A Doctor of Their Own: The History of Adolescent Medicine (review)

In A Doctor of Their Own: The History of Adolescent Medicine, Heather Munro Prescott examines the development of the specialty of Adolescent Medicine in twentieth century America. Prescott argues that society’s views of adolescence, issues regarding medical professionalization and specialization, as well as concerns of adolescents themselves all combined to shape the growing specialty of Adolescent Medicine. The book is divided into four chapters, which are not necessarily the best format for making her argument. The first examines American attitudes toward adolescents from the 1920s up to, and including, the World War II period. In addition, this same section examines the development of Pediatrics as a medical specialty, covering roughly the same time period. The second chapter is an in-depth discussion of the career of Dr. J. Roswell Gallagher, the first physician to establish a successful hospital unit devoted exclusively to the care of adolescents. The third chapter, covering primarily the 1950s and early 1960s, focuses on the perspective of patients and their parents, paying close attention to the effect of race, class and gender on adolescent medical care. Chapter Four deals with the development of the specialty in the 1960s and 1970s, placing this development within the context of a rapidly changing youth culture. Prescott discusses contemporary adolescent health issues in the Conclusion, in an attempt to advocate for the continuation of a specialty in Adolescent Medicine.

During the first few decades of the twentieth century, physicians began to specialize, albeit on a small scale, since skepticism regarding specialization was pervasive because it was associated with quackery. In addition, many “generalists,” who feared their livelihoods were threatened, were critical of physicians who began to declare expertise in a given area. The new developing specialties, in order to justify their existence, had to claim expertise in a particular area, and for pediatricians it was artificial infant feeding. This scientific technology, aided by the Progressive era welfare reforms, lent credibility to Pediatrics, an important step in a society that gave great authority to science in the early twentieth century. Other new scientific discoveries also aided pediatricians, such as advances in diagnosis, treatment and prevention of childhood diseases, as they sought to establish their authority over generalists and other specialties. Interestingly, as these new discoveries helped to lend credibility to Pediatrics, they also served to undermine the market for pediatricians’ services, and so pediatricians sought other areas in which they could claim expertise. Two strategies were implemented to do this. One included the development of subspecialties within Pediatrics. The other strategy, in contrast, was an increasing use of rhetoric focusing on holistic care, sometimes referred to as the “new pediatrics.” This strategy incorporated psychosocial issues into the body of pediatric knowledge.

During roughly the same time period, theories regarding adolescence as a distinct period of childhood were becoming more refined. The nineteenth century transition to an industrial-capitalist economy and the resultant cult of domesticity, caused childhood to be viewed as a distinctive period, apart from adulthood. In addition, distinctions based on race, class and gender were becoming more apparent in American society. By the 1920s, anxiety regarding the behavior of teens had become widespread, and many parents sought help for their teens’ behavior in the new “modern” culture of the twenties. A growing parent education movement and the development of new theories regarding child development, often focusing on the relationship between the social and political turmoil of the day and emotional maladjustments, further identified teens as a separate age group in need of expert care. In order to be assured of having emotionally stable leaders, capable of combating communism and fascism, it was essential that teens’ emotional disorders and behavior problems be addressed accordingly. J. Roswell Gallagher, who established the first service for adolescents in the United States at Boston Children’s Hospital, is generally credited with being the founder of Adolescent Medicine. As the director of health services at Phillips Academy in Andover...