American Medicine and the Public Interest

American Medicine and the Public Interest, by ROSEMARY STEVENS, New Haven and London, Yale University Press, 1971, pp. xiii, 572, £9.00. Rosemary Stevens has delineated the effect on medicine of the formation of professional societies representing the specialties into which it became divided in the nineteenth and twentieth centuries. Its introductory section, an examination of professionalizaton from colonial times to 1900, represents essentially a recapitulation of events largely from secondary sources with no new insights gained from juxtaposing the material. Similarly, Part V (the last 115 pages), an account of national health legislation in the 1950s and 60s, dealing with the passage and results of Medicare and Medicaid and the role of the federal government in health care, said little new and seemed unintegrated into the body of the book. What then of its middle? Here, Professor Stevens makes an original contribution to the literature and gives us the best account to date of the complicated rise of specialty boards in America. Analysed well is the role of medical schools and professional societies in deciding educational and manpower issues, the emasculation of general practitioners in the face of the specialist onslaught and the efforts of the former to recover through an academy and specialty boards of its own. She provides enlightening commentary on the effect of the open versus closed staff system of American hospitals on medical practice. In England, the closed system that barred generalists from hospitals and fostered a more decentralized system; in America the open system tended to centralize care in hospitals by allowing physicians of all kinds to use its facilities. Interesting too are herdiscussions of the forces leading to the creation of internships and residencies, the relationships of non-physician health professionals to the doctor, and the circumstances that determined the number of students admitted to medical schools during the twentieth century and its consequences. The American Medical Association's role in professionalization, its relationship to the specialty societies and medical schools also is handled adroitly. Her frequent comparison between the developments in English and American medical systems proved enlightening. This middle section, and the book in general, represents medicine seen from one aspect of its development-its professionalization through societies. It does not provide discussion of the technological and clinical factors accompanying and causing professionalization. Omitted too is any sustained discussion of the effect of social philosophies and movements, such as Progressivism or New Deal ideology in the organization of medicine. These limitations notwithstanding I recommend this book as a fine addition to the library of medical and general historians, and those interested in public policy.