Table Of ContentSOCIAL MEDICINE AND MEDICAL
SOCIOLOGY
IN THE TWENTIETH CENTURY
THE WELLCOME INSTITUTE SERIES IN
THE HISTORY OF MEDICINE
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SOCIAL MEDICINE AND MEDICAL
SOCIOLOGY
IN THE TWENTIETH CENTURY
Edited by Dorothy Porter
Amsterdam - Atlanta, GA 1997
First published in 1997
by Editions Rodopi B. V., Amsterdam-Atlanta, GA 1997.
© 1997 Dorothy Porter
Design and typesetting by Christine Buckley, the Wellcome Trust.
Printed and bound in The Netherlands by Editions Rodopi B. V.,
Amsterdam -Atlanta, GA 1997.
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the
Wellcome Institute for the History of Medicine.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 90-420-0346-4 (Paper}
ISBN 90-420-0356-1 (Bound)
Porter, Dorothy
Social Medicine and Medical Sociology
in the Twentieth Century/Dorothy Porter, -Amsterdam-Atlanta,
GA: Rodopi.-ill. (Clio Medica 43 I ISSN 0045-7183;
The Wellcome Institute Series in the History of Medicine}
Front cover:
Still from cartoon "See How They Won", 1935.
In 1935, Boots Pure Drug Company Ltd launched a Winter Health Campaign
which focused for the first time on preventative healthcare, encouraging people to
buy products such as throat pastilles, children's cough mixture, aspirin and cod liver
oil to combat the inevitable winter coughs and colds.
Central to the Campaign was a Hollywood-made cartoon "See How They Won"
which was released in cinemas throughout the UK. It was supported by a
promotional boardgame, gramophone record, and poster campaign as well as
window bills and displays in over I 000 branches of Boots The Chemists.
Details courtesy of The Boots Company Archive
© Editions Rodopi B. V., Amsterdam -Atlanta, GA 1997
Printed in The Netherlands
I dedicate this book to Alexander.
Contents
Introduction
Dorothy Porter
1. Milton C. Winternitz and the Yale Institute of Human
Relations: A Brief Chapter in the History of Social Medicine
Arthur]. Vise/tear 32
2. Training Doctors for the National Health Service: Social
Medicine, Medical Education and the GMC 1936-48
Nigel Oswald 59
3. Making Medicine Social: The Case of the Two Dogs with
Bent Legs
Ann Oakley 81
4. The Decline of Social Medicine in Britain in the 1960s
Dorothy Porter 97
5. Social Medicine and Medical Sociology 1950-1970:
The Testimony of a Partisan Participant
Margot Jefferys 120
6. The Dilemma of Social Pathology
Uta Gerhardt 137
7. The Social Space of Illness
DavidArmstrong 165
8. Medicine, Diet and Moral Regulation:
Foucault's Impact on Medical Sociology
BryanS. Turner 175
Index 195
Introduction
Dorothy Porter
Virgin Territory?
'An exploration of the almost virgin territory which lay between
the provinces of the medical and social sciences'1
The biometrician and geneticist Francis Crew believed this to be the
central aim of the new academic discipline of social medicine founded
in BTitain in the 1940s. Crew, Professor of Social Medicine at
Edinburgh University, had first seen the potential role which the
social sciences could play in medicine while he was a Chief M.O. in
the services during World War II. Working in the armed forces
allowed doctors a unique opportunity to make a study of positive
health.2 'In the Army,' he argued, 'positive health is no empty phrase;
for a purely negative health standard is not good enough for a medical
service which is called upon to assess training procedures and to
promote and prescribe a regimen appropriate to the maintenance of
the highest level of attainable efficiency for an exacting life and an
increasing variety of specialised activities imposed by mechanisation.'3
In the army the term positive health was given an exact meaning.
Through various tests of intelligence, agility, endurance, strength,
motivation etc. the army aimed to match each recruit to the most
appropriate occupational role within the force. Crew explained that
this constituted 'a measure of inherent and acquired qualities,' which
prevented 'a disharmony between the individual and the conditions of
his employment. In the Army as in Civil life much sickness is nothing
more or less than disinclination born of dissatisfaction and
transformed into disability.'4 He believed that the marriage of social
science and medicine could achieve a similar social biology of health
and human ecology for the civilian population too.5
1
Introduction
Like the first Professor of Social Medicine in Britain, John Ryle,
Crew linked medicine as a social science to political reform because
both perceived the social sciences to be dedicated to social
transformation.6 Their view was understandable because, from its
inception, social science was bound to a prescriptive mission. The
earliest attempts to develop a 'social mathematics' and 'social physics'
of society were directed at reforming the political operation of power
and restructuring of social relations. The reform impulse of early
'social physics' carried over into the first attempts to make medicine a
social science in the mid-nineteenth century. Advocates of 'social
medicine' at that time invented the physician as an attorney to the
poor and encouraged him to take up his duty to participate in the
political planning of society. The idea that social science could assist
medicine to fulfil a political role in the planning of a future society
extended into late-nineteenth-century investigations of social
pathology which relied upon eugenics to improve population health.
Some late-nineteenth-century public health theorists suggested that
medicine should become involved in the corporate planning of
communal life by turning itself into 'medicine from the social
standpoint.' The idea of social medicine as a form of political and
social engineering had a profound legacy for the relations of social
science in medicine.
Crew's view, therefore, that uniting the medical and the social
sciences was crossing 'virgin territory' was rather myopic.
Nineteenth-century experiments ln social medicine had already
achieved that. Furthermore, nineteenth-century sociology was born
out of a medical metaphor which compared the analysis of social
order to the analysis of living organisms/ Sociology, like its social
scientific predecessors, was wedded to reordering society but its
prescriptive goals were derived from the organic analogy of society.
The intellectual objective of the new 'positive' science of the social
organism was to identify the laws which governed the harmonious
functioning of its organs. Its method was to differentiate normal
from pathological social states. The prescriptive nature of the
organic analogy continued to have an equally profound influence on
the development of the social science ofm edicine.
Let us look for a moment at the political character of the early
social sciences and examine the way in which this influenced their
relations with medicine. We can begin with the translation of social
physics into nineteenth-century political medical programmes. This
will provide a background for understanding the mission of social
science in medicine, or social medicine. An essential background for
2
