Balneology
Balneology serves the health
Prof. Dr. Dr. Helmut G. Pratzel
President of the International Society of Medical Hydrology and Climatology
Baln
1
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
Baln 2
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 abstinenceregulate.
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.
Baln 3
To die young, but as late as possible!
Patients
Tourists
Baln 4
The bath a gift of the Romans
Leben und Treiben an einem Jungbrunnen. Holzschnitt nach einem Bild von Hans Sebald Beham
Baln 5
Other people with other applications
Baln 6
The baptism
Baln 7
The sweating bath
Baln 8
The Mud bath
Baln 9
The drinking cure
Lithographie von
Honoré Daumier
Baln 10
Balneotherapy in the 10th Century
by 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,

Baln 11
Balneotherapy in the 11th Century
by 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

Baln 12
Bath-regulates of the 14th Century
by 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.
Baln 13
Bath-regulates from the 14th Century
by 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.
Baln 14
Bath-regulates from the 14th Century
by 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.
Baln 15
Bath-regulates from the 14th Century
by 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.
Baln 16
Bath-regulates from the 14th Century
by 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.
Baln 17
Bath-regulates from the 14th Century
by 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.
Baln 18
Water as elixir of the life

Dietetic bath





Medical bath




cleans
refreshes
pleases
enjoys
healthy-gets
calm
trouble ease
heals
Baln 19
The dietetic bath
It serves
 The joy
 The relaxation
 The body-care
 The beauty
Baln 20
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 respirationorgans
Baln 21
The variety of the water-application
for bathing
 Sea
resorts
 River resorts
 Indoor baths
 Wave-baths
 Whirlpools
 Tub-baths
 Bubble-baths
 Shower
 Dust-baths
 Downpour
 Drip-baths
 Rain-baths
Baln 22
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.

Baln 23
In Balneology not only water is used
for bathing
 Natural
water baths
 Artificial baths with
additions
 Sunbathes
 Air-baths
 Mud-baths
 Bog-baths
 Sand-baths
Baln 24
Overview of this lecture
Main focuses to the topic
History
 Definitions in Thermalism
 Health Resorts
 Therapeutic principles
 Systems, Inventory, Licenses, Education
 Organisation of Thermalism
 Statistics and economics
 Research
 Conclusion

Baln 25
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“!)

Baln 26
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 partbaths.
 Balneotherapy is enforced in the framework of the
health resort-medicine as complex salvationmeasure together with other fully organised
therapy-procedures as bath-cure, drinking-cure or
inhaling-cure under the influence of fixedclimatic factors (no pure bath-therapy!).

Baln 27
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.

Baln 28
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 salvationmeasure together with other fully organised
therapy-procedures with climate-cures.

Baln 29
Definitions in Thermalism V
Thalasso-therapy is enforced in the framework of
the health resort-medicine as complex salvationmeasure 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.

Baln 30
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“.

Baln 31
Health Resort Science
Health Resort Medicine
Science of remedies
Science of resorts
Management of Health Resorts
Medical Hydrology (Balneology)
Medical Climatology
Physical Medicine
Medical Rehabilitation
Research
Protection
Quality control
Development of new Resorts
of Clinic
of Equipments
Planning and Organisation
Diagnostic
Clinical research
Hydrogeology
Balneochemistry
Urbanity
Architecture
Economy
Marketing
Indications
Fundamental research
Balneobiology
Balneophysics
Clinic planning
Ingineering
Quality management
Public relation
Therapies
Quality control
Balneotechnique
Bioclimatology
Toxicology and Hygiene
Biometrics
Baln 32
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.

Health Resorts
Which 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 ?
Baln 34
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.

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.

Public Health the goal of present-day
Health Resort Medicine

Prevention is better than Therapy

Learning to Live Healthfully
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.
Baln 38
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
The cure as the 3rd pillar of health-care-system
1.
The out-patient care through the family-doctor generally as
possible
2.
The necessary stationary care in hospitals with certain acuteillnesses
3.
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.
Baln 40
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
Baln 41

Sano

Agotado

Enfermedades crónicas

Enfermedades agudas

Caso de emergencia
Médico de familia
Situación y competencia térapéutica
Vacaciones
de salud
en
spa
en spa
Tratamiento
Hospital
Baln 42
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 stressfree environment at health resort to promote of the
therapeutic acceptance

Baln 43
Therapeutic Principles
1
2
3
4
stimulatio
• Naturopathic, reactivate of self
healing power
substitutio
• Substitution for metabolic
malfunctions
directio
• Pharmacotherapy
excludio
• Surgery
hygiogenetic
oriented
„self healing"
pathogenetic oriented
„artificial healing"
Baln 44
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).

Baln 45
2. Substitutio

Substitute and supplement of lacking
substances and abilities, if these cannot
be mobilised sufficiently by stimulation
(insulin, vitamins, prostheses, glasses,
etc).
Baln 46
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.
Baln 47
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).

Baln 48
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.
Baln 49
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 illnessstabilising habits.
Baln 50
Ternary prevention
or medical rehabilitation

to reach an improvement of the health-condition
and one progressing of the illness-process, to
detain and to enable the concerned, to handle his
illness adequately, and despite hindrance to
perceive his function in occupation, family and
company as wide as possibly.
Baln 51
Cure systems
Free (out-patient) cure
 Compact cure (group treatment)
 In-patient cure in sanatorium or clinics

Baln 52
Course of Treatment
depending on impairment, malfunctions, disability or handicap
Out-patient treatment
(Patients stay in pensions or special hotels)
 In-patient treatment
(Patients stay in sanatorium or rehabilitation
clinics)

Compact cure
Led group-therapy
 Indication oriented contractual treatmentconcept
 Estimated-emolument

Baln 54
Guidelines for health resorts
§ 1 type-terms
§ 2 natural remedies
§ 3 analysis-guidelines
§ 4 medical norms
Baln 55
General rules for effective bathing


Chemical effects of water can be used only in bath tubs
• No disinfections
• Concentration in bath tub
 H2S > 10 mg/l
 Radon > 1 kBq/l
 CO2 > 1 g/l
 Brine 10-150 g/l (in case of indication)
Physical effects of water can be uses in pools
• With disinfections (chemical substances are destroyed
• Temperature >30 °C (in case of application)
Baln 56
Performance-description for physical
therapy in health resorts
 Baths
 Kinesitherapy
 Bath-additions
 Physiotherapy
 Warmly-packets
 Electro-therapy
 Kryotherapie
 UV-Irradiation
 Inhaling
 Radon-treatment
 Hydrotherapy
 Psoriasis-treatment
 Massages
 Night-silence
Baln 57
Quality in Health Resort Medicine
Quality control
- of the remedies at the health resorts
- of the treatment-strategies at the health resort
 Quality protection
- by technical measures
- by protection of the resources
- by establishing of the performance-standard

Baln 58
Medical licences of physicians with
relevancy in the treatment in Health Resorts
Balneology and medical climatology
 Physical medicine
 Rehabilitative medicine
 Nature-treatments
 Environment-medicine

Baln 59
Specialities of Physicians in the EC
Physikalische und Rehabilitative Medizin
(Germany)
 Rééducation et Réadaptation Fonctionnelles
(France)
 Rehabilitación (Spain)
 Fisiatria (Portugal)
 Fisioterapia (Italy)

Baln 60
Courses to get special licences and
specialities

Licences
Nature healing (4 months)
Balneology and Medical Climatology (1 year)
Physical Medicine (2 years)
Rehabilitative Medicine (1 year)
Environmental medicine (1,5 years)

Specialities
Specialist in physiotherapy in the EC (3 years)
Germany:
France:
Spain:
Portugal:
Italy:
Physikalische und Rehabilitative Medizin (Facharztanerkennung)
Rééducation et réadaptation fonctionnelles (Attestation de médecin
spécialiste qualifié)
Rehabilitación (Título de Especialista)
Fisiatria (Tìtulo de Especialista)
Fisioterapia (Diploma die medico specialista)
Baln 61
Course to get Physiotherapist (3 years)
2900 h theoretical and practical education
 500 h Gymnastics
 380 h Anatomy and Physiology
 440 h Pathology and Hygiene + 100 h Diagnostic
 160 h Massage
 120 h Physiotherapy + 580 h practice
 100 h Kinesitherapy + 120 h practice
 60 h Physical Therapy + 60 h practice
 60 h Social medicine
 40 h Applied Physic
 40 h Occupation + 40 h first aid
1600 h Practice
 ever 240 h in: Surgery, Inner Medicine, Orthopaedics, Neurology
 160 h Paediatrics
 ever 80 h in: Psychiatrics and Gynaecology
Baln 62
Education-principles of physicians
The treatment chronically sick person can be
learned only there, where
 these patients are treated,
 efficient therapy-centres existing,
 Teachers with enough experience practice.
Baln 63
Topics of the high-school-training







Application of active and reactive methods
Technologies and methods of the classic nature-treatments
Bases over autonomous functions in the biochemistry,
physiology and psychology. Adaptive and regulative
processes especially in the context with inflammationprocesses and pains.
Diagnostic and therapeutic concepts with chronic illnesses
Manuals technologies of the diagnosis
Functional diagnosis
Acute rehabilitation in the area of the neurology, inner
medicine, orthopaedics, geriatrics,
Baln 64
Health Resort Organisation
Baln 65
Medical Societies in Germany






Scientific Society of physicians: “Deutsche Gesellschaft für
Physikalische Medizin und Rehabilitation e.V.”
Section of the I.S.M.H.: “Deutsche Sektion der Internationalen
Gesellschaft für Medizinische Balneologie und Klimatologie e. V.”
Occupation Society of spa physicians: “Verband Deutscher
Badeärzte e. V.”
Occupation society of physicians: “Berufsverband der Ärzte für
Physikalische und rehabilitative Medizin e.V.”
Society of physicians: “Kneippärztebund e.V.”
Society of sciences in balneology: “Vereinigung für Bäder- und
Klimakunde e.V”
Baln 66
Economic Association of Health
Resorts

In all European states economic national
associations of the spas are working. In Germany:
“Wirtschaftsverband Deutscher Heilbäder und
Kurorte”.
Baln 67
World Organisations of Health Resort
Science

I.S.M.H. (since 1921) Medicine
•

FITEC (since 1947-2000) Federation of National Health
Resort Associations
•

Société Internationale des Techniques Hydrothermales
OMTh (since 1977) Economic, Management
•

Fédération Internationale du Thermalisme et du Climatisme
SITH (since 1955) Spa technique
•

International Society of Medical Hydrology and Climatology
Organisation Mondiale du Thermalisme
FEMTEC (since 2000) before FITEC
Baln 68
European Organisations

EHV (since 1995) European Federation of
National Health Resort
“Europäischer-Heilbäder-Verband”
 ESCNM (since 1996) Medicine
• European Society for Classical Natural Medicine
•
Baln 69
World-Organisations of Health Resort Science
Patients
Quality Standards
I.S.M.H. (1921)
International Society of Medical Hydrology and Climatology
Physicians
Biochemists
SITH (1955)
Societé Internationale des Techniques Hydrothermales
Chemists
Geologists
OMTh (1977)
Organisation Mondiale du Thermalisme
Manager
Economists
Quality Control
Resources
Economy
Tourisme
Common Congresses of the I.S.M.H. and founding
the International League of Rheumatology
1921
London
1925
Paris
1926
Piestany
1926-28
1928
Buxton
Founding of the International Society of Medical
Hydrology (ISMH)
1. President Dr. R. Fortescue Fox, London
ISMH founded „Comité International pour l’Etude des
Maladies Rhumatismales
ISMH founded „ International Committee on
Rheumatism“
National Committees on Rheumatism are founded in
Czechoslovakia, Belgium, Russian, Great Britton,
France, Austria, Danemark, Germany, Netherland,
Spain, Norway
Founding the International League on Rheumatology
by the International Committee on Rheumatism of
the ISMH
1. President Dr. R. Fortescue Fox, London
1. Issue of „Acta Rheumca“ is published
Baln 71
Congresses of the International League of Rheumatology
1929
1930
Budapest
Liége
1. Intern Congress
2. Intern. Congress
1931
Moscow
Congress in national Institut of Balneology
1932
Paris
3. Intern. Congress
1934
Moscow
4. Intern. Congress
1936
Lund-Stockholm
5. Intern. Congress
1938
London-Oxford
6. Intern. Congress with ISMH
1949
New York
1953
Genf
7. Intern. Congress: Founding of the European
League of Rheumatism (EULAR) and the Pan
American League against Rheumatism
8. Intern. Congress
1957
Toronto
9. Intern. Congress
1960
Lacco Ameno
Intern. Symposium „Spa Treatment and Rheumatism“
1961
Rom
10. Intern. Congress „Sulphur“
1965
Mar de la Plata
11. Intern. Congress
1969
Prag
12. Intern. Congress
Baln 72
International Congresses of the I.S.M.H.
1921
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1941
London
Paris
Pistany
Rome
London
Budapest
Lisbon
Amsterdam
London
London
Zürich
Brussels
Innsbruck
Wiesbaden
Oxford
Montecatini
Bruxton
GB
France
Czechoslovakia
Italy
GB
Hungary
Portugal
Netherlands
GB
GB
Switzerland
Belgium
Austria
Germany
GB
Italy
GB
1947
1948
1950
1952
1954
1958
1962
1966
1970
1974
1978
1982
1986
1989
1994
1998
2002
Locarno
Brussels
Florence
Munich
Paris
Ischia
Baden Baden
Cannes
Estoril
Varsovic
Rome
Azores
Nancy
Madrid
Bad Wörishofen
Karlsbad
Budapest
Switzerland
Belgium
Italy
Germany
France
Italy
Germany
France
Portugal
Poland
Italy
Portugal
France
Spain
Germany
Czech Rep.
Hungary
Baln 73
Committees of the I.S.M.H.










Rheumatology
Cardiology, circulation and vessel diseases
Gastroenterology and Endocrinology
Gynaecology
Dermatology
Respiratory diseases
Prevention
Paediatrics
Cure of the old person
Radon-applications
Baln 74
Objectives of international Committees



Preparing of uniform indication-listings for the treatment
at health resorts
Preparing of a catalogue of checked and
acknowledgement-appreciates treatment-strategies at
health resorts.
Formulation of the priority health resort-medical
research-demand and the criteria suitable for clinical
questions.
Baln 75
Objectives of national Sections
Delegation of representatives for health resortspecific application-strategies into the
international committees
 Organisation of the exchange of scientific works
 Reconnaissance and patronage of national
structures to the research-transaction
 Use of national subventions and organisation of
global research-projects

Baln 76
European Health Resorts
Austria
Belgium
Bulgaria
Croatia
Czech Republic
Estonia
France
Germany
Netherlands
Hungary
Italy
98
3
43
13
31
5
100
329
3
28
300
Luxembourg
Poland
Portugal
Romania
Russia
Slovakia
Slovenia
Spain
Switzerland
Turkey
United Kingdom
2
79
41
89
20
23
15
63
56
31
20
Statistics of Health Resort Treatment
1992
53 % Diseases of the locomotoric system
14 % Diseases of the circulatory system
13 % Psycho-social diseases
5 % Metabolic diseases
5 % Tumours
5 % Respiratory tract diseases
5 % others
Costs of Chronic Back Pain in
Germany 1994
1989
2,3 million cases of back pain resulted
43 million non-working days
 1994
about 25.000 million$ treatment costs
for disorders of spine and back pain and
about 15.000 million$ non-working salary
total about 40.000 million$

Costs of Treatment in Health Resorts
Out-patient treatment $2000 during 3 weeks
• insurance pays $10 per night and 90% of
treatment costs
 In-patient treatment $2500 during 3 weeks
• patients pay about $10 per day

Health Costs in Germany




1969
46.000 million$
1992
286.000 million$
payment of the State Health Insurance
138.400 million$
• in-patient treatment in hospitals 37,1 %
• out-patient treatments
29,0 %
• administration
6,0 %
• health resort and spa treatment
2,3 %
payment of the Retirement Insurance
19.300 million$
German Health Resort Industry
329 Health Resorts and Spas
annual increment value 13.300 million $
Work force 310.000 persons (=$42.903 per
person)
 118 million overnights 1993 in 726.000 beds
(=44,5%)
 9.8 million visitors 1993 (=12 days per visitor)
 8.2 million patients privately financed (=83,6%)
 1.6 million patients social financed (=16,4%)



Number of German Health Resorts
Mineralwater and
MudResorts
ClimeResorts
ThalassoResorts
KneippResorts
total
166
41
54
50
311
Baln 83
Guests in German Health Resorts
Mineralwater and
MudResorts
ClimeResorts
ThalassoResorts
KneippResorts
total
1998
5.364.746
3.243.475
4.390.842
1.786.228
14.785.391
1999
5.700.857
3.312.442
4.788.909
1.837.148
15.639.356
2000
6.099.605
3.534.588
5.964.124
1.970.475
16.668.793
Baln 84
Overnight in German Health Resorts
Mineralwater and
MudResorts
ClimeResorts
ThalassoResorts
KneippResorts
total
1998
37.327.697 17.498.886.. 29.879.320
10.124.427
94.830.330
1999
3999.238.94
17.534.352
7
31.342.372
10.347.391
98.463.062
2000
41.549.361
33.141.168
10.840.043 103.827.079
18.296.507
Baln 85
Mean days overnight in German
Health Resorts
Mineralwater and
MudResorts
ClimeResorts
ThalassoResorts
KneippResorts
total
1998
6,96
5,40
6,80
5,67
6,41
1999
6,88
5,29
6,54
5,63
6,30
2000
6,81
5,18
6,54
5,50
6,23
Baln 86
Patients in German Health Resorts
1928 London
1929 Budapest
1930 Lisbon
1931 Amsterdam
1932 London
10.000.000
1933 London
Zurich
19349.000.000
1935 Brussels
Innsbruck
19368.000.000
Wiesbaden
19377.000.000
1938 Oxford
Montecatini
19396.000.000
1941 Bruxton
5.000.000
GB
Hungary
Portugal
Netherlands
GB
GB
Switzerland
Belgium
Austria
Germany
GB
Italy
GB
1954
1958
1962
1966
1970
1974
1978
1982
1986
1989
1994
1998
Paris
Ischia
Baden Baden
Cannes
Estoril
Varsovic
Rome
Azores
Nancy
Madrid
Bad Wörishofen
Karlsbad
France
Italy
Germany
France
Portugal
Poland
Italy
Portugal
France
Spain
Germany
Czech Rep.
Bulgaria
Chile
Costa Rica
Croatia
Cuba
Germany
Hungaria
India
Iran
Israel
4.000.000
3.000.000
private patients
social patients
2.000.000
1.000.000
0
1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994
Baln 87
Research
Three levels of research goals are important:
 medical treatment effect during the course of treatment
 long-term medical and social-medical effectiveness
 difference between expense and success: the efficacy.
The following methods are suitable:
 clinical comparison
 comparison of costs before and after treatment
 comparison of non-working time
Criterions for evidence of the
efficiency
•
•
•
how is the treatment success?
how is the follow up success ?
which relevancy does the singles-measure have
at the total-success?
Baln 89
Quality protection by clinical
research
 Observation of applications
Risks and benefits are recognized by big
collectives by long observation times .
 Controlled trials
Risks and benefits are recognized by
small collectives by short observation
times.
Traditional evaluated inductive
medicine
(Naturopathic treatments)
By free market rules evaluated
deductive medicine
(Pharmaceutical research)
Baln 90
Clinical Research
Fundamental Research
as evidence the effectiveness
and recognition of risks
to understand the
principle of effectiveness
Trial with low evidence
(Observation of applications)
Risks are recognized by long
observation times
Trials with high evidence
(Controlled trials)
Risks are recognized
by rules of drug law
Effect and effectiveness
have to be in
plausible context
Exploration of effectiveness
is of academic interest
and to recognize of the rest-risk
Reliability of clinical research
Long experience
by big collectives
Controlled research
by small collectives
Baln 92
Clinical Trial Protocol
by the Guidelines for Good Clinical Practice (GCP) of the European
Community








Trial objectives and purpose

Trial design
Randomisation, Blinding

Selection and withdrawal of

subjects

inclusion and exclusion criteria
Treatment of subjects and control 
medication

Assessment of efficacy
Assessment of safety
Control of side effects and
interactions
Control of Compliance
Statistics
Direct Access to Source
Data/Documents
Quality control and Quality
Assurance Procedures
Ethics
Baln 93
Primary Efficacy Variable





Only validated parameters should be used.
Only one efficacy parameter is to defined.
Endpoints used to determine efficacy should be clearly
specified.
Multiple parameters should be assembled to one score
parameter.
An efficacy threshold is to defined.
Baln 94
Physical Medicine and Health Resort Medicine
Cumulative Number of Congress lectures in specific fields
300
300
200
200
100
100
0
0
1992
1988
1984
1980
1976
1972
1968
1964
1958
1953
1949
1938
1934
1930
1926
1921
1912
1908
1904
1900
1896
1891
1887
1883
1879
700
700
600
600
500
500
400
400
Balneologie
Thalassotherapie
Balneology
Climatology
Crenotherapy
Thalassotherapy
1879
1880
1881
1882
1883
1884
1885
1886
1887
1888
1889
1890
1891
1892
Baln 95
0
Chiropractise
Kneipp
Politics
Magnet therapy
History
Inhaling
Dietetics
Massage
others
Kinesitherapy
Phototherapy
other therapies
Thalassotherapy
Cure teatment
Hydrotherapy
Thermotherapy
Rehabilitation
Crenotherapy
Physical
Diagnistics
Electrotherapy
Physiotherapy
Gymnastics
other diseases
Rheumatology
Climatology
Balneology
Main focuses of the physical medicine and health resortmedicine frequency of the topics of 100 congresses 1879-1995
700
600
500
400
300
200
100
Baln 96
Circulation of contributions in
free market systems
No
promotion
Public
research promotion
Contributions
Research, education
Lack of
comprehension
Use of professionalism
Goal of interests
Development of Political opinions
Co-operation
Thermalism
low Profit
Pharmaceutical industry
high Profit
research promotion
Conclusion





Most medical bath application were evaluated by traditional
experiences.
Critical check-ups by drug-legal criterions have confirmed these
experiences largely.
Treatment in Health Resorts are important to enjoy and well-being
both in the medicine as well as in the culture.
The quality-requests in therapeutic and dietetic use of natural
remedies are different. The difference is included in governmental
certifications of medical health resorts or health resorts to use in
health tourism.
Water as the elixir of life. It has useful scientific qualities without
spiritual imaginations.
Baln 98
Conclusion
Chronically ill patients are dependent on the
possibilities offered at the Health Resorts.
But healthy tourists learn in Health Resorts too.
The goal of both groups in treatment and prevention is
the same:
“To die young, but as late as possible”.