NEUROLOGICAL SPECIALISM. 
PRESIDENTIAL ADDRESS DELIVERED AT THE ANNUAL MEETING 
OF THE NEW YORK NEUROLOGICAL SOCIETY, MAY I, 1883 
BY 
W. J. MORTON, M.D. 
NEW YORK 
[Reprinted from the Journal of Nervous and Mental Disease, Vol. x. No. 4, 
October, 1883] NEUROLOGICAL SPECIALISM. 
PRESIDENTIAL ADDRESS DELIVERED AT TTJE ANNUAL MEETING 
OF THE NEW YORK NEUROLOGICAL JgdciETY, MAY I, 1883. 
WILLIAM J. MORTON, M.D., 
NEW YORK. 
GENTLEMEN :—I enter upon the duties which you 
have assigned to me, deeply conscious of the com- 
pliment and the confidence conveyed in your vote, and in 
full reliance upon that active and earnest support that 
has always been characteristic of the proceedings of this 
Society. 
In accordance with the precedent which demands on 
this evening “ the addresses of the retiring and newly 
elected Presidents,” I venture to bring before you some 
general remarks relating to our Society,—its past, its future, 
its aims, and its position as the exponent of a vigorous and 
special offshoot of general medicine. 
Of the past I shall say but little. Our age is not yet so 
venerable as to present charms whose enumeration shall 
obliterate the novelty of our present. Our records do not 
yet invite the antiquary to rehearse in detail our earlier 
achievements. 
But, for the benefit of those who have recently joined 
our ranks, I may note, in passing, several prominent points 
in our career. 
We are disposed to believe that an unusual degree of 
success has thus far attended our efforts. With us hard 
Reprinted from the Journal of Nervous and Mental Disease, Vol. 
x. No, 4, October, 1883. 2 
PRESIDENTIAL ADDRESS. 
work and good fortune have often auspiciously joined 
hands. Not the least notable of the events that contrib- 
uted to strengthen our position were the dissolution of the 
rival Society of Neurology and Electrology in 1877, and the 
hearty invitation that was issued to its members to unite 
with us. In response to this invitation a large accession of 
working talent was added to our already active organiza- 
tion. The divided interests thus happily joined have since 
flowed on in comparatively uninterrupted harmony. 
The position of the Neurological Society has been from 
the very outset unique among our metropolitan societies. 
Its work has been a double and parallel one. It has been 
the forum for a remarkable amount of scientific work, and 
it has been a powerful agent in the formation and guidance 
of public opinion upon subjects about which it has the 
special right to speak. I would not for a moment be 
accused of magnifying our own merits,—allowable though 
it be for an incorporated organization of many persons to 
speak of itself in terms denied by conventional modesty to 
the individual,—but I am sure I speak within the facts, and 
in the spirit of that just pride which we all feel in our work, 
when I say that we deserve and enjoy a well-earned reputa- 
tion for industry and devotion to the specialty of neuro- 
pathology. 
In merely glancing over the titles and recalling the char- 
acter of the scientific productions that have been brought 
before us in formal papers during the last nine years, the 
observer cannot fail to be impressed with the amount and 
merit of the work that has been accomplished; and not the 
least profitable of our proceedings have been the animated 
and instructive discussions which have been called forth. 
In this latter respect, the proceedings of the Society have 
offered to its members a peculiar interest. As a rule, in 
medical societies a few men do the actual work. One of WILLIAM J. MORTON. 
3 
these few, for instance, reads a paper, exhaustive, carefully 
prepared, and probably presenting debatable original ideas; 
this paper is attentively listened to ; several members arise, 
make complimentary corroborative remarks, or relate a 
“ similar case,” and there the subject ends, and the paper is 
passed on to its routine place in medical journals. But this 
has not been the practice in the Neurological Society, and 
herein lies one secret of its vitality and interest to its 
members; individuality is well marked; opinions differ 
widely, and those who hold them sustain them warmly. 
And it may be true that there sometimes arises a slight 
acerbity born of animated attrition, but this is quickly 
obliterated by the common interest. 
Our Society has a reputation of being “lively.” This 
criticism we regard as the highest compliment, for to be 
“lively ”isto be working, comparing ideas, progressing; our 
emulation is friendly and healthy. May the dust of burnt- 
out opinions never settle down upon its proceedings and 
clog its energy; may it never become conservative, but 
rather press on and excite competitive intellectual activity 
to the fullest bent of which the individual is capable. 
In looking ovef the titles of the papers that have been 
already read before our Society (an average of about one 
and a half to each meeting, to say nothing of presentation 
of cases and specimens), the attention is attracted by the 
diversity of topics treated. Each year’s work is a fair 
reflection of the history of neurological advance, and in 
this connection I cannot refrain from expressing a keen 
regret that our work is not accessible in the shape of printed 
transactions. 
And added to the proper satisfaction that we may gain 
from a retrospect of our routine work, there also remains 
to us a higher pleasure in recalling the initiative share that 
we have taken in the great movement of amelioration in 4 
PRESIDENTIAL ADDRESS. 
the treatment of the insane, which is now occupying public 
attention. In 1878 there was voiced by this Society ideas 
that have been powerful in preventing great injustice to 
these unfortunates. The movement, signalized in its early 
stages by single and scattered shots from various quarters, 
opened into a steady fire against the oppressors of the 
insane from the moment that the Neurological Society en- 
tered into the contest. The history of our share in this 
work should not be forgotten. At the stated meeting of 
March, 1870, our retiring President read a paper upon 
“ Reform in Scientific Psychiatry,” and a Committee on 
“Asylum Abuses,” consisting of Drs. Wm. A. Hammond, 
E. C. Seguin, E. C. Spitzka, W. J. Morton, L. C. Gray, T. 
A. Mcßride, and E. C. Harwood, was appointed to make 
a report. The committee drew up a memorial to the Legis- 
lature of the State of New York, praying for an inquiry 
into the management of our insane asylums. This memo- 
rial was referred to the Committee on Public Health. The 
members of the Committee on Asylum Abuses will prob- 
ably never forget their first experience on coming in contact 
with a political medical ring, as shameless as it was power- 
ful by reason of its alliance with low politics. 
The report of the Senate Committee in response to the 
memorial was an unexampled specimen of trickery and 
mendacity. But a breach in the Chinese wall of seclusion, 
secrecy, and tyranny which surrounded the management of 
the insane in many asylums was effected. Our committee 
was pertinacious and undaunted, and within two years had 
the pleasure of knowing that a second Senate report, 
V 
embracing all that they had claimed, had been presented 
to the Senate; though, strange to say, thanks to methods 
known to Albany politics, this report has never been 
printed and made public. 
But the proceedings in the Legislature are now compara- WILLIAM J. MORTON. 
5 
tively unimportant. That great engine of reform, public 
opinion, has begun its irresistible movements. The press 
records blows struck on every hand at medisevalism in the 
treatment of the insane. Legislative committees are being 
appointed, asylum after asylum is being investigated. In 
some asylums there exists all that can be expected, under 
the present system, even from the most humane of superin- 
tendents; in others, the blighting influence of officialism is 
exposed; while in others again, unspeakable barbarities are 
unearthed. 
And, most encouraging of all, advanced minds among the 
superintendents of asylums themselves are attaining to the 
consciousness that in them resides the prerogative of bring- 
ing about the very reforms which the public now demands. 
The Neurological Society touched the spring that set the 
wheels of reform in motion. It may now calmly watch the 
result. 
But I turn from our past to our future. Even the brief 
retrospect in which we have indulged is sufficient to throw 
into clear light the golden thread of continuity of purpose 
in our history wdiich seems to forecast the way to us who 
take up and carry on the strand. We are the inheritors of 
a worthy patrimony, and it becomes our fortunate lot to 
contribute, so far as lies within our power and capacity, 
to the dignity and value of the inheritance that our prede- 
cessors have accumulated in the archives of this society. 
As I glance over our list of seventy or more active mem- 
bers I am encouraged to expect an unusual amount of 
neurological work during the coming year. I see the names 
of veterans in the service who may be always relied upon to 
furnish papers; the names of other members, who, great as 
are their talents, possess a still greater inertia, against which 
must be brought a certain amount of urging. I see also 
the names of our modest members, and those of newly 6 
fledged neurologists now coming forward to receive their ac- 
colade. From all these we expect assistance. We have only 
to look about us at our meetings to recognize the great inter- 
est in the cause of neurological work, which only steadfastly 
awaits an opportunity to express itself. The Society says 
to all its members ; We expect your earnest support. 
PRESIDENTIAL ADDRESS. 
It is really a serious mission that we are engaged in. All 
along the line, the world over, neurological medicine is 
pushing forward its work in a manner that proclaims it to 
be, of all the specialties, the most advanced, the most active, 
the most fruitful in results to humanity. True, some of 
this advance is due to the labors of those who are by no 
means specialists in the treatment of diseases of the nervous 
system,—but is rather a contribution to general medicine ; 
the fact still remains that the work is done in the de- 
partment of neurology, and that its results are greeted, 
fostered, utilized, and perpetuated beneath the banner of 
specialism. In Germany and France the study of the symp- 
toms, the causes, the pathology, and the treatment of 
diseases of the nervous system has long held a strongly 
accentuated position, derived from the special labors of a 
long line of eminent workers in this field, whose contribu- 
tions to the subject have now become classical in medical 
literature. Of England and, in more recent times, of Italy, 
the same remark may be made. And never in our own 
country has the interest in this subject been more generally 
diffused throughout the medical profession than at present. 
The truth of this assertion may be verified from many points 
of view. Our medical periodical literature contains numeri- 
cally more observations relating to nervous diseases than 
ever before, and, what is of more consequence, these con- 
tributions are of a higher order of merit. 
In the various cities of the Union a number of physicians 
are taking up the study as a specialty and are devoting 
much labor to it. WILLIAM J. MORTON. 
7 
Medical schools are awakening to the importance of 
offering to their students advanced instruction in this 
department, while the post-graduate schools and the poli- 
clinics contribute notably to a clearer definition of this 
branch of medicine. In the midst of this generally in- 
creasing interest, organized and equipped for the work, 
and recognized as a leading special society, it is peculiarly 
appropriate that the Neurological Society should assert 
itself with renewed ardor, and should concentrate within 
the systematized fold of its labors all the neurological work 
that is now being done in this city. In this connection 
it is not amiss to refer to the fact that two or three of our 
members, whose labors have always been a credit to the 
Society, have expressed the opinion, that work in neurology 
could be more advantageously performed in the medical 
sections of the New York Academy of Medicine. And since 
neurology, according to them, is to be relegated to section 
work in the Academy, the same holds true, of course, of 
laryngology, ophthalmology, otology, and so on. The effect 
of this plan, successfully carried out, would be to break up 
in turn all the special societies in the city—to merge all into 
a common level of general society work. Identity and 
individuality are to be lost in an official machine of wheel 
within wheel, revolving for the glory and advance of—what? 
—not of specialism but of general medicine. Surely this 
would be a retrograde step. For years past the specialties 
have been branching off from the parent stem in the face of 
great opposition from general medicine ; they have planted 
themselves firmly on their own pedestals, and have a fixed 
position, and respect, and confidence. The constant tendency 
of the last twenty years in medicine has been toward de- 
centralization—in other words, specialism ; and now we are 
asked to go back on our tracks and centralize. It is un- 
doubtedly true that an act of amalgamation of the kind 8 
proposed would benefit neither general medicine nor 
neurology. For, owing to the very multiplicity of the facts 
of medicine to-day, large bodies become entangled in their 
own lines, or neutralize by want of unity of direction the 
efforts of individuals. Smaller bodies like our own concen- 
trate their energies, and in their very unity of purpose find 
a stimulus to exertion unknown to the larger body. 
PRESIDENTIAL ADDRESS. 
I have alluded more at length to this question than would 
have been worth while did it not concern other special 
societies in common with our own. The danger needs but 
to be recognized to be averted. Members of the Academy, 
as many of us are, and holding it in highest esteem, we 
yet feel that in this endeavoring to absorb into itself 
under its several sections the various special societies of this 
city, the Academy is undertaking a task beyond its powers 
and beyond its capacity of adequate control. Certain it is, 
that the opinions expressed and now carried into effect by 
the two or three late members alluded to will find little 
sympathy in this body. 
I have so frequently referred to the fact that the mem- 
bers of this Society were engaged in the study of a particular 
and sharply defined branch of medical science, that I feel 
that a few words defining our position in this respect may 
well be embraced in these general remarks. 
The principle that governs the necessity of studying the 
diseases of the nervous system by themselves, is the same 
principle that has compelled specialization in other branches 
of medicine. 
Medical art and science of to-day have expanded to 
enormous proportions; numberless investigators are at 
work ; allied sciences are introduced ; facts are daily added 
to the sum of medical knowledge, until it has become 
impossible for a human being even of extraordinary intel- 
lectual power to grasp the new facts, arrange them in his WILLIAM J. MORTON. 
9 
mind, or utilize them in practice. Time was, and that 
not thirty years ago, when the general practitioner of good 
ability conscientiously felt that he could make himself 
master of all medical science. To-day, few, if any, can 
pretend to keep pace with medical progress. One by one 
a branch has shot off the parent stem, dependent yet inde- 
pendent. The very attempt to keep up in the race of 
accumulating knowledge begat hyprocrisy and discourage- 
ment. Specialism is, then, the substitution of precision for 
vagueness—of a concrete differential diagnosis for an 
abstract supposition ; it is the forced acknowledgment 
that the average human mind cannot practically grasp all of 
medical science ; it is, in short, the protest of knowledge 
against ignorance, and it now becomes, indeed, a matter of 
conscience to specialize medical labors according to the 
tasks or talents of the physician. And specialists them- 
selves have even begun to again subdivide. There is, no 
doubt, a danger to medicine in thus becoming cut into 
smaller and still smaller sections. The eye, it is said, will 
become microscopic—the mental reach of comprehension 
correspondingly narrowed. This is the evil of specialism 
It must be faced, for the disseveration now begun will go 
on. It is but the natural law of the division of labor,— 
true of commerce, and now of law and medicine. 
The danger alluded to is however more superficial than 
real. The conscientious specialist never forgets his relations 
to general medicine. It is well understood that he should 
have had a good preliminary experience in general prac- 
tice. There can be no sympathy with the immature jump 
from a medical school into a specialty. 
Neurology is but following the general tendency of the 
times, and with better right than many other specialties, for 
it offers to its followers a field for investigations so vast, 
so fruitful, so impossible of exhaustion, that even if they PRESIDENTIAL ADDRESS. 
should desire it they are precluded from equally extended 
investigations into other branches of medicine. 
From a purely practical point of view, it is, then, proper, 
nay, it is even compulsory, to the neurologist to be a 
specialist. But the remark has often been made that 
neurology is less a specialty than other specialties ; that 
it is an unnecessary subdivision of medicine, since the 
morbid processes that go on in the nervous tissue are 
either themselves the real basis of other diseases, or, on 
the other hand, are caused by diseases in other parts; 
our boundary lines, it is claimed, are quite too shifting, 
and may be so construed as to include almost all of 
general medicine. This criticism is no more nor less than 
a criticism upon the defects of our present nosology or 
classification of diseases. If it shall ever become demon- 
strated that affections of the nerves are the essential basis 
of all diseases, why, so much the better for the neurolo- 
gist; he has been upon the right track. If, on the other 
hand, there are diseases (and no one doubts that there 
are) peculiar to the nervous tissue, then, for practical reasons 
already given, the neurologist is justified in devoting his ex- 
clusive attention to these diseases. 
But the best basis for a separation of the affections of the 
nervous system from other diseases is from the stand-point 
of symptomatology. The study of symptoms alone has 
led to the discovery of many of the most important 
diseases known to medical science. By this method, Du- 
chenne discovered locomotor ataxia, progressive muscular 
atrophy, pseudo-hypertrophic paralysis, and other affec- 
tions. True, physiology lent its aid, and pathology verified, 
but symptomatology furnished the lines of demarcation 
that erected the unknown affection into the dignity of a 
recognizable and a predicable disease. I would by no 
means underrate the value of the facts contributed to WILLIAM J. MORTON. 
11 
neuro-pathology by pathological anatomy or by physiology. 
On the contrary, a thorough study of these branches is 
essential to the clinician. A familiarity with the methods 
that reveal to us the secrets, so far as this is possible, of the 
morbid processes that are associated with nervous diseases, 
may be our guide in our efforts to correlate the symptoms 
of our patient, but they should not constitute the chief end 
and aim of the neurologist. Familiar with the fundamental 
laws of neuro-anatomy, physiology, and pathology, let symp- 
tomatology—in other words, clinical study—be his main 
pursuit and interest. In this direction also lies the greatest 
amount of material for clinical study; for those suffering 
from affections are many, while but few of them 
will be ever available for examination, by scalpel or micro- 
scope. And we are right in emphasizing the position of 
neurology in medicine, and in devoting our best energies to 
its success. To the sick, the subdivision of labor is an ad- 
vantage, since, other things being equal, this means skilled 
labor. Clearly, the field for work is all that the neurologist 
can attend to—it is certainly more than the general prac- 
titioner can keep up with. 
It is, indeed, a great pity, in my opinion, that there are 
not more specialists than there now are in all branches of 
medicine. 
I have but a word more to say, and that word a passing 
tribute to a deceased member. Time is laying his hand 
upon all of us, but death has rarely been with us. One of 
our number—Dr. Geo. M. Beard—has lately passed away. 
A man, singular, but honest and strong in his singularities. 
His intellectual capacities were far above the average; the 
phases of his mental activity were distinctly original. He 
wrote much—possibly too much. A critical friend has said 
that his fame would have been more enduring if he had 
written five books instead of fifty. His generalizations 12 
PRESIDENTIAL ADDRESS. 
were often too sweeping and too hastily arrived at. On the 
other hand, they were often strikingly accurate ; and when 
subsequently some few of them, relating to the Gospel of 
Relaxation and other subjects, fell from the lips of Mr. Her- 
bert Spencer, they were thought to be words of golden 
truth. Again, Dr, Beard attempted very difficult problems. 
He often grasped one portion of a circle, and hauled in 
upon it only to find the same portion in due time again in 
his hands. 
But far be it from us to criticise. His work is done. And 
in judging of a man’s life-work we must ever keep in mind 
that we are probably not familiar with an innermost corre- 
lation of factors peculiar to the man, worked out in his own 
consciousness, but cpncealed from his friends, and born of 
his attrition against circumstances. 
In Dr. Beard the Society has lost an active member 
whose presence at our meetings will always be kindly 
remembered. 
But I fear that the limits of time which your courtesy 
has extended to me are now more than occupied by these 
desultory remarks, which, in the present instance, I trust 
you will accept in lieu of a more formal address. To you 
I now look for a year’s work satisfactory to your own con- 
sciences and commensurate with that which this Society 
has a right to ask from you. g. p. putnam’s sons, printers 
NEW YORK