Chemotherapy was given to 26 cases who had been discharging infrequently bacilli of 1 to 10 colonies after surgical treatments of pulmonary tuberculosis, and whose opposite lung were not the source. Effects of the chemotherapy were investigated with regard to the degrees of negative conversion. Incidentally, all patients were of stable condition and without significant findings by radiological and bronchoscopic examination.
Twenty-one cases were treated with SM + PAS, 1 case, with INH + PAS and 4 cases, with Tibion alone.
The results were as follows:
By 2 months' treatment, negative conversion was 76.9%; by 6 months, 66.6% and by 11 months, 27.8%, that indicate remarkable decrease in the rate of negative conversion with the duration of time.
To expect complete negative conversion in these cases was impossible. However, we must admit this therapy as an effective medical treatment of the cases.
By dividing these patients to bed-rest group and prominade group during chemotherapy, another observation was attempted to see the relation between negative conversion and rest grade after treatment. The prominade group was better than the bed-rest group in their negative conversion rate.

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Emulsified oleum hydnocarpi with sodium salt of oleic acid has marked bacteriostatic and bacteriocidal activities on human tubercle bacilli.
The emulsified oil was found to exert inhibition or retardation of the growth of small inocula of human tubercle bacilli (Frankfurt strain) in Kirchner synthetic sera media. Results obtained were as follows:
With 1% bacteriocidal, with 0.1% bacteriostatic, completly and with 0.01% bacteriostatic, incompletly.
Oleic acid (C₁₇H₃₃COOH) exerts dual effects on tubercle bacilli, generally, their sodium salts and hydnophobic esters (glycerides) will not be utilized by bacteria, without influences of concentration and milieu, i. e., existence of serum albumin, potato starch and charcoal.
The emulsified oil took the admixture, 1 part of 10% sodium salt solution of oleic acid and 3 parts of oleum hydnocarpi (pH 7.0), and then it obtained chemical equilibrium and fusible action for caseous lesions due to the surface active action of sodium salt of oleic acid.
Ten ml of the emulsified oil, mixed with each 1ml of distilled water with 250mg of INH and 50mg of Teben, were injected into pulmonary tubercular cavities and bronchial ulcer by Nelaton's or Metras sonde, approximately 30 to 50 times twice weekly.
It was found that reduction of the cavity in 1 case, cicatricial changes of bronchial ulcer in 1 case, inclination of bacilli negative results in bacteriological cultures of sputa and improvement of general symptoms in 3 cases, with exception of 1 case in which emulsified oil could not reach the tuberculous lesions because of intense coughing at the injection.
At present, it may be inadequate to estimate the therapeutic effect, because of the more scanty cases and no observation of the long-range outcomes.
The present paper described the effects of emulsified oleum hydnocarpi with sodium salt of oleic acid as a basic drugs for direct chemotherapy in tuberculous cavities.

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It is rational that one physician establishes diagnosis and treats successively for chronic diseases such as pulmonary tuberculosis. Thus, we, specialists of internal medicine, have performed thoracoplasties on app cases, since December 1947. The data of 270 cases operated during December 1947 and August 1953 were investigated at the end of March 1954. Thirty-seven cases were not investigated because of unknown address.
Out of all cases, 88 cases (32.6%) returned to their works and 190 cases (70.4%) were progressively favourable after thoracoplasties. Incidentally, Ono, Latard, Lees, Kano and others reported some cases which died immediately after thoracoplasties, but we have experienced neither table-death nor early death, and we believe this is remarkie thing. Of our cases, there were 11 cases that should have died if not unforced operation methods and careful observation with partinent treatment by operation.
In order to obtain good remote results, ribs should be resected enough in length, especially from the 1st rib to the fourth.
As for cavity, its extent was more serious than its number. A giant cavity over 5cm in diameter, was worse in remote results than under 4cm ones, if Monaldi's operation was not beforehand conducted. As for the location of cavity, it was generally successful in the second lung region, according to Kano's classification, however, if the cavity located immediately near the hilus, it was unsatisfactory.
Body temperature, blood sedimentation rate and tuberculoss bacilli in sputa before operation did not have great effect on remote results. If pulmonary capacity was under 1, 000cc, it was unsuccessful. Body temperature, blood sedimentation rate and results of culture during the 3 months after operation were not responsible for remote results.
If a case has over 2, 000cc of pulmonary capacities after operation, possibility of rehabilitation can be expected.
It was effective to give antibiotics before and after operation.
Infiltration in opposite lung generally showed improvement after operation. When collapstherapy such as pneumothorax, pneumoperitoneum and thoracoplasty were indicated for the opposite lung, it was more favourable for remote results to conduct them.

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Data of the cases bronchoscoped before and after chemotherapy with SM, PAS, INH, TB₁, separately and in combination, i. e., SM and PAS, SM, PAS and INH; Out of 129 nonulceration cases, 2 cases became worse, 28 cicatrized, 40 unchanged, and in 57 the therapy was remarkably effective. Out of 99 ulceration cases, 8 cases unchanged, 29 cicatrized and in 62 the therapy was effective. Out of 23 cases with scar, 21 had no changes, 2 became worse. Cases with new shallow ulceration showed improvement and half of the nonulceration cases showed improvement, however, cicatrized cases showed no improvement. No other suitable therapy except resection of bronchi is at hand for cicatrized stenosis. As for local treatment, aerasol of chemotherapeutics and local use of silver nitrate were effective. Intubation of laminalia and metal ball for bronchial stenosis had no effect.
Secondary reactions; a case had tooth breakage and huskiness for a long time. Main complications due to local anesthesia with cocain were acute cocainismus with convulsion, that developed in 5 cases out of 890 cases, due to the use of 2 to 4cc of 5% of cocain, but this is not caused by overdosage. However, all of them recovered by 10 to 30 minutes. In 200 cases, elevation of body temperature, sore throat, increase of coughing, haemosputum, huskiness, headache, dry feeling of mouth were resulted, however, they disappeared in several hours.

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The occurrences of dental erosion among tuberculous patients by age were studied. The results are as follows:
Male: 49.8% in the average; 4 out of 25 (16%) in the 16 to 20 age group, 42 out of 114 (36.8%) in the 26 to 30 age group.
Female: 55.8% in the average; 18 out of 45 (40.0%) in the 21 to 25 age group, 43 out of 77 (55.8%) in the 26 to 30 age group.
This indicated that more than one-half of tuberculous patients, regardless of sex, were sufferring from erosion of teeth.
Factors of age and length of the illness to the erosion of teeth: Male: 13 out of 19 (68.4%) in the 36 to 40 age group, that had been ill for one to five yeas, 17 out of 22 (77.3%) in the 41 to 45 age group, that had been ill for 6 to 10 years, 17 out of 24 (70.8%) in the 36 to 40 age group, that had been ill for more than 11 years.
Female: 5 out of 6 (83.8%) in the 41 to 45 age group, that had been ill for one to 5 years, 5 out of 10 (50.0%) in the 36 to 40 age group, that had been ill for 6 to 10 years, 7 out of 10 (70.0%) in the 26 to 30 age group, that had been ill for more than 11 years.
Data drawn from the classification by length of illness: Male: 4 out of 7 (57.6%), that had been ill less than one year, 116 out of 264 (57.1%), that had been ill for one to 5 years, 105 out of 165 (63.6%), that had been ill for 6 to 10 years, 78 out of 119 (65.5%), that had been ill for more than 10 years.
Female: 0 out of 3 (0%), that had been ill less than one year, 51 out of 120(42.5%), that had been ill for one to 5 years, 35 out of 78 (44.9%), that had been ill for 6 to 10 years, 22 out of 31 (71.0%) that had been ill for more than 11 years.
This indicated that the occurrence of erosion of teeth was in proportion to length of illness.
The relation between erosion of teeth and dentifrices and tooth brushes: 104 out of 202 (51.5%), that were using nylon brushes and 46 out of 98 (46.9%) that were using bristle brushes.
In nylon brush group: 50 out of 102 (49.0%) used paste, 38 out of 74 (51.3%) used pastepowder, 16 out of 26 (61.5%) used powder.
In bristle brush group: 16 out of 42 (38.1%) used paste, 19 out of 36 (52.8%) used pastepowder, 11 out of 20 (55.5%) used powder.

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We have observed the anesthesia at certain regions of the skin of leprous patients and the relation between anesthesia and disturbance of sweating at the same regions.
1) Twenty leprous patients were chosen and their tuberculoid macula of skin and the anesthesia were observed. It was noticed that the extent of tactile agnosia was generally wider than that of analgesia.
2) Thirteen cases were chosen and their lepromatous infiltrations, lepromatous nodule and clinical pictures of the skin anesthesia were observed. In some of them, the extent of analgesia was wider than that of tactile agnosia, and in the others it was in reverse order.
3) Thirtyfive cases of various types of leprosy were chosen and their skin without primary lepromatous change but with anesthesia were observed. It was noticed that region of analgesia was wider than that of tactile agnosia regardless of type, lepromatous or tuberculoid.
4) It was noticed that extent of paralysis of temperature sensation was widest of the four. Generally, extent of paralysis of warm sensation was wider than that of cold sensation.
5) It was considered that extent of sweatless area may not become wider than that of paralysis of skin sensitivity, according to the relation between the figure of anesthesia and the disturbance of sweating at tuberculoid macula and leucoderma leproua.
6) As for the relation between anesthesia and disturbance of sweating of lepromatous infiltration or lepromatous nodule, the region of sweatless part was smaller than that of analgesia, and there were two types, wider and smaller than the part of tactile agnosia.
7) As for the relation between anesthesia and disturbance of sweating at the part where skin sensitiveness had been paralysed without revealing primary lepromatous changes on the skin, many instances showed that the region of sweatless part was smaller than that of the anesthesia, but sometimes there was reverse condition.

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Bronchogram were made before and after extrapleural pneumothorax in ten cases and pneumoperitoneum in ten cases.
In the moderately collapsed lung treated by extrapleural pneumothorax, decrease of the angle of inclination of main bronchi, shortning or no filling of R. apicalis, R. dorsalis were observed. And yet, all of them were moved towards the mediastinum. R, medius and basal bronchi were slightly moved as findings in thoracoplasty. On the other hand, in the slightly collapsed lung, R. apicalis was inconsiderably and R. dorsalis were remarkedly moved towards spine.
The bronchogram which treated by artificial pneumoperitoneum showed displacement of basal bronchi, especially R. ventrobasalis, and R. retrobasalis, but upper lobe bronchi was not affected.

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