The author obtained by door-to-door visits the actual incidence of illness among the entire population of Naguri-mura, Saitama prefecture, a village where forest management is their main occupation, during the month of August, 1957 (the then population consisting of 3401 persons) and of May, 1958 (3290 persons). With a view to confirming the authenticity of the data the author obtained by his personal inquiry, he concurrently conducted another investigation of the same subject on the basis of the medical records of the people's health insurance and other kinds of insurances. A comparative study conducted on the results of the above-mentioned two investigations is concluded as follows. 1. Reports on the visits to doctors obtained by the personal inquiry and the results of investigation based on medical records showed about 80% level of congruity on the occasion of the August investigation which was carried out without any previous notice, and about 93% level of congruity at the next May investigation when the villagers were given special instruction and also got more or less familiar with it. 2. Agreement in the names of diseases reported at the personal inquiry and given in the medical records was 63% level for the August investigation and 80% level for the May investigation; the rates of the females were always 10-7% lower than those of the males. 3. About 10% of the cases failed to give correct names of their illness on account of the dim concept they had in regard to the nature of diseases. 4. Those who reported to have consulted doctors while they actually had not turned out to be 17% in the August investigation and 14% in the May investigation-no remarkable difference was obtained. 5. Those who replied as perfectly healthy although in fact found out to have consulted doctors were as many as 37% in the August investigation and 20%in the May investigation.
The author conducted an investigation into the incidence of illness in the whole population of Naguri-mura, Saitama Prefecture, by making door-to-door visits.Investigation was made twice, in August, 1957 (covering 3401 population)and in May, 1958 (covering 3290 population), taking a whole month respectively.The materials thus obtained were adjusted in consideration of the results of another investigation of similar kind concurrently conducted on the basis of medical records.The findings adjusted in this way were made to represent the authentic total amount of diseases in respective months, and were then subjected to various analyses.Total cases were classified into four categories according to whether or not they turned up during the respective periods of investigation, and according to whether or not they were healed, moved to other doctors or died during the same periods.In this way analyzing the incidence of illness in this village from static and dynamic standpoints, the following results were obtained. 1. The total number of cases was 1444 in August and 865 in May according to houseto-house inquiry, but the authentic numbers obtained after correction in the light of the medical records were 1605 in August and 958 in May. 2. Ratio of prevalence was 34.3% in August and 18.1% in May incidence was 188.6% in August and 178.6% in May. 3. The kinds of diseases notable in August were neuralgia, lumbago, cold, gastro-duodenal diseases and wounds, and those of May were conjunctivitis, lumbago, neuralgia, cold, hypertensive diseases, wounds, gastro-duodenal diseases and allergy, according to the order of frequency. 4. Percentages held by healthy families(families whose entire members were free from illness) were 21.3 in August and 38.0 in May.Percentage of families healthy in both periods was 13.0. 5. On the basis of the present investigation it became clear that, in order to grasp the true conditions of health and disease, investigation must be undertaken over and over again in a variety of seasons, taking into consideration seasonal variations, diseases and wounds incidental to farming, conditions of location, etc.
This is a study on the incidence, during the whole month of May, 1958, of 11 different kinds of symptoms associated with the so-called Nofusho (a kind of farmers' occupational syndrome) among the inhabitants of Naguri-mura, Saitama Prefecture, a village where they make livelihood almost exclusively from forest management. It covered 2099 persons, the entire population of the village excluding the infants less than 9 years of age. The survey was made by means of personal interviews at their own homes. Taking into consideration the outcome of the study on the incidence of diseases conducted concurrently also by means of door-to-door visits, especially paying attention to the cases who were not brought to doctors' attention, the following conclusion was obtained. 1. The incidence of respective symptoms was: stiffness of shoulders 29.4%, lumbago. 20.6%, joint pain 14.2%, pyrosis 13.0%, paraesthesia 12.2%, vertigo 11.5%, nocturia 11.0%, cold limbs 8.9%, and so on. 2. Those who complained one or more symptoms associated with Nofusho turned out to be 50.0% in males and 55.1% in females. 3. Tentatively classifying those who had 3 or more symptoms as Naushei cases, the incidence of Nausho was 18.6% in males and 22.4% in females-i. e. more common in females. 4. The total number of days within the month on which those on and above 40 years of age actually suffered from such symptoms were: not more than 5 days with half of the patients, and their sufferings were deemed as temporary, but in case of the remaining half, they continued for more than 20 days.
Farmers in Japan who live mostly on rice-cropping, because of the nature of their work and climatic restrictions, have busy seasons of outdoor work and a comparatively inactive season of indoor work.The former are called “Nohan-ki”, lit, busy farming seasons or on-seasons falling in spring and autumn, and the latter called “Nokan-ki”, slack farming season or off-season corresponding to winter. The conditions of agricultural labor in the on-and off-seasons have already been reported by many scholars, but we have few reports on the transitional time lying inbetween. The author named this transitional time “moderately busy season”, and studied the conditions of the agricultural labor in such seasons from the aspect of labor science. In consideration of climatic, economic and other conditions, the author selected a village deemed as an average rural area in Japan in Ibaraki Prefecture and conducted a time study in the three “ moderately busy seasons” and on-and off-seasons then calculating the energy consumption in labor on the basis of working hours and the degree of labor, analyzed the findings.Along with this study, the author also tried to elucidate the labor conditions through the estimation of individual worker's labor capacity.The results of the present study revealed the existence of excessive labor among farmers, esp.among women in the young housewife bracket, even during the “moderately busy seasons”.
1. As a result of examination of serum protein by paperelectrophoretic method, it was found that the value of albumin in the serum of farmers was low as compared with industrial workers, but those of α1-, α2-and γ-globulin were high. This fact is related with anemia caused by parasitic worms, eapecially hookworm disease, which affected many farmers. In comparison with the hypertensive group, the author recognized more cases of hypoalbuminemia in the normal blood pressure group. 2. In the seasonal variations of the fractions of serum, albumin fraction decreased and γ-globulin fraction increased due to their intensive farming labor. 3. In the study of specific gravities of blood, hematcrit and water balance of blood, the author recognized that farmers had peculiar hydremia suggestive of their latent undernutrition. 4. It is not owing to the protein deficiency in their diet, but to the dilution of blood on account of the excessive intake of polished rice and to the accelerated function of adrenal cortex due to the excessive intake of sodium chloride to cope with the cold climate and the heavy physical labor induced by their occupation.
With a view to learning the status, on a wide scale, of the new-infection of hookworms in a rural district, the author examined the pupils of lower secondary schools in Ichiharagun, Chiba Prefecture, and obtained the following results: 1. The ratio of hookworm-ova positive cases was as high as 29.7%of all the pupils examined. By sex, it was higher in the male group than in the female group; and farmers'children showed a higher percentage than non-farmers'. 2. The percentage of new-infection was 2.2%at the minimum, 28.0%at the maximum, 12.4%on an average.In the 20 schools of all the 21 examined, percentages were not higher than 20%.And a significant correlation was found between the total infection rate and the rate of new-infection. 3. The rate of new-infection was also higher among the male than among the female examinees. By their family occupation, it was higher among farmers' children. 4. Distribution of different species among the group of people newly infected with hookworms was closely correlated with such distribution picture in the corresponding area.
This is a study conducted in regard to the 299 persons who visited the clinics as out-patients or those who were subjected to the mass examination and were found as a result of stool examination to be hookworm infection cases-all of them found in the. rural area in the vicinity of Anan-machi, Ina-gun, Nagano Prefecture.Measurement of haemoglobin, red-cell count, direct eosinophil count, reticulocyte count, total serum-protein, serum-iron and serum-copper, and Gluferricon load test were executed.Results of study of the blood pictures thus obtained before and during anthelmintic treatment (with or without iron administration) are summarized as follows: 1. Hookworm infection caused iron deficiency anemia, accompanied with eosinophilia. Reticulocyte count showed a marked increase in hookworm carriers. 2. The minimum number of parasites that produced anemia was about 30 for the male patients and about 20 for the femle patients. 3. Serum-iron decreased whereas serum-copper remained normal in the present cases of anemia. 4.By Gluferricon load test, increase in “Decrease” and “ Decrease-increase ratio” was observed in some of hookworm carriers. It was conspicuous in anemic cases. 5. Increase of haemoglobin per diem by oral administration of iron was 1.09% before the execution of anthelmintic treatment and 1.815% after it;only by anthelmintic treatment, it was as low as 0.1%. 6. In the very heavily infected cases (with more than 60 worms), oral administration. of iron was ineffective. 7.Anthelmintic treatment alone was found effective for recovering haemoglobin value almost to normal in one year's time.
Tuberculosis in Japan which had once been dreaded under the name of “the people's disease” has come to assume quite a different aspect, because of the sharp drop in its mortality rate, after the ten-odds years of strenuous efforts against it. Meeting a demand from parties concerned for the elucidation of the present situation of this disease, the Welfare Ministry undertook a national survey over a period of three consecutive years, i. e. 1953-55. The national survey contributed a great deal for the understanding of the existing status of this disease in our country, but in our opinion there remain not a few questions yet to be solved. Different behaviors of tuberculosis in rural and urban districts would be one of them. The author, therefore, trying to find out what different features there are between tuberculosis of rural people and of townsmen with respect to its onset, contrived to undertake a survey on national basis by means of the following two methods:one of them a survey by “written enquiry” system of in-patients admittei to 77 hospitals in different parts of this land; and the other a survey by “personal interview” system conducted by hymself at the 25 geographically representative hospitals of this country. Many of the results obtained from the present survey were congruous with the reports previously published by various researchers, but some of them were different. Among the findings of particular interest, there was an even lower level of familial aggregation of tuberculous patients in rural areas than in urban areas, which was contradictory to the traditional concept.It may be taken as a manifestation of the changes in the behavior of tuberculosis in rural areas.Also obtained were several findings suggestive of the important role played by the mental and physical burden of rural women in their contraction of tuberculosis.
This is a comparative study of the rural and urban groups of tuberculous patients with respect to the conditions of their disease at the time of their hospitalization and to the efficacy of chemotherapy.The cases of study consist of the typical rural and urban people of mixed sexes, in the 20-49 age bracket, picked up from among the 1, 800 inpatients of the 25 hospitals and sanatoriums, covering all parts of this land, to whom the author was allowed to get access through the courtesy of the said institutions. The results of study are summarized as follows: 1. Although there existed no particular difference between the two groups as to the conditions prior to hospitalization-length of time between the onset of illness and hospitalization, medical treatment received before hospitalization, etc.-at the time of hospitalization there were more cases, in the rural group than in the urban group, of exudative type, and more cases with the extent of lesions radiographically moderately or far advanced. Moreover, the former group had a higher percentage of proven cavity cases, often with large cavities, and of sputum-positive cases. 2. Tuberculosis among rural people was found to be rapidly progressing and disposed to get serious. 3. Comparative study of the efficacy of chemotherapy in the two groups, with similar background factors, showed a poorer rate of improvement after 6 months of treatment in the rural group, especially with respect to bacteriological conversion to negative. 4. Deliberation on the factors which contribute to the ingravescence of rural patients made the author feel the need for further study of various factors, including undernutrition, acting upon the rural people's predisposition to disease.
It is statistically known that there are more cases of advanced pulmonary tuberculosis among rural people than among urban residents. The author worked on the difference in the behaviors of tuberculosis in such two groups of people from a point of view of pathological physiology and discovered the following facts: As a result of comparison of the rural and urban patients with radiographically similar extent of lesions, the rural patients were found to be inferior to the other group at the time of their hospitalization with respect to haemoglobin values, albumin-globulin ratio, body weight, icterus index, etc., and to show higher values of γ-globulin and higher rates of positive Gros reaction, Among these items, haemoglobin value, albumin-globulinratio and body weight of the rural group showed a marked increase after 6 months' and 12 months' hospitalization.Such increase is ragarded to be a combined effect of improvement both in disease and nutriture. There are many anemic cases in rural area even among the apparently healthy people free from hookworm infection, and they also present a decrease in total serum protein and albumin values, icterus index, etc., for which their inadequate or unbalanced dietary intake is said to be accountable.In the light of this fact, it is considered that prior to the attack of tuberculosis rural tuberculous patients have already been in more or less poor nutriture, which is further aggravated by the disease, while such poor nutriture assists the progress of the disease itself playing as a causative agent for its ingravescence.
For all the benefit of therapeutic progress for pulmonary tuberculosis lately attained, advanced cases of pulmonary tuberculosis would not cease to exist-some of them discovered in advanced state and some others taking a turn for the worse notwithstanding the best possible medical care available.As a means for analyzing the factors influencing the resistance of the “host” against the disease, the author conducted electrocardiographical examination and calculation of serum-albumin values of the “urban group” and the “rural group” of pulmonary tuberculous patients, as well as measurement of serum-potassium values of some of them.The findings were dealt with in relation to the different types of pulmonary tuberculosis, esp.to the far advanced lesions (Type F according to Gakken Classification). Results of deliberation are as follows: 1) Comparison between the “urban group ” and the “rural group” revealed a higher incidence of electrocardiographical abnormalities in the “rural group”; 2) in regard to serumalbumin values, the “rural group” had a higher percentage of hypoalbuminemic cases; 3) serum-albumin values were closely related to the incidence of electrocardiographically abnormal signs; 4) in the Type F, hypoalbuminemic cases were more frequently found. than in other types; 5) exclusively in regard to the Type F, incidence of hypoalbuminemia made no discrimination between the “urban” and the “rural” groups, but the incidence of electrocardiographical abnormalities was definitely higher in the “rural group”. Serum-potassium values of the 18 cases of hypoalbuminemia were measured, and showed the higher incidence of typopotassemia in the “rural group”. This hypopotassemia was regarded not as the condition caused by their pulmonary tuberculosis but as the sequence of undernutrition which had existed since before their illness.And such undernutrition was found to be one of the factors that contribute to the ingravescence of pulmonary tuberculosis.
1. Hypertensive patients (systolic arterial blood pressure upward of 160mm Hg.) in a rural village, who had been found electrocardiographically abnormal, were subjected to an observation for a period of four years. Stochastically, no significant change was noticed in the values of systolic, mean and diastolic pressure respectively, provided that the patients had received in the meantime no systematic medical treatment. Moreover, according to the results of a long-term observation undertaken separately on another group of hypertensive cases, values of their blood pressure made no seasonal fluctuations. 2. As for their electrocardiographical findings, those who had shown abnormal signs four years ago but received almost no treatment since then, remained the same and showed no improvement in their status, as confirmed by the present study. 3. Comparing the serum components of the hypertensive patients in rural and urban areas, no significant difference was obtained between the two groups as to the amounts of serum-albumin and of serum-cholesterin.Serum-sodium values were higher in the rural group than in the urban group at 0.05 level of significance. On the contrary, serum-potassium values were lower in the rural group at 0.05 level of sighificance. The dietary habit and the mode of living in rural area, such as excessive intake of salt and hard physical labor involved in farming, would account for their hypopotassemia. Last year the authors reported on the marked higher incidence of electrocardiographical abnormalities among the hypertensive patients of rural area as compared with those of urban area; hypopotassemia in rural patients may constitute an answer, if not the sole answer, to such phenomenon.
This is a report on the findings obtained through the experience of treating 115 cases of diphtheria-all of them inhabitants of the middle part of Tottori Prefecture, a rural area, who contracted the disease during the period of 5 years between April 1954 and March 1959. 1. Incidence of diphtheria has been observed to increase since 1956. The epidemic season for this disease depends upon the climatic conditions of each district, and in the middle part of Tottori Prefecture it covers October, November and December. 2. The most susceptible ages are, from 3 to 6 years, without sex difference. 3. In the light of the conditions of local psudo-membrane and of or around the lymph nodes of the neck, disease conditions have been classified into 9 categories. A certain level of parallelism was seen between this classification and prognosis or appearance of postdiphtheritic paralysis. On the other hand the study of the relationship between the classification and body temperatures produced negative result. In view of these findings as well as of the fact that there were 11 cases (9.6%) who showed no fever throughout the course of the illness, it is concluded that the more important items for diagnosing the seriousness of this disease are local signs and signs of the neck, and that body temperature is diagnostically not so valuable.