THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY Volume 20, Number 7, 2014, pp. 521–526 Paradigms ª Mary Ann Liebert, Inc. DOI: 10.1089/acm.2013.0423

The Legacy of : Linking Wellness, Naturopathic, and Allopathic Medicine

Cornelia Locher, PhD,1 and Christof Pforr, PhD2

Abstract

Sebastian Kneipp (1821–1897) is seen as a vital link between the European nature cure movement of the 19th century and American . He promoted a holistic treatment concept founded on five pillars: hydro- and phytotherapy, exercise, balanced nutrition, and regulative therapy. Kneipp attempted to bridge the gap with allopathic medicine, and many modern treatments that are based on his methods indeed blend wellness elements with naturopathic medicine and biomedicine. Because Kneipp’s approach to health and healing today are mainly covered in German literature, this paper aims to provide a broader international audience with insights into his life and his treatment methods and to highlight the profound influence Kneipp has had to this day on natural and preventive medicine. The paper emphasizes in particular the continued popularity of Kneipp’s holistic approach to health and well-being, which is evident in the many national and international Kneipp Associations, the globally operating Kneipp Werke, postgraduate qualifications in his treatment methods, and the existence of more than 60 accredited Kneipp spas and health resorts in Germany alone.

Introduction in hundreds of accredited Kneipp spas and health resorts across Europe. In Germany, for example, the ‘‘Kneipp ebastian Kneipp, born in Stephansried, Germany, in Cure’’ was recognized in 1953 as a legitimate form of re- 1821 into a poor family of weavers, was a pioneer of the S habilitation therapy reimbursable through the country’s European nature cure movement, which inspired naturopathy public health insurance fund and has remained so, albeit to a in the United States and provided the foundations for modern lesser extent, to this day.6 naturopathic medicine.1–3 In his time Kneipp was a celebrity: In this light, it is surprising that Kneipp’s holistic approach He was voted in the United States among the best-known to health and healing, as well as the popularity his teachings people (running third only after the US president and the still enjoy to this day in many countries in continental Eur- German chancellor Bismarck). He treated up to 200 patients a ope, appears to be little known in the English-speaking world. day, and his first book, My Water Cure,4 has since been On the basis of a detailed analysis of primary and secondary published in more than 100 editions and has been translated data sources, this paper aims to provide interesting insights into 14 languages.2 Kneipp also travelled extensively into Kneipp’s life and his healing philosophy and to highlight throughout Europe; it is estimated that around 1 million the profound influence he has had on natural and preventive people listened to Kneipp’s lectures given during 1 of the 32 medicine. tours he undertook between 1890 and 1896.5 Even after his death in 1897, his holistic approach to Kneipp’s Life and His Teachings health and healing continued to thrive. Organized in vari- ous confederations, associations, and institutions across 40 Kneipp’s healing methods had their origin in a series countries under the umbrella of Kneipp Worldwide, the of hydrotherapeutic self-experiments. In 1849, after com- Kneipp movement, with its 170,000 members (Kneipp mencing his theological studies, he suffered badly from Bund. Personal communication. August 2013), constitutes pulmonary tuberculosis and had been given up on by con- one of the largest noncommercial global health promotion ventional medicine. Being a prolific reader and convinced of organizations. Perhaps the most visible legacy of Kneipp’s the body’s self-healing powers, he drew inspiration from philosophy in the 21st century is the continued practice of a book on the healing powers of water that had been pub- offering his holistic therapy concept (known as Kneipp Kur) lished by Sigmund Hahn nearly a century earlier,1,2 Having

1Pharmacy Program, School of Medicine and Pharmacology, Centre for Optimization of , University of Western Australia, Crawley, Australia. 2Curtin Business School, Curtin University, Perth, Australia.

521 522 LOCHER AND PFORR strengthened his immune system through cold water treat- healing powers of water,4 today it is considered one of ments, he was eventually ordained as a priest in 1852 with Kneipp’s significant contributions to naturopathic medicine.2 fully restored health and was assigned to the small, im- To this day, herbal Kneipp products are still manufactured poverished, and remote Bavarian parish of Wo¨rishofen in and distributed by Kneipp International, a global company 1852; there he continued to experiment with a range of with headquarter in Wu¨rzburg, Germany, and more than 30 preventive and curative water treatments on himself and a branches worldwide.10 Trained in the use of medicinal plants growing number of patients.3,7 His approach was inspired by by his mother, an experienced herbalist,2 Kneipp considered that of (1799–1851), a famous Austrian the promotion of simple herbal remedies a very useful way of nature cure proponent of the 19th century, who is often providing the poor with easily accessible, yet effective, basic referred to as the ‘‘Father of .’’2 treatments. In My Water Cure,heemphasized: But over time Kneipp refined Priessnitz’ cold water treat- No expensive stock-in-trade will be found here, for most of ments, in particular by making them more gentle through a my medicines, infusions, extracts, oils, and powders are much-reduced treatment time, and complemented them with drawn from simple weeds and herbs, well known and much other hydrotherapeutic practices, which soon became a hall- prized by our ancestors, but mostly now forgotten and de- mark of his treatment regimen. Kneipp’s approach to health spised. These may be found in almost every field and garden, and healing was also more complex than that of Priessnitz on the common, and by the wayside; and as this little work is as he added another four elements to his refined hydro- chiefly written for the poor, the greatest merit of my remedies 4 therapeutic treatments: the complementary use of medicinal lies in their very cheapness and vulgarity. herbs, physical exercises and different forms of massage, Kneipp’s consideration of and care for the underprivileged healthy and balanced nutrition, and regulative therapy to seek is well documented. Although he is reported to have suc- inner balance. Kneipp’s therapy therefore reflects a paradigm cessfully treated some prominent members of the high society shift away from an almost exclusive focus on physical aspects of his time, such as Pope Leo XIII, he mainly cared for the to an understanding of health that the World Health Organi- poor, offering his treatments free of charge.2 He also opened a zation about a century later defined as ‘‘state of complete children’s asylum (Kinderheilsta¨tte) and the foundations Se- physical, mental and social wellbeing and not merely the ab- 8 bastianeum and Kneippianum, which are still in operation and sence of disease or infirmity.’’ In doing so, Kneipp also offer Kneipp treatments in his hometown of Bad Wo¨rishofen. moved away from the image of passive patients and in turn promoted the active involvement in their therapy. Known as Exercise the ‘‘five pillars,’’ the different elements of Kneipp’s treatment concept are discussed in more detail in the following section. In line with his promotion of an ‘‘active’’ patient, phys- ical exercise was part of Kneipp’s various hydrotherapeutic

Hydrotherapy treatments (e.g., treading in cold water), but he also advo- cated brisk walks, home callisthenics, and other moderately Kneipp considered the cold water treatments promoted by intense physical activities on a daily basis ‘‘to make the earlier hydrotherapists as often ‘‘too violent or too frequent’’ joints more supple and the muscles stronger.’’11 He placed a and was concerned about their potential negative physical and/ particular emphasis on the strenuous aspect of these activ- 4 or emotional effects. Typical elements of his more gentle ities and in doing so set them clearly apart from the popular approach were water treading, hot and cold half-baths and full ‘‘promenading’’ of his time.12 Today, in light of a broad baths, contrast baths, steaming treatments, wraps and com- social acceptance of sport and other outdoor leisure activi- presses, and, most important, the brief cold gush to different ties, these recommendations seem far from being farfetched, body parts.2,7,9 These techniques were constantly refined and but Kneipp also highlighted the importance of hardening, in described in detail in his immensely popular book My Water particular the feet, to different surfaces and temperatures. 4 Cure. Today, there is a growing body of clinical evidence for Consequently, patients walking in the early mornings the complex processes that underpin successful hydro- barefoot around the dewy fields of Wo¨rishofen, through therapeutic treatments, which are outlined in more detail later. freshly fallen snow or cold water and on wet stones,13 must For Kneipp, however, water simply served the purpose of have been and still is an extraordinary sight. dissolving and removing toxins, stimulating circulation, and strengthening a patient’s constitution.4 This oversimplified Nutrition perspective reflects in part the time of his teachings and the fact Kneipp was not an advocate of an ascetic lifestyle. Ra- that Kneipp had no formal medical training. It might, however, ther, he emphasized the importance of ‘‘varied and simple,’’ also help explain his enormous popularity amongst the general balanced nutrition and moderation in eating habits.11 He was public, who found his ‘‘almost childish simplicity.of lan- not in favor of a vegetarian diet and recommended, if at all, guage’’ without ‘‘incomprehensible medicinal phrases,’’ as the only occasional caffeine and alcohol intake in very moder- translator of his books describes it,4 very appealing. ate quantities. He was also an outspoken advocate of the use of simple, wholesome food and green vegetables and un- Phytotherapy refined flour.11,12 In Norway to this day, Kneipp bread In particular, his use of medicinal herbs, externally in the (Kneippbrød) still enjoys enormous popularity, the whole- form of bath additives and internally as teas, powders, and meal-based recipe having been brought to the country more tinctures, made Kneipp the first to introduce these treatments than a century ago by a Norwegian who had been treated by into the nature cure movement. Although some of his fellow Kneipp. A succinct summary of Kneipp’s attitude toward nature cure proponents were critical of this ‘‘herb cure,’’ nutrition can be found in a rather detailed chapter in his fearing that it could be seen as a vote of mistrust against the book, titled ‘‘Thus Shalt Thou Live,’’ where he states: THE LEGACY OF SEBASTIAN KNEIPP 523

It is not the quantity of food that makes man strong and this was a result of Kneipp’s enormous popularity as ‘‘[t]he healthy. What we must do is to choose good food, then a sick came in such numbers that we knew not what to do with small portion at a time will be sufficient. We must further be them.’’14 Nonetheless, what was seen by some as a hastily careful that nature should be able to digest well what we give ‘‘dispatching’’ of 30 or 40 patients per hour and the absence it and nothing should be eaten and drunk from which nature of proper patient records attracted strong criticism from the is not likely to draw any advantages.12 medical profession. They also criticized, for example, that Although none of Kneipp’s nutritional recommendations he did not even attempt a diagnosis.15 Because he had de- seem exceptional from today’s point of view, they illustrate veloped his therapeutic approach on the basis of observa- his sound understanding of dietary requirements and the tion, reading about other naturopathic health practices and importance of balanced nutrition for general health and his own practical experience but never had any medical well-being at a time when processed and refined foods came training, the majority of allopathic medical professionals strongly into fashion and were often consumed in large were very skeptical toward his methods and accused him of quantities to display personal wealth. profiteering and being a Kurpfuscher (quack or charlatan).

Regulative therapy Kneipp organizations While each of the individual pillars of his approach was When physicians increasingly stirred up hostility against acknowledged for its contribution to health and well-being, him in the light of his rising fame, Kneipp employed doctors it was their combination and a general inner balance that in to attend all his consultations for libel protection but also to Kneipp’s view made a healthy person. ‘‘This beautiful stimulate research on his methods. About 150 allopathic harmony and order, which we call health,’’ he remarked,4 physicians travelled to Wo¨rishofen every year to experience ‘‘may be upset and disturbed by various interruptions, which and study the Kneipp Kur.16 In Kirchfeld and Boyle’s view,2 we designate by the name of illness.’’ Moving away from a Kneipp’s attempt to bridge the gap with biomedicine was purely biomedical toward a more wellness-oriented health very successful because ‘‘no other lay healer attracted as paradigm and a focus on long-term health promotion, in- many followers from the ranks of the medical profession.’’ cluding individual self-healing and self-care,13 Kneipp stres- Consequently, in 1894 a number of physicians founded the sed the importance of balance for the health and well-being of International Society of Kneipp Physicians to provide pro- a person, be it with respect to an appropriate work-life bal- fessional training in Kneipp’s methods,16 following the ance, the right daily mix between physical and mental exer- launch of the Kneipp Association by former patients in 1890. cise and relaxation, or adherence to the natural biological Shortly after Kneipp’s death in 1897, the establishment of the rhythm. Because Kneipp was a key figure in the European Kneipp Bund provided an umbrella organization for the ex- nature cure movement, living in harmony with nature was an change and collaboration of the 45 associations that had been important element of his teachings. Although his simple in- launched since. To date, the organization coordinates 600 structions12 for the best way of living, cooking and eating, German Kneipp Associations and has also grown interna- lodging, sleeping and dressing, for example, might feel rather tionally into Kneipp Worldwide, with representations from 40 patronizing today, the underlying message strikes a chord at a different countries.17 Similarly, the International Society of time when a growing number of people long for a more Kneipp Physicians today counts about 1000 members (A¨ rz- balanced and slower-paced life in harmony with nature. tegesellschaft fu¨rPra¨ventionsmedizin und klassische Nat- urheilverfahren, Kneippa¨rztebund. Personal communication. Kneipp’s Legacy October 2013) and offers a range of postgraduate qualifica- tions in Kneipp and other naturopathic methods.16 With his holistic view on health and wellbeing, Kneipp already foreshadowed what today is seen by many as the most Kneipp Kur appropriate definition of health, namely ‘‘a state of complete physical, mental and social well-being and not merely the Many had predicted that because of Kneipp’s charismatic absence of disease or infirmity.’’8 His acknowledgment of an personality, the popularity of his treatments would quickly emotional and spiritual dimension to health resonates strongly wane after his death; instead, naturopathic methods, such as in modern approaches to complementary and alternative hydrotherapy and the Kneipp approach, were gradually in- medicine. Similarly, Kneipp was an outspoken advocate of corporated into mainstream medicine. In the 1880s under treatments that were tailored to an individual’s particular cir- the German chancellor Bismarck, prevention and health cumstances. He emphasised4 that ‘‘[t]o discriminate, therefore, promotion and also natural healing methods had already which applications are adapted to the disease in question, and became politically more accepted, which paved the way for furthermore to determine how these are to be varied according the development of the Kurwesen, a ‘‘German institution to the constitution of the patient, is the touchstone of the true which most distinctly reflects therapeutic pluralism and the physician’’ and ‘‘[t]o each new patient who comes to consult continuation of naturopathic healing principles in medi- me I address certain questions, in order to avoid the danger of cine.’’18 Evident, for example, in Baden-Baden, Germany, prescribing hastily and without sufficient knowledge.’’ and other famous, elegant, and luxurious European health Although Kneipp emphasized that he had no intention to resorts, the Kur in the past was ‘‘a social institution for the ‘‘enter a competition with the scientific art of healing,’’12 privileged class to combine health concerns with pleasure in he faced strong resistance from the professional medical an exclusive resort.’’18 But today, the term refers to specific community. While Kneipp stressed the importance of a medical prevention and reconvalescence, as well as reha- tailored treatment regimen, he was unable to devote a lot of bilitation programs for a range of mainly chronic dis- time to personal interactions with his patients. Most likely eases (e.g., certain pediatric, psychological, dermatologic, 524 LOCHER AND PFORR rheumatoid, musculoskeletal, or respiratory conditions), that teopathy and , , and manipulative are offered in accredited spa and health resorts. These are therapy to Kneipp’s treatment methods. Over the decades and carried out by highly qualified health professionals, in- after some tumultuous years, the concept of naturopathic cluding so-called Kura¨rzte (spa physicians) who have ob- medicine eventually matured from these beginnings.3,29 tained additional qualifications in balneology and medicinal climatology.19 In Germany, costs for these Kur treatments The Way Ahead can be privately met or, since 1953, can be covered by various health insurance funds when recommended and To this day, naturopathic healing methods, including prescribed by a physician.19 In the light of growing financial Kneipp treatments like the Kneipp Kur, have retained a strong pressures on the country’s health insurance system, the Kur position in Germany (and other European countries). How- has, however, been targeted over the past two decades as an ever, many allopathic health professionals still doubt the ef- area where public spending should be significantly reduced; fectiveness of any type of Kur. In the light of mounting this caused considerable challenges for Germany’s accre- financial pressure on the country’s health insurance systems, dited spas and health resorts after decades of enormous has added weight to the political demand of recent years to growth.6 cut back the involvement of the state in the Kurwesen.6,22 At Today, the Deutsche Heilba¨derverband (German Spa As- the same time, there have been calls for a stronger evidence sociation) oversees the accreditation of towns to become offi- base (e.g., efficacy) and for more cost-benefit analyses for cially recognized German Kurorte (health resorts and spa Kur treatments to meet the requirements of a health care towns), which are easily identified by the prefix Bad (‘‘bath’’). system dominated by the biomedical paradigm.18 These towns, which have to meet strict quality standards, can To this end, although rarely designated as specific Kneipp be classified as mineral, thermal and mud spa resorts; climate applications, there are indeed many scientific studies re- health resorts; seaside spas and resorts; health resorts with porting the effectiveness of hydrotherapeutic methods. They medical tunnel and radon therapy; and also as Kneipp health are, for example, documented to be effective in a range of resorts.20 The latter are different from those in the other ca- medical conditions, spanning from anxiety disorders,30 tegories as their accreditation is not based on the availability of chronic pain,31 back pain,32,33 Guillain–Barre´ syndrome,34 certain local characteristics, such as a favorable climate, clean osteoarthritis,35,36 fibromyalgia,37 and ankylosing spondyli- air, mineral waters, or moor mud. Rather, they are certified as tis38 to cardiovascular conditions.39,40 Hydrotherapy has also Kneipp Kurort for offering a whole range of therapies based on been successfully used in the improvement of geriatric cog- the five pillars of Kneipp’s therapeutic approach. nitive brain function,41 for athletic recovery,42 and after hip The Kneipp Kur, prescribed by an allopathic physician, and knee replacement.43,44 However, there is no Cochrane

potentially paid for by public health insurance and super- Collaboration–level evidence for any of these treatments; this vised by a specially trained spa physician, can thus be seen might also reflect the difficulties in assessing naturopathic as step toward integrative medicine, the vision of a ‘‘com- treatments, such as hydrotherapy and other aspects of the bination of mainstream medicine and CAM [complementary Kneipp approach, under a biomedical paradigm. and ] on a scientific basis.’’21 The best- In My Water Cure,4 Kneipp listed more than 40 different known Kneipp Kurort is Wo¨rishofen, Kneipp’s parish of 42 medicinal plants that he had studied and found to be safe and years, where he developed and practiced his treatments. As effective in self-experiments. These plants, which could sim- one of the earliest towns, Wo¨rishofen was officially ac- ply and cheaply be prepared into tinctures and extracts, teas, or credited as a spa town and awarded Kurort status; thus, in powders, constitute the phytomedicinal pillar of the Kneipp 1920, it was renamed Bad Wo¨rishofen.22 Today, it is 1 of philosophy. He gave detailed instructions on their preparation about 60 Kneipp Kurorte among the more than 350 offi- into herbal remedies and on their correct storage in an effort to cially accredited spas and health resorts in Germany.23 A provide the poor in particular with their own household large number of destinations offer Kneipp treatments in pharmacy. Many of these medicinal plants are still popular Austria, Switzerland, Poland, Hungary, the Czech Repub- today, although advancements in pharmacognosy research lic, and Slovenia.24–28 over the past 120 years have led to a much better understanding of their active principles, pharmacologic profile, and mecha- nism of action. Kneipp recommended St. John’s wort tea, for Naturopathic medicine example, as a liver and kidney cleanser and to treat bed wet- Although his impact has not been as pronounced in the ting, and valued valerian root tea or powder for the treatment of United States as in Germany and continental Europe, another headaches and as a carminative. While the applications of important legacy of Sebastian Kneipp is undoubtedly his in- these and other plants differ strongly from their modern use, it fluence on the development of the naturopathic movement in is nonetheless telling of Kneipp’s sound herbalist knowledge the United States in the early 20th century. that most of the herbal remedies in his household pharmacy are (1872–1945), who in 1901 founded the Naturopathic Society still popular medicinal plants today. For many of them, evi- of America (later renamed American Naturopathic Associa- dence of their safety and efficacy is demonstrated in favorable tion), was successfully treated by Kneipp, according to his- Cochrane Collaboration reviews (e.g., for St. John’s wort) or toric accounts, from tuberculosis after he had also been given ‘‘positive monographs’’ (e.g., for stinging nettle, arnica, and up on, like Kneipp nearly half a century earlier, by conven- valerian) awarded for a favorable risk-benefit profile by tional medicine. He then returned to the United States in 1896 Commission E, an internationally highly regarded advisory ‘‘to spread the Gospel of the Water Cure’’ beyond the board to the German Federal Health Office.45,46 country’s German immigrant population.3 He added other Despite the above briefly mentioned contributions toward nature cure therapies, such as massage and sunbathing, os- a stronger evidence base for Kneipp’s methods, in particular THE LEGACY OF SEBASTIAN KNEIPP 525 in the hydrotherapy and phytotherapy areas, the interplay of people visited German Kneipp spas and health resorts, the five pillars to his teachings—in other words, his holistic spending a total of more than 10 million guest nights approach to health and healing—has not been subjected to a there.48 While not all of these visitors would have partici- lot of model fit scientific scrutiny. Advocates of Kneipp’s pated in a full Kneipp Kur program, there would have been philosophy argue that an assessment under a biomedical ample opportunities for them to experience at least some of health paradigm would in any case be the wrong approach as the many facets to Kneipp’s teachings, be it by attending the benefits of a holistic treatment regimen that not only lifestyle seminars, consulting resident spa physicians or targets physical symptoms but also aims for inner balance qualified nutritionists, participating in water-based exercises cannot be fully appreciated and accounted for in this way. or relaxation therapies, carrying out Kneipp water applica- Nonetheless, for nearly 40 years now the Kneipp Stiftung tions, or undertaking self-guided walks barefoot.22 (Kneipp Foundation) has supported scientific studies that Providing more information on the five pillars of his investigate the basis of Kneipp’s empirical approach and healing philosophy, insights into his life, and a broader seek to provide data on its effectiveness, in particular the discussion of the significant influence he has had to this day interplay of his phytochemical methods with other elements on the development of alternative medicines, this paper has of his teachings. To date, more than 50 studies have been highlighted the continued relevance of Kneipp’s holistic funded under this scheme and thus continue what Sebastian approach to health and well-being in the 21st century, be- Kneipp already initiated during his lifetime: a much closer yond German-speaking countries. It is hoped that it will also collaboration with the scientific community.47 stimulate further research into this, not only from a histor- Possibly as a result of the mounting financial pressures ical but also contemporary standpoint, very important ele- on health care systems and their effects, for instance, on ment of naturopathic medicine. the public funding of Kneipp Kur treatments, as well as the challenges inherent in providing scientific biomedical Author Disclosure Statement evidence for efficacy and cost-effectiveness, the various No competing financial interests exist. Kneipp products and treatments today appear to fall mainly into the alternative medicines sphere. While the Kneipp Kur References initially mainly targeted sick patients with various acute and chronic diseases, most of Kneipp’s methods can indeed be 1. Helwig D. Kneipp wellness [homepage on Internet]. Gale applied as health promotion measures and thus go well with Encyclopedia of Alternative Medicine. 2005. Online document a growing wellness trend in many countries.22 This is also at: http://www.encyclopedia.com/doc/1G2-3435100456.html. well demonstrated in the product range of Kneipp Interna- Accessed August 16, 2012. 2. Kirchfeld F, Boyle W. Nature Doctors. Pioneers in Nat- tional, a company that has its roots in the contractual ar- uropathic Medicine. Portland, Oregon: NCNM Press, 1994. rangements made in 1891 between Sebastian Kneipp and his 3. Whorton JC. Nature Cures: The History of Alternative Med- friend the pharmacist Leonhard Oberha¨uber, who was given icine in America. New York: Oxford University Press, 2002. the exclusive rights to promote the formulas the two keen 10 4. Kneipp S. My Water Cure as Tested Through More Than advocates of naturopathic remedies had jointly developed. Thirty Years and Described for the Healing of Diseases and Today the Kneipp Group offers more than 200 different the Preservation of Health. Edinburgh: Blackwood, 1891. phytomedicines, nutritional supplements, and body care and 5. Waltenberger S. Sebastian Kneipp [homepage on Internet]. bath products. Many of them strongly promote a wellness Okologische Erinnerungsorte. 2012. Online document at: theme, their marketing evoking images a far cry from the http://www.umweltunderinnerung.de/index.php/kapitelseiten/ often harsh hydrotherapeutic treatments, such as cold water verehrte-natur/38-sebastian-kneipp. Accessed September 22, gushes, prescribed by Kneipp. Rather, they appear to rein- 2012. force Kneipp’s holistic approach to health and his emphasis 6. Pforr C, Locher C. The German spa and health resort in- on inner balance. In fact, many of his treatments are in- dustry in the light of health care system reforms. Journal of trinsically pleasurable or can be made enjoyable and are Travel and Tourism Marketing 2012;29:298–312. thus very well suited to a wellness experience.22 7. Kneipp US. Sebastian Kneipp [homepage on Internet]. 2013. Online document at: http://kneippus.com/sebastian- kneipp.html. Accessed November 3, 2013. Conclusion 8. World Health Organization. Preamble to the Constitution of So what relevance do Kneipp’s teachings have in the 21st the World Health Organization as adopted by the Interna- century? With his holistic understanding of health, his tional Health Conference. New York: WHO, 1948. consideration of not only the physical but also the emotional 9. Winnewisser S. Gesund mit Wasser. Hannover: Humboldt, 2009. aspects of diseases, and his promotion of hydrotherapy and 10. Kneipp International [homepage on Internet]. 2013. Online phytomedicine, Kneipp laid the foundations for modern document at: http://www.kneipp.com/. Accessed October naturopathy. This holistic view meets the current needs and 10, 2013. expectations of many who seek more for their physical and 11. Kneipp S. The Codicil to ‘‘My Will’’ for the Health and the emotional well-being than what biomedicine has to offer. It Sick. Kempten, Germany: Koesel Publisher, 1897. is therefore no surprise that the Kneipp brand continues to 12. Kneipp S. Thus Shalt Thou Live. Hints and Advice for the thrive. Perhaps the most visible legacy of Kneipp’s philos- Healthy and the Sick on a Simple and Rational Mode of ophy is the continued practice of offering his therapy con- Life and a Natural Method of Cure. Kempten: Koesel cept, the Kneipp Kur, to ‘‘tourist-patients’’ in a large number Publisher, 1894. of spas and health resorts, particularly in German-speaking 13. O’Conner B. Conception of the body in complementary and countries. In 2012, for example, more than 2.2 million alternative medicine. In: Kelner M, Wellman B, Pescosolido 526 LOCHER AND PFORR

B, and Saks M, eds. Complementary and Alternative Medi- 33. Barker K, Dawes H, Hansford P, Shamley D. Perceived and cine; Challenge and Change. Cambridge: Polity, 2000:39–60. measured levels of exertion of patients with chronic back 14. Kneipp S. My Will: A Legacy to the Healthy and the Sick. pain exercising in a hydrotherapy pool. Arch Phys Med London: Grevel, 1896. Rehabil 2003;84:1319–1323. 15. Baruch S. Kneipp’s Water Cure in the Light of Medical 34. Taylor S. The ventilated patient undergoing hydrotherapy: History. N Y Med J 1895;1:522–525. a case study. Austral Crit Care 2003;16:111–115. 16. A¨ rztegesellschaft fu¨rPra¨ventionsmedizin und klassische 35. Vaht M, Birkenfeldt R, U¨ bner M. An evaluation of the effect Naturheilverfahren, Kneippa¨rztebund. A brief history of the of differing lengths of spa therapy upon patients with oste- Kneipp therapy [homepage on Internet]. 2012. Online docu- oarthritis (OA). Complement Ther Clin Pract 2008;14:60–64. ment at: http://www.kneippaerztebund.de/de/english-version/. 36. Hill S, Eckett MJH, Paterson C, Harkness EF. Effects of Accessed October 10, 2013. floatation spa treatment on patients with osteoarthritis. 17. Kneipp Worldwide. The International Confederation of the Complement Ther Med 1999;7:235–238. Kneipp Movement [homepage on Internet]. 2013. Online 37. Matsumoto S, Shimodozono M, Etoh S, Miyata R, Kawa- document at: http://kneippworldwide.kneippbund.de/en/ hira K. Effects of thermal therapy combining sauna therapy startseite/. Accessed October 1, 2013. and underwater exercise in patients with fibromyalgia. 18. Maretzki TW, Seidler E. Biomedicine and naturopathic Complement Ther Clin Pract 2011;17:162–166. healing in West Germany: a historical and ethnomedical 38. Helliwell PS, Abbott CA, Chamberlain MA. A randomised view of a stormy relationship. Cult Med Psychiatry 1985; trial of three different physiotherapy regimes in ankylosing 9:383–421. spondylitis. Physiotherapy 1996;82:85–90. 19. Deutscher Heilba¨derverband. Die Kur in Deutschland. 39. Meredith-Jones K, Waters D, Legge M, Jones L. Upright Berlin: DHV, 2009. water-based exercise to improve cardiovascular and meta- 20. Deutscher Heilba¨derverband. Begriffsbestimmungen— bolic health: a qualitative review. Complement Ther Med Qualita¨tsstandards fu¨r die Pra¨dikatisierung von Kurorten, 2011;19:93–103. Erholungsorten und Heilbrunnen, 12th ed. Gu¨tersloh, Ger- 40. Caminiti G, Volterrani M, Marazzi G, et al. Hydrotherapy many: Flo¨ttmann Verlag, 2005. added to endurance training versus endurance training 21. Dobos G. Integrative medicine—medicine of the future or alone in elderly patients with chronic heart failure: a ran- ‘old wine in new skins’? Eur J Integrat Med 2009;1:109–115. domized pilot study. Int J Cardiol 2011;148:199–203. 22. Locher C, Voigt C, Pforr C. The Kneipp philosophy—a 41. Doering TJ, Thiel J, Steuernagel B, et al. Changes of labo- ‘‘healthy’’ approach to destination development. In: Voigt ratory markers of cognitive brain function by thermostimuli C, Pforr C, eds. Wellness Tourism: A Destination Per- in the elderly. Arch Phys Med Rehabil 1999;80:702–705. spective. London: Routledge, 2013:188–200. 42. Cochrane DJ. Alternating hot and cold water immersion for 23. Deutscher Heilba¨derverband. Spas and health resorts in athlete recovery: a review. Phys Ther Sport 2004;5:26–32. Germany [homepage on Internet]. 2013. Online coument 43. Giaquinto S, Ciotola E, Dall’Armi V, Margutti F. Hydro- at: http://www.die-neue-kur.de/en/spas-and-health-resorts- therapy after total hip arthroplasty: a follow-up study. Arch in-germany.html. Accessed October 10, 2013. Gerontol Geriatr 2010;50:92–95. 24. O¨ sterreich Werbung Wien. Kur & Kneipp [homepage on 44. Giaquinto S, Ciotola E, Dall’Armi V, Margutti F. Hydro- Internet]. 2013. Online document at: http://www.austria therapy after total knee arthroplasty. A follow-up study. .info/at/erholen-entspannen/kur-kneipp-1194769.html. Ac- Arch Gerontol Geriatr 2010;51:59–63. cessed October 23, 2013. 45. Linde K, Berner MM, Kriston L. St John’s wort for major 25. Kuren 24. Lassen sie es sich gut gehen [homepage on In- depression. Cochrane Database Syst Rev 2008;4:CD000448. ternet]. 2013. Online document at: http://www.kuren24 46. Blumenthal M, Goldberg A, Brinckmann J. Herbal Medi- .com/. Accessed October 23, 2013. cine: Expanded Commission E Monographs. Newton, MA: 26. Heilba¨der und Kurha¨user Schweiz. Ihre direkte Verbindung Integrative Medicine Communications, 2000. zu mehr und neuer Lebensfreude [homepage on Inter- 47. Sebastian-Kneipp-Stiftung. Staatlich annerkannte ge- net].2013. Online document at: http://www.wohlbefinden meinnu¨tzige Stiftung [homepage on Internet]. 2013. Online .com/ Accessed October 23, 2013. document at: http://www.kneipp-stiftung.de/. Accessed 27. FFAIR Reisen. Kuren in Polen [homepage on Internet]. October 14, 2013. 2013. Online document at: http://www.kurreisen-nach- 48. Deutscher Heilba¨derverband Ga¨ste- und U¨ bernachtungs- polen.de/. Accessed October 23, 2013. zahlen in den deutschen Heilba¨dern und Kurorten [home- 28. EuroMed. EuroMed Kurreisen [homepage on Internet]. page on Internet]. 2013. Online document at: http://www 2013. Online document at: http://www.euromed-kurreisen .deutscher-heilbaederverband.de/Statistik-2012-pdf-700511 .de/. Accessed October 23, 2013. .pdf. Accessed October 10, 2013. 29. Micozzi M S. Historical aspects of complementary medi- cine. Clin Dermatol 1998;16:651–658. Address correspondence to: 30. Dubois O, Salamon R, Germain C, et al. Cornelia Locher, PhD versus paroxetine in the treatment of generalized anxiety Pharmacy Program disorder. Complement Ther Med 2010;18:1–7. School of Medicine and Pharmacology 31. Cimbiz A, Vayazit V, Hallaceli H, Cavlak U. The effect of Centre for Optimization of Medicines combined therapy (spa and physical therapy) on pain in University of Western Australia various chronic diseases. Complement Ther Med 2005;13: M315 (Curnow Building) 244–250. Crawley 6009 32. McIlveen B, Robertson VJ. A randomised controlled study Australia of the outcome of hydrotherapy for subjects with low back or back and leg pain. Physiotherapy 1998;84:17–26. E-mail: [email protected]