Climatotherapy

CLIMATOTHERAPY, treatment with climate (see), based on the knowledge of experimental climatophysiology. Climatotherapy began to develop only from the middle of the 19th century, although Hippocrates already attached great importance to the state of health of the exposure of the place where a given person lives, the location on a mountain or in a hollow, and the prevailing winds, and Galen drew attention to the role of sea voyages and considered the mountain climate the best for the treatment of consumption. At the present time, a large amount of experimental and clinical material has been collected, allowing for the evaluation and comparison of the climates of the globe by their influence on healthy and sick organisms. In the first place among climatic factors are the factors regulating the intake and expenditure of heat in the organism. Therefore, the classification of climates is also accepted partly according to the temperature criterion (see; Climate). The thermal regime depends not only on the temperature of the air, but also on the humidity and the speed of its movement (wind), which can both strengthen and weaken the influence of temperature, as a result of which great importance is attached to the "cooling power" (Abkühlungsgröße), which can characterize every climate. Diverse climatic factors, acting as a stimulus (Reiz), can be reduced to the following groups: 1) factors acting through the skin, 2) through respiration, 3) through the sense organs. Solar radiation, air temperature, wind, humidity, fog, cloudiness, precipitation, atmospheric electricity, air ionization, radioactivity, barometric pressure, etc., act on the skin. Air temperature, humidity, air ionization, barometric pressure, wind, and the degree of air purity (in chemical and mechanical respects) act through the lungs. Sunlight, air transparency, colors and shapes of the landscape, winds, and thunderstorms act through the sense organs; geological and soil features also act indirectly through peculiar modifications of climatic factors. Climatic factors by origin are divided into two groups: atmospheric, or meteorological (meteorological elements), and terrestrial, or telluric. From various combinations of climatic factors—"stimuli"—depends the different reaction of the organism to them, which explains the diverse influence of different climates on healthy and sick organisms. In physiological and clinical relations, mountain, maritime, forest, steppe, desert, tropical, and polar climates are interesting. The physiological influence of climatic factors on animals and humans began to be studied methodically for the first time in a mountain climate, the characteristic features of which are rarefied air (lowered barometric pressure), dryness and lower temperature, wind, an abundance of sunshine hours, especially in winter, richness in ultraviolet rays of a shorter wavelength than on the plains (up to 289.5 mµ), high air conductivity, its unipolarity, etc. The exposure of slopes and the composition of the soil determine the thermal regime, and the width of the horizon determines the duration of sunshine. Physiological action. 1. Low temperature, wind, and the degree of humidity influence thermoregulation through the skin and muscles (hardening). 2. Solar radiation causes erythema and pigmentation (see Heliotherapy). 3. Thermal and other factors influence the redistribution of blood and on hematopoiesis; neutropenia and mononucleosis are noted; erythrocytes increase in number up to 8 million and Hb by 16-22%. 4. The pulse quickens, starting from an altitude of 500 m to 3,000 m (individually), which depends on the combined action of altitude, wind, solar radiation, and air temperature. 5. The decrease in the amount of O₂ and CO₂ increases the frequency of breathing, increases the work of the respiratory muscles, strengthens the activity of the lungs, and increases the influx of blood and the vital capacity of the lungs. The basal metabolism is increased. Nitrogen metabolism changes: it intensifies at first and decreases subsequently. Salt metabolism increases (due to the excretion of phosphorus through the kidneys and NaCl through the skin). Sharp changes at high altitudes (2,000-4,500 m and more), which are detected in metabolism, in the nervous system, in the organs of circulation, etc., are noted under the name of mountain sickness (see). Indications for sending patients to a mountain climate follow from all its listed properties (see Mountain-climatic stations). Maritime climate, differing from mountain climate by the highest barometric pressure and the smallest temperature (diurnal and annual) fluctuations, thanks to an open horizon, has a large number of hours of sunshine and free movement of air. Maritime climate can in some cases soothe, in others—excite, depending on the state of the weather and climatic factors associated with geographical longitude and latitude. Being strongly exciting in northern latitudes (east coast of England, island of Ösel), the maritime climate acts soothingly in more southern latitudes (Riviera) and even relaxingly under the tropics (islands of Ceylon, Cuba, etc.). Depending on latitude and longitude and on the relief of the terrain, the seaside climate, i.e., the climate of shores, beaches, seaside towns, etc., also differs. To the main features of the maritime climate, the influence of land is added here in the form of coastal (breezes) or mountain winds, changing the temperature, air humidity, etc. The influence of seasons can be felt more in seaside climates than in maritime ones. On the southern coast of Crimea, at a close distance (5-25 km), one can note different climatic variants (microclimates); thus, for example, Simeiz is drier and warmer than Yalta and the nearby Miskhor, which changes the indication when sending patients there. Blood pressure, especially systolic, falls on the seashore, although in the north, low temperature and wind could raise it. This is explained by hyperemia of the skin. The number of erythrocytes and Hb increases. The number of pulse beats during work is greater than on the plain, the excretion of CO₂ and the consumption of O₂ increase. Nitrogen and mineral metabolism increase; in growing organisms, intensified growth of bones and muscles is noted, which is partly connected with the increased need for movement. Body weight, especially in children, increases in parallel with the increase in musculature; this is especially noted in the spring and early summer. But sometimes, especially in the first weeks, a loss in weight in children and a certain "exhaustion" are noted. The main factors of the maritime (seaside, coastal) climate are the following: 1) wind, 2) sunshine, 3) on northern beaches—cool humidity, on southern ones—humid warmth. 1. Wind (change of cyclones and anticyclones) can cause the appearance of three groups of symptom complexes: a) peripheral (rheumatoid), b) catarrhal (gastrointestinal), c) cerebral (congestive). The first group is most often encountered, manifesting in the form of "rheumatoid" pains in the muscles, in the region of serous membranes and peripheral nerves; it is detected in the form of neuralgias, arthralgia, etc.; it manifests mostly in persons who have in their history traumatic, rheumatic, and inflammatory diseases of the corresponding tissues, predisposing to the manifestation of these pains. The second group is characterized by symptoms of gastrointestinal catarrh. The third group manifests by irritable mood, excitement, insomnia, headaches, hyperemia of the face, conjunctivitis, nosebleeds, tachycardia, haemoptysis, etc., and sometimes general weakness, lethargy, depression, weakening of thinking ability and will, a feeling of fear, sudden sweating, dizziness, vomiting, etc. 2. Bright sunshine as a climatic stimulus (see Heliotherapy, Insolation) on the seashore acquires even greater importance due to the reflection of solar rays from the beach, rocks. 3. Humidity as a climatic factor plays a large role, and the organism's relationship to it depends on the air temperature and the strength of the wind. On this are based the indications and contraindications for sending to northern and southern beaches. General indications. 1. To northern sea coasts (Ostend, Riga seaside, Sestroretsk): predisposition to tuberculosis with slight irritability of the nervous system, initial forms of tuberculosis without fever, without a tendency to hemoptysis, chronic fibrous (persistent) forms, initial forms of laryngeal tuberculosis, catarrh of the upper respiratory tract, glandular tuberculosis, mild neuroses, metabolic diseases. Contraindications: slight excitability of the nervous system, erethistic, febrile tuberculous forms with a tendency to hemoptysis, caseous pneumonia, cavernous forms, sharply expressed laryngeal tuberculosis, tuberculosis of other organs (intestines, kidneys), disorders of cardiac, renal activity, etc. 2. On a moderately warm coast (Atlantic Ocean, Arcachon) are indicated erethistic, congestive forms of tuberculosis, nervous excitability, slightly febrile cases. Contraindicated are torpid, asthenic, depressed forms. 3. On the southern coast [Cannes, Menton (French Riviera), southern coast of Crimea, Black Sea Riviera] are indicated all forms of tuberculosis, different in course and clinical picture, especially chronic pleurisy and chronic pneumonia, diseases of the heart, metabolism, kidneys, organs of movement, the nervous system, etc. Contraindicated are rapidly progressing, with large destructive phenomena, congestive forms of tuberculosis, cases with a tendency to hemorrhages.

The climate of continental plains (continental climate) is characterized by large temperature fluctuations, both diurnal and annual, a lower (on average) wind speed (than in a maritime climate), and a smaller amount of precipitation, especially in the cold season, and greater dryness and dustiness of the air.

Depending on the proximity of water surfaces, the climate of plains can acquire the properties of a maritime climate, and with an increase in relief (above 400 m above sea level)—the properties of foothills.

Temperature fluctuations in a continental climate are more pronounced in summer, and absolute humidity is high; in winter, on the contrary, fluctuations in the relationships between air temperature, its humidity, and wind speed can cause haemoptoe in tuberculosis patients, and attacks of angina pectoris in cardiac patients.

High barometric pressure can also act unfavorably on neurotics and tuberculosis patients.

Vasomotor reflexes cause a redistribution of blood in the skin and viscera, and a change in the exchange between blood and tissues.

Irritation from the skin and other sense organs reflexively affects the mechanism of respiration and, consequently, indirectly affects blood gases and the speed of blood circulation.

Changes in the relative humidity of the air alter heat loss; for example, dry warm air removes more heat from the body than warm humid air, and dry cold air is perceived more pleasantly than cold humid air.

Dry, very warm air excites the central nervous system, the result of which, given its increased excitability, is headaches, irritability, absent-mindedness, and sometimes, on the contrary, stupor.

Overheating of the body (hyperthermia) due to a decrease in heat loss occurs more quickly in humid air.

At different times of the year, depending on the composition of the soil, vegetation cover, wind regime, and temperature conditions, the climate of plains can be either moderate ("calming") or hardening, highly suitable for hygienic-prophylactic purposes.

The purity of the air and sometimes a large number of hours of sunshine favorably distinguish the climate of open plains.

Forest climate is distinguished by cool air, greater relative humidity, faster cooling after sunset than air in the steppe or on a meadow, negligible movement of it, and greater purity.

The variety of color tones of trees, shrubs, grass, moss, or sand, and the variety of sounds of forest life attract the tired, neurasthenics, and convalescents to such places, and the majority of German health resorts (Luftkurort) are located in forest areas.

It is necessary to distinguish between the climate of deciduous and coniferous forests, since the soil, the composition of the air, the aeration, and the scattered short-wave and long-wave solar (direct) radiation in them will be different qualitatively and quantitatively.

Furthermore, it is necessary to take into account the altitude above sea level, since with an increase in terrain, features of a mountain climate are added to the characteristic features of a forest climate, and in the presence of large bodies of water—features of a maritime climate.

The climate of deserts differs most strongly from other plain climates, which, just like the forest climate, can have a number of variants depending on the latitude, longitude, and altitude of a given area, as well as on the proximity or remoteness of large water surfaces.

Even in Egypt, the climate fluctuates within certain limits in Upper and Lower Egypt, as well as on the banks of the Nile and a few kilometers away from it.

Characteristic features of the desert climate: dryness of the air, relative humidity changing by the hours of the day, reaching its maximum at night and beginning to drop with the sunrise (the lowest figures are between 12 and 15 hours).

In winter, the relative humidity in Cairo can reach 70% at 9 a.m. and 9 p.m., drop to 50% during the day, and in April even to 29% (in August at noon, a relative humidity of only 5% was noted in the desert).

Diurnal temperature fluctuations are also great, since the soil, heated during the day, cools down quickly at night due to the great dryness of the air.

The magnitude of the electrical potentials of the air is also related to the dryness of the climate—on average 128 according to Exner, which has pronounced diurnal fluctuations similar to a mountain climate with 2 maxima (8 p.m. and 7 a.m.) and 2 minima (3 a.m. and 12 noon).

Conditions in the desert are unfavorable for the development of microorganisms due to the great dryness of the air, the heated soil, and bright sunshine.

-Physiological action of the desert climate has been studied relatively little.

Due to the dryness of the air, the release of water by the organism increases sharply, and in relation to the loss of water by the skin, relative humidity plays an important role, while in the loss of water by the lungs—absolute humidity.

The ratio between the loss of water by the skin and the lungs in the desert climate becomes much more significant (instead of 1:3 it becomes 1:5.5).

Heat loss in the desert climate occurs predominantly by the evaporation of water (up to 61%), whereas in our climate—predominantly by conduction and radiation; at the same time, a significant part of the increase in evaporation is due to a purely physical factor—an increase in the diffusion of water vapor, and not to increased secretion of the sweat glands.

Therefore, the influence of the desert climate on the functions of the skin must be considered differently than it has been until recently.

The skin apparently reacts to the external irritation of the desert climate at rest only by the dilation of peripheral vessels, without increasing perspiration and the excretion of salts and without easing the work of the kidneys; only during muscular work, when increased heat loss is required, does the skin also react by increasing the functions of the sweat glands.

Sometimes the skin and visible mucous membranes react very painfully to the dryness of the desert climate: the skin becomes dry, cracks, and peels; hair and nails also crack and lose their luster; lips crack and bleed.

Urine analyses indicate that solid substances are excreted by the kidneys in the same quantity as in our climate; the same applies to water.

-Nitrogen metabolism increases, mineral (chlorides and phosphates), on the contrary, decreases. The retention of P makes it possible to assume that the breakdown of phosphorus-containing cellular material does not occur.

-Gas exchange is lowered, the depth of respiration as well.

Blood pressure decreases due to the intensity of illumination and high air temperature, and sometimes systolic pressure decreases, sometimes diastolic, sometimes both.

This has been noted both in healthy individuals and in nephritics.

Pulse rate (at rest) does not change and only accelerates somewhat in the first days of stay.

In general, the pulse, like the temperature, becomes more labile, which is especially noted during physical work.

-The influence of the desert climate on the nervous system and psyche is more pronounced than on somatic functions.

In the first days, transient anxiety is sometimes noted, which is replaced by lively activity, cheerfulness, vitality, a feeling of contentment, and increased enterprise, i.e., sensations characteristic of a maritime climate (respectively, a beach).

Even patients with a depressed mood become more cheerful and energetic, but a special need for movement, as happens on beaches, is not noted here.

The picture changes with a longer stay in the desert climate, especially during great heat: general relaxation, a state of depression, and loss of appetite (the latter is individually variable) set in.

Nighttime cooling of the air contributes to better sleep.

The wind (khamsin in Egypt) has a particularly strong influence on the nervous system, accompanied by extreme dryness of the air and a rapid rise in temperature, which is tolerated with difficulty not only by nervous and cardiac patients but even by healthy people, in contrast to pulmonary and renal patients.

Different latitude, longitude, and altitude determine the diversity of the desert climate.

Indications: 1) pulmonary tuberculosis—non-febrile forms complicated by emphysema, bronchitis, nephrosis; 2) arthropathies and myopathies not very sensitive to temperature changes; 3) nephrosis-nephritis, especially in winter, so that in summer they can be transferred to mid-mountain stations (up to 1,000 m above sea level).

-Contraindications: heart defects, dry catarrhs of the upper respiratory tract, tuberculosis of the larynx, eye diseases, etc.

-Recently, the study of the climate of the Trans-Caspian steppes (Ashgabat, Firyuza), which have a desert climate with extremely high dryness and an abundance of sunshine, has acquired special importance; these can be a place for the special referral of renal patients there.

The tropical climate, occupying a large area, also has a number of varieties depending on the greater or lesser distance from the sea and greater or lesser altitude.

It is generally accepted to understand by this word the climate on the shore of a tropical sea or ocean.

High temperature and humidity cause general relaxation.

Heavy muscular work leads to severe consequences, which manifest themselves in profuse sweating, headaches, stupor, etc., and can end in heatstroke.

The skin is covered with sweat even at rest, cardiac activity is weakened, appetite worsens, intestinal activity is disrupted, and resistance to infectious diseases is lowered.

The functions of the central nervous system of Europeans in a tropical climate become more labile than in our latitudes.

During prolonged, continuous stays of Europeans in a tropical climate, general psychological fatigue and weakening of memory are noted, to which increased irritability is added, even in people distinguished by sufficient self-control; in general, a depressed mood prevails. Such an influence is especially strongly noted toward the end of the rainy season. In Europeans, a reduced capacity for physical labor is noted due to easily occurring palpitations, tightness in the chest, heavy sweating, and forced breathing caused by overheating due to insufficient thermoregulation; these phenomena, under equal conditions, are not noted in the indigenous population. In a resting state, gas exchange does not differ from that in a temperate climate. Sleep disorders have an especially severe effect. Due to the high air temperature, heat dissipation occurs only through evaporation: heat loss through thermal conduction and radiation recedes into the background. Therefore, the less acclimatized a European is, the more sweating is noted. In the indigenous population, however, sweating is less than even in acclimatized Europeans. To clarify the difference in thermoregulation, it is necessary to take into account the nakedness of the indigenous people and the clothing of Europeans, which, although light, still exerts an influence. After staying in a humid tropical climate, the skin becomes especially sensitive to fluctuations in temperature; minor decreases in it, not felt as a sensation of cold in temperate latitudes, can cause even a sensation of chills in a tropical climate. In a dry hot climate (dry tropical climate), temperature fluctuations are less perceptible.

The southern part of the Black Sea Riviera (Sukhumi, Batumi) possesses a subtropical humid climate, in which the features of a tropical humid climate are not as sharply expressed; but nevertheless, a summer stay there is very burdensome for tuberculous forms, and sanatoriums function only in the wintertime.

A polar climate in its pure form is either completely uninhabited or contains few inhabitants and isolated research stations. One has to judge its physiological effect only from Arctic and Antarctic expeditions, but a difference is noted here as well, depending on the latitude and longitude of the locality. A sharp difference is, of course, noted in the influence of the polar winter and summer. To the extent that the former has a depressing effect and often causes insomnia, the latter improves general well-being, brings a desire to work, and provides normal sleep. Body temperature does not show significant changes. The respiratory rate in summer decreases, the depth increases, as does the alveolar exchange and the production of CO₂. In summer, solar erythema forms, the skin becomes pigmented, the epidermis thickens, and dermatitis may appear. In winter, the epidermis becomes thinner, and the pigment partially disappears.