I_!.;:-- ( International Public Health between the Two World Wars -The Organizational Problems Norman Howard-Jones Director, Division of Editorial and Reference Services, World Health Organization, 1948-1970 Visiting Scientist, History of Medicine Division, National Library of Medicine, Bethesda, MD, USA, 1971-1972 WORLD HEALTH ORGANIZATION GENEVA 1978 HISTORY OF INTERNATIONAL PUBLIC HEALTH, No. 3 This study originally appeared in WHO Chronicle, 1977, 31, 391-403, 449-460; 1978, 32, 26-38, 63-75, 114-125, 156-166. ISBN 92 4 156058 4 ©World Health Organization 1978 Publications of the World Health Organization enjoy copyright protection in accord­ ance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of WHO publications in part or in toto, application should be made to the Office of Publications, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Director-General of the World Health Organization concernffig the legal status of any country, territory, city or area or of its authorities" or concerning-the delimitation of its frontiers or boundaries. The author alone is responsible for the views expressed in this publication. ' ( \ . CONTENTS Page Author's preface 6 Introduction . 7 CHAPTER I: THE FIRST INITIATIVES 9 Foundation of the League of Red Cross Societies (LRCS): first postwar session of the Office international d' Hygiene publique (OIHP) . 13 The Informal London Conference, July 1919 15 CHAPTER Il: THREE INTERNATIONAL HEALTH ORGANIZATIONS . 16 The OIHP considers its future, October-November 1919 16 The League of Nations enters the health field, February 1920; consolida- tion of the LRCS Bureau of Health . 17 The International Health Conference, London, April 1920 . 18 Report on the typhus epidemic in Poland . 19 Appointment of the League's Epidemic Commission . 20 CHAPTER 111: PROPOSALS FOR A HEALTH ORGANIZATION OF THE LEAGUE OF NATIONS . 21 The First Assembly of the League decides to establish a Health Organiza- tion, December 1920 . 22 The problem of the co-existence of two international Red Cross organ- izations 22 The Council of the League of Nations proposes a compromise with the OIHP, March 1921 . 24 Tensions between the two international Red Cross organizations . 24 Fortified by the veto of the USA, the OIHP becomes recalcitrant, April-May 1921 . 26 The Temporary Health Committee of the League, May 1921 . 27 CHAPTER IV: THE TROUBLED RELATIONS BETWEEN THE OFFICE INTERNATIONAL D'HYGIENE PUBLIQUE AND THE PROVISIONAL HEALTH COMMITTEE OF THE LEAGUE OF NATIONS . 29 Action by the Council and the Assembly of the League, September 1921 31 The OIHP victoriously independent, October 1921 31 CHAPTER V: FAMINE AND PESTILENCE IN EASTERN EUROPE 34 Provisional Health Committee of the League, second and third sessions, October 1921 and May 1922 . 35 Page Continuing activities of the LRCS 36 International Classification of Diseases . • . 37 Provisional Health Committee of the League, fourth session, August 1922: the Russian famine . 39 CHAPTER VI: THE ASSEMBLY OF THE LEAGUE OF NATIONS DECIDES THAT ITS HEALTH ORGANIZATION SHOULD CONTINUE • . • • . • • • • • • . • 42 The LRCS changes its orientation . 44 Provisional Health Committee of the League, fifth session, January 1923 45 The " International Commission " for the Soviet Union 46 CHAPTER VII: THE CONFIRMATION OF INCOORDINATION 48 The League proposes a Mixed Committee of its Provisional Health Committee and the OIHP . 48 The Permanent Committee of the OIHP dooms the task of the Mixed Committee to failure, May 1923 . 48 Recommendations of the Mixed Committee, June 1923 • . 52 Provisional Health Committee, sixth and last session, May-June 1923 55 Council and Assembly of the League, August-September 1923 . 56 The OIHP endorses the proposals of the Mixed Committee, October 1923 57 The permanent Health Committee is constituted, December 1923 . 59 CHAPTER VIII: THE SEARCH FOR A RATIONAL STRUCTURE: THE LEAGUE TRIES AGAIN •.......•.•.....•. 61 A new attempt at rationalization, 1934-1936 . 63 The reaction of the OIHP, May 1936 . 64 The dilemma of the Health Organization of the League 66 The new regime . 67 CHAPTER IX: THE FINAL YEARS BEFORE WORLD WAR 11 . 69 The resignation of Rajchman. 70 The OIHP discusses the new arrangement, May 1937 70 The General Advisory Council of the League's Health Organization, 1937-1939 . 71 Conclusions and reflections . 72 CHAPTER X: EPILOGUE: WORLD WAR 11 AND IMMEDIATELY AFTER 74 The OIHP during and after the war 76 The prelude to the World Health Organization 79 Varying views on the idea of a single international health organization 79 The last meetings of the Permanent Cqmmittee of the OIHP 81 Survivors of the old regime 81 Annotated name index 85 Subject index . 91 ILLUSTRATIONS Page Members of the Executive Council of the Medical Conference, Cannes, April 1919 10 Henry Pomeroy Davison: founder of the League of Red Cross Societies . 11 Report of the Informal Conference on International Public Health, London 1919 14 Arthur James Balfour, first President of the Council of the League of Nations . 17 Dame Rachel Crowdy, one of the earliest senior officials of the Secretariat of the League of Nations . 19 Charles-Edward Amory Winslow receives the Leon Bernard Medal and Prize, 1952 . 23 International Journal of Public Health, published by the League of Red Cross Societies, 1920-1921 . 26 Report of the unusually "Temporary" Health Committee of the League of Nations 28 Leon Bernard, and the medal that commemorates him. 30 Camille Barrere, the Methuselah of international health . 32 Fridtjof Nansen, a champion of displaced persons . 35 Nikolai Aleksandrovich Semashko, first People's Commissar for Health and friend of Lenin . 38 Health education posters produced in 1920 in the USSR 40 Ludwik Rajchman, pioneer of modern international public health 43 Sir Henry Dale, pioneer of international biological standardization 45 Members of the Permanent Committee of the OIHP in 1933 50 Sir George Buchanan, an early member both of the Permanent Committee of the OIHP and of the Health Committee of the League . 51 The Health Committee of the League in the mid 1920s . 53 Thorvald Johannes Marius Madsen, President of the Health Committee of the League from 1921 to 1937 . 54 The. Health Section of the League circa 1924 . 56 Delegates at the conference convened in Singapore in 1925 to establish the Eastern Bureau of the Health Organization of the League . 58 Sir Edward Mellanby, Chairman of the Technical Commission on Nutrition of the Health Organization of the League . 62 The League's 1928 conference on malaria . 63 Rene Sand, pioneer of social medicine and recipient of the Leon Bernard Medal and Prize in 1951 . 65 Jacques Parisot, President of the Health Committee of the League from 1937 and recipient of the Leon Bernard Medal and Prize in 1954 . 67 Title-page of the last proceedings of the General Advisory Council of the League's Health Organization-an alias of the OIHP . 71 Raymond Gautier, who joined the Health Section of the League in 1924 and retired from WHO in 1950 . 75 Neville Marriott Goodman, member of the Permanent Committee of the OIHP and of the Health Committee of the League from 1938. Retired from WHO in 1949 . 77 Hugh S. Cumming, who from 1920 to 1926 was simultaneously Surgeon-General of the USA and Director of the Panamerican Sanitary Bureau . 78 The Technical Preparatory Committee, Paris 1946 . 80 Andrija Stampar, Chairman of the Interim Commission of WHO and President of the First World Health Assembly . 82 The inaugural session of the International Health Conference, New York, 1946 . 83 AUTHOR'S PREFACE International public health between the two World Wars was complicated by the simultaneous existence in Europe of two entirely independent international .health organizations: the Office international d'Hygiene publique (OIHP) and the Health Organization of the League of Nations. The former, rooted in nineteenth century concepts of international health coopera­ tion, was mainly concerned with protecting Europe and North America from cholera, plague, and yellow fever, with minimal inconvenience to international trade. It was not until 1926 that smallpox-as also typhus-were added to its list of" pestilential" diseases. For the whole of the interwar period, the OIHP obstinately and repeatedly resisted the·attempts of the League of Nations to achieve a more rational organization of international health work. The Health Organization of the League of Nations, on the other hand, laid the foundations of international health cooperation as we understand it today, both by establishing international standards and by direct technical cooperation with Member States. Moreover, the establishment in 1925 of the Eastern Bureau of the League's Health Section represented an early recognition of the need for regionalization of international health work. On the political plane, it was impossible that the League of Nations could succeed when three of the major world Powers, two of whom had permanent seats on the Council of the League, were bent on war and conquest. But it is generally conceded that the health work of the League was an outstanding achievement. That this was so was in very large measure due to the genius and energy of the Medical Director of the League's Health Section, Ludwik Rajchman,