BALNEOTHERAPY

From Big Medical Encyclopedia

BALNEOTHERAPY (hydrotherapy) — use of water in the medical and preventive purposes. In a broad sense the term «balneotherapy» includes actually V. — use of sweet water and balneoterapiya (see) — use of mineral water. Century (use of sweet water in the treatment-and-prophylactic purposes) is one of sections physical therapy (see).

Water was considered long since a source of life and applied for the purpose of improvement of an organism. The first data on V. contain in the drevneindussky book Rig-Veda, and also in Hippocrates's works. At the people of the Ancient East to lay down. use of water had character of a religious ritual. During various historical periods at V. gave preference to use or is hotter, or a cold water. More ancient on the origin are hydropathic procedures with hot water. The diseases caused by cold it was considered it expedient to treat the agent opposite to cold, i.e. heat. However and use of a cold water found supporters, especially in Sparta where the hardening of an organism was widely cultivated. B was widely applied. in Ancient Rome; the remains destroyed a term testify to it. In Ibn-Sina (Avicenna's) «Canon» created in 11 century AD, water is mentioned as means of preservation of health. In Europe in the Middle Ages of V. it was forgotten, and only in 18 century interest in it is noted again. A long time of V. the people who do not have relations to official medicine, so-called naturvrach were engaged: teacher Ertel, (F. Ch. Oertel), peasant V. Prissnitts, pastor S. Kneipp, etc. In 1899 in Vienna the first department according to V. was created, to-ruyu Vinternitts headed (W. Winternitz, 1835 — 1917).

The famous Russian doctors V. I. Afanasyev, F. I. Inozemtsev, V. A. Manassein, etc. were supporters of use of V., especially procedures with a cold water.

After Great October socialist revolution of V. was widely adopted; the organization of network of research in-t of physical therapy and balneology promoted development of scientific research in theoretical and methodical questions B.

Physical and chemical bases of balneotherapy

V. includes use of water in firm (application of ice), liquid and vaporous (steam souls, inhalations, etc.) states. For treatment by water in liquid aggregate state use it physical. - chemical properties: high thermal conductivity, considerable heat capacity, small viscosity, specific weight close to the specific weight of a human body. Also the fact that water — good polar solvent of solid, liquid and gaseous inorganic and organic matters is of great importance (see. Water ).

Depending on need of use in to lay down. - professional, the purposes of this or that physical. - chemical properties of Water the organism is exposed to preferential influence of temperature, mechanical or chemical irritants (see. Balneoterapiya , Bathtubs , Shower ).

Anatomo-fiziologichesky bases of balneotherapy

Responses of an organism to V. have the phase character reflecting transient phenomenons in systems biol, regulations (see the Homeostasis). One of problems of V., as well as during the use of other physical factors, is achievement of favorable reaction of an organism that is provided with the correct dosage of quality and number of procedures.

The thermal factor influences an organism at all techniques of V. Razlichayut a cold water (lower than 20 °), cool (20 — 33 °), so-called indifferent (34 — 36 °), warm (37 — 39 °) and hot (40 ° above). Action of a thermal factor is based that between a body of the person and water there is an exchange of thermal energy.

The main place of application of hydropathic procedures is skin and to a lesser extent mucous membranes of nek-ry perigastriums. Therefore reactions of an organism to V. in many respects are defined anatomo-fiziol. properties of an integument.

In skin not encapsulated nerve terminations and 14 types encapsulated are found. Was considered that the encapsulated receptors, in particular Ruf-fini's little bodies, perceive heat, Krause's flasks — cold, Fater's little bodies — Pachini define perception of a touch, but not encapsulated nerve terminations — pains. However it is established that temperature irritations perceive not encapsulated nerve terminations in skin.

On fiziol, to properties thermoreceptors can be subdivided into the following basic groups: cold, mechanothermal and thermal.

1. Cold receptors are characterized by slow adaptation. To each size of temperature of an external irritant in the range of 10 — 41 ° there corresponds a certain frequency of a steady tonic impulsation of a cold receptor, the maximum frequency (to 10 imp / sec.) there corresponds t ° 20 — 30 °.

2. Mechano-thermal receptors adapt quickly. To cooling react phase increase of an impulsation, and to warming — a phase urezheniye. At long and considerable warming of a body their sensitivity to mechanical influences increases.

3. Thermal receptors slowly adapt and, is similar to Cold receptors, answer with a steady impulsation, the proportional size of temperature of an irritant in the range of 20 — 47 °. At t ° 38 — 43 ° the impulsation reaches the maximum frequency (4 imp / sec.). Elektrofiziol, thermal receptors are authentically identified by researches only in areas of an innervation of a trifacial (cold receptors in skin in 10 — 15 times more, than thermal). In other body parts the caumesthesia during the warming is caused by decrease in frequency of categories of cold and mechano-thermal receptors.

Action on c. N of page. From thermoreceptors of skin signals come as a part of back roots of a spinal cord and an afferent portion of a trifacial to c. N of page. During the warming of a body the impulsation on fibers of the side and front columns of a spinal cord which are a part of a spinothalamic path urezhatsya. As a result also the quantity of the impulses coming on collaterals from a medial loop to a reticular formation of a mesencephalon decreases. The last renders the ascending activating influence on bark of big hemispheres, a cut of subjects is more powerful, than the high frequency of an afferent impulsation. For these reasons hydrotherapeutic procedures with the water temperature coming to so-called indifferent have sedative effect, cause feeling of drowsiness. On the contrary, considerable warming, increasing sensitivity of mechano-thermal receptors to mechanical influences, and, therefore, speeding up quantity of the afferent impulses arriving to a reticular formation makes exciting impact. Result the cold procedures exciting cold receptors (the first phase of reaction) in similar effect. Prolonged use of procedures as with cold, and hot water is followed by development of the second phase of reaction — oppression of c. and. page. Thermoreceptors of internals and thermoreceptors in back, oblong and a mesencephalon take part in formation of reactions to a thermal factor of hydropathic procedures (see. Thermoreceptors ). In response to action of temperature irritants the skin and visceral reflexes changing first of all blood circulation in internals join. E.g., the hot foot bath increases a blood stream in vessels of a brain, warming of hands improves conditions of food of a myocardium, and the cold sedentary bathtub leads to vasoconstriction of lungs. Through c. the N of page and the autonomic nervous system is implemented influence of a thermal irritant on sweating, breath and other functions of an organism.

Action on cardiovascular system. Skin is richly supplied with blood vessels with a large number of an arteriovenous anastomosis. The blood stream through skin can change considerably depending on temperature of an irritant that causes unique opportunities of skin as body physical. thermal controls.

According to Neyf's theory (Nafe, 1962), the temperature irritant is capable to influence directly smooth muscle structures of a vascular wall, and cooling causes its reduction, and warming — relaxation. At the maximum relaxation vessels of skin can contain up to 30% of the blood circulating in an organism. Increase in a blood-groove through skin leads to its reduction in internals whereas narrowing of superficial vessels is followed by vasodilatation in more deeply the lying bodies and fabrics.

Under the influence of cold hydropathic procedures at the first moment there is a spasm of small vessels of skin. In response to signals of decrease in temperature of skin through c. the N page and endocrine system of an organism joins the mechanism of nesokratitelny thermogenesis (see. Thermal control ), owing to what exchange processes, hl accelerate. obr. in a liver and cross-striped muscles.

As a result temperature in more deeply the located bodies and fabrics increases that in turn through system of thermoreceptors of internals and c. and. the page leads to increase in microcirculation in skin (increase in quantity of the operating capillaries and expansion of already functioning capillaries). Kompensatorno develops the arterial hyperemia which is subjectively accompanied with a pleasant caumesthesia (see. Hyperemia ). At this stage it is necessary to stop the hydropathic procedure as the excess thermolysis through skin (owing to big heat conductivity of water) leads through a nek-swarm time to overcooling and development of an undesirable phase of reaction — a venous hyperemia.

Cold procedures slow down and strengthen, and hot speed up and weaken cordial reductions. The first increase arterial pressure, the second render hypotensive effect.

Action on blood. Under the influence of single general hydropathic procedures and their especially course influence the quantity of erythrocytes and leukocytes increases a little; it is caused by the increase in permeability of vessels accompanying an arterial hyperemia. The quantity of uniform elements increases as a result of an exit of water from a vascular bed in fabric. Considerable cooling increases viscosity of blood, and compensatory receipt in fabrics vessels of liquid leads to their relative dehydration. Therefore, e.g., use of a cold water reduces puffiness after bruises, an injury etc. Procedures with hot water promote increase in coagulability of blood, and cold — to decrease it. Adequately appointed procedures can promote improvement of composition of blood, stimulating functions of the hemopoietic bodies.

Action on respiratory system. Cold hydropathic procedures brake respiratory activity on central and activate at the spinal level therefore at procedures B. with a cold water at first there is breath holding, then the strengthened cycle a breath — an exhalation then the deepened and slowed down breath during all procedure is established follows. Thermal and hot hydropathic procedures speed up breath and reduce its depth. Features of the mode of breath at V. are caused by the fact that at decrease in temperature of skin is lower 30 ° and increase St. 35 ° gas exchange increases.

Action on a metabolism. Procedures with a cold water stimulate a metabolism, first of all due to combustion of nitrogen-free connections. Physical thermal control (hl. obr. sweating) also demands energy consumption; therefore procedures with hot water and steam result in similar effect, i.e. stimulation of a metabolism.

Action on muscles. Cold influence causes increase in a tone of skeletal and smooth muscles. Thermal hydrotherapeutic procedures promote decrease in a muscle tone, have the weakening effect on unstriated muscles of intestines.

Action on a mocheotdeleniye. Vessels of kidneys react to temperature irritants the same as vessels of skin. The cooling of skin which is followed by vasoconstriction of kidneys involves decrease in a diuresis. At the same time cooling, raising a tone of the neuromuscular device of a bladder, speeds up an urination. Procedures with short thermal influence promote vasodilatation of kidneys, improve blood circulation in them and increase release of urine. At the long thermal procedures which are followed by increase in sweating, the amount of the emitted urine decreases.

Value of phases of reactions to balneotherapy

Procedures with cool water at the first moment cause a spasm of small vessels of skin, reduction of heatloss, increase and strengthening of cordial reductions and a nek-swarm increase in arterial pressure: skin becomes pale and cold to the touch — I phase of reaction. At longer action of cold the narrowed vessels of skin extend — it is followed by acceleration of a blood-groove, skin becomes pink and warm to the touch. The patient feels a pleasant caumesthesia. This,

II phases of reaction it is necessary to try to obtain at each hydropathic procedure. Approach it can be accelerated and to increase effect, increasing mechanical irritation (massaging, grinding etc.). At continuation of the cold procedure comes following, undesirable, III phase of reaction, at a cut vessels remain expanded, but walls lose them the tone, the blood stream is slowed down, venous stagnation (a passive hyperemia) is formed, skin becomes cyanotic-red, cold to the touch; the patient tests a fever, the health worsens. Emergence of this phase of reaction indicates inadequacy of the procedure to a functional condition of an organism. Procedures with hot water at the first moment also cause a short-term spasm of peripheral vessels that is followed by increase of cordial reductions, shortening of a diastole and increase in arterial pressure, sweating amplifies. The patient quickly gets tired. Both cold, and hot procedures lead to a condition of overexcitement in the beginning, and later — to oppression of function of a nervous system. At procedures with the water temperature coming to indifferent the I phase (vasoconstriction) drops out. Reaction begins with very slow, gradual vasodilatation and does not lead to considerable changes in a condition of blood circulation. Degree of manifestation of functional changes of various bodies and systems depends on the size of the site of the body surface which is affected, water temperature and duration of the procedure. Action of subjects is stronger, than more difference between water temperature and skin.

The sensitivity of skin caused by specific features of an organism, its fitness to temperature irritations and also influence of the previous temperature irritation is of great importance for perception of a temperature irritant. In this regard the same temperature irritant can be perceived differently. So, e.g., if to lower on a nek-swarm time one hand in a vessel with water t ° 26 °, and another — in a vessel with water t ° 36 °, and then to ship both hands in one vessel with water t ° 30 °, then the first hand will perceive this water as warm, and the second — as cold.

At the choice of a place of application of a temperature irritant it is necessary to consider irregularity of distribution of the skin receptors perceiving influence of the last. Change of a temperature irritant at V., places of its appendix, duration of the procedure, the area of influence it is possible to receive various reactions from a number of bodies and systems of an organism. This circumstance is the basis for a number of methodical receptions of V. and is used for the purpose of a training of adaptation opportunities of an organism, hardenings (see). So, strengthening of influence of a thermal factor is reached, e.g., by alternation of influences by water of various temperature — contrast bathtubs (see), Scottish shower (see) etc.

Along with temperature in each hydropathic procedure takes place and a mechanical factor — pressure of water, its movement. At nek-ry hydropathic procedures mechanical influence is specially created and dosed (e.g., souls), by various receptions the special form of influence can be given it or it comes down to a minimum that takes place, e.g., at foamy bathtubs. A mechanical factor, joining temperature, strengthens a systemic effect of the procedure, causing preferential changes in the blood circulatory system.

The general indications to hydropathic procedures depending on water temperature

Procedures with a cold water are shown as the all-tonic stimulating functions of nervous and cardiovascular systems, raising a metabolism in an organism. Procedures with warm water are shown at chronic inflammatory diseases, especially a musculoskeletal system, disturbances of nek-ry types of a metabolism (water-salt, fatty, etc.) . Procedures with hot water are shown as diaphoretic, and also for increase in exchange processes. Procedures with water of indifferent temperature work sedatively at a hyperexcitability of nervous and cardiovascular system, at a hypertension, sleeplessness. In more detail — see Balneoterapiya, Bathtubs, the Shower, Intestinal washings. Indications to separate hydropathic procedures — see below.

The general contraindications

Sharply expressed atherosclerosis, a hypertension of the III stage, especially at the phenomena of disturbance of cerebral and coronary circulation; a decompensation of cordial activity, a new growth, tuberculosis in an active phase, bent to bleedings, diseases of system of blood and the hemopoietic bodies, infectious diseases of skin. In more detail — see. Balneoterapiya .

The dosage of hydropathic procedures shall be strictly individual taking into account not only character of an irritant, but also a condition of reactivity of an organism of the patient. During the carrying out a course it is necessary to consider also duration of reaction of the patient. At the weak and quickly taking place reaction of the procedure it is possible to appoint daily, at stronger — every other day or two days running with rest to the third. Century usually appoint in the form of a course — from 12 — 15 to 25 — 30 procedures. At adequately appointed and correctly methodically conducted course B. reactive shifts on single procedures as if are summed up, promoting, as a rule, recovery of the broken functions. For prevention and a hardening hydrotherapeutic procedures begin with the small dosages having slaborazdrazhayushchy effect and gradually increase them, training adaptable mechanisms and increasing resistance of an organism to conditions of the environment.

Procedures of balneotherapy

Procedures of balneotherapy — shower (see), bathtubs (see), nek-ry types of wet compresses (see. Compress ), intestinal washings (see), bathings (see), douches, washings, rubdowns, wrappings, etc.

Douche

the Procedure having tonic effect. The course of such procedures is applied as a method of treatment at functional frustration of cardiovascular and nervous systems, and also to a hardening of an organism. Pour over the naked patient standing on a wooden lattice in a big basin or a bathtub 2 — 3 buckets of water, and then vigorously pound the warmed rough sheet to easy erubescence. It is necessary to pour over the patient slowly, holding a bucket at the level of his shoulders so that water evenly flew down on back and front body surfaces. The procedure is carried out daily or every other day within 2 — 3 min., gradually lowering water temperature with 34 — 33 ° at each subsequent douche on 1 — 2 ° and leading up it to 22 — 20 ° by the end of a course of treatment, to-ry consists of 15 — 30 procedures. Local douche is carried out from a rubber hose or a jug, more often by a cold water (t ° 16 — 20 °); hands and legs pour at the increased perspiration, vasculomotor frustration etc.

the General washings by cool water carry out Washing to the healthy people trained to Cold irritants for the purpose of a hardening, and also not heavy patient for increase in resistance of an organism. Local washings by warm water — the weak patient who is in a bed for increase in reactivity. For carrying out the general washings in a basin with water (apprx. 5 l) the appointed temperature plentifully moisten a sponge or a terry towel, wring out and quickly wash the naked patient sitting on a stool. At first wash a front surface of a body, since an upper part of a breast, and then — back, since a nape. This procedure is repeated by 2 — 3 times then the patient is carefully pounded a linen towel before emergence of the expressed vascular reaction. For strengthening of a hyperemia after washing and grinding of the patient it is necessary to lay and wrap up in the warmed sheet and a blanket. Healthy people can independently make further the procedure of the general washing for a hardening. At local (partial) washing at the patient covered with a sheet and a blanket consistently open, and then wash and pound separate parts of a body then wrap up. For local washings take water t ° 32 — 30 °, lower water temperature at each subsequent procedure and lead up to 20 °. At the trained people and not really weak patients it is possible to begin also with lower water temperature (25 °). The procedure is carried out daily or every other day, very weak patients have two times a week. Duration of the procedure 2 — 3 min. Total quantity of procedures 15 — 20.

Rubdown

Fig. 1. Rubdown: 1 — the general rubdown; 2 — 4 — partial (2 — spins a towel, 3 — hands a special mitten, 4 — legs a special mitten).

Rubdown — the refreshing and tonic procedure, on a course 2 — 6, is carried out as introduction to a course B., and also as an independent course of treatment of patients with overfatigue, a neurasthenia, with an asthenic condition, a hypometabolism of substances and for a hardening. The patient or the medic can carry out the general rubdown. The naked patient is wrapped up with the linen sheet (fig. 1, 2) moistened with water and which is carefully wrung out, through a sheet vigorously pounded to a caumesthesia. Then the sheet is removed, pour over the patient water then it is carefully pounded a sheet from a scrim. Rubdown is begun with water t ° 32 — 30 °, gradually reducing it to 20 — 18 ° below. The weak patient procedures are carried out only by medical staff. At the same time serially open for the patient who is in a bed, covered with a sheet and a blanket one hand, then the second, then one leg etc. and if the condition of the patient allows, but to parts rub off all body the moistened and well wrung out towel or a mitten (fig. 1, 2—4) at then pound a dry towel and again cover with a sheet or a blanket.

For strengthening of response of an organism of the patient after the general rubdown sometimes pour 1 — 2 buckets of water, temperature over a cut on 1 — 2 ° below that, a cut moistened a sheet at rubdown (rubdown with douche), and dry wipe. Sometimes with the same purpose for rubdown add salt, vinegar, alcohol, cologne to water and so forth. Procedures lasting 3 — 5 min. are carried out daily, more rare every other day. In total on a course of treatment of 20 — 30 procedures.

Wrapping

Fig. 2. General wet wrapping (1 — 4 consecutive stages): 1 — a wraparound in a wet sheet; 2 — wrapping by a woolen blanket; 3 — a podvorachivaniye under legs of sick free edge of a blanket; 4 — the patient is wrapped up.

The patient is wrapped up with a wet sheet, and over it a warm blanket (fig. 2). Holding a procedure demands clearness and speed of performance. Technique: on a couch spread a woolen or flannelette blanket, and on it the sheet moistened with water t ° 30 — 25 ° and wrung out. The naked patient lays down, raises hands, and it is wrapped one end of a sheet. Then the patient puts hands along a trunk, and it is wrapped up other end of a sheet, laying a sheet between legs, and wrap up with a blanket. Free edge of a blanket as well as sheets, twist under legs of the patient. The sheet shall be hardly tense and not form rough folds; to exclude the irritating influence of a woolen blanket, on skin of a neck lay a dry towel. Action of the procedure" depends on its duration. The first stage is characterized exciting, and at in the fever patients and febrifugal action, duration is its 10 — 15 min. It is shown to in the fever patients and as tonic the patient with an asthenic form of a neurasthenia and being in a stage of reconvalescence. The second stage which is characterized by the calming action comes in the next 30 — 40 min., at patients the drowsy state develops, and it is frequent also a dream.

The procedure of such duration is shown to patients with a hyperexcitability of a nervous system (a hypersthenic form of a neurasthenia, an idiopathic hypertensia of the I—II stage), at sleeplessness. If to continue the procedure more than 40 min., it becomes thermal and causes plentiful sweating — the third stage. The procedure of such duration is shown at disturbances of exchange (obesity, gout) and for the purpose of desintoxication. Appoint wet wrapping daily or every other day, to a course 15 — 20 procedures. At bad portability of the general wrappings it is possible to carry out so-called incomplete (partial) wrapping. In this case the wrapping becomes only to armpits; hands remain free.


Bibliography: Minut-Sorokhtina O. P. Fiziologiya of thermoreception, M., 1972, bibliogr.; Mugdusiyev I. P. Balneotherapy, M., 1951, bibliogr.; Neurohumoral mechanisms of reaction of an organism to cooling, under the editorship of E. V. Mack fear and E. M. Stabrovsky, L., 1973, bibliogr.; Olefirenko V. T. In the slot a nlolecheniye, M., 1970, bibliogr.; With y-r oyechok skayam.n. Balneotherapy. M, 1968.

V. T. Olefirenko, V. N. Uranov.

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