## CULTURE AND HISTORY Nr. 01 Juni 2023

## RAJCHMAN AND THE LEAGUE OF NATIONS' HEALTH INTERVENTION IN GREECE

By: Rasmus Wasim Andersson History

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ABSTRACT: This article offers insights into the development and implementation strategies of the League's health intervention in Greece. The first part uses Ludwik Rajchman, medical director of the League  of  Nations,  as  an  analytical  prism.  It  explores  his  active  involvement,  how  he  drew  on  a mainstream approach to social hygiene and how he recruited expertise globally. It is also argues that Rajchman likely drew inspiration from Australian hospital systems, which he studied in preparation for the  intervention.  The  second  part  highlights  the  deliberate  emphasis  on  technical  aspects  of  the intervention  for  diplomatic  reasons.  Seeking  funding  from  the  Rockefeller  Foundation,  Rajchman aimed to portray the intervention as a technical rather than political endeavor. Moreover, emphasizing the technical nature of Rajchman's team allowed for presenting its efforts as noninvasive with respect to Greek sovereignty, positioning the intervention as a continuation of Greek government initiatives.

KEYWORDS: League of Nations, Rajchman, Greece, health, technocratic

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## Introduction

In October 1928, the League of Nations was asked for assistance in restructuring Greece's public health  service.  The  request  was  prompted  by  a  significant  influx  of  refugees  into  the  country. Between 1912 and 1922, Greece was involved in three successive wars: the Balkan Wars (19121913),  World War One (officially from 1917-1918), and the Greco-Turkish War (1919-1922). Refugees  from  the  Ottoman  Empire  began  arriving  in  Greece  during  the  Balkan  Wars  and continued to do so throughout WW1. However, it was during and immediately after the GrecoTurkish War that a large number, estimated at 1.5 million refugees, arrived in the country. While approximately  1  million  refugees  arrived  during  the  war,  an  additional  wave  was  triggered  by  a consequential  convention  on  the  compulsory  exchange  of  populations  signed  during  the  peace negotiations.  This  convention  mandated  the  resettlement  of  Greek  Orthodox  Turkish  nationals from Eastern Thrace and Asia Minor to Greece, while Muslims in Greece (with few exceptions) were to relocate to Turkey. It was signed following Greece's defeat by the Turks in 1922 - but should be distinguished from the primary peace treaty of Lausanne in 1923, which superseded the Treaty of Sèvres signed by the Allied powers and the Ottoman Empire in 1920 (Renée, 2003: 35). While many of the refugees shared a language and national identity with the local population, there were also Turkish-speaking groups among them, as well as a significant percentage who faced communication difficulties due to dialects (Kontogiorgi, 2006: 165-180). The massive influx of refugees brought about social, economic, and health upheavals, prompting the League of Nations to organize loans to assist with their settlement.

Historian  Jamie  Martin  (2022:1-28),  who  has  studied  the  birth  of  international  economic assistance,  contends  that  it  was  controversial  to  accept  international  assistance  in  the  interwar period. Martin emphasizes that ideas of national self- determination were highly influential at the time. Moreover, the aftermath of the First World War had left a trail of instances where powerful nations had violated the sovereignty of weaker nations in pursuit of power and profits. The League of Nations' reform of Greece's public health system, while not primarily an economic intervention,  would  have  entailed  an  extensive  endeavor,  granting  the  League  considerable influence over Greece's national health policies. This influence could be seen a challenge to Greek

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sovereignty.  It  is  worth  noting  that  the  League  had  previously  involved  itself  in  health-related assistance  to  Greece  during  the  refugee  crisis,  with  its  Malaria  Commission  advising  Greek authorities on a worsening malaria situation in 1924, and its Health Section providing guidance on a  Dengue fever  epidemic  in  1928  (Gardikas,  2018:  184,  307).1 Nevertheless,  these  previous interventions would be dwarfed by an intervention to reorganize Greece's public health system.

Furthermore, the call  for  such  reorganization  came  amidst  a  turbulent  period  in  Greek  politics. The early interwar years witnessed the temporary abolition of the Greek monarchy (1924) and a short-lived  military  dictatorship  (1925-1926).  Political  dynamics  were  marked  by  heightened tensions  between  Venizelism,  which  largely  advocated  Greek  republicanism,  and  a  conservative, predominantly royalist opposition (Martin, 2022: 140-141). Moreover, the League's final proposal for the reorganization was put forth in April 1929, just a few months before the Wall Street Crash that  triggered  the  Great  Depression.  This  economic  downturn  led  to  a  significant  decline  in tobacco prices and subsequent political turmoil in Greece (Theodorou and Karakatsani, 2008: 5375; Mazower, 1991: 116-120). The initiation of the intervention into Greek health administration thus  occurred  at  an  intriguing  moment  in  history.  The  Greek  request  for  assistance  followed  a period  of  political  unrest,  and  the  Great  Depression  lay  just  around  the  corner.  Ideas  of  selfdetermination  were  highly  influential,  and  a  long  period  of  war  had  just  ended,  resulting  in  a massive influx of refugees.

The  first  part  of  this  article  is  interested  in  how  the  recommendations  to  reorganize  Greece's public health service took shape. It puts a specific spin on this overarching interest by using the League's  Medical  Director,  Ludwik  Rajchman,  as  an  analytical  lens. 2 It  looks  at  Rajchman's interactions  with  colleagues  and  major  stakeholders,  as  well  as  his  interactions  with  important medical  practices  of  the  time.  It  is  argued  that  Rajchman  was  enthusiastically  engaged  in  the intervention and had a profound impact on it. At the same time, Rajchman was himself influenced both by a form of preventative hygiene and a transnational, multi- stakeholder style of medicine.

1 See Also Epidemic of Dengue, 1928 - Various correspondence , 1928.

2 On using biography to explore societal themes, see Kessler-Harris (2009: 625-630). On biography as a tool to study international organizations, see Ikonomou (2020); Reinalda (2020: 15-32).

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The  second  part  of  the  article  is  interested  in  what  strategies  were  used  to  move  the  proposed intervention towards becoming reality. It analyses the League's final recommendations, as well as an application for funds written by Rajchman.  It  has a specific interest in technocratic internationalism,  which  as  described  by  historians  Johan  Schot  and  Vincent  Lagendijk  (2008: 196-217)  is  an  ideology  that  includes  a  preference  for  separating  technical  issues  from  political ones  in  international  cooperation.  This  article  posits  that  the  League  sought  to  portray  the intervention  as  a  technical  endeavor  rather  than  a  political  one,  aligning  with  the  principles  of technocratic  internationalism.  Rajchman  strategically  emphasized  the  technical  aspects  of  the intervention  to  ease  relations  with  the  primary  financier,  the  Rockefeller  Foundation,  and  to appease stakeholders within Greece. The League sought to downplay concerns regarding Greece's political sovereignty, while planning for a significant intervention in its health policies.

In previous research, some of the most ambitious studies on the League's intervention in Greece have held long term perspectives (Borowy, 2009; Macfadyen, 2014); although some shorter-term perspectives exist as well (Giannuli, 1998; Theodorou & Karakatsani, 2008). This article refines the  short-term  perspectives  by  treating  the  creation  of  the  intervention  (in  1928-1929)  as  a moment  in  history.  Rajchman  is  used  as  a  biographical  prism  for  understanding  the  League's intervention,  building  upon  previous  biographical  works  on  Rajchman's  life  (Balinska,  1998; Woltanowski, Wincewicz, and Sulkowski, 2018: 1-7). 3 His socialist pathos and the connotations of his Polish origins has been described in detail in health science researcher, biographer, and great granddaughter  Marta  A.  Balinska's  work,  and  will  not  be  central  themes  in  this  article,  which focuses  more  on  Rajchman's  interplay  with  medical  ideas  -  as  it  relates  to  the  intervention  in Greece.  It  should  also  be  noted  that  David  Macfadyen  (2014:  84-104)  disputes  Rajchman's importance  for  the  intervention  in  Greece  -  claiming  that  one  of  his  employees  -  Melville Mackenzie was the driving force behind it. Furthermore, Rajchman by no means operated alone in Greece. The League's Health committee, while relying on Rajchman and his team for information - had a profound influence on the intervention. Its chairman, Thorvald Madsen, visited Athens as preparation for the intervention. The League also provided economic assistance to Greece through

3 Works on Rajchman's life tend to rely heavily on Balinska's biography, see for example Pasteur Institute (http://webext.pasteur.fr); IO- BIO (www.ru.nl/politicologie/io-bio).

## Background

In early 1929, the League of Nations Health Section formed a research group of health experts, headed by Rajchman. Arriving in Greece on the 25th of January 1929, the group carried out a field  survey  studying  Greece's  economic  resources,  demographic  profile,  medical  services  and sanitary conditions. Results were submitted to the League of Nation's Health Committee which used  it  as  a  basis  for  its  final  proposal  for  the  reorganization  effort,  delivered  to  the  Greek government on April 18th. This proposal was called 'Collaboration with the Greek Government in the Sanitary Re-Organization of Greece' but will henceforth be called the report. 5

This  document  critiques  Greece's  old  health  services  for  having  been  unable  to  prevent  what  is seen  as  preventable  diseases:  malaria  tuberculosis,  enteric  fever  and  dysentery.  It  also  contains critique of hospitals, medical universities, and the proportion of professional roles in the system. Hospitals  are  described  as  badly  equipped,  badly  constructed  and  overcrowded  with  patients. Medical  universities  are  described  as  being  unable  to  produce  officers  that  live  up  to  modern standards  of  curative  or  preventative  medicine.  And  the  profession  as  a  whole  is  described  as overcrowded  with  doctors  but  lacking  in  nurses,  health  visitors  and  well-trained  midwives.  The report  recommends  that  rather  than  expanding  upon  Greece's  present  health  services  -  a  new health  service  should  be  built.  Great  emphasis  is  put  on  centralization  of  this  new  service.  It  is suggested  that  a  new  technical  center  should  be  built  in  Athens  with  specializations  in  multiple areas and a school of hygiene (with the ability to train personnel in other areas). The report also

4 Arrangements for a survey of Greece , 1929; Greek Public Health Service - Documentation , 1929; Collaboration of the Rockfeller [sic] Foundation , 1929; Rajchman, (Dr) Ludwik, W , 1921-1939; Explanatory Memorandum on the Documentation Collected by the commission, Together With a Subject Index , 1929; Hospital and health Survey of Athens and Pireaus , 1929.

5 'Collaboration with the Greek Government in the Sanitary Re-Organization of Greece' in Arrangements for a survey of Greece , 1929

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its  Economic  and  Financial  Section  (directed  by  Author  Salter);  and  parallel  health-  related assistance through its Malaria Commission. All source material was gathered from the League of Nations Archive hosted by the United Nations in Geneva. 4

## Analysis

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recommends centralizing the health administration, rather  than  it  being  distributed  over  several ministries. Apart from an emphasis on centralization, the report also suggests creating a committee to  study  how  Greek  sanitary  legislation  could  be  altered  as  to  harmonize  with  the  report's recommendation. It also makes economic assessments of costs; and it stresses the importance of philanthropic contributions to health services. Thus, the recommendations are extensive enough to  go  beyond  medicine,  into  areas  of  political  administration  and  sanitary  legislation  as  well  as discussing the economy of the intervention. 6

## Rajchman's Freedoms and Constraints

The  League  of  Nations  Health  Organization  had  many  parts  -  a  Health  Committee,  a  Health Section, a Health Bureau and a General Advisory Council. Rajchman was hired by the League in 1921  as  the  director  of  the  Health  Section.  This  section  officially  answered  to  the  Health Committee  (where  Rajchman  was  a  member  as  well)  but  should  be  understood  as  a  relatively autonomous  unit  through  which  Rajchman  made  a  substantial  impact  on  the  League's  health activities (Gram-Skjoldager & Ikonomou, 2021: 31-50; Ranshofen-Wertheimer, 1945: 120-123). Towards the end of 1929 - the same year as the creation of the intervention in Greece - SecretaryGeneral Eric Drummond wrote in a confidential evaluation about Rajchman: 'I consider it mainly due  to  him  that  the  Health  Organization  plays  such  a  preeminent  part  in  League  activities'. 7 Rajchman  also  acted  as  the  Health  Organization's  connection  to  the  Rockefeller  foundation, which funded a substantial amount of its activities (providing over $2 million between 1922 and 1934)  (Weindling,  1997:  269-281).  By  the  time  the  intervention  came  around  (in  1929)  the Section's finances were in good order. Drummond had noted in 1926 and 1927 that the Health Section's finances needed Rajchman's 'personal attention'. 8 But in 1928 he wrote instead that he wished  to  congratulate  Rajchman  on  the  'financial  organization  of  the  [Health]  Section'. 9 It would also be Rajchman who wrote an application to the Rockefeller foundation in order to fund the  intervention  in  Greece.  Balinska  (1991:  456-465)  has  argued  that  Rajchman  was  an  odd

6 Explanatory Memorandum on the Documentation Collected by the commission, Together With a Subject Index , 1929, p 21; Arrangements for a survey of Greece, 1929.

8 'Annual reports, Dr.Lw.Rajchman, Director, Health Section', 1926-1927 in Rajchman, (Dr) Ludwik, W , 1921-1939.

7 'Copy of annual report', 29 nov 1929 in Rajchman, (Dr) Ludwik, W , 1921-1939

9 'Annual report, Dr.Lw.Rajchman, Director, Health Section', 1928 in Rajchman, (Dr) Ludwik, W , 1921-1939.

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choice  as  Director  of  the  Health  Section,  since  he  held  socialist  sympathizes.  Yet  Rajchman's personnel file reveals that his socialist background was not the only objection to him. Rajchman was neither French nor British - and British authorities seem to have had concerns about him not belonging to the second category. An internal (unsigned) letter in the secretariat suggests sending word out that under no circumstances would the Secretariat appoint anyone of British or French nationality - so as to clear away 'British' objections to Rajchman. 10 Rajchman also seems to have enjoyed  the  support  of  his  superior,  Drummond,  who  continuously  gave  him  good  evaluations (short  and  positive).  It  was  not  until  tensions  arose  between  him  and  the  second  SecretaryGeneral, Josef Avenol, that his position was threatened: Avenol terminated his contract in 1939. But this was ten years after the intervention was put together (and still made Rajchman the longest serving Director in the Secretariat). 11

## Rajchman's Involvement

The many letters found in the League of Nations Archive indicate that Rajchman was actively and enthusiastically  involved  in  the  intervention.  In  these  letters,  Rajchman  can  be  seen  actively shaping  the  intervention,  inviting  experts  to  be  part  of  it,  setting  up  meetings  with  people involved in the survey, prioritizing among health goals in the vicinity, applying for funds to the Rockefeller  Foundation,  arranging  accommodation  and  other  travel  details  for  his  colleagues;  as well as communicating his own travel plans to the Greek Under-Secretary for Hygiene, Apostolos Doxiadis.  As  concrete  examples  of  this,  one  can  mention  a  telegram  that  communicated  how Rajchman had decided a Malaria Survey in Macedonia was not desirable. One could also mention two letters where he invited C.L. Park of the Australia Public Health Organization and B. Borcic, head of the Zagreb School of Hygiene to join the project; and a telegram where he set up a twoday meeting with Haven Emerson, a professor at the University of Columbia who was on his way to  Athens;  as  well  as  a  letter  where  Rajchman  decided  on  a  replacement  for  an  important

10 Letter, unknown author to Monnet, 6 Aug 1921 in Rajchman, (Dr) Ludwik, W , 1921-1939.

11 'Annual reports, Dr.Lw.Rajchman, Director, Health Section'; 'Contract', 1 Nov 1921; Internal document 'The

Treasurer. The Internal Control Officer. The Chief Accountant', 27 Jan 1939. All documents are from the folder Rajchman, (Dr) Ludwik, W , 1921-1939.

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participant  (Lumsden, an American doctor) who had been in an accident. There are also letters and  telegrams  that  mention  how  Rajchman  booked  a  hotel  in  Athens  for  Thorvald  Madsen, chairman of the League of Nations health committee; arranged a trip to the same city for Gorge Buchanan  of  the  Health  Committee;  and  communicated  his  own  travel  plans  to  Doxiadis  (the health minister of Greece). Furthermore, a letter from Emerson to Buchanan indicate that other people were anticipating relying on Rajchman. The letter describes how Emerson and Buchanan could expect to rely on 'a good deal of information' from Rajchman, who was already in Greece as they were traveling there. 12

Perhaps  even  more  interestingly,  a  letter  from  Buchanan  to  Rajchman  hints  at  Rajchman's enthusiasm  for  the  project.  At  an  early  stage  of  the  project,  Buchanan  attempted  to  curb Rajchman's quick response to Greece's request, warning him that the health committee cannot be expected to 'run wherever it is whistled to'. 13 He writes:

It is too easy to imagine cases in which, for purely political and temporary reasons and not on the medical merits, a Health Department or its Minister, or even a Cabinet, might find it convenient to ask for the intervention of the Health Organization merely to give cover or to buttress up some project which ought to be settled by the national Government itself. 14

Buchanan wanted the Council of the League to make sure that Greece's request was a matter of medical technocracy, rather than a form of national politics. He feared Rajchman was running too quick  with  the  request,  thus  not  allowing  the  Council  to  make  sure  that  this  was  the  case. Furthermore,  Rajchman  had  previously  been  involved  in  the  League's  intervention  on  Dengue Fever in Greece. The prime minister of Greece, Eleftherios Venizelos - took the time to thank the Medical  Director  (Rajcman)  for  this  previous  work  and  specifically  mention  that  it  was  the

12 Several letters and telegrams: Letter Rajchman to Borcic, 17 Jan 1929; Letter Rajchman to Park, 3 Nov. 1928; Telegram, Rajchman to Emerson, 8 Feb. 1929; Telegram, Rajchman to Cumming, 31 Jan 1929; Telegram Rajchman to Madsen 25 March 1929; Letter Rajchman to Buchanan Mar 1929; Letter, Rajchman to Doxiadis 11 Feb. 1929; Letter, Emerson to Buchanan till 28 jan 1929, in Arrangements for a survey of Greece , 1929.

14 Ibid.

13 Letter, Buchanan to Rajchman 20th Nov. 1928, in Arrangements for a survey of Greece, 1929.

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Director  and  his  experts  'previous  engagement'  with  Greece  that  led  to  Greece's  invitation  of assistance. 15

Considering  communication  preserved  between  Rajchman  and  various  stakeholders,  this  article posits  that  Rajchman  was  deeply  and  enthusiastically  involved  in  the  creation  of  the  League's intervention into Greece's public health service. 16

## Health Internationalism

While  the  previous  section  presented  signs  of  Rajchman's  agency  and  engagement  in  the intervention; this section takes a contextualizing approach - indicating ways in which Rajchman's attitudes towards health internationalism line up with two major types of medical practice. One the one hand, they line up with the multi-stakeholder nature of international health interventions in the interwar period; and on the other hand, they line up with the preventative nature of social hygiene.

The  intervention  in  Greece  featured  an  aspect  of  national  and  organizational  multiplicity.  This can be seen in the team Rajchman put together, the stakeholders he negotiated with and the ideas and  models  he  used  as  inspiration.  Rajchman  (himself  of  Polish  origins),  brought  together competences  from  a  variety  of  nations  and  medical  organizations.  Though  he  hardly  did  this without outside influence, Rajchman staffed the survey group with Haven Emerson, a professor at the University of Columbia, Allen McLaughlin of the U.S.A. Health Organization, C.L. Park of the Australia Public Health Organization, B. Borcic, head of the Zagreb School of Hygiene and M.D. Mackenzie, an American doctor at the League of Nations. Furthermore, letters preserved in the League's archive show how Rajchman communicated with both the prime minister of Greece and  the  Rockefeller  Foundation,  a  private  philanthropic  organization.  He  also  asked  that Mackenzie should be allowed to study at the Rockefeller Foundation as preparation for the survey,

15 Arrangements for a survey of Greece , 1929.

16 Theodorou and Karakatsani (2008: 53-75) also describe Rajchman as having considerable influence in the intervention.

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and asked Park to send acts from the Australian national health services which he could study for himself. 17

Extracts  from  these  Australian  health  service  acts  have  been  preserved  and  archived,  and  these contain some similarities to ideas in the report. The extracts highlight three systems operating in Australia: one Victorian, one Tasmanian and one from Queensland. Both the Australian hospital acts and the report stress the importance of maternity care as well as philanthropic contributions to  the  healthcare  system.  While  the  authors  of  the  Australian  acts  write  that  'The  necessity  to provide for a Maternity Service in any hospital system is recognized'; the report notes that 'The welfare  of  mothers  and  infants  is  often  capable  of  great  improvement'.  Extracts  from  the Australian acts also describe it as a 'defect' in the Queensland and Tasmanian system - that these do not encourage 'philanthropic persons' to devote their time to the work of hospital boards. The report recommends giving support to 'societies' which out of 'philanthropic motives' contribute to 'public utility'. The Victorian system is described as the most successful one in the Australian acts.  It  is  described  as  a  highly  differentiated  hospital  system  that  focuses  skills  on  metropolitan hospitals. The report on the intervention in Greece also contains an idea of centralizing skills, in this case to one specific metropolitan area - Athens. It suggests establishing an 'Athens Center'. This  center  would  give  instructions  to  services  in  other  regions;  provide  advice  to  'central  and local authorities' and contain specializations in several areas and train 'the future medical officers of  the  Permanent  Hellenic  Health  Service'. 18 However,  even  with  these  similarities,  it  remains challenging to determine the precise extent to which Rajchman drew inspiration from the acts and how much of that inspiration materialized into concrete suggestions in the report. Additionally, there are sections within the acts that do not bear any resemblance to the recommendations put forth in the report. For example, the Australian acts are more concerned with sourcing finances in a  variety  of  ways  than  the  report  is.  What  seems  safe  to  say  is  that  Rajchman  sought  to  bring together  ideas  and  models  from  different  nations,  arenas  and  organizations  as  he  attempted  to

17 Minutes, 'Extracts from the minutes of the meeting of the 55:th session of the council June 1929', in Greek Public Health Service - Documentation , 1929; Collaboration of the Rockfeller [sic] Foundation, 1929; Letters, Park to Rajchman, 31 Dec. 1928; Rajchman to Gunn 18 Dec. 1928, in Arrangements for a survey of Greece , 1929.

18 'Extracts from Hospital Acts and Reports Emanating from Australia'; Collaboration with the Greek Government in the Sanitary Re-Organization of Greece'. Both documents are found in Arrangements for a survey of Greece , 1929

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organize a viable health intervention. The team he built, the stakeholders he communicated with and  the  fact  that  he  studied  the  Australian  hospital  acts  -  are  all  signs  of  this.  Historian  Sunil Amrith  (2017:  245-264)  has  argued  that  the  intertwining  of  national  and  international,  public and private organizations was a major characteristic of international health policy in the first half of  the  twentieth  century.  Amrith  describes  how  the  Rockefeller  Foundation  brought  together disparate  groups  of  doctors,  missionaries  and  humanitarians  in  support  of  its  work,  even  while relying on the support of imperial and national states. Amrith also argues that this was not unlike how  other  international  health  organizations  worked,  such  as  The  Red  Cross  and  the  Office International d'Hygiene Publique. Seen in this light, the national and organizational multiplicity of  Rajchman's  attempt  at  health  internationalism  fit  in  with  how  other  international  health organizations have been described as operating in the interwar period.

The  intervention  in  Greece  also  seems  to  have  been  influenced  by  the  preventative  and government centered attitudes of social  hygiene.  While not  studying  the  intervention  in  Greece specifically,  Balinska  (1991:  456-465)  sees  Rajchman  as  a  revolutionary  force  in  international medicine. She has argued that Rajchman invented a form of broad preventative healthcare - which included housing - and that he did so based on his socialist ideals. The report does in fact contain a very broad perspective on health, stressing the importance of preventative measures. It calls for the  improvement  of  Greece's  'Public  water  supplies,  sewerage,  good  roads  and  paving,  public baths, parks and recreation grounds, facilities for sport, means of communication, construction of healthy  houses,  factories  and  schools,  public  lighting,  town-development  planning'.  The  report also suggests that the Athens Center get a 'Division of Hygiene and Preventive Medicine' as well as a 'Division of Sanitary Engineering'. 19 However, Rajchman was not unique - even within the League  -  in  supporting  broad  preventative  health  measures.  Mackenzie,  a  colleague  who  lacked Rajchman's  socialist  background,  explicitly  criticizes  Greece's  medical  personnel  as  being  to  a great  extent  'ignorant  of  modern  preventative  medicine'.  He  describes  Greece's  incapacity  to secure  good  'water  supplies',  'sewage'  and  'communications'. 20 Mackenzie's  attitudes  indicates that some of Rajchman's attitudes to prevention were not as unique as they have been described by

19 Arrangements for a survey of Greece , 1929.

20 Explanatory Memorandum on the Documentation Collected by the commission, Together With a Subject Index , 1929, p21; On the plurality social hygienes, see Porter & Porter (1988: 90-106).

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Balinska  -  and  could  be  arrived  at  from  other  vantage  points  than  a  socialist  one. 21 As  far  as Rajchman  was  interested  in  securing  external  conditions  of  health,  he  can  be  thought  of  as influenced by a form of social hygiene rather than pure socialism. Nickolas Rose (1993: 283-299) has described how politicians from many different ideological backgrounds supported versions of social hygiene in order to make sense of health interventionism. He has argued that while many types  of  social  hygiene  existed,  there  were  two  major  state-  sponsored  versions  in  the  early twentieth  century.  The  first  attempted  to  improve  external  conditions  of  health  through  town planning,  sewage  systems,  anti-  filth  campaigns  and  the  like.  The  second  strand,  so  called eugenics, sought to improve upon perceived biological traits in the nation's population. It seems the intervention in Greece lines up with the first major strand of social hygiene, in that it aimed to secure external conditions of health.

The first part of this article has argued that Rajchman was enthusiastically involved in the creation of the intervention into Greece's public health system and played a significant part in shaping it. The intervention was deeply influenced by Rajchman's attitudes towards the global multiplicity of international health work, as well as his and Mackenzie's attitudes towards preventative hygiene. These attitudes were broadly present in health governance at the time.

## Technocratic Internationalism

While an influential  individual,  Rajchman  did  not  act  in  a  bureaucratic  or  diplomatic  vacuum. The following part of this article discusses strategies in the report and in Rajchman's negotiations, seemingly intended soften relations with stakeholders and move the planned intervention towards becoming a reality. Previous research by historians Vassiliki Theodorou and Despina Karakatsani (2008: 53-75) has attempted to map out tensions between Greek politicians on the one hand and Thorvald Madsen and Rajchman on the other hand. They have also described tensions between the Greek Medical Association and League-appointed health experts, as well as between liberal and conservative  politicians  within  Greece.  In  the  following  two  sections,  rather  than  focusing

21 MacKenzie seems to have largely avoided clear public expressions of ideology, although Springings (2008: 120-121) describes him as having an aversion to social ideology.

## CULTURE AND HISTORY Nr. 01 Juni 2023

exclusively on conflict, emphasis is put on how the report was formulated in ways that were likely to help mediate stakeholder tensions. Using Schot and Lagendijk's (2008: 196-217) understanding of technocratic internationalism, it is argued that the report attempts to present itself as technical in opposition the political - and that Rajchman used this presentation to soften relations with the Rockefeller Foundation, as well as potential critics within Greece.

## The Technical vs. the Political

In  Rajchman's  application  for  funds  sent  to  the  Rockefeller  Foundation,  he  emphasized  the intervention's 'technical nature'. 22 This attempt to define the intervention as technical was backed up by the report itself, which had been sent to the foundation beforehand. The report accentuates the intervention's technical properties in two main ways. First of all, explicitly, and secondly, by repeatedly using the term technical to define the properties of all the main nuts and bolts in its recommendations.

The explicit effort to define the intervention as technical was formulated as follows: 'We consider it  an  indispensable  condition  for  the  working  of  a  modern  and  effective  health  service  that  it should be fully protected from political influences; such a service ought to be a purely technical service'. 23 Note that the technical is here defined as separate from the political.

Thereafter, the message that the intervention would be technical is reinforced a multitude of times in the report through the repeated use of the term 'technical', which is one of the most central and commonly used terms that appear in the text. The survey is described as a 'technical survey', the new central  'technical  services'  are  recommended  to  have  a  'technical'  head  -  the  authority  of which  should  in  fact  be  'technical'.  Likewise,  the  direction  of  the  malarologist,  the  sanitary engineer and the professor of pharmacology are also described as 'technical'. In general experts are in  the  text  referred  as  'technical  experts';  instructors  are  'technical  instructors';  public  health

22

Collaboration of the Rockfeller [sic] Foundation, 1929.

23 Arrangements for a survey of Greece, 1929 , 7.

## CULTURE AND HISTORY Nr. 01 Juni 2023

advisors  are  'technical  health  advisors'.  General  staff  is  referred  to  as  'technical  staff'  and equipment  is  referred  to  as  'technical  equipment'. 24 Ironically  the  text  contains  no  specialized medical vocabulary.  Instead,  the  term  technical  is  only  used  to  define  the  different  parts  of  the intervention program as belonging to a technical realm, thus a realm that has been predefined as separate from the political.

Towards  the  end  of  the  report  -  the  document  returns  to  a  more  explicit  method  of  signaling technical  properties.  The  Greek  Prime  Minister  is  quoted  stressing  the  technical  nature  of  the intervention; officially requesting the League's 'technical assistance'. 25

Having  sent  this  report  to  the  Rockefeller  Foundation,  Rajchman  was  arguably  armed  with  a thoroughly  expressed  claim  to  the  realm  of  the  nonpolitical.  Making  sure  that  the  foundation notes the claim, Rajchman quotes the Greek prime minister's request for technical assistance in his application  for  funds  (which  as  mentioned  also  figures  in  the  report  already  sent).  After  this Rajchman also explicitly writes himself that the intervention into Greek Public Health Service will be of a 'strictly technical nature'. 26

The early interwar period was a tumultuous time for Greek politics. A good reason for defining the intervention as technical was - as the document states - to have it last across shifting Greek political landscapes. However, Rajchman was attempting to pitch the intervention to an American philanthropic  foundation:  the  Rockefeller  Foundation.  Historian  Ludovic  Tournès  (2022),  has studied  American  philanthropic  foundations  in  the  interwar  period  and  argues  that  these foundations  generally  belonged  to  US  internationalist  circles  and  should  be  understood  as  a counterweight to traditional US isolationism. He also argues that the Rockefeller Foundation had a specific vision of internationalism which was based on governing global issues through scientific ventures  -  rather  than  political  ones. 27 In  this  situation,  Rajchman's  claim  to  a  nonpolitical

24 Arrangements for a survey of Greece , 1929, 7.

26 Collaboration of the Rockfeller [sic] Foundation , 1929

25 Arrangements for a survey of Greece , 1929, 20.

27 Tournès describes this as a general tendency among American philanthropic foundations. These foundations did not want to get involved in political decision making, but aimed to stimulate the growth of what was seen as technical activities.

## CULTURE AND HISTORY Nr. 01 Juni 2023

intervention  may  have  been  important  to  soften  relations  with  the  Rockefeller  Foundation,  by emphasizing  aspects of the intervention that harmonized  with  the  foundation's  vision of internationalism.

Emphasizing  the  technical  aspects  of  the  intervention  may  also  have  been  a  strategy  to  avoid tensions with Greek stakeholders. The report claims that the survey was done to '…form a happy consummation  of  the  studies  already  made  by  the  Greek  authorities'. 28 Thus,  it  describes  a continuation  between  Greece's  own  technical  studies  and  the  technical  enquires  headed  by Rajchman. Martin (2022:1-28) argues that a state in the interwar period which allowed large scale intervention into matters classically understood as belonging to national politics could be seen as relinquishing  part  of  its  sovereignty.  He  asks:  'In  a  profoundly  unequal  world,  how  could  a sovereign  state  open  its  internal  affairs  to  outside  intervention  without  admitting  to  a  loss  of status,  power  and  autonomy?' Martin is interested in international economic assistance. Yet the League's health intervention could certainly be considered large scale as well. It was the first time in history an international organization had attempted a health intervention extensive enough to reconstruct not only a nation's health policies, but also related health administration and sanitary law.  The  intervention  touched  upon  a  whole  branch  of  society.  Defining  the  intervention  as technical- as opposed to political may have been a strategy to ease or preempt concerns about an intervention scheme which could be understood as infringing on Greek political sovereignty.

## Conclusion

This article has studied the League of Nation's intervention into the Greek public health service in 1928-1929.  The  article  contributes  insights  to  how  an  individual,  Rajchman,  became  an important bridge between ideas in global health governance and the League's reform recommendations. Communication preserved between Rajchman and various stakeholders indicate  that  he  was  enthusiastically  involved  in  the  intervention  and  played  a  central  part  in shaping it. The intervention was deeply influenced by his attitudes towards the global multiplicity of  international  health  work.  Rajchman  drew  competence  from  three  different  continents  and studied Australian hospital acts himself before commencing a survey into Greece's health service.

28 Arrangements for a survey of Greece , 1929, 1-2.

## CULTURE AND HISTORY Nr. 01 Juni 2023

Furthermore,  both  Rajchman  and  his  colleague  Mackenzie  were  highly  influenced  by  the preventative  attitudes  of  social  hygiene.  Preventative  attitudes  towards  medicine  were  broadly present in central and northern European health governance at the time, spanning the ideological spectrum  -  but  the  survey  lead  by  Rajchman  indicated  that  it  was  largely  absent  in  Greek medicine.

This article has also contributed insights to what role the ideology of technocratic internationalism played  in  the  intervention.  It  is  argued  that  the  League's  reform  recommendations  contained strategies to emphasize the intervention's technical status - for diplomatic reasons. These strategies can be understood as based on the ideology of technocratic internationalism. The report explicitly defines  the  intervention  as  technical  in  opposition  to  political,  and  then  repeatedly  reminds  the reader of its technical status through the abundant use of the term technical - to describe all the nuts  and  bolts  of  the  intervention.  This  emphasis  is  likely  to  have  been  important  in  order  to soften relations with the Rockefeller Foundation, where Rajchman was applying for finances. The foundation  held  a  vision  of  internationalism  based  on  an  ideal  of  the  technical  health  aid. Additionally, defining the intervention as nonpolitical may have been a strategy to ease tensions with Greek stakeholders such as politicians, civil servants and the Greek medical corps. The survey headed  by  Rajchman  was  presented  as  a  happy  consummation  of  technical  studies  already commenced by the Greek government. To use a medical term, it was presented as noninvasive. This  was  in  spite  of  the  unprecedented  scale  of  the  intervention,  which  would  affect  a  whole branch of society - and was written in a context were self-determination and national sovereignty were highly influential political concepts.

## CULTURE AND HISTORY Nr. 01 Juni 2023

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## Unpublished sources

All sources are from League of Nations Archives, UN Archives Geneva. R[egistry Files] and S[ection files] were used.

- Epidemic of Dengue, 1928 - Various correspondence, R5892/8A/6674/6674/J1
- Bacteriology - Greek Public Health Service - Reorganisation - Arrangements for a survey of Greece, 1929, R5897/8A/8323/8323/Jacket-1
- Greek Public Health Service - Documentation, 1929, R5898/8A/8323/13315/Jacket-2
- Reorganization of the Greek Public Health Service - Collaboration of the Rockfeller [sic] Foundation, 1929, R5899/8A/8323/14219
- Personnel file: Rajchman, (Dr) Ludwik, W, 1921-1939, S861-166-2966
- Explanatory Memorandum on the Documentation Collected by the commission, Together With a Subject Index, 1929, R5898/8A/8323/13315/Jacket-1
- Hospital and health Survey of Athens and Pireaus, 1929, R5898/8A/8323/13315/Jacket-2

## Web pages

- http://webext.pasteur.fr/archives/e\_raj0.html. Accessed April 2021.
- www.ru.nl/politicologie/io-bio/io-bio-biographical-dictionary-sgs-ios. Accessed April 2021.