Poster illustrated with a cartoon of a small silhouette of a solder in front of a large drawing of a civilian man.

“Fit to Fight”: Home front Army doctors and VD during WW I

By Susan L. Speaker ~

A man in a suit seated at a desk in an office with a wood stove heater..
Wilbur A. Sawyer at city hall in Hanford, California, investigating a typhoid epidemic, April 1914
NLM Profiles in Science

After the United States entered the World War in April 1917, Dr. Wilbur Sawyer, 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 “did his bit” on the home front instead. Nearly forty percent of the U. S. Army Medical Corps—doctors, nurses, sanitary engineers, and others—served state-side. They examined new recruits, kept them “fit to fight” 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’s Office in January 1918.  For his first assignment, he worked with California colleague William Snow on a statistical study of VD rates in the army, published in August of that year.  His second assignment was to direct an innovative VD control experiment in the Newport News, VA Port of Embarkation from July through November.

Control of disease, while it may have lacked the drama of battlefield medicine, was essential to the war effort: sick soldiers are liabilities—they can’t 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.  Long 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.

Poster illustrated with a cartoon of a small silhouette of a solder in front of a large drawing of a civilian man.
Cartoon in “Venereal Disease Control in the Army,” in Journal of the American Medical Association, August 10, 1918
NLM Profiles in Science

Venereal diseases were especially hard to control because they were usually acquired outside the camps during soldiers’ leave time, from prostitutes or other companions.  Traditional military culture had accepted drinking, gambling, and visiting brothels as normal, even necessary free-time activities in soldiers’ 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 1880,1985, the military’s 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 (ASHA). Dr. Sawyer was an early member and became ASHA’s 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’s 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 and keep adjacent community areas “decent and respectable.” He authorized the Commission on Training Camp Activities (CTCA) in April 1917, with ASHA members in leadership roles.

Caricature of the bottom half-length of a soldier with metal rings fastened about the ankles and attached by chain to large, heavy balls on which are written, Venereal Disease, and Enslaving Habits.
Will You Be a Free Man or Chained, 1918
National Library of Medicine #101447415

The CTCA/ASHA strategy for moral and medical salvation was multifaceted. First, they worked with state and local authorities to render prostitutes and other “antisocial venereal disease carriers” less accessible by strengthening anti-prostitution ordinances and enforcement; they closed brothels, dance halls, and saloons—and often entire “red light” 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 “weak-minded” girls and women, providing permanent custodial care if needed. They taught courses on “social hygiene” at the camps and published educational pamphlets and posters. They even made films, including the feature-length “Fit to Fight” later re-titled “Fit to Win.” 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.

Statistics from “Venereal Disease Control in the Army,” by William Snow and Wilbur Sawyer in Journal of the American Medical Association, August 10, 1918
NLM Profiles in Science

Did such measures actually reduce VD rates?  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 in the official Army Medical Department history shows how the military’s efforts evolved within a complex situation. Dr. Sawyer served as both director of the project and supervisor of non-military activities. Several of Sawyer’s letters to his wife mention the project, describing the town as “amorous” and also giving an account of a trip to Richmond, Virginia where prostitutes had been rounded up for VD treatment.

The Newport News demonstration showed that a joint military and civilian effort could indeed reduce the levels of venereal disease among the troops there—VD rates dropped from 24.8 per thousand in June to 4.5 per thousand in November. Those numbers increased again after the project (and the war) ended. Overall, while the military and civilian efforts to reduce VD had some success, many soldiers caught the diseases. From April 1917 (when the U.S. entered the war) to December 1919 (when demobilization was done) there were about 3,500,000 soldiers admitted to sick report for disease only. Syphilis and gonorrhea accounted for over ten percent of these (357,969) and resulted in 6,804,818 duty days lost.

Dr. Sawyer never worked on VD control again after the war. In June 1919, he went to work for the Rockefeller Foundation’s International Health Division, and spent the next three decades investigating tropical diseases, and developing an early yellow fever vaccine.

Through 2018, Circulating Now will periodically publish posts featuring NLM collections that illuminate the medical history of The Great War, which lasted from August 1914 to November 1918.

Susan Speaker, PhD, is Historian for the Digital Manuscripts Program of the History of Medicine Division at the National Library of Medicine.

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