The cold-induced vasodilation (CIVD) was measured of 30 male university students who were daily engaged in three or four kilometers running, a rubdown with a dry towel and sports activities (trained group), and of 20 male university students who were hardly doing any physical exercise (untrained group) . Measurements were made five times in spring, summer and autumn in 1976 and in winter and spring in 1977. The results were summarized below:
1. The mean skin temperature (MST) and the temperature at first rise (TFR) were higher and the time of temperature rise (TTR) was earlier in the trained than in the untrained. This trend of difference between the two groups was particularly remarkable in summer, autumn and winter. MST was high in summer and low in winter, and this seasonal variation of MST was in conformity with that of the previous reports. The variation of the index of MST, TFR and TTR well conformed with that of temperature before water immersion (TBI), supporting the reasonability of Nakamura et al's rating method.
2. The resistance index (RI) was higher in the trained after summer and was significant in winter and spring of the following year. The increase of RI in one year was as significant as 18% in the trained while it was only 2% in the untrained. The seasonal variation of RI showed a two-peak behavior, high in summer and winter and low in spring and autumn.
The above differences of CIVD scores between the trained and the untrained indicate that physical training is useful for resistivity against cold.

Comparative studies were carried out on methods for measuring and evaluating bodily flexibility using the data of measurements of toe touching and chest and leg raising (one of the so-called distance methods) and the ventro-dorsal motion range (degree) of the lumbar spine with Iino's spinometer (taken as one of the so-called angular methods) in 100 young male subjects. After reviewing the values of the distance method in relation to physique and statistical relations between the values of the angular method and the distance method, the following conclusions were obtained.
A. The values of measurement by the conventional distance method were correlative with physique values. The value of toe touching (TT) showed a significant correlation with body height, leg length and arm length. The value of chest and leg raising (CLR) showed a correlation with body height and leg length. These two values involve a risk that the assessment of flexibility may be influenced by physique.
B. Accordingly it is proposed that the following formula is reasonable for TT in order to eliminate the influence of physical factors.
(1-arm length-conventional toe touching value/body height) ×100
This may be called a toe touching index (TT Index) .
An index of CLR relative to body height is likewise proposed as follows.
Chest and leg raising index (CLR Index) =chest and leg raising value/body height×100
C. TT Index and CLR Index were not correlative with physique. The correlation of TT Index to CLR Index was higher than that of conventional TT value and CLR value
D. Regarding the correlation with the values for the maximal motion ranges (degree) of the lumbar spine, these two indices were higher than the conventional values of TT and CLR, especially they showed the closest correlation with the range of maximal extension (degree) among some measurment items on the mobility of the lumbar spine.
Above all, the correlation of TT Index and CLR Index added together, with the range of maximal extension was the highest, showing a coefficient of +0.571.

Balneotherapy of patients with rheumatoid arthritis (RA) has been done empirically from ancient times. As a matter of fact, the pain and stiffness are significantly relieved by bathing in a hot spring. The mechanism of action, however, remains still unclear in some points. The authors have pointed out some of the mechanisms, by which RA patients were influenced from spring water bathing.
1) Vascular dilatation. Gas containing hot springs, such as CO₂ spring or H₂ S spring, have vasodilating action on peripheral blood vessels, which increases the blood circulation, resulting in the acceleration of metabolism and the improvement of pain and stiffness.
2) Stimulation on the adrenocortical hormon secretion. Urinary 17-KS excretion increased significantly after serial bathing in hot spring water, especially in sulfur containing spring water, indicating the stimulatory effect on the adrenocortical function.
3) Stimulation on the sympathetic nerve. Plasma norepinephrin levels were elevated during the bathing either in a hot spring or in a cold spring water, although the elevation was much higher in a cold spring water. This may suggest the stimulatory effect of spring water bathing on the sympathetic nerve function.
4) The effect on plasma prostaglandin levels. Plasma prostaglandin levels were concentrated into around the mean level after 3 weeks of serial bathing in a hot spring water.
5) The effect on plasma cyclic AMP levels. Plasma cyclic AMP levels were elevated significantly after 1 week of serial bathing in a cold spring water, but returned to the initial levels after 3 weeks of the serial bathing.
6) The effect on plasma neuropeptide levels. Plasma beta-endorphin levels were lower in RA patients and they were insignificantly elevated by the bathing in a hot spring water. Both the leucine-encephalin and methionine-encephalin levels were unchanged by the bathing, although the initial levels were both within normal ranges in RA patients.
7) The effect on connective tissue metabolism. Urinary excretion of the total hydroxyproline was higher in RA patients, and it was decreased after the bathing in a hot spring water containing sulfur. Serum monoamine oxidase activities, on the other hand, was lower in RA patients, and they were elevated after the bathing in hot spring waters.
8) The effect on the autonomic nerve function. Abnormality of the autonomic nerve function indicated by the coefficient of variance of R-R intervals in EKG was much more found in RA patients than in healthy controls, and it was improved significantly after 4 weeks of serial kinetic bathing in a simple hot spring water.
In spite of the above mentioned beneficial effects on RA patients, bathing in either hot or cold spring water has shown no effect on the inflammatory activity of RA, but only shown ameliorating effects on the pain and stiffness, just like an effect of non-steroidal anti-inflammatory drugs. It should be recommended, therefore, to use hot spring water not only for relieving pain and stiffness, but also for positive rehabilitation exercise.

Body height, arm span and mobility of thoraco-lumbar spine with a spinometer were measured for 1071 males and 1243 females selected from among the local residents of over 20 years of age. Upon reviewing the mutual relationships among the values of body height, arm span, body height, arm span ratio, and mobility of thoraco-lumbar spine, a study was conducted to see if body height arm span ratio as an index of body height shrinkage would serve for evaluation of senility. The results may be summarized as follows.
1. The values of mobility of thoraco-lumbar spine decreased with age. The angle at maximal flexion (AF) was shallow and the angle of erected posture (AEP, physiological lordosis) and the angle at maximal extension (AE) shifted forward. As the result, the range of maximal flexion (RF), the range of maximal extension (RE) and the range of total flexion-extension (RTFE) decreased. Among the values of mobility of thoraco-lumbar spine, RE showed the greatest rate of decrease due to aging.
2. According to the investigation of the relationships among the values of mobility of thoraco-lumbar spine, smaller values of AEP or physiological lordosis resulted in forward shifting of the area of total flexion-extension and in a decrease of RTFE.
3. As Dequeker et al. claimed, the body height and the arm span in the mature 20's were almost equal, the ratio being approximately 1.0. Moreover, the values in the literature measured over 20 years ago together with those in the present study were reviewed and it was found that the ratio body height/arm span was constant regardless of the difference in body height and era. This evidence provides scientific support for the theory of Dequeker et al. that the ratio is an index of the shrinkage of body height due to aging.
4. Although neither body height nor arm span showed any relationship with the values of mobility of thoraco-lumbar spine, the ratio body height arm span show correlationship with the values of mobility of thoraco-lumbar spine. Moreover, the relationship was evident in older subjects over 40 years of age while it was not so evident in younger subjects under 39 years of age, and thus there was a trend noted that the mobility of thoraco-lumbar spine becomes worse as the value of body height/ arm span decreases. This evidence indicates that the shrinkage of body height and the decrease of mobility of thoraco-lumbar spine progress simultaneously. Accordingly, the ratio body height/arm span and the mobility of thoraco-lumbar spine may be regarded as indices of senility of the morphology and function of lumbar spine.

A statistical study was made of the senility of those engaged in three different types of occupation by measuring their body height, arm span, body height/arm span ratio and mobility of thoraco-lumbar spine. The subjects of the study were 323 males and 305 females engaged in fishery (primary industry), 382 males and 731 females engaged in farming (primary industry), and 366 male and 207 female industrial workers (secondary and tertiary industries) . The results obtained were as follows.
1. The body height of males was greater than the national average in the fisherman and industrial worker groups but smaller in the farmer group. The shortening of body height due to aging after 40 was gradual in the fisherman group but remarkable in the farmer and industrial worker groups. The body height of females was smaller than the national average in all the three groups up to the age of 40, but after that age, it was greater than the average in the fisherman group and almost identical to it in the industrial worker and farmer groups. Arm span showed the same tendency as body height in both males and females. However, the reduction of arm span due to aging was less than half that of body height.
The body height/arm span ratio which is considered as an index of the shortening of body height due to aging was alike among the three groups in both males and females up to the age of 40. At greater ages the ratio was maintained highest in the fisherman group, suggesting that the shortening of body height due to aging was smaller in the fisherman group than in the other occupation groups.
2. Various scores of mobility of thoraco-lumbar spine showed changes with age corresponding to their respective characteristics. Generally, there was a tendency that the scores were highest and the changes with age were smallest in the fisherman group. Difference by occupation was noted in the range of total flexion-extension and maximal extension ; particularly the range of maximal extention for both males and females was highest in the fisherman group, lowest in the farmer group and medium in the industrial worker group, indicating difference by occupation most remarkably.
3. No significant relationship was observed between the body height/arm span ratio as an index of the shortening of body height and the mobility of thoracolumbar spine in any of the three groups for either males or females under 40. However, a positive correlation was noticed at ages greater than 40. Although there was in each test item some difference between males and females, the correlation. ship at advanced ages was generally lowest in the fisherman group and highest in the farmer group.
4. In view of the above findings, the shortening of body height due to aging and the reduction of mobility of spine at advanced ages were smallest in the fisherman group, and it may well be said that the occurrence of senility in the fisherman group is more delayed than in the other occupation groups. The relation of the shortening of body height with the reduction of mobility of thoraco-lumbar spine, particularly of the range of maximal extension, was most remarkable in the farmer group, suggesting that premature senility in terms of mobility of spine occurs earliest in those engaged in farming. It is desired to take the sort of physical exercise that stresses the flexibility of the spine for a prevention against senility.

In clinic-based training, medical students take part in various activities, including watching or assisting in clinical procedures and participating in home visits, vaccinations, industrial inspections, health education, and elderly service adjustment meetings. Through these experiences students gain a practical understanding of the importance to primary care of a close patient-physician relationship; consideration of the life and background of patients and families; continuity of care; a suitable relationship between a primary-care clinic and a hospital or specialist; a team approach with other medical staff, such as nurses, community health nurses, helpers, and social workers; and medical and welfare resources of the community. These concepts are difficult to teach effectively in a large university or private hospital. On the basis of my experiences, I would like to comment on the policy of clinic-based training and problems in expanding such training.