The results obtained from a medical survey of the spa treatment at Atsumi Spa in Yamagata Prefecture, and the effect of spa bathing on the blood pressure are reported. The results of our medical survey may be summarized as follows:
1) the greater number of spa visitors are inhabitants of Yamagata Prefecture, the majority being farmers. Most of them are young men and women about equal in number.
2) Atsumi Spa is mostly used as a place for recreation, and those seeking for curative treatment are no more than one-fourth of the spa visitors.
3) An examination of visitors for diseases reveals that neuralgia and rheumatism stand at the top of the list, and the larger number of visitors to this spa are healthy persons.
4) More than 80% of the visitors to this spa are those who have been here before, but only 2.4% of them have ever consulted doctors for directions in the hot spring bathing before coming to this spa.
5) Although those who come to this spring for the purpose of curative treatment are few in number, many of them stay here for about two weeks.
6) About 60% of the spa visitors for curative treatment bath 4 to 5 times a day, and only 20% of them less than 4 times a day.
7) Considering the effect of this spa bathing on the blood pressure, further studies must be made on the manner of bathing in this spa.

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A general survey and the results of some medical investigations of the spa treatment made by the authors at Shirabutakayu and Shin-Shirabutakayu Spa may be summarized as follows:
A. Shirabutakayu Spa
1) A large number of spa visitors are inhabitants of Yamagata prefecture, the majority being those who are engaged in occupations other than agriculture in the city and suburbs of Yonezawa. Most of them are more than fifty years old.
2) More than half of the spa visitors come here for recreation or rest.
3) 35% of the visitors come for the express purpose of balneological therapy; of this number, each 30% are of those with neuralgia, with rheumatism and with digestive disease. About 23% of them complain of so-called “nobose” or hot fit, including high blood pressure, headache, singing in the ears, stiff shoulders, etc., for which this spa is said to have special therapeutic effect.
4) Most of the visitors stay for less than a week for balneological therapy.
5) Most of the visitors come here every year without specific direction of doctor, only 2.4% being in observance of such direction. They prefer to bathe in excess, but hardly any bathing reaction can be observed in them, only 14.8% being conscious of such reaction. It is probable a minute examination by a doctor will raise the percentage of those who are conscious of the reaction.
6) To examine the adrenal cortical function, Thorn's test was performed on newcomers before and after the 7-day spa bathing. The result shows that those in whom the adrenal cortical function proved decreased before bathing revealed a tendency to return to the normal function after bathing.
7) Successive hot-spring bathing gave a fairly high curative coefficient in experiments with rabbits artificially wounded.
B. Shin-Shirabutakayu Spa
The hot-spring bathing is effective in many cases of burn, incised wound or neuralgia. This primitive balneological treatment practised for several centuries is often more effective than medical treatment because of peculiar character of germ-free and analgetic hot-spring and of the fresh prevalent air in this retired spot.

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Influences of ultraviolet irradiation were studied, using a fluorescent sunlamp which emits a continuous spectrum ranging from 2800 to 3900Å similar to the ultraviolet rays in natural sunlight, and the results were compared with the effects of a quartz mercury vapour lamp which has maximum radient energy at 2537Å.
1) Guinea pigs were divided into 6 groups, each consisting of about 10 animals. The animals were inoculated subcutaneously with 0.01mg KH₁ strain three weeks before the irradiation.
Fifteen (3×5cm)cm² of their back skin were depilated and irradiated by the sunlamp, daily 24, 48 and 144 E-viton cm^-2min. respectively in the three groups for 6 weeks.
Then the animals were sacrificed, plasma protein fractions, autopsy findings, and quantitative cultivation of tbc. bacilli from the lung and liver, were studied.
144 E-v. cm^-2m. group showed a marked improvement compared with 11 control animals without irradiation concerning macroscopic and microscopic findings at autopsy and plasma protein patterns.
Two groups were given daily 4mg of INH. per kg body weight for 6 weeks, of which one group was irradiated by sunlamp daily 48 E-v. cm^-2m. And the latter group showed a better results concerning protein patterns and autopsy findings.
Next five groups of guinea pigs were inoculated subcutaneously with 0, 01mg of KH₁ strain.
The first group of 9 animals, as cotrol without irradiation.
The second group of 10 animals was irradiated daily by quartz mercury vapour lamp, beginning with 120 E-v. cm^-2m. daily increasing to 600 E-V. cm^-2m., during 6 weeks.
The third group was irradiated by sunlamp for 6 weeks, in the same dosis as the second group.
The fourth and the fifth group were given 4mg/kg of INH., and the fifth group was irradiated with sunlamp, increasing to 400 E-v. cm^-2m. daily, and all animals were sacrificed after 6 weeks.
The second group (excessively irradiated quartz mercury vapour lamp group) showed an exacerbation in autopsy findings and plasma protein patterns.
The third group (excessively irradiated sunlamp group) had a similar findings as in the control group without irradiation.
The fifth group (INH.+400 E-v. cm^-2m. irradiated group) and the fourth group (INH. group) showed roughly equivalent pictures at autopsy.
Independent of autopsy findings, the 24-600 E-v. cm^-2m. groups gained a better increase in body weight.
2) With combination of chemotherapy, 42 pulmonary tuberculosis patients exposed to sunlamp irradiation twice weekly with a dosage of 48 E-v. cm^-2m. on their whole naked back for a period of 6 months, were compared with 42 patients administered almost same che-motherapy only.
Absolute and relative increase of lymphocytes in haemogram, and increases of albumin fraction and A/G ratio with corresponding decreases of α- and γ-globulin fractions were seen more apparently in the irradiation group, especially in exsudative and infiltrative caseous types.
Improvements were seen also in roentogenogram, smear and cultivation of sputum, erythrocyte sedimentation rate, and other clinical symtoms such as body weight and cough, by the irradiation especially in exsudative and infiltrative caseous types.
Conclusion was drawn that fluorescent sunlamp irradiation combined with chemotherapy may be applied for all types of pulmonary tuberculosis without risk of exacerbation.

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Of late many studies have been reported upon the permeability of the skin to sulfateions in spring waters.
Kusatsu Hot Springs (hydrogen sulfide-containing acid springs, pH at 1.5-1.7, SO₄ 1.1-3.2g/kg) have a peculiar way of bathing, that is, so-called “Jikan-yu” (or time-limit bath). Bathers take thermal bath under the command of a bath master at a high temperature of 43-48°C, 4 times a day, for 3 minutes. This custom has been known from old days, and is still today kept by some bathers, though day by day diminishing in number, as a home cure for chronic diseases. As a result of such spa treatment many of the bathers would come to suffer from an acid spring dermatitis in the axillary or genitofemoral regions. And increases in bactericidal activity of the blood, phagocytosis of leucogtes, PBI, urinary excretion of 17-KS and estrogen, etc. were proved.
To give a clue to solve the mechanism of these strongly stimulative actions of acid spring bath the author intended to investigate the percutaneons absorption and excretion of sulfate in the spring waters by using S³⁵-labeled sulfate.
I. Absorption of Sulfate through the Mouse Skin
After bathing in with S³⁵O₄ labeled spring waters under varing conditions, mice were killed and their skins were removed. The carcasses were ignited to ashes, dissolved in HCl and then precipitates were obtained by adding BaCl₂.
Radioactivity measurement of S³⁵ in each sample indicated that the longer the duration of bath and the higher the temperature of bath-water was, the more the amount of absorbed sulfate increased.
No significant difference was found, however, concerning the percutaneous absorption between the controls and the animals that had been bathed for three weeks in non-radioactive spring waters. It did not coincide with previously reported findings that the frequent baths had decreased the ionic absorption from bath-water. A presumptive explanation for it may he that a stimulative effect of acid spring might have produced some change in the skin through repeated bathing which might result in an increase of the percutaneous sulfate absorption. Indeed with animals which got burnt, sulfate absorption proved to increase remarkably. This fact suggests a probable increase in permeability of the impaired skin.
II. Excretion of Sulfate through the Rabbit Skin
Wet dressing soaked with bath-water in question was applied to the abdominal slain of each rabbit, to which an isotonic solution of S³⁵-labeled Na₂SO₄ was intravenousiy administered beforehand.
The percutaneous excretion of S³⁵ was confirmed. But it failed in this study to prove significant difference in sulfate excretion, if there be any, among soaking fluids such as fresh water, natural spring water, and H₂SO₄ solution (pH 1.7).
III. Absorption of Sulfate through the Human Skin
Test subjects, including both sexes, were divided into three groups according to the skin conditions, that is:
(A) Five persons with manifest acid spring dermatitis: flush, crosion and secretion in the genitofemoral or axillary regions.
(B) Three persons without recognizable dermatitis in spite of their repeated thermal hathings for one month or over.
(C) Three persons as control subjects, who had not bathed in the spring for some time before the experiment.
Every one of them was applied a wet dressing soaked with the labeled spring waters to the inflammatory part, or otherwise to the corresponding region during thirty to sixty minutes. Then, their 36 hour-urines were collected and radioactivity of the excreted S³⁵ was measured.
Elimination of S³⁵ in the urines from the dermatitis group was strikingly increased as compared with that from the control group—roughly one thousand times on the average.
The percutaneously absorbed SO₄

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In the previous paper the author reported that:
1) Serum cholinesterase activity of rheumatoid arthritis showed normalization after 3 weeks of daily thermal baths at 41°C for 10min. in the Spa Itoh.
2) An increase in amplitude or an inversion of type of changes in cholinesterase activity after a bath occured following thermal baths between 4. -14th day, and these changes were explained by the adaptation reaction against a stimulating effect of the Spa treatment.
3) Blood pressur showed also normalization after a series of thermal baths.
The present report describes the effects of thermal bathing and drinking of the hot spring water or electrolyte solutions of similar composition on hypercholesterolemia and atherosclerosis of rabbits fed cholesterol 0.1gr/kg daily), to study the influence of sulfate and silicate which are contained in the thermal water.
The results obtained were as follows:
1) Daily thermal bathing at 38°C for 20min., commenced simultaneously with cholesterol feeding, showed a remarkable suppressive effect on both hypercholesterolemia and atherosclerosis after 90 days, compared with tap water bathing and control without bath.
2) Daily thermal bathing in the aged thermal water (stored for a week) at 38°C for 20min. showed no suppressive effect on both hypercholesterolemia and atherosclerosis compared with control group after 75 days.
3) Internal administration of hot spring water (daily 10cc/kg) showed no difference against the tap water administration (daily 10cc/kg) after 75 days.
4) Daily baths in Na₂SO₄, solution (SO₄ 359mg/l as same as in Itoh hot spring) at 38°C for 20min. during 90 clays showed a slightly suppressive effect on both hypercholesterolemia and atherosclerosis compared with tap water control and control without bath.
5) Daily baths in Na₂SO₄+Na₂SiO₃ solution (SO₄ 359mg/l, Si 9.2mg/l as same as in Itoh spring) at 38°C for 20min. showed a slightly suppressive effect on both hypercholesterolemia and atherosclerosis, compared with control without bath, but the internal administration of silicate solution (Na₂SiO₃ 7.5mg/kg) for 60 days enhanced hypercholesterolemia and atherosclerosis compared with tap water administration and control without water administration.
With above-mentioned results, the author discussed the significance of sulfate and silicate, which are absorbed percutaneously while bathing or per os by drinking.

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Researches were made on the swelling of the thyroid gland among school children, 380 boys and 273 girls of a country village: Masutomi in Yamanashi Prefecture, where strongly radioactive springs issue, and further 3182 boys and 4547 girls in the control district: Namely Tadao Village near Tokyo, Tokyo City, Usuda Town in Nagano Prefecture, and Funabashi City in Chiba Prefecture. The thyroid enlargement was classified into 5 grades according to a modified Dieterle's method.
The investigation revealed that the children in the radioactive spring area have more enlarged thyroid gland than those in the other district.
The content of Radon in the ground waters of Masutomi Village ranged from 1.31×10^-10C/l to 103×10^-10C/l, 19.59×10^-10C/l in an average, but Radon content of the ground waters in the other district proved mostly less than 4×10^-10C/l. The thyroid function was investigated in 13 school children of Masutomi Village who showed thyroid swelling of Grade II-III.
(1) Examination of basal metabolic rate revealed in increase over 20% in 5 of 13 cases. The highest values recorded +24%.
The lowest being -5.8%, +11.8% on an average.
Eight cases showed normal values.
(2) P. B. I.: Eleven cases out of 13 cases showed higher values than 8γ/100ml. P. B. I. ranged from 7.5 to 12.6γ/100ml, 9.6γ/100ml on an average.
(3) Plasme I¹³¹ Conversion rate: Eight cases out of 13 cases showed higher values than 45%, and remaining 5 cases proved normal. The highest value being 65.5%, the lowest 15.5%, average 44.8%.
Therefore the above-mentioned enlargement of the thyroid gland in school-children living in radioactive spring district did not correspond to a hypofunction of the gland, hot it coincides rather with an increase in the thyroidal function.
Akisada measured iodine and calcium content in the ground waters of Masutomi, but neither deficiency of iodine nor excess of calcium were proved.
Seo and Akisada administered to rabbits daily 10ml per kg body weight of a radioactive water of Masutomi (Rn: 8363×10C/l) with stomach tube for 150 days.
They found a hyperplasia in the thyroid gland histologically but no pathological signs were found in the other organs.

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Effect of a saline bitter spring on the capillary formation in the granulation tissue was studied with small collodion pipes (length: 8mm, inner diameter: 1.5mm, wall thickness: 0.3-0.5mm) which were embeded into the abdominal subcutaneous tissues of 9-12 rats, four of them in each rat.
Rats were bathed in a saline spring water at 38°C for 10 minutes daily during 3 weeks since the 3rd day after collodion pipe embedding. The pipes of about one-third of the whole rats were taken out every week to study histologically.
Similar experiments were carried out with a series of baths in a control plain water, in an aged thermal water, or in a synthetic saline water, and also with intravenous injection of sodium chondroitin sulfate or heparin solution.
Following results were obtained:
1. Capillary formation of granulation tissue in the collodion pipes was increased by a series of thermal baths in the saline bitter water.
2. Cells of various kinds, such as histiocytes, mononucleares and fibroblasts were more abundantly observed in the granulation tissue grown in the pipes after a series of baths in the saline bitter spring as compared with the results with the control plain water baths.
3. Bloodways, which were surrounded by these cells and differentiated later partially into capillaries, were more frequently observed in the thermal water bathed rats than in the control groups which were bathed in plain water or aged thermal water.
4. Cicatrication of granulation tissue in the collodion pipes was considerably refreshed by bitter spring baths for 3 weeks. Namely scar tissues were filled vigorously with blood and their shrinking was seemingly delayed after a series of baths in the bitter spring as compared with the results with the control plain water bath group.
5. Many lymphocytes were observed in collodion pipes of rats, to which 0.1-0.15ml of 1% sodium chondroitin sulfate or 0.2% heparin solution was administered intravenously daily for 3 weeks, but capillary formation was not so much increased as in the collodion pipes of rats bathed in a saline bitter spring.
The similarities between the granulation tissues in the collodion pipes of the rats that were bathed in a synthetic saline bitter water and of the rats, to which were given intravenously sodium chondroitin sulfate or heparin solution, were mentioned referring to the action of sulfate ions in the connective tissues.

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Die meisten Lebenserscheinungen der im mit dem radioaktiven Sediment versetzten Nährboden kultivierten Bacillen sind mehr oder weniger beträchtlich herabgesetzt. Es kommenh äufig langfädige Formen ohne Teilungsfähigkeit in stäbchenförmige Bacillen vor. Sie persistieren nicht lange und gehen ohne Hinterlassen von Nachkömmlingen zugrunde.

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