Kurotology

KUROTOLOGY (from German Kurort-therapeutic place and Greek logos-science), a new term introduced for the first time in the USSR. K. studies the therapeutic factors of health resorts, their influence on healthy and diseased organisms, and develops methods for their most effective use for therapeutic purposes. In this, it uses data from other sciences: physics, chemistry, meteorology, physiology, hygiene, etc. The main departments of K. 1. The Natural Science Department studies health resorts (balneoclimatology, phenology), the origin of natural therapeutic forces (geology, geophysics, meteorology) and their natural properties (physics, chemistry, microbiology). 2. The Balneo-sanitary-technical department develops issues related to bringing mineral waters to the surface (hydraulic engineering) and the associated technical devices (see Captaige, Pavilion), rational mud farming, mountain-sanitary protection (see) and the regime of mineral waters, lagoons, lakes, issues of rational construction of bathhouses, sanatoriums, solariums, aeraria, beaches, issues of planning health resorts, their improvement, etc. 3. The Clinical Department studies the methodology of internal and external application of resort remedies and the conditions of regimen and nutrition for various diseases, as well as their effect on the diseased organism, and has as its task to provide a scientifically grounded clinical prescription for resort therapy, to replace the empiricism prevailing in health resorts, and to develop indications and contraindications for treatment in health resorts. 4. The Experimental Department, to assist the clinical study, investigates the essence and mechanism of the influence of resort "irritants" (balneodynamics) on healthy and diseased organisms, using the methods of physiology, biochemistry, biophysics, and provides the foundation of primary importance for the scientifically established dosimetry and standardization of factors of resort treatment. 5. The Social-organizational department sets as its task to apply the data of the above departments for the scientific substantiation of the organization and planning of resort affairs from the point of view of the general tasks facing the national economy and healthcare at the present stage (the problem of accounting for the need of the working population for resort treatment, accounting for its results; zoning of resort assistance, rationalization of the structure of health resorts, their economy, management, etc.). Connecting along the lines of the above departments with various fields of science and technology, K. applies those of their laws, methods and data that can have applied significance in resort affairs. In this, the guiding role should belong to experimental medicine, under the control of which the optimal methods of resort treatment are established. The concept of K. in the broad sense outlined above could have arisen only on the basis of Soviet healthcare and resort affairs, which gave rise to and for the first time in history carried out a fruitful synthesis of those branches of science and technology that should be put at the service of the development of resorts for the working people. The science of treatment in health resorts in its modern state has won a place as an independent field of scientific knowledge in all countries (for the history of development-see Balneology, Health Resorts). K. rightfully occupied this place in the USSR, where it received unprecedented development after the October Revolution. This is written by one of the prominent German balneologists Prof. Bickel in connection with a critique of the state of experimental development of problems of German balneology in the following expressions: "The strongest interest for the development of scientific balneology in the sense of a branch of experimental medicine I have encountered in present-day Russia, which in a grand manner, using exemplary organizational methods, has provided for this as no other country". The state of resort science in pre-revolutionary Russia is characterized by the testimony of Lozinsky, who writes: "The scientific development of balneology is still at a very low level... In no other field of medicine are printed works compiled with such biased intentions as in the field of practical balneology. A special type of resort monographs has been created, the authors of which seek to prove that this particular cures all diseases in all stages of their development... The authors of these monographs often draw their inspiration from the administration of this particular resort. Among the multitude of these works, it is very difficult to find several dozen works deserving of attention and trust". The reasons for this situation lay in the commercial character of pre-revolutionary health resorts, in the corresponding selection of most resort physicians, and in the complete absence of scientific-resort institutions. The October Revolution freed scientific thought, opened up the widest perspectives before it, and together with the growth of resort construction created a powerful scientific research base, the only one in the history of Russia and Western Europe. Scientific forces were attracted by the People's Commissariat of Health to resort affairs from the first days of the development of resorts for the working people. From 1921 to 1929, six all-union scientific-organizational congresses on resort affairs were held (during the entire pre-revolutionary history of resort affairs in Russia, three congresses of Russian balneologists were convened: in 1898, 1903, 1915). Already at the I Congress (February 1921), a broad program of scientific research work was launched, providing for the organization of five scientific institutes on health resorts and a central balneological institute in Moscow (Bagashev). In the inter-congress period, the Central Scientific Conference on Resort Affairs functioned under the department of health resorts of the People's Commissariat of Health (Chairman M. P. Konchalovsky), which was reorganized in 1928 into the resort section of the Scientific Medical Council of the People's Commissariat of Health. The Central Scientific Conference, with its 4 sections (balneological, climatic, koumiss, and sanitary-technical), played a major role in the development of research activities and in the development of methodology for studying health resorts. In this regard, a significant role belonged to local scientific conferences, which annually summarized scientific and organizational results on individual health resorts. Since 1925, scientific resort councils have been established on health resorts for consultation on scientific-production issues. A prominent place in the development of Soviet K. is occupied by scientific resort societies: the oldest balneological society in Pyatigorsk (1863), the Odessa balneological society (1874), and the Moscow scientific-resort society, founded in 1925. Institutes and scientific institutions. As early as the I Congress of workers of Russian balneology in 1898, Minister Ermolov put forward a project for the organization of a balneological institute. The Governmental Resort Conference on the Caucasian Mineral Waters (1912) decided to establish in Pyatigorsk an institute of experimental balneology with clinical departments attached to it, for which an appropriation of 50,000 rubles was provided. This project was not implemented before the October Revolution. Only on July 29, 1920, was the State Balneological Institute established in Pyatigorsk, and after it, a number of other institutes and scientific institutions arose on health resorts. Below are data on the state and activities of these institutions as of 1930. 1. Pyatigorsk Balneological Institute. It conducts its work in the experimental-biological, bioclimatic, hydro-geological, balneotechnical, physico-chemical, sanitary-bacteriological and balneo-therapeutic directions. The latter is carried out in 4 clinics (cardiological in Kislovodsk, for metabolic and gastrointestinal diseases in Essentuki and departments in Pyatigorsk and Zheleznovodsk). The institute has a large library and museum. A large number of the institute's scientific works have been published in its six published volumes of Proceedings. 2. Clinical Institute of Physical Methods of Treatment named after Prof. Sechenov in Sevastopol. In 1920, the institute was recognized as a scientific institution for the study of physical methods of treatment and balneological factors of Crimea. For clinical improvement of physicians in physio- and balneotherapy, a clinical department was opened at the institute. The institute has published 2 volumes of Proceedings, devoted mainly to experimental-clinical works in the field of physical therapy. 3. North Caucasian Clinical Tuberculosis Institute. It arose in Krasnodar on July 18, 1921, as a school for workers in tuberculosis, setting as its main task the study of general issues of pathology and clinical tuberculosis and in particular resort methods of treatment of tuberculosis patients. The institute was fully formed by the end of 1925. A clinical department with a dispensary was attached to the institute in Krasnodar, a children's skeletal tuberculosis sanatorium in Gelendzhik and a clinical sanatorium for pulmonary tuberculosis in Uch-Dere. The institute has published five books of Proceedings. 4. Yalta State Tuberculosis Institute. Established on January 1, 1922, and conducts its work in the direction of bioclimatology, biopathology, social pathology and hygiene and clinical tuberculosis. The institute's clinics consist of departments for pulmonary, throat tuberculosis and tuberculosis of bones and joints and children's tuberculosis. At the institute, physicians undergo training who are preparing to work in tuberculosis. In recent years, the institute has conducted research work mainly in the field of studying the climatic factors of Crimea, in connection with which in 1929 the question was raised of renaming it to the Institute of Climatology and Climatotherapy."

The Institute has published two volumes of its Proceedings. 5. State Physico-Balneological Institute in Tomsk. Organized in November 1920; the status of a scientific institution was established by a decree of July 30, 1923. The main task of the Institute is to study physical methods of treatment and to improve the qualifications of physicians in this field. The Institute simultaneously conducts research on balneological and climatic factors at some Siberian resorts, mainly on Lake Shira and Karachi. 6. Central Institute of Kurotology in Moscow. Emerged from the former resort clinic, founded on July 1, 1921, and was reorganized into a higher educational and scientific institution by a decree of the Council of People's Commissars (1926). The work of the Institute is carried out in five sectors. a) The Natural History sector consists of hydrogeological, physico-chemical, and biophysical laboratories and has as its task the study of the natural properties of resort treatment factors and the development of methods for their research. b) The Experimental-Biological sector studies the effect of resort factors on the organism in experimental-physiological, experimental-dietetic, and koumiss laboratories. c) The Clinical sector consists of six clinical departments for the main types of diseases that are treated at resorts (cardiological, diseases of the nervous system and motor organs, diseases of the digestive organs and dietetic, orthopedic-surgical, neurological, gynecological, and pulmonary-koumiss). It also includes an outpatient department with a mud therapy facility, inhalation room, and other auxiliary institutions. d) The Socio-Organizational sector has as its task the scientific substantiation of the organization and planning of resort affairs; includes an office for recording the results of resort treatment, a department for the medical selection of patients for resorts, and an office for the rationalization of resort affairs with a consulting bureau. e) The Pedagogical sector covers various areas of work for personnel training: four-month advanced courses for resort physicians, courses for physicians of selection committees, courses for cooks and housekeeping sisters, and courses for resort administrators. In addition, graduate students, interns, and students are being trained (the student resort circle brings together senior students of the 1st and 2nd years of Moscow State University). Scientific sections operate at the Institute: mineral waters, koumiss, dietetics, and issues of resort organization. The Institute's activities take place from October to May in Moscow, where pedagogical work is conducted, the results of the summer scientific work are summarized, the application of resort factors in non-resort conditions is studied, and preparation for the summer work at resorts is carried out. For the summer period, the work of the Institute's laboratories and clinics is transferred to resorts (Caucasian mineral waters, Matsesta, etc.). In recent years, the Institute has shifted its focus to the examination of so-called local resorts and remote treatment areas in expeditions. Branches have been established by the Institute at some resorts. These are: clinical departments with experimental laboratories in Old Matsesta, Zheleznovodsk, and Shafranovo, a physico-chemical laboratory in Sadgorod, Sergievsk mineral waters, and others. The extensive scientific material of the Institute has been published in three volumes of its Proceedings and in a number of special collections and monographs on individual problems and resorts. The Institute has published a series of popular brochures on resort treatment issues. 7. In Ukraine, the All-Ukrainian Balneological Institute (Odessa) has been established, which mainly carries out experimental-clinical development of the problems of mud and peloid therapy and combined methods of mud therapy with the application (on the principle of synergistic action) of protein-, opotherapy, and physiotherapy. 8. The problems of the resorts of the Transcaucasian Soviet Federative Socialist Republic are being developed by the Tiflis Institute of Kurotology and Physiatry. In addition to the listed institutes, a number of clinical-type scientific institutions operate at resorts, such as the Semashko sanatorium clinic (Talas) in Yevpatoria or the Bobrov children's sanatorium for bone tuberculosis in Alupka. In order to introduce planning and the most effective organization of scientific research work in resort institutes, the All-Scientific Association of Institutes was established under the Central Institute of Kurotology. Its task is to coordinate the activities of the institutes and a comprehensive study of the fundamental problems of resort affairs on the basis of Marxist methodology. The Association has established the specialization of the institutes within it in certain problems, replacing the historically established universalism characteristic of most of them. - Museums and exhibitions on resort affairs are very few. Museums have been established at the Pyatigorsk Balneological Institute, at the Central Institute of Kurotology, and a museum on the Odessa resorts, founded in 1920 by the outstanding expert in resort and museum affairs E. M. Brusilovsky, which most fully covers the current state of the doctrine of limans, muds, and sea bathing. He also established a permanent resort exhibition in Odessa. In 1923, a resort museum was organized in Moscow on the initiative of N. I. Tezyakov, which became part of the museum of the Institute of Social Hygiene. The museum has over 2,000 exhibits, among which are very valuable models, relief maps, plans, etc. Part of the museum's exhibits constitutes a permanent exhibition, which has seven sections: general part, mineral waters, mud therapy, koumiss therapy, seaside resorts, local resorts, new construction at resorts. Modern problems of K. The problems facing Soviet K. stem from its fundamental task - to scientifically substantiate the organization and planning of resort affairs as a sector of the construction of the socialist economy. The ways and methods of solving these problems are set forth in the description of the work of scientific institutes, in particular the Central Institute of Kurotology, which most fully reflects in its structure the main directions of modern K. In a number of these directions, scientific-kurotological thought has enormous achievements thanks to the combined efforts of clinicians, physiologists, physicists, chemists, microbiologists, and other specialists developing the problems of the effect on the organism and methods of application of mineral waters, therapeutic muds, climate, and koumiss. - From the cycle of works of the natural history section, the original research in the field of the genesis of mineral waters and their radioactivity, the study of their physico-chemical properties, the structure of muds, their regenerative properties, and the rationalization of mud farming, works on actinometry, on the study of the effect of biologically active parts of the solar spectrum on the organism, and a number of other research are of particular importance. The theoretical and practical interest of the works of the Pavlov Experimental Laboratories in Pyatigorsk and the Central Institute of Kurotology, as well as the numerous clinical research in resort institutes, is great. An original chapter is represented by the works on the experimental and clinical study of strong hydrogen sulfide waters (Matsesta, Talgi), which laid the foundation for their application, especially in cardiovascular diseases. In the field of koumiss therapy and koumiss production, the least researched until recently, mention should be made of the works on the study of the effect of koumiss on various diseases, the development of koumiss standards, the rationalization of methods of its production, etc. In connection with the giant growth in demand for resort treatment, the overload of all-state resorts, and the impending 's HOLOGY

In order to bring resort-therapeutic assistance to the patient on the basis of regionalization, expeditionary surveys of therapeutic localities in the USSR have received extraordinary development over the last decade. At the initiative of the People's Commissariat of Health and under the general guidance of the former Central Scientific-Resort Conference, the expeditionary study of natural therapeutic wealth was carried out mainly by the forces of resort institutes. The Pyatigorsk Balneological Institute has surveyed many therapeutic localities and mineral springs in Georgia (Borjomi, Tskhaltubo), Azerbaijan (Isti-Su, Surakhany, etc.) and Dagestan; the Krasnodar Institute has studied a number of mountain-climatic stations of the North Caucasus; the Tomsk Institute has studied some therapeutic localities of Siberia. Comprehensive expeditionary surveys with the participation of the Pyatigorsk and Krasnodar Institutes have studied the therapeutic localities of the Kabardino-Balkar region and the Black Sea coast (1928-29). Extensive development has been given to the expeditionary activities of the Central Institute of Kurotology. In 1929, hydrogeological surveys of Darasun and Olentuy (Transbaikal), surveys of therapeutic muds of Sadgorod, and chemical surveys of the springs of Kul'dur (Far East), physico-chemical surveys of the salt lakes of the Kulunda Steppe and Lake Lebyazhye (Western Siberia), the mineral waters of Sergievsk (Volga region), the resort of Seregov (Komi region), comprehensive medical, physico-chemical and hydrogeological surveys of some therapeutic localities of the Northern Territory (Solvychegodsk, Totma, Ledengsk, Lapominka, Nenaksa), and surveys of desert-climatic stations of Turkmenistan (the renal resort of Bajram-Ali of the Geluana type in Egypt). Despite the significant development of expeditionary surveys in recent years, they are extremely behind the needs of remote areas and national republics due to the enormous complexity of studying the numerous natural therapeutic forces scattered throughout the territory of the USSR. The problem of planning the expeditionary activities of resort institutes and the broad involvement of all organizations and scientific institutions engaged in the study of resort areas from different points of view (All-Union Academy of Sciences, Geological Committee, local history organizations, etc.) plays a most important role. On the basis of these principles, the All-Union Association of Resort Institutes is developing a map of therapeutic localities of the USSR with a comprehensive description of the physico-geographical properties, therapeutic forces, and prospects for the use of resort areas in connection with the general plan for the development of the national economy and resort affairs. On the new paths of building resort affairs in the USSR, some new original problems of Soviet Kurotology have arisen and developed. The problem of effectiveness, or the scientific accounting of the results of resort treatment, has fundamental significance. The scientific accounting of the results of resort treatment logically follows from the socio-economic tasks of resort affairs. This problem arose from the need to find an answer to the basic question: whether the therapeutic effect of resort treatment is a full biological (more precisely, bio-energetic) equivalent of the enormous expenditures made on it by the state, professional, economic and other organizations. Ordinary resort statistics, of course, could not answer this question due to its methodological defects (extreme subjectivism in the assessment of the treating physician, the variety of assessments, the impossibility for the treating physician in many cases to take into account the final results during treatment at the resort itself, and the complete impossibility of tracing the stability and duration of the results). The problem of the scientific accounting of the results of resort treatment was put forward as a primary task by the V All-Union Resort Congress (1926), and under its assignments it has been systematically developed at the Central Institute of Kurotology. The basic orientation in which the development of the accounting problem is proceeding is reduced to the following provisions. 1. The patient is examined before going to the resort and after returning from the resort at certain intervals (immediately after returning from the resort, in six months, in a year and more). The task is to take into account not only changes in the condition of his main and concomitant diseases, but also the degree of restoration of his work capacity, i.e., the increase in living labor power as an equivalent of the expenditures made for treatment. The search for methods and the imperfection of the clinical methodology of work capacity assessment led to the synthetic application of methods of clinical examination (including a number of functional energy tests) and accounting for the overall functional capacity of the organism. The latter is conducted by two methods: a) by studying the resistance of the patient before and after resort treatment in relation to domestic and industrial injury - accounting for absences from work on insurance slips (temporary disability) - and b) by studying the labor productivity in production conditions before and after treatment at the resort. The first results of the work carried out in this direction give grounds to believe that with the current state of medical knowledge, this synthesis of data from clinical practice, insurance slips, and the productive capacity of the worker (under the guidance of the clinic) represents the shortest path to solving the problem of the effectiveness of resort treatment. 2. The main goal is to identify the duration and stability of the results. The minimum observation period is one year. Much material of longer observation has been accumulated. 3. Proceeding from the tasks of planning resort treatment in connection with the general system of therapeutic-prophylactic medicine, the accounting aims to give a comparative assessment of the treatment of certain diseases in localities (in local sanatoriums, extra-resort mud therapy, etc.) and at various resorts. These are the basic provisions that currently determine the path of developing the scientific accounting of the results of resort treatment. By 1930, a significant network of accounting offices has been established. All work on accounting is carried out under the general methodological guidance of the council of the Central Institute of Kurotology and is based on the complete unification of methodology (a single accounting card scheme for different groups of diseases), and complete unity in the technique of collecting materials (standard equipment and precise instructions for filling out schemes in all offices). This method achieves maximum comparability of the data obtained. By 1930, in the network of offices for accounting for the results of resort treatment, long-term observation is being conducted for groups of diseases of the cardiovascular system, 'rheumatic', tuberculosis, digestive organs, nervous, gynecological and pediatric diseases. The scheme adopted in the USSR for accounting for cardiovascular patients represents a typical accounting card, in which some sections have been modified for certain groups of diseases, mainly in the part of the clinical status (pages 2 and 3 of the accounting card). The results of the analysis of the accumulated extensive materials (over 4,000 people) show that an increase in the patient's work capacity is obtained in 70-80% of observations, and during the first half of the year after resort treatment, it continues to increase noticeably according to a number of signs: weight, height, muscle strength, and functional capacity of the cardiovascular system (the latter especially after mud therapy). As a rule, by the time of observation, the stability of most of the results obtained is found in the overwhelming majority of patients (about 75%) treated with mud and gas baths (Kislovodsk, Maikop). Temporary disability during the year of observation after the patient's return from the resort (accounted for by insurance slips) is significantly reduced compared to the data for the year before resort treatment in the trend of the curve and gives a correlation with clinical data. The reduction in temporary disability averages 57% in 'rheumatics' and 32.5% in patients with cardiovascular diseases, varying depending on living conditions, work, etiology, and the nature of resort treatment. The noted conditions are the subject of special study based on accumulated data. The scientific accounting of the results of resort treatment was the first step toward the dispensarization of resort patients at their place of residence. The latter has already begun to be developed and is being established on the basis of the general dispensarization of the population.

Thus, accounting becomes the key problem, linking issues of resort construction with labor and living conditions and with the organizations that build and study them, receiving universal recognition as the fundamental problem of the socialist reorganization of resort affairs on a planned basis, as the path to its scientific substantiation and the displacement of the empiricism that has hitherto prevailed in resort affairs. The problem of developing indications and contraindications for the treatment of professional diseases at resorts represents the most important chapter, which has been studied extremely little. Since 1928, a number of special studies have been conducted, based on the principles of accounting for long-term results according to an in-depth clinical and laboratory examination scheme of the patient. The main work is carried out by the Pyatigorsk Balneological Institute (in Pyatigorsk, Essentuki and Kislovodsk) with the participation of Moscow institutes for the study of occupational diseases. Strictly selected groups of patients with pronounced occupational diseases, subjected to special examination in Moscow, are sent to clinical departments at resorts according to established indications (to Pyatigorsk - workers in chemical plants and chemists with occupational intoxication from aniline, mercury and lead, to Essentuki - workers in hot shops and glass-porcelain production with diseases of the gastrointestinal tract and metabolism, etc.). Long-term observation of the effectiveness of the applied resort treatment methods makes it possible to establish scientifically based indications. Among other problems of Soviet Kurotology, one should note the task of designing a new type of socialist resort, which has been placed on the agenda by the reconstruction period, based on the achievements of modern science and technology and the general principles of socialist construction. This problem is very relevant in connection with the design of the construction of new resorts near areas of large industry (Urals, Kuzbass), but it awaits its development, like a number of other problems requiring their urgent resolution. According to data by Khrisanfov, from 1920 to 1928, over 2,000 works on various issues of kurotology were published. Most of these works were published in the organ of the Resort Administration of the People's Commissariat of Health of the RSFSR 'Resort Affairs', founded in 1923 (in 1928 renamed 'Resort and Sanatorium Affairs'). The successes of Soviet science over the last decade have contributed to the publication of a three-volume original textbook 'Fundamentals of Kurotology', prepared by the Central Institute of Kurotology together with other institutes. A number of guides on medical selection, reference publications on resorts and popular brochures have been published. Teaching of Kurotology. The question of establishing an independent department of balneology in universities has occupied the minds of leading Russian balneologists since time immemorial. At the I Balneological Congress (1898), this idea was put forward by Podyvotsky. However, for decades, physicians did not receive even the minimally necessary knowledge in the field of balneology at the university bench. According to the university teaching program, balneology was taught in the department of pharmacology with prescription writing, toxicology and the doctrine of mineral waters. In this presentation, the 'doctrine of mineral waters' was reduced to a mechanical listing of the names of the largest resorts with indication of the main salts contained in mineral springs and their effect on the body from a pharmacological point of view. Such teaching did not give listeners any idea of the complex of diverse therapeutic effects that constitute the basis of their healing influence. The information that students received in the course of general therapy was also fragmentary. This situation, with minor exceptions, has remained in university teaching even in the last decade. Despite the enormous growth of resorts, the great popularization of resort treatment, the development of resort science and a number of decisions of all post-revolutionary congresses, Kurotology still has not taken its proper place in the university. In only a few universities of the USSR it is taught at the department of physiotherapy (Moscow, Tiflis, Tomsk) or is presented in optional privat-docent courses (Odessa, Rostov, Kiev). There is no independent department of Kurotology, although Kurotology has every right and reason for it. The need to fill the gaps in university education has fully highlighted the task before the resort institutes of training new cadres of Soviet physicians-kurotologists. In this direction, the first steps were taken by the Central Institute of Kurotology (formerly the Central Resort Clinic), where since 1922 the advanced training of young physicians in some disciplines of resort therapy was organized. Since 1926, at the Institute of Kurotology, annually functioning (November-March) 4-month advanced training courses have been established for physicians sent from resorts with at least three years of practical work experience. The courses are the only ones in the USSR and have the task of preparing a broadly educated resort physician-clinician. The main focus of the courses is to give the physician knowledge of the general foundations of the construction of Soviet resorts as a branch of socialist economy and the necessary information on the essence, influence and methods of application of resort therapeutic factors. The program of the courses covers 3 main cycles - natural-historical, clinical and scientific-organizational and is divided into 2 semesters: I semester - general foundations of kurotology and II semester - private resort therapy with specialization in individual clinical disciplines. The following subjects are taught at the courses: geology of mineral springs and therapeutic muds, physico-chemistry of mineral waters and therapeutic muds, physical foundations of resort treatment methods, foundations of medical meteorology, doctrine of therapeutic muds, history of resort affairs in the USSR and the West, foundations of resort construction in the USSR, principles of scientific accounting of resort treatment results and medical selection, foundations of hygiene, sanitation and improvement, sanitary-educational work at resorts, dialectical materialism in natural science and medicine, physiology of nutrition, biochemistry, dietetics, therapeutic physical culture, doctrine of internal and external application of mineral waters, meteorotherapy, koumiss therapy, hydrotherapy, photo-electrotherapy, resort treatment of tuberculosis of the lungs, cardiovascular diseases, diseases of the movement organs, nervous, gynecological and children's diseases. In the widely organized practical sessions, students study the practice of clinical and laboratory research methods, culinary dietary preparations, research of food products, meteorological observations, etc. Physicians specializing in individual clinics of the institute treat patients, participate in rounds, pedagogical outpatient consultations, etc. Special attention is paid at the courses to questions of Marxist methodology, presented in a special course and developed in systematically functioning circles. On short-term courses for physicians of selection commissions (established at the Central Institute of Kurotology in 1928), the basic principles and practice of medical selection of patients for resorts are presented. Along with the cycle of lectures on main groups of diseases, seminars and practical sessions on selection methodology are conducted with students. In the matter of personnel training, the work of graduate students and interns plays a significant role, whose staff is established in all resort institutes. Graduate students and interns are admitted on a competitive basis for 3 years at state expense and are trained: the first for scientific and pedagogical activity in the field of Kurotology, the second as practical treating physicians. Over the past years, the Central Institute of Kurotology has trained about 400 physicians of the above categories from the republics of the USSR. A large number of physicians annually specialize in other resort institutes in individual areas of resort therapy (in the Yalta Institute in climatotherapy for tuberculosis, in Pyatigorsk - in balneotherapy for cardiovascular diseases, etc.). A special role in replenishing the ranks of resort physicians with proletarian youth is played by student resort circles, organized in Moscow, Rostov and Tomsk. The Moscow circle has been functioning since 1918 (since 1925 it has been part of the Central Institute of Kurotology) and unites students of senior courses of the 1st and 2nd Moscow State University, giving listeners in a two-year course a cycle of theoretical foundations and practical knowledge in the field of resort affairs (lectures, seminars and practicals in Moscow and summer production practice at resorts). Kurotology in the West. Since resort treatment in capitalist countries is accessible mainly to the propertied classes, kurotology in European countries has a pronounced bourgeois character and does not at all touch upon questions of resort assistance to the working population. The planned scientific development of problems of resort affairs is excluded by the capitalist nature of foreign resorts. Due to the extreme insufficiency of the scientific base, weak funding and lack of planned connection between scientific workers, scientific work lacks the necessary effectiveness. Despite the presence of many outstanding researchers - balneologists and climatologists (Dietrich, Maliwa, Zorkendorfer, Forester, Fox, etc.) - and some exemplary scientific institutions, a very large part of the scientific works published in European literature has an advertising character.

They are printed by those authors about whom Bickel writes that they 'instead of accumulating experimental data in a laboratory setting and contributing to the consolidation of scientific balneology, prefer to continue to publish works about the miraculous properties of the resort where they practice, or to extol in high-flown phrases the beneficent gifts of balneology'. A unique view of the scientific significance of kurotology in the West is vividly reflected in the words of the foremost German balneologist Dietrich: 'Our resorts could not have withstood the war and the difficult post-war period to the extent that they did, if they had not had a tremendous superiority in a scientific sense in comparison with other countries ("dem Ausland gegeniiber")'. The significance of economic incentives and competition in the development of scientific measures is also very great for all other Western countries, leaving 'primum movens' for scientific work on foreign resorts. Scientific societies, at their high level and enormous significance in the history of resort affairs, are detached from practical life. Among the individual societies, it is necessary to note: 1) International Society of Medical Hydrology; founded after the world war, it unites kurotologists from 35 countries of the world, and has included representatives of the USSR since 1928. 2) German Balneological Society (Deutsche Balneologische Gesellschaft), transformed in 1878 from the resort section of the Berlin Medical Society. 3) German Society of Thalassotherapy (since 1911). 4) German Society of People's Resorts (Deutsche Gesellschaft fur Volksbader). 5) German Commission for Health Measures in Resorts (Deutscher Ausschuss fur die gesundheitlichen Einrichtungen in den Kur- und Badeorten). 6) Association for the Research and Observation of Mineral Springs (Vereinigung fur Quellenforschung und Beobachtung). The German Balneological Society has its own special scientific center (Zentralstelle fur Balneologie), which sets as its task the unification of all branches of modern knowledge, natural-historical sciences and technical disciplines for general research work in the field of resort affairs. This organization, according to the idea of its founders, should prepare the creation of a Central German Balneological Institute, which would reflect all aspects of resort affairs. In recent years, scientific K. in the West, maintaining a connection with related physiotherapy, has defined itself as a completely independent field of scientific knowledge. International resort congresses have their beginning since 1886. The first congress on hydrology and balneology was held in Biarritz and was devoted to the problems of hydrology (geology, physics, chemistry, balneotechnics, balneodynamics and therapy) and climatology—general and medical. The decision made in Biarritz to convene international congresses every 3 years was not fulfilled. The second congress was held in Liege in 1905, the third—in Paris in 1910. After the world war, the last congress, devoted mainly to questions of climatology, was held in 1927 in Lyon with the participation of representatives of Soviet K. The outstanding role in the life of resorts is played by the annual meetings of the International Hydrological Society (Annual Meeting) and the German balneological congresses, which take place annually at the main resorts of the continent. -Teaching of K. is carried out systematically only in France, where in 1922 chairs of balneology were established in Bordeaux and Toulouse, and since 1927 such chairs have been introduced in all universities, even in Algeria. Each chair groups around itself the nearest resorts. These chairs do not have their own clinics. In addition, in Paris at the College de France there exists an institute of balneology and climatology, maintained at the expense of a supplementary tax to the resort fee, from which 35% is allocated for its needs. The institute has five departments: chemical, physical, geological, climatological and clinical. The theoretical laboratories are better represented than others. The institute annually organizes three-month courses for doctors and has its own publication (Annales de l'Institut d'Hydrologie). Resort questions are also dealt with by the Medical Academy, which has a special commission on mineral waters, which gives an opinion on the use of new sources. Scientific reports from resort doctors are sent to the Academy for appropriate evaluation. For students of the last two years, excursions to resorts are arranged, organized by the balneological institute and medical faculties and subsidized by the National Resort Federation and the resorts themselves. -In Germany, compulsory teaching of K. in universities does not exist. For doctors, advanced courses in resort disciplines are held annually with the participation of leading scientists. The programs of courses are usually developed by the resort where the courses take place and play to some extent an advertising role for this resort. In recent years, the question of organizing balneological resort academies according to the model of institutes in the USSR has been raised by a number of German balrologists, which, according to Dietrich, 'carry out what German science has been striving for for decades'. Great importance is attached to the training of culinary personnel for resorts. The main role in this matter belongs to the Lette-Verein in Berlin and the dietary department of the Eppendorf Hospital of Prof. Brauer in Hamburg. -In Italy, teaching of K. is included in the course of pharmacology; in addition, regular advanced courses for doctors are held at various universities. -Scientific institutes in the West are few in number, have a local character and develop individual problems of modern K. Among them (besides the balneological institute in Paris) should be mentioned the Institut fur Balneologie u. Stoffwechselkrankheiten in Wiesbaden and the following scientific laboratories: the chemical Fresenius in Wiesbaden, the balneological Hertl in Kissingen, the diagnostic Weber in Naugheim and the balneological Zerckendorder in Marienbad (with a branch department in Franzensbad). In the study of medical climatology, the outstanding role is played by the Dormont institute in Switzerland. The project of organizing a state balneological institute in Prague with a clinic, outpatient department, laboratories, lecture hall and dietary canteen is being developed, as well as the project of organizing an International Balneological Academy, put forward in 1927 in Franzensbad. D. Danishevsky.