First World Health Assembly

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OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION

No. 9

REPORT OF THE INTERIM COMMISSION

TO THE FIRST WORLD HEALTH ASSEMBLY

Part I

ACTIVITIES

United Nations WORLD HEALTH ORGANIZATION Interim Commission

350 Fifth Avenue, New York Palais des Nations, Geneva

June 1948

FOREWORD

In presenting to the first Health Assembly this account of the stewardship of the Interim Commission of the World Health Organization, as called for in Article 10 of the Arrangement of 22 July 1946, I am moved by mixed feelings. During the unexpectedly long life of the Commission, its members have eagerly looked forward to the day when the permanent organization should be established, but itis natural that they should feel some regret at the disbanding of a team that has consistently been inspired by the will to co- operate in pursuit of a common ideal. Although there were, during the Commission's five sessions and two years of existence, conflicts of opinion on some issues, it was always ultimately found possible to harmonize discordant views and to formulate solutions acceptable to all members.All decisions taken were therefore unanimous. The reason for this was to be found not only in the personal qualities of the members of the Commission, but also in the fact that they were drawn together by the conviction that health was pre -eminently a subject in which the necessity and the advantages of international co- operation were manifest and could be demonstrated to the full.The work of the Commission is described in the pages which follow.To the Health Assembly, and to the World Health Organization, will be entrusted the continuance and extension of that work. The knowledge and the tools required for the improvement of health in all countries are available, and it is becoming increasingly possible to alter detrimental environments and to work towards a positive conception of health that will contribute immeasurably to the full enjoyment of life.Yet only a very small proportion of men, women and children of the world at present enjoy the benefits to health that science can bring. To secure international agreement on the best means of applying available knowledge and resources to the prevention of avoidable suffering and the raising of standards of health will be the principal task of the Assembly. May this task be undertaken in the spirit that has animated the work of the Interim Commission.

A. STAMPAR, M. D. Chairman of the Interim Commission NOTE

The period covered by this report on the activities of the Interim Commission dates from the establishment of the Interim Commission on 22 July 1946 to 3o April 1948. TABLE OF CONTENTS

SECTION I GENERAL REVIEW Page Administration and staff 9 Relations Io Technical questions : headquarters : priorities 10 Assimilation of earlier international health organizations II Special health problems 12 General services provided 14 Final task 14

SECTION II SYNOPSIS

Chapter I. HISTORICAL INTRODUCTION 19 Pan American Sanitary Organization 19 Office International d'Hygiène Publique 20 Health Organization of the League of Nations 21 Other international organizations 22 United Nations Relief and Rehabilitation Administration 23 United Nations 23 International Health Conference 25

Chapter 2. HEALTH PROBLEMS CONSIDERED 28 International Lists of Diseases and Causes of Death 28 Malaria 3o Biological standardization 31

Tuberculosis - 33 Quarantine 35 Unification of pharmacopoeias 37 Venereal diseases 38 International epidemic control 39 Revision of the pilgrimage clauses 40 International control of habit -forming drugs 41 Other technical subjects : Alcoholism 42 Crime prevention 42 Fonds Léon Bernard 42 Housing and town -planning 42 Influenza 43 Insulin 43 Medical examination of immigrants 43 Public -health services 44 Radiotherapy in uterine cancer 44 Other problems 44

Chapter 3 SERVICES PROVIDED 46 Epidemiological services 46 Emergency services during the cholera epidemic in Egypt 47 Field Services (UNRRA funds) 48 Publications 52 Reference service and library 53 Public information 54 Page Chapter 4. RELATIONS WITH OTHER ORGANIZATIONS 57 United Nations and its organs 57 Agreement between United Nations and WHO 57 General Assembly 57 Economic and Social Council 59 Commissions of the Economic and Social Council ; related bodies : UNICEF . 59 Other councils, commissions and committees 6i Specialized agencies of the United Nations 6i Food and Agriculture Organization (FAO) 62 International Civil Aviation Organization (ICAO) 62 International Labour Organization (ILO) 62 Preparatory Commission for the International Refugee Organization (PCIRO) 63 United Nations Educational, Scientific and Cultural Organization (UNESCO) 64 Pre -existing organizations 64 Office International d'Hygiène Publique (OIHP) 65 Pan American Sanitary Organization (PASO) 66 Sanitary Bureau at Alexandria 66 Non -governmental organizations 67

Chapter 5. ADMINISTRATION AND FINANCE 69 Organization 69 Budgetary and financial policy 71 External audit report and financial statement 74

Table I. Forms of service provided in the Field Service programme 5o Table II. Fellowships awarded, by countries of origin 52 Table III. Fellowships awarded, by fields of study 52 Table IV. Numbers of staff at different periods 69 Table V. Distribution of staff by nationality Table VI. Budgetary comparisons by financial years 72 Table VII. Places and dates of sessions of the Interim Commission 78 Table VIII.Officers of the Interim Commission 78 Table IX. Representatives,alternates,andadvisersattendingsessionsofthe Interim Commission 79 Table X. Observers attending sessions of the Interim Commission 8i Table XI. Membership of internal committees and sub -committees 82 Table XII.Membership of expert committees 83 Table XIII.Ratifications of the Constitution 86

Index 87

6 SECTION I

GENERAL REVIEW

EIGHTEEN countries were elected to membership of the Interim Commission of the World Health Organization :Australia, Brazil, Canada, China, Egypt, France, India,Liberia, Mexico, the Netherlands, Norway, Peru, the Ukrainian SSR, the USSR, the United Kingdom, the United States of America, Venezuela and Yugoslavia. It was originally expected that the Commission would not remain in being for more than a few m'bnths.However, the unexpected happened, and delayed ratifications prolonged its life to almost two years. The Commission was accordingly faced with many important technical problems which could not await the establishment of the permanent organization, but, in spite of initial handicaps, a large variety of technical subjects was successfully dealt with and a firm foundation was laid for the handling of many urgent health problems. A choice of problems had to be made, separating those which could await the formation of the permanent organization from those which were too pressing to permit of further delay.Moreover, in the selection of problems for immediate attention, the Commission had to consider not only their urgency and importance but also the extent to which available resources made it feasible to initiate effective action.It was also necessary to adjust the work of the Commission to the complex framework of the United Nations and its councils, commissions and specialized agencies, and of other official and voluntary bodies. In all, the Interim Commission held five sessions.1 The first opened in New York, towards the end of the International Health Conference.Dr. F. G. Krotkov, Deputy Minister of Public Health of the USSR, who was elected Chairman, was unable to continue as such owing to the pressure of other duties.He was succeeded by Dr. Andrija Stampar, Professor of Public Health and Social Medicine at the University of Zagreb, who held the office for the remainder of the Commission's existence.As Executive Secretary, the Commission elected Dr. Brock Chisholm, Deputy Minister of National Health and Welfare of Canada. The four remaining sessions were held in Geneva at intervals of about four months. For the execution of the Commission's tasks, an adequate administrative machinery was the first essential. A competent staff had to be found and appointed, a plan of activities had to be framed, and budgets had to be prepared.

Administration and Staff

The Commission's work was carried out largely through five internal committees.2 Budgetary and staff matters were the responsibility of the Committee on Administration and Finance, which was advised by a special Sub -committee on the Field Services Budget on the best way of allocating funds received from UNRRA. It was to the Committee on Administration and Finance that the work of preparing the budgets for 1946-1948 was entrusted, as well as the proposed budget for the first year of activity of the permanent organization .3The sum budgeted for 1948 was slightly over 3 million dollars, while the budget proposed for 1949 for the permanent organization amounted to $ 6,324,700.During the life of the Commission, funds were obtained from three sources - as loans from the United Nations, as funds transferred from the Board of Liquidation of the League of Nations, and, in respect of field services, as grants made by UNRRA ; and in submitting its budget proposals to the Health Assembly, the Com- mission had to take into account the obligation to repay the sums obtained from the first

i See table VII, p. 78 2 For membership of internal committees and sub -committees, see table XI, p. 82 8 See p.71

9 GENERAL REVIEW

of these sources.It was decided that provision for repayment of the United Nations loans should be made in a budget for the period of 1948 following the establishment of WHO. It was natural that the Commission should at first be largely dependent on the United Nations for its personnel and administrative services, and that it should have been guided by United Nations precedents in regard to staff and financial regulations and procedures .4It was soon necessary, however, to make considerable increases in the small staff with which the Commission had started, and in some cases it was possible to recruit experienced personnel from the pre- existing organizations which had been assimilated. The bulk of the Commission's functions was concentrated in Geneva.The headquarters office in New York maintained liaison with the United Nations and with other agencies, and supervised the Commission's accounting and financial procedures.The New York office also took responsibility for public information and for the administration of field services in the Far East, and of fellowships awarded and materials procured in America. In the appointment of staff, due regard had to be paid to equitable distribution by nationality.Between the second and the fifth sessions, the staff grew to a total of nearly 200, distributed between the New York and Geneva offices, the Singapore Station, and the field missions.Yet even this number was not at times adequate to deal with the growing volume of work.

Relations The study of the relationships that should be established and of the degree and kinds of co- operation that should be effected with the United Nations and its specialized agencies and with non -governmental organizations was one of the special tasks of the Committee on Relations.5This work was not of purely administrative significance. Many international bodies had a direct or indirect interest in health and medical science, and it was important that the field of activities of the World Health Organization should be so delineated as to render it an effective instrument for pursuing the aims embodied in its Constitution.Special sub -committees were sometimes appointed to carry on negotiations, as in the case of the United Nations itself and some of its specialized agencies. This aspect of the Commission's work reached final expression in the preparation of draft agreements for consideration by the first World Health Assembly. It was also to the Committee on Relations that the Commission delegated the work of studying and advising on the form of relations with the Pan American Sanitary Organization and the Sanitary Bureau at Alexandria, and with the Office International d' Hygiène Publique.

Technical Questions :Headquarters :Priorities

The most urgent of the Commission's duties were to carry on the functions of previous international health organizations and to take action on pressing health problems.For guidance on the technical implications of these duties, the Commission appointed a Committee on Epidemiology and Quarantine.The title of this committee was later broadened to Committee on Technical Questions, with a corresponding extension of its terms of reference. For examination of the question of the permanent seat of WHO, the Commission appointed a Committee on Headquarters, which prepared a report embodying the results of studies on New York, Geneva, Paris and the United Kingdom as possible sites.This report was approved by the Commission for submission to the first Health Assembly.6

4 See p. p. 7o, 72 5 See Chapter 4, p. 57. 5 See Off. Rec. WHO, zo, 87.

IO GENERAL REVIEW

Finally, a Committee on Priorities was appointed to give advice on the relative amount of attention to be given to the various problems which continued to arise during the extended life of the Commission.

Assimilation of Earlier International Health Organizations

In accordance with the duties laid upon it, the Commission early took steps to assume the functions of the three earlier international health organizations - the Office Interna- tional d'Hygiène Publique (OIHP),7 the Health Organization of the League of Nations,8 and the Health Division of UNRRA.9 To facilitate the transfer of functions from OIHP a special sub -committee on negotiations was appointed, and within a few months the epidemiological and advisory work of OIHP had become the responsibility of the Commission, and the notifications previously issued by OIHP were incorporated by the Commission in the Weekly Epidemiological Record.Responsibility for dealing with various technical questions and for publishing information hitherto included in the Bulletin mensuel of OIHP was also accepted, and preliminary arrangements were made for taking over its library and archives.The Commission also agreed to undertake the administration and investment of the pension fund of OIHP. By February 1948, the duties and functions of OIHP had passed to the Commission, although its assets could not be taken over until the termination of the Rome Agreement of 1907. Less than four months after its appointment, the Commission had taken over the functions of the Health Organization of the League of Nations and continued without interruption its epidemiological notification services and its work on biological standardization.The Commission also took over the League's Eastern Bureau at Singapore, as well as certain of its assets, and made plans for the eventual transfer of the Darling Foundation and the Fonds Léon Bernard. Arrangements were made to use the health and medical sections of the League's library, pending a decision of the United Nations on the transfer of ownership to the permanent organization.Later, other health functions of the League which had been suspended during the war were resumed by the Commission.

The remaining international health agency to be superseded by the Commission was the Health Division of UNRRA, which, in addition to its rehabilitation work in war -devastated areas, had temporarily assumed responsibility for the essential work of administration of the international sanitary conventions and of epidemiological notification.These latter functions were transferred to the Commission on 1 December 1946 -a month before the Commission took over the functions of OIHP. A few days later, the Commission signed an agreement by which it became responsible for most of the field -service work of UNRRA's Health Division, UNRRA providing a grant of $1,500,000 to finance the work in 1947.10Countries which had formerly received aid from UNRRA were thus enabled to obtain from the Commission continued assistance, in the form of field missions, fellowships and other services, in building up and restoring their medical and publichealth services.For this purpose, a Field Services Division was created in the Secretariat.Later, a second grant of $1,500,000 was received from UNRRA as a result of the extension of the Commission's life. It was clear that further work of the same kind would be necessary when the permanent organization came into being, and that assistance would be required by other countries which had not been eligible under the terms of the agreement with UNRRA. The Commission therefore included in its recommendations to the first Health Assembly provision for aid to governments in the form of missions, fellowships, visiting experts

7 See p. 4o,46,52 8 See p. 31,37,46,52 9 See p. 46,48 io See p. 49

II GENERAL REVIEW and lecturers, supplies of medical literature and teaching equipment, and certain other emergency services. In April 1948, UNRRA authorized the transfer from its funds of $ I,000,000 to help meet any need of the permanent organization for hard currency through mid -1949 ;it was understood that any uncommitted balances would be returned to UNRRA.

Special Health Problems

To assist in the discharge of its inherited statutory function of administéring the international sanitary conventions, the Commission appointed an Expert Committee on Quarantine.11Later a panel of experts was appointed to advise on yellow fever. The Commission believed, however, that much more than the administration of existing conventions was required, and that the entire field of international epidemiological control should be re- examined in the light of modern scientific knowledge, although the conventions had, as an emergency measure, been revised by UNRRA as recently as 194.4. It therefore set itself the task of formulating a uniform code of sanitary regulations, as visualized in Article 21 of the WHO Constitution.Such regulations, becoming automa- tically binding on all countries which did not lodge an objection within a stated period, would avoid the delays consequent on the necessity of separate ratification of conventions by each country. The Commission accordingly appointed an Expert Committee on International Epidemic Control, giving it a mandate to propose a complete revision of international sanitary legislation.12 As the revision of the conventions by UNRRA in 1944 had not taken into account the provisions relating to the Mecca pilgrimage, an Expert Sub- committee for the Revision of the Pilgrimage Clauses was appointed to make appropriate recommendations, and this sub -committee prepared a report and a new draft text relating to the sanitary control of the pilgrimage.13 The need to establish international agreement on technical problems was not limited to those fields in which the Commission had statutory obligations.The work of the Health Organization of the League of Nations in establishing international biological standards had come to an end during the war.In the meantime, new biological products had been developed and the need to establish international units of potency was urgent. Early in its life, the Commission decided to resume and extend this work by the appointment of an Expert Committee on Biological Standardization.14In two sessions, this committee adopted new international standards for penicillin, heparin and vitamin E, and made studies and recommendations on a wide variety of essential therapeutic, pro- phylactic, and diagnostic agents of animal and plant origin, including diphtheria and tetanus toxoids, cholera vaccine, tuberculin, BCG, streptomycin, and the human blood - group substances. It was not only in respect of biological products that international agreement was necessary.Many potent new chemical remedies were being made available and it was becoming increasingly urgent that rules of nomenclature and dosage should be the same in different countries, and that international authority should be created for establishing such uniformity.As a collateral activity to its work on biological standardization, the Commission therefore started preliminary work on the unification of pharmacopoeias, in continuation of the earlier work of the League's Technical Commission of Pharmacopceial Experts. An expert committee was appointed and, at its first session, divided all drugs in common use into three categories : those requiring immediate consideration, those which would require attention at a later stage, and those which could be disregarded.As an

11 See p.35 12See p. 39 12 See p. 40 14See p. 3!

I2 GENERAL REVIEW ultimate solution to the problems arising from differences in national usage, the Com- mission recommended to the first Health Assembly the preparation of an international pharmacopoeia.15 Medical aspects of the control of narcotics and other habit -forming drugs presented a related problem.The transfer of the international control of such drugs from the League of Nations to the United Nations imposed technical and advisory obligations on the Commission, for which it was necessary to appoint an Expert Committee on Habit - forming Drugs. 16 The Commission also undertook the work of preparing for the decennial revision of the International Lists of Causes of Death and establishing international lists of the causes of morbidity.For the execution of this work it appointed an Expert Committee for the Preparation of the Sixth Decennial Revision of the International Lists of Diseases and Causes of Death. 17This committee, working in close co- operation with expert bodies in Canada, the United Kingdom and the United States, held three sessions, one in Ottawa and two in Geneva, and prepared the basis for a proposed international manual in several languages. Apart from its more academic, but fundamental, work of international standardization of terminology and measures of activity, and the necessity for meeting its statutory obligations, the Commission was confronted with the task of initiating a direct attack on the diseases which were the principal causes of wastage of human life and effort.Of these, malaria,18tuberculosis,19and venereal diseases 20 were regarded as of such para- mount importance that the establishment of expert committees could not be deferred. The work of these committees was essentially to advise the Commission on the broad strategy of the respective problems and to assist in the framing of recommendations for action by the permanent organization. The Expert Committee on Malaria was later asked by the Commission to advise on a general plan for the world control of malaria, as well as on such specific problems as the use of insecticides and chemotherapeutic drugs.The work of the expert committees on tuberculosis and venereal diseases followed essentially similar lines, including general assessments of the possibilities for international action in the light of scientific advances, as well as recommendations in relation to specific technical matters. The Commission recognized the great importance of undertaking work on the problems of maternal and child health, and it was decided accordingly that assistance and services should be given to the United Nations International Children's Emergency Fund, which was in a position to take immediate action. 21Technical support was given to UNICEF's campaign of mass inoculation with BCG, and the Commission appointed a pediatrician to work with UNICEF and also a full -time medical officer as adviser in public health and as liaison officer.Further, the Commission joined with FAO in forming a committee on child nutrition 22 to advise UNICEF, which used the committee's report as a basis for its child- feeding programme. An opportunity of testing the effectiveness of international measures for the control of an outbreak of disease in a particular country was given to the Commission by the Egyptian cholera epidemic of 1947. 23In addition to the essential services of notification performed, the Commission undertook the bulk ordering of cholera vaccine and other supplies from many different sources, thus effecting a substantial reduction in the cost to the Egyptian and other governments.Lack of uniformity in batches of cholera vaccine from different sources, and infringement of sanitary conventions during the epidemic by several countries, presented the Commission with further problems urgently requiring solution.

is Seep. 37 16 See p.41 17 See p. 28 18 See p. 30 19 Seep. 33 20 See p. 38 21 See p. 61 22 See p. 62 28 Seep. 47

13 GENERAL REVIEW

The Commission also undertook preliminary work on a number of other subjects, in some cases appointing expert members to the Secretariat to make inquiries and studies. Information was collected on the world supply of insulin with a view to estimating the extent to which present and future demands could be met. 24Arrangements were made for the establishment of an international influenza centre, 22 and preliminary surveys on alcoholism 26and public -health services 27were undertaken.The Commission also agreed to co- operate in the preparation and publication of the Annual Report on the Results of Radiotherapy in Cancer of the Uterine Cervix 23 and, at the request of the Venezuelan Government, to give technical advice in relation to the medical examination of immigrants.29 In response to a request from the United Nations Secretariat for co- operation in the preparation of a report on the prevention of crime and the treatment of offenders, the Commission made available the services of a consultant psychiatrist to the Social Commission of the Economic and Social Council. 30

General Services Provided

In addition to the notification services assimilated from pre- existing organizations, and the special services undertaken during the cholera epidemic, the Commission provided certain general services applicable to a multitude of subjects.Of these, by far the most important were the missions, liaison officers, fellowships, visiting lecturers and experts, and medical literature and teaching material provided in the field- services programme. 31 By April 1948, 25o fellowships of an average duration of six months had been awarded, most of them in public -health or clinical subjects.Fourteen countries had received one or more of the forms of service provided for in the programme. Another service undertaken by the Commission was the publication of several journals for the dissemination of scientific, legislative and general information. 32The Bulletin of the World Health Organization was designed to incorporate features both of the bulletin of OIHP and that of the Health Organization of the League of Nations. Material on sanitary legislation was published by the Commission as the International Digest of Health Legislation.For the general information of the medical and other interested professions, the Commission published the Chronicle of the World Health Organization, a month -by -month account of its activities.The Weekly Epidemiological Record was continued in a modified form, and a monthly supplement, the Epidemiological and Vital Statistics Report, was published. In planning this service, the Commission attempted to provide only for the most essential needs without attempting to anticipate the views of the first Health Assembly on a definitive publishing programme.The attempt was also made to create a solid basis for the special library and reference services 33 that would be required by the permanent organization, and a start was made with the provision of public information by Press, radio and film. 34

Final Task

When it became clear that the coming -into -effect of the Constitution of the World Health Organization would not be much longer delayed, the final task of preparation for the first World Health Assembly remained to be undertaken by the Commission.At

24See p. 43 25See p. 43 28See p. 42 27See p. 44 28See p. 44 28See p. 43 38See p. 42 31See p.48 32See p. 52 28 See p. 53 34See p. 54

14 GENERAL REVIEW its last session it decided to convene the Assembly on 24 June 1948.Under the terms of the Arrangement of 22 July 1946, the Commission was obliged to submit to the Assembly an account of its stewardship and also a provisional agenda complete with necessary documents and recommendations.It was decided that the documents called for should be presented as two parts of a report, part I of which would be a general account of the Commission's activities, while part II 35 would contain the detailed proposals to be considered by the Assembly. In making these proposals, the Commission recognized that the permanent organization would hardly be in a position during the first full year of its existence to develop definitive programmes for all the important health matters requiring international action.Special emphasis was therefore given to malaria, maternal and child health, tuberculosis and venereal diseases.The Commission also proposed a number of other subjects for action, and recommended that particular attention be given to alcoholism, drug addiction, hygiene of seafarers, influenza, nursing, nutrition, rural hygiene and schistosomiasis.Provision was made for continuing the essential work of earlier international health organizations which had now been superseded, and for maintaining the special and general services which would be indispensable to the new organization.The Commission's final task was not limited to the outlining of a programme, for it had also to consider and prepare detailed recommendations on the machinery by which such a programme would be implemented. Proposals were accordingly made for the staff that would be necessary, and draft staff and financial regulations were prepared. Budget proposals for the year 1949 totalling nearly 966,500,000 were submitted, together with draft agreements with the United Nations and certain of its specialized agencies, and a statement of principles involved in the establishment of relations with non -governmental international organizations.Studies were also submitted on the location of the headquarters of the permanent organization. The question of adjusting regional organizations to geographical areas was discussed, and recommendations were made on collaboration with the Economic and Social Council, UNICEF, and other United Nations bodies. Finally, the Commission recommended the adoption of regulations and rules of procedure for the Health Assembly and for the expert advisory committees to be appointed by WHO, and the acceptance of a draft resolution on its own dissolution.

85 Published as Off. Rec. WHO, Io

SECTION II SYNOPSIS

CHAPTER 1

HISTORICAI. INTRODIJCTION

The first definite movements towards inter- nationalsanitaryconferencesfollowed :at national co- operation inpublic health date Dresden in 1893, Paris in 1894 and Venice from the earlier half of the nineteenth century, in 1897. a period when a series of epidemics of cholera Four quasi -international bodies were already and plague from the East swept across Europe. in existence at the time of the Paris Conference Every country dreaded these scourges, and of 1851.These were the Conseil sanitaire inter- each attempted to protect itself by the methods national de Tanger, the Conseil sanitaire de which itsofficials judged to be possible and Téhéran,theConseilsanitairemaritime et effective.The inconveniencesofsuchuni- quarantenaire d'Egypte and the Conseil supé- lateral action to rapidly expanding communi- rieur de Santé de Constantinople.Although cations and commerce became so great that they differed individually in certain important severalattempts were made toarrangea respects, they were on the whole similar in meeting of representatives from the different origin and development.All had originally interested nations.But nothing came of these been set up as local health boards, on the until 1851, when an international conference initiative of the rulers of Morocco, Persia, Egypt was held in Paris to try to reach some mutual and Turkey respectively ;but, owing to the understanding on the sanitary requirements of paucity of competent native physicians, their shipping in the Mediterranean.The immediate membershipwaspredominantlyEuropean. results of the conference were negligible, but They all played an important role in the pre- the firstofficial contact had been made in vention of epidemics, especially, in the case international collaboration in the prevention of the Egyptian and Constantinople councils, of disease. in relation to the sanitary control of the Mecca The cholera epidemics of 1853, 1854 and 1865 pilgrimage ;but, with the exception of the led to other conferences, inParis in1859, Egyptian council, their activities came to an Constantinople in 1866 and Vienna in 1874.At end during the first World War. these and subsequent conferences (Washington, The Conseil sanitaire maritime et quarante- 1881 ; Rome, 1885) the necessity for a common naire d'Egypte, usually known as the Egyptian understanding based upon recently acquired Quarantine Board, was the most important of knowledge became more evident ;but it was these four bodies.It acted as a " regional not until 1892, at the International Sanitary bureau " of the Office International d'Hygiène Conference in Venice, that a formal international Publique for epidemiological intelligence from sanitary convention was first drawn up, result- countries of the Near East, and continued to ing from the general desire to prevent the function until it was formally abolished by the introduction of cholera into Europe from the Convention of 31 October 1938, which trans- East by way of the Suez Canal.Further inter- ferred its duties to the Egyptian Government. Pan American Sanitary Organization The first health agency to function over a revised at the seventh Pan American Sanitary wide area and on behalf of many governments Conference, Havana, 1924.This convention, was the Pan American Sanitary Bureau.The later called the Pan American Sanitary Code, Bureau was formally organized by the first Pan has been ratified by all the twenty -one American American SanitaryConference,Washington, republics. 1902, following a decision of the second Inter- The Bureau acts as the executive organ of the national Conference of American States, Mexico Pan American Sanitary Conferences, of which City, 1902.These Conferences and the Bureau twelve have now been held, and its status is wereoriginally known as" International " fixed by Chapter IX of the Code.It is under instead of " Pan American ", the names later the direction of a council of eleven, designated being changed as a result of the creation of the in rotation by the conferences.Its members Office International d'Hygiène Publique. are chosen by governments from " persons A sanitary convention was drawn up, based connected with the public health services of their upon the International Sanitary Convention respectivecountries ", no government being of 1903, accepted in 1905, and subsequently allowed more than one representative on the

79 HISTORICAL INTRODUCTION council.The Bureau, together with the Direct- tions, as the number of diseases obligatorily repor- ing Council and the Conferences, constitutes the table under the Code is considerably greater. Pan American Sanitary Organization. In addition to epidemiological information, The Pan American Sanitary Bureau undertook some of the principal duties of the Bureau are the collection and dissemination of epidemio- the prevention of the introduction of infectious logical information soon after its establishment, diseases into the American republics, and from and in 1927 it became a " regional bureau " of the one republic to another, the restriction of qua- Office International d'Hygiène Publique under rantine measures to the minimum compatible the provisions of the International Sanitary with the prevention of disease, improvement of Convention of 1926. With its headquarters in national health- administrations, and the pro- Washington, the Bureau forms the central co- motion of liaison between the different national ordinating sanitary agency under the Code, and healthservices.It has also acted as a conve- collects and distributes epidemiological inform- nient agency to which the American republics ation for all countries adhering to it. But the could turn for advice or assistance in combating system of notification and collection of epidemio- epidemics, in reorganizing public -health services, logical information in the zone covered is wider in formulating sanitary codes, and in many than that of the international sanitary conven- other fields of hygiene and sanitation.

Office International d'Hygiène Publique It had become obvious that the rules laid The OIHP was under the authority and down by the conventions would require revision, control of the Comité permanent, comprising and that revision as well as enforcement could delegates of the 55 member governments, who not be left to international sanitary conferences were usually public -healthofficialsof their possessing no permanent staff.Moreover, epi- country, although others might be officers of the demiological knowledge was advancing rapidly, staff of the embassies in Paris.The Comité and there was need for continuous study on permanent, which normally met twice yearly, the transmission of pestilential diseases.Only worked throughCommissionsdealingwith suchstudy,andrecommendationsagreed current or occasional matters. between the technical representatives of all the The establishment of the League of Nations States concerned, could ensure the success of after the first World War had repercussions on the measures advocated and of the obligations the activities of OIHP, for Article 24, para- collectively assumed. graph 1, of the Covenant provided that " all Proposals for the establishment of a permanent international bureaux previouslyestablished international health office had been discussed under international agreement shall, subject to at earlier sanitary conferences, but it was not the consent of the contracting States, be placed until 1903 at the International Sanitary Con- under the authority of the League of Nations ". ference in Paris that a resolution was passed But there were difficulties which prevented approvingitscreation.The proposal took fusion.Some members of the League were not definite shape at the Rome Conference of 1907, parties to the Rome Agreement, while certain and the Office International d'Hygiène Publique governments which had signedthe Rome (OIHP) was formerly established by the Rome Agreement were not members of the League. Agreement of 9 December 1907.The OIHP In 1923 a compromise was reached, which was set up in Paris in January 1909, and maintained the separate existence of the two functioned until the negotiations for its amal- organizations but defined their relationship and gamation with the World Health Organization delimited their respective fields of activity. which took place in November 1946.Its prin- The main concern of OIHP was the enforce- cipal object as laid down by Article 4 of its ment and the periodical revision of the interna- Statutes was " tocollect and bring to the tionalsanitaryconventions.Two principal knowledge of the participating States facts and conventions were administered, the Interna- documents of a general character which relate tional Sanitary Convention of 1926 and the to public health, especially as regards infectious International Sanitary Convention for Aerial diseases, notably cholera, plague, yellow fever, Navigation of 1933.The first required adher- smallpox and epidemic typhus, as well as the ing governments to notify the appearances measures taken to combat them ".Article 10 withintheirterritoriesofthepestilential provided for the publication of a monthly diseases - plague, cholera, smallpox, yellow bulletin(Bulletin mensuel del' Office Interna- fever and typhus -- and dealt with the qua- tional d'Hygiène Publique) to contain : " 1. Laws rantine and other provisions to be observed, and general or local regulations promulgated so far as land and sea transport were concerned, inthevariouscountriesrespectingtrans- on their appearance and the measures to be missible diseases ; 2. Information concerning the adopted to prevent their spread.Co- operating spread of infectious diseases ;3. Information with OIHP under the terms of Article 7 of the concerning works executed or measures under- Convention were a number of autonomous taken for improving the health of localities ; regional agencies known as regional bureaux, 4. Statistics dealing with public health ; 5. Biblio- theEgyptianQuarantine Board,thePan graphical notes. " American Sanitary Bureau, and the Eastern

20 HISTORICAL INTRODUCTION

Bureau of the Health Organization of the League were incorporated in a weekly communiqué sent of Nations at Singapore.The second conven- to health administrations throughout the world. tiondealt with thefivediseasesintheir Urgent information was cabled immediately to relation to air communication. any country concerned.To ensure as wide a The epidemiological intelligence service thus circulation as possible, the communiqué was required involved the circulation every two or printed in the Weekly Epidemiological Record, three days of mimeographed sheets of notifi- published by the Health Section of the League cations, which, with additional information, of Nations. Health Organization of the League of Nations During the first World War, many of the cutive body of the Organization and carried functionsof OIHP wereinabeyance.It out the programme of work decided by the possessed neither the machinery, the staff nor Health Committee. the funds to permit rapid action required by an The presence in the Far East of certain emergency.But the immediate post -war years epidemic diseases prompted the decision in 1925 saw an attempt to establish an international to open an office in Singapore to collect and health organization with greater resources and distribute epidemiological information by cable wider scope.Article 23 f of the Covenant of and wireless.The serviceeventuallyesta- the newly -formed League of Nations provided blished covered all Far -Eastern countries and that member States would " endeavour to take 186 ports in East Africa, Asia, and Australasia. steps in matters of international concern for The value of the Eastern Bureau of the Health the prevention and control of disease ".The Organization was recognized by Far -Eastern danger of epidemic typhus, which was raging countries, which made special contributions to in Russia and threatening to spread across its upkeep and appointed an advisory council Poland to the rest of Europe, stimulated imme- composed of technical representatives to meet diateaction.To meet the emergency, the annually and to supervise its activities. Council of the League on 19 May 1920, autho- The principles governing the work of the rized the establishment of a temporary Epidemic Health Organization have been summarized in Commission. the Report on the Work of the League during The object was to secure, if possible, a single the War, Geneva, 194.5: " To inform national health agency, dependent upon the League of health authorities on matters of fact, to docu- Nations.An international conference of experts ment them on methods of solving their technical convened by the Council of the League of Nations problems, and toafford them suchdirect in London in April 1920, prepared a draft assistance as they may require ". constitution of a public -health agency, which An Epidemiological Intelligence and Public was accepted with some modifications by the Health Statistics Service ensured the collection first Assembly of the League in December 1920. and publication of information on infectious It would have placed OIHP under the direction diseases and vitalstatistics, and the rapid of the League, and made all health activities interchange of information.The service had dependent on a general assembly consisting of two centres : Geneva and the Singapore Bureau. technical delegates nominated officially by their The former was started in 1921, with activity respective governments ; but to become effective, at first limited to Eastern Europe, but gradually it required the assent of all the governments extended to cover the world.The Singapore parties to the Rome Agreement of 1907, and Bureau, in addition to its normal duties, acted this unanimous assent could not be obtained, as a " regional bureau " of OIHP.Information the United States in particular not being a was published weekly, monthly and annually, member of the League. A compromise was and the weekly communiqué of OIHP was reached at a " Mixed Commission " in Paris in transmitted to Geneva for inclusion in the May 1923, composed of members of the provi- Weekly Epidemiological Record. sional Health Committee of the League and of Technical commissions, composed of recog- the Comité permanent of OIHP.The two nized authorities from various countries, were organizations henceforward were to work in close set up to study and advise on specific problems. co- operation, each maintaining its individuality. They were responsible for some of the most As modified in 1936, the Health Organization important medical work performed by the of the League of Nations comprised a General Organization, and their findings were often Advisory Health Council, a Health Committee, adopted by nationalhealth- administrations. and a Health Section forming partof the Some of them were permanent (malaria, biolo- SecretariatoftheLeague.TheAdvisory gical standardization), others were set up for a Council consisted of the members of the Health particular purpose at a given time (nutrition, Committee and those of the Comité permanent physical fitness, cancer, housing, typhus, leprosy, of OIHP.The Health Committee consisted of medical and public -health training, rural hygiene, twelve members, including the President of the unification of pharmacopceias, etc.).Wherever Comité permanent of OIHP, who was Vice - necessary,joint committees and secretariats President ex officio, and eleven other members were established with the International Labour appointed for three years by the Council of the Organization, the Social and other committees League.The Health Section formed the exe- of the League, and others.

2I HISTORICAL INTRODUCTION

The experience of the Health Section and of The Health Organization of the League of the experts of the technical commissions was Nations showed for the first time the full value atthedisposalof governments to provide of international collaboration in medicine and advice and to carry out specific tasks.Thus public health, and much of its scientific work expert opinion was provided on anti -malarial has been recognized as being of the highest measures (Albania), syphilis (Bulgaria), dengue standard.But the existence of two independent fever (Greece).Ireland was helped in hospital health organizations entailed, in spite of the reorganization and Chile in nutritional problems. efforts to perfect collaboration, a certain amount The demands grew rapidly in number and of overlapping, and the resulting friction undoub- importance, until advice was provided on the tedly limited the development of international reorganization of the entire public -health admi- healthwork.Alltheinternationalhealth nistration of such countries as Bolivia, China, organizations in existence in1939, the Pan Greece, Liberia and Roumania. American Sanitary Organization, OIHP, and Finally, one of the most important steps in the Health Organization of the League of stimulating international collaboration in public Nations, were bodies with advisory but without health was the provision of collective courses executive power, authorized only to collect and and study- tours, which included all the more distribute technical information and statistical important aspects of the control of disease and data, and to act as liaison organs between public -health administration. national health- administrations.

Other International Organizations Itisimpossible toconsider international and has takenspecialinterestinmatters organization in public health without mention- affecting the welfare of the merchant seamen. ing the work of the International Red Cross, the International Labour Organization, and the International Labour Organization many international non -governmental organi- The activities of the League of Nations in zations and congresses. industrial medicine were dealt with, not by the Health Organization, but by a medical International Red Cross section of the International Labour Office with a separate staff and budget, deriving authority The International Red Cross includesthe from the general duties placed upon the Office by national Red Cross societies, the International the Covenant of the League.The Organization Committee of the Red Cross, and the League haditsown constitutionand independent of Red Cross Societies. international obligations, and later became a specialized agency of the United Nations. The history of the Red Cross movement dates In the past, there was a joint committee on back to Dr. Henri Dunant, to whose initiative social medicine between theHealth Organi- was due the first Geneva Convention of 1864 zation of the League and theInternational and the establishment of theInternational Labour Organization.It dealt particularly with Committee of the Red Cross.The International the means of avoiding overlapping between the Committee deals with major issues and with the medical service developed by thesickness - international conventions from which it derives insurance institutions and the national health - authority.The creation of national Red Cross administrations. Industrialmedicine was or Red Crescent societies was almost contem- exclusively the province of the International porary with the founding of the International Labour Organization, except in the case of Committee.They undertake in each country anthrax, which was the subject of a joint sub- the many activities of the Red Cross ; but such committee.The medical service of the Inter- activities are not confined only to wartime, in national Labour Organization was responsible peacetime they operate wherever their help is for technical studies, which frequently led to needed to alleviate human suffering. the adoption of international labour conventions, The League of Red Cross Societies forms the and for the publication both of original work federation of the national societies, and repre- and of bibliographical information. sents them internationally. The League was founded in 1919 on the proposal of Mr. Henry International Medical Congresses P. Davidson, of the War Council of the American International collaboration in medicine and Red Cross, and the importance of this new public health was greatly assisted by the many organization was recognized by a reference to congresses and conferences on medical subjects it in the Covenant of the League of Nations. which were organized year after year by the The principal peacetime work of the League profession itself.Sometimes even international of Red Cross Societies, in addition to co- ordinat- medical organizations were establishedas a ing the activities of the national societies, lies resultof these congresses,to continue this in relief in times of disaster, popular health - workofinternationalco- operation. The education, and the training of nurses.The congresses ranged from small gatherings with a League was also instrumental in the establish- select membership to large meetings with lay ment of the International Hospitals Association, as well as medical representatives.

22 HISTORICAL INTRODUCTION

United Nations Relief and Rehabilitation Administration During the second World War and the notification within the limits of military security, German occupation of large parts of Europe, of diseases likely to become epidemic, unifor- theactivitiesof OIHP and of the Health mity in quarantine regulations, and for other Organization of the League of Nations were measures of prevention ".In accordance with necessarily curtailed.The extent of material the powers granted by thisresolution, an destruction, of food scarcity and malnutrition, Expert Commission on Quarantine was appointed and the fear of widespread epidemics in the in May 1944 to draft emergency international period immediately following the end of the sanitary conventions to take effectat the war, led the Allies as early as 1941 to take earliest possible date and to continue in force steps for temporary international organizations throughoutthe immediate postwarperiod. to fill the gap until international health colla- These conventions were prepared, and by their boration had recommenced. terms duties previously performed by OIHP, Thus,in September 1941, the Inter -allied were transferred to UNRRA in January 1945. Committee on Post -war Requirements was set They were originally due to lapse on 15 July up, including a medical committee among its 1946, but were extended by a protocol until technical advisory committees.The work of such time as the new international health thiscommittee,together withofficialand organization should come into existence. voluntary work in the United Kingdom and Early inits existence, UNRRA requested the United States in connexion with postwar the help of the Health Organization of the relief, led to the establishment in November 1943 League in epidemiological intelligence.Infor- of the United Nations Relief and Rehabilitation mation received in Geneva was accordingly Administration (UNRRA). cabled weekly to Washington and London, and The activities of UNRRA were limited in a Health Section unit formed the epidemiological health, as in other matters, to relief and rehabi- information service of UNRRA in Washington. litation programmes.Its plans therefore pro- This unit was eventually absorbed by the vided for the sending of medical, reliefto Health Division of UNRRA.Liaison was also occupied countries after their liberation, the established betweentheEuropeanregional medical supervision of displaced persons, and office and OIHP, after the latter had been in general the provision of help to war- weakened freed from German control. national health- administrations.Supplies were The epidemiological work and the adminis- collected and medical and auxiliary personnel tration of the conventions formed, however, formed for field missions in various parts of only one part of the medical work of UNRRA. the world. Extensive programmes of postgraduate fellow- The Health Division, with the Division of ships for medical and auxiliary personnel were Repatriation and Welfare, formed the Bureau undertaken, and medical literature covering the of Services, one of the four principal functional war years and large quantities of drugs and bureaux of the Administration. A headquarters essentialchemicalsweresupplied. Health office was set up in Washington and a European missions were sent to many European and Far - regional office in London. Eastern countries,certaindiseases, such as At the first session of the UNRRA Council tuberculosisandmalaria,receivingspecial in November 1943, a resolution was passed attention. recommending that " Governments and recog- Inaccordance withitsoriginalstatutes, nized national authorities co- operate fully with UNRRA'sactivitiesinEuropeendedon theAdministrationinestablishingatthe 31 December 1946 and in the Far East on earliest possible date regional and other emer- 31 March 1947, although certain functions were gency agreements and arrangements for the transferred to the Interim Commission.' United Nations The proposal to convene an international con- Following this action, the States represented ference to establish a new and comprehensive on Committee II /3 unanimously approved a international health organization originated at declaration submitted jointly by the delegations the United Nations Conference held in San of Brazil and China calling for an international Francisco in 1945.The Conference, recognizing conference to establish an international health the vital importance of health as a factor in the organization. promotion of " conditions of stability and well being ", included health among the subjects " The Delegations of Brazil and China with which the United Nations should be recommend that a General Conference be concerned.Articles55,57 and 59of the convened within the next few months for Charter contemplated the creation by inter- the purpose of establishing an international governmental agreement of a specialized agency health organization. of the United Nations having wide international responsibilities in all matters relating to health. 1 See p. 48. HISTORICAL INTRODUCTION

They intend to consult further with 5. Dr. P. Z. King (China) the representatives of other Delegations (Alternate :Dr. Szeming Sze), with a view to the early convening of such 6. Dr. Josef Cancik (Czechoslovaka), a General Conference to which each of the 7. Dr. AlyTewfikShousha Pasha (Egypt), Governmentshererepresentedwillbe 8. Dr. André Cavaillon (France) invited to send representatives. (Alternate : Dr. Xavier Leclainche), " They recommend that, in the prepar- 9. Dr. Phokion Kopanaris (Greece), ationofaplanfortheinternational io. Major C. Mani (India) healthorganization,fullconsideration (Alternate : Dr. Chuni Lal Katial), should be given to the relationship of such H. Dr. Manuel Martinez Baez (Mexico), an organization and methods of associating 12. Dr. Karl Evang (Norway), it with other institutions, national as well 13. Dr. Martin Kacprzak (Poland), as international, which already exist or 14. Sir Wilson Jameson (United Kingdom) which may hereafter be established in the (Alternate : Dr. Melville Mackenzie), field of health. 15. Surgeon -General Thomas Parran " They recommend that the proposed (United States) international health organization be brought (Alternate :Dr. James A. Doull), into relationship with the Economic and 16. Dr. Andrija Stampar (Yugoslavia), Social Council. " and, in a consultative capacity, represen- The Governments of Brazil and China followed tatives of : the declaration by suggesting that a conference be held before the end of 1945, but it was The Pan American Sanitary Bureau, apparent thatthedeliberationsin London L'Office Internationald'Hygiène would result in the establishment of the essential Publique, organs of the United Nations early in January TheLeagueofNationsHealth 1946.The proposals, therefore, for convening Organization, the conference at the instance of one or other TheUnitedNationsReliefand State were dropped in favour of the idea that Rehabilitation Administration ; such a conference should be held under the " 4. Directs the Technical Preparatory auspices of the United Nations. Committee to meet in Paris not later than The General Assembly was constituted on 15 March 1946, and to submit its report, ro January 1946, and a week later the Economic including the draft annotated agenda and and Social Council was elected.One of its proposals, to the Members of the United first tasks was to implement the terms of the Nations and to the Council not later than San Francisco declaration and on 15 February i May 1946 ; 1946 it passed the following resolution : " 5. Decides that any observationsit " The Economic and SocialCouncil, may make at its second session on the taking note of the Declaration proposed report of the Technical Preparatory Com- jointly by the Delegations of Brazil and mittee will be communicated to the pro- China at San Francisco, which was unanim- posed international conference ; ously approved, regarding an international " 6. Instructs the Secretary- General to healthconference,and recognizingthe call the Conference not later than 20 June urgent need for international action in the 1946, and, in consultation with the President field of public health : oftheCouncil,toselectthe placeof " r. Decides to call an international con- meeting. " ference to consider the scope of, and the appropriate machinery for,international Technical Preparatory Committee2 action in the field of public health and proposals for the establishment of a single The Technical Preparatory Committee held international health organization of the twenty -two meetings between 18 March and United Nations ; 5 April 1946 at the Palais d'Orsay, Paris. " 2. Urges the Members of the United Four preliminary draft constitutions, sub- Nations to send as representatives to this mitted respectively by Drs.Cavaillon and conference experts in public health ; Leclainche, Sir Wilson Jameson, Dr. Parran " 3. Establishes a Technical Preparatory and Dr. Stampar, provided a basis on which Committee to prepare a draft annotated the committee prepared a set of draft constitu- agenda and proposals for the consideration tional proposals, as well as a provisional annota- of the conference, and appoints the follow- ted agenda, for submission to the international ing experts or their alternates to constitute health conference.The committee laid down the Committee : certain principles which not only took present possibilities into account, but would enable the r. Dr. Gregorio Bermann (Argentina), future organization to extend its sphere of action 2. Dr. René Sand (Belgium), to problems which had never been tackled by 3. Dr. GeraldoH.dePaula Souza the earlier bodies. (Brazil), 4. Major -General G. B. Chisholm 2 The proceedings of the committee are published in (Canada), Off. Rec. WHO, i

24 HISTORICAL INTRODUCTION

It decided to recommend to the Economic and United Nations had decided to take over the Social Council that States not members of the health functions of the League of Nations, a United Nations, the Allied Control Authorities decision which was endorsed by thefinal for Germany, Japan and Korea, and several Assembly of the League of Nations in April 1946. inter -governmental and private international The principle had been recommended by the organizations concerned with health should be Technical Preparatory Committee in April and invited to send observers to the conference. by the Economic and Social Council in June. The committee further proposed that all States At its second session in New York (May - invited to the conference should be requested June 1946), the Economic and Social Council to authorize their representatives to sign an noted the report of the Technical Preparatory inter -governmental agreement establishing a Committee, and on II June adopted a resolution World Health Organization, together with a approvingitsrecommendations andtrans- protocol designed to facilitate the absorption mitting to the International Health Conference of OIHP intosuch anorganization.The various observations made by members of the committee included in its report to the Council Council on the draft constitutional proposals. recommendations relating to the transfer to the The Council invited not only members of the World Health Organization of the functions of United Nations to be represented at the con- the Health Organization of the League of ference,butalso,inconformity withthe Nations, and the peacetime phases of the work principle of universality enunciated at Paris, of the Health Division of UNRRA. asked sixteen non -member States to send repre- In the meantime, on 12 February 1946, at the sentatives to take part in the discussions of the first meeting of the General Assembly, the conference, without the right to vote.

International Health Conference'

The International Health Conference, the The Governments of the following States were first conference to be called by the United represented by observers : Nations, held its inaugural meeting at the Albania Hungary Portugal Henry Hudson Hotel in New York City on Austria Iceland Siam 19 June 1946, with Sir Ramaswami Mudaliar Bulgaria Ireland Sweden (India), President of the Economic and Social Finland Italy Switzerland Council, in the chair.Its organization was Transjordan entrusted to the Health Division of the United Nations. The Governments of the following States were The Governments of the following States invited to send observers, but were not repre- were represented at the conference by delegates : sented : Afghanistan Roumania Yemen Argentina Lebanon Australia Liberia Observers representedthe .AlliedControl Belgium Luxemburg Authorities for Germany and for Japan and Bolivia Mexico Korea, and the following organizations : Brazil Netherlands Food and Agriculture Organization (FAO) ByelorussianSovietNew Zealand International Labour Organization (ILO) Socialist RepublicNicaragua League of Red Cross Societies Canada Norway OfficeInternational d'Hygiène Publique Chile Panama (OIHP) China Paraguay Pan American Sanitary Organization Colombia Peru ProvisionalInternationalCivilAviation Costa Rica Poland Organization (PICAO) Cuba Republic of the Rockefeller Foundation Czechoslovakia Philippines United Nations Educational, Scientific and Denmark Saudi Arabia Cultural Organization (UNESCO) Dominican RepublicSyria United Nations Relief and Rehabilitation Ecuador Turkey Administration (UNRRA) Egypt Ukrainian Soviet World Federation of Trade Unions El Salvador Socialist Republics Dr. Thomas Parran, chairman of the United Ethiopia Union of South Africa Statesdelegation,was unanimously elected France Union of Soviet President. Greece Socialist Republics Dr. Brock Chisholm (Canada), Rapporteur Guatemala United Kingdom of the Technical Preparatory Committee, pre- Haiti United States sented the report of that committee to the of America Honduras conference.Statements expressing the general India Uruguay Iran Venezuela 8 The proceedings of the conference are published in Iraq Yugoslavia Off. Rec. WHO, 2

25 HISTORICAL INTRODUCTION views of the delegates on the work of the thus distributed were discussed point by point, conference, the adoption of rules of procedure and the resulting draft was submitted to the and of the agenda, and the establishment of plenary meeting of the conference forfinal five working committees and a general (steering) discussion.It was approved in general outline, committee completed the preliminary business though several changes of detail were made. of the conference.From 23 June to 22 July, One of the fundamental questions with which the closing day of the session, the meetings plenary meetings of the conference had to deal were held at Hunter College, then the interim was the admission to the organization of States headquarters of the United Nations. not members ofthe United Nations.The The conference met eighteen times in plenary Technical Preparatory Committee had stated session.It had, first to consider, procedure that membership should be open to all States. by which the work of the former international The conference stipulated that non -member or regional publichealth organizations could States invited to New York might become be taken over by the organization being created, members of the organization by signing or and secondly, to draft the Constitution of that otherwise accepting the Constitution before the organization. first session of the World Health Assembly, The States represented at the conference whereas States not invited to New York might decided to take steps to dissolve OIHP and to be admitted only by decision of the World take over its functions immediately.As regards Health Assembly. the Health Organizationof the League of The work of the International Health Con- Nations, the conference adopted a resolution ference concluded with the signature of four requesting the Secretary -General of the United Acts designed to give legal force to the decisions Nations to make the necessary arrangements for takenfortheestablishmentofthe World transferring its functions to the future organi- Health Organization.The final Act 4sum- zation. marizes the work leading to the creation of the Although UNRRA had displayed consider- organization, the remaining Acts being the able activity in providing assistance to public - Constitution of the World Health Organization, health administrations,there was no need the Protocol concerning the Office International to take over its functions juridically because d'HygiènePublique andtheArrangement of its temporary nature. establishing an Interim Commission. Finally, the possibilities of integrating the Pan American Sanitary Organization with WHO Constitution of the World Health were discussed at length.The States represented Organization 5 at the conference agreed to include in the Consti- The Constitution was signed by the representa- tution itself an article under the terms of which tives of sixty -one States, two of which, China the Pan American Sanitary Organization was and theUnited Kingdom,signedwithout to be integrated with WHO " through common reservation, and was designed to come into action based on mutual consent of the competent force when twenty -six members of the United authorities expressed through the organizations Nations had ratified their signature. concerned ". It establishes the World Health Organization The greater part of the time of the conference as a specialized agency within the terms of wasdevotedtodrafting theConstitution. Article 57 of the Charter of the United Nations, Although this work was considerably simplified integrating all other international and regional by thepreliminarydraft prepared by the inter -governmental health organizations.The Technical Preparatory Committee, which was structure of WHO as laid down by its Constitu- taken as a basis for discussion, it nevertheless tion resembles that of the Health Organization required long and arduous efforts.In fact, it of the League of Nations, its organs consisting entailed drawing up a charter of international of a World Health Assembly, an Executive collaboration in health. Board, and a Secretariat.But the functions The detailed examination of the draft consti- and the powers of WHO are much wider than tutional proposals was referred to five working those of previously existing health organizations. committees, each of which elected a rapporteur Its activities extend broadly over medicine and and set up a small drafting sub -committee. public health, while, among other powers, the The GeneralCommittee,composedofthe Health Assembly is invested with the power to President and Vice -Presidents of the conference, adopt, by majority vote, regulations to come the chairmen of the five working committees, into force for all members after due notice has and three members elected by the conference, been given, except for those members which served as the co- ordinating and steering group notify non -acceptance within a prescribed period. for the conference and its various committees. Protocol concerning the Office International During the latter part of the conference, the d'Hygiène Publique 6 General Committee established a Central Draft- ing Committee to edit and co- ordinate the The Rome Agreement of 1907 establishing reports and recommendations of the working OIHP provided for its renewal every seven committees. years, and any State wishing to withdraw was From 23 June to 19 July the five working 4 Off. Rec. WHO, 2, part VA committees held altogether forty -two plenary 5 Ibid. 2, part Vs meetings.The various parts of the Constitution 6Ibid. 2, part VD

26 HISTORICAL INTRODUCTION required to give prior notice of its intention at assume the responsibilities and tasks which least a year before the expiry of a seven -year would devolve upon it - that is, the continua- period.This means that OIHP cannot legally tion of the functions of former international be terminated before the end of x949, when the organizations and the consideration of urgent current seven -year period comes to an end, health problems. except by the agreement of all member States. The establishment of the Commission was Those member States that took part in the the result of an Arrangement concluded by the conference, being convinced of the need for a governments representedattheconference, single organization in the field of health, agreed defining the nature and scope of its functions. that, although OIHP must continue de jure The following eighteen States were entitled to until 1949, its functions should be assumed designate persons to serve on the Commission : by WHO as soon as the protocol to this effect came into force, that is, as soon as it had been Australia Norway accepted by twenty governments parties to Brazil Peru the Agreement. Canada UkrainianSovietSocialist China Republic Egypt UnionofSovietSocialist Arrangement establishing an Interim France Republics Commission 7 India United Kindgom The New York Conference decided that, until Liberia United States of America the entry- into -forceof the Constitution, an Mexico Venezuela InterimCommissionconsistingofeighteen NetherlandsYugoslavia States should undertake the preparatory work for the establishment of the organization and Its first duty was to prepare for the World Health Assembly, and its expenses were met 7 Off. Rec. WHO, 2, part Vc from funds advanced by the United Nations.

27 CHAPTER 2

HEALTH PROBLEMS CONSIDERED

International Lists of Diseases and Causes of Death

The Commission was empowered by Article 2k Preparation of the Sixth Decennial Revision of the Arrangement of 22 July 1946 " to review and Establishment of the List of Causes existing machinery and undertake such pre- of Morbidity paratory work as may be necessary in connexion with : Three sessions of the committee were held - the first 4 in Ottawa from 10 to 22 March 1947 " (i) the next decennial revision of' The (in combined meetings with the United States InternationalListsofCausesof Committee on Joint Causes of Death), the Death '... and seconds in Geneva from 21 to 29 October of " (ii) the establishmentof International the same year and the thirds also in Geneva Lists of Causes of Morbidity ". from 4 to 7 May 1948. The committeeconcludedthat asingle To meet these obligations, the Commission classificationapplicablebothtocausesof appointed an Expert Committee for the Pre- sickness and of death would not only satisfy paration of the Sixth Decennial Revision of the urgent need fora uniform morbidity - the International Lists of Diseases and Causes classification but would also permit parallel of Death." presentation of morbidity and mortality sta- The committee2 was given the following tistics.In giving effect to this conclusion, the terms of reference : 3 committee had the advantage of the very large amount of preparatory work accomplished (a) toreviewthedevelopmentsas by the United States Committee on Joint regards morbidity and mortality classifi- Causes of Death under the chairmanship of cation which have taken place since the Dr. L. J. Reed, Vice -President and Professor fifth decennial revision in 1938 ; ofBiostatistics,Johns Hopkins University. (b) to formulate proposals to be sub- This committee had been appointed in 1945 mitted through the Interim Commission by the Secretary of State of the United States to governments ; in accordance with a resolution of the fifth International Revision Conference in 1938, and (c) to consider suggestions from govern- included, among its members and consultants, ments and agenciesinterestedinthe representatives of the Canadian and British problem of morbidity and mortality classi- Governments and of the Health Section of the fication ; League of Nations. (d) to prepare recommendations regard- In taking up the matter of joint causes, the ing the International Conference for the United States committee decided to consider Sixth Decennial Revision of the Inter- classification from the point of view of morbi- nationalListsofDiseases and Cájes dity and mortality, since the problem of joint of Death. causes belongs to both types of statistics. Utilizing the experience in morbidity classi- At all stages of the work, co- operation was fication accumulated inthelastdecade in maintained with the United Nations Statistical Canada, the United Kingdom and the United Office and with the International Labour Organ- States, and keeping to the framework of the ization.Dr. F. Linder was invited to represent International List, the United States committee the United Nations Statistical Office at the prepared, in a series of working sessions, a single committee's second session, and Dr. L. Féraud classification suitable for both morbidity and attended the second session, as an observer mortality statistics.This work was embodied of ILO. inthe ProposedStatisticalClassificationof

4 For report, see Off. Rec. WHO, 8, 17 1 Off. Rec. WHO, 4, 161 H For report, see Off. Rec. WHO, 8, 2I 2 For membership, see table XIj, p. 83 Report not yet published at the time of going Off. Rec. WHO, 8, 19 to press

28 HEALTH PROBLEMS CONSIDERED

Diseases, Injuries and Causes of Death, consist- allocation of diagnostic statements found on ing of two parts : I - Introduction and List of medical records and death certfiicates. Categories, and II - Tabular List of Inclusions (Tentative Edition).This document was then submitted for criticism and review to various Application of the International Lists agencies and individuals in Canada, the United The committee gave detailed consideration Kingdom and the United States.The British to this subject, being well aware that only Minister of Health appointed for this purpose uniformity in application can assure the full aspecialinvestigatingbody,theMedical benefit of the proposed system of classification. Advisory Committee on the Sixth Decennial It studied the problem of joint causes of death Revision of the International List of Causes as presented in the preliminary report of the of Death, composed of experts in medical UnitedStatesCommittee onJointCauses statistics and in various branches of medicine. of Death and endorsed the recommendations After making further modifications based on of this committee on the selection of the cause the amendments suggested by theBritish to be tabulated if multiple causes were stated committee and other bodies, the United States on the death certificate. committee met in Ottawa on io March 1947 In taking action on these recommendations, and approved a final draft of the proposed the committee drafted a form of medical certi- classification. fication of cause of death intended for inter- Duringitsfirstsession,thecommittee national adoption, accepted the form of mul- appointed by the Interim Commission reviewed tiple -cause tabulation suggested by the United the document of the United States committee States committee, and formulated rulesfor and prepared a modified version under the the selection of the underlying cause of death. titleInternationalStatisticalClassificationof Diseases, Injuries and Causes of Death. Shorter Lists for Tabulation On the recommendation of the committee, the Introduction and List of Categories of this The committeeconsideredtheneedfor classification was distributed to all governments shorterlistsserving special purposes where as the preliminary proposalforthe Sixth the tabulation according to the detailed list Decennial Revision.The replies received from would not be practical.Having defined the governments were then consideredatthe uses to be made of the detailed list and shorter second session of the committee, which drafted lists in the tabulation of mortality statistics, an amendedversionoftheClassification two listsof selected causes were designed : constituting the committee's definite proposal (i) Intermediate List of 150 Selected Cate- for the Sixth Decennial Revision of the Inter- gories for Tabulation of Diseases and national Lists of Diseases and Causes of Death. Causes of Death ; and In order to assure uniform assignment of (ii) Abbreviated List of 5o - Selected Cate- causes of sickness and of death to individual gories for Tabulation of Causes of Death. category- numbersoftheclassification,the committeecompiled,utilizingtheprepara- With regardtotabulationofmorbidity tory work done by the United States committee, statistics,the committee recommended that the Tabular List of Inclusions, a list of diseases the detailedlistor any convenient shorter and conditions to be classified in each of the list be used depending on the detail of the detailed categories of the classification.The desired information.Using as a basisthe preparation of an Alphabetical Index of the proposal of the Inter -American Committee on inclusion -terms was entrusted to the Index Social Security, it prepared, as one example, Sub -Committee 7 appointed on the committee's (iii) Special List for Tabulation of Morbidity recommendation. Statistics for Social Security Purposes. The International Statistical Classification of Diseases, Injuries and Causes of Death, as resulting from the second session, represented in its International Conference List of Categories the standard list for obliga- for the Sixth Decennial Revision tory use in the classification (coding) of causes The last stage of international clearance of of sickness and of death.This detailed list the proposed Classification was carried out by consistsof610categoriesofdiseases and theInternational ConferencefortheSixth morbid conditions, plus 153 categories for the Decennial Revision of the International Lists external causes of injury and 189 categories of Diseases and Causes of Death, convened for injuries according to the nature of the by the French Government from 26 to 3o April lesion.A more extended code, consisting of 1948 inParis.The conference, which was subdivisions of the obligatory list, is provided attended by 29 States, approved, with minor (in the Tabular List of Inclusions) for optional reservations, the new classification as well as use by countries and agencies interested in several recommendationsofthecommittee further detail.The Tabular List of Inclusions, concerningother problems with a bearing indicating the content of the categories, and on the international comparability of morbidity the Alphabetical Index assist in the uniform and mortality statistics.A third session of the committee was held immediately after the 9 For membership, see table XII, p. 83 conference to incorporate changes in the Lists

29 HEALTH PROBLEMS CONSIDERED

as suggested by the conference.The Lists Proposed Expert Advisory Committee on resulting from the third session are to be sub- Health Statistics mitted to the first Health Assembly with the The committee finally stressed the need for recommendation that regulations be adopted a permanent committee on health statistics to ensure the compilation and publication of to deal with problems arising from the practical statistics according to the revised lists. applicationoftheInternationalLists,to The final versions of the Lists are to be stimulate and co- ordinate studies contributing published as an international manual in several to the improvement in international compara- languages incorporating the classification, special bility of health statistics, and to act as the lists for tabulation, and the procedures to be consulting body on statistical methods to WHO followed in the assignment of causes of death. and its various technical committees.

Malaria The Interim Commission decided that malaria chloroquine was formulated and was put into was sufficiently important to warrant imme- effect during the summer of1947,by Dr. M. diate action, and accordingly, appointed an Ciuca in Roumania.Dr. Ciuca later submitted Expert Committee on Malaria,8 consisting of a report on experiments with paludrine in the four members,9 to study and advise on this causal prophylaxis of infections induced with problem. P. falciparum, and progress reports on treat- The initial terms of reference of the committee ment with paludrine.18 were to advise the Commission on the general The committee also recommended that assist- problem of malaria and to make recommen- ance should be given to Roumania in controlling dations to the first World Health Assembly the malaria epidemic in the Tulcea region, and concerning the creation of a malaria committee that the Secretariat should collect more complete and the programme of work of such a commit - information and should approach the League tee,10 but these terms were later extended to of Red Cross Societies on thequestionof include advice on a general plan for world mala- supplies of antimalarials and insecticides.As a ria- control and on the part that WHO could play result of this approach, large supplies were sent in the execution of such a plan" Furthermore, to Roumania by several Red Cross and . Red the committee was asked to make recommen- Crescent societies. dations on technical problems relating to the It was decided that the second session of the use of insecticides and chemotherapeutics in committee would be held in Washington, D.C., malaria control, and to consult with the Fourth in connexion with the Fourth International International Congress on Malaria on these Congresses on Tropical Medicine and Malaria. subjects. An exhaustive account of the eradication of The Commission responded to the interest Anopheles gambiae from Upper Egypt was which FAO showed in malaria control in a received from Dr. Shousha Pasha.1ó number ofcountries where thediseaseis regarded as one of the main factors affecting Advisory Visits and Inquiries agriculturaldevelopments by invitingthat organization to be represented in the Expert In May -June1947,the secretary of the Committee on Malaria.12 committee visitedGreece and Italy,where missionsoftheInterimCommission were functioning, in order to study the programme Technical Studies and Recommendations that the respective governments have adopted for malaria control or for eradication of anophe- At itsfirst session in Geneva, from 22 to lines (as in Sardinia).A report on this mission 25 April1947,the committee prepared a report 13 was circulated to members of the committee. to the Commission, in which it was recommended In March1948,following a request from the that the first Health Assembly should appoint Government of Poland, the secretary went to a malaria committee.The terms of reference, Warsaw to discuss, with relevant authorities constitution and functions of this committee were of the Ministry of Health and with the specialists outlined, and it was also recommended that the of the State Institute of Health, a plan for malaria committee should draft the new statutes of the control in Poland, where malaria has spread Darling Foundation and nominate the recipient over most of the country since the second World of the Darling medal and prize to be awarded War. by the Assembly. The Secretariat also undertook inquiries on The report also contained technical sections malariaincidence and malaria- controlpro- on the chemotherapeutic control of malaria grammes in variouscountries, and made a and on DDT.14 An experimental scheme of survey of methods of testing residual toxicity prophylaxis and treatment with paludrine and

12 Ibid. 7, 254 8 Off. Rec. WHO, 4, 167 13 Ibid. 8, 8 9 For membership, see table XII, p. 84 14 Also published in Bull. WHO, 1948, i, 21 111 Off. Rec. WHO, 5, 52 13 To be published in Bull. WHO, 1948, i 11 Ibid.7, 254 18 To be published in Bull. WHO, 1948, z

30 HEALTH PROBLEMS CONSIDERED and of results obtained in malaria control by lent by the Rockefeller Foundation to the residual indoor spraying with DDT.17Docu- Commission,closelycollaborated,withthe ments on malaria- control operations in Italy, assistance of another sanitary engineer and an Greece and Cyprus, and memoranda on contem- aircraft mechanic, in the campaign undertaken porary malaria -conditions and on experiments with DDT on anationalscale.18Reports being carried out in various countries were received by the end of 1947 indicated that all prepared by the Secretariat for the committee. villages in malarious areas to which access was On the invitation of the United States Govern- possible had been treated by residual spraying, ment, the Commission decided to be represented and that marshy areas had been similarly sprayed at the Fourth International Congress on Malaria by the seventeen aircraft specially equipped for in Washington. Dr. A. Gabaldán, chairman the purpose.19Reports also indicated a pro- of the committee, and Dr. E. Pampana, its gressive loweringofmalaria- incidence.The secretary attended.Dr. Pampana prepared an campaign for 1948 began well, in spite of dis- address to the Congress on the subject of " Ma- turbed conditions. laria as a problem for the WHO ". In Italy, the mission maintained close contact The Executive Secretary of the Congress with governmental agencies with a view to kindly agreed to organize an informal meeting ensuring,fromthe" Lira Fund "budget of all the malariologists attending, so that the resulting from the sale of UNRRA goods, the committee might have the benefitof their necessary funds for the five -year anti -malaria views on the problems entrusted to it by the programme and for the anopheles- eradication Commission. scheme in Sardinia. 20 A three -months fellowship was offered to an Italian malariologist of the Field Services (UNRRA Funds) State Institute of Health, Rome, who visited Belgium, France and the United Kingdom. The missions of the Interim Commission in In Ethiopia, a sanitary engineer specially various countries gave support, including techni- trained in malariology organized a preliminary cal assistance, to anti -malaria programmes.In investigation on spleen and parasite -rates of Greece, Colonel D. E. Wright, a sanitary engineer children in Addis Abeba.

Biological Standardization In 1921, the Health Organization of the market ;anditenabled manufacturersto League of Nations decided to study the possi- express the potency of products marketed in bilities of establishing international standards different countries in the same units. for certain substances which could be assayed At the outbreak of war, 31 substances assayed only by biologicalmethods. A permanent by biological methods had been thus standar- commission was appointed in 1924 to adopt dized.They comprisedtheprincipalsera, international standard preparations and to de- tuberculin, four of the vitamins, pituitary and fine units of activity.In 1935, an inter- govern- steroid hormones, insulin,digitalis, ouabaine mental conference was attended by members and the arsphenamines.During the war, three from 24 countries, and the obligatory use by all new substances - heparin, vitamin E and countries of international standard preparations penicillin - were added to the list. and units was recommended. A year later, no The International Health Conference having less than 36 countries had officially adopted resolved to continue the technical work of the these standards.The conference also considered Health Organization of the League, the Interim it essential that each country should possess an Commission decided to establish an Expert officially recognized centre with a trained staff Committee on Biological Standardization, com- in charge of the storage and distribution of the posed of a maximum of eight members.21The international standards.The burden on the committee was to advise the Commission on the twocentrallaboratories,theStateSerum international standards and units which were Institute, Copenhagen, and the National Institute most urgently required.22 for Medical Research, London, was, in this In December 1946, the Secretariat sent to the way, to be relieved, since they would need only members of the committee 23 a note reviewing to maintain stocks of standard preparations at the existing international standards and contain- a single agency in each country. By 1939, ing proposals for future action.The necessity 57 such centres had been created in 38 countries. was emphasized for reaching some degree of Biological standardization proved useful in standardization of vaccines and toxoids and of three respects : it placed in the hands of clinicians establishing an international standard for strep- weapons of well -defined calibre and range ;it tomycin.Amongst other subjects considered supplied health authorities with measures of the worthy of review were tetanus and gas -gan- valueof biological products placed on the grene antitoxins, antivenins, antianthrax and antityphoid sera, tuberculin, neoarsphenamine, 17 To be published in Bull. WHO, 1948, i 18 Bull. WHO, 1948, I,197 21 Ibid. 4, 164 18 Chronicle WHO, 1947, i, 182; Off. Rec. WHO, 6, 50 22 Ibid. 5, 52 20 Off. Rec. WHO, 6, 51 28 For membership, see table XII, p. 84

31 HEALTH PROBLEMS CONSIDERED vitamins A, D and K, and the anterior- pituitary- Following the cholera epidemic in Egypt, lobe hormones.On the basis of this note, the Dr. Shousha Pasha requested that anticholera agenda of the first session 24 of the committee, agglutinating sera should be made internatio- held in Geneva, 9 to 13 June 1947, was framed. nally available as an aid to diagnosis.It was, A second session was held from 18 to 23 March however, considered more expedient to establish 1948.25 a preparation of O antigen, suitable for the immunization of rabbits, in order to produce National Control Centres antisera capableofdistinguishing thetrue The committee re- emphasized the principle cholera and the El Tor strains from other cholera - that each country should have a single national likevibrios.Furthermore,tofacilitatethe centreforthestorage and distributionof differentiationof Inaba and Ogawa strains, international standards. monospecific agglutinatingseraofthe two The resultsof an inquiry made by the types should be prepared in India and held by Secretariat showed that 26 of the national the State Serum Institute, Copenhagen, for centresexistingbeforethe war werestill distribution. functioning.It was agreed that, in countries where no centreexisted,health authorities Tuberculin would have to be approached with a view to In 1931, an international standard for old establishing such centres. tuberculin was adopted - the unit being left undefined.The moment seemed opportune for Toxoids assigning a unit of activity to this preparation, A highly purified diphtheria toxoid has been and it was accordingly proposed that this unit obtained by a new method involving the use of be defined as the activity contained in 10 micro- benzoic acid.It was agreed that a toxoid grams of the international standard preparation. sample so prepared should be distributed to The committee,atitsfirstsession,had various laboratories in order to determine its recognized the necessity for establishing a sepa- suitability as a reference preparation. Should rate international standard for thePurified these tests prove the material to be satisfactory, Protein Derivative (PPD), obtained from Myco- its adoption as the international standard would bacterium tuberculosis. A batch of PPD prepar- be considered. ation had been previously selected and retained A similar procedure would in all probability to serve as the standard, should it prove suitable. be followed with regard to tetanus toxoid.In Comparative assays, however, showed that this view of the accumulated evidence of the hetero- material possessed excessive sensitizing proper- geneity of tetanus toxin, a property of signi- ties, and, at its second session, the committee ficance in the assay of the sera, it seemed desirable therefore rescindeditsprevious decision to that this toxin should be further analysed from establish a PPD standard.Nevertheless,it a chemical, physical, physiological and immuno- entrusted the State Serum Institute, Copenhagen, logical standpoint. with the distribution of a new preparation as free as possible from sensitizing properties for Cholera Vaccine the purpose of comparative tests. The consideration of the possible establishment of a standard for this vaccine was referred to the BCG committee by the Expert Committee on Quaran- tine during the Egyptian cholera epidemic in The committee considered the establishment October 1947.26 Before endeavouring to establish of a BCG standard premature, but, in view of a standard vaccine, the committee considered the necessity for uniformity with regard to the that further information was required regarding vaccines in current use, it recommended that the relation between immunizing potency in the original BCG strain kept at the Institut animals to that in man.The hope was therefore Pasteur, Paris, should be made available to all expressed that the health authorities in India countries, and that the preparation and utili- would provide all facilities to Sir Sahib Singh zation of the vaccine in each country should be Sokhey, for the carrying -out of the inquiries on centrally co- ordinated. this subject that he was about to undertake. In the meantime, the committee entrusted Other Antigens Dr. M. V. Veldee with the preparation of vaccines It was considered impracticable as yet to from the Ogawa and Inaba strains which, after standardize pertussis,plague,smallpox and having been examined for stability in different yellow -fevervaccines.Nevertheless, progress laboratories, would be held for distribution by would be greatly facilitated by exchange of the the State Serum Institute, Copenhagen, for relevant strains. comparative tests.In order to facilitate the As regards yellow -fever vaccine, the committee use of these vaccines in assays of activity, the felt that close consultative liaison should be Kasauli Institute would hold freeze -dried living established between the Yellow Fever Panel Ogawa and Inaba cultures at the disposal of and the committee, particularly with regard interested workers. 25 Report not yet published or considered by Com- 24 For report, see Off.Rec.WHO, 8,5; and mission at the time of going to press Bull. WHO, 1948, z, 7 26 Seepp. 35, 48

32 HEALTH PROBLEMS CONSIDERED

to the minimum requirements for yellow -fever tially pure sample of penicillin K (IV) should vaccine intended for use in conformity with the be set up as a reference preparation. international sanitary regulations. Streptomycin Streptococcus Antitoxin In view of the impossibility of adopting as An attempt to standardize this serum had to yet a standard, the committee limited itself to be abandoned in 1928, owing to lack of a setting up a reference preparation.The acti- sufficientlyaccuratetest -methodandthe vity was to be expressed both as milligram - existence of patent rights covering production. equivalent of pure streptomycin, and in provi- Today these patents have expired and a satis- sional units, which should have substantially factory method of assay has been evolved, the same value as the S unit originally proposed enabling a further review of thisquestion. by Dr. S. Waksman. Samples of sera possessing high immunizing and flocculating potency would be examined Vitamins in different laboratories with regard to their Recent progress in research would necessitate suitability to serve as international standard the future replacement of existing standards preparations. for fat -soluble vitamins A and D by purer preparations (esters of vitamin A and vitamin Digitalis D3).This task was entrusted to a sub- commit- tee which was to meet in the autumn of 1948. The stock of international standard of digitalis purpurea being almost exhausted, the depart- Blood -groups ment of biological standards of the National ABO system.The committee having decided Institute for Medical Research, London, had to establish international standards for anti -A collected samples of powdered digitalisleaf and anti -B agglutinating sera, large batches from Switzerland, the United Kingdom and the of pooled natural and stimulated material for. United States.As the mixture had proved each group had been collected in the United suitable for use as a standard preparation, it Kingdom and the United States.The pooled would be distributed to seventeen laboratories preparations, if proved suitable by concerted in the following countries :Canada, France, tests in different laboratories, would serve as Hungary, India, Netherlands, Sweden, Switzer- international standards for these two sera. land, the United Kingdom and the United Rh system.It was arranged that the pro- States, for collective assay to determine the blem of the Rh antigens should be examined unitage to be assigned to this new standard by a sub -committee which would advise on preparation. the selection and designation of the sub -groups for which international standards were re- Penicillin quired. The penicillin standard established in 1944 consisting of crystalline penicillin G (II) had International Salmonella Centre shown itself to be satisfactory from all points The committee recommended that the Centre of view.In spite of recent progress achieved established in 1938 at the State Serum Insti- in the identification of the different penicillins, tute, Copenhagen, should be taken over by any modification of the present standard was WHO.If so desired, its field of activity could considered unjustifiable.On the other hand, be extended at very little extra cost to cover the committee recommended that a substan- other species of enteric bacteria.

Tuberculosis As in the case of malaria, the Commission improvement in the situation could be expected early decided that an expert committee should without an increase in their numbers. be appointed to advise on tuberculosis.27Two It was therefore agreed that one of the sessions of this committee 28 were held, the first important functions of WHO should be to in Paris from 3o July to 2 August 1947, and the provide travelling fellowships,principally to second in Geneva from 17 to 20 February 1948.29 train medical officers in administration, epidemiology, and laboratory and clinical work. An International Campaign The number of fellowships which should be The work of the Expert Committee on Tuber- provided by the organization during the first culosis was based on the recognitionthat year was estimated atfifty,fellowships for tuberculosis had reached epidemic proportions, experts and senior workers being'given :priority. and that international measures were urgently In this connexion, the need was stressed for needed in addition to national efforts. impressing national health -administrations with There were not enough trained doctors and the great advantages of releasing key- workers other medical workers in the wide areas where for relatively short periods of time for study. tuberculosis was rampant, and no substantial 29 For report on first session, see Off. Rec. WHO, 8, 27 Off. Rec. WHO, 5, 137 49 ;report on second session, not yet published or 28 For membership, see table XII, p. 84 considered by Commission at time of going to press

33 HEALTH PROBLEMS CONSIDERED

In every case, there should be assurance that the Expert Committee on Biological Stan- selected candidates would return to positions dardization and with representativesofthe of responsibility in tuberculosis control in their United Nations International Children's Emer- own countries. gency Fund (UNICEF),inthe large -scale Another function of WHO, serving the same tuberculin- testingand BCG campaign now purpose, would be to provide demonstration being carried on in several European countries,31 field -teams to various countries on request. involving thetuberculin- testingofapproxi- Their size and the length of their stay should mately 5o million children and the BCG vaccina- always be kept to a minimum, and such teams tion of about 15 millions in Europe.As an should, in the opinion of the committee, be interim body, the Commission did notfeel replaced on their departure by national training - able to accept any responsibility for the field- centres. work, but it agreed to supply expert statistical An important problem considered was the and technical advice to UNICEF and to other lack of uniformity in procedure and technique bodies involved in the programme 32 in bothclinical and laboratory aspectsof anti -tuberculosis work.There was urgent need for standardization, and the committee believed Studies and Visits that WHO could help to develop uniform procedures in the preparation and use of tuber- Memoranda were prepared by the Secre- culin and BCG, the classification of tubercu- tariat on the following subjects : losis,x -ray interpretation and mass radio- i. Mortality -rates and other data concerning graphy, the laboratory identification of tubercle tuberculosis in different countries ; bacilli, and, finally, in the evaluation of new chemotherapeutic agents such as streptomycin. ii. Race and nativity in tuberculosis ; This last subject was considered of particular iii. Morbidity ; tuberculin- testing, mass radio- urgency,andthecommittee recommended graphy and epidemiological surveys ; the holding of a conference to consider pro- iv. The role of certain environmental factors blems of the clinical use of the new antibiotic. in the causation of tuberculosis : climate, It was agreed that the one means by which density of population, employment ; econo- WHO could help national campaigns against mic position of the people ; tuberculosis was by giving advice on the v. Organizationoftuberculosisservices : number, type and location of facilities needed. finance and administration, bovine tuber- Mass -radiography equipment should not be culosis, notification, propaganda and edu- procured until there was definite provision for cation, dispensary services ; fullclinicalinvestigationofthosepersons vi. Institutional care and rehabilitation. with abnormal radiographic findings.In some At the same time, a questionnaire for investi- countries it would be necessary to provide cheap gation of the problem of tuberculosis in any temporary buildings for housing beds for the given community was prepared, and data were treatment and isolationof the . tuberculous. received from several countries. ti Tuberculosis among immigrants appeared to Thesecretaryofthecommitteevisited be another important international problem, and Prague in September 1947 and discussed with the committee urged that medical examina- several officials some aspects of the tubercu- tions be made at the point of departure.Such examinations should include a chest radiogram losis problem in Czechoslovakia.Literature was supplied to the Czechoslovak Government. to be interpreted by a medical officer acceptable In December 1947, a visit was made to the to the government receiving the immigrant. Italian National Conference on Tuberculosis, Other forms of participation of WHO in the and an interview held with Professor A. Cocchi common fight against tuberculosis might be in Florence on streptomycin. financial grants to governments and distri- Epidemiological data were supplied to the bution of information on recent developments Association suisse contre la tuberculose, and of special importance.The committee strongly articles on differentaspectsoftuberculosis recommended the intensification and extension were provided to the League of Red Cross oflaboratory andfieldstudiesindifferent Societies,theJewishOrganizationforthe countriestodeterminethe main nutrition factors influencing susceptibility to tuberculosis. Care of Children (OSE), and to the Preparatory Commission for the International Refugee Organ- The report on the first session of the committee ization (PCIRO). was accepted, with minor reservations, by the Contacts were maintained with the Inter- Commission.The proposed conference on strep- national Union against Tuberculosis, and the tomycin was approved, and it was decided secretary of the committee attended a meeting that it should be held in New York in July 1948. in Paris in July 1947 to discuss possible methods It was also agreed that a special committee of co- operation. on tuberculin and BCG should be established.3° Arrangements were initiated for the appointment of specialists to act, in co- operation with la Albania, Austria, Bulgaria, Czecoslovakia, Finland, France, Greece, Hungary, Italy, Poland, Roumania, and Yugoslavia 80 Off. Rec. WHO, 7, 226 32 Off. Rec. WHO, 7, 98

34 HEALTH PROBLEMS CONSIDERED

Field Services (UNRRA Funds) Eleufsis near Athens was the latest project undertaken by the Commission in Greece. An epidemiological unit was set up in Shanghai, In Italy, the " Lira Fund ", resulting from China, with mass -radiographical examinations, the sale of UNRRA goods, was providing for tuberculin- testing, and BCG vaccination to be the completeorpartial equipmentof 152 undertaken by Interim Commission experts in dispensaries,for12,595additionalhospital- associationwithChinesemedicalofficers 33 beds, new x -ray apparatus, and a comprehensive Arrangements were initiated for the establish- educational programme overthe nextfive ment of similar units in Peiping, Tientsin and years.Frequent interviews took place between Ningpo.Lectures were given to groups of officials of the Commission and representatives doctors and students.An anti -spitting cam- of the Italian Government on these matters. paign wasinitiated and a nationalanti- The totalcostof these improvements was tuberculosis league founded. estimated at nearly two and a half billion lire. Chinese doctors were given scholarships to Dr. I. A. B. Cathie (London) and Dr. O. Turning study in the United Kingdom, and a team (Copenhagen)wereinvited by theItalian of three doctors was sent to Copenhagen to be Government to speak on streptomycin and trained in the technique of preparation and use artificialpneumothorax respectively. These of tuberculin and BCG.There was sufficient visits were made possible under the Commis- equipment in China to establish eight mass - sion's lectureship scheme. . radiography centres in 1948. In Poland, a scheme for tuberculosis control In Greece, the Commission's medical and in the city and province of Lodz was prepared technical services were used in opening a sana- by the Secretariat and accepted by the Polish torium for 267 patients in the Peloponnesus. Government and other interested organizations. The scheme was originated by UNRRA but This project was intended to serve as a model was supervised by officers of the Commission. for the country as a whole, and included provi- In the Dodecanese, assistance was given in the sion for dispensaries, more -accurate statistical opening of a new sanatorium, a dispensary and services,healthinsurance,etc.An x -ray a preventorium.The foundation of a new technician was lent to the Polish authorities.3" chest hospital in Athens was initiated as a Arrangements were made for a small team result of efforts made by the Commission and to proceed to India in May to begin tuberculin - by Greek physicians in 1946 and 1947.It testing and BCG vaccination at the request of was anticipated that seven more mass- radio- the Indian Government, which agreed to send graphy sets would soon be in use in Greece and Indian tuberculosis workers for special study that, by the end of 1948, nearly 250,000 people in Europe, so that, when the Commission team would have been examined by this method. had finished its work, the Indian team would A nursing adviser, in addition to giving general be able to continue on the same lines. advice on nursing policy, completed a course At the request of the Ethiopian Government, on tuberculosis nursing for some 25o practical arrangements were made for a member of the nurses in two sanatoria. A complete survey Secretariat to visit that country in May 1948 of the more vulnerable groups in the town of to give advice and assistance.

Quarantine

TheadministrationoftheInternational tions were considered to be adequate.The Sanitary Conventions of 1926 -1938, of 1933 and apparently considerable differences in the con- of 1944 was vested in July 1946 in the Interim centrationof organismsintheanticholera Commission, in virtue of Article 2 e and / of the vaccines supplied to Egypt from abroad resulted Arrangement of 22 July 1946, and the Commis- in the committee's referring the matter of sionappointedanExpertCommitteeon cholera- vaccine standardization to the Expert Quarantine to advise on questions arising out Committee on Biological Standardization.3s of the interpretation and application of the The forms of international certificatesof conventions 35 inoculation and vaccination and the question The committee consisted of eight members oftheir endorsement were referred tothe drawn from countries particularly interested Expert Committee on International Epidemic in maritime and aerial traffic 36 Control.4o Thecommittee'sfirstsession,convened Although in the International Sanitary Con,- urgently because of the cholera epidemic in ventions of 1944 a period of 10 days is regarded Egypt,37 was held in Geneva from 13 to 16 assufficiently long for the development of October 1947.38 immunity after yellow -fever inoculation, certain For the international control of cholera, the countries base their quarantine requirements measures prescribed in existing sanitary conven-

87 For an account of emergency services during the 83 Off. Rec. WHO, 6, 49 ; Chronicle WHO, 1947, I, 177 cholera epidemic, see p. 47 84 Chronicle WHO, 1948, 2, no. 6 88 For report, see Off. Rec. WHO, 8, 27 88 Off. Rec. WHO, 4, 167 88 See pp. 32, 48 88 For membership, see table, XII, p. 84 48 See p.39

35 HEALTH PROBLEMS CONSIDERED

on a period of 15 days.The committee there- Fever Panel was appointed to assist the com- fore decided to request the Commission to mittee in this respect.43 entrust the Yellow Fever Panel with the task The panel consisted of eight members and of making the studies necessary to determine included experts on matters relating to the objectively the time required for obtaining production and testing of yellow -fever vaccine, effective immunity. and others with special experience infield- The committee further recommended approval work and in the delineation of yellow -fever by the Commission of the ten laboratories already endemic areas.49 approved by UNRRA for testing the activity It was not intended that the panel would of yellow -fever vaccines, and also recommended meet as a body except in special circumstances, that the yellow -fever vaccines produced by the but that each member would be available for seven UNRRA -approved institutes should con- consultation on problems coming within his tinue to be so recognized ad interim, but that special competence. the measures already decided upon by the Matters on which the panel was consulted by Commission41 for systematic international testing the Secretariat included :the practicability of should be put into force as soon as possible, so as having regular tests carried out on all yellow - to ensure maintenance of the activity of all fever vaccines approved for international use, yellow -fever vaccines in international use. thereby ensuring maintenance of the standard In addition,the committee recommended degree of activity in such vaccines ;the ini- methods for the disinfection of aircraft, the use tiationofstudiesnecessarytodetermine of 17 D vaccine in the case of infants transported objectively the time required for obtaining effect- from areas of yellow -fever endemicity to non - ive immunity after protective inoculation against endemic areas, and the abolition of billsof yellow fever ; the need for a revision of the ende- health and consular visas.It also reaffirmed mic yellow -fever areas in Africa and in South the undesirability of issuing deratization- exemp- America as delineated by UNRRA in 1946 ; tion certificates to ships with loaded holds. and the application made by the governments In connexion with the administration of the of Singapore Colony and the Malayan Union sanitary conventions, the Secretariat received for recognition, by the Commission,of the complaints lodged by 17countriesagainst Institute for Medical Research, Kuala Lumpur, restrictive measures taken by 25 other countries as an institute approved for the carrying -out of in excess of the provisions in any of the conven- potency -tests on yellow -fever immunizing vac- tions in force.42 cines, under Article 36 (II) of the International These complaints were immediately made Sanitary Convention for Aerial Navigation, 1944. known to the governments concerned, and in Inaddition,theSecretariatcircularized certain cases the result was an alteration of the governments concerned in the administration measures imposed. of territories in Africa and on the north -east International inquiries were also instituted coast of South America (British Guiana, Surinam by the Secretariat on the following subjects andFrenchGuiana)whichweresituated relatedtoquarantine :significanceofthe withintheboundariesoftheyellow -fever " immune reaction " after revaccination against endemic areas, on the question of revising the smallpox; 43 prevalence and prevention of post - delimitationoftheseareas.Similarly,the vaccinal encephalitis ; 44 list of ports accepting advice of the Director of the Pan American quarantine messages by wireless ;list of ports Sanitary Bureau was sought as regards endemic qualified to carry out deratization of ships areas in the western hemisphere. and to issuederatization and deratization- exemption certificates ; authorities for the issue Post -vaccinal Encephalitis of valid international certificates of inoculation At its session in October 1946, the Comité against yellow fever ; quarantine measures taken permanent of the Office International d'Hygiène by governments to avoid the introduction and Publique decided to pass to the Interim Com- spread of psittacosis within their territories ;45 mission a number of urgent items on its agenda; so aircraft -disinsectization procedure followed by among these items waspost- vaccinal encephalitis. governments ; methods of estimating rat- infes- The Secretariat was instructed by the Com- tation on ships ; 46 sanitary conditions of the missiontodispatchtoallgovernments a 1946 Mecca pilgrimage 47 circular letter containing a request for recent data and publications on the complication in Yellow Fever Panel respect of their territories.The results of this Asthe terms of reference of the inquiry up to 31 December 1947 were published, Expert Committee onQuarantineincluded together with the information originally in the work relating to yellow fever and its control possession of the Secretariat.51 under the International Sanitary Convention for Aerial Navigation, 1944, a special Yellow 48 See Bull. WHO, 1948,i,63 47 See p. 4o 41 Off. Rec. WHO, 6, 18o 48 Off. Rec. WHO, 4, 267 42 Seepp. 39, 48 as For membership, see table XII, p. 84 ssSee Bull. WHO, 1948, z, 29 5° Off. Rec. WHO, 5, 128 " See below 51 Ibid. 5, 129 ; " Seep. 37 Bull. WHO, 2948, 1, 36

36 HEALTH PROBLEMS CONSIDERED

In view of the fact that its etiology remained The Interim Commission considered a memo- obscure and that infallible methods of prophy- randum b2 prepared by the Secretariat, referring laxis and treatment were lacking, post- vaccinal to the history, occurrence and cause of psitta- encephalitis continued to be the subject of cosis, and, based on the results of the 1936 investigation by the Commission. inquiry, indicating the nature of the quarantine restrictions then imposed by various countries. Thereafter, the Commission, with a view to Psittacosis ascertaining the existing situation as regards psittacosis, instructed the Secretariat to com- As psittacosisisusually contracted from municate the memorandum to all governments recently imported birds, a number of countries, and to request from them data concerning the in consequence of its - prevalence in 1929 /30, incidence of the disease within their territories took quarantine measures to avoid the intro- and the regulations in force against the impor- duction and spread of this disease, either by tation of birds capable of carrying the virus. prohibiting or regulating the importation of Analysis of 32 replies received on or before birds of the order Psittaci - parrots, parakeets, 1 April 1948 showed that 20 countries enforced budgerigars,macaws, cockatoos,bories,etc. quarantine restrictions.In only three territo- From an inquiry made in 1936 by the Office ries had human incidence been reported in International d'Hygiène Publique, it emerged recent years, although the disease continued to that at that time 16 countries had taken such be enzootic in several countries in psittacine measures. birds, finches, and pigeons.

Unification of Pharmacopoeias A unified system of nomenclature of drugs, technical commission and to produce a draft providing that the same name should represent international agreement for the unification of in all countries a preparation of the same strength pharmacopoeias, modifying and extending the and composition,isan urgent need which existing Agreement for the Unification of the could best be filled by the establishment of Formula of Potent Drugs, and to present the aninternationalpharmacopoeia.Thisidea draft agreement as an international pharma- was expressed for the first time in the preface copoeia, similar in form to national pharma- to the French Codex of 1866 and steadily copoeias.It was understood that such an inter- gained ground until the first Convention for national pharmacopoeia could have no authority the Unificationof the Formula for Potent in any country until it had been adopted offi- Drugs was finally adopted in 1906. cially by that country. A second international agreement was signed Thirtydraftmonographs werediscussed in 1929 at Brussels by 26 countries.Article 35 and accepted at the first session of the committee, of this agreement stipulated that the Belgian and a list of 543 drugs was divided into three Government shouldenterintonegotiations categories : 248 drugs were deemed of primary with the League of Nations for the constitu- importance for immediate attention, 90 drugs tion of a permanent secretariat for pharma- did not need immediate attention, and 205 copoeias, the Belgian Pharmacopoeia Commis- needed no further consideration. sion being provisionally entrusted with the The drafting of the monographs forthe work of the proposed secretariat. drugs warranting immediate attention, and the In 1937, negotiations between the Belgian experimental investigations,thereby necessi- Government and the League of Nations resulted tated, were allocated among the members. in the appointment by the latter of a Technical The Secretariat was entrusted with the task Commission of Pharmacopceial Experts to deal of obtaining legal advice on the inclusion of with general rules of nomenclature, usual and proprietary drugs and the use of trade names maximal doses, and monographs on important in the international pharmacopoeia. drugs. The committee also recommended that the To continue the work of the League's com- Executive Secretary be empowered by the mission,the Interim Commission appointed Commission to enter into negotiations with an Expert Committee on the Unification of the Belgian Government for the establishment Pharmacopceias.63 of a single international secretariat for pharma- The committee 54 held itsfirstsession in copoeias, under the agis of the World Health Geneva from 13 to17 October 1947.Its Organization.The report 55of the first ses- object was to review the work of the League's sion of the committee was accepted by the Commission.68

52 Off. Rec. WHO, 6, 186 52 Ibid. 5, 137 55 Off. Rec. WHO, 8, 54 54 For membership, see table XII, p. 85 55 Ibid. 7, 253

37 HEALTH PROBLEMS CONSIDERED

Venereal Diseases The Commission, having decided that the the treatment of venereal diseases, the pro- problem of venereal diseases required urgent duction of penicillin was limited to a few attention67 established an Expert Committee countries, and current requirements could not on Venereal Diseases 68, requesting that " a survey be met. with regard to scientific,practical and other The committee recommended that measures aspects of the problem be pursued with a view should be taken to encourage production of to developing practical plans for international penicillin and to ensure its equitable distri- combating of venereal diseases " and that it bution toallcountries.It recognized that should prepare a report for consideration by penicillin was often wastefully used, and stressed the Commission for eventual recommendation to the need for discriminating use of the drug. the first World Health Assembly. - Fellowships and demonstration units.In view Programme recommended of the shortage of trained personnel, WHO should provide a number of fellowships for At the committee'sfirstsession,held in training in various branches of venereal- disease Geneva from12to 16 January1948,69it was control, as well as field -units to visit countries recognized that, although venereal diseases had been the subject of international discussions on request for demonstrations and consultation. and action before the second World War, there Grants, advice and information.The com- was urgent needforfurtherinternational mittee recommended that financial support by measures in the light of new aspects of the WHO of research in venereal diseases should problem.The first of these was the greatly be confined to the study of significant pro- increased prevalence of venereal infections as a blems.Information on venereal diseases should consequence of the second World War, which be provided to health administrations, public - intensified the need for vigorous measures of health and venereal- diseasecontrolofficers, control on an international scale.The second specialists,andthemedicalprofessionin was the effectiveness of the treatment of some general.At a later stage, the requirements in venereal infections with recently introduced regard to information on venereal diseases for drugs, especially with penicillin. the general public might be studied. The committee recommended that priority Finally, WHO should be prepared to give in an international venereal- disease programme expert advice on various phases and methods should be given to syphilis, particularly in its of the control of venereal diseases, drawing on early stages. the experience of individual countries. The measures advocated may be summarized under five main headings. Internationalregulations. Thecommittee endorsed the principle of replacing diplomatic Serological standardization and other laboratory conventions in technical fields by international procedures.There was an urgent need for stand- regulations, which would not require the slow ardization of the several serodiagnostic methods and complicated machinery necessary for the in common use, and it was recommended that ratification of conventions. an international conference on serological standardization and laboratory aspects of syphilis Several governments had already suggested be called under the auspices of WHO in 195o the revision and extensionof the Brussels or later. A special sub -committee on serology Agreement of 1924 respecting facilities to be accorded to merchant seamen for the treatment and other laboratory procedures was suggested, of venereal diseases, and the committee sup- to undertake the preliminary work for such a ported these views. It was agreed that the new conference.Atleastonefirst -classcentral international regulations should be expanded serological reference laboratory should be at to include displaced persons, foreign labourers, the disposal of WHO, and the potential ser- butitwas vices of existing laboratories should be explored emigrants and other migrants, with a view to developing regional reference - recognizedthatseafarerswereparticularly exposed to risk of infection. laboratories. The committee decided that the new inter- Treatment andavailabilityofdrugs. The national regulations should embody the fol- committee also stressed the need for the inter- lowing basic principles : national evaluation of methods of treatment and for the adoption of reasonably accurate thera- 1.Medical examination, treatment and peutic techniques, but it recognized that the drugs, and hospitalization, where necessary, effectiveness of any large -scale plan for the should all be free. control of venereal diseases would be limited 2. Services provided should be of the by the quantities of medicaments available. highest professional quality, and treatment While sulphonamides were recognized to be applied should, wherever possible, follow the most widely available of all drugs used in such optimal treatment -schedules as might be recommended frqm time to time by WHO. 67 Off. Rec. WHO, 6, 190 58 For membership, see table XII p. 85 59 For report, see Off. Rec. WHO, 8, io6

38 HEALTH PROBLEMS CONSIDERED

3. An individual treatment -book should to discuss possible methods of co- operation. be provided free of charge to the patient. A visit was also made to the U.S. Zone of 4. An internationallistof treatment Germany and to Berlin, to study methods of centres, including facilities available in in- venereal -disease control in these areas. land towns as well as ports, would be ad- At the request of the Polish` Government, the vantageous. secretary of the committee visited Warsaw to 5. The epidemiological necessity for treat- discuss with specialists of the Ministry of Health ment of venereal diseases in their infectious a proposed plan for a mass attack on syphilis. stages is in the interest of the community This plan was approved by the committee and is concerned.A system of international con- now in operation. tact- tracingshouldthereforebeesta- At the request of the Ethiopian Government, blished, such that each country would agree the secretary of the committee visited Ethiopia to communicate confidentially, directly to to discuss the introduction of legislation and thepublic- healthauthoritiesofother venereal -disease control methods in that country. countries,the names and addressesof Liaison was maintained with the Interna- venereal- disease contacts, thus facilitating tional Union against Venereal Diseases, the rapid epidemiological investigations. Preparatory Commission for the International Refugee Organization (PCIRO), and the Inter- 6. A social- welfare worker should be nationalLabourOrganization(ILO),with available in every large port. special reference to seamen, displaced persons, In accepting the committee's report, the and migrants respectively.Discussions were Commission reaffirmed its belief that venereal carried out with and advice given, to the United diseases deserved a high priority among the NationsInternational Emergency Children's essential activities of WHO, and that, while it Fund (UNICEF) regarding its programmes for might be desirable to concentrate initially on the combating prenatal and infantile syphilis in public -health aspects of the problem, activities several countries. should be gradually widened and co- ordinated with social programmes of the United Nations and other international organizations.ó0It also Field Services (UNRRA Funds) recommended the establishment of an expert The Commission's field missions gave support advisory committee on venereal infections. ortechnicalassistancetovenereal- disease control programmes.In Italy, a programme Studies and Visits to be financed by the UNRRA "Lira Fund" The Secretariat collected information on the was proposed, but was not included in the nature and extent of venereal diseases, parti- finally approved expenditures from UNRRA cularly syphilis.The views of governments sources. In Poland, educational and other and of individual experts in various countries material was supplied to the Ministry of Health were obtained, as well as documents on the in connexion with the Polish anti -syphilis plan. incidence and control of venereal disease. Fellowships provided under the field -services The secretary of the committee visited Paris programme in 1947 included eight grants for the and attended the first post -war assembly of the study of dermato -venereology in Europe and International Union against Venereal Diseases the United States.

International Epidemic Control

Article 2 j of the Arrangement of 22 July 1946 three legal experts on proper procedure for the authorized the Interim Commission " to under- replacement of existing international sanitary take initial preparations for revising, unifying conventions by sanitary regulations 64 and strengthening existing international sanitary Governments were also invited to put forward conventions ". such amendments as they might wish to see The Commission accordingly appointed an introducedinexisting sanitaryconventions Expert Committee on International Epidemic and to make any suggestions which might guide Contro1,61 with the request thatitshould the committee inits work of revision.As, "examine the circumstances underlying the during the 1947 cholera epidemic in Egypt, the spread of the major epidemic diseases and... measures prescribed in the conventions were not re -study the principles which should serve as considered by certain countries to be sufficiently a basis for their international control ".62 comprehensive, the Secretariat was instructed to ask the governments of those countries to Preliminary Inquiries and Studies Before the Committee's first session in Geneva 68 Report not yet published or considered by Com- on 12 to 17 April 1948,83 the Secretariat consulted mission at time of going to press e4 J. Secretan, Legal Adviser, ILO ; J. D. Tomlinson, Assistant Chief, Division of International Organization 80 Off. Rec. WHO, 7, 255 Affairs, UnitedStatesDepartment of State ; 61 For membership, see table XII, p. 85 F. A. Vallat, Assistant Legal Adviser, Foreign Office, 88 Off. Rec. WHO, 6, 179 London

39 HEALTH PROBLEMS CONSIDERED state the scientific grounds on which they had disseminating urgent information on pestilential exceeded the conventions 86 diseases and particularly thepossibilityof The first session of the committee was also extending the system of broadcasting telegra- preceded by the meeting of three study -groups phic epidemiological bulletins. set up jointly by theOfficeInternational The committee also considered at length each d'Hygiène Publique and the Commission to of the pestilential diseases, and decided on provideexpertadviceonthepestilential principles to be followed in their control. Yellow diseases.66These groups made observations fever was referred for later discussion by the on recently establishedfacts which, in their Yellow Fever Panel.The views of experts on opinion, should be taken into consideration each disease were examined, proposed investi- in the drafting of international sanitary regu- gations which boredirectlyon quarantine lations, and undertook or recommended inves- practice were selected, and other lines of research tigations on points which, in this respect, still suggested both for the study -groups and for required elucidation. the Secretariat. As early as April 1947, a special sub -committee The committee decided to include louse - had met in Alexandria to study the revision of borne relapsing fever among the pestilential clauses in the international sanitary conventions diseases and to include cerebrospinal meningitis, relating to the Mecca pilgrimage.67 dengue fever, influenza and poliomyelitis among the diseases for which immediate notification must be made in case of an epidemic. Recommendations of the Committee It decided to refer to the Expert Committee on The committee agreed with the study -groups Biological Standardization questions relating to that protective measures taken by countries at standardsofvaccinesagainstcholera and their respective borders under existing inter- smallpox, and to the Expert Committee on national sanitary conventions were palliatives, Malariatherequest made by theItalian as effective international control of epidemics Government for special protective measures required,first,the delimitationof endemic against the re- introduction of anopheline mos- areas whence epidemicsofthepestilential quitos into Sardinia, an island from which the diseases originated and, secondly, an attack on malaria vectors had been eradicated. these endemic foci, with the technical help of The committee recommended that active WHO if needed. studies with a view to establishing international The committee considered the simplification standards for the disinsectization of aircraft and improvement of the present system of should be pursued.

Revision of the Pilgrimage Clauses Conferences held at Beirut and Paris, in 1929, On this occasion, however, the representative 1930 and 1931, sought to give satisfaction to of Saudi Arabia made observations and sugges- the various proposals or suggestions which had tions of a fundamental nature, and in 1939 the been laid before the Comité permanent of the delegate for the United Kingdom forwarded Office International d'Hygiène Publique (OIHP) certainpreliminaryproposals.These docu- - the sole international body at that time ments were referred by the Comité permanent of empowered to deal with matters affecting the OIHP to its Commission du Pèlerinage, but the international sanitary conventions.In October outbreak of war interrupted the preparatory 1938, a conference held in Paris authorized, work of that Commission. asa resultof the abolitionof the then - On the resumption of the meetings of OIHP existingcapitulations,thesubstitutionof in April 1946, the delegate from Egypt, supported the Egyptian Sanitary Administration for the by the delegates from Saudi Arabia and Syria, Conseil sanitaire maritimeetquarantenaire presented new proposals, which were referred d'Egypte. The textofcertainArticlesin by OIHP to the international organization Part III of the 1926 Convention was thereby destined to replace it. modified in form, but in substance remained Thus, the matter became the concern of the unchanged. Interim Commission, and, as it was urgent, the

'66 Off. Rec. WHO, 7, 253 Study -groupIII dealt with plague, typhus and 66 Aid. 7, 184 some diseases in respect of which measures on an Study -group I on cholera met in Paris from 5 to international level might be required.It met in Paris 7 April 1948.It included Dr. C. G. Pandit, Director, from 31 March to 3 April 1948 and included Dr. E. J.Y. KingInstituteofPreventiveMedicine,Madras ; Aujaleu, Directeur de l'Hygiène Sociale, Ministère de Dr. A. T. Shousha Pasha, Under -Secretary of State, la Santé publique et de la Population, Paris ; Dr. G: Ministry of Public Health, Cairo ; Dr. P. Bruce White, Blanc,Directeur de l'Institut Pasteur du Maroc, National Institute for Medical Research, London Casablanca; Dr. P. C. C. Garnham, Reader in Medical Study -group II on smallpox met in Paris from 8 to Parasitology, London School of Hygiene and Tropical 10 April 1948. It included Dr. E. T. Conybeare, Medical Medicine ;Dr. A. Macchiavello, United States Public Officer,MinistryofHealth,London ;Professor Health Service, representing the Pan American Sanitary A. Lemierre, Académie de Médecine, Paris ; Dr. R. E. Bureau ;Major - GeneralSirSahib Singh Sokhey, Muckenfuss, New York CityHealth Department Director, Haffkine Institute, Bombay Laboratory ; Dr. C. G. Pandit, Director, King Institute 67 See below of Preventive Medicine, Madras

40 HEALTH PROBLEMS CONSIDERED

Commission established, pending a meeting of be adapted to modern conditions and adding the Expert Committee for the Revisionof newarticleswherenecessary. Thesub- existing International Sanitary Conventions,68 committee's work, summarized initsfinal an Expert Sub- Committee for the Revision report," permitted the drawing -up of draft of the Pilgrimage Clauses of the International regulations for the control of the pilgrimage, SanitaryConventiotis.69Thesub -committee revising the provisions contained in Part III consisted of six members,70 drawn . from the of the 1926 Convention and intended to form countries directly concerned (Egypt, France, an annex to the future general convention. India,Netherlands,Saudi Arabia, and the The draft regulations' contained not only United Kingdom) to consider the clauses relating articles governing the sanitary control of trans- to the control of the Mecca pilgrimage. port by sea, but also special sections on the The terms of reference given to the sub- sanitary measures to be taken in connexion committee, of a technical nature only, were thus with transport by air and by land. summarized : 71 The provisions adopted by the sub -committee " (a) Need for taking, in respect of all had for their principal aims the following : pilgrims leaving their country of origin, i) to secure the sanitary defence, not every possible measure to ensure individual only of Western countries, but Tof the and collective protection against disease Hedjaz itself, against the danger of spread of (inoculations and vaccinations, disinfection, epidemic disease, consequent on the move- disinsectization,biologicalexamination, ment of pilgrims of such diverse origins : etc.) and the need for official certification to save the pilgrims from undergoing that such measures have been adequately unnecessary or obsolete formalities, such carried out ; as periods of observation, the value of " (b) Determination whether the sanitary which was questionable ; installations and equipment of the Hejaz iii) to improve the condition of pilgrims' are capable of carrying out the measures transportation, particularly by the installa- proposed by Egypt and Saudi Arabia ; tion of berths on board ship ; (c) Decision as to what sanitary autho- iv) to contemplate the making of special rity will declare the pilgrimage` clean 'or arrangements for pilgrims travelling by air infected '; or by land. " (d) The matter of the Red Sea sanitary stations mentioned in the Conventions now Generally speaking, the sub -committee en- in force ; deavoured to reduce to the minimum con- " (e) Sanitary measures to be taken in sistent with security the measures for the regard to pilgrims travelling by land or air." protection of the health of the pilgrims. The sub -committee's report and the draft regulations were accepted by the Commission Work of the Expert Sub -Committee for further submission to the first World Health On the invitation of the Egyptian Govern- Assembly."Assembly. ment, the sub -committee met in Alexandria on On 21 July 1947, the Secretariat forwarded 16 April 1947 and continued to meet twice daily to all governments copies of the report and draft between 16 and 22 April ; on 21 and 22 April regulations together with a request for obser- it examined the sanitary installations and equip- vations on the draft regulations, on sanctions ment of the port of Jeddah ; on 23 April it and sanitary dues, and on the type of instrument reassembled at Alexandria and continued its to be prepared for the control of the Mecca work there until z6 April. pilgrimage.Analysisandsynthesisofthe The sub -committee examined,article by replies received were made by the Secretariat in article, Part III of the Convention, deleting or January 1948 and submitted for consideration modifying such provisions as did not appear to the Commission.

International Controlof Habit - forming Drugs The Conventions on Narcotic Drugs signed at conventions and which might prove habit - Geneva on 19 February 1925 and on 13 July 1931 forming should be submitted to international empowered the Health Committee of the League control.Thosesubstances,however, which of Nations to propose to the Council of the " are compounded and which in practice pre- League of Nations, after consultation with the clude the recovery of the said drugs " were Office International d'Hygiène Publique (OIHP), exempt.This system ensured that any new that any drug not yet falling under these habit -forming drug could be placed under 88 Subsequently named the Expert Committee on Medical Services, Khartoum ; Dr. E. D. Pridie, Medical International Epidemic Control, see p. 39 Counsellor, British Embassy, Cairo ; and H.E. Youssef 68 Off. Rec. WHO, 4, 167 Yassin, Minister for Foreign Affairs, Saudi Arabia 70 For membership, see table XII, p. 85 71 Off. Rec. WHO, 5, 135 To assist the sub -committee, the following advisers 72 Ibid. 8, 32 were called from time to time : Dr. M. Khalil Bey, former 78 Ibid. 8, 42 Under -Secretary of State for Quarantine, Ministry of 74 Ibid. 6, 179 Public Health, Cairo ; Dr. A. E. Lorenzen, Director of 78 Ibid. q, 244 HEALTH PROBLEMS CONSIDERED

internationalcontrol.When the League of Pending the coming- into -force of the 1946 Nations was dissolved, there was no organ left Protocol, the Interim Commission had decided to exercise these functions.On II December in November 1946 to appoint an Expert Com- 1946, a protocol was signed by the governments mittee on NarcoticDrugs.76Itstitlewas represented in the General Assembly of the subsequently changed to the "Expert Committee United Nations, which provided for the transfer on Habit -forming Drugs as as itwas felt of the functions and powers of the Health that certain substances, although not narcotic, Committee of the League of Nations and of should be considered by the committee because OIHP to WHO or its Interim Commission. of their habit -forming tendency. Five experts Similarly, the authority previously held by the were appointed to serve on the committee, 78 Council of the League was transferred to the which was to hold its first meeting as soon as Economic and Social Council of the United possible.7° Nations, which set up a Commission on Narcotic A request had already been received from the Drugs. French Ministère de la Santé Publique et de la The amendments introduced into the Con- Population for the exemption from the 1925 ventions of 1925 and 1931, in virtue of the and 1931 Conventions of Valbine, a proprietary Protocol of II December 1946, came into force product containing I mg. of Eucodal per tablet. in 1947 for the Convention of 1931, and in the The synthetic drug known as Amidone presents spring of 1948 for the Convention of 1925. a further problem.

Others Technical Subjects Alcoholism was appointed psychiatric consultant to the The Interim Commission decided to undertake Commission.84 a preliminary study of the problem of alcoholism,80 and Dr. A. Cavaillon was entrusted with Fonds Léon Bernard the task of preparing a report.Simultaneously, The Fonds Léon Bernard was established by the Secretariat undertook inquiries to obtain international subscription in 1947, in perpetua- information on work in progress on the various tion of the memory of Professor Léon Bernard, aspects of alcoholism. a member of the Health Committee of the The Secretariatalsoestablishedunofficial League of Nations, to award an international relations with several organizations and with a prize for practical achievement in social medicine. large number of specialists, in Switzerland and The Léon Bernard Foundation Committee, elsewhere, who were studying the problem of composed of the President and Vice -Presidents alcoholism. of the Health Committee of the Leagueof Early in 1947, Dr. Cavaillon submitted a Nations, awarded the Léon Bernard Foundation detailed report, and on the basis of this the Prize, consisting of a medal and the sum of Commission decided to draw the attention of I,000 Swiss francs.Candidates were proposed the first World Health Assembly to the problem by members of the Health Committee of the of alcoholism.S1 League of Nations or by any national health - administration. TheInterimCommissioninstructedthe Crime Prevention and Treatment Executive Secretary to take the necessary steps of Offenders withtheSecretary -GeneraloftheUnited The United Nations Secretariat requested the Nations, the Economic and Social Council, and co- operationof the Interim Commission in the General Assembly of the United Nations, certain aspects of the preparation of a report for the transfer of assets of the Fonds Léon on the prevention of crime and the treatment Bernard to the WHO.85 of offenders, " showing which suggestions are suitable for international action, and how they Housing and Town Planning should be carried out ".82The plan had been Since the war, several United Nations bodies, initiated by theSocial Commission ofthe as well as certain specialized agencies, have, Economic and Social Council, which requested endeavoured to assist in the solution of the that this report be submitted to one of its problems of housing and town planning.The future sessions. Emergency Economic Committee for Europe TheCommissionagreedtomeetthe (EECE), in August 1946, set up a sub -committee request,83 and Dr. M. S. Guttmacher, Chief to study urgent housing problems.The Econo- MedicalOfficer, MedicalServiceofthe mic Commission for Europe (ECE), a section SupremeBench of Baltimore City Court House, of the Economic and Social Council of the

78 Off. Rec. WHO, 4, 161 81 Ibid. 7, 54 77 Ibid. 5, 141 82 Ibid. 6, 67 78 For membership, see table XII, p. 85 83 Ibid. 6, 214 79 This meeting had not taken place at the time of 84 Ibid. 7, 119 going to press 85 Ibid. 5, 125 8O Off. Rec. WHO, 5, 23, 137 HEALTH PROBLEMS CONSIDERED

United Nations, later carried on EECE's task. services of Dr. C. H. Andrewes had been placed A Housing Group was formed under itsagis at the disposal of the Commission as Director with instructions to make recommendations to of the centre." ECE.This group, which consists of represen- It was intended that the functions of the tatives of 28 States, met in Geneva on 1 -3 Octo- centre should be threefold : ber 1947.During this session, a permanent i. collection and distribution of information ; body was formed to direct ECE's attention to ii. collection,preservationand studyof the technical and economic means required strains ; to supply effectiveaidto member States. Although the discussions were mostly concerned iii. education of a small number of visiting with economic action tofurther the rapid workers in techniques. building of dwellings in Europe, a special ses- Inadditiontotheinternationalcentre, sion was devoted to co- operation with other regional centres would be required, capable institutions, and an observer of the Interim Com- of making : mission formally offered the closest co- operation.86 i. serological diagnosis of strains ; This offer was made on the authority of a ii. isolationof strainsinfertileeggsor resolution passed by the Commission instruct- ferrets ; ing the Executive Secretary " to endeavour to iii. desiccation of virus strains and filling of obtain adequate representation of the Interim Commission in any international scheme for ampoules. town planning orforthe improvement of The National Institute for Medical Research housing. "87 A report on the steps taken was agreed to accept one foreign worker, as from presented to the Commission, which recom- July 1948, for a course lasting one month and, mended theclosestco- operationwiththe when the new building of the Institute was United Nations, and, in view of the importance completed in 1949, two foreign workers. of housing for the health of people, placed the The Secretariat also received, as a result of the question on the agenda of the first Health Copenhagen Conference, offers of co- operation Assembly.88 from various institutions in Ceylon, Denmark, France, Iceland, the Netherlands, Norway and Influenza the United. States. TheInterimCommissionconsideredthe Insulin measures that might be taken in the event In recent years the demand for insulin has of an influenza pandemic, and instructed the increased, while supplies have in some countries Executive Secretary to arrange for attendance diminished.The Interim Commission autho- of an observer at the Fourth International rized the Executive Secretary to approach the MicrobiologicalCongressinCopenhagenin health administrations of all governments for 1947,to obtain from experts attending as information on needs and supplies of insulin complete information as possible on influenza.S9 in their respective countries, as well as for a An informal meeting of forty -five interested statement on needs and supplies in the future.93 experts from 15 countries was held outside The information received from 47 States, the Congress, on 25 July 1947, and a small although not complete in all cases, enabled the committee was chosen to consider how the Secretariat to make a study,94 which showed views expressed could be best put into practice. that the difficulties encountered in obtaining At the request of the committee, Dr. C. insulin supplies remained acute. H. Andrewes, National Institute for Medical The Secretariat also obtained information on Research, London, prepared a memorandum" a discovery, made in Germany, of a new method on international collaboration for the control for the collection of pancreas glands without of influenza, in which he proposed the setting -up refrigeration, by means of which the glands of a world influenza centre.The Commission could be collected even in the smallest and most approved this proposal and decided to contri- remote places, thus making it possible to increase bute a sum not to exceed $3,000 yearly to the the production of insulin. working of the centre.Such a centre could obviously be established only in a scientific insti- Medical Examination of Immigrants tute already engaged in research on influenza, A request was received from the Government and the Commission proposed to the British of Venezuela for assistance by the Interim MedicalResearchCouncilthatthecentre Commission in the issue of medical certificates should be placed in the Council's National to immigrants to that country.It was explained Institute for Medical Research.91 that, while the Government of Venezuela was Early in 1948, the Commission was informed anxious to receive immigrants, it was highly that a favourable answer had been received desirable that they be medically examined from the Medical Research Council and that the before leaving their countries of origin, a task which the Government was unable tofulfil 86 Chronicle WHO, 1947, z, 152 87 Off. Rec. WHO, 5, 107 91 Ibid. 6, 190 88 Ibid. 7, 183 92 Ibid. 7, 87 88 Ibid.5, 137 83 Ibid. 5, 137 9° Ibid. 6, 193 94 Ibid. 7, 88 ; see also Chronicle WHO, 1948, 2, 53

43 HEALTH PROBLEMS CONSIDERED as it could not send doctors and equipment to Radiotherapy in Cancer Europe.95 of the Uterine Cervix The Commission instructed the Secretariat A formal request for the publication, under to give advice and the assistance of its technical the sponsorship of WHO, of the Annual Report servicestogovernmentsinterestedinthe on the Results of Radiotherapy in Cancer of the medical examination of immigrants, without Uterine Cervix, formerly issued by the Health incurring any special expense for this purpose.86 Organization of the League of Nations, was It also drew attention to the necessity for submitted to the Interim Commission by the representation on the proposed United Nations British Empire Cancer Campaign, London, the Consultative Committee on Migration ®7 Cancerfbreningen, Stockholm, and the Donner Foundation, Inc., Philadelphia.'" Public -health Services The matter was discussed by the Commis- and Training of Staff sion, which decided that the request be granted A proposal for the appointment of an expert to the extent of co- operation by the Secretariat committee " to make a preliminary compara- in the statistical work required, and expenditure tive study on the organization, size and strength in connexion with the publishing of results103 of the Central Public Health Services in various countries "wasdiscussedbytheInterim Other Problems Commission,9S together with a similar proposal regarding the training of publichealth staff.99 The terms of reference given to the Interim The Commission decidedthat,duringthe Commission by the International Health Con- interim stage of the World Health Organization, ference restricted its activities to the prepara- action should be limited to a preparatory study tory work for the establishment of the organ- on these subjects, but agreed to recommend ization proper, the continuation of the functions their inclusion as a joint item on the agenda of former international organizations, and assist- of the first Health Assembly.100 ance in the solution of urgent health problems. To giveeffecttothisdecision,Dr.E. These terms of reference, as well as financial Grzegorzewski, Professor of Hygiene at the limitations, prevented the Commission from University of Gdansk, Poland, was appointed taking action in a number of fields which would to the Secretariat.Preparatory material was be of direct interest to the permanent organ- collected, and introductory notes on the subject, ization.A selection of subjects which might including a review of previous work done, require action during the first year of existence a brief study of some recent international and of WHO was nevertheless deemed necessary, national trends, and an outlineforfuture and the Commission devoted some time to a activities, were prepared. discussion of these. In view of the interest displayed by several Maternal and child health was recognized as a governments and institutions in the present subject of sufficient importance to share with organization of central health- authorities, an malaria,tuberculosis, and venerealdiseases inquiry into this problem was undertaken by the highest priority in the provisional agenda means of a questionnairecirculated toall for the first World Health Assembly,103 although member governments. the Commission had not itself been able to The Secretariatprovided information on undertake a programme on this subject apart public -health administration and medical and from the support given to UNICEF.104 public- healtheducationattherequestof Six other subjects on which no action had various institutions, and problems of common been taken were thought sufficiently important interest were discussed with several specialized to be submitted to the first Health Assembly agencies of the United Nations and with other with specific recommendations for the appoint- institutions.Of these, the International Labour ment of expert committees :nursing, hygiene OrganizationandtheInternationalSocial of seafarers, schistosomiasis, industrial hygiene, Security Association showed a special interest nutrition, and rural hygiene?" The last three in the international aspects of problems of were expected to be joint responsibilities of public -healthservices and intherelations WHO and other specialized agencies of the between health administration and medical -care United Nations.Schistosomiasis was brought services.Informal views were also exchanged to the attention of the Commission early in with the World Medical Association as to the 1947,106by Dr. A. T. Shousha Pasha, the necessity for recent information on medical representative from Egypt, who had presented education. a study bearing on the general problem and on Field activities in relation to health services measures taken in Egypt against the disease. and the training of public -health workers were The problem of radioactive isotopes was undertakenintheformofmissions and discussed by the Commission at a late stage of fellowships.

95 Off. Rec. WHO, 6, 68 101 Ibid. 7, 211 96 Ibid. 6, 190 102 Ibid. 7, 184 97 Ibid. 7, 182 1" Ibid. so, 6 98 Ibid. 4, 169 104 See p. 61 99 Ibid. 4, 16g 106 Off. Rec. WHO, Io, I0 loo Ibid.4, 66 106 Ibid. 6, 191

44 HEALTH PROBLEMS CONSIDERED its existence.107The Executive Secretary was by the Secretariat, before other steps were authorized to appoint an official in the head- taken.These were acute anterior poliomye- quarters office in New York to act as " desig- litis,ankylostomiasis, filariasis,hospitals and nated representative " of those countries which clinics,leishmaniasis,leprosy,medicalcare, had no scientific attaché in the United States, medical rehabilitation,medicalsocialwork, provided that the United States Atomic Energy mental health, natural resources, public -health Commission agreed to this arrangement ?o8 administration,rabies,rheumatoiddiseases, Finally, a number of other subjects was sanitary engineering, technical health education, considered to require only preliminary study trachoma, tropical hygiene and trypanosomiasis.

107 Off. Rec. WHO, 6, 22I 108 Ibid. 7, 254

45 CHAPTER 3

SERVICES PROVIDED

Epidemiological Services

The Interim Commission's Epidemiological This telegraphic information was confirmed Services were initiated by the transfer to the and completed by the Weekly Epidemiological Commission, on the dates given in parentheses, Record, issued at Geneva and distributed by of the several epidemiological responsibilities airmail to all countries of the World except previously shared by the Health Section of the those of the Far East, which received the League of Nations(16 October1946),the Weekly Fasciculus issued by the Singapore Health Division of UNRRA (1 December 1946), Epidemiological Intelligence Station. The Fas- and the Office International d'Hygiène Publique ciculus contained information received weekly (1 January 1947). by cable from 282 Eastern sea- and airports. The functions of the Epidemiological Services The Weekly Epidemiological Record was for consisted essentially in the collection and the over 20 years published by the Health Section of distribution to national health- administrations the League of Nations.As from 3 January 1947, of information regarding the occurrenceof it consolidated information formerly published pestilentialdiseases - i.e.,of notifications in the weekly and fortnightly periodicals of under the international sanitary conventions OIHP, the League of Nations and UNRRA. and data on the prevalence of other commun- As from 14 May 1947, its subject- matter was icable diseases of public -health importance and confinedtopestilentialdiseases,including on the general trend of morbidity and mortality. quarantine notifications concerning them and Epidemiological information from all quarters otherinformationrelatingtointernational was collected in Geneva and thence distributed. sanitary conventions ; and its circulation was This centre was directly related to the Epi- therefore restricted to national health- adminis- demiological Intelligence Station at Singapore,' trations and health officers of sea- and airports, which served the countries bordering on the and frontier towns. 2 western Pacific and Indian Oceans.It operated Since June 1947, statistical information on in close collaboration with the Pan American infectiousdiseases,birth- rates,general and Sanitary Bureau in Washington, which serves infant mortality, etc., has been published in the the Americas, and the Sanitary Bureau at monthly Epidemiological and VitalStatistics Alexandria, which serves countries bordering Report, which is sent not only to health services on the eastern Mediterranean and the Red Sea. but also to medical institutes and schools, and Urgent notifications of pestilential diseases technical libraries.3The statistical tables in were received by telegram.From Geneva they the Report have been supplemented by articles were redistributed,also by telegram.From onbothcommunicablediseasesandvital Singaporetheredistributionwas made by statistics.Up to the present,articles have means of telegraphic epidemiological bulletins, appeared on recent trends in birth- and -death which were broadcast by a comprehensive rates, stillbirths, diphtheria, poliomyelitis, and networkofwirelessstationsoperatingin cholera. Batavia, Hong Kong, Karachi, Labuan, Madras, The need for more comprehensive and accu- Saigon, Shanghai, Singapore, Tananarive, and rate data than those which can be published in Tokio. a monthly report resulted in the publication The bulletins were issued " in clear " or in by the League of Nations of a series of Annual thespecial AA Epidemiological Telegraphic Epidemiological Reports.Preparation for the Code drawn up in 1926, the third edition of resumption of this series, interrupted by the which wasissuedinJanuary1948.The war, began in 1943 and has been continued. A Batavia and Saigon wireless stations issued special volume is now being prepared which daily the Singapore bulletin, brought up to will cover the period 1939-1946.The next date when necessary. regular issue, covering 1947, is also in course of preparation. 1 This station, the Eastern Bureau of the League of Nations from 1925 to 1942, was reopened by the Commissioner for South -East Asia.The Director of South -East Asia Command ontheliberationof the Singapore Station is Dr. P. M. Kaul Singapore, and transferred to the Interim Commission 2 Off. Rec. WHO, 6, 101 on 1 April 1947 by His Britannic Majesty's Special 3 Ibid.6, loi

46 SERVICES PROVIDED

Collaboration was established between the for their views and suggestions.From the Epidemiological and Statistical Services of the 32 replies there emerged a general desire for Commission and the statistical services of the speedier communication of urgent epidemio- United Nations, and spheres of activity were logical data, and proposals that telegraphic delimited to avoid overlapping, particularly as broadcasts might be used for this purpose. regards population and vital statistics.The Suggestions were also received that a uniform Secretariat was represented at the meetings reporting period might be instituted and that of the United Nations Statistical and Population grid maps for indicating the precise location of Commissions by Mr.K.Stowman,expert infected areas might be used in connexion with consultant of the Commission .4 the revised and completed version of the WHO With a view to improving the Epidemiological Epidemiological Telegraphic Code .5 Services, the Commission asked governments

Emergency Services during the Cholera Epidemic inEgypt

The epidemiological and emergency services In December 1947 a comprehensive article provided by the Commission are well illustrated was published in the monthly Epidemiological by the action taken with regard to the 1947 and Vital Statistics Report (Vol. I, No. 7) des- cholera epidemic in Egypt. cribing the course of the epidemic, indicating The story shows in a concrete way both the its probable origin, and showing its episodic good points and the present weaknesses of the character, in contrast with the permanency of machinery for international epidemic control. the disease in a few endemic foci in Asia. Epidemiological Intelligence Quarantine The first news of the outbreak was a Press The Weekly Epidemiological Record published communiqué which appeared on 25 September regularly the quarantine measures that were 1947. A telegram was at once sent to Egypt adopted in the various countries and notified asking for denial or official confirmation with to the Commission under the terms of the details.On the next day, confirmation was international sanitary conventions. received and telegraphed to 36 directly interested It was soon apparent that many of the mea- countries, including all neighbours of Egypt, sures taken did not conform with the provisions to the Singapore Station 6 for relay to Eastern of these conventions but were very much countries, and to the Pan American Sanitary excess of them.This fact,as well as the Bureau for relay to the Americas. desirability of obtaining first -hand information On I October, the Weekly Epidemiological on the situation within Egypt, and possibly Record contained,inadditiontothefirst ofprovidingthatcountry withtechnical telegraphic report on the outbreak, a note advice, led to an emergency convening of the - summarizing the previous epidemics of cholera Expert Committee on Quarantine,7 the first in Egypt and, a reminder to health administra- sessionof which was advanced from late tions, the text of relevant provisions of the November to 13 October. international sanitary conventions.The subse- The meeting was attended by Dr. Nazif quent issues of this periodical included tele- Bey, Under -Secretary of State for Quarantine, graphic information on the trend and distri- Ministry of Public Health, Egypt, who brought bution of the disease in Egypt, together with comprehensive information on the epidemic occasional commentaries, graphs, and maps. and the measures taken to stay its spread. Although the Record was airmailed to them, The effectiveness of the measures prescribed health authorities of a number of countries by theexistingsanitaryconventions was requested daily or semi -weekly telegrams on discussed by the committee in the light of the the development of the epidemic, and it was actual situation and of recent knowledge of the necessary to arrange for a voluntary sending bacteriology and epidemiology of cholera, and of this information by the Egyptian authorities, it considered that these measures were adequate. as its issue was not required from them at this This view was conveyed to health adminis- rhythm or speed under the sanitary conventions. trations through the Weekly Epidemiological The Singapore Station incorporated the data Record.In order that countries might be kept thus obtained in its regular epidemiological adequatelyinformed,thecommitteealso broadcasts, but the Geneva centre was not then stressed the need for prompt notification to the authorized to use wireless telegraphy for the Commission of any further outbreak of cholera. routine distribution of epidemiological infor- As events proved, the Commission, after mation to all health authorities concerned, and obtaining official information, had repeatedly had to telegraph information repeatedly to to deny reports appearing in the Press of the meet requests. spread of thedisease tocountriesoutside Egypt, and to induce the health authorities

°Off. Rec. WHO, 7, 99 e See p. 46 5/bid. 7, 7o 4 See p.35

47 SERVICES PROVIDED

which had given credencetofalsereports donated two million ml., which were transported to repeal unwarranted quarantine -restrictions at cost by United States Army planes. against cholera -free countries. Appeals for motor ambulances were made As the epidemic developed, measures taken by the Commission to governments and Red by countries tended to exceed more and more Cross Societies.The Greek health authorities, the provisions of theconventions,8 and to with the help of the Commission and the interfere seriously with Egypt's foreign trade United States Mission to Greece, sent some and with the food situation in several other 17 tons of DDT for the fly -destruction campaign countries.The Commission was officially called in which United States Army planes participated. upon to take steps to have such measures The American Red Cross donated 2,50o litres withdrawn. of normal human plasma - twice the amount After consultation with the members of the requested by the Egyptian authorities. Expert Committee on Quarantine in doubtful The Commission also bought, on behalf of the cases, or immediately in clear contraventions, Egyptian authorities, and sent by specially the Secretariat took action and inseveral chartered plane, urgently -required chemicals, instances was able to have the offending measures syringes and needles for intravenous injections, modified.The attitude adopted by several a million tablets of sulphaguanidine and, partly countries showed, however, the necessity for by ship, 20 tons of chlorinated lime. modifying either the sanitary conventions them- Apart from material help that the Commission selves, or the machinery for their enforcement. was able to organize, Dr. W.W. Yung, Director, Department of Epidemic Prevention,Natio- Emergency Assistance 9 nal Health Administration, China, and a mem- On 27 September, following receipt of the ber of the Commission's Expert Committee official notification of cholera, the Commission on Quarantine, and Dr. P. M. Kaul, who held made a telegraphic offer to Egypt to help in a similar post in India before joining the Com- the procurement of anticholera vaccine.Sub- mission's staff, paid a visit to the Egyptian sequently, the Geneva and New York offices health authorities to give them the benefit of asked various commercial and non -commercial their experience in the control of cholera. laboratories how much vaccine they would be It is noteworthy that, owing largely to the able to supply, special attention being given to efforts of the. Egyptian health authorities and the time required and to the cost.The concen- perhaps to the outside help extended to them, tration by the Commission of the placing of the mortality from the last cholera outbreak orders for vaccine prevented the rise in prices was seven times less than during the previous which had already become manifest as soon as one, and that, in spite of increased speed and the epidemic became known, owing to compe- developmentof internationaltraffic,not a titive buying by threatened countries.This single case of cholera occurred abroad as a resulted in a considerable saving, both to Egypt result of the Egyptian epidemic. and to those countries. The fact that the anticholera vaccine received Partly as a result of the action taken by the by Egypt from 23 sources in 17 countries varied Commission, substantial quantities of vaccine greatly in all respects showed the necessity, for were donated to Egypt by a number of countries, practical as well as other reasons, of standar- including Afghanistan, Australia, Belgium, Brazil, dizing as far as possible methods of preparation China,Czechoslovakia,France,Iran,Iraq, of anticholera vaccines. Italy,the Netherlands,Spain, Turkey, the The Expert Committee on Quarantine there- United States of America and the Union of fore requested the Commission's Expert Com- Soviet Socialist Republics, as well as by the mittee on Biological Standardization to consider International Red Cross.China, for instance, this matter." Field Services (UNRRA Funds) At the fifth session of the Council of UNRRA the fact that the establishment of a World in August 1946, it was decided in principle that Health Organization is in process and that UNRRA's activities should end on 31 December an Interim Commission thereof has been 1946.Fears were expressed that such a sudden established and is functioning : cessation of its health activities would be detri- " It is therefore resolved mental not only to the aided countries but " 1. That the Director- General consult might endanger the health of others.Conse- with the Interim Commission of the World quently a resolution was adopted in the follow- Health Organization with a view to the ing terms : transfer as soon as practicable to the Com- " Whereas the functions of UNRRA in the mission of the duties and functions entrusted field of health are necessarily of a temporary to the Administration... as well as such character; and other functions of UNRRA in the field of " Whereas the Council has taken note of health as the World Health Organization or its Interim Commission may be willing 8 See p. 39 to undertake. " 9 See also Off. Rec. WHO, 7,78; Chronicle WHO, 1947, I, 157 18 See p. 32

48 SERVICES PROVIDED

The resolution also dealt with the transfer to andothereducationalactivitieswasalso the Interim Commission of the duties and stressed. functionsentrustedto UNRRA undérthe The original grant from UNRRA was based International Sanitary Conventions of1944, on the assumption that WHO would be consti- and with the transfer of records, equipment, tuted in 1947.When it became clear that the materials and personnel. lifeoftheInterim Commission would be The Director- General of UNRRA was autho- extended, a request for a further grant was made, rized to take steps to effect the transfer of such and in September 1947 a sum of $1,500,000 was functions and, in addition, againvoted by theCentral Committeeof " (b)subjecttotheapprovalofthe UNRRA,'5 to be paid in three quarterly instal- Central Committee,totransfertosuch ments, provided that the third instalment would OrganizationorCommission,fromthe lapse if WHO were independently and adequa- available resources of UNRRA, such funds tely financed before the end of the second as may be necessary for the performance quarter.Otherwise, the grant was on the same of the transferred functions, provided that terms as that for 1947. the Organization or Commission has not The Commission's main consideration in its available other resources for financing the Field Services activities was the need to bridge performance of these functions. " the gap between UNRRA's short -term work of medical relief and rehabilitation and the time Just previously, the Agreement setting up when WHO could review the health needs of the Interim Commission of the World Health the world as a whole. Organization had been signed in New York, and the Commission was therein empowered under Article 2m, Forms of Service " to consider any urgent health problem Early in 1947, a small Field Services Division which may be brought to its notice by any was established at Geneva with the former government, to give technical advice in Director of the Health Division in the European regardthereto,tobringurgenthealth Regional Office of UNRRA as Director, and needs to the attention of governments and a Deputy Director, with special charge of the organizations which may be in a position to fellowship programme.Later in the year, an assist, and to take such steps as may be Assistant Director in charge of the programmes desirable to co- ordinate any assistance such in the Far East was appointed to the New York governments and organizations may under- office. take to provide. " The governments of the countries concerned were asked in what form they wishedto A small committee was appointed to nego- receive aid from the Commission,16 and it was tiate these transfers,l1 and, with the assistance agreed that, inter alia :17 of members of the Secretariats of the Commis- sion, UNRRA and the United Nations, concluded i. nationals of professional status should its work by 22 October 1946 with the drawing - not be paid by the Commission if they upofadrafta ,eement,12underwhich worked in their own country $1,500,000 was made available by UNRRA to ii. no direct subsidy should be paid for the Commission for 1947.This agreement was operations within a country by its own adopted by the Commission, with an additional health services clause that any services provided would be in iii. any sums saved by a reduction in the consultation with govemments,13 and was signed cost of providing missions should be on 9 December 1946. transferred to the fellowship programme Under the terms of the agreement,the iv. savings made by the provision of any Commissionwastotakeover UNRRA's necessary local currency by the govern - healthactivities(excludingepidemiological) ment would be credited for additional from 1 January 1947 for Europe and from aid to the country concerned 1 April 1947 for the Far East, with the exception v. at the request of the United Nations of the medical care of displaced persons. International Children's Emergency Fund The Commission's Field Services programme (UNICEF), governments should be asked started on this basis.It provided for general toincludeintheirfellowshipspro- advice and assistance in public health and grammes as least 10 per cent of specialists medicine, including missions of experts, to be in child health undertaken in consultation with the governments concerned. 14 Special mention was made vi. UNRRA staff regulations should conti- of the needs of China and Ethiopia and of the nue to be applied to field staffs transferred importance of the programmes for the control to the Commission. oftuberculosis and malaria.The need to The programme of aid requested by govern- continue UNRRA's programme of fellowships ments and approved by the Commission was

11 Off. Rec. WHO, 4, 104 Korea(Northern and Southern),thePhilippines, 12 Ibid. 4, 113 Poland, Ukraine, and Yugoslavia 12 I bid. 4, 26 15 Off. Rec. WHO, 7, 155 14 Albania, Austria, Byelorussia, China, Czechoslo- 16 Ibid. 5, 87 vakia,Ethiopia,Finland,Greece, Hungary,Italy, 17 Ibid. 5, 89

4g SERVICES PROVIDED

of four types :(a) continuation of missions of Missions, Liaison Officers, technical experts or a medical liaison officer as Visiting Lecturers and Experts, established by UNRRA (for seven countries) ; (b) grants for fellowships or study -tours (for Medical Literature and Teaching Materials, elevencountries) ;(c) provisionofvisiting and Other Services 2° lecturersorexperts(forninecountries) ; Austria. By arrangement with the Prepara- (d) supply of medical literature(for twelve tory Commission for the International Refugee countries) 18 Of the fifteen countries concerned, Organization (PCIRO), its chief medical officer all save Albania asked for one or more of these in Austria acted as medical liaison officer for forms of aid.Budget allocations to meet these the Commission until he was taken over by the requests during 1947 were $708,000 for field Commission for the last quarter of the year. missions, $483,000 for fellowships, $30,000 for The local expenses of his office were paid by visitinglecturersand $40,000formedical the Austrian Government. In conjunction with literature.In addition, approximately $381,000 the Unitarian Service Committee, a group of was made available inlocal currency by the eminent specialists - eight American and two countriesreceivingmissions,forthelocal Swiss - gave lectures and demonstrations at expenses of those missions.Provision was also Vienna, Graz and Innsbruck during July 1947.21 made for the administration costs of the Field Medical literature requested was sent. Services Division in the Geneva and New York China.TheCommission'sChinaMission offices, for a share in the cost of certain specia- began to operate on 1 April 1947.Out of lists in these offices whose work was partly 29 experts, 25 had been recruited by UNRRA concerned with UNRRA -aided countries, and and carried on their services without inter- for a small contingency reserve - the total for ruption.The UNRRA officein China also 1947 amounting to the total of the UNRRA continued to assist in the operation of the mis- grant - i.e., $1,500,000. sion.The Chinese Government, through its Ministry of Health, appropriated a sum of Services provided 3,880,000,000Chinesedollarstocoverthe The forms of service provided to devastated local expenses of the mission. countriesin1947 -1948are summarizedin Two main interlinked fieldsof UNRRA's Table I19 health activities in China were continued - emergencypublic -healthmeasures andthe Table I training of personnel.The emergency public - health measures included epidemic control and OF SERVICE PROVIDED IN THE FIELD port -quarantine, a demonstration of tuberculosis SERVICES PROGRAMME control, and certain uncompleted obligations taken over from the UNRRA Health Division. o Special attention was given to the epidemic o (0,0 control of plague, cholera and kala -azar.The Country ro g o dY Commission's expert in charge of plague control :o ro in the field dealt with outbreaks in Nanchang 464 >4" ál 51 El and Yunnan.The incidence of cholera was Austria + + + gratifyingly low in 1947, but work was done Byelorussian SSR -- + on human subjects on the standardization of China* + + + + cholera vaccine and other research problems. Czechoslovakia - + + Kala -azar is in some ways perhaps the most Ethiopia + - + important epidemic disease in China, with an Finland - + + estimated incidence of three to five millions. Greece + + + Unfortunately, the area involved was disturbed Hungary + + + by military operations, and work was found Italy + + + to be impossible after September 1947. Korea, N. and S.. - + A survey of the port -quarantine service was Philippines . . . - + + made by a quarantine expert loaned by the Poland + + United StatesPublic Health Service.Nine Ukrainian SSR . -- seaports were surveyed, and a valuable report Yugoslavia . . . - + with recommendations was submitted. Uncompleted UNRRA -obligations which were China had no visiting experts or lecturers. The experts are continued consisted of work for the National full-time and attached to mission operations Institute for Biological, Chemical and Pharma- The notes below give additional information ceutical Production in the survey of suitable sites for plants for penicillin, DDT, etc.,of on the operations undertaken. assistance in the installation and maintenance of x -ray equipment, and advice on the assign- 18 The Commission later extended the definition of ment of medical supplies. " medical literature " toincludespecialteaching - apparatus (Off. Rec. WHO, 6, 78) 20 Off. Rec. WHO, 5, 48; 6,47:7, 155 9 Chronicle 19 Albania has not been included as no reply was WHO, 1947, I, 73, 173 received 91 Chronicle WHO,1947, I, 113

50 SERVICES PROVIDED

As regards training of personnel, a group of for the visitsof other named experts were teachers in the fields of clinical medicine, sur- received and considered. gery, ophthalmology, pædiatrics, gynæcology Italy.A small mission of two medical officers and obstetrics, radiology, psychiatry and ortho- was established in Rome by the beginning of p dics, and also in sanitary engineering, hospitals 1947, under a formal agreement under which and public -health nursing and bacteriology, were either continued from UNRRA or recruited. the Italian Government paid the local expenses Of a total of 32 mission members in China, of the mission.The agreement was termi- 19 were engaged in this training work, ten being nable at three months' notice on either side. based at Nanking, while the other nine were An expert in sea- and airport sanitation and assigned to regional training -centres, including quarantinevisitedItaly, andarrangements were initiatedforvisitsby otherexperts. Formosa and the communist -controlled areas. The main task of the mission was to advise Considerable quantities of books, journals, the Italian Government on the health projects and other teaching materials such as films, established from the fund derived from the sale projectors and museum material, have been of UNRRA goods. These included malaria con- provided. trol, tuberculosis, trachoma, quarantine stations, Ethiopia.The chief object of the mission was a national nutrition and orthogenetic centre, to give elementary training for nurses (chiefly and maternity and child welfare. male) and sanitary officers.Five courses were completed and others initiated in the provinces. Poland. A medical liaison officer was taken Eighty -five dressers received certificates after over by the Commission in Warsaw in the examination, and training -manuals were pre- middle of 1947: he had previously been acting pared in Amharic.Two courses were given as the Commission's agent whilst with UNRRA. for sanitary inspectors.In addition, advice His local costs were paid by the Polish Govern- was given on many subjects to the Ministry ment, through an exchange of letters at the end of Health at its request, and also assistance in of May. the control of epidemics in the provinces and Other services. Among other activities of the in the sanitation problems of Addis Abeba.The Field Services Division in 1947 may be mentioned mission consisted on I January 1947 of two liaison with departments of the United Nations, doctors and three nurses, and later of one doctor, and with specialized agencies and non- govern- two nurses, one sanitary engineer, and one mental organizations, both centrally and in sanitary inspector.A formal agreement cover- the field. For example, talks on the Commission's ing the activities of the mission from I January work were given to four groups offellows 1947 was signed with the Ethiopian Government coming to Geneva for orientation before taking in March, and was terminable at three months' up fellowships from the United Nations Social notice on either side.22 Affairs Department.Liaison with this depart- Greece.The Commission'sFieldServices ment's field representatives was established by programme was concentrated on the control of the missions of the Interim Commission.The malaria and tuberculosis, and the operations same applies to FAO, PCIRO, UNICEF, and undertakenaredescribedelsewhere.23The non -governmental organizations.Consultations mission consisted at the beginning of 1948 of with UNESCO and the Rockefeller Foundation two medical officers, two sanitary engineers, one and the United Nations Social Affairs Depart- nurse, one x -ray technical adviser, and one chief ment were held on fellowships, and joint work aircraft -mechanic, and by the end of the year was done with PCIRO on the resettlement of numbered two medical officers, one sanitary doctors and nurses.It was agreed that the engineer and one nurse. technical work undertaken by the Commission The activities of the mission were covered by for UNICEF should be financed and admini- a formal agreement with the Greek Government, stered by Field Services Division.25All the terminable at three months' notice on either missions were visited once during the year by side." the Director of Field Services.Czechoslovakia Hungary.A medicalliaisonofficer was and Finland were also visited. stationed in Budapest in March, with local expenses paid by the Hungarian Government. Fellowships 26 The Government indicated that his services would not be required in 1948, as the programme The fellowship programme began in the early was to be administered by the Ministry of spring of 1947 in the first few months of the Social Welfare. Geneva office, and it expanded to the New York The Commission made arrangements for a officeintheearly summer.Of the fifteen Unitarian group of visiting lecturers to visit countries formerly aided by UNRRA, eleven Hungary during August 1947, but, as that time applied for assistance from the Commission in was not convenient to the Hungarian Govern- the organization and financing of fellowships ment, the proposal was abandoned.Suggestions Austria, Czechoslovakia, Finland, Greece,

22 Off. Rec. WHO, 5, 93 25 /bid. 7, 143 23 Malaria, see p. 31 ; tuberculosis, see p. 35 26 Ibid. 6, 123; 7, x58.Chronicle WHO, 1947, I, 75, 24 Off. Rec. WHO, 5, 95 114: 1948, 2, 3

51 SERVICES PROVIDED

Hungary,Italy, Poland and Yugoslavia in approved.Only men of senior status would be Europe, and China, Korea, and the Philippines awarded grants for shorter study- tours, usually inthe. Far East.From these countries, an of not less than three months, with the possible unceasing flow of specialists in public health, exceptionoffellowsvisitingneighbouring clinical medicine, and the medical sciences, as countries. well as sanitary engineers, hospital architects, On the whole, the fellowship programme and nurses, visited the United States of America proved to be the most popular of the forms of and Canada, Denmark, France, Sweden, Switzer- service provided to governments by the Field land, the United Kingdom, and other European Services programme. countries, to refresh their knowledge. Considering the difficulties and crowded post- Tables II and III show the number and war conditions in the medical schools and average duration of fellowships, the countries institutions, the response to requests for accept- assisted, and the main fields of study. ance of prospective fellows was excellent.The placement of fellows was arranged in co- operation Table II with the national health- administrations, teach- FELLOWSHIPS AWARDED, BY COUNTRIES OF ing institutes and foundations, and with the ORIGIN OF FELLOWS assistance of members of the Commission.All ( January 1947 to April 1948) the fellows were proposed by their respective nationaladministrations,usually bysmall 8 w W o N selection- committees including representatives Country t+ t,' N0:a, from the educational body and universities. The un en 0 > ç° 0 chiefs of the missions were helpful links in the zw zwS "b.8E fellowship programme and usually sat on the Austria II 6r 5.5 selection committees in an advisory capacity. China 58 500 8.6 A fellowship manual was prepared which was Czechoslovakia 35 153 4.4 founded on actual experience in the organization Finland io 68 6.8 and rehabilitation of public -health and medical Greece 4 28.5 7.1 education in the war -stricken countries.For Hungary 12 59 4.9 the countries which lost many of their physi- Italy 6 24 4.0 cians and qualified teachers during the war, Korea, Northern 2 24 12.0 the fellowships were a welcome assistance in Korea, Southern 2 24 12.0 the rebuilding of a nucleus of specialists and Philippines . . . 3 16 5.3 teachers in health ;for others it meant the Poland 63 203 3.2 resumption of prewar relations and the raising Yugoslavia . . 44 345 7.8 of standards. Many type of training and varied periods of Totals. . 25o 1,505.5 6.o study were required.Some countries were in a position to send a small number of selected Table III specialists for long -term fellowships, whereas FELLOWSHIPS AWARDED, BY FIELDS others were more urgently in need of a larger OF STUDY number of fellowships for short periods.In (January 1947 to April 1948) practice, short -term fellowships often had to Number be extended, as they were rarely long enough Field of study of fellows to enable the fellows to take the best advan- Public health 132 tage of the opportunitiesoffered.In view Clinical subjects 136 of this experience, the Commission ruled that Medical sciences 3o normally fellowships of less than six months, especially for junior workers, would not be Some fellows were studying in more than one field Publications The objects of the Commission's publication interim period.The publication of the Inter- programme were : to fulfil statutory obligations national Health Yearbook had to be deferred.28 inherited mostly from the Office International The publication of abstracts relating to public d'Hygiène Publique (OIHP) ;to place at the health and tropical medicine was considered disposal of public -health administrations and by the Commission, and it was decided to refer the medical and related professions technical this matter to the first World Health Assembly.29 information on current problems, and on the development of the activities of the Commission Weekly Epidemiological Record 30 and its expert committees ;to initiate, during the interim stage, only such essential publications The inherited obligation to supply up -to -date as might be later continued by WHO.27 epidemiological informationnecessitated the Owing to shortage of specialized staff, this continuance of a weekly epidemiological public- programme was not fully implemented during the ation.The publication of the Record under 29 Off. Rec. WHO, 4, 170 ; 5, 62 ; 6, Io1 "Ibid. 5, 138 28 Ibid. 6, 34 so See p. 46 SERVICES PROVIDED theauspicesofthe Commission began on Bulletin of the World Health Organization was 15 December 1946, and, as from 14 May 1947, published in January 1948.Its title inten- it was devoted exclusively to notifications and tionally recalls that of its two predecessors, the information relating to the " conventional " Bulletin mensuel of OIHP and the Bulletin of diseases. the Health Organisation of the League of Nations. The Bulletin was intended to be the chief scien- Epidemiological and Vital Statistics Reports' tific publication of the organization and to Information on non -conventional diseases and bring to the knowledge of governments, health on vital statistics was transferred from the administrations, and the medical profession Record to the moiithly Epidemiological and communications submitted by the represen- Vital Statistics Report, the first number of which tatives of member States, reports of expert appeared in June 1947. committees, and original articles by experts and specialists.Separate editions were published in Both of the above publications are bilingual. English and in French. Weekly Fasciculus International Digest of Health Legislation The Weekly FasciculusoftheSingapore EpidemiologicalIntelligenceStation,which The Bulletin of OIHP contained a section confirmed and amplified any epidemiological dealing with public -health legislation, which information broadcast by its network of wireless proved of the greatest value to administrations. stations, was published as from I January 1948. The Commission decided to publish such information separately, and in considerably extended Official Records of the World Health form, as the International Digestof Health Organization Legislation, to contain the original texts, translations, and, where necessary, extracts, of all This periodical contains minutes of the ses- the more important health -legislation promul- sions of the Interim Commission, and documents gated throughout the world.It was decided considered. No. 3,the minutes of the first to publish separate editions in English and in session, was the first to appear, in June 1947. French. No. I was the Report of the Technical Prepa- ratory Committee forthe preparation of the Chronicle of the World Health Organization International Health Conference, and No. 2 dealt with the discussions and Final Acts of the The chief purpose of the Chronicle was to International Health Conference itself.Nos. 4 -7 provide public -health administrations and mem- contain minutes and documents of the second bers of the medical and scientific professions to fifth sessions of the Interim Commission, with monthly information on the current acti- and No. 8 the reports of all the expert com- vities of the Commission and of its expert mittees submitted to the Interim Commission committees.The first issue (Nos. 1 /2) appeared up to the time of the fifth session.The Provi- in June 1947.Eight numbers inall were sional Agenda, with Documents and Recommen- published during 1947, thefirstfour being dations, was published as No. 10 of the Official doublenumbers.TheCommissiondecided Records.Separate editions were published in that it should appear not only in English and English and in French. French, the two working languages, but also in Chinese, Russian, and Spanish. Bulletin of the World Health Organization By agreement with OIHP, the last number AA Epidemiological Code of the latter's bulletin was issued with the Pending the preparation of an epidemiolo- help of the Secretariat of the Interim Commission gical code covering the whole world (Codepid), and under the names of both organizations. the AA Epidemiological Code, originally adapted The last two numbers of the Bulletin of the Health for the use of the Singapore Epidemiological Organization of the League were also issued by Intelligence Station, was brought up to date theCommission.Thefirst number ofthe and reprinted to meet an urgent need. Reference Service and Library

The need for an adequate reference service referenceservice.The organizationofthe and for a technical library, forming an essential library was actively pursued, and it was possible adjunct to the technical work of the Commission to provide a service within a short period of and its Secretariat, was recognized at an early time. stage.S2 Documentation on problems handled The task of the library during the interim by the organizations preceding the Commission, period was : to provide the Commission and the current bibliographical work on subjects of Secretariatwithessentialtechnicalbooks, immediate interest and on activities of other periodicals,and referencematerial such as bodies and specialized agencies connected with dictionaries,directories, gazetteers; to ensure the Commission's work, were dealt with by the procurementofperiodicals and government

n See p. 46 82`0ff. Rec. WHO, 5, 6o

53 SERVICES PROVIDED documents, avoiding duplication with those 1940-1946 of series of periodicals received by received by the library of the Office International the health and medical sections of the League d'Hygiène Publique (OIHP) and those available of Nations library before the war was actively in the health and medical series of the former pursued. League of Nations library, which was included in The location, far away from the Secretariat, the United Nations library ; and to prepare a of the Commission's library in Geneva hampered library organization which would permit future full utilization of its services.On the other expansion. hand,itsproximity to the United Nations An additional responsibility was also assumed library to some extent facilitated access to the by the library in procuring medical literature health and medical sectionsofthe former under the Field Services programme 33This League of Nations library.In spite of staff involved obtaining some io,000 volumes and limitations,thereferenceserviceandthe subscribingto400periodicalsforeleven library were able to deal with a growing volume countries. of requests for information and literature from Progress was made in obtaining new books, the technical officers of the Secretariat. and a regular supply of medical and other The importance for WHO of free access to the technical periodicals, mostly by exchange with health and medical sectionsof the former the Commission's publications.Efforts were League of Nations library, as well as to the also made to obtain current government reports. archives of the Health Organization, and ,of Arrangements were made to adapt the classi- ownership of the stock of publications of the fication of the United States Army Medical Health Organization, was recognized by the Library to the needs of WHO. A systematic Interim Commission,34 and the Commission took inventory of the library of OIHP was under- note of the decision of the United Nations on taken,and thecompletionfortheperiod this subject.36

Public Information Bringing the aims and functions of WHO to Nations Information Centres in various the knowledge of the public has been one of the countries responsibilities of the Commission.This long - ii. World -wideradiobroadcasts through range task, which requires an adequate machi- United Nations news and reports pro- nery and programme, has only been initiated grammes in various languages during the interim period, and during the early months the public- information activities of the iii. United Nations Bulletin. This publica- Secretariat were strictly limited to provision of tionof wide circulationinEnglish, Press material distributed by the machinery of French andSpanishlanguagesgave the' Department of Public Information of the attention to the Commission's work and United Nations.36 The developmentofthe published several articles on its activities Commission's activities and of a steadily growing iv, Features Service. This clip -sheet (English, interest in them prompted the establishment French, Spanish) utilized various items of a public- information unit under a professional about the Commission public- information officer.3? The guiding principles in the development of v. Co- operation with non -governmental or- its programme were to publicize the aims of the ganizations, through a special section organization by taking full advantage of the maintaining contact with such organi- facilities at the disposal of the United Nations zationsat Lake Success,provided a forinformationactivitiesintendedforthe useful, means of reaching many bodies general public throughout the world, and to having their own publications, news- supply material on the Commission's technical letters and speakers activities to the technical Press,tospecial vi. Speakers and lecturers.The United writers and periodicals, and to international, Nations Section for Lecture Services and national and professional organizations inte- Educational Liaison prepared material rested in public health.. onallspecializedagencies,including Collaboration with the Department of Public WHO. The Commission was represented Information of the United Nations was consi- on the Consultative Committee on Infor- dered by the Commission,38 and close working mation composed ofthe Information relations with this department were maintained Officers of the United Nations and the in order to realize fully the advantages of the specialized agencies. The meetings of this machinery for world -wide distribution of infor- committee afforded the opportunity for mation. The channels for distribution included : discussing common problems and learning i. PressreleasesatLake Successand viewson informationalpracticeand Geneva, and through the existing United procedure of other specialized agencies.

38 See p. 5o ae I bid.4,136 as O ff. Rec. WHO,5, 125 39Ibid.5, 61 se Ibid. 7, 95 ae Ibid.4, 135

54 SERVICES PROVIDED

The material prepared for distribution through associations, health authorities, and university the above -mentioned channels and other outlets and medical- faculty libraries.39 included : The public -information unit also provided (a) Fact Book on WHO, a mimeographed ideas and suggestions for writers and for perio- publication available in English and French, dicals ;it prepared special data for numerous which was repeatedly revised to include news services, mainly in the United States, newest data. both of a general and technical character. (b) WHO Information Folder, a condensed Motion and still Pictures.Arrangements were printed publication suitable for answering made to provide material and facilitate the briefly simple questions about the organi- production by the United Nations Film Board zation, which was issued in English and of a film on some aspects of the Commission's French. A Spanish version was published activities.Still- photographs on itsfield -acti- by the Pan American Sanitary Bureau in vities were collected and made available to its bulletin. the Press. (c) A Condensed Fact Sheet, which pro- An exhibit on the aims and work of the vided background information on the work Organization was prepared, and was used at of each session of the Commission. the biennial meetings of the American Public Health Association in Atlantic City, October (d) Frequent Press releases. 1947. A monthly News Letter, containing condensed Radio broadcasts.Taking advantage of the items of public information, was circulated to United Nations radiofacilities, a successful health administrations, to publications of health series of broadcasts was arranged, and recordings services,toassociationshavingtheirown by members of the Commission were utilized journals, and to a number of general publica- in United Nations radio programmes in diffe- tions.The mailinglistof the News Letter rent languages. steadily increased.It did not duplicate in any way the Chronicle ofthe WHO, which was circulatedmainly tomedicaljournalsand 89 See p.53

55 Chart 1 STRUCTUREOF THE GENERAL ASSEMBLY© SHOWING BODIES WITH WHICH THE INTERIM COMMISSION WAS IN RELATION

AD HOC BODIES MAIN COMMITTEES Established at the first part of the first session: First Committee GEN FRAL PERMANENT HEADQUARTERS COMMITTEE POLITICAL AND SECURITY seam LEAGUE OF NATIONS COMMITTEE

COMMITTEE ON U.N.R.R.A.

ASSEMBLY COMMITTEE ON NEGOTIATIONS, WITH U.S.A.

j/////////////// /iii/ / 'COMMITTEE ON NEGOTIATIONS FOR THE econd Committee / 7 TRANSFER OFLEAGUE FINANCIAL ASSETS,AND THEREM SESOFITHE APEACE PALACE AT THE HAGUE// HEADQUARTERS COMMISSION PROCEDURAL COMMITTEES STANDING COMMITTEES Established at the second part Third Committee / /// of the first session: SOCIAL, HUMANITARIAN ADVISORY COMMITTEE ON ADMINIS-/. COMMITTEE ON RULES OF PROCEDURE AND CULTURAL/ GENERAL COMMITTEE /TRATIVE AND BUDGETARY QUESTIONS/ GOVERNING THE ADMISSION OF NEW MEMBERS

COMMITTEE ON TRANSMISSION OF INFORMA - °//////// / //////////// Fourth Committee j:TION UNDER ARTICLE 73 (e)% / / / / /// TRUSTEESHIP ADVISORY COMMITTEE ON HEADQUARTERS CREDENTIALS COMMITTEE COMMITTEE ON CONTRIBUTIONS SPECIAL TECHNICAL COMMITTEE ON POST- U.N.R.R.A. RELIEF

COMMITTEE ON PROGRESSIVE DEVELOPMENT OF INTERNATIONAL LAW AND ITS jif/th/Comm/i CODIFICATION A / / / / / / / / / / / / /te/ /// % /ADMINISTRATIVE AND BUDGETARY/ COMMITTEE ON PROCEDURES AND ORGANI- ZATION

BOARD OF AUDITORS ////////// ///////i/ / Established at the first Sixth Commi / special session: LEGAL SPECIAL COMMITTEE ON PALESTINE A -1 *At the opening of its second regular session Iri10. 8/8 CHAPTER 4

RELATIONS WITH OTHER ORGANIZATIONS

United Nations and its Organs

In accordance with Article 2C of the Arrange- Secretary -General of the United Nations on ment of 22 July 1946 and with the principles 28 November 1947 and 23 January 1948. expressed in the United Nations /WHO Agree- The Commission decided to submit this agreement,theInterimCommission maintained ment 3to the first Health Assembly for its effectiveliaisonwiththeUnitedNations approval.4 through representationat meetings and by other means.Representatives of the Interim General Assembly of the United Nations Commission attended as observers and, when appropriate, participated in meetings of the The General Assembly approved the establish- several bodies of the United Nations when ment of WHO at its first session, and there- matters of concern to the Commission were after the granting of two loans to the Interim under discussion. Commission, the transfer of the functions and The reports prepared on assets of the Health Organization of the League thesemeetingsaresummarizedbelow.In addition, the Secretariat of the Interim Com- of Nations, and the agreement with WHO. mission took part in the work of the various At its second session, the Assembly approved coordination committees and consulted with a Convention on the Privileges and Immunities the relevant divisions of the Secretariat of the of the Specialized Agencies b and urged member United Nations.Reports were submitted and States to apply this convention as far as possible, documents exchanged.In a few cases, the pending their formal acceptance of it. Commission appointed expert consultants or The Interim Commission later approved the seconded staff to United Nations bodies. reports on the convention submitted by its The principal organs of the United Nations Panel of Legal Experts, which expressed certain maintained reservations regarding its terms.° with whichrelationswere are General provisions for the coordination of those shaded in charts i and 2 (pp. 56, 58), programmesandadministrativeprocedures showing the structure of the General Assembly were incorporated into the agreements of the and of the Economic and Social Council. United Nations with the specialized agencies. In a seriesof recommendations to member Agreement between the United Nations States, the Secretariat of the United Nations, and WHO and thespecializedagencies, the Assembly After preliminary discussions between the has outlined in some detail the mechanism of Executive Secretary and representatives of the coordination.Notably, it has requested the Secretariat of the United Nations,' this agree- specialized agencies to submit periodic reports ment was negotiated at a joint meeting on and budgetary estimates, to consult with the 4 August1947oftheSub- Committee on Secretariat of the United Nations, and to work Negotiations of the Interim Commission and with the coordination committees of various of the Committee of the United Nations on United Nations bodies on means of achieving Negotiations with Specialized Agencies.It was greater uniformity in administrative, financial, approved by the Economic and Social Council and budgetary procedures.?The Interim Com- on 13 August 1947, by the Interim Commission mission decided to transmit to the first Health on 12 September 1947,2 and by the General Assembly documents containing these recom- Assembly on 15 November 1947.It has been used, mendations of the General Assembly.8 as far as possible, by both parties, pending The General Assembly approved at its first finalapproval by thefirstWorld Health session the Protocol ofII December 1946, Assembly, in accordance with letters of agree- which, by amending the previous international ment exchanged between the Executive Secre- agreements for the control of narcotic drugs, tary of the Interim Commission and the Acting provided for the transfer to the United Nations of the powers and functions of the League 1 Off. Rec. WHO, 4, 75, 118 ; 5, 38, ,o8 2 Ibid.6, 145 ;for membership of sub-committee, 6 Ibid. Io, III see table XI, p.83 6 Ibid. 6, 209 ; 7, 235 8 Off. Rec. WHO, lo, 59 7 See p. 99 4 Ibid. 7 1-82 8 Off. Rec. WHO, 7, 51 ; io, 4o, 63

57 SHOWING BODIES ® WITH WHICH THE INTERIM COMMISSION WAS IN RELATION V/SUR- COMMISSN INTERNATIONAL LABOR EIOMPLOYMENTAND ORGANIZATION% ECONOMIC STABILITY

á r ï//%élïá Po00 AND AGRICULTUR TRANSPORT AND / ECOÑÓMIC EIELOPME NT / ORGANIZATION OFTHS COMMUNICATIONS /UNITED 111171015/ i/ e/ ...... / //SUR /COMMISSION /UNITED NATIONS EDUCATIONA STATISTICAL/ /STATISTICAL SAMPLING ///SCIENTIFIC AND7 4ÇULTURAL ORGAIHZA710N/ //// ER/NCTIONÁLCÎÎL/ FISCAL W AVIATION ORGANIZATION ton

ECONOMIC AND POPULATION INTERNATIONAL BANK r FOR RECONSTRUCTION o AND DEVELOPMENT SOCIAL COUNCIL /g/i INTERNATIONAL CHILDREN'S' SOCIAL WORLD HEALTH gc %/%%%/%%%/%/%%%/%j// ORGANIZATION %/ Interim Commission COMMITTEE ON s, 'COMMISSION COORDINATION,_J /AD HOC FREEDOM OF INFORMATION. /iiiii/iiiii/ 'SNEGOTIATIONS WITH7 COMMITiEE/ COMMITTEES AND OF THE PRESS/ INTERNATIONAL / PECIALIZED AGENCIES MONETARY FUND W SUB-COMMISSION STATUS OFWOMEN PREVENTION OF /N /ERNNAT//////REF000EE// H DISCRIMINATION AND REFUGEE / PROTECTION OF MINORITIES INTERNATIONAL /COMMITTEE ON ARRANGE- /iiaaaiiaiiiaa ORÇAN 1 ZIITION ///// (Prepirat/ry CemtabeNxOj// MENTS FOR CONSULTATION //iii/iii////iiiii/iii ¡WITH NON- GOVERNMENTAL) NARCOTIC DRUGS DRAFTING COMMITTEE/ ON THE BILL OF RIGHTS/ INTERNATIONAL ORGANIZATIONS Vi TRADE ORGANIZATION 1 (croo...) ECONOMIC COMMISSION 1 FOR EUROPE,/ I //////7 // /iii/ I UNIVERSAL 1 lull POSTAL UNION jÉCON01171C CÓMMÎS810N/ ASIA AND NON -GOVERNMENTAL FAR EAST UU REGIONAL ORGANIZATIONS INTERNATIONAL / //ar/ 41/ /%iii/ COMMISSIONS TELECOMMUNICATIONS ECONOMICCOMMISSION j UNION AMERICA/ %% % %/ %% l 7 / /AD HOC COMMITTEE ON THE / PROPOSED ECONOMIC COMMISSION: / /FOR THE MIDDLEEAST/ Relations pending RELATIONS WITH OTHER ORGANIZATIONS of Nations in this matter.The Protocol, which of the United Nations and WHO in fellowship came into effect on 3 February 1948, placed programmes (see p. 61). certain technical responsibilities upon WHO In addition to approving the conferences and (seep.6o),andtheInterimCommission investigations mentioned below, the Council adopted the report of the Committee of Legal directed the Secretariat of the United Nations Experts on responsibilities with respect to the to study and report on (i) expert assistance Narcotics Conventions.9 given by the United Nations and specialized At itsfirstsession, the General Assembly agencies to member States,(2) social -welfare established the International Children's Emer- services for under -developed areas, (3) co- ordina- gency Fund (UNICEF) " for the benefit of tionof cartographic servicesof the United children and adolescents of countries which Nations and thespecializedagencies,and were victimsof aggressionand...for child (4) establishment of United Nations research health purposes generally..." laboratories.It also recommended co- ordinated The Assembly adopted at its first and second action by the specialized agencies to meet the sessions a series of resolutions implementing world food -crisis. Article73e of the United Nations Charter, Information on expert assistance given by which relates to the transmission of information the Interim Commission was forwarded to the on non -self -governing territories.It appointed United Nations in accordance with previous an ad hoc committee (see p. 61), which was decisions,11 and the Commission requested the invitedtocollaboratewith thespecialized Economic and Social Council to defer action agencies, where appropriate, and directed the in regard to international research laboratories Secretary -General,inconsultation withthe in health, pending further consultation with specialized agencies, to study this question. the interested agencies and the recommendations of the first Health Assembly.12The Commission Economic and Social Council also authorized consultations with FAO ' on Since the Council is responsible for co- ordinat- plans for increasing food production.13 ing the work of the specialized agencies with that of the United Nations, it took steps to Commissions of the Economic and Social fulfil the decisions of the General Assembly on the establishment of WHO. At its third Council : Related Bodies : UNICEF session,the Council recommended measures Co- ordination Committee : (Secretary -General's forco- ordination subsequently approved by Committee on Co- ordination). This committee, the Assembly, and requested the Secretary - on which the Executive Secretary represented General to set up a Co- ordination Committee the Interim Commission, is probably the prin- composed of himself as Chairman and the cipal body responsible for working out co -ordi- corresponding officers of the specialized agencies nation of programmes and administrative proce- (see below). dures. It has agreed upon schedules and methods At its sixth session, held in February -March to be followed by the specialized agencies in 1948, the Council considered in detail, for the submitting reports of their activities, work pro- first time, reports of the specialized agencies. grammes, and budgetary estimates.In con- It set up a Committee on Matters relating to nexion with personnel procedures, the committee Co- ordinationand adoptedfiveresolutions has proposed an internationalcivilservice. which supplemented its previous recommenda- In January 1948,itasked the specialized tionswithrespecttoco- ordination (see agencies to consult with the Secretariat of the below).The Interim Commission resolved to United Nations regarding techniques for the draw to the attention of the Council its view presentationoftheir1949 budgets and to thatco- ordinationwasessentialandthat collaborate with the United Nations in improv- " each specialized agency should be encouraged ing budgetary coordination.In January 1948, to operate as far as possible in its own field, the committee set up a preparatory committee independently of political influences ".10 ofdeputies,to whichitreferred questions Much of the Council's work has been con- relating to administrative coordination, regional cerned with the establishment of its functional offices, non -statistical questionnaires, and joint commissions and the discussion of their reports action to alleviate the food crisis. and recommendations.In this connexion, the The Interim Commission decided to refer to Council reviewed the activities of the League the Health Assembly the questions raised by of Nations and of UNRRA in social welfare possiblearrangementsforapproval by the and directed the Secretariatof the United General Assembly of the budgets of specialized Nations to continue certain of these activities, agencies and the proposal that the Secretariat includingfieldadvisory- services and fellow- should consult with the United Nations on ships in social welfare.At its fourth session possible arrangements for joint collection of (February -March 1947), the Council directed budgetary contributions.14It decided to call UNICEF togiveprioritytochild- feeding to the attention of the first Health Assembly programmes, restorationof institutions and the recommendation of the Co- ordination Com- services, and the enlisting of the co- operation mittee thatfuturesessionsofthe Health 0 Off. Rec. WHO, 6, 207 12 Ibid. 4, 139 10 Ibid. 7, 182 18 Ibid. 7, 183 ; see also p. 6o 11 Ibid. 6, 145 14 Ibid. 6, 217

59 RELATIONS WITH OTHER ORGANIZATIONS

Assembly should take place in February or member States.The interest of WHO in data March.16It agreed to participate in an inter- on causes of death and infant mortality, and in national civil service advisory board.'6 the vital statistics in the Demographic Year- The detailed work of coordination is carried book has been recognized, as well as the sole on by threeconsultativecommitteessub- responsibilityof WHO for annual epidemio- ordinate to the Co- ordination Committee of the logical reports.The Interim Commission was Secretary- General ;these in turn have set up represented at the World Statistical Congress. sub -committees and working parties.The consultative committees are those on administrative Economic and Employment Commission and questions (includingpersonnel and adminis- itsSub -Commissions and Regional Economic trative and budgetary problems), public informa- Commissions.Studies by several commissions tion (including the Film Board), and statistical and by the Secretariat of the United Nations on matters.The Secretariat of the Interim Com- housing and town and country planning ; mission worked as closely as possible with the preparations for the proposed Scientific Con- pertinent coordination bodies. ference on the Conservation and Utilization of Resources, which may be concerned with the CommissionsoftheEconomic and Social concurrent development of health services and Council.The Economic and Social Council economic resources ;the application of this hascreatednine commissions whose work same principle in the work of the regional isgenerally concerned withstatistical and commissions ;a proposed inquiry on economic economic matters, and four which deal primarily reconstruction in North Africa ;and prepara- with social matters.The first group consists tionsforaConferenceon Passportsand of the Economic Commissions for Europe, for Frontier Formalities. Asia and the Far East, and for Latin America, The Interim Commission recommended the and an ad hoc Committee on the proposed closest co- operation with the United Nations Commission for the Middle East ; the Fiscal in housing, and decided that the hygiene of Commission, the Population Commission, the housing should be placed on the agenda of the Commission, Transportand Statistical the first Health Assembly.17It also recommended Communications Commission, and the Economic close co- operation with the United Nations in and Employment Commission, which has two preparation for the Resources Conference, in sub -commissions.In social affairs, the Council order that the views of WHO might be presented has established theSocialCommission, the at this conference.18Upon receiving the report Commissions on Human Rights and on the of its observer to the Conference on Frontier Status of Women, and the Commission on Formalities, the Interim Commission decided Narcotic Drugs. UNICEF isresponsible to to inform the United Nations that WHO was theCouncil(seep. 6i).Inaddition,the thesolebody competent toestablishthe Councilhassponsoredseveralinternational sanitary measures applicable to international conferences and investigatingbodies whose traffic.19The Commission also authorized the work is of interest to WHO. appointment of a specialist to take part in the Representatives oftheSecretariatof the field- survey in North Africa ; 20the survey, Interim Commission attended thepertinent however, has been postponed. meetings of these commissions and other bodies, In social affairs, the following commissions and informed them of the services which WHO have taken action of concern to WHO : could, or might be expected to, render in their respective subjects.Furthermore, close work- Narcotics Commission and Permanent Central ing- relationshipswere maintained withthe Opium Board (also Drug Supervisory Body). divisionsoftheSecretariatof the United The Narcotics Commission replaces the cor- Nations which serve the commissions.This responding Advisory Committee of the League work has been valuable not only from the point of Nations, and advises the United Nations with of view of mutual advice and assistance, but respect to the administration and revision of also as a means of avoiding overlapping and the agreements for international controlof ofassuringadequateattentiontohealth narcotics. Under the Protocol of ii December aspects of the problems dealt with by these 1946, WHO, aided by its relevant expert com- commissions. mittee, is to advise the Interim Commission on Instatistical and economic matters,the any narcotic drugs referred to it. principal activities which concern WHO, and In reponse to requests from the Narcotics the commissions or other bodies responsible for Commission, the Interim Commission referred them are as follows : to its Expert Committee on Habit - forming Statistical Commission and Population Com- Drugs the question of the new synthetic drug mission (also World Statistical Congress).Deve- amidone " and agreed to appoint a member lopment of an international statistical system to serve on a commission of inquiry on the and an integrated plan for the various statistical effects of chewing coca -leaf in Peru and neigh- yearbooks of the United Nations, and co- ordina- bouring countries.In accordance with the tionofstatisticalquestionnairessentto terms of the Protocol, the Interim Commission

15 Off. Rec. WHO, 7, 182 15 Ibid. 7, 183 16 Ibid. 7, 182 15 Ibid. 6, 181 17 Ibid. 7, 183 ao Ibid. 6, 190 RELATIONS WITH OTHER ORGANIZATIONS named two experts toserve on the Drug of staff and collaboration in the BCG programme Supervisory Body.21 were approved by the Interim Commission.26 Social Commission. This Commission debated ThePolishGovernment submittedtothe general topics of social welfare and child welfare Expert Committee on Venereal Diseases in (including the Declaration on the Rights of the January 1948 the plan for syphilis control27 Child) and considered the social problems of for which ithas requested UNICEF aid 28 under -developed areas,the questionnaire on trusteeshipterritories,standardsofliving, Other Councils, Commissions and migration,housing, and the preventionof Committees crime.Atitssecondsession,theSocial Commission appointed an Advisory Committee Trusteeship Council.The Council has drafted on Planning and Co- ordination, whose work a questionnaire concerning the trust territories, supplemented that of the Co- ordination Com- whichcallsforinformationon,interalia, health conditions and mortality statistics.The mittee with respecttoactivitiesinsocial welfare. Interim Commission was represented at the On a request from the Social Commission, Council's second session, at which the discussion the Interim Commission appointed a consultant ofthatquestionnairewasdeferred ;this psychiatrist to work with the Secretariat of document was later formally transmitted to the United Nations in a study of the prevention the Interim Commission forits comments.29 of crime and the treatment of offenders.22The AdThoc Committee of the General Assembly Interim Commission also recommended repre- ontheTransmissionofInformation under sentation on the proposed Consultative Com- Article 73e of the Charter.This committee has mittee on Migration.23 prepared a draft outline to serve as a guide to Commissions on Human Rights and on the the administering powers in the preparation of Status of Women.The former commission has their reports.The Interim Commission was been working on a draft Bill of Human Rights represented at those meetings in which vital which includes the right to the preservation of statistics, infant mortality, and other matters health ;the latter has requested information of concern to WHO were discussed, and recom- on the activities of the Interim Commission in mended that co- operation with this ad hoc the control of venereal diseases. committee be continued.3o United Nations International Children's Emer- PalestineCommission. Thiscommission, gency Fund.Liaison with UNICEF is assured establishedinaccordancewithaGeneral by a public -health expert seconded by the Assembly resolution of 29 November 1947 on Interim Commission, who serves as Deputy the future government of Palestine, had the Director of UNICEF's European Office.A task of implementing the proposed partition, pediatrician has also been seconded to UNICEF. but was unable to do all that the resolution UNICEF hasundertakenthreemedical required.It did not establish formal relations projects : a programme of BCG vaccinations to with the Interim Commission, but its Secretariat be carried out by Danish Red Crossfield sought and accepted the advice of the Secretariat teams ; 24anti -syphilis campaigns ; 25 and fel- of the Commission on the establishment of lowships for child -welfare personnel, including working relations with the Arab and Jewish a large percentage of health personnel.The health authorities.The Palestine Commission BCG programme envisages periodic consulta- indicated that it would " request the WHO to tions with a panel of tuberculosisexperts, send an expert to Palestine to undertake a including the Interim Commission's representa- general inspection of the situation ", but no tives,and thestatisticalanalysisby the such request had been received at the time of Commission of the data obtained.The loan going to press.

Specialized Agenciesof the United Nations During the International Health Conference, Social Council the task of defining and co- ordinat- the need for co- operation between WHO and ing the work of the specialized agencies. other specialized agencies of the United Nations The Interim Commission accordingly initiated was repeatedly stressed.It was pointed out collaboration in varying degrees with appro- that proper provision for technical advice and priate specialized agencies, and, in pursuance collaboration in matters of common interest, of Article 2h of the Arrangement of 22 July besides being of mutual benefit, would prevent 1946, entered into negotiations with four of duplication and overlappingof work.The them for the conclusion of agreements as con- Charter of the United Nations had recognized templated in Article 7o of the WHO Consti- this principle in giving to the Economic and tution.These relationships and negotiations are outlined below. 21 Off. Rec. WHO, 6, 145 ; see also p. 41 22 Ibid. 6, 190 ; 7, 182 ; see also p. 42 27 Ibid. 8, 66 ; see also p. 39 28 Ibid. 7, 182 ; see also P. 43 29 A full report on collaboration with UNICEF is 24 Seep. 34 in course of preparation at the time of going to press 25 See p. 39 29 Off. Rec. WHO, 7 183 26 Off. Rec. WHO, 6, 145 ; 7, 252 80 Ibid. 7, 183

bY RELATIONS WITH OTHER ORGANIZATIONS

Food and Agriculture Organization (FAO) International Civil Aviation Organization It was early recognized that, in view of the (ICAO) several common interests of WHO and FAO, According to Article 2k of its Constitution, particularly in nutrition, an obvious case existed WHO has, as one of its functions, " to propose for the setting -up of a joint committee. conventions, agreements and regulations, and Observers from the Interim Commission who make recommendations with respect to inter- attended the second session of FAO's annual nationalhealthmatters... "Inregardto Conference, held in Copenhagen in the autumn such regulations as concern air traffic, it was of 1946, suggested that a joint committee on clear that close co- operation with ICAO was nutritionbe formed toadviseboth FAO required, and representatives from the Pro- and WHO 31 visionalInternationalCivil Aviation Organ- The Commission subsequently appointed a ization were invited to be present as observers Sub -Committee on Negotiations with FAO,32 at the International Health Conference held its terms of reference being to negotiate a draft in New York in June -July 1946. agreement between FAO and WHO for ultimate Further, in order to establish effective relations submission to the first World Health Assembly, with ICAO, the Interim Commission instructed and to represent the Commission on a joint the Executive Secretary to initiate discussions advisory committee on nutrition to FAO and with the Secretariat of that body with a view to the Interim Commission. to the preparation of a draft agreement between A jointFAO andInterimCommission ICAO and WHO for submission to the first negotiatingcommitteemetinGenevaon World Health Assembly4° 9 September 1947, and drew up an agreement 33 The draft agreement prepared by the secret- which was accepted by the FAO Conference on ariats of ICAO and the Commission was sent IISeptember1947 and approved by the to the United Nations Secretariat (Division of Commission on the following day.The Com- Liaison and Co- ordination), which suggested mission decided that relations should be esta- only minor modifications.This draft agree- blished on the basis of this draft agreement, ment 41 was approved by the Commission for subject to an exchange of letters between the transmission to ICAO, on the understanding secretariats.34The Commission later approved that negotiations would be undertaken with the text of the draft agreement 35 for submission a view to developing an agreed text suitable for to the first Health Assembly 36 submission to the first Health Assembly, such The FAO Standing Advisory Committee on text to be approved by the Commission before Nutrition,inSeptember 1947,stressed the the opening of the Assembly 42 On 27 February necessity for close co- operation in the regional 1948, the draft text was forwarded to the activities of FAO and the Commission (and Secretary- General of ICAO, and correspondence WHO itself when it should come into exist- continued between the secretariats. ence).It was also of the opinion that collabor- A further instance of co- operation was the ation should be arranged with WHO, in accord- attendance of ICAO observers at the third and ance with the report of the joint Negotiating fourth sessions of the Commission. The Com- Committee and the agreement, for the revision mission was represented at the first Assembly of the international standards for vitamin A of ICAO in Montreal during May 1947, by and vitamin D, and for other similar purposes.37 Dr. F. Soper, Director of the Pan American The Commission decided that a representative Sanitary Bureau. from FAO should be invited to attend meetings A representative from ICAO was invited to of the Expert Committee on Biological Stand- attend, as observer, the firstsession of the ardization.It also authorized the Executive Expert Committee on Quarantine, in October Secretary to consult the Director- General of 1947, and a representative was invitedto FAO astopracticable means ofinitiating participate ex officio in the discussions of the collaboration in various projected undertakings Expert Committee on International Epidemic designed to increase world food-production.38 Control, which met in April 1948 to consider An ad hoc joint committee on child nutrition, the revision of the international sanitary con- composed of representatives of FAO and the ventions.There was co- operation between the Interim Commission, met in Washington in secretariats in regard to the disinsectization and July 1947, and inits report gave technical disinfection of aircraft. advice to the United Nations International Children's Emergency Fund on nutrition and International Labour Organization (ILO) child- feeding problems39 The assistant head of FAO Nutrition Division A closerelationship between the Interim was appointed to serve in Europe as liaison Commission and ILO began in September 1946, officer between FAO and the Commission. when the Executive Secretary wrote to the Director -General of ILO suggesting the creation 31 Off. Rec. WHO, 4, 92 32 Ibid. 5, 1o8 ;for membership of sub -committee, 37 Ibid. 7, 200 see table XI, p. 83 38 Ibid. 7, 183 33 Off. Rec. WHO, 6, 156 38Ibid. 6, 6o, 145 34 Ibid. 6, 145 48 Ibid. 5, 142 85 Ibid. zo, 68 41Ibid. zo, 71 88 Ibid. 7, 183 42 Ibid. 7, 183

62 RELATIONS WITH OTHER ORGANIZATIONS of two jointtechnical committees, one on the Inter -American Conference for Social Security industrial hygiene, the other on medical care held at Rio de Janeiro in November 1947. and health services43 A representative of the Commission attended The Director- General, in his reply, informed the session of the Permanent Committee on the Executive Secretary that, on 17 September Migration, held in February -March 1948.That 1946, the Governing Body of ILO had committee approved thesuggestionofthe Commission that countries concluding bilateral " noted with satisfaction the provisions agreements on migration should undertake to contained in the Constitution of the WHO observe the provisions of the existing inter- that the Health Organization would act national sanitary conventions. inco- operationwithotherspecialized At the session of the Governing Body in agencies in respect of a number of matters March 1948, during the discussion of the report of direct interest to the ILO, notably the of the Permanent Committee on Migration, the preventionofaccidentalinjuries ;the observer from the Commission emphasized the improvement of nutrition, housing, sanit- importance to WHO of migration questions, ation,recreation,economicor working not only from the epidemiological point of conditions and other aspects of environ- view but also in respect of the establishment mental hygiene ;the promotion of maternal of medical criteria for the selection of immigrants, and child health and welfare ;and the and the furnishing of immigrants with inform- study of administrative and social tech- ation on health conditions in the country of niques affecting public health and medical immigration 49He spoke also of the interest of care from preventive and curative points WHO in medical aspects of social security. of view, including hospital services and At the same meeting, the Director -General social security." of ILO expressed the hope that WHO would be able to advise on the problem of pneumo- He recalled that the International Labour coniosis and to take an active part in the Conference had already, by the terms of the preparatory work for the International Con- declaration of Philadelphia, pledged the full ference of Experts on Pneumoconiosis to be co- operation of ILO with such international held in 1949. bodies as might be entrusted with a share of the responsibility for the promotion of the health of all peoples." Preparatory Commission for the Inter. The Governing Body of ILO approved in national Refugee Organization (PCIRO) principlethecreationofjointcommittees, As one of the successor agencies to UNRRA but the Commission at that time had not with an interest in health questions and as a available the qualified personnel necessary to prospective specialized agency of the United put the proposal into effect.4bThe Commission Nations, the Preparatory Commission for the instructed the Executive Secretarytocon- International Refugee Organization was invited, tinue discussions with the ILO Secretariat with from the time of its establishment in Geneva, a view to the formulation of a draft agreement to send an observer to the sessions of the Interim between the two bodies 46 Commission.Dr. R. L. Coigny, Director of The draft agreement 47 was approved by the Health, PCIRO, attended the fourth and fifth Governing Body of ILO in December 1947 sessions.Previously,liaison had been estab- and was adopted by the Commission, which lished between the secretariats on a number decided to submit it to the first World Health of matters, including the dietary scales laid Assembly.48 down for displaced persons.Since PCIRO was An observer from the Commission attended responsible for all aspects of the care of dis- the sessions of the Governing Body and of the placed persons, as officially defined, including International Labour Conference, both held in health,it possessed its own medical service, June -July 1947.In his report, he suggested and the Commission was not asked to assume the desirability of including in the Secretariat any direct or indirect responsibilities, except of WHO, whçn the latter should be definitively in connexion with one question :the resettle- established, a section on industrial medicine. ment of displaced persons who were doctors, The ILO was represented by an observer at nurses, dentists, etc. sessions of the Commission and of the Expert This problem was brought to the attention Committee for the Preparation of the Sixth of the Interim Commission by the observer Decennial Revision of the International Lists of from PCIRO, who stated that nearly 1,800 Diseases and Causes of Death. doctors, 1,000 dentists and 4,000 nurses were On behalf of the Commission, the repre- then available among the displaced persons for sentatives from India and Brazil respectively resettlement b0In answer to a request for attended the Preparatory Asian Regional Con- help in solving this problem, the Commission ference held at New Delhi from 27 October to decidedtocirculatethe PCIRO observer's 8 November 1947 under the auspices of ILO, and statementtoallmember governmentsof

48 Off. Rec. WHO, 4, 92 47 Ibid. zo, 73 44 Ibid. 4, 93 4s Ibid. 7, 183 45 Ibid.5, 42 48 See also p. 43 40 Ibid. 5, 142 60 Off. Rec. WHO, 6, 162

63 RELATIONS WITH OTHER ORGANIZATIONS

PCIRO, with a covering letter asking for details common interest, and broadly indicates which of the conditions under which foreign doctors, aspects of such matters are proper to each dentists and nurses could be admitted to those organization.It recognizes that " WHO shall countries and exercise their professions.b1The have the primary responsibility for the encou- Commission stressed the urgency and impor- ragement of research, education, and the organ- tance of the problem.The replies received ization of science in the fields of health and were sent to PCIRO, which adopted a reso- medicine, without prejudice to the right of lution thanking the Interim Commission for UNESCO to concern itself with the relations its action. between the pure and applied sciences in all An Advisory Committee on the Resettle- fields, including the sciences basic to health ". ment of Specialists was set up by PCIRO, with In order to facilitate close co- operation on a medical sub -committee.The Directorof current issues, the negotiating sub -committees Field Services of the Commission was nominated at their joint meeting in April 1947 concluded as a member both of this committee and of the a provisional working arrangement, outlining medical sub -committee, and was invited to methods of co- operation on a number of projects attend a conference on the question. of mutual interest, and providing for reciprocal representation at meetings.56 Guided by these principles, the collaboration United Nations Educational, Scientific and between the organizations developed in several Cultural Organization (UNESCO) practical ways. A representative of the Com- mission took an active partin a meeting UNESCO, as the specialized agency dealing organized by UNESCO on the Hylean Amazon with education and science, has a common or project.Fellowship programmes were co- ordin- allied interest in many subjects of concern to ated in such a way as to prevent duplication WHO, and the InterimCommission early and overlappingof work,the Commission cameintorelationwith UNESCO inan granting fellowships in medicine and health, attempt to distinguish as clearly as possible UNESCO in all other sciences. the respective fields and lines of approach of Collaboration was also established in work the two organizations.The general principles for the improvement of scientific document- ofco- operationwereoutlinedinanote ation and abstracting :on the invitation of which was approved by the Commission 52 UNESCO, members of the Secretariat of the A Sub -CommitteeonNegotiationswith Commission attended meetings of the Interim UNESCO was appointed,b3 met jointly with Co- ordinating Committee on Medical and Bio- the Negotiating Committee of the UNESCO logical Abstracting and of the Expert Com- Executive Board and produced areport 64 mittee on Scientific Abstracting. containing principles which were subsequently The Commission agreed, in principle, to a incorporated into the final text of the UNESCO / request by UNESCO that the coordination of WHO draft agreement. internationalmedicalsciencecongresses - The draft agreement b5 was accepted by the which had been initiated by UNESCO - Interim Commission, noted by the Executive should become a joint activity of the two Board of UNESCO and, in accordance with bodies.57An organizing committee composed UNESCO procedure, circulated to all member of representatives of several international asso- States.The agreement will come into force ciations was set up in April 1948 to undertake when officially approved by the Executive the planning and preparatory work for the Board of UNESCO and the World Health creation of a bureau for the coordination of Assembly. such congresses. The agreement provides(in Article 1)for The Commission also agreed in principle to closeco- operation and regularconsultation collaboration in the UNESCO field -projects in between WHO and UNESCO on matters of the Hylean Amazon basin and in Haiti.5$

Pre -existingOrganizations The importanceofunifying international of them, was discussed by the conference at health work under the auspices of one world- length.The debates resulted in Article 54 of wide organization was recognized by the Inter- theConstitution,whichprovidesforthe national Health Conference, which drew up a integration in due course with WHO of the Pan Protocol providing for the assumption by WHO American Sanitary Organization - represented of the duties and functions of the Office Inter- by the Pan American Sanitary Bureau and the national d'Hygiène Publique. Pan American Sanitary Conferences - and all The relationship to WHO of existing regional other inter -governmental regional health organ- health agencies, particularly of the Pan American izations in existence prior to the signing of the Sanitary Bureau, the oldest and most important Constitution.

84Ibid. 6, 159 81 Off, Rec. WHO, 6, 146 88Ibid. zo, 76 82 Ibid. 4, 94 88Ibid. 6, 159 88 Ibid. 5,106 ;for membership of sub -committee, 87 Ibid. 7,203 see table XI, p. 83 88 Ibid. 7,203

64 RELATIONS WITH OTHER ORGANIZATIONS

Article 2g of the Arrangement of 22 July 1946 Commission the study of a certain number empowered the Interim Commission to enter of questions on its agenda, and these were taken into negotiations with the bodies concerned, in over by the Committee on Epidemiology and pursuance of the Protocol and of Article 54. Quarantine 65 The subjectsincluded post - Thesenegotiations,undertaken withthe vaccinal encephalitis ;immune reaction after Office International d'Hygiène Publique, the smallpox vaccination ;abolitionofbillsof Pan American Sanitary Organization, and the health and consular visas ;the issueof a Sanitary BureauatAlexandria,aresum- revised edition of the International Quarantine marized below. Directory ; a list of ports accepting quarantine messages by radio ;the vaccination of children Office International d'Hygiène Publique against yellow fever ;disinsectization ;and (OIHP) 59 the drawing -up of an index of rat infestation of ships.With one exception(forfinancial The Protocol concerning the OfficeInter- reasons), all these subjects were studied and national d'Hygiène Publique, adopted by the discussedandtheresultsinsomecases International Health Conference in July 1946, published.66 provides for the taking -over of the duties and Another question passed to the Interim Com- functions of OIHP as soon as possible by WHO mission by the Comité permanent in October or its Interim Commission.6o 1946 was that of the revision of those clauses On the basisof a resolution adopted in of the international sanitary conventions con- October 1946 by the Comité permanent of cerning the Mecca pilgrimage.The matter OIHP, negotiations were accordingly under- was urgent, as concrete proposals had been taken for the transfer of its assets, liabilities receivedfromseveralgovernmentsofthe and functions ;and by the end of that year Middle East, and the Commission appointed the Interim Commission had already provision- an expert sub -committee to undertake this ally taken over the epidemiological notification task67 service. When the entry -into -force of the Protocol In February 1947, a sub -committee appointed of 22 July 1946 became imminent, the Com- by the Commission took part in a meeting of the mission instructed the Executive Secretary to Commission des Finances et du Transfert of co- operate with OIHP representatives in the OIHP, and subsequently recommended that preparation of a draft agreement for the transfer the Commission shoulddischarge,as from of the duties and functions of OIHP and of I January 1947, the obligations of OIHP to thenecessaryfundsfortheirexecution.68 governments under the Rome Agreement of Accordingly, a committee of both bodies met 1907, as long as that instrument should remain in Geneva, and on 27 January 1948 adopted in force. and signed a text which came into force the The recommendation was adopted by the same day.ó9Under theprovisionsofthis Commission, and OIHP ceased publication of agreement, the duties and functions of OIHP itsBulletinmensuel.ó1The variouspublic- were forthwith assumed by the Interim Com- ations 62 of the Commission collectively inherited mission pending the definitive establishment of the functionofpublishing the information WHO, in so far as the countries parties to the formerly contained in the Bulletin. protocol were concerned, the other countries On the basis of the report of the Commission beingstillserved through OIHP.Further- des Finances et du Transfert it was agreed that, more, OIHP placed at the disposalof the pending completion of the transfer arrange- organization a financial contribution towards ments, the members and staff of the Interim the expenses incurred through the taking -over Commission should have the use of the library, from 1 January 1947 of the regular duties and technical archives, and certain other material functions of OIHP under the Rome Agreement. of OIHP.It was also agreed that OIHP With regard to the obligations of OIHP in should retain its premises in Paris and the quarantine and epidemiology, a joint com- attaching rights, with a view to their eventual mittee was set up to establish a programme of assumption by WHO.63 work, and a financial contribution was also On the recommendation of the Committee made for that purpose.Finally, the agreement on Relations, the Interim Commission under- provided for reciprocal representation of the took to be the agent of OIHP in respect of the two organizationsatmeetings.Itwas to OIHP pension- funds.ó4The matter was accord- remain in force until the termination of the ingly taken up by the Executive Secretary, Rome Agreement. and the new pension -arrangements for former The Commission subsequently notedthe staff of OIHP came into effect in October 1947. entry- into -force of the Protocol and decided The Comité permanent of OIHP had further to recommend to the World Health Assembly decided in October 1946 to pass to the Interim that it take note of the agreement, approve

59 For an account of the history of OIHP, see p. 20 80 Off. Rec. WHO, 2, VD 65 Ibid. 5, 128 61 See p. 20 66 Ibid. 6, 63 62 See p.53 87 See p. 40 63 Off. Rec. WHO, 5, iso 69 Off. Rec. WHO, 6, 206 64 Ibid. 5, 109 69 Ibid. 7, 203

65 RELATIONS WITH OTHER ORGANIZATIONS it in so far as might be necessary, and con- to obtaining, in the draft agreement with WHO tinue, on the basis of that agreement, to take as approved by the Directing Council of PASO, all necessary measures for the transfer of the the removal of that paragraph which referred assets and liabilities of OIHP to the Organiza- torevisionor annulmentafteroneyear's tion at the moment of expiry of the Rome notice,79 and further recommended that inter - Agreement." secretariat collaboration should continue pend- A joint committee of OIHP and the Com- ing the production of a revised draft agreement mission examined methods by which OIHP acceptable to both parties.Attention was also could provide the organization with technical drawn to the fact that the membership of WHO aid in epidemiology and quarantine, and decided at the moment in the region served by the Pan to assist in the work of the Expert Committee American Sanitary Bureau would be insufficient on International Epidemic Control by furnish- for the establishment of a regional committee.80 ing viewsofexperts on cholera,smallpox, plague, typhus and on some other diseases Sanitary Bureau at Alexandria againstwhich quarantinemeasures areor In 1946, the Pan Arab Sanitary Bureau, might be taken.71 successor to the Regional Bureau of Epidemio- That decision was put into effect, and meet- logical Information at Alexandria, which had ings were held in April 1948 at the head- functioned under the former Conseil sanitaire quarters of OIHP inParis, by three joint maritime et quarantenaire d'Egypte, was ful- groups of experts.The results of these con- filling the functions of regional bureau of the sultations were presented to the Expert Com- Office International d'Hygiène Publique in the mitteeonInternationalEpidemicControl Near East, under the terms of Article 7 of the atitsfirstsession, held in Geneva shortly InternationalSanitary Conventionof1926. afterwards.72 After the setting -up in Geneva by the Interim Commission of an epidemiological notification Pan American Sanitary Organization service comprising the activities formerly carried (PASO)73 on by OIHP, UNRRA and the Health Section In application of Article 54 of the WHO of the League of Nations, relationship was Constitution, which provides for the integration maintained between the Commission and the of the Pan American Sanitary Organization Sanitary Bureau at Alexandria. with WHO, and of Article 2g of the Arrange- Hence, since 1946, the Bureau has continued ment of 22 July 1946, giving to the Interim to operate vis -à -vis the Commission as a local Commission the duty of entering " into necessary organ for the collection and dissemination of arrangements with the Pan American Sanitary information, as its predecessor had done under Organization ", the Interim Commission set up the arrangement concluded on 9 November a Sub -Committee on Negotiations with the Pan 1927 between the Comité permanent of OIHP American Sanitary Organization.74The sub- and the President of the Egyptian Quarantine committee drew up a tentative draft agree - Board, and ratified by the latter on 7 February ment,7b designed to serve as a basis for negotia- 1928.The functions entrusted to the Bureau tions with the Twelfth Pan American Sanitary are detailed in a memorandum of 26 July 1947 Conference at Caracas in January 1947. This from the Egyptian Ministry of Public Health,81 conference includedinits" FinalAct "a and mainlyconsistinensuring aregional resolution on the Agreement between PASO notificationserviceinaccordance with the and WHO, and an " annex " containing a provisions of the sanitary conventions and in statement of principles 76 for the guidance of keeping the Commission informed on the health the Directing Council of PASO, which was aspects of the Mecca pilgrimage. empowered to conclude the agreement without On the invitation of the Egyptian Govern- the necessity of approval by the governments ment,theExpertSub -Committeeforthe or by a subsequent inter -American sanitary RevisionofthePilgrimageClausesofthe conference. InternationalSanitaryConventions metin The matter was further studied by the Com- Alexandria in April 1947, and was aided by the mission along with additional proposals,77 and Sanitary Bureau both through the loan of staff negotiations. continued.The Directing Council and in the making of all material arrangements.82 of PASO, in October 1947, specifically considered The possibility of attaching the Bureau to relations with WHO and adopted resolutions WHO as a regional office was examined by the thereon.78 Commission, but appeared torequire more The Commission, in the light of the progress detailed study, as difficulties of a legal nature achieved and of further proposals, recommended might arise from the fact that the Bureau was that negotiations between the sub -committees under the jurisdiction of a national government of the two bodies should continue with a view and had no realautonomy.83The Commission

7° Off. Rec. WHO, 7, 205 77 Ibid. 5,109;6, 168 71 ibid. 7, 204 78 Ibid. 7,205 72 See p. 39 79 Ibid. 7,184 78 For an account of the history of PASO, see p. 19 8o Ibid. 7,207 74 For membership, see table XI, p. 83 S1 Ibid. 6,173 75 Off. Rec. WHO, 5, 114 82 See also p. 4o 78 Ibid. 5, 115 83 Off. Rec. WHO, 6, 28

66 RELATIONS WITH OTHER ORGANIZATIONS thereforedecided toappoint a smallsub- the International Sanitary Convention of 1938.84 committee to study, along with the competent The Chairman of the Interim Commission authorities, the question of the relations of visited Egypt and prepared a report on the WHO with the Bureau, in the light of Chapter XI Sanitary Bureau, which has been circulated to of the Constitution and of the provisions of members of the Commission. Non- governmental Organizations Article 2b and j of the Constitution specifies, Committee on Relations with Non -governmental as one of the functions of the World Health Organizations 87 to report on : Organization,theestablishment and main- " (a) the criteria which should be met tenanceof" effectivecollaboration with .. . before an organization can be regarded as professional groups and such other organizations eligible for association ; as may be deemed appropriate ",and the " (b) organizations which have applied promotion of " co- operation among scientific for association and with which it is con- and professional groups which contribute to sidered desirable to make interim arrange- the advancement of health ". ments at the present time ; As a number of professional and technical " (c)the arrangements recommend ed non -governmental organizations,85 both inter- in each case under (b) above; national and national,desiredtoestablish " (d) the machinery required for dealing official relationships with the Interim Com- with applications when the WHO comes mission and with the World Health Organiza- into being." tion,it became essentialat an early stage In its report, dated 3 September 194.7, the to adopt a policy for dealing with their requests. sub -committee recommended, with regard to The Commission accordingly approved a set (b) and (c), that no relationships, save of the of guiding principles.88In doing so, the Com- most informal nature, should be entered into mission, while feeling thatit was not in a with non -governmental organizationsduring position to extend help to such organizations theinterimperiod.Withregardto(a) under satisfactory conditions, nevertheless fully and(d),thesub -committeeestablisheda recognized the desirability of co- operating with set of principles, suggested machinery for their them, and contemplatedco- operation when application, and made recommendations as to WHO should have come into existence.Con- the privileges to be conferred upon organiza- sequently, although it accepted invitations to tions brought into relationship.88The Com- be represented at certain meetings, the Com- mission adopted the sub -committee's report as mission did not create any formal links between a first step, and later approved further recom- such organizations and WHO. mendations of the sub -committee with respect The Commission appointed a special Sub- to such privileges.89

84 Off. Rec. WHO. 6, 146 86 Off. Rec. WHO, 4, 97 86 Any international organization not established by 87 Ibid. 5, 109 ; for membership, see table XI, p. 83 inter -governmental agreement was considered as a 88 Ibid. 6, 161 non -governmental organization 88 Ibid. Io, 82

CHAPTER 5

ADMINISTRATION AND FINANCE

Organization

On i April 1948, the Interim Commission had Table IV. a total staff of 204, of whom 391 were at head- NUMBERS OF STAFF AT DIFFERENT PERIODS quarters in New York, 115 in Geneva, 41 in the Organization 1. X. 1.I 1. I 1. IV field, and ,nine at the Singapore station. Units 1946 1947 1948 1948 From a nucleus of 15 on 1 October 1946, Headquarters 5 7 32 -I- 2*32 + 7* the staff had grown, three months later, to 70, Geneva office . . . 3 32 97 115 a sharp advance reflecting the Commission's Singapore Station . 7 8 8 9 taking -over of the functions of earlier bodies. Field missions. . 23 41 41 With the development and expansion of acti- - Totals . 15 7o 18o 204 vitiesin1947 the increasecontinued, and by the end of that year the staff total had * Consultants and "while actually employed "'staff. reached 180.2 Table V. The broad allocation of functions - outlined DISTRIBUTION OF STAFF BY NATIONALITY in the first section of this report 8 - between ON 1 APRIL 1948 the New York and Geneva offices, under the supervision of the Executive Secretary, followed d upon a resolution 4 adopted by the Commission. Countries x of A. Ñ Certain responsibilities, such as general planning origin a and the preparation of documents for sessions, dd 1a7 a r.m

xz were shared by the two offices.Other functions c. ró iñm W i3 are indicated below. Australia I I Austria I I

Headquarters, New York Belgium T I Senior officials of the New York office included Bulgaria 2 3 the Director and Assistant Director, Director Canada I 2 2 5 ofFinancialand AdministrativeServices,5 China 2 2 Director of Public Information, and Assistant Colombia I I Director of Field Services. Costa Rica . I I The office had extensive liaison responsi- Czechoslovakia I 4 5 bilities :it maintained constant contact with Denmark I I 2 the United Nations, particularly on matters Egypt I I of administrative policy and in connexion with France 18 2 20 theloan made totheCommission ;and Greece 2 3 5 asimilarlycloserelationshipexistedwith Hungary I I UNRRA, Washington, with regardtothe India I UNRRA grants for field services to govern- Italy 2 2 ments. Netherlands 4 4 The office was responsible for the representa- New Zealand tionof the Commission at conferences con- Norway 2 3 cerned in various degrees with health, and for Palestine . I general contact with the Economic and Social Poland 3 3 Council, the Pan American Sanitary Organiza- Roumania I tion, FAO and the International Bank in Spain I Washington, ILO and ICAO in Canada, and Switzerland 37 38 numerous medical institutions and organizations. United Kingdom 3 26 IO 39 United States 1 Including seven specialists or consultants employed of America . . temporarily for specific duties 30 4 13 47 2 See table IV USSR . . I 3 See p. Do Yugoslavia . . 2 3 4 Off. Rec. WHO, 4, 27 Stateless I 2 b The DirectorofFinancial and Administrative Unknown . 8 8 Services was transferred to the Geneva officein May 1948 Totals 39 115 9 41 204

69 ADMINISTRATION AND FINANCE

The New York office also directed part of Use of Services of the United Nations the programme of the Field Services Division. The Commission utilized as much as possible Its functions in this respect included super- the available services of the United Nations. vision of the China mission, operation of the In New York, such services were chiefly used fellowship programme in the Far East and the for travel arrangements.The Geneva office western hemisphere, and the procurement of used them for procurement, travel arrange- large quantities of medical literature and teach- ments, distribution, duplicating and printing, ing equipment. and officemaintenance, and also used the The responsibilities of the Director of Financial postal, telephone and messenger services.In and Administrative Services and the Director addition, the United Nations furnished inter- of Public Information embraced all offices and preters and other temporary personnelfor activities of the Commission. conferences. Staff Policy Geneva Office Under authority granted by the Commission In addition to supervising administration, to the Executive Secretary, the conditions of staff, and liaison with the United Nations in employment of the staff were governed by the Geneva, the Head of the Geneva office directed regulations of the United Nations, in so far the work on biological standardization and on as these were applicable.10The Commission theunificationof pharmacopceias.Directly latersetup a Sub -Committee onSpecial responsible to him were the legal officer, experts Administrative Problems 11 to consider questions onmalaria,tuberculosis,venerealdiseases, of salary scales, allowances, provident fund and publichealth administration and training, and insurance for the staff, and accepted its report alcoholism, and the chief medical editor. with somemodifications.Itdecidedthat, The office had responsibility for the meetings during and because of the short life of the Com- of the several expert committees, and for liaison mission,certainUnited Nations allowances with UNICEF and UNESCO in Paris, FAO would not apply :namely, salary increments in Rome, PCIRO, ILO, and the United Nations for length of service, the installation grant, in Geneva, and correspondence and relations rentalallowance(New York),expatriation with various medical bodies. allowance, home leave and transportation of The Division of Epidemiology and Public household goods.12 Health Statistics performed many functions, For Field Services staff assigned to missions, which are described elsewhere in this report,' authorization was given for. the continuance and was responsible for the Singapore Epide- of the conditions of service and allowances miological Intelligence Station. granted under UNRRA field -staff regulations.13 The Division of Field Services was responsible Agreement with the Swiss Government for planning, supervising and operating the The Commission signed a draft agreement with field programme, which included policy- making for China and the Far East and fellowships, mis- the Swiss Federal Council concerning the legal sions, visiting lecturers, and medical -literature status of WHO in Switzerland.14The draft programmes in Europe and Africa.?The divi- agreement, which grants certain privileges and sion also maintained relations with UNICEF immunities to the organization and its staff, through two medical officers attached to that is subject to acceptance by the Health Assembly. organization's Paris office.The procurement Its provisions, however, were applicable to the of a considerable amount of medical literature Interim Commission. on behalf of the division was undertaken by the Headquarters and Regional Offices of WHO ReferenceandLibraryService,themain The factors bearing upon the location of the functions of which are described elsewhere.' headquarters of WHO were studied by a special The Editorial Service was mainly responsible committee,15 which also took cognizance of for editing and translation for printed publica- earlierdiscussions on thequestion by the tions 9 and other documents. Technical Preparatory Committee l' and the The functions of the Financial and Admi- International Health Conference.'? nistrative Services were subdivided, each being The Secretariat, in a circular letter, requested in charge of an officer responsible directly to governments to communicate their views, and the Head of the Geneva office.These included the replies were placed before the Commission.18 finance, personnel, registry, and administrative Information was sought from other specialized services for such matters as travel arrange- agencies on the results of their studies on the ments, procurements, accommodation and equip- location of their own headquarters. ment,localtransportation,preparationfor A survey and analysis of this complex question meetings, and the stenographic and typing pool. were subsequently made by the committee in itsfinal report, which was adopted by the sSee p. 46 7 Seep.48 1s Ibid.5, 75 See p.53 14 Ibid.4,81;5, 139 9 See p. 52 15 Ibid.4,89 10 Off. Rec. WHO, 4, 77 16 Ibid. I, 23, 73 11 Ibid,5, 82 ;for membership see table XI, p. 83 17 Ibid. 2, 23 and annex 3 12 Idib.6, 125 ; 7,151 18 Ibid.5, 65 ;6, 43 ;7, 135

70 ADMINISTRATION AND FINANCE

Commission.19The report embodied the results resolution to the President of the 1947 General of studies 6n Geneva, New York and Paris as Assembly, asking him to draw the attention of possible seats of the headquarters, and on the members of the United Nations to the impor- United Kingdom as a possible area for the seat. tance of ratifying their signature of the Consti- The Commission likewise undertook studies, tution." When theentry- into -forceofthe in the light of Chapter XI of the Constitution, Constitution became imminent early in 1948, with a view to defining areas for the location the Commission settled the time and place of oftheOrganization'sregionaloffices.The the first World Health Assembly, and determined Secretariatcircularized governments on this the general form ofits own report to the subject also, and the substance of the replies Assembly.22 will be available to the Health Assembly.2° It further decided, in view of the provisions of Article II of the Arrangement of 22 July First World Health Assembly 1946, to submit to the consideration of the In view of the long delay in the establish- Assembly a draft resolution on the dissolution ment of WHO, the Commission forwarded a of the Commission.23 Budgetary andFinancial Policy Policies for budgetary and financial admi- tocertain governments during the cholera nistrationofthe Interim Commission were epidemic in the Middle. East,27 it was found established,andfinancialregulationswere possible to repay the 1946 advances, totalling adopted 24 which were later amended in order $175,000, before the end of 1947. to bring them into harmony with the changed budget- format.25 Transfer of Funds from UNRRA. By agreement with UNRRA,2$ certainhealthpro- Sources of Funds grammes formerly carried on by UNRRA were transferred to the Commission, together with The operations of the Interim Commission funds to finance these activities.29The Com- were financed generally under the authority mission resolved that all direct office- expenses granted by the Arrangement of 22 July 1946, incurred in connexion with the administration Article 8 of which provides that of field services should be charged to the field- " the expenses of the Interim Commission services fund, but that no effort should be made stall be met from funds provided by the to apportion any indirect office -costs attribut- United Nations and for this purpose the able to field services, in view of the fact that Interim Commission shall make the neces- any such apportionment either would have to sary arrangements with the appropriate be made on an arbitrary basis or would involve authorities of the United Nations.Should considerable expense if a more accurate method these funds be insufficient,the Interim of costing were employed. Commission may accept advances from governments.Such advances may be set Funds transferred from the Board of Liqui- off against the contributions of the govern- dation of the League of Nations.An amount of ments concerned to the Organization ". 5,319 13s. 9d. ($21,412), the available balance of the funds of the Eastern Bureau of the Funds for specific purposes were transferred League ofNations, was transferredtothe to the Commission by UNRRA and by the Commission in July 1947 by the Board of Board of Liquidation of the League of Nations. Liquidation of the League.After consideration, Particulars regarding the sums received from the Commission resolved 30 as follows : 31 these three sources are as follows : " Whereas the Board of Liquidation of Loans from United Nations.Loans, totalling the League of Nations, considering it a $175,000 in 1946 and $1,125,000 in 1947, were matter of public interest that the work obtained from the United Nations to cover the of the Eastern Health Bureau of the League operations of the Interim Commission, other of Nations at Singapore should be resumed than those undertaken as a result of an agree- as soon as possible, has transferred to the ment with UNRRA.26 Interim Commission of the World Health The General Assembly of the United Nations, Organization the balance of the funds of in authorizing the making of loans to specialized the Bureau, to be used for the purpose for agencies and/or their preparatory commissions, which the money was originally allocated, stipulated that such loans should be repaid namely, for a working capital fund, within two years.As a result of arrangements The Interim Commission instructs its made in connexion with the assistance given Executive Secretary to apply such funds by the Commission, on a reimbursable basis, for the constitution of a Working Capital

19 Off. Rec. WHO,io,87 as See p. 48 20 Ibid. 5, 9 ; 6, 196 ;7, 135 27 See p. 47 21 Ibid. 6, 213 28 Off. Rec. WHO, 4, 113 22 Ibid. 7, 239 92 Particulars of the funds so transferred are given 22 Ibid.zo, 29 in table VI, p. 72 24 Ibid.4, 147 so O ff. Rec. WHO, 6, 215 29 Ibid.6, 141 21Ibid.6, 123

71 ADMINISTRATION AND FINANCE

Fund for the Epidemiological Intelligence Preparation of the Budget.The preparation Station at Singapore.Any sums drawn of the budget was originally undertaken in from the Working Capital Fund shall consultation with representatives of the United be repaid to the Fund at the earliest Nations Bureau of Administrative Management opportunity." and Budget, the Secretariat, and the Com- mission.At each session of the Commission, Scale of Contributions to WHO the budget was reviewed by the Committee on Administration and Finance, and as a result The Commission considered the question of changes and improvements were made from the scale of contributions for the first budget time totime.The Secretariatproposed a of WHO and came to the conclusion that no revision in the format of the budget for the specific recommendations to the first Health financial year 1947, and this was approved. Assembly could be made,asthequestion The budget for the financial year 1948 was affected directly all members of WHO and prepared on the same basis and subsequently hence only the Health Assembly itself could approved by the Commission. properly deal with it 82 Budgetary Comparisons by Financial Years. Budgetary Administration Table VI sets out the approved budgets, by major sections, for each of the financial years The arrangements made for budgetary admi- 1946, 1947 and 1948.The figures shown for nistration provided for considerable flexibility the financial year 1946 are those of actual so as to allow the making of changes which expenditures,audited andcertified by the experience showed to be necessary. external auditor ;the figures shown for 1947 Structure of the Budget.The structure of and 1948 are the budget estimates. the budget was evolved as a result of experience Budgetary Controls and Responsibilities. Every in efforts to provide an informative document effort was made toestablisha system of showing estimates under approved programme - budgetarycontrolwhich wouldpermita categories.Provision was made for integrated reasonabledegreeofflexibility and decen- budgetary and accounting records, not only so tralized responsibility. that the day -to -day operations could be mana- The Commission, in making appropriations, ged effectively but also so that expense data vested complete responsibility for the budget could be collected for future use of WHO itself. administration in the Executive Secretaráy and authorized him to effect certain specific transfers 82 Off. Rec. WHO 7, 143 of funds, with the restriction that no transfers

Table VI BUDGETARY COMPARISONS BY FINANCIAL YEARS

FINANCIAL YEARS Section Activity 1946 1947 1948 $ $ PART I I Organizational meetings 16,430 89,700 304,900

PART II

2 New York office 60,970 200,472 328,289 3 Geneva office 38,890 533,965 741,745 4 Epidemiological Intelligence Station, Singapore 23,400 38,420 5 Field Services 1,330,042 1,248,852 6 Technical services 90,900 139,200 7 Technical meetings 81,443 154,700

PART III 8 Contingencies 333,788 72,218 Totals 116,290 2,683,710 3,028,324

Sources of Funds

General fund (Loans from UN) . . . 116,290 1,183,710 1,528,324* Field- services fund (UNRRA) . . . . - 1,500,000 1,500,000 Totals 116,290 2,683,710 3,028,324

* The United Nations approved a loan of $1,200,000 to cover the first ten months of 1947

72 ADMINISTRATION AND FINANCE betweengeneralandfield -services funds and expenditures thereon were submitted to could be made.The Executive Secretary was New York or Geneva but were not included in authorized to use the contingency fund for meet- the accounting records nor reflected in the ing unforeseen expenditures within approved reports of the Commission. programmes, and further authorized to re -dele- When such a course became necessary, as a gate such authorizations as he deemed necessary. result of the accumulation of a reasonable sum, Allotments of funds, combined with delegations a separate bank -account was to be opened for of authority, were thereupon issiied to the the publications revolving -fund. heads of the offices in New York and Geneva, Accounting, Auditing and Retorting.For a on the basis of the approved budgets for specific short period immediately following the estab- functions controlled administratively by those lishmentoftheInterimCommission,the offices.The delegations of authority authorized accounts were handled by the United Nations the incurring of obligations and making of expen- Bureau of the Comptroller, until in January ditures, including the employment of staff, sub- 1947 an independent financial service came into ject to specific limitations and subject to the total being and assumed accounting responsibility. amount of the allotments.The heads of the The system at first installed was a simple offices were held responsible for the carrying -out one and was followed until Gune 1947, when, of operations within the limitation of the allot- following the revision of the 1947 budget by ments, and the delegations of authority included the Commission, the budgetary system became provisions, with limitations, for re- delegation. formalized. 36 After a second revision of the Bonding and Insurance.The Commission 1947 budget, 36 revised allotments were made consideredthequestionsofbondingand and the accounting records re- written to con- insurance 33 and approved the arrangements form to the revised budget.Central control - put into effect by the Executive Secretary in accounts were maintainedinNew York ; respectofworkmen's compensation,public in the case of field missions, accounting con- liability and property damage, fidelity bonding, trol was handled by Geneva or New York, fire,and other comprehensive coverage.It depending upon facility of communications with decided that,as some employees were res- the individual missions. ponsiblefor handling funds only for short The auditing arrangements broughtinto periods, the Commission itself should bear the effect consisted of (a) the pre -audit of bills, cost of fidelity bonding.34 claims, and vouchers prior to payment and Banking Arrangements.The financial regu- (b) an external audit.All payments were lations gave the Executive Secretary the right subjected to a pre -audit examination of the to open bank accounts for the Interim Com- documents supporting the payment- request. mission ;withdrawals were made, in principle, No arrangement was made for any post -audit only on joint signature by two officials desig- to be performed internally(internal audit). nated by the Executive Secretary. The deciding factor in not providing for an At the beginning, all banking transactions internal audit was the additional cost of the were carried out through a New York bank ; staff necessary for this purpose. later, accounts were opened in Geneva and in Pending the appointment of an external the centres where field missions were operating, auditor, as provided for in the financial regu- transfers of funds from New York to Geneva lations, the Executive Secretary requested the and to field missions being made on a monthly United Nations Audit Division to make an or semi- monthly basis. As the scope of work external audit of the accounts, first,for the increased, it became necessary to open a small financial year 1946 and, later,for the first number of additional bank -accounts for operat- half of the financial year 1947.The audit ing disbursements. reports 37 were presented to the Commission A separate bank -account was opened for the and were accepted, the Commission at the provident fund, to segregate from Commission same time appointing the United Nations Audit funds monies belonging to members of the Division to be its external auditors for the staff and held in trust for them, and a reserve remainder of its existence.38 bank- account was established to provide a The financial regulations required the submis- separate fund from which to reimburse staff sion of a report on the budgetary position to each members for national income -taxes. session of the Commission, and such reports were Special funds in local currency were made regularly presented to and considered by the available by the governments of certain countries ComMittee on Administration and Finance. to meet specified expenses of the field missions, Thereportoftheexternalauditoron and in most instances these funds were trans- the Commission's financial operations up to ferred by the government to the chief of the 31 December 1947 is given below.It is expected mission and were lodged in separate bank - that the final financial report of the Interim accounts. Missions were responsible for account- Commission, together with the audit report ing for these funds directly to the governments thereon, will be available for submission to concerned, and accounting reports of receipts the second World Health Assembly.

33 Off. Rec. WHO, 5, 82 33Ibid. 6, 1 0 34 Ibid. 6, 74 37Ibid. 6, 81 35 Ibid. 5, 82 33 Ibid. 6,74

73 ADMINISTRATION AND FINANCE.

External Audit Report and Financial Statement to 31 December 1947 The following is the text of the report, dated 12 May 1948, addressed to the Chairman of the Interim Commission by Mr. C. L. Poudrier (Chief Internal Auditor, United Nations) : " At its fourth session, on 6 September 1947, the " The following field missions of the Organization Interim Commission of the World Health Organization, expended during the year1947 the amounts set by adoption of the first report of the Committee on opposite their respective names, in local currencies Administration and Finance, appointed the Chief of furnished to them by the governments of the countries the Audit Division of the United Nations as external in which they are located. auditor for the remainder of the life of the Interim Mission Currency Amount Commission. Austria . . . Austr. schillings 22,756.18 " In pursuance of this appointment, my staff and Greece . . . . Greek drachm 272,291,427.00 I have carried out an extensive audit of the Com- Hungary . . . Hungarian forints mission's financial operations both at the New York 95,280.11 Italy . . . . Italian lire 7,605,784.00 headquartersandtheGenevaoffice.Yourfield Poland . . . Polish zloty 2,318,968.00 missions' operations in Italy, Greece and China were China * . . . Chinese dollars 1,560,000,000.00 also subjected to audit at their respective centres. " As a result of this examination, I attach hereto : To 3o November 1947 The Italian, Greek and Chinese accounts were audited (a) Consolidated Balance -sheet as at 31 December in detail and found to be entirely in order.Officials 1947 [Statement A] of the Italian and Greek Governments, the only ones (b) Consolidated Statement of Cost of Operations questioned by me, expressed complete satisfaction to 31 December 1947 [Statement B] with the purposes of the funds and the manner in which they wereadministered.The Polish Government " As the statements indicate, we have based our itself administers, in compliance with mission requests audit on the Revised Budget for the financial year which they approve, the funds which thePolish Government furnishes.I have satisfied myself that 1947,as contained in document WHO. IC /AF /44. theother governments aremaintaining adequate Corr.1, adopted by the Interim Commission at the control over the funds they furnish. eighth meeting of the fourth session on 12 September Certain changes were made thereto by the " It is understood that all such currencies come 1947. from ex -UNRRA funds being administered by the Executive Secretary by way of transfers, the approval respectivegovernments. arrangements for which was obtained in 1948 at the fifth session of Similar are the Interim Commission (document WHO. IC /193) in effect with some other specialized agencies and with some of the United Nations Social Welfare Advisory when document WHO. IC /AF /59,Rev.1,listing Services. is an open question whether such these transfers by the Committee on Administration As it expenditures may be considered an integral part of and Finance, was adopted. the operations of the international agencies involved, " We have closely and extensively inspected the various vouchers and the recording thereof in the itissuggested that your Organization give consideration to the advisability of submitting detailed books.Bank accounts have been reconciled to certi- statements of local currency transactions concurrently ficatesof balances at 31 December 1947 obtained with the submission of your regular financial state- directly from the various banks, except for the bank ments.So far as I am aware, no other international accounts controlled by those field missions which we agency has yet included such statements. have not been able tovisit.These accounts as " The co- operation of your staff in carrying out the recorded on the books amount to less than , % of the audit has been generous and unfailing, and the general total cash on hand.Assets and liabilities have been morale in your offices and missions has been of such a carefully verified and all the adjustments which we have found necessary have been submitted to the high order as to call for special comment. accountant in the form of journal entries. " Respectfully submitted, " To the best of our knowledge the balance -sheet and the budgetary statement as submitted herewith [Signed] C. L. POUDRIER represent the correct financial condition of the affairs Chief Internal Auditor, of the Interim Commission as at 31 December 1947. United Nations."

74 Statement A WORLD HEALTH ORGANIZATION - INTERIM COMMISSION

CONSOLIDATED BALANCE SHEET AS AT 31 DECEMBER 1947

ASSETS Current Assets : S Cash on hand 1,725,624.14 Cash in transit 55,000.00 Deposit with United Nations 41,049.86 Deposit with UNRRA 7,619.59 Advances to officials and employees 6,200.60 Accounts receivable 20,631.01 1,856,125.20 Deferred Charges : Costs of general operations, deferred until appropriation of assessed contributions : 1946 costs per Statement 31 /XII /46 116,289.38 1947 costs per Statement B 947,726.31 Total costs per Statement B 1 064,015.69 Exchange adjustment 207.73

s 1,064,223.42 Less :Refunds, Cholera programme 204,234.47 Miscellaneous income 1,369.75 205,604.22 858,619.20 Prepaid 1948 expenditures 4,464.42 863,083.62 2,719,208.82 LIABILITIES Current Liabilities : Salaries and allowances payable 10,448.56 Accounts payable, OIHP 4,520.55 Accounts payable, sundry 68,124.26 72,644.81 83,093.37 Other Liabilities : Loan from United Nations 1,300,000.00 Less amount repaid 175,000.00 1,125, 000.00 Estimated tax reimbursements 77,275.97 1,202,275.97 Trust Accounts : League of Nations Fund for Epidemiological Intelligence Station 21,412.75 UNRRA field -funds for 1947 1,500,000.00 Cost of field operations per statement 654,845.54 Balance forward to 1948 845,154.46 Other UNRRA field -funds for 1948 500,000.00 1,345,154.46 Provident fund 67,272.27 1,433,839.48 2,719,208.82

75 WORLD HEALTH ORGANIZATION - INTERIM COMMISSION Statement B CONSOLIDATED STATEMENT OF COST OF OPERATIONS TO 31 DECEMBER 1947 StatementB

Appropriation GENERAL FUND FTFT.TD SERVICES ..o PURPOSE Revised budget UnencumberedRevised budget Recorded Unencumbered Chap- Transfers Allotments Recorded Transfers Allotments Sectionter 1947 charges balance 1947 charges balance

Part I $ $ $ $ $ $ $ $ $ $ I ORGANIZATIONAL MEETINGS : (i) Interim Commission 65,000.00 - 65,005.00 64,226.73 773.27 - - - - - (ii) Committee on Administration and Finance 3,000.00 - 3,00:00 525.60 2,474.40 - - - - - (iii) Sub- committee on Field Services Budget - - - - - 5,000.00 - 5,000.00 3,548.01 1,451.99 (iv) Sub- committees of the Committee on Relations . . . . , 6,200.00 - 6,200.00 765.6o 5,434.40 - - - - - (v) Negotiating sub -committees 10,500.00 - 10,500.00 1,441.01 9,058.99 - - - - Part II f I27,708.93* l 2,500.00 10,554.00 f 9,336.05 l II NEW YORK r Personal services and allowances 136,083.00 4,500.00 14o,5$0.00 II,86L97 1,012.10 8,054.00 l414.00*} 803.95 OFFICE Sl Travel, supplies andcommon services 52,464.00 3,000.00 55,464.00 55,066.16 397.84 3,871.00 2,500.00 6,371.00 5,284.32 1,086.68 51,310.00 III GENEVA (Personal services and allowances 365,360.00 - 365,360.00 {291,000.00 *} 71,474.90 51,310.00 - {454,000.00 *} 2,241.43 OFFICE Sl Travel, supplies and common services 92,790.00 92,790.00 63,598.03 29,191.97 24,505.00 - 24,505.00 14,075.30 10,429.70 IV OTHER OFFICES AND fPersonal services and allowances I0,goo.00 - I0,900.00. 9,415.50 1,484.50 - - - _ REGIONAL ACTIVITIES 1 Travel, supplies and common serv. 12,500.00 - 12,500.00 5,959.97 6,540.03 - - - ' - - V FIELD SERVICES : (i) Mission operations : Austria 6,380.00 - 6,380.00. 2,101.98 4,278.02 China 401,831.00 (202,810.00) 199,021.00 165,121.88 33,899.12 Ethiopia 58,101.00 - 58,101.00 42,774.17 15,326.83 Greece 82,660.00 - 82,660.00 80,801.59 1,858.41 Hungary 10,527.00 - 10,527.00 5,690.88 4,836.12 Italy 20,417.00 - 20,417.00 9,444.96 10,972.04 Poland 12,000.00 - 12,000.00 5,612.95 6,387.05 Yugoslavia Io,000.00 (I0,000.00) - - - (ii) Fellowship programme : Austria ' 20,000.00 - 20,000.00 6,483.08 13,516.92 Byelorussia 30,000.00 - 30,000.00 - 30,000.00

China - 142,190.00 107,810.00 250,000.00 72,899.70 177,100.30 Czechoslovakia 67,500.00 - 67,500.00 30,305.26 37.194.74 Finland 25,300,00 (550.00) 24,750.00 9,691.51 15,058.49 Greece 12,700.00 - 12,700.00 4.339.23 8,360.77 Hungary S 25,000.00 - 25,000.00 - 25,000.00 Italy 25,000.00 - 25,000.00 943.13 24,056.87 North Korea 7,600.00 - 7,600.00 15.47 7,584.53 . South Korea 7,600.00 - 7,600.00 3,917.15 3,682.85 Philippines 11,400.00 - 11,400.00 1,140.30 10,259.70 Poland . . 74,500.00 - 74,500.00 26,206.98 48,293.02 Ukraine 66,500.00 - 66,500.0o - 66,500.00 Yugoslavia 75,000.00 10,000.00 85,000.00 24,812.53 60,187.47 (iii) Visiting lecturers : Austria 4,950.00 - 4,950.00 4,881.74 68.26 Finland 200.00 500.00 700.00 207.87 492.13 Hungary 4,950.00 - 4,950.00 2,581.79 2,368.21 Italy 4,950.00 - 4,950.00 380.56 4,569.44 Poland 4,500.00 - 4,500.00 - 4,500.00 (iv) Medical literature : Austria 1,350.00 - 1,350.00 357.63 992.37 Byelorussia v 5,000.00 - 5,000.00 - 5,000.00 China 1 20,000.00 95,000.00 115,000.005. 7,3 0.77 107, 39.23 Ethiopia 90.0o - 90.0o 6.4! 83.59 Finland 90.00 50.0o 140.00 86.74 53.26 Greece 90.00 - 90.00 313.40 (223.40) Hungary 4,500.00 - 4,500.00 571.47 3,928.53 Italy goo.00 - 900.00 203.85 696.15 Poland 3,483.00 - 3,483.00 414.07 3,068.93 Ukraine 11,533.00 - 11,533.00 - 11,533.00 Yugoslavia 11,250.00 - 11,250.00 3,450.24 7,799.76 (v) Reserve for income -tax reimbursement: Mission and field personnel 6o,000.00 - 6o,000.00 6o,000.00 * - VI TECHNICAL SERVICES : (i) Biological standardization 16,500.00 - 16,500.00 15,188.55 1,311.45 - - - - - (i) Epidemiological Intelligence Service 20,000.00 - 20,000:00 16,023.06 3,976.94 - - - - - (iii) Technical publications 54,400.00 - 54,400.00 33,590.86 20,809.14 - - - - - (iv) Cholera programme - 225,000.00 225,0000 204.234.47 20,765.53 - - - - - VII TECHNICAL MEETINGS : (i) Expert Committee on Quarantine and sub -committees 19,000.00 -- x9,000.00 9,507.36 9,492.64 - - - - - (ii) Expert Committee on Malaria 4,503.00 - 4,503.00 3,771.85 731.15 2,000.00 - 2,000.00 - 2,000.00 (iii) Expert Committee on Habit -forming Drugs 4,320.00 - 4,320.00 - 4,320.00 - - - - - (iv) Expert Committee on Biological Standardization . . . . 10,700.00 - 10,700.00 3,334.o6 7,365.94 - - - - - (V) Expert Committee on International Lists 22,920.00 - 22,920:00 21,525.68 1,394.32 - - - - - (Vi) Joint expert committees 3,500.00 -. 3,501D.00 1,108.83 2,391.17 - - - - - (vii) . Expert Committee on Unification of Pharmacopoeias . . 7,000.00 - 7,000.00 2,098.83 4.901.17 ------(viii) Expert Committee on Tuberculosis 1,50o.00 - 1,500.00 1,340.20 159.80 - - - - - (ix) Expert Committee on Venereal Diseases 3,000.00 - 3,000.00 110.13 2,889.87 - - - - - (x) Non- Secretariat representation of Interim, Commission at meetings of other organizations 3,000.00 - 3,000.00 1,437.83 1,562.17 - - - - - Part III VIII CONTINGENCIES 258,570.00 (232,500.00) 26,070.00 - 26,070.00 75,218.00 (5,000.00) 70,218.00 - 70,218.00 IX EXPENDITURES FOR 1946 I16,290.00 - 116,290.00 I16,289.38 -.62 - - - - - Total 1,300,000.00 - 1,300,000.00 1,064,015.69 235,984.31 1,500,000.00 - 1,500,000.00 I 654,845.54 845,15446 *Charges in respect of estimated tax reimbursement on staremunerationspaidin 1947 TABLE VII PLACES AND DATES OF SESSIONS OF THE INTERIM COMMISSION

Number of Place Date Number of session meetings

First New York 19 -23 July 1946 5 Second Geneva 4 -13 November 1946 10 Third Geneva 31 March -12 April 1947 9 Fourth Geneva 3o August -13 September 1947 9 Fifth Geneva 22 January -7 February 1948 17

TABLE VIII

OFFICERS OF THE INTERIM COMMISSION

Chairman : Dr. A. STAMPAR, Yugoslavia (succeeding Dr. F. G. Krotkov, USSR, temporary Chairman, first session) Vice -Chairmen : Dr. G. H. de PAULA SOUZA, Brazil (succeeding Dr. O. S. Mondragón, Mexico, Vice- Chairman, first session) H.E. Dr. A. T. SHOUSHA Pasha, Egypt Dr. Szeming SzE, China Executive Secretary : Dr. Brock CHISHOLM

78 TABLE IX REPRESENTATIVES, ALTERNATES, AND ADVISERS ATTENDING SESSIONS OF THE INTERIM COMMISSION Sessions Sessions attended Australia China attended I (two Sir Raphael CILENTO, Director - General Dr.J.K.SHEN,DeputyDirector - I(first meetings only) of Health and Medical Services, State General,NationalHealth Adminis-meeting only) of Queensland tration, Nanking I Mr.A.H.TANGE,FirstSecretary, Dr. Szeming SzE,Resident Represen-1,2,3,4,5 AustralianMissiontotheUnited tative,Chinese Ministry of Health, Nations, New York, United States Washington, D. C.,UnitedStates óf America of America.Alternate during fourth 2, 3, 4, 5 Dr.G.M. REDSHAW,Chief Medical session Officer, AustraliaHouse,London, Dr. P. Z. KING, Vice -Minister of Health, 4 United Kingdom Nanking I Mr. A. H. BODY, Third Secretary, Dr. T.L.Su, Technical Expert, 3 Australian Mission to the United National Health Administration of Nations, New York, United States China ; School of Pathology, Uni- of America. Adviser versity of Oxford, United Kingdom. Alternate Brazil Egypt I, 2, 3, 4, 5Dr. G. H. de PAULA SOUZA, Director, Faculty of Hygiene and Public Health, H. E. Dr. A. T. SHOUSHA Pasha, Uniler- I,2, 3, 4, 5 University of SSio Paulo Secretary of State, Ministry of Public Health, Cairo I (elected Canada Executive France Secretary, Dr. Brock CHISHOLM, Deputy Minister first session) Dr. X. LECLAINCHE, Inspecteur général I, 2, 4, 5 of National Health, Ottawa de la Santé, Ministère de la Santé I,2,3,4 Dr. T. C. ROUTLEY, General Secretary, publique et de la Population, Paris. Canadian Medical Association, Toronto. Alternate during second, fourth and Alternateduringthirdandfourth fifth sessions sessions Professeur J. PARISOT, Professeur d'Hy- I (three 2 (first Hon.BrookeCLAXTON, Ministerof giène, Faculté de Médecine de Nancymeetings only) meeting only) National Health and Welfare, Ottawa Dr.A.CAVAILLON, Directeur général 2, 3, 4, 5 3, 4 Dr. G. D. W. CAMERON, Deputy Minister de la Santé, Ministère de la Santé of National Health, Ottawa publique et de la Population, Paris Dr. F. W. JACKSON, Deputy Minister, 5 Dr. H. Y. SAUTTER, Médecin Inspec- 2, 3 DepartmentofHealth andPublic teur de la Santé, Ministère de la Welfare, Province of Manitoba Santé publique et de la Popula- Dr. H. A. ANSLEY, Assistant Director 2 tion, Paris.Alternate of Health Services, Department of Médecin Général Inspecteur M. A. NatkonalHealthandWelfare, 4, 5 VAUCEL, DirecteurduService Ottawa. A dviser de Santé colonial au Ministère 2 M. J. CHAPDELAINE, Secretary, de la France d'Outre -Mer, Paris. EmbassyinParis, Canadian Alternate France.Adviser Dr. L. BERNARD, Chef du Bureau 2, 4, 5 3 Dr. J. A. MELANSON, Chief Medical d'Epidémiologie, Ministère de la Officer,DepartmentofHealth Santé publique et de la Popula- and Social Services, Province of tion,Paris.Adviser New Brunswick.A dviser Mme C. LABEYRIE, Chef de Bureau, 3, 4 4 Dr. M. R. Bow, Deputy Minister, Ministère des Affaires étrangères, Department of Health and Public Paris.A dviser Welfare,ProvinceofAlberta. M. R. BOLLECKER, Administrateur 5 Adviser civil au Ministère des Finances, Dr. L. GÉRIN- LAJOIE, Professeur et 4 Paris.A dviser Vice -Doyen, Faculté de Médecine, Dr. G. MONTUS, Médecin Inspecteur A dviser 5 Université de Montréal. divisionnaire de la Santé, Marseille. J. 4,5 Mr. G. H. HALSTEAD, Foreign Adviser ServiceOfficer,Departmentof External Affairs, Ottawa. Adviser India 5 Dr. E. COUTURE, Director, Division of Child and Maternal Health, Lieutenant -Colonel C. K. LAKSHMANAN, Department of National Health All -India Instituteof Hygiene and and Welfare, Ottawa.Adviser Public Health, Calcutta

79 Sessions Sessions attended attended I, 2, 3, 4, 5Dr. C. MANI, Deputy Director -General Professor K. VINocoUROFF,Prin- 5 of Health Services, Government of cipal Scientific Officer, Academy India, New Delhi.Alternate during of Medical Sciences of the Ukraine, first session Kiev.Adviser

Liberia Union of Soviet Socialist Republics I, 2 Dr.J.N. TOGBA, Acting- Directorof Dr. F. G. KROTKOV, Deputy Minister of I, 2 Public Health and Sanitation, Monrovia Public Health ;Member, Academy of Dr.J.B. WEST,Director,U.S. MedicalSciences. oftheUSSR., Public Health Service Mission to Moscow Liberia, Monrovia.Adviser Dr. S. KOLESNIxov, President, Alliance 3 ofRedCrossandRedCrescent Mexico Societies, Moscow Dr.N. VINOGRADOV, Vice -Minister of I Dr. O. S. MONDRAGON, Under -Secretary, 4, 5 Public Health, Moscow Ministry of Public Health and Social ProfessorV. TIMAKOV, Director, 5 Welfare, Mexico City, D.F. Epidemiological and Microbiolo- Permanent ; 3 Dr.M. MARTINEZ BAEZ, gical Institute of the Academy of Representative of Mexico to UNESCO, Medical Sciences of the USSR., Paris, France Moscow. A dviser I Dr. M. BUSTAMANTE, Research Epi- Dr. B. VASILTEF, Assistant in the demiologist, Institute of Health 5 InstituteofMedicine, Moscow. and TropicalMedicine,Mexico Adviser City, D.F.Adviser

United Kingdom Netherlands I, 2, 3, 4, 5Dr. C. van den BERG, Director -General Dr. Melville D. MACKENZIE, PrincipalI, 2, 3, 4, 5 of Public Health, Ministry of Social Medical Officer, Ministry of Health, Affairs, The Hague London I, 2, 3, 4, 5 Dr. W. Aeg. TIMMERMAN, Director, Sir WILSON JAMESON,Chief Medical 3 (first 3 Rijks Instituut voor de Volks- Officer, Ministry of Health, Londonmeetings only) gezondheid, Utrecht.Alternate Mr. G. E. YATES, Assistant Secre- I tary, Ministry of Health, London. 2 3, 4, 5 Dr.C.BANNING, ChiefMedical Alternate OfficerofHealth, The Hague. Alternate Mr. L. M. FEERY, Principal, General 2, 5 2,3,4,5 Mr. C. J. Gov-ma/HT, Legal Adviser, Register Office, London. Alternate. Ministry of SocialAffairs, The A dviser during fifth session Hague.Adviser Dr. W. H. KAUNTZE, Chief Medical 2, 3 Miss H. C. HESSLING, Ministry of Adviser, Colonial Office, London. Social Affairs, The Hague. Adviser Alternate Dr. A. M. W. RAE, Deputy Medical 4, 5 Adviser, Colonial Office, London. Norway Alternate I, 2, 3, 41 5 Dr.K. EVANG,Director- Generalof Mr. R. BRAIN, Principal, Ministry of 2 Public Health, Oslo Health, London.Adviser I Dr. H. T. SANDBERG, Department of Mr. C. H. K. EDMONDS, Assistant2, 3, 4> 5 Public Health, Oslo.Alternate Secretary,MinistryofHealth, 5 Dr.J. BJORNSSON, Chief,Section London. A dviser for Epidemiology and Hygiene, Dr. Percy STocks, Chief Statistician 2 Ministry of Social Affairs, Oslo. (Medical), General Register Office, Alternate London.Adviser Mr. F. A. VALLAT, Assistant Legal 2 Peru Adviser, Foreign Office, London. Adviser I, 3, 4 Dr.C.E. PAZ SOLDAN, Professor of Mr. M. E. BATHURST, Foreign Office, 4 Hygiene, Faculty of Medicine, Uni- London.Adviser versity of San Marcos, Lima MissK.V.GREEN, Ministryof 4, 5 Health, London.Adviser Ukrainian Soviet Socialist Republic United States of America Dr. L. I. MEDVED, Deputy Minister of Public Health, Kiev Dr. T. PARRAN, Surgeon--General, U.S. I, 2, 4 5 Dr. N. BARAN, Vice -Minister of Public Public Health Service, Washington, Health, Kiev D.C.

8o Sessions Sessions attended attended I,2, 3, 49 5Dr. H. VAN ZILE HYDE, Senior Surgeon, of State, Washington, D.C. U.S. Public Health Service, Washing- Adviser ton, D.C. Alternate during first, second and fourth sessions Venezuela I, 2 Dr.J. A. DouLL, Chief, Office of Dr. A. ARREAZA GUZMAN, Director of I InternationalHealthRelations, PublicHealth,MinistryofHealth U.S. Public Health Service, Wash- and Social Welfare, Caracas ington, D.C.Adviser Dr. A. GABALDÓN, Chief, Malaria Division, 2 Dr. L. B. WILLIAMS,jr.,Medical Ministry of Health and Social Welfare, Director, U. S. Publit Health Ser- Maracay vice, Washington, D.C. Adviser Dr. D. CASTILLO, Assistant to the Director 31 4 2, 4 Mr. H. B. CALDERWOOD, Consultant, of Public Health, Ministry of Health OfficeofInternationalHealth and Social Welfare, Caracas U.S.Public Relations, Health Dr. D. CURIEL, MedicalChief, 2 Service, Washington, D.C. Adviser DivisionofEpidemiology and 3 Mr. L. W. HAYES, Specialist, Divi- Vital Statistics, Ministry of Health sion of International Organization andSocialWelfare, Caracas. Affairs, DepartmentofState, Alternate Washington, D.C.Adviser Dr.S. RUESTA MARCA, Technical 2 3, 4 Mr. S. T. PARELMAN, Chief, Inter- Assessor, Ministry of Health and nationalOrganizationsBranch, Social Welfare, Caracas.Adviser Officeof Budget and Finance, Department of State, Washington, Yugoslavia D.C.Adviser Dr.A. STAMPAR, President, Yugoslav 5 Dr. Martha M. ELIOT, President, I22,324,5 American PublicHealthAsso- AcademyofSciencesandArts ; ciation, Washington, D.C. Adviser Professor of Public Health and Social 5 Dr. M. A. KRAMER, Chief, Inform- Medicine, University of Zagreb ationandResearch,Officeof Dr. D. JuzBASIÓ, Professor, Medical 2 InternationalHealthRelations, School ofSkoplje.Alternate U.S. Public Health Service, Wash- Dr. P. GREGORI&, Minister, Govern- 4,5 ington, D.C.Adviser ment of the People's Republic 5 Mr.J.D. TOMLINSON,Assistant of Croatia ; President,Public Chief,Division of International HealthProtectionCommittee, Organization Affairs, Department Belgrade

TABLE X OBSERVERS ATTENDING SESSIONS OF THE INTERIM COMMISSION Sessions Sessions attended attended United Nations United Nations International Children's 2 Mr. A. B. ELKIN, Assistant Director, Emergency Fund (UNICEF) Administrative Services, Geneva Mr. A. E. DAVIDSON, Director, European 3, 4 2 M. A. J. LUCAS, Chief, General Research Headquarters Section, Department of Trusteeship Dr. L. RAiCISMAN, Chairman, Executive 5 2 Mr. G. E. YATES, Secretary, Economic Board and Social Council 3 Dr. G. da Sà LESSA, Director, Health Food and Agriculture Organization Section,SocialActivitiesDivision, (FAO) Department of Social Affairs Dr. J. M. LATSKY, Nutrition Represen- 3, 4, 5 3 Mr. B. TURNER, Assistant Director, Joint tative in Europe and Chief Nutrition Division of Co- ordination and Liaison, Consultant to the UNICEF Department of Economic Affairs Dr. W. R. AYKROYD, Director, Nutrition 4 4, 5 M. L. GROS, Executive Assistant, Depart- Division ment of Social Affairs Lord HORDER, Chairman,Standing 5 4 Dr. A. PONS, Acting Director, Health Advisory Committee on Nutrition Section,SocialActivitiesDivision, Mr. F. L. McDouGALL, Counsellor Department of Social Affairs 5 4 Mr.L. STEINIG,Director,Narcotics Division, Department of Social Affairs International Civil Aviation 5 Miss H. SEYMOUR, Senior Liaison Officer, Organization (ICAO) Joint Division of Co- ordination and Mr.R.J.MoULTON,Member,Air Liaison,DepartmentofEconomic Transport Bureau Affairs M. E. PÉPIN, Chief of Legal Studies 4 8i Sessions Sessions attended International Labour Organization Office International d'Hygiène Publique attended (ILO) (OHIP) 3 Mr. C. W. H. WEAVER, Principal Chief Dr. M. GAUD, Président de la Commission 2, 3, 4, 5 of Section des Finances et du Transfert 4 M.H. GALLOIS, Counsellor,Special Dr. M. T. MORGAN, Président du Comité 2, 4, 5 Assistant to the Director -General permanent 5 Mr. E. W. HuxcHisoN, Member of Section Dr. E. J. Y. AUJALEU, Membre de la Com- 5 mission des Finances et du Transfert Preparatory Commission for the International Refugee Organization Pan American Sanitary Organization (PCIRO) (PASO) 3 Mr. M. K. Amax, Legal Adviser Dr. A. A. Mom., Secretary 2 Dr. R. L. COIGNY, Director of Health 45 5 Dr. F. SOPER, Director 3 United Nations Educational, Scientific and Cultural Organization (UNESCO) United Nations Relief and Rehabilitation Administration (UNRRA) 3, 4 M. A.de BLONAY, Head ofSection, External Relations Dr. N. M. GOODMAN, Director, Health 2 3 Dr.J. NEEDHAM, Head of Section of Division, European RegionalOffice, Natural Sciences London 3, 4, 5 Dr. I. M. ZHUKOVA, Counsellor in Medical Dr. A. TOPPING, Director, Health Divi- 3 Sciences, Section of Natural Sciences sion, European Regional Office, London

TABLE XI

MEMBERSHIP OF COMMITTEES AND SUB -COMMITTEES

Internal Committees Committee on Administration and Finance Vice -Chairman : Dr. C. Mani (India) Chairman : Dr. C. van den Berg (Netherlands) Rapporteur: Dr. W. Aeg. Timmerman (Netherlands) Vice- Dr. A. Cavaillon (France) Members :Representatives from : Chairmen :JDr. N. Baran (Ukrainian SSR) i. Brazil 7. Peru Rapporteur :Dr. Szeming Sze (China). 2. China 8. USSR Members :Representatives from : 3. Egypt 9. United Kingdom r. Canada 6. Ukrainian SSR 4. France ro. United States of America 2. China 7. United Kingdom 5. India rr. Yugoslavia 3. France 8. United States of America. 6. Liberia 4. Mexico 9. Yugoslavia 5. Netherlands Committee on Priorities Committee on Relations Chairman : Dr. K. Evang (Norway) ** Chairman : H.E. Dr. A. T. Shousha Pasha (Egypt) Rapporteur : Dr. H. van Zile Hyde (United States) Vice- Dr. K. Evang (Norway) Members : Representatives from : Chairmenl,Dr. G. H. de Paula Souza (Brazil) r. Egypt 5. Norway Rapporteur : Dr. K. Evang (Norway) 2. France 6. USSR Members :Representatives from : 3. India 7. United Kingdom r. Australia 7. Norway 4, Mexico 8. United States of America 2. Brazil 8. USSR 3. China g. United Kingdom Committee on Headquarters ro. United States of America 4. Egypt Chairman :Dr. C. Mani (India) 5. Mexico rr. Venezuela 6. Netherlands Members :Representatives from : I. Canada 4. India Committee on Technical Questions * 2. Egypt 5. Mexico Chairman : Dr. Melville D. Mackenzie 3. France 6. Norway (United Kingdom) * Originally entitled Committee on Epidemiology and Quarantine ** Replacing Dr. M. Martinez Baez (Mexico)

8z Sub-Committees

(Committee on Administration and Finance) Sub -Committee on Negotiations with UNESCO Sub -Committee on Field Services Budget Chairman Dr. H. van Zile Hyde (United States (UNRRA Funds) of America) Chairman : Dr. C. van den Berg (Netherlands) Members :Representatives from : I. Brazil 3. United Kingdom Members :Representatives from : r. Canada 4. Ukrainian SSR 2. France 4. United States of America 2. China 5. United States of America Sub -Committee on Negotiations with the Office 3. Netherlands 6. Yugoslavia International d'Hygiène Publique Dr. C. van den Berg (Netherlands) Sub -Committee on Special Administrative Problems Chairman : Members :Representatives from : Chairman : Dr. Szeming Sze (China) I. Australia 3. United Kingdom * Members : Representatives from : z. Netherlands r. China 2. United States of America Sub -Committee on Negotiations with the Pan (Committee on Relations) American Sanitary Organization Chairman : Dr. A. Gabaldón (Venezuela) Sub -Committee on Negotiations with the United Nations Members :Representatives from : I. Brazil 3. United States of America Chairman :Dr. W. Aeg. Timmerman (Netherlands) 2. Mexico 4. Venezuela Members : Representatives from : i. China 3. USSR Sub -Committee on Relations with Non -governmental 2. Netherlands 4. United States of America Organizations Chairman :Dr. Melville D. Mackenzie Sub -Committee on Negotiations with FAO (United Kingdom) Chairman : Dr. K. Evang (Norway) Members :Representatives from : i. China 3. Venezuela Members :Representatives from : 2. United Kingdom I. Australia 3. Venezuela * 2. Norway * Replacing Mexico

TABLE XII MEMBERSHIP OF EXPERT COMMITTEES Expert Committee for the Preparation of the Sixth Decennial Revision of the International Lists of Diseases and Causes of Death Julia E. BACKER, Sc.D., Chief, Demographic Section, Secretaries :Dr. Maria CAKRTOVA, member of the Central Bureau of Statistics, Oslo, Norway Secretariat of the Interim Commission Dr. S. T. Box, Professor of Medicine, University of Mr. J. T. MARSHALL, Assistant Dominion Leiden ;Chief,SectionforStatistics,Institute Statistician;ActingDirector,Social for Preventive Medicine, Leiden, Netherlands Welfare Statistics Division, Dominion Bureau of Statistics, Ottawa, Canada Dr. D. CURIEL, Medical Chief, Division of Epidemiology and Vital Statistics, Ministry of Health and Social Index Sub -Committee Welfare, Caracas, Venezuela S. D. COLLINS, Sc.D., Head Statistician, Division of Dr. P. F. DENOIx, Chef des Services techniques et de Public Health Methods (U.S. Public Health Service), la Section du Cancer, Institut national d'Hygiène, Bethesda, Md., United States of America (Chairman) Paris, France J.T. MARSHALL, Assistant Dominion Statistician ; W. Thurber FALES, Sc.D., Research Associate, School Acting Director, Social Welfare Statistics Division, of Hygiene, Johns Hopkins University, Baltimore, Dominion Bureau ofStatistics,Ottawa, Canada Md., United States of America (Secretary) Dr. M. KACPRZAK, Professor of Hygiene ;Director, I. M. MORIYAMA, Ph.D., Chief,Mortality Analysis State School of Hygiene ;President, National Health Section, National Officeof VitalStatistics (U.S. Council, Warsaw, Poland Public Health Service), Washington, D.C., United States of America Dr. Percy STOCKS, Chief Statistician (Medical), General Winifred O'BRIEN, R.N., Supervisor, Nosology Register Office, London, United Kingdom (Chairman) Section, Vital Statistics Branch, Dominion Bureau Dr.J. WYLLIE, Professor of Preventive Medicine, of Statistics, Ottawa, Canada Queen's University, Kingston, Ont., Canada Dr. A. H. T. Ross -SMITH, Nuffield Reader in Patho- Member from the USSR not yet appointed logy, University of Oxford, United Kingdom

83 Expert Committee on Malaria

Dr. M. CIUCA, Co- Director, Cantacuzène Institute ; Rockefeller Foundation, New York, United States Professor of Bacteriology, University of Bucharest, of America Roumania Médecin Général Inspecteur M. A. VAUCEL, Directeur Major - General Sir Gordon COVELL,* Ministry of Health du Service de Santé colonial au Ministère de la MalariaLaboratory,HortonHospital,Epsom, France d'Outre -Mer, Paris, France Surrey, United Kingdom Dr. D. K. VISWANATHAN, Assistant Director of Public Dr. A. GABALDÓN, Chief, Malaria Division, Ministry Health, Poona, India of Health and Social Welfare, Maracay, Venezuela Member from the USSR not yet appointed (Chairman) Secretary :Dr.E.J.PAMPANA, member ofthe Dr. P.F. RUSSELL, International Health Division, Secretariat of the Interim Commission

Expert Committee on Biological Standardization

Professor E. GRASSET, Directeur de l'Institut d'Hygiène, Dr. W. Aeg. TIMMERMAN, Director, Rijks Instituut Geneva, Switzerland voordeVolksgezondheid,Utrecht,Netherlands (Chairman) Dr. A. A. MILES, Director, Department of Biological Standards, National Institute for Medical Research Professor J. TRÉFOUBL, Directeur de l'Institut Pasteur, (Medical Research Council), London, United Kingdom Paris, France Dr. M. V. VELDEE, Chief, Biologics Control Laboratory, Dr.J.ORSKOV,Director,State SerumInstitute, National Institute of Health (U.S. Public Health Copenhagen, Denmark Service), Bethesda, Md., United States of America Major -GeneralSirSahib Singh SOKHEY,Director, Secretary : Dr. R. GAUTIER, Counsellor of the Interim Haffkine Institute, Bombay, India Commission

Expert Committee on Tuberculosis

Dr. P. M. d'Arcy HART, Farm Laboratories, National Dr.J.HOLM, Chief,TuberculosisDivision,State Institute for Medical Research (Medical Research Serum Institute, Copenhagen, Denmark (Chairman) Council), London, United Kingdom Member from the USSR not yet appointed Dr. H. E. HILLEBOE, Commissioner of Health, New York State Department of Health, Albany, N.Y., United Secretary :Dr.J.B. MCDOUGALL, member of the States of America Secretariat of the Interim Commission

Expert Committee on Quarantine

Dr. R. DUJARRIC DE LA RIVIÈRE, Sous -Directeur de Secretary : Dr. G. STUART, member of the Secretariat l'Institut Pasteur, Paris, France of the Interim Commission Dr. G. L. DUNNAHOO, Medical Director, Chief, Foreign Quarantine Division,U.S. Public Health Service, Yellow Fever Panel Washington, D.C., United States of America Dr. W. S. Sà ANTUNES, Director, National Yellow Dr. G. D. HEMMES, Inspector of Public Health, Utrecht, Fever Service, Rio de Janeiro, Brazil Netherlands Dr. G.L. DUNNAHOO, Medical Director, Chief, Foreign Dr.C.MANI, Deputy Director- General of Health Quarantine Division, U.S. Public Health Service, Services, Government of India, New Delhi, India Washington, D.C., United States of America H.E. Dr. M. NAZIF Bey, Under -Secretary of State for Médecin Général C. DURIEUX, Directeur de l'Institut Quarantine, Ministry of Public Health, Cairo, Egypt Pasteur de l'A.O.F.,Dakar, French West Africa Dr. G. H. de PAULA SOUZA, Director, Faculty of Dr.A.F.MAHAFFY,Director,ColonialMedical Hygiene and Public Health, University of SAo Paulo, Research, Colonial Office, London, United Kingdom Brazil Médecin Général Inspecteur M. PELTIER, Directeur Dr. P. G. STocx, Medical Adviser, Ministry of Health, général de la Santé publique de l'A.O.F., Dakar, London, United Kingdom (Chairman) French West Africa Dr. W. W. YUNG, Director, Department of Epide- Dr. R. M. TAYLOR, Director,Laboratories of the mic Prevention, National Health Administration, International Health Division, Rockefeller Founda- Nanking, China tion, New York, United States of America Member from the USSR not yet appointed Dr. M. V. VELDEE, Chief, Biologics Control Laboratory, National Institute of Health (U.S. Public Health "Succeeding Dr. N. Hamilton FAIRLEY, Wellcome Pro- Service), Bethesda, Md., United States of America fessor of Tropical Medicine, London School of Hygiene and Tropical Medicine, who resigned for health reasons Member from the USSR not yet appointed

84 Expert Committee on the Unification of Pharmacopoeias ProfessorH. BAGGESGAARD -RASMUSSEN, Chairman, Dr. C. H. HAMPSHIRE, Secretary of the British Pharma- Chemical Division of the Danish Pharmacopoeia copoeia Commission, General Medical Council Office, Commission, Copenhagen, Denmark London, United Kingdom (Chairman) E. Fullerton Coox, M. Sc., Chairman, Committee of Dr. R. HAZARD, Professeur de Pharmacologie et de Revision of the Pharmacopoeia of the United States Matière médicale à laFaculté de Médecine de of America, Philadelphia, United States of America l'Université de Paris, France Professor D. van Os, Professor of Pharmaceutical I. R. FAHMY, Ph. D.,Professor of Pharmacognosy, Chemistry and Toxicology, University of Groningen ; Fouad I University, Cairo, Egypt ;Secretary of Chairman of the Netherlands Pharmacopoeia Com- the Egyptian Pharmacopoeia Commission mission, Groningen, Netherlands H. FLÜcx, Dr. Sc. Nat., Professor of Pharmacognosy, Expert from South America not yet appointed EidgenossischeTechnischeHochschule, Zurich, Acting Secretary :Dr. W. M. BONNE, member of the Switzerland Secretariat of the Interim Commission

Expert Committeeon Venereal Diseases Professor W. E. COUTTS, Chief, Department of Social Hy- Dr. J. F. MAHONEY, Medical Director, VD Research giene, Public Health Administration, Santiago, Chile Laboratory (U. S.Public Health Service), Staten Professor M. GRZYBOWSKI, Chief, Clinic of Dermato- Island, N.Y., United States of America (Chairman) Syphilology, University of Warsaw, Poland Dr. G. L. M. McELLIGOTT, Adviser on Venereal Diseases, Secretary :Dr. T. GUTHE, member of the Secretariat Ministry of Health, London, United Kingdom of the Interim Commission

Expert Committee on International Epidemic Control Dr. J. BIQIRNSSON, Chief, Section for Epidemiology médical du Personnel navigant de l'Aviation and Hygiene, Ministry of Social Affairs, Oslo, Norway de Paris, Paris, France Dr. A. CAVAILLON, Directeur général de la Santé, Raporteur of the Joint OIHP /WHO Study -groups : Ministère de la Santé publique et de la Population, Dr. M. GAUD, Directeur de l'Office International Paris, France d'Hygiène Publique, Paris, France Dr. Melville D. MACKENZIE, Principal Medical Officer, Secretary :Dr. Y. M. BIRAUD, Director, Division of Ministry of Health, London, United Kingdom EpidemiologyandPublicHealthStatistics, Dr.C. MANI, Deputy Director - General of Health Secretariat of the Interim Commission Services, Government of India, New Delhi, India Dr. Wasfy OMAR, Director, Pan Arab Regional Health Expert Sub-Committee for the Revision of the Bureau, Alexandria, Egypt Pilgrimage Clauses of the International Sanitary Dr. G. H. DE PAULA SOUZA, Director, Faculty of Conventions Hygiene and Public Health, Sic) Paulo, Brazil Dr.M. GAUD, Directeur del'OfficeInternational Dr. G. M. REDSHAW, Chief Medical Officer, Australia d'Hygiène Publique, Paris, France (Rapporteur) House, London, United Kingdom Professor J.J. van LOGHEM, Professor of Hygiene, University of Amsterdam, Netherlands Ex officio members : Dr.C. MANI, Deputy Director- General of Health Président du Comité permanent de l'Office Inter- Services, Government of India, New Delhi, India national d'Hygiène Publique : Dr. M. T. MORGAN, Président du Comité permanent Dr. M. T. MORGAN, Medical Officer of Health, del'OfficeInternationald'HygiènePublique ; Port of London, United Kingdom (Chairman) Medical Officer of Health, Port of London, United Director of the Pan American Sanitary Bureau, Kingdom (Chairman) represented at first session by : Dr. Yehia NASRI, formerly Director -General of Health, Dr. A. MACCHIAVELLO, U.S. Public Health Service; Mecca, Saudi Arabia ConsultingEpidemiologist, Pan American Dr. Wasfy OMAR, Director, Pan Arab Regional Health Sanitary Bureau, Lima, Peru Bureau, Alexandria, Egypt Representative of ICAO, at first session : Secretaries : Dr. G. STUART and M. G. DE BRANCION, Dr. J. DUGUET, Médecin Chef du Centre d'Examen members of the Secretariat of the Interim Commission

ExpertCommitteeon Habit -forming Drugs Dr.J. BOUQUET, Pharmacien des Hôpitaux de Tunis, PublicHealthService),Bethesda,Md.,United Tunis States of America Dr. H. P. CHU, Professor of Pharmacology, National Dr.J.R. NICHOLLS, Deputy Government Chemist, Medical College, Shanghai, China Government Laboratory, London, United Kingdom Dr. N. B. EDDY, Principal Pharmacologist, Division of Physiology, National Institute of Health (U.S. Dr. P. O. WOLFF, Buenos Aires, Argentina

85 TABLE XIII RATIFICATIONS OF THE CONSTITUTION

In conformity with Article 8o of its Constitution, State Date of ratification the World Health Organization was constituted on i8. * Norway 18 August 1947 7 April 1948, when twenty -six members of the United ig. * Sweden 28 August 1947 Nations had ratified their signatures and had deposited 2o. * Iraq 23 September 1947 their formal instrumentsofacceptance with the 21. * Siam 26 September 2947 Secretary -GeneraloftheUnitedNations.States 22. Finland 7 October 1947 which had ratified by 15 June 1948 are listed below, 23. Ireland 20 October 1947 in the order of their dates of ratification : 24. * Yugoslavia ig November 1947 25. * Egypt 16 December 1947 State Date of ratification 26. * Turkey 2 January 1948 * China 22 July 1946 27. * India 12 January 1948 2. * United Kingdom 22 July 1946 28. * Australia z February 1948 3. * Canada 29 August 1946 29. Portugal 13 February 1948 4. * Iran 23 November 1946 3o. * Czechoslovakia. 1 March 1948 5. * New Zealand to December 1946 31. * Greece 12 March 1948 6. * Syria 18 December 1946 32. * USSR 24 March 1948 7. * Liberia 14 March 1947 33 * Ukraine 3 April 1948 8. Switzerland 26 March 1947 34. * Byelorussia 7 April 1948 9. Transjordan 7 April 1947 35 * Mexico 7 April 1948 io. * Ethiopia 11 April 1947 36.* Afghanistan 19 April 1948 II. Italy II April 1947 37* Denmark 19 April 1948 12. * Netherlands 29 April 1947 38.* Poland 6 May 1948 r3. Albania 26 May 1947 39. Roumania 8 June 1948 14. * Saudi Arabia z6 May 1947 4o. Bulgaria g June 1948 15. Austria 3o June 1947 41. * France Ti June 1948 16. * Union of South Africa 7 August 1947 17. * Haiti 12 August 1947 * Member States of the United Nations

86 INDEX

Pages Pages

Abstracts 52, 64 Cholera epidemic in Egypt . . . 23, 32, 35, 39, 47-48 Accounting procedures 10, 73 excessive restrictions during 13, 48 Administration g -Io services during 13,47-48 Administration and Finance, Committee on 9 -IO Cholera vaccine, procurement of ...... 13, 48 membership 82 standardization of 12 32, 35, 4o, 48 Administrative problems, special,see Special Chronicle of the World Health Organization . 14, 53, 55 administrative problems Coca -leaf chewing 6o Administrative services 69 -70 Commission, see Interim Commission Advisers, list of 79 -81 Committee on see under subject of Agencies, specialized, see Specialized agencies Committee Aircraft, disinsectization of 36, 40, 62 Committees, expert Alcoholism 14, 15, 42, 70 membership 83 -85 Alexandria, Sanitary Bureau at, see Sanitary regulations for 15 Bureau at Alexandria rules of procedure for 15 Alternates, list of 79-81 Committees, internal 9 -Ir Amidone 42 -60 membership 82 -83 Ankylostomiasis 45 Congresses, international medical 22, 64 Annual Epidemiological Reports 46 Conseil sanitaire international de Tanger . . 29 Annual Report on the Results of Radiotherapy in Conseil sanitaire maritime et quarantenaire Cancer of the Uterine Cervix 14, 44 d'Egypte 29 Anopheline eradication 3o-31,4o Conseil sanitaire de Téhéran 19 Anthrax, anti -, sera 31 Conseil supérieur de Santé de Constantinople. 19 Assembly, see Health Assembly Constitution, ratifications of 71, 86 Assistance to governments II-12, 22, 23, 48 Constitution of World Health Organization . 24 -26 See also Field services Contingency fund 73 Audit report 74-77 Contributions, scales 72 Auditing arrangements 73 Control centres 32 Austria, field services in 5o " Conventional " diseases, see Sanitary conventions, international Balance -sheet 75 Conventions, see Sanitary conventions, inter- Banking arrangements 73 national BCG, standardization of 22,32 Crime, prevention of 14, 42, 61 BCG vaccination 13,34-35,61 Darling Foundation II, 30 Bilharziasis, see Schistosomiasis DDT 30 -31 Bills of health 65 Death, causes of,see International Lists of Biological standardization 11 12, 7o Diseases and Causes of Death Biological Standardization, Death -rate 46 Expert Committee on12, 31 -33, 34, 35, 4o, 48, 62 Decennial Revision of the International Lists of membership 84 DiseasesandCausesofDeath, see Biological standards, see Biological standardi- , International Lists .. zation International Conference for the .. . Birth -rate 46 Demographic Yearbook 6o Blood -group substances, standardization of 12, 33 Dengue fever 40 Bonding 73 Dentists, resettlement of 63-64 Brussels Agreement 38 Deratization certificates 36 Budget proposals for WHO 9 -Io, 15 Digitalis Budgetary controls 33 72 -73 Diphtheria 46 Budgetary and financial policy 71 -75 Diphtheria toxoid 12, 32 Budgets, 1946-1948 9 -Io, 72 -73 Diseases,see InternationalLists of Diseases format of 72 and Causes of Death Bulletin of the Health Organisation 53 Disinsectization of aircraft 36, 40, 62 Bulletin mensuel de l'Office International Doctors, resettlement of 63 -64 d'Hygiène Publique II, 20, 53, 65 Documentation 64 Bulletin of the World Health Organization . . . 14, 53 Drug addiction 15 Drugs, dosage 12, 37 Cancer 44 nomenclature 12, 37 Cancer statistics 14, 44 see also Habit -forming drugs Categories, List of, see International Statistical Narcotic drugs ClassificationofDiseases,Injuriesand Causes of Death Education, technical health 45 Cerebrospinal meningitis. . /. . . . . 40 Egypt, cholera epidemic in, see Cholera epidemic Certificates, see Deratization certificates in Egypt International certificates of ino- Encephalitis, post -vaccinal,see Post -vaccinal culation and vaccination encephalitis International certificates of ino- Epidemic Control, International, Expert Com- culation against yellow fever mittee on 12 35, 39-40, 42, 62, 66 Chairman of Interim Commission 9, 78 membership 85 Child health 13, 15, 44, 49 Epidemiological information, broadcasting of 4o, 46, 47 See also UNICEF Epidemiological intelligence. fI, 20, 21, 23, 47, 65, 66, 7o Child nutrition 13, 62 See also Sanitary convention, international Child welfare 61 Epidemiological Intelligence Station, Singapore, China, field services in 50 -51 see Singapore Epidemiological Intelligence tuberculosis control in 35, 50 Station Chloroquine 30 Epidemiological notifications, see Epidemiolo- Cholera 46, 50 gical intelligence Cholera, Study -group on 40, 66 Epidemiological services 46 -47

87 Pages Pages Epidemiological Telegraphic Code 46, 47, 53 Immunities, see Privileges and immunities Epidemiological and Vital Statistics Report 14, 46, 47, 53 Index Sub -Committee, membership 83 Epidemiology and Quarantine, Committee on, India, tuberculosis control in 35 see Technical Questions, Committee on Industrial hygiene 44,63 Ethiopia, field services in 51 Industrial medicine 22 malaria in 31 Influenza 15,40,43 tuberculosis control in 35 Influenza centre, international 14 venereal disease in 39 Insecticides 13 Eucodal 42 Institute for Medical Research, Kuala Lumpur 36 Executive Secretary of Interim Commission. 9, 78 Insulin 14,43 Expert committees, see Committees, expert Insurance 73 Inter -Allied Committee on Post -War Fact Book on WHO 55 Requirements 23 FAO, agreement with 62 Inter -American Conference on Social Security 63 co- operation with . . 13, 30, 51, 59, 62, 69, 7o Interim Commission Standing Advisory Committee on Arrangement establishing 27 Nutrition of 62 dissolution of 15,71 Sub -Committee on Negotiations with . 62 establishment of 9,27 membership 83 membership 9,27,79-81 Fellowships 10 11, 14, 23, 38, 39 officers 75 51-52,59,64,7o report of, form 15, 71 Field services 9, To, II, 14, 23, 31, 35 sessions of 9, 78 39, 48-52, 54, 6g, 70 attendance at 79-82 Field Services Budget, Sub - Committee on . g Internal committees, see Committees, internal membership 83 International certificatesof inoculation and Filariasis 45 vaccination 35 Finances, see Accounting International certificates of inoculation against Audit yellow fever 36 Auditing InternationalChildren'sEmergencyFund, Balance -Sheet see UNICEF Banking International Civil Service Advisory Board . . 6o Budget proposals International Conference for the Sixth Decen- Budgets nial Revision of the International Lists Contingency fund of Diseases and Causes of Death. - . 28, 29 -30 Funds International Congress on Malaria 3o -31 Loans International DigestofHealthLegislation ¶4, 53 United Nations, budgetary and International epidemic control, see Epidemic financial relations with control, international Financial policy 71-75 International Health Conference. . 23, 25 -27, 70 Financial procedures Io attendance at 25 Financial statement 76-77 work of 26-27 Fonds Léon Bernard II 42 International health organizations, history of19 -23 Food and Agriculture Organization, see FAO International health organizations, previous, Food production $9, 62 assimilation of 11-12,25-26 Funds, sources of 9, 71, 72 work of so, ¶5, 19 -23, International Health Yearbook 52 Geneva office, work of 9, .70 International Labour Organization, see ILO Greece, field services in 51 International Lists of Diseases and Causes of malaria control in 30-31 Death, Expert Committee for the Preparation tuberculosis control in 35 of the Sixth Decennial Revision of the 13, 28 -30, 63 membership 83 Habit -forming Drugs, Expert Committee on International Lists of Diseases and Causes of 13, 41-42, 6o-61 Death, International Conference for the membership 85 Sixth Decennial Revision of the . . . 28, 29 -30 See also Narcotic drugs International Microbiological Congress . . . 43 Haiti Pilot Project 64 International Quarantine Directory 65 Headquarters, Committee on ro-11, 7o -71 International Refugee Organization, see PCIRO membership 82 International Salmonella Centre 33 Headquarters, location of 10-11,15,7o-7/ International sanitary conferences, see Sanitary Headquarters office, work of 9,69-7o conferences, international Health Assembly, agenda for 15 International sanitary conventions, see Sanitary recommendations to 15 conventions, international rules of procedure of . 15 International Social Security Association . . 44 time and place of 71 International Statistical Classification of Diseases, time of, future $9 -6o Injuries and Causes of Death 29 Health organizations, international, see Inter- International Union against Tuberculosis . . . 34 national health organizations International Union against Venereal Diseases 39 Heparin 12 IRO, see PCIRO 51 Hospitals 45 Italy, field services in Housing 42-43, 6o, 61 malaria control in 30 -31 tuberculosis control in Hungary, field services in 51 35 Hylean Amazon project 64 Jewish Organization for the Care of Children . 34 ICAO, agreement with 62 Kala -azar, see Leishmaniasis co- operation with 62, 6g ICEF, see UNICEF League of Nations 41-42,57-59,6o ILO 21, 22 League of Nations, Board of Liquidation, funds agreement with 62, 63 from 9,71-72 co- operation with. . . . 28, 39, 44, 62 -63, 6g, 70 League of Nations, Covenant of 20, 21 Immigrants, medical examination of. . 14, 43-44, 63 League of Nations Health Organization 12, 31, 44, 53, 66 See also Migrants see also Darling Foundation Immune reaction, see Smallpox vaccination Fonds Léon Bernard

88 Pages Pages

Eastern Bureau, see Singapore Bureau of Sub -Committee on Negotiations with . . 66 Epidemiological Intelligence membership 83 functions II 21 -22 Pan Arab Sanitary Bureau, see Sanitary Bureau assimilation of 11,25-26,46 at Alexandria library II54 Panel of... see under subject of Panel Technical Commission of Pharmacopoeial Passports and frontier formalities 6o

Experts 12 PCIRO, co- operation with . . 34,3%50,51,63-64,7o Legal Experts, Committee of, on Responsibi- Penicillin 38 lities with respect to the Narcotics Convention 59 standardization of 12, 33 Legal Experts, Panel of Pertussis vaccine, standardization of . . . 32 report on privileges and immunities . . . 57 " Pestilential " diseases, see Sanitary conven- Legislation, sanitary, see International Digest tions, international of Health Legislation Pharmacopoeia, international 12 -13, 37 Leishmaniasis 45, 50 Pharmacopoeias, Unification of, Expert Com- Leprosy 45 mittee on the 12, 37 Library 14, 53, 70 membership 85 Lists of Diseases and Causes of Dealth,see Pilgrimage, sanitary control of the 12, 36, 40-41, 65, 66 International Lists... PilgrimageClauses,Revisionof the, Sub - Literature, medical 14, 23, 50, 54, 70 Committee on the /2,40-42,65,66 Loans 9, 71 membership 85 repayment of 9 -10, 71 Plague 5o Study -group on 4o, 66 Plague vaccine, standardization of 32 Malaria 13,15,3o-31,7o Pneumoconiosis 63 field services in 31, 49 Poland, anti- syphilis campaign 39,6r Malaria, Expert Committee on 13, 30-31, 40 field services in 51 membership 84 malaria control in Maternal health 30 13, 15, 44 tuberculosis control in 35 Mecca pilgrimage, see Pilgrimage Poliomyelitis 40, 45, 46 Medical care 45, 63 Post -vaccinal encephilitis 36-37, 65 Medical Research Council 43 PPD, see Tuberculin Medical social work 45 Preparatory Commission for the International Medical supplies 50-51 Refugee Organization, see PCIRO Mental health 45 Priorities, Committee on II Migration 61, 63 membership of 82 See also Immigrants Privileges and immunities 7o Missions Io, Ir, 14, 50-51, 7o Privileges and immunities of specialized agen- Morbidity, see International Lists... cies, convention on Mortality, see International Lists... 57 Panel of Legal Experts on 57 Procedure, rules of, see Rules of procedure Narcotic drugs 13,4r-42,57-59,6o-6i Psittacosis 36, 37 See also Habit -forming drugs Public- health administration 45, 70 United Nations, Commission on Public -health services 14, 44 Narcotic Drugs Public -health staff 44 Narcotics Convention, see Narcotic drugs Public information io14, 54-55, 70 NationalInstituteforMedicalResearch, Publications I4,52-53,7o London, see Biological standardization See also under titles of publications Natural resources 45, 6o Neoarsphenamine 31 New York office, see Headquarters office Quarantine 12, 20, 23, 47-48, 65 News Letter 55 See also Sanitary conventions, international Non -governmental organizations jo, 15, 66 Quarantine, Sub -Committee on Relations with . . 67 Expert Committee on . .12, 32, 35-36, 47-48, 62 membership 83 membership 84 Notifications, see Epidemiological intelligence Nurses, resettlement of 63 -64 Rabies 45 Nursing 15, 44 Radioactive isotopes 44-45 Nutrition 15, 44, 62 Radiography, mass 34 -35 Radiotherapy of cancer Observers, list of 81 -82 See Annual Report on the Results of Radio- Office International d'Hygiène Publique therapy in Cancer of the Uterine Cervix 36,40,52,65-66 Rat infestation 36, 65 See also Bulletin mensuel de l'Office Inter- Ratifications, see Constitution, ratifications of national d'Hygiène publique Red Cross, Danish 6r archives /1,65 Red Cross, International 22 assets I I, 65-66 Red Cross Societies, League of 22 30, 34 functions Reference services r4, 53, 70 11 20-21, 65 -66 Regional organizations 15,66,71 assimilation of 11,25,46,65-66 Registry library 11, 54, 65 70 pension -fund II, 65 Rehabilitation 45 Protocol on 25,26-27,64-65 Relapsing fever, louse -borne 40 Relations, Committee on IO regional bureaux 19, 2o, 66 membership 82 relations with Io 65 -66 Representatives, list of Sub -Committee on Negotiations with I I 79-81 Research laboratories 59 membership 83 Revision of International Lists of Diseases and Official Records of the World Health Organization 53 Causes of Death, see International Lists... Rh antigens 33 Paludrine 31 Rheumatoid diseases 45 Pan American Sanitary Organization Rome Agreement, seeOfficeInternational integration with WHO 26 d'Hygiène Publique relations with Io, 64, 66, 69 Roumania, malaria in 30

89 Pages Pages Rules of procedure Typhoid, anti -, sera 31 for expert committees 15 Typhus, Study -group on 40, 66 for Health Assembly Rural hygiene 15, 44 UNESCO, agreement with 64 co- operation with 64,7o Sub -Committee on Negotiations with 64 Salmonella 33 San Francisco declaration 23 -24 membership 83 UNICEF, relations with . Sanitary Bureau at Alexandria . . . . to, 65, 66 -67 13, 15, 34, 39, 44, 49, 51, Sanitary conferences, international 19 59, 6o, 61, 62, 7o Sanitary conventions, international 19 -20 Unitarian Service Committee 5o administration II, 12, 20, 23, 35 -36, 46-47,49, 65, 66 United Nations 23 infringements 36, 40 ad hoc Committee on the Transmission of Information 59, 61 revision 12, 39 -4o, 62 agreement with Io, 15, 57 Sanitary engineering 45 Sanitary regulations, international 12, 39 -40 budgetary and financial relations with Io, 57, 59-6o, 75-72 Schistosomiasis 15, 44 Commission on Human Rights . . . . 6o, 61 Seafarers, hygiene of 15, 38- -39, 44 See also Brussels Agreement Commission on Narcotic Drugs . . . . 42, 6o-6i Secretariat 9 -10 Commission on the Status of Women . . 6o, 61 See also Executive Secretary Conference on Frontier Formalities . . . 6o Staff Consultative Committee on Migration. . 61 Secretary, Executive, see Executive Secretary Convention on privileges and immunities . 57 Department of Public Information . . Serological standardization 38 54-55 Singapore Bureau of Epidemiological IntelligenceII, 46 Drug Supervisory Board 6o-6, Singapore Epidemiological Intelligence Station Economic Commission for Asia and the Far East 6o Io, 21, 46, 47,53, 70 Sleeping sickness, see Trypanosomiasis Economic Commission for Europe . . . 42-43, 6o Economic Commission for Latin America 6o Smallpox, Study -group on 40 Smallpox vaccination, see also Post -vaccinal Economic Commission for the Middle East, encephalitis proposed 6o Economic and Employment Commission 6o Smallpox vaccination, immune reaction . . 36, 65 Smallpox vaccine, standardization of 32, 40 Economic and Social Social welfare 59, 61, 63 Council 15,24-25,42,59-61,69 Special Administrative Problems, Sub -Com- Economic and Social Council, Co- ordina- mittee on 70 tion Committee 59-60 membership 83 Economic and Social Council, structure of 58 Specialized agencies io 61 -64 Film Board 55 agreements with Io, 15, 61 Fiscal Commission 6o co- operation with to, 61 General Assembly 57 -59 Staff 9-1o, 69-7o International Children's Emergency Fund, allowances 7o see UNICEF geographical distribution of so, 69 loans from 9 -lo, 71 number of ro, 69 Palestine Commission 61 policy 7o Permanent Central Opium Board . . . 60 -6I Standards of living 6o, 61 Population Commission 6o State Serum Institute, Copenhagen, see Biolo- relations with to, 57 -61, 69, 70 gical standardization Scientific Conference on the Conservation 6o Statistics 6o and Utilization of Resources health 28 -3o, 46, 70 services, use of 7o Stillbirths 46 Social Affairs Department 51 Social Commission 14, 42, 61 Streptococcus antitoxin 33 Streptomycin Statistical Commission 6o 34 Statistical Office 28 standardization of 12, 31, 33 Study -group on... see under subject of Study - structure of 56 group Sub -Committee on Negotiations with 57 Sub -Committees, membership 83 membership 83 Sub -Committee on... see under subject of Sub - Transport and Communications Commis- Committee sion 6o Trusteeship Council 61 Swiss Federal Council, agreement with. . . 7o Syphilis, see Venereal diseases United Nations Bulletin 54 UNRRA 36,48-52,59,63,66,69 agreement with 48 -49 funds from 9,11-12,49,71 Tabular List of Inclusions 29 UNRRA Health Division " 23, 49 Technical Preparatory Committee 24-25, 70 Expert Commission on Quarantine 23 Technical Questions, Committee on 10, 65 functions of 23 membership 82 assimilation 11-12,25,26,46,48 Tetanus antitoxin 31 Tetanus toxoid 12, 32 Town planning, see Housing Vaccination Toxoids, standardization of 31 -33 See BCG vaccination Translations 7o Cholera vaccination Travel arrangements 7o Smallpox vaccination Tropical hygiene 45 Yellow -fever vaccination Trypanosomiasis 45 Vaccines, standardization of 31 -33 Tuberculin 34 Valbine 42 standardization of 12, 31. 32 Venereal diseases 13, 15, 61, 7o Tuberculosis 13, 15, 33 -35, 7o field services in 39 field services in 35, 49 Venereal Diseases, Expert Committee on13, 38 -39, 61 See also BCG vaccination membership 85 31 Tuberculosis, Expert Committee on 13,15,33-35 Venins, anti- membership 84 Vice -Chairmen of Interim Commission . . . 78

90 Pages Pages Vitamins, standardization of 12.32,33,62 Yellow -fever endemic areas 36 Yellow Fever Panel i2, 32,36, 40 Weekly Epidemiological Record s 1, 14.21,46,47,52 membership 84 Weekly Fasciculus 46,53 Yellow -fever vaccination 35 -36, 65 World Health Assembly, see Health Assembly immunity in 35 -36 World Medical Association 44 Yellow -fever vaccine, standardization of . . 32 -33 World Statistical Congress 6o Yellow -fever vaccines, approval of 36