COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX64077675 RA805.H792 Un32 The waters of the Ho Columbia 2l!ntoer£ttp mtfjeCttpofiftrttigork College of ipijpo'iriansi anb burgeons Hturarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons (for the Medical Heritage Library project) http://www.archive.org/details/watersofhotsprinOOunit 62 M C S?sf£n Sa [ HOUSE OF REPRESENTATIVES j ^ 905* THE WATERS OF THE HOT SPRINGS OF ARKANSAS IN RELATION TO THE ALLEVIATION AND CURE OF DISEASES A REPORT OF THE SECRETARY OF THE INTERIOR ON H. R. 24737 (62d CONGRESS, 2d SESSION), "A BILL TO AUTHORIZE THE INVESTIGATION OF THE PHYSIOLOGICAL AND THERA- PEUTICAL EFFECTS OF THE WATERS OF THE HOT SPRINGS OF ARKANSAS AND TO REPORT UPON THE APPLICA- TION OF THESE WATERS TO THE ALLEVIA- TION AND CURE OF DISEASES." WASHINGTON GOVERNMENT PRINTING OFFICE 1912 RAZ0S.H71Z 32. [Sixty-second Congress , Second Session.] In the House of Representatives, Awjust 10, 1912. Resolved, That there be printed as a document five hundred copies of the report of the Secretary of the Interior, dated June seventh, nineteen hundred and twelve, and accompanying papers, on H. II. 24737. to authorize the investigation of the physiologi- cal and therapeutical effects of the waters of the hot springs of Arkansas, and to report upon the application of these waters to the alleviation and cure of diseases. Attest: South Trimble, Clerk. PHYSIOLOGICAL AND THERAPEUTICAL EFFECTS OF THE WATERS OF THE HOT SPRINGS OF ARKANSAS. Department of the Interior, Washington, June 7, 1912. Hon. Joseph T. Robinson, Chairman Committee on the Public Lands, House of Representatives. Dear Sir: Your letter of May 28 has been received, inclosing with request for report thereon H. R. 24737, "to authorize the investiga- tion of the physiological and therapeutical effects of the waters of the hot springs of Arkansas and to report upon the application of these waters to the alleviation and cure of diseases." The bill in question is as follows : Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That the sum of fifty thousand dollars, or so much thereof as may be necessary, be, and the same is hereby, appropriated to investigate the physiological and therapeutical effects of the waters of the hot springs of Arkansas and to report upon the application of these waters to the alleviation and cure of diseases, including the employment of all persons necessary in carrying on the work, the purchase of labora- tory apparatus, equipment, and other supplies, the renting of building and other appurtenances, and all other expenses necessary to effectuate such investigation, to be expended under the supervision of the Secretary of the Interior and to continue available until expended. Sec. 2. That the Secretaries of the Treasury, of the War, of the Navy, and of the Agricultural Departments, respectively, are hereby directed to cooperate with the Secretary of the Interior in such investigation, by detailing competent officers, and by extending all hospital, laboratory, and other facilities necessary and desirable in the carrying on of such investigation. In response thereto I have to state that the minutes of the sixty- second annual session of the American Medical Association, Los Angeles session, June 26 to June 30, 1911, as published in the official journal of that organization, provides, among other things: Proposal to examine radioactive waters .—Owing to the importance attributed to radioactive mineral waters in the treatment of gouty and other affections by compe- tent European observers, and the special interest excited by the symposium on the subject at the Thirty-second Pharmacologic Congress recently held in Berlin, the section on pharmacology and therapeutics of the American Medical Association requests the house of delegates to suggest to the United States Government the advisa- bility of investigating the radioactivity of the various mineral waters of the United States and publishing the result for the benefit of the medical profession. Dr. Harry M. Hallock, medical director of the Hot Springs Reserva- tion, under date of July 10, 1911, invited attention to the great and widespread faith in the curative properties of the water and to the recognition of the benefits to be derived from its use, as exemplified by the act of Congress in establishing the reservation of the Hot Springs, stating, among other things : The intelligent application of any remedial agent, as distinguished from quackery, depends fundamentally upon definite knowledge as to the effects upon the living 4 WATERS OF HOT SPRINGS OF ARKANSAS. organism which maj be expected to follow its exhibition, and these have never been determined with reference to the water of the hot springs, at leasl in detail and with the scientific accuracy requisite for announcement to and acceptance by the medical world. The relation of the Federal Government to the springs and the authority it exercises with reference to the prescribing <>f the water would appear to amounl to a recom- mendation for it- use in certain cases, and consequently it may lie assumed that there believed that the cooperation of the Secretary of War, the Secretary of the Navy, and the Public Health and Marine-Hospital Service can he secured a- well as the facilities of the Army and Navy General Hospital. The work would probably extend over at least a year and possibly longer. Your name has been suggested as one eminently competent in the research held and I therefore beg to inquire as to whether in your opinion it would be possible to obtain results from this line of work that would be of real value to the medical profession and commen- surate with the expenditure involved. Would you be willing to accept such an appointment if it were formally tendered to you and at what compensation? Could you give an estimate of the probable total cost including your own com- pensation, that of all necessary apparatus and supplies, the employ- ment of subjects for experiments in the study of blood and excretory changes, etc., covering the work of the commission for the period of one year? There are enclosed for your information certain papers and reports that it is believed may be of interest in connection with the subject. Very respectfully. Harry M. Hallock, Medical Director. A copy of the attached letter was also sent to the following: Prof. E. P. Lyon, professor of physiology, St. Louis University, St. Louis, Mo. Prof. Waldemar Koch, assistant professor of pharmacology, University of Chicago, Chicago, 111. Prof. Abel W. Howell, Johns Hopkins University, Baltimore, Md. Dr. Ralph S. Little, department of zoology, University of Pennsylvania, Phila- delphia, Pa. Prof. Jacob Rosenbloom, College of Physicians and Surgeons, 437 West Fifty-ninth Street. New York City. N. Y. Prof. Yictor Yaughan, M. D., University of Michigan, Ann Arbor, Mich. Prof. A. E. Taylor, Medical School. University of Pennsylvania, Philadelphia, Pa. Sheffield Laboratory Physiological Chemistry, Yale University, New Haven, Conn., March 6, 1912. Dr. Harry M. Hallock, Hot Springs Reservation, Hot Springs, Ark. My Dear Sir: I desire to acknowledge the receipt of your letter of February 29, with reference to the possibility of a series of experi- ments to determine the physiological effects of the waters of the hot springs. WATEES OP HOT SPRINGS OF ARKANSAS. H In view of the importance and scope of the questions raised in your communication, it will be necessary for me to delay a formal and definite reply until I can consider with some care the problems which are involved therein. Any investigation along the lines outlined by you will call for careful and exhaustive studies in several related fields ; and in order to give you some facts and opinions which are likely to be of any value to you I must ask for a brief time in which to give ques- tions at issue and the probability of useful outcome to research more careful consideration. I assume, from statements in the documents which you forwarded to me, that at the present time the unique therapeutic properties of the spring waters are in good part ascribed to radio-active manifestations. These are, as you well know, being widely investigated in some of the foremost laboratories of Europe. Very respectfully, Lafayette B. Mendel. Department of the Interior, Hot Springs Reservation, Office of Medical Director, Hot Springs, Ark., March 12, 1912. Prof. Lafayette B. Mendal, Sheffield Laboratory of Physiological Chemistry, Tale University, New Haven, Conn. My Dear Sir: I beg to acknowledge your letter of March 6 in reply to mine of February 29, 1912, and thank you sincerely for the interest and attention you have given the matter. Should the in- vestigations be undertaken it will doubtless take some time to arrange the details, but there is one point that it is greatly desired to have settled at once and that is the determination of the sum to be re- quested from Congress for carrying on the work. This must be deter- mined by April 1 in order to have the bill presented during the present session. I am in receipt of a letter from the department which reads in part as follows: I have to request that you will take up the subject with the other members of the Federal registration board and submit a general outline as to the amount of money which you think should be appropriated by Congress for this purpose, and such appro- priation to include compensation of physicians employed, laboratory facilities, appli- ances, and hospital facilities in connection with the matter. In submitting the estimate of the amount to be appropriated for this purpose a lump sum will be asked for, out of which all necessary expenses, including compensation of experts, etc., is to be paid, and it is also proposed to suggest to Congress that the Secre- tary of War, the Secretary of the Navy, and the Public Health and the Marine-Hospital Service, be authorized to cooperate with this department in handling the subject, the entire matter to be under the supervision of the Secretary of the Interior. It would be of material assistance if you would be willing to give at least an approximate estimate as to the necessary expenditures basing the figures on the work of such a commission for the first year, and also if you could express an opinion as to the number of years that would be required to complete the work. It is believed that hospital facilities can be obtained at the Army nd Navy General Hospital without cost other than the subsistence 12 WATERS OF HOT SPRINGS OF ARKANSAS. of patients. Information is especially desired as to the probable cost of i be following items: Compensation of experl . ( !ompensatioD of assistant . Chemical laboratory equipmenl and operation (exclusive of build- ing). Number and cost of animals used for experimental purposes. Number of healthy subjects to be employed Tor experimental purposes. Number Of patients to be observed. Thanking you for any assistance you may be able to render, I am, Very truly, yours, Harry M. Hallock, Medical Director. Sheffield Laboratory of Physiological Chemistry, Yale University, New Haven, Conn., March 18, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. My Dear Sir: I desire herewith to reply to your letters of Feb- ruary 2 ( .t, and March 12, in regard to the advisability of undertaking a series of investigations upon the therapeutic and physiological effects of the baths at the Hot Springs Reservation. Several distinct ques- tions raised in your communications must be answered independently. In considering the probable value of any further elaborate research on the physiological effects of the waters it must be borne in mind that there already exists an enormous literature on balneotheraphy. The Government circular which accompanied the documents sent to me states that "the therapeutic value or the baths is dependent upon the radioactivity of the waters." This aspect of the subject has been under consideration in very recent years only. The observations on the physiological and therapeutic effects of radium emanation which have Lately been reported by competent observers, e. g., from the clinics of His in Berlin and Von Xoorden in Vienna, encourage the belief that there is n useful field of investigation in this direction which deserves careful and speedy attention. In justification for this state- ment I may cpiote from a recent communication from Prof, von Noorden and Dr. Falta in Vienna: Die Emanationskuren haben einen miichtigen Einfluss auf wichtige Stoffwechsel- prozesee und auf den Erregungszustand des vegetativen Nervensystems und erfordern ebeuso wie die Behandlung mil Kohlensaurebadern und andere Bade- oderTrinkkuren voile Bingabe an die Anibrderungen der Kur. Es scheint ratsam, die Emanatorien hauptsachlich in Kurorten, Spitalern und Sanatorien zu errichten, wo die Patienten aue der BerufsarbeiJ ausgeschaltet sind. Naturgemass werden hierfur solche Kurorte die gunstigsten Yorhaltnisse darbieten, wo auch natiirliche Radiumbader zur Ver- rugung -ifhen. Emanation cures have a powerful influence on important processes of metabolism and on the excitability of the living nervous system and require, the same as treatment with carbonic acid and other bathing and drinking cures, a complete compliance with the requirements of the treatment . It appears advisable to establish emanation cures principally in bathing resorts, hospitals, and sanitoria, where the paitents are removed from the usual work of their respective occupations. WATEES OF HOT SPEINGS OF ARKANSAS. 13 Naturally the most favorable conditions will be afforded by bathing resorts where natural radium baths are also available. (Translation of German quotation.) I have no specific information at hand regarding the actual com- position of the hot springs water; but if their radioactive properties are of sufficient significance to warrant scientific exploitation in the form here indicated, a careful and responsible investigation along the lines proposed is, in my judgment, both desirable and timely. With respect to the conduct of such an investigation I am con- vinced that the cooperation of a number of men in different depart- ments of research whose fitness in respect to both training and ability is widely recognized, would alone give any report the prominence and authority which is desired. No investigation will be worth while which fails to carry with it the stamp of scientific excellence and cri- tique. In view of the circumstances involved it seems to me most practicable to have the responsibility for the plan and general execu- tion of such an investigation invested in a commission. The latter should include men of acknowledged capacity in medical fields and the underlying sciences, both clinicians and physiologists (which of course includes the physiological chemist) who could not only broadly direct the scope of the work, but what is equally important could competently criticize and evaluate the data. The general objection to a commission constituted of delegates from county medical societies, etc., as indicated in your letter of February 29, lies in the unfitness of such individuals, as a rule, to contribute in any peculiarly useful or expert way to the real duties of such a commission. Their work is likely to be perfunctory, subject to the bias of local traditions or the influence of important home interests. It might also be difficult to induce first-class investigators to work under the direction of an un- sympathetic board. A further highly advantageous feature of. the commission system constituted of several competent scientists is the presumable elimination of the danger of errors from the judgment of single individuals. We have suffered enough in this country from such one-man pronouncements. Much useless and uncalled for work has been done in the name of science and under authoritative sanction owing to the elimination of critical review by competent colleagues. The cost of a comprehensive investigation along the lines sug- gested will, of course, depend on its scope and on the personnel of the commission. Having in mind the necessary laboratory facilities and equipment, a number of laboratory workers (chemists, assistants, and helpers), eight or ten subjects, and their maintenance, and experimental animals, I estimate an outlay of at least $1,500 per month in this direction. To this should be added an initial cost of establishing a laboratory outfit. In Hot Springs (where no such outfit is now available) this ought not to exceed $2,000. To com- plete the budget for the first year the salary of a supervising physio- logical chemist must be added. It will be impossible to deflect anyone of the experience and rank of assistant professor in our universities to such work at a salary less than $3,000 per year. This would seem to me to represent the type of man to cooperate with the commission as proposed in my suggestion. A scientist of higher professional rating and ability ought to command a higher income for obvious reasons. J 4 WATERS OF HOT SPRINGS OF ARKANSAS. Ad expenditure of about $25,000 for the first year is thus provided for. The estimates are hascd on my experience in such matters in larger researches in our laboratory, on the published budgets of the Carnegie Institution nutrition investigations, and on the experiences of the Referee Board of Consulting Seientiiic Exnerts of the United Stai<- Departmenl of Agriculture. It must be Dome in mind that there are no opportunities at Hot Springs to use the equipment of established research plants, such as universities. The cost of re- search may thus be raised. Such an investigation ought to give valuable indications within two years. From the standpoint of therapeutic evidence a longer collection of statistical data might be desirable. In considering the make-up of a commission of three (or five) members in addition to the supervising physiological chemist and the medical director, I am inclined to believe that desirable individuals can be induced to serve from a sense of public duty and scientific interest, without what might strictly be termed a salary. Such individuals should, of course, receive compensation for traveling expenses, or similar outlay, together with a modest honorarium in proportion to the time required of them. The outlay thus involved is not taken into consideration in the above estimate because the amount involved will depend entirely on the plan followed. It may be noted that highly competent investigators, such as Prof. Reid Hunt of the Hygienic Laboratory of Washington, might be directly available through the cooperation of the Public Health and Marine-Hospital Service. Will the results be commensurate with the expenditure involved ? The answer depends on the mental attitude of those who expect the reply. If a group of foremost American citizens, whose experi- ence and judgment is attested by their position, do not hesitate to authorize the expenditure of half a million dollars for astronomical research in one institution alone, and when successful American firms feel justified hi expending $4,000 for a single page advertisement of an article of uncertain merit, shall we debate the question asked ? Finally, in reply to your tentative inquiry as to whether I would be willing to accept the appointment as physiological chemist, if it were formally tendered, I may say that my academic and research preferences and duties at present are such that I would not care to do so. If an occasion should arise in which I might be of service in some less direct way than through resident activity in Hot Springs — more specifically if I might be desired to cooperate in some advisory function — my readiness to serve might be considered. Respectfully, Lafayette B. Mendel. P. S. — If a personal interview would be helpful to you in any way while you are making the preliminary plans I shall be glad to have you or other representatives meet me here or in some convenient place. L. B. M. watees of hot springs of arkansas. 15 Department of the Interior, Hot Springs Reservation, Office of Medical Director, Hot Springs, Ark., March 25, 1912. Prof. Lafayette B. Mendel, Sheffield Laboratory of Physiological Chemistry, Yale University, New Haven, Conn. Dear Prof. Mendel: I beg to acknowledge your letter of March 18, 1912, and desire to express my deep appreciation of the very careful consideration you have given to my inquiries. All of the correspondence with reference to the proposed investiga- tions will be forwarded to the Secretary of the Interior in due time and I am sure that the officials of the department in Washington will appreciate your courtesy as much as I do. Very respectfully, Harry M. Hallock, Medical Director. Department of the Interior. Hot Springs Reservation, Office of Medical Director, Hot Springs, Ark., February 8, 1912. The Secretary of the Interior. Washington, D. C. Sir: July 10, 1911, recommendation was made by this office that provision be made for a complete study of the physiological effects of the water of the hot springs. By letter from the department of December 6, 1911, I was instructed to "make due inquiry and ascer- tain if possible the name of some competent person to do this work and the compensation he would be willing to accept therefor." December 19, 1911, a circular letter was addressed to the secretary of the American Medical Association and to the secretaries of the leading medical colleges of the country outlining in a general way the proposed investigations and requesting the nomination, in each instance, by an appropriate committee of the faculty, of a biological chemist of recognized standing and ability. February 20, 1912, a circular letter was sent to each of the physiological chemists, recom- mended by the committees of the faculties referred to, giving a more detailed outline of the general proposition, requesting an expression of opinion as to the advisability of undertaking the study and an estimate of the cost. Only a few replies have been received so far. The general plan, however, is indorsed by Prof. Otto Folin of Harvard University, Prof. Victor Vaughan of the University of Michigan, Prof. A. E. Taylor of the University of Pennsylvania, and Prof. Ralph S. Lillie of the University of Pennsylvania. The secretarj 7 of the American Medical Association has expressed much interest and referred the letter to the council on therapeutic research. Prof. Otto Folin has furnished me with a list of the members of the Ameri- can Society of Biological Chemists. The proposed undertaking is one of considerable magnitude. Such a series of investigations would require at least a year and quite pos- sibly two or three years. A chemical analysis of the water is a simple 16 WATERS OF HOT SPRINGS OF ARKANSAS. proposition. The study of the physiological effects involving obscure changes in the metabolism of the Living body is an extremely difficult problem. It is quite within the bounds of possibility thai definite results could not be obtained. It therefore appears desirable to obtain an expression of opinion from a considerable number of com- petent men as to the advisability of undertaking the work and tbe probability of its yielding scientific data that will be of real value to the medical profession and through tliem to Buffering humanity. It is also believed that as lull indorsement of the plan should be secured as possible in connection with the effort to secure from Con- gress the necessary appropriation. 1 have accordingly prepared a circular letter, a copy of which is inclosed with the intention, if it meets witb the approval of the department, of forwarding a copy to every member of tbe American Society of Biological Chemists and to the professors who are occupy- ing the chairs of the practice of medicine and of therapeutics and materia medica in the class A medical colleges These are the men who are most directly in touch with the problems involved and with clinical medicine. It is believed that this plan wi 1 bring a sufficient number of replies rom competent sources to settle definitely any ossibl ■ question as to the advisability of undertaking tbe work. As it is impracticable with the clerical assistance available to promptly conduct the correspondence involved, I have the honor to request that the department have the circular letter multigraphed and that I be furnished, for inclosure, copies of the circular of general information and the medical director's annual report. The number of each required is as follows: Circular letter multigraphed 200 Medical director's annual report 200 Circular of general information 200 There has been forwarded to the department, under separate cover, 225 letter heads for the multigraphed letter. Very respectfully, Harry M. Hallock, Medical Director. Department of the Interior, Hot Springs Reservation, Office of Medical Director, Hot Springs, Ark., Sir: The Secretary of the Interior is considering the advisability of conducting a series of experiments for the purpose of determining the physiological effects of the water of the hot springs of Arkansas. The faith of the laity in its remedial and curative properties is well established, and a steadily increasing number come to the springs each year for treatment. There are now upward of 100,000 visitors annually. Through the establishment of the office of the medical director there is now direct medical supervision over the administra- tion of the baths and an earnest effort is being made by the Federal Government to place the medical service on a high ethical plane. As part of this general policy it is thought that a study of the physio- logical effects of the water is of first importance. WATERS OF HOT SPRINGS OF ARKANSAS. 17 A complete chemical examination has been made by Prof. J. K. Haywood of the Bureau of Chemistry of the Department of Agricul- ture and by Prof. Walter Harvey Weed of the United States Geolog- ical Survey. In 1905 the department secured the services of Prof. B. B. Boltwood and Prof. Joseph Hyde Pratt for further analysis. Their report contains the following conclusions: (1) The waters of the springs on the Hot Springs Reservation are all radioactive to a marked degree. (2) The radioactivity of the waters is due to dissolved radium emanation (a gas) and not to the presence of salts of radium or other radioactive solids. (3) The tufa deposited by the springs does not contain appreciable traces of radium. A letter has been received from the secretary of the council on pharmacy and chemistry of the American Medical Association stating that the council's committee on therapeutic research has been plan- ning to secure the cooperation of scientists for a thorough study of the therapeutic value of mineral waters, and it is also noted that at the sixty-second annual session of the American Medical Association held at Los Angeles June 26 to 30, 1911, the following resolution was passed : Owing to the importance attributed to radioactive mineral waters in the treatment of gouty and other affections by competent European observers and the special inter- est excited by the symposium on the subject at the Thirty-second Balneologic Congress recently held in Berlin, the section on pharmacology and therapeutics of the American Medical Association requests the House of Delegates to suggest to the United States Government the advisability of investigating the radioactivity of the various mineral waters of the United States and publishing the results for the benefit of the medical profession. The arrangement contemplated by the Secretary of the Interior includes the securing of the services of a competent physiological chemist to work in conjunction with a commission of medical men. It is thought that investigations would extend over one and possibly over several years. It is believed that an appropriation from Con- gress can be obtained for the purpose and that the cooperation of the Medical Departments of the Army, of the Navy, and of the Marine-Hospital Service can be had, together with the facilities of the Army and Navy General Hospital at Hot Springs. It is not desired to enter this field for commercial exploitation but to determine the legitimate therapeutic value of the water, and to secure the respect and support of the medical profession with a view to the development in our own country of a spa that will compare favorably with resorts of like character abroad. Before requesting an appropriation from Congress for this work it is desired to obtain from competent sources an expression of opinion as to whether there is a reasonable probability that a series of bio- chemical investigations conducted by competent observers upon ani- mals and upon human beings, both the sick and the well, would yield results that would be of value to the medical profession and through them to suffering humanity. In other words, is the subject a legiti- mate and proper one for scientific research from the standpoint of clinical medicine. There are inclosed for your information certain reports and papers relative to the subject, and it is hoped you will favor the department with an expression of your opinion. Should you advise that the 56511— H. Doc. 905, 62-2 -2 1 s WATERS OF HOT SPRINGS OF ARKANSAS. work be undertaken, any recommendations von may be willing to submit as to the best method of procedure will be carefully considered. Thanking you for any assistance thai you may be able to render, 1 beg to remain. Very truly, your-. Harry M. Hallcm k. Medical Direct The Umvkksity OF 1i.ii.noi>. Urbana, III, March SI, 191$. Dr. Harry Hallock. Medical Director, Hoi Springs 11 ( novation, Hot Springs, Ark. My Dear Dr. Hallock: Your com muni cation concerning the proposition to ask Congress for an appropriation to cover the expense of an exhaustive investigation into the physiological effect of the hot springs water has just reached me. A thoroughly scientific study of a far-reaching character of this most important topic would without doubt yield data of immense importance to the physical welfare of the citizens of our own and other countries. I was extremely gratified when the American Med- ical Association in session at Los Angeles passed the resolution to which reference is made in your letter. The pronounced benefits to be derived from the proper use of water both externally and internally have not been fully appreciated by the medical fraternity, to say nothmg of the laity. For a period of two to three years we have been devoting considerable time to the question of physiological effect of ingested water. Under separate cover I am sending you reprints of some of our publications. Accord- ing to our data the free use of water with meals or between meals is of great benefit to the human organism from every standpoint inves- tigated. We have also been interested in the physiological effect of baths but have been unable to investigate the subject because of the fact that the investigations on water drinking and on fasting have demanded the major portion of the energy of myself and statF. In connection with one oi our studies we made a short superficial study of hot baths, using two normal men as subjects. The data are not yet in form for publication. I trust that you may be successful in convincing Congress of the very great need for an extended series of investigations such as you propose. I say "extended" advisedly for you wall most certainly need to investigate a large number of cases both normal and clinical over a considerable period of time before you will feel warranted in announcing your final conclusions. Work of this character to meet the approval of the scientific world must of necessity be done by men of proven ability. The experimental staff would of necessity be large in order to properly conduct an investigation of that character. It is my belief that a staff of 10 to 15 men with scientific or medical train- ing would be required to investigate such a problem from all sides, e. g., clinical, bacteriological, pathological, chemical, biochemical, and physiological. WATEKS OP HOT SPRINGS OP ARKANSAS. 19 I have outlined no definite plan of procedure but have simply at- tempted to impress one or two matters of prime importance in the preliminary organization of such an extensive study as is proposed. My personal scientific and research interests have always occupied channels such as must of necessity be followed by your hot springs investigation and for that reason it will give me great pleasure to be of any possible assistance to you in your attempt to interest Congress in this most worthy and humane proposition. Very sincerely, P. B. Hawk, Professor of Physiological Chemistry. American Medical Association, Council on Pharmacy and Chemistry, Chicago, December 23, 1911. Maj. H. M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: Dr. A. R. Craig, secretary of the American Medical Association, has referred your letter of December 19 to me. I am submitting your inquiry to the council and it will receive very careful consideration. It may interest you to know that the council's committee on thera- peutic research has been planning to secure the cooperation of scien- tists for a thorough study of the therapeutic value of mineral waters. Yours, truly, W. A. Puckner, Secretary. American Medical Association, Council on Pharmacy and Chemistry, Chicago, January 19, 1912. Maj. H. M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Shi: Your letter of December 19 having been referred to the council's committee on therapeutic research, the chairman, Dr. Torald Sollmann, asked me to reply that it would appear impossible to make any suggestions to you until more definite information is available regarding the intended scope of the investigation. He believes that it is doubtful that the physiological effects of the waters could be determined by one individual — certainly not by a physio- logical chemist. It is Dr. Sollmann's opinion that it would probably require a commission working through a series of experiments extend- ing over some years. If the council or its research committee can give you any further aid it will be glad to do so. Yours, truly, W. A. Puckner, Secretary. 20 WATBBS OF HOT SPRINGS OF ARKANSAS. Department of the I ntebiob, Hot Springs Reservation, ( m in e of Medical Director, Hot Springs, Ark., February 20, 1912. Mr. W. A. Pu< ener, retary American Medical Association, ( Tiicago, 111. Deaf. Sir: Replying to your letter of January 19, 1912, in answer to my inquiry of December 19, 1911, on the subjecl of the deter- mination of the physiological effects of the waters of the hoi springs of Arkansas, you state — Dr. Torald Sollman asked me to reply thai it would appear impossible to make any suggestions to you until more definite information is available regarding the intended scope of the investigation. He beli< ves that it is doubtful that the physioloirieal effects of the waters could be determined by one individual certainly not by a phys- iological chemisl . Et is 1 >r. Sollmann's opinion that it would probably require a com- mission working through a series of experiments extending over some years. If the council or its research committee can give you any further aid. it will be glad to do so. The therapeutic value of the springs in certain conditions appears to ho well established by popular concensus of opinion of the many who have been benefited ana by physicians who have had an oppor- tunity to observe the effects of the use of the water. Heretofore commercialism has had an undue influence in local conditions and in the administration of the baths. Direct medical supervision was established September, 1910, by the creation of the office of medical director, and an effort is now being made to develop, along legitimate and ethical lines, whatever therapeutic resources are inherent in the waters and in the resort. It i-- believed that an appropriation can be obtained from Congress for the purpose of conducting a series of experiments to determine the physiological effect of the water, and that such work could be undertaken by a commission consisting of a physiological chemist, the medical director of the reservation, the Federal registration board, all of whom are practicing physicians familiar with the use of the waters, and possibly one or more members of the county medical society. It is thought that the facilities of the Army and Navy general hospital could be obtained and possibly the cooperation of members of the medical departments of the Army and Navy, and of the Marine-Hospital and Public-Health Service. It is assumed that the work would extend over a considerable period. The most important point to determine at present is whether it is worth while to undertake this work: whether there is a reasonable probability that a study of the blood, the excretions, etc.. in health and in disease, would give data as to the physiological effect sand indications for the administration of the water that would be of value of the medi- cal profession of the country and through them to suffering humanity. There are inclosed certain reports and papers that have some bearing on the subject, and if the council or its research committee would be willing to express an opinion as to the advisability of attempting this research along the lines suggested, or on any modifi- cations of them, their action, opinion, or recommendation would be valued highly and most carefully considered. Very respectfully, Harry M. Hallock, Medical Director. WATEES OF HOT SPRINGS OF ARKANSAS. 21 American Medical Association, ' Council on Pharmacy and Chemistry, Chicago, February 23, 1912. Dr. H. M. Hallock, Hot Springs Reservation, Hot Springs, Ark. Dear Dr. Hallock: I have received your letter of February 20 and shall transmit it to the council. Personally, I am very much interested in the proposed investiga- tion and I hope that the council may be of some aid in solving the problems. I will write you further as soon as the matter has received consideration. Yours, truly, W. A. Puckner, Secretary. Harvard University, Cambridge, Mass., December 22, 1911. My Dear Sir: Your letter of December 19, in regard to a physi- ological chemist to conduct some experiments with the water of the hot springs of Arkansas, has been received. I am referring it to the secretary of the Harvard Medical School, Dr. Channing Frothingham, jr., who will. I hope, be able to recom- mend to you a competent man. for the work. Sincerely, vours, E. H. Wells. Harry M. Hallock, M. D. Harvard University Medical School, Boston, Mass., December 27 , 1911. Dr. Harry M. Hallock. Dear Mr. Hallock: Your letter of December 19 is at hand, and I have referred it to Prof. Otto Folin, our professor of biological chemistry. I feel sure that he will be able to suggest some one to you if there is anyone available around this part of the country. Very truly, yours, C. Frothingham, Jr., Secretary. Department of Biological Chemistry, Harvard Medical School, Boston, January 2, 1912. Dr. Harry M. Hallock, Hot Springs, Ark. Dear Sir: Your letter to Harvard University regarding a bio- chemical investigation of the physiological effect of the hot springs water has been referred to me for an answer. In my opinion it is not possible to determine the "exact physiological effects" of that water with any such degree of certainty as to meet with general and unqualified acceptance. An investigation of the kind referre to 22 WATERS OF HOT SPRINGS OF ARKANSAS. would be very expensive and in t lie hands of a properly qualified and scientious expert might yield practically negative or at least very doubtful results. If von. after reading these comments, still believe thai your department is justified in having this work done and will let me know. J will send yon a list of the best men in the country qualified in the field involved. Very truly, yours, Otto Folin. Department of the Interior, Hot Springs Reservation. Office of Medical Director, Hot Springs, Ark., February 21, 1912. Prof. Otto Folix. Harvard ^f<(lical School, Boston, Mass. Sir: I beg to acknowledge and thank yon for your letter of January 2, 1912, with reference to the determination of the physiological effects of the water of the hot springs of Arkansas. In it you state: In my opinion it is not possible to determine the "exact physiological effects" of that water with any such degree of certainty as to meet with general and unqualified acceptance. An investigation of the kind referred to would be very expensive and in the hands of a properly qualified and conscientious expert might yield practically negative or at least very doubtful results. If you, after reading these comments, still believe that your department is justified in having this work done, and will let me know, I will send you a list of the best men in the country qualified in the field involved. The therapeutic value of the baths in certain conditions appears to be well established. The faith of the laity in the curative prop- erties of the water has steadily increased despite the unfavorable local conditions of the past, and many physicians believe that this resort is destined to become one of the great spas of the world. Before the creation of the office of medical director the medical features of the service were largely overshadowed by the commercial spirit. An earnest effort is now being made to place the treatment of patients and the administration of the baths on a high ethical plane and in developing the medical service it was thought that a study of the physiological effects of the waters should be undertaken. A part of the general plan was to secure the services of an expert physiological chemist to conduct a series of experiments working in conjunction with a commission to consist of the medical director of the reservation, the Federal board of medical examiners, and possibly one or more delegates from the county medical society. This work would probably extend over a period of a j r ear or more. It is believed that an appropriation can be obtained from Congress and that the cooperation of the Secretary of War, the Secretary of the Navy, and the Public Health and Marine-Hospital Service can be secured as well as such facilities as can be extended by the Army and Navy general hospital. I am in receipt of a letter from the secretary of the council on pharmacy and chemistry of the American Medical Association stating that the council's committee on therapeutic research has been plan- ning to secure the cooperation of scientists for a thorough study of WATERS OF HOT SPRINGS OF ARKANSAS. 23 the therapeutic value of mineral waters, and I also note that at the sixty-second annual session of the American Medical Association held at Los Angeles, June 26 to 30, 1911, the following resolution was passed: Owing to the importance attributed to radioactive mineral -waters in the treatment of gouty and other affections by competent European observers, and the special interest excited by the symposium on the subject at the Thirty-second Balneologic Congress recently held in Berlin, the section on pharmacology and therapeutics of the American Medical Association requests the house of delegates to suggest to the United States Government the advisability of investigating the radioactivity of the various mineral waters of the United States and publishing the result for the benefit of the medical profession. The water of the hot springs has been examined by Profs. B. B. Boltwood and Joseph Hyde Pratt, chemists, of New Haven, Conn., as to its radioactivity and their report contains the following con- clusions : (1) The waters of the springs on the Hot Springs Reservation are all radioactive to a marked degree. (2) The radioactivity of the waters is due to dissolved radium emanation (a gas) and not to the presence of salts of or other radioactive solids. (3) The tufa deposited by the springs does not contain appreciable traces of radium. The first point to determine is whether there is a reasonable proba- bility that such a series of investigation would yield results of value to the medical profession and through them to suffering humanity. It is not desired to enter upon a fool's errand or to undertake the work with any view toward commercial exploitation, but rather to determine the legitimate therapeutic value of the water and of the resort and to obtain the respect and support of the medical profession in the development in our own country of a spa that will compare favorably with the resorts of like character abroad. There is inclosed for your information certain reports and circu- lars bearing on the subject in a general way, and if after reading this more detailed explanation you are willing to advise as to whether or not the department would be justified in taking up this work you would confer a service that would be greatly appreciated. Very respectfully, Harry M. Hallock, Medical Director. Department of Biological Chemistry, Harvard Medical School, Boston, February 27, 1912. Dr. H. M. Hallock, Hot Springs, Ark. Dear Sir: Your letter of February 21, together with the reports and circulars on the hot springs water, has thrown new light on the subject so far as I am concerned. If the facts reported by Dr. Martin are substantially correct the effects of the water constitute a legiti- mate and important subject for research from the standpoint of metabolism as well as from the standpoint of clinical medicine. Before any serious metabolism work could be undertaken some- thing in the way of a chemical laboratory would have to be arranged for. That laboratory would not need to be large and would be of permanent value, for in a place of that sort where so many sick WATERS OF HOT SPRINGS OF ARKANSAS. people conic there should be faculties For making chemical examina- tion- in connection with the treatment of patients. As such it mighl be made practically self-supporting. I have never been in Hot Springs ana therefore have no idea as to the facilities now available. I believe that yon are justified in going ahead with the work of securing an appropriation from Congress for such work. You might perhaps go ahead with greater confidence after consult- ing with other experts in biochemistry. I, therefore, send you a list .»!' the members of the American Society of Biological Chemists. So far as the actual biochemical investigation is concerned it looks to me as though it would be accessary to virtually get two men. one of high standing and recognized ability to plan and direct the work in conjunction with the commission referred to in your letter, and an assistant to stay at Hot Springs nil the lime till the work is finished. All the mature and recognized men hold positions which they, of course, can not give ap for a temporary work like that involved at Hot Springs. There is a certain element of danger in that arrange- ment, too. unless the director also is required to spend a considerable time on the spot, and the assistant must be no beginner, for much will depend on his keenness and discrimination. If I can assist you further, don't hesitate to write me again. Very truly, yours. Otto Foi.ix. Dr. II. M. Hallock, Hot Springs, Ail. Department of the Interior. Hot Springs Reservation, Office of Medical Director. Hot Sjirings, Ark., March 4- 1912. Prof. Otto Folix, Harvard Medical College, Boston, Mass. Sir: I beg to acknowledge your letter of February 27, 1912, and desire to express my appreciation of your interest and to thank you for the assistance you nave so willingly given. In the last paragraph you state, ''If I can assist you further, don't hesitate to write me again." It is the desire of the department to have a bill introduced at the present session of Congress asking for an appropriation for carrying on the work of a commission in determining the physiological and therapeutic effects of the waters of the hot springs. The time is rather short and in all probability it will be necessary to determine the details of the work and to appoint the personnel at a later date. In order to determine the sum to be requested, however, it is neces- sary to have an estimate of the cost of the investigations. I am in receipt of a letter from the department which reads in part as follows: I have to request that you will take up the subject with the other members of the Federal registration board and submit a general outline as to the amount of money which you think .should be appropriated by Congress for this purpose, such appro- priation to include compensation of physicians employed, laboratory facilities, appli- ances, and hospital facilities in connection with the matter. WATEES OF HOT SPRINGS OP ARKANSAS. 25 In submitting the estimate of the amount to be appropriated for this purpose a lump sum will be asked for, out of which all necessary expenses, including compensa- tion of experts, etc., is to be paid, and it is also proposed to suggest to Congress that the Secretary of War, the Secretary of the Navy, and the Public Health and Marine- Hospital Service, be authorized to cooperate with this department in handling the subject, the entire matter to be under the supervision of the Secretary of the Interior. . It would be of material assistance if you would be willing to give at least an approximate estimate as to the necessary expenditures basing the figures on the work of such a commission for the first year, and also if you could express an opinion as to the number of years that would be required to complete the work. It is believed that hospital facilities can be obtained at the Army and Navy general hospital without cost other than the subsistence of patients. Information is especially desired as to the probable cost 'of the following items : Compensation of expert. Compensation of assistant. Chemical laboratory equipment and operation (exclusive of building) . Number and cost of animals used for experimental purposes. Number of healthy subjects to be employed for experimental purposes. Number of patients to be observed. Thanking you for any assistance you may be able to render, I am. Very truly, yours, Harry M. Hallock, Medical Director. Jefferson Medical College, Philadelphia, December 26, 1911. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Doctor: Your letter of December 19, 1911, will be referred to the appropriate committee of our faculty immediately after the termination of the holidays. Believe me, very truly, yours, Ross V. Patterson, M. D., Subdean. ■ Jefferson Medical College, Philadelphia, January 8, 1912. Harry M. Hallock, M. D., Medical Director, Hot Springs, Ark. Dear Sir: Your letter of December 19, 1911, has been referred to me to name a physiological chemist. I can heartily recommend, for the inquiry referred to, Prof. Victor Vaughan, M. D., University of Michigan, Aim Arbor, Mich. Respectfully, J. W. Holland, Professor of Medical Chemistry. 26 WATERS OF HOT SPRINGS OF ARKANSAS. I NIVKKSITY OF M KIIKi.VX . Department <»r Medicine and Surgery, * Ann Arbor, March .,'. 1912. Dr. Harry M. Halixm k, Medical Director, Hot Springs, Hoi Springs, Ark. Dear Doctor: Your Letter and the papers accompanying it have interested me very much. If it be true in any large number of cases that immersion of the body, or a part of the body, m water causes the body temperature to go several degrees higher than the temperature of the water, this is a most interesting question. It should certainly nvestigated. I know of no other water in the world of which this is true. I have made a study of some of the great medicinal springs, such as those <»f Carlsbad, and I am quite sure that there is not another water in the world that does anything like this. It seems to me that the matter is of enough importance to justify a thorough and scientific investigation. T wish to make the following suggestion: It seems to me that it would be well for a medical board to be convened at Hot Springs for a period of 10 days to make a preliminary investigation, and report to the Department of the Interior as to what, in the opinion of the board, should be done. This board might consist of a few medical officers detailed from the Army, Navy, and Public Health Service. If such a thing as this is done, I should like very much to be on' the board. 1 am a member of the Reserve Corps of the Army, and could be ordered on such service if the Surgeon General wishes. Please think this over and let me know what you decide about it. It as to me that this would be the best way to get at it. If it is decided to undertake a thorough study, such a board as I have men- tioned could map out the way in which the work should be done. Thanking you very much, and with best wishes, I am, Yours, truly, V. C. Yaughan. Department of the Interior, Hot Springs Reservation, Office op Medical Director, Hot Springs, Arl\, March 8, 1912. Prof. Victor Vaughan, M, D.. University of Michigan, Ann Arbor, Mich. My Dear Prof. Vaughan: I beg to acknowledge your letter of March 4. 1912. in reply to my inquiries of February 20, and to thank you for your interest and the careful consideration you have given the matter. Your suggestion as to the appointment of a preliminary board to be assembled at Hot Springs for the purpose of making a report to the department will be borne in mind. It will take some little time to arrange the details of the proposed investiga- tions but there is one point that it is greatly desired to have settled at once, and that is the amount of money that should be requested as an appropriation by Congress for carrying on the work. I am in receipt of a letter from the department which reads in part a- follow-: I have to request that you will take up the subject with the other members of the federal registration board and submit a general outline as to the amount of money WATEES OF HOT SPRINGS OF ARKANSAS. 27 which you think should be appropriated by Congress for this purpose, such appropria- tion to include compensation of physicians employed, laboratory facilities, appliances, and hospital facilities in connection with the matter. In submitting the estimate of the amount to be appropriated for this purpose a lump sum will be asked for, out of which all necessary expenses including compensa- tion of experts, etc., is to be paid, and it is also proposed to suggest to Congress that the Secretary of War, the Secretary of the Navy, and the Public Health and Marine- Hospital Service, be authorized to cooperate with this department in handling the subject, the entire matter to be under the supervision of the Secretary of the Interior. It would be of material assistance if you would be willing to give at least an approximate estimate as to the necessary expenditures basing the figures on the work of such a commission for the first year, and also if you could express an opinion as to the number of years that would be required to complete the work. It is believed that hospital faculties can be obtained at the Army and Navy general hospital without cost other than the subsistence of patients. Information is especially desired as to the probable cost of the following items : Compensation of expert. Compensation of assistant. Chemical laboratory equipment and operation (exclusive of build- ing). m /.., Number and cost of animals used for experimental purposes. Number of patients to be observed. Thanking you for any assistance you may be able to render, I am, Very truly yours, Harry M. Hallock. Medical Director. University of Michigan. Department of Medicine and Surgery, Ann Arbor, March 11, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Doctor: In reply to j^ours of March 8 I will say that it would be necessary to equip and supply a laboratory. There would have to be tables, sinks, shelves, benches for balances, at least two first- class balances, at least two good microscopes, a full set of chemicals, beakers, graduates, buretts, recording apparatus, drums, hi fact everything necessary for a first-class pharmacological laboratory. The research part of our pharmacological laboratory, not counting the part devoted to students, inventories about $5,000. This of course does not include the room nor the permanent equipment of the room. I should say for laboratory purposes there should be an appropriation of about $10,000. The director of the laboratory should have a salary of $5,000. There should be two good assistants, each of whom should receive a salary of $3,500. There should be two subassistants, each of whom should receive $2,000. There should be two laboratory servants, each of whom should receive $1,000. The cost of animals used for experimental purposes would not be less than $500. There should be not less than 200 patients under observation, while 25 normal persons should be used for controls. I can not give you any estimate as to what this would cost. The figures that I have given, 28 WATERS OF HOT SPRINGS OF ARKANSAS. except for Laboratory equipment . of course mean annual expenditures. 1 think provision should Be made for two years of work. ProbaDly this will give you enough to assist you in figuring out what appropriat ion you should ask for. If 1 can oe of further service to you in this matter please consider me at your command. Yours, truly, V. (\ Yaioiian. University of Pennsylvania, Philadelphia, December 22, 1911. My Dear Sir: I beg to acknowledge receipt of your letter of the 19th instant in regard to experiments with a view to determining the physiological effects of the water of the hot springs of Arkansas. I shall take pleasure in referring this matter to the dean of our school of medicine, with the request thai he be kind enough to make any suggestion that may be feasible in the matter. Believe me, very sincerely, yours, Edward Robins, Secretary. Harry M. Hallock, M. D., Medical Director, Department of the Interior, Hot Springs, Ark. University of Pennsylvania, Philadelphia, December 22, 1911. Mr. II. M. Hallock, Hot Springs, ArJc. My Dear Mr. Hallom: Your letter to the secretary of the Univer- sity of Pennsylvania lias been referred to me for reply. I would suggest to you the name of Prof. A. E. Taylor, our professor of physiological chemistry, medical school of the University of Penn- sylvania. You may know of him as one of the so-called Remsen board connected with the United States Department of Agriculture. He is at present in California but will return in about 10 days, and a letter addressed to him at the medical school of the University of Pennsylvania will reach him within a short time. If he can not per- sonally undertake the work, very possibly he can arrange to have it done under his direction by some of his assistants. Very sincerely, A. J. Smith, Dean. University of Pennsylvania, Philadelphia, February 23, 1912. Dr. H. M. Hallock Hot Springs, Ark. My Dear Dr. Hallock: In reply to your communication in reference to taking up work on a commission to investigate the waters of the hot springs, it will not be possible for me to give you any reply until I know more about it. How much time would be consumed? How much time would need to be spent there? Of course, scientific WATEES OF HOT SPRINGS OF ARKANSAS. 29 results could be reached by proper investigations. If you will let me know what would be expected I will be in a position to say whether I could be available. Thanking you, I am, very truly, yours, A. E. Taylor. Department of the Interior, Hot Springs Reservation, Office of Medical Director, Hoi Springs, Ark., February 28, 1912. Prof. A. E. Taylor, University of Pennsylvania, Philadelphia, Pa. Sir: Replying to jout letter of February 23, requesting further information as to the proposed investigation of the physiological effects of the water of the hot springs of Arkansas, I beg to saj- that it is believed that it would be necessary for whoever undertakes this work to be present in Hot Springs and to devote practically his entire time to it. It is thought that the series of experiments would extend over the period of one 3 T ear, and that by the expiration of that time it would be possible to determine whether it would be worth while to continue them longer. These observations would naturally be directed toward noting changes in metobolism, excretion, secre- tion, blood changes, and variation of vascular tension, both in the sick and in the well. The investigator would have largely to plan his own work, the object being to define if possible the legitimate therapeutic value of the water in the various forms of its administra- tion. There is at present more or less difference of opinion on all these points. It is desired to have the observations conducted in a way and by one whose work will be accepted by the medical profession as reliable and ethical to the general, and that we may have in our own country a spa that will compare favorably with places of like character abroad. The first point to be determined is whether by investigations of this character it would be possible to arrive at sufficiently definite results to warrant the undertaking. The second point to be deter- mined is an approximate estimate, as much in detail as practicable, of the cost. Very respectfully, Harry M. Hallock, Medical Director. Columbia University, College of Physicians and Surgeons, New York, January 18, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: Our faculty referred your letter of December 19 to Dr. William J. Gies, professor of biological chemistry, and Dr. Gies writes in reply as follows : I desire to nominate Jacob Kosenbloom, M. D., Ph. D., associate in biological chemistry, as a physiological chemist competent to conduct the proposed series of 30 WATERS OF HOT SPRINGS OF ARKANSAS. riments on the physiological effects of the water of the hoi springs of Arkansas, une that the work will oner such remuneration as would enable Dr. UoMinldooni • ■ ;ill his time an attention to the investigation. His thorough medical training and his extended chemical experience here, and his numerous Investigations of the pasl Eew years, convince me that he would be more than ordinarily competent to conduct the work to which the medical director of the Hoi Springs Reservation refers in his letter if !' 9, which you have submitted tome. I trust that this answers your inquiry of December 19. Yours, very truly, Saml. W. Lambert, Dean. Columbia University, College of Physicians and Surgeons, New York, Dec <', 1911. Dr. Harry M. Hallock. Medical Director, Hot Springs Reservation . Hot Springs, Ark. Dear Sir: Jn reply to your letter of December 19, I would state that your inquiry will be placed before the faculty of medicine at their meeting on Monday, January 15. Their decision will be com- municated to you as soon as possible after that meeting. Yours, very truly, Saml. W. Lambert, M. D., Dean. Philadelphia, Pa., March 1, 1912. My Dear Dr. Hallock: I have your kind letter. It would not be possible for me to undertake any such work as you have detailed. You have the correct plan, and I wish you success in it. Very truly, yours, A. E. Taylor. Columbia University, College of Physicians and Surgeons, New York, March 27, 1912. Dear Dr. Hallock: I have read with care and attention your communication of recent date and the documents that came with it. I am convinced that it would be in the public interest to conduct a thorough investigation on the waters in the hot springs of Arkansas. It is obvious that positive therapeutic value, if such is possessed by the waters, might oe clearly established by adequate investigation. It is just as clear that lack of curative properties would be shown by proper investigations if remedial qualities were lacking. Either result would provide knowledge of public utilit} r . Should it ultimately be decided to proceed with sucn work, it would give me pleasure to nominate Prof. William H. Welker, of this department, to take charge of it. Prof. Welker cooperated with me several years ago in a research on the effects of radium after its introduction into the body, and his training as a physicist, chemist, and biologist makes him particularly competent to conduct work of the kind in the proposed research WATEES OF HOT SPRINGS OF ARKANSAS. , 31 under consideration. Prof. Welker's family have for some time pre- ferred to live in a smaller city than New York, and I am confident you would, find him ready to accept appointment in this relation, providing it would make it possible for him financially to accept. Yours, very truly, Wii. J. Gies. University of Pennsylvania. Philadelphia, February 28, 1912. The Medical Dieectoe, Hot Speings Eeseevation, Hot Springs, Ark. Dear Sie: I have your letter of February 20, informing me of the plan, lately taken under consideration by the Secretary of the Inte- rior, of conducting a series of investigations in reference to the physi- ological action of the water at Hot Springs, and inquiring as to my opinion of the probable value of such an investigation and my own willingness to take part in it. In view of the number of persons who go to Hot Springs in hope of being benefited by the baths, I am decidedly of the opinion that such an investigation should be undertaken, and conducted com- pletely — and of course impartially — with the object simply of ascer- taining what definite and demonstrable physiological effects the water is capable of producing. There is no doubt that the reports of cures, and the claims made by persons whose health has been improved while or after taking the baths, are often highly inaccurate and mis- leading. Post hoc is not propter hoc, and the only way of finding whether any connection exists between the properties of the water and the benefit gained by patients who undergo treatment at the springs is a scientific investigation conducted by entirely unbiased and properly qualified persons. There is no doubt that "the results of any such carefully conducted investigation would be of value both to science and to the medical profession. I am, however, not prepared to accept an appointment of the kind you describe. I am not a medical man, and I have never engaged in any investigations having a purely medical bearing, so that I feel myself unqualified to take part in an investigation of this nature. There are, however, a considerable number of physiological chemists in the country who are primarily interested in the medical applica- tions of their science, and there would, I believe, be little difficulty in securing the services of one or more well qualified investigators. Thanking you for your courtesy, and appreciating the honor im- plied in your offer, I remain, Yours, very truly, Kalph S. Lillie. Columbia Univeesity Biochemical Association, New York, March 14, 1912. My Dear De. Hallock: Your letter of the 20th just received on my return to the city from a western trip. I tliink results could be obtained from the work you mention that would well commensurate with the expenditure involved. * * * 32 WATERS OF HOT SPRINGS OF ARKANSAS. It is impossible for me to state what the work would cost without a full knowledge of the exact scope of the work. Respectfully, Jacob Rosenbloom. Pennsylvania State College, Institute of Animal Nutrition, StaU College, Pa., March JO, 1912. Dr. IIarky M. IIali.ock. Malico I Director, Hot Springs lieservation. Hot Springs, Ark. Peak Sir: I am iu receipt of your letter of .March 1(5, and in reply would say that a scientific investigation of the therapeutic value of the wale:- of hot springs seems to me a very desirable undertaking, both as a means of increasing scientific knowledge of the general subject and as a practical measure to better utilize this natural resource. A> regards methods. I do not feel competent to make any sugges- tions other than the very obvious one that it is essential that the committee or commission charged with this work should be composed of men whose scientific standing and personal character will put the results of their work above criticism. If it is possible to secure such men. they would be more competent than anyone else to determine upon the methods to be followed, and if they were not competent to do this they would not be suitable members of a commission. Very respectfully, yours, W. P. Armsbt, Director. Catonsville, Md., March 21, 1912. Dr. H. M. Hallock, Hot Springs, Ark. Dear Doctor: For more than 20 years the physiological action of certain mineral waters has been a puzzle to me. I could not explain why a carefully prepared artificial imitation of certain nat- ural waters would not act alike, even when the natural water was not taken at the source but bottled and shipped away. The chemical analyses showed the same constituents in the same proportions, and yet I was forced to admit through evidence before my eyes that the physiological action of the waters was not identical. The thought sometimes occurred to me that our analytical methods were not* sufficient to show the presence of some agent or agents imparting such properties to the respective waters. It was, therefore, I might say. a relief to my troublecl mind when, through the wonder- ful discovery of radium and radioactivity a possible explanation might be found. From these remarks you may readily draw the conclusion that I am thoroughly in favor of an}' steps which may lead through a scientific study to definite results. Very truly, yours, Dr. W. Simon, College of Physicians and Surgeons, Baltimore, Md. waters of hot springs of arkansas. 33 Sheffield Laboratory of Physiological Chemistry, Yale University, New Haven, Conn., March 22, 1912. ' Dr. H. M. Hallock, Hot Springs, Ark. Dear Sir: In reply to your communication of the 16th concerning the advisability of making an experimental study of the influence of the hot springs waters upon the body, I would say that such a pro- cedure would be very desirable. Just at this time precisely this type of work is being carried forward in certain laboratories abroad, but they have not the opportunity or facilities that may be possible in the work proposed in your letter. The investigation would be of scien- tific value whatever the outcome, and in every sense is a proper and legitimate subject for research. Very truly, Frank P. Underhill. The Otho S. A. Spragtte Memorial Institute, Chicago, March 22, 1912. Dr. Harry M. Hallock, Hot Springs Reservation, Hot Springs, Ark. My Dear Dr. Hallock: From what I can learn in the communica- tions you have just sent me concerning the waters of the hot spring, it would seem most desirable that thorough investigation on the physiological action of the springs, both upon man and animals, be made under Government auspices, so that we may have unprejudiced and reliable information upon which to base future therapeutic use of the springs. It is my opinion, in reply to your direct question, that the subject is most decidedly a legitimate and. proper subject for scientific research not only from the standpoint of clinical medicine, but also from that of physiology. Yours, very truly, H. Gideon Wells, Director. Cornell University, Department of Chemistry, Ithaca, N. Y., March 19, 1912.. Dr. Harry M. Hallock, Medical Director, Hot Springs, Ark. Dear Sir: Your circular letter of March 16 came yesterday, and I have read it with great interest and care. Prof. J. K. Haywood, of the Bureau of Chemistry, who made the chemical analysis of the water of the hot springs, is a graduate of the chemical department of this university and a personal friend of the writer. I also know the other chemists you mention in your letter, and feel sure that their reports and conclusions are reliable and valuable. Something more is required, however, than a mere chemical analysis, and I think the arrangement contemplated by the Secretary of the Interior to secure the services of a competent physiological chemist to work in conjunction with a commission of medical men an excellent one. 56511— H. Doc. 905, 62-2 3 34 WATERS OF HOT SPRINGS OF ARKANSAS. 1( Beems to me thai the results of such an investigation would be of ii value, and 1 am of the opinion that the work contemplated is a tlmate and proper one for scientific research from the standpoint of clinical medicine. I would suggest that an attempt be mad* 1 to gel the Carnegie Institution and the Rockefeller Foundation for Medical Research Interested in the matter. Dr. Benedict, of the Carnegie Institution, has been investigating problems connected with metabolism and knows more about this subject than any other man in this country. Pr. Benedict is now in Boston, Mass., and I feel sure lie would be much interested in such an investigation as you contemplate. The Rockefeller Foundation has a very able corps of experts whose aid would be absolutely invaluable in such investigation. I have mentioned these institutions because any roiilts published by them would command attention ami be at once accepted by the medical profession. I suppose you arc familiar with the work Dr. Benedict has been doing with the calorimeter, ami I need not empha- size the importance 01 this kind of work in connection with the present investigation of the therapeutic value of these wati rs. Yours, very truly, W. R. Orxdorff, Professor of Organic and Physiological Chemistry. American Cltmatological Association, March 21, 1912. Pr. Harry M. Hallock, Medical Director. Mt Dear Sir: I beg to acknowledge your very kind letter of the 18th instant, and also your very interesting report for 1911 to the Secretary of the Interior, with other inclosures. I will reply later on to the subject referred to in your letter and as it is quite complicated I should give it consideration and see if some plan can not be outlined to afford a practical plan of investiga- tion. Very truly, Gut Hinsdale. Carnegie Institution of Washington, Nutrition Laboratory, Fenway, Boston, Mass., March 21, 1912. pr. Harry M. Hallock, Medical Director, Hot Springs, Ark. Dear Sir: I have your circular letter of March 16 with regard to investigations ot the therapeutic value of the water of the hot springs of Arkansas, and I have glanced through the literature that you have sent along with this letter. There is no difficulty in determining definitely by physiological tests the action of water, provided it has any. There is a great question in the minds of experimenters as to the influence of radium emanation on metabolism, and I must confess I feel very skeptical with regard to many of the experiment reports in the literature you sent me; inasmuch as the main claim to benefit from the hot springs water is their radioactivity upon metabolism. WATEKS OF HOT SPRINGS OF ARKANSAS. 35 This could only be done by persons trained in metabolic studies, par- ticularly studying the gaseous exchange, so as to make some estima- tion of the actual amount of metabolic activity. Unless such a series of experiments be made, I should look very much askance at any studies undertaken. If the United States Government wishes to send to the laboratory an accredited scientist to learn the technique of making these studies, I shall be very glad to accord him what facilities we can; other than that, we are not in a position to do anything. I am, very truly, yours, Feancis G. Benedict. Baltimore, March 22, 1912. Dr. Harry M. Hallock, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: In reply to your letter of March 18, I would state that I believe it would be an investigation of great value to have a study made of the action of the hot springs water, not only its effects on the body in health but also in diseased conditions and its effects upon metabolism. I believe that in order to be of any value such an investigation would have to be undertaken by a number of well-trained men, and that it would have to extend over a considerable period of time, and that an important part of the work would be to investigate the effect of the water in reference to any deleterious changes that it might cause. It seems that in certain diseases the water does harm rather than good. I have no special suggestions at this time to make regarding the scope of such an investigation, but certainly urge that it be under- taken with the view of placing these curative waters on a scientific basis, where they certainly deserve to be. Very sincerely, yours, John Ruhrah. Tulane University of Louisiana, New Orleans, March 25, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Doctor: I am glad to reply to your communication of March 18, but must necessarily do so in a very general way. I have always deplored the popular estimate of hot springs in their relation to syphilis, and have considered that more harm has been done to the victims of this disease through hot springs than through any other agent in modern times. The belief of the general public in the efficacy of the water of hot springs has created the impression that one or two "courses" there was all that was needed for a cure, and you know the results. I believe that the thorough investigation of hot springs in its rela- tion to syphilis is not only desirable but imperative for the good of the American people and for the education of the rank and file of the profession. It should be especially demonstrated that hot springs have advan- tages over ordinary hot baths or other thermal resorts, if such be 36 WATERS OF HOT SPRINGS OF ARKANSAS. the case, and 1 shall welcome the results of the efforts of the Govern- ment in this direction. It will require some time to obtain the proper results, and these should be derived from systematic experiments with groups of cases not only of syphilis hut of skin diseases and of those other ailments (like rheumatism, gout, etc.) which are now in the habit of being t reated at the springs. If 1 can be of any other service at any other time I shall he glad to sen e von. Very truly, yours. J. Radovbt Dyer, Dean. Boston. March 28, 191$. Dr. Harry M. 11 u. lock, lint Springs, Ark. My Dear Sib: 1 acknowledge with thanks the receipt of your favor of ' -arch 18. In reply to your question, 1 would give it as my opinion that the thorough investigation into the effects of the waters from the hot springs would certainly he a legitimate and proper subject for scientific research from the standpoint of clinical medi- cine. It seems to me very desirable to determine what effects these radioactive waters have on healthy animals and healthy human beings. It might be desirable also to determine whether or not these effects differ from those obtained by the use of ordinary waters at the same temperature as that from the springs itself. The medical world and humanity would be the richer for the possession of this knowledge. Very truly, yours, J. P. Sutherland. New York City, March 29, 1912. Dr. Harry M. Hallock, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: Your letter of 16th instant at hand. In answer to your question I am of the opinion that a carefully conducted investi- gation into the various effects of radioactive waters upon metabolism wotdd be of scientific value. But such a research would not be at all a simple one, and, in my opinion, the ordinary type of observation conducted on patients under treatment is devoid of scientific value. Only such studies as utilize the most perfect methods are worthy of consideration. These should be in the first place physiological, and then with these results as a basis some deduction might be made regarding pathological conditions. I should be interested in seeing such work done, but it is by no means certain that any practical result could be arrived at. Yours, truly, X. B. Foster. Brooklyn Institute of Arts and Sciences, Brooklyn Botanic Garden, March 27, 1912. Dr. Harry M. Hallock, Hot Springs Reservation, Hot Springs, Ark. My Dear Sir: Your letter of March 16, addressed to me at the University of Missouri, has been forwarded to me at my address as given above. WATERS' OF HOT SPRINGS OF ARKANSAS. 37 I am very much interested in the proposition to make a thorough investigation of the physiological and. therapeutic properties of the waters of the hot springs. It seems to me that it is a very desirable thing to do, not only because of its scientific interest, but also because it may be the means either of protecting the public against worthless expenditure of money for treatment of no value, or be of positive benefit in demonstrating the real efficacy of the hot springs baths for certain ailments or merely as a tonic. I should think the subject was one entirely legitimate and proper for scientific research, to be undertaken under Government auspices. In fact, it seems to me that it is unfortunate that such an investiga- tion has been so long delayed, in view of the fact that so many people have been led to look for relief and have spent considerable sums of money in that direction at the hot springs. I believe the investigating staff should include a physiological chemist, a physical chemist, and a practicing physician, and the data gotten together ought to include information with reference to the history of past treatments, with their success or failure for different diseases, not only at these springs, but also by comparison with similar springs abroad. Undoubtedly, if a competent force of investigators was appointed, the details of the investigation could very properly and advanta- geously be left to them. I should be very much interested to know what further steps are taken in this matter, and if I can in any way render any service in this connection I shall be more than glad to do so. Thanking you for the courtesy of addressing me on the subject, I am, Yours, very sincerely, C. Stuart Gager. KOCKEFELLER INSTITUTE FOR MEDICAL RESEARCH, New York, April®, 1912. Dr. Harry M. Hallock, Hot Springs, Ark. Dear Sir: Your favor of the 16th was received, and, with the accompanying paper, read with interest. The striking physiological properties of the hot springs assuredly deserve a thorough investiga- tion. For that I can suggest nothing better than the assignment of a properly equipped physiological chemist from the Department of Agriculture or the Public Health and Marine-Hospital Service to remain on the work until it has been completed to a satisfactory degree. Yours, very truly, Donald A. Van Slyke. Chicago, March 27, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Ark. Dear Doctor: I would say in reply to your inquiry that I am heartily in sympathy with the proposed investigation, under the auspices of the United States Government, of the physiologic effects of the waters of the hot springs of Arkansas. Am convinced that 38 WATERS OF HOT SPRINGS OF ARKANSAS. our national resources, climatic as well as balneologic, do not receive the attention and the study thai they deserve. Investigation conducted by persons commercially interested in a health resort are hardly likely to be of great scientific value, as per- sonal bias can not be eliminated even by good intentions. Such investigations should be conducted by the Government, and the results, good or had, published for the benefit of the people. Thanking you for the opportunity to express my opinion in this matter, I am, Yours, very truly. Bernard Fantus, M. D. WINNIPEG GENEEAL HOSPITAL, ^Yinnipeg, March 25, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Doctor : In reply to yours of March 16, 1 am much gratified that the effort is at last being made to put America's best-known spa on a scientific basis, as the taint of the Diamond Joe regime has probably been the greatest drawback the hot springs have ever had, and they have not been permitted to do the good of which they are capable. It would be of great value to the profession of the country if they could have a definite and reliable statement of the actual therapeutic value of the springs. While we know, of course, that the bulk of the good results of the foreign springs rests on a more or less scientific basis, the present day developments of radiotherapy indicate that if these springs arc really endowed with radioactivity they may become of great value. As to the method of investigation. Your letter suggests a physio- logical chemical investigation. I assume that this term is used in its broad application to include pharmacology and experimental thera- peutics, as it is with mineral waters particularly that physiological chemistry, or any chemistry alone, is extremely liable to lead us astray, the only thing of any great reliability being actual animal experimentation, followed by definite experimental therapy, for which I suppose the hospital would furnish sufficient material, after the animal experiments had suggested promising lines of procedure. If I can at any time be of service, I will be pleased to do so, not the least for the reason that while I am now under the British flag, I still hold my commission in the M. R. C. Yours, respectfully, W. P. Morrill, M. D., Superintendent. Madison, Wis., March 19, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: Yours of the 16th instant at hand. I would state to begin with that I am hardly qualified to answer authoritatively the questions asked. Reports of the work done abroad in determining WATEKS OF HOT SPRINGS OF ARKANSAS. 39 the effects upon metabolism of radioactive baths and drinking Waters does not seem to offer great encouragement in this field. A number of such investigations have been carried on, the reports of which have been published in the Zeitschrift for Experimentelle Pathologie Unci Therapie during the last few years. Very little, if anything, tangible has been found to indicate any deep-seated or definite effect upon metabolism. My own impression, therefore, is that much time mighfe be wasted in such investigation. On the other hand I should hesitate to express a positive opinion which might in the slightest degree discourage research along any line. This line seems so much less promising than many others in the field of preventative and curative medicine that I should personally prefer to see the Government appropriate money for more valuable lines of investigation. * * * I believe it is generally conceded that the cures effected by the well-known spas of Europe are to be attributed to the out-of-doof life enjoined on the patients, to the regular regimen of diet and sleep and exercise; to the simple, nutritious food provided, rather than to any inherent property of the waters themselves. It is possible* however, that these radioactive waters may prove beneficial in certain types of skin diseases. Very truly, yours, H. C. Bradley. Note. — Harold C- Bradley, assistant professor of physiological chemistry, merit of physiology, University of Wisconsin. United States Department of Agriculture, Office of Experiment Stations, Washington, D. C, March 27, 1912, Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, ^Ar-lc. Dear Sir: Your letter of March 16 was received, together with the additional data regarding the Arkansas hot springs. I am much interested in the subject and in the plans for future development, Without doubt biochemical studies of the effects of the waters would prove valuable. In my judgment, it is also important to study the effect of food conditions in combination with the waters. A number of years ago, an attempt was made in connection with the nutrition investigations or this office to compile experiments with men and animals in which the balance of income and outgo was determined usually in terms or nitrogen. As the work progressed it became evident that a very large number of studies had been made in which the effects of mineral waters and baths of different sorts and similar factors had been studied. . _ A considerable number of the articles abstracted were published in Russian, and others in French and German. Many additional reports have appeared since our bulletin was published, and it may safely be said that the total amount of literature existing on this subject is fairly large. In my opinion, this material might be very profitably collected and digested as a preliminary to and in conjunction with other studies, the Arkansas springs. 40 WATKRS OF HOT SPRINGS of ABKANSAS. T( might be possible to arrange for cooperation between your bureau and the Office of Experiment Stations, for such a project, should you think favorably or it. Trusting that it will prove of interest to you. the Division of Publi- cations has been asked to mail you under separate cover a eopy of Bulletin 15, " : ' the Office of Experiment, Stations, Dietary Studies in New York City in 1895 and 1896, which contains a summary of the data referred to above, and also a number of our general pub] f ions on food and nutrition topics. Very truly, yours, • ('. F. Langworthy, Chief of Nutrition Investigations. New Y(>i:k. March 23, 1912. Dr. H. M. IIallock, Medical Director. Dear Doctor: Your letter of the 15th instant has given me great satisfaction in that it is in line with efforts I have been making tor a long time to study the scientific and practical aspects of our abundant and numerous mineral waters. The latter, having been so long exploited by commercial enterprise, have fallen into desuetude because physicians have not observed the therapeutic results they had reason to expect from the too often false representations of adver- tisers and promoters. Moreover, medical men at some of these springs, being iu the employ of or at least dependent for patronage upon the proprietors of the springs, have not been as frank as was their real desire, in dissuading persons whose cases were not adapted to the waters of their particular resort from remaining. This is one reason for my hearty approval of the scientific investigation of the waters of Hot Springs and their clinical application under unbiased and skilled supervision. This may seem a singular reason, but I am convinced that if the definite and reliable result- that will surely accrue from the investigation you propose will stimulate other spring owners to follow your example, and the result will be the same splen- did one which has been achieved by the demonstrations of the Depart- ment of Agriculture to our farmers. Every good health resort will emulate your example, and there will ensue a renaissance in physical therapeutics which I have been in vain endeavoring to initiate. So far my result has been mainly to convince intelligent physicians that there is a physiological action of water which has not been sufficiently studied and that water may be applied therapeutically with success only upon the same physiological basis as digitalis or strychnia or other medicinal agents. Prior to the discovery of the effect of radio- activity in mineral waters, I have based ail hydrotherapeutic action on the thermis, mechanical, and (feeble) chemical excitation of the cutaneous nerve and vascular supply when used externally. In my article on ''Mineral springs," in the first edition of " Hares System of Practical Therapeutics." I stated that ''it is more important for the physician who sends a patient to the springs to know the mental composition of the doctor than the chemical composition of the water." Little confidence have I had in the latter. If radio- activity may be added to the feeble and often inert chemical con- stituents which are the boast of most of the springs, their therapeutic WATERS OP HOT SPRINGS OP ARKANSAS. 41 value will surely be vastly enhanced. I heartily indorse the plan contemplated by the Secretary of the Interior of securing the services of a competent physiological chemist to work in conjunction with a commission of medical men. I am convinced that there "is a reasonable probability that a series of biochemical investigations on animals and human beings, both the sick and the well, would yield results that would be of value to the medical profession, and through them to suffering humanity." The whole subject is of great promise from a clinical standpoint. Not having received the inclosures you refer to, I am not prepared to give you suggestions. I need not say that you will need physicians who have more than an academic acquaintance with hydrotherapy. Indeed, I discussed the subject of jour letter two summers ago with Surg. Gen. Torney, at his office in Washington, and recommended this investigation, advising that he send one of the Hot Springs staff to my clinic for observations on hydrotherapy. Very truly, yours, S. Baruch. The folio wing is an extract taken from booklet entitled, "The Suc- cess of Physical Eemedies in Pulmonary Phthisis as an Index of Their Value in Other Chronic Diseases," by Simon Baruch, M. D., of Xew York: [Reprint from the Medical Record, Aug. 13, 1904.] The celebrated health reports of Germany, which attract a multitude of people, more or less afflicted with chronic diseases, do not owe their well-earned reputation so much to the climate and chemical composition of the waters or other local condi- tions as is generally supposed. These useful therapeutic elements would be abso- lutely inefficient if their application were not directed by the medical men residing in these resorts, who have made it a life study to investigate the climatic and balneo- logical advantages of their respective springs, and have convinced their confreres in all parts of the world, by conscientious striving for the welfare of tbe patients com- mitted to their care and by the intelligent application of their respective local advan- tages, and by close attention to and guarding of the sanitary arrangements of the springs. It is really more important for the physician who sends his patient to health resorts or springs to know the mental composition of the doctor than to know the barometric characteristics of the climate or the chemical composition of the waters. As an example, let me cite the recent marvelous growth of Xauheim as a resort for cardiac cases, which is due to the studies of Dr. Theodore Schott and his conscientious selection of cases adapted for the Nauheim waters. By scorning mer- cenary methods, unfortunately prevalent at many resorts, he has builded better than he knew, for the town of Nauheim has since his death become the Mecca of patients from all parts of the world. It will retain its well-earned reputation so long as its physicians will utilize it judiciously, select the patients with care and firmly decline to retain cases not adapted, though the material interests of the resort may seem to suffer. [New York Sun, Mar. 26, 1912.] HOT SPRINGS RESERVATION. By Dr. S. Baruch, professor of hydrotherapy, University of Columbia. The enormous annual exodus to Europe of people suffering from ailments of various kinds, and especially from rheumatism and gout, involves so large an expenditure of money, time, and* comfort that it becomes a matter of public interest to ascertain if these can not be avoided or at least diminished to a great extent. The fact that our own country possesses mineral springs the water of which is second to none in efficacy for healing to those of Europe has often been pointed out by some of our physicians who are specially interested in this branch of medicine. No serious effort has, however, been made to demonstrate scientifically the curative value of 42 WATERS OF HOT SPRINGS OF ARKANSAS. waters. The resull has been thai the numerous health resorts of this country from Maine to California have lacked proper utilization except for commercial pur- . a method of exploitation which has damaged their repute and inclined med- ical men to avoid them in their practical application of mineral springe by reason of fantastic analyses, and the mosl extravagant claim.- of curative properties made by the owners. An awakening has come, however, manifested in the action of the New York I.' lature, which has acquired the Saratoga Springs as a State reservation, impelled thereto by the systematic robbing of the precious gases contained in the Saratoga spring waters by manufacturers or distributors of carbonic-acid gas. Ii became quite obvious that if this course continued these waters would become practically inert for medicinal purposes. This acl of the legislature was the first step in the ignition by the Stale of the immense value and importance of mineral springs to the welfare of the people. The development of this State reservation has been exceedingly slow and halting, probably from lack of appropriations. The commission appointed by the governor has not yet been successful in developing Saratoga as a health resort: it is to be hoped that ere long Saratoga may become as famous among physicians for the health-giving properties of its w aters as it was in its golden prime for its cuisines, its fine hotels, and good Bporte to the seekers after pleasure. Perhaps the action now being taken by the United States Government in developing the Hot Springs Reservation as a scientific health resort may stir up the Saratoga com- mission To emulate its example. For many years the hot springs of Arkansas have been famous for the treatment of rheumatism, gout, and other blood diseases. One hundred thousand visitors annually attest the efficacy of these waters. In order, however, to obtain the full benefit for the largest number, and to save many the trouble and expense of journeying to these springs without prospect of advantage, the Government has wisely determined to institute certain scientific experiments to ascertain definitely their true curative properties. A medical director has been _!ied to supervise the baths and the administration of the reservation. Under the direction of Surg. H. M. Hallock, of the Army Medical Department, analyses have been made by the agricultural and geological departments, and a recent investigation has led to the discovery of what is called by physicians "radioactivity " of positive type. This does not mean that radium exists in the water of the hot springs, but "radium emanation." a gas dissolved in the water, which is regarded by medical men of great value in certain diseases, has been found which affords a more mild though effective a> tion. This discovery is of marked importance: it places the hot springs of Arkansas on equality with, if it does not render them superior, to most of the renowned springs of Europe which claim radioactivity for their waters. That further observations on this subject, together with the practical application of the waters in disease, will be absolutely reliable and entirely free from commercial bias is guaranteed by the type of men under whose direction they will be executed. It is to be hoped that the Congress may grant any appropriation that may be called for to further the thorough investigations, scientific and practical, which are proposed. The outcome of the latter can not be overestimated. It will not only be of immediate value to the large number of sufferers who flock to these springs, but. what is more important, the systematic and scientific application of this mineral water will demon- -irate to owners of other springs and to physicians that the European methods of administration are worthy of imitation, especially when they will be improved by the infusion of the true American spirit of utility to the largest numbers. The develop- ment of this long-neglected field may inure to the lasting benefit of our people. The State University of Iowa, Department of Chemistry, Iowa City, March 18, 1912. Harry M. Hallock, M. D., Medical Director, Hot Springs, Ark. My Dear Sir: I have your letter of March 16 asking my opinion as to the desirability of an experimental study of the effects of the hot springs water upon animals and human beings. I regard it of the greatest importance to have such problems taken up if they can be properly studied. Tradition is the chief evidence WATERS OF HOT SPRINGS OF ARKANSAS. 43 that we have as a rule, and when some attempt has been made to investigate such questions it is too frequently not completed. As a requisite for conclusive results I think the subjects should be under control as to their diet, hours, etc. Lacking this I do not think very definite results can be obtained. I believe the matter should be taken up from both the clinical and physiological sides. From the latter I should like to see a thorough investigation made of the effects of the water upon metabolism, such as possible modification of amounts of excreted materials, urea, uric acid, ammonia, creatinin, total nitrogen, compounds of sulphur, phosphorus, etc. I hope that you may be successful in being able to take up the work. Yours, very truly, E. W. Rockwood. Department of the Interior, Hot Springs Reservation, Office of Medical Director, Hot Springs, Ark., March 25, 1912. Prof. Elbert W. Rockwood, Department of Chemistry, State University of Iowa, Iowa City, Iowa. Dear Prof. Rockwood: I beg to acknowledge your letter of March 18, 1912, and to express herewith my appreciation of the consideration you have given to my inquiries. All of the correspondence with reference to the proposed investiga- tion will be forwarded to the Secretary of the Interior in due time and I am sure that the officials of the department in Washington will appreciate your courtesy as much as I do. Very respectfully, Harry M. Hallock, Medical Director. Chicago, March 20, 1912. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Sir: I have your letter of March 16, 1912, containing a statement of the governmental control of Hot Springs Reservation and also your report to the Secretary of the Interior for 1911 and a copy of the pub- lications on the hot springs of Arkansas. I think that further investigations, biochemical and clinical, should be made of the waters of Hot Springs, Ark. In my opinion the sub- ject is a legitimate one and a proper one for scientific research for the purpose of making more practical the uses of the waters for patients. I wish that it were possible for the Government to more fully con- trol the uses of the waters by patients. If it were possible for the Government to cut out all outsiders and to conduct the bathing pavilions under complete governmental control, I believe it would remove many of the objections which now exist there. 44 WATERS OF HOT SPRINGS OF ARKANSAS. I appreciate very much what the Groremmenl has already done through the officials to remove and correcl as far as possible the former abuses which came through private interests of all kinds. Very truly, yours. Frank Billings. Note. — Frank Billings, dean Northwestern University Medical School; professor of practice of medicine, Rush Medical College; professor of medicine. University of Chicago. Chicago, March 19. 191 ?. Mr. Harry M. IIallock, Medical Director, Hot Spring*, Ark. My Dear Sir: I strongly urge that tests be made to determine the chemical, thermal, and radioactive variations of the waters of Hot Springs, Ark., for this is knowledge which the medical profession needs. More than that, 1 urge that a physiologist of experience be given facilities for determining the effects produced by the spring water when taken internally and when tised for bathing. Unless the pro- fession has this knowledge, the water can not be used in a scientific way. Something is known of its usefulness, but it is prescribed empirically not because it is known why it should be used. I hope the United States Government will make these investiga- tions. Not only will they be valuable for the development of the use- fulness of this spring, but doubtless much will be learned which will be useful in applying other spring waters. Very respectfully, yours. X. S. Davis. Note. — Nathan S. Davis, A. M., M. D., professor of principles and practice of medi- cine, North western University, Chicago, 111.; ex-president Chicago Medico-Legal Society: member American Medical and American Climatological Associations, etc. Rockefeller Institute for Medical Research, New York, March 27, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: Your letter of March 16, with the printed matter, was forwarded to me. I should be glad to be of assistance to you, but I know so little about the effects of springs on health that I am not in a position to make a definite statement or recommendation. Thanking you for your note, I remain, Yours, very truly, James Lee. Albany, X. Y.. March 25, 1912. Harry M. Hallock, M. D., Washington, D. C. My Dear Doctor : Your letter and reports concerning hot springs of Arkansas were duly received, and. while I do not claim to have any very expert knowledge of such matters, it seems to me that there can be little doubt that such an investigation as you propose would be of the greatest value in determining in what class of cases they could WATERS OF HOT SPRINGS OF ARKA.NSAS. 45 be resorted to with advantage. As in many other cases it is not pos- sible to tell beforehand in precisely what way they may turn out to be of the greatest use. Very truly, yours, Saml. B. Ward. Cornell University Medical College, New York, March 20, 1912. Dr. Harry M. Hallock, Medical Director , Hot Springs, Ark. Dear Sir: Replying to your note of March 16 regarding the possi- ble value of careful investigations with regard to the value of the baths of Hot Springs, Ark., I would say that I heartily approve of the idea. Of course the value of such work would depend upon the training of the head chemist who had the matter in charge. There is so- much that is published nowadays which is not properly controlled that it would be a great misfortune unless the work were conducted by a man whose knowledge of the problems to be attacked was of the most thorough and fundamental order. The recent work in Germany with regard to the value of radium emanations upon the destruction of uric acid in the body is of great suggestiveness, and it would be well if similar work could be done in this conutry, if placed in the hands of competent observers. Very truly, yours, Graham Lusk. Note. — Graham Lusk, Ph. D., Sc. D., F. R. S. (Edin.), professor of physiology, Cornell University Medical College. American Medical Association, Council on Pharmacy and Chemistry, Cleveland, Ohio, March 25, 1912. Dr. H. M. Hallock. Dear Sir: I have perused your letter to the council and to me, and also the printed matter, with interest. It appears to me^ that an investigation by a physiological chemist, working rn conjunction with a medical commission, holds forth promise of considerable usefulness. This investigation might bear on the following problems: Effect on temperature; effect on metabolin; effect on excretion of water, salts, metabolites, and drugs (Hg. iodid, plumbism, etc.); effect on circu- lation; effect on blood. These observations will be made on healthy and diseased subjects. Comparative experiments should be made with the hot and cooled waters, also with ordinary hot water, and with the springs and plain water taken internally. If some such program is submitted to the prominent laboratories where biochemical researches are in progress, it might facilitate the obtaining of the properly qualified investigator. Very truly, yours, TORALD SOLLMANN. 46 waters of hot springs of arkansas. Bureau of Animal Industry, Washington, D. C, April 1, 1912. Director Harry M. IIallock, Hot Springs, Ark. De \r Sib : I have your circular dated March 16. In reply to your question "Is a biochemical investigation * * * of the waters * * * a legitimate and proper one for scientific research from the standpoint of clinical medicine?" I beg to answer, in spite of my limited knowledge of the physiological effects of radium and its products, yes; provided, however, that those who arc in charge of the investigations realize that the most skillful physiological chemist working for a few years probably will not get results that will appeal strongly to anyone except scientists interested in just that line. I mean that I doubt whether practical results can justly be expected from one man working a few years. I believe that before results of a direct clinical value are obtained many men will have worked for many years. If a biological chemist were engaged in research at the hot springs, a very grave injustice might be done to him if he were regarded as incompetent because "practical results" were not forthcoming. I believe that the work should certainly be done — the more biochemists, the better— but let there be no expectation of anything definite for about 10 years. This is not too long. I used radium bromid (and barium bromid) in some metabolism experiments on dogs, and one of the results was to point out the endless labor and difficulty involved in working out the physiological and pharmacological action of a sub- stance like radium or its allied products. Permit me to emphasize the desirability of the work and the length of time it will probably take to arrive at results that are of "practical value." Respectfully, William W. Berg. April 2, 1912. Dr. Harry M. Hallock, My Dear Doctor: I most heartily indorse the efforts you are making to have tested the therapeutic value of the waters on the reservation. There seems every reason for believing that these waters will prove as beneficial, if not more so, than those in European countries. If I can aid you in securing the necessary appropriation by speak- ing to a few Members of Congress I will cheerfully undertake the task. Very truly, Samuel S. Adams, Georgetovm University. Note. — Samuel S. Adams, A. M., M. D., professor of theory and practice of medi- cine and diseases of children, Georgetown University. waters of hot springs of arkansas. 47 United States Department of Agriculture, Bureau of Plant Industry, Washington, D. C, March 20, 1912. Dr. Harry M. Hallock, Hot Springs, Ark. Dear Sir : I beg to acknowledge the receipt of your letter of March 16, together with the inclosures. I will give the matter my very best consideration and will communicate with you again as soon as I have opportunity to read the literature you sent me and to con- sider the whole question. I hope that you can give me a few days in which to turn the matter over in my mind. It is certainly of such importance as to warrant earnest thought. Moreover, while I am familiar with the literature of radioactivity in a general way, I wish to refresh my memory by reading again some of the recent work on the subject. In that way I hope I will be able to give you an opinion that will be worth more than if I should reply to your ques- tion at once. If, however, it is necessary for me to reply at once please do not hesitate to say so and I will do what I can under the circumstances. You will then hear from me again in the course of some days. Very truly, yours, Carl L. Alsberg, Chemical Biologist. Chicago, April 6, 1912. Dr. H. M. Hallock, Hot Springs, Ark. My Dear Dr. Hallock: In answer to your ' circular letter of March 15 regarding the scientific investigation of natural mineral waters, I would say that such investigations under Government supervision would undoubtedly be of enormous value to the people of this country, and that the value would gain in importance by having the work conducted jointly by the Government and a com- mittee of the American Medical Association, because this would insure the transmission of such results directly to the entire medical profession and through them to the public. Yours, very sincerely, A. J. OCHSNER, Professor Clinical Surgery of the Medical Department oj the University of Illinois. New York, April 4, 1912. Harry M. Hallock, M. D., Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Doctor : Please accept my thanks and appreciation of your letter of March 14 and my apologies for the delay in answering the same. I have been greatly interested to hear of the plan of instituting investigations of the physiological effects of the waters of hot springs. It is not so very long that attention has been directed to the radio- active qualities of European mineral springs, and the study of the 48 WATERS OF HOT SPRINGS OF ARKANSAS. subject is far from completed. Therefore then' seems to l>e no doubt biochemical investigation, conducted by competent observers, :ie actiou of the waters of hot springs upon animals and upon human beings, both the sick and the well, at t he springs, would result in the production of valuable scientific information beneficial to the medical profession in general and indirectly to suffering humanity. ; Lnvestigat ions conducted by officers of t be United Stales ( rovern- ment would command attention in this country as well as abroad, and would certainly he welcomed from the clinical standpoint. American mineral springs have heretofore been woefully neglected by the medical profession as well as by the American people. Meeting '■e<|iiest of the committee on therapeutic research of the American Medical Association for an investigation of the radioactivity of the various mineral waters, the plan indicated in your letter would un- doubtedly be welcomed and supported by the physicians of the entire country and largely contribute to a more genera] appreciation of our domestic watering pla< Under these circumstances it is to he hoped that Congress will make a sufficiently large appropriation for the purposes of such an investigation. Very truly, yours, Herman (i. Kixyrz, M. D. United States Department of Agriculture, • Bureau of Soils, Washington, D. C, April 11, 1912. Dr. H. M. Hallock, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: I have your letter of March 16 concerning the physio- logical effects of the water of Hot Springs, Ark. I am interested in what you write and believe that if the matter can be arranged satisfactorily a thorough investigation of the physio- logical effects of the waters would be of value. I have shown your letter to Prof. R. B. Moore, recently of Butler College, Indianapolis, and now of this bureau, who has published some work on the radio- activity of waters of this country, and he informs me that lie is quite well acquainted with the work you quote of Prof. B. B. Boltwood, and that the statement Xo. 3, "•The tufa deposited by the springs does not contain appreciable traces of radium," is not correct. At the time that Prof. Boltwood did this work the methods of detecting -mall quantities of radium were not as far advanced as they are at the present time. Prof. Boltwood's work on the radioactivity of the waters is reliable, but more recent investigations of .the tufa by Prof. Schlundt, of the University of Missouri, has disclosed the fact that some of the tufa is exceedingly active; in fact, in one case the sedi- ment in a spring is one of the most radioactive in the whole world. Therefore, before drawing any conclusions regarding the therapeutic value of the waters, it might be advisable to have the investigation as regards the radioactivity still further extended. Mr.' Moore is now in the Government service in connection with the Bureau of Soils. I am sure he will be glad to give you any advice or suggestions that you may desire in connection with this matter or in connection with the resolution adopted by the medical associa- WATEES OF HOT SPRINGS OF ARKANSAS. 49 tion at Los Angeles that the Government take up the investigation of the radioactivity of the various mineral waters of the United States. Yours, very truly, Oswald Schreiner, In Charge. New York University, University and Bellevue Hospital Medical College, New York City, April 17, 1912. Harry M. Hallock, M. D., Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: Your circular letter addressed to me at the Albany Medical College was forwarded to me at my present address above. I deem it extremely wise and would recommend by all means that an investigation as to the therapeutic value of the waters at the hot springs be made with scientific accuracy and under competent supervision. The exploitation of so many spas where remedial waters are dis- pensed at high cost both for services and living has had its effect upon the profession as well as the laity, and it is therefore, above all things, highly necessary that you become able to present scientific proof of the functional efficacy of the spring water. It would be impossible to give you an outline of a possible line of procedure, for that would entail months of study into the conditions of climate, composition of water, methods of ingestion, physiological effects, etc. I can simply call your attention to the importance which has quite recently been emphasized from various standpoints of the equilib- rium of salts which must exist and be held constant in the full-grown individual and the abnormalities of function which result from any disturbance of this equilibrium. Also the importance of certain salts, such as potassium compounds, for the proper growth of the young. All this is apart from the question of the therapeusis of radioactive substances. Any data which you may obtain in any of these fields will be of great value to the medical profession and would result in increased cooperation on their part. Very truly, Holmes C. Jackson. P. S. — If you are actually anxious for details in any specific matter I shall be glad to supply them. College of Medicine of Syracuse University, Syracuse, N. Y., April 18, 1912. Dr. Harry M. Hallock, Medical Director, Hot Springs Reservation, Hot Springs, Ark. Dear Sir: Your letter of March 16, addressed to Dean Heffron, has been handed to me, with the request that I make a reply. I am in hearty sympathy with any attempt which leads to estimating the 56511— H. Doc. 905, 62-2 4 50 WATERS OF HOT SPRINGS OF ARKANSAS. exacl physiological effects of the water al Hot Springs. ! believe that yon arc to be congratulated because of the fact that the Government is taking hold of this spa, and I consider it one of the duties of the Government to not only make the springs accessible to the people, but to so study them that the baths and water will be used only in a perfectly proper way. very truly, yours, W. 1). A^sever, Professor of Therapeutics. The University of Wisconsin, Department of Pharmacology and • Toxicology, Madison, Wis., April 24, 1912. Dr. Harry M. IIallock, . Medical Director, Hot Springs, Arl. Dear Sir: Due to serious illness in my family and my absence from the city, I have been unable to answer your letter earlier. I think a thorough study of the physiological effects of the water of hot springs and a determination of its therapeutic value would be very desirable. I can not make any recommendations "As to the best method of pro- cedure," because I do not understand what you mean by this phrase. Scientifically, the work should determine the effect of the water on metabolism in health and disease, and physiological investigations of various kinds should determine the effect in detail of the water on the circulation and respiration in health and disease. Yours, very truly, A. S. 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