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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 Croatia 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 Zagreb. 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 Vinkovci 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). www.cmj.hr 709 Croat Med J 2008;49:709-719 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- 710 Editorial 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.

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