The cholera epidemics and the development of public health in Meiji Japan. 2. Strength and weakness of public health politics

We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show that in Japan as well as in western nations public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.     

The cholera: The epidemics and their social-demographic features in Southern Italy

Cholera, as it was regarding each infective disease of which nobody knew its aetiologic agent or, in any way, if its agent was present really, was for the Calabrian people an unknown enemy that nobody knew anything about either its behaviour or the modality of its penetration into the human body. During many years characterized by a medical methodological obscurantism, Calabrian people lived, during the different choleric epidemics, on a daily life based upon the ignorance, and the pseudo-treatments, and pseudo-physicians. During the cholera epidemics, not only the people groped in the dark, but also the governmental authorities were confused because were subdivided into those who supported the theory of the epidemics spread and those who supported the theory of the contagion spread. It must be emphasized that from the XX century, when the pathologies due to natural agents were reduced and were substituted with those due to humans, cholera influenced very much the demography and the social-cultural features of the Southern Italy.     

Medicine, public health, and the ethics of rationing.

Physicians, like all citizens, have communal and private identities, each attending various associated roles and fulfilling diverse obligations. In light of these dual personae, we seek a moral philosophy which encompasses the responsibility for providing care to the patient and at the same time acknowledges the physician's role of arbiter of distributed care. In the traditional doctor/patient relationship, rationing, the admission that health resources are limited and must be distributed equitably by universally accepted criteria, is essentially ignored. When the physician assumes a population-based system of ethics to optimize care for all patients within a group, rationing is embraced as the realistic admission that any social action resides within boundaries--in this case health care resources--and that such restraints have economic consequences that present ethical choices. A common ground to accommodate these dual allegiances is offered by communitarian philosophy, whose outline and applicability is presented here as an alternative to the apparent moral opposition of optimized individual care and the requirement of community-wide distribution of limited health resources.     

The distribution of HIV-1 subtypes in Fukuoka, Japan.

To determine the incidence of human immunodeficiency virus type-1 (HIV-1) subtypes in Fukuoka, Japan, viruses from 41 HIV-1 infected individuals were subtyped. Subtyping by V3-loop enzyme-linked immunosorbent assay (ELISA) showed 31 of the 41 subjects as subtype B (MN type), one as subtype A, one as subtype C, and eight untypable. The subject infected with subtype C was identified as a foreigner; the subtype A subject was Japanese. A phylogenetic analysis of nucleic acid sequences from the env C2-V3 region was also conducted. Genetic subtyping was successful for 25 samples: 23 samples were determined as subtype B, one subtype A and one subtype E. One of the individuals infected with subtype B, as well as the subtype A and subtype E subjects, were not Japanese. This study indicated that subtype B (USA and European type) is still dominant among HIV-1 infections in Fukuoka. Further, no Japanese were subtype E positive, which is increasing in the Kanto region. It is notable, however, that subtype A and subtype C infections, which are rare in Japan, were found in Fukuoka, located far from the metropolitan area of Tokyo.