As a means of indicating the general changes in rural people's physical capacityby age group, in men and women, I applied Shirai's correlation chart to the values of the six kinds of body measurements. In this way I obtained straight-lines representing their morphological correlations, which visualized the general tendencies existing in such changes. Measurements were made in the two villages located in the south of Ibaraki Prefecture, in the summer of 1955 and in the autumn of 1958. I have also obtained the standard values of the same subjects' basal metabolism, as well as the straight-lines by age group for the two sexes representiog the same persons' physiological functions calculated on the basis of Ohshima's assessment. I have then transcribed these three kinds of lines prepared for the two sexes into so many index straight-lines, and compared them with one another. Lines of basic metabolism and of physiological functions showed no particular difference between the two sexes. The morphological correlation line for the male ran almost parallel with the physiological line for the same sex. But, for the female, the former kept up well with the latter up to 49 years of age and made a sharp drop thereafter. Considered from various angles, the above-mentioned fact has been interpreted as a proof for rural women's premature senility.
On the occasion of the mass anthelmintic treatment for hook worm carriers, we conducted a statistical study of the incidence of so-called “Koekase” which was prevalent in the rural part of lchihara-gun, Chiba Prefecture.Data for this study were obtained through direct interviews with the ova positive cases. 1. 35% of all the 240 ova positive cases had had the local dermatitis: 32.3% of 136 male cases and 38.4% of 104 female cases. 2. Sites affected were: hands & arms (46%) and feet & legs (54%). Same persons had had the disease more than once. It usually healed within one or two weeks, but 6.3% of the cases were long in recovery and received medical treatment. 3. Incidence was about the same with the group infected with Anchylostoma duodenale only and that infected with Necator americanus only. It was about 18% with both groups comparatively low ratio. With the group of mixed infection, ratio was as high as 43%. Incidence was about the same for male and female in the mixed infection group, while in both of the two groups infected with single species incidence in women was twice as high as that in men. The avarage number of worms discharged was larger for the cases who had had the dermatitis, and those of Necator americanus were discharged in larger amount.
We performed a mass treatment of anchylostomiasis for the inhabitants of four rural villages and for the pupils of two lower-secondary schools in Ichihara-gun, Chiba Prefecture, and obtained the following results: 1. Evaluation of the effect was made 3-4 weeks after the treatment by salt flotation method (plus zinc sulfate) and also by culture. For the salt flotation method two specimens were prepared for each subject. Follow-up examinations were made at regular intervals by the said two methods, and the results were corrected accordingly. 2. Percentages of conversion to negative (i. e. disappearance of both larvae and ova from stool specimens) by different anthelmintics were approximately: 43.5% for tetrachlorethylene, 41.0% for 1-brom naphtol (2), 38.2% for ascaridol-tetrachlorethylene compoundno significant difference was observed among these three drugs; while 14.8% for the compound preparation of ascaridol-tetrachlorethylene-carbonum tetrachloratum and 4.8% for oil of chenopodium. All of these anthelmintics were found more effective for Necator americanus than for Anchylostoma duodenale. And the percentages of conversion to negative were in reverse proportion to the number of worms discharged. Even with the same kind of anthelmintic, percentages of conversion to negative differed with areas where it was administered. Percentages seemed lower in the severely infected villages. Percentage of cenversion to negative by 1-brom·Enaphtol (2) was lower with smaller doses than with the standard dose for adults (4g.per diem for two consecutive days). There was significant difference between them. In the mass treatment with tetrachlorethylene, both the percentage of conversion to negative and the appearance of secondary effects were about the same with the group dosed together with laxativa and with the group dosed without it. 3. Delayed effect (i. e. conversion to negative observed by follow-up examinations subsequent to the anthelmintic treatment) occurred to 10.8-17.6% of the cases treated with tetrachlorethylene, to 3.0-11.1% of those treated with 1-brom·Enaphtol (2), and to 14.6%-24.1% of those treated with ascaridol-tetrachlorethylene compound. 78% of such delayed conversion was observed during the four months and 93% during the six months succeeding the treatment. Development of the delayed effect was grasped by monthly counting of ova in stool specimens. The number of ova discharged (E. P. G.& L. P. G.) decreased to half the previous number at each consecutive examination, after the treatment, and in a manner of geometric progress gradually reached zero.
We examined the stool of the 989 prisoners who were serving their time at the Chiba Prison. to see the percentage of anchylostomiasis. on the assumption that the channel of infection should have been cut off for them. The percentage of all the ova positive cases was 12.2. The percentages were in reverse proportion to the length of imprisonment. The relationship between the years of imprisonment (X) and the percentage of ova positive cases (Y) was: Y=19. 12-1. 92X. These positive cases were left untreated for two years.Stool examinations were executed one whole year and two whole years after the initial examination. both by flotation technic and by culture.each repeated twice at short intervals. At each examination.3 specimens were taken for flotation and 2 specimens for culture per capita. The examination conducted in the second year or one year after the initial examination revealed 16.5% spontaneous conversion to negative. and that of the third year 16.7% conversion among the remaining positive cases. The ratio of spontaneous conversion to negative was higher among the prisoners of shorter imprisonment; by species. it was higher for those who were infected only with Anchylostoma duodenale; and by degree of infection. it was higher for those of mild infection.
When we try to confirm the presence of the ova of human parasites by flotation technic, we occasionally come across unknown ova, which resemble in form those of hook worm and of trichostrongylus orientalis.Such ova look like those of meloidogyne, parasite on plants. We took measures of the meloidogyne ova taken from three kinds of plants as well as the ova of hook worm and of trichostrongylus orientalis. The meloidogyne ova collected from carrots measured 82.7±4.26μ in length, and were found to be easily mixed with the ova of hook worm and trichostrongylus orientalis. The highest frequency of the presence of unknown ova was 4.3% according to the results of our out-of-door stool examinations. We are of the opinion that we should bear in mind the presence of such unkonwn ova at stool examinations. We hope to make clear whether these unknown ova are of the species of meloidogyne or not, and also to show how to differentiate ova of human parasites from such unknown ova.
In the rural district of Hokkaido, which holds 70% of the whole area of Hokkaido, those villages where the death-rate of sucklings is of the order of 40's (per 1, 000 births) come up to more than one third of all the villages, whereas in the cities it ranges between 20 and 39 A variety of factors may be accountable. With a view to contributing something to the clarification of the causation, I should like to introduce the existing conditions of a typical rural village located in the east of Hokkaido. 1. In comparison with cities, there are more premature babies born in the village, and furthermore about one half of the babies there are below the standard in weight and height. 2. Beginning and completion of the process of ablactation are delayed;diet is of ten low in protein and fat. There are many cases of rachitis ascribed to malnutrition; and a considerable number of babies suffer from anemia or eczema 3. Luxatio coxae congenita is found in 17% of the babies and it is often accompanied with rachitis;and there are many artificially fed babies. 4. On the other hand, the sleeping hours of nursing mothers are insufficient. There Were many hypertensive cases among them, and 37% of them showed decrease in serum protein. 5. Toxicosis is observed in 62% of pregnant women. 6. Cases of artificial abortion are numbered lately 1.3-1.5 times as many as the number of births. 7.38% of families are still using “izuko (a small cradle made of straw traditionally used in the northern parts of Japan, which is found to be detrimental to the baby's growth)”. The factors enumerated above would all in all be accountable for the aggravating conditions of sucklings: the poor health conditions of pregnant mothers play such injurious effects on their potential babies that they give birth to premature babies, and the dissatisfactory environment following the birth contributes to the appearance of undernourished sucklings-a vicious cycle which terminates in deaths. In order to rectify the present situation the following plans would be effective. First of all, births should be controlled so as to take place at intervals of 3 or 4 years, preferrably from spring to summer; women in pregnancy and in nursing period should take diet especially rich in protein and vitamins; sucklings should be placed under careful health control including timely ablactation and prevention against rachitis; besides, the authorities concerned and the health centers are required to collaborate more positively in the health campaign.If all such efforts are made, mothers and sucklings in rural areas may no doubt attain the health standards held in the cities.
Attention has been drawn to the fact that there are more cases of mild type than of serious type in acute pancreatitis, and there is a marked increase in the number of reports published on this theme. In Japan, however, we have still comparatively few of such reports. The author handled 103 cases of acute pancreatitis in the past 5 years, and conducted a statistical study of its incidence, clinical signs and symptoms, etc. As aresult, he realized that in rural areas there also existed not a few cases of that disease and that round worms frequently played an important role in it. In diagnosing acute pancreatitis, values of serum and urinary amylase are usually measured. But, in view of the fact that the values of urinary amylase rise or fall sensitively in keeping with the course of general clinical signs and symptoms, and that specimens are more easily collected, frequent measurement of amylase values in urine should be recommended as the better of the two. There are a variety of ways of measuring amylase values, but the techniques are not always simple. Besides, any and every one of them requires renewal of the starch solution reagent at each test. As a device to remove this technical obstacle, the author thought out a new method in which a specially prepared long-keeping “starch tube” was used. Report II is written about this method. The values obtained by this new method were compared with those obtained by the Wohlgemuth method the values obtained by the two methods showed satisfactory congruity with one another. The use of this “starch tube” seems worth recommendation to the general clinicians, as it is easily handled at any place whenever occasion calls for.
This is a report on the 48 cases of peptic ulcers with perforation, which have been diagnosed and treated at a rural hospital during 10 years since its establishment. The ratio of the perforation cases corresponds to 15.4% of the entire peptic ulcer cases surgically operated during the same period-the percentage is a little higher than that of the general hospital statistics. Death-rate is 14.6%. It shows a remarkable decrease as compared with the rate of the first 4 years, which was as high as 31.6% of the 19 perforation cases. This improvement owes much to the medical and technical progress in dietary management before and after the operation, administration of antibiotics and anesthetics. What we must not neglect in this connection, however, are the rural people's marked advancement in the correct understanding of surgery for ulcers, and the physicians' cooperation to that cause.
Our hospital plays the role of a medical center for a rural district, giving medical service for the approximately 20, 000 settled farming population. There is no mixingof patients with other hospitals. The author deliberated on the 242 female cases of appendicitis treated at this hospital. 1. Incidence of appendicitis.Female cases surpassed male cases in the ratio of 1: 0.75. Majority of the female cases consisted of the married women of 26-36 age group, who take the lead as housewives both in the household work and in farming. It was noted that acute cases increased in the April-June on-season, while chronic cases increased before and after the on-season, i. e. in February, March and June. The increase of acute cases may be due to the hard physical labor and overwork of rural women. 2. Histological classification of the resected specimens. Attention of the author was drawn to the existence of neuroappendicitis or appendicitis ascribed to disturbance in the vegetative nervous system.It may have something to do with the slackened mental tension before and after the on-season. 3. Affinity with gynecological diseases. Confusion in diagnosis of appendicitis and gynecological diseases occurred to 10% of appendicitis cases. Relationship with urinary diseases is not to be neglected either. Question of appendicitis in pregnancy was also taken into consideration. In conclusion, emphasis was placed on its close affinity with gynecological diseases, with the suggestion of hints for differential diagnosis.
The surgical department of our hospital, the majority of whose patients consist of farmers and their families, treated 100 cases of the diseases of gall -duct and of pancreas in the past 7 years, and studied their causation, post -operative troubles, etc. They were classified as: 1) cholelitiasis, 2) cases whose major troubles consisting of gall-duct passage obstruction caused by the pathological changes at the head of pancreas or at papilla duodeni, 3) cholangitis, 4) round worm penetration, 5) dyskinesia, 6) swelling of the peripylic lymph nodes, etc. In half of these cases no stone was pre-sent. Changes in the pancreas and at the papilla duodeni seem to require special attention. In many cases of acute pancreatitis and pancreasnecrosis, pancreasenzyme was found in high concentration in gall-bladders; the fact made the author assume that repeated inflammation might cause cholangitis. Recurrence and post-operative troubles occurred to 17% of the cases with stones and to 19% of those without stones. Accurate diagnosis and application of appropriate treat-ment worked out on the correct understanding of the cause are most important for the cases in which no stone is present.