A reliable treatment of leprotic malum perforans has not been discovered yet. The authors conducted studies on this problem clinically and obtained score results.
The objects of present study were 11 cases of neural type and 33 cases of lepromatus type of leprosy patient, of which 36 cases were male and 8 were female cases. Neural symptoms of them were of different grades. Locations of maium perforans in the m were: toe, sohl of foot and external ankle. Nature and course of perforation were not priority taken into selection in our investigation.
Main treatment was ‘the extension of ischiatic nerve’. The treatment was performed at the 5 to 7 cm upper part of fossa poplitea (the authors' modification method). This operation were conducted one to two times in each case.
Other treatments were as follows:
1) Local treatments of maium perforans: Administration of penicillin ointment, pilocarpin ointment, chrolophyll ointment, penicillin gaze, and heftpflaster. Operation of Reverdin's skin transplantation, and sequesterotomy and application of splints.
2) Chemotherapy: Kariklein, acetocorine and anti-biotics
3) General: Bed resting.
Post-operational observing period was 3 to 12 months.
Results were as follows:
Curing period of maium perforans through this modification was generally shorter than in case of original method However, byeffect of the modification method was severer than that of original method. It may be due to the stronger extending power resulted form the modification method. Furthermore, it may affect the peroneal nerve more severly than the tibial nerve. Since almost all malum perforans are situated at the sohl of foot, the authors are intending to perform the operation of extending the tibial nerve. It is concluded that the succeeding operation should be conducted within 1 month after the initial operation, if the effect of the initial operation is not satisfactory. No correlation was found between the difference of method and rate of relapse. The ratio of recovery through the modification method is bigger than that of the original method. Incidentally, in the modification method, patients received two operations, i. e., initial and secondary operations. The ratio of relapse is higher in the former than the latter.
Relapses were hematoma, edama, excoriation, chaps of re-inflammation of local reposed infection, etc., which developed within 3 months. Therefore, if lesions were taken care of after recovery against relapses within 3 months at least, relapses n:ay be prevented.
In conclusion, according to our data, the modification method will be considered as the main treatment of leprotic malum perforans, although further improvements Ehall be made to the method.

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Thickness of subcutaneous fat (T. S. F.) of tuberculosis patients were measured at 36 different regions of body by means of Martin's compass calipers. The results were as follows:
1) T. S. F. of TB patients were thinner than the normal average of T. S. F., at both ex-tensor-side and flexor-side of extremities. At the back of trunk, there were no differences between TB patients group and normal group, while at the abdominal side, the T. S. F. of TB patients were thinner than the normal average.
2) T. S. F., especially at the back side of trunk and the proximal regions of extremities, of severer cases were thinner than those of slighter cases of TB patients.
3) T. S. F., especially at the abdominal side of trunk (near navel) and at the proximal regions of legs, of TB patients under occupational therapy were thinner than these of mild cases under rest therapy. Boad of working may be considered as a cause of the difference.
4) The ratio of the sum of the T. S. F. at six regions of abdominal side to that of dorsal side of trunk was 0.597 in case of severer tuberculosis and 0.553 in case of milder ones. In the patients under occupational therapy, the ratio was 0.446, which is almost equal to that of normal average(0.451). These shall be significantly related to the degree of rest(1 % lever.)
5) Regions, at which the deviations of T. S. F. were remarkable, were abdominal side (especially near navel), dorsal side of trurk and the flexor side of leg.
6) Corelations between the T. S. F. (measured near navel) and clinical items such as the degree of rest, cough, amount of sputum, body weights. blood sedimentation rate, vital capacity and excretion of tubercle bacilli were also investigated. The T. S. F. of TB patients were significantly related to the amount of sputum and body weight, while no relationships were found between the T. S. F. and the other items.

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Prior to the measurement of sensitivity of tubercle bacilli against antituberculous agents, in sputum smear or through cultivation, by means of slide culture method, the author studied mainly Tsuji's Modification of Berry & Lowrry's method, and obtained the following improvements:
1) In case of slide culture of tubercle bacilli through cultivation, it is better to prepare 1 mg/ml of bacilli emulsion with 50 to 100% horse serum and to use slightly centrifuged supernatant part of the emulsion for the smear.
2) The optimal pH value of Kirchner's liquid medium for the slide culture method is around 6.8.
3) It is recommended to add 0, 001% of malachit green to the medium, in order to inhibit the growth of saprophyte.
4) The suitable number of culture days of tubercle bacilli in the said slide culture method is 7 days, in case of sputum, and 10 to 14 days in case of cultivation.
5) The count of more than 11 bacilli, in case of sputum, can be generally considered as of positive growth, and sometimes more than 21 bacilli, in case of cultivation.

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In the last paper, the author reported on the blood protein chemistry of healthy persons and of untreated tuberculous patients. This paper deals with the investigation into hemoglobin contents, total serum protein, albumin, γ-glcbalin concentrations, albumin-globulin ratio and thymol test in tuberculous patients, treated with streptomycin or tibione.
I. Method:
The same method, described in detail in the last report, were used, i. e., cyanmethomoglobin method far hemoglobin content, and ‘salting-out’ method for serum protein, albumin and γ-globulin contents were used Luminal was used instead of veronal in thymol test.
II, Results:
1) Out of 14 cases, in which streptomycin therapy was effective, 11 cases showed initially lower value of hemoglobin content. Out of the 11 cases, 4 cases gradually regained normal value, while the rest of the cases later showed almost normal value. 3 cases were continuously of normal value. In 4 cases, in which streptcmycin was ineffective, hemoglobin content remained below normal level throughout the investigation.
In 4 cases out of streptomycin effective cases, the total serum protein became normal from the initial low value, while it increased to higher values from the initial normal value in 4 cases, and in 3 cases it remained normal, another 3 cases showed higher value. Among the streptomycin ineffective cases, the total serum protein decreased from the initial normal value in 1 case, remained at normal value in 3 cases.
Among the streptomycin effective cases, γ-globulin initially showed high value, except in one case. The initial high value decreased later, and in about half of the cases, the value returned to normal value. In the rest of the cases, terminal value was slightly larger than the normal level. In 2 cases, in which streptomycin was ineffective, the initial high value became higher by the end of the test.
Among the streptomycin effective cases, thymol test was normal in 5 cases, it increased from initial high value to higher terminal value in 2 cases and in 6 cases it was continuously high. Among the streptomycin ineffective cases, thymol test gave high value in 3 cases and in 1 case it became normal value.
2) Among the 10 tibione effective cases, hemoglobin content showed terminally low value, except in 1 case, in which it was continuously low. Total serum protein became normal in 3 cases and it was continuously normal in 7 cases. Although albumin content was low in all cases, 6 cases had a trend to reach almost normal and another 4 cases gave more slightly low value. In half of the cases, γ-globulin decreased from initial high value to almost normal value, and in the rest of the cases, it increased and reached high value finally.
Albumin-globulin ratio showed initial low value in all cases. It increased later in 7 cases, of which 2 cases regained normal value, while other 3 cases were of low value throught the test. Thymol test gave initial normal value in 8 cases, in which it later decreased. In 4 cases, it ended with high terminal value, and in another 4 cases it became normal. In 3 cases, it remained high throught the test.
III. Conclusion:
It was revealed that abnormal blood protein contents due to tuberculosis will become normal in time through effective therapy. However, the fact that tibicne has the side-effect of decreasing hemoglobin content, shall be taken into consideraticn in the use of the drug in a prolonged treatment of tuberculosis.

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This paper deals with the painless delivery by means of the application of Hyaluronidase, in addition to the Demerol, for local anesthesia 46 cases were proved to be very satisfactory.
1) Demerol was administered for the preceding anesthesia, and for pudental nerve and for outer-pudendum. 5, 000 V. U. M. of Hyaluronidase and 100 cc of 1% novocain added with Bosmin were used for infiltration anesthesia.
2) Since Demerol affects higher synccptic conditions of fetus, its dose was limited within 105 mg and was injected into mother's upper arm. In this method, anesthesia continued about an hour and a half. Therefore, the said injection was conducted at the time of crowing for primpara or after opening of four finger with at the ostium of uterus in case of para, as a rule.
3) As for local anesthesia of pudendum, the said 1 % novocain was prepared in a 20 cc syringe with a 8 to 10cm intramuscular needle. Physician's first and middle fingers were inserted into vagina for searching of spina ischiadica, with the leading of the fingers, the said needle was placed into the inside of tuber ischiadicum, and 10 cc of the said preparation was injected into the nearest sourrounding tissues of spina ischiadica. Then the said needle was changed with hypodermic needle, and 20 cc of the said liquid was injected into labia minors, commissura posterior and perineum, for the infiltration anesthesia. An appropriate time for the injection is 30 to 40 minutes before the delivery.
4) 76% of the total cases was perfect anodynia, 13% was thankful slight anodynia delivery. Therefore, 85% of the total cases was of satisfactory in the decrease of pain.
5) No harmful reactions upon the use of demerol for mother were observed. Almost no influences were seen in blood pressure and pulse. Travail was generally restrained in its slightest restrait-action.
6) The most suitable dose of Demerol will be 135 mg and 70 mg was probably somewaht insufficient dose. However, because of individual difference, partial injection of smaller dose may be more desirable.
7) Even the amount of 105 mg of Demerol may sometimes cause respiratory troubles in born-baby. Therefore, oxygen inhaler and baby heater are always desirable in maternity room. The characteristics of syncope by Demerol was weak cring of baby for hours after recovery and continuation of slight cyanosis. For the prevention of syncope, injection of vitacampher into born-baby's head was effective. As the last resort, the said injection into heart shall be tried. Cyanosis and syncope of born-baby appeared in 15%, and 6%, respectively.
8) As for local anesthesia, hyaluronidase was administered to promote the absorption of the medicine and to reduce oedema. Moreover, pains in lateral incision and stitching of perineum were sufficiently prevented.
9) As for a deect of this method, it will take more than 20 minutes to reach satisfactory anesthesia. Therefore, in case of a rapid delivery, it may be of little use.
10) When the quantity of medicine and starting time of injection are carefully settled. This method will be very satisfactory one.

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There are lots of poor administrative measures in the administration of pediatric clinics or nursing units in general national hospitals of Japan. Lately, administration of pediatric nursing unit has been considered of its special natures and gradually it became one of the important problems of hospital administration. The present paper deals with the status presence of pediatric departments and pediatric nursing units of national hospitals in Japan, for the period from June to July, 1953.
1) Out of the total of 80 rational hospitals(as of June 1953), 65 hospitals held pediatric departments. Scales of their pediatric departments were small in case of smaller national hospitals of 200 beds or less.
2) Many pediatric department used to admit less than 30 patients and the average rate of children to the total in-patients were 4.5%. They used to have about 10 to 40 children for out patients per day and the rate of children to the total out-patients were 7, 5%.
3) Medical staffs and nurses who were in charge of pediatric clinics were very few, the equipments were very poor, and it was difficult to treat or take care children satisfactorily.
4) It was one of the important problems that there were so many tuberculous children hospitalized in general national hospitals.
5) It was not easy to give good care and education for children who had been hospitalized for a long period.
6) Two hospitals were equipped with hot-spring, and one of them had largest pediatric department in Japan Incidentally, it had about 80 in-patient-children and about 100 out-patient-children per day. while the other hospital admitted children only.
7) There are many other problems concerning to new-born babies, diet for children, clothing and equipments of pediatric nursing unit, , etc.

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