In order to grasp the actual condition of the "physically handicapped" in leprosy, 1, 209 patients (755 cases of Lepromatous type and 454 cases of Tubercujoid type) were examinedwith the following results.
Among the examined, 940 cases (77.7%) were diagnosed as the crippled ; 295 cases (24.4%) having an impediment only in the upper evtremity, 54 cases (4.4%) only in the lower, and 591 cases (48.8%) both in the upper and the lower extremity.
The disturbance of upper limbs were seen in 1584 (65.5%), the claw finger in 5, 247(43.4%), 3, 141 of which showed the ankylosed finger. The wrist-drop was found in 143(5.9%), 864 (35.7%) showed the hands being lack of opposition in the thumb. 1, 024 (42.3%) showed the disturbance of lower limbs, 55 (22.7%) the ankle-drop, and 162 (6.6%) theamputated lower thigh.
The graduation table (in six classes) established by the Disabled Persons Welfare Law, was applied in 797 cases (65.9% to the amount), 69 cases (5.7%) to the first class, 157cases (12.9%) to the second, 302 cases (24.9%) to the third, and 269 cases (22.2%) to therest.
The combination of visual disturbances with disturbance of morility was very fequent in L-type casses. The handicapped was 833 in total, i. e. 68.8% of the examined. In these cases, 36 patients had only visual disturbances, 246 both disturbances of visual acuity and that of motility of limbs, and the rest only disturbances of extremity.

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The 4 species of wild mice (Apodemus speciosus speciosus, Apodemus geisha geisha, Meriones unguiculatus, Microtus montebelli montebelli) shown in Fig. 1-4 were tested for sensitivity to murine leprosy and the results in Table 1-4 were obtained.
Cortisone and hyaluronidase were administered in Meriones unguiculatus, which proved the least sensitive, with the object of heightening infectivity and the results are shown in Table 5. From the results, the following is suggested.
1) The morphological classification of wild mice and sensitivity to murine leprosy appear to coincide closely and Apod. s. s. was most susceptive.
2) In Mer. ung., growth of murine leprosy bacilli takes place only in testicular tissue and inoculation of a small amount of bacilli gives better results than a large amount.
3) Another finding of interest was the production of lesions at joints, that is at location other than the site of inoculation after a long latent period in a case of Micr. m. m. It is suggested that long-term diligent observation is required for the determination of sensitivity.
4) It is difficult to alter natural sensitivity or resistence so when animals are to be experimentally infected with the human leprosy bacilli, animals which are sensitive should first be found.

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C-strain rats were subcutaneously inoculated with 0.4 cc of 50 x live muri-lepra bacilli solution. The two groups, viz.,
(1) the asialadenism group,
(2) the asialadenism+group injected with large dose of salivary gland hormone (daily administration of 1 mg. Parotin/100 gr. bod, wt. revealed marked difference within a short period (7 wks.) after inoculation, in the skin muri-leproma and the main organs. That is to say, the asialadenism group showed hypofunction of the reticulo-endothelial system, and aggravation of the muri-lepra change ; on the other hand, the group administered with salivary gland hormone showed hyper-function of the reticulo-endothelial system, inhibition of the muri-lepra change, and thus bringing about the transition from the synbiotic phase (a histological finding found in human and murine leprosy, in which the histiocyte phagocytizes the mycobacterium, and the bacilli continue to exist as well as multiply within the cytoplasm) to the granulomatous phase (an epithelioid granuloma accompanied by lymphocyte-infiltration containing Langhans' giant cells, the finding of productive tubercles and of the tuberculoid type human leprosy).

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C-strain rats were inoculated with 0.4 cc of 50 x live muri-lepra bacilli solution ; and with the untreated rats with normal salivary glands, subcutaneously inoculated with live muri-lepra bacilli as the control group, the influence of asialadenism and hypersialadenism at the time of subcutaneous inoculation of muri-lepra bacilli in regard to infection towards murine leprosy was observed over a short period (7 wks.) and over a moderate period (15 wks.).
In the skin leproma, inoculated with live muri-lepra bacilli and in the lymph glands, spleen, liver and lungs, similar to Report I, the muri-lepra change is strongly inhibited in the hypersialadenism group as compared with the normal salivary glands untreated group, shows a tendency towards aggravation in the asialadenismus group, and at the same time the hyperfunction of the reticulo-endothelial system cells can be seen. That is to say, asialadenismus group untreated normal group hypersialadenismus group.
In this experiment, the difference was not so marked between the various groups in regard to the skin muri-leproma, but showed comparatively marked differences in the visceral phase.

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C-strain rats were divided into 2 groups, viz., the group inoculated with moderate dose of live muri-lepra bacilli (100* baci. sol. 0.25 cc) and the group inoculated with small dose of the same (10, 000 * baci, sol. 0.25 cc) ; and these were further divided into 3 groups respectively as in report 2 ; and by periodically (5, 7, 10, 15, 20, 25 wks.) observing the muri-lepra change in the skin muri-leproma, lymph glands, and the internal organs, and also the reticulo-endothelial system, a finding similar to that of the preceding report was confirmed.
In this experiment, the dose of bacilli being small and the period of observation long, the results were marked. The hypersialadenism group have almost all changed to granulomas. The salivary gland hormone activates the reticulo-endothelial system, increases the resistance of the living body, inhibits muri-lepra infection, and transfers from the synbiotic to the granulomatous phase. This fact makes possible the presumption that mechanisms involved in the transition from the lepromatous to the tuberculoid type of one of the human leprosy, is the increase of resistance of the living body caused by the hyperfunction of the reticulo-endothelial system.

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The tuberculous foci of all the organs from 66 autopsy cases (The National Institute for Leprosy Research) were examined histo-anatomically and histopathologically, in order to investigate the complication of tuberculosis in leprosy. That is to say. the difference of the primary focus of the lungs and secondary tuberculosis in the two types of leprosy, was examined in order to pursue the relation between leprosy and tuberculosis by the condition of infection and progress of the two diseases. Results :-
1) The ratio of number of patients of the two types handled in the present study, viz. the lepromatous (L-type) and the tuberculoid (T-type) is 45: 21, the L-type being about twice as many as the T-type.
2) The percentage of the complication of tuberculosis is 71.2% (47 out of 66 examples). The ratio of combined tuberculosis in the two types was almost the same, being 71.1%in the L-type (32 out of 47 L-type cases), and 71.4% in the T-type (15 out 21 T type cases).
3) In the L-type all the 32 cases of combined tuberculosis progressed to secondary tuberculosis, but in the T-type 12 cases (80%) out of the 15 cases of combined tuberculosis were healed at the stage of primary foci of the lungs, only 3 cases (20%) transferring to the secondary stage.
4) There were no severe cases of secondary tuberculosis in the T-type, but in the L-type there were 17 slight cases, 7 moderate cases, and 8 severe cases, the latter showing severe symptoms during lifetime. Five cases of intestinal tuberculosis and tuberculous peritonitis, one case of spinal caries with complication of sinking abscess, two cases of phthisis pulmonum have all been causes of death.
The following conclusion was obtained from the above:-
The rate of combined tuberculosis in leprosy is over 70% in both types, but in the L-type there were no cases of recovery, all progressing to secondary tuberculosis, while in the T-type there were many cases of cures in the stage of primary focus of the lungs (12/15 cases, 80%). This fact suggests the possibility of the prevention of leprosy by BCG which possesses a common antigenic character bacteriologically, immunologically, and epidemiologically, towards both tuberculosis and leprosy bacilli. Further, between leprosy and tuberculosis which show the same histologicall reaction in living body a common antigenicity way between both diseases can be presupposed. That the T-type, more resistant towards the leprosy bacilli than the L-type possesses a stronger tendency to inhibit tubercu-losis than the L-type.

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The state of complication of tuberculosis in leprosy and the relation between leprosy and tuberculosis according to the disease types was further examined by histo-patho-anatomical examination as in Report I, of all the 450 autopsy cases of the National Oshima Seisho-en Leprosarium from 1924 to 1959.
Further, the process of the disease was examined by dividing into 3 stages, taking into consideration the influence of the period and of chemotherapy ; that is, 1) before the introduction of chemo-therapy (stage of hydnocarpus oil therapy) (1924-1942) … before World War II ; 2 after introduction of chemo-therapy (1943-1950) … during and directly after the War ;
3) after chemo-therapy (1951-1959) … after the War. Conclusion :-
1) Out of the 450 cases, there were 313 cases of the L-type (64.3%) and 137 cases of the T-type (30.6%), the L-type being over 2.3 times that of the T-type.
2) The percentage of combined tuberculosis was 77.2% (347 cases out of 450), 80.5% in the L-type (252/313), and 69.6% (95/137) in the T-type. Further, of the 252 cases of combined tuberculosis in the L-type, 84.3% was found in those before the war, 56.4% during the war, and 80% in those after the war; and of the 95 cases of combined tuberculosis in the T-type, the percentage was 70.8%, 76.6%, and 53% respectively, tube- rculosis being found in more than half in both types.
3) As for the foci of secondary tuberculosis, similar to Report I, they were found in all the L-type cases. Moreover, in the T-type, 24% were healed in the stage of primary foci ofthe lungs, while 16/74, 21.3% … before the War ; 13/45, 30% … during the war ; and 3/8, 37.5% … after the War, i.e. over one-third were healed in the stage of primary foci of the lungs.
4) As for the frequency of tuberculosis, there were about 70% of severe cases in both L-, and T-types in the period before the War, but with the passage of years the absolute number of patients is decreasing conspicuously. In the L-type, severe cases of tuberculosis were found in 76.7% before the War, 81.8% during the War, and 56.3% after the War; while in the T-type it was found in 63.8%, 30.8%, and 12.5% respectively during the above periods, showing a marked decrease, being only 500 of the L-type in the latter half period. Many severe cases could be seen in both types, but with the progress of chemotherapy, the spread of BCG vaccination, and the improvement of nutrition, the mortality of both leprosy and tuberculosis patients have shown a marked decrease.
The same tendency as seen in Report I was also confirmed, that is to say, the L-type which has a weak resistance towards leprosy has also a weak resistance towards tubercu-losis, while the T-type more resistant towards leprosy, possesses a strong resistance towa-rds tuberculosis.

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Clinical studies on the course of pulmonary tuberculosis complicated with leprosy has been conducted on tuberculosis patients admitted to National Leprosarium, Tamazensho-en during the period from 1948 to 1957. The results obtained are the following:
1. Prognosis of pulmonary tuberculosis was, in general, very severe in the period when chemotherapeutics had not been used in the treatment of tuberculosis. All forms of tuberculosis, except indurative type, showed a tendency to deteriorate. This tendency was similar to that observed in tuberculosis patients free from leprosy.
2. The course of pulmonary tuberculosis was remarkably influenced by chemotherapy. All forms of tuberculosis, except indurative type, showed a good response to chemotherapy.
3. Comparing the effect of chemotherapy on tuberculosis with and without leprosy on the same back ground, no remarkable difference was observed between these two groups, and the influence of "promin" on the course of pulmonary tuberculosis was hardly observed.
4. Activation of leprotic lesion, if it was simple, showed no notable influence on the course of pulmonary tuberculosis, but if it was succeeded by erythema nodosum or neu-ralgia, exacerbations of the disease were more frequently observed.
5. No significant difference was found between lepromatous and tuberculoid type in the occurance of tuberculosis, and in the type and extent pulmonary lesions.

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In order to investigate the metabolism of sulfoxide radical of DDSO by in vivo oxido- reduction system, this author attempted the separation of DDS, DDSO, and 4, 4'-Diaminodiphe- nylsulfide (DDSD) by the use of paper chromatography and paper electrophoretic method.
As the result of this investigation, a basic analytical method was found, when DDSO was used alone, which enables the separation of those three compounds by certain combi- nations of buffer chromatography and paper electrophoresis.

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In view of the lack of adequate methods for the selection of antileprous substances worthy for clinical trial, the authors have been much interested in Bun-Hoi's postulation that substances effective against human leprosy exhibit both antituberculous and antifungal activities, and that these substances are soluble in fat solvents. In this connection about twenty substances known to be antileprous, antituberculous or antifungal were determined of the in vitro antituberculous and antifungal activities, as well as of solubility in fat solvents.
Almost all the substances known to be antileprous showed, though not so strong, definite antituberculous and antifungal activities. Their solubility in fat solvents, however, was not remarkable. Among the tested substances, o-aminophenol was found to possess the pro-perties to satisfy best Buu-Hoi's postulation, but it was ineffective in few cases of lepro-matous leprosy. This discrepancy might be due to the specific response of o-aminophenol on the dehydrogenase reaction of Mycobacieria including human and murine leprosy bacilli.
In conculusion, it was difficult to determine whether Buu-Hoi's postulation has any pra- ctical use as a screening test for the selection of antileprous substances worthy for clinical test.

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It has been known that the antituberculous activity of certain polyethylene glycol deri-vatives of DDS was stronger than that of DDS itself, and that Triton WR 1339, a surface active agent having a polyethylene glycol group in the molecule, was effective in the treatment of experimental tuberculosis of animals. On the other hand, when a carbon chain such as acyl group is introduced into the molecule, compounds with a certain specific carbon number of the carbon chain thus formed are generally increased of physiological activities including antimicrobial action. Enhancement of the antimicrobial action is que-stionable in the chemotherapy of leprosy, but experiments were undertaken from the views above mentioned. Polyethylene glycol ethane sulfonates of p-monoacylamino-p'-amino-diphe nylsulfone were synthesized to determine their in vitro antimicrobial activities, and thus to obtain some basic informations for their clinical applicability. None of the compounds employed in the present experiments were found to have antimicrobial activities stronger than DDS itself.

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Recently, two different diphenylthiourea derivatives (Dianilide and Ciba 1906) are reported to be effective in the treatment of leprosy by two groups of researchers. In order to throw light on the relation between chemical constitution and antileprous effect of thiourea derivatives, about twenty symmetrically substituted thiourea derivatives were synthesized for the determination of in vitro antimicrobial activities, and then some were put on clinical trials. On account of undesirable effects, the administration of p, p'-dihydroxy-and p, p'-dichloro-derivatives were given up within a month. While, p, p'-di-dimethylamino- derivative, which is not so strong in antituberculous action, was found to be effective with-out serious side effects. This fact seems to suggest that higher antituberculous activity is not so important for the exhibition of antileprous effect, as it may also be concluded from the antituberculous activity of DDS.
It seems interesting that the introduction of several radicals into a benzene ring with-out destruction of the structure of NH-CS-NH group, probable active center of the anti-bacterial action, might result a number of derivatives different in chemical, physicochemi-cal and biological properties.

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