What kind of rest and climate are indicators for tuberculosis? Sanatorium-resort treatment of tuberculosis. You are susceptible to moderate lung disease

The need for sanatorium-resort treatment of tuberculosis patients, both adults and children, tends to grow. This is due, on the one hand, to the unfavorable epidemiological situation regarding tuberculosis, which is sharply deteriorating, by the state of public health, and on the other hand, to the possibility of achieving high results in sanatorium treatment: clinical cure of tuberculosis in 75-80% of patients with tuberculosis, improvement in functional indicators in 95-98% sick.

Sanatorium-resort treatment is an important step in the complex treatment of tuberculosis patients and in the prevention of tuberculosis among people at risk. In children, especially with extrapulmonary forms of tuberculosis, as well as in adults with newly diagnosed small and limited forms of pulmonary tuberculosis in the phase of infiltration and resorption without bacterial excretion, the entire period of treatment can take place in a sanatorium, bypassing the inpatient stage. In other cases, the sanatorium stage includes follow-up treatment and rehabilitation after the acute phase or surgery.

An important point in the modern approach to sanatorium-resort treatment of tuberculosis is the combination of courses of specific chemoprophylaxis and chemotherapy using natural-climatic, preformed physical and other sanatorium-resort factors.

Types of sanatoriums for the treatment of tuberculosis

Sanatorium-resort treatment of tuberculosis is carried out in anti-tuberculosis sanatoriums located in seaside, mountain, forest and steppe climatic resorts.

The specificity of seaside climatic resorts is the possibility of conducting thalasso procedures, including both breathing sea air and sea bathing. In mountain resorts, the main operating factors are low atmospheric pressure and partial pressure of oxygen, and increased solar radiation. They have a training, hardening effect, stimulate protective-adaptive mechanisms, and the function of the cardio-respiratory system.

Anti-tuberculosis sanatoriums are located in low mountains (from 400 to 1000 m above sea level), where a healthy person does not feel any signs of discomfort. But for the body of a patient with tuberculosis, even those changes in atmospheric pressure and partial pressure of oxygen characteristic of this altitude can create a training load.

Forest and steppe resorts are mainly either included as part of other types of resorts, or as local resorts. The main health factor at these resorts is forest or steppe air, cleaner than in cities, enriched with oxygen and volatile biologically active substances released by plants.

In Ukraine, seaside anti-tuberculosis sanatoriums are concentrated mainly on the southern coast of Crimea - the South Coast (resorts Alupka, Simeiz). Most of them are intended for the treatment of patients suffering from pulmonary tuberculosis. Treatment in them is especially indicated for patients with a torpid course of respiratory tuberculosis, as well as in the presence of concomitant nonspecific respiratory diseases, stage I-II hypertension, and initial forms.

On the South Coast there are also sanatoriums for the treatment of patients with tuberculosis of bones and joints and tuberculosis of the genitourinary organs. Treatment of residual effects of extrapulmonary tuberculosis (bones and joints, eye, lymph nodes, genitourinary organs) can be carried out in sanatoriums of the coastal-steppe zone (Evpatoria, Odessa region, Berdyansk) in sanatoriums of the corresponding profile.

Mountain climatic resorts (low mountains) are located on the southern slopes of the Crimean Mountains (Big Yalta) and in the Carpathians (Vorokhta, Tatarov, Yaremche). The sanatoriums of these resorts specialize in treating patients suffering primarily from pulmonary tuberculosis.

There are no steppe kumiss-therapeutic resorts in Ukraine. But in some sanatoriums of the South Coast, kumis made from mare’s milk is supplied from the foothills of Crimea. Tuberculosis patients with poor tolerance to chemotherapy and concomitant diseases of the digestive system should be sent to such sanatoriums.

Local climatic resorts are distinguished not by their climate, but by their proximity to a person’s place of residence. In Ukraine, most local climatic resorts are lowland forest or forest-steppe resorts in the temperate zone. They have a significantly more favorable environment compared to nearby cities and allow for climate-therapeutic procedures. For sick people, it is important that these resorts do not require acclimatization. For this reason, seriously ill people are usually recommended treatment at local resorts.

Methods of sanatorium-resort treatment of tuberculosis

The main methods of climatotherapy at resorts are aerotherapy (aerorespiratory therapy, air baths), heliotherapy and swimming in ponds. Different types of climate influences activate different adaptation mechanisms. But almost all of them affect the state of the neuroendocrine and cardiovascular systems.

Thermal effects, in addition, have a pronounced effect on the respiratory system, excretion, and energy production. Aerorespiratory - on the respiratory and hematopoietic organs, energy production. Helium-influencing - on the skin, connective tissue. Most factors directly or indirectly affect immunity.

The use of these methods is determined by the prescribed sanatorium-climatic regime and depends on the patient’s condition.

Tuberculosis treatment regimens

Mode 0 (rest mode, bed) is prescribed during periods of exacerbation of tuberculosis or concomitant diseases, as well as in cases of pronounced acclimatization reactions.

Mode I (gentle) is aimed at creating optimal conditions for adaptation to new climatic factors, preserving the body's reserve forces, facilitating the functioning of the cardio-respiratory and nervous systems in patients with clinical signs of tuberculosis and related diseases.

Mode II (gentle training or tonic) is used to stimulate the body’s compensatory capabilities, train adaptation mechanisms, cardio-respiratory, neuroendocrine and other systems through gradually increasing physical, thermal and other types of stress. This regimen is prescribed during the period of subsidence of the tuberculosis process and remission of concomitant diseases, as well as for patients who have undergone surgery for tuberculosis with mild functional impairments.

Mode III (training) is aimed at training the functional systems of the body, hardening, preparing for work through the maximum use of active methods of climate therapy and physical activity and aims to increase the body's resistance, normalize metabolism, respiratory function, blood circulation, and thermoregulation. This regimen is prescribed for stable remission of the tuberculosis process and concomitant diseases.

Aerorespiratorytherapy consists of breathing fresh air for as long as possible, which differs from indoor air in its high oxygen content, the presence of light negative air ions and volatile plant biologically active substances and other components beneficial to the body. Staying outdoors improves oxygenation of the body both due to increased oxygen content and by stimulating breathing. Breathing sea air and the air of parks and forests, especially coniferous ones, is especially beneficial.

Compared to land air, sea air is enriched with particles of salts of sodium, magnesium, calcium, etc. It also contains more ozone and negative air ions, including iodine, bromine, etc. The salts contained in sea water have a beneficial effect on the mucous membranes of the respiratory tract ways. Negative light ions are beneficial for the nervous (sedative effect) and cardiovascular systems, stimulate metabolism, activating respiratory enzymes of tissues, have a hyposensitizing effect, and increase the body's resistance. The air of forests and parks is clean and oxygenated. Volatile biologically active substances released by coniferous plants improve bronchial patency, lung ventilation, and have an anti-inflammatory effect. This is especially important for patients with pulmonary tuberculosis, who often experience hypoxia and respiratory failure.

Normoxic aerorespiratory therapy during exposure to air in comfortable thermal conditions has no contraindications. The most effective option for aerorespiratory therapy is 24-hour stay in the open air, including sleeping on the seashore. In the warm season, round-the-clock aerotherapy is a gentle method of climatic treatment and can be prescribed to almost all patients in remission. But in the cold season there is a combination of aerorespiratory and cold effects, which increases the workload of this type of therapy. Therefore, it requires a special organization, set out in the climatotherapy manuals.

Air baths

Carrying out air baths for patients has two goals: firstly, to reduce sensitivity to cooling, and secondly, to activate and balance homeostatic mechanisms.

The dosage of air baths is carried out using two indicators: equivalent effective temperature - EET and cold load. By temperature, air baths are divided into cold (EET 1-8 ° C), moderately cold (9-16 ° C), cool (17-19 ° C), indifferent (21-22 ° C) and warm (23 ° C and higher).

The cold load of the baths is divided into three levels: strong with uncompensated heat loss procedure 40-45 kcal / m2 of body area, medium - 30-35 kcal / m2, weak - 20-25 kcal / m2. Dosing of the cold load is carried out using tables contained in special manuals. Air baths are prescribed on the 7-10th day of acclimatization at the resort. The duration of the course of cool baths is 25-30 procedures. In the summer, baths can be provided throughout the patient’s entire stay in the sanatorium. Warm air baths can be prescribed to patients on bed rest.

Air baths within the limits of a weak cold load throughout the entire course are indicated for patients who are on sanatorium-climatic regime No. 1. These are patients: in various forms in the resorption phase (with EET not lower than 12-15 ° C), as well as in the postoperative period after 2 -4 weeks after surgery on the lungs for tuberculosis in the absence of complications (with EET not lower than 18 ° C). You need to start with minimal doses (from 10-15 kcal/m2) and, increasing the dose every 3-5 days by 5 kcal/m2, bring it to the prescribed dose. During the course of treatment, the flask increases the hardening of the body, the boundary EET, during which air baths are carried out, can be reduced.

Air baths with an average cold load are usually prescribed to patients on sanatorium-climatic regime No. 2. They are indicated for patients with: pulmonary tuberculosis in the initial period of remission (with EET not lower than 12-15 ° C), and also 3-4 weeks after surgery on the lungs in the absence of complications (with EEA not lower than 16 ° C). The procedures begin with a dose of 15 kcal/m2, increasing by 5 kcal/m: every 2-3 days. It is possible to individually increase the dose of air baths to 35 kcal/m2 in the second half of the course of treatment for patients who are indicated for air baths with a weak cold load, if they tolerate it well.

Air baths due to strong cold loads are indicated for patients who are not susceptible to cold reactions in a period of stable remission of the pathological process, in the absence of respiratory and cardiovascular failure, that is, in sanatorium-climatic regime No. 3. For patients listed in the indications for air baths of average cold load, if they tolerate this dose well, the individual dose can be increased by the end of the course of treatment to 45 kcal/m2. Air baths can be released at EET up to 10-12 ° C, and with sufficient resistance to cooling at EET up to 0-5 ° C. Air baths at a dose of 45 kcal / m2 are not recommended for children.

Swimming in reservoirs

The purpose of swimming in reservoirs is the same as air baths. Compared to air baths, bathing has a much greater effect on the body, which, on the one hand, accelerates the achievement of the effect, on the other, increases the list of contraindications. Swimming in natural bodies of water (sea, lake, river) is prescribed to patients after 3-5 days of adaptation to resort conditions. If negative acclimatization reactions occur, bathing can be prescribed only after they have been eliminated.

For dosing bathing, indicators of water temperature and cold load are used. The EET of air is also taken into account. The gradations of cold load are the same as for air baths. Practical dosing is also prescribed according to special tables. Bathing with a weak cold load is indicated for patients on sanatorium-climatic regime No. 1 (patients with various forms of pulmonary tuberculosis in the phase of fading infiltration, in the postoperative period, as well as little training to the effects of external factors).

Bathing at an average cold load is usually prescribed to patients who are on sanatorium-climatic regime No. 2. They are indicated for patients with pulmonary tuberculosis in the initial period of remission, as well as for those who have undergone effective surgery on the lungs in the absence of complications. The same regimen is indicated for patients with active, torpid pulmonary tuberculosis, but with a long period of transition from a weak cold load with monitoring of the tolerability of the procedures.

Bathing under severe cold stress is prescribed for patients staying in sanatorium-climatic regime No. 3. These are patients with metatuberculous changes in the lungs with stable remission of the pathological process, the absence of respiratory and cardiovascular failure, patients with newly diagnosed pulmonary tuberculosis after completing the main course of chemotherapy, and those undergoing effective pulmonary resection.

Heliotherapy

It is used for long-term torpid or burnt-out tuberculosis of pulmonary (, infiltrative) and non-pulmonary (bones and joints, peripheral lymphadenitis, mesadenitis) localization in order to accelerate the resorption of foci of infiltration and healing of destruction, stimulation of the immune system, desensitization and increasing the general resistance of the body, normalization of external respiration function, cardiovascular system, thermoregulation.

But an overdose of helium influence can lead to increased inflammation and processes of decay, dissemination, and bleeding. Therefore, heliotherapy should be used only against the background of chemotherapy at the exact dosage. Heliotherapy procedures are dosed individually according to the minimum dose of solar radiation that causes the formation of skin erythema (biodose), and massively - according to the energy equivalent of the biodose (EEB), which is approximately 20 cal/cm2 of total solar radiation at a height of the Sun above the horizon of 60 °. This dose causes erythema in most untanned whites.

When prescribing solar irradiation, the occurrence of erythema, i.e. 1st degree radiation burns should be avoided. All the beneficial effects of solar radiation can be obtained at suberythemal doses. At the same time, it should be taken into account that during the course of irradiation the body’s resistance to solar radiation increases significantly. Due to this, by the end of the course, a dose of even 2-3 EEB may turn out to be suberythemal. The interaction of the thermal and photochemical effects of solar irradiation enhances their overall physiological effect. Therefore, solar irradiation regimes are determined not only by biodoses, but also by the range of radiation equivalent effective temperatures (REET).

Heliotherapy is contraindicated for all diseases in the acute stage and during exacerbation, bleeding, exhaustion, for malignant and benign tumors, progressive forms of pulmonary tuberculosis, for the combination of tuberculosis with severe atherosclerosis, stage III hypertension, circulatory failure of II-III degree, bronchial asthma with frequent and severe attacks, severe dysfunction of the nervous system, severe organic lesions of the central nervous system (syringomyelia, multiple sclerosis, etc.), with blood diseases, lupus erythematosus, malaria, thyrotoxicosis, increased sensitivity to sunlight (hematoporphyria, etc.).

In addition to the described climatic treatment methods, sanatorium-resort medical and rehabilitation complexes use physical therapy, massage, balneotherapy and hardware physiotherapy.

Exercise therapy, balneotherapy, physiotherapy

Physical exercise strengthens the body, stimulates compensatory mechanisms, the function of various organs and systems and, above all, the cardio-respiratory, nervous, and movement organs. For the purpose of general training, such forms of therapeutic physical culture are used as morning hygienic gymnastics, sports games, health paths, short-range tourism, etc. Special exercises are used to correct local disorders caused by the tuberculosis process. The level of physical activity is regulated according to the sanatorium-climatic regime in which the patient is located.

Massage is an effective means of both general stimulation of the body and the elimination of local disorders by improving blood and lymph flow, tissue trophism, and relieving spasms. Balneotherapy is used in the form of baths (sodium chloride, carbon dioxide, oxygen) and mud therapy (silt and peat mud). Among the means of hardware physiotherapy, ultrasound, phonophoresis and electrophoresis of medicinal substances, and diadynamic currents are most often prescribed. Inhalation aerosol therapy is widely used for respiratory tuberculosis and concomitant nonspecific lung diseases.

Anyone can become infected and develop tuberculosis, regardless of what rung of the social ladder they are on. The main source of infection is a sick person who secretes tuberculosis microbacteria. can enter the body through the respiratory and digestive tract, sometimes through lesions on the skin.

Basic Rules

The patient must follow certain rules of behavior. First, he should know not to cough up phlegm from his lungs into the toilet. The causative agents of the disease are very tenacious and do not die during the treatment of domestic wastewater. You should also not wash dishes from which the sick person has eaten. It must first be boiled for half an hour in a separate pan, and only then washed in the sink and placed separately in a cabinet.

You also need to be careful about the patient’s leftover food. They should not be fed to animals or thrown into trash cans without additional heat treatment. Most microbacteria of the disease enter the environment along with saliva and when coughing up sputum.

Therefore, the patient must collect them in a special jar with a lid, keeping it with him at all times. The rules discussed concern the safety of others, but what should a patient not do so as not to harm himself? Let's try to figure out how to live with this disease.

Nutrition

When drawing up a dietary menu for patients with tuberculosis, it is necessary to take into account the characteristics of this disease. Since the breakdown of protein in such an organism is increased, it is necessary to strictly adhere to the daily norm of its consumption.

Fats should be easily digestible, two-thirds of vegetable origin. It is advisable to use in cooking:

• butter;
• sour cream;
• cream.

You can't eat too fatty foods. Prohibited:

• beef (mutton) or cooking fat;
• confectionery with cream;
• fatty fish or poultry.

Due to the disease, as a rule, a deficiency of vitamins develops, primarily A and C. Ascorbic acid increases bactericidal properties in the blood and helps fight the disease.

Therefore, it is very important that the patient’s diet is varied, high in calories, and contains sufficient amounts of vitamins, mineral salts, protein and fats. However, if the patient is overweight, some restrictions on carbohydrate consumption may be prescribed.

But moreover, it is strictly prohibited:

• follow various diets;
• starve;
• fast.

Prohibited foods for tuberculosis include alcoholic beverages. It is especially harmful to take them during chemotherapy. Both alcohol and anti-tuberculosis drugs are broken down in the liver. Their simultaneous use will create an unbearable load on this organ, as a result of which a hepatotoxic reaction may occur, and treatment will have to be discontinued.

Sport

When the disease recedes a little, many patients begin to ask whether it is possible to play sports in their position. People who are accustomed to an active lifestyle find it difficult to come to terms with forced inactivity.

Light physical exercise has a beneficial effect on the recovery of the body, but when it comes to heavy sports activities, the answer from doctors is always the same - you should avoid it until complete recovery.

Restoring the body and its fight against Koch's bacillus requires effort and energy, and when playing sports, as you know, a lot of calories are consumed.

Therefore, energy must be conserved and directed towards the main task - victory over tuberculosis. To keep muscles toned, such patients are recommended:

• walk more;
• taking walks in the morning and evening;
• do exercises;
• attend physical therapy classes.

A patient who regularly engages in special pulmonary exercises significantly strengthens the respiratory muscles, normalizes the functioning of the inhalation-exhalation mechanisms, and increases the mobility of the chest.

Bath (sauna)

Despite the popular belief that taking a steam bath in a bathhouse will cure a hundred ailments, this rule does not apply to tuberculosis patients. Water-steam procedures and high temperatures are not only undesirable, but are strictly contraindicated for this disease. Otherwise, the patient’s condition can become very complicated and lead to irreversible consequences.

A patient with tuberculosis can afford such pleasure only after complete recovery, after two or three years, not earlier.

Until then, even if the disease is not in active form, you should not go to the bathhouse. Rehabilitation after tuberculosis is a long process that requires maximum caution and vigilance from the patient.

Summer rest

Separately, it is worth mentioning the rules of summer holidays for tuberculosis patients. If they undergo a course of treatment and have positive dynamics, they can swim in the sea. But at the same time, everything should be done carefully, gradually accustoming the body to new conditions. As a rule, it takes only 4-5 days for the body to get used to new climatic conditions. And only after its adaptation can you begin water procedures in natural reservoirs.

You can start if there are two favorable factors. The ambient temperature, both water and air, should not be below 20 degrees. Over time, when the patient’s body gets stronger and gets used to new conditions, it will be possible to take colder water (and air) baths.

First of all, one should not forget that a patient with tuberculosis can only swim if his general health is good, there is no weakness or weakness. At the first signs of fatigue or other deterioration of your condition, you should stop swimming.

The duration of the procedures is determined:

• water and air temperature;
• the patient's condition.

Coming ashore, the patient should dry himself with a towel and do several warming exercises. If you experience increased fatigue, deterioration of appetite and general condition of the body, you need to postpone water procedures for a while and consult a doctor.

In the presence of residual phenomena, the maritime climate is undoubtedly . Holidays on the Crimean coast with pine forests will be an excellent prevention of complications of this dangerous disease and will help restore the patient’s body.

With active tuberculosis, especially if hemoptysis is present, bathing the patient in an open body of water is unacceptable.

Is it possible to sunbathe with tuberculosis? This question worries a lot of people. Summer is the time for vacations and holidays. You need to go somewhere, relax, gain strength and health for the entire subsequent period of cold weather and the lack of natural, vitamin-rich food.

For a long time it was believed that the sun's rays have a healing effect, and a bronze tan is beneficial to everyone without exception. But that's not true. There are quite a lot of diseases for which you should not sunbathe, including pulmonary tuberculosis.

As a rule, tuberculosis patients are sent for rehabilitation to resort and sanatorium areas with a sunny, hot climate. From this it was concluded that sunbathing during tuberculosis is possible and beneficial.

It has not yet been scientifically proven whether the sun's rays are harmful or not for people with this disease. But most medical practitioners believe that in case of pulmonary tuberculosis it is necessary to avoid prolonged exposure to hot sunlight. Otherwise, this may provoke an outbreak of infection and significantly slow down the healing process.

While being under the summer sun, the body heats up, and favorable conditions are created for the activation of Koch's wand, which loves a moist, warm environment and reproduces well at temperatures from 30 to 40 degrees, which is why such conditions should be avoided.

Tuberculosis germs can remain unnoticed in the human body for a very long time without causing illness. And under unfavorable conditions, domestic or weather, as well as when the body’s resistance is weakened, reinfection, that is, re-infection, can occur.

After tuberculosis, you still need to behave as carefully as possible so as not to provoke its reappearance.

In the surgical department Sanatorium named after V.I. Lenin in Gulripsha, when preparing patients for surgery, along with antibacterial therapy according to generally accepted methods, climatic treatment methods are widely used. The most widely used method is dosed and round-the-clock stay of patients on verandas, air baths. The dosage of climatic procedures is based on the climatic regimes developed for the southern coastal sanatoriums by E. D. Petrov and adapted for a similar resort on the Black Sea coast by G. D. Meladze and Sh. V. Dzhgamadze.

results perennial Observations allow us to say with certainty that after rational complex treatment against the backdrop of the favorable climate of the Gulripsh resort, on average, in 2-3 months there is a significant improvement in the general condition, the main indicators of the functions of external respiration and gas exchange decrease.
Next powerful factor complex therapy for patients with pulmonary tuberculosis with severe drug allergies is the use of an aerosol decoction of eucalyptus globulus.

Eucalyptus globulus decoction affects neurotropic components, promotes the processes of tissue resorption and regeneration.
The decoction of Eucalyptus globulus we use prepared at the rate of 15 grams of dry eucalyptus leaves per 100 g of water. The leaves are finely chopped with scissors and boiled slowly for 3-4 minutes. (preferably on a water tank). After this, the broth is filtered through gauze cloth. It can be stored for months in a hermetically sealed non-metallic container. The appearance of sediment at the bottom of the dish is not a sign that the broth is unsuitable. It must be shaken when using.

In order to resolve the issue of effectiveness inhalation aerosol in the complex treatment of patients to prevent or relieve allergic phenomena during antibacterial therapy, we analyzed the results of treatment of 42 patients treated in 1971-1973. in therapeutic departments with allergic phenomena without inhalation of eucalyptus decoction and 34 patients when prescribed the entire treatment complex with inhalation of eucalyptus decoction.

Treatment course for patients with 15% decoction eucalyptus the average was 30 sessions. Inhalations were given daily. 25 ml of decoction was consumed per patient in one session. Breathing was done through the mouth. All patients, with extremely rare exceptions, tolerated inhalation well. Of the 34 people, only 3 patients who had bronchitis with an asthmatic component had an increase in cough. Before decoction of eucalyptus, we began to prescribe to these patients the inhalation of a 5% ephedrine solution in an amount of 0.5 ml, as a result of which breathing became deep and calm.

IN further Considering that the mucous membrane of the entire respiratory tract system has a high and rapid ability to absorb aerosols, and also represents a massive interoreceptive field, we began to prescribe an aerosol of novocaine solution (0.5-1%) before inhaling eucalyptus in order to relieve cough, so as well as bronchospasms.
Patients, the degree of allergic reactions and phenomena in both groups was completely identical.

By improvement we consider cases when patients began to tolerate one of the main antibacterial drugs with a decrease in cough, amount of sputum, and improvement in general condition.
To groups " significant improvements» included patients in whom taking 2 or 3 antibacterial drugs did not cause allergic reactions with the disappearance of cough, sputum, and a decrease in the hypoxemic state of the body.

When conducting complex treatment without an aerosol of 15% eucalyptus decoction, 73% of patients did not experience significant changes in desensitization, while complex therapy using an aerosol of eucalyptus decoction relieved allergic symptoms in 67.5% of patients.

For some forms of tuberculosis, the most favorable effect is exerted by the climate of resorts located on the sea coast, protected by mountains from mainland influences. Of particular importance in this regard are the resorts of the southern coast of Crimea and the Caucasian coast of the Black Sea.

The climate stations of the Southern Coast of Crimea are distinguished by temperature uniformity, air purity and transparency, relatively low humidity (450-560 mm per year), abundance of solar radiation (about 2200 hours of sunshine per year), low amplitude of average annual and daily temperatures, favorable wind conditions, picturesque nature.

Due to the significant predominance of benign conditions, the climate of the southern coast of Crimea places less demands on the patient’s body than the meteorological factors of the continental climate of the plains, which significantly contributes to the normalization of the physiological systems of the body, increasing its resistance to tuberculosis infection.

The influence of the above-mentioned climate features of the southern coast of Crimea and the Caucasian coast of the Black Sea is manifested primarily in the detoxification of the body of a tuberculosis patient - in improving well-being, appetite and sleep, in normalizing temperature, gas and other types of metabolism. Under the influence of treatment in the gentle conditions of southern resorts, the patient’s reactivity changes, infiltrative changes in the lungs and respiratory tract are more likely to resolve or significantly decrease, resulting in accelerated healing processes.

Characteristic of the climate of the sea coasts of the south, which is generally gentle, elements of irritation (abundant solar radiation, winds, sea surf) necessitate a strict individual dosage of climatic procedures depending on the reactivity of the patient, the nature and phase of the tuberculosis process and in accordance with the characteristics of a particular season.

According to numerous and long-term clinical observations, at the resorts of the southern coast of Crimea and the Caucasian coast of the Black Sea, subacute pleurisy and peritonitis resolve more quickly, tuberculosis of the skin and mucous membranes is cured faster, and fistulas with peripheral tuberculous lymphadenitis are closed within a short time. Focal forms of pulmonary tuberculosis, chronic lympho-hematogenous disseminations, infiltrates with a tendency to thicken, as well as infiltrative-productive lesions of the larynx occur here relatively favorably. According to the observations of M. S. Binshtok, on the southern coast of Crimea, healing is accelerated with the simultaneous use of streptomycin and radiotherapy.

In the spring and autumn seasons, stay at climatic stations on the southern coast of Crimea and the Black Sea coast of the Caucasus is indicated for patients with calm, non-extensive fibrous-cavernous pulmonary tuberculosis. According to the observations of N. G. Stoyko, A. G. Gilman and D. P. Mukhin, patients with these forms of tuberculosis here more easily tolerate surgical interventions on the chest - extrapleural pneumolysis, thoracoplasty, etc. On the beneficial effect of climatic conditions of the Caucasian coast of the Black Sea on The postoperative course and long-term results of surgical interventions on the chest are also discussed by N.V. Antelava.

The most indicated seasons for the treatment of patients with pulmonary tuberculosis on the southern coast of Crimea are spring and especially autumn (the most sparing). It is necessary to distinguish the climatic stations of the Southern Coast of Crimea, located in the coastal zone, from stations in the mid-mountain zone.

The climatic therapeutic capabilities of the southern coast of Crimea are significantly expanding due to the presence of climatic stations in the mid-mountain zone, the climate of which to a certain extent combines the properties of the coastal and mountain climates. Elements of irritation in the conditions of the mid-mountain climate are more pronounced than in the coastal zone, however, the climate of the stations in the mid-mountain zone in the summer (June-September) corresponds to the climate of spring or early autumn in the coastal zone, therefore in the summer the sanatoriums of the mid-mountain zone are suitable for treating a wider range of tuberculosis patients, than the sanatoriums of the coastal zone.

In the mid-mountain zone there are Dolossy (480 m above sea level), one of the largest sanatoriums in our country, the sanatorium "Mountain Health Resort" (formerly "Ereklik") 460 m and "Tuzler" 700 m. Treatment at the resorts of the Southern Coast of Crimea is shown:

1) for pulmonary tuberculosis patients who are recovering poorly in the local climate, with sluggishly ongoing compensated and subcompensated focal, infiltrative and non-extensive chronic disseminated and fibrous-cavernous processes;

2) for patients with dry and serous pleurisy, pneumopleuritis;

3) for patients with chronic disseminated laryngeal-pulmonary tuberculosis in the period of subsidence of the process with a stable normal temperature, with productive lesions of the internal vocal or external cartilaginous ring of the larynx or with recently advanced infiltrative and infiltrative-ulcerative lesions of the larynx (all year round);

4) for patients with chronic disseminated laryngeal-pulmonary tuberculosis with a slowly progressive course or in a period of subsiding exacerbation, with normal or slight subfebrile temperature, with damage to the vocal or cartilaginous ring, predominantly of a productive nature, with the presence of limited ulcerations, but without lesions of the pharynx and mouth (from September 1 to June 15);

5) for patients with extrapulmonary forms of tuberculosis - with osteoarticular tuberculosis, lymph nodes, etc. (all year round).

Depending on the nature, phase and degree of compensation of the process, different seasons are chosen for the treatment of tuberculosis patients. Indications for treatment of children at the resorts of the Southern Coast of Crimea:

1) primary complex and bronchoadenitis in the infiltrative phase (in a state of compensation or subcompensation);

2) compensated and subcompensated focal forms of pulmonary tuberculosis in the infiltrative phase, infiltrative forms of pulmonary tuberculosis without decay and with decay, subacute and chronic disseminated forms with a tendency to subside;

3) compensated and subcompensated chronic fibrous-cavernous forms of tuberculosis;

4) tuberculosis of peripheral lymph nodes (without fistulas and with fistulas); scrofuloderma;

5) tuberculosis of the genitourinary organs;

6) polyserositis, mesoadenitis, peritonitis not in the acute period.

For school-age children there are sanatoriums in Simeiz and Alupka. The presence of irritating elements in the climate necessitates individual dosage of climate procedures.

In accordance with the phase of the process and the reactivity of the patient, various climatic regimes are used. The regimes developed and proposed by A.V. Ovsyannikov are generally accepted in medical institutions: 1) acclimatization regime; 2) three dosed climate modes; 3) 24/7 veranda mode. This scheme, with amendments depending on meteorological and climatic conditions, is quite applicable not only in the conditions of the Southern Coast of Crimea, but also for resorts on the Caucasian coast of the Black Sea, as well as for resorts in other regions.

The acclimatization regime, which requires the patient to stay in the ward, is mandatory for all patients arriving at the resort. The duration of this regimen varies depending on the patient’s reactivity, the degree of compensation of the process, as well as the season. For patients with compensated processes in the phase of resorption and compaction, 3-5 days are usually sufficient, during which the body adapts to new environmental conditions. During the acclimatization period, the patient’s reactivity and his ability to adapt to new conditions are carefully studied. If significant functional disturbances are detected (palpitations, sleep and appetite disturbances, headaches, increased excitability of the nervous system, etc.), which do not disappear within 3-4 weeks with rest, then such patients are transferred to other, more indicated for them climatic conditions.

With normal adaptation, the patient is assigned an appropriate climate regime with a gradual increase in the duration of stay on the veranda (1-3 hours - with the 1st mode and 4-6 hours - with the 2nd mode). Some patients who are on the 2nd mode, as the outbreak subsides and the process is compensated, are prescribed dosed walks, physical exercises, air baths, light labor processes while staying on the veranda.

Patients in a state of full compensation or with mild subcompensation of the process after a period of acclimatization or after a preliminary stay in the 2nd mode are transferred to the 3rd climatic mode, and then, if indicated, to a round-the-clock veranda mode, the features of which are, as A. points out. V. Ovsyannikov, maximum out-of-hospital treatment, allowing for wider use of the resort’s healing climatic capabilities.

For certain indications, patients, in addition to the indicated general climatic regimes, are prescribed some elements of private climatotherapy: air baths, night aerotherapy on the seashore, sunbathing, sea bathing. When sending tuberculosis patients to the resorts of the Caucasian coast of the Black Sea, it is necessary to take into account that they differ in comparison with the southern coast of Crimea in more favorable climatic conditions in winter (higher average temperature and less wind) and a worse combination of excessive humidity and high temperature in summer. Consequently, the resorts of the Caucasian coast are of little use for the treatment of tuberculosis patients in the summer season and are more indicated for them in the winter season. This applies mainly to the climatic stations of the Caucasian coast from Tuapse to Batumi. The climatic properties of the areas located north of Tuapse (Gelendzhik, etc.) are very similar to the climate of the southern coast of Crimea (A. L. Samoilovich, I. T. Stukalo).

The climatic regimes proposed by A.V. Ovsyannikov are undoubtedly applicable both for the resorts of the Caucasian coast of the Black Sea and for mountainous regions. The sanatoriums on the Caucasian coast of the Black Sea have become widely known: Gulripsh in Sukhumi, Uch-Dere near Sochi, Solntsedar in Gelendzhik. Treatment here is mainly indicated for patients with the same forms of pulmonary and laryngeal-pulmonary tuberculosis, which are listed in the indications for referral to the southern coast of Crimea, but with the amendment that the summer season should be used with caution for the treatment of tuberculosis patients on the Caucasian coast.

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