Divide and Conquer: A Comparative History of Medical Specialization

by George Weisz

Overview

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.

Product Details

ISBN-13:	9780195179699
Publisher:	Oxford University Press
Publication date:	08/11/2005
Pages:	392
Product dimensions:	9.21(w) x 6.14(h) x 0.88(d)

About the Author

McGill University

Table of Contents

Part I: The Emergence of Medical Specialization in the Nineteenth Century
Chapter 1: The Rise of Specialties in Early-Nineteenth-Century-Paris
Chapter 2: Medical Specialization in London: A Reverse Mirror Image
Chapter 3: Specialization in the German-Speaking World
Chapter 4: The Rise of American Specialties
Part II: Domesticating Specialist Practice, 1890-1950
Chapter 5: Regulating Specialists in National Medical Directories
Chapter 6: Regulating Specialists in Germany
Chapter 7: Regulating Specialists the American Way
Chapter 8: The French Style of Regulating Specialists
Chapter 9: Regulating Specialists in the British Manner
Chapter 10: Medical Specialties in Comparative Perspective
Epilogue: Medical Specialization in Second Half of the Twentieth Century

Editorial Reviews

Reviewer: Ralph D. Arcari, Ph.D.(UConn Health)
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.

Doody's Review Service

"This is clearly the most authoritative and up-to-date treatment of the history of medical specialization. The author's fluency in French and German enables him to compare and contrast developments in America, Britain, Germany, and France and do justice to both national differences and cross-border similarities. His grasp of the secondary literature is also formidable, making this book a valuable contribution to not just the history of medical specialization, but also the history of medicine in general."—Ian R. Dowbiggin, Chair, Department of History, University of Prince Edward Island

"This is an impressive, encyclopedic study, which provides wonderful source material and ways of looking at the struggles to incorporate specialization into organized medicine in four countries with different political structures, health payment arrangements, and professional organization. The research is impeccable. Weisz knows what has happened in the four countries better than anyone I can think of. He has an exceptional command of primary and secondary sources." —Rosemary A. Stevens, Stanley I. Sheer Professor Emeritus, University of Pennsylvania

"Divide and Conquer reveals rich, uncharted territory. It is a great pleasure to read, evocative, and splendidly detailed."—Medical History

"The book is a tour de force and deserves a wide readership in the health-policy world, as well as among historians and sociologists of medicine and the professions."—Bulletin of the History of Medicine

"Indispensable. This well-informed, lucidly-written, and sophisticated comparative study constitutes an important contribution not only to the history of medicine, but to the sociology of the professions - and to the enterprise of comparative history itself."—Charles E. Rosenberg, Ernest E. Monrad Professor to the Social Sciences, Harvard University

"In this important historical study, George Weisz, PhD, professor of Social Studies of Medicine at McGill University, cogently analyzes the forces that gave rise to specialties and continue to shape their futures... For those who are interested in contemporary health care challenges, Weisz's book provides essential and compelling historical perspective."—JAMA

"This book will be widely read by historians of medicine...Non-specialists will also find much in Divide and Conquer. Anyone working on a medical specialty will want to consult with Weisz's work."—H-France

From the Publisher

3 Stars from Doody