By Janet Farrar Worthington
A pssionate teacher and brilliant scholar, Henry Sigerist ascended to the top ranks of medical historians. Then, he invested all his enthusiam on the wrong horse - the Soviet Union.
The Time article raved, in equal parts, about Sigerist’s scholarship — “considered by many to be the world’s greatest medical historian” — and his missionary zeal as an “articulate apostle of socialized medicine,” for whom “medicine is not only a science whose triumphs are technical improvements, but a service whose success is measured by the ability… to make mankind’s life more livable,” and concluding: “No man’s arguments are read by either side of the socialized medicine controversy with greater respect.”
As Sigerist saw it, the entire history of medicine was spiraling toward one inevitable end: socialized medicine. His detailed plan was decades ahead of its time, featuring nationalized health insurance and salaries for physicians, and emphasizing preventive medicine.
A Hopkins Star
The Time story packed a huge wallop throughout the medical community; it even had a life-changing effect on at least one doctor-to-be, an 18-year-old Victor McKusick. “That was the reason I came to Hopkins,” he says. It wasn’t so much Sigerist’s politics, but his passion for history and the excitement that surrounded him and Hopkins that drew him here, adds McKusick, who would become a pioneer in the new field of medical genetics. He arrived at Hopkins in 1943, and found Sigerist’s class on medical history to be every bit as thrilling as the Time article had promised. “He was arguably the leading medical historian in this country ever. He knew everything that happened in the development of medicine, and it was that depth in his scholarship that let him really make the history of medicine come alive. And he was a charismatic teacher, with great enthusiasm.”
It was Sigerist’s dynamic historical writing, too, that first hooked Gert Brieger, M.D.—who now holds Sigerist’s old job as head of the Institute of the History of Medicine—on medical history when he was a physician in the Army. “I thought, This is what I would like to do.”
Henry Sigerist possessed, it is agreed by all who knew him, a spark that ignited (and often inflamed) colleagues and inspired medical students. He was a gifted teacher, who bounded up the oak steps of the lecturer’s platform in the teaching hall on the third floor of the Welch Medical Library. His appetite for learning was voracious: A philologist, orientalist and medievalist, he was fluent in more than a dozen languages and preferred to read ancient medical texts in their original Greek, Chinese, Sanskrit, Latin, Persian, Arabic or Hebrew. His lectures were intoxicating; history through his eyes was intimate and vital. Once, he made a detailed textual study of a 15th century German translation of the Latin work De Vinis, “the earliest printed book on wine,” just for fun. His writing, unlike that of most of us, nearly always came out of his head in completed form, notes Brieger. “He wrote by hand on huge blue notebooks; he would write on one page and the opposite would be left blank for revision. Those were virtually always totally blank.”
Sigerist’s work, and his views, defied specialization. In fact, he had chosen as his life’s field the entire history of medicine because of its sweep. He refused to be pigeonholed.
Sigerist rocketed to international prominence in 1925 at age 34, when he became director of the University of Leipzig’s prestigious Institute of the History of Medicine. He came to Hopkins as the first William Henry Welch Professor and director of the Institute of the History of Medicine, succeeding beloved “Popsie” Welch (one of the “Big Four” founding faculty of the School of Medicine). He was recommended for the job by the great Hopkins-trained neurosurgeon and historian Harvey Cushing, who had been so impressed at a lecture by Sigerist that he sent Welch this telegram: “Sigerist has captivated everyone here by his modesty, learning, lively interest in everything, and personal charm. I cannot imagine a more suitable person for the post or one more certain to develop it in the way you would desire. He is certain to have a great following.”
From Russia With Too Much Love
And Sigerist did; Cushing was right. Until Sigerist took all his enthusiasm, his passion, his dreams of changing medicine and the world for the better, and invested it on the wrong horse—the Soviet Union.
Certainly Sigerist was not the only intellectual to be dazzled by the promise of Marxism—particularly in the face of looming fascism—in the 1930s. “He believed that, just as the (Russian) revolution had replaced capitalism with socialism, so it also marked the beginning of a new medical epoch in which preventive medicine would replace therapeutic medicine,” writes John Hutchinson in Making Medical History: The Life and Times of Henry E. Sigerist, a collection of essays about Sigerist edited by historians Elizabeth Fee and Theodore M. Brown (The Johns Hopkins University Press, 1997). But Sigerist bought the whole package; if Soviet socialized medicine had been a new car, Sigerist would have paid extra for every last option, including the rust-proofing. He wasn’t just infatuated, he fell hard. “I love the country,” he once wrote. “I love its socialism but I also love the people and the landscape, so much that I would have liked it even under Tsarism.” He also loved its ideology, particularly the Soviet focus on preventive medicine. “Our students are still trained to be primarily interested in disease and not in health,” he wrote. “Most people do not see a doctor unless they are sick. Russia is far from having reached its goal, but the idea to supervise man medically from the moment of conception to the moment of death and to concentrate all efforts on prevention of disease is undoubtedly very promising and impresses me as the beginning of a new era in medicine.”
“He had blinders on,” says Brieger. “He didn’t want to see any problems; he just saw the theory.” Sigerist, notes Hutchinson, “positively reveled in the combative rhetoric of class warfare. ‘Our place,’ he once wrote, referring to his fellow academics, ‘is with the coal miners and stevedores, not with the bankers and industrialists.’ While writing the publicity blurb for a book on Soviet medical care, he confessed to his diary that ‘I do not care a hang whether the bourgeois moron reads it or not.’”
Overlooked Mass Murder
So drawn was Sigerist to the ideological whole—that is, as he hoped it would one day become—that he overlooked such glaring, horrific aspects of the Stalinist regime as mass murder. “Enamored of the Soviet experiment, he was unwilling to see or believe the hideous purges, which he dismissed as part of a necessary transition period,” writes his daughter, Nora Sigerist Beeson, in Making Medical History. “He only saw the positive features of a socialized organization of medicine.”
Sigerist brought Russia into the American debate in a big way with the publication of his controversial book, Socialized Medicine in the Soviet Union, in 1937. Impervious to arguments that he was seeing only part of the picture—the part the expert Soviet propaganda machine wanted him to see—he hammered away on socialized medicine through the ’40s, blind to an increasingly hostile political climate in the West with the escalation of the Cold War and dawn of the era that would spawn McCarthian witch-hunts. He alienated many physicians and policymakers who linked socialized medicine with Communism and wanted no part of it. Politics aside, Sigerist’s “big picture” approach was also a losing ticket in an age of unprecedented medical specialization and subspecialization.
Sigerist, writes Hutchinson, “shared with the architects of Soviet health policy under Stalin an outlook best described as medical totalitarianism. He really believed that humanity would be better off if every individual were under the medical supervision of the state from the cradle to the grave…. Sigerist’s belief in the necessity for state control over all aspects of medicine ultimately made him an apologist for state control over most aspects of human life, as his Stalinist hosts were the first to appreciate.”
Worse—to the dismay of colleagues and family—on the subject of his blind spot, he couldn’t seem to leave well enough alone. “His liberal pronouncements on political events, often ill-timed and wrongly considered, made him a thorn in the side of the [Hopkins] administration,” writes Beeson. “I’ll never forget how the FBI came to question him at home; their file on him was growing.” In 1944, writes Elizabeth Fee, a letter from the Civil Service Commission informed him that his eligibility for government service had been canceled because he did “not measure up to the general standards of suitability and fitness maintained for government employees. He stood accused of belonging to ‘Communist front’ organizations and of displaying too much interest in the political and economic theories of Communism.” Sigerist was not a Communist, but in the eyes of many, his work had become tainted by association. The American Medical Association attacked him; so did colleagues and alumni even at Hopkins.
'I am considered a crackpot'
In 1947, plagued by exhaustion and poor health, and yearning to get away from American politics—“here, I am considered a crackpot,” he stated—and finally begin work on the masterpiece he’d dreamed about for decades, a comprehensive history of medicine, Sigerist retired to Switzerland. When he died in 1957, notes Fee, although American historical journals mourned his loss and paid tribute to his influence, other publications (such as the Journal of the American Medical Association) either glossed over his support of Soviet medicine or (like the New York Times) didn’t mention it at all. Ironically, Time—after that gushing cover story—never even ran his obituary.
However, Fee notes, in many parts of the world, Sigerist’s reputation never dimmed; as an international consultant on planning and improving public health, he was as sought-after and respected as ever. And in this country, many of his former students and friends remained inspired by Sigerist’s ideas for improving health care. As they moved into positions of influence in medical care and policy-making, they carried Sigerist’s still-burning torch of reform with them. “My history…” Sigerist once said, “is meant to be stirring, moving people into action.” It did, and still does.
Photos courtesy of the Alan Mason Chesney Medical Archives at Johns Hopkins.