Spas are an ancient global phenomenon: prehistoric traces are found in Europe, Africa and Asia. The word spa, which likely derives from the eponymous town in present-day Belgium, came into use in the late nineteenth century (before then, one went "to the baths" or "took the waters"), is intended here to mean all the practices relating to mineral springs, sometimes carbonated, sometimes still hot, for reasons of health, rest, spirituality and overall wellness. The water can be drunk, inhaled, gargled, applied to the skin with substances such as mud or seaweed and taken as a bath or shower. Spas drove a major economic, social and cultural phenomenon: tourism. This article examines their development from the eighteenth century to the present.

How can a transatlantic perspective provide a fresh approach to the historiography of spas? First, by shifting the focus away from Europe. National case studies have shown that spas are a driver and marker of contemporary economic and cultural globalization. Second---and this will be the article's leitmotiv—by examining the specificities and international circulation of spa practices.

The globalization of spas

After two centuries of fluctuating uses, several factors brought about the unprecedented growth of spas starting in the eighteenth century. The development of chemical analysis revealed that spring water contained minerals that, it was hoped, could have medicinal properties. Spas fit in with the Enlightenment idea of an ordered natural world created to serve the needs of man. Physicians wrote treatises as never before, both a sign and a driver of their popularity. The practice of "taking the waters" dovetailed with contemporaneous medical discourse: the old medicine based on the humors, the new vitalism (whose theorist, Théophile de Bordeu, was the physician at the Barèges spa) and hygienism. As a treatment, spas did what therapy was expected to do: relieve symptoms or stimulate them the better to obtain a cure.

A new cultural trend bolstered the appeal of some spas: travel for pleasure to rural and mountain settings. Taking the waters offered tourists an opportunity to enjoy scenic, thrilling landscapes. Another key factor was the economic opportunity that private owners and public officials saw in mineral springs, spurring the construction of accommodations and access infrastructure based on the models of Bath and Spa. All of these aspects led to the brisk growth of spa towns in Europe, from Karlsbad to Bagnères-de-Bigorre, Wiesbaden, Aix-en-Savoie and Vichy, as well as across the Atlantic.

While colonization was an essential factor in the growth of spas, it would be unwise to see them through a Eurocentric lens: indigenous populations frequented mineral springs independently of colonial influence. They were tools of colonial domination in the areas ruled by Spain, Portugal, France and Great Britain. In Guadeloupe, for example, from the beginning of the modern era to the twentieth century, white residents fled the lowlands to springs in the Basse-Terre mountains (Camp-Jacob, Ravine-Chaude, Dolé-les-Bains) to escape the tropical heat, which was deemed unhealthy. Colonial officials and Europeans in general sought out the waters for their reinvigorating properties, but also to ward off dysentery, yellow fever and malaria. Spa towns were replicas of France in the tropics; they manufactured familiar places in "exotic" settings. Colonial resorts also had a role in reaffirming the cultural identity of Europeans in places where they were outsiders.

This was a global phenomenon. Whites began using South Africa's many hot springs in the late eighteenth century. Shortly before then, the Portuguese had discovered springs in Brazil where people of European origin sought medicinal relief for their ailments. In Cuba, a Spanish colony until 1898, spas such as Ciego Montero and San Diego de los Baños were patterned after models in the French and English colonies as key places of healing, emotional sustenance and cultural renewal.

Mineral springs played a role in both colonial domination (diseases ravaged Spanish soldiers) and economic development (in 1862, Cuba's captain general set up a committee to improve the facilities at San Diego). The idea of "racial preservation" was espoused in the United States before the Civil War. Virginia's hot springs were segregated spaces of regeneration for whites.

Specific national and regional trajectories

The United Kingdom, the birthplace of modern tourism, went its own way. The British took the practice of taking the waters with them wherever they established their dominion. At home, in the eighteenth century, Bath became the first spa town to host tens of thousands of visitors. After peaking during the Napoleonic period, when traveling to the continent was impossible, English spas seem to have stalled just as the phenomenon was growing in the rest of the world. A shift took place in the early nineteenth century: Bath became a place of rest, refuge and regeneration as its function as a hot springs resort faded. During the long nineteenth century, seaside tourism grew more popular with ordinary people as the continent and the rest of the world exerted a much stronger power of attraction on British elites.

Thermal springs in metropolitan Spain are concentrated in the Pyrenees and along the Atlantic coast. In contrast with France, growth was late in coming—although, like in its Northern neighbor, the earliest records and public edifices date from the last third of the eighteenth century: the establishment in Caldas de Oviedo (Asturias) was built in 1773. While Spain exerted a romantic fascination, it was hard to reach and, from 1808, rocked by political turmoil. Spas did not come into their own until political stability returned in 1874. However, despite their modest scale, they brought tourism to the country and laid the groundwork for its brisk growth in the twentieth century.

In Mexico, severe instability across the nineteenth century—independence struggles, war with the United States and French intervention—also hindered the development of spas. Moreover, Mexico seems to have gone its own way: visitors used public baths more for hygienic than therapeutic purposes. The Aguascalientes spa resulted from urban growth and not the other way around, as in Europe, where they became the century's leading tourist destinations. A strategy to attract visitors was also implemented. The Ojocaliente baths opened in 1831 as a place of leisure for visitors to a large fair created in 1828. The case of Aguascalientes also lays bare the tensions that arose from the privatization of springs that had been public property. That friction could be found around the world.

In the United States, many springs that had been located during the colonial period were commercially exploited in the nineteenth century. Local tycoons who had made fortunes in logging or owned large estates built hotels. Hot Springs, Arkansas, "The American Spa", became the first federal reserve in 1832, a precursor of the national park system. In Saratoga Springs, New York, the water was bottled and bathing facilities were built in the 1800s. White Sulphur Springs, West Virginia, which Euro-Americans began using in 1778, became known as "Queen of the Watering Places". A social whirl very similar to that found in European spa towns emerged amidst mineral-water bottling plants.

Spa-goers and tourists

Two factors can be said to distinguish contemporary spas: their development as an industry and the growth of medical intermediation. From being used freely, or guided by local customs, they came under the domination of market forces and physicians.

Mineral springs had been frequented by the ancient Romans, then the Muslims around the Mediterranean, of course, and well beyond. The Late Middle Ages coincided with the use of thermal waters by the elite under medical supervision. French aristocrats frequented them in the Pyrenees, which received an additional boost from the development of firearms: their sulfurous waters were used to heal gunshot wounds. Before and after, rural populations continuously bathed in the thermal pools for their restorative and medicinal properties, despite Christian abhorrence of the practice. While the attraction seems almost universal, uses depended on culture. Native Americans frequented mineral springs before the Europeans arrived. In the Canadian Rockies, they used the waters at Radium Hot Spring until an investor privatized them in 1890. In sixteenth-century Mexico, the Spanish reported that indigenous people bathed in hot springs on a daily basis, while the European custom was to take them as a cure. In Argentina, the Indians bathed in springs and sea water long before the Europeans arrived. In Cuba, there are more or less legendary accounts of slaves who were healed by the waters. In what was to become the United States, indigenous peoples indicated the existence of places such as Saratoga Springs to the British. The rise of "modern" spas led to the regulation of uses to discriminate between places and the people who went there. The use of springs by elites and colonizers was superimposed on the practices of indigenous peoples, Blacks and Creoles.

A people's history of spas focusing more on Africa and populations of more modest means on every continent undoubtedly has yet to be written. In Europe, the Germanic states and France guaranteed access of the poor to springs, a legacy of the Ancien Régime. In theory, spas were required to host them free of charge, with communes and departments taking care of travel and accommodation expenses. But in practice, the disadvantaged were barred from the main resorts during the summer season or, at least, during peak hours, to keep them from being seen by the paying leisured classes. For a while, Napoleon reserved the baths in Amélie and Barèges in the Pyrenees for his convalescing soldiers before being overwhelmed by events in Spain. As in France, in Spain, military, in particular colonial, needs sharpened the State's interest in baths. In 1787, a royal ordinance gave the army the possibility of paying the full cost of their cures.

After being more or less banned from spas, local populations faded into the background as mythological folklore. They were romantic servants in European resorts or Indians in the United States. The memory of indigenous peoples bolstered the imagery of the wildness and naive authenticity of the springs and their surroundings. However, this physical and cultural appropriation should be taken with a grain of salt: many natives, racial and colonial oppression notwithstanding, willingly acted out stereotypes for tourists in order to promote spas and the areas in which they were located.

A history of uses would also be interesting. The Ojocaliente spring (Mexico City, Aguascalientes) had multiple applications, from health to personal and urban hygiene and horticulture. In Ax-les-Thermes (Ariège), the thermal waters traditionally served to treat skin disorders, clear snow from roads, bleach laundry and, it is said, cook food and boil animal carcasses to remove the skin or feathers. They were also used to treat animals. As springs became part of the market economy, medical uses gradually prevailed.

Medicalization led to a paradox. In the nineteenth century, spas for the most part attracted a healthy clientele, to the point where resorts specializing in treating patients were neglected and drew fewer wealthy visitors. In this context, hot springs became focal points for tourist resorts. Thermal waters, resort life and local excursions allowed people to flee the cities' moral and physical degradation, enjoy fresh air and escape the industrialization, political turmoil and social problems that plagued urban areas on both sides of the Atlantic.

Spas set global elites in motion. Reading Casanova's memoirs is all it takes to picture a map of the most fashionable resorts in Enlightenment Europe. The trend gathered speed and became transcontinental in the nineteenth century, when people travelled between countries, colonies and continents to take the waters. An astonishing variety of visitors frequented the leading French spas, from Brazilians to Argentines, Chileans and Mexicans. Every season, tourists from the United States went to Luchon, Cauterets, Vichy and Aix-les-Bains by the hundreds. In the early twentieth century, the Goodyear family traveled to the Pyrenees. The Occitan names of the dozen Latin Americans in Aulus (Ariège) in 1908 suggest that their ranks must have included immigrants returning to France. Resorts were elite meeting places that became increasingly open as the nineteenth century advanced and means of transportation improved, allowing for shorter stays.

Not only tourists but also qualified hotel and casino staff were on the move, including across the Atlantic. For example, professional casino workers crisscrossed the world chasing contracts and seasons. A man born in Luchon was a croupier in early twentieth century Buenos Aires before working in Nice, Vichy, Bagnoles-de-l'Orne, San Sebastian and Monte Carlo. Capital also flowed across borders and oceans (English pounds and French francs to hotels and railroads in Latin America, American dollars to Alpine resorts). French capitalists invested in Spanish casinos, while capital from Marseille spread worldwide in the same field.

Cultural and ecological acclimatation centers

Spa entertainment was mocked for its mediocre quality: Performers cheerfully massacred the musical and theatrical repertoires before indifferent or ignorant audiences. However, these cultural offerings, whose importance grew from the middle of the century with the arrival of monumental casinos, were occasionally glittering events, as in Aix-les-Bains and Vichy in France. The great national theater companies toured the resorts during the summer. Parisian actors, dancers, musicians and singers performed at resorts such as Luchon, where Paris Opera director Pierre Gailhard (1848—1918) was a regular visitor. Every spa, even the most modest ones, had a house orchestra that could range in size from a dozen musicians in Ax-les-Thermes to eighty in Vichy. They played the great repertoire, sometimes the most recent works (Wagner's Tristan and Isolde premiered in France at Aix-les-Bains in 1897) and operettas, and accompanied classical theater and low-brow plays. Well-attended concerts at casinos and bandstands, which were prominent landmarks at the resorts, acclimated spa-goers to new sounds. In 1902, music hall shows were introduced at Aix-les-Bains, where later generations enjoyed jazz and rock. Even casinos at the most ordinary resorts presented these imitative forms of music.

In Europe and the United States, golf, tennis, dances and horseraces occupied the seasons. Daring imports were also attempted, such as bullfights at Vichy, Spa and Luchon in the late nineteenth century. Emerging sports such as cycling, automobile races and flying were presented as shows. In the early twentieth century, European and American mountain resorts introduced winter sports to extend the season. Casinos, the ultimate places of tourist sociability after hotel restaurants and lounges, offered ballrooms, theaters, cafés and gambling. They marked the tourist space, with more or less monumentality and depending on gambling regulations. They were controlled and limited in Europe (in France before 1914, only small horses and baccarat could be played, for example) or banned in England (after 1745), Switzerland and Germany (after 1872), while in the United States popular games like poker and roulette could be played.

Spas were places of ecological exchanges. They imported exotic species. Redwoods were very common in parks and gardens, at least in the Pyrenees, to evoke the American wilderness. In the twentieth century, public and private fishing tourism promotors introduced rainbow and brook trout from North America to European streams, while colonial resorts imported European flora to recreate the climate, scents and vegetation of home—and civilize resorts a little more.

Urban circulation

Urban planners left a common mark on transatlantic spaces. Like ancient cities, the foundation narratives of resorts were more or less shrouded in myth. In North America, stories about the discovery and foundation of each site featured Native Americans cooperating with Europeans. In Europe, origin narratives began in Antiquity and ended with the arrival of an important figure or the decisive act of a director or an enthusiastic entrepreneur, like the dukes of Lorraine in Plombières, the superintendent of Etigny in Luchon, Louis Ramond in Mont-Dore, Louis Bouloumié in Vittel and François Brocard in La Bourboule. In any case, public planning and investment seem to have played a key role in the origins of the leading European resorts.

The urban planning of resort towns was surprisingly similar around the world. In a way, the exploitation of nature's tourist potential led to the reproduction of identical urban sites. Imitation was the rule. French planners drew inspiration from Central European spa towns, which themselves looked towards France, especially Vichy. Spain, where the spa economy finally blossomed in the 1880s and 1890s, imitated the North. Despite Bath's anterior status, England exported tourists but did not become a model in Europe.

In the United States, the references were Victorian. Hot Springs, Arkansas, which was admitted to the Union in 1803, gradually became a spa town. Planners haphazardly aligned visitor accommodations along a street in the hollow of the valley. From 1870, the state tried to rationalize the springs' exploitation as well as urban planning and architectural themes. After an 1878 fire, architects rebuilding the city borrowed from the eclectic vocabulary of European resorts. Majestic buildings in brick, stone and marble replaced wooden ones. Between 1900 and 1920, Hot Springs became a real spa town with the hotels, mansions, thermal baths, a park, an artificial lake and promenades characteristic of European resorts set in nature.

In Saratoga Springs, New York, grand hotels rose in the first half of the nineteenth century. By 1849, they could accommodate 40,000 people, on a par with the highest European figures. While most of the buildings were cheaply constructed of wood, they featured European-inspired decorative details.

Latin America's spa towns imitated European models, the ultimate embodiment of the holiday resort. While Cuba adopted the Spanish model, in Argentina the resorts that sprang up in the late nineteenth century followed a British pattern. This was a consequence of the informal empire, in particular the funding of railway companies by English capital. Immigrants from Spain, France, the United Kingdom, Germany, Switzerland and Italy undoubtedly spread and maintained the practice of taking the waters in the New World. In Brazil, most spas began growing in the early twentieth century. Cities like Poços de Caldas (Minas Gerais) were founded whose urban planning, financed by private capital, drew inspiration from the great European resorts, especially Vichy, Baden-Baden, Aix-les-Bains, Luchon and Montecatini.

Everywhere, railways spurred the growth of spas. Banff sprang up from the building of the Canadian Pacific Railway. In Great Britain, railways reached coastal areas before spa towns, which led to their decline and fostered the democratization of seaside resorts in the industrial Northwest as early as the 1870s. Later, the automobile put more sites within easy reach, sometimes at the expense of spas, which fell out of favor with tourists.

A sufficiently descriptive and general pattern appertaining to all the urban forms of spa towns on both sides of the Atlantic could be identified: waters flowing through pre-existing cities where spa activities developed alongside others; waters flowing near the town, polarizing new districts with a tourist function; and waters flowing through the countryside giving rise to new towns, sometimes limited to a spa hotel. However, each country had its own specific features: for example, spas in remote rural areas were nearly non-existent in Great Britain, where the few known cases were unsuccessful.

On both sides of the Atlantic, spas spread through imitation and colonial development. They were manifestations of cultural globalization and its local offshoots, even in valleys perceived from the outside as cut off from the world and enjoyed for that reason.

Twentieth-century divergences

American troops were stationed at French spas during the First World War, attesting to the fact that they were still held in high regard.

However, cracks in the medical credibility of hot springs began to appear. In the nineteenth century, they were expected to treat and even cure many ailments, from rheumatism to cancer, rashes, digestive disorders, venereal diseases, malaria and tuberculosis. Medical advances, especially the discovery in France and Germany of bacteria as a cause of disease in the 1870s and 1880s, posed a serious challenge. Antiseptics like Dankin's solution could disinfect open wounds and prevent gangrene. The discovery of vaccines for illnesses like tuberculosis, the progress of medical science and the growth of the pharmaceutical industry from the 1910s onwards offered spa treatments stiff competition. In the 1940s, the mass production of penicillin jeopardized the role of sanatoriums and spas in the treatment of infectious diseases. Medical spas gradually lost their relevance, their markets and much of their credibility. The rise of seaside bathing and tanning, which accelerated between the wars, also contributed to the spa towns' dwindling appeal to tourists.

They reacted in various ways. Responding to medical progress, technological treatments arose in the nineteenth century. Electricity, massages, showers, inhalations, vibrations and radioactivity were introduced. Before 1914, some major resorts cared little about keeping visitors' loyalty because they had diversified their tourist offerings. The falling numbers of spa-goers were offset by a surge of tourists who no longer came for the waters. Elsewhere, sometimes precociously, spa towns broke their dependency on the springs by branching out into other commercial, residential or industrial activities (Bath and Harrogate in England, Bagnères-de-Bigorre in France). Another line of attack, which gathered momentum after 1945, was to focus on chronic ailments, such as certain skin, respiratory, digestive and rheumatoid diseases that medicine was unable to treat. After the diversification of tourism, medical specialization began to emerge, with resorts imposing rigorous therapeutic regimens. The shift was sometimes made early, such as in Battle Creek, Michigan, which in 1876 turned to medicalization, sanatoriums and strict diets under the direction of John Harvey Kellogg. Some spas forged partnerships with cosmetics companies to develop products that combine the waters' natural properties with advances in chemistry. A prominent example of this trend is Vichy's collaboration with L'Oréal.

As differences grew more important than convergences on the transatlantic scale, a common pattern emerged: governments became more directly involved in the twentieth century. In the nineteenth, European States intervened by implementing regulations: medical inspections to monitor the waters for uses, discipline and cleanliness (1785 in France, 1816 in Spain, 1818 in Portugal and Brazil); rules on accommodation of the poor; administrative directives; a gambling law (1907 in France); and a spa tax, first in the German States, then France (1910). In the twentieth century, systematic bacteriological testing became mandatory. The American states intervened even more directly, monitoring thermal resources deemed strategic, despite their decline. In the early twentieth century, the State of New York began buying up springs in Saratoga Springs to rationalize their use. Governor Franklin D. Roosevelt fervently promoted the springs, and after becoming president a spa complex was built under the auspices of his New Deal Works Progress Administration (WPA). The Canadian government acquired Radium Hot Springs in the early twentieth century. In Chile, the State nationalized tourism in 1930 and made beaches, mountains, snow and spas (especially in Jahuel) points of attraction in the context of an emerging Latin American rivalry to attract visitors.

From the 1930s to the 1980s, spa towns seemed to be declining almost everywhere. In the United States, the number of springs commercially exploited as spas or for bottled mineral water fell from 2,000 in 1930 to 500 in the late twentieth century. Saratoga Springs fared better than others. In the 1960s, the decision was made to focus on wellbeing packages and to build a performing arts center (1966) that became the summer residence of the Philadelphia Orchestra and the New York City Ballet. Hot Springs declined steeply until the 1980s, with spas closing one after another, but in the late 1990s, deluxe hotels offering in-house spas, entertainment, aquariums and trips to local farms marked a fresh start. In 2010, Hot Springs even produced the first beer made with spa water. The resort updated its image, with the result that the accommodation occupation rate has risen from 10% in the 1980s to 90% today. The city's charming architecture is a major draw.¹ Elsewhere, niche markets such as anti-aging, anti-stress and weight-loss treatments sometimes gave spas a new lease on life. In the 1950s, seaside resorts in Brazil became more popular than spas, which at first were frequented by the elite, but that did not prevent some of them from expanding. Caldas Novas, whose first master plan was drawn up in 1910, has boomed since the 1960s. The world's largest spa, it also became the most popular after introducing festive activities that now attract more visitors than the springs.

Once discredited by medical progress, spas received a boost from the rising popularity of "natural" medicine in the late twentieth and early twenty-first centuries. In 1986, the WHO recognized the therapeutic value of spas as an accompaniment to treatments and convalescence. Wellness and recreational activities began to grow. South American countries promoted their spas within the more general framework of health tourism, which has risen by over 10% since the 1980s and attract guests from the Northern countries, reversing the flow seen in the previous century. Spas are presented as an alternative to mass beach tourism offering more genuine contact with nature. In the 1990s, Costa Rica began promoting its spas to break into the high-end sustainable tourism market. Echoing, in a way, what had happened elsewhere in the nineteenth century, spas were marked by architecturally eclectic buildings and foreign influences, from landscaping to parks, waterfalls, lakes and hiking trails. They became recreational resorts life rather than healthcare facilities.

France was somewhat out of step with the global trend. From 1947 until the 1980s, the country's social health insurance system reimbursed cures, ensuring a prosperous period but also creating a strong dependence on policies for the insured, who accounted for over 90% of the clientele. It also meant that doctors were instrumental in running spas, which impeded diversification. In the 1980s and 1990s, French spas lagged far behind those of other countries in making the shift to recreational resorts, just as medical demand began to stagnate and decline because of an ageing clientele, fewer prescriptions and shrinking therapeutic markets due to competition from pharmaceutical companies. Anxious to maintain the waters' medical credibility, physicians frowned upon the development of leisure and wellness activities, which moreover could provide grist for an old criticism: spa cures were vacations in disguise at the public's expense. Therefore, the leading resorts were slow to focus on wellness activities, while after 1945, spas in Germany and Italy were the first to introduce them. Spa treatments were portrayed as a therapeutic supplement rather than an alternative to conventional medicine.

A new movement has emerged in recent decades: spas as architectural and historical heritage. They highlight specific places yet attest to cultural and economic globalization. Bath, the first spa town, which fell into decline in the nineteenth century and saw its baths close in the 1960s, began preserving and promoting its heritage in the 1970s. In 1974, the Hot Springs spa district was placed on the National Register of Historic Places. Saratoga Springs served as the model for a hotel with an in-house spa at Disneyworld in Orlando, Florida. In France, the process has run less smoothly. The preservation and conservation of heritage conflicts with the need to update tourist, hotel and medical infrastructure. In Luchon, the first purpose-built guest accomodation was designated an official historic site in 1927,. Etigny's lanes followed in 1947, but the other buildings, including the baths that opened in 1852, did not receive protected status until the 1970s. In Auvergne, the process did not begin until the late 1990s, when planners conducted a survey and developed an itinerary called the "Route des villes d'eaux du Massif central" ("The Road of Massif Central Spa Towns"). This long-overlooked built heritage has become a tourism diversification tool. Promoting heritage to create a brand image: the "Route des villes d'eaux du Massif central"

The heritage movement reached its peak when UNESCO placed a network of eleven European spa towns on its World Heritage List in 2021. Together they illustrate a model of elite excellence that spread on both sides of the Atlantic, but they do not reflect the variety of places and spa practices.

As John Walton wrote, spas are "an important but neglected set of phenomena with global reach but local traditions and manifestations".² Tourism and spas were a part of the industrial revolutions and a form of cultural globalization. Their history is marked by constant tensions arising from harnessing the springs as well as conflict between their medical and recreational uses. Today they are alive and well. Brazil even launched a reimbursement program in 2006. But the rise of recreational centers and leisure resorts is diminishing their specific features. Today, they include many hotel amenities that no longer have anything to do with thermal waters. After privatization and medicalization, banalization and artificialization may be two of the greatest threats to natural spas.