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GENERAL HEADQUARTERS
SUPREME COMMANDER FOR THE ALLIED POWERS
Public Health and Welfare Section
BULLETIN
Number 145
For Period
1 - 15 December
In anticipation of possible cases or outbreaks of influenza during the coming winter season, the Ministry of Welfare has published new instructions on case reporting, serologic diagnosis, and control measures. The new instructions are contained in EI-HATSU No.1244 of 14 December 1949, subject, “Prevention and Control of Influenza”. These instructions supercede those published last winter in YO-HATSU No.75 of 27 January 1949 and YO-HATSU No.151 of 17 February 1949. The new EI-HATSU requires reporting by telephone or telegram and later by written report of initial cases and of epidemics of influenza with daily reporting of new cases both suspect and confirmed, together with the number of serologic tests performed and the number positive. In order to adequately utilize existing services of the national government in identifying an epidemic at the earliest possible date, sera from 8 to 10 patients early in any local outbreak suspected to be influenza are to be sent to the National Institute of Health. At least two serum specimens of not less than 5 cc each are to be collected on each patient to be tested, one as early as possible in the course of the illness, preferably within 48 hours of onset but not later than the 5th day, and the second from the 10th to the 14th day after onset. When an earlier report is desired an additional specimen may be submitted 5 or 6 days after the first, but a definite laboratory report requires comparison between an early serum specimen and one taken at the calculated height of serologic response, about two weeks after onset. EI-HATSU 1224 also outlines routine control measures to be followed such as disinfection, home isolation, and where indicated, the prohibition of public gatherings. Typhus Fever and Sanitation of Public Conveyances. Attention is invited to SCAPIN 2011, dated 28 May 1949, subject, “Prevention and Control of the Typhus Fever Group of Diseases in Japan.” Particular attention is called to paragraph 3(d) (e) pertaining to disinfection and disinfestation of public and private transportation utilities, etc. Reports and observations reveal that disinfestations and disinfection procedures are being done in a haphazard manner in many instances and not being given a thorough residual effect DDT spray treatment. Particular fault lies in the proper application of spray to the 3rd class railway coaches, buses and electric cars. Some transportation companies, particularly certain of the bus companies, are still using pyrethrum emulsion spray. This spray is not the equivalent of 5% DDT residual effect spray and its use should be discouraged in this work. Wettable DDT dust and DDT emulsions when applied as 5% sprays are considered to be the equivalent of the 5% DDT oil sprays and their use should be encouraged as stocks become available. At the moment investigation work and field trials continue in an effort to produce acceptable wettable DDT dusts and DDT stock emulsions. Until such time as these products are available only 5% DDT residual effect spray should be used. The addition of cresolis to the residual spray in a concentration of not less than 5% in final solution is still recommended for its action against the rickettsia of typhus fever which may be present in the fecal droppings of lice and fleas mixed with dirt particles on the floors and seats of all public conveyances. It is important that the attention of all transportation officials be directed towards the improvement of the residual spray treatment of transportation utilities and also to seek a decided improvement in the generally poor sanitation of these utilities. Streptomycin Dosage Recently a copy of Minutes of the Seventh Streptomycin Conference which was held in the spring of this year, was presented to the Ministry of Welfare for translation and distribution to those to whom it might be considered to be of interest or benefit. This report which is quite voluminous (about 400 pages) was published by the Veterans Administration and represents the collective studies and opinions available concerning streptomycin therapy. Considerable space was given to the development of streptomycin resistance. Results of treatment in various types of tuberculosis are reported as guaged by different criteria - clinical, x-ray, laboratory, etc. It is important to note that the report gives the regime consisting of 1 gram a day for forty-two days top rating in the evaluation of all the treatment regimes studied. This is very close to the 1 gram a day for forty days which has been suggested as standard for Japan from the inception of the program here. The only change which might be indicated here at present, is the giving of one gram in one dose daily rather than multiple doses. Recent experience seems to indicate that a high level on blood streptomycin once a day will accomplish as much or more than a continued intermediate level. This procedure has no yet been adopted by the Ministry of Welfare. Streptomycin Study Attention is directed to Inclosure No.1 EI-HATSU No.1189, which orders the furnishing and describes the form of the first interim report concerning the results obtained from the use of the first lot of imported streptomycin. The method of evaluation indicated is very similar to those which have been used in the United States. This document is published for information only. Japanese Veterinary Medical Association The Board of Directors of the JVMA recently in Tokyo with full representatives from every region in Japan. One entire day and evening was devoted to current problems with active participation of the regional representatives. The Board selected the City of Osaka for the annual national convention on March 26-27-28, 1950. Support is requested for the attendance of all prefectural veterinary leaders and especially government officials. A sectional meeting will be devoted to veterinary public health. Veterinary Biologics Assay Laboratory Plans are now on the drawing board for the first unit of a new assay laboratory. It will be located in Tokyo on the site of the old Animal Hygiene Experiment Station, Committees on assay standards for veterinary biologicals have been active in recent months and the list of approved methods is becoming more complete. Record of Certificates Covering Fumigation of Straw Rope and Animal Diseases Status. A total of 455,849 bundles of mandarin oranges were shipped to Vancouver, B.C. Canada. The final shipment took place from Kobe and Shimizu on 29 November 1949. As required by the Canadian Veterinarian Director General, Department of Agriculture, certificates were prepared for each shipment to cover the fumigation of the straw ropes that were utilized for binding the cases together, and also to include the status of animal diseases in Japan in which Foot and Mouth disease, Rinderpest and Contagious Pleuro-pneumonia are specifically mentioned. Bovine Influenza The Animal Hygiene Section, Ministry of Agriculture and Forestry submitted a report in which no new cases of bovine influenza were reported from the Prefectures. There still remains a remote possibility that a few sporadic cases still exist which are not being reported. Recovery of approximately 300 cases in Gifu and Mie Prefectures is expected as the incidence of the disease was very low therein. At the present time, Drs. Kono and Someya of the Institute of Public Health are engaged in research on the relationship of bovine influenza virus with that of the human strain. Materials consisting of nasal mucus, blood and tissue specimens from diseased cattle in Hyogo were collected on 9 November and research is continuing. A virus has been isolated from the specimens and it is now undergoing comparative study with the human strain of influenza virus. A serological study is being made of the antibody reaction of bovine influenza in blood of cattle when challenged with the virus of human influenza. A report of findings is expected sometime during the month of December. Correlation of the research study has been carried with Dr. Tajima of National Institute of Health. The Veterinary Affairs Division, Ministry of Welfare, submitted the following report concerning the incidence of rabies in Kanto Region, and the number of cases reported for the period 20 - 26 November: Since August, the incidence of rabies in the Kanto Region has become more localized in those Prefectures showing active cases as of this report. The Prefectures have exerted effort in trying to immunize all dogs regardless of whether or not they have been registered with city offices. The high tax that is placed on each dog has been in many cases, responsible for increased incidence of rabies as the owners were not offering their dogs for immunization. Plans are now under way to modify present city ordinances so that they do not serve as a barrier to future immunization programs. Weekly Rabies Report The Veterinary Affairs Section, Ministry of Welfare, submitted the following report on rabies occurring in dogs in the Kanto Region during the period 27 November 3 December 1949; The Animal Hygiene Section, Ministry of Agriculture and Forestry submitted the following report on those animal diseases occurring during the period of 26 November 2 December: Prefecture Disease Note: Number of swine erysipelas cases occurring since 1 January now total 1,412. Weekly Animal Disease Report The Animal Hygiene Section, Ministry of Agriculture and Forestry, submitted the following report on those animal diseases occurring during the period of 3 - 9 December 1949: Prefecture Disease Note: Number of swine choleras cases occurring since 1 January now total 1,657. The result of the August 1949 nutrition survey (See Incl. No.2) for the areas covered, Tokyo, 11 large cities, other cities and the 46 rural prefectures, evidenced in the average per capita consumption of food, a light decrease compared with the May 1949 survey. Rural areas show the usual higher calorie diet over that of the urban areas with the still greater deficit in animal protein. However, the figures given below indicate the general improvement in the consumption of food by Japanese in the August 1949 survey when compared with the August 1948 survey. While the consumption of leafy green and yellow vegetables and legumes are definitely less, there is a slight increase in the consumption of other fruits and vegetables. This may account for the drop in vitamin A intake and the slight increase in the vitamin C content in the diet. Nutritional deficiency symptoms of bradycardia, edema, loss of knee jerk, and anemia, show a general increase. Hyperkeratosis and glossitis are especially evidenced in the rural areas. Vitamin B1 deficiency is wide spread in all Japan, particularly at this season of the year (August) when the low nutritive value of the Japanese diet is more in evidence. Losses in body weight are noted in the 16 year age group. This too may be attributed to seasonal influences when high temperatures demand greater need for vitamin B in the diet. The decrease in ration foods at this time may also be another factor contributing weight losses. Article 3, paragraph 2 of the Pharmaceutical Affairs Law (Law No.197 of 1948) limits the classification of individuals who are entitled to be licensed to practice pharmacy in Japan, as follows: “License of pharmacist shall not be given to any person who does not fall under one of the following classifications: A person who has passed the National Pharmacist Examination. A person who is licensed as a pharmacist in a foreign country designated by the Minister of Welfare.” Ministry of Welfare Notification No.254 published in the Official Gazette 21 November 1949 designates the United States of America under paragraph 2b of Article 3. Reorganization of the Pharmaceutical and Supply Bureau A partial reorganization of the Pharmaceutical and Supply Bureau of the Ministry of Welfare has been effected. Ministry of Welfare Ordinance No.38 (Enforcement Regulation of the Ministry of Welfare Establishment Law, Law No.151 of 1949), promulgated 25 October in the Official Gazette, sets forth the present organization in Articles 35 through 41. The Bureau consists of six sections as follows: Enterprise The major changes from the previous organization are the creation of the Enterprise Section and the absorption into the Pharmaceutical Affairs Section of the defunct Medical Material Section. The Enterprise Section has been established to strengthen the activities of the Bureau concerned with economic affairs, both domestic and foreign (export). Chloromycetin Chloromycetin has been used successfully in treating typhoid fever and the typhus fever group of rickettsial diseases. It has been produced on an experimental scale by Japanese scientists, by both the fermentation and synthesis methods. Efforts are being made to inaugurate commercial production in Japan of this valuable drug. Critical Raw Materials The Ministry Welfare announced allocations of critical raw materials for the production of essential medical supplies and equipment, for January, February, March 1950, are the largest since the Occupation began. For the first time, sufficient quantities of such medical items as textile sanitary materials, rubber medical goods, artificial limbs and certain controlled medicines, will be produced to meet minimum domestic requirements. Biologics Assay During the period 22 November to 5 December the following biologics have been assayed and found to Narcotic Control Activities Report - October The October report on narcotic control activities from the Ministry of Welfare contained the following (including #### foreign nationals and #### ) (including eight foreign nationals and two Koreans) Theft of narcotics (including nine hospitals and one local wholesaler) 31 Losses by fire Penalties for registrants varied from two months penal servitude and ¥ 5,000 fine to six months penal servitude and ¥ 10,000 fine. One sentence of penal servitude was suspended. Penalties for non-registrants tried in Japanese Courts varied from ¥ 5,000 fine to three years penal servitude. Nine out of 39 sentences of penal servitude were suspended. Fifteen sentences were appealed by defendants and two by procurators. Penalties for foreign national varied from $100 fine to four years confinement at hard labor. Seven defendants were sentenced to confinement in hard labor including two defendants who were sentenced to deportation after a term of confinement in hard labor. There were no suspended sentences. Three defendants were found not guilty. Forty-three registrants were admonished and 11 were dealt with administratively, their licenses being suspended from two weeks to three months. Twenty-seven violations of the Marihuana Law were reported and all defendants were admonished. One defendant, previously arrested, was fined ¥ 1,000. The report also summarized the activities of the narcotic agents as follows: The Children’s Bureau is requesting each To, Do, Fu and prefecture to submit one or two cases handled by child welfare officials and any good case handled by a child welfare center or child welfare institution. From these cases, to be at the Children’s Bureau by the end of December 1949, a committee will select a group of 10 to 20 to be published in a pamphlet for training purposes. The selection will be completed by 15 February 1950. Refer to pamphlet in Japanese entitled “Child Welfare Work”, a collection of 12 cases selected from over 200 cases submitted by child welfare officials and child welfare workers, published by the All Japan Minsei-iin Federation. The new pamphlet is to be primarily for child welfare officials and other child welfare personnel not voluntary, but in paid positions, and therefore the cases are expected to be more professionally handled. Considerable detail about this project is given in Ji-Otsu-Hatsu-No.55 dated 24 November 1949 sent to each prefectural welfare department through the governor. Child Welfare - Law, Rules and Regulations as Amended Attached (Incl No.3) are copies of the Child Welfare Law, Cabinet Order, and Ministry Regulations as amended during the past session of the Diet. Amended portion of the Law and orders are underlined. CCCC As of 8 Dec 1949, 89.9% of the total goal set for the Community Chest drive had been reached. In comparison at this last year only 74.9% of the goal had been obtained. Against the total fund goal of ¥ 1,221,717,000 for this year ¥ 1,086,608,750 has been collected. A year ago at this time, against a goal of ¥ 1,175,450,000 a total of ¥ 879,631,985.05 yen had been raised. Public Assistance - Personnel The Ministry of Welfare has secured funds for 1950-51 fiscal year for subsidization of additional employees in the public welfare field - particularly for those localities which will delegate public welfare responsibilities to full time paid workers and which do not have sufficient staff to competently carry on the work. It is hoped that such funds may primarily be used to secure more competent staff than that now employed. Hatsu-Sha #77 (Incl No.4), subject: “Qualifications for the Welfare Official in Charge of Public Assistance Service” attempts to point out to the governors that these officials should meet certain minimum qualifications. In addition to this the Ministry will soon release an analysis of the job of the paid worker for further guidance. This material will be included in a future Bulletin. Public Assistance - Distribution of UNICEF Clothing Attached (Incl No.5) is a copy of Ji-Hatsu #33, dated 14 Nov 49, subject: “About Distribution of UNICEF Supplies” which set up the criteria by which UNICEF clothing will be distributed. Included therewith is a list of the clothing, by prefecture, of the first allotment (children under 9 years). The Ministry hopes to complete distribution by 1 January 1950. Public Assistance - Distribution of Winter Relief Clothing Attached (Incl No.6) is a copy of Sha-Otsu-Hatsu #254, dated 15 Nov 49, subject: “Special Distribution of Winter Relief Clothing to the Persons in Need.” It will be noted that distribution is free of charge to public assistance recipients. Housing for Repatriates - Repair & Purchase Enclosed with this Bulletin (Incl No.7) is a copy of En-Shi #1277, dated 18 Nov, subject: “Concerning Repairing of Residences for Repatriates from Abroad” which deals with allocations of funds for the stated purpose, sets up standards for such repair, and describes standards for management. Inclosed also as Inclosure No.8 is a copy of En-Shi #1278, dated 18 November, subject: “Purchase of Companies Building: Used as Repatriates Housing”, which describes procedure for the purchase of certain buildings now used for housing of repatriates. Plan for Tidal Wave Forecasts In accordance with Memorandum for the Japanese Government, AG 000.92 (3 Oct 49) GC-O, SCAPIN 2049, 3 October 1949, subject: “Earthquake Reports and Tidal Wave Forecasts”, the National Disaster Planning Board has developed a national system for disseminating tidal wave warnings to the indigenous population. The plan is comprehensive in nature and if effectively applied will insure warning to danger areas with least possible delay. A “Test run” is scheduled for 20 December 1949 in the Miyagi-Sendai area as a demonstration of the practical operation of the plan. Reference “As United Nations Fellows See Us - Observations of Foreign Visitors on American Public Welfare”, an article by Elma H. Ashton appearing in the October 1949 Social Work Journal is recommended as a highly informative review of the reactions of United Nations foreign study visitors to social work programs in America. Outline of Welfare Objectives for 1950-1951 Attached to this Bulletin as Inclosure No.9 is an outline of objectives which will be used as a guide by Public Health and Welfare Section and the Ministry of Welfare during the coming year in further shaping the organizational and administrative structure considered essential for an effective system of national welfare services in Japan. Those objectives have been presented to the Ministry and have been agreed upon in principle. The Regions will, of course, recognize that the initial implementation of the objectives will require a great deal of staff work and coordination before practical working plans and procedures will be perfected by the Ministry for release and direction of affected agencies of the Japanese government. However, it is expected that the Ministry will immediately inform the Prefectures of the general nature of the objectives and the steps contemplated in their accomplishment and strongly advise against any abortive efforts at their implementation pending the release of detailed and uniform procedures by the Ministry. Every effort will be made to keep the Regions currently informed concerning the efforts of the Ministry in carrying out the several programs. The Ministry has asked for and been assured of maximum assistance from Public Health and Welfare Section and Region Civil Affairs Teams in the development and execution of the programs. Accordingly, the role of the Civil Affairs Welfare Officers will be detailed and released to the field through appropriate channels with the least possible delay. In the meantime, the Regional Welfare Officers will consider the attached outline as informative only and will wish to discourage the development of interim projects and demonstrations upon which their advice and assistance might be requested by the prefectural or local Japanese officials. The application of Ministry instruction Sha-Otsu-Hatsu No.322 (10 October 1949), reference PHW Bulletin No.141, dated 1 - 15 October 1949, and Hatsu Sha No.72 (31October 1949), reference PHW Bulletin 142, dated 15 - 31 October 1949, during the immediate interval suggest certain problems particularly in light of the above statement. Projects and demonstrations which have already been started should, of course, be contained as seems necessary and desirable. The cities affected by the latter Ministry directive, it is hoped, will proceed with the instructions concerning utilization of paid workers but will delay general reorganization pending further and uniform instructions from the Ministry. Further comments on such problems will be contained in future PHW Bulletins. Social Insurance Medical Fee Payment Fund Law and Ordinances The attached inclosure (Incl No.10) contains the basic legal sources governing the operation of the Social Insurance Medical Fee Payment Fund, to wit: Law No.129 of 10 July 1948 as amended by the Law No.167 of 30 May 1949 establishing the Fund as a non-governmental institution but supervised and partially endowed by the National government, and two Ministerial Ordinances, No.34 of 30 July 1948 as amended by No.27 of 7 July 1949 containing general rules for the enforcement of the above Law, and No.56 of 13 December 1948 as amended by No.28 of 7 July 1949 regulating scope and exercise of the function, given to representative prefectural committees, of examining and certifying bills submitted by purveyors of medical care. One further legal source implementing the law, to wit: Cabinet order No.277 of 31 August 1948, “Registration Ordinance of the Social Insurance Medical Payment Fund” has here been omitted. It merely specifies the mechanics of registering the Fund pursuant to Article 6 of the basic law and in keeping with other provisions of civil law. It should be borne in mind that, owing to the above-said nature of the Fund, these legal instruments constitute only one part of its basis of operation. While the Fund derives from authorization under certain conditions and in certain way to render services to the several social insurances, it derives its mandate to do so from contracts entered into with the several insurers or federations thereof. These contracts set forth the mutual obligations of the Fund and the insurer subscribing to its services. In regard to the government-managed part of Health Insurance and Seamen’s Insurance one contract is entered into by the Ministry of Welfare as the representative of the insurer (the National government). In regard to society-managed Health Insurance the national Federation of Health Insurance Societies acts as representative of the insurers and signs one standard contract for all of them. In the cases of the National Public Service Mutual Aid associations separate contracts are signed by the Fund with the head-office of each association cooperating (23 out of the 30 associations existing at this time). As regards National Health Insurance, the prefectural federations of National Health Insurance carriers or their Central Society would seem to be the logical parties to the contract. However, after an abortive attempt of one such prefectural federation effectively to utilize the services of the Fund, National Health Insurance is not cooperating for the time being and probably won’t do so until its finances have been stabilized. Thus the contracts new in existance number 25 in all. Further sources regulating the business of the Fund and its 46 branch offices are the “Detailed Articles” adopted by the Fund and approved by the Welfare Minister and, finally, the directives on procedure, reporting requirements, forms, etc. issued to the branch offices by the Chief Director of the Fund. As a result of the latter there are now in use standard notification forms to the insurers, doctors and banks involved in the bill examination and payment process as well as a uniform system of record keeping and accounting by each branch office. The following figures, all pertaining to the first business year of the Fund (only seven months, September 1948 through March 1949) will convey a general idea of the scale and volume of business transacted. Total deposits received from insurers (Includes ¥ 90,136,708 for the administrative expenses involved) Of the above total the individual programs cooperating with the Fund during the period specified above account for the following amounts: National Public Service Mutual Aid Associations Total payment made to purveyors of medical and allied care Total number of doctors and dentists paid through the Fund is estimated in excess of 50,000 or better than 80 percent of all the doctors and dentists cooperating with the social insurances serviced by the Fund. Rescission of Memo Pertaining to General Travel of Japanese National Leaders to United Disposition of Deteriorated Imported Streptomycin. Results of Nutrition Survey - Japan, August 1949. Child Welfare Law, Cabinet Order and Ministry Regulations as Amended During Past Session of the Diet. Outline of Major Welfare Objectives - 1950-1951. 10. The Social Insurance Medical Fee Payment Fund Law. 11. Japanese Hospital Report - October 1949. 12. Digest of Weekly Report of Communicable Diseases in Japan for Week Ended 26 November 1949. 13. Digest of Weekly Report of Communicable Diseases in Japan for Four Week Period Ended 26 November 14. Digest of Weekly Report of Communicable Diseases in Japan for Week Ended 3 December 1949. GENERAL HEADQUARTERS
SUPREME COMMANDER FOR THE ALLIED POWERS
Public Health and Welfare Section
BULLETIN
Number 146
For Period
15 - 31 December
Sufficient toxoid has been produced and assayed to fill about 40% of the annual requirement. Since diphtheria immunization is scheduled twice annually, the balance of this year’s inoculations will be performed about six months hence. The Ministry of Welfare has allocated the toxoid now available according to estimated population of the age group whose immunization is required by law, modified by reported case rates for diphtheria during the past year. Advice to prefectures regarding the priority which they are to follow in preparing lists and administering the toxoid to certain age groups of children has been published in Ei-Hatsu No.1212 of 6 December 1949, subject “Opening of Preventive Vaccination against Diphtheria”, a copy of which is attached to this bulletin (Inclosure No.1). An attempt is being made to immunize as many as possible of those children who would have otherwise been given toxoid during the past year if toxoid had been available. Additional toxoid is expected to be available in time for use during the coming program and will be allocated to supplement the initial distribution. If stocks (re-assayed and approved lots of toxoid) on hand are not usable due to improper storage or deterioration, information concerning the matter should immediately be sent by prefectures to the Ministry of Welfare so that consideration may be given when making additional allocations. Typhus Fever Errata. Attention is invited to the artic e entitled, “Typhus Fever and Sanitation of Public Conveyances”, which appeared in Bulletin No.145 for period 1 - 15 December 1949. The last sentence of the first paragraph should read as follows: “The addition of cresolis to the residual spray in a concentration of not less than 2% in #### dilution … “. Publicity. In keeping with the general public health information program it is urged that at this time of the year emphasis be placed on publicity programs relating to the prevention and control of epidemic (louse-borne) typhus and murine (flea-borne) typhus in Japan. Quarantine Routine immunization requirements for entry into Japan were revised by SCAP Circular 17 of 30 July 1949, subject, “Foreign Quarantine Regulations for Japan.” This circular extended from one year to three years the period of validity for certificates of immunization against smallpox, retained typhoid-paratyphoid validity of twelve months and included the requirement of yellow fever immunizations of persons arriving in Japan from endemic yellow fever areas. The above circular also gave the duration of validity of various immunizations, when required, as calculated from the date of immunization as follows: Cholera Special requirements applicable to persons coming from epidemic areas of quarantinable disease have been revised by SCAP Memorandum, File AG 720.4 (29 Nov 49) PH of 29 November 1949, subject “Quarantine Regulations”. The only special requirements now applicable are: A valid certificate of inoculation against cholera of persons entering Japan by air from Calcutta. A certificate showing successful vaccination against smallpox within 60 days of all persons entering Japan Reference YO-HATSU No.39 of 12 January 1949, subject “Individual Permanent Record Card”. By reference YO-HATSU the adoption of the individual record card was required of all model health centers and advised for all others. However, national funds were available as subsidy only to model health centers, and a temporary record in the form of a ledger continued in use in most health center districts. These were described in YO-HATSU No.1355 of 15 October 1948, subject: Temporary Records of Immunization for Smallpox, Diphtheria and Typhoid-paratyphoid and in YO-HATSU No.38 of 13 January 1949, subject, “Temporary Record of Preventive Inoculation Against Tuberculosis”. The Ministry of Welfare has now published Ministry of Welfare Notification No.255 of 16 November 1949 (Inclosure No.2) which directs discontinuation of the use of temporary records of immunization effective 31 March 1950, after which date all records of immunization are to be entered on the individual record cards as described in reference YO-HATSU No.39 and amended by YO-HATSU No.128 and No.233. The form to be used for individual records is a card 6 1/8 x 8 3/4 inches, printed on both sides, as indicated INDIVIDUAL RECODE OF PREVENTIVE INOCULATION Note: (1) Each separate injection of the initial series as well as of later inoculation will be recorded in the proper column. (2) In recording “Reaction” of tuberculin test, enter the long and the short diameters of redness in millimeter on either side of (x) (in case of redness, its outer diameter). Indicate double redness “D” induration “I”, vesicles “V” and necrosis “N” by initial within the parenthesis. (3) In recording “reading” of tuberculin test get the average of the two diameters of redness and indicate (-) if less than 4mm, (=) if 5 to 9mm, (+) if larger than 10mm, (- +) if induration is present, (- ++) if induration is accompanied by double redness or vesicles, necrosis etc. (4) Method of BCG inoculation will be shown “Intradermic” or “scarification. (5) The following information should be recorded under “remarks; a. Severe reaction; b. Name of disease, date of onset, severity recovery or other results; c. In case of T.B., patient, name and relationship of any other member of the family or household who is a T.B. patient, date of onset. Training Course at the Institute of Public Health Sanitary Engineers. Because of a scarcity of candidates for training, the three month course for sanitary engineers scheduled to begin on 9 January at the Institute of Public Health in Tokyo has been postponed until 3 April. A questionnaire sent to prefectural health departments indicated only 7 students available to take the course if it was held in January. It is hoped that a larger number of candidates will be ready for training by April. Medical Health Officers. Medical Health Officers attending the next three month course beginning 9 January will be housed in new dormitory rooms recently completed on the fifth floor of the Institute of Public Health building. Meals will be served in a dining room located in the basement. Thus living arrangements for medical officers while in Tokyo will be much more comfortable and convenient than they have been in the past. Ihatsu No.1031, dated 27 December was sent to prefectural governors by the Medical Affairs Bureau of the Ministry of Welfare. This notification outlines the plans for the establishment of the one year public health nursing schools in accordance with Public Health Nurse, Midwife and Nurse Law No. 203, July 1948. As previously recognized at the regional nurses conference (October 1948) only a few public health nursing schools will be needed in the immediate future. Ihatsu No.1030 outlines the necessary qualifications for instructors of these schools. Institute for Health Insurance Nurse From the budget of the National Health Insurance Section of the Insurance Bureau of the Ministry of Welfare funds will be allotted to each prefecture (except Kochi) for a 5-day Institute for Health Insurance Nurses to be held between February - April 1950. The nine health insurance nurses of Kochi will be included in the Ehime program. This institute has been jointly planned by the Nursing Section of Ministry of Welfare and the Educational Committee of the Public Health Section of the Nurse Association. Nursing procedures for public health nurses are to be taught. Teaching materials are being prepared by the Educational Committee of the public Health Section of the Nurses Association and will be sent to the chairman of Public Health Sections of the Prefectural Nursing Associations. Detailed plans regarding the institute were sent by the above mentioned Educational Committee to the Chairman of the Public Health Section of the Nurse Association on 16 December 1949. Educational Materials Educational materials in the form of mode s, dolls, and instruments to be used in teaching programs in nursing schools may be obtained from the following sources: Yamakoshi 1, 3-chome, Okachi-machi, Taito-ku, Tokyo 17, 1-chome, Kuramae, Asakusa, Taito-ku, Tokyo-to 9, 2-chome, Yumi-cho, Bunkyo-ku, Tokyo-to 18, Kuwabara-cho, Nishi-no-kyo, Chukyo-ku, Kyoto-shi A new book “Safer Ways in Nursing to Protect Against Tuberculosis”, has just been translated and published. This book may be obtained from the Medical Friend Company, 40 Momozano-cho, Nakano-ku, Tokyo-to, for the sun of 75 yen and postage. This book was originally prepared by the Joint Tuberculosis Advisory Service of the National League of Nursing Education, the National Organization for Public Health Nursing and the National Tuberculosis Association. A comprehensive semi-annual report for period 1 April - 30 November 1949, on the experiments being performed at the National Annual Hygiene Experiment Stations has been submitted. It is believed that the current programs are being pursued with more vigor and practical objectiveness than heretefore. Major programs being continued include studies on Japanese Equine Encephalitis, Equine Infectious Anemia (improvement of diagnostic methods), abortion diseases of equines and bovines, and the treatment of lumber paralysis of sheep and goats. The recent importation of the Weybridge strain of hog cholera virus and the #### strain and Newcastle disease virus has reviewed the hope of maxing successful vaccines against these diseases. Beginning 1 January 1950, a series of experiments will be conducted to determine its adaptability in Japanese swine and poultry. Bovine Influenza Final survey by Prefectural Veterinarians discloses that approximately 145,622 cattle were attacked by Bovine Influenza during the period August to November 1949. Deaths totaling 551 were reported, and were a result of secondary bacterial invasion of pasteurella organisms. A specific virus has been isolated and is undergoing serial passages in mice. Research is continuing and findings will be compiled and published. Past history discloses that Bovine Influenza has been present in Japan, but due to its mild nature, it was never included in the list of reported diseases as required by law. Necessary steps are now being taken. Monthly Food Sanitation Report The Food Sanitation Section, Ministry of Welfare, submitted the following report on the sanitary inspections as conducted by prefectural food inspectors in those establishments processing, handling and selling food and beverages during the month of October. a. Number of establishments completing improvements Number of cases to be tried under civil law Number of samples collected for analysis Number of establishments requesting food analysis During the month of October, a total of 90 outbreak of food poisoning involving 681 people occurred with Number of food inspectors now total 1,433. Prefectural veterinarians conducted the following sanitary inspections of dairy farms and milk plants Over bacterial standards (50,000 per cc) Under butterfat standards (3.3 percent) Over bacterial standards (50,000 per cc) Under butterfat standards (3.3 percent) Ordinary Milk Number of farms inspected Over bacterial standards (2,000,000 per cc) Under butterfat standards (3.0 percent) Over bacterial standards (2,000,000 per cc) Under butterfat standards (3.0 percent) Over bacterial standards (2,000,000 per cc) Under butterfat standards (3.0 percent) Quantity of Milk Bottled in Milk Plants in October Milk Products Produced in October Powered whole milk Powered whole milk modified - 15% sugar added Powered whole milk modified - 35% sugar added Prefectural veterinary seafood inspectors conducted sanitary inspections on the following seafood establishments during the month of October. a. Wholesale Seafood Markets Cause for condemnation - Putrefaction Disposition - Fertilizer Cause for condemnation - Putrefaction Disposition - Fertilizer Cause for condemnation - Putrefaction Disposition - Fertilizer The Animal Hygiene Section, Ministry of Agriculture and Forestry, submitted the following report on those animal diseases occurring during the month of November. Prefectural veterinary meat inspectors conducted ante and post-mortem inspection on the following number of livestock slaughtered during the month of October. Prefectural veterinary meat inspectors conducted sanitary inspections on the following establishments Meat Processing Establishments Number of establishments Amount of meat and meat food products examined Amount of meat and meat food products condemned Meat Retail Shops Number of establishments Amount of meat and meat food products examined Amount of meat and meat food products condemned Cause for condemnation - Putrefaction Disposition Amendment to Enforcement Regulation of Pharmaceutical Affairs Law Ministry of Welfare Ordinance No.40, published in the Official Gazette 15 December, amends parts of the Ministry of Welfare Ordinance No.37, 1948, which is the Enforcement Regulation of the Pharmaceutical Affairs Law, Law No.197, 1948. The purpose of these amendments is: 1. To bring the Enforcement Regulation in line with Article 17 of the Law Revising Parts of Local Finance Law, Law No.168 (31 May 1949). This article amends the Pharmaceutical Affairs Law, in conformity with extension of local autonomy, to allow prefectures to set and collect fees for licensing of pharmacies and sellers of drugs, rather than the Minister of Welfare who previously did so. 2. To add to the list of poisons and powerful drugs, Appendix No.1, certain drugs and their preparations newly licensed for manufacture in Japan. This action is taken upon the recommendation of the Japanese Pharmacopoeia Committee. Sodium p-hydroxy m-nitrohydroxymercuribenzene Sodium p-hydroxy m-dinitro c-hydrxy #### Molecular compounds of diallyl-barbituric acid and aminopyrine Removal of Control from Designated Ration Goods Ministry of Welfare Notification No.266, published in the Official Gazette 16 December, deletes 15 items of drugs and 3 items of infant foods from those designated for ration distribution by Ministry of Welfare Notification No.70, 1947, as follows: Item Ephedrine hydrochloride (including racemic) production. Substitutes are used: Sulfa drugs, etc. evipan soda, phenobrabital, promvalerylurea With the publication of Notification No.266, hexylresorcinol capsules have been removed from distribution control. It is expected that such release of control will stimulate the sale of this valuable anthelmintic drug. The Ministry of Welfare is planning a wide program of public information, based on results of clinical tests now in progress, to acquaint the general public and the professions with the worth of hexyresorcinol in the fight against intestinal parasites. Production of sulfadiazine during October and November totaled 1,436 kg., which amounts to 11 times the total production for CY 1948. This greatly increased production is explained by the receipt of 4.8 metric tons of pyridine scheduled under CARIFOA FY 1949. A second shipment of 5.2 metric tons of pyridine will arrive in Yokohama this month. Buffered Penicillin Tablets The Ministry of Welfare announced 457,046 buffered penicillin tablets of 100,000 Oxford units each, were produced in Japan during November. Six manufacturers are producing the tablets which retail for ¥ 120 each. Total penicillin production for the period reached the all-time high figure of 236.1 billion units. Precious Metals for Medical and Dental Use To maintain a minimum standard of health, and for use in the production of medicines and dental materials, the Japanese Government will release precious metals for the first quarter, CY 1950, in the following amounts: Gold - 311,330 grams, Silver - 273,435 grams, Platinum - 569 grams, Palladium - 1,395 grams and Silver foil - 30,600 grams. Ten hexylresorcinol manufactures produced 1,461kg of hexylresorcinol crystals and 901,392 grams (adult dosage) of hexylresorcinol capsules in November. All passed assay, 2,426,114 grams of hexylresorcinol (capsules) are stockpiled in manufacturers’ warehouses. Biologics Assay During the period 6 December to 21 December the following biologics have been assayed and found to During the period 29 August to 22 Novembe, the following lots of Diphtheria Toxoid have been assayed and found to meet minimum standards: Manufacturer The lots of Diphtheria Toxoid (listed below) which are in storage at prefectures indicated, have been reassayed and found to meet minimum standards. Use of these lots should be made only when storage conditions have been proper. Reference is made to letter to all commands, (File AG 444.2) PH dated 6 December 1949, subject: “Release of Japanese Produced Diphtheria Toxoid for Human Use”. Paragraphs 3 and 5 subject letter follow: “3. At the present time, 113 lots of diphtheria toxoid are ready for release for use: Of these, 45 lots were under the control of the various prefectural health departments throughout Japan at the time its use was suspended in December 1948. During the past year these lots have been in storage within the various prefectures wherever they were located. Conditions of proper storage should have been 0-5℃, refrigerator temperature. Inspections and reports indicate that some of this material has not been stored properly. However, it has not been possible to determine accurately which lots, or portions of lots, have and which have not been stored properly. The material which has not been stored properly is unsuitable for use and should not be used even through it may be included in the lots released. “5. Prior to release and distribution of diphtheria toxoid on or about 15 December 1949, the Ministry of Welfare will notify the Chief of each Prefectural Health Department of the material to be released and that reassayed material which has not been properly stored is not be used. It will then be his responsibility to see that such material is not used and that it is destroyed.” Conclusive evidence has been obtained that heroin being supplies to the illicit traffic in Japan is originating from the Asiatic Continent. Seven hundred eighty-two grams were seized during an attempt to smuggle the heroin into Niigata. On another occasion one pound of heroin was seized among contraband goods destined for Kobe. The smuggling of narcotics into Japan is significant in that it demonstrates the under world must rely on sources outside Japan. The seizure of 70 grams of heroin in Yokohama led to the seizure of 260 grams in Osaka as the source of supply. The Osaka case resulted in the arrest of a well-known narcotic peddler who was free on bail pending trial at the time of his arrest. Ten persons were arrested in Gumma Prefecture as the result of seizure of 510 grams of cocaine in a hotel in Takasaki City. Additional amounts of heroin, morphine and other narcotics were seized in the home of the leader of the racketeers. Investigation of the source of the narcotics is continuing. Eight Japanese in Yokohama were arrested and charged with illegal possession and sale of narcotics which are believed to have been obtained by the burglary of a hospital in the same city. As of 21 December, 92.3% of the total goal of ¥ 1,221,717,000 had been collected, or ¥ 1,129,891,122.57. Sixteen prefectures as of that date have made 100% or more of their quota, the highest being Aichi with a total of ¥66,192,028.18, or 110.3%. Consumers’ Livelihood Cooperative Association in Japan At present there are 720 Consumer Cooperative Associations in Japan and seven Consumer Cooperative Federations (84 Cooperative Association members). Total amount invested is ¥ 123,990,450 in 2,173,725 investment units. The main building of newly constructed Red Cross Hospital at Musashino City (Tokyo-to) was formerly dedicated and opened for business on December. Construction was financed by the JRC Tokyo Chapter and JRC National Headquarters. The JRC has received in the United States a gift of $ 15,052.01 from the liquidation committee of the Tule Lake Cooperative Enterprises. This donation will be held in account by the ARC in Washington, D.C., to meet dollar obligations of the JRC, primarily in financing travel and incidental expenses of Red Cross Study-visitors to the United States. Public Assistance Statistical Report - October The Ministry of Welfare has submitted the attached figures for the month of October. Figures for September 1949 and for October 1948 are shown for purpose of comparison. Public Assistance Statistical Report by Prefectures Attached to this Bulletin as Inclosure No.3 is a copy of the prefecture public assistance totals. The Ministry of Welfare gives two reasons for decreases in the number of recipients. First, a decrease in disaster relief, and, secondly, decreases in 29 prefectures as a result of annual recertification of public assistance cases. Inclosure No.4 summarizes in tabular from the current financial provisions governing the several social insurance programs effective in Japan. The financing of these programs is briefly stated under three headings: (1) the basis and (with reference to National Health Insurance and Unemployment Insurance) method of assessing contributions, (2) their rate and appointment, and (3) the nature and extent of subsidization from general government revenues. It is hoped that this summary will be helpful as a reference for orientation and surveillance purposes. 7 Incls: 1. Opening of Preventive Vaccination Against Diphtheria 2. Ministry of Welfare #### #### No.255. 3. Public Assistance Report - October 1949. 4. Financial Provisions Governing the Several Social Insurance Programs Effective in Japan. 5. Monthly Summary of Vital Statistics in Japan - October 1949. 6. Digest of Weekly Report of Communicable Diseases in Japan, Week Ending 10 December 1949. 7. Digest of Weekly Report of Communicable Diseases in Japan, Week Ending 17 December 1949.

Source: http://www.rekishow.org/GHQ-PHW/pdf/wb4912.pdf