Andrija Štampar
(an excerpt from 'Selected Papers of Andrija Štampar': "Life and Achievements of Andrija Štampar, Fighter for the Promotion of Public Health" by M.D. Grmek)

Building up of the Former Yugoslav Health Services

Štampar remained at Nova Gradiska only for a few weeks because by the decree of the National Assembly in Zagreb of November 25, 1918, he was appointed Health Advisor to the Commission for Social Welfare in Croatia.

In 1919, Štampar published a series of articles on child health, venereal diseases, and agrarian reforms. He also continued his work on health education, and his 'People's Primer on Alcohol' earned him a great success.

In April 1919, Štampar attended the Congress of Inter-Allied Countries for Social Hygiene in Paris, and gave a lecture on child health. By his publications, Štampar showed that he had a very clear concept of how to establish a public health service in his country. It was therefore justifiable that Andrija Štampar, although only 31 years old at the time, should be entrusted with the task of taking over the duty of the head of the former Yugoslav Health Service in Belgrade. Soon he was surrounded by a group of young people who believed in ideals of social medicine. With very modest material resources, the first period of his work in Belgrade (1919-1923) was for the most part theoretical and organizational, and only in the second phase (1924-1930) did the building of hygienic institutions take place.

Throughout those years he did a lot of writing and published articles expounding the main lines of health policy, ideological treatises, legal acts and regulations on health, reports on people's health condition, etc. Significant for Štampar's programme were his treatises on social therapy, the reform of health institutions, the reform of medical education, and on the new law on health. He put forward ideas which were of great practical importance and which, of course, aroused both great enthusiasm and bitter controversy.

Štampar struggled for the introduction of the subject 'Social Medicine' into the regular curriculum of Medical Schools. In addition to his administrative activities, he took over the task of teaching future physicians the fundamentals of hie views on medicine. In September 1922, Štampar was given 'permission to teach' (venia docendi) in Social Hygiene by the Faculty of the Medical School in Zagreb and by the Provincial Governor of Croatia. By the King's decree of October 30, 1922, the title of Associate Professor was conferred on him. Thanks to Štampar's endeavours, a special Institute of Social Medicine was founded at the Zagreb Medical School.

Štampar started organizing and materializing his grandiose, revolutionary hygienic-epidemiological and preventive-prophylactic-curative programme. He first revitalized the existing few bacteriological stations, opened new ones, and simultaneously organized urgently needed epidemiological services. The first epidemiological institutes also came into existence. He paid the greatest attention to the control of serious social diseases, and to tuberculosis, malaria, endemic syphilis, typhus, and trachoma in particular. The first Anti-Tuberculosis Dispensary in Zagreb, the Institute for the Study and Control of Malaria in Trogir, the Tropical Institute in Skoplje, etc. - all these institutions were opened where possible according to their need. Štampar was particularly proud of these institutes, in which also foreigners worked and came often to exchange experiences to the mutual advantage. All these numerous and varied institutions which were opened at the time cropped up appearingly unconnectedly but in fact according to a very well devised and minutely elaborated plan with a view to being linked together, at a given moment, in a harmonious whole. In his endeavours he gathered a series of young collaborators: Borcic, Petrik, Prebeg, Rasuhin, Sremec, and many others. With them, he propagated his ideas with all his heart, from Cetinje to Triglav.

The crucial year for the implementation of Štampar's policy was 1924, when from the theoretical and organizational phase he passed onto a more active, and more fighting phase. In his article 'Our New Tasks in Health Services' (1924), he said that the first stage in the building of public health was over and that it comprised the setting up of the Ministry and central institutions in towns, as well as training of experts, while the second stage, which he inaugurated, should mean transition to active field work, rural sanitation, and socialization of health services. A number of private physicians and owners of pharmacies reacted by a series of statements and petitions, in the conviction that their professional and economic interests were in danger. About this opposition Štampar said: 'The health service was the subject of severe and, very often, bitter criticism on the part of our general public.' The opposition against Štampar was led by the Medical Chamber and the Croatian Medical Association. For that reason Štampar withdrew from the membership. The journal 'Lijecnicki vjesnik' published criticism of his 'Social Medicine' blaming it as a biased work, aimed against the medical profession. The fight between the Ministry of Health and medical societies lasted for years. On the contrary, in other countries of the world, Štampar's work gained great recognition. The greatest help was given to former Yugoslavia by the Health Organization of the League of Nations and the Rockefeller Foundation. Štampar came into closer touch with the League of Nations mostly through the President of the Health Organization Ludwig Rajchman. From 1924 Štampar was a member of several international expert committees. Large sums of money were granted through Štampar by the Rockefeller Foundation, and this also made possible the building of the School of Public Health in Zagreb (1927) and sending abroad a great number of medical doctors. The opening of the Zagreb School of Public Health was attended by outstanding, world known hygienists, such as Madsen, Grotjahn, and Leon Bernard, all of them Štampar's close friends. Štampar's friendship with Prof Gunn, representative of the Rockefeller Foundation for Europe, was of great significance for the former Yugoslav Health Service. In financially corrupted ruling circles of Belgrade, the administrator Štampar was one of the very rare persons conspicuous for his irreproachable honesty and whom foreign institutions readily entrusted large sums of money. Among central health institutions built at the time of Štampar's administration, the most important ones were the Central Institute of Hygiene in Belgrade, and the Institute of Hygiene, incorporating the School of Public Health in Zagreb.

King Alexander's dictatorship put a stop to Štampar's work at the Ministry of Public Health. In March 1930, he was appointed General Inspector of Hygiene at the Ministry of Social Welfare and Public Health. This was a nice title but in fact meant his removal from the position of respinsibility. In 1931, he was put on the retired list by the King's decree of May 20. He also came into personal conflict with King Alexander because he refused an invitation to enter the government. He was offered the portfolio of the Minister of the Interior, but he refused it, i.e. he asked for free elections as a condition.

Štampar never belonged to any political party but from his student days he favoured people of progressive ideas. His link with the Croatian politician Stjepan Radic lay in their common love of the exploited, oppressed peasant. On several occasions Radic praised Štampar's work on rural sanitation and it was Radic himself who opened the Zagreb School of Public Health.

Štampar's retirement produced a twofold reaction. Some could not hide their pleasure that the man who endangered their economic interests was no longer the head of the Health Service. On the other hand, there appeared articles expressing sympathy, even concealed protests. Štampar's influential friends from abroad, such as P.F. Russell, Director of the Rockefeller Foundation, openly protested against his retirement as being due to political reasons only.