restricted access 3. War and Its Aftermath
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chapter three war and its aftermath When the United States declared war against Germany in April 1917, the PHS was ready with plans for addressing wartime health threats. Under an executive order issued by President Woodrow Wilson, the service was made part of the US military. Within months, most of its prewar plans were being put into practice. The service’s efforts focused on war industries, venereal disease control, and the management of diseases such as malaria around military encampments in the South. Working with the army’s ordnance department, PHS officers examined hygienic conditions in a number of explosives factories. In West Virginia, the PHS helped build the town of Nitro, which supplied gunpowder for the war effort. There, service officers examined job applicants, vaccinated new employees, installed a water and sewer system, and examined housing conditions. In addition to public health work, they provided individual medical services to Nitro residents.1 The effort in Nitro was unique but indicative of the importance accorded to the health of workers in an essential industry. The PHS’s effort against venereal disease, meanwhile, got off to a somewhat slow start. Viewing the problem as one of education, regulation, and criminal enforcement, the service focused on providing expert advice to state governments. As the nation mobilized, the PHS entered into agreements in which it detailed officers to state health departments, who in turn paid half of their salaries. In terms of personnel, planning, and public prestige, the most significant component of the PHS’s wartime work was its effort to confront the daunting health problems of the Southern United States. Although most essential war industries were located in the industrial North, a significant number of industrial sites were located in the South. In addition, a disproportionate number of military encampments were located in the region, where training would be less hampered by the threat of cold weather.2 Endemic malaria, hookworm, typhoid, and the South’s underdeveloped public health infrastructure quickly became pressing issues of national concern . Although the federal government had not previously engaged in largescale domestic public health work, the PHS, with the support of Congress WAR AND ITS AFTERMATH : 59 and the president, moved quickly to establish a series of extracantonment zones, or areas of intensive public health work in the civilian areas surrounding military installations. By the end of the war, the PHS oversaw public health work in forty-eight extracantonment zones. All but nine were located in the South (Figure 3.1).3 Particularly for young PHS officers, the war was a transformational experience, suggesting an exciting new direction for the service. In its aftermath , the PHS proposed an ambitious postwar program, which sought to establish a role for the service in promoting health both in industry and in rural America. Benjamin Warren, author along with Edgar Sydenstricker of the service’s report on health insurance, began calling for a “unified health service,” capable of bringing together the nation’s disparate health efforts, coordinating health work across political jurisdictions, and bridging the gap between public health and individual medicine. Ultimately, Congress did not adopt the PHS’s postwar program. Although the service imagined a powerful role for itself in promoting health among American workers, it had little political support in industrialized states, where local authorities were already creating high-quality public health institutions. As a result of its work in the wartime extracantonment # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # Figure 3.1. Headquarters of World War I extracantonment zones. Source: Warren and Bolduan, “War Activities of the United States Public Health Service.” 60 : CHAPTER THREE zones, however, the service could now count on significant support from the Southern states where diseases such as malaria played an important role in restraining economic development. Working with the PHS, South Carolina Democrat Asbury “Frank” Lever introduced a Rural Health bill, which would have placed the PHS in charge of a program of federal assistance to states and localities for the development of local public health infrastructure . The Republican takeover of Congress in 1919 ensured that this bill, whose base of support came from Southern Democrats, would not become law. Nonetheless, the PHS was able to build on its wartime effort in important ways. Indeed, the wartime extracantonment effort provided the basis for a new initiative that would ultimately help to transform the role of the federal government in American public health. Public Health Efforts in Extracantonment Zones The PHS’s domestic efforts during World War I were both...