Briefing - "The Cleanest Army in The World" -- Pershing, the AEF, and VD

To the ordinary passer-by the military camp at Grieve, France, in 1918 looked like a dozen other similar compounds belonging to the American Expeditionary Force (AEF); that is until he read the sign over the entry gate. "This Is A Venereal Camp. These Men Are Helping the Hun" it proclaimed. The AEF was engaged in a second front against a far more ancient adversary.

Venereal diseases (or sexually transmitted diseases as they are now known in common usage) have been the bane of armies since time immemorial. In 1495 King Charles VIII of France was forced to evacuate Naples when syphilis ravaged his army. During the American Civil War nearly 20 percent of those fighting acquired infections. In the 1890s, U.S. Army admission rates for venereal disease averaged 70.6 per 1000 troops per year. Despite this, a hushed atmosphere surrounded the subject, with predictable results � by 1910 admission rates had risen to 197.0 per 1000. With hospital stays in the pre-penicillin era averaging 30-60 days, the drain venereal diseases exerted on available manpower was enormous.

At the time that World War I broke out in 1914, available statistical evidence indicates that the level of venereal disease was high in both European civilian and military populations. During the war years, over 50-percent of the people in some European cities reportedly had gonorrhea or syphilis, sometimes both. In 1917 alone, 23,000 British soldiers were hospitalized with VD. In France things were even worse, the French government reported over one million cases of venereal diseases in the military between August 1914 and the summer of 1917. In the United States, which did not enter the war until April 1917, leaders of the Progressive movement (who could be pretty bigoted) viewed these developments with a growing alarm. As America edged closer to war, the possibility of the European experience being repeated among American soldiers led them to demand action. In that period of Woodrow Wilson's "new world moral order", the American Social Hygiene Movement (ASHM) was called upon to lend a hand. The entire male professional staff of the ASHM were commissioned officers in the Army or Navy to help implement a comprehensive anti-VD program. For the armed forces, the problem of venereal disease was viewed in terms of the loss of essential manpower. To the ASHM the problem viewed as a social evil amenable to the appropriate application of moral and scientific principles.

Certainly there was plenty of cause for concern. The venereal disease problem in the United States was particularly severe as the nation mobilized for war. During the war the Surgeon General reported that VD was the most frequent cause for rejection of draftees, 938,232 men. The next highest cause of rejection was heart disease which was found in 564,768 men. Obviously something had to be done.

Prodded by the ASHM, the government initially looked at VD as one caused by prostitution and conducted a concerted and successful effort to close down the "red light" districts in towns near military training camps. With the prospect of sending troops to Europe drawing ever closer, the social hygienists and reformers felt that a great test was about to begin. If venereal disease appeared in the AEF, it meant that rather than exporting American democracy and virtue, the doughboy was importing Old World degeneracy, a common icon of the Progressive Movement. In an appropriately euphemistic turn of phrase, Woodrow Wilson promised that "The federal government has pledged its word that as far as care and vigilance can accomplish the result, the men committed to its charge will be returned to the homes and communities that so generously gave them with no scars except those won in honorable conflict."

The selection of General John J. Pershing as the Commander of the AEF was initially greeted by leaders of the ASHM with a marked lack of enthusiasm. During his 1916 campaign against Pancho Villa in Mexico, Pershing had supported the maintenance and inspection of houses of prostitution. While he questioned the morality of regulating prostitution, he saw it as the only practical answer to controlling VD among the troops. "The establishment was necessary and proved the best way to handle a difficult problem," he explained, "Everyone was satisfied." The ASHM was concerned at that such an approach would be repeated in France. Unable and unwilling to block Pershing's appointment, they sought to convince him of the error of his ways.

On the cruise across the Atlantic aboard the SS Baltic in June of 1917, Pershing was joined by Hugh Hampton Young, a urologist from Johns Hopkins University and one of the medical leaders of the ASHM. Young, an energetic and forceful proponent of ASHM thinking, convinced Pershing of the perils of VD in a series of lurid and graphically detailed lectures. Regulated prostitution, Young argued, was little more than self-delusion. By the time Baltic docked, Pershing had become fixated on the problem of controlling VD among the men of the AEF. It was his goal, he said, "to make the American forces in Europe the cleanest army in the world" � to make the AEF the first army in history to be free of venereal disease. Pershing's conversion became something of an obsession. Future Supreme Court Justice Felix Frankfurter, in Europe studying conditions among the American forces, wrote to Secretary of War Newton D. Baker that "General Pershing is filled with anxiety about the sexual morale of the troops." Young's arrival and his appointment as director of the Division of Urology of the Medical Corps led to a far reaching examination of the medical practice with regard to VD of the other armies. Young was openly critical of the British practice of sending all cases to base hospitals far from the front. This procedure, he felt, placed a premium on acquiring the disease. He discovered that some men tried to re-infect themselves, while others reportedly intentionally infected themselves by passing a contaminated match stick, in order to return to the relative tranquility of the hospital.

Young's approach was to combine moralism with pragmatism. He suggested that sexual contacts be minimized through education, recreation, and the repression of prostitution. On the other hand he also advocated medical means of controlling VD, such as chemical prophylaxis, frequent inspections, and early treatment, to lessen the impact. Young was able to bring Pershing around to his views.

The arrival of US forces at French ports heralded a clash of sexual cultures. The French accepted prostitution as a way of life. They attempted to maintain health and limit the spread of venereal disease through a system known as reglementation. This called for periodic inspection of prostitutes for VD. If free from disease, they were issued a certificate which they were required to display to their clientele. If the physician discovered disease, the woman was committed for treatment. The system was not without its abuses. Colonel George Walker of the Army Medical Corps reported that he had seen 59 women examined in an hour at Bordeaux, 15 in 13 minutes at Cherbourg. At one point, Walker reported, the same speculum was used on several women in line without any attempt to sterilize it. He argued that the inspections themselves might be spreading disease from one woman to another under such conditions. Young, having already won Pershing's support, warned the Commander again of the dangers to the men, the AEF and the war, if the Entente Cordiale became excessively intimate in nature.

On July 2, 1917, only a few days after the arrival of the first transports, Pershing issued General Order No. 6. It read in part "a soldier who contracts a venereal disease not only suffers permanent injury, but renders himself inefficient as a soldier and becomes an encumbrance to the Army." The order called for semi-monthly inspections of the men by physicians, lectures by unit commanders on the dangers of venereal disease, and chemical prophylaxis within three hours of any sexual contact. Soldiers who contracted a venereal disease were considered to have been at fault. Pershing's order made contracting VD a crime punishable by court martial. The order made no prohibition or pronouncement on houses of prostitution, thus tacitly accepting their presence and services, provided the soldier sought prophylaxis following his visits.

General Order No. 34, Pershing's next pronouncement on the subject, sought to ensure that infected men were not sent to clean hospitals far from the front while healthy men risked their lives. Issued in September, 1917, the order required that men with VD be treated in their divisions on an ambulatory basis.

The impact of these measures was gratifying to Young and Pershing as the strength of American forces grew. The admission rate for September of 1917 was 80 per 1000 men on strength, which fell to 54 per 1000 by the end of October. Then to Pershing's and Young's alarm the rate shot up to 201 per 1000. An assessment of the situation indicated that the epidemic was localized to troops debarking at the port of St. Nazaire. Young was dispatched to investigate. What he found confirmed ASHM's fears of a debauched Europe seducing Americans.

After quaffing West Indian rum and Niger gin, newly debarked American troops would flock to one of St. Nazaire's six houses of ill repute. Each housed only five or six ladies and Young found lines of American soldiers winding from doorways into the street. Each woman serviced from forty to fifty customers per day. One bragged to Young of a commercial success of sixty-five men in a 24 hour period.

Under these circumstances the prophylaxis system broke down. Men returned to the camp in various conditions of sobriety to find the lines at the prophylaxis stations longer than those at the bordellos. Thus discouraged, they stumbled to their billets. A few days later they overwhelmed the port hospitals. Young telegraphed his findings to Pershing.

Pershing took the first train to the seaport, and conducted a personal inspection. "This is one of the most disgraceful things that has happened to the American Army," an irate Pershing told Young, "Drastic measures must be taken immediately." The AEF Commander called the officers together and demanded that they follow the regulations or face the consequences. All houses of prostitution were surrounded by military police on his instructions, as well as the bars. Prophylaxis was to be rigidly enforced.

The next month, a still angry Pershing issued General Order No. 77. It said that commanding officers were to be held accountable for the health of their troops. "No laxity or half-hearted efforts in this regard will be tolerated. The number of effectives in a command is an index of its efficiency and this depends on the efficiency of the commanding officer." The order further required examination of men prior to debarkation. All those infected would be detained in camp. Under Young's prodding, all encampments were to be fenced with a single entrance that all men must pass through upon return. Guards would evaluate the men for prophylaxis and inebriated men would be summarily treated. Houses of prostitution were declared off limits. Finally, each Base Section was required to report its cases of venereal disease to Young. "These reports" warned the Order, ominously, "will be filed at these [i.e., Pershing's] Headquarters with the personal records of organization commanders and will be used as a basis in determining the commander's efficiency and the suitability of his continuing in command."

French reaction to General Order No. 77, was a combination of derision and disbelief. A report commissioned by French Premier Georges Clemenceau, stated that that "The object of the Americans is to prevent soldiers from having sexual relations. Beginning with the policy that chastity is possible, they have declared an official continence, and they confide to religion and morals the duty of maintaining morality in man and keeping him always master of his passions. They depend, however, on violent exercise to afford and diminish the desire for their soldiers." It was an accurate assessment.

Clemenceau asked Pershing to reappraise the new policy. The French Premier argued, with support from his medical inspectors, that the new order would undermine the reglementation system, by encouraging the growth of a clandestine trade by amateurs. Clemenceau also doubted that physical exercise could serve an adequate substitute for sex. He also suggested that the order would be to place innocent French women at risk from rape by American soldiers. The letter cited reports from French police commissioners that such crimes were already taking place. In a state showing that the French leader completely misunderstood the American position, Clemenceau went so far as to generously offer to arrange for "special houses" reserved to Americans and inspected by American medical men. Pershing rejected the offer.

Clemenceau's letter was given by Pershing to Raymond Fosdick, a major leader of the ASHM and crony of Woodrow Wilson, who was in France on a tour of inspection. Fosdick dropped the letter on Secretary of War Newton D. Baker. Baker took one look at it and told him, "For God's sake, Raymond, don't show this to the President or he'll stop the war."

Not surprisingly, Young discovered in his analyses of VD rates that leaves represented the time men were most likely to contract venereal disease. The AEF policy of granting seven days leave every four months for morale and health, he saw, possessed a great potential for men to contract disease. Here to, Young had an answer. Education and distraction through exercise, in addition to stringent regulations, derived from the Progressive Movement's catchwords of self-sacrifice, self-respect, and self-control. They were another method by which Young, and consequently the Medical Department, sought to keep the men from contracting venereal disease while on leave. Through his contacts in the ASHM, Young, with Pershing's wholehearted support, arranged for the construction of nineteen recreation centers by the YMCA, a staunch supporter of the ASHM position on the value of exercise and self-sacrifice. Simple economics was used to encourage their use by the troops; they were free. The AEF paid for the food and lodging of men using the camps. None of the centers were built in urban areas. Instead, they were located in provincial and rural areas. Paris � the new Babylon � was declared off-limits by the YMCA planners. The programs at the recreation camps centered on filling the soldier's free time so that the men would not look for amusements on their own.

Young had the Medical Department require that soldiers be examined for VD before departing for and upon arrival from leave. Officers were required to lecture men on the dangers of dalliance and disease. Some company commanders went so far as to demand signed statements promising upright behavior by the soldier.

The troops also received flyers.

The efforts of the AEF medical staff had mixed results. Venereal disease rates were held well below that of the other Allies, and even of the American forces still in the United States. Of the two million men stationed in the US, 12.7-percent were admitted for a diagnosed VD, while the admission rate in the AEF was only 3.4-percent.

However, the D problem in Europe continued to grow even with the comparatively low rates. In 1918, of the approximately two million men in the AEF, 18,000, roughly a division, missed action each day because of venereal disease.

The Medical Department established special camps in the summer of 1918 to segregate the infected men, such as that established at Grieve. The theory was that the camps would restrain infectious VD patients who did not require hospitalization and minimize the number of non-effective days. Regulations required that men in these camps work and the ubiquitous flyers warned the doughboys: "How about a job with a Labor Battalion? Would you like to join one? Then keep clean!"

With the coming of the Armistice things changed somewhat, at least from the soldier's point of view. With the battle won, some who were willing to accept the rationale of keeping fit to fight began to ignore it. In spring 1919, Pershing wrote the chief surgeon about the issue. "I have watched with concern the gradual rise in the rate of venereal disease in the A. E. F. since active operations ceased. Steps must be taken at once to check this, as I am determined that a very high standard in this respect shall be attained." It seemed to have little effect, in September 1919 a yearly admission rate of 766.55 per 1000 men on strength was reported as opposed to 34 per 1000 the previous year, an enormous jump.

With the war over, emphasis shifted from protecting the AEF to protecting the home front from the venereally infected warrior. To meet this danger, in November, 1918, Pershing issued General Order No. 215, requiring that "Officers and enlisted men returning to the United States will be subjected to a physical examination previous to embarkation and all those found to be affected with venereal disease in a communicable stage will be detained and placed in segregations camps." A Medical Department flyer warned, "The people of the United States know this, and will want to know why you did not return with your company." One medical surgeon went so far as to suggest that the wives and children of these soldiers be notified. While Pershing rejected the latter suggestion, the effect of General Order No. 215 was far-reaching, and in some cases devastating. The press suggested that only venerable were detained though men were detained in France for other communicable illnesses, such as tuberculosis. Broken engagements, crushed sweethearts, divorces, and marital tensions followed in its wake. These unfortunates were, in a sense, the last of the war's casualties.

Despite all these efforts, venereal diseases were an expensive and continuous problem. Between April 1917 and December 1919, a total of 383,706 American soldiers were diagnosed with either syphilis, gonorrhea, or cancroids. A case of VD cost the Army seven dollars per man per day for approximately thirty-three days. Venereal disease during the war cost the government almost fifty million dollars and in Europe kept the equivalent of a division inactive each day.

Many of the components of Pershing's General Orders, in particular the official stigma attached to venereal disease, were retained by the American military, a legacy of Pershing's goal for the cleanest army in the world.

--David W. Tschanz

Addendum: Prophylaxis and Treatment of VD in World War I
Note: Probably not suitable for the squeamish.

Chemical prophylaxis was a critical element of AEF venereal policy, and was, short of abstinence, the only other officially sanctioned method of VD control. Though General Order No. 6 made acquiring a venereal disease a court martial offense, General Order No. 32, issued in February 1918, added failure to take prophylaxis after sexual exposure as a separate offense constituting neglect of duty.

Prophylaxis in the era before antibiotics was a relatively simple procedure, though not a pleasant one. A soldier reporting for prophylaxis would first urinate. Then, sitting on a specially designed stool, he would wash the genital area with soap and water, following that with bichloride of mercury. An attendant, often referred to as a "Professor of Prophylaxis," would inspect the man. Then the attendant would inject a solution of protargol into the penis, which the soldier would hold within the urethra for five minutes, and then expel. Following the injection process, calomel ointment would be rubbed on the penis, which would then be wrapped in waxed paper. For the procedure to be effective the soldier could not urinate for four to five hours.

Not surprisingly, many sexually active soldiers never took prophylaxis. Because lectures and flyers had stressed a great deal of emphasis on receiving prophylaxis within three hours of exposure, some men believed it useless to report for prophylaxis late. Others, drunk, or lost on unfamiliar streets in a French town, simply could not find a station.

Amazingly the use of prophylaxis by the AEF caused a bitter debate between the social hygiene reformers in the United States and the Army Medical Department. Having worked vigorously to close the red light districts and lecture men on the value of abstinence and self-control, the American wing of the movement felt betrayed by the Medical Department's tacit acceptance of sexual activity. Edith Houghton Hooker, the most articulate of the opponents of prophylaxis summarized the position, "In so far as prophylaxis encourages incontinence, and in so far as it undercuts the positive demand for continence on the part of men in like measure it defeats its own purpose, that of preventing venereal disease."

The debate would rage throughout the war, leading to the banning of the issuance of self-administered "pro-kits" except in outlying areas. Josephus Daniels, Secretary of the Navy, a notorious blue nose who had already banned booze, and even soda pop from the fleet, was hardly willing to allow pro-kits, and banned them as well, saying,

The use of this packet I believe to be immoral, it savors of the panderer; and it is wicked to encourage and approve placing in the hands of the men an appliance which will lead them to think that they may indulge in practices which are not sanctioned by moral, military or civil law, with impunity, and the use of which would tend to subvert and destroy the very foundations of our moral and Christian beliefs and teachings with regards to these sexual matters.

While the debate raged, venereal disease continued unabated and unconcerned. It was the only real winner.