Baln1 Balneology Balneology serves the health Prof. Dr. Dr. Helmut G. Pratzel President of the International Society of Medical Hydrology and Climatology

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BalneologyBalneology

Balneology serves the health Balneology serves the health

Prof. Dr. Dr. Helmut G. PratzelProf. Dr. Dr. Helmut G. PratzelPresident of the International Society of Medical Hydrology and ClimatologyPresident of the International Society of Medical Hydrology and Climatology

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Overview to the following lecturesOverview to the following lectures

OverviewOverview Video „Video „Sanfte ReizeSanfte Reize“(German)“(German) Physical factors in BalneologyPhysical factors in Balneology Video „Aix le Bain” (French)Video „Aix le Bain” (French) Kneipp therapyKneipp therapy Videos „Kneipp treatment“(German)Videos „Kneipp treatment“(German) Percutaneous AbsorptionPercutaneous Absorption Video “Sibyllenbad” “Bad Nenndorf” (German)Video “Sibyllenbad” “Bad Nenndorf” (German) Chemical factors in BalneologyChemical factors in Balneology Video “Copahue Argentinia”(English)Video “Copahue Argentinia”(English) Creno therapyCreno therapy Video “Balneorio de Alange” (Spain)Video “Balneorio de Alange” (Spain) Medical ClimatologyMedical Climatology

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Regulates for health-conscious life by Hippokrates and Galen

Regulates for health-conscious life by Hippokrates and Galen

Cultured relations with light and air, waters and heat, the climate, the Cultured relations with light and air, waters and heat, the climate, the ground, the environment.ground, the environment.

Culture of the meal and drinking, the table-manners and abstinence-Culture of the meal and drinking, the table-manners and abstinence-regulate.regulate.

Balanced rhythm of movement and rest, work and leisure time, stress and Balanced rhythm of movement and rest, work and leisure time, stress and

leisure.leisure. Sleeping and waking state oriented at the cosmic rhythms,Sleeping and waking state oriented at the cosmic rhythms, Culture of the metabolism-processes.Culture of the metabolism-processes. Mastery of the passions, economics of the emotion-household, cultured Mastery of the passions, economics of the emotion-household, cultured

contact with itself. contact with itself.

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To die young, but as late as possible!To die young, but as late as possible!

PatientsPatients TouristsTourists

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Leben und Treiben an einem Jungbrunnen. Holzschnitt nach einem Bild von Hans Sebald BehamLeben und Treiben an einem Jungbrunnen. Holzschnitt nach einem Bild von Hans Sebald Beham

The bath a gift of the RomansThe bath a gift of the Romans

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Other people with other applicationsOther people with other applications

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The baptismThe baptism

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The sweating bathThe sweating bath

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The Mud bathThe Mud bath

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The drinking cureThe drinking cure

Lithographie vonLithographie vonHonoré DaumierHonoré Daumier

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Balneotherapy in the 10th Century by Paulos of Agina

Balneotherapy in the 10th Century by Paulos of Agina

Sulphur-baths: annoy-ailments, rashes, paralyses, Sulphur-baths: annoy-ailments, rashes, paralyses, Alaun-waters: blood-cough, blood-departure from Alaun-waters: blood-cough, blood-departure from

the uterus, the uterus, Copper-waters: strengthening of the eyes and Copper-waters: strengthening of the eyes and

ears, wholesome the guts, haemorrhoids,ears, wholesome the guts, haemorrhoids, Iron-waters: spleen-troubles, stomach-troubles, Iron-waters: spleen-troubles, stomach-troubles,

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Balneotherapy in the 11th Centuryby Kanon des Avicenna

Balneotherapy in the 11th Centuryby Kanon des Avicenna

Sulphur-baths: annoy-ailments, rashes, paralyses, Sulphur-baths: annoy-ailments, rashes, paralyses, Alaun-waters: blood-cough, blood-departure from the Alaun-waters: blood-cough, blood-departure from the

uterus, uterus, Copper-waters: strengthening of the eyes and ears, Copper-waters: strengthening of the eyes and ears,

wholesome the guts, haemorrhoids, wholesome the guts, haemorrhoids, Iron-waters: spleen-troubles, stomach-troubles, Iron-waters: spleen-troubles, stomach-troubles, Aquae salse: laxatives Aquae salse: laxatives Thermal water: pains in the jointsThermal water: pains in the joints

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Bath-regulates of the 14th Century by Pietro da Tossignano

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 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. the doctor and have left to the vein, provided it is wholesome.

Whoever into the bath climbs, may not be cold or heated. Whoever into the bath climbs, may not be cold or heated. The body may have no signs to inflammations, as that is the The body may have no signs to inflammations, as that is the

case to all those who an acute fever survived, or disposes to case to all those who an acute fever survived, or disposes to fevers or are exhausted. fevers or are exhausted.

Before the cure, one doesn't show to frequent coitus or to big Before the cure, one doesn't show to frequent coitus or to big temperance, as well all other, which the strength could weaken. temperance, as well all other, which the strength could weaken.

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Bath-regulates from the 14th Century by Pietro da Tossignano


Before one climbs into the bath, one must be sober. Before one climbs into the bath, one must be sober. Whoever doesn't tolerate the bath takes 2 spoons well Whoever doesn't tolerate the bath takes 2 spoons well washed raisins with 2 parts waters and 1 parts wine or some washed raisins with 2 parts waters and 1 parts wine or some prunes softened in waters several times. One still drinks in prunes softened in waters several times. One still drinks in the bath after it neither, as long as one has not yet eaten. the bath after it neither, as long as one has not yet eaten.

One must bath every day and must remain approximately 1 One must bath every day and must remain approximately 1 hour in the bath, approximately 15 days long.hour in the bath, approximately 15 days long.

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If one has left the bath, one puts itself into the bed and waits If one has left the bath, one puts itself into the bed and waits for the perspiration-outbreak there. If one has sweat, one for the perspiration-outbreak there. If one has sweat, one leaves dry off and rubs off with cloths completely. One gets 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 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 heat of the bath still continues to have an effect. First then should have breakfast one. If one should have thirst should have breakfast one. If one should have thirst previously, so takes one of white sugars or raisins or previously, so takes one of white sugars or raisins or something, which deletes the thirst, but no drinks. The poor something, which deletes the thirst, but no drinks. The poor people who have no bed, should remain in the bath-room, until people who have no bed, should remain in the bath-room, until he has sweat well. Then he exits and does, as declared. he has sweat well. Then he exits and does, as declared.

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One is be careful during the time, that one is in One is be careful during the time, that one is in the bath, against coldness of all type, but also still the bath, against coldness of all type, but also still several months after it, because the strength of the several months after it, because the strength of the bath continues to have an effect even longer time, bath continues to have an effect even longer time, normally 6 monthsnormally 6 months. .

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If one uses the bath for the first time, one may remain in it only 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 short time, the second time somewhat longer, the third time even somewhat longer, first at the fourth bath, one is allowed to somewhat longer, first at the fourth bath, one is allowed to remains in the water up to the prescribed time (1 hours). The 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 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. 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 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 the same day 1 on the head directional drip-bath. It is better, to take the tub-bath before the drip-bath. take the tub-bath before the drip-bath.

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Whoever wants to take a drip-bath must shear or is Whoever wants to take a drip-bath must shear or is shaved, so that the hair doesn't hinder the effect of the shaved, so that the hair doesn't hinder the effect of the bath. bath.

Because with these measures an inflammation of the liver Because with these measures an inflammation of the liver or the kidneys is to be afraid, one should rub in the or the kidneys is to be afraid, one should rub in the named positions with sandal-ointment before each bath. named positions with sandal-ointment before each bath.

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Water as elixir of the lifeWater as elixir of the life

Dietetic bathDietetic bath

Medical bathMedical bath

cleanscleans refreshesrefreshes pleasespleases enjoysenjoys

healthy-getshealthy-gets calmcalm trouble easetrouble ease healsheals

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The dietetic bathThe dietetic bath

It serves It serves The joyThe joy The relaxationThe relaxation The body-careThe body-care The beautyThe beauty

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Water is a medical remedy and a health remedy

Water is a medical remedy and a health remedy

It serves the health-prevention (dietetics)It serves the health-prevention (dietetics)• To drinking as foodTo drinking as food• To bath as toiletriesTo bath as toiletries

It serves the suffer-treatment (balneology)It serves the suffer-treatment (balneology)• To bath because of its physical and pharmacological To bath because of its physical and pharmacological

effects over the skineffects over the skin• To drink because of its stimulating effects on inner To drink because of its stimulating effects on inner

organsorgans• To inhale because of its effects on the respiration-To inhale because of its effects on the respiration-

organsorgans

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The variety of the water-application for bathing

The variety of the water-application for bathing

Sea resortsSea resorts River resortsRiver resorts Indoor bathsIndoor baths Wave-bathsWave-baths WhirlpoolsWhirlpools Tub-bathsTub-baths

Bubble-baths Bubble-baths ShowerShower Dust-bathsDust-baths DownpourDownpour Drip-bathsDrip-baths Rain-bathsRain-baths

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Water is the most used remedyWater is the most used remedy

Everybody is using it.Everybody is using it. Everybody believes its effectiveness.Everybody believes its effectiveness. The medical experience is bigger than in any other drug.The medical experience is bigger than in any other drug. The private share in costs is higher than in any other The private share in costs is higher than in any other

medicament.medicament. It is the cheapest medicament.It is the cheapest medicament. No other medicament was described so many times by No other medicament was described so many times by

artists than water.artists than water.

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In Balneology not only water is used for bathing

In Balneology not only water is used for bathing

Natural water baths Natural water baths Artificial baths Artificial baths with with

additionsadditions Sunbathes Sunbathes Air-baths Air-baths Mud-baths Mud-baths Bog-baths Bog-baths Sand-bathsSand-baths

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Overview of this lecture Main focuses to the topic

HistoryHistory Definitions in ThermalismDefinitions in Thermalism Health ResortsHealth Resorts Therapeutic principlesTherapeutic principles Systems, Inventory, Licenses, EducationSystems, Inventory, Licenses, Education Organisation of Thermalism Organisation of Thermalism Statistics and economicsStatistics and economics ResearchResearch Conclusion Conclusion

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Definitions in Thermalism IDefinitions in Thermalism I

Balneology is the science of the remedies of the Balneology is the science of the remedies of the water and the ground. water and the ground.

Medical balneology or Medical hydrology Medical balneology or Medical hydrology (French: (French: hydrologie médicalehydrologie médicale) is the science of ) is the science of the medical application of the remedies of the the medical application of the remedies of the water and the ground. water and the ground. (it is meant the place, the resort (Greek: (it is meant the place, the resort (Greek: balaneionbalaneion, Latin: , Latin: balneumbalneum, English: spa) and not , English: spa) and not the bath-tub or pool or „bathing-medicine“!) the bath-tub or pool or „bathing-medicine“!)

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Definitions in Thermalism IIDefinitions in Thermalism II

Hydrotherapy is a section of the physiotherapy. It is Hydrotherapy is a section of the physiotherapy. It is used tap-water or mineral water for showers, bath used tap-water or mineral water for showers, bath tubs, affusions (acc. Kneipp), packs or part-baths. tubs, affusions (acc. Kneipp), packs or part-baths.

Balneotherapy is enforced in the framework of the Balneotherapy is enforced in the framework of the health resort-medicine as complex salvation-health resort-medicine as complex salvation-measure together with other fully organised measure together with other fully organised therapy-procedures as bath-cure, drinking-cure or therapy-procedures as bath-cure, drinking-cure or inhaling-cure under the influence of fixed-climatic inhaling-cure under the influence of fixed-climatic factors (no pure bath-therapy!). factors (no pure bath-therapy!).

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Definitions in Thermalism IIIDefinitions in Thermalism III

Chemical balneology is a section of the Chemical balneology is a section of the balneology as support-science of the medical balneology as support-science of the medical balneology to the quality-protection and -control balneology to the quality-protection and -control of the remedies of the water and the ground. of the remedies of the water and the ground.

Hydro-geology is an autonomous science-area to Hydro-geology is an autonomous science-area to the opening and quality-protection of the mineral the opening and quality-protection of the mineral resources.resources.

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Definitions in Thermalism IVDefinitions in Thermalism IV

Medical climatology or Bio-climatology is the Medical climatology or Bio-climatology is the science of the remedies of the climate. science of the remedies of the climate.

Meteorology and climatology are autonomous Meteorology and climatology are autonomous science-areas to the judgement of the climate. science-areas to the judgement of the climate.

Climate-therapy is enforced in the framework of Climate-therapy is enforced in the framework of the health resort-medicine as complex salvation-the health resort-medicine as complex salvation-measure together with other fully organised measure together with other fully organised therapy-procedures with climate-cures. therapy-procedures with climate-cures.

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Definitions in Thermalism VDefinitions in Thermalism V

Thalasso-therapy is enforced in the framework of Thalasso-therapy is enforced in the framework of the health resort-medicine as complex salvation-the health resort-medicine as complex salvation-measure together with other fully organised measure together with other fully organised therapy-procedures with sea-waters, silt, sand and therapy-procedures with sea-waters, silt, sand and sun as bath-cure under the influence of the climate sun as bath-cure under the influence of the climate of the sea. of the sea.

Crenotherapy (Greek: kreno the source) is Crenotherapy (Greek: kreno the source) is understood as drinking therapy. The concept is also understood as drinking therapy. The concept is also used synonymously for Balneotherapy in some used synonymously for Balneotherapy in some languages. languages.

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ThermalismThermalism

The Roman word “Thermalisme” is translated in The Roman word “Thermalisme” is translated in German to „German to „Kur- und BäderwesenKur- und Bäderwesen“ and is the “ and is the same like Balneology.same like Balneology.

Thermal-baths are treatment-places with a source Thermal-baths are treatment-places with a source from deep waters, that must have over 20 °C in from deep waters, that must have over 20 °C in Europe. This is a hydro-geological definition and Europe. This is a hydro-geological definition and not a medical.not a medical.

Spa treatment during a period of 3 or 4 weeks is Spa treatment during a period of 3 or 4 weeks is named „cure“.named „cure“.

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Health Resort ScienceHealth Resort Science

D iagnostic C lin ical research

Indications F u n d am en ta l research

Therapies Q uality con trol

Toxico log y an d H yg ien e B iom etrics

M edica l H ydro logy (Ba lneo logy)M edica l C lim ato logyPhysica l M ed icine

M edica l R ehab ilita tion

Health Resort M edicine

H ydrogeology B alneochem is try

B alneobiology B alneoph ys ics

B alneotech n ique B ioc lim atology

R esearchProtection

Q uality contro l

Science of remedies

U rban ity A rch itec tu re

C lin ic plann ing Ingineering

D evelopm ent o f new R esortso f C lin ic

o f Equ ipm ents

Science of resorts

E conom y M arketin g

Q uality m an agem en t P ublic relation

Plann ing and O rgan isa tion

M anagem ent of Health Resorts

Cure and Rehabilitation (Definitions)

"Kur" (cure of treatment, course) is a special "Kur" (cure of treatment, course) is a special typetype of medical treatment in Health Resorts with of medical treatment in Health Resorts with natural remedies during a period of 3-6 weeks. It natural remedies during a period of 3-6 weeks. It mainly use the reactivation of self-healing powers mainly use the reactivation of self-healing powers by stimulation and training by minimise the use by stimulation and training by minimise the use of drugs.of drugs.

Prevention or Rehabilitation are the Prevention or Rehabilitation are the goalgoal of of treatment.treatment.

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Health ResortsWhich kind of principles are included?

Health ResortsWhich kind of principles are included?

Centres using methods to re-activate self-healing power by Centres using methods to re-activate self-healing power by Salugenetic and hygiogenetic concepts of treatmentSalugenetic and hygiogenetic concepts of treatment Personally patient-oriented conceptsPersonally patient-oriented concepts Use of endogenous power stimulation and stabilising forms of Use of endogenous power stimulation and stabilising forms of

treatment treatment Activation of the patient's own responsibility for his healthActivation of the patient's own responsibility for his health Use of a pleasant and culturally encouraging environment close Use of a pleasant and culturally encouraging environment close

to nature to stimulate the therapeutic acceptance. to nature to stimulate the therapeutic acceptance.

Health Resorts ?Health Resorts ?Health Resorts ?Health Resorts ?

Importance of Health Resorts

Therapeutic use of classical forms of prevention Therapeutic use of classical forms of prevention and rehabilitation.and rehabilitation.

They provide economic incentives for regional They provide economic incentives for regional health care industries and tourist markets.health care industries and tourist markets.

They serve as healthy ecological location for They serve as healthy ecological location for environmental protection and appreciation.environmental protection and appreciation.

Two Functions of Health Resorts

Health Resorts are centres in treatment of Health Resorts are centres in treatment of chronicle diseases and to realise preventive and chronicle diseases and to realise preventive and rehabilitative goals.rehabilitative goals.

Health Resorts are centres to get health in Health Resorts are centres to get health in healthful vacations.healthful vacations.

Public Health the goal of present-day Health Resort Medicine

Prevention is better than TherapyPrevention is better than Therapy

Learning to Live HealthfullyLearning to Live Healthfully

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Purviews of the Health Resorts

Health Resort Medicine fills its tasks in the Health Resort Medicine fills its tasks in the framework of prevention and medical framework of prevention and medical rehabilitation under appropriate participation of rehabilitation under appropriate participation of the liability community and the liability community and

Health Tourism fills its tasks as one itself tourism Health Tourism fills its tasks as one itself tourism under utilisation of the offered measures in Health under utilisation of the offered measures in Health Resorts.Resorts.

Integration of Health Resorts in the Health Care System

Out-patient treatment by the Out-patient treatment by the Family PhysiciansFamily Physicians In-patient treatment of special acute diseases in In-patient treatment of special acute diseases in

Hospitals Hospitals In-patient or out-patient rehabilitation mainly in In-patient or out-patient rehabilitation mainly in

Health ResortsHealth Resorts• of chronic diseasesof chronic diseases• of acute diseases, stroke, street accidents a. o. after of acute diseases, stroke, street accidents a. o. after

treatment in special hospitalstreatment in special hospitals In-patient or out-patient prevention in In-patient or out-patient prevention in

Health ResortsHealth Resorts

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The cure as the 3rd pillar of health-care-system

1.1. The out-patient care through the family-doctor generally as The out-patient care through the family-doctor generally as possiblepossible

2.2. The necessary stationary care in hospitals with certain acute-The necessary stationary care in hospitals with certain acute-illnessesillnesses

3.3. The health resort-medical care in rehabilitation clinics and The health resort-medical care in rehabilitation clinics and by out-patient cure after survived acute-illnesses, by chronic by out-patient cure after survived acute-illnesses, by chronic illnesses or to avoidance of illnesses with the possibilities of illnesses or to avoidance of illnesses with the possibilities of post-treatment, rehabilitation and prevention. post-treatment, rehabilitation and prevention.

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Types of Health ResortsTypes of Health Resorts

Medical Treatment centres:Medical Treatment centres:• Balneotherapeutic centres with medical useable mineral waters or mudBalneotherapeutic centres with medical useable mineral waters or mud• Thermal centres with medical useable thermal water Thermal centres with medical useable thermal water • Clime centres using healthy climate in the mountainsClime centres using healthy climate in the mountains• Kneipp centres with equipment and experience in Kneipp therapyKneipp centres with equipment and experience in Kneipp therapy• Thalasso centres using the natural remedies of the seaThalasso centres using the natural remedies of the sea

Wellness centres Wellness centres using equipment for pleasure and funusing equipment for pleasure and fun : :• Spa hotelsSpa hotels• Sea resorts (Thalasso-wellness)Sea resorts (Thalasso-wellness)• Air resortsAir resorts

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Situación y competencia térapéuticaSituación y competencia térapéutica

SanoSano

AgotadoAgotado

Enfermedades crónicasEnfermedades crónicas

Enfermedades agudasEnfermedades agudas

Caso de emergenciaCaso de emergenciaM

éd

ico d

e f

am

ilia

Hospital

Vacaciones de salud

en spa

en spa Tra-

tamiento

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Balneology and climatology are the science of health resorts

Balneology and climatology are the science of health resorts

it uses the therapy-principle basing on a health-science, it uses the therapy-principle basing on a health-science, it offers an integral therapy-concept, it offers an integral therapy-concept, it applies stimulating and stabilising treatment-methods, it applies stimulating and stabilising treatment-methods, it strengthens the health own-responsibility, it strengthens the health own-responsibility, it uses a culturally edifying and psychologically stress-it uses a culturally edifying and psychologically stress-

free environment at health resort to promote of the free environment at health resort to promote of the therapeutic acceptancetherapeutic acceptance

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Therapeutic Principles1 stimulatiostimulatio

• Naturopathic, reactivate of self Naturopathic, reactivate of self healing power healing power

2 substitutiosubstitutio• Substitution for metabolic Substitution for metabolic

malfunctions malfunctions 3 directiodirectio

• PharmacotherapyPharmacotherapy4 excludioexcludio

• SurgerySurgery

pathogenetic pathogenetic orientedoriented„artificial „artificial healing"healing"

hygiogenetichygiogeneticorientedoriented„self healing"„self healing"

}

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1. Stimulatio1. Stimulatio

Activation, somatic and psychic, especially by Activation, somatic and psychic, especially by release of counter-reactions, followed by training release of counter-reactions, followed by training of physiological function-systems to improve the of physiological function-systems to improve the performance-capacity (performance-capacity (PreventionPrevention) or ) or

reactivation of endogenous defence-mechanisms reactivation of endogenous defence-mechanisms to self overcome of pathological situations to self overcome of pathological situations ((CurationCuration and and rehabilitationrehabilitation by reactivation of by reactivation of existing self healing power). existing self healing power).

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2. Substitutio2. Substitutio

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

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3. Direktio3. Direktio

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

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4. Exklusio4. Exklusio

Endogenous: elimination of not repairable Endogenous: elimination of not repairable systems by surgical intervention, if other systems by surgical intervention, if other measures seem unsuccessful. measures seem unsuccessful.

Exogenous: relief of sick-doing noxe and Exogenous: relief of sick-doing noxe and behaviour (wrong nutrition, drug addiction, behaviour (wrong nutrition, drug addiction, medicament abuse, insufficient inurity). medicament abuse, insufficient inurity).

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Primary preventionPrimary prevention

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

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Secondary preventionSecondary prevention

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

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Ternary preventionor medical rehabilitation

Ternary preventionor medical rehabilitation

to reach an improvement of the health-condition to reach an improvement of the health-condition and one progressing of the illness-process, to and one progressing of the illness-process, to detain and to enable the concerned, to handle his detain and to enable the concerned, to handle his illness adequately, and despite hindrance to illness adequately, and despite hindrance to perceive his function in occupation, family and perceive his function in occupation, family and company as wide as possibly. company as wide as possibly.

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Cure systemsCure systems

Free (out-patient) cureFree (out-patient) cure Compact cure (group treatment)Compact cure (group treatment) In-patient cure in sanatorium or clinicsIn-patient cure in sanatorium or clinics

Course of Treatmentdepending on impairment, malfunctions, disability or handicap

Out-patient treatment Out-patient treatment (Patients stay in pensions or special hotels)(Patients stay in pensions or special hotels)

In-patient treatment In-patient treatment (Patients stay in sanatorium or rehabilitation (Patients stay in sanatorium or rehabilitation clinics)clinics)

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Compact cureCompact cure

Led group-therapyLed group-therapy Indication oriented Indication oriented contractual treatment-contractual treatment-

conceptconcept Estimated-emolumentEstimated-emolument

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Guidelines for health resorts

§ § 1 type-terms1 type-terms§ § 2 natural remedies2 natural remedies§ § 3 analysis-guidelines3 analysis-guidelines§ § 4 medical norms4 medical norms

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General rules for effective bathingGeneral rules for effective bathing

ChemicalChemical effects of water can be used only in bath tubs effects of water can be used only in bath tubs• No disinfectionsNo disinfections• Concentration in bath tubConcentration in bath tub

HH22S > 10 mg/lS > 10 mg/l Radon > 1 kBq/lRadon > 1 kBq/l COCO22 > 1 g/l > 1 g/l Brine 10-150 g/l (in case of indication) Brine 10-150 g/l (in case of indication)

PhysicalPhysical effects of water can be uses in pools effects of water can be uses in pools• With disinfections (chemical substances are destroyedWith disinfections (chemical substances are destroyed• Temperature >30 °C (in case of application)Temperature >30 °C (in case of application)

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Baths Baths Bath-additions Bath-additions Warmly-packets Warmly-packets Kryotherapie Kryotherapie Inhaling Inhaling Hydrotherapy Hydrotherapy MassagesMassages

Kinesitherapy Kinesitherapy Physiotherapy Physiotherapy Electro-therapy Electro-therapy UV-IrradiationUV-Irradiation Radon-treatment Radon-treatment Psoriasis-treatment Psoriasis-treatment Night-silenceNight-silence

Performance-description for physical therapy in health resorts

Performance-description for physical therapy in health resorts

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Quality in Health Resort MedicineQuality in Health Resort Medicine

Quality controlQuality control- of the remedies at the health resorts- of the remedies at the health resorts- of the - of the treatment-strategies at the health resorttreatment-strategies at the health resort

Quality protection Quality protection - - by technical measures by technical measures - - by protection of the resources by protection of the resources - - by establishing of the performance-standardby establishing of the performance-standard

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Medical licences of physicians with relevancy in the treatment in Health Resorts

Medical licences of physicians with relevancy in the treatment in Health Resorts

Balneology and medical climatology Balneology and medical climatology Physical medicine Physical medicine Rehabilitative medicine Rehabilitative medicine Nature-treatments Nature-treatments Environment-medicineEnvironment-medicine

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Specialities of Physicians in the ECSpecialities of Physicians in the EC

Physikalische und Rehabilitative MedizinPhysikalische und Rehabilitative Medizin (Germany)(Germany)

Rééducation et Réadaptation FonctionnellesRééducation et Réadaptation Fonctionnelles (France)(France)

RehabilitaciónRehabilitación (Spain) (Spain) FisiatriaFisiatria (Portugal) (Portugal) FisioterapiaFisioterapia (Italy) (Italy)

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Courses to get special licences and specialities

Courses to get special licences and specialities

Licences Licences Nature healing (4 months)Nature healing (4 months)Balneology and Medical Climatology (1 year)Balneology and Medical Climatology (1 year)Physical Medicine (2 years)Physical Medicine (2 years)Rehabilitative Medicine (1 year)Rehabilitative Medicine (1 year)Environmental medicine (1,5 years)Environmental medicine (1,5 years)

SpecialitiesSpecialitiesSpecialist in physiotherapy in the EC (3 years) the EC (3 years) Germany:Germany: Physikalische und Rehabilitative Medizin (Facharztanerkennung)Physikalische und Rehabilitative Medizin (Facharztanerkennung)

France:France: Rééducation et réadaptation fonctionnelles (Attestation de médecin Rééducation et réadaptation fonctionnelles (Attestation de médecin spécialiste qualifié)spécialiste qualifié)

Spain:Spain: Rehabilitación (Título de Especialista) Rehabilitación (Título de Especialista) Portugal:Portugal: Fisiatria (Tìtulo de Especialista)Fisiatria (Tìtulo de Especialista) Italy:Italy: Fisioterapia (Diploma die medico specialista) Fisioterapia (Diploma die medico specialista)

Baln 62

Course to get Physiotherapist (3 years)Course to get Physiotherapist (3 years)

2900 h theoretical and practical education2900 h theoretical and practical education 500 h Gymnastics 500 h Gymnastics 380 h Anatomy and Physiology 380 h Anatomy and Physiology 440 h Pathology and Hygiene + 100 h Diagnostic 440 h Pathology and Hygiene + 100 h Diagnostic 160 h Massage 160 h Massage 120 h Physiotherapy + 580 h practice 120 h Physiotherapy + 580 h practice

100 h Kinesitherapy + 120 h practice 100 h Kinesitherapy + 120 h practice 60 h Physical Therapy + 60 h practice 60 h Physical Therapy + 60 h practice 60 h Social medicine 60 h Social medicine 40 h Applied Physic 40 h Applied Physic 40 h Occupation + 40 h first aid 40 h Occupation + 40 h first aid

1600 h 1600 h PracticePractice ever 240 h in: Surgery, Inner Medicine, Orthopaedics, Neurology ever 240 h in: Surgery, Inner Medicine, Orthopaedics, Neurology 160 h Paediatrics 160 h Paediatrics

ever 80 h in: Psychiatrics and Gynaecologyever 80 h in: Psychiatrics and Gynaecology

Baln 63

Education-principles of physiciansEducation-principles of physicians

The treatment chronically sick person can be The treatment chronically sick person can be learned only there, where learned only there, where

these patients are treatedthese patients are treated,, efficient therapy-centres existingefficient therapy-centres existing,, Teachers with enough experience practiceTeachers with enough experience practice..

Baln 64

Topics of the high-school-trainingTopics of the high-school-training

Application of active and reactive methods Application of active and reactive methods Technologies and methods of the classic nature-treatments Technologies and methods of the classic nature-treatments Bases over autonomous functions in the biochemistry, Bases over autonomous functions in the biochemistry,

physiology and psychology. Adaptive and regulative physiology and psychology. Adaptive and regulative processes especially in the context with inflammation-processes especially in the context with inflammation-processes and pains. processes and pains.

Diagnostic and therapeutic concepts with chronic illnesses Diagnostic and therapeutic concepts with chronic illnesses Manuals technologies of the diagnosis Manuals technologies of the diagnosis Functional diagnosis Functional diagnosis Acute rehabilitation in the area of the neurology, inner Acute rehabilitation in the area of the neurology, inner

medicine, orthopaedics, geriatrics, medicine, orthopaedics, geriatrics,

Baln 65

Health Resort OrganisationHealth Resort Organisation

Baln 66

Medical Societies in GermanyMedical Societies in Germany

Scientific Society of physicians: “Scientific Society of physicians: “Deutsche Gesellschaft für Deutsche Gesellschaft für Physikalische Medizin und Rehabilitation e.V.”Physikalische Medizin und Rehabilitation e.V.”

Section of the I.S.M.H.: “Section of the I.S.M.H.: “Deutsche Sektion der Internationalen Deutsche Sektion der Internationalen Gesellschaft für Medizinische Balneologie und Klimatologie e. VGesellschaft für Medizinische Balneologie und Klimatologie e. V.”.”

Occupation Society of spa physicians: Occupation Society of spa physicians: “Verband Deutscher “Verband Deutscher Badeärzte e. V.”Badeärzte e. V.”

Occupation society of physicians: Occupation society of physicians: “Berufsverband der Ärzte für “Berufsverband der Ärzte für Physikalische und rehabilitative Medizin e.V.”Physikalische und rehabilitative Medizin e.V.”

Society of physicians: Society of physicians: “Kneippärztebund e.V.”“Kneippärztebund e.V.” Society of sciences in balneology: Society of sciences in balneology: “Vereinigung für Bäder- und “Vereinigung für Bäder- und

Klimakunde e.V”Klimakunde e.V”

Baln 67

Economic Association of Health Resorts

Economic Association of Health Resorts

In all European states economic national In all European states economic national associations of the spas are working. In Germany: associations of the spas are working. In Germany: “Wirtschaftsverband Deutscher Heilbäder und “Wirtschaftsverband Deutscher Heilbäder und Kurorte”.Kurorte”.

Baln 68

World Organisations of Health Resort Science

World Organisations of Health Resort Science

I.S.M.H. (since 1921) MedicineI.S.M.H. (since 1921) Medicine• International Society of Medical Hydrology and ClimatologyInternational Society of Medical Hydrology and Climatology

FITEC (since 1947-2000) Federation of National Health FITEC (since 1947-2000) Federation of National Health Resort AssociationsResort Associations

• Fédération Internationale du Thermalisme et du ClimatismeFédération Internationale du Thermalisme et du Climatisme SITH (since 1955) Spa techniqueSITH (since 1955) Spa technique

• Société Internationale des Techniques HydrothermalesSociété Internationale des Techniques Hydrothermales OMTh (since 1977) Economic, ManagementOMTh (since 1977) Economic, Management

• Organisation Mondiale du ThermalismeOrganisation Mondiale du Thermalisme FEMTEC (since 2000) before FITECFEMTEC (since 2000) before FITEC

Baln 69

European OrganisationsEuropean Organisations

EHV (since 1995) European EHV (since 1995) European Federation of Federation of National Health Resort National Health Resort • ““Europäischer-Heilbäder-Verband”Europäischer-Heilbäder-Verband”

ESCNM (since 1996) MedicineESCNM (since 1996) Medicine• European Society for Classical Natural MedicineEuropean Society for Classical Natural Medicine

World-Organisations of Health Resort Science

Q u a lity C o n tro lR eso u rces

S IT H (1 9 5 5 )S o c ie té In tern a tio n a le d es T ech n iq u es H yd ro th erm a les

C h em istsG eo lo g is ts

E co n o m yT o u r ism e

O M T h (1 9 7 7 )O rg a n isa tio n M o n d ia le d u T h erm a lism e

M a n a g erE co n o m ists

I .S .M .H . (1 9 2 1 )In tern a tio n a l S o c ie ty o f M ed ica l H yd ro lo g y a n d C lim a to lo g y

P h ysic ia n sB io ch em ists

P a tien tsQ u a lity S ta n d a rd s

Baln 71

Common Congresses of the I.S.M.H. and founding the International League of Rheumatology

Common Congresses of the I.S.M.H. and founding the International League of Rheumatology

1921 London Founding of the International Society of Medical Hydrology (ISMH) 1. President Dr. R. Fortescue Fox, London

1925 Paris ISMH founded „Comité International pour l’Etude des Maladies Rhumatismales

1926 Piestany ISMH founded „ International Committee on Rheumatism“

1926-28 National Committees on Rheumatism are founded in Czechoslovakia, Belgium, Russian, Great Britton, France, Austria, Danemark, Germany, Netherland, Spain, Norway

1928 Buxton 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 72

Congresses of the International League of RheumatologyCongresses of the International League of Rheumatology

1929 Budapest 1. Intern Congress 1930 Liége 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 7. Intern. Congress: Founding of the European League of Rheumatism (EULAR) and the Pan American League against Rheumatism

1953 Genf 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 73

International Congresses of the I.S.M.H.International Congresses of the I.S.M.H.

1921 London GB 1947 Locarno Switzerland 1925 Paris France 1948 Brussels Belgium 1926 Pistany Czechoslovakia 1950 Florence Italy 1927 Rome Italy 1952 Munich Germany 1928 London GB 1954 Paris France 1929 Budapest Hungary 1958 Ischia Italy 1930 Lisbon Portugal 1962 Baden Baden Germany 1931 Amsterdam Netherlands 1966 Cannes France 1932 London GB 1970 Estoril Portugal 1933 London GB 1974 Varsovic Poland 1934 Zürich Switzerland 1978 Rome Italy 1935 Brussels Belgium 1982 Azores Portugal 1936 Innsbruck Austria 1986 Nancy France 1937 Wiesbaden Germany 1989 Madrid Spain 1938 Oxford GB 1994 Bad Wörishofen Germany 1939 Montecatini Italy 1998 Karlsbad Czech Rep. 1941 Bruxton GB 2002 Budapest Hungary

Baln 74

Committees of the I.S.M.H.Committees of the I.S.M.H.

Rheumatology Rheumatology Cardiology, circulation and vessel diseasesCardiology, circulation and vessel diseases Gastroenterology and Endocrinology Gastroenterology and Endocrinology Gynaecology Gynaecology Dermatology Dermatology Respiratory diseasesRespiratory diseases PreventionPrevention Paediatrics Paediatrics Cure of the old person Cure of the old person Radon-applicationsRadon-applications

Baln 75

Objectives of international CommitteesObjectives of international Committees

Preparing of uniform indication-listings for the treatment Preparing of uniform indication-listings for the treatment at health resortsat health resorts

Preparing of a catalogue of checked and Preparing of a catalogue of checked and acknowledgement-appreciates treatment-strategies at acknowledgement-appreciates treatment-strategies at health resorts. health resorts.

Formulation of the priority health resort-medical Formulation of the priority health resort-medical research-demand and the criteria suitable for clinical research-demand and the criteria suitable for clinical questions.questions.

Baln 76

Objectives of national SectionsObjectives of national Sections

Delegation of representatives for health resort-Delegation of representatives for health resort-specific application-strategies into the specific application-strategies into the international committees international committees

Organisation of the exchange of scientific works Organisation of the exchange of scientific works Reconnaissance and patronage of national Reconnaissance and patronage of national

structures to the research-transaction structures to the research-transaction Use of national subventions and organisation of Use of national subventions and organisation of

global research-projects global research-projects

European Health Resorts

Austria 98 Luxembourg 2Belgium 3 Poland 79Bulgaria 43 Portugal 41Croatia 13 Romania 89Czech Republic 31 Russia 20Estonia 5 Slovakia 23France 100 Slovenia 15Germany 329 Spain 63Netherlands 3 Switzerland 56Hungary 28 Turkey 31Italy 300 United Kingdom 20

Statistics of Health Resort Treatment 1992

53 % Diseases of the locomotoric system53 % Diseases of the locomotoric system14 % Diseases of the circulatory system14 % Diseases of the circulatory system13 % Psycho-social diseases13 % Psycho-social diseases 5 % Metabolic diseases5 % Metabolic diseases 5 % Tumours5 % Tumours 5 % Respiratory tract diseases5 % Respiratory tract diseases 5 % others5 % others

Costs of Chronic Back Pain in Germany 1994

1989 1989 2,3 million cases of back pain resulted 2,3 million cases of back pain resulted 43 million non-working days43 million non-working days

1994 1994 about 25.000 million$ treatment costs about 25.000 million$ treatment costs for disorders of spine and back pain andfor disorders of spine and back pain andabout 15.000 million$ non-working salaryabout 15.000 million$ non-working salarytotal about 40.000 million$total about 40.000 million$

Costs of Treatment in Health Resorts

Out-patient treatment $2000 during 3 weeksOut-patient treatment $2000 during 3 weeks• insurance pays $10 per night and 90% of insurance pays $10 per night and 90% of

treatment coststreatment costs In-patient treatment $2500 during 3 weeksIn-patient treatment $2500 during 3 weeks

• patients pay about $10 per daypatients pay about $10 per day

Health Costs in Germany

1969 1969 46.000 million$ 46.000 million$ 1992 1992 286.000 million$286.000 million$ payment of the State Health Insurance payment of the State Health Insurance 138.400 million$138.400 million$

• in-patient treatment in hospitalsin-patient treatment in hospitals 37,1 %37,1 %• out-patient treatmentsout-patient treatments 29,0 %29,0 %• administrationadministration 6,0 %6,0 %• health resort and spa treatmenthealth resort and spa treatment 2,3 %2,3 %

payment of the Retirement Insurance payment of the Retirement Insurance 19.300 million$ 19.300 million$

German Health Resort Industry

329 Health Resorts and Spas329 Health Resorts and Spas annual increment value 13.300 million $annual increment value 13.300 million $ Work force 310.000 persons (=$42.903 per Work force 310.000 persons (=$42.903 per

person)person) 118 million overnights 1993 in 726.000 beds 118 million overnights 1993 in 726.000 beds

(=44,5%)(=44,5%) 9.8 million visitors 1993 (=12 days per visitor)9.8 million visitors 1993 (=12 days per visitor) 8.2 million patients privately financed (=83,6%)8.2 million patients privately financed (=83,6%) 1.6 million patients social financed (=16,4%)1.6 million patients social financed (=16,4%)

Baln 83

Number of German Health ResortsNumber of German Health Resorts

Mineral-Mineral-water and water and

Mud- Mud- ResortsResorts

Clime- Clime- ResortsResorts

Thalasso-Thalasso-ResortsResorts

Kneipp- Kneipp- ResortsResorts

totaltotal

166166 4141 5454 5050 311311

Baln 84

Guests in German Health ResortsGuests in German Health Resorts






totaltotal

19981998 5.364.7465.364.746 3.243.4753.243.475 4.390.8424.390.842 1.786.2281.786.228 14.785.39114.785.391

19991999 5.700.8575.700.857 3.312.4423.312.442 4.788.9094.788.909 1.837.1481.837.148 15.639.35615.639.356

20002000 6.099.6056.099.605 3.534.5883.534.588 5.964.1245.964.124 1.970.4751.970.475 16.668.79316.668.793

Baln 85

Overnight in German Health ResortsOvernight in German Health Resorts






totaltotal

19981998 37.327.69737.327.69717.498.886.17.498.886.

..29.879.32029.879.320 10.124.42710.124.427 94.830.33094.830.330

19991999 3999.238.93999.238.94747

17.534.35217.534.352 31.342.37231.342.372 10.347.39110.347.391 98.463.06298.463.062

20002000 41.549.36141.549.361 18.296.50718.296.507 33.141.16833.141.168 10.840.04310.840.043103.827.07103.827.07

99

Baln 86

Mean days overnight in German Health Resorts

Mean days overnight in German Health Resorts






totaltotal

19981998 6,966,96 5,405,40 6,806,80 5,675,67 6,416,41

19991999 6,886,88 5,295,29 6,546,54 5,635,63 6,306,30

20002000 6,816,81 5,185,18 6,546,54 5,505,50 6,236,23

Baln 87

Patients in German Health Resorts

1928 London GB 1954 Paris France Bulgaria Germany1929 Budapest Hungary 1958 Ischia Italy Chile Hungaria1930 Lisbon Portugal 1962 Baden Baden Germany Costa Rica India1931 Amsterdam Netherlands 1966 Cannes France Croatia Iran1932 London GB 1970 Estoril Portugal Cuba Israel1933 London GB 1974 Varsovic Poland1934 Zurich Switzerland 1978 Rome Italy1935 Brussels Belgium 1982 Azores Portugal1936 Innsbruck Austria 1986 Nancy France1937 Wiesbaden Germany 1989 Madrid Spain1938 Oxford GB 1994 Bad Wörishofen Germany1939 Montecatini Italy 1998 Karlsbad Czech Rep.1941 Bruxton GB

0

1.000.000

2.000.000

3.000.000

4.000.000

5.000.000

6.000.000

7.000.000

8.000.000

9.000.000

10.000.000

1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

private patients social patients

Research

Three levels of research goals are important:Three levels of research goals are important: medical treatment effect during the course of treatmentmedical treatment effect during the course of treatment long-term medical and social-medical effectivenesslong-term medical and social-medical effectiveness difference between expense and success: the efficacy.difference between expense and success: the efficacy.The following methods are suitable:The following methods are suitable: clinical comparisonclinical comparison comparison of costs before and after treatmentcomparison of costs before and after treatment comparison of non-working timecomparison of non-working time

Baln 89

Criterions for evidence of the efficiency

Criterions for evidence of the efficiency

• how is the treatment successhow is the treatment success??• how is the follow up successhow is the follow up success ? ?• which relevancy does the singles-measure have which relevancy does the singles-measure have

at the total-successat the total-success??

Baln 90

Quality protection by clinical research

Quality protection by clinical research

Observation of applicationsRisks 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)

Clinical ResearchClinical Researchas evidence the effectivenessas evidence the effectiveness

and recognition of risks and recognition of risks

Fundamental ResearchFundamental Researchto understand the to understand the

principle of effectivenessprinciple 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

Baln 92

Reliability of clinical researchReliability of clinical research

Long experienceby big collectives

Controlled research by small collectives

Baln 93

Clinical Trial Protocol by the Guidelines for Good Clinical Practice (GCP) of the European

Community

Clinical Trial Protocol by the Guidelines for Good Clinical Practice (GCP) of the European

Community

Trial objectives and purposeTrial objectives and purpose Trial designTrial design Randomisation, BlindingRandomisation, Blinding Selection and withdrawal of Selection and withdrawal of

subjectssubjects inclusion and exclusion criteriainclusion and exclusion criteria Treatment of subjects and control Treatment of subjects and control

medicationmedication Assessment of efficacyAssessment of efficacy

Assessment of safetyAssessment of safety Control of side effects and Control of side effects and

interactions interactions Control of Compliance Control of Compliance StatisticsStatistics Direct Access to Source Direct Access to Source

Data/DocumentsData/Documents Quality control and Quality Quality control and Quality

Assurance ProceduresAssurance Procedures EthicsEthics

Baln 94

Primary Efficacy Variable

Only validated parameters should be used.Only validated parameters should be used. Only one efficacy parameter is to defined.Only one efficacy parameter is to defined. Endpoints used to determine efficacy should be clearly Endpoints used to determine efficacy should be clearly

specified.specified. Multiple parameters should be assembled to one score Multiple parameters should be assembled to one score

parameter.parameter. An efficacy threshold is to definedAn efficacy threshold is to defined. .

Baln 95

Physical Medicine and Health Resort MedicineCumulative Number of Congress lectures in specific fields

Physical Medicine and Health Resort MedicineCumulative Number of Congress lectures in specific fields

0

100

200

300

400

500

600

700

Balneologie Thalassotherapie

1879188018811882188318841885188618871888188918901891189218

7918

8318

8718

9118

9619

0019

0419

0819

1219

2119

2619

3019

3419

3819

4919

5319

5819

6419

6819

7219

7619

8019

8419

8819

92

BalneologyClimatology

Crenotherapy

Thalassotherapy

0

100

200

300

400

500

600

700

Baln 96

Main focuses of the physical medicine and health resort-medicine frequency of the topics of 100 congresses 1879-1995

Main focuses of the physical medicine and health resort-medicine frequency of the topics of 100 congresses 1879-1995

0

100

200

300

400

500

600

700

Bal

neol

ogy

Clim

atol

ogy

Rhe

umat

olog

y

othe

r di

seas

es

Gym

nast

ics

Phy

siot

hera

py

Ele

ctro

ther

apy

Dia

gnis

tics

Phy

sica

l

Cre

noth

erap

y

Reh

abili

tati

on

The

rmot

hera

py

Hyd

roth

erap

y

Cur

e te

atm

ent

Tha

lass

othe

rapy

othe

r th

erap

ies

Pho

toth

erap

y

Kin

esit

hera

py

othe

rs

Mas

sage

Die

teti

cs

Inha

ling

His

tory

Mag

net

ther

apy

Pol

itic

s

Kne

ipp

Chi

ropr

acti

se

Thermalismlow Profit

Pharmaceutical industryhigh Profit

research promotion

ContributionsContributionsContributionsContributions

Co-operationCo-operationCo-operationCo-operation

Publicresearch promotion

Publicresearch promotion

Research, educationResearch, education

Use of professionalismGoal of interests

Development of Political opinions

Use of professionalismGoal of interests

Development of Political opinions

No promotion

No promotion

Lack ofcomprehension

Lack ofcomprehension

Circulation of contributions in free market systems

Circulation of contributions in free market systems

Baln 98

ConclusionConclusion

Most medical bath application were evaluated by traditional Most medical bath application were evaluated by traditional experiences. experiences.

Critical check-ups by drug-legal criterions have confirmed these Critical check-ups by drug-legal criterions have confirmed these experiences largely. experiences largely.

Treatment in Health Resorts are important to enjoy and well-being Treatment in Health Resorts are important to enjoy and well-being both in the medicine as well as in the culture. both in the medicine as well as in the culture.

The quality-requests in therapeutic and dietetic use of natural The quality-requests in therapeutic and dietetic use of natural remedies are different. The difference is included in governmental remedies are different. The difference is included in governmental certifications of medical health resorts or health resorts to use in certifications of medical health resorts or health resorts to use in health tourism. health tourism.

Water as the elixir of life. It has useful scientific qualities without Water as the elixir of life. It has useful scientific qualities without spiritual imaginations. spiritual imaginations.

Conclusion

Chronically ill patients are dependent on the Chronically ill patients are dependent on the possibilities offered at the Health Resorts. possibilities offered at the Health Resorts.

But healthy tourists learn in Health Resorts too.But healthy tourists learn in Health Resorts too.The goal of both groups in treatment and prevention is The goal of both groups in treatment and prevention is

the same:the same:““To die young, but as late as possible”. To die young, but as late as possible”.