Problems with classification of spa waters used in balneology

doi:10.4236/health.2010.211187

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Vol.2, No.11, 1260-1263 (2010)

doi:10.4236/health.2010.211187

Health

Problems with classification of spa waters used in

balneology

Csaba Varga

Department of Environmental Health, University of Pécs, Pécs, Hungary; [email protected].

Received 14 September 2010; revised 25 September 2010; accepted 30 September 2010.

ABSTRACT

Recently, several measurements have indicated

the presence of biologically active organic mi-

cropollutants or trace components in different

types of waters, including spa and medicinal

waters. The wide spectrum and abundance of

organic components of spa waters in the Car-

pathian basin and other European regions has

been demonstrated by gas-chromatographic ana-

lyses. These components may have main role in

the therapeutic and preventive mechanisms.

Considering the new analytical data, traditional

European classification of spa waters based on

the quality and quantity of inorganic ions (salts)

should be reevaluated. The association of inor-

ganic components and the therapeutic effects is

also necessary to reconsider.

Keywords: Spa Water; Medicinal Water;

Classification; Organic Compounds; Balneotherapy;

Prevention

1. INTRODUCTION AND AN

HISTORICAL BACKGROUND

Therapeutic use of spa (thermal) waters has been a

part of the cultural and medical traditions of the Euro-

pean and especially the Central European (CE) nations.

Frequent visits of middle-class people and the aristoc-

racy at the famous spas were social events, as well. That

is why successor countries of the former German Empire,

Italy and Austro-Hungarian Monarchy have preserved

this unique culture and their scientists are overrepresented

in balneological science and mineral water chemistry,

even today.

In spite of the expansive research, we are not aware of

the exact mode of action of the different spa waters. Only

few countries have specific regulations or acts in this

field. Based upon the regulations of CE countries (e.g.

Hungary, Slovakia, and Romania) a simple analytical

study is enough for qualification as “mineral water” [1-

3]. However, medical observation is also needed for qua-

lification as “medicinal water”, that is, a specific thera-

peutic effect should be proved in a comparative study, by

using treated and placebo groups of patients [3-5]. Its

exact way is to perform a double or triple blind (inter-

ventional) epidemiological study [6-8]. In brief: the law

in the CE countries declares that medicinal waters should

be mineral waters, but mineral waters are not definitely

medicinal ones.

2. INORGANIC COMPOUNDS

The effects of spa waters were already well-known in

the 16th century [9]. At the turn of the 20th century, a

series of scientific books mapped the most important

spas in the Carpathian Basin (Hungarian Kingdom) from

the Highland (recently Slovakia) to Transylvania (recently

Romania) from point of view of geology, chemistry and

therapeutic effects [10,11]. The inorganic analysis of wa-

ters has been performed accurately since the 18th-19th

centuries, therefore their medical effects have also been

tried to explain with the salt content. Traditionally, me-

dicinal (or healing) waters in the European literature are

categorized into the following groups [12,13] indicated

in Table 1.

The healing effects of balneotherapy in wide range of

diseases are well described [14], however, exact mecha-

nism of the healing spa cure is completely unknown, at

least its relationship to the presence of certain chemical

ingredients. The well-known physical (thermal, mecha-

nical) features affect the circulation and locomotor or-

gans (disorders). But same effects can also be detected

using simple hot water as a consequence of the similar

hydrostatic and thermal circumstances.

The chemical effects may be caused by the substances

forming real aqueous solutions or colloidal systems.

Their absorption takes place through the skin, or in case

of volatiles, by inhalation. The classical theory tries to

explain the therapeutic efficiency exclusively with the

presence of inorganic ions (salts) and gases. That is why

C. Varga / HEALTH 2 (2010) 1260-1263

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Openly accessible at

Table 1. Classification of medicinal waters (modified Papp’s

system).

Category Main features

Simple thermal waters  25℃

Simple acidic (carbonized)

waters  1 g/L free CO2

Alkaline (Na-K-bicarbonated)

waters

 1 g/L total dissolved solid,

dominant anion: HCO3-

Ca-Mg-bicarbonated waters

 1 g/L total dissolved solid,

dominant cations: Ca2+, Mg2+

dominant anion: HCO3-

Chloridated (saline) waters

 1 g/L total dissolved solid,

dominant cation: Na+

dominant anion: Cl-

Ironic (ferrous) waters  10 mg/L Fe2+ or Fe3+

Sulphuric waters Total sulphur  1mg/L (HS- or

S2O32- or S2- or H2S)

Sulphated waters  1 g/L total dissolved solid,

dominant anion: SO42-

Iodated-bromidated waters  1 mg/L I- or  5 mg/L Br-

Radioactive waters Radon or toron content

the presently used classification of spa waters are based

on the inorganic contents.

3. FACTS AND ARGUMENTS FOR THE

POSSIBLE ROLE OF ORGANICS

The basic problem of balneology (balneotherapy, bal-

neoprevention) can be outlined with a simple formal lo-

gical approach. If A contains B too (that is the spa water

contains salts too) and A cures C (that is water is effec-

tive in some diseases), it does not mean that B cures C.

Therefore not definitely the salts which are effective in

the water, since other components are (may be) also pre-

sent in it, not just salts. In this study we try to collect the

direct and indirect evidences for an unconventional ex-

planation on the mode of action of spa waters used in pre-

vention and therapy.

3.1. Why Medical Trial is Necessary for

Qualification of Spa Water as

“Medicinal Water”?

Because, the exact inorganic analytical study cannot

predict the therapeutic efficiency. We have no exact data

whether redissolution of the total salt content in distilled

water can recover the therapeutic effects. Sometimes, even

the complete redissolution of salts is impossible without

residuals.

3.2. All Known Medicinal Water Contain

Organic Fraction

Results of science and practice of organic water analy-

tics cannot be neglected by balneology, either. Recently,

several measurements have indicated the presence of bio-

logically active organic micropollutants or trace compo-

nents in different types of waters, especially in disin-

fected drinking waters [15,16]. Observed concentrations

are very low: pg/L, ng/L or μg/L, but biologically active

compounds may have stochastic effects without thresh-

old dose. The wide range of organic components of spa

waters in the Carpathian Basin [17] and other European

regions [18,19] is also demonstrated by the state-of-art

analytical methods. Hot spring or deep artesian well wa-

ters may contain many identified and unidentified com-

pounds from the simple aliphatic through the simple aro-

matic hydrocarbons to the heteroaromatics and sophisti-

cated polycyclic aromatic compounds. A simple gas-chro-

matogram can characterize the unique spa water or its

springs and wells, like a fingerprint [20-22] (Figure 1).

These components either may have main role in the

therapeutic mechanism or/and probable toxicity [23].

3.3. Biological Activities

Even biological activities of the single aquatic organic

compounds are not known, but we are not aware of their

possible interactions, in particular. At least one biologi-

cally active organic compound has, however, been well-

known for a long while. Water and mud of some Hun-

Figure 1. Gas-chromatogram of a drinking water sample (up)

and a Hungarian medicinal water sample (Hajdúszoboszló)

(down). (Etanol extraction, temperature programming, FID).

C. Varga / HEALTH 2 (2010) 1260-1263

1262

Openly accessible at

garian spas contain natural estrogens of geochemical ori-

gin and are highly effective in gynecological postopera-

tive states and disorders [12]. In this case, salt quality and

concentration is probably indifferent.

3.4. Dissolution and Absorption

Organic fraction can also promote dissolution of inor-

ganic compounds and their absorption into the human

body. Therefore, modeling of absorption using inorganic

isotopes alone is not valid if the organic complexes pro-

mote this process.

3.5. Blood Analyses

Chemical analysis of patients’ blood samples for the 4

main cations could not show any evidence of absorption

during bathing in spa waters. A Hungarian study suggests

that the main inorganic cations (Na+, K+, Ca2+, Mg2+)

cannot have any effect, if they are absorbed at all, be-

cause their concentrations in the human body is higher

with several order of magnitude [24].

3.6. Mode of Action

Organic fractions of medicinal waters may have cru-

cial issue in the mode of action. Considering the new ana-

lytical data, traditional classification of spa waters based

upon the quality and quantity of inorganic ions (salts)

should be revaluated. The relationship of inorganic com-

ponents and the therapeutic effects is also necessary to

reconsider, excepting some specific waters used in drink-

ing cures (sulphated, alkaline, fluoridated, iodated waters).

3.7. Importance of Inorganic Analyses

The presence of the inorganic components and not least

the pH, however, can strongly affect the hydrophilic and

hydrophobic characteristics of organics, inhibiting or pro-

moting the absorption. Therefore inorganic analyses are

also crucial in assessment of the possible effects.

4. CONCLUSION

Spa (medicinal) waters should be reclassified in the

scientific literature related to their therapeutic and pre-

ventive characteristics. The new categories should also

be based upon the state-of-art methodological armament

of water analytics and therapeutic evidences, meeting

requirements of the 21st century. At present, we have li-

mited data to establish such a new system due to the lack

of organic analyses. Complete set of data needs to be re-

gistered in case of medicinal waters, involving determi-

nation of all chemical (inorganic and organic), geo-phy-

sical, hydrobiological, microbiological and toxicological

parameters, representing the particular medicinal water.

Quality assurance of therapeutic elements should also be

in close correlation with the parameters mentioned above.

On the other hand, a new logical possibility should be

ruled. Namely, if the therapeutic efficiency of particular

water is caused by organic compound(s), mineral content

as a necessary condition is not a valid parameter for

“medicinal water” qualification [25,26]. The chance for

the absence of the necessary salt concentration—re-

quired by the acts—in medicinal waters is actually very

little, but cannot be excluded theoretically. This logical

conclusion should be accepted by the regulatory authori-

ties, as well.

5. ACKNOWLEDGEMENT

This work was supported by the Faculty of Medicine, University of

Pécs (grant No. 34039).

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