As a part of systematic studies at the author's institute on the effect of gradually warming partial bathing (Sugiyama) upon functions of the circulatory system, the response of blood pressure, phonocardiogram, electrocardiogram and digital plethysmogram to this bathing was compared with their response to whole-body steam bathing. The results are as follows.
1) In whole-body steam bathg a sharp, transient rise followed by a rapid fall in blood pressure was commonly observed both during and after completion of bathing. Such a change was particularly remarkable in cases with hypertension, and in these instances blood pressure resumed the pre-bathing hypertensive level in a comparatively short time after bathing. In gradually warming partial bathing, on the other hand, blood pressure fell gradually and mildly without showing an initial rise, ahd maintained a lowered level for a fairly long time. These and previous experimental results indicate that bathing has influence on blood pressure in the ascending order of severity of gradually warming partial bathing, long bathing in lukewarm carbon-dioxated water, hightemperature whole-body bathing of conventional mode and whole-body steam bathing.
2) The effect of gradually warming partial bathing on intracardial hemodynamics, as revealed by phono-electrocardiography, was apparently more gradual and milder in contrast with that of whole-body steam bathing: in the former case the load on the auriculo-ventricular and the semilunar valves varied less abruptly and less vigorously, and the cardiac output increased more gradually.
3) The intracardial hemodynamic effect of gradually warming partial bathing tended to be alleviated during repeated treatments with this bathing. Particularly in patients with hypertension who initally had responded to the bathing with rather prominent changes in phono-electrocardiogram, the changes became less remarkable as the treatment progressed and eventually approximated to those of normotensive subjects.
4) Plethysmographic observation disclosed that the response of peripheral vessels to bathing, i. e. a decrease in vascular tone resulting in an increase in peripheral blood flow, was gradual, moderate and long-durating in the case of gradually warming partial bathing, whereas this was rapid, intensive and short-durating in whole-body steam bathihg.
5) Such an effect of bathing on peripheral hemoynamics also tended to become less intensive during repeated treatments with gradually warming partial bathing. This was particularly true in hypertensive patients, with progress of the treatment the plethysmographic changes in bathing gradually resembling those of normotensive subjects.

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Seven patients with hemiplegia due to cerebral apoplexy and 5 subjects without any sign of cardiovascular abnormalities (as the contol cases) were used in this study. Systemic blood pressure by sphygmomanometer, digital blood pressure and digital blood flow by digital plethysmograph were recorded and the peripheral vascular resistance was calculated from the values. The extensibility of arterial wall was calculated from transmission time of the pulse wave and length of the vessel. The effect of bathing therapy in hot spring water (sodium sulphate spring; bathing temperature ranging from 41-43C; bathing duration ad libitum) on the peripheral vascular hemodynamics was examined.
1. Effects of single bathing
In patients with hemiplegia, systolic blood pressure decreased 40mm Hg in the paralyzed, but slightly in the unparalyzed side, and also the decrease of digital blood pressure was greater in the former than in the latter. Digital blood flow increased and the peripheral vascular resistance decreased in both sides, and the rate of change was much greater in the paralyzed than in the unparalyzed side, respectively.
In the control cases, the changes were fairly comparable to those in the unparalyzed side of the patients except the extensibility of the arterial wall which was manifest in both sides of the patients but only scarce in the control subjects.
2. Effects of repeated bathing
In patients with hemiplegia who had taken the bathing therapy for 30-90 days, the digital blood flow increased and the paripheral vascular resistance decreased but without noticeable differences between the paralyzed and the unparalyzed side, and the size of the increase or the decrease was almost equal to that in the control subjects. Increase in the extensibility of arterial wall was found more in the patients than in the controls. In general the effects of repeated bathing were less distinguished than those of single bathing.

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It has been reported that urinary urate excretion was increased by the spa treatment of gout. While it is generally accepted that mineral water constituents are absorbed through balneotherapy, not only by oral intake but also percutaneausly.
Two modes of hypouricemic action may be considered in the spa treatment: one is the promotion of urinary urate excretion, and the other is the suppression of urate formation.
The influence upon the purine metabolism was studied using Ikaho (iron containing calcium sulphate spring), Kusatsu (H₂S containing acid alum vitriol spring), Atami (weak common salt spring), Itoh (simple thermal), Shimobe (simple thermal), Masutomi (radioactive spring), & Otari (alkaline spring) waters, and the following results were obtained.
(I) In vitro experiments, xanthine oxidase activity was suppressed by Kusatsu, but it was accelerated by Atami, Ikaho and Masutomi.
No effect was shown by Itoh, Shimobe and Otari.
Uricase activity was suppressed markedly by Kusatsu, slightly suppressed by Atami, Ikaho, and Otari, but was not influenced by Itho, Shimobe and Masutomi.
(II) Xanthine oxidase activity and uricolytic activity were examined in the liver of rats after bathing for 15 minutes at 40°C and/or after administration of allopurinol, uric acid and alcohol.
The xanthine oxidase activity was decreased by bathing in Kusatsu thermal water and/or administration of allopurinol, but it was enhanced by plain water bathing while it was not changed by Ikaho and Atami thermal water bathing.
The uricolytic activity was decreased by the loading of uric acid and the administration of ethyl alcohol, enhanced by plain water bathing, and not changed by the bathing in Kusatsu, Ikaho, and Atami thermal waters.
(III) The purine metabolism was investigated in human subjects by the determination of urate and oxypurine in plasma and urine after oral administration of the mineral waters for three successive days.
By drinking of Kusatsu thermal water plasma urate and oxypurine levels were lowered and urinary excretions were increased.
By drinking of Ikaho a minor elevation of plasma urate and oxypurine levels were observed, but no changes were found in urinary excretion of these purines.
By drinking of Atami thermal water the plasma urate levels were lowered, but no definite trend was found in the plasma oxypurine levels.
Urinary oxypurine excretion was increased but orate excretion remained unchanged.

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