Medical Directories and Medical Specialization in France, Britain, and the United States

This paper explores two subjects. It is in the first instance concerned with medical directories, a genre of professional literature that is utilized occasionally as a historical source but whose historical development is only beginning to be charted. ¹ The essay deals in addition with medical specialization, about which a great deal has been written. By focusing on the treatment of specialization in medical directories, I hope to cast new light on both topics. More specifically, medical directories allow us to approach specialization at a systemic level and from a comparative perspective, supplementing the more usual emphasis on case studies of individual specialties.

In two previous papers, I utilized medical directories of the late nineteenth and early twentieth centuries to analyze the evolution of specialist categories and populations in Paris and the largest provincial cities of France. ² In this essay, I propose to compare the treatment of specialization in French directories with that of comparable publications in the United States and Britain. I shall begin by briefly describing the emergence and proliferation of medical directories in the three countries. I shall then examine how different directories dealt with the spread of medical specialization. Finally, I shall offer some quantitative data based on the information contained in the major national directories during the interwar period.

In offering such comparative data, I do not suggest that the recapitulation of these results is unproblematic. In previous studies, I have emphasized the volatility and ambiguity of specialty status in the early twentieth century. The quantification of data from directories is difficult enough within one country, and the problems are compounded when we attempt international comparisons because different national directories approach specialization in distinctive ways. Such variations, however, themselves yield valuable insights into the nature and meaning of specialization in the countries involved.

The Medical Directory

The medical directory is a curious genre with a complex literary pedigree. One precurser is the astrological almanac, itself a successor to the medieval computus manuscript, which might contain all sorts of practical information including lists of professionals. ³ As directories developed, they frequently retained the most characteristic feature of the almanac, the calendar. Until the 1870s, the British Medical Directory contained an elaborate calendar including information about the phases of the moon, times of sunrise and sunset, days of meetings of scientific societies, historical anniversaries, days of religious significance, and days for renewing fire insurance, paying taxes, or voting in county elections.

Long before they abandoned calendars, directories had become primarily concerned with the representation not of time but of social space. As social life became increasingly complex from the seventeenth century on, individuals required practical guides to the intricate patchwork of institutions, groups, and persons that constituted their society. By the late seventeenth century there existed several different sorts of directories appearing at more or less regular intervals. One important category described the major elite institutions and corporations of the nation, ranging from the royal family and state officials to lists of professionals like physicians, notaries, and lawyers; the Almanach royal, which appeared in France from 1699 until the twentieth century, and Debrett’s Royal Kalendar (1765–1893) in Britain were among the most successful publications of this type. A second category, whose origins in Britain go back to lists of guild merchants of the fourteenth century, were trade and business directories, which especially proliferated in Britain. ⁴

In the late eighteenth century, directories devoted to specific professional groups began appearing sporadically. Medical directories appeared in France as early as 1776, ⁵ and in Britain as early as 1779. ⁶ But it was not until the nineteenth-century emergence of large-scale publishing enterprises that medical directories began to proliferate.

In France, two directories began appearing on something like an annual basis during the 1820s. One of these, the Almanach général de médecine (founded in 1827) managed to survive in various forms until World War I. ⁷ It was joined in the next decades by a variety of other publications. Some were highly idiosyncratic, like Henri Meding’s Paris...