Upper case Bee ; Therapeutic procedure ; Hepatitis, Chronic

Our hospital plays the role of a medical center for a rural district, giving medical service for the approximately 20, 000 settled farming population. There is no mixingof patients with other hospitals.
The author deliberated on the 242 female cases of appendicitis treated at this hospital. 1. Incidence of appendicitis.Female cases surpassed male cases in the ratio of 1: 0.75. Majority of the female cases consisted of the married women of 26-36 age group, who take the lead as housewives both in the household work and in farming. It was noted that acute cases increased in the April-June on-season, while chronic cases increased before and after the on-season, i. e. in February, March and June. The increase of acute cases may be due to the hard physical labor and overwork of rural women. 2. Histological classification of the resected specimens. Attention of the author was drawn to the existence of neuroappendicitis or appendicitis ascribed to disturbance in the vegetative nervous system.It may have something to do with the slackened mental tension before and after the on-season. 3. Affinity with gynecological diseases. Confusion in diagnosis of appendicitis and gynecological diseases occurred to 10% of appendicitis cases. Relationship with urinary diseases is not to be neglected either. Question of appendicitis in pregnancy was also taken into consideration. In conclusion, emphasis was placed on its close affinity with gynecological diseases, with the suggestion of hints for differential diagnosis.

It is statistically known that there are more cases of advanced pulmonary tuberculosis among rural people than among urban residents. The author worked on the difference in the behaviors of tuberculosis in such two groups of people from a point of view of pathological physiology and discovered the following facts:
As a result of comparison of the rural and urban patients with radiographically similar extent of lesions, the rural patients were found to be inferior to the other group at the time of their hospitalization with respect to haemoglobin values, albumin-globulin ratio, body weight, icterus index, etc., and to show higher values of γ-globulin and higher rates of positive Gros reaction, Among these items, haemoglobin value, albumin-globulinratio and body weight of the rural group showed a marked increase after 6 months' and 12 months' hospitalization.Such increase is ragarded to be a combined effect of improvement both in disease and nutriture.
There are many anemic cases in rural area even among the apparently healthy people free from hookworm infection, and they also present a decrease in total serum protein and albumin values, icterus index, etc., for which their inadequate or unbalanced dietary intake is said to be accountable.In the light of this fact, it is considered that prior to the attack of tuberculosis rural tuberculous patients have already been in more or less poor nutriture, which is further aggravated by the disease, while such poor nutriture assists the progress of the disease itself playing as a causative agent for its ingravescence.

With a view to elucidating some aspects of round-worm infection and mass anthelmintic treatment in rural area, the author conducted an investigation of all the pupils of elementary and lower secondary schools in Shirahama-machi, Chiba Prefecture (5 schools, 2, 180 pupils). Monthly stool examination was carried out from Feb. 1957 to Mar. 1959, together with more than ten times of mass anthelmintic treatment in between. Thus, such facts as transition of positive reaction rates, speed of infection or how soon infection occurred, infection rates by seasons, relationship between consecutive anthelmintic treatment and rate of conversion to negative, and that between the frequency of treatment received and the cumulative rate of conversion to negative were obtained by schools. The results of study are as follows.
1. Althouge all the five schools belong to the same local administrative unit, machi, their initial positive rates showed a considerable variance, the highest rate being 58.5% and the lowest 12.5%.
2. The infection speed by schools was high for the groups with high initial positive rates, in regard to both new- and re-infection. The cumulative positive rates by schools at the end of the first year ranged between 63% and 26%. The infection speed for the re-infection cases showed a higher value than that for the new infection cases.
3. Infection rates by seasons inclined to be lower in June and January, and higher in November and February to May inclusive.
4. Both Macnin and Nemacin, when employed repeatedly in consecutive treatment, appeared to cause a gradual decline in the rate of conversion to negative;and the severer the degree of infection, the more difficult it was to attain conversion to negative, it seemed.
5. The cumulative rates of conversion to negative obtained were: 78.6-94.3% by two courses of anthelmintic treatment, and 94.7-100% by four courses.
6. As for the transition of positive reaction rates, the rates became lower in the second year as compared with the first year of anthelmintic treatment program. However, in spite of the consecutive treatment given almost monthly, it would not fall beyond a certain level but rather showed a kind of side crawls (5-15% on an average).
On the basis of the above-mentioned findings it was concluded that, taking into consideration the infection speed, treatment should be give more frequently to the groups with high initial positive rates and to the reinfection groups, although it is generally said that mass treatment should be given 2 or 3 times a year.
Furthermore, it was considered that it would be difficult to attain the objective of the extermination of round-worms only by means of mass anthelmintic treatment, and that the treatment should be executed side by side with such measures for preventing reinfection as hygienic education, environmental improvement, and esp. the hygienic disposal of human waste, etc.

This is a clinical study conducted with a view to determining the effect of Vitamin A on the prevention of Ascaris re-infection. 692 school children were used as subjects of study. A strict preliminary examination was conducted from February to October, 1957, as a result of which 110 children were deliberately selected. Such 110 children were divided into two groups at random, one of which was given V. A.(10, 000 IU per capita daily) for a whole year, and the other served as a control group. Thus, during the period of V. A. administration and during the 9 months' follow-up period succeeding it, the occurrence of re-infection was closely observed for comparative study.
A. Preliminary examination
1) The cumulative rate of re-infection among school children during 6 months' time was 42.0%. 2) All the egg-positive children were subjected to mass anthelmintic treatment in February and in June. And, from among those whose conversion to negative was confirmed by the August stool examination, but who had previously been positive both in May and in June and also positive from February to April consecutively or who had become negative as a result of treament executed in February but had been infected again thereafter, 110 children were finally chosen at random for the purpose of this experiment. These 110 persons were divided at random into two groups;then it came out that they were of practically holomogous composition as to the sex distribution ratio and the severity of infection (number of eggs detected). 3) For caution's sake, these subjects were again given two courses of anthelmintic treatment before the experimental administration of V. A, i. e. in September and in October, so that the possible inclusion of such cases as those who had larvae circulating within one or other organ unnoticed or of false negative cases be eliminated.
B. Results of experimental V. A. administration and follow-up results
1) Re-infection rate during the period of V. A. administration: The rate of the V. A. administered group was markedly lower than that of the control group. 2) Transition of the cumulative re-infection rate: After 5 months of the commencement of the V. A. administration, marked difference was observed in the ascending rates of the two groups. At the termination of the V. A. admintration, the V. A. administered group showed 29.1% while the control group reached to 60.0%-significant difference was obtained between the two values. 3) Relationship between the severity of infection prior to treatment and the severity of re-infection that took place during the V. A. administration: No definite relationship was recognized. 4) Severer re-infection occurred more frequently in the control group. 5) Spontaneous conversion to negative during the V. A. administration period: No significant difference was seen between the two groups. 6) Transition of the cumulative rate of re-infection during the follow-up period: The two groups presented no particular difference. Rise of the re-infection rate in V. A. administered group was ascribed to the lack of long lasting effect of V. A. 7) No side effect was recognized in the administration of V. A.
It is concluded that V. A. is effective in preventing round-worm re-infection, but its effect appeared not long lasting.