The Health Spa Phenomenon in Europe: Writing Promises in Water

Story and photography by
Nancy Allen, RN & Eric Anderson, MD 

 

"When the world comes to an end, come to Baden-Baden. It will last a fortnight longer," Otto von Bismark 

A review of all this by health professionals 

In the third century AD the Emperor Caracalla fell wounded in battle against the Alemanic tribes. Fortunately, Aquae the district capital of Rome was near. His legions carried the Emperor down the Valley of the Oos to where the healing thermal springs gushed from the rock. There, Roman rhetoric, Germanic pageantry and the magic waters cured the Emperor of all Rome. In gratitude, the Emperor built a new marble temple over the deluge that made him well, and proclaimed the spot Aquae Aureliae: the Imperial Baths of Germany. Remnants of those baths, the Kaiserbad, can still be explored under the marktplatz of Baden-Baden and the city's 22 springs still pour out 800,000 liters a day of the flood said to cure.

"We've worked for 2000 years with the same water and the same methods," said director Joseph M. Bartholemy, Badergeschafts-fuhrer, "But not the same management." Bartholemy commands an industry in Baden-Baden half owned by the town half owned by the state which employs 500 people. Health spas flourish in forty seven countries other than Germany, but Bartholemy feels that Baden-Baden is the flagship of them all. The Augustabad over which he presided was finished in 1966. The modern building seemed half temple, half physical therapy institute. It had the hottest springs in Western Europe: 68.8°C and a European reputation for great success with musculoskeletal problems.

The Friedrichsbad is almost 140 years old; its involved Roman-Irish baths have a ritual handed down for centuries: First, a hot shower for 5 minutes, then hot air at 54°C for 15 minutes, a bath for 5 minutes at 68°C, then a shower; then a soaping for 8 minutes followed by another shower; then the devotee has a 10 minute steam bath at 45°C, a 5 minute steam bath at 48°C, a hot tub for 10 minutes at 36°C, a "spring bath" for 15 at 34°C, and a plunge at 28°C followed by a shower, then a cold water wash, then warm towels for 4 minutes and a rest period for 30 minutes. Mmmmm.

Reactions of those initiated into such programs vary from "it's a glorious madness" to "this treatment left me virtually lifeless." Said local physician Dr. Werner Hess: "When you come to Baden-Baden you must be willing to change your life style.

So it seemed. And most American physicians we know perceive a lot of this as foolishness.

Yet a walk through the Augustabad is a walk through as modern a physical therapy plant as you could see in America. Here are thermal mud baths, saunas, aerosol inhalation facilities, all forms of massage including underwater, "remedial gymnastics," carbonic acid gas baths, and the famous Kneipp hydrotherapies named after a monk who first developed them.

The visit ends with a trip to the top floor where a huge thermal swimming pool has its temperature maintained at 34°C. Patrons can sit afterwards on deck chairs and gaze, like penthouse owners, over a city which is part casino, part race track, part garden and part Mecca for this strange mass of humanity that comes to its doors: people with arthritis, with gynecological complaints, with neuro-psychiatric disorders and people with acute exacerbations of chronic fatigue. Patients with problems as specific as weakness following tendon transplant and as general as vague feelings of tiredness.

Here comes genuine illness and narcissistic self indulgence. Here comes bored wealth. Here comes Royalty: Queen Victoria found the air invigorating as did Queen Augusta of Prussia. And the Grand Duchess Olga of Russia, the Duchess of Windsor, Napoleon III, and Kaiser Wilhelm I. Recently the deputy to Prince Rainier took the waters. "Your Highness," boomed Bartholemy enthusiastically, "You will enter our bath as a prince and leave it as a king!"

Although the health spa mystique is widely revered in Europe even to the point where government workers can request a spa sojourn and have the insurance plans pick up the cost, there is considerable cynicism even skepticism in America. Mark Twain was distressed to find in his day that a title seemed necessary to get the royal treatment but he did say: "I fully believe I left my rheumatism in Baden-Baden. Baden-Baden is welcome to it."

It is difficult for most American doctors to understand the health spa idea because health concepts in Europe are themselves such a combination of ethnic beliefs. Who, for example, in the States can understand or sympathize with the French cris de foie -- a liver crisis nonentity? Who in American can really believe that a hot soak cures anything other than the blues? Clinical discussions of value are hard to find and European medical spokespersons tend to have rather obvious connections with this multi-million dollar industry. "Spa therapy does not readily lend itself to such scientific, so-called 'double-blind' studies," said Dr. W. Marktl of the University of Vienna but he did claim that patients on long-term medication could be maintained on smaller doses after spa treatments. At the same university, Dr. Werner Grunberger of the First Women's Clinic stated that regular visits to a sauna granted shorter, less painful labor to healthy pregnant women.

Karl Neumann, MD, a physician interested in balneology countered that "a spa vacation is a relaxing, soothing pause amidst flowers, shady walks, brooks and ponds, music and clean air, far away from the nerve-racking stresses of the real world.... How can you not feel better?" Dr. Erich Rutten considered this point when as president of the German Spa Association he addressed the press at a luncheon in New York. He felt the ecological hazards of modern-day life could be counteracted, to a degree, by spa treatments but admitted the treatment itself was not an alternative to clinical medicine. It was in fact part of a package where "springs, utilization of climate as a supplementary agent of physiological medicine, stimulation therapy, diet, psychotherapy and internal medicine" all combined to help the patient.

The patient's role was appraised by Joel F. Miller, MD. While emphasizing the importance of increased knowledge of disease and the continued discovery of new drugs, he felt physicians have rather neglected the vital role of host resistance. "It's not merely the bug or the medicine that's crucial, but also the defensive strength of the individual," he said. He claimed that although the health spa had its own "aquarian jargon" it still had a lot to offer the sick to help them rise above "passive patienthood."

Yet health spas cannot divest themselves from the show biz nature of the tourist industry. In the 1970's, at the height of German government health insurance acceptance of the role of the spa, 40 percent of the total overnight stays in the Federal Republic of Germany were in health spas and resorts. To go shopping in Baden-Baden is to stare into stores whose windows are full of bath hats.

The need for advertising was unknown to Baden-Baden's Brenner's Park the most famous spa hotel in Europe. Purchased in 1872 by Anton Alois Brenner, a garment maker to the royal court, the hotel was developed by his family to the point where it was certainly the inn place for a European season. Anton's son Camille a textile merchant became one of the pioneers of modern luxury hotels in Europe -- "with brilliant intuition he anticipated the age of automobiles" and was the first German hotel-keeper to build a garage for guests.

There was nothing Brenner's would not do for quests, said Thomas Axmacher, then the hotel director. "When the Tsar of Russia was kept awake by the noise of carriages on the Lichtentaler Allee, the hotel placed straw on the street to muffle the sound." Any request from the discriminating guests of the last century was a pleasure for the hotel. One valet's task was to iron guests' shoe laces. One visitor repeatedly returned, an Italian who favored hand made shoes with different colored panels. He would check into the Brenner's Park with a case containing 30-40 pairs of such shoes because this was the only place he could get his shoes properly polished. Even today, the hotel washes guests' cars on arrival. Clearly patrons wouldn't wish to have a dirty car parked outside the Brenner's Park.

The guests of those elegant hotels would all approve. They know each other. There are no strangers in Paradise. They meet sniffing the vapors at Sierra Leone, sitting in the baths of hotels des thermes in la Belle France and certainly they've taken the cure in that lush city which lies basking in the charm of Tuscany in the Valdinievole plain of Italy: Montecatini Terme.

The town itself is quiet placid and comfortable, full of trees, parks and gardens. Traffic is subdued, pedestrians polite and police refined. Driving a Fiat through a red light isn't the smartest thing for a tourist to do, but the polizia can recognize an Americano who has come to take the waters. The policeman thus is simpatico even apologetic but "Sir, pleeze look. That light is red, 'eh? Be careful." A smile to the tourists, a glare at Italian drivers who are becoming restive, a further nod to the Americanos and he waves them off to the Grand Hotel & La Pace. The hotel built in 1870 is a beautiful rambling structure with its own five acre park. The spacious corridors are lined with Belle Époque antiques; one bedroom even has an original Goya. There is a delightful old world atmosphere, the staff listening gravely, courteously to any request made them because nothing is too much bother. There is even a special restaurant exclusively for guests on diets.

The Grand Hotel & La Pace has its own natural health center for those who feel "it is better to prevent illnesses than to cure them." There guests can consult doctors, dieticians, sports directors, physical therapists and receive the benefits of gymnasium, sauna, Swiss showers, solarium, swimming pool and underwater and manual massage.

Or you can take the waters -- a custom which goes back at least six centuries.

From 1370 when the Tettuccio Bath was constructed, natives and visitors have drunk its waters. Today's tourists hear those claims: that it stimulates hepatic cells, increases biliary flow, and improves gall bladder tone thus decreasing stone formation and cholesterol production. Tettuccio water is also reputed to buffer gastric secretions, increase gastric motility, activate duodenal function and "control fermentation." Antitoxic and antibacterial effects are also suggested.

Analysis of Tettuccio water shows a mixture of sodium, potassium, lithium, ammonium, calcium, magnesium with manganese, chloride, bromide, iodide, sulphate, bicarbonate, iron and aluminum phosphates, siIicic anhydride and free carbon dioxide. Its specific gravity is 10041.

There are other waters: Regina water "with greater action on liver and intestine"; Tamerica and Torretta waters which act on intestine; and Rinfresco water which has a diuretic action. There are also spring waters for baths: Leopoldina and Giulia and Grocco Crater mud and Gineko vaginal irrigations.

It sounds as if getting a health history from a European patient would need all the time allocated for a history and physical. It sounds as if a tired hospital intern asleep on his feet need only knock back a bottle of IV Ringer's lactate to lose that Clark Kent feeling. It all sounds as if we're still in the 1890s. And yet, we know gall stones can under certain conditions be dissolved by bile salts, and numerous Italian physicians have testified to reduction in size of gall bladders and even discovered gall stones passed in the feces. Said one Dr. Grocco, "I have observed this action . it would he absolute blindness to doubt this effect."

Yet doubt is the demand that brings forth truth in science; it is the basis of all experiment. Yet the church doubted Galileo making him recant his discoveries. Huxley doubted Charles Darwin, mocking his theories. Vienna doubted Semmelweis driving him and his theories of cleanliness into oblivion. Paracelsus did not doubt. He knew the best waters of Europe. His "Baderbuchlein" after all was the little book of the baths. But Paracelsus was a physician who believed that man was composed of sulphur, mercury and salt. His concept of medicine was the four pillars of philosophy, astronomy, alchemy and virtue. He is hardly a modern authority.

Yet did he leave us a glimpse of truth? He wrote once: "The doctor must be a traveler because he must inquire of the world.