The Shikoku Association of Agricultural Medicine-Rural Health, which was organized in 1975 as a local chapter of the Japanese Association of Rural Medicine, last year celebrated the 20th anniversary of its existence. At the beginning of a new year, the author would like to look back on the past years and dwell on what it should be in the future.
Agricultural medicine-rural health, which has a character of agricultural medicine and rural health combined in practice, is such a branch of social medicine that its mission is to provide comprehensive medical and health care for the rural populace.
Foreseeing its future requires us to envison what the Japanese rural community and agriculture would be like in the future. There is every indication that agriculture will become more and more specialized and larger in scale from now on. In parallel with this trend, rural medicine will be required more than ever to make an approach to the specialized farmers group and agricultural management group from the viewpoint of agricultural medicine. In the meantime, the rural community will get more mixed in terms of sociology, with an increasing number of inhabitants finding their occupation in other than agriculture, and our preventive health services will become more important. Moreover, care for aging rural inhabitants will become a problem we have to address ourselves to more resolutely.
And lastly, the author would feel like to propose that a rural medical laboratory be establish within hospitals affiliated with the Welfare Federation of Agricultural Cooperatives.

The author participated in a joint project to investigate the health state and urination of people of advanced age. Under this project, commissioned by the National Mutual Insurance Federation of Agricultural Cooperatives (Zenkyoren), a questionnaire survey was carried out on a total of 1, 238 old people (mean age: 75.2 years) in a typical Japanese rural community in flatlands. The results brought out the realities about their health conditions and way of life in full relief.
Well over 90% of those living in their own homes were doing fairly well almost without depending on others, compared with 12.9% of those staying in old-age institution. The need of care for the aged in institutions stemmed mostly from sequela of strokes and bone fractures as well as psychiatric disorders such as nyctophobia, an obsessive, irrational fear of night.
Ambulatory old patients of general hospitals ware as good as those old people at home in terms of independence. Hospitalized old patients were largely between the old people at home and those institutionalized.
However, of those old people who look after themselves in daily life, it was, found, about 20% complained about loss of bladder control. The prevalence of urinary incontinence was 20.5% for men and 25.8% for women.
Geriatric troubles associated with voiding and urination would undermine the old people's quality of life and enervate their will to stand on their own two feet. Understanding the implications of these facts and establishing the countermeasures are crucial today when the nation is graying faster than any society in recent history.

A questionnaire survey was conducted to find out the fact about urinary incontinence in the elderly populace of a rural area in Tokushima prefecture. The survey was part of the study of the health status and urination of the aged, commissioned by the National Mutual Insurance Federation of Agricultral Cooperatives (Zenkyoren).
It was found that 23.6% of the old people, male and female combined, living in their own home have the incontinence problem. The ratio for hospitalized patients was a little lower than this, but the involuntary voiding of urine into clothing and bedclothes was a problem in 27.0% of those staying in nursing homes.
The number of incontinent persons was slightly larger in women than men. It showed a tendency to increase with advancing age.
As for the type of incontinence, urgency and overflow types were common in men, while urgency and abdominal pressure types are predominant in women.
The cause of urinary incontinence was unidentified in most of the cases. Next to the unknown cause came a sequela to cerebral apoplexy. A relatively larger number of incontinence cases among nursing home inmates could be ascribed to senile dementia.
Even among those old people who live in their own home without depending much on their children, more than 20% said they have involuntarily leaked urine. About 30-50% of them confided they wet their pants more than once a day. To them, incontinence is a perennial problem, undermining the old people's quality of life. They wish to go out but cannot help staying at home only to swear at the condition they are in.
In nursing homes, a great deal of time and energy has to be spent for looking after incontinent aged people. The burden of care which falls on nurses and aids is beyond measure. These findings suggest that we should face up to the actual state of affairs connected with incontient old people and care for those people and hasten to frame measures to cope with the situation.

We conducted a questionnaire survey of the state of health and daily living of the people over 65 years of age who live in a commercial district and an adjoining rural area. In this survey, subjects were asked to select answers to multiple-choice questions by themselves. The survey revealed various facts. Among them, our attention was riveted on the fact that loss of bladder control is a serious problem for many of the people of advanced age, especially women. So, we worked toward gaining an insight into the lifestyle of the aged with urinary incontinence.
In both commercial and agricultural communities, predominantly more women than men complained of incontinence. Over 50% of them replied that the frequency of incontinence is once every day, more or less. There also were indications that the inability to control urination indubitably threatens the physical and mental well-being of the old people irrespective of sex. However, as far as women are concerned, problems associated with incontinence are more serious for inhabitants in the farming area than in the commercial district. Our analysis also found notable declines in ADL (activities of daily living) and physical functions among incontinent women in the farming area. We deem it important to reach out a helping hand to them.

This is the third report of the findings of the investigation we made in Tokushima Prefecture as part of a joint research project designed to work up measures against the problems of the elderly with urinary incontinence in rural areas. The project, led by Dr.Kazunori Sugiyama, was commissioned by the National Mutual Insurance Federation of Agricultural Cooperatives (Zenkyoren).
The two previously published reports dealt with (1) independence of the elderly in rural community and urination trouble and (2) urinary incontinence in the elderly populace of a rural area.
Of the elderly men living at home, 20.5% was found to have urinary incontinence and a further 14.4% complained about difficulty in urinating. Those who registered an IPSS count of 10 or over accounted for 20.1% of the urinary incontinent persons. The IPSS showed a tendency to go up with advancing age. To be noted was the fact that there is a regional difference in the average score. It was lower in the mountain villages than in the flat-land farming areas. This suggested that the incidence of prostatic hypertrophy may be low in the mountain villages than in the flat-land areas.
In prostate examination, the use of IPSS is helpful in screening for enlargement of the prostate to some extend. More clinically dependable tools are ultrasonography, cystourethroscopy (cystoscopy) and uroflowmetry. However, whether these tools should be introduced for first-line screening is debatable.
In contrast, blood tests that measure levels of PSA and PAP are not only effective but also feasible for mass screening. Thus, the authors would like to recommend their immediate implementation in health screening programs for the elderly.

Since 1976, allergic contact dermatitis caused by Chrysanthemum morifolium Ramalk (commercial name: Kinriki) occured on the grower in Tokushima Prefecture. Consequently, a systematic study aimed at the isolation of the allergen of the chrysanthemum was udertaken.
The allergens were contained in the fresh juice of the leaves of chrysanthemum and they were of two types: one was water-soluble and the other was fat-soluble, judging from the results of application test of the skin reaction for sensitized guinea pigs.
The fresh juice of the chrysanthemums was fractionated with ammonioum sulfate saturation method and the active precipitates were chromatographed on Sephacryl S-300 and DEAE-cellulose column, successively. The most active fractions contained sugar and protein, suggesting that the water-soluble principles are high molecular glyco-protein. The other hand fat-soluble fraction was obtained from ethyl acetate extract of the supernatant of 65% ammonium sulfate saturation. The extract was chromatographed on silica gel column and on the thin layer to yield 5, 7-dihydroxychromone (I) and sesquiterpens (II-VI). Unfortunately, at that time the sensitization of ginea pigs was unsuccessfuly. Therefore their compounds could not be tested for the allergenic reaction.
When the precipitates of ammonium sulfate were extrcted with ethyl acetate, the allergenic activeity of the precipitates decreased. However, re-addition of the ethyl acetate extracts to the extracted precipitates recovered the activity. Cross reaction between the juice of leaves and sesquiterpene lactone, alantolactone, failed on skin reaction of sensitized ginea pigs.

A 52-years-old female farmer has suffered from bronchial asthma during the last 10 years during the lettuce growing season (NOV.-May). Laboratory test findings showed that her sumptoms were due to type I allergy. Namely, she showed eosinophilia, an increased level of Ig E and an immediate positive reaction to intracutaneous lettuce allergen. But, she gave negative reactions in RAST and immediate skin reaction test to 23 common allergens. By provocation tests she showed positive reactions to both the environment (FEV_1.0-26.8%) and allergen inhalation (FEV_1.0-30.0%), and had amoderate attack 15 minutes after inhalation of undiluted lettuce juice. The allergen was extracted from fresh lettuce juice by Coca's method. The protein concentration of the allergen was 8.74 mg/ml and its concentration in crude juice was 0.874 mg/ml.
Inhalation of lettuce juice during the harvest time was concluded to be the cause of this allergy.
A survey of farmers cultivating lettuce by a questionnaire and by mass physical examination revealed dermatitis as the most frequent complaint, with a similar incidence (7.1%) of respiratory symptoms including rhlnitis. However, further detailed questioning showed that the cause of most respiratory symptoms was not allergic, and the intracutaneous reaction of the farmers to the allergen was similar to that of control subjects who were not farm workers. The positive rate of the skin patch test was significantly higher in farmers growing lettuce than in control who were not farm workers.
Allergic disease caused by lettuce might be generated as allergic dermatitis of type IV. Type I allergy caused by lettuce is rare, but here we reported one case of this rare type.

We have reported that many chrysanthemum- and lettuce-growers have dermatitis caused by juice of the leaves of these plants and that this dermatitis is caused by an allergic mechanism. In arecent questionnaire on the cause of this dermatitis, half the farmers answerd that it was due to agricultural chemicals. Therefore, we tested the farmers by skin patch tests with several widely used chemicals. In the tests, daconil gave the strongest reaction, results being positive in 60% of the farmers. Daconil was very irritative and phototoxic, the percentage of positive reactions in the patch test with 800 times diluted daconil solution of the concentration commonly used being about 30% after 48 hours and about 60% at 48 hours after peeling off the patch.
The parcentage of positive reactions in the skin patch test with several fractions of chrysanthemums on chrysanthemum-growers were significantly higher than non-farm-workers. Similary, tests with allergen extracted from lettuce showed a significantly higher percentage incidence in lettuce -growers than in other subjects. The patch test with 4000 times diluted daconil solution showed ahigher incidence in farmers than in other subjects. Therefore, 4000 times diluted daconil solution seems to cause allergic contact dermatitis in farmers, and as farmers reported, dermatitis seems to be caused by allergy to farm products, and the irritability, phototoxicity and allergenicity of TPN (Daconil).

Three patients with hypersensitivity pneumonitis caused by inhalation of spores of Cortinus shiitake (Lentinus edodes) cultivated in vinyl houses were observed. These three patients developed the disease after harvesting shiitake for several hours in closed frame houses with a heater in the autum and winter. The frames were full of spores of shiitake and the patients suffered from a discordant feeling, systemic weakness, a feeling of cold, fever (over 38 C), a feeling of airway occlusion, a slight cough and sputum. These symptoms disappeared during rest the next day.
Case 1 was examined by the inhalation provocation test with a suspension of shiitake spores and spore-allergen. This test caused several clinical symptoms (fever, airway occlusion and various symptomatic feelings), leucocytosis, decrease of PaO₂ a positive reaction of CRP and X-ray findings (appearance of interstitial pneumonitis shadows).
The 3 patients were considered to be suffering from allergic hypersensitivity pneumonitis due to inhalation of spores of Cortinus shiitake, because of their work, the development of symptoms after work in specific occupational conditions, a positive reaction to precipitating antibody against spore-allergen of shiitake, negative reactions to precipitation antibodies to 11 molds-allergens, various abnormal values in immunological tests and a positive reaction in a provocation test in one case.
In a survey of 45 shiitake-grower, it was found that 6 (13.3%) suffered from respiratory disease. No difference was found in the incidence of intracutaneous reactions to spore-allergen or allergen of dried shiitake in non-farm workers. Among 31 growers of shiitake a precipitation antibody to spore-allergen was observed only in these three patients. These results indicate that an allergic disposition is very important for development of hypersensitivity pneumonitis.

At institutions in 9 areas of all over Japan, epidemiological and clinical surveys and investigations have been performed on the relationship between alcohol drinking and health for inhabitants in agricultural and fishing villages. The ethanol cutaneous patch test showed about 40% ALDH2 defficiency in these subjects. There were remarkable defferences in the drinking behavior between these positive and negative 2 groups. Various factors affecting the drinking behavior of subjects are there congenital diathesis, sexual difference, natural and social differences as well as age and occupation. By drinking, various abnomalities have been observed in various indexes such as medical examinations namely, hepatic functions (γ-GTP, GOT, GTP, etc), lipids (HDL-C, TG, etc), circulating functions (blood pressure, pulse, etc), metabolisms (uric acid, blood sugar, etc), and pancreatic functions. Most of them are risk factors in adult diseases. Accordingly, through collective education for drinking, its effect can be observed earlier and it will be very important to educate individuals for health control.