Henry E. Sigerist:: Architect for Saskatchewan Medicare

Medicare: A People's Issue

Sigerist on cover of Time, 1939

Henry E. Sigerist was in Saskatchewan for less than a month but his recommendations would act as a blueprint for health care in Saskatchewan for the next fifty years.

Soon after coming to power Premier T.C. Douglas contacted the Johns Hopkins professor who had written extensively and glowingly about Soviet medicine.

Dr. Sigerist was born in Paris, received his M.D. from the University of Zurich in 1917 and, after a period of medical service in the Swiss army, devoted himself to the study of the history of medicine while teaching at the Universities of Zurich and Leipzig. In 1931 he came to Johns Hopkins as a visiting lecturer in history of medicine and the following year succeeded William H. Welch as director of the Institute of the History of Medicine. In 1933, Sigerist founded the Bulletin of the Institute of the History of Medicine, which later became the Bulletin of the History of Medicine.

In Saskatchewan, the 1944 Sigerist Report gave sudden impetus to building new hospitals and to the forming new Union Hospital Districts. Forty-four new districts were created in three years. A major figure in the socialized medicine movement, Sigerist was also a pioneer in the study of the social history of medicine. In 1947 he returned to Switzerland to work on a comprehensive multi-volume history of medicine. He died in 1957.

The following article is from Time Magazine, Monday, Jan. 30, 1939

Medicine: History in a Tea Wagon

One fresh spring afternoon twelve years ago, a stout, bald American and a compact, bright-eyed young Swiss lingered over lunch in Leipzig's famed Auerbach's Keller. "This is the place," said Dr. William Henry Welch, dean of U. S. pathologists, shifting his big cigar to the other side of his mouth, "where my career started.'' He told how he had met great Dr. John Shaw Billings in Auerbach's Keller half a century before, how he and Billings had worked to establish at Johns Hopkins the first modern medical school in the U. S. Then he launched into a glowing description of Johns Hopkins' new Institute of the History of Medicine and the library that was to bear his name.

As he listened, Professor Henry Ernest Sigerist, who w:as then teaching history of medicine at the University of Leipzig, little realized that the major phase of his career was starting in Auerbach's Keller. Five years later, a short time before he died, old Dr. Welch asked Dr. Sigerist to succeed him as head of the History of Medicine Institute.

Before he accepted. Dr. Sigerist carefully explored the great medical centres of New York City, Chicago. Boston. Philadelphia, San Francisco and institutions in smaller towns. He studied history, economics and folkways, wrote home poetic letters on the bright beauty of New England autumn, the "whiplash" of Colorado winds. He found the U. S. "a great world, a gigantic historical process, strange and alluring," and felt that medicine's centre of gravity was shifting from Germany to the U. S. So he finally decided to settle down at Hopkins.

Henry Sigerist is considered by many to be the world's greatest medical historian. He reads 14 languages, has taught and lectured from Cornell University to Zurich, is an expert on such things as medieval prescriptions and the 16th-Century treatment of gunshot wounds. To Dr. Sigerist, however, medicine is not only a science whose triumphs are technical improvements, but a service whose success is measured by the ability of a small group of men to make mankind's life more livable. Even in his first enthusiasm over the U. S., Dr. Sigerist felt medical care was unevenly distributed, that physicians had not yet found their proper place in a complex new society. In the early 1930's he became known to U. S. physicians as an articulate apostle of socialized medicine. No man's arguments are read by either side of the socialized medicine controversy with greater respect.

Many a thoughtful U. S. physician opposes socialized medicine because, like a businessman, he dislikes the idea of government interference and fears the influence of politics. Nevertheless, in the past century every civilized government in the world has enormously increased its aid to the ill. And a strong current in favor of socialized medicine runs through recent writings of physicians on both sides of the Atlantic. Last week a Gallup poll on voluntary health insurance indicated that some 25,000,000 persons largely in the group earning over $980 a year would be willing to pay $3 a month for complete medical and hospital care. Only representative poll taken among doctors was last year when Modern Medicine asked its readership whether they favored use of public funds to provide medical care for low income groups. Over 16,000 doctor-readers replied of whom 54% said yes.

No medical politician, Dr. Sigerist has never plunged into the bitter medical battles that rage in Chicago and Washington. But as a No. 1 Medical Historian who is convinced that history spirals toward socialization, Henry Sigerist has a big intellectual influence at this time when the U. S. Government is taking socialized medicine seriously.

Washington Plans. No Administration has taken so deep an interest in medical legislation as Franklin Roosevelt's. Under the Social Security Act of 1935 Congress authorized annual expenditures of $3,800,000 for maternal and child health, $8,000,000 for grants to State health departments, $3,000,000 for the blind. In 1937, it appropriated $1,500,000 for cancer, in 1938, $3,000,000 for venereal disease.

This week, as evidence of the Federal Government's increasing sense of its public health obligations, the President told Congress: "[We do] not propose a great expansion of Federal health services, [but recommend] that plans be worked out and administered by States and localities with the assistance of Federal grants-in-aid. The aim is a flexible program ... a sound investment which can be expected to wipe out, in the long run, certain costs now borne in the form of relief."

Legislator most interested in Medical legislation is New York's Senator Robert Ferdinand Wagner, and this week he was dressing up a health bill which will closely follow7 the liberal recommendations of the President's Technical Committee on Medical Care. The Senator will ask for Government grants to States an 1 the U. S. Public Health Service amounting to $50,000,000 for 1939. The recommendations include extension of public health services, expansion of hospital facilities, medical care for reliefers and the "medically needy" (those whose low incomes make payment of doctor bills a hardship), workers' compensation for loss of wages through illness.

The not so liberal American Medical Association (110,000 of the 170,000 U. S. doctors) has approved these recommendations, but objects to the further suggestion that all medical service in the U. S. be organized on a taxation or insurance basis. To A. M. A. leadership, this proposal smacks of socialized medicine. As the bill headed toward the floors of Congress, A. M. A. Leaders Irvin Abell and Olin West rushed to Washington to repeat their objections to President Roosevelt.

Objections. Opponents of socialized medicine, especially the powerful A. M. A., have long argued that State control of medicine would be a radical and costly experiment. Millions of dollars would be spent on extra medical care at a time when the nation is in grave economic difficulties. All the fine old traditions of private practice would be swept away. A patient would no longer be free to choose his own physician, and the close relationship between patient and physician would be spoiled. Standards of medical care would be greatly lowered, for doctors would become involved in so much red tape that they would have no time for careful diagnoses or experimental" laboratory work. Physicians would have no incentive to improve their skill, for they would remain on fixed salaries. Worst of all, politicians would dictate to medical men, and public health officials would change with each election.

Rebuttal. In his quiet lecture hall in Baltimore, 40 miles from the Capitol, Dr. Sigerist was repeating, in a new course on "medicine and its relations to society," his rebuttal to A. M. A.'s famous arguments. His chief points:

1) State control of medicine is not a radical departure. "More than sixty per cent of all hospital beds are owned and operated by the Government. . . . Only one-tenth of the work performed by the Public Health Service is devoted to ... control of water supplies, sewage systems. and so on, and nine-tenths of the work consists of new tasks which private medicine was unable to fulfill." In the past 30 years the duties of the Public Health Service have grown to include care for cases of tuberculosis, blindness, leprosy and narcotic addiction, and research on practically every disease, common and uncommon, that is found in the U. S.

2) To finance a system of State medicine in the U. S. would not be difficult or extravagant. An estimated ten billion dollars of manpower is lost each year through sickness and premature death and the nation's medical bill is three-and-a-half billion dollars annually. This money is "spent in a haphazard and wasteful way. If the same amount were spent rationally, little more would be required to provide adequate medical service for the whole population.'' The most efficient system, under the present circumstances. Dr. Sigerist believes, would be one in which the indigent would receive complete medical care, free, in well-equipped Government health centres; the low income group would finance its medical costs through compulsory health insurance:*the higher income group would take care of their health in any way they pleased. All competent doctors who wished would be placed on salaries in medical centres.

3) To say that salaried doctors lose their incentive to do good work is an insult. Koch, Pasteur, Gorgas, Reed, Welch were all salaried men. So are the workers in the Mayo Clinic and the Rockefeller Institute and 15% of U. S. doctors who work in other institutional hospitals. "Whenever a [salaried] position is vacant, hundreds [of doctors] apply for it." (The average income of a U. S. general practitioner is under $3,500 a year.)

4) Although socialized medicine would certainly limit a patient's free choice of a physician, few people today are free to choose their doctors. Dispensary patients, farmers, and even city dwellers, usually have to accept the doctor who is handy. But socialized medicine should have this advantage: doctors on salary would be more competent for they would have time and money for frequent periods of postgraduate training which are neglected by most physicians today. And those who are attached to a family doctor would always have the privilege of calling him at a price.

5) Socialized medicine would not spoil the personal relationship between patient and physician. "The fact that [a] doctor is a member of an organized group . . . does not spoil the relationship. What spoils it today is that the doctor has to charge a fee ... and the patient has to pay the bill. Once the money question is removed, the relationship between physician and patient becomes purely human. '

6) Socialized medicine need not lower the standards of medical care. "The quality of [medical] service given to most people today is," says Dr. Sigerist, "rather inferior, to put it mildly." Many patients cannot afford expensive examination and treatment, and most general practitioners have neither the special knowledge nor the equipment, to render such services in their offices. "Socialized medicine . . . endeavors to bridge the gap that exists today between individual and hospital practice by bringing the general practitioner into close contact with a health centre."

7) It will be serious if Government control brings politics into medicine. A recent shocking example: Philadelphia's ill-run municipal hospital for the insane at Byberry, which four months ago was placed under State control, is now being efficiently reorganized. But corruption and inefficiency do not need to occur in all Government activities. The old and able U. S. Public Health Service has never been touched by the breath of scandal, and many cities and States have honest health departments, free of politics. Dr. Sigerist argues that because the average citizen is more interested in his health than he is in highway construction, "political corruption in the medical field would not be tolerated; it would be opposed by public opinion in the strongest possible way."

Theory v. Practice. No one realizes better than Professor Sigerist that theory, no matter how well bolstered with facts and figures, must be tested by practice. Next week in his book-lined seminar room he will give assignments to 30 medical and graduate students for the first course in practical socialized medicine ever held in the U. S.

Each student will be given a Maryland county, told: 1) to investigate its economic groups, their incomes and occupations, health conditions and medical facilities; 2) to present an ideal plan for county medical organization that would emphasize prevention of disease and guarantee to every inhabitant the best possible medical care. In May the class will face the hard facts of how much it would cost to finance their plans. In this way Dr. Sigerist hopes to raise a generation of socialized medicine enthusiasts who will know what they are talking about.

"Adventurous Career." Dr. Sigerist admits with pride that he has had "an adventurous career." Born in Paris in 1891. he moved at an early age to Zurich, Switzerland, later went to the University there. He also studied in England and Germany. When he was 14 he decided to become an Orientalist, ordered an Arabic grammar from an astounded bookseller, and rose an hour early every morning to plough through Arabic verbs. Then he plunged eagerly into Hebrew, Syriac, Persian, Chinese. His career as an Orientalist came to an end when his teachers wanted him to specialize. "All my life I have avoided specialization," says Henry Sigerist. He went into science, then medicine, and practiced obstetrics, then studied experimental pharmacology.

After the War he thought he would be a country doctor in a Swiss valley. "I would love my valley," he said, "and keep it in order." But it dawned on him that a valley in Switzerland was too narrow for his ambitions, and he returned to the limitless world of scholarship. He has traveled in almost every European country, has studied their medical systems, histories, social systems.

In Baltimore he spends most of his time at the Institute, on the third floor of the granite and limestone Welch Medical Library. Tucked among his books are large files of notes for a three-volume series on the history of Latin medical literature in the early Middle Ages, which Dr. Sigerist began 16 years ago. In a wheeled filing cabinet, called the "tea wagon" are notes for a definitive four-volume History of Medicine (he hopes to publish the first volume next year), and a two-volume Sociology of Medicine.

To the lecture hall on the third floor go hundreds of enthusiastic students during the week from the schools of Medicine, Hygiene and Public Health. Three steps lead up to the lecturer's oaken platform, and a hand railing stands next to the steps. It was built for Founder Welch, who was so rotund that he could not see beyond his middle, had to use the railing for a guide when he came to the edge of the platform and descended the steps. No need for a hand rail has energetic Dr. Sigerist who often takes the steps in one leap. Students enjoy his lively classes, for Dr. Sigerist does not mind expounding his dynamic conception of medical history in hand-to-hand argument. A student once took issue with him, and when Dr. Sigerist asked him to quote his authority the student shouted, "You yourself said so."

"When?" asked Dr. Sigerist.

"Three years ago," answered the student.

"Ah," said Dr. Sigerist, "three years is a long time. I've changed my mind since then."

*Of many foreign systems of health insurance, Dr. Sigerist is critical. For example the English system, under which a doctor receives about $2.25 a year to take care of each insured patient has led to a cheap type of bottle practice, and for the premium he pays, the insured patient receives only general medical care."

Find this article at:
http://www.time.com/time/magazine/article/0,9171,760717,00.html