Tuberculosis mass survey was carried out on the inhabitants of Okierabu-island (1961) and Setouchitown (1962) successively. In the present paper, relationship between the prevalence of tuberculosis and the experience of life outside these islands was presented, and further, general discussion was made on tuberculosis in Amami-islands.
1) Positive rate of tuberculin reaction in these islands were obviously lower than the average of Japan. Among them, the rate was highest in Okierabu-island (59.0%) and lowest in Setouchi-town (45.5%), and in Tokunoshima-town it was inter mediate.
2) Tuberculin positive rate by age shows that the rate was very low in the age groups younger than 30 years old and increased very steeply to the rate of rural area of Japan at 30 years old. In the age groups 40-50 years old, the rate reached to the figures in the urban area of Japan.
3) X-ray examination revealed that the preva lence of tuberculosis was highest in Okierabu-island and lowest in Setouchi-town, but generally speaking, prevalence of tuberculosis in these islands was obviously lower than the average of Japan. On the other hand, the rate of cavitary tuberculosis in Okierabu-island and Tokunoshima-town was about the same to the average of Japan.
4) Relationship between tuberculosis and the experience of life outside island was checked in Okierabu-island on the inhabitants of older than 20 years to analyse the mode of tuberculous infection. Persons who have had the experience of life outside this island for longer than one year was 40.4 %, and the rate was higher in male than in female. Among tuberculous patients, the rate of persons with the experience of life outside island was higher than in non-tuberculous persons.
It seems likely that tuberculosis was imported to the islands in the majority of cases after getting infection in elsewhere outside the island, just like the rural area of Japan in the past. Low tuberculin positive rate among younger age groups and high rate in older age groups observed in these islands mentioned in paragraph3) might be explained by the fact mentioned above.
5) In these islands, living standards are very low both economically and hygienically. In spite of such a poor living conditions, the accumulation of active tuberculosis among household was similar to the average of Japan, whereas the rate of house holds with active tuberculosis to the total housholds was lower than that of Japan.
Accordingly, it seems that tuberculosis which was imported from elsewhere outside the islands did not spread so widely in these islands. This may due partly to the less chance of infection caused by the good climate, inconvenience of transportation, and no facilities for entertainment where many people come into contact, etc.
6) In addition to give intensive treatment for already detected patients, tuberculosis control program should be conducted in these remote islands in such a way to vaccinate people with BCG when they go out from the islands to get jobs, and to examine those who come back again after certain period of stay outside the islands.

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In the first report, the authors compared the results of chemotherapy in the short term hospitalization group with that in long term hospitalization group and the ambulatory group, and recommended to start chemotherapy under short term hospitalization, if the long term hospitalization was impossible. The authors continued studies on the same problem, and the results were presented in this report. The number of cases was increased, and the observation period was extended to two years after starting treatment.
A total of 692 patients with pulmonary tuberculosis who were detected by the mass survey and had no previous history of chemotherapy were subjected to the study. Of these patients, 345 were hospitalized for various period, and they were divided into 3 groups according to the term of hospitalization; namely, 92 were hospitalized for 3 months (short term), 136 for 6-8 months (semi-long term) and 117 for 9 months and over (long term). Remaining 347 cases were treated at out-patient clinic and continued to work. Among them, 213 received regular treatment, 71 received irregular treatment and 63 dropped on the way of treatment. The results of treatment were evaluated by the course of radiological findings during treatment, and the results were the following.
1) Evaluated at 2 years after starting chemotherapy, as shown in Fig. 1, the rate of cases showed radiological improvement in the hospitalization groups was clearly superior to that in the ambulatory groups, but, no significant difference was observed in the rate of radiological improvement among the long term, semi-long term and short term hospitalization groups. The rate of significant radiological improvement was highest in the long term hospitalization group. No significant difference was found in the frequency of radiological deterioration during 2 years among the hospitalization groups and the ambulatory groups.
2) Comparing the rate of radiological improvement in cases with exudative or infiltrative-caseous type lesions treated by the triple combination of SM, INH and PAS, as shown in Fig. 3, the results of ambulatory group was nearly equal to that of the hospitalization groups, if ambulatory treatment was conducted regularly.
3) Among the ambulatory group, 20% received treatment irregularly and 18% dropped on the way of treatment. Among the hospitalization group, chemotherapy was continued at out-patient clinic after discharging from the hospital, and of these cases, 12% received treatment irregularly and none dropped on the way of treatment. The results of chemotherapy evaluated by the rate of radiological improvement and deterioration in the irregular ambulatory group was inferior to that in the short term hospitalization group. These facts indicate the difference in the results of chemotherapy between the hospitalization and ambulatory groups.
From the results of the study mentioned above, it can be concluded as follows: it is advisable to start chemotherapy under hospitalization for all tuberculous patients newly detected by the mass survey, and if long term hospitalization is impossible, short term hospitalization followed by chemotherapy at out-patient clinic is recommended to improve the results of treatment.

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Maruyama vaccine is prepared from tubercle bacilli of human type, and is consisted mainly of polysac charide fraction of tubercle bacilli. In the present paper, the author made a study on the effect of Maruyama vaccine on experimental tuberculosis of guinea pigs with special reference to autopsy find ings and immunochemical properties.
Pure strain of male guinea pigs, 24 in number, were used for the study, and they were divided into 7 groups as shown in Fig. 1. Macroscopical examinations were conducted on Organe and Ly mphnodes taken from autopsied guinea pigs. The number of eosinophilic leucocytes was counted at 1 week before infection, 2 and 7 weeks after infection by the Bonner's method. The immunochemical observation of animal serum and its electrophoretical fractions were made by Takahashi-Adachi's kaolin agglutination reaction sensitized with Takahashi's phospholipids and Maruyama vaccine. Analysis of antibody was done by Williams-Graber's method and Poulik's method. Changes of serum protein fractions were observed by paper electrophoresis. The results were the following:
1) No animal died during the experiment.
2) As shown in Fig. 2, the increase of body weight was most marked in group C treated with high concentration Maruyama vaccine alone.
3) Lesions in infected site was most obvious in group A as shown in Fig. 3. Local lesions were, in general, slight in group C.
4) Changes in regional lymphnodes were slighter in groups E and F treated with SM than in the other groups. (Fig. 4)
5) As shown in Fig. 5, macroscopical changes in spleen, lung and liver were most marked in group A, less in groups C and D, and least in groups E and F.
6) Increase in the number of eosinophilic leucocytes was most marked in group C at 2 weeks after infection, which suggests the influence of high concentration Maruyama vaccine. (Fig. 6)
7) As seen in Fig. 7, antibody corresponds to Maruyama vaccine was widely distributed from α globulin to γ-globulin, while antibody corresponds to phospholipids was distributed mainly in γ-globulin.
8) By paper electrophoretic analysis, slight in crease of α-globulin was observed in group B, albumin was not reduced and α and γ-globulin were increased in group C, nearly the same pattern seen in group A was found in group D, and a and globulin remained unchanged in groups E and F.
By the use of Maruyama vaccine, antibody corresponds to polysaccharide fraction of the vaccine showed increase, and by electrophoretical analysis, the relative increase of α and γ-globulin was observed in animals infected with H₂Rv and treated by the vaccine alone. The increase was, however, not so marked in animals treated by the low concentration vaccine, especially together with SM. The facts suggest that the effect of Maruyama vaccine shows certain correlation with the increase of α -globulin in serum, and the effect is diminished when animals were treated effectively by antituber culous drugs. The poor effect of Maruyama vaccine in animals treated together with SM may beexplained by the assumption that the excess of tuberculopolysaccharide, as was noted by Raffel et al. or Seibert et al., causes the unbalance between tuberculopolysaccharide corresponding antibody and tuberculoprotein corresponding antibody due to the consumption of α-globulin fraction corresponding to tuberculo-polysaccharide.
In conclusion, Maruyama vaccine prevents the reduction of albumin and increases α and γ-globulin, thus increases resistance to tuberculous inflammation, but in order to confirm the correlation between Maruyama vaccine and specific tuberculostatic factor located in α-globulin, further studies are necessary.

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The author made biochemical analysis of phosphorus fractions in tuberculous cavity, its surrounding lesions and healthy lung tissue as a part of patho physiological study of tuberculous cavity in order to investigate the process of cavity formation, developement and healing. Acid-soluble phosphorus, phospholipids, DNA and RNA were extracted from cavity wall, its surrounding lesions and healthy lung tissue by the modified Schmidt-Thanhau ser's method, and measurement of each fraction was made by theAlien'ss method. Surgicallyreseated ed lung specimens, 23 in number, were used for the study, and similar analysis was made on 7 cases of lung cancer as a control. The results obtained were the following.
1) In case of tuberculosis, the amount of acid soluble phosphorus was biggest in cavity wall, next in surrounding lesions, and least in healthy lungtissue. The amount of phospholipids was, on the contrary, least in cavity wall, next in surrounding lesions, and biggest in healthy lung tissue. Nosignificant difference was found in the amount of DNA and RNA among the different parts oreseated ed lung specimens.
2) Observing by the radiological findings of tuberculous cavity, the amount of acid-soluble phosphorus in cavity wall and surrounding lesions was more in larger and thick-walled cavity than in small and thin-walled cavity. The amount of phospho- lipids was more in larger, thin-walled and non- sclerotic cavity and in cases with marked or mede- rate and fibrocaseous pericavitary lesions than in cases with contradictory findings in all parts of lung tissue. The amount of DNA was more in, small, thick-walled and non-sclerotic cavity and in, cases with marked or moderate pericavitary lesions, and the amount of RNA was more in small and non-sclerotic cavity.
3) Observing by the macroscopic findings of tuberculous cavity, the amount of acid-soluble phos- phorus was more a) in monolocular cavity than in multilocular cavity, b) in cleansed cavity or cavity with few caseous mass than in cavity with more caseous mass. The amount of phospholipids was more in cleansed cavity and cavity with few caseous mass, in multilocular cavity with fibrous pericavitary lesion, and the amount of DNA and RNA was more in cleansed cavity and multilocular cavity.
4) The amount of phospholipids was more in cases operated within 12 months after the onset of the disease, but regarding other fractions, no significant difference was found by the intervalbetween the the onset of disease and pulmonary resection and by the duration of chemotherapy. The amount of phospholipids tended to be more in younger agegroups and female than in older age group and male, and the fact suggests the difference in phospholipids by age and sex.
5) The amount of phosphorus fractions of cancer lung was more than that of tuberculosis lung in all parts of lung tissue. In case of tuberculosis, no, significant differenc was found in the amount of DNA and RNA among different parts of lung, but. in cases of lung cancer, the amount of DNA and RNA was more in cancer lesion than in the other parts of lung. The fact shows that the difference in energy metabolism exists between tuberculosis. and canoer.

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The local effect of cortisone on tuberculin reaction of healthy men was observed by the same method used in the previous report. Old tuber culin in dilution of 1: 2, 000 was injected intracu- taneously into the flexor surface of one forearm. On the other side, various concentration of saline suspended crystaline cortisone (1. 25 mg cortisone acetate) mixed in old tuberculin was injected intra- cutaneously as shown in the table. The reactions were read at 16, 24, 40, 48, 64 hours and 7 days after injection. Erythema was measured in diametelesss anin durationon was measured in the pinch-up thickness of the injected site.
The following results were obtained:
The tuberculin reactions were diminished by cortison in most of the cases, even by adding 0.05 cc of 1: 20 cortisone (0.0625 mg) to old tuberculin. The in duration was effected more strongly than the redness. And the reactions at 48 hours were effected more clearly than those at 24 hours. (The results of the study was reported at the 18th Annual Meeting of Japanese Society for Public Health in 1962).

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Distribution of NAD-ase and its inhibitor in myco- bacteria was studied.“ Heat-activated” NAD-ase was found only in Mycob. butyricum and Mycob. avium. Heat-labile NAD-ase inhibitor had the same distribution pattern in mycobacteria.
In the case of the isoniazid-resistant variants of the above strains, the enzyme-activity was revealed only in the heat-treated cell-free extract, and not in the heat-treated cell-suspension.
The anzyme-inhibitor relationship was absolutely specific.
Isoniazid-analogue formation hypothesis for the action mechanism of isoniazid was discussed as having some difficulties.

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