Achievements of UNR
    Till as an
International Health Organization

  WILBUR A. SAWYER, M.D., LL.D.,`F.A.P.H.A.
Director of Health, United Nations Relief and Rehabilitation Administration,
            WasAington, D. c.

S 0 astounding is the magnitude of the
overall performance* of the United
Nations Relief and Rehabilitation Ad-
ministration, with its mammoth ship-
ments to war-ravaged countries of food,
clothing, agricultural seeds, implements,
and other essential supplies, that the
strictly health functions are dwarfed by
comparison. Nevertheless, in order to
meet its responsibilities during the emer-
gency, the Health Division of UNRRA
had to expand until it became by far
the largest international health organiza-
tion which the world has yet seen. This
is true even if the coijperating Division
of Medical and Sanitation Supplies*
is not included.

The extent of UNRRA's operations
was dramatically illustrated by a com-
ment of Mr. Noel-Baker l at the recent
session of the Council of UNRRA at
Geneva:

During the war I was a Minister under Mr.
Churchill in our Department of War Trans-
port, and month by month I used to watch
the convoys which brought to Britain the food
and the raw materials with which we fought
the war.  The scale of UNRRA's supply
operations each month is now equal to the
total import programme of the United King-
dom in those historic times.

For UNRRA's entire period of active
operations lasting about three years, the

o The Division of Medical and Sanitation Supplies.
nJponsible for procurement and distribution, is in the
Bureau of Supply, while the Health Division, under
the Director of Health, is in the Bureau of Services.

total budget amounts to approximately
3 billion 7 hundred million dollars.
When the Administration closes its
books next year it is estimated that its
health work will account for close to
168 million dollars. The largest por-
tion of this amount, or about 146 million
dollars, will have been spent for pro-
curement and shipment of medical and
sanitation supplies. By June 30, 1946,
105,000 tons of sera and vaccines,
chemicals and drugs, hospital equipment,
and laboratory supplies had already
been dispatched, and about an equal
amount was still to go forward. The
estimate of 22 million dollars for the
health activities exclusive of expendi-
tures for supplies was reached by pro-
rating the total estimated operational
and administrative expenditures up to
December 31, 1946, according to the
numbers of international employees
engaged in health and the number in
the total functions and thus determining
the share belonging to health.

The maximum annual expenditure of
UNRRA for health is that for 1946,
estimated as about 14 million dollars
for the activities of the Health Division
plus 68 million dollars for the procure-
ment and shipment of medical and sani-
tation supplies. This gives an estimated
sum of 82 million dollars for health,
medicine, and sanitation during that
year. The annual sum for health activi-
ties was substantially increased by allot-
ments by certain governments from the
proceeds of sales of part of their

c411


AMERICAN JOURNAL OF PUBLIC HEALTH    Jan., 1917

UNRRA supplies. Such sales to persons
who could afford to buy were permitted
on condition that the net proceeds in
local currency should be turned back
into relief and rehabilitation activities.
The size of UNRRA's effort in the
field of international health can best
be appreciated if we mention for com-
parison a few other important annual
health budgets. The League of Nations
Health Organization had the equiva-
lent of U. S. $414,078 in its largest
annual budget, the one for 1931, and
did valuable pioneering work with
these resources.  The Interim Com-
mission of the World Health Organ-
ization is reported to have a budget
of $300,000 for the remainder of 1946
and $l,OOO,OOO for 1947. The Inter-
national Health Division of the Rocke-

feller Foundation for the calendar year
1945 had a budget of $2,200,000 for
its regular program and expended also
$157,016 from the special war funds
of the Rockefeller Foundation Health
Commission. The United States Public
Health Service has a total budget for
the fiscal year ending June 30, 1947, of
$88,423,516, including $290,700 for its
new Office of International Health Rela-
tions. All the 48 states of the United
States of America together appropriated
about 50 million dollars for health for
the year ending June 30, 1946, and the
corresponding figure for the local gov-
ernments is about 70 million.  These
comparisons bring out the magnitude of
UNRRA's total expenditures for health.
They had to be large because the re-
quirements for relief health services and

TABLE 1

International and Local Professional Health Personnel by Profession and Place of Duty
                 June 30, 1946

Place of Duty 1
Headquarters-Washington
European Regional Office
AibilUiZl
AUSti
Belgium
Byelorusafa
China
Czechoslovakh
D0deCatX.X
Ethiopia
FraXa
Germany
Greace
Hungary
Italy
Middle East
Poland
Ukraine
Yugoslavia

1
4
-
489

                                        ,
                   Sanitary    Other
Physi&nr          NUNeS   Engineers  P&?S&~l
   7       0       2       1       4
  10       2       2       0       1
   1       0       0       0       0
  36       1       28       0       0
   1       0       1       0
9;       0       0       0   8
         18      32       14      20
   1       0       0
   1       0       5   :   :
   1   8              1       cl
   2                     0       0
280       7      348
  21       1       32   :       1
                               26
          0   2"       0       0
    i              2       11
                 9       2       2
    x   :   i       1
                               0
          0       2       2       1

         30      512      36      61

1:
4
4

Total
14
15
a:*
2
1
174 *
A
4
2
640 '
114
0
59 =
171
9
1
9

1,134 g

Grand Total  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .._..............................

lThere wz~ no professional health personnel in Finland, Korea, or the Philippines, where

LO.%1
Em~loyea
  0
  0
  0
  0
  3
  0
  11
  1
  0
  0
  2
  43 4
  79 0
  1
  79 0
  1
  4
  0
  5

229
1,134
--
1,363

activity wa5

exclusively on supplies.
  9 Occupied exclusively with Displaced Persons:  Austria, 55, Germany  640, Italy  5,  Middle  Easl  17.
Total 717.

* Including I` program personnel " for clinical work and teaching. 113 (59 Physicians, 17 Dentist+
20 Nurses, 5 Sanitary Engineers, 12 Other).
4Including 34 Physicians and 9 Nurses.
EIncluding 20 Physicians, 19 Nurses, 24 Sanitary Enginews, and 16 Other.
a Including 25 Physicians, 10 Dentists, 44 Nurser.


p.37        ACI&WEMENTS.OF UNRRA

                          TABLE 2

International Professional Health Personnel by Profession and Nationality

Notionoli0'

June 30, 1944

Physician5    Dcntirts     NUWS

Australia
Austria

BelgilUU
Bolivia

B&i1
  Callada
  ChilM
  COlOdii
  Cuba
gxm~vakia
  Dominican Republic
Eire
  El Salvador
  Equador
  France
  GEeCG
  Hawaii
  Holland
  Honduras
  Iran
  If4
Luxembourg
  Mexico
  New Zealand
  Norway
  Palestine
  Poland
  South Africa
  stateless
  Switzerland
  u. IL
  u. s.
  USSR
  Venezuela
Yugoslavia
  UllkIKlWll

TOtal.

I
2
28
1
9
8
:
13
20
9
1
18
2
5:
6
1
13
0
i
3
12
1
2
3
31
1:
a
100
90
:
3
19

12
1
76
0
0
28
0
0
0
1
43
0
21
8
50
0
0
68
0
0
13
1
0
6
5
0
2
:
4
1::
0
0
0
10

489

30

supplies were extreme at this time of
unprecedented emergency.

THE STAFF OF THE HEALTH DIVISION
The professional staff of the Health
Division at Headquarters in Washing-
ton, at the European Regional Office in
London, in the China Office, in the dis-
placed persons operations in Germany,
and in the Missions to the several
assisted countries,,is shown by numbers,
professions, and nationality in Tables
1 and 2, as of June 30, 1946. At that
time recruitment of new personnel
ceased and numbers were already be-
ginning to decrease.

The recruitment of a large profes-
sional staff during the war was extremely

512

difficult.

0
0

0
0
0
:
z
25
0
0
0
0

0
:
0
0
2
0
0
0
:
:
00
0
0
0
1
0
::
0
0
0
0
0

:
0
0

:;
0
0
1
3

Total

19
3

104
1
10
39
:
:J'
53
3:
2
1
101
7
2
a2
1
3
13
1:
:
3
34
4
13
12
206
263
1
3
4
32

36        67       1,134

In Great  Britain and the

United States, military needs had pri-
ority. Many other areas which were
drawn on later were at first inaccessible.
The Surgeon General of the United
States Public Health Service and the
Chief Medical Officer of the British
Ministry of Health appreciated the in..
ternational importance of the health
activities of UNRRA and helped
arrange for the temporary release of
experienced personnel from positions in
their countries.  The U. S. Public
Health Service also assigned many of
its commissioned officers to service with
UNRRA and in September, 1946, there
still remained on duty with the Health
Division 34 medical and 4 dental of-


44      ~IMER~CAN JOURNAL OF PUBLIC HEALTH

ficers, 66 nurses, and 16 sanitary
engineers.

The international professional staff
was recruited principally from the 48
nations now participating in UNRRA
and on. as broad an international basis
as possible. From Table 2 it will be
seen that the 1,134 professional persons
in the international (" Class I ") cate-
gory, included nationals of 35 countries
and a few classified as stateless or un-
known. The posts of greater responsi-
bility were also widely distributed
among the nations, as will be illustrated
by a few examples. At Headquarters
in Washington, the Director of Health
came from the United States, the
Deputy Director of Health from Czecho-
slovakia, the Chief of the Far Eastern
Branch from China, the Chief of the
Epidemic Control Branch from Brazil,
and the Chief of the Branch of Medical
and Sanitation Supplies from the United
Kingdom. In the European Regional
Office, the Regional Director of Health
is from the United Kingdom, his Deputy
from the United States, and the Chief
of the Branch on Medical Services to
Displaced Persons from France.

Chief Medical Officers for Country
Missions and the China Office have been
drawn from many countries; to cite
only a few examples, from Yugoslavia
for China, from Greece for Ethiopia,
from the United States for Poland, and
from the United Kingdom for Italy
and Greece. The Chief Field Medical
Officer in China is from El Salvador.

The international doctors and nurses
fall into two categories, those with
public health training and experience
and those primarily concerned with the
care of the sick.  The public health
group was invaluable in the administra-
tive and supervisory offices, and in field
work in their specialties. Most of the
clinical staff were assigned to assembly
centers for displaced persons or to hos-
pitals and clinics for the general popula-
tion, although a few were primarily

Jan., 1947

engaged in teaching and demonstration.
The volume of accomplishment was far
beyond what the size of the UNRRA
staff would indicate, for staff members
worked side by side with a much larger
personnel of the local health depart-
ments and medical institutions. In
China, coijperation by the Health Divi-
sion was facilitated by a parallel organ-
ization, the Health Commission of the
Chinese National Relief and Rehabilita-
tion Administration. In the 15 regions,
the UNRRA personnel coijperated with
their Chinese opposites in a combined
effort to restore public health and medi-
cal activity to at least pre-war effective-
ness as rapidly as possible.

Several hundred doctors and dentists
found among the displaced persons were
asked by UNRRA to help care for their
fellows in the assembly centers. For
example, in the British and United
States occupation zones of Germany at
the end of July, 1946, there were 152
dental clinics staffed by 311 dentists,
nearly all displaced persons.

Certain principles determined whether
a country desiring assistance needed a
Mission and heahh services. Such
assistance was available to invaded
countries  seriously damaged, and
finally liberated from the enemy, which
did not have enough foreign exchange
to purchase the imports they needed.
This was the case with Greece, Poland,
Czechoslovakia, Yugoslavia, Albania,
Ethiopia, China, Byelorussia, and the
Ukraine.

Work was done also in ex-enemy
countries under conditions determined
by the UNRRA Council. These were
Italy, Austria, and Hungary. In Ger-
many, UNRRA assistance was given
solely in the care of displaced persons.
Limited assistance was given to the
Dodecanese, Finland, Korea, and the
Philippines.

In the assisted countries, the health
staff, headed by a chief medical officer,
is an integral part of an UNRRA Coun-


vi. 37         ACHIEVEMENTS OF UNRRA             45

h M&&n, and is, under the overall
&ction of the Chief of Mission and
h+, deputies.  For technical guidance
and gene& health policies there is,
nevereelest+ a close dependence on re-
gional offices and headquarters.  The
international professional health staff
in a Country Mission varies from one
medical officer in Czechoslovakia and
&e Ukraine, for example, to 174 pro-
fessionally trained people in China.
However, what we have come to think
of as a I` standard mission," has at least
a chief medical officer with public health
training, a chief public health nurse,`and
a chief sanitary engineer at Mission
headquarters, with field personnel in the
districts assigned according to need.
The large staff of 640 persons in Ger-
many is occupied only with the care
and health protection of displaced per-
sons. Similarly engaged are 55 persons
in Austria (29 physicians, 26 nurses),
5 in Italy (3 physicians, 1 sanitary engi-
neer, and 1 nurse) and all 17 of the
persons in the Middle East.

ORIGIN AND FUNCTIONS OF THE
      HEALTH DIVISION
When the future historian evaluates

the work of UNRRA's Health Division,
he will probably attribute greater sig-
nificance to its service in bridging the
war-caused gap in the evolution of inter-
national health organization than to its
relief operations of a purely emergency
nature.  Many of the national health
departments, on which the world health
structure must rest, were inhibited or
broken by the most widespread and
destructive of all wars. There was an
unprecedented shortage of materials,
apparatus, transportation, communica-
tions and buildings essential to the pro-
tection of health and the maintenance
of medical care. There was, in addition,
disorganization, loss of trained per-
sonnel, and isolation from the newer
health knowledge.  The international
bodies such as the League of Nations

Health Organization and the Interna-
tional Office of Public Health in Paris, to
which the affected national health de-
partments would naturally turn for
guidance and leadership, were cut off
from most of their field of activity an&
were largely prevented from functioning,
The International Health Division of
the Rockefeller Foundation had been
forced to terminate most of its activities
in Europe, and had as a result deflected
more of its attention to South America.
The Pan American Sanitary Bureau,
operating only in the Americas, was less
disturbed.  The experiences of these
organizations, and the experts they had
trained, were most valuable for the
restoration of health departments in the
liberated countries and in carrying for-
ward the health work of UNRRA,
To face the challenging situation,
UNRRA's Health Division was created    .
in December, 1943. Forty-four nations
had signed an agreement on November
9 establishing the United Nations Relief
and Rehabilitation Administration. The
Health Division  started operations
shortly after the first Council session,
meeting in Atlantic City, had laid down
in detail the purposes and objectives
of the new agency, and had given it
the necessary framework of instructions
and authority.2

The functions of the Health Division
may be summarized briefly as follows:

1. Assistance to national health authorities
a.in the prevention of war-engendered
epidemics,
b.in the rapid restoration of national health
departments,
c. by assignment of technical staff for con-
sultation and cooperation,
d. in determining the requirements in med-
ical and sanitary supplies to replace losses
through destruction, looting, and the cut-
ting off of sources, and in cooperating
with UNRRA's Bureau of Supply in re-
lated technical matters of procurement
  and distribution.

2. Revision and administration of international
sanitary conventions for maritime and aerial
quarantine, as applied to signatory mem-


46'

AMERICAN JOURNAL OF PUBLIC HEALTH    Jan., 1947

bers of the United Nations, and the carrying
out of the specific duties imposed on
UNRRA by the revised conventions.
3.Provision and technical supervision of
medical and sanitary personnel for the care
and health protection of persons displaced
by war wherever UNRRA has responsibility
for them in assembly centers, or camps, or
during travel back to their countries.
4.Trainmg of professional health and medical
personnel of the assisted countries, in
preparation for relief and rehabilitation
work, through study fellowships in foreign
lands and by supplying teachers and lec-
turers for courses in the assisted countries.

PREVENTION OF EPIDEMICS

The great wars of history have been
accompanied and followed by sweeping
epidemics, usually directly related to
the devastation and hardship. In the
recent World War, since the destruction
was more widespread than ever before,
the greatest catastrophes were to be ex-
pected, Multitudes of people were being
driven from place to place. Thousands
were crowding into makeshift dwellings.
Scarcity of food, clothing, medical care,
and even of pure drinking water was
almost universal.  .4nd most of the
health departments that had survived
the war had been completely disrupted
and so largely deprived of necessary per-
sonnel and supplies that they were quite
ineffectual.

The only hope of avoiding major
health disasters lay in the advances in
medical science made since the previous
World War and in early organization to
apply this new knowledge effectively.

Appreciating the appalling risks to
world health, the Council of UNRRA
gave the Health Division a wider man-
date with regard to epidemic prevention
than in its other fields of activity. It
authorized measures to control epi-
demics not only in liberated areas but
also in enemy and ex-enemy countries
with the purpose of preventing the
spread of such epidemics to United
Nations areas or to displaced persons
of United Nations nationality.

Of the war-engendered epidemics to
be expected, the one that presented the
most alarming threat was typhus fever.
Consequently, the Health Division felt
the highest degree of responsibility for
curbing it. Without control, widespread
epidemics of typhus were inevitable.
With control, safety was possible be-
cause of the effective new weapons which
had been developed against the disease.
UNRRA was in a position not only to
secure and distribute vast quantities of
DDT delousing powder, but through its
field staff it could give directions as to
the method of application.

The results have been highly grati-
fying. No great runaway epidemics of
typhus have occurred as the result of
the recent war.  Credit must be given
first to those who devised the practical
and effective methods of delousing fully
clothed persons by powdering with
DDT. The Bureau of Entomology of
the U. S. Department of Agriculture,
the International Health Division of the
Rockefeller Foundation, and the United
States of America Typhus Commission
all contributed invaluable evidence ob-
tained through experiments and field
trials. Before UNRRA had free access
to some of the critical areas, the occu-
pying armies, the U. S. A. Typhus Com-
mission, and the International Red
Cross here and there helped the local
health authorities to keep the situation
in check. As soon as the shipping lanes
were cleared, UNRRA dispatched thou-
sands of tons of DDT powder and many
hundreds of dust pumps. UNRRA staff
was sent in to help organize control
and to give instruction in methods. A
limited amount of typhus vaccine was
supplied also but it was not used on a
large scale in the general population,
and therefore played only a secondary
r6le. The size of UNRRA's effort is
disclosed by the large amount of 10 per
cent DDT delousing powder which is
being distributed to the various coun-
tries, as shown in the first column of


+CHIEVEMENTS OF UNRu              47

TABLE 3

Total Program for Shipping DDT, by Recipient Countries

Fm Ty9hn.s
Controi

Far Malaria Control
     L          ---

10% DDT     `20% DDT       26% DDT
POW&7          SOlUfiO~         Solution

In Powbis        In Galhs        In Gallons

198,100
2.394,410
216,040
170,000
205,175
  8.900

224;640
100,000

  ..,.
2,014,980
1,254,236

39,000
. . . .
. . . .

. . . .
275,204

. . . .
. . . .

. . . .

. . . .
. . . .
90,000

50,000
130,000

. . . .
4,000
253,cao

. . . .
225,000
. . . .

.,..
. . . .
270,000

-                ---         --
  Totals           6,786,481         404,204         932,000
               (3,393 tom)

Table 3. The other columns showing dence was 33,929 cases in May. For
the amounts of DDT being shipped for  1945 our reported figures began with
use in malaria control will be referred  April, and the comparable peak seems

to later.  A single dusting of one per-
son requires about 2 ounces of the
10 per cent DDT delousing powder,
and it is effective for several weeks.

Probably the most practical estimate
of the general results of the campaigns
against typhus can be obtained by com-
paring the typhus incidence in Poland
in the years 1919 and 1920, immedi-
ately after World War I, with the avail-
able figures for part of the corresponding
period of 1945 and 1946, after World
War II. This is done in Table 4 and
Chart 1.

In 1919, the maximum monthly inci-

to have been reached also in Nay with
2,987 cases, or less than one-eleventh
as many as in May, 1919. In 1920 and
the early part of 1946, the correspond-
ing maximum figures, both of them in
January, were 34,530 and 1,235, giving
a ratio of approximately 28 to 1. The
data for 1919-1920 are for Congress
Poland and Galicia only, while those
for 194.5-1946 relate to the present ter-
ritory of Poland, including the three
former German provinces which came
under Polish administration in Septem-
ber, 194.5. Eastern Galicia is therefore
excluded in the later period, but Poland

lOOc/o DDi
POWdl7

In Pou?uis

24,000
250,000
6,450
. . . .
533,100
,...
406,000

,...
20,000
157,525
55,000

1,452,075

TABLE 4

Typhus Fever in Pokand, 1919-1920 and 1945-1946

JUUIy               14,207
FebIW3~                           34,530

March               17,061          25,858

April               23,272          27,843

May                28,190          24,616
                  33,929
JUW                             24,339

July               20,445           12,329

@ust              22,287           5,366
September             14,735            1,388

October               11,986           1,650
Nwember             12,980           2,195

December              12,382           3,013
                 18,333           4,576

    Number oj Cares
v-
               1920

I

  Number of Cares
       L
1945

. . . .

. . . .

. . . .
1,867
2,987
1.795
1;536
794
782
869
601
682

-
1946

1,235
635
516
417
221
89
99
78
47

. . . .
. . . .


48

AMERICAN JOURNAL OF PUBLIC HEALTH    Jan., 1947

CHART l-Typhus fever incidence in Poland after World War I in comparison with the
               incidence after World War II

west of the German frontier of 1914 is
included, which makes the two sets of
figures fairly comparable. Moreover,
the differences observed in the compari-
sons are so great that we are not.
attempting here to make allowances for
changes of area or population. It is evi-
dent from the chart that typhus in
Poland is being conquered and that the
war emergency with respect to this dis-
ease is over. In fact, we are given hope
that Poland could exterminate typhus
before long by the modern methods
which have been introduced. This result
could be hastened by international
planning with participation by Poland's
neighbors as well.

A flare-up of typhus fever in Yugo-

slavia was also to be expected, for it
was in Serbia that the great epidemic
of 191.5 occurred early in the previous
World War.  During that visitation,
over 150,000 people died of typhus
within a period of 6 months, and the
daily admissions for typhus to military
hospitals alone rose to the staggering
height of 2,500.  Nothing comparable
was permitted to occur in the recent
war, although the disease was epidemic
in Croatia and Serbia before effective
control could be initiated. The U. S.
of America Typhus Commission was
invited early to Yugoslavia to help con-
trol typhus. The Commission organized
control by DDT dusting and vaccina-
tion and trained many persons in the


.i.:;
,yf?l. 3z "'       ACHIEVEMENTS OF UNRRA              49

`&ethods. Later UNRRA took over and  two sanitary engineers to its Poland
.a&& to advise and to provide the  Mission in the hope that they can assist
&cessalY supplies.  Typhus in Yugo-  the trained sanitary engineers of the
&via is steadily responding to control.  Ministry of Health in discovering and
There were about 50,000 cases in 1945,  correcting some of the responsible con-
but only 3,000 in the first half of 1946.  ditions in the post-war environment.
The same rosy picture cannot be   In Table 5 and Chart 2 is shown
painted for another serious preventable  for comparison the monthly incidence of
disease.  During my visit to Poland  typhoid and typhus fevers from April,
in November and December, 1945, I  1945, to August, 1946. The great seri-
was astounded at the amount of typhoid  ousness of typhoid and the present low
fever then present. It was being largely  incidence of typhus are clearly shown.
attributed to the great amount of migra- The typhoid fever maximum in October,
tion and to contact between cases.  1945, was 17,629 cases and the peak in
Unfortunately, we had no .new tech-  May of the same year for typhus was
niques, comparable to the use of DDT  only 2,987 cases.  The three former
in a dust gun, that could be used for  German provinces now under Polish ad-
combating epidemics of typhoid. Since  ministration are included only from
then the Health Division has assigned  September, 1945.  Later returns show

R i i

CHART Z-Comparison of typhoid fever and typhus fever incidence in Poland,
           April, 1945-August, 1946
           .


50 ".

ABEEIUC~ JOURNAL OF PUBLIC HEALTH    Jan., 1947

TABLET

Typhu; and Typhoid Fkoer in Poland,
   April, 19+August, 1946

                Number of Cases
             r        L        \
           Tyfihoid Fcvw     Tjrphw
April, 1945        1,871       1,867
Miy             2,825        2,987
JUne              3,835       1,795
July              7,457        1,536
August            10,628         794
September          16,569         782
October            11,629         869
November          10,999         601
December           6,345         682
January, 1946         5,983       1,235
February           3,551          635
March             3,180         516
April             3,110         417
May             2,335         221
Jmle              2,088          89
July             3,475          99
August             2,680          78
September           2,605.         47*
o Provisional figwes

year when an epidemic was developing
in Chungking. An UNRRA team of
7 physicians and 2 sanitary engineers,
with 6 tons of needed medical supplies,
was flown to India and over the Hump
to that city.  Unfortunately, one in-
stallment of the supplies was lost over
the Himalayas. The team took part in
the control of the epidemic and the care
of the sick.4

that typhoid seems definitely to be
coming under control.

Early in March of this year (1946),
I saw in the Contagious Disease Hos-
pital of Canton the first five cases of
cholera of the recent epidemic. Subse-
quently, other cities of China were in-
volved successively. The experience of
the larger ones is shown in Table 6. By
mid-summer, cholera became active also
in southern Manchuria, where it flared
up in numerous localities. In July alone,
11,910 cases and 4,697 deaths were re-
ported from 26 cities and 2 rural areas
of Manchuria.

The war and post-war conditions that   Assistance to the Chinese authorities
brought a marked increase in the preva-  in the control and treatment of cholera
lence of typhoid fever in countries of
continental Europe would have spread  has been promptly given by the medical
                      staff of UNRRA. Cholera vaccine for
cholera also, had it not been completely  mass immunization, and even calcium
absent.  In fact, the disease had not  hypochlorite for water purification, were
extended west of Iran since 1931. In  flown to Canton early in its epidemic.
China, on the other hand, cholera is  Since then several emergency shipments
endemic and was quite active in the  of material necessary for fighting cholera
summer season of 1946.3 UNRRA was  and for treating the sick with intra-
first called on for emergency help in  venous salt solution and plasma have
fighting cholera in June of the previous  been sent by air directly to China from

           TABLE 6
Cholera Cases in Certain Chinese Cities, 1946

YOnlh                  Cantorr        Shanghai        Nanking
March                  548
Ati.                1,196      it      Et
5
A&u&     1,097 853 250   2,468 816 27t   209 ot 4
                      37            933            300
September                 22'           171             22

Total, Cases             4,003          4,415            535
Deaths                1,208            352             31
Case Mortality cent
        per            30.2            8.0            5.8
Population in thousands        1,ooO          3,500            700

  o 20 days only
  t Excluding imported cases

Foochow
z
  0
  22
422
204
  44 o

692
133
19.2
325


gig* J;!      ACHIEVEMENTS OF UNRRA             51

Toledo, ijhio. In Shanghai, two million
cholera vaccinations had been performed
`by early July and this may have been
one- reason that the epidemic WAS ~OS-
ing momentum by the middle of that
month.  Investigations in connection
with the cholera epidemics in Canton
and Shanghai were carried out by an
epidemiologist of the China Office.
Plague was almost completely kept
out of the European post-war picture.
It gained entry to the port of Taranto
b southern Italy when the disease was
present in the island of Malta. From
September 3, 1945, to October 25, there
were 25 cases in Taranto with 12 deaths.
An anti-rat campaign was initiated. All
the premises in the infected area were
sprayed with 5 per cent DDT in kero-
sene to kill the potentially infected fleas,
and about 20,000 workers were dusted
weekly with 10 per cent DDT powder.
UNRRA, as part of its coiiperation,
made available the advice of an expert
on rat extermination.  There was no
spread to other cities.

In China, plague was a greater prob-
lem, but there was no really extensive
epidemic after the country was liberated
and opened to UNRRA. Since then,
the focus centering in Fukien Province
has been active.6 In the early months
of 1946, there was much concern over
reports from Mukden of pneumonic
plague in Manchuria. There were 39
cases with 36 deaths, and the recovery
of 3 was attributed to treatment with
sulfadiaxine.   This small outbreak
stopped abruptly, but there were 13
additional fatal cases of plague early
in March about 70 miles from Mukden.
The National Health Administration is
continuing the study and control of
plague in the Fukien area, using supplies
sent by WRRA, such as plague vac-
cine, sulfadiazine, DDT for killing fleas,
and poison for rats. UNRRA has also
assigned to this work a team consisting
of an epidemiologist, an entomologist,
and a sanitary engineer.

Since Kala-azar is a disease trans-
mitted by a bloodsucking fly, a species
of Ptiebotomus, it can hardly be re-
garded as a result of the war, although
aggravated by the resulting neglect.
There are about three hundred thousand
persons near the Yellow River in Honan,
Kiangsu, and neighboring Provinces,
who have this serious disease in acute
form and urgently need treatment.
They have been cut off by the war from
the source of supply of the antimony
drugs that would cure them. UNRRA's
Chief Medical Officer in China has urged
that for the time being these drugs be
given priority over all other medical
supplies in shipments to China. Unfor-
tunately, the world's entire manufactur-
ing capacity for antimony drugs is not
enough to fill the needs promptly
and it is proving necessary to bring
about the expansion of the facilities for
production.  The medical officers of
WRRA and CNRRA are not satisfied    .
to limit their program to treatment
alone and are hoping to use DDT sup-
plied by UNRRA in an attack on the
Phlebotomus responsible for trans-
mitting the disease, thus initiating a
program of real prevention. This may
not get into full swing until more is
known of the insect and its habits.

For several years: diphtheria has been
the leading epidemic disease in a large
part of Europe.e  Great quantities of
diphtheria toxoid for immunization and
antitoxin for treatment are being shipped
-by UNRRA to the assisted countries.
The amount of diphtheria toxoid in the
supply program is 6,015,960 ml., or
enough to immunixe 2,406,384 persons.
Diphtheria antitoxin is being supplied
up to a total amount of 5,167,080,000
units. Material for the Schick test also
is provided.

    CURBING ENDEMIC DISEASES
The incidence of tuberculosis has gone
up so high in the war-ravaged countries
that this disease presents a serious and


52      AMERICA& JOURNAL OF PUBLIC HEALTH    Jan., 1947

lasting post-war problem, as it did after
the first world war. Tuberculosis ex-
perts on UNRRA's staff have made!
surveys in many countries, using mass
radiography, have analyzed the problem,
have given advice as to the control of
the disease, and have assisted in restor-
ing and correcting the institutions for
the tuberculous.  Such a program has
reached an advanced stage in Greece, for
example, but is still far from complete.'
The Greece Mission has a Chief Tuber-
culosis Consultant and under him are
five area teams, each consisting of a
tuberculosis specialist, nurses experi-
enced in this disease, a radiologist, and
a clerk. These teams travel from vil-
lage to village, examining people to
determine the extent of the problem,
inspecting sanatoria and helping set up
clinics, advising the authorities, and
training technicians in the use of radio-
graphic units.  Some 70,000 persons
have already been examined by mass
miniature radiography. When tuber-
culosis has been dependably diagnosed,
an effort is made to arrange for supple-
mentary rations.  Interest has been
stimulated, an advisory National Tuber-
culosis Council has been organized, and
there is large-scale coijperation from
voluntary agencies.  Supplies from
WRRA have been given to nearly
every sanatorium and dispensary in
Greece. Such supplies range from bed-
steads and x-ray apparatus to drugs
and special surgical instruments. All
this is of great assistance to the govem-
mental health authorities, who are fac-
ing an otherwise insuperable problem,
for in Greece as in the other liberated
countries the surveys reveal a marked
increase in tuberculosis.
. The results of the tuberculosis survey
ln Poland have been published by an
UNRRA specialist.8 He reports that
the restoration of the sanatoria is going
ahead and that much equipment has
come from UNRRA. In Italy, the war
against tuberculosis is benefitting not

only from the UNRRA surveys and
, equipment but also from generous allot-
ments by the government from the pro-
ceeds of sales of WRRA supplies.

Wars produce a marked increase in
venereal diseases, and World War II
was no exception. Fortunately, treat-
ment has become myth more Fffective
in recent years, and the knowledge of
methods of control has also advanced.
UNRRA has supplied large quantities
of drugs useful in treating diseases of
this class and has supplied information
about their use. A specialist in venereal
disease control and treatment has been
attached to the UNRRA Mission in
Poland, and several of the other medical
officers possess special knowledge and
experience in this field.

In the treatment and control of many
diseases beside those here .mentioned,
there is a growing dependence on spe-
cific and effective drugs. Many of the
older effective drugs were not generally
available in the occupied countries dur-
ing the war. The more recent ones were
not known when the war started and
had not been brought in when UNRRA
began operations. The physicians and
health officers were eager to get the
newer drugs and biologicals and infor-
mation regarding  their effectiveness,
safety, and methods of use. To illus-
trate the quantities in which drugs were
supplied by UNRRA, I shall give a few
items from UNRRA's total procurement
program for the assisted countries:
penicillin, 809,550 million units; insulin,
663,690 thousand units; various sulfa
drugs, 1,074,265 lbs.; acetyl-salicylic
acid (aspirin), 1,207,OOO lbs.

   CAMPAIGNS AGAINST MALARIA
Several of the liberated countries
assisted by UNRRA have suffered long
and intensely from malaria. The war
increased the problem by disrupting
drainage systems, depriving the public
of suppressive and curative drugs, and
in general interrupting the existing


voz* 37

ACHIEVEMENTS OF UNRRA

activities against malaria. An extraor-
dmary opportunity for widespread and
systematic malaria control presented
itself to the Health Division after these
countries were liberated, and no time
was lost by the. sanitary engineers of
the Division in organizing the field
operations.  The new methods which
made cheaper and more effective con-
trol possible were the residual spraying
of houses with DDT solution to destroy
the adult mosquitoes and the distrtibu-
tion of the same insecticide from hand
pumps or airplanes on water surfaces
to kill the larvae.

The largest of the campaigns planned
by UNRRA personnel in cooperation
with the governmental health authorities
were in Italy and Greece. The results
were highly successful and the pro-
cedures were most popular. Not only
did mosquitoes diminish and malaria
almost disappear, but there was also
a heavy incidental mortality among
houseflies, bedbugs and fleas.

The campaigns in Italy were carried
out with the approval of the High Com-
missioner of Hygiene and Public Health
and with the cooperation of the Pro-
vincial Medical Officers and the anti-
malaria committees. The program de-
pended mainly on residual spraying. It
began in Sicily in January, 1946, and
was continued first in Frosinone, then
in the highly malarious strip of the
south coast of Central Italy, and finally
in the delta of the River PO. In the
entire operation, the Italy Mission of
UNRRA supplied technical supervision
through its engineers. Moreover, it fur-
nished 21 vehicles, 50 tons of pure
DDT, 216,000 gallons of kerosene,
8,000 galloni of concentrated DDT
emulsion, and the necessary sprayers.
Twenty-five to 150 persons were engaged
in spraying in each of the areas treated.
These areas had an extent of 1,890
square miles and included about one-
third of the total malarious territory
of Italy, excluding Sardinia. The num-

ber of houses sprayed was 50,000; other
structures similarly treated numbered
143,000; and the total area of internal
wall space sprayed was 3 1,405,049
square meters. The good results gave
rise to the prediction that a similar
scheme of operations applied to all the
malarious areas in future years could
reduce malaria until it ceased to be a
problem.

The preliminary work of an attempt
to eliminate malaria from Sardinia by
exterminating the anopheline species re-
sponsible for transmission has been
started.  This will be a joint project
of the Government of Italy, the Inter-
national Health Division of the Rocke-
feller Foundation, and UNRRA. The
International Health Division is supply-
ing the directing scientific staff, the o Gov-
ernment is allotting funds for expenses
from the proceeds of the sale of UN
RRA supplies, and UNRRA is making
available motor equipment, DDT, and
other materials. Encouraged by the sue-
cesses in eliminating Anopheles gambiae
from Brazil and southern Egypt, the
directors of the project are hopeful
that a similar drive on the European
anophelines responsible for transmitting
malaria in this isolated island will
result in their complete and permanent
elimination.

The campaign against malaria in
Greece was nation-wide from the start,
and was planned and directed by the
Chief Sanitary Engineer of the UNRRA
Mission in coijperation with the Greek
health officials.  The methods all in-
volved the use of DDT and included
residual spraying of houses, distributing
an oil solution of this larvicide by hand
pump on small mosquito breeding places
near malarious villages, and applying
20 per cent DDT as a thermal aerosol
to large and inaccessible breeding places
from 10 specially equipped airplanes.
It is estimated that approximately 300
tons of DDT, in terms of the pure
chemical, will have been used during


54;     AtiRIcAN JOURNAL

1946, or most of the supply designated
  for Greece in Table 3. For administra-
tive purposes Greece was divided into 11
regions, in each of which there were
  an WRRA medical officer and a sani-
tary engineer who worked in close co-
operation with a Greek Government
malarlologlst and a sanitary engineer.
Seventeen planes were supplied by
WRRA, of which 10 are used in the
regions.. The other 7 are used for train-
ing pilots, for inspection trips, and as
a source of replacement parts. Each
plane can treat 17 acres per minute,
,and approximately 285,440 acres of mos-
quito breeding  surface have been
treated, counting each area every time
it is gone over. The interval between
treatments is about ,15 days.  This
amount of operation by airplanes has
required 17,840 gallons of 20 per cent
DDT. Residual spraying has been
applied to over 4,000 villages and
towns to approximately 300,000 houses,
stables, and other diurnal resting places
for mosquitoes. The results of the com-
  bined methods seem to have been excel-
lent and the people are enthusiastic.
The fall survey should give a more
  accurate estimate of the reduction in
malaria and its mosquito vectors.

The malaria experience of the Health
Division seems to have demonstrated
that it has at last become practicable
and economical to control malaria on a
national scale.

  VARIOUS OTHER ~ACTIVITIES
It is natural that nutrition should be
.

a pnme interest of the Health Division
in view of UNRRA's great responsibility
to supply food under its relief program.
Medical Nutrition Consultants and
Dietitians of the Health Division made
many surveys of the physical condition
and diets of population groups suffering
from food deprivation. Their primary
duty was to report on the current state
of nutritional health and to advise on
matters of food and nutrition. The de-

OF PUBLIC HEALTH    Jan., 1947

tailed survey for Italy has already been
published?  Some of the specialists
made observations of acute starvation
in Germany, Holland, and China.. One
of them organized a group of about 100
medical students and directed their
efforts to save starving inmates of Belsen
Camp by scientific methods.

In Italy, in addition to the study cited
above, there was an extensive survey by
the Italian Medical Nutrition Mission
sent out by the Unitarian Service Com-
mittee and the Congregational-Christian
Service Committee with the coijperation
of WRRA. They undertook to find out,
by experimental feeding of malnourished
children, what important food elements
were most lacking, and to advise UN
RRA as to needed supplements to the
diets being supplied to hospitals. This
team of medical scientists and labora-
tory technicians worked from April,
1945, to March, 1946, in six different
parts of the country.   It examined
28,651 persons, and gave service to
1,984.

In China, five CNRRA-UNRRA
nutrition teams investigated the famine
areas to determine their nature and
extent. The results confirmed the exist-
ence of acute famine and general low
caloric and protein intake, especially in
Hunan Province. As a follow-up, spe-
cial emergency supplies, including vita-
min products and serum protein, were
flown in from Shanghai. In the mean-
while every attempt was being made
to hasten the sending of quantities of
food.

The general conclusions in the re-
ports from all countries investigated
seemed to be that various degrees of
underfeeding were encountered, some-
times actual starvation, but that frank
deficiency diseases, such as scurvy, pel-
lagra, rickets, and beriberi, were less
frequent than would be expected. Of
these diseases, rickets is the one most
frequently encountered.

Consultants in maternal and child


: ACHIEVEMENTSOF UNRRA            55

mth:l& made surveys and advised
a+,&ments and Missions, A school
feeding program is a prominent feature
& &e Greek program, and the preschool
-&dren al.50 receive attention.
~ Dental consultants have surveyed
he needs in the several Countries for
dental care and have given special atten-
con to the organization of dental serv-
ices in assembly centers for displaced
persons. The dental consultant attached
to the European Regional Office has
given lectures and demonstrations to the
]oca] dental profession.
. The medical and surgical side of the
rehabilitation of the disabled is a respon-
sibility of the Health Division, although
the other aspects have fallen to welfare
workers and voluntary agencies. In
Athens, a rehabilitation center has been
sponsored by the Greek Government,
UNRRA, and the Near East Founda-
tion. The Health Division has provided
an orthopedic surgeon consultant. Arti-
ficial limbs and materials for local manu-
facture and repair are being supplied.

A series of UNRRA facie-maxillary
surgery teams was sent to Yugoslavia
from London. The first, consisting of
6 persons, arrived near the end of 1945.
These teams demonstrated the latest
techniques for correcting mutilation,
and trained local surgeons and nurses.

In many projects which have been
mentioned voluntary agencies took an
effective part. This was especially the
case in the work with displaced persons
in the Middle East Camps and in Ger-
many.  Voluntary agencies provided
health personnel numbering about 500
for work in Europe and an additional
number for China. They also contrib-
uted medical supplies for devastated
areas.

INTERNATIONAL SANITARY CONVENTIONS
The occupation of France isolated the
International Office of Public Health
and interfered with its administration
of the International Sanitary Conven-

tion of 1926 (Maritime) and the Inter-
national Sanitary Convention for Aerial
Navigation of 1933. This left intema-
tional quarantine in so serious a predica-
ment that something had to be done
about it. To meet the situation UN
RRA's Standing Technical Subcommit-
tee on Health for Europe promptly
appointed an Expert Commission on
Quarantine to draft international sani-
tary agreements of an emergency na-
ture.lO The Commission later submitted
to the Standing Technical Committee on
Health in Washington drafts for two
conventions, modifying and modernizing
the existing ones. Each draft provided
that TJNRRA should carry out the
duties previously assigned to the Inter-
national Office of Public Health in
Paris. After some modification in the
light of the comments of member gov-
ernments, UNRRA approved the pro-
posed conventions and they were opened
for signature at the State Department
of the United States of America, the
depository of the conventions.   The
required number of signatures was
reached on January 15, 1945. The two
conventions of 1944 came into effect
on that date and have been administered
since then by the Health Division from
the Headquarters of UNRRA in Wash-
ington, with the European Regional
Office in London acting as a branch for
the regions in  its sphere-Europe,
Africa, and the Middle East. Head-
quarters makes notifications directly to
China, Australia, New Zealand, Canada,
and the United States, and through the
Pan American Sanitary Bureau to the
other American republics.

At Headquarters, the Division is
publishing the semi-monthly Epidemio-
logical Information Bulletin, carrying
disease  reports and epidemiological
analyses. The European Regional Office
is bringing out an additional fortnightly
Bulletin of Communicable Diseases and
Medical Notes for distribution to the
governments in its area. A small Weekly


.s's   AMERICAH JOURNAL
Epidemiolog&l Bketin is also sent out
from London in printed form to
give prompter information regarding the
appearance and movements of serious
diseases.. Most of the reports to and
from both offices with regard to pesti-
lential diseases are transmitted by cable.

The duties imposed by the 1944 con-
vention for aerial navigation include the
delineation of the yellow fever areas of
the world for purposes of quarantine,
and also laying down standards for
yellow fever vaccine and designating
institutes approved for carrying out tests
of the vaccines. These special functions
have been performed by an Expert
Commission on Quarantine appointed by
the Standing Technical Committee on
Health. In 1946 the Commission car-
ried out an exhaustive test of the im-
munizing properties of the Dakar yellow
fever vaccine administered by scarifica-
tion, alone or mixed with smallpox
vaccine. The Commission recommended
that the method be certified as accept-
able in the issuance and recognition of
international certificates of inoculation.

All the duties imposed on UNRRA
by the International Sanitary Conven-
tions of 1944 and the Protocols pro-
longing them were of temporary and
emergency nature. They will, therefore,
be transferred to the Interim Commis-
sion of the World Health Organization
on December 1, 1946, as agreed in
letters exchanged by Mr. F. H.
LaGuardia, Director General of UN
RRA, and Dr. G. Brork Chisholm,
Executive Secretary of the Interim Com-
mission.  Although the Central Head-
quarters of the Interim Commission will
remain in New York, according to latest
advices, the Epidemiological Office in
charge of the administration of the con-
ventions will be in Geneva.

The last issue of the Epidemiological
Information Bulletin will appear on
December 15.  The two complete
volumes will form a valuable compila-
tion of statistics for reference with

OF PUBLIC HEALTH    Jan., 1947

regard to the war and post-war period.
Complete sets can still be made avail-
able to libraries and institutions requir-
ing them.

MEDICAL CARE AND HEALTH PROTECTION

OF DISPLACED PERSONS

In May of 1944, the responsibility
for the six refugee camps in the Middle
East was assumed by UNRRA. At the
end of March, 1945, there were about
40,000 displaced persons in these camps,
including nearly 15,000 children. The
health staff contained specialists in
nutrition, dietetics, tuberculosis, mater-
nal health, child health, public health
nursing, and sanitary engineering, and
also clinical doctors and nurses. Since
then, most of these refugees have been
repatriated. Each returning group was
accompanied to its destination bv an
UNRRA repatriation team, including a
doctor and two nurses. There now re-
mains only one of these camps, at El
Shatt, with a few hundred refugees.

A problem of greater magnitude was
presented by the displaced persons un-
der UNRRA care in Germany, Austria,
and Italy. At the end of May, 1946,
there were 826,580 such persons in as-
sembly centers in the three countries.
The Health Division was responsible for
recruiting the necessary health personnel
and giving technical supervision. An
extensive immunization program was
undertaken.  In most of the assembly
centers a large part of the medical, den-
tal, and nursing services was provided
by professional persons found among
the displaced persons, with overall
supervision by UNRRA staff. Dispen-
saries have been set up and arrange-
ments made for hospital care, mostly in
local institutions with UNRRA super-
vision.  Nurses among the displaced
persons  are being given refresher
courses, and other women are being
trained as nurses' aides, in order to re-
place UNRRA nurses as they are with-
drawn. The health conditions in the


yo1j37    ACHIEVEMENTSOF UNRM             57

assembly centers have been on the whole
quite satisfactory.

INSTRUCTION OF HEALTH PERSONNEL
III the long run much more is gained
by training the natiouak of a COUntIy
to do their own health work than by
introducing relays of foreigners to do
it for them. For training for participa-
tion in relief and rehabilitation work in
the field of health, UNRRA brought
many Fellows from the assisted coun-
tries to educational centers of the United
States and of the United Kingdom and
other countries of Europe, and arranged
for their studies and tours of observa-
tion. The first group consisted of 12
technical experts from China who came
to the United States in 1944. After
their return, many of them assumed key
positions, becoming, for examples, Head
of the Medical Commission of CNRRA,
Director of Medical Supplies of this
Commission, Director of the Anti-
Epidemic Prevention Bureau of the
National Health Administration, Direc-
tor of Hospitals and Health Centers of
the NHA, and Head of the Department
of Sanitary Engineering in the National
Institute of Health.

In 1946 a new program of UNRRA
fellowships was offered, with 44 falling
to the Health Division. The recipients
included physicians, nurses, sanitary en-
gineers, radiography technicians, and
students of penicillin production. They
received their instruction in the United
States, Canada, the United Kingdom,
Sweden, and Switzerland. In 1946
there was set up also a special Nurse-
Teacher Fellowship project. The Fel-
lows were carefully chosen graduate
nurses interested in teaching, 121 in
number.  Twenty-seven came from
Italy, 20 from China, 18 from Czecho-
slovakia, and 19 from Poland. This
group received its special training in
institutions of the Department of Hos-
pitals of New York City, with brief
observation trips  to other centers.

Twenty nurses from Austria and 17
from Greece were similarly trained in
London.

In another of the training projects of
the Health Division, medical teaching
missions were sent to Poland and
Czechoslovakia to visit the medical
centers and bring the newer knowledge
of the war years to the medical and den-
tal professions. They had been almost
completely isolated during the war years.
The lecturers were provided for Poland
and Czechoslovakia by a voluntary
agency, the Unitarian Service Commit-
tee, with the cooperation of UNRRA.
In Czechoslovakia, 14 lecturers from 8
universities began their tour in Prague
and then went to Moravia and Slovakia,
giving lectures and demonstrations in
all 6 of the medical schools of the
country. In Poland, the team of 7
lecturers included 2 dentists. It visited
the principal cities, giving lectures to
professional groups and students and
leading discussions. Several lecturers
had previously been sent to Poland by
the Health Division, beginning in
November, 1945, to get this valuable
and much appreciated teaching started.

In 1945 a team of 11 teachers was
sent to China to start a medical train-
ing program in conjunction with the
National Institute of Health. The early
courses in Chungking, with a total en-
rollment of 258 students, covered public
health administration, medicine, sur-
gery, gynecology, tuberculosis, public
health and hospital nursing, maternal
and child health, and bacteriology. A
second series of courses was given in
Peiping in the spring of 1946, with 136
students. In the interval between the
two series, the teachers gave refresher
courses to local medical societies and
schools in Shanghai, Nanking, Peiping,
and Tientsin. More recently they were
assigned to medical schools in Peiping,
Nanking, Chengtu, and Shanghai. Other
technical personnel of the Health
Division working in China have co-


A-CAN Jqmk~ OF PUBLIC HEALTH
                .

operated in short courses or lectures for

Jan., 1947

mately one year, after which `the World
Health Organization should be fully
established, the Central Committee has
authorized the Director General of
UNRRA to turn over $1,.500,000 to the
Interim Commission. No supplement
of the Commission's budget will be
needed when the administration of the
sanitary conventions is transferred on
December 1.

l&orato~ tech&&s, dentists, medical
students, nurse trainees, field workers in
rcdi;; control, and medical supply
     .
The UNRRA nurse consultants in

several countries, and especially in
Greece, worked with the local nurse
leaders in reopeniug and reorganizing
schools of nursing and giving refresher
courses in public health.

The Health Division's project in
Ethiopia is essentially an attempt
through teaching to take the first steps
toward creating an indigenous medical
and nursing profession. III this way, the
ground work will be laid for a future
public health service, and meanwhile
the people will benefit from service of
steadily rising quality. Courses for
medical " dressers " and for sanitary in-
spectors are being conducted, and as-
sistance is being given to the hospitals
and clinics essential to this educational
effort.

HANDING OVER TO A PERMANENT
       ORGANIZATION
The activities of UNRRA as here

outlined are corring to au end, but many
of the needs will continue and great
opportunities stand open. So UNRRA
has made its plans, in conference with
officers of the Interim Commission of
the World Health Organization, to hand
over a number of its functions, on Janu-
ary 1, 1947, for Europe and Africa, and
on April 1 for the Far East. The ac-
tivities suggested for transfer to the
Commission are ( 1) fellowships and
teaching, (2) the project in Ethiopia,
(3) tuberculosis, (4) malaria, (5) mis-
sions of experts to countries with special
needs, and (6) the administration of
these functions. To make possible the
continuation of this work in the present
UNRRA-assisted countries for approxi-

The temporary Health Division will
soon be giving place to a permanent and
growing international health organiza-
tion. On relinquishing their duties, the
officers of the Health Division hope that
their efforts have accomplished more
than the alleviation of ravages of war.
The World Health Organization should
make a quicker start and be able to see
its way more clearly because UNRRA,
at a most difficult time, attacked the
problems of international health.

REFERENCES

1. Journal, Fifth Session of the Council, United
Nations Relief and Rehabilitation Administratfou,
Geneva, 5:146 (Aug. 17), 1946.
2. Selected Documents.   First Session of the
Council of the United Nations Relief and Rehabili-
tation Administration, Atlantic City, New Jersey, Nov.
IO-D=. 1, 1943, pp. 139-148. UNRRA, Wasiugton.
3. Stowman, Gnud. (Notes on Cholera) E~detnfe-
togtcol Injomation Bulletin (UNRRA), 1~465-469,
551-561, 2:674-678, 718-720 (July 1SSept. 15),
1945, 1946.

4. Reimsnn, Hobart A., Chmg, G. C. T., Chu.
L.-W., Liu, P. Y., and Ying, Ott. Asiatic Cholera.
Clinical Study and Experimental Therapy with
Streptomycin.  Am. 1. Tro#. Med., 26:631-647
(Sept.), 1946.

5. Fan, J. H. Commuuicable Diseases in China
during Recent Years.  Epidemioldgical IJmmation
Brrlletin (UNRRA), 1:493-521 (July 31), 1945.
6. Stowman, Knud.  The Diphtheria Situation in
Europe.   Epidetniological   Injomotion   Btd-tctin
(UNRRA), 2:147-l% (Feb. 28), 1946.
7. Vine, J. M.  UNRRA's Health Campaign in
Greece. Lancet. 250:789-791 (May 25), 1946.
8. Dauids, Marc. Tuberculosis in Polaud. Laacet,
2.51537-540 (Oct. 12), 1946.
9. Metcoff, J., and McQueeney. A. J. Clinical
Malnutrition in Italy in 1945, Nutritional Status of
Selected Population Groups. New England 1. Med.,
235:451-460 (Sept. 26), 1946.
10. Sousa, G. H. de Paula. History of the Inter-
national Sanitary Conventions, 1944. Epidemiologicat
h{oynotion Bulletin (UNRRA), 1:5-12 (Jan. 15),