By Susan Muaddi Darraj
Photos courtesy of the Alan Mason Chesney Medical Archives of the
Johns Hopkins Medical Institutions and others
letter arrived shortly after August 29th, 1918, with a stark subject
line: "Orders." Sent by the Adjutant General of the U.S.
Army, it was addressed to William Henry Welch informing him that
he would proceed to several military camps along the southeastern
United States "for duty in connection with the investigations
The 68-year-old Welch no doubt wondered how much longer the Great
War, already in its fourth year, would last. One thing was certain:
the Central powers were not the only enemy. The men of the U.S.
military faced the threats of tuberculosis, influenza, pneumonia,
and venereal disease. This battle against disease was one the Americans
appeared to be losing.
So the nation turned for help to Welch, former president of the
National Academy of Sciences and founding dean of the country's
first school of public health. It was not the first time during
World War I that Welch, MD, DSc, LLD, found his expertise in demand.
Nor would it be the last time that the School would find itself
engaged in a national wartime emergency. Throughout the major conflicts
of the past century — World Wars I and II, the Korean War, Vietnam
War, the Gulf War, and the ongoing war against terrorism — faculty
from the School have played pivotal roles in the fight to slow illness
and contain the spread of disease.
The pursuit of public health in the face of battle is not without
bitter irony: public health professionals have a mission to save
the very lives that war seeks to destroy. Reconciling these two
opposing objectives has not always been easy for the School's public
health practitioners. And the struggle has only intensified in recent
decades, as the face of war has changed dramatically. The trench
warfare of World War I has yielded to wars with less defined battlefronts,
displacing civilian populations and creating mass movements of refugees
dogged by illness and disease. And as Sept. 11 and the fall's anthrax
attacks have shown, civilian populations themselves have become
targets in warfare's latest incarnation.
"War is the prototype of public health destruction," according
to Frederick Burkle, MD, MPH, senior scholar at the School's Center
for International Emergency, Disaster and Refugee Studies. It's
an apt explanation: Whatever its form, war is the ultimate threat
to public health. Yet when the nation has called the School to war,
its faculty and alumni have resolutely done their part, seeing the
enemy not in the faces of combatants but in the bacteria, viruses,
and other pathogens that threaten public health.
World Wars I and II, and Korea
In some ways, the School itself almost became a victim of World
War I. The Johns Hopkins School of Hygiene and Public Health was
expected to open in October 1917, but Welch, its driving force,
had joined the war effort in July — three months after the United
States entered the war. He temporarily abandoned the project in
order to accept an appointment as a major in the Officer's Reserve
Corps. (The School opened a year later, in October 1918.)
Welch traveled along the East Coast, inspecting military facilities,
training camps, and army barracks to report on soldiers' health
in the camps and to make recommendations for improvements to the
War Department. With an army of only 200,000 men when the country
entered the war, the United States hastily constructed 32 training
camps across the country, giving little thought to potential public
With thousands of young American men away from home for the first
time, the dire threat of venereal disease emerged. Effective treatments
would not be available until Alexander Fleming's discovery of penicillin
in 1928, and many feared that returning soldiers, reluctant to disclose
their symptoms (including chancres, rashes, fevers, and sore throats),
would infect their wives.
In addition, the Spanish influenza epidemic of 1918 also posed an
acute threat to American troops and civilians; in March of that
year, soldiers in a Kansas military camp complained of high fevers
and sore throats. Within one day, 100 soldiers were ill, a number
that shot up to 500 by the week's end. The epidemic spread to other
camps and to civilian populations, killing 675,000 Americans — five
times the number that would die in the war.
After surveying one Army camp, Welch ominously
wrote in his journal: "Fear outbreak."
Pneumonia, tuberculosis, malaria, and other diseases also proved
to be mighty challenges. Welch arrived at the camps with a mission
to help the men survive their training. On December 26, 1917, he
carefully surveyed ill servicemen at Camp Travis, Texas, and recorded
380 cases of measles, 124 cases of the mumps, 178 cases of pneumonia,
and 14 cases of meningitis among the camp's 34,000 inhabitants.
Welch scribbled in his journal that the facilities have a "great
deal of dust — then pneumonococcus. Have had much conjunctivitis,
and sore throat-colds." He also noted that "sanitation
is neglected and camp disorganized" and concluded forebodingly,
"Fear outbreak." Welch recommended that the hospital be
sent additional nurses, more medical officers with public health
training, sterilization supplies, and Rockefeller type I pneumonia
While the nascent School spent the Great War getting on its feet,
it acted definitively after the war's end. Public health was still
a new field in the United States, and one of the great lessons from
the recent war was the need for medical officers trained in controlling
epidemics. In May of 1923, the School granted a Surgeon General
request that U.S. Army medical officers who had taken courses in
preventive medicine and had experience as sanitary inspectors be
admitted to the School for a DrPH degree.
In less than 20 years, the public health field — and the mettle
of the School itself — would be tested as the United States entered
World War II. So many of the School's students and faculty joined
the war effort that the School's then-Dean Lowell J. Reed, PhD,
proclaimed in a wartime newsletter: "Some of you have probably
wondered whether we would continue to have any students at all during
the war — we did ourselves."
spring 1942, the School received a special request from the National
Research Council to develop and offer public health training courses
that, according to the minutes of the School's Health Advisory Board,
would educate "personnel to meet the increased demand in the
field of public health caused by the present emergency." Faculty
devised three courses: Venereal Disease Control, Clinical Laboratory
Methods, and later Epidemiology. Army and Navy medical officers
were pulled from active duty for up to four months at a time to
enroll in the unique 6- to 12-week courses.
The Army had originally rejected men with any form of venereal disease
(VD), but increasing war casualties and the need to replenish forces
changed that policy. By 1943, 12,000 American men with VD were being
inducted into the Army every month. Despite penicillin's availability,
VD continued to pose a vexing problem, and several faculty members
were called upon to help control outbreaks among the troops. While
consulting for the Surgeon General, Margaret Merrell, ScD '30, professor of Biostatistics, designed studies that evaluated penicillin's success in treating syphilis. J. Earle
Moore, MD, professor of Public Health Administration, developed
programs to contain syphilis outbreaks in the military camps and
later chaired a venereal disease control subcommittee for the National
Research Council, which advised the armed forces.
The School also launched the Army Industrial Hygiene Laboratory
in October 1942, housing it on the seventh and eighth floors of
the Wolfe Street building. Seeking women to fill factory jobs left
vacant by men heading off to war, the government had promoted the
image of "Rosie the Riveter." But what effect did such
work have on the health of women?
Anna Baetjer, ScD '24, professor of Physiological Hygiene, concluded
that certain measures, such as adjustments to machinery and more
flexible schedules, should be implemented to accommodate women's
different needs. Baetjer's study was published in 1946 as Women
in Industry, Their Health and Efficiency, long considered a
classic in the field.
Overseas, the humid climates of Asia and the South Pacific provided
a fertile breeding ground for malaria-carrying mosquitoes, and the
disease quickly became a major threat to American servicemen. During
the war, the School provided critical support to Hopkins' Office
for the Survey of Antimalarial Drugs, an effort that would evaluate
more than 13,000 drugs for their efficacy in malaria treatment.
An entire floor at the School was used to house ducklings on which
candidate drugs were tested. The survey identified chloroquine as
the preeminent antimalarial. Overseas, former faculty member Justin
Andrews, ScD '26, Medical Zoology, the first scientist to attain
the rank of general, led an Army malaria control unit. Under his
direction, the Army drained mosquito breeding areas and used diesel
oil and DDT as insecticides and larvicides. Such efforts proved
effective: Just 0.1 per 1,000 Americans quartered in the United
States were infected with malaria in 1945, as compared to 7.5 per
1,000 in 1917 during World War I.
the Philippines, Johns Hanks, PhD, professor of Pathobiology, was
living with his family and researching leprosy when the war began.
Once the Japanese had occupied the islands, Hanks found it almost
impossible to acquire the supplies he needed to continue his research.
Putting his creativity to the test, he began producing his own supplies
by using plant components and spring water. He and his wife, Julia,
briefly became prisoners of war during the Japanese occupation.
There were others who found themselves too close to the action for
comfort. Alan W. Donaldson, ScD, a professor of Parasitology, who
served as captain of the Sanitary Corps' 28th Malaria Unit in the
Pacific from 1943 to 1946, wrote from the Philippines: "This
is the third time we've been moved in with the combat troops. Thus
far, we've been lucky in that no one in our unit has been hurt as
the result of enemy action, but these have been times I would have
given a lot to be some place else."
During the Korean War, the School conducted training programs with
the U.S. Air Force. Ernest Stebbins, MD, MPH '32, then Dean of the
School, was especially involved in this collaboration, participating
in studies of public health administration, while Paul Lemkau, MD,
professor of Mental Hygiene, developed courses in military mental
health for the Air Force. The School continued to pursue VD research
while the war raged in Korea. The 1952-1953 academic year marked
the School's largest post-war group of special students studying
VD prevention and control.
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