EPIDEMIOLOGY OF THE DISEASES OF

NAVAL IMPORTANCE IN

MANCHURIA

NavMed 958

Printed by

BUREAU OF MEDICINE AND SURGERY

NAVY DEPARTMENT

January 1946



Epidemiology of the Diseases of

Naval Importance in

Manchuria

Prepared by

Tsal-yu Hsiao

Entomologist, Division of Preventive Medicine

NAVMED 958

Bureau of Medicine end Surgery

Navy Department, Washington, D. C.

January 1946

FOREWORD

The purpose of this compilation is to summarize the available medical, parasitological and entomological literature on Manchuria and to present condensed picture of the prevalence, distribution and transmission of the infectious diseases of military importance, together with information on the distribution, habits and identification of

the vectors and reservoir hosts. Emphasis has been placed on the epidemiology of those diseases which present

control problem different from that experienced elsewhere and which can involve large numbers of naval personnel,

such as the arthropod-borne diseases and acute infectious diseases.

The area included in this manual is the former "Four Northeastern Provinces" of China, viz. Liaoning, Kirin,

Heilungkiang and Jehol and the "Kwantung Leased Territory". The four provinces were administered by the Japanese

through puppet state "Manchoukuo" during the Japanese occupation.

The Important sources of Information have been the Journal of Oriental Medicine, the Chinese Medical Journal,

the Journal of the Chosen Medical Association, Transactiones Socletatis Pathologicae Japonlcae, Kitasato Archives of

Experimental Medicine, Transactions of the Far Eastern Association of Tropical Medicine, Gunidan Zassl (Official

Publication of the Imperial Japanese Army Medical Corps), Insecta Matsumurana, Oyo-Dobutsugaku Zassi (Journal of the

Japanese Society of Applied Zoology) and the reports of the Institute of Scientific Research. The statistical information has been derived principally from the official reports in the Manchoukuo Year Book, Japan-Manchoukuo Year

Book, Manshu Nenkan, the Orient Year Book, Kantocho Tokelsho (Statistical report of the Kwantung Government) and

reports of the League of Nations. Classified Intelligence reports have also been an Important source. The bibliography contains list of the principal references used in compiling the manual.

The Gazetteer of Chinese Place Names prepared by the Army Map Service, War Department, 1944, is followed to

great extent for the romanizatlon of the names of the places appearing in the manual. However, well established

English names, such as Mukden, Harbin, etc., are used in preference to the above.

Acknowledgement is due to Lt. R.J. Dicke, USNR, who has critically examined the entire manual and made

numerous valuable suggestions.

Tsal-yu Hsiao

Entomologist

Bureau of Medicine and Surgery,

Division of Preventive Medicine,

Epidemiology and Epidemic Disease

Control Section
EPIDEMIOLOGY OF THE DISEASES OF NAVAL IMPORTANCE

IN MANCHURIA

Table of Contents

Page

Foreword

Introduction iv

Chapter Dysentery, Diarrhea and Enteritis

Chapter II Cholera

Chapter III Typhoid and Paratyphoid Fevers

Chapter IV Plague.; 10

Chapter Kala Azar 11

Chapter VI Malaria 12

Chapter VII Typhus 16

Chapter VIII Other Arthropod-borne Diseases 18

1. Relapsing Fever

2. Tick-borne Typhus Fever

3. Scrub Typhus (Tsutsugamushi Disease)

4. Japanese Encephalitis

5. Tick-borne Encephalitis

6. Dengue Fever

7. Fllariasis

8. Sandfly Fever (Pappataci Fever)

Chapter IX Tuberculosis 19

Chapter Acute Respiratory Diseases 20

1. Pneumonia

2. Influenza

3. Bronchitis and Pleurltis

Chapter XI Miscellaneous Acute Infectious Diseases 21

1. Diphtheria

2. Scarlet Fever

3. Smallpox

4. Chickenpox

5. Measles

6. German Measles

7. Whooping Cough

8. Mumps

D. Erythema Infectiosum

10. Cerebrospinal Meningitis

11. Poliomyelitis

12. Epidemic Encephalitis

13. Undulant Fever

14. Weil's Disease

15. Erysipelas

10. Trachoma

17. Tetanus

18. Rabies

19. Anthrax

20. Glanders
Page

Chapter XII Venereal Diseases 24

Chapter XIII Skin Diseases 25

1. Dermatomycoses

2. Endemic Dermatitis

3. Leprosy

Chapter XIV Special Endemic Diseases 27

1. Epidemic Hemorrhagic Fever

2. K'oshan Disease

3. Kashin-Beck's Disease

Chapter XV Helminthiases 29

1. Nematodiases

2. Treraatodiases

3. Cestodlases

Chapter XVI Intestinal Protozoa 31

Chapter XVII Animals of Medical Importance 32

1. Culicidae (Mosquitoes)

2. Psychodldae (Sandflies)

3. Heleidae (Culicoidae) (Biting midges)

4. Simuliidae (Black flies)

5. Muscoid Flies

6. Tabanidae (Horse flies)

7. Anopleura (Lice)

8. Siphonaptera (Fleas)

9. Cimlcidae (Bed bugs)

10. Ixodoidea (Ticks)

11. Mollusca and Crustacea of Medical Importance

12. Fish of Medical Importance

13. Poisonous Snakes

14. Mammals of Medical Importance

Bibliography 37

Appendices 51

1. Death Rate among the Japanese Population in Manchuria.

2. Fecal Examinations for Intestinal Parasites.

List of Tables 54
INTRODUCTION

Geography. Manchuria, composed of Liaoning,

Kirin, Heilungkiang, and Jehol Provinces, lies between latitude 38° 40' and 53° 50' N. and longitude

115° 20' and 135° 20' E. and embraces £tn area of approximately 55,000 square miles. It extends from

Po-hal Bay in the south to the Amur River bordering

Soviet Siberia in the north. The Ussuri River forms

natural boundary with the Maritime Province of the

U.S.S.R. to the east and the rivers T' umen and Yalu

are recognized as the boundary with Korea to the

southeast. The internal boundary with Mongolia in

the west is more indefinite and runs in general

course along the Great Hsingan Mountain range (Tahsing-an-ling) Between this mountain range and the

Ch'ang-pai-shan range along the eastern border of

the country are extensive plains crossed by number

of navigable rivers.

The coastline of Manchuria is extremely short,

consisting of about 690 miles or about one-eighth of

the total boundary of the country. It extends from

the mouth of the Yalu River to Shanhaikuan where the

Great Wall Joins the sea. The most important of the

harbors is Ta-lien (Dairen) which is located on the

east side of the Liaotung Peninsula. The harbor is

protected on three sides by land, opening to the

east. It is 36 feet deep at the entrance, with

minimum of 23 feet at low tide at the wharves. Lushun (Port Arthur) is land locked harbor situated

at the southern extremity of the Liaotung peninsula,

about 20 miles southwest of Ta-llen. This is the

only port in Manchuria which is ice-free throughout

the year. An-tung, at the mouth of the Yalu River

on the Korean border, is an important shipping port

for timber. The river around the port is 3,300 to

5,000 feet wide and twelve feet deep at low tide.

It is closed to traffic by ice during the winter

months. Ying-kou is situated at the mouth of the

Liao River on the western side of the peninsula. The

average depth within the harbor is from 20 to 33 feet

at low tide, with its deepest portion as much as 50

to 70 feet. The harbor is practically closed by ice

from the middle of December to the latter part of

March. section of land, known as Hu-lu-tao, projects into the sea of Lien-shan Bay around which the

water is deep and free from ice in winter. It is

connected by railway with the mainland.

The southern part of the Liaotung Peninsula with

an area of 1,336 square miles and Including 40 adjoining islands is known as Kwantung Leased Territory.

This territory together with zone along the South

Manchuria Railway were leased to Japan after the RussoJapanese War. In 1931 Japan occupied the whole of

Manchuria. puppet government was established in

the following year which proclaimed the independence

of the four provinces from the Republic of China. In

1934, Manchuria was divided into 14 provinces or administrative units, with subsequent changes to 16

provinces in 1937, to 18 in 1939, and to 19 in 1941.

Further change of the administrative units was made

in 1943.

Climatology. Manchuria has continental climate

marked by extremes of heat and cold. Intensely cold

winters alternate with Intensely hot summers. In

many places the temperature ranges from 40° C. to as

many degrees below zero. The hottest month of the

year is July and the coldest, January. The highest

temperature on record was 42° C. recorded at Chalantum on July 23, 1919, while the lowest was 50. 1° C.

below zero at Mientuho on January 16, 1922. The

mean temperature falls as one moves further Inland

in north and north-westerly direction from Ta-llen

to Man-chou-li. In Ta-lien the mean temperature of

the year is 11.0° C. It is 8.3° in Mukden, 4.7° in

Ch'ang-ch'un, 3.1° in Harbin, and 1.8° in Man-chouli.

Rain and snow are generally not abundant and

excessive drought occurs in many parts of the country. The average annual rainfall is from 500 to 700

mm. Th'e rainy season begins in June and ends in September. In Ch'ang-ch'un the rain during these four

months makes up 77 per cent of the total annual precipitation while the precipitation in July and August

makes up 55 per cent of the annual total. The rainfall is more abundant in the southern part of Manchuria, becoming less as one proceeds northward. The

annual rainfall is 678.4 mm. at Mukden, 660.9 mm. at

Ch'ang-ch'un, 577.3 mm. at Harbin, 464.0 ram. at Tsltslhar and 272.2 mm. at Man-chou-li. The area east of

the South Manchuria Railway Line has an annual rainfall ranging from 600 mm. to 1,000 mm., with less precipitation west of the line. The heaviest rainfall

recorded in 24 hours occurred at Ylngkou on August 13,

1811, with 209.2 mm. On the same day Mukden had

rainfall of 148.7 mm. The earliest date of frost was

September 3rd at Mientuho in northern Manchuria mid

the latest was November 13th at Port Arthur in southern Manchuria. The frost ends in the northern region

between April and May and in the southern region during the latter part of April. Snow is first encountered about the end of September in the north, and

one month later in the south. The average humidity

in Manchuria ranges from 60 to 68 per cent. The driest

months are April and November,when the humidity often

drops to 10 per cent.

Population. Manchuria is not heavily populated

except in few cities in the southern part. However, the population of the country has been notably

increased in the last 50 years. In 1907 the population was estimated at 16,780,000 for the three Eastern Provinces, and at the end of 1939 it was officially reported as 40,679,570, Including 1,225,570 in the

Kwantung Leased Territory. The Chinese are the predominant race, accounting for 94.94 per cent of the

total population in 1939. The Koreans followed with

2.87 per cent and the Japanese with 2.05 per cent. Since the Japanese occupation in 1931, the Japanese

Government adopted program of colonization in Manchuria. Japanese Immigration into Manchuria was en- couraged and subsidized by the Department of Over- seas Affairs and private companies, and at the same

time the immigration of Chinese from other parts of

China was restricted. During the year 1938,the Japanese population in Manchuria increased at ratio of

248 per 1,000, while it was 133 for the Koreans, 40

for the Chinese and -9 for other nationalities. In 1939 the average population density in Manchuria was

approximately 30 persons per square mile. By far

greater density is found in southern Manchuria especially along the South Manchuria Railway. The population density decreases toward the interior of north- ern Manchuria. In the southern part of Liaoning Province there are from 60 to 129 persons per square mile

while in the northern part of Heilungkiang Province

there are only 4.2 to 5.1 persons per square mile.

Public Health Administration. The Public Health

Administration in Manchuria has gone through several

changes since the establishment of puppet government.
The latest available information shows that the central

organization of public health is the Bureau of Public

Health, which is part of the Department of People's

Welfare. The Bureau consists of four sections: the

Medical Affairs Section, the Preventive Medicine Section, the Plague Prevention Section and the Medical

Supply Section (Manshu Nenkan 1943). In the provinces

there are health divisions which are directly under

the provincial Department of People's Welfare. In

the hsien and cities the public health affairs are

taken care of by the respective police stations.

public physician system (Kung-yl-chlh) was established

in 1933 to promote education in sanitation among the

people, and to improve their general health. One

public physician was to be appointed to each district

(hsien) or banner (ch'i). Besides carrying on his

regular practice, the public physician was to take

charge of matters relative to public health, sanitary

investigation and medical affairs of the police. Coupons for free medical treatment were Issued to the

poor people. At the end of 1939, 157 such public

physicians were scattered throughout the country.

Public physicians were also provided for Japanese

colonization.

The Sanitation Section of the Police Department,

Kwantung Government was in charge of the public health

administration in the Kwantung Leased Territory and

the Railway Zone. The Local Affairs Department of the

South Manchuria Railway Company had participated to

great extent in the public health affairs in the

railway zone. Quarantine and other hygienic matters

in the harbors of Ta-lien and Lu-shun were under the

supervision of the Marine Bureau of the Kwantung Government.

Medical Facilities. The number of medical

schools in Manchuria is uncertain due to the frequent

renaming of old schools following the change of names

of the localities where they are situated, and the

Incomplete or even contradictory reports concerning

those newly established. There are probably 14 medical schools, Including twc dental schools. Mukden is

one of the most important medical centers in the country. There are at least three medical schools in

this city, the Manchuria Medical University, the Mukden Medical College, and the Fengtien Medical College

The Manchuria Medical University, which is probably

the most important medical institution in Manchuria,

was founded in 1911 under the management of the South

Manchuria Railway Company. It offers preparatory

course of thrfee years and university course of four

years. It had total enrollment of 935 in April

1939 and had total of 941 graduates up to 1935. The

Mukden Medical College was established in 1910 under

the management of an English Mission. The Fengtien

Medical College was established in 1933 and had an

enrollment of 125 and staff of 41 in 1939. There

appears in some publications fourth name, the Mukden-Tungshan Medical School, the status of which is

not clear. Harbin is another medical center in Manchuria. The Harbin Medical College had an enrollment of 323 and staff of 37 in 1939. The total

number of graduates from this college was 164 up to

1935. There is also Military Surgeon School with

about 30 graduates up to 1935. One of the three

Colonization Medical Academies which gave two-year

course is located in Harbin. The other two are one

each in Lung-chlng and Tsltslhar. There are also

two Russian dental colleges In Harbin and dental

institute incorporated in the Harbin Medical College.

The Hsinklng Medical College was established by the

puppet federal government at Ch'ang-ch'un and had an

enrollment of 270 students and staff of 28 in 1939.

The Chia-mu-ssu Medical College was established in

1940 for the welfare of the Japanese Immigrants. The

Hsingan Medical College, situated at Wang-yeh-miao,

near the northern border of Liaoning province is for

the Mongolians.

Bacteriological laboratories have been established by the South Manchuria Railway Company at

Mukden, Ying-kou, An-tung, Ch’ang-ch'un, and Fu-shun.

Medical experts are attached to each laboratory to

enforce preventive measures. Several bacteriological

examination stations are also maintained in certain

towns. The Hygienic Institute in Mukden has been

founded by the South Manchuria Railway Company for

studies on the local health problems and the manufacture of sera and vaccines for the prevention of

diseases peculiar to Manchuria.

There has been an increase in the number of

hospitals in Manchuria in recent years. By the end

of 1940 there were four federal hospitals located in

Yung-chl (Kirin), Cheng-te, Yen-chi and Lung-chlng,

eight provincial hospitals, 174 municipal, district,

or banner hospitals and 120 fumln (people's welfare)

clinics. In addition, 45 hospitals and clinics were

operated by the Manchuria Railway Company and eleven

by the Manchuria Red Cross Society. The number of

beds in these hospitals is not known. However,

total of 6,196 beds were reported in 111 government

and public hospitals in 1939. As the number of hospitals increased in 1940, the total number of beds

probably increased accordingly. There was also

federal leprosy clinic located in Tieh-llng, and

hospital for the insane at Harbin. The number of

public physicians in charge of the medical affairs

for the people in remote regions where no other medical facilities are available has increased from 148

in 1937 to 157 in 1939. Hospitals operated by foreigners are located in various regions in Manchuria

and have rendered valuable service not only to foreigners but also to the native population. There

were 16 such hospitals in 1940, twelve operated by

the British, two by the Danish, and one each by the

Canadians and the French. In the Kwantung Leased

Territory the Kwantung Government maintains five hospitals, two in Ta-lien and three in Port Arthur, with

total of more them 20 physicians. The Dairen (Talien) Hospital which is one of the hospitals established by the South Manchuria Railway Company is one

of the best equipped hospitals in the country. In

addition, there are about eight other private hospitals in the leased territory.

Physicians in Manchuria are classified into two

groups, those of the native school and those of the

Western school. In March 1939 there were in all 23,

367 physicians, of whom only 4,519 were trained in

modern methods. This total figure represents ratio

of 6.2 doctors per 10,000 population. However, for

the qualified physicians the ratio was only 1.2 per

10,000 population. In the same month 653 dentists

and 800 pharmacists were reported in the country of

which probably no more than one third to two thirds

were fully qualified. The total number of nurses

was reported to be 2,100 at the end of 1938.

679114 46 -2

CHAPTER

DYSENTERY

Due to Insanitary conditions and the lack of

satisfactory water supply, dysentery Is one of the

most prevalent Infectious diseases In Manchuria and

an Important cause of morbidity and mortality among

children as well as adults. According to the statistics of the Kwantung Government (Tsubozakl, 1939)

there was an average of 76.3 dysentery cases with 6.7 deaths for every 10,000 persons In the Kwantung Leased

Territory. In the Manchuria Medical College Hospital

the number of dysentery cases represented 16.9 per

cent of the total admissions and 47.2 per cent of the

total cases of communicable diseases during the years

1933 to 1935 (Itonoke, 1938)* The Manchurian Government reported 38,192 cases of acute Infectious diseases In Manchuria during the three-year period 1934

to 1936* Of these, 12,196 were dysentery cases, representing nearly one-third of the total number of

cases (Tsubozakl, 1939). Kawahlto (1936) reported

that the .average mortality rate for dysentery among

the Japanese in Manchuria was 9.8 per 10,000 during

the years 1925-1930.

Both the bacillary and the amebic types of dysentery are widespread. Although most of the early

reports do not differentiate the types of the disease,

It Is assumed that nearly half of the cases are of the

amebic type. The so-called Manchurian dysentery which

Is widespread among the inhabitants seems to be amebic

dysentery (Rlyeda, 1934)• high percentage of the

people were reported to be carriers of dy'sentery bacillus and Endameba histolytica. About 1.2 per cent of the school children and 3.86 per cent of the

workers In the public places were found to be carriers

of bacillus, and large proportion of these

(44.6 per cent to 77*8 per cent) were of the Shiga

type (Tsubozakl, 1937) According to Hlyeda (1934),

an average of 21 per cent of the Manchurian population,

and In the heavily infested areas as many as 38 per

cent, were cyst-carriers of _E_. histolytica. The disease occurs throughout the year hut is most prevalent

during the summer months from June to September.

Notes on the Distribution and Incidence of Dysentery In Ta-llen, Hoshlzakl (1928) of the Dairen

(Ta-llen) Isolation Hospital studied 1,220 cases of

dysentery treated in the hospital during period of

ten years, and reported that the ratio of bacillary

to the amebie type was 34 to 1. The case fatality was 54.9 per cent for bacillary dysentery and 17.2 per cent for amebic dysentery. The highest case in- cidence occurred In the age group of one to five

years, dropping sharply at the ages of 11 to 15, and

then gradually Increasing until the Incidence reached

another peak at the age group of 26 to 30 years. The

seasonal Incidence suddenly increased In June, reaching Its peak during the months of July to September,

and then rapidly decreasing by October. One hundred

ninety six (196) cases were treated In the hospital

In 1927. Of these 167 cases were bacillary, 26 eklrl

and only three were amebic. Yokoyama (1937) made an

epidemiological survey of the Japanese dysentery cases

in the city of Ta-llen from 1930 to 1934. There were

1,892 cases reported during this period representing

about one third of the communicable disease and morbidity rate of 33.5 per 10,000 population. The average mortality of this series was 13.8 per cent. Dysentery cases occurred throughout the year. The period

of highest Incidence was observed during July to October, accounting for 80 per cent of the total cases.

The seasonal distribution of the 1,889 dysentery cases

reported, and the number of deaths recorded during the

period 1931 to 1935 Is shown In Table 1.

TABLE

SEASONAL DISTRIBUTION OF DYSENTERY IN TA-LIEN IN 1931-1935

Of 421 cases of the bacillus type studied, 247 or 58.7

per cent occurred during the ages one to ten years,

and 73 or 17.3 per cent during the ages 21 and 30

years. Eklrl, foudroyant form of dysentery In children, accounted for 29 per cent of the pediatric dysentery cases In Ta-llen (Ratal, 1924). The mortality

of this form of the disease was about 43 per cent. In

Lii-shun(Port Arthur), 118 dysentery cases were treated

In the Lu-shun Hospital from 1928 to 1932, and 318

cases Including three cases of amebic dysentery were

treated in the Lu-shun Clinic according to the report

of the Kwantung Government Hlyeda, 1933).

Our knowledge of the disease In Mukden Is derived

mainly from reports of workers In the Manchuria Medical College. Kato and Hlsamochl (1933) reported 813

cases of dysentery received by the Manchuria Medical

College during period of six years from 1927 to 1932,

representing about 52.3 per cent of the total cases of

Infectious diseases admitted In the same period. Of

these cases, 231 (28.4 per cent) were bacillary dysentery, 31 (3.8 per cent) amebic, and 556 cases (68.3

per cent) undertermlned. Cases occurred throughout

the year, but the highest Incidence (35.8 per cent)

was In July, followed by June and August, with 17.4

per cent each. In 1933, 307 dysentery patients were

treated In the College Hospital of which 105 were bacillary, 75 amebic, 21 mixed cases, and 106 undertermlned

(Hlyeda 1935). Taylor (1935) reported 313 cases of

bacillary dysentery against 130 cases of amebic dysentery treated In Mukden Medical College during 1929-

1933, representing ratio of 24 to 10 for the two

types of the disease. Itonoke (1938)studied 438 cases

of dysentery admitted to the Department of Internal

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov •Dec Total

Cases 33 45 51 39 30 80 283 590 408 217 65 48 1,889

Deaths 12 10 29 57 74 31 11 257
Medicine, Manchuria Medical College,from 1933 to 1935. This number represents IP. per cent of the total admissions and 47.2 per cent of the total cases of reportable diseases. The Incidence of males was much

higher than that of females, being 74.4 against 25.6

per cent. Sixty per cent of the patients were of the

age group 20 to 30 years. The seasonal distribution of this series showed that the disease occurred

throughout the year, the Incidence Increasing In June,

reaching Its peak In July and beginning to decrease

in August. The case fatality rate was about four per

cent. In 1940, Klkuta reported the result of mercury

treatment among 31 amebic dysentery patients In the

Mukden Army Hospital. Altogether 183 cases of dysentery were admitted to the hospital from July 1937 to

June 1938- All of the patients were soldiers transferred from north China. The amebic cases represent

16.9 per cent of the total. The disease is more prevalent with higher mortality among children than among

adults. Over period of five months from May to

October, 1931, 98 cases were treated in the Pediatric

Department, Manchuria Medical College, 39 or 39.9 per

cent of them being positive for dysentery bacillus.

Tsuji et al (1938) over period of three years studied 1,230 cases of the disease treated In the Manchuria Medical College, 813 cases In the Takamorl Laboratory of Internal Medicine and 417 cases (including

43 cases of eklrl) In the Pediatric Department. The

case fatality was 2.2 per cent among the adult patients and 15.5 per cent among children. Dysentery

bacilli were found In 63.7 per cent of the cases and

only 25 cases were amebic dysentery. Forty-three

cases among the children were eklrl representing 10.3

per cent of the total pediatric cases. The case fatality rate of eklrl was 69.7 per cent, being higher

than that reported for the city of Ta-llen. Dysentery

was epidemic In Mukden In 1939 when 1,263 cases were

admitted to the Mukden Municipal Isolation Hospital

(Aokl and Suo, 1940)• The Incidence greatly increased

In May, reached Its peak in June and practically

ceased after September. The case fatality rate was

15.9 per cent among children and 3.8 per cent among

adults. The highest mortality occurred In September

as the disease became more malignant at the end of the

epIdemlo.

Hiyeda et al (1935) reported that about 20 per

cent of the apparently healthy workers along the

South Manchuria Railway were Infected with amebic

dysentery. In Ch'ang-ch'un (Hslnklng) of Kirin Province, 311 cases of dysentery (Including eklrl) were

reported In 1934, 366 In 1935, 302 In 1936, and 240

In 1937 (Abe and Kaneko, 1938)* The disease Is most

prevalent from May to September with peak In July.

The case fatality of the disease was from 1.99 per

cent in 1936 to 7.38 per cent in 1935, with an average

of 5.09 per cent for the four years. The morbidity of

the disease was highest (11,7 per 1,000) during the

ages under five years, followed by 6.6 per 1,000 during the ages from five to nine years and from 20 to 29

years. The lowest Incidence occurred between the ages

of 10 to 14 (1.1 per 1,000)- The average morbidity of

the disease was 4.9 per 1,000 for the four years studied. Only 0.82 per cent of the cases In 1935 and 3.31

per cent of the cases In 1936 were definitely amebic.

Although It is believed that dysentery Is widespread all over Manchuria, data regarding Its incidence In other localities than those discussed are

extremely rare. An outbreak of the disease occurred

In Fu-shun In 1928 with 121 cases reported in the city

during the first three months of the year (Health

Dept., S.M.R. Co., 1929). According to the report of

the South Manchuria Railway Company, there were 1,141

cases of dysentery treated in 14 of their hospitals

of which 90 cases were proven to be amebic dysentery.

The distribution of these cases is shown In Table

(Hiyeda, 1932 and 1933)

TABLE

DYSENTERY CASES REPORTED BY THE SOUTH MANCHURIA RAILWAY CO. IN 1930

Among 611 residents In Chang-chia-tien, Kirin, 73

suffered from dysentery with four deaths In 1938

(Ozaki, 1938). According to the reports of the

League of Nations, the following cases of dysentery

were reported along the Chinese Eastern Railway Zone

among population of about 44,000: 567 in 1928, 292

in 1929, 193 in 1930, 131 in 1931, 123 in 1932, 109

in 1933 and 75 in 1934. There were altogether 31

deaths in seven years representing case fatality

rate of 2.08 per cent. Lin and Wu (1927) reported

104 cases in Pin-chlang (Harbin) over period of

four months from January to June, 1926, representing

20 per cent of the total number of cases of infectious

diseases. In the Liao-si region, Takeroatsu (1933)

reported 25 cases of the disease occurring in the

Japanese Army from July to September.

Dysentery Cases Proven Amebic Dysentery Cases

Mukden 205 Fu-shun 256

Ch'ang-ch'un 156 An-tung 107

Liao-yang 76

An-shan 66 19

Pen-chl-hu 43 23

Szu-ping-chleh 42

K'ai-yuan 41 38

Tieh-llng 38

Va-wu-tlen 33

Ta-shlh-chlao 32

Ylng-kou 29

Kung-chu-llng 17

Total 1141 90
Types of dysentery bacilli in Manchuria. Hoshi

(1929) studied 241 strains of dysentery bacilli isolated from 241 dysentery patients in South Manchuria

with the following results:

By agglutination:

Shiga Type 12.0 per cent

Shiga Type II III 48.6

Shiga Type IV 39.4

By carbohydrate fermentation;

Original Shiga type 12.2 per cent

Quasi original type 2.4

Y-type 46.3 Flexner type 23.8

Strong type 4.3

Hiss IV type 5.5

Masugl type 3.1

Masugl type 1.2

Ohara Minota type 1.2

Tsubozakl (1939) made bacteriological study of dysentery and dysentery-like diseases in Manchuria. Three

hundred thirteen (313) strains of dysentery bacilli

were collected from all over Manchuria during the epidemic of 1936 and classified according to various

methods. The results may be summarized in Table 3.

TABLE

TYPES OF DYSENTERY BACILLI ISOLATED IN MANCHURIA IN 1936

The geographical distribution of the different types in this series is as follows (Table 4)

TABLE

GEOGRAPHICAL DISTRIBUTION OF BACILLUS TYPER IN 1936

Method of

Classlflcation Type No. Percentage

Shiga Typical 38 12.14 Atypical 159 50-8

Atypical II 1.28 Atypical III 0.64

Others 110 35.14

Lentz

Prlgge Shlga-Kruse 38 12.14

Schmitz 0.64

Flexner 95 30.35

159 50.8

Strong 1.28

Kruse-Sonne 11 3.51

Others 1.28

Futaki Shiga 38 12.14

Komagome 44 14.06

Komagome 156 49.84

Kawase 1.28

Nakamura 24 7.67

Oh era 11 3.51

Others 36 11.50

Tsubozakl Shlga-Kruse 38 12.14

Paradysentery 255 81.15

Paradysentery 1.28 Schmitz 0.64

Ohara (Kruse-Sonne) 11 3.51

Others 0.96

Ta- Port An- Ch ang- Bar- Tsi- ChengTypes lien Arthur shan Mukden ch 'un hln tslhar te Hal Total

0)

Shlga-Kruse 18 12 38 bU

•H ■p Schmitz

cu Flexner 22 30 25 95

«8 •H<P 12 43 83 14 159

(0 Strong

cC Kruse-Sonne 11

1-5 cJ Others

Shiga 18 12 38

Paradysentery 30 20 74 110 14 255

cd Paradysentery

rQ 71

Vi Schmitz «d -p

cd Ohara 11

CJ Others

Total 33 15 26 97 128 14 313
Tsuchiya and Kagata (1928) stated that in South Manchuria Shiga dysentery bacillus were almost always

Isolated from great many dysentery cases among

children, and that its toxicity was more virulent

than the Japanese type. In Ta-lien, Hoshlzakl (1928)

isolated number of strains of dysentery bacilli

from the stools of 95 patients during the epidemic of

1927 and classified them as follows:

1. By carbohydrate fermentation and indol reaction:

Original type of Shiga 39.3 per cent

Y-type (Hiss-Russel) 46.1

Flexner-type 5.6

Strong-type 5.6

Mannlt non-fermenter 3.5

2. By agglutination reaction:

Original type of Shiga 39.3 per cent

Y-type 53.9

Flexner-type 6.8

Hatai (1924) Isolated 28 strains from 123 eklrl cases

in Ta-lien and classified them as variant type (60

per cent), variant type II (15 per cent) and variant

type III (25 per cent). Yokoyama (1936) classified

the strains of bacilli isolated from 163 dysentery

cases in Ta-lien according to the classification of

Shiga and Hiss and reported that five per cent belonged to the typical type (type I) 57 per cent to

type II, 27 per cent to type III and eleven per cent

to type IV. The most common types in Ta-lien were

type II and type III. The former was only prevalent

in summer, while the latter occurred during other

seasons as well. In Mukden, Nakamura (1930) examined

stools of 60 cases during the dysentery epidemic in

the summer of 1929. Dysentery bacillus was found in

44 cases with litmus-agar medium, representing 73 per

cent. Of the 44 strains, 29 (or 65.9 per cent) belonged to the Flexner type, twelve (or 27.2 per cent)

belonged to the Y-type and three to the Shiga type.

Tsubozaki (1939) studied 51 strains of dysentery bacilli collected at Mukden and 49 strains collected

at Ch'ang-ch'un in 1938. Table shows the classification of bacillus types in these two series.

TABLE

TYPES OF DYSENTERY BACILLI IN MUKDEN AND CH'ANO-CH'UN IN 1938

Koike (1938) reported that 195 strains of dysentery

bacilli were collected from Mukden, Ch'ang-ch'un,

Fu-shun, An-sban, and Ying-kou during the months of

July and August 1936, and were classified as follows:

34 belonging to the typical type, four to Ohara type

and 157 to atypical type. Of the bacillary dysentery

in Ch'ang-ch'un (Hslnklng) studied by Abe and Kaneko

(1938), the following types of bacilli were reported:

Per Cent

Of 25 cases of bacillary dysentery among the Japanese

troops stationed at Llao-sl region, eight were infected with bacillus of the Shiga type, six of the Ytype, one of the F-type and ten were unclassified.

high percentage of the people in Manchuria are

found to be dysentery bacillus carriers, especially of

the Shiga type. Tsubozakl (1937) made survey on the

bacillus carriers among the workers in public places

in Mukden and reported that of 1,450 nersons examined

in April 1937, 56 (or 3.86 per cent) were found to be

carriers of dysentery bacilli and that 25 (44.6 per

cent) of the positives carried Shiga bacillus. Tsubozaki et al (1937) examined 758 Chinese school children

and 844 Japanese school children in Mukden for dysentery bacilli. The carrier rate was found to be 1.17

per cent for the former group and 0.12 per cent for

the latter group. Of these, 77.7 per cent of the

carriers were infected with Shiga bacillus, batanabe

and Ikeda (1938) examined 1,300 Japanese soldiers in

the same city and found that 2.5 per cent of them were

carriers of dysentery.

Classification Type Mukden Ch ang-ch'un Total

Lentz Shlga-Kruse 18 16 34

Prlgge Schmitz

Flexner 13 10 23

16 22 38

Strong

Kruse-Sonne

Others

Tsubozakl Shiga 18 16 34

Paradysentery 29 31 60

Paradysentery

Schmitz

Ohara

Others

Total 51 49 100

Shlpa Pars Ohara Undetermined Posltive

1934 2.69 3.37 6.06

1935 4.86 14.94 0.82 21.44 1936 5.96 53.64 1.32 64.23

1937 12.18 46.55 1.68 60.41

1938 14,29 64.29 7.14 91.72
Amebic Dysentery. The actual incidence of amebic

dysentery in Manchuria is not clear because most of

the reports do not contain the specific figuration of

the types of the disease. Although it is estimated

that nearly half of the dysentery cases in Manchuria

are of amebic type (Hlyeda, 1933), the information derived from literature shows much lower percentage,

due probably to the lack of technique in examinations.

Hoshizakl (1928) reported only 35 cases of amebic

dysentery out of 1,220 dysentery cases treated in the

Dairen Isolation Hospital over period of ten years

from 1917 to 1927. Yokoyama (1937) reported 45 cases

of amebic dysentery with four deaths as against 163

cases of bacillary dysentery with four deaths among

the Japanese in Ta-lien from 1931 to 1935, According

to the Kwantung Government there were 122 cases of

amebic dysentery treated in various hospitals in Talien and Lu-shun from 1927 to 1932 against 2,217

bacillary cases during the same period (Hlyeda, 1933)

In 14 hospitals along the South Manchuria Railway

there were treated 1,141 dysentery cases in 1930 of

which only 90 were demonstrated to be amebic. The

geographical distribution of these cases is by no

means uniform. Of 256 dysentery patients in Fu-shun

in 1931 not single amebic case was verified, while

of 41 dysentery cases in K'ai-yuan 38 were amebic

dysentery (Hlyeda, 1932» 1933)

In the Manchuria Medical College Hospital 40

per cent of the dysentery cases in 1932 were bacteriologically proved to be bacillary cases, most of

the bacteria negatives being amebic cases. In 1933,

307 dysentery cases were treated in the college hospital. Of these, 105 were bacillary, 75 amebic, 106

unidentified and 21 mixed infections (Hlyeda, 1933,

1934). Of the 438 cases of dysentery treated at

the Takamori Laboratory of Internal Medicine, Manchuria Medical College from 1933 to 1035, 9.8 per

Cent were proved to be bacillary, 15,7 per cent

amebic and 3.4 per cent mixed (Itonoke, 1938)

Tsuji and Sasaki (1938) however worked at the same

hospital and reported that dysentery bacilli were

found in 63.7 per cent of 1,187 cases of dysentery

and amebic dysentery was demonstrated in only 25

cases. In Ch'ang-ch'un only 0,82 per cent of the

dysentery cases in 1935 and 3.31 per cent of those

in 1936 were proved to be amebic dysentery.

Endameba histolytica was observed to be common

intestinal parasite in Manchuria. Of 350 Japanese

farmers examined in Ying-kou, 65 (18.5 per cent) were

found to be ameba carriers (Kitabatake, 1935), Hlyeda

(1933, 1935) reported that about an average of 21 per

cent of the apparently healthy Chinese laborers in

various localities along the South Manchuria Railway

are cyst-carriers of Eh. histolytlca and in some places

the infection was as high as 38 per cent. Hlyeda et al (1935) reported that about 18 per cent of the farm

workers in Ying-kou were infected with the parasite,

Hondo (1939) examined feces of 162 adult Japanese in

Peng-chlh-hu and found only nine (five per cent) of

them to harbor cysts of E.. histolytica.

Diarrhea and Enteritis. Due to food contamination, water pollution and other insanitary conditions,

diarrhea and enteritis are common in Manchuria.

Kawahlto (1936) showed that the death rate due to

these diseases among the Japanese in Manchuria was

from 7.1 to 14.2 per 10,000 in 1925-1930. These

diseases seem to be more prevalent in Ta-lien, Yingkou, An-tung and Llao-yang than in other cities.

Cases occur throughout the year, but the incidence is

highest from June to October.
CHAPTER II

CHOLERA

Cholera has been known in China since ancient

times. Numerous epidemics have been recorded which

often swept from south China to Manchuria. Modern

records of the disease in Manchuria go back as far as

1862 when the epidemic spread from the south. Such

epidemics recurred in 1877, 1883, 1884 and 1902, In

1907 the disease occurred in Ta-lien, Lu-shun, Liaoyang, and An-tung, and many cases were reported. In 1909 number of cases were again reported from Talien, Ying-kou, Ta-shi-chiao, and Liao-yang. In 1911

cholera epidemics occurred in the Kwantung Leased

Territory with 143 cases. Several cases were discovered on board ship in Ta-lien in 1913 and 1918,

In 1919 an epidemic started from Swatow, invaded

Shanghai in July and then attacked Ying-kou and

spread all over Manchuria, involving more than

300,000 cases. In Manchuria, 13,000 cases with

6,300 deaths occurred. The epidemic ended in October

and only few cases were reported in the following

year. In 1922, Iff cases were reported in Ying-kou

of which one was discovered on boat, and six cases

from Ta-lien of which five were on boat. In 192G

six cases were reported from Harbin in August and the

disease reached An-tung, Mukden, Lu-shun, Ta-lien and

Pi-tzu-wo with total of G1 cases. In 1927, 29

cases were reported from Ying-kou, two cases and two

vibrio-carriers in Ta-lien (on boat), and 130 cases

from Harbin and its vicinity. In 1929 three cases

occurred in Ying-kou.

In June, 1932, an epidemic with unprecedented

violence started from Ta-lten and Ying-kou and spread

to northern Manchuria by August. The epidemic ended

in the middle of September with about 0,500 cases

and 3,000 deaths. Table lists the number of cases

and deaths in different localities (Manako, 1933).

TABLE

CASES OF CHOLERA IN MANCHURIA, 1932

LocalIty No. Cases No. Deaths Started Knded

Lu-shun 21 11 July 24 Sept

Ta-1ien 163 107 une 30 Sept 17

Pl-tzu-wo 75 15 Sept Sept 22

Chin-chou July 12 Sept 16

P'u-lan-tien 19 16 July 18 Sept 19

Wan-chia-llng July 24 July 30

Kai-p'ing July 17 Aug 11

Ying-kou 65 30 June 28 Sept 22

Liao-yang 26 16 July 28 Sept 17

Mukden 108 57 July 18 Sept 17

Tleh-1ing 22 14 Aug 10 Sept 17

Kai-yuan Sept 19 Oct 15

Kung-chu-llng Sept 27 Sept 27

Ch'ang-ch'un 92 67 July 11 Aug 19

An-tung 54 37 Aug Sept 21

Fu-shun 15 14 Aug Sept 11

Chln-hslen 21 July 15 Sept 29

Liao-yuan 141 67 July 16 Sept 20

Kou-pang-tzu Aug Aug

TsItslhar 332 120 July 22 Aug 22

Tung-1iao 3,000 1,414 July 10 Sept

Harbin 608 365 Aug Sept 15

Yung-chi (Kirin) 70 28 Aug Sept 19

Hsln-mln-tun 730 325 July 23 Aug 31

Chlen-chia-tien 30 July 20 Aug

Ta-1in 30 July 20 Aug

Yao-nan 391 173 July 20 Aug

Pei-chen 330 155 Aug Sept

Chla-lun 30 July 16 Aug 31

San-hslng (I-lan) 32 24 July 25 Aug

Pa-mien-cheng Aug Aug 11

Kai-tung 11 Aug 10 Aug 10

Wen-ho Aug Aug 21

Hsia-chang-tang (?) 14 Aug Aug 11

Tai-p'ing-chuan Aug 10 Aug 18

Chien-wel Aug 15 Aug 30

Total 7,479 3,094 Aug 25 Sept
It is noted that the epidemics of cholera in Manchuria occurred generally about one to two months

later that those in Shanghai. It has been stated

that there are no endemic centers of cholera in Manchuria, all outbreaks being traceable to importation

from the south (Yang, 1928). However, the disease is

so persistent in this country that it should be considered as constant hazard to public health. The

information on the cholera situation in Manchuria in

recent years is Incomplete. Kikuta (1937) reported

477 cases from the southeastern part of Liao-ning

Province in 1934-1937. Three cases were reported

from Ch'ang-ch'un (Hsinching) in 1937 (Abe and Kaneko,

1938). The official report shows that 2i cases with

nine deaths occurred in the whole territory in 1938

(Manchoukuo Yearbook, 1941), and no cases were reported in 1939 and 1940. An unverified report indlcates that cases of cholera occurred in 1942 and

1943. Rigid quarantine against cholera was carried

out by the Japanese in the coastal harbors.

Tsuchiya and Yasumura (1930) stated that from

the biological and immunological characters the

strains of Vibrio cholerae prevailing in Ta-llen and

Ying-kou in 1929 belonged to the so-called intermediate type. Manako (1933) reported that the result

of both cross agglutination and the agglutinin absorption tests made on 167 strains of cholera vibrios in

Manchuria during the summer of 1932 proved that most

of them belonged to what is called the variant type.

One strain from Ta-lien was found to be of the intermediate type and another strain from Mukden did not

belong to either the intermediate or the variant type.
CHAPTER

TYPHOID AND PARATYPHOID FEVERS

Dae to general insanitary conditions, this group

of enteric diseases is widespread and forms an important cause of morbidity and mortality in Manchuria.

Yamada and Kawahlto (1939) reported death rate of

4.7, 5.7, and 2.6 per 10,000 population for typhoid

and paratyphoid fevers among the Japanese in Manchuria for the years 1920-25, 1925-30 and 1932-35

respectively. The Manchoukuo Yearbook (1941) listed

for the whole territory the following cases and

deaths of typhoid and paratyphoid fevers:

Notes on the Distribution of Typhoid and Paratyphoid Fevers. These diseases are common throughout

the whole territory. Kawahlto (1936) reported that

the death rate among the Japanese population in Manchuria from 1925 to 1930 as 3.8 per 10,000 in Port

Arthur, 5.5 in Ta-llen, 5.7 in An-tung, 3.5 in Yingkou, 6.0 in An-shan, 8.2 in Llao-yang, 4.8 in Mukden,

7.3 in Fu-shun and 10.5 in Ch'ang-ch'un. In Ta-lien

65 cases of typhoid and 28 cases of paratyphoid fever

were treated in the Pediatric Department, Dairen

(Ta-llen) Hospital during period of three years

from 1922 to 1924. The majority of the cases occurred in October and November (Kawashima 1925, 1926).

In the same department Kitahara (1932) recorded nine

deaths with typhoid fever and one death with paratyphoid fever during 1925-1930, while the total number of deaths during the same period was 1,471.

Urabe (1939) reported that 456 cases of typhoid fever

were admitted to the Dairen (Ta-lien) Isolation Hospital in 1938. The incidence was highest in September

among children and in October among adults. There

were 102 deaths, representing case fatality rate of

22.2 per cent. Tsuchiya and Nagata (1928) reported

on typhoid fever in south Manchuria excluding the

Kwantung Leased Territory. Over period of ten

years (1918-1927) 6,103 cases with 827 deaths were

reported principally along the South Manchuria Railway Line, with case fatality rate of 13.55 per cent.

The disease was most prevalent during the period

August to December. The seasonal distribution of

the disease for the years 1925-1927 is given in Table 7.

The case fatality rate ranged from 9.0 per cent in

1938 to 19.8 per cent in 1935. The ManshQ Nenkan

(1943) listed 7,141 cases of typhoid fever with 971

deaths and 1,341 cases of paratyphoid fever with 53

deaths in 1940. Cases of typhoid and paratyphoid

fevers were reported throughout the year, but the

highest Incidence occurred in the months from August

to December with the peak in October (Miura, 1926;

Kawahlto, 1933). They were principally diseases of

middle-aged persons.

TABLE

SEASONAL DISTRIBUTION OF TYPHOID AND PARATYPHOID FEVERS

In the first four months of 1928, 141 cases of typhoid

fever, and 191 cases of paratyphoid fever were reported along the South Manchuria Railway area. In

Fu-shun alone there were 64 cases of typhoid fever and

132 cases of paratyphoid fever (Health Department,

S.M.R. Co. 1929). The high incidence of paratyphoid

fever was due to the epidemic of paratyphoid in Fushun in that year. The reports of the League of

Nations for the notifiable diseases showed the following records of typhoid and paratyphoid fever in the

South Manchuria Railway Zone:

latter were autochthonous cases. Toya (1933) reported

59 cases of typhoid fever occurring in the city in

1930-1932. Thirty-three (55.93 per cent) of these

occurred in October and November. In the Isolation

Hospital at Ch'ang-ch'un (Hslnching) there were

total of 2,886 admissions from May 1934 to April 1938; 406 were cases of typhoid fever and 94 were cases of

paratyphoid fever, representing 14.07 and 3.25 per

cent respectively. The population of the city in 1937

was 358,431. The majority of both typhoid and paratyphoid cases occurred among the people between the

ages of 20 and 30 years. There were about twice as

many infections of males as of females. The case fatality rate was 22.66 per cent for typhoid fever

and 7.45 per cent for paratyphoid fever. Of the 81

paratyphoid cases classified 39 were paratyphoid A, 32

were paratyphoid and ten were paratyphoid (Abe and

Kaneko, 1938). Kikuta (1938) of the Epidemic Prevention Corps of the Japanese Hslng-ching (Hsin-pin) garrison reported 352 cases of typhoid and paratyphoid

fevers in Hsin-pin in 1935 while the total number of

cases of the communicable diseases was 931. Cases

occurred throughout the year wljth the highest incidence in February and March and lowest in September to

In Mukden, Taylor (1935) of the Mukden College

Hospital reported that the number of typhoid cases (131) treated in their hospital from 1929 to 1933 represented ten per 10,000 admissions, and that paratyphoid cases (5) represented three per 100,000 admissions. The majority of the former and all of the

Year No. Cases No. Deaths

1935 4,549 904

1936 4,628 1,004

1937 14,850 2, 423

1938 5,207 468

1939 5,036 514

IN MANCHURIA IN 1925-1927

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Total

No. Cases: 91 80 52 68 49 107 115 246 303 401 332 203 2,047

Per Cent: 4.44 3.91 2.54 3.32 2.39 5.23 5.62 12.02 14.80 19.59 16.22 9.92 100.00

1020 1930 1931 1932 1033 1934

Cases of Typhoid Fever 36« 432 227 241 528 569

Cases of Paratyphoid Fever 179 266 103 128 173 160
November (Kikuta, 1938). Lin and Wu (1927) reported

47 cases of typhoid fever during the first six months

of 1926 in Pin-chiang (Harbin) which had population

of about 100,000. Twenty-five of the cases occurred

in April. Kung (1928) reported 116 cases of typhoid

fever in the city in 1927. An outbreak of typhoid

and paratyphoid fevers was reported to occur in Tsltslhar in August 1943 with 50 to 60 cases among the

civilians and about 100 cases in the Japanese army.

The origin of the disease was reported to be contaminated vegetables which were washed in an infected

pond.

All three types of paratyphoid fevers have been

reported from Manchuria. Of the 28 cases of paratyphoid fevers occurring at Ta-lien as reported by

Kawashima (1926), twelve were paratyphoid and 16

were paratyphoid B. The former occurred from July to

January and the latter from August to November. Male

cases were twice as frequent as female cases for paratyphoid A, and three times as frequent for paratyphoid

B. Nagata and Hayashi (1934) reported serologically

and bacteriologically proved case of paratyphoid

from Ta-lien. Hoshizaki (1927) reported case of

paratyphoid in the Dairen (Ta-lien) Isolation Hospital, August 1927, indicating symptoms of ekirl. Matsubara(1928) reported an epidemic of paratyphoid in

Fu-shun in the first part of 1928, with about 130

cases. Of 36 strains of bacilli obtained from the Fushun Railway Hospital, 34 belonged to Bacterium paratyphosus A. The Health Department of the South Manchuria Railway Company (1929) reported the prevailing

condition of the epidemic as being one case in January,

six cases from the 1st to the 18th of February, 66

from the 19th of February to the 1th of March, and 54

cases from the 5th of March to the 4th of April. The

number of cases greatly decreased afterward. Of the

94 cases of paratyphoid fevers reported by Abe and

Kaneko (1938) from Ch'ang-ch'un in 1934-1938, 39 were

paratyphoid A, 32 were paratyphoid B, ten were paratyphoid C, and 13 were unidentified to type.

Fukada (1938) stated that in Chien-tao (eastern

Kirin Province) an "unknown fever" was reported and

most of the cases were proved to be paratyphoid A. He

claimed that the disease occurred sporadically in

Jehol, but broke out among Japanese cavalry brigade

in Ch'l-feng in the middle of September 1933, resulting

in 46 cases. Ten cases of bacteria carriers were discovered in the same brigade. Kurita (1938) reported

30 cases of paratyphoid occurring among the Japanese

soldiers in Manchuria in 1935-1936. Seven cases occurred in Ch'ang-ch'un, one in Yung-chi, five inHarbin,

seven in Mukden, three in Kung-chu-1ing, and seven in

Hailar. With the exception of three cases in Mukden

whose records were incomplete, five cases were reported

to be fatal, representing case fatality rate of 18.5

per cent. The seasonal distribution of the cases were

as follows: three in March, one in April, two in

June, four in August, two in September, seven in October, eight in November, two in December and one with

an unknown date, indicating that the disease was more

prevalent during the cold season. Isolation ofthe

bacilli revealed that 24 were Bacterium cholerae-suis

var. kunzendorf, five were American sulpestifer and

one was Bacterium typhi-suls var. voldagsen.

679114 46 -3
10

CHAPTER IV

PLAGUE

Plague Is one of the most important infectious

diseases in Manchuria and there have been frequent

epidemics. These epidemics may be classified into

two categories according to their origin.

1. Those epidemics which originated outside of

Manchuria, such as the epidemics in 1910-1911, and

1920-1921. The epidemics usually spread all over

Manchuria. The 1910-1911 epidemic started from Transbaikalia in the late fall of 1910, entered Manchuria

through Man-chou-li and spread to Hailar, Harbin and

Ch'ang-ch'un at the end of the year. Early in 1911

the epidemic included Mukden, Ta-lien, and Shantung

with over 40,000 cases. The 1920-1921 epidemic also

originated in Transbaikalia, infecting all of Manchuria but causing fewer deaths.

2. Those epidemics which originated from endemic foci within Manchuria. The epidemic of 1927-

1928, for example, originated in the T'ung-liao region,

and the epidemic in 1930 occurred along the Ssuplngchieh-Yaonan Railway Line and Chengchiatun-T'ungliao Railway Line. Epidemics of the first category occurred during the winter season and were pneumonic

In nature, while those of the second category occurred from early summer to the end of autumn and

were bubonic In nature. Case fatality rates were

usually very high: 75-95 per cent for the bubonic

type and nearly 100 per cent In the pneumonic type.

Plague In Mongolia and Transbaikalia Is enzootic

among the tarabagans (Marmota bobak Arctomys bobak)

and the principal vector is the tarabagan flea,Oropsylla sllantlewl. Outbreaks of human plague In this

area often started In late summer or autumn when

people were camping In the field for hunting or harvesting. Under such conditions they came In close

contact with rodents and their fleas. The disease In

this region s£ems quiescent at present; there has been

no Information of human outbreaks since 1928. Nevertheless, rodent reservoir probably persists, and

outbreak of the disease Is constant hazard. The

sylvatlc reservoir of the disease In southern Manchuria Is principally the common rat, especially

Rattus norveglcus, and the main vector Is the rat flea,

Xenopsylla cheopls. The susliks. Cltellus pygmaeus

muslcus and _C_, daurlcus, are also suspected by some

workers (Kurachl, 1930; Ando, Kurachi and Nlshlmura, 1931) to carry the disease.

In south Manchuria the port of Neu-chuan became

infected with plague as early as 1899. The disease

has reappeared in this city and the surrounding area

many times. In T'ung-liao and other areas in south

Manchuria several epidemics have occurred since 1924. Here the disease was thought to have been introduced

from Inner Mongolia about 1917. In this region plague

is predominantly of the bubonic type. In Chien-chiatlen, northeast of T'ung-liao, 434 cases of bubonic

plague were reported during the period September to

November, 1928, of which 424 cases (97.7 per cent)

were fatal. The population of the village was estimated at 1,300. Wu et al (1929) reported that 30

fatal cases resembling pneumonic plague had occurred

in Nung-an District, Kirin, on December 14, 1928.

In 1931 the South Manchuria Railway Company reported

that plague was epidemic in K'ai-t'ung and T'ai-p'ingch'uan along the Ssu-Yao Railway, Tu-chuan (west of

Yao-nan), Ta-lin along the Chinese Eastern Railway

and Nung-an during th,e latter part of August 1930, resulting in about 200 cases. In 1933, plague broke

out at the beginning of July in the northern part of

the Nung-an District and subsided in November. About

42 villages in this area were infected by the epidemic and 624 deaths were reported (Hiroki, 1934).

There was no marked correlation of mortality -with

age groups. The case fatality rate was over 90 per

cent, and about 70 per cent of the deaths occurred

within two or three days after the first symptoms

of the disease. The epidemic was almost entirely

bubonic in type, find only few pneumonic cases were

found at the close of the epidemic.

The Army Medical Corps of the Kwantung Army(1934)

reported 1,306 cases of plague which occurred throughout Manchuria in 1933. The majority of the cases

originated in Nung-an and T'ung-liao. In 1935, the

disease spread to twelve counties (hsien), four banners

(ch'i) and 59 villages (pulo) north of Nung-an in

central Manchuria, causing 430 deaths from July to

November (Yato, 1936). In Harbin, central Manchuria,

the first epidemic in recent times occurred in the

winter of 1910-1911 and lasted from November to February. The number of deaths was estimated to be

9,000, death rate of 90 per 1,000. The second epidemic occurred in 1921, from January to May. total

of 3,125 deaths were reported with death rate of ten

per 1,000 (Chun, 1923). Both epidemics were almost

exclusively pneumonic in type. As mentioned above,

these epidemics originated in Transbaikalia and spread

throughout Manchuria. Wei-ch'ang in Jehol Province

was formerly another north China plague area. Although the plague season in this region occurred during July to November, the pneumonic type of the disease was conspicuous. About one third of the total

cases in the 1896 outbreak were reported to be pneumonic, occurring mostly during the last one and one

half months of the epidemic. The infection seems to

have disappeared in this area in 1899. In November,

1933, an outbreak was recorded in the province in

locality north of Ch'lh-feng, but it was considered

to have been imported from the T'ung-liao district

and not of local origin.

In recent years the extent of plague infection

in Manchuria is obscure. According to the 1941 Manchoukuo Yearbook there were throughout Manchuria 248

cases with 239 deaths in 1937, 18 cases with 687

deaths in 1938, and 657 cases with 500 deaths in 1939.

No cases were reported in 1940 (Manshfl Nenkan, 1943).

The majority of infections reported occurred in the

central part of Manchuria. It was reported that

village near Harbin was quarantined for bubonic plague

during 1941-1944. The Manshfl Nenkan of 1939 gave the

distribution of 443 cases and 395 deaths during January to September 1938 as listed in Table 8.

TABLE

DISTRIBUTION OF PLAGUE IN 1938

The localities for the cases that occurred in 1939

also centered in this region (Central Manchuria).

It may be safely assumed that plague persists both

endemically and epidemically in this region up to

the present time. Yato (1936) reported that 88,707

persons in this area were inoculated for prevention

of plague in 1935.

Locallty Cases Deaths

Tung-k'o central Banner 26 25

T'ung-liao hsien

K'ai-t'ung hsien 61 56

Hsin-hul hsien 47 37

Chan-yu (Kai-hua) hsien 21 17

Ch'ang-ling hsien 137 127

Koerlos front Banner 105 91

An-kuang hsien 39 35

Total 443 395
CHAPTER

KALA AZAR

Kala azar, caused by Lelshmania donovanl and

transmitted by sandflies (Phlebotomus) is widespread

in China north of the Yangtze River. In Manchuria

it constitutes one of the most important endemic

diseases. It is particularly prevalent in south

Manchurian villages situated along the coast of the

Llao-tung Peninsula and the Liao River and other

rivers flowing into the Po-hal Bay. The endemic

area extends from the Kwantung Leased Territory

north to Mukden, and west to Jehol Province. Cases

have oeen reported in the cities along the Mukden

Talien Railway and the Mukden Shanhalkuan Railway.

According to Mo (1935) cases of the disease have also

been reported from the northern part of Manchuria.

The earliest report of kala azar in Manchuria

was in 1911 when Endo reported the probable contraction of the disease by Japanese while visiting in

Manchuria. In 1914 Saito reported the infection of

Chinese child in Lu-shun who was natlveof Che-foo,

Shantung. In 1917 one case was demonstrated at Mukden

Men's Hospital by splenic puncture. Mltsuse (1930)

reported six suspected cases from Mukden in 1927-1929

including the isolation of L. donovanl from child

who was native of Fu-shun. Taylor (1931) reported

several cases each year since 1920 occurring in Liaoyang, Ta-shlh-chiao and Kal-p'ing along the Mukden

Talien Railway, with few in Sui-chung and Kuang-nlng

(Pei-chen) along the Mukden Shanhalkuan Railway.

The same author (1935) again reported 31 cases treated

at Mukden Hospital in 1929-1933, representing 23 per

10(3,000 admissions. The majority of these cases were

believed to be autochthonous. Buto and Yamamoto

(1934) reported the Infection of child native of

Neu-chuang. Leishraan-Donovan bodies were found particularly numerous in the reticular cells and also

visible in the endothelial cells of the sinusoldes.

In- 1934-1935, Mo made an intensive survey of the

disease in Manchuria. Three regions in south Manchuria were Investigated: viz., (1) the Kwantung

Leased Territory centered at Chou-shut-1zu (2) Fuhslen and (3) Kal-p'ing-hslen with Hsiung-yueh-cheng

as center. The following cases were included in

his report:

In Fu-hslen, four children were found to be suffering from this disease in one family. Most of the patients

were below the age of 15 years and only ten were between the ages of 15 and 31. The disease is more

prevalent in the lowland of the countryside than in tne cities. Yosezato (1936) reported that cases of

kala azar were found in the following localities

along the Mukden Shanhalkuan Railway Line: Shanhal-kuan, Ta-llng-ho, Shlh-shan-chan, Kou-pang-tzu,

Lu-chia-tzu, Yang-shan, Pa-yuan-ying-tzu, Ch'ao-yartg,

Er-tao-ho-tzu, and Ch'eng-te (Jehol). Ilayashl (1936)

made histological studies on eleven cases of splenomegaly which had been diagnosed as Bantl's disease and surgically extirpated at the Manchuria Medical College, Mukden, and found that three of the cases were kala azar infections.

Canine kala azar has not been reported from

Manchuria although it is rather common in northern

China. Andrews (1933, 1935) reported the first

Chinese canine kala azar case in Shanghai and

expressed the opinion that the Infection was probably acquired in Mukden where the dog was born.

Recent research in the field of leishmaniasis has

adequately demonstrated that the disease is transmitted by blood sucking insects. The only group of

Insects definitely shown to be vectors are the sandflies of the genus Phlebotomus. However, very little

is known regarding the sandfly fauna of Manchuria, and

Yang (1935) stated only that these insects are rare in

Mukden. Mo (1935) questioned the sandfly theory of

transmission in Manchuria, and Kubo, et al (1939) were

of the opinion that the disease may be contracted from

the feces of biting insects.

Cases demonstrated by splenic puncture and positive

serum reaction.

True Cases* Suspected Cases Total

Ta-lien City 14 23 Lu-shun 11 12 Chou-shui-tzu Region 16 17 Fu-hslen Region 35 12 47

Hsiung-yueh-cheng Region 66 42 108 Llao-chung

128 80 208
CHAPTER VI

MALARIA

Due to cold climate and relatively unimportant

mosquito vectors, malaria is not the serious health

problem that it is in south China. However, the incidence of malaria in Manchuria has greatly Increased

in recent years. According to the Manchoukuo Yearbook

(1941), 4,949 cases with 266 deaths were recorded by

public clinics in 1935, and 5,055 cases with 342 deaths

in 1937. The early history of the disease in this

territory is obscure. According to the report of the

Health Department, South Manchuria Railway Company,

there were only few reported cases of malaria in the

cities and towns along the railway up to 1924. However, in 1924, the disease suddenly broke out inTlehllng where 255 cases of Japanese troops and 74 cases

of civilians were reported (Hlyeda, 1933). In 1925-

1930 about 0.9 to 1.9 per cent of the patients,

treated in the Japanese hospitals in different localities along the South Manchuria Railway, were

malaria cases, and about ten per cent of the mine

workers in Fu-shun suffered from malaria. The incidence in other places however was much lower

(Hiyeda, 1934, 1935). Taylor (1935) stated that malaria was definitely menace to the health of certain communities in south Manchuria. Faust (1926)

first noted that in the lower Amur River region malaria is highly endemic and estimated that about 30

per cent of the population was infected. Jettmar

(1932) stated that there are two endemic foci of malaria in northern Manchuria: one between Lahasusu

and Gaidlkaudza at the lower end of the Sungari River,

and the other small swampy area between Aigun and

Mergen. Ch'in (1939) also stated that in the northern part of Manchuria, especially the Sungari River

region, malaria was more prevalent than other parts

of the country.

According to Jettraar (1932) and Hiyeda (1932)

vlvax-malari Is the only form of the disease encountered In Manchuria. However, Iketanl (1937)

reported two cases of malariae-malaria from Ta-llen,

Taylor (1935) two cases of autochthonous falciparummalaria from mukden, and both types were reported

from Harbin by Faust (1926) and Hayashl and Li (1936).

The mosquito vectors of malaria in Manchuria are ndt well known. Jettmar (1932) was the first to report the presence of Anopheles hyrcanus sinensis In

north Manchuria, and suggested that it might be the

malaria vector in that region. This species is common in southern Manchuria according Hiyeda (1935)

and Kltabatake (1935) In 1937, Feng and Ch'ln reported the presence of abranchlae atroparvus at

Hel-ho and Lung-cheng of northern Heilungkiang Province. _A_. messeae, proven malaria vector, has also

been reported to occur along the Amur River country.

It is possible that all of these three species are

responsible for the transmission of malaria in northern Manchuria.

Notes on the Distribution and Incidence of Ma1aria. Information regarding the incidence of malaria in Manchuria is extremely fragmentary. report by the Health Department of the South Manchuria

Railway Company concerning the incidence of malaria

in 15 railway hospitals over six-year period from

1925 to 1930 is summarized in Table (Hiyeda, 1933).

TABLE

INCIDENCE OF MALARIA ALONG THE SOUTH MANCHURIA RAILWAY IN 1925-1930

of the principal factors responsible for this Increase

is thought to be the growth of cities with an expansion of industries.

Malaria in southern Manchuria is most prevalent

during the months of June to October. The number of

cases begin to increase in April, reach its maximum

in August, and decrease abruptly ‘in October. Table

10 gives the monthly distribution of the malaria cases

in various localities of south Manchuria from 1925 to

1930 (Hiyeda, 1933).

These data list mainly the records of Japanese. The

number of malarial cases among the Chinese is considered many times higher. In An-shan and Fu-shun

where many Chinese work in mines, the malaria incidence

is much higher than in other places. It was estimated

that about ten per cent of the Chinese, in An-shan and

Fu-shun were affected annually. In the region south

of Kung-chu-ling there is more or less increase of

the disease each year particularly in Fu-shun and Anshan, while in the area north of Kung-chu-ling there

is no tendency toward an increase of the disease. One

Hospital No. Cases Per Cent of Total Admission

Lu-shun 80 0.7

a-1 en 91 0.1

Ylng-kou 28 0.2

Ta-shlh-chiao 25 0.3

An-shan 224 2.2

Liao-yang 138 1.4

An-tung 116 0.8

Pen-chi-hu 64 0.8

Fu-shun 2,385 9.1

Mukden 280 0.8

Tieh-ling 110 1.7

Kai-yuan 74 0.8

Rung-chu-ling 10 0.1

Ch'ang-ch'un 36 0.2

Yung-chl (Kirin) 15 0.2
TABLE 10

MONTHLY DISTRIBUTION OF THE MALARIA CASES IN VARIOUS LOCALITIES IN 1925-1930

Official reports of malaria cases during 1935-1937 by the sanitation divisions of the local police departments

are listed in Table 11 (Ch'ln, 1938).

TABLE 11

DISTRIBUTION OF MALARIAL CASES IN 1935-1937

In Mukden, 1,646 cases were reported in 1934. This

record, though fragmentary, Indicates that the disease

is widespread. Nishihorl (1932) reported that 18 per

cent of the Japanese soldiers in Manchuria examined

were found to be malaria carriers and five per cent

were verified to carry_P. vlvax. In Ta-lien the malaria incidence is comparatively low, representing

only 0.13 per cent of the total number of patients

(Hlyeda, 1933) Iketanl (1937) reported 54 cases of

malaria treated at the Department of Internal Medicine,

Dairen (Ta-lien) Hospital, over period of six years

from 1931 to 1936, representing only 0.07 per cent of

the total admissions of 78,440 patients. All of the

patients, with the exception of two, were Japanese,

including three children. According to the author,

anopheline mosquitoes are rather rare in Ta-lien and

the patients possibly contracted the disease outside

the city. From the hospital records it appears that

all except four of the patients suffered from tertian

malaria. Two patients showed subtertian type of infection which was probably the result of reinfection

of tertian malaria. Two others showed quartan type.

The majority of the cases occurred during July and

August. Kltabatake (1935) investigated the parasitic

Lushun a-1ien

Anshan

Llaoyang

Antung

Dench' i-hu

Fushun Mukden*Tlehllngaiyuan Total

Jan 15 31

Feb 20

Mar 19

Apr 16 41 73

May 136 17 10 192

Jun 17 24 13 13 324 32 12 13 462

Jul 10 11 40 27 27 10 526 101 23 11 786

Aug 21 53 23 35 11 639 108 20 11 929

Sep 20 28 51 27 21 16 511 82 24 24 804

Oct 13 11 19 19 10 138 46 274 Nov 11 42 26 104

Dec 10 34

Total 80 91 224 138 109 64 2,385 453 110 74 3,728

*For period of ten years from 1921 to 1930.

Locality 1935 1936 1937 Locality 1935 1936 1937

Mukden 813 431 Ming-shui

Fu-shun 31 32 K'o-tung 12 13

Li ao-^yang 58 28 Pai-chuan 82 24

Pen-ch'i 58 154 Teh-tu 13 15

Hai-cheng Lung-chen 81 25

Ying-kou 83 12 Ta-lai 17

a-k' 166 107 49 An-kuang

K'ang-p'ing 31 44 Chen-tung 23 20

Li-shu 61 121 27 K'ai-t'ung 17

Ch'ang-t'u 172 11 Chan-yu 10 36

K'ai-yuan 30 An-tung City 69

Si-zeng 54 60 287 Feng-cheng

Si-an 132 77 67 Chuang-ho 410

Tung-feng 21 14 42 Hsiu-yen 37

Hai-lung 116 460 61 Huan-J en 73

Ch’ing-yuan 83 91 31 Chi-an 107

Hsing-chlng 31 15 58 T'ung-hua 11

Llu-ho 12 15 Fu-sung

Chin-chuan 18 Hei-ho

Hul-nan 17 104 Chi-k*

T'ai-lai 62 Mo-ho 25 72 36

an-nan 33 Al-hun 12

Fu-yu 13 Wu-yun

Lin-tlen 17 Fo-shan

Na-ho 19 72 Chi-pu 55

K'o-shan 81 Hu-ma
diseases among the Japanese immigrants in two villages

(one near Chln-chou and the other near Ylng-kou) in

south Manchuria and stated that malaria is widely

spread in these districts. Epidemics of malaria were

confined to mid-summer, June to August. Several hundred of the inhabitants in the vicinity of these villages were Infected in one epidemic. Blood samples

of 64 persons from the village near Chin-chou were

examined and six (9.3 per cent) infections with Plasmodium were observed. Fifteen malaria patients were

examined from neighboring village and reproductive

bodies of Plasmodium were discovered from ten of them.

Blood examinations of 122 persons were made at the

village near Ylng-kou, of which four were positive

for parasites. Both larvae and adults of Anopheles

hyrcanus sinensis were abundant in the villages.

In Mukden, Taylor (1935) reported 147 cases of

malaria treated in the Mukden Hospital from 1929 to

1933 (two falciparum cases in 1934) representing

eleven per 10,000 admissions. These include 144

cases of vivax-malaria, one case of malariae-malarla

and two cases of falciparum. The majority of the

vlvax cases and one of the falciparum cases were

autochthonous.

In Fu-shun the number of malaria cases was

greatly increased after 1924. About 16.5 per cent of

the patients in 1927 and 14.0 per cent in 1929 were

malaria cases (Kudo, 1932). From 1928 to 1932, 8,832

cases were reported among 20,000 laborers in twelve

mines in this region. The disease was prevalent during the summer months and ranked first to fourth in

frequency of 56 diseases reported by the Labor Department of the Fu-shun Mining Company. Table 12 shows

the monthly distribution of the disease in percentage

of the total admissions of 56 diseases during 1929-

1932 (Kitabatake, Yamamoto Murase, 1934).

TABLE 12

MONTHLY DISTRIBUTION OF MALARIA IN FU-SHUN IN 1928-1932 (IN PERCENTAGE)

Blood examinations on 2,223 apparently healthy workers

from two mines were made and 95 (or 4.3 per cent) of

them were found to be gamete-carriers. The only

Plasmodium found was _P. vivax. The larvae of Anopheles

hyrcanus sinensis became abundant after May (Kitabatake et al, 1934). Blood examinations were also reported at Tleh-llng, another Industrial center in

Manchuria. Blood specimens were taken from 841 persons from April to July 1924 and Plasmodia were found

in 42 (or about five per cent) of them. (Health Department, S.M.R. Co., 1927). In Harbin, Lin and Wu

(1927) reported 56 cases of malaria from January to

June, 1926, representing 10.8 per cent of the total

of 521 cases of Infectious diseases.

In the northern part of Manchuria, Jettmar (1932) first noted two malaria endemic areas, one in the region below the confluence of the Sungari and Amur

Rivers between Lahasusu and Galdikaudza and the other

in the swampy valley from Aigun to Mergen. Ch'ln (1939) made preliminary survey of malaria and mosquitoes in certain places of north Manchuria. Investigations of malaria were made at six places:

viz., K'o-shan, Pei-an, Sun-chuan-kou (about 20 miles

north of Pei-an), Teh-tu, Tu-lee-ssu (about six miles

west of Teh-tu), and Hsu-er-tun (about 18 miles east

of Teh-tu) with the following results:

These data were based on the clinical symptoms

and past history of malaria of the native people

examined. No blood or physical examinations were

made. From this survey the author concluded that

the regions near Teh-tu and Lung-chen along the

Namor River were the most heavily Infected among

the places investigated.

One hundred thirty three (133) Anopheles hyrcanus

sinensis (twelve from Ko-shan, 85 from Pei-an and 36

from Teh-tu) and three _A_. labranchiae atroparvus (two

from Pei-an and one from Teh-tu) were collected and

dissected for malaria parasites. These dissections

were negative. Little is known regarding the malaria

situation in other regions of Manchuria.

Mai aria-vectors in Manchuria. Only two species

of anopheline mosquitoes have been found in Manchuria,

A. hyrcanus sinensis and A. labranchiae atroparvus.

The former, A,, hvrcanus sinensis, is widely distributed in the country and its adjacent territories. It

is very common mosquito and is probably the only

malaria vector in the southern part of Manchuria. The

larvae of this species are found in grass-covered

stagnant water, such as swamps, drying rivers or

streams, lakes, ponds, marshes, ditches, pools, rice

fielcis, drains, large wells, and stagnant or slowly

running water along the shores of streams, rivers or

lakes. They breed occasionally in the water of artificial containers. The adult females enter houses

and attack man as well as domestic animals. This mosquito is primarily zoophillc and attacks man only

when other mammals are not available. In other parts

of China where more important vectors are present it

plays relatively minor role in the transmission of

malaria. But in south Manchuria where few other anopheline mosquitoes have been found it is the main

vector of the disease.

1929 1930 1931 1932 Average

Jan 0.4 0.1 0.1 0.2 0.2

Feb 0.4 0.2 0.4 0.3 0.3

Mar 0.2 0.1 0.7 0.1 0.3

Apr 1.1 1.0 2.4 0.6 1.3

May 5.1 4.2 13.6 3.9 6.3

Jun 16.2 8.2 25.3 9.8 14.9

Jul 23.9 11.5 30.0 13.6 18.8

Aug 21.1 13.8 23.2 12.5 17.7

Sep 15. 18.5 20.0 12.0 16.4

Oct 9.2 9.3 6.2

Nov 3.6 6.0 3.9 1.2 3.7

Dec 0.5 0.9 0.9 0.4 0.7

Locality No. Examined Positive Cases Percentage

K' o-shan 300 1.0

Pei-an 380 13 3.4 Sun-chuan-kou 104 17 16.4

Teh-tu 485 77 15.9

Tu-lee-ssu 112 40 35.7

Hsu-er-tun 167 70 42.0
15

Anopheles 1abranchlae atroparvus was first reported from Hel-ho and Lung-chen in Heilungkiang

Province by Feng and Ch'in in 1937, and was again

collected from Pel-an and Teh-tu in the same province

by Ch'in in 1938. Since malaria is endemic in this

region and atroparvus is an important malaria vector elsewhere it may be the vector of the disease in this

region. However, as Feng's determination was based

on single specimen, the identity of the variety is

still open to question. The larvae of atroparvus

breed in ditches containing fresh water as well as

in brackish water along coastal areas. Adult females

have been taken from human dwellings. They readily

attack man as well as domestic animals.

Anopheles messeae has been reported by Russian

observers from Khabarovskly Kray, Chltinskaya Oblast,

and Buryat-Mongol'skaya, ASSR. It is possible that

further Investigation may reveal the presence of this

species in Manchuria. This species is proven malaria vector. The larvae breed in cool, fresh, standing bodies of water in large Inland river valleys,

lakes, and marshes. Adult females appear to prefer

animal to human blood. They hibernate in barns and

houses during winter months. It should be also noted

here that two varieties, _A. macullpennls ewl si and

A_. macullpennls selengensls were described by Ludlow

from Selenga, Siberia In 1920. Recently Altken (1945)

suggested with reservation that "Falleroni's messeae

(1926) originally described from Italy is In reality

Ludlow's lewis (1920) and should be known as A. macullpennls 1ewlsi". A. macullpennls selengensls

should then remain as synonym of _A. macullpennls

lewlsl.

Anopheles (My zomyl a) at tonl which has been

shown to be good experimental carrier of malaria

and considered to be an important vector in the

hilly regions In Shantung, Hopei and Szechwan provinces, has been reported as far north as Ch'inhuang-tao, south of Shan-hai-kuan. Its occurrence

farther north in Manchurian territory is probable.

Anopheles (Anopheles) llndesall .1 aponlcus which is

widely distributed in China and Japan, has been collected in Peiping. It is possible that this species

is also present in south Manchuria. This mosquito

has been regarded as malaria vector of secondary

importance in Japan.
CHAPTER VII

TYPHUS

that it Is not often reported. Cases occurred

throughout the year with two peaks, one In June and

the other In October, the latter being by the

highest. morbidity rate of 46.6 per 1,000 was

reported. The authors observed that Manchurian rlckettsla was detected In house rats and rat fleas

collected In the homes of patients, as well as an

intermediate type of the virus observed In human lice.

Kodama et al (1932) pointed out the dissimilarity between Manchurian typhus virus and typical

typhus virus In experimental animals (guinea pig):

(1) R. manchurlae does not always produce nodules

In the brain of an Infected guinea pig, and if at

all, to lesser degree than the typical disease;

(2) the Neill-Mooser reaction Is characteristic and

strongly positive In R. manchurlae; (3) R. manchurlae

may be detected In large numbers from the tunica

exudation of tin Infected experimental animal.

Under natural conditions the two types of rlckettsla are different,. The rat Is the host of R,

manehurlae and the disease Is transmitted by rat

fleas and rat lice, while man Is the host of R_.

prowazekl and the disease is transmitted by body

lice. Passage of II. manchurlae in the louse tends

to decrease the Neill-Mooser reaction, increase

the virulence of the parasite, and cause the disease

to assume the characteristics of classical typhus.

Kodama et al (1932) reported that when three strains

of n. manchurlae were experimentally passed through

body lice (Welgl's method) for four generations, the

characteristics of R. prowazekl were produced (false

Neill-Mooser reaction). cross immunity has been

established for the Manchurian type, not only against

itself but also against the typical typhus virus

(Kodama et al, 1932)

On the other hand, Iwata (1938, 1939) studied

the types of the disease in various parts of Manchuria

and expressed different view regarding the typhus

types and their causative agents. The following

account is based on his studies. He reported 30

cases treated in the Mukden Municipal Infectious

Diseases Hospital from late in 1936 to September

1938. One was critically, two were moderately and

27 were mildly ill, and there were no fatalities.

About 28 per cent of the cases were Japanese, while

the remainder were Chinese. One hundred four (104)

cases occurred during the epidemic in Chia-mu-ssu

from January 19 to March 10, 1938. The population

of the city was about 37,000. Before this epidemic,

small outbreak was reported at the prison of the

Chia-mu-ssu Prefecture Public Office during the

first week of December. There seemed to be definite relation between the outbreak in the prison and

the epidemic in the city, because the majority of

the patients in the first stage of the city epidemic

were policemen and others who had visited the prison

and had contracted the disease shortly after. Following this incident, the disease spread throughout the

city. Nine hundred seventy three (973) body lice

collected during the epidemic were examined, of which

79, or 8.1 per cent, were infected with typhus virus.

R. pedlcul1, which is not known to be pathogenic,

was found in 29.7 per cent of the lice, and 4.5 per

cent contained rickettslae which were unidentified

as to species. During an epidemic, centered in

Fu*-shun, 126 cases occurred in succession from the

middle of December 1936 to January 16, 1937, of

which twelve (9.5 per cent) were fatal. It seemed

probable that the disease had been introduced from

Typhus is endemic and often assumes epidemic

proportions in all parts of Manchuria. According to

the Manchoukuo Yearbook (1941) there were 1,220 cases

of typhus with 272 deaths in 1935, 4,496 cases with

763 deaths in 1936, 7,349 cases with 1,025 deaths in

1937, 1,395 cases with 209 deaths in 1938 and 1,577

cases with 254 deaths in 1939. The case fatality

ranged from 13.9 per cent in 1937 to 22.3 per cent

in 1935. Of these, 3.4 per cent were Japanese and

19.3 per cent Chinese. Manshu Nenkan (1943) listed

2,515 cases with 276 deaths in 1940. Both the classical type (louse-borne) and the murine type (fleaborne) are prevalent. The former frequently breaks

out in various parts of the country and constitutes

one of the major contagious diseases in this territory. The murine typhus which is better known as

"Manchurian fever" in the Japanese literature is

endemic throughout the country. great deal of

work has been done on this disease by Japanese workers regarding its etiology and epidemiology in recent

years.

Early reports do not differentiate the types of

the disease. In 1918 it was reported to be epidemic

in Harbin due to crowding of refugees from the European war. There were usually 200 to 600 cases each

year in this city (Chen et al, 1938). Ogawa (1929)

at Fu-shun studied four typhus cases (Chinese mine

workers) in 1915, and at Mukden one case in 1918 and

one Korean case in 1919. The Kwantung Government

statistical report gave 210 typhus cases in the

Kwantung Leased Territory and 456 cases in the South

Manchuria Railway Zone from 1922 to 1935 (Kikuta, 1937). The disease was reported to be epidemic in

south Manchuria in 1928 especially in the area along

the South Manchuria Railway. Over 1,000 cases were

treated in the Dairen (Ta-lien) Clinic in that year.

From 1934 to 1937, 119 cases were reported among

Japanese troops stationed at different districts in

the southeastern part of Liaoning Province. In 1934

the number of typhus cases in the Feng-tien Japanese

Army Hospital was the most prevalent of all diseases

(Kikuta, 1937,' 1938). Kodama, Takahashl and Kawano

(1932) reported 500 cases of Manchuria fever in

town of 15,000 population near Ta-lien in 1928.

Todani (1933) reported 59 cases of typhus in Mukden

over period of two years. The disease seems to

have two prevalent seasons year, one from March to

June and the other from September to December. The

majority of the patients (43) were between 21 and

40 years of age. The author stated that two types

of the disease existed in Manchuria, the endemic

type (mild type) which occurred sporadically and the

epidemic type (severe type) which occurred epidemically. Chen et al (1938) observed 136 cases of so- called Manchuria fever in the Manchuria Medical

College Hospital during period of three years

from January 1933. Most of the patients were Japanese, 20-30 years of age. There were twice as

many male patients as female patients. The highest

incidence occurred during the months of September,

October and November. Ozaki and Ohtsuka (1935) investigated the epidemiological aspects of the socalled Manchuria fever which prevailed in different

regions in the city of Ch'ang-ch'un (Hslnching) in

1933. total of 124 cases were studied, including

115 Japanese, five Koreans, three Chinese, and one

Russian. Of 118 cases where ages were known,73 were

between 20 and 39 years of age. Only two cases were

under seven years of age and one over 60. The rarity

of reported cases among children was attributed to

the mild nature of the disease in this age group, so
the epidemic areas of the neighboring districts

where there had been conspicuous epidemic during' the autumn of 1936. The author studied nine cases in the village of Ying-pan. All of these were Chinese ranging from 18 to 51 years of age, and seven were males. There were no child or infantile cases. Six of the patients were moderately and

three critically ill. In two R. prowazekl was demonstrated, and in five strains of an intermediate

form. Strains of _R_. manchuriae were not observed.

In another epidemic which centered in southern Liaoning Province, over 5,000 cases occurred from the

autumn of 1936 to the winter of 1937. The mortality

was about 16.4 per cent. Of 27 cases studied, R_.

prowazekl was isolated from four cases, and strain of an intermediate form from nine cases. No cases ji» manchuriae were encountered. Strains of the

three types, R_. prowazekl, R. manchurlae and the intermediate form, coexisted in the sporadic out- break in Mukden. Of 20 strains which originated from this outbreak, one was that of R. prowazekl, five were of an intermediate form and 14 were R. manchurlae. In the Chia-mu-ssu epidemic, similar distribution typhus viruses had been observed.

Clinical data and virus studies for 46 cases (20 from Mukden, 19 from Chla-mu-ssu and seven from Ying-pan) are compiled in Table 13.

TABLE 13

RELATION BETWEEN SYMPTOM OF TYPHUS AND TYPES OF VIRUSES

Based upon his studies and those of others, Iwata

arrived at the following conclusions:

1. Typhus fever virus may be classified as one

of three types: the strain of Rickettsia prowazekl,

the strain of Jl_. manchurl ae or R. mooser 1, and the

strain of an intermediate form.

2. The sporadic typhus virus is perhaps the

original form and the epidemic virus its variety.

3. The three types may be classified by NeillMooser reaction and Maxcy phenomenon. These tests

are usually negative to the epidemic typhus virus,

positive for sporadic typhus virus, and intermittently positive for the intermediate form.

4. The strain of JU manchurlae is better suited for organ-peritoneal than blood-heart passage;

the strain of R. prowazeki has greater affinity to

blood-heart passage, and the intermediate is suitable for both passages.

5. Typhus fever is classified under three forms

by clinical symptoms: mild, moderate and critical.

There is definite relation between the three forms

of clinical pictures and the three types of typhus

virus. R_. manchurl ae is, as rule, isolated from

the mild form, and the strain of R_. prowazeki from

the critical form.

In Mongolia the disease Is also prevalent. During the period 1911 to 1920, 39 young missionaries

died of typhus, and 23 during the period 1921 to

1930. Upon the Introduction of Welgl's vaccination

technique, only one death from typhus occurred among

these missionaries during the period 1931-1940. This

death was caused through failure of prompt delivery

of vaccine (Chinese Med. Jo.ur. Aug 1940)

The body louse, Pedlcuius humanus co rporls,

which is the vector of epidemic typhus fever, is very

common in Manchuria, especially among the poor classes and refugees. Iwata (1939) collected 973 body

lice during the epidemic of Chla-mu-ssu in 1938 and

found that 79 (8.1 per cent) contained typhus virus,

279 (29.7 per cent) contained Rlcket tsla pedlcull

and 44 (45 per cent) contained Rickettsla unidentified to species. Kodama et al (1932) examined 240

rats (including 202 Rat tus norveglcus norveglcus,

four Rattus no rvegi cus hlbernlcus and one Rat tus

rattus alexandrlnus) from two Chinese towns near

Ta-llep during an epidemic of sporadic typhus in 1926.

Of these, 16 were found to be definite carriers of R.

manchurlae. All of the infected rats except one

alexandrlnus were norveglcus. The predominant species

of fleas found on the rats were Xenop sylla cheopis

and Monopsyllus anisus (Ceratophyllus), the former

being more numerous and the only species infected.

679114 46 -4

R. manchuriae Intermediate form R. prowazekl Total

Mild cases 17 25 Moderate cases 13 Critical cases

Total 17 21 46
CHAPTER VIII

OTHER ARTHROPOD-BORNE DISEASES

Japanese Encephalitis. This disease has been

epidemic in Japan, frequently involving several thousand cases. It has also been reported in the Maritime

Krai of USSR in the regions bordering Manchuria.

small epidemic which was thought to have been of the

Japanese type was described from Peiping (Chu et al,

1940). The disease is caused by virus and the mosquitoes, Culex pip lens and Culex trltaenlorhynchus are

suspected as vectors. Cases have not been reported

from Manchuria but both species of the mosquitoes have

been found in Liaoning and Kirin Provinces. The disease may be readily introduced, if not already present,

in Manchuria.

Tick-borne Encephalitis (Russian Spring-summer

Encephalltls). Tick-borne encephalitis transmitted

by Ixodes persulcatus, has been reported from various

areas in the far eastern parts of the USSR. Neither

the disease nor its vector has been reported from Manchuria, but its introduction is probable.

Dengue Fever. Dengue fever appears periodically

along the south China coast and extends northward

during the warm season. However, cases of the disease have not been definitely reported from as far

north as Manchuria. Tournier and Guenole (1928) reported twelve cases in small epidemic which occurred

among the Annamese riflemen of the French garrison in

Shan-hai-kuan from the 4th to the 23rd of February,

1928. It is doubtful that this was an epidemic of

dengue fever and furthermore it is possible that none

of the cases were contracted locally as the described

"epidemic" occurred during the time of season when the

mosquito vector is absent. The mosquito vectors Aedes

aegyptl and albopictus are rather widely distributed in China. While the former is principally southern species the latter has been recorded as far north

as Peiping. It is possible that its range extends

further north into Manchuria.

Fllarlasls. No autochthonous cases of fllarlasis

have been reported from Manchuria, although the mosquito vectors, Culex plpiens pallens and C. trltaenlorhynchus have been found in Liaoning, and Anopheles hyrcanus sinensis occurs in all parts of the country. Dlrofllarla immitis was demonstrated in eleven

of 60 dogs in Mukden, representing an infection rate

of 18.3 per cent (Yamane, 1938).

Sandfly or Pappatacl Fever. Kitahata (1939) reported that this disease is present in Jehol and in

the region aldng the Mukden Shanhaikuan Railway

Line. Its distribution in Manchuria is similar to

that of kala azar. Further confirmation regarding

this report has not appeared in the literature.

Relapsing Fever. Relapsing fever, caused by the

spirochete Borrella recurrentls and carried chiefly by

the body louse, is common in Manchuria. The disease

usually accompanies outbreaks of typhus fever. Cases

have been reported throughout the country. During the

first five months of 1938, 95 cases with 28 deaths

were reported among the Chinese from the whole of Manchuria. In the Dairen (Ta-lien) Isolation Hospital 81

cases were treated from April to August, 1939. Of

these, 72 (88.9 per cent) were male and only nine

(ll.l per cent) were female, and 55 of the cases were

between the ages of 21 and 40 years. Taylor (1935)

reported 21 cases of relapsing fever treated in the

Mukden Hospital from 1929 to 1933, representing 16

per 100,000 total admissions. One hundred sixty (160)

cases were reported from Fu-shun in 1915 (Shrimpton, 1936). In Ch'ang-ch'un (Hsinching) there were several

cases reported each year (Toki, 1936; Abe and Kaneko, 1938). Cases were also reported from An-tung (Hiroki

Toda, 1933) and from the city of Harbin (Kung, 1928)

Miyabe (1938) reported that in the northern part of

Heilungkiang Province there had been an unknown fever

which was prevalent every year from January to May

with considerable number of deaths. An investigation of ten cases which occurred in Al-hun (Algun)

and Hei-ho in March 1938 revealed kind of spirochete

in the blood of the patients. This organism, which

was believed to be the cause of the disease, is morphologically very similar to _B. recurrentls, and the

disease was later determined as relapsing fever.

Tick-borne Typhus Fever. This disease has been

reported in the far eastern part of the Soviet Union

since 1936. have occurred in Vladivostok

and in the areas of the Amur and Ussuri Rivers bordering upon Manchuria. It*is caused by an undetermined

Rlckettsia and carried by ticks. Dermacenter nuttal11

was found to be an important vector. Other ticks,

such as Dermacenter sllvarum, Haemaphysalis cone Inna,

and Ixodes persulcatus, were also suspected to trans- mit the disease. Some species of rodents have been

reported to be Infected with the disease and suspected

to be natural reservoir. Cases occur from April to

September with peak in May. The disease has not

been reported from Manchuria, but its occurrence in the northeastern regions is very likely.

Scrub Typhus. Scrub typhus (tsutsugamushi disease) caused by Rickettsia tsutsugamushi (or JU oriental!s) and carried by the larva of the harvest mite

Trombicula akamushl, is known to be endemic at Honshu

Island, Japan and other regions of the Far East. It

has not been known to occur in Manchuria, but due to

the widespread distribution of the disease its introduction into Manchurl is likely.
CHAPTER IX

TUBERCULOSIS

Tuberculosis is one of the most serious menaces

to public health in Manchuria. All forms of infection were observed with the pulmonary type most frequently encountered. According to Yamada and

Kawahlto (1939), the death rate due to tuberculosis

among Japanese in Manchuria during 1920-1935 was

16.2 to 21.5 per 10,000 population, with 11.2 to

16.0 per 10,000 for pulmonary tuberculosis. The

highest mortality occurred in the age groups of 15 to

24 years and 60 to 70 years. Honma (1927) stated

that the morbidity rate for pulmonary tuberculosis

among the adult Japanese in Ch'ang-ch'un was calculated (based on the record of Ch'ang-ch'un Hospital)

as 384.9 per 10,000, for Mukden 340.6, for Ta-llen

241.0, and for An-tung 225.2. From these rates it

was calculated that 600 adult Japanese in Ch'angch'un, 2,792 in Mukden, 2,064 in Ta-llen and 457 in

An-tung, totaling 5,913, suffered from tuberculosis

annually. Similarly, an estimated 1,056 Japanese

children in Manchuria contracted pulmonary tuberculosis. Based on data compiled by the Kwantung

Government, it was calculated that an annual average

of 5,582 cases of pulmonary tuberculosis existed

among the Japanese in Manchuria with morbidity

rate of 274.3 per 10,000. The disease occurs in

all seasons but appears to be more prevalent during

the first half of the year. Iwamoto (1938) reported

that out of about 40,000 patients treated in the

Hsinching (Ch'ang-ch'un) Railway Hospital over

period of three years from 1935 to 1937, 7.9 per

cent were tuberculosis cases. These cases constituted 13.0 per cent of the patients treated by the

Department of Internal Medicine. More than half

of the tuberculosis patients were 20 to 39 years

of age. Hlrose (1938) reported that 377,682 patients were attended by all the "public physicians"

in the whole territory from 1934 to 1937, of which

10,339 were tuberculous cases representing 2.74 per

cent of the total.

All forms of tuberculosis are represented in Manchuria. Okada (1940) reported that 195 cases

of genital tuberculosis (mostly Japanese) were treated in the Clinic of Dermato-Urology of the Dairen

(Ta-llen) Hospital during period of about 16 years.

Teramoto (1927) reported that 422 out of 25,031 outpatients in An-tung Hospital were cases of tuberculosis of joints, representing 1.6 per cent of the

total.

Mantoux tests have been made on various groups

of people in Manchuria and high percentage of positive reaction is indicated in all cases. lio et al

(1937) reported that 22,815 Japanese and 11,966

Chinese from 51 primary and secondary schools in Ta-lien and its adjacent villages, representing

87.83 per cent of the total student population in

this area, were tested by the Mantoux method. The

results of these facts were given in Table 14.

TABLE 14

RESULTS OF MANTOUX TESTS ON STUDENTS IN TA-LIEN AND VICINITY

Endo et al (1938) studied tuberculosis among the

school children in Ta-llen. Altogether 995 children

from seven schools were tested, and 268 (26.9 per

cent) gave positive reaction. Yamada (1938) reported the Mantoux tests on 623 Chinese students from

K'uan-tien and T'al-p'ing-shao in the southeastern

part of Liaoning Province. The percentage of positive reactions is higher among the older students

(ages 15-23) than among younger students (ages 7-14),

being 47.8 and 39.8 respectively. In Mukden, Nakamura

et al (1938) examined 294 Chinese primary school

teachers between the ages of 20 and 45 years for

tuberculin reaction during July 1937, and found 288

(98.0 per cent) to be positive. Microscopic examination of sputum was conducted for 202 of the teachers and tuberculous bacilli were found in eight

cases (3.9 per cent). Akizuki et al (1940) examined

1,453 applicants for employment at certain company

in Ta-lien city for tuberculosis and reported that

75.8 per cent were positive for tuberculin reaction,

and 9.6 per cent required further care or treatment for their infection.

Age

MALE FEMALE

No.

Tested

No.

Positive

Per Cent

Positive

No.

Tested

No.

Positive

Per Cent

Positive

Japanese 6-13 yrs. 7,666 2,521 32.89 7,320 2,375 32.45

Above 13 yrs. 4,325 2,382 55.08 3,504 1,683 48.03

Total 11,991 4,903 40.89 10,824 4,058 37.49

Chinese 6-13 yrs. 5,075 2,763 54.44 2,335 1,282 54.90

Above 13 yrs. 3,540 2,247 63.47 1,016 632 62.20 Total 8,615 5,010 58. 15 3,351 1,914 57.12
CHAPTER

ACUTE RESPIRATORY DISEASES

Pneumonia. Pneumonia (of all types) is one of

the important respiratory diseases in Manchuria and

often complicates influenza cases and other respiratory

infections, resulting in high mortality. Yamada et al

(1939) showed that the death rate due to pneumonia and

bronchitis among the Japanese population of Manchuria

during 1932-1935 was 16.5 per 10,000, while that of

all respiratory diseases was 24.6. (The death rate of

bronchitis alone was 2.7 per 10,000). Kltahara (1933)

reported 362 infant deaths from pneumonia and pneumonia

complications in the Pediatric Department, Ta-llen

Hospital in 1925-1930, representing 25.5 per cent of

the total deaths during this period. Takeyama (1938)

reported 125 cases of pneumonia treated in the Manchuria Medical College during period of five years

from 1933. Of the cases, 106 were lobar pneumonia,

16 catarrhal pneumonia and three deglutition .pneumonia.

There were about twice as many male cases as female

cases. The mortality rate of this series was about

30 per cent. The Manchoukuo Yearbpok (1941) listed

1,932 cases of pneumonia with 329 deaths as reported

by public clinics throughout Manchuria in 1935, and

2,959 cases with 225 deaths in 1937 The disease

persisted throughout the year but was more prevalent

from December to June.

Influenza. Influenza is very prevalent in Manchuria. This disease caused death rate of 1.6 per

10,000 among the Japanese in Manchuria in 1932-1935

(Yamada Kawahito, 1939) It headed the list of

diseases resulting in infant mortality at Dairen (Tallen) Hospital from 1918 to 1923 (Suzuki, 1924). An

epidemic of the disease started in Lu-shun at the end

of 1927 and extended to April 1928, involving 271

cases with 14 deaths (Mlgai, 1928). In Ch'ang-ch'un,

out of 2,754 cases of infectious diseases treated at the

Railway Hospital from April 1933 to March 1934, 1,778

were reported to be influenza cases representing 64.4

per cent of the total (Ozakl Ohtsuka, 1935) Offlcal reports (Manchoukuo Yearbook 1941) show that

throughout- the territory of Manchuria 44,096 Influenza

cases were treated at public clinics with 2,309 deaths

in 1935, and 98,718 cases with 9,751 deaths in 1937.

Although cases occurred in every month of the year,

the disease was much more prevalent during the winter

and early spring months, starting about December, with

the number of cases gradually increasing until peak

was reached in March.

Bronchitis and Pleurltis. Bronchitis and pleurltls are also common respiratory diseases in Manchuria. The death rate due to bronchitis was reported

to be 2.7 per 10,000 among the Japanese population in

Manchuria in 1932-1935, and 2.3 per 10,000 for pleuritis (Yamada et al, 1939). The incidence of pleurltls in the Japanese army in Manchuria was 17.1 to

45.5 per 1,000, according to Nlshihori (1932). Jono

and Iketanl (1937) observed 738 cases of the disease

treated in the Dairen (Ta-lien) Hospital over period

of five years, representing 9.13 per cent of the total

admissions. About 78 per cent of all the cases were

between the ages of 15 and 25 years. The case fatality

of this series was about 7.1 per cent. Tsukamoto et al (1938) noted 559 cases treated in the Takamorl

Laboratory of Internal Medicine, Manchuria Medical

College, from 1930 to 1937. Iwamoto (1938) stated

that 2.1 per cent of the patients treated at the Railway Hospital in Ch'ang-ch'un were pleurisy cases. The

disease occurred throughout the year, but the incidence

was highest during the months of April to*July and

lowest during the months of October, November and

December.
CHAPTER XI

MISCELLANEOUS ACUTE INFECTIOUS DISEASES

Diphtheria. Diphtheria is common disease in Manchuria. Yamada and Kawahlto (1939) showed that the

death rate of the disease was 0.8 per 10,000 Japanese

population in Manchuria in 1932-1935. The highest

death rate, 3.6 per 10,000, occurred among 1-4 year

old children. Official sources show that in the whole

territory there were 312 cases with 77 deaths in 1935i,

238 cases with 43 deaths in 1938, 1,179 cases with

191 deaths in 1939 (Manchoukuo Yearbook, 1941) and

1,523 cases with 201 deaths in 1940 (Manshu Nenkan, 1943). The case fatality rate ranged from 16.2 per

cent to 28.1 per cent. In Ta-lien, 1,407 cases of

diphtheria were reported during period of ten years

ending 1933. The case fatality rate was 7.16 per cent

among the Japanese and 36.36 per cent among the Chinese (Oga, 1933) The disease occurred throughout

the year but was most prevalent during the cold season

with the peak in November to February. Abe and Kaneko

(1938) reported 176 cases in Ch'ang-ch'un from 1934 to

1937. The highest incidence occurred among children

under the age of ten, and the case fatality ranged

from 2.08 per cent in 1936 to 13.95 per cent in 1935

with an average of 7.95 per cent. Kung (1928) reported eleven cases of the disease in the city of

Harbin and its vicinity in 1927. According to the

League of Nations report, there were about 100 cases

of the disease each year in the Chinese Eastern Railway Zone

Scarlet Fever. Scarlet fever is regarded as an

endemic disease in Manchuria and is one of the most

important contagious diseases of children. Epidemics

of the disease occur periodically. During an epidemic

in 1916, 209 cases with 35 deaths were reported in the

South Manchuria Railway Zone. The disease again

assumed epidemic proportions during the latter .part of

1925. Five hundred eighty two (582) cases and 66

deaths were reported along the railway area in 1925

(Ozaki, 1930). From December 1925 to January 1926,

615 cases were observed at the Dairen (Ta-lien) Clinic

(Moriwakl et al, 1927). During this epidemic the

morbidity and mortality among the Japanese in Manchuria were reported to be the highest in the world.

The epidemic subsided during 1929 to 1931, but recurred in 1932. Kawahlto (1936) gave the death rate

of scarlet fever per 10,000 Japanese population in

Manchuria as 5.1 in 1925, 7.8 in 1926, 1.9 in 1927,

1.6 in 19 28 and 1929 and 1.1 in 1930. The average

death rate in different localities of Manchuria is

summarized in Table 15.

cases and deaths due to scarlet fever for Manchuria

during the years 1935-1940.

TABLE 16

CASES OF SCARLET FEVER AND DEATHS DURING 1935-1940

In Ta-lien there was total of 1,396 reported cases

with 52 deaths in 1930-1934 (Yokoyaraa, 1937). Dick

tests were made on 472 persons at Ta-lien, 454 Japanese and 18 Chinese, of which 34.9 per cent of the

former and 5.6 per cent of the latter gave positive

reactions (Nlshihorl, 1932). Kikuta (1938) reported

28 cases of scarlet fever in Hsln-pln (Hsingchlng) in

1935. In Ch ang-ch un, 160 cases were reported in

1934, 132 cases in 1935, 103 cases in 1936 and 196

cases in 1937, representing an average morbidity rate of 1.9 per 1,000 population. The highest incidence

was in March 1935 and May 1937. The majority of the

cases were below 15 years of age, and the average case

fatality rate was 12.18 per cent (Abe and Kaneko, 1938).

Kuan (1930) claimed that in Harbin this disease was the

main cause of death during the fall and winter. More

deaths occurred among children than among adults. Kung

(1928) reported 649 cases of the disease at Harbin and

its vicinity in 1927, representing the greatest number

of infectious diseases reported. Kunltake (1939) reported that 139 cases were treated in the Pediatric

Department of the Harbin Municipal Hospital from 1936

to 1938. Nineteen (or 13.6 per cent) of the cases were

fatal. Lin and Jettmar (1925) showed that out of

1,275 Dick tests made on the Chinese population in this

city, 47.7 per cent gave positive reactions. The seasonal prevalence of the disease varies with different

years. In general, the disease in Manchuria is on the

increase from late autumn, remaining prevalent until

the following summer.

Smallpox. Smallpox is still an Important communicable disease in Manchuria. The disease was epidemic about every five years and was pandemic in 1933-

1934. The epidemic started in October and extended

to the end of May in the following year. At Ta-lien

alone 571 cases were reported during this epidemic.

The case fatality rate was 10.2 per cent among the

Japanese and 17.0 per cent among the Chinese (Yamatsuta, 1934). The disease was epidemic in northern Korea in

1938 with more than 1,000 reported cases, spreading

northward into Manchuria. In Mukden the number of

cases greatly increased in December 1938 and began to

decrease in July 1939. About 100 cases were reported

in the city in 1939, 55 of which occurred in January,

The case fatality rate was 8.7 per cent (Mochizukl

and Koreeda, 1940). Kawahlto (1936) reported that

the death rate among the Japanese population in Manchuria due to smallpox was 2.5 per 10,000 in 1925 and

0.1 in 1930. Official sources (Manchoukuo Yearbook

1941; Manshu Nenkan, 1943) listed the following data

concerning the prevalence of the disease during recent

years throughout Manchuria (Table 17):

TABLE 15

DEATH RATE DUE TO SCARLET FEVER AMONG THE JAPANESE

IN MANCHURIA FROM 1925 TO 1930

Table 16 was compiled from the official reports (Manchoukuo Yearbook, 1941 and Manshfl Nenkan, 1943) of

Year No. Cases No. Deaths Fatality Rate

1935 1,844 314 17.0

1936 1,102 217 19.7 1937 1,442 269 18.5 1938 1,947 244 12.5

1939 1,303 248 18.0

1940 1,650 167 10.1

Local ty Death Rate (per 10,000)

Port Arthur 2.7

Ta-li en 2.4

An-tung 6.0

Ylng-kou 4.9

An-shan 1.4

LIao-yang 6.

Mukden 2.9

Fu-shun 2.

Ch'ang-ch'un 6.2
22

public clinics in Manchuria in 1935, and 21,457 cases

with 1,672 deaths in 1937. Whooping cough cases are

often complicated with pneumonia. The disease generally begins in early summer and reaches its maximum in August.

Mumps. Mumps is probably widespread in Manchuria, although available statistics are meagre.

Rung (1928) reported 69 cases in the city of Harbin

and its vicinity in 1927. The Manchoukuo Yearbook

(1941) listed 4,416 cases with 219 deaths recorded at

public clinics in 1935 and 3,595 cases with 167 deaths

in 1937.

Erythema Infectlosum. Erythema infectlosum (the

fifth disease) has been reported from Manchuria. The

disease was epidemic in Ta-lien from the end of December 1926 to July 1927 when 164 cases were observed

at the Dairen General Hospital (Hoshi, 1927). Kataoka

reported 38 cases from Fu-shun in 1922, Fuwa 18 cases

from An-shan in 1930, and Akazawa 20 cases from Mukden

in 1931 (Sano et al, 1934). Sixty six (66) cases

occurred at Ta-lien city from November 1932 to April

1933. Sixty four (64) of the cases were children

under 13 years of age, and two were older than 15

years (Makl et al, 1933). The disease was prevalent

during the cold season, especially from December to

February. Incubation periods varied from six to 19

days, and in most cases ranged from eleven to 14 days.

Cerebrospinal Meningitis. Cerebrospinal meningitis is rather common disease in Manchuria. Kawahito

(1936) reported death rate of 0.7 per 10,000 Japanese population in Manchuria in 1926, and 1.4 in

1927. Table 18 is compiled from official sources (Manchoukuo Yearbook, 1941; ManshCi Nenkan, 1943) listing the cases of cerebrospinal menirtgitis and deaths

reported from Manchuria during the years 1935-1940.

TABLE 17

SMALLPOX IN MANCHURIA IN 1935-1940

program of country-wide vaccination was carried on

since 1934. Within period of five years ending 1938,

total of 13,082,783 persons were vaccinated, representing about 34.2 per cent of the entire population

(Manshu Nenkan, 1940).

Chlckenpox. Chickenpox is common and widespread.

Ozaki and Ohtsuka (1935) reported 35 cases treated at

the Ch ang*-ch'un Railway Hospital from April 1933 to

March 1934. Rung (1928) listed 42 cases observed in

Harbin and its vicinity in 1927. The report of the

League of Nations showed 1,390 cases of the disease

in the Chinese Eastern Railway Zone from 1927 to 1934.

The Manchoukuo Yearbook (1941) listed 2,681 cases

treated by public clinics throughout Manchuria in

1935, and 3,425 cases in 1937. The case fatality

rate was reported to be 18.2 to 19.8 per cent, which

is much higher than would be expected.

Measl es. Measles is an appreciable cause of

mortality in Manchuria and ranks as the fourth most

important disease among infants. Yamada and Kawahito

(1939) reported that the death rate due to this disease was 7.2 per 10,000 Japanese population in Manchuria during the period 1920-1925 and 2.5 during

1932-1935. The incidence begins about February and

continues into August, becoming most prevalent during

the months of April to June. Morlta (1936) showed

that 4,749 cases of measles among children were treated

at the Dairen (Ta-lien) Hospital during period of

20 years (1912-1931). The case fatality rate was

eleven per cent among the out-patients, and 23 per

cent among the in-patients. Shlma (1924) reported

that measles epidemic broke out in Fu-shun towards

the end of 1923, causing 303 cases with 31 deaths.

The most frequent complications in about 20 per cent

of the cases were pneumonia and bronchiolitis. The

Manchoukuo Yearbook (1941) listed 5,540 cases with

1,269 deaths at public clinics in Manchuria in 1935,

and 9,665 cases with 1,663 deaths in 1937, with case

fatality rate of 23.4 and 17.2 per cent respectively.

German Measles (rubella). This disease is not

uncommon in Manchuria and occasionally assumes epidemic proportions. It was epidemic in Ta-lien in 1923

following an epidemic of ordinary measles during the

preceding months of November, December and January.

The epidemic started suddenly in March after the other

epidemic had subsided. Altogether 85 cases were observed in the Children's Clinic, Dairen (Ta-lien)

Hospital during the year, of which 74 occurred from

March to May (Suzuki, 1923). Ninety four cases were

reported at the Railway Hospital at Ch'ang-ch'ur from

April 1933 to March 1934 (Ozaki et al, 1935). The

disease was most prevalent among children under five

years of age.

Whooping Cough. Whooping cough occurs throughout

Manchuria. Yamada et al (1939) reported that this

disease caused 1.9 deaths for every 10,000 Japanese in

Manchuria from 1932 to 1935. The Manchoukuo Yearbook

(1941) reported 11,505 cases with 1,034 deaths at the

TABLE 18

CEREBROSPINAL MENINGITIS IN MANCHURIA FROM 1935 TO 1940

The case fatality rate ranged from 8.2 per cent in

1935 to 37.3 per cent In 1940. The disease occurs

principally during the first six months of the year

and especially from March to June. Kao (1936) noted

that during small epidemic o‘f the disease in Mukden

in 1933, 78 per cent of the cases were under 15 yeaTs

of age and 58 per cent were under five years of age.

The fatality rate was 40 per cent.

Poliomyelitis. Poliomyelitis has been reported

from Manchuria but detailed information concerning its

incidence and distribution was not available. Yamada

and Kawahito (1939) reported an average death rate of

0.05 per 10,000 among the Japanese population in Manchuria from 1932 to 1935, The death rate was much

higher among children between the ages of one and 14

years than among the older persons, being 0.14 and

0.01 per 10,000 respectively. More than twice as many

females died from the disease as males.

Epidemic Encephalitis (Encephalitis A, Encephalitis letharglca). Encephalitis has been reported in

Manchuria and seems to be widespread, Yamada and

Kawahito (1939) gave the death rate due to this disease as 0.03 per 10,000 Japanese, population in Manchuria in 1932-1935. The prevalence of the disease in

Year No. Cases No. Deaths Fatality Rate

1935 1,629 341 20.9

1936 1,749 441 25.1

1937 3,064 452 14.8

1938 1,345 171 12.7

1939 1,005 148 14.8 1940 1,490 241 16.2

Year No. Cases No. Deaths Fatality Rate

1935 426 35 8.2

1936 185 40 21.6

1937 103 20 19.4

1938 193 32 16.

1939 191 68 35.

1940 359 134 37.
Ta-lien is better known* In this city, as in Japan,

the disease occurred in 1920 and 1924 with ten cases

reported for each year. From 1919 to 1926 total of

31 cases were reported, 24 of which were between the

ages of 21 and 40 years (Ochlai, 1931). The disease

in Ta-lien, unlike in other areas, seldom occurred in

summer but was most frequent during the cold months

from September to March. Yokoyama (1937) listed two

additional cases in the city, one each in 1931 and

1933. According to the report of the League of Nations, six cases were reported in the South Manchuria

Railway Zone in 1929, and 74 cases with 31 deaths in

the Chinese Eastern Railway Zone from 1927 to 1933,

the average case fatality being about 42 per cent.

Undulant Fever. Undulant fever seems to be widespread in the western part of Manchuria where cattle

and goats are raised in great numbers. During the

spring of 1936, an outbreak of the disease was first

reported from goat farm in the neighborhood of Linhsl in the northwestern part of Jehol Province. Twenty one (21) cases were reported. Brucella melitensls

was cultured from the blood of one patient. Since all

of the patients reported that raw milk or raw dairy

products had not been eaten, it was assumed that the

disease was contracted through contact with infected

goats. It was reported that infectious abortion was

prevalent among the goats of that farm from January to

March (Saikl et al, 1939). At one cattle farm in the

same area 132 out of 292 cattle, and nine (26 per cent)

of 34 employees were found to be infected. On cattle farm in Ta-erh-han in northern Liaoning Province,

eleven of 62 cattle were found infected, and B_. abortus strain was cultured from one animal. Four of 59

employees at this farm were infected with the disease.

Both animal and human infections were found at Palcheng-tzu and 0u-ll in northern Liaoning. In Mukden,

Taylor (1935) reported one human case of undulant

fever treated at the Mukden Hospital in 1930. Saiki

reported seven cases of the disease during period of

ten months. One of these was laboratory infection,

four contracted the disease from infected cattle, and

in the remaining two cases the cause of infection was

uncertain (Saikl et al, 1939). No animal infections

were reported from Mukden.

Well's Disease (Spirochetal Jaundice). Epidemics

of the disease have been reported from north China,

such as in the provinces of Hopei and Shantung which

are adjacent to Manchuria (Maxwell, 1929). The epidemiology of this disease in Manchuria is uncertain.

Yamada and Kawahlto (1939) reported death rate of

0.01 per 10,000 Japanese population in Manchuria during

the period 1932-1935 due to this disease. Information

regarding other leptospiroses in Manchuria was not

available.

Erysipelas. Erysipelas, caused by Streptococcus

eryslpelatis, seems to be common in Manchuria. Yamada

and Kawahlto (1939) reported death rate of 1.3 per

10,000 population among the Japanese in Manchuria from

1932 to 1935. The incidence was much higher among

Infants, with death rate of 17.9 per 10,000 among

children under one year of age. Ozaki and Ohtsuka

(1935) reported 41 cases of the disease treated at the

Ch'ang-ch'un Railway Hospital from April 1933 to March

1934. Kung (1928) listed 36 cases in Harbin and its

vicinity in 1927. The disease occurs throughout the

year but it is more prevalent in the cold season from

November to April.

Trachoma. Trachoma is very common disease in

Manchuria. It is believed that the disease occurs in

about one half to two thirds of the Manchurian population. Wang (1935) examined 65,800 Chinese in Manchuria and found 66.02 per cent of them infected. The

infection rate was higher among women (68.17 per cent)

than among men. Kurihara (1939) examined 476 school

children in Chln-hsien and found that 240 (or 50.4 per

cent) were positive for the disease. Morbidity was

found to increase markedly in children with an advance

in age. Taylor (1935) reported 8,175 cases treated in

the Mukden College Hospital from 1929 to 1933, representing more than six per cent of the total admission. Public clinics in Manchuria recorded 13,538

cases of trachoma in 1935, and 31,028 cases in 1937 (Manchoukuo Yearbook, 1941).

Tetanus. This is fairly common infection in

Manchuria with death rate of 0.05 per 10,000 among

the Japanese population (Yamada et al, 1939). Ommyoji

and Chu (1929) demonstrated tetanus bacilli in three

of 240 soil samples collected in Mukden, as well as

from the feces of monkey, pig and goat. The

Manchoukuo Yearbook (1941) listed 2,597 cases with

198 deaths in 1935, and 1,782 cases with 304 deaths in

1937 as reported from public clinics in Manchuria.

The case fatality rate was 7.8 per cent for 1935 and

17.1 per cent for 1937.

Rab1es. Rabies is rather common in Manchuria.

Nine hundred sixty six (966) persons were bitten by

rabid dogs in the Kwantung Leased Territory and the

South Manchurian Railway Zone during 1925. The number of persons bitten by rabid dogs in 1926 was 742,

of which 229 were reported from the city of Ta-lien

(Nishikawa, 1928). In 1935, 410 rabid cases were

treated at public clinics, and 391 cases in 1937. Of

these, 86 cases in 1935 and 59 cases in 1937 were

fatal (Manchoukuo Yearbook, 1941)

Anthrax. Anthrax is endemic in Manchuria and has

caused the death of several thousand animals annually.

The disease is especially common in the northern and

western parts of the country where cattle, horses and

goats are being raised extensively. Human infections

were caused either by direct contact with living animals or by handling hides and wool. Eleven human

cases were reported from Kan-nan-hsien, Heilungkiang

Province from 1934 to 1935 (Olshi et al, 1938). Imamura (1937) reported more than 50 human cases among

railroad laborers of the Pei-Ll Railway Line. The

report of the League of Nations listed 18 cases in

the Chinese Eastern Railway Zone from 1927 to 1934.

One fatal case occurred in 1932 and two in 1933.

G1anders. Glanders due to Actlnobaclllus mallei

is primarily disease of horses and is communicable

to man. The disease is reported to be common among

horses in Manchuria. Report on human infection is

rather meagre. Mochlta first reported human infection with this disease in south Manchuria in 1931.

Mori (1937) studied four cases treated in the Hlrayama

Surgical Laboratory of the Manchuria Medical College.

Two of the patients were veterinary surgeons and the

other two contracted the disease in the laboratory.

Two of the four cases were fatal. In view of the

prevalence of the disease among horses and the lack

of medical care in rural districts, human infection

with glanders is possibly much more prevalent in Manchuria than the available data would indicate.
CHAPTER XII

VENEREAL DISEASES

Venereal diseases are prevalent in Manchuria

and constitute one of the most Important groups of

Infectious diseases. Official reports show that of

157,401 prostitutes examined, 4,281 were Infected

with syphilis, 17,570 with gonorrhea, and 3,387 with

chancroid (ManshG Nenkan, 1937). The Manchoukuo

Yearbook (1941) listed 15,504 cases of syphilis and

15,815 cases of gonorrheal diseases treated by the

public clinics in Manchuria in 1935, and 30,293 cases

of syphilis and 27,631 cases of gonorrhea in 1937

About 30 per cent of the Mongolian people examined

were Infected with venereal diseases (Manshu Nenkan,

1943). The five plague prevention hospitals in

north Manchuria recorded an average of 6.4 per cent

syphilis admissions while in Neu-chuang, southern

Manchuria, 13.5 per cent syphilis and 14.8 per cent

gonorrhea Infections were reported (Wu, 1927). Mateuda(1929) reported the results of serodl agnosis

for syphilis of 1,460 women who were engaged in

certain occupations in Ta-llen from 1926 to 1929.

Seven hundred sixty three (763) of these were positive for the reaction, representing rate of 52.26

per cent infection. Of 48,420 patients treated at

the Manchuria Medical College from 1914 to 1933,

2,445 (5.05 per cent) were cases of chancre and

lymphadenitis (Sakural et al, 1934). Of 1,071 Chinese school children tested for congenital syphilis,

18 (1.68 per cent) gave positive Wasserman reaction

(Yamaglshi and Kano, 1938). Yamane (1938) examined

2,325 Manchurian prostitutes and reported 5.3 per

cent positive for syphilis, 4.2 per cent positive

for chancroid, and 7.2 per cent positive for gonorrhea.
CHAPTER XIII

SKIN DISEASES

Due to Insanitary conditions, skin diseases

are very prevalent throughout Manchuria. The Manchoukuo Yearbook (1941) reported that of 185,843

patients treated by "public physicians" In 1937

15,759 were cases of skin disease and adnexa. The

"circulating clinic" sponsored by the Manchuria

Medical College, which contacted people in areas

where medical facilities are not available, reported

the prevalence of skin diseases throughout the country. Nilzawa (1936) showed that ten per cent of

all patients at 26 localities along two railway

lines In central Liaoning Province were Infected

with skin diseases. Murayama (1934) reported that

of 5,322 at en treated during ten missions to western Manchuria and Inner Mongolia, 3,527 (66.3

per cent) were cases of skin diseases. However,

statistical data concerning this group of diseases

are scarce and no accurate statement can be made

regarding their relative prevalence. The following paragrsphs Include only diseases of Importance

or those peculiar to Manchuria.

Dermatomycoses. Trichophytoses are common In Manchuria. Kitamura and Teral (1933) reported that

170 cases of trichophytosis were treated In the Department of Dermatology, .Manchuria Medical College,

from December 1931 to February 1933. One hundred

fifty five (155) cultures were made of these cases

of which 80 were positive. Among 3,500 Korean refugees in the Mukden region, 130 cases of trichophytosis were found from September to November 1932.

In Harbin 170 cases of trichophytosis were detected

among 4,102 Manchurian refugees from January to January 9, 1933. Of 540 school children in Harbin,

50 were infected with trichophytosis. Of 187 cases

of dermatomycosis treated in different localities

of north Manchuria, 123 suffered from trichophytosis, 42 from zoster facialis and 22 from favus.

Nilzawa (1936) reported that 80 of 250 patients with

skin diseases suffered from mycosis and 67 of them

from trichophytosis. This author (1938) further

reported 163 cases of dermatomycosis among the Japanese troops stationed in Liao-yang and Tieh-ling

over period of 25 months from April 1934 to May

1936, all of which were cases of trichophytosis.

Terai (1934) again reported 147 cases of trichophytosis treated in the Laboratory of Dermatology

of the Manchuria Medical College from February 1933

to March 1934. The total number of patients during

this period was 3,374 and trichophytosis cases represented 4.35 per cent. Cultures were made of 107

cases with 60 of them positive. The author obtained

231 positive cultures including 143 from patients

in the Manchuria Medical College, eight from Korean

refugees in southern Liaoning Province, 21 from

Manchurian refugees in Harbin and 59 from patients

of several localities in northern Manchuria. The

types of disease and the species of fungi for 231

cases are tabulated in Table 19.

TABLE 19

TRICHOPHYTOSES AND THEIR CAUSATIVE ORGANISMS IN MANCHURIA

The climate of Manchuria Is favorable for the growth

of Mlcrosporon 1aponlcum, Sabouraudltes ruber and S.

Interdlgltalls and these fungi are responsible for

the majority of the trichophytosis cases.

Teral (1935) stated that tinea Imbricate is

very rare in Manchuria and only three cases had been

reported up to that time. But Taylor (1935) listed

20 cases of the infection treated at the Mukden

Hospital from 1929 to 1933, representing 16 per

100,000 admissions.

MicrosporonBodinia

viol a- Bodinia

Sabouraudites S. inter- S. aster- Tr.

aponlcum ceum glabrum ruber digitalis oides pedis Total

Trichophytosis

superflcialis

caplllitli 56 60

Kerlon celsi

T. maculoveslculosa 17 22

T. eczematosa

marginata 23 24

T. pompholyciformls 29 54 84

T. interdlgltalis 17 24

T. onychomycosis 12 14

Eczema mycoticum

Total 59 98 63 231
Hongkong foot, or tinea pedis, is very common

in Manchuria. Taylor (1935) reported 387 cases at

Mukden Hospital during period of five years, representing 38 per 10,000 of the total patients.

Favus infection is also common in Manchuria.

Terai (1934) showed that 22 out of 187 cases of

skin diseases were Infections of favus. Nllzawa

(1936) reported that twelve out of 58 mycosis cases

were favus. The latter author identified the pathogen

of these particular cases as Grubyella schonlelnli

var mongollca Ota and Hashimoto,

Pityriasis has also been reported from Manchuria.

Yajima (1935) observed case of pityriasis rubra

pilaris treated at the Manchuria Medical College

Hospital. The patient was Japanese girl, 19 years

of age. Japanese male case of pityriasis clrclnata

was reported from the same hospital by Mori in 1937.

The author stated that one Chinese case and two Korean

cases of the disease had been reported in the literature. Takahara (1938) studied 15 cases of pityriasis

rotunda treated in the Dermatological Clinic, Dairen

(Ta-llen) Hospital, during period of 15 years, representing 0.05 to 0.2 per cent of the total admissions of the department. Twelve cases occurred from

1931 to 1937.

Endemic dermatitis. This disease occurs in the

wet low land along the Liao and Sunghua Rivers and

their tributaries. The prevalent season Is from

July to the end of August. It affects only the workers in the rice fields. Those portions of the body

frequently submerged in water, especially the legs

and hands, become reddish with an Itching vesicular

rash. Susceptibility to the disease differs with

individuals, but initial symptoms usually appear

from two to 20 days after the workers are exposed

to water in the field. The etiology of the disease

is still obscure, and such organisms as the fluke,

hookworm and bacteria, and chemical substances in

the water have been suspected. An aquatic mite belonging to the family Tyroglyphldae was believed

by many authors to be the cause of the dermatitis

(Kubo and Baba, 1938; Kubo, Baba and Goml, 1938;

Kubo, Hlyeda and Takemore, 1939; Yasui and Himura,

1939).

Leprosy. Lepers have been seen in various parts

of Manchuria for many years. Yu and Taylor (1931)

noted that about 0.1 to 0.29 per cent of the total

patients treated in various skin clinics in Manchuria were infected with leprosy. Apparently none

of these cases were indiglnous to Manchuria. These

authors maintained the opinion that the disease

was due to recent but not to earlier migrations from

inner China. Yu (1935) again reported 23 cases

seen in the Mukden College Hospital since the 1931

report. Three of these cases were natives of Manchuria and had never been out of the country.
CHAPTER XIV

SPECIAL ENDEMIC DISEASES

Epidemic Hemorrhagic Fever. Epidemic hemorrhagic

fever* was first encountered in the Japanese array during the invasion of Manchuria- It Is probably an old

disease in Manchuria but Its menace has not been recognized until recent years by Japanese medical personnel. special commission was appointed and control regulations were drawn up by Japanese army authority for the prevention of the disease- However,

this disease Is still not well known and medical literature Is not available.

The disease is known to occur In northern Manchuria, east of Greater Hslng-an Mountain (Ta-hsingan-ling) and north of Ch' ang-pai-shan. Information

as to Its Incidence is meagre. relative incidence

of 30 per cent and true Incidence of one per cent

were reported by Japanese army hospital at Sun-wu

in 1942. In Hu-lin on the eastern border of Kirin

Province as many as 40 cases were seen during one

month In Japanese regiment. During an epidemic of

the disease In Hel-ho, northern Manchuria, In 1941,

ten per cent of the personnel In the Japanese army

were affected.

The case fatality rate was variably reported

from 13 to 36 per cent. Death rarely occurs suddenly

within one or two days. Epidemics of the disease

generally occur during the change of season, in early

April and November In Hel-ho and the Amur region and

in April and May In areas further south.

The etiology and transmission of the disease have

not yet been determined. Some Japanese workers believe

that It Is rickettsial disease and is spread by

ticks (Dermacentor nuttalll) parasitic on rodents, and

that man contracts the Infection through handling hay

and other material. Others believe that It Is transmitted by fleas, lice or other blood-sucking Insects,

and still others consider It to be caused by flltrable virus. Positive reaction of Well-Fellx test of

the blood has been reported but no detail of this

study was available. The incubation period of the

disease is said to be from one to three weeks. The

onset Is sudden with chills, fever, headache, sore

joints, nausea and vomiting. The temperature rises

sharply and may reach 38° to 40° C. It Is characterized by hemorrhagic areas on the skin and mucous

membranes, more marked on the body than on the extremities. Such areas, sometimes In the form of

petechial rash, begin to appear on the third to fifth

day, starting on the neck, shoulder and axilla and

then spreading to other parts of the body. At times,

hemorrhages occuif at the gum line, along with eplstaxls

and hemoptysis- The conjunctiva becomes congested.

There is tendency to constipation, but sometimes

diarrhea occurs and stools may be bloody. If there

are extensive hemorrhages In the internal organs such

as the liver, kidney, heart and brain, death is inevitable. The chief symptoms of the disease may be

summarized as follows:

In the late fall of 1935, number of cases of the

disease were reported from this district and surrounding counties with sudden onset and high fatality.

At first It was suspected to be plague but later

proved otherwise. Headache and dizziness was noted

at the onset, then nausea, vomiting and acute weakening

of the heart, and finally death within few days.

The heart muscles were principally Involved. Autopsies demonstrated substantial change in the heart

with Infiltration of the cells and also scar-formation

Preventive measures, which are reported to be

practiced by the Japanese army In Manchuria, consist

of removing and burning the vegetation In the barrack

area, exterminating rodents, which are the primary

hosts of the ticks, and segregating patients and disinfecting their clothes and rooms.

K'oshan Disease. The disease was named "K'oshan

disease" or "K'oshan heart disease" since It was first

reported from K'o-shan-hsien In Hallung-klang Province.

 The Japanese name of the disease is ryukosel-shukketsu-netsu. Other terms encountered were Songo fever, Ta-ylnshan disease, Korinnetsu, epidemic spotted fever, acute spotted fever, and eruptive typhus.

Day of Illness 10 11 12 13

Flushing ++ ++ ++ ++

Congestion of

Conjunctiva ++ ++ ++ ++ ++ ++

Reddening of

Pharynx ++ ++ +++ ++ ++

Hemorrhages, Skin

and Uucous membranes ++ ++ ++

Nausea ++ ++ ++ ++ ++

Insomnia ++ ++ ++ ++ ++ ++

Albumin in

Urine ++ ++ ++

Fever +++ +++ +++ +++ +++ +++ +++ ++

Note: The circles Indicate clots of fibrin.
28

as In the chronic heart muscle disease. Kubo (1938)

divided the disease Into three types according to Its

symptoms: acute type, "consumption" type, and "no disease" type. It Is the acute type of the disease

which has attracted the attention of the local authorities. total of 183 cases were reported during

the months of November and December 1935. More cases

were reported In later years. Up to the end of 1938

more than 450 cases had been reported, all among the

the native population. The case fatality Is nearly

100 per cent and death generally occurs within few

days after the onset. More than 80 per cent of the

cases were women of middle age. This type occurs

only In the winter season from October to March. The

disease was principally reported from Heilungkiang Province but cases have also been reported from Jehol

and eastern Liaoning Province (Hara, 1939)

Various theories have been advanced regarding

the cause of the condition without conclusive result

(Abe, 1937, Shoyama et al, 1939). It Is believed by

many workers that the disease Is non-communicable and

that chronic CO poisoning with an acute final stage Is

probably the cause of this disease (Kubo, 1938; Kara,

1939). This assumption is based on thfe following

facts: (1) the anatomical findings of the disease

were very similar to those resulting from CO poisoning,

(2) the situation In the dwellings of the endemic area

Is apt to cause CO poisoning, and (3) the symptoms of

the disease are similar to those demonstrated experimentally In animals hy CO poisoning. However,

others (Hiyeda, 1939) considered that S102 had more

to do with the disease. Two to five times the ordinary

amount of S102 was found in the lung, liver and heart

of the persons who died from K'oshan disease.

Kashln-Beck*s Disease. The disease Is endemic

in northern Korea and Transbalkal. In Manchuria It Is

widely distributed In the northern part and has been

reported from Kirin and various parts of Heilungkiang

Province. The disease occurs mostly In the mountainous

areas, with children more susceptible than adults.

The cause of the disease Is not well known. A. close

relationship between the disease and food was observed,

and chronic excessive absorption of inorganic iron

was assumed to be the cause. Vegetables and grains

were Investigated, and those from the endemic area

were found to have higher Iron content (Tanabe

et al, 1939)
CHAPTER XV

HELMINTHIASES

NEMATODES

Ascarlasi s. In Manchuria, as in other parts

of China, infection with As arl umb rl col des is

prevalent and widespread. The average infection

rate is reported to be 74 per cent. It is generally

more prevalent in southern than in northern cities.

In Ta-llen, 1,919 Japanese were examined and 47.2

per cent were found to harbor As cari lumbricoides

(Shimizu, et al, 1925). Okamoto (1930) examined

the feces of 1,026 school children and found 400 (39 per cent) Infected with the round worm. Salto

(1935) reported an average infection rate of 69.6

per cent among 326 prisoners examined in the city.

The infestation was reported as high as 90 per cent

among the Chinese. Hlyeda (1934) expressed the

opinion that more than 80 per cent of the residents in Ta-lien and its vicinity are infested with

Ascarls. Kitabatake (1935) found that of 62 persons in village near Chin-chou, 28 (45.1 per cent)

were infested with the round worm, and out of 350 persons on farm near Ylng-kou 179 (51.1 per cent)

were Infested. In Lu-shun (Port Arthur) 87.3 per

cent of 954 Chinese children examined were found to

harbor the worm (Hlyeda, 1932). In Mukden, Shimizu

et al (1925) examined the feces of 650 persons (including school children and factory workers), and

found 429 (66 per cent) with ascaris infection.

This, if corrected at the rate of six examinations,

would be about 90 per cent. Ishlkawa (1929) found

49 per cent of the Chinese in-patients examined three

times in the Manchurl an Medical Hospital to harbor

the worms, the infestation rate being 54 per cent

if corrected to six examinations. Suml and Kawasaki

(1932) obtained 82 per cent of ascaris infection

among school children by six successive examinations

of their feces. Hlyeda (1934) reported an infection

rate of 62 per cent. In Fu-shun, mining center

near Mukden, survey was made by Ryo (1936) of

10,293 persons of various groups and an average infestation rate of 84.6 per cent was obtained. In

the northern parts of Manchuria, ascari*s infestation

was much lighter. Lin and Wu (1927) found that only

111 (19.47 per cent) of 570 persons examined were

Infested with the nematode. The ascaris infection

among the Mongolian people seems fairly heavy. Ishikawa (1929) reported the examination of 234 natives

of Eastern Mongolia with 60.3 per cent positive for

the infection.

Ankylostomlasls. Hookworm infection is found

in most parts of Manchuria but its distribution varies

with latitude. Like ascarlasis, the infestation is

generally heavier in the south than in the north. The

following infestation rates have been reported in

various localities: 10.7 to 38 per cent in Ta-lien

(Salto, 1935; Hlyeda, 1932; Morlkawa and Fukuda,

(1937); 19.6 per cent in Port Arthur (Hlyeda, 1932);

six per cent in Ylng-kou (Kitabatake, 1935); 6.3 per

cent in Mukden (Hlyeda, 1934) 42.7 per cent in Fushun (Ryo, 1936); three per cent in Ch'ang-ch'un

(Hlyeda, 1934); 3.3 per cent in Harbin (Lin and Wu,

1927). It should be noted that the infestation of

hookworm is particularly heavy among the inhabitants

of Fli-shun. Ryo (1936) expressed the opinion that

the main route of Infection of this worm in Fu-shun

seems to be cutaneous, while Hlyeda (1934) believed

that most of the hookworm infection in Manchuria takes

place orally since the people are seldom barefooted.

According to Ryo, Necato americanus is rare in Fushun and the rate of Infection compared with that of

Ankylo stoma duodenale is approximately seven to 40.

Hlyeda (1934), however, claimed that the Incidence

of the two species Is about the same.

Trichuriasis. Whipworm Infection is common

and widespread in Manchuria. The infestation rate seems also to he heavier in the south than in the

north. In Ta-lien, the rate of infection was reported as high as 80 per cent (Hlyeda, 1934) with

an average of 25-50 per cent (Saito, 1935; Morlkawa

et al, 1937); in Lu-shun 66.5 per cent (Hlyeda, 1932);

in Mukden ten to 35 per cent (Shimizu et al, 1925;

Ishlkawa, 1929); in Harbin about five per cent (Lin

and Wu, 1927).

Trlchinosls. Human cases of trichinosis have

not been reported from Manchuria. But the parasite,

Trichinella spiralis, has been found in five out of

19 dogs in Liao-yang, and in five out of 150 dogs in

Mukden (Yugawa, 1934; Yamane, 1938). Ch'in (1937)

reported an infestation of cat at Mukden, and

Yugawa (1934) reported its occurrence in swine in Harbin and vicinity.

Other nematodlases. Other nematodes which have

infected man in Manchuria are Enteroblus vermlcularis

which is widespread and affects great number of

Chinese children, and Tri chostrongylus orientalis of

which an Infestation rate of three per cent was found

among the Japanese in Mukden and rate of 0.8 per

cent as reported from Harbin (Lin and Wu, 1927).

TREMAT0DES

Infestation by this group of helminths in Manchuria is light as compared with other parts of China,

and fewer species are involved. Human infection has

been reported with the following species: Clonorchls

sinensis. Metagonlmus yokogawai, Paragonlmus westermani. The liver fluke, Clonorchls sinensis, is widespread. Human cases have been reported from Ta-llen

(Morlkawa et al, 1937; Saito, 1935) Mukden (Ishlkawa,

1929), Liao-yang (Okabe, 1939) and Harbin (Lin and Wu, 1927). It is interesting to note that in Ta-lien,

more than 20 cases were reported among the "foreigners" (probably mostly Russians) each year from 1930

to 1933 against only one Chinese case each in 1930

and 1931 and one Japanese case in 1931 (Morlkawa

et al, 1937). The parasite was also found in five

of 60 dogs examined in Mukden (Yamane, 1938) Miyanaga(1939) examined 15 species of fresh-water fish

in the Mukden area and found six of them to be infected with cysts of C_, sinensis. The species of

fish Infected were ar as sius vulgaris, Hemlculter

cleupoldes, Pseudogoblo rivularis, Leucogoblo herzenteinl. Pseudorasbora parva, and Rhodeus notatus,

the last three species being especially heavily infected with 125 to 188 cysts per 100 gram of meat.

Asoda reported that Ophlcephalus argus collected in

the Sungari River near Harbin was infected with

Clonorchls cysts (Okabe, 1939) The intestinal fluke,

Metagonlmus yokogawai, is fairly common, especially

among the Japanese population. Fukuda and Morlkawa

(1936) reported 38 cases of the infection out of 5,077

patients examined in Ta-lien in 1935-1936, all but

■one of which were Japanese. The authors assumed the

cases were not indlginous since the snail hosts of

the trematode have not been found in Manchuria.

In Fu-shun, 108 cases were reported in 1936 (Okabe,
30

Manchuria, except three cases of the former among

305 Japanese in Manchuria. However, these cases

were not considered as being contracted locally

(Matsuo, 1935).

CESTODES

Tapeworm infections are not uncommon in Manchuria, especially among the Mongolian natives living

in the northern part of the country. According to

Kwantung Government report there were 399 cases of

taeniasls in Ta-lien from 1930 to 1932. Most of the

cases were Japanese (Morlkawa et al, 1937). Both

Taenia sollum and T_. saglnata have been reported from

Ta-llen (Okamoto, 1930; Morlkawa et al, 1937) and

Mukden (Shimizu et al, 1925; Ishikawa, 1929). The

beef tapeworm seems to be more common than the pork

tape worm', although definite Information is not available. Cystlcercus cellulosae hominis is often found

in Manchuria. Four cases were observed in Mukden; two

were Chinese (Kato, 1932) one Korean (Terai, 1933)

and one Japanese (Matsuura, 1935). On farm near

Ying-kou, out of 350 persons examined 23 were found

to harbor tapeworms, Including 16 cases of Hymenolepis

nana (Kltabatake, 1935). few cases of this dwarf

tapeworm have also been reported from Ta—lien (Morlkawa

et al, 1937) and Mukden (Ishikawa, 1929). Lin and

Wu (1927) reported three cases of Infestation with

Bothrlocenhalus 1atus of 220 persons examined at

Harbin. One case of Dlnvlldlum canlnum was found

among 650 persons examined at Mukden (Shimizu et al,

1925)

1939). Cases have also been reported from Mukden

(Ishikawa, 1929) and Harbin (Lin and Wu, 1927)

Okabe (1939) reported that the fish, Culter erythroeterus Basilewsky, Slnlperca chuatsi (Basll^,

Parabramls peklnensls (BasiL) Pseudorasbora parva

(T, et S) Ophlcephalus argus Cantor and Hemlbarbus

maculatus Sleeker, collected from Ha-ta-ho, Chlamu-ssu, Yung-f eng-ch en and Harbin were infected

with the cysts of M_, yokogawal. Eggs of the parasite have been found on pickled vegetables sold in

Ta-llen (Morikawa et al, 1937; Fukuda and Akl, 1937).

Infections with the lung fluke, Paraeonlmus westermanl, were reported from Ta-llen, Mukden and Harbin.

In Ta-llen, the Kwantung Government reported three

cases each in 1930 and 1931, and 125 cases in 1932.

Of these, 124 cases were Japanese (Morikawa et al,

1937). Leo (1938) observed three cases at the Mukden Medical College Hospital and claimed that one

case seemed to have contracted the infection in Mukden and the other two in south China. Lin and Wu

(1927) reported single case of 350 persons examined

in Harbin. Abe and Asada (1938) collected the snail

host of P. western)anl from Kirin and southern Liaoning

province. The snail was identified as Cambaroldes

daurl cus. The crab host, Erl ochel .1 aponicus and

probably also E_. sinensis were reported from Manchuria (Kobayashl, 1934). The Oriental blood fluke,

Schistosoma .1 aponicum and the giant intestinal fluke,

Fasclolopsis buskl, both of which are prevalent in

central and south China, have not been reported from
CHAPTER XVI

INTESTINAL PROTOZOA

Endamoeba histolytica is the most notable intestinal protozoa in Manchuria. great number of apparently healthy persons were observed to be cystcarriers of the parasite. An average of 21 per cent

of the population were cyst-carriers, and in the

heavily infected area of Mukden as much as 38.6 per

cent (Hiyeda, 1934). About 24 per cent of Chinese

prisoners and 21 per cent of the Korean prisoners at Ta-lien were infected with the parasite (Saito,1935).

Endamoeba nana is the most common intestinal protozoa

in Manchuria. The average Infection rate is reported

to be 41 per cent, with the highest rate of 58 per

cent at Mukden and the lowest of 26 per cent at Antung. The average infection rate of JLt col1 was reported to be 23 per cent and that of Iodampeba but

schli1 nine per cent (Hiyeda, 1934). An Infection

rate of 5.4 per cent with Glardla Iambila was reported

among the railway workers along the South Manchuria

Railway, and rate of 25 per cent among the school

children in Mukden (Hlyeda and Suzuki, 1933). Kitabatake (1935) showed that eight of 25 Japanese child

emigrants at Ai-chuan village, Chln-chou, were infected with the parasite. Parasitism with this protozoa

frequently causes temporary diarrhea in children but

seldom in adults. Tsuda (1936) reported an infection

rate of 44.0 per cent with Enteromonas homlnls

Trichomonas intestlnalis) in the vicinity of Ch'eng-te,

Jehol Province. Hiyeda (1934) reported the infection

rate with this parasite in south Manchuria to be 2.6 (at An-shan) to 11.3 per cent (at Ta-lien), averaging

8.4 per cent. Infection with Chllomastlx mesnlll in

.Manchuria was reported to range from 1.7 to 6.6 per

cent with an average of 4.4 per cent (Hiyeda, 1934).
CHAPTER XVM

ANIMALS OF MEDICAL IMPORTANCE

Culicldae (Mosquitoes). The mosquito fauna of

Manchuria is more or less similar to that of north

China although the number of recorded species is considerably smaller. This is probably due to the fact

that much less collecting has been done in this territory. The available information shows that only

two species of Anopheles, six species of Ae'des and

seven species of Culex have been recorded from Manchuria. The following information Is based largely on

Feng (1938) with some additions from subsequent

pub 11c at ions.

Anopheles hyrcanus sinensis Wiedemann, 1828. This

is the most common anophellne mosquito in China. In

Manchuria it is also widespread and has been collected

from Hai-lung and Mukden of Liaoning Province, Ch'angch'un and Yung-chi of Kirin Province and in the lower

Sungari region between Lahasusu and Gadikaudza (K'oshan, Pel-an and Teh-tu) of Heilungkiang Province. The

larvae of this mosquito breed in almost any collection

of ground water and occasionally even in artificial

water. Adult females enter houses and attack man as

well as domestic animals. There is diversity of

opinion regarding the feeding habits of this mosquito.

In some areas it appears to be strongly zoophilic,

rarely attacking man while in other areas relatively

large percentages of the engorged females are found to

contain human blood. This species plays only minor

role in the transmission of malaria in other parts of

China. However, in southern Manchuria where no other

anophellne is found this is the only species responsible for malaria transmission. This species is also

vector of fllariasls in China.

Anopheles (Anopheles) labranchiae atroparvus van

Thiel, 1927. This mosquito has been reported by Feng

and Ch'ln (1937) from Hel-ho and Lungchen in the

northern Heilungkiang Province. The authors stated

that "the structure of the male terminalla suggests

that it probably belongs to_A. maculipennls var. atroparvus Since this variety is one of the principal

malaria carriers in Europe, its presence in north Manchuria may explain the high Incidence of malaria in

certain localities of that region". In 1938, Ch'ln

collected three more specimens, two from Pel-an and

one from Teh-tu, together with many specimens of A.

hyrcanus inensls in the same area. One should bear

in mind that _A_. messeae has been reported by Russian

workers to occur along the Amur River country and that

Anopheles lewis Ludlow and selengensls Ludlow were

originally described from Siberia. Recently Altken

(1934) noted that_A. maculipennis selengensls should

remain synonym of A. madulIpennls lewisi, and suggested that Falleronl's messeae from Italy is in reality Ludlow's lewisi. It is possible that the Siberian messeae may be proved to be Identical with

lewisi. Feng stated that the larvae of atroparvus

are found in ditches containing fresh water. Adults

have been collected within houses.

Aedes (Ochlerotatus) dorsalis (Meigen) 1832. This

holarctic mosquito has been collected from Mukden of

Liaoning Province. Its larvae are found in natural

pools and in marshes. The female adult is anthropophllic and diurnal in habits. There is no definite

evidence concerning the role of this mosquito as

vector of disease.

Aedes (Ochlerotatus) maculatus (Meigen), 1804.

This species is palearctic in its distribution and

has been collected from Ch'ang-ch'un of Kirin Province and Mukden of Liaoning Province. Its breeding habits are similar to those of the preceding

spec ies.

Aedes (Aedlmorphus) vexans (Melgen), 1830. This

mosquito has wide distribution in other parts of

China but has been recorded only from Hallung, Liaoning Province, in Manchuria. Larvae are found in

natural pools and swamps. The females have been observed to bite man both during the day and at night.

Aedes (Finlaya) korelcus Edwards, 1917. This

Korean species has been found in Hopei and Shantung.

In Manchuria it was collected only from Mukden. The

larvae of this species breed in household containers

such as flower pots, barrels, etc. as well as in water

pools in rocks and in hills. The adults are anthrophlllc and bite both day and night. This species was

demonstrated experimentally to transmit Dlrofllarla

immitis of dogs at Peiping.

Aedes (Flnlaya) Seoulensis Yamada 1921. This

species has been collected front Mukden. The larvae

breed in tree holes. Adults have been reported to

bite during the day.

Aedes (Stegomyia) chemulpoensls Yamada, 1921.

This species has been recorded from Mukden. It is

also tree hole breeder. The females vigorously

attack man during the day. Wuchereria bancroftl

were found partly developed in this specles.

Culex (Barraudlus) modestus Ficalbl, 1890. This

is rare species in Manchuria and has been collected at Mukden and Hai-lung. The larvae breed in

ponds. Nothing is known regarding the habits of the

adults.

Culex (Neoculex) hayashl Yamada, 1917. This is

also an uncommon species in Manchuria, and was collected only in Mukden. The larvae seem to prefer

pools and slowly flowing, streams. Nothing is known

concerning the adult habits.

Culex (Culex) bltaenlorhynchus Giles, 1901. This

species is widespread in China and has been reported

from Mukden of Liaoning Province. The larvae breed

in fresh and clean natural water with filamentous

green algae. The adult females generally attack man

at night but sometimes also during the day. Infective

larvae of--Wuchereria bancroftl have been obtained experimentally from one specimen (Hu, 1939) but it is

not considered as suitable host of the parasite.

Culex (Culex) ri entali Edwards, 1921. The

larvae of this species were collected from lake

near Mukden with much surface vegetation. Nothing

is known concerning the habits of the adults.

Culex (Culex) piplens pallens Coquillett, 1898.

This is common northern species in China and has

been reported from Yung-chi and Ch'ang-ch'un in

Kirin Province, and Mukden and Hai-lung of Liaoning

Province. The larvae breed almost in any collection

of water but especially in those containing much

.organic matter. Adult females are strongly anthropophlllc and attack at night. They are frequently

found inside human dwellings. It is suitable

intermediate host of Wuchererla bancroftl in central

China and Japan.

Culex (Culex) trltaenlorhynchus Giles, 1901.

This is widespread mosquito in China. In Manchuria it has been collected from Yung-chi and Ch'angch'un of Kirin Province and Hai-lung of Liaoning

Province. The larvae breed in ponds, pools, ditches,

rice fields, etc. The adults bite man frequently

during the night Inside houses as well as in the

open. This species is possible vector of fllarlasls.
33

Culex (Culex) vagans Wiedemann, 1828. This

species is widespread in China. In Manchuria it

has been reported from Yung-chi of Kirin Province,

and Mukden of Liaoning Province. The larvae breed

in lakes and pools, and also in water pools in hilly

streams containing filamentous algae. No information has been recorded concerning the habits of the

adul ts.

Psychodldae (Sand Flies) The genus Phlebotomus

of this family Includes vectors of kala azar which

disease is endemic in southern Manchuria. No investigation has been made regarding the Phlebotomus

fauna of Manchuria. Yang (1935) reported that these

insects are uncommon in Cheng-te, Jehol Province and

rare in Mukden, without specifying the Species.

Phiebotomus chlnensis and JP. sergentl mongolensls

which are common in north China may also occur in

Manchurla.

Heleidae (Biting Midges) These are very small

blood sucking gnats. With the exception of few

species of Cull coldes which have been reported to

transmit fllaria non-pathogenlc to man, these flies

are of medical importance because of their extremely

annoying bites. number of species belonging to

various genera have been reported in Manchuria. Eight species of Cullcoldes are represented in this region.

These are:

Cullcoldes albicans (Wlnnertz) This species is

not blood sucking as far as known.

Localities: Shlh-men-tzu, Huang-tao-ho-tzu

(Takahasi, 1941).

Cullcoldes buhetoensls Takahasi. This is biting species and is recorded only in Po-k'o-t'u

(Buheto) (Takahasi, 1941).

Cullcoldes chlopterus (Meigen). There is no record of blood sucking habits for this species.

It was collected in Huang-tao-ho-tzu (Takahasi,

1941).

Cullcoldes erairai Kono and Takahasi. This is

troublesome and abundant species in northeastern

Manchuria. It principally attacks the hairy

parts of the body, and its bite causes large

painful swelling. It is most active in the

evening or in cloudy weather and has been collected in Shlh-men-tzu, Tung-nlng, Mu-tan-chiang

and Ma-shan (Takahasi, 1941)

Cullcoldes nubeculosus Meigen. This species

attacks man during the day. It has been collected from Yen-chi, Hsl-la-mu-lun River and

Hsing-ho, Manchuria, and also from Chang-pei,

Inner Mongolia (Tokunaga, 1940).

Cullcoldes obsoletus (Meigen). This is very

troublesome small species and its bite is always

painful. It has been collected in Huang-tao-hotzu, and Mu-tan-chlang (Takahasi, 1941).

Cullcoldes onol Tokunaga. This species has been

collected only from Ch'ang-ch'un, Kirin (Tokunaga, 1940). There is no record of its feeding

habits.

Culicoldes pul1caris ocellaris Kleffer. This

variety is very troublesome on calm days, and

attacks man severely. It has been collected

from Chang-pei, Inner Mongolia (Takunaga, 1940).

CulIcoldes pulicaris punctatus (Meigen). This

variety is also very troublesome and is most

active out of doors in the evening. It has been

collected from Shlh-men-tzu, Huang-tao-ho-tzu and Tung-ning (Takahasi, 1941).

Key to Species of Cullcoldes In Manchuria

1. Wings uniformly colored or with single dark spot

on costal margin

Wings with light spots on dark ground or dark

spots on light ground

2. Wings with macrotrichia nearly all over.jC, albicans

Wings nearly bare chlopterus

3. Wings with second radial cell entirely dark....

Wings with second radial cell partly pale

4. Wings bare except at the tip, markings very

faint _C_. obsoletus

Wings clothed with macrotrichia on the greater part

of surface, markings more definlte. _C_. pullcarls

5. Wings without dark spot on basal half of costal

margin, legs pale brown.. C. buhetoensls

Wings with dark spot on basal half of costal margin, legs dark or with dark markings

Thorax with numerous dark dots at base of setae

C,. nubeculosus

Thorax otherwise marked

7. Wings dark, with three pale spots beyond the second

radial cell _C_. erairai

Wings grayish, with only one definite pale spot

beyond the second radial cell.... C. onol

In 1941, Tokunaga added five more species of Heleldae

to the Manchurian fauna, viz., Atrichopogon (Kempla)

dorsalis Tokunaga, Dasyhelea sp., Spaeromlas pictus

Meigen, PalpOmyla nubeculosa Tokunaga and Dicrobezzla

venus ta Meigen; all being collected from Harbin. In

addition the author listed number of other species

with the locality data as "Yablonia, Manchuria” which

cannot be located and hence are omitted here.

Slmullldae (Black Flies) Only one genus, Simullum, of this family has been reported to transmit

disease. Certain species of the genus are intermediate hosts for the filarial worm causing onchocerclosis

in Africa and Central America. S. decorum was incriminated for the mechanical transmission of tularemiai

The black flies are vicious and persistent biters.

They attack both man and domestic as well as wild animals during the day. Takahasl (1940) reported the following species of Slmullldae from Manchuria:

Slmullum (Helllchla) karlyal Takahasi

Locality: Kung-chu-1ing

Slmulturn (Astega) lanata Takahasi

Locality: A-erh-shan

Slmullum (Nevermania) koldzumll Takahasi

Localities: Hallar, Sun-wu, Hel-ho,

Nan-tun, Nai-lo-mu-tu,

Shang-ku-li, Man-chou-li,

A-erh-shan.

Slmullum (Odagmla) halonensls Takahasi

Locality: A-erh-shan

Slmullum (Slmullum) ishlkawal Takahasi

Locality: A-erh-shan

Slmullum (Slmullum) rep tans (Linnaeus)

Locality: Huang-tao-ho-tzu
34

The following key to the species is taken from Takahasi:

Key to Species of Manchurian Slmullldae

1. Hind leg without calcipala and pedlsulcus

Hind leg with distinct calcipala and pedisulcus.

2. Claws simple Helllchla karlyal

Claws bifid (l.e. with basal tooth). Astega lanata

3. Fore tarsi cylindrical, brown; fore tibiae without white patch Nevermanla koldzumli

Fore tarsi flattened, black; fore tibiae with

white patch

4. Claws simple

Claws bifid Odagmla halonensis

5. All femora clear yellow Slmullum ishlkawal

Femora browhlsh Slmullum reptans

Muscold Flies. With the exception of the genus

Glosslna which is known to be true vector of African

sleeping sickness, the members of this large group

are not vectors in an epidemiological sense. However, many sp.ecies of these flies are Important as

mechanical carriers of such diseases as dysentery,

typhoid fever, cholera, etc. and in many species

the larvae may be tissue parasites of man, producing myiasis. Only one blood-sucking species, Haematobla perturbans Bezzl, was reported from Ch'eng-te,

Jehol Province (Kato, 1936). Although records of

other blood-sucking species in Manchuria are lacking,

their presence should be suspected. number of

non-blood-sucking species of muscoid flies were

reported from Manchuria and of these the following

are of medical importance.

The flesh flies (Sarcophagidae) usually have

Strikingly large bodies with greyish abdomen. Wo hi

fahrtla magnlfica (Schlner) was found in Manchuria.

This species has been reported to commonly infest

man in Europe and especially in Russia. The fly

deposits its living larvae not only in wounds but

also in nasal fossae, the eyes and the ears. Four

species of the genus Sarcophaga are found in Manchuria. These are _S_. ass ip alpi Macquart,

striata (Fabricius) Si. peregrlna Roblneau-Desvordy

and J5_. carnarl (Linnaeus). The larvae of these

flies usually feed upon meats but have also been

found in other food stuff and waste. Many cases

have been recorded of their occurrence as accidental

parasites of the human intestine.

The blue bottle flies (Cal1iphorldae) can be

easily recognized by their robust size and the metallic color of their bodies. They are generally scavengers, feeding on fish, decaying meat and human and

animal excrement. They are also ovoviviparous and

occasionally deposit their living young in wounds.

The following species have been reported from Manchuria: Lucllla caesar (Linnaeus) Lucllla lllustrls

(Meigen), Lucllla serlcata (Melgen) and Calllphora

erythrocephalus (Meigen). Chrysomyla megacephala

Fabrlcious and Lucllla cuprlna Wiedemann have been

collected from Jehol (Takano, 1936).

The larvae of the heel flies (Hypodermatidae)

are normally parasitic in cattle but occasionally

also in man. The two well-known species, Hypoderma

ineata (de Villers) and Hypoderma bovis (DeGeer)

are both found in Manchuria.

Of the family Oestrldae (sheep hot), only one

species, Rhlnoest rus purpureus (Brauer), is found

in Manchuria. This species usually attacks horses

but may also attack man either in the nose or eye.

The family Muscidae (house flies and their

allies) includes many house invading flies. Because of their habit of feeding on and alighting

on human food, these flies are important mechanical

transmitters of many diseases. The common house

flies, Musca, and the lesser house flies, Fannla,

have the additional habit of regurgitating Ingested

food on substance upon which they are resting and

readily contaminating food. The following species

are represented in this region: Musca domestlca

(Linnaeus) Muscina tabulans (Fallen), Fannla anicularis (Linnaeus) and Fannl scalarls (Fabricius)

Tabanldae (Horseflies). The family Tabanldae

(horseflies) Includes large and sturdy flies which

are well known pests of cattle, horses, and other

animals, and are often extremely annoying to man.

Some species of horseflies have been reported to play

important roles as carriers of certain diseases such

as anthrax, trypanosomiasis, and tularaemia. This

important group of insects is little known in Manchuria. The following species have been recorded

from Manchuria (Olsoufiev, 1937 and Wu, 1940): Chrysops suavis Ludlow, Chrysops valida Ludlow, Tab anus

tar andlno ides Olsoufiev,. Tab anu brevis Ludlow,

Tab anus pleskei Krober, Tab anus gemi nus Szllady,

Chrysozona tamerlanl Szi ady, and Chrys-ozona yamadal

(Shlrakl). Since many species of this family are

known from Siberia, Mongolia and Korea, this family

is probably much betteh represented in Manchuria than

is Indicated by this record.

Anopleura (Lice). The role of the body louse,

Pedlculus humanus co rpo rls, in the transmission of

typhus fever and relapsing fever is discussed in

previous chapters. This species is wide-spread in

Manchuria. It may be assumed that the distribution

of the head louse, _P. humanus capltus and the crab

louse, Phthirius pubis, are wide-spread in Manchuria

although definite Information is lacking. Ono (1939)

reported that Polypi ax splnulosa (Burmelster) was

collected from Rattus norveglcus at Ch'ang-ch'un and

Nung-an, Kirin, and considered it vector of typhus

fever among rats.

Slphonaptera (Fleas). In addition to annoyance

caused by their biting, fleas are of considerable

medical importance in the transmission of plague and

murine typhus. The species involved in this transmission are the rat fleas Xenopsylla cheopls and

Ceratophy1lus anlsus which are wide-spread in Manchuria. The Manchurian Siphonaptera are listed as

follows (Liu, 1939 and subsequent publications):

Amphallus runatus (Jordan and Rothschild), 1923.

Ceratonhyllus runatus Jordan and Rothschild, 1923.

Host: Oc hotona dahurlea, Ochotona alplna.

Records: Manchuria, Mongolia (Urga), Transbaikalia.

Oropsylla sllantlewl silantlewl (Vagner) 1898.

Ceratonhyllus sllantlewl Wagner, 1898.

Host: Marmota bobac.

Records: Manchuria.

Oropsylla elana Jordan, 1929.

Host: Cltellus mongollcus (?), Crlcetulus

ampbe111.

Records: Manchuria (Bank of Sungari River

opposite Harbin and Anda Steppe near Harbin).
35

Ceratophyllus (Cltellophllus) tesquorum sungaris

Jordan, 1929

Cltellophllus tesquorum sungaris Jordan, 1929 Host: Crlcetulus arenarlus,Cltellusmongollcus (?)

Records: Manchuria (Ta-lln, Chien-chia-tlen,

T'ungliao, and Sungari River opposite Harbin).

Ceratophyllus (Monopsyllus) anlsus Rothschild, 1908.

Monopsylla anlsus (Rothschild), 1908

Host: Rattus spp.

Records: Manchuria (near Ta-llen).

Ophthalmopsylla kukuschlklnl loff, 1927.

Host: Crlcetulus grlseus fumatus.

Records: South Manchuria (sand dunes near Chienchia-tlen). Transbaikalia on Cltellus dahurlcus.

Ophthalmopsylla ettmar1 Jordan, 1929.

Host: Crlcetulus spp.

Records: South Manchuria (sand dunes near Chienchia-tlen)

Frontopsylla elatus botls Jordan, 1929.

Host: Rats.

Records: South Manchuria (Charithun near Nungklang)

Front opsy11 luculenta luculenta (Jordan and

Rothschild) 1923

Ce ra ophy11 us luculentus Jordan and Rothschild, 1923.

Host: Ochotona dahurlea.

Records: Manchuria, Transbaikalia.

Amphlpsylla aspalac is Jordan, 1929.

Host: Myotalna aspalax (?)

Records: Manchuria (Sansin, Lahasusu)

Amphlpsylla vlnogradovl loff, 1927.

Host: Crlcetulus furunculus.

Records: Manchuria (Sansin), Transbaikalia.

Neopsylla bldentatlformls (Wagner) 1933.

Typhlopsylla bldentatlformls Wagner, 1933.

Host: Many species of wild rodents.

Records: Manchuria.

Pectlnoctenus adalis Jordan, 1929.

Host: Rat.

Records: Manchuria (Charithun near Nunkiang).

Rectofrontla dahuric (Jordan and Rothschild), 1923.

Rhadlnopsylla dahurlca JordanandRothschild, 1923

Host: Ochotona dahurlca.

Records: Manchuria, Transbaikalia.

Rectofrontla tenella (Jordan), 1929.

Rhadinopsylla tenella Jordan, 1929.

Host: Crlcetulus sp.

Records: Manchuria. (Chien-chia-tlen).

Rectofrontia dives (Jordan), 1929.

Rhadlnopsylla dives Jordan, 1929.

Host: Crlcetulus grlseus, Cltellus sp.

Records: South Manchuria (Near Chien-chla-tien

and Ta-lin)

Rectofrontla jaonls (Jordan), 1929.

Rhadlnopsylla ,j aonls Jordan, 1929.

Host: Scaptochlrus gllllesl, Myotalpa aspalax.

Records: Manchuria (Sansin)

Rectofrontla Insolita (Jordan), 1929.

Rhadlnopsylla insolita Jordan, 1929.

Host: Crlcetulus sp.

Records: South Manchuria (near Chien-chia-tlen

and Ta-lln).

Myodopsylla trlsellls Jordan, 1929.

Host: Plplstrellus.

Records: Manchuria (Charithun near Nunkiang).

Xenopsylla cheopls (Rothschild), 1903. Pulex cheopls Rothschild, 1903.

Loemopsylla cheopls Rothschild, 1903.

Host: Various species of Rattus. occasionally man.

Records: Manchuria (near Ta-llen).

Pulex Irrltans Linnaeus. 1758.

Host: Man, domestic mammals, other mammals.

Records: Manchuria; Ch'ao-yang (Jehol)•

Pulex oriental is Klshlda, 1939.

Host: Qog.

Records: Jehol.

Clmlcldae (Bed Bugs)  Bed bugs are common In

Manchuria, especially In public places such as hotels

and dormitories. The species Involved is Clmex

1ectularlus. There is no definite evidence that the

bed bugs are vectors of diseases although they may

serve as mechanical carriers.

Ixodoldea (Ticks). At present there is no Information concerning the medical Importance of ticks

in Manchuria. However, Ixodes persulcatus has been

demonstrated by Russian authors (Solov'yev, 1941;

Chagln Kondratiev, 1943) as the vector of the

tick-borne encephalitis which occurs throughout the

wooded areas of the Khabarovsk and Maritime Krais

of the USSR. This species has been reported from

the Amur River region and Japan. It is possible

that the tick as well as the disease also occur in Manchuria. Some Japanese authors suspected Dermacento sp. as the vector of haemorrhagic fever which

is reported to be endemic in northern Manchuria.

Ticks also serve as vector of relapsing fever, tickborne typhus, tularemia, etc. The tick-fauna of

Manchuria is poorly known; only two species, Hyalomma

detrltum albiplctum Schulze, and Dermacentor re tlculatus (Fabricius) have Manchurian record and four

species, Argas persicus Qken, Haemaphysalis neumannl

Doenitz, Pis colophus tokunagal Kishida and Ixodes

angulatus Kishida are reported from Jehol (Kishida,

1939). Due to their cosmopolitan distribution and

their occurrence in the neighboring areas the following species will be eventually found in Manchuria:

Ixodes persulcatus Schulze, 1930; Ixodes autumnalls

Leach, 1815; Ixodes ri clnus (Linnaeus, 1758); Rhlplcephalus sanguineus Latrellle, 1806; Hyalomma aegyptlum (Linnaeus, 1758); Haemaphysalls blspinosa Neumann, 1897; Haemaphysal camp anul at Warburton,

1908; Haemaphysalis Japonica douglasl Nuttall

Warburton, 1915; Dermacentor nuttal1i Olenev, 1929;

Argas persicus Oken, 1818.

Mollusca and Crustacea of Medical Importance.

Various species of snails are important as obligatory

intermediate hosts of trematodes. Few available

reports on the species of snails serving as intermediate hosts of the human parasitic flukes in Manchuria are available, although human infection with

such flukes as Clonorchi sinensis, Metagonimus

yokogawal, and Paragonlmus westermanl has been reported in this territory. snail host of westermani, identified as Cambaroldes daurlcus was collected in Kirin and southern Liaoning Province (Abe

and Asada, 1938). Ono (1935) reported that s>nalls

of the genus Lymnaea are common in the vicinity of

Mukden. About one per cent of small-sized Lymnaea

(L. pervla ?) was found to be infected with Fasciola

hepatlca. Fork-tailed cereariae, echinosdome cercariae and stylet-cercariae were observed in largeslzed Lymnaea, resembling _L_. aponlca. The presence

of snails of the genus Melania and B1thynia should
36

also be suspected. Kobayashl (1934) reported•that

the crab, Erlochelr ,1 aponicus and probably also E.

sinensis, both serving as second host of west- ermani were present in Manchuria.

Fish of Medical Importance. Certain species

of fresh-water fish, primarily of the families Cyprlnidae, Oobldae, Anabantldae and Salmonldae, serve

as the secondary intermediate hosts of parasitic

flukes. Mlyanaga (1939) examined 15 species of

fresh-water fish in the Mukden area and found six

of them to be Infected with cysts of Clono hi

sinensis. These were Carassius vulgaris, Hemlculter

cleupoldes, Pseudogoblo r1vularis, Leucogoblo herzenstelni, Pseudorasbora parva, and Rhodeus notatus.

Asada reported that Op bleep halus argus collected

in Harbin was found to be Infected with Clonorehls

cysts (Okabe, 1939). Okabe (1939) found the cysts

Metagonlmus yokogawai 1n Culter rythrop terus

Basilewsky (?) from Mi-shan-hsien, in Si nipec

chuatsl (Basil.), Parabramls peklnensls (Basil.)

and Ophlcephalus argus Cantor from Chla-mu-ssu, in Pseudo rasbora parva (T. S.) from Hua-chuan-hslen

and in Hemlbarbus macula tus Sleeker from Harbin.

There is no authentic report on the poisonous and

venomous fish in Manchuria, although they may be

present.

Poisonous Snakes. Poisonous snakes, which are

hazard in tropical and subtropical regions, are

of little medical Importance in Manchuria. Only

one species, Agklstrodon halys (Pallas) (= blomhoffl1 Bole), has been reported from this territory. This is rather short and thick species

less than two feet long and is light gray with

series of large more or less alternating darker

gray blotches extending along either side of the

dorsum. These blotches are Irregularly margined

with black. The belly is gray and very densely

mottled with blackish gray. The head is light gray

above and darker on the side with conspicuous

narrow, light stripe. Its venom is hemotoxic. This

snake is widely distributed in Manchuria. It has

been collected from Harbin (Mori, 1937), An-tung

(Mori, 1937) and Hsiao-1ung-shan-tao, small Island

beyond the tip of the Liaotung Peninsula (Koba,

1938). Okada (1935) reported it from Wu-llng-shan

which is located in northern Hopei Province. Some

authors divided this species into several subspecies.

Of these A. halys brevlcaudus Stejneger and A. halys

intermedins bear Manchurian record (Mori, 1937).

Mammals of Medical Importance. Rats are of

considerable importance as reservoirs of plague in

Manchuria. Several species of the genus Rattus occur

in this region. Among them are _R. rattus rattus, R. rattus alex andr inus, R. humll1atus sowerbyl

Howell and _R. norveglcus caraco (Pallas), the last

one being by far the most common species, Mus

musculus and its varieties manchu and mongol1um

Thomas are also found. The Siberian marmots (tarabagans) Marmota bobak Muller serve as the principal

reservoir of plague in the northern area. Two species of susliks, Ci tellus daurlcus mongollcus and

Cltellus pygmaeus muslcus were found to be infected

with plague in Manchuria. Kuroda (1939) reported

'Cltellus daurlcus daurlcus (Brandt), Cltel lus daurlcus yamashlnal Kuroda and Cl tellus eversmannl ,j acutensls (Brandt) from this region. Other rodents

which have been reported from Manchuria are (Kuroda,

1939); Sclurus vulgaris mantchurlcus Thomas, S.

vulgaris chlliensls Sowerby, Sclrustamlas davldlanus

av1dlanu (Mllne-Edwards) Eutamlas slberlcus

uthensls (Pallas), JL slberlcus sencscens Miller,

Tamlop swinhoel vestl tus Miller, Mlcrotus fortls

pelllceus Thomas, Mlcrotus mandarinus faeceus Allen,

M. brandtll (Raddi) Eothenomys Inez ehol1cus Kuroda,

Clethrlonomys rutilus (Pallas), C. rufocanus arsenevl (Dukelski) C■ rufocanus regulus (Thomas)

Cricetulus onglcaudatus nlgrescens Allen, _C_. barabens1s griseus (Milne- Edwards) Cj_ barabens is obscurus (Milne-Edwards), C. barabensls fumatus Thomas,

C. triton nes tor Thomas, Phodopus songorus campbel11

(Thomas), Apodemus agrarlus mantchuricus (Thomas),

A. agrarlus gloverl Kuroda, speclosus penlnsulae

(Thomas) Mlcromys mlnutus ussurlcus (Barrett-Hamllton).

Rabid dogs are common. Dogs are now considered

to be reservoir of kala azar. The first Chinese

canine kala azar case reported by Andrews in Shanghai

in 1933 was suspected to have contracted the infection in Mukden.
BIBLIOGRAPHY

Anonymous, 1927. report of malaria prevention measures at Tlehling, Manchuria. (Health Department, South

Manchuria Railway Company). J. Publ. Health Ass. Japan, 3(9): 29-31. (In Japanese).

1929. On sudden outbreak of dysentery and paratyphoid epidemics in Fushun, south Manchuria. (Health Department, South Manchuria Railway Company). J. Publ. Health Ass. Japan, 5(5):

214-226. (In Japanese with English summary).

1931. Kala-azar in China. brief addendum to the symposium on kala-azar published in the January

Journal. China Med. J., 45(2): 146-147.

1933. Distribution of leprosy in China. Chinese Med. J., 47(3): 299-300.

1934. Plague in Manchuria and its prevention. (Army Medical Corps, Kwantung Army). Gunldan Zassl

(Official Publication of the Imperial Japanese Army Medical Corps), 248: 274-282. (In

Japanese).

1934-1936. Kwanto-cho Tokelsho (Statistical Report of the Kwantung Government), Dairen. (In Japanese).

., 1935. Round table discussion on plague. Trans. Ninth Cong. Far East Ass. Trop. Med. Nanking (1934),

2: 773-784.

1937-1943. Manshu Nenkan (Manchuria Yearbook), Dairen. (In Japanese).

1938-1939. Japan-Manchoukuo Year Book, Tokyo.

1940. Weigl's vaccine against typhus in Mongolia. Chinese Med. J., 58(2): 257.

1940-1941. The Manchoukuo Year Book, Hsinking.

1942. The Oriental Year Book, Tokyo.

Abe, Toshio, 1937. Report of the investigation on the cause of K'o-shan disease. Report of the Institute of

Scientific Research, Manchoukuo. 1(10):345-396. (In Japanese).

Asada, J., 1938. Paragonlmus westermanl in Manchuria. J. Chosen Med. Ass., 28 (11) :1750-1751. (In

Japanese).

Abe, Tokukei, Kaneko, K., 1938. Epidemiological observations of infectious diseases in Hslnchlng, Manchuria.

J. Orient. Med., 29 (5):1432-1436. (In Japanese).

Aliso, M., 1936. Kaschin-Beck's disease in To-Hen-Do of Manchoukuo. J. Orient. Med., 24 (3) :561-604. (In

Japanese with English summary).

Aitken, H.G., 1945. Studies on the anophellne complex of western America. Univ. of California Publ. in

Entomology, (11):273-364.

Aklzukl, M., Morita, M., Yamamoto, Y., 1940. Physical examination for tuberculosis -of 1,453 applicants of

certain company in Dairen City. J. Orient. Med., 32 (4):745-755.

Ando, K., Kurachl, K., Nishimura, H., 1931. new endemic plague area in northeastern part of Inner Mongolia.

Kltasato Arch, of Exper. Med., 8(l):25-38.

Andrews, M. N., 1933. Lelshmanla in the organs of Shanghai dog. Trans. Roy. Soc. Trop. Med. Hyg., 27(1):1.

1935. case of canine kala-azar occurring in China. Trans. Ninth Cong. Far East. Ass. Trop. Med.,

Nanking (1934), 1:679-681.

Aoki, H., Suo, T., 1940. Dysentery epidemic in Mukden in 1939 and its prevention. J. Orient. Med., 32(3):592.

(In Japanese).

Aral, M., 1938. Ueber die Ureasenreaktion der Undulantsflebererreger. J. Orient. Med., 28(6) :1145-1180.

(In Japanese with German summary)

1940. Immunologische Studien ueber die Undulantsflebererreger. J. Orient. Med., 32(2):229-271. (In

Japanese with German summary).

1940. Ueber das Sein und Wesen der heterogenetischen Immunitatsreaktlon zwlschen den Undulantsfiebererregern und der Vibrio cholerae. J. Orient. Med., 32 (2): 273-309. (In Japanese with

German summary).

Anonymous references are quoted in the text under the publication or the reporting organization
Awaja, S., 1942. Contagious and Endemic Diseases of Far East, Tokyo. 249 pp. (In Japanese).

Buto, T., Yamamoto, Y., 1934- case of kala-azar found In native child born In Mu-Chuang, Manchuria. J. Orient. Med., 21(1):151-156. (In Japanese with English summary).

Buxton, P.A., 1941* The recorded distribution of certain fleas. Bull. Ent. Res., 32(2):119-122.

Chang, C., Robertson, D.S., 1934- Amoebic liver abscess In Manchuria with special reference to Intraperitoneal rup- ture. Chinese Med. J., 48(4):375-380.

Chen, P.S., Ts'al, C.H., Hwang, Y.M., Fan, T., 1938- Statistical observations on Manchurian typhus, J.. Orient. Med., 29(5):1422. (Abstract). (In Japanese).

Ch'in, Y.T., 1936- On some mosquitoes collected from Manchuria. Peking Nat. Hist. Bull., 11(1):23-25.

1937- Trlchlnella Infection In cat in Mukden. Chinese Med. J., 51:500*

1938* Report of malarial conditions in certain places In Manchuria. J.Chosen Med. Ass., 28 (11):1749-1750*

(Abstract) (In Japanese)

1938• Malaria In Manchuria and anophellne mosquitoes. J. Orient. Med., 29(5): 1456-1460. (Abstract). (In

Japanese).

1939. Notes on malaria In certain parts of Manchuria. J. Orient. Med., 30(5):221-224.

Chun, J.W.H., 1930* The new plague menace in Manchuria. Nat. Med. J. China, 16 (1) 111-113.

Endo, S., Komatsu, Y., Oda, H., 1938* Investigation on tuberculosis among the school children In Dairen. J. Orient.

Med., 29(5):1447-1449. (Abstract). (In Japanese).

Faust, E.C., 1926. An Inquiry Into the prevalence of malaria In China. China Med. J., 40(10):937-956.

Feng, L.C., 1937. The anophellne mosquitoes and the epidemiology of malaria In China. Chinese Med. J-, 51:1005-1020.

1938. critical review of literature regarding the records of mosquitoes In China. Part I. Subfamily

Cullclnae, Tribe Anophelini. Part II. Subfamily Cullclnae, Tribes Megarhlnlni and Cullclni.

Peking Nat. Hist. Bull., 12(3):169-181; (4):285-318-

Ch'ln, Y.T., 1937. The presence of Anopheles macullpennis In certain parts of Manchuria. Chinese Med. J.,

51(4):496-499•

Fujlta, S., Rin, K., 1941. Health protection during the winter season and sanitary conditions of the Collective

Colonization Corps of Manchuria. Okayama Igakkal 7asshl (Mltteilungen der Medlzinlschen

Gesellschaft zu Okayama), 53(7):1519-1526* (In Japanese).

Fukada, M., 1938- Paratyphoid and bacteria carriers among the Cavalry Brigade stationed at Ch'ifeng, Jehol.

Gunldan Zassl (Official Publication of the Imperial Japanese Army Medical Corps), 296: 31-

48* (In Japanese).

Fukuda, S. see Hukuda, S.

Kara, K., 1939. K'o-shan disease, an endemic disease In Manchuria, with principal symptoms of heart muscle obstruction. J. Orient. Med., 30(1): 1-16- (In Japanese).

Hara, T., 1937. Chronic myocardosis. J. Orient. Med., 26(4): 581-586* (In Japanese).

Hata, B., 1939. Traveling-diary of Manchuria. Okayama Igakkal Zasshl (Mltteilungen der Medlzinlschen Gesellschaft

zu Okayama), 51(2): 490-500* (In Japanese).

Ratal, K., 1924* Eklrl (a foudroyant form of dysentery In children) in Dairen. J. Orient. Med., 2(4)- 703-718*

(In Japanese with English summary).

Hayashl, A., LI, Y.M., 1936. case of subtertian malaria in Harbin. J. Orient. Med., 25(5): 1273-1274. (Abstract).

(In Japanese).

Hayashl, S., 1936* Surgically extirpated splenomegaly In Manchuria. J. Orient. Med., 25(3): 591-601. (In Japanese

with English summary).

Hlrokl, H., 1934. Plague epidemic at Nung-an In Kirin Province, Manchoukuo, in 1933. J. Orient. Med., 21(2): 227-

275. (In Japanese with English summary).

Toda, T., 1933. Experimental study on the persistence of Splrocheta recurrent!? In the brain. J. Orient.

Med., 18(2): 313. (In Japanese).
Hlrose, A., 1938. Distribution of tuberculosis in Manchuria. J. Orient. Med., 29(5): 1452. (Abstract). (In Japanese)

Hlyeda, K., 1932. Distribution of parasitic diseases in Manchuria. J. Orient. Med., 16(2): 343-354. (In Japanese).

1932. Malaria in Manchuria. J. Orient. Med., 16(3): 417-431. (In Japanese with English summary).

1932. Amoebic dysentery in Manchuria. J. Orient. Med., 16(3): 433-435. (In Japanese with English summary).

1933. Distribution of human parasites and parasitic diseases in Manchuria. J, Orient. Med., 19(1): 1-32. (In Japanese)

1934. Distribution of parasites and parasitic diseases in Manchoukuo. J. Orient. Med., 21(4): 39-56.

1934. Necessary understanding concerning the parasitological studies in Manchuria. J. Orient. Med., 21(5):

727-734. (In Japanese).

1935. On the distribution of parasites and parasitic diseases in Manchuria. Trans. Ninth Cong. Far East. Ass.

Trop. Med., Nanking, (1934), 2:557-562.

1939. Endemic diseases and acute contagious diseases in Manchuria. J. Orient. Med., 31(3): 371-396. .(in

apanese).

Hayashi, N., Inoue, K., 1937. On the etiology of Kaschin-Beck's disease. Trans. Soc. Path. Japonicae, 27:

624-636. (In Japanese).

Kitabatake, E., Kubo, M., Yamamoto, Y., Yosezato, M., 1933. Investigations on amoebic dysentery. Trans. Soc.

Path. Japonicae, 25: 136-139. (In Japanese).

Mo, T.S., 1935. Kala-azar in Manchoukuo. Trans. Soc. Path. Japonicae, 25: 134-135. (In Japanese).

Suzuki, M., 1933. Parasites of Manchurians. J. Orient. Med., 18(5): 759-767. (In Japanese with English

summary).

Honma, Y., 1927. Tuberculosis problem in Manchuria. J. Publ. Health Ass. Japan, 3(2): 15-28; (3): 22-33; (4):

5-12; (5): 8-15; (6): 18-28. (In Japanese)

1927. Statistical observations of tuberculous patients in Manchuria. J. Orient. Med., 7(2-3): 418-419. (In

apanese)

Hoshl, N., 1925. On the types and the toxities of the bacilli of child dysentery in Manchuria. J. Orient.

Med., 3(1): 37-79. (In Japanese with English summary).

1926. On the fever and bacillus type of dysentery and ekirl in children in Manchuria. J. Orient. Med., 4(3):

64-65. (In Japanese with English summary).

—, 1926. Ueber Saeuglings-Dysenterie 1m Orient. Polyclinica Dairen, 2(1): 47-79. (In Japanese with German

summary).

1927. Epidemics of erythema infectiosum in Manchuria, 1927. J. Orient. Med., 7(5): 703-742. (In Japanese

with Ehglish summary).

192». On child dysentery in Manchuria, especially in the bacillus types and blood findings. J. Orient. Med.,

10(1): 1-9.

Hos..xzakl, S., 1927. case of paratyphoid Indicating symptoms of eklri. J. Orient. Med., 8(2): 177-182. (in Japanese with English summary).

1928. The clinical and bacteriological examination of dysentery in Dairen, south Manchuria. J. Orient.

Med., (l): 49-81. (In Japanese with English summary).

1932. Studies of virus of Manchurian typhus and typhus fever in tissue culture. Trans. Soc. Path. Japonicae,

22: 712-723.

Hukuda, S., Aki, K., 1937. Ueber die Darm-Parasiteneir, die an "Tukemono" haften. J. Orient. Med., 27(2): 89-94. (In Japanese with German summary).

Morlkawa, K., 1936. Metagonlmus yokogawal in Dairen. J. Orient. Med. 25(5): 1031-1042. (in Japanese with

German summary).

Ho, J., et al, 1937. Report of Mantoux tests on 34,781 Japanese and Manchoukuo school pupils in the Kwantung

Leased Territory (Japan). J. Orient. Med., 26(6): 1103-1142. (In Japanese with English

summary).

Iketanl, T., 1937. Malaria in Dairen, with special notice on the existence of malaria quartana. J. Orient. Med.,

27(4): 499-505. (In Japanese with English summary).
Imamura, S., 1937. An unknown disease, so-called K-oshan disease, prevalent In early winter In north Manchuria. Gunidan Zassi (Official Publication of the Imperial Japanese Army Medical Corps), 286: 357- 384. (In Japanese).

Imudzu, K., et al, 1941. Report on the health conditions of the immigrant farmers in Tleh-11-hslen, Pel-an Province of Manchuria in 1941. Kyoto Ikadaigaku Zasshl, (Mlttellungen aus der medlzlnischen Akademle zu Kioto) 31(1); 1-56. (In Japanese)

Ishll, N., 1940. Studies on kala-azar. Report I. Japanese J. Exper. Med., 18(3): 137-147.

Ishlkawa, S., 1929. On the fate of the ova of the Ascaris in heaped manure mixed with human feces, and the investi- gation of the eggs adhering to vegetables. J. Orient. Med., 11(4): 127-131. (In English with Japanese summary).

1929. On the results of repeated fecal examinations of Japanese and Chinese in-patients of the hospital, Man- churia Medical College, and results of examination of feces of Mongolians. J. Orient. Med., 11(5): 619-627. (In Japanese with English summary).

1929. case of myiasis. J. Orient. Med., 11(4): 124-126. (In English with Japanese summary).

1930. Enterohemorrhage of dysentery patients and its statistic observations. J. Orient. Med., 12(3): 419-432. (In Japanese with English summary).

Itonoke, T., 1938. Statistical observation of the dysentery cases. J. Chosen Med. Ass., 28: 1738. (Abstract). (In apanese)

Iwamoto, S., 1938. Statistical observations on the tuberculous patients in the Hsinchlng Manchuria Railway Hospital.

J. Orient. Med. 29(5): 1437. (Abstract). (In Japanese).

Iwata, S., 1938. Experimental studies of typhus fever. 1. On the types of typhus fever epidemic in Manchuria. J.

Orient. Med., 29(5): 1420-14?2. (In Japanese).

1939. Study on typhus fever. Of types, varieties and clinical symptoms of typhus fever in Manchuria. J.

Orient. Med., 30(5): 193-220.

Jettmar, H."M., 1932. Beitraege zur Epidemlologie der Malaria und Pest 1m Fernen Osten. Zentralblatt fuer Bakteylol- ogie, Parasltenkunde und Infektionskrankheiten, 127(1/3): 178-184.

Jono, Y., Iketanl, T., 1937. Pleurisy. 1. Statistic observation. J. Orient. Med., 26(5): 921-932. (In Japanese with

English summary).

Kambayashi, Y., 1935. Report concerning the hygienic conditions of Manchoukuo. Bull. Nav. Med. Ass., Tokyo, 24;

310-314. (In Japanese).

Kamlmura, T., 1937. Smallpox epidemics in Manchuria. J. Orient. Med., 27(4): 603-612. (In Japanese with English

summary).

Kaneko, J., 1923. Statistical studies of tubercular meningitis among children in Dairen. J. Orient. Med., 1(4):

515-538. (In Japanese with English summary).

1930. Problem of child welfare in Manchuria. Polycllnlca Dairen, 4:485-508. (In Japanese with English

summary).

Kao, Y.E., 1936. The incidence of various diseases among children in Moukden, Chinese Med. J., 50(4): 466-477.

1936. Cerebro-splnal meningitis in Moukden. Chinese Med. J., 50(4): 478-490.

Katayama, K., 1930. The statistical observation of whooping cough with pneumonia at Dairen and one case of pneumothorax that have brought good effect upon serious whooping cough pleuropneumonia. J.

Orient. Med., 13(1): 17-35. (In Japanese with English summary).

Kato, K., 1932. Ueber zwei Falle von Cystlcercus cellulosus homlnls. J. Orient. Med., 17(3): 481-483. (In Japanese

with German summary).

Kato, S., 1936. Insects of Jehol (IX) Orders: Diptera and Aphanlptera. Family Muscidae. Report of the First

Scientific Expedition to Manchoukuo, Sec. V, Dlv. 1, Pt. 13, Art. 73, p. 1-5.

Kato, T., Hisamochi, Y., 1933. Statistical observation of dysenteric patients in Mukden. J. Orient. Med., 19(6):

987-1002. (In Japanese with English summary).

Kawahlto, S., 1933. Observations on recent mortality statistics of Japanese in Manchuria (Parts and II). J.

Orient. Med., 19(2): 289-356. (In Japanese)

1934. Vital statistics of Chinese in Kwantung Province, Manchuria, 1925-1930. J. Orient. Med., 20(1): 1-12.

(In Japanese with English summary).
1936. Observations on recent mortality statistics of Japanese in Manchuria. (Part III.) J. Orient. Med., 24(1): 109-130. (In Japanese).

1936. Statistical study of the relation between the climate and diseases in Manchuria. J. Orient. Med., 24(3): 635-676. (In Japanese).

1936. Statistical s-tudy of the Influence of meteorological conditions upon mortality from various diseases in Manchoukuo. J. Orient. Med., 24(3): 635-676. (In Japanese with English summary).

1936. supplement to the statistics of tuberculosis of Japanese in Manchoukuo. J. Orient. Med., 25(4): 799- 807. (In Japanese with English summary).

Kawamura, K., 1935. Verification of virus (Rickettsia) in the urine of patients and guinea pigs Infected with typhus fever in broad sense. J. Orient. Med., 24(5): 1051-1063. (In Japanese with English summary).

Kawamura, R., Imagawa, Y., Ito, T., 1935. The Weil-Fellx reaction in tsutsugamushi disease and its relation to endemic typhus in Manchoukuo and Formosa. Kltasato Arch. Exper. Med., 12(1): 26-57.

Kawashima, S., 1925. Clinical observations of typhoid and paratyphoid fever among children in Manchuria. J. Orient.

Med., 3(4): 525-550. (In Japanese).

1926. Typhus und Paratyphus abdominalls bei Klndern in der Mandschurei. Polyclinica Dairen, 2; 1-26. (In

Japanese with German summary).

Klao, Y.S., 1927. Circular medical service along the Taonan-Angangchi Railway. Chlnesische Zeitschrlft Fur die

Gesamte Medlzin, 5(1): 44-47. (In Chinese).

Kikuta, K., 1937. On the investigation of typhus in Manchoukuo. I. Rlckettsiosis in Tohendo, Manchoukuo, especially

on its infestation. J. Orient. Med., 27(3): 389-408. (In Japanese).

1937. Mercury treatment for typhus and Manchurian fever. J. Orient. Med., 26(3): 579. (Abstract). (In

Japanese).

1938. Report of the Epidemic Prevention Corps of Hslngchlng Garrison in Manchuria, April 1936. Gunidan Zassl

(Official Publication of the Imperial Japanese Army Medical Corps), 299:328-336. (In Japanese).

1938. On the investigation of typhus in Manchoukuo. Orient. Med., 29(1): 211-230; (3): 715-747; 749-759; (4): 1057-1108. (In Japanese with English summary).

1940. The result of the mercury treatment among the amoebic dysentery patients in the Mukden Army Hospital in 1937 and 1938. J. Orient. Med., 32(5): 965-969.

Kimura, Y., 1932. Two cases of Weil's disease in Fushun. J. Orient. Med.,. 17(5): 807.

Klshlda, K., 1939. Insects of Jehol (IX) Orders: Dlptera and Aphaniptera. Order Aphanlptera. Report of the

First Scientific Expedition to Manchoukuo. Sec. 5, Div. 1, Pt. 13, Art. 77, p. 1-18. (In

Japanese and English).

1939. Arachnida of Jehol Orders: Scorpions, Aranelna, Opiliones and Acarlna. Order Acarina. Report of the

First Scientific Expedition to Manchoukuo, Sec. 5, Div. 1, Pt. 4, Art. 13, p. 1-49. (In

Japanese and English).

Kitabatake, E., 1935. Parasitic diseases among immigrants in Aikawa Village, Kinshu and in Denshodal Farm, Eiko,

Manchoukuo. J. Orient. Med., 22(2): 369-37,7. (In Japanese with English summary).

1938. Investigation of kala-azar along the Peiping-Shanhaikwan Railway. J. Chosen Med. Ass., 28(11): 1755.

(In Japanese).

Yamamoto, Y., Murase, W., 1934. Control of malaria in the Fushun mines in 1933. J. Orient. Med., 21(2): 215-

225. (In Japanese with English summary).

Kltahara, T., 1932. Statistical observations of child mortality in Dairen, south Manchuria. J. Orient. Med., 16(6):

729-750. (In Japanese with English

Kitahata, E., 1939. Pappatacl fever and kala-azar. J. Orient. Med., 31(4): 799. (In Japanese).

Kitamura, M., Endo, M., 1933. Ohara's bacillus in dysentery. Agglutination test on Ohara's bacillus in children,

in Mukden, attacked by dysentery and like diseases. J. Orient. Med., 19(5): 935-938. (In

Japanese with English summary).

Kitamura, S., Teral, T., 1933. Ueber die Dermatomycosen in dem neuen unabhaengigen Staat "Manchoukuo" und Studien

ueber ihre mycologischen Erreger. (1. Mittellung). J. Orient. Med., 19(4): 705-736. (In

Japanese with German summary).

Kitano, M., 1938. Ophthalmic myiasis in Mongolia. Gunidan Zassi (Official Publication of the Imperial Japanese

Army Medical Corps), 299: 291-308. (in Japanese).
Koba, K. 1938. Some notes on Agklstrodon halys (Pallas) from Syoryuzan Island, Kwangtung, south Manchuria. Dobutsugaku Zassl (Zool. Mag. Japan), 50(5): 245-264. (In Japanese with English summary).

Kobayashl, H., 1934. The second Intermediate host of Paragonimus westermani. J. Chosen Nat. Hist. Soc., 18:1-5.

(In Japanese).

Kobayashl, S., Yokoyama, T., 1928. Eln Beltrag zur Statlstik des Trippers. Polyclinica Dairen, 3: 1-18. (In

Japanese with German summary).

Kodama, M., Kawano (Knon), M., Takahashl, K., 1932. Demonstrations of Rickettsia manchurlae appearing In the

stomach epithelial cells of rat fleas and lice Infected with so-called Manchurial typhus.

Kitasato Arch. Exper. Med., 9(2): 91-97.

_, Honma, H., 1933. Experimental studies on the possibility of interchanging the properties of

Rickettsia manchurlae and Rickettsia prowazekl through natural and artificial passage through

louse and flea. Trans. Soc. Path. Japonlcae, 23: 754-755. (In Japanese with English title).

Takahashl, K., Kono, M., 1932. Experimental studies on the course of infection of so-called Manchurian fever.

Trans. Soc. Path. Japonlcae, 22: 711. (In Japanese).

1932. Natural hosts and disseminators of Rickettsia manchurlae. (Preliminary note) Kitasato

Arch. Exper. Med., 9(1): 84-89.

1932. On experimental observation of the so-called Manchurian typhus and its etiological agent

(Rickettsia manchurlae). Kitasato Arch. Exper. Med., 9(2): 97-133.

1932. Difference of the pathogenic property of Rickettsia prowazekl and Rickettsia manchurlae.

virus of so-called Manchurian fever in guinea pigs, rats and common rats. Trans. Soc. Path.

Japonlcae, 22: 710-711. (In Japanese).

Kodama, T., 1927. Prevention of dysentery in Manchuria. J. Pub]. Health Ass. Japan, 3(11): 3-14. (In Japanese).

Koike, K., 1938. Studies on dysentery bacilli in Manchuria. J. Orient. Med., 29(5): 1425. (Abstract). (In Japanese).

Kondo, H., 1939. Carriers of cysts of hystolitlca among the Japanese in Peng-chih-hu. J. Orient. Med., 31(5):

1205-1206. (In Japanese).

Koyama, E., 1940. Migratory population in Manchuria coolie as labor potential. J. of Studies of Population

Problems, 1(3): 1-3, (4): 1-38. (In Japanese).

Kuan, Y.M., 1930. An investigation on scarlet fever in China. Internal. Med. J., 10(7): 49-55. (In Chinese).

Kubo, H.., 1937. Ueber elne elgenartlge Herzmuskelerkrankung in der Mandschurei. Trans. Soc. Path. Japonlcae, 27:

397-406. (In Japanese with German title).

1938. Ueber die Kusan-Herzkrankheit mit besonderer Beruckslchtlgung ihrer Aetiologle. Trans. Soc. Path.

Japonlcae., 28: 88-100. (In Japanese with German title).

Ozasa, T., Chin, C.C., 1938. Prevalence of Kaschln Beck's disease and endemic goitre in northern Manchuria.

J. Orient. Med., 29(5): 1481. (Abstract). (In Japanese).

Kubo, K., 1920. Flies collected in the houses in Manchuria. Tokyoer Medlzinlsche Wochenschrlft, 2180: 1085-1087. (In Japanese).

Kubo, M., Baba, H., 1938. Preliminary report on the cause of endemic dermatitis in Manchoukuo. Trans. Soc. Path.

Japonlcae, 28:100-102.

_, 1938. Studies on the cause of the endemic dermatitis in Manchoukuo. (First report) J. Orient. Med., 29: 1189-1193. (In Japanese with English summary).

Gomi, T,, 1938. Studies on the cause of the endemic dermatitis in Manchoukuo. (Second report) J. Orient.

Med., 29: 1195-1202. (In Japanese with English summary).

Hlyeda, K., Takemori, T., 1939. On the cause of endemic diseases in Manchoukuo (endemic dermatitis, kala-azar)

and the location of causative organisms of dysentery, typhoid and cholera. Trans. Soc. Path.

Japonlcae, 29: 89-91 (In Japanese with English title).

Kudo, T., 1932* Malaria in Fu-shun, Manchuria, during the past ten years. J. Orient. Med., 16(4): 487-492. (In

Japanese with English summary).

Rung, H.W., 1928. brief history of the public health work in Harbin. Nat. Med. J. China, 14(4): 281-296. (In

Chinese).

Kunitake, Y., 1939. Treatment of severe cases of scarlet fever. J. Orient. Med., 30(1): 89-90. (In Japanese).

Kurauchi, K., 1930. Epidemiology of plague in Inner Mongolia. Plague Studies I. J. Orient. Med., 12(4): 569-596. (In Japanese with English summary).
1930. The wild rodents of Inner Mongolia. Plague Studies II. J. Orient. Med., 12(5): 671-700- (In Japanese with English summary).

1930- Differentiation of B. pestis from allied organisms by means of their biological properties. Isolation of strain of plague-like Bacillus from suslik. Plague Studies III. J. Orient. Med., 12(6): 827-856- (In Japanese with English summary).

Kurihara, H., 1939. Observations on trachoma morbidity of school children in Chln-hslen, Manchoukuo. J. Orient. Med., 30(5): 919-925. (In Japanese with English summary).

Kurlta, A., 1938. Studies of Salmonella sulpestlfer (Paratyphoid C) in Manchuria. Gunldan Zassl (Official Publi- cation of the Imperial Japanese Army Medical Corps), 300:479-504; 302:659-690. (In Japanese)-

Kurlta, F., 1939. Observations of relapsing fever patients. J. Orient. Med., 31(4): 903-904 (In Japanese).

Urabe, H., 1939. Application of sulfanilamide for epidemic cerebrospinal meningitis. J. Orient. Med., 31(4): 921-922- (In Japanese).

Kuroda, N., 1939- Mammal fauna of Manchoukuo preserved in the collection of Marquis Yamoshina. Bull. Blogeog. Soc. Japan, 9(1): 1-48-

Gen. H., 1939- small collection of mammals from southern Manchuria. Bull. Blogeog. Soc. Japan, 9(13):

207-222.

Leo. T.L., 1938. Cases of Dlstoma pulmonale seen in Mukden and their treatment. J.Chosen Med. Ass., 28:1751- (Ab- stract). (In Chinese with English translation).

Li, F.S., Mu, S.C., 1934. On the known species of Chinese Aedes (Diptera, Culicldae). Eht. and Phytopath., 2(35):

682-688- (In Chinese).

1935- On the known species of Chinese Cullcinl, with few other species. Ent. and Phytopath.,

(3-5): 44-90* (In Chinese).

Li, T.C., 1928. Statistics of the plague epidemic in Chlenchlatlen. J. Orient. Med., 9(6): 898- (In Japanese).

Lin, C.S., Jettmar, H.M., 1925- The scarlet fever problem in the Far East. Nat. Med. J. China, 11(6): 399-412.

Wu, L.T., 1927. Report of preliminary health survey of Plnchlang (Chinese City of Harbin) (January-June

1926). Nat. Med. J. China, 13(1): 24-82.

Liu, C.Y., 1939. The fleas of China: Order Slphonaptera. Philippine J. Sci., 70(1): 1-122-

Ludlow, C.S., 1920- Siberian Anopheles. Psyche, 27(4): 74-78-

Maki, T-, Takahashl, K., 1933. Forschungen auf dem Geblete der in diesem Jahre herrschenden Erythema infectlosum.

J. Orient. Med., 19(4): 737-745- (In Japanese with German summary).

Manako, K., 1933-1934- Cholera and cholera-like Vibrio. Part I. Types and biological characters of cholera

vibrios prevailing in Manchuria during the summer of 1932. Part II. Water-vibrio, Isolated

during the summer of 1932 In Mukden. Part III. Kind of strain in dejecta of patients

suffering from acute gastro-enterlc disorder agglutinated by cholera serum. J. Orient. Med.,

19(5): 775-798; 20(2): 165-178; 179-187. (In Japanese with English summary).

Matsubara, M., 1928- Paratyphoid epidemic in Fushun in February 1928- J- Orient. Med., 9(1): 247- (Abstract).

(Ip Japanese)

Matsuda, K., 1929. On the result of serodlagnosis for syphilis of women engaged in certain professions in Dairen

and their treatment. J. Publ. Health Ass. Japan, 5(12): 507-512. (In Japanese with English

summary).

Matsuo, Y., 1935. Pathologisch-anatomlsche statlstlsche Beobachtung bei Japanern, Koreanern und Chlnesen in der

Mandschurei. (Auf Grund des Sektlonsmaterlals unseres Institutes im Verlaufe der letzten

23 Jahre.) J. Orient. Med., 22(3): 513-534. (In Japanese with German summary).

Matsuura, T., 1935. case of Cystlcercus cellulosae homlnls. J. Orient. Med., 23(3): 627-629. (In Japanese).

Matsuura, Y., 1934. Eine statlstlsche Beobachtung ueber Meningitis tuberculosa in Dairen. J. Orient. Med., 21(3):

361-367- (In Japanese with German summary).

1934. Ueber elnen Fall von Morbus Banti. J. Orient. Med., 20(4): 543-548- (In Japanese with German summary)

1937. Glardla intestlnalls parasitic on child in Dairen. J. Orient. Med., 27(6): 1099- (Abstract). (In

Japanese).
1938- Glardla Intestlnalls bel elneni Japanlschen Kind In Dairen, Sudmandschurel. j. Orient. Med., 29(1) 287-291. (In Japanese with German summary).

Maxwell, J.L., 1929- The Diseases of China Including Formosa and Korea, 2nd Ed., Shanghai.

Mlgal, H., 1928. Statistical observations on the recent epidemic of pediatric Influenza. J. Orient. Med., 9(1):

230-232. (In Japanese).

Mltsuse, B., 1930. report on case of kala-azar found In Fu-shun, Manchuria. J. Orient. Med., 12(3): 461-464. (In Japanese with English summary).

Mlura, U., 1926* Some observations on mortality statistics of the Japanese In Manchuria. J. Orient. Med., 5(5):

445-463. (Japanese with English summary).

1928. Some observations on the mortality statistics of the Japanese In Manchuria. (Pt.2) J. Orient. Med., 8(2): 89-126* (Japanese with English summary).

1934. Sanitation of the living quarters In Manchuria. Ventilation and heating system. J. Orient. Med., 21(4): 605-622. (In Japanese).

Mlyabe, I., 1938* kind of splrochaetosls occurring in Helho Province. J. Orient. Med., 29(5): 1431. (Abstract).

(In Japanese).

Mlyanaga, S., 1939. Studies on second Intermediate host of Clonorchls sinensis In Mukden area. J. Orient. Med.,

31(3): 565-568- (Japanese with English summary).

Mo, T.S., 1934-1935. Distribution of kala-azar fn the southern district of Manchoukuo. (Part I-IV) J. Orient.

Med., 21(4): 705-720; (6): 1029-1066; 22(2): 403-429. (In Japanese with English summary),

Mochlta, 1931- Glanders and cases of human Infection. Nenman Jul Chlkusan Gakkal Zassl (J. of Veterinary and

Animal Husbandry Association of South Manchuria), Vol. 13, No. 3-4. (Not available).

MocTilzuki, N., Koreeda, M., 1940. Smallpox epidemic In Mukden In 1938 and 1939- Orient. Med., 32(3): 592. (In

Japanese).

Nishlmoto, Y., Otorao, T., 1938- Three cases of cholera In Mukden and their pathological Investigation. J.

Orient. Med., 29(6); 1551-1572. (In Japanese).

Montschadsky, A., 1936. Les Larves des Moustlques (Fa. Cullcldae) de 1'URSS et des Pays Llmltrophes. Izdatyelstvo

Akademll Nauk SSSR, Moscow and Leningrad. 383 pp. (In Russian).

Mori, Kaoru, 1937. Eln Fall von Pityriasis circlnana, Toyama (Pityriasis rotunda Matsuura). J. Orient. Med., 26

(1) 63-71. (In Japanese with German summary)

Mori, Kenltl, 1937- Study of glanders (Report 1-4) J. Orient. Med. 27(2): 95-113; (5): 617-674. (In Japanese with

English summary).

Mori, T., 1937. Hand-List of the Manchurian and Eastern Mongolian Vertebrate, Tokyo. 186 pp. (In Japanese and

English).

Morlkawa, Y., Fukuda, S., 1937. Ueber die Darm-Parasiten Eler, die an "Tukemono" haften. J. Orient. Med., 26(2):

269-276* (In Japanese with German summary).

1937* Parasitic Infections observed In Dairen. J. Orient. Med. 27(5): 859-870. (In Japanese with

English summary).

Morita, Y., 1936- Statistical observation on measles in Dairen. J. Orient. Med., 24(2): 337-360* (In Japanese

with English summary).

Morlwakl, J., Hoshizakl, S., Futagl, Y., 1927- Clinical observations on 615 cases of scarlet fever epidemic In

Dairen, 1926- J. Orient. Med., 7(2-3): 396-397. (In Japanese).

Murayama, M., 1934. Statistlk der dermato-urologischen Krankhelten wahrend elner zehnmallgen medizlnlschen Rundreise

In Manchoukuo. J. Orient. Med., 21(2): 287-296. (In Japanese with German summary).

1938* Endemic dermatitis In Manchuria. J. Orient. Med., 28(1): 137-140. (In Japanese).

Nagahara, 0., 1925. Statistical observations on the pleurltls among children In Dairen. J. Orient. Med., 3(3):

427-432. (In Japanese).

Nagata, S., Hayashl, N., 1934. case of paratyphoid C. J. Orient. Med., 20(4): 537-542. (In Japanese with English

summary).

Nakamura, H., 1930. Litmus agar medium for the isolation of dysentery bacilli. J. Orient. Med., 12(4): 485-491* (In Japanese with English summary).
Nakamura, M., Hirose, M., Tsukamoto, I., Sawal, S., 1938. report on the results of the tuberculin reaction and

microscopical examination of the tuberculous bacilli in the sputum conducted among the

Manchurian primary school teachers. J. Orient. Med., 29(1): 87-94. (In Japanese with

English summary)•

Nakashlma, T., Shikano, Y., 1937. Betrachtungen ueber Pocken und Vaccination in der Antung Gegend in der Mandschurel.

J. Orient. Med., 27(1): 73-84. (In Japanese with German summary).

Nauck, E.G., 1928. Epidemiologle und Tropenkrankheiten in China. Arch. Schlffs. u. Trop. Hyg., 32, Beiheft 5: 1-83.

Neumann, L.G., 1911. Ixodidae, Kbnigl. Preuss. Akademle der Wissenschaften zu Berlin. XV 169 pp.

Nilzawa, S., 1936. Ueber die Dermatomykosen bsd. Favus in dem Lehoshan, Dakushan, Tonrlan und Suplngal in "Manchoukuo". J. Orient. Med., 24(3): 605-612. (In Japanese with German summary).

1938. Ueber die Dermatomykosen in unserer Kllnik, in Llaoyang, Tienring und in elnlgen Japanlschen Militaerreglmentern. J. Orient. Med., 28(6): 1275-1308. (In Japanese with German summary).

Nlshida, H., 1924. Clinical observations of ancylostomiasis in Manchuria. J. Orient. Med., 2(1): 162-169. (In Japanese).

Nlshihori, S., 1932. Malaria in Manchuria and the result of control. J. Orient. Med., 17(3): 469-479. (In

Japanese).

1932. Pleuritls in Manchuria. J. Orient. Med., 17(4): 573-584. (In Japanese with German summary).

1932. Beobachtungen ueber die Schlarlachprophylaxle. J. Orient. Med., 17(5): 795-806. (In Japanese with

German summary).

Nishikawa, N., 1928. case of rabies. J. Orient. Med., 9(3): 481-490. (In Japanese).

Nuttall, G.H.F., Warburton, C., Robinson, L.E., 1908-1926. Ticks. Monograph of the Ixodoldea. Pt. 1-4.

Cambridge, England. 852 pp.

Ochiai, K., 1931. On the epidemiological and clinical observations of encephalitis epldemlca in Dairen during

1919-1926. J. Orient. Med., 14(2): 197-206; (3): 369-382; (4): 482-497; (5): 680-692.

(In Japanese with English summary).

Oga, K., 1933. Epidemiological observation on diphtheria in Dairen. J. Orient. Med., 19(1): 226-228. (In

Japanese).

Ogawa, K., 1929. Beltrag zur pathologlschen Anatomie und pathologischen Hlstologie helm Fleckfieber. J. Orient,

Med., 10(5): 485-506. (In Japanese with German summary).

Olshl, I., 1938. Experimental study of carbon monoxide poisoning of the heart and its effects, with investigation

on the cause of the oshan disease. Gunidan Zassi (Official Publication of the Imperial

Japanese Army Medical Corps), 306:1251-1276. (In Japanese).

Wakabe, S., Hashlmoto, S., 1938- Human anthrax. Gunidan Zassi (Official Publication of the Imperial

Japanese Army Medical Corps), 298: 197-216.

Okabe, K., 1939. On the trematode cysts of the fresh water fishes in north Manchuria. Fukuoka Acta Medica

(Fukuoka-Ikwadaigaku-Zasshl) 32(2): 289-296. (In Japanese with English summary).

Okada, K., 1940. Statistische Studlen ueber die Urogenital-Tuberculose. I. Teil: Innermedlzlnlsche Studie.

J. Orient. Med., 32(2): 421-438. (In Japanese with German summary).

Okamoto, M., 1930. Fecal examinations of 1,026 school children in Dairen. J. Orient. Med., 12(6): 885-886.

(In Japanese).

Okamoto, R., Masayama, S., 1937. Pathologisch-hlstologische Untersuchung elner aetiologlschen unklaren Myokardenschaedlgung in der Gegend von Koshan, Rebez. in der mandschurischen Provlnz Lunkiang.

Trans. Soc. Path. Japonlcae, 27: 390-396. (In Japanese with German title).

Olsoufiev, N.G., 1937. Faune de 1'URSS. Insectes. Dipteres. Vol. 7, No. 2. Family Tabanidae. (In Russian

with German summary)•

Onmyojl, M., Chu, P.S., 1929. On the distribution of tetanus bacilli, particularly in the feces of animals and

in soil in Mukden. J. Orient. Med., 11(6): 761-769. (In Japanese with English summary).

Ono, S., 1935. Studies on the trematodes invading Lymnaea snails as the first intermediate hosts found in the

vicinity of Mukden. J. Jap. Soc. Vet. Sci., 14(1): 24-35; (2): 232-245. (In Japanese with

English summaries).

1938. Studies on warble flies of Manchuria and Inner Mongolia. Kitasato Arch. Exper. Med., 15(3): 199-246.
1939. general study on the cattle files (Hypoderma bovls and H_. llneatum) In Manchuria and Mongolia.

Volumen Jubllare pro Prof. Sadao Yoshlda, I: 272-276. (In Japanese).

Ono, Z.E., 1939* Studies on Manchurian Anoplura. I. Morphological notes on Polyplax splnulosa (Burmeister) from

Manchoukuo. Mushi, 12: 107-111. (In Japanese).

Otomo, T., 1936. Acute hepatitis. J. Orient. Med., 25(5): 1227-1230. (In Japanese).

Ozakl, K., 1930. Result of preventive inoculation for scarlet fever In the South Manchuria Railway area. J-. Orient

Med., 13(6): 729-739. (In Japanese).

1938. Investigation on dysentery. J. Orient. Med., 29(5): 1424-1425. (In Japanese).

Ozakl, Y., Ohtsuka, I., 1935. Epidemiological observation on the-so-called "Manchuria fever" in the city of

Hslnking, Manchoukuo, In 1933. J. Orient. Med., 22(2): 319-332. (In Japanese with

English summary).

Ozasa, T., Takamatsu, H,, Kubo, H., 1937. Ueber eine eigenartlge Dermatitis In der Mandschurel. Trans. Soc. Path.

Japonlcae, 27: 646-648. (In Japanese with German title)

Pope, C.H., 1935. The Reptiles of China, turtles, crocodlllans, snakes and lizards. Natural History of Central

Asia. Vol. 10, New York.

Russell, P.F., Roseboom, L.E., Stone, A., 1943. Keys to the Anopheline Mosquitoes of the World. With Notes on

their identification, Distribution, Biology and Relation to Malaria. The American Entomological Society, Philadelphia. 152 pp.

Ryo, S., 1936. survey of the distribution of helminthic and protozoan parasites among 10,293 Inhabitants of

Fushun. J. Orient. Med., 24(6): 1145-1152. (In Japanese with English summary).

Salki, S., Onmyojl, M., 1939. The first epidemic of human brucellose and its spread in Manchuria. J. Orient.

Med., 30(4): 693-705. (In Japanese with English summary).

Tsukamoto, K., 1939. Three cases of the first recognized human undulant fever in Manchuria. J. Orient.

Med., 30(4): 707-720. (In Japanese with English summary).

Salto, H., 1915. Demonstration von Lelshmanla donovanl. Verhandl. Japan. Pathol. Ges., 5: 41.

Salto, Y., 1935. Intestinal parasites of prisoners in Dairen Prison. J. Orient. Med., 22(4): 693-697. (In

Japanese with English summary).

Sakural, J., Chang, W.W., Klta, A., Kawazaki, S., 1934. Statistical observations of chancre and lymphadenitis

in period of 20 years. J. Orient. Med., 21(3): 591. (Abstract)•

Sano, G., Fukuda, S., 1934. Zur Epidemic von Erythema infektlosum in Korea. J. Chosen Med. Ass., 24(1): 154-166.

(In Japanese with German summary).

Satake, T. et al, 1927. Problems of scarlet fever. J. Orient. Med., 6(l/2): 37-178. (In Japanese).

Scovel, F.G., 1944. Kala-azar: review of its Incidence and epidemiology in China and clinical observations on

585 cases. Ann. Intern. Med., 21(4): 607-627.

Shlma, J., 1924. The Fushun measles epidemic of 1923. J. Orient. Med., 2(3): 427-438. (In Japanese with

English summary).

Shimizu, T., Yano, S., Shlral, S., Kaneko, T., 1925. Intestinal parasites in the vicinity of Mukden. J. Orient

Med., 4(1): 177-180. (In Japanese).

Shoyama, S., Matsuoka, K., Ikarashl, T., Salto, E., 1939. Pathogene Untersuchung der Llppenpomade, welche "Tau

Hung" die Maedchen in entlegenen Gegenden der Nordmandschurel gebrauchen. J. Orient. Med.,

30(4): 567-576. (In Japanese with German summary).

Shrimpton, E.A.G., 1936. survey of the incidence of relapsing fever in China. Chinese Med. J., Suppl•

l: 312-344.

Sparrow, H., 1935. Etude d'un virus typhique d'origlne huraalne isole en Mongolle. Arch. Inst. Pasteur de Tunis,

24(1): 56-64.

Stackleberg, A.A., 1937. Faune de 1'URSS. Insectes Dlpteres. Fam. Culicidae (Subfam. Culicinae). Izdatyelstevo

Akademll Nauk SSSR. Moscow Leningrad. Vol. 3, No. 4, 258 pp. (In Russian).

Suml, I., Kawasaki, S., 1932. Influence of Ascarls infection on the growth of school children. J. Orient. Med., 17(6): 839-845. (In Japanese with English summary).

Suzuki, T., 1923. study of,rubella among children in Manchuria. J. Orient. Med., 1(3): 85-111.
1924. Special causes of Infant mortality in Dairen. J. Orient. Med., 2(3): 367-389. (In Japanese with

English summary).

Takahara, K., 1938. Statistical observation of "pityriasis rotunda (Matsuura)". J. Orient. Med., 29(2): 447-464.

Takahashl, K., Li, T.C., Yuan, C.T., Tsuchlya, K., Ablko, A., 1929. Kleinere Beitraege zur pathologisch-anatomischen

Veraenderung der Druesenpest bei Menschen aus 1928 Jaehriger Epidemie zu Chlen-Chla-Tlen

in Mongolia, China. J. Orient. Med., 11(1): 57-68. (In Japanese with German summary).

Takahasi, H., 1940. Description of five new species of Simullldae from Manchoukuo. (Studies on Slmulildae of

Manchoukuo I). Insecta Matsumurana, 15(l/2): 63-74.

1941. Notes on some species of the genus Cullcoldes from Manchoukuo with description of new species.

Insecta Matsumurana, 15 (3): 80-85.

Takematsu, S., 1933. Statistical observations of the bacillary dysentery prevalent in the Llao-sl region,

Manchuria, and the effect of the dysentery prophylactic preparation. Gunldan Zassi (Official Publication of the Imperial Japanese Army Medical Corps), 237: 369-379. (In

Japanese).

Takeyama, K., 1938. Statistical observations of pneumonia. J. Orient. Med., 29(5): 1385. (Abstract). (In Japanese).

Tanabe, E., Eto, F., Furuki, T., 1939. The iron-content of the grains and vegetables produced in the areas where

Kaschln-Beck's disease is endemic. J. Orient. Med., 31(1): 175-177. (In Japanese with

English summary)

Tanaka, M., 1927. Clinical observations of scarlet fever in Ch'ang-ch'un. J. Orient. Med., 7(2-3): 390. (In

apanese)

Hsu, C.W., Yamaoka, Y., 1934. Statistical and clinical observations of tuberculosis in children in Manchuria. J. Chosen Med. Ass., 24(8): 1118. (In Japanese).

Taylor, H.W.Y., 1931. few facts about the distribution of kala-azar in Manchuria, China Med. J., 45(1): 40-42.

1935. The incidence of certain tropical diseases in Moukden and the surrounding parts of south Manchuria.

Trans.Ninth Cong. Far East. Ass. Trop. Med., Nanking, (1934); 2: 403-406.

Terai, T., 1933. Sur un cas de Cystlcercus cellulosae homlnls. J. Orient. Med., 18(5): 769-772. (In Japanese

with French summary).

., 1934. Ueber die Dermatomycosen in dera neuen unabhaenglgen Staat "Manchoukuo" und ueber die mycologlschen

Studlen an denselben. J. Orient. Med., 20(4): 525-535; 21(2): 277-286. (In Japanese

with German summary).

1935. Ueber Hautpllzkrankheiten und ueber mykologische Studlen 1m Bereiche Mandchoukuos. 5. Mitteilung:

Ueber Tinea imbrlcata. J. Orient. Med., 22(2): 387-402. (In Japanese with German summary).

Teramoto, 0., 1927. Statistical observations of tuberculosis of the joints. J. Orient. Med., 7(1): 55-68. (In

Japanese).

Toda, T., 1936. Tuberculosis in Manchuria and its prevention. J. Orient. Med., 25(2): 213-234. (In Japanese).

Todanl, G., 1933. Clinical report of exanthematous typhus, Mukden local type. J. Orient. Med., 19(5): 945-958. (In Japanese).

Toki, K., 1936. On the dog-bitten patients in Hsinklng and its neighborhood. J. Orient. Med., 24(5): 1041-1050.

(In Japanese with English summary).

Tokunaga, M., 1940. Biting midges from Japan and neighboring countries, including Mlcroneslan Islands, Manchuria,

north China and Mongolia. (Dlptera, Ceratopogonldae). Tenthredo (Acta Entomologlca), (1): 58-100; (2): 101-165.

1941. Biting midges from Manchuria. Insecta Matsumurana, 15(3): 89-103.

Tokuye, K., Ratal, K., 1923. The distribution of the dysentery bacillus in children affected with dysentery.

J. Orient. Med., 1(4): 539-582. (In Japanese with English summary).

Toumanoff, C., 1936. L'Anophellsme en Extreme-Orient. Contribution Faunlstique et Biologlque. Coll. Soc. Path.

Exot. Monograph IV. 434 pp.

Tournler, E., Guenole, A., 1928. Epidemie de dengue hivernale en Chine du nord. Bull. Soc. Path. Exot., 21(8):

617-619.

Toya, G., 1933. Clinical report of typhoid fever in Mukden. J. Orient. Med., 19(5): 945-958. (In Japanese).
Toyoda, T., 1928* Endemic focus of plague and the tarabagan In Outer Mongolia. J. Orient. Med., 9(4): 619-634. (In Japanese)

Tsubozakl, H., 1938. Studies on bacillary dysentery In Manchuria. 1. Types of bacilli, J. Orient. Med., 29(5):

1425. (Abstract). (In Japanese).

1939. Experimental studies on bacillary dysentery. 2. Bacteriological studies of dysentery and dysenterylike disease In Manchuria. J. Orient. Med., 30 (3): 403-440. (In Japanese).

et al, 1937- Dysentery bacillus carriers among school children In Mukden. J. Orient. Med., 27(5): 901.

(Abstract). (In Japanese).

Wang, S.K., Ikeda, K., Sun, P.C., 1937. Dysentery bacillus carriers among the Manchurian "sekkakugyo" In

Mukden. Orient. Med,, 27(5): 901. (Abstract). (In Japanese).

Tsuchlya, K., LI, T.C., 1929* On pest epidemic at Chlenchlatlen, Inner-Mongolla. J. Orient. Med., 10(3): 33-37.

Nagata, S., 1928. On dysentery In south Manchuria, J. Orient. Med., 8(5): 71-85.

1928- report of typhoid fever in south Manchuria. J. Orient. Med., 9(4): 47-52.

Yasumura, T., 1930. On the strains of Vibrio cholerae of the epidemics prevailing In Manchuria In 1929,

especially In Ylngkow. J. Publ. Health Ass. Japan, 6(1): 2-9. (In Japanese).

Tsuda, M., 1936. Trichomonas Intestlnalls. Gunidan Zassl (Official Publication of the Imperial Japanese Army

Medical Corps), 272: 1-18* (In Japanese).

Tsujl, M., Sasaki, T., 1938. Statistical observations on dysentery In Mukden over period of three years. J.

Orient. Med., 29(5): 1423-1424. (Abstract). (In Japanese).

Tsukamoto, K., Lu, T.C., 1938. Statistical observations on pleurisy. J. Orient. Med., 29(5): 1446. (Abstract).

(In Japanese).

Uklta, T., 1930. Manchurian children and diseases. Polyclinlca Dairen, 4: 209-213. (In Japanese).

Urabe, H., 1939. Statistical observations of the typhoid fever epidemic In Dairen 1938. J. Orient. Med., 31(4):

946-948. (In Japanese).

Urabe, K., 1934. Species and distribution of mice In Mukden and Hwal-te. Studies of animals connected with the

carrying of plague. Part I. J. Orient. Med. 21(3): 303-319. (In Japanese with English

summary).

Wang, I.S., 1935. The present situation of trachoma in Manchuria. J. Orient. Med., 22(2): 433. (Abstract). (In

Japanese).

Watanabe, S., Ikeda, K., 1938. Examination for bacillus carriers among the Japanese soldiers. J. Orient. Med.,

29(5): 1432. (Abstract). (In Japanese).

Watanabe, T. 1932. Ohara bacillus In the pediatric cases of dysentery and dysentery-llke diseases in Mukden.

J. Orient. Med., 16: 651-654. (In Japanese).

Wei, Y.S., Hung, P.Y., Liu, W.M., 1938. Statistical observations of smallpox. J. Orient. Med., 29(5): 1430-1431.

(Abstract). (In Japanese).

Wen, C.N., 1933. Etiological studies of so-called "Manchurian fever". J. Orient. Med., 18(3): 345-358. (In

Japanese)

Wu, C.F., 1940. Catalogus Insectorum Slnensium. Dlptera and Siphonaptera. Fan Mem. Inst. Biol., Peiping. Vol. 5, 524 pp.

Wu, C.Y., 1935. The occurrence, distribution and seasonal prevalence of rat fleas In China. Trans. Ninth Cong.

Far East. Ass. Trop. Med., Nanking, (1934)-, 2: 761-771.

Wu, L.T., 1917. North Manchurian Plague Prevention Service. Reports 1914-1917. Peking. 133 pp.

1921. Second pneumonic plague epidemic In Manchuria, 1920-21. Nat. Med. J. China, 7(3): 98-121.

1921. North Manchurian Plague Prevention Service. Summary of eighth annual general report, 1920. Nat. Med

J. China, 7(4): 240-249.

1922. North Manchurian Plague Prevention Service. Reports 1918-1922. Tientsin. 314 pp.

1922. Plague In the Orient with special reference to the Manchurian outbreaks. China Med. J., 36(1): 25-26

1926. Treatise on Pneumonic Plague. Publications of the League of Nations. III. Health. C. H. 474. 466 pp.
1926. North Manchurian Plague Prevention Service. Reports 1925-1926. Tientsin. 360 pp.

1927. The problem of venereal diseases In China. Nat. Med. J. China, 13(1): 109-131.

1928. Hibernation experiments in plague. J. Orient. Med., 9(2): 17-20.

1929. North Manchurian Plague Prevention Service. Reports 1926-1928. Tientsin. 350 pp.

1929. Rodents of Manchuria and Mongolia and their significance in disease. Peking Soc. Nat. Hist. Bull.,

4(2): 95-102.

1930. North Manchurian Plague Prevention Service. Reports 1928-1930. Tientsin. 233 pp.

Pollitzer, R., Lin, C.S., Jettmar, H.M., 1929. Studies upon the -plague situation In north China. Nat. Med.

J. China, 15(3): 273-402.

Yajlma, K., 1935. Un propos sur le pityriasis rubra pilaris, le lichen ruber planus et le lichen ruber acuralnatus.

J. Orient. Med., 22(4): 571-580. (In Japanese with French summary).

Yamada, H., Kawahlto, S., 1939. Statistical observations on the mortality rate of Japanese In Manchoukuo. J. Orient.

Med., 30(6): 1017-1053. (In Japanese with English summary).

Yamada, S., 1938. Tuberculin reaction among Manchurian school children In the southern part of Tohendo. Gunldan

Zassl (Official Publication of the Imperial Japanese Army Medical Corps), 298: 233-240.

(In Japanese)

Yamaglshi, R., Kano, T., 1938. Serological reactions for syphilis among the Manchurian school children In An-shan

City. J. Chosen Med. Ass., 28(11): 1731. (In Japanese).

Yamane, N., 1938. Examination of Manchurian prostitutes for syphilis In 1937. Gunldan Zassl (Official Publication

of the Imperial Japanese Army Medical Corps), 298: 286. (In Japanese).

Yamane, Y., 1938. Studies on the natural Infections with Trlchlnella spiralis. Entamoeba histolytica, Clonorchls

sinensis and Dlrofllarla Immltls on.the street dogs In Mukden. J. Orient. Med., 29: 111-115.

Yamashlta, J., Tosa, K., 1940. Damage caused by ox warbles In Manchuria and some related problems. Oyo-DobutsugakuZasshl (J. of Japanese Society of Applied Zoology), 12(1): 30-38. (In Japanese).

Yamatsuta, H., 1934. Epidemiological and clinical observations on 571 cases of smallpox In an epidemic In Dairen.

J. Orient. Med., 21(3): 491-496. (In Japanese).

1938. Statistical observations on diphtheria. J. Orient. Med. 29(5): 1430. (Abstract). (In Japanese).

Yang, F.H., 1935. Zur Kenntnls der Phlebotomen-Arten In China und zur Aetiologle des Phlebotomenflebers. Trans.

Ninth Cong. Far East. Ass. Trop. Med., Nanking (1934), 1: 495-502.

Yang, T.K., 1928. Problems of cholera In China and Japan. J. Orient. Med., 9(3): 29-34.

Shih, F.H., 1924. Scarlet fever In China. Nat. Med. J. China, 10(3): 153-170.

Yasui, S., Mlmura, H., 1939. Ueber elne Dermatose im lyasakae-Dlstrikt von Manchoukuo. J. Orient. Med., 30(4):

759-773. (In Japanese with German summary).

Yato, M., 1936. Plague control In Kirin Province In 1935. J. Orient. Med., 24(3): 736. (In Japanese).

Yokoyama, T., 1937. Dysentery In Dairen. Part I. Epidemiological survey. J. Orient. Med., 27(2): 131-138. (In

Japanese with English summary).

1937. Mixed Infection of bacillus dysentery and dysentery amoeba. J. Orient. Med., 26(3): 497-502. (In

Japanese with English summary).

1939. Mikrobiologlsche Studlen ueber die Unterdriickung der die Pest uebertragenden Tlere In der Mandschurei.

J. Orient. Med., 31(3): 417-537. (In Japanese with German summary).

Yosezato, M., 1936. Kala-azar along the Mukden-Shanhalkwan Railway Line. J. Orient. Med., 25(2): 235-237. (In

Japanese with English summary).

Suml, I., 1932. Helminth eggs on vegetables In Mukden. J. Orient. Med., 16(4): 493-506. (In Japanese with English summary).

Yoshlno, M., 1938. Ancylostomiasis among"the-factory workers In Dairen. J. Chosen Med. Ass., 28: 1751 (In Japanese).

Yoshltoml, K., 1928. Statistics of meningitis In childhood In Manchuria. J. Orient. Med., 8(6): 585-599. (In

Japanese with English summary).

Young, C.W., 1923. Kala-azar In China. China Med. J., 37(10): 797-802.
Yu, K.Y., 1934. Leprosy among natives of Manchuria. J. Orient. Med., 21(5): 67-71.

1935. Indigenous cases of leprosy In Manchuria. Report of cases. Chinese Med. J., 49(7): 644-651.

Taylor, H.Y.Y., 1931. Notes on leprosy In the three eastern provinces. China Med. J., 45(9): 855-867.

Yugiwa, T., 1934. Trichina found In dogs In south Manchuria. J. Orient. Med., 21(5): 805-810. (In Japanese with

English summary).

Zinsser, H., 1937. The Rickettsia diseases. Varieties, epidemiology and geographical distribution. American J.

Hyg., 25(3): 430-463.
APPENDIX

Death

Rates

per

10,000

among

the

Japanese

population

in

Manchuria

from

1932-1935*

10

15

20

25

30

35

40

45

50

55

60

65

Total

Corrected

Under

Ove

Age

1-4

5-9

14

19

24

29

54

39

44

49

54

59

64

69

70

Ma

Fema

le

Total

Rate

Paras

it

ic

seases

0.17

0.08

2.03

0.02

0.05

0.03

0.0

Tubercu

os

is

17.2

20.

9.8

12.6

37.7

32.8

22.2

19.6

18.

20.0

16.2

23.7

24.7

32.4

35.0

16.3

21

22.5

1.8

21.5

Pulmonary Tb.

7.3

6.5

3.7

7.3

30.

25.5

18.6

16.8

16.0

18.2

14.4

20.9

22.9

30.0

33.5

14.2

16.3

16.

16.2

16.0

Other

Tb.

9.9

13.5

6.

5.3

7.3

7.3

3.6

2.8

2.5

1.8

1.8

2.8

1.8

2.4

1.5

2.0

4.9

6.4

5.6

5.5

Diseases of

Resp.

Organs

188.8

38.

3.5

2.5

7.5

7.3

6.8

6.5

8.

9.4

13.5

16.4

35.5

46.2

87.4

185.9

17.6

16.7

17.

24.6

Pneumonia Bronch

it

is

162.9

1.4

3.0

1.4

4.0

4.2

4.8

3.8

5.

6.6

7.

10.9

21.6

21.

49.5

89.5

12.4

12.4

12.4

16.5

Bronch

18.1

2.6

0.

0.

0.2

0.2

0.2

0.4

0.

0.5

1.0

2.2

7.3

8.7

40.7

.4

.2

.3

2.7

1eur

sy

4.

3.3

0.3

0.9

3.2

2.8

.7

1.2

.7

1.3

2.4

.4

3.

3.2

8.7

8.

2.

2.0

2.

2.3

Others

3.5

0.8

0.

0.

0.

0.

0.8

1.0

1.0

3.0

3.3

8.5

14.6

20.

46.8

1.6

.0

.3

3.0

Diseases of

Di

gest

ive

Org.

87.4

34.4

5.6

3.

5.8

4.7

4.6

4.2

5.5

7.9

12.2

15.9

20.2

34.8

49.5

124.

12.3

.9

12.

17.

Diarrhea Enter

it

80.7

30.6

3.

0.4

0.8

0.6

0.8

0.9

0.6

2.0

3.

9.0

9.8

14.6

67.

6.7

7.0

6.9

9.

Diarrhea,

Ent.

Dysentery

85.4

73.9

9.5

0.8

2.

2.9

2.5

.5

1.3

1.2

3.5

5.0

13.0

13.0

23.3

77.3

12.8

13.

13.

16.6

1nfect

ous seases

142.5

88.8

16.8

5.3

9.4

9.9

9.0

7.6

7.8

7.8

7.3

8.9

12.

22.7

26.2

46.

21.6

21.1

21.4

24.0

TyphoidParatyphoid

0.8

0.7

.4

5.2

4.7

4.0

3.8

4.4

2.8

1.8

2.0

1.8

4.9

1.5

3.0

2.8

2.9

2.6

Sma

pox

12.7

1.

0.2

0.

0.5

0.4

0.8

0.6

0.6

1.8

1.2

1.7

3.3

4.4

2.0

1.2

0.8

.0

1.2

Meas

1es

26.8

13.8

1.4

0.

2.3

2.2

2.3

2.5

Whoop,

cough

1.8

8.9

0.

1.4

2.2

.7

1.9

Scarlet

fever

8.0

11.6

3.3

0.5

0.2

0.6

0.7

0.3

0.8

0.4

2.

2.0

2.

2.2

Di

phther

ia

2.2

3.6

2.5

0.4

0.

0.8

0.6

0.7

0.8

1nf

1uenza

13.

2.

0.6

0.

0.

0.2

0.

0.2

0.

0.6

0.2

2.4

2.9

22.4

0.9

0.9

0.9

.6

Cho

1e

ra

0.

0.

0.2

0.2

0.3

0.9

1.5

0.

0.

0.

0.

Oysente ry

and

Ek

4.8

43.3

6.

0.5

1.0

2.0

1.

0.7

0.4

0.6

1.6

2.0

4.

3.3

8.

10.2

6.

6.2

6.

7.0

Typhus

Fever

0.07

0.

14

0.09

0.05

0.02

0.01

0.02

Sp

rochaetos cterohaemorrh.

0.28

0.02

0.0

0.0

Syphilis

8.9

0.2

0.

0.

0.4

0.6

0.8

1.3

0.8

4.4

0.5

0.3

0.4

0.5

Pyemia

Sepsis

7.6

0.9

0.5

0.6

0.6

0.6

0.9

1.0

0.7

0.3

0.6

0.3

0.5

1.6

0.8

0.9

0.9

0.9

Mycos

0.32

0.02

0.0

0.01

Relapsing

Fever

0.03

0.03

0.02

0.02

rys

pe

as

17.9

0.5

0.4

5.0

1.0

1.0

.0

Po

1i

omye

litis

0.

14

0.0

0.03

0.07

0.05

0.05

Encepha

litis ep.

leth.

0.41

0.02

0.0

0.03

Epid.

Cerebro- spin.

Meningitis

7.0

1.3

0.6

0.4

0.8

1.0

.0

Rab

es

0.08

0.04

0.08

0.02

0.05

0.05

Tetanus

.0

0.06

0.01

0.06

0.04

0.05

0.05

Leprosy

0.41

0.02

0.01

0.03

Other

infec.

is.

0.32

0.06

0.4

0.03

0.04

0.03

0.06

Yamada

Kawahito,1939
APPENDIX

II

I.

Fecal

Examinations for

Intestinal

Parasites in

Fu-Shun*.

Population Group

and

Total

No.

Examined;

Gene

ra

Popu

at

ion

Mine

Workers

Schoo

Child

ren

Prisoners

Out-patients

of

Tien-shing

Hospital

Total

3613

2912

2695

331

400

10293

No.

No.

No.

No.

No.

No.

Ascaris

lumbricoides

152

87.24

2579

88.50

2203

81.70

299

90.30

295

73.70

87

16

84.60

Fe

rx

1i

zed

eggs

2632

72.

85

2048

70.30

1870

69.30

279

84.20

224

56.00

163

69.50

Unfert

1i

zed

eggs

1410

39.03

1529

52.50

1340

49.70

217

65.50

175

43.70

4804

46.60

Hookworms

1360

37.64

2341

80.30

355

13.20

105

1.70

80

20.00

4396

42.70

Ancylostoma duodenale

1339

37.06

193

75.30

326

12.00

99

30.20

80

20.00

4186

40.60

Necator

americanus

208

5.76

408

14.00

87

3.20

18

5.40

13

4.20

765

7.40

Tr

ichocepha

us

trichiurus

1949

53.94

1765

60.60

713

26.40

172

51.90

153

58.20

4932

47.90

Enterobius vermioularis

1.97

13

3.80

33

1.20

24

7.20

2.70

260

2.50

Taenia

solium

10

0.28

0.20

0.20

0.30

0.50

25

0.20

Taenia

saginata

0.08

0.

10

0.20

0.00

H.ymenolepis nana

26

0.72

19

0.60

60

2.20

0.60

0.50

1.00

Hymenolepis diminuta

0.06

0.00

0.

10

0.00

CJlto

Metaqonimus

yokoqawai

43

1.19

0.20

0.20

2.70

108

1.00

Clonorchis

sinensis

0.22

0.

10

0.70

16

0.

10

Fascioloosisbuski

0.06

0.00

0.00

0.00

Trichost

ronqy us

oriental

is

27

0.75

28

0.90

0.20

0.30

12

3.00

84

0.80

St

ronq.y

oides

stercoral

is

0.06

0.00

0.00

0.00

ic

rocoesurn

dend

it

icum

15

0.42

0.00

0.00

36

0.30

Endamoeba

histolytica

771

21.34

889

30.00

401

14.80

100

30.20

142

37.20

2364

22.90

Endamoeba col

1746

48.33

1690

58.00

1271

47.10

19

33.90

17

42.70

5097

49.40

Endo1imax

nana

1646

45.56

1533

52.60

992

36.80

85

25.70

148

39,20

4488

43.60

odamoeba

327

9.05

381

13.00

219

8.

10

48

14.50

19

4.70

1003

9.70

rd

336

9.30

479

16.40

413

15.30

64

19.30

29

7.20

1361

13.20

Chi

lomast

ix

105

2.91

187

6.40

88

3.20

23

6,90

2.70

425

4.

10

Dientamoeba

142

3.93

12

3.60

14

3.50

460

4.40

Ente

romonas

58

.61

0.90

1.00

172

1.60

Embadamonas

17

0,47

0.60

0.50

63

0.60

Trichomonas

hominis

130

3.60

175

6.00

61

2.20

25

7.50

2.00

409

3.00

*Ryo,

1936
53

2.

Fecal

Examinations for

Intestinal

Parasites in

Various Localities in

Manchuria

in

%).

Local

ity

No.

Ascar

is

1umbri- co

des

richo- cepha

us

trichi

urus Hookworms

richo- st

rona

us

Or

enta

1i

Ente

rob

us

ve rmi- cu

1ar

Tapewo

rms

onorch

Metaqon

mus

Paragon

imus

Author

and

date

Exam

Ined

nens

.yokogawa

westerman

Ta1i

en

1919

47.2

42.

17.6

0.

0.2

0.5

1.6

Yoshitomi, 1921

Ta-I

en

2906

57.6

23.4

.0

Mo

wak

Ta1i

en

107

85.0

80.7

50.5

Hiyeda

and

Suzuki

Ta1i

en

326

77.0

42.0

34,0

Saito,

1935

Ta-I

Ie

1026

39.0

12.0

0.5

Okamoto, 1930

a12492

21.6

25.5

10.7

Morikawa

Fukuda, 1937

Ta-I

ie

371

38.6

52.0

15.

Morikawa

Fukuda, 1937

Ta1i

en

381

17.5

15.3

8.

•Morikawa

Fukuda, 1937

Lu-shun

954

87.3

66.5

19.6

Yi

ng-kou

350

51.1

21.4

6.0

8.0

6.5

Kitabatake,1935

Chin-chou

62

45.

25.8

Kitabatake,1935

iao-yang

151

74.8

42.6

61.6

Hiyeda

and

Suzuki

An-shan

151

64.8

21.9

50.3

Hiyeda

and

Suzuki

An-t

ung

120

70.8

70.7

49.2

Hiyeda

and

Suzuki

Fu-shun

44

14

78.0

12.0

13.0

1.5

Co.

Fu-shun

14

79.8

30.7

54.4

Hiyeda

and

Suzuki

Mukden

650

66.0

25.0

0.9

0.3

Shimizu et

al.,

1925

Mukden

308

49.0

9.7

6.8

Ishikawa, 1929

Mukden

316

36.7

37.0

10.

3.1

.8

Ishikawa, 1929

Mukden

32

62.5

16.3

6.3

Hiyeda

and

Suzuki

Ch

'ang-ch' un

85

48.2

30.6

2.4

Hard

350

19.7

4.6

5.

0.8

0.3

0.6

0.6

0.3

0.3

Li

and

Wu,

1927

Eastern

Mongolia

234

60.3

1.6

0.4

4.4

Ishikawa, 1929
54 U. S. GOVERNMENT PRINTING OFFICE 0—1946

LIST OF TABLES

Page

Table 1. Seasonal distribution of dysentery in Ta-llen in

1931-1935

Table 2. Dysentery cases reported by the South Manchuria Railway

Company in 1930

Table 3. Types of dysentery bacilli Isolated in Manohuria

in 1936

Table 4. Geographical distribution of bacillus types in 1936

Table 5. Types of dysentery bacilli in Mukden and Ch'angch'un in 1938

Table 6. Cases of cholera in Manchuria, 1932

Table 7. Seasonal distribution of typhoid and paratyphoid

fevers in Manchuria in 1925-1927

Table 8. Distribution of plague in 1938 10

Table 9. Incidence of malaria along the South Manchuria

Railway in 1925-1930 12

Table 10. Monthly distribution of the malaria cases in

various localities in 1925-1930 13

Table 11. Distribution of malaria cases in 1935-1937 13

Table 12. Monthly distribution of malaria in Fu-shun in

1928-1932 14

Table 13. Relation between symptom of typhus and types of

viruses 17

Table 14. Results of Mantoux tests on students in Ta-llen

and vicinity 19

Table 15. Death rate due to scarlet fever among the Japanese

in Manchuria from 1925 to 1930 21

Table 16. Cases of scarlet fever and deaths during 1935-1940 21

Table 17. Smallpox in Manchuria in 1935-1940 22

Table 18. Cerebrospinal Meningitis in Manchuria from 1935

to 1940 22

Table 19. Trichophytoses and their causative organisms in

Manchuria 25