{"id":15301,"date":"2018-10-18T11:00:11","date_gmt":"2018-10-18T15:00:11","guid":{"rendered":"http:\/\/circulatingnow.nlm.nih.gov\/?p=15301"},"modified":"2022-08-03T11:48:48","modified_gmt":"2022-08-03T15:48:48","slug":"fit-to-fight-home-front-army-doctors-and-vd-during-ww-i","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2018\/10\/18\/fit-to-fight-home-front-army-doctors-and-vd-during-ww-i\/","title":{"rendered":"\u201cFit to Fight\u201d: Home front Army doctors and VD during WW I"},"content":{"rendered":"

By Susan L. Speaker ~<\/em><\/p>\n

\"A<\/a>
Wilbur A. Sawyer at city hall in Hanford, California, investigating a typhoid epidemic, April 1914
NLM Profiles in Science<\/em><\/a><\/figcaption><\/figure>\n

After the United States entered the World War in April 1917, Dr. Wilbur Sawyer<\/a>, a 37-year-old public health administrator with the California State Board of Health, joined the Medical Reserve Corps. Like many physicians, he hoped to see some service in Europe. And, like many physicians, he \u201cdid his bit<\/a>\u201d on the home front instead. Nearly forty percent of the U. S. Army Medical Corps\u2014doctors, nurses, sanitary engineers, and others\u2014served state-side. They examined new recruits, kept them \u201cfit to fight\u201d at the training camps and departure points, and cared for wounded troops sent home from the front. Sawyer, who had directed campaigns to control outbreaks of rabies, typhoid, and venereal diseases (VD) (as sexually transmitted diseases were then called) in California, took up his duties in the Venereal Diseases Section of the Surgeon General\u2019s Office in January 1918.\u00a0 For his first assignment, he worked with California colleague William Snow on a statistical study of VD rates in the army<\/a>, published in August of that year.\u00a0 His second assignment was to direct an innovative VD control experiment in the Newport News, VA Port of Embarkation from July through November.<\/p>\n

Control of disease, while it may have lacked the drama of battlefield medicine, was essential to the war effort: sick soldiers are liabilities\u2014they can\u2019t fight or carry out other duties, and they might infect others, further reducing available manpower. And one of the biggest disease challenges for medical officers during the war years was not common camp infections like measles or mumps, but sexually transmitted diseases, mainly gonorrhea and syphilis. \u00a0Long acknowledged as a drain on the military, the diseases accounted for more sick time than any other single ailment except influenza. With the drug therapies available at the time (arsphenamine and mercury compounds for syphilis and colloidal silver for gonorrhea) treatment could sideline a soldier for up to four weeks at a time, see details in Medical Department of the United States Army in the World War, Vol 9, chapter 7<\/a>.<\/em><\/p>\n

\"Poster<\/a>
Cartoon in “Venereal Disease Control in the Army,” in Journal of the American Medical Association<\/em>, August 10, 1918
NLM Profiles in Science<\/em><\/a><\/figcaption><\/figure>\n

Venereal diseases were especially hard to control because they were usually acquired outside the camps during soldiers\u2019 leave time, from prostitutes or other companions. \u00a0Traditional military culture had accepted drinking, gambling, and visiting brothels as normal, even necessary free-time activities in soldiers\u2019 often rough lives, and nearby communities made money from such businesses. Reducing military VD levels thus required a change of attitude among military commanders, plus cooperation from the communities near army and naval bases. Fortunately, as historian Allan Brandt relates in No Magic Bullet: A Social History of Venereal Disease in the United States since 1880<\/em><\/a>,1985, the military\u2019s needs dovetailed with a substantial VD control movement already underway in America. From the early 1900s, Progressive anti-vice reformers had campaigned against the morally degrading influences of alcohol, illicit sex, and gambling. In a parallel effort, medical and public health groups sought to frame VD as a public health problem, require reporting of cases, and educate the public about the health costs such diseases carried for individuals and families. The Bureau of Social Hygiene, established by John D. Rockefeller, Jr. in 1911, applied social science and scientific management principles to its expert investigations of vice and disease, completing four major studies of prostitution. In 1913, vice-control and public health advocates joined forces, forming the American Social Hygiene Association<\/a> (ASHA). Dr. Sawyer was an early member and became ASHA\u2019s recording secretary in 1915. Public health officers and reformers knew that a military build-up would vastly expand the presence and the dangers of vice and disease. They had had a preview of this during the Army\u2019s Mexican border campaign in 1916, when brothels and saloons appeared near the camps almost overnight and Army VD rates soared. Visiting ASHA investigators reported on the debauchery to Secretary of War Newton D. Baker, who subsequently ordered Army commanders to work with local communities to control the problems. When it became likely that America would enter the war in Europe, ASHA officials advised Baker to establish a commission to oversee U.S. training camps<\/a> and keep adjacent community areas \u201cdecent and respectable.\u201d He authorized the Commission on Training Camp Activities<\/a> (CTCA) in April 1917, with ASHA members in leadership roles.<\/p>\n

\"Caricature<\/a>
Will You Be a Free Man or Chained, 1918
National Library of Medicine #101447415<\/em><\/a><\/figcaption><\/figure>\n

The CTCA\/ASHA strategy for moral and medical salvation was multifaceted. First, they worked with state and local authorities to render prostitutes and other \u201cantisocial venereal disease carriers\u201d less accessible by strengthening anti-prostitution ordinances and enforcement; they closed brothels, dance halls, and saloons\u2014and often entire \u201cred light\u201d districts. They instituted routine testing and treatment of women arrested for prostitution, under quarantine. To reduce the number of potential VD vectors, they proposed to protect and rehabilitate \u201cweak-minded\u201d girls and women, providing permanent custodial care if needed. They taught courses on \u201csocial hygiene\u201d at the camps and published educational pamphlets<\/a> and posters<\/a>. They even made films, including the feature-length \u201cFit to Fight\u201d later re-titled \u201cFit to Win.\u201d And, through civic organizations like the YMCA, they provided alternative social and recreational facilities for soldiers and civilians of both sexes. At the same time, the Army strengthened its disease-reporting protocols. Medical officers examined the men every two weeks, checking for VD, and soldiers returning from leave were required to report any sexual contact, so that they could be given prophylactic treatment. They also followed up on the many soldiers who had entered the service with VD infections.<\/p>\n

\"Annual <\/a> <\/div> <\/div>
\"Annual <\/a> <\/div> <\/div>
\"Comparison <\/a> <\/div> <\/div> <\/div>
\"Percentage <\/a> <\/div> <\/div>
\"Annual <\/a> <\/div> <\/div> <\/div> <\/div>\n

Statistics from “Venereal Disease Control in the Army,” by William Snow and Wilbur Sawyer in <\/em>Journal of the American Medical Association, August 10, 1918<\/em>
\nNLM Profiles in Science<\/a><\/p>\n<\/blockquote>\n

Did such measures actually reduce VD rates?\u00a0 In 1918, at the Newport News Port of Embarkation in Virginia, the U.S. Army, and the ASHA\/CTCA collaborated in a community VD control demonstration project to find out. The project was funded by the Rockefeller Foundation, and ran for five months. The account of this project<\/a> in the official Army Medical Department history shows how the military\u2019s efforts evolved within a complex situation. Dr. Sawyer served as both director of the project and supervisor of non-military activities. Several of Sawyer\u2019s letters to his wife mention the project, describing the town as \u201camorous\u201d<\/a> and also giving an account of a trip to Richmond, Virginia where prostitutes had been rounded up for VD treatment<\/a>.<\/p>\n