Atempts have been made to study the effects of single and successive bathing upon the metabolism of vitamin B₁ in rheumatoid arthritis patients, by using the Bunin-no-yu (muriated saline spring) of Narugo Spa, Miyagi Prefecture, and the peloid (chief ingredient, SiO₂, Al₂O₃, etc.) of Goshogake Spa, Akita Prefecture.
The results may be summarized as follows:
1. Blood level and urinary excretion of vitamin B₁ in 24 hours in rheumatoid arthritis patients were significantly lower than healthy subjects. This may suggest that the secondary vitamin B₁ defficiency due to the decrease of vitamin B₁ utilization is caused by the various kinds of internal factors. In fibrositis, the patients' level was close to that of healthy subjects.
2. The results were also obtained by observing the effects of hot-spring bathing upon blood level and urinary excretion of vitamin B₁ in rheumatoid arthritis patients.
1) Immediately after hot-spring bathing, the blood level of vitamin B₁ was decreased in healthy subjects, but thereafter it was increased and showed a tendency to return to the former level in 60 to 90 minutes; it had little variation and individual difference. In fibrositis patients, the variation was about the same as that of healthy subjects but it was fairly unstable. In rheumatoid arthritis patients, it showed significant variation and remarkable individual difference, and it had no diffenite tendency. These were the same as in Bunin-no-yu and the peloid bathing. This meant that hot spring bathing acted as the unspecific stimuli to which rheumatoid arthritis patients showed a very unstable reaction in vitamin B₁ metabolism. This suggested unstable status of autonomic nervous system in rheumatoid arthritis patients.
2) In the vitamin B₁ tolerance test, rheumatoid arthritis patients showed the type II or the mixed type in Inoue's classification.
A suggestion might be made that the secondary vitamin B₁ defficiency was caused by the disturbance of vitamin B₁ metabolism due to anemia, dysproteinemia, disturbance of liver function and adrenocortical insufficiency.
The observation of the effects of single bathing upon the vitamin B₁ tolerance test showed that the tolerated vitamin B₁ was augmented to be absorbed but that the vitamin B₁ metabolism was not improved: the temporary disturbance of vitamin B₁ utilization was observed.
3. The observation of the effects of successive bathing led to the followings:
1) In successive bathing, the blood level of total vitamin B₁ and co-carboxylase were both likely to increase, especially in a low blood level group, and the metabolism of vitamin B₁ was improved.
2) Both the effects of single bathing and individual differances became smaller in successive bathing, showing a tendency almost the same as that of healthy subjects.
This might suggest that the unstable status of autonomic nervous system observed before bathing was gradually controlled by successive bathing.
3) The vitamin B₁ tolerance test in rheumatoid arthritis patients tended to come nearer to the normal type by successive bathing and it was seen that the vitamin B₁ utilizing ability could be accelerated and vitamin B₁ metabolism could be improved.
4. The experimental results mentioned above suggest that successive bathing had an effective influence on the disturbance of vitamin B₁ metabolism in rheumatoid arthritis patients, and especially accelerating the ability of vitamin B₁ utilization.
5. It is difficult to reach a conclusion on the mechanism of the effects of hot spring bathing upon the metabolism of vitamin B₁, but studies made by the author as well as a series of studies made in the laboratory of which the author is

A few attempts were made to study the effect of Tamagawa hot spring bathing upon the capillary resistance in healthy subjects and patients with hypertension, rheumatoid arthritis and fibrositis.
The results may be summarized as follows:
1) The capillary resistance decreased more significantly in patients with hypertension and rheumatoid arthritis than in healthy persons, but there was no difference in capillary resistance between healthy persons and patients with fibrositis.
2) Similarly, single bathing showed a decrease in capillary resistance both in healthy subjects and patients immediately after bathing, but tended to return gradually to the pre-bathing value about 1 hour later.
3) Successive bathing clearly increased capillary resistance in patients with hypertension in whom the decrease of capillary resistance was apparent. Such tend was also observed in patients with rheumatoid arthritis. The variation in capillary resistance in them brought forth by single bathing gradually grew smaller in degree with progress of successive bathing and showed a tendency to be similar to that in healthy subjects.
No significant variation was observed in capillary resistance in healthy persons and patients with fibrositis.
4) It can be said from the results mentioned above that balneotherapy is very effective for the treatment of rheumatoid arthritis and hypertension.

This paper deals with general survey of hot spring curative treatment at Higashine Spa, Yamagata Prefecture, and the effect of this spa on the capillary resistance and the variation in the blood pressure.
The results of the medical survey are summarized as follows:
1) Higashine Spa consists of saline weak common salt springs, in each of which chemical components are almost the same.
2) The visitors to this spa are inhabitants of Yamagata Prefecture, farmers being the largest in number.
3) Most of them (78%) are old men and women over 50 years of age, and the number of women are four times that of men.
4) The examination of spa visitors reveals that hypertension stands at the top. However, in most cases, the chief complaints are of rheumatic disorders in natwe and hypertension is found at the time of medical examination.
5) Those who bathe five times a day are the largest in number.
6) Those who noticed the bathing reaction are small in number. The bathing reaction may be considered as a serious thermal crisis.
7) Bathing in this hot spring increases the capillary resistance and lowers the blood pressure.
Accordingly, bathing in this spa, under a proper guidance, may be effective in the treatment of hypertension. For balneal treatment of hypertension, physicians' directions as to how and when patiens should bathe, will be necessary: unplanned bathing cannot be approved of.

The result of our general and medical survey are summarized as follows:
1) More than half the number of visitors to this spa are those who live in Yamagata Prefecture, and the rest are inhabitants of neighboring prefectures. Compared with the reports of our previous surveys, the number of inhabitants of neighboring prefectures is larger. Farmers are the largest in number, and their ages range from 20 to 60.
2) Considering the fact that more than half the number of spa visitors come here with therapeutic or convalescing purpose, this spa be said to be a spa where the sole object of visitors should be the hot spring curative treatment.
3) Form the viewpoint of classification of diseases, it may be said that patients with rheumatism and neuralgia are more than half the number, followed by those with the diseases of the stomach. This clearly shows the reason why this spa is called “the hot spring for rheumatism and neuralgia”.
4) More than half the number of spa visitors stay for about 2 weeks, and most of them take bath 5 to 6 times a day for curative treatment. Generally the spa visitors tend to bathe in excess.
5) 37.4% of the spa visitors drink hot spring water for curative treatment and this rate of drinking cure is higher than that in our previous reports.
6) Only 5.7% come to the spa under doctors' direction. 31.6% of them are conscious of the bathing reaction, symptoms of which are headache, feeling of weakness, anorexia, constipation, etc.
7) Observation of the effect of hot spring bathing on Thorn's test shows that in the larger number of patients with rheumatism and neuralgia the rate of decrease in eosinophilic leucocyte count becomes clearly higher after single bathing, but in healthy persons it is not uniform. And observation of changes in these rate of variations after succesive curative bathing reveals that in the group in whom the rate of decrease is low at the beginning of the bathing the vate tends to become higher after a week of curative bathing, while in the group in whom the rate of decrease is high it tends to become lower.