It is now more than 25 years Since Hawaiian strain was used for the infection in our laboratory. Since that time this strain has been maintained by two ways of mouse passage, in one way it being passaged only by C3H strain mice and in another way being passaged only by C57BL/6 strain mice. In the former way subcutaneous lesion at the inoculation site constantly developed a soft and large, malignant-type, leproma, whereas in the latter way that was usually palpable as a hard and small, benign-type, leproma. Then, Hawaiian strain maintained by the former way was designated as Hawaiian-M (H-M) and that by the latter way was designated as Hawaiian-B (H-B).
In our experiments on murine leprosy, in general, H-M strain has been used since 1956. Recently, virulence of H-M bacilli seemed to be attenuated ollowing the serial C3H mouse passage, because H-M bacilli-induced leproma in C3H mice was somewhat smaller in the latest experiments than in the earlier experiments. On the other hand, H-B bacilli produced a soft and large leproma at the inoculation site in C3H mice such as the leproma of C3H mice observed in our earlier experiments.
Based on these facts, comparative observations were made on the susceptibility to the bacilli of H-M and H-B strains of various inbred strains of mice to ascertain the differences in the virulence between these two strains following the subcutaneous infection. In mice of C3H, CBA/J and DBA strains, H-B bacilli-induced leproma was much more soft and larger than H-M bacilli-induced one.
In BALB/c strain mice and KK strain male mice, a soft and large malignant leproma was found in the cases infected with H-B bacilli, while a hard and small benign leproma was observed in the cases with H-M bacilli, although almost all the cases showed very severe visceral lesions at the late stage of infection.
However, there were no remarkable differences in the susceptibility of C57BL/6 strain mice between the cases infected with H-M bacilli and with H-B bacilli.
It is obvious from these observations that H-M bacilli are much less virulent than H-B bacilli.

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In this experiment Hawaiian-M (H-M) and Hawaiian-B (H-B) strains were used for infection, the former being attenuated and the latter having original virulence. Details of these two strains were described in Part 1 of this report.
A half of female and male mice of various inbred strains was inoculated subcutaneously on the thorax with 0.25m1 of a 1: 1000 suspension prepared from a H-M bacilli-induced malignant leproma. And another half of these mice was also inoculated with 0.25ml of a 1: 1000 suspension prepared a malignant leproma which was obtained from a C3H mouse infected with H-B bacilli 25 weeks earlier. The development of subcutaneous and visceral lesions was evaluated by palpable time, clinical features, tendency of spontaneous healing and size of the leproma at the inoculation site and also by survival time and grade of lesions in 3 organs, lung, liver and spleen, of the infected mice. The experimental results were summarized in a Table.
As shown in Table, in almost all the mouse strains but C57BL/6, H-B bacilli-induced lesions were much more severe than H-M bacilli-induced ones. specially in BALB/c strain, the malignant features were observed in mice infected with H-B bacilli, whereas mice with H-M bacilli were of the intermediate type. And in KK and DDD strains remarkable differences in the susceptibility were found between female and male mice with H-B bacilli.
On the other hand, in ICR strain the subcutaneous lesions developed a large leproma at the late stage of infection, while the visceral lesions were still slight. This disease course was very characteristic compared with that of the other strains of mice. Then, we recorded it as intermediate? (I') in the Table.

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This study is based on the data which were collected at Etawah clinic, Uttar Pradesh State, India, from September to October of 1971. The clinic was established by JALMA in January of 1966 and the staff of Agra Center of JALMA attended there once a week
or two weeks.
The data were analized in the point of view that the satisfaction or evaluation of the patients to the treatment will have an important influence for them to continue the regular and long period treatment at out patient clinics, especially in the cases of the patients who are suffering from chronic diseases such as leprosy.
The number of male patients was 941, female 103 and totally 1, 044 in the object group. The male-female rate was 9.1: 1 and it showed the decrease of the female patient number compared to the male-female rate of the newly registered patients in the same year. Some social and historical factors were supposed to have an influence for the decrease of female patient number attending to the clinic.
The rate of the patient who gave a good evaluation to the treatment were 50% from male group and 39% from female. The rate of patient who complained of any symptoms was below 50% in both sex groups. There was a difference of the evaluation between male and female groups and it seemed due to the higher percentage of female patients who answered 'No change'.
Over 50% patients out of male lepromatous group gave a good evaluation and the value did not depend on the length of the treatment period. Out of male tuberculoid patients, about 70% showed a satisfaction after 6 month to one year treatment, but the value went down to 50% after the period and it waved from the higher to the lower areas of the 50% line or con-trarily. From male borderline group, only 25% patients showed a good evaluation after three month treatment and even after the period, the value stayed lower than 50% generally.
The difference of the evaluation by the patients seemed due to the various symptoms and reaction to the treatment observed in the different types or groups of the disease.
Further analization of the investigation will give useful suggestions to the health education for the patients who must continue the regular treatment at the clinics.

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Comparative studies of the stamp method with the histopathological tissue sections of ear-lobes were performed for the investigation on 47 cases autopsied during three years (1978 to 1981).
As the technique of the stamp method, tissues of both side ear-lobe skin were cut down with a sterilized scissor and put on slide-glasses immediately, then staining for acid-fast bacilli by Harada's method and other staining such as Giemsa stain were done. This technique could be easily carried out and the detection rate of leprosy bacilli in the stamp specimens was found to be concurred with that in the tissue sections, the percentage of each beingidentically 10.6% (5 cases out of 47 cases). The 5 positive cases of leprosy bacilli were all out of 6 relapse cases, so that the number and form of leprosy bacilli detected by the stamp method were compared with those and also with the skin lesions by the histopathological observation as shown in able 1 and 2.
Besides, the detection rate of fungi was relatively remarkable at 27.7% in the stamp specimens, while fungi were hardly seen in the tissue sections. Moreover, histochemical analysis and the fluoressence antibody method may be applicable in the stamp specimens.

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In the national sanatorium Oshima Seisho-en, the average age of admitted patients went over 60 ages, the number of old patients being rapidly increasing. Accordingly, the review of medical treatment, welfare and life which were done from habit is requested. This examination was made as a first step for making the fine method of correspondance after thinking about "what is asked for medical treatment and nursing?" and "what can we do?". The actual condition of health and life of admitted patients in Oshima Seisho-en was examined by questionaire.
The table of anamnesis was used for the examination. The symptoms of digestive system, circulatory system, urinary system and respiratory system were listed. Besides, the items of drinking, smoking, past history and sphere of action were adopted in order to know the taste and habit of answerer. The subjects of questionaire were 399 cases admitted patients except long out stayer (male 255 cases: 64%, female 144 cases: 36%, over 65 years 153 cases: 38%). The answer of questionaire was got by alternative judgement by answer as "yes" or "no". Nurse or assistant nurse asked the answer.
Table 3 shows the percentage of symptoms of each system and two symptoms which were frequently complained of (dizziness and thirst). When the systems are arranged in order of frequent complain, the first was cicrulatory system (164 cases: 41%), 2) respiratory system (100 cases: 25%), 3) digestive system (58 cases: 15%), 4) urinary system (30 cases: 7%). The dizziness is a symptom which appear by the disease of several system, and was complained by 141 cases (35%). The thirst is regarded as a symptom by common use of many drugs or glucosuria, and was complained by 132 cases (33%).
The table 4 shows the sex of answerers which have complaint. Circulatory system (male 99 cases: 39%, female 65 cases: 45%), respiratory system (male 66 cases: 26%, female 35 cases: 24%), digestive system (male 38 cases: 15%, female 22 cases: 15%), urinary system (male 19 cases: 7%, female 13 cases: 9%), dizziness (male 82 cases: 32%, female 58 cases: 40%), thirst (male 77 cases: 30%, female 56 cases: 39%). Accordingly, the rate of cases having complaint is a little more in female than in male.
The table 5 shows the percentage of complaint of each system per 153 patients over 65 years. The number of patients having the complaint of circulatory system was 64 cases (42%), respiratory system 47 cases (31%), digestive system 21 cases (14%), urinary system 14 cases (9%), dizziness 63 cases (41%) and thirst 70 cases (46%).
The table 6 shows the rate of patients over 65 years per the number of patients having complaint. In circulatory system, the number of patients over 65 years is 64 cases (39%), in respiratory system 47 cases (47%), in digestive system 21 cases (36%), in urinary system 14 cases (47%), in dizziness 63 cases (45%) and in thirst 70 cases (53%). The number of patients over 65 years is no more than 153 cases (38%) among 399 cases, the total number of answere. Considering it, it is thought that the morbidity of old patients over 65 years is high.
The table 7 shows the rate of patients who pass a day in their private room except inevitable going out. One hundred and thirty six patients (34%) among 399 cases, the total number of answerer, pass almost a day in their private room. This rate is high. Sixty nine patients (45%) among 153 patients over 65 years pass almost a day in their private room.
All these complaints obtained by questionaire do not mean the presence of some disease, but the possibility of latency of serious disease among the patients having these complaints is thought.

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The cause of death and the conditions at the time of death of 25 patients admitted in National Sanatorium Oshima Seisho-en who died from April, 1978 to July, 1981 were investigated. The investigations were made by the detailed reading of clinical records which were kept in Oshima Seisho-en. The dead patients were 25 in number. The age of those patients is as follows: 3 cases in his fifties (12%), 6 cases in his sixties (24%), 9 cases in his seventies (36%), 5 cases in his eighties (20%) and 2 cases in his nineties (8%).
Eighteen cases (72%) were lepromatous, tuberculoid cases were 6 (24%) and one case (4%) was borderline.
The cause of death is as follows: pneumonia in 9 cases (36%), malignant tumor in 5 cases (20%), cerebral bleeding in 3 cases (12%), abrupt death which occured within 90 minutes after finding abnormality in 3 cases (12%), liver cirrosis in a case (4%), sequela of head trauma in a case (4%), kidney insufficiency in a case (4%), Guillain-Barré's syndrome in a case (4%) and unknown death in a case (4%).
The place where the death occured is as follows: sickward in 22 cases (88%), residental room in 2 cases (8%) and road in a case (4%).
The length of period of admission in the sickward is as follows: 4 years in a case (5%), 3 years in two cases (9%), 2 years in two cases (9%), a year in a case (9%), half a year in a case (5%), less than half a year in 14 cases (59%) and unknown in a case (5%).
The precise grasp of the conditions in which the death of patients admitted in sanatorium occured does not only mean the consideration of "death" itself, but also mean the present conditions of life of admitted patients. Besides it becomes the data presuming the state of medical treatment of sanatorium. The authors expect the presentation of similar report of other sanatoriums.

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