Chapter 3 Page 1 | A Brief and Selective History of Medical Tourism
(A (necessarily) brief history of traveling for health care)
My dear Athos,
I wish, as your health absolutely requires it, that you should rest for a fortnight. Go, then, and take the waters of Forges, or any that may be more agreeable to you, and recuperate yourself as quickly as possible.
From The Three Musketeers
The history of cosmetic surgery, and of traveling extended distances for medical care or health reasons, goes back to the beginning of recorded time. Reconstructive plastic surgery procedures were performed in India at least as far back as 600 B.C. (1)
Literature and history are replete with stories of people who have traveled for health reasons; the healing and recuperative powers of bathing in the hot mineral springs around the world is documented in both fact and in fiction. School children are taught that the Spanish explorer Ponce de Leon allegedly went in search of the Fountain of Youth and found Florida and death by an Indian arrow instead. I say “allegedly” because a number of scholars dismiss the Fountain of Youth part of the story as myth. In more recent history, Franklin D. Roosevelt received therapeutic baths and muscle treatments for his debilitating pain from polio in Warm Springs, Georgia during his administration from 1933-1945, making the place sort of a southern White House for months at a time.
You could say that President Roosevelt was a pioneer of modern health tourism, the precursor of medical tourism, though the two are distinct, historically and even today. Health tourism is the business of spas selling weekend or week-long indulgences of luxurious massages, exotic baths, healthy foods, beauty makeovers, and soothing or exhilarating scenery for an even more exhilarating price. Some even have a spiritual component. The actual medicinal value of much of this has long been debated, though many medical professionals vouch for their therapeutic benefits.
Medical tourism, on the other hand, is entirely recent and has become the more narrowly applied term for traveling abroad for the services of a doctor or surgeon. Recuperating in a spa or vacation-like setting is an option, and an attractive embellishment for many. While, no doubt, there are scholars who could step forward with examples from history of people who traveled great distances for the services of a particular doctor or a particular treatment or surgery, they would also acknowledge that medical tourism is mostly a modern phenomenon. It tracks very closely with the 20th century refinement of cosmetic surgery as a medical specialty spawned from necessity during World War I when reconstructive techniques were developed to treat those maimed in combat.
By the 1950s, the groundwork for what was to become modern cosmetic surgery had been laid. Though far from common, surgery for purely aesthetic reasons had become less peculiar. Initially there was little competition. Through the 1950s and 1960s cosmetic surgery was the province of the United States and Europe; the clients, whatever nationality, were mostly wealthy. Quick, affordable international air travel was the first precondition for medical tourism to emerge and international patients started to head for the great hospitals of the United States and Europe, as they still do today. The main difference today is that the international competition to provide medical services has become fierce.
In addition to the patients, however, an ever-increasing number of medical students, doctors, and surgeons from around the world converged on the United States and Europe seeking medical training. As time passed, more information was exchanged and spread; more technology was were shared. Some of the medical students stayed in the United States as part of the infamous “brain drain” that was attracting the best and the brightest from around the world, to the detriment of efforts to modernize and improve economic conditions abroad. But some went home to build medical practices in their own countries and to found new institutes, hospitals, and centers of learning. Among the skills they took with them were cosmetic surgery techniques.
In time, inevitably, other destinations for patients besides the United States and Europe arose.
(1) Rana RE, Arora BS. History of plastic surgery in India. J Postgrad Med 2002; 48:76-8