The Social Responsibilities of Modern Medicine 现代医学的社会责任

The Social Responsibilities of Modern Medicine.pdf

FrederickR. Green, A.M.,M.D., Secretary,Council on Health and Public Instruction, American Medical Association, Chicago


The problems of social medicine are peculiar to the present generation; their development is due to the change that has taken place in the relations between physicians and the public. Up to the middle of the last century, medical practice was individual. No one consulted a doctor until afflicted with some specific disorder. The only interest that the physician had in the patient was a personal one. Little was known regarding the cause of disease, the method of its transmission or the means for its prevention. If a physician was called to see a patient suffering from typhoid fever, he treated that patient until he recovered or died. There was no way of knowing how the patient had acquired the disease, or how any other individual could acquire the disease from him. The physician had no responsibility to the community, since there was no act of his, the performance or omission of which could in any way affect society, either favorably or unfavorably. All that he could do was to care for his patient and, so far as possible, in the case of those diseases which experience had shown to be infectious, to prevent others from contracting them. As Sir George Newman, the chief medical officer of the British Ministry of Health, says, up to 1850 the medical profession had no public or social functions or responsibilities except the enfor cement of such crude methods of quarantine as had been developed through experience. Public health work up to the last half century was largely accidental and empiric.

社会医学的问题是当代人所特有的;它们的发展是由于医生与公众之间的关系发生了变化。直到上世纪中叶,医疗实践都是个体化的。没有人咨询过医生,直到患上某种特定的疾病。医生对病人的唯一兴趣是个人兴趣。人们对疾病的病因、传播方法或预防手段知之甚少。如果医生被叫去看伤寒病人,他会一直治疗那个病人,直到他康复或死亡。没有办法知道病人是如何染上这种疾病的,或者其他人是如何从他身上染上这种疾病的。医生对社会没有责任,因为他没有任何行为,他的表现或不作为会以任何方式影响社会,无论是有利的还是不利的。他所能做的就是照顾他的病人,并在那些经验表明具有传染性的疾病的情况下,尽可能地防止其他人感染这些疾病。正如英国卫生部首席医疗官乔治·纽曼爵士所说,直到 1850 年,医疗行业没有公共或社会职能或责任,除非执行通过经验发展起来的这种粗暴的检疫方法。直到过去半个世纪,公共卫生工作在很大程度上是偶然的和经验性的。

Today an entirely different situation exists. Modern medicine has a social value as great as, if not greater than, its individual importance. The development of the natural sciences during the nineteenth century has increased our knowledge of diseases and their prevention more rapidly during the last fifty years than in the preceding 1,800 years of the Christian era. The development of preventive medicine since 1870 is too well known to need recounting. Today, if a physician is called to see a patient and makes a diagnosis of typhoid fever, while he will naturally do everything possible to promote the comfort and recovery of his patient, yet the determination of the source of the disease and the prevention of the development of other cases from the initial case as a focus, i. e., the social aspects of the problem, are of as great if not greater importance than the treatment of the individual patient. This becomes increasingly true as the disease increases in rarity and severity. Suppose a single case of bubonic plague were discovered tomorrow in New York City. The correctness of the diagnosis in this single case would affect directly or indirectly every man, woman and child of the millions in New York and of the many millions in the eastern half of the nation. A single case of cholera unrecognized in one of our seaports might easily change the currents of trade and affect millions of dollars of capital and innumerable human beings. Modern scientific medicine is today one of the most vitally important and indispensable factors inmodern life, and we have as yet only seen the beginning. We cannot now appreciate or realize the possible benefits which our present and future knowledge of diseases and their control will have on the well being and happiness of the human race.

今天,情况完全不同。现代医学的社会价值与其个体重要性一样大,甚至更大。19 世纪自然科学的发展使我们在过去 50 年中对疾病及其预防的了解比基督教时代的前 1800 年更快。1870 年以来预防医学的发展众所周知,无需赘述。今天,如果一个医生被叫到一个病人身上,诊断出伤寒,他自然会千方百计促进病人的舒适和康复,但要确定病源,预防疾病的发生。以初始案例为重点发展其他案例,即。例如,问题的社会方面与个体患者的治疗一样重要,甚至更重要。随着疾病的罕见性和严重性增加,这种情况变得越来越真实。假设明天在纽约市发现一例黑死病。在这个单一病例中诊断的正确性将直接或间接影响纽约数百万人以及美国东部地区的数百万人中的每个男人、女人和儿童。在我们的一个海港中未被发现的单个霍乱病例可能很容易改变贸易潮流并影响数百万美元的资本和无数人。现代科学医学是当今现代生活中最重要、最不可或缺的因素之一,我们还只是看到了开始。我们现在无法理解或意识到我们现在和未来对疾病及其控制的了解对人类的福祉和幸福可能带来的好处。

For half a century our knowledge, as Tennyson says, has“grown from more to more,” but our professional habits have remained the same. The social value ofmedical services is now equal to, if not greater than, the value of medical services to the individual, yet the medical profession is, in its methods, as individualistic today as it was fifty years ago and as it has been for the last five hundred years. In spite of the rapid development of public health administration as a function of municipal, state and national governments and the constantly increasing demand for properly trained and qualified men to serve in official positions, medical students are still trained almost exclusively for the treatment of individual patients. Practically nothing is taught regarding social medicine. If after graduation a physician has an opportunity to take up public health work, he is forced to get his training at the expense of the community after he has been appointed to office. It is only in the last few years that any differentiation has been undertaken between the training necessary for individual practice and that required of a man who desires to devote himself to the service of the community or the state…


The issue is plainly before us. Shall we adhere to the methods and practice of the past until we are forced to abandon them, or shall we broaden our methods to keep pace with the ever widening bounds of scientific knowledge? The question must be answered by those who are practicing medicine today, for in their hands lies the future of scientific medicine.