Two cases of acute colitis due to salmonella changhai were experienced in Matsuyama, Ujiie, Tochigi Prefecture. The major symptoms consisted of high fever (40°C at maximum), vomiting (twice a day), headache and abdominal pain with muddy stools containing mucus. One of the patients showed Ekiri-like symptoms. Both cases were well controlled by the administation of streptomycin and thiazin, for a week.
A gram-negative rod isolated from both patients demonstrated general characteristics of salmonella, and on the other hand, the convalescent sera showed a high agglutinin titer against it. The organism with an antigenic structure 16: 1, v: 1, 6 proved to be serologically entirely identical with salmonella changhai by the cross-agglutinin-absorbtion tests.
From the above findings, it was concluded that the acute colitis was caused by salmonella changhai.

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A mass incidence of bacillary dysentery broke out in March, 1957 among 728 students and 29 teachers on an educational trip to Shikoku and Chugoku districts. Afterreturning to Nagoya, the feces of not only the students who travelled but also those who did not travel and their family members were examined for dysentery bacilli.
Of 54 positive cases 28 were diagnosed as bacillary dyentery and 26 as bacillary carriers. The isolated strains were serologically classified into Sh. flexneri 2a, 3a, 4a, var. Y and Sh. sonnei, the most numerous being Sh. flexneri 2a, i. e. 45 strains.
Fourty nine strains were examined for resistance against various antibiotics and sulfonamides. Out of 40 2a strains isolated from those travelling and regarded as causative agent of the mass incidence, 32 demonstrated 250 γ/cc resistance against oxytetracycline (Terramycin), 100 γ/cc against tetracycline, 50 γ/cc to aureomycin, 0.5 γ/cc against chloromycetin, 10 γ/cc to streptomycin and 100 mg/dl against sulfathiazol.
The clinical symptoms disappeared rapidly by the application of antibiotics, particularly chloromycetin. Out of 12 cases treated with terramycin, 11 reexcreted the bacilli in their feces after the medication, and out of 38 cases including carriers the reexcretion was detected after having left the hospital. The source of infection could not be discoverd.

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The albuminuria in diphtheria has long been well known and, the tubular degeneration was generally incriminated for it. Consequently, a too great importance was attached to the hyaline droplet degeneration in tubular epithelium. A great regard, however, has recently been paid to the glomerular lesions or glomerular filtrate containing albumin in the pathogenesis of nephrosis. From this angle, a new interpretation of renal changes in diphtheria was attempted by the author with special refernce to hyaline droplets in tubular epithelium, based on 27 autopsy cases of this disease; 20 pharyngeal, 3 laryngeal and 4 combined cases.
Pathological findings:
No swelling of kidney was observed macroscopically except one case, while cloudiness of cortex was noticed in most cases. The principal finding of glomerulus consisted in edema of mesangium which was most conspicuous at the beginning, and they diminished gradually, leaving hyalinisation of mesangium after the first week. The most important tubular changes were the so-called hyaline droplet degeneration which reached the highest grade after the first week and then decreased gradually. The hyaline droplet degeneration was always accompanied by the so-called “albuminous degeneration”evidencing a close relationship between the two findings.
From the above mentioned findings the following conclusions were obtained.
1) The most important kidney findings in diphtheria consist in edema of glomerular mesangium and hyaline droplets or so coiled “albuminous degeneration”of tubular epithelium.
2) All these findings can be explained from the increase of permeability of glomerular capillaries. Namely, the hyaline droplets result from the absorption of glomerular filtrate containing albumin by tnbular epithelium, but not from a primary epithelial degeneration
3) The diphtheria kidney should be regarded as a kind of acute glomerulonephritis.

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A series of “Ekiri” cases was investigated on the attitude of the vegetative nervous system, based on the idea, that a disturbance of the system might be involved in the essential aspect of the disease, particularly the mechanism of it's initial development, utilizing the results of preliminary study by our co-workers concerning the relationship between the vegetative nervous system and Na and K concentration in saliva.
1. Regarding the serum concentration, Na increased in the height of the disease in a recognizable grade, while K tended to fall slightly or to remain in a normal range, so that Na/K ratio resulted in a slight increase in contrast with dysentery cases. However, because of the buffer activity of serum, as is well known, no definite conclusion could be drawn from the analysis.
2. From this reason, day-fluctuation of Na and K was then followed up with saliva. A fall of Na/K ratio, resulting from an enormous concentration of K, was cnaracteristic of acute stage of “Ekiri” and dysentery, indicating a preponderance of the sympathic nervous system.
3. In order to confirm these results, the influence of subcutaneous injection of pilocarpin on Na and K concentration in saliva was investigated in the acute and convalescent stage. The conspicuous initial rise of Na and K in saliva, common in healthy persons, was hardly recognized in the acute stage of “Ekiri”. It might be concluded that “Ekiri” patients were unresponsive to parasympatic stimulation. On the other hand, consulting the results of study on the influence of adrenalin on eosinophilic leukocytes in peripheral blood stream performed by our co-workers, it was confirmed that the acute stage of “Ekiri” represented a hypertensive state of the sympathic nervous system.

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