The author observed on the laboratory tests and autopsy which were examined in the attached Hospitals to national university and in the national Hospitals, comparatively, and noticed that the national Hospitals were far behind qualitatively in laboratory tests and quantitatively in autopsy.
The author considered on the cause of the inferiority of the national Hospitals as above described and discuscd on the way of improvement, and concluded that the most effective way of improvement is the practice of following facts:
1. Increase of the numbers of medical technologist, reasonably.
2. Increase of the laboratory instruments.
3. Development of new laboratory tests.
4. Increase of the numbers of hospital pathologist and practice of the effective training for hospital pathologists.

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In 1956, Nishimura and Shibata reported that tyrosine metabolism was abnormal in patients with dermatomyositis.
Since 1963, Matsumura and Shibata have studied the tyrosine metabolism of rats given repeated loads o tyrosine.
From our biochemical and immunological experiments, a large amount of p-hydroxyphenyl pyruvic acid is excreted in the urine from rats given repeated loads of tyrosine or thyroxine.
These findings suggested that the loaded tyrosine might be convented to thyroxine, the depression of suprarenal function was observed and then a large amount of hydroxyproline might be excreted in the urine.

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During the period of about one year from Dec., 1965 through tact., 1966, the urine of 5684 cases in medical clinic were tested. The patient with positive result was followed up, and the cause of positive result was investigated.
It consists of 283 cases of proteinuria, 170 cases of glycosuria and 1243 cases of urobilinogenuria. Except the cases with already some disease or suspicious symptom, unexpected positive result, which contribute to diagnosis of unexpected disease, was found in 0-5% of proteinuria, 0-5% of glycosuria, 0-3% of urobilinogenuria respectively.
In this screening, it was recognized that unexpected protein and sugar may be a key for the diagnosis of hyperthyroidism and cystitis, However positive urobilinogen was not useful because of the unspecificity.

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Small outbreak of pharyngeal fever occured in Children's rooms in National Hospital of Sendai, November 1965, All patients were less than 8 year-old. Adenovirus type 3 was isolated from the throat swabs of the 6 cases with this disease of 10 and significant rise of HI antibody against adenovirus type 3 in paired sera obtained from the patients was demonstrated in 8 cases of 11. Then it was evident that the outbreak of pharyngeal fever was due to adenovirus type 3. Antibody against adenovirus type 3 in sera obtained from the children in the same rooms who did not suffer from the disease was also titrated. Neutralizing antibody was found in 22 cases (81.5%) of 27, although HI antibody was positive in 7 cases (25.9%) of 27. Thus it is suggested that most of susceptible children against adenovirus type 3 were infected with this virus and apparently suffered from the pharyngeal fever.

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On the day of June 30, 1966 Tuberculous patients were examined at 27 National Sanatoriums in Kyushu District. The total numbers of patients were 7014.
Among these patients, 2292 were bacillus-productive: 21.2% of them (483 patients) were resistant to one kind of antitubercle, 30.1% (704 patients) to two kinds of antitubercles and 27.8% (637 patients) to three kinds of antitubercles. These primary antitubercles resistant patients were 79.6% (1824 patients).
Out of these primary antitubercles resistant patients, moreover, 61.4% are resistant to SM, 49.4% to PAS and 5.0% to INH.
Much difference was observed among these results between each Sanatoriums.

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In 1965, 3305 of patients with tuberculosis were discharged from 27 national Sanatoriums, among them 8.5% (282 patients) was bacillus productive. The Primary antituberculons drug resistance was examined on 240 of these discharged patients: 19.6% (47 patients) were resistant to one kind of antitubercle, 30.4% (73 patients) to two kinds of antitubercles and 27.9% (67 patients) to three kinds of antitubercles. These antitubercles resistant patients amount to 77.9% (187 patients) in total.
As for resistant rates of these antitubercles, 57.9% were SM resistant, 52.4% PAS resistant and 53.7% INH resistant.
These results resemble those on admitted patients but in this regard, much difference has been observed among each of sanatoriums. No bacillus productive patients are included only at one of the sanatoriums among those discharged ones.
From the results, we should emphasize the importance of isolating the patients at sanatoriums, but the above observations, on the other hand, also show difficulties in isolating of the patients.

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Recently the standdization of the clinico-pathological tests became very important in laboratory medicine, because there were too much their methods to evaluate accurately. Accordingly we established a team for the Co-operative study about that theme in the National Hospitals of the Ministry of Health and Welfare on April 1st 1963.
A standing committee for the planning and arrangement of that study was made, and we divided in next five groups; physiology, biochemistry, hematology, serology and histopathology, as our research field was so wide. Due to the bylaw determined by the committee, we collected data and compared each result sent from hospitals, using control serum or blind test methods, and discussed eagerly in our committee from a standpoint of standardization.
Through three years study, several instructful results for promoting the standardization in methodology, were obtained as the following reports show.
As a reprensenter of this studying team, the author is grateful to the National Hospital Section of the Japanese Ministry of Health and Welfare, and all related staffs and members, for the kind advice and help on the completion of this report.

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The Department of Physiology, National Hospitals' Joint Study Unit, presents the following recommendations.
1. In Japanese, the chest leads should be recorded on the scale of 0.5 cm, deflection for 1mV. The usual scale of 1.0cm, for 1mV. in standard leads results in scale out in many cases owing to the higher voltage of the complexes in the chest leads.
2. The article “S_V1+R_V5″≤35mV.” alone, in “electrocardiographic criteria of left ventricular hypertrophy” by Sokolow-Lyon, makes risk of containing many pseudo-positive cases in Japanese.
The decision should be done on the basis of “40-45mV.”, and also of other articles in consideration.
3. In the cases of hypoteinsive disease, the E. K. G. should be taken not only in the supine position, but also in the erect positon.

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As the first step of the joint study to standardize the presently used methods of the laboratory tests, the author investigated the data of quantitative examinations collected from various institutes. For this purpose, the same sample was first sent to the various national hospitals, and then the results obtained were collected. These results were evaluated with particular reference to their accuracy or precision, and in turn the standardization of the method of individual test was attempted.
The Investigation on the Present State.
1) The Method of Investigation;
Twelve items were selected for the study. Those include total protein, A/G ratio, blood sugar, sodium, potassium chloride, nonprotein nitrogen, urea nitrogen, total cholesterol, calcium, transaminase (GOT) and alkaline phosphatase. In the past two years, these tests were performed 3 times by the 2 sorts of common lyophilized sera.
2) The Criteria of Evaluation for the Data;
As a criteria of evaluating the data, accuracy or precision was applied. Namely, the percentages of the number of the institutes, from which assumably correct figures or ratios for the two samples were obtained (L or M), against the total numbers of institutes (N) were calculated. The former (L/N×100%) was referred as to accuracy and the latter (M/N×100%) as to precision respectively.
3) The Results and Discussion;
Using this criteria, the following results were obtained as to the accuracy and precision.
1: Comparing the data of 1963 and 1954, the accuracy was almost concurrent in the majority of the items with only ±10% difference.
2: The data of total protein, A/G ratio, total cholesterol, urea nitrogen, blood sugar (Hagedorn-Jensen's Method) and potassium revealed more than 50% of accuracy.
3: The data of blood sugar (Somogyi-Nelson's Method), alkaline phosphatase, nonprotein nitrogen, calcium and sodium revealed less than 50% of accuracy. Above all, the accuracy for sodium (especially for the sample of lower range) and GOT was low.
4: The accuracy of the hitherto applied methods for the determination of non-protein nitrogen was poor, Rappaport being 31% anb Kjeldahl-Nessler 27%. On the other hand, every method for urea nitrogen determination revealed about 70% of accuracy, and it is noteworthy that a simplified method (Unigraph) revealed 73% of accuracy, even better than the orthodox quantitative method.
5: As a rule, precision was better than accuracy. The reason for this is probably follows. Since precision is calculated from the concentration ratio between two samples, it may not be influenced so much by the difference in the concentration of the standard solution as accuracy.
6: This tendency was most remarkable in GOT. Therefore, it is well assumed that the low accuracy of the method of GOT determination is attributable not to the testing technic but to the concentration of standard solution or to the method itself.
7: Contrarily, the precision of the method for total protein determination is worse than its accuracy. This tendency is more remarkable in the data of 1964. This is probably due to the fact that the concentration of protein is not proportional to refractory index in its lower range.
The Standardization of the Method of Serum Urea Nitrogen Determination:
After the two year evaluation of the present state of laboratory examinations, in the third year (1955), the author attempted to establish the urease-indophenol method as a standard method for serum urea nitrogen determination.
1) The Selection of Item and Method;
There are two reasons that urea nitrogen was selected for the item of standardization. Firstly, the data of urea nitrogen are apt to be more accurate or precise than those of non-protein nitrogen which has been used in the similar clinical purpose so far. Secondly, it is more logical to determine urea nitrogen, the end product of metabolism, than to do non-protein nitrogen in the cases with renal

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Sixtyeight technicians working in the hematological department in eight national hospitals, three other public hospitals and two university hospitals were examined.
The differential counts of same blood smear and naming of same leucocytes of color films were presented for their test with miserable results, that we are much disappointed.
We concluded that this kind of test disclosed their lack of knowledge sufficient enough for hematological cellmature of leucocytes.

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Recently, it becomes a problem that the biological false positive reactions (BFP) were shown in the serological tests for syphilis (STS), especially when the cardiolipin-lecithin antigen (C-L antigen) methods were used.
Generally, in our country, there are two main methods for STS. Group 1 C-L antigen used contains the slide test (according to VDRL), the agglutination test and the comple-
ment fixation test (Ogata method). Group if is the method using the reiter antigen from treponema reiter strain (RPCF).
We compared and studied each result by above mentioned four methods about 10, 000 cases which were gained from 1st Tokyo, 2nd Tokyo, Kyoto, Nagoya, Osaka and Okura national hospitals during past three years from 1963 to 1965.
Obtained results were as follows:
1. Though it is described that the highest percentages of BEP occur in malaria and leprosy, in 17 cases of leprosy, 6 cases of BFP with three STS which used C-L antigen were observed while all cases with the RPCF were negative.
2. In a number of diseases unrelated to syphilis, incidence of BFP with the RPCF only showed 0.7 per cent in the Kyoto national hospital about 4, 000 cases and 0.2 per cent in the Okura national hospital about 3, 516 cases.
3. Therefore, the specificity with the RPCF can be considered 99-100 per cent from our co-operative studies as G. R. Cannefax et al reported in 1957.
4. Concerning to the sensibility of STS, the slide test and the agglutination test are better than the Ogata method and the RPCF, but we must always consider about the incidence of BFP with those methods.
5. It is desirable that the above mentioned four STS are performed routinely on each case at the same time.

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Standardization of the special staining method about the pathology was discussed and following conclusions were obtained.
1. Standard methods of the silver staining and elastica staining were defined.
The preparations by these methods were excellent than another methods.
2. Relatively fine method about the fungus staining was P. A. S, staining.
But Gomoris' methenamine silver staining was the best, especially when the organs were fixed in a formol for a long time.
3. About the mucin staining, alcianblue staining was the best on the histology; and P. A. S. staining was the best on the cytology.

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On the occasion of the guide-revision of the the-bac, examination-method, the research association was concluded for the purpose of re-examination of the customary technics and of planning the technic standerizing of the method.
The results were as follows:-
1) The Kokuryo-type shaker was invented for mixing of sputum.
2) The results of inoculation of 1% HaOH sputum are apparently improved by using this shaker.
3) For promoting efficiency of culture manipulation, 6-7 days long horizontal situation of culture medium following gumcapping direct after inoculation was tried and was proved as usefull as customary methods.
4) Concerning the culture of the-bac, in gastric juice, the treatment with 4% NaOH is more usefull than the others.
5) For diminution of resistance culture titre through long time incubation there is no fear as far as the culture is selfmade.
6) As to SM and PAS, resistance is higher estimated on the 3% Ogawa culture than on the 1% culture. But to INH no differences.
7) Resistance titres of the same samples, estimated by each laboratory with indirect method, differed much more than expected. So the causes of this incoincidence will be investigated by this association.

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