Hydrotherapy in Medicine and Spa Applications
In classical spa medicine, hydrotherapy and spa are centered around the element of water. Behind the increasingly attractive buzzword “hydrotherapy” lies a field of medicine with a long and rich history, particularly in Europe.
Drawing on this legacy, a morning of lectures will shed light on the nature of hydrotherapy, its history and context and its application in modern medicine and therapy, concluding with a provocative look at its role in therapy and wellness today.
The History of Hydrotherapy in Germany
Since primeval times, water has had the aura of something mystical. Water was referred to as the elemental force of nature, the primary source of all freshness, all cleaning, strengthening, and healing. The history of water is as old as mankind.
Even before the era of old Egypt, the Greeks obtained knowledge of the anasthenic effect of water, and in their legislation of social hygiene, the Spartans propagated cold baths. In 63 BC, public buildings, such as water pipes and the thermal baths in Rome were financed and supported. In 30 AD, the first medical encyclopaedia of Celsus prescribed water for diseases of internal organs. Galenus of Pergamon (129 – 199 AD) used hot baths for therapy. From the 11th to the 14th centuries, Arabism predominated medicine; the traditional Roman bathing culture was celebrated.
The first papers in German concerning bathing were published in the period of Renaissance. Here the roots of contemporary nature cure can be found. Hydrotherapy developed further in the 16th century, when mineral baths in Spa were used. In the 18th century, hydrotherapy experienced glorious days, Hahn and Hufeland must be mentioned as representatives.
In the 19th century, hydrotherapy undergoes some kind of further development by users as Oertel, Prißnitz, Schroth and Kneipp. This is an essential shaping of hydrotherapy in a contemporary sense.
In Germany, the 20th century is shaped by the grand Berlin hydrotherapy school. Names like Brieger, Vogler and Krauss as well as Hentschel, Jordan and Bühring establish hydrotherapy as a branch of classic hydrotherapy.
The application of water as a systematic therapeutic (hydrotherapy) includes a variety of applications, such as applications with cloth (e.g. packs), applications with running water (e.g. affusions), use of hydrostatic pressure (e.g. baths, partial baths), and baths without hydrostatic pressure (e.g. carbon dioxide bath, sauna). Here, hydrotherapy makes use of the water mainly employing its property as a heat conductor to intervene in the sense of thermoregulation. In addition, pressure conditions as well as chemical substances play a role. Apart from pragmatic use, contemporary hydrotherapy is mainly characterized by intensity, duration and way of application of the stimulus. Hydrotherapy has a firm position in the physiotherapeutic complex of different therapeutics.
Evidence Based Medicine in Balneology
Evidence-based medicine (EBM) has been defined by one of his most prominent protagonists, David Sackett, as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” The concept of “individual clinical expertise” mirrors the idea that the therapeutic relationship between an individual who seeks help (commonly referred to as the “patient”) and an individual who provides help (commonly referred to as the “health care professional”) needs much more than “technical skills”, it means “the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice”. The practice of EBM is therefore neither “cook book medicine” nor a sheer, anonymous expert system.
On the other hand, EBM defines best available external clinical evidence as “clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens”. Thus external clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.
In the medical field of balneology, where a wealth of empiric evidence has accumulated over centuries, EBM can help to identify therapies which are reliably superior to those of other areas of medicine as well as those which might have lost their competitiveness for a given medical problem. Both types of information help improve performance. EBM is therefore a vital instrument to ensure the best possible therapeutic decision.
Hydrotherapy in traditional European Medicine
Prof. Dr. Dr. Jürgen Kleinschmidt
According to the origins of the word balneum (bath), medicinal balneology is the examination and exploitation of the beneficial health effects of bathing. In practice it usually involves the application of bathing and balneological therapies in medicinal cures. This includes not only immersion baths in waters of different temperatures and mineral composition, but also saline inhalations, drink cures, gas baths (CO2, radon, hydrogen sulphide), peloid baths and packs, Kneipp cures and many others.
Quality of products and structure – type of application
This includes, for instance, investigations into the skin permeability of soluble substances as well as the testing of the immediate effects of different saline concentrations.
Quality of process – means of application
When appropriately prepared so-called ‘bathing peat’ (with particular product qualities) can be used as a thermally conductive medium for a combination of warming localised tissue as well as general systemic warming. In other situations, when diluted considerably, the same bathing peat functions as a general convective heat transfer medium for overall warming of tissue and the core body temperature, much like a hot water bath. It is well documented that a period of relaxation and thermal insulation (in some cases even continued heat application) after treatment is beneficial for the application of peloids.
Research into these and other forms of application and the development of guidelines and standards is also part of medicinal balneology.
Quality of results – long-term benefits of application
The study of the quality of the results of medical intervention has acquired considerable importance in the context of current evidence-based medicine. Particular focus is given to the degree and sustained improvement health observed as a result of medical interventions. This is assessed with the help of follow-up examinations.
The lecture will provide a variety of different examples.
Further speakers include:
Professor Dr. Christoph Gutenbrunner