1) Of 3887 patients hospitalized in our surgical clinic during about 20 years from 1946 to 1966, 43% were patients with abdominal surgery, 20% with neuralgia or rheumatoid arthritis, 9.8% with injuries of four extremities, 9.6% with malignant diseases, and 5.8% with postoperative disturbances.
2) It was concluded by our clinical investigations and laboratory findings that postoperative early ambulation (walk from 3rd. postoperative day) with early thermal bathing (40-42°C, 5 minutes bath from 7th postoperative day) in about 520 patients with gastrectomy or cholecystectomy promoted their postoperative recovery. But it was noted that postoperative recovery with malignant was not always promoted by early ambulation with early bathing and so care must be taken of such postoperative patient.
3) Recently patients with postoperative disturbances have been gradually increasing in our clinic. Of 99 patients with postlaparotomy disorders, 78 of them were postoperative intestinal adhesion. 38 of which were not re-operated and were treated by hydrotherapy that diminished their complaints from 100% to 37.7% after average 48 day therapy.
4) 328 patients with lumbago and sciatica were treated combined with balneotherapy. Of 28 patients with lumbal disc hernia, 53.6%, healed, 46.4% were markedly improved after two month therapy. But, of 21 patients with postlaminectomy or postmyelogram disturbances, only 23.8% healed, 57.1% were improved and 19% were unchanged after two month therapy.
5) 380 patients with rheumatoid arthritis were treated by balneotherapy combined with intraarticular corticosteroid injection. When local improvement by these treatments was little, these patients were treated by means of such procedures as intraarticular pumping and washing, curettage of synovial membrane and fenesteration or partial synovectomy. Balneotherapy markedly improved operated joint function. R. A. patients were permitted to take thermal bathing 6-12 hours after intraarticular corticosteroid injection and there were no articular infection by bathing.

It is said that medical care is a social application of medicine to the benefit of community or individual. In step with progress in medicine, medical care has been made all the more complicated. Moreover, the system supporting medical care has fallen behind the times when its surroundings have been changing drastically. This situation could be ascribed to the institutional fatigue that the system itself is suffering from after a long period of existence. It also can be pointed out that there have been revolutionary changes in traditional Japanese cultural values together with the awareness of people concering health. However, the primary factor that lies behind need of reform is financial difficulties. At present, in connection with deregulation of medical care, the introduction of mixed medical care and the entry of joint-stock corporations are taken up for discussion as topics of the day. In the meantime heated debates are being held over the subjects of institutional reform including the setting up of medical care for the aged as part of the fee-for-service system and reconstruction of the network of providers of health care and services. Moreover, the institutions that are engaged in the practice of medicine are expected to tackle a broad range of tasks- -catching up with ever-progressing information technology, disclosure of information, and strengthening of safety measures against medical accients, among many others. However, these are not the issues which have cropped up in recent years. Many have been brought up and discussed from an angle a little different from what it is today. It is now high time for us to discuss these issues through and through in light of actual situations while looking back on the history of medical care and its system. In this paper the author shall dwell on the development of the nation's medical system and point out some problems confronting us today with the use of some materials thus far presented by the Japan Medical Association. His view is based on his personal experience in hospital management and with the Japan Medical Association.
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Before, and at various time intervals after a marathon race, we examined the changes in serum β -enolase concentration in 6 healthy, non-athlete volunteers and compared then with changes in serum creatine kinase (CK) and creative kinase MB isozyme (CK-MB) activities. The enzyme β-enolase (a β and ββ) exists in skeletal and heart muscle, where it catalyzes the step in the glycolytic pathway between 2-phosphoglycerate and phosphoenolpyruvate. For determination of β-enolase concentration, serum was analyzed by the sandwich enzyme immunoassay method. The β-enolase concentration was significantly increased from the pre-race value. At 6 h after the race, the β-enolase concentration became maximal in all subjects, while CK and CK-MB activities did so in one and two subjects, respectively. CK and CK-MB activities peaked at 24 h in five and four subjects, respectively. The rise and fall of β-enolase concentration was faster than those of CK and CK-MB activities. Therefore, assay of β-enolase concentration has considerable advantage for early detection of skeletal muscle damage and is highly specific and sensitive. The mean β-enolase concentration±S. D. before and immediately after, and 6, 24, 48 h and 1 week after the race was 7.7±5.96, 204±87.6, 400±292.0, 214±166.3, 41.1±30.89, and 6.5±2.20 ng/ml, respectively. There was a significant correlation between the peak β-enolase concentration and peak CK activity (r=0.981, p<0.05) and peak CK-MB activity (r=0.926, p<0.05) . However, there was no significant correlation between β-enolase concentration and Vo₂max.
These results suggest that serum β-enolase concentration may be a more effective marker of skeletal muscle damage after prolonged exercise, as well as for determination of CK activity.

We report on an 88-year-old woman who underwent successful repair of ventricular septal perforation (VSP) following acute myocardial infarction. She was admitted as an emergency case to our hospital with acute myocardial infarction. Color Doppler echocardiogram revealed anterior VSP. Right heart catheterization was conducted under intraaortic balloon pumping and showed a Q_P/Q_S of 3.0. She also had acute renal failure for which continuous hemodialysis and filtration was started. In spite of intensive medical therapy, her hemodynamic condition was gradually worsened. An emergency operation was performed on the 6th day after the onset. A single porcine pericardial patch was sutured on the left side of the septum around the perforation and the left ventricular free wall was closed including the patch with two felt strips. She suffered from various complications through the postoperative course. However, she recovered and was discharged on the 77th postoperative day. She was, to the best of our knowledge, the oldest among the reported cases of successful surgical repair of VSP in Japan.