The New York Times headline of July 12, 1917 announced the men that had been picked to “fight white plague abroad.” Subtitled “Rockefeller Foundation Selects Livingston Farrand as Director of Commission to Go to France,” the article listed the members of the commission which included Professor Gunn who in addition to his MIT and APHA responsibilities was cited for his “long experience in public health administration and in working out the new health laws of Massachusetts.” Other members listed, besides Farrand, included Dr James Miller, Homer Folks, both from New York.
Miller was a professor of clinical medicine at Columbia University and director of tuberculosis at Bellevue hospital in New York. Folks was Secretary of the New York State Charities Aid Association (SCAA). Farrand and Folks were old associates in the National Tuberculosis Association (NTA). Left out of the Times article, but nevertheless a member of the commission, was its one female member, Elizabeth Crowell, also of the Association of Tuberculosis Clinics in New York.
Both Farrand and Folks were born in 1867. Farrand graduated from Princeton University in 1888 and earned a medical degree from the College of Physicians and Surgeons in New York. Interested in primitive psychology, he joined expeditions to northwestern America with Franz Boas and others, and was appointed professor of anthropology at Columbia University in 1903. This period of his life led to a series of books on American history including several on the history of American Indians. While executive secretary of the NTA from 1905 to 1914, he was largely responsible for guiding the organization to be one of the most important nation-wide voluntary organizations in America. He left the association in 1914 to become president of the University of Colorado from which he took a leave of absence in 1917 to head the mission to France.
Folks, too, brought to France a rich experience. He graduated from Albion, a Methodist college, in 1889 and after one year at Harvard he entered the world of voluntary social work with which he was associated until his retirement in 1947 at the age of 80. It was Folks who initiated the press campaign that led to the New York legislature withdrawing several bills opposed by Hermann Biggs, a campaign that Gunn had commented on favorably in one of his editorials. Folks contributed extensively to the development of public health in New York State as well as the promotion of the social dimension of public health.
While Farrand had worked closely with Gunn before, and was probably responsible for his inclusion as a member of what came to be known in Europe as the Rockefeller Commission, the degree to which Folks influenced the course of Gunn’s career is difficult to assess. For example, just before Gunn took the position of Health Officer in Orange, an educational program aimed at tuberculosis that the SCAA, headed by Folks, had initiated in 1907 for New York came to a close. The statewide program emphasized preventive measures; educational messages were passed by means of lantern slides, pamphlets, lectures, photographs and models, measures that Gunn would shortly adapt for use in France. Folks’ ideas concerning tuberculosis were the center of attention at a meeting held by the NTA in 1909. As reported in the New York Times (May 16. 1909):
In the opinion of Mr. Folks the control of tuberculosis was a problem for the local authorities. He said that the most effective work which could be done by organizations was to follow the example of the National Association in forming local organizations or committees to take the responsibility of securing county and municipal control for the disease.
It was such a program that Gunn developed in Orange before his departure in 1910.
The boat passage that took the commission from New York to Le Havre in July 1917 provided ample time for Gunn, Folks and Farrand to compare their notes on how best to combat this dreaded disease.
Tuberculosis was not one of the diseases that the Rockefeller Foundation addressed in America in its early programs. Initially, tuberculosis control measures were undertaken as part of the relief efforts that the Foundation found itself supporting from the moment the war broke out. France became the focus of attention largely due to pressures placed on the Foundation from several eminent French as well as American personalities who stressed the emergency nature of the disease and the inadequacy of the French medical care system to meet ever-increasing numbers of cases.
During the summer of 1916 Professor Wallace Sabine of Harvard, who happened to be in Paris at the time, was asked by the Foundation to investigate the situation. A brief study was made by William Welch as well, who was in Europe primarily to discuss his plans for the organization of the Hopkins School of Hygiene with English physiologists. Biggs, who at the time was considered to be the leading American authority on tuberculosis, was asked to review these results and to provide further advice. In a long letter to the Foundation he expressed his agreement with the urgency of the problem. Tuberculosis was a “real menace to the health of the French people and to the economic development of the nation.” Particularly worrisome were the number of infected service men who untreated would carry the disease back to their communities at the end of the war. Biggs used the occasion to note all of the difficulties present: an ignorant population that was “generally indifferent” to the problem; comparatively few clinics for the treatment of pulmonary tuberculosis; few trained nurses and no visiting nurses; no facilities for the free bacteriological examination of the sputum; no efficient local sanitary organizations; the lack of institutions for the care of the disease; and no system of compulsory registration of the disease. In effect France would be taking up the tuberculosis problem “almost at the beginning (and) under extremely trying conditions.”
Biggs proposed that a “competent young man” be sent to France for at least two or three months to conduct a careful examination. He underlined the fact that no results could be expected in the short term – “we must… wait several years for them to appear.”
In the end, the Governor of New York granted him a leave of absence and Biggs went himself at the beginning of 1917 for a period of several weeks. He was accompanied by Alphonse Dochez, a Belgium-American physician. What Biggs saw confirmed the impressions that he had drawn from the previous studies undertaken. He wrote Edwin Embree, Secretary of the Foundation, “there is no health problem with which I am familiar, or with which I have ever come in contact which it seems to me to offers a broader or a more useful field of activity for the Rockefeller Foundation than this one; nor is there anywhere a more fruitful field of usefulness or one in which a greater contribution can be made to the benefit of the human race.”
The French authorities were not particularly happy with the negative assessment that Biggs had made of the situation. He might have been more tactful in the choice of his words but he was not paid to be diplomatic; he was asked for his opinion and advice and this was what he provided. The Foundation thanked him and indicated that they had approved his plan. Rose further elaborated the plan in May 1917; this plan was approved by the Board of Trustees.
Rose’s plan stressed the experimental nature of the whole effort, one that should begin modestly to be followed by an expansion “as opportunity may offer and as results may justify.” The work would be done under the “sanction and general administration of the French government.” Going further, he stressed that in the main it would be carried out by “France and the French people.” America “will lend stimulus and direction and a limited amount of financial aid.”
A duration of at least five years was envisaged during which four mobile educational agencies and four training centers would be established under the direction of a central administration located in Paris and headed by American Director, i.e. Farrand.
Biggs had estimated that ultimately some 300 to 400 anti-tuberculosis dispensaries were needed. These would be maintained by local funds with the proviso that the Foundation “might well contribute something toward the maintenance of a limited number…to serve as a stimulus and a guide to other communities to duplicate the effort.” Also to be undertaken were the setting up of diagnostic laboratories for general public health purposes.
An annual budget of $150,000 was estimated for the central administration, mobile educational units and training centers. The budget for the dispensaries and laboratories was listed as “indefinite” at this stage of the undertaking.
Folks was in charge of the American Red Cross’ Department of Civil Affairs, which dealt a number of problems besides tuberculosis. The Red Cross had already started working earlier in the war on the gigantic task of returning refugees to their homes and rehabilitating devastated areas. Folks, who had been given almost a carte-blanche by his organization, established nine bureaus, later consolidated into six – Reconstruction and Relief, Children and Infant Mortality, Repatriates, Tuberculosis, Refugees, and Re-Education of Mutiles. He left Paris one day after the war ended to head a commission for a survey of the needs of other countries where the Red Cross had been asked to help. Miller was placed in charge of the dispensaries while Crowell took charge of training public health nurses. Crowell would soon join the Foundation to head their nursing program.
Gunn was responsible for the educational campaign. He was able to move relatively quickly while the other member of the Commission had to contend with strong professional antagonism on the part of the medical as well as the nursing community to some of the ideas that they were trying to introduce. Gunn had the advantage of developing an educational campaign whose focus was the school children, an approach that the NTA had introduced in America in 1915 under the label of the “modern health crusade.” There, its aim was to get children to adopt certain hygienic measures, e.g. washing hands before meals, brushing teeth, taking a bath regularly, etc. In France, the aim was targeted against tuberculosis. Once the program was in full swing, children were asked to write short essays on such topics as – what do you know about tuberculosis? and How can tuberculosis be avoided?
Gunn had to overcome what was perceived (by the Americans at least) as a deeply rooted belief among the French that tuberculosis was incurable. “Disgrace and despair was associated with it.” To get people to voluntarily submit to an examination would require considerable change to long-held ways. By focusing on children, who hopefully would not yet have succumbed to their parent’s way of thinking, they could be instrumental in convincing their parents to change their views. However, children were not the only focus of the campaign; wherever possible all locally organized groups were approached such as factory workers and mothers.
Gunn’s program evoked considerable admiration and enthusiasm among the French. By the end of 1917 the first educational unit was in full operation. Its essential feature was a traveling exhibit mounted on motor trucks on each of which was mounted a generator that produced enough electricity to run movie and slide projectors. The exhibit also featured forty-two panels and much printed material. The use of large multi-color posters, common to US advertising, was new to the French.
The first unit was established in Eure-et-Loir, a department (State) just to the South of Paris. Ten more departments were visited in 1918. Meetings were held in all communities visited which had a population of over 3,000 inhabitants. In 1918 nearly 150 such towns were visited and 875 lectures given. Recognizing that such visits might not have any permanent impact, Gunn stressed the necessity of organizing permanent educational activities organized by the French themselves. By the end of 1919 some 28 departments had been visited. By then Punch and Judy shows had become a standard and very popular feature of the traveling exhibit, which during the year had reached more than 3 million people and distributed more than 3 million pieces of paper. At one point the demand for educational material was so great that there was difficulty in keeping up. Even the supply sent to the New York office was inadequate. Gunn was told that they were going “like hot cakes.”
The educational campaign was carried out in cooperation with Folks’ Children’s Bureau. This allowed Gunn to wear the uniform of the Red Cross. As reported in an AJPH editorial entitled “honors to Captain Gunn,” Gunn was also made Knight of the Legion of Honor, one of France’s most prestigious awards. Gunn is standing 8th from the right in the picture that was taken in March 1918 in Rennes. The third person to his right is Louis Destouches who later became known as one of France’s greatest authors under the name Céline.
Destouches was hired by the program as an interpreter. He quit the mission when the war was over to prepare for his baccalaureate, which he obtained in July 1919 in Bordeaux. Gunn played an important role in helping him find a job with the League of Nations Health Organization, a job which formed the base for all of his important fictional works written under the name of Celine.
Several years later, Rose wrote Gunn that the work “which developed under your direction in France I regard as the most successful public health educational work that has been done anywhere.” He hoped “to see it tried in our own country.” At the time Vincent judged Gunn’s campaign to be “a model of imagination, ingenuity and efficiency” and tried on several occasions to obtain a faculty appointment for Gunn at the Hopkins School of Public Health. Welch declined to accept this proposal. As it was, Gunn returned to America but for totally different reasons. He had contracted tuberculosis in the course of his work and was granted 6 months sick leave beginning in early May 1920. He returned for treatment at the Trudeau Sanatorium at Saranac Lake, New York, the first rest home for TB patients in the United States. Dr. Edward Livingston Trudeau was the first American to promote isolation as a means to heal the sick. His sanatorium featured a strict regimen of diet and exercise and as much time to be spent outdoors as possible. In a letter to “Charlie” Winslow dated May 28, 1920, Gunn described his tuberculosis in terms of being “‘winged’ in my left lung.” His stay lasted 5 months. He left New York for service in Czechoslovakia on October 7, 1920. His work in France was judged to be over, at least for the time being.
Gunn had visited Prague twice before, the first time for two weeks in June 1919 and the second time in February 1920 accompanied by Rose. An invitation for Gunn to visit Czechoslovakia resulted from a visit paid to the Paris office of the RF TB Commission on May 19, 1919 by Alice Masaryk, daughter of Thomas Masaryk, the country’s president. She was also president of the Czech Red Cross and had close ties to America. Her mother was American and earlier in the century she lived in Chicago where she interacted with other Progressive Era social activists in the United States. Her father, too, had deep political connections in America, built with the exclusive purpose of creating the independent state of Czechoslovakia.
Czechoslovakia was a creation of World War I. Its two major parts – the Czech lands (Bohemia, Moravia, and Silesia) in the West and Slovakia in the East – had different histories. Further complicating the situation was the presence of many Germans and Austro-Germans who for centuries lived in towns that were now inside the Czech lands bordering on Germany and Austria. Many Czechs did not accept these Germans to be part of their country. These and other divisive factors played heavily on the work in which that the Foundation engaged Gunn.
Gunn was not alone in Prague. With him was Dr. Frederick F. Russell, who arrived several months ahead of him with the very specific task of helping the Czechs establish a central laboratory as part of a National Health Institute. Russell, some 13 years older than Gunn, was a military physician whose typhoid-related work has already been described; his main interest was in the laboratory side of public health. After many years in the US Army Medical Corps he joined the RF’s IHB in 1919. When he left the Corps his rank was that of Colonel, but in the reserve it was that of Brigadier General.
Their work initially was more or less defined by the plan that Gunn and Rose had outlined earlier, the more critical points of which were the provision of emergency aid in the control of infectious diseases, the establishment of an efficient public health laboratory service as well as an effective statistical service, training of young cadre who would be the future leaders in public health, advising on the development of an effective public health administration, planning for the eventual building of a school of hygiene and public health, and the training of public health nurses. Five fellowships were arranged at the time of Rose’s and Gunn’s visit. These fellows were sent to America for study.
With the help of Russell, Gunn and his wife Clara settled into a hotel for five days before finding a small apartment complete with “bath room, servant, electric light and a dog.” Almost from his first day Gunn found himself immersed in work, the highest priority being given to finding suitable positions for the fellows who were waiting in America to learn of their fate. One of them, H. Pelc, Gunn claimed for himself to help him conduct a survey of all of the operations of the ministry of health. Hulka was wanted by the Minister for tuberculosis. Karl Driml was earmarked to help develop a public health program in a district in Slovakia or elsewhere “as a demonstration to the rest of the country.” Gunn wasn’t certain that the Minister had bought this idea but he seemed to think that he had for the time being (November 1, 1920). Bernard was to study questions related to industrial hygiene. (January 14, 1921)
In early December Gunn wrote to Rose the first of many letters in which he summarized what he had been doing and the many obstacles that only now were beginning to be more evident. Office methods, for example, as found in one of the divisions that had been studied, were “indescribable:”
It takes weeks and sometimes many months to accomplish anything. The whole system is bureaucratic in the extreme. It is said to exist in all ministries, in all departments in the Land Government (i.e. Bohemia, Moravia, etc), in city departments and down to the smallest governmental area.
These methods were said to have been inherited from “Austrian days.” They would have to be changed if any progress was to be made.
Not for the first time would Gunn (as had Russell already) complain of important and frequent changes in the organization of the ministry, changes due to higher level politics. Russell had noted earlier, for example, that the Social Democrats wanted to abolish the ministry (as part of a left wing led effort to install a “Russian Bolshevist regime”) and that President Masaryk had appointed a cabinet of officials to stabilize matters. Gunn wrote of the country being in a “state of transition.” In any case, “new blood” was needed. If the men trained in America “can get into important positions much will be done.” The odds for this happening were, however, low, “The men in the higher positions have in many cases spent years in the laborious climb to the higher classes of the service. Why should these young men travel faster than they have, they ask?” Why indeed. Gunn ended this letter on an almost resigned note, “It is an interesting experience for me. I hope it will bear fruit for the Foundation.”
Starting in December Gunn made it a point to travel to other parts of the country to “get some idea of the health work going on there.” He began with Bratislava (capital of Slovakia) with Pelc joining him. There they studied the functioning of a branch office of the Health Ministry, the University, and the local Hygienic Institute and interviewed city officials, representatives of the YMCA and the American Red Cross. They learned that “practically no field work is done” by the branch office. Most of the work consisted of writing letters to the health officers in the country. It was here that Gunn hoped to have Driml undertake a demonstration project.
“It is in no sense functioning as a health department,” wrote Gunn. Many districts were without health officers or doctors, pay being too low to live on with the chances for practicing medicine “on the side” slim. Worse, “people are afraid of them (the doctors).” Gunn concluded from this visit, “the communities are too poor and too ignorant to expect them to start work locally. The State must do the work.” But educated health officers were in great need. The medical profession could not be expected to help as in general “they are out for the money” and “they have absolutely no social sense and the teaching they get at the present time is such that questions of this kind never enter their heads.” Later, Rose noted that “the attitude of indifference and quiet hostility on the part of the physicians is not novel. This is to be met with in connection with the development of public health work in all countries; but this attitude must in the end yield to the public good.” (February 10, 1921)
These trips brought to light the intense distrust that existed among the different ethnic groups in the country. As well, each region wished to be the main beneficiary of the largess that they imagined to be coming from the Foundation. In his discussions with public health leaders concerning the establishment of a School of Public Health, for example, he learned that Kucera, the Director of the University at Bruno thought it would be best for the school to be located there, while Ruzicka, the Professor of Hygiene in Brataslava pushed for his city. If it were in Prague, it would be necessary to face the problem that the Czechs are “not popular” in many parts of Slovakia, thus complicating any thoughts of having Slovaks coming to Prague for training. Not that the Czechs liked each other all that much either, “they either like or dislike, and if they dislike they will not work together even if their duties impose a close cooperation.” (December 31, 1920)
The reality of what he found in the field made Gunn realize that there was no way for the Foundation to try to impose the idea that health officers work on a full-time basis, a principle that their earlier programs had convinced them was of essential importance. This was “entirely impossible until conditions are radically changed.” A “strong demand for adequate health service” was a prerequisite. For such a demand to develop educational work in health matters was needed among the medical profession, the governing officials and the people.
A further complicating feature of the situation was the fact that health officers at all levels have little if any authority. As he learned from a visit to Moravia in March, 1921, “the health officer never signs a letter every communication being signed either by the President of the Moravian Land Government, the President of the Okres (county) or the mayor of the town.” (March 24, 1921)
From the beginning or their long correspondence Rose encouraged Gunn to keep him informed of everything he was doing as he wanted “to be able to visualize the situation in the field and to feel the human touch at the other end of the line.” (December 9, 1920) At the same time he underlined the importance of what Gunn was doing:
This study of public health in Czechoslovakia has tremendous possibilities. You and I have discussed at different time the importance of a survey of public health problems and public health administration in certain European countries. The matter came up for incidental discussion at the last meeting of our Board. It was suggested that if our Board could know under what health conditions the people are living, what the public health machinery is, how it works, the source of its strength and its weaknesses that we should have just the kind of information which we need for guidance in maturing our own programs for Europe. Now that you are to be in one of these countries for a considerable time and are undertaking apparently just the kind of study indicated above, it occurs to me that you may, upon completion of your study, formulate a report that may serve as a sort of standard for future studies of this kind.
Going further:
I am very interested in what you have to say concerning office administration and bureaucratic methods generally. If you can contribute toward having function dominate form you will have rendered a fundamental service to this young Republic.
With such encouragement it is not surprising to learn that Gunn kept reporting to Rose in great detail and often, especially when he could dictate his letters. Rose replied in kind. Given the length of time that it took letters to cross the ocean (2 to 3 weeks), it is amazing to see how well they were able to keep up this exchange for the more than 18 months that Gunn was stationed in Prague.
Early on, perhaps in response to Gunn’s enthusiastic exploration of many possible means of supporting Czechoslovakia, the word “modest” began to emerge with greater frequency in Rose’s letters. A simple demonstration was a good idea but it should be undertaken on a “modest scale and with modest expectations.” Carefully sidestepping the problem of where to locate a School of Public Health, Rose outlined a “modest” beginning in which he envisaged centrally located (Prague) public health laboratory serving as a nucleus “of what might in time grow into an Institute of Hygiene and Public Health.” (January 6, 1921) A short time later he wrote how he had “supposed” that the Institute of Hygiene “would involve the central Public Health laboratory, with perhaps a modest beginning in the direction of training for public health work.” This was a clear indication that Gunn probably had overstepped himself in discussing with the Czech authorities the notion of a public health school that was a separate entity from the Hygiene Institute.
The presence of many American-led non-governmental organizations in Czechoslovakia encouraged Gunn to try to find some way for them to work together more harmoniously and efficiently. He met with Miss Masaryk towards the end of December to suggest that she call a meeting of representatives of “all the important health organizations for the purpose of discussing coordination of programs.” He envisaged the creation of a National Public Health Association, something along the lines of the APHA while worrying that it might be too late for such an ambitious undertaking to be launched. While this was in the works, the individual organizations turned to Gunn for advice. By January the American Red Cross had practically made him their advisor and refused “to pass on any project without my OK.” A similar relationship developed with the League of Red Cross Societies representative (more on the League in a later chapter), as well as with the American Relief Administration directed by Herbert Hoover and established at the end of the war to help feed millions of starving Europeans. By mid January Gunn’s list of such organizations had grown to now include the YWCA as well as Lady Muriel Paget’s Mission. (January 14, 1921 RE LOOK) Rose supported Gunn in this effort, noting that “it is distinctly valuable to have the advice of a person like you as a coordinator of activities.” (February 1, 1921) When the National Council did get established, Gunn arranged for the Foundation to pay the salary of its secretary for six months with the understanding that at the end of that period the participating agencies would take over this responsibility. (February 19, 1921)
There were significant changes with the arrival of the new year. To begin with, Russell left, leaving Gunn fully in charge of all developments there including that of the Hygiene Institute. Gunn expressed his sorrow at his departure to Rose, noting how Russell had been a “great companion for us both.” Furthermore, life at home began to worsen. They were stuck with a servant who it seemed could only prepare one dish “stewed meat and potatoes” and badly at that. But good meals could be had at the American Club that had recently opened in Prague. But of much greater significance was the continuing fragility of Clara’s health. The first indication of this is in a letter to Russell in mid-January in which he wrote “Mrs. Gunn is bothered with neuralgia again.” He, on the other hand, was “very well” behaving himself by “going to bed between 8.30 and 9 every evening.” (January 15, 1921)
The frequent exchanges between Gunn and Rose served as a means of clarifying certain basic principles. On one occasion, for example, Rose wrote:
There can be no such thing as effective public health by the “big stick” method. A few things might be done in this way, but sound public health work must be based upon the willing cooperation of the people. Our experience in many countries has convinced me that it is possible to educated the people, however illiterate they may be, and to secure their interested cooperation in public health measures.
An illiterate peasantry may, after all, be pretty intelligent. They can see what is for their own good when it is made clear to them. They are particularly appreciative when they understand that the government is genuinely interested in their welfare. They are not adverse to spending their money when they get value received, but all this must be made clear by demonstration. Getting officialdom in line, I should regard vastly more difficult than creating health interest on the part of an illiterate peasantry. (January 17, 1921)
Russell, too, offered some general remarks on how he saw the development of public health. Responding to Gunn’s criticism of how much money the Ministry was spending on hospitals, a position he held when he was in Prague, recent developments in New York State, where Biggs was attempting to introduce hospitals into the public health system, led him now to say, “personally, I am not at all sure that curative medicine should be separate from preventive medicine and as the socialization of the medical profession increases, I think we are more apt to bring the two things together than we are to separate them.” While adding, “I hope you will forgive me for this lecture.” (March 21, 1921)
A thorny problem emerged with the arrival of the Fellow Hulka back from America. He did not want to enter the service of the Ministry, a condition that had been agreed to earlier when his fellowship was offered. He wanted to stay in America for another year and was “sore” at having been denied that opportunity. Gunn observed that “he seems to have little of the spirit of doing something for his country.” At best he was a “difficult person” but “distinctly capable.” Rose sympathized with Gunn noting that Hulka would have to “work out his own salvation” and that “public health work cannot be carried on by strong individualists or by persons governed by selfish motives.” (January 25, 1921) Furthermore, having accepted a fellowship, it could be hoped that in time he will come to realize that “he is under some obligation to his government.” (February 10, 1921)
The problem with Hulka was masked by a bigger problem with the granting of fellowships, namely the attitude of the older staff in the Ministry and the poor career prospects for those joining it:
The Minister himself commenced his public service 22 years ago at the bottom of the ladder and sees no reason why the young men of today should not do likewise. Also there are men in the Ministry who have never had a chance of going to America or elsewhere and they do not see why these men should be especially favored… I imagine that they are afraid of these young men and not anxious to see them put into important places. Everybody with few exceptions is on part time and miserably paid… The young men trained in America are fearful of entering a service where they cannot use their knowledge, make an adequate living and satisfy their natural ambitions. It is a tough nut. (February 8, 1921)
Russell, in a letter to Gunn, amplified on just how complex this problem was:
When I was in Prague I heard a good deal of criticism of the Czechs who had received their education or who had traveled in other countries, particularly those who went to Vienna. The criticism came from those who had not been away from Prague… There are others who are proud of the fact that they have never been outside of Bohemia. It is these “stay at homes”, I imagine, who have done their best to make it difficult for those who have been educated elsewhere, particularly for those who have been in Vienna. This situation will continue as long as the old timers are in power. (March 29, 1921)
In February 1921 Gunn made a four-day trip to Warsaw with a representative of the LRCS on an entirely unofficial trip. Two things emerged from this visit, the first was the promise of cooperation between the two countries, and the second was his learning first hand of the “splendid” work of Ludwik Rajchman, head of the State Institute of Hygiene. It would seem this was the first meeting between them.
Rajchman was two years older than Gunn. He would soon be asked to take over as Director of the newly established Health Organization of the League of Nations (LNHO). He and Gunn later became close friends when Gunn moved back to Paris and took over responsibilities for managing the support given by the Foundation to the LNHO. Russell was pleased that Gunn liked his “Polish experience” for he had “a similar feeling” which he believed was shared by Rose. It was not improbable that “some work for Poland may be considered in the near future.” (March 31, 1921)
Within several days of his return to Prague, Gunn was visited by Winslow, in his capacity as Medical Director of the LRCS. It was a short visit that aimed at establishing some kind of training for public health nurses, a need which Gunn said existed but for which there was not much demand. The discussion turned around an issue that had proved and was still proving to be rather contentious in France, namely whether “real public health nurses” were to be trained as opposed to “health visitors” who would receive far shorter training and be responsible for a more limited set of activities. Winslow was anxious that the LRCS have a role in such training in a number of countries, but as this had to be worked out with the local Red Cross societies, prospects for success were far from certain.
Rose was very interested in this development. If a tuberculosis program were to be developed in Czechoslovakia there would be a need for public health visitors with some more advanced training. This situation would have to be met “promptly but … without compromising any standard in the training of nurses.” Rose went on to note:
The training of public health nurses is a matter of growing international interest; some agency should undertake it and push it. The International Health Board has been holding aloof on the ground that the League of Red Cross Societies might perhaps enter the field. If they should do it we should be disposed to leave the field to them. Unless some agency should undertake it with energy in the near future, our Board will be forced to consider it. (March 19, 1921)
In early March, Gunn reported to Rose that the “Minister and others in the Ministry seem to want me to stay on here indefinitely.” Gunn spoke of “leaving in the Fall” which led them to protest, his “‘spirit’ was of the greatest value to them.” Gunn was pleased to learn this but still felt that if they were able to make the changes to the Ministry that were under discussion it should be possible for him to leave. The “constant attendance of a representative of the IHB” was not needed. Rose responded that this question should “be left open for the present,” but indicating that if his duties there were to diminish “there may be interests calling for your attention in Poland and possibly at a somewhat later time in Serbia.” He added, “You personally have made an important contribution to the success of the program (in Czechoslovakia) and should feel rewarded by the results attained for your patient and well-directed efforts.” (March 21, 1921)
A trip to Paris in late March, 1921 allowed Gunn to dictate his letters to Rose, a luxury which he fully took advantage of. For most of the 1921 he typed his own letters and reports, as well as organizing files. In the dictated letters to Rose he bombarded him with all kinds of details on what he had seen and what he was doing. We also learn of his difficult home life, something which had only emerged in bits and pieces in previous communications:
As you may know Mrs Gunn and I have left in America our young daughter who is staying with her grandparents. It appears at the present time that her grandparents must go to California in June for at least two months. It would be impossible for them to take the child with them and it is very difficult to find some person who could take care of Barbara during their absence. Barbara, who has been a sick child practically all her life, at the present time is distinctly better and we are hopeful that from now on she is going to be much stronger. Mrs Gunn feels, and I agree with her, that it will be necessary for her to return to America in June and take care of Barbara. It is by no means certain that it would be wise at this time to have Barbara brought back to Prague with Mrs Gunn. Of course it might be possible to leave the child in America and have Mrs Gunn return to Prague later on. I fell that a new separation of myself and my family must be avoided; unfortunately none of the three of us are very husky: my health is at the present time excellent, but I can only maintain it by cautious living; Mrs Gunn’s health is nothing famous, she has had a hard siege for years and is by no means strong. Now, I am wondering about the future of my work with the International Health Board, provided my services are considered satisfactory. It seems to be from the information that I have that I would probably continue to serve as a field agent, spending perhaps another year or so in Czechoslovakia and possibly transferred to some other European country and so on. My own feeling and that of my medical advisors, is that I would look with favor on a proposition for a position in the United States where I can feel sure of being at home at least the bulk of the year. I have no prospects however of a position of this kind, at this time, nor have I taken any steps to attempt to find one. I do not know whether there might be a possibility of employment by the International health Board in New York.
On receipt of this letter Rose went to see Vincent to discuss Gunn’s future. The episode is recorded in Vincent’s diary (April 6, 1921), “Ought to tell him frankly that there is no likely to be a place in the central office,” which Rose did while at the same time indicating that they would help him if he wished “to have a permanent home in the States…” and that “your health and your continued usefulness in the field of public health interests us, I am tempted to say, as keenly as it interests you; count upon us to the limit of our ability in aiding you in making any arrangement that would seem to you most satisfactory.” (April 15, 1921) Gunn wavered. His family would have him return to America, but his work had become a “religion.” If Rose sanctioned it, it would be his “duty… to remain here another year.” Possibly adding to his desire to hold the fort was his sentiment that he had “never worked for six months on a job without having more to show for my efforts.” (April 28, 1921)
Anytime Gunn expressed doubts in what he had accomplished, Rose would respond immediately with reassuring words. To the above he replied:
I can quite understand how progress may seem slow; you are in the midst of the situation; you are eager to see things done; you would like to see results from day to day. All this is human. It is quite clear, however, to us at this distance that great progress has been made; that your stay in Czechoslovakia has justified itself many times over. We are much gratified with what has been done; are quite pleased with the tendencies; have great faith in the future.
With Rose’s support, Gunn weathered the storm; his wife and daughter returned to Prague later in the year and while not always in the best of health, they joined him when he moved to Paris in July 1922. Also, he managed to take a long-delayed vacation in which he visited London to see his mother. He wrote Rose that the vacation had done him a “lot of good. I regained the weight I had lost and am now only 4 pounds under my weight when I left Trudeau.”
A possibility for Gunn to return to America did arise during this period, but with a different organization. This is discussed in the next chapter so as not to interrupt this account of his work in Czechoslovakia.
One of the reasons that led Gunn to stay in Czechoslovakia was to be able to better judge whether it was good policy or not for the IHB to send an advisor “to serve in a capacity similar to mine.” He thought this was a “debatable question” as it was “vastly more complex than going in to a country to carry on with the government’s specific demonstrations, with the idea that such demonstrations will in time lead to the development of a complete public health program.” To make sure that Rose was fully aware of just how problematic his assignment was he added:
You have got to realize the almost complete of public health matters in the group of men who are carrying on so-called public health work throughout the Republic in the name of the Ministry of Health, to grasp the enormity of the problem and the long time necessary to change it. It is a question of years. (September 26, 1921)
Rose well appreciated this fact. One of Rose’s key arguments in support of Gunn’s work in Czechoslovakia was his ability to help place “the men as they return after their period of training abroad.” (November 8, 1921) From the detailed accounts of Gunn’s efforts to place each fellow upon his return, it seems likely that, without Gunn’s presence in Prague, most probably would have drifted away either into private practice or some minor public health position available in one of the major cities. Only with new blood coming into the Ministry could the future of public health in Czechoslovakia be ensured.
Gunn also had the full support of the Czech authorities, if one can take at face value the statement made by Semerad, the State Secretary, at an internal meeting of the Ministry held in May 1921:
Wanted to say something as a citizen. Gunn will wonder why we want and beg him to stay. It is not that they only want money. Gunn is at the beginning of development of public health in one of the most important nations in Central Europe. Czech nation survived because it stood always for ideals. We never were strong physically, our only forces were mental. We are a small nation and we must follow great nations, especially in science. We used to be absolutely under German influence. This was against our nature. We want to draw on the Anglo Saxon race for our inspiration. The final aim of health work is to strengthen the whole state. Welcomed first of all moral assistance before financial. (May 17, 1931)
Gunn replied:
Knows of no other country where Health Ministry has taken a similar step… Do not want to impose ideas or methods. Glad that the motives of RF and IHB are so well understood. Ministry on threshold of new era. Realizes what has already been done under difficult conditions… Desirability of combination of Czech and American ideals and methods…The time has come when we must get down to work, face the facts fearlessly and push ahead.
Russell, too, in the few times that he wrote Gunn, added encouraging lines. In October 1921 he wrote, “You certainly have your hands full, but it must, nevertheless, be a gratification to be able to arrange in a satisfactory way so many diverse problems.” (October 6, 1921)
Rose not only wrote to bolster Gunn’s morale. He also kept him fully informed as to what was going on elsewhere in the world as far as the IHB was concerned. Gunn was informed of how Russell, who soon would be given the title of Director of Public Health Laboratories (Rose was General Director), was “hard at work” promoting laboratories in America as well as in other parts of the world. (March 31, 1921) In July 1921 Rose, after several paragraphs on Russell’s planned visits to Central America, Mexico and Brazil, concluded “Colonel Russell’s appointment is proving to be a valuable investment.” One can’t help but wonder at what point Rose knew that he would ask Russell to succeed him when he left the IHB in early 1923. Was he in any way warning Gunn to expect such a change?
One of the areas that Gunn was particularly interested in was Podkarpatska Rus (Sub-Carpathian Ruthenia), a remote rural region in the extreme Eastern part of Czechoslovakia. When Gunn raised this subject with Masaryk, the President told him, “the(se) people were really nomads – all they wanted was a few cattle – they did not know how to work the land and had no innate love of the soil – they needed to be helped in all directions. Schools were being established in Podkarpatska Rus which taught the people how to plough, etc…” Whether Masaryk knew about the health projects that Gunn had helped initiate there was not indicated.
In early 1921 Gunn told Rose that he might take a trip to Ruthenia with “their representatives,” expressing that he was “anxious to see that country.” He deliberately used the word “country” to reflect his awareness that Ruthenia earlier had had hopes of becoming an independent state. (February 1, 1921) Instead, they were promised a good degree of autonomy after the war, if they joined the Czech Republic. Gregory Zatkovich, a Pittsburgh lawyer, had been proclaimed its President in America at the end of the war and was then appointed first Governor by Masaryk in April 1920. A year later Gunn recorded how Zatkovich had sent his resignation “quite a while ago” but had not received a reply and he was “now threatening to get out,” because an autonomous status had not yet been granted.
Whether Gunn was aware of a story going around about Zatkovich’s wife is not recorded, and while perhaps of little relevance to our story, I can’t resist not including it. It was related by the Senior Red Cross official, Ernest Bicknell:
He (an American business man) talked with the President’s wife who had arrived only a short time before. Impressed by the romantic story of the president elect in America and his trip to far-off Ruthenia to help his people, he said something to this effect:
“It must be a great pleasure to you, Madam, to come over here under such inspiring circumstances, to become the leader of the women of this country and to share with your husband the great privilege of building your people into a happy and prosperous nation. Are you now enjoying it tremendously?”
The “first lady” looked at her enthusiastic visitor with an expression of disdain and replied briefly:
“Hell, no I wish I was back in Pittsburgh!”
She got her wish. Zatkovich did not remain in his office much longer; he returned to Pittsburgh where he resumed the practice of his legal profession. But before leaving he and Gunn had several opportunities to discuss public health in his country.
When Gunn first met Zatkovich in April 1921 he “told him a few things about the budget for public health in his country which he knew nothing about.” Much more money had been voted by the central government for Ruthenia than they had received. Not surprisingly Zatkovich asked Gunn to “make a study of public health conditions and services.” (April 22, 1921)
Gunn finally made his “strenuous but fascinating” trip to Ruthenia in July 1921. (July 16, 1921) There “he slept in 15 different beds” in 18 days, a number of which were “full of bugs which made sleep difficult if not impossible.” (July 18, 1921) Following this trip it was arranged for Karl Driml to take on the “pioneer’s” job of County Health Officer in Beregsas, a position that Gunn “rather envied.” (August 25, 1921) The Minister (Prochazka at that point) visited Ruthenia in September for 10 days which Gunn recorded as “being a bit of an eye-opener for him” and one that would lead to Driml getting “good backing.” (September 6, 1921) But it was at this point that Prochazka was forced out and Driml found himself no longer a health officer because the political area where he was located “had been carved up.” (November 14, 1921). Within the month Driml was assigned to work in a hospital, a development that Rose hoped would be “only temporary.” (December 6, 1921) This proved to be the case; by the end of the year Driml was back to his rural health demonstration project.
By May 1922 Gunn was able to report on the successful Clean Milk Exhibit that Driml had organized as part of an agricultural fair. (May 18, 1922) In his proposed budget for 1923 Gunn indicated that Driml would be responsible for “numerous public health educational activities such as typhoid fever exhibit, clean milk exhibit and plays for children. (August 30, 1922) By the end of 1922 Gunn rather proudly informed Rose that “Driml seems to be wedded to Public Health Education, and a new sub-bureau in the Ministry of Health for Public Health Education will be started at the beginning of the year.” (December 4, 1922) In his review for 1923 Gunn reported that the work for which Driml was responsible accounted for “the larger part” of the 18,240$ spent in support of the Division for the Study and Reform of Public Health Activities.” (October 3, 1924)
In a short report written by Driml one learns how similar his health education efforts were with those that Gunn had so successfully promoted in France. Lectures, exhibits, cinema, schools, articles for school books, school pictures, education of teachers in practical hygiene, material for health articles in daily newspapers, posters for trade and industrial working-rooms, pamphlets on hygiene, etc. were all used to reach the Czech people, particularly its children. Plays were written: The Enchanted Land, “an allegorical play on the fight against tuberculosis;” The Tiny Bacillus, “a puppet play for children dealing with the fight against tuberculosis;” Brok and Flok, “a story of three dogs, dealing in an entertaining way with the fight against rabies;” Punch’s Health Talks, “short scenes for children’s theatres, puppet theatres, school festivities, etc.;” the Chinese Mirror, “a play for young people dealing with the fight against smallpox;” The Sun’s Valley, “a play from the life of Indians, the object of which is to propagate healthy scouting and gymnastics;” and The White Lady, “a puppet play describing the importance on public health nurses and visitors in rural cities.”
Czechoslovakia had at that time about 2000 permanent puppet theatres, which accounts for the central place that plays for puppets occupied in Driml’s program. These were located in schools, rooms of different organizations, and gymnasiums, and on the average played at least twice a week with an average attendance 50 people. A monthly publication The Puppet Theatre was in its 9th year of existence. No puppet plays had ever been produced before on the subject of health. Nor was health a topic that newspapers paid any particular attention to. But, slowly, the subject caught on. Major newspapers started including regular articles on public health for their readers.
Gunn, like Russell, was hard at work, especially in the spring and fall of 1921, when the various pieces of his work began to come together. Most important was the Ministry agreeing to the establishment of a Bureau for Study and Reform of Public Health Activities, which Gunn was hoping would tackle such questions as 1. Office methods, 2. Study of Statistical Procedure, 3 Study of Child Hygiene, 4. Study of Tuberculosis, 5. Study of Public Health Administration, and 6. Study of the Typhoid Fever Situation. (April 5, 1921) Several of the RF Fellows (Pelc, Driml, and Hulka, who was “getting better” (May 12, 1921)) were placed in charge of these subjects with the Foundation paying for much of their salaries as there was no provision for the Ministry to do so. In April Gunn wrote to Rose, “the new division must be a success. Our danger will be a tendency to go a bit too fast.” (April 12, 1921)
The Public Health Council, on the other hand, was an up and down affair. Just as the new department was about to be launched with considerable enthusiasm, Gunn reported that the Council “is somewhat on the rocks.” The immediate problem was the fight between public health nurses and the social workers of the Paget Mission, leading Gunn to write with some degree of exasperation, “how can we expect the Czechs to pull together when we see foreign workers scrapping amongst themselves.” (April 16, 1921) The Paget Mission was an UK-based organization created by a British philanthropist Lady Muriel Paget that carried out various humanitarian relief efforts. As well, there was friction between the ARA (?) and the ARC, about which Gunn wrote to Rose confidentially without going into the details. Both organizations were at the end of their mandate. In fact, many thought that they had overstayed their stay. Rose wrote that as far as the ARC was concerned, it would have been “sound policy” for them to have left Europe soon after the Armistice was signed. (May 4, 1921) As it was they pressed on, much to Gunn’s frustration:
Doctor Burnham of the ARC has recently come here from Paris … He tells me that the Red Cross has a certain sum of money available to make a ‘complete’ demonstration in child hygiene in some selected district… The work must be organized and completed and the results obtained by July 1st. It is painful to listen to such talk. He asked my opinion and I gave it freely.
I think I had him on the run with my questions and arguments. He then said that it was a pity not to spend the money when it was voted for this purpose even if the work could not be properly done. I had hoped that the ARC had gotten over their ideas of chucking money away.
However, Gunn had only the best to say about the ARC’s Child Hygiene program led by Dr. Henry Eversole, whose aim was to set up 22 Child Welfare Stations, one in each Zupa (division) of the country. This program emerged out of a personal appeal of Alice Masaryk to the Red Cross on the first day of the Armistice. She asked for the establishment of clinics and dispensaries for mothers and children as well as to secure training for nurses. Eversole arrived from Siberia where he was responsible for the medical care of part of the thousands of Czech soldiers who were part of the Czech Legion that had fought their way there against the Bolsheviks at the end of the war! Drafted by the Austro-Hungarian empire to fight the Russians, with whom they were in sympathy, they quickly became prisoners of the Czar (a move supposedly arranged in advance by President Masaryk), and then got caught up in the revolution.
By the end of 1921 the work of the National Council was developing on a more positive footing. Key to this development was the agreement of the Czechoslovak Red Cross to take over its funding. Rose qualified this development as “a great achievement,” going on to say, “It looks as if in the end Czechoslovakia is going to give to our country a good demonstration in team play in public health work.” The significance of this statement can be better understood in the context of what was going on in America at the time, as discussed in the next chapter(?).
Matters were moving ahead so smoothly by March 1922 that Rose agreed to Gunn moving to Paris which he did at the end of June. As will be learned later, Gunn still kept close ties with Czechoslovakia but by means of frequent visits. In his end of 1923 report to Russell, who had taken over from Rose earlier in the year, Gunn ended with, “patience is needed, and after all, we are not expecting to see the ripe fruit in Czechoslovakia for a number of years. All we can do now is to see that the trees grow straight and are taken care of at this formative period. A few buds now and again, encourage us to believe that ultimately the tree will bear a crop of sound fruit.” (September 11, 1923)
This is the only period of Gunn’s life that is so well documented. Much of this is due to Rose’s sympathetic handling of Gunn, thereby encouraging many letters to be exchanged. Russell, as we shall see, was a totally different personality. Many have suggested that he and Gunn did not get along, 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 had, but he was as attentive as Rose had been to the complexities of Gunn’s task. However, for reasons that have to do with how Russell saw the future of public health work, Russell became less sympathetic with Gunn’s approach to public health. This internal tension was to define Gunn’s career for the next 15 years and is the core story of the chapters that follow.
The more important lesson to be obtained from this detail account of his time in Czechoslovakia is the complexity that surrounds any kind of change – internal to a countries administrative structure and external where competing agencies are involved. Also of importance is the differing views concerning the role of specific types of health workers as illustrated by the example of public health nurses and health vistors.
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