According to our concepts, it mainly owes to characteristic properties of tubercle bacilli themselves that various and complicated reactions appear during the course of tuberculosis in animals or patients.
In general, these mycobacteria) cells contain a lot of lipoidal material, of which biological and biochemical roles in tuberculosis are being clarified recently, Here, our biochemical aspects on some of such biological reactions, originated from the infection of tubercle bacilli, will be presented in this special lecture.
1) Virulence of tubercle bacilli The properties which seem to have an close correlation to the virulence of tubercle bacilli are; the magnitude of proliferation in vivo, the affinity to organ or tissue, the production of proper toxic substances, the ability to compete the elimination of bacilli from the host and the secondary toxic manifestations based on the antigen-antibody reactions.
We designed a method to estimate the number of the whole bacterial population, by plate counting technique of the homogenate of whole body of mice after infection. The ability of multiplication of mycobacteria in vivo could be classified as follows:
(i) Highly virulent strain which begins to multiply immediately after the inoculation and kills mice in 10 to 14 days (bovine strain; Ravenel).
(ii) Virulent strain which multiplies after 7 days of lag phase and kills mice in 21 to 28 days (human strain; H₃₇Rv).
(iii) Attenuated strain which shows a weak tendence of multiplication and survives in vivo for long time without killing mice (vole daeillus and BCG).
(iv) Avirulent strain which disappears from mice bodies at the 6th to 8th week after inoculation, showing a slow and continuous becrease of number (human streptomycin-dependent strain; 18-b and human strain; HrRa), (v) Non-pathogenic mycobacteria which disappears from mice bodies at longest after 2 weeks (Mycobacterium phlei).
When virulent tubercle bacilli, strain H₃₇Rv, were used for infection, the death of a mouse seems to occur at whichever time the total number of bacteria in a mouse had ream ched a value of about 10⁹ to 10¹⁰. Early in the period of infection, most of the bacilli were found in the liver, whereas later in the course of the disease, the highest population of the bacilli was found in the lungs.
Being tested by the same method as above, atypical acid-fast bacilli of 11 different strains were classified into following three groups in the manner of in viv multiplication:
1) H₃₇Rv-type, 2) vole bacillus-type and 3) H₃₇Ra-type. And histological changes are also classified into three types each respectively, i. e. 1) necrosis-type, 2) pneumonia-type and 3) alveolitis-type.
Acid-fast bacilli seem to have some specific affinity to organ or tissue, thus, H₃₇Rv strain is largely affinitive to the lung and M, butyricum to the kidney of rabbits, M, phlei showed such pathogenic activity as causing encephalitis accompanied with paralysis or ataxia, when inoculated into auricular vein.
Virulent tubercle bacilli contain some substantial factors which are deemed to originate their virulence. In fact, intravenous injection of heat killed bacteria of virulent strain could afford to similarize the manner of in vivo multiplication of avirulent strain to that of viru lent one, And such factor exists in the particle fraction of virulent bacteria. It was made clear by use of ³²P-labelled tubercle bacilli that this factor was contained in cord factor or cord factor containing lipid.
Cord factor is a proper toxic substance of tubercle bacilli. The toxicity of this substance seems to base on the inhibition of succinic dehydrogenase system and the NAD-linked dehydrogenases, such as lactic-, malic-, and α-glycerophosphoric-dehydrogenases. Cord factor possibly inhibits the biosynthesis of desamino Coenzyme A, since the lowered enzymic activities by cor

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There is a group of patients with hypertension who end up with poor prognosis in a rather rapid course. This condition is referred to as “malignant hypertension”, which seems a term not clearly defined at present.
It has long been discussed as to whether this is a type of essential hypertension taking a special course or another independent disease. There is a general tred, however, to believe that “malignant hypertension” is not an independent disease but a syndrome which develops from primary or secondary hypertension.
In an attempt to shed some light to this controversial problem, we have investigated 416 cases, in which the prognosis was known, out of the 586 hypertensive cases which entered the Nagoya National Hospital during the period from January 1954 to June 1963.
Forty three of the 416 cases were considered to be “malignant hypertension”.
The major clinical findings in these cases were the presence of high diastolic pressures as well as high systolic pressures, hypertensioe retinopathy with papilledema and severe neurocirculatory symptoms such as headache and dizziness, Most patients belonged in younger age brackets, particularly in the third and fourth decades, and died in uremic states. On the other hand, these cardinal findings were not invariably present in those cases that invariably showed definite nephrosclerosis at autopsy.
Therefore, from the clinical point of view, it seems more appropriate to consider “malignant hypertension” a syndrome rather than a disease entity.
Moreover, because of the lack of findings suggestive of this condition in its early stage, it seemed impracticable to establish criteria to predict the final outcome of a hypertension at the time of initial examinations.
Thus, as a compromise, it seems reasonable to handle a case characterized by the following findings as “premalignant hypertension”, that is, markedly high systolic as well as diastolic pressure that respond poorly to antihypertensive drugs, accompanying continuous deterioration of the renal function.
For such cases, efforts should be made to remove or lessen any factors that are detrimental, and to give antihypertensive drugs which can afford an optimal effect, if available.

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This experiment was made to investigate the effects of vitamin C on the mucous membrane and the secretion of parasinuses, particularly of maxillar sinus, of the cases of chronic sinusitis which developed within recent 3 years by means of oral administration of daily dosis of 1, 000mg of vitamin C with together an antihemorrhagic agent for one to six weeks prior to surgery.
The results obtained are as follows:
1) Administration of vitamin C for 1 week prior to surgery:
No effects were observed on the content of vitamin C in the mucous membrane and the microorganisms in the secretion of paranasal sinuses.
2) Administration for 2 weeks:
Vitamin C was appeared slightly in the connective, epithelial and glandular tissue.
The number and kind of microorganisms in the secretion of paranasal sinuses began to decrease and the some of the membranes became immune from that microorganisms.
3) Administration for 3 weeks:
The increase was observed in the content of vitamin C as well as the rising in the titer of immunity of the connective tissue.
4) Administration for 4 weeks:
The content of the vitamin C was markedly increased and significant reduction of the microorganisms was observed.
5) These effects of vitamin C have not any relationship with the pathological type of the mucous membrane of paranasal sinuses.

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We examined chest X-ray films of 604 cases with almost complete re-expansion of lungs in 3 weeks after partial or segmental resections.
1) Sixty one cases of them had round shadows in the operated area, 55 of them were solid and 6 were cavity-like.
2) Fifty two cases with solid shadows (94%) had no clinical symptoms and these shadows were thought to be haematomas which actually disappeared in 5 months. Three of the rest cases with solid shadows had evident clinical symptoms, we knew I of them had haemorrhagic pulmonary infarction in those area and another 2 had tuberculous lesions there. Latter 2 cases showed A. F. B, positive sputum post-operatively.
3) Five of the cavity-like shadows began to show nibeaux gradually, then disappeared in 5 months just like the solid shadows. These 5 cases had no clinical symptoms either, while one case showed bloody sputum in pretty long periods post-operatively and never had tendency to disappear.
4) These abnormal shadows were seen about 3 times more frequently on the cases in which pulmonary plication or suture were performed at the resected surface of lungs than on the cases without such procedure.

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As the therapeutic principle of congenital malformation, it is obvious that early detection and treatment are ideal and consequently its prognosis will be better. As a part of policy for treatment of CDH we have been getting good results by commencing immediate guidance or treatment for acetabular dysplasia, subluxation or dislocation which was found out by routine medical examination for babies, or early detection, On the other hand there have been seen various abuses. First, since a large number of the so-called natural healing has been seen at the age of 8 to 9 months, it gives fear of getting deformity to start treatment from 3 or 4 months old, by treatment even the baby who has possibility to get natural healing and by fixing in abnormal position. Second, in high grade of dislocation it would give possibility of causing poor prognosis to damage young immature joint and surrounding soft tissue during reduction procedure and to fix in inadequately reduced position for a long time.
Now, we are dealing with CDH under the following principles; e. g. we classified babies into 4 classes according to X-ray on the routine medical examination, (a) normal, (b) one who has only acetabular dysplasia, (C) subluxation with or without acetabular dysplasia, (d) one who has dislocation morse than first degree. And (d) group is to be treated at the hospital from the beginning, (b) and (c) are given therapeutic guidance only or proper treatment considering the degree of acetabular dysplasia, form of acetabulum, head and neck of femur, angle of spreading of hip, existence of hereditary factor, and growing state, etc.

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1) We have urged the effectiveness of early recognition and early and definite treatment of congenital dislocation of the hip.
2) During the period of 1957 to 1963, 1074 children, 1544 hips were treated mostly by closed method.
3) In 1957, 90 children including 11 infants (13.8 per cent) were treated before six months of age. In 1963, 207 children, in which 122 (60 per cent) infants, were treated.
4) We discussed the general principles concerning the treatment of this condition.
5) Of these 25 children, between age of two to seven years, 28 hips were treated by open reduction.
6) we have used the method of the capsular arthroplasty (Colonna's operation) with excellent results in children even below the age of three years.
In this procedure, postoperative treatment (extension or massage) is valuable.

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Since 1955 we had performed Colonna's capsular arthroplasty in 55 cases involving 66 joints of congenital dislocation of the hip and reviewed a follow-up study conductcd on 61 joints of 51 cases: 7 cases over 7 years after the operation, 21 cases over 5 yeas, 15 cases over 3 years and 8 cases over one year.
Among the cases ranging from three years and six months old to 26 years old of age at the time of operation, 24 cases were elder than 10 years of age for whom Colonna himself did not indicate this operation.
End-result of 51 cases was as follows ; excellent-24 cases (39.2%), good-7 (13.7%), fair-6 (11, 7%), poor-12 (23.3%) and bad-6 (11, 7%). Of six bad cases two were caused by postoperative infection and another two by complication with enchondral dysostosis.
Unilateral cases under 10 years of age at the time of operation and bilateral cases under 8 years were 29 (33 joints). Result of them was as follows ; excellent-19 (70.30, good-3 (11.1%), fair-1 (3.7%), poor-0 and bad-2 (7.4%). The causes of two bad cases was postoperative infection.
Result of 24 cases elder than 10 years at the time of operation was following ; excellent-1, good-4, fair-5, poor 10 and bad-4. The cause of two of four bad cases was enchondral dysostosis, Even in this group 5 cases showed excellent or good results without any discomfort in their daily lives, contrary to Colonna's insistence, so that we concluded that this operation could be indicated for elder children when the dislocation and the deformity or atrophy of the femoral head would not be so severe.
Several attempts have been made to overcome technical difficulties as follows.
1) According to Colonna's original procedure plaster cast was applied for 4 weeks after operation, but we did only for one or two weeks in order to restore the wide range of joint movement.
After removal of the stitches skin traction was applied at once, and active exercise of joint was begun to practise at the end of the third week after operation. We believe these procedures are essential to have good results.
2) Colonna allowed the patients to walk at 3 months after operation, but we did at 6-8 weeks for 18 cases of younger children without any disadvantages for end-result. We believe however, it is better to allow weight-bearing after longer period for elder patients.
3) In 15 cases (17 joints), in whom newly moulded acetabulum was shallow and unable to cover the femoral head enough, we performed acetabuloplasty, modified to Spitzi operation, with capsular arthroplasty and obtained very good result.
4) All of four cases in which fascia lata or OMS membrane were used to cover the femoral head because of the lack of the inherent capsule showed good results, while 15 cases with reshape of the highly deformed or too large head showed bad results except one case.
As whole, the degree of dislocation seemed to have not so much corelation to the endresult of the operation. It was found, however, the result for the fourth degreed dislocation by Gaugele was always bad and in the elder patients, the lesser the degree of dislocation, the better the result.

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We treat the oongenital dysplasia of hip joint with Povlik's splint, but the oomplete dislocation was treated with two step splint therapy.
In the first step, we apply the “stereo-limitation splint” which is specially made for us recently and mobilizes hip joint three dimentionally, and then move to the second step using Batchelor's splint.
We have had good result by this two step splint therapy in congenital hip dislocation of a nurseling.

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1) An occurence of residual subluxation in congenital dislocation of hip joint is different by the method of treatment.
Residual subluxation highly occures when the leg is fixed in Lorenz position for all period, but it does not happen in the cases fixed in Lange position subsequently.
2) Residual subluxation is caused by insufficency of inner rotation in the hip joint, relaxation of the joint capsule and abnormal anteversion of the upper end of femur.
3) As treatment of the residual subluxation, we advocate the fixation by Batchelor splint except abnormal version of the upper end of femur.

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From 1960 to 1964 we experienced 70 cases, 99 hip joints among them 57 had dysplasia, 14 had partial dislocation and 29 had complete congenital dislocation of the hip joint.
Fifty one patients were treated successfully with the method described by Pavlik's Riemenbügel.
Nineteen patients were treated with closed reduction and application of a cast described by Lorenz and Batcherer for 1 or Z months.
Disturbance of growth of the femoral head was seen in only 1 case, treated with closed reduction.
It is recognized that disturbance of growth is less frequently seen.

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Eighty-three joints in 50 patients with congenital dislocation of the hip were followed up for 5 to 15 years after closed reductions, The reductions were performed after Lorenz's method under ether anesthesia, The age of patients was between 5 months to 3 years, Among the 83 joints in 50 cases reported, 47 joints were redacted in less than 1 year of age and the remaining 36 were elder than 1 year of age, Results of the closed reductions were evaluated with the subjective, objective findings and X-ray examinations.
1) uses undergone reduction in less than 1 year of age showed better results than those over 1 year of age.
2) Results on clinical evaluation were excellent in 59ao of the cases, good in 27. 7%, fair in 9.6%, poor in 3.6%, but on X-ray evaluation excellent in 30.1%, good in 48.2%, fair in 20.5%, poor in 1.2%.
3) These results were not only related to the age of patients but also to the degree of dislocation, the shape of acetabular roof, the technic of reduction and the postoperative treatment.
4) There were some cases which showed clinically good and unsatisfactory on X-ray examinations. X-ray changes did not overcome clinical manifestations, particularly in those cases in which the clinical symptoms began to appear in hip joint. The cases with subluxa tion of the hip at the time of treatment revealed unexpectedly discouraging results with poor congruence and other anatomical changes of the joints at the time of survey.
5) The results of the therapy were not parallel to the degree of dislocation.
The survey revealed generally poor results in cases of the coxa vara, excessive antetorsion, aseptic necrosis and non eccentricity of the femoral head which developed after completing routine treatment.
6) These studies suggest that early diagnosis and early protective reduction are necessary in congenital dislocation of the hip.
In our hospital every new born infant used to be checked within 1 week after birth at orthopedic department, having a close contact with gynecologists and pediatricians.
Especially for the hip joint, Ortolani's Click test and Barlow's technic are performed as routine procedure. When a dislocation is suspected, then the baby is examined by the both methods of Andren and von Rosen.
522 babies had been checked, 15 showed subluxation or dislocation, and underwent early treatments.
Recently, von Rosen's splint has been used and in the cases which failed to be reduced naturally by this splint, the apparatus applied with universal joint is used with good result after over-head traction.

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Food poisoning by salted sardines, which showed neither putrid odor nor abnormal appearance, occured at Hyogo National Sanatorium, in November, 1962.
The cause and clinical symptoms of those were as follows: One sort of pseudomonas was cultured in the same group of sardines which produced poisoning, On chemical examination an amount of 400mg% of histamine was proved in these sardines.
On this poisoning, I suppose histamine was produced in putrefaction of sardines. But, some tests of the germ, in order to make histamine from sardines, were unsuccessful. I believe, however, histamine was the main cause of this poisoning, and some patients were more intensely influenced by histamine with other substances than by histamine alone.
The clinical symptoms just like as in allergy were observed in 162 out of 238 cases (68.1%). Symptoms and signs were headache (82%), eruption (77%), feeling of fever (49%) and chill (27%), and actually 17% of the cases were febrile. In addition, symptoms of digestive organs were nausea, vomiting, diarrhea and stomache-ache.

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