380 multibacillary leprosy patients were treated with combined chemotherapy at Anandaban leprosy hospital in Nepal. The drugs used were Rifampicin, Dapsone, Clofazamine and Isoprodian. This treatment is modelled on the short course chemotherapy of tuberculosis. A remarkable clinical and bacteriological improvement was observed in all patients. Group A patients were bacteriologically negative after 24-32 months of treatment and Group B patients were skin smear positive even after 36 months of treatment. However, patients in Group C, who received five drugs, showed marked clinical and bacteriological improvement. Discolouration caused by Clofazamine did not lead to interruption of treatment. We found the drug regimens safe, effective and economical.

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Positivity of lepromin reaction (LR) was often said to be increased after leprosy skin lesions were improved by chemotherapy. But there were no special reports dealing with long term observation of LR in the same patients.
This study in Kuryu-Rakusenen concerned the 248 in-patients, whose clinical records were relatively complete and who were followed for more than 20 years. And the LR by standard Mitsuda antigen was tested covering 20 years (every year between 1957 and 1969 and each other year between 1970 and 1977). The following results were obtained.
1. Thirty three tuberculoid patients showed slight increase in LR during these 20 years (r=0.58).
2. There were also slight increase in lepromatous patient during these 20 years (p<0.05). Three groups were divided in relation to the bacteriological status in 1957 and 1977. A very few patients in the group, which were bacteria-positive in 1957 and same in 1977, gave over 7mm in LR in 1977. But other two lepromatous groups indicated significant increase in LR in 1977 (p<0.05) ; one of the two groups was bacteria-positive in 1957 and bacteria-negative in 1977, and another was bacterianegative in 1957 and same in 1977.
3. There was no significant relation between bacterio-negative time and LR in 1977 (r=0.288). But there was significant increase of positivity in LR of the group which showed over 16 years in bacteria-negative time. However we must give attention to the six lepromatous cases with negative LR whose bacteria-negative time was over 16 years.
4. The lepromatous patients with over 7mm LR in 1977 could be said to have eye brows and to have no episode of ENL (p<0.01). It seems that these patients may have the element of borderline leprosy.
5. The lepromatous patients, who were bacteria-negative and over 7mm in LR, had few relapses with skin lesions or without skin lesions. Erickson reported subclinical relapse in 1951. It is considered that our relapse cases without skin lesions were subclinical, because these cases had no real relapses. The relapses with skin lesions were found within three years. It could be said that the quiescent lepromatous patients with over 7mm in LR will have no episode of relapse after three years (p<0.01).

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The involvements of peripheral nerve in both extremities were histopathologically classified into five grades by changes of nerve tissue elements based on the demyelination, axonal degeneration and nerve thickening as shown in Fig. 1.
The nerve change grade could be correlated with the clinical course of leprosy. Except Grade 1 from infection to early stage, in general, Grade 2 corresponding to the early stage, Grade 3 to the developing stage, Grade 4 to the resorbing stage and Grade 5 to the terminal stage respectively.
Pathological and histopathological investigation was made from active, early resorbing and inactive (reactional) BL of 3 autopsy cases. Each autopsy case could be said to be very rare in Japan.
The active case of BL was of 92 yrs. old, male, who died at the short period of about 6 months from onset. It was during chemotherapy of CIBA for 3 months after admission. Leprous lesions of skin and peripheral nerves of this case were demonstrated BL lesion as shown in Fig. 8 to Fig. 15. The histopathological findings of peripheral nerves in common with skin were characterized by less leprosy bacilli than that of LL lesion and lymphocytic infiltration in the leprous lesion. And the nerve fibers were markedly affected by the invasion of the leprous lesion developed in the intrafunicular interstice. In these nerve tissues Schwann cells contained leprosy bacilli which were short rod and/or granulated less in number as compared with those of regular LL lesion.
The BL case of an early resorting stage was of 31 yrs. old, male, hospitalized for a long duration of 16 years. The chemotherapy of promin was continued for 6 years. The leprous lesions in skin as well as peripheral nerves represeented the characteristic feature of BL. The nerve changes showed considerable remains of scattered leprosy bacilli in the nerve bundles, while, the infiltration of lymphocytes was more markedly proliferated. It was also characteristic of the early resorbing stage that homogenized and elongated acid-fast substances were demonstrated in the Schwann cells as shown in Fig. 19, and more proliferated lymphocytes, some rupture and collagenous-fibrotic proliferation of nerve fibers were found.
The inactive and reactional BL case was of 27 yrs. old, male, admitted about 6 years ago and committed suicide during chemotherapy of Promin for one year. It was considered that a reversal reaction occurred in this case judzing from marked edema, obious dilatation of blood-capillaries and some lymphocytic infiltration in the nerve interstice, Atrophy and fragmentation was seen in the nerve fibers. Also, as another finding, foreign body giant cells containing acid-fast substances char-acteristically appeared in the nerve interstice in this reactional case

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