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)

Childhood and Education at Home

Andrija Štampar was born in the village Drenovac (commune Brod), on the border of the then

Austro-Hungarian Monarchy, on September 1, 1988. His father Ambroz Štampar, son of a

carpenter from Lika, was a school-master in Drenovac, and Andrija was born in the building

of the village school where they lived.

Andrija had to leave his parental home very early. His gifts were obvious, and his parents

wanted him to obtain higher education. From 1898-1906 he went to grammar school in

Vinkovci. During his secondary schooling, Andrija proved a brilliant pupil. It was at that time

that he wrote his first literary attempt: a collection of popular riddles published in the

periodical 'Pobratim' (1902). 

 

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)

Medical Studies in Vienna

He wanted to study medicine, because he came to the conclusion that what Croatian peasants

needed most was physicians - physicians who had an understanding of people's needs. He

enrolled at the Viennese Medical School on October 18, 1906. At that time Vienna was one of

the most important medical centres in the world.

Unlike most students of the time, he led a solitary, modest life, did not frequent cafes, and had

already firmly decided never to drink alcohol. He took all his examinations in due order, and

in addition to obligatory subjects, he indulged in reading socio-medical papers.

Among other scientists who influenced Štampar by their outlook, special attention should be

made of the biologist Ernst Hackel and Alfred Grotjahn, German hygienist, who later in his

memoires wrote very flattering words about Štampar's work.

Already as a medical student, Andrija Štampar initiated the editing of didactic medical papers

and wrote pamphlets and articles with the intention to educate people in health matters. He

persuaded the printer M. Mladjan in Nova Gradiska to start publishing the series called

'Public Health Library'. In one year alone (1909), Štampar prepared 3 volumes for this series.

The same year he prepared a pamphlet on alcoholism (after M. Helenius and A. Trygg-

Helenius) and venereal diseases (after Finger and Schumburg). Also, 3 more volumes were

ready to appear - on trachoma, nutrition and child health - but Štampar did not succeed in

publishing them since the publisher got into financial difficulties.

Štampar's 'Instructions on Health' are very well written, sometimes with real poetical

enthusiasm. The basic idea he expounded was that the duty of each person is to take care of

his own health; if we care for our health, we do not do it for ourselves only but for the

community in which we live as well.

Štampar's philosophical thoughts and his views on life are expounded in his papers

'Mechanisms of Mental Life', 'Oneness of Matter', 'Generatio Aequivoca'.

A series of articles entitled 'From the Field of Social Medicine' and published in the periodical

'Zvono' (1909) are definitely polemic in character. Štampar stood firmly on his feet and

nothing is his writing revealed that he still lacked a diploma. Throughout the articles he cried

for reforms in Croatia.

Although he published over 70 articles and pamphlets as a student, he neve neglected his

regular studies. He passed successfully all his examinations and on December 23, 1911 the

was awarded the title of Doctor of Universal Medicine (doctor medicinae universae).

 

 

Return Home and World War I

On January 1, 1912 Dr Andrija Štampar started working as a resident at the town hospital at

Karlovac. He remained at this post till August 8, 1913. He married Marija Mesnjak, with

whom he had two sons and three daughters (Slobodan, Ljerka, Boris, Bosiljka and Zorka).

He dealt with general practice, even performed some minor surgeries but his eyes were turned

towards social medicine. He examined the health conditions at Karlovac, and wrote an article

about it in the local newspapers.

He enrolled in the 'Zbor lijecnika Hrvatske' (Croatian Medical Association), a professional

organization of physicians, and published a few articles in the journal of the Association,

'Lijecnicki vjesnik'.

By a decree of the Zupan (Prefect) of the Pozega District of May 9, 1913, Štampar was

appointed district health officer at Nova Gradiska, and in the middle of August he took over

his new duty. As a district health officer, he became familiar with rural health problems,

realized the hardship of physician's work in rural areas, and gained experience which in his

later endeavours as organizer of health services proved extremely useful.

From the beginning of World War I till July 1916, Štampar was on duty as district health

officer and also as assistant physician at the Red Cross Hospital at Nova Gradiska, which was

used for military purposes.

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.

In the Service of the Health Organization of the League of Nations

Immediately after Štampar's retirement, the Council of the Medical School in Zagreb elected

him full professor of Hygiene and Social Medicine, but the state authorities did not want to

confirm this election.

From July 1, 1931 till July 1, 1933, Štampar was permanently employed as the expert of the

Health Organization. In this period, he entered upon a new kind of work: study travels,

extensive lecturing in various parts of the world, the tackling of health problems at the

international level, and an ever deepening considerations of general issues of social medicine

and public health services.

From October 1931 till January 1932 Štampar stayed in the United States and Canada as the

guest of the Rockefeller Foundation. The League of Nations also entrusted him with the task

of acquainting himself with the work of a special American Committee dealing with the costs

of medical care. From January to March 1993 he spent in China. The Health Organization

sent him there as an advisor to help the Chinese health administration in the control of the

mass infectious diseases which cropped up after devastating floods in 1931. In the spring of

1932, Štampar came back to Europe and worked at the Hygiene Committee in Geneva, of

which he was elected Vice President.

From the autumn of 1932 till the summer of 1933, as the expert of the Health Organization

and in the capacity of a visiting professor, Štampar delivered a series of lectures at the

European universities and Schools of Public Health.

The Secretary General of the League of Nations, in a letter of August 30, 1933, asked Štampar

to be 'the League expert on health matters to be put at the disposal of the Chinese Government

in connection with the plan of technical cooperation with the League of Nations in the

national reconstruction'. Štampar accepted this task and set ou immediately on the journey to

Shanghai where he got in touch with the National Economic Council and the national health

administration.

The first region of Štampar's work was the province of Kiangsi which is situated in the

southern part of China. Štampar prepared a detailed report on the economic and health

conditions in this province and proposed a series of measures for the improvement of the

living conditions of Chinese peasants.

The chief point of Štampar's report on the province of Kiangsi was, no doubt, his request for

an immediate implementation of agrarian reform. For the then Chinese rulers, Štampar's

proposals were too revolutionary. During his stay in China, he also visited the provinces of

Yunnan, Kwangsi and Szechwan. On leaving China, he was given two testimonials from the

Central Chinese Government as a sign of their gratitude and appreciation. The text of one of

these testimonials, written in the Chinese alphabet on a wonderful silk and coloured paper

ground, runs in free translation as follows:

'Dr Štampar has cometo China to help our Government in its work on reconstruction based on

the plan of technical cooperation with the League of Nations. He went round several

provinces, from Kansu and Shanghai in the West to Kwangtung and Kwangsi in the South,

and made a valuable contribution to the reconstruction of our villages, especially in the field

of rural health protection services. On his departure we wish to give this to him as a

remembrance of his work in China, hoping he will come to visit us again. - Ching Feng'

In August 1936, Štampar returned home, to Zagreb. The following year, four years after his

first wife died, he married Dr Desanka Ristovic, a physician who distinguished herself as

Head of the School Polyclinic in Zagreb and had been from the beginning one of the most

faithful followers of Štampar's sociomedical ideology. The great understanding of his wife

and their harmonious family life greatly helped Štampar in his future work.

In 1936 he received an offer from the Secretary General of the League of Nations for the post

of an expert at the Health Organization in Geneva. In 1938, he received an invitation from the

Harvard University in Boston, and he delivered the Cutter lecture there. After Boston, at the

invitation from the Rockefeller Foundation, he toured a great part of North America and

lectured on hygiene and social medicine at a series of universities (Yale, Cornell, Johns

Hopkins, Cincinnati, Vanderbilt, McHarry, Tulane, Texas, Los Angeles, Berkley, Portland,

Minnesota, Toronto, McGill, Columbia, Galvestone).

Taking Over the Chair of Hygiene at Zagreb and World War II

By the decree of March 5, 1939, eight years after his election as full professor of Hygiene and

Social Medicine in Zagreb, the Government confirmed the decision of the professorial staff

and Štampar finally became a professor at the Zagreb University.

Štampar returned to Zagreb and took over the Chair of Hygiene and Social Medicine. In

Croatian cultural circles his book "Zdravlje i drustvo" ('Health and Society'), published in

Zagreb in 1939, aroused considerable attention. In that book Štampar spoke again about his

impressions on America and China and explained his views, already well known, on the

social aspects of health and disease. The value of the book lies in the fact that the author's

ideological concepts were very fittingly substantiated by a series of authenticated details

collected during his travels over three continents. Immediately after taking over the Chair at

the Medical School, he prepared the textbook for students "Higijena i socijalna medicina"

('Hygiene and Social Medicine'), Zagreb 1940, which is in a way the synthesis of his views on

medicine.

Elected by the Council of the Medical School in Zagreb, Štampar became the Dean of the

School for academic year 1940/41. With the energy so characteristic of him, he set to work on

the reform of medical training. In an exceedingly well documented treatise he analyzed the

existing methods of training at the former Yugoslav Medical Schools and proposed radical

changes. Then he published a study on social and health conditions of Zagreb students.

He was working on the establishment of a model students' home with a university polyclinic,

a restaurant, and bathing facilities, when the invasion of former Yugoslavia by the German

army (April 1941) put a stop to his endeavours.

On the third day of the occupation of Zagreb, Štampar was arrested by the Ustasa police, only

to be released and soon arrested again by the German police (June 14, 1941) and sent to Graz

where he was first imprisoned and then interned till the arrival of the Russian army.

 

A New Era at the Zagreb Medical School

(The Aftermath of World War II)

On his return from Graz in May 1945, Štampar resumed his duty as Professor of Hygiene and

Social Medicine at the Medical School and became Director of the School of Public Health in

Zagreb. In 'Lijecnicki vjesnik' he published a treatise on the effects of social and economic

conditions on human life and health. The result of his work in internment in his book 'The

Physician, His Past and Future' (1946), a monograph on the past of the medical profession, on

the merits of physicians, and the scope of their work, their position and tasks in the

contemporary world, with a short reference to their prospects in the future.

One of the basic ideas of social medicine is that work on health problems belongs not only to

the physician but also to other experts, such as engineers, chemists, veterinarians, pedagogues,

agronomists, etc. Stamar wanted to give a practical example of such collaboration by the work

of the Zagreb School of Public Health, his pet institution, which in 1947, as a result of his

endeavours, became an integral part of the Medical School, accredited with the task of

providing training for undergraduate medical students and for physicians and other workers

dealing with health matters. The School organized postgraduate courses on public health,

environmental sanitation, occupational health, social pediatrics, nursing, anesthesiology, etc.

According to Štampar's intentions, the School was meant to take over the organization of all

postgraduate medical training.

From 1947 to 1957, under the leadership of Professor Štampar and his closest collaborators,

B.Kesic, V.Vouk, B.Cvjetanovic, and B.Teodorovic, the School recorded remarkable

successes. In this period over 15,000 students attended regular training, and in postgraduate

courses there were over 500 candidates. In 1948 Štampar initiated the publication of

"Zdravstvene novine Skole narodnog zdravlja" ('Health News of the School of Public Health')

which at first had something of the character of a newspaper but from 1951 were edited as a

technical journal.

Štampar was the Rector of the Zagreb University for the academic year 1945/46. In the

autumn of 1952, he was again elected the Dean of the Medical School, and contrary to the

established usage, he was re-elected the Dean for 5 years consecutively.

In a comparatively short time, he put into practice very important reforms: he gave training a

more preventive and social note, introduce a strict regime of examinations and attendance at

lectures and practical work, enlarged the practical part of the training, and extended teaching

to non-university hospitals. Thanks to Štampar, the curriculum of the Medical School was

supplemented by such new obligatory subjects as Nursing, Health Statistics, and Introduction

to Medicine. Also, a mention should be made of the important role Štampar played in

connection with the founding of the Medical School at Rijeka (1955).

President of the Former Yugoslav Academy of Sciences and Arts

A great part of Štampar's activities after World War II was devoted to the former Yugoslav

Academy of Sciences and Arts, a member of which he became on February 11, 1947 (Section

of Philosophy and Social Sciences). On April 4 of the same year, he was already the President

of this prominent scientific institution. The idea behind his election was to give the Academy

a new, more active life, and Štampar's enterprising spirit, his organizational abilities, and his

world-wide scientific reputation were the guarantees. Under his management the Academy's

research, creative, and publishing activities in all fields of sciences and arts were flourishing.

Owing to his endeavours the Institute of Industrial Hygiene, later reorganized into the

Institute for Medical Research, was founded. He gave a great impetus to the study of

industrial hygiene issues. 

Work at the Promotion of International Cooperation in Matters of Health

Much of Štampar's life energy and mental capacity was devoted to the creation and shaping of

World Health Organization (WHO). He was called the father of WHO in Copenhagen,

Geneva, Manila, in any place where WHO was active. From 1945 he was engaged in the

formation of WHO, trying to make it as powerful as possible. He worked out the Statute of

WHO and through the letters of this international document he spread progressive ideas and

fought against colonialism, racism, and for the equality of all nations and all people.

Štampar was elected the First Vice Chairman of the Economic and Social Council of the

United Nations and the Member of the Technical Preparatory Committee for the creation of

WHO.

Probably Štampar's major contribution to the constitution of the World Health Organization,

as one looks back on the Paris and New York meetings that developed it, was the broad vision

incorporated in its oft-quoted preamble.

The International Health Conference held in New York in the summer of 1946 was attended

by the official representatives of 51 nations. With only a few minor alterations, they accepted

the draft of the WHO Constitution drawn up by the Preparatory Committee. The Conference

formed a special commission, the so-called Interim Commission of 18 states. Štampar was

elected the Chairmed at that Conference. On the authorization of the International Health

Conference, the Interim Commission was commissioned to carry out all the functions of

WHO up to the formal establishment of this organization, i.e. till the ratification of its

Constitution. The Interim Commission was in fact the World Health Organization but did not

bear this name till its ratification by the United Nations. This Commission, under Štampar's

guidance, carried out an extremely important task of establishing collaboration in health

issues and helping the economically weaker countries.

The First World Health Assembly was called with the ratification of the WHO Constitution. It

was in session from June 24 to July 24, 1948. Štampar was elected the President of the

Assembly unanimously.

In his later years, Štampar again travelled to distant countries. Thus in 1955 he was in

Afghanistan where, at the request of WHO, he was to give advice about the reorganization of

the Medical School in that country. The following year he visited Egypt and Sudan, as the

leader of a seminar for public health administrators. Towards the end of 1957, he went to

Ethiopia to see the conditions under which the Medical School could be established there.

Then he went to Sudan again to study the problem of health services.

At the 8th regular session of WHO in Mexico City, on May 13, 1955, Professor Štampar was

awarded the Leon Bernard Foundation Prize and Medal, the greatest international recognition

of merit in the field of social medicine.

Epilogue

In accepting the Leon Bernard Prize, Štampar said in his speech: 'The few years of active life

that I have before me will be dedicated, as those of the past, to our common aim: to world

health.' Although the sword of Damocles in the form of arterial hypertension was already

hanging over him, Štampar, a peasant descendant of robust health, had no premonition of his

near end. He died in Zagreb, on June 26, 1958, from cerebral apoplexy.

Just as everybody who knew Andrija Štampar personally was impressed by his sound vitality

and the elemental, unbending strength of his spirit, so must everybody who is acquainted with

the story of his life be deeply impressed by the clear-cut, firm homogeneity, the logic, the

persevering integrity and single-mindedness of all his activities. In spite of very turbulent

times and tremendous changes round him, he persistently strove, up to his last breath, for the

same ideals and objectives that he had formulated as early as his university days. Unlike a

great many other physicians, he himself consequently put into practice in his own life all the

theoretical and scientific knowledge he imparted to others. His life and work cannot be

forgotten. We should pay him the tribute he deserves, but even more: we should continue

learning from him.