Preliminary Programme

During the last decades of the 19th century, discoveries in microbiology paved the way in health programmes as an integral part of social modernisation. Public opinion on the consequences for governmental involvement differed, but in Denmark, the state’s openness to modern medicine encouraged the establishment of Statens Serum Institut (SSI) in 1902, initially for the production of anti-diphtheritic serum. Under its director, Thorvald Madsen (1870-1957), the SSI soon acquired a reputation for the quality of its products and cutting edge research. After qualifying in medicine in 1893 he worked both at the Pasteur Institute and with Paul Ehrlich in Frankfurt. During World War I he served with the Red Cross caring for German, Austrian and Russian prisoners of war. He had an extensive and expanding network of international scientific contacts, and he was eminently qualified when elected President of the League of Nations Health Committee.
The Committee served as the ‘parliamentary body’ of the League of Nations Health Organisation (LNHO) and Madsen’s hand can be seen in much of the work undertaken by the LNHO. The drive to achieve uniform standards for biological products related directly to his own and the SSI’s interests and expertise. Undoubtedly, standardization of biological products had an immense importance for the exchange of them, scientific, commercial and therapeutic. Madsen was president of the LNHO’s Commission on Biological Standardisations from 1924 to 1939, during which time the SSI was heavily involved in establishing standards for microbiological products like tuberculin and tetanus antitoxin.
Madsen’s interest extended to application of prevention technologies, and he utilized the opportunities in Denmark to further their use, notably in the case of tuberculosis. The introduction of the BCG vaccine promised a solution to the TB problem, but the Lübeck disaster generated a widespread reaction against the vaccine. Sponsorship from the Rockefeller Foundation led to close investigation of TB incidence in Denmark, and eventually to the offer of vaccination of tuberculin-negative Danes. This programme provided a foundation for later UNICEF and WHO eradication policies.
This paper aims to illuminate how local cultures and experience, and personal dedication, shaped the policies developed by the interwar international health movement. . (Show less)

Selskar Gunn joined the Rockefeller Foundation as a member of the Commission for the Prevention of Tuberculosis established in France in July 1917. Trained as a biologist/bacteriologist by William Sedgwick at MIT, and with a decade of diverse experiences at both local and state level, including serving as managing editor of the American Journal of Public Health from 1912 to the time he left for Paris, he was an exemplary representative of the so-called "New Public Health" that was in vogue in America at the time. He was particularly keen on the importance of an educated public; his role in the anti-TB campaign was to organize the educational campaign for which he developed traveling exhibits that included panels, printed matter and films.
Gunn was assigned to Czechoslovakia in 1920 as an advisor to the Ministry of Health. Upon his return to Paris in 1922 he became European regional director of the foundation's International Health Division, a position which made him a central figure in all negotiations between the foundation and European countries as well as the newly established League of Nations Health Organization (LNHO).
Gunn's interaction with European's leading public health specialists, in particular Andrija Stampar of Yugoslavia and Ludwik Rajchman, Director of the LNHO, helped him broaden his approach to public health, so much so that by the end of the 1920s he was openly questioning whether the foundation's underlying faith in its (American) approaches to public health were really what European countries needed best.
Encouraged by the foundation's "new policy in Social Sciences," adopted in 1929, Gunn pushed for the development of programs that went well beyond the traditional boundaries of public health, noting that many of the health officers with which he worked "feel that the time has come when governments should consider the possibility of elaborating more unified programs." In time, this search took him to China where he led a rural development project.
The Gunn that emerged from China was one that openly espoused the need to raise the economic and cultural level of rural populations for there to be any hope of employing curative or preventive measures with any degree of success. He ranked land reform high on the list of problems to be resolved if rural reconstruction was to be realized on a permanent basis. He differed with the foundation's malariologists in his belief that malaria control could only be achieved if it were attacked simultaneously from both a health and social angle.
John Grant, who worked with him in China, saw him as a "born imaginative leader." The purpose of this paper is describe the slow but steady evolution of Gunn's thinking with the aim of justifying such an appraisal. (Show less)

Today, many historians are moving away from using the nation-state as the primary unit of analysis. Locality and place are being constituted as legitimate centers for historical reconstruction. The “best man” the Rockefeller officers saw outside Paris, was the Lorraine resident Jacques Parisot [1882-1967], who, precisely, held no position in the French state apparatus. Coming from a dynasty of professors at the Faculty of Medicine in Nancy, Meurthe-et-Moselle, himself professor of bacteriology (1927), then of preventive medicine (1927), and finally of social medicine (1934), he was first and foremost a man of public health whose reputation was made on the spot as head of the Office of Social Hygiene in the Meurthe-et-Moselle department. Like Charles-Edward Amory Winslow, who called him “the most outstanding man of public health in France”, Parisot was so convinced that the distinction between preventing and curing was untenable that he managed to make the Medical Association, the Social Hygiene Office and health insurance boards work together — and even along with private charities, public housing authorities, municipalities, departmental officials and the prefecture — inside a Committee of Collaboration for the Development of the Means for Protecting Public Health, all this so as to draw up a joint plan that, in order to fight against social afflictions at the regional level, would not be restricted to towns but would reach out into the countryside. Supporting this constructive civic approach, the Popular Front called on public and private practitioners to form “coordination committees” with charities for developing general statistics on morbidity and mortality in France’s departments.
Nancy would be ranked as the “capital of social hygiene in France”. But what is important here is that what was local became cosmopolitan. Modeled on German social insurance and Italian bonifiche — both transnational and provincial, — the program for coping with problems of social hygiene would reach over local lines and encourage the Health Section in Geneva to intervene in new domains: working class family budgets and leisure activities, rural hygiene, the effects of the recession on health, etc. Andrijà Stampar in Zagreb and Bela Johan in Budapest did the same in their respective “realms”, turning their Schools and Institutes of Hygiene into rear guard bases for the League of Nations Health Organization. But nowhere else did everything come together as in Lorraine. Field surveys were undertaken to sway opinion and the elites, influence local politics, draw the attention of national authorities, win over officers in the Rockefeller Foundation, and gave rise to an international career for Parisot. This feudal lord who succeeded Léon Bernard on 28 November 1934 as the French member on the LN’s Health Committee, which he would chair as of 1 November 1937, had an exceptional destiny. A region, a nation, the LN, all of this came together in the person of a single individual.
It is this cross-border process started at Nancy, this exchange of experience based on a highly organized network of « translocal » professionals, which this paper will elaborate upon, using previously examined sources: Jacques Parisot’s papers (Vandœuvre-les-Nancy), OHS archives, Revue d’Hygiène et de Prophylaxie Sociales (Nancy, 1922-1939), archives of the Rockefeller Foundation, archives of the LNHO… (Show less)

Gustavo Pittaluga (Florence, 1876; Havanna, 1956) was a key-man in the development of public health in the first third of 20th century Spain, as well as for the fields of parasitology and haematology. He was the early parasitologist hired by the National Institute of Health (1906 to 1924), and his teachings drove to the diagnosis of Kala-azar disease in children and to the full depiction of a Spanish recurrent fever. He won the first chair on Parasitology and Tropical Diseases at the Madrid University (1911) and he opened several laboratories and consulting rooms for teaching, care and research in haematology (from 1916 on). We can judge that his role in the sustaining of laboratory based approach to the problems of health and disease, under Spain’s Nobel prized Santiago Ramón y Cajal’s paramount shadow, is stronger than his influence in any particular field. Moreover, he played a connecting role with the international sphere of health experts through the League of Nations Health Organisation, where he sat as permanent representative of Spain from its founding and until the start of the Spanish Civil War in July 1936. By mood, strategy and aims he belonged to the fruitful generations of concerned educated people that pushed on the full-fledged modernisation programme —or, as it was used to say at the time, europeisation of Spain— that was cut off by the Civil War and its aftermath; for instance, he was a close friend to the philosopher José Ortega y Gasset, whom he joined in several of his political enterprises, like the League for Political Education of the People or the weekly journal called Spain, while at the same time he formed in the ranks of the first Spanish League for Human Rights. At the beginning of the Civil War, pressures from the left pushed him away Spain, although at the end of the war he reinforced his personal engagement with the defeated Republic. But the Nazis drove him away from France to Cuba, where he finally settled and contributed to the strengthen of science and culture, as so many other thousands of Spaniards were doing throughout Latin America and especially in Mexico.
This paper will review the multilayered interests of Pittaluga, his endeavours and personal contributions, as an example of the liberal minds in science that shaped the interwar years. (Show less)