Japan

JAPAN. General Data and Population Movement. Area—382,265 km², and counting Japanese possessions (Korea, Formosa, Kwantung, the South Manchurian Railway zone, and Sakhalin)—652,900 km². The population movement is presented as follows (per 1,000 population): Table 1. Years: Population, Births, Deaths, Natural Increase, Stillbirths, Infant Mortality. (Data omitted in source text fragments). Unlike European countries, in Japan, as in most Asian countries, men numerically predominate: in 1930, there were 32,390,155 men and 32,059,850 women. Sanitary Organization. Sanitary organization and sanitary legislation play a very weak role. Sanitary administration is under the jurisdiction of the Ministry of Interior, since there is no separate Ministry of Health. School hygiene depends on the Ministry of Public Education, and health care in the army and navy—on the respective ministries. The Central Bureau of Health was created under the Ministry of Interior in 1877, and its activities gradually expanded. It consists of a director and 30 members and directs all matters of health care, the organization of which, like the entire administrative organization of Japan, is highly centralized. Industrial hygiene is managed by another bureau—the Bureau of Social Activity. Since 1916, a National Bureau for research in the field of hygiene has been founded under the same ministry. Its role is general supervision of health care, study of the population and sanitary statistics, maternal and child welfare, study of parasites, food, alcoholism, water supply systems, housing construction, family budgets, etc. Employees of this Bureau are sent for specified periods to rural areas in groups of 3–6 physicians, 2–3 pharmacists, and 3–5 social work nurses. Under the same ministry, there is a Central Health Council and a council for compiling the Japanese Pharmacopoeia, the tasks of which are to give opinions on questionnaires in the field of health care. Directly dependent on the ministry are the following research institutions: the Institute of Infectious Diseases, founded in 1892 by the Health Society and transferred to the state in 1899, which produces and controls sera and vaccines; the Research Institute of Nutrition, founded in 1902; and government bacteriological-hygienic laboratories in Tokyo and Osaka. In the provinces, each prefecture has a sanitary department that is part of the local police department and depends on the provincial governor. Attached to this department are a laboratory and experts. Many large cities have their own sanitary departments and laboratories, while in small towns and villages the entire sanitary administration is usually represented by a single official. There is a port quarantine administration in 6 ports. In addition, Japan maintains an Epidemiological Bureau in Singapore, dependent on the League of Nations, whose role is to notify the Japanese administration about epidemics in the East. Medical Personnel. Medical training is provided to physicians in 5 imperial universities with medical faculties, in 11 private and state medical schools, and in 9 special medical institutes. Graduates of these institutions undergo state examinations before a special commission. The number of students in each medical institution is small, and the graduation of physicians lags somewhat behind population growth. Thus, in 1929/30, there were 2,275 medical students in all imperial universities and 3,984 in private ones. The first medical school modeled on American ones was founded only in 1870. The proportion of physicians and dentists in cities is approximately twice as high as the proportion in rural areas. The number of medical personnel in the country for 1932 is expressed as follows: Table 2. Medical Personnel: Physicians—60,068 (6.94 per 10,000 pop.), Dentists—17,164 (2.47 per 10,000 pop.), Pharmacists—20,470 (8.09 per 10,000 pop.), Midwives—54,665 (8.24 per 10,000 pop.), Nurses—89,684 (18.0 per 10,000 pop.). In addition, Japan has a huge number of healers applying methods of Chinese medicine, masseurs, etc., practicing various pseudomedical methods of treatment. Over half of them are blind. In 1932, there were 33,196 sighted and 37,980 blind healers and masseurs of this kind. There are almost no physicians in state service; the vast majority of physicians engage in private practice or work in private hospitals. In 1932, there were 13 state hospitals, 87 public ones with 8,729 beds, 2,351 private ones with 66,836 beds, for a total of 2,451 hospitals. In addition, in 1932 there were 36 charitable hospitals with 3,566 beds. In recent years, a process of reduction of state hospital care has been observed due to the development of private fee-based hospitals that cannot serve the indigent population of the country. State and public hospitals and clinics are overloaded with patients. There is also a shortage of beds for psychiatric patients, whose number is growing rapidly. In 1932, there were 73,540 psychiatric patients (11.09 per 10,000 population); the number of psychiatric hospitals was 110, with 14,368 beds. The pharmaceutical industry is widely developed in Japan, exporting its products mainly to China. The opium trade for medical purposes has been a state monopoly since 1878. However, as is well known, Japan is one of the main suppliers of narcotics to China, exported through smuggling in huge quantities (mainly morphine and heroin, as well as cocaine). The number of pharmacies is growing rapidly, rising from 8,689 in 1927 to 9,322 in 1928 and 11,282 in 1932. Infectious Diseases. The most widespread are dysentery (bacillary), typhoid fever, and paratyphoid fevers. Smallpox, which until 1928 caused several hundred cases per year, has almost completely disappeared since 1930 thanks to measures taken to vaccinate the entire population. Conversely, scarlet fever, to which the Japanese were considered immune, yields an increasing number of cases every year. Imported cholera cases through ports are observed almost every year. By 1925, infectious diseases had assumed such a threatening character that it was necessary to create a whole network of infectious hospitals and isolation points. Thus, in 1923, the country had 1,482 infectious hospitals with 25,037 beds and 8,136 isolation points with 74,910 beds. Since then, their number has decreased. Leprosy was very widespread. In 1906, there were 23,815 lepers, including 16,607 men and 7,208 women. In 1919—16,261; in 1932—4,358. All of Japan is divided into 5 districts with a state leprosarium in each, but most patients do not end up in them; thus, in 1919, out of 16,261 lepers, only 6,010 were treated, while the rest were not even isolated. In 1932, there were 15 public and private leprosariums with 4,338 beds. Social diseases are extremely widespread, and the fight against them is conducted inadequately. Their spread is greatly facilitated by the desperate plight of the working masses, malnutrition, and difficult sanitary living conditions. Tuberculosis. Mortality from tuberculosis is high and in 1932 remains at the same level as 30 years ago. Thus, in 1932, mortality reached (per 10,000 population) 12.7 from pulmonary tuberculosis and 16.4 from all forms of tuberculosis. Mortality among women is much higher than among men, which is explained by the predominance of female labor over male labor, beggarly wages, and the absence of legislative labor protection. The fight is conducted on the basis of the 1919 law. According to this law, access for tuberculosis patients to certain professions can be prohibited. Cities with a population of 300,000 inhabitants are required to have a tuberculosis sanatorium. Subsequently, this law was extended to cities with a population of over 50,000 inhabitants. The state subsidizes sanatoriums in the amount of 50% of the construction cost and patient maintenance. Mass screenings of the population for tuberculosis are carried out (in 1927, 1,346,575 people were examined). The Japanese Anti-Tuberculosis Association organizes sanitary-educational work and clinics for patients. Venereal diseases are extremely widespread and are supported by widespread and legalized prostitution. By law, prostitution is permitted from the age of 18; special quarters are set aside for prostitutes. In 1932, there were 492 such quarters with 49,825 prostitutes.

Secret prostitution widely flourishes, although it is punished by law. The fight against venereal diseases is conducted partly by the state, which maintains prison-hospitals for prostitutes, but mainly by the Japanese Association for Combating Venereal Diseases. Thus, in 1923, there were 162 prison-hospitals with 5,001 beds and 494 special consultations for prostitutes. In 1927, the number of hospitals was 149 with 5,613 beds, and in 1932—136 with 5,381 beds. Through them, in 1932, passed 55,366 "legal" prostitutes and 551 clandestine ones. A special law on the fight against venereal diseases was issued in April 1927. In 1928, at the time of this law coming into force, there were 1,812 societies for combating venereal diseases in the country with 120,216 members. In 1928, 98 venereal dispensaries were established, in which 757 patients were hospitalized and 3,922 treated on an outpatient basis. At the end of 1931, the number of dispensaries rose to 122, the number of hospital patients to 10,731, and outpatients to 42,301. In 1932, there were already 136 dispensaries, in which 13,682 patients were hospitalized and 37,158 treated on an outpatient basis. But all these measures, given the huge cadre of prostitutes in the country, yield poor results. Trachoma is extremely widespread. Thus, in 1914, trachoma was found in 20.49% of those conscripted into the army, and in 1923—in 14.68%. According to questionnaires in 1919, 8.59% of students suffered from trachoma, and in elementary schools—14.85% of boys and 16.69% of girls. Among factory workers, there were 10.84% trachomatous individuals. In some prefectures, this percentage reached 17.5. In 1932, 6,029,241 people were examined for trachoma, and 625,697 were recognized as sick. Treatment is free for the indigent, but no serious widespread campaign is being waged. In 1916, the Trachoma Association was established. Some funds are allocated by the state, prefectures, and cities. In March 1928, there were 2 dispensaries organized by prefectures, 54 private ones, and 1,212 organized by cities and villages. Beriberi is very widespread. Its incidence increased from 1912 to 1922, then began to decline somewhat. In 1922, beriberi was the cause of death in a proportion of 0.33 per 10,000 inhabitants. On average, 15,000 to 19,000 people die from it annually. The struggle against it is weak and extremely difficult, given that rice is the staple and often even the sole food of the working masses. Cancer. Mortality from cancer over the past 15 years has been stationary, fluctuating from 6.8 to 7.1 per 10,000 inhabitants per year. Labor protection is almost nonexistent. In Japan, the percentage of working women is extremely high, and their labor is severely exploited. In 1930, in factories with a workforce of over 10, 806,921 men and 880,451 women were employed. Existing labor protection legislation applies only to factories employing over 10 workers. Meanwhile, in 1930, 55.4% of factories, numbering 194,560 workers, employed fewer than 10 workers. At the same time, 42% of workers live at the factories in special dormitories. Thus, in 1924, 506,951 female workers (58% of all female workers) lived at the factories in barracks-dormitories, as well as 17% of male workers. Over 50,000 women work in coal mines. When hiring, a medical examination is usually performed—in the interest of the employer, but there are no periodic check-ups. Restriction of working hours exists only for women and children. The labor of women and children under 16 years of age may not exceed 11 hours per day, including a one-hour lunch break. Weekly working hours are not limited. Only in the textile industry, until September 12, 1931, was the working day, regardless of the number of workers in the enterprise, limited to 12 hours a day, and from that date—to 11 hours. Until 1930, in the overwhelming majority of enterprises, workers had no more than 2 days of rest per month. Since 1930, under the influence of the crisis, the application of weekly rest expanded, and the working day averaged 9 hours in most enterprises, with a corresponding reduction in wages. Night work for women and children under 16 is prohibited, but work until 11 PM is permitted for them. In fact, in 1932, 17% of women and children worked at night. An amendment to the 1928 law limits working hours in mines to 10 hours for women and children, but not for adult workers. According to the 1927 census, 77% of workers in mines worked an average of over 9 hours, excluding overtime work. Until 1919, even these hints of labor protection did not exist. From September 1, 1933, night work for children under 16 in mines was prohibited, but enterprises were given a further period to bring this law into force. There are sanitary rules for industry; to monitor their implementation in each prefecture, there are medical inspectors subordinate to the provincial governor. In April 1922, a social insurance law was published, which came into force only in 1927. According to this law, factory and mining workers in enterprises with more than 10 workers and earning no more than 1,200 yen a year are insured against accidents, illness, and disability. Seasonal workers are not included. Insurance is carried out either by government offices or private societies; mutual aid funds can be formed in any enterprise with more than 300 workers. Medical assistance is provided free of charge from the day of illness or accident for 180 days, after which the patient falls under the provisions of the disability law. The victim or patient receives an allowance from the very first day amounting to 60% of wages; in case of death, his family receives an allowance equal to 360 times the daily wage. A pregnant woman receives, upon request, leave for 4 weeks before childbirth and compulsory leave for 6 weeks after childbirth, provided she has paid insurance contributions for at least 180 days. She is paid 60% of her wages during the leave. Insurance contributions are paid half and half by workers and employers. The state adds 10% to the mutual aid funds. The worker's share, depending on the category, cannot exceed 3% of wages; workers are divided into 16 categories according to wage size. The families of the insured do not fall under the law. In 1926, the number of insured workers was 2,101,446, of whom 1,140,865 were in government offices. Since the crisis, by 1930, this number dropped to 1,877,835, of whom 1,079,128 were in government bureaus. The Bureau of Social Problems of the Ministry of Interior is preparing a bill to extend social insurance to transport workers, construction workers, and workers in enterprises with fewer than 10 workers, as well as to persons earning less than 1,800 yen a year. This system could cover 4,230,000 workers, but enterprise owners, mainly small ones, vigorously oppose this, arguing that it will prevent Japan from exporting its industrial products. The healthcare budget in 1931/1932. Expended (in thousand yen): by the Ministry of Interior—16,817, departments—9,285, municipalities—69,324, communes—24,914. In addition, credits for the maintenance of hospitals in the provinces, sanitary measures in large cities, small cities, and rural areas, as well as subsidies for social insurance, must be added here. It is very difficult to calculate these expenses precisely; in 1927 they amounted to 150,978,506 yen, in 1928—162,914,640 yen, but in fact in recent years the healthcare budget has rather decreased, since it is precisely this budget that is cut first under the influence of the policy caused by the aggravation of the economic crisis in the country and the increase in armaments appropriations.