In order to clarify the relationship between the appearance of drug resistant tubercle bacilli and the effect of chemotherapy in the course of the disease, the clinical course of 123previously un-treated tuberculosis patients receiving triple drug combination therapy with SM, PAS and INH were analysed.
The drugs analyse d here were SM, PAS and INH and the strains were difined as resistant if there were equal growths of tubercle bacilli on culture media containing 10 mcg SM, 1 mcg PAS or 0.1mcg INH.
The analysis was performed on the following three groups of patients.
Group A: 26 cases in which the tubercle bacilli were negative at the start of original treatment or converted to negative within 3 months, attaining therapeutic target, though aggravation occurred after cessation of original treatment. The susceptibility of the bacilli at the end of original treatment was substituted by the finding at the time of aggravation. The mean duration of the primary chemotherapy in this group was 17.5 months.
Group B: 55 cases in which the tubercle bacilli were negative or con v erted to negative within 3 months but pulmonary resection was performed. The susceptibility of bacilli was measured with the bacilli obtained from resected lungs. The mean duration of chemotherapy before operation in this group was 10.4 months.
Group C: 42 cases in which the tuberc l e bacilli was positive after 6 months chemotherapy. The mean duration of chemotherapy of this group was 12.5 months. The results obtained were as follows:
1) The incidence of drug resistant ca s es were 19.2% in group A, 64.4% in group B and 83.3% in group C.
2) The incid e nce of drug resistant cases was 19.2% when the course of bacteriological findings and that of chest roentgenogram were both excellent, 65.5% when the course of bacteriological finding was good but chest roentgenological finding did not improve, 72.7%when tubercle bacilli did not convert to negative but chest roentgenogram improved, 95.0%when the course of both bacteriological and roentgenological findings were poor.

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Utilization of carbon compounds for growth of mycobacteria was studied by many investigators already in early days of study on mycobacteria. A number of investigations on this subject were carried out recently with the aim of identifying various spe cies of mycobacteria. Most of the studies, however, related to the differentiation of rapid growing mycobacteria, and only a few papers have dealt with the differentiation of slow-growing mycobacteria. It was desired to detect some methods to differentiate slowgrowing mycobacteria. In the course of studies on nutritional requirements of mycobacteria conducted in this laboratory, utilization of n-butanol and iso-butanol for growth was found to be useful for differentiation of M. avium and M. intracellulare, which was considered to be important and was studied by many workers.

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The areal difference of the mortality from tuberculosis on prefectural level has not been dissolved so far, despite the rapid and precipitous decrease of the mortality after the introduction of chemotherapeutics in 1950 s. The highest-lowest ratio of the mortalities among prefectures in 1967 is 2.6, which is approximately the same level as those of 15 years ago, 1952 and 30 years ago, 1937.
The purpose of this s tudy is to detect the factors which caused the prefectural difference of the mortality from tuberculosis. In this report the analysis was conducted especially on the indices which represent the characteristics in the changes of the mortality from tuberculosis in each prefecture from the beginning of this century. The indices which were observed as the factors are the trend lines of the mortality from tuberculosis by sex for three characteristic periods Trend I: 1909-50, before the introduction of chemotherapeutics, Trend II: 1949-53, immediately after the introduction of chemotherapeutics and Trend III: 1953-66, recent trend. excess mortalities due to the flu pandemic and due to the World War II. and the mortality from tuberculosis by sex for selected calendar years.
The following conclusions were drawn from the observations.
1. The areal difference in the mortality from tu b erculosis, which were gradually shrinking for 20 years at the beginning of this century, is widening in male at present, and it is expected to continue to be widened unless taking effective counter-measures to correct the difference.
2. The high- rank prefectures in the mortality rate from tuberculosis before the War such as Tokyo, Kanagawa, Kyoto, Osaka and Hyogo and prefectures in Hokuriku block were, with exception of Osaka and Hyogo, replaced by prefectures in Kyushu, Shikoku and Chugoku blocks after the War.
3. The fact t hat the mortality from tuberculosis in Kyushu, Shikoku and Chugoku blocks where the ranks of the mortality are highest at present, were declining less than other prefectures before the introduction of chemotherapeutics suggests that the past history of the epidemics of tuberculosis even before the War is one of the factors responsible for the areal difference of the mortality from tuberculosis at present.
4. It should be noted that the popularizatio n of the controlmeasures immediately after the introduction of chemotherapeutics still has the effect on the areal difference of the mortality and of its decrease at present.
5. The present are a l difference in the mortality from tuberculosis is, presumably, caused not only by the difference of the effects of the treatment and preventive measures after the War but also other factors before the introduction of chemotherapeutics. Those to be mentioned among all are the effect of the intensity of the epidemic before the War on the mortality for female and effect of the War excess on the mortality for male. It is emphasized that the historical aspect of the prevalen c e of tuberculosis should be taken into consideration to eliminate the areal difference of the mortality from tuberculosis.

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The antituberculous activities of rifampicin (RFP) were studied experimentally on the following five subjects:
1. the antituberculo u s activities in vitro of RFP, Rifamycin-RV & Desacetyl-RFP.
2. regrowth of tubercle bacilli contacted with RFP or INH in vitro.
3. electronmicroscopic changes of tubercle bacilli contacted with RFP.
4. uptake of ¹⁴C-RFP by tubercle bacilli.
5. distribution of ¹⁴C-RFP in the b o dies of guinea pigs and mice.
1) The antituberculous activity in vitro of RFP, Rifamycin-SV and Desacetyl-RFP.

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This is a special lecture at the 46th Annual Meeting of the Japanese Society for Tuberculosis.
Tuberculosis control policy of Asian countries should have been established on the basic condition that about 80% of population lived in rural area where the prevalence of tuberculosis was almost equal as in urban area and the number of inhabitant per one medical doctor was very large especially in rural area, and that the national budget for tuberculosis control was obliged to be limited.
It was nat u ral that BCG vaccination was recommended as the first choice of the control program in this condition because it was least expensive, easy to carry out and most effective although immediate effect was hardly expected.
Because of a considerable number o f escape from the reading of tuberculin reaction, direct BCG vaccination was recommended in these countries and it was revealed that there was no much trouble in side reaction in tuberculin positive persons. To answer the urgent problem to give immunization as early as possible, study on the simultaneous BCG vaccination with small pox vaccin was carried out and marked increase of the coverage of BCG vaccination of small infants has been attained especiallyin Taiwan.
As to the case finding the study on the sputum examination of symptomatic patients, which was carried out at the National Research Institute of Tuberculosis, Bangalore, was explained and the usefulness of the method for the integration of case finding program into general health services was emphasized introducing a wide scale trial of this method in Tumkur district of South India.
Treatment of infectious patients with symptome is important not only from epidemiological standpoint but also from psycological standpoint. It has an immediate effect to reduce infections sources and satisfies inhabitant's demand to be cured. But the treatment is the most expensive control program. So statistical thinking in the choice of place of treatment and regimen of chemotherapy was explained in connection with actual number of negative conversion of sputum, which would be attained by the given budget, introducing various studies on this subject. At the same time efforts to decrease the drop-out from treatment in the self administration of drugs and the studies on the regimens of chemotherapy, which were suitable for the treatment under supervision, were introduced.
Waaler's cost-benefit consideration i n the combination of BCG-program and case findingtreatment program was demonstrated as one of the guide lines of establishing tuberculosis control program in these countries.
At the end of the lecture it was emphasized that if Japan intended to cooperate to promote tuberculosis control of some of Asian countries, it should be done along the line of the policy which was already employed by respective country and should not be pushed according to the view of an old-fashioned specialist without recognizing modern policy of the control of tuberculosis.

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