From June 1990 to October 1998, 100 patients with adult-type atopic dermatitis (59 males and 41 females, 25±8 years) were admitted to our hospital to receive balneotherapy using Kusatsu hot-spring water. The atopic dermatitis in all but 9 cases occurred while the patients were still under 20 and had been refractory to various treatments including steroid ointment therapy over a long period of time. The patients took a 10-minute 40-42°C hot-spring bath followed by immediate application of white petrolatum 1-2 times daily for 75±46 days. The main components of the hot-spring water are aluminium, sulphates and chlorides, and its pH is 2.0. The skin symptoms of 79 of 100 cases (79%) were improved through the balneotherapy and furthermore pruritus was improved in 55 of the 79 cases (70%). The improvement of skin manifestations was supported by a significant decrease in serum LDH levels. In contrast, pruritus was not improved in the remaining 21 cases who showed no changes in skin symptoms and serum LDH levels. Moreover, changes in the number of Staphylococcus aureus on the skin surface were examined before and after balneotherapy. In the 69 cases examined whose skin symptoms were improved, many Staphylococci aureus were detected in 52 of the cases but not in the other 17 cases before starting balneotherapy. They disappeared in 24 cases and decreased in 18 cases of the 52 cases, but were not changed in the remaining 10 cases through the balneotherapy. On the other hand, the number of Staphylococcus aureus on the skin surface was not changed in 11 of the 14 cases examined whose skin symptoms were not improved. Our previous study reported that bactericidal activity against Staphylococcus aureus is expressed by the co-existence of manganese and iodide ions contained in the hot-spring water under an acidic (pH 2.0-3.0) condition. Thus, the mechanisms of the improvement of skin manifestations through the balneotherapy may be explained by considering bactericidal activity of Kusatsu hot-spring water against Staphylococcus aureus inducing acute flares of skin manifestations. Therefore, balneotherapy at Kusatsu can be useful for the treatment of refractory cases of adult-type atopic dermatitis as a suitable method of skin care.
Although it has 100 years since the massage techniques developed by John Harvey Kellogg, an American, were introduced to Japan, not much of them are known today. This paper clarifies the characteristics of his theory and techniques as a method of physical therapy so they can be applied to clinical practices. Our study mainly consists of the review of J. H. Kellogg's “The Art of Massage” (4thed. 1923). These massage techniques, a combination of massage techniques developed in Europe and osteopathy, an original idea developed in the United States, were systematized through his clinical experience at sanitariums over a period of 50 years or more. Always based on strict physiological principles, Kellogg cited three types of comprehensive effects: direct “Mechanical”, indirect “Reflex”, and general “Metabolic” effects. He advocates that external manipulations are effective for building strength in the whole body and activating living power because they not only influence deep tissues of the body by improving general circulation and reactions of the nervous system but also on the metabolic renewal processes of the various parts of the body. He emphasizes these phenomena as the sources of large therapeutic effects. Kellogg's massage techniques consist of seven types of basic manipulations (touch, stroking, friction, kneading, vibration, percussion, and joint movements), each of which is divided into several sub-types of manipulations, which are unique to Kellogg, according to his theory. To improve the usefulness of current medical massage therapy, it is essential to review these unique techniques and apply them to clinical practices.
One hundred and seven cases of sudden death in bathtubs, bath-death, were reviewed from the records of inquest by the Naruko Office of Miyagi Prefectural Police from 1984 to 1997. Eighty-four cases were of visitors staying at hot-spring hotels and 33 cases were of local residents. The number of cases of local residents increased by 1.8 times in the latter 7 years as compared with that of the first 7 years of the period investigated, probably because of aging of the population. The annual number of bath-death cases among visitors varied on a large cycle of over 10 years, seemingly in correlation with business conditions because it showed a strong correlation with the official discount rate. The average mortality rate of visitors was much higher than that of residents in the best business conditions and lowered to the same level as that of residents in the worst business conditions. One reason for such changes in mortality rate may be that while a majority of trips in the best business conditions were for pleasure, sometimes accompanying fatigue and stress of aged members including 85% or more of male, as business conditions became worse, the purposes of trips changed into recuperation and sightseeing. The number of bath-death cases among visitors increased every April and December, probably because of social customs such as new fiscal year parties, year-end parties, and so on. Bath-death cases occurred more frequently among those over 70 years, and were seen more at midnight, in winter, after drinking, at a bath temperature over 40 degree centigrade, and for a large temperature difference between the room and bath. Sixty-six percent of the bath-death cases were caused by cardiovascular diseases; 23%, by cerebrovascular events; and 11%, by other accidents.
La Roche Posay, a spa, is situated along the Creuse river and it is one of the fortresses of Rome. More than ten thousand skin disease patients from Paris and other cities visit here every year. Among those patients, 38% are women, 32% are men and 30% are children 6 month and older. As for the types of the skin diseases, eczema (inculding atopic dermatitis) accounts for 30% of total patients, psoriasis for 45%, acne for 7%, and rosacea for 4%. Other diseases inculd scar (from burn), bed-sores, ichthyosis, lichen planus, keratodermia palmo-plantaris, special prurigo, and stomato-dermatitis. Physico-chemical character of spring water is as follows: simple spring, 13°C, pH 7, evaporated residue 550mg, T. H. (Titre Hydrotimétrique ou Dureté) 38°, HCO3 370mg, oligo-éléments Se 45μg and Zn 10μg. The bathing treatments involve approximately 30 minutes in water temperature of 28-38°C, and amin colorings can be used for the treatment, in order to prevent infections. By using bottles with one liter or more, plenty of water is drunken as the drinking spring water. As for the hydrotherapy, la douche (la pulvérisation, la douche filiforme, la douche intense), athletic exercises in the water, massages and shiatsu are performed, depending on the type of the skin disease. Special medicine for external use which contains spring water are manufactured at pomade manufacturing plants within the area, and used. Those medicines do not inculde preservatives or perfume, and are not mixed with steroid or non-steroid medicines. As for the playing therapy and psycho-somatic therapy, La Roche Posay has an amusement park for children, an athletic field and a library. There are also organizations which deal with the planning of group therapy. Treatment cost is covered by health insurance. Honorarium to doctors and treatment cost at the thermes is paid immediately by health insurance, with a copayment of 30 to 50%. The staying cost can be paid as “prise en charge” by submitting receits and the travel expenses can be discounted by S. N. C. F. (National Railway Company in France). The spa therapy of skin diseases in France, generally, is carried out under protectionism, contrariwise, it, as a rule, is carried out under the policy of training, in Japan.