World War I -- Life Histories/Section 019/Milton Joseph Rosenau

''“We find monuments erected to heroes who have won wars, but we find none commemorating anyone’s preventing a war. The same is true with epidemics.” – M.J. Rosenau''

Overview
Milton Joseph Rosenau, a scientist in public healthcare, worked with the United States government and the country’s universities to improve preventative medicine and standards of sanitation throughout his life and World War I (1914-1918).

Early Life
Milton J. Rosenau (January 1,1869-1946) was born in Philadelphia, Pennsylvania. His father was a Jewish merchant. In 1889, he received his medical degree from the University of Pennsylvania. A year later, the United States Marine Hospital Service (currently the United States Public Health Service), commissioned him as an assistant surgeon. This service was a collection of coastal hospitals committed to providing healthcare to sailors and preventing diseases from entering the country from the coast. He later became director of their hygienic laboratory - a center for the research of infectious diseases - in 1899, Washington D.C.

During the War
During World War I, Rosenau studied the diseases caused by unsanitary conditions in trenches and military quarters that ravaged the soldiers. In response, Rosenau published a military edition of his Preventive Medicine and Hygiene. This book was an influential work regarding hygiene concerning health inspections of new recruits, the prevention of the spread of diseases in trenches, and the sanitation of troops. He believed that the efforts to prevent healthy people from becoming sick were just as important as measures taken to improve those already ill.

In addition to publishing guidelines for reducing deaths by diseases for soldiers on the front, Rosenau worked at various laboratories in the Northeast while enrolled in the Naval Coast Defense Reserve in 1917. In this branch under the Navy Department in Washington, he worked as a surgeon. In the following years, associations such as the Baby Hygiene Association, the Medical Advisory Committee, and the Mount Sinai Hospital Society elected Rosenau to various high positions for his work in public health. He was also concerned with the improvement of sanitation in Palestine and Israel, where typhus and cholera had broken out due to war conditions, and with the movement of prohibition.

Later Life
His work concerning food preservation, specifically the pasteurization of milk, and “keeping the well – well” proved indispensable to the United States. The State of Massachusetts personally expressed appreciation for his efforts against the epidemic of 1918, the Spanish Influenza, which claimed more lives than the Great War itself. Additionally, Rosenau became a Harvard University Medical School professor and served as the Dean of the School of Public Health at the University of North Carolina at Chapel Hill until his death in 1946 at the age of 77.

Milk Hygiene
In 1916, doctors heralded milk as an important source of nutrients. In a time of food scarcity, milk would be able to help lower one’s ration need effortlessly. However, milk could also be a source of contamination and disease. A Public Health Service study reported 500 outbreaks of milk-borne diseases such as typhoid fever and diphtheria. “The German microbiologist Robert Koch discovered the tubercle bacillus in 1882 and almost immediately it was realized that milk might be a powerful agent of its spread.” Before Rosenau or even Pasteur’s work on the preservation of milk, the best methods of preventing bacterial contamination included limiting exposure to any possible source of contamination and using sterile containers. This proved difficult, however, because farmers did not have the goal of producing perfectly sterile milk. Instead, they simply wanted a product that would last on a shelf long enough to be sold.

When Pasteur invented the process of heating liquids to just high enough temperatures to kill bacteria in 1864, milk was being chilled to slow the growth of bacteria. Eventually, in other areas of the world, pasteurization of milk became the preferred method of keeping the milk bacteria-free; however, this process did not become popular in the United States due to the affect on taste. Having studied at the Pasteur Institute in Paris in 1900, Rosenau discovered, during his time at the United States Marine Hospital Service, that heating the milk slowly and at a low temperature would kill off most bacteria while not affecting the quality. “The safest method for pasteurizing is in the sealed bottle, allowing at least thirty minutes for heating to the temperature of pasteurization and then pasteurizing at 145° F. for thirty minutes all done under official supervision.” The basis of this practice is still used today.

United States Marine Hospital Service
On July 16, 1798, the Marine Hospital Service was established under the Treasury Department as a place of relief for sick and disabled seamen. During the First World War, Congress extended many powers to the Marine Hospital Service such as the jurisdiction to control all quarantine stations established by the US to prevent the spread of yellow fever and other diseases during the 59th Congressional Session. Additionally, the 66th Congress granted the service the power to more strictly enforce regulations against ships coming into port at US cities. It also placed pressure on ports worldwide to follow more careful procedures to avoid contaminations and the transference of dangerous diseases. “This Service has published definite rules for the medical examination of aliens which if followed insure a uniform system of inspection and records at all ports of entry”.

Abroad, the US Marine Hospital Services placed strict restrictions on the transportation of deceased soldiers suspected of having diseases to prevent their spread back home. The power of prevention reflected Rosenau’s ideas about the most powerful form of medicine and healthcare during his time there. In 1912, the United States Marine Hospital Service became the Public Health Service and continues to exist to this day.