JJO.l - ITALY: Health Projects

Issued by Office of Public Information UNRRft IT,,.LI. N lHSSION

UNRRh IT i. U1,N MISSION

Weekly Bulletin

Vol. 1 No. 2 16 E,~y 1945

NUTRITION CONFERENCE FOR PUBLIC HE"LTH NUHSES

A nutrition conference is being held in Rome for Italian Public Health nurses at the Opera Nazionale Ma.tcrnita o Infanzia headquarters in Lungotovcre. Respond­ing to the initiative taken by UNRRA's ,Jelfa.rc Division in cooporution with the Italian authorities, about sixty nurses from Na.ples and the five most dev-::.sted provinces are attending the conference. Italian Public Health authoriti(.;S ho..vo stressed the importance of tho event, tho first of its kind in IteJy.

The purpose of the conference is to inaugurate a national program of nutrition education to reach ultimately the housewif o rocei ving UNRR.,1. foods at the various points of O.NMI distribution. Sim~lo recipes are being deraonstro..tod for the pro­per use of UNRRA foods with the purposE- of n12king them familiar to the average Italian.

Mr. s. M. Keeny, Chief of tho UNRR'.i. Italian 1-J.ssion, outlined tho function of U.NRRA in Italy and the soope of the conference with tho following remarks deliver­ed in Italian at the opening session=

"War does not md when the firing stops. 'I'he destruction of v.rar affects the lives of people and especially of children for yeo..rs u.fterward. The ignoring of this obvious fact caused infinite suffer~ng at the end of World War I. Hungry people must be fed. But this is not enough . Credit must bo found to buy raw matoric:.ls if people are to have work_ and normal life is to be restored.

"To help avoid some of the mistakes at the end of 1u'orld Wc::.r I, UNR.lli.. was created.

"Its program in Italy, as you perhaps lmow, is limited to the provision of medical supplies, care of refugees, and especially care of children. It is significantthat two thirds of "lll the money is to bo spt.nt on the children.

11 The UNRRA program in Italy is more than food; it is a symbol that some good will exists in the world. The $50,000,000 assigned to It2.ly was voted unanimously by tho forty-four nations that are mem'bers of lJNRRf,.. Moreover , this program represonts a real p~rtnership with Italy. The Italian Government is really a part, in that it supports the prograrn by an amount equal to the cost of the imported supplies. These lire froni the Italian Governmont do not pay for the imported supplies; they pay for the expenses in Italy of the progrruns made possible by the su}plies. These lire will also be used to strengthen local agencies, so that when UNR!tA leaves, as it v'li.11, in a year or two at r.1ost, the Italian '.lgencies can go forward by themselves.

11The program under discussion today is your program. ivhother it is o.. good or a bad one , will depend on hew well you , or pooplo like you, do the job. People like myself, who are here as foreigners are very well aware how awkward our attempts to help must seem to you. But some things we foreigners can do. We can get the supplies to It.:i.ly, and we crm some..: times aid in making thiggs happen with the military. Most of all, we can send through our Headquarters to the United Nations, reports of the good work you do. By doihg this, we hope that supplies cc.n be kept ·cor;ii.ng as long as they are needed.

"But we carinot get everything we need. Becaus~ of the lack of ·rr,anpower in other countries, and the lack of ships, some foods are scarce. Milk arid

1 -133PI

NOTE: ....

. •· . ' . The ~nclosures listed below would normally be accompanied by a weekly letter .from Mr. s.1.1. Keeny, Ohief of the Italian Mission. For some reasonj however, the regular letter (No. 69) was orn:ttted from this package and included with another group of enclosures dispatched under separate cover.

T.D.Thomas Postal Unit

UNITED u,,Trmrs RELIEF JOO) REH,.,BILIT,..TION iillbIINISTRitTION Italian Mission

Ref. No. i/9/005 17/5/45

W-2

WASHINGTON POUCH

Confirl7laticn copies of cables (1-20) - sent to Welk

21. 22. 23.

24. 25. 26. 27. . 28.

29.

30. 31. 32.

33.

34. 35. 36.

To Div of Personnel ERO from personnel office re: Personnel Records-F~ 14 May To I-iQ AC from Keeny re: Request for Release of :P,;aj or Hopkins-F&.-;.; PT 15 11

To Hopkins from Keeny re: Employment with mm.RM. IT,LLLJ'J 1,ISSION -l copv to F&A; l dopy to PT

To UNRRA Wa~h. for :'leintraub (copy) from Keeny - Supply To Bt..reau of F & A from Hodgetts re; Appointment of 1farunich - PT To Putz from Keeny - PT To Deputy Director of Operations from Sorieri re: Retay - assignment

to Czechoslovakia Mission - copies Menshikov, Hoehler, .!eish, FT

12 II

10 II

16 II

To ERO London from Hodgetts re: Transfer of Dr. Layton's documents - 17 11

Lukas · Translation: Ministry of posts & telecommunications - copies to Feller,14 11

Gill~ Welk To Bureau of F & A from Hodgetts re: 1-2. poin+,ment of 1·1arunich - Pr . To Bureau of F & a from Hodgctts ru: 1-.ppointment of Silveira - PT To Div. of Personnel and Training from Personnel Office re:

10 II If

14 II

Applicant J..lbert Cotton - PT 12 11

To Feller fran ·.Keeny re: Assignment of Paolo Contin:i. - 1 cop;r-Fellcr; 16 11

1 copy-PT Weekly Bullett 4 ., 16 Hay 1945 - 2 copies : 1-PR; 1 duplicated and attached To Robert Broll?l .from ,~. i-i.. Sorieri - krmshikov-1~ Hoehler, Camp 1 }tinutes of Fifth !eeting of Joint Committee on 83.turdny - 4 copies:

1- Supply; 1- Welk; 1- Health, .lelfare; 1- PR.

Confirmation copies of cables (37-47) - to Welk 48. To Rolf Roth from S.hl.Keeny re= Return to the U.S. - copy to Cooley 49. • To Principal Representative of UNRRA 1,FHQ from Keeny re: Your communi­

cation of 11- May, concerning employ .. tcmt of Dissident Yugoslavs novr in Itazy. - copies to Welk, Xanthaky, Caustin, Feller, SDDG,Gill, Roehler,

Tomasevich 50, To vashington Fin~.nce & Admi.Pistration Division from C.E. Hodgetts Direc­

tor Finance & Adminio~r~tion Division re: Salary nllQtment Richard Brookbank - To Camps & Lukas

Confirmation Copies of cables (51-58) - sent to Welk 59. To Hodg~tts from Keeny re: Philippeville Inventory - Copies to Xanthaky,21 11

Camps, DP, Caustin, Feller, SDDG, Services, Welk 60. Dr. Rukies Report - copy to Sawyer 19 11

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fats and meat are going to beespecia~ly scarce, and there are many hungry mouths in the North of Europe that must now be fed by the Allies. We shall not get everything the hungry children of Italy need, but we shall try to get their share of the world. supply.

'' ·" "Since the fooaY·that ' we ·can· get . i:s limited in variety' it is doubly im­portant that wise use be ·made --of it, and food is well used only if it is prepared so that one likes it. It is always difficult for the peop~e of one country to realize that. peo1.-le in another country have food tnste·s -of their own. How to translate these supplies from foreign lands into combinations Italian children like is one of the most important steps in our feeding program. I am very happy that a conference of this kind can be held at the very beginning of our national program, and hop.9 that the results of it will reach every c arunune in Italy where chi:}.dre·n: n_eed to be fed. 11

The first seession was attended and addressed by prominent Italian officiais•, among them, H. E. Giuseppe Solimena, Director General of Public Health, who deliver• ed the addresss of welcome; H. E. Gino Bergam:,., High Food Commissioner, whose sub.:.. ject :was 11 UNRRA Food in the Total Food .SUpply of Italy"; Frofessor Gino FrontaJ.?-,

. Director of the Pediatrics Clinic at the Policlinic Hospital, Rome, discussing . 11UNRRA Foods in Children I s Diets" and Dr. Edvige Fileti, Nutrition Consultant and Supervising Dietitian of Italian Hospitals, who described 11 The Role of the Public Health Nurse in the Postwar Food Program."

: . '

WAR DAMAGE IN ITAIX

It is estimated that about one million Italians 1have been displaced by the war

in ItaJy. The following percentages, prepared by Mrs. s. K. Sperer, statistician for the UNRRA Italian Mission, give a further picture of the devastation wrought by the war in Italy. For ,obvious reasons, these percentages apply only to the 38 provinces in so-called Liberated It~ly:

UMBRIA Peru.gia Terni

LAZIO Frosinone Littoria Rieti Roma Viterbo

ABRUZZI Aquila: Campobasso Chieti Pescara Teramo

CAMPANIA Avellino Benevento Napoli Salerno

PUGLIA Bari Brindisi Foggia Taranto Lecce

Homes & Premises Dam­§l:Sed or .Destroyed

5% to 10% less than 5%

25% to 50%. 25% to' 50%

less than 5% 5% to 10%

10% to 25%

10% to 25% 5% to 10%

25% to 50% 10% to 25%

less than 5%

less than 5%, 5% to 10% 5% II 10% 5% II 10%

less than 5% less than 5%

5% .. to 10% less :. than 5% .. less than 5% ..

·, )

Industrial Destruction

I

·,'

25% to 50% 25% to 50%

25% to 50% over 50%

10% to 25% 25%·to SO% 10% to. 25%

over 50% over . 50% over .50% over 50%

10% to :?-5%

. 10% to 25% over 50~b' over 50%

25% to 50%

less than 5% less·· than 5%

10% to 25% :5% II 10%

less than 5%

,.l .. ,

LUGANSA Madera Potenza

CALABRIA Cotanzaro Cosenza Reggio Calabria

SICILY Agrigento Caltanissetta Catania Enna Messina Palermo Ragusa Siracusa Trapani

SARDINill Cagliari Nnoro Snssari

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Homes & Premises Dam­aged or Destroyed

less than 5% less than 5%

less than 5% less ' than 5%

5% to 10%

less than 5% less than 5%

5% to 10% 5% II 10% 5% II 10%

10% II 25% less than 5% less than 5%

10% to 25%

10% to 25% less than 5% less than 5%

Industrial Destru­tion

less than 5% 10% to 25%

25% to 50% 5% II 10%

10% II 25%

10% II 25% less than 5% less than 5 ~~

25% to 50% 25% 11 50)l 10% II 25%

less than 5% · 10% to 25% 25% to 507b

10% II 25% less than 5% less than 5%

Supplies for Italy The Supply Division reports that to date 28,000 tons of UNRRA supplies have been

received in Italy and that 14,500 tons have been signalled for arrival in the very near future.

Medicnl Supplies UNRRJ. has received 3,000 cases of medical supplies in Itnly. These cases con­

tain ~urgicnl instruments, drugs and medicines, hospital equipment, laboratory equipment, field equipment and supplies and X-Ra.y equipment.

Surplus Supplies fran the Mill tary Discussions are under way about procedures to be used to enable UNRRA getting

surplus supplies from the Military in Italy.

Distinguished Visit6r Governor Cochran, who has just returned from a quick trip to the United States,

was n visiter at UNRRA headquarters in Rome this week. The Governor, who looks hale and hearty, brought good tidings about the Italian Mission both ways.

Incidentally, we understand from Governor Cochran that Buell Maben had been designated as Head of the UNRRA Mission in Greece.

Liaison Office Dr. M ria Can-Pinna, Chief of the Research branch of thcVice High Corrunissioner

for Food, has been design1ted as Head of the Liaison Office Between UN.Rful. and the Italian Government.

Dr. Maria Can-Pinna will have her office in Room 55, Tel: 471592

The Fair Sex in a Dither Today is a red-letter-day among the girls of the U11RRA Italian staff. Material

for summer dresses arrived and there vre.s much excitement as the fair members made their selection from the lovely patterns. Orchids to Mr. Keeny for being father to t he thought. ·neparturvs Personnel "ovements - ri!'riv::i.ls Helen A. Wilson to Bari -'nrgnret nsteip ,rumble h.dams to London Fred Bellows A. Visick to London Rolf Roth from Philippeville T. B. Layton to London Mary Rubin from Cairo H. Horowitz to Bari Carle! Corbyn 11 11 Gladys Le Gros to Bari Barau~n Bondurant from Lecce Margaret nrnstcin to LJndon

Lt. Col. S. Gass Roydon to London

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Italy

An agreement between UNRRA and the Italian Government supplementary t('I the Agreement of 8 March 1945, which provided for a limited program of assistance, was signed in Rome on 19 January. Under_ the new agreement the 1945 UNRRA program will be continued as regards assistan~e to special categories of the population and displaced persons and in addition UNRRA assumes responsibility for-: a general supply program r~mprising, among other items, besides· foodstuffs, coa~f gasoline, fuel oil and kerosehe, raw co·~ton and Wool, fertilizers, seeds and· ~ther agri­culteral supplies.

A meeting of the Subcommittee under Resolution #23 held on 11 January in Washington reccm.mended that the Italian Goverrur.ent be considered at this time not·in a position to pay with suitable _means of foreign exchange for relief anq rehabilitation supplies and services which will be ma.de available, the position to be again examined not later than 30 June 1946.

UNRRA Health activities in Italy ar~ now mainly confined to supervision bI1d a large part of the staff has b·een _withdrawn in recent months. Medical and nursing ca~e for displac8d persons is now given entirely by Italian physicians, hospitals anri clinics and by UNR..'-tA t,rained displ~ced i:;ersons personnel in the camps with UNRRA I s small heah,h staff. ""X~_rcising over all superYis ion.

·. The final plan for the second dis tributicn cf medical supplies under the 1945 prograin was received in January and considerable progress has been made in aiding the 2,000 Italian hospitals ·to resum'? normal sr>rvice .. A prcgram for · placing about 40 hospital uni ts is being G.eveloped. The target is to get all supplies in this th9ater, inslud::.ng those from rlrmy surpluses, a t'Jtal of s-ome 3,000 tons, distributed by 1 July 1946. The distribution of 47,660,000 units of insulin is taking place simulta.neously with t_he general distribution. JI. distri­bution :plan for 3,350,000 squa:re meters o_f cott•'.,n material for hcspital use (bed linens, t_cwling, medical gowns) was apprrwed in February and distribution has started. The material has been rr.anufactured from l,OCO tons of raw material imported for the purpose, The distribution of penicillin continues. 500 vials were distributed in Februc.ry to 23 centers.

The Health Division Penicillin Officer has completed a survey of penicillin centers in the compartments of Emelia and Toscana. He reports that the control of distribution is satisfactory but thc..t the clinical use of the drug was not fu],.ly understood. He addressed rre etings in Florence and Bologna which were well attended by physicians and medical faculties of the universities. His aadress · · in Bologna is to be printed in the proceedings of the Societa iViedico C11irurgie.a which sponsored the rre eting in th.at city.

An agreement has been reached by the High Commissioner for Public Health and the manufacturers of. X-ray tubes whereby 6afo of production from the 100 lbs, of tungsten irr;.ported by Ul~RrlA will be controlled in distribution and pr ice by the High Commissioner: distribution of the tungsten is now in pr egress.

The Regional li.1edical Vffi cer for Region E reported that on his recent visit to Siena, the Institute Siero Terapico Selavo had increased its production of anti-anthrax serun,i and now-has from 300 ~o 400 liters ready for use, and can rapidly produce a large quantity if necessary. This serum, and certain other biologiccil. preparations, are avaiL1ble ·to nieet demand outside Italy if the need shoul~ arise.

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Surveys of hospitals, clinics and institutions continue. The six main hospitals in Crete have been inspected and a_ review of their equipment needs made. The survey of private clinics has been completed in the Athens area, 69 clinics being visited and classified in order of priority of needs.

Full inquiries were made into the histories of these clinics and problems were discussed before class ification was made. It was found that the most im­portant requiremeits in order of necessity are: ward equipment (blankets, sheets, hot water bottles, beds, etc.) kitchen equipment and surgical · equipment.

Transport and warehouse strikes have held up the distribution of much needed supplies and insufficient advan~ed data from London and Washington concern­ing supplies to be expected have als~ restricted the efficient work of the Supply Section. Drugs now available to the trade are in small demand with the exception of petroleum prouucts, the reason given by the pharmacists and cooperatives being that they cannot afford to pay for them. Drugs must be paid fo~ at the time of delivery. The stabilization of the drachma may have a favorable influence on this phase of distri tuti on . The Greek Red Cross has been of considerable assistance in supplying. a number of iterr..s n ot included in Ur1RRA imports or in shcrt supply, such as cod liver oil, hospital soap, surgical drassings, etc. Raw materials are needed for appliances and braces and hospital beds are required for orthofedic cases.

Six institution::; in Athens have been visited in order to determine their needs and rrake suggestions fo r the setting up of laboratories. Laboratories are being set up :tn the provinces but unless the Governrr.ent appoints qualified Greek bacteriologists to take charge of themrauch of the value of the work will be wasted.

The voluntary societies continue to give vaiuable assistance in the thealth field setting up v.orkshops ior the disabled, training schools in midwifery, physical theraphy, etc •

.rln agreerr.ent has been signed by the Ministrie s of ~far and Hygiene providing for the devel~p~ent of a vetera.ns hospital: hostel, an goverrurent appliance workshop for< the disatled civiliaLs and veterans .. .

A measles epiderric is sweeping the country and the scabies incidence is in­creasing, especially in the north where transport problems have delayed supplies of mectica.ID.ents but there is no other significa.nt increase in sickness . Typhoid is still prcminent and after the aarr.p winter thA malaria ro.te. may be expected to be high. Ir.:proved sanitation and water sJ.pp:._ies and DDT spraying will, however, lessen the incidencP of t!-1is disease. There are no accurate figur es of V.D. cases available but it must be assumed that the incidence is very high.

An epidemiological study on epiderr.ics and liillI'ine ·typhus and similar diseases in Greece is to be made.

"'· - 21-

The pr esent pr ogram for disinfestation of hospitals and other insitutions in the Rome- Florence a r eas has been completed and the teams have been transferred to malari al control work . Two disinfestor units have been delivered and put into operation at Frosinone and Bari by a Health Division Sanitary Engineer . A third unit is earmarked for Sardinia .

The malarial control proeram in Sicily has been in operation since 1 February and is progressing well . A program of adult mosquito control in the province of Frosinone was carried out in the latter part of Fabruary under the direction of two UNRRA Sar.itary Engineers and the units were transferred to the Rome prcvinc8 early in ·;arch, The rralaria survey of the Po Valley area has been completed a~d a suggested control program is being subrritted for approval. The proposed starting date is 1 1'1ay and the programme is expected to last 2 months . As a part of the SarGinia malarial eradication program two airplanes are being purchased fer larviciding and an instructor cl!ld·maintenance man will be trans ­ferred from the Greek W~ssion to train pilots and ground staff in the technique of airplane spraying .

The Uriit,arian--Ccnrr2_;q,t::i.onal 1l1edical Nutritional !vliss icn which started work in A:r;::-il 19h5 has Go::i.p:i..eted its vi0rk. During its eleven mor:ths in Italy the organization exarrined 28)65.L perso:.~s and gave service to l.;984 persons, either through the extensive stu,:l_y group Y,hich operated for six months in 7 different parts of the cou..."ltry) o::' th".'•J•lgh .::.he int...-,r.sive study group v':hir,h operated in Naples . rvhilest the final ;v2..:l.1~-- :~ ion of all scientific dJ.ta will ha Ye to await thorough exar.rin~tion, which rr~7 t1ke many rrnnths, it is at present possible to recognize the trends of t!i.e ·_·: 1restigations made by the· intensive study group and to make certain tentative e•,,2 lud ions mainly ·concerned :dth practical aspects .

The experimental fevding prograin of rrL.lnourished children comprised thr8e diets and involved 206 children, including 78 patients who had earlier been discharged for complicating factors such as actiire Tuberculosis) lues, or lack of cooperation, anct 65 normal brothers and sisters of the patients in cne of the dietary groups . In the first diet one-third of the total protein requirements was derived from animal sources, in the second diet half of the normal protein requirerr.ent was derived from animal sources, and in the third diet, which was called 11 supplerr.entary" the diet ignored the protein question and included such foods as whole milk powder, lard dnd sugar . The aver~ e composition of the 11 supple1rentary11 diet, which was designed to meet ir.dividual n.eeds, was a:r;,:,roxi­mately 1,250 calories, including 60 grams of prote•in, 30 gr ms fd.t dlld 200 gra!T'.S of carbohydrates.

Results indicating a general slowing µp of average weight gained during the winter months an:1 showing the effects of influenza, rr.easles, mumps, whc,oping cough and pneumonia on the weight gains of s orr:e pa ti~n ts· are noteworthy and the experiment gives evidence that vegetable proteins derived from·wheat germs, soy beans) born germ, and sunflower seed ars; accep~able to the Italian population if the fl our is enriched to 1cr.1o v.d. th tte se products, tm t physical growth an<i development are ensured and that the gain in weight is at least as good as with diets in which the protein is derived froni oth:ir sources .

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About 90 per eent of the teen age boys and girls examined were found to be under-developed, the weight being more affected than ~he height, with signs of Vitamin A, Bl, B2 and niacin deficiencies and old signs of rickets prevalent . The incidence of Tuberculosis was much higher than was generally fauna in the population of Naples dl'ld the pallor of these children was outstanding . A feeding program designed to test the adequacy of vegetable protein in stimulating growth and development was carried out on ten boys and girls . This showed that a high protein diet, including animal protein, is the most effective stimulant to weight gain.

The majority of pregnant women examined were found to be underweight ond anaemia found to be more pronounced tha.'1 in normal pregnancy . Signs of vi tamin deficiency were found in practically all cases . Premature births had increased with an equally greater proportion of infant deaths. Abnor111cJ.1ities had increased : 35 per cent were accompanied by severe abnormality or abortion .

The effect of the malnutrition of mothers on their newborn was demonstrated by a study of the children born between July anci December 1945 , This showed that 87 per cent were underweight and 78 per cent were too short accor ding to Italian pre-':ar standarc.s . Only 72 per cent were live born .

. 'J;he most severe cases of rr.a.lnutriti on with a very high death rate were seen in infants. It is considered that the causes for this high mortality, especially during the hot season can be found in the lack of orainarf ~an~tation, the tenaency of malnourished mothers not to be able to nurse tneir infants , the lack of modern medical facilities for the treatments of severely ill infants , the lack of rigid and modern milk control which results in diluted as well as polluted milk, and neglect to combat rigorouslu aarly stages of dehydr ation . In institutionalized children whose water intake had been extremely low due to lack of facilities, water theraphy - 1 quart per day for six weeks - resulted in a marked increase in weight,

Studies on fluorosis were also carried out on 1000 inhabitants of Campagnano Di Roma and on 400 inhabitants of Quarto . Since the population of Quarto is suffering from malnutrition whereas the people of Campagnano are healthy w11d well fed an evaluation of the two factors - fl~orosis and malnutrition coula be made , It was concluded that the incidence of dental caries is related to the degree of flurosis rather than to the degree of malnutrition ctI1d gingivitis is related to the degree of malnutrition rather th '-n to the degree of fluro~is •.

The Fourth Nutrition Conference for nurses organized by UNltRA's -. l 1:1trition Section was held at Palermo, Sicily, at the beginning of December, 1945 .. The food value and use of soy flour., soy grits and soy beans received considerable attention. The conference was attended by approximately 200 persons comprising governmental officials, doctors, nurses, teachers, and c.irectors of institutions .

Sub-cormr.ittees on Nutrition were organized in each of the nine provinces of Sicily, each composed of 3 doctors and 3 nurses, whose responsibility it is to formulate nutritional educational material suitable to local conditions •

. ,:

.. .. -23-

Following the conference bread containing soy flour was made in six Omni centers and was served to 531 mothers and 596 children over a perioo of three weeks. The results weriq s.a.tisfactory . The addition of soy flour was said 1not to be detectable .

SupplenBntary feeding began in approximc..tely 30 provinces in the n~rth in January bringing the total nurr.ber being fed in Italy to between 1,250, 000 and 1,500,000.

Preliminary dis cuss ions have been held within the h-,ission on the advisability of establishing d program of supplementary rations to tuberculosis p0.tients and their farr.ilies . The officer s of the tuberculosis Section are Illdking a survey f0r the all~cation of X-ray units provided by UNR.RA . The EJ.location will be determined. on vhe basis of minimum loc:;il need and UNrtrU-1. techniques ,.. ill c..ssist in the erection of the units and in the instruction of local technicians in their use .

Assistciilce has beer, given in the selection of rugerculosis Italian University students .tor adJ1.ittance to the Sane.tori.um of Leysiri, Switzerlc..nd .vhich hc1s offered the use of 20 beds to the Itc:J..ian Governrr.en t,

Dr . '11:arc k.niels , Tuberculosis Consultant , has been relea.sed for Quty in Austria and Poland .

A meeting of the l1uberculosis AG.visory CoHu,ittee wc:.s he ld. on 6 Febru&y at the office of the High Corn1,_issior,er 1.or Hygiene ~nd. Public Heu.1th 2nd. was attended by the hssist.:::nt Consultar:t in Tub~rculosis . 0everal im~~rtdnt treasures conce rning reorgariization of tuberculosis services were discussed ~.nci c.p1Jroved :

1) 1-1. sum of 2 billion 1.ire has been ass ig1ce d by the Tr0J.sury t.o the High Commissioner for re- establishment of tuberculosis servic\.:;s .

2) T,:e debts of the consorzi n.ntitubercolari ·v1ill be piid by the High Corr,missioner.

, 3) The fixed tax paid. by the comn,unj_ d.nd the provir1ces to the conzorzi will be rais ed to cover treatrr,t::n t cos1:,s of tuberculosis patients .

4) Hospitalization of uninsured path,nts who cam,ot c.L.ora to pi:l.y hol'ir-,ital expenses will be paid by the High Con,n.issi0ner .

5) The conzorzi have been instructed t"o c..ct upon the t erms of d long­forgot ten statute which gives them th•.; ·ri0ht to St.,.lect patients r e ­quiring L-,s.t itc.l c~r e r ~garc..less of wheth,:r or not they c:1re ir,sured .

6) ·The transformation of preventoria ir.to tuberculosis hospit kls, cilld the es tablis~nt of tuberculosis secti_ons in general hosi itc...ls, hi:..ve been strongly r ,c;conm,:mded .

7) Instructions hc,ve b .... en given to 1:'Stabli h rahc..bi1-iCc.tion sections in saric,.toria •

.t-1. .rreeting of administrative and tecur,ical secti0ns of thto t ...... tional 0chermo­graphy Center was helc. in th.3 mrn •• ,-1. O1·fice in rlome on 28 Ft.:bru&ry . Details were given on the number nc.. tupes of schermogr~ hie units availc1ble in Italy and it was greed that work :=mould begin as sco1 as _tJossible in Rome nd hil ... n, ec1ch c~nter operating one mob~_le , nd 2 fixed units , A r:·,eetin~ was dls:- held. in 1.ila.n to discuss the develo ,md1 t ann op"'ration of a .s~ction of tho N:.t1.on~l l-'hoto-1luorogrJ.phic cc:r,t.::r in thc;.;.t city .

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There have been no further cases or plague and the· Taranto outbreak may now be considered ended.

The scheme for rodent destruction was successfully completed according to plan during February. Comments and statistical data received in February from the High Comn~ssioner for Hygiene and Public Health indicate that epideu~c diseases are creating r10 cause for alarm at present, The following vital sta­tistics per 1,000 population relating to the City of Rome have been furnished:

Birth Ru.te Death Rate Infant Mortality Rate

(per 1,000 births)

December 1945

17.5 12.39

~anber 1944

12.02 14.68

80,93 148,85 ( 69. 04 in lfovember 1945)

Subsequent to the withdrawal of tLe MAG public health officer from·the Naples area, the UNRRA Regional i-i1edicel Officer h ~~s 3.ssumed the duties previously ce.rried out by AlJ.G in the c..:.ccumul tion, correl.:.t ion wd distribution of infecti­ous ciiseases statistics in the district,

During February a Stnff Dispensary Vic.S op0ned for the trent..r1an t of UNRRA employees . Cl,,ss I employees .:.re: being given <• comprehe:nsi ve iredicc..l service, end Class II employe~s are rec0iving an emrgeucy s0rv1ce .nd treatment of con­ditions for which national services or drugs c..re not av~ilnble . 'ihe Bis pt.:nsnry staff ct present consists of one Class I physicicsn, one Clc.1.ss II physicic::n, thr0e nurses ana a secretary. It is expected th~t ~ staff ctent3l service vrill shorJ:,ly become av n-.bk to Class I e11ploye0s ,

iv.Ij)lJLE EAST OFFICE

Fourteen hundred Greek refugees were reeeived from iast Africa auring January. UNRRA nurses, with dis l~ced persons doctors, travelled to E1st Africa and es­corted the refugees to El Shatt camp from wl,ich they will lo.ter be r0pc..tri:.ted, The first group impos d a fnirly heavy lo don th~ m0diccl service of the camp since a high p~rc~. tage sufftr~d from m:~l~ria . Over 2 p8rc0nt of the total group required bospi-r, lization on c.rriv-.1 ,_t El Shatt . ith this exception hospital troGtmcnt fi&rures ~t El Sh~tt end El Arish c,:;.mps continu~ to bc low and th0 gen1;ral he:alth of the r ,dug01;:;s is Very sc.tisfactory.

Yugoslavs, Greeks, ~nd Itnli,.;1.ns h._ve passed out on t:,cir hom0ward journeys c1nd, \'iith the inprov~m:mt in nv;::.ilablc shipping .::.nd r.,he rop trLt.. on of th(; Yugoslav refuge0s, the problem of l~bor in the c3.Illp medical services is under considerc.tion, Ncgoti tions for the: r .tri_tion of inv.::..lids h .Vt.- -lso been opened with GHQ in viuw of the curt_ilm~nt effected in trds field by the Ministry of War Transportation Regul:itions.

To:

From:

Subject:

Edward B. Williams

William G. Welk

29 July 1945

Summary of various materials relating to Italian Mission activities.

I am surnmarizing below the principal items of interest in certain materials describing the Italian Mission's activities which have recently come to hand.

~ -to San Marino

A cable from the Italian ':ission stntes that on 23 July a fully equippc d ambulance was f onnclly turned over to the Republic of San l!arino by the ~Iission. A variety of drugs and mcdicDl supplies a.s well as a suprly of sb.,. · :3 , blankets, powdered milk and sugar were ru.so turned over to Sc:..n i:~arino. This contribution is the first under the agrec.m:mt recently signed with lJNaRA v'lhereby the small republic is to r eceive assistcnco up to $30,000.

Health Division Report for June

During the month Dr. Rockie toured the Northern provinces to confer with AI.iG provincinl h0alth officers on the proposed UNRRA. program end projected rcquirer.:cnts for redico..1 supplies.

i1edicnl Nutrition ~'lission. The surveys at Fondi nnd Ponte Corvo were completed and the survey t0nr.1 was noved to Vnrese in Northern Italy to continue its v..ork in that locnlity. As o.. result of the surveys c1.t Fondi and Ponte Corvo U!JHRA food is roaching selected families cspeciclly those discovered to be tubercular. Neighboring cities such as Gaeta, Formia and Terracina are also to be assisted. Intensive work by the Bedical Nutrition U:ission has begun in }Japles where in the Clinica Pedic..trica both clinicru. and laboratory worl{ is hcing undert.:i.kcn. Ten tons of cquipr.icnt wore moved into this institution, sorted, nsser,1bled m d put to use. Clinical work and ser.iinars n.rc alrc1.dy under way. U}!RRA milk and sugnr r.i.rc being issued to nll patients who cone to this clinic with nutritional deficiencies. Prep.:i.rntions ure under way to start sir:til.'.l.r v;ork in nn orphanage.

,.faJ.aria Control. The application of DDT er:mlsion to the 1,200 houses selected as requiring this kind of nalurin control in Littorin, Pontine nnd Fondi is under way. The work is proercssing slowly prinnrily because no knapsack sprnycr. havo a.s yet nrri vcd. '.Jerk is expected to proceed nore ro..pidly in Jul, 'lfter the nrrivc.l of the sprc'.ycrs shipped in June. As soon ns equipncnt i'or the 5 1:wlnria control units for Sardini.:i. and Sicily is assembled malaria control progr.'.'.ms in those two islmids will be undertaken.

.. 2 -

Tuberculosis C0ntrol. The It<'.:.licm 1.nti-Tuberculosis Lcc.gue held a meeting in June at which en effort was r.IBdc to work out a progrcn for the country ns n whole. lflith J'!U'.tcrinls supplied b;,r the Hission two Ittli.:i.n oobilc photofluorogrgphs ~rnro µcopnred for :>pcr2.tion. Production cn.pncity for X-Ray filn in Northern Italy was cstir.1.,~tod to ao:unt to 10,000 squ::irc 1:.otcrs of film fer e;ach of the nEJxt two nonths .

Work cf the Nutrition Section. This section is surveying food rcquircr:1:.:nts in the northe,rn pr::-vinces. Initicl reports inili.cc.tc thnt the food sit uati c,n in Lonbe.rcly is not pres sing and only in o. f c..vi selected areas will UNRRi~ food be required. !.gain it is found that the, big problco is trnnsportation pcrr.tlting ship:i.cnt of .?.vailable fxd from one rr~vincc t~ mother.

J.ccommodation Centers :Icdical Progr21:i. ;. decision was reached that beginning in July the ItaJ..ic.n :iission will begin a :i:rogrnn of arrc.ngint; for the hospitalization of r.lispL.".ccd pcrscns in Italinn com­mt:nity h ">Spitcls by giving selected hosritc.ls assistcncc with supplies c111d cssenticl l:ir:tited staffing to ennble the1~1 t0 i:rovidc the service requested. As a result of th0sc nrrnnga.1ents scvcr.::tl nt;f.ltcrs cf the !,!is sion :todical Division staff will be declared surplus and rclcns cd for other duties or for return to tho United Stntes.

Six rnbulcnccs iH,.L'C 0btmncd ru1d delivered to Southern Italian /,ccor:ir.1odl'.tion Centers. One i:!.dc':.itionnl ~r.1bul2.nce was allocnted tL Sardinia and 5 c:>.rc on Cc'.'.11 to the Itru.ic...11 Hofuc;eu Adr.ri.nistr2.tion fer the novencnt of sick refugees from cru-.1ps to th0ir horxs or to provinci.'.11 hospitc.ls.

Eedictl Supplic s. Ifoclic.'.\l supplies h2. vc cc<.,n nccur:iulnting in Dl1 kmy r.1edicnl depot in Ifr.:pl<.,s since J:inun.ry nnd sm1itc..tion supplies in other Fc..ples depots sinco /.rril. Bccc'.'.usc L.f the sc"rci ty c,f worknble vir,rch us o f ".cilitics in raplcs nnd "'s n result of pressure by the /.r:1y tho Sui:ply Division is neGotio.tinc_; v-iith It".li.:m ~.uthoritics to c..ccopt Ui·imi. r.JC clictl suprlic s in wnrch uses opcr<>.tcd by then vii. th the rcservo.tion thnt the di. stril:ution be ncrccd u~on j-Jintly with tho Itclian hcc:>.lth c'llth-.,ritics nnd the Health Division < f the Itnlim :IissiJn. In th1,.; ~c"ntinc c..11 .:-.. c dic.'.'.l md smit ':..ti:in su;-: lies 2rc tcinc aovcc: to Rome.

Excoq:ts frcm Itclic'.'.n : [issicn 1cckly Bulletin I'u . 10 - 12 July 194~

During a race.mt rress ccmfcr<.;ncc :rr. Keeny statcJ thc..t $10,000,000 worth of supplies arc now in Itnly md in the rrocess of distribution. The number of :r:crsuns b cine f <.-d is !lppr ,xi.!1ntcly JOO, 000 c.nd will rise crndually. Some 1500 tons of rnw cotton c:i.nd scvercl. hundred tons of raw wool nre on their v1ay to Italy to be used in the nanufa.cture of hosritnl sheets, blmkets, etc. under the lJl'.'J.R.J, medictl nssistc..nce pro€;rcr.i.

456371

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Ir

r. S Ke ny Chier, Ital an saio urn.RA c/o kleric Rom Italy

D ar • Keeny:

Attached is a lett r cov ri g conduct d in Italy und r the ian crvic Committ th

Both th 1ed t ropos 1 c· substantial contxi vi.de a t. od of o sati r actory to by the Offic of +. e of Arc , th tion.

e r st th t you anees may be n c r achin final

w3.s di cus ed ton, and was giv

f

15 ov

t you ., ur t

r 1944

Dr. a: pro-

or civil cl r­rd fr you b r ore

e antic pate no difficult in ocuri lief Control o rd d th t volunt

c s of the ar scone n d.

nelosure

d cision by c

FOR TH DIR CTO G AL:

Conr d V Hyning irector ivision

C O P I

15 av r 1944

,

• rr;y

ppr -

DIRF.CTCR RAL1

I i

ti

C O P

Mr. Sam Keeny Chief, Italian ~Q.ssion Ulm.RA c/o American Delegation Rome Italy

Dear r. Keeny:

15 November . 1944

ttached is a letter covering a proposal for a Health project to be conducted in Italy under the g~neral direction of Ui by the Unitar-ian Service Committee and the Congregational Christian Service Committee.

e understand that the proposal was discussed with you and with Dr. Reekie before you left ashington, and was given your tentative a:ppro-valo

Both the ,elf re and the H alth Divisions here in ,ashington have stud­ied the proposal carefully and e are satisfied that it v.ill 1113.ke a substantial contribution to the U • program 3.nd at the same time pro-· vide a method of operation to the t lO volun.tary agencies which will be satisfactory to themo his proposal has been cleared at Headquarters by the ffices of the uirector General, the Legal ~ounsel, the _urP u of r as, the Bureau of Sup"'lY and the Bureau of F:inance and J-\drr.i!'.istra-tior.o

e recuest t" t you secure at ever ae.ditional r.tilitar • or civil clear­ances y b n<>cessar~r in the field. .e .:..11 await ord• fran you before r i:hir.g final agreement ith th ,-,e two ar,cncies .

e anticipate no difficulty ir. lief Control Board and the t

securing the ccncurrences of the voli.:.ntary ag ncies concernedo

ar Re-

,ill you advise us of your decision by ca le at th earliest possible moment , since e ill not be a le to co letc ~ITangements here until

e are cert in th t the propos 1 • s t .e approval of th Chief of ssion

closure

berg/mdp

FOR H D .3C

Conrad Van Hyn:ing ctir..g Director

,elfare Divi io

Ire Charles R. Joy, Executive Director UnitaricJl Service Committee 25 Beacon Street Boston, Massachusetts

Mr. James C. Flint, Director The Congregational Christian Service ComJ11ittee 289 Fourth Avenue New York 10, New York

Dear Sirs:

16 November 1944

14 The purpose of this letter is to outline an agreement between the Unitarian Service Committee, the Congregational Christian Service Committee and the United Nations Relief and Rehabilitation Administration for the establishment, maintenance and administration of a study and service pro­ject in the field of medical nutrition in Italy0 The terms of this agreement should be cleared with the Executive Director and the Co-directors of the project, Drs. R. B. Bragg, E. Lo Sevringhaus and aurice B. Visscher, res­pectively. On our part, it will be necessary for this agreemmt to be con­curred in by Mr. s. o Keeny, Chief of UNRRA 1 s Italian Mission, and Dr. Dudley A. Reekie, Chief edical Officer of the · ssion; and the general approval and consent of the Italian Government and of the military will have to be obtained by UNRRA rs Italian Mission. It is well to recognize that the necessary clearances in Italy will take some time.

2 The study and service project referred to in this agreement may be briefly described as follows:

A Objectives. (1) To assay the nutritional and associated medical status of pop­

ulation groups. (2) To make intensive study of the results of a carefully super-

vised experimental feeding program in individuals who have suffered prolonged malnutri ti.on.

(3) To evaluate the general feeding pr~ra.rn in one or more areas. (4) To assist local medical groups in the application of knowledge

of medical nutrition to their rehabilitation problems and to encourage their continued scientific studyo

B. Proposed Program., (1) Send the executive officer and the co-directors of the project

to the site of operations as soon as it is possible to do so (2) These persons will make preliminary surveys and will arrange for

laboratory and clinical facilities for intensive work.

~o Charles R. Joy, ~. James C. F~int - 2 - 16 November 1944

(3) Thr or four eeks later, eight to eleven additional workers will arrive to assist in c rrying out the program.

(4) The senior staff ould be able to serve in the field not in excess of four onths at one time. The junior staff rould remain for one year. One or more members of the senior staff ould plan to return at the end of the period for final studies.

( 5) T'ne erican persormel ould be augmented by suitable personnel recruited on the field .

(6 Additional personnel will be called for upon recognition of need on the field

(7) ersonnel, S nior (a) 1 • Raymond B. Br~gg - Executive Officer (b) ✓Dro l.~er L. Sevringhaus - Co-~irector and Internist ( c) Dro aurice • Visscher - Co-Director and Physiological

Tutri tionist (d) r • .tmcel . ys - Biochemist ~nd utritionist (e Dr . Irvine c uarrie (?) - eciatrician (f) Dr. Chester Jones(?) - Interni$t and Nutritionist

ers nnel, Junior. (g) - Epide. iolo0 ist (h) Dr. Otto Klineberg -- eymty ecutive Officer (i) r. .a yhos - ssistant Internist

.., 1 t .. ec!iatrician (k, ss orot y L edorn, R. L, - echnolo ist (1 ss arjorie .no ton - Technologist (!!'.) Die ti tia!l (n, - c tal. .esearch orker

ese indi:vidu servic s in he project as indicated by their titles, and~ erence n be de onl tot • r. Otto Klineberg ill serve fficer r en the senior personnel have left the field

~nd · 1, · e psyc olo ical observations, in refer nee to m nutr.:.tion and r -1 · ntation. ·.e epidemiolo ist .· 11 stud.,r the past records of co .. _ .ic bl .d o er diseases in the popula ion, of hich th recipients of ., e~ · al f eedin and study by the pro· ect -f'orm a part, a..TJ. ill gather similar data during the r of operation of the project.

3. , the Unitarian ervice Committee, ~ th Con r u_tional Ch~ist: Service Comnri.ttee agree to the folio;·. stdtements o tlirj__ the administr tion of this proj ct.

(a) .e stu d service project in medical nutrition referred to in t ·s - ·n form an integral part of the operations of the U It i ;ssion This project represents a valuable rqJlific t·on of opera-

ich ould be underta.~en in y c se, but not so exh-ustively, by the Health Section of the It lian ·ssion ands ould, therefore, be closely in­tcgr ted into the rk.of the Healt Section of that mis ion.

(b o attain t.is inteer tion and to insur- tlat the project fits into th- ge •. eral fr e ork of the rt~ ian · ssion, in respect to the

·ss·on's · s , objectives and limitations, ~d the necessities of good public relations, the decisions of the ecutive Director, the Deputy Director and th Co-Dir ctors oft e project in reference to administr~tive and op-er tion , matter s all be subject to approval by the Chief of the cission

,Jr. Charles J.. Joy, ... ..r. James C. Flint - 3 - 16 Ifove.mber 1941+

and the Chief Medical Officer of the Mission, and in addition the personnel of the project shall be administratively responsible to the Chief of the UNRRA Mission.

(c) The choice of a suitable location in Italy for this service and study project will be made by the Executive Director and the Co-directors of the project in consultation with the Chief of the Mission and the Chief l edical Officer of the Mission as will also the choice of the population group to be studied, and the location of the lab::>ratory, clinics and other facilities,

(d) In carrying out the second objective of the project mentioned acove, namely, an intensive study of the results of a carefully supervised ex:per i­mental feeding program, the Executive Officer and Co-directors will consult with the Chief Medical Officer of the Mission in planning their experimental feeding program and L~ selecting the examinations and techniques to be applied to the individual subjects of the study. The project should be so set up as to yield early results of use in the evaluation of the feeding program under­taken by the Italian ldssion and hence should be based upon this latter feeding program. Provision is made in reference to the latter point in the third objective of the project mentioned above.

(e) To an extent that it will not jeopardize the success of this service and study project, the scientific personnel of the project will be available for consultation with members of the UNRP..A Mission and ItaJ ian governmental agencies on matters within their special competence.

(f) The personnel engaged in this project shall successfully pass the physical examination prescribed by UNRRA and shall be subject to a,n:,roval by UNRRA on the basis of stanaards established by UNRRA for all of its personnel

(g) ~fuile U~m.RA agrees in principle both to the tentative schedule of transportation of junior and senior personnel outlined in sections (1), (2), (3), and (4) and to the number of positions referred to in section (7) of the proposed program of the project outlined above, it is understood that some changes in those matters may be made necessary by field and trans­portation conditions which cannot be foreseen at the present time~

(h) It is of utmost importance that the preliminary results of the project be reported to the Chief Medical Officer of the Italion Mission as rapidly as they are obtained and reasonably established, in order that they may be of early service to UNRRA and other organizations engaged in relief operations

(i) All reports of the findings of this study and service project made during the course of the field operations will be submitted to the Chief edical Officer of the Italian Mission~ Manuscripts prepared for publication

during or subsequent to the field operations will be submitted also to the Director of Health of UNRRA for approval prior to publicc:t ion

4~ For the establishment and maintenance of the study and servic8 project which is the subject of the agreement , the Unitarian Service Committee and the Congregational Christian Service Committee undertake the following re­sponsibilities:

(a) To procure the personnel needed for the operation of the project and to pay their salaries i ncluding the salaries of Italian Nationals en­gaged b7 the .ixecutive Officer or the Deputy Executive Officer in the field~

(b) To provide the supplies , including l acoratory apparatus and special foods, needed for the project over and above the supplies ordinarily furnished by UNR...~ in its relief program for Italy These supplies are to be delivered to a point in the United States designated by UN~'l:U, at which

Mr. Charles R. Joy, . • Jame~ v• Flint -4- 16 November 1944

time and place UNPRA ill ssume custody thereof for purposes of transportation to their destination and will arrange for their shipment to Italy with the understanding that they are destined for this project. The supplies are. to be packaged according to instructions by the Ocean Shipping Branch of UNRRA, ar.d the to voluntary agencies contributing to this project will, on request, supply the Ocean Shipping Branch with a complete list and specifications of the supplies in order that shipping space may be procured

(c) Personnel employed by the Unitari.:m Service Committee and the Congregational Ghristian Service Committee in the operation of this project in Italy .shall, if requested to do so by the Chief of the Mission, wear either the unifonn designated and provided by U:NRR or their o-wn uniform with the UNRRA flash, on the same basis as the personnel of other voluntary agencies operating with or under the direction of UNRRA in the field.

5. For the establishment and maintenance of the study and service project which is the subject of the agreement, U .... RA undertakes the following res-ponsibilities:

(a) To provide or assure the following for the personnel of the project: (1) Transportation from ashington, D.C. to the scene of operations (2) a.intenance (or where maintenance is not provided to UNR?..A

personnel, liviP..g and quarters allowances) and necessary medical services in the field.

(3) Return passage to ashington, D. C. for the personnel at the conclusion of their respective tours of duty. In the case of the junior personnel, the return passage ould be provided at the end of the yea:r of study unless otherwise agreed between the .!!.Xecutive Director or the Deputy xecutive Director of the project and the Chief edical Officer of the UNRR

ssion. In the case of the se!lior personnel, UNRRA will provide transportar- V tion to .ashington, D.C. at the end of their leaves of absence fro~ ~heir present employers, and will further undertake to return one or more members of the senior staff to Italy at the close of the project for the purpose of making final studies. The number of senior staff so returned to Italy will be subject to agr ement bet e n the Executive Director and the Co-directors of the project and the Chief of U 's · ssion to Italy and the Cb.ief edic al Officer of the ssion~

(b) Personnel employed by the Unitarian Service Committee and the Con-gregat:or.al Christian Service Committee in"t_is project, other than Italia.~ nationals hired and e!!!ployed in the field, may participate in the UNRRA e~loyees compensation plan o~ the s e basis as is or may be provided i.~ .my agreement bet een U and the erican voluntary agencies

(c) Urn will not be responsible fc:r salaries or any claim for per­sonal injury, ccident or disability, or any loss sustained by employees of the to voluntary agencies contributing to this project, except as provided in 5 (b, bove. .

(u, Upon delivery of the special supplies (laboratory equipment, special foods) ........ volved · this project to point in t .e United St.:. es des.i.

0

.,...1,tc b., U _· , U • · 11 ass e custody of such goods an~ the r sponsibi ity of s. ippi.TJ.g them to Italy and of making them available to mer:nb<=>rs of the project, exc ~pt, ho v ver, tha.t all risk of damage and loss in respect thereto shall at all tim s be borne by the two voluntary agencies contributing tote project.

Mr, CLarles R. Joy, J!i.lJ'.'o James C. Flint - 5 - 16 November 1944

I trust you will notify me as soon as possible of the action of your Boards in reference to this agree!Ilent so that we may speedily obtain the necessary cleara..'1ces in Italy viith the Italian irission, the Italian Government and the military.

S:incerely yours,

Conrad Van Hyning Deputy Director, /elf are Division

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