The literatures on the source and infection route of pathogenic mycobacteria other than tubercle bacilli which cause lung disease in humans are reviewed. Human-to-human and animalto- human transmissions do not appear to exist. Transmission of pathogenic mycobacteria from environments to humans is most likely to occur. In our environments, especially in the soil and dusts, almost all kinds of mycobacteria are detected. It is believed that lung mycobacterioses are an opportunistic infection, and that the infection of the mycobacteria is manifested as disease depending on the host condition.
It has been shown that there is a significant difference in the serotype of M. intracellulare between the strains isolated from lymphadenitis of swine and those having caused lung disease in patients (Table 1). This finding suggests that swine is not a source of infection for humans.
The serotype of M. intracellulare isolated from sputa of tuberculous patients as casual isolates belongs, in the majority, to Watson (20/30, 66.7%) and Dent (6/30, 20.0%), whereas a considerably large portion of the serotype of the strains isolated from patients with lung disease due to this organism in this country belongs to Yandle (8/46, 17.3%), Altman (6/46, 13.0%), Dent (9/46, 19.6%) and Watson (6/46, 13.0%). The serotypes Yandle, Altman and Dent may be correlated to high virulence for Japanese patients.
The author's data of ecological studies on the mycobacteria occurring in the environment are shown in Table 2.

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Schizophyllan (SPG) is a polysaccharide obtained from the culture fluid of Schizophyllum commune, and its fundamental structure is β-1, 3 linked glucan as shown in Figure 1. Its molecular weight is estimated to be about 50, 000.
This substance does not exhibit any anti-microbial effect in vitro, however, it has been already indicated by Komatsu et al., that its intraperitoneal application elongate the life span of mice experimentally infected with coli bacilli, pseudomonas, fungus, tubercle bacilli and so on.
Such phenomena are explained as follows, that is, SPG would probably stimulate the reticuloendothelial system of the hosts and enhance their antimicrobial activity.
As we have proved the antituberculous effect of SPG in vivo as previously reported, our objects of these animal experiments are to clarify that such antituberculous effect of SPG is due to its special character, differently from the substances as Glycogen, Drakeol or Zymosan, and 0to find the most favorable administration conditions of SPG to show its antituberculous effect.
Experimental methods are presented in the following figures.
The results of our experiments are as follows:
Experiment 1. Comparison of survival effects of intraperitoneal administration of SPG, Glycogen and Drakeol in the mice experimentally infected with tubercle bacilli (Fig.2). Intraperitoneal administration of SPG, Glycogen or Drakeol enhance the activity of intraperitoneal macrophage (i. e. phagocytic activity and hydrolysis enzyme activity). If the antimicrobial action of SPG is due to this phenomenon, Glycogen and Drakeol are also expected to show similar antituberculous effect. However, neither Glycogen nor Drakeol revealed in vivo any antituberculous effect in the same dosage as that of SPG.
Experiment 2-1. Comparison of antituberculous effect of SPG with Zymosan (Fig.3).
Since SPG is a high molecular polysaccharide, we compared the antituberculous effect of SPG and other high-molecular polysaccharides, Zymosan, which increases the lysosomal enzymes of macrophages. However as to Zymosan, no antituberculous effect could be proved at all either in the intraperitoneal or intramuscular application.
Experiment 2-2 (Fig. 3) and Experiment 3 (Fig.4). The relationship between antituberculous effect of SPG and its dosage. In these experiments we attempted to clarify whether the antituberculous effect of SPG increases in proportion to its dosage. The effect of SPG was indeed strengthened with the increase of dasage, but its degree was not so high.
Experiment 4. The relationship between inoculated dose of tubercle bacilli and survival effect of SPG in experimental mice tuberculosis (Fig. 5 and 6).
If the dose of inoculated tubercle bacilli is too high, no significant effect is seen both in treated and untreated groups. This is probably due to the rather weak antituberculous effect of SPG.
If the inoculation dose is within certain range, however, surviving bacilli in the groups treated with SPG are apparently smaller in number than those in untreated groups.
And in the groups inoculated with too small dose of bacilli, the difference in survival time of hosts between treated and untreated groups becomes insignificant again, suggesting that the defense mechanism of the hosts is strong enough to suppress the bacilli without SPG. In the group administered SPG prior to inoculation of tubercle bacilli, there was seen some prolongation effect of survival time of mice due to the enhancement of the host's deffensive ability, but this effect did not last so long, but transient after administration.

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A retrospective study of causes of tuberculous pleural empyema and outcome of medical treatment was conducted on a total of 237 inpatients treated at this hospital during the period of thirty-five years from 1939 to 1974.
Tuberculous empyema accounted for 1.37 per cent of all hospitalized cases and there is still no tendency to any significant decline in this proportion.
The overall cure rates were 22 per cent by drug therapy and 33 per cent by surgery. Of 148 cases treated by medical treatment alone, the cure rate was 35.8 per cent (53 cases) and this success of medical treatment alone for empyema is noteworthy.
Complete cure by medical treatment was achieved more frequently in those who were younger, whose lesions of pyothorax were circumscribed, who had no pulmonary fistula, who had no or minimal pulmonary lesion and/or who discharged no tubercle bacilli in sputum. In many cases, the improvement of pyothorax was observed in accordance with the amelioration of intrapulmo nary lesions. Cure of empyema by drug therapy occurred within twelve months of treatment in the majority of cured cases.
Although pleural empyema at present is primarily subjected to surgical treatment and high cure rate is obtained by operation, we have to emphasize that the complete cure of pyothorax could be achieved even by medicinal treatment alone in some selected cases.

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A retrospective study, as to the causes of death, on 298 patients dismissed by death among 4, 194 patients discharged from the National Hiroshima Sanatorium during the last ten-years period (Group A), comparing with 260 cases among the 5, 420 discharged_ during the preceding ten-years period (Group B), has been performed. The results are as follows.
1) The overall mortality rate to the total number of patients dismissed has increased during the last ten years (7.1%) as compared wtih that of the preceding decade (4.8%), and the mor tality from tuberculosis has failed to decrease.
2) The average age of death in Group A (54.5) was higher than that in Group B (38.8). This does not totally imply the prolonged duration of illness but advanced ages at the onset of pulmonary tuberculosis with the patients in Group A seem to account in greater part for the hightened average age of death.
3) Cardiopulmonary failure accounts, among other immediate causes of death, for 23.8% of all deaths in Group A in contrast to 7.7% of all the deaths in Group B, whereas deaths due to tuberculosis, conversely, declined to 35.2% for Group A as compared with 51.5% for Group B. The combined mortalities (cardiopulmonary failure and tuberculosis) being virtually comparable for both groups, i. e. 59.0% and 59.2%, respectively. The finding indicates that, in Group A, those who would have otherwise succumbed to tuberculosis became improved to attain an “inactivec” state by the advanced chemotherapy without significant amelioration in pulmonary function.
4) In both Groups A and B, deaths from hemoptysis were more frequent in patients under 60 years of age, patients with enlarged cavitations of over 7.0 cm diameter and with for ad vanced cavitary type
5) Complication of pulmonary carcinoma was encountered in 2.3% of those who died in Group A, five males and two females. Of these seven cases, four showed sputa positive for tuber cle bacilli by culture at the time of death.
6) Sixteen (20.3%) who died from tuberculosis out of 79 patients who were discovered their disease during the period since 1966 in Group A were assessed individually as to factors concerned with the death from tuberculosis to determine whether there might be any scope for possible future reduction of such cases. The results indicated the importance of making further thorough health examinations.
7) The rate of mortality from tuberculosis (20.3%) among those who were discovered their disease during the decade since 1966 in Group A is remarkably lower than the corresponding rate of 51.5% for Group B.

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Tryptophan and some indole derivatives proved to be tuberculostatic both in vitro and in vivo. Indole, in therapeutic doses was effectively tuberculostatic in guinea pigs and human beings. Indole acetic and indole-propronic acid were less effective as tuberculostatic agents. Skatol had also a tuberculostatic effect both in vitro and in vivo, but in large therapeutic doses it was toxic to mice which limited the experiment.
Some indole compounds have been found to increase in blood and urine of tuberculous patients and to diminish as a metabolic consequence to treatment with traditional antituberculous drugs This work was therefore conducted to study the metabolism of some indole compounds in tuberculosis, namely serum total indoles and blood serotonin level, in tuberculous guinea pigs.

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The results at 6 months of a controlled trial of two regimens are presented. Adults with newly-diagnosed sputum-positive pulmonary tuberculosis were treated in hospital for 6 months. They were submitted from 4 chest clinics and were allocated at random to: -
A. SM 1g daily for 3 months, followed by SM 1 g biweekly+INH 0.6g daily +RFP 0.45 gdaily
B. SM 1g daily for 3 months, followed by SM 1g biweekly+INH 0.6 g dail +EB 15 mg/kg daily
A total of 50 patients was admitted to the study. Of these, 44 (26 in regimen A, 18 in regimen B) patients were included in a main comparison, even if they had had changes or in terruptions of chemotherapy due to drug toxicity or other reasons. In the remaining 6 patients, there were 3 early discharges and 3 bacteriologically negative cases.
At 6 months, none of the patients in regimen A had an unfavorable bacteriological response.
On the contrary, 5 patients in regimen B showed culturable tubercle bacilli in their sputum off and on after 12 weeks' chemotherapy, even if in some of the cases the original regimen was changed to the presumably more potent regimens.
As for the rapidity of the sputum conversion to negative, regimen A showed 73% negative conversion at 4 weeks, though regimen B showed only 44%.
Although the courses of X-ray findings had no significant differences between these two regimens, the rapidity of the negative conversion of the sputum on -culture as well as overall favorable bacteriological response of regimen A suggest its superiority to regimen B.
The adverse reaction of daily 1 g SM was not trivial in its frequency. In case of daily use, the dose less than 1 g will be more suitable.

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