Editorial > Croat Med J. 2008;49:709-19 > doi:10.3325/cmj.2008.49.709

“Society as an Organism:” Metaphor as Departure Point of Andrija Štampar’s Health Ideology

Andrija Štampar (1888-1958) was one of the Organicistic approach to society and social most charismatic figures of the 20th century diseases at the turn of the 20th century shaped public health and a typical representative of so- both the unquestionable faith in the impor- cial medical ideology at the turn of 20th centu- tance of disease prevention and the physicians’ ry. He was the founder of many health-related approach. Thereby, the metaphor “society as an institutions in and world-wide. In 1927, organism” became a specific cultural ethos of with the help of a large grant from the Rockefell- health protection movement, with Štampar as er Foundation, he opened the School of Public the leading representative at the national and in- Health and the Institute of Hygiene in . ternational level. Andrija Štampar was among the leading fig- Andrija Štampar (1888-1958) (Figure 1) ures in Croatian medicine. His endeavors and was born in Drenovac, a small village in Sla- sociomedical ideas found fertile ground and left vonia, Croatia, as the son of a village teach- a mark not only in the national, but also in in- er. He completed his elementary education in ternational setting. As a young man, he started his place of birth and finished high school in publishing programmatic and popular science in 1906 (1). After that, he left Slavo- articles, promulgating his beliefs about social nia to study medicine in Vienna, where he also medicine and health enlightenment. earned his doctoral degree in 1911. Štampar be- Using the preserved corpus of Štampar’s pub- gan his medical career as a general practitioner lished work, I analyzed the use of metaphor “so- in Nova Gradiška. In 1919, he joined the Min- ciety as an organism” as a basic instrument of ex- pression of Štampar’s health ideology. Štampar’s language and metaphorics are clearly time- and context-dependent. On the one hand, they re- flect a specific manner of expression character- istic of sociomedical framework and health en- lightenment, widespread in the world at the turn of the 20th century. On the other, they are heav- ily influenced by national zeitgeist at the time, particularly the works of the writers such as A. M. Relković, Josip and Ivan Kozarac, and T. G. Masaryk. Figure 1. Andrija Štampar (1888-1958).

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award for his contributions to social medi- istry of Public Health in Belgrade, dedicat- cine. He died in Zagreb on June 26, 1958 (2). ing his time first to theoretical-organizational Andrija Štampar was one of the leading fig- work and then to systematic development of ures in Croatian medicine, whose efforts and health institutions in the old Yugoslavia. Due sociomedical ideas found fertile ground and to his opposition to the dictatorship of the left a mark not only in national, but also in in- king Aleksandar Karađorđević, he was forced ternational setting. While still a young man, into early retirement in 1931 and returned to he started publishing programmatic and pop- Zagreb, where he was elected professor at the ular science articles, promulgating his beliefs Zagreb University School of Medicine, De- about social medicine and health enlighten- partment of Hygiene and Social Medicine ment, which he continued to follow through- (2). Since the authorities did not allow him out his whole life. to work in the country, Štampar emigrated to In the present article, I analyzed the use of China, where he served as a professional ad- metaphor as a means of expressing Štampar’s visor for the Chinese government from 1933 health ideology in the rich corpus of his pre- to 1936. Upon his return to Europe, he start- served texts (7,8). My analysis also includes ed developing the activities of the School of Štampar’s attitude toward eugenics, which has Public Health but soon received a letter from not been studied so far. The parallel develop- the secretary of the League of Nations offer- ment of eugenics and public health during the ing him a job at the League of Nation’s Hy- second half of the 19th and early 20th centu- giene Section in Geneva. In 1938, he left for ry established mutual resonance and specific the United States, where he spent a year as a discourse through which these two areas con- visiting professor at the Universities of Har- strued and popularized their goals. vard, Yale, and California (3-6). When his appointment as professor at the Zagreb Uni- Bellum contra morbum: invasion of body- versity School of Medicine was confirmed, he fortress returned to Croatia. Štampar spent World War II in internment in Graz, Austria. After Ever since the ancient, pre-scientific times, the War, he resumed his duties as a professor the human body had been metaphorically de- of hygiene and social medicine at the Zagreb scribed as a fortress resisting diseases (9). Dis- University School of Medicine and assumed eases, on the other hand, were described by the the position of the director of the School of metaphor of threatening danger – an enemy Public Health in Zagreb. He fought to in- that invades the body-fortress. This old meta- crease the proportion of practical classes for phor survived in the language of public health future physicians. Due to his endeavors, a education, which saw disease as a social cat- College of Nursing was established under the egory and used the expressions such as fight, auspices of the Zagreb University School of battle, or war to describe the efforts to reduce Medicine. From 1952 to 1957, Štampar was mortality rates. In the old times, the physician the Dean of the Zagreb University School of was the one who led bellum contra morbum – Medicine. He was a member and the presi- war against disease; in Štampar’s times, the so- dent of the Yugoslavian Academy of Sciences ciety was supposed to play that role. Thus, the and Arts and chaired the First World Health transformation from fighting a war to having Conference in Geneva in 1948. In 1955, he an opportunity to initiate a mass ideological received the international “Leon Bernard” mobilization made the notion of war a met-

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aphor useful in all sorts of melioration cam- the same text, entitled Constitutional Illness paigns aimed at defeating the enemy. of Society, the adjective “constitutional” has The metaphor of society as an organism a double meaning: a legal one (pertaining to marked the introduction of anthropomorph, the constitution, or organization, of the state organicistic approach into the interpretation and authorities) and a medical one (physio- and understanding of social processes. Al- logical and psychological characteristics of the though its roots could be traced back to the human organism). There is no doubt that this ancient times, it became almost paradigmatic term was chosen to strengthen the analogy be- at the turn of the 20th century, with the arriv- tween society and the human organism, em- al of the founder of cellular pathology, Rudolf phasizing the characteristics that influence the Virchov. He considered the metaphor of liber- appearance and course of disease. This is obvi- al state useful for his theory of the cell as the ous from the quote where Štampar points out basic unit of life; as much as the structure of that “social illness can be called constitutional an organism is complex, it primarily consists illness” and explains that each individual rep- of many cells/citizens, ie, the body is a repub- resents one cell in the social organism. Such an lic (9). organism, according to Štampar, needs a dif- If we assume the standpoint that crisis of ferent kind of help (by stronger means) be- science occurs only when its tasks and meth- cause “an ill social organism cannot be treated odology become questionable (10), we can see individually but socially” (11). the classical symptoms of a paradigm shift in Štampar’s texts. A sharp swerve in topic – from Concept of social disease: congenital disease toward the binomial illness/health sys- poverty, King Alcohol, and tuberculosis as tem, with an emphasis on health, marked a a disease of poor-quality housing radical change in the perception of medicine and treatment and made Štampar a promi- Under the influence of the main representa- nent representative of that change. Štampar’s tives of social medicine at the time, whom he texts contain typical elements of sociomedical met during his studies in Vienna, Štampar movement in which anthropomorphic soci- continued to develop a concept of social dis- ety takes a key position in the approach to and ease, ie, a specific pathology harmful to social analysis of disease, health, and treatment: “by organism. Ascribing almost parasitic charac- taking a position that the society should be ob- teristics to social diseases, he insisted that they served as an organism, the organicistic school exhaust the entire society and thus cannot be strongly influences the development of medi- treated on an individual basis. Štampar sees cal science. As an individual organism consists these diseases as a pathology “so deeply rooted of cells, so does the society consist of individ- in the society that it has become part of it: it uals representing cells; as an individual organ- lives with the society and it is the most wide- ism can become ill, so can the society become ly spread and the most dangerous of all” (12). ill. Thus, medical observation becomes tightly In such context, he emphasizes the predomi- linked to sociological one and remains under nant poverty/illness binary system, which be- continual influence of sociological principles. comes his crucial starting point and model for The object of medical observation is a social interpreting the origin of social diseases (Fig- rather than individual organism, and the phy- ure 2). The metaphor of vicious circle, which sician as a representative of medical science be- associates working class with poverty and so- gins to feel the “pulse of the society” (11). In cial diseases, is evident not only in Štampar’s

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talked to the village miller (14), who said that more people drowned in liquor than at sea. Young Štampar remembered these words, which led him to the most radical combat he ever fought, the one in which his enemy was King Alcohol. Štampar called it an “evil spirit rooted in people, a tyrant worse than plague or war, the most ruthless liar, a hazardous player, an enemy with claws, and bitter poison” (15- 20). In the context of antialcoholic movement that was spreading across Europe and Ameri- Figure 2. Zagreb school of “public” health (today’s Andrija Štampar School of Public Health), founded in 1926 and opened on October ca at the time and the tradition of alcohol con- 3, 1927. sumption in our country, Štampar used every texts, but also in the language of other rep- opportunity to advise people against alcohol. resentatives of the sociomedical movement. He wrote: “Alcohol takes away the paycheck Francisco Murillo (1865-1944) used it as an from the father of a family and his children are argument for the introduction of social insur- left hungry. Because of alcohol, many lose their ance in Spain and René Sand (1877-1953) af- eyesight, the strong become weak, the rich be- ter he moved from social biology toward social come poor. Alcohol makes a man belligerent epidemiology in the early 1930s (13). While and quarrelsome, it makes him commit mur- Štampar considers poverty as a congenital so- der and robbery. In our country, it has thou- cial disease, the source and setting of social sands of servants, thousands that celebrate it diseases; he calls alcoholism, tuberculosis, and as a king: Croatian people spend thousands of sexually transmitted diseases the most devas- krunas on alcohol. But alcohol does not seek tating cancer of today’s society (12). money – it seeks people: young and old, male Alcoholism is a disease that Štampar talks and female, noble and common. Year after and writes extensively about and almost obses- year, it sends entire battalions to death, thou- sively works against (Figure 3). He was sensi- sands to jail, to sanatoriums or poorhouses... tized against alcoholism at an early age. On Alcohol is worse than plague or war. Nobody one occasion, while he was still a teenager, he is safe from Alcohol the Tyrant. Alcohol is dangerous because it does not come as an en- emy, but rather as the best friend. It comes over with a smile, happily offering foamy beer to the thirsty, comforting the doubtful with rosy wine, mercifully warming up those who are cold.... it promises to make you big, strong, wise. But alcohol is a liar. Those who believe it are fools!” (19). Doubtlessly, by using the met- aphor of a tyrant, Štampar creates a character of a callous and powerful manipulator of hu- man destinies, a vicious and seductive demon that can be easily recognized by the illiterate as well as the literate. Antialcoholic message Figure 3. People’s Textbook on Alchohol (Narodna čitanka o alko- holu), second edition by Vuk Vrhovac, Zagreb, 1931. in Štampar’s work is intended to two types of

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readership. His professional publications, ex- fight against alcoholism also requires a new so- tensive reviews full of statistical data are aimed cial order with requirements from organized at educated readers (17,20). On the other working class (16). hand, his use of Biblical imagery resonates well Each social disease has its specific place among the common people, since these are the where it spreads from and where it reins (Fig- motives that persisted for centuries in popular ure 4). Taverns, says Štampar, are well-known culture. By using the metaphor of King Alco- hotbeds of alcoholism, fatal places where tears hol as a readily recognizable demon, Štampar of the poor form and where they dig their own ingrains visually strong and powerful messag- graves (23). es in the minds of even the most uneducated Tuberculosis, which Štampar calls the dis- people. The power of alcohol, Štampar says, ease of poor-quality housing, was on the other lies not only in psychophysical destruction of hand the disease of the weak, often young, and an individual, but in its ability to undermine susceptible people. It lived in damp, stale spac- the very foundations of ethical principles. “An es and spread by air from poor dwellings full of alcoholic is always ethically indifferent, a fillis- evaporations of infected saliva (Figure 4). The ter and a reactionary, saved only by utopia and patient spat and coughed infective sputum and fantasy. An alcoholic is often a hazardous play- blood, becoming the very focus of infection. er, who makes and imagines a completely dif- The therapy was expensive and inaccessible to ferent world and future for himself.” the poor, so Štampar suggested implementa- Štampar’s attitudes on alcohol may be tion of sanitary measures in inadequate living compared to those described in Ethics and Al- spaces and establishment of outpatient service coholism (21) by T. G. Masaryk (1850-1937). for patients with tuberculosis (24). The physi- Masaryk was Austro-Hungarian and Czecho- cian in the outpatient service, writes Štampar, slovakian statesman, sociologist, and philos- “spends less time prescribing medications and opher held in high esteem and considered a more time studying family and social relations spiritual role model by many intellectuals in of the patient” (18). Croatia. Building upon these standpoints, The main reason for the spread of sexual- Štampar emphasizes that “to drink and to ly transmitted diseases, in Štampar’s opinion, work are two diametrically opposed notions. was prostitution. His view of the problem was A modern ethicist considers love thy neighbor also sociological, with a special emphasis paid to be the basis of all ethical duties. But love thy neighbor also includes work toward thy neigh- bor. A modern person should be characterized by awareness of duty rather than sentimental philanthropy” (22). All social diseases origi- nate from the ruthlessness of capitalism, ie, a social order that is insensitive toward working class and the poorest and ruthlessly exploits them at the same time. Štampar calls this cou- pling between social disease and social order alcoholic capitalism, which strives to gain as Figure 4. Štampar called tuberculosis the “disease of poor-quality much profit as possible from its capital, where- housing.” Such damp, stale spaces full of evaporations of infected as unorganized workers, who live in unfavor- saliva were common in the city of Zagreb in the first decades of the 20th century. Copyright: Institute for the History of Medicine of THE able conditions, take the bait. Therefore, the Croatian Academy of Science and Arts.

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to the poor background of prostitutes. In the that culture, can be in the fight against disease. analysis of this problem, Štampar appeals to Chinese government has recognized it and social sensitivity and calls for global social ac- seeks European and Japanese physicians” (26). tion. He calls prostitutes white slaves, there- The recognition of interdependence between by implying that the responsibility to fight the development of society (culture) on the this problem lies on the shoulders of the en- one hand and development of science (medi- tire society: “we abandon living beings to a lib- cine) on the other in the fight against disease eral, concessional exploitation by the unaware and in protection of human health is the es- and degenerated white slave traders, and all sential characteristic of Štampar’s writing. A the while we refuse to ask ourselves why these firm belief in this interdependence continual- slaves were brought to such a low point in the ly inspires Štampar to teach and produce texts first place. It seems we do not want to assign of educational nature by using examples of so- any blame for fear of being implicated our- cial diseases and describing the relationship to- selves” (18). ward these diseases in the past and the role of The social frame used in Štampar’s under- physicians and their future mission (Figure 5) standing of the prevalence, spread, and treat- (27). Understanding the history and develop- ment of diseases also required knowledge of ment of culture as an important determinant cultural and historical characteristics of a par- in understanding of prevalence of pathology in ticular people (25). A good example is his ar- a particular area, as well as the standpoints in ticle on plague. Although plague was not a the choice of preventive and therapeutic mea- danger anymore, Štampar used it as an exam- sures, makes Štampar a forerunner of the con- ple of a socially conditioned disease by trac- cept of global health, the realization of which ing its spread through China (26). According he would support for his whole life (28). to the area where it appeared, he called it the Yellow Death and reached for the usual met- aphors to describe it – a spreading evil, an ag- gressor, and the activities for its prevention a fight against enemy in which medicine was to provide a bulwark (26). In addition, Štampar used plague as a model to emphasize the im- portance of cultural development in the fight against this disease. He says “culture and cul- tural progress are the most powerful enemy of this disease, as proved by the example of Japan. The Japanese belong to the same race as the Chinese do and they share a similar religion. But they, a small island nation, have absorbed Figure 5. Štampar’s book “Physician. His Past and Future” (27). the European culture and taken over many European ways... And now the plague is ram- pant where these two cultures clash, the Asian Corporeality of society: body of nation and European one, and we already see that it over the body of an individual is Asian culture that will draw the short straw. It is the loveliest example of how powerful the The practice of using body metaphors for so- culture and modern medical science, as part of ciety began by the ancient description of a so-

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ciety as a disciplined body governed by the ward public health thinking – the application “head.” During the 19th century, this analogy of quantitative, statistically-based medicine was revitalized as a basic metaphor, a leitmo- to the inborn pathologies of population. Eu- tif, especially due to the influence of Herbert genics is often associated with the movement Spencer’s scientific positivism and the emer- called “social Darwinism,” a phrase credited to gence of Lamarckism and evolutionism (29). Herbert Spencer. “To be a good animal is the At that time, medicine developed under the first precondition for success in life, and to be influence of basic sciences and aspired to be a nation of good animals is the first precondi- a paradigmatic profession of liberal industri- tion for national prosperity” was often repeat- al society. Every provocative factor for soci- ed by prominent eugenicists to support their ety was seen and experienced as a disease. Both biologically-based social program (31,32). At spheres of co-existence, the social and medical that time, Rockefeller foundation was financ- one, were represented in the texts of medical ing German eugeneticists Poll and Grotjahn, writers at the time, explaining social phenom- as well as main eugenics institutes in Germany, ena in medical terms. Due to the power of so- such as Kaiser Wilhelm Institute for Psychia- cial arguments, individual rights became sub- try and Kaiser Wilhelm Institute for Anthro- ordinate to the more important strategic goals pology, Eugenics, and Human Inheritance. and could have been used as the corrective of The same foundation financially supported high risk behaviors if they became a threat to the construction and organization of the Za- public health. The body of nation was neces- greb School of Public Health (today’s Andri- sarily superior to the body of an individual. So- ja Štampar School of Public Health), found- cial disease became an influential rhetoric cat- ed in 1926 and opened on October 3, 1927 egory and a persuasive way of attracting public (6). Štampar definitely took part in these new interest. trends, considering eugenics an acceptable and Those were the times of unshakeable faith inevitable form of social therapy, in which the that scientific method can solve all problems. reproduction/degeneration binary system de- Initial evidence of genetic inheritance of pros- termined the discourse as well as action. In titution, pauperism, idiotism, alcoholism, re- Štampar’s words, “many degenerated people belliousness, and crime was additionally rein- would disappear by themselves if their condi- forced by the faith in eugenics as a scientific, tion affected their reproductive abilities” (18). quantitative, rigorous solution. All over the Metaphors that Štampar uses include “inferi- USA, laws were being introduced on forced or,” “degenerated,” “mentally,” and “bodily de- sterilization and on prevention of “inferior” fected.” He concludes that “the number of the marriages, such as in Indiana in 1907, Califor- less valuable constantly increases and becomes nia and Connecticut in 1909, Nevada, Iowa a sad mark of modern culture. This conglom- (banned marriage and enforced sterilization erate of people, which we physicians mark as of people with epilepsy, drug addicts, and rap- ill, as mentally and bodily defected, is excret- ists), and New Jersey in 1911, New York in ed by itself from the people because of neglect 1912, and Kansas, Michigan, North Dakota, and continual deterioration.” As a method, he and Oregon in 1913 (29,30). In the American recommends general asylum that would serve context, eugenics was the marriage between to cleanse human society from the procreation the fledgling field of biostatistics and Mende- of improper elements (18). lian notions of genetic inheritance. Thus, this While public health rhetoric was in general field became an arena with a clear affinity to- characterized by the activities related to quar-

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antine, fumigation, and eradication, the dis- and competition (there is deplorable compe- course of eugenics was characterized by terms tition among physicians); and he sees the pa- such as segregation and sterilization. Quaran- tient as an object of exploitation (12). To tining the infectious achieved the same kind overcome the previous approach to the treat- of public health goal as eugenically segregat- ment of a patient as an individual, physicians ing the feebleminded from “normal” people should be familiar with sociology and use so- or separating the white race from other races. ciological methods in their work. “In this way, Quarantine interrupted disease transmission; the physician’s knowledge of biological phe- institutional segregation interrupted the trans- nomena in a healthy or ill individual is com- mission of supposedly hereditary feeblemind- pleted, applied, and expanded to different so- edness, abnormality, and susceptibility to dis- cial layers, to all people, and thus the physician ease by preventing procreation (31). becomes the physician of the whole society, of the people. On the basis of such observations Physician of the people in the mission and work, the physician will learn, not only of attentive listening to the pulse of the to feel the pulse of an individual patient, but people also to feel the pulse of the people, not only to study pathological phenomena on individual At that time, social medicine just started to corpses at departments of pathology, but on develop into a complex area of various princi- the body of different social layers and the en- ples that stimulated a special relation toward tire people (12). Besides being a very popular the goals of medicine and public health, focus- motif in writings of educators of the 19th cen- ing on the necessity of protecting the entire tury, education also became the key element in population. Thus, physicians were faced with a the physician’s profession. For Štampar, igno- special mission – to become a crucial factor in rance is the greatest disease of people (12,33) saving people in the name of science. Štampar and it ought to be treated by drug of educa- supported this new trend in medicine. He was tion. its typical representative. It was an era of in- tense socialization, when natural and social Value of human life: factories as Roman sciences tended to converge and even inter- arenas sect. Medical practitioners were getting clos- er to the leading social elite, using and sharing In the spirit of liberalism of the late 19th cen- their language. The biology/society analogy tury, it became obvious that proprietary rights was used to describe social processes in biolog- of some people go against the dignity of oth- ical frames of reference or social terminology ers, whereas the early 20th century clearly ar- was used to explain medical phenomena. The ticulates the need for a society that would social concept of disease necessarily paved the ensure the basic level of protection and edu- way for physicians to step out of their offic- cation. Within the debate about the “nation’s es toward the people. Štampar describes phy- health,” expressions like human economy, val- sicians’ practice by using the language of eco- ue, and worth in relations with people became nomic sociology. He sees the previous role of common. In that context, it is significant how physician as that of a detrimental interdepen- Štampar interprets the attitude toward the dence with the patient (the calling of physi- value of human being from the position of cian suffers due to economic dependence on capitalist relations by use of metaphors from the patient) and as taking part in a market race social economy. Štampar contrasts the value

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of human being, which is devaluating, to the Discussion industrialization and capitalism as the main forms of exploitation: “A large number of fac- At the end of the 19th century, the develop- tories is built without the simplest regard to ment of biomedical sciences strongly influ- the human health and with a only single in- enced the public health rhetoric (35). By in- tention – to amortize the invested capital as corporating the abstract, the metaphor of quickly and efficiently as possible, but at the society as an organism becomes a predominant expense of human health. A man, has no eco- means to ascribe organic characteristics to ev- nomic value. We are shocked by what was go- erything that is social. The shift in the focus ing on in Roman arenas, but we do not see of physician’s interest from individual to gen- that they have not changed, because the mass- eral served as a basis for conceptualization of es of working people deteriorate in factories, social disease. Proceeding from the hereditary which are many times worse than Roman are- and sanitary concept of disease, the language nas!” (34). of public health and eugenics emphasized the Štampar attached great significance to concept of social disease on the one hand, es- health statistics, which he used as an argument pecially with respect to its hereditary etiology, and indicator of people’s health, often calling and the role of experts in their control for the it sad statistics. Vital statistics transformed in- benefit of the entire community on -the oth dividual human bodies into quantifiable units, er. Eugenicists as well as public health work- which allowed the state to adapt its health pol- ers claimed that individual rights were subor- icy according to the statistics. In that context, dinate to the common good, which justified vital indicators served as an index of social the state’s intervention and corrective (29-31). health, but also of interdependence of econ- In that context, Štampar’s program and the omy and medicine. “The value of human life manner in which he presented it also implied is best reflected in health budgets. Our entire the shift from paternalistical to biopolitical work economy is managed and developed at state, which would play the role of a health in- expense of people’s health, which is the reason strument (36,37). The use of metaphor to de- why there is a continual deficit in health bud- scribe anthropologic characteristics of society get. Despite this, Štampar persists in claiming was not specific only of Štampar’s expression, that human life/health is the greatest value. As but an elementary constituent of the language he started to see the human being as a biopo- of other sociomedical movement representa- litical rather than socioeconomic being, as a tives of the time (13,35). However, Štampar’s qualitative rather than quantitative category, language, metaphors, and ideology were not he also saw ethical revival as a process parallel inspired only by famous sociomedial move- to health revival. Štampar foresaw that in near ment representatives, such as Ludwig Teleky, future “economy of things will replace econo- Julijus Tandler, or even Karl Marx and Fri- my of people and economy of nation will re- dich Engels. They were additionally influenced place national economy. Health budget will by Slavonian literature and the expression of not be restricted only to helping the sick, but writers such as Antun Matija Relković (1732- invested into the benefit of human materi- 1798), who spread the ideas about healthy al, which will become the main focus of pub- society through his literary work, Josip Ko- lic care. The impulse to this was given by world zarac (1858-1906) who realistically described development and it will not be hindered in life in and sharply criticized the de- that direction by any reaction” (34). cay of traditional values in his book Dead As-

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sets (Mrtvi kapitali), and Ivan Kozarac (1885- 5 Dugac Ž. Against disease and ignorance. The Rockefeller Foundation in Yugoslavia between two world wars [in 1910), a writer and Štampar’s friend, who Croatian]. Zagreb: Srednja Europa; 2005. died young from tuberculosis and for whom 6 Brown TM, Fee E. Andrija Stampar: charismatic leader of social medicine and international health. Am J Public Štampar wrote a touching in memoriam (38). Health. 2006;96:1383. Medline:16809579 doi:10.2105/ Organicistic approach to the society and AJPH.2006.090084 social diseases shaped the unquestionable be- 7 Grmek MD, editor. Selected papers of Andrija Štampar. Zagreb: Andrija Štampar School of Public Health; 1966. p. lief in the importance of disease prevention, 51-245. as well as qualified physicians in their spe- 8 Balen I, Vukovac S, editors. Andrija Štampar, part I. Youth of Andrija Štampar (1888-1919). Slavonski Brod: Sveučilište cial approach. It implied the inclusion of so- J.J. Strossmayer i Opća bolnica Josip Benčević; 2006. cial and quantitative methods that require not 9 Sontag S. Illness as metaphor. London: Pengiun book Ltd; only “listening to the pulse of the people as a 2003. 10 Husserl E. The crisis of European science and transcendental whole,” but also the vigilance and control to phenomenology. Introduction to phenomenologic prevent social diseases and degeneration. This philosophy [in Croatian]. Zagreb: Globus; 1990. was paradigmatic for the rest of the popular 11 Štampar A. On social therapy [in Croatian]. Glasnik Ministarstva narodnog zdravlja. 1919/1920;7:261-71. ideas of the 20th century in Croatia, as well 12 Štampar A. Social medicine [in Croatian]. Zora. 1911;2:126- as within the broader context. Modern life of 31. these ideas can be detected from Hans Selye’s 13 Rodriguez-Ocana E. Medicine as a social political science. The Case of Spain c. 1920. Available from: http://www. (1907-1982) stress concept widely used to ex- ep.liu.se/ej/hygiea/v6/i2/a04/hygiea07v6i2a4.pdf. plain the interaction of organic life with the Accessed: October 15, 2008. 14 Jandrić-Balen M, Balen I. Andrija Štampar and his fight environment in the second half of the 20th against alcoholism [in Croatian]. In: Balen I, Vukovac S, century (39). Thus, the society as an organism editors. Andrija Štampar, part I. Youth of Andrija Štampar (1888-1919). Slavonski Brod: Sveučilište J.J. Strossmayer i metaphor overcomes its primary role and be- Opća bolnica Josip Benčević; 2006. p. 85-94. comes a global movement and specific cultural 15 Štampar A. Alcohol in Croatia [in Croatian]. Crveni ethos of health protection till today. It was due kalendar. 1911;4:58-65. 16 Štampar A. Alcoholism [in Croatian]. Hrvatska njiva. to Štampar’s endeavors and dedication that 1918;2:322-4. this movement found fertile ground in Croa- 17 Štampar A. Station for alcoholics [in Croatian]. Lijec Vjesn. tia and helped making significant advances in 1919;41:36-7. 18 Štampar A. On health politics [in Croatian]. Jugoslavenska the quality of life and health protection during njiva. 1919:3:1-29. the 20th century. 19 Štampar A. Alcohol [in Croatian]. Materinska riječ. Stella Fatović-Ferenčić 1908;66:5. 20 Štampar A. The day of Austrian alcoholics [in Croatian]. [email protected] Lijec Vjesn. 1908;3:390. References 21 Masaryk TG. Ethics and alcoholism [in Croatian]. : Izdanje St. Jelača; 1912. 1 Vukovac S. School teacher Ambroz Štampar – father of Andrija Štampar [in Croatian]. In: Balen I, Vukovac S, 22 Štampar A. From the field of social medicine [in Croatian]. editors. Andrija Štampar, part I. Youth of Andrija Štampar Zvono. 1909;3:645-50. (1888-1919). Slavonski Brod: Sveučilište J.J. Strossmayer i 23 Štampar A. Winter [in Croatian]. Banovac. 1912;25:1-2. Opća bolnica Josip Benčević; 2006. p. 21-32. 24 Štampar A. Fight against tuberculosis [in Croatian]. Zvono. 2 Grmek MD. The life of Andrija Štampar and his 1909;3:371-4. achievements in improving public health [in Croatian]. In: 25 Štampar A. Trachoma [in Croatian]. Pravo naroda. Grmek MD, editor. Selected Papers of Andrija Štampar. 1911;5:2-5. Zagreb: Andrija Štampar School of Public Health; 1966. p. 13-49. 26 Štampar A. Plague [in Croatian]. Zvono. 1911;5:28-31. 3 Fatović-Ferenčić S, Dugac Ž. Learning from less developed 27 Štampar A. Physician his past and future [in Croatian]. countries: from rural hygiene to strengthening peace. Zagreb: Ministarstvo narodnog zdravlja narodne vlade Hrvatske; 1946. Available from: http://www.bmj.com/cgi/eletters/328/7443/ DC1#75169. Accessed: March 1, 2007. 28 Smith R, Beaglehole R, Woodward D, Grager N, editors. 4 Hyde HV. A Tribute to Andrija Stampar, 1888-1958. Global public goods for health. Health economic and public Am J Public Health. 1958;48:1578-82. doi:10.2105/ perspectives. New York: Oxford University Press; 2004. AJPH.48.12.1578 29 Polšek D. The faith of the chosen: eugenic inheritance in

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times of gene technology [in Croatian]. Zagreb: ArTresor 35 Hähner-Rombach S. The construction of the “anti-social naklada; 2004. TB-patient” in the interwar years in Germany and the 30 Kevles D. In the name of eugenics. New York: Alfred A. consequences for the patients. In: Borowy I, Gruner WD, Knopf; 1995. editors. Facing illness in troubled times: health in Europe in the interwar years 1918-1939. Berlin: Peter Lang; 2005. 31 Lombardo PA, Dorr GM. Eugenics, medical education, p.345-63. and the Public Health Service: another perspective on the Tuskegee syphilis experiment. Bull Hist Med. 2006;80:291- 36 Štampar A. Hygiene and social medicine [in Croatian]. 316. Medline:16809865 doi:10.1353/bhm.2006.0066 Zagreb: Zaklada tiskare narodnih novina; 1940. 32 Laughlin HH. Eugenical sterilization in the United States. 37 Štampar A. Health and society [in Croatian]. Zagreb: Chicago: Municipal Court; 1922. Hrvatska naklada; 1939. 33 Štampar A. Our ideology [in Croatian]. In: Grmek MD, 38 Štampar A. Iva, in memoriam of late Ivan Kozarac [in editor. Selected papers of Andrija Štampar. Zagreb: Andrija Croatian]. Hrvatski pokret. 1910;7:2-3. Štampar School of Public Health; 1966. p. 99-101. 39 Perdrizet GA. Hans Selye and beyond: responses to stress. 34 Štampar A. On health politics [in Croatian]. In: Grmek Cell Stress Chaperones. 1997;2:214-9. Medline:9495278 MD, editor. Selected papers of Andrija Štampar. Zagreb: doi:10.1379/1466-1268(1997)002<0214:HSABRT>2.3. Andrija Štampar School of Public Health; 1966. p. 55-73. CO;2

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