History of the discovery of Mycobacterium scrofulaceum and problems of the taxonomic position of this organism, especially in relation to M. gordonae and to M. avium-M. intracellulare, were stated. Infection cases due to M. scrofulaceum were reviewed in this paper.

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Eleven cases with miliary tuberculosis who had been admitted to Kawasaki Medical School Hospital during the last 10 years were observed clinically. The results were as follows:
1) Eleven miliary tuberculosis patients consisted of nine men and two women. Their age was ranged from 27 to 79 years (mean, 60.3 years).
2) Ten out of 11 patients had the underlying diseases and/or the predisposing factors, in paticular 4 patients had been administrated with corticosteroid hormone.
3) The PPD skin reaction was attenuated in 8 out of 10 patients, and 8 out of 11 patients showed lymphocytopenia in peripheral blood counts. These results suggest cellular immunosupression.
4) Tubercle bacilli were proved from clinical materials in 9 patients, which consisted of 2 smear positives and 9 culture positives.
5) The diagnosis was confirmed by histopathological findings in 8 cases; 4 by autopsy, 1 by TBLB and autopsy, 1 by TBLB and pleural biopsy, 1 by TBLB and 1 by liver biopsy. As the positive rate of biopsy examination is high and the isolation of tubercle bacilli by culture requires long time, the histological diagnosis by biopsy specimens is considered to be useful, especially in patients with atypical clinical findings.

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Tryptophan, an essential amino acid, is biologically important as a precursor of serotonin and nicotinic acid derivatives.
The aim of this work is to study the metabolism of tryptophan in tuberculous patients at different stages of the disease before and after tryptophan load. A parallel study was also done in normal control subjects and tuberculous patients to study the hormonal pattern of thyroid gland in the different stages of tuberculosis and to exclude the effect of thyroid hormone as one of the causative agents for tissue destruction occuring in tuberculous patients.

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Studies on clinical and bacteriological problems related to smear positive and culture negative tubercle bacilli (SPCN) were carried out, and the results were summarized as follows.
1) The frequency of SPCN was 8.7-25.1% for sputum and 52.0% for resected lesion in specimens of positive smear.
2) Cases with SPCN were clinically grouped into five patterns, (1) cases found prior to conversion to negative on both smear and culture, (2) cases found three months or later after the complete negative conversion, without following culture positve results, (3) same to (2) but with following culture positive results, (4) chronic tuberculous cases with tubercle bacilli resistant to multiple antituberculous drugs, (5) cases found only at the beginning of treat ment. The frequency of each group was 57.6% for the 1st pattern, 12.1% for the 2nd, 4.0% for the third, 12.1% for the 4th and 14.2% for the 5th, respectively. Among cases (2) and (3), cases who showed positive culture one month later after the appearance of SPCN (the 3rd pattern) occupied 60% in retreatment cases and 9.1% in initial treatment cases.
3) 3.04% of specimens which was determined as SPCN became positive on culture by extending the inoculation period up to 24 weeks and 10.5% of specimens which werenegative culture by Ogawa's medium showed positive result by Lowenstein-Jensen medium.
4) Sputum taken from cases determined as SPCN by 22 weeks observation by routine technique showed positive culture by the pre-treatment with 0.5% NaOH. This isolated strain showed positive niacin test in spite of the lost virulence to guinea pigs.
5) It was noted that the frequency of SPCN was significantly higher in cases treated with regimens containing RFP than in cases treated with other regimens, and the results suggest that tubercle bacilli exposed to RFP kept their nature of acid fastness better than bacilli exposed to other drugs through bacilli were damaged in both exposures.

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