Kislovodsk

KISLOVODSK, a mountain subalpine station with the famous carbonated mineral spring 'Narzan' (in the local dialect, 'bogatyrsky'), enjoys wide renown as a balneological resort, mainly for cardiac patients. K. is part of the state resort association of Caucasian Mineral Waters, located in the North Caucasus, in the Tersky District, and is the terminal point of the Kislovodsk-Mineral Vents branch of the North Caucasus Railway [see separate table (pp. 55-56)]. K. occupies an elevated basin, surrounded on all sides by mountains, at an altitude of 850 to 1,000 meters above sea level, in the basin of two streams—Olkhovka and Berezovka (flowing into the Podkumok). The emergence of K. as a resort dates to the era of the Caucasian conquest. The healing power of 'Narzan' was long used by the local inhabitants—the Abazins. This is testified to by Shober, the personal physician of Peter I (1717), mentioning a sour source located in the 'land of the Circassians.' In 1803, the Kislovodsk fortress was built, and sick people began to gather here for treatment under the protection of troops. From the end of the 18th century, Russian scientists began to study the source (Güldenstädt, Dallas, Haaz and others). Throughout the 19th century, a series of capture works were carried out: under Pallas—diversion of the Olkhovka River (1803), which flooded Narzan; the works of Myasnikov (1820), Upton (1851), Ruchevich (1894), and finally Ogilvy-Puginov (1909). In 1927, a new Ogilvy source—the 'Dolomite Narzan'—was discovered, making K. a drinking resort. The first bathing facilities were built in 1812; the park was laid out in 1823; a special bathing building was constructed in 1832. With the construction of the railway in 1875 (Rostov-Mineral Waters), wide-scale construction began in K. (hotels, dachas, pensions, bathing buildings, buildings for medical institutions). From the imperialist war until 1920, construction stagnated, and only in recent years has K. again begun to be enriched with medical institutions (October Narzan Baths) [see separate table II (pp. 55-56), fig. 2], new sanatoriums and houses.—At present, the resort is well equipped with balneo-physiotherapy institutions, a specialized cardiological clinic, a polyclinic, sanatoriums, etc. The resort operates year-round with a break from April 1 to May 15. In the center of K., on both sides of the Olkhovka stream, there is an extensive park, adjacent on one side to the Narzan Gallery, where the drinking fountains of both sources are located, and on the other side to the mountain meadows. Adjacent to the park are a number of sanatoriums and the Lenin Cardiological Clinic. The southern side of the park borders on a town consisting of mountain streets. The climate of K. is moderate and uniform. In terms of the number of sunny hours per day, the number of sunny days, and the stability of clear weather in the autumn-winter period, K. is not inferior to the best climate stations (Davos, Arosa, Montre, Yalta). The average annual temperature is +7.9°C; there are no sharp temperature fluctuations during the day. The increase in temperature from January to July, as well as its decrease from July to December, is characterized by great gradualness (see table 1). Table 1. | Months | Abs. max. | Abs. min. | Jan. | -4.7 | 46.0 | July | +19.4 | 31.1 | Feb. | -2.5 | 34.2 | Aug. | +19.0 | 31.4 | Mar. | +2.3 | 47.0 | Sept. | +14.1 | 36.6 | Apr. | +7.5 | 40.1 | Oct. | +9.0 | 42.7 | May | +13.8 | 30.3 | Nov. | +1.6 | 44.7 | June | +17.2 | 31.1 | Dec. | -2.0 | 44.2 | Average barometric height—691.5 mm. Average amplitude of barometric pressure fluctuations—20.4 mm; absolute amplitude of fluctuations—30.9 mm. The amount of atmospheric precipitation during the year averages 485.3 mm. Rainy days are most numerous in May and especially in June. The prevailing winds are northern and southeastern. Winds have the lowest speed in winter months and the highest in summer. It is particularly calm in the mornings. Annual cloudiness—5.5. The number of completely clear days is 83 per year, and the number of cloudy days does not exceed 80. Winter is characterized by considerable continuity of sunshine, constancy of temperature, a small number of days with precipitation and a small amount of the latter, rare winds, their negligible strength, and the predominance of calm. Summer is never sultry. The average summer temperature is +18.5°C. The ionization of the air in K. is high due to its purity and abundance of sunny days. On average for July-October 1927: n+ = 811, n- = 1.90 × 10-4, A- = 1.84 × 10-4, α = 1.12. The daily discharge of Narzan is about 1,980,000 liters. Its water is a product of mixture—some primary, juvenile alkaline water containing a huge amount of CO2, with fresh, gypsum, differently mineralized waters of several aquifers (Lower Cretaceous and Jurassic); in the mineralization of narzan, carbonate earths predominate mainly, and sulfates to a lesser degree, in the presence of a large amount of free CO2 (see table 2); temperature +13.2°C. Therapeutic resources and methods: narzan baths, drinking mineral waters, physiotherapy, terrain cure and climate. The carbonic baths of Narzan, in their physiological action, have mainly the element of exercise (Übung) and to some extent the element of protection (Schonung). The organism in the bath is subjected to the simultaneous effect of a number of factors—thermal, mechanical, etc. Under the influence of the narzan bath, after 1-1½ minutes, active hyperemia of the skin occurs, venous circulation improves; the tortuosity of capillary loops disappears; blood pressure, both systolic and diastolic, usually increases; pulse pressure increases. In persons with pathologically elevated blood pressure, it decreases. The sphygmogram shows a steeper and higher anacrotic wave; systole and diastole lengthen. The pulse slows down by 5-15 beats. The number of respirations in the bath decreases, respiratory excursions become deeper, contributing to the improvement of venous circulation. On auscultation, strengthening of heart tones is noted; organic murmurs, especially mitral, often intensify, non-organic ones usually disappear. Diuresis sharply increases. The gas coefficient (i.e., the ratio of CO2 to O2), sugar and calcium content in the blood increase. The course of treatment—15-20 baths. Baths are prescribed 3-4 times a week. The first baths are usually dilute, starting at 35°C, and then transition to full and cooler baths (down to 30°C and lower).—Other bathing buildings. 1. The main, or New Narzan Baths—for 62 baths, cabins are equipped with English faience baths with copper coils. In the bathing building there are electrotherapy, hydrotherapy, and inhalation rooms. 2. 'October Baths'; a new building (1928) for 60 baths (see Bathing building). 3. In addition, baths are available in the Narzan Gallery, in the Grand Hotel, in the Lenin Cardiological Clinic, and in the sanatorium 'Named after the Decade of October.' In the Narzan Gallery, next to the Narzan drinking fountain is another source, opened in 1927—the Ogilvy Dolomite Narzan, with a discharge reaching 720,000 liters; its temperature is +16.7°C, dry residue—3.396 g (see table 3). The water of this source is used exclusively for drinking; it sharply increases the secretion and evacuation capacity of the stomach, regulates the motor function of the intestine, activates metabolism, promotes the evacuation of waste products from the body and shifts Table 3. Assumed salt composition of Narzan and Dolomite Narzan. In 1 liter contains Narzan Dolomite Narzan Sodium chloride NaCl Sodium sulfate Na2SO4 Calcium bicarbonate Ca(HCO3)2 Magnesium bicarbonate Mg(HCO3)2 Iron bicarbonate Fe(HCO3)2 Potassium chloride KCl Sodium bromide NaBr Magnesium sulfate MgSO4 Silicic acid H2SiO3 Sum of solid parts 0.2219 0.0888 1.5793 0.0043 0.0272 0.0004 0.4687 0.0120 0.5507 0.5073 2.8972 0.0916 0.0453 0.4878 0.0320

Free carbon dioxide . . . » semi-free 2,3926 2,1650 0,4275 4,6119 2,0125 0,8144 Radioactivity (in units 4,70 Temperature ........ 13.2° 16.7° 19.8D0 Table 4. Comparative ionic composition of Narzan, Dolomite Narzan and similar foreign waters. Name B(D HCO3 Cl Ca Na Mg. Dolomite Nar- ' 2,11 o m 0,3 0.12 0.25 0.004 0.006 0.65[0.27 0.36|0.11 0.27)0.55 0.20|0.04 0.44)0.07 0.15 0.08 0.004 0.10 0.01 i 1.07 0.45 Smirnovsky . Wildungen . . Counter eksvyal 1.22 Very little 1.74 0.05 1.0 its reaction in the direction of alkalization and is quite a potent cholagogue. Terrenkur is widely used in K. as an auxiliary treatment method in summer and winter. For this purpose, mountain paths have been laid out in the park in the direction of the so-called 'red sun', with a total length of 6 km, with a 5° incline, starting from 850 to 1,000 meters above sea level. Every hundred meters is marked with a pole indicating the station number, height above sea level, and distance from the Narzan gallery. Benches for rest are placed along the entire path.-Physiotherapy institutions of the resort are located in the main building of the Narzan baths; in addition, there are facilities in the Cardiological clinic named after Lenin and in some sanatoriums. Inhalatorium, with departments for dry and wet general and individual inhalation, is located in the main building, in which an electro-light treatment office is also equipped. Electro-light treatment offices are also located in the Cardiological clinic and other sanatoriums. Behind the Narzan baths is a solarium.-Treatment is provided for outpatient, sanatorium and clinical patients. For the first group, there is a state polyclinic with 6 therapeutic departments, an office for accounting for the results of resort treatment, special offices and a laboratory. Outpatients live in state hostels and hotels and use the dining room in the dietary cafeteria. For sanatorium patients, there are 19 sanatoriums with 2,865 beds (1928). For clinical patients (cardiovascular), there is the Cardiological clinic named after Lenin with 130 beds. In addition to sanatoriums, 14 rest homes belonging to various institutions have been organized in K.-A number of natural factors operate in K., and the moment of training predominates over the moment of protection; the mountain climate and Narzan baths impose a number of serious requirements on the functional adaptability of physiological systems (cardiovascular, hematopoietic, nervous, etc.). Indications and contraindications for K. have been developed on the basis of general principles of medical selection of patients for resorts (see), i.e., taking into account not only the properties of this particular resort, but also the data that determines its place in the general plan of resort treatment assistance in the USSR. In this regard, it is characteristic for K. to be used mainly as a resort for cardiovascular diseases, although climatically it is also fully suitable for the treatment of tuberculosis. The indications and contraindications given below were developed in 1930.-Indications. I. Diseases of the cardiovascular system. 1. Lesions of the heart muscle, conducting neuromuscular and valve apparatus of various origins, with or without rhythm disturbances, with signs of compensation disorder not higher than moderate degree, i.e., without persistent, widespread edema, stagnation phenomena in the liver, kidneys, etc. 2. Initial forms of both general and localized sclerosis, for example, sclerosis of cerebral vessels, aorta, nephrosclerosis. 3. Mild forms of angina pectoris, i.e., not accompanied by frequent, prolonged or intense attacks of angina. 4. Hypertension provided there is no significant weakening of the heart muscle, disturbances of cerebral circulation, and signs of nephritis.-II. Diseases of the nervous system. 1. Angioneuroses and neuroses associated with decreased activity of the endocrine glands and not accompanied by convulsive attacks, impulsiveness and sharply increased affective excitability, when combined with other diseases indicated for treatment in K. (mainly in the autumn-winter season). 2. Initial forms of tabes dorsalis.-III. Diseases of metabolism. Obesity, gout, uric acid diathesis, in which symptoms of cardiovascular system disorder come to the forefront, phosphoric acid diathesis.-IV. Diseases of the respiratory organs. 1. Chronic diseases of the upper respiratory tract of non-tuberculous nature. 2. Emphysema of the lungs without signs of decompensation from the cardiovascular system. 3. Bronchial asthma without severe signs of increased nervous system excitability.-V. Pyelitis in cardiovascular patients.-Contraindications (excluding general contraindications to resort treatment). I. Diseases of the cardiovascular system: a) unfinished acute inflammatory processes of the heart and blood vessels, b) severe signs of decompensation, c) aneurysm, d) angina pectoris in the presence of severe signs of decompensation, e) hypertension with signs of nephritis, pronounced cardiac weakness or severe general sclerosis of blood vessels, f) diseases of the heart and blood vessels with signs of sharply increased nervous excitability.-II. Diseases of the nervous system: a) organic nervous diseases with hyperkinetic and spastic manifestations; b) all neuroses and psychoneuroses with severe signs of endocrine gland hyperfunction, including with the presence of thyrotoxic signs from the heart in Basedow's disease.