That Was the Century That Was: Historical Perspectives on Medical Life at the Fin de Siècle

• History of medicine, 20th cent.
• Specialties, medical
• Technology, medical
• Hospitals
• Economics

Lately, to many of us, medicine has felt like a large leaky vessel weaving uncertainly across uncharted seas. The profession's continued soundness remains a focal concern for many (1-3). Some in the medical community express discomfort (4), while a few adventurous souls even sally forth into prediction (5). So as U.S. medicine drifts toward the millennium, we can be forgiven if we peer out warily from the deck and wonder what lies ahead—or whether a rudder is down below. Some sort of dramatic change feels imminent. There is a queasy sense of transformation, driven by dramatic late-20th-century developments in the molecular and information technologies in the economic bases of medicine. But toward what? At such times it is worthwhile to ponder the past and seek insights, if not answers, about our current state in this fin de siècle narrative. In what follows, I survey recent historical works on specialization in an attempt to locate what little stability we might find in this sea of change.

At the end of nearly every century, general historians have obliged us by providing needed perspective. Lately, a new cadre of authors on general history have provided fresh detail on where we have changed and how we are the same, warts and all (6-8). Historians of 20th-century medicine also address a profession increasingly seen not as it might wish to be but as it is and has been. This is a nuanced view of medicine in the United States, fissured within by specialties' contested claims over the body and thus over the daily work of clinicians. Time for a reality check: Start with self-examination.

Recent historical work is carried along by four interlocking currents: hospitals, technology, specialization, and the organization and financing of health care. Of these, the most prominent one …