Since 1933, effects of the internal use of mineral waters in this district were studied by Prof. Dr. T. Misawa and his coworkers concerning gastric and bile secretion, gastrointestinal motility, diuresis, glucose metabolism, anemia and others.
In this report, present status of the internal use of mineral waters in this district, the results of studies on the therapeutic and toxic effects, maximum permissible concentrations of trace elements in the spring waters, several experimental and clinical studies on atherosclerosis etc. will be reported.
I. The present status of internal use of hot spring waters in Kanto district and its environs.
The research was carried out by enquête method. Answers were obtained from 40spa admimistrations. Following results were concluded:
1) In the majority of the spas the internal use of spring waters are uncommon, only at 3 spas (Spas Shima, Kuronagi, Shibu) the internal use is more frequently carried on than the bathing cure.
2) The majority of the visitors take hot spring waters 2 times a day (morning and evening), ca. 100ml at a time, in total usually 5 go (900ml-1000ml), maximum 1.5 sho (2700ml), a day.
3) The majority of patients utilizing the drinking cure are suffering from gastro-intestinal diseases, and rarely from other diseases.
4) For the gastrointestinal disease, sodium chloride waters, sulfur waters and alkaline waters are used mostly and for the constipation hydrogen sulfide waters, sodium bicarbonated waters and sulfated waters were used.
II. Statistical observation on the spa treatment in Shiohara Hot Springs, Tochigi Pref. 1) The patients had predominantly gastrointestinal disorders in Motoyu (pH 6.3, hydrogen sulfide containing sodium bicarbonate and chloride spring).
In Motoyu, the patients with drinking cure suffered from stomach ulcer (15/41), chronic gastritis, duodenal ulcer and gastroptosis with atonia. It seems that they select a spring according to their empirical evaluations.
2) About 87% of the visitors put in practice of drinking of hot spring water in Motoyu. Most visitors take thermal bath 5 to 6 times a day on an average, and drink spring water at the time of bathing, in total 4-6 go (720-1080ml) a day in 18/41 cases, 9-10 go (1620-1800ml) in 12/41 cases.
3) Liver function of patients (B. S. P. test and Gros test) was investigated before and after the cure, but no significant change was observed.
III. Effects of trace elements.
1) Effects of the addition of Cu and/or vitamine C on the absorption of iron in mineral waters from the digestive tract were studied using the radioactive iron experimentally.
Iron absorption from the digestive tract was promoted by the addition of copper, and vitamin C in the test solution. No promoting effect was proved by the addition of copper in the ratio of Fe:Cu=1:1, but it proved most effective with the ratio of
Fe:Cu=2.6:1
2) Maximum permissible amount of Pb, Zn and Cu contained in mineral waters were studied in rabbits experimentally. It was concluded that the maximum permissible dose of orally given Pb, Zn and Cu were between 7.5mg, 20mg or 1.9mg per kg body weight daily by administration for a month, respectively.
This concentration of lead is 100 times higher than that of mineral waters with highest lead content in Japan. And as mineral waters with high zinc or copper content in Japan used to be strongly acid and mostly belong to acid vitriol or acid alum vitriol springs, only daily 10-50ml can be taken after 5-10 times diluted with common water for drinking cure.
The highest record of zinc content in Japan is 965mg/kg ZnSO₄ (Sasakura Hot Spring), therefore there would be no probability of Zn poisoning from drinking cure of mineral waters in Japan, and when taken 25ml of copper containing mineral water daily the maximuan permissible concentration of copper containing waters will be 75mg/kg. Only few of the Japanese mineral waters contain more than

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A few attempts were made to study the effect of Tamagawa hot spring bathing upon the capillary resistance in healthy subjects and patients with hypertension, rheumatoid arthritis and fibrositis.
The results may be summarized as follows:
1) The capillary resistance decreased more significantly in patients with hypertension and rheumatoid arthritis than in healthy persons, but there was no difference in capillary resistance between healthy persons and patients with fibrositis.
2) Similarly, single bathing showed a decrease in capillary resistance both in healthy subjects and patients immediately after bathing, but tended to return gradually to the pre-bathing value about 1 hour later.
3) Successive bathing clearly increased capillary resistance in patients with hypertension in whom the decrease of capillary resistance was apparent. Such tend was also observed in patients with rheumatoid arthritis. The variation in capillary resistance in them brought forth by single bathing gradually grew smaller in degree with progress of successive bathing and showed a tendency to be similar to that in healthy subjects.
No significant variation was observed in capillary resistance in healthy persons and patients with fibrositis.
4) It can be said from the results mentioned above that balneotherapy is very effective for the treatment of rheumatoid arthritis and hypertension.

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The results of our general and medical surveys are summarized as follows:
1) The visitors to this spa are inhabitants of Yamagata prefecture, farmers being the largest in number.
2) Considering the fact that more than half the number of spa visitors come here with therapeutic or convalescing purpose, this spa may be said to be a spa to which visitors come with the sole object of curative treatment.
3) Visitors came for the treatment of common cold, hypertension, neuralgia and diseases of the stomach and intestines respetively from the frequency of diseases. The fact that the visitors with cold were largest in number was probably because of the prevalence of common cold at the time of our survey.
4) Half the number of spa visitors stayed for about 2 weeks, and most of them took bath four to five times a day for curative treatment.
5) 40.1% spa visitors drank hot spring water for curative treatment. Which incidence is higher than that in our previous reports for other Tohoku Area.
6) Only 6.1% of the visitors came to the spa under doctor's direction. Those who noted the bathing reaction: anorexia, feeling of weakness etc., were 23.1%
7) In the tubeless gastric analysis (Gastrotest) scarcely any change was observable for successive drinking of hot spring water.
8) In most cases the oral temperature measured at the time of bathing in this spa never returned to the value before bathing for two hours and the feeling of warmth remained for a long time. This is probably due to the chemical properties of the spring waters and proper treatment after bathing.

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Atempts have been made to study the effects of single and successive bathing upon the metabolism of vitamin B₁ in rheumatoid arthritis patients, by using the Bunin-no-yu (muriated saline spring) of Narugo Spa, Miyagi Prefecture, and the peloid (chief ingredient, SiO₂, Al₂O₃, etc.) of Goshogake Spa, Akita Prefecture.
The results may be summarized as follows:
1. Blood level and urinary excretion of vitamin B₁ in 24 hours in rheumatoid arthritis patients were significantly lower than healthy subjects. This may suggest that the secondary vitamin B₁ defficiency due to the decrease of vitamin B₁ utilization is caused by the various kinds of internal factors. In fibrositis, the patients' level was close to that of healthy subjects.
2. The results were also obtained by observing the effects of hot-spring bathing upon blood level and urinary excretion of vitamin B₁ in rheumatoid arthritis patients.
1) Immediately after hot-spring bathing, the blood level of vitamin B₁ was decreased in healthy subjects, but thereafter it was increased and showed a tendency to return to the former level in 60 to 90 minutes; it had little variation and individual difference. In fibrositis patients, the variation was about the same as that of healthy subjects but it was fairly unstable. In rheumatoid arthritis patients, it showed significant variation and remarkable individual difference, and it had no diffenite tendency. These were the same as in Bunin-no-yu and the peloid bathing. This meant that hot spring bathing acted as the unspecific stimuli to which rheumatoid arthritis patients showed a very unstable reaction in vitamin B₁ metabolism. This suggested unstable status of autonomic nervous system in rheumatoid arthritis patients.
2) In the vitamin B₁ tolerance test, rheumatoid arthritis patients showed the type II or the mixed type in Inoue's classification.
A suggestion might be made that the secondary vitamin B₁ defficiency was caused by the disturbance of vitamin B₁ metabolism due to anemia, dysproteinemia, disturbance of liver function and adrenocortical insufficiency.
The observation of the effects of single bathing upon the vitamin B₁ tolerance test showed that the tolerated vitamin B₁ was augmented to be absorbed but that the vitamin B₁ metabolism was not improved: the temporary disturbance of vitamin B₁ utilization was observed.
3. The observation of the effects of successive bathing led to the followings:
1) In successive bathing, the blood level of total vitamin B₁ and co-carboxylase were both likely to increase, especially in a low blood level group, and the metabolism of vitamin B₁ was improved.
2) Both the effects of single bathing and individual differances became smaller in successive bathing, showing a tendency almost the same as that of healthy subjects.
This might suggest that the unstable status of autonomic nervous system observed before bathing was gradually controlled by successive bathing.
3) The vitamin B₁ tolerance test in rheumatoid arthritis patients tended to come nearer to the normal type by successive bathing and it was seen that the vitamin B₁ utilizing ability could be accelerated and vitamin B₁ metabolism could be improved.
4. The experimental results mentioned above suggest that successive bathing had an effective influence on the disturbance of vitamin B₁ metabolism in rheumatoid arthritis patients, and especially accelerating the ability of vitamin B₁ utilization.
5. It is difficult to reach a conclusion on the mechanism of the effects of hot spring bathing upon the metabolism of vitamin B₁, but studies made by the author as well as a series of studies made in the laboratory of which the author is

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1) The majority of the visitors are farmers in Tochigi Prefecture. Men and women are equally distributed.
2) About 92% of the visitors come to cure diseases or for reconvalesence.
The diseaes from which they suffer are predominantly gastrointestinal disorders in Motoyu (68%) and neuralgia or rheumatic diseases in Arayu (70%) and in Oami (50%). It seems that they select a spring according to their empirical evaluations.
3) About 79% of the visitors stay at the Spa for from one to two weeks, and most visitors come to the Spa two to five times, and take bath five to six times a day on an average.
4) About 87% of the visitors put in practice of drinking of hot spring water in Motoyu, but only 10% of the visitors in Oami and Arayu drink spring waters.
5) The majority of visitors come to the Spa according to their own experience or recommendation of others, and only 3.6% have consulted doctors for the indicatiou in hot spring bathing before coming to the Spa.
6) The practice of the Spa treatment in Shiobara brought improvement of symptoms in about 69%, and occurence of thermal crisis proved in about 26% of the visitors.
In abdition it must be noted that these data are the results of the Spa treatment without any doctors' instruction, so that more beneficial effect will be obtained by proper instruction of the doctors.

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