Settling Down in Europe

Selskar Gunn returned to Paris in June 1922 where he established his residence until his departure for China some ten years later. During the first five years, the subject of this chapter, he worked for the International Health Board. In early 1927 he was promoted to Vice President of the Foundation, a position established to mark the creation of a more independent European Office. How and why this came about and what new responsibilities came with this appointment are treated in the chapters that follow.

Gunn wrote to Rose in May 1922 that his short visit to Paris to look for an apartment had been successful. There he had found a “very pleasant apartment with lots of air and sunlight and running hot water in Neuilly, which is located within 20 minutes from our present office in Paris.” (May 18, 1922) His hopes for being able to keep his family together, however, did not materialize. Within a year, while visiting New York, he informed George Vincent that he had made plans “to keep his family in the South of France” where he intended to “visit them frequently.” (July 13, 1923) For health reasons, he moved them to Cannes where, given his incredible travel schedule, they probably saw him as much as they had when they were living together in Paris.

Gunn was the first Foundation staff member to be placed in a country with the task of helping the government develop their national public health system. In other countries the Foundation approached the question of public health differently. There, major infectious diseases were attacked as a wedge for subsequent public health work, with an initial focus on hookworm, then malaria and yellow fever. Public health institutes were created to meet the laboratory needs of infectious diseases. In some instances, following the Johns Hopkins model in America, steps were taken to establish public health schools in close affiliation with a major medical school. These other approaches led to reasonably well-defined projects, even though in many instances they did not live up to their early promise, for reasons that often were similar to those that Gunn had encountered in his work: politics, both within the medical establishment and at the national level; weak leadership; poorly functioning public administration; low public esteem of public health; disagreement with the proposals of the IHB. Gunn, in most instances, was forced to improvise from day to day, doing his best under ever-changing conditions, most often of a political nature.

Gunn’s experience while living in Czechoslovakia was judged positively, as reflected in the many laudatory messages Rose sent him. Rose had told him, as noted earlier, that if his duties lessened “there may be interests calling for your attention in Poland and possibly at a somewhat later time in Serbia.” (March 21, 1921)

As already noted, Gunn was very favorably impressed with what he saw in Poland during his visit in February 1921 while he was still stationed in Prague. Following a short visit by Ludwik Rajchman to Prague in July that year, Gunn prepared a summary of “Dr Rajchman’s plans for Poland” and cabled Rose requesting that the Foundation make available funds to support Fellows from Poland. (July 8, 1921; July 18, 1921) (See Dimitrov as well) Gunn eventually did make it to Yugoslavia with Russell in December 1923, but before that he visited Hungary for a “short study” in March 1922, Ireland in November 1922 and again in November 1923 with Russell, Bulgaria from February 26 to March 16, 1923, Denmark from ?? to ??, 1923 and Sweden from ?? to ??, 1923! Gunn returned to Yugoslavia on Mar 20 to April 14, 1924. In that same year he visited Ireland (May 22 to June 10), Hungary (June 28 to July 13) and Algeria (Oct 19 to Nov 8, 1924). Following each of the more substantive trips Gunn wrote extensive reports, ranging from 123 pages for Bulgaria to 250 pages for Yugoslavia, not counting the appendices. Each report was illustrated with photographs as well as postcards depicting important local sites.

His almost frenetic pace hardly slowed down as time passed. However, at the end of 1925, as the following exchange of letters show, Russell tried to put a break on him, with only partial success.

In September 1925 Gunn wrote Russell to inform him of his forthcoming travels:

I am leaving the office on the 15^th September for Norway, via England, and in London I shall see Dr. Stephenson, of Dublin and Dr. Belfour. In Cale I shall hope to arrange the final details with regard to the Institute of Hygiene there and get the additional information which you have asked for. In Copenhagen I am especially anxious to see Dr. Tryde and find out if we can solve the difficulty which exists concerning their statistical service. I shall then stop off for a day or two in Hamburg to see Nocht and determine whether there is any possibility (or desirability on our part) of helping Nocht in connection with his Institute with special reference to malaria courses. I shall then return to Paris for a day or two and leave for Rome, for the malaria congress. I am particularly anxious to see Hackett as we have rather a large number of things to talk over. From Rome it is highly probably that I shall go directly to Prague via Vienna. The Institute of Hygiene in Prague will possibly be opened about the 11^th October, and I think it would be considered discourteous if I did not go. (September 2, 1925)

On his return to Paris Gunn wrote Russell to tell him how pleased he was with his visit to Rome where he was most impressed with “Hackett’s position in Italy.” Nevertheless, he did not feel that the time had come yet “for us to consider making a general public health survey in Italy.” Gunn found the discussions stimulated by Hackett’s paper on Paris Green at the Malaria Congress to be “most interesting,” noting that “the divergence of opinion amongst malariologists on practically every subject is immense and certainly a good indication of the fact that the whole subject is one in which many lacunae exist in our knowledge. (October 18, 1925) Gunn was absolutely right; the dilemma of malaria in Europe would preoccupy Hackett and European malariologists over the next decade. Only when it was discovered that what was thought to be one malaria-carrying vector was in fact several different sub-species of anopheline mosquitoes could the many divergences of opinion be resolved.

Within a month Russell wrote:

There are three new countries in Europe which you have recently been invited to visit, – Sweden, Finland, and Belgium. You will of course choose your own time to make a study of the public health situation of these countries. I am writing now to say that even though something very desirable might develop in one of them as a result of your visit, we do not feel at all sure that we could undertake any program involving a considerable expenditure at this time. We could, if it were desirable, grant a limited number of fellowships to each of these countries. Beyond that, it is not clear that there is anything that we could do now…

I think it is extremely desirable that we should bring to completion some of the projects already under way before starting new ones, and that requires a lapse of time. Furthermore, I do not believe that either your office or this office is able to administer satisfactorily with its present limited staff, additional projects that call for close attention. The development of the departmental health organizations in France will require an increasing amount of your time, and in my judgment there is no more important piece of work anywhere under way than that.

Gunn fully agreed with Russell concerning France. As for the other visits, after acknowledging that he had understood Russell’s message, he curtly went on to say, “I am looking forward to our discussions when I come to America next year.” He probably hinted to what he had in mind for these discussions when he went on to say:

I am more than ever convinced of the necessity of our having enough men in the field to really give close attention to our various activities. Very often an activity involving a relatively small sum of money takes much more time and requires very much greater thought and attention than some large proposition involving building, for example.

The issues that Gunn raised on this and other future occasions became central to the history of the ongoing changes that the Foundation was experiencing at the time, a subject treated in the next chapter.

It is difficult to imagine what projects Russell thought should be brought to completion. Almost every time Gunn visited any country new requests were almost certain to result. Public health was a long term affair. It is true that the construction of buildings must come to an end at some point, but all of the other types of activities that Gunn was engaged in – strengthening institutions, educating the public, increasing the availability of public health services – these never ended, as a brief review of some of the other countries in which Gunn was involved well illustrates.

Gunn’s visit to Yugoslavia resulted from an invitation to the IHB from Dr Andrija Stampar, Director of the Division of Hygiene of the Ministry of Public Health. Stampar accompanied Gunn during most of his visit in early 1924. Gunn was clearly impressed with what he saw, “without any assistance from outside and with limited and inadequately trained personnel they have been able to accomplish much within a short period of time.” In fact, he doubted if there was any country in the world in which such strides had been made in “so short a period of time.” As Gunn understood it, this was exactly the kind of situation the Board was looking for, “to help those countries which are both anxious and capable of helping themselves.” Without such help Yugoslavia would continue on its path but with help “we can accelerate it very materially.” Of perhaps even greater importance was the fact that “by showing our interest in a material way we can undoubtedly assist in stabilization of the whole public health program.”

The political situation of Yugoslavia was complex and potentially explosive. There were political parties that wished to develop the country into a “greater Serbia.” Another favored the monarchy, while still others wished for the autonomy of Croatia or favored the special interests of the clerics, the Mussulman, the Germans and the Hungarians. The border with surrounding countries was still in dispute and sometimes difficult to protect, especially the one with Albania:

The difficulties… have mostly to do with bandits who, unlike the political bandits on the Bulgarian frontier, are ordinary robbers. According to Dr. Stampar, banditry in Albania is a symptom of malaria. The Albanians, who suffer enormously from this disease, are unable to raise sufficient crops, and after a summer of fever, the easiest way in which to make a living is to go out and rob. Unfortunately, these robberies are often associated with murder…

Gunn identified some weak spots: vital statistics, sanitary engineering, and difficulties in controlling malaria. But Stampar’s list was an inclusive one; no area of activity was left out:

1. Traveling and resident fellowships
2. Sending some of the higher officials on study missions to the United States and elsewhere
3. Assistance towards the building of the School of Public Health in Zagreb
4. Assistance towards the development of the training of Public Health Nurses in the Belgrade School of Nursing
5. Assistance towards finishing the equipment of the Institute of Tropical Medicine in Skoplje
6. Assistance towards completing the equipment of the Central Epidemiological Institute in Belgrade
7. Assistance in the erection of School Clinics in Serbia
8. Assistance towards the erection of ten public health centers in ten villages in Macedonia, with financial aid for one-half of their maintenance during the first year of their existence
9. Assistance towards building an Epidemiological Institute in Catinje, Montenegro

10. Assistance for a period of two years to make it possible for the Ministry to employ two tri-lingual stenographers.

In time, Yugoslavia would receive significantly more funding than any other European country that Gunn was actively involved with. In comparison, requests from the other countries visited during this period were not as comprehensive, although all shared in their desire for fellowships and study missions. Some requests already reflected what had gone on earlier in Czechoslovakia. For example, the Hungarian Ministry wished to develop a Sanitary Reform Bureau similar to the one that Gunn had helped establish while in Prague. They had “watched with interest” what the Czechs were doing and concluded that they could benefit from such an idea. The Minister was “enthusiastic” and Gunn recommended that “an appropriation not to exceed $5000.00 be made available” during 1925. Larger investment in Hungary depended on just how solid its economy was, a question that was outside Gunn’s “sphere of knowledge and experience,” although he was optimistic.

Gunn did not carry out an in depth survey of Poland in 1921 during his short visit there. He relied mostly on what he learned from Rajchman, “a very energetic and clever man who has done a wonderful piece of work…” Rajchman’s top priority was the creation of a school of hygiene that would house laboratories, a hygienic museum, lecture and demonstration rooms, a plant for the scientific testing of apparatus, a library and a workshop. Training would be given to sanitary inspectors, health visitors (nurses), health officers and health department secretaries. Sanitary inspectors would not be expected to have degrees but would have taken secondary school courses. They would act as the “executive officers of the Health Officers in all routine matters as disinfection, placarding, sanitary inspection, etc.” Health visitors would probably have standards that for some time “would be lower than those in the United States for public health nurses.” Health officers would be offered two possibilities, a public health diploma course of 6 months and a shorter course of one month. All health officers would be required to take one or the other. Secretaries would serve as clerks capable of handling statistical material and public health legislation among other matters. “Women would be favored for this training.”

Gunn found this program to have a “certain British flavor” which was not surprising given Rajchman’s earlier contact with the Royal Sanitary Institute. He thought that “it must be conceded that in general his plan is a good one.” Rajchman was “very solid with the Minister of Health” but suffered “an enormous prejudice against him on account of his being a Jew.” While funding for his program was well advanced, a good deal more would be forthcoming if the IHB expressed interest in his program, or so Rajchman indicated to Gunn, who continued, “you will gather perhaps that Rajchman is a canny man and has the characteristics of his race.” He ended his letter to Rose with another sweeping observation, “the educated Poles are certainly more polished than the Czechs but they have had better opportunities to become so.”

Gunn rarely made observation of the above kind so it is difficult to judge how prejudicial he was either as regards Jews or nationalities as a whole. More revealing, perhaps, is this letter to him from Edna Ferber some 17 years later:

In our interesting talk … a few weeks ago your reply to my question about the mystery (to me) of the hatred against the Jews seemed to me to be so unsatisfactory that I must try to show you how completely wrong you are.

I asked you what, in your opinion, caused the hideous anti-Semitism now more than ever prevalent. You said that it was their measures for their own preservation. As an example of this you cited the case of a Vienna doctor, famous, and head of a Vienna hospital, who appointed Jews (he himself being a Jew) to all staff vacancies. This you said was doubtless done in a spirit of self-preservation, but that it was a false system which ultimately brought ruin upon himself and his colleagues…

New York Jewish doctors are virtually barred from the large and important hospitals which are not Jewish hospitals. That is, according to your theory, THE CHRISTIAN DOCTORS ALWAYS APPOINT CHRISTIANS IN THE SPIRIT OF SELF PRESERVATION. Or, in other words, self-preservation is fine for Christians, but not for Jews.

I am taking the trouble to write you thus simply because you are, evidently, a man who travels and a man who talks, and a man who is supposedly informed. I feel that I must do what I can, at least, to prevent you from repeating the unsound statement made to me. Jewish doctors in Vienna were subjected to the same discrimination that one finds in New York hospitals. What, then, did you expect the head of a hospital to do, once he was in a position to help brilliant Jewish physicians to practice their art, or science or whatever it is?

No, my dear man. You’ll have to find a better excuse. Sorry to seem cross, but that is the sort of false reasoning that infuriates me.

Edna Ferber was a popular American author who was born in Kalamazoo, Michigan in 1887.  Both her parents were Jewish; her father was a Hungarian-born storekeeper while her mother was born in Milwaukee. It’s not likely that Gunn knew her well; this may even have been their first and only encounter. However, they had at least one friend in common, William Allen White, who may have been instrumental in bringing them together. In any case, it is even more unlikely that Gunn was aware that, at the time they met, Ferber was just completing an autobiographical work, A Peculiar Treasure, published in 1939, which she used “to write about being a Jew.” Ferber pays particular attention to the times when she personally encountered prejudice against Jews. Although not numerous, each such occasion is used to remind the reader of Hitler and the “poison of Nazism.” (p122) With this threat hanging over her and the rest of the world, it is not surprising that she attacked Gunn as she did.

We do not know if Gunn replied to Ferber’s letter, nor are we in a position to guess what his reply might have been. For the moment we must return to the narrower subject of public health, as much as we would have liked to have been able to explore this and other more intimate subjects of his life in greater detail.

When Gunn had left Prague in 1922 it seemed that the Ministry of Health was on its way to carry out the reforms needed to strengthen its public health services. But by 1926 he found that matters had not developed as hoped for. In an intense 3-day visit that began and ended with confidential talks with his close associate Pelc, Gunn managed to meet with senior officials of the Ministry as well as with President Masaryk himself. The picture that emerged was not a promising one.

The Ministry of Health was deeply disturbed by national politics. It was a “scandal” as far as Pelc was concerned. Either it would get a new minister who was a Slovak priest or it would be merged with the Ministry of Social Welfare. Although the country was prosperous the ministry of public health “was at a standstill.” Dr Prochazka was the only man who could save the situation and he had “serious defects.” Even Alice Masaryk judged Pelc to be “vague and vacillating.” Prochazka had been Minister of Health several years earlier but had resigned after serving briefly. Russell thought that he was “the best practical public health man in the Republic.” (September 22, 1920)

In his discussions with Antonin Kolinsky, a “jurist” and head of the Reform Group, and someone that Gunn knew well from his earlier stay and who he judged to be “an extraordinary character,” Gunn learned that the “old-line medical practitioners” were still making life difficult for those committed to reform. They occupied important posts and were always opposed to new activities. Kolinsky ascribed “much of the trouble… (to) the jealousies of fellows and their division into groups.” Also, “things go slower in Czechoslovakia” as compared to Poland or Yugoslavia. He spoke “bitterly of Pelc” while agreeing that Prochazka was needed

Gunn had lunch with the President, Miss Masaryk and the President’s private secretary. He learned that Masaryk was “unable to prevent his (the Slovak priest’s) appointment.” Gunn raised the question of who might be appointed Chief Medical Officer, noting the “the most prominent man was Prochazka,” while also noting that he (SMG) of course “was not in position to consider whether politically Prochazka was the only man available.” The President was not happy with the way Prochazka had behaved after he had left the Ministry, but he would send for him “and talk the whole thing over with him.” Miss Masaryk volunteered the opinion that Prochazka “was the only man available.” Gunn had met with Prochazka earlier and learned that he would be ready to take the position of Chief Medical Officer but only “if guaranteed proper title and authority,” while volunteering the fact that “his political affiliations might be against him as he was connected with the Opposition Party.”

Other intrigues were discussed during the trip as well as some concrete steps for forwarding the progress of various projects in different parts of the country, including some health demonstrations. Gunn, however, made it clear that “the IHB will not contribute to building programs (and) there should not be too many demonstrations.”

One of the areas that Gunn was particularly interested in was Podkarpatska Rus (Sub-Carpathian Ruthenia), a remote rural region in the extreme Eastern part of Czechoslovakia. When Gunn raised this subject with Masaryk, the President told him, “the(se) people were really nomads – all they wanted was a few cattle – they did not know how to work the land and had no innate love of the soil – they needed to be helped in all directions. Schools were being established in Podkarpatska Rus which taught the people how to plough, etc..” Whether Masaryk knew about the health projects that Gunn had helped initiate there was not indicated.

In early 1921 Gunn told Rose that he might take a trip to Ruthenia with “their representatives,” expressing that he was “anxious to see that country.” He deliberately used the word “country” to reflect his awareness that Ruthenia earlier had had hopes of becoming an independent state. (February 1, 1921) Instead, they were promised a good degree of autonomy after the war if they joined the Czech Republic. Gregory Zatkovich, a Pittsburgh lawyer, had been proclaimed its President in America at the end of the war and was then appointed first Governor by Masaryk in April 1920. A year later Gunn recorded how Zatkovich had sent his resignation “quite a while ago” but had not received a reply and he was “now threatening to get out,” because an autonomous status had not yet been granted.

Whether Gunn was aware of a story going around about Zatkovich’s wife is not recorded, and while perhaps of little relevance to our story, I can’t resist not including it. It was related by the Senior Red Cross official, Ernest Bicknell:

He (an American business man) talked with the President’s wife who had arrived only a short time before. Impressed by the romantic story of the president elect in America and his trip to far-off Ruthenia to help his people, he said something to this effect:

“It must be a great pleasure to you, Madam, to come over here under such inspiring circumstances, to become the leader of the women of this country and to share with your husband the great privilege of building your people into a happy and prosperous nation. Are you now enjoying it tremendously?”

The “first lady” looked at her enthusiastic visitor with an expression of disdain and replied briefly:

“Hell, no I wish I was back in Pittsburgh!” (p370)

She got her wish. Zatkovich did not remain in his office much longer; he returned to Pittsburgh where he resumed the practice of his legal profession. But before leaving he and Gunn had several opportunities to discuss public health in his country.

When Gunn first met Zatkovich in April 1921 he “told him a few things about the budget for public health in his country which he knew nothing about.” Much more money had been voted by the central government for Ruthenia than they had received. Not surprisingly Zatkovich asked Gunn to “make a study of public health conditions and services.” (April 22, 1921)

Gunn finally made his “strenuous but fascinating” trip to Ruthenia in July 1921. (July 16, 1921) There “he slept in 15 different beds” in 18 days, a number of which were “full of bugs which made sleep difficult if not impossible.” (July 18, 1921) Following this trip it was arranged for Karl Driml to take on the “pioneer’s” job of County Health Officer in Beregsas, a position that Gunn “rather envied.” (August 25, 1921) The Minister (Prochazka at that point) visited Ruthenia in September for 10 days which Gunn recorded as “being a bit of an eye-opener for him” and one that would lead to Driml getting “good backing.” (September 6, 1921) But it was at this point that Prochazka was forced out and Driml found himself no longer a health officer because the political area where he was located “had been carved up.” (November 14, 1921). Within the month Driml was assigned to work in a hospital, a development that Rose hoped would be “only temporary.” (December 6, 1921) This proved to be the case; by the end of the year Driml was back to his rural health demonstration project.

By May 1922 Gunn was able to report on the successful Clean Milk Exhibit that Driml had organized as part of an agricultural fair. (May 18, 1922) In his proposed budget for 1923 Gunn indicated that Driml would be responsible for “numerous public health educational activities such as typhoid fever exhibit, clean milk exhibit and plays for children. (August 30, 1922) By the end of 1922 Gunn rather proudly informed Rose that “Driml seems to be wedded to Public Health Education, and a new sub-bureau in the Ministry of Health for Public Health Education will be started at the beginning of the year.” (December 4, 1922) In his review for 1923 Gunn reported that the work for which Driml was responsible accounted for “the larger part” of the 18,240$ spent in support of the Division for the Study and Reform of Public Health Activities.” (October 3, 1924)

In a short report written by Driml one learns how similar his health education efforts were with those that Gunn had so successfully promoted in France. Lectures, exhibits, cinema, schools, articles for school books, school pictures, education of teachers in practical hygiene, material for health articles in daily newspapers, posters for trade and industrial working-rooms, pamphlets on hygiene, etc were all used to reach the Czech people, particularly its children. Plays were written: The Enchanted Land, “an allegorical play on the fight against tuberculosis;” The Tiny Bacillus, “a puppet play for children dealing with the fight against tuberculosis;” Brok and Flok, “a story of three dogs, dealing in an entertaining way with the fight against rabies;” Punch’s Health Talks, “short scenes for children’s theatres, puppet theatres, school festivities, etc.;” the Chinese Mirror, “a play for young people dealing with the fight against smallpox;” The Sun’s Valley, “a play from the life of Indians, the object of which is to propagate healthy scouting and gymnastics;” and The White Lady, “a puppet play describing the importance on public health nurses and visitors in rural cities.”

Czechoslovakia had at that time about 2000 “permanent puppet theatres,” which accounts for the central place that plays for puppets occupied in Driml’s program. These were located in schools, rooms of different organizations, and gymnasiums, and on the average played at least twice a week with an average attendance 50 people. A monthly publication “The Puppet Theatre” was in its 9^th year of existence. No puppet plays had ever been produced before on the subject of health. Nor was health a topic that newspapers paid any particular attention to. But, slowly, the subject caught on. Major newspapers started including regular articles on public health for their readers.

Gunn’s 21 month stay in Czechoslovakia had made it possible for him to obtain an intimate understanding of its problems and its possibilities, something that he was not able to do in any of the other countries that he was involved in subsequently, with the possible exception of China. With that knowledge he could influence the course of a handful of careers, including those of Driml and Pelc. Whether this was cost-effective in the modern sense of the word is impossible to determine. But for Gunn, it provided tangible evidence of the need for people like him in each country in which the Foundation was working, especially, as he had pointed out to Russell in 1925, if the activity involved “a relatively small sum of money.” And as the IHB budget was growing tighter with each passing year, Gunn’s argument made increasingly more sense. Gunn’s criticism of how the Foundation carried out its work, in time, was actively sought for by Vincent, a development that is explored in a later chapter. For now we turn to another responsibility that Gunn gained by moving to Paris.

In an article written for the Atlantic Monthly in June 1920, Raymond Fosdick, member of the RF Board of Trustees, wrote, “In spite of the failure of the United Nations to ratify the compact, the League of Nations is alive. It is a going concern. It machinery is being completed, and its influence is spreading.” In his annual report for 1921 Vincent wrote of the Foundation’s intention to take part in “world-wide team work for preventing disease and bringing about improved conditions of health.” (Dubin, p 57 and 75)

As described earlier, an alternative possibility for international public health had materialized around that time, the League of Red Cross Societies (LRCS). But the Foundation chose to restrict its support of the LRCS to the provision of modest grants for the education of nurses. (Weindling, p271) It made far more sense, given its commitment to the well-being of mankind, for the Foundation to promote health as part of a wider program of work, which at the time the League of Nations possessed. It had been established to promote international co-operation and to achieve international peace and security.

Rajchman was asked to take over the position of Director of the LNHO early in 1921, a post he assumed later in October. His administrative abilities combined with a solid technical background, as demonstrated as a member of the League’s Epidemic Commission, had already been noted by Foundation staff as well as others involved in the work of the League, thus this appointment was greeted with general acclaim. As the newly established Director of the Paris Office, it was Gunn’s task to manage the Foundation’s support to the League.

Rose, before his departure as Director of the IHB, had helped shape two major LNHO programs which the Foundation supported, the establishment and maintenance of a Special International Service of Epidemiological Intelligence and an International Interchange of Public Health Personnel. Both were to begin no later than  January 1923; the Service was to last for a period of five years, while the Interchange was to continue for “not less than three years.”

Gunn was not involved in any of the early discussions between the Foundation and the League of Nations. Although Rose had gotten two programs going, Rajchman was constantly seeking to expand them and prolong their duration. Gunn, as the intermediary between Rajchman and New York headquarters, examined the various possibilities that Rajchman brought to his attention, discussed them with Russell and re-worked them if necessary to make them acceptable to Russell and the Board of Trustees. One of the first such efforts concerned the Epidemiological Intelligence Service for which Edwin Sydenstricker, a specialist in the establishment of statistical systems, had been borrowed from the US Public Health Service in 1923 to direct. Sydenstricker developed standardized statistical methods and wished to establish a program to train national officers in these methods. Gunn’s proposal to grant fellowships for this purpose was supported by Russell. (March 16, 1923) Russell found Sydenstricker’s outline of field work “to be well worked out.” That outline called for a preliminary (and confidential) survey that covered public health and vital statistics as well as obtaining a picture of the organization of field staff responsible for gathering and maintaining such statistics. Sydenstricker envisaged that “no less than 3 epidemiologists should be secured” for such work. They should be “men of high grade, good personality, knowledge of languages, trained and experienced in vital statistics, epidemiology and public health organization and administration, and conversant with European conditions.” They would keep in touch with what was going on in other countries in Europe and suggest “special studies” which the LNHO might help organize on an inter-country basis. (February 22, 1923) This was an ambitious goal, well beyond the capacity of most European countries at the time. Those that did gather comparable statistics were in a better position to evaluate their public health programs; the others were pressured to follow suit, which in time they did, although in some instances this was well after the second World War had ended.

Gunn and Rajchman corresponded regularly and met each other when their travel schedule allowed. Gunn passed on what he learned to Russell who also had occasion to meet Rajchman on occasion. After spending several days in Geneva in December 1923 where he attended an official conference of the men who had participated in the Interchange program, Gunn wrote Russell, “I have a better idea of the League of Nations than I ever had. I may say also that my enthusiasm for the League has increased.” (January 2, 1924) From this point on one senses in Gunn’s letters to Russell a more positive attitude with greater attention paid to the various ideas that he had explored with Rajchman obviously with the latter’s intent of gaining the interest of the Foundation. Various new initiatives emerged in this manner, e.g. the interchange of Medical Officers of large urban areas with the idea of studying the “tremendous problem” of improving housing conditions. On this occasion Gunn added, “As you know I am tremendously impressed with the value of this kind of activity and believe that the League of Nations is spending our money extremely wisely.” (February 14, 1924)

Russell, too, expressed support of the League’s health activities, but he wished to see a clear intent on the part of the countries involved eventually to take over from the IHB the costs of any program initiated. As early as March 1924 he wrote Gunn concerning the Interchange program, “The question therefore arises whether our main purpose in making this grant is not already achieved and whether we should not look to the member governments for the expansion and further support of the work.” Russell was of the opinion that the IHB should help the League “develop one department after another until they are able to assume the expense themselves or until it is clear that they cannot.” Also, “we might arrange for an occasional international conference.” (March 13, 1924) Gunn agreed in principle but questioned “if the time limits set in the contract are too short and if the credits voted are too small,” adding further, “I believe that the IHB should be liberal in this whole matter.” (April 1, 1924) Russell was willing to consider the possibility of funding the Interchange program as part of their Fellowship program but as concerned the Epidemiological Intelligence Service, he was waiting to see what the League would do given that the Division established by Sydenstricker was “already fairly well established,” i.e. could Rajchman guarantee that the program was viable if the IHB decided to withdraw gradually its financial support. Gunn replied with excerpts from a letter that he had received from Rajchman that it was an “undoubted fact” that the Service would receive “definite financial support” from the League, but then went on to point out that Europe was “still passing through a very severe financial crisis.” In any case, Rajchman was more concerned with the future of the Interchange, as this was the instrument for “bringing about a permanent ‘change of heart’ in the ranks of Public Health Services.” (May 2, 1924)

Similar exchanges continued to take place over the years that followed. Although Russell constantly reminded both Gunn and Rajchman that an ever increasing contribution on the part of the IHB was contrary to practice, he was equally constant in his support of the work of the League and managed to present new requests successfully to the IHB.

In the exchange of letters one learns that Rajchman, in early 1924, was having difficulties extending the services of Sydenstricker. He spoke with the Surgeon-General Hugh Cumming who advised him that it would be “ill-advised to even take up (this question) with the American authorities … until after the elections in the United States.” Even his own reappointment “was made difficult on account of the fact that he was a member of the Health Committee of the League of Nations.” (May 6, 1924)

That the US Surgeon-General could be a member of the LNHO’s Health Committee while the United States was not a member of the League of Nations (LN) is due to the existence of the Office international d’hygiène publique (OIHP), a body created in 1907 to oversee international quarantine regulations. (Dubin, p56) Hopes for making the OIHP part of the LN were dashed in 1921 when the United States unexpectedly vetoed the plan to transfer the OIHP into the LN. (Dubin, p58) Instead, the OIHP remained an independent entity while members of its Permanent Committee (PC) served on the League’s Health Committee. Cumming, the US member of the PC, was always selected for one of the seats assigned to the PC.

This arrangement did not mean that Rajchman stopped trying to take over the work of the OIHP, as witness the New York Times article dated May 18, 1926 headlined, “Cumming Protests League Methods.” Cumming called the effort of the League to take over the work of the OIHP as “highly injudicious.” When advocates favoring the position of the League pointed out that the League was receiving large financial support from the Rockefeller Foundation, Cumming replied, “The American Government was not concerned with what private American organizations did with their money.”

Real tensions existed between Rajchman and Cumming. One incident particularly upset both of them. This arose during a visit of health officials to various countries organized by the League in early 1925. The officer responsible for organizing and guiding the visit was Dr Louis Destouches, who Gunn had introduced and recommended to Rajchman in 1924, and who later gained fame as an author under the name of Céline.

As described by Gunn to Russell, “Rajchman and the officials in the League are very sore about it. Rajchman stated that when President Coolidge received the men, he asked who had sent them on their study trip and that the President was informed that they were sent by the Pan-American organization.” Gunn went on to note that Rajchman was also sore that “Cumming never acknowledged any of the letters sent to him with regard to the meetings of the Health Committee which have just taken place in Geneva. There certainly appears to be a feeling over here that Cumming does not do very much to push the League, although he is a member of the Health Committee.” (April 29, 1925) Cumming, in his capacity as Surgeon-General was also head of the Pan-American Sanitary Bureau. As such, he was concerned with the League extending its activities around the world. He interpreted any LNHO activity in the American region as an attempt to “lessen the prestige” of the PASB. (Birn ref)

Gunn took a special interest in the activities of the LNHO concerning malaria which at the time was considered by many “to be perhaps the most urgent health problem in Eastern and South-Eastern Europe.” (October 12, 1923) Initial efforts focused on the question of why malaria had disappeared in some countries, e.g. Denmark and Holland, and not in others. Gunn thought that it had been due to “the almost complete use of land for agricultural purposes, combined with high intelligence on the part of the people,” while adding, “there may of course be other important reasons.” Rajchman wanted to go further. Such studies will not assist countries in controlling malaria. He wanted the League to carry on some malaria control work while suggesting to Gunn that the IHB assist Greece in the malaria campaign. He also pressured the IHB to make Louis Hackett a member of the Commission.

Hackett could not be made a member of the Commission under IHB rules but he could actively participate in its work as an observer. This proved critical in helping Rajchman overcome the conservative position of members led by Col. James who in March 1930 had prepared what Rajchman judged to be “a hopeless document” which if adopted “would probably have resulted in almost complete stagnation in anti-malarial work in Europe.” Gunn pointed out to Russell that had it been adopted “it would have made it impossible for Stampar to continue the kind of malaria work in which he is now engaged.” (March 30, 1925) Russell pointed out in his reply that “Hackett deserves a good deal of credit for analyzing the situation at an early date, which permitted everyone to have knowledge of the danger and to take some steps at least to correct the errors. It means a good deal to have brought about a reconsideration of the old formula for the eradication of malaria, and this we have in some measures been able to do so during the past year. (April 13, 1925)

Linsly Williams remained until July 31, 1922 at which time he resigned to become the managing director of the NTA. Gunn, who by then was in charge of the Foundation’s Paris office, took over.

The French anti-TB budget rose steadily from one year to the next despite the desire to have the French take over as quickly as possible. The 1919 budget was slightly more than 600,000$, a figure that was found to be “disproportionate to other phases of the Board’s program.” (p1037) Although steps to transfer responsibility to the French were accelerated, when the program finally came to a close in 1925 some $2.4 million had been expended.