CLIMATOTHERAPY (climate + Greek therapeia treatment) — the use of influences of meteorological factors and features of climate of this area in the medical and recreational purposes based on achievements of medical climatology, a climatophysiology and which is carried out taking into account clinical data. To. is the section of medical climatology. It can be applied as independently, and as a part of complex therapy. Vida K.: 1) change of climatic districts and short-term stay of the patient in climate, favorable for it, that promotes a training of adaptable mechanisms, normalization of reactivity and improvement of a functional condition of an organism; 2) use meteorol, factors in climate, usual for the patient, at the place of residence (in suburban sanatoria, dispensaries,-tsakh and others to lay down. - professional, institutions) that has special value for patients with the weakened adaptable mechanisms, the climatic districts which are sharply reacting to change. Both at the first, and at the second look To. the special dosed klimatoterapevtichesky procedures are widely applied (aero - gelio-, thalassotherapy and bathing in natural reservoirs and pools).
In Ancient India, Greece and Rome doctors applied climatic factors in the recreational purposes at various diseases. Doctors of the Salerno medical school (9 century) at treatment considered influence of seasons of year. In 17 — 18 centuries seaside resorts in England, France were created, in 19 century H. Brehmer organized the first mountain sanatorium in Germany. In Russia the first experience To. the so-called spring treatment of patients applied at the beginning of 19 century by A. Nikitin was (stay in the area with a pure air), G. A. Zakharyin and S. P. Botkin attached great value to lay down. to properties climate (see).
Most widely problems K. began to be developed at the Soviet power. To development To. V. A. Alexandrov's works, H promoted. M. Voronin, G. M. Danishevsky, P. G. Mezernitsky, E. D. Petrov, A. D. Slonim, G. A. Ushveridze, etc. From foreign scientists a big contribution to development To. Assmann, Yordan, Plavshich (D. Assmann, H. Jordan, Q. Plavsic), etc.
brought Physiological bases of a climatotherapy
Difference To. from other methods of treatment consists that climatic factors are natural irritants for a human body in response to which in the course of evolution various regulatory mechanisms developed: thermoregulatory system — in response to cooling and, the overheating, neurohumoral mechanisms of regulation connected with development of a histamine — on action of solar radiation etc. It gives the grounds to consider To. as biologically reasonable means of stimulation of life activity of an organism (see. Climatophysiology ). In a basis to lay down. - professional, actions To. lie obshchefiziol. (nonspecific) and pathogenetic (specific) mechanisms.
Identity fiziol, reactions at various climatic methods of treatment allows to speak about nonspecific action of climatic factors.
To obshchefiziol. reactions at To. the training of thermoadaptable mechanisms which is a basis belongs hardenings (see) and strengthenings biol, bonds of an organism with the environment. At the same time reaction to a holodovy irritant decreases, there is a normalization and stimulation of different types of exchange processes, including oxidation-reduction. In this regard To. it is possible to consider as a method of a natural oxygenotherapy. To. contributes also to normalization of specific and nonspecific reactivity of an organism, improvement and recovery of the broken functions respiratory, cardiovascular and some other systems that allows to consider it method of recovery therapy and funkts, rehabilitations. At the same time also the specific reactions connected as with features of influence of climate of this or that resort, and with a type of klimatoterapevtichesky procedures are noted. So, To. compensates a lack of climatic factors (natural UF-radiation, aeroions, etc.), especially at residents of districts of Far North and big cities that promotes reduction connected with it patol, the phenomena (light starvation, a hypoxia, etc.), to the prevention and elimination of a number of diseases (rickets, etc.). During the holding various klimatoterapevtichesky procedures reactions of those systems to which influence of this or that climatic factor is preferential directed have the leading value: at an air-cure — systems of thermal control, at heliation — sympathoadrenal system etc. At the same time To. influences pathogenetic mechanisms of a disease, causing the corresponding effect. So, e.g., heliation in initial stages of atherosclerosis promotes decrease in content of cholesterol and lipids in blood, in early stages of an idiopathic hypertensia — to decrease in the ABP and improvement of function of a myocardium etc. From the point of view of the doctrine about functional systems (see) at To. the corresponding coordinate (functional) systems combining a row fiziol are created. mechanisms and providing the most economical and effective functioning of an organism In these conditions. More detailed the mechanism of action of various klimatoterapevtichesky procedures — see articles Air-cure , Heliation , Bathing , Thalassotherapy .
To. it is applied for the purpose of increase in resistance of an organism to adverse external effects (to cooling, etc.), prevention of the diseases which are especially connected with overcooling and also it is appointed the patient after long diseases, operative measures for the purpose of rehabilitation and acceleration of recovery of working capacity.
In seaside climate of the Mediterranean type (The southern coast of the Crimea) with lack of sharp daily allowance and annual fluctuations meteorol, elements, abundance of solar radiation, bathings in the sea K. it is shown by the TB patient and nonspecific diseases of lungs, at a pulmonary heart the I—II stages are not higher, the patient with cardiovascular diseases with a circulatory unefficiency it is not higher than I stage, funkts, diseases of a nervous system, exchange disturbances; in warm season — hron, nephrites, nefroza without the expressed insufficiency of kidneys. In regions of humid subtropics, where To. it is combined with a balneolecheniye (Sochi — Matsesta, Tsqaltubo), patients with diseases of cardiovascular system, diseases of a musculoskeletal system, endocrine and nervous system are treated. The increased air humidity in combination with high temperature creates in a zone of humid subtropics less favorable, than in the Crimea, conditions for treatment of patients with pulmonary diseases. In seaside climate of the Baltics with frequent winds, sharp change of temperature it is shown To. patients with cardiovascular diseases in a stage of compensation, with funkts, diseases of a nervous system, with unsharply expressed endocrine disturbances, and in warm season — patients with nonspecific diseases of a respiratory organs. Mountain climate (St. 1000 m above sea-level) with the reduced partial pressure of oxygen in air increased by the radiation mode and high ionization, considerable daily temperature variations exerts the training impact, stimulates the general metabolism and it is used preferential for To. suffering from tuberculosis lungs and nonspecific diseases of lungs without pulmonary heart. The climate of deserts and semi-deserts with dry hot summer and steady weather is shown preferential sick hron, nephrites, nefroza with sufficient function of kidneys, without disturbance of blood circulation.
To. it is contraindicated at all diseases in an acute stage and at sharp aggravations of various chronically current processes, at pulmonary and cordial and cardiovascular insufficiency of the II—III degree. More detailed than a contraindication to the direction of patients to these or those climatic resorts — see. Sanatorium selection, table .
Methodical bases of a climatotherapy
To. it is most widely applied in climatic resorts. In the USSR there is a large number of climatic resorts: seaside, mountain, flat, with climate of deserts, and also mixed — balneoklimatichesky, klimatogryazevy and klimatobalneogryazevy (see. Resorts ). Methods K. — the air-cure, heliation, thalassotherapy can be applied in various climatic zones not only in resorts, in sanatoria and rest houses, but also in others to lay down. and preventive institutions (-tsakh, dispensaries etc.). Efficiency To. depends on observance of a number of methodical requirements: the accounting of nature of acclimatization, medical assessment of weather, control of reactions to klimatoprotsedura, prevention of meteopatichesky reactions (see. Klimatopatologiya ), dosing of climatic influences.
At normal process acclimatization (see) it is possible to carry out all types To. taking into account the nature of a disease and seasons of year, at the slowed-down acclimatization To. appoint in the minimum doses, at pathological — special klimatoterapevtichesky procedures are not appointed. For control of reactions of patients to klimatoterapevtichesky procedures consider subjective thermal feelings (warmly, cold, stuffy etc.) and a wedge, data (a fever, cyanosis, «goosellesh», an asthma, a condition of pulse, the ABP, breath, duration of the recovery period funkts, indicators after the procedure, etc.).
For the timely prevention of meteopatichesky reactions at weather, adverse for this patient, it is necessary to lower a dose of klimatoterapevtichesky procedures or to temporarily cancel them, to reduce intensity physical. loadings to appoint individual preventive medicinal therapy — broncholitic, vasodilating, sedative, etc.
P. G. Mezernitsky (1927 — 1937), V. G. Boksha, G. D. Latyshev (1955 — 1970), V. I. Rusanov (1960 — 1976) and others developed the technique of dosing of the main klimatoterapevtichesky procedures which is based on definition of the factor which is most characterizing fiziol, activity of procedures. For solar radiations — it is the size of total solar radiation estimated in calories on 1 cm 2 body surfaces in 1 min., or the biodose characterizing biol, activity of UF-radiation; for air bathtubs and bathings — extent of cooling — the size of «cold loading», i.e. a difference between a thermolysis of an organism and its heat production in kilocalories on 1 m 2 body surfaces. Thus, dose of the procedure K. (the size which is a measure biol, actions of a klimatofaktor) it is expressed most often in calories on a surface unit of a body. Duration of the klimatoterapevtichesky procedure depends on weather conditions in which it is carried out. The special tables showing a ratio between the size of a dose, duration of the procedure and conditions of the environment are in practice used. The last are determined by the equivalent and effective temperature (EET) for air bathtubs, by the radiation and equivalent and effective temperature (REET) for solar bathtubs, by water temperature for bathings. EET characterizes heatfeeling of the person on the basis of the accounting of air temperature, its humidity and speed of wind. The essence of an indicator of EET is in what each this specific combination of air temperature, its humidity and speed of wind is designated that temperature, at a cut the heatfeeling is equivalent to heatfeeling in the motionless and completely saturated with water vapors air. The indicator of REET, except stated above meteorol, components, includes also the size of intensity of total solar radiation.
For definition of optimal conditions of carrying out klimatoprotsedur so-called zones of comfort (in size REET and EET) which borders are various for patients with different diseases are established. The same dose out of a zone of comfort works more annoyingly, the in borders of a zone, and the stronger, than more conditions differ from comfortable. There are attempts of creation of autodosers for more exact dosing klimatoprotsedur (the Helios system, etc.).
The volume and a dosage of special climatic influences
the Volume and a dosage of special climatic influences are defined by the sanatorium and climatic modes (see. Sanatorium ).
Allocate the mode No. 1 (shchazheniya) including the dosed day dream on air, air bathtubs and bathings in the sea, the lake, the river, the pool with weak cold loading (to 25 kcal/m 2 at EET higher than 18 ° and water temperature higher than 20 °), solar radiations to 20 — 30 kcal (1 — 1,5 biodoses) at REET 20—26 °; the mode No. 2 (toning, moderate influence), at Krom a dose of air bathtubs and bathings increases to 35 kcal/m 2 (average cold loading) at EET higher than 15 ° and water temperature higher than 17 °, solar radiations — to 40 kcal (2 biodoses) at REET 16—29 °, the night dream on air, a dream on the seashore (a sea air-cure) is appointed; the mode No. 3 (trainings of the expressed influence) with air bathtubs and bathings to 45 kcal/m 2 (strong cold loading) at EET higher than 6 — 10 ° and water temperature higher than 10 — 15 °, solar radiations to 60 — 80 kcal (3 — 4 biodoses). For children of 7 — 13 years of a dose of cold loading decrease by 10 kcal/m 2 , doses of solar radiations — on 0,5 — 1 biodose.
For carrying out To. various constructions are used: special klimatopavilyona, aero sunbeds (see) to lay down. beaches (see), pools, and also loggias and verandahs for a dream on air at sanatorium cases, etc. Special devices (boards for protection against wind, a cabin for a winter heliotherapy, etc.) allow to extend time of holding klimatoterapevtichesky procedures for several months. In day of reception of a complex klimatoprotsedur it is possible to appoint no more than one physiotherapeutic procedure. If solar bathtubs or bathings are not carried out, then it is possible to apply two physiotherapeutic procedures, them replacing (e.g., UF-radiation from artificial sources and a sea bathtub). Between reception klimato-and physiotherapeutic procedures there has to be a break not less 2nd hour. After thermal fizio-balneoprotsedur it is impossible to apply cold climatic influences. It is not necessary to carry out klimato-and physiotherapeutic procedures with action of an identical orientation (e.g., solar radiations and UF-radiation). Combination To. to different types to lay down. physical cultures (gymnastics, swimming, rowing, sports, etc.) are strengthened by its tempering and training effect.
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V. G. Boksha.