In 1918 the Red Cross counted thirty million Americans (out of a total population of 105 million) as active supporters. Eight million Americans, nearly 8 percent of the entire population, served as production workers in local chapters. (The Red Cross had more volunteers in World War I than in World War II despite a 30 percent increase in the nation's population.) Women made up nearly all this enormous volunteer workforce, and they might as well have worked in factories. Each chapter received a production quota, and each chapter produced that quota. They produced millions of sweaters, millions of blankets, millions of socks. They made furniture. They did everything requested of them, and they did it well. When the Federal Food Administration said that pits from peaches, prunes, dates, plums, apricots, olives, and cherries were needed to make carbon for gas masks, newspapers reported, 'Confectioners and restaurants in various cities have begun to serve nuts and fruit at cost in order to turn in the pits and shells, a patriotic service' . Every American man, woman or child who has a relative or friend in the army should consider it a matter of personal obligation to provide enough carbon making material for his gas mask.' And so Red Cross chapters throughout the country collected thousands of tons of fruit pits - so many they were told, finally, to stop.
As William Maxwell, a novelist and New Yorker editor who grew up in Lincoln, Illinois, recalled, '[M]other would go down to roll bandages for the soldiers. She put something like a dish towel on her head with a red cross on the front and wore white, and in school we saved prune pits which were supposed to be turned into gas masks so that the town was aware of the war effort' . At all events there was an active sense of taking part in the war.'
*
The war was absorbing all of the nation. The draft, originally limited to men aged twenty-one to thirty, was soon extended to men aged eighteen to forty-five. Even with the expanded base, the government declared that all men in that age group would be called within a year. All men, the government said.
The army would require as well at least one hundred thousand officers. The Student Army Training Corps was to provide many of that number: it would admit 'men by voluntary induction,' placing them on active duty immediately.'
In May 1918 Secretary of War Newton Baker wrote the presidents of all institutions 'of Collegiate Grade,' from Harvard in Cambridge, Massachusetts, to the North Pacific College of Dentistry in Portland, Oregon. He did not ask for cooperation, much less permission. He simply stated, 'Military instruction under officers and non-commissioned officers of the Army will be provided in every institution of college grade which enroll 100 or more male students' . All students over the age of 18 will be encouraged to enlist' . The commanding officer' [will] enforce military discipline.'
In August 1918 an underling followed Baker's letter with a memo to college administrators, stating that the war would likely necessitate 'the mobilization of all physically-fit registrants under 21, within 10 months from this date' . The student, by voluntary induction, becomes a soldier in the United States Army, uniformed, subject to military discipline and with the pay of a private' on full active duty.' Upon being activated, nearly all would be sent to the front. Twenty-year-olds would get only three months' training before activation, with younger men getting only a few months more. 'In view of the comparatively short time during which most of the student-soldiers will remain in college and the exacting military duties awaiting them, academic instruction must necessarily be modified along the lines of direct military value.'
Therefore the teaching of academic courses was to end, to be replaced by military training. Military officers were to take virtual command of each college in the country. High schools were 'urged to intensify their instruction so that young men 17 and 18 years old may be qualified to enter college as quickly as possible.'
*
The full engagement of the nation had begun the instant Wilson had chosen war. Initially the American Expeditionary Force in Europe was just that, a small force numbering little more than a skirmish line. But the American army was massing. And the forging of all the nation into a weapon was approaching completion.
That process would jam millions of young men into extraordinarily tight quarters in barracks built for far fewer. It would bring millions of workers into factories and cities where there was no housing, where men and women not only shared rooms but beds, where they not only shared beds but shared beds in shifts, where one shift of workers came home (if their room could be called a home) and climbed into a bed just vacated by others leaving to go to work, where they breathed the same air, drank from the same cups, used the same knives and forks.
That process also meant that through both intimidation and voluntary cooperation, despite a stated disregard for truth, the government controlled the flow of information.
The full engagement of the nation would thus provide the great sausage machine with more than one way to grind a body up. It would grind away with the icy neutrality that technology and nature share, and it would not limit itself to the usual cannon fodder.
CHAPTER TEN
WHILE AMERICA still remained neutral William Welch, then president of the National Academy of Sciences, and his colleagues watched as their European counterparts tried to perfect killing devices.
Technology has always mattered in war, but this was the first truly scientific war, the first war that matched engineers and their abilities to build not just artillery but submarines and airplanes and tanks, the first war that matched laboratories of chemists and physiologists devising or trying to counteract the most lethal poison gas. Technology, like nature, always exhibits the ice of neutrality however heated its effect. Some even saw the war itself as a magnificent laboratory in which to test and improve not just the hard sciences but theories of crowd behavior, of scientific management of the means of production, of what was thought of as the new science of public relations.
The National Academy had itself been created during the Civil War to advise the government on science, but it did not direct or coordinate scientific research on war technologies. No American institution did. In 1915 astronomer George Hale began urging Welch and others in the NAS to take the lead in creating such an institution. He convinced them, and in April 1916 Welch wrote Wilson, 'The Academy now considers it to be its plain duty, in case of war or preparation for war, to volunteer its assistance and secure the enlistment of its members for any services we can offer.'
Wilson had been a graduate student at the Hopkins when Welch had first arrived there and immediately invited him, Hale, and a few others to the White House. There they proposed to establish a National Research Council to direct all war-related scientific work. But they needed the president to formally request its creation. Wilson immediately agreed although he insisted the move remain confidential.
He wanted confidentiality because any preparation for war set off debate, and Wilson was about to use all the political capital he cared to in order to create the Council of National Defense, which was to lay plans for what would become, after the country entered the war, the virtual government takeover of the production and distribution of economic resources. The council's membership was comprised of six cabinet secretaries, including the secretaries of war and the navy, and seven men outside the government. (Ironically, considering Wilson's intense Christianity, three of the seven were Jews: Samuel Gompers, head of the American Federation of Labor; Bernard Baruch, the financier; and Julius Rosenwald, head of Sears. Almost simultaneously, Wilson appointed Brandeis to the Supreme Court. All this marked the first significant representation of Jews in government.)
But Wilson's silent approval was enough. Welch, Hale, and the others formed their new organization, bringing in respected scientists in several fields, scientists who asked other colleagues to conduct specific pieces of research, research that fitted in with other pieces, research that together had potential applications. And medicine, too, had become a weapon of war.
*
By then a kind of organizational chart had develop
ed in American scientific medicine. This chart of course did not exist in any formal sense, but it was real.
At the top sat Welch, fully the impresario, capable of changing the lives of those upon whom his glance lingered, capable as well of directing great sums of money to an institution with a nod. Only he held such power in American science, and no one else has held such power since.
On the rung below him were a handful of contemporaries, men who had fought beside him to change medicine in the United States and who had well-deserved reputations. Perhaps Victor Vaughan ranked second to him as a builder of institutions; he had created a solid one at Michigan and been the single most important voice outside the Hopkins demanding reform of medical education. In surgery the brothers Charles and William Mayo were giants and immensely important allies in forcing change. In the laboratory Theobald Smith inspired. In public health Hermann Biggs had made the New York City Department of Health probably the best municipal health department in the world, and he had just taken over the state health department, while in Providence, Rhode Island, Charles Chapin had applied the most rigorous science to public health questions and reached conclusions that were revolutionizing public health practices. And in the U.S. Army, Surgeon General William Gorgas also had developed an international reputation, continuing and expanding upon George Sternberg's tradition.
Both the National Research Council and the Council of National Defense had medical committees that were controlled by Welch himself, Gorgas, Vaughan, and the Mayo brothers, all five of whom had already served as president of the American Medical Association. But conspicuous by his absence was Rupert Blue, then the civilian surgeon general and head of the U.S. Public Health Service (USPHS). Welch and his colleagues so doubted his abilities and judgment that they not only blocked him from serving on the committees but would not allow him even to name his own representative to them. Instead they picked a USPHS scientist they trusted. It was not a good sign that the head of the public health service was so little regarded.
From the beginning of their planning, these men focused on the biggest killer in war - not combat, but epidemic disease. Throughout the wars in history more soldiers had often died of disease than in battle or of their wounds. And epidemic disease had routinely spread from armies to civilian populations.
This was true not just in ancient times or in the American Civil War, in which two men died from disease for every battle-related death (counting both sides, one hundred eighty-five thousand troops died in combat or of their wounds, while three hundred seventy-three thousand died of disease). More soldiers had died of disease than combat even in the wars fought since scientists had adopted the germ theory and modern public health measures. In the Boer War that raged from 1899 to 1902 between Britain and the white settlers of South Africa, ten British troops died of disease for each combat-related death. (The British also put nearly a quarter of the Boer population in concentration camps, where 26,370 women and children died.) In the Spanish-American War in 1898, six American soldiers died of disease (nearly all of them from typhoid) for every one killed in battle or who died of his wounds.
The Spanish-American War deaths especially were entirely unnecessary. The army had expanded in a matter of months from twenty-eight thousand to two hundred seventy-five thousand, and Congress had appropriated $50 million for the military, but not a penny went to the army medical department; as a result, a camp of sixty thousand soldiers at Chickamauga had not a single microscope. Nor was army surgeon general Sternberg given any authority. Military engineers and line officers directly rejected his angry protests about a dangerously unsanitary camp design and water supply. Their stubbornness killed roughly five thousand American young men.
Other diseases could be equally dangerous. When even normally mild diseases such as whooping cough, chickenpox, and mumps invade a 'virgin' human population, a population not previously exposed to them, they often kill in large numbers - and young adults are especially vulnerable. In the Franco-Prussian War in 1871, for example, measles killed 40 percent of those who fell ill during the siege of Paris, and a measles epidemic erupted in the U.S. Army in 1911, killing 5 percent of all the men who caught the disease.
Those facts were of deep concern to Welch, Vaughan, Gorgas, and the others. They committed themselves to ensuring that the best medical science be available to the military. Welch, sixty-seven years old, short, obese, and out of breath, put a uniform on, devoted much time to army business, and took a desk in Gorgas's personal office that he used whenever in Washington. Vaughan, sixty-five years old and equally obese at 275 pounds, put a uniform on and became head of the army's Division of Communicable Disease. Flexner at age fifty-four put a uniform on. Gorgas had them all commissioned majors, the highest rank then allowed (regulations were changed and they all later became colonels).
They thought not only about caring for soldiers wounded in combat. They thought not only about finding a source for digitalis, which was imported from Germany (Boy Scouts gathered foxglove in Oregon and tests found it produced a suitable drug), or surgical needles (these too were all imported, so they set up a U.S. factory to produce them), or discovering the most efficient way to disinfect huge amounts of laundry (they asked Chapin to look into this).
They thought about epidemic disease.
*
The single man who had the chief responsibility for the performance of military medicine was Surgeon General of the Army William Crawford Gorgas. The army gave him little authority with which to work (not much more than Sternberg had had. But he was a man able to accomplish much in the face of not only benign neglect but outright opposition from those above him.
Naturally optimistic and cheerful, devout, son of a Confederate officer who became president of the University of Alabama, Gorgas took up medicine ironically in pursuit of another aim: a military career. After he failed to get an appointment to West Point, it seemed his only way into the army, and he took it despite his father's bitter opposition. He soon became entirely comfortable in medicine and preferred to be addressed as 'Doctor' rather than by rank, even as he rose to 'General.' He loved learning and set aside a fixed amount of minutes each day for reading, rotating his attention among fiction, science, and classical literature.
Gorgas had a distinct softness around his eyes that made him appear gentle, and he treated virtually everyone with whom he came into contact with dignity. His appearance and manner belied, however, his intensity, determination, focus, and occasional ferocity. In the midst of crisis or obstacles his public equanimity made him a center of calm, the kind that calmed and gave confidence to others. But in private, after encountering obtuseness if not outright stupidity in his superiors, he slammed drawers, hurled inkwells, and stormed out of his office muttering threats to quit.
Like Sternberg, he spent much of his early career at frontier posts in the West, although he also took Welch's course at Bellevue. Unlike Sternberg, he did not personally do any significant laboratory research. But he was every bit as tenacious, every bit as disciplined.
Two experiences epitomized both his abilities and his determination to do his job. The first came in Havana after the Spanish-American War. He did not belong to Walter Reed's team investigating yellow fever. Their work in fact did not convince him that the mosquito carried the disease. Nonetheless he was given the task of killing mosquitoes in Havana. He succeeded in this task (despite doubting its usefulness) so well that in 1902 yellow fever deaths there fell to zero. Zero. And malaria deaths fell by 75 percent. (The results convinced him that the mosquito hypothesis was correct.) An even more significant triumph came when he later took charge of clearing yellow fever from the construction sites along the Panama Canal. In this case his superiors rejected the mosquito hypothesis, gave him the barest minimum of resources, and tried to undermine his authority, his effort, and him personally, at one point demanding that he be replaced. He persisted (and succeeded) partly through his intelligence and insight into the problems disease presented, partly through
his ability to maneuver bureaucratically. In the process he also earned a reputation as an international expert on public health and sanitation.
He became surgeon general of the army in 1914 and immediately began massaging congressmen and senators for money and authority to prepare in case the country went to war. He wanted no repeat of Sternberg's Spanish-American experience. Believing his work done, in 1917 he submitted his resignation to join a Rockefeller-sponsored international health project. When the United States entered the war, he withdrew his resignation.
Then sixty-three years old, white-haired, with a handlebar mustache, and thin (as a boy he had been almost fragile, and he remained thin despite an appetite for food that rivaled Welch's) he took as his first task surrounding himself with the best possible people, while simultaenously trying to inject his and their influence into army planning. His War Department seniors did not consult his department on the sites for its several dozen new cantonments, but army engineers did pay close attention to the medical department in the actual design of the training camps. They too wanted no repeat of the mistakes that had killed thousands of soldiers in 1898.
But only in one other area did the army medical department receive even a hearing from War Department leadership. That was its massive campaign against venereal disease, a campaign supported strongly by a political union of progressives, many of whom believed in perfecting secular society, and from Christian moralists. (The same political odd couple would soon unite to enact Prohibition.) Gorgas's office recognized 'to what extremes the sexual moralist can go. How unpractical, how intolerant, how extravagant, even how unreasoning, if not scientifically dishonest, he can be.' But it also knew that one-third of all workdays lost to illness in the army were caused by venereal disease. That loss the military would not tolerate.
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