The Meaning of Social Medicine

The author is impatient with a Medicine that cures disease but does not bestow health, and urges a reorientation to concern with life and its fulfillment rather than with death and disease. The current dilemma is blamed upon a faulty philosophy of medicine traced to the influence of Pasteur and von Behring, who led into the search for single causes of disease and disregarded broader concepts of etiology that considered individual variations and environmental factors affecting the health of the individual. The trend led to "curative" medicine that does not promote health and has left us with an ever-increasing burden of cured people who remain unhappy, unproductive, and physically or emotionally infirm. Dr. Galdston is highly critical of contemporary medical education which continues to teach an unsuitable approach and prepares the physician of tomorrow to practise a medicine that was inadequate yesterday. The criticisms of medicine are often justified and are very well stated, but the historical analysis of the situation seems biased and misleading. However, the major fault of the book is that its purpose, as stated in the title, remains unfulfilled. Many usages of the term "Social Medicine" are offered in the opening chapter, but the divergent definitions are never resolved. The author's closest approach is found in his appeal for comprehensive, patient-oriented medicine, but does not include the field which many workers consider to be the particular province of "Social Medicine" -the statistical correlations between social factors and the health of populations and the analysis of such data. The book contains arguments that seem unnecessary to state the case for social medicine and some of them seem prejudiced to the extent of being antagonizing. The emphasis upon the bacteriologists as the spiritual fathers of modern medicine shows a disregard for Claude Bernard and his followers, whose primary concern with the consideration of the homeostasis of the organism has thoroughly permeated medical school teaching. Strangely, the social change that has made the need for a new orientation to medical practice critical, and the r6le that "curative medicine" has played in producing this change in social conditions is not considered adequately. The critique of American medical education, while often germaine, displays an unfamiliarity with current trends. It is a gross overstatement to write, "the goals and objectives of medical education have not changed since the time of Sydenham. They remain: to teach the novitiate to recognize the presence of disease, to be able to diagnose it correctly, i.e., to fit it into some nosological category, and to treat the disease (or the diseased person) so that disease is eliminated or its malign effects are countered or reduced." Basic alterations in education are necessary to prepare the student with broader concepts and abilities. It does not help to misrepresent the situation that needs to be changed. The leaders of American medical education include many persons who are aware of the task before them. Dr. Galdston has only stated the need. He has not offered any practical guides.