The Historical Development of Social Medicine as a Responsibility of the Physician

In our contemporary Western society, the essential role of the physician is generally considered to be one of healer of the sick. Therefore the education and training of the future physician is primarily directed towards the goal of curing the physically or mentally diseased person and returning the same to a healthy state. It has, however, been more and more accepted that to avoid such physical and mental dysfunction, preventive measures must be taken which also must include attention to social factors. This was recognized by the World Health Organization, which defined health as “not only the absence of disease, but the complete state of physical, mental, and social well-being.” Critics say that with this definition the physician would assume a dominant role in all aspects of human life and behavior and would become, so to speak, the high priest of society. And indeed, in antiquity and frequently in the Middle Ages, the healers were also the priests and chieftains. How then, through the centuries, has the question of the physician's responsibility and competence for dealing not only with physical and mental diseases, but also with the underlying social causes, been answered?

In ancient Greece, the god of health, Asklepios, had two competing and quarreling daughters, Hygeia and Panakeia. Hygeia was given the role of maintaining health through sound living and “prophylaxis” (hygiene, preventive medicine) while Panakeia was responsible for healing and curing illness (panaceas, curative medicine).¹ Originally meant to be equals, visits to her temple, sacrifices for and prayers to Panakeia appear much more frequently in our sources than those for Hygeia, indicating a greater demand by the people for assistance in healing their illnesses than willingness to change their lifestyles or social behavior aimed at avoiding the same. As described by Rosen²: “Health problems have always been intimately related to the political, economic and social conditions of particular groups of people; but in earlier periods these relationships were not the subject of systematic investigation. … Nonetheless, sporadic observations linking social and cultural factors or situations with the health of the members of a community were recorded in antiquity and in medieval times.” However, the imbalance between preventive and curative care persisted, and the healing of illness remained at the center of the physician's activity.