Twenty years ago, we started medical examinations on health care at suburban farming village (TATSUTA village. AICHI Prefecture). There were many differences between suburbanfarmers and other ones. We discussed different points in the results and recognized those causes. The chief differences in many causes were 1) dietary life 2) labor. We think that the future examinations of farmers' health will have to be changed as are done at hospitals' “human docks” fromon-visit examination.
This is a review on the research work undertaken by the cooperative study group (chief: T. Wakatsuki) from 1986 to 1988. The results of many studies including clinical case study, epidemiological study and experimental study as well were presented and discussed.
The corrected death rate is by far higher among those engaged in agriculture and fishery than those engaged in other occupations. The purpose of this study is to provide data useful for the public health service and medical care in the future. For this purpose, investigation was made into the ways of life the deceased had led while alive and medical treatment they had received. Furthermore, the causes of death were examined in light of social as well as medical factors. 1. Our survey at hospitals showed that the largest number of deaths was caused by malignant neoplasm. This was followed by cerebrovascular disorder, heart disease and others, in that order. According to a comparative study conducted by a group of researchers at Hiroshima General Hospital on the causes of death between urban and rural communities, the ratios of cerebrovascular disease, accidents, trauma and suicide to the total are higher in rural areas than in urban areas, respectively. Malignant neoplasm and myocardial infarction were associated with urban lifestyle. As for neoplasm, lung cancer more frequently attacks urbanites, while cancer of the colon occurs in rural inhabitants. 2. Pattern of Death A close look at death notices does not always reveal a clearcut pattern of death in rural areas. It varies greatly depending on economic, industrial and other factors of regions. However, a general picture of what takes the lives of people can be drawn. The most frequent causes of death among those at 50 or below are accidents, neoplasm, and suicide. A study of the suicide cases in Shimane Prefecture over the past eight years shows that there is a upward tendency for men aged 65 years or above in urban areas and younger than 65 in rural areas to commit suicide. As for women, suicide cases are on the rise among those younger than 65 years old in both urban and rural areas. As the causes of self-killing, suffering from illness stands out from any other, with mental disturbance, household economy, family trouble, pressure of work and love affairs trailing behind. 3. Start of Medical Examination Of the dead, the majority had visited hospitals or clinics before their death, complaining about displeasure. About 30% of those who had suffered from mental disease, attempted suicide or had some other reasons had seen doctors. Unexpectedly, however only a small number of them consulted physicians after undergoing a regular mass health screening. Within a month from the onset of subjective symptoms, 80% received medical examination and most of them visited hospitals or clinics early in the morning. Nevertheless, many met their death in a relatively short period of time. That was a surprising finding. To be more specific. In one month after the onset of their disease, 30% of them died; in 6 months, about 60%; and one year, 70%. In the cases of neoplasm, about 50% survived for more than one year. A very few, who had their malady detected early in a screening, remained alive for more than five years. This fact proved that the screening for early detection of diseases is important. 4. Risk Factors The correlations between the major causes of death and the ways of living were examined to ponder over risk factors for diseases. However, it was difficult to link the causes of death and lifestyles. Various research institutes study this subject in different ways. The biological process from birth to death is interlocked with various social factors and environmental influences. Based on the findings of a case control study on lung cancer, we obtained the odds ratios by occupation. The ratio was low among those engaged in agriculture, forestry and fishery, and significantly high among those working in wood and metal processing plants. Moreover, it was made clear that cigarette smoking and exposure to mineral particulates multiply risks of developing lung cancer.
When the present circumstances surrounding agriculture is looked at worldwide, several factors that may aggravate the situation further in the 21th century and endanger human well-being and health immediately arrest our attention. First, the upsurge of world population. Can we increase food supply keeping up with a rapid rate of growth of population? Second, there are environmental threats. The arrival of “nuclear winter” would inevitably endanger the very existence of human beings. We must make every endeavor to ward off the danger of nuclear war. However, nuclear weapons are not the only culprit that threatens to destruct the global environment. Already deterioration in the quality of our natural surroundings is progressing at a steadfast pace. To be noted is the fact that the environmental decay mostly accrues from the advance of material civilization. The depletion of ozone layer, greenhouse effect and deforestation are among the symptoms that manifest themselves in the environment of our only Earth. These two problems-population growth vs. food and environmental destruction-weigh heavily on humankind. We must grapple with these problems in earnest to find solutions through international collaboration. The 21st century will be a period for agriculture and all-out effort must be bent to secure the fundamentals for the survival of human race. Rural medicine is a branch of medicine with the object of protecting the health of and curing the diseases of farmers and residents in rural areas. Rural medicine will gain in importance in the 21st century, as it is the century for agriculture. As a medical discipline, rural medicine will be expected to make advances in a direction different from what it is today. Medicine in Japan was developed into modern medicine with the nation's assimilation of Western civilization which was introduced after the Meiji Restoration of 1867. Before that, herb medicine originating in China was predominant. Medical colleges have ever since played a significant role in pushing forward research and development in medicine as well as sending graduates into society. In other words, Japan's medical care has progressed on the basis of the so-called top-down system. Real progress in medicine by nature is made on the basis of knowledge gained in clinical practice rather than in laboratories. In this respect, Japan's rural medicine originated in part of the agricultural cooperative union movement. The founders and initial members of the Japanese Association of Rural Medicine began work to protect the health and human rights of the inhabitants in a village where living conditions are characterized by poverty, overwork and poor sanitation. We are proud of their devotion to helping medically and socially deprived people to become aware of their health, thus advancing and ideal of medicine. Radical changes which have taken place in rural areas during the past years may seem to suggest that rural medicine has lost ground. On the contrary, there are plenty of tasks to be done-care and welfare of the aged, education and health of children, dietary habits, nutrition etc. Furthermore, Japan's rural medicine is expected to serve not only the rural population in this nation but also the peoples of foreign countries. I sincerely hope that every one of you who belong to the Japanese Association of Rural Medicine will assume a more active role in advanchng the cause of rural medicine and contributing to the welfare and health of people around the globe.
The first person who appeared in history as a diabetic patient is Du Fu (712-770), China's greatest poet along with Li Po (701-762). Du led a life full of cares. In his late years, he suffered from diabetes and pulmonary tuberculosis, and died on board a ship on the Yangzi. He was 59 years old. Everyone today knows the incidence of diabetes is basically linked to nutritional conditions. However, considering the food situation in both West and East historically, the odds were against humans having diabetes in all ages. Even today, the so-called “affluent diet” flourishes only industrially advanced nations, many poor countries still being in dire need of provisions. In Japan, since the era of Emperor Tenmu (7th century), the people high and low alike have not been allowed to eat meat. Their diet has been based on rice, fish, miso soybean paste and soya sauce. This pattern fundamentally remained unchanged until after the termination of WorldWar II. It is an irony that the people living at the age of affluence now have come to regard some of the traditional food items as health foods. In a previous report, I dwelled on the case of Emperor Meiji who had suffered from diabetes. Emperor Komei died while recovering from smallpox. Presumably, the cause of the death was keoacidosis that developed rapidly as a complication of diabetes mellitus. SaionjiKinmochi, an elder statesman in the days of the Meiji Restoration, often came down with diabetes. A physician in charge was Professor Katsunuma Kiyozo at the University of Nagoya, who later became the first president of the Japanese Society of Diabetic Medicine. Prof. Katasunuma is known as one of the three pioneers in diabetes research in this nation, the other two being Professors Sakaguchi Yasuzo and Taizo Kumagaya. The discovery of insulin is among the most illustrious achievements in the 20th century medicine. It was Frederick Grant Banting, 29, and Charles Herbert Best, 22, who erected a monumental landmark with this accomplishment. They set to work on May 16, 1921, and succeeded in having a dog with diabetes survive for 70 days by administering Isletin, an extract of the pancreas. On January 11, 1922, Banting worked wonders by saving the life of a boy named Leonard Tompsonfrom the abyss of death. In a similar way, he saved the life of Dr. R. D. Lawrence, an otolaryngologist. With this feat, Dr. Banting was catapulted into fame. By autumn of that year, rumors had been circulating that he would win the Nobel Medicine Prize. On October 25, 1922, it was decided that the Nobel Prize in Medicine went to Drs. Banting and Macleod. At the news Banting got furious and said that the Nobel Prize should go to Best and him. He complained that Macleod had not played any part in discovering insulin. It is said that Banting had entertained animosity toward Macleod for liffe.