According to the Guide for Japanese Standard Tests concerning the SM, PAS and INH sensitivity tests, 3 % Ogawa medium is to be used for the direct method, and 1 % or 3 % Ogawa medium for the indirect method. When one observes the changes in the results of a series of sensitivity tests performed on a single patient by using various types of media, he will find that the results are not arranged in expected order. One of the reasons known to us for a long time is that there is a difference in sensitivity test results obtained with various media. However, there has been no report of clear cut results on this subject. Thus, following the Guide for Japanese Standard Tests, 0.1 ml. of 4 %NaOH treated sputa or suspension of tubercle bacilli was inoculated on the 3 % Ogawa media containing 10r and 100γ of SM, 1γ and 10γ of PAS, 0.1γ, 1γand 5 γ/ml of INH, and 0.1ml. of neutralized sputa and suspension of bacilli on the 1 % Ogawa media. Then, the results of the sensitivity tests obtained from the bacilli grown on these two media were compared. Samples used were sputa, and tubercle bacilli isolated from sputa gastric content, laryngeal swabs of the patients suffering from pulmonary tuberculosis having received or receiving SM, PAS and INH, and the tuberculous lesions of surgically resected lungs, totalling 284. The following is the result obtained.

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In the previous paper, it was reported that tubercle bacilli inoculated onto the surface of Ogawa's glycerol egg medium were highly sensitive to the bactericidal activity of streptomycin and isoniazid contained therein. According to some report, however, such strong bactericidal activity is not exhibited against tubercle bacilli of submerged growth in Kirchner's liquid medium, where culture conditions are so different from those on Ogawa's glycerol egg slant. The present authors presumed that one of the factors responsible for such difference might be “ventilation” in test medium. And, this problem was examined using Ogawa glycerol egg slants of air-tight or air-passable conditions, and also using Kirchner's semi-solid agar mixed with the bacilli.
In our laboratory, the cotton plug of Ogawa's slants inoculated with tubercle bacilli is usually replaced with a gum-cap in a week or so of incubation to prevent them from drying. This treatment does not allow the air ventilation on the surface of medium any more. However, as a device to prevent the medium from drying but to allow air-passage to some extent, a double-winded thread of 1 mm × 30 mm was passed through the center of gum-cap. Then, a streptomycin-sensitivity test was made of a strain of streptomycin-resistant tubercle bacilli comparing the growth between the case of air-tight slants and the case of air-passable slants. The results are shown in Table 1 and Fig.1, where stronger bactericidal and bacteriostatic activities are expressed in the air-passable condition than in the air-tight condition.
In the Kirchner's agar-bac illi mixture, both the bactericidal and bacteriostatic activities of SM, INH and PAS were much stronger in the overlayer of the agar than in the bottom layer in which air ventilation was poor and oxygen tension was low. In the control case without antituberculous agents, numerous small colonies formed a turbid layer near the surface of the medium, but this colonial layer became sparse, increased in breadth, and moved deeper into the medium when the threshold concentrations of INH and SM were added. This finding also shows that the drug sensitivity of tubercle bacilli is lower in the poorly-ventilated area of the medium. In Ogawa's glycerol egg slants, colonial formations in both conditions were the same in numbers, but colonial size was larger in the airpassable tube indicating the rapid multiplication of tubercle bacilli. Therefore, it will be concluded that the activity of those antituberculous agents is stronger in the environment where air-ventilation is adequate for the bacilli and their multiplication is more rapid.

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Using Kirchner semi-solid agar as a basal medium, the effect of adding blood components upon the in vitro antituberculous activity of dihydrostreptomycin, viomycin, kanamycin, isoniazid, and ethionamide was examined, particularly by the quantitative analysis of survival curves of H₃₇R_v organisms.

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Enteric coating tablet has been used extensively in order to reduce the gastric disturbance caused by ethionamide. The author measured the specific anti-mycobacterial activity of enteric coating ethionamide made by 2 companies, A and B. Three tablets (1 tablet contains 0.1 g ethionamide) of enteric coating ethionamide made by the company A was administered per orally to 5 healthy persons, and the SSAT value was measured at 2, 4, 6 and 24 hours after administration. The same experiment was conducted on the same persons by using enteric coating ethionamide made by the company B. As shown in Fig.1, the maximal SSAT value of ethionamide made by the company A was 16 to 32, while in the case of tablet made by the company B, slight anti-mycobacterial activity was observed in 2 cases, and the remaining 3 cases showed no activity. The fact shows that marked difference is found in the SSAT value of enteric coating ethionamide made by different companies.
The author made further analysis on the dissolution time of enteric coating ethionamide made by 5 companies, A, B, C, D and E. The following 7 solutions were added to ethionamide tablets made by the 5 companies, and they were kept in the incubator and were shaken during the experiment.
1) kept in artificial gastric juice (pH 1.2) for 3 hours, then in artificial enteric juice (pH 8.4)
2) kept in artificial enteric juice
3) kept in mixture of 1 a. g. j. and 3 a. e. j. (pH 7.2)
4) kept in mixture of 1 a. g. j. and 2 a. e. j. (pH 6.6)
5) kept in mixture of 1 a. g. j. and 1 a. e. j. (pH 6.4)
6) kept in mixture of 2 a. g. j. and 1 a. e. j. (pH 4.8)
7) kept in artificial gastric juice (pH 1.2) Dissolution time was measured for each tablet, and the results were shown in Fig.2.
Ethionamide tablet was not dissolved in artificial gastric juice, and after transfered to artificial enteric juice, tablets began to dissolve. Dissolution time was different by the tablets made by the different companies, 12 minutes in the case of tablet made by the company A and 60 minutes in the case of tablet made by the company B.
The above mentioned results suggest that sufficient ethionamide concentration in blood serum will not be obtained by the use of tablets made by the company B and E. When the enteric coating tablet of ethionamide is administered, dissoluble tablet must be selected, and preferably, SSAT must be conducted after administration of enteric coating ethionamide.

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As a series of path o-physiological studies on lung cavity, which have been conducted at the author's clinic, the author induced experimental tuberculous cavity with BCG and experimental suppurative cavity with staphylococci and streptococci in dog, and followed up the rediological and pathological changes of these cavities with special reference to their patho-physiological changes. The results were the following.
1. The stage of cavity formation after the introduction of secondary antigen into the lung was divided into following 4 stages: pre-cavitation stage, early stage of cavitation, completion stage and regression stage. In experimental tuberculous cavity, pre-cavitation stage was within 20 days, early stage of cavitation between 21 to 60 days, completion stage between 61 to 120 days and regression stage over 120 days after the introduction of secondary antigen. Though regression of lung cavity was observed in later stage, disappearance of cavity was hardly noted. In experimental pulmonary suppuration, cavity was formed very early (3 days) after the introduction of secondary antigen, and the course of cavitation was similar to that of tuberculous cavity, though the duration of each stage was shorter in pulmonary suppuration, and disappearance of cavity was observed finally.
2. The course of tuberculous cavity was divided into 2 types rediologically. In one type, the size of cavity reached to maximum in early stage, and in the other type, the size of cavity was small in early stage and showed increase later. In the latter group, giant cavity was formed in many cases. On the other hand, in pulmonary suppuration, cavity was formed very early with relativery large size in early stage, showed rapid regression and finally disappeared. Generally speaking, tuberculous cavity was thick-walled, and both monolocular and multilocular types and the transition of both types were observed. Positive pressure cavities were found more frequently in regularly shaped cavities. Suppurative cavity was, in general, thin-walled, regular in shape and small in size. Clear difference was found in the nature of surrounding lesions between tuberculous and suppurative cavities.
3. Patho-morphological changes of both cavities were non-specific pneumonia in pre-cavitation stage. In early stage of cavitation, specific granulation tissue with caseation and epithelioid cell reaction was formed in tuberculous cavity, whereas nonspecific granulation tissue consisting mainly of compact mass of neutrocytes was found in suppurative cavity. In completion stage, wall of tuberculous cavity was thicker with more necrosis mass than that of suppurative cavity, and the surrounding lesions were more marked in tuberculous cavity. In regression, stage fibrosis of cavity wall and cleansing of caseous mass were found in tuberculous cavity, while regression and disappearance were observed in suppurative cavity.
4. Patho-physiol ogical changes of both cavities were as follows:
a) Intracavitary pressure: In tuberculous cavity, respiratory changes of intracavitary pressure showed decrease in later stage of cavitation, while in suppurative cavity, it showed little changes with the course of cavitation.
b) Intracavitary sound: Types of intracavitary sound were divided into continuous type (Type II)and intermittent type (Type I). The former was found more frequently in tuberculous cavity with small size, monolocular type, negative intracavitary pressure and exudative type surrounding lesions.

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