酷暑といわれた1995年7月, 8月に山梨県で発生した熱中症の症例について, 会員へのアンケート調査結果及び救急搬送データを用いて解析した.アンケート調査では発送490名, 回答66名, うち25名より27症例が報告された.救急搬送データでは34症例が報告されている.うち5例は両者でとり上げられていた.発症は, 27例中23例が晴天下での戸外の作業中又は運動中であった.環境温約30℃をこえると発症がみられ, 35℃をこえると発症数の著しい増加がみられた.発症は気温が急に上昇した日に最も多かったが, 気温の上昇が持続している間は発症がみられた.高齢者の症例は, 成人に比べやや多い傾向があった.ただ室内で発症した4例中3例は高齢者であった.高齢者の生活状態, 経済状態に特徴的な点は見当たらなかった.体内温 (直腸温または腋窩温) が40℃以上の症例4例中3例が死亡した.体内温40℃以下での死亡例はなかった.体内温40℃以下の症例では著しい発汗が, 40℃以上では意識障害や錯乱が特徴的にみられた.治療として輸液と体冷却 (体表冷却, 冷却点滴, 冷却胃洗浄など) 及び薬剤投与が行われて効果がみられていた.

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When 19, 900 persons that died in the Yamanashi Kyoto district during the 289 years from the middle Edo era to the present according to the necrologies available at 7 temples in the district in which diseases as causes of death are scarcely entered were classed into two age groups, ie, one aged not less than 10 years and the other aged less than 10 years, and by each month, the death curves in the two groups showed the respective characteristic patterns. A survey was also made by a similar method on 8073 persons that died during 82 years and are entered in the necrology of an O temple in the Hida district in which diseases as causes of death are entered. As a result. the death curves of the two groups in this district showed the respective characteristic patterns according to the kinds of infections. When the death curves due to small pox, typhoid, measles, dysentery, which were so obtained were compared with the death curves in the Yamanashi district, it was found that these infections followed very close courses in the two districts, though there were some lags between the districts. In both the Yamanashi and the Hida district, it was noted that the major causes of death in the aged group were typhoid, cholera, influenza, famine, battle, and those in the younger group, small pox, measles, dysentery. Moreover, each kind of disease, showing its characteristic pattern, was often recognizable. Severe famine and big battles were overlapped or complicated by these diseases, to make the disasters more serious. The disease structure in the pre-war period was fundamentally altered from about 1955 on. The deaths due to infection and tuberculosis and those of neonates that had persisted since the Edo era drastically decreased, to be taken over chiefly by adult diseases in the post-war period. Seasonal alterations in the causes of death in the year show such a pattern that the peak deaths due to infection and and the peak deaths of neonates in summer that had persisted to and including the Meiji era have been overcome, to disappear in and after 1955. Annual and decadal alterations in the causes of death were then examined epidemiologically, and this disclosed the status of outbreak of infections and the occurrence of famine that had varied from district to district. Long-term alterations in the distribution of these causes of death by age showed the predilect ages of deach due to infection, death due to famine and death in battle, the frequencies of them, and the complications by them, and further disclosed alterations in the disease structure. When the causes of death in the Hida Takayama district were compared with those in the Yamanashi Kyoto district, the disease structures in the two districts during the past about 300 years proved basically close to each other, but there was marked difference in the occurrence of famine or in the outbreak of cholera between the two districts. We have proposed a method which is capable of unraveling the causes of death of inhabitants all over Japan during the period of from the middle Edo era to the present, based on the actual reliable status of death according to the necrologies, even if not filled in with diseases as causes, witn reference to the local history and to the chronological tables of Japanese and local histories as presented in the foregoing.

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1995年より1999年までの5年間に亘り,7,8月に山梨県で発症した熱中症の症例について,会員への質問紙郵送法調査結果及び救急搬送データを用いて解析した.5年間に205例が報告された.質問紙郵送法調査62例,救急搬送152例で,両者に共通の症例9例であった.8月の平均最高気温が高い年ほど症例数が多かった.5年間に症例数が次第に増加又は減少する一定の傾向は認められなかった.環境温28°Cより症発がみられ,35°Cをこえると症発の著しい増加がみられた.発症は気温が急に上昇した日に最も多くみられた.発症数のピークは10歳代と70歳代の2つある.発症の大部分(88%)は屋外(および体育館)での運動中または作業中であった.特に60歳以下では(第1のピーク),車中の症例を除く全例が屋外での運動中,作業中の症例であった.一方70歳代以上になると(第2のピーク),屋外での日常生活行動中(歩行中,買物など)にも発症し、さらに慢性疾患のある場合には屋内でも発症した.男性に多く,全例の2/3を占める.死亡例は5年間で5例であった.5例中4例では核心温が40°Cを超え,意識障害などの中枢神経機能異常がみられた.治療には輸液と,核心温が38°Cを超えた場合には体外·体内冷却(体表冷却,冷却点滴,冷却胃洗浄など)が行われ効果がみられた.

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現在,尿中赤血球鑑別の情報は血尿の由来を推測するための重要な指標のひとつとされており,血尿に遭遇したときには臨床への質のある情報報告するための検査として実施されている.山梨県臨床検査技師会一般検査研究班においては,血尿診断ガイドライン１）に「尿中赤血球鑑別」が掲載され,後「尿沈渣検査法2010」２）に判定基準が掲載され今日に至るまで,研修会等を通じて山梨県内施設尿中赤血球鑑別の実施の推奨及び報告方法の整備,県内各施設において尿中赤血球の正確な分類が実施できることを目標に活動してきた.今回,一般検査研究班活動の成果と今後の課題を,会員へのアンケート調査,外部精度管理調査から評価したので報告する.

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本報告は, 日本における偶発性低体温症の現況についての調査研究の第一歩として行ったものである. 北海道, 東京都, 神奈川県, 山梨県の4地区を選び“凍死および低体温症に関するアンケート”を送付した. 発送総数2,366通, 回答数597通, 症例数30例であった.
I. 偶発性低体温症について次の結果が得られた.
1. 偶発性低体温症は, 遭難 (10例) のほか酩酊 (13例) や各種疾患 (7例) でみられた. 男性に多い.
2. 発症は冬期に多く夏期に少ない. 夜間とくに早朝に多い.
3. 発見時体内温20℃以上の場合は治療により全快しうる可能性があり, 30℃未満では, 合併症がなくても低体温により死に至る可能性がある.
4. 処置として, 再加温, 人工呼吸, 輸液, 強心剤などの薬剤投与が行われており, 有効であった.
II. 老人性低体温症 (老人における偶発性低体温症) について次の結果が得られた. 症例数は, 偶発性低体温症30例中8例であった.
1. 発生時の状況は遭難2例, 酩酊2例, 疾患4例であった. 健常成人に危険のない環境条件下で, 健常老人が低体温症に罹患した例は報告されていない.
2. 老人性低体温症患者の社会環境については5例の回答があった. 家族との同居が多く, 経済状態は普通で, 家屋は一戸建である. 介護を要するもの5例中3例, 失禁・痴呆は5例中1例であった. 欧米でみられる一人暮しで, 経済状態の悪い老人に低体温症が多いとの傾向はあらわれていない.

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Epidemiological records were not reported before the discovery of the causative agent Schistosoma japonicum. The first comprehensive epidemiological survey was conducted in 1911. Out of 69,131 patients, 7,893 were recorded to have a high infection rate of 11.4%. Countermeasures for snail control since 1909 when the intermediate snail host was discovered are historically divided into three stages. The first stage was from 1913 when the life history of the parasite was elucidated to the end of the World War II in 1945. In 1916, Yamanashi Prefecture provided funds for the systematic control of the disease including snail control. In 1924, molluscicides of lime were introduced. In 1932, the Japanese government created a law to support parasite control. The second stage was from 1946 after the end of the World War II to eradication in 1996. During occupancy, the United States army started surveys and instructional programs. Na-PCP was introduced and used until 1971 when it was incriminated as a water pollution agent. Starting in 1950, cementing of rice paddy ditches was shown effective so an official fund of 11 billion yen was provided until 1985. In 1996 Yamanashi Prefecture finally declared the area safe with cessation of the epidemic. The third stage was from 1997 when the disease was not reported anymore and vigilant activities continue to examine possible infections from the snails till date. Now the snail survives and even proliferates in the Kofu Basin without infection.

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