Part I
Spa life
1 Shrinesâspringsâspas
Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces. ⊠Then the winds, the hot and the cold, especially such as are common to all countries. ⊠We must also consider the qualities of the waters, for as they differ from one another in taste and weight, so also do they differ much in their qualities.
âHippocrates, âOn Airs, Waters and Placesâ
Throughout the 19th century, European aristocrats set aside a special time of the year, usually in midsummer and early fall, for spa cures that took between 10 days and 3 months. Spa cures relied on the combination of thermalism (mineral water treatments) or thalassotherapy (systematic use of seawater, sea products and shore climate),1 diet and rest to repair the patientsâ health. The spa routine remained basically unchanged during the 19th century, despite the incorporation of innovative treatments: a traditionâs strength is in its invariability.
Using water for treating disorders and diseases is one of humanityâs oldest traditions. Like many traditions, it is partly instinct â water is synonymous with life â and partly the eternal quest for simple solutions to complex problems. We are witnessing its latest form, the mania of constantly sipping water from a bottle. The âkeep-drinking-bottled-waterâ campaign capitalized on the long-standing reputation of mineral sources and the confusion between âmineral waterâ and âwater from a sourceâ. Mineral water, which is bottled directly at the mineral source, has specific chemical ingredients that may be beneficial to human health; âwater from a sourceâ is simply water that has passed sanitary control and contains no bacteria or toxic matter,2 like tap water. Bottling makes it more expensive but not more medicinal.
Balneology
The first Europeans known to believe in the medical virtues of bathing â that is, the first balneologists â were the Greeks, followed by the Romans who built âbath complexesâ, the famous thermae. Wherever the Romans went they looked for rivers, lakes or springs and built temples on the sites. The Roman architect and civil engineer Marcus Vitruvius explained it by the fact that âfor all the temples the most healthful areas are chosen and in these places, in which shrines are to be erected, there be adequate springs of waterâ.3
Water was only a component of the treatment. The Greek and Roman worshippers of the divine healer Asclepius made pilgrimages to his shrines in order to undergo healing by prayer, fasting and ceremony â all three being the well-known staples of the spa method that under different guises survive to this day: meditation, relaxation, diet and the ritual of bathing and drinking waters.
Our respect for the Romansâ judgment has never flagged. That is why the best marketing claim for a European watering place has always been: âknown since Roman timesâ, and spa owners considered their success ensured if there were ruined Roman baths in the vicinity.
The Middle Ages witnessed a tug of war between the humansâ instinctive striving for cleanliness as a synonym of physical and spiritual perfection, and their vague feeling that dirt also had its merits, spiritual and medical. The attachment to cleanliness found its reflection in the Christian ritual of baptism and sprinkling holy water, and in the doctorsâ concern with keeping their patientsâ wounds washed; the mistrust of hygiene brought about the medieval Christiansâ rejection of bathing as a pagan rite and the use of organic matter in varying stages of decay for treating skin diseases and wounds. Eventually, the two trends were reconciled at spas where physicians prescribed water and mud baths.
Hydrotherapy
The Catholic Church maintains that God heals through sacraments and natural elements, water being one of them. In the mid-18th century, the father of Evangelism, John Wesley, preached a healthy life based on simple gifts that God provided, water among them. So the spreading of holistic medicine in the 18th century met no opposition from the religious authorities. Romanticism contributed to its popularity by frequent references to the healing effect of the nature on wounded hearts and shattered souls. Hydrotherapy fitted well into the older German and Austrian tradition that used the heavily mineralized waters of the Central European sources.
Copious amounts of water applied externally or taken internally were believed to be either a cure or a palliative for many diseases. The founding fathers of hydrotherapy were âinstinctive healersâ, unfamiliar with medicine (the schoolteacher Oertel, the peasant Preissnitz and Pastor Kneipp), who were inspired by observation of wounded or maimed animals that swam in the fresh water. The healers acquired a fanatical following.4
Unlike balneology, hydrotherapy used fresh water, which contains only a limited amount of minerals. While, strictly speaking, all water existing in nature contains a certain amount of gases and minerals, in medicine the difference between âfresh waterâ and âmineral waterâ is in the amount of mineral elements per litre.
Hydrotherapy treated illnesses mainly by thermal stimulation â the external use of water at different temperatures and in different physical states (liquid, gaseous or ice). The logic was as follows: when an average healthy person is submerged into a bath at the temperature of 34â35° C, the bodyâs thermal balance remains undisturbed and the person feels neither hot nor cold. But if the patient takes a bath of either higher or lower temperature, it becomes stimulating: the body loses or acquires a certain amount of heat, and the balance is lost. In order to regain its thermal balance, the human body reacts by switching on various protective and compensatory mechanisms. The lower or higher the water temperature, the stronger the stimulation.
Based on what resources they had, spas offered cure by mineral waters or sea baths, hydrotherapy; there were also wintering stations that relied on the effects of pure cold air and sunshine. At some locations physicians prescribed the dieting cures of milk, whey or grapes or combinations of the same with exercise, such as treatment of heart disease by walking to the top of a nearby hill, known as âOertelâs terrain cureâ.
Mineral waters are classified
As doctors became convinced of the benefits of certain spring waters for specific health disorders, they analyzed the chemical composition of mineral waters. In the 19th century, waters were classified into multiple categories: simple or indifferent thermal waters; common salt or muriated waters; simple alkaline waters; muriated alkaline waters; sulphated alkaline waters; sulphated and muriated waters; iron or chalybeate waters; arsenical waters; sulphur waters; âearthyâ or calcareous waters; and other. As more chemical elements were identified, the classification expanded. The springs of Austrian Gastein and Töplitz had been popular long before the end of the 19th century when the phenomenon of radioactivity was discovered and their bracing waters were found to be mildly radioactive.
The purpose of chemical analysis was threefold: to promote and improve their therapeutic use; to identify the impurities to be removed prior to treatments; and to manufacture artificial waters.5 Watering places were classified, too: the thermal springs of the French Pyrenées and Vosges Mountains, the warm waters of Wildbad, Schlangenbad and the French PlombiÚres, as well as the cold waters of the German Homburg and Kreuznach, were recommended for digestive problems, and so were the effervescent waters of the Austrian Kissingen and Nauheim.
The lighter waters of the Prussian Baden-Baden, Wiesbaden and the heavily saline waters of the Austrian Ischl were praised for improving appetite, cleaning the bowels and healing anemia, while the muriated waters (Marienbad, Kissingen and Homburg) were considered tonic because the chloride of sodium (common salt) that they contained was also part of the blood serum.
The alkaline waters of the French Vichy were diuretic; they reduced appetite (and if not, diet helped) and expelled uric acid, the excess of which causes gout. They were also prescribed for depression: a young Russian diplomat posted to Paris was sent to drink Vichy waters because he suffered from toska [nostalgia].6 Ischl, Kissingen and Homburg were recommended to those with chronic rheumatic problems and digestive tract disfunctions, as well as ulcers, scrofula, glandular enlargement, eczema and psoriasis (in which case they had to take 3 pints of water a day).
Seaside resorts: Thalassotherapy
With the progress of the industrial age, doctors began to deal with new ailments and complaints in their patients. For the âvictims of neurasthenia, of overwork and of brain worryâ7 they prescribed sea voyages, including sea bathing. An 1880 British brochure The Ocean as a Health-Resort,8 explained the benefits of sea voyages, their organization, timing and the management of health at sea. But this was an extreme measure, taken mostly by patients suffering from severe nervous disorders and depression, who wanted to reduce social contacts to the minimum, as opposed to the spas and resorts on dry land.
In the early 19th century, doctors began to recommend baths of warmed seawater because it contained practically all of the known minerals; next, coastal resorts became popular, largely thanks to the doctors persuading the people to take off their clothes for sea bathing. Bathing in the warm Mediterranean Sea took off in the early 19th century, but people who could not travel to Italy or France were content to bathe in the colder waters of the Baltic or North Sea. Belgian and Dutch beaches were quite popular, especially with the northerners who feared the effects of hot weather.
The sea became âeroticizedâ in the imagin...