History

CHAPTER 5

Disease in the Aftermath of War: Disaster Aid to Poland and Russia after World War I

In the aftermath of World War I, members of the Army Medical Department became involved in unusual foreign relief operations that resembled earlier battles with epidemics after the Spanish-American War. This postwar activity contributed very little to the definition of the Army`s medical assistance role; but it illustrated the variety of relief tasks that Army doctors could perform and further illuminated the complex motivations of the United States government in providing assistance.

Postwar Relief and America`s Sense of Humanitarian Mission

The unusual postwar medical missions occurred as part of a larger, comprehensive American relief effort, designed to reduce starvation and disease among European noncombatants during and after the First World War. To help them, several American private and governmental agencies furnished food, medical care, and other assistance. They did not do so solely for humanitarian reasons, however. On occasion, American relief officials frankly donated or withheld food to further American policy- not unlike the time ninety years earlier when the government had used similar tactics with the Creek Indians.

More important was the fact that the entire assistance program implied a decision by American leaders to employ humanitarian relief to encourage governments and ideologies compatible with those of the United States. Herbert Hoover, who directed the American effort, and his boss, President Woodrow Wilson, sought through American relief measures to prevent civil disintegration, preserve a liberal world order, and thereby check the spread of bolshevism. Hoover declared that his program was designed to "sustain the feeble plants of parliamentary government which had sprung up in all of these countries. A weak government possessed of the weapon of food and supplies for the starving people can preserve and strengthen itself more effectively than by arms." President Wilson agreed: "Bolshevism

is steadily advancing westward, it is poisoning Germany. It cannot be stopped by force, but it can be stopped by food."¹

With such statements, Hoover and Wilson displayed a political motivation for humanitarian relief that had rarely been so forcefully or clearly enunciated. Their thinking, however, did not differ drastically from that of earlier leaders who had supported, overseas relief as a means to gain commercial entry into an area or to demonstrate to the world America`s superiority. In fact, in the debate over a later phase of postwar relief-the decision to send aid to Russia during its famine, of 1921- the continuity with previous efforts was especially pronounced.

Some historians have argued that the relief effort in Russia was but a cleverly disguised attempt at counterrevolution, and such a goal probably influenced Hoover`s support for it. Yet few Americans shared Hoover`s hope that American aid would reverse the fortunes of Russian communism; rather, they suspended their hostility toward Russia`s new leaders for a time to ease the suffering of its citizens. Many probably agreed with New York, Congressman W. Bourke Cockran, who vividly evoked the traditional American sense of humanitarian mission.²

In 1921 Cockran told his colleagues in the House that he supported an appropriation for famine relief in Russia because it was a "measure of sound policy" and "of absolute necessity to the security of our civilization, which is seriously imperiled- aye, rocking on its foundation-by reason of conditions which must be remedied if it is to survive. "And, Cockran,

¹See George W. Hopkins, "The Politics of Food: United States and Soviet Hungary, March-August, 1919," Mid-America55 (1973): 245-70; Benjamin M. Weissman, "The American Relief Administration in Russia, 1921-1923: A Case Study in the Interaction between Opposing Political Systems," (Ph.D.), Columbia University, 1968), p.47. Quote from. Herbert Hoover, The Memoirs of Herbert Hoover: The Years of Adventure,1874-1920 (New York: Macmillan Co. 1951), p. 301, but see also pp.412-14,427. Wilson quoted in Weissman, "ARA in Russia," p. 37.For additional evidence on Wilson`s attitude, see Raymond L Bland and Frank M. Surface, American Food in the World War and Reconstruction Period: Operations of the Organizations under the Direction of Herbert Hoover,1914 to 1924 (Stanford: Stanford University Press, 1931), p. 30; Joan Hoff Wilson, Ideology and Economics: United Stares Relations with the Soviet Union, 1918-1933 (Columbia University of Missouri Press, 1974),pp. 6-7; John M. Thompson, Russia, Bolshevism, and the Versailles Peace(Princeton: Princeton University Press, 1966), pp. 15-16, 220.
²For a summary of the historiographical controversy, see Banjamin M. Weissman, Herbert Hoover and Famine Relief to Soviet Russia: 1921-1923(Stanford: Hoover Institution Press, 1974), pp. 188-89, but also Leo Eugene Chavez, "Herbert Hoover and Food Relief: An Application of American Ideology," (Ph.D. diss., University of Michigan, 1976), which stresses Hoover`s search for a new world order, and Wilson, Ideology and Economics, p, 7, which emphasizes its political intent. Even one of the scholars who stresses its, counterrevolutionary purpose admits the American Public considered it humanitarian relief. See Peter G. Filene, Americans and the Soviet Experiment, 1917-1933 (Cambridge: Harvard University Press, 1967),pp. 76-79. Another factor in the American decision may have been support for domestic grain prices. See Weissman, Hoover and Famine, p. 103,and Thompson, Russia, Bolshevism, and Versailles, p. 222.

continued, no one could "dispute the proposition that of the civilization which we call Christian, this country is at once the bulwark and the citadel, the latest fruit and the crowning glory." In a situation where a people are "starving before our eyes" and will "disappear under conditions too awful to describe or even to conceive" if not given food, he thanked God that "philanthropy is always included within the scope of duty to American patriotism." The United States must now act to preserve "an important part of the human family "and on all other occasions as well to bring "relief to the uttermost ends of the earth wherever the hand of God rests heavily upon His creatures." In evoking an American, God-given responsibility to provide relief for the world, Cockran unknowingly expanded on themes in speeches delivered by Clayton in 1845 and Jenkins in 1902.³

Cockran expressed the older tradition of American philanthropy, but Herbert Hoover gave it new form. Hoover directed all the major American agencies that tendered assistance in Europe, and his personality and goals shaped each one. During the first years of fighting in Europe, Hoover headed the private Commission for Relief in Belgium and after American entry into the war directed the government`s Food Administration. Following the armistic he continued the same efforts under the aegis of the American Relief Administration(ARA), a governmental agency that later became a private corporation. Through the four different bureaucracies, Hoover and the United States distributed more than 33 million tons of food at a cost of about $5 billon.⁴

In the ARA, Hoover`s staff included some soldiers, nearly all volunteer officers whose wartime enlistments were extended so that they could serve while still salaried by the government. Hoover also secured presidential approval to draw supplies from the surplus stocks of food and equipment the Army had at the end of the war. Even with this Army aid, Hoover`s relief operations were always civilian, not military, programs. They could not precisely be called disaster relief, and only rarely did they involve Army Medical Department personnel. On three occasions, however, Hoover did summon the Army and its, doctors to perform relief missions- and two of them involved disaster relief.⁵

³Quote from Congressional Record, 67thCong., 2d sess., 1921, pp. 470-71; see also pp. 452-58, 556-58, 574-81.
⁴Curti, American Philanthropy, pp. 224-300; Robert D. Cuff, "Herbert Hoover, the Ideology of Voluntarism and War Organization during the Great War," Journal of American History 64 (1977):358-72; Chavez, "Hoover and Food Relief"; Bland and Surface, American Food, passim, statistics from pp. 274-75.
⁵On Army involvement in the ARA, see Bland and Surface, American Food, pp. 52-55; Herbert Hoover, An American Epic, 4 vols. (Chicago: H Regnery Co., 1959-64), 2: 247-49 274-79, 373; Hoover, Memoirs, pp. 306, 319.

In 1919, Hoover asked the Army to conduct what would later come to be called a nation building mission. Near East Relief, a private philanthropic organization, discovered its resources insufficient to strengthen Armenian its struggle for independence amid a flood of returning refugees, shortages of food, and the threat of a Russian invasion. Officials of the organization asked Hoover for government assistance, and in August 1919 he and President Woodrow Wilson dispatched a military mission under Col. William N. Haskell, a Regular Army officer. Haskell`s contingent included a medical department headed by Medical Corps officer Maj. Walter P. Davenport. Davenport and his American and Armenian staff provided hospital service for about 4,000people each month and significantly improved Armenia`s health care facilities. The American doctors also conducted a successful program of inoculation against typhoid and vaccination for smallpox, which reduced death rates from both diseases. Finally, they tried to improve sanitary practices in local communities but devoted less attention to that work and met with less success. Early in the summer of 1920, a Bolshevik invasion seemed imminent, and Haskell`s mission withdrew. Shortly after it did, the Russians overran Armenia.⁶

Typhus in Poland

Concurrently, and again at Hoover`s instigation, Army medical personnel undertook a second mission, one that did involve disaster relief. From the first months of World War I, typhus had been a threat in many areas of Europe. Transmitted by lice, typhus was a particularly painful and dangerous disease whose course ran from twelve to sixteen days, during which the victim suffered from high fever, a generalized rash, severe headaches, and nervous disorders. Historically, typhus epidemics had been associated with a cold climate, a starving population, and the movement of armies or refugees. All three conditions existed in Europe following the outbreak of War.⁷

Typhus was endemic in southeastern Europe, the Balkans, and Russia, and with the breakdown of social discipline in the area the disease spread

⁶On private efforts, see James Barton, Story of Near East Relief (1915-1930): An Interpretation (New York: Macmillan Co., 1930) or Robert L. Daniel, American Philanthropy in the Near East(Athens: Ohio University Press, 1970), pp. 148-70. On the Haskell mission, see Barton, Near East Relief; Bland and Surface, American Food, pp. 151-52; Hoover, American Epic, 3: 397-408; Walter P. Davenport, "General Health Conditions and Medical Relief Work in Armenia. "Military Surgeon 48 (1921): 139-58
⁷Melville D. Mackenzie, "Louse-Borne Typhus Fever, "in Medical Diseases of War, ed. Sir Arthur Hurst et al. (Baltimore: Williams & Wilkins Co., 1944), pp. 235-60: Hans Zinsser, Rats, Lice and History (New York: Blue Ribbon Books, 1934).

rapidly. In 1915 it ravaged Serbia, and by 1920 it had struck in Russia, Rumania, Lithuania, and the Near East. Poland- where typhus first appeared in the closing months of 1916 and raged for nearly four years- was one of the more severely afflicted countries. Multitudes of refugees fleeing Russia and the Ukraine repeatedly reinfected its people. In 1919 alone, more than 230,000 Poles contracted typhus, and nearly 20,000 died.⁸

In late March of that year, Hoover began receiving reports of the dire developments in Poland. Moved by the human suffering and fearful that typhus would spread to other parts of Europe, Hoover sought a means to check the epidemic. He may have considered relief a means to halt the spread of communism as well; certainly some Americans eventually sent to Poland considered stopping the spread of bolshevism a part of their task. In any case, Hoover verified the reports of suffering and investigated various means of sendingrelief.⁹

He found that the international community was only slowly responding to Poland`s plight. In the spring of 1919, the American Red Cross sent a delegation of about fifty relief workers. Later its contingent grew to more, than 150 people who distributed clothing, provided medical care, and helped the Poles establish preventive measures. That summer, the British Society of Friends also dispatched a small unit to Poland. Late in 1919and early in 1920, the League of Red Cross Societies sent two groups- one to aid in the treatment of the sick and to assist in the battle against the epidemic, the other to study the etiology of the disease.¹⁰

In the late spring and early summer of 1919, however, the expectation for sufficient private aid was extremely dim. Hoover determined that his

⁸Richard P. Strong, "The Anti-Typhus Campaign in 1915 in Serbia Considered in Connection with the Present Typhus Epidemic in Poland," International Journal of Public Health 1 (1920):188-210; Harry L. Gilchrist, "Typhus Fever in Poland," Military Surgeon 46 (1920): 622-29; Harold H. Fisher and Sidney Brooks, America and the New Poland (New York: Macmillan Co., 1928), p. 242; Richard P. Strong et al. Typhus Fever with Particular Reference to the Serbian Epidemic (Cambridge: Harvard University Press, 1920), pp. 94-98.
⁹Hoover, Memoirs, pp. 324-25; Fisher and Brooks, America and Poland, pp. 238-40. For participants` references to political motives, see Marjorie K. Snively, comp., The Battle of the Non-combatants: The Letters Dr. Harry Hamilton Snively to His Family from Russia, Poland, France, Belgium, Persia, etc., Assembled by His Daughter (New York: Business Bourse, 1933), p. 110; Ltr, Harry L Gilchrist to James Grindstaff, 27 Jul 20, box 2, American-Polish Relief Expedition (APRE), Record Group 120,NA. Also see Vernon Kellogg, "Poland, the Verge, of Bolshevism, "Atlantic Monthly 124 (1919): 126-31 William R. Grove, War`s Aftermath(Polish, Relief in 1919) (New York: House of Field, 1940), pp. 127-28,152-54, 191-92.
¹⁰Strong, Typhus Fever, pp. 98-104; E.W. Goodall, "Typhus Fever in Poland, 1916-1919," Proceedings of the Royal Society of Medicine 13 (1920): 261-76; Charles Halliday, "Conditions in Poland,1919-1920," Military Surgeon 51 (1922): 418-43; S. Burt Wolbach, John L. Todd, and Francis W. Palfrey, The Etiology and Pathology of Typhus: Being the Main Report of the Typhus Research Commission of the League of Red Cross Societies to Poland (Cambridge: Harvard University Press, 1922).

only recourse was to enlist the aid of the United States government. He expected no problems in arranging the sale of American stores to Poland but realized that the Polish government needed expert advice as badly as it did supplies. "The mere furnishing of equipment . . .," Hoover wrote the president, "will have little result unless it is handled by experienced men." The American Army had men who possessed the requisite expertise and experience, and Hoover urged their dispatch to Poland as an expression of America`s "sympathy for the distressed peoples of Central Europe." Wilson approved both the sale of equipment and dispatch of medical experts if Gen. John J. Pershing, commander of Army forces in Europe, concurred. Pershing did, and once Hoover had circumvented bureaucratic objections to the detailing of Regular Army officers, he secured his relief force.¹¹

To direct the Polish Typhus Relief Mission- in October 1919 redesignated the American-Polish Relief Expedition (APRE)- Hoover, apparently at Pershing`s suggestion, requested Col. Harry L. Gilchrist. A Medical Corps officer, Gilchrist had gained experience in public health work while serving in the military government of Manila and with disaster relief as part of the Army`s medical contingent in San Francisco after the earthquake. He had arrived in Europe with the first American units in World War I and stayed to direct the Medical Section of the American Expeditionary Forces Gas Warfare Service. More important, Gilchrist had commanded the Army`s delousing program in France after the armistice and so was familiar with typhus control. In the last days of June 1919, Gilchrist, who was still in Paris conducting research on gas warfare, received orders to organize a relief expedition and take it to Poland.¹²

Remaining in Paris and relying on second- or thirdhand reports of the epidemic, Gilchrist decided he would need at least 500 enlisted men and25 or 30 officers, 12 of whom should he medical officers. On 16 July the Secretary of War approved Gilchrist`s request for personnel and authorized the detail of the necessary officers and enlisted men, though he insisted Gilchrist accept only volunteers. Meanwhile, Gilchrist had begun to assemble his staff. He convinced Col. Harry H. Snively to serve as his

¹¹Hoover, American Epic, 2: 444-45.Quotes from Fisher and Brooks, America and Poland, pp. 240-41; Telg, Pershing to AG, 3 Jul 19, box 3, APRE, Record Group 120, NA. On a similar pattern of behavior by Hoover in a later disaster see Bruce Lohof, "Herbert Hoover, Spokesman of Humane Efficiency: The Mississippi Flood of 1927,"American Quarterly 22 (1970): 690-700.
¹²"Obituaries: Major General Harry L Gilchrist, U.S. Army Ret.," Military Surgeon 94 (1944): 122-23. After this study was completed, an extensive discussion of the APRE appeared; see, Alfred E. Cornebise, Typhus and Doughboys: The American-Polish Typhus Relief Expedition, 1919-1921 (Newark: University of Delaware Press, 1982).

deputy; launched a search for officers who spoke French, German, or Polish; and wired several posts seeking enlisted volunteers. For the most part the officers who responded, like Snively, had served in the Army`s delousing, program and therefore had the necessary expertise. The enlisted volunteers did not always possess the required skills, and some were not even of suitable character. But at least they were easily recruited, and by the end of July, Gilchrist had the number if not the type of men he needed. He and three other medical officers departed for Poland on 6 August, leaving Capt. Fred Pumphrey in charge of collecting and forwarding equipment and personnel.¹³

Pumphrey, a Sanitary Corps officer, inherited an irksome responsibility. The United States Army donated beds, hair clippers, portable baths, a million and a half suits of underclothes, and tons of soap to the Polish government. In addition, the Poles bought great stocks of surplus supplies from the American Expeditionary Forces, including numerous motorized bath plants, mobile steam laundries, mobile machine shops, portable bathing plants, trucks, ambulances, touring cars, beds, bedding, more soap and underclothes, and many other items. Pumphrey and his assistants were to advise the Polish government on acceptance of individual items in the huge purchase. But the Polish officer in charge, who Pumphrey alleged spent all of his time motoring about Paris with his lady friends, neglected to inspect the goods and even accepted damaged or useless equipment against the counsel of the American advisers.¹⁴

Once the Poles had accepted the purchases, Pumphrey had to ship the supplies to Poland, no mean logistical feat in an area recently ravaged by war. He sent some by rail; in all, thirty-three trains with a total of 1,291 cars carried supplies to Poland. But shortages of rolling stock necessitated transporting many of the vehicles and other parts of the purchase by motorcade. Unfortunately, the convoys were slow and expensive and the troops in them undisciplined. Many of the vehicles that had been accepted with mechanical problems broke down, and others were demolished in accidents caused by inexperienced drivers among Gilchrist`s volunteers. All along the route, citizens complained about the soldiers` rowdy behavior. One convoy commander, for example, dressed a group of French women in American uniforms and brought them along. When the "men under him reported to Warsaw undisciplined and a large number of them with

¹³Harry L. Gilchrist, Rpt. of the American-Polish Relief Expedition, 1 Aug to 31 Dec. 19, box 1, APRE, Record Group 120,NA. See also Telgs sent from the Paris office, box 8, APRE, Record Group120, NA.
¹⁴Hoover, Memoirs, p. 326; Strong, Typhus Fever, p. 100. Memo for Gilchrist by Fred Pumphrey, 1 Sep 19, box 1; Ltr, Gilchrist to Minister of Public Health of Poland, 29 Oct 19, box 4. Both in APRE, Record Group 120, NA.

venereal disease," the captain was court-martialed, convicted, and discharged.¹⁵

As Pumphrey struggled with purchasing and shipping supplies, Gilchrist began operations in Poland. He and the three medical officers arrived in Warsaw on 10 August and immediately met with the minister of health, through whom the Americans would coordinate their relief effort. After conferring with him, Gilchrist traveled about the countryside to observe conditions, discussed Poland`s problems with other Americans on the scene, and reviewed the lessons learned by the Army in earlier campaigns against plague, cholera, and yellow fever. Gilchrist concluded that his relief program had to achieve two interrelated goals: elimination of typhus-bearing lice and modernization of the Polish health care system. In its dual aim, his program resembled Army medical operations after the Spanish-American War. But in Poland, unlike Cuba and the Philippines in 1898, a national ministry of health had, already begun efforts to check the epidemic, so Gilchrist adapted his plans to it.¹⁶

To eliminate the lice, Gilchrist committed his relief force to the maintenance of a sanitary cordon along the eastern border of Poland, the project that Hoover had intended for the APRE all along. The APRE and Polish officials would operate facilities for cleaning and delousing everyone crossing the border to destroy the typhus-bearing lice before entering Poland. The Americans would also help eliminate typhus where it already existed through establishment of bathing and delousing plants in local communities and the operation of mobile columns to delouse residents of the remaining towns and villages.

Gilchrist also wanted to accomplish the second goal, modernization of the Polish health care system. That involved American participation in the reorganization of Poland`s various health agencies into one administration with a central committee to direct operations and functional departments to carry out it`s will. Gilchrist joined four Polish physicians on this central committee which was supported by departments of Propaganda, Transportation, Statistics, Hospitalization, Quarantine, Finance, and Schooling. This bureaucracy oversaw health and sanitation throughout Poland. To administer its policies, the committee and the minister of health created six districts of 18 to25 counties each and appointed resident chief medical officers for every county.

To provide "expert" advice, not only in typhus control but also in the administration of public health, Gilchrist assigned three Army physicians

¹⁵Gilchrist,Report of APRE; Ltr, Gilchrist to J.C. White, 11 Jun 20; Ltrs, Pumphrey to Gilchrist, 10 Sep 19, 29 Aug19. All in box 1, APRE, Record Group 120, NA. Quote from statement by Gilchrist,29 Jan 20, box 3, APRE, Record Group 120, NA.
¹⁶Ltr, Gilchrist to Surgeon General, 20 Aug 19, box 1, APRE, Record Group 120, NA.

to work with Polish medical officers at the district and county levels. Visiting the districts, the American doctors advised local officials on general sanitary conditions and inspected facilities and management in hospitals, orphanages, and other public institutions. To improve their services, other Americans distributed the supplies that had arrived from Paris and had been stored in a Warsaw warehouse to local hospitals throughout Poland. Still other members of the APRE established bathing and delousing stations in various towns and trained local citizens to operate them.¹⁷

Another facet of the modernization of the Polish health service- motorizing it- absorbed the energies of a large number of the American enlisted personnel. The Polish government had purchased a sizable fleet of mobile steam baths, trucks, ambulances, and assorted sedans. The lax inspection process at purchase, the long and rugged convoy to Poland, and the lack of spare parts which necessitated frequent cannibalization combined to make keeping the vehicles in operating condition a task beyond the capabilities of the Polish nationals, who had little experience with motorized vehicles. The American soldiers, not always the best of mechanics themselves, trained the Poles to operate, and repair their new equipment.

A chauffeurs` school graduated more than 300 Polish drivers from a twenty-day course, but in a school for mechanics training took longer and never really succeeded. Language difficulties complicated instruction, and even the use of pictures only slightly eased the confusion. Too often the Americans, who either did not speak Polish or lacked the necessary technical vocabulary, tired of the tedious process of explaining repairs to the Poles and simply performed the maintenance themselves. Certainly the temptation to do so grew as the months passed, language imbroglios continued, the Poles learned only gradually, and commanders ranted about slow service. When Americans yielded to the temptation, however, they achieved efficiency at the cost of subverting attempts to teach the Poles to operate a motorized healthservice.¹⁸

The soldiers participating in vehicle maintenance not only trained the Poles but also serviced many of the vehicles used in the second aspect of Gilchrist`s plan, the direct assault on lice. In the APRE`s first fall season in Poland, five Army medical officers assumed command at stations with bathing, delousing, and quarantine operations in the sanitary cordon

¹⁷"Information from Poland," Military Surgeon 46 (1920): 221-28; Gilchrist, "Typhus Fever," passim.
¹⁸"Information from Poland," passim; Rpt of the Service Department of the Motor Transportation Service, 1 Feb 20; Ltr, I.L. Hunt to commanding General, American Forces in Germany (AFG), 3 Mar 20; Ltr, Frank H. Dixon to Gilchrist, 14 Oct 20. All in box 1, APRE, Record Group120, NA. Ltr, Francis McFitts to All Units. 17 Oct 19, box 6, APRE, Record Group 120, NA.

along Poland`s eastern border. They worked at the important border crossings, while Polish officials administered the remaining posts. The program intended to clean and delouse everyone entering Poland, but between 1 November 1918and 1 January 1920, more than 2.5 million prisoners of war and civilian refugees entered the country. American and Polish officials did their bes against such odds, but the sanitary cordon was far from totally effective.

In addition to the cordon, the APRE utilized mobile field columns in its attack on lice. Each column had a staff of one commissioned officer, three noncommissioned officers, and fifteen privates and was equipped with a motorized bath plant, tents, stoves, bedding, and everything needed to support the staff and its operations. Gilchrist had initially considered sending 10 to 40 such units into the Polish hinterland but actually deployed only 4, which traveled from town to town in affected areas.

The commander preceded the column to each town and conferred with the medical officer and other local leaders. With his advice, they chose a site for the temporary bathing facility and set its hours of operation. Then the commander and the officials attempted to convince the residents to submit to the delousing program. Rumors proliferated about the "real" purpose of the columns, and in one town everyone fled fearing the baths were in preparation for deportation. In other instances, Polish reluctance stemmed simply from a natural fear of the strange and unknown. One old lady living in a filthy little shack could not be persuaded to participate. "Death here in my hovel," she reportedly cried, "rather than the torture of bathing." Such vehement opposition should not have surprised Army medical officers whose predecessors after the Spanish-American War had encountered similar mistrust when bringing modern health care to a people unused to it. Nevertheless, the Americans in Poland quickly became exasperated and forced the people to cooperate, usually by withholding bread from anyone without a certificate from the bathing units.¹⁹

As preliminary coordination was accomplished, the column entered the town or village. With the help of civilians hired locally, the soldiers pitched two tents in a line with showers near one end and a sterilizer positioned to one side. When the equipment was in place and the appointed hour had arrived, local residents- whether cajoled or coerced- reported in designated groups. The process began with clipping the people`s hair;

¹⁹Quote from Ltr, Howard J. Gorman to CO, 17Nov 19, box 1, APRE, Record Group 120, NA.

Snively told of one column that had four or five men who spent an entire day doing nothing else. "If long hair means Bolsheviki," he commented, "we are converting a big bunch every day." For many Polish Jews, long hair had a very different symbolic meaning, and in deference to their religious practices the Americans never insisted that they be shorn.²⁰

Clipped and unclipped alike then entered the tents, where American attendants, or Polish employees in the case of women, directed them through the showers and at the same time took and sterilized their clothes. Scarcity of water and the high cost of heating it necessitated strict regimentation in bathing; the attendants allowed each group only a short time under the showers. After their baths, the people dressed and left, clutching their bars of soap- a valuable commodity in Poland- which they were allowed to keep.²¹

Through this systematic procedure, each column bathed an average of500 people each day, and on some days as many as 800. In all, the four columns deloused 28,000 Poles, and no area in which they operated reported cases of typhus. Unfortunately, early winter storms forced the Americans to discontinue field operations in the first days of November. "From now on to May there will be intense suffering among these people,"Snively wrote home, "cold, lack of fuel, clothing, food. My God! How I pity them." In the remainder of the letter, Snively recounted an earlier experience in the field that revealed the psychological and emotional turmoil that the relief workers themselves had endured. "I went back to Warsaw after two weeks in the villages, more nearly knocked out and nervous than ever in my life. I stayed in my room, refused to think of them, read the lightest literature." Only "after a week away from it" could he return to the field without "those awful nightmares."" It is awful when you cannot keep from seeing this mass of hungry, staring, hollow-eyed, ghostly, ragged, verminous humans. When they stare out at you from the walls of your locked room, from the sky, from the forest, from the rivers, and from the books you are trying to read."²²

The winter storms that ended the operations, of the field columns arrived only shortly before the scheduled departure of the Americans. The Polish government wanted to retain American assistance, however, so the minister of health wrote Secretary of War Newton D. Baker requesting that the APRE be allowed to remain in Poland. The minister also convinced

²⁰Quote from Snively, Non-combatants, p. 127.
²¹Ltr, Howard J. Gorman to CO, 17 Nov 19; J.M. Gillespie, Rpt on Activities of the Field Column No, 3, 1 Oct to 8 Nov 19; Rpt to Commanding Officer, AFG, 21 Jan 20, All in box 1, APRE, Record Group 120, NA. Snively, Non-combatants, passim.
²²"Information from Poland," passim; J.M. Gillespie, Rpt on Activities of the Field Column No. 3, 8 Nov 19, box 1, APRE, Record Group 120, NA. Quote from Snively, Non-combatants, p. 143.

Hoover to intervene with the secretary on Poland`s behalf. The lobbying succeeded, and Baker extended, the APRE`s stay, at first until 30 June1920 and later to 1 November 1920. Baker reasoned that the Polish campaign provided the Army Medical Department with "experience not otherwise to be secured in dealing with an epidemic disease" at a minimal cost since Poland provided the equipment and with the help of private agencies paid most of the administrative expenses. Despite the extension, the strength of the APRE was reduced to 161 men in November and even further cut in December. Between January and November 1920, the total number of soldiers serving with the AVRE fluctuated between 94 and 51.²³

Despite his smaller staff, Gilchrist attempted to continue all the programs except the field columns. Efforts to strengthen and modernize the Polish health service continued and increased. After a crisis in the Polish cabinet in early 1920, the government appointed a new health administrator with authority over areas of the country previously subject only to military rule. He became an antityphus dictator of sorts, and Gilchrist worked closely with him. Even under the reorganization, however, American officers continued to inspect health facilities, counsel local authorities on sanitary matters, and instruct the Poles in delousing procedures and the operation of sterilizers.²⁴

In fact, Gilchrist wanted to expand efforts at sanitary reform in the smaller Polish towns. As an experiment, he sent 1st Lt. Robert C. Snidow to one of the filthiest villages, Garwolin. Studow and three American enlisted men, two of whom spoke Polish, instituted programs to clean and disinfect houses and public facilities. Partly because of tensions between Poles and Jews, but mostly because of the reluctance of all the villagers to participate, the Americans exercised greater and greater authority. Serving simply as advisers did not ensure reform, Snidow reported, and "we in a very insidious manner gradually assumed the control of the towns so that at the end of the work we were practically the government." Lack of time

²³Fisher and Brooks, America and Poland, pp.243-44; RSG, 1920, p. 378; Memo for Chief of Staff by Newton D. Baker,6 May 20, Poland 710, Records of the Adjutant General`s Office, 1917-,Record Group 407, NA. Company Returns, 1 Oct 19 to 31 Dec 20, HQRA, APRE, box 9, APRE, Record Group 120, NA. Hoover estimated total costs at well over $100 million (see Hoover, American Epic, 3:266). The ARA paid$950,000 for transportation and incidental expenses; the U.S. Foreign Service paid some civilians; The Surgeon General listed the cost to the Medical Department at $105,601 (see RSG, 1921, p. 192).
²⁴Summary Report, APRE, 1920, box 10, APRE, Record Group 120,NA; RSG, 1921, p. 193; Fisher and Brooks, America and Poland, pp.246-47. For a report by one such American officer, see Ltr, Frank H. Dixon to Gilchrist, 14 Oct 20, box 10, APRE, Record Group 120, NA.

and personnel, however, limited work in individual communities.²⁵

The major focus of American and Polish health officials during the winter of 1919-1920 remained maintenance of the sanitary cordon along Poland`s eastern border. American medical officials helped to staff the stations. In December 1919 one of them, Lt. Col. Edward C. Register, contracted typhus and several weeks later died. He was not the only casualty in the APRE; one enlisted man was killed when a sterilizer exploded, and another died of pneumonia. Still the work of the fifteen delousing stations continued, and at each, health officials let no one pass without a bath and sterilization of his clothes. As an added precaution, Gilchrist assigned Lt. Arthur E. Fox and a group of eighteen enlisted men to a mobile unit that included four rail-mounted delousing plants located in cities where rail lines enteredPoland.²⁶

Just as the increased activity along the border began to yield results, a Russian invasion of Poland destroyed the sanitary cordon. As early as May 1920, Fox reported difficulty maintaining contact with his units because of the Russian advance, and during early summer the Bolsheviks completely overran the area. One American sergeant who waited until the last minute to get his train out of the Soviet`s path was captured but soon released. Other bathing trains were captured, and all the quarantine stations fell to the Russian troops. Gilchrist termed, the Bolshevik advance "a great calamity," and later ARA historians estimated that the invasion nullified 75 percent of the progress the APRE had made against typhus.²⁷

With its major program so summarily suspended, the APRE turned to other, less important tasks. Some of its members deloused and prepared for repatriation of a group of Polish-Americans, known as Haller`s army, who had come to Europe to fight for Poland before American entry into the war and had remained to help the Allies. Other members of the APRE supervised sanitation and conducted a delousing program in a refugee camp near Krakow with more than6,000 residents. Late in August 1920, stunned by the success of the Russian invasion, Gilchrist agreed to establish within the Polish Army a delousing program similar to that he conducted for the American Army in France. Although Poles performed most of the work, American soldiers traveling with Polish fighting divisions instructed and supervised them. Their contribution to the Polish

²⁵Quote from Rpt of Duties Performed, APRE,1 Jan to 1 Nov 20, by 1st Lt Robert C Snidow, box 1, APRE, Record Group120, NA.
²⁶Gilchrist, "Typhus Fever," p. 625; RSG, 1921, p.192-93; Rpt, Inspector General to Commanding General, AFG, 1 Sep 20, Poland710, Record Group 407, NA.
²⁷Ltrs, A.H. Fox to Commanding Officer, 27 May and 27 Jul 20,box 10, APRE, Record Group 120, NA. Ltr, Gilchrist to Col Godlowski, 9Sep 20, box 1, APRE, Record Group 120, NA. Quote from Rad, Commanding Officer, APRE, to Commanding General, AFG, 21 Aug 20, Poland 710, Record Group 407,NA; Fisher and Brooks, America and Poland, p. 247.

Army was neither large nor of long duration. It began at a time when only fifty soldiers remained with the APRE, and by October almost all APRE activities had ended.²⁸

On 2 November all of the Americans except Gilchrist and four enlisted men left Poland; the latter stayed to finish the paperwork and dispose of the remaining supplies. On 4 January 1921 they, too, completed their duties, and the unit officially disbanded. It could not easily be labeled a stellar success. A highly negative Inspector General`s report, on its operation concluded that the APRE had simply not accomplished its mission. The inspector proposed several reasons for the failure: Gilchrist had to plan, his mission in Paris without knowing the real situation in Poland; the personnel sent did not best represent the United States; the constant breakdown of motor transportation curtailed effectiveness; and the Americans coordinated relief through the Ministry of Health rather than the Polish Army, which actually had the power to accomplish things.²⁹

Even though tainted by line prejudice against a medical officer in command, the report retained some validity. The troops who went to Poland did not conduct themselves in exemplary fashion. Courts-martial for drunkenness, introducing women into quarters, theft, disorderly conduct, disobeying officers, striking civilians, and various combinations of these were frequent. Gilchrist may not have exercised sufficient control amid such disorder, but his task was more difficult than it need have been. He simply had too many responsibilities: professional consultant to the Polish Ministry of Health, director of a campaign against an epidemic entrenched in a large area wracked by war, as well as commander of a military unit. And the unit had been especially assembled- though thrown together might more accurately describe the process- for the mission, when one already established might have served better. Finally, a development over which he had no control, the Russian invasion, more severely limited the APRE`s accomplishments than did poor planning, shoddy maintenance, or disciplinary problems.³⁰

²⁸Rpt, Inspector General to Commanding General,1 Sep 20; Rpt, Commanding Officer APRE to Commanding General AFG, 21 Aug20. Both in Poland 710, Record Group 407, NA. Ltr, Gilchrist to Minister of Public Health, 26 May 20, box 4, APRE, Record Group 120, NA: Rpt of Duties Performed, APRE, 1 Jan to 1 Nov 20, by 1st Lt Robert C. Snidow, box 1, APRE, Record Group 120, NA; Company Returns, APRE, Mar to Nov 20,box 9, APRE, Record Group 120, NA.
²⁹Company Returns, APRE, box 9, APRE, Record Group 120, NA; Rpt, Inspector General to Commanding General, AFG, 1 Sep 20, Poland 710,Record Group 407, NA. The IG came from Headquarters, AFG, which had administrative control over the APRE after 5 Nov 19. See Memo for Chief Surgeon by Brehon Somervell, 29 Jan 20, box 10, APRE, Record Group 120, NA.
³⁰See the records of special courts-martial and summary courts-martial, box 10, APRE, Record Group 120, NA. Although no one was tried, at least one Pole accused an American serviceman of the rape of a Polish woman. For a comment on the creation of the unit, see Synopsis of Reports from APRE, Poland 710, Record Group 407, NA.

Despite all shortcomings, the unit did help the Polish people. The APRE may have failed to rid the country of typhus, but it did ease the intensity of the epidemic. It deloused thousands of entering refugees; it deloused many residents in the hinterland that first fall; it helped to modernize, motorize, and generally strengthen the Polish health service. The American-Polish Relief Expedition proved something less than a total success, but it was far from an abject failure.

Famine in Russia

In the year after the antityphus campaign in Poland ended, Hoover called on Army medical personnel a third time. In 1921 the devastation of war followed by the disruption of revolution, both compounded by the cruelties of nature, left Russia in the throes of one of the worst famines in recorded history. Starvation loomed for nearly 10 million people; 2 or 3 million did die; and some survivors were desperate enough to turn to cannibalism. In a small village, young boys orphaned by the famine hanged their little sister, left her swinging in the kitchen, and cut off pieces of her body to eat as they became hungry. Those who survived starvation, by whatever means, still had to endure intense cold and outbreaks of typhus, typhoid, cholera, smallpox, and other diseases. Taxed by war and reorganized by the Communists, the Russian medical system offered little comfort to the suffering. Medical personnel fell victim to famine as readily and rapidly as patients, and poorly supplied, unsanitary hospitals did not have sufficient space to accommodate the sick and dying.³¹

On 13 July 1921 Russian writer Maxim Gorky appealed for foreign assistance to save his starving countrymen. Gorky`s plea prompted Herbert Hoover, then secretary of commerce but still head of the ARA, to instigate a new ARA relief program. He began a complicated series of

³¹On the causes of the famine, see Weissman, Hoover and Famine, pp. 1-3; Harold H. Fisher, The Famine in Soviet Russia, 1919-1923: The Operations of the American Relief Administration,(New York: Macmillan Co. 1927), pp. 429-36, 469 506, Frank Golder and Lincoln Hutchinson, On the Trail of the Russian Famine (Stanford: Stanford University Press, 1927), pp. 1-26. The incident of cannibalism is mentioned in W.R. Dear, "The A.R.A. in Russia." Military Surgeon69 (1931): 403-4; but for others, see F.H. Foucar, "Resume of Experiences and Work Accomplished in Russia with the American Relief Administration,1921-1923, Part I," Military Surgeon 54 (1924): 688; Henry Beeuwkes, "American Medical and Sanitary Relief in the Russian Famine,1921-1923," American Relief Administration Bulletin, 2d ser.,no. 45 (Apr 26): 20-21. On problems in the Russian medical system, see Golder and Hutchinson, On the Trail pp. 70, 125-26, 137, 143; Beeuwkes,"Medical and Sanitary Relief."

negotiations with the Russian, government to set the conditions under which the ARA would render aid to the famine-stricken. With each side extremely suspicious of the other`s intent, the talks dragged on for nearly two months before, reaching agreement. Though the ARA had become a private corporation, its need for huge sums of money and large quantities of supplies to fulfill the pact forced it to seek United States government support. During the fall, Hoover asked Congress for aid; after a heated debate it appropriated$20 million for Russian famine relief. Still later in the fall, at the request of the president, Congress made $4 million worth of War Department, Navy, and Public Health Service medical supplies available to the ARA.³²

Well before the congressional appropriation, the ARA had begun its work in Russia, Toward the end of the summer, Hoover appointed Col. William N. Haskell, who had headed the Army mission to Armenia and served with relief forces in Rumania, to direct the operation. The agreement with the Russians allowed him a staff of about 180 Americans, who started trickling into Russia in August. They served both in administrative departments and as district supervisors and assistants actually controlling the flow of food and supplies to the people. Though some of them were Regular Army personnel, Haskell directed an essentially civilian operation that happened to have soldiers serving with it.³³

However, a little more than a fifth of the Regulars who served in Russia with the ARA were in its Medical Division, in which military doctors occupied key leadership positions. Hoover again called on the Army to direct medical relief, appointing Medical Corps officer Col. Henry Beeuwkes to head the division. Beeuwkes assembled a staff that included five other Regular Army officers from the Medical Department: Maj. Walter P. Davenport, his assistant director, Capt. John H. Dawson, of the Medical Administrative Corps, chief of the central medical warehouse; and Majors William R. Dear, Frederick H. Foucar, and Glenn I. Jones, all district medical officers. Thus medical relief work depended more on the Army than did other aspects of the operation, even though the remainder of the division`s personnel were civilians.³⁴

When Beeuwkes arrived in Russia on 21 September,1921, he promptly opened a Moscow office from which he directed medical operations. The

³²Fisher, Famine, passim, but especially pp. 138-54: Weissman, Hoover and Famine, pp. 1-110; Bland and Surface, American Food, pp. 115-16.
³³On Army involvement, see Weissman, Hoover and Famine, p. 85; on the administration of relief, see Fisher, Famine, pp. 112-15.
³⁴Hoover, American Epic, 3: 467: Beeuwkes, "Medical and Sanitary Relief," pp. 85-87. A list of the Medical Division`s personnel was compared with the Army Register. In all, 26 Regulars served with the ARA, but no more than 19 were in Russia at any one time.

capital was also the site of the ARA`s central warehouse, which received medical supplies shipped from the United States and channeled them to locations throughout Russia. Both Beeuwkes`s office and the warehouse supported health teams in the districts that had an American doctor in charge, one or two American assistants, and a varying number of Russian workers. Together, they conducted four types of assistance programs.³⁵

First, and most important, the district medical officers sought to improve the Russian health care system. They frequently inspected hospitals and other types of health care facilities to determine their needs and then requested appropriate supplies from the central warehouse. When the warehouse, shipped their requests, the district staff distributed them to the various facilities. In all, the ARA Medical Division furnished medical stores and equipment to 16,419 institutions- most of them hospitals, dispensaries, or children`s homes- with a total capacity of more than a million beds. Supplies furnished included 357 kinds of medicine, 627 types of surgical instruments, and hundreds of varieties of laboratory supplies, disinfectants, and other medical items. Some of them came from the cache of Army supplies donated by Congress, but since it offered limited variety the ARA also depended on purchases and grants from the American Red Cross. District medical officers also ensured that the Russian personnel at medical institutions had enough food to eat. With staffs no longer starving and facilities better equipped, hospital service in Russia improved.³⁶

Perhaps not as important as the resupply of Russian hospitals but still a major aspect of medical operations was a program to vaccinate and inoculate the people. The district medical officers administered the program but employed and trained Russians to serve as vaccinators. Both the Americans and the Russians had to proceed cautiously, because in earlier attempts visiting vaccinators, had been beaten or killed by suspicious or hostile villagers. Before sending vaccinators to any town, the medical staff conducted an intensive educational and propaganda campaign. For the most part, it succeeded, and nearly 10 million Russians submitted to inoculation against five types of disease: typhoid fever, two kinds of paratyphoid, smallpox, and diphtheria.³⁷

The other types of medical relief, public saturation and delousing,

³⁵For the philosophy behind them, see, Beeuwkes,"Medical and Sanitary Relief,," pp. 75-76.
³⁶Beeuwkes, "Medical and Sanitary Relief," pp. v,70-72; Bland and Surface, American Food, pp. 252, 936-86.
³⁷Bland and Surface, American Food, pp. 252-53, For the operation of the program in the districts, see F.H. Foucar, "Resume of Experiences and Work Accomplished in Russia with the American Relief Administration, 1921-1923, Part II," Military Surgeon 55 (1924):32-34; Dear, "ARA in Russia," pp. 393-94.

were not as central to the ARA medical staffs efforts. District officers did encourage local officials to improve sanitary practices and sometimes used food to hire local citizens to clean streets, sewers, and drains. To delouse the residents, medical workers opened baths equipped with autoclaves for sterilizing clothes in Moscow, Samara, and other locations. The district doctors insisted that institutions supported by the ARA operate delousing programs for their own patients. Between the two methods, many Russians were deloused.³⁸

A list of the various types of medical relief, although indicating what the Americans did, obscures the personal sacrifice and dedication the work entailed. The American doctors lived and labored among an alien people and under the watch of hostile political officials. When they visited a town to discuss inoculation, they did not know if they would be killed for their trouble, as some previous health emissaries had been. But they did know that their visits necessitated freezing rides through vast snow-covered regions where any accident meant they would not be found until the, spring thaw, if then. Many times they slept in cold haylofts rather than endanger themselves in the warmer but usually contaminated peasant huts. Despite their precautions, several of the Americans contracted typhus, and others for whom the mental strain surpassed the physical suffered nervous break-downs. And, one of the Army medical officers observed, "the horrifying experiences to which [they] were continually subjected in this land of despair" left. none who were not "permanently changed by the experience."³⁹

Their sacrifices helped to ease the suffering, however, and by April1922 Hoover suggested the mission conclude its work in Russia. Other relief officials disagreed, and Hoover consented to the continuation of the ARA`s labors, though after the September harvest the Americans did greatly reduce heir assistance. The next month they sensed pressure from the Soviets to withdraw, which indicated the crisis had indeed passed and political priorities were reemerging. Nevertheless, the ARA continued a less extensive program until June 1923, when the operation drew to a close. By then all the district physicians had gone home and of the medical contingent only Beeuwkes and his assistant remained. On 20 July, Haskell, Beeuwkes, and the remainder of the staff left Moscow, and the ARA mission to Russia ended. It had fed almost ten million people, inoculated nearly as many, and significantly improved medical and hospital service. The ARA had done so with a minimum of political

³⁸Hoover, American Epic, 3:474; Bland and Surface, American Food, p. 253; Foucar, "Experiences, Part II," pp. 29-30; Dear, "ARA in Russia," pp. 401-2.
³⁹Based on Foucar, "Experiences, Parts I and II ";Dear, "ARA in Russia," quote from p. 396.

friction and without subverting the Russian government. The operation had proved both a helpful humanitarian venture and a successful experiment in cooperation between hostile political systems.⁴⁰

The operations in both Russia and Poland had been responses to particular situations to some extent created by the war, and Army Medical Department personnel undertook no more such missions. Both operations, though, testified to the continued strength of America`s sense of humanitarian mission. The famine relief operation in Russia revealed that the United States would undertake aid in a nation with whom it shared few political values if the needs of humanity demanded it. On the other hand, the ARA`s operation in Europe- and Gilchrist`s typhus control efforts as part of it-suggested that the United States often sought political as well as benevolent goals in its relief activities. Just as Hoover had hoped to use American food and medical care to strengthen the free countries of Europe, government leaders after World War II would dispatch disaster relief to many parts of the world for similar reasons. But for the remainder of the interwar years, America`s fear of expanding bolshevism as well as its commitment to internationalism waned, and the relative inactivity of Army medical personnel in foreign, disaster assistance resumed.

⁴⁰Fisher, Famine, pp. 393-401; Weissman, "ARA in Russia," pp. 2, 308-94; Weissman, Hoover and Famine, pp. 192-202.