On June 18, 1861, President Lincoln signed a bill making the United States Sanitary Commission an official government agency to see to the welfare of the troops. Even as he signed it, he had his doubts. He was afraid that the Sanitary Commission could well become the "fifth wheel to the coach," obviously not convinced of the need for the relief efforts advocate Henry Bellows outlined. Lincoln would soon change his mind. During the next four years the volunteer work of thousands of women, many working with the U.S. Sanitary Commission, would cut the disease rate of the Union Army in half, and raise more than twenty-five million dollars in money, goods and services to support the Northern war effort. In a nation that had no medical association, no nursing schools, and suddenly a huge strain on all medical and hospital services, the US Sanitary Commission proved indispensible as it mobilized resources on behalf of the troops. But in the beginning, it was a struggle. The agency had no real authority. It was an uphill battle to convince military officials and the medical department, such as it was, to even admit that they needed help.