III Trends in Public Medical Institutions
1 Public Hospitals in the Early 1950s
There were many public hospitals (74) in Hiroshima Prefecture from 1950 to 1954 without counting the hospitals seized by the occupation forces.31) There were many hospitals despite continued economic hardships because the government responded to the prefectural residents’ request for hospitals and diverted military hospitals and the Japan Medical Treatment Corporation hospitals to national hospitals, the Hiroshima Prefectural Medical College Hospital and other prefectural hospitals. Hospitals were also established by local governments and health insurance associations to effectively implement medical insurance, by agricultural cooperatives to provide better medical services for agricultural communities, and by corporations to maintain the health of their employees. While many of these hospitals were established in Hiroshima City and other war-damaged cities, hospitals were established to cover rural communities as well.
What requires special mention for medical institutions that opened in Hiroshima City in the early 1950s is the Social Insurance Hiroshima Citizens Hospital. Since before the war, opening a city hospital was a long-standing issue for the City of Hiroshima; but with the city reduced to ashes from the atomic bomb it was difficult to realize this dream over the years. The City Council’s Health and Welfare Committee, which met on November 22, 1948, requested the city authorities, specifically the Public Health Division, to conduct research and surveys to develop a plan for opening a city hospital.32) This rekindled action for opening a “City Hospital.” By 1949, however, economic difficulties had intensified, and it became difficult for bonds to be issued to establish a City Hospital. No further concrete action was taken.33)
Hiroshima Prefecture, aware of the difficult medical situation in the City, submitted an application to the national government to bring a “social insurance hospital” to Hiroshima City. The Ministry of Health and Welfare was building social insurance hospitals to provide examinations to persons insured under the government health insurance. The City of Hiroshima was asked by the Ministry of Health and Welfare to submit information on establishing a social insurance hospital. The City proposed reorganization of the Hiroshima Municipal Funairi Hospital. As requested by the ministry, Hiroshima Prefecture presented the city with four conditions on March 25, 1950, including 1) the site should be in the center of the City, with convenient transportation access, and be 2,000 to 3,000 tsubo (6,612 to 9,918 square meters), and that 2) the cost for establishing it (including for medical equipment) should total 20 million yen.34)
When the City of Hiroshima learned of these conditions, it strengthened its intention to open a social insurance hospital. It soon selected four candidate sites: 1) the Funairi Hospital site, 2) Moto-machi (green area, the current site of the hospital), 3) Moto-machi (green area, municipal housing, etc.), and 4) the planned site for building Otemachi Elementary School. The areas were inspected on August 15, 1949 by Iwao Yasuda, a Hiroshima native and head of the Ministry of Health and Welfare’s Health Insurance Bureau, and he concluded that the second site, which would later be the hospital site, was the most suitable. However, the site was slated to be a soccer field for the sixth National Athletic Meet, scheduled to be held mainly in Hiroshima Prefecture in 1951. Opposition was strong, with people saying that they had conducted a careful investigation and had finally settled on Moto-machi for the soccer field, and that this was an auxiliary condition for attracting the national athletic meet.35) However, due to its ease of transportation access, the Moto-machi site was the irreplaceable, “absolutely ideal site.”36) On October 17 the City of Hiroshima told the Ministry of Health and Welfare the they had decided on site No.2.
The difficult problem of selecting the location was resolved, and plans for the social insurance hospital progressed. On January 21, 1951, the memorandum on the establishment of a social insurance hospital was exchanged between the City and the Ministry of Health and Welfare.37) According to this memorandum, the City of Hiroshima would be responsible for securing 4,000 tsubo (13,233 square meters) of land for the site of the hospital, at Moto-machi 1-banchi; the Ministry of Health and Welfare would bear the construction costs up to the limit of 30 million yen in fiscal year 1951; and the Mayor of Hiroshima would be entirely responsible for the hospital’s management.
On April 18, 1951, construction started on the entrance, examination, and administration wings and was complete on June 30, 1952. After just two months of preparation, the Social Insurance Hiroshima Citizens Hospital was opened on August 11. The hospital started small, with four departments, 89 beds, and 59 employees, but it gradually expanded its facilities and scale. It has become one of Hiroshima’s iconic medical institutions.
2 Public Hospitals from 1955 to 1964
From 1955 to 1964 there were 85 public hospitals in Hiroshima Prefecture,38) which means that only 11 were added compared to the early 1950s. This was because the massive reformation of the medical system after the war was mostly settled. However, although the number was small, national health insurance hospitals established by towns and villages, hospitals run by agricultural cooperatives and by mutual aid associations, and company hospitals continued to be opened. New kinds of hospitals also appeared with rapid economic growth, such as the Chugoku Rosai Hospital (run by the Labour Welfare Corporation), the Fukushima Hospital (run by a consumer cooperative), and the Kure City Medical Association Hospital (run by a medical association). As the increase in the number of hospitals leveled off, the number of beds of the hospitals in urban areas increased.
Hiroshima University’s Faculty of Medicine was moved to Hiroshima City on October 1, 1957, with the closure of the National Sanatorium Hiroshima Hospital on September 30, 1956 and opening of the National Kure Hospital on October 1. These were major changes that would lead to “the establishment of a new medical structure” in Hiroshima Prefecture.39) The prime mover behind this was the Hiroshima Prefectural Medical School, the predecessor of Hiroshima University’s Faculty of Medicine. Prefectural residents had hoped for a medical school to be opened for many years, and it was finally approved on February 13, 1945. The opening ceremony for the school was held on August 5, and it was evacuated on the same day to Korinbo Temple in Odamura in Takata-gun. So, the majority of the teachers and students escaped the calamity of the atomic bomb on August 6. An entrance ceremony was held on August 8, and classes began. However, the Minami-machi Campus (the former site of the Hiroshima Prefecture Normal School) and the adjunct hospital in Kako-machi (the former Hiroshima Prefectural Hospital’s facilities which had been transferred to the Hiroshima Prefectural Medical School on April 1, 1945) were burned down from the bomb. There was no place for the school to return to in the city.
For this reason the Hiroshima Prefectural Medical School was transferred to the site of the former location of the Yasuura Naval Training Corps in Yasuura-cho, Kamo-gun on December 6, 1945, where classes were resumed. There were few facilities for medical education, and Hiroshima Prefecture considered that it would be difficult for the school to be upgraded to a medical college in that situation and that the school could not continue. So, the prefectural government asked Kure City (where the former Navy hospital facilities remained) for cooperation. As the City of Kure, which had hosted the Navy and had lost sight of the its reason for being after the defeat in the war, attempted to convert its former naval facilities into facilities for peaceful uses, the city immediately promised to collaborate.40) Preparations were made to establish a campus and an adjunct hospital. On March 10, 1948, the establishment of the Hiroshima Prefectural Medical College was approved, and the college opened in Kure City on April 1, 1948.
The Hiroshima Prefectural Medical College, which had secured a location in Kure City, further developed its facilities and expanded its organization. Then, when Hiroshima University’s Faculty of Medicine was established, the Hiroshima Prefectural Medical College started a gradual process to merge with Hiroshima University’s Faculty of Medicine on August 1, 1953. In this situation, the opinion that relocation of the campus to Hiroshima City was necessary for further development grew stronger. To this, Kure City asked relevant parties to keep the faculty in Kure and expand and strengthen it, as Hiroshima University’s Faculty of Medicine was now “a symbol of Kure, a cultural city.” 41)
Eventually, it was decided that a national hospital would be invited to Kure City, and the university’s adjunct hospital in Hiro-machi would remain as a branch hospital of the university. The National Sanatorium Hiroshima Hospital was closed on September 30, 1956, and its staff and patients were transferred to the facilities of the former Kure Naval Hospital, which had been returned to Japan in June of that year by the British Commonwealth Forces Korea. In this way, the new National Kure Hospital was opened. The Hiroshima University’s Faculty of Medicine and its adjunct hospital were transferred to Kasumi-cho, Hiroshima City on September 30, 1957. This move shifted the center of medicine in Hiroshima Prefecture from Kure City to Hiroshima City.
3 Public Hospitals from 1965 to 1974
There were 75 public hospitals in Hiroshima Prefecture from 1965 to 1974, nine less than the preceding decade.42) While the overall number of medical institutions was increasing, along with the expansion of private hospitals, the number of public hospitals declined due to the closing of prefectural hospitals that specialized in tuberculosis, those run by towns and villages in rural areas, and national insurance hospitals.
While there was a decline in the number of medical institutions in this decade, the Asa Health and Welfare Co-operative Asa Seikyo Hospital opened in 1971 in Asa-gun, a suburb of Hiroshima City, which had an increasing population. This trend of concentration of medical institutions in cities and suburbs where population was increasing became more noticeable in Hiroshima after 1975. The majority of public hospitals in Hiroshima City and other urban areas added more beds to their facilities and grew larger, although the number of medical institutions did not change. As for private medical institutions, the trend of concentration in cities and suburbs was even more conspicuous. This resulted in more villages in underpopulated areas without doctors.
Notes
31. Department of Health, Hiroshima Prefecture. Hiroshimaken Eisei Tokei Nenpo (Annual Report of Statistics on Public Health of Hiroshima Prefecture). Edition of 1951 through 1955.
32. Dai Nijuni Kai Kosei Iinkai Kaigiroku (Minutes of the 22nd Committee on Health and Welfare). November 22, 1948. Hiroshima City Council. Kosei Iinkai Kaigiroku (Minutes of the Health and Welfare Committee). 1948 – 1949.
33. Kosei Iinkai Kaigiroku (Minutes of the Committee on Health and Welfare). February 25, 1949. Hiroshima City Council.
34. Letter to the mayor of Hiroshima City from the director of the Hiroshima Prefecture Citizen’s Affairs Department titled “Shakai Hoken Byoin Kensetsu ni Tsuite” (Regarding construction of a social insurance hospital). March 25, 1950. Collection of Hiroshima City Council.
35. Kosei Iinkai (Health and Welfare Committee). August 24, 1950. Hiroshima City Council. Kosei Iinkai Kaigiroku (Minutes of the Health and Welfare Committee). 1950.
36. Yasuda, Iwao. “Soritsu no Koro no Omoide” (Memories from around the Time of Founding). In Social Insurance Hiroshima Citizens Hospital. Byoin Ju Nenshi (10-year History of the Hospital). 1962: p. 5.
37. Social Insurance Hiroshima Citizens Hospital. Byoin Niju Nenshi (20-year History of the Hospital). 1972: p. 13.
38. Department of Health, Hiroshima Prefecture. Hiroshimaken Eisei Tokei Nenpo (Annual Report of Statistics on Public Health of Hiroshima Prefecture). Edition of 1955 through 1964.
39. Hiroshima Ken Gankaikaishi Henshu Iinkai (Ed.). Hiroshimaken Gankaikaishi (History of the Hiroshima Prefecture Ophthalmology Association), Hiroshima Ken Gankaikai, 1989: p. 188.
40. Hiroshima Daigaku Igakubu Goju Nenshi Hensan Iinkai, Hiroshima Daigaku Igakubu Goju Nenshi Tsushi Hen (50-year History of the Hiroshima University Faculty of Medicine: Overview). Alumni Association of Department of Medicine at Hiroshima University (Kojinkai), 2000: p. 96.
41. Chinjosho Hiroshima Daigaku Igakubu Iten Mondai ni Tsuite (a petition from the City of Kure titled “Regarding the Relocation of the Hiroshima University Faculty of Medicine”). October 1, 1955: p. 29.
42. Department of Health, Hiroshima Prefecture. Hiroshimaken Eisei Tokei Nenpo (Annual Report of Statistics on Public Health of Hiroshima Prefecture). Edition of 1965 through 1974.
