Foreword:
From olden times Japan has had in various places the so-called “hot springs for apoplexy, ” which even now as ever are well frequented by hemiplegic patients seeking anxiously for their cure. In addition to it, after World War II the American idea of rehabilitation for invalids has come to prevail that Japan now shows an increasing interest in promoting such institutions, in which are treated various chronic diseases and dysfunctions through injuries and especially the cerebrovascular stroke, which really imposes a very high morbidity upon our nation. And as such kinds of institutions in Japan are mostly, as they are, established in an intimate connection with the respective local spring resorts, it is rather imperative for hemiplegic rehabilitation to be studied from the balneological point of view, and we hope our present report of experimental study about the balneotherapeutics' role in the treatment of cerebrovascular disorders can be one contribution to this field of medicine.
I. Fact-finding Survey through Questionaires dispatched to the other various Balneotherapeutic Institutions
Survey were made through enquêtes sent back from thirty such hot spring institutions throughout Japan, enquiring about the results of rehabilitation of hemiplegic inpatients who were registered during January through December of 1966. Our summary findings are:
1) 30.6% of the in-patients in the internal section of the balneotherapeutic institutions were the hemiplegics, whose total number being ca, 3, 000, and of whom the ratio of the male was 77% against the female 23%.
2) According to the one-year records of their hospitalization, 42 of 2669 (or 1.6%) had a relapse or some other troubles, including 14 deaths, 28 survivals, thus showing a very low rate in relapsing and mortality.
3) All the institutions on our list applied to the patients their local thermal minerals, whose diversity of mineral water nature covers simple thermals, and mostly salt springs, being followed by the minerals of hydrogen sulfide as well as sulfur springs. Their principal application was for bathing, but sometimes it was administered for internal use and also some peloid found, though less frequently, its external application.
The temperature ranged from 37° to 42°C., but dominant was such a tepid water as of 39°C., in which they bathed once or twice a day.
The third day after the stroke was the earliest application; most of the patients, however, visited the institutions not later than one month.
II. Experiments at Noboribetsu Spa
Some hemiplegic patients were experimentally treated in salt springs of Noboribetsu Spa.
1) The first one month of hospitalization showed 54% improvements in their ADL (Activity of Daily Living), followed, however, by no further remarkable result.
2) There was a gain in their grasping power in the second month of bath treatment.
3) The blood pressure was seen to decrease at their early admission, and so it was with both the systolic and diastolic pressures, nevertheless with no outstanding change later on.
4) With the serum cholesterol, there was seen no particular change soon after their admission, but its average in the third month showed a slight decrease.
5) As for the normal electrocardiographical investigation during their hospitalization, the patients had each their E. C. G. checked more than two times at least and revealed a favorable normalization of their otherwise more or less abnormal P-Q interval, S-T segment as well as T wave; besides the disappearance of extrasystole, when it had existed.

I. Foreword
Quantitative, serial surveys of the uropepsin output in the urine of the bathing patients in Kusatsu Spring have led us to a knowledge that there exists in the gastric secretion relationship between its activation caused by consecutive-bathing stress and its suppresion brought about as an effect of hot bathing.
II. Experiment
(1) Procedure: West's rennett method was employed in our investigation, using a buffer of sodium acetate with a pH of 5.3, and the results are given in terms of mg. value of the concentrated pepsin manufactured by the Mikuni Chemical Firm.
(2) Nature of Spring Water and Way of Bathing: The hot springs at Kusatsu are of strongly acid sulfated water and of a high temperature of ca. 44°C. The subjects were ordered to take a bath three times a clay, in the morning, afternoon, and evening.
(3) Subjects: The test subjects were chosen chiefly from among those patients, who were already almost restored to normal.
III. The Fluctuation seen during Consecutive Daily Bathing
(1) Uropepsin Output: See Chart 2. Six patients were examined. The uropepsin output gradually increased with bathing and reached its maximum in about 10 days, four times higher than at the start of the experiment, then followed a gradual decrease until it returned to its original value.
(2) Diurnal Change: The urine for test was collected in such a way that the first portion was that of urination during the night from 10 p. m. to 7 a. m Then, the material was collected every three hours until 10 p. m., thus six separate urine samples were obtained. For control, similar test was conducted again in the same subjects without taking a bath.
Comparative study with each corresponding materials showed clear decrease of uropepsin quantity in the 2nd, 4th, and 6th portion of the urine, which coincided with the bathing, as seen on chart 3.
(3) Diurnal and Daily Fluctuation: Daily difference in uropepsin excretion and difference within a day were checked. Chart 4 shows the relationship between those two kinds of fluctuation in one case. Even at the height of uropepsin output, there was still noted a certain decrease in the portion of the urine, when the subject took a bath.
IV. Discussion
Stress increases uropepsin output with the stimulation of pituito-cortico-gastric system, as said by Gray et al.
There are some reports, proved at our institute, that bath treatment brings a stimulation effect upon the adrenal cortical function, the climax being reached about 10 days after the start of treatment. Our findings agree with them.
On the other hand, there are some reports that high temparature bathing brings supression of gastric secretion, which has been proved with Katsch-Kalks' method in our institute, too. Our study of diurnal fluctuation coincides with it.
Serial quantitative determinations of uropepsin output enabled the study of these two simultaneously by and contradictorily working reactions, because temporary decrease of uropepsin excretion was observed even at the climax of consecutive bath effect, However, an increase of uropepsin output was noted in the total amount.
V. Conclusion
The action of consecutive bath treatment was studied through the quantitative determination of uropepsin output and it was proved that hot bath treament produces two different effects, that is, consecutive bath treatment having a stimulating effect on the adrenal cortex and hot bath a suppresive effect on gastric secretion.

Balneotherapy was applied to 15 male cases of vibration disorder for four weeks, whereby examinations were made to judge their disorder of peripheral circulating and nervaus functions at the time of entering and leaving hospital. Results of the examinations disclosed an improving trend concerning skin temperature of fingers, score of nail press test, vibration sensation and pain sensation, which evidently suggests that this therapy is useful in curing of the disorder of peripheral circulation and peripheral nerves.
Meanwhile each of the examinations of skin temperature at the immersion test of one hand, score of nail press test and vibration sensation provides a useful measure for the judgement of remedial values.

Muscle is regarded as a kind of thermodynamic open system that exchanges matter and energy with its surroundings. In this paper we attempt to give a thermodynamic description of muscular disorders as well as considering the thermodynamic meaning of their physical treatment.
Muscular contracture
dU=dQ-dW (2-1)
This is the first law of thermodynamics.
If a muscle performs in a cyclic process as in fig. 1→fig. 2→fig. 3, the change of internal energy through the whole process will be as follows.
fig. 1→fig. 2 U₂-U₁=-ΔQ-ΔW<0 (2-2)
fig. 2→fig. 3 U₃-U₂=ΔW>0 (2-3)
from (2-2) and (2-3) U₁>U₃>U₂ (2-4)
The internal energy level of contracted muscle U₂ is less than U₁ and U₃, which is in a relaxed state. If the muscle remains in this shortened state, we call this state muscular contracture.
It has been proved above that this is the state of reduction of internal energy within the muscle.
Muscular atrophy
All the extensive properties of the thermodynamic system are homogeneous functions of the first order in the mass of the system.
For example, internal energy, U (m₁, m₂mγ) may be doubled by doubling the mass of the system without changing its composition, so that
U(2m₁, 2m₂, 2mγ)=2U (m₁, m₂mγ)
Here m₁ indicates the mass of the composition. If muscle becomes atrophic, the mass of this muscular composition will be reduced.
Therefore, if a muscle with internal energy level U₁ reaches an atrophic state, in which internal energy level is U₂, we will obtain the next equation between U₁ and U₂.
U₂=U₁ (λAm₁, λm₂, , λmγ)
=λU₁ (m₁, m₂, , mγ)
=λU₁(0<λ<1)
U₂/U₁<1
∴ U₂1 (2-5)
We have proved that muscular atrophy is a state with a lower internal energy level than normal muslce.
Meanings of physical therapy
Almost all neuromuscular diseases involve shortening of muscle, contracture, and muscular atrophy, in which the internal energy level becomes low.
Therefore, physical therapy for these diseases must at least be directed towards increasing the internal energy level of the muscles.
Since the first law of thermodynamics is
ΔU=ΔQ-ΔW,
to increase the ΔU of the malfunctioning muscles, we must provide moderate heat ΔQ or work ΔW to the muscles. This is the thermodynamic principle of physical therapy. Various kinds of heat therapy and the stretching of shortened muscle are therefore reasonable.
From the thermodynamic point of view, it is very interesting that isotonic exercise is more useful in increasing muscle power than isometric exercise, which does not perform work.
Further studies will be attempted in the future.