Tuberculin reaction and Fernandez's reaction were compared on the inhabitants of four towns (O, T, S and K) of remote islands on the occasion of tuberculosis prevalence survey, carried out yearly from 1960 to 1964.
The total number examined was 18, 391 and BCG vaccination has been conducted to certain, extent on persons 7 to 15 years old in these several years.
Results obtained were as follows:
1) Tuberculin positive rate was 50. 1% in T, 63.6% in 0, 39.8% in S and 65.3% in K, respectively, while that of Fernandez's reaction was 38.9% in T, 35. 2% in O, 20.8% in S and 27.9% in K, respectively. Positive rates of Fernandez's reaction in all towns were obviously lower than those of tuberculin reaction. And no obvious relationship was observed between the differences of positive rates of Fernandez's reaction among these four towns and those of the tuberculin reaction.
2) Tuberculin positive rate in female was nearly the same or a little lower than that in male, whereas that of Fernandez's reaction was generally lower in female than in male. The positive rates to both antigens, tuberculin and Dharmendra's, were about the same in both sex up to the age of 20 years old, but thereafter, those of female became lower than the male.
3) Frequency distribution curves of the positive rate of Fernandez's reaction were quite similar in four towns showing bimodal distribution curves with two peaks at the age groups of 15-19 and about 40 years old. Tuberculin positive rates in four towns also resembled each other and bimodally distributed, but the first peak at the age group of 15-19 was small and the second peak was high and big.
No difference was observed between the positive rates of these two reactions up to 15 years Old, but in the age groups more than 20 years the difference between these two reactions increased resulting in the obviously low positive rate of Fernandez's reaction.
Referring to the tuberculin positive rate and the BCG vaccination program hitherto been carried out in these towns, it can be said that the first peak at 15-19 age group in Fernandez's reaction curve is affected largely by the BCG vaccination and that the second peak at about 40 years old is, on the contraly, due to tuberculous infection.
4) The size of both reactions did not show close correlation in 4 towns. Positive rate of Fernandez's reaction among the tuberculin positive persons was 62.8% in T, 47.9% in O, 43.0% in S and 38.6% in K, respectively. And it was higher in the age group of 7-15 years old, more than half of which were BCG vaccinated, than in that of 30-69 years old, of which majority was tuberculous infected, regardless to the intensity of tuberculin reaction. From these results it can be said that the higher positive rate to Fernandez's antigen is observed among BCG vaccinated than among persons naturally infected by tuberculosis.
5) Positive rate of Fernandez's reaction among tuberculin negative persons was 9.1% in T, 9.5% in O, 4.9% in S and 6.1% in K, respectively, and was higher than that of S-village (1.5%) in the first report. Positive rate of Fernandez's reactions among population of more than 30 years old, in which no affect of BCG vaccination was seen, was 19.2% in T, 9.8% in 0, 9.5% in S and 5.2% in K, respectively. These figures are higher than that of S-village (4.1%) in the first report.
The fact that the difference of positive rates of Fernandez's reaction among tuberculin negative persons in these 4 towns showed close correlation with the prevalence of leprosy in these 4 towns, suggests that positive rate of Fernandez's reaction among the BCG unvaccinated tuberculin negative population may be used to a certain extent to estimate the prevalence of leprosy in certain district.

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The virulence of forty three strains of M. tuberculosis isolated from tuberculous patients who were discovered at “Tuberculosis Prevalence Survey in Japan” (Japanese Ministry of Health and Welfare, 1963 and 1964) was examined. All the patients under these studies were new cases discovered at the Survey and had no history of antituberculous treatment. The virulence of the bacilli isolated from these patients was compared with that of two English strains and eight Indian strains from Dr. Mitchson. Also the standard strain Kurono was examined in these studies.
The bacilli were cultured on egg madia at the isolation and subcultured on the same media for drug sensitivity tests. The bacilli grown on the control tubes were planted in Dubos' liquid media and the bacterial suspension was obtained. The various bacterial suspensions were standardized to a given optical density. Each animal was infected with 0.1mg (wet weight) of bacilli.
Ten female mice of dd strain were infected intravenously with each strain of bacilli. The death rate up to 8 weeks after infection was observed. All the survived mice were sacrificed at the 8 th week, the tuberculous change was observed, and the degrees of tuberculous pulmonary involvements were judged macroscopically. The weight of lungs and spleens was measured at the same time. The results were as follows:
1. The viable unit of bacilli used in the infection was almost the same in number in all the strains examined. The average unit was 38.5×10⁵ (standard deviation 13.1×10⁵) (Table 1 and Fig. 1).
2. The death rate of mice infected with 0.1mg of each strain was varied from 100% to 0% (Table 1 and Fig. 2).
3. The degree of tuberculous involvement in lung used in these experiments was graded as follows: no lesion…0; minute tubercles less than 20 in number…1; minute tubercles more than 20 in number…2; minute tubercles mixed with some tubercles larger than 2mm in diameter…3; minute tubercles mixed with many tubercles more than 2mm in diameter…4; the surface of the lung all studded with many tubercles from one to several mm in diameter…5; in the group where tuberculous death was observed from 4 to 5 weeks after infection, one point was added mechanically to point 5, i.e. 6; when dea th was observed from 2 to 3 weeks, 2 points were added to point 5, i.e. 7.
The average degree of tuberculous involvement in lung of each strain was varied from 7.1 to 2.3 (Table 1 and Fig. 3). If the difference of the average degree of tuberculous involve ments was more than one, a significant difference could be confirmed statistically.
4. The weight of the lung and its ratio to the body weight were correlated with the degree of tuberculous involvement in lung (Fig. 4). To compare the degree of tuberculous changes with the lung weight, weighing of the lung must be carried out after removing lymph glands, and without blood congestion. In Fig. 4, only the results of experiments were demonstrated where the lungs were weighed as above mentioned.
5. INH resistant strains (primary resistant cases) showed low virulence to mice (Table 2). Comparison of English and Indian strains with Japanese strains will be discussed in the further reports.

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Bronchial fistula is one of the most difficult post-operative complications in the surgical treatment for pulmonary tuberculosis, and other severe post-operative complications are often induced by bronchial fistula (Table 1). The results of treatment for bronchial fistula reported in the past literature is not satisfactory (Table 2). Trial was made by the authors to improve the results of treatment.
Cases with bronchial fistula undergone surgical treatment in the authors' sanatorium during the period from 1958 to April 1964 were subjected to the study (Table 3). The total number of cases were 43, of which 28 developed bronchial fistula after pulmonary resection performed in our sanatorium, and 15 cases were sent from other hospitals.
The method of treatment was divided into the following 3 groups Group A…re-resection of remaining lobe, Group B…re-resection or resuture of bronchus, Group C…cmuscle plom bage with additional thoracoplasty. Group C was subdivided into two, namely Cb and Cc. The former with resuture of bronchus, and the latter without it.
The result was best in Group A, next in Groups B and Cb, and worst in Group Cc (Table 6). One case in Group Cb died 1 year and 9 months after the first operation. By post-mortem examination, it was found that the main pulmonary artery was mistaken as Truncus superior, and was amputated at the time of right upper lobe lobectomy. Therefore, this case died not because of bronchial fistula, but mistake of operation technique. The results mentioned above show that the method of suturing bronchus directly when inflamation is over (this was called as ‘direct attack’ by Mulvihill in the discussion on Murphy's report), is far better than the other methods as the surgical treatment for bronchial fistula.
The authors' method used at present for closing bronchial fistula is as follows: Open thora cotomy is done attending not to open the dead space, and the remaining lobe is stripped off from thorax sufficiently. Bronchus is disclosed, and remaining lobe is stripped off upto hilum, thus suture of bronchial wall is made possible. If the bronchus stem is long enough, bronchus is cut off, and if it is short, the edge of fistula is scraped with a sharp curet and resuture is made. Bronchial stump is covered by the remaining lobe, pulmonary ligament is cut if necessary, and the remaining lobe is sutured to the upper thorax wall with several stitches of cutgut. Hematoma between diaphragm and lung often developes by this method, but re-expansion of lung is possible by physical therapy.
In conclusion, among 43 cases of bronchial fistula treated at the authors sanatorium, 39 (91%) were cured, 3 (7%) were still hospitalized, and 1 (2%) died. The best result is obtained by the ‘direct ataack’ on bronchus, and this new method is recommended as the surgical treat ment for bronchial fistula in stead of thoracoplasty with muscle plombage.

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