A new book from the Hoover Institution Press, Bread + Medicine: American Famine Relief in Soviet Russia, 1921–1923, tells the story of how the American Relief Administration, led by future president Herbert Hoover, undertook a large-scale humanitarian relief effort that saved the lives of millions of starving people in Soviet Russia from 1921 through 1923. The authors, Hoover research fellow Bertrand M. Patenaude and scholar Joan Nabseth Stevenson, wrote the book as a companion to an exhibition at Stanford University this year.

Jonathan Movroydis: What were the origins of Bread + Medicine and how did you get involved in it?

Bertrand Patenaude: I’ve spent most of my professional life working on this particular story about the American Relief Administration, led by Herbert Hoover. I’ve spent a lot of time delving into the Soviet famine of 1921 to ’23, and did a lot of work that went into a book that came out in 2002 [The Big Show in Bololand: The American Relief Expedition to Soviet Russia in the Famine of 1921], which was the first real book in English about the famine—surprising because that’s a major famine. But the story I really wanted to tell was about the relief mission.

Since completing the book, I’ve always said there were two stories that someone will come along and do one day. One was the story of Ukraine. We’re talking about Soviet Russia, it’s dominated by Moscow, but Ukraine is one of the constituent parts of this fledgling country. But I also said that there’s an untold story still in the archives having to do with the medical relief. The American doctors and their counterparts launched this amazingly complex, vast medical relief effort.

When COVID hit in 2020, I was convinced that what we ought to do is mark the centennial of the Soviet Russian famine and of the Hoover relief mission. Given the COVID pandemic and all the focus on medical issues and the fact that in 1922 the ARA introduced a vaccination program which was controversial, I thought it would really resonate with audiences today.

Where does the title come from? The way the world found out about the famine was that in July 1921, the writer Maxim Gorky sent out an appeal to anybody who would help. People are dying. The fields are burning. And the very last line of the appeal says, “Give bread and medicine.”

I wanted to make clear that in 1921–23, this relief mission succeeds only because there is a collaboration of Americans and Soviets—which means Russians in most cases—and including doctors. We highlight in the book how American and Russian doctors—and Ukrainian doctors as well—work together for the whole two years. American doctors are spread very thin; they are there as administrators and they need staffs. They need the local physicians to help them, people working in the hospitals, nurses, medical students. And the collaborative dimension of the story is one that I really wanted to emphasize.

Movroydis: Herbert Hoover is considered by many to be a rugged individualist and capitalist. How does he extend his relief efforts in Western and Central Europe and parts of Eastern Europe into the Soviet Union?

Patenaude: This is a fascinating part of the story. Gorky’s appeal comes out in the West, and there’s really only one person who can do anything about the famine: Herbert Hoover. He has the organization, the ARA, the American Relief Administration. He has the experienced personnel, he has the know-how, and he is also by this point secretary of commerce in the Harding administration. He has the contacts and he can make the wheels turn.

The question among historians is, was Lenin’s government in Moscow surprised when Hoover responded and offered to feed one million children? Eventually that figure goes way up, by the way, and by the summer of 1922 the ARA is feeding 10.5 million Soviet citizens a day, adults and children. I think they were surprised. You see in the internal correspondence that Lenin and company were really panicky about this because Hoover was also known for his anti-communism. He was a strident anti-Bolshevist. He was against any military intervention in Soviet Russia, but he was very hardheaded about Bolshevism. He did think food would cure it. So, if you started feeding anywhere in Europe or in Russia, eventually Bolshevism would go away.

Lenin and company set strict guidelines. They set up a whole hierarchy of secret police minders who would be affiliated and associated with all of the relief operations of the Americans throughout the country. And they occasionally arrested some of the Americans’ local staffs. Hoover insisted, “We must have a free hand in hiring our local staffs who would help us choose the beneficiaries.” So, there were strained relations throughout the two years, but ultimately, because Hoover has the food and the medicine, they’re able to succeed.

Feeding the enemy . . . there was concern at home that maybe we shouldn’t be sending aid over to a communist system. Herbert Hoover has a great quote. He writes a letter to a man in Kansas City who’s questioning why we’re feeding Bolsheviks. He writes, “You have to separate in your mind the 150,000 communists over there from the 150 million Soviet citizens.” We’re feeding the Soviet people, Hoover was saying, not the Soviet government.

In 1921, only Herbert Hoover could have led the way in arranging for an American-endorsed relief mission to Soviet Russia. Everyone trusted that Hoover knew what he was doing. Few questioned it.

Movroydis: What was the Russian people’s reaction to Herbert Hoover and the American Relief Administration? Did they have a favorable view despite the minders and some of the Soviet propaganda?

Patenaude: Absolutely. They were just coming out of an absolutely tumultuous period of revolution and civil war, and then came famine. The Americans were a godsend. They saw the Americans as a tie to the outside world from which they had been cut off for all of these years. Remember, Herbert Hoover at this time was known as the master of efficiency. The Russians marveled at how quickly these Americans worked. Overall, there was great admiration and enthusiasm about the Americans. And there was tremendous sadness and a sense of loss when the Americans left because they felt that they were losing a lifeline. Their hopes that the Bolsheviks would go away, or that Russia would once again become normal and it would have relations with other countries the way it had before the world war, all those hopes were vanishing.

Hoover’s picture shows up in the background of photos we have throughout Soviet Russia, in kitchens and so on. When a few Americans returned just a couple years later, in 1925 and 1927, they noticed that Hoover had been eclipsed by Henry Ford, with his factory system for building automobiles. But for those two years, no other American was as popular as Herbert Hoover.

Movroydis: Could you talk about the vaccination efforts?

Patenaude: The ARA had never mounted a medical program in any of its operations in Central and Eastern Europe. But in the summer of 1921, it’s clear that there’s a threat of typhus, especially; typhus might even spread into Europe through Poland because there are a lot of people trying to get out of the country. So Hoover thinks, “Well, the American Red Cross can go in and do a medical program.” But the Soviet government would not allow the American Red Cross in. It had been associated with some of the White, or anti-Red, armies on the periphery during the civil war.

So Hoover decides, “We’re going to have to do this,” and gathers a couple of doctors who had been associated with the American Expeditionary Force in World War I. They don’t understand the enormity of the problem. It’s the same with the food relief: they ended up feeding not a few but many, many millions. Russia had not been able to import medical equipment since 1914. Germany had been its main supplier.

In some areas, 50 percent of the doctors are gone. Some are leaving the country, but most are succumbing to the diseases they’re trying to conquer. Hospitals have no supplies—even basic stuff like linens, surgical instruments, bandages. One of the first American doctors on the scene arrives to see surgery being performed without anesthesia and the wound covered up with dirty newspaper.

This was a surprise to me. The doctors say, “Above all, we need soap.” They set up bathhouses for the kids. They realize that they’re not going to stop a lot of these diseases without that.

Once they get the ball rolling, there are two major threats. The first one is typhus. There is no vaccine for typhus; it’s spread by infected lice. The approach was to sanitize various facilities, provide better hygiene. They fumigate clothing, which they have to import machinery to do. And they also have to gather refugees, millions of whom are on the move, and get them into barracks where they can be cleaned and their clothing can be sterilized.

Then, as the temperatures are warming up toward the spring of 1922, cholera becomes the main threat. Now here, they can do something about it: vaccination. But the head of the relief mission in Moscow realizes that not only will the population be a bit skeptical, but so will Soviet medical doctors. So, even though the vaccines are available more cheaply from the United States, he imports all the vaccine from the Pasteur Institute in Paris because he knows that the Russian doctors regard the Pasteur Institute as the gold standard.

You can imagine vaccine skepticism. But the big deal here is that the ARA has leverage: food, so bread and medicine. You go to an ARA kitchen and the kids line up for their meal. You want your food, you get your shot. And if you want to get on a train to leave Soviet Russia for the West, you need proof of the ARA vaccination.

There were cholera outbreaks in 1919, 1920, and the summer of ’21, but not in the summer of ’22. The ARA basically put an end to that.

Movryodis: What was the overall impact of the bread and medicine mission? Do any data speak to that?

Patenaude: That’s a tough one. How do you add up the number of lives saved? Here’s the thing that I now know that I wish I had known or been aware of more clearly twenty years ago: in a famine, most people do not die of starvation. Few people starve to death. Most people die of famine-related disease.

There’s one exception in recent times: Mao’s Great Famine and the Great Leap Forward, with numbers that run up to forty million victims. That’s a case where probably most of the victims died of outright starvation.

To go back to the ARA and its work in Soviet Russia, it’s hard to add up how many lives were saved there. But if you think about the big picture—and how the ARA took it upon itself to install water filters, to put in new piping for sewers and water lines, and so on—I would feel comfortable saying that six million died, and it probably would have been double that absent the ARA’s bread and medicine.

This interview was edited for length and clarity.

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