Health Spa Culture: From Ancient Roman Baths to Modern Thermal Spas

Bathing as ritual shows up wherever people have written about religion. Hindu tradition holds that bathing in sacred rivers, above all the Ganges, washes away sin. In Judaism the mikveh, a pool of natural water, is used for ritual purification. Ancient Greek gymnasia had washing rooms, and sanctuaries of healing gods were often built near springs. People who walked days to reach a sacred river were travelling for the same reasons later pilgrims did, as the history of pilgrimage makes clear: purification, healing and the chance to stand somewhere that mattered.

The Romans turned bathing into infrastructure. Their great public baths, the thermae, were fed by aqueducts and heated by underfloor furnaces, and they were cheap enough that most citizens could use them. A visit was a social event: exercise in the yard, a slow progression through the cold frigidarium, warm tepidarium and hot caldarium, a massage with oil, conversation, business deals, gossip.

Caracalla’s baths covered about 25 hectares. Modern estimates suggest between 6,000 and 8,000 visitors a day. The end came in 537, when the Ostrogothic king Vitiges besieged Rome and cut the aqueducts, and the complex was abandoned soon afterwards.

The ruins found a second life. From 1937 the vast caldarium became the summer stage of the Rome Opera, and in 1990 the first Three Tenors concert was held there. Summer performances continue today on a movable stage set outside the main structure to protect the ruins.

Aquae Sulis

At the far edge of the empire, the Romans found something better than an aqueduct: hot water coming out of the ground. In what is now the English city of Bath, springs rise at about 46 °C and deliver some 1.17 million litres a day. The Romans built a temple to Sulis Minerva and a bathing complex around them and called the town Aquae Sulis.

The Great Bath they built is still there, open to the sky now that its roof is gone, its water a murky green. The whole city was inscribed as a UNESCO World Heritage Site in 1987. Visitors who want to bathe in the same water today can do so at Thermae Bath Spa, a modern complex opened in 2006 with a rooftop pool overlooking the city.

In the Ardennes of eastern Belgium, about 35 kilometres south-east of Liège, lies a small town that gave its name to every spa that followed. Spa’s mineral springs were known in antiquity; Pliny the Elder described one of them. From the 16th to the 18th century the town became one of Europe’s most fashionable resorts, and visitors came to drink the iron-rich water as much as to bathe in it. Casinos followed in the 18th century. Over time the town’s name passed into English as the general word for a resort built around healing waters.

A small side-track: Spa is also where the world’s first beauty pageant was held, in 1888. The town’s springs, meanwhile, are still bottled and sold under its name. Its best-known spring pavilion, the Pouhon Pierre-le-Grand, named after the Russian tsar who once took the waters there, dates from 1880.

Between the end of Roman Rome and the rise of Spa, public bathing in western Europe had a rough time. Medieval towns had bathhouses, but from the 16th century they were increasingly shut down or avoided. Outbreaks of plague and the spread of syphilis made crowded warm water look dangerous, and church and civic authorities worried about what went on in the steam. Many Europeans washed far less in the 17th century than their Roman predecessors had.

The return of the health spa came through medicine, and through the wealthy patients who could afford to follow their doctors’ advice across borders. From the 18th century, doctors prescribed courses of mineral water, drunk and bathed in, for everything from gout to nervous complaints. Grand spa towns grew up around the springs, with pump rooms, colonnades, parks, casinos and theatres. In 2021 UNESCO recognised 11 of them together as the Great Spa Towns of Europe, from Baden-Baden and Bad Kissingen in Germany to Karlovy Vary in the Czech Republic, Vichy in France, Montecatini Terme in Italy and Bath in England. The listing covers the period from the early 18th century to the 1930s, when spa culture shaped much of the European calendar for those who could afford it.

Baden-Baden’s Friedrichsbad, opened in 1877, still runs a bathing sequence of more than a dozen stages that a Roman would recognise. In Budapest, the Ottoman-era baths of the 16th century sit a short tram ride from the neo-Baroque Széchenyi bath, opened in 1913, where men play chess in the hot outdoor pools through the winter.

The Roman habit survived best in the eastern Mediterranean, where Byzantine and then Ottoman builders adapted it into the hammam. The sequence is familiar: a warm room, a hot room built around a heated marble platform, and a cooler room to rest in, with an attendant to scrub and wash. In Istanbul the Çemberlitaş Hamamı, designed by the architect Mimar Sinan and completed in 1584, has been in use for more than four centuries.

For visitors, the hammam is the most social of the bathing traditions. Conversation, tea and a long rest afterwards are part of it.

Japan’s volcanic islands are full of hot springs, and the onsen is one of the country’s defining pleasures. Japanese law defines a hot spring by water temperature of at least 25 °C at the source or by its mineral content, which is why there are thousands across the country, from rustic outdoor pools to large resort hotels. Etiquette matters more than anything: bathers wash thoroughly at a row of taps before getting in, swimsuits are generally not worn, and the small towel stays out of the water. In the mountains of Nagano the Japanese macaques of Jigokudani have become famous for warming themselves in a hot spring through the winter.

In South Korea the equivalent is the jjimjilbang, a bathhouse usually open around the clock. Separate hot and cold pools for men and women lead to a shared floor of heated rooms, where families in matching issued clothes lie on mats, eat boiled eggs and drink sweet rice drinks, and some stay the night.

The Finnish sauna works on a different principle: dry heat from a stove, with water thrown on the stones for bursts of steam, often followed by a plunge into a lake or a roll in the snow. Saunas are found in most Finnish homes, and in 2020 UNESCO added Finnish sauna culture to its list of intangible cultural heritage.

On Ireland’s Atlantic coast, seaweed baths were a seaside staple in the early 20th century. Bathers soak in hot seawater with freshly harvested seaweed, whose oils leave the skin slippery. The tradition nearly disappeared; by 1989 only two bathhouses were left. Kilcullen’s in Enniscrone, County Sligo, opened in 1912 and has stayed in the same family for four generations.

In Iceland, the Blue Lagoon on the Reykjanes Peninsula is fed by geothermal seawater from the neighbouring Svartsengi power plant, its milky blue colour coming from silica and other minerals. It is less a natural wonder than an accident turned into an attraction, and since late 2023 it has had to close for periods during the volcanic eruptions nearby.

Today the word spa covers everything from a hotel basement with a steam room to a destination resort with medical staff. Much of the modern industry is about skin, rest and quiet rather than mineral water. Natural skincare brands such as Western Australia’s Sodashi built their business around spa treatment rooms rather than shop shelves, and wellness retreats have spread into art and meditation, as at the Chapel of Sacred Mirrors run by Alex Grey in New York’s Hudson Valley.

The old thermal towns have not gone away. If you want the long view of health spa culture in one trip, Bath is hard to beat: Roman stones in the morning, Georgian pump room at lunch, and a rooftop pool of the same spring water at sunset.

Before going to any bathhouse abroad, read the local rules on towels, swimwear and showering. Most of the awkward moments in bathing culture come from skipping that step.