本研究では,伝統的な小療養温泉地に近代的温泉療養所が開設された長野県を例として,温泉集落の形成過程と機能・構造の変化を追求し,一般的には停滞または衰退してきている療養温泉が地域社会の発展に大きくプラスしたことを明らかにした.湯量の少ない共同湯を核に成立した閉鎖的外湯旅館集団は,新しい大量の温泉湧出に際しても,まず長野県厚生農業協同組合連合会の温泉療養所を誘致して療養温泉地としての充実を図ったが,このような地域の側の開発姿勢が療養温泉地発展の基本要因をなした.それに伴って,農民のための冬季集団保養が実施され,夏季には東京からの老齢湯治客が集中して入湯客の地域的季節配分が合理的になされるようになると,周辺農家の観光産業への転換が顕著となった.また丸子町当局は外来資本の進出を避けるために,温泉開発の主導権を握って温泉統合をなしとげ,ここに歓楽化を排除した療養温泉集落の機能が一層強められたのである.

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今日、グローバル化の影響のもと、多くの地域社会において、外発的な開発による急速な都市化が進展している。それとともに、地域アイデンティティの喪失・環境問題などが危惧されており、地域固有の地域資源の再発見・再認識に基づいた内発的発展が求められている。本研究の対象であるもそうした地域のひとつである。は、長野県小県郡丸子町の西内地区に位置する温泉町である。その歴史は約1200 年前にまで遡るといわれ、古くから湯治場として知られてきた。1956( 昭和31) 年に国民保養温泉地に指定され、それ以降は、周辺地域の農村医療を担った鹿教湯病院とともに大きく発展したが、今日では、生活様式の変容を主な要因として、当時の活力が失われつつあるのが現状である。本稿は、地域資源の再発見・再認識ならびに地域住民への意向調査に基づき、今後の当該地域の発展の方向性を導出することを目的としたものである。

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The effects of Kageyu Spring (simple thermal spring) on the blood pressure and some other circulatory factors of hypertensive patients were studied.
Results obtained are as follows:
1) During serial baths, once to three times a day for 2 to 4 weeks, there was gradual fall of blood pressure about 10per cent on an average.
2) Following the immersion of one hand to the wrist into ice water for one minute, vascular responses such as vasoconstriction checked by digital photoelectric plethysmography, fall of skin temperature and transient rise of blood pressure (cold pressor test) were examined.
During serial baths, these vascular responses showed gradual rise which reached its maximum in about 7 days, and they fell again gradually in the following 7 days.
Through the changes of vascular response the autonomic regulatory function may be brought to a more stabilized state and consequently the abnormally elevated blood pressure may be set at a lower level.
3) Changes of some circulatory factors during serial baths are as follows:
a) ECG findings, especially changes in ST segment and T wave, were improved in some cases, while they got worse in cases which showed marked fall of blood pressure by spa treatment.
b) Previously elevated cardiac output fell to normal level in about one to two weeks, while the previously lowered one showed a tendency to rise.
c) Renal blood flow increased in cases with normal ECG findings, while in cases with worse ECG it remained unchanged or decreased.
4) Factors on which the balneotherapeutic effects on blood pressure were dependent are as follows:
a) Cases with good vascular responses to cold stimulus excepting cold pressor test showed marked decrease in blood pressure, while cases with moderate cold pressor response showed the most marked fall in blood pressure.
b) Cases with significant arteriosclerotic or hypertensive changes of eyegrounds showed little change of blood pressure by bath treatment.
c) Cases with remarkable ECG changes, especially of ST and T, did not show any fall of blood pressure.

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Soaking one hand into a water bath at 6° or 42°C, reflective vasoconstriction occurred on the finger-tip on the other side was investigated with digital photoelectric plethysmography in 45 cases of healthy control, 10 cases of Buerger's disease, 6 cases of Raynaud's disease, and 58 cases of hypertension. And the influence of thermal baths on vascular reaction in hypertension was examined.
Results obtained were as follows:
1) An initial vasoconstriction was recognized both on 6°C and 42°C stimulation.
2) The time from the moment of the thermal stimulation till the minimum pulse amplitude in the initial constriction was described as ΔT. And ΔA was calculated by following formula:
ΔA=(Amplitude before stimulation-Minim. amplitude/Amplitude before stimulation)×100%
i) No correlation was observed between ΔA and ΔT in both warm or cold stimulation.
ii) No significant correlation was established between 6°C ΔA and 42°C ΔT.
iii) A significant correlation was proved between 6°C ΔA and 42°C ΔA.
3) In Buerger's disease a prolongation of 6°C ΔT was observed compared with that in healthy controls.
In Raynaud's disease prolongation of 6°C ΔT and reduction of 6°C ΔA were proved in comparison with the data in the healthy adults.
4) In hypertensive patients 6°C ΔA was proved smaller than that of the control and a significant correlation was shown between 6°C ΔA and fall of skin temperature on the finger tip of one side by soaking the other hand into 6°C water. Hardly recognized was a correlation between 6°C ΔA and results of cold presser test.
5) 6°C ΔA increased after warm bath. And by a series of daily thermal baths at the Kageyu Spa (simple thermal springs) hypertensive patients showed the most sensitive reaction concerning 6°C ΔA and 6°C ΔT about the end of the first week.
6) In hemiplegie patients, 6°C ΔA on the affected side was proved to be smaller than that on the healthy side, and after a thermal bath at the Kageyu Spa 6°C ΔA of the affected side increased more than that of the healthy side.
7) In hypertension, patients with larger ΔA showed more marked fall in blood pressure after a series of thermal baths than patients with smaller ΔA.

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At Kageyu, Nanasawa, and Kusatsu Spas, the author studied the balneological effects on lipoprotein, triglyceride, non-esterified fatty acids and fatty acid components in total lipids, cholesterol ester fraction, triglyceride fraction, non-esterified fatty acid fraction and phospholipid fraction in sera.
The results were as follows.:
(1) At Kageyu and Kusatu Spa, a single bath showed a quantitatively significant effect on non-esterified fatty acids but not on β-lipoprotein and triglyceride. An hour later after the bath, non-esterified fatty acids rose at maximum.
(2) Successive baths decreased β-lipoprotein at Kageyu, pre β-lipoprotein at Nanasawa but no significant change was observed in non-esterified fatty acids and triglyceride. A week after initiation of daily baths, value of β-lipoprotein and per cent of pre β-lipoprotein were lowered.
(3) Successive baths had no significant influence on fatty acids.

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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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