Social Medicine and Medical Sociology in the Twentieth Century

The eight essays in this volume represent a dialogue, conducted by historians, between social medicine and medical sociology. In the first five essays Arthur Viseltear, Nigel Oswald, Ann Oakley, Dorothy Porter, and Margot Jeffreys trace twentieth-century attempts by British and American epidemiologists, medical educators, policy makers, and practitioners who would reorganize medicine around the recognition that health and disease are social phenomena. In the final three, Uta Gerhardt, David Armstrong, and Bryan Turner analyze the assimilation of matters of health and illness into academic sociology, a term that here includes the legacy of Foucault.

The story of the campaign for some form of social medicine is one of heroic failures. In the late 1920s and early 1930s, Yale’s dynamic medical dean, Milton Winternitz, discovered that interdisciplinary enthusiasm (for an Institute of Human Relations that would bring medicine, along with nursing, psychology, psychiatry, sociology, economics, and government, into an enterprise that integrated every element of human existence) might persuade donors, but not researchers whose careers were tied to disciplines (Viseltear’s essay). Things were similar in Britain, as Oswald shows: efforts to broaden the education of the general practitioners who would be the front line of an equitable public medical service that would provide health for heroes during the 1940s never got beyond the glowing endorsement of the ironically named “Goodenough” Commission. The odyssey of Richard Titmuss, whom Oakley follows from his early career as actuarial scientist through the Eugenics Society, and into (and then out of) an incipient discipline of academic social medicine, is one of idiosyncrasy: he was a compassionate and brilliant thinker, but not an institution builder. Porter treats the wreck of social medicine on the rock of professionalism around 1970, as the Society for Social Medicine, established in 1956, sought to work out with the Royal College of Physicians what kind of entity a Faculty of Community Medicine might be. The negotiations failed. Finally, Margot Jeffreys recalls the marginal role accorded her as a social scientist at the London School of Hygiene and Tropical Medicine in the 1950s and 1960s.

One is tempted to say that the promoters of social medicine were poor sociologists. Social medicine was the gleam in the idealist’s eye, so beautiful it had to be true, and disciplinary and professional inertia was the unpleasant truth to be ignored precisely because it was unpleasant. Then too, while it was easy to admit that health and illness had social determinants, quite what social medicine was to be was never wholly clear; for most it was something beyond epidemiology (perhaps an epidemiology acknowledging a greater range of causation), but no one could say exactly what. Was it only analytical, or programmatic as well? Statements like “Social Medicine is medicine in the matrix of society” (Titmuss and Morris, quoted by Oakley on p. 91) said something positive, but nothing definite.

Had they followed more closely the work of the academic sociologists surveyed in the second half of this volume, the pioneers of social medicine would have found that they faced disturbing moral and practical problems as well as problems of conceptual clarity and professional naiveté. By the 1940s it had been argued, notes Gerhardt, that the central concept of “social pathology” was disturbingly arbitrary in equating deviance with disease. Bringing the same theme further into the present, Armstrong and Turner help to explain why the good intentions of the “helping professions” with their wellness campaigns and lifestyle improvement seem to many an attack in the name of the “social” by a dictatorial foreign power. Yet, the academic sociologists, however successfully they were able to bring matters medical into the domain of social theory, were not offering much that seemed medically usable in any direct way.

In retrospect, what is curious about these twin trajectories of inquiry is the assumed power of academic knowledge—the belief that with knowledge would come, automatically...