penicillin, totracyclin, and in some cases streptomycin. We stopped
these antibiotics about the middle of May, and used them later as the
eceasion demanded. We also prescribed soveral Kinds of vitamins. of

course, rest and nutrition were fundamental; and from the beginning

we prescribed a diet which would favor tha livor.

These were roughly the conditicns at the begiming.

Some of the

serious cases showed gradual increase in peripheral white cell count

from about the end of April and the beginning of May; the patient who
showed a count of 1,500 began to return to normal. However, in sone

cases, although we tried puncturing the bone marrow at various spots,
the number of cells was szall and the nu-ber of peripheral white cells

was 3,000 or 4,000 at the most.

Dr. Koyama et al.)

(Seo Picure 35 in the monograph by

Soma of the potients at Tokyo University Hospital began to show
synptons of jaundice froa the beginning of May and soze of the patients
“at our hospital, from the <iddle of lay. Up +o now, seven patients at
the First Tokyo Naticnal Hospital and three patients at Tokyo Univer-

sity Hospital have definitely been jaundice cases.

Five or six pati~

ents had a lesser fora of jaundice, in which the eyes wore slightly
yellow. Exanination of the liver revealed that all of the mtionts
had dysfunctions at cng tice or another. The BSP test (30 minute value),
snowed that ell of thea patients suffered liver dysfimctinn of nore
then 10 poreent or in soze cases more than 20 percent, at some point.
Cue paticnt at the First Tokyo National Hospital still has jaundice;
the white cell count is low and the myslecyte cout is also low. This
janniice has recurred six tires to date end the patient has not been
cured since tha end of May. In the case of four other patients jaundice recurred tuleo or three tines. This is the rough swouary of the
conditions of disease and treatment.

Tho Progress of ir. .

Case

How let me discuss Mr. i
« The change inthe blood picture
in this case is shom in Figure 19 of the monograph by Koyama et al,

Tha white cell count was 1,900 at the minimra during the middle of
April. The myolocyte coumt wes 19,000 on 2 April and 9,000 on 15
April. Tho nuwver of thro-becytss remained betwoen 50,000 and 60,000
witil the middle of April.

The red cell count wes about 3 million, so

we gave a blood transfusion immediately, using blood from the First

Tokyo National Hospital blood bank. Eleven transfusions were given,
200 ce each, and dry blood plasma was given 51 times, 100 ca each time,

until the beginning of June.
before.

The use of antiblotices has been described

After this, the myslocytea count did not increase mich, but

the sora myolocytes, scarcely noticed earlier, began to appaar and the
nunbsr of poriphsral white cells rose to beticen 5,000 ar2 6,000 at the
end of I‘ay. The thrombocytes and red cells began to increases. However,
froa theriddle of May, ag gnerie cout of about 3 million was noted
again. The liver was swollen from the tims of hospitalization. The
BSP was 50 parcent in the latter part of June and definite symptoms

of jeundice appeardd a fow days thereafter. The Meulengracht index
was 60 carly in July, and the jaundice was nearly cured toward the

end of July when the Meulongracht index was 15, though it reached
30 around 29 July. Later, the jaundice was gradually clearing up and
the BSP was lower than 20 percent on 1 August. At that tine the patient

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