3. Tubercle bacilli stained on the cavity wall and results of culture: Even when the amount of intracavitary caseous mass was small, tubercle bacilli were observed on the wall of sclerotic walled cavity in 45% of the cases, although their number was very small, and in such cases, culture of caseous mass showed negative results, except one. In some of Kd-type cavity, however, the result of culture of caseous mass showed even when only a few bacilli were found on the stained section. In the group of cases, cavities of which disappeared during chemotherapy, the result of culture was usually negative, while many bacilli which had a marked tendency to show granular structure were found on stained sections of caseous mass. Most of the cultivated bacilli showed resistance to INN, and nearly half of them showed resistance to SM and/or PAS.
4. Relation between the amount of tubercle bacilli and histological findings of cavity wall: In the cases which had numerous bacilli in the cavity, such as, drug-resistant cases, the granulation tissue of the cavity wall showed a marked hyperemia, a new formation of capillary blood vessels, sometimes, edema, and contained abundant leucocytes in caseous mass. These phenomena subside with the decrease of the bacilli and caseous mass on the cavity wall, and disappear in the clean walled cavity. Relationship between the amount of bacilli on the cavity wall and the degree of reaction of the cavity wall could be drawn from the above mentioned facts. In the cases which showed thick caseous mass on the cavity wall, the reactions of the wall were less, even when many bacilli were seen on the surface of thick caseous mass. Arginophilic fibres in the caseous mass were seen to be quelled and finally disappeared when many leucocytes had migrated into caseous mass.
Comment: During chemotherapy, the number of tubercle bacilli decreases gradually, and caseous mass on cavity wall is excreted. The granulation tissue of the cavity wall become more hyperemic, new formation of capillary blood vessels occurs vigorously, epitheloid cells changes to atrophic, and specific granulation tissues have been mostly displaced by the small round cell infiltration with capillary vessels, namely, unspecific granulation tissue. On such hyperemic cavity w alls, the imigration of leucocyte into caseous mass is accelerated, resulting softening and liquefaction of caseous mass.
When a cavity decreases its size markedly and rapidly, hyperemia and new formation of blood capillary vessels of granulation tissue is rather few, and epitheloid cells are rather proliferative. Furthermore, the amount of tubercle bacilli on the cavity wall showed some rela tionship to the degree of unspecific reaction of cavity wall.
From these facts, it is thought that unspecific granulation tissue does not mean a good result of chemotherapy, but rather mean a result of unhealed open state of cavity for a certain period under chemotherapy. With the decrease of tubercle bacilli and caseous mass on cavity wall by effect of chemotherapy, the hyperemia of granulation tissue and leucocyte imigration into caseous mass subside, and the tendency of softening and discharge of caseous mass on cavity wall also decreases. In such a way, open negative syndrome may appear.
In the cases which show resistance to drugs, numerous bacilli in a cavity provoke hyperemia, sometimes edema of granulation tissue, and cause now necrosis of granulation tissue on the other hand.

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Following the basic experiments on the optical ability of Odelca 70 mm camera and Canon 70 mm mirror camera, the authors made clinical evaluation on the diagnostic value of radiopho togram by both cameras.
In the first experiment, the same cases were radiographed and radiophotographed by using both cameras, and the detectability and nature of 85 tuberculous lesions on radiophotogram (P) were compared with those on radiogram (R). Assessment was made by the discussion of two, chest specialists, and the results were presented in Tables 1 and 2. Comparing the detectability of lesions on P by Odelca camera with that on R, 87% were detected equally, and the detecta bility on R was superior to that on P in 13%. Observing by the size of lesions, some of the lesions 10 mm or less were not detected on P. Comparing the detectability of lesions on P by Canon camera with that on R, nearly the same results were obtained. Thus, no significant difference was found in the detectability of lesions on P by Odelca camera and Canon camera.
Nature of lesions was difficult to evaluate in 8% and 11% respectively on P by Odelca camera and by Canon camera. In the majority of the remaining cases, nature of lesions was evaluated as the same both on R and P by Odelca camera and Canon camera.
In the second experiment, 47 cases of pulmonary tuberculosis were radiographed and radio photographed by both cameras, numbered differently, and films were read by 9 chest specialists. independently. About 1 month after the first reading, the second reading was repeated. Presence of tuberculous lesions, and if present, type, size and extent of lesions were described on each side of the lung seperately. Rates of agreement in the judgement of type, size and extent of lesions within the same reader on the same subject between R 1 and R 2, R 1 and P 1, R 2 and P 2, and P 1 and P 2 were calculated. As the type of lesions, two classifications (KE and KA) were used. In KE classification, type of lesions was divided into 4 main cate gories, namely type A (homogenous diffuse shadow), type B (poorly defined shadow), type C (well defined shadow with shrinkage) and type D (linear or star-like shadow). As the inter mediate types between types B and C, types BC and CB were subdivided, and as the inter mediate type between types C and D, type CD was subdivided. Pure types B and C were denoted as BB and CC respectively. Calcium deposit in lung field and hilar lymph nodes was added. In KA classification, type of lesions was divided into 5 categories, namely type I (far advanced cavitary type), type II (cavitary tuberculosis other than type I), type III (non-cavitary tuberculosis with poorly defined shadow), type IV (non-cavitary tuberculosis with well defined shadow), and type V (healed type). The size of lesions were divided into 5 categories, namely 1 (less than 3 mm), 2 (3-5 mm), 3 (6-40 mm), 4 (11-20 mm) and 5 (21 mm or larger). The extent of lesions were divided into minimal and moderately advanced. The results were shown in Tables 3, 4, 5 and 6.
Taking the rate of agreement within the same reader on the same subject on R as the control, the rates of agreement in the judgement of type, size and extent of lesions between R and P were approximately 10% lower than the control, but no significant difference was found in the rates of agreement between R and P by Odelca camera and Canon camera.
Although Odelca camera was slightly superior to Canon mirror camera in the basic experi ments, in the clinical evaluation, no significant difference was found in the quantitative and qualitative diagnostic value of radiophotogram by both cameras. Diagnostic value of 70 mm radiophotogram by mirror camera is slightly inferior to both radiogram and 100 mm radiopho togram, but clearly superior to that of lens camera, and in order to conduct the mass survey on high level, lens cameras must be replaced by mirror camera in the near future.

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The unclassified mycobacteria, especially, scotochromogens and nonphotochromogens are more resistant than M. tuberculosis to streptomycin, isoniazid and para-aminosalycylic acid. Today the major problem in the chemotherapy is the formulation of drug regimens for the treatment of the patients infected with unclassified mycobacteria which have become resistant to the primary anti-tuberculous drugs.
The “specific serum antimycobacterial activity test” described by Dye and Kass has been considered as useful for the formulation of the drug treatment of tuberculous patients.
This paper presents the study on modified method of 2-hours serum antimycobacterial activity test to obtain adequate chemotherapy regimens for unclassified mycobacterial patients. Materials and methods
1. Unclassified mycobacteria were cultured from sputum or resected lung specimens. The strains used were as follows:
scotochromogens: Nagashima, Ariga, Mitsui A, Uemura, Aoki and Ishii
nonphotochromogens: Mitsui B, Hikichi, Tanaka, Kamamori and Shirakashi
2. Serum:
serum of normal adults
serum of tuberculous patients under chemotherapy
serum of patients infected with unclassified mycobacteria
3. The bioassay method is as follows: The serum is diluted with Kirchner liquid medium, to make a series of tubes with dilutions of 1: 4, 1: 8, 1: 16, 1: 32 and 1: 64.
Each tube is inoculated with 0.01 mg of unclassified mycobacteria. These tubes are incubated at 37°C for three days. At the end of this period, one drop of 0.05% Resazurin solution is added to each tube. The tubes with dye are incubated at 37°C for twenty-four hours. The color of the control tube with mycobacteria becomes pink by the reduction of Resazurin. In the tube containing serum with inhibitory activity, the color remains either blue or purple by the complete or incomplete prevention of the reduction of Resazurin. The highest dilution of serum which prevented the reduction of Resazurin to purple is regarded as the titer of antimycobacterial activity.
Results
Sera of normal adults did not inhibit the growth of unclassified mycobacteria.
Sera obtained from the patients who received SM, INH and PAS scarcely inhibited the growth of all scotochromogens and nonphotochromogens.
The serum activity, to unclassified mycobacteria, 2 hours after the drug administration was higher than that after 4 hours.
The chemotherapy with KM plus EB plus INH or TH will be successful in the treatment of the disease caused by unclassified mycobacteria.
It is believed that this test can serve as a guide to the effective antimycobacterial treatment for the patients infected with unclassified mycobacteria.

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Since 1958, studies have been made on the factors influencing the radiological aggravation after the cessation of ambulatory chemotherapy. Among many factors, analysis was made on the age of cases, type, extent and maximal size of lesions, and the duration and regimen of chemotherapy, and it was revealed that the radiological aggravation was more frequently found among younger age groups and INH twice weekly and PAS daily groups than among older age groups and triple combination or INH daily and PAS daily groups. Among cases treated with triple combination or INH and PAS daily, the essential factor influencing the radiological aggravation was the type of lesions at the end of treatment.
In the present report, analysis was made on the above mentioned 6 factors among 876 cases of pulmonary tuberculosis treated with triple combination or INH and PAS daily. Furthermore, the radiological aggravation after the cessation of chemotherapy was observed by the type of lesions on the beginning of treatment among 1951 cases of pulmonary tuberculosis treated with various kind of chemotherapy for longer than 1 year. The results were the following:
A. Analysis on cases treated with triple combination or INH and PAS daily.
1) No significant difference was found in the rate of radiological aggravation after the cessation of chemotherapy between the groups treated with triple combination and INH and PAS daily.
2) The rate was significantly higher among cases with CB type lesions at the end of chemotherapy than among cases with CC type lesions.
3) No significant difference was found in the rate of radiological aggravation between the age group less than 30 years and the age group 30 years and over.
4) The rate was significantly higher among cases treated for 6-17 months than among cases treated for 24-35 months.
5) No significant difference was found in the rate by the extent and maximal size of lesion.
B. Analysis on cases treated with triple combination or INH and PAS daily for longer than 1 year.
No significant difference was found in the rate of radiological aggravation by the age group and the type of lesions at the end of chemotherapy.
C. Analysis by the type of lesions at the beginning of treatment.
1) Among cases showing CC type lesions at the end of treatment, no significant differ ence was found in the rate of radiological aggravation by the type of lesions on the beginning of treatment.
2) Among cases showing CB type lesions at the end of treatment, the rate was higher among cases showing B type lesions on the beginning of treatment than among cases with CB type lesions.

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Histological examinations were made on tularemia and tuberculosis to compare both diseases, using removed lymphnodes of the former and the lymphnodes which were obtained from autopsy cases and the removed ones of the latter.
Results obtained were as follows:
1) As the case of Ranke's classification on tuberculosis, stage of the primary complex and that of the early generalization were observed in tularemia which was lacking in stage of the late generalization and the 3rd stage. Most of the cases of tularemia in Japan were confined to the formation of the primary complex.
2) Formation of granuloma and its healing process in tularemia was fundamentally identical with tuberculosis. The lesion of tularemia, however, consited of a large amount of polymor phnuclear leukocytes and large mononuclear cells, forming a widespread abscess in it's central part. In tuberculosis, infiltration of polymorphnuclear leukocytes was unexpectedly intense in the lesions of the primary complex and the stage of the early generalization. It was, however, slight or completely absent in lesions of the stage of the late generalization and the 3rd stage, in which large mononuclear cells were mainly infiltrated.
3) In tularemia, argyrophil fibers were completely disappeared in the abscess or homoge neous necrotic area of the central part of the lesion. On the other hand in tuberculosis, they were abundantly observed in the form of nodular networks in the caseous area of the lesions of the stage of the late generalization and the 3rd stage. This may give the evidence of the fact that the caseous area was made by fusion of many lesions caused by caseation of each tubercle. Argyrophil fibers, however, were widely disappeared in caseous areas of the primary complex and the stage of the early generalization by influence of leukocytic infiltrations, though they were observed in reticular or stringy arrangement in advanced portion of the caseous area.
Conclusively, complete disappearance of argyrophil fibers in the central necrotic area of the lesion was one of the most important differrentiation to distinguish tularemia from tuberculosis.
4) Spontaneous healing process of granuloma in tularemia was markedly accelerated by the treatment with antibiotics such as streptomycin6; epithelioid cell zone was replaced by non specific granulation tissue, and organization was occurred even in the central necrotic area. This process was identical with a tuberculous lesion, and was expressed merely in exaggeration as compared with tuberculosis.

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The draining bronchus and the modes of its connection with the pulmonary cavity are highly significant for the formation, development and healing of the cavity. Especially, the opening or obstracting of the region of connection with the cavity is closely related to the healing of the cavity, but there is not always an agreement in opinions as to such a standpoint. However, the cavity and draining bronchus are always under the strong influence of respiratory movement in the living body. In this sense, both organic and functional investigations of the relation between the cavity and draining bronchus and especially the site of their connection are indispensable. In this report the organic relationship between the cavity and draining bronchus was explored in 96 dogs (experimental tuberculosis) and 20 dogs (experimental suppuration) as well as in clinical cases (30 cases of tuberculosis and 3 cases of abscess), by means of bronchography and unsaturated polyester resin casting of the draining bronchus and cavity. From the standpoint of comparative pathophysiology, similar observations were made on experimental suppuration and clinical cavities. The following results were obtained.
1) As compared with bronchography, the rate at which air was introduced into the resin cast specimen was greater (45%), and a specimen almost similar to the original cavity was prepared. By the resin casting technique the relation between the cavity and draining bronchus could be observed in three dimensions and minutely under conditions near those in the living body.
2) The number of draining bronchi averaged 2.4 in the experimental tuberculosis cavity. The draining bronchus entered the cavity at about the 3 rd-4 th branches. The number of draining bronchi was intimately related to the characters of the cavity it was greater in monocular (3.2 bronchi) and large (2.9) cavities than in the multilocular (1.8) and small cavities (1.2). It is presumed that multilocular small cavities become confluent into a large monocular cavity with a resultant increase in the number of draining bronchi. The number of draining bronchi was generally greater in caseous (3.6) and old cavities (2.2) than in exdative (1.8) and fresh cavities (1.8). The greater the number of draining bronchi, the easier becomes the excretion of cavity. As compared with the experimental suppurative cavity, the number of draining bronchi was 4.1 on the average, being greater than that of the tuberculous cavity. Clear-cut differences were noted in respect to cavity forms and the course of cavitation, etc.

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