"Repeated Disappointment": The Rockefeller Foundation and the Reform of the Greek Public Health System, 1929-1940

Bulletin of the History of Medicine

Volumn 72, Issue 1, 1998, Pages 47-72

  Giannuli, Dimitra ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; FINANCIAL MANAGEMENT; GREECE; HEALTH CARE POLICY; HISTORY; HUMAN; INTERNATIONAL COOPERATION; NON PROFIT ORGANIZATION; PUBLIC HEALTH SERVICE; UNITED STATES;

FOUNDATIONS; FUND RAISING; GREECE; HEALTH CARE REFORM; HISTORY, 20TH CENTURY; HUMANS; MEDICAL MISSIONS, OFFICIAL; PUBLIC HEALTH ADMINISTRATION; UNITED STATES;

EID: 0032019543     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (100)

1. For an overview of the RF's activities in East and South Europe, the Rockefeller Foundation Annual Reports series is a useful point of departure.
2. Selskar Gunn, Director of the Rockefeller Foundation International Health Board Office in Paris, to F. F. Russell, Director of the International Health Board/Division, 28 August 1923, letter no. 70, enclosure, RG 5, International Health Board, ser. 1, box 175, folder 2268, Rockefeller Foundation Archives (hereafter RFA), Rockefeller Archive Center, New York, N.Y.
3. H. O. Eversole, M.D., Acting Director, International Health Board Office in Paris, to Russell, 22 June 1923, letter no. 52, enclosure, ibid.
4. Sara E. Foulks, Director, American Women's Hospitals, Athens, Greece, to Rockefeller Foundation, 20 August 1925, ibid., box 237, folder 3034; Florence M. Read to Gunn, 16 February 1925, ibid., folder 3035.
5. Memorandum by Russell to Dr. Vincent, 8 April 1929, RG 1.1 Projects, International Health Division, ser. 749 Greece, box 1, folder 2, RFA (hereafter cited as PIHD).
6. Unsigned letter to Vernon Kellogg, National Research Council, Washington D.C., 11 March 1929, ibid.
7. Kōstas Daphnes, Apostolos Doxiades: Ho Agōnist kai ho Anthrōpos [Apostolos Doxiades: the fighter and the man] (Athens, 1974), pp. 149-50.
8. In the 1930s the physician:patient ratio in the urban centers was 1:500 while in the countryside it was 1:1,900. See Christos D. Zelides, Axiologese tōn Prōtovathmiōn Hyperesiōm Hygeias tou Agrotikou Plethysmou [Assessment of primary health care services for the rural population] (Athens: Agrotike Trapeza Ellados, 1989), pp. 129, 112-16.
9. Ibid., pp. 57-60.
10. "Report of the Under-Secretariat of Hygiene from 1 September 1928 to 15 February 1929," n.d., Papers of Apostolos Doxiades, 256/folder 10/ser. doc. 161, Historical Archives, Benaki Museum, Athens.
11. Iōannes D. Mastrogiannes, Historia tes Koinōnikes Pronoias tes Neōteras Ellados (1821-1960) [History of social welfare in modern Greece (1821-1960)] (Athens, 1960), p. 355.
12. B. G. Valaōas, "Demosia Hygieine" [Public hygiene], Megale Hellenike Enkyklopaideia [Great Hellenic encyclopedia] (Athens: Ekdotikos Organismes Ho Phoinix, 195?-1964?), 10: 659; Daphnes, Doxiades (n. 7), pp. 143-44.
13. B. G. Valaōas, "Demosia Hygieine" [Public hygiene], Megale Hellenike Enkyklopaideia [Great Hellenic encyclopedia] (Athens: Ekdotikos Organismes Ho Phoinix, 195?-1964?), 10: 659; Daphnes, Doxiades (n. 7), pp. 143-44.
14. Zelides, Axiologese (n. 8), p. 60. The number of those infected by the disease in the late interwar period reached 1,200,000 annually, while malaria mortality was estimated at 74 per 100,000 inhabitants. It is, then, no surprise that Greece was one of the major consumers of quinine; it is estimated that from 1925 to 1929, 488 tons were imported about 32.5 tons annually, amounting to almost one quarter of the world production of quinine. See ibid., p. 61; Leonard Jan Bruce-Chwatt and Julian de Zulueta, The Rise and Fall of Malaria in Europe: A Historico-Epidemiological Study (New York: Oxford University Press, 1980), p. 37.
15. Zelides, Axiologese (n. 8), p. 60. The number of those infected by the disease in the late interwar period reached 1,200,000 annually, while malaria mortality was estimated at 74 per 100,000 inhabitants. It is, then, no surprise that Greece was one of the major consumers of quinine; it is estimated that from 1925 to 1929, 488 tons were imported about 32.5 tons annually, amounting to almost one quarter of the world production of quinine. See ibid., p. 61; Leonard Jan Bruce-Chwatt and Julian de Zulueta, The Rise and Fall of Malaria in Europe: A Historico-Epidemiological Study (New York: Oxford University Press, 1980), p. 37.
16. Zelides, Axiologese (n. 8), p. 60. The number of those infected by the disease in the late interwar period reached 1,200,000 annually, while malaria mortality was estimated at 74 per 100,000 inhabitants. It is, then, no surprise that Greece was one of the major consumers of quinine; it is estimated that from 1925 to 1929, 488 tons were imported about 32.5 tons annually, amounting to almost one quarter of the world production of quinine. See ibid., p. 61; Leonard Jan Bruce-Chwatt and Julian de Zulueta, The Rise and Fall of Malaria in Europe: A Historico-Epidemiological Study (New York: Oxford University Press, 1980), p. 37.
17. From 1913 to 1916 the International Health Board was called the International Health Commission; it was then renamed the International Health Board, and finally, in 1927, the International Health Division.
18. During and after the massive refugee evacuation to Greece, the Near East Relief dispensed emergency aid to incoming refugees with emphasis on the rehabilitation of Armenian and Greek refugee orphans. In 1929 it redefined its mission to offer technical assistance to refugee communities. The League of Nations, on the other hand, assumed an active role in the refugee settlement in late 1923 when an international agreement provided for the creation of the Refugee Settlement Commission, under the auspices of the League of Nations, to administer the permanent refugee settlement in Greece.
19. George Strode to Russell, 11 September 1929, attached memorandum, PIHD, box 1, folder 2; "Statement made to the Council of the League of Nations by H.E. Dr. Doxiadis, Health Minister of Greece," n.d., Doxiades Papers, 256/folder 11/ser. doc. 193.
20. Other members of the committee included Haven Emerson, professor of hygiene at Columbia University; Allen McLaughlin of the U.S. Public Health Service; C. L. Park of the Public Health Service of the Commonwealth of Australia; and B. Borcic, director of the Institute and School of Hygiene at Zagreb, Croatia. See League of Nations, Health Organization (henceforth LNHO), "Annual Report of the Health Organisation for 1929," July 1930, Geneva, A.9.1930.III.
21. "Report," n.d., Doxiades Papers, 256/folder 10/ser. doc. 161. The areas selected for the survey were the following: Macedonia, including the city of Salonica; Thrace; the Athens-Piraeus metropolitan region; the city and district of Patras; the island of Corfu; the western region of Crete, including the city of Canea; and the city and prefecture of Ioannina in Epirus. See LNHO, "Collaboration with the Greek Government in the Sanitary Re-Organization of Greece," April 1929, Geneva. C. 162.M.63.1929.111.
22. "Report," n.d., Doxiades Papers, 256/folder 10/ser. doc. 161. The areas selected for the survey were the following: Macedonia, including the city of Salonica; Thrace; the Athens-Piraeus metropolitan region; the city and district of Patras; the island of Corfu; the western region of Crete, including the city of Canea; and the city and prefecture of Ioannina in Epirus. See LNHO, "Collaboration with the Greek Government in the Sanitary Re-Organization of Greece," April 1929, Geneva. C. 162.M.63.1929.111.
23. LNHO, "Collaboration" (n. 18); Memorandum to Mr. Capps signed by R.C., filed May 1929, PIHD, box 1, folder 2; Eleftheron Vema [Free tribune], Athens, 15 May 1929 p. 1.
24. LNHO, "Collaboration" (n. 18); Memorandum to Mr. Capps signed by R.C., filed May 1929, PIHD, box 1, folder 2; Eleftheron Vema [Free tribune], Athens, 15 May 1929 p. 1.
25. RF cooperation with the League of Nations Health Organization was not rare during the interwar years. Handicapped by its lack of funds, the LNHO sought the RF's financial support. The two organizations exchanged medical science specialists and public health personnel. Of considerable value to the RF was the statistical work of the League of Nations Epidemiological Intelligence Service (EIS), specializing in the compilation of vital statistics of European countries. It was in this capacity that the EIS accommodated the RF work in Greece. See Raymond B. Fosdick, The Story of the Rockefeller Foundation (New York: Harper, 1952), p. 281; Martin David Dubin, "The League of Nations Health Organisation," in International Health Organisations and Movements, 1918-1939, ed. Paul Weindling (Cambridge: Cambridge University Press, 1995), p. 72.
26. RF cooperation with the League of Nations Health Organization was not rare during the interwar years. Handicapped by its lack of funds, the LNHO sought the RF's financial support. The two organizations exchanged medical science specialists and public health personnel. Of considerable value to the RF was the statistical work of the League of Nations Epidemiological Intelligence Service (EIS), specializing in the compilation of vital statistics of European countries. It was in this capacity that the EIS accommodated the RF work in Greece. See Raymond B. Fosdick, The Story of the Rockefeller Foundation (New York: Harper, 1952), p. 281; Martin David Dubin, "The League of Nations Health Organisation," in International Health Organisations and Movements, 1918-1939, ed. Paul Weindling (Cambridge: Cambridge University Press, 1995), p. 72.
27. R. Raphael, Greek chargé d'affaires to the Greek Ministry for Foreign Affairs, 10 May 1929, Berne, Switzerland, Health Matters, 1929/A/25/IX, ser. doc. 1147, Arheion tou Ypourgeiou Exōterikōn [Archives of the Ministry for Foreign Affairs] (henceforth AYE), Athens; League of Nations Health Committee, Minutes of the Fourteenth Session, July 1929, Geneva, C.246.M.85.1929.III.
28. R. Raphael, Greek chargé d'affaires to the Greek Ministry for Foreign Affairs, 10 May 1929, Berne, Switzerland, Health Matters, 1929/A/25/IX, ser. doc. 1147, Arheion tou Ypourgeiou Exōterikōn [Archives of the Ministry for Foreign Affairs] (henceforth AYE), Athens; League of Nations Health Committee, Minutes of the Fourteenth Session, July 1929, Geneva, C.246.M.85.1929.III.
29. Strode to Russell, 3 February 1930, PIHD, box 1, folder 3.
30. Strode to Russell, 11 September 1929 (n. 16), memorandum.
31. L. Rajchman to Strode, 19 August 1929, attached to Strode to Russell, 11 September 1929 (n. 16), exhibit B. On Rajchman's role in making the LNHO an effective participant in the international campaign for the improvement of public health, see Dubin, "Health Organisation" (n. 20), pp. 56-80.
32. Strode to Russell, 10 May 1929, letter no. 243, PIHD, box 1, folder 2; Strode to Russell, 3 February 1930 (n. 22), attached memorandum; Apostolos Doxiades to Eleftherios Venizelos, 25 April 1929, Doxiades Papers, 256/folder 9/ser. doc. 37.
33. On the specific duties of each division see LNHO, "Collaboration" (n. 18).
34. During the 1920s White served as the League of Nations' chief epidemic commissioner; see Dubin, "Health Organisation" (n. 20), p. 69. His appointment in the Greek reform was contested by the Italian government, which intended to promote an Italian candidate for that office. The Greek government supported White's appointment and hoped that the LNHC could also attract Rockefeller Foundation experts. See Nicholas Polites, Greek Ministry for Foreign Affairs, 12 June 1929, Madrid, Health Matters, 1929/A/ 25/IX, ser. doc. 6519, AYE.
35. LNHO, "Annual Report of the Health Organisation for 1930," April 1931, Geneva, A.7.1931.III.
36. Venizelos to Strode, 26 March, 1930, PIHD. box 1, folder 3.
37. LNHO, "Note by the President of the Delegation of the Health Committee" (Annex to Report C.162.M.63.1929.III), May 1929, Geneva, C.162(a).M.63(a).1929.111; Strode to Russell, 11 September 1929 (n. 16), attached memorandum; Strode to Russell, 3 February 1930 (n. 22).
38. LNHO, "Collaboration" (n. 18); Strode to Russell, 3 February 1930 (n. 22); Phokiōn Copanaris, He Demosia Hygeia en Helladi [Public health in Greecel (Athens, 1933), pp. 492- 93.
39. LNHO, "Collaboration" (n. 18); Strode to Russell, 3 February 1930 (n. 22); Phokiōn Copanaris, He Demosia Hygeia en Helladi [Public health in Greecel (Athens, 1933), pp. 492-93.
40. Gregory A. Livadas and John C. Sphangos, Malaria in Greece (1930-1940), vol. 1 (Athens: Pyrsos Press, 1941), p. 27.
41. The Rockefeller Foundation Annual Report for 1935, p. 59; Livadas and Sphangos, Malaria (n. 32), p. 28.
42. The Rockefeller Foundation Annual Report for 1935, p. 59; Livadas and Sphangos, Malaria (n. 32), p. 28.
43. Alice Carr, Public Health, Medicine, and Sanitation in Greece (Before the Axis Occupation) (New York: Near East Foundation, 1942), p. 5.
44. Strode to Russell, 10 May 1929 (n. 25); A.J. Warren to W. A. Sawyer, 12 August 1938, letter no. 239, ibid., box 2, folder 14.
45. Harold B. Allen, Come Over into Macedonia: The Story of a Ten-Year Adventure in Uplifting a War-Torn People (New Brunswick, N.J.: Rutgers University Press, 1943), pp. 166-77; Robert Daniel, American Philanthropy in the Near East, 1830-1960 (Athens, Ohio: Ohio University Press, 1970), p. 214; Carr, Public Health (n. 34), pp. 10-11.
46. Harold B. Allen, Come Over into Macedonia: The Story of a Ten-Year Adventure in Uplifting a War-Torn People (New Brunswick, N.J.: Rutgers University Press, 1943), pp. 166-77; Robert Daniel, American Philanthropy in the Near East, 1830-1960 (Athens, Ohio: Ohio University Press, 1970), p. 214; Carr, Public Health (n. 34), pp. 10-11.
47. Harold B. Allen, Come Over into Macedonia: The Story of a Ten-Year Adventure in Uplifting a War-Torn People (New Brunswick, N.J.: Rutgers University Press, 1943), pp. 166-77; Robert Daniel, American Philanthropy in the Near East, 1830-1960 (Athens, Ohio: Ohio University Press, 1970), p. 214; Carr, Public Health (n. 34), pp. 10-11.
48. LNHO, "Annual Report of the Health Organisation for the Period January 1931 to September 1932," 12 September 1932, Geneva, A.28.1932.III. As of January 1931, Annual reports of the Health Organization are published in the Quarterly Bulletin of the Health Organization.
49. LNHO, "Annual Report of the Health Organisation for the Period January 1931 to September 1932," 12 September 1932, Geneva, A.28.1932.III. As of January 1931, annual reports of the Health Organization are published in the Quarterly Bulletin of the Health Organization.
50. Strode to Russell, 3 February 1930 (n. 22).
51. Rockefeller Foundation Annual Report for 1930, p. 72; LNHO, "Collaboration" (n. 18); Bruce-Chwatt and Zulueta, Malaria (n. 13), p. 37.
52. Rockefeller Foundation Annual Report for 1930, p. 72; LNHO, "Collaboration" (n. 18); Bruce-Chwatt and Zulueta, Malaria (n. 13), p. 37.
53. Rockefeller Foundation Annual Report for 1930, p. 72; LNHO, "Collaboration" (n. 18); Bruce-Chwatt and Zulueta, Malaria (n. 13), p. 37.
54. Warren to Sawyer, 12 August 1938 (n. 35).
55. Rockefeller Foundation Annual Report for 1936, p. 107; Near East Foundation, "Addresses and Reports Submitted in Connection with the First Annual Rural Life Conference Program, Salonica and Athens, 14-21 March 1932," Project Files, Cabinet #5, Drawer 2, Near East Foundation Archives, New York, N.Y.; Livadas and Sphangos, Malaria (n. 32), pp. 165-202.
56. Rockefeller Foundation Annual Report for 1936, p. 107; Near East Foundation, "Addresses and Reports Submitted in Connection with the First Annual Rural Life Conference Program, Salonica and Athens, 14-21 March 1932," Project Files, Cabinet #5, Drawer 2, Near East Foundation Archives, New York, N.Y.; Livadas and Sphangos, Malaria (n. 32), pp. 165-202.
57. Rockefeller Foundation Annual Report for 1936, p. 107; Near East Foundation, "Addresses and Reports Submitted in Connection with the First Annual Rural Life Conference Program, Salonica and Athens, 14-21 March 1932," Project Files, Cabinet #5, Drawer 2, Near East Foundation Archives, New York, N.Y.; Livadas and Sphangos, Malaria (n. 32), pp. 165-202.
58. Livadas, "Report of Activities," 1 April 1940, PIHD, box 2, folder 15; M. C. Balfour, "Malaria Studies in Greece: Measurements of Malaria, 1930-1933," Amer. J. Trop. Med., 1935, 15: 306-24.
59. Livadas, "Report of Activities," 1 April 1940, PIHD, box 2, folder 15; M. C. Balfour, "Malaria Studies in Greece: Measurements of Malaria, 1930-1933," Amer. J. Trop. Med., 1935, 15: 306-24.
60. On the RFs work in Italy see Darwin H. Stapleton, "A Success tor Science or Technology? The Ruckfeller [sic] Foundation's Role in Malaria Eradication in Italy, 1924-1935," Medicina nei Secoli Arte e Scienza, 1994, 6: 213-28.
61. Rockefeller Foundation Annual Report for 1931, p. 99.
62. Edward Capps to Russell, 12 June 1930, PIHD, box 3, folder 25; D. E. Wright to Russell, 30 May 1930, ibid.
63. Wright to Russell, 30 May 1930 (n. 45).
64. Strode to Russell, 3 February 1930 (n. 22); Copanaris, DemosiaHygeia (n. 31), p. 414.
65. Rockefeller Foundation Annual Report for 1938, p. 112; Allen, Come Over (n. 36), pp. 178- 202; Daniel, Philanthropy (n. 36), p. 214.
66. Rockefeller Foundation Annual Report for 1938, p. 112; Allen, Come Over (n. 36), pp. 178-202; Daniel, Philanthropy (n. 36), p. 214.
67. Rockefeller Foundation Annual Report for 1938, p. 112; Allen, Come Over (n. 36), pp. 178- 202; Daniel, Philanthropy (n. 36), p. 214.
68. Livadas and Sphangos, Malaria (n. 32), pp. 52-53.
69. Rockefeller Foundation Annual Report for 1935, p. 38.
70. "1937 Estimates," 29 October 1936, PIHD, box 2, folder 12.
71. Livadas and Sphangos, Malaria (n. 32), p. 52.
72. Rockefeller Foundation Annual Report for 1935, p. 38; "1937 Estimates" (n. 51).
73. Rockefeller Foundation Annual Report for 1935, p. 38; "1937 Estimates" (n. 51).
74. Land allotments were not assigned to rural refugees until the 1950s. On the issue of land reclamation in interwar Greece, see Louis Cassimatis, American Influence in Greece 1917-1929 (Kent, Ohio: Kent State University Press, 1988), pp. 166-84.
75. "General Considerations," 15 July 1930, Munich, PIHD, box 1, folder 8; Alan Gregg, "Recommendations," 20 May 1930, ibid.
76. "General Considerations," 15 July 1930, Munich, PIHD, box 1, folder 8; Alan Gregg, "Recommendations," 20 May 1930, ibid.
77. Gregg, "Recommendations" (n. 55). Marcos Cueto points to a similar clash of attitudes between the RF and Latin American experts; the persistence of multiple roles among Latin American scientists, he argues, was the result of a "non-specialized ethos that permeated the university" ("Visions of Science and Development: The Rockefeller Foundation's Latin American Surveys of the 1920s," in Missionaries of Science: The Rockefeller foundation and Latin America, ed. Marcos Cueto [Bloomington: Indiana University Press, 1994), p. 10).
78. Gregg, "Recommendations" (n. 55). Marcos Cueto points to a similar clash of attitudes between the RF and Latin American experts; the persistence of multiple roles among Latin American scientists, he argues, was the result of a "non-specialized ethos that permeated the university" ("Visions of Science and Development: The Rockefeller Foundation's Latin American Surveys of the 1920s," in Missionaries of Science: The Rockefeller foundation and Latin America, ed. Marcos Cueto [Bloomington: Indiana University Press, 1994), p. 10).
79. Gregg, "Recommendations" (n. 55).
80. LNHO, "Collaboration" (n. 18); Eleftheron Vema, 15 May 1929, p. 1 (n. 19).
81. LNHO, "Collaboration" (n. 18); Eleftheron Vema, 15 May 1929, p. 1 (n. 19).
82. Strode to Russell, 11 April 1930, letter no. 113, attached report by F. Elisabeth Crowell, PIHD, box 1, folder 3; Carr, Public Health (n. 34), p. 4; Copanaris, Demosia Hygeia (n. 31), pp. 495-96.
83. Strode to Russell, 11 April 1930, letter no. 113, attached report by F. Elisabeth Crowell, PIHD, box 1, folder 3; Carr, Public Health (n. 34), p. 4; Copanaris, Demosia Hygeia (n. 31), pp. 495-96.
84. Livadas and Sphangos, Malaria (n. 32), pp. 7, 28.
85. For an overview of interwar Greek domestic and foreign policies, see Richard Clogg, A Short History of Modern Greece (Cambridge: Cambridge University Press, 1986), and George Th. Mavrogordatos, Stillborn Republic: Social Coalitions and Party Strategies in Greece, 1922- 1936 (Berkeley. University of California Press, 1983).
86. For an overview of interwar Greek domestic and foreign policies, see Richard Clogg, A Short History of Modern Greece (Cambridge: Cambridge University Press, 1986), and George Th. Mavrogordatos, Stillborn Republic: Social Coalitions and Party Strategies in Greece, 1922-1936 (Berkeley. University of California Press, 1983).
87. "Agreement," published in Greek Government Gazette, Athens, 24 October 1936, PIHD, box 1. folder 1; Allen, Come Over (n. 36), pp. 287-89.
88. "Agreement," published in Greek Government Gazette, Athens, 24 October 1936, PIHD, box 1. folder 1; Allen, Come Over (n. 36), pp. 287-89.
89. Livadas and Sphangos, Malaria (n. 32), pp. 28-40.
90. Wright to Warren, 8 December 1939, Ankara, Turkey, PIHD, box 1, folder 3.
91. Zelides, Axiologese (n. 8), pp. 133-35. In 1940 the Ministry of State Health and Public Assistance was renamed the Ministry of National Welfare. See Mastrogiannes, Historia (n. 11), p. 356.
92. Zelides, Axiologese (n. 8), pp. 133-35. In 1940 the Ministry of State Health and Public Assistance was renamed the Ministry of National Welfare. See Mastrogiannes, Historia (n. 11), p. 356.
93. Wright to Warren, 8 December 1939 (n. 64).
94. The last major malaria epidemic occurred in 1942 during the German occupation due to malnutrition and terrible hardship. See Bruce-Chwatt and Zulueta, Malaria (n. 13), p. 37.
95. Strode to Russell, 22 February 1933, letter no. 77. PIHD, box 1, folder 3. Wright to Warren, 8 December 1939 (n. 64).
96. Memorandum by the League of Nations' Health Section to Russell, 4 July 1930, PIHD, box 1, folder 3.
97. Norman White to the President [of the Greek Republic], 17 August 1934, Health Matters, 1938/League of Nations/7/1/III, AYE.
98. Strode to M. C. Balfour, 4 October 1933, PIHD, box 2, folder 13.
99. Strode to Russell, 11 September 1929 (n. 16), attached memorandum.
100. A gradual annual decrease in RF allocations began in 1935. In that year the RF contribution for antimalaria work in Greece was $39,375; by 1940, it bad decreased to $4,000. The Greek government's expenditures on the antimalaria campaign under the administration of the Malaria Division were significantly higher: about $100,000 or 10,000,000 drachmas per year, excluding the cost of antimalaria drugs. See Warren to Sawyer, 12 August 1938 (n. 35).