SPECIALISM IN MEDICINE. 
READ BEFORE THE 
NEW LONDON COUNTY MEDICAL MEETING, 
April 12th, 1866. 
ASHBEL WOODWARD, M.D., 
OF FRANKLIN, CONN. 
FROM THE TRANSACTIONS OF THE CONNECTICUT MEDICAL SOCIETY 
NEW HAVEN. 
Printed by Tuttle, Morehouse & Taylor. 
1866. SPECIALISM IN MEDICINE. 
READ BEFORE THE 
NEW LONDON COUNTY MEDICAL MEETING, 
April 12th, 1866. 
BY ASHBEL WOODWARD, M. D., 
OF FRANKLIN, CONN. 
• FROM THE TRANSACTIONS OF THE CONNECTICUT MEDICAL SOCIETY 
//•£ 4/. //< / 77f i bij 
Printed by Tuttle, Morehouse & Taylor. 
1866. 
NEW HAVEN. SPECIALISM IN MEDICINE. 
Serious evils often arise from the misapplication of local laws. 
Theories that work beautifully in one employment, not unfrequently 
fail utterly when extended to others. In mechanical pursuits, in- 
crease of production from a division of labor is a favorite fact of the 
political economist. But the mode of applying labor, most efficient 
in the manufacture of needles, may lead to narrowness and injury, if 
transferred to the learned professions. Because the fingers employed 
for a score of years in polishing a shaft or rounding a point, become 
expert and nimble in that particular work, it does not follow that the 
theologian should confine his researches to the origin of evil, or that 
the lawyer should devote the exclusive energies of a life to the inves- 
tigation of titles. He is the wisest religious teacher who compre- 
hends most profoundly the spiritual relations subsisting between the 
soul and the universe. The wisdom which illumines the path of man, 
showing a way of deliverance from one perplexity, will deliver from a 
thousand. Wisdom is manifold and many-sided, seen only by the 
eye that takes in a broad segment of the horizon. Lawyers, whose 
clear insight into the eternal principles of justice has builded systems 
of jurisprudence on enduring foundations, have stood equally ready 
to grapple with any and all questions falling within the scope of their 
profession. The statesmen, who have given birth to nations, and 
shaped the policy of empires, have been no specialists, but men 
whose vision covered the arena of politics. Depth and breadth are 
required to establish systems. In subordinate positions, indeed, the 
victim of a single idea may seem to effect marvels, but results will 
show his achievements to be narrow and temporary. The child will 
grow only to the stature of the parent. 4 
The prevalent popularity of specialism in medicine, springs in no 
small measure from a perversion of the principle that justifies the 
subdivision of labor in the mechanical arts. Were the human system 
a mere machine, like an engine or a watch, there would be reason for 
thus extending the theory. But the subtle relationships subsisting 
between the parts of the human frame, their mutual dependence and 
reciprocal offices, above all the subordination of the whole to that 
mysterious force, the vital power, lifts the animal body far above the 
law of inert matter. In the exercise of our vocation, we deal with 
something inconceivably transcending mere bone and muscle, fibre 
and tissue. If one member suffers, all the members suffer with it. 
Nature abhors hobbies and narrowness. Broad as the universe, and 
lasting as time, she scorns to reveal her secrets to the bigoted, partial 
inquirer. From her votaries she demands somewhat of her own 
breadth and generosity. 
A skillful general, on the day of trial needs to be informed of the 
movements on all parts of the battle-field. If he neglects the wings, 
the enemy will turn his flank ; if he looks to the wings alone, the ene- 
my will crush his center. So it is in medicine. The eye, the ear, the 
heart, the lungs, are related parts of a complicated organism. Slight 
circumstances may determine where the disease is to make its first on- 
set. Often, the tendency to disorder lurks in the system, waiting for 
a slight local injury, or inflammation, to invite attack upon the im- 
periled organ. The remote cause is permanent and all pervading; 
the proximate cause accidental and temporary. Sometimes the effect 
is far in excess of any apparent cause, the resulting disorder being 
wholly disproportionate to the initial derangement. Shall the practi- 
tioner now direct all the resources of his art to the restoration of the 
suffering member, regardless of the enemy beyond, who has but es- 
tablished an outpost where the malady first declared itself, and is 
equally ready to advance upon a score of other points ? What would 
be thought of the general, with armies to lead, campaigns to plan, 
and victories to win, who understood only the science of fortification, 
or the maneuvering of infantry, or the theory of projectiles 1 Ruin 
would overwhelm him at the first trial. Uniform experience, cover- 
ing more than thirty centuries of time, proves that success in arms 
depends on the union of comprehensiveness of intellect with quickness 
of perception. In medicine a similar rule prevails. Disease is one 
of the most subtle and vigilant of foes. Its messengers hover un- 
seen in the air, sweeping across seas and continents, surprising amid 
security, and, with a beckon from their spectral fingers, summoning 5 
thousands to the court of Death. Disease fights behind masked bat- 
teries, neglecting no advantage. How absurd, nay criminal, then, to 
restrict preparations for defense to a single pass-way, when a score 
are endangered ! The eye sees dimly, and in pain, because poison 
circulates through the system; the lungs disintegrate, because the 
vital energies run low, and the vital forces are perverted. Shall 
we deal then with the eye or with the lungs as independent organs, 
bound by no laws except those regulating their peculiar functions ? 
Yet this is what the specialists propose. The tendency of local prac- 
tice is to magnify the importance of local disorders and of local reme- 
dies. The judgment becomes warped by too exclusive attention to 
single objects. 
In evidence of this, we need only refer to that numerous 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 error of diagnosis. With ail 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. 
Nor does any sufficient reason exist for excepting surgery from the 
general rule. The skill which permits a successful operation upon 
the ear or eye, will avail equally when applied to any part of the 
body. Whatever routine of practice excludes a single limb or organ, 
is by so much too circumscribed. The capabilities of man, " god- 
like" and long lived, are adequate to master the art in its details. If 
one cannot become skilled in all departments, he cannot in any ; and 
contrariwise, if he is endowed with the gifts which enable him to op- 
erate successfully upon one organ, he can operate successfully upon 
all. Facts sustain our position. Without exception, the lights of 
surgery have performed all operations equally well. Furgusson, Val- 
peau, Mott, were too great, too thoroughly saturated with a spirit of 
devotion to their work, to be pinned down to a specialty. Every 
surgeon of equal genius must be equally expansive in his aims. True, 
some specialists have earned more or less celebrity, in spite of the 
cramping influences with which they have surrounded themselves. 
The merit, when genuine, would have been far more richly rewarded, 
we believe, had it been more liberal in scope. In the judgment of 
well regulated minds, the presumption will be against the operator 
who lacks the genius and the ambition to claim as his own the entire 
field of surgery. 6 
Moral considerations weigh against specialism. More and more 
our profession is consolidating into a brotherhood, united by common 
sympathies and noble aims. Generous souls can yield no room to 
pettiness or jealousy. Our conventions have adopted a code which 
promises to extirpate the last root of bitterness, and to lift the pro- 
fession " out of the shot and danger" of reproach. One prominent 
feature of the code requires that the practitioner shall advertise only 
by his merits. Artifices, insinuations, secrecy and parade, are rigidly 
prohibited. These wholesome regulations the specialist is under con- 
stant temptations to violate. To become broad and noble in action 
and character, one must first become noble in aims. 
I cannot, perhaps, more fittingly close this paper, than by trans- 
cribing some just and significant remarks from an address* delivered 
before the Royal College of Surgeons, not on specialism, but on the 
progress of surgery, by a distinguished ornament of our profession, 
Dr. Furgusson,-now Sir William Furgusson,-he having been recently 
knighted, entirely on the ground of professional distinction, an honor 
rarely conferred, it having been over thirty years since the last was 
conferred on the distinguished Benjamin Brodie. 
He says, " Throughout the history of our profession, from the ear- 
liest date to the present time, distinctions have been drawn between 
surgery strictly and physic. The wisdom or necessity of drawing 
such distinctions is very questionable, particularly since the pass- 
ing away of the dark days of surgery, when an inferior class 
acted under the orders of those who themselves could know but little 
of the art. As our profession gets older, the custom becomes less 
apparent, although in large and populous districts there will always 
be those who devote themselves specially and respectively to these 
departments. This, in my opinion, depends upon, and is determined 
by, natural habits and tastes, rather than upon any actual necessity 
that the two should be disjoined, or that a union of skill in both is in- 
compatible with man's mental and physical powers. I cannot myself 
see why there may not, should not, could not be such a combination." 
****##" impression seems to get stronger, that 
whilst a physician must be all the better for a good knowledge of sur- 
gery, the surgeon must be a poor practitioner Who has not a knowl- 
edge of physic." " One of the greatest lights in surgery, Sir Benja- 
min Brodie, who has but recently passed from amongst us, was as 
*This Lecture may be found entire in " The Lancet,' [Amer. Edition, Dec. 1865, 
p. 553.] 7 
much distinguished in this respect, as for his power in surgery, prop- 
erly so called ; and the professional reputation of Abernethy was as 
much based on blue pill and black draught, as upon tying great arte- 
ries, opening abscesses, or any oilier surgical proceedings with which 
his name was associated. In fact, the term ' pure surgery,' should, 
in my opinion, be banished from our vocabulary." SPECIALISM IN MEDICINE. 
READ BEFORE THE 
NEW LONDON COUNTY MEDICAL MEETING, 
April 12th, 1866. 
ASHBEL WOODWARD, M.D., 
OF FRANKLIN, CONN. 
FROM THE TRANSACTIONS OF THE CONNECTICUT MEDICAL SOCIETY 
NEW HAVEN. 
Printed by Tuttle, Morehouse & Taylor. 
1866.