“Kaplıca” (Thermal Spring) From Past to Present

“Kaplıca” is a nice word in Turkish meaning “indoor thermal spring”; it derives from two other words meaning “closed” and “hot spring”. It identifies “districts” or “buildings” where natural hot springs are used especially for health purposes. It exactly corresponds to the word “spa” in English. Yet, the Latin word “thermal”, which is used almost in all languages around the world, gives the same meaning. This word comes from spectacular “thermae” built in all territories ruled by Roman Empire, a world empire; and expresses use of natural hot springs for health and recreation. Ottoman, another world empire, has developed and sustained this tradition of natural hot spring use, and extended it to areas under its rule, like the Romans. Both Roman Baths and Turkish Baths represent typical examples of this use. Thermae of the Romans as well as Kaplıcas of the Ottomans still exists in Asia, Africa, and Europe.

This historical utilization of thermal springs for health purposes, as nowadays expressed by “thermalism” and “thermal medicine” concepts, is being reexamined on the basis of modern evidence-based medicine approach; and scientific evidences on deep rooted empirical benefits of traditional use are rapidly growing in number. Actually; in contrast with England and North Africa countries; thermal treatment has continued being a part of scientific medicine throughout the past century in middle, east, and South Europe countries; and has been considered within partially or fully covered health services network by health insurance policies in these countries. However, In Turkey, thermal medicine could only display limited scientific activity; the Hydroclimatology Chair established in Istanbul University Faculty of Medicine in accordance with Atatürk’s directives, could unfortunately not be increased in number except Gülhane Military Faculty of Medicine, and Gaziosmanpaşa University (Tokat) Faculty of Medicine. A separate section was dedicated to thermal springs, and legal arrangements were identified in the Pubic Health Law, the main health law of Young Republic of Turkey. Standards and specifications with health care personnel were identified in further laws and regulations. Thermal treatments and transportation expenses of patients were financed by both Retirement Fund and Social Security when applied in thermal spring facilities, which were licensed by Ministry of Health in accordance with regulations; and patients were supported by daily allowance. Yet, utilization of social thermal springs remained limited since prevailing understanding of medicine in the second half of 20th century did not support utilization of thermal spring treatment. Still, our people have kept “kaplıca” tradition alive, in innumerable thermal springs in our territory, and numerous facilities, both bare and luxurious, established on these thermal springs. In a calculation, number of people staying in a thermal spring at least 1 night per year counts to 8 million; while number of people sent to thermal spring treatment by medical report for 2 to 3 weeks under the scope of social thermalism, remains at single digit thousands.

The facts that thermal spring treatment mostly involves change of environment; that it allows drawing away from physical, psychological and social stresses of everyday; and that it provides an opportunity for recreation and recovery; have gained thermal spring visits the qualities of a holiday and a touristic phenomenon. In countries like USA, Canada, and England, thermal spring treatment has not been included in the scope of health services covered by insurance. As a result, in these countries, it has been pushed outside fundamental medicine, and considered within alternative medicine practices. Recently, an effort has been developed to replace this lack of use of traditional thermal springs in these countries with a health tourism modality for beauty, aesthetic and care; and a thermal spring/ spa phenomenon has emerged and rapidly grown as a unilateral interpretation of European (Roman-Ottoman) tradition.

Now, the concept of SPA, which can be defined as the acronym for “Salus Per Aquas”, has taken the place of classical thermals connected to thermal water springs. The point here is to gain health with plain water; natural mineral water or thermal water has been replaced by tap water and sometimes with mineral salts or aromatic essences added to this water. Besides, massage, exercise, diet, health training and similar complementary practices, which accompany “kaplıca” experience, have been preserved while adding exotic alternative eastern medicine practices to these. This “modern trend” or “SPA epidemic” originating from North America has taken hold of whole Europe including our country.

In recent years, in Turkey, “SPA” units in 5 star urban and resort hotels and “talasso” units – derivatives of SPAs where sea water is used- in sea resorts have become almost “sine qua non” accessories. On the other hand, every day a new “thermal” hotel is being added to the “kaplıcas” in our thermal districts most of which are 4-5 star. And unfortunately still a “thermal cure center” could still not be established and started in our country.

Prof. Dr. M. Zeki Karagülle