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The Great White Train: Typhus, Sanitation, and U.S. International Development during the Russian Civil War (Endeavour, 2012).

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This article examines the work of the American Red Cross in Siberia from 1919 to 1921, and specifically on the organization's anti-typhus work along the Trans-Siberian Railway. It analyzes the political and diplomatic function of humanitarian
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  The   GreatWhite   Train:typhus,sanitation,andU.S.InternationalDevelopmentduringthe   Russian   CivilWar JuliaF.Irwin* University   of    South   Florida,   History,   Tampa,   FL   33604,   United   States In   January    2009,   Senator   Hillary    Rodham   Clinton   stoodbefore   the   Senate   Foreign   Relations   Committee   during    herconfirmation   hearing    for   the   post   of    Secretary    of    State.Timeand   again,   Clinton   affirmed   her   belief    that   U.S.national   security    depends   on   balancing    three   ‘D’s:   Diplo-macy,   Development,   and   Defense.   ‘In   order   to   protect   anddefend   the   United   States   of     America,   to   advance   ourinterests,   and   to   further   our    values,’   she   stressed,   ‘we   haveto   have   all   three   of    those   elements   of    our   power   working    inconcert.’ 1 In   proclaiming    a   commitment   to   development,Clinton   was   attempting    to   set   herself    apart   from   herimmediate   predecessors   in   the   State   Department,   whomshe   criticized   for   their   failure   to   devote   ample   resources   toforeign   aid   and   assistance.   Her   multidimensional   ap-proach,   however,   was   by    no   means   a   novel   strategy    of U.S.   global   engagement.   Ninety    years   earlier,    Americanpolicymakers   were    just   as   aware   of    the   importance   of    eachof    these   elements   to   their   nation’s   relations   with   the   world.The   winter   of    1919found   theUnited   States   knee-deep   initsinterventioninRussia’s   Civil   War.Two   yearsearlier,onNovember   7,   1917,Vladimir   Leninhadleda   successfularmed   coup   in   Petrograd,   declaringBolshevik    controlof Russia   andsparking    a   protracted   battle   for   controlof    thecountry.U.S.   President   Woodrow   Wilson,   alongwith   many  American   citizens,deplored   thisnew,radicalphase   of    theRussian   Revolution   andthrewhis   firm   support   behind   theanti-Bolshevik    factions.   In   thesummer   of    1918,theUnitedStates    joinedBritain,France,Japan,   and   Italyin   sending armedforces   to   Russia   –   a   militarycommitment   made   for   anumber   of    reasons,   butespecially    to   swaytheoutcome   of    theCivil   War   against   theBolshevik    government   andto   aidCzechoslovak    forcesthenstuck    in   Siberia.FromAugust1918   through    April1920,roughly12,000   U.S.troops   occu-pied   thenorthwestern   cityof     Archangel,thepacific   port   of  Vladivostok,   andtheirsurrounding    environsas   part   of    thisinternational   coalition.Althoughthese   efforts   to   influencethe   Russian   Civil   War   in   favorof    theanti-Bolshevik    forcesultimatelyproved   futile,   theintervention   nonethelessrepre-sented   oneof    themost   important   U.S.foreign   relationsissuesof    theearly    post-World   War   Iperiod   (Figure1). 2 While   the   defensive   and   diplomatic   aspects   of    this   story have   received   much   scholarly    consideration,   historianshave   paid   less   attention   to   the   Wilson    Administration’sembrace   of    the   third   ‘D’   in   its   foreign   affairs   arsenal,development. 3  Yet   from   the   beginning,   U.S.   policymakersrecognized   that   development   –   here   defined   as   the   use   of medical,   scientific,   and   technological   interventions   toimprove   a   target   population’s   quality    of    life   –   must   consti-tutea   central   part   of    their   approach.   Both   Russian   soldiersandcivilians   suffered   the   effects   of    malnourishment,   poorliving    conditions,   and   illness.   By    addressing    these   condi-tions,   the   U.S.   government   hoped   to   win   hearts   and   minds,to   persuade   Russians   of    the   legitimacy    of    both   the   U.S.intervention   and   of    the   White   Russian   (anti-Bolshevik)government.   Beyond   the   clear   propaganda    value   of    suchassistance,   officials   believed   that   tackling    disease   wasessential   to   maintaining    social   order   and   stability    and   tocounteracting    the   influence   of    Bolshevism.   To   complementthe   U.S.   military    intervention   ofRussia,   the   Wilson    Ad-ministration   therefore   promoted   a   major   humanitarianintervention   as   well.   During    Russia’s   Civil   War,   develop-ment   would   serve   as   a   central   piece   of    the   U.S.   foreignaffairs   arsenal. The   American   Red   Cross   goes   to   Russia WhentheU.S.   government   takesonglobalreliefanddevelopment   projectstoday,   itdoes   so   largelythroughsuchstate   organsastheU.S.    AgencyforInternationalDevelopmentandtheU.S.   military.   It   also   works   throughsuchinternational   agencies   astheWorld   Health   Organi-zation.In   theperiod   from   1918to   1920,however,thingswereverydifferent.No   suchfederalor   globalreliefinfra-structureexisted.Instead,   theWilsonAdministrationreliedona   quasi-governmentalorganization,theAmeri-can   RedCross   (ARC),to   administerforeignreliefon   itsbehalf.Establishedin1881,theARCwasa   privately funded   andstaffed   association,primarilydependent   on volunteer   labor.However,itshareda   special   relationshipwiththeU.S.   government,   formalized   bytheGenevaConvention   andCongressional   charters,   whichmade   itthe‘the   official    volunteer   aiddepartmentof theUnitedStates’   intimes   of    warandnatural   disaster. 4 During    theFirstWorldWar,theARChadservedasthenation’sprincipal   instrument   for   humanitarianrelief,   carrying outaidandassistanceprojects   insome   two-dozenEuro-peannations.   When   Wilsondetermined   to   send   U.S.troopsto   Russia,heaskedtheARC’swartime   leaderstosendreliefworkers   thereaswell,a   request   to   whichthey  Feature  Endeavour  Vol.xxxNo.x *Tel.:+18134049052. 1 Forthistranscriptseehttp://www.nytimes.com/2009/01/13/us/politics/13text-clin-ton.html?pagewanted=all. 2 SeeN.GordonLevin,Jr., WoodrowWilsonandWorldPolitics:America’sResponsetoWarandRevolution (NewYork:OxfordUniversityPress,1968),ch.1,andDavidFoglesong,  America’sSecretWarAgainstBolshevism (ChapelHill:UniversityofNorthCarolinaPress,2001). Availableonlinexxxxxx 3  AkeyexceptionisDavidEngerman,ModernizationfromtheOtherShore: AmericanIntellectualsandtheRomanceofRussianDevelopment(Cambridge:Har- vardUniversityPress,2003). 4 WilliamTaft,‘‘ProclamationbythePresidentoftheUnitedStates,’’1911,CentralDecimalFile811.142/218,RecordsoftheDepartmentofState,NationalArchivesandRecordsAdministration,CollegePark,MD. ENDE-434;   No.   of    Pages   8 Pleasecitethisarticleinpressas:Irwin,J.F.,TheGreatWhiteTrain:typhus,sanitation,andU.S.InternationalDevelopmentduringtheRussianCivilWar,Endeavour(2012),doi:10.1016/  j.endeavour.2012.03.001 Full   text   provided   by   www.sciencedirect.com www.sciencedirect.com0160-9327/$–seefrontmatter  2012ElsevierLtd.Allrightsreserved.doi:10.1016/j.endeavour.2012.03.001  gladlyconsented.   Though   inparta   privateorganization,theARCthus   behavedasanarm   ofthestate,   theU.S.government’s   official   channelforaiding     American   sol-diers,   other   anti-Bolshevikforces,   andRussiancivilians. 5 In   the   late   summer   of    1918,   coincident   with   the   deploy-ment   of    U.S.   troops,   two   contingents   of     ARC   personnelarrived   in   Russia.   The   first,   the   Commission   to   NorthRussia,   was   the   smaller   of    these.   Based   in    Archangel,   itsstaff    focused   primarily    on   relief    efforts   for   U.S.   soldiers   andremained   less   than   a   year,   departing    when   U.S.   troopswithdrew   in   July    1919.   The   second,   the   Commission   toSiberia,   would   prove   far   more   important   and   influential   asan   agent   of    aid   and   development.   Under   the   command   of    an American   physician   named   Rudolph   B.   Teusler,   then   su-perintendent   of    St.   Luke’s   Hospital   in   Tokyo,   the   Commis-sion   to   Siberia   established   headquarters   in    Vladivostok    inSeptember   1918.   The   Commission’s   personnel,   however,did   not   remain   in   that   port   city;   they    carried   out   relief    work along    the   entire   4,100-mile   stretch   of    the   Trans-SiberianRailway.   For   twenty    months,   from   the   fall   of    1918   to   thespring    of    1920,   over   five   hundred    American   doctors,   nurses,and   lay     volunteers   served   as   the   staff    of    the   Commission   toSiberia.   From    Vladivostok    in   the   East   to   Omsk    inthe   West,they    administered   a   far-reaching    program   of    military    andcivilian   relief.During    their   time   in   Russia,   Commission   to   Siberiapersonnel   established   or   aided   dozens   of    hospitals,   clinics,and   dispensaries.   They    equipped   trains   with   medical   sup-plies,   food,   and   clothing,   and   distributed   these   itemsthroughout   the   Siberian   countryside.   Going    well   beyondemergency    and   material   aid,   they    offered   nursing    educa-tion   classes   to   Russian   women,   established   colonies   tohouse   and   educate   Russian   orphans,   and   created   employ-ment   opportunities   for   Russian   civilians   on    ARC   farms   andin    ARC   offices.   Through   such   a   comprehensive   approach   toaid,    ARC   workers   aspired   to   do   more   than   feed   rumbling stomachs   or   cure   acute   illness.   They    intended   to   imposeorder   on   widespread   upheaval,   to   transform   local   ideasabout   public   health,   politics,   and   social   organization,   andto   prove   to   sk eptical   Russians   the   benevolence   of    theUnited   States. 6  Although   the    ARC   Commission   to   Siberia   employed   amultifaceted   approach   to   foreign   aid,   the   remainder   of    thisarticle   will   concentrate   on   one   particular   issue,   typhus,   andthe   rather   unconventional   approach   the    ARC’s   leaders   andtheir   allies   took    to   respond   to   it.   In   the   winter   of    1918,shortly    after   the    ARC   arrived   in   Siberia,   Commissionleaders    joined   with   representatives   from   the   other   co-belligerent   nations   to   fund   a   mobile   treatment   clinic,dubbed   the   Inter-Allied   Typhus   Train.   Over   the   next   yearand   a   half,    ARC   personnel   used   the   train   to   carry    out   amajor   anti-typhus   campaign   for   both   soldiers   and   civiliansat   points   all   along    the   Trans-Siberian   Railway.   In   so   doing, ARC   workers   played   a   critical   role   in   fulfilling    the   human-itarian,   diplomatic,   and   military    objectives   of    the   UnitedStates   (Figure2). Tackling   typhus Typhus   posed   one   of,   ifnot   the,   greatest   health   problemsfacingCivil   War   Russia.    At   the   time,   the   diagnosis   ‘typhus’couldrefer   to   two   similar,   yet   distinct,   diseases.   The   first,epidemic   or   spotted   typhus,   is   caused   by    the   bacteria  Rickettsia    prowazeki .It   is   an   acute   illness   that   causesextreme   fever,   weakness,   and   a   full   body    rash.   Left Figure1 .   AmericanRedCrosspersonnelinArchangelwithasupplytruckandreindeer-drawnsleigh, ca. 1919–1921.CourtesyoftheLibraryofCongressPrintsandPhotographsDivision. Figure2 .   OriginalmapofAmericanRedCrossstationsinSiberia.InHenryP.Davison,TheWorkoftheAmericanRedCrossDuringtheWar(Washington,D.C.:AmericanNationalRedCross,1919):84. 5 ForbackgroundontheARC,seeFosterRheaDulles, TheAmericanRedCross:A History (NewYork:Harper,1950),JohnF.Hutchinson, ChampionsofCharity:War andtheRiseoftheRedCross (Boulder:Westview,1996),esp.224–277,GustaveGaeddart,‘‘TheHistoryoftheAmericanNationalRedCross,’’unpublishedfour volumemanuscript(Washington,DC:TheAmericanNationalRedCross,1950),andEmilyRosenberg,  SpreadingtheAmericanDream:AmericanEconomicandCulturalExpansion,1890–1945 (NewYork:HillandWang,1982). 6 ‘‘TheAmericanRedCrossinSiberia,’’undatedmanuscript,Box140,AmericanNationalRedCrossCollection,AccessionXX482-9.19/21,HooverInstitutionArchives,PaloAlto,CA(hereafterARC/HI);ARCReporttoErnestLloydHarris,ConsulGeneraloftheUSinVladivostok,November26,1919,ErnestLloydHarrisCollection,Box2,HooverInstitutionArchives(hereafterHI).LittlehasbeenwrittenabouttheARCCommissiontoSiberia.Animportantexception,however,isJenniferPolk,‘‘TheCanadianRedCrossandReliefinSiberia,1918–1921,’’MAthesis,CarletonUniver-sity,2004.Polkiscurrentlycompletingadissertationentitled‘‘AngelsandUncles:TheAmericanRedCross,theYMCA,andthePoliticsofReliefinCivilWarSiberia,1918–1923,’’attheUniversityofToronto,whichdealsevenmoreexplicitlywiththe AmericanRedCrossanditsefforts.SeealsoCliffordM.Foust,‘‘Sanitarytrainsandepidemiccontrol:theAmericanRedCrossinSiberiaduringtheRussiancivilwar,’’in  ActasdelXXXIIICongresoInternacionaldeHistoriadelaMedicina ,   J.CarrilloandG.deRos,eds.(Seville,1994):1005–1010.Forolderpublishedworks,seeLaviniaDock, TheHistoryofAmericanRedCrossNursing (NewYork:TheMacMillanCompany,1922),910–936andErnestBicknell, WiththeRedCrossinEurope,1917–1922 (Washington,D.C.:TheAmericanNationalRedCross,1938),433–443. 2  Feature  Endeavour  Vol.xxxNo.x ENDE-434;   No.   of    Pages   8 Pleasecitethisarticleinpressas:Irwin,J.F.,TheGreatWhiteTrain:typhus,sanitation,andU.S.InternationalDevelopmentduringtheRussianCivilWar,Endeavour(2012),doi:10.1016/  j.endeavour.2012.03.001 www.sciencedirect.com  untreated,   infection   can   result   in   mortality    rates   upwardsofforty    percent.   The   second,   recurrent   typhus   or   relapsing fever,is   caused   by    the   bacteria    Borrelia   recurrentis .Likespottedtyphus,   infection   results   in   a   sudden,   intense   fever.However,   as   the   name   suggests,   recurrent   typhus   is   char-acterized   by    periodic   episodes   of    fever,   separated   bylong periods   of    normal   body    temperature.   Death   rates   may    be   ashigh   as   seventy    percent.   Though   caused   by    different   bac-terial   agents,   the   two   diseases   had   much   in   common.   Bothwere   spread   by    the   human   body    louse    Pediculus   humanus ,both   caused   high   fevers   and   high   death   rates,   and   bothwere   exacerbated   by    famine   and   close,   unsanitary    living conditions.   Lacking    a   clear   understanding    of    the   etiology and   unaware   that   the   diseases   were   separate   organisms,many    scientists   and   physicians   at   the   time   referred   to   bothas   typhus,   a   linguistic   convention   that   this   article   willfollow.   Whatever   the   causative   agent,   one   thing    was   clear:typhus   is   and   was   a   disease   of    poverty    and   war. 7 The   early    twentieth   century    witnessed   the   eruption   of major   epidemics   in   areas   of    conflict   across   the   globe,   fromRevolutionary    Mexico   inthe   1910s   to   Serbia   and   much   of the   Eastern   Front   during    the   First   World   War. 8 In   Russia,thedisease   had   been   a   leading    cause   of    mortality    in   bothurban   and   rural   areas   for   decades.   It   was   largely    respon-sible   for   the   destruction   of    much   of    Napoleon   Bonaparte’s Armyin   the   early    nineteenth   century.   Throughout   thenineteenth   and   early    twentieth   centuries,   major   epidemicscropped   up   frequently,   especially    in   the   cold   wintermonths.   Typhus   morbidity    in   Russia   increased   markedly following    the   eruption   of    the   First   World   War,   but   in   thewinter   of    1917   and   1918,   following    the   Bolshevik    Revolu-tion   and   the   outbreak    of    the   Russian   Civil   War,   contagionrates   truly    began   to   skyrocket.   Hunger,   frequent   refugeeand   troop   movements,   and   the   effects   of    constant   wartimedeprivation   combined   to   generate   one   of    the   most    virulenttyphus   epidemics   in   Russian   history.   By    the   winter   of 1919–1920,   the   disease   had   overwhelmed   the   entire   coun-try.Some   health   officials   at   the   time   speculated   that   asmany    as   25%   of    Russians   might   have   been   infected.Though   estimates    vary    widely,   it   is   now   clear   that   millionsof    Russian   civilians   and   soldiers   died   from   the   disease,whiletens   of    millions   more   contracted   it. 9 From   the   beginning,   both   Red    Army    and   White    Army officials   understood   that   controlling    typhus   among    theirtroops   and   supporters   would   be   essential   to   turning    theCivil   War   in   their   respective   favors.   By    this   time,   bothsides   had   some   idea   of    how   to   combat   its   spread.   In   1909,French   bacteriologist   Charles   Nicolle   had   conclusively demonstrated   the   louse    vector   of    transmission;   by    1916,thebacterial   agent   of    epidemic   typhus   had   been   identifiedas   well.   Nonetheless,   many    physicians   and   medical   per-sonnel   continued   to   lack    a   clear   understanding    of    thedisease   or   to   recognize   that   ‘typhus’   actually    referred   totwodiseases.    A     vaccination   and   effective   antibiotic   cures,moreover,   both   remained   years   in   the   future.In   the   1910s   and   early    1920s,   physicians   and   publichealth   officials   thus   had   to   rely    on   isolation   of    the   infectedand   the   destruction   of    lice   to   halt   the   spread   of    disease.   Inareas   where   epidemics   raged   at   this   time,   it   was   commonfor   both   governments   and   private   agencies   to   build   disin-fection   stations   where   medical   officials   could   delouse   cloth-ing    and   bodies,   thereby    targeting    the    vector   of    contagion.Suchmeasures   played   some   part   in   reducing    typhus   mor-bidity    by    decreasing    the   sheer   numbers   oflice.   Indeed,before   the   Bolshevik    Revolution,   Russia’s   Tsarist   govern-ment   had   seen   some   success   in   limiting    the   disease’sspread   by    employing    such   methods. 10 In   the   end,   however,the   surest   means   of    reducing    the   incidence   of    typhus   wasfor   societies   to   become   more   stable   and   prosperous.   Fur-thermore,   as   a   number   of    historians   have   argued,   disinfec-tion   stations   posed   potential   threats   to   civil   liberties.   In   thehands   of    governments   and   health   professionals,   they    oftenbecame   tools   for   to   achieve   rather   nefarious   ends,   namely the   exercise   of    surveillance   and   discipline   over   individualsregarded   as   foreign   or   threatening.   Disinfection   stations,in   short,   had   clear   limits.   Nonetheless,   they    played   a   majorrole   in   typhus   management   strategies   in   the   early    twenti-eth   century    world. 11  Adopting    these   contemporary    methods   of    lice   abate-ment,   Soviet   officials,   together   with   the   Russian   Red   Cross,worked   to   combat   the   disease’s   spread   through   the   con-struction   of    disinfection   stations   and   hospitals   in   the   areasthat   they    occupied.    Anti-Bolshevik    forces,   too,   tried   toestablish   similar   operations   in   the   regions   they    controlled. As   part   of    its   wider   intervention   into   Russian   political   andsocial   life,   the   United   States   would   play    aleading    role   inhelping    the   White    Army    control   the   spread   of    typhus   inSiberia.   Given   the   relatively    small   scale   ofthe   U.S.   mili-tary    and   diplomatic   machinery    at   the   time,   the   task    of orchestrating    this   campaign   on   behalf    of    the   United   Statesfell   not   to   U.S.   government   agencies,   but   instead   to   thenewly    arrived    American   Red   Cross   Commission   to   Siberia.The    American   Red   Cross    volunteers   who   arrived   inSiberia   in   1918   and   1919   expressed   tremendous   shock    atthe   state   of    the   hygiene,   sanitation,   and   illness   they    en-countered.   ‘The   condition   of    the   Military    Trains   was   theworst   thing    I   have   seen   over   here,’   reported    Annie   Wil-liams,   a   nurse   from   New    York    City    who   had   spent   much   of her   career   working    in   tenements.   ‘The   filth   was   unspeak-able   in   these   cars.   Some   of    the   men   delirious   from   typhuswere   lying    on   the   hard   floors   of    the   cars.   They    had   not   evena   shirt   on   and   were   crusted   with   the   filth   and   excretionsfrom   their   own   bodies.’ 12 Colleagues   describing    civilianconditions   had   little   better   to   report.   ‘While   we   were   wait-ing    at   one   town   a   refugee   train   came   in   and   it   surely    wasawful,’   a    volunteer   named   Carrie   Pickett   wrote   to   her 7 RobertArgenbright,"LethalMobilities:BodiesandLiceonSovietRailroads,1918–1922,"  JournalofTransportHistory 29(September2008):259–276. 8 Formoreonmodernunderstandingsoftyphus,seeY.Bechah,C.Capo,J.L.Mege,andD.Raoult,‘‘Epidemictyphus,’’  LancetInfectDiseases (2008):417–426. 9 Formoreonthisepidemic,seeJohnF.Hutchinson,  PoliticsandPublicHealthin RevolutionaryRussia,1890–1918 ,(Baltimore,JohnsHopkinsUniversityPress,1990)andK.DavidPatterson,‘‘TyphusanditsControlinRussia,1870–1940,’’  Medical History 37(1993):361–381. 10  Argenbright,‘‘LethalMobilities,’’265. 11 Formoreonearlytwentiethcenturytyphuscontrol,seePaulWeindling,  Epi-demicsandGenocideinEasternEurope (Oxford:OxfordUniversityPress,2000),esp.ch.1;AlexandraMinnaStern,‘‘Buildings,Boundaries,andBlood:MedicalizationandNation-BuildingontheU.S.-MexicoBorder,1910–1930,’’ TheHispanicAmerican HistoricalReview 79(1999):41–81. 12  AnnieLeeWilliams,‘‘ANarrativeReportofSiberia,’’1920,Box4,ForeignWarReliefCollection:SiberianCommission,AnnieL.WilliamsCollection,HazelBraugh Archives,Lorton,VA(hereafterHB). Feature  Endeavour  Vol.xxxNo.x3 ENDE-434;   No.   of    Pages   8 Pleasecitethisarticleinpressas:Irwin,J.F.,TheGreatWhiteTrain:typhus,sanitation,andU.S.InternationalDevelopmentduringtheRussianCivilWar,Endeavour(2012),doi:10.1016/  j.endeavour.2012.03.001 www.sciencedirect.com  parents.   ‘People   huddled   into   filthy    box   cars   like   a   lot   of sardines,   their   faces   are   the   most   pathetic   things   I   haveever   seen,   a   patient   and   resigned   sort   of    looking    and   thepoor   little   babies   had   the   same   look.’ 13 Ida    Appenzeller,another   nurse,   lamented   that   wherever   she   went   she   ‘sawfilthy    military    hospitals   and   yellow   faced   typhuspatients.’ 14 Typhus,   these    ARC   workers   and   their   super-iors   recognized,   was   omnipresent.   Crowding,   filth,   poverty,hunger,   and   wartime   upheaval   conspired   to   create   anenvironment   hospitable   to   lice   and   therefore   to   contagion.Onlybycleaning    up   these   conditions,    American   humani-tarians   believed,   could   they    stop   the   scourge   of    typhus.In   late   1918,   Rudolph   Teusler,   the   head   of    the    ARCCommission   to   Siberia,   met   with   representatives   from   theBritish,   French,   Italian,   Japanese,   and   Czechoslovak    mili-taries   to   determine   their   plan   of    attack.   The   assembleddelegates,   declaring    themselves   the   Inter-Allied   TyphusCommission,   recognized   that   establishing    enough   station-ary    disinfection   clinics   and   isolation   hospitals   to   sufficient-ly    deal   with   the   typhus   crisis   would   take   time   and   wouldrequire   significant   resources.   While   they    decided   to   con-struct   as   many    of    these   permanent   institutions   as   possible,they    also   came   up   with   another   idea   to   facilitate   theprevention   of    disease   more   quickly:   they    decided   to   bring a   delousing    station   to   the   people.   In   the   winter   of    1918–1919,   the   members   of    the   Inter-Allied   Typhus   Commissiondetermined   to   organize   a   sanitary    train   to   carry    medicalcare   and   disinfection   services   to   the   far   reaches   of    Siberia.Originally,   the   Inter-Allied   Typhus   Commission   plannedonly    to   treat   soldiers   in   the   easternmost   provinces   of northern   Russia.   Ultimately,   however,   its   members   decid-edto   extend   their   operations   further   west,   and   to   assistboth   civilians   and   troops   in   the   far   reaches   of    Siberia.   Thesix    Allied   governments   agreed   to   defray    costs   for   the   train,but   all   concurred   that    ARC   physicians   and   nurses   woulddesign   it   and   staff    it.   This   decision   gave   the    ARC   (and,   by extension,   the   United   States)   a   disproportionate   share   of control   over   its   operations.   While   the   Typhus   Train   wouldbe   an   international   enterprise   in   spirit,   in   practice   it   waslargely    an    American   undertaking    (Figure3). 15 The   work   of   the   Great   White   Train In   charge   of    the   outfitting    the   expedition,   the    ARC   Com-mission   to   Siberia   prepared   the   Inter-Allied   Typhus   Train–   or   the   ‘Great   White   Train’   as   it   came   to   be   called   –   for   itswork.    ARC   leaders   filled   several   train   cars   with   medicinesandfresh   clothing    and   transformed   the   others   into   amobile   delousing    clinic.   The   completed   train   included   abath   car,   a   car   with   a   water   tank    and   boiler,   and   cars   forsterilizing    clothes,   dressing    and   undressing    patients,   andcutting    hair.    ARC   leaders   staffed   the   train   with   thirty-onemedical   and   nursing    professionals   and   other   personnel.Originally,   only    two   of    the   train’s   staff    members   were American,   though   more   would    join   later.   The    ARC’s   lea-ders   hired   many    Russian    Feldshers   and    Sanitars ,   orhealthcare   workers,   to   assist   them,   as   well   as   several   staff members   from   the   other   participating     Allied   nations.   Withthe   Russian   words   for   ‘American   Red   Cross’   emblazoned   onitsside,   however,   the   Typhus   Train   plainly    announced   thatit   was   the   United   States   that   had   come   to   Russia’s   aid. 16 On   February    2,   1919,   the   train’s   first   crewmembersdeparted    Vladivostok    for   the   Typhus   Train’s   inauguralmedical   mission.   Fifteen   days   later,   they    arrived   in   thecity    of    Irkutsk    and   began   work.   Over   the   next   few   months,they    traveled   west   to   stops   in   a   number   of    other   citiesincluding    Chelyabinsk,   Petropavlovsk,   Novonicolavsk,Tomsk,   and   Omsk.   In   each   town   they     visited,   the   TyphusTrain’s   personnel   utilized   a   number   of    approaches   to   killlice   and   prevent   further   contagion.   They    bathed   and   cutthe   hair   of    soldiers   and   civilians.   They    disinfected   oldclothing    and   distributed   new   garments.   Those   found   tohave   the   disease   were   given   medicine   and,   when   thefacilities   were   available,   taken   to   a   hospital   for   convales-cence.Workers   on   the   Great   White   Train   prized   efficiency;disinfection   procedures   resembled   a   factory    assembly    line.Workers   treated   hundreds   of    people   per   day,   with   a   record990   patients   on   one   day    alone.   Bukeley    reported   that   ‘if    itwere   possible   to   keep   the   men   moving    into   and   out   of    thecars   for   24   h,   it   would   be   well   within   the   capacity    ofthetrain   to   handle   2,000   cases.’ 17 Working    like   cogs   in   amachine,    ARC   personnel   and   their   allies   launched   anall-out   assault   on    Pediculus   humanus .In   addition   to   treating    patients,   the   Typhus   Train’swork    included   education   and   preventive   services   for   localRussian   civilians   and   their   civic   and   military    leaders.    Ateachstop,   staff    met   with   local   doctors,   health   officials,   andarmy    officials   to   plan   their   strategies.   In   advance   of    theirarrival,    ARC   officials   requested   that   these   individualsprovide   all   the   information   they    could   about   typhus   intheir   towns   to   better   facilitate   their   work.   Once   reaching a   town,    ARC   workers   then   surveyed   local   health   and Figure3 .RussiancivilianillwithtyphusnearAmericanRedCrossbuilding, ca. 1919–1921.CourtesyoftheLibraryofCongressPrintsandPhotographsDivision. 13 CarriePicketttoHerFolks,June23,1919,Box1,CarriePickettCollection,HI. 14 PersonalAccountofIdaAppenzeller(Crom)ofSiberianCommission,1920,Ida AppenzellerCromManuscriptCollection,HB. 15 MinutesofmeetingconvenedbyGeneralS.Inagaki,ChairofInter-AlliedTyphusExpedition,toDirectorofMedicalBureauofARCSiberia,Dec10,1918;RudolphTeusler,memorandumre.AlliedAnti-TyphusCampaign,January25,1919;bothBox135,ARC/HI. 16 ‘‘TheWarAgainstTyphusWagedbytheRedCross,’’ TheNewYorkTribune , August3,1919,3. 17 RudolphBukeley,paraphrasedin‘‘WorkoftheAmericanRedCross:TheGreatWhiteTrain,’’ TheTrainedNurseandHospitalReview 3(September,1919):136. 4  Feature  Endeavour  Vol.xxxNo.x ENDE-434;   No.   of    Pages   8 Pleasecitethisarticleinpressas:Irwin,J.F.,TheGreatWhiteTrain:typhus,sanitation,andU.S.InternationalDevelopmentduringtheRussianCivilWar,Endeavour(2012),doi:10.1016/  j.endeavour.2012.03.001 www.sciencedirect.com  hygieneconditionson   theirown   inorder   to   determinewhatmoremight   bedone   foreachregion.   Theythenreported   backto    ARCbases   inlarger   cities,whichin   turnsentoutsupplytrains   loaded   withtherequested   medicalandhospital   supplies   andother   formsof    materialrelief. Atthesametime,   plumbersandengineers   inspectedlocalbaths   and   hospitalfacilitiesto   makerecommenda-tionson   howto   improvethese   sites.    ARCpersonnel   alsoworked   withlocalpublichealthofficialsto   organizeanti-typhuscampaigns,hopingto   educate   thepublicaboutthediseaseandits   prevention.Goingfarbeyond   treating andpreventing    typhuson   thetrainitself,   Bukeley    andhisstaff    aspiredto   reshape   theentireRussianmedicallandscape.Even   as   the   Train’s   staff    endeavored   to   tackle   typhus,they    experienced   some   serious   setbacks   as   a   result   of    thedisease   as   well.   Originally    in   charge   of    the   train   was   F.A.Dallyn,   a   Captain   in   the   Canadian   Expeditionary    Force,assisted   by    business   manager   Rudolph   Bukeley,   an    ARCstaff    member   from   Honolulu,   Hawaii.   Within   a   matter   of weeks,   however,   Dallyn   succumbed   to   typhus   himself.Though   he   survived,   his   departure   left   Bukeley    in   chargeofthe   train   for   the   duration   of    its   time   in   action.   Dallyn   wasnot   the   only    Typhus   Train   member   to   fall    victim.   By    thesummer   of    1919,   fourteen   of    the   srcinal   thirty-one   staff members   had   contracted   the   disease,   forcing    Bukeley    andhis   colleagues   to   find   replacements.   The   louse   proved   aformidable   adversary. 18 Nonetheless,   theGreat   White   Trainsoonprovedits value   asa   mechanism   for   reachingRussiansfarandwide.Within   thefirst   sixmonthsof    operations,its   staff had   provided   care   to   anestimated   20,000civilians   andsoldiers   andofferedlessons   inhealth   and   hygienetohundreds   of    localphysicians. 19 TheTrain   remainedanimportantfixture   oftheARC’sworkthroughout   theduration   of    its   time   inSiberia.Beginning    inthesummerof1919,in   fact,theARCwouldenjoy    even   greaterautonomyover   its   operations.   WiththetyphussituationamongAlliedsoldiersbetter   under   control,theInter- AlliedTyphusCommittee   cededdirectionoftheGreatWhite   Train   fullyto   theARC.UnderBukeley’scom-mand,theTyphusTraincontinued   to   operateuntilMay29,1920,when   itwas   forced   to   close   following theARC’sdecision   to   withdrawfrom   Siberia   (a   pointto   whichwe   will   returnshortly).Duringthatyear,theTyphusTrain   traveled   anestimated   11,000milesandtreatedover   1,000,000   soldiersandcivilians.   Certainly,theARC’sefforts   didnotbringan   endthetyphus   epi-demicinRussia,   buttheydidoffercare   andpreventiveservicesto    vast   numbersofpeople.Perhaps   more   impor-tantly–   atleast   inAmerican   minds   –   sucheffortsserved vitalU.S.   diplomaticagendasandthereforerepresentedacentral   partofthewiderU.S.   intervention   intoRussia’scivilwar,a   themeto   whichwe   now   turn(Figure4). 20 The   purposes   of   anti-typhus   work On   the   surface,   the   purpose   of    the   Inter-Allied   (and   later ARC)   Typhus   Train   appeared   clear   cut:   to   improve   thewellbeing    of    Russian   soldiers   and   civilians   by    overcoming thescourge   of    typhus.   To   be   sure,   many    of    the   TyphusTrain’s   personnel   understood   this   as   their   principal   goaland   saw   their   work    as   overwhelmingly    beneficent.   Butalthough   individual   humanitarian   relief    workers   may    havebeen   motivated   by    altruistic   convictions,   their   efforts   none-theless   served   the   interests   of    the   Wilson    Administrationand   the    Anti-Bolshevik    coalition   in   several   ways.    Analyz-ing    the   intended   outcomes   of    aid   and   its   perceived    valuecalls   attention   to   the   important   role   that   medical   andscientific   relief    projects   played   in   the   period’s   foreign   rela-tions.Firstand   foremost,   decreasing    the   incidence   of    typhusat   the   immediate   moment   served   clear    American   strategicinterests.   Typhus   was   a   serious   health   crisis   for   the   Rus-sian   people,   but   for    American   and   other    Allied   military    anddiplomatic   officials,   it   was   also   a   tactical   nightmare.   Mili-tary    leaders   rightfully    understood   that   the   disease   imper-iled   their   White    Army    allies   and   their   own   troops.Consular   officials,   meanwhile,   recognized   that   the   epidem-icthreatened   the   morale   of    Russian   civilians   and   riskedmaking    the   existing    social   upheaval   even   worse. 21 Working to   reduce   the   incidence   of    the   disease,   these   policymakersrealized,   offered   several   obvious   benefits   to   the   anti-Bol-shevik    cause.   First,   by    improving    the   health   of     Allied   andWhite   Russian   soldiers,   anti-Bolshevik    forces   would   claima   distinct   advantage   over   their   opposition   in   terms   of strength   and    vitality.   Second,   successful   eradication   of the   disease   among    Russian   women,   children,   refugees,and   other   civilians   could   go   a   long    way    towards   reducing unrest   and   increasing    resolve   against   the   Bolshevik    forces. Figure4 .   PhotographoftheAmericanRedCrossTyphusTrain.In‘‘WorkoftheAmericanRedCross:TheGreatWhiteTrain,’’TheTrainedNurseandHospitalReview63(September,1919):135. 18  AmericanRedCross,PressReleaseforSundayMorningPapers,August3,1919,CentralDecimalFile811.142,Volume875,RG59,RecordsoftheDepartmentofState,NationalArchivesandRecordsAdministration,CollegePark,MD(hereafterDOS). 19 RudolphBukeleytoARCCommissiontoSiberia,May15,1919;RileyAllentoChairofInter-AlliedTyphusTrainCommittee,June28,1919;bothBox135,ARC/HI. 20 RileyAllentoInter-AlliedSanitaryCommittee,May15,1920,Box155,ARC/HI;ErnestBicknell, WiththeRedCrossinEurope ,435. 21 U.S.diplomaticofficialsfrequentlywarnedofthethreatoftyphus.SeeforinstanceConsulHarrisatIrtutsktoSecretaryofStateviaCharge´ in   China,December3,1919,  PapersRelatingtotheForeignRelationsoftheUnitedStates,1919.Russia (Washington,D.C.:U.S.GovernmentPrintingOffice,1919):228;‘‘RefugeesinSiberiaDyinginTrains:TyphusandHungerTakeTerribleToll,’’  NewYorkTimes ,August11,1919. Feature  Endeavour  Vol.xxxNo.x5 ENDE-434;   No.   of    Pages   8 Pleasecitethisarticleinpressas:Irwin,J.F.,TheGreatWhiteTrain:typhus,sanitation,andU.S.InternationalDevelopmentduringtheRussianCivilWar,Endeavour(2012),doi:10.1016/  j.endeavour.2012.03.001 www.sciencedirect.com
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