Attempts have been made by the author to improve the treatment of ekiri in conformity with the author's investigations on the essential factors in this disease. Venoclysis by means of venous catheterization has been introduced in the therapy since August 1952, and has brought remarkably successful results. For a further improvement in the treatment comparative investigations were carried out on 334 clinically confirmed ekiri cases, which were admitted to the Komagome Hospital up to March 1955 and treated with venoclysis. Biochemical and pathological findings, as well as clinical observations, were taken into consideration to reach the fallowingg conclusions.
1) The age distribution had its peak at 3 to 5 years. Although no sex difference was observed in the incidence rate, the case mortality rate was higher in the female.
2) The above-mentioned 334 cases included 76 mortal cases with a case mortality rate of 22.8% and 4 cases with sequelae. When recovery took place, the alleviation of symptoms could be noticed promptly and in a few hours after the beginning of treatment. A practical restoration was reached generally in 10 odd hours. The treatment was especially effective in controlling circulatory disturbances.
3) The results by venoclysis were superior to those by subcutaneous infusion in every respect, clinical and biochemical, though there was a certain limit even to venoclysis in its therapeutic effect.
4) The results obtained by the treatment varied naturally according to the severity of clinical symptoms, which generally reached their maximum points within 10 odd hours, On the other hand, a close relation was confirmed between the therapeutic results and the time elapsed since the onset of the disease to the beginning of treatment, indicating the importance of early initiation of therapeutic measures.
5) The development of therapeutic effect in the first few hours had a decisive influence on the further course of the disease. The infusion in this period was most adequately adjusted to a rate of 7-9 cc/kg/hour, and the quantity of infusion fluid must be: controlled according to clinical symptoms and hematocrit value.
6) Hypophyseal and adrenocortical hormones, angiospasmolytica and lipotropic factors exerted only ambiguous effects on the clinical course of the disease. The significance of these medicaments in the treatment remained undetermined.
7) Hemoconcentration, acidosis and a decrease in plasma sodium were characteristicf eatures at the height of the disease. This condition returned to normal hand in hand. with the restoration of the patients. Hemoconcentration was attributed to an abnormal. water distribution in, rather than to a loss outside, the body.
8) Plasma potassium, at the height of the disease, had an average value in the normal. range with a wide deviation in its individual values. Accordingly, potassium-free infusion fluids were regarded to be preferable at the initial stage of the disease. Characteristic to re convalescence were hypokalemia and hydremia. The hypokalemia was attributable to an insufficient potassium supply to cover the loss of intracellular potassium, at the height of the disease. No causal relation was confirmed between hypokalemia and hydremia.
9) On the basis of predominance of one of the two important clinical symptoms, cerebral symptom and circulation disturbance, the disease could be classified into a clinical types, cerebral, circulation-disturbed and intermediate. Urine excretion rate (rate of urine quantity during the venoclysis to that of infused fluid), elevation in hematocrit value and, the severity of diarrhea and vomiting were remarkably higher in the circulation-disturbed, than in the cerebral type.
10) Venoclysis caused no untoward side effect during, and of ter the procedure.

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In order to study the hepatic disturbance in ekiri and bacillary dysentery, the serum of ekiri and dysentery patients was examined for various serum reactions by means of cobalt test, cadmium test, thymol turbidity test, zinc sulfate test and phenol turbidity test.
1) For the acute stage the following results were obtained:
a) The serum cadmium test revealed left side reactions both in ekiri and dysentery.This was more marked in dysentery, especially in severe cases, than in ekiri.
b) Generally, less marked left side reactions were also observed in the serum cobalt reaction in both diseases.
c) The serum thymol turbidity test and the zinc sulfate test usually gave normal reactions in all cases.
2) A striking elevation in the serum phenol turbidity reaction in the convalescence was observed in ekiri cases only, in contrast to an unchanged reaction in dysentery patients throughout the course of the disease.
3) This remarkable elevation in the phenol turbidity reaction indicated a significant increase in total serum lipid, and consequently this phenomenon might be closely correlated to fatty metamorphosis of the liver specific to ekiri.
4) The characteristic increase of total serum lipid in ekiri patients suggested furthermore, that besides dysenteric infection, a certain toxic substance was responsible for the hepatic injury in ekiri.

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In the previous investigations (reports I and II), the somatic antigen structure of Kauffmann's standard strains (E. coli O-1-O-25) and that of the test strains (E. coliO-260-126) were studied, and a simple technique for the determination of antigen structure was devised by the use of suitable mixtures of 0 sera and absorbed 0 sera deprived completely of group agglutinins.
This report deals with the results obtained by the application of this method on E. coli from healthy as well as various infected persons.
1) Of the 289 strains of E. coli, isolated from healthy persons, 20% fell into the E. coli O-1-O-25 group, 60% into the E, col O-26-O-126 group and the others remained unidentified.
2) E. coli from an individual was confined to a few types. The organisms, isolated from one and the same individual and belonging to the same O-group, could be subdivided into several types according to their biochemical properties.
3) E. coli belonging to O-25, O-75 and O-86 groups, which are suspected of their pathogenicity, were also isolated from the stools of apparently healthy persons.
4) Pathogenic coli (E. coli O-26, O-25, O-75 and O-111) were isolated from the feces of adults with sporadic diarrhea.
5) The coli strains from the inflammatory appendices or from the urine of cystitic patients, had mostly different antigenic structures to those of the strains, found in the intestinal canal of the same individual.

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The effectiveness of PANS No.610 in the treatment of Japanese B encephalitis was reported by many investigators both in patients and experimental animals. The combination product of PANS No.610 with simple protein and nucleic acid and its action were discussed in this report, to throw light upon the mechanism of inactivation of encephalitis virus by this medicament.
The results of experiments, carried out by means of dialytic procedure, were as follows.
1) PANS No.610 produced a combination product with albumin or γ-globulin.
2) The combination was apolar and reversible, and in a ratio of 9-11 mois of the medicament to a protein molecule.
3) The lauroyl group of PANS No.610 was the essential radical, which enabled the combination.
4) Combination of PANS No.610 with PNA and DNA was not demonstrated by dialysis procedure.
5) The virus inactivation of PANS No.610 was not inhibited by the addition of albumin or γ-globulin.
6) The direct action of PANS No.610 was not influenced by the addition of PNA or DNA.
These results did not substantiate the concept that the virus inactivation by PANS No.610 was attributable to its combination with simple proteins and nucleic acids contained in virus.

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In the previous report the authors studied the combination of PANS No.610 with simple proteins and nucleic acid and discussed the effe: t of the combination process on the direct antiviral action of the medicament. The experimental results did not support the assumption, that the direct antiviral action of PANS No.610 might be due to its linkage to the above-mentioned substances. In the present report the influence of complex proteins on the direct action of PANS No.610 was examined with the following results.
1) PANS No.610 produced a combination product with lipovitellin, one of those compounds belonging to the lipoprotein group.
2) Lipovitellin exerted an inhibitory effect on the virus inactivation with PANS No.610.
3) The lauroyl group of PANS No.610 proved to be the essential radical to the linkage.
4) PANS No.610 affected lipid-protein bridges in lipoprotein.
5) The combination was reversible but more stable than that with simple proteins.
6) The antiviral activity of PANS No.610 was not influenced by added synthetic lipoproteins, such as cephalin-salmine complex or cephalin-clupein complex, with which the medicament went into a combination.
7) PANS No.610 could be linked to liponucleoprotein, prepared from the mouse liver, without a reduction in its antiviral activity.
Based on the experimental results obtained, the mechanism of antiviral action of PANS No.610 was defined as follows.
The linkage of PANS No.610 to constituent lipoprotein of virus body represents one of the underlying processes in the antiviral action of this medicament, while unspecific combination with simple proteins or nucleic acids does not partake in the antiviral mechanism.
It still remains to be studied, whether or not the direct antiviral action of the preparation depends solely upon the above-mentioned process. Other high molecular compounds of virus body must be likewise taken into consideration, and the problem will further be discussed in the following reports.

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