An acute infectious disease like bacillary dysentery has a strong tendency for natural recovery.
In such a case, the factors of parasite and host have a great influence on the evaluation of the clinical effect of antibiotics.
In this report, bacterial group and sensitivity to antibiotics were considered as bacterial factors, along with host factors of sex, age and severity of symptoms, while the day of illness on which medication was begun and its duration of use was considered as the condition of medication, etc. The effect of each on the clinical course was examined to determine what should be taken or left out of the above factors in evaluating the clinical effect.
In this study, the severity of initial symptoms and duration of illness were expressed by numerical values and analyzed mathematically. Scores were based upon the tables explained in the first and second reports of this series.
The result was that bacterial group, age, and severity of symptoms at the start of medication significantly influenced the clinical course. Accordingly, these factors should be further considered in the comparative studies of antibiotics, even if the condition of medication is fixed.
The main points are as follows:
There is a correlation between the initial severity of symptoms and its duration. If the initial severity of illness is equal, we compared the illness scores using the same criteria, even if the starting day of medication is different. But the distinction of bacterial group is necessary. And in the mild cases, significant differences are prone to happen on evaluating the course.
Difference by sex was not observed even if examined by several age groups.
It is reasonable to devide the ages into four groups generally, 0-1, 2-15, 16-60 and >61. But because 0-1 and >61 groups follow quite different courses, it is better to exclude them from others on totaling.
The influence of sensitivity of bacteria to antibiotics on the clinical course is not so marked, but is sometimes significant in the severe cases of Flexner in childhood.

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In evaluating the clinical effect of antibiotics to bacillary dysentery, one encounters such inexact terms or abstract concepts as “excellent, good, ineffective or effective rate”.
Moreover, if certain criteria are established and a double blind controlled trial is employed, it is possible to investigate the comparative merits of two drugs, even if the standard of effective rate is somewhat careless. However, the concept of “effective rate” may remain undefined until the last stages of such a comparative study, so there is some possibility leading to confusion about the efficacy of the drug, if it is carried in the place of practical medicine as it is.
Through the previous three papers of this series, the severity of initial symptoms and clinical course were expressed by numerical values. In conformity to this table, a criterion of the clinically effective degree of antibiotics was made for trial, on the basis of the natural course of dysentery and the course of the cases treated by Kanamycin. (KM).
Secondly, a double blind trial study with active placebo of KM was reported, in which the following tendencies were detected on evaluation: a) In the severe cases, instead of avoiding to judge “excellent” it is usual to evaluate progress as “good” or “ineffective”. b) And conversely, in the mild cases, many are judged “excellent” or “good”, when in fact the drug effect may be confused with natural recovery. c) Lastly, when the drug effect is negligible, it is usual to evaluate “unknown” instead of judging “ineffective”.
These are the problems before the comparative process in the double blind method. But it is sometimes risky to open the blind data evaluated by the equivocal criteria. On the contrary, if the investigator uses reliable criteria, it is often unnecessary to analyse the data by the double blind method.

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For examination of HBs Ag and anti-HBs, 11 pools of mosquitoes were collected in indoors of patients' houses with HBs Ag positive chronic liver diseases.
In homoginates of 2 pools HBs Ag was detected by RIA, but anti-HBs was not detectable. The specificity of the test was confirmed by inhibition test. Serum HBe Ag in one of the 2 patients was positive. In 3 pools of mosquitoes derived from seronegative families, neither HBs Ag nor anti-HBs were detected. No relations were observed between the detection of HBs Ag and serum HBs Ag titers of patients as well as numbers and species of mosquitoes.
Seasonal prevalence of acute hepatitis B with exceptions of that of the posttransfusion cases were studied. A tendency that onsets of acute hepatitis B were frequent in october and november, was showed. On the other hand non B hepatitis were frequent in early spring.
These findings suggest a possibility that blood-sucking mosquitoes may play a significant role as a natural mode of parenteral transmission of HBV in Japan.

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