Mountain Climatic Stations

MOUNTAIN CLIMATIC STATIONS, one of the types of climatic resorts where various diseases are treated with the 747

predominant use of the features of the mountain climate. - Features of the mountain climate. The mountain climate is a variety of the continental climate, which is divided into the following types: 1) climate of plains and low altitudes - up to 500 m above sea level, 2) subalpine or pre-alpine climate - from 500 m to 900 m above sea level, 3) alpine (high-mountain) climate - from 900 m to 2,000 m above sea level, 4) high-alpine (hyperalpine) climate - higher than 2,000 m above sea level. Mountain localities are considered to be those located higher than 500 m. For therapeutic purposes, localities with an altitude of up to 2,000 m are usually used (the altitude of only a few mountain climatic stations exceeds this value and reaches up to 3,000 m in rare cases). The properties of the mountain climate are characterized by great diversity. - Air pressure decreases with increasing altitude of the place. At 0°, it is equal to 671 mm at an altitude of 1,000 m, 590 mm at 2,000 m, and 517 mm at 3,000 m. With increasing altitude of the locality, the amount of oxygen also decreases, but at altitudes suitable for climatic treatment (up to 2,000 m), it does not reach such degrees that would cause sharp changes in respiration in a healthy person (see Mountain sickness). Fluctuations in air pressure in the mountain climate are usually smaller than in lowlands. - Temperature is closely related to altitude. Due to the high thermal transparency of the upper layers of the atmosphere, the air at high altitudes easily transmits all rays, including thermal ones. Therefore, it is warmed little both by passing sun rays and by those radiated back by the heated soil. The higher the locality, the lower its temperature. An increase of 100 m on average lowers the temperature by 0.58°; this figure is not constant (in winter 0.43-0.45°; in spring 0.67°; in summer 0.68-0.35°; in autumn 0.51-0.58°). In summer, the change in temperature with altitude proceeds faster than in winter. The smaller the mountain range, the greater the heat radiation and the lower the temperature. Therefore, wide mountain valleys have a higher temperature than individual peaks having the same altitude. Along with the decrease in temperature at high altitudes, its annual and daily fluctuations decrease. But there are numerous exceptions to this rule, since the magnitude of the amplitude depends on the accessibility of a given place to sun rays, cold and warm winds, on the direction of mountain ranges and their slopes, and the like. Consequently, the daily temperature fluctuation in various mountain localities is very diverse. In warming high-altitude localities, insolation plays a predominant role, as a result of which a sharp difference in air temperature in the shade and in the sun, and between the temperature of the air and the soil, is noted in the mountains. The climate of high-mountain localities differs from that of plains by a greater intensity of insolation, an abundance of short-wave rays (actinic, ultraviolet), and greater uniformity of its daily and annual course. - Absolute humidity decreases as the locality rises above sea level. Relative humidity is not directly related to altitude. Soil heated by the sun's rays gives off water vapor, which at a certain altitude condenses into clouds.

laka and produce precipitation. Above this lower moist belt lies a dry belt where vapors reach in insignificant quantities. The boundary between these belts is variable. In winter, vapor condensation due to lower temperature occurs lower down, and therefore this boundary descends. Many high-lying localities turn out to be in a dry, cloudless belt. They are distinguished by a clear winter and great insolation. If such a locality is located on a windless slope from which cold air easily flows down into the deeper-lying valley (replaced by warm air flowing from it), this creates extremely favorable conditions for the establishment of mountain climatic stations. In the lower belt, relative humidity is extremely variable. It depends on soil moisture, the presence or absence of large lakes, swamps, as well as on the arrangement of mountain ranges and slopes in relation to prevailing winds, whether dry or moisture-bearing (see Climate). The latter circumstance sharply affects the amount of precipitation and the height of the snow line in the mountains. Very characteristic examples of this are found in our Caucasus. Air currents in the mountains are stronger than in the lowlands. Local winds join the general winds in the mountains. These include so-called falling winds (the foehn, warm and dry), as well as daytime and nighttime mountain-valley winds. The regular change of winds—day and night—in the mountains occurs due to the uneven heating of the layers of air adjacent to the slope and located at a distance from it. Mountain air is usually distinguished by cleanliness, low dust content, high electricity content, and greater radioactivity than the air of plains. These features of the mountain climate are sharply expressed in high-mountain localities (above 1,000 m). The climate of lower-lying middle-mountain localities (500–1,000 m) represents a series of gradual transitions from the climate of lowlands to that of high mountains. Influence of the mountain climate on the organism. The physiological action of the mountain climate is diverse. The main action on the organism is expressed in the stimulation to increased activity of vital systems. Reflections of this influence of the mountain climate are changes in the mechanism of respiration and heart activity, in general and protein metabolism, in blood formation, in the work of the vascular musculature, in the irritation of sense organs (skin and eyes), and in the increase in the work of skeletal musculature. The degree of excitation received by the organism in a mountain climate varies depending on the individual excitability of the individual and on the strength of the climatic stimulus, which in mountainous localities depends on altitude above sea level, geographical position, and local features (position, direction of illumination, character of the locality—flat elevation or deep gorge, protection from winds, height and character of surrounding mountains, forest cover). Under the influence of the mountain climate, the number of respirations in the first days increases by 3–10 per minute, and then gradually returns to normal. Respiration initially becomes more superficial, and the vital capacity of the lungs decreases, but with a more prolonged stay in the mountains, the depth of respiration and the vital capacity of the lungs increase compared to the dimensions noted during life on the plain. Regarding individual phases of respiration in the mountains, an ease of inspiration and difficulty of expiration are noted. The volume of the chest in the mountains increases. The cause of respiratory changes lies in the reflex increase in the excitability of the respiratory center. The number of heart contractions in the mountain climate increases (sometimes by 40 beats per minute). With a prolonged stay in the mountains, the pulse levels out. The increase in the pulse is more sharply expressed during movement and physical exertion. Changes in blood pressure in the mountains are individually different, not sharply expressed, and decrease as the organism adapts to the mountains. Fluctuations in blood pressure in the direction of an increase are more constant in elderly subjects. Metabolism in the mountain climate increases (compared to the plain) both at rest and during muscular work. At high altitudes, an increased expenditure of energy and an increase in gas exchange are noted. In the mountains, an increase in proteins and a retention of nitrogen in the organism are noted. These phenomena are individually different and stop with altitude (above 4,000 m, a loss of protein by the organism is noted, see Mountain sickness). Adults on the plain show a protein gain during muscular work; in the mountains, they resemble growing organisms in this regard. An increase of acidosis in the blood is noted. The influence of the mountain climate on blood formation is important. This influence has been thoroughly studied in a number of works. Researchers have noted an increase in the number of erythrocytes and hemoglobin under the influence of the mountain climate. At present, two processes are distinguished: 1) a rapidly passing effect in the first days of stay in the mountains, which manifests itself in a relative increase in the amount of erythrocytes and hemoglobin (the so-called "redistribution of blood"); 2) with a prolonged stay in the mountains, a real increase in blood mass and the number of erythrocytes occurs as a result of increased erythropoiesis. The number of leukocytes does not show sharp fluctuations in the mountains. Regarding individual types of leukocytes, the blood of mountain dwellers differs (compared to lowland dwellers) by neutropenia and lymphocytosis ("mountain type of white blood"). At present, far from the entire complex mechanism of organism reactions to the irritating influence of the mountain climate has been studied in sufficient detail. The most sharp changes are noted in the organism in the first hours and days of its stay in the high-mountain climate. The period of acclimatization lasts in the mountains up to 10–14 days and is sometimes accompanied by painful manifestations ("acclimatization difficulties"). The severity of these painful manifestations can be reduced by a gradual ascent with long stops at medium altitudes. Therapeutic application of the mountain climate. In the history of the therapeutic application of the mountain climate, the first place is occupied by its prescription for the treatment of pulmonary diseases, mainly tuberculosis. Starting from 1859, on the initiative of Brehmer, numerous sanatoriums for patients with pulmonary tuberculosis began to be established in the mountains. Over the 70 years that have passed since then, the field of therapeutic application of the mountain climate has expanded significantly. Many disease forms began to be considered indicated for treatment in the mountains. Over the past 25 years, on the initiative of Bernhard and Rollier, treatment in mountain climatic stations has begun to be widely used for bone and joint tuberculosis. Indications and contraindications for treatment in high-mountain climate have been most thoroughly developed by Swiss doctors. Indications. 1. Predisposition to tuberculosis and suspected tuberculosis. 2. Pulmonary tuberculosis, but without a tendency of the process to rapid spread, without signs of extensive destruction, without high fever (below 38.5° and of a non-hectic type), without an increase in pulse above 100, without severe circulatory disorders, without shortness of breath and similar symptoms. Therefore, incipient and older tuberculous infiltrations are suitable for high-mountain treatment, as well as fibrous pulmonary tuberculosis of not very large extent. 3. Chronic bronchitis of tuberculous and non-tuberculous nature. 4. Chronic pneumonias of non-tuberculous nature with good cardiac activity. 5. Chronic pleurisies with remnants of exudate and the formation of adhesions. 6. Mild tuberculous lesions of the intestine and almost all forms of external and surgical tuberculosis, if the general condition of the organism allows a stay in the mountains. 7. Bronchial asthma. 8. Chronic catarrhs of the stomach and intestines, as well as secretion anomalies in the digestive tract. 9. Chlorosis and mild forms of anemia (especially secondary anemias—after tuberculosis, syphilis, malaria, past blood loss). 10. Mild forms of diabetes, gout, and obesity. 11. Hard-to-heal wounds of all kinds, as well as syphilitic ulcers with a weak tendency to heal, despite specific treatment. 12. Chronic purulent processes of the middle ear of tuberculous and non-tuberculous nature, as well as suppuration in the accessory cavities. 13. Mild neurasthenia. Contraindications. 1. All severe cases of pulmonary tuberculosis of a destructive character, pulmonary tuberculosis with a tendency to rapid spread or with severe tissue loss. Tuberculous patients with fever above 38.5° and a constantly accelerated pulse—from 120 and more—at rest. Strong tendency to hemoptysis. 2. Laryngeal tuberculosis, especially with a tendency to irritable cough and in the presence of severe ulcerations. 3. Severe tuberculous lesions of the intestine. 4. Feverish and inoperable tuberculous kidney lesions. 5. Severe diseases of the nervous system with an erethic constitution (severe neurasthenia, psychoneuroses, psychoses). 6. Diseases of the circulatory organs (valvular heart disease, myocarditis, myodegeneration, arteriosclerosis). 7. Severe lung diseases (severe emphysema, stagnant bronchitis, lung tumors, lung gangrene). 8. Acute and chronic nephritis. 9. Severe degrees of metabolic diseases (diabetes, gout, obesity). 10. Severe blood diseases (severe secondary anemias, pernicious anemia, leukemia). 11. Severe rheumatism. Doubtful indications. 1. Dry catarrhs of mucous membranes (rhinitis, pharyngitis, laryngitis, bronchitis). 2. Habitual constipation. This list is compiled with reference to well-equipped stationary institutions at mountain climatic stations. Therefore, regarding indications, it must be considered maximal.

Under less favorable conditions, it is subject to significant reduction, and great caution is necessary when selecting patients for dispatch to mountain climatic stations. A trip to a resort and the spa treatment itself in the mountains require a sufficient reserve of strength from the patient. It is impossible to send heavily emaciated patients, exhausted by disease, or hopeless in terms of prognosis to mountain climatic stations; if the patient's reserve of strength is sufficient, treatment there is often an important auxiliary measure. It is necessary in each individual case (especially when referring tuberculosis patients to mountain climatic stations) to consider whether the patient can stay at the resort for a properly long period, because in very many cases a prolonged climatic treatment is required, i.e., over the course of several months, whereas sending them for a short period often brings no benefit. After a careful decision on the main question of the desirability of sending the patient to the mountains, special attention must be paid to the choice of a mountain climatic station. It is extremely important in this case for the physician to know and take into account the difficulties and conditions that the patient will encounter both on the way to the mountain climatic station and back, and at the resort itself (medical supervision, care, therapeutic facilities, housing, nutrition, etc.). Mountain climatic stations in Western Europe are very numerous (several hundred). Many of them are located in the middle mountain belt, many in the high mountain belt, at an altitude of from 1 to 2 thousand meters or more. Mountain climatic stations exist in Switzerland (in the Alps and the Swiss Jura), France (French Jura, Vosges, Auvergne, Savoy, French Pyrenees), Italy (Italian Alps, Apennines), Austria (Tyrol, Carinthia, Styria), Czechoslovakia (Tatra, Carpathians) and Germany (Black Forest, Bavaria, Thuringian Forest, Harz, etc.). The most famous Swiss mountain climatic stations are Davos, Leysin, and Arosa.

Mountain climatic stations in the USSR. The vast territory of our Union, intersected in many places by mountain chains, opens up wide prospects for the development of mountain climatic stations. In the mountainous parts of the Union, numerous points suitable for the organization of mountain climatic stations are noted. The largest number (up to 180) of such points is noted in the mountains of the Caucasus, in second place are the mountains of Turkmenistan and Uzbekistan (more than 20), then the Altai and Sayan mountains of southern Siberia (more than 10), the Yayla in the Crimea, and the mountain ranges of Transbaikalia and the Urals. In these regions, at various heights, there are rich opportunities for creating a whole range of diverse mountain climatic stations in the middle mountain and high mountain belts. Many localities in the mountains have not been surveyed at all. Future surveys will naturally supplement the current lists. At the present time (1928), about 40 mountain climatic stations are used (to varying degrees) in the USSR. Only in two places (Kislovodsk, Abastumani) is climatic treatment carried out all year round. In the remaining mountain climatic stations of the USSR, treatment is of a seasonal character. Most of our mountain climatic stations have been studied far from sufficiently. Most of them are equipped primitively; far from all have properly equipped stationary medical institutions. The mountain climatic stations of the USSR possess rich natural properties, are distinguished by their great diversity, and are in need of further study and improvement.—A brief list of used mountain climatic stations in the USSR (1928): I. Caucasus (see map). 1) Abastumani, 1,273–1,450 m, 2) Bakuriani, 1,663 m, 3) Bakhmaro, 1,830 m, 4) Borjomi, 805 m, 5) Gunib, 1,050 m, 6) Dilijan (Armenia), 1,280 m, 7) Dzhelal-Ogly, 1,406 m, 8) Zheleznovodsk, 640 m, 9) Karaklis, 1,324 m, 10) Kislovodsk, 823 m, 11) Kojori, 1,340–1,504 m, 12) Krasnaya Polyana, 500 m, 13) Lysogorsk (Nagorno-Karabakh), 1,920 m, 14) Manglis, 1,204 m, 15) Nalchik, 500 m, 16) Stepanakert (Nagorno-Karabakh), 800 m, 17) Suram, 730 m, 18) Teberda, 1,300 m, 19) Tsagveri, 1,020 m, 20) Tsebenda, 388–640 m, 21) Tsey Glacier, 2,100 m, 22) Tsemi, 1,116 m, 23) Shatoy (Chechen Autonomous Oblast), 561 m, 24) Shusha, 1,368 m.—II. Turkmenistan. 25) Brichmulla, 26) Kara-Tube, 1,200 m, 27) Medeo, 1,600 m, 28) Osh, 1,020 m, 29) Firyuza, 600 m, 30) Chimgan, 1,372 m, 31) Chimkent.—III. Siberia. 32) Arshan-Tunkinsky, 900 m, 33) Katon-Karagay, 1,088 m, 34) Chemal, 500 m.—IV. Crimea. 35) Tuzler, 680 m, 36) Ereklik, 460 m.—V. Transbaikalia. 37) Makkaveevo, 38) Olentuy.