A LECTURE 
ON 
Specialism in Medicine, 
DELIVERED 
Before the Class Inaugurating his Annual Course of Instruction, 
September 21, 1876. 
E. D. FOREE, M. D. 
Professor of Diseases peculiar to Women in the Hospital College of Medicine, 
Medical Department Central University, Louisville, Ky. 
Reprinted from the American Practitioner, Nov., 1876. 
INDIAN A'FO Cl'S: 
JOURNAL COMPANY, PRINTERS. 
iBy 6. A LECTURE 
ON 
Specialism in Medicine, 
DELIVERED 
Before the Class Inaugurating his Annual Course of Instruction, 
September 21, 1876. 
E. D. FOREE, M. D. 
Professor of Diseases peculiar to Women in the Hospital College of Medicine, 
Medical Department Central University, Louisville, Ky. 
Reprinted from the American Practitioner, Nov., 1876. 
INDIANA PO'itl'si- 
JOURNAL COMPANY, PRINTERS. 
1876. SPECIALISM IN MEDICINE. 
E. D. FOREE, M. D.* 
Professor of Diseases peculiar to Women in the Hospital College of 
Medicine, Louisville, Ky. 
In the organization of the medical department of Central 
University, the chair of diseases peculiar to women was estab- 
lished, and he who now addresses you was designated for the 
place. By this appointment and its acceptance I have be- 
come, in fashionable parlance, a specialist. Being so recog- 
nized and acknowledged, I shall claim the privilege inherent 
to the position of using the time allotted to this, our first 
interview, of offering a few thoughts upon medical specialism, 
which is now prevalent and rapidly increasing. 
You will learn, as you progress in the profession, that 
Fashion, that inexorable tyrant, extends its sway over medi- 
cine to a more presumptive limit than over any other science, 
excepting, perhaps, the social science alone; and that he who 
runs counter to it does so at his personal hazard, and may be 
chargeable with undue temerity. Nevertheless, having be- 
come convinced, by ample observation, that the fashion ot 
splitting up the art of medicine into innumerable parts is 
fraught with mischief to the people, is subversive of the inter- 
ests of the physician, and retards the progress of the science 
itself, I shall venture to discuss it in its various bearings. 
*From a lecture delivered by Dr. E. D. Force, before the class inaugurating 
his annual course of instructions, September 21, 1876. 2 
Specialism in Medicine. 
Specialism in medicine is the outgrowth of the half century 
just ending. Prior to that there was no division of practice, 
except into the two great branches of surgery and general 
practice; and these even were so intimately blended that it 
was only as a medical man of general and thorough acquire- 
ment betrayed the greater aptitude and skill for either branch 
did he become a devotee to medicine or surgery. For exam- 
ple, our own Physic having made himself a finished anatomist 
and physiologist, and having learned well the rudiments of all 
other departments, then by a ripe clinical experience, running 
through many years, having won distinction in both medicine 
and surgery, yet excelling in the latter he had surgical prac- 
tice thrust upon him to such an extent that he had no time to 
give to other departments of practice. In this way he became 
a practitioner of surgery alone. 
Dr. Gross, who by general consent is styled the Nestor of 
American surgery, whom we in our city delight to honor, and 
whose name is familiar to enlightened physicians everywhere, 
was an assiduous student of general medicine; anatomy, phy- 
siology, pathology, therapeutics, histology, indeed all of ele- 
mentary medicine alike, engaged his earnest attention. Then 
he sought clinical experience in every department of practice; 
and not till after he was forty years old, and had accumulated 
a large experience in the art of recognizing and treating all 
classes of disease, did he become an exclusive practitioner of 
surgery. 
Simpson, of Edinburgh, having become learned in every 
branch of medical science and obtained a large clinical experi- 
ence in both hospital and private practice, was appointed Pro- 
fessor of Obstetrics in the University of Edinburgh. This acci- 
dent gave the direction of his great mind to the study of the 
diseases of women. Very soon his achievements in this di- 
rection were found to be so grand, and gynecological practice 
accumulated upon him so largely, that he was compelled to 
become an exclusive practitioner—a specialist. 
In like manner Hewitt, Barnes, Spencer Wells, and others, 
of Great Britain, Sims, Emmet, Thomas, Peaslee, and many Specialism in Medicine. 
3 
others, of our eastern seaboard, have been driven into special- 
ism. So also did our own lamented Miller, after having ac- 
quired a most thorough knowledge of the whole science, and 
a rich clinical experience in general practice, become a spe- 
cialist, not by choice but because it was thrust upon him. 
Ricord, of Paris, whose education and enlarged observation 
of diseases qualified him for any and all branches of practice, 
became a specialist because his saloons were so crowded with 
subjects of venereal diseases that he had not a moment for 
any other practice. 
Civiale, of Paris, and Sir Henry Thompson, of London, 
both ripe medical scholars and replete with general experi- 
ence, became, after they had each reached the zenith of their 
manhood, the practitioners of their specialty. 
Von Grafe, Bader, Schalber, Stellwag, Politzer, Sichel, Toyn- 
bee, Carter and Wilde, of Europe, Agnew, Jeffries, Williams, 
Loring and Roosa, of our own country—all distinguished for 
their thoroughness in all departments of medical learning, 
and having had extensive and enlightened clinical experience, 
gained deservedly high reputations as ophthalmologists or 
aurists, or both—devoted themselves especially to diseases of 
the eye and ear. So I might mention a host of others who 
are working in special fields, and who are accomplishing great 
good for medicine and for the public. 
Of this class of specialists I can not speak in too high com- 
mendation. In them we have many of the most renowned 
members of our profession, and persons who have contributed 
most liberally to the progress of our science. They are men 
who have grown into specialties through great mental train- 
ing, who have become proficients in all medical learning, and 
though found in devotion to diseases of a single organ, or of 
one set of organs, would be fully competent to investigate 
and treat almost all the diseases to which our frail forms are 
liable. It is the success of such men which has awakened 
the ambition of some and aroused the cupidity of others, and 
thus become the origin of, and the impetus to, the prevalent 
and increasing fashion of the day to divide the practice of 4 
Specialism in Medicine. 
medicine, aye, not merely the practice but unfortunately the 
study of medicine also, into infinitessimal parts. Men, seeing 
the reputations made and the large honorariums gained by 
such distinguished exclusivists, are led into the effort to be- 
come specialists also, and that with but little study, no per- 
sonal aptitude, and with scant underlying acquirement. They 
enter the offices of specialists, with the avowed purpose of 
pursuing a single branch of medicine; the private training is 
with that one object in view, and when in medical institutions 
this single idea is still dominant. They give but little heed 
to the instructions of the school save to those which have a 
direct relation with their chosen field, or at the most strive to 
obtain only so much knowledge of the general science as will 
let them through the too lax gates ol the colleges, and insure 
to them an illy-earned doctorate. 
This is, in few words, the history of a large number of men 
who are now in their offices claiming to be endowed with 
wondrous knowledge, and the highest skill in the art of mend- 
ing eyes, restoring lost audition, healing rectums, cutting, 
slashing and burning wombs, giving fecundity to the barren, 
and instruction to prevent excessive fruition; and of others 
who claim the power to cure all skin diseases from leprosy 
down to right up the nasal and laryngeal cavities, whatever 
their diseases, and so on. They do not publish their claims 
in newspapers or circulars, as do their cousins, the quacks; 
but they whisper them in great confidence to the Betsey Ma- 
lones, Sairey Gamps, and the street tattlers of the male sex, 
who not merely tell them to all persons whom they meet, and 
send word to the balance of mankind, but crowd the ante- 
rooms and slyly exhibit themselves as living examples of the 
miraculous cures their favorite specialists can accomplish. 
Another and a higher dodge is to get up long papers com- 
posed of the opinions and teachings of the able masters in 
their line, but so grooving and dove-tailing them together as 
to make a handsome and finished mosaic. These they pub- 
lish as their own, thus to advertise themselves and bring cus- 
tom to their doors. Specialism in Medicine. 
5 
This is the kind of specialism and such the specialists 
against which and whom I beg, in the interest of true sci- 
ence, to enter my solemn protest, and urge you, gentlemen, 
to hold in absolute abhorrence. It is this class of specialists 
which misleads the people and gives extent and permanency 
to a baneful fashion. 
In our larger cities it is now not uncommon for a single 
individual to have half a dozen doctors, every doctor restricted 
to his own peculiar sphere. It is Dr. Barnes, I believe, who 
tells an anecdote to about this effect: A lady, seeking his 
advice, told him when he was making inquiry about her cir- 
culation, that he need not mind that; Dr. A. had her heart; 
Dr. B. took care of her lungs; Dr. C. looked after her eyes; 
Dr. D. did her general practice, and she wished to place her 
genitals only in his charge. The Doctor facetiously adds that 
he was curious to know to whom her umbilicus would be 
committed. This picture is no exaggeration; many similar 
ones are mentioned by the busy practitioner. It is coming 
to be the very summit of the ton. 
The result of this fashion is gracefully yet truthfully told in 
a recent address by Dr. Henry, of New York, to the alumni 
of the Medical Department of the University of Vermont. 
He says: “Experience has forced me to the belief that the 
evils of this subdivision are individually nursed and fostered 
through lack of proper general qualifications, indolence, and 
the greater prospect of large fees. Diseases that were skill- 
fully treated in the early part of this century by the general 
practitioner, are now sent from one ‘ ologist ’ to another, until 
the sufferer, exhausted of patience and means, seeks in utter 
despair the assistance of the nearest quack.” 
Such unfortunates as those described by Dr. Henry consti- 
tute no small part of the persons who pass into the hands of 
the homoeopathists, or who subject themselves to the tortur- 
ing processes of the sticking doctors; not unfrequently to be 
redeemed from their ailments by the do-nothing practice of 
the one, or conjured into health by the other. Such parti- 
tioning of practice, and such sectional study, are debasing 6 
Specialism in Medicine. 
our profession, lessening the confidence of the people, and 
changing the science from Athens, the city of light, to Lute- 
tia, the city of mire. 
It should, therefore, be the pleasure of every lover of his 
profession to discountenance superficial, partially-trained, and 
incompetent specialism. Ido not mean by this that we should 
decline to avail ourselves of the superior skill of all such spe- 
cialists as have earned their positions by earnest toil, thorough 
acquaintance with the science of medicine, and careful and ex- 
tended observation. Such men rarely fail to throw brilliant 
light upon obscure points in diagnosis, and give valuable hints 
for treatment. They become, indeed, to the general practi- 
tioner what the light-house is to the mariner; they guide him 
within lines of safety, and save him from hidden rocks and 
perilous currents; they are in truth towers of strength. 
It has been charged that the medical schools of the country 
are contributing in a large measure to the production and per- 
petuity of these dangerous forms of specialism. Dr. Henry, 
in the address already alluded to, says: “For the purpose of 
leading the mass of the profession and the public into the 
belief that the schools are progressive, too many of the facul- 
ties have yielded to the fashionable spasm of the day and ap- 
pointed persons to deliver special courses of lectures. With 
some few exceptions, these special lecturers are scarcely up 
to the standard which might be fairly asked in so-called spe- 
cialists. ” 
The proposition made in the first clause of his argument, I 
do not believe is well founded, and must emphatically dissent 
to it. The schools are not striving to mislead the profession 
or the public, but are, in my judgment, both honest and wise 
in their arrangement of the machinery of teaching. They 
have multiplied chairs and lectureships only as the widening 
and extending boundaries of the science have imperatively 
demanded. In the early history of medical teaching, when 
the science was meager in its principles, and not as now volu- 
minous in detail, but few teachers were required to give 
instructions in all that was known. The most ancient and Specialism in Medicine. 
7 
renowned school of our continent, the Medical Department 
of Pennsylvania University, began with but three professors. 
Those three taught the students who assembled all that was 
known of medicine at that time, as thoroughly as the most 
numerously appointed schools can possibly teach it to-day. 
Thus it will be seen our institutions are merely keeping step 
with the advancing profession, and striving by a multiplication 
of lectureships to give to the student, in the most compre- 
hensive yet concise manner, all which constitutes the enlarged 
science. They do not inculcate, or even propose, the policy 
of studying for a specialty, but on the contrary insist that 
every aspirant for the medical doctorate shall faithfully follow 
the instructions given in every branch, in order to his qualifica- 
tion for general practice or the pursuit of a single department. 
I know of no school which is favoring the study of a single 
branch, none which will accept, in extenuation of imperfect 
knowledge of the whole science, the plea that the applicant is 
preparing for a specialty. On the contrary, teachers of special- 
ties themselves insist, in no dubious terms, upon a thorough 
knowledge of all. 
Billroth, in the introduction of his Course on Surgery, says; 
“The surgeon can only judge safely and correctly of the state 
of his patient when he is at the same time a physician; more- 
over, the physician must have surgical knowledge, or he will 
make the grossest blunders.” 
Dr. Fordyce Barker, the distinguished teacher of Clinical 
Midwifery, in the preface to his valuable work on Puerperal 
Diseases, says; “A man may become eminent as a physician, 
and yet know very little of obstetrics; or he may be a suc- 
cessful, even distinguished surgeon, and be quite ignorant ot 
even the rudiments of obstetrics; but no one can be a really 
able obstetrician, unless he be both physician and surgeon.” 
Sir Henry Thompson says; “No man should become a spe- 
cialist until he has had a ripe experience engrafted upon a 
most liberal professional education, and be forty years old.” 
Mr. R. Brudenell Carter, in the conclusion of his address 
before the International Medical Congress recently sitting in 8 
Specialism in Medicine. 
Philadelphia, said, ‘‘ It gave him real pleasure to find so many- 
eminent specialists identified with the great body of the pro- 
fession. He believed the specialist a man of great utility, 
but thought the separation of specialism from general medi- 
cine detrimental to the earnest practitioners of both. He 
thought the knowledge of the specialist should become the 
property of the general practitioner also, and that it is wise in 
schools to include in their plan chairs of special branches. 
He believed the ranks of useful specialism could only be 
reached by the most thorough training in the entire science; 
and concluded by saying it is absurd to attempt respectability 
in medicine by the study of an exclusive branch.” Thus it 
becomes apparent that teachers of specialties discourage spe- 
cialism except of the kind that comes through learning and 
observation. 
The point made by Dr. Henry, in the second clause of his 
argument, is more valid, namely, that “teachers of specialties 
are too frequently not up to the standard fairly to be expect- 
ed; ” yet this objection is more apparent than real, for though 
a teacher of a specialty may not be a thorough master of it, 
his teaching may in the main be correct and useful. Lacking 
the necessary store of knowledge, and being deficient in ex- 
perience, he may nevertheless be a good teacher. He may 
draw the instruction which he imparts from the texts of the 
most approved authorities, and make it valuable to the stu- 
dent; and though such teaching may not be as complete or 
exact as that given by the acknowledged masters, still it will 
be vastly better than no teaching. The argument of Dr. 
Henry is, therefore, fallacious. The schools do not foster or 
encourage uneducated and vicious specialism, but are doing 
all that lies within their power to promote liberal and universal 
medical education. 
I hope I shall not be misunderstood in the positions taken 
in the course of these remarks. Lest I may be, I beg to reit- 
erate the points taken, and will venture the opinion that the 
unprejudiced judgment of all intelligent gentlemen of the pro- 
fession, whether they be general practitioners or specialists, Specialism in Medicine. 
9 
will fully sustain them. They are these : that specialties pur- 
sued by men of general and proficient cultivation in the science 
of medicine, who have had a clinical experience sufficiently 
enlarged to give them acquaintanceship with the current mor- 
bid processes of the body and enable them to distinguish be- 
tween them, and to trace them to their probable pathological 
sources, must rarely fail to be productive of good, both to the 
profession and public, and materially advance the interests of 
the science, and for the very forcible reason that one field 
assiduously cultivated by a wise laborer yields more abundantly 
than a number of fields imperfectly tilled. The shortness of 
time and the limitation of the human intellect render it very 
evident that a single mind can not reach the perfection in the 
whole that it can in a part. The second position is, that a 
person, notwithstanding he may be of gigantic intellect and 
untiring industry, unless he becomes a general medical scholar 
and a patient and careful student of diseases generally, can 
not become a successful and useful specialist, but will retard 
progress and injure the science by his frequent blunders, and 
will consequently become the instrument of mischief to the 
public. 
Precisely as it is necessary for the artist to have a familiarity 
with nature in all its forms, an eye cultivated in the percep- 
tion of colors, their changes and combinations; the sculptor 
to have “a knowledge of mathematics, anatomy, physiology 
and a cultivated imagination;” or the novelist to have a full 
acquaintance with human nature, a knowledge of history, and 
be learned in the sciences in order to success—so is it of prime 
necessity that the specialist in medicine shall combine with a 
native adaptation a familiarity with the organization of man 
in health and disease, a profound knowledge of the laws gov- 
erning both states, and clinical experience sufficient to enable 
him to recognize disease of whatever form may come before 
him. Then, and not till then, should he allow himself to enter 
upon the higher domain of specialism. Even when gentle- 
men have reached the high standard indicated, and are in all 
regards useful and distinguished special practitioners, there Specialism in Medicine. 
are difficulties in the way, many of which could be mentioned" 
if time served; but one which is so common to all with whom 
I have met, I can not pass over in silence. It is that almost 
every specialist is prone to find in the organs of his peculiar 
province the morbid change which will account for all the 
symptoms in every case which is presented to him. He is 
sincere in this opinion, yet he often finds that it has drifted 
him into the vortex of error, from which he too frequently 
does not become extricated until the opportunity of remedy- 
ing the real malady is lost forever. 
In conclusion, gentlemen, allow me to whisper into your 
ears a little item of information for your personal good. It 
may seem ignoble to do so in connection with an examination 
of a subject belonging wholly to the interests of the science 
of medicine; yet I shall do so for the double purpose of plac- 
ing you upon your guard, and as an incentive to more diligent 
study. 
It is this; that besides promoting the science, you will ad- 
vance your individual interests by so studying every depart- 
ment of medicine as to enable you to manage skillfully all the 
diseases of your patients, and thus keep them out of the hands 
of specialists as entirely as possible consistent with their good. 
For the reason that you will now and then meet with one to 
whom you entrust your patient for the relief of a special dis- 
ease, who will retain and treat him and other members of his 
family for whatever affliction may arise in the course of his 
connection with the case. He will not be just and liberal as 
you have been. He will not say to the patient, your physi- 
cian can treat this new and different disease better than I can, 
but will hold him as long as possible. 
This, I doubt not, is within the personal experience of 
almost every physician. You will encounter it when you 
come to practice. Therefore, it will be greatly to your advan- 
tage to neglect no branch, but become, as far as the power 
within you lies, the master of all.