military hygiene and sanitation essay

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• Published: 07 April 2020

Fit to fight – from military hygiene to wellbeing in the British Army

• Martin C. M. Bricknell 1 &
• Colonel David A. Ross 2  

Military Medical Research volume  7 , Article number:  18 ( 2020 ) Cite this article

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This paper reviews the historical evolution of the language and organization surrounding the health of personnel in the British Army from ‘hygiene’ through  to ‘wellbeing’. It starts by considering the health of the army in the mid-nineteenth century and the emergence of military hygiene as a professional subject. It continues by looking at advances in military hygiene in the two world wars. Hygiene was replaced by the term ‘health’ in the 1950s as the collective noun used by professionals working in this field. This unity split when the professions of occupational medicine and public health established separate faculties and training pathways. However, the health issues for the armed forces remain fundamentally unchanged. Going forward, the term ‘wellbeing’ is helping to refresh the close relationships between executives, their medical advisers and those within the population of health professions charged with keeping the British Army healthy. The core theme is the collaborations between civil society, executive leadership and medical services in maximizing the health of the military population from recruitment through to life as a veteran.

This paper reviews the evolution of the conceptual framework for sustaining the health of the British Army as an occupational group from the introduction of military ‘hygiene’ in the middle of the nineteenth century to that of ‘wellbeing’ in the early twenty-first century. This evolution is based on the story of the British Army. However, this does not mean that a similar story is less important in either the Royal Navy or the Royal Air Force. Indeed, since the establishment of a tri-service Surgeon General in 1990, this narrative has become framed around the health of armed forces personnel. This description of the evolution of thinking about the health of a defined population mirrors the evolution of the thinking and language used for global health, especially from a ‘hygienic’ approach to protecting the health of a population, through to  the improvement of health by social and political interventions alongside the improvement of health services [ 1 ].

The historical journey starts with the emergence of the speciality of military hygiene and its influence on the public health movement in the United Kingdom. Next, the current study will consider the public health innovations that arose from strategic concern over the quality of the nations’ manpower for the army prior to World War I. Experiences in World War I and World War II led to the emergence of ‘health’ as an attribute for military capability based on a holistic perspective of the performance of soldiers within a physical and social environment. This holistic view of ‘army health’ lasted until the early 1970s, when civilian industrial medicine and social medicine became separate medical specialities of occupational medicine and community medicine (and later of public health). This separation split the professional training of specialist army health doctors into either occupational medicine or public health. Since the 1990s, medical services have become more Joint and Defence in their orientation. The health of the armed forces continues to be of strategic importance, and the current paper will close by discussing the emergence of thinking about ‘health and wellbeing’ for armed forces personnel and veterans through collaborations across the government, between the armed services and within healthcare professions. The core theme of the current study is the collaboration between civil society, executive leadership and medical services in maximizing the health of the military population from recruitment through to life as a veteran.

Military health and hygiene in the nineteenth century

The story of the ravages of disease experienced by the British Army during the Crimean War (1853–1856) and the role of Florence Nightingale to bring this experience to the attention of the British government and the public is widely recognized. Less well known is the impact of disease on the army in garrisons both abroad and in England. In 1858, a Royal Commission led by Sidney Herbert (Secretary of State for War and a close friend of Florence Nightingale) published a report on the health of the army. This report showed that the mortality of soldiers stationed in England was 17.5 / 1000 people-year, which was substantially greater than the mortality rate of the general adult male population at 9.2 / 1000 people-year [ 2 ]. Even more surprising, the mortality of the army when garrisoned in England was nearly one-third greater than that of the army when it was stationed at Sevastopol, Crimea, in 1856 (at 12.5 / 1000 people-year). It was demonstrated through statistical analysis that substantial savings in army manpower could be attained by improving the health of the army through better hygiene, better army hospitals and better-trained army doctors. The report made wide-ranging recommendations for the improvement in the organization and management of the Army Medical Services, army hospitals, and the education of army medical officers in military medicine and hygiene. This report made the health of soldiers into a political and executive issue rather than solely a medical issue.

Edmund Parkes - the first professor of military hygiene

There was a substantial reform of the Army Medical Services over the course of the second half of the nineteenth century. This reform included the creation of the Army Medical School in 1860 at Fort Pitt in Chatham (which became the Royal Army Medical College, Millbank, in 1907). The school was endowed with three professors: one of clinical and military medicine, one of clinical and military surgery, and one of sanitary science and military hygiene. The appointment of Edmund Parkes as the first Professor of Military Hygiene became one of the most important innovations in the education of military medical personnel. Parkes joined the army at the age of 22 and served for 3 years before establishing himself in private practice in London and University College. In 1855, he was sent to Turkey and established a military hospital at Renkoi based on a prefabricated structure that was designed and manufactured by Isambard Kingdom Brunel [ 3 ].

After his appointment, Parkes wrote the Manual of Practical Hygiene that had influence across the public health movement in the UK and overseas [ 4 ]. The manual’s preface highlighted the altered position of the army medical officer because of changes to the Queen’s Hospital regulations in 1859 [ 5 ]. ‘Previously, the Army Surgeon had been entrusted officially merely with the care of the sick…..(now) he is ordered to advise commanding officers in all matters affecting the health of troops, whether as regards garrisons, stations, camps and barracks, or diet, clothing, drill, duties or exercises’ . This is the epitome of occupational medicine. In the introduction, Parkes defines hygiene as the ‘..art of preserving health; that is, of obtaining the most perfect action of body and mind during as long a period as is consistent with the laws of life. In other words, it aims at rendering growth more perfect, decay less rapid, life more vigorous, death more remote’ . This is the epitome of public health.

The introduction continues by stating that ‘..in many cases, the employer of labour finds that, by proper sanitary care of his men, he reaps at once an advantage in better and more zealous work, in fewer interruptions from ill-health so that his apparent outlay is more than compensated. This is shown in the strongest light by the Army. The State employs a large number of men, whom it places under its own social and sanitary conditions. It removes from them much of the self-control with regard to hygienic rules which other men possess and is therefore bound by every principle of honest and fair contract to see that these men are in no way injured by its system. But more than this: it is as much bound by its self-interest. It has been proved over and over again that nothing is so costly in all ways as disease and nothing is so remunerative as is the outlay which augments health, and in doing so, augments the amount and value of the work done’ . These three quotes provide enduring social and economic arguments for protecting the health of soldiers in the army and show the interrelationship between the modern clinical specialities of occupational medicine and public health in advising on the health of army personnel.

This focus on military hygiene reduced all-cause admissions to hospitals per thousand strength from 1060 in the 1870s to 1020 in the 1880s, 850 in the 1890s, and 500 in the first decade of the twentieth century [ 6 ]. By the time of his death in 1876, Parkes had established the importance of hygiene within the military and of the contribution of military hygiene experts within the wider public sector alongside the civilian Medical Officers of Health in towns and cities. Teaching military hygiene now had equal status to military medicine and surgery.

The health of the public and its impact on the health of the Army

The army faced many challenges during the Boer War in South Africa (1899–1902) both in trauma care and preventive medicine. However, the requirement to mobilize the manpower of Great Britain for the war also exposed the very poor standards of health amongst the civilian male population. This resulted in very high rates of rejection for military service. Such was the concern that Parliament set up a Committee on Physical Deterioration ‘to determine, with the aid of such counsel as the medical profession are able to give; the steps that should be taken to furnish the Government and the Nation at large with periodical data for an accurate comparative estimate of the health and physique of the people; to determine generally the causes of such physical deterioration as does exist in certain classes; and to point out the means by which it can be most effectually diminished’ [ 7 ]. This report made 53 recommendations, many of which are recognizable as public health and industrial health improvements that persist today. These recommendations included a national anthropometric survey of the population; the medical examination of school children, factory workers and coal miners; the training of mothers in the domestic economy (which became Health Visiting); and health education and sport as part of the school curriculum. The army continued with the progress of sanitary reform after the Boer War. In 1904, training in basic hygiene was added to the curriculum for officer training, and the Army School of Sanitation was established in 1906. There was considerable technical progress in subjects such as water purification, the ‘hygiene of the march’ and immunization against infectious disease [ 8 ]. Institutional knowledge was codified as the Manual of Elementary Military Hygiene, published by the War Office in 1912 [ 9 ]. Thus, by the beginning of World War I, the public health movement had unified the importance of both the health of the population to be recruited into the army and the maintenance of the health of soldiers once in the army.

World War I – hygiene at scale

The substantial role played by military hygiene in keeping the mobilized armed forces fit for military operations during World War I was summarized in 1924 by Colonel Anderson, who was a professor of hygiene at the Royal Army Medical College [ 10 ]. This experience led to a greater understanding of infectious diseases such as typhus, relapsing fever, cerebrospinal fever, and influenza and the prevention of these diseases by setting standards for accommodation, sanitation and cleanliness. These standards also included the education and training of individual soldiers in ‘sanitary habits’ [ 11 ]. Many aspects of military hygiene were transferred to civil society. The work to define the food and energy requirements for soldiers on the march was used by the Food (War) Committee of the Royal Society to determine the rationing requirements for the civil population. The requirement for preserved military rations led to the development of pasteurization and canned food. The subject of medical topography, which we would now call travel health, emerged from the requirement to analyse the potential impact of endemic medical disease on military forces. Finally, the Chemical Warfare Medical Committee, under the chairmanship of the first Director of Military Hygiene, Colonel Sir William Horrocks, supervised the development of protective equipment and medical treatments for gas warfare, which could be considered a very specific branch of industrial hygiene. This momentum was maintained during the inter-war years through the creation of an Army Hygiene Directorate in 1919 and an Army Hygiene Advisory Committee comprised of military and civilian experts. In 1922, a hygiene specialist was appointed to the staff of the Army School of Physical Training to carry out research and advise on the physiology of exercise [ 12 ]. This knowledge was consolidated through the publication of the Manual of Army Hygiene and Sanitation in 1934 [ 13 ].

In his presidential address of 1922 to the Navy, Army and Air Force groups of the civilian Society of Medical Officers of Health, Major General Sir William Macpherson [ 14 ] summarized military hygiene as ‘the maintenance of physical fitness, physical training, the hygiene ‘of the march’, the relationship between food and energy and camp sanitation ’. He also highlighted other subjects in military hygiene that have equal importance in civilian life, such as the prevention of epidemics and the preservation of health in communities living in close contact with one another. Major-General Beveridge [ 15 ], in his presidential address to the same body a year later, compared military hygiene and public health as follows: ‘Public health, as applied to the civil community, is concerned with the individual during the whole period of life, but in the fighting services it is chiefly concerned, for all practical purposes with selected personnel during a certain period of life’ . This close relationship between the practice of hygiene in the army and civilian practice by members of the Society of Medical Officers of Health continued through the twentieth century as the professional body evolved into the Faculty of Community Medicine in 1973.

World War II – hygiene to health

In World War II, military hygiene continued to be critically important in ensuring the health of the army both in the UK and in operations across the world, notably extending from physical health to mental and social health. There were advances in the application of science to hygiene, for example, the introduction of chemoprophylaxis against malaria, the use of dichloro-diphenyl-trichloroethane (DDT) as an insecticide, and the use of penicillin in the control of sexually transmitted disease [ 16 ]. Lessons from the contribution of hygiene to winning the campaign in the Middle East were incorporated into the preparation of the 21st Army Group to fight in Northern Europe. Field Marshall Montgomery is quoted as saying that ‘the men of 21 Army Group were fully immunised and fully trained; their morale was at its highest; they were well clothed and well fed; they were fighting in a climate to which the average British soldier is well accustomed; hygiene, both personal and unit, was exceptionally good; welfare services were well organised. The exhilarating effect of success also played a role in reducing rates of sickness’ [ 17 ].

The opening section of the chapter on the Army Medical Services in the volume of Principal Medical Lessons of the Second World War describes how the concept of the nature of health was enlarged to encompass much more than just the physical functioning of the single individual. ‘ It came to be recognised that disharmony between the individual and the conditions and circumstances that obtained within the community was the cause of much ill-health and so the search for causation became extended from the physical to the social environment of individuals and groups’ [ 18 ]. This social perspective on health was also strongly championed by General Sir Ronald Forbes Adam, the Adjutant-General (head of personnel for the British Army), alongside medical services. He directed the development of aptitude selection based on psychological tests and physical tests and introduced the concept of the demobilized soldier as a returning citizen member of the nation. The experience of preventive medicine in World War II also re-emphasized the responsibilities of commanders to ensure that the recommendations of their medical advisers were implemented alongside the developments in hygiene measures by the Army Medical Services [ 19 ].

Army Health – 1950s - organization

In addition to the widening of the outlook in the attainment of physical and mental health in the British Army, it was also felt that the term ‘hygiene’ had become restricted to the field of sanitation rather than the earlier broad ‘health’ perspective. Therefore, in 1950, the Directorate of Army Hygiene became the Directorate of Army Health [ 20 ] within the Army Medical Directorate of the War Office. The Army Health Advisory Committee (comprising leading civilian authorities on public health, malariology, physiology, nutrition, and statistics) continued to provide external advice. The directorate was responsible for leading the Army Health Organisation [ 21 ]. Senior staff officers were graded as specialists in Army Health with civilian public health qualifications. The majority also attained a Diploma in Tropical Medicine and Hygiene that was jointly taught by the Royal Army Medical College and the London School of Hygiene and Tropical Medicine. Postgraduate education for medical officers in Army Health was delivered through the Army Health Department of the Royal Army Medical College, and non-professional training was provided by the Army School of Health to members of the Royal Army Medical Corps (RAMC), non-RAMC officers and other ranks. King’s Regulations and Army Council Instructions continued to place the primary responsibility for the health of the army upon the chain of command. Senior leaders of medical services framed this as the welding together of the traditional art of man-management and the modern scientific methods of disease control into the so-called ‘health discipline’ [ 22 ].

Organizing health education was one of the primary tasks of specialists in Army Health. To aid them in this task, new films dealing with personal and communal hygiene were released in 1950, and Mobile Health Training Teams were set up. A great deal of thought was given to the various educational techniques involved. A new pamphlet was produced to help the individual soldier, Your Health and You [ 23 ]. The lessons of World War II were incorporated into the Handbook of Army Health [ 24 ] for non-specialists and into the Manual of Army Health for specialists [ 25 ]. The importance and interdisciplinary nature of Army Health continued to be championed during the 1960s. In an article in the Journal of the Royal Army Medical Corps , Colonel Lewis (Professor of Army Health) stated that ‘to select military personnel in accordance with high physical and mental standards, to subject them to long and expensive training, and then to dissipate a large portion of this human treasure in non-productive man-hours wasted through preventable ill-health is uneconomical, to say the least; and, when manpower resources are limited the issue is nationally vital (…) the successful practice of Army Health calls for team-work in which everyone in the Army, irrespective of regiment, corps, trade; grade, mode of employment and rank has a part to play’ [ 26 ]. These observations echo the social and economic arguments about military hygiene made by Parkes almost a century earlier.

Army Health separation into Public Health and Occupational Medicine in the 1970s

This integrated Army Health Organisation continued until the late 1970s, when postgraduate professional training for medical officers in the RAMC was formally structured into general practice, hospital specialities and a new grouping, namely, Army Community and Occupational Medicine (ACOM). Doctors in this third stream were required to qualify for Membership of the Faculty of Community Medicine or Occupational Medicine [ 27 ]. ACOM changed to Army Public Health and Occupational Medicine (APHOM) when the Faculty of Community Medicine was renamed the Faculty of Public Health in 1989 [ 28 ]. Slowly, the professional training routes for Army Health doctors split, despite the considerable overlap of their roles as preventive medicine or health specialists [ 29 ]. Consultants in each speciality were quite public in their views of the differences in their professional knowledge [ 30 ]. The postgraduate medical training route for both specialities followed the discrete civilian faculty models with a blend of military and civilian experience [ 31 ]. This led to the demise of the dual-speciality education course at the Royal Army Medical College and the competition to label the previous health posts as either public health or occupational medicine [ 32 ]. An Army Health research capability was created by the formation of the Army Personnel Research Establishment in 1965 [ 33 ]. This developed into the Army Occupational Health Research Unit in the 1980s that was manned by occupational physicians. It was disestablished when QuinetiQ was formed from the Defence Evaluation and Research Agency in 2001 with its military manpower being incorporated into the Army Health Unit in the Army Medical Directorate in the early 2000s.

Occupational medicine in the military has become a more clinical speciality, as army general practitioners and hospital specialists have become less closely associated with army personnel in their workplace [ 34 ]. This has also led to the creation of military occupational health (OH) nurses in a model that partially mirrors civilian practice. Public health has become a central staff function, with posts in the Joint Medical Group and the service commands [ 35 ]. This separation of medical specialties has also distanced the environmental health care from a ‘military health’ identity. Indeed, a review of occupational health in the armed forces published in 2009 did not mention the relationship between occupational health and the specialities of public health or environmental health [ 36 ]. Thus, the unifying identity of ‘Army Health’ became disaggregated during the 1980s into the early 2000s as the individual professions aligned to their separate identities in the civilian sector.

Current issues in military health and wellbeing across the military life course

Many issues in military health remain the same as those of the nineteenth century, though the context has changed (and deaths in the barracks are very rare!). The 2017 Francois Report of a review of recruiting for the armed forces stated, ‘At present, over 90% of individuals who are failed when attempting to join the Armed Forces do so on medical grounds [ 37 ] ’. This has raised concerns about the physical and mental health of the recruitable population and the thresholds at which those with a pre-existing medical condition are excluded. At the other end of military service, the rate of medical discharge in the armed forces attracts attention because the two primary causes, musculoskeletal injury and mental ill health, are perceived to be preventable. Mental health in the armed forces and the veteran community has had particular political and media prominence, with the House of Commons Defence Committee conducting an inquiry into mental health in the armed forces and veterans from 2017 to 2019 [ 38 ]. Preventive medicine continues to be scrutinized, with legal cases pending on the anti-malarial Mefloquine, Q fever, non-freezing cold injury and noise-induced hearing loss.

The integration of professional knowledge from all health specialities to promote health and prevent disease for the military population has been re-emphasized over the last decade. The Defence Medical Services Top Structures review in 2008/2009 introduced a life-course approach to force health protection and the preparation of armed forces personnel for military operations. This starts at the stage of recruitment from the civil population through to understanding the long-term health effects of military service amongst Veterans and takes place on a ‘continuum of care’ [ 39 ]. The three services of the Royal Navy, the British Army and the Royal Air Force continue to promote wellbeing and healthy living through education during entry training and periodic mandatory additional training. Briefings on keeping healthy are included within pre-deployment training for military operations. There are active research programmes on physical fitness, diet, mental health and other dimensions of health in the military.

The military medical services remain empowered as advisers on health to the executives, with structural collaboration between the personnel and the medical function. In the evolution from ‘hygiene’ to ‘health’, the term ‘wellbeing’ has become preferable to that of ‘health’ to further emphasize the contribution of all other stakeholders in supporting armed forces personnel to maximize their physical, mental and social potential. The Defence Mental Health and Wellbeing Strategy, launched in 2017, described the role of the Defence Health and Wellbeing Board to bring coherence across Defence [ 40 ]. There are subordinate groups with the responsibility for lifestyles, injury prevention, preventive health and mental health. This shift is also occurring within civilian occupational medicine [ 41 ] and other military medical services [ 42 ]. In the army, the Director of Personnel for the Army is supported by a Senior Health Advisor (Army) as the most senior medical services officer. The Head of the Royal Navy Medical Service is the medical adviser to the Navy Board, and the Head of the Royal Air Force Medical Services is also the medical adviser to the Air Force Board [ 43 ]. Outside the Ministry of Defence, the National Health Service (NHS) Long-term Plan seeks to give people more control over their own health and to invest in more NHS prevention services [ 44 ]. The plan also includes a specific section on NHS services for armed forces personnel and veterans. The UK government has recently established an Office for Veterans Affairs to coordinate activities and existing funding to ensure that ex-service people get access to medical treatment, training and housing to meet their unique health needs [ 45 ].

Conclusions

This paper has described the enduring importance of physical, mental and social health and wellbeing amongst army personnel as a key enabler of military capability. Although the language has changed (from ‘hygiene to ‘health’ and then to ‘wellbeing’), the core issues regarding the health of the British Army remain. The scourge of infectious disease in garrison in the 1800s has been addressed by improvements in housing, sanitation and wider public health measures such that mortality in the army population is no longer an issue. However, the quality of the health of the civilian population for entry into the army remains a concern, although the modern issue is obesity and poor physical conditioning rather than malnutrition. Non-medical, military leaders continue to emphasize the promotion and maximization of health for serving military personnel to support the personnel component of military capability. The current subject areas of lifestyles, injury prevention, preventive health and mental health are similar to those listed by Parkes in the late nineteenth century. The media and the wider public maintain an interest in how government services meet the health needs of the armed forces and military veterans. There has been a recent refreshing of the close relationship between military health and wider civilian public and occupational health. This paper has also demonstrated the requirement for a cadre of military health professionals with a combination of public health, occupational health and environmental health competencies who can provide technical advice that informs policies, procedures and practices in the promotion and protection of the health of the military population. This paper has focused on experiences in the UK, especially those of the British Army. It would be interesting to compare these results with other nations’ military medical experiences.

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Abbreviations

Army Community and Occupational Medicine

Army Public Health and Occupational Medicine

National Health Service

Occupational health

Royal Army Medical Corps

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Acknowledgements

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Health and Military Medicine, Conflict and Health Research Group, School of Security Studies, King’s College London, Strand Campus, London, WC2R 2LS, UK

Martin C. M. Bricknell

Parkes Professor of Preventive Medicine, Robertson House, Camberley, GU15 4NA, UK

Colonel David A. Ross

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MB was the primary author. DR provided a comprehensive review and significant additional material. All authors read and approved the final manuscript.

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Lt. Gen. (Rtd.) Professor Martin CM Bricknell retired from the post of Surgeon General of the UK Defence Medical Services in April 2019. He is trained in public health, occupational medicine and general practice and has extensive operational experience.

Colonel David A Ross is the Defence Consultant Adviser in Public Health in the UK Defence Medical Services and holds the Parkes Professorship in Preventive Medicine.

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Correspondence to Martin C. M. Bricknell .

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Bricknell, M.C.M., Ross, C.D.A. Fit to fight – from military hygiene to wellbeing in the British Army. Military Med Res 7 , 18 (2020). https://doi.org/10.1186/s40779-020-00248-6

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DOI : https://doi.org/10.1186/s40779-020-00248-6

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Military Hygiene and Sanitation.

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This treatise is an elaboration of the lectures delivered by the author while professor of hygiene at the Royal Army Medical College. He has wisely not attempted to deal with all the problems of hygiene, but has selected those which are more likely to be encountered in time of war. The same applies to the discussion of the prevention of communicable diseases. The introductory chapter is one of the most valuable in the book as it not only is an introduction, but also gives a summary of information indispensable to every sanitary officer. The author then takes up the topics in the logical order, beginning with sanitary organizations, and the recruit, physical training, marching, food, the ration, water-supply, ventilation, disposal of waste matters, clothing, equipment, prevention of infectious diseases, and disinfection, and closes with a short chapter on sanitation of the battle-field, The appendixes give scales of field-service rations, tabulated

Military Hygiene and Sanitation. JAMA. 1913;60(13):1021. doi:10.1001/jama.1913.04340130067047

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Department of Military Hygiene, 1922-1961

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First classmen were receiving instruction in 1857 at the Soldiers' Hospital in the care of sick soldiers, police discipline, and sanitary arrangements. This first attempt at training in military hygiene was not expanded significantly until 1886, when an act of the Congress authorized the teaching of a course in physiology and the effects of alcohol, tobacco, and narcotics on the human body. The course was given by the Department of Chemistry, Mineralogy, and Geology until 1905. In August of that year the Surgeon General of the Army recommended the appointment of an instructor of military hygiene at the Academy; shortly thereafter, the Department of Military Hygiene was established by War Department General Order 176, October 19, 1905. The Surgeon, USMA, was made head of the department and appointed to the Academic Board. An act of April 19, 1910, created a professorship in the department, and Lt. Col. Frank R. Keeffer became the first incumbent. Instruction in military hygiene has been given in various class years since 1906, and the total amount of hours allotted has changed periodically. The course has been conducted largely through lectures. By 1940, subjects studied included anatomy and physiology, first aid, the effects of alcohol and drugs, field sanitation, personal hygiene, and control of disease. After the Second World War, subjects such as pharmacology and psychiatry were introduced, along with the study of new developments in military medicine and sanitation and the organization and operation of the medical services. The general purpose of the study of military hygiene has been to prepare the future officer to care for his own health and for that of his men so that the effectiveness of his command can be maintained or improved.

• Creation: 1922-1961

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PI185/RG404

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Department of Military Hygiene, 1922-1961, RG 404.3.3.12. Records of the United States Military Academy, RG-404. United States Military Academy Library Archives and Special Collections.

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Department of Military Hygiene, 1922-1961, RG 404.3.3.12. Records of the United States Military Academy, RG-404. United States Military Academy Library Archives and Special Collections. https://archives.westpoint.edu/repositories/2/archival_objects/700 Accessed May 20, 2024.

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Sanitation, Health and Hygiene during World War 1

This paper analyses the crisis and the condition of public health, sanitation and hygiene in four countries of the World War 1, including UK, USA, Ottoman Empire and Germany.

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Melanie S Tanielian

Elina Gugliuzzo

The aim of this paper is to understand the sanitary policies adopted by the Ottoman Empire during the recurring outbreaks of plague in a comparative perspective. When the Black Death first arrived, Constantinople was still part of the Byzantine empire and the Ottomans were a small Anatolian group. This was followed by three phases of plague activity from the time the Ottoman’s conquered Constantinople, renaming it Istanbul.

Javier Abellán

We still don’t have a truly European history of modern water supply and sanitation services. The existing literature on this topic can be characterized by a national or local scope. We try to offer a descriptive account of the key developments in water supply and sanitation services in nineteenth- and twentieth-century Europe following a transnational approach. Four periods are identified. Between 1800 and 1830, urbanization set the perfect environment for the spread of contagious diseases. In 1830-1850, contemporaries began to give importance to an appropriate water management system due to the spread of cholera. In the period ranging from 1850 to 1870 the first large infrastructures were built, but they only reached the affluent districts of large cities. From the 1870s onwards, the public sector took a leading role and extended the access to water and sanitation services to the whole population.

Daniel Gallardo-Albarran

Clean water provision is considered crucial towards eradicating water-borne diseases. However, the benefits of piped water are limited in the absence of efficient systems of waste disposal due to recontamination or the exposure of citizens to excrement. In this article, I analyse the historical experience of German cities and estimate the impact of water supply and sewerage systems on mortality. The results show that waterworks lowered mortality, although to a lower extent than suggested previously. I observe a much stronger effect of sanitary interventions in cities that also established sewerage systems. Together they explain 19 percent of the overall mortality decline during this period. Three pieces of evidence show that the limited effects of waterworks is related to illnesses spread via faecal-oral transmission mechanisms. First, sanitary infrastructures account for a quarter of the decline in infant mortality, which is largely affected by water-borne ailments. Second, I find a large effect for enteric-related illnesses, while deaths from etiologies with a different pathological basis are not affected. Finally, the estimated effect is related exclusively to the sanitary interventions because mortality only declines significantly after their completion, and not before.

Hygiea Internationalis An Interdisciplinary Journal for the History of Public Health

Nermin Ersoy

Benoit Pouget

American Journal of Public Health

Lisa Haushofer

World War II created a large group of persecuted, homeless or stateless people who came to be united under the term “displaced persons” (DPs). The United Nations Relief and Rehabilitation Administration (UNRRA) was charged with the care of these individuals in various camps in Germany, although the military governments of the respective zones of occupation had ultimate authority over them. Among the various public health efforts directed toward DPs was a campaign against venereal disease during which compulsory examinations were particularly stressed by the military governments. The controversy resulting from this campaign opens a new window on the complex context of an international organization working under the roof of a national authority to achieve common—or differing—public health goals.

Public Health

Robert Atenstaedt

Background: The aim of this study, which evaluated historical data, was to delineate the probable impacts of infectious diseases on human populations under extraordinary circumstances. The second goal was to disclose the mortality rates for infectious diseases in the absence of antibiotics. Methods: The Third Ottoman Army records at the Turkish General Staff Military History and Strategic Study Directorate were studied retrospectively for the period between March 1915 and February 1916. Results: For the Third Ottoman Army, the number of infection-related deaths over the single-year period was 23,601. Malaria, relapsing fever and dysentery were the most common infections. In that pre-antibiotic era, the highest mortality rates were seen for cholera (80%), pulmonary tuberculosis (58%) and typhoid fever (51%). However, typhus had the maximum share in soldier deaths (6053 soldiers). The rate of vector-borne infections peaked in the summer of 1915, while the frequency of respiratory tract infections was highest in the colder months. In contrast, gastrointestinal tract infections appeared to maintain a steady state throughout the year. Conclusions: If the wartime data for 1915 are accepted to provide a model for extraordinary circumstances in the 21 st century, vector-borne, respiratory tract and gastrointestinal infections can be accepted as the challenging issues with signifi cant mortality.

Theodorou Vassiliki

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Personal Hygiene in the Military

The topic of personal hygiene is one of the most controversial yet crucial topics that applies to all and sundry. It encompasses the basic cleanliness routines of hand and body wash, cleanliness of clothes, footwear and other personal effects that surround an individual such beddings and towels. It is expected that each and every individual regardless of age, sex, profession, social class and culture lives in a hygienic manner not only for their sake but also for that of the people around them.

If this sample essay on "Personal Hygiene in the Military" doesn’t help, our writers will!

Military personnel play quite an important role in the defense and protection of their jurisdictions and most of the time put their lives on the line in service of their respective nations. It is important to note that most of these military officers are deployed in areas with harsh conditions hence making it very difficult for them to maintain a high standard of hygiene as compared to when they stay in their normal non-deployment residential areas.

Some of the common deployment zones are extreme and usually include very cold alpine conditions, very hot desert areas, those with no water supply and regions that are unfavorable to basic cleanliness such as taking regular showers, maintaining a regular change of clothes and keeping sleeping quarters clean. In some harsh weather, unexpected rainfall can soak soldier encampments while in other scenarios the soldiers may even be living in defensive bunkers which make it difficult for them to carry out practices such as regular washing of garment cloths and body parts and proper drying techniques. The result is that most soldier garrisons have unfavorable stench with the soldiers characteristically exhibiting poor personal hygiene. Congestion is also a key factor that contributes to poor personal hygiene as soldiers in overcrowded facilities are likely to be infected with communicable respiratory, alimentary and dermatologic diseases.

Basic hygiene practices involve the proper drying of moist surfaces since they might attract bacterial and fungal infections. The main reason behind this is that most microbes reproduce in moist environments hence spreading infections. Military personnel are advised to properly wash and dry specific body parts due to their susceptible nature. Emphasis lies on: genital areas, feet, between thighs, armpits and between the buttocks. Talcum powder is advisable for use in places where wetness is a problem such as between the thighs and under the breast in females. Loose fitted clothing should thus be worn so as to ensure adequate ventilation. Nylon and silk undergarments should not be worn in humid environments (Headquarters, Department of The Army and Commandant, Marine Corps, 41).

Casualty rates are also reduced by proper personal hygiene among soldiers in combat regions. Most warfare zones have poor sanitation conditions hence high probability of mortality when a soldier is wounded during battle. It is a common occurrence that medical supplies are limited in nature due to the strained capability to deliver and replenish used medical supplies. As such, wounded soldiers may develop septic wounds that are easily contaminated if they do not maintain proper personal hygiene. Normally, it is common practice to take regular showers and change beddings, bandages and clothes all in a bid to ensure fast recovery and save the lives of wounded soldiers.

Studies have shown that poor personal hygiene usually results in psychological disorders as the individual is not able to focus and pay keen attention to the military mission at hand (Weyant ,9-10). An individual in such an unclean environment is easily distracted by the events going on in the environment and cannot act in pinpoint precision required of soldiers on a mission. The result is that the soldiers have a high probability of making mistakes that are very costly in terms of both human life and property. The individual thus risks their own life and that of their military unit when they cannot function at peak concentration hence putting other soldiers at risk of death.

In some instances, a soldier with poor personal hygiene is likely to be easily irritable and hence little provocation can degenerate into a violent confrontation with their colleagues. The ensuing bad blood usually manifests as arguments, brawls and even fights among soldiers who are on the same team and are tasked with accomplishing a planned mission. Such negativity hinders cohesion among soldiers and this impairs teamwork and their ability to achieve success in their planned objectives.

A military unit is likely to isolate a soldier whom they deem unhygienic and sideline such an individual making them feel not listened to and not part of the team. Therefore, it is expected that such an individual does not feel part of the close knit military unit and the stigma drives them to become loners who cannot interact properly with other team members.

From this standpoint, it is critical that soldiers maintain clean surroundings and sanitation of items that they use in their day to day lives. One cannot overlook the importance of personal hygiene on the saving of soldiers lives from contaminable wounds and equally important on cohesion within their military teams and units.

Works Cited

BIBLIOGRAPHY Headquarters ,Department Of The Army And Commandant, Marine Corps . Field Hygiene And Sanitation. Washington, DC: United States Army, 2000. Electronic.

Weyant, R. "Interventions based on psychological principles improve adherence to oral hygiene instructions." J Evid Based Dent Pract. (2009): 9-10. Web.

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Military Hygiene and Sanitation

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• Global Water, Sanitation and Hygiene (WASH)
• Water, Sanitation, and Hygiene (WASH) in Healthcare Facilities and GWASH in Healthcare Facilities
• Global WASH Posters Resources
• GWASH Success stories

About Global Water, Sanitation and Hygiene (WASH)

• Global access to safe water, sanitation, and proper hygiene education can reduce illness and death from disease, improve health, reduce poverty, and help economic growth.
• Every year, diseases like diarrhea, cholera, and typhoid fever cause millions of illnesses and deaths, yet they can be prevented with better WASH practices.

Everyone needs clean water, safe toilets, and good hygiene habits to stay healthy, but not everyone has access to these essentials. Today, millions of people around the world do not have clean water to drink, and billions do not have a safe place to go to the bathroom. This can lead to serious illnesses like cholera, typhoid, and diarrhea, which are especially dangerous for infants and children.

Access to clean water, sanitation, and hygiene remains a significant global challenge, with over 2 billion people lacking clean drinking water at home, 1.5 billion lacking basic sanitation facilities , and 2 billion lacking basic hygiene services .

Universal access to safe drinking water, sanitation, and hygiene has the potential to greatly reduce global disease burden. Investing in water and sanitation interventions brings economic, environmental, quality of life, and health benefits. WASH also plays a key role in improving nutritional outcomes, particularly among children.

Global impact of waterborne infections

Unsafe water, inadequate sanitation, and poor hygiene play a major role in spreading diseases like cholera and typhoid fever . These conditions also contribute to the emergence of more dangerous forms of diseases, such as extensively drug-resistant typhoid fever. Addressing these challenges requires dedicated efforts to improve water, sanitation, and hygiene (WASH) practices. These improvements are necessary for preventing the spread of disease and dealing with emerging threats like antibiotic-resistant infections.

Harmful germs, parasites, or toxic chemicals can contaminate water. This contaminated water comes from human or animal waste, pesticides, and industrial waste. This can make people sick with diseases like cholera, typhoid, polio, and diarrhea. Diarrhea is one of the leading causes of death in children under five years old. The primary risk factors for diarrhea include unsafe water and sanitation, along with childhood malnutrition.

In addition, not having access to clean water, toilets, and good hygiene practices makes it harder to stop and manage neglected tropical diseases like schistosomiasis , trachoma , and Guinea worm disease . This keeps the cycle of poverty and sickness going. Having reliable access to safe water, proper sanitation, and good hygiene practices significantly reduces the burden of disease globally.

Key facts highlight the impact of these conditions:

• Diarrhea is a major cause of mortality among children under five, with about 88% of these deaths attributable to WASH issues.
• Cholera affects 47 countries, primarily impacting vulnerable populations, with efforts focusing on improving WASH and vaccination to prevent outbreaks.
• Typhoid fever, notably its drug-resistant strains, underscores the importance of enhanced sanitation, hygiene, and vaccination efforts for prevention.

Improving WASH infrastructure and practices is key to breaking the cycle of disease and poverty and highlights the need for global efforts to ensure everyone has access to safe water and sanitation.

Global Water, Sanitation, and Hygiene (WASH)

Global access to safe water, adequate sanitation, and proper hygiene can reduce illness and death from disease.

• Biology Article
• Need For Hygiene And Sanitation

Need for Hygiene and Sanitation

What is hygiene.

Hygiene is a set of personal practices that contribute to good health. This includes washing hands, cutting hair/nails periodically, bathing, etc.

What is Sanitation?

Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation.

Also Read:  Health and Hygiene

Read on to explore the importance of hygiene and sanitation.

Importance of Hygiene and Sanitation

Maintaining personal hygiene and sanitation is important for several reasons such as personal, social, psychological, health, etc. Proper hygiene and sanitation prevent the spread of diseases and infections. If every individual on the planet maintains good hygiene for himself and the things around him, diseases will eradicate to a great level.

Importance of Hygiene

Hygiene, as defined by the WHO refers to “ the conditions and practices that help maintain health and prevent the spread of diseases. ”

This means more than just keeping ourselves clean. This means shunning all practices that lead to bad health. Throwing garbage on the road, defecating in the open, and many more. By adopting such a practice, we not only make ourselves healthier but also improve the quality of our lives.

Personal hygiene means keeping the body clean, consumption of clean drinking water, washing fruits and vegetables before eating, washing one’s hand, etc. Public hygiene refers to discarding waste and excreta properly, that means, waste segregation and recycling, regular disinfection and maintenance of the city’s water reservoir. Quality of hygiene in the kitchens is extremely important to prevent diseases.

Diseases spread through vectors. Say the vector is contaminated water as in the case of typhoid, cholera, and amoebiasis (food poisoning). By drinking clean water, we can completely eliminate the chances of getting diseases.

Some diseases are caused by pathogens carried by insects and animals. For eg., plague is carried by rats, malaria, filarial, roundworms by flies and mosquitoes, etc.

Mosquitoes thrive in stagnant water and rats in garbage dumps and the food that is dumped out in the open. By spraying stagnant water bodies with kerosene or other chemicals, we can completely eliminate mosquitoes from our neighbourhood. If that is unfeasible, we can all use mosquito nets prevents us from mosquitoes while we’re asleep. This poses a physical barrier for the mosquito.

Rats thrive on unsystematic waste disposal. By segregating the waste we can ensure that we don’t leave food lying around for rats to eat. Close contact with sick people is also another way of contracting diseases .

A country has to strive to educate more doctors so that medical need of every citizen is taken care of. The importance of cleanliness should be inculcated in every citizen and this will in turn show in the cleanliness of the places we live in.

Importance of Sanitation

Sanitation is another very important aspect. Many of the common diseases mentioned earlier such as roundworms spread through the faeces of infected people. By ensuring that people do not defecate in the open, we can completely eliminate such diseases and even more severe ones such as the one caused by E. Coli. The advancement in biology has given us answers to many questions, we are now able to identify the pathogen and treat an ailment accordingly.

Also Read:  Health and Diseases

For more detailed information about what is hygiene, what is sanitation, the Importance of Hygiene and Sanitation, keep visiting BYJU’S website or download BYJU’S app for further reference.

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Jonathan Alter

Contributing Opinion Writer

A Tongue-Lashing for a Defense Witness Isn’t Great News for Trump

Eight times a day during his felony trial, a former president of the United States must stand and honor 12 jurors and six alternates as they walk past, eyes straight ahead or down, casting no glances at him. It’s inspiring to watch these ordinary citizens as sovereign soldiers for justice.

On Monday this calm processional was disrupted, as jurors were forced to hurry out after a witness for the defense mocked the authority of the court. Moments later, Justice Juan Merchan ordered the courtroom immediately cleared, and reporters fled in a frenzy.

The reason for all of this was the testimony of Robert Costello, an astonishingly arrogant former federal prosecutor who has defended the likes of George Steinbrenner and Leona Helmsley, borrowing a little of his nasty affect from each.

Michael Cohen testified earlier that Costello and Rudy Giuliani were assigned by Donald Trump to open a back channel to Cohen to keep him in the Trump fold.

Costello testified before a friendly House subcommittee last week that Cohen was a liar. This apparently impressed Trump and — presto! — Costello was the first important witness the defense called after the prosecution rested.

On direct examination, Costello did next to nothing for the defense beyond landing a few more mostly irrelevant blows on Cohen.

On cross-examination by the prosecution, however, you could almost see steam coming out of Costello’s ears. The temerity of this lowly local female prosecutor asking him questions! Merchan ruled earlier that Costello could testify only on certain subjects. When Merchan sustained several objections from the prosecution and struck a couple of Costello’s answers from the record, Costello decided to play judge.

He muttered “ridiculous” and “strike it” after disliking a question. An enraged Merchan excused the jury and said sharply, “I want to discuss proper decorum in my courtroom.” He continued, “You don’t say, ‘Geez,’ and you don’t say, ‘Strike it.’ And if you don’t like my ruling, you don’t give me side-eye and roll your eyes.”

Merchan apparently didn’t want reporters to hear the rest of his tongue-lashing and cleared the courtroom.

None of this was good for the defense, which struggled all day to build on Thursday’s success in making Cohen seem he was lying about the purpose of his calls to Trump in late October 2016. Cohen looked bad admitting he passed $20,000 in cash in a paper bag to Red Finch, a tech firm that uses algorithms to rig online polls. But Trump looked even worse by directing Red Finch to cheat his way onto CNBC’s list of the most famous business leaders of the 20th century. Classic Trump.

Jurors may conclude that the whole bunch of ’em are liars and reasonably doubt every word out of all of their mouths. At this point, that may be Trump’s best hope of avoiding conviction.

When Michael Cohen’s Lies Help the Case Against Trump

Is it possible to use a lie to illuminate the truth? If the lie is told by the serial liar Michael Cohen in the right context, the answer is yes. Credit the prosecution in the Trump felony trial for pulling off this tricky maneuver.

On Monday, we finally got closer to a key factor in this case: campaign finance law. To convict Donald Trump of a felony, the jury must find that he falsified business records (or directed that they be falsified) with “the intent to commit another crime.” Trump need not be found guilty of any of those other crimes — in this case, it could be tax fraud, intervening in an election or violating campaign finance laws — in order to convict him. But he needs to have crime in mind in at least one of those areas.

Late in the morning, Susan Hoffinger — a prosecution lawyer on her game — drew Cohen’s attention to a letter written by his lawyer, Stephen Ryan, after the Stormy Daniels hush-money story broke in The Wall Street Journal in 2018. At that time, Cohen was still in Trump’s camp, telling the world that he had paid the $130,000 to Daniels on his own. In his letter, Ryan wrote, “The payment in question does not constitute a campaign contribution.”

Hoffinger asked, “Was that a true statement?” Cohen, in his new, polite incarnation, replied, “No, ma’am.” This told the jury: Here goes Cohen, lying again. In other words, because Cohen was such a known liar, it is more plausible than not that he was lying when he said the payment was not a campaign contribution, to protect Trump and himself.

After a sidebar, Justice Juan Merchan turned to the jury and repeated instructions he had already given, during direct examination of Cohen, when the subject of his 2018 guilty plea in the criminal case that sent him to jail for 13 months came up: “Mr. Cohen’s guilty plea is not evidence” of Trump’s guilt.

The judge was basically saying to the jury, “I know you may think these two guys both intended to commit this other crime, but you can’t use Cohen’s guilty plea to convict Trump.”

As Norm Eisen, an expert on campaign finance law, told me during a break, “The jury will listen to the judge, but that’s like saying, ‘Don’t look at the elephant.’”

To emphasize the point further, Hoffinger asked, “Did Mr. Trump approve the substance of these false statements by you?” This brought another “Yes, ma’am.”

The prosecution caught another break when Merchan refused to allow Bradley Smith, a Republican and former chair of the Federal Election Commission, to testify about his conservative interpretation of campaign laws. The judge said if he allowed that testimony — which the defense desperately wants — he would have to let the prosecution call an expert witness with his or her opposing interpretation. Merchan concluded that as judge, it was his job — and his job alone — to interpret how campaign finance law should be regarded by the jury.

All in all, this was an unsexy but significant win for the prosecution.

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Nicholas Kristof

Opinion Columnist

Israel’s Denial of Gaza Aid May Lead to an Arrest Warrant

The decision on Monday by the prosecutor of the International Criminal Court to seek arrest warrants for leaders of Hamas and Israel probably will not result in anyone being put on trial immediately for crimes against humanity. But it does further tarnish Israel’s invasion of Gaza, add to the isolation of Prime Minister Benjamin Netanyahu and raise questions about President Biden’s steadfast support for Israel’s war in Gaza.

It’s no surprise that the prosecutor, Karim Khan, is seeking to arrest Hamas leaders for their rampage of murder, rape, torture and kidnapping on Oct. 7, which clearly constituted war crimes. Those protesters making excuses for Hamas should read Khan’s statement and understand Hamas’s brutality.

The allegations against Netanyahu seem to focus on the Israeli government’s decision to throttle aid, including food assistance, to civilians in Gaza and thus cause starvation. The very first allegation listed by the prosecutor against Netanyahu is “Starvation of civilians as a method of warfare.”

That has always seemed to me a part of the Israeli operation in Gaza that is particularly difficult to justify. My view is that Israel absolutely had a right to strike Gaza militarily after the Oct. 7 terrorist attacks, to destroy Hamas leadership and to try to recover hostages. I have argued that the military operation should have been far more restrained, calibrated to target Hamas officials rather than to level entire neighborhoods, but bombing targets in Gaza was not inherently wrong or unlawful.

What has seemed utterly indefensible has been the constraints placed on aid entering the territory, so that Gaza is teetering on the edge of famine — even as trucks filled with food are lined up at Gaza’s border, waiting to enter. That is what seemed to galvanize the International Criminal Court.

A panel of international experts convened by the International Criminal Court unanimously backed the prosecutor. “Parties to an armed conflict must not deliberately impede the delivery of humanitarian relief for civilians, including humanitarian relief provided by third parties,” the experts said.

I’m not an expert in international humanitarian law, so I’ll leave it to others to argue about whether a prosecution of Netanyahu is justified. But the court’s efforts underscore the moral stain of the starvation in Gaza, in which the United States is complicit.

America’s highest-priority response needn’t be a flurry of legal arguments, but instead could involve a far greater effort — using all the leverage we have — to persuade Israel to allow more aid into Gaza and to ensure that the aid is actually delivered to starving children. Whether or not one agrees that starving children is criminal, it is unconscionable. And preventable.

Patrick Healy

Deputy Opinion Editor

The Dangerous Political Headwind Facing Biden

Every Monday morning on The Point, we kick off the week with a tipsheet on the latest in the presidential campaign. Here’s what we’re looking at this week:

All eyes will be on Donald Trump’s criminal trial in Manhattan this week. His lawyers are expected to wrap up their cross-examination of Michael Cohen on Monday, and then will reveal if Trump is going to testify in his own defense before heading to closing arguments, probably on Tuesday. As much as Trump might be tempted to take the stand, he knows very well the lies he has told about Cohen, Stormy Daniels and his business records over the years — lies he could get caught telling under oath. The risk of testifying is enormous for a born liar, and Trump wasn’t born any other way. I don’t see him taking that chance.

For me, this trial has underscored two things: The enthusiasm and loyalty that the Trump base feels for their man, and the dangerous political dynamic that President Biden faces this year. That dynamic, as I see it, is this: Many Americans want change, and while they may respect Joe Biden, they don’t want Joe Biden anymore. Even the Trump criminal trial hasn’t been enough to make Biden look good by comparison, if the latest polls are any measure. My colleague Ezra Klein has a great new column about why this may be , but whatever the reason, the Biden campaign has big choices to make.

The biggest choice to me: His campaign has been focused on getting people to respect Biden — by portraying him as a defender of democracy, a champion of a normal America, a trusted ally to the less fortunate, a more decent man than Trump — rather than on making people want the Biden presidency to continue. He gave a good speech Sunday at Morehouse College in Atlanta about manhood and faith, but given his weak polling in that battleground state, I was surprised he didn’t make a stronger case for why people should want him in office for another four years.

He then headed to another battleground, Michigan, where he is also struggling in the polls. Based on his speech at an N.A.A.C.P. dinner there, I’m sure there was a lot of respect for him in the room, but what’s he doing that’s new or especially persuasive to make more Black voters and others want him for another four years?

On Tuesday, Biden heads to New Hampshire, another traditional battleground where he is polling strongly. As Trump gets closer to a verdict on that day, I’ll be watching New Hampshire to see if Biden and his team demonstrate any new thinking to make the case for why Americans should want another four years of his presidency.

Farah Stockman

Editorial Board Member

A Close Setback for Labor in the South

The United Automobile Workers union fell short in its bid to unionize two Mercedes plants in Alabama on Friday but accomplished something historic nonetheless. Simply having the election — and getting close to passing — was a victory in itself, given what union organizers were up against. (The vote was 2,045 to 2,642.)

People in power — from the governor of Alabama to a Tuscaloosa city councilor — spoke out against organized labor as antithetical to the state’s best interests. Mercedes has been blasting anti-union emails and videos to workers for weeks and requiring workers to attend information sessions about the bad stuff that can happen when a plant unionizes. (The U.A.W. has accused the company of unfair labor practices.)

My cousin works in the Mercedes plant and has been forwarding the videos that the company has been sending around. It’s clear that Mercedes pulled out all the stops to get workers to reject the union. But it is also clear that workers saw firsthand what labor solidarity can do. Just the threat of the union coming into the plant prompted the company to give him a $2 raise to $34 an hour.

“All the stuff started blowing about the union, and Mercedes done gave us a raise,” he told me. (I’m withholding his name to avoid any trouble for him.) He also got a new quarterly bonus, based on sales. “Like they are trying to correct what they should have done a long time ago.”

He said that union organizers have popped up at the plant every few years since the 1990s and that he attended a meeting once. But it never came to a vote. This time, a recent ruling by the Biden administration’s labor-friendly National Labor Relations Board made it far easier for the U.A.W. to bring an election to the factory floor.

That ruling helped Volkswagen workers in Chattanooga, Tenn., join the U.A.W. That plant was the first nonunion auto plant in a Southern state to vote to join a union, after the U.A.W.’s president, Shawn Fain, announced an audacious campaign to unionize auto plants in the South.

My cousin said he initially wasn’t sure which way he’d vote, but he cast a ballot for unionization. He liked working for Mercedes but recalled times he wasn’t treated with respect, such as how he was treated after a white woman he worked next to falsely accused him of brushing up against her on the assembly line.

After the vote, he expressed disappointment but said he hoped the union would try again.

“This is the first time it ever got this far,” he said. “We made history.”

Zeynep Tufekci

North Carolina Says Yes to Clowns and No to Cancer Patients

It seems that police officers in North Carolina will soon be allowed to penalize cancer patients for wearing a medical mask in a grocery store.

Since 1953, North Carolina has had a law on the books banning masks in public in order to hamper secret societies like the Ku Klux Klan, and ever since the Covid-19 pandemic, that law has had an exemption for people wearing masks for health and safety reasons.

But the way things are going, that exemption may not exist for much longer.

“Individuals would no longer be able to wear masks in public for health or safety reasons,” reads North Carolina’s House Bill 237, which was passed by the Republican-controlled State Senate in a vote along party lines on Wednesday . (Republicans have said the bill is designed to target masked protesters.) Because the bill was amended by the Senate, it has since been sent back to the Republican-controlled State House of Representatives for reapproval, where it will probably pass.

It is unlikely that even a veto by the state’s Democratic governor, Roy Cooper, would stop this bill from becoming law. After the 2022 elections, Republicans were a single seat short of a supermajority in the General Assembly. When State Representative Tricia Cotham became a Republican, she handed the party enough votes to override the governor’s vetoes.

The bill is titled Unmasking Mobs and Criminals, and it still allows some exceptions to the mask ban: for a “secret society or organization to wear masks or hoods in a parade or demonstration if they obtain permission” or “by a person wearing a traditional holiday costume in season.” The bill would allow clowns to keep wearing masks, too, as part of an exception for professional activities.

So secret societies are fine, Halloween is fine, and clowns are fine — just not cancer patients, other immunocompromised individuals or any other people concerned with protecting their health.

Jesse Wegman

Alito’s Inverted Flag Epitomizes the Ethics Crisis at the Court

Thanks to Supreme Court Justice Samuel Alito’s neighbors, Jodi Kantor of The Times was able to report a shocking bit of news on Thursday: In January 2021, shortly after the deadly Capitol assault incited by Donald Trump, Alito’s front yard openly displayed an upside-down American flag — an unmistakable pro-Trump symbol used by those who believed the 2020 election was stolen.

But wait: It turns out this wasn’t Alito’s fault. “I had no involvement whatsoever in the flying of the flag,” he told The Times, explaining that the flag was “briefly placed” there by his wife, Martha-Ann, in an escalation of a neighborhood spat that included “objectionable and personally insulting language” on yard signs.

For a guy who earns his paycheck evaluating the quality of arguments, Justice Alito is remarkably bad at coming up with ones in his own defense. Even if he had no role in raising the flag, what stopped him from taking it down immediately and apologizing profusely for his wife’s intemperance? Doesn’t his failure to do so suggest tacit agreement if not outright support — not only for a violent insurrection based on a demonstrable lie but also for one of the litigants who was at that time before his court arguing over the election?

This disregard for the appearance of bias is in line with how Alito and Justice Clarence Thomas, in particular, have long approached their job and the enormous power they wield. (You may recall that Thomas’s wife, Ginni, cosplayed as a legal insurrectionist who tried to overturn the 2020 election.) That disregard extends to the institution of the Supreme Court and to the American people forced to live under its edicts. How are we expected to respect a court that has so little respect for us?

Yes, other justices have revealed their political biases over the years. In 2016 the Times editorial board called out Justice Ruth Bader Ginsburg for referring to Trump as a “faker,” comments for which she quickly expressed regret . I’m not holding my breath for any comparable avowal of humility from Alito, who is well known for his self-righteousness.

Nor do I expect him or Justice Thomas to recuse themselves from the continuing cases related to Jan. 6, including the one about Trump’s immunity from prosecution for that day, which the court has prevented from moving forward for months. By any reasonable ethical standard, they should recuse themselves, and they would be required to do so if the Supreme Court were bound by any meaningful ethical standards . Any lower-level federal employee would probably fail a security screening for being connected to a flag-flying stunt like this.

The integrity of the court may be beyond repair, but you still have to wonder, are Thomas and Alito trying to get themselves impeached?

Spencer Cohen

Opinion Editorial Assistant

Iran’s Nuclear Expansion Remains a Threat to the Middle East

Will Iran go for the Bomb?

That question looms over the volatility in the Middle East, particularly after the tit-for-tat attacks last month by Israel and Iran , which ended after an Israeli airstrike damaged an S-300 system, used by Iran to protect its nuclear sites.

Last week, Rafael Grossi, head of the International Atomic Energy Agency, traveled to Iran to meet with senior officials. Iran has enriched uranium to near weapons grade and barred Grossi from its centrifuge plant under construction deep underground in Natanz . After the trip, he told reporters that Iranian officials are ready to engage in “concrete measures” that appear to be based on a deal hashed out last year that expanded cooperation and monitoring. But he gave few specifics.

Behind the opaque diplomacy, there are worrying signs.

Iran is rapidly advancing its nuclear program, seemingly teetering on the edge of weaponization, as oversight by the international community is falling away. “We are moving closer to a situation where there is a big, huge question mark about what they are doing and why they are doing it,” Grossi told The Guardian this week.

Iran is not currently working toward building a nuclear weapon, according to a recent U.S. intelligence assessment . But this month a senior Iranian official declared that the country could change its nuclear doctrine, moving the program away from solely peaceful purposes, if seriously threatened (the Iranian Foreign Ministry has walked back similar statements). Safeguards put in place after the 2015 deal to limit Iran’s nuclear program are now all but gone following the U.S. withdrawal from the agreement in 2018, and the I.A.E.A. is increasingly flying blind.

In February, an I.A.E.A. report said the agency has lost what it calls “continuity of knowledge” in key areas of the program, all while Iran has expanded its overall stockpile of enriched uranium and effectively blocked several of the agency’s inspectors. It has also removed monitoring equipment, which the report said “had detrimental implications for the agency’s ability to provide assurance of the peaceful nature of Iran’s nuclear program.”

If Iran does make the leap, it will probably need a week or two to enrich enough weapons-grade uranium for at least one weapon. It may be a bit longer, only six months by one estimate , for Iran to have a crude nuclear device.

A nuclear-armed Iran would be a mortal threat to Israel and would probably further destabilize the Middle East. It could also set off a chain reaction: Saudi Arabia has threatened to go nuclear if Iran does, which could push the region further into an arms race.

Finding an Opening, Trump’s Team Catches Michael Cohen Unawares

If Donald Trump beats the rap in his felony trial, he might be able to thank a 14-year-old prank caller, backed by some bad staff work at the Manhattan district attorney’s office.

This was one of those peculiar tales that can sink cases, because if it undermines the credibility of the prosecution’s key witness with just a single juror, we could see a hung jury.

All morning, Todd Blanche, Trump’s lead defense attorney, was barking up mostly fruitless trees. When cross-examining the key witness, Michael Cohen, he scored a few points by making Cohen seem as if he had a personal vendetta against Trump, and he dinged him for stupidly claiming that Judge William Pauley — who earlier sentenced him to prison — was in some kind of conspiracy against him. But Blanche’s inexperience kept him from gaining the rhythm to truly nail Cohen.

Then, about 20 minutes before lunch, Blanche hit pay dirt.

On Tuesday, Cohen had testified that on Oct. 24, 2016 — just a couple of weeks before the election — he called Trump to discuss the Stormy Daniels matter and to tell him that he would move forward to pay the hush money. The call lasted for a minute and 36 seconds.

Unfortunately for the prosecution, the update on Daniels was not the only purpose of the call.

That week, Cohen felt victimized by harassing calls from a phone number that hadn’t blocked him. He called the number and found that the prank caller was only 14 years old. Cohen told the boy’s parents what their son had done. But he didn’t stop there. He wanted to connect to the Secret Service, which was traveling with Trump on the campaign trail. Cohen texted Keith Schiller, Trump’s bodyguard, who texted him to call and discuss the harassment.

The D.A.’s office didn’t review those texts with Cohen before he testified. This gave Blanche a chance to blindside him, which is never good for a witness.

“You talked to Keith Schiller about what you just went through” with the harassing calls, Blanche charged, his voice rising. “You can admit it!”

Cohen said he believed the call was about the hush money.

“We’re not asking what you believed!” Blanche shouted. “This jury doesn’t want to hear what you think happened.” The prosecution’s objection was sustained but the damage had been done.

Cohen then said he talked to Schiller and Trump about both the harassment and the hush money deal, and he can emphasize the point when prosecutors get a chance to question him again.

Fortunately for the prosecution, we’ve heard about several calls where Cohen discussed hush money with Trump. The most critical one — which Cohen taped — has Trump mentioning the $150,000 promised to a former Playboy model, Karen McDougal. After lunch, Blanche tried and failed to crack Cohen on that critical call.

Even so, I saw Trump smiling as he whispered to one of his lawyers. It was a good day for him.

Trump Is the Nostalgia-Protest-Change Candidate. Can Biden Beat That?

After 90 minutes of talking to a dozen women who voted for Donald Trump in 2020, as part of our latest Times Opinion focus group , I was reminded of something my colleague Michelle Cottle wrote in November : Trump is tapping into the desire of many voters for nostalgia (e.g., the Trump-era economy), protest (President Biden is doing things wrong) and change (new policies on the economy and the border).

Our 12 focus group members didn’t think Trump was perfect — and in that respect they echoed the latest New York Times/Siena poll , where voters also were critical of Trump, yet gave him a lead over Biden in five swing states. But it’s crystal clear at this point that a lot of Americans credit Trump as a better steward of the economy, and they just don’t see evidence that Biden will change things up enough to attack inflation and interest rates.

The nostalgia for the Trump economy, the protest against Biden’s belief that he has earned a second term, and the desire to change the picture on inflation and the border are adding up to a powerful combination. Think what you will of Trump, but a lot of voters agree with something my colleague Kristen Soltis Anderson wrote in December about the former president:

Much of his candidacy and message so far is aimed at arguing that he can restore a prepandemic order and a sense of security in an unstable world. And unlike 2020, there’s no guarantee most voters will see President Biden as the safer bet between the two men to bring order back to America — in no small part because Mr. Biden was elected to do so and hasn’t delivered.

What Biden needs now more than anything is to pierce that nostalgia bubble that’s enveloping and protecting Trump while making the case to voters that he has delivered, and will continue to do so. That’s why I think Biden on Wednesday made the most radical of moves for an institutionalist like himself and proposed a June debate with Trump, far earlier than normal, which seems like it will happen for now. There’s only one reason any candidate would do such a thing: Because he thought he needed it.

Trump needs it, too. It’s historically very hard to knock off an incumbent president, and he knows he has to do more to make it happen. Being the nostalgia-protest-change candidate may be enough for Trump to win in the end, but in America, re-election is still the incumbent president’s to lose. Biden told the political world on Wednesday that he’s willing to take a big risk, even a bad or embarrassing debate, to save his job.

Serge Schmemann

Silencing Independent Voices Is Not the Way to Join the West

In Tbilisi, Georgia, the country’s parliament passed a “foreign agent” bill on Tuesday that, according to the ruling Georgian Dream party, will increase transparency on foreign funding of nongovernmental groups and media outlets.

But the thousands of Georgians who have been demonstrating in the streets since the measure was first introduced don’t agree with that description. Nor does the Biden administration, nor the European Union. They see the bill for what it is: a repressive measure intended to silence independent NGOs and media and move Georgia closer to the Kremlin’s orbit.

The law is modeled on one Russia enacted in 2012, which the Kremlin has used to smear or silence anyone challenging the government. The Georgian variant — widely known as the “Russian law” — would require organizations getting more than a fifth of their funding from abroad to register as “bearing the interests of a foreign power” or face stiff fines. The law was first introduced last year and withdrawn under heavy protest; this year the protests failed to dissuade the ruling party. Georgia’s largely ceremonial president, Salome Zourabichvili, says she will veto it, but Georgian Dream has enough votes to override her.

Why is the ruling party doing this?

One reason is the national elections set for October: Tamping down the opposition and the independent press will help Georgian Dream stay in power, which it’s held since 2012. The party has demonstrated distinctly authoritarian ambitions.

The more worrisome possibility is that Georgian Dream, the creation of the richest man in Georgia, Bidzina Ivanishvili, wants to get on the right side of Russia. Ivanishvili, who was prime minister from 2012 to 2013 and still wields considerable power behind the scenes, initially took a robust anti-Moscow stance, but that has been changing, especially since Russia invaded Ukraine.

The ruling party maintains that it is still keen on joining the European Union, which formally granted Georgia candidate status in December. The party has little choice, given that the overwhelming majority of Georgians are in favor of moving westward. But the party’s actions and words have pointed the other way, either out of fear of Russia — not irrational, given that Russia invaded Georgia in 2008 — or for gain, or to keep the party in power.

The United States and the European Union have made no secret of their alarm and annoyance. A State Department statement condemned the “foreign influence” legislation, warning that the law and Georgian Dream’s anti-Western rhetoric “put Georgia on a precarious trajectory.” A U.S. official warned that Washington may slap some financial and travel restrictions on some Georgian officials. It may not be too late.

Paul Krugman

Is Disinflation Back on Track?

The latest news on inflation has been pretty good. It has also been extremely weird. And that weirdness is, in a way, the message.

With underlying inflation fairly low but probably still above the Fed’s 2 percent target and people still worried that it might go back up, quirky measurement issues can lead to big mood swings that are quickly reversed when the next numbers come in — or sometimes even a few hours after the initial announcement, once knowledgeable people have had some time to dig into the details.

There were two big official inflation reports in the past couple of days: the Producer Price Index (what we used to call wholesale prices) on Tuesday and the Consumer Price Index on Wednesday morning . There was also a private survey from the National Federation of Independent Business that may add some clarity.

So what do I mean by “weirdness”? On Tuesday I was busy most of the day with plumbers and dentists, so I was able to check in on events and commentary only once in a while. But this enforced limitation on the information flow might actually have given me more perspective. The first thing I saw was a hot P.P.I., with inflation coming in well above expectations. There was much wailing and rending of garments. Then, as the analysts I follow had time to parse the details, they started to declare that this was actually a good report.

Financial markets seemed to agree. One quick and dirty way to judge how markets view inflation data is to look at the yield on two-year U.S. Treasuries, which largely reflects what people think the Fed is going to do. If inflation looks hot, they expect the Fed to keep rates high and maybe even increase them; if it looks cool, they expect the opposite.

And if you look at two-year yields over the past few days, you see the market reaction matching my sense of the commentary:

Yields spiked when the P.P.I. report was released, then fell back once there was time to dig into the numbers, ending the day lower than they started.

On the other hand, markets from the get-go liked the C.P.I., which seemed to show inflation resuming its downward trend, with yields falling sharply. But as I write, analysts are still digging into the details. Will they be less optimistic by evening? Probably not: Early commentary seems, if anything, to be saying that the numbers were even better than they first appeared. But after yesterday, I’m going to wait and see.

I also mentioned the survey from the N.F.I.B., which represents small and medium businesses. One question it asks is whether businesses are planning to raise or lower prices over the next three months; the percentage difference from current numbers is often a useful indicator of inflation trends. And that spread is currently close to what it was before the pandemic, although slightly higher:

So my best guess? The acceleration in measured inflation over the past few months was probably a statistical illusion; inflation wasn’t as low as it seemed in late 2023 but probably hasn’t risen much, if at all. Underlying annual inflation is probably around 2.5 percent, maybe even less. So my guess is that we’ve already won this war — that we have basically achieved a soft landing, with low unemployment and acceptably low inflation.

But I could be wrong, and even if I’m right, it’s going to take at least a few more months of good inflation news before this happy reality sinks in.

Frank Bruni

Biden’s Daring Debate Proposal Could Recharge His Campaign

I’ve been waiting and hoping — no, I’ve been desperate — for President Biden to do two things. One, boldly project strength. Two, recognize that he cannot coast to re-election and that he needs to shake up the state of the presidential race.

With his offer on Wednesday to debate Donald Trump at least twice before the election and as early as next month, he has done just that.

The Biden campaign’s proposal came with the condition that the debates be in a television studio and there be no audience present to hoot, holler and otherwise interrupt. Trump subsequently indicated that he was onboard, though it wasn’t clear if he would agree to Biden’s terms.

By emphasizing debates and suggesting that they start soon, Biden is taking a risk. But it’s a necessary one. Trump and his supporters lean hard on the charge that Biden is too rickety — in terms of both energy and intellect — to face off against Trump, and they have sold that idea skillfully and mercilessly, with the help of right-wing news organizations that portray Biden as a doddering wreck. It’s selective and often malicious stuff, but that doesn’t mean that Biden can ignore it. He must refute it. Signaling an eagerness to debate is the crucial first step.

The next one is performing well in those debates, should they happen, and that’s where the risk comes in. Some Democrats who’ve spent time with Biden over the past year privately express concerns about his sharpness and stamina, and a debate is less scripted — and arguably more draining — than a State of the Union speech read from a teleprompter. But a reluctance or refusal to debate could be as damaging to Biden as half a dozen terrible moments at the lectern.

Besides which, Trump could have scores of such moments, to go by his bizarro stump speeches of late. That’s where the rewards that Biden could reap come in. Do I think that he will turn in debate performances for the ages? No. Do I think that Trump will have a harder time insisting on Biden’s wobbliness if he has demonstrated his own profound unsteadiness on the same stage where Biden is standing, with plenty of swing voters watching? Yes.

I also think that it’s past time for Biden to pivot from caution to daring. Maybe that pivot is finally here.

Putin’s Defense Shake-Up Is a Danger for Ukraine

With Vladimir Putin’s revival of Soviet-style centralized and secretive rule, the old art of Kremlinology is making a comeback. It’s not quite the same as when the lineup atop Lenin’s mausoleum on May Day was scrutinized for signs of who was on the way up or down, but Putin’s abrupt replacement of the long-serving Sergei Shoigu as defense minister last Sunday was still a distinct blast from that dismal past.

Technically, Shoigu was kicked upstairs, to head up the national security council. Putin is not given to publicly punishing loyal courtiers, and Shoigu was about as loyal as they come, even going fishing and hunting with the boss. Still, Kremlin-watchers have long expected his ouster, given the sloppiness of the Russian invasion of Ukraine, the widespread corruption in the military-industrial complex, and Shoigu’s reported unpopularity with the generals. There was also the dramatic rebellion of the mercenary commander Yevgeny Prigozhin, who marched on Moscow last June demanding Shoigu’s head (only to lose his own in a plane crash broadly presumed to have been an assassination).

So, very briefly, here are the questions and speculation now keeping Kremlinologists busy:

Shoigu’s replacement at the Defense Ministry is Andrei Belousov, a senior Kremlin economist. That he is not a military man is not surprising; neither was Shoigu, a former construction foreman, nor his two predecessors. Military matters are handled by the generals of the General Staff; the defense minister looks after the military-industrial base. The thinking is that Belousov’s task will be to manage the rapid growth in Russia’s military spending and to clean up the corruption that is siphoning off huge amounts of the money earmarked for the Ukraine war.

How long Shoigu will be allowed to survive remains an open question. One of his top deputies, Timur Ivanov, was arrested on bribery charges in April. One of Ivanov’s nicknames was “Shoigu’s wallet.” And on Tuesday morning, government investigators announced that a senior general on the General Staff, Lt. Gen. Yuri Kuznetsov, had been detained on suspicion of “large-scale” bribe-taking.

A big question is what happens to Nikolai Patrushev, who is being displaced by Shoigu at the helm of the Russian security council. Patrushev, like Putin a former K.G.B. official, is among the oldest and closest members of Putin’s ruling clique, and among the most hawkish. Where he lands — or fails to land — will say a lot about where Putin is headed.

On balance, the musical chairs point to a major overhaul of the military as Russia moves toward what is basically a war economy. Russia is making incremental but steady advances in Ukraine, albeit at an astounding cost in casualties and armaments. Putin’s plan is to press on at any cost, squeezing Ukraine and its ever more reluctant Western backers, and keeping China on board as a major supplier. None of that bodes well for Ukraine.

Where’s the Devastating Takedown of Michael Cohen That Trump Needs?

For months, we’ve known that the cross-examination of Michael Cohen would be the decisive moment of Donald Trump’s New York felony trial — the day we learned whether his defense team could plant reasonable doubt in the minds of jurors.

On Tuesday it became clear that the team was struggling with its most important task.

Todd Blanche, Trump’s lead defense lawyer, was like a baseball pitcher assigned to start Game 7 of the World Series after only two or three wins in his major-league career. Though a seasoned former federal prosecutor, he has little experience as a defense attorney — and it showed.

We’re only about a third of the way through Blanche’s cross, but so far, he’s too meandering and pleasant for the sharp-toned, rat-a-tat style necessary for the role.

Blanche spent more than an hour showing that Cohen, like Stormy Daniels last week, despises Trump, and this line of inquiry was entertaining if not informative. When he quoted Cohen calling Trump a “boorish cartoon misogynist,” Cohen wielded the same mild and effective rejoinder he used twice earlier: “Sounds like something I would say.” My kids would like to see me in that T-shirt.

Blanche spent a long time depicting Cohen as a publicity hound cashing in on his decision to flip on Trump. Guilty as charged. But Cohen’s unwise decision to make sport of Trump in an orange jumpsuit (and worse) earlier in the trial, while angering both the prosecution and defense, doesn’t relate to the falsification of business records at issue in the case. And Cohen made it clear that he was merely responding in kind to Trump’s childish posts, a few of which jurors have seen more than once. All told, an annoying waste of the jury’s time.

Blanche had trouble finding a rhythm. For instance, he asked Cohen if he had appeared on MSNBC shows anchored by Ali Velshi and Joy Reid. When Cohen said yes, Blanche had no follow-up.

But his real problem is that he has so little to work with. Cohen delivered devastating direct testimony all day Monday and again Tuesday morning, and he has been careful and low-key on cross.

Instead of attacking the prosecution’s case head-on, Blanche has been handcuffed by a client nursing a perverse desire to see Cohen’s insults — and his own — aired in open court.

At around 4 p.m. Tuesday, shortly before court adjourned for the day, Blanche began delving into why other prosecutors have passed on this case. That could be promising for him. But after all the runs the prosecution has already scored, he’ll have to strike Cohen out with the bases loaded to get back into the game.

Michelle Goldberg

Top Republicans Come Face to Face With Trump’s Seamy Past

On a day when Michael Cohen, Donald Trump’s former fixer, testified about the price of loyalty to Trump, a group of Republicans, including House Speaker Mike Johnson, Gov. Doug Burgum of North Dakota and Vivek Ramaswamy, a former presidential candidate, showed up at the courthouse to demonstrate their loyalty to Trump.

Sitting in the courtroom on Tuesday on my first day at the trial, I kept wondering what they were thinking as they heard Cohen, seeming every bit the weary, reluctantly reformed TV gangster, testify about his mafia-like interactions with Trumpworld.

He described how, after his home and office were raided by the F.B.I., Trump encouraged him, both through a “really sketchy” lawyer and through his own Twitter posts, to, in Cohen’s words, “Stay in the fold, stay loyal, don’t flip.” He described how once he decided “not to lie for President Trump any longer,” the then-president publicly attacked him.

Cohen now seems like a man whose life has been essentially wrecked — he went to prison, lost his law license, had to sell his New York and Chicago taxi medallions and is still on supervised release. Though his implosion has been particularly severe, he is far from alone; many people who’ve served Trump, no matter how faithfully, have been ruined in various ways by the experience.

Nevertheless, as Trump runs for re-election, Republicans are climbing over one another to get as close to him as possible. Toward the end of his testimony for the prosecution, Cohen was asked about his regrets.

“To keep the loyalty and to do things that he had asked me to do, I violated my moral compass, and I suffered the penalty,” he said. I’d like to know if Johnson, hearing this, had even a flicker of foreboding.

The Increase in Drowning Deaths Should Be a National Priority

Drowning deaths in the United States rose by more than 12 percent to an estimated 4,500 per year during the pandemic, according to grim new data from the Centers for Disease Control and Prevention. The increase, from 4,000 per year in 2019, comes as this long-neglected public health crisis is slowly beginning to draw some attention from government policymakers.

“It’s moving in the wrong direction,” the C.D.C. director, Dr. Mandy Cohen, told The Times. The agency said more than half of Americans had never taken a swimming lesson.

The sobering data is an opportunity for President Biden and health officials to finally make drowning prevention a national priority.

Drowning is the leading cause of death for children ages 1 to 4 in the United States and the second leading cause of death by accidental injury for children 5 to 14. Tackling the issue has clear bipartisan appeal and would improve quality of life in every American community.

Despite the obvious need for action, federal, state and local governments in the United States have invested very little to prevent these deaths.

The rise in deaths has caught the eye of former New York City Mayor Michael Bloomberg, whose philanthropy told The Times this week it plans for the first time to direct millions of dollars to drowning prevention efforts within the United States to improve data collection and help fund swimming lessons in 10 states where drowning rates are highest: Alaska, Arizona, California, Florida, Georgia, Louisiana, Michigan, New York, Oklahoma and Texas.

The planned $17.6 million investment by Bloomberg Philanthropies is modest compared with the $104 million it is spending globally on preventing drownings. But the focus by Bloomberg, whose prominent public health campaigns helped ban smoking in bars and restaurants in New York, could help raise the profile of this issue. Executives at the philanthropy said they planned to work with the C.D.C.

Many Americans of even wealthy backgrounds have lost children to drowning. But drowning is also an issue of equity. Black people and Native Americans are at substantially increased risk of drowning. So are teenage boys. The C.D.C. report found that these trends have continued. In 2020, they said, Black Americans saw the greatest increase in fatal drownings.

Red Cross surveys suggest that a majority of Americans lack basic swimming abilities. With C.D.C. data showing the existence of more than 10 million private pools in the United States and fewer than 309,000 public ones, it’s clear that large numbers of Americans lack access to basic information about water safety, as well as safe places to learn to swim. Instead of a public health issue, drowning is treated as a private matter and swimming as a luxury. To save lives, this needs to change.

David Brooks

Why Trump Is Ahead in So Many Swing States

What do American voters want? The latest New York Times/Siena polls of swing states offer some confusing evidence on this point. Some of the polling results suggest that Americans are in a revolutionary frame of mind: Asked whether the political and economic systems need major changes, 69 percent of respondents said those systems need major changes or should be entirely torn down.

On the other hand, when the pollsters gave voters a choice between a candidate who would bring the country back to normal and one who would bring major changes, 51 percent said they would prefer the back-to-normal candidate and only 40 percent would prefer the major-changes candidate.

So which is it? Is 2024 a change election in which people want someone who will shake things up, or is this a stability election in which people are going to vote for the candidate of order over the candidate of chaos?

Well, different voters want different things. But if I had to write a single sentence that reconciled these diverse findings, it would be this: The people who run America’s systems have led the country seriously astray; we need a president who will shake things up and lead the country back to normal.

When they hear “systems,” I assume voters are thinking of the network of institutions run by America’s elite — corporations, governing agencies, higher education, the news media and so on. If voters believe one thing about Donald Trump it’s that he’s against these systems and these systems are against him.

Voters clearly see President Biden implicated in these systems. The heart of his problem heaves into view when people are asked which candidate will bring about change. Seventy percent of voters said that Trump would bring about major changes or tear down the system entirely if elected. And 71 percent of voters said that little or nothing would change if Biden was re-elected.

In other words, the evidence suggests that the swing voter wants reactionary change, not revolutionary change. The mood suggested by the evidence is angry nostalgia. That would be my explanation for why Trump is so convincingly ahead in most of the swing states.

Trump Told Cohen Disclosure of His Fling Would Be a ‘Total Disaster’

When Michael Cohen took the stand for the first time in Donald Trump’s hush-money trial on Monday morning, he almost accidentally sat down without taking the oath. But after he raised his hand and swore to tell the truth, he seemed to do so.

In dry language, with his impulse-control problems nowhere in sight, he landed blow after blow on the former president.

Cohen, Trump’s former lawyer and fixer, is willing to look like a stooge — pathetically eager for any praise from the boss — to implant in jurors’ minds that even in the absence of incriminating emails, he should be believed because of all the time he spent looking for Brownie points from Trump. When he did so, he was implicating Trump.

Cohen’s testimony about the Playboy model Karen McDougal, who says she had a nine-month affair with Trump, is important beyond Trump describing her to Cohen as “beautiful.” It cemented Trump’s attention to detail, which we’ve heard a lot about already. He constantly asked for updates on the hush money that American Media Inc., publisher of The National Enquirer, was paying at his direction to McDougal, replying, “Great!” or “Fantastic,” when Cohen delivered them.

Cohen’s tape of Trump discussing that deal landed hard when it was played, and not just because it was Trump’s voice talking about “150” — a clear reference to the $150,000 in hush money that Trump — through Cohen and A.M.I. — was originally going to pay McDougal. Trump’s micromanaging, which we’ve heard about for two weeks, came to life in a way that didn’t help him. And when Cohen dissected practically every moment of the call, there was no mistaking the meaning of the brief conversation.

When Cohen told Trump that Stormy Daniels was shopping her story, “Trump was really angry with me,” he said. Trump told Cohen: “‘I thought you had this under control, I thought you took care of this! … Just take care of it!’”

According to Cohen, Trump thought he would surely lose the 2016 election if the Daniels story came out. He testified that Trump said, “This is a disaster, a total disaster. Women will hate me,” and added that “guys, they think it’s cool” to have sex with a porn star, “but this is going to be a disaster for the campaign.” In combination with the fallout from the “Access Hollywood” tapes, they agreed, it would send his already low polling with women into a tailspin.

“Get control of it!” Trump barked, Cohen testified. “Just get past the election. If I win, it’ll have no relevance when I’m president. And if I lose, I don’t really care.”

Here the prosecutor, Susan Hoffinger, asked if Cohen inquired about Melania Trump. He said yes, and said Trump responded: “Don’t worry. How long do you think I’ll be on the market for? Not long.”

Wow. With Trump, every time you think he’s touched bottom, he crashes through the floor. Here he was already looking ahead to his third divorce.

Cohen is doing very well on direct examination. The test will come Tuesday afternoon, when cross-examination is likely to begin.

Israel Needs to Allow More Aid Crossings to Keep Gazans Alive

An already unbearable situation in Gaza is getting far worse, as hundreds of thousands of desperate Palestinian families flee an Israeli ground operation in Rafah, in southern Gaza. Aid groups say the so-called humanitarian zone near the sea, where people are being told to move, doesn’t have enough shelter, food, water or sanitation to support the people who are already there. Without a significant infusion of new aid, this place is at risk of total famine and social chaos.

One glimmer of good news came on Sunday, when Israel opened the Western Erez crossing in northern Gaza. But virtually no aid has got through to southern Gaza for nearly a week, aid groups say. The reality is that the Gaza Strip needs many, many more crossings.

“If you have only one entry point in, then it becomes extremely valuable, and every adverse actor can disrupt it for their own gain,” Dave Harden, a former U.S.A.I.D. mission director in the West Bank and Gaza, told me.

If there were a dozen access points, spread across every two or three kilometers, then no single crossing would become a choke point, vulnerable to attack. He said there’s no reason that Israel, which controls the security envelope around Gaza, could not open far more checkpoints.

“People complain that Hamas is stealing aid, but there would be no incentive to steal if there was enough food going in,” said Harden, adding that he shared a plan to open more than half a dozen more border crossings in Gaza with a branch of the Israeli military about six weeks ago.

But since then, the opposite has occurred. The main artery for humanitarian aid, Kerem Shalom, was shut down on May 5 after a Hamas rocket attack killed four Israeli soldiers. Then Israel seized the border crossing at Rafah , gaining full control over the vital entry and exit point for people and goods for the first time since 2005. Israeli officials have blamed Egypt for the halt in humanitarian goods through Rafah since last week. But for months aid groups have cited the onerous inspections of aid convoys, Israeli attacks on aid workers and protests by right-wing Israeli settlers who have destroyed or delayed truckloads of aid as the cause of famine in Gaza.

“The situation is absolutely desperate,” Sean Carroll, who leads Anera, an American aid organization that has operated in Gaza for decades, wrote in an email on Monday. His staff members have been forced to evacuate Rafah at a moment’s notice, just like the rest of the population, and were forced to leave vital supplies in a warehouse behind.

“They are trying to keep delivering but there’s not much to deliver,” he told me.

Believe It, Democrats. Biden Could Lose.

Donald Trump may be the presidential candidate whose midday snoozing has generated headlines and animated late-night comics, but President Biden is the one who needs to wake up.

He’s a whopping 12 points behind Trump among registered voters in Nevada, according to polls by The New York Times, Siena College and The Philadelphia Inquirer that were released on Monday morning. Biden won that state by nearly 2.5 points in 2020. He’s behind among registered voters in Arizona, Pennsylvania, Georgia, Michigan — in all of the six battleground states surveyed except Wisconsin. That’s not some wildly aberrant result. It echoes alarms sounded before. It speaks to stubborn troubles.

And it’s difficult for Democrats to believe. I know: I talk regularly with party leaders and party strategists and I’ve heard their incredulity. They mention abortion and how that should help Biden mightily. They mention the miserable optics of a certain Manhattan courtroom and a certain slouched defendant. They mention Jan. 6, 2021. They note Trump’s unhinged rants and autocratic musings and they say that surely, when the moment of decision arrives, a crucial share of Americans will note all of that, too, and come home to Biden.

From their lips to God’s ear. But with stakes this huge, I can’t help worrying that such hopefulness verges on magical thinking and is midwife to a confidence, even a complacency, that Biden cannot afford. He needs to step things up — to defend his record more vigorously, make the case for his second term more concretely, project more strength and more effectively communicate the most important difference between him and his opponent: Biden genuinely loves America, while Trump genuinely loves only himself.

The new polling shows that Democratic senators up for re-election are doing better than Biden , so his party affiliation isn’t his doom. That’s the lesson, too, of the favor enjoyed by Democratic governors in red and purple states . Look, for prime example, at Josh Shapiro in Pennsylvania .

But Biden seems to get the blame for the war in Gaza. For the high cost of living, too. Regarding the economy, he has a story to tell — infrastructure investment, the CHIPS Act, low unemployment — and must tell it better, with an eye not on his liberal base, but on the minorities and young people who are drifting away from him. That’s the moral of the latest numbers: Take no voter for granted. And there’s not a second to waste.

Will Michael Cohen Throw Cold Water on Trump’s Polling Lead?

The next two weeks are critical for Donald Trump. He is leading President Biden in most polls in Arizona, Georgia, Pennsylvania and other swing states that will decide the 2024 election. But on Monday, the star witness in Trump’s criminal trial — Michael Cohen, his former lawyer — will begin telling a Manhattan jury that he gave $130,000 to the porn star Stormy Daniels in exchange for her silence about a sexual encounter with Trump. And based on the pace of the trial, the case could go to the jury as soon as next week.

Cohen is the linchpin to any conviction, acquittal or hung jury for Trump. More than any other witness in the case, he will put words in Trump’s mouth for jurors — telling them how the former president directed the payment to Daniels. Expect the cross-examination to be withering, but in the end, Trump’s lawyers may be hard-pressed to contain or thwart the damaging Cohen testimony without strong witnesses who can rebut it.

The trial matters because some voters say a conviction could change their thinking about Trump — a man who for years has shaken off scandals like Teflon. Failure to convict, in turn, could boost the martyr message that he’s been campaigning on at rallies like his big one in New Jersey on Saturday.

I just did a focus group with Trump voters from 2020 about how they see him now, which will be published on Tuesday. Most of these voters want to support him again because they think the economy will do better under him. But these voters volunteered how much they dislike Trump’s chaotic and inappropriate behavior, and several of them are looking at R.F.K. Jr. as a third-party candidate. What happens in the trial could steer some of these Trump voters away from him.

Biden had a successful fund-raising weekend on the West Coast, but it’s Israel’s military actions in Gaza and the cease-fire talks that will loom over both his week and the biggest event on his schedule: his commencement address at Morehouse College next Sunday. Many voters are unhappy with Biden’s approach to Gaza and general handling of the war, and he came in for some criticism over his latest move on U.S. weapons to Israel.

This isn’t an easy time for Mr. Biden to set foot on a college campus, but he’s been an admired figure at many historically Black colleges like Morehouse — and he and his campaign need to improve his standing with both Black voters and Georgia voters, where he is lagging Trump in polls. No single event will turn it around for Biden, but I think this will be one of his highest-stakes speeches of the spring.

The Table Is Set for Michael Cohen to Testify Against Trump

For months, we’ve heard that the prosecution’s entire case in Donald Trump’s New York felony trial boils down to one man: Michael Cohen.

It turns out that it doesn’t — as long as Cohen, Trump’s former lawyer, behaves himself on the witness stand beginning early next week.

For three weeks, I’ve sat in the courtroom and watched prosecutors carefully set the table for the feast of Cohen’s testimony against his longtime boss. Knowing that Cohen is a disreputable witness, they’ll basically argue that you don’t have to like the chef to swallow the food he serves.

The arc of the prosecution’s narrative has taken the jury from the “catch and kill” scheme (a coherent prelude to the crime) to the validation of highly incriminating records to the debunking of arguments for the defense. It all adds up to an effective precorroboration of Cohen’s likely testimony.

Stormy Daniels had no connection to the falsification of business records, the fundamental charge against Donald Trump. But by establishing that she did, indeed, have sex with Trump, her testimony provided important proof of motive. It’s increasingly clear to the jury that Trump coughed up the hush money to save his 2016 campaign after it was sent reeling by the “Access Hollywood” tape. He knew that a credible story of sex with a porn star would sink him. So he broke the law.

The defense has responded mostly by grasping at straws. It tried to make the hush money look like an extortion scheme, with the former president in his favorite position as victim — a difficult maneuver, considering that Trump has spent years in the same tawdry milieu.

On Monday and Friday, the defense attorney Emil Bove used technojargon and innuendo to suggest, without a shred of proof, that a key piece of evidence — a Sept. 9, 2016, call in which Trump and Cohen discussed hush money for the Playboy model Karen McDougal — was somehow tampered with by Cohen, the F.B.I. or some other sinister force and that it might not have been Cohen on the call. The idea was to use a nanosecond gap in the call and a change in phone ownership to capture the imagination of even a single conspiracy-minded juror. It takes only one to create a hung jury.

But Bove’s cross-examination crashed when a young prosecution witness explained that when people (in this case, Cohen) buy new phones, they usually keep their old numbers.

Is that all they’ve got? No, the defense is betting on the offensiveness of Cohen, who has been ignoring repeated pleas from prosecutors to keep his mouth shut in the days before he takes the stand. (Justice Juan Merchan strongly suggested he do so.)

If Cohen can straighten up and fly right, riding on a trove of evidence and surviving cross-examination, a conviction is well within sight.