, etc.). .,5 065

IubCll" of hofe'ssiona1s l'EIglstered by t.heir Respective Board of ~.1QIrl al of 31 December 1951 were:

Physicians • • • • • • 15 414 or 2.8 per .5 * 000 population

Dentists • 8 160 or 1.5 per " " · • • • • •

Nurses • 1. 300 or 2.6 per " " • · · • · • •

PharmacUtts 13 593 or 2.5 per " " • • • • •

*Based on the 1960 Census that the national population is now 27 500 000.

SINGAPORE

Report on the Progress of Health Activities during 1959/1960

There has been no basic change in the type of medical facilities available to the public. The general pr&ctitioner service continues to be reinforocd. by public health and. raedica;l services provided by" Govern­ment. These are hospital services (provided by Government, voluntary agencies and nursing homes), general out-patient services, specialized out-patient services (at many hospitals for consultation and follow-up

-,:.: of specified types of cases), health services (both urban and rural in­cluding school health and maternal and. child health), dental services and a teaching service.

2 VITAL STATISTICS

Vital statistics maintain a progressive decline; the birth rate 39.8 (compared with 42.0 in 1958; total births, 64 067), the crude death­rate 6.4 (compared with 7.0 in 1958 of total deaths 10 246), infantile mortality 36.0 (compared with 43.73 in 1958) and maternal mortality rates 0.7 (compared with 0.8 in 1955).

3 NUTRITION

The general nutritional state of the population as a whole is very satisfactory.

4 ENVnWNl·jENTAL SANITATION

There was further strengthening of the environmental sanitation services with special emphasis on the r.ural areas. wi th the establish­ment of the present Government, the cleansing services, markets and hawker services and environmental health services of the local authori­ties were unified under one administrative control on an island wide basis. The second step was the integration of these services under the ¥dnistry of Health early in 1960.

A sub-committee on Po~elitis Vaccination was appointed by the Minister for Health to carry out a serological and faecal survey and to submit a report. The survey has been completed aId the report is in the process of preparation.

5 Attna~ISTRATION

In 1959 steps were taken to unify the GOVernment medical services

/with the heal~h •••

with the health services provided. by the local authorities. In November 1959, the health services of the local authorities wer brought under th Minister lor Health. To providegrea'ter co-ordination ot hospital administration, the Hospitals Board was r$pealed am a Hospitals Division stablished under the direction of the ASQistant Director of Medical Ser­

vices (Hospitals). Fran. June onwards, al':J;"angements were made to integrate , '

the Deplrtment at Chemistry within the Ministry of Health. Thus, the health services of Singapore are now founded on a unified preventive and, curative health structure and aim to provide medical and health care through full-time statt.

6 PERSONNEL

Singapore still bas a shortage ot medical and nurs1ng personnel in the public service but this situation is expected to be relieved in due course bl the rising output of the Universit..Y's Hedica1 Faculty and the Government School of Nursing. In 1959, there was one ph¥sici&n per 2 300 persons, one qualified dentist per 19 000 (one dentist ot all categories per 4 000) am, one nurse (all types) per axl. Despite the extensive plblic III8d1cal service, more than halt of the ~sic1ans on the medical register are engaged. in private p!'actice.

? WHO ASSISTANCE

Under regular programme:

One nurse educator (public tt:ealth) One nurse educator (midwifery)

UDder exparded progr8111118:

,One senior nursing consultant One nurse educator tcl1n1cal) One nurse educator (clinical)' one nurse educator (psychiatric)

No assistance was obtained tor the city' council or the rural board during 1959/1960. I

8 FINANCE

The aaegate public expenditure tor health in 1959 was iii; '7.5 mns. which represents 'i;;2S/-per capita.

,

/9 H<EprrAL AIm •••

~ ..

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9 HOSPITAL AIm OUTPATIENT SERVICES

The new hospital in Thomson Road opened in 1959 is :10t function¥lg fully at the time of writing - only three wards being in use. The hospi­tal is desi@1ed to pr ovide 400 beds. A new unit of 40 beds for the treat­ment of burns was opened in the General Hospital. four new blocks in Woodbridge Eospital have been renovated to take in the chronic sick. A mental defective home for children is now si:i:,U9.ted in the same hospital grounds. Two large out-patient units were put in operation during 1959. Each has a capacity to receive 600 patients a day.

The hospitals (excluding leprosy and mental care f2.cilities) provide 2.4 beds per 1 000 per~ons and furnish in-patient care of a little over one patient per dB3" per capita and 1.5 out-patient atten:lances per capita during 1959.

Average attendance at out-patient clinics continues to iDCreas beyond expectation - 5 800 per day in the first half of 1959 to nearly 8 000 per day in the second half.

10 MA.TERNAL AND CHIlD hEALTH

The 11aternal and Child Health Service is provided in 7 centres in the city and 20 in the rural districts, 22 visiting centres aIXl 8 village midwife centres. A total of 8 316 confinements were a ttelXied by the Domiciliary Yddwifery Service - 7 021 in the rural districts and 1 295 in the city. Over 30 000 diphtheria immunizations vlere completed in both cit~ and rural districts.

II QUARAHTINE SERVICES

2 206 ships arrived from infected or suspected ports in 1959; a total of 168 914 sea passengers were inspected and 94 718 air passengers and crew. 2 IG8 aircraft called at Singapore from infected or suspected ports. A total of 12 479 passengers were quarantined during the year.

12 COilHUlUCABIE DISEASES

Singapore remained free from cholera, plague and yellow fever in 1959. A minor outbreak of smallpox occurred in April involving 10 cases with 2 deaths, initiated by a transit passenger possessing a valid inter­national vaccination certificate. No cases of malaria. of indigenous origin occurred during the year.

Tuberculosis presents the most serious problem; the report on a

/pilot survey •••

-4-

pilot Sllr'V'q. conduoted under the Colombo Plan was read¥ in 1959 and set th inc1d.ence at :3 per cent of the population (1.5 per oent in the rural and 4.0 per oent in the urban population SUl'9'ey). Control 1& exercised by the TB control unit, which maintains a reg:i.stry, and. ep1demio1ogica1 and follow-up sections. Active C8Dpigns in BCG vaccination are being conducted at the Kandang Kerbau Hospital and in HOH centres, and through the sohoo1 health servioes. Altogether 60 000 vaccinations again8t tuber­culosis were performed during the year and over 60 000 tuberculin tests were made among schoo10hUdren. Case-fiDding is at present through the Government olinics, but Government intends to introduoe a uss X-ray SUrv87 in 1960. The TB hospital (Tan Took Seng) has 1 144 beds.

Control of tuberculosis is difficult because a large proportion of the popllation ,live in slums am squatter areas despite heroic public and private measures tor the improvement ot housing.

Government & City Counell Hospitals

General Hospital Maternity Hospital (1<. K. H.) (excluding infant cou) T .B. Hospital (Tan Tock Seng) Infectious Diseases Hospital (Middleton) Orthopaedic Hospital (St. Andrew's) Leper Settlement (Trafalgar Home) Mental Hospital (Woodbridge) Mental Defective Hospital Venereal Disease Hospital (excluding cots)

Middle Road Hospital Prisons Hospitals Opium Treatment Centre (St.John'S Island) Police Training School Hospital Thomson Road Hospital

Private HosEltals

Youngberg Hospital Gleneagles Hospital St. Andrew's Mission Hospital ~hildren) Kwong Wai Shui Hospital Red Cross Crippled Home Cheshire Home

Govemment Out-Patient ll'lstitutions

General Out-Patient Services

School Medica 1 Service Mate;rnity and ChildHealth Services

Volunta~ Out-Patient Institutions {other than . thoSe attached to Hospitals)

Royal Singapore Anti-Tuberculosis Association

~ \I~~ ~,

..),1 --: ... J)

APPENDIX A

Medical Institutions 1959

Beds Doctors Dentists

1231 134 8 316 31

1144 21 250 120 1

1023 3 1869 9

80 1

65 4 160 2 20 20 1

396 2

67 4 90 1 60 4

445 8 40 2 40 2

40 13 17 11 5

9

OUt-patient Nursing Staff Admissions Attendances

785 39918 1514278 303 44 436 273 467 440 3362 384 826

63 3451 22 144 12 376 17831 65 2043 5152

2 43

37 1349 2182'70 5 2163 60789

448 907 I 398 9 ~25 7 16 27

58 2068 34 2'75 45 391 107 35 1153 51062 10 1198 28918 2 22 2 39

80 2390841 23 103 '734

120 293 732

33 293 593

ffiIGlNAL: PffiTUGUESE

TIMffi

Report on the Progress of Health Activities dur~ the Fiscal Year 1960-1960

During the past year, progress was made in all fields. This was due to the improved services and installations. Notewortny is the building of the badly needed surgical block.

Mobile health work was intensified during this year. This was done in spite of difficult access and the bad condition of the roads. The prOVincial health service was thus able to reach inhabitants in very remote and isolated areas.

Allover the island territory, the campaign against intestinal parasites and bubones continued and the crop having been satisfactor,y, the general health of the population improved considerablY.

Furthermore, the permanent mission in oharge of studies of endemio diseases and their control continued its work on malaria and a malaria eradication projeot was prepared for 1961. For the time being, large numbers of staff are being specially trained to this effect. This mission is also assisting the laboratory of the Health Services and continues its research work on the high haemoglobin rate in Timor and on the breast-feeding habits of the Melano-Asian women in Dili. These activities are scheduled to be completed this year.

The pharmaceutical section continued the manufacturing of injectable solutions and as the allocations for the purchase of drugs were increased, there are now no more problem in this field.

~ TRUST TERRITORY OF Tl-':E PACIfIC ISIANDS ·3 ., 4_

~

. ~;

Report on the Progress of Health Activities during the Fiscal Year 1960

All district hospitals are under the direction of Micronesian medical officers and all district programnle planning and execution is done by them. This same policy is in effect in all departments of the public health service viz: medical, dental, nursing and sanitation. Staff divisional directors are American personnel who are responsible for the over-all policy on a territ.ory-wide basis but no interference at the district level. Micronesian personnel has been moved from district to district to help when need arises and closer unity has resulted in the whole service. Better co-operative effort has been achieved because of improved understanding of common and individual problems.

1 EDUCATION

One medical officer corr~leted a six-month special course in anaesthe­sia at the United states i'll-aval Hospital at Guam. This man returd.ed to his home district to direct and teach anaesthesia along with his other duti s.

In all districts one medical officer was designated as the tubercu­losis control director and became responsible for creating general health education material. This tuberculosis knowledge information is brought to the people by the public health nurse and concerns protection principles for all people.

A school for dental hygienists was opened and a representative from each district attends the formal classes. This is planned to be a two­year school.

Didactic classes in general basic health and simple medical care are in operation in the district hospitals to train the out-island h alth aides. These classes coupled with actual ward work extend over a number of months to as much as one year in some hospitals. This type of teaching gives the health aide better qualifications to perforn his work when he returns to the small island dispensary •

Special intensive classes were held by ~1e Director of Dental Ser­vices for a few dental officers in laboratory work.

Classes in midwifery continue to be taught in several district hospitals with the student midwives getting traininG in classrooms and in delivery rooms. These trainees are required to pass certain qualifying examinations before receiving certification in midwifery.

A sanitation refresher course was completed and the student boqy

/ contained personn 1 •••

- 2 -

contained personnel from all districts. Th~ bulk of the students were people from the sanitation division but la few from the education depart­ment participated.' .

Students were sent to foreign countries for special education in pllblic health administration and sanitation subjects. Students were started on their education careers with the destination of medical degrees as the end. Medical students continue to study at Suva, Fiji. Firm agree­ments have been made with the United States Naval Hospital at Guam for a one year post-graduate training course for medical officers. This course includes both class and clinical work in all fields of medicine. Medical officers completing this work return to their home district hospitals.

• . • 1 ' .:'. , ~ : . , ' , "

The School of Nursing continues its standard two-year course.

2 TUBERCUlOSIS

This disease produces much concern in the health field and receives special recognition under an organized programme of attack. Each district has a special assigned medical officer, public health nurse and assistant. whos chief work is in the pursuit of this disease. The problem is not large enough to be a full-time job, but does deserve and get special. atten­tion. Each district team follows a general probl'8lIlII1e outlined by the Assistant Director of Public Health. The Assistant Director of Public Health, at staff level, makes policy of territory-wide nature and has a

. public health nurse who goes with him into the districts to establish and aid the district programme. This unity of general programming gives a b tter result in case-finding, reporting and treatment. iti.nor varia­tions do occur from district to district but the general pattern is uniform. Case discovery and treatment is increased as a result of this increased attack upon this disease.

3 lEPROSY

Parallel to the attack upon tuberculosis is the leprosy programme. This disease is not a problem but is classified as a general public health disease and is followed with a careful reporting ~ treatment system.

4 COI'TSTRUCTION

One new tuberculosis ward has been added at one district hospital.

One new hospital unit is under construction in one district. This will be a complete in-patient unit.

One smaller 8ub-hospital has been completed and is in operation on an out-island of fairlY large population.

• •••

IJ/,

-3~

Final plans and the location for a new hospital are completed in order that construction may begin next year.

5 FIEID HEALTH SERVICES

All district centres have continued to send to the out-islands health teams composed of personnel from all departments. The medical group to care for the ill and bring preventive medicine iri the form of vaccinations, pre-natal care and well-baby clinics. The dental group to bring' repair and prevention especially to the school children. Fluorine is used in the preventive programme. The nursing group brings patient care and assists in the preventive work for both above services. The sanitation group instructs in general sanitation and assists in teaching in adult health education through the medium of visual and auditory aids. All groups function as a unit but each performs its spe­cial work. The whole enables the gathering of better health statistics and an improved record system.

These services are put into the field as often as facilities permit, viz shipping.

6 SUPPLIES

Medical supplies, both drugs and eq\iipment, have been in adequate supplY. On occasions brief shortages occur but are overcome by air shipment of the needed items. Ho dangerous or harmful shortages have developed. The shipping service is dependable and a regular schedule maintained •

7 PERSOlrnEL

The total personnel count remains about the same without addition or loss of either Micronesian or American personnel.

.'

, i

ORIGINA.L: FRENCH

VIET iYIAM

Report on the Progress of Health Activities

The health situation in Viet Warn improved considerab~ up to 1960.

At present; Viet Nam has 1 120 hospitals and hea.lth centres with 21 916 beds, 5 531 555 attendances and 349 524 hospitalizations.

1 THE TECI-TI-nCAL STAFF mCi:Ej.SED COi~S]JJC;:\ABT.sY

In 1960, the Hinistry of Health had the foll~Ting staff at its disposalJ-

Medical officers 180

Dentists 17

Pharmacists 19

Midwivea 360 :£-1ale and female nurses 1 666

Assistant nurses 404 Rural midwives 609

Health technicians 145 Assistant pharmacists 67

Sanitar,y engineers :3 Sanitary agents 61

District health visitors 218

Village nurses 2 689

2 VARIOUS PUBLIC HEALTH PROGRAtil1ES

A. ¥.ta.laria control

Since the beginning of 1960, malaria control has been in the attack phase. The Territory was divided into eight operational areas.

The results obtained until the end of the first quarter of 1960 ar as follows:

Number of houses sprayed with DDT

Number of inhabitants protected

Quantity of DDT used

1 843 462 8 326 182 l. 113 255 kgs.

/B. Leprosy control. •••

R

-2-

B. Leprosy control

A central organization was created within the Ministry of liealth. This organization is under the direction of specialized medical officers assisted by an expert leprologiet of the French Technical Hission. The cas -finding activities have provicied epidemiological data on leprosy in Viet Nam.

A central service in Saigon, seven leprosaria and specialized services in the provine ial hospitals are responsible for treatment.

C. Rural health prograJl!l!!e

This programme started at the be~nning ot 1957 and important progress has since been made.

Forty-two new buildings were erected.

The following staff was trained in a. training centre,

Sanitary agents

District nurses

Village nurses

61 218

2 989

This programme emphasizes both cura'Uve and preventive medicine.

D. Maternal and child health program1D8

With its expansion to rura.l areas, the MCH programme entered ita third phase. '

At the Children's Hospital in Saigon, a new 4O-bed service has just been created.

At Hu', a hospital for sick children is being constructed and will be comple;ted by the end of 1960.

In the provinces, a plan for the integration of MOR into the rural health program&1'1e is under study. A pilot school for rural midwives is to 'be created in Binh-Duong. Similarly, two pilot provinces will be selectec1 to become the firBt centres of the 11CH programme in rural areas.

E. Tuberculosis control

The TB control centre, situated within the pre~se8 of the Hong-l3ang Hospital, includes two sections: '

1. mass case-finding with 2 7O-mm X-ray apparatus.

/2. clinic tor •••

"--..

:~-

OJ

, .

- 3 -

2. clinic for the treatment of TB cases.

The creation of a mass case-finding section at the TB control centre at Hue is being considered.

F. Cancer control

The National Cancer Institute is being built and the first part of the construction was completed.

The installa t1 on of tLe new buildings is being undertaken, more particularlY the installation of deep radio-therapy apparatus.

G. Comnnmicable diseases control

As a result of the mass vaccinations performed every year, no case of smallpox or cholera occurred during the year.

3 BlOOD BAlr::~S

Existing blood banks texcluding those of the Army Medical Corps);

One at the Cho~y Hospital, Saigon

One at the Hue Hospital

Newly-created blood banks: at the Binh~an Hospital (Saigon)

Blood bank under construction: Phoung~ing (province of South Viet Nam)

4 CONCll1SIONS

There has been marked progress in the field of health in Viet Nam. Very satisfactory results have been obtained in the programme receiving WHO, UNICEF and International Cooperation Administration assistance.