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Most Arkansans know that Hot Springs was among the nation's top health spas from the late 1800s through World War II. What hasn't been written about much is the fact that many of those who visited Hot Springs did so because they had or thought they had syphilis.

That's the subject of a fascinating book titled "In Search of Sexual Health: Diagnosing and Treating Syphilis in Hot Springs, Arkansas, 1890-1940." The book, written by Elliott Bowen, was released earlier this year by the Johns Hopkins University Press. Bowen, an assistant professor in the history of medicine and public health at Nazarbayev University in Kazakhstan, began his research during his graduate school days at Binghamton University in New York.

"For much of human history, syphilis, gonorrhea and other sexually transmitted diseases have been regarded as taboo subjects--as things that, if discussed at all, are discussed only among close friends or intimate acquaintances," Bowen says. "Thankfully, that has not been the case in the 10 years I've spent researching and writing this book. Over the past decade, my thoughts about Hot Springs and its experience with syphilis have benefited immensely from untold numbers of conversations with mentors, colleagues, archivists, friends, relatives and fellow researchers."

Bowen begins the meticulously researched book with a March 14, 1897, letter from a Baltimore man named G.W. Banks to a woman named Genie. Banks had learned from a newspaper in West Virginia that two men he knew--identified as Ross Hodges and Shepherd--had gone to Hot Springs. He knew why, writing that "all syphalitics [sic] go to Hot Springs."

"Whether Hodges and Shepherd ever reached their destination is unknown," Bowen writes. "Had they done so, they would have been only two of some 30,000 individuals to descend on Hot Springs in 1897, 70 percent of whom reportedly suffered from syphilis. According to local physicians, Hot Springs was a city 'where thousands come annually to be treated for syphilis,' many from 'hundreds of miles away.'

"Testifying to its popularity among sufferers of this venereal disease, one medical authority reported in the final decade of the 19th century on how 'syphilitic subjects by the thousands flock to the place from all parts of the United States.' It was for these reasons that late 19th century medical men began referring to Hot Springs as a 'mecca for syphilitics in America.'"

A Hot Springs doctor wrote in 1913: "We see every day, here in Hot Springs, from 10 to 100 persons" suffering from the "terrible disease."

"Over the course of the next two decades, some 60,000 syphilitic men and women traveled to this Southern city for treatment, a phenomenon that prompted one resident observer to note that 'to the average layman, Hot Springs means VD, and VD means Hot Springs,'" Bowen writes. "Only with the expanding availability of penicillin in the 1940s did this Arkansas locale's status as a therapeutic refuge for syphilitics come to an end. For more than a half-century, much of the United States' struggle with sexually transmitted illness ran through Hot Springs.

"The city was home to dozens of medical offices run by privately practicing venereal specialists, a military hospital whose surgeons treated the nation's syphilis-stricken soldiers and sailors, and a free VD clinic operated by the U.S. Public Health Service. Within these varied institutions, attempts to understand and overcome the debilitating disease took on an intensely local character. Despite considerable shifts in clinical practice during the 19th and 20th centuries, Hot Springs' response to syphilis drew more on the interactions of visiting health seekers, resort doctors and the city's permanent residents than it did on the writing of national medical authorities, the policies of the federal government or the beliefs of prominent cultural figures."

Bowen describes it as a period during which elites on the coasts "exercised increasing authority over all aspects of medical care." But Hot Springs--far from either coast--"played a key role in determining treatment norms, attitudes and parameters around syphilis."

One visitor described Central Avenue as a place where one met "all kinds of cripples and diseased human beings." He wrote about men who walked from their boarding rooms to the bathhouses and back again.

"Here is a man with crutches, and he meanders slowly, and walks as though he were stepping on eggs; his joints are enlarged, and he is here working out a case of gonorrheal rheumatism," the visitor wrote. "Here comes the patient pushing his feet along, and with a cane in either hand, walking like a patient with a Potter's spine. He's recovering from a lesion of the spinal cord, of syphilitic origin."

Bowen tells of how developers began replacing the city's "miserable board shanties" with "palatial hotels," noting that Hot Springs became "a place of elegance and opulence, a fin-de-siecle paradise whose luxurious accommodations included hotels boasting porcelain tubs and long-distance telephones, parks replete with horseback and bicycle paths, tennis courts and golf courses, and numerous other places of amusement. ... Bathhouses became increasingly elaborate, updated with state-of-the art hydrotherapeutic gadgetry such as vapor cabinets, electrical massage and needle showers."

In the process, he writes, local officials "forcibly uprooted the city's poorer health seekers--those living in shanties or tents or found encamped under the trees with no other shelter."

--ā€“ā€“ā€“ā€“ā€“vā€“ā€“ā€“ā€“ā€“--

Senior Editor Rex Nelson's column appears regularly in the Arkansas Democrat-Gazette. He's also the author of the Southern Fried blog at rexnelsonsouthernfried.com.

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