In a group consisting of 40 patients with gastrointestinal psychosomatic diseases, a new balneotreatment including various psychotherapies was instituted at the Sukawa Spa, in two phases, one in 1965 and the other in 1966, and the results of the new treatment was compared with the results obtained from the control group which was consisted of 36 patients with same diseases. The rate of the cure at the terminal stage of the treatment was found to be 85% and at the 6 month period 90%. The new treatment was thus confirmed to be exceedingly effective in the control of gastrointestinal psychosomatic diseases.

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Both in the West and the East, heat has been used to appease aches and pains from time-honored experiences, and scientific evidences of thermotherapy has been accumulated and systematized. Thermotherapy is one of the indispensable managements of physical therapy, which consists of the main prop for rehabilitation program, and hydrotherapy also has an important position in the rehabilitation for patients with chronic ailments.
Temperature, buoyancy, hydropressure, chemical compositions and so on of the mineral waters act on the sick body as compound stimuli so that the disturbed functions of patients with chronic disorders are regulated. Balneotherapy is the specific treatment process at spa designed to help physically and functionally handicapped individuals make maximal use of residual capacities.
The author stated in this symposium the therapeutic effects centered mainly in physical side of hot spring bathing in view of experimental results and the clinical experiences at Misasa Spa (radio-active hot springs).
In conclusion, the author has thought that balneotherapy is the one to be indicated for rehabilitation program.

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Biological effects of the hot-spring waters are considerd to be a sum effect resulting from the constituents of spring waters which act under either competitive or cooperative relationship between each ion, thus effect of one or two constitutents being not definitely attributable.
Entrance of these constituents into the body occurs as well by bathing or inhalation as by drinking the hot-spring waters. This has been known for a long time as for the gaseous substances. Isotope technique revealed that many minerals enter as well.
It is not feasible, however, to show biological effects of these incoming substances, because some of these substances are abundantly existing in the body originally. In addition, resulting effects may be altered by the autonomic nervous function or endocrine function which may be simultaneously activated by application of hot-spring waters.
On the other hand, some metallic substances such as Zn or Cu in spring water existing in a slight amount are considered to show a detectable effects, because, in general, the amounts of them are slight in the body and the biological effects are significant, some of them being known to act as co-enzyme.
Percutaneous absorption of radio-active Zn, added to a hot-spring water, was studied on mice and it was found that Zn behaves like other cation.
After single bathing, however, the amount absorbed was not allways dependent on pH of spring waters.
Regardless of what kinds of spring waters were used, the entered Zn was found in a higher concentration in the prostate, pancreas, adrenal gland and blood. This may show that Zn is apt to accumulate in these organs where a larger amount of Zn is originally contained and turn-over rate of the substance is rapid.
It may be resonable to assume that an existence of large amount of a substance in a certain organ or tissue is responsible for its function.
Absorbed metallic substances which accumulate in a particular organ, even in a slight amount, may exert an activating effect on the function of the organ.
Though biological activities of some substances have been studied by eliminating the substances from diet, the activating threshold of substances contained in spring waters are entirely unknown.
An attempt was made to elucidate the effects of a substance added to the hot-spring water of which chemical components and biological effects are well known. Inorganic compounds of Zn, Cu, Co, Fe, Mn and Mg were thus investigated. Various amounts of the substances were tested up to the maximum amount which had been ever estimated in any spring water in Japan. Groups of volunteers unaccustomed to hot-spring bathing were subjected to bathing in thus treated Onken hot-spring water and resulted effects were observed.
The results obtained on Zn showed that optimal corticoids-effect was expected when Zn was added in an amount of 100mcg/kg, When 300-5, 000mcg/kg of Zn was added, a moderate hypoglycemic effect ensued.
Addition of Cu ion in an amount of some mg/kg of the spring water resulted in the corticoids-effect. A limited amount of nearby 500mcg/kg of Cu was presented for lowering the blood sugar levels and activating the hematopoesis.

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To treat patients with thermals, it is necessary to know the climatotherapeutical effects of the resort. But in Japan according to my investigation this time, there are only 6 hot-spring sanatoriums or institutes, which make meteorological observation among 15 institutions. And 5 institutes use meteorological data to the treatment or researches.
Now this cause was investigated and the reasons will be presented.
(1). Meteorological data of 37 weather stations in Japan were studied. Data for max. and min, air temperature, daily change ef temperature, relative humidity and wind velocity were quoted from the Monthly Report of the Japan Weather Bureau.
To exclude the climatic differences caused by different air masses, 15 days were picked out in which one airmass overlies all over Japan (“H” type according to my classification, that is high atmospheric pressure type) between Sept. 1966 to March 1967.
Results:
A. Northern parts are colder than southerns. At the high grounds it is colder than the others.
B. The daily change of air temperature is big in the interiors and small at seasides or islands, as learnt from the text-book. But some places in the heights show small daily change in air temperature.
C. The relative humidity is high at seasides or islands. But the heights have not always low relative humidity, contrary to our expectations.
D. The wind velocity is big at capes and islands but some heights show small wind velocity contrary to our expectations.
From these results it is noticed that some places show unexpected climatic characters. Therefore meteorological observations must be carried out ourselves about our resorts at first.
(2). In Sept. 1966 daily air temperature at the Yokohama weather station was compared with those at the place ca. 1km. apart from the station.
Both temperatures agreed with each other generally but in some days there were a little differences between them.
(3). The use of air conditioning has been spread all over Japan today. Therefore the dry bulb and wet bulb temperature were compared in a room and out of the door on 21 March 1967, from 6 am. to 12 pm.
From this investigation it was noticed that there were distinct differences between them.
Conclusions:
Our knowledges about climatic characters of highlands, seasides or islands and inlands can not be applied without caution.
There are some differences between the actual conditions and the knowledges which are learnt from the text book.
Attention must be paid to local enviroments furthermore. And it is better not to use the data of the near-by weather station, because there may be some differences. Therefore meteorological observations must be done ourselves about our resorts.
More attention must be paid to the environment inside a room, because the air conditioning is used widely today.
But the climatotherapeutical effects of many resorts are not yet known in Japan today, and climatotherapeutical researches about the environment inside a room are scarcely done.
By reason of this, climatotherapy is not used in practice widely in Japan.

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Haemodynamic effects of warm bathing were studied on subjects with cardiovascular diseases, and the results were applied for setting up a reasonable standard of warm bathing for these patients.
Subjects: 20 normal cases, 32 cases of essential hypertension with no ischemic changes in ECG, 9 cases of coronary sclerosis including 4 cases of old infarction and 9 cases of acquired valvuar diseases were selected for investigation.
Methods: Fresh-water and a salt water (Atami Spa) bathing with different temperature (38°C to 42°C) and time 3min. to 8mim. were adopted. Heart rate, respiration rate, blood pressure, ECG, PDG and A-VCG (acceleration vibrocardiography) before and after bathing were compared.
Results:
1. No remarkable difference of haemodynamic effects was observed between fresh and salt water bathing.
2. In hypertensive patients, blood pressure tended to decrease during bathing and increase after bathing. This tendency was exaggerated when room temperature being below 20°C. Passive bathing (Hubbard's tank) caused decrease of pressure during and after bathing irrespective of room and bathing temperature.
3. No remarkable change was observed in ECG, except several cases showing a sporadic ventricular extrasystole, and a case of coronary sclerosis showing a moderate ST depression after bathing.
4. In one of 4 patients with mitral stenosis, bathing caused an accentuation of the first and second heart sounds with increase of Q-I-II-OS, and a rise in left atrial pressure was suggested.
5, In normal subjects, A/S and V/S ratios of A-VCG were decreased or remained unchanged after bathing. In cases with hypertension and coronary sclerosis, relatively hot (42°C) and long (over 5min.) bathing occasionally caused a increase of A/S and V/S. This was considered to indicate a temporary pressure rise in the left atrium, and suggest a manifestation of transient left heart failure.
Summary and Conclusion:
It was concluded from our results that warm bathing of 41°C within 5min. may be indicated without undesirable overloads to the patients with hypertension, coronary sclerosis and acquired valvular diseases. A-VCG was regarded as a most simple and reliable examination for assessment of transient haemodynamic change after bathing when combined with blood pressure measurment and recording of ECG.

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Foreword:
From olden times Japan has had in various places the so-called “hot springs for apoplexy, ” which even now as ever are well frequented by hemiplegic patients seeking anxiously for their cure. In addition to it, after World War II the American idea of rehabilitation for invalids has come to prevail that Japan now shows an increasing interest in promoting such institutions, in which are treated various chronic diseases and dysfunctions through injuries and especially the cerebrovascular stroke, which really imposes a very high morbidity upon our nation. And as such kinds of institutions in Japan are mostly, as they are, established in an intimate connection with the respective local spring resorts, it is rather imperative for hemiplegic rehabilitation to be studied from the balneological point of view, and we hope our present report of experimental study about the balneotherapeutics' role in the treatment of cerebrovascular disorders can be one contribution to this field of medicine.
I. Fact-finding Survey through Questionaires dispatched to the other various Balneotherapeutic Institutions
Survey were made through enquêtes sent back from thirty such hot spring institutions throughout Japan, enquiring about the results of rehabilitation of hemiplegic inpatients who were registered during January through December of 1966. Our summary findings are:
1) 30.6% of the in-patients in the internal section of the balneotherapeutic institutions were the hemiplegics, whose total number being ca, 3, 000, and of whom the ratio of the male was 77% against the female 23%.
2) According to the one-year records of their hospitalization, 42 of 2669 (or 1.6%) had a relapse or some other troubles, including 14 deaths, 28 survivals, thus showing a very low rate in relapsing and mortality.
3) All the institutions on our list applied to the patients their local thermal minerals, whose diversity of mineral water nature covers simple thermals, and mostly salt springs, being followed by the minerals of hydrogen sulfide as well as sulfur springs. Their principal application was for bathing, but sometimes it was administered for internal use and also some peloid found, though less frequently, its external application.
The temperature ranged from 37° to 42°C., but dominant was such a tepid water as of 39°C., in which they bathed once or twice a day.
The third day after the stroke was the earliest application; most of the patients, however, visited the institutions not later than one month.
II. Experiments at Noboribetsu Spa
Some hemiplegic patients were experimentally treated in salt springs of Noboribetsu Spa.
1) The first one month of hospitalization showed 54% improvements in their ADL (Activity of Daily Living), followed, however, by no further remarkable result.
2) There was a gain in their grasping power in the second month of bath treatment.
3) The blood pressure was seen to decrease at their early admission, and so it was with both the systolic and diastolic pressures, nevertheless with no outstanding change later on.
4) With the serum cholesterol, there was seen no particular change soon after their admission, but its average in the third month showed a slight decrease.
5) As for the normal electrocardiographical investigation during their hospitalization, the patients had each their E. C. G. checked more than two times at least and revealed a favorable normalization of their otherwise more or less abnormal P-Q interval, S-T segment as well as T wave; besides the disappearance of extrasystole, when it had existed.

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In the rehabilitation of the patients with rheumatoid arthritis, beneficence of the hot-spring cure has been well established.
Under-water exercise in the hot-spring water produces both physical and chemical effects favorable for treating the patients. An attention should be paid, however, as for the dosis of the remedies; spring waters indifferent in temperature, moderate in biological effects (simple thermals, simple hydrogen sulphide springs) are preferable.
When acute stage symptoms of the disease subsided, spring waters of irritable natures either in chemical compositions (sulphur, sulphurated acid, saline etc) and temperatures (41°-42°C) can be successfully employed. Physical exercise is better to be avoided in this occasion, merely the biological effects of spring waters being expected.
Indication of the hot-spring cure in the rehabilitation program of the disease can be well guided by body temperature and subjective complaints of the patients such as weakness, not depending on CRP., blood sedimentation rate, stages or classes of the disesase.
During the hot-spring cure no significant side-effects were seen but the so-called bath-reaction in 20 of the 82 cases such as mild fatigue and dullness were seen mainly at the beginning but soon subsided after several days without cessation.

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The authors performed a survey of the treatment of fracture and the prognosis and described about the importance of rehabilitation for improving the result of treatment of fracture.
Eight hundred and forty-six cases of fractures (included 324 cases of open fracture and 181 cases of pseudoarthrosis) were observed in this report. The main point of treatment of fracture is to avoid the sequels and to reduce a period of therapy.
The systematic treatment fo fracture should include a detailed plan of treatment a proper therapy and an appropriate after-treatment with the concept of rehabilitation. Namely, it has to keep a principle of treatment of fracture and needs to carry out autokinesis, the subject of after-treatment, constructively.
In 233 cases of fractures 17% of them showed dysfunction after treatment and the average period of admission was 4 months. At this point the authors realized an impostance of rehabilitation in cure of fracture.
On the after-treatment of fracture patients enforced to do isotonic muscular contraction and cross-education even in the time of fixation.
After removal of fixation, they received physical therapy, such as supported active movement, autokinesis and duplicated motion (or movement against resistance.) The hydrotherapy was more effective in the early muscular training.

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1) Of 3887 patients hospitalized in our surgical clinic during about 20 years from 1946 to 1966, 43% were patients with abdominal surgery, 20% with neuralgia or rheumatoid arthritis, 9.8% with injuries of four extremities, 9.6% with malignant diseases, and 5.8% with postoperative disturbances.
2) It was concluded by our clinical investigations and laboratory findings that postoperative early ambulation (walk from 3rd. postoperative day) with early thermal bathing (40-42°C, 5 minutes bath from 7th postoperative day) in about 520 patients with gastrectomy or cholecystectomy promoted their postoperative recovery. But it was noted that postoperative recovery with malignant was not always promoted by early ambulation with early bathing and so care must be taken of such postoperative patient.
3) Recently patients with postoperative disturbances have been gradually increasing in our clinic. Of 99 patients with postlaparotomy disorders, 78 of them were postoperative intestinal adhesion. 38 of which were not re-operated and were treated by hydrotherapy that diminished their complaints from 100% to 37.7% after average 48 day therapy.
4) 328 patients with lumbago and sciatica were treated combined with balneotherapy. Of 28 patients with lumbal disc hernia, 53.6%, healed, 46.4% were markedly improved after two month therapy. But, of 21 patients with postlaminectomy or postmyelogram disturbances, only 23.8% healed, 57.1% were improved and 19% were unchanged after two month therapy.
5) 380 patients with rheumatoid arthritis were treated by balneotherapy combined with intraarticular corticosteroid injection. When local improvement by these treatments was little, these patients were treated by means of such procedures as intraarticular pumping and washing, curettage of synovial membrane and fenesteration or partial synovectomy. Balneotherapy markedly improved operated joint function. R. A. patients were permitted to take thermal bathing 6-12 hours after intraarticular corticosteroid injection and there were no articular infection by bathing.

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