Rose was 20 years senior to Gunn; Vincent 19 and Russell 13. Clearly the relation between Rose and Gunn resembled that of a father to son, during the time that Gunn was stationed in Prague, while Russell was much too aloof for that kind of relationship to have established. In any case, they started out as co-workers before Russell took over from Rose.
Many historians have suggested that Russell and Gunn did not get along, and that Russell resented the fact that Gunn was not a medical man like him. If there is any truth to this none of it shows up in their correspondence. Russell may not have been willing to play the hand-holding role that Rose and Vincent had, but he was as attentive as both were to the complexities of Gunn’s task. However, they had radically different concerning public health. While Gunn developed a broad social approach to health, in which it was necessary to help countries develop their administrative structure, health and otherwise, Russell’s focus was the control of specific diseases and investing in key nationals to lead such disease control efforts. There was tension between them, certainly, but equally there was a mutual appreciation of their efforts. One small instance was the letter that Russell wrote in early 1927 shortly after Gunn had been promoted to Vice-President:
(My dear) Gunn,
… I am rather curious and interested in watching the new organization develop….I have the greatest confidence in you, Strode [who had become the IHD representative in Paris with the promotion of Gunn to VP], Gregg, and the others, and I believe that you will find a way out which will not only be mutually satisfactory, but will enhance and simplify the work we are attempting to do.
Before we look at Gunn’s role in the reorganization of the Foundation, we have to look more closely at the earlier history of Fosdick’s reform efforts. It is useful to see what Robert Kohler, a historian who studied this bit of history in great detail, had to say about the situation the Foundation faced in 1925:
Five years of uncoordinated entrepreneurship and growth inevitably resulted in duplication and conflicts among the various Rockefeller divisions and boards. Medical education was split between the foundation and the GEB. Richard Pearce, Abraham Flexner, and the IHB’s Frederick R. Russell vied for control of public health. Nursing education was supported by four divisions, hygiene by three. Pearce tried to start a program in the basic premedical sciences, but the trustees dismissed the idea only to give it to Rose a few years later. Pearce, naturally, was put out. Abraham Flexner resented Rose’s diversion of the GEB from general education and became increasingly protective of this own turf and intolerant of his fellow officers. (Alan Gregg recalled one meeting when Flexner itemized the failings of each in turn, leaving everyone stunned) Rockefeller officers began to trip over each other in the field).
Not only were the officers tripping over each other, that the represented different parts of Foundation was poorly understood by the public. After meeting with Gunn in July 1925 Vincent noted in his diary: Difficulties distinguishing between different units of the R.F. and from Rockefeller Boards – Public does not and will not understand but regards everyone who represents a Rockefeller Board in any capacity as being familiar with what is going on in all the organizations. Earlier, following a visit to Vienna, Gregg noted in his diary: “I wish we could get a copyright for the name ‘Rockefeller Foundation! Or else fuse IHD, DME, RF, PUMC, IEB, DS, GEB, and LSMR and go into business as ‘the Rockefeller people! our common name in Europe.” He wrote to Fosdick on this subject in July 1926.
The LSMR was the Laura Spellman Rockefeller Memorial, an organization formed in 1918 by John D. Rockefeller and named for his late wife. Initially it focused on improvements in public welfare and operated from the office of John D. Rockefeller, Jr. In 1923 Ruml was named director; under his leadership it moved into the field of the social sciences – economics, sociology, political science, and related subjects – psychology, anthropology, and history.
Fosdick had initiated informal meetings several years earlier to sound out the kinds of changes that the officers saw as being useful. Those involved included Embree, Abraham Flexner, Roger Greene, Rose, Beardsley Ruml, Russell, Pearce, and Vincent.
In this kind of bureaucratic exercise everyone present knows that there are potentially important stakes involved – any new program threatened existing ones; any talk of merger threatened those who would lose out in the deal. Russell seemed least concerned – his potential agenda of work was inexhaustible and in the military tradition from which he came his job was to follow orders. His temperament did not lend itself to empire building. He had enough on his plate, noting that “if we were to work on public health things on which we are now engaged and other things which now offer in Europe alone, this would employ all our resources and all our men.” Going further, he noted that after having started with the “single item of tuberculosis control,” the IHD development in Europe had “now grown to a generalized program in public health throughout the continent.”
Several possible directions were identified, none of them strictly speaking new – the humanities and the fine arts, including “music and beautifying of cities and towns,” public education, teacher training, schools of law, advancing art in industry, and the social sciences. Greene worried that they were “spending too much time hunting for things to do,” which interfered “with an orderly and wise conduct of existing programs.” Some others, however, were not immune to expansion, as witness Flexner’s suggestion that the Memorial could be merged with the GEB to avoid “conflict in social sciences and general education.” Fosdick, when referring to the “increasing complexity of life,” asked “whether we are watching closely enough for these boards to make greatest contribution to this developing civilization. We must develop social control to meet the increasing potentialities of destruction by the forces of science.”
Pearce, who had “nothing to contribute” during the first go around in January 1924, a year later, in a personal letter to Vincent, observed: “It seems to me that we are piling up our own traditions and establishing our own personal privileges in the R. organization, thus losing sight … of what is best for the development of medicine, or education generally.” Clearly the status quo held strong. However, on the very same day he wrote Vincent, ???
No doubt there were many proposals aired during this period; one interesting one is that of Ruml who proposed the liquidation of the LSRM and the establishment of a so-called Public Administration Board composed specially selected Trustees resulting from a “merging of the Foundation’s public health work and the Memorial’s public welfare activities”. He concluded his short memorandum with “This program or any like it would take a decade to work out, I suppose. I feel presumptuous in putting this on paper at all, and, of course, I would concede the possibility that it might be desirable to modify a detail here and there!!!!”
It’s not likely that Gunn ever saw this proposal but Ruml must certainly have discussed it at some point especially when Gunn took on responsibilities in the social sciences, as discussed in the next chapter.
In a confidential letter to Gunn Vincent informed him that the work of the IEB would be transferred to the Foundation. Since agriculture had been part of their mandate, it “is likely to be a continuing interest under the new organization.” He also informed Gunn that the social sciences work of the Memorial was to be transferred to the Foundation. With Gunn being “precisely the man to continue to represent the reorganized Foundation in Europe…(he was) sure that you will find the new era sufficiently varied and interesting to satisfy you fully.” (December 1, 1927)
By February 1928 the re-organization had progressed far enough for Vincent to send Gunn a preliminary statement which he was free to share with “RMP, AG and AT,” i.e. Pearce, Gregg and Augustus Trowbridge, European Director for the IEB.
The statement had been prepared by Fosdick. It announced that “we are all agreed that the Rockefeller Foundation should be built around a central idea, i.e. the advancement of human knowledge.” The “all” in this must have been the small circle involved in its preparation (Rockefeller Jr., Vincent, Rose, and Thomas Debevoise, a legal counsel to the Trustees) since he then went on to say “with perhaps one or two exceptions, I am confident that we can gain unanimous support for this proposition.” Here, he was referring to the Board of Trustees who would have to approve the plan before it could be put into effect.
Fosdick’s plan called for bringing together interests that before had been “scattered among other boards.” The IEB was to be abandoned and its program in the physical sciences and in agriculture transferred to the Foundation. Also to be brought into the Foundation were the physical sciences and the humanities and medical education programs currently with the GEB as well as the social sciences of the Memorial.
The resulting “set-up” would “involve the following divisions for the Foundation:”
- The natural Sciences: mathematics, physics, chemistry, biology, including research and engineering
- The Social Sciences
- The Humanities and Arts
- The Medical Sciences and Medical Education
- Agriculture and Forestry
There remained some “troublesome” details as well as obstacles yet to be overcome. These included legal questions related to transfer of funds from the IEB, GEB and the Memorial; the relationship between the Foundation and the remaining elements of the GEB and the Memorial; and the question as to “whether the International Health Board should be an independent operating organization, cut loose from the Foundation with a subsidy over a term of years or whether it should be made subordinate to the Foundation.” The China Medical Board was to be cut loose entirely so it would seem that this option was really under consideration for the IHD as well.
This was more or less the situation when Gunn became Vice-President. At first he confined his attention to the same concern that he had had over the previous years, namely, the lack of unity between the IHD and the DME, which had not yet become the DMS. Vincent encouraged him to present his ideas to the Board of Trustees in writing and to interact more with various bodies that were expected to visit Europe to explore the work of the IHD.
Gunn promised Vincent that he would on occasion send him “special memoranda” dealing with various policy issues. It took Gunn several months before he indicated to Vincent that he would send him “from time to time special memoranda dealing with matters involving general policy and work of the Foundation.” He would have preferred to discuss his ideas by “direct conversation” but at least Vincent would have some inkling of what Gunn was concerned with and could indicate which items he might like to have him present in “greater detail.” (May 16, 1927)
Gunn’s first “special memorandum,” dated April 30, 1927, touched on the sensitive issue of the RF being perceived in some quarters as having a definite program of “americanization” of European public health. The creations of the Schools of Public Health in London, Warsaw, Zagreb, Prague, etc. were seen as part of this program as was the fact that the majority of fellows went to the United States.
While Gunn denied that such a program existed, he foresaw a danger in the manner in which the Foundation worked:
Are we not dogmatists and too much sold to our dogma; Are we developing the same weaknesses as are attributed to missionaries. Too much faith in our particular brands of public health, medical education, nursing, etc..
He used the example of malaria to clarify his concern. There were people in Europe who refer to the “Hackett System” of fighting malaria and who seem to think that “we have entered into a sort of competition with the “quininists,” to which Gunn added “practically they are right, although we have not gone into malaria work with this spirit (but) … is it the proper function of the RF to get into such a position?” Gunn then rattled of a list of comparable problems:
Does Stampar know more about the best way to develop public health nursing in Yugoslavia then Miss Crowell? Are RKC and myself or Réfik Bey the more capable of deciding what are the next steps to take in Turkey in the advancement of public health? Is Gregg or Lepine more competent in deciding what is the best way to develop medical education in Lyons? Is it right for RMP to decide not to help medical education in Prague while there exist two medical faculties, or is the Czech Government correct in its assumption that both Czech and German faculties should continue indefinitely? Are we on solid ground when we refuse to appropriate a lump sum to the Health Section of the L. of N. when Rajchman and his associates believe that help in this form would advance their work better and make their task easier? Etc., etc., etc..
In his second memorandum, dated May 5, Gunn raised “some matters” that he had discussed on previous occasions with Russell. He wanted Vincent to be aware of them and to realize that they were “part of the complications actually encountered in the daily routine.” In this short note Gunn focused on the fact that “our work” distorts relationships among the national public health workers involved. In gaining the confidence of a new group that comes into power we risk making enemies with those who previously were our friends. He gave the name of Kolinsky to illustrate this point. Individual success, especially in Central and Eastern European countries “is a danger.” That person becomes a target for others. “Theoretically we should be neutral in such conflicts, but at times we are not and take steps to protect an individual in whom we have faith and whose position is in danger.” Here he submitted the name of Stampar, adding “Dangerous also for us perhaps.” Those with whom they worked sometimes use their relationship to threaten their foes, with, e.g., “If you insist on such and such, the RF won’t help us.” Bulgaria was one such case in point.
In his third and final memorandum of this kind, undated but sent along with his second one, Gunn addressed the “lesser personnel” of the Foundation who are responsible one way or another for giving away money, which is what “we exist (for) primarily.” These should be of the “best quality possible,” but they are not. “Why? Lack of competent men? Too low scale of salaries? Desire to build up our own staff with our ideas rather than take older men who have points of view divergent from those of our directors or perhaps from our policies.” Here Gunn added the qualifying phrase, “These remarks pertain to the IHD rather than the DME.”
Gunn continued:
My belief is that the best is none too good. Our personnel is at times poorly trained, immature, ignorant of the world (and its languages), moderately paid and therefore not in a position to do the job they are called upon to do in the best manner. Does our retirement scheme militate against employing older men? If it makes it desirable that we employ young men, it would seem to. It is one thing to carry on successfully a hookworm campaign and quite another to advise with a government on its public health policies.
He concluded with the example of Frank Boudreau whose salary with the League of Nations had just been raised from $5000 to $6500, adding, “we need men of this type, age, maturity and judgment. We would do better work; increase our ‘overhead’ but to great advantage.”
Gunn discussed his memoranda with Vincent during the latter’s visit to Paris that summer. Vincent made note in his diary adding that Boudreau “has been under consideration – some delicacy in proposing to take him from the L. of N.,” something that did not materialize. Instead, Boudreau who at that time was Rajchman’s deputy, succeeded Sydenstricker as director of the Milbank Memorial Fund in 1937 and later became a senior advisor matters pertaining to nutrition to the WHO and the US Government.
Vincent had several occasions to visit Europe. He met with Gunn frequently and visited him and his family in Cannes during a week’s holiday in the South of Europe. Some of the items that they discussed appear in Vincent’s diaries but only in the form of brief notes thus making it difficult to judge how really important they were:
Social medicine – SMG conviction that this is going to develop more and more in Europe and that professorship of social medicine in important medical schools would have stimulating effect upon public health work in general.
Cooperation with Health Section of L. of N. FFR has agreed to conferences, etc. Seems questionable whether there is any feasible way of actually cooperating with the health Section in field projects – Rajchman was a little disturbed because he knew nothing about our arrangement with Swellengrebel whom he regards as his man – there ought to be no difficulty in maintaining satisfactory relations without being involved in any embarrassment.
SMG would heartily welcome visits by trustees to Europe to familiarize themselves at first hand with what the RF is doing.
Some discussion of non-medical men in public health work – the training provided at Yale, etc.
Nurse-training standards – Sometimes SMG thinks that we are suggesting rather elaborate arrangements, dispensary records, etc.
Vincent, perhaps aware of the impact on Gunn’s morale of this slow process of change, communicated at the end of 1927 the observation, “so far as you are concerned personally, it seems to be generally agreed that you are precisely the man to continue to represent the reorganized Foundation in Europe. I’m sure that you will find the new era sufficiently varied and interesting to satisfy you fully”.
Vincent clearly supported Gunn’s views on medical education; when, for example, Daniel O’Brien was hired as Gregg’s assistant in mid-1926, he urged upon him the “importance of stressing the preventive idea in all our medical education work – We entered the field for the sake of promoting public health interests – more important to educate the average dr. than even the special p.h. Officer…we should aim at as intimate team-play as possible between the 2 aspects of med”. Also, Vincent seems to have made it a point to talk with American public health specialists where he learned about the “very serious situation in the recruiting and training of personnel for p.h. Work”. Some classes have hardly any students, while the ‘old Harvard Tech Course’ is attracting 25 to 35 students for reasons that they do not understand.
Outside of Vincent and to a lesser degree Fosdick, it’s not clear how aware Foundation officers were of Gunn’s criticisms. How much did they hear, given the fact that most of it was transmitted to Vincent in conversation and that little seemed to come of Vincent’s attempts to get Gunn to put his ideas on paper. Gunn preferred to deal with people face-to-face, which is one reason the failure of Newsholme to take on the assignment of evaluating IHD activities in Europe, as discussed below, was such a disappointment to him, especially given the fact that Newsholme was a strong advocate of social medicine.
One has to presume, however, that Gunn shared many of his views with Gregg as friendship between them grew. But even this is not totally clear, as witness the number of times that Gunn wrote Gregg about everything else but the discussions that he had with other staff. Perhaps the most blatant example of this was his what he had to say about the conversations in Geneva in August 1928 where Fosdick, George Strode, Ruml, and Vincent were present.
He wrote that “Vincent has come and gone…He certainly is an attractive travelling companion. The conversations in Geneva were interesting, but I am too lazy to tell you about them … Vincent gave a luncheon the other day … There were ten of us there and a vote for President of the USA was taken and resulted in Smith seven and Hoover three. I will leave you to guess who were the three Hooverites. As far as I can make out from reading the newspapers the vote in America is more apt to be in the opposite direction.”
Not everyone thought that Smith had no chance. Vincent, who met Bernard Baruch on his way back to London from Paris, recorded this in his diary:
B. going back to work for Smith – would vote for him if only because he is a Catholic – interesting implications of this remark – says Smith wanted him, B., to manage his campaign but B. thought that a Catholic and Jew would be too much for the public. Owen Young (a prominent American business man who from the conversation seemed also to be involved in Smith’s campaign) an exceptionally fine man … thinks Smith has a real chance to be elected.
Hoover won in a landslide with an electoral vote of 444 to 87 and a popular vote of 58.3% to Smith’s 40.8%.
Gunn had nothing to say to Gregg about the reorganization. The only related point was to inform him that Vincent “understands our point of view with regard to the disadvantage of frequent changes of IEB chiefs in Europe. I gather that MM [Max Mason] will probably be the next President of the RF. A remark which I heard to the effect that GEV might get out before the end of next year seems to me to be entirely unfounded.” Gunn was more or less right as Vincent announced his retirement in December 1929.
Vincent’s charm and wit were proverbial as already noted. They may have hidden a deeper commitment to helping shape the future of the RF than historians have credited him with. Instead, Fosdick is given nearly all of the credit for managing the Foundation’s reorganization. Yet from Vincent’s exchanges with Gunn one gets the impression that he was encouraging Gunn to move in a direction in which he himself favored for the organization. Knowing that he would shortly be leaving the Presidency must have constrained him from interfering too directly in the changes that were taking place. For the same reason Gunn might have preferred not to put too many of his ideas down on paper before Mason took over from Vincent.
Advantage was taken of Gunn’s presence in New York in October 1928 to organize a four-day conference on European policies and programs. Also present were Vincent, Russell, Gregg, and Pearce. From the short account of the meeting it would seem that Gunn did not raise any of the issues that he had raised with Fosdick earlier. As no increase in staff was foreseen, and since supervision was “indispensable to present programs”, it was not likely that enough good people could be found ‘to make expansion possible, it was agreed that certain countries should be concentrated on “with a view to completing work and moving on”. It was also agreed that local health demonstrations served first to convince health officers with a later aim being to convince the population. Concerning training, it was agreed that “hygiene, public health, medical education and nursing shall always be thought of in relation”. However, the ‘procedure’ would differ according to situation. This is wishy-washy bureaucratic language at its best; clearly no one wanted to rock the boat.
In private, however, Gunn expressed his hopes to Vincent that aid to medical education would not be “suddenly or wholly abandoned in Europe”, arguing that “country physicians need much better training (since) their co-operation in public health work (is) essential”. On learning about the new policy for the DME from his discussions with Pearce, he wrote in his diary:
SMG wonders whether the new policy of the RF in connection with medical education would mean that the program to develop strong departments of hygiene and preventive medicine in strategic medical faculties would be abandoned. RMP says that it will not necessarily be abandoned but will be approached from a different point of view, namely in the form of possible aid in research, etc., in bacteriology and immunology, etc. SMG doubts if such aid would really materially affect and modernize teaching of hygiene in the medical schools.
Gunn was not the only one to complain about the Foundation’s approach to public health training. William Carter, in response to Edsall’s request for “comments, suggestions concerning past, present and future activities of the DME”, described various episodes involving countries where he had worked to obtain support from the IHD or the DME in this area, only to be frustrated by the unclear division of labor between the two divisions. Carter, who was a DME staff member stationed in the Far East, concluded that “the separation of graduate teaching and research in public health from undergraduate instruction in this field seems an arbitrary, unnatural and very costly arrangement”.
The Trustees approved the direction that the reorganization was taking in the summer of 1928. Rose retired from the IEB as did Abraham Flexner from the GEB. To guide the transformation of the IHD and the DME special committees were established for each. The study committee established for medical education was headed by Edsall, who Gunn knew well from his earlier visits to Harvard; that for the IHD was headed by Simon Flexner, who Gunn had few, if any, occasions in the past to have met.
Vincent informed Gunn that he would be asked by Flexner’s committee to present his ideas on present programs and future policies, suggesting that he “ought to be turning things over in your mind and preparing notes which you can make the basis of a document to be submitted to the Committee”. He particular asked him to comment on “the relative value of various items, the things which might be brought to a close, those which ought to be developed, new projects which might be undertaken and weaknesses in personnel, organization, etc., which might be corrected …. Here is a chance to take account of stock and inaugurate a new era”. A week later Vincent realized that he had restricted his request to the work of the health division. “Of course, this was an oversight. You should feel precisely the same obligation to comment upon the work of the Division of Medical Education… As Vice-President, you are expected to see the enterprise as a whole, to express judgments and to offer suggestions”.
Flexner fell ill and he and Gunn never met to discuss this subject as Vincent had hoped they would. However, Flexner decided to request someone to undertake a study of the IHD activities in Europe. Gunn expressed a reluctance to make any immediate suggestions as he was “about to start in on a study of the whole situation here and any suggestions now would be premature.” What study Gunn had in mind is not clear. In any case, it may have been interrupted by the fact that someone was to undertake a study of the IHD activities in Europe.
Vincent responded positively to Flexner’s proposal “provided a group of men of independent judgment and strong character can be secured. Everything depends on that”. At the same time he indicated that an independent study of the situation in Europe, might not only take a long time, it might “impair the morale of our force here … if it were known that such a study were being made”.
At first it was believed that Andrew Balfour, Director of the London School of Hygiene and Tropical Medicine, would take on this study, someone that Gunn thought to be “too highly specialized on laboratory and tropical medicine sides – not sufficiently familiar with public health administration, field work and administrative problems”. Newsholme, on the other hand, would be most suitable. In any case during his stop in London Vincent learned that Balfour found it “utterly impossible” to take on this assignment. Balfour agreed, however, that Newsholme was “well fitted for the proposed study.”
Vincent dined with Newsholme who he found to be “in vigorous health and mentally keen and alert. He is seventy-one but like Dr. Welch seems to retain an unusual measure of bodily and mental vigour and to be animated by a kind of youthful enthusiasm.” This he reported back to Flexner along with an indication that he was careful “to put everything on a tentative basis.” It was up to Flexner to act. At the same time he added, “The more I think about the problem and after discussion with Mr. Gunn, the more I am impressed with the complexity of the situation, the need of studying it carefully and deliberately and the difficulty of reaching early decisions.” (July 17, 1928)
Vincent used the excuse of Flexner’s illness to indicate to Newsholme that it was “rather probable that the study will be either postponed or possibly abandoned.” (July 28, 1928) Newsholme was not upset, as he had already committed himself to a major study of a number of European countries under the sponsorship of the Milbank Memorial Foundation. (ADD SOME MORE) It was prudent of Vincent to suggest a likely postponement of this study because Flexner had come to the conclusion that he expected “less gain from a mere inspection of activities of the division than I should from a policy based on principles. These principles can, I believe, be discussed any time and the steps be taken to put those adopted into operation.” Flexner managed to not even visit the county health work at Quebec, which Russell was “eager” to have him see. (July 14, 1928)
Flexner suggested to Vincent that a board of Scientific Directors should be established to oversee the work of the Division. He outlined the qualities that members of a board of directors should possess. He proposed that the operations in the field be separated from the administration of the Foundation “as a whole,” giving China work as an example. The present setup encouraged “fixity of the official personnel.” He preferred a “trial and error system of having men go and bringing in new blood from time to time.”
Vincent responded positively to Flexner’s proposal concerning the Board of Directors “provided a group of men of independent judgment and strong character can be secured. Everything depends on that.” If such a Board could be established and an “appropriation made for a five year period, the directors could have leisure to study the problem for themselves. He again referred to a point made by Gunn, namely, “that only after a relatively long period will it be possible to appraise the actual achievements in most cases of our cooperation in European countries.” (July 24, 1928)
Concerning Edsall’s committee, Vincent had informed Gunn that he would be hearing from Edsall, which Gunn did, but at the same time Vincent informed him that he had heard from Edsall “that all that was wanted was rubber stamp approval and that raising questions was somewhat resented”!
Edsall’s report indicated that the particular functions of the DME ‘should be to develop opportunities for aiding men in and training others for research in those fundamental sciences that bear upon the problems of Hygiene and Preventive Medicine’. No need for distinct Schools of Hygiene, as such, anywhere in the world, assuming the ‘proper use of reasonably well developed departments of Hygiene in the Medical Schools, together with the cooperation of other suitable departments in the Medical Schools and in other parts of the University’. The role of the DME should be ‘largely confined to aiding those sciences upon which Public Health is built, and furthering research and advanced training in these’. As for the training of health officers, this should not be a ‘matter of special interest unless unexpected peculiar opportunities with especially fruitful promise appear’. Some support was being provided by the IHD, but by and large the training of ‘actual governmental employees in Public Health…would seem to be properly the function of government’.
Edsall’s committee presented a plan of action in November 1928, whose first point summarized the committee’s recommendation:
That concern with the development of medical schools as institutions be lessened and the principle of aid to individual, groups, and department in relation to research and advance of medical knowledge be emphasized with the understanding that this change implies lessening concern with medical problems of backward countries and departure from the policy of multiplying well-organized and complete schools, but leaves the officers free to continue to promote such parts of the old policy as may seem wise.
Gunn’s premonitions concerning the future policies of the DME were right. The shift in emphasis was reflected in the new name given this division, that of Medical Sciences. On Pearce’s unexpected death in early 1930, Gregg was made Director.
Not only was Gunn unhappy with how matters were developing regarding medical education, he was equally upset with the direction that the IHD was taking. Gunn wrote to Fosdick that the IHD had avoided “as far as possible public health questions which were complicated by fundamental, social and economic problems”. He doubted “very much the wisdom of such a program”, citing the tuberculosis program in France which was never popular with the officers of the IHD. An anti-tuberculosis campaign could “be used as a very excellent entering wedge for the development of a general public health program”, as had been the case in the United States. To Vincent that he wrote that he was “still dubious about withdrawal from local health work or any serious curtailing of the program in Europe”. (November 7, 1929)
Gunn had come to realize that his future rested outside both divisions, as discussed in the next chapter. Further evidence of this is to be found in his rather indifferent attitude towards the Scientific Board of Directors that Flexner was establishing. Flexner exchanged his ideas concerning this Board with Vincent. For example, in a letter dated October 29, 1928, Flexner wrote:
About the choice among Smillie, Drinker, and Zinsser at Harvard, I think a great deal can be said in favor of Smillie … It will be a great help at the outset to have someone besides Dr. Russell with first-hand knowledge of all the work. My impression of Smillie is that he will act independently…
As between Drinker and Zinsser, I should be in favor of Drinker. With Cole and Winslow on the board, another bacteriologist is not needed and, between ourselves, I do not think Zinsser is a man of remarkable judgment.
Flexner’s proposal to establish a Board of Scientific Directors was approved in early 1929. Despite Flexner’s apparent indifference to anyone visiting Europe, Vincent encouraged Board members to conduct such a visit. Vincent wrote Gunn to inform him that “everything went through yesterday as planned.” After a “long and thorough discussion” the Trustees named the following six men as the first scientific directors of the International Health Division under the new plan:
Dr. Rufus Cole of the Rockefeller Institute
Dr. Louis I. Dublin of the Metropolitan Life Insurance Company
Dr. Wade H. Frost of the Johns Hopkins School of Hygiene & Public Health
Dr. C.E.A. Winslow of the Yale Univ. School of Medicine
Dr. W.G. Smillie of the Harvard School of Public Health
Dr. E.L. Bishop of the State Board of Health, Nashville, Tenn.”
WHO WERE THESE MEN? DID ANY OF THEM OTHER THAN WINSLOW VISIT?
Winslow contacted Gunn in February 1929 to get his help in arranging a trip on his part to Yugoslavia, Hungary and possibly Greece, as well as the Paris Office. He reported that the Scientific Directors had had their first meeting and that he thought that “all of us were enormously pleased with the atmosphere and with the attitude of Dr. Russell.” They got the “distinct impression that our job as directors is a real job with the whole problem of policy wide open for consideration.” (February 9, 1929) Gunn in his reply indicated his pleasure that he had accepted this appointment and agreed that a visit to Hungary and Yugoslavia “would give you quite a good idea of public health conditions in Central Europe.” He recommended Poland as well. (February 28, 1929)
Winslow did visit Europe in 1929: Gunn in Paris in May, followed by his attending (in an unofficial position) at Geneva the spring meeting of the Health Committee, and then a German-Austrian trip of the joint LNHO-ILO committee on social insurance questions (with Jacques Parisot), and last but not least, a visit to Štampar’s Yugoslavia. By the time of his visit Gunn had largely disassociated himself from the IHD program as witness the fact that when he forwarded to Vincent the report of the work done by the IHD in Europe in 1928, which was written by Strode, he indicated that he “did not have a chance to read it through before it was mailed, but I was very much impressed with the first two pages of the report.” On the basis of those pages his views of the future of the IHD program in Europe coincided with his own. (March 4, 1928)
It is thus not surprising that Gunn did not seem to have raised any of the issues that had led him to question how the IHD was carrying out its work; he simply noted Winslow thinking that the program of the IHD (now IHD) in the past had been “remarkably successful”, and he saw no reason that it should change in any way. Winslow, however, raised some of the points that he would soon write Russell about, namely, that he did not believe that the IHD should carry out studies itself, but should subsidize and stimulate studies by health departments. Russell disagreed:
I told him we had not done that sort of thing and I had no idea of doing it, that I had an entirely different idea to furnish not merely money and an observer but that we would furnish a leader, and our efforts would be on a small scale in order that the study might be intensive; that we were obviously thinking about quite different policies.
Interestingly enough, given his strong advocacy for a broad social approach to public health, Winslow informed Russell that he felt “that no other activities of the IHD can quite compare in importance with the full and vigorous prosecution of the yellow fever program”. On the other hand, this is perhaps not so surprising given Winslow’s intense interest in the history of communicable disease control as witness his wonderful history – The Conquest of Communicable Diseases. ??
Winslow reported to Gregg how impressed he was with Yugoslavia’s experiments in disease control. He also thought that Štampar’s position in the control of hospitals would provide him with “an excellent opportunity for the development, hand in hand, of preventive and curative medicine”.
Gunn was probably unaware of some of the other issues that seem to have divided the Board Members concerning the future work of the IHD. As noted by Frost, the directions given to the Board concerning the future work of the IHD were “so broad that pretty much everything depends upon the interpretation given to it and the emphasis put upon different phases of the several functions enumerated”. This being the case, Frost thought it best to outline in detail how he saw the future of the IHD.
He assumed that that the broad purpose was still to “promote public health on an international scale, especially by the control of preventable (not necessarily communicable) diseases”. Given the fact that the Rockefeller Institute was already conducting fundamental research, the policy of the IHD should be “to develop research, not as an independent function, but as part of each control project, which may require special research”. This is what he believed Winslow meant in saying that “he thought the research should be of an ad-hoc sort.
Frost pointed out that investigations that had developed “naturally in the course of projects for the control of hookworm, malaria and yellow fever” but as yet “the development of rural health organizations” had not as yet led “to any serious or extensive investigations”. What was called for were “deeper and more serious studies of the actual problems which confronts” existing organizations. By this he meant “epidemiological studies … in connection with the up-building of local and State health department organizations, and equally in connection with any laboratory research program….”
He suggested that a few local health departments be picked out, “here and there, either State, county or city organizations”, where the IHD would place one or two of its own men “who are especially well qualified for epidemiological investigation, each unit undertaking the study of one or two definite and concrete problems, as for instance, rural epidemiology of tuberculosis, a more intimate study of infant mortality and its prevention, etc.”.
There is little indication that he involved himself to any great degree in the work of the Scientific Directors who, as Winslow had indicated, became deeply involved in trying to influence Russell and the manner in which the IHD was carrying out its mandate. Although this history did not directly involve Gunn, it is important to our story. It is easy to imagine that had Russell not been successful in pushing forward his ideas Gunn’s future might have remained with the IHD rather than with the social sciences. All of this is conjecture but many possibilities were in the air in 1929 so there is much to conjecture about.
His charm and wit were proverbial but Vincent may have used his humor to keep himself from not being taken too seriously, but as President of the leading philanthropic organization in the world, his humor might have his personal impressions of Vincent because Vincent’s role in bringing in the reorganization of the RF has not been elucidated. Historians have preferred, instead, to give Fosdick nearly all of the credit for managing the change. Yet from his exchanges with Gunn one gets the impression that was encouraging Gunn to move in a direction in which he himself would have been pleased to see developed. Knowing that he would shortly be leaving the Presidency, however, must have constrained him from interfering too directly in the changes that were taking place. For the same reason Gunn might have preferred not to put too many of his ideas down on paper before Mason took over from Vincent.
Be that as it may, Gunn found time to write a children’s book, Pools, that he sent to the publisher Macmillan’s. He wrote this to Gregg as a footnote adding “I did not include return postage but suggested the wastepaper basket instead.” Some 9 years later Gunn did write and have publish a 102 page children’s book in which ‘pools’ occupied a major place, but it’s title was: The Doings of Dinkie. This part of his life is discussed in later chapters.
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