We have treated cases of silico-tuberculosis as well for seven years since July, 1960. A study on 156 cases of them revealed the following results. (1) A remarkable difference of the silico-tuberculosis from the simple silicosis was that the percentage of improvement far surpassed that of aggravation, i.e. improved cases 49%, cases which showed no change 40%, and aggravated cases only 11%. (2) As to the type according to X-ray shadows, p occupied 64%, while n occupied only 6%. Such a distribution may be due to the fact that most of the present cases were silicosis in pottery workers, which ordinarily belong to pneumoconiosis of small opacity, p. (3) As to the type of quantitative features of pneumoconiosis, 81% of all the cases belonged to type 1 and type 2 both of which are relatively mild. (4) The grosser the small opacities (i.e. the qualitative features of the opacities advanced from p to n via m ), the higher was the percentage of aggravated cases; and the more advanced the quantitative features of the silicotic changes, the lower was the percentage of improvement. We see here that the qualitative difference as well as the quantitative difference in the silicosis were also affecting the healing of tuberculosis, but that such effects were not so marked as in the cases of simple silicosis. The reasons for this are: that the present cases were mostly pneumoconioses of the small opacity, p that they were mostly mild cases, and that intensive chemotherapy prove effective. (5) The younger the patient, the more prospective was the improvement. And, the percentage of improvement was low in proportion to the length of employment. (6) The results of healing according to the type of tuberculosis were: in cases of type F more than 60% was fatal, in cases of type B more than half of the cases improved, and most of the cases of type C and of type MT showed no change. Cases of Type F and of type A were not found in the non-open cases of tuberculosis, in which all the cases improved or showed at least no change. (7) Percentage of the cases showing positive tubercular bacilli in the sputum (P) was 52%-33% in the cases without cavities (Q) and 77% in those with cavities (R)-, and the percentage of cases out of P becoming negative through chemotherapy was also 52%-77% in Q and 37% in R-, showing remarkably effective results. Although in 59% of P the bacilli were found fast against the primary chemotherapeutic drug, the percentage of improved cases in P was 67%. (8) Percentage of R among all the 156 cases was 42%, most of which belonged to the type B. And the percentage of improvement in R was 61%, showing disappearance of cavities in half of the cases. Cases still showing positive tuberculous baccili in the sputum after the treatment were seen in 43% of R, the percentage of aggravation being 17%; whereas they were seen in only 10% of Q. (9) Cases of silico-tuberculosis found in workers working in metal mining and quarrying which usually cause small opacity n and m in X-ray shadow were higher in the percentage of aggravation, of positive tuberculous bacilli in the sputum, of the persistence of bacillary discharge, and were worse in the prognosis than those found in workers working in pottery and metal making which ordinarily cause small opacity p.

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So far possibility of preventive medical application of dimercaptosuccinic acid (D.M.S.) has been studied so little that we have almost a virgin land, where detoxication of heavy metals, prevention of radiation injuries, and other pharmaceutical and pharmacological investigations have to be cultivated. Having surveyed results concerning D.M.S. hitherto reported, the present author considered that it would be significant to apply the acid to the detoxication of lead and mercurial poisonings, and performed a series of experiments to see its effectiveness. Experiments in acute poisoning, LD 50 and its observation, were made on mice. Changes in the body weight, blood findings, urinary findings, and the quantity of lead and mercury excreted into the urine of lead- and mercury-admin istered rabbits, were seen under administration of D.M.S. And the effectiveness of D.M.S. was judged by comparing its results with those obtained by the use of BAL and Ca-EDTA, and with the results of the control group. The results are as follows. 1. LD₅₀ of D.M.S. on mice was found to be 3, 132mg/kg (±44mg/kg) by probit method. 2. Mice were subjected to acute poisoning and put under observation. Abnormality was not found up to the dosis 2.8g/kg, a slight though temporary change was seen at 2.9g/kg, and at 3.0g/kg it became remarkable. Just before their death came dyspnea and deep breathing in turns, tail-raising, pupillary dilation, and short fits of convulsions. Those convulsions were of tetanic-clonic type, and their recurrence was fatally serious with short intervals every time. Other symptoms immediately before death were generally inhibitory-pilo-erection, swaying of the body, cyanosis, lying on the side, and repeated fits of tetanic-clonic convulsions occurring at special locations of the lower parts of the leg and at muscles of mastication. 3. Decreasing in body weight of rabbits was the smallest in the D.M.S.-administered group, especially in the lead poisoning. 4. Blood findings. In the D.M.S.-administered group an early recovery of anemia was seen and erythrocytes with basophilic stipplings were likely to appear in far less degree and disappeared more quickly. 5. Urinary findings. In the D.M.S.-administered group diminution of the urine amount was prevented, and this effect was seen markedly in mercurial poisning. Disturbance of renal functions due to lead-poisoning was slightly less in degree in the BAL-administered group and in the Ca-EDTA-administered group. The renal disturbance due to mercurial poisoning was least in the D.M.S.-administered group. 6. The excretion-promoting effect of D.M.S. for heavy metals progressed day after day, the excreted concentration of the metals becoming higher and higher as days went on, and the excretion was completed comparatively early. But D.M.S. was somewhat different form Ca-EDTA and BAL which caused excretion in large quantity immediately after administration. The total quantity of the excreted lead during the experimental period was larger in the D.M.S.-administered group than in the Ca-EDTA-administered group but less in the BAL-administered group. That of mercury was the largest in the D.M.S.-administered group.

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There have recently been many discussions on what is and should be an industrial physician. A majority of them, however, have a gap of knowledge which will be obtaind by an actual investigation. The author surveyd 351 enterprises of various sizes and categories of business in Osaka Prefecture in 1964 to look into the activity and situation of industrial physicians or of so-calld 2physician health supervisors". The survey revealed that there was a serious shortage of industrial physicians even in large scale corporations, that the activity of so-calld "physician health supervisors" was generally sluggish, and that this tendency was particularly imminent among the enterprises of small to middle size i.e. those with employees up to 500.

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