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progress as the last five, even the skeptics will be compelled to admit. that this new diagnostic and therapeutic agent is the most useful, if not the most interesting, contribution that the science of Physics has ever made to the science of Medicine.

A SURGICAL PILGRIMAGE TO ARKANSAS.

BY HAL C. WYMAN, M. S., M. D., DETROIT, MICHIGAN.

PROFESSOR of surgERY IN THE MICHIGAN COLLEGE OF MEDICINE AND SURGERY.

ARKANSAS was settled originally by people from Tennessee, and consequently the Arkansans maintain the customs and trend of thought common to the Tennesseeans. In the early days of that state, there was a law to the effect that if a negro went about the country practicing medicine or healing the sick, he was punished by a drubbing not to exceed twenty-five lashes, while his master, if he were cognizant of the fact, was liable to a fine. The people of Tennessee would not allow any "free" colored person to remain in their state more than twenty days, and slaves were never permitted to assemble in unusual numbers. without the expressed consent of their owners. In Arkansas now there is a State Medical Society composed entirely of colored physicians. I met the president, Doctor Claude M. Wade, during a recent sojourn in Hot Springs. I found him a regular graduate in medicine, practicing his art in accordance with the laws of the state. He is at the head of the Saint Pythias Sanitarium in that city, an institution with twenty beds, which takes patients of any color. The medical law of Arkansas recognizes all the "pathies." If a man would practice regular medicine, be he white or colored, he must appear before a board of regular physicians, exhibit his diploma, and pass a satisfactory examination. If he is an eclectic, as many of them are, he is required to appear before a board of that persuasion, exhibit his diploma, and give written evidence of qualification in order to gain the right to practice.

Hot Springs, the mecca of many medical pilgrims like myself, is located in Garland county, and after having visited all its sanitariums, including the splendid institution of Doctors Holland and Laws, I visited the County institution about four miles distant from the city, over West Mountain. Judge of my surprise, after finding the color line in the city so distinctly drawn as to require two separate medical societies, at finding the County Poor House containing inmates, both white and colored, without separate buildings. In one little building, called the "jail," or "crazy house," I found two helpless melancholic female patients in the midst of the most wretched filth and fetor, in cells adjacent to three men afflicted with acute mania, one of whom was colored. One of these poor women had stripped herself of clothing, torn her bedding to bits, and during the recent cold nights had her feet frozen, so that great sloughs of skin and fascia were now adding to her discomforts. The crazy negro wanted to kill somebody

all the while. One of the men had epileptic seizures two or three times a day. The other woman shrieked and moaned almost incessantly, begging to be taken to her home. A physician comes out from Hot Springs at intervals to visit these unfortunate people, instruct the manager in the art of cleaning the cells, and making the occupants comfortable. Other of the inmates, irrespective of color, were wandering about the little frame building in all stages of mental debility, from low grade idiocy to the lighter forms of senile and moral imbecility.

I had a talk with Doctor Joseph W. Shaw, at his office in Buckville, about twenty-five miles from Hot Springs, about the people I saw in the County Poor House, and he said they ought to be sent to the asylum at Little Rock. He had served several terms as a member of the legislature from Montgomery county, and his son, Doctor Argus D. Shaw, of Hot Springs, was county physician at the Poor House. Doctor Shaw is a fair type of the better qualified rural practitioners of Arkansas. He has been in practice since the close of the Civil War and is thoroughly familiar with the law governing the care and medical treatment of pauper and insane persons. He told me that it was the custom to let the paupers out to the highest bidder, that is, a man who would agree to keep the pauper in his own home for the lowest figure per annum would get the patients; and with the insane, unless the malady was pronounced, the same rule obtained. But when the case was at all severe, the person was taken before the county judge, and examined, the testimony of the physician in attendance being taken and the patient sent to the asylum at Little Rock. I could not learn of any very careful discriminating examinations to determine the likelihood of this or that operation or treatment being useful to the patient. The county judge does the examining and the physician merely determines the question of insanity, basing his conclusions on the disposition. of the patient, without regard for the pathology, surgery or therapeutics in the case. Doctor Shaw has another son practicing with him, and together they do most of the practice within a radius of twelve or fifteen miles, riding the rough mountain trails, and fording the mountain torrents on horseback. They have some malarial fever and Doctor Shaw, elder, is not a believer in all phases of the mosquito theory. He doubts whether the mosquito is the only vehicle for the conveyance. of the plasmodium malaria. There are occasional cases of appendicitis occurring in the mountain regions remote from the city hospitals and surgical sanitariums of Hot Springs and other cities, wherein the rural practitioner does his own operating, and in more than many instances I found physicians splendidly equipped with a knowledge of the serious. phases of abdominal surgery. The city physicians of Arkansas are reluctant to go into the country, for the reason that the people in the fastnesses of the Ozarks, though happy, are often poos, consequently the doctor on this or that creek, or in this or that hollow, as the country is spoken of, must do his serious surgery himself. At the little town of Harrison in the midst of a most rugged country teaming with

people living in the easy way of the Arkansan, there is a doctor whose fame keeps him busy and brings him all sorts of surgical cases within a radius of from fifty to sixty miles. His results in hernia, appendicitis, and ovariotomy are just as good as those obtained by any man. The pure air, the fine water of the mountain districts, as well as the skill of the operator are strong factors in the recovery of patients.

The medical visitor at Hot Springs is not surprised at the character of ills observed on the much frequented streets. One of the grandest clinics in the world may be observed passing in an almost endless procession through the principal streets and about the springs. Just why the hot water emanating from the earth at this place should possess such great value in the cure of many chronic ills is difficult to say, but certainly it has the power of attenuating and eliminating almost any poison contained in the system of those who drink enough of it. It increases voluminously the excretory functions of the skin, kidneys, and bowels. The Government controls the sources of the water, there being a reservation maintained by the United States. Entrance to this reserve is indicated by two huge gate-posts, surmounted by bronze eagles, and illuminated with the name of "Hoke Smith," who happened to be Secretary of the Interior when certain improvements on the Government Reserve were made. I cannot but consider the disfigurement of these two splendid gate-posts with the name of Hoke Smith cut upon them a matter of very bad taste, but since this officer was one who cleaned out the "old mud hole"-the "old ral hole," as it was called by countless thousands, who bathed in it and were cured of their specific ailments and substituted for it the present free bath-house, where anyone who registers his name, may receive a bath in a clean porcelain tub and cement pool, free of charge, I do not see why the medical visitor at Hot Springs may not pass judgment on matter of taste and public policy. It is not considered in good form for officers of the United States government to have their names cut in the solid stone to commemorate any of their acts performed as the servants of the people. The profession in Hot Springs is in a state of turmoil, into which they have dragged the courts, over the matter of drumming for patients. A Visitors' Protective League exists among the physicians, and its function is to ascertain and endeavor to stop the practice. The United States Government has jurisdiction over the water coming out of the Government mountain on the reservation and will allow only those whom it examines and registers as competent, qualified physicians to prescribe the water for their patients. There are a great many physicians in Hot Springs who are not permitted to use the water of these springs in their practice.

Surgery in Hot Springs is not practiced very extensively, as comparatively few of the horde of invalids coming here present operable cases. There are a number of sanitariums with neatly equipped operating rooms, where all sorts of operations may be performed. There are numbers of men skilled in the surgical arts, who are ready at any

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hour of the day or night to perform any operation needful for the relief of human suffering, and there are plenty of trained nurses, too, who like surgical cases, but relatively few operations are performed. Hot Springs is not a surgical center, it is a place where drugs are tested to their full value and where the healing powers of the hot waters of the earth exert their greatest efficiency. A curious custom prevails among the physicians in regard to charges. The consultation fee, or first visit of a patient to a doctor, is five dollars. He is then informed that the subsequent charges will be twenty-five dollars per month, invariably in advance, and no matter what the disease, the patient may come to the doctor's office as often as he thinks the condition demands attention. I was told that this rule in regard to charges and custom in regard to visits was established very early in the history of the springs, that it works admirably, and that all the patients sitting in the doctors' waiting-rooms represent pay patients, on the twentyfive-dollars-a-month plan. The doctors are located, mostly, on one street, facing the Government Reservation. Generally their offices are over the stores, and the patient must climb a long flight of stairs. The doctor, in prescribing baths, writes his instructions, which are carried out to the letter in the bath-houses on the reservation using the hot waters. I saw some very interesting cases of necrosis of the bones of the face, nasal bones, grouped about the hot springs inhaling warm vapor which rises from the waters in the early morning. Many of these poor people were in need of surgery, to cut away the diseased bone.

The country around about Hot Springs is mountainous, the town being situated in the foot-hills of the Ozarks. The drainage of the country is through the Ouchita river, a beautiful stream heading up near Indian Territory and Arkansas. The hills are covered with splendid forests of pine, oak, ash, gum, and hickory. In many of the hills gold has been found. In almost any direction you may travel on horseback you will find extinct mining camps, where dilapidated buildings and rusted-out machinery are to be seen. The region for twentyfive miles about Hot Springs is quite thickly populated, notwithstanding the forests, and nearly every section of land has one or two families living upon it in neat little log cabins with plenty of children whom I found invariably healthy and happy, subsisting largely on a diet of corn meal which is grown in a patch of rarely more than four or five acres (usually the only cultivated ground about the homestead), and the delicious meat of the long-nosed, half-wild, razor-back pig, which thrives the year around on roots and nuts. Once in awhile a church or a school-house is found, and on the streams occasionally a mill with the old French burrs for grinding corn, which preceded the introduction of the modern roller process of milling grain. The simple diet of the native Arkansans who settled this country in the thirties largely, maintains a sturdy class of citizens. I would not have you think that hog and hominy is the sole diet of these people. The mills just mentioned.

make splendid meal of the pure hard corn, which thrives everywhere in the country around Hot Springs. This meal contains all the nutritive elements of the grain, and is quite different from the product of our northern mills. The people have cattle and use milk and butter to a moderate extent. They are not, however, well posted in the science of dairying, and I fear the rugged little cattle are not profitable producers of fat. They are so numerous in the country I traveled over that they have devoured all the canebrake which used to fill the valleys and low places along the mountain streams. Their hides are a source of income to the mountain farmer, or cracker, as he is sometimes called. Inquiry revealed an occasional case of anthrax and progressive purulent infection of the hands of persons who had been handling hides of cattle found dead in the woods. I could not learn that deaths were due to tuberculosis among the cattle, but believe that they were the result of insufficient food during the winter period, a little shorter though much less severe, than that of Michigan. The people are beginning to learn the value of poultry as food, and as a means of increasing the family revenue. I found fine chickens about every homestead, and fresh eggs and fresh fowl supplement the pork and corn meal diet I have been writing about. In the little field about the house, are commonly grown a few potatoes of the Irish variety, and a larger quantity of sweet potatoes, which are secured for use through the winter season. Cabbage, turnips, cauliflower, tomatoes and all sorts of wild fruits and berries are valuable adjuvants to the foods I have just mentioned. The total cost of living on a good wholesome diet in the country round about Hot Springs is surely not very high. Corn is worth fifty-five cents a bushel shelled, a bushel loses one-eighth in the process of grinding, and will feed, when made into meal, a family of five persons three weeks. That is only two and one-half cents per day. The pork, dressed, is worth six dollars a hundred, and a family of five persons will eat three hundred sixty-five pounds a year. That is about six cents a day, making the total cost of living for a family of five persons about eight cents a day. That this diet, inexpensive as it is, is sufficient for good sound health and mental vigor is amply attested by the freedom of the people from tuberculous infections, chronic anemia, or neuritis.

Not a small part of the curative value of a sojourn at Hot Springs is due to frequent excursions, either on foot or on horseback, into the mountainous country round about the town. The better qualified physicians nowadays advise these excursions as a part of routine treatment accompanying the baths, and they are of fully as much value as the massage and inunctions liberally practiced. I could not learn that anyone was doing anything in a surgical way for the cure of nerve. syphilis. The well-known fact that a surgical operation upon the cranium-opening the bony vault of the skull with the trephan-often determines the action of the iodide of potash in these cases of cerebral disease commonly attributed to venereal infections, seems to have passed unnoticed.

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