Colloquium II: August 31, 2020

Shinpei Goto
The most famous
person in thehistory of Nagoya
University School of
Medicine, and of
public health inJapan

History in JapanThe Emperor Meiji from
Kyoto to Tokyo in 1869

1867 The Meiji Restoration
1868 The first year of Meiji era©Wikipedia
1874 Law on medical system 医制
1876 National examination to allow practice at clinic
1883 Law of licensing doctors, leading to the abolitionof Chinese medicine
1894 First Sino-Japan War
Gotō Shinpei
1904 Russo-Japan War(1857-1929)©Wikipedia

Nagoya University Medical Library
Albrecht von Roretz (1846-84)
Invited professor from Austria

1894-95 First Sino-Japan War
1904-05 Russo-Japan War

Sinpei Goto 1857-1929
Director of Aichi Hospital and School of Medicine(former Nagoya Univ. Sch. of Med.)https://www.med.nagoya-u.ac.jp/medlib/history/index.html 2020/12/2

Taisuke Itagaki
http://www.banknoteworld.it/japan.htm 2020/12/2

Dr. Goto treated
Politician Itagaki in Gifu.
https://www.excite.co.jp/news/article/Japaaan_86068/ 2020/12/2

When Taisuke Itagaki was attacked
and injured by a thug in Gifu, 1882,
he said "Itagaki may die, but liberty
never!“

https://www.izumishobo.co.jp/onlinebook/c02_denki/itagaki/itagaki1.html 2020/12/2

Gotō Shinpei(July 24, 1857 – April 13, 1929)
https://en.wikipedia.org/wiki/Got%C5%8D_Shinpei©Wikipedia

Gotō was born in Isawa, Mutsu Province (present-day in
Iwate Prefecture). He entered Sukagawa Medical School
in Fukushima Prefecture at the age of 17, and became adoctor in Nagoya after graduation. In 1877, he served as agovernment medic during the Satsuma Rebellion.
In 1876, a doctor of Aichi Prefectural Hospital
In 1881, president of Aichi Prefectural Hospital
In 1882, treated Itagaki
In 1883 at age 26, moved to Ministry of Internal Affairs

History of the University
http://en.nagoyau.ac.jp/about_nu/history_data/history/index.html

In 1867 The Meiji Restoration

In 1871, Temporary Medical School/Public Hospital,
under the guidance of Keisuke Ito and other pioneersfrom the Nagoya Domain's Smallpox Vaccination Clinic
Goto Shinpei at Nagoya
1876 to 1883

In 1881 Aichi Medical School
In 1903 Aichi Prefectural Medical College
In 1920 Aichi Medical College
In 1939 Nagoya Imperial University
In 1949 Nagoya University

Having distinguished himself through his work at the
Nagoya Medical School and at the military hospital in
Osaka during the Satsuma Rebellion, Gotō joined theHome Ministry’s Medical Bureau (衛生局) in 1883,
eventually becoming its head. While at the ministry, in
1890 he published his Principles of National Health (国家衛生原理) and took part in the creation of new
sewage and water facilities in Tokyo. This recommended
him to Army Vice-Minister Kodama Gentarō (18521906), who made Gotō chief of the Army Quarantine
Office looking after the return of more than 230,000
soldiers from the Sino-Japanese War (1895-95).

©Wikipedia

Gotō Shinpei(July 24, 1857 – April 13, 1929)
In 1929 The Great Depression

Poster for the recruitment
of officers with medical
doctor license to Ministryof Health, Labour andWelfare, Japan

He was a statesman and cabinet minister in the Taisho and early
Shōwa period Empire of Japan.

©Wikipedia

After First Sino-Japan War in 1894-95,
Taiwan was ceded to Japan.

He served as
1. the head of civilian affairs of Taiwan under Japanese rule in
1898-1906 ,2. the first director of the South Manchuria Railway in 1906-08,
3. the seventh mayor of Tokyo in 1919-23,
In 1923 The Great Kanto Earthquake
4. the first Chief Scout of Japan,
5. the first director of NHK (Japan Broadcasting Corporation)
6. the third principal of Takushoku University, and7. the Home Minister and Foreign Minister of Japan.

History of Taiwan

https://en.wikipedia.org/wiki/History_of_Taiwan

Prehistory
to 1624
Dutch Formosa
1624-1662©Wikipedia
Spanish Formosa (north part)
1626-1642
Kingdom of Tungning (Ming dynasty from main land of China)
1662-1683
Qing rule1683-1895
Japanese rule
1895-1945
Republic of China rule
1945-present
Formosa = Taiwan, Kingdom of Tungning = Kingdom of FormosaShinpei Goto（1857-1929）
・Era of acute infectious diseases
・Era of poverty without social infrastructure

1874 Law on medical system 医制
1875 Medical Bureau in Home Ministry 内務省衛生局設置
1879 Epidemic of cholera in Japan* Discovery by Filippo Pacini in 1854
1884 Vibrio cholerae found by Koch*1885 Method for sewage system by Goto “Proposal to implement thepolicy against cholera”
1889 Sanatoriums of tuberculosis

1890 Study in Germany of Goto

1897 Implementation of Infectious Diseases Prevention Act against cholera,dysentery, typhoid, smallpox, typhus fever, scarlet fever, diphtheria, and plague1898 Goto age at 41 years to Taiwan as the head of civilian affairs
1898 Monopolization of tobacco in Japan
1903 Monopolization of camphor in Japan1905 Monopolization of salt in Japan
1910 Vaccination against smallpox
1929 Discovery of penicillin, the Great Depression
1938 Establishment of Ministry of Health©Wikipedia

Japan Association of Legal Philosophy: November 10, 2012 in Osaka

https://www.med.nagoyau.ac.jp/medlib/history/archi
ve/print/1876gotousinpei.ht
ml 2021/1/19

Public health and governing foreign teritory

Shinpei Goto and public health policy
Nobuyuki Hamajima,
Nagoya University Graduate School of Medicine

Dr. Goto, Director of
Aichi Prefectural Hospital

Definition of public health by Winslow CEA (1877-1957)
Public health is the art and science of preventing
disease, prolonging life and promoting physical andmental efficiency through the organized community
efforts.

Administration in Taiwan by Goto 1898-1906
Railway construction
Port construction
Measurement of land
Monopolization of
Salt
Camphor (insect repellent)
TobaccoOpium

Establishment of economy basis :Life improvement is accompaniedwith hygiene (sanitation).
The enactment with the similarpace to that in Japan.

- Facility construction for water supply and sewage system- Foundation of Taiwan Medical School in 1899（Maiji 32nd)- Public doctor system：120 medical doctors were invited fromJapan
- Taiwan Central Institute in 1907（Meiji 40th）

Goto believed that hygiene administration is important.
He described in his autobiography that he addressed in 1886
that the level of hygiene deserves the fate of country.
While at the ministry, in 1890 he published his Principles of
National Health (国家衛生原理) and took part in the creationof new sewage and water facilities in Tokyo.
Not available

General health

Sanitary conditions & wealthModern strategies
1. Innoculation
2. Improvement oflifestyle
3. Screening/healthcheckup

Camphor樟脳 しょうのうCamphor (pronounced ’kæmfər’) is a waxy, flammable, white ortransparent solid with a strong aromatic odor. It is a terpenoid withthe chemical formula C10H16O. It is found in wood of the camphor
laurel (Cinnamomum camphora くすのき), a large evergreen tree
found in Asia (particularly in Sumatra, Borneo and Taiwan) and alsoof Dryobalanops aromatica, a giant of the Bornean forests. It also
occurs in some other related trees in the laurel family, notably
Ocotea usambarensis. Dried rosemary leaves(Rosmarinu officinalis), in the mint family, containup to 20% camphor. It can also be synthetically
produced from oil of turpentine. It is used for its
scent, as an ingredient in cooking (mainly in India),as an embalming fluid, for medicinal purposes,
and in religious ceremonies.
https://www.waplus-shop.jp/shopbrand/20180417060636/ 2020/12/2

Celluloid
Celluloids are a class of compounds created from nitrocellulose andcamphor, with added dyes and other agents. Generally regarded tobe the first thermoplastic, it was first created as Parkesine in 1862
and as Xylonite in 1869, before being registered as Celluloid in
1870. Celluloid is easily molded and shaped, and it was first widelyused as an ivory replacement. Celluloid is highly flammable andalso easily decomposes, and is no longer widely used. Its mostcommon uses today are in table tennis balls and guitar picks.

©Wikipedia©Wikipedia

Table tennis balls

Celluloid and sterling silver pen©Wikipedia

Monopolization of Camphor
In 1863, Taiwan government monopolized camphor, as well as
saltpeter (potassium nitrate) and sulfur
In 1868, the monopolization was abolished because of the
opposition of England embassy. Foreigners allowed to export
camphor freely, resulting in the actual monopolization by England.
In 1887, the second monopolization by Taiwan government, but
again imposed to abolish it by England.
At that time, Taiwan and Japan were the only production countries.
The price was controlled by countries other than Taiwan and Japan.
In 1898, Goto issued the monopolization. The civilian affairs of
Taiwan decided the price and amount exported to each country.
The benefits was 13 millions yen in eight years, which was used for
Taiwan project public bond.

Evaluating the Goto’s performance in terms of public healthAvedis Donabedian’ method• Structure
e.g. New organizations• Processe.g. Documentation• Outcomee.g Disease prevention

In terms of structure and process,starts from nothing
Infectious disease prevention law
Disinfection work
Train quarantine law
Quarantine stations and facilities
In terms of outcome,sanitation, resulting in infectious
disease prevention (malaria, plague,cholera, dysentery, etc）

Opium monopolization
Governing ?
Economical merits ?
Public health ?
https://www.opioids.com/opium/opiumwar.html 2020/12/2

First Opium War
The First Anglo-Chinese War (1839–42),
known popularly as the First Opium War or
simply the Opium War, was fought
between the United Kingdom and the Qing
Dynasty of China overtheir conflicting
viewpoints on
diplomatic relations,trade, and theadministration ofjustice.
https://deon.pl/blogi/artykuly-blogerow/handel-i-misje-co-maja-ze-soba-wspolnego,86853 2020/12/2

Narcotics 麻薬 from plants
Opium アヘン

Cannabis 大麻
Marijuana

Coca コカ

Ganja
チャラス
Hashish©Wikipedia

Opium poppy©Wikipedia

Morphine

Heroinhttps://www.reportecuatro.com.ar/imprimir_nota.php?id=22308 2020/12/2

Cocaine

THC：Tetrahydrocannabinol
Corn poppy ヒナゲシ
is different fromopium.
https://www.naturephoto-cz.com/%E3%83%92%E3%83%8A%E3%82%B2%E3%82%B7-picture_ja-19208.html 2020/12/2

Narcotics made by chemical synthesis
Amphetamine

LSD
LysergsäurediethylamidMethamphetamine
PhiloponⓇ/shaboo/S/speed/
ice/meth/crystal meth

MDMA/ecstasy/molly/E/X/EXC
3,4-methylenedioxymethamphetaminePsychedelic drugs
Magic mushroom /Psychedelic mushroom /Psilocybe mushroom /Psilocybin mushroom

PeyoteAyahuasca

https://www.ara.cat/societat/floristes-Rambla-exemplars-allucinogena-prohibida_0_1535246645.html 2020/12/2©Wikipedia©Wikipedia

Psilocybin

Mescaline

Harmaline

Narcotics
Stimulants Control Act
Stimulation

Narcotics and Psychotropics
Control Act
Hallucination

Cannabis Control Act
Repression
Opium Law
All the above
https://tantei-nito.com/information/news159/ 2020/12/16

Act on Securing Quality, Efficacy and
Safety of Products Including
Pharmaceuticals and Medical Devices

Numbers of the arrested criminals
Stimulants Control Act

Narcotics and Psychotropics
Control Act

Cannabis Control Act

Opium Law

1989

2014

Numbers of the arrested criminals
In 2016
Stimulants Control Act

10,607

Cannabis Control Act

2,722

Narcotics and Psychotropics Control Act

505

Opium Law

7

Act on Securing Quality, Efficacy and Safety of
Products Including Pharmaceuticals andMedical Devices: 2,373 chemicals as of March2018. All sellers were closed

Narcotics and Psychotropics Control Act"Narcotics Handler" means a Narcotics Importer, Narcotics
Exporter, Narcotics Manufacturer, Formulator of Narcotic
Pharmaceuticals, Manufacturer of Exempt Narcotics, Primary
Wholesaler of Narcotics, Narcotics Wholesaler, Narcotics Retailer,
Person Licensed to Administer Narcotics, Narcotics Manager, orNarcotics Researcher;
Opium
Opium alkaloids
Chapter III Control of Psychotropics
Morphine
Section 1 Licensing and Registration
Oxycodone
Section 2 Prohibitions and Restrictions
Hydromorphine
Section 3 Handling
Tapentadol
Section 4 Business Records and Notifications
Fentanyl
Section 5 Miscellaneous Provisions
Pethidine
MethadoneEvaluating the Goto’s performance in terms of public healthAvedis Donabedian’ method• Structure
e.g. New organizations• Processe.g. Documentation• Outcomee.g Disease prevention

In terms of structure and process,starts from nothing
Infectious disease prevention law
Disinfection work
Train quarantine law
Quarantine stations and facilities
In terms of outcome,sanitation, resulting in infectious
disease prevention (malaria, plague,cholera, dysentery, etc）

Opium monopolization
Governing ?
Economical merits ?
Public health ?
https://www.opioids.com/opium/opiumwar.html 2020/12/2

Utilitarianism
Utilitarianism is a theory in normative ethics holding that theproper course of action is the one that maximizes utility,
specifically defined as maximizing happiness and reducing
suffering. Classic utilitarianism, as advocated by two influential
contributors, Jeremy Bentham and John Stuart Mill, is hedonistic*.
It is now generally taken to be a form of consequentialism,
although when Anscombe first introduced that term it was todistinguish between "old-fashioned Utilitarianism" andconsequentialism. According to utilitarianism the moral worth of anaction is determined only by its resulting outcome, although there
is debate over how much consideration should be given to actual
consequences, foreseen consequences and intended
consequences.
*Hedonism is a school of thought that argues that pleasure is the only intrinsic good.

Deontological ethics
Deontological ethics or deontology (from Greek deon, "obligation,
duty"; and -logia) is the normative ethical position that judges themorality of an action based on the action's adherence to a rule orrules. It is sometimes described as "duty" or "obligation" or "rule" based ethics, because rules "bind you to your duty". Deontologicalethics is commonly contrasted to consequentialism. Deontologicalethics is also contrasted to pragmatic ethics.

©いらすとや©wikipedia

https://www.amazon.co.jp/dp/B004H0M78C 2020/12/16

Disadvantages
Utilitarianism
1. Which is the appropriate method to maximize utility or
happiness? It is not rare that the method cannot be
decided even among specialists.
2. How to minimize or compensate the persons with damages
due to the method.
Deontological ethics
1. Which should be used for the rule?
2. The evaluation on the adherence to a rule may be done
subjectively by a leader, if the rule is complicated.

Wow, children arewatching.

The obedience of law is important.
This law is for the safety of pedestrians. If safety, there is
no reason simply to obey the rule.

1. Subjects of ethics

Intention

Good
Bad

Action
Good
Bad
○
？
？
×

2. Good for whom?
3. Who evaluates ?

The question
Which is the base ofhealthcare administration?

Utilitarianism or deontological ethics

The question
Which is the base ofhealthcare administration?

Utilitarianism or deontological ethics
Philosophy of public health staff / researchers /educators : Utilitarianism* The efforts are needed to minimize the damages or
injuries of given groups due to public health actions.

Trends in reported cases and deaths frompertussis (whooping cough) in Japan
P vaccine in 1950, DP vaccine in 1958, DPT vaccine in 1968

Vaccine encephalopathy in 1970’
Stop of DPT vaccinationin Feb. 1975
(whole cell vaccine)

Cases
Death
Start of acellular vaccine(DPaT) in autumn, 1981

Fatality10%

206 casesin 1971

Calendar year

Summary of Goto’s achievements
１．Goto had medical knowledge, recognizing the importance of
public health. It was great advantages over the officials with theother background.
２．Goto had a strong power as a government officer. It wasadvantageous over the other public health specialists.
３．There were good precedents for the administrative
approach.
４．He started from nothing. The evaluation was simple andclear.
５．It was the era of acute infectious diseases. Improvement ofpublic health is consistent with the development of the society.
６．The usefulness was clear for the persons in Taiwan, and hisachievements actually contributed to the modernization of
Taiwan.

Public health
Order

Government
AdviceBenefited nations
Opposition

AdvicePublic health specialists
independent ofadministration

Restricted individuals
Damaged individuals
Taiwan under Japanese rule

Advice based on the below basic concepts

Government by foreign country

Utilitarianism : the greatest
happiness of the greatest numbers(minimum damage and compensation)

No independent public healthspecialists

Liberalism: free selection on nations（no harm to the others）

Goto was a public health specialist