TERRAIN CURATIVE TREATMENT

TERRAIN CURATIVE TREATMENT, treatment by systematic ascents in mountains along marked paths with a specific angle of incline; a complex therapeutic intervention that affects the cardiovascular system, pulmonary respiration, and metabolism in the patient. This method was proposed by Oertel in 1885 for the reduction of fat and dehydration in cardiac patients and was first tested by the author on himself. T., initially overestimated in Germany, subsequently caused harsh criticism. In recent years, T. is beginning to be used again, particularly in our Union. The method has received new clarification through scientific development at the Lenin Kislavodsk Cardiological Clinic under the direction of Pletnev. Technique of T. The patient begins treatment with walks on horizontal roads without any inclines. After some time, when the patient has strengthened and can easily cover the prescribed distance (1-2 km), he is assigned to paths of the second category with a slight incline (from 5° to 10°), then the patient is transferred to paths with a larger incline (10-15°) and finally with an incline of over 15° (fourth category of paths). The four categories of paths mentioned above constitute the first group of paths according to Oertel. These paths should be well-arranged, sufficiently wide, easily passable, should be provided with benches for rest and posts with indicators of distance and height of incline, and finally should be protected from wind. The second group of paths consists of longer roads, without strict determination of incline throughout the route. The ascent should be made with measured steps, with one breath per 3-4 steps; in more severe diseases of the cardiovascular system, one breath per two steps, i.e., each step is either an inhalation or an exhalation. If any sensations from the cardiovascular system occur, the patient stops and takes several deep breaths. During the ascent, the patient should wear appropriate clothing (light and hygroscopic), as sweating increases significantly during mountain ascent. The terrain in which T. is conducted should be protected from winds and should have abundant sunny days and clean, dust-free, dry, rarefied air. Among the resorts of the USSR, Kislavodsk best satisfies the listed conditions (see); T. is also applied in Pyatigorsk, Zheleznovodsk, Sochi, Borovoye and other resorts. Gradual mountain ascents increase the strength of the heart muscle, eliminate venous stagnation, increase sweating and respiratory excursions. Due to increased oxygen absorption, tissue respiration is enhanced. Simultaneously, the amount of Hb and red blood cells increases. During mountain ascent, blood pressure rises and pulse quickens, pulse pressure increases, heart tones become clearer, organic noises at the valves intensify. In cases of incorrect dosage or in persons who poorly react to T., blood pressure decreases, pulse and respiration sharply increase, pulse pressure falls, heart tones become muffled, organic noises become less distinct. Excretion of water during T. significantly increases, mainly through extrarenal pathways. Reserve alkalinity increases due to hyperventilation on one hand, and sweating on the other. The blood sugar level usually rises during the walk in order to return to the original figure by the end of the walk. Treatment with T. requires special caution in dosage, taking into account the individual characteristics of the patient; special caution is required for those with sclerosis. For dosage of T., particularly valuable research methods due to their simplicity are the Valsalva test and the Broadbent-Pletnev phenomenon. Indications for T.: 1) fatty heart, 2) incomplete compensation in diseases of the heart muscle and in heart defects, 3) initial sclerotic changes of the heart and blood vessels, 4) emphysema of the lungs and initial forms of compensated tuberculosis of the lungs, 5) disturbances of heart and lung function depending on mechanical causes (deviations of the spine, pleural adhesions, etc.). Contraindications: 1) uncompleted or recently completed inflammatory process in the endocardium and heart muscle, 2) clearly expressed sclerosis of the heart and blood vessels, 3) angina pectoris with frequent attacks, 4) decompensation of the cardiovascular system, 5) sharply expressed emphysema of the lungs or decompensated tuberculosis of the lungs, 6) aneurysm of the aorta, 7) nephropathies.