In 1950, P₅₄ was for the first time administered orally to 9 cases of lepra tuberosa and as the result of which an obvious degeneration of the lepra bacilli of the modules was observed. However, in approximately 4 months some started complaining of anorexia with occasional hearttap and the treatment was discontinued. In an effort to remedy these by-effects, 30 mg of P₅₄ was suspended in 1cc refined Chaulmoogra Oil, and 1cc of this was injected to 4 rabbits, each weighing approximately 3, 000 g, six times weekly for 4 weeks consecutively with the intention of observing changes in their weight, appetite and induration of the injected parts. The following was observed: appetite unchanged; one rabbit showed a weight decrease; no case of incuration indicating that absorption was good. Therefore, in April 1951 it was decided to adopt this injection for the treatment of lepra patients.
The formula of P₅₄ is as follows : C₂H₅SO₂_??_CH: N-NH-C_??_NH₂ S It is in the form of brilliant white crystal with melting point at 132°C. It does not melt easily in water, however, it is soluble in aceton, propylglycocol, chloroform, ether and alcohol. P₅₄L is liquidized at 25°C and when injected intramuscularly, it is painless and does not form induration even when administered eonsecutevely.
Dosage is : start with 0.5cc 3 times weekly, increasing gradually up to 3cc. Simultaneous administration of 2.5cc-5cc of Promin by intravenous injection every other day will be excellent, and the usual by-effect of Promin, i, e. anaemia and general weekness, do not occur.
Starting in April 1951, 59 patients (4 cases of lepra maculosa, 15 lepra nervosa and 40 lepra tuberosa) were treated with P₅₄L alone or together with Promin for 2 to 34 months. As for the lepra maculosa cases, generally speaking, in about one year resorption of macula was observed and in 2 years sense of the affected area was restored and an investigation of the histopathological tissues of skin proved it cured. However, the thickening of ulnar nerve was not completely resorbed.
In the cases of lepra nervosa, no remarkable results were obtained, except for the restoration of sense, increase of perspiration area, cure of malum perforans pedis, and restoration of motorial paralysis where hyarulonidase was given simultaneously.
In the cases of lepra tuberosa, in appsoximately six months, absorption of nodule became obvious, together with degeneration of leprosy bacteria and in about 2 years leprosy bacteria were negative. The Mitsuda-Skin-Test turns positive approximately 6 months before leprosy bacteria prove negative. Hair and eye-brows start growing; no infiltration in the histopathological tissues of skin is observed; vegetation of connective tissue was noticed and in some cases lepro bacteria were completely negative. In such cases no erythema nodosum leprosa was observed. Cure of ulcer was also seen and there were hardly any violent complaints of leprous ueuralgia. It results in considerably less erythema nodosum leprosa than where other antileprotics are used. It is believed that simultaneous administration of Metionin will prevent such growth to a considerable extent. As a toxic manifestation, 2 cases developed jaundice but whether or not such was caused by P₅₄L is not known. However, there was no case of albuminuria, anaemia or leucopenia.
Bacteriostatic action upon tubercle bacilli (Typus humanus H37RV) of P₅₄L is 30 times as strong as that of P₅₄ alone. Blood concentration is highest on the 2 nd day and it is proved that it remains in a human body for 5 days, and consequently it can be said that even a small dose is effective.
P₅₄L is one of the drugs to be used for the treatment of leprosy.

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The acceleration of blood sedimentation is generally recognized in serious leprosy patients, though the reason of it is not yet thoroughly clarified. This experiment has been carried out in order to investigate the correlation between leprosy types and B. S. R. and to reseach for the accelerating factors, frequent blood sedimentation tests with many patients over the long treatment period in the Oshima Seisho-en and by animal experiment with rabbits.
In this paper Part1 the correlation of leprosy types and B. S. R. is referred.
The number of patients tests was 209 without any complication, and their types, lepromatous 133, neural 64, tuberculoid 12. The ages were ranging from 5 to 52 years, and the course from 1 to 33 years since the initiation of the disease. The measurement was carried out by Westergren's method three times at three months interval and the fourth measurement after five years. The experiment informed of the following facts.
1) B. S. R. of lepra patients is generally more accelerated than that of healthy people.
2) Tuberculoid, neural and lepromatous types take turns in the acceleration. In the lepromatous it is most remarkable, especially due to the aggravation of the disease.
3) The ratio of acceleration keeps a direct proportion with seriousness of disease.
The paper Part 2 mentioned the correlation of B. S. R. to tuberculin test. The examination was made with 209 patients (L 133, N 64 and T 12), from whom tuberculous diseases could be stricktly excluded. The results are presented beneath.
1) The negativity and positivity show no significant difference in any type of leprosy.
2) Comparing of tuberculin positivity (presented in +_++_+++) or negativity with B. S. R., the latter is not in accordance with tuberculin-positivity.

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The ordinary administered drugs were examined in their influence upon B. S. R. The number of patients was 180 with Koha, Cepharanthin with 28 and 120 with promin.
1) Koha has no influence upon it in every type of leprosy when used in large or small doses.
2) Neither injected nor per os administered Cepharanthin produce no effect. Though B. S. R, is accelerated when the disease is aggravated by usage of this drug.
3) B. S. R. of the patient is quickened by injection of promin. This fact should be understood as a side reaction of this sulfone. When the disease progresses better after promin injection. B. S. R. of every leprosy type is recognized to come up nearer to the normal value.

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In the advanced cases of acute fever and erythema which appear in the process of leprosy, eruption and infiltration like that of erysipelas take place. When these symptoms of infiltration develope in lepromatous type of leprosy, it is called "acute infiltration".
Acute rash has been the general term for this and the other kind of infiltration which suddenly attacks leprosy of nerval-macula type, as both their causes and syptoms show apparently slight variances.
Acute infiltration nevertheless, is different from acute rash in relation to the types of leprosy, as is revealed in the interesting results of the Mitsuda's reaction.
Since 1932, 28 cases of acute infiltration have been experimented by Mitsuda reaction. In these cases 17 were tried before the development of acute infiltration. 13 out of these 17 cases were negative, while 4 proved as positive.
Of these negative group 11 became positive following the outbreak of acute infiltration, 2 remaining negative (one of which, however, turned positive two year later.)
In all the 4 positive cases above-mentioned, their positivity bebame strong alter the development of aeute infiltration.
The results of the Mitsuda's reaction experimented of these 28 cases alter they suffered from acute infiltration have shown all the cases, with only one exception turned positive.
Among these cases we have observed 3 cases which had been returned negative, but it took the interval of two or three years before they thus became negative again.
According to the classification of Madrid conference these cases of acute infiltration are to be included in intermediate groups, nevertheless they represent a process of special interest.
The cases which have turned positive, after acute infiltration generally last long, and some even persist for twenty or more years.
The details concerning this acute infiltration are to be given in my next report.
(Journal of Japanese Leprosy Association- Lepro- it will be issued in this year.)

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To examine the treatment effects, animals with manifest disease divided into four groups. Each of three groups received respectively combined administration of INAH+ SM, INAH+PAS, SM+PAS, and the fourth group was remained unadministered as control.
For the inhibitory experiment, one of six groups consisted of 10 rats, five of which had been inoculated with 0.5cc of ×10, 000 diluted suspension of Kumamoto strain leproma and the rest with 0.5cc of ×200 dilution. Each group received, from the next day of inoculation, combined administration of SM+PAS, INAH+SM, INAH+PAS, INAH +TBI, INAH+Promin and the last one was remained as a control group.
The doses and administration route of drugs in both experiments were as following.
INAH (Hycozid: Takeda) 4mg per Kg, PAS (Pasnal: Daiichi) 25mg, TBI (Atebison: Daiichi) 3mg per Kg, daily through mouth and SM (Dihydrostreptomycin: Takeda) was injected 20mg per Kg subcutaneously. These drugs were given six days in a week. Promin (30% Protomin: Yoshitomi) was injected every other day, three times a week.
The results obtained are undermentioned.
1) The combination of INAH+SM is excelent both in treatment and inhibition, though the effect is not so different from that of the single usage of INAH. But from the result of the successive inoculation with the remaining granular tissue, it is known that the combined administration inhibited the infectiousness of the bacillus. (Fig. 1, 4, 5, 6)
2) The combination of INAH+PAS produced no effect in treatment, but inhibited nearly half of the onset of disease compared with a control group. The use of PAS seems rather to decrease the efficacy of INAH administered with it. (Fig. 2, 4, 5, 6)
3) The combined usage of INAH+TBI and INAH+Promin prevented strongly the onset of the disease, but the effects are somewhat weaker than when only INAH administered. (Fig. 5, 6)
4) The combination of SM+PAS produced some effect both in treatment and prevention, but show no great difference from that of the single injection of SM. The added PAS does not appear to attenuate the effect of SM. (Fig. 3, 4, 5, 6)

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Following the previous report, the present work was undertaken with an intention to reveal the reliability of hemagglutination test with antigen of tuberculin in the diagnosis of rat leprosy on the white rats experimentally injected with rat leprosy bacilli.
The test appears to have a some diagnostic value in rat leprosy expect in the early stages of the infection.
The test appears to be closely related with the leprous changes developed in the visceral organs of the infected white rats.
The sera of animals infected intraperitoneally or intravenously showed much higher titers than those of animals infected subcutoneously.

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(1) The staining of lepra bacilli in paraffin section is hard. That is cause by the employment of chloroform and xylol at the time of paraffin-embeding and stain of section.
(2) In order to stain the lepra bacilli in paraffin section, it had better use the toluol instead of chloroform in paraffin embeding, and use the xylol when clear away the paraffin in section.
(3) The section made in this method can be used in other stainings.
(4) Amyl acetate is useful as well as toluol, but for practical use the latter is better.

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The children who have no one to take charge of them after their infected father or mother have been admitted in leprosaria are sent to children home established near the leprosaria.
In Aisei-en these 232 children were taken care under the close observations of doctors.
Almost all of the children are not isolated immediately after their birth and they lived with parents for different periods of time between one month and thirteen years.
These results indicate that the children should be put under observation at least for 5-6 years in the children home in order not to overlook the initiation of leprosy. After this period the development of the disease seems not to take place, though the incubation period varies remarkably by the authors.
12 cases have developed leprosy among them (5.1%).
The type of infection source was all moderately advanced lepromatous leprosy. The initial lesion in children was tuberculoid macule for the most part, i. e. 8 cases.
Meanwhile, there was one case which showed lepromatous infiltration at the time of onset.
9 cases developed neural leprosy and 3 cases lepromatous leprosy. In general the prognosis of these cases was favourable. This is considered as the retults of early diagnosis and treatment.

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The statistical observation of leprosy patients in Osaka gives us the following figures: The total number is 94 and the ratio of men to femal 2.7=1.The nerve type occupies 47 % of all the patients. The age curve comes up between 36 and 50, and 45% of them have had the disease course of more than ten years.

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