The patient was 52 years old male. Even though a long duration of the chemotherapy of leprosy, the skin smear test for the detection of leprosy bacillus never showed negative result anytime. While the exacerbation of leproma occured sometimes over again, a small multiple black tumor appeared in the skin of various position of body i. e. the chest, back, upper arm, abdomen and breech etc. as shown Fig. 2. Especially in the left upper arm a black tumor, which was measured 13×10 mm in size, was largest among the other portion, Then it was removed for the microscopical observation. As the results nature of this tumor was seborrheic keratosis (verruca senilis) without a melanoma or pigment cell nevus. This seborrheic keratosis was presented together with the nodular exacerbated leproma, which showed abundant rod-shaped bacilli and many globi in the star-shaped or spindle-shaped lepra cells. There were not leprous foamy cells and nerve thickening in the dermis. The epidermis in a center of the seborrheic keratosis was very thinn by the pressure of the developing leproma. The epidermis of the center demonstrated macroscopically slight red color and its surroundings was thickening. It was characteristic that minimal lepromas formed in the thickening epidermis.
We discussed the correlation between seborrheic keratosis and exacerbated leproma. Although we have considered the possibility that the stimulation of the leproma might be developed the seborreic keratosis, of course we have not clear evidence.

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The mice were divided into two groups, each group being composed of the control groups and the treated ones.
Preparation of an oil-in-water-in-oil-in-water emulsion : 0.1mg. of E. Coli-12 cells was freezed and dried and 10% Emazol-liquid-paraffin was at once added to them until it was easily dispersed and penetrated thoroughy of itself in them and then the water was added as shown in Table 1 and Table 2. The above-made mixture was heated in warm water less than 50°C. and it was diluted 1500 fold or 4000 fold (referred to A-emulsion). The A-emulsion was kept at 4°C until use. It had a characteristic feature that it was never separated in each component, even when it was kept quiet. Preparation of a water-in-oil-in-waser emulsion: it was made and kept by means of the above-mentioned same process only excepting freezing and drying the E. Coli-12 cells. (referred to B-emulsion). Its striking characteristic was that the cells were more swollen and so the 10% Emazolparaffin was little dispersed and penetrated in them therefore, it was easily separated of itself in each component when it was kept quiet.
The treated mice were previously given subcutaneous and intraperitoneal injections with 0.1mg. of the A or B-emulsion simultaneously twice a week for one month. One week later, all the animals were subcutaneouly injected with 0.1mg. of the bacillus. At the end of the experiment, all the survivors were killed for macroscopic and microscopic studies. Pathological appearance : Severe destructive leprous lesions were recognized in the control groups; the multiplication of histiocytes followed that of the bacilli, becoming a specific nodular mass of histiocytes and the formation of muri-leproma accompanied by slight perivascular infiltration of inflammatory cells and what was called by globi could be found in the control groups^{2), 3), 4)}, while in marked contrast was the regression of active lesions in the A-emulsion-treated groups; the formation of epithelioid granuloma sometimes containing Langhans type giant cells and including granular-shaped degenerative acid-fast bacilli could be observed, the inflammatory cells surrounding the granulomas being found^{2), 3), 4)}.
It is concluded that the A-emulsion-treated groups revealed favourably more protective power against the development of the progressive leprosy here, as determined by the clinical, macroscopic and micoscopic examinations^{2), 3), 4)}.
The principle included here can be applied not only in the treatment of the inflammatory diseases but also be probably on the high road of paving the way for the immunotherapy of the malignant tumors^{17), 18), 19), 20)}.

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Mice of 5 strains (C3H, BALB/c, KK, DDD and C57BL/6) were inoculated subcutaneously in the back wtih 0.25 ml of a 1:1000 suspension prepared from malignant leproma (Hawaiian strain). By electron microscopy, measurments of bacillary length were made on the bacilli recovered from the subcutaneous tissues at the inoculation site at varying time intervals and solid ratio of the bacilli was also culculated. Distribution of these bacilli was figured on the basis of bacillary length, ranging from 0.75μ to 6.0μ, as shown in Figs. 1 and 3.
In the bacillary length, there were no significant differences among these 5 strains during the first 2 weeks. Elongation of the bacilli was evident at 2 weeks. In C3H mice mean length of the bacilli began to decrease 4 weeks after infection and reached a constant level similar to that of the initials in 8 to 10 weeks. On the other hand, mean length of the bacilli in DDD and C57BL/6 mice reached maximum size at 2 to 4 weeks and maintained rather longer forms throughout the observation period, showing somewhat decrease in the length. The mean lengths in BALB/c and KK mice showed intermediate values, being nearer to those in DDD and C57BL/ 6 mice.
Solid ratio of the 5 strains of mice was decreased in 1 week and somewhat increased in 2 weeks. Thereafter, solid ratio of the bacilli in C3H mice increased gradually and, in 8 to 10 weeks, reached a high level as that of the bacilli recovered from fully established malignant leproma. In contrast, the solid ratio in the other 4 strains showed constant levels similar to those of the established benign leproma, in 4 to 10 weeks.
These differences became more remarkable from the observations on distribution curves of bacillary length among these mouse strains. Especially, pronounced differences were found between C3H and C57BL/6 mice in the distribution curves, being a highly peaked curve with narrow range and a flattened one with wide range, respectively.

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In order to find out whether M. lepraemurium grown on egg-yolk solid medium would be able to grow in the Nakamura's liquid medium or not, the bacterial suspensions of M. lepraemurium grown on solid medium were inoculated into various synthetic liquid media which had been established by Nakamura, and the growth was measured by a slide culture and bacillary counting methods.
The results obtained demonstrate that there are no growth of M. lepraemurium grown on Ogawa's solid medium, in liquid media.
On the contrary, unequivocal multiplication of M. lepraemurium obtained from mouse leproma in NC-5 as well as ND-5 medium was indicated.
At present, it is uncertain whether the fact might depend upon the qualitative difference between M. lepraemurium in vitro and in vivo, or quantitative contents of growth potentiality of bacilli present in the starting material.

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To evaluate the growth rate of M. lepraemurium on the course of cultivation in cellfree liquid medium, a new estimation method for this purpose was established, and named the Sediment Smear Method (SSM). The procedure is as follows: centrifugalize culture tubes at 2, 500 rpm for 30 min, discard carefully the culture fluid by a capillary pipet, resuspended collected sediment in 0.1 ml of a formaline-gelatin solution, smear this suspension by a loop on a slide glass, and stain, then observe the bacterial mass under the low magnification. The results obtained illustrate there is roughly a parallel relationship with the increase of the number of bacilli measured by a bacillary counting method. Therefore, the SSM could be recommended as a simple screening method for course evaluation of the growth of M. lepraemurium, may be as well as M. leprae, in the cellfree cultivation experiments.

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M, lepraemurium suspension was inoculated into NC-5 and ND-5 medium and cultivated at 30°C. The growth was measured by the bacillary counting method. The results obtained demonstrate that there is a temporary peak of the increase of bacilli 4 days and 3 days after cultivation in NC-5 and ND-5 medium, respectively. Thereafter, the number of bacilli decreased, and then gradually increased until 6 weeks. The meaning of the peak in the initial growth is still not clear.

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Evidence is presented that the multiplication of M. lepraemurium is remarkably stimulated by addition of adenosine at final concentration of 0.005 % to NC-5 and ND-5 medium. The effect resulted in maintenance of plateau of stationary phase of M. lepraemurium. On the other hand, there is no effect of addition of thymidine on the growth of M. lepraemurium in NC-5 as well as ND-5 medium.

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Operations for deformity and functional disturbance of the lower limbs
What are important in treating the lower limbs, unlike the treatment of the upper limbs, are to secure the stability in the normal limb position and how to treat plantar ulcer. Moreover, these two factors are so intimately correlated with each other that it is necessary to perform the treatment by considering them.
a) Peroneal palsy: Transference of the posterior tibial muscle is most common. Elongation of the Achilles tendon is often necessary. Carayon's procedure that transfers the flexor digitorum longus muscle to the extensor hallucis longus and extensor digitorum longus muscles may also be performed.
b) In the case where all the muscles at and below the level of the leg except for the triceps surae muscle are paralyzed, tenodesis on the anterior side of the crural bones, involving the crural bones, ankle joint and instep, should be performed, while the triceps surae muscle is split longitudinally into two, one of which is passed on the medial side of the tibia to be transferred to the anterior tibial muscle.
c) Paralytic talipes equinovarus: Triple arthrodesis is performed for correction of the varus position. and transference of the posterior tibial muscle for talipes equinus.
d) Unstable ankle joint: In the presence of tibial and peroneal paralysis, the stability of the ankle joint may have been impaired over a long period. In such a case the brace will be but on but arthrodesis of the ankle joint may also be considered.
e) Neuroarthrepathy (what is called Charcot's joint-like disintegration of tarsal bone) It the stages of disintegration are classed into the stage of development, the stage of coalescence and the stage of reconstruction, it is the stage of reconstruction that is most suitable for arthrodesis of the ankle joint, while no surgery should be performed in the stage of development. Pantalar arthrodesis and talo-tibial fusion by the use of Kunntscher's nail has proved the procedure giving good results.
f) Flat foot: If the longitudinal arch of the foot becomes flat due to some cause, flat foot and abductus deformity of the anterior and middle portions of the foot occur, often leading not only to a disturbance in gait but also to incurable plantar ulceration. In such cases, the longitudinal arch of the foot is recontructed by arthrodesis of Chopart joint and the abductus deformity of the anterior and middle portions of the foot are corrected: these operations result in decreased recurrence of the ulcer.
g) In the case where marked disintegration of bone is noted in the part from near the Chopart joint to the peripheral area, associated with incurable ulcer, and where it is difficult to perform arthrodesis, Boyd's amputation is indicated.
h) Deformity of the metatarsal heads and toes: For the hallux valgus separation of the abductor hallucis muscle, arthrodesis of the IP joint, tenodesis of the extensor muscle, and fusion of the part from the base of the lst metatarsal bone to the Chopart joint should be performed, depending on the condition in each case. In the case where there is disintegration of bone the area around the metatarsal head associated with plantar ulceration, fusion of the metatarsal bones with the toes may be performed.
i) Clawtoe: Girdlestone's procedure will do in the case where the contracture is not severe, but elongation of the extensor muscles of the toes and tenodesis to the metatarsal bones must often be additionally performed in the cases with severe contracture.

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