The Changing Pattern in the Scene of the so-called Legal Communicable Diseases in Japan and Reappraisal of the Law Concerned

Abstract

What we call legal communicable diseases (LCD) is one of two main versions designated for lawspecified infectious diseases in this country. Diseases belonging to this category are isolation-compulsory in a certain law-specified isolation hospital whether or not they are communicable directly from man to man. Their names are as follows: bacillary dysentery (including ekiri-a Japanese version to toxic form of dysentery characterized by general cramp), amebic dysentery, typhoid and paratyphoid fever, scarlet fever, diphtheria, meningococcal meningitis, Japanese encephalitis, cholera, typhus, small pox, plague, and polio. Of them, typhus, small pox, plague, and cholera are quarantinable at the same time. Polio is isolation-obligatory only when the physician decided so. Another version is notifiable communicable diseases (NCD). They are only reporting-obligatory. Their names are: influenza, tetanus, food poisoning, measles, rabies, epidemic gastroenteritis, anthrax, pertussis, malaria, tsutsugamushi disease (scrub fever), filariasis, yellow fever, relapsing fever, schistosomiasis, tuberculosis, leprosy, trachoma and venereal diseases. Of them, yellow fever and relapsing fever are quarantinable at the same time.
The original form of now acting law concerning LCD was established and put into effect in as early as 1897, about 70 years ago. Amazingly, the law has remained almost intact until now and continuedto exercise its relentless power upon us. And, more amazingly, few have ever raised the question about it in public.
Once one happened to be diagnosed by a physician as, say, dysentery or scarlet fever and however mild his symptoms would be, he is at once destined to be sent to one of isolation hospitals and confined there for 2 or 3 weeks, or more.
With the passage of time, even to limit a period within about 35 years since the author entered to this medical field and began specializing in LCD at Tokyo Municipal Komagome Hospital (TMKH), one of the law-specified isolation hospitals run by Tokyo Metropolitan Government, the scene in LCD has fundamentally changed.
In those days when the law was instituted, it would be true that the isolation was thought as only means available to prevent effectively the spread of epidemics, partly because they were lacking other formidable means to deal with, and partly because they were lacking due knowledge as of now. Therefore, it cannot be blamable that they, at that time, selected the subjects to the law putting main emphasis on the rate of morbidity and mortality.
Nowadays, however, by virtue of many favorable factors such as emergence of antibiotics, effective vaccines, improvement of environmental hygiene along with our socio-economical development, or enhanced individual health and resistance to diseases, most LCD that were once looked upon as life-threatening or nearly fatal are substantially tamed and are dwindling in number. Some are really disappearing. Once horrifying scenes seen in and outside TMKH in those days are now only told like an old-time legend. Moreover, the nature of the diseases as well as the mode of infections is becoming more and more clarified.
This paper describes the changing pattern of a general picture of this medical field outlining the hospital (Table 1., 2., 3., and 10.) and the national (Table 4., 5., 6., 7., 8., 9., and 11.) statistics of LCD as well as some of NCD, describes some noticeable findings in these individual diseases, discusses anachronistic aspects of the law, and makes proposal of its immediate overhaul and revisions.
The author's arguing points are summed up as follows:
1) No delay should be allowed in revamping this time-honored law. First of all, enforcement of such unconditional obligatory isolation must be retracted.
2) It is undisputable that strict isolation of scarlet fever is bordering on nonsense.