癩病巣のphosphataseの組織化学的研究は既にGault等によつて発表されたのであるが,細胞が如何なる状態に於て,phosphatase活性を示すかという問題を解析するには,生きた細胞の機能を知らねばならない。著者は癩病巣のphosphataseを研究するに当り,その一助として組織培養を利用して,培養細胞のphosphatase分布を組織化学的に検討した。
材料としては癩腫結節真皮,結核様斑紋真皮,類結核大耳神経,及び対照として,鼠坐骨神経,並びにlem-mocyteを得る目的でv. Recklinghausen氏病皮膚結節を選び,ローラーチユーブ法により試験管内で培養し,第二代以後のものを組織化学的実験に用いた。
方法としては,基質にα-グリセロ燐酸,ATP, ADP DNA, RNA,を選び,培養細胞を載せたスライドグラスを生塩水で洗滌後,Gomori氏法に準じて発色させた。
増殖細胞の性格は,どの母組織から増殖した細胞も,皆,線維芽細胞の諸変形と考えられる。v. Reckling-hausen氏病結節から増殖した細胞も線維芽細胞であつて,lemmocyteではない様に思われる。尚,鼠坐骨神経の培養に於て,神経線維断端からSchwann細胞の増殖が見られた。
組織化学的には,増殖細胞内phosphatase分布は,母組織の性格が異るのにも拘らず同様である。之は培養中に細胞が原始形に戻つた事を意味している。又,細胞をアセトン固定した後,組織化学的操作を行うと,未固定の場合よりも活性度が高い事が認められた。
次に各種其質液に於ける細胞内phosphatase分布を比較すると,幾分差異が認められる。即ち,DNA-phos-phataseは核のみに活性を示し,RNA-phosphataseは核,核小体,細胞質にも活性を示し,これ等の事実は核酸の細胞内分布とよく一致している様に思われる。ATPase, ADPaseは細胞構成要素のすべてに活性を示し,これ等が特異性を示すとすれば,代謝のエネルギー論的立場から興味のある事実である。グリセロ燐酸phosphataseは主として細胞質に分布しているが,退行変性途上にある細胞では核も強い活性を示す様になり,小円形化すると細胞全体が強い活性を示す。一方,分裂期にある細胞も細胞構成要素のすべてに強い活性を認める。
以上の結果から,組織化学的には,phosphataseは退行変性という生化学的分解過程のみならず,分裂増殖と云う生化学的合成過程にも関係していると考えられる。

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癩病巣に於ける燐代謝の研究の第一段階として,Ph-osphataseの組織化学的実験を行い,既に第I編に於いて述べた生きた細胞のPhosphatase分布と比較する事により,類結核型,癩腫型,並びに鼠癩腫のPhosphatase分布が示す意義を検討した。
材料としては癩腫型及び類結核型の大耳神経並びに皮膚病変部,更に鼠癩皮下結節を選び,アセトン固定,パラフィン包埋後,脱パラフィンを行わずに基質液内で反応を行わせた。基質液の組成及び発色方法等は第I編に述べた方法と同じである,成績並びにその酵素活性の示す意義は次の通りである。
1. 皮膚の癩性変化に関しては,類結核型,癩腫型ともに,どの基質に対しても活性を認めた.即ち,癩細胞,類上皮細胞,浸潤細胞に陽性であり,特に浸潤細胞群及び病巣部血管壁に著明である。これは分解酵素としてのPhosphataseの運搬に,浸潤細胞が興つている事を示していると同時に,これ等細胞自身の変性過程を意味していると考える。
2. 癩性神経病変のPhosphatase活性は皮膚病変よりも高い。これは神経病変に於ける組織の破壊度の方が皮膚病変より甚だしく,且Phosphataseが主として分解の方向に働く酵素である以上,当然の事と思われる。又,両型の神経病変を比較すると,類結核型の方が活性度が高い。神経の類結核病巣に於ける組織の破壊は癩腫型より盛んである。従つて,これも分解酵素としてのPhosph-ataseの作用を示しているのであろう。
3. 各基質による差は余り認められないが,ATP, RNA, DNA.を用いた時には,何れも癩腫型の活性度が高い。これ等の基質の特異性に関する問題はあるが,一芯これ等が癩菌の代謝に関係していると考えられる。
4. 癩腫型と類結核型の病変部が示す活性の意義は異るものである。即ち,癩腫では癩菌が増殖し,同時に組織は破壊される。一方,類上皮細胞結節では癩菌と組織の破壊のみが行われている。従つて,癩腫型に於けるPh-osphatase活性は癩菌のAnabolismと組織のCatabolismに関係し,他方,類結核型では癩菌及び組織ののみに関係していると云える。
5. 鼠癩腫に於けるPhosphatase分布は人癩腫の場合と同様であり,その意義も人癩の癩腫型の場合と同様に解せられる。又,Phosphataseの組織化学的観察のみからは,鼠癩腫と人癩腫を区別出来なかつた。

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The occurrence of giant cells and the appearance of incluston bodies in the lesions of the skin was examined in 276 cases of leprosy.
1) In the tuberculoid type, giant cells were obsered in 22 of 28 cases (78.5 %) in the flourishing stage whereas in the absorption stage, they could not be found. Giant cells were noted in 22 of 180 cases (12%) of the lepromatous type.
2) Giant cells were observed in the skin lesions of the reactional stage in 19 of 45 cases of erythema nodosum leprosum, 3 of 4 cases of acute infiltration and 2 cases of acute exacerbation.
3) Giants cells which were observed included the typical Langhans type, the foreign body giant cell and the Touton type giant cell. It was noted that development was by clumping and division.
4) Examination of the relationship between appearance of giant cells and clinical sym-ptoms showed that the giant cells appeared in the flourishing stage of the tuberculoid and the declining stage of the lepromatous type.
5) Inclusion bodies were observed in the giant cells in 9 cases of the lepromatus type and 3 cases of erythema nodosum leprosum but were not observed in the tuberculoid type.
6) The inclusion bodies were asteroid in all 12 of the cases and Schaumann body could not be detected.

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The Lepromin reaction was tested in leprosy patients using 1, 000, 5, 000, 10, 000, (original method), 30, 000, 50, 000, 70, 000, 100, 000, 300, 000 and 1, 000, 000 fold dilutions of Dharmendra's antigen.
1) Injection of concentrated antigen solutions (1: 1000, 1: 5000) in lepromatous cases which had given negative results to the original antigen showed a slight increase in the early reaction but a conversion to positive was rare whereas the late reaction frequently became positive especially in the case of the 1: 1, 000 antigen, with the diluted antigens, both the early and late reactions were weaker.
2) In the non-lepromatous cases, which had given positive results with the original antigen, dilution of the antigen resulted in a weakening of the early reaction. Similar results were noted in the late reaction.
3) Only the early reaction is of value in the classification of leprosy type using Dhar-mendra's antigen and up to 3-fold dilutions of the original antigen are quite accurate. It is suggested that up to 7-fold dilutions (1: 70, 000) may be used but in this case, a new criterion for evaluation should be devised.

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For the purpose of selecting a mouse strain adequate for immunological experiments, comparative observations were made of the effects of BCG vaccination on the onset of murine leprosy in various uniform strains of mice (C 57 BL, dd, CFW, CF 1, and C 3 H). Mice used were of approximately the same age, and lived under the same dietary and environmental conditions.
It was found that two strains, C 3 H and CF 1, were adequate for immunological experiments in that the leproma developed to a much larger size whereas ulcers develo-ped more slowly.
In strains in which the leproma generally remained small and the ulcer formed early, such as C 57 BL, the differences between the vaccinated and non-vaccinated mice were less marked although the lepromas were palpable in the earlier stage of infection. Therefore, these strains seemed inadequate for the study of immune responses.

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The mice of different strains (C 57 BL, dd, CFW, CF 1, A, and C 3 H), which were inoculated subcutaneously with murine leprosy bacilli, were examined after the administion of Isonicotinic acid hydrazide and Pyrazinamide to select an adequate strain for the determinarion of efficacy of therapeutic agents.
The experiments were carried out in two series, namely,
1) inhibition of the onset and 2) therapy.
1) Inhibition of the onset
No significant difference was recognized among the mouse strains tested. A strain, such as C 57 BL, with a tendency toward earlier leproma formation, therefore, seemed adequate for leproma inhibition experiments.
2) Therapy
Slight difference was found between the treated and nontreated mice of the C 57 BL strain, whereas a remarkable one was found in the C 3 H strain. Therefore, the C 3 H strain was superior to the C 57 BL strain for thrapeutic experiments.

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A case of leprosy in which pulmonary mycosis occurred was experienced. The patient was a 45 year old male with a history of leprosy of 20 years duration. He had received a total of 87 injections of Promin (13.05g) and the manifestations had become stabilized in the early part of 1956. In Sept. of the same year however, he had become afflicted with pleurisy of the right side. Streptomycin treatment was instituted after one month as there was a slight worsening in the symptoms whereupon he took a sudden turn for the worse with high fever and pain of the throat. The sputum was tuberculosis bacilli negative but a large number of mycotic spores and fibers were found. The general con-dition rapidly deteriorated and the patient died on November 9, 1956.
Autopsy findings verified the clinical diagnosis and changes due both to leprosy and mycosis were found.

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A breakdown of the 292 reported cases of leprosy occurring in Gifu prefecture between 1936 and 1955 showed that a greater number were from the rural areas the cities. There were 11 towns and 27 villages however, in which not a single case was reported during this 20 year period. This is equal to 34% of of the total cities, towns and villages.
Of the total number of cases, 90% occurred in natives of the prefecture while the remaining 10% were Koreans.
The figures suggert that the percentage of leprosy cases in Korens is 13.0∼8.7 per 100, 000.
The prefecture was arbitrarily divided into 4 districts according to locale and economic status, It was found that there were districts in which the cases were on the decline, where it was yet prevalent, others where the number or cases appeared small due to poor medical facilities and still others where a large number of cases were a large number of cases were present in a single family.
The familial incidence was 23.3% (68 out of 292 cases) and the source of infection
was one of the parents in 38.2%, other siblngs 32.4% and the grandparente in 10.3%.

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