BALNEOLOGY

BALNEOLOGY (from Latin balneum - bath and Greek logos - science), the science that studies: 1) the origin of mineral springs, 2) their physical and chemical properties, 3) the technical devices for their therapeutic application, 4) the principles of the therapeutic effect of mineral waters, 5) the clinical pictures of disease courses during external and internal use of mineral waters, and 6) the indications and contraindications for their prescription. With the gradual development and complication of medical knowledge, B. designated: a) the doctrine of fresh and mineral baths and sea bathing (among the Romans), b) the doctrine of mineral springs (in Europe in the Middle Ages) and c) the doctrine of resorts, both purely balneological and climatic (in Germany and Russia at the end of the 19th and beginning of the 20th centuries). At the present time, a precise distribution of material is accepted between B. (see above), mud therapy, hydrotherapy, climatotherapy, and resortology (see). In various systems and classifications of medical disciplines, B. belongs to the disciplines that study the healing forces of nature, is part of general physiotherapy, or serves as a link between pharmacotherapy and physical methods of treatment. B. studies its subject from the most diverse points of view, by various methods, and is divided into several departments differing in content: balneography, balneohydrochemistry, balneophysics, balneotechnology, and balneotherapy. The history of B. as a scientific discipline begins only with the first years of the 20th century, when it received a firm foundation in the natural sciences (physics, chemistry, geology, hydrology, etc.). Previously, indications and works of this direction were encountered by individual authors and scientists, but they were not systematized. Former B. in its historical development reflected the general course of culture and the evolution of medical practice: a religious hue - among the Hindus, Egyptians, and Greeks; hygiene, which degenerated into effeminacy - among the Romans; the struggle for enlightenment against obscurantism - in the Middle Ages, etc. (for details on the history of B., see the literary index).-The subject of B.-mineral springs (see)-does not yet have a precisely established scientific definition. Various authors (Ditrich, Bertenson, Golubinin, etc.) call these springs healing, therapeutic, mineral, etc. In essence, every water in nature, even rainwater, contains salts and gases dissolved in at least negligible amounts. Only distilled water corresponds to the chemical formula H₂O. But in practical application, it is possible to distinguish mineral water from fresh water, which is suitable for food, drinking, domestic use, and industrial use. In therapeutic medicine, mineral water (for B.) differs from fresh water (for hydrotherapy) by conventional boundaries (per liter of water): dry residue-1.0 g, sodium bicarbonate-0.34 g, bicarbonate ion-0.25 g, iron-0.01 g, bromine-0.005 g, iodine-0.001 g, sulfur-0.001 g, arsenic-0.001 g, radon emanation-3.5 M-E (the indicated doses may also be larger-MH),t° 20°. Hints Grunhut distinguish mineral water either by unusual temperature, or by the presence of rare components, or by the presence of a large amount of dissolved salts and gases. The first group includes acratotherms (see); the second-bromine, iron, lithium, arsenic, radioactive, sulfur, etc. waters; the third-salt, bitter, alkaline, lime, carbonic and other springs. The most general representative of mineral waters is the water of oceans and seas, since all chemical components brought to it by deep and surface sources from rocks and earth layers into streams-rivers-seas are delivered to it. In sea water, upon careful analysis, all substances included in the periodic system of elements are found. But essentially sea water is characterized by certain combinations of sodium chloride, bitter salts, etc. (see Sea bathing, Seaside resorts). The study of the composition of mineral waters is the task of a special department of B.-balneohydrochemistry. The methods of research of mineral waters are general with ordinary chemical analysis. But for B., some features of balneohydrochemistry are important: historically, the analysis of mineral waters has passed all stages from dualistic analysis of minerals (acids and alkalis), from representing the results of analysis in salts or in radical groups (metal oxides and acid anhydrides) to the modern method of representing analysis in ions. The theory of electrolytic dissociation is also applicable to the analysis of mineral springs. But it should be noted that methods of ionic analysis, such as the determination of electrical conductivity, osmotic pressure, etc., are in fact applied to mineral waters at springs and in laboratories very rarely (due to their complexity and high cost), and the overwhelming majority of analyses are performed by the ordinary chemical method (on radicals) and only then converted to ions. On the basis of such analyses, springs are distributed into separate groups, and a classification of mineral springs is established. It is, of course, imperfect, like any classification, but it helps in the practical work of a balneologist. Various systems of classifications of mineral waters are given by Ditrich, Bertenson, Lozinsky, Pletnev; the oldest system-Leroi (1785), one of the newest-Prof. Kurlov (1921). In the simplest form, these systems can be combined as follows: Group 1-hot, chemically indifferent waters (acratotherms); 2-gas springs (with carbonic acid and hydrogen sulfide); 3-alkaline and earthy waters (with a predominance of sodium, potassium, calcium, and magnesium); 4-salt waters (with a predominance of sodium chloride); 5-bitter waters (with sodium sulfate and magnesium); 6-specific waters (As, Br, Li, Fe, etc.); 7 group-radioactive waters (adding radon emanation to the first groups). B. has a close connection with geology in the question of the origin of mineral springs. Usually atmospheric precipitation penetrates through the soil into deep layers of the earth's crust and, after a more or less long path, emerges to the earth's surface, carrying with it dissolved salts leached from underground rocks. Such springs (according to the theory of Suess) are called vadose. Their formation and chemical composition depend on the geochemical features of underground rocks; therefore, the closest participation of a geologist in the work of a balneologist is necessary. Even more important is the role of geology in the study of juvenile and mixed springs (see Mineral springs). Juvenile springs are those that emerge to the earth's surface for the first time, from volcanic depths, not depending on atmospheric precipitation. Juvenile water and the elements dissolved in it are formed in the depths (primarily from cooling molten magma) and appear on the earth's surface for the first time. Geology, coming to the aid of B., in these cases must determine from what depth the water comes, through which layers it passes, where and what vadose waters are mixed with it, and how all this affects the questions of balneohydrochemistry and balneotherapy. The greatest practical role in questions of B. is played by hydrogeology, which, in addition to the general geological questions mentioned above, must delve into the details of the regime of a given spring: the conditions of its emergence to the earth's surface, the nature of the upper layers of soil and their influence on the emerging streams, changes in chemical composition depending on the properties of the soil (sand, rubble, rocks, etc.), temperature fluctuations of water under the influence of soil features, the amount of water emerging outward (the flow of the spring), and losses of water in the main streams. In these purely practical questions, B. enters into connection, besides geology and hydrogeology, also with technology-in the form of balneotechnology. Mineral water must be captured as deeply as possible, in an unchanged form, either by drilling wells or by collection wells (see Collection). The water brought out, intended for drinking, is protected from contamination by special technical structures-drinking pavilions. For mineral water, which is prescribed for external use, more complex balneotechnological structures are already required: collection, water reservoirs, pipelines, devices for heating water, bath buildings with bathtubs and other equipment (see Bath building), a system for draining used water, etc. Under the conditions of connection with mud procedures, similar balneotechnological tasks also face technicians at mud resorts (see Mud therapy). In practice, balneotherapy relies on the century-old experience inherited from the peoples of remote antiquity and enriched by continuous, purely empirical observations of later times. The methodology of balneotherapy comes down to two main forms: external and internal use of water. In the fulfillment of practical tasks of balneotherapy, B. relies on its essential branch-balneography. Some understand this term in a broad sense, uniting under it all natural science parts of B. (balneohydrochemistry, balneotechnology, etc.); others, on the contrary, give the term 'balneography' a narrow meaning-'the geography of balneological resorts.' Even in the latter, narrower sense, balneography is a vital part of B. The geographical description of a resort, following the example of all geographical works, has a universal character and helps to form a complete view of a given resort as a therapeutic unit.

The geography of a balneological resort acquires special significance in connection with the modern theory of resort treatment, which explains its beneficial effect not only by the forces of the therapeutic water, but by the entire complex of resort factors in a given place (climate, nature, regimen, change of location, etc.). Besides the important role of balneography for individual resorts, it acquires particular significance in the state resort economy, by accounting for resorts by districts. These districts are determined, first of all, by their natural properties and general geographical features, but their connection with each other is also confirmed from the point of view of therapeutic tasks. Balneological resorts of the USSR are united into districts: Caucasus and Transcaucasia, mud estuaries and lakes, resorts of the Central District and the Urals, springs of Central Asia, springs of Transbaikalia, the Far East and Kamchatka. Balneological resorts of Western Europe also form several larger districts: resorts of the Central German Upland and the Rhine region, resorts of the Central French Plateau, Pyrenean resorts, etc. B. as a science began to develop only in recent decades. The history of this development is particularly instructive in the USSR and in Germany. The therapeutic part of balneology—balneotherapy—is also developing strongly at present in Germany and Austria in connection with the activity of the Balneological Society (Balneologische Gesellschaft) and the establishment of the State Balneological Center (Zentral-stelle für Balneologie). The picture of scientific growth of balneology in the USSR presents some even more distinctive features. Many periodical publications are devoted to questions of B.: "Messenger of Hydrotherapy and Mineral Waters" by Lewis, 1881-82; "Journal of the Russian Society for the Protection of Public Health", 1891-1912; "Messenger of Balneology, Climatology and Physiotherapy", Kharkov, 1910-1911; "Medical Gazette" and "Russian Physician" for the first one and a half decades of the 20th century; "Resort Affairs", 1923 and following. Particularly rich material on B. has been collected in the works of special and general medical societies: "Russian Balneological Society in Pyatigorsk", "Odessa Balneological Society", "Moscow Physiotherapeutic Society", "Physical-Medical Society at Moscow University", "Society of Russian Physicians in Moscow", "Russian Society for the Protection of Public Health", "Saratov Physical-Medical Society", "Tomsk Society of Naturalists and Physicians", "Society of Physicians of Eastern Siberia" in Irkutsk, "Caucasian Medical Society" in Tiflis, "Society of Physicians Practicing on the Caucasian Mineral Waters" in Essentuki, "Kislovodsk Medical Society" and many others; and in the works of congresses (all-Russian congresses of workers in B., climatology and hydrology—in 1899 and 1903, Congress on the improvement of native therapeutic localities in 1915, I-VI all-Russian and all-union scientific-organizational congresses on resort affairs for 1921-1937). Together with the growth of Soviet balneology, scientific institutes dealing with corresponding questions are also growing: Balneological Institute on the Caucasian Mineral Waters in Pyatigorsk, Physiotherapeutic Institute named after Sechenov in Sevastopol, State Central Institute of Balneology in Moscow.