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Sigerist in Saskatchewan: The Quest for Balance in Social and Technical Medicine

1996; Johns Hopkins University Press; Volume: 70; Issue: 4 Linguagem: Inglês

10.1353/bhm.1996.0174

1086-3176

Jacalyn Duffin, Leslie A. Falk,

American History and Culture

Sigerist in Saskatchewan: The Quest for Balance in Social and Technical Medicine Jacalyn Duffin (bio) and Leslie A. Falk (bio) Click for larger view View full resolution Figure 1. Henry E. Sigerist (left), Mindel Sheps (second from right), and other members of the Health Services Commission in the garden of the Weyburn Hospital, Saskatchewan, 1944. Courtesy of the Alan Mason Chesney Medical Archives, The Johns Hopkins Medical Institutions, Baltimore, Maryland. The leadership role played by Saskatchewan in the development of the Canadian health care system has long been recognized. 1 In addition, the beginnings of socialized medicine in that province have been related to its social and political history. 2 It is also well known that Henry E. Sigerist [End Page 658] (1891–1957) chaired a survey of health care services in Saskatchewan in September 1944; on the basis of his report, the newly elected Cooperative Commonwealth Federation (CCF) government of that province enacted free hospitalization for all citizens, to be paid for by tax revenues—the first step in an ambitious program for comprehensive health care. 3 Most accounts of the Saskatchewan initiative mention Sigerist, but they do not explain how the Swiss historian of medicine employed by an American university came to be involved in a project on the Canadian prairie, nor do they assess his personal impact on what came to be the only successful program for health care reform among the many that he observed in far-flung places. 4 Our paper seeks to explain how Sigerist was chosen to survey Saskatchewan, to assess his personal impact on the resultant plan, and to examine his opinions of events in Canada. It is based on a study of documents pertaining to his trips to Canada between 1941 and 1944 and on interviews and correspondence with those who remember the visits. The Canadian invitations were sparked by Sigerist’s stature, not so much as a historian, but as an advocate for “social medicine”; each successive visit enhanced his reputation in that domain. The early steps to universal prepaid medical care in Canada were part of a long-planned political strategy played out in a receptive society. They did not originate with Sigerist. For him, the Saskatchewan initiative was a concrete example of his philosophic vision of how ideal health care could be achieved; however, his influence on the resultant structure of the Canadian health care system may have been somewhat less tangible [End Page 659] than he or his admirers might have imagined. His role was that of a distinguished outsider, a well-chosen catalyst who lent authoritative credibility and political detachment to a course of action. Saskatchewan was the one practical extension of his intellectual vision; only there had his message about the need for progress in both social and technical medicine been understood and implemented. For Sigerist, medical knowledge had two facets, one technological, the other social; both were needed in equal measure for good health care. “Social medicine” was attention to the structure of resource distribution at all levels of care, in order to guarantee equal access to “technical medicine” for all people. If advances in medical technology outstripped advances in social medicine, then some people—for example, the poor, or those living in rural areas—would be deprived of services. Health care would be universally accessible only when both social and technical medicine developed together. 5 The idea of progress in social medicine was fundamental to Sigerist’s approval of the Saskatchewan experience; his despair over the future imbalance between technical and social medicine in the United States was a factor in his decision to return to Switzerland in 1947. Sigerist’s First Visits to Canada Readers of the Bulletin of the History of Medicine need little introduction to the medical historian Henry E. Sigerist. Born in Paris to Swiss parents and educated in France, Switzerland, and Germany, he studied languages and history, before graduating from medicine in Zurich in 1917. After holding positions in Zurich and Leipzig, he came to the Johns Hopkins University in Baltimore in 1932 at the invitation of William Henry Welch, founder of the Institute of the History of Medicine. Soon after, he began to edit the precursor of...