The 1976 Ramon Magsaysay Award for Community Leadership

BIOGRAPHY of Toshikazu Wakatsuki

His family was well-to-do and he was brought up "lapped in luxury," TOSHIKAZU WAKATSUKI remembers. His parents had met in Yamanashi Prefecture where his father, Kosaku Wakatsuki, was serving as accountant in the administrative office of Yamamiya village and his mother, Aki Mochizuki belonged to a farming family in Chizuka village. Their marriage did not receive approval because his mother was divorced and several years older than his father; consequently the two eloped to Tokyo. There they had four children and the haberdashery his father opened in downtown Tokyo flourished. The youngest of his two sisters and one brother was more than 10 years old when TOSHIKAZU was born on June 26, 1910. By his own account a bookworm since his early childhood, he fared well at the Shinmei Primary School in Shiba Ward of Tokyo where he began his formal education.

In spite of living in the city and running a prosperous haberdashery the family was strongly attached to rural values and passed these to their son. WAKATSUKI’s mother stressed the importance of frugality, and usually served simple meals of little more than rice. His father entertained old fashioned ideas about business and had the countryman's distrust of banks. As a result he kept all his money at home and lost both his money and his business in the 1923 earthquake and fire. He, however, reconstructed his haberdashery and gradually built up again a profitable business.

The Kanto (plain on which Tokyo is situated) earthquake of September 1, 1923 and resulting fires, which destroyed a major portion of Tokyo and killed about 100,000 people, had a profound impact on 13-year-old WAKATSUKI. He observed the mass suffering which followed the holocaust and developed a concern for the underprivileged. During a free examination made of victims of the disaster he himself was found to have tuberculosis and he spent three months in the hospital. There he grew to have a great admiration for doctors.

WAKATSUKI’s formative years were a time of turmoil and ferment in Japan. Societal disquiet was already evident during his childhood, but economic, social and political unrest began to surface more clearly in the period of inflation following World War I. When WAKATSUKI was a teenager attending middle school there was a pervasive sense of crisis and frustration. Strikes, rice riots and student, labor and agrarian movements all contributed to this sense of instability and breakdown.

After finishing the five-year course at Tokyo Prefectural First Middle School (in 1927) WAKATSUKI entered the preparatory Matsumoto High School to study for admission to the university. Instead of attending classes, however, he spent most of his time reading Marx, Hegel and Engels in the original German. Already widely read in the field of Japanese social thought, he had been much influenced by such activists as Toyohiko Kagawa, the socialist, Christian thinker and social worker who was a leader in the labor and farmers' movements of the 1920s. Now Marxist theories made a deep and lasting imprint on his thinking and outlook. His health suffered, however, as a result of his self-imposed rigorous studies and because he had not prepared for the university entrance examinations, he failed on his first attempt.

He succeeded the second time and in 1931 entered Tokyo Imperial University in the Faculty of Medicine. At the same time he became active in the student movement—a primarily clandestine affair because of government proscription—which had a long history of involvement in the labor and farm movements and a devotion to proletarian causes. WAKATSUKI was soon in charge of the Faculty of Medicine's student group within the university's Student Self-Government Association, distributing the student newspaper and participating in student demonstrations on the campus. He and his colleagues were deeply concerned with the growing militarism in the country and Japanese adventurism in China: "The slogans of student demonstrations in those years may be boiled down to absolute opposition to an imminent Second World War," he has written. As a result of his activity in the student movement WAKATSUKI was arrested in 1932 and suspended from medical school for one year.

In the winter of 1932 "police began to clamp down on students in an increasingly merciless manner," he explains, "with the consequence that my colleagues at the university were rounded up one after another. I ran about to the last trying to shun police detectives but, partly because I had suffered lung infiltration, I calmly resigned myself to the inevitable and told police upon my oath that I would be ready for conversion."

At this time Japanese authorities had developed a policy of tenko (conversion) for use against political activists rather than resorting to mass jailings, executions or exile. Tenko was based on the assumption that no "thought criminal" was hopeless and was aimed at pressuring offenders to purge themselves of their radical thoughts. WAKATSUKI like many others went through this process of reevaluating his political beliefs. His announcement of conversion, however, "was no more than a gesture in disguise," WAKATSUKI states. "In no way did I abandon the idea of taking a stand against war and fighting for the poor. But I simply could not go as far as to kill myself at once or put up with every sort of horror and agony in a prison life. I was determined to act upon my earlier resolution to become a physician with the hope that I would one day be able to serve for a democratization of medical care in my country." During the year of his suspension university authorities made it possible for him to pursue self-study of pathohistology at the Department of Pathology.

Although he graduated from the prestigious Imperial University of Tokyo (1935) and was known as a serious medical student, he had a difficult time finding an internship because of his student activities. However Dr. Kikuo Otsuki, head of the Koishikawa Branch Hospital and physician to the Emperor, overlooked WAKATSUKI’s political notoriety and provided him with a place on his staff. It was at this clinic and under the direction of this famous surgeon that WAKATSUKI got his surgical training.

Surgery was not his first choice in the medical field. He had previously been interested in becoming a specialist either in the area of tuberculosis or syphilis, or in becoming a practitioner of labor medicine. And Otsuki was not an intern's first choice; he was known for his strictness and rigorous training and students were said to have become physically sick from fear of him. WAKATSUKI, too, went through periods of disgust with Otsuki's harshness and entertained occasional thoughts of leaving, but in the end he developed a strong admiration and reverence for this strict and demanding teacher.

When he had graduated from medical school WAKATSUKI had been required to go through a physical examination for conscription and had been classed Grade A. Thus, toward the end of 1935, he was ordered to join the Third Infantry Regiment with headquarters at Azabu, Tokyo. In January 1936 he was transferred to a unit of the Kwangtung Army stationed in Manchuria, which had been occupied by the Japanese military in 1931 and renamed Manchukuo. At times, his unit took part in expeditions to stamp out bandits. WAKATSUKI feels that because of his "undesirable" ideological background he did not manage to become a medical officer, but he finally was able to sit for and pass a medical cadets' examination. He was then shipped back to Tokyo for reorientation at an army medical school. Soon after his return, however, he had a relapse of tuberculosis and was hospitalized for six months. Upon receiving a medical discharge from the army in 1939 he resumed to Otsuki's clinic to continue his medical training. Unbeknownst to him Otsuki had been instrumental in his getting the discharge rather than being sent to the war front.

During the period 1939-1944 WAKATSUKI not only continued his training as a surgeon but was involved in research and writing. His article, "Statistical and Clinical Studies of Work Hazards," appeared in 1942 and was expanded into the book Industrial Accidents and First Aid, published the same year. Both dealt with hazards for factory workers.

In January 1944, WAKATSUKI’s work at Otsuki's clinic came to an end when he was arrested by the Tokyo Metropolitan Police Department. The detective who arrested him, WAKATSUKI relates, was an assistant police superintendent who was understood to have rendered meritorious service in what was known in Japan as "the Sorge case—the most notorious spy case to be revealed there in the postwar years—in which the German correspondent and press attaché Richard Sorge, supplied to the Kremlin the top secrets of Japan's highest decision-making body." The ostensible reason given for WAKATSUKI’s arrest was the lines of research work he had conducted at the Department of Surgery of Tokyo Imperial University Hospital, particularly his research on accidents at industrial plants. The detective said that "anti-war wording" has been found at 10 places in his book on industrial accidents and in other discourses, including the one he wrote for his doctorate. He was surprised to learn that the detective had been tailing him for 10 years since his university days and seemed to have "followed every one of the words I had uttered to acquaintances of mine," WAKATSUKI reports. "The reason for my 'conversion' for the second time may be ascribed to my submission to his threat that it was the duty of the police 'to kill ugly mugs like [me], one and all.'" WAKATSUKI was detained for one year, until December 1944, in the Mejiro Police Station in Tokyo. "The unearthly life inmates had to put up with in a wartime police detention house in those years baffles all description," he writes. "Kiyoshi Miki and Jun Togawa, Japan's most celebrated philosophers in those years, fell into the clutches of the police almost at the same time but died of illness after only half a year of detention in the same police station as mine."

Aware upon his release that his possibilities of finding a medical position were limited, WAKATSUKI sought the advice of Dr. Otsuki who suggested a small rural hospital that was seeking two surgeons. Otsuki recognized an imminent end to the war and advised WAKATSUKI to contribute to the reconstruction of Japan by working for the farmers. Therefore, in March 1945, WAKATSUKI set off for Saku Hospital in Usuda, Nagano Prefecture. Usuda was a small town at an elevation of 2,300 feet, with severe winters and temperate summers, in a mountainous rice and fruit growing area northeast of Tokyo.

On arriving Dr. WAKATSUKI found a small hospital supported by a farmers' cooperative. It had—"albeit nominally," he observed—20 beds and he was surprised to be told that it had never accepted any inpatients. Formed little more than a year before, it was housed in an old dormitory of a silk mill. Rooms were of Japanese style, with a tatami floor and shoji screen separations. There were no modern facilities, not even a sterilizer for surgical instruments. The physicians available were an old doctor in internal medicine who had been his senior at the university and a woman doctor fresh out of school. Looking upon his assignment as a surgeon to this backwater facility as a challenge, WAKATSUKI determined to develop a full-fledged hospital with the help of the community whose support he must win.

The state of rural health in Japan was dismal at the time WAKATSUKI started work at Saku Hospital. Health facilities and doctors were few in number and the Japanese farmer, strongly attached to tradition al cures such as bark, herbs and charms, was reluctant to seek medical care. Not only was there the cost and loss of time in the fields to consider, but society had taught him it was noble to suffer; he feared "lost of face" if he admitted to symptoms of physical pain.

The Japanese farmer, however, had long been plagued by various diseases and health problems due to his traditional type of farm work, poor living conditions and poor diet. The patients that WAKATSUKI first saw when he went to Nagano Prefecture exhibited such ailment as lumbago from bending over to plant rice, illnesses from eating too much rice and too many salty foods, and parasitic diseases from working in wet rice fields. During those early days WAKATSUKI was most perturbed by the sight of farmers coming to the hospital when their diseases were in such an advanced state that medical care could do nothing for them. High on his list of priorities, then, was to develop educational programs which would encourage the farmers to come to the hospital or seek medical care before it was too late.

Only three months after arriving at Saku WAKATSUKI performed an operation for breast cancer which was the most serious operation that had been done there. During the food shortage of 1947 he started providing meals for patients. In so doing Saku was the first, outside of government-run hospitals, to include meals as part of hospital services.

In this early period he also formed the first blood bank. In mountain and other remote hamlets immediately after World War II residents "simply did not take up the habit of offering their own blood to sick people in general, not to speak of totally unrelated persons or people who had temporarily settled down after drifting from war-torn cities," WAKATSUKI explains. Blood transfusion, however, was "categorically indispensable" when he began major surgical operations. His answer was to organize war widows into a Society for Transfusion. He had observed that these women were eking out a scanty living, having been offered no government subsidy for loss of their husbands in the war, and membership in the society—giving carefully supervised blood donations at safe intervals—would enable them to make up the deficit between their small incomes from odd jobs and their living costs.

Recognizing the need to demystify the medical profession, WAKATSUKI had windows built into the operating room so that people could watch and listen to the proceedings inside. He added departments of dermatology, urology, and obstetrics and gynecology. In March 1951 a contagious diseases ward was included. Some time before WAKATSUKI had been asked to treat a child with diptheria who was being kept in the contagious diseases ward of the town. Seeing that the child was near death and required surgery, he had the child moved to the hospital where he performed the first operation there for diptheria. He was notified by public health officials, however, that he would be sued for violating the contagious diseases law for removing a patient from the isolation ward. As a result WAKATSUKI began to work with the mayor to overcome the reluctance of the townspeople to get such a ward attached to the hospital. In 1951 a tuberculosis ward was also opened and Saku led the way in providing a ward for mental patients and in introducing cancer treatment in the 1950s.

In his fifth year at Saku, in 1949, WAKATSUKI had embarked on spondylodesis for the first time in all Japan in surgical operations on tubercular spinal caries (decay of the bones). In 1951 he also began to employ vertebrotomy. Though these surgical methodologies became accepted later on he was severely criticized for his use of them. "The primary reason for this harsh censure was because I was not a bone specialist in any sense or an orthopedist," he states. "Another reason may have been because I was a mere physician at a tiny hospital located deep in the mountains. Before World War II surgeons had been banned from operating on the abscess of spinal caries, lest, as was feared, the operation should pave the way for 'the gate to death.' Conservatives in the Japanese Society of Orthopedics might be described as having stood in the way of familiarization with new developments in surgical operations, due to the introduction of antituberculosis agents and antibiotics."

Within a period of 30 years the hospital grew from a small outpatient clinic to a facility with 930 beds, 60 full-time physicians and 300 nurses. Approximately 152,000 outpatients are seen annually and over 10,000 patients per year are admitted. Under WAKATSUKI’s direction the hospital has expanded to include such facilities as a nursing school; a national training center in rural health for doctors, nurses and dieticians; and an Institute of Rural Medicine which carries out research on environmental hazards to farmers. There are two branch hospitals, one established in 1951 and the other in 1960.

WAKATSUKI was instrumental in founding and served as first president of the Japanese Association of Rural Medicine "to bring together physicians working in rural communities all over Japan to promote their common cause. "With unified advocacy of "rural medicine" WAKATSUKI thought he and likeminded colleagues could draw public attention to their contention that the delivery of medical care in the future should be comprehensive in nature. "More than anything," he writes, "I wanted to hoist a banner of humanism in the everyday delivery of medical care." The first national congress of the association held in Nagano City, Nagano Prefecture, in 1952 was rewarded with much success in establishing shared values, problems and goals.

Since 1970 a Saku team has been working on plans for a College of Rural Medicine in response to the growing recognition that doctors must be specifically trained to serve rural communities. Outreach programs and the "total health control program" of Yachiho village are also among developments that WAKATSUKI spearheaded.

Saku is the largest hospital in Nagano Prefecture, the largest of the 118 agricultural cooperative hospitals in Japan, and one of the largest of Japan's approximately 8,000 hospitals. It sits on a rise and is visible for miles as one approaches Usuda, still a small town with a population of only 15,000. Upon entering the hospital the visitor finds a large and pleasing lobby which has educational wall panels dealing with rural medicine. Preventive medicine, personal hygiene and agrochemical poisoning are some of the subjects; artwork by patients and staff decorate other areas. Visitors are impressed by the easy camaraderie which exists between the staff and the patients, and the warm personal atmosphere that pervades the facilities.

Early on WAKATSUKI instituted a 5-3-2 formula for guiding the development of the hospital: five parts of staff activity were to be devoted to the care of inpatients, three parts to outpatients, and two parts to service outside the hospital in the fields of health education, public health and hygiene. With this policy the hospital not only grew into a large modern facility, but added programs to reach out to educate the farmers. As WAKATSUKI has written, health education is important because "there is no fruitful and constructive life without health; cultural flowers do not bloom where the fundamental physiological substructure is left poor in nourishment . . . .If the people can correctly grasp the significance of health, then they will exercise a greater desire for its improvement and for bettering the conditions by which it is governed."

From the beginning WAKATSUKI recognized the vital importance of both curative and preventive medicine, but knew that neither could be simply handed out to rural people. The key to gaining the farmers' support was to educate them to be aware of their needs, of the measures they themselves could take, and of the benefits of modern scientific medical care. He began by encouraging farmers to keep personal health diaries, he instituted the practice of having personal notebooks for recording medical exams and living conditions, he designed physical exercises specifically geared to combat farm labor ailments, and he pushed for changes in dietary customs, away from dependence upon rice and salty foods.

Less than one year after his arrival he organized medical teams to canvass the rural area to survey the health problems, do mass screening and try to motivate the people to improve their own well-being through improved sanitation and better diet. These units have become much more sophisticated since those early days and now have medical equipment such as electrocardiographs and X-ray machines; blood samples are taken which can be analyzed quickly. For about 200 days of the year teams of 16 hospital personnel are out in the villages examining some 200 people daily, 40,000 yearly.

An educational tool WAKATSUKI began to use in 1946 was drama. He organized a group to put on plays which he himself wrote and directed. Aimed at educating the farmers about the need for better medical care, as well as giving information about the diseases common to farmers, these plays enjoyed great success. The farmers were most impressed at seeing hospital personnel traveling on foot (many rural areas were inaccessible by train and cars were not available in the immediate postwar years) to bring them this educational entertainment. Later on WAKATSUKI made educational films as well. To further involve the population he started a "hospital festival" which became an annual event. Movies, lessons on physical exercises, panel displays and tours of the hospital were some of the attractions of these May festivities.

In order to keep in touch with the interests of the community WAKATSUKI designated the first and fifteenth day of every month as "Director's Counseling Day"; such days were set aside so that he could hear about problems from the people themselves. He also met with farmers' wives, youth groups, and agricultural cooperative officials in order to widen his knowledge and understanding of the people of the area.

The "total health control program" for Yachiho, a village of about 5,000 a few kilometers south of Usuda, was initiated in 1959 and is another pathbreaker. This program was instituted because the new policy of the National Health Insurance System required immediate payment in cash for medical treatment. This was particularly hard on farmers with a low cash income and further deterred them from seeking medical aid. Village leaders of Yachiho repeatedly requested government leniency but without success. As an outgrowth of discussions between village officials and Saku Hospital personnel, the "total health control program" was developed which offers the village annual physical checkups and is subsidized by the local community government. In addition to the annual examination, the living conditions of the villagers are surveyed and each resident has a health notebook in which details of his medical exams and living conditions are recorded. Each person also has a notebook which is meant to be used as a personal health diary. Doctors and farmers meet on a regular basis to study the relationship between conditions of rural life and health. A Village Health Committee—composed of representatives from the village council, the village office, the women's association and the agricultural cooperative—studies measures for improving health and makes recommendations.

As a result of this intensive program there has been a drop in the number of persons from Yachiho arriving at the hospital too late for effective treatment, and thus a reduction in deaths. There have been fewer cases of serious diseases requiring expensive treatment, and the per capita medical expenditure in the village has decreased year after year. In addition the analysis of the data gathered from the medical exams plus the surveys of living conditions have yielded interesting and useful findings.

While the program has had some notable successes, there have also been some disappointments. Studies have shown that the people of Yachiho, who have better medical knowledge than their neighbors because of the intensive program, are not necessarily more preventive-health conscious. Also there is an inclination to become lax if the medical subsidy is too generous.

Under Dr. WAKATSUKI’s inspiration Saku personnel and other rural health workers have carried out extensive research and have identified the major health problems of the rural population. In so doing they have contributed a new set of terms to the rapidly expanding medical language of Japan. Some of the specific health problems identified and labeled by WAKATSUKI and his researchers are: 1) nogyobyo, agricultural occupational diseases, such as accidents and pesticide poisonings; 2) nokabyo, agricultural household diseases, arising from poor housing conditions, diet deficiencies and physical and emotional stress; 3) nosonboyo, agricultural village diseases, such as parasitic infestation; 4) health disorders from kachan nogyo (lit. housewives' agriculture by which agriculture in Japan is called as 90 percent of farmers have side jobs and farm work is mostly done by housewives); and 5) nofusho, Japanese farmers' syndrome, manifesting itself in such disabilities as shoulder stiffness, lumbar pain, partial paralysis of the extremities, difficult breathing and insomnia. Nofusho has been found to be a precursor of such medical problems as hypertension, gastritis, cardiovascular and cerebrovascular diseases and premature senility. Research has shown that nofusho is common in rural areas, especially among women, and that it is definitely linked to cold weather, excessive work and fatigue. Other health problems found to be particularly evident among the rural population of Japan include anemia (again especially among women), rheumatic conditions, bronchial asthma and chronic bronchitis.

WAKATSUKI has also become well known for his work on the hazards of agrochemicals to the farmers who use them, as well as to the public which is exposed to them indirectly. In the 1950s he led a crusade, based upon extensive research, against the excessive use of chemicals such as BHC (Benzen, Hexan and Chloride) parathion, folidol and phenyl mercury. Although challenged by manufacturers and some government officials, his campaign eventually won international recognition and the Japanese government began to ban the use of some of these chemicals in 1969. Japan was one of the largest users of agrochemicals, using seven times as much as Americans and five times as much as Europeans per hectare. WAKATSUKI and his colleagues found that certain diseases, such as dermatitis, acute all-body poisoning, eye inflammations and liver problems, come from the chemicals used in farming. They have also found residuals of chemicals in the human body and in water, soil and food products such as rice. Chemicals have been found to be particularly hazardous when used within the poorly ventilated vinyl greenhouses which have rapidly become popular in Japanese farming. This aspect of farming has led rural medical researchers to identify and add a new disease to Japanese medical terminology, "greenhouse sickness," characterized by dizziness, fatigue, headaches and the like. As a result of their studies on vinyl greenhouses, improvements have been made by the manufacturers, e.g., larger greenhouses and the inclusion of ventilating fans.

Other work by rural medical researchers has concentrated on farm accidents which have increased with the progress in mechanization. For example, Saku hospital workers have found a high incidence of miscarriages resulting from vibrations of small motor-driven cultivators. WAKATSUKI repeatedly urges better farmer education in the use of both chemicals and machinery.

A prolific writer, WAKATSUKI has over a hundred publications to his name. Some are very technical but others are written for the layman. He has also written plays and poems dealing with health problems. He has presented papers at numerous national and international medical conferences and has received a number of awards, including recognition by the Japanese Association of Rural Medicine (1962), the Cultural Award from Shinano Mainichi Shimbun (newspaper) (1964), the Minister of Agriculture and Forestry's Award (1970), and in 1972 the Health Culture Award and the Asahi Shimbun Social Service Award. In 1966 he was named honorary member of the Purkiniers Society of Czechoslovakia. In addition to his work as Director of Saku Central Hospital WAKATSUKI has been President both of the Japanese Association of Rural Medicine and of the Asian Chapter of the International Association of Agricultural Medicine and Rural Health, and Secretary-General of the International Association.

Gregarious, well-read and articulate, WAKATSUKI begins his day at 6 a.m. at the hospital. The trim, energetic doctor is busy with few moments to spare until 6 p.m. when he returns home for dinner with his wife, née Tsugie Takahashi, whom he married in November 1935. By 9 p.m. he is back at his office, working on his research and writing and usually is not ready to retire until 2 a.m. The WAKATSUKIS have two children—a son Kenichi, age 35, and a daughter Toshiko, age 30, both of whom are married—and three grandchildren.

Dr. WAKATSUKI has faced many uphill battles during his career with Saku Central Hospital. At first he was considered an outsider and had to win over the rural population, not only to himself but to his approach to health care. He had to combat age-old attitudes toward disease and pain. He and his colleagues have occasionally been accused of "having communist leanings," and in 1950 there was a movement to place the hospital under the control of the prefectural government. This failed after an outpouring of support from the hospital staff and the rural community. The Welfare Federation of Agricultural Cooperatives still retains control. He has also had to face opposition to his research regarding chemical poisoning of farmers and consumers. Yet he has carried on his work tirelessly. He has demonstrated an innovative approach to, and a deep understanding of, rural health problems. He has led in promoting the medical education of the Japanese farming community, and in encouraging the medical profession to engage in rural medical research and in specialized training for doctors serving the rural community.

August 1976
Manila

REFERENCES:

Abrams, Herbert K. "Together with the Farmers, A Report From Japan." N.d. (Mimeographed.)

Mitchell, Richard H. Thought Control in Prewar Japan. Ithaca, N.Y.: Cornell University Press. 1976.

Ong, Jaime. "Toshikazu Wakatsuki: Small Victories." N.d. (Typewritten.)

Saku Central Hospital. Usuda, Nagano, Japan: Saku Central Hospital. N.d. Pamphlet.

Wakatsuki, Toshikazu. Development of Rural Medicine in Japan. Paper presented at the 1st Asian Congress of Rural Medicine, Tokyo & Usuda, Japan, October 24-27, 1973. Pamphlet.

______. Environmental and Medical Aspects of Japanese Rural Life. Special Address at the 4th International Congress of Rural Medicine, Usuda, Nagano, Japan. 1969. Pamphlet.

______. Environmental Pollution and Farmers' Health in Rural Japan. Paper presented at the International Meeting on Human Ecology, Vienna, Austria, September 15- 19, 1975. Pamphlet.

______. Hazards of Agro-Chemicals-An Experience in Japanese Rural Settings. Paper presented at the 10th International Congress on Nature et Progrés, Paris, France, November 15-17, 1974. Pamphlet.

______. "How Should Postgraduate Education on Rural Medicine be Conducted?" N.d. (Mimeographed.)

______. "Medical Service in Rural Communities," in Profiles of Japanese Science and Scientist. Hideki Yukawa, ed. Tokyo: Kodansha Ltd. 1970.

_______. Role of General Pracutioners in Vdlages for Improvement of Health Services for Rural Populahons in Asia. Paper presented at the 5th International Congress of Rural Medicine, Vama, Zlatni, Pjassutsi USSR, May 11, 1972. Pamphlet.

______. Questions in, and Possibilities for, Cooperation Between Asia and Europe in the Improvement of Health Care for Rural Populations. Paper presented at the European Symposium International Association of Agricultural Medicine and Rural Health, Neubrandenbury, German Democratic Republic, September 10-14, 1974. Pamphlet.

______. "Saku Central Hospital's Rural Health Program and Its Challenges." Presentation to Group Discussion. Ramon Magsaysay Award Foundation, Manila. September 3, 1975. (Typewritten transcript.)

_____. Salient Problems of Rural Health in Asia: Paper presented at the 29th National Conference on Rural Health, Phoenix, Arizona, April 8-9, 1976. (Mimeographed.)

______, ed. Rural Medicine in Japan. Paper presented at the 4th Intentional Congress of Rural Medicine, Usuda, Nagano, Japan. 1969. Special Booklet.

Letters from and interviews with persons acquainted with Dr. Toshikazu Wakatsuki and his work. Visit to Usuda and Saku Central Hospital.