National sanatoria for Hansen's disease in Japan were special institutions that only treated in-patients.But a few sanatoria for Hansen's disease located in islands and rural districts should have other duty, namely service to community health because there was no other clinic office.
New patients with Hansen's disease are very small in number and inpatients become older and older. Then the new role should be seeked to National sanatoria for Hansen's diaease in Japan.
Amami-wakoen, National sanatoium for Hansen's disease in Amami island started skin clinic for out -patients with skin diseases in March, 1983 because there were few skin clinics in Amami district. The number of patients with skin diseases increases year by year (from 12.3 persons every day in 1983 to 36.4 in 1989).
We surveyed receipts of Naional health insurance for the purpose of studying the main diseases in Amami main island and the behavior of the patients with skin diseases.
The results of survey are followings; 1. The percentage of patients with skin diseases in Amami main island in August, 1987 was significantly superior. 2. The percentage of patients with mental diseases and pregnant woman in hospital and patients with gastrointestinal disorders and pregnant women in clinic were significantly large in May, 1987 in Amami main island. 3. There was a tendency that the patients with skin diseases visited to the clinic near in place. It was found that we treated only 5.1 percent persons of patients with skin diseases in August, 1987.

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The schoolchildren in three regions of Miyako Islands, Okinawa Prefecture, were surveyed annually, from 1978 to 1984, by using the fluorescent leprosy antibody absorption (FLA-ABS) test and the lepromin reaction with the Dharmendra's antigen, for detecting the individuals at high risk of leprosy and for evaluating predictive value of these immunological tests. Constant potency of these tests was confirmed by the percentage of positive reactions among the children in the first grade of elementary schools (5 or 6 years old) surveyed from 1980 to 1984. A temporal rise or drop of the percentages during this period seemed to associate with the yearly reported number of new leprosy cases in each region. Among 1, 168 schoolchildren tested with FLA-ABS once or twice or more, the percentage of positive reactions was significantly higher in the children with the enlargement of peripheral nerve without sensory loss than in those without this signs and symptoms. The longer the duration of this signs and symptoms, the higher the percentage of positive FLA-ABS tests. Lepromin test did not show any significant correlation with this signs and symptoms. A concordant persistence or change between the FLA-ABS tests and neural signs or symptoms was observed in 133 out of 331 children examined twice or more. Discordant changes in the remaining were mainly attributed to a conversion to seronegativity before the disappearance of neural signs and symptoms. Changes of FLA-ABS and lepromin reactivities between the initial and final tests suggested a spontaneous cure of subclinical infection with Mycobacterium leprae among the children who were FLA-ABS positive but lepromin negative at the initial test and therefore considered to be a group at high risk of leprosy. Although neural signs and symptoms were found in the majority of these children, none of them so far developed overt symptom of the disease. Based on these findings, predictive value of FLA-ABS test together with lepromin was discussed.

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[in Japanese]

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