Carbon Dioxide Baths

Carbon Dioxide Baths belong to the group of so-called gas baths, the active therapeutic effect of which is due primarily to the carbonic acid (CO₂) contained in them in significant quantities. Carbon dioxide baths have been used with success for a long time in diseases of the cardiovascular and nervous systems. The application of carbon dioxide baths received its greatest development after the works of Groedel, Schott, Benecke, and others, who believed that in terms of therapeutic effect, carbon dioxide baths are equivalent to digitalis. However, this view met with critical assessment from a number of leading cardiologists (including Mackenzie and Huchard). All researchers agree that the main result of the action of carbon dioxide baths is the improvement of metabolism and the increase of cardiac activity. The acute action of carbon dioxide baths consists of the hyperemia of the skin of the immersed part of the body with a sharply demarcated line on the border with the non-immersed part of the body, a noticeable slowing of the pulse and respiratory rate, and an increase in diuresis. Müller (O. Müller) reduces the diverse action of carbon dioxide baths on the organism mainly to the influences of the thermal factor. Goldscheider, recognizing the primacy of the thermal factor, also attributes a major role to carbonic acid, which irritates the endings of the heat-sensitive nerves of the skin. Basically, there are two groups of views on the mechanism of action of skin irritants, including gas baths, on the organism. The first explains their action by the penetration of chemical substances (CO₂, H₂S, etc.) through the skin, similar to the action of drugs taken internally, and the second explains their action only by the irritation of the skin. The majority of researchers in interpreting the action of carbon dioxide baths agree that the site of application of their action is the skin and that through the skin carbon dioxide baths act on the circulatory system and on the whole organism as a whole. Bubbles of CO₂, settling on the surface of the skin, are intense irritants of the peripheral nerve endings, from which the irritation is transmitted to the central nervous system. Thus, the influence on the vegetative centers is realized and the intensification of metabolism and the increase of other functions of the organism occur. Others assume that carbon dioxide baths contribute to the dilation of peripheral vessels and act in an excitatory manner on the cardiac muscle. In recent times, in connection with some new views on the mechanism of the skin's reaction to various irritants (Lewis, Ebbecke, Krogh, etc.), new hypotheses have been advanced in understanding the mechanism of action of balneological factors in general and carbon dioxide baths in particular. It is assumed that as a result of the influence of carbon dioxide baths on the skin, some chemical substance is released and excreted in it, acting on the smallest vessels and nerve endings and causing a sharply expressed redness reaction (equally characteristic for both carbon dioxide and hydrogen sulfide baths). The similarity of the balneological reaction during different balneological procedures, including carbon dioxide baths, with clinical phenomena observed during parenteral administration of protein preparations, confirms the position that the basis of the influence of carbon dioxide baths apparently lies in the parenteral entry into the general circulation of the products of the breakdown of the body's proteins (histamine-like substances), which play a major role both in the mechanism of the local redness reaction and in the subsequent influence of carbon dioxide baths. In terms of the mechanism of therapeutic action on the organism, the effect of the influence of carbon dioxide baths approaches microprotein therapy, which accounts for the established changes in metabolism and hemodynamic shifts regarding pulse, blood pressure, blood flow speed, minute and stroke volume of the heart, acid-base balance, carbohydrate metabolism, blood electrolytes, etc. The physiological and therapeutic action of carbon dioxide baths is to a significant extent conditioned by the amount of dissolved free carbonic acid in the bath. Natural carbon dioxide baths satisfy this requirement the most. The Naugheim and Eynhausen baths (Germany), which have a natural, fairly high temperature (about 34°), and the Roya sources (France) with a natural temperature of about 35°, thus these baths can be administered without artificial heating. Our carbon dioxide sources have a relatively low temperature (Kislovodsk 13.2°, Darsun 7°, Arzni 21°), as a result of heating part of the carbonic acid is lost and thus its content in the bath compared to the source decreases. In addition to natural baths, artificial carbon dioxide baths are applied. There are two ways of preparing artificial carbon dioxide baths. The simplest, chemical method consists in the fact that some carbonic acid salt is dissolved in the bath and then acid, usually hydrochloric, is added to it, at which point usually abundant gas release of CO₂ begins immediately. The method of preparing artificial carbon dioxide baths by pumping CO₂ with the Fischer and Kiffer apparatus is significantly more perfect, in which water is saturated with carbonic acid in a closed space under increased atmospheric pressure (1¹/₂-2 atmospheres). With this method it is possible to bring the gassed water to a high degree of concentration of CO₂, although part of the gas is still lost during the mixing of cold gassed water with warm water used for heating. In the artificial carbon dioxide baths applied in Odessa, prepared on sea water, it was possible to bring the concentration of carbonic acid in the baths of 34-30° to 457.4--574.3 cm³ of free CO₂ per 1 liter, i.e., to sizes close to the content of it in a Narzan bath (554.7-645.4 cm³). A comparative study of the effectiveness of natural and artificial baths showed their different properties, the results of the observations are contradictory. The dosage of both natural and artificial carbon dioxide baths is regulated depending on the individual reactivity of the organism and the nature of the disease. Carbon dioxide baths are prescribed starting from an indifferent temperature, which for carbon dioxide baths is slightly lower than for fresh water baths (about 33°), and then the temperature of the baths is gradually lowered. The duration of the baths is 5-6-8-10-12 minutes, and in Kislovodsk and Naugheim usually treatment begins with diluted baths (3/4, 1/2, 2/3 of a Narzan bath), and then transitions to full baths. Sometimes diluted half-baths are prescribed initially. The course of treatment in Kislovodsk is currently established at an average of 12-14 baths (approximately the same in Naugheim), and the baths are prescribed every other day. Indications and contraindications for the treatment with carbon dioxide baths - see Kislovodsk.