Divide and Conquer: A Comparative History of Medical Specialization

This wide-ranging book is the first to examine one of the most significant and characteristic features of modern medicine - specialization - in historical and comparative context. Based on research in three languages, it traces the origins of modern medical specialization to 1830s Paris and examines its spread to Germany, Britain, and the US, showing how it evolved from an outgrowth of academic teaching and research in the 19th century into the dominant mode of medical practice by the middle of the 20th. Taking account of the parallels and differences in national developments, the book shows the international links among the nations' medical systems as well as the independent influences of local political and social conditions in the move toward specialization. An epilogue takes the story up to the twenty-first century, where problems of specialization merge into the larger crisis of health care which affects most western nations today.

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Reviewer:Ralph D. Arcari, MSLS, MA, PhD(University of Connecticut Health Center)
Description:Relying heavily on medical directories from four countries, the U.S., Great Britain, France and Germany, published over the past 200 years, the author compares and contrasts the growth of medical specialties based on medical directory professional categories. The author also provides an extensive commentary on the healthcare, political, and economic conditions in each country and how these factors affect the growth of medical specialties.
Purpose:I do not attempt, even in these chapters, to provide a comprehensive history of the specialties discussed. Here, as throughout this book, my goal is to account for the broader history of specialization," the author states. The interrelationship between medical specialization and the availability of medical care from a national perspective is an important topic as countries struggle with the prospect of healthcare as a citizen's right. Stated objectives are addressed; however, major developments in U.S. medical care and education are inadequately covered.
Audience:The book is written for the general reader. The author is the Cotton-Hannah Professor of the History of Medicine, McGill University. His previously published works include The Medical Mandarins (Oxford University Press, 1995) and Greater than the Parts (Oxford University Press, 1998) are his previously published works.
Features:The socioeconomic factors behind the growth of medical specialties in four countries were significantly different in the 19th and early 20th centuries. However, the similarity between the specialties that ultimately developed is significant. The delineation of historical detail and the concomitant bibliographic documentation is noteworthy. Statistical appendixes provide cross-national data comparisons. Topics that could have been more fully articulated relative to their impact on the development of U.S. medical specialties include: medical specialties that came and went, e.g., neurasthenia, phrenology; the establishment of Johns Hopkins University Medical School (1892) as the gold standard for U.S. medical education; the Flexner Report (1910); and the Association of American Medical Colleges (1876) and its role in representing medical specialties in academic medicine.
Assessment:In his introduction, the author synthesizes other medical historians who have considered the topic of medical specialization. The writings of George Rosen (The Specialization of Medicine with Particular Reference to Ophthalmology (Froben Press, 1944)), Rosemary Stevens (Medical Practice in Modern England: The Impact of Specialization and State Medicine (Yale University Press, 1966)), and Sidney Halpern (American Pediatrics: The Social Dynamics of Professionalism (University of California Press)) are among those discussed. The author acknowledges the analytical work which his predecessors provided for his own study. The bibliography in Divide and Conquer is sufficiently detailed and comprehensive to warrant this title's acquisition.