Healthy in body, healthy in mind (Greek)
Philosophical words that do nothing for suffering and medicines that do not cure disease are useless. A bath is good for you, Salvom Lavisse (Roman)

Herein, we focus on health tourism and health spa history in Opatija a fishing village, that awoke, from three and a half centuries of slumber, without much ado, like in a fairy tale. In the 19th century, and throughout Europe, hydrotherapy and thermalism regained popularity when the therapeutic benefits of baths and bathing and their chemical contents became widely known. Straddling the 19th and 20th century, health tourism unfolded along the superb shores of the Adriatic coastline. The coalescence of natural sea resources, the commercial interests of the Viennese medical profession and a profitable investment in the South Railways Company (SRC) brought rapid development. In 1885, the SRC organised a Congress of Balneologists a word derived from Greek. [1]

By 1889, Opatija’s climate sanatorium on the Austrian Riviera stood easily, side by side with other popular European spa towns (Karlovy Vari, Biarritz, Cannes, Nice). Some of the Monarchy's most eminent physicians opened their sanatoriums in Opatija and numerous promenades and bathing places were built. From all over Central Europe, physicians opened offices from autumn to spring. Heath laboratories, technology and medical treatments received a boost from neurologists, dermatologists, dentists, internists and rhinolaryngologists. In 1904 there were 23.223 tourist visits; wealthy but sickly visitors that contributed significantly to the wealth of the town. Spa luxury was assured by the sponsorship of the SRC, support from prestigious Viennese medicine and as a result of Royal connections.

Now on that same Adriatic coast, a Pharmaco-Economics Conference is promoted by the European Center for Peace and Development (ECPD), Belgrade (2013-2018). It came as quite a surprise to learn that its activities in Istria reflect the pattern of activities of the Austrian Society of Balneologists in Opatija (1904, 1908).

On the sidelines of pharmacoeconomics, 2017, a spontaneous activity erupted in and out of Hotel Milenij with Klaus-Dirk Henke (Germany) and Branka, Legetic (Serbia) to take on a life of its own. [2] Our aims? Awareness raising with respect to the complex world of medications and patient drug costs, facilitation of an interaction of scientific experience between the Balkan region and other countries and a means of promoting this activity of the ECPD. Another common denominator bridging 1904 and 2018 is marketing.

In 1904, Balneologist participants were transported from Vienna by special train to follow discussions on tuberculosis, malaria and heart disease. Representatives of 25 pharmaceutical companies some alive and well today partook of a grand social programme. Sufferers from a rich diet and lazy lifestyle came to cure their gout.

Between the lines, Railways and Medicine pursued business interests, maximum investment returns for wealthy shareholders and influence gain at the highest level. On the sidelines, public health of rail and shipping were being developed. It was a case of spa comfort for the well heeled, dread for the consumptive and nothing for the poor.

Opatija became a glamorous health resort of international fame provoking inspiration from trembling leaves, lonely Emperor romance with an actress and the anguish of a lost King as well as Opatija’s stormy sea shot for a Lumière brothers' movie, 1898. Its most appreciated guest was “Love” an historical echo perhaps of a Liburnian goddess of love, health and fertility, or was it Apollo? Chekhov (1894), Joyce, Mahler (1900) and Puccini came. Isadora Duncan came (1902) and danced and my favourite tenor Benjamino Gigli came and gave a concert on Opatija’s Summer Stage (1934). North of Opatija in Visegrad another medicinal spa with radioactive waters (radon) cured barrenness, which, without a visit here, to say her incantations, she never could have wed, or bred with much head shaking in the village.

Anton Chekhov was summoned by Ariadne. He characterized Opatija both as an earthly paradise and a filthy little Slav town with only one stinking street. At some point he bought pears. He visited parks, wandered streets, observed life and listened to brass band music. Having spat blood for 20 years, one character in the Seagull says, You’re sixty years old. Medicine won't help. There were no drugs for tuberculosis then.

Anton and I arrived to Opatija on a bright warm day separated by more than a century. I arrived in a crowded minibus from Belgrade nowhere as grand as when the participants of the 4th Balneology Congress came. It was after rain for Chekhov, rain drops still hanging on the trees, glistening on the residence where Ariadne and Lubkov were living, but they were out.

Healthy in body, healthy in mind was a philosophical gold standard in ancient Greece. Restoration of health was possible in Asclepieia where Asclepios taught medicine. His daughter the goddess Hygiene is the symbol of public health while his student Hippocrates, father of western medicine introduced hydrotherapy. In 33 B.C. Agippa built thermae in Rome, which spread throughout space and time to later influence the Turkish Hamam.

Early in the Bronze Age, health was pursued in places where natural mineral waters sprang. Urban planners pursued advanced civil engineering projects; construction of wells, cisterns and bathing areas in Ancient Egypt, Crete, Mesopotamia and civilisations of the Indus Valley. Some of the first springs of healing were referred to as Aquae Balissae. The Slavs named the Teplá, the warm river, since even in the harshest of winters, it did not freeze. In the late Middle Ages a health resort grew up around a natural spring at Espa, indicating a fountain in Walloon. Later it became Spa, a town in Belgium symbolic of health through water. It was made more chicque-chichi, romantic and marketable with the label, Salud Per Aqua (SPA). Toplice, is the word used for spa in Istria.

With the arrival of rail and the recognition of the high market value of leisure time, Well Being Centers sprang into life. The down side was acid rain also an outcome of the industrial revolution and a phrase first coined together with the title of climatologist about 1850. Even then climate damage was in the mind of the enlightened.

John Capodistria the first Governor of modern Greece commissioned an analysis of thermal spring water and the first positive findings were provided in 1835 by the personal Bavarian pharmacist to King Otto. A decade later, Queen Amalia popularised such sites, with Loutraki being one of the most popular, organised in the 1850’s. According to Xenophon the location was used by battle weary Spartan soldiers for their reinvigoration.

Friedrich Julius Schüler, managing director of Southern Rail introduced tourist marketing, invited Viennese doctors to the Adriatic coast and built sanatoria. Doctor, Professor Julius Glax a business oriented Viennese doctor with royal connections became head physician of Southern Railway’s sanatoria. His considerable personal experience was gained in Slovenia (Rogaška Slatina) and his recommendations for reform were well received in the world of financiers and economists. Public health: sanitation of carriages, sleeping cars and tracks became a growing concern, in parallel to resort hygiene, clean drinking water, organised pharmacies with facilities for the incineration of drugs and isolation for infectious diseases. Chemical-bacteriological institutes and metrological observatories were developed. Much credit goes to Dr. Glax and his insight to designate Opatija as a health resort of excellence.

Glaxa street of staircase design climbs towards a Promenade or Setaliste Carmen Sylve, in honor of a royal poetess. It reminds us that Royalty and the famous once patronised Opatija. A memorial plaque placed on the building where medicine was practiced by Dr. Julius Glax reminds us of the prestige of Austrian medicine and such names as Semmelweise, Theodor Billroth and Virchow who was enchanted by Opatija’s vegetation. A mark of distinction is given to Glax by his mention in the Austrian bibliographic lexicon.

In 1938, Opatija lost its status of a climate and sea health resort and was relegated to a third category luogo di cura. On Marshal Tito Street, the Tourist Board now proclaims it, a renowned wellness center and a romantic place. The sculpture, Girl with a Seagull was unveiled in 1956, more than half a century after Chekhov’s death in Badenweiler, a spa town in Germany (1904). His last act was to drink a glass of champagne.

Anton Chekhov doctor and man of public health helped the hungry and those with cholera, even as he himself suffered the symptoms of tuberculosis. He would have liked to build a sanatorium for aging village schoolteachers. Chekhov’s believed that the poor required services to prevent multiple hospitalisation and he was committed to humanity’s right to health.

Chekhov would make a great contribution to our Vth pharmaco-economics conference later this year, 2018. I am hopeful that this thought will add prestige. In my mind’s eye I can imagine him walking into the conference to greet our participants.

Not knowing what he would say to our distinguished participants and facilitators let me recall another Chekhov character that looking out onto the cherry orchard sees her dead mother. Hallucination no, just a snapshot taken by the brain, a cognitive contour perhaps that suspends her momentarily, between one reality and another. The illusion resulted from an interaction between a visual sensory impression and her memory; in this case, cherry blossom and a white dress. Our world is a universe of dichotomy; prevention v therapy; inequality and great riches suspended between enormous wellbeing and political ineptitude; pulling down of the public to promote the private. Chekhov’s had a vision of disappearing forests, dried up rivers, extinct wild life and a ruined climate with lands growing poorer and uglier in the clear sight of health for all. But then life was never a full bowl of cherries for the many.

Opatija’s heyday was an outcome of latent heat and the industrial revolution, the emergence of public health; bacteriology, state policy and a several fold growth in income in Europe with the Balkans lagging behind. Wealthy tuberculosis sufferer could afford comfort in sunny and mild climates near the sea or clean air in mountain sanatoria. The poor today, are oblivious of Davos as they struggle to care for children in unventilated, dark, and damp rooms which brings unavoidable early death. Population vulnerability is growing and TB remains a public health priority; each year nine million fall ill and 1.5 million die. Today, we have several first line drugs, about 20 in all but we also have unsettling drug resistance. The road ahead is long and we are only at the beginning.

Notes:
[1] Balneology is the study of the therapeutic uses of various types of bathing or hydrotherapy as a complementary medicine and branch of medical science concerned with the therapeutic value of baths, especially those taken with natural mineral waters. [2] ECPD Pharmacoeconomics conference (2013-18). Two digests Sweet and bitter pill and Taking our Medicine, have been recorded ahead of the next conference 28-29 September, Hotel Milenij, Opatija, and Specialist Seminar relating to alternative medicine; Medicinal Plants, Phytotherapy and Aromatherapy and Predictive Homeopathy. Thanks go to Amela Mujic.

References
Lund, John W. (1996). Balneological Use of Thermal and Mineral Waters in the USA, Geothermics, Vol. 25, No. 1, Pergamon, Elsevier Science, Ltd., Great Britain, pp. 103-147.
Rockel, I. (1986). Taking the Waters - Early Spas in New Zealand, Government Printing Office Publishing, Wellington, 195 p.
Sarnoff, P. M. (1989). The Ultimate Spa Book, Warner Books, New York, 276 p.
Many interesting articles have appeared in Acta Med Hist Adriat. 2007, 2011, 2012, 2017 some under the pens of Fischinger A, Fischinger B, Fischinger D. Fischinger.
Vladislav Bajac. Hamam Balkania, Geopoetika Publishing, 2009
Muzur A. Thalassotherapy in Opatija: A century and a half long tradition and a century of an institution. Acta med-hist Adriat. 2006; 4(1); 9-12.
A compendium in Croatian containing a wealth of information.