RESORTS (German Kur treatment + Ort the place) — the areas having natural medical factors (mineral springs, deposits of therapeutic muds, favorable climate), and also having balneotekhnichesky, hydraulic engineering constructions and a number of treatment and prevention facilities. Definition To. only how to lay down. areas it was lawful at early stages of history of development To., when natural factors were applied spontaneously, methods of treatment were based on empirical representations and evidence-based indications to their use did not exist.
The main type to lay down. institutions on To. — sanatorium (see). Along with the sanatoria located on To., there are so-called local sanatoria which are out of To., near the cities and industrial centers. These sanatoria are intended generally for patients, the Crimea stay in usual climatic conditions is recommended. On To. exists so-called out-patient kursovochnoye treatment for patients whose state of health does not demand observance of a sanatorium regime. Such patients are treated in all-resort policlinic, and live in boarding house (see), hotel, etc. On many To. along with sanatoria there are also rest houses (see. Rest house ). Vacationers in rest houses use natural resort factors in the recreational and preventive purposes.
- 1 Classification of resorts
- 2 History
- 3 Organization and development of the Soviet resorts
- 4 Bases of sanitary protection of resorts
- 5 Foreign resorts
- 6 Tables
- 6.1 Table 1. Distribution of bed fund of sanatoria according to their medical profile (as of 1978)
- 6.2 Table 2. Growth of number of sanatoria, institutions of rest and beds in them for years of the Soviet power (in comparison with 1913)
- 6.3 Table 3. APPROXIMATE DISTRIBUTION of the RESORTS of the USSR ACCORDING TO THEIR PROFILE, the MAIN NATURAL MEDICAL FACTORS, LOCATION (according to Central office on management of resorts of labor unions for September 10, 1979)
Classification of resorts
On character natural to lay down. factors To. are divided into several types (or profiles): balneal, mud and climatic (see tab. 3 — distribution of the resorts of the USSR according to their profile and the main natural medical factors). Many To., wanting several natural to lay down. factors, are balneogryazevy, balneoklimatichesky, klimatogryazevy, klimatobalneogryazevy; allocate also To. klimatokumysolechebny and To. with special, unique natural factors. On balneol. To. the basic natural to lay down. a factor are mineral waters (see), used for bathtubs, flourishes, inhalations, rinsings, irrigations, intestinal washings and for drinking treatment (see. Balneoterapiya ). On mud To. (see. therapeutic muds ) apply curative dirt (sulphidic silt, peat, sapropelic, clay Ils, sopochny and hydrothermal dirt); methods of their use — mud applications, mud tampons (band techniques), etc. (see. Mud cure ). On climatic To. leading to lay down. a factor are the climatic properties of the area caused by a geographical arrangement To., land relief, height above sea level, character of vegetation, etc. Climatotherapy (see) on climatic To. it consists of methods air-cures (see), heliations (see) and thalassotherapy (see).
The alphabetic list of the main To. The USSR with the short characteristic of their leaders to lay down. factors — see. the List of resorts and resort regions of the USSR with their short characteristic . Accommodation of the main To. in the territory of the USSR — see on the enclosed card.
Use of curative forces of nature (sunshine, pure air, mineral waters and to lay down. dirt) began in an extreme antiquity. Ancient Egyptians, Assyrians and other people of the ancient world used natural to lay down. factors. Especially widely mineral thermal waters in Ancient Greece and Ancient Rome where much attention was paid to culture of a body applied climatic factors of pi. To this purpose served sea bathings, solar bathtubs and walking without clothes on the sea beaches carrying the name of «arenariya», or «гелиозис», massage physical. exercises.
Hippocrates noted dependence of health of the person on state of environment, climatic features nearly 2400 years ago, pointed to beneficial influence of mineral waters, to lay down. dirt and physical. exercises. In Ancient Rome areas with healing mineral waters were known. On site an exit of mineral sources in Rome built terms. A. Tsels's treatises, K. Galen, etc. (1 — the beginning 2 century AD) contain the first attempts of classification of mineral waters, creations of a technique of treatment by dirt, solar radiations, councils for treatment * some diseases are given by curative climate. In particular, K. Galen recommended to patients with bent mountain climate for «an ulceration of lungs».
The Roman legions found in the countries won by them new to lay down. and some of them arranged well areas. Many terms and balneotekhnichesky constructions founded by Romans on the coast of the Black Sea remained. So, in the resort functioning nowadays in SRR Bale-Erkulanum (Herculaneum) the texts cut on stones showing the road to «sacred» waters of Oat-flakes remained. Doctors of Italy applied for a long time in to lay down. the purposes of a bathtub from the diluted volcanic dirt — fango. In «Canon of medical science» (see) Ibn-Sina ideas of a role natural are in detail described to lay down. factors in strengthening of health.
The beginning of development To. in Russia treats the first half of 18 century. In 1717 Peter I issued the decree to the Senate «... to look for in our fatherland, and especially in such places where there are iron ores, key waters which can use from diseases».
In 1714 the worker of Konchezersky iron-works Ivan Ryabov in Karelia, near present Petrozavodsk, found a source of the ferruterous mineral waters called in honor of Mars — god of iron and war — «Marcial». On the basis of this source the first resort in Russia was created. Peter I himself was repeatedly treated on it. Under its decree were made «Dokhturskiye governed as at these waters to arrive»; before going to Olonets waters, patients were recommended to consult to doctors. In 1717 Shober opened several warm mineral sources in the North Caucasus (Beshtausky sources), he reported also that «in the Circassian earth there is fairly acid spring» (possibly, it was talked of the narzena); sources of Sergiyevsky Mineralnye Vody were opened for them.
In 1771 S. G. Gmelin described the Lipetsk mineral waters, in 1773. I. A. Gyuldenshtedt, and then and P. S. Pallas — natural to lay down. resources of Caucasus Mineralnye Vody region.
In 1784 according to the recommendation K. I. Gruma Baldonsky mineral sources in the territory of modern Latvian SSR were inspected. In 1798 I. G. Georgi made the systematic list of all mineral waters of Russia which became known from 1714 for 1798 and made attempt of their classification. F. P. Gaaz in the book «My Travel on Aleksandrovsky Waters 1809 — 1810» published in 1811. Moscow the un-volume in fr. language, lit history of the Zheleznovodsk and Yessentuki mineral waters opened for them, submitted their chemical characteristic, described experience of use of these waters in to lay down. the purposes, and also made proposals on the structure of medical institutions in the Russian resorts arising at that time.
Wars in the Caucasus and Central Asia were followed by «opening» to lay down. areas which were known to local population. These To. were partially used for treatment of the military personnel, however their device, as well as most of the others To., had primitive character and depended on an initiative of certain enthusiasts and owners. In the second half of 19 century the significant role in studying of resort richness of Russia was played by such scientists as A. IT. Nelyubin, F. A. Batalin, A. I. Voyeykov, A. A. Lozinsky, etc.
Great value in development domestic To. scientific had 19 century created in the 60th medical societies (see). So, founded in 1863 by S. A. Smirnov Russian balneal about-in on Caucasus Mineralnye Vody region (see) along with development of problems of balneology and a resort therapy paid to business of the organization and K. Sposobstvovalo's improvement to development of resort business much attention Russian society of protection of national health (see).
Paying tribute to progressive public figures, doctors, hydrogeologists, chemists, climatologists and other specialists (to F. P. Gaaz, S. P. Botkin, V. I. Vernadsky, A. I. Voyeykov, G. A. Zakharyin, M. V. Sergeyev, etc.) who the works in many respects promoted studying natural to lay down. richness of the country and to their use for the benefit of the people, it is necessary to emphasize that development domestic To. it was braked by imperial autocracy. Already open resort areas with the richest natural resources did not accustom, and in huge territories of Siberia, the Far East and Central Asia only small number K was known., in spite of the fact that the local population long since used curative sources, dirt, etc. Treatment on To. to workers it was unavailable.
Original blossoming domestic To. came after Great October socialist revolution.
Organization and development of the Soviet resorts
After establishment of the Soviet power in the first decrees of SNK RSFSR about resorts the foundation of modern system a dignity was laid. - hens. help to workers. On April 4, 1919 I. Lenin signed the decree «About medical areas of nation-wide value». In it nationalization was proclaimed To. also ways of development are planned to lay down. the help on them. This historical document defined further ways of development of resort business and the principles of the organization of medical service in sanatoria and in resorts. It was specified in the decree that «medical areas or resorts where those in the territory of RSFSR neither were also to whom nor belonged, with all constructions, structures and a personal property servicing earlier the resort and being on the lands attached and attributed to the resort, make property of the Republic and are used for the medical purposes». The decree established special a dignity. protection of resort areas; the institutions located there were equated concerning provisioning and fuel to-tsam that was at that time of great importance. The decree signed by V. I. Lenin on December 21, 1920 «About use of the Crimea for treatment of workers» also will get care of the Communist Party and Soviet state about health of the people. It was specified in the decree: «... beautiful dachas and mansions which big land-owners and capitalists used earlier palaces of the former tsars and grand dukes shall be used under sanatoria and health resorts of workers and peasants». According to this decree of Narkomzdrav of RSFSR had to develop in January, 1921 in the Crimea 5 thousand beds, and in the spring of the next year to have sanatoria on 25 thousand beds. Overseeing by selection of sick workers, and also behind placement them in sanatoria in the Crimea was assigned to labor unions and Narkomzdrav of RSFSR.
In 1920 in Narkomzdrava of RSFSR the department was organized to lay down. areas, in 1923 transformed to the Head resort department, the Crimea directed N. A. Semashko. Organized in 1926. Central in-t of balneology, being engaged, in addition to development of scientific problems, also questions of the organization a dignity. - hens. business and planning To., and the Central scientific resort office created in 1936 at the Head resort department performed management of all business a dignity. - hens. help in the country, accounting of resort resources, their protection and check of the correct use. In planning and the organization a dignity. - hens. affairs in the country since 1919 were directly involved D. I. Ulyanov, N. I. Tezyakov, H. E. Hrisanfov, N. A. Kost, G. M. Danishevsky, I. D. Yakhnin, S. A. Mamushin, A. N. Ogilvi, S. S. Nalbandov, A. A. Akopyan, And. G. Koniashvili, etc. For successful use to lay down. factors To. in the first years of the Soviet power important organizational and technical measures for preservation were carried out to lay down. dirt of the lake. Big Tambukan, the Odessa estuaries, Saksky and Moynaksky mud lakes and to recovery balneo-and mud baths of Yessentuki, Zheleznovodsk, Kislovodsk, Odessa, Pyatigorsk, Saca, Sergiyevsky Mineralnye Vody, Sochi-Matsesta, Staraya Russa, Tbilisi a term, etc.
V. I. Lenin personally monitored recovery To. and their construction, was interested as treatment and food of patients will be organized. According to its instruction network K. and sanatoria extended. If in 1919 there were only 5 resorts, then in 1922 22 worked; the resorts of Caucasus Mineralnye Vody region, and also in Transcaucasia and in the Far East began to function.
Development of scientific research of resorts allowed to lay the strong theoretical basis of methods of a resort therapy. For the short period new forms of the organization and the methodical principles of development of the theory and practice of resort business were developed. Great value in further improvement a dignity. - hens. in the country development and creation of organizational and methodical bases of medical selection of patients on a dignity dealt. - hens. treatment. New hydromineral resources are reconnoitered, districts, perspective for resort construction are defined.
Development of the resort help in the country went according to economic development and creation of material and technical resources of socialism. For the first five-years period construction To. considerably extended.
By 1940 the considerable material and technical resources for carrying out a resort therapy were created and its major scientific principles are developed; in the country 1750 sanatoria with a total capacity at 224 700 beds and rest houses on 50 000 beds functioned.
From the first days of the Great Patriotic War all sanatoria were turned in hospital in which there was a specialized medical aid to wounded soldiers and officers of the Soviet Army. At treatment of gunshot wounds of bones and joints, the central and peripheral nervous system, effects of internal injuries, at contractures, trophic ulcers, etc. along with surgical methods resort factors in combination with physical therapy and physiotherapy exercises were widely applied. Such complex treatment promoted more bystry recovery of health and fighting capacity of wounded and their return to the front. Before the end of war in the districts freed from fascist aggressors medics and workers of resorts under the direction of party and Soviet bodies achieved considerable results in recovery of the destroyed buildings of sanatoria and balneokhozyaystvo To.
New stage in development To. in post-war years it is characterized by further considerable expansion of sanatorium base as due to recovery destroyed during war to lay down. - professional, institutions on To., and constructions of new sanatoria, resort policlinics, balneo-and mud baths, hydraulic engineering and klimatoterapevtichesky constructions. Considerable development was gained by local and children's sanatoria, and also institutions of rest — rest houses, boarding houses.
Hydrogeological researches and prospecting works with the purpose of identification and studying of new hydromineral resources were conducted, were under construction balneotekhnichesky constructions (see), the service of overseeing was organized by the mode and the correct operation of mineral waters. Significant assistance in improvement of methods of a resort therapy was given by the researches of the mechanism of action conducted in in-ta of balneology physical. factors on an organism, development and use of techniques of the differentiated use of these factors at the most often found diseases.
A further important stage of improvement of the sanatorium help was the resolution of Council of ministers of the USSR of March 10, 1960. «About transfer to labor unions of sanatoria and rest houses». Sanatoria were enlarged and the reorganization of medical and diagnostic base K is begun. On large To. all-resort offices on functional diagnosis are created, the physiotherapeutic and mechanotherapeutic offices equipped with electrophysiologic, x-ray and other equipment and also are organized basic sanatoria. Tasks of basic sanatoria include generalization and distribution of the best practices of the best a dignity. - hens. institutions, implementation in practice to lay down. the techniques developed by research in-ta of balneology and physical therapy, other in-ta of M3 of the USSR, the USSR Academy of Medical Sciences and departments of medical in-t and in-t of improvement of doctors. Improvement of quality of medical and diagnostic work was promoted by the organization on many large To. the centralized all-resort biochemical, allergological and immunological laboratories, the x-ray centers and other specialized offices. On a row K. collecting, transfer and processing of medical information are automated, methods of radio telemetry for remote funkts, researches of a condition of patients are implemented during reception balneoprotsedur, the dosed walking on terrainkur, etc.
Expansion of network of sanatoria, hl continued. obr. in the central and northern districts of the European part of the USSR, in the Caucasus, the Urals, in Western and Eastern Siberia, in the Far East, in Kazakhstan and the Central Asian republics.
Essential value in work on further specialization of sanatoria had improvement of their material equipment, providing with the corresponding medical equipment and shots of specialists doctors, professional development of medical shots. Expansion of network of specialized sanatoria and distribution of specialized sanatorium beds are made on the basis of the differentiated definition of need of patients in specialized a dignity. - hens. help. These standards make proceeding from the general incidence. According to it plans of perspective development specialized a dignity are developed. - hens. institutions. Data on distribution of bed fund of sanatoria according to their medical profile for 1978 are provided in tab. 1.
In addition to distribution of sanatoria on the main medical profiles, there are sanatoria and sanatorium departments of narrower profile for adults and children. So, there are sanatoria for treatment of patients with inflammatory diseases of peripheral vessels of extremities, with effects of injuries and diseases of a backbone and spinal cord, patients with bronchial asthma, occupational diseases of a respiratory organs, etc.
Great value for increase in efficiency a dignity. - hens. further improvement of scientific and methodical bases of medical selection of patients for a dignity had treatments. - hens. treatments. As dignity. - hens. treatment is only one of stages of treatment of the patient, it shall be coordinated with the previous and subsequent treatment. Proceeding from it, selection of patients on a dignity. - hens. treatment is carried out to lay down. - professional, institutions in the place of work or a residence of patients, MSCh of the enterprises, policlinics, tubercular clinics, clinics for women etc. according to the rules and medical indications established to M3 of the USSR in coordination with the All-Union Central Council of Trade Unions (see. Sanatorium selection ).
Efficiency of treatment of patients on To. and in sanatoria of the country the dignity is one of the most important indicators of quality. - hens. treatments. In the course of scientific developments the original positions characterizing efficiency a dignity were revealed. - hens. treatments. The statistical calculations which are carried out by V. V. Poltoranov, M. M. Masur, etc. on indicators of temporary disability after a resort therapy revealed high therapeutic and economic efficiency a dignity. - hens. treatments of patients with various diseases, it is preferential in early stages. The most accurate and objective indicator of assessment of sanatorium treatment is the percent of unsuccessfulness of this treatment. It was statistically established that on average it fluctuates within 2 — 5% depending on clinical forms of diseases. The accounting of unsuccessfulness of treatment allowed to determine expediency of the direction of patients with various nozol by short-term results. forms of a disease on these or those To. The accounting of the long-term results showing was of great importance, the effect in time in usual working conditions and life is how steady received to lay down. It was statistically shown that within one year the effect remains at 50 — 80%, and within the next 3 — 4 years — at 22 — 62% treated. The effect of a resort therapy of patients with diseases of a peripheral nervous system is steadiest, is least steady — patients with an idiopathic hypertensia of the II stage.
Thus, in the USSR there were philosophy of the organization a dignity. - hens. help. 1. Development dignity. - hens. networks on the basis of studying of resort natural resources in various districts of the country, the accounting of needs in a resort therapy of the population and the scientific accounting of medical and economic efficiency of such treatment. 2. Rational medical selection of patients for treatment on To., carried out according to evidence-based indications. 3. Availability dignity. - hens. the help for all segments of the population. Providing permits in sanatorium and institutions of rest of hl. obr. free of charge or for 30% of cost at the expense of the budget of social insurance, and in children's sanatoria, in sanatorium for TB patients — it is only free at the expense of the state budget. Free permits are provided also to disabled people of the Great Patriotic War and disabled people of some other categories (see. Health care ).
Management and management dignity. - hens. network in the USSR it is carried out by Central office on management of resorts of labor unions. In federal republics regional, regional territorial councils on management of resorts of labor unions are subordinated to it republican (except RSFSR).
Councils carry out planned development a dignity. - hens. institutions, will organize their material support, are engaged in upgrading of medical and diagnostic process and efficiency of treatment of patients on To.
Obligations for coordination of activity a dignity are assigned to Central office on management of resorts of labor unions. - hens. and recreational institutions, irrespective of their departmental subordination, in questions of use to lay down. natural factors and organization of the resort mode. It allowed to create uniform instructions for use all health resorts of the country, all-spa facilities. The main questions of activity To. are regulated by the Provision on the resorts of the USSR approved by Council of ministers of the USSR (1973). The order of recognition of the area by the resort of all-union, republican or local value is defined. The main requirements to protection natural are regulated to lay down. factors and dignity. to a state To., districts a dignity are provided. protection To.
To upgrading of the medical and diagnostic help on To. work of the scientific and resort commission at Central office on management of resorts of labor unions promotes. Chief specialists of Central office, the Central scientific research institute of balneology and physical therapy, specialists of in-t of the USSR Academy of Medical Sciences and M3 of the USSR are a part of the commission. Chief specialists of republican, regional territorial councils on management of resorts of labor unions take part in work of the commission. This advisory body studies a condition of medical and diagnostic work To., introduces amendments in its organization, plans and considers scientific and practical work of doctors in a dignity. - hens. institutions, develops and recommends rational forms of the organization of medical service of patients and vacationers for implementation, defines perspectives of development To., etc. The essential help in the solution of these and other scientific organizational issues is rendered Central and republican research in-you to balneology and physical therapy, and also by the research laboratories of balneology which are on separate To.
The general management of network of resorts and sanatoria for TB patients, and also children's sanatoria is carried out by the Ministry of Health of the USSR and the Ministries of Health of federal republics.
For years of the Soviet power in the country a dignity. - hens. the network considerably extended (tab. 2).
As show these tab. 2, the number of sanatoria and institutions of rest in 1960 — 1978 increased by 3 times; the quantity of beds during this time increased in them almost by 3,7 times.
The number treated and using organized rest in 1978 in comparison with I960 of increased by 5,7 times, including only in one 1977 in system of labor unions the number of treated and having a rest increased by 2351 thousand persons.
The number of the sanatoria functioning round the clock (without sanatoria dispensaries), and boarding houses with treatment since 2106 to 2229, sanatoria dispensaries — since 1066 to 2386 increased, including under the authority of labor unions their quantity increased from 895 to 2292. If in 1960 „in rest houses and boarding houses 3103 thousand, then in 1978 — 5337 thousand persons had a rest.
The data which are stated above confirm big scope of the organization of treatment and rest of workers in the USSR that really provides the right for medical aid and the rest which is written down in Constitutions of the USSR.
The Communist Party and the Soviet government pay much attention to further development To. and institutions of rest. The «Main directions of development of the national economy of the USSR for 1976 — 1980» accepted by the XXV congress of the CPSU provided: to increase network a dignity. - hens. institutions, rest houses, boarding houses and dispensaries, and also hotels in the cities and especially in the tourist and resort centers; to carry out further expansion and improvement a dignity. - hens. zones, especially in the Urals, in Siberia and in the Far East; to provide further development of resort areas and tourist centers on the coast of the Black Sea and in mountain districts; to continue development of resorts on the Riga beach; to develop works on creation of the resort area near the Lake Issyk Kul.
Except the listed districts, development acting and creation new is provided in the tenth five-years period To., especially close large industrial and page - x. centers. For wider extra resort use natural to lay down. factors in the large cities and industrial centers of a pas to base of the removed mineral sources and close located deposits to lay down. dirt construction of balneogryazelechebnitsa is provided that will give the chance to workers to use these types of treatment in climatic conditions, usual for them. The tenth five-year plan provided construction of such institutions in Kiev, Minsk, Saratov, Kuibyshev, Bitter, Perm, Lipetsk, Nizhny Tagil, Magnitogorsk, Saransk, Cheboksary, Kostroma, Omsk, Krasnodar, Yakutsk and other cities. For treatment of mothers with children construction with use of the means earned by workers from All-Union communistic community work days, the relevant sanatoria on 3000 places in the resorts of Kislovodsk, Karachi (lake Karachi), Belokurikha, Kuldur, Morshin, the Bayram Alya, etc. is planned.
On construction To., sanatoria, policlinics, mud baths, balneolechebnitsa, swimming pools, beaches, klimatosooruzheniye, institutions of preventive rest, their improvement, hydrogeological and other works only through Central office on management of resorts of labor unions from 1976 to 1980 is planned apprx. 1 billion rubles; it is supposed to put into operation due to new construction 80 thousand places in sanatoria and institutions of rest. Big participation in resort construction in the tenth five-years period on a contract basis with Central office on management of resorts of labor unions as shareholders and builders is accepted also by the ministries, departments, the industrial enterprises, collective farms, state farms and other institutions and the organizations. == Organizational bases of a resort therapy == In-depth studies of the mechanism of action separate natural physical. factors and their combination to physical therapy to lay down. with physical culture, mechanotherapy, etc. at various diseases, specialization of sanatoria and equipment of their necessary medical and diagnostic equipment, implementation in sanatorium practice of achievements of scientific research and increase in efficiency of complex treatment allowed to expand indications for a dignity. - hens. treatments and it is more rational to use opportunities physical. factors in the medical, preventive and rehabilitation purposes.
Earlier was considered that the resort therapy can be applied only at initial stages of diseases, functional disturbances, at chronic diseases for the purpose of prevention of their progressing, in a stage of full or incomplete remission. The scientific research of in-t of balneology and physical therapy which are carried out jointly with specialized clinics and practice of treatment of patients on To. and in sanatoria showed that physical. methods of treatment can be applied not only in these stages of a disease, but also in earlier terms after the postponed acute disease, at subacute diseases or soon after the recurrence of a disease, chronic, inclined to progressing, that prevents their further development, reduces terms of temporary disability and promotes recovery of health of the patient.
In complex therapy physical. factors apply as successive treatment at the following stages: policlinic or a hospital — local sanatorium — the resort — policlinic. Such sequence is defined by the fact that if in local sanatorium the patient practically does not adapt to climatic conditions, unusual for it (atmospheric pressure, temperature and air humidity, level of insolation, force and the direction of the dominating winds, etc.), then in climatic resorts there can be a need for very big secondary stress of adaptable mechanisms which failure sometimes leads to an exacerbation of the disease which served as the indication to the direction to the resort. The special tension of adaptable mechanisms is noted during any changes during a disease, especially in the period of its aggravation. It is necessary to take into account and the course of associated diseases which, irrespective of the main suffering, also in a varying degree cause tension of adaptation and compensatory processes. At last, it is necessary to resolve an issue of expediency or inexpediency for a while to tear off the patient from usual living conditions and work. Therefore the inspection of the patient preceding his direction to the resort shall be careful and profound, but not just come down to filling of columns a dignity. - hens. cards.
Conducting examination, the doctor shall pay attention not only to a condition of the patient at present, but also to establish whether he is tended to development of a disease that is especially important. So, at the coronary heart disease which is shown in the form of stenocardia it is necessary, collecting the anamnesis, to pay special attention not so much to the frequency, intensity and duration of attacks of angina pectoris at the time of inspection how many to change of these indicators for the last weeks and months. If at the stable course of a disease of the patient it can be directed according to indications to certain climatic resorts, then in case of ascertaining of change of character of attacks (their increase, strengthening of intensity, lengthening, lack of effect of reception of nitroglycerine which clearly stopped earlier attacks, transformation of an angina of exertion in stenocardia of rest) in general remove a question about a dignity. - hens. treatment even in local sanatoria without preliminary hospitalization and selection of therapy. Only through 2 — the Snake, after stabilization of a course of a disease of the patient it can be sent for an aftercare to Local sanatorium. It is necessary to remember that in some cases the state described above called by unstable stenocardia precedes development of a myocardial infarction. Sometimes the heart attack is preceded by the nonspecific changes which are shown complaints to excessive fatigue, weakness, causeless decrease in mood, apathy which are most often regarded as result of overfatigue. However, meeting them at the patient with coronary heart disease, the doctor shall show big vigilance and find out carefully whether there is a real reason for overfatigue. Unlike overfatigue, the specified conditions of fatigue, a depression, apathy develop at patients with coronary heart disease sharply and most often for no apparent reason. The direction of such patients on a dignity. - hens. treatment, even in local sanatoria, it is also necessary to postpone and observe their condition of 2 — 3 weeks in out-patient or stationary conditions.
According to new provisions it is possible to send to local sanatoria for an aftercare and rehabilitation of the patients who had a myocardial infarction, in 3 months from the moment of development of a disease. At the direction in sanatorium of such patients it is necessary to inspect especially carefully. The sanatorium therapy is possible, only on condition of progressive improvement of their state within these 3 months. So, from the formal point of view it is admissible to direct to local resorts of the patients who had a myocardial infarction with a circulatory unefficiency of the I stage. However if the doctor at the time of survey states heart failure at the patient, edges was absent at it at an extract from a hospital, it is necessary to postpone the direction of the patient in sanatorium and to pick up to it adequate therapy for elimination of the arisen heart failure. Only after that against the background of the picked-up treatment of the patient it can be directed to the local resort. According to the current situations of the patients who had a myocardial infarction it is possible to direct to local resorts in the absence of heavy disturbances of a rhythm. Unfortunately, it is not always easy to reveal similar arrhythmias of heart: at the patient rare paroxysms of ventricular tachycardia which subjectively are not perceived by it can take place, e.g. It is possible to state such arrhythmias only by long registration of an ECG, napr, by means of portable cardiomonitors (see. Monitor observation ).
Similar focus is necessary during the collecting the anamnesis at the patient with an idiopathic hypertensia. It is undoubted, important to define a stage, a phase and a form of a disease, but it is even more important to find out whether its character for the last months changed. At the same time it is necessary to pay attention to emergence or increase of hypertensive crises, change of their character — transition of sympaticoadrenal crises of the I type to the heavy crises of the II type which are shown edematous encephalopathy (see. Idiopathic hypertensia ).
If patient at whom not heavy sympaticoadrenal crises are for many years observed it is possible and it is useful to direct even to the climatic resort, then at heavy crises of the II type hospitalization is necessary, and only after selection of adequate therapy and elimination of such crises the question of the direction of the patient in local sanatorium can be raised. Emergence in the patient with an idiopathic hypertensia of persistent severe headaches of localization, unusual for it, can be a harbinger of disturbance of cerebral circulation in any stage of a disease and demands careful nevrol, inspections. It is possible to return to a question of the direction of such patient to the local resort only after the reason of pains is specifically established, it is proved that disturbances of intracerebral blood circulation are not their cornerstone (pain can be, e.g., a consequence of sinusitis, at Krom a dignity. - hens. treatment is shown).
The same approach is most reasonable at the direction on a dignity. - hens. treatment of patients with heart failure irrespective of its etiology. So, proceeding from the current situations, it is possible to send patients with coronary heart disease with an angina of exertion and a circulatory unefficiency to local sanatoria not above IIA of a stage. However if the doctor found out that heart failure arose recently, a rezistentna to the carried-out therapy or that its symptoms tend to increase before sending the patient to sanatorium it is necessary to achieve improvement and stabilization of its state, and also shall pick up adequate and rather effective therapy, to continue to-ruyu the patient in sanatorium conditions.
At the direction to resorts of patients with rheumatism it is very important to define activity patol, process. At active rheumatic process of patients it is possible to send only to local sanatoria and only when the tendency to improvement a wedge, symptoms and corresponding a lab clearly is traced. indicators, especially so-called indicators of activity of rheumatic process (see. Rheumatism ). Treatment in climatic resorts is possible according to indications only at total absence of the activity of rheumatic process proved both by dynamic overseeing by a condition of the patient, and resistant absence biochemical, or serol, signs of activity of process.
The patients who underwent heart operations (aortocoronary shunting, a korrigirovaniye of heart diseases) in the first months after operation in connection with instability of a state and a possibility of development in them of heart failure and disturbances of a heart rhythm, and also tromboembolic episodes are subject to an aftercare and rehabilitation only in local specialized sanatoria. If the condition of the patient remains steadily satisfactory for a year after operation, it can be directed to the climatic resort of the corresponding profile (tab. 3).
Scientific research on a problem of an aftercare and rehabilitation of patients directly after performing hospitalization in local sanatorium showed high performance of such step-by-step treatment. So, it is established that at the patients recovering after the postponed myocardial infarction in local sanatorium terms of disability were considerably reduced, the level of disability in comparison with the patients treated only in a hospital and then in policlinic decreased. In the resolution of the Central Committee of the CPSU and Council of ministers of the USSR 1977. «About measures for further improvement of national health care» allocation for an aftercare of the patients who had a myocardial infarction on 50 thousand a dignity is provided. - hens. permits annually, since 1981 who will be given by a patient free of charge at the expense of the budget of social insurance.
At the first and second stages of treatment (a hospital — local specialized sanatorium) depending on a condition of patients medical physical apply. factors — natural and preformirovanny by the sparing technique (a physical activity, terrainkur, an air-cure, local bathtubs, electro-, phototherapy, etc.) — at control of the general condition of the patient and a wedge, displays of a disease. On this ethane and further (already in conditions To.) at absence at sick any indicators of activity of process, the expressed hemodynamic, secretory and trophic disturbances of a technique of use these medical physical. factors (motive loading, kinesitherapy, air-cure, etc.) are intensified. Their use in complex treatment of patients extends due to inclusion of a balneoterapiya — purpose of mineral waters inside, the general mineral bathtubs and, besides, the general air bathtubs, etc.
If at the beginning of such step-by-step treatment most of patients needed to appoint drug treatment, then at the subsequent stages in process of manifestation to lay down. effect of natural factors of a dose of medicines, as a rule, gradually decrease, and at a resistant positive take of a resort therapy pharmaceuticals can in some cases and be cancelled. Thus, the resort therapy is complex, it includes use natural and preformirovanny physical. factors, if necessary — medicinal therapy, and also psychotherapy (see). Use of psychotherapeutic methods improves an emotional condition of patients, promotes creation of a favorable background for to lay down. effect the applied natural and preformirovanny physical. factors, medicines, and also promotes potentiation of action of a resort therapy. Considerable value in efficiency of a resort therapy has switching off of the patient from a usual situation, the maximum stay in the open air and observance of an all-resort and sanatorium regime. All schedule of life on To. and in sanatorium submits to requirements of treatment and the mode, rational for patients. The all-resort mode regulates an order and working hours of all-spa facilities (beaches, balneogryazelechebnitsa, etc.), the dignity provides observance. conditions, silence. The sanatorium regime provides an operating procedure of medical and diagnostic offices, and also the individual regime of the patient including rules of his behavior, the mode of treatment, rest etc. (see. Sanatorium ).
The resort therapy is important in prevention of diseases. So, in the presence funkts, disturbances methods of resort therapy by recovery and activation of a row funkts, systems promote elimination of initial (starting) mechanisms of a disease (primary prevention). In the presence hron, and active forms of a disease methods of resort therapy promote recovery and compensation of the broken functions, slow down progressing of a disease, reduce number of aggravations and a recurrence, i.e. are methods of secondary prevention.
Bases of sanitary protection of resorts
Recognition of the area To. it is carried out in the order established by article 45 of Bases of the legislation of USSR and federal republics about health care. For preservation natural to lay down. factors To., providing efficiency of a resort therapy, it is necessary to protect them from adverse effects which can change physical. - chemical structure of mineral waters to lay down. dirt and the air basin to contaminate them various household and production waste. Measures of protection To. are regulated by the legislation of the USSR and federal republics and resolutions of the Soviet government. For protection from damage, pollution and premature exhaustion natural to lay down. resources K. are established zones of sanitary protection (see). Within these zones any works contaminating the soil, water and the air basin, and also any works which could cause damage to the woods, the green plantings which especially have essential value for preservation of moisture in the next from To are prohibited. districts where mineral waters form.
During the use of one or several fields of mineral waters, adjacent beaches connected among themselves and others natural to lay down. means several To. for them the uniform district a dignity can be established. protection.
District dignity. protection is divided into three zones.
The feed zone (a zone of a high security) covers areas where there are to a surface mineral waters, fields are located to lay down. dirt, mineral lakes and estuaries, beaches, and also coastal strip of the sea and territory adjacent to beaches, not less than 100 wide. In the territory of the feed zone are prohibited not connected directly with operation natural to lay down. means To. full-time and temporary residence of citizens, construction of facilities, production mountain and excavation, and also other actions which can exert an adverse effect on natural to lay down. means and dignity. a state To. In the territory of this zone are allowed only mining operations, construction and placement of the constructions providing rational operation natural to lay down. means.
The second zone (zone of restrictions) covers the territory, on a cut there is a drain of surface and subsoil waters to places of an egress of mineral waters and to fields to lay down. dirt, to mineral lakes and estuaries, to places of circulation of the mineral and sweet waters, superficial from the Earth's surface, participating in formation of mineral sources; natural and artificial storages of mineral waters also to lay down. dirt; the territory, on a cut are located a dignity. - hens. institutions and institutions of rest, and also the territory intended for construction of such institutions; parks, forest parks and other green plantings.
In the territory of the second zone construction of facilities and constructions (except objects and constructions which construction is allowed for improvement of resort service of patients), production of the mining and other operations which are not connected directly with development and improvement To is forbidden., the device of the absorbing wells, fields of irrigation and underground filtering, cemeteries, cattle mortuaries, a mass run of the cattle, use of toxic chemicals for fight against weeds, wreckers and diseases of plants, cutting down of green plantings (except cabins for the purpose of care of the wood and a dignity. cabins) and any other use of the land plots, forest grounds and reservoirs, a cut can lead to deterioration or reduction of quantity natural to lay down. means To.
The third zone (a zone of observation — its external borders match borders of the district a dignity. protection To.) covers all area of food and formation of hydromineral resources, the forest plantings surrounding To., and also territories, which economic use without observance of the rules established for the district a dignity. protection To., can exert adverse impact on gidrogeol. the mode of fields of mineral waters also to lay down. dirt, on a dignity. and landscape climatic conditions To. In the territory of the third zone all types of works which cannot exert negative impact on natural medical factors and a sanitary condition of the resort are allowed.
Observance of basic bases dignity. protection of these zones has essential value for upgrading of rest and treatment on To. Operation of mineral springs also to lay down. dirt, constructions of kaptazhny devices, systematic overseeing by an output, level, chemical structure and physical. properties of these to lay down. factors are carried out by the relevant services of Central office on management of resorts of labor unions.
In the countries of the socialist commonwealth all To. are nationalized, resort resources are state ownership and are used for the benefit of health of workers. Forms of the organization and methods of work To. have a number of similar lines with accepted in the USSR. Studying of resort resources and development of resort business are carried out on a scientific basis. At the direction of patients on To. and in sanatorium doctors are guided by the medical indications and contraindications approved by the Ministries of Health. The system of medical service of patients provides obligatory medical control of carrying out the appointed course of treatment. The resort therapy of workers is carried out generally free of charge or on favorable terms. Almost in all countries of the socialist commonwealth To. and sanatoria are under authority of bodies of health care, and rest house and boarding houses of rest — under the authority of labor unions.
A basis of resort matter in the capitalist countries — private-ownership, its character — commercial, the state system of the organization and management K. no. Though most part balneol. resources belongs to governmental bodies, but the state does not manage To., does not exploit them, and leases to municipalities, joint-stock about - to you and individuals. The large role in resort business is played by the tourist organizations which purpose — inflow of the foreign capital (especially in seaside and mountain resorts). Bodies of health care exercise control of observance a dignity. - a gigabyte. the mode on To., but do not take part in definition of an order of selection of patients for a dignity. - hens. treatments, in development of indications and contraindications to the direction on To. etc. The ground mass of workers cannot use a resort therapy.
However in post-war years ruling circles, bodies of social insurance and labor unions were forced to provide with preferential treatment the considerable mass of disabled people of World War II, the former prisoners, prisoners of concentration camps, orphans, some categories of the insured workers. There was a current of a so-called social termalizm and climatology and is created in 1958. The international federation of a termalizm and climatology combining resort businessmen, doctors, representatives of insurance medicine and labor unions. Originally tasks of this association was coordination of the purposes and work of the public and private institutions providing with a resort therapy the specified categories of patients. However further activity of this organization came down to the solution of economic problems of resort «industry» of the bourgeois countries, protection of interests of resort businessmen and care of increase in profits joint-stock about-in, owning resort «industry».
Table 1. Distribution of bed fund of sanatoria according to their medical profile (as of 1978)
Table 2. Growth of number of sanatoria, institutions of rest and beds in them for years of the Soviet power (in comparison with 1913)
Table 3. APPROXIMATE DISTRIBUTION of the RESORTS of the USSR ACCORDING TO THEIR PROFILE, the MAIN NATURAL MEDICAL FACTORS, LOCATION (according to Central office on management of resorts of labor unions for September 10, 1979)
With mineral waters for external use (in the form of bathtubs)
Angkawang, Arzni, Borjomi, Darasun, Dzhava, Dzhermuk, Yessentuki, Zheleznovodsk, Zaramag, to Zvare, Istis, Kislovodsk, Kozhanovo, Nakalakevi, Glade, Pyatigorsk, Sioni, Solar Transcarpathia, Tsagveri, Shivanda, Shmakovk, Yamarovk
Sulphidic (including hydrosulphuric) waters
Angara, Archman, Bakirovo, Baldone, Gagra, Gorisdzhvari, the Hot Key, Yeysk, Zekari, Kverneti, Kemeri, Kirillovn, the Maple Mountain, Keys, Codri, Krasnousolsk, Lyuben-Veliky, Matsesta, Mendzhi, Nemirov, New Keys, Nunisi, Oktomberi, Pyatigorsk, Sergiyevsky Mineralnye Vody, Sernovodsk-Kavkazsky, Bruise, Sochi, Suras, Surakhana, Sukhumi, Talgi, Tamisk, Ust-Kachka, Hilovo, Tsikhisdzhvari, of Chapayev, Cherche, Chimion, Shikhovo
Radon (radioactive) waters
Aqsa, Bila Tserkva, Belokurikha, Dzhety-Oguz, Koncha-Zaspa, Krasnousolsk, Mironovka, Molokovka, Pyatigorsk, Tkvarcheli, Uvilda, Urguchan, Ust Kut, Hop garden, Tsqaltubo, Yamkun
Nitric siliceous poorly mineral isobathing thermal waters
Almaarasan, Annensky Mineralnye Vody, Arasankapal, Aspindza, Garga, Goryachinsk, Jalal-Abad, Issyk-Ata, Kuldur, Nachiki, Obigarm, Paratunka, Pitatelevsky, Rakhmanovsky Keys, Thawed, Tersinka, Torgvas-Abano, Ush-Beldir, Hodge-Obigarm, Tsaisha, Chistovodnoye
Chloride, sulphatic, gidrokarbonatno - sulphatic and other waters without specific components and properties
Angara, Babruysk, Big Taraskul, Borisovsky, Botany, Verkhovina, Guy, the Horyn, Dzhergalan, Zhdanovichi, the Green City, Green Town, Karacharovo, Kashin, Kayakent, Kvishkheti, Kemeri, Kuryi, the Leningrad resort area (Zelenogorsk, Komarovo, Youth, Petrodvorets, Privetninskoye, Repino, Serovo, Sestroretsk, Smolyachkovo, Solar, Ushkovo), Lankaran, Lyottsa, Massala, Mezhtsiyems, Morshin, Nalchik, Narach, Nemirov, Neringa, the New Source, Obolsunovo, Rogachyov, Saryagach, Seregovo, Sitora and Mocha-Hosa, Smoke, Soligalich, Solonikh, Solvychegodsk, Staraya Russa, SU lory, the Tashkent Mineralnye Vody, the Tbilisi balneological resort, Totm, Truskavets, Usolye-Sibirskoye, Hilovo, Shaambary, Shikhovo
Yeysk, Cahul, Kudepsta, Mayan, Nalchik, Ust-Kachka, Hadyzhensk, Chartak
Mountain Yew, Nakalakevi, Sinegorsky Mineralnye Vody
Guy, Kirovakan, Kozhanovo, Cook, Kuryi, Lebarde, Marcial Waters, Bear (Lake Bear), Neringa, Shivanda, Yamarovk
With mineral waters for internal (drinking) use
Angkawang, Arzni, Arshan, Archman, Berezovsky Mineralnye Vody, Birstonas, Babruysk, Borjomi, Borisovsky, Varzi-Yatchi, Verkhovina, Veshensky, Volzhank (Undora), the Horyn, the Hot Key, Darasun, Dzhava, Jalal-Abad, Dzhermuk, Dilijan, Dorokhovo, Druskininkai, Yessentuki, Zhdanovichi, Zheleznovodsk, Zvare, the Zvenigorod and Odintsovo resort area, Green Town, the Izhevsk Mineralnye Vody, to Istis, Kalaalta, Karacharovo, Karachi, the Carpathians, Karmadon, Kashin, Polonina's Receipt, Kemeri, Kirovakan, Kisegach, Kislovodsk, Maple Mountain, Codri, Krainka, Krasnousolsk, Cook, the Leningrad resort area (Green it is bitter, Komarovo, Youth, Petrodvorets, Privetninskoye, Repino, Serovo, Sestroretsk, Smolyachkovo, Solar, Ushkovo), Likenay, Lipetsk, Mardakyan, Marcial Waters, Mayan, Myrgorod, Molokovka, Morshin, Muasha, Nabeglavi, Nalchik, Narach, Neringa, Nizhneivkino, Lower Sergi, New Keys, Obukhovo, the Glade, Pyatigorsk, Ry Elenovka, Ritsa-Avadkhara, Rogachyov, to Sairma, Sevan, Sernovodsk-Kavkazsky, Sinegorsky Mineralnye Vody, Solar Transcarpathia, Solonikh, Solvychegodsk, Tishkovo, Truskavets, Utser, Uchum (Lake Uchum), Hilovo, of Chapayev, Chartak, Chinabad, Shaambary, Shayan, Shivanda, Shira (Lake Shira), Shklo, Shmakovk, Shovi, Shusha, Shchuchinsky, Yamarovka, Yanykurgan
Peat, sapropelic, sulphidic silt (ozernoklyuchevy, continental, seaside, sea), clay Ils and sopochny dirt
Anapa, Arkady, Akhtal, Bakirovo, Baldone, Berdyansk, Birstonas, Babruysk, Big Taraskul, Botany, Varzi-Yatchi, Vasilyevsky, Guy, Gopri, Bitter (Lake Bitter), Dzhergalan, Druskininkai, Yevpatoria, Yeysk, Zhdanov, Zhdanovichi, Green City, Issyk-Ata, Kaliningrad group of resorts (Zelenogradsk, Otradnoye, Pioneer, Svetlogorsk), Karachi, Kashin, Kayakent, Kemeri, Kempendyay, Kirillovna, Kisegach, Maple Mountain, Krainka, Krasnousolsk, Kuyalnitsky, Leningrad resort area (Zelenogorsk, Komarovo, Youth, Petrodvorets, Privetninskoye, Repino, Serovo, Sestroretsk, Smolyachkovo, Solar, Ushkovo), Lyottsa, Liepaja, Likenay, Lipetsk, Lunacharskoye, Lyuben-Veliky, Marcial Waters, Mayan, Bear (Lake Bear), Mezhtsiyems, Mollakar, Muyalda, Nalchik, Narva-Yyessu, Neringa, Nizhneivkino, New Keys, Palanga, Paratunka, Prokopyevsk, Pärnu, Pyatigorsk, Rogachyov, Rush, Sadgorod, Saky, Semi-precious stone, Sergeevka, Sergiyevsky Mineralnye Vody, Seregovo, Sloviansk, Soligalich, Solonikh, Solvychegodsk, Staraya Russa, Tagarsky (Lake Tatar), Thawed, Tamga, Tinaki, Uvilda, Usolye-Sibirskoye, Ust Kut, Uchum (Lake Uchum), Feodosiya, Haapsalu, Hilovo, of Chapayev, Chedyr, Cherche, Cholpon-Ata, Shira (Lake Shira), Shklo, Shchuchinsky, Elton, Yakty-Kul, Yanykurgan, Yaunkemeri
Northwest regions of the USSR and Baltics
Vyborgsky Kurortny district, Leningrad resort area (Zelenogorsk, Komarovo, Youth, Petrodvorets, Privetninskoye, Repino, Serovo, Sestroretsk, Smolyachkovo, Solar, Ushkovo); Kaliningrad group of resorts (Zelenogradsk, Otradnoye, Pionersk, Svetlogorsk); Jurmala (Avota, Asari-Vayvari, Bulduri, Dzintari, Dubulta, Lielupe, Mayori, Melluzhi-Pumpuri, Yaundubul-ty, Yaunkemeri), Liepaja, Neringa, Palanga, Pärnu, Saulkrasta, Haapsalu
The southern regions of the USSR on the coast of the Black Sea
Odessa group of resorts (Arkady, Big Fountain, Zatoka, Kuyalnitsky, Lermontovsky, Luzanovka, Sergeevka, Chernomorka), Ochakov, Skadovsk
Crimean resorts: Alupka, Alushta, Artek, Gaspra, Gurzuf, Dolossa, Yevpatoria, Kastropol, Kiparisnoye (byvsh. Ku-chuk-Lambat), Koreiz, Crimean Primorye, Livadia, Massandra, Melas, Miskhor, Oreanda, Planerskoye, Simeiz, Old Crimea, Pike perch, Feodosiya, Foros, Yalta
Caucasian coast of Krasnodar Krai: Anapa, Gelendzhik group of resorts (Arkhipo-Osipovka, Gelendzhik, Dzhankhot, Divnomorskoye, Kabardian), Sochi (Adler, Ashe, Golovinka, Kudepsta, Lazarevskoye, Loo, Magri, to Makopsa, Matsesta, Uch-Dera, Khosta), Tuapse group of resorts (Dzhubga, Gizel-Dera, Nebug, Novomikhaylovskoye, Olgink, Shepsi)
Georgian SSR: Anakliya; Abkhaz ASSR: Gagra, Gantiadi, Gudauta, Gold Coast, Leselidze, Myusser, New Athos, Pitsunda, Sukhumi group of resorts (Agudzer, Besleti, Gulripsha, Gumist, Sukhumi, Eshera); Adzharian ASSR: Batumi group of resorts (Batumi, Cape Verde, Kobuleti, Makhindzhauri, Tsikhisdzi-ri, Chakva)
On the coast of the Caspian Sea
Apsheron group of resorts (Bilgyakh, Buzovna, Zagulba, Mardakyan, Pirshaga, Surakhana, Tyurkyan, Shikhovo, Shuvelyan), Lankaran
On the coast of the Sea of Azov
Berdyansk, Yeysk, Zhdanov, Kirillovna
In the Far East
Vladivostok resort area
Abastumani, Agveran, Adzhikend, Aktash, Armkhi, Arslanbob, Arshan, Aspindza, Akhtala, Bakuriansky group of resorts (Bakuriani, Libani, Patara-Tsemi, Tsagveri, Tsemi, Tsikhisdzhvari), Bakhmaro, Vorontsovk, Vorokhta, Vuadil, Gava, Gyulagarak, Dzhava, Jalal-Abad, Dzhermuk, Dilijan, the Issyk kul Kurortny district (Aqsa, Dzhergalan, Dzhety-Oguz, Issyk Kul, Tamga, Cholpon-At), Kverneti, Kvishkheti, Kalaalta, Kiketi, Kirovakan, Kodzhori, Krementsa, Kyzyl-Bulak, Lebarde, Manglisi, Martuni, Muasha, Nalchik, Obigarm, Olentuy, Re-dant of I, Ritsa-Avadkhara, to Sairma, Sevan, Smoke, Stepanavan, Suras, Teberda, Tor-gvas-Abano, Turksib, Utser, Firyuza, Hodge-Obigarm, Tsakhkadzor, Tskhneti, Che-is small, Chimgan, Shakhimardan, Shaki, Shovi, Shusha, Yakty-Kul, Yamarovka, Yaremche
Flat (forest and forest-steppe)
Birstonas, Borisovsky, Butch, Vasilyevsky, Veshensky, Vorzel, Gorky Sea, Dorokhovo, Druskininkai, Zvenigorod and Odintsovo resort area, Green Town, Irpen, Cahul, Karacharovo, Kachanovka, Kisegach, Codri, Koncha-Zaspa, Kosov, Kriusha, Kuryi, Lyottsa, Lunacharskoye, Medvezhyegorsk, Mikhaylovskoye, Narva-Yyessu, Narach, Obolsunovo, Pechyor (Bugsky Thresholds), Reach, Pushcha-Vodytsia, Pärnu, Rush, Sigulda, Slavyanogorsk, Sortavala, Sosnovka, Tishkovo, Uvilda, Chyonki, Shchuchinsky
With climate of deserts
Bayram Alya, Botany, Jalal-Abad, Sitor and Mocha-Hosa, Firyuza, Chinabad
Aksakovo, Aksenovo, Alkino, Aul, Bør-chogur, Pine-forest, Upper Beryozovka, Gloux-hovsky, Kamensk Plateau, Swan, Forest, Manych, Nikolaev, Pallasovsky, Peschansky, Troitsk kumysolechebny area, Lousy, Chimgan, Shafranovo, Yumatovo, Yutaza
Agveran, Arshan, Borisovsky, Botany, Verkhovina, Veshensky, Darasun, Dzhava, Jalal-Abad, Dilijan, Doro-hovo, Zvenigorod and Odintsovo resort area, Green Town, Cahul, Kalaalta, Karacharovo, Kverneti, Kvishkheti, Kirovakan, Kisegach, Kislovodsk, Codri, Koncha-Zaspa, Kuryi, Lebarde, Lankaran, Muasha, Nabeglavi, Narach. Obolsunovo, Ritsa-Avadkhar, to Sairma, Smoke, Sitor and Mocha-Hosa, Sochi, Suras, Sukhumi, Tishkovo, Torgvas-Abano, Utser, Chinabad, Shovi, Shusha, Yamarovka
Bakirovo, Baldona, Babruysk, Big Taraskul, Varzi-Yatchi, Guy, the Hot Key, Yessentuki, Shdanovichi, Zheleznovodsk, Issyk-At, Karachi, Kashin, Kaya Kent, Kemeri, Maple Mountain, Kozhanovo, Krainka, Krasnousolsk, Likenay, Lipetsk, Lyuben-Veliky, Marcial Waters, Mayan, Bear (Lake Bear), Mezhtsiyems, Myrgorod, Morshin, Nalchik, Nizhneivkino, New Keys, Paratunka, Pyatigorsk, Rogachyov, Sergiyevsky Mineralnye Vody, Seregovo, Soligalich, Solo nikha, Solvychegodsk, Staraya Russa, Thawed, Tamga, Truskavets, Usolye-Sibirskoye, Ust Kut, Uchum (Lake Uchum), Hilovo, of Chapayev, Cherche, Shir (Lake Shira), Shklo, Shusha, Yanykurgan, Yaunkemeri
Anapa, Arkady, Berdyansk, Vasilyevsky, Zhdanov, Zelenogradsk, Kirillovna, Kuyalnitsky, Lermontovsky, Liepaja’ Lunacharskoye, Narva-Yyessu, Palanga’ Pärnu, Rush, Semi-precious stone, Svetlogorsk, Ser-geevka, Tamga, Haapsalu, Yakty-Kul
Birstonas, Botany, Dshalal-Abad Evpatoriya, Yeysk, Green City, Kirillovn, Kisegach, Leningrad resort area (Zelenogorsk, Komarovo, Youth, Petrodvorets, Privetyaikskoye, Repino, Serovo, Sestrorrtsk, Smolyachkovo, Solar, Ushkovo), Lyottsa, Nalchik, Neringa, Uvilda, Feodosiy, Shchuchinsky
WITH SPECIAL (UNIQUE) FACTORS
Medical oil, free of gasoline and its light distillates — the resort of Naftalan
the Hot gases containing the increased amount of carbon dioxide — the resort of Yangantau
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