Sensitivity tests to various antibiotics were performed on the 111 strains of hemolytic Streptococci, isolated from the throat of patients with scarlet fever and bacillary dysentery, who were admitted to the Toshima Hospital from October, 1954 to February, 1955. The 111 strains consisted of 104 strains belonging to the A group and 7 strains, whichbelonged to the II. type of Kobayashi and therefore were not included in the A group. The results were as follows:
1) The most conspicuous antibacterial action against hemolytic Streptococci was confirmed with Erythromycin, Leucomycin and Penicillin, and was f ollowed by a less distinct action of tetracycline derivatives, such as Aureomycin, Terramycin and Tetracyn. The antibacterial action of Chloromycetin was weaker than that of the above-mentioned preparations, and Streptomycin had the weakest antibacterial action among the antibiotics examined.
2) Up to the present none of the isolated strains acquired definite penicillin resistance.
3) The sensitivity of the strains belonging to the A group to Chloromycetin, Aureomycin, Terramycin, Tetracyn and Erythrocin was higher than that of the strains which did not belong to the A group.

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This report is a summary of the blood picture studied daily on 267 Izumi-f ever patients at Minamiota Primary School, Yokohama City, in March 1954.
The leukocyte count, after an initial increase in many cases, showed a fluctuation parallel to body temperature. The initial temperature fell on the 4th to 7th day of disease, with a corresponding fall in the leukocyte count to a value of 8. 600 on an average. At the stage of secondary fever the number of leukocytes increased again and returned to a normal level only after the lapse of disease.
There were, however, some cases, which did not show leukocytosis throughout the course of disease. They might give normal leukocyte count or they had leukopenia.
The main component, which caused the initial increase in leukocyte count was the neutrophilic polynuclear leukocyte. This showed not only an increase in number, but also a shift of nuclei to the left, and had DOhle's bodies in 22. 0% of the cases. Toxic granules. were demonstrated more clearly at the early stage of disease.
Leukopenia, if present, was likewise caused by a decrease in neutrophilic polynuclear leukocytes.
The average number of eosinophilic leukocytes was normal or rather decreased in many cases before the 3rd day of disease, and was followed by a sudden increase after the 4th day.
Leukopenia with decrease or disappearance of eosinophilic leukocytes, as reported by Kasahara and others, was not confirmed with our cases The grade of eosinophilia was independent of the presence or absence of parasite eggs in stool, and no particular variation in eosinophilic leukocytes was observed even in patients with concurrent erythema nodosum.
Lymphocytes increased only after the 4th day of disease, to reach a maximum value after the 3rd week.
Many patients had slight or moderate monocytosis. Plasma cells and atypical cells were found in the majority of the cases after the 4th day of disease. Both of them, however, rarely exceeded 4% of the total leukocyte count.
The erythrocyte count was normal or slightly reduced. Slight reduction in hemoglobin content was recognized in some cases, without any morphological abnormality of erythrocytes.
The fever types were classified into 5 groups according to Kodama and Iimura. No particular relation was f ound between the leukocyte pictures and the fever types. Nor a definite difference was confirmed in hemogram between Izumi-fever and scarlet fever, contrary to the reports of Abe and others. Two, patients out of this epidemic were later readmitted, to our hospital, on account of newly infected scarlet fever. Comparative studies of blood pictures of the patients in both diseases, failed to reveal any significant difference.

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It is generally accepted that Izumi-fever is always associated with a f avourable prognosis. In spite of relatively long lasting high fever, complications are rare, and recovery takes place usually without any specific treatment. Mortal cases have hitherto been only exceptionally recorded, although mass incidences in various districts are reported by many investigators. The authors experienced an Izumi-f ever epidemic among school. children of the Minamiota Primary School of Yokohama City in March 1954. The total number of children, attending this school, was 1.409, out of which 1.019 were presumed to be infected. The authors investigated 288 hospitalized cases in which definite diagnosis of Izumi-fever was confirmed. The reported epidemic was characterized by so severe clinical symptoms as had not yet been described in the literature. Including mortal cases some patients exhibited severe ekiri-like disorders.
1) In general, the investigated 288 cases had rather severe symptoms, especially those of the gastrointestinal tract.
2) Ten cases were accompanied by severe ekiri-like symptoms. They showed beside pathognomonic symptoms of Izumi-fever, symptoms of remarkable circulation disturbance, such as weak and accelerated pulse, cyanosis, etc., psychoneurological symptoms represented by disturbance of consciousness, delirium, etc. and gastrointestinal symptoms such as vomiting, diarrhea, abdominal pain, greenish mucous stool, etc. On account of these symptoms such cases had a striking resemblance to those of ekiri.
3) Because the so-called “ekiri” and ekiri-like symptoms are commonly caused by intestinal flora, and on the other hand, the gastrointestinal symptom, as one of thecharacteristic symptoms of Izumi-fever, indicates possible inducement of ekiri symptoms from the intestinal tract, it was suspected that Izumi-fever might develop on the basis of intestinal infection. However, the culture of intestinal flora of the above-mentioned severe cases as well as of several other cases was not contributory to demonstrate an intestinal origin of the disease. Although dysentery bacilli (Shigella sonnei) were demonstrated in 4 of 70 Izumi-fever cases and in 2 of the above-mentioned cases with severe ekiri-like symptoms, they had of course nothing to do with Izumi-f ever. Nor could ekiri-like symptoms in Izumi-fever, with the exception in the two cases, ascribed to concomitant dysentery bacilli. Staphylococci were further isolated from other 2 cases with severe ekiri-like symptoms and from several other cases. But the rate of isolation was not significantly different from that of the control group, consisting of dysentery patients. The role of these kinds of bacteria, however, in the pathogenesis of Izumi-fever should not yet be disregarded utterly, until the etiology of this disease is ultimately determined.

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The ineffectiveness of Penicillin in the treatment of Izumi-fever has already been confirmed by many investigators. Attempts are made at present, therefore, to treat the disease with more newly prepared antibiotics, such as Aureomycin, Terramycin, chloramphenicol and Streptomycin. The authors investigated 288 infected children in an epidemic at the Minamiota Primary School of Yokohamo City in March 1954, and had a chance to examine the therapeutic effects of these antibiotics on Izumi-fever cases, which outnumbered the experiences reported up to that time.
At the initial stage of the disease Aureomycin was given to 7 cases, Terramycin to 2 cases, chloramphenicol to 4 cases, Streptomycin to 5 cases, two of these medicaments combined to 3 cases and Penicillin to 184 cases. The total number of cases, to which antibiotics other than Penicillin were given at the inital stage, was, therefore, 21. At the stage of secondary fever Aureomycin was given to 102 cases, Terramycin to 20 cases, chloramphenicol to 28 cases and Streptomycin to 19 cases. Most of these medicaments were given to the patients every hour, and their effect was evaluated by their influence on body temperature. The results were summarized as follows.
1) Aureomycin, Terramycin, chloramphenicol and Streptomycin, given at the stage of initial fever, caused either an abrupt fall in body temperature in a day or two in most of the cases, and induced the fever type C, or caused only an incomplete development of secondary fever, or at least prolonged the afebrile period before the secondary fever.
2) Aureomycin, Terramycin, chloramphenicol and Streptomycin, given at the stage of secondary fever, brought about defervescence generally in 5 days.
3) The results in a small number of patients, to whom Aureomycin, Terramycin or chloramphenicol was given in a dosage greater than 50mg/kg, revealed greater security in the therapeutic effects.
4) Paroxysmal fever and relapse were sometimes observed after the treatment with the above-mentioned f our antitiotics and were attributed to an insufficient dosage of the medicaments. The authors experienced a case, suggesting a relapse, after the treatment with Penicillin and sulfonamide, respectively.
5) The problems were discussed concerning the separation of initial and secondary fever peaks and relapse after the administration of antibiotics, It was concluded further that antibiotics employed were not only effective in suppressing secondary bacterial infections, but also against the pathogen of Izumi-fever itself.
6) The authors believe, that the four antibiotics were definitely effective in the treatment of Izumi-fever in their defervescent action and in shortening the fever period.

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A suction culture method for the isolation of dysentery bacilli from the mucus of dysentery patients and carriers was devised by the authors. The mucus on the rectal ulcer or in the rectal cavity was aspired at the rectoscopical examination of dysentery patients and carriers, with a small pipette (5mm×35cm) equipped with a rubber cap and then cultured on SS agar.
The results obtained with this method were compared with those obtained with swab culture or fecal culture for the isolation of dysentery bacilli in 785 cases, including dysentery patients and reconvalescent and healthy carriers. Coincident results were obtained in 80.3% of 579 cases, in which the suction culture method was compared with swab culture method simultaneously. In 15.0% of the cases dysentery bacilli were isolated only with the suction culture method, while in the remaining 4.7% only the swab culture gave positive results. Of the 206 cases, in which the suction culture method was compared with the fecal culture method, 89.7% delivered coincident results. In 8.7% the suction method alone, and in 1.5% the fecal culture method alone, gave positive results.
It would be noteworthy that dysentery bacilli were more easily demonstrated with the suction culture method than with other methods in cases of reconvalescent patients and healthy carriers, in whom the amount of excreted bacilli was so small, that their isolation was difficult with the usual methods. The suction culture methods was therefore considered to be superior to the ordinary methods in the detection of bacillus discharge after treatment or in carrier state.
The suction culture of mucus was performed once a week, and the results were compared with those obtained with daily cultures of feces or swabs for a week. In 88.3% of the examined cases the results with the both methods were in agreement. In 7.2% positive results were obtained only with the suction culture method. The sum of the above-mentioned percentages, 95%, was regarded by the authors to represent the reliability of the suction culture method carried out once a week, in comparison with the results by daily cultures from feces or swabs for a week. This indicated that the ordinary daily examination of feces and swabs for a week could be replaced by the suction culture method once a week, without a significant reduction in the percentage of isolation 8f dysentery bacilli. If a rectoscopic examination was available, this method was recommended for the judgement whether dysentery bacilli continued to be discharged or not.
Not only the examination of feces, but aho that of rectal mucus should be taken into consideration in the diagnosis, immunology, epidemiology and therapy of dysentery.

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Since Kauffmann's report on the serological studies of Escherichia group in 1947, serological classifications of Escherichia coli have been attempted by many investigators, and the knowledge on the antigenic structures of these organisms attained a rapid advance. In Japan, there were several investigations on E. coli reported, but the fundamental studies on the antigenic correlations of standard strains of these organisms have not yet been carried out.
The biochemical and serological investigations of standard strains (0-groups 1-25) and the newly isolated strains from healthy adult Japanese were reported in the present paper. The results are shown as below.
(1) Standard strains E. coli 01-025 showed typical biochemical properties of Escherichia with exceptions of strains 014 and 019, the former being lactose-non-fermenting and the latter non-motile.
(2) In serological investigations, bilateral antigenic relationships were found among 04, 013, 018, 019 and 025. The presence of such relationships was proved between 07 and 025 as well as 03 and 023. Meanwhile, the relationships between 05 and 07 were unilateral.
(3) The results of the complement fixation tests with standard strains agreed in general with those of the 0-agglutination reactions.
(4) A number of test strains belonging to 0-groups 26-126 demonstrated crossagglutinations with the immune sera of strains 01-025.
(5) There were some rabbits which possessed so-called normal agglutinins against some E. coli in their sera. Therefore, cross agglutinins in each serum were different in quantity, even though it was obtained by immunizing with the same organism. So that, great caution might be needed for the determination of the antigenic structures of E. coli in this respect.
(6) A simple slide agglutination method for the determination of the antigenic structures of E. coli was proposed by using mixed and factor-O sera. Classifications of 392 strains of E. coli derived from 149 healthy adults were carried out by this method. The results indicated that only 20 strains (5.1%) out of 392 from 8 persons (5.3%) were able to be identified as strains of E. coli 01-025.

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