Water Cures and Science

George Weisz, “Water Cures and Science: The french Academy of Medicine and Mineral Waters in the Nineteenth Century,” Bulletin of the History of Medicine 64, no. 3 (1990): 393-416.

In this piece, Weisz discusses institutional and individual attempts in nineteenth century France to place mineral waters and the therapies that involved them on a biomedical, statistical, and chemical foundation of therapeutic efficacy. He argues that the different way in which spa therapies are understood, utilized, and supported in Europe versus in North America is due to the medical and scientific fields’ support of hydrotherapy in the former, where it is largely absent in the latter.

“Water cures in North America were largely an entrepreneurial activity with limited links to public health authorities and even less to academic medicine.” (394)
He doesn’t cite anything here, so I wonder from where he has gathered this impression. Not that I disagree, but it’d be nice to see where this is discussed elsewhere.

The French Academy of Medicine was put in charge of “authorizing” mineral waters in the 19th century “on the basis of chemical analyses carried out in the Academy’s laboratory.” They didn’t make judgements on the therapeutic efficacy/action of the waters, but just looked at what was in it and compared it to other well-known spots. (396) They added bacterial analyses by the end of the 19th century. (397)

The organization had a branch of inspectors whose job it was to “study scientifically the properties of local waters, to supervise the medical functioning of spas, to suggest improvements to appropriate authorities, and to provide free medical care to indigents.” Their role changed in emphasis from statistics-gathering to the production of original scientific research as the century wore on. (398)

The reports they submitted were gathered, cross-referenced, and published by the Academy yearly (though this was sometimes poorly done and late). “…the aim was to set down information in a logical manner so that correlations among what we would call variables could be made visible. The key question in this case was the extent to which a particular water could be shown to be especially effective against particular diseases or conditions. The goal was to determine each water’s therapeutic specificity…” (398-99)
This is the exact kinda thing that’s going on in climatology. Woot woot!

Weisz spends some time discussing how the reports and the scientific validity they gave the waters were a source of medical authority for the Academy over mineral waters. They advocated for legislation that would prevent people from using the waters without the aid of a physician (this failed — legislation in the early 1860s made waters free to use for anyone).

Spa proprietors were understood as greedy; “the only counterbalance to commercial greed was medical authority.”
Since there was little medical authority in ES, this may explain why the spa industry didn’t take off in America like it did on the continent. Capitalists were permitted to make outrageous claims, and nothing was regulated — they became untrustworthy as medicine scientized. They tried to jump on the bandwagon of scientific legitimacy, but the commercial aspects of their endeavor were too pronounced. Too many unsustainable claims. Trust (particularly of the thin variety, I’d imagine) is a ruthless balancing act. 

The Academy believed that “[t]he prosperity of the spa industry would be ensured if the applications of water cures could be determined scientifically; if a degree of therapeutic specificity were to be established physicians could be made fully to understand the range of conditions for which each water was useful. Explaining the actual mechanisms through which waters acted on the body might be part of this task, but it was secondary to the precise determination of therapeutic efficacy.” (402-3)
This focus on empirical evidence over explanatory theory may have sustained therapeutics through the late 19th and early 20th centuries, but as bacteriology, pharmaceutical chemistry, and other sciences provided a mechanistic (word choice?) explanation, this kind of mass evidence based on “subjective” experience would cease to be as convincing.

Weisz spends some time discussing the difficulties in establishing the extent of therapeutic efficacy; do you take a clinical approach? The variables are very difficult to isolate, particularly for hydrotherapy, where many things are at play. Clinical testing strategies were also in their infancy. The laboratory is another strategy (that became increasingly popular as time wore on), but it is even more reductionist and restrictive. How could you conduct a laboratory test on the community healing aspect of a health spa?

Details attempts at establishing hospitals and laboratories near spa towns, which don’t seem to have happened.

“Chemistry was in certain respects hydrology’ main claim to rigorous scientific status…” though there was some tension between “chemistry adn clinical therapeutics.”

Discusses the case of Forges-les-Bains, a site where chemical testing indicated that the waters had very little mineral content (like Eureka Springs!). The Academy authorized the waters anyway, citing the history of therapeutic efficacy. This was an instance in which, Weisz argues, “…the primacy of therapeutic effects over chemical analysis was affirmed.” (406)
Idea for the conclusion of my thesis (in which I plan to briefly speak on why spa therapies did not take off in America): the fact that Eureka Springs did pretty well despite chemical analyses proving no active agents speaks to the weakness of chemical/hydrological science in the US. 

On data collection, which Hamlin also discusses –
“Collecting data, on the model of public health statistics, seemed in fact one of the few ways to ridge the gap between chemistry and therapeutics by permitting the Academy to utilize inspectors’ reports in order to process these two types of knowledge into data that might conceivably show clear relationships between chemical composition and the healing of particular diseases.”
Hamlin details this same process in England; he refers to it as an attempt, in the Baconian vein, to gather voluminous information about something in order to subsequently construct an underlying theory. I wonder if this was going on in America as well, or if chemistry wasn’t well established enough or interested in different kinds of questions than therapeutics or mineral waters? This could also help shed light on the question of why hydrotherapy didn’t do well in America. If its handmaiden, chemistry, wasn’t organized, authoritative or interested enough to provide solid medical legitimacy, especially considering the active role it played in establishing the science of hydrology in France… there’s no way it could compete with other therapeutic systems. 

Weisz argue that the Academy “helped keep hydrology alive as a scientific speciality in the nineteenth century and invested it with whatever prestige the Academy itself possessed. It also produced a body of medical writing that pretty much confirmed the belief in the efficacy of water cures.” (415)
I don’t think hydrotherapy/hydrology/climatology had similar institutional support. This would be a good argument to make at the end of chapter two; cite the differential in university appointments and commmittees in public health and other government bodies that concern mineral water, hydrotherapy, hydrology, climatology, etc. 

“The scientific effort expended on mineral waters…has in the final analysis been most significant because it has made a clear statement that water cures are valuable enough to be the object of such interest by the medical elite. In so doing, it has helped keep this therapy within orthodox medicine (though far from the center), in spite of the fat that it does not conform easily to the dominant models of scientific explanation.” (416)


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