Essentuki

ESSENTUKI, one of the oldest and principal health resorts of the USSR, is part of the State Spa Association of the Caucasian Mineral Waters. It is located in the North Caucasus in the Terek Okrug, between Pyatigorsk and Kislovodsk, on the railway line, in a picturesque steppe terrain featuring a number of isolated laccolith mountains (Beshtau, Mashuk, etc.). The elevation is 603 m above sea level. The resort got its name from the Essentuk River, which flows into the Podkumok River near the resort. The resort originated in the early 19th century near the springs of Alkaline Mountain; in 1847, part of the land immediately adjacent to the springs was acquired by the Waters Administration, after which the development of the resort began. The first scientific description of the waters was made by Haas, but their true renown dates back to 1823, when Nelubin described 23 springs. In 1874 and 1882, at the invitation of the Russian government, they were investigated by prominent hydrologists J. François and L. Dru. Based on these studies, necessary catchment works for the principal springs were subsequently carried out by Russian engineers. The most important event from the perspective of the resort's development was the exploratory drilling initiated by the Geological Committee in 1905, thanks to which new springs were discovered (the main vein No. 17, new water outlets of type No. 4, etc.), thereby significantly increasing the yield of the drinking springs. At present, Essentuki consists of three parts: the stanitsa, the town, and the resort proper, which differ in the degree of their municipal improvement. The resort section (northern) of Essentuki is a "garden city" with straight, wide, well-paved streets lined with trees, featuring a water supply system, sewage, and electric lighting. From the north and south, two extensive parks—the English Park and the Old Park—adjoin the resort; the latter contains all the springs and buildings for administering salt-alkaline and sulfur-alkaline baths, as well as the Zander Institute and a theater. A magnificent (the best in Europe) mud bath establishment is located outside the parks, but close to them. The climate features characteristic traits of a middle-mountain and steppe climate: moderately humid, with cool summers and cold winters (Table 1). Barometer fluctuations range from 695 mm to 720 mm; prevailing winds are southwestern and eastern, the former blowing from the snow-capped mountains and lowering the air temperature. Spring and early summer (approximately until June 10) are usually rainy. The treatment season runs from May 15 to October 1, the course of treatment lasts from 4 to 6 weeks, and the resort attendance reaches up to 20,000 people per season.

Therapeutic resources. 1. The well-proven fame of Essentuki, unmatched by any other Russian resort, is based primarily on its drinking springs. The latter, especially their primary carbonated-alkaline component, originate from the crystalline rocks of the deep interior. The water wealth of Essentuki is composed of primary carbonated salt-alkaline springs and two waters of surface origin: No. 401 and the Haas-Ponomarev spring (see Tables 2 and 3 for analyses performed by E. E. Karstens in 1912).

Table 1. Meteorological Data

Table 2. Mineral Composition of Essentuki Springs (in grams per 1 liter of mineral water)

The latter two are outlets of abundant groundwater originating from beneath Essentukskaya stanitsa; in contrast to the primary type, they are rich in sodium and magnesium sulfates and calcium bicarbonate, and consequently belong to the category of Glauber's bitter-earthy waters. Among the primary carbonated salt-alkaline springs, two clearly defined subgroups can be distinguished: on the one hand, highly mineralized waters of the type of No. 17 and No. 18, with a dry residue of up to 12.1 g; on the other hand, less mineralized waters of the type of No. 4, with a dry residue of up to 8.5 g. Springs of type No. 4 represent water of the highly mineralized type No. 18 diluted with fresh water circulating in Upper Cretaceous deposits. Among foreign waters, Ems, Selters, Fachingen, and Montecatini are the closest to the Essentuki waters, but they are significantly inferior to the Essentuki waters in the amount of solid residue.

2. Bathing establishments: a) Sulfur-alkaline baths—located in the center of the Old Park on Alkaline Mountain, utilizing the water of the Haas-Ponomarev spring; capacity for an 8-hour working day is 949 procedures. b) Salt-alkaline baths—located near pump rooms No. 17 and No. 20 (see Vol. IV, p. 291, Fig. 3); this building is supplied mainly by the water of the latter spring; capacity is 702 procedures. The same building houses a hydropathic department (350 procedures). c) Mud bath establishment, constructed in 1913 according to the latest technology; mud is brought from Lake Tambukan and heated in special machines by steam that does not come into direct contact with the mud; capacity is 1,152 procedures. 3. Zander Institute with 50 apparatuses for active and passive mechanotherapy; capacity is 240 people. 4. Physiotherapeutic clinic, opened in 1927, with a capacity of 600 procedures. In addition to these balneological institutions, special dietary dining rooms have existed since 1924. Treatment is provided at the resort for both sanatorium and outpatient patients. For the former purpose, there are 14 sanatoriums with 1,765 beds (1928), and for the latter—a state polyclinic with 4 therapeutic departments, a number of special offices, and an extensive laboratory. Treatment methods: 1) drinking mineral waters, 2) mud therapy applied in the form of local mud applications, 3) mineral baths, 4) dietotherapy, 5) physiotherapy.

Action of the waters. Essentuki waters are used primarily for drinking; they have been studied in detail from various perspectives both experimentally on animals and clinically. The physiologically active principle in Essentuki springs is the combined effect of free carbon dioxide, bicarbonate ions, and sodium and chloride ions. Studies have shown that Essentuki waters are a rather energetic cholagogue and bile-producing agent and that their action is apparently specific, caused by the direct impact of the salt composition of the water on the liver cell. When administered into the stomach simultaneously with food, Essentuki waters significantly increase the secretion of gastric juice (both its quantity and acidity); No. 17 acts particularly intensely. A different effect is produced by these same waters when administered into the stomach 1 1/2 hours before...

Table 3. Chemical composition of Essentuki springs

- 10,829 0,0191 0,0015 0,2666 149,39 0,1607 7,830 0,0274 0,0408 6,9458 0,2554 Source № 18 (10.4°; 13.56 gl) Gram Millimol. 0,0140 3,4628 0,00110 1,1590 0,0011 0,0024 0,0858 0,00661 66,20 0,0672 0,0146 98,259 164,54 66,20 0,0672 0,0146 98,259 2,3677 0,00530 0,00180 0,0195 6,0198 0,3577 150,23 0,1564 3,975 0,0125 0,0175 3,5262 0,1180 Milligram equivalent. Source № 20 (19.6°; 691.2 gl) Gram Millimol. Milligram equivalent 66,790 0,0663 0,0142 0,2030 98,672 0,3577 150,23 0,1564 7,950 0,0250 0,0350 7,052 0,2360 0,00478 0,4211 0,2232 0,1039 0,00019 0,1220 ! 0,1220 18,27 I 18,27 5,565 4,2651 0,0034 166,04 66,790 0,0663 0,0142 0,4060 98,672 0,1959 1,2215 0,4388 12,716 7,1934 12,071 1,6471 35,16 13,718 164,54 12,162 0,0183 0,0015 12,72 1,9148 14,087 43,52 0,73 165,95 2,812 0,0195 2,831 0,3782 3,109 1,10 8,530 0,0068 38,06 5,5232 25,43 7,193 38,15 food: they somewhat reduce gastric secretion; therefore one must think that Essentuki waters, similar to a soda solution, act differently when in the stomach and in the duodenum: when in the stomach, they stimulate gastric juice secretion (i.e., possess a secretory property), but from the duodenum they inhibit it. - On this basis, with reduced acidity, it is advisable to administer the water 30-15 minutes before meals, and with no acid - simultaneously with food; but with high acidity, on the contrary, the water should be given 1-2 hours before meals. The best results in E. are obtained in treating diseases of the stomach with reduced, not increased, acidity. One must of course select such forms of disease in which the evacuative capacity of the stomach is little or not at all impaired, otherwise an increase in juice secretion may occur due to the delay of water passing from the stomach into the duodenum (for the effects of Essentuki waters on other organs and systems - see the relevant works cited in the bibliography). - Indications for treatment in E.: catarrhs of the stomach with reduced acidity, functionally reduced acidity, absence of HCl - the effect of Essentuki waters on increasing juice secretion; colitis - the anti-catarrhal effect of warm intestinal irrigations with Essentuki waters; sluggishness of the intestine - the effect of cold waters and physiotherapy; catarrhs of the gallbladder and bile ducts, gallstone disease, hepatitis - the effect of waters on the bile-forming and bile-excretory functions of the liver; pericholecystitis - the resorptive effect of muds; obesity, diabetes, all forms of gout, uric acid and oxalic acid diathesis - improvement of metabolic processes with internal and external use of waters; diseases of the peripheral nervous system - the effect of mineral and mud baths; catarrhal and calculous pyelitis and cystitis with acidic urine reaction - the irrigating effect of waters; female diseases with the character of chronic inflammation or with manifestations of ovarian hypofunction - the resorptive and hyperemic effect of muds. - Contraindications are organic diseases (mainly stenoses) of the stomach, substantially impairing its evacuative capacity, ulcers of the stomach and duodenum, catarrhs with sharply increased acidity, ulcerative enterocolitis, phosphaturia, disorders of cardiovascular compensation, nephroses, nephritis, neoplasms, and acute diseases.