Hydrotherapy:
The Health Benefits of Hot Tubs and Spas
History of Hydrotherapy
Hydrotherapy is as old as the history of mankind and information on activity in water for both therapeutic and recreational purposes has been documented despite the fact that the popularity of this modality has fluctuated through the ages. The word "hydrotherapy" is derived from the Greek words hydor (water) and therapeia (healing). The past shows us that many forms of treatment once greeted with enthusiasm have long since been abandoned.
By the time of Hippocrates, bathing was regarded as more than a simple hygienic measure. Both general and specific healthful and healing properties were assigned to baths over and above the previously accepted tonic and cleansing effect. Using a combination of hot and cold baths as part of a wider regimen, the bodily humors could be adjusted-heating, cooling, moistening, and drying as deemed necessary-to bring them into harmony. Bathing was therefore considered beneficial for most patients. Like the humoral doctrine itself, this therapeutic use of spas and hot tubs was remarkably long-lived, spanning the entire classical period. Such popularity was no doubt partly due to the fact that baths were both pleasant and, by the Roman imperial period at least, comparatively freely available.
More specifically, hot tubs were credited with an indirect curative role, specifically the softening of the bather's body prepared it for assimilation of nutriments from food. Galen developed this Hippocratic notion in the second century AD, and Oribasuius further expanded it in the fourth. Thermal baths were also recommended in the treatment of particular maladies such as soothing the chest and back pains from pneumonia, promoting good respiration, and relieving fatigue.
Roman baths were regarded not only as places for cleansing and social intercourse but also as centers of medical treatment. Although some went there to wash, take exercise, socialize, have a massage or a manicure, or have unwanted hair removed, many went for medical treatment or for advice on dietetics from athletics trainers.
Asclepiades, a Greek physician who practiced in Rome in the late second century BC, was a forceful advocate of the use of baths in regimens for the sick and for the healthy. He employed cold water extensively as a therapeutic measure both internally and externally administered, for which Pliny gave him the nickname "cold-water giver". Although he had detractors, there were many who respected his methods, and hydrotherapy increased in popularity throughout the first century BC. Towards the end of the century one of Asclepiades' followers, Antonius Musa, was responsible for the single most celebrated application of water therapy. In 23 BC, according to Suetonius, Augustus "was in such a desperate plight from abscesses of the liver, that he was forced to submit to an unprecedented and hazardous course of treatment. Since hot fomentations gave him no relief, he was led by the advice of his physician Antonius Musa to try cold ones. After his unexpected and dramatic cure, Augustus richly rewarded Musa, whose water treatment, despite subsequent less successful applications, was adopted as a fashionable form of therapy.
Baths were included in his preventative measures, and as an integral part of a healthy regimen, while he recommended them as a restorative to those who had incurred fatigue or who had become chilled or overheated. Like Hippocrates, he imbued baths with the power to regulate the humoral balance, and he also recommended their use in the treatment of many different diseases and disorders, notably skin complaints, "diseases of sinews", gout, wounds, digestive disorders, "wasting diseases", eye diseases and fevers, as well as in convalescence after surgery
Despite Musa's success in treating Augustus, Celsus advised not cold, but hot baths. Baths, then, were considered a vital part of dietetic treatment together with food,
Drinking water was one of Asclepiades' "common aids", and Celsus placed water in his "weakest" category of drinks. It was to be substituted for wine and meat if there were signs of impending illness, and copious draughts of cold water were given as a medicine to those with ardent fevers. The "lightest" water, that most suited to the sick and convalescent, was considered to come from springs and rain. For the poor these had the virtue of being available at little or no expense, unlike the costly concoctions of druggists and physicians. Part of this advice carried through to today under the medical admonishment to drink lots of fluids when sick and to remain well hydrated as part of a regular health maintenance program.
Soranus, the most famous Methodist physician, saw extra value in hot tub baths for relaxation from both physical and mental stress The softening and loosening effect they had on pregnant women was, he believed, beneficial in she later stages of pregnancy but detrimental in the early stage when the seed or embryo could be shed from an over relaxed womb. Bathing in natural waters was thought to ease the afflictions of women suffering from difficult menstruation and to relieve many other disorders of the womb. Today doctors preach caution and for pregnant woman to avoid overheating.
Asclepiades, Celsus, and Soranus were interested in water in its various forms inasmuch as it was thought to be useful in healing the sick and preventing disease. It is interesting to note the broad similarity between the diseases and disorders treated by baths by the medical writers and those which were believed to be cured or relieved by spa therapy. Foremost are diseases of sinews, gout, skin diseases, stomach disorders and diseases of the urinary tract.
Vitruvius and Pliny recognized several classes of thermal and medicinal springs, not dissimilar to modern classifications of sulphur springs, whose waters "refresh muscular weakness and sinews" by heating and burning poisonous humors from the body; alum springs, immersion in which was used as a treatment for paralysis, because their warmth opened the pores and restored health; bitumen springs which provided draughts to purge and to heal "interior defects"; alkaline springs, whose waters were taken to purge and to lessen "scrofulous tumours' and acid springs, draughts of which were drunk to dissolve bladder stone, an effect which Vitruvius explained as happening "by nature, because a sharp and acidic juice is present in the soil, and when water currents pass out of it, they are tinctured with the acridity". Pliny listed further sources which had powers to heal wounds, dislocations and fractures, and cure gout, foot diseases, sciatica, fever, psoriasis, diseases of the eyes, ears, and head, insanity, and barrenness in women. He also compiled a similarly extensive list of the medicinal uses of sea water, repeatin and endorsing the contemporary adage that "for the whole body nothing is more beneficial than salt and sun". Celsus, too, extolled the virtues of warm sea water, notably for those suffering from "relaxing of the sinews" or paralysis. Certain sources were especially renowned for their healing properties and were singled out for mention, as, for example, the intensely cold waters of Aquae Cutiliae,
near Rome, which Pliny and Celsus praised for their effectiveness in curing stomach disorders; and the sulphur springs of Aquae Albuhsé, between Rome and Tivoli, described by Vitruvius, Strabo, and Martial, recommended by Pliny for the healing of wounds, and frequented by Augustus when he was troubled with rheumatism As "Ia Solfatara" the Albula hot spa springs are still in use today.
Early pioneers of hydrotherapy were Sir John Floyer who wrote a treatise in 1697 'An enquiry into the right use and abuse of hot, cold and temperate baths'; John Wesley, the founder of Methodism, who published a book on hydrotherapy in 1747, called it an easy and natural way of curing most diseases; and Dr Wright who in 1779 published a work on the use of cold baths for treating small pox. Vincent Pressnitz, had plenty of time and plenty of water. He set up outdoor baths in a woodland setting and placed his clients on treatment programs that included cold douches, massage and chopping wood. The medical profession viewed his success with concern and tried to put a stop to the craze.
Image: St John’s Hospital, Lichfield. Floyer based much of his evidence in his book, The Physician’s Pulse-Watch, from evidence he obtained from the pulses of elderly men who lived in the almshouse. The building is still a home for retired men in contemporary Lichfield.
Photograph from: Malcolm Dick (1983)
During this period a Bavarian priest Sebastian Kniepp, became well known for his water cures.
in America, Dr Joel Shaw developed a more systematic water cure at his hydropathic establishment in New York. Professor Winterwitz of Vienna dedicated his life to the scientific study of the practice of hydratics and gave an accurate foundation to modern hydrotherapy.
Advances in the use of water continued in Europe but America lagged behind during the nineteenth century. However, the warm hot tub gradually gained popularity and was used in other surgical, neuralgic and psychiatric conditions. Dr. Simon Baruch who worked with Professor Winterwitz furthered the use of Hydrotherapy through his work which revolved around the fact that heat or cold was conveyed to the central nervous system by the cutaneous nerves and thus became reflected in the motor pathways. Hydrogymnastics or underwater exercise in warm water was advised in the late nineteenth century. However, it was not until the first Hubbard tank was made in the 1920s that therapeutic pool exercises really began to be developed systematically.
Today, the ever increasing popularity and value of Hydrotherapy appears to be highlighted by an upsurge in research into many different aspects of water, the physiology of exercise in water and so on. Recognition of the ways in which the characteristics and properties of water may be used to create techniques which enhance activity in and the therapeutic value of the water as part of the total physical and psychological care characterized modern hydrotherapy.
Asclepiades, a Greek physician who practiced in Rome in the late second century BC, was a forceful advocate of the use of baths in regimens for the sick and for the healthy. He employed cold water extensively as a therapeutic measure both internally and externally administered, for which Pliny gave him the nickname "cold-water giver". Although he had detractors, there were many who respected his methods, and hydrotherapy increased in popularity throughout the first century BC. Towards the end of the century one of Asclepiades' followers, Antonius Musa, was responsible for the single most celebrated application of water therapy. In 23 BC, according to Suetonius, Augustus "was in such a desperate plight from abscesses of the liver, that he was forced to submit to an unprecedented and hazardous course of treatment. Since hot fomentations gave him no relief, he was led by the advice of his physician Antonius Musa to try cold ones. After his unexpected and dramatic cure, Augustus richly rewarded Musa, whose water treatment, despite subsequent less successful applications, was adopted as a fashionable form of therapy. 
Drinking water was one of Asclepiades' "common aids", and Celsus placed water in his "weakest" category of drinks. It was to be substituted for wine and meat if there were signs of impending illness, and copious draughts of cold water were given as a medicine to those with ardent fevers. The "lightest" water, that most suited to the sick and convalescent, was considered to come from springs and rain. For the poor these had the virtue of being available at little or no expense, unlike the costly concoctions of druggists and physicians. Part of this advice carried through to today under the medical admonishment to drink lots of fluids when sick and to remain well hydrated as part of a regular health maintenance program.
Soranus, the most famous Methodist physician, saw extra value in hot tub baths for relaxation from both physical and mental stress The softening and loosening effect they had on pregnant women was, he believed, beneficial in she later stages of pregnancy but detrimental in the early stage when the seed or embryo could be shed from an over relaxed womb. Bathing in natural waters was thought to ease the afflictions of women suffering from difficult menstruation and to relieve many other disorders of the womb. Today doctors preach caution and for pregnant woman to avoid overheating.
