OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 16

1/4"44A Prly

ANNUAL REPORT OF THE DIRECTOR-GENERAL

TO THE WORLD HEALTH ASSEMBLY

AND TO THE UNITED NATIONS 1948

WORLD HEALTH ORGANIZATION

Palais des Nations, Geneva April 1949

NOTE

This report covers the activities of the World Health Organization during the first four months of its existence-from r September to 31 December 1948. Although the first World Health Assembly was convened in July, the Organization did not come into being until z September, when the Interim Com- mission was dissolved. In the course of the report a few references are made to events which took place in the month of August, when essential services were carried on by the Interim Commission. This period for the most part was spent in initial recruitment and in organization of the staff. Summary analyses of annual reports from Member States, which normally would be a part of the report of the Director-General, have not been included as the report covers so little of the calendar year. Information specifically requested by the Economic and Social Council of the United Nations has been included in annexes. Additional material, containing programmes of meetings and activities planned for 1949, will be submitted with the report to the Economic and Social Council, so that the report may meet the purposes of both the World Health Assembly and the United Nations. In view of the changing nature of international activities, the form of this report will not necessarily be followed in succeeding annual reports.

CONTENTS

Page Page Introduction 7 Co-ordination of research 33 Editorial and reference services 34 Chapter I.SPECIFIC ACTIVITIES Chapter 4. PUBLIC INFORMATION, LIAISON, Malaria 9 AND ORGANIZATION Tuberculosis II Venereal diseases 13 Public information...... 37 Maternal and child health 15 Liaison 39 Nutrition 16 Regionalization and the special office for Environmental sanitation 16 Europe 41 Public-health administration 17 Organization of the Secretariat . . . 41 Mental health 18 Annex 1. Membership of the World Health Other subjects : Organization as on 31 December 19 Penicillin 1948 43 Dental hygiene 19 Physical training 19 Annex 2. Membershipofthe Executive High altitude research stations . 20 Board as on 31 December 1948 44 Co-ordination of medical congresses 20 Annex 3. Organizational chart as on 31 De- cember 1948 45 Chapter 2.GENERAL OPERATIONS Annex 4. Expert committees established Activities in the field 21 by WHO 46 Fellowships 24 Medical literature and teaching material 25 Annex 5.Conferences and meetings called Bureau of medical supplies 26 by WHO, 23 July-31 December Assistance to Palestine refugees . . 26 1948 46 Annex 6.Conferences and meetings called Chapter 3.TECHNICAL SERVICES by the United Nations and its Epidemiology 27 specializedagenciesatwhich Health statistics 30 WHO was represented, 24 July- Biological standardization 31 December 1948 47 Unification of pharmacopoeias 32 Habit-forming drugs 33 Index 49

- 5 -

INTRODUCTION

The World Health Organization, during the first few months of its existence, has prepared plans and begun operations for launching offensives against disease. Through field operations and demonstrations on an increasing scale, expert advice, and the provision of international fellowships, medical literature and various types of technical services, WHO is embarking on an effective programme of assistance to governments. The Organization, first focusing its attention on three of the world's major disease problems-malaria, tuberculosis and venereal diseases-has begun a planned attack on these scourges and certain other infectious diseases, and has taken effective action to promote positive health. Work has started on subjects of wide social significance-the improvement of maternal and child health, nutrition, environmental sanitation, and certain aspects of public-health administration and mental health. Very important, also, are the technical and statutory services which have been effected, mainly in epidemiology and standardization, essential to the control and prevention of disease. Activities in these and other fields during the short period which has elapsed since the end of the first World Health Assembly are described in this report. Together with this increased activity, the Organization itself has developed. At the end of the year (1948), WHO had fifty-six Members (see annex 1). Some progress had been made in regionalization : the Regional Organization for South-East Asia was established and the regional office set up in New Delhi on I January 1949 ;the convening of the Regional Committee for the Eastern Mediterranean Area was arranged for 7 February in Cairo ; and by the end of 1948 a working arrangement with 'the Pan American Sanitary Bureau was being negotiated, pending arrangements which would enable the Pan American Sanitary Organiza- tion to act as a regional organization. WHO also established a special administrative office for war-devastated countries in Europe, provisionally locating it in Geneva. This office will assist in the task of solving the problems of health and medical rehabilitation of Europe. Expert committees and study-groups, made up of specialists of international reputa- tion, planned immediate and long-term programmes for improving the world's health, and joint committees on specific subjects were sponsored by WHO and other organizations. Close collaboration with the United Nations and its specialized agencies was continuously maintained through the machinery of the Administrative Committee on Co-ordination. A great willingness to co-ordinate activities with those of WHO was at all times manifest. In order to give effect to the decisions of the first Health Assembly and to perform other necessary functions, the Executive Board held two sessions during 1948-one during and immediately following the first Health Assembly, one from 25 October to II November- and a third session was arranged for February 1949. Although dealing mostly with organiza- tional questions, the Board nevertheless discussed a wide variety of technical matters.' To deal with the growing work undertaken, the staff, which was at first largely trans- ferred from the Interim Commission, was substantially increased. Much of its time was taken up in preparation for the sessions of the Executive Board and for the second Health Assembly. Within a period of two months, for instance, following the second session of the Board, besides administering current programmes, answering requests for assistance and information and conducting preliminary surveys, the Secretariat prepared the report on 1948 activities, worked out the allocation of funds for 1949, and planned the programme and budget for 1950. It is clear that to crowd so much into so short a time, with a necessarily restricted staff, was to jeopardize the technical work required, and it is to be hoped that it will not again be necessary to concentrate attention on the work for three separate years at the same time.

For reports on first and second sessions, see og. Rec. World Hlth Org. 14 - 7 - INTRODUCTION

The period covered by this first report is, then, one of transition and intensive preparation, transition from the somewhat limited programme begun by the Interim Commission to the rather more extensive projects to be undertaken by WHO in 1949, and preparation in 1950 for serious attempts towards the realization of the ideal embodied in the WHO Constitu- tion-that of making available to every human being the enjoyment of the highest attainable standard of health.

BROCK CHISHOLM, M.D. Director-General

- 8 - C HAPTER 1

SPECIFIC ACTIVITIES

Malaria

Malaria, which still attacks, incapacitates and the committee set up by the Interim Commission kills millions of people in many parts of the world, has continued to be consulted on urgent problems. but which lends itself to effective new measures of prevention and cure, was one of the first Malaria Projects in the Far East subjects to which WHO gave special attention. By means of advice furnished by the Expert WHO establishedjointlywithUNICEF Committee on Malaria, field services and visits a committee on health policy, which held two of individual experts, the Organization has assisted meetings during 1948.3 Following the recommen- governments in carrying out malaria control. dations of this committee, it was decided that, so far as malaria was concerned, in Far-Eastern It has thus paved the way for action to be taken countries other than China, the field activities by the United Nations through its Economic of WHO and UNICEF in any given malarial Commissions, and has caused the world to think, area, taking the form mainly of control demonstra- perhaps for the first time, in terms of worldwide tions, should as far as possible be amalgamated. eradication of malaria. For these demonstrations, the Expert Com- The Expert Committee on Malaria established mittee on Malaria outlined the essential guiding by the Interim Commission held two sessions, one principles which are to be followed as far as convened in Geneva and one in Washington.2 possible by the chief of mission for the Far East (Dr. M. H. Watt) appointed by the Joint Com- Following the recommendations contained in the mittee on Health Policy UNICEF/WHO. It was report on its first session, technical studies were decided that WHO would provide the chief of undertaken ; advisory visits were made in Greece, mission with the services of a competent malario- Italy and Poland ; and, through the Red Cross logist and that all requests, along with comments and Red Crescent Societies, help was given in made by the WHO Executive Board, would be the control of an epidemic situation in the Tulcea referred to the chief of mission for his negotiation. region of Roumania. WHO field staff assisted Consideration was also to be given to the necessity in the antimalaria programme inItaly and for selecting projects which would increase food Greece. The Organization was represented at production (see page ro). Fellowships in malariology have been granted the fourth International Congress on Malaria and, arranged in India for two Siamese doctors. and convened a special conference of malario- They have been trained in the Malaria Institute logists in Washington. of India, Delhi, and have followed up their The report on the second session included training by field work in India. recommendations on the future malaria policy of WHO, methods of collaboration with FAO on the selection of areas for control projects in Field Services malaria,the use ofinsecticides(particularly Continuing part of the UNRRA health pro- DDT), chemotherapeutics in malaria control, gramme, the Interim Commission authorized and an experimental project of species-eradica- field missions and other forms of assistance to be tion in Africa. Work on these recommendations, sent to governments formerly aided by UNRRA. under way by the end of the year, is described in During the last part of 1948 these gradually the following paragraphs. ceased and were replaced by the provision of The two reports of the expert committee, as demonstration teams, a greater number of fellow- well as other technical studies on malaria, have ships, and medical literature and supplies to an increasing number of countries. already been published by WHO. Pending the Reports received at the end of 1948 on the DDT establishment of the WHO expert committee campaign undertaken in Greece showed that, in decided upon by the first World Health Assembly, 3 For report by WHO ,members of the Joint 2 For reports on these sessions, see Off. Rec. World Committee on Health Policy, UNICEF/WHO, see filth Org. 8, 8 ; 11, 43 Off. Rec. World Filth Org. 14, 49 - 9 - SPECIFIC ACTIVITIES spite of the difficult political situation, 4,733 result in an increase of food-production and in communities had been sprayed with DDT and improved conditions of rural life.The expert that, by II September, 702,705 acres had been committee agreed that it was desirable to con- sprayed from the air. At the end of the year, one centrate efforts in malaria control on regions WHO sanitary engineer was still working on where increased food-production was possible, malaria in Greece, and the antimalaria campaign and it suggested methods by which WHO could was being continued. co-operate with FAO in selecting such regions.' Close contact with the Government of Italy At the end of 1948, collaboration between the two was maintained in connexion with the expenditure organizations was already yielding fruitful results, of part of the Lira Fund resulting from the sale and joint action on two types of projects was of UNRRA goods, for the five-year antimalaria contemplated. programme and for the eradication of anophe- On the one hand were the small health-demon- linesin Sardinia, a project which has been stration areas which are a part of the WHO remarkably successful. scheme. FAO has been informed of requests In Poland, where advice had been given on the from governments for demonstration teams to programme for malaria control and on other assist in malaria control, and has been invited aspectsofpublic-healthadministration,the to send its experts to accompany malariologists medical officer was withdrawn in October.This into the field, to make the initial surveys of the decision was taken because of lack of sufficiently areas suggested for such demonstrations. qualified personnel. On the other, larger-scale operations were also planned. WHO and FAO drafted a proposal for joint action programmes in rural rehabilitation Economics of the Production and Distribution of large areas (of approximately ten million acres), of Insecticides where malaria control would be associated with On the recommendation of the Expert Com- general improvement of health standards, includ- mittee on Malaria, the question of the regional ing economic, agricultural, sociological and other production of insecticides (especially DDT), of considerations. solvents, and wetting and emulsifying agents, InSeptember,thislatterproposalwas and that of the waiving of customs duty on these submitted to the UNRRA Central Committee, insecticides in non-manufacturing countries, were with a request for financial support.Although referred to the appropriate bodies of the Economic UNRRA found it impossible to support the plan, and Social Council of the United Nations. WHO it will be presented to the third session of the was later informed that these questions would be ExecutiveBoard,withtherecommendation put on the agenda of the February 1949 session that it be referred to the Economic and Social of the council.These points have also been the Council of the United Nations. subject of an exchange of correspondence with the Economic Commission for Europe. Other Measures for Malaria Control Protection of Sardinia from Rehnportation of Towards the end of the year, members of the Anophelines ad hoc Expert Committee on Malaria were consulted on a series of specified measures for An important subject considered by the first malaria control, proposed for recommendation Health Assembly was the programme mentioned to governments of countries in which malaria was above for the eradication of anophelines from prevalent. Thisproposal,'referred by the the island of Sardinia.This project had been Assembly to its Executive Board, was, in turn, successfully carried out by the Sardinian author- referred by the Board to the expert committee. ities.Agreeing that this governmental agency should also take steps to prevent the reintroduc- A summary of the replies received from the tion of the mosquito into that island, the Assembly experts was prepared for presentation to the recognized the right of the government to apply third session of the Board. additionalmeasuresofdisinsectization,and recommended the co-operation of other Members. Special Requests from Governments The resolution adopted by the Assembly on this subject 4 was communicated to all Members In answer to a letter informing all Members of of WHO. In addition, the Italian Government the Organization of the assistance available in was requested to report on the measures it had malaria control, many requests were sent in by taken, the techniques used, and the results governments. These have been met, within the obtained. limits imposed by the budget, and, in the light of guiding principles approved by the Executive Board,7 itis planned tooffer the following Increased Food-Production assistance in the first quarter of 1949 : It has been more and more widely recognized that the control of malaria will, in certain regions, 5 Off. Rec. World II lth Org. 11, 48 6 Ibid.13, 306 4 Off. Rec. World Hlth Org.13, 301 7 Ibid.14, 17 -IO - 8PECIFIC ACTIVITIEg

1. Malaria-control demonstration teams : one 4.Fellowships :an estimated number of 18 team to India, one to Yugoslavia and one to fellowships in malariology, most of them for Pakistan training in malaria schools, and a few for specialized training of senior malariologists. 2. Assistance to schools of malariology :one consultant tothe South-East Asia region, At the end of 1948, action was being taken to who will participate in the teaching at the appoint the nine members of the definitive Expert Malaria Institute of India Committee on Malaria, and preparations were being made for the first session of this committee, 3.Consultant advice :one area-consultant which will be held in August 1949. A panel of allocated to Europe corresponding members was also being appointed.

Tuberculosis

Tuberculosis having reached epidemic propor- immigrants should take place at the point of tions in many war-stricken countries, it was early departure, and should include a chest radiogram recognized that, to combat the spread of the to be interpreted by a medical officer acceptable disease, international action was needed not only to the receiving government. on long-term preventive planning in environ- mental hygiene, but also on emergency measures An Expert Committee on Tuberculosis was Technical Visits and Studies therefore established by the Interim Commission. During 1948, technical visits were made to This committee held two sessions under the Czechoslovakia, Egypt, France, Italy and North auspices of the Interim Commission, and then, as an ad hoc committee of WHO, it met for a third Africa ;the report on the visit to Egypt, in time on 30 September.' December, in which suggestions were made and Projects on tuberculosis, based on the recom- anevaluationgivenoftheantituberculosis mendations of the expert committee, have taken campaign being conducted in that country, has the following forms : been forwarded to the Minister of Public Health in Cairo.Meetings of various tuberculosis asso- 1. The award of travelling fellowships, prin- ciations in Switzerland were attended, and a cipally in administrative, laboratory, epidemio- number of studies on tuberculosis were circulated. logical and clinical work, to increase the num- bers of trained doctors and other medical workers in countries most in need. on environmental factors in relation to tubercu- losis were prepared and distributed to inquirers 2.The preparationof material on recent from many parts of the world, and an annotated developments of special importance, for use bibliography on streptomycin has been circulated. of physicians and others in different countries. 3.The provisionof demonstration teams, which, at the request of governments, may Mass-Immunization Programme proceed to countries where new schemes in In the summer of 1948, arrangements were made prevention, diagnosis and treatment of tuber- with UNICEF for a WHO official to be seconded culosis are about to be introduced. Such to Dr. J. Holm, in charge of the joint enterprise schemes are continued by the countries them- programme for tuberculin-testing and BCG vacci- selves after the initial period of demonstration. nation being carried on by UNICEF, and the 4.The maintenance of the closest liaison with Danish Red Cross and its Scandinavian associates. otherinternationalorganizations-govern- This collaboration helped in the expansion of the mental and voluntary-which have an interest scheme throughout Europe and into Asia and in combating tuberculosis. North Africa.In addition, a research group was 5.The development of uniform procedures on appointed to follow up the work being done in such matters as the classification of tuberculosis, the field, and a sum of money was appropriated x-ray interpretation, laboratory diagnosis of the for the research, to start early in 1949. presence of tubercle bacilli, and the evaluation The joint enterprise was confined to Europe in of new therapeutic agents, such as strepto- 1948, but plans were made to extend it to countries mycin. in the Near and Far East and in the Western Hemisphere, and it was decided, on 19 November Consideration has also been given to tuberculosis among immigrants, especially to the recommenda- 1948, to include Ceylon, Egypt, India, Lebanon, tion that, as far as is possible, examinations of Mexico, and Pakistan, bringing the total number of eligible countries to 21. By the end of the year, the campaign was well under way in Czecho- For reports on these sessions, see Off. Rec. World Hlth Org. 8, 49 ; 11, 5 ; 15, 5 slovakia, Finland, Greece, Hungary, Poland and SPECIFIC ACTIVITIES

Yugoslavia, and agreements were being negotiated has made available technical x-ray services, has with Albania, Algeria, Austria, Bulgaria, China, inspected and repaired a vast amount of equip- Italy, Morocco, Roumania and Tunisia. ment supplied by UNRRA, and has given training courses in elementary care and operation WHO isintimatelyassociatedwiththe technical, practical and research aspects of the of x-ray apparatus to over one hundred technical joint enterprise and will continue the follow-up assistants. work after UNICEF has fulfilled its emergency Finally, it has prepared and printed in the function.The programme in Europe, for which Polish language a handbook on practical x-ray WHO has assumed the scientific responsibility, technique-the first of its kind. is an extremely large one :some fifty million children and young adults will be examined and In Greece, where tuberculosis is now perhaps approximately fifteen million will be vaccinated. the greatest post-war health problem, WHO In North Africa, the plan calls for the testing maintained a specialist in tuberculosis and a very of about seven million.When the Asiatic and small staff, up to the end of 1948.They have other countries are added, the total to be tested followed up the work initiated by UNRRA. and examined may well exceed a hundred million, Recently, this staff assisted in the opening of a which, in the words of the director of the field modern and well-equipped Chest Hospital in work of the joint enterprise will " make this anti- Athens. Mass-radiographycentresarealso tuberculosis campaign the largest single mass- maintained in Athens, and in Salonica and Eleusis ; immunization programme ever undertaken ". another such centre is about to be opened at Lavrion, near Athens.It was estimated that about 250,000 people in Greece had been examined Other Operations by x-ray by the end of 1948. Collaboration with the Danish team concerned with BCG vaccination Included in the special assistance granted by the and with the American Mission working in that Interim Commission to countries formerly aided country has been well maintained.9 by UNRRA were field services in the prevention, diagnosis and cure of tuberculosis. The missions to Although no WHO tuberculosis specialist has governments which had been furnished by the been stationed in Italy during the period under Interim Commission were continued by WHO, review, the WHO medical officer in Rome has to some extent, during the last part of 1948 had many interviews with the Italian authorities (see page 21). concerning the disposal of that part of the Lira In China, WHO arranged with the government Fund which was set aside for the improvement to send three doctors to Europe for a study of of the tuberculosis services.This involves the tuberculosis and BCG vaccination ; pending provision, over the next five years, of complete their return, propaganda on tuberculin-testing or partial equipment for some 152 tuberculosis and BCG vaccination was disseminated, and pro- dispensaries,including12,595 beds and new cedures were discussed and demonstrated.The apparatus. WHO tuberculosis specialist, who has been in that Ethiopia was visited early in 1948, and the country since May 1947, has continued to give findings of the official who investigated the situa- courses and training in mass-radiography. A new tion with regard to tuberculosis have been incor- NationalTuberculosisAssociationhasbeen porated in a special report. established ;ten sets of x-ray apparatus have been put into use in different parts of the country ; In the summer of 1948, a team of two workers and centres for demonstrating modern procedures was sent to India to set up a laboratory for the in diagnosis have been opened in Shanghai, manufp.cture of BCG near Madras. At the end of Peiping, Tientsin, Nanking, Taiwan (Formosa) the year, this work was nearing completion.It and Canton. will be taken over by Indian doctors who have The information on tuberculosis services in been training in Copenhagen, and the WHO team Poland, which was obtained from the investiga- will then be withdrawn." tions of two WHO x-ray specialists sent there Finally, Ceylon was visited in December 1948 by in 1947, has been included in the schedule used a WHO official, who helped to initiate a BCG for the evaluation of other national tuberculosis programme and advised generally on the setting- services.Such information is also now available up of a comprehensive antituberculosis programme for Belgium. Ethiopia,Greece, Hungary and in that country. Switzerland, and will soon be obtained from Egypt,Italy,Palestine and othercountries about to be visited.In addition to setting up, with the approval of the Polish Government, a 9 See Chron. World Huh Org. 1948, 2, 272 model scheme for tuberculosis control, WHO 10 Ibid. 1949, 3, 2 3 12 - SPECIFIC ACTIVITIES

Plans for 1949 in detail what particular service, demonstration During 1949, it will be a major function of or other, might best suit the needs of the countries. WHO, initsantituberculosiscampaigns,to Only by such close contact will WHO be able to ascertain needs more precisely.It is planned, plan with confiderli e for the future ; only on the therefore, that consultants of wide experience receipt of such iniormation will the relatively should visit as many countries as possible, advise limited funds at its disposal be used to best authorities where advice is needed, and ascertain advantage.

Venereal Diseases

International action on some aspects of the tions in syphilis. WHO arranged for such evalua- major health problem of venereal diseases was tions to be made by national laboratories in early thought imperative by WHO. As a result several countries, and the US Public Health of the second World War, the numbers suffering Service Venereal Disease Research Laboratory, from venereal infections had greatly increased ; Staten Island, New York, has acted as an inter- intensified measures of control were required ; national reference centre.By this method, a and penicillin, recently introduced, had proved basis for the further study of antigens and for effectivein the treatment of thesediseases, uniformity in techniques and test-performance especially syphilis and gonorrhoea. procedures will be established. An Expert Committee on Venereal Diseases was established by the Interim Commission.In two sessions " (meeting the second time in October Penicillin Programmes as an ad hoc expert committee of WHO) it One of the most extensive activities under- particularly emphasized the following subjects : taken by WHO has been to combat, in collabora- various aspects of serological standardization ; tionwith UNICEF,prenatalandinfantile themaritimevenereal-diseaseproblem ;the syphilis with penicillin (see page 19), as part of administrationand revisionoftheBrussels overall anti-venereal-disease programmes being Agreement ;the establishment of international carried out by governments. health-regulations for venereal diseases ;norms for treatment ;the promotion of a wider avail- UNICEF having proposed to provide supplies," ability of anti-venereal-disease drugs ;requests mainly of penicillin, to countries willing to carry for assistance to governments ;the composition out broad control programmes, experts from and type of demonstration teams to be sent into WHO consulted with experts from UNICEF on the field ;and, in co-operation with UNICEF, the possibility of launching penicillin campaigns projects for a penicillin attack on prenatal and in II European countries ;joint surveys were infantile syphilis.The specific recommendations made in Bulgaria, Hungary and Yugoslavia, made by the experts are being implemented as and, as a result, UNICEF set aside a total of described below. two million dollarsfor such projects. The technical responsibility for evaluating and advising on them has rested with the Joint Committee on Studies Health Policy, UNICEF/WHO and with WHO. In the early days of the Interim Commission, In August 1948, on the recommendation of the considerable information was collected on the Expert Committee on Venereal Diseases, the joint nature and extent of syphilis, gonorrhoea and committee took action to assist Poland ;peni- other infections, and the ways in which WHO cillin and equipment to a total value of $384,220 might assist health administrations in combating were appropriated by UNICEF for the treatment them. Many of these technical studies and of children and pregnant women. The participa- opinions have now been circulated. tion of WHO and UNICEF in the overall Polish Studies were also carried out in preparation for campaign is referred to below. the contemplated International Serological Labo- By the beginning of 1949, programmes with ratory Conference in1950 ; and, based on UNICEF were also going forward in four other recommendations made by the expert committee, European countries-Bulgaria, Finland, Hungary tentative plans for this conference have now been and Yugoslavia.UNICEF allocated a sum of made.In order to carry forward these plans, $337,000 for supplies for these programmes, which a sub-committee on serology and laboratory were proposed by the WHO Expert Committee aspects will be established in 1949. on Venereal Diseases and the joint committee, Of particular importance in 1948 were prepa- and WHO experts are now initiating them in the ratory sero-diagnostic test-performance evalua- four countries through model demonstrations in clinics, the granting of fellowships, and the n For reports on these sessions, see Off. Rec. World Filth Org. 8, 6o ;15, 18 " Off. Rec. World filth Org. 12, 42 - 13 - SPECIFIC ACTIVITIES provision of special literature.In Yugoslavia, The WHO fellowship programme for countries the programme isof particular national and receiving UNRRA aid included 18 grants for the international interest because of the high endemic studyofdermatology and venerealdiseases syphilisareaofBosnia-Herzegovina,where in the United States and Europe. These fellow- previous approaches to the problem with old ships were being administered in 1948. methods have failed. In Naples, with supplies provided by UNICEF, Hygiene of Seafarers and Displaced Persons a pilot demonstration in treatment of children and pregnant women with penicillin was conducted Implementing the Health Assembly's decision in 1948, and the Italian Government requested to revise and expand the Brussels Agreement into that similar demonstrations, based on the expe- an instrument of wider international control," rience gained up to October, should be conducted WHO will work on different aspects of venereal in other Italian cities.Possibilities of extending diseases,particularly among special groups- the scheme were studied in December by a WHO seafarers, migrants and displaced persons (see expert in Italy. also page 18). Negotiations have been started with ILO to WHO willalsoconsider establishinganti- establish a joint committee on the hygiene of venereal-disease programmes in other European seafarers, and proposals on the maritime aspects countries which have requested assistance from of the problem were submitted to the ad hoc WHO and UNICEF. In December, consultations expert committee by the International Union were held with the Czechoslovak Government against Venereal Diseases. The expert com- on the possibility of initiating such a programme mittee recommended, as a special project, the in Slovakia. demonstration and investigationofvenereal- disease control in a major port. This project was approved by the Executive Board and is now being Other Operations studied. WHO has also given expert advice to the At the request of the Polish Government, the International Refugee Organization on various WHO Interim Commission had sent an expert to aspects of venereal-disease control among dis- Poland in late 1947.Acting on advice which placed persons in European countries, particu- he gave and consultations previously held, under larly with reference to norms of treatment, pre- the UNRRA health programme which was emigration examination, and control and follow- continued by the Interim Commission, the Polish up of patients. health authorities proposed an overall attack on syphilis in that country, where the problem of venereal diseases had been significantly intensified Brussels Agreement during the second World War. The Polish anti- syphilis plan, subsequently considered by the The administration of the Brussels Agreement expert committee la and put into operation early itself was transferred from the Office International in 1948, is now well under way. As an overall d'Hygiène Publique to WHO in 1948, with the national antisyphilis campaign based on peni- coming-into-force of the protocol drawn up by cillin, it is the first of its kind in Europe. A the International Health Conference in New progress report of the results of the campaign has York. recently been received, indicating that more than From time to time, OIHP had drawn up an half a million persons were examined and more international list of treatment centres as a supple- than 43,000 cases of syphilis treated between ment to this agreement, and the Health Assembly April and September 1948.14WHO has also decided to include in thelistcertain inland supplied Poland with various educational and centres. other material. By the end of 1948, information had been In Ethiopia, an extensive study of the nature obtained from 41 governments on the publication and extent of the measures necessary to combat of the International Listof Venereal-Disease venereal diseases there was undertaken during Treatment Centres, and WHO had drafted a March and April 1948.15 A comprehensive pro- provisional text for International Health Regula- tions for Venereal Diseases, to include the Brussels gramme for venereal-disease control was sub- Agreement. This text will be sent to govern- sequently proposed to the Ethiopian Govern- ments, to ILO and to other appropriate inter- ment. national organizations for comment, and will Expert advice was also requested by the later be submitted to the Health Assembly. PhilippineGovernment. A WHO consultant was in Manila in December and will remain in the field for the first quarter of 1949. Traffic in Women and Children, Prostitution In order to assist in unifying into a single instrument the various pre-existing international la 011. Rec. World Hlth Org. 8, 66 conventions and agreements on such subjects 14 Ibid. 15, 29, 37 ;see also Chron. World Hlth Org. 1949, 3, 29 16 Published in Bull. World Hlth Org. 1949, 2, 85 16 Off. Rec. World Hlth Org. 13, 303 - 14 - w.

SPECIFIC ACTIVITIES as traffic in women and children, and prostitution, The initiation of organized venereal-disease con- WHO has co-operated with the Social Commission trol in underdeveloped areas and the introduction of the United Nations, which is responsible for in these areas of new methods of ambulatory this task. The Expert Committee on Venereal treatment of early syphilis will be of particular Diseases drew attention to the fact that the importance, since control of venereal diseases statement suggested for inclusion in the instru- has, up to the present, been largely confined to ment was not quite in line with the resolution Europe, North America and Australia. adopted by the first Health Assembly." At the Recognizing the epidemiological and socio- end of the year, this matter was being examined economic significance of the transfer of venereal in consultation with the United Nations. diseases from country to country with its con- sequent reduction in working efficiency, WHO will combat venereal diseases in ports, in co-operation Plans for 1949 with governments and with other interested international and national organizations. In 1949, WHO activities in combating venereal Relationships with UNICEF will be continued, diseases will be continued and extended to several in carrying forward and expanding the joint countries in Europe and in the Eastern Medi- antisyphilis programme in co-operation with the terranean and South-East Asia areas, through governments concerned. In 1949 activities are expert assistance (consultants and teams), fellow- visualized in Albania, Czechoslovakia, Greece, ships, and the provision of technical information. India, Pakistan, Roumania and Siam.

Maternal and Child Health

It is comparatively recently that doctors and The expert committee, consisting of nine mem- other medical workers have recognized that one bers as decided by the Executive Board," was of their important functions should be to raise scheduled to meet during the last week of January the levels of health and living rather than merely 1949.This will be the first meeting of an inter- to supply treatment for the sick. national committee composed of experts on The League of Nations conducted a number maternal and child health. of surveys in various countries with a view to the re-organization of public-health services.It collected about roo monographs and reports of Programme of Work conferences relevant to infant diseases, mortality A circular letter asking for suggestions on the and hygiene.It is probably due to the interest maternal and child health programme to be of the League that there has of recent years begun by WHO was sent to governments on been such a well-marked improvement in the 12 August.This letter requested information attitudeofpublic-healthauthoritiestothis on : subject, and in the attitude of the medical pro- fession towards paediatrics. The research and r.the kind of assistance which WHO should interest in nutrition and in rural hygiene sti- supply to national health-administrations, and mulated by the League have also been of con- 2.the manner in which maternal and child siderable benefit. ,health services of the countries concerned were ILO, the Save the Children International Union organized. and the International Association for the Promo- tion of Child Welfare have likewise contributed By the end of December, about thirty replies to child protection and welfare. had been received. At the fifth session of the Interim Commission Experts from WHO attended the meetings of of WHO, the United States representative sub- the Joint Committee on Health Policy, UNICEF/ mitted a paper outlining a comprehensive pro- WHO, and co-operated closely in the maternal gramme for maternal and child health."It was and child health aspects of the UNICEF pro- recommended to the first Health Assembly that gramme. From the one million dollars supplied major emphasis be given to this subject, and, by UNRRA for health programmes approved by recognizing that the children of today represent the joint committee (see page 42), WHO allocated the futnre of humanity, the Health Assembly 6o fellowships in maternal and child health. approved the programme submitted by the In addition, it was administering 56 fellowships Interim Commission, including the establishment which had been granted from UNICEF funds, of an Expert Committee on Maternal and Child for South-East Asia. Health.Italsorecommendedcertainother At the request of the United Nations, WHO measures to be taken by governments and by prepared a draft Declaration of the Rights of the WHO." Child," which,after being revised and then adopted by the Executive Board, was sent as a 17 Off. Rec. World Hlth Org. 15, 2 7 18 Ibid. 7, 228 28 Off. Rec. World Hlth Org. 14, 2 3 19 Ibid. 13, 302 21 Ibid. 14;352 - 15 - \ W

SPECIFIC ACTIVITIES working paper to the Social Commission of the group composed of fifty doctors and nurses in Economic and Social Council. the United Kingdom. In Stockholm, the General Council of the Towards the end of 1948, one of the WHO International Union for Child Welfare, held from experts spent two months in the United States io to 16 August, and the Seventeenth Inter- ofAmerica,studyingdifferentproblemsin national Red Cross Conference, from 20 tO 30 maternal and child health. Preparations for the first session of the expert August, were attended by representatives from committee had been almost completed by the WHO. Reports on suggested methods of col- end of the year, and plans for 1949 were under laboration with these non-governmental organiza- way. Through continuedactiveco-operation tions,which had been brought intoofficial with UNICEF and other organizations, combined relationship with WHO, were considered by the with implementation of the recommendations of Executive Board. the expert committee, the maternal and child At the invitation of UNICEF, WHO has health programme of WHO will be greatly worked out the 1949 curriculum for a study- expanded during 1949.

Nutrition

The importance of nutrition as an environ- hoped that the post would be filled before the mental factor in health was not overlooked by third session of the Executive Board. At the the first Health Assembly. The Assembly empha- invitation of FAO, WHO nominated Lord Horder, , sized, however, that the success of any nutrition Professor F. Verzár and Dr. F. Boudreau to the programme undertaken would be dependent upon Standing Advisory Committee on Nutrition, as the closest collaboration with FAO. members from WHO," and the last two attended Earlier, 'recognizing the desirability of making a meeting of this committee in Washington, on available an adequate amount of nutritious food 29 November, when a basis for co-operation to all peoples in the world, the Interim Com- between the two organizations was worked out. mission had recommended the setting-up of a It was felt that the work accomplished at this joint FAO/WHO advisory committee on nutrition. meeting constituted a firststep toward the Consultations between the two organizations took development of a joint expert committee on place as to practical means of initiating collabora- nutrition. tion in various undertakings designed to increase On II June 1948, a circular letter had been world food-production." issued to different countries, requesting informa- ThefirstHealth Assembly endorsedthis tion on laws and regulations pertaining to sales collaboration.After considering the programme and import of skimmed milk and on various other proposed by the Interim Commission, it recom- questions relating to that subject. Approximately mended establishing with FAO a joint expert thirty answers were received. At the end of the committee on nutrition ;it referred the nomina- year,, these replies were being compiled and tion of a panel of correspondents to the Executive analysed, and a provisional summary was being Board, and agreed that WHO should set up a prepared. nutrition section within its Secretariat.23 At the end of 1948, plans were under way During 1948, it was not possible to find a forsetting up thenutrition section inthe suitable candidate for the Secretariat, but it was Secretariat.

Environmental Sanitation

Another subject which the first Health Assem- with other bodies, active in housing and town bly particularly emphasized for work in 1948-49 and country planning, and agreed that the was environmental sanitation, including (a) urban Organization should be represented at the con- and rural sanitation and hygiene,(b) housing ference on the conservation and utilization of and town and country planning, and. (c) natural resources, being organized by the United Nations. resources." Although a special section in the Secretariat The Assembly recognized the joint responsi- was not set up in 1948, and no expert committee bility of WHO, UNESCO and FAO in the amelio- on sanitation has yet been appointed, WHO has ration of rural and tropical areas, and the possible done extensive field-work in environmental sani- desirability of setting up a joint committee on tation.Campaigns with insecticides against mala- the subject with FAO. ria have been highly successful(see page 9), It recommended that WHO should co-operate demonstration projects in other forms of sanita-

22 011 Rec. World Hlth Org. 9, 62 24 011. Rec World Hlth Org. 14, 20 " Ibid. 13, 308 " Ibid. 13, 308 - 16 - SPECIFIC ACTIVITIES tion have been begun, and long-term control on participation in the United Nations programme programmes established. on housing and town and country planning.It In Ethiopia, WHO has both a sanitary engineer also approved the establishment of relations with and a sanitary inspector.Effective use has been appropriateinternationalregionalauthorities, made of insecticides(especially DDT). They and with the Committee on Hygiene of Housing have been used for delousing, for residual spray- ofthe American Public Health Association. ing, to some extent in water courses, and, on a Action has been taken to implement these deci- limited scale, they have been sprayed in fly- sions : WHO is to take part in a technical working breeding areas-especially in the latrines and party on housing being organized by the United city dumps. Various projects, such as converting Nations and to collaborate on the health aspects an uninhabitable area into a city square, have of its work." been undertaken in that country. With regard to natural resources, the Board The DDT campaign against malaria in Greece authorized the Director-General to meet from has also included fly-control, and has been success- WHO funds the expense of sending experts to ful against bedbugs, lice and fleas. A WHO the United NationsScientificConference on sanitary engineer is continuing sanitation projects Conservation and Utilization of Resources to be in that country. held in June 1949, at Lake Success." A pre- A third WHO sanitary engineer has been liminary study of this question, in so far as it stationed in China, where a long-term programme affects the work of WHO, has been begun. is under way. Recently, plans have been made Dr. A. Kündig was sent with the mission to for the improvement of city water-supplies and Haiti as representative for WHO, to study the city sewage-disposal systems. health problems of the Haiti project being under- In implementation of the decision to colla- taken by UNESCO and the United Nations.29 borate with FAO in urban and rural sanitation, Informationhasalsobeenfurnished and Dr. L. B. Williams, Jr., United States Public assistance offered to the Economic Commission Health Service, was appointed a member of for Latin America, and it is planned that WHO FAO's Standing Advisory Committee on Rural will be represented at the next session of this Welfare,torepresent WHO. Work onthis commission to be held in Havana in May 1949. subject will proceed in 1949. At the end of 1948, plans were being made to In the hygiene of housing, the Board adopted set up the section on environmental sanitation, a resolution authorizing the establishment of a and to continue the collaboration already begun small panel of expert correspondents to advise with other organizations.

Public- Health Administration

Until the convening of the first Health Assem- small joint committees on industrial hygiene and bly,activities had been limited to collecting on the hygiene of seafarers should be formed information,sendingouttogovernmentsa with ILO. questionnaire on general trends, and preparing a Owing to a very small staff, activities during programme to be submitted to the first Health 1948 were limited to work at headquarters, except Assembly.29 for the missions in Austria, China, Ethiopia, The Health Assembly attached the greatest Greece, Italy and Poland, which continued the importance to the study of public-health admi- programmes carried out by the Interim Com- nistration in the various countries and recom- mission.31 In answer to the questionnaire sent mended thatit should include, in addition : out at the beginning of 1948, descriptions of hospitalsandclinics,medicalcare,medical central health-administrations were received from rehabilitation,nursing,medicalsocialwork, 24 countries.This material was studied and, healtheducation(popular),industrial(occu- at the end of the year, was being prepared for pational) hygiene, and the hygiene of seafarers.3° publication, in mimeographed form, as the first Special reference was made to the desirability part of a report on the subject. of studying the importance of providing for full- Distribution of medical personnel in various time public-health officers in local health services. regions of the world was the object of another Attention was also called to the problem of re- study, and the information obtained served as habilitating soldiers and others injured as a result the basis for planning the 195o programme. of the war and to the shortage of nurses in many Following the decisions of the first Health countries. Assembly oncollaboration with the United The Assembly recommended thatin1949 29 op'. Rec. World Hlth Org. 9, 44 ; 10, ii 26 Off. Rec. World Hlth Org, 14, 20 3° Ibid. 13, 308 27 Ibid. 14, 22 31 Advisory services in Austria and Poland were 28 Ibid. 14, io discontinued before the end of 1948. - 17 - SPECIFIC ACTIVITIES

Nations Special Committee on Information trans- the actual training itself and world resources mitted under Article 73(e) of the Charter (from in medicine. Non-Self-Governing Territories), liaison was main- In considering educational activities, the first tained with the appropriate division of the United Health Assembly emphasizedtheneedfor Nations, and consultation took place regarding training medical practitioners and paediatricians information on health problems in these terri- and the importance of stimulating the production, tories. WHO was represented on the special use and exchange of films and other audio-visual committee and collaborated in working out a media in medicine, health and related sciences.32 procedure for obtaining more complete informa- The latter activity will be carried out jointly by tion.Similar liaison was established with the several of the specialized agencies. United Nations Division of Trusteeship, with a view to obtaining the truest possible picture of Since the Assembly, information has been health conditions in dependent territories. collected on needs and possibilities in the training WHO has also made available to governments of medical and public-health personnel through- and interested organizations information collected out the world, especially in underdeveloped areas, on different aspects of public-health administra- and a programme has been prepared for future tion-such as the number of medical personnel activities.Itwas found thatvariousother in public-health services, medical care in non- international agencies had undertaken investiga- self-governing territories,etc., and has taken tions on the same subject, and itis thought steps to answer the request for advice on matters imperative that these activities should be co- of hospital construction, the experience of the ordinated. At the request of several govern- International Hospital Federation being helpful ments, some of the information collected has been in this instance. placed at their disposal. With regard to the hygiene of seafarers, liaison WHO has collaborated with UNESCO on was maintained with ILO ;and WHO agreed medical and health aspects of international co- to collaborate with the League of Red Cross operation between universities ;this collabora- Societies in the revision of its publication on tion has been based on the programme adopted this subject (see also page 14). by the Preparatory Conference of Universities." An expert in public-health administration was Preliminary steps have also been taken to establish appointed to the staff, to take up his duties on liaison with UNESCO and ILO in the production January 1949. and exchange of educational films. It is planned that in 1949 an expert on health education of the public will be made available, Education and Training both for working out a programme for WHO Medical education and training of public-health and for giving advice to governments. personnel are justly considered highly essential The more extensive programmes which are to the improvement of public-health services. proposed will require much preparatory work in The Interim Commission of WHO, although 1949, such as surveys, the establishment of prevented by its terms of reference from carrying schemes for co-operation with various agencies, out a broad programme in this field, prepared the selection of areas and personnel for demonstra- studies on trends in medical education. These tions in public-health administration, and the included the teaching of public-health training, preparation of detailed programmes.

Mental Health

In order to fulfil one of the functions of WHO, to WHO which this congress might make, and, " to foster activities in the field of mental health, within the scope of the budget, to take such especially those affecting the harmony of human interim action for their implementation asit relations "," the first Health Assembly decided might find desirable and practicable." that for mental health (including alcoholism and The International Congress on Mental frealth drug addiction) a nuclear committee of experts was attended by the Director-General, who later should be established and that the staff for this made a report to the second session of the Execu- group should includeat least one expert in tive Board.The Board adopted, in principle, mental health. The Assembly, further, offered the recommendations addressed to WHO, and its good wishes for success to the International made some specific recommendations." Notably, Congress on Mental Health, which was held in itrequested the Director-General to prepare London in August1948.Itauthorizedthe documents on the subject of mental health for Executive Board to consider any recommendations " Constitution of WHO, Article 211i,Off. Rec. "Off. Rec. World Hlth Org. 13, 310 World Hlth Org. 2, IOI 38 Held in Utrecht, 2-13 August 1948, under the "Off. Rec. World Hlth Org. 13, 309 auspices of UNESCO. "Ibid. 14, zo - 18 - SPECIFIC ACTIVITIES submission to the third session of the Board, which had set up a special division to deal with which would then consider the type of recom- the question, an expert appointed by WHO mendation to make to the Assembly concerning collaborated in the preparation of a report, and the establishment of an expert committee and WHO was represented at a meeting of interested the carrying out of a mental-health programme. non-governmental organizations, called by the At the end of 1948, this documentation was United Nations in Paris on 15 October.Colla- being prepared, and an expert had been appointed boration with this division will be continued. to the staff to take up his duties on r January It is expected that WHO, perhaps through 1949, as chief of the section on mental health. the World Federation for Mental Health, will WHO also co-operated with the Department also be asked to co-operate in the preventive of Social Affairs of the United Nations, in its aspects of the work of the Second International study of the prevention of crime and treatment Congress of Criminologists, to be held in Paris in of offenders. At the request of this department, 195o. Other Subjects Penicillin (See also page 41.)This work will proceed in In 1944, the Permanent Commission on Bio- 1949. logical Standardization of the League of Nations The decision of UNICEF to allocate two million Health Organization established an international dollars for penicillin and supplies in campaigns penicillin standard consisting of crystalline peni- to combat syphilis in pregnant women and cillin G (II). children has been referred to in some detail on Attention was drawn by the Interim Com- page 13.In view of the rapid development in mission to the limited availability and unequal penicillin preparations of the repository type, distribution of penicillin.87In view of the large the Joint Committee on Health Policy, UNICEF/ quantities of the drug used to combat venereal WHO approved a recommendation by the Expert diseases and in view,also,of its therapeutic Committee on Venereal Diseases that WHO should importance in the control of other diseases, it advise on procurement of this drug, particularly was felt that WHO should take allpossible with regard to quality. On the basis of this measures to encourage penicillin production. advice, UNICEF has allocated a sum of $750,000 The programme for venereal diseases called for penicillin and other material to be sent to for a study of the amount of .penicillin required Bulgaria, Finland, Hungary, Poland and Yugo- and the supply available.This study is being slavia, for use in such campaigns. made ;and at the end of 1948 relevant informa- tion had been collected from more than 6o Dental Hygiene countries.88 A proposal for the study of dental hygiene A study was made, at the time of the Interim was referred by the first Health Assembly to the Commission, on the penicillin plants furnished Executive Board.41 The Board requested the by UNRRA to six European countries and to Director-General to collect information, in colla- one Far-Eastern country. The first Health As- boration with the International Dental Federation sembly recommended that WHO should negotiate where appropriate, to consult the Federation with the UNRRA authorities on the possibility with a view to formulating an international of taking over the completion of these plants, programmefortheimprovementofdental the funds to be provided by UNRRA." services, and to place the subject on the agenda By decision of the 1948 General Assembly of of the second Health Assembly." the United Nations, however, UNRRA's residual Correspondence and consultations with the funds were transferred in toto to the United International Dental Federation have been con- Nations, to be used by UNICEF ;and a proposal tinued. The President of the Federation has had by the WHO Expert Committee on Venereal the opportunity to discuss certain preliminary Diseases that UNICEF might provide the neces- aspects of the study with organizations in a sary funds for rehabilitating these factories was number of countries, including those of North considered by UNICEF to be outside the scope America. This has inevitably resulted in delay of its activities. in receipt of a report which could express the The Executive Board of WHO then reiterated opinion of the International Dental Federation the importance of having the UNRRA plants as a whole. surveyed by a team of experts, and recommended This report will be submitted for the considera- that the question of rehabilitating them should tion of the second Health Assembly. also be studied by the Economic Commissions of the United Nations." By the end of 1948, active co-operation with the Economic Commission for Physical Training Europe was being effected in studying the possible During the first Health Assembly, the impor- rehabilitation of one of the UNRRA plants. tance of physical training was brought forward by the Bulgarian delegation.It was decided 27 011. Rec. World HUh Org. 7, 255 that the Executive Board should study the means 38 Ibid. 15, zo " Ibid. 13, 310 41- Off. Rec. World HUh Org. 13, 31 10 Ibid. 14, 19 42 Ibid. 14, 21 - I - SPECIFIC ACTIVITIES whereby WHO could ensure the establishment early in 1948, and it was decided that action on of physical training on a reliable scientific basis, this problem should be a joint responsibility of and should consider placing this question on the UNESCO and WHO." The project consists of agenda of the second Health Assembly." Infor- bringing togetherallrecognized international mation on the subject was obtained from the bodies which organize congresses on medical International Bureau ofEducation and the sciences, in order to co-ordinate congresses as to Fédération internationale médico-sportive. date, place and possibly subject, to give them The Executive Board agreed that the collection technical assistance, and to provide for a per- ofscientific information on physical training manent link between them in periods when no should be continued, with a view to possible congresses take place. With this aim, an orga- integration of this subject into the programme nization-the Permanent Council for the Co- of the Organization for 1950." ordination of International Congresses of Medical According to information received, a British Sciences-is to be established, composed of all Commonwealth and Empire council for the corre- recognized non-governmental organizations inte- lation of medical science and physical education is rested. The organizing committee, set up jointly contemplated, with the aim of helping " in the by the Interim Commission of WHO and by attaining of a better standard of fitness among UNESCO, elected a small executive committee to the people of the British Commonwealth and do the necessary preparatory work forthe Empire, in relation to their educational, nutri- establishment of this council. tional,social,industrial,medical and other The Health Assembly approved the project, requirements ". WHO should maintainclose decided that WHO should take stillgreater relations with such a council, when established. responsibility for it and requested the Director- In 1949, itis planned to correlate medical General to open negotiations with UNESCO sciencesand physicaltraining,toestablish accordingly." standards, and to continue with the collection of Accordingly, negotiations with UNESCO took scientific information. place.In the first half of 1949, when the per- manent council has been established as a non- High Altitude Research Stations governmental body, WHO will be in a position WHO, inits interim stage, was asked by to arrange for collaboration with and sponsorship UNESCO to provide the services of an expert of the council to the extent mutually desired. on the biological aspects of human life at high Progress was achieved with regard to co- altitudes and to take part in a Conference on ordination of congresses itself : both WHO and High Altitude Research Stations, held at Inter- UNESCO made an inquiry into the possible laken from 31 August to 3 September 1948." membership of the future council, and over 50 In view of the fact that conditions at high alti- organizations were invited by the organizing tudes affect many millions of people living in committee to take part in the conference for the various parts of the world, and are of considerable establishment of the permanent council. The importance for human biology and pathology, executive committee met in October and decided the Executive Board decided to request the to convene this conference in Brussels from Director-General to send an appropriate expert 4-9 April 1949.It accepted the list of organiza- to this Conference." tions eligible for membership in the council and On the recommendation of this expert, the the statutes prepared, and, at the request of Board subsequently decided that liaison with WHO, gave its opinion on a proposal made by UNESCO on the question should be continued, the Yugoslav delegation to the World Health and empowered the Director-General to use for Assembly requesting the publication of papers this study the balance of a sum allocated by the presented to the congresses.5° first Assembly for participation in the Interlaken Following a recommendation made by the Conference.47 Interim Commission of WHO, the statement on The International Council of Scientific Unions the character of the council was redrafted so as has set up a Commission on High Altitude to stress its non-governmental structure. Research Stations, which will probably meet in The Executive Board agreed to sponsor the 1949, and, UNESCO will assist in planning a Brussels Conference, approved in principle the conti- 1949 Symposium on High Altitude Biology. nuation of the activity, and requested the Director- WHO has been asked to participate in these General to study the question of the future two activities. arrangement between WHO and the permanent council." Co-ordination of Medical Congresses This arrangement is being studied and relations A provisional agreement with UNESCO on with various congresses are being maintained co-ordination of medical congresses was reached with a view to encouraging co-operation in the international aspects of health. 4. off. Rec. World Hlth Org. 13, 310 " Ibid. 14, 21 45 011. Rec. World Hlth Org. 129 54 " Ibid. 129 54 " Ibid. 13, 323 46 Ibid. 14, so 5° Ibid. 13, 238 " Ibid. 14, 22 51 Ibid. 14, 22

- 20 - CHAPTER 2

GENERAL OPERATIONS

In continuing the UNRRA health programme powered to re-allocate any substantial balances of direct assistance to 15 governments, the Interim for which proposals from the countries concerned Commission provided services which, since i Sep- had not been received by 15 December 1948.52 tember 1948, have been continued, with some The Board also authorized the Director-General modifications, by WHO. This assistance has to use the amount of $70,000 (which had not included the provision of expert advisers, that of been specifically allocated to programmes) for postgraduate education abroad, and of medical the expansion in 1949 of field services in malaria, literature and teaching equipment. tuberculosis,venerealdiseases,maternal and In October, the $ioo,000 remaining in the 1948 child health, and public-health administration, Field Services Budget was allocated by the to be allocated in accordance with principles laid Executive Board for fellowships and medical down.53 By the end of 1948, these allocations literature ;and the Director-General was em- had provisionally been made.

Activities in the Field

During the last quarter of the year,field than in the past, to conform with the principles activities were somewhat altered in the light of laid down by the Executive Board." WHO's the changes in policy which would be necessary policy during the last quarter of 1948, therefore, in 1949. The situation had changed :at the aimed at achieving a smooth transition to the end of 1948, the $3,000,000 assigned to WHO new conditions of 1949, as outlined above. by UNRRA for 1947/48 had been expended or The following notes show, by country, the committed ;requestsforassistancein1949 assistance in the field which was provided by had been received from many Members not WHO between September and December 1948. previously included in the programme ;policies had been laid down by the first Health Assembly restricting major activities to malaria, tuber- Albania culosis, venereal diseases, maternal and child health, nutrition and environmental sanitation ; $12,000 was allocatedforfellowships and regionalorganizations were beginningto be literature to Albania, but at the end of 1948 established ;many WHO health programmes detailed proposals from that country had not had to be co-ordinated with those of UNICEF ; yet been received. and there were budgetary limitations. One practical result of the influence of these Austria factors was that since there was less " butter " and more " bread " on which it had to be spread, The WHO liaison officer and adviser in public WHO would no longer find it possible to assign health had to be withdrawn early in December groups of experts as semi-permanent " missions " for another assignment, although the Austrian to particular countries ;emphasis would have Government had requested continued assistance. to be placed rather on the temporary assignment An expert was provided to lecture on industrial of one or two experts or teams, who, in principle, hygiene in November, and a specialist in venereal would leave a country when their particular diseases was to visit the country in January task had been completed or sufficient local staff 1949, under the 1948 programme. Six fellow- had been trained by them to continue. ships were awarded after i September, bringing the total awards to zo ;and procurement of Another result would be a much closer linkage of expert teams and fellowship programmes with the subjects on which the chief emphasis had 52 Ofl. Rec. World Hlth Org. 14, 77 been placed.Moreover, requests from govern- 53 Ibid. 14, 1 7 ments would have to be more critically examined 54 Ibid 14, 17 21 - GENERAL OPERATIONS medical literature was continued for the pro- year school for medical assistants, and completed vincial directors of health, the libraries of the plans for a three-year course for nurses.

,Ministry of Social Welfare, and the medical Reports of the visiting experts on venereal schools of the universities. diseases and tuberculosis have been transmitted to the government ;and at the end of 1948, Byelorussia arrangements were being completed for granting two undergraduate fellowships and two fellowships Byelorussia had sent in, of all countries, the to foreign graduated government employees. most extensive requests for medical literature. An additional allocation of funds by the Executive Board permitted procurement of a further part Finland of the literature requested. A number of the professors forming the joint WHO/Unitarian Service Committee mission which China had previously visited Poland went on to Finland in September to lecture and to demonstrate. The Chinese programme, the largest of those No new fellowship awards have been made. directed by WHO, was continued by an imported staff of ten, including five medical officers, two nurses and one sanitary engineer.Activities Greece included the control of plague and tuberculosis, The number of WHO expert advisers in Greece the production of sera and vaccines, the teaching was still further reduced ;at the end of the of obstetrics, water and sewage disposal pro- year, they consisted of one general public-health jects, public-health nursing and nursing educa- adviser, one public-health and tuberculosis nurse tion, including the production of manuals. and one sanitary engineer working on malaria. Two of the staff were temporarily withdrawn Besides general consultative and liaison work, to Shanghai from Peiping and Nanking respec- the chief activities were concerned with the tively ; one is at Lanchow, one at Canton and malaria- and tuberculosis-control programmes, one in North China, assigned to UNICEF. The which, considering the disturbed political condi- nurse in Lanchow has visited Kiuchuan, near the tions, were continued with fair success. One Turkestan border. fellowship was awarded, bringing the total number The civil war had not yet seriously limited the to seven. activitiesof WHO officials,and information indicated that they were prepared to carry on irrespective of developments.More requests for Haiti medical literature were dealt with and 13 fellow- ships awarded during September, October and A WHO specialist in public health and tropical November, making a total of 136. diseases was included in the team sent to Haiti for the preliminary survey of the basic education project conducted by UNESCO. Czechoslovakia Five more fellowships were awarded during Hungary this three-month period, making a total of 61. Eight awards were made in the last quarter of 1948, the total number of fellowships awarded Ethiopia reaching 27. The long-term plan for training local health personnel was continued.The mission has con- India and Ceylon sisted of a public-health officer, two nurses, a sanitary engineer, a sanitary inspector and a In the South-East Asia region, a tuberculosis secretary.These officers have recently extended expert and a bacteriologist were provided to training programmes fordresserstovarious assist the governments of India and Ceylon with institutions, and there are at present a total of their BCG vaccination programmes and the 13 primary and secondary courses leading to production of BCG. state certificates which have been initiated since the beginning of the Ethiopian programme. A third advanced course for sanitary inspectors Italy was completed, and associated activities carried A WHO liaison office in Rome, consisting of on in the drafting of sanitary regulations and in two medical officers, was maintained, with the the establishment of a sanitary demonstration primary object of assisting in furthering the area in Addis Ababa.WHO also started a healthprojectsofthe UNRRA Lira Fund. preparatory course for admission to the three- These include long-term programmes in subjects - 22 - GENERAL OPERATIONS such as tuberculosis malaria, trachoma and port Medical literature and teaching material, notably sanitation. film projectors and microscopes, were also pro- During the last four months of 1948, preliminary cured. arrangements were made for WHO co-operation in the radical survey of public-health organization both central and local, being undertaken by the Turkey Rockefeller Foundation.Efforts will be concen- At the request of the Turkish Government, rtated on this survey. two visits were made to Turkey by the WHO Progress was made in meeting the requests for adviser in Greece, to advise and report on public- medicalliterature ;elevenfellowshipswere health activities and institutions in the chief awarded, bringing the total to 23 ;and visiting centres of that country. experts gave a series of conferences on education of the public in health and the new health ser- vices in the United Kingdom. Ukraine The request from the Ukraine for medical Korea, Northern literature was met, although by the end of 1948 detailed proposals for the balance of the allocation At the end of the year, a request for medical had not yet been received. literature and teaching equipment, received from the Red Cross of Nothern Korea and endorsed by the government, was being considered. Yugoslavia Four fellowships were awarded during the Korea, Southern period under review, bringing the total number of awards to 70 ;requests for medical literature Two fellowships were awarded, bringing the were met as far as the allocation permitted. total number to five by December 1948. Further details on the malaria, tuberculosis and venereal-disease programmes, including joint acti- Philippines vities with UNICEF, will be found on pages 9, II, 13. A joint WHO/Unitarian Service Committee mission was provided to thePhilippinesin Because the end of 1948 closes, in some sense, November, to give a series of lectures and demon- a chapter in the story of the field activities of strations.Specialistsin venereal diseases and WHO, attention should be drawn to the value tuberculosis from Costa Rica and Argentina, of the work of the experts in the field, who have respectively, who were selected by the Pan served the Interim Commission and WHO so American Sanitary Bureau on behalf of WHO, well during 1947 and 1948. Although these were included in this mission, along with teachers experts were few in number (just over 30 at the of internal medicine and neurology from the beginning of 1947, and under20at the end of UnitedStatesofAmerica. The number of 1948), the influence which they have exerted has fellowship awards totalled three. been outofallpropoition.This was due, partially, to the fact that their services were freely requested by governments themselves. Poland It was also due to the ability of these experts, The WHO medical officer and the secretary to their disinterestedness and devotion to duty, of the liaison office which had been maintained and to the help which they were able to give in in Poland since mid-1947 were withdrawn on the struggle, in which all health authorities must 15 October. be involved, to convince governments of the In July, a most successful WHO/Unitarian importance of health programmes.Finally, the joint lecture and demonstration tour was held, fact that the experts represented a worldwide with eight experts from the United States of organization, linked to the United Nations and America (on internal medicine, surgery, neurology, its other specialized agencies and able to draw orthopaedics, psychiatry, paediatrics and anaes- on specialized knowledge for the solution of all thesiology) and nine from other countries, includ- types of health problems, has undoubtedly made ing one from Czechoslovakia (on internal medicine) theirassistancetogovernments even more and three teams from Sweden, Switzerland and effective.That their services have been appre- the United Kingdom (on thoracic surgery). ciated is shown by the extent to which govern- WHO awarded 15 fellowships to Poland during ments have contributed to their local expenses. the last part of the year, the total number of In many cases, their assessment of the health awards reaching 86, and assigned to that country conditions, problems and possibilities in a given a consultant radiological technician to assist in area has led governments to turn to WHO or the tuberculosis-control project initiated by WHO. elsewhere for other forms of technical aid and - 23 - GENERAL OPERATIONS thus, through making use of international assis- medical relief and rehabilitation and the longer- tance, to raise levels of health. term objectives of WHO, as defined in its Consti- Whilst their work cannot be assessed quanti- tution.It was for that purpose that UNRRA tatively in terms of lives saved or diseases pre- placed three million dollars of its residual funds vented, it is clear that it helped to bridge the at the disposal of WHO. gap between the short-term aims of UNRRA in

Fellowships

A time-lag in the application of new knowledge Finland, Hungary, Luxemburg, the Netherlands in the diagnosis, treatment and prevention of and the USSR. disease must always exist, both within a country, A few of the practices followed in the WHO and, still more, between countries. fellowship programme may be mentioned : The free and rapid diffusion of medical litera- ture will not entirely meet the problem, since (r)Priorityisgiventopersonsholding there are kinds of knowledge and certain skills administrative or teaching positions in the which cannot be acquired solely by scanning main fields of WHO activities. the printed page. Moreover, personal contacts (2) Fellowships are limited to graduates, with are lacking. On an international level, therefore, preferencetoseniorgraduates,exceptin this need has long been met by the provision of countriesnotpossessingsuitablegraduate fellowships, exchanges and study-tours for stu- candidates. dents unable to travel to other countries on their own resources. (3)Governments are requested to set up During the second World War, the time-lag national selection committees representing all was greatly increased, when the complete isolation interestsconcerned,which,aftersuitable of many countries, damage done to institutions publicity, select candidates for nomination by and libraries, loss of life of professional personnel, the governments. and the impossibility of undertaking research in (4) WHO decides provisionally whether the devastatedcountriesallcontributedtothe award should be made and arranges for " place- disruption of the exchange of medical knowledge. ment ", with the generous co-operation of the For that reason, UNRRA, in the last stages of national health-administrations, official agencies the war and immediately afterwards, regarded it and teaching institutions of the countries to as one of its important functions, in addition to which the candidates have elected to go. offering material help, to train health specialists in devastated countries by arranging for them to (5) The awards are made by the Director- be sent abroad as Fellows. General, after placement, in the form of (a) The Interim Commission of WHO, in taking " resident " fellowships for persons who are over many of UNRRA's health activities, con- going to study without much travel from place siderably expanded itsfellowship programme, to place, or (b) " travel " fellowships, or (c) which has been continued by WHO. both combined. Since the inception of the programme in the (6) The Fellows, at the time when they are spring of1947,twelve of the fifteen countries formerly aided by UNRRA have applied for studying abroad, are kept in contact with the Organizationthrough conferenceswithits fellowships. The total of awards has reached representatives and by monthly reports, and at 461fellowships, with an average duration of six the end of their studies, they summarize their months. The requirements of different countries activities and suggestions in final reports. have varied according to their needs :some countries are interested almost exclusively in the (7) Every six months thereafter for two years, training of public-health staff ;in others, the the Fellows report to the Organization, govern- improvement of medical teaching, both in clinical ments being under an obligation to see that they and in basic sciences, is most urgent. are afterwards employed in fields in which their Between i September and r December1948, fellowship experiences will be of value and to 65awards were made for417months of fellowship report to WHO on this point. studies.Most of the Fellows applied for study in the USA, the United Kingdom, Switzerland, Figures showing the number of fellowships, the Sweden, France and Denmark. Others were countries assisted and the duration of fellowships placed in Belgium, Canada, Czechoslovakia, Eire, are given in table I.

- 24 - GENERAL OPERATIONS

TABLE I. FELLOWSHIPS AWARDED UP TO 1 DECEMBER 1948

September-r December 1948Cumulative total on i December 1948

Country of origin of Fellows Average Average Fellowships Fellowship duration Fellowships Fellowship duration awarded months of fellowship awarded months of fellowship (in months) (in months)

Europe Austria 6 31 5.2 20 105 5.25 Czechoslovakia 5 27 5.4 61 306 5.0 Finland -- 23 128 5.6 Greece 1 6 6 7 46.5 6.6 Hungary 8 28.5 3.6 27 113.5 4.2 Italy 11 63 5.7 23 114.5 5.0 Poland 15 72 4.8 86 304.5 3.5 Yugoslavia 4 36 9 70 496.5 7.1 TOTAL 50 263.5 5.3 317 1,614.5 5.1 Asia China 13 144 11.1 136 1,271 9.3 Philippines - - 3 15 5 Southern Korea 2 10 5 5 35 7 TOTAL 15 154 10.3 144 1,321 9.2

GRAND TOTALfor all countries . 65 417.5 6.4 461 2,935.5 6.4

During 1948, WHO fellowshipsoriginating given to countries not included in the present inthe Far East were administered by the fellowship scheme. New York office, which was also responsible for The fellowship programme has proved to be a European Fellows studying in the United States. welcome form of service to governments, and, if Programmes for European Fellows and also for one may judge by the interest of Member States small groups from the Far East studying in so far not included in it (owing to its restriction Europe have been administered by the Geneva in 1947/48 to war-devastated countries),this office. activity, started originally as a post-war emer- WHO has also arranged for a number of fellow- gency service, may develop into a permanent ships of the United Yugoslav Relief Fund of programme, supplemented by the exchange of America, and has made preparations for admi- health personnel and by courses arranged so that nistering about 6o individual fellowshipsfor groups can attend special health demonstrations UNICEF, mostly for Fellows from the South- inaugurated by WHO. East Asia area.Advice on fellowships was also

Medical Literature and Teaching Material

It is a proud tradition of the medical profession themost extensive programmes were those that advances in knowledge have always been carried out for Byelorussia, China, the Ukraine made freely available by the publication and and Yugoslavia. To the Ukraine, for instance, dissemination of periodicals and books.Until 5,500books were supplied, and for Byelorussia, the outbreak of the second World War, there were overL000subscriptions to periodicals. no serious obstacles to any government, medical As early as August 1947, the definition of school, library or individual keeping abreast of medical literature was broadened by the Interim recent advances in medical knowledge in other Commission to include special teaching apparatus countries. The war, however, created impassable not obtainable within a country." Under this barriersto the general exchange of medical definition such material as film projectors and literature ;and it was natural that the provision films,microscopes,microfilmreaders,special of such literature by the Interim Commission drugs, reagents and other apparatus necessary was welcomed, particularly by war-devastated for teaching were supplied on request to Austria, countries. China, Ethiopia, Italy, Poland and Yugoslavia. In 1947 and 1948, literature was ordered for With the aid of national and international 13 countries amounting to some10,500books institutes, the Rockefeller Foundation in par- and 2,500 subscriptionstoperiodicals,not including the orders for China, etc., which have been directed by the New York office. Among " 09. Rec. World Hlth Org. 6, 78 - 25 GENERAL OPERATIONS ticular, many deficiencies have been made up ; the gap from being completely filled.The pro- but the resiriction of this programme in 1947 vision of medical literaturewill therefore be and 1948 to UNRRA-aided countries and the continued in 1949 with the $150,000 voted by continuing currency difficulties have prevented the Assembly for this project."

Bureau of Medical Supplies

Following the decision of the firstHealth tion and distribution of Chemical and biological Assembly," implemented by the Executive Board, products and the standardization of medical a bureau of medical supplies was established in equipment, and will act as a procurement agent the headquarters office at Geneva, to give advisory in case of emergency. services to governments on the procurement of At the end of 1948, a medical supplies officer such supplies, including insulin, medical literature had been appointed, to take up his duties as and teaching equipment.58 This office will also head of this office as from I January 1949. take any necessary action regulating the produc-

Assistance to Palestine Refugees

In compliance with a request from the United field services-the International Red Cross Com- Nations, WHO sent an expert to the Middle mittee, the League of Red Cross Societies, and East in October to undertake a general inspection the American Friends Service Committee-WHO of the health situation among refugees. The assigned one of its experts, Dr. J. D. Cottrell, report was made available to the United Nations. to advise the director and the field staffs on health Later, in November, when it seemed possible aspects of Palestine refugee relief, and to co- that the United Nations might ask WHO for ordinate plans for epidemic control and sanitary further technical assistance, the Executive Board matters.His appointment, to begin on 8 January authorized the Director-General, within certain 1949, will last for a period not exceeding six limitations, to take necessary emergency measures months. to deal with any events which might require Further, on the request of the American Friends immediate action, and asked him to study the Service Committee, Dr. J. Peterson was appointed long-term implications of the situation." by WHO to work as chief medical officer of its Following a request in December, from the field staff. A medical assistant to Dr. Cottrell Director of the United Nations Relief for Palestine was recruited locally and a sanitary engineer Refugees and agreements with the three non- assigned to assist in the antimalaria programme. governméntal organizations responsible for the

58 oil. Rec. World Hlth Org. 13, 320 58 011. Rec. World Hlth Org. 14, IS 57 Ibid. 13, 31 o 58 Ibid. 14, r8

- 26 - CHAPTER 3

TECHNICAL SERVICES

Epidemiology

In discharge of certain of the statutory obliga- Answers to many of the problems involved in tions which have been assumed, WHO provides ihe preparation of modern international sanitary a number of epidemiological services essential regulations require further research. The experts to the proper functioning of governmental depart- proposed to undertake much of this research in ments of health. Such services form part of a their respective institutes. Some other problems group of activities which play a necessary role in will require the attention of experts in biological the development of many of the projects of the standardization and in insecticides, while epide- Organization. miological and statistical studies will be dealt During the latter part of1948,work in this with by the WHO Secretariat. field included the interpretation and application The reports submitted by the experts contain of the present international sanitary conventions ; the following points of special interest. the continuation and development of the existing epidemiological and notification system ;the revision of the conventions to be drawn up in the Cholera form of WHO regulations ;and technical research and consultation in the field of communicable The Study-Group on Cholera emphasized the diseases.In practice, these activities are closely limited extent of endemic cholera areas, as con- co-ordinated and interrelated. trasted with the danger of this disease developing into epidemic proportions.It consequently re- Expert Advice commended an exact delineation of endemic areas, field studies on factors governing endemi- The Interim Commission of WHO recommended city, and the organization of teams of cholera that, in revising the sanitary conventions, WHO specialists, which, in1950,should be sent to should devote itself first of all to the medical and endemic areas and, on the basis of the experience scientific aspects of certain pestilential diseases. gained in the field studies, should study and Some of the points to be covered by the new demonstrate methods of cholera eradication. regulations, such as the recognized incubation- period for certain diseases and the time necessary From the epidemiological point of view, sub- for effective immunity to be established after clinical cases and cases at the end of the incubation vaccination, are of a purely medical and technical period were found to be the most important nature ;others, like the disinsectization of aero- agents in the transmission of cholera ;conva- planes and the disinfestation of ships, require lescents did not play a significant part.Studies particular technological knowledge. Thus, it has were suggested in order to verify this point, been necessary to seek advice not only from especially in relation to thefact previously medical experts but also froin various other established that (in cholera) specialists. " ...duringconvalescenceanincreasing In view of the relation of some of the facts proportion of the vibrios excreted by the patient brought to light by these specialists to the work are in the process of " roughening " or are of WHO, and particularly to the WHO regulations entirelyrough. Transformation from the now in the process of preparation, the more smooth to the rough state corresponds to a important of them are outlined below. lossof pathogenicity of the organism. No With the collaboration of the Office Inter- reversion from the fully rough to the smooth national d'Hygiène Publique, in Paris, study- form has so far been observed." 62 groups have been set up to examine, from the standpoint of international quarantine, the latest findings on cholera, smallpox, plague and a series Finally, on the basis of research carried out on of other communicable diseases falling within infants and childrenin Egypt, the experts the scope of international control. A study of ascertained the precise degree and duration of recent work on these diseases was made for the the immunity conferred by cholera vaccination, use of the expert groups, which met first in and called attention to a vaccine now being Paris in April 1948,60 and again in October 1948.61 tested in the field in India and which, experi- mentally, had proved much more potent than the 60 For reports, see 09. Rec. World Hlth Org. 11, ordinary type. 12, 15, 18 61 The reports will be published in 09. Rec. World Hlth Org. 19 62 09. Rec. World Huth Org. H, 15 TECHNICAL SERVICES

Smallpox pulmonary plague cases), and suggested continued To aid in interpreting international vaccination research. certificates and determining the measures to be taken with regard to their bearers, the Study- Typhus and other rickettsioses Group on Smallpox put forward exact definitions of the various types of reaction following smallpox The most effective measure for the control of vaccination and revaccination.It recommended typhus, in endemic areas and at frontiers, is the for general use in vaccination the technique application of insecticides with residual action, known as " Leake's multiple-pressure method " such as DDT. This fact was noted by the Study- (1927). Group on Plague, which also dealt with typhus The study-group recognized the existence of and other rickettsioses.Although the use of abnormal and attenuated forms of smallpox killed vaccines has afforded effective temporary (varioloid-alastrim), but felt that they should be protection to persons exposed to infection and subject to the same international prophylactic live vaccines have been used effectively in pro- measures as classical smallpox.It was pointed tecting millions of individuals in endemic areas, out that the degree of contagiousness was the the group was of the opinion that vaccination same for malignant and for mild cases and that had no place as a quarantine measure at frontiers. ambulatory cases were particularly dangerous in The group also took note of the therapeutic spreading the infection. The study-group con- efficacyof alpha-para-aminobenzoicacidand sidered that possible morphological differences chloromycetine in various rickettsioses, including between the variola major and the alastrim type classical typhus, and drew attention to the spread of smallpox virus should be investigated. of Queensland fever and the roles played by Finally, in order to ascertain whether primary livestock and milk in the transmission of this vaccination of newborn children was completely disease. effective,it was suggested that a comparative study should be made of results obtained by Other diseases systematic annual revaccination of children vac- cinated under the age of three months, and of The same study-group considered the possi- those vaccinated between the ages of three and bility that, besides covering the usual five pesti- twelve months, and that the titration of anti- lential diseases, the international sanitary regula- bodies contained in the serum should complement tions should be extended to louse-borne relapsing the data obtained from the reactions subsequent fever.After each world war, one limited endemic to revaccination. focus in the interior of Tripolitania was the origin of a pandemic of this disease, which in each case extended over the northern half of Africa, causing Plague several million cases of the disease and large By thorough application of an insecticide with numbers of deaths.Eradication measures taken residual action (such as DDT) and of a rodenticide within the endemic focus could have prevented (such as sodium fluoracetate (1080)), the eradica- these outbreaks. tion of plague from stricken cities and towns has International quarantine legislation was not become possible, and its elimination from endemic recommended for dengue fever, psittacosis, epi- regions, where the infection is not directly related demic influenza, cerebrospinal meningitis or for to wild-rodent plague in neighbouring areas, can poliomyelitis.While recognizing the importance therefore now be contemplated. The Study- of these diseases, and especially of the last three, Group on Plague concluded, however, that areas the group felt that in practice it was impossible where enzootic plague exists among wild rodents to detect carriers and prevent them from passing and their ectoparasites are so extensive, that the over national borders.Telegraphic notification of general application there of the known insecticides the epidemic foci of these diseases was considered and rodenticides is not practicable. When loca- advisable, however, and also rapid communica- lities had once been freed from plague, prophylaxis tion of information on their incidence. would consist of protecting human habitations and outbuildings from invasion by wild rodents capable of spreading the infection. Trachoma In seaports, on the other hand, and in air- A special study-group, examining the advisa- ports, even though surrounded by regions where bility of including in the sanitary regulations wild-rodent plague is prevalent, the combined measures for combating the spread of trachoma, use of modern insecticides and rodenticides was was of the opinion that ordinary travellers recommended for plague-eradication, and also as suffering from acute eye trouble should not be a basis for international prophylaxis. For tra- subjected to measures exceeding " surveillance ". vellers arriving from plague areas with baggage, In the case of countries to which they had im- the use of insecticides with residual action, such migrated, stricter requirements would be justified, as DDT (5% to 10%), was proposed as a pro- both in regard to eye examinations and to control- phylactic measure. measures. The study-group remarked on the therapeutic As the eradication of trachoma from its endemic efficacy of certain sulfonamideg and antibiotics, foci was the ultimate objective of any inter- such as streptomycin (which is effective even in national control of the disease, the group suggested 28 - TECHNICAL SERVICES that WHO should gather information on the that the provision of epidemiological information geographical distribution and the endemic areas by wireless telegraphy, which, for more than of trachoma. twenty years, had been thepractice of the The use of certain sulfonamides and antibiotics Epidemiological Intelligence Station in Singapore rapidly relieved acute clinical manifestations of for countries bordering on the Indian Ocean and trachoma and its associated infections, and thus the Western Pacific, should be extended, and considerably reduced the danger of transmission. that, as an experiment, apart from the conven- However, because of the divergencies in the tional notification system, daily messages relating results obtained with individual drugs, the group to pestilential diseases and quarantine measures recommended investigation of their dosage, mode should be sent from Geneva in Morse to all health of administration and relative efficacy during the administrations. By using multiple-address tele- various stages of the disease. grams, these administrations could immediately pass on the information to sanitary authorities It was further suggested that WHO set up in sea- and airports. an expert committee to co-ordinate research on trachoma. It was also emphasized that measures taken at frontiers should be the minimum compatible with the existing sanitary situation. The com- Yellow fever mittee denounced the trend toward stiffening The members of the Yellow-Fever Panel set requirements, which had manifested itself since up by the Interim Commission were consulted by 1944, and recommended that vaccination against correspondence on several occasions during 1948, plague and typhus be no longer required of and, at the end of the year, they were asked to travellers, even when arriving from infected areas. state their views on the period required for the It felt that each country should, as far as possible, development of effective immunity after inocula- develop its internal resistance to disease, rather tion against yellow fever. They were of the opinion than rely on measures at its frontiers. that the ten days stipulated in the Convention Sixteen million French francs had been placed of 1944 were adequate, but suggested that in at the disposal of WHO by the Office International order to create uniformity in the application of d'Hygiène Publique for field studies in epide- international sanitary legislation,it might be miology during 1949.In drawing up a plan for found expedient to adopt a twelve-day period. thesestudies,the committee suggested that precedence should be given to control-measures against cholera.It also recommended, in certain Expert Committee on International Epidemio- regions of Asia and Africa, demonstrations of logy and Quarantine plague-eradication methods, which had proved their value in South America. The Expert Committee on International Epide- miology and Quarantine was established in order As a basis for the future sanitary regulations to assume the functions of the Expert Committee and to facilitate their adoption at a later date, on Quarantine and the Expert Committee on the committee drew up a number of principles, International Epidemic Control, both created by which will be submitted to the Health Assembly the Interim Commission." It met for the first for approval.It also recommended that work time in Geneva from 15 to 20 November." On should be begun on schistosomiasis, rickettsioses the basis of technical advice furnished by the and on filariases, particularly onchocerciasis. study-groups it had as its main task the prepara- tion of the new international sanitary regulations, Implementation of Sanitary Conventions to replace the existing sanitary conventions. The responsibility, also, of interpreting these During 1948, WHO, both in Geneva and at the conventions had been delegated to the expert Singapore Epidemiological Intelligence Station, committee by the Executive Board," in order to continued to administer existing sanitary con- facilitate the rapid intervention of WHO in case ventions.In view of the complex character of of violations of the conventions. The expert these conventions, their administration has in- committee entrusted this task to its Section on volved a great variety of tasks. Quarantine. On numerous occasions, by the imposition of The committee pointed out thatsanitary unjustified measures, health administrations have regulations emanating from WHO would con- infringed conventions to which their governments tinue to be necessary as long as the ultimate were signatories, and in such cases, WHO has objective of international control-measures against intervened, either spontaneously or upon the epidemics-the eradication of pestilential diseases official request of a government. For example, -had not been attained. during the last three months of 1948, WHO has examined cases of undue requirement of plague, It emphasized the importance of the rapid typhus and yellow-fever vaccination certificates ; communication of information, and recommended the extension of quarantine measures to the produce of a whole country when only a single 63 011. Rec. World Hlth Org. 13, 303 district was infected ;the quarantining of tra- " The report will be published in 011. Rec. World vellers holding valid cholera vaccination certi- Hlth Org. 19 ficates ; and unsatisfactory sanitary conditions in 65 011. Rec. World Hlth Org. 14, 12 a quarantine station. - 29 - TECHNICAL SERVICES

Epidemiological Notification logical and Vital Statistics Report. In1948, studies were published on typhoid fever, smallpox, Another essential task devolving on WHO has malaria, population increase, infant mortality been the notificationofpestilentialdiseases. and definitions of stillbirth. For this, information has been received by letter or telegram from various countries, from the All epidemiological information is ultimately Singapore Epidemiological Intelligence Station, arranged and submitted for correction, verifica- the Sanitary Bureau in Alexandria, and the Pan tion and completion, to tbe sanitary and statistical American Sanitary Bureau in Washington, and authorities from which it originates, with a view telegrams have been sent to notify countries to its publication as a permanent reference work exposed. The information is then published in the for epidemiologists and statisticians.This will Weekly Epidemiological Record, which is distri- continue the series of annual statistics published buted by airmail to the various health authorities. by the League of Nations for the years 1923 to Information on sea- and airports in Eastern 1938. A volume covering the years 1939 to 1946, Africa, Asia and Australasia, which is received is being completed, to be followed by yearly by the Singapore Station, has also been included publications for 1947 and onwards. inradio-telegraphicbulletinsbroadcasteach week from Singapore,Labuan, Hong Kong, Activities pursuant to Sanitary Conventions Shanghai, Tokio, Karachi, Madras, Tananarive, and each day by the Batavia and Saigon stations. WHO has collected, prepared and, in some cases, These bulletins are corroborated later by the published data useful to administrations in charge Weekly Fasciculus published by the Singapore of sanitary surveillance at frontiers, and to air Epidemiological Intelligence Station. and maritime navigation companies, as well as to international travellers. Epidemiological Information Health administrations situated in endemic yellow-fever areas and neighbouring territories Information not only on pestilential diseases have recently been requested to supply informa- but on other communicable diseases and on tion on the presence, in one form or another, of subjects such as general and infant mortality- the yellow-fever virus, in order that a new delinea- rates has been collected by WHO, and, in the tion of the endemic area can be made.Periodic event of serious epidemics, this is presented in the reports have also been received on the A2des Weekly Epidemiological Record.Epidemiological aegypti index in ports and territories which are data appear regularly in tabular form in its free from yellow fever although situated within statistical supplement-the monthly Epidemio- the perimeter of the endemic yellow-fever region.

Health Statistics

The Executive Board of WHO, acting on a the conference showing the greatdifferences resolution passed by the first World Health in the definitions of stillbirth in use in the various Assembly," recommended the establishment of countries of the world.Practical examples were the Expert Committee on Health Statistics to given of the considerable degree of distortion and act as an advisory body to WHO. Its nucleus of inaccuracy introduced into several demographic three members was later raised to five." indexes by the statistical use of legal definitions At the end of 1948, some, but not all, of the which did not correspond to a biological criterion appointments to the committee had been made, of stillbirth.This is a question of great interest, and a first meeting was contemplated during the solution of which may be extremely useful 1949. from the international standpoint, and the WHO A sectiononhealthstatisticswasalso Expert Committee on HealthStatisticswill established within the Secretariat, in accordance probably investigate the matter thoroughly. WHO with a further decision of the Assembly. willcontinuetocollectinformation on the subject. Programme of Work Inconnexionwiththe BCG vaccination In the meantime, work has been wider way on camPaign in Europe, undertaken with UNICEF, several projects. Thus, at the International WHO initiated a survey of the statistical aspects Conference held in Paris for the Sixth Decennial of the results of this campaign. WHO, under the Revision of the International Lists of Diseases aegis and direction of the Expert Committee on and Causes of Death,68 a survey was presented to Health Statistics, will study the statistical aspects of the new programmes of medical research on 86 Off. Rec. World Hlth Org. 13, 304 BCG to be undertaken in the near future. 67 Ibid. 14, II, 23 At the end of 1948, statistical data on cancer 68 For report of this conference, see 0 World Hlth Org. 11, 23 werebeingcollected,assuggested by the - 30 - TECHNICAL SERVICES

Assembly, and studies on certain aspects of health and several countries announced forthcoming statistics presenting international interest, such action ; others notified acceptanceswithout as, for example : the comparative course of the reservation.In Canada, the United Kingdom mortality-rate by sex and age in different nations ; and the United States of America, the application statistics on the practice of compulsory notifica- of the regulations was required before the date tion of diseases from the point of view of public- on which they became effective (1 January 1950, health administration ; statistics on measles and according to Article19 of the Regulations). other diseases of childhood ; and statistics on the Besides these countries, Czechoslovakia stated its seasonal distribution of notifiable diseases. intention of bringing its health statistics into The Statistical Handbookv Series,formerly agreement with the rules laid down by the Health published by the Health Organization of the Assembly, beginningi January 1949. It was the League of Nations, was being revised so as to first country to ask WHO for assistance in working complete the series and bring it up to date. out its plans. WHO was also reviewing the official basic docu- The early action of the Czechoslovak authorities mentation available in health statistics, in order is of particular significance. Outside the countries to make it complete as soon as possible, and to which took the most active part in the develop- provide the essential foundation without which ment of the classification (Canada, the United adequate work of this kind cannot be carried on. Kingdom and the United States of America), Czechoslovakia was the first to attempt a co- Demographic Statistics ordinatedapplicationofinternationalhealth By the early part of January 1949, volume statistics. Czechoslovakia also found it necessary, of the Manual ofthe InternationalStatistical in view of the difference in language, to prepare Classification of Diseases, Injuries and Causes of a national manual to be used in conjunction with Death, in English, was to appear in print. Volume the international manual in either English or 2 containing an alphabetical index, was in the French, and, before deciding on the applicability press. The list was being translated into French of the regulations to local conditions, prepared and Spanish for publication before the end of a thorough study and evaluation of the needs 1949. of the differentadministrations,investigating The WHO Regulations No. 1,69 regarding ways and means of aligning the compilation of nomenclature with respect to diseases and causes vital and healthstatistics with international of death, were circulated to all Member States, standards.

Biological Standardization

In accordance with the decision of the first its October session, 1947, had recommended that World Health Assembly, the Executive Board the question of the standardization of cholera established an Expert Committee on Biological vaccine be referred to the Expert Committee on Standardization, to act as an advisory body to BiologicalStandardization.92 To meetthis WHO ; and authorized it to set up the necessary request, Dr. M. V. Veldee of the National Institute sub-committees.96 It is planned that the first of Health, Bethesda, Md., obtained a stock of meeting of the expert committee will be held in the 350 ampoules of dried vaccines of the Inaba spring of 1949. type and a similar number of the Ogawa type. In the meantime, routine distribution of biolo- These batches were sent to Copenhagen and gical standards has been carried on by the State distributed to various laboratories, in order that Serum Institute, Copenhagen, and the National their suitability to serve as reference preparations Institute for Medical Research, Hampstead, and might be assessed. Favourable reports were the work onbiologicalstandardizationhas received on the tests carried out. proceeded according to the plans framed in March In response to a request for a specific agglutina- 1948 at the second session of the Expert Com- ting serum, Dr. P. Bruce White, of the National mittee on Biological Standardization set up by the InstituteforMedicalResearch,Hampstead, Interim Commission.91 has been engaged in the preparation of cholera-0- Certain items of this work are reported in more antigen for diagnostic purposes. By the end of the detail below. year,considerableprogress had been made towards the completion of this reference prepara- Cholera Vaccine tion. The preparation of freeze-dried live Ogawa and In connexion with the cholera epidemic in Inaba strains to serve for diagnostic purposes Egypt, the Expert Committee on Quarantine, at is being undertaken at the Haffkine Institute, Bombay, and the preparation of mono-specific 69 Off. Rec. World Hltlt Org. 139 349 Inaba and Ogawa agglutinating sera is being 7° Ibid. 13, 307 ; 14, II, 23 carried out by the King Institute, Madras. n For report on second session, see Off. Rec. World Hltlz Org. 11, 8 72 011. Rec. World Milt Org. 8, 27 - 31 - TECHNICAL SERVICES

Streptococcus Antitoxin powers of the batch of PPD originally prepared Dr. A. A. Miles, of the National Institute for by Dr. Seibert. This material had been acquired Medical Research, Hampstead, was engaged in the in 1939 and it was destined, if found suitable, selection of samples of streptococcus antitoxins to become the international standard preparation. of high neutralizing and flocculatingpowers. During the war, this batch of PPD had been These samples will be examined in various labo- storedatthe NationalInstituteofHealth, ratories with regard to their suitability to serve Bethesda, Md.In view of the divergencies of as the international standard preparation. opinion expressed by the members of the com- mittee regarding the advantages of this material Blood Groups over the batch prepared in Copenhagen by a different technique,it was feltthat parallel Anti-A and anti-B blood-group agglutinating sera tests should be performed on the two preparations. have been prepared and at the end of the year It was therefore agreed to ship the preparation were in the process of being tested. Owing to the in the United States to Copenhagen for distribu- contamination of one of the pooled samples from tion and testing.This batch arrived in Copen- overseas,the anti-A standardisofentirely hagen and, at the end of the year, the tests were British origin. in progress in Denmark, France,India, the In accordance with the recommendations of the Netherlands,SwitzerlandandtheUnited expert committee, opinions were sought from Kingdom. Rh experts regarding the system of nomenclature which should be given preference, and reports were received from experts from the Netherlands, Sulfarsphenamine Switzerland and the United States of America. The second international standard of sulfars- The question of a dual nomenclature (Wiener phenarnine having been exhausted, a batch of and Fisher) advocated by American experts will this substance was acquired by the National have to be considered from an international Institute for Medical Research. Four laboratories standpoint in order that a standard procedure may will be requested to make comparative tests for be adopted. determination of toxicity and therapeutic effi- ciency in terms of the second international Digitalis standard. The third standard preparation of digitalis, consisting of three leaf-samples from Switzerland, Androsterone and Oestradiol the United Kingdom and the United States, was completed and distributed to the 17 laboratories Since the androsterone and oestradiol inter- which had agreed to collaborate in the final assay national standards are running low, the question against the second international standard. as to the necessity of replacing them was raised. From inquiries amongst various workers, it Fat-soluble Vitamins would appear that androsterone is now almost entirely a chemical standard for the purposes of It was suggested that the Sub-committee on calibrationof photometric instruments. The Fat-Soluble Vitamins should hold its meeting oestradiol monobenzoate, on the other hand, is immediately preceding that of the Expert Com- still a convenient biological standard for workers mittee on Biological Standardization in May engaged in hormone analysis of body fluids, in 1949.In this way, the expert committee may be which there is usually no question of obtaining a guided in itsdecisions regarding the possible crystalline preparation. As there is still a heavy establishment of new vitamin A and D3 standards. demand for the standard preparations, it was The substitution of a vitamin A acetate for the considered expedient to renew both standards. '9-caroteneinternationalstandardisunder consideration, but satisfactory information has Negotiations for the purchase of suitable quantities first to be obtained on the biological value of of these two substances are in progress. vitamin A acetate in terms of '9-carotene and on its stability and physical constants.As regards National Control Centres vitamin D, the present calciferol standard may be In agreement with the respective Military replaced by a vitamin D3 preparation in the light Governments, two national control centres for of the tests in progress. the storage and distribution of the international standard preparations have been designated in Purified Protein Derivative (PPD) the Western Zone of Germany. Similar agreement At the second session of the expert committee, was obtained for the re-establishment in Austria doubts were raised as to the excessive sensitizing of the two former national control centres.

Unification of Pharmacopoeias The ad hoc Expert Committee on the Unifica- mittee decided upon by the Assembly.74It met tionofPharmacopoeias,whichhadbeen forthethirdtimeinGeneva from15to established by the Interim Commission, was 23 October.75 retained as such by the Executive Board,73 pending the appointment of the permanent com- 74 Off. Rec. World Hlth Org. 13, 307 75 For report on third session, see Off. Rec. World 73 Off. Rec. World Hlth Org. 14, ii Hlth Org. 15, 39 - 32 - TECHNICAL SERVICES

Monographs Due notice was taken of a telegram from the Belgian Government intimating that it would The greater part of the se,ssion was devoted to prefer that the secretariat remain in Bru§sels, the consideration of 91 monographs on important where it had -been maintained in a provisional drugs, which had been prepared by the members manner since 1925, when its creation had been of the committee. Fifty-nine of theSe monographs decided on by the second International Conference were approved with amendments, the others on the Unification of the Formulae of Potent being either deferred or withdrawn from the Drugs. committee's programme. In a letter dated 13 November 1948, the Belgian It was agreed that, for the labelling of antitoxins, Government stated that it still held this view, the name of the manufacturer, the reference unless for practical reasons it appeared indis- number of the batch, and the proportion of the pensable to integrate the secretariat within that bacteriostatic agent added should be given. of WHO. Negotiations with the Belgian Govern- The committee decided not to include mono- ment on this subject are being continued. graphs for toxoids and vaccines until such time as international standards had been established for these substances. An exception was made for Other Aspects OldTuberculin,forwhich aninternational standard was available. A table of usual and maximal doses for drugs The drafting of certain monographs will require in common use was drawn up, to be submitted to consultation with the Expert Committees on representatives of the medical profession in various Biological Standardization, on Malaria and on countriesforadvice,and generalprinciples Habit-forming Drugs. concerning chromatographic analysis, botanical and chemical nomenclature, melting and boiling ranges, potent tinctures and ultra-violet absorp- International Secretariat tion were approved. The question of the establishment of a single By the end of the year, work on the unification international secretariat for pharmacopoeias, the of pharmacopoeias had progressed to a point study of which had been entrusted to the Exe- where the publication in 1949 of a first attempt cutive Secretary by the Interim Commission,76 ataninternationalpharmacopoeia appeared was considered by the committee. feasible.

Habit-forming Drugs

In view of the ruling of the Interim Commission Government of the United States requesting that at its fourth session that any decision arrived at metopon hydrochloride should beconsidered by the Expert Committee on Habit-forming a habit-forming drug to which the Convention of Drugs would have no legal basis as long as the 1931 could be applied. amendments annexed to the Protocol of II De- Further, the Permanent Central Opium Board cember 1946 had not come into force," such an and the Drug Supervisory Body have called to the expert committee could not usefully meet until attention of WHO the views of these two bodies the spring of 1948, when the necessaly ratifica- on the present use of heroin and the problems tions of this Protocol were obtained.78At that which it raises in medical practice. time, owing to the proximity of the first World A critical study has been made of the papers Health Assembly, the meeting of the expert so far published on the various synthetic drugs, committee was postponed untilithad been belonging to the group of Dolantin and Metha- definitely constituted under WHO." The members done, which are now on the market and which have all having been appointed in November 1948, a proved to be habit-forming drugs. meeting was called for 24 January 1949, in The above subjects will be considered by the Geneva. expert committee. Meanwhile a notification was received from the

Co-ordinationof Research

Influenza National Institute for Medical Research, Hamp- stead, London, under the direction of Dr. C. H. At the beginning of 1948, the World Influenza Andrewes. It was decided by the first World Centre was created as a joint enterprise of WHO Health Assembly that the grant to the centre, and the Medical Research Council of Great proposed by the Interim Commission, should be Britain.Its laboratories were located at the continued. 8° In August 1948, memoranda were then pre- 76 Ofl. Rec. World Hlth Org. 7, 2 53 pared, setting forth the objects of the centre and 77 Ibid. 6, 213 the plan for obtaining international collaboration 78 On 3 February 1948 79 011. 1Rec. World Hlth Org. 13, 309; 14, ix 89 00. Rec. World Hltli Org. 91 43 - 33 - TECHNICAL SERVICES on influenza research.They were circulated to Brucellosis countries all over the world, and many replies were received.At the end of the year, there Action for setting up a world centre for brucel- were prospects of collaboration from regional losis was referred by the first World Health laboratories or observers in 27 countries. Assembly to the Executive Board." The Board The State Serum Instituteat Copenhagen requested the Director-General to suggest an prepared and sent antigens and reference sera to institute specializing in the study of brucellosis the centre, for use in the haemagglutinin and as a world centre, which would co-ordinate the complement-fixation tests. Samples of these work of the regional centres, and disseminate were distributed to13 co-operating regional information to workers engaged in research.82 laboratories, which were invited to inform the At the end of 1948, this question was being centre of needs for further supplies. investigated. Dr. C. M. Chu was appointed to work in the As the disease affects not only man but the centre and is now in a position to teach influenza production of food, WHO has approached FAO techniques to small numbers of visiting workers with a view to collaboration in the study of who intend to collaborate in regional laborato- aspects of mutual interest.Accordingly FAO ries elsewhere. decided to place both the subject of brucellosis A modified complement-fixation technique has and the WHO proposal to set up a world centre been used, in an endeavour to clarify the sero- on the agenda of a conference on animal disease, logical relationships amongst influenza strains to be held in Poland. from various sources. Evidence has already been obtained that A strains from outbreaks in the Netherlands, Sweden, the United Kingdom and Salmonella Centre the United States of America in 1947 and from Australiain1946areantigenicallyclosely Following the recommendations of the Expert related and different from at least the majority Committee on Biological Standardization, the of strains isolated in previous years. first World Health Assembly decided to maintain A collection of influenza strains preserved in the International Salmonella Centre, established the dried state is being made at the centre for at the State Serum Institute, Copenhagen." purposes of further study and for distribution This centre, to which an annual subsidy of $20,000 to other interested laboratories. was later allocated, began operations on I January The influenza epidemic which began in Europe 1949.Steps were taken to re-establish relations at the end of 1948 was the subject of special with the 12 national Salmonella centresstill study by the centre, the results of which will be functioning in ten countries, as well as to select available later. appropriate laboratories elsewhere.

Editorial and Reference Services

With the establishmentofthe permanent On 15 October 1948, WHO was represented at organization, several pre-existing elements were the meeting of the Executive Committee of the merged into a single Division of Editorial and Interim Co-ordinating Committee, which recom- Reference Services, in which were centralized mended that, to avoid unnecessary duplication, arrangements for editing, translation, and other WHO should refer any project for the abstracting documentaryservices,includingthelibrary. of medical literature to the Interim Co-ordinating During 1948, much time was necessarily spent on Committee before taking action. The Executive the organization and staffing of this division. Board resolved that full consideration should be given to this recommendation." Much time was devoted to the production of the Editorial Services Official Records of the World Health Organization, The first World Health Assembly recommended and by the end of the year work had been com- that WHO should continue co-operation with pleted on four numbers in separate English and UNESCO in the Interim Co-ordinating Com- French editions, all of which had either appeared mittee on Medical and Biological Abstracting in printed form or were in the final stages of and that a budgetary allocation should be made publication. for participation inthis work during 1949.84 These volumes, amounting to some 1,200 printed pages in both languages, comprised : 81 Off. Rec. World HUT; Org. 13, 310 82 Ibid. 14, 22 84 Off. Rec. World Hltls Org. 13, 320, 323 83 Ibid. 13, 307 85 Ibid. 14, 24 - 34 - TECHNICAL SERVICES

No. II - Reports of Expert Committees and other translated and published in Shanghai. A special Advisory Bodies number of the Chronicle (vol. 2, no. 8/9, August/ dealing with tuberculosis, plague, ty- September) was devoted to thefirst World phus,cholera,smallpox,schistoso- Health Assembly. miasis, malaria, biological standardi- Work on the Bulletin ofthe W orld Health zation, international epidemic control, Organization had to be interrupted, but vol. I, theunificationofpharmacopoeias, no. 2 (with which vol. i closed) appeared in and the International Lists of Diseases English and French in December 1948. In and Causes of Death. addition to the reports of two expert committees, this number contained a detailed account of No. is - Supplementary Report of the Interim the eradication of Anopheles gambiae from Upper Commission to the First World Health Egypt,a preliminary report on the cholera Assembly epidemic in Egypt, a survey of methods for a sequel to the report of the Com- testing the residual toxicity of DDT, and other mission contained in Official Records, technical papers. nos. 9 and ro, which it brought up During this period, plans were made for typo- to date and completed. graphical improvements in the Bulletin and the No. 13 - First World Health Assembly Chronicle, to come into effect with the beginning containing the verbatim records of the of the 1949 volumes. plenary meetings, the minutes and The first number of the International Digest of reports of the main committees, a HealthLegislation was publishedinEnglish summary of the resolutions and deci- and French before the end of the year. sions, and supporting documents. The W eekly Epidemiological Record and the No. 14 Reports of the First and Second Sessions monthly EpidemiologicalandVitalStatistics of the Executive Board Report were also published. with relevant annexes. In addition to these periodicals,vol.i,in English,ofthe Manual oftheInternational The material for another number of the series- Statistical Classification of Diseases, Injuries, and Official Records, no. 15-was in course of pre- Causes of Death was in the final stages of publica- paration.This volume contains further reports tion, and the printing of volume 2 had been oftheExpert Committees on Tuberculosis, started.This is the sixth revision of the Inter- Venereal Diseases, and the Unification of Pharma- national Lists of Diseases and Causes of Death, copoeias, together with reports of other expert as adopted by the Sixth International Revision bodies. Conference, Paris,1948. The Chronicle of the W orld Health Organization Table II gives the number of issues, in all continued to appear, editions in English, French, languages, together with the number of pages Russian and Spanish being written, translated of WHO publications, i September-31 December and published in Geneva, and a Chinese edition 1948.

TABLE II.PUBLICATIONS, 1 SEPTEMBER - 31 DECEMBER 1948 (issued or in final stages of publication)

Number Number of pages in Title of issues (all languages) English French Spanish Russian All langua ges

Chronicle of the World Health Organization 13 128 138 116* 80** 462*** BulletinoftheWorld Health Organization 2 178 198 376 International Digest of Health Legislation 2 144 152 296 OfficialRecordsoftheWorld Health Organization . . 8 636 636 1,272 W eekly Epidemiological Record 18 180 (bilingual) 180 Epidemiological and Vital Statistics Report 3 60 (bilingual) 60 ManualoftheInternational Statistical Classification . . . 1 416 416 TOTALS 47 1,742 1,124 116 80 3,062

* Only three issues ** Only two issues *** Excluding the edition in Chinese - 35 - TECHNICAL SERVICES

Translation Services The work of the translation services is shown in table III.

TABLE III.NUMBER OF PAGES (TYPEWRITTEN) TRANSLATED* 1 September - 31 December 1948 (revision work not included)

into French into English into Russian Total

September 612 121 45 778 October 566 148 62 776 November 875 142 80 1,097 December 387 96 36 519 3,170

* The Spanish translation of the Chronicle was commissioned in Geneva and the Chinese translation was done in China.

Library and Reference Services the remainder being obtained by exchange with Full use of the WHO library had always been WHO publications) ;3,366 works were loaned hampered by its distance from the Secretariat. to members of the Secretariat (1,186 coming from With the amalgamation ofthelibrary and the WHO library, 2,078 from the United Nations reference services, a readily accessible reading- library,and 102 from otherlibraries) ;and room was opened. In it were placed publications 19,950 separate numbers ofperiodicals were and documents of WHO, important reference circulated. works, and 50 of the medical periodicals most in The library also undertook arrangements for demand, as well as a certain number of essential the order and dispatch of medical literature for technical works. the field services programme (see page 25). The cataloguing of the library occupied a Finally, the larger part of the library of the considerable amount of time : a subject catalogue OfficeInternational d'Hygiène Publique was was started, copies of which it was decided to transferred to Geneva, including sets of periodicals make available in the reading-room as well as in (since 1909)and theofficialpublicationsof the library. governments.The remainder of the collection, During 1948, 1,018 works (not including un- including some sets of periodicals, remains in bound documents and pamphlets) were received Paris. As no catalogue of the library existed, the by the library.Furthermore, 556 current perio- arrangement and cataloguing of the collection dicals were received (7 of which were purchased, had to be done before it was moved to Geneva.

- 36 - CHAPTER 4

PUBLIC INFORMATION, LIAISON, AND ORGANIZATION

Public Information

The Public Information Office, which came pressreleases,distributedtocorrespondents into being on i September, was able to undertake, and, in addition, mailed in each instance to during the period ending 31 December 1948, only more than 2,968 addresses (general news agencies, a limited range of activities. newspaper and radio correspondents or editors, Continuing work which had already been featurewriters,educational institutions,etc.) initiated on a smaller scale during the life of the in more than 30 countries.These releases in Interim Commission,thisofficedevotedits abbreviated form were also sent from Geneva attention primarily to media of mass communica- by cable or air mail to the United Nations tion capable of reaching the greatest number of DepartmentofPublic InformationatLake people with the smallest expenditure of money and Success and at the Palais de Chaillot, Paris, for labour-power :press,periodicals,publications further worldwide dissemination.Releases were and radio. However, with a staff of six informa- issued as follows : tion officers (including both headquarters and the New York Office) these media could not be 17 on the second session of the Executive exploited fully in a sufficient number of countries, Board (25 October-II November) while the vast potentialities of the visual media 5 on sessions of various expert committees (still photos, films,film-strips,slides,posters, 2 ontheEuropeanHealth Conference television, etc.) had to be left largely untapped. (15-16 November) There is obviously no possibility of estimating, 43 miscellaneous. even roughly,thetotal number ofpersons reached in the various countries where informa- Twenty-nine press cables were dispatched to tion on the present activities and future projects theUnitedNationsDepartmentofPublic of WHO was disseminated.Moreover, numbers InformationortoregionalUnitedNations alone would not represent a valid criterion for Information Centres, such as those in New Delhi assessing the effectiveness of the work.It is and Copenhagen : none the less worth mentioning .that, with a press cutting service which has covered only 14 on the second session of the Executive Switzerland and certain other areas of Europe, Board together with a very few non-European centres, 4 on sessions of various expert committees thePublic InformationOfficereceived each 2 on the European Health Conference month, during the period covered by this report, 9 miscellaneous. 800 to 1,000 clippings from newspapers and periodicals on the subject of WHO. Rather than Numerous press conferences on developments aiming primarily at mere numerical inclusiveness, in the Organization were arranged in Geneva, the Public Information Office made efforts to Paris and New York. place material on WHO in well-known, large- circulation newspapers and periodicals or with major radio-broadcastingoutletsinstrategic Periodicals and Publications centres. The WHO Newsletter, a monthly six-page The effectiveness of the work will be cumulative information bulletin for the general public, was and will depend, in the long run, on such factors issued regularly in mimeographed form to an as continuity and a gradually expanding scale of expanding mailing list, as follows : effort in the utilization of all available media over a much wider geographical area. Some indication 3,920 addressesfor September of the nature and the scope of the work carried 4,800 addressesfor October outduringtheperiodSeptember-December 5,250 addressesfor November-December. 1948 is provided below. This bulletin, published in English, French, Press Span. ishand Portuguese, was distributedin nearly 6o countries throughout the world.In Significant developments in connexion with the addition,1,350 copies were released through Organization and its work were covered in 67 the facilities of the United Nations Department - 37 - PUBLIC INFORMATION, LIAISON, AND ORGANIZATION of Public Information at the time of the General Board in connexion with several film projects, Assembly at Paris (September-December 1948). one of them-The Eternal Fight-being completed An eight-page printed folder, " WHO, What with the assistance of WHO during the period ItIs, What It Does, How It Works ", was covered in this report.Arrangements were also publishedinEnglish, made for WHO to be represented on the Film French and Spanish ; Board. and preparations for its publication in Russian The United Nations Film and Information and Italian were virtually completed. Copies Division was supplied with a series of photo- published were as follows : graphs for use in the production of a film-strip 50,000 in English on epidemiology, and material was also sent to a private expert engaged in a similar project. 35,000 in French 12,000 in Spanish. Relations with United Nations Department of More than 30 special articles, editorials, contri- Public Information butions to yearbooks, etc. were prepared in response As indicated in the above paragraphs, a con- to various requests for such material. stant effort has been made by WHO to co-ordinate its work with the Department of Public Informa- tion in Lake Success and with all existing United Radio NationsInformationCentres. Duringthe General Assembly in Paris, WHO was represented In Geneva and New York, 69 radio recordings at a series of meetings at which representatives of (talks,interviewsorround-tablediscussions) Lake Success, the specialized agencies, and the concerning the work of the Organization were United Nations Information Centres discussed made. These recordings, in thirteen different methods by which United Nations informational languages, were sent to the Radio Division of the activities could be carried out in the most econo- United Nations Department of Public Informa- mical and the most efficient manner.Concrete tion, and to local radio stations or networks in arrangements were made to enable WHO to over 20 countries. They related to the following take maximum advantage of facilities offered by subjects : the various divisions-press, publications and radio, film and others-in Lake Success.All 22 on the second session of the Executive these contacts were followed up by almost Board daily routine exchanges between Geneva and II on various expert committees Lake Success, as well as by continuing direct 36 miscellaneous. co-operation between the Public Information Section of WHO in New York and the United Nations Department of Public Information. Visual Media Direct Contacts with Press, Publications and As a basis for more extensive activity in the Radio use of visual media, the Public Information Office built up a still-photo file of approximately An essential part of WHO's activities from 300 negatives(with sample printsofeach), September to December 1948 was the establish- appropriately captioned and catalogued ;and, ment of direct personal contacts with representa- in response to various requests from individuals tives of important telegraphic agencies, press and institutions,distributed more than250 associations, newspapers, publications and radio standard-size prints for use in, exhibitions or for organizations in different countries.This aspect illustrating articles and lectures by members of of the work, initiated during the first World the Secretariat and the Executive Board. Health Assembly, represents the beginning of a long-range effort aiming at replacing the rather Threeexhibitionswereprepared-forthe haphazard public information activities based United Nations General Assembly, Paris,the on anonymous mailing of press releases, cables celebration of United Nations Day, Geneva, and and articles, by concrete personalized services. the meeting of the American Public Health Already, as a result of contacts made in various Association, Boston-consisting of photographs Europeancapitals, a specializedmailinglist and maps, charts, miscellaneous technical equip- exists through which correspondents and writers ment, etc., which represented different phases receive releases and articles on specific items in of WHO's work and its basic objectives.In which they are interested.Full advantage was addition, photographic and other material was taken of the presence of more than 1,500 news- supplied for use in two exhibits arranged by other paper and radio correspondents assigned to the agencies. General Assembly in Paris to stimulate interest The Public Information Office has maintained in WHO and to encourage the writing of articles close co-operation with the United Nations Film on various aspects of the work of the Organization.

- 38 - PUBLIC INFORMATION, LIAISON, AND ORGANIZATION

Liaison Close relations with other organizations, essen- WHO has been represented at the meetings of tial for avoiding the duplication of work and the vari6us co-ordinating bodies. The discussions for correlating activities in the same or allied of policy covered co-ordination of programmes, fields, has been carried on by the New York office of administrative and budgetary' matters and of and by the liaison section of the office at head- regional activities, as well as the processes of quarters. co-ordination.These include the compilation of a comparative review of the activities of the Agreements with other Specialized Agencies United Nations and the specialized agencies. When the first Health Assembly approved the draft agreements with ILO, FAO, and UNESCO, Collaboration with UNICEF it made small formal changes in the texts approved by the conferences of these specialized agencies, In accordance with the recommendations of and further amended the agreements with the the Social Commission, the first Health Assembly two latter agencies, mainly to provide for the examined the problemofco-ordinatingthe establishment of joint committees." The amended emergency health programmes of UNICEF and agreements have been approved by the Fourth the work of WHO. The Assembly recommended Conference of FAO, which met in November the formation of a Joint Committee on Health 1948, and by the Third General Conference of Policy to regulate the health programmes of UNESCO, which was held in December.The UNICEF, pending the assumption of responsi- Agreement between ILO and WHO will be bility by WHO. The Executive Board of UNICEF considered by the 32nd International Labour approved a similar resolution.88 Conference in June 1949.Consultations were TheJointCommitteeonHealthPolicy, begun with theseagenciestocorrect small UNICEF/WHO accordingly held its first meeting discrepancies in the French texts of the agree- on 23 July 1948 in Geneva.It agreed notably, ments. that : Since a formal agreement between WHO and i." this committee shall act as the advisory ICAO was considered unnecessary, the Health medical body, on the understanding that its Assembly decided that the informal arrangements advice will be followed by UNICEF in accord- under which the Interim Commission and WHO ance with its general policy " and that had conductedrelationswith ICAO should 2." the medical programmes undertaken by continue to form the basis for collaboration the Fund will proceed only on the recommenda- between the two organizations.87 Similar arrange- tion of this committee, in order to guarantee ments were made in October with the Interim that all medical activities shall be carried out Commission of the International Trade Organiza- in accordance with the international authority tion (ICITO). The Executive Board at its second in this field ".88 session noted the letters exchanged forthis purpose between the Director-General and the A second meeting of the committee was held Executive Secretary of ICITO, and recommended in Paris on 19 October.The projects carried that these arrangements be approved by the out under the direction of the joint committee second Health Assembly. have been described elsewhere in the report. Administrative Committee on Co-ordination Representation at Meetings called by the United Effectiveco-ordinationwithintheUnited Nations Nations system requires that the various organi- zations consult in advance on policiesand It is important that WHO be represented at programmes, and arrange to keep their administra- meetings of some of the organs of the United tive procedures reasonably uniform.This is the Nations in order to draw attention to the health responsibility of the Administrative Committee aspects of certain problems, to make known the on Co-ordination, whose members are the Secre- activities and policies of WHO with regard to tary-General of the United Nations and the heads them,to implement theformal agreements of the specialized agencies. The Preparatory between WHO and otheragencies, and to Committee assists the Administrative Committee maintain liaison at the working level. This makes on Co-ordination, and several questions of common considerable demands on the time of the medical interest are dealt with by subordinate bodies, officers concerned and on the funds of the Organi- namely the Consultative Committees on Adminis- zation. trative Questions, on Statistical Matters, and on WHO was represented at all relevant meetings Public Information,the United Nations Film of the Economic and Social Council, which held Board,the Library Co-ordinating Committee and the Technical Working Groups on Fellowship 88 Oil. Rec. World Hlth Org. 13, 327 ; 14, x Programmes,Migration,Housing and Town 89 In regard to the programme of BCG vaccina- and Country Planning, and Publications. tion as already established, the committee recog- nized theexistenceofspecialcircumstances, notably the agreements which had been concluded 88 Off. Rec. World Hlth Org. 10, 69, 73, 76 ;13, between the Danish Red Cross, signing on behalf 322, 323 of its Norwegian and Swedish associates, certain 8 7 Ibid. 13, 322 governments and UNICEF. - 39 - PUBLIC INFORMATION, LIAISON, AND ORGANIZATION its seventh session at Geneva in July and August Non-governmental Organizations 1948. The most important matters discussed were the recommendations of the Social Commission The Health Assembly decided thatinter- regarding programmes in which WHO isco- national non-governmental organizations which operating with the United Nations ;the reports have recognized standing and represent a sub- of the specialized agencies and the mechanism stantial proportion of the persons organized for of co-ordination ;the draft protocol to bring the sake of participating in a specific field of under international control drugs outside the activity should be brought into relationship scope of the 1931 Convention ; the United Nations with WHO." Such organizations have a right Appeal for Children ;and the use of the UN to present their views to the Health Assembly library at Geneva. and Executive Board.The non-governmental organizations may be asked to advise WHO on The United Nations Special Committee on specific technical questions, such as the establish- Informationtransmitted under Article73 (e) ment of new programmes, to collect data which of the Charter met in Geneva in September. are not already available, to assist in making known WHO has agreed to helprevise the health the aims and activities of the Organization, or sections of the standard form which this com- to enlist support of local voluntary agencies mittee has drawn up as a guide to reports by the for such programmes as those in maternal and administering governments onconditionsin child health, for example, in which WHO is non-self-governing territories.A representative assisting their governments. of WHO attended the meetings of the special committee in order to discuss the standard form The Executive Board appointed a Standing and to report on the work planned by WHO in Committee on Non-governmental Organizations, the relevant territories (see also page 18). which considers new requests for relations with WHO and which, every two years, will review the At the third General Assembly of the United relations already established. Eighteen non- Nations, the matters of principal concern to governmental organizations were admitted to WHO were the report of specialized agencies relationship with WHO at the first two sessions of and the co-ordination of activities and procedures ; the Executive Board.91 the decision that UNICEF should take administra- For the third session of the Board, a study was tive responsibility for a United Nations appeal for prepared on the relations of WHO with (1) children in 1949 and that the proceeds of the sectional non-governmental organizations,i.e., appeal should be for the benefit of the Fund ; thoserepresentingracial,religiousorother the decisions regarding relief to Palestine refugees limited groups, and (2) non-governmental organi- (see page 26) ; and the resolutions of the Assembly zations whose main activities are not connected concerning technical assistance to governments with health. for programmes of economic development. WHO was represented, so far as possible, at the relevant WHO has been represented at meetings of a meetings and, at the Secretariat level, maintained number of non-governmental organizations during contact with the United Nations regarding these the period under review, and in several cases has matters.One result of these contacts was the consulted with such organizations regarding the improvement of the temporary working arrange- development of specific programmes. Liaison ment for the use of the United Nations library is maintained with the Interim Committee of at Geneva. ConsultativeNon-governmentalOrganizations, having consultative status with the Economic and Social Council and with the section on non- RepresentationatMeetingsofSpecialized governmental organizations of the United Nations Agencies Secretariat. In co-operation with UNESCO, WHO has The Fourth Session of the FAO Conference taken part in the work of the Organizing Committee (Washington, 15 November 1948) endorsed the of the Permanent Council for the Co-ordination proposals for a joint FAO/WHO expert com- of Medical Congresses. A conference will be held mittee on nutrition and a joint secretariat to in Brussels or 18 April 1949 to establish a bureau, servicethiscommittee. Representativesof which will function as an independent agency, WHO participated in the discussionofthe and will receive financial assistance from WHO programmes for nutrition and rural welfare, on and UNESCO in order to initiate its work (see which the two organizations are collaborating. also page 2o). The third session of the UNESCO General In 1949, WHO plans to expand somewhat its Conference was held in Beirut early in December. co-operation with non-governmental organiza- Owing to shortage of staff,it was impossible tions, both by establishing relations with addi- to designate a member of the Secretariat to tional organizations and by developing more attend this conference. Upon the request of the fully the working arrangements which now exist. Director-General, the Egyptian Government se- conded to WHO the Director of the Sanitary Bureau at Alexandria, who actedas WHO 9° Off. Rec. World Huth Org. 13, 326 representative at this important meeting. '1 Ibid. 14, 40, 62

- 40 - PUBLIC INFORMATION, LIAISON, AND ORGANIZATION

Regionalization and the Special Office for Europe

South-East Asia Regional Office performed many valuable servicesfor WHO The first session of the Regional Committee in providing expert advice and liaison in the for South-East Asia was convened in New Delhi Western Hemisphere ;and at the end of the on 4-5 October 1948 ;and the Executive Board, year, a working arrangement was being negotiated at its second session, approved the establish- to govern the relationships between the two ment of the South-East Asia Regional Office on organizations subsequent to the signing of the about I January 1949, appointing Dr. C. Mani initial agreement. as Regional Director.92After consultation with the United Nations,in accordance with the Special Office for Europe agreement between WHO and the United Nations, As the result of decisions taken by the first the site of the South-East Asia Regional Office World Health Assembly and theExecutive was established at New Delhi. Board,94 a conferencein Geneva was organ- ized by WHO on 15-16 November, and was Eastern Mediterranean Regional Office attended by representatives of 17 war-devastated Plans were under way for the establishment of countries in Europe.Corroborating replies to the Eastern Mediterranean Regional Office early anearlierquestionnaire,therepresentatives in 1949. During the last part of 1948, invitations emphasized that the needs of these countries were dispatched to some fifteen governments to were not only for advisory and demonstration send representatives or observers to the first services and fellowships but for medical supplies session of the regional committee, to be held in of many types,includingpenicillin,strepto- Cairo on 7 February 1949. mycin, and DDT. The Director-General accordingly established in the headquarters office in Geneva a temporary Pan American Sanitary Organization special office for Europe, as on i January 1949. The initial agreement between WHO and the This office, working in collaboration with the Pan American SanitaryOrganization having national health administrations, will organize the been approved by the competent bodies of both WHO programme of services to governments and, organizations, it was recognized that, as soon as by the poolingoftechnical knowledge,will 14 members of PASO had ratifiedthe WHO assistin any other approach towards health Constitution, the agreement, although not yet rehabilitation among the European countries constituting" integration ",accordingtothe concerned. Constitution, would come intoeffect ;PASO Co-operation with the Economic Commission would then act as a regional organization of for Europe in the medical supply problems of the WHO.93 At the end of 1948, ten of the American war-devastated countries will soon be begun. countries concerned had ratified. One of the first objectives will be to increase In the meantime, the Pan American Sanitary penicillin supplies by assisting to get UNRRA Bureau, with its headquarters in Washington, penicillin plants into production.

Organization of the Secretariat

Immediately following thefirst World comprisingaDivisionof Epidemiology, a Health Assembly and during the last quarter of Division of Editorial and Reference Services, 1948, an organizational pattern was established a Section on Health Statistics and a Section on for WHO. Staff rules, based, for the most part, Therapeutic Substances ; on those of the United Nations, were worked (2) a Department of Operations, comprising out,96 and recruitment was begun, in proportion a Division of Planning, a Division of Field to the increased responsibilities of the Secretariat. Operations and the Special Office for Europe ; The bulk of the work was carried on in the head- quarters office in Geneva ;but staff was also (3) Administration and Finance, comprising distributed among the liaison office in New York, an Office of Internal Audit, Office of Personnel, the Singapore Epidemiological Intelligence Sta- Office of Conferences and General Services, tion, and the various field missions scattered Office of Budget and Management and Office throughout both hemispheres. of Finance and Accounts ; The headquartersofficewas organizedto (4) an Office of Public Information ; consist of the following : (5) a Legal Section, and (i)aDepartmentofTechnicalServices, (6) a Liaison Office.

92 Off. Rec. World Hlth Org. 14, 27 " Off. Rec. World Hlth Org. 13, 331 ; 14, IS 93 Ibid. 14, 27 95 Ibid. 14, 85 -- PUBLIC INFORMATION, LIAISON, AND ORGANIZATION

The current organizational chart is reproduced on a site belonging to the City of Geneva, which in annex 3, page 45. would be made available to WHO. A preliminary estimate of the cost of such a building has been Staff made. On i September, with the dissolution of the The second proposal was for the construction Interim Commission, such members of its staff of an addition to the Palais des Nations. as were required were taken over by WHO, in The question of the premises of WHO is being accordance with a resolution of the first World discussed further with the Swiss Federal author- Health Assembly." A totalof 206 persons ities and with officials of the United Nations. (including a few who had been employed on a temporary basis for the Assembly) was trans- ferred and distributed as follows : Finance

Place of Number Contributions assignment of persons Geneva 140 At the end of December 1948, 16 of the Member New York 25 Governments of the Organization had paid their London 1948 contributions, totalling $2,751,869, leaving Paris 2 the uncollected balance at $2,108,354.Because Singapore 9 ofparliamentaryprocesses,variousMember Austria Governments may not have been able to make China o their contributions by the end of the year. Ethiopia 6 However, the slowness with which payments Greece 5 have been received gives cause for concern.It India is hoped that it will not create a precedent Italy 3 because of the possible effect which such a delay Poland . 3 might have on future programmes. Total 206 UNRRA Grant By the end of December, the staff had been increased and was distribu ted as follows : During the spring of 1948, the Central Com- mittee of UNRRA made a grant of $1,000,000 Geneva 186 to the Interim Commission, in order to ensure New York 29 adequate financing for the operations of WHO. Singapore 13 With the authorization of the first World SEA Regional Office HealthAssembly,theDirector-Generalap- China to proached UNRRA with the request that WHO Czechoslovakia be permitted to retain the grant. The Central Denmark Committee concurred, on the condition that the Ethiopia 6 entire amount be used for projects approved France 2 by the Joint Committee on HealthPolicy, Greece . 4 UNICEF/WHO.Guiding principles for the use Haiti of this fund were formulated by the Executive Italy 3 Board.97 Philippin es Poland ROayment of Loan to the United Nations Total 259 Pending the receiptof contributions from A separate confidential report by the Director- Member Governments, WHO borrowed, in all, General on the composition of the Secretariat, $2,550,000 from the United Nations in order to giving the name, nationality, grade and salary finance the Organization - $2,150,000 at the of each staff member, will be submitted at the time of the Interim Commission, and $400,000 time of the second Health Assembly. after the Organization had come into being. In early November, however, during the second Premises session of the Executive Board, $1,250,000 of this At the end of 1948, there were two proposals sum was repaid.This payment was made in under consideration with regard to the problem advance of the date on which it was due, in of obtaining premises for WHO headquarters in order to help the United Nations meet the Geneva. emergency situation in Palestine. The first was for the construction of a new Details of the finances of WHO during 1948 building, separate from the Palais des Nations, will be found in the report of the External Auditor,

" 011. Rec. World Hltli Org. 13, 317 " 011. Rec. World Hlth Org. 14, 17, 18

- 42 - ANNEXES

Annex 1

MEMBERSHIP OF THE WORLD HEALTH ORGANIZATION (as on 31 December 1948)

States which have accepted the Constitution of WHO, signed in New York on 22 July 1946, listed in the order of their dates of ratification :

State Date of ratification State Date of ratification 1. China 22 July 1946 29. Portugal 13 February 1948 2. United Kingdom 22 July 1946 30. Czechoslovakia . I March 1948 3. Canada 29 August 1946 31. Greece x2 March 1948 4. Iran 23 November 1946 32. USSR 24 March 1948 5. New Zealand io December 1946 33. Ukrainian SSR . 3 April 1948 6. Syria 18 December 1946 34. Byelorussian SSR 7 April 1948 7. Liberia 14 March 1947 35. Mexico 7 April 1948 8. Switzerland 26 March 1947 36. Afghanistan 19 April 1948 9. Transjordan 7 April 1947 37. Denmark 19 April 1948 ro. Ethiopia ix April 1947 38. Poland 6 May 1948 II. Italy iiApril 1947 39. Brazil 2 June 1948 12. Netherlands 25 April 1947 40. Roumania 8 June 1948 13. Albania 26 May 1947 41. Bulgaria 9 June 1948 14. Saudi Arabia 26 May 1947 42. France 16 June 1948 15. Austria 30 June 1947 43. Hungary 17 June 1948 16. Union of South Africa 7 August 1947 44. Iceland 17 June 1948 17. Haiti 12 August 1947 45. Dominican Republic 21 June 1948 18. Norway 18 August 1947 46. United States of America 21 June 1948 .19. Sweden 28 August 1947 47. El Salvador 22 June 1948 20. Iraq 23 September 1947 48. Pakistan 23 June 1948 21. Siam 26 September 1947 49. Belgium 25 June 1948 22. Finland 7 October 1947 50. Burma I July 1948 23. Ireland 20 October 1947 51. Ceylon .. 7 July 1948 24. Yugoslavia 19 November 1947 52. Venezuela 7 July 1948 25. Egypt 16 December 1947 53. Monaco 8 July 1948 26. Turkey 2 January 1948 54. Philippines 9 July 1948 27. India 12 January 1948 55. Chile 15 October 1948 28. Australia 2 February 1948 56. Argentina 22 October 1948

-43 - ANNEXES

Annex 2

MEMBERSHIP OF THE EXECUTIVE BOARD (as on 31 December 1948)

Member States entitled to designate persons to serve on the Executive Board

t. Australia one year to. Mexico two years 2. Brazil two years . Netherlands three years 3. Byelorussian SSR three years 12. Norway one year 4. Ceylon one year 13. Poland three years 5. China two years 14. Union of South Africa three years 6. Egypt two years 15. USSR two years 7. France two years 16. United Kingdom one year 8. India three years 17. United States of America one year 9. Iran one year 18. Yugoslavia three years

As elected by the first World Health Assembly on 12 July 1948, the terms of office being decided by the drawing of lots.

Persons serving on the Executive Boardat the end of 1948 :

Sir Aly Shousha, Pasha (Egypt), Chairman Dr. B. Kozusznik (Poland) Dr. K. Evang (Norway), Vice-Chairman Dr. M. Mackenzie (United Kingdom) Dr. W. W. Yung (China), Vice-Chairman Dr. C. Mani (India) Dr. C. van den Berg (Netherlands) Professor J. Parisot (France) Dr. D. A. Dowling (Australia) Dr. G. H. de Paula Souza (Brazil) Dr. N. Evstafiev (Byelorussian SSR) Dr. A. Stampar (Yugoslavia) Dr. H. S. Gear (Union of South Africa) Dr. N. A. Vinogradov (USSR) Dr. M. H. Hafezi (Iran) Dr. W. G. Wickremesinghe (Ceylon) Dr. H. van Zile Hyde (United States of America) Dr. J. Zozaya (Mexico)

- 44 - Annex 3 ORGANIZATIONAL CHART (as on 31 December 1948)

HEALTH ASSEMBLY WORLD IFEALTH ORGANIZATSCH ORGANIZATIONAL CHART Revised 1 October 1945 EXECUTIVE BOARD] Approved LIAISON Director-General OFFICE OF THE DIRECTOR-GENERAL LEGAL SECTION HEADQUARTERS OFF/CE

DEPARTMENT OF TECHNICAL SERVICES OFFICE OF DEPARTMENT OF OPERATIONS PUBLIC INFORMATION

DIVISION OF EDITORIAL & DIVISION OF FIELD IDIVISION OF EPIDEMIOLOGY IADMINISTRATION & FINANCE I DIVISION OF PLANNING REFERENCE SERVICES OPERATIONS

Expert OFFICE OF .r, Committees INTERNAL AUD T Cannittees

REGIONAL FIELD OPERATIONS EPIDEMIOLOGICAL INFORMATION EAITORIAL SECTION MALARIA SECTION AND STATISTICS SECTION SECTION

SECTION OF SANITARY CONVENTIONS AND TRANSIATION SECTION TUBERCULOSIS SECTION FIELD OPERATIONS IN AREAS QUARANTINE SECTION WITHOUT REGIONAL ORGANIZATION MATERNAL AND CHILD HEAL SECTION OF STUDIES CT PUBLICATION SECTION COMMUNICABLE DISEASES SECTION FELLOWSHIPS SECTION

LIBRARY' AND NOUSEONCE VaIERE.AL DISEASES SECTION TOM-BIOLOGICAL SECTION SECTION SUPPLY SERVICE SECTION Medical Literature & Teaching Equipment - Duergency Supplies NUTRITION SECTION Advice to Governments HEALTH STA.TISTICS swam; ENVIRONMENTAL SANITATION secao Expert}..1 Omni ttee PUBLIC HEALTH ADMIIRSTRATION SECTION Biological Stxndnrdicntiox Maternal & Child Health MENTAL HEALTH SECTION Nutrition Environoontal Sani tation Unificat on of Fhannacopee as Malaria Tuberculosis Habi -Forming Drugs Venereal Disease etc 4,

PUBLIC INFORMATION ADIENISTRATION & FINANCE A REG/ONAL OFF/CE OMATICNS

OFFICE OF THE REGIONAL DIRECTOR

REGIONAL COMMITTEE WHO 051 ANNEXES

Annex 4

EXPERT COMMITTEES ESTABLISHED BY WHO

Expert Committee on Malaria of the World Health Organization Expert Committee on Tuberculosis of the World Health Organization (with Sub-committee on Streptomycin and Sub-committee on Tuberculin-testing and BCG Vaccination) Expert Committee on Venereal Infections of the World Health Organization (with Sub-committee on Serology and Laboratory Aspects) Expert Committee on Maternal and Child Health of the World Health Organization Expert Committee on International Epidemiology and Quarantine of the World Health Organization (with Section on Quarantine) Expert Committee on Health Statistics of the World Health Organization Expert Committee on Biological Standardization of the World Health Organization (with Sub-Committee on Fat-soluble Vitamins) Expert Committee on the Unification of Pharmacopoeias of the World Health Organization Expert Committee on Habit-forming Drugs of the World Health Organization Expert Committee on Insecticides of the World Health Organization Joint Committee on Nutrition, FAO/WHO

Annex 5

CONFERENCES AND MEETINGS CALLED BY WHO (23 July-31 December 1948)

23-24 July Joint Committee -on Health Policy, UNICEF/WHO, first session Geneva 30 Sept.-4 Oct. Expert Committee on Tuberculosis, third session Paris 4-5 October Regional Committee for South-East Asia, first session New Delhi 5-8 October Joint OIHP/WHO Study-Group on Plague Paris 9-12 October Joint OIHP/WHO Study-Group on Trachoma Paris 13-15 October Joint OIHP/WHO Study-Group on Cholera Paris 18-19 October Joint OIHP/WHO Study-Group on Smallpox Paris 5-19 October Expert Committee on Venereal Diseases, second session Paris 15-23 October Expert Committee on the Unification of Pharmacopoeias, third Geneva session 19-20 October Joint Committee on Health Policy, UNICEF/WHO, second Paris session 20-21 October Joint meeting of the OIHP Committee on Finance and Transfer Paris and WHO Negotiating Committee 22-23 October Working Party on Allocation of Field Services (UNRRA) Funds, Geneva set up by the Standing Committce on Administration and Finance of the Executive Board 25 Oct.-ir Nov. Executive Board, second session Geneva 15-16 November Conference on Temporary Special AdministrativeOfficefor Geneva Europe 15-20 November Expert Committee on International Epidemiology and Quaran- Geneva tine, first session

-46 - ANNEXES

Annex 6

CONFERENCES AND MEETINGS CALLED BY THE UNITED NATIONS AND ITS SPECIALIZED AGENCIES AT WHICH WHO WAS REPRESENTED (24 Judy 1948.31 December 1948)

Economic and Social Council, seventh session July-August Geneva Advisory Committee of Library Experts August Lake Success IRO First General Conference September Geneva Permanent Central Opium Board, 51st session September Geneva Conference on High Altitude Research Stations September Interlaken (UNESCO) UNESCO Executive Board, ninth session September Paris Meeting of Representatives of Non-Governmental Orga- September Paris nizations Special Committee of the General Assembly on Informa- September Geneva tion Transmitted under Article 73(e) of the Charter Drug Supervisory Body, 30th session September-October Geneva Third General Assembly of UN September-December Paris ExecutiveCommitteeoftheInterim Co-ordinating October Paris Committee on Medical and Biological Abstracting (UNESCO) Conference of International Organizations concerned in October Paris the Prevention of Crime and Trea tment of Offenders FAO Standing Advisory Committee on Rural Welfare October Washington UNICEF Programme Committee and Executive Board October Paris Consultative Committee on Administrative Questions October Paris Executive Committee of the Organizing Committee of October Paris the Permanent Council for the Co-ordination of Inter- national Congresses of Medical Sciences (UNESCO) Drug Supervisory Body, 31st session November Geneva Permanent Central Opium Board, 32nd session November Geneva FAO Council, fourth session November Washington FAO Conference, fourth session November Washington Preparatory Committee of the Administrative Committee November Paris on Co-ordination Administrative Committee on Co-ordination November Paris Third General Conference of UNESCO November-December Beirut FAO Standing Advisory Committee on Nutrition December Washington ILO Governing Body, ro7th session December Geneva

- 47 -

INDEX

Abstracts, medical, 34 Education Agencies, specialized, 39 health, 17 See also under name of agency medical, 18 Aircraft, disinsectization, 27 Egypt, tuberculosis control in, II Albania, assistance to, 21 Environmental sanitation, see Sanitation, environ- Alcoholism, 18 mental Alexandria,Sanitary Bureauat,seeSanitaryEpidemiological information, 29, 30 Bureau at Alexandria broadcasting, 29, 30 Altitude effects, 20 Epidemiological IntelligenceStation, Singapore, American Friends' Service Committee, 26 see Singapore EpidemiologicalIntelligence American Public Health Association, 17 Station Androsterone, 32 Epidemiological services, 27-30 Annual Epidemiological Reports, 30 Epidemiological and Vital Statistics Report, 30, 35 Anopheles, eradication, 9, 10 Epidemiology, 7, 27-30 Assistance to governments, 21-24 Epidemiology and Quarantine, Expert Committee Austria, assistance to, 21 on International, 29 Ethiopia BCG vaccination, 11-13, 22, 30, 39 assistance to, 22 Biological standardization, 7, 27, 31-32 malaria control in, 17 Biological Standardization, Expert Committee on, sanitation in, 17, 22 31-32, 33, 34 tuberculosis control in, 12, 22 Blood groups, 32 venereal-disease control in, 14, 22 Brucellosis, 34 Brussels Agreement, 13, 14 Europe, Special Office for, 7, 41 Bulletin of the World Health Organization, 35 Executive Board Bureau of Medical Supplies, 26 membership, 43-44 Byelorussia, assistance to, 22 sessions, 7 Expert Committee on . . see under subject Cancer statistics, 30 FAO Cerebrospinal meningitis, 28 co-operation with, 9, 1o, 16-17, 34, 39, 40 Ceylon Standing Advisory Committee on Nutrition,16 assistance to, 22 Standing Advisory Committee on Rural Wel- tuberculosis control in, 12, 22 fare, 17 Child, Declaration of the Rights of the, 15 Far East, malaria control in, 9 Child health, see Maternal and child health Fellowships, 21-25 China F,ield services, see Assistance to governments assistance to, 22 Films, 18, 25 sanitation in, 17, 22 Finance, 42 tuberculosis control in12, 22 Finland, assistance to, 22 Cholera, 27, 29 vaccination, 27, 29 Food and Agriculture Organization, see FAO vaccine, standardization, 31 Food-production, 9, 10 Cholera, Joint Study-Group on, 27 Gonorrhoea, see Venereal diseases Chronicle of the World Health Organization, 35 Greece Committee, Expert, on. ..see under subject assistance to, 22 Committees, expert, 46 malaria control in, 9-i'o, 17, 22 Conferences, 46 tuberculosis control in, 12, 22 Congresses, medical, co-ordination, 20, 40 Contributions, 42 Habit-forming drugs, 33 Control centres, 32 Habit-forming Drugs, Expert Committee on,33 Conventions, see Sanitary conventions Haffkine Institute, Bombay, 31 Crime prevention, 19 Haiti Pilot Project, 17, 22 Czechoslovakia, assistance to, 22 Headquarters, 42 Heroin, 33 DDT, see Insecticides Hospitals, 17, 18 Death, causes, nomenclature, 31 Housing, 16, 17 Declaration of the Rights of the Child, 15 Hungary, assistance to, 22 Dengue fever, 28 Hygiene, dental, see Dental hygiene Dental hygiene, 19 Hygiene, industrial, see Industrial hygiene Dermatology, 14 Hygiene, rural, see Sanitation, environmental Digitalis, standardization, 32 ICAO, 39 Diseases, nomenclature, 31 ICITO, 39 Disinfestation, 27 ILO, co-operation with, 14, 15, 17, 18, 39 Disinsectization, 27 Immigrants, see Migrants See also Insecticides India Displaced persons, 14 assistance to, 22 Dolantin, 33 tuberculosis control in, 12, 22 Drug addiction, 18 Industrial hygiene, 17, 21 See also Habit-forming drugs Influenza, 28, 33-34 Drugs, dosage, 33 Information, public, 37-38 Eastern Mediterranean Regional Office, 7, 41 Insecticides, 9-1o, 16-17, 27, 28 Editorial services, 34-36 Insulin, 26 -49 - INDEX

Interim Commission of the International TradeOestradiol, 32 Organization, see ICITO Office International d'Hygiène Publique, 54, 27, Interim Committee of Consultative Non-abovern- 29, 36 mental Organizations, 40 Official Records of the World Health Organization, Interim Co-ordination Committee on Medical and 34-35 Biological Abstracting, 34 Paediatrics, 15-16 InternationalCivilAviationOrganization,see Palestine refugees, assistance to, 26, 40 ICAO International Conference for the Sixth DecennialPan American Sanitary Organization, 7,23, 30, 41 Revision of the International Lists of Diseases Penicillin, 13-14, 59 and Causes of Death, 30, 35 Penicillin plants, UNRRA, 19 International Congress on Malaria, 9 Permanent Council for the Co-ordination of Inter- International Congress on Mental Health, 18 national Congresses of Medical Sciences, 20, 40 International Dental Federation, 19 Pestilential diseases, see Cholera International Digest of Health Legislation, 35 Plague International Hospital Federation, 18 Sanitary conventions, International Labour Organization, see ILO international International Red Cross Committee, 16, 26 Smallpox International Refugee Organization, see IRO Typhus International Salmonella Centre, 34 Yellow fever International Union against Venereal Diseases, 14Pharmacopoeias, Expert Committee on Unification IRO, co-operation with, 14 of, 32-33 Italy Pharmacopoeias, unification, 32-33 assistance to, 22 Philippines, assistance to, 23 malaria control in, 9-1 o Physical training, 19 tuberculosis control in, 12 Plague, 27, 28, 29 venereal-disease control in, 14 vaccination, 29 Joint Committee on Health Policy, UNICEF/Plague, Joint Study-Group on, 28 WHO, 9, 13, 15, 19, 39 Poland Joint Enterprise, ri-i 2 assistance to, 23 Joint Study-Group, see under subject malaria control in, 9 King Institute, Madras, 31 tuberculosis control in, 12, 23 Korea, Northern, assistance to, 23 venereal-disease control in, 13 Korea, Southern, assistance to, 23 Poliomyelitis, 28 PPD, see Tuberculin League of Nations Health Organization, 15, 31 Premises, 42 Permanent Commission on Biological Stan-Prostitution, 14-15 dardization,19 Psittacosis, 28 League of Red Cross Societies, 9, 18, 26 Public-health administration, 7, 15, 17-18, 21 Liaison, 39-40 Public-health education, 18 Library, 36 Public Information Office, 37-38 Literature, medical, 21-23, 25-26 Publications, 34-35 Loan, repayment, 42 Purified protein derivative, see Tuberculin Malaria, 7, 9-II, 17, 21, 26 Quarantine, 29 control projects, 9, 16-17 See also Sanitary conventions, international fellowships in, 9, II Quarantine, Section on, 29 Malaria, Expert Committee on, 9-1o, 33 Queensland fever, 28 Malaria Institute of India, 9, II Manual of the International Statistical Classifica-Radiography, mass, 12 tion of Diseases, Injuries, and Causes of Death, Red Cross 31, 35 see International Red Cross Committee Maternal and child health, 7, 15-16, 21 League of Red Cross Societies fellowships in, 15-16 Scandinavian Red Cross Maternal and Child Health, Expert Committee Reference services, 36 On, 15 Refugees, 14, 26, 40 Medical care, 17 Regional organization, 41 Medical congresses, see Congresses, medical Regional Organization for Eastern Mediterranean, Medical literature, see Literature, medical 7, 41 Medical personnel, distribution, 17 Regional Organization for South-East Asia, 7, 41 Medical Research Council of Great Britain, 33 Rehabilitation, i7 SeealsoNationalInstituteforMedical Relapsing fever, louse-borne, 28 Research, London Research, co-ordination, 33-34 Medical supplies, see Supplies, medical Resources, conservation, 16, 17 Meetings, 46 Rh antigens, 32 Membership of WHO, 7, 43 Rickettsioses, 28 Mental health, 7, 18-19 Rockefeller Foundation, 23, 25 Methadone, 33 Rodenticides, 28 Metopon hydrochloride, 33 Roumania, malaria control in, 9 Migrants, II, 14 Rural hygiene, see Sanitation, environmental Milk, skimmed, 16 Rural welfare, to, 17, 40 Mosquitos, see Anopheles Salmonella, 34 National Institute of Health, Bethesda, 31, 32 Sanitary Bureau at Alexandria, 40 National Institute for Medical Research, London, Sanitary conventions, international, 27-30 31, 32, 33 administration, 27, 29 Non-governmental organizations, 2o, 40 infringements, 29 Non-self-governing territories, 18, 40 revision, 27, 29 Notifications, see Epidemiological services Sanitary regulations, international, 27, 29 Nursing, 17 Sanitation, environmental, 7, 15, 16717, 21 Nutrition, 7, 15, 16, 21, 40 Sardinia, anopheline eradication in, TO - 50 - INDEX

Scandinavian Red Cross, xi Division of Trusteeship, 18 Seafarers, hygiene of, 14, 17, 18 Drug Supervisory Body, 33 See also Brussels Agreement Economic Commission for Europe, ro, 19, 45 Secretariat, organization, 41-42, 45 Economic Commission for Latin America, 17 Serological standardization, 13 Economic and Social Council, io, 39-40 SingaporeEpidemiologicalIntelligenceStation, Educational, Scientific, and Cultural Orga- 29, 30 nization, see UNESCO Smallpox, 27, 28 Film Board, 38 vaccination, 28 General Assembly, 19, 38, 40 Smallpox, Joint Study-group on, 28 InternationalChildren's Emergency Fund, South-East Asia Regional Office, 7, 41 see UNICEF Special Office for Europe, 7, 41 Library, 40 Staff, 7, 42 loan, 42 Standing Committee on Non-governmental Orga- Permanent Central Opium Board, 33 nizations, 40 Relief for Palestine Refugees, 26, 40 State Serum Institute, Copenhagen, 31, 34 ScientificConference on Conservation and Statistical Handbooks Series, 35 Utilization of Resources, 17 Statistics, Expert Committee on Health, 30-31 Social Commission, 15-16, 39, 40 Statistics, health, 30-31 Special Committee on Information Trans- Stillbirth, definition, 30 mitted under Article 73 (e), x8, 40 Streptococcus antitoxin, standardization,32 United Yugoslav Relief Fund of America, 25 Streptomycin, I I ,28 UNRRA, 9, 12, 14, 19, 2/, 24 Study-group on .. . see under subject Central Committee, io Sulfarsphenamine, standardization, 32 grant, 42 Supplies, medical, 26, 41 residual funds, 59 Syphilis, see Venereal diseases Vaccination, see BCG vaccination Teaching material, 25-26 Cholera vaccination Town and country planning, 16 Plague vaccination Toxoids, standardization, 33 Smallpox vaccination Trachoma, 28-29 Yellow-fever vaccination Trachoma, Joint Study-Group on, 28-29 Vaccines. standardization, 33 Translation services, 36 Venereal Disease Research Laboratory, US Public Tuberculin, standardization, 32 Health Service, 13 Tuberculin-testing, 11-12 Venereal diseases, 7, 13-15, 19, 21 Tuberculosis, 7, I I -I 3, 21 fellowships in, 14 fellowships in, ii Venereal Diseases, Expert Committee on, 13-15, 19 Tuberculosis, Expert Committee on, I I Vitamins, standardization, 32 Turkey, assistance to, 23 Vitamins, Sub-Committee on Fat-Soluble, 32 Typhus, 28 Weekly Epidemiological Record, 30, 35 vaccination, 28, 29 Weekly Fasciculus, 3o Ukrainian SSR, assistance to, 23 WHO Newsletter, 37 UNESCO, co-operation with, 16, 17, 18, 20, 22,WHO Regulations No. I, 31 34, 39, 40 Women and children, traffic in, 14-15 UNICEF, co-operationwith,9,II-12,13-14, World Federation of Mental Health, 19 15-16, 19, 21, 25, 30, 39, 40 World Influenza Centre, 33-34 Unitarian Service Committee, 22, 23 X-ray apparatus, 12 United Nations Yellow fever, 29, 30 co-operation with, 7, 15, 19, 39-40, 42 vaccination, 29 Administrative Committee on Co-ordination, Yellow-fever Panel, 29 7, 39 Yugoslavia Appeal for Children, 4° assistance to, 23 Department of Public Information, 37-38 venereal-disease control in, 13-14 Department of Social Affairs, 19

- 51 -