JANIS 75 CHAPTER XI JOINT ARMY-NAVY INTELLIGENCE STUDY OF KOREA

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• Collection: General CIA Records
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• Document Creation Date: December 19, 2016
• Document Release Date: May 26, 2006
• Sequence Number: 11
• Publication Date: April 1, 1945
• Content Type: STUDY

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IANIS 15
CHAPTER XI
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JOINT ARMY-NAVY INTELLIGENCE STUDY
OF
KOREA
(INCLUDING TSUSHIMA AND QUELPART)
HEALTH AND SANITATION
APRIL 1945
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List of Effecti~~e .Pages, Cha~iter ~~I
CHAIv GE IN
' SUBJECT MATTER EFFECT
Cover Page . -Original
List of Effective Pages and Table of Contents,
Chapter-XI (inside front cover) .Original
Text Ori?;inal
Figure (insert, reverse blank) .Original
Text and Figures Original
Imprint (inside back cover, reverse blank) Original
PAGE NUMBERS
unnumbered
unnumbered ',
pp. XI-1 to XI-2
:Figure XL-1
pp. XI-3 to XI-28
unnumbered
Fable of Contents .
Note: This chapter is based upon material available in Washington, D.C., on 1 March 1945?
I?age
110. INTRODUCTION XI - 1
113. DISEASES
Page
A. Summary XI - 1
A. Diseases of military importance .
. XI - 18
(1) Dysentery (amebic and bacillary) .'
. XI - 18
B. Evaluation .
XI - _1
(2) Diarrhea and enteritis . .'
. XI - 18
ENVIRONMENT
111
XI - 2
(3) Malaria
. XI-1S
.
(4) Venereal diseases !
XI - 19
A. Water
XI - 2
(5) Typhus fever . .
XI -19
(1) Korea proper .
XI - 2
(6) Dermatological diseases
XI - 20
(2) Quelpart Island
(3) Tsushima
XI - 3
XI - 3
(7) Trench foot and frostbite
B. Diseases of potential military importance
XI - 20
XI - 20
B. Waste disposal
XI - 4
(1) Endemic diseases
XI - 20
(1)~Human excreta
XI - 4
(2) Diseases which may be introduced '
XI - 21
(2) Sewage, waste, and garbage
XI - 4
(3) Injuries caused by heat
XI - 21
C. Animals
XI - 4
C. Diseases of minor military importance '
XI - 21
(1) Vectors of disease
XI - 4
(1) Leptospirosis
XI - 21
(2) Dangerous animals
XI - 6
(2) Rat-bite- fever
XI - 21
(3) Pests
XI - 6
(3) Rabies
XI - 21
Pla
D
XI - 6
(4) Cerebrospinal meningitis
XI - 22
nts
.
(1) Pollen-producing plants
XI - 6
(S) Helminth (worm) infections {other.
(2) Poisonous plants
XI - 6
than filari asis)
XI - 22
(3) Medicinal plants
products in relation to health
Food and dair
E
XI - 7
XI - 7
D. Diseases common among the civil population
(1) Acute communicable diseases spread by
XI - 23
y
.
(1) Nutrition
XI - 7
respiratory tract
XI - 23
XI
2
(2) Food supplies
XI - 7
(2) Enteric diseases .
(3) Chronic infections
-
3
XI - 24
PUBLIC HEALTH AND MEDICAL FACILITIES
112
XI - 9
(4) Eye diseases .
XI - 24
.
(5) Nutritional diseases
XI - 24
A. Public health organization
Central organization
(1)
XI - 9
XI - 9
E. Miscellaneous diseases ~.
i
i
XI - 24
XI
24
-
(2) Provincial and-local organization
XI - 10
(1) Act
nomycos
s
-
XI
2
(3) Quarantine organizations
(4) Scope and estimate of effectiveness
XI - 10
XI - 10
(2) Anthrax
(3) Encephalitis letha~~gica (epidemic ''
encephalitis, A encephalitis) !
-
4
XI - 24
(5) Tsushima
XI - 10
(4) Kala-czar
XI - 25
B. Hospitals and medical institutions
XI - 11
(5) Tetanus
XI - 25
(1) Hospitals and dispensaries
XI - 11
(6) Tularemio.. J
XI - 25
(2) Leprosaria
XI - 15
(7) Diseases of cattle -
XI - 25
(3) Medical schools .
XI - 15
(4) Dental schools . ?
XI - 1S
114. RECOMMENDt',TIONS
XI - 25
(5) Veterinary schools
XI - 15
A. Water supply
XI - 25
. (6) Schools of pharmacy
XI - 15
B. Sewage
XI - 25
(7) Laboratories
XI - 15
C. Mosquito control
XI - 25
(8) Mineral springs
XI - 15
D. Fly control
XI - 26
ersonnel
Medical
C
XI - 16
p
.
(1) Physicians.
XI - 16
E. Typhus control .
XI - 26
(2) Dentists
XI - 16
(1) Louse-borne typhus
XI - 26
(3) Veterinarians
XI - 17
(2) Scrub typhus (tsutsugamushi disease)
XI - 2G
(4;) Pharmacists
(5) Nurses
XI - 17
XI - 17
F. Sandfly control
G. Control of plague and other rat- and flea-borne
XI - 26
(6) Midwives
XI - 17
diseases .
XI - 26
(7) Vaccinators
XI - 17
alers
t
l
h
i
8
N
XI - 17
H. Venereal disease control
XI - 26
ve-s
y
e
e
at
(
)
I. Control of schistosomiasis and ancylostomiasis
XI - 26
D. Social-service agencies
XI - 17
'
(1) Japanese Red Cross Society
XI - 17
J. Food precautions ~
XI - 26
(2) Imperial Relief Association
XI - 17
K. Prevention of trench foot and frostbite'.
XI - 26
(3) Goverriment activities
XI - 17
L. Control of in; uries caused by heat ..
XI - 27
(4) Private organizations
XI - 17
(5) Evaluation
XI - 18
115? PRINCIPAL S017RCES
XI - 27
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Chapter XI
HEALTH AND SANITATION
110. Introduction
Page XI - 1
hospitals serve the Japanese first of all, while the Koreans re-
ceive much less modern medical attention.
The total number of qualified physicians in Korea is re-
ported to have been 2,931 in 1938. For the same year, 879
dentists, 494 pharmacists, 1,843 nurses, and 1,978 midwives
were listed.
While the ratio of registered physicians to the total popula-
tion was 8.75 per 10,000 in Japan during 1938, the ratio for
Korea was 1.3 per 10,000 in the same year.
Most diseases that prevail in temperate climates, as well as
certain other diseases that prevail with greatest intensity in
tropical or subtropical regions, occur in Korea.
The most important diseases are enteric diseases, including
bacillary and amebic dysentery, typhoid and paratyphoid fever,
and unspecific diarrhea. Malaria is very common, especially in
the southern part of the country. Venereal diseases are wide-
spread.. Both forms of typhus, the louse borne and the flea
borne, are always present. The various acute communicable
diseases spread. through the respiratory tract (diphtheria, cere-
brospinal meningitis, scarlet fever, smallpox, and others) are
known to be prevalent. There is a high incidence of diseases
of the skin. Heltninth infections prevail throughout the country.
Among the chronic communicable diseases, tuberculosis is
the most important afliiction and affects a large but unrecorded
percentage of the population. Leprosy and trachoma are also
fairly widespread.
Recommendations include proper treatment of water supply,
all of which should be considered unsafe, proper care of waste
disposal, mosquito, fly, and. rat control, measures against lice,
proper handling of food supplies, and supervision of food
handlers. Prevention of trench foot and frostbite as well as pre-
vention of injuries caused by heat also are of importance.
A. Summary.
The present chapter is concerned with the environmental.
and administrative factors influencing health and sanitation,
the medical facilities, and. the prevalence of disease in Korea,
including Quelpart (Cheju-do), and Tsushima.
The environmental factors affecting public health include
water supply, waste disposal, animals of importance to man,
plants, and food.
Water is found in sufficient quantities and all 20 cities
and. many towns have modern waterworks, but even in these
cities, only 20 % to 60 % of the population are supplied by
these facilities. More than 80 % of the total population of
Korea thus depend on wells, springs, creeks, and similar sources
of water, most of which is heavily contaminated. Waterborne
sewerage systems are known to have been established in 18
cities but the majority of the population depends on more
primitive methods of waste removal.
The ordinary Korean native house is built chiefly of mud
or mud and stone, with. a timber framework. Practically all
native-style houses -are single-storied with thatched roofs. The
characteristic system of hearing these houses is by an arrange-
ment called "ondol." The heated air and smoke from the
kitchen fire, passing through horizontal flues. below the mud-
plastered stone floor of the house, escape through a chimney
on the side of the dwelling opposite to the fireplace. This
method of heating is said to keep the house dry and. to be
effective in diminishing somewhat the degree of rat infesta-
tion of the house. It tnay be mentioned in this connection
that Korea has never suffered. from plague.
The standard of sanitation for the Korean population, es-
pecially in rural area , is very low, although the Japanese
police authorities in charge of public health have always been
able to prevent and. check epidemics.
Vectors of disease are numerous and include mosquitoes,
flies, fleas, lice, ticks, water snails, and rodents.
Korea is predominately an agricultural country and cereals
are the mainstay of the diet, followed by legumes and. vege-
tables. Fruit is consumed in small quantities. Food of animal
origin is represented by fish, while meat is occasionally con-
sumed and dairy products play an insignificant role in the
diet of the great. majority of the people.
The actual number of hospitals in Korea is not known but
can be estimated at about 150 to 160 on the basis of the
last official reports.
While hospitals in Japan Proper provided approximately
34 beds per 10,000 people in 1938, Korean hospitals exclusive
of leprosaria provided only about 2.7 beds per 10,000 civilian
population in the same year. Furthermore, while the number
of Japanese patients treated in government hospitals of Korea
during 1938 was 334,438, the number of Korean patients
was 389,739. Assuming that each patient was treated. only
once, it can be inferred that 1 Japanese out of 2 and 1 Korean
out of 56 were treated in these hospitals. In other words, the
B. Evaluation.
As is the case of Japan Proper, no important official statis-
tical data beyond 1940 have been published. The latest public
health statistics of practical value refer to 1938.
Although most observers agree that health conditions in
Korea are less favorable than in Japan Proper, the official fig-
ures for several reportable communicable diseases show a low-
er incidence of these diseases in Korea than in Japan. In
1938, for example, the following number of cases per 100,000
population was listed:.
KOREA 1938
JAPAN 1938
Dysentery
21.9
73.1
Typhoid fever
25.8
58.3
Paratyphoid fever
2.7
8.5
Diphtheria
11.0
.39.4
These figures would seem to show that the incidence of
these communicable diseases is about two or three times as
high in Japan as in Korea. It must be kept in mind, however,
that the relative number of hospital accommodations is more
than 10 times higher in Japan than in Korea. The ratio of
physicians per total population is more than 6 times higher
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Page XI - 2 HEALTH AND SANITATION
in Japan than in Korea. The situation in respect to midwives,
dentists, pharmacists, and nurses is even less favorable in Korea
than is the case of physicians. In other words, as a competent
observer has summarized it, medical facilities in Korea still
do not exist for the majority of the population. The apparent
incidence . of many communicable diseases is so low because :>o
many cases are never? recorded. Most sick Koreans never see a
hospital or a physician and thus lie outside the domain of the
reporting system. On the other hand, it must be conceded that
the Japanese authorities were able to control cholera and Ito
prevent the introduction of plague.
Notwithstanding; the lack of detailed and recent statistics
and the doubtful reliability of available official disease statis-
tics, sufficient information from various sources could be se-
cured to provide an adequate general picture of sanitary and
health conditions up to 1940. While various changes caused
by war conditions may have taken place within the last 4
years, it may be assumed that the health situation has not
changed in any major degree.
111. Environynent
ion in Songj u (Seishu) and '9 unspecified other places. This
would agree with the number of 64 Korean waterworks listed
in the Japan Municipal Yearbook-for 1941 operating in March
:1938. The unofficial Korea Yearbook (Chosen Nenkan) of
:1940 to 1941 lists 81 localities with waterworks, including
cities, towns, and some townships.
TnaLt? XI - 1
WATIiR SUPPLIES IN KOREA
A. Water Supply o f Korean Cities (1937 )
(From Japan Municipal Yearboob: 1940-1941. Population figures ac-
cording to 1940 census from Asahi Nenkan, 1942. The cities are
listed in the official sequence used in the original Japanese statistics. )
(1) -Korea ~iro~er.
The natural water resources of Korea provide an adequate
supply of fresh water, although the annual precipitation is not
considered to be very large and shortages of water supplies
occur from time to time, especially in some of the large cities
and towns. 1'recip:itation varies from 53.5 inches in Wonsan
(Genzan) to 37 inches jn P'yongyang (Heijo); this is con-
siderably less than in Japan and more nearly comparable with
data for the corresponding places on or near the Atlantic sea-
board of the United States. The general character of the country
is mountainous; most of the streams are short and swift, in
conformity with the direction of the mountain ranges and their
lateral spurs, as well as with the relative narrowness of the pen-
insula. This- combined with the concentration of rainfall in the
summer months causes many disastrous floods. The water in
Korea is said. to be generally very hard.
In the rural communities and smaller towns water is taken
from springs, wells, creeks, and rivers, and, as night-soil is
used for fertilizer, most .of such water is contaminated. It is
estimated that approximately 80 % to 85 % of the total popu-
lation is not supplied by water from waterworks.
In 1940 there were altogether 20 cities (fu), 76 towns
(yu), and 2,262 townships (men) in Korea. A11 of the cities
and approximately 75 % of the towns had waterworks (TABLE
XI - 1) . The present number of modern waterworks in Korea
is unknown but presumably amounts to about 85. The most
recent official report (for 1938) listed 74 Korean cities alid
towns provided with waterworks, including those with incotn-
pleted waterworkso In 1937 waterworks were under construc-
*Pigures refer to 1936
**Slow sand filters are reported from several cities, including Kyongsong
(Keijo), P'yong-yang (Heijo), Inchon (Jinsen), ',Wonsan (Genzan),
Kwangju (Koshu), and several others. No reports are available concern-
: ing the use of rapid sand filters.
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TABLE XI - 1 Continued
B. Other Korean Localities Provided with Waterworks.
(Compiled from various sources previous to 1941)
1. Andong (Auto)
32. Kumje (Kintei )
2. Anju (Ansha)
33. Kyomip'o (Kenjiho) (?)
.3. Chaeryong (Baines)
34. Kyongju (Keisha )
4. Changjon (Chosen)
35. Kyongsan (Keizan )
5. Changhang-ni (Choko?ri)
36. Miryang (Mitsuyo )
6. Changsungp'o-ri
37. Nanam (Ranan)
(Choshoho-ri)
38. Nonsan (Ronzan )
7. Chinhae (Chinkai)
39. Pakch'on (Hakusen )
8. Choch'iwon (Chochiin)
40. Pohang-dong (Hoko-do )
9.
Ch'onan (Tenan)
41. Pyoktong (Hekido )
10.
Chongju (Teishu)
42. P'yonggang (Heiko )
1L
Chongju (Seishu)
43. Pukchin (Hokuchin) (?)
] 2.
Ch'orwon (Tetsugen)
44. Naeraro-do (Nairaro-to )
13.
Ch'uji-do (Shashi-to)
45. Sach'on (Shisen)
14.
Ch'unch'on (Shunsen)
46. Samch'onp'o (Sansenho )
15.
Chunghwa (Chawa)
47. Sin'gosan (Shinkozan )
16.
Haeunt'ae (Kaiundai,
Kaiuntai)
48. Sonch'on (Sensen )
49. Songjin (Joshin)
17. Hoeryong (Kainei)
50. Songju (Seishu)
18. Hunghae (Kokai) (?)
51. Sunch'on (Junten )
19. Hungnam (Konan)
5 2. Tanch'on (Tansen )
20. Hwangju (Koshu.)
53. T'ongch'on (Tsasen)
21. I-ri (Ri-ri)
54. Tongnae (Torai)
22. Kanggye (Kokai)
55. T'ongyong (Toes)
23. Kangnung (Koryo)
5cuxE XI - 5. Na figures concerning incidence are avail-
~ble. The only type of importance appears to be infection with
[Y~uchereriu b~ncro f ti. One author reports a', few infections
with. "Filariu ~ierstans" (Acanthodheilonema perstuns), a rela-
tively harmless parasite occurring in tropical Africa, South
America, and probably New Guinea. This statement needs
further corroboration before it can be accepted as the descrip-
tion given applies also= to Microfilaria actoni, found in eastern
India. The filarial larvae migrate into the lymph channels,
blocking these mainly through secondary tissue reactions. This
may lead to a swelling of the scrotum and legs, known as ele-
phantiasis. Man is inoculated with mature larvae escaping into
or onto the human skin from the proboscis of infected mos-
ejuitoes which serve as intermediate hosts of', the organisms.
These mosquitoes have previolusly become infected from in-
~esting the microfilari:ae of the organism swarming into the
peripheral blood of actively infected human subjects, usually
cjuring the night. The principal vectors of filariasis in Korea
FIL.ARIA;51S IN -KOREA
?INDICATES AREAS WFfERE
FILARIASIS PATIENTS WER1=
FOUND, 1327-1928.
KEY TO PROVINCES
~. Hamgyong Pukto
2. Hamgyong Namdo
3. Kangw2Sn Do
4. Ky~ngsang Pukto
~. KyEngsang Namdo
fi. Cholla Pukto
~. Cholla Namdo
$. Ch'ungch'ong Namdo
9. Ch?ungch'ong Pukto
10. Kyonggi Do
If. Hwanghae Do
la. P'ybngan Namdo
13. P'yiingan Pukto
FIGURE XI - 5. Filaria.ris in Koreu (1927, 1928) .
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are Anopheles hyrcanus sinensis, A. albolateralis, A. togoi, Cu-
lex fatigans, C. pipiens pallens, and C. tritaeniorhynchus, Aeries
aegypti, the occurrence of which is doubtful in Korea, is also
an important vector.
(2) Diseases which naay be introduced.
(a) Plague. According to a 1924 sanitary report of the
League of Nations, no indigenous case of plague, either pneu-
monic or bubonic, has ever been reported from Korea. This
statement is corroborated by the official statistics of the Gov-
ernment General. The absence of plague is very remarkable
in view of the close proximity of Korea to territories in which
plague is endemic and. in which pneumonic plague has been re-
sponsible for devastating epidemics. How far this freedom from
plague infection may be attributed to the well organized meas-
ures taken by the local health authorities is difficult to say.
The chief danger has undoubtedly been from the north during
pneumonic plague epidemics. Unsubstantiated reports, more
in the form of rumors, claim that sylvatic plague is found in
Korea and that rare cases of human plague occur, but these
statements could not be verified.. Nevertheless, as rats and fleas
are prevalent and plague is known to occur in neighboring
regions, this disease remains a serious potential threat.
(b) Japanese summer or B encephalitis. This disease has
its greatest incidence between the latitudes of 30 ? N to 40 ? N
in Japan Proper. It is a virus disease believed to be transmitted
by certain mosquitoes, among which Culex pipiens pallens, C.
tritaeniorhynchus, and Aeries togoi are especially incriminated.
Infection occurs from July to September, ending with cool
weather. Morbidity seems to be high in subjects over 50 years
of age. A second attack is possible as no complete immunity
is acquired after recovery. The convalescence period is, as a
rule, protracted. The disease differs from epidemic encephalitis
serologically and also clinically by abrupt onset, less somno-
lence, and less tendency to eye muscle paralysis. It is character-
ized. by high fever and. beclouded consciousness and may be
followed. by paralysis of various degrees and other complica-
tions. Epidemics involving several thousand. people have oc-
curred from time to time in Japan Proper, the last important
known epidemic being recorded in 1937. The case fatality rate
may exceed. 60 ~ . Although epidemics of Japanese B encepha-
litis have not been reported from Korea, sporadic, but not def-
initely verified cases are said to have occurred. The disease
may easily either become introduced or, if already present,
spread out as suitable vectors are found. This disease repre-
sents thus a potential threat as sudden outbreaks may affect
a number of troops.
(c) Dengue. No reports of dengue occurring in Korea in
recent years were found, but one of the principal vectors of
the disease, the Aeries albopictus mosquito, is found and an-
other one, A. aegypti, may be present. The disease could be
introduced from south China, Formosa, the Ryukyu Islands,
and other areas in which dengue is endemic. Dengue or break-
bone fever is a virus disease which is very seldom fatal but
which may incapacitate a large number of persons by sudden
and explosive outbreaks. The possibility of an occurrence of
epidemic waves must be kept in mind, especially since in its
epidemic form this disease appears at a considerable distance
beyond its usual confines.
(d) Pappataci fever (sandfly fever) . This is a virus dis-
ease spread by sandflies. The vector is a species of Phlebotomus,
Page XI - 21
usually P. papatasii, but in China the main vector is P. chinen-
sis. The disease is a fever of short duration, usually lasting 3
days and causing no fatalities, but it has a tendency to. occur
in sudden sharp outbreaks involving numerous persons at one
time. During the period of convalescence the patients remain
greatly weakened for a long time. The disease is known to
occur in north China but because of difficulties in the diagnosis
of the disease and its possible confusion with influenza, the
exact limits of the area in which sandfly fever occurs are not
known. No reports concerning sandfly fever in Korea are
available but the presence of sandflies in some parts of Korea
is suspected and thus the possible occurrence of this disease
or the possibility of its introduction from neighboring China
should not be overlooked.
(3) Injuries caused by heat.
A "form of sun stroke" is said to occur during the hot season
among the natives. Although apparently mild, it may be fol-
lowed by recurrent headaches for years. Heat stroke, heat ex-
haustion, and heat cramps also are known to occur occasion-
ally.
C. Diseases of minor military importance.
(1) Leptospirosis.
In contradistinction to Japan where at least 3 different forms
of leptospirosis are known to occur, the only form of lepto-
spirosis said to be endemic in Korea is Weil's disease (Spiro-
chetal jaundice) , caused by Leptospira icterohaemorrhagiae.
This disease is spread in food or water contaminated by the
urine of infected rats or field voles. Man contracts the disease
by eating or drinking contaminated food. or water and by swim-
ming or wading in water contaminated by rat urine. Weil's
disease occurs generally from July to November and only
rarely in winter. It is a severe form of fever, associated, though
not invariably, with jaundice, enlargement of the liver and
sometimes of the spleen.
(2) Rat-bite fever.
't'his disease, also known under its Japanese designation,
sodoku, is an infection following the bite of a diseased rat. It
has an incubation period of about 2 weeks and consists of
febrile attacks accompanied by a bluish-red rash and a secondary
inflammation at the site of the lesion. It is attended by severe
neuralgic pains. Two forms of rat-bite fever with identical
symptoms exist, one caused by the spirochete Borrelia muris
(Spirocheta morsus muris, Spirillum minus), the other by
Streptobacillus moniliformis. The disease is known to be not
uncommon in Korea but no figures concerning its incidence are
available.
(3) Rabies.
This virus disease is communicated to man mostly through
the bite of infected dogs, but it occurs also in the cat, wolf,
fox, horse, and in cattle. The outbreak may be prevented with
preventive inoculation by the Pasteur method, but once estab-
lished, the disease is usually fatal, death occurring through
paralysis after a stage of painful and violent muscle spasms.
Rabies is reported to be common in Korea and is spread by
the many stray dogs. Because of the prevalence of this disease,
an adequate supply of rabies vaccine should be available for
troops.
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(4) Cereb'ros~inal meningitis.
Cerebrospinal meningitis is endemic in Korea and occurs in
epidemic outbreaks from time to time. From 1929 to 1939,
from 48 to'S17 cases were reported yearly with a case fatality
rate of 50 % to C-?0 %. The last major outbreak of which a
record is available occurred during the years 1934 and 1935.
This communicable disease is likely to cause some morbidity
among the :troops. Statistics concerning cerebrospinal menin-
gitis in Korea are shown in TABLE XI - 9.
(5) Helrrcinth (?worm) infections (other than filariasis).
Helminth infections abound in Korea because of widespread
neglect of sanitation, associated with the use of night-soil as
fertilizer.
Infections discussed here are (a) intestinal worm infections
by nematodes and cestodes, and (b) trematode infections
(flukes) , including lung, liver, intestinal, and blood flukes.
(a) I rttestinal worm infections.
1. NEMA'T'ODE INFECTIONS. Ascarinsis. The large :in-
testinal roundworm, Ascaris lumbricoides, is the most common
intestinal parasite in Korea. It is estimated that more than 95
of the population are infected. This worm, if present in large
numbers, may occasionally cause obstruction of the gastro-
intestinal tract. The worms also may cause malnutrition by con-
suming ingested. food which otherwise would be utilized by
their host.
Hookworm disease (Ancylostominsis).InfeCtions with hook-
worms is frequent in the rural areas of Korea, and it is es-
timated thar. between 25% and 30% of the population are
affected. Both Ancylostoma duodenale and Necator americanus
occur. The: disease causes anemia, loss of strength, breathlc?ss-
ness, and, in extreme cases, edema of the legs. The infective
filariform larvae, which develop in moist soil from the eggs
discharged 'with the feces, enter the human body through the
skin. -Infection occurs most often where the skin of the bare
foot has cpme in contact with soil previously polluted with
excrement of an infected individual. Infection through in?;es-
tion of raa~ food or water contaminated with larvae is possible
but rare.
Others. ~`Iarious less important nematode parasites, includ-
ing the whipworm (Trichuris trichiura) , and the pinworm
(Oxyuris uermicitlaris) , are found. also. Trichinella s(~iralis,
causing trichinosis in man through consumption of under-
cooked infected hog meat, is known to occur in China and may
be expected in Karen. _No definite reports are available and this
parasite presumably is of minor importance in the peninsula.
2. CESTODE INFECTIONS. Three species of tapeworms
are reported from. Korea and all are said to be fairly common.
The prevalent tapeworm is the broad fish tapeworm Diphyllo-
bothrium Tatum. The infection is ,acquired by eating under-
cooked fresh water fishes containing plerocercoid (Sparganum)
larvae. Strictly marine fishes have never been incriminated.
Diphyllobdthrium Tatum and some related species have a com-
plicated life cycle with 2 intermediate hosts. The first inter-
mediate host is a species of Cyclops (a copepod or minute crus-
tacean) . T:he second intermediate host is provided by fresh
water fish :feeding upon the copepods. These fish include the
pike (Esox Lucius), the trout (Trutta vulgaris), the perch
(Perca f luviatilis) , and salmon (Salmo umbin) .Other related
species 'of' bothriocephaloid tapeworms infect frogs as their
second intermediate hosts.
Human beings may also take the place of the second inter-
mediate host by drinking polluted water containing infected
Cyclops and thus acquiring spa.rganosis, an infection character-
ized by the development of typical spargana'' in the muscula-
aure. The region involved becomes swollen,''. edematous, and
'very painful. Intense inflamrriation may result, often in the
immediate vicinity of the eyes. The lesions, when opened, may
contain living or degenerating larvae. Human sparganosis may
:also result from local application of the flesh of infected frogs
'or other vertebrates to the skin in the form of poultices, result-
ing in the migration of the :larvae out of the flesh into the
:human tissues. Applicration of such poultices is said to be in-
cluded in the practices of native-style Chinese medicine as fol-
lowed in various far eastern countries.
The beef tapeworm (Taenin saginata) and the pork tape-
worm (Taenia soliuna) also occur. The presence of additional
species, including the dwarf tapeworm Hymenolepis nano can
be suspected.
(b) Trematode (fluke :infections) . Fluke infections are
common in Korea. 7"he widespread custom of eating certain
:fish, crustaceans, and vegetables raw or in an undercooked con-
dition, and the use of untreated water for drinking or bath-
ing purposes account for thc: prevalence of these infections
among the natives. All flukes undergo a complicated life cycle,
with a water snail as first intermediate host '.for the first-stage
larva known as miracidium. Iti the mollusr_an' host the embryos
develop into tailed larvae or cercariae which break out and be-
come free-living organisms .infecting a second intermediate
host to become metncercarine, except for the blood flukes or
schistosomes which, after leaving the snails, directly invade the
definitive host, usually through the skin.
1. PARAGONIMIASIS (LUNG FLUKE '.INFECTION) . In-
fection with the luni; fluke Parngonimus evestermani is wide-
spread and represents the most common fluke infection in
Korea. It is acquired by ingesting fresh water crab or crayfish
-meat in a raw or insufficiently cooked condition. The first inter-
- mediate host is provided by various snails of-the genus Melanin,
the crustaceans reprei>enting the. second intermediate host. Nat-
Ural definitive hosts ether than man include ',rodents, cats, and.
dogs. The .eggs of the parasite, coughed up and expectorated or
swallowed and passed in the feces, are the source of reinfection
for the intermediate hosts. Human pollution of water is prob-
ably less important than that by reservoir hosts. In the defini-
tive host the swallowed larvae pass from the, intestine into the
lungs where they reach maturity and cause tubercle-like infil-
tration of the lungs, as well as abscesses. Fever, a chronic cough,
and the spitting of blood are prominent symptoms which may
simulate tuberculosis. Paragonimiasis is also known as endemic
hemoptysis on accowzt of these symptoms. The patients usually
become very emaciared and the disease may become fatal un-
less treated. In 1923 the number of persons', in Korea infected
with lung flukes was estimated to be 30,000. In 1924 the spread
of paragonimiasis became so alarming that the Government
General issued an order prohibiting the catching of and trade
in "mokuzu" and "zari" crabs which the Koreans were- in the
habit of eating raw. In 1934 this order was rescinded and simul-
taneously instructior,~s were issued by the provincial governors
to the effect that the crabs were to be eaten only after thorough
cooking. No recent figures on the incidence of paragonimiasis
are available.
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2. INTESTINAL FLUKE INFECTIONS. Two Species Of
intestinal flukes are fairly common in Korea, Heterophyes hete-
rophyes and Metagonimus yokogawai. The infection is acquired.
by ingesting the raw flesh of fresh or brackish water fishes,
fresh or salted. The most important second intermediate hosts
for Heterophyes heteropi~yes are the mullet (Mugil cephalus),
and an Acanthogobius species. The molluscan first intermediate
host is a brackish water snail Tymphonotomus microptera. The
second intermediate host for Metagonimus yokogawai is pri-
marily the Oriental fresh-water trout Plectoglossus altivelis, but
other fresh-water fishes also may be infected. Snails of the genus
Melanin are the first intermediate hosts for this parasite. In roan
both flukes invade the walls of the small intestine, causing diar-
rhea and possibly more severe local symptoms. Water pollu-
tion provides a continuous source of infection. The eggs of
both flukes are very similar and. accurate diagnosis must depend.
upon examination of evacuated flukes.
A third intestinal fluke, Fasciolopsis buski, occurs in Japan
Proper and. China and also may be present in Korea, but specific
reports are not available. This fluke may in severe cases pro-
duce abscesses and acute intestinal obstruction. Generalized
-edema and severe abdominal pain together with toxic diarrheas
are common symptoms. Various snails serve as first intermediate
hosts for the immature forms, the second. intermediate hosts
being represented by water plants. The infection in man is as-
sociated with the consumption of raw pods, roots, stems, or
bulbs of various water plants in the regions where the mollus-
can hosts abound.
3. CLONORCHIASIS. This disease, caused by the liver
fluke Clonorchis sinensis, is also fairly common in Korea but
much less widespread than paragonimiasis anti intestinal fluke
infection. The adult fluke reaches the bile passages of roan,
causing enlargement of the liver, edema, and diarrhea. The
eggs are passed out with the feces. The infection is acquired
by eating raw or undercooked fresh water fishes in which the
cercariae are encysted. Snails of the species Bithyhia represent
the first. intermediate hosts. Fasciola hepatica, the sheep liver
fluke, occasionally infects man and may cause symptoms some-
what similar to those of clonorchiasis. The sheep liver fluke is
acquired through the ingestion of infected green vegetables
which carry the encysted metacercariae and represent the second
host of the parasite. Various snails of the genus Limnaea are
the first intermediate hosts. Fasciola hepatica occurs in Korea
but seems to play only a minor role. Infection with liver flukes
is, as a rule, a more serious disease than intestinal fluke in-
fection.
4. SCHISTOSOMIASIS (BLOOD FLUKE INFECTION) .
The oriental blood fluke Schistosoma japonicum occurs in Korea
but is said to be infrequent. The infection with the parasite
may be acquired by drinking polluted water or by merely wad-
ing through or bathing in water infested with the parasites. In
the human body the parasite is carried into the liver circulation.
Rashes, fever, pain, and enlarged liver and spleen result. Eggs
are deposited in the smaller veins of the intestinal wall and
break through into` the lumen of the intestine. The eggs ex-
creted. with -the stool are hatched and the larval forms invade
snails, the snail Katayama (Oncomelania) nosophora being one
of the most important hosts. Within the snails, fork-tailed cer-
cariae develop which leave the snails and attack man, rodents,
or domestic animals, whose unbroken skin they can perforate.
D. Diseases common among the civil population.
(.l) Acute communicable diseases spread by the respira-
tory tract.
Acute communicable diseases of this type, including pneu-
monia, influenza, diphtheria, whooping cough, measles, scarlet
fever, cerebrospinal meningitis, anterior poliomyelitis, small-
pox, chickenpox, and mumps occur throughout the whole of
Korea. On account of the inadequate public health and medical
facilities, accurate estimates of incidence cannot be given. Con-
cerning some of these diseases the following additional informa-
tion is available.
(a) Diphtheria. Diphtheria is said to be very common
among the civil population and reported cases indicated that
up to 1938 it was increasing. In 1937, 2,361 cases with 608
deaths were recorded and case fatality rates for persons over
12 years of age were from 21 % to 29%. In 1938, 2,490
cases with 513 deaths were listed, decreasing to 1,380 cases
with 247 deaths in 1939. Statistics concerning this disease are
shown in TABLE XI - 9.
(b) Whooping cough. The morbidity from this disease is
stated to be high.
(c) Scarlet fever. This disease is also frequent, and from
1929 through 1937 the annual number of cases varied from
937 to 2,190, with case fatality rates of from 8% to 20%.
The reported figures for 1938 and 19.39 show a decrease both
in incidence- and. case fatality rate. Statistical figures concerning
this disease are shown in TABLE XI - 9.
(d) Cerebrospinal meningitis. This disease is discussed
above among diseases of minor military importance (Topic
113, C, (4) ).
(e) Smallpox. Smallpox occurs regularly but the enforce-
ment of country-wide vaccination by the Japanese has done
much to reduce the prevalence of the disease. It is stated that
8,321 cases were reported in 1921. In 1936 there were'1,400
cases with 371 deaths, and in 1937 there were 205 cases with
!14 deaths. The case fatality rates have varied from 20 % to
27 %. The available figures for 1938 are exceptionally low
but may be inaccurate (30 cases, 10 deaths) . An epidemic is
reported to have occurred in 1940. Properly performed vac-
. cination provides satisfactory protection but in Korea the qual-
ity of the vaccine lymph presumably is dubious at times, and
some of the lay vaccinators may be inadequately trained. The
number of vaccinations performed each year since 1911 has
varied between 1,300,000 and 2,200,000. Statistics coricern-
ing smallpox are listed in TABLE XI - 9.
(2) Enteric diseases.
(a) Typhoid and paratyphoid fever. Typhoid and para-
typhoid fever are prevalent throughout Korea, typhoid fever
being the most common of the serious enteric diseases in the
peninsula. From 1929 to 1938 there were from 5,417 to 7,954
cases reported annually with a case fatality rate of approxi-
mately 17 %. The number of reported paratyphoid fever cases
varied between 309 to 707 annually during the same period.
with a case fatality rate of approximately 5% to 8%. The
available figures for 1939 show a much lower incidence but
may be incomplete or inaccurate. The fact that these cases of
typhoid and paratyphoid fever were only the recorded ones
would give the erroneous impression that the morbidity rates
for these diseases would be lower in Korea than in Japan. It
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is believed by most observers that many such cases are not: re-
corded and that the incidence of these diseases i much higher
than the official figures would seem to indicate. Typhoid and
paratyphoid fever are especially prevalent in the summer and
fall. Statistics .concerning these diseases are shown in TABLE
XI-9.
(b) Others. The various intestinal diseases discussed above
as of military importance, including amebic and bacillary
dysentery, various forms of diarrhea and enteritis, and food
poisoning are very common among the civil population.
(3) Chronic infections.
(a) 7"uberculosis. Tuberculosis is very widespread. among
the civil population and reports indicate that the disease is in-
creasing in prevalence. It is present in all forms, including cu-
taneous, bone, joint, intestinal, and pulmonary tuberculosis,
the last being the most common. The bovine type of tuberai-
losis also is known to occur. Crowding in homes, promiscuous
spitting, general lack of hygiene, and undernourishment are
the chief causes of the widespread occurrence of the disease.
In Korea it is practically impossible to remove a tubercu]!ous
patient to : a hospital unless he is in the last stages; usually he
remains at home, sleeping side by side with other members of
the family in a closed and crowded room. No statistics con-
cerning the prevalence of tuberculosis in Korea are available.
The official number of deaths from tuberculosis recorded for
1939 is 1:L,706, but even Japanese comments state that in
view of the pecuaiar conditions obtaining in Korea, this figure
is inaccurate and far below the actual total. It is estimated
that the true annual number of deaths caused by tuberculosis
exceeds 50,000. This would at least correspond to a death
rate of more than 20 per 10,000 population and be equal to
the figure recorded for Japan Proper. It may be assumed that
the actual death rate from tuberculosis in Korea is much
higher than the corresponding figure for Japan. Japanese
sources estimate that the number of Koreans suffering from
tuberculosis amounts to approximately 470,000.
(b) .e~rosy. Leprosy is very widespread in Korea, es-
pecially in the south of the peninsula. It is estimated that there
are between 20,000 and 25,000 lepers in Korea. Official sta-
tistics for 1.939 list 14,438 cases in advanced condition. Segre-
gation of advanced cases is partly enforced, but as yet sufficiient
facilities are not available for the isolation of all patients in
leper coloflies. In 1940 more than 5,000 cases were cared for
in the Government Leprosarium on Sorok-to (Shoroku-to or
Little Deer Island) off the southern coast of Korea, and ap-
proximately 1,900 to 2,000 were in the mission operated col-
onies at Taegu (Taikyu) , Yosu (Reisui) , and Pusan (Fusan) .
Most of the lepers belong to the poorest classes of the popula-
tion.
(4) Eye diseases.
Trachoma is prevalent in Korea and the pannus, entropion,
trichiasis, and corneal ulcerations which it causes are responsi?
ble for many instances of poor vision and blindness. Other
causes of poor vision and blindness are smallpox and gonor-
rheal ophthalmia. Other types of purulent conjunctivitis, such
as that caused by Koch-Weeks bacillus (Hemo~hilus in f luen-
x~e) also occur.
(5) .Nutritional diseases.
(a) Beriberi.:Beriberi, caused by a lack of Vitamin B,, is
characterized by polyneuritiis with frequent paralysis of the
legs, edema, and cardiac symptoms which may result in heart
failure. This disease is said. to be relatively more prevalent
among the Japanese residents of Korea than among the na-
tives. In normal times the Japanese diet 'often consisted al-
most exclusively of white rice deprived of its vitamin contents,
while the Korean diet is better balanced. No figures concern-
ing the occurrence of beriberi in Korea' are available but
famine and war conditions tend to raise the incidence of this
disease to a considerable extent.
(b) Other avitaminoses. Scurvy is sometimes observed in
Korea, but pellagra is rare. Rickets, nutritional edema as a re-
sult of malnutrition;, and xerophthalmia, a dry condition of the
eyeball, also are seen, but figures or estimates are not available.
(c) Spree. This is a chronic .deficiency state marked by
sore mouth, periodic diarrhea with frothy 'stools, emaciation,
and anemia. In severe cases it may be fatal. 5prue is now recog-
nized as a deficiency state occurring chiefly in hot countries
and often as a sequel to .chronic -dysentery. "T"his disease is said
to be common among Occidentals in Korea.'',One observer with
experience in Korea points out that a number of cases later
proved to be chroriic amebic dysentery had been reported as
spree and takes the view that spree is comparatively rare
among Occidentals in Korea. "',
(1) Actinomycosis.
Actinomycosis, a fungus infection which may affect the
skin of the jaws and neck, the mucous ',membrane of the
mouth, and also the lungs, liver, and intestines, seems to be
rare but is said to be found occasionally in Korea.
(2) Anthrax.
Anthrax is caused. by Bacillus anthracis ahd is contracted by
man from infected cattle, sheep, horses, hogs, and goats, either
directly from the living animals or from the hides, wool, or
other parts of the cadavers. It is characterized by ulceration and
swelling at the point of infection. Rapid collapse and death will
frequently ensue. Cases are ]mown to occur!. in Korea and the
disease is reported to prevail among the ca>