Microbiological, physicochemical study on waste water, and the determination of concentrations of disinfectants in waste water obtained from medical centers were performed. The components of waste water from the medical centers were classified into the following four patterns based upon time-course variations; Coliform group and total colonies, time-course variation of which showed close relation with patients population movement, were classified as group 1. BOD, COD, SS and Kje-n which showed the similar time-course variation as those in group 1, but in higher range of variation were cassified as group 2. Disinfectants such as phenols, formaldehyde and chlorhexidine which showed an original pattern of time-course variation unrelated with those group 1 and 2 were classified as group 3. Chloride ion, pH and metals which present almost constant time-course phase were classified as group 4. It was considered that those which belonged to group 1 and 2 were mainly influenced by the waste water originated in the daily life, whereas those which belonged to group 3 and 4 were much more influenced by the waste water originated in the medical treatment.
Since the concentrations of the disinfectants detected in this study were considerably lower compared to the concentrations of other components in waste water, it was therefore clarified that the disinfectants in waste water did not show interference for the bioactivation of activated sludge.

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Experiments on antagonism between virulent and avirulent strains were carried out, using Shigella flexneri 2b 17-A (Sh. flex. 2b 17-A, a virulent strain), Shigella flexneri 2b 17-N (Sh., flex. 2b 17-N, an avirulent strain), Escherichia coli 0-124 (E. coli 0-124S, a virulent strain) and R form Escherichia coli 0-124 (E. coli 0-124R, an avirulent strain). The results of the experiments may be summarized as follows:
1) Cultured on Congo red agar, Sh. flex. 2b 17-A and E. coli 0-124R were differentiated from Sh. flex. 2b 17-N and E. coli 0-124S; that is, the former absorbed Congo red dye, showing red colony (CR⁺ colony) and the latter did not absorb the dye, showing colorless colony (CR colony).
2) There is no significant difference in the growth ability of these strains in the broth at 37°C. The generation time of them was about 25 minutes. On the mixed cultivation of the virulent and the avirulent strains in the broth, these strains were found to be almost equal in number estimated by the culture on the Congo red agar.
3) Infection rates of Sh.flex. 2b 17-A or E. coli 0-124S in HeLa cells increased with the lapse of infection time and the rate reached 36% or 13% in 8 hours, respectively. However, such increase was not seen on the experiment with Sh. flex. 2b 17-N or E. coli 0-124R.
4) In the case where HeLa cells were infected with both the virulent strain and the avirulent strain simultaneously, using Shigella or E. coli, the infection rates decreased to around 50% and also numbers of live bacteria in HeLa cells decreased markedly as compared with the case of the infection with the virulent strain only. In HeLa cells, mainly Sh. flex. 2b 17-A or E. coli 0-124S formed colonies on Congo red agar.
5) Virulent strains (Sh. flex. 2b 17-A, E. coli 0-124S) evoked keratoconjunctivitis of guinea pigs (KC test) and loop inflammation of rabbits (De test), whereas, avirulent strains (Sh.flex. 2b 17-N, E. coli 0-124R) did not evoke them. When eyes or loops were infected with the virulent strain and the avirulent strain simultaneously, it was found that an increased number of bacteria was needed to evoke the same degree of inflammation as the virulent strain only.
6) On the mixed infection in KC test or De test, only the virulentstrains (Sh. flex. 2b17-A, Ecoli 0-124S) were isolated from inflammed samples.

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In the period from February 1976 to Jury 1978, epidemic hemorrhagic fever (EHF) developed in 7 doctors among the clinical staffs together with working at the experimental laboratory in Wakayama Medical College.
All instances were 20-40 year-old male doctors who had lived in Wakayama city, and admitted to our clinic of Wakayama Medical College. The patients were hospitalized from 4th to 8th day after onset and the duration of hospitalization varied from 7 to 78 days. Six patients suffered in spring or eary summer. From the clinical severity, the patients were divided into two groups, 3 severe cases and 4 mild or moderate cases.
Majority of the cases had an abrupt onset with high fever and chills, sometimes malaise and anorexia. The symptomes included high fever of 39-40°C, chills, malaise, anorexia, body aches, nausea, vomiting, sore throat, abdominal pain, diarrhea and oliguria. On admission physical examinations demonstrated injected pharynx, cervical lymphadenopathy, periorbital edema, purpura, abdominal tenderness and mild hepatomegaly. Within a few days after the duration of fever, severe cases revealedthe various signs including shock, heart murmur, enlargement of the heart, pulmonaly congestion, skin edema, ascites, atrial fibrillation, atrioventricular block, retention of pleuropericardial effusion, mental disturbance, tremor and abnormal sensorium.
Laboratory examinations showed marked proteinuria, leukocytosis (early leukopenia), an increase of atypical lymphocyte, thrombocytopenia and an elevation of serum GOT, GPT, LDH, CPK and α-HBDH activity, but serum bilirubin and alkaline phosphatase were not elevated. In severe cases a rise of BUN and creatinine, a decrease of serum total protein and the abnormality of serum electrolytes. These abnormalities reached a peak within about 7 days and return to normal within a few weeks. The degree of these laboratory data paralleled to the severity of the disease.
The instances in mild and in severe cases were clinically and biochemically recovered within about a week and within about two weeks respectively.
Immunofluorescent (IF) antibodies to Korean hemorrhagic fever (KHF) virus (Lee and Lee, 1976) were tested by Dr. H. W. Lee in convalescent sera of all 7 patients obtained during from 72 da ys to 54 months after recover. Six patients were positive and had the titers ranged 1/512-1/8192. Also IF antibodies were tested in sera of experimental animals which seemed to be the reservoier of EHF virus. They were at high rate positive only in rats. In 119 sera obtained from the staffs in contact with IF antibody-positive rat, 17 instances (include above 7 patients with EHF) were positive (14.3%). Eleven of 17 had a history of transitory fever, malaise, anorexia and other flu-like symptomes, and they were diagnosed as a common cold.
Finally it is considered that the characteristic clinical features and course of illness in outbreak 7 patients at Wakayama Medical College correspond to that of EHF (Ibuki, 1942), and serologically to KHF (Lee, 1979). Therefore the diagnosis of EHF was done on the ground of the clinical patt ern of the disease and comfirmed by demonstrating IF antibodies to KHF virus

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It is well known that the unabsorbed O-antisera of Vibrio parahaemolyticus contains considerably high agglutination titer against heterologous O-antigens. To prepare specific O-antisera by eliminating these agglutinins, the mutual relationships of O-antigens of V. parahaemolyticus and the relationships between these O-antigens and the heat-killed cells of other vibrios such as Vibrio cholerae and Vibrio alginolyticus were investigated.
The results were as follows.
1. The V. parahaemolyticus possessed one O-antigen which was non-type specific and common to all strains of V. parahaemolyticus besides the confirmed antigens of 0-1 to 0-12.
2. This common O-antigen of V. parahaemolyticus was also found in V. cholerae and V. alginolyticus but not in Escherichia coli. It seems likely that this O-antigen is distributed among vibrios as a common antigen specific for the genus Vibrio.

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Legionella pneumophila, serogroup I were isolated from water samples in eight of eleven cooling towers in both Nagasaki University and municipal hospital on October, 1980.
They are the first isolation from environmental sample in Japan. The cooling towers were used for the air-conditioning systems of both hospitals.
We used a modification of the system for detection of L. pneumophila described by Morris and associates (Ann. Int. Med., 1979). The cooling tower water for detection of L. pneumophila was collected aseptically in the sterile contrifuge tubes (250 ml each) from the collecting pan of thecondenser.
The sample was centrifuged at high speed (10, 000 rpm) for 20 min. and its supernatant was discarded with remainning the sediment in volume of 10 ml.
Three guinea pigs were inoculated intraperitoneally with each 3 ml of a sample, and sacrificed at 4 days after inoculation.
The lung, liver and splenic tissue, blood and peritoneal swab were used for direct fluorescent antibody (DFA) examination and culturing. All eight isolates had typical appearance on B-CYE agar, failed to grow on blood agar and yielded typical patterns of biochemical properties.
Four of eight isolates were confirmed with cellular fatty acids by gas-liquid chromatography. These strains were also sent to both Center for Disease Control (CDC, Atlanta) and Wadsworth VA Medical Center (Los Angeles) in U. S. A. and finally identified as L. pneumophila serogroup I.

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Primary Epstein-Barr Virus (EBV) infections are more often expressed as clinical infectious mononucleosis.
Occurrence of the disease among young adults, espicially in the 15 to 25 year age group, is the most characteristic epidemiologic feature.
Primary EBV infection in senile cases is often atypical and very rare.
We reported herein a senile case of a 65 year-old male who exhibited no increase in monocyte or lymphocyte, but a rise in EBV antibody titer as well as a positive Paul Bunnell test, and who was eventually diagnosed as having a primary EBV infection.
Further, the patient developed fever of 6 weeks duration, skin rash with small vesicles, and arthralgia and myalgia. In addition, the electrocardiogram showed atrial fibrillation. Thus, this case was accounted to be very specific.
We think that there has as yet been no report of such a rare case as we have described.

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