Balneology

1. Balneology Balneology serves the health Prof. Dr. Dr. Helmut G. PratzelPresident of the International Society of Medical Hydrology and Climatology Baln

2. Overview to the following lectures • Overview • Video „Sanfte Reize“(German) • Physical factors in Balneology • Video „Aix le Bain” (French) • Kneipp therapy • Videos „Kneipp treatment“(German) • Percutaneous Absorption • Video “Sibyllenbad” “Bad Nenndorf” (German) • Chemical factors in Balneology • Video “Copahue Argentinia”(English) • Creno therapy • Video “Balneorio de Alange” (Spain) • Medical Climatology

3. Regulates for health-conscious life by Hippokrates and Galen • Cultured relations with light and air, waters and heat, the climate, the ground, the environment. • Culture of the meal and drinking, the table-manners and abstinence-regulate. • Balanced rhythm of movement and rest, work and leisure time, stress and leisure. • Sleeping and waking state oriented at the cosmic rhythms, • Culture of the metabolism-processes. • Mastery of the passions, economics of the emotion-household, cultured contact with itself.

4. To die young, but as late as possible! Patients Tourists

5. The bath a gift of the Romans Leben und Treiben an einem Jungbrunnen. Holzschnitt nach einem Bild von Hans Sebald Beham

6. Other people with other applications

7. The baptism

8. The sweating bath

9. The Mud bath

10. The drinking cure Lithographie vonHonoré Daumier

11. Balneotherapy in the 10th Centuryby Paulos of Agina • Sulphur-baths: annoy-ailments, rashes, paralyses, • Alaun-waters: blood-cough, blood-departure from the uterus, • Copper-waters: strengthening of the eyes and ears, wholesome the guts, haemorrhoids, • Iron-waters: spleen-troubles, stomach-troubles,

12. Balneotherapy in the 11th Centuryby Kanon des Avicenna • Sulphur-baths: annoy-ailments, rashes, paralyses, • Alaun-waters: blood-cough, blood-departure from the uterus, • Copper-waters: strengthening of the eyes and ears, wholesome the guts, haemorrhoids, • Iron-waters: spleen-troubles, stomach-troubles, • Aquae salse: laxatives • Thermal water: pains in the joints

13. Bath-regulates of the 14th Centuryby Pietro da Tossignano • If you will go to a bath, you must take away after the advice of the doctor and have left to the vein, provided it is wholesome. • Whoever into the bath climbs, may not be cold or heated. • The body may have no signs to inflammations, as that is the case to all those who an acute fever survived, or disposes to fevers or are exhausted. • Before the cure, one doesn't show to frequent coitus or to big temperance, as well all other, which the strength could weaken.

14. Bath-regulates from the 14th Centuryby Pietro da Tossignano • Before one climbs into the bath, one must be sober. Whoever doesn't tolerate the bath takes 2 spoons well washed raisins with 2 parts waters and 1 parts wine or some prunes softened in waters several times. One still drinks in the bath after it neither, as long as one has not yet eaten. • One must bath every day and must remain approximately 1 hour in the bath, approximately 15 days long.

15. Bath-regulates from the 14th Centuryby Pietro da Tossignano • If one has left the bath, one puts itself into the bed and waits for the perspiration-outbreak there. If one has sweat, one leaves dry off and rubs off with cloths completely. One gets dressed and goes to the fresh air for a very long time, like the heat of the bath still continues to have an effect. First then should have breakfast one. If one should have thirst previously, so takes one of white sugars or raisins or something, which deletes the thirst, but no drinks. The poor people who have no bed, should remain in the bath-room, until he has sweat well. Then he exits and does, as declared.

16. Bath-regulates from the 14th Centuryby Pietro da Tossignano • One is be careful during the time, that one is in the bath, against coldness of all type, but also still several months after it, because the strength of the bath continues to have an effect even longer time, normally 6 months.

17. Bath-regulates from the 14th Centuryby Pietro da Tossignano • If one uses the bath for the first time, one may remain in it only short time, the second time somewhat longer, the third time even somewhat longer, first at the fourth bath, one is allowed to remains in the water up to the prescribed time (1 hours). The same is valid for the drip-bath directional on the head. On the first day, one may take only 1 bath, on the second day 2 baths. Furthermore one must know, that one can take 1 tub-bath and on the same day 1 on the head directional drip-bath. It is better, to take the tub-bath before the drip-bath.

18. Bath-regulates from the 14th Centuryby Pietro da Tossignano • Whoever wants to take a drip-bath must shear or is shaved, so that the hair doesn't hinder the effect of the bath. • Because with these measures an inflammation of the liver or the kidneys is to be afraid, one should rub in the named positions with sandal-ointment before each bath.

19. Dietetic bath Medical bath cleans refreshes pleases enjoys healthy-gets calm trouble ease heals Water as elixir of the life

20. The dietetic bath It serves • The joy • The relaxation • The body-care • The beauty

21. Water is a medical remedy and a health remedy • It serves the health-prevention (dietetics) • To drinking as food • To bath as toiletries • It serves the suffer-treatment (balneology) • To bath because of its physical and pharmacological effects over the skin • To drink because of its stimulating effects on inner organs • To inhale because of its effects on the respiration-organs

22. Sea resorts River resorts Indoor baths Wave-baths Whirlpools Tub-baths Bubble-baths Shower Dust-baths Downpour Drip-baths Rain-baths The variety of the water-application for bathing

23. Water is the most used remedy • Everybody is using it. • Everybody believes its effectiveness. • The medical experience is bigger than in any other drug. • The private share in costs is higher than in any other medicament. • It is the cheapest medicament. • No other medicament was described so many times by artists than water.

24. Natural water baths Artificial baths with additions Sunbathes Air-baths Mud-baths Bog-baths Sand-baths In Balneology not only water is used for bathing

25. Overview of this lectureMain focuses to the topic • History • Definitions in Thermalism • Health Resorts • Therapeutic principles • Systems, Inventory, Licenses, Education • Organisation of Thermalism • Statistics and economics • Research • Conclusion

26. Definitions in Thermalism I • Balneology is the science of the remedies of the water and the ground. • Medical balneology or Medical hydrology (French: hydrologie médicale) is the science of the medical application of the remedies of the water and the ground. (it is meant the place, the resort (Greek: balaneion, Latin: balneum, English: spa) and not the bath-tub or pool or „bathing-medicine“!)

27. Definitions in Thermalism II • Hydrotherapy is a section of the physiotherapy. It is used tap-water or mineral water for showers, bath tubs, affusions (acc. Kneipp), packs or part-baths. • Balneotherapy is enforced in the framework of the health resort-medicine as complex salvation-measure together with other fully organised therapy-procedures as bath-cure, drinking-cure or inhaling-cure under the influence of fixed-climatic factors (no pure bath-therapy!).

28. Definitions in Thermalism III • Chemical balneology is a section of the balneology as support-science of the medical balneology to the quality-protection and -control of the remedies of the water and the ground. • Hydro-geology is an autonomous science-area to the opening and quality-protection of the mineral resources.

29. Definitions in Thermalism IV • Medical climatology or Bio-climatology is the science of the remedies of the climate. • Meteorology and climatology are autonomous science-areas to the judgement of the climate. • Climate-therapy is enforced in the framework of the health resort-medicine as complex salvation-measure together with other fully organised therapy-procedures with climate-cures.

30. Definitions in Thermalism V • Thalasso-therapy is enforced in the framework of the health resort-medicine as complex salvation-measure together with other fully organised therapy-procedures with sea-waters, silt, sand and sun as bath-cure under the influence of the climate of the sea. • Crenotherapy (Greek: kreno the source) is understood as drinking therapy. The concept is also used synonymously for Balneotherapy in some languages.

31. Thermalism • The Roman word “Thermalisme” is translated in German to „Kur- und Bäderwesen“ and is the same like Balneology. • Thermal-baths are treatment-places with a source from deep waters, that must have over 20 °C in Europe. This is a hydro-geological definition and not a medical. • Spa treatment during a period of 3 or 4 weeks is named „cure“.

32. Health Resort Science

33. Cure and Rehabilitation (Definitions) • "Kur" (cure of treatment, course) is a special type of medical treatment in Health Resorts with natural remedies during a period of 3-6 weeks. It mainly use the reactivation of self-healing powers by stimulation and training by minimise the use of drugs. • Prevention or Rehabilitation are the goal of treatment.

34. Health ResortsWhich kind of principles are included? Centres using methods to re-activate self-healing power by • Salugenetic and hygiogenetic concepts of treatment • Personally patient-oriented concepts • Use of endogenous power stimulation and stabilising forms of treatment • Activation of the patient's own responsibility for his health • Use of a pleasant and culturally encouraging environment close to nature to stimulate the therapeutic acceptance. Health Resorts ?

35. Importance of Health Resorts • Therapeutic use of classical forms of prevention and rehabilitation. • They provide economic incentives for regional health care industries and tourist markets. • They serve as healthy ecological location for environmental protection and appreciation.

36. Two Functions of Health Resorts • Health Resorts are centres in treatment of chronicle diseases and to realise preventive and rehabilitative goals. • Health Resorts are centres to get health in healthful vacations.

37. Public Health the goal of present-day Health Resort Medicine • Prevention is better than Therapy • Learning to Live Healthfully

38. Purviews of the Health Resorts • Health Resort Medicine fills its tasks in the framework of prevention and medical rehabilitation under appropriate participation of the liability community and • Health Tourism fills its tasks as one itself tourism under utilisation of the offered measures in Health Resorts.

39. Integration of Health Resorts in the Health Care System • Out-patient treatment by the Family Physicians • In-patient treatment of special acute diseases in Hospitals • In-patient or out-patient rehabilitation mainly in Health Resorts • of chronic diseases • of acute diseases, stroke, street accidents a. o. after treatment in special hospitals • In-patient or out-patient prevention in Health Resorts

40. The cure as the 3rd pillar of health-care-system • The out-patient care through the family-doctor generally as possible • The necessary stationary care in hospitals with certain acute-illnesses • The health resort-medical care in rehabilitation clinics and by out-patient cure after survived acute-illnesses, by chronic illnesses or to avoidance of illnesses with the possibilities of post-treatment, rehabilitation and prevention.

41. Types of Health Resorts • Medical Treatment centres: • Balneotherapeutic centres with medical useable mineral waters or mud • Thermal centres with medical useable thermal water • Clime centres using healthy climate in the mountains • Kneipp centres with equipment and experience in Kneipp therapy • Thalasso centres using the natural remedies of the sea • Wellness centres using equipment for pleasure and fun : • Spa hotels • Sea resorts (Thalasso-wellness) • Air resorts

42. Vacaciones de salud en spa en spa Tra-tamiento Hospital Situación y competencia térapéutica • Sano • Agotado • Enfermedades crónicas • Enfermedades agudas • Caso de emergencia Médico de familia

43. Balneology and climatology are the science of health resorts • it uses the therapy-principle basing on a health-science, • it offers an integral therapy-concept, • it applies stimulating and stabilising treatment-methods, • it strengthens the health own-responsibility, • it uses a culturally edifying and psychologically stress-free environment at health resort to promote of the therapeutic acceptance

44. Therapeutic Principles • stimulatio • Naturopathic, reactivate of self healing power • substitutio • Substitution for metabolic malfunctions • directio • Pharmacotherapy • excludio • Surgery hygiogeneticoriented„self healing" } pathogenetic oriented„artificial healing"

45. 1. Stimulatio • Activation, somatic and psychic, especially by release of counter-reactions, followed by training of physiological function-systems to improve the performance-capacity (Prevention) or • reactivation of endogenous defence-mechanisms to self overcome of pathological situations (Curation and rehabilitation by reactivation of existing self healing power).

46. 2. Substitutio • Substitute and supplement of lacking substances and abilities, if these cannot be mobilised sufficiently by stimulation (insulin, vitamins, prostheses, glasses, etc).

47. 3. Direktio • Steering of patho-physiologic functions by drugs, if it is not possible to reactivate endogenous self healing power by stimulation, by the goal to develop stabilised physiological functions again, and to avoid long-term dependence.

48. 4. Exklusio • Endogenous: elimination of not repairable systems by surgical intervention, if other measures seem unsuccessful. • Exogenous: relief of sick-doing noxe and behaviour (wrong nutrition, drug addiction, medicament abuse, insufficient inurity).

49. Primary prevention • to contribute the avoidance of a damage through activation of defence-strengths in one still healthy assuming organism by construction of a healthy behaviour. The organism has an elevated risk through certain habits or a special occupation and would take early or late damage without prevention measure.

50. Secondary prevention • Elimination of risk factors by early-treatment of existing illnesses, to reach a decrease of the pathogen or pathoplastic appearing influence-sizes and to stabilise one still remained „rest-health“ by elimination of illness-stabilising habits.