Monday, 6 November 2017

When Does The Air Matter? by Janet Greenlees

Air Quality and the Working Environment

In this month's blog post Dr Janet Greenlees, Senior Lecturer at Glasgow Caledonian University, looks at  the history of industrial air quality and considers how it has variously been considered a worker's health, community health, and economic concern.

When Does Air Matter?

Men and women weaving at the White Oak Mill in Greensboro, NC, 1909.
Courtesy of the National Museum of American History.
When do people think about the air quality inside buildings? Similar to other health issues, the honest answer probably would be when either they or someone they care about is affected by the poor air they breathe on a regular basis. That being the case, the air quality in working environments could only then be of concern to a relatively small number of people with any improvements sought by labour and their representatives or employers seeking to increase productivity. However, sometimes public health concerns about air quality can apply to both the community and the working environment. How then, is the public health discourse negotiated when the needs of industry can be affected? And, why do certain health issues attract public or political interest and intervention, while others do not? A simple answer might be that the only health issues to attract widespread public interest are those which can affect large numbers of people, such as contagious diseases. However, a closer look suggests regional and national variations regarding responses to public health concerns, even when the same issues and industries cross special boundaries.

An Air Laden with Dust and Dirt

During the nineteenth and early twentieth centuries, cotton cloth manufacturing grew rapidly in New England, America and Lancashire, Great Britain. Both industries subsequently declined, albeit at different rates. Cotton manufacturing was also an industry where men and women worked alongside each other, performing the same tasks for the same rates of pay and experiencing the same workplace health hazards. The air these men, women and sometimes children breathed was laden with dust and dirt, factory ventilation was poor and concerns were raised about the spread of contagious diseases in such environments, particularly tuberculosis. In addition, the noise from the machines was horrendous, particularly in the weaving rooms, and could cause hearing loss and in some cases, deafness. While since the earliest cotton factories, workers had been aware that inhaling dust and dirt made them feel unwell and the noise was uncomfortably loud, it was the late nineteenth century before the workplace became entwined with public health reform, starting with fears about tuberculosis contagion. Public and much scientific belief held that the tubercle bacilli attached itself to dust and quickly spread disease throughout the mill. In the progressive state of Massachusetts, the leading cotton cloth manufacturing state, these fears about TB contagion secured both a legislative ban of a particular technology, the suction shuttle, and selective employer cooperation at improving ventilation. In contrast, and despite widespread belief that England led the way with factory regulation, the tuberculosis risk in the Lancashire mills was debated, but economic concerns prevented both regulation and industrial reform.

Worker Fatigue and Factory Ventilation

The Boott Cotton Mill of Lowells, Massachusetts.
Courtesy of the Lowell Museum Collection.
During the early twentieth century new health concerns arose, firstly surrounding the importance ventilation and following the Great War, fatigue. Fatigue was not simply related to long hours of labour but also to working in poorly ventilated factories. In Massachusetts cotton towns, ventilation became a public health campaign with improvements introduced in many public buildings, including schools and government buildings and extending into workplaces. Some (but not all) employers accepted the notion that a healthy worker was a more productive worker. Ventilation attracted considerable British debate and scientific interest, but while some communities sought to improve factory ventilation and legislation imposed air quality standards on the cotton mills, in reality, employers remained able to operate as they saw fit. Factory air quality was secondary to the needs of industry. The Great War turned scientific, political and medical interest to fatigue research, particularly in Britain. Textile workers were included in the research; however, industrial decline meant political and scientific interest in operative fatigue quickly faded. The same was true in New England. During the 1920s, most of the cotton manufacturing industry shifted to the southern states. Remaining northern firms were more concerned about economic survival than the air quality in the mill. Worker and community concern about mill air quality also declined as jobs took priority. Indeed, wider economic concerns were increasingly influencing the public health agendas of both countries.

Cotton Dust Inhalation

Nevertheless, scientific and medical interest about occupationally specific health concerns was growing, particularly surrounding cotton dust inhalation. However, the physical symptoms of respiratory damage caused by dust inhalation mirrored those of respiratory diseases common to many textile towns, including bronchitis and pneumonia, namely, tightness of the chest, dyspnea and coughing. Therefore, doctors found it very difficult to identify cases of byssinosis, the respiratory disease caused by prolonged cotton or flax dust inhalation. While public concern grew surrounding the widespread dust found in urban environments, such concerns were not transferred to factory dust. There, dust remained an occupationally specific hazard about which middle class social and political reformers had little interest. This was only reinforced by the ambiguity surrounding diagnosis. For workers, dust was an everyday reality that was simply part of the job and unions sought compensation rather than reform. Britain was first to introduce byssinosis compensation for selected male workers in 1941, although it was the 1970s before compensation was extended to all affected workers. By this time, cotton manufacturing had virtually disappeared from the country. Despite individual American doctors and scientists recognizing byssinosis cases, it was 1969 before the federal government introduced compensation for byssinosis sufferers. Instead, public health concerns about dust remained confined to the urban living environment and, when combined with the ambiguity surrounding diagnosis, many workers were left to suffer on their own.

Interior of a Lancashire Cotton Mill with Mill
Workers at their Machines, Lancashire, c. 1890.

Managing the Health Impact of the Working Environment 

Lastly, noise, but not internal industrial noise, briefly became a public concern. Community concerns about specific urban noises increased as the twentieth century progressed. Societies were formed to tackle ‘unnecessary noise.’ However, the continuous crashing of metal-tipped shuttles against metal loom frames in the mills which caused hearing loss in many workers was ignored. Instead, communities, medics and even operatives accepted that hearing loss was a risk attributable to certain jobs, including weaving. Weavers adopted coping strategies to manage the noise, including sign language and lip reading. Indeed, despite the fact that other air quality issues had attracted public interest and industrial reform, operatives regularly found themselves needing to adopt coping strategies to manage the health consequences caused by working in confined spaces with poor air quality. Other strategies included taking unpaid time off, patent medicines, cooperative strategies, switching firms to where conditions were better and exiting the industry. Air quality at work was important to workers, but managing the health impact from the working environment comprised only one part of their decision-making surrounding work, health and community. Similarly, at different times, certain aspects of air quality became community health concerns. Only at certain times did the two environments entwine.

Janet Greenlees

Dr Janet Greenlees
Janet Greenlees is a Senior Lecturer in History at Glasgow Caledonian University, based in the Centre for the Social History of Health andHealthcare. Her research interests include women and work, public health and the working environment and maternal health and she has published on all these topics. The intersection of health in the community and work environment described above is explored in greater detail in her book: When the Air became Important: A Social History of the Working Environment in New England and Lancashire, 1860-1960 (Rutgers: Rutgers University Press, forthcoming 2018). For more on gender and workers’ responses to poor air quality at work, see ‘Workplace Health and Gender among CottonWorkers in America and Britain, c. 1880s-1940s’, International Review of Social History, 61, 3 (2016), 459-83.

Thursday, 27 July 2017

Dr Sinead McCann: Receives Two Arts Council Awards

We're delighted to announce that Dr Sinead McCann of the UCD Centre for the History of Medicine in Ireland (CHOMI) has received two prestigious funding awards from the Arts Council of Ireland for her projects 'Health Inside' and 'The Trial'.

Pictured from left to right: Dr Sinead McCann (UCD CHOMI), Dr Orlaith McBride
(Director, Arts Council of Ireland), and Associate Professor Catherine Cox (Director,
 UCD CHOMI). Photograph taken at the announcement of the recipients of the Arts
Council of Ireland's Open Call programme awards, July 2017.

Sinead, a noted Irish visual artist, received these awards in her role as a Public Engagement Officer on the Wellcome Trust Senior Investigator Award project, Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000. This project is led by co-Principal Investigators Associate Professor Catherine Cox, Director of UCD CHOMI, and Professor Hilary Marland, Director of the Centre for the History of Medicine, University of Warwick.

Inside Health: Thinking about Prisoners' Right to Healthcare

Health Inside: Thinking about Prisoners' Right to Healthcare is a new public art project, due for exhibition in June 2018, which will focus on health and welfare provision in Irish and English prisons. The project is funded by the Arts Council of Ireland under its Open Call programme. The Open Call programme funds one-off ambitious artistic projects by some of Ireland's leading artists and arts organisations.

For further details see:

The Trial

The Trial is the working title for a new visual art project due for public exhibition in April 2018. It will focus on health and welfare provision in Irish prisons and access to healthcare following release from prison. 

The project is funded by the Arts Council of Ireland under its Arts Participation Project Award scheme. The project will be led by Dr Sinead McCann, who will work collaboratively with historian Dr Holly Dunbar (UCD CHOMI), film-maker Mary Caffrey, and participants from the Bridge Project. The Bridge Project is a community-based organisation providing training and support programmes for high-risk violent ex-offenders in the greater Dublin Area. In April 2018, the team will produce a visual arts installation for public exhibition in Kilmainham Gaol Museum's Old Court Room.

For further details see:

Friday, 23 June 2017

An Tobar: a Two-day Workshop on Sacred Springs and Holy Wells

Waterford Museum of Treasures, 26-27th June 2017

For further details please see: Holy Wells and Sacred Springs

This two-day workshop brings together scholars from across the world and from a variety of backgrounds and disciplines, all working on aspects of holy wells and sacred water. Most commonly a spring (but sometimes a pond, an entire lake, or even a hollow in a rock or tree where dew and rain collects), a holy well can possess miraculous healing qualities and is associated with supernatural beings, for example, being dedicated to a saint in Europe, associated with fertility goddesses in Africa, or the abode of boon-granting dragons in China. Water is sacred around the globe because water is life, and our critical need for water means hallowed wells and springs are found cross-culturally. 

The social significance of sacred water bodies and their associated traditions is now an emerging subject of study. One area where Irish scholars in particular are making great advances is the medical and curative dimension to these sites. These papers represent exciting new research taking place across Ireland into the various ways holy wells and their landscapes have played and continue to play a role in approaches to health and wellbeing. 

Healing Waters and Therapeutic Landscapes 

North Leinster Holy Wells: A Medical Geography – Ronan Foley, Maynooth University 

One of the primary reputations of holy wells is their function as curative sites. Medical/health geographers are equally interested in the idea of therapeutic landscapes, places or spaces with established reputations for health and healing. With increased access to spatial information on the location of holy wells, and a parallel development in the mapping of folklore sources about specific cures, it has become possible for the first time to create a medical geography of holy wells in Ireland. Sources vary from traveller’s accounts and local historical sources to material from the Schools Collection and more recent surveys and ethnographic site visits. This paper describes the spatial distributions of specific cures in North Leinster as a representative location and considers the extent to which some wells had quite specific named curative powers, while others were panaceal. In addition, the location of the different cures across time and space will complement ongoing work at Trinity College Dublin on scientific testing of the waters to see if local geographical conditions can in part explain their distribution. Finally, the use of GIS and other geo-spatial mapping approaches identify the ongoing ways in which holy wells databases can be developed to promote the preservation of their narrative histories and ongoing curative performances. 

Dr Ronan Foley is a Senior Lecturer at the Department of Geography at Maynooth University, Ireland. He has written extensively in the broad area of therapeutic landscapes, including Healing Waters: Therapeutic Landscapes in Historic and Contemporary Ireland (2010). He is currently the PI on an Irish Environmental Protection Agency project on Green/Blue Spaces and Health & an advisory partner on an ESRC project at the University of Exeter on Sensing Nature. 

Tobair beannaithe agus ‘an leigheas’: Holy Wells and ‘the cure’ in 20th Century Ireland – Carol Barron, Dublin City University 

The Schools Manuscript Collection of 1937-38, housed in the Folklore Department in UCD is believed to be the largest single medical folklore collection in Europe, and offers us a unique insight into the believes, practices and rituals surrounding ‘the cure’ and Holy wells in 20th Century Ireland. This paper examines a subsection of over 7,500 ‘cures’ sampled from the Schools Manuscript Collection from each barony of each of the 26 counties of Ireland, of which over 250 ‘cures’ are specific to Holy wells. This shared socio-cultural phenomenon is critically examined from a folkloristic/anthropological perspective, focusing on the specific disease states and their cultural importance to the health of Irish society at the time of recording and through history. 

Dr Carol Barron is a lecturer in the Department of Nursing and Human Sciences at Dublin City University. She received her PhD in Anthropology from NUI Maynooth and her research focusses on child health. In particular, she has conducted extensive investigation into the use of Irish folk cures.

Well-being: Holy Wells as Emergent Therapeutic Spaces – Richard Scriven, University College Cork

Applying the concept of therapeutic landscapes to holy wells, this paper examines these sites as spaces of wellbeing that are forged through the interactions of people and place. Holy wells can be appreciated as sources of health offering spiritual and emotional support to individuals and communities. These experiences are generated in the meeting of bodies and practices, location and materials, and beliefs and emotions. Within these processes, well-being emerges with the site rather than being taking from it: there is a ‘taking place’ of health and wellbeing. Drawing on my fieldwork at holy wells across Munster, I explore the practices and meanings that contribute to the creation of these spaces of wellbeing and offer speculations on further engagements with this arena. 

Dr Richard Scriven is an Irish Research Council Government of Ireland Postdoctoral Fellow in the Department of Geography, UCC. His research examines pilgrimage in contemporary Ireland as a socio-cultural phenomenon. 

Holy Wells: The Evidence from Ulster – Finbar McCormick, Queen’s University 

The experience of attending holy wells was composed of two main components, health and penance. While the curative nature of the wells is generally emphasised, the great majority of those who attended sites were not suffering for sickness or disability, - “every face beaming with the glow of health” as one observer noted. The main aim was to ensure the maintenance of good health for the coming year. This aspect of the ritual often involved washing or bathing in the well’s waters something that has for the most part disappeared in modern holy well rituals. The earliest place-name evidence for holy wells in Ulster and elsewhere, dating to the early Medieval period, indicates their association with health. It is likely that the penitential aspect of the wells is a later development. This paper considers a chronology for understanding the layered meanings of holy well rituals in Ulster. 

Dr Finbar McCormick teaches Archaeology at Queen’s University Belfast and has recently been researching and excavating Struell wells in County Sown. Struell contains the most extensive set of buildings associated with a holy well in Ireland and can be documented back to the early Medieval period.

Further Details

Thursday, 22 June 2017

Disorder Contained: Theatre Performances, Coventry, Dublin, Belfast

A Theatrical Examination of Madness, Prison and Solitary Confinement

Disorder Contained: A theatrical examination of madness, prison and solitary confinement is a major public engagement activity for the Wellcome Trust funded project Prisoners, Medical Care and Entitlement to Health in England and Ireland 1850-2000. It draws on the work of Associate Professor Catherine Cox (UCD) and Professor Hilary Marland (Warwick) and forms the final part of The Asylum Trilogy exploring various aspects of the history of mental health.

The production, created with Talking Birds and to be performed in Coventry, Dublin, Belfast, and London during 2017, will be accompanied by Expert Panel Discussions as well as Post-show Artistic Conversations which will be recorded along with the performance.

Book Tickets

See Also


Friday, 7 April 2017

Alcohol, Medicine and Irish Society, c.1890-1970 by Alice Mauger

Wellcome Trust Medical Humanities Fellowship

A Wellcome Trust Postdoctoral Fellowship has been awarded to Dr. Alice Mauger. Her three-year project on ‘Alcohol, Medicine and Irish Society, c.1890-1970’ is being hosted by the UCD Centre for the History of Medicine in Ireland (CHOMI). It is mentored by Dr. Lindsey Earner-Byrne, Deputy Head of the School of History, UCD and sponsored by Associate Professor Catherine Cox, Director of UCD CHOMI.

The project explores the evolution of medicine’s role in framing and treating alcoholism in Ireland. It assesses the period from the 1890s, when acceptance of inebriety as a disease led to the creation of the short-lived inebriate reformatories, to the 1970s, when dedicated rehabilitation facilities were formed in response to the rising number of psychiatric patients diagnosed with alcohol-related illnesses.

Until now, the history of medicine has offered little reflection on the relationship between medicine and alcoholism in Ireland. While the ubiquitous “drunken Irish” stereotype, still prevalent today, has been evaluated from several viewpoints, we have yet to discover how international and Irish medical communities interpreted, informed and absorbed this label. By investigating care in asylums and inebriate reformatories, along with medical debates and shifting government policies, the project questions how the exchange of medical, government and lay ideas came to shape understandings and experiences of alcoholism in Irish society.

Still image from the television show, 'Home Truths', featuring a segment
on alcoholism,  RTÉ, 7 December 1966. Image courtesy of the RTÉ Stills Department.


Despite the popularity of temperance and pioneer movements in Ireland since the mid-nineteenth century and high levels of abstinence reported into the 1950s, the Irish have traditionally been viewed as being especially prone to alcoholism. Irish emigrants were persistently portrayed as heavy drinkers, while the emergent Irish nationalist movement sought to associate abstinence with patriotism – some prominent members even claiming that the British encouraged Irish drinking to demoralise the population. In these ways, alcoholism was inextricably linked to theories or fears of Irish degeneration.

This project questions the extent to which enduring stereotypes of the Irish as violent and drunken permeated contemporary medical conceptions of alcoholism, and whether this in turn influenced political and lay interpretations.

Internationally, several works have focussed on shifting medical concepts of addiction. This project situates Irish therapeutic and diagnostic trends alongside those in other western countries, including Britain, America and Australia. It also seeks to inform the extensive literature on the history of psychiatry, particularly degeneracy and ethnicity, and related discourses in Irish social history covering themes such as poverty, violence and the family.


The project aims to make a significant contribution to the medical humanities, exploring historical sources to better understand and contextualise Irish society’s relationship with alcohol. In doing so, it hopes to inform present-day social and cultural concerns.

Keys findings from the project will be presented in a monograph, journal article and a series of posts on the CHOMI blog, as well as papers given at relevant forums.

In 2019, Alice will organise an interdisciplinary workshop on ‘Alcohol, Medicine and Society’ at CHOMI, inviting policy makers and academics from Ireland and overseas. A call for papers for this event will feature on this blog.

Alice has also planned a one-month knowledge exchange to the Centre for History in Public Health in the London School of Hygiene and Tropical Medicine to engage with prominent experts on addiction history including Professor Virginia Berridge and Dr. Alex Mold.


Dr Alice Mauger

Dr Alice Mauger is a postdoctoral fellow at the UCD Centre for the History of Medicine in Ireland, University College Dublin. She was awarded a PhD by UCD in 2014 for her thesis which examined public, voluntary and private asylum care in nineteenth-century Ireland. Prior to this she completed the MA programme on the Social and Cultural History of Medicine at the UCD Centre for the History of Medicine in Ireland, UCD. Both her MA and PhD were funded by the Wellcome Trust. Dr Mauger has published on the history of psychiatry in Ireland and is currently finalising her first monograph: The Cost of Insanity in Nineteenth-Century Ireland: Public, Voluntary and Private Asylum Care.

Monday, 13 March 2017

A Forgotten Episode of International Health by Dora Vargha

In this month's blog post, Dr Dora Vargha, University of Exeter, uncovers the neglected role of the Socialist Bloc and Eastern Europe in the history international public health. Dora argues that rectifying this omission is essential to capture a complete picture of international and global public health in the crucial era following the postwar settlement. 

The Establishment of the World Health Organization

The establishment of the World Health Organization is no doubt a crucial and fundamental moment in the history of international (and global) public health. The leadership, ideas and early decades in the unfolding Cold War can be assembled through biographies of Director-Generals, the Organizations own chronicle of its first decades and through histories of malaria eradication. However, certain equally important aspects of the early years of the WHO, like the sudden exit of the Soviet Union and Eastern Europe shortly after the establishment of the organization merit little more than a mention in these histories.

The Socialist Bloc and the Missing History of the WHO

Andrija Stampar (1888-1958), born in Drenovac, Croatia,
was a key figure in the history of twentieth-century public
health and  a leading figure in the League of Nations Health
Organisation. Commemorative Stamp of Anrija Stampar,
 issued 1970, Yugoslavia (Public Domain).
This omission from the historiography is not entirely surprising. The Socialist Bloc, and Eastern Europe in general has been, until recently, missing from international health narratives on the whole, despite foundational Eastern European figures in its history such as Andrija Stampar, key member of the League of Nations Health Organization (LNHO) and president of the First World Health Assembly, and Ludwik Rajchman, director of the LNHO and founder of UNICEF. Often seen as a politically homogeneous area under complete Soviet control in the postwar era, Eastern European countries have not been considered to have agency in international health during the Cold War.

But the history of international and global health has a lot to gain by including the Socialist Bloc in the picture. This unexplored history points to questions whether international health always happens within organizational structures of international agencies and through philanthropic entities such as the Rockefeller Foundation; what the stakes were in this Cold War divide in the formative years of the WHO; and the extent to which we can talk about a unified response within the Socialist Bloc to diplomatic and public health challenges in their time outside of the organization.

Socialist Networks and International Public Health

Considering alternative international public health, in this case socialist networks, is crucial in getting a complete picture of postwar international public health and its effect on modern global health. The historiography of internationalism has been going under a rapid change by including alternative internationalisms and focusing on socialist exchange in ideas, practices and knowledge. Much of this new research has addressed issues of development, culture and education. Many have called attention to Eastern Europe’s role in transcontinental collaboration and have placed contributions to postcolonial projects in focus. With some notable exceptions, such as Young-Sun Hong’s work on East German development projects, or Ana Antic’s research on transcultural psychiatry in Yugoslavia, health has mostly escaped the attention of these new histories.

Through the lens of Hungary, the last country to re-join the WHO in 1963, my research aims to put Eastern Europe in the focus of international health inside and out of the World Health Organization. I seek to explore what happened to international health in Eastern Europe, outside of the purview of the usual suspects: international agencies and non-governmental organizations, like the Rockefeller Foundation, how complete was the break with liberal internationalism and what, if anything, took its place.

It was not long after Eastern European states successfully joined that the Soviet Union decided to leave the WHO. The Russians were not very eloquent in their reasoning, they cited the mammoth bureaucracy, high member fees and the political influence of the United States in the WHO. The exit of the Soviet Union, followed by the whole Socialist Bloc challenged the proclaimed universality of the newly formed WHO and the centrality of technical expertise in opposition to political allegiance. The quick deterioration of the East’s relationship with the organization seems to fit neatly into a narrative of the escalating Cold War and increase of the Soviet Union’s hold on Eastern Europe. However, when inspected in detail, the reasons for the exit of these countries was more complex and had to do as much with expectations of what an international health agency should do, as with foreign policy.

Grievances towards the WHO

Dr Josepf Plojhar, (right), Minister for Health, Czechoslovakia.
Also pictured, Tadeusz Michejda (left), Minister for Health, Poland;
Luitpold Steidle (right), Minister for Health, GDR.
Berlin, 14 September 1950. Bundesarchiv. Bild 183-T00826
The grievances towards the WHO had been many and from an Eastern European perspective, were mostly justified. The overpowering American influence undoubtedly played a large role in this. Certain issues, such as Americans barring access to vital drugs, such as penicillin in Poland and Czechoslovakia, became especially sore points for Eastern European politicians and physicians. In his memoir from 1978, Tibor Bakács, Hungarian virologist and representative to the second World Health Assembly in 1949 gave a dramatic account of the appeal of Josef Plojhar, Czechoslovak health minister and roman catholic priest.

Socialist countries did not have their own penicillin plants back then, they had to import the needed amount for hard currency from the West. The Czechs, in order to become independent, purchased a whole penicillin plant from the Americans before the political turn of February 1948, which according to the contract the US had to deliver in two installments. The first one arrived, but the second one, which was to be delivered after the political turn, was held back by the Americans. Father Plojhar, wearing priest’s attire, asked the delegation of the United States in front of the Assembly, why they had not honored the contract. The American delegate, putting aside all civility (and with the knowledge of the subservient voting machines behind its back) just briefly said: "Contract, no contract, you turned socialist, you get nothing!" The president of the assembly then put the Czechoslovak question to vote, and apart from the 5 yes votes of the socialist countries present, the issue was overruled by the majority. The vassals "voted well" - it was a real American decision. I wouldn’t have thought that professional issues, what’s more, questions of health can be distorted so under political duress.1  

While Plojhar’s speech does not appear in the minutes, the American delegate, Leonard A. Scheele Surgeon General referred to it and dismissed the claim by stating that the equipment in question is not necessary for the production.

Attributing Eastern European countries’ decision to leave solely to Cold War political alignments would be a mistake, however. Recent research on the years of communist takeover has shown that the relationship of the Soviet Union and Eastern European countries was a complex one and certain aspects of that relationship were very much open ended. We cannot readily assume a master plan from the Soviet side, with which Eastern European states quickly fell in line with. Moreover, while the overwhelming influence of the United States in the WHO and pressure from the Soviet Union no doubt playing an important part, countries like Hungary had other, substantial reasons for discontentment.

Second World Health Assembly

Second World Health Assembly, Rome,
13 June to 2 July 1949: Decisions and
resolutions: plenary meetings verbatim records:
committees minutes and reports: annexes.
Courtesy of WHO: IRIS
The Socialist Bloc did not immediately follow the Soviet Union in stepping out of the WHO. The minutes of the second World Health Assembly in 1949 give a glimpse of the short time when Eastern European countries took part in the WHO’s work without the presence of the Soviet Union in the organization. In their speeches, Eastern European delegates acknowledged the merits of the WHO and the overall significance of the organization.

However, there were problems: several Eastern European delegates criticised the WHO for its one size fits all approach. Apart from issues with access to penicillin, the Czechoslovak delegate called on the WHA to rethink the universality of certain public health issues and instead, consider health priorities on a national level. The Hungarian Health Minister, István Simonovits pointed to the fact that while Hungary considers fellowships to be crucial as a form of pursuing international public health, many of its fellows are regularly denied entry visas to WHO member states and are therefore unable to attend conferences they are invited to. Simonovits also considered visiting lecturers to be less useful for Hungarian public health: “Even the best lecturer was hardly more useful than a good article, because in many cases the lecturer had no knowledge of our special local problems.”

The criticism of several of the Eastern European delegates point to a different expectation of the tasks and responsibilities of international health organizations. In the late 1940s the countries in question were still in a horrid state, their hospitals bombed, medical equipment seized or destroyed, with extreme housing problems and crumbling infrastructure. In countries with extreme shortages of medication, physicians and buildings fit to house patients, and with no access to the Marshall Plan or other forms of aid, the policy of the WHO to give technical assistance instead of material aid seemed pointless, offensive even. As Plojhar, the Czechoslovak delegate put it: "It is more urgent for us to dispose of some public-health problems than to receive good advice."

The buildings of the Foreign Ministry and War Office in Budapest, 1949.
Photograph by Carl Lutz. Foto:Fortepan/Archiv Für
Zeitgeschichte Eth Zürich / Agnes Hirschi. Photo ID: 105808

Withdrawal from the WHO

The second World Health Assembly was the last one that Eastern European countries attended for almost a decade. Romania, Albania, Poland, Czechoslovakia and Hungary left the organization in 1950. Some of the delegates, like Plojhar warned of this possibility at the Second WHA in 1949. But perhaps the withdrawal was not a clear choice. Instead of issuing a warning, the Hungarian delegate used his speech to plead for the inclusion of socialist approaches to public health, and to remedy the situation that caused the Soviet Union to leave the organization.

The withdrawal of such a substantial number of countries from the WHO placed the question of membership into focus and pointed to broader questions of supranationality and state sovereignty. The WHO navigated its practice among two legal school of thoughts: one of which considers such an international organization to be supranational, making a unilateral withdrawal impossible once a member voluntarily joined, and another considering membership in the international organization to be dependent on its alignment with foreign policy. The United States favoured the latter interpretation, its Congress upholding the right to withdraw within a year of joining the WHO. The organization itself adopted a position of compromise between the two schools, introducing “inactive membership” for withdrawing states. This latter solution also helped save the international organization some embarrassment, when the Soviet Bloc exited the WHO.

Not only did the practice of international public health in Eastern Europe continue with the budding socialist internationalism within the Bloc, but countries like Hungary continued to participate through interaction and collaboration with the West. Being out of the WHO, divided by the Iron Curtain also did not mean that the region was isolated in terms of international health. If we shift our focus from viewing internationalism in public health from the perspective of international organizations and governments, and turn to the agents of internationalism themselves, we find that the sites of international collaboration in public health were as varied as the people acting as internationalists. Families and virologists, hospital directors and religious scholars were actively involved in shaping international collaboration in research, treatment and access to technology.

Decentering Narratives of Internationalism and Global Public Health

Geographically and conceptually de-centring narratives of internationalism and global public health, especially ones tied to the Cold War, is crucial for a nuanced understanding of this formative era. By bringing Eastern Europe into the focus and considering alternative internationalisms, new faces, practices and relationships become visible, which, in the end, can help us piece together a very messy and often confusing picture of international and global health in the 20th century.

Dora Vargha
Dr Dora Vargha

Dr Dora Vargha is a lecturer in the Medical Humanities at the University of Exeter. Previously, she has held research fellowship positions at the Max Planck Institute for the History of Science, Berlin and at Birkbeck, University of London. She is an acclaimed authority on the history of global health and biomedical research in the Cold War era with a particular focus on Eastern Europe. 

Dora's work has been widely published in leading peer-reviewed journals including Contemporary European History, and Bulletin of the History of Medicine. She has recently completed the manuscript for her forthcoming monograph Iron Curtain, Iron Lungs: Governing Polio in the Cold War which explores a series of polio epidemics in Hungary in the context of international Cold War politics. She has recently embarked upon a new research project, for which she received a Wellcome Trust Seed Award, titled, 'Socialist Medicine: An Alternative Global Health History'.

Dora is the recipient of many scholarly awards including the J Worth Estes Prize from the American Association for the History of Medicine and the Young Scholar Book Prize from the International Committee for the History of Technology. She is the founding editor of and a contributor to the Central and Eastern European History of Medicine Network Blog. Dora is also a collaborating member of the Reluctant Internationalist research group, a Wellcome-Trust funded project that is researching the history of public health and international organisations. 

1 Tibor Bakács, Egy Életrajz Ürügyén (Budapest: Kossuth Könyvkiadó, 1978).

Wednesday, 15 February 2017

Event: Mind-Reading 2017


Venue: Studio Theatre, dlr LexIcon
Date: 10 March 2017

Conference Organisers:
Dr. Elizabeth Barrett (UCD) and Dr. Melissa Dickson (Oxford).

Keynote Speakers:
Prof. James V. Lucey (TCD),
Prof. Fergus Shanahan (UCC) and
Prof. Sally Shuttleworth (Oxford).


This one-day programme of talks and workshops seeks to explore productive interactions between literature and mental health both historically and in the present day. It aims to identify the roles that writing and narrative can play in medical education, patient and self-care, and/or professional development schemes.

Bringing together psychologists, psychiatrists, interdisciplinary professionals, GPs, service users, and historians of literature and medicine, we will be asking questions about literature as a point of therapeutic engagement. We will explore methods that can be used to increase the well-being and communication skills of healthcare providers, patients and family members.

Conference Coordinator:
Victoria Sewell (UCD)

Book HERE with UCD