R I - l*l HUSHED FROM TUI PROCEEDINGS OF THE CONNECTICUT MEDICAL SOCIETY, 1870. 
SPECIALISM, 
IN IT8 
RELATIONS TO PRACTICAL MEDICINE. 
BY S. (i. HUBBARD, M.D., 
PROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN, 
IN' YALE COLLEGE. 
NEW HAVEN: 
TUTTLE, MOREHOUSE & TAYLOR, PRINTERS. 
1870. SPECIALISM IN ITS RELATIONS TO PRACTICAL MEDICINE. 
H. G. HUBBARD, M.I)., 
/Professor of Obstetrics and Diseases of Women and Children, 
in Yale (Jolleye. 
“ Wore it not hotter for a man, in a fair room, to sot up one great light, than to 
go about with a rush-light into every dark comer?”—Bacon. 
Within the last twenty or thirty years practical medicine in 
this country has made greater advance in all its departments, than 
in the two generations previous; in consequence, as I believe, of 
the superior quality and wider range of the medical education 
afforded, and the greater demands made upon medical men by a 
higher civilization—but mainly because of the assiduous cultiva- 
tion of distinct sub-divisions of medical science, by men who, in 
greater numbers, have devoted themselves exclusively to the study 
of them. 
The mature results of their labors, have been freely given to 
the profession in systematic treatises, monographs, and papers of 
loss pretension, and as freely appropriated and assimilated by us, 
until they have become a very largo and important portion of the 
common stock of professional knowledge. Nearly all the impor- 
tant improvements in operative surgery, the accepted methods of 
treating diseases of the eye and ear,—the skin, the kidneys,—dis- 
eases of the nervous system, and of the thoracic organs,—diseases 
of the male and female generative organs,—the best means of 
exploring cavities, and indeed nearly our entire knowledge of the 
structure and physiology of the organs themselves, we owe to the 
labors, often unrewarded, of a class of men, who, having devoted 
themselves to the study of a single department, or a sub-division 
of it, are properly called “specialists.” 
The ideal specialist, as he exists in the imaginations of some 
men, is a superficially educated person whose medical studies have 2 
been limited to the narrow boundaries of a single organ, and who, 
knowing nothing of the laws of life, or of the influence which 
disease in one organ exercises over the functions of all the others, 
is incompetent to treat intelligently the local affections which he 
professes to understand. 
It would seem to be unnecessary to assert in this presence, as I 
do, that a specialist of this ideal type, does not exist in the 
ranks of the profession in any civilized country. It is entirely a 
figment of the imagination. In a few instances, perhaps, the 
delusion may be honestly entertained and believed; but with the 
majority of men who declaim against specialism in medicine as a 
great and overshadowing evil, to be got rid of at any cost—and as 
such, having no claims on the respect of the profession, it is a mere 
stalking-horse behind which individual plans may be more effect- 
ually concealed, or it is a straw-image of their own creation, set 
up for the purpose of enjoying the cheap amusement of knocking 
it down. In a brief paper presented to this society in 1806 and 
published with the Proceedings of that year, the writer seems to 
view this subject from a peculiar standpoint; and assumes, what I 
believe has no foundation in fact, when he says more than once, 
and in varied phraseology, that the specialist is so narrowed in 
the scope of his intellectual vision, by treating much the dis- 
eases of one organ, that he takes no cognizance of the morbid con- 
dition of the general system, which may be either the effect or the 
cause of the organic disease which he is specially treating. And 
he adds, “ Shall we deal then with the eye, or the lungs, as inde- 
pendent organs, bound by no laws except those regulating their 
peculiar fuuctions? Yet, this is what the specialists propose.” 
As the writer is evidently in search of information, I will en- 
deavor to answer his question, and show that specialists propose 
nothing of the kind; and moreover, that the highest interests of 
practical medicine require that the labors of specialists, from which 
general practitioners have derived all the knoweledge they possess 
of the diseases of certain organs, should be continued; not only 
this, but that these labors should be fostered, encouraged and 
appreciated by the profession, as freely and openly as their results 
have been appropriated. 
That they are already so appreciated by the leading minds in 
the profession, I am well aware; yet it is important that the 
unjust and groundless prejudice against specialists, which still ex- 
ists, to some extent, among the mass of practitioners, whoever 3 
may be responsible for it, should, if possible, be dissipated by a 
better understanding of their aims, as well as of the basis on 
which they rest their claims for full professional recognition. 
W e sometimes hear it alleged as an argument against the ne- 
cessity for specialists, and even against the propriety of their ex- 
istence, that some of the early fathers of medicine were able to 
master, and write intelligently upon, not only the various branches 
of medical science, but general science; and the fact that Hip- 
pocrates and Aristotle were able to discover and elucidate the laws 
of all science, to an extent that was remarkable even in that early 
period of the world’s history, has been offered in proof of the asser- 
tion, that the medical mind of the present day is of an inferior order. 
‘k When scientific phenomena were scarce, and scientific observers 
still more rare, when science had hardly any laws, doubts or con- 
tradictions, generalization was easy; and if, among such conditions, 
a highly intelligent mind sprang up, the difficulty would not be 
great of grasping, in one comprehensive mental view, all the di- 
visions of the most extensive science, or indeed the entire horizon 
of existing knowledge.” 
“ It was thus easy for Hippocrates to extract the essence of every 
branch of medicine, and even on some points of medical philoso- 
phy to write profoundly. And in the same manner, Aristotle 
became the very symbol of every science.” 
Hut observers increased in numbers, facts multiplied, and grad- 
ually as science extended, universal knowledge remained no longer 
the possession of a single individual. In medicine, which as a 
science is extraordinarily complex, and as an art, altogether inde- 
finable, and hitherto uncertain, a similar evolution may be traced, 
and is still in progress. Step by step, as experimental induction 
advanced, and took the place of conjecture, definite diseases, 
brought to the test of analysis, were resolved into their eonstituent 
elements; and what was before regarded and treated as a single, 
dist inct disease, a morbid entity, was divided into many, and served 
to concentrate upon themselves such a measure of attention and 
study as formerly would have sufficed for the whole nosology. 
So that, even in Hippocrates’ time, and still later, men made 
choice of special departments of medicine, and were recognized as 
specialists by the public, who believed that by concentrating their 
labors, these men were able to accomplish results which were 
practically beyond the reach of those great minds which could 
be satisfied with nothing less than universal knowledge, and 
mistakenly supposed they had acquired it. 4 
l>y some of the most eminent men among medical teachers of 
our own time, the opinion is held that, owing to the wonderful 
progress of medical science in later years, and the rapidly 
extending boundaries of its domain, the curriculum of studies in 
medical colleges cannot properly be condensed within four years 
of tuition; that at least ten years of hard study would be required 
for the student to attain a competent knowledge of all branches 
of medicine, in their present state of development. Whoever has 
for the last twenty years, or even less, attempted to acquaint him- 
self with the daily growth of medical science, will readily concur 
in this opinion, and I think, will admit that, in his own efforts to 
keep himself abreast of the front line of scientific progress, he 
finds the work too much for him, and unconsciously or by compul- 
sion, he ultimately confines his daily study to those branches of 
the profession which he is most frequently called upon to practice, 
or which his taste, or a just estimate of the situation leads him to 
select. In this way it is that men have become specialists. 
Matured in mind, educated by years of self-culture, they bring 
to bear upon their chosen subject the full force of disciplined 
powers, and the accumulated wisdom of other fields, with an inten- 
sity of mental concentration, and sublimity of devotion, equaled 
oidy by the transcendent importance of their results. Every day, 
the general practitioner makes more or less use of these results 
without knowing to whom he is indebted, and often without spend- 
ing a thought upon, or caring to know the immense cost of 
time, labor, money, health, and even of life itself, at which they 
have been produced. 
I have said that Practical Medicine is indebted for its present 
advanced stage of development as a science, mainly to the labors 
of specialists. To this our minds must yield assent, whenever we 
glance at the books that fill our libraries, or follow out the train of 
reflection suggested by the sight of our standard authors. When 
we would examine the literature of any department, whether in 
book or periodical form, who would think of looking for reliable 
information except in the works of those who had in special clin- 
iques, devoted to it years of special observation and study ? 
Who can fail to remember that for our knowledge of the phys- 
ical signs, diagnostic of the diseases of the lungs and heart, and 
for the invention of the stethoscope, we are indebted to Laennec— 
a specialist—who extended and improved upon the labors of Aven- 
brugger, Corvisart and other specialists who had preceded him ? 5 
For the most approved treatment of the diseases of the throat 
hy topical applications, we are indebted to an American specialist, 
(ireenj.one of the earliest innovators in this country upon the old 
and indefinite methods of treatment of the diseases of special 
organs. As might have been anticipated, his brilliant discovery 
brought upon himself, as a specialist, an amount of envy, obloquy, 
and detraction, from the men of “broad views ” and “ comprehen- 
sive knowledge” in the profession, which is without a parallel in 
this country. Yet, he lived long enough to witness the substantial 
adoption of his views and practice, notwithstanding their early 
crudeness, by all men everywhere, who could recognize and appre- 
ciate scientific progress. 
Starting from this point, and investigating the principles in- 
volved, Richardson and others have given us a still higher devel- 
opment of therapeutic scieuce, in the treatment of diseases of the 
air passages by the atomization of medicated fluids. 
The laryngoscope, for which we are indebted to another special- 
ist—Czermak—enables us to diagnosticate and to cure diseases of 
the larynx and vocal chords, which had previously been beyond 
our knowledge, and thus beyond the reach of human skill. 
Another specialist, Desormcaux,* has given us the endoscope, 
an important means of exploring cavities by direct vision, as yet 
but little known in this country, but which promises to be an in- 
strument of great value. 
In what a hopeless labyrinth of confusion and mortifying help- 
lessness should we be, in our attempts to treat diseases of the 
kidneys, were it not for the labors of Bird, Beale, Roberts and 
other specialists? 
Who among us is not familiar with the writings of Erasmus 
Wilson—an honored specialist, who has devoted a life-time to the 
study of the diseases of the skin? 
What should we know about the treatment of syphilis, that most 
loathsome scourge of the human race, were it not for the labors of 
specialists ? 
In ophthalmology, a branch of medicine now as much a science 
* Although to Dueormeaux is generally credited the invention of the endoscope, 
ho himself awards it to M. Segalns in 182(1. But truth requires that it should bo 
known that it was first invented by Bari ini of Frankfort in 180G ; and that in 1824, 
I)r. J. D. Fisher, of boston, devised and actually used an instrument indentieal 
in principle, and similar in construction with that at present recommended by 
Ddsormeaux. 6 
in itself, as Astronomy or Mineralogy, almost everything that has 
given it character and definiteness, nearly all the most important 
recent additions to our knowledge of the physiology, pathology 
and therapeutics of the eye, has been accomplished by the obser- 
vations and investigations of specialists. Much of that which is 
most valuable in it, and which has placed it almost on a level with 
the exact sciences, has been gained within comparatively a recent 
period, by the labors of men like Mackenzie of Edinburgh, Bow- 
man and Critchett of London, Yon Graefe, Arlt, Jager, Stellwag, 
and others of Germany, Donders of Utrecht—all specialists—not 
to mention the valuable contributions of American ophthalmolo- 
gists. 
Previous to the invention of the ophthalmoscope, the most im- 
portant means of diagnosis ever given to the science, the path- 
ological conditions of the deep structures of the eye had never 
been demonstrated on the living subject. Although this instru- 
ment was the invention of Helmholtz, a professor of physiology 
in the University of Heidelberg, and not a practitioner, it was 
applied to the study of disease, and its powers were fully devel- 
oped by such specialists as Graefe, Jager, Liebreich and their co- 
workers, who have by its means contributed very much that is of 
the highest value, not to their own specialty only, but to general 
medicine, by teaching us how we may usefully apply it to the 
study of diseases of the general nervous system, and of the circu- 
latory system, and even of the affections of the kidneys. 
All who are familiar with Aural Surgery, and know much of its 
history, progress and present scientific status, will most freely 
acknowledge that nearly all that is of any value in it, is due to 
the labors of such specialists as Wilde of Dublin, Toynbee of Lon- 
don, Politzer, Gruber, Von Troltsch, and many others of Germany, 
who have especially labored to relieve this department of the 
opprobrium which until a recent period has rested upon it. 
It would be easy to extend our inquiries in this general direc- 
tion to very great length, if it were necessary; but it must be 
too apparent to require further proof that, had it not been for 
the enlightened and honest labors of specialists, the claims of 
Medicine to be ranked among the sciences of the nineteenth cen- 
tury would be beneath contempt. 
Without disparaging what has been done by specialists in other 
sciences, candor compels us to acknowledge a w eight of obligation 
to medical specialists, which will remain undiminished by the lapse 7 
of time, or tlie brilliancy of future discoveries. Specialism holds 
the same relation to definite progress in all other departments of 
science; and to its existence there we are also equally indebted. 
If illustrations of this fact were needed, we have only to turn to 
Chemistry and Physics. We should he ignorant of the constitu- 
tion of the blood, and of course of its pathology, and therapeu- 
tic indications, but for this special branch of chemical and micro- 
scopic investigation. And we owe to the same source our knowl- 
edge of the constitution of the urine and other fluids of the body, 
both in their physiological and pathological relations. Our phar- 
maoopceia could never have been enriched by the large class of 
alkaloids and resinoids, so indispensable to the modern physician, 
except through the labors of specialists; and to-day, the salts of 
Opium and Cinchona would be unknown to us, had not Sertuerner, 
or some other chemical specialist, examined the bitter principles of 
those substances. The same is true of Strychnine, Atropine, 
Aconitine and all the proximate principles of the crude drugs 
which formed the staple of the Materia Medica of the last century. 
For the discovery of Chloroform, we must bear in grateful re- 
membrance the independent labors of three chemical specialists; 
(iuthrie of the United States, Soubeiran of France, and Liebig of 
(iermany. And to the latter distinguished specialist we are also 
indebted for another no less remarkable and perhaps important 
medicinal agent, the Hydrate of Chloral, which, although discov- 
ered forty years ago, we have only recently appropriated to our- 
selves on the suggestion of Liebreich, another specialist of Berlin. 
Ilow much do we not owe to the labors of specialists, for our 
knowledge of Physiology and Physiological Chemistry, Botany 
and Toxicology ? The results of these investigations in special 
departments of science, frequently extended through a life-time, 
have been freely given to the world, and have become an 
inseparable portion of medical science. In like manner, the dis- 
coveries of medical specialists, the inventions of new instruments 
and operations, new modes of treatment, with the development of 
new principles, which admit of a great variety of applications in 
other general and special departments, are all brought generously 
into the common stock, and laid at our feet as trophies from the 
domain of the unknown. 
Ilow do we receive these pioneer workers, as they come back to 
us, laden with treasures from the very frontiers of science? And 
what acknowledgement do we offer them, as we coolly appropriate 8 
to ourselves their invaluable additions to scientific knowledge— 
the very blood and brains of their lives? Do we point at them 
in derision, as visionary dreamers, characterized only by “ narrow- 
ness —as “ men of one idea,” who spend their lives in the inves- 
tigation of diseases which exist only in the imagination of the 
observer ? 
Every department of science that is successfully cultivated, has 
its specialties; and to this fact, in an eminent degree, is due the 
remarkable progress that has been made within the memory of 
most of us, in Chemistry, which has for its special departments, 
Chemistry applied to the arts, Commercial Chemistry, Analytical 
Mineral Chemistry, Analytical Organic Chemistry, and Organic 
Chemistry proper, with perhaps others. The numerous Astronom- 
ical observatories of the world, are in the care of observers who 
are well versed in all the sciences pertaining to their profession, 
and are capable of turning their attention to any investigations 
which are required. If they were all to give their attention alike 
to general astronomy, the accumulations of observations would be 
immense but comparatively limited to the ordinary phenomena of 
the heavens, while the progress of discovery would be very slow. 
And so, recognizing it as a governing principle of practical life 
as expressed in the maxim—“ Omnes non omnia possumus ”—“ We 
cannot all do everything that has to be done in the world,” these 
astronomers devote themselves to special work, special lines of in- 
vestigation, and thus all are enabled to carry their researches far 
beyond what would be possible under the first named general 
plan ; and thus have resulted the wonderful discoveries of the pres- 
ent century in relation to the constitution and laws of the heaven- 
ly bodies. Is Schwabe any the less an astronomer, because he has 
devoted more than forty years of his life to the investigation of 
the sun’s spots ? And because it was not until recently that his 
observations were utilized by others, and found to prove the peri- 
odicity of return of the spots, and led to still further discovery of 
the constitution of the sun, shall, therefore, the full meed of praise 
be denied him, as an eminent scientific explorer ? 
The same sub-division of labor exists, to a considerable extent, 
in the legal profession; and it is the position we see taken by 
many members of the bar, by distinguishing, every day more 
completely, between the civil and the criminal lawyer, the writers 
and students of commercial law, the law of patents and interna- 
tional law. The same sub-divisions, and consequently higher 9 
results, are noticed among engineers, who devote themselves by 
preference to mechanics, architecture, hydraulics, rail-roads, or 
mining. But with these same distinctions, thoroughly practical .as 
they are, shall any man say that the Chemist, who devotes himself 
to any of the specialties of his science, is therefore any the less a 
chemist ? Tuckerman may give his life to the study of lichens, 
and Dewey to the grasses of America, and Michaux and Nuttall 
to our forest trees. Are they any the less botanists? Indeed, are 
they not more than others, by thus penetrating the inner circles 
of science, likely to make a nearer approach to the central thought 
and principle of a scientific classification ? 
Could it ever be conceived that an advocate, or a judge, who 
devoted himself to the trial of civil or criminal cases, would be 
for that reason less familiar with the entire science of jurispru- 
dence? With still less reason could it bo supposed that a 
physiciua should be less accomplished in his art, who understood 
more thoroughly than his neighbor, some specialty in medicine? 
And that, because he bestowed particular attention and study 
upon mental alienation, diseases of the eye, or of the skin, or upon 
diseases of women, he should no longer be recognized as a phy- 
sician, in the fullest and highest sense of the word? 
To affirm this, would be equivalent to denying the mutual de- 
pendence, every day more clearly revealed, of the various organs 
of which the human body is composed. And yet the idea, as 
applied to one branch of practical medicine, meets us at every 
turn ; confronts us in strange company ; and compels our attention 
by endless reiteration of the same stereotyped platitudes. 
By a certain class of medical men, the term specialist is used as 
one of disparagement; and applied with that purpose to any who, 
by natural taste, peculiar circumstances, or a desire for higher pro- 
fessional culture, have been led to practice particularly in any one 
of the many departments of professional labor. It lias even been 
assumed by the unwise and unthinking among them, that the study 
and practice of a specialty unfit a man for everything else; and 
that excellence in any special department is prima facie evi- 
dence of deficiency in all other departments of practical medicine. 
I say the unwise and unthinking, because it is difficult to believe 
that others could possibly be so unacquainted with the extent and 
exacting nature of the demands for comprehensive knowledge, 
which must be met by specialists, as to compare them to men 
who have “spent their lives in the rounding and polishing of 
needles,” or to the incompetent “ general, with armies to lead, cam- 10 
paigns to plan, and victories to win, who understands only the 
science of fortification and because no others would assume that 
the division of professional labor, by which, alone, practical medi- 
cine has been brought to its present elevated position as a science, 
leads to the same intellectual narrowness as does a minute division 
of labor when applied to cheapen production in the mechanic arts. 
If one of you were suffering from a disease of the eye, which 
threatened the loss of vision, to whom would you instinctively 
turn for relief? To the general practitioner, who has spent his life 
in diversified labors, and whose very “comprehensive powers,” 
and “ broad views,” have prevented him from acquiring any special 
knowledge whatever ? Or would you seek the services of a pro- 
fessed surgeon and oculist ? 
If one of you were the subject of a tumor (possibly malignant), 
in a situation dangerous to life, you would apply to a surgeon for 
its removal; and if it were important to determine its e*act path- 
ological character, would you be likely to refer it to the general 
practitioner, who might be unable to distinguish between a cancer- 
cell and an air bubble, or to a pathologist, who makes microscopic 
study a specialty f 
If your wife or daughter were the victim of any of those serious 
and insidious diseases which are peculiar to her sex, would you 
take for her the advice even of the most eminent general practi- 
tioner in your vicinity, or that of some one whose special studies 
and practice had better qualified him to treat her case successfully ? 
Of course, if these supposed contingencies should ever become, 
to any of you, matters of actual personal experience, your practical 
answers to these interrogatories would be in every instance the 
same. You would each choose for yourselves, or your dearest 
friends, the opinion and treatment of a qualified specialist, or of 
some one who is constantly seeing and treating cases of the kind. 
How does it happen then, I ask, that we so frequently see in our 
periodical literature, even in Reports to the American Medical Asso- 
ciation, and hear spoken, the language of inuendo and detraction, 
as applied to men who devote particular attention to special 
classes of disease ? In some instances it may be accounted for, on 
the supposition of a want of general professional knowledge, with- 
out which there cannot be an honest disbelief in the existence of 
the special diseases treated. In other instances it can only be 
accounted for on a supposition which I prefer not to mention, and 
would not willingly entertain. Whatever may be the real reason, 11 
there can be offered for such a course no apology which is not at 
the same time the condemnation of those who indulge in it. 
lid us pause for a moment, and inquire who are the men against 
whom this storm of dust and wind is raised? What is their stand- 
ing at home and abroad? Are they found among the inert mass, 
or even among the average members of the profession? Are they 
violators of the Code of Ethics, or regardless of the honor and the 
dignity of the profession, more than others? Do they, more than 
others, give themselves to extra-professional pursuits? Do they 
from entire loss of interest in medical practice, or for other reasons, 
prostit ute their professional characters to the level of a trade, and 
sell their wares in open market to the highest bidder? llavethey 
so conducted as to forfeit the respect of the public, professional or 
otherwise ? 
Let the opponents of “Specialism” make out their catalogue of 
offenders, that we may learn their numbers, their standing as 
physicians and as men, and become acquainted with their personal 
history, and principles of action ; and if they are found to have 
injured the profession, or degraded themselves below an average 
rank in it, sustaining no other relation to it than as barnacles on 
a ship’s bottom at the close of a voyage, it will then not be too 
late to denounce them and visit them with penalties. But until 
this is done, is it too much to hope that this puerile clamor and 
declamation will cease? 
But to return to the examination of the paper to which early 
allusion was made, let us see if there be even a grain of truth in 
its assumptions. The writer says :—“The tendency of local prac- 
tice is to magnify the importance of local disorders, and of local 
“remedies. In evidence of this, we need only refer to that nu- 
“merous class of uterine disturbances, a class of troubles from 
“ which the females of a former age were happily exempt. Here, 
“as elsewhere, narrowness leads to errors of diagnosis. With all 
“the light that the speculum has shed upon this inviting and 
“ thoroughly explored field, not a tithe of the diseases claimed to 
“be there discoverable, do exist, other than in the eye of the 
“ observer.” 
Such reasoning is incompatible with any adequate acquaintance 
with the writings of specialists, as such,—or with the profundity 
of knowledge in general science and literature, combined with the 
widest and most critical knowledge in every department of prac- 
tical medicine, which some of these “ men of one idea ” have shown 
themselves to possess. 12 
Can Sir James Simpson be accused of “ narrowness ” because 
for more than thirty years the best energies of his mind, stored as 
it was with vast treasures of medical lore, both ancient and 
modern, were devoted to the alleviation and cure of the diseases 
of women ? Can we find any evidences of “ narrowness ” in his 
many and valuable contributions to practical therapeutics,—in his 
writings on public hygiene,—in his researches in archaeological 
science,—in his work on Acupressure,—in his very voluminous Ob- 
stetric Memoirs, or in his investigations of the action of new 
remedies ? And lastly, is there any evidence of “ narrowness ” 
in that remarkable series of experiments with anaesthetics, which 
have culminated in the greatest discovery of the age, and conferred 
upon suffering humanity (especially on woman) that priceless boon, 
“ the thrice blessed chloroform ” ? 
Yet he was pre-eminently a specialist, and as such, received the 
honor of knighthood; bestowed solely as a public acknowledg- 
ment of the distinguished services that he had rendered to science 
and to humanity, but which can add nothing to the lustre of a 
name so gratefully cherished in every portion of the civilized world. 
Examine critically the writings of any other specialist—of 
Churchill, West, Spencer WTells, Wilson, Beale, Roberts; of 
Matthews Duncan, Keith, Graily Ilewitt, Bowman and McClintock; 
of Byford, Emmet and Peaslee; Sims, Thomas and Storer, with 
scores of others whom I might name, and if you detect in them 
evidences of “narrowness” I beg to inquire by what standard 
have they been measured ? 
Narrowness of mind is confined to no class of men; nor is it the 
peculiar result of any form of intellectual labor. It is peculiar to 
the individual, and is more or less pronounced in proportion as the 
man is more or less educated, or more or less highly endowed with 
natural gifts. Intellectual powers, while they are capable of 
increase by cultivation, are also in so great a measure due to inher- 
itance, that the most laborious efforts are in many cases insufficient 
to enlarge the mental horizon beyond the narrowest limits. Such 
minds are congenitally narrow; and whatever their surroundings, 
or the advantages enjoyed, or in whatever calling they are found, 
“ narrowness ” is their most distinguishing characteristic. 
If artizans, they may spend their lives in the “rounding and pol- 
ishing of needles.” If physicians, they have the most limited 
knowledge of the general principles which underlie the science 
and art of medicine, and still less acquaintance with the isolated 13 
facts and discoveries of those patient, self-denying workers in all 
the s|>eoi;d departments of knowledge, the aggregation of whose 
labors forms the very foundation of all science, and the ma- 
terials from which, by wise generalization, the great principles of 
practical medicine have been gradually evolved. What evidence 
is there to suppose, as this writer declares, “ that the females of a 
former age were happily exempt” from diseases of the uterus ? 
Let us see. The causes of the diseases peculiar to women are 
of infinite variety. Some of them have been in operation ever 
since the fall of our first parents, and are still active through the 
functions of menstruation and child-bearing, of course with in- 
creased force and frequency, as the race has progressed in civiliza- 
tion, and in the cultivation of aesthetic tastes. There are still 
other causes, incidental to the more artificial and unnatural style 
of female education, and modes of life common to modern society. 
So that, in addition to those which have been in operation from 
the beginning, and which, being inherent in nature, must always 
continue, we have a still larger class of causes now in operation, 
and to the preponderance of which must be referred, if it exists, 
the greater frequency of uterine diseases now than formerly. 
Four hundred years before the Christian era, Hippocrates wrote 
largely on this subject, and his writings, as well as those of Galen 
and Aretams who came after him, and all of whom practiced in 
Home, afford positive evidence that there existed at this early 
period a very advanced state of knowledge of the diseases of 
women. For example, the writings of Galen contain the earliest 
allusion to the vaginal speculum, while Aretams describes “ ulcer- 
ation of the womb,” with a precision that leaves no room for doubt 
that he also employed this instrument as a means of diagnosis. 
Hut the vaginal speculum has, perchance, even an earlier history 
than this, for a three bladed instrument of the kind has been ex- 
humed in the excavations of Pompeii and Herculaneum!—Cities 
founded in the time of unknown antiquity, but destroyed, as we 
all know, in the reign of Titus, A. 1). 70. With the writings of 
Hippocrates, began the literature of medicine in this department; 
and if we may judge from his voluminous writings upon the sub- 
ject, uterine diseases must have been very common in his day. 
To diseases of women alone, ho devoted three volumes, in which 
he discussed Metritis, Induration, Fibroid Tumors, Menstrual Dis- 
orders, and Uterine Displacements. Then, as now, the knowledge 
of these special diseases was not in the possession of the entire 14 
profession; for, so limited had been the diffusion of knowledge, 
that more than four hundred years afterward, physicians generally 
were ignorant of what had been already known. Witness the New 
Testament narrative of the “ woman which had an issue of blood 
twelve years, and had suffered many things of many physicians, 
and had spent all that she had, and was nothing bettered, but 
rather grew worse.” Either the faculty were ignorant of the treat- 
ment of uterine hemorrhage, or refused to attend after the patient’s 
money was exhausted, or perhaps they were afraid of incurring 
the charge of “ narrowness ” by attempting to remove the polypus 
from which the woman had so long and so terribly suffered. Besides 
the authors already mentioned, Archigenes and Celsus, who prob- 
ably lived in the second century, also wrote on the diseases of 
women. The first, accurately described the “ vaginal touch,” the 
varieties of lcucorrhcea and ulceration of the womb;—while the 
the last, gives an excellent description of pelvic-cellulitis. 
For centuries afterward the study of the diseases of women was 
pursued with great vigor, but unfortunately for us, many of the 
writings of the authors of that period are destroyed or in frag- 
ments, so that now, reference is almost exclusively made to the 
compilation by Aetius, showing the state of medical science in his 
own times, and an abstract of the existing writings of men who 
had preceded him. In describing his own practice, as well as that 
of his contemporaries and predecessors, he treats of the diseases of 
women in such a way as to render it certain, that he had a thor- 
ough knowledge of many of them; also of many of the means of 
investigation and treatment which are in use at the present day, 
and which have in many instances been regarded by us as new ; 
and very properly so, inasmuch as they have been re-discovered 
more than thirteen hundred years afterward. This industrious 
compiler devoted 112 chapters of his 16th Book, to diseases of 
women. Thirty-seven of these treat of pregnancy, parturition and 
suckling. There are six chapters on “ Ulcers of the Uterus,” 
three on Abscesses, two on “ Displacements,” two on “ Obstructed 
and Imperforate Uterus,” seven on growths occuring in the vagina 
and uterus, and eighteen on menstruation and its disorders. 
If further evidence is needed to show the excessive “ narrowness ” 
of the fathers, and that they described diseases which existed only 
“ in the imagination of the observer,” I will add that Aetius 
particularly described nearly every disease of the uterus that is 15 
recognized by the best observers of modern times; and the treat- 
ment lie advises, includes most of our modern appliances, with 
frequent mention of the use of the speculum. 11 is directions for 
the preparation and use of sponge tents are almost identical with 
those* commonly followed to-day; and lie clearly sets forth the 
uses of medicated pessaries, for which he gives more than a hun- 
dred formulas; the use of vaginal injections; caustics for ulcer- 
ation of the cervix; dilatation of the cervix by tin tubes; the 
treatment of inflammation of the various tissues and appendages 
of the uterus; and lastly of the modern uterine sound.* 
1 have repeatedly inquired of the wives of our Foreign Mis- 
sionaries whether the native women are exempt from uterine dis- 
eases, and in all cases they have assured me that the native women 
do sutler from a considerable variety of uterine affections, for 
which they are treated by native physicians by sorcery and other- 
wise. I could quote from the historical literature of this special 
department, at still greater length if it were desirable; but 1 
think 1 have satisfactorily disproved the charge that uterine dis- 
eases are a modern invention, “from which the females of a for- 
mer age were happily exempt ”; and which are limited in number 
only by “the imagination of the observer”; and that any degree 
of excellence in a special department of medical practice is fol- 
lowed as a necessary sequence by “ narrowness ” of mind. More- 
over, is it not clear, from what has been said, that we actually owe 
to “specialism” not oidy all the definite, permanent progress 
which the science of medicine has hitherto made and is now making, 
but that the rate of progress and discovery in every department 
of scientific knowledge, depends on the numbers and faithfulness 
of the “specialists” who cultivate them? 
It is charged that “the tendency of local practice is to magnify 
the importance of local disorders, and of local remedies;” and the 
special treatment of uterine diseases is cited as conclusive proof of 
this. .Vs the treatment of diseases of females is thus made the 
scape-goat for all the imaginary sins and evils of special practice; 
and is held up as a typical example of the disastrous effects of 
specialism in medicine, thus revealing more clearly the purpose of 
* I am indebted for the historical data of the subject, to papers in the Dublin 
Quarterly Journal bv Dr. Wright,—a'«oto the Medico-Chirurgical Review, and 
other modern sources of information. 16 
the writer, I have confined my remarks more particularly to that 
branch of the subject. For, although I am not myself a specialist, 
in the strict sense of the term, being largely engaged in general 
practice as well, my daily treatment of this class of diseases per- 
mits me to speak of them from personal knowledge; and I believe 
that an experience derived from the special treatment of many 
hundreds of cases of uterine disease, and a general practice of 
nearly thirty years combined, qualifies me to express an unbiased 
opinion, not only as to the merits of the special department to 
which 1 attend, but also, as to the value and relations of “ special- 
ism ” as an element of substantial progress in medical science. 
And I wish distinctly to say here, that I disclaim all desire or 
intention of being personal in my remarks in any direction. I am 
combatting and criticising opinions, not persons; and I desire par- 
ticularly to dislodge from your minds what I believe to be an 
error, and to substitute for it what I know from ample experience 
to be the truth. 
To any one who is practically familiar with uterine pathology 
and therapeutics, and to the best informed among those who are 
not, it may appear almost an unnecessary labor to controvert such 
statements. For every one knows that, to attempt to treat a 
serious disease of one organ, without giving particular attention 
also to the condition of all the others, especially to those with 
which the suffering organ is in most intimate relations and sym- 
pathy, would be as unsuccessful as it is unphilosophical. To such 
a mind, nothing can be more illogical—than to say that, the special 
treatment of uterine diseases tends to magnify unduly the impor- 
tance of this organ and its diseases to the female economy. For 
the sympathies of the uterus with every other part of the female 
organism are so evident, and the sympathetic relations of all the 
organs of woman’ with the uterus are so numerous and complicated 
—so intimate and often so distant, yet pervading her entire being, 
that it would almost seem, to use the expression of another, “ as 
if the Almighty, in creating the female sex, had taken the uterus 
and built up a woman around it.” 
When we consider the important functions of the uterus, and 
the wonderfully complicated processes carried on within it, and 
the fact that, the peculiarities of woman, as well as her happiness 
in health and disease, depend upon, and are in a great measure 
controlled by, the condition and sympathies of the uterus—the 17 
great central, pivotal organ of her existence—is it not strange that 
any well informed, intelligent physician should persistently close 
his mind against the evidences of this sympathy, and against the 
patent fact, that the functions of the most distant organs may 
he so perverted or destroyed by uterine disturbances, as to 
deceive the very elect, and lead physicians otherwise skillful, to 
suppose that these organs are themselves the seat of serious dis- 
ease ? Yet instances of this kind are of daily occurrence. And 
I am certain that I only state what many of you know perfectly 
well, when I say that women are often most actively treated dur- 
ing weary months and years, for various diseases which have no 
existence whatever, except in the obtuse imaginations of the 
observer—but are simulated by the reflex sympathies of a diseased 
womb. 
I could cite to you numerous cases coming under my own ob- 
servation, which remarkably illustrate this fact, but I prefer to 
postpone to some other occasion any more particular allusion to 
them, and will only say in this connection, that such is the mutual 
dependence of every special branch upon every other department 
of medicine, that in my judgment, no man can be successful in a 
special department, without being well informed in all the others. 
And further, that there is no department of practical medicine 
which requires such a concentration upon it, of all the accumula- 
tions of medical knowledge, or makes such exhausting draughts 
upon the resources and powers of the physician, and tests so 
severely his qualities as a careful, painstaking and patient obser- 
ver, and skillful prescriber, as that of the diseases of women. 
Two classes of medical men have, in opposite modes, contributed 
not a little to bring undeserved odium and disrepute upon the sci- 
entific treatment of uterine diseases. In the one class, we see 
those few, who, having never given particular attention to the 
subject, are without adequate knowledge of its pathology, etiology 
and therapeutics, providing themselves with a speculum and a 
piece of lunar caustic, and with a rashness as frightful as it is 
criminal, “ rushing in where angels fear to tread,” carrying fire 
and sword into the most innocent localities. They find uterine 
disease in every woman ; and the track of their fiery raid can be 
distinctly traced for years afterward, by the scarred, distorted, 
narrowed and sometimes obliterated cervical canals which they 
have invaded. It is these rash and ignorant men—men with as 18 
little conscience as learning—and still less of delicacy than of 
either, who have been, and are, mainly instrumental in bringing 
unmerited reproach upon the scientific treatment of the diseases 
of women. 
The unwarrantable and disastrous procedures of this class of 
superficially educated men, are used as the basis of the indictment 
of specialism at the bar of public opinion, by another and more 
respectable class of physicians, who are, doubtless, excellent gen- 
eral practitioners, but who, having long ago abandoned habits of 
study and reflection, find themselves behind the age ; and in cast- 
ing about to find the reasons for their changed relations, they are 
quite willing to charge upon “ specialism,” results which really 
have their origin in the congenital or acquired conditions of their 
own minds. The representatives of each class are, I am happy to 
believe, comparatively few in numbers, (and some may think them 
too few to require notice) yet such is the nature of their peculiar- 
ities, the tendencies of their misguided efforts, and the persistency 
of their attacks, that they cannot be allowed to pass unchallenged. 
It would be out of place in this paper to allude particularly to 
the “ errors of diagnosis,” and the results of treatment, made by 
either of these classes of physicians; yet they are continually 
coming to notice, and are in some cases exceedingly ludicrous; 
but in many the consequences are of the utmost seriousness, and 
not very seldom even fatal to life. Is it any wonder, then, that 
the public mind is unsettled respecting the value and propriety 
of special treatment of uterine diseases, when the subject is seen 
only in the false lights cast upon it from these two extremes of 
error ? 
It would be too much to expect the non-professional mind to be 
able to distinguish the true from the false, respecting a subject 
which is so variously regarded by the profession itself, and there- 
fore we cannot wonder that suffering women, who have been dis- 
appointed in the results of treatment of these affections by their 
ordinary medical advisers, should finally, in their desperation, seek 
relief at the hands of male or female quacks. I could easily show 
that it would promote the highest interests of the public and of 
the profession, both individually and collectively, to encourage 
and everywhere commend the labors of “ specialists,” instead of 
meeting them with words of ridicule and disparagement; but it is 
unnecessary, for the line of argument is so plain that it is already 
anticipated. 19 
Science is a unit. Its multiplied facts are so closely related, 
and each is so indispensable to the full force and effect of all, that 
the attempt to ignore or remove from the structure a series of 
facts, or to cast odium upon the laborers by whom these blocks in 
the foundations have been wrought and placed in their proper 
order, would, if successful, utterly destroy the entire fabric. It is 
an act of sacrilege. It is treason, alike against the interests of 
humanity, and the civilization of the age. 
In all countries, the estimation in which specialists and their 
labors are held, is the best index of the existing standard of med- 
ical education, as well as of the degree of individual culture in the 
profession. Wherever that standard is highest, there specialties 
are most assiduously cultivated, and the labors of specialists most 
highly appreciated; and everywhere, the dependence of general 
medicine upon Specialism, for all that gives it vitality and pre- 
cision ; for all that renders it self-sustaining and progressive, is 
freely acknowledged by the profession, just in proportion as its 
members are enlightened, and just in proportion as we have been 
able to free ourselves from the bondage of prejudice, jealousy, and 
narrovmess.