Specialists and Specialties 
IN 
M E D I C 1 N E . 
ADDRESS DELIVERED BEFORE THE ALUMNI ASSOCIATION OF 
THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF 
VERMONT, BURLINGTON. JUNE 27, 1870. 
By M. IT. HENRY, M.A., M.D., 
SURGEON-IN CHIEF TO THE STATE EMIGRANT HOSPITALS, WARD’S ISLAND, NEW 
yoiik; president of the alumni association of the medical 
DEPARTMENT OF THE UNIVERSITY OF VERMONT; FELLOW OF THE 
NEW YORK ACADEMY OF MEDICINE; MEMBER OF THE 
MEDICAL SOCIETY OF THE COUNTY 
OF NEW YORK, ETC., ETC. 
NEW Y O RK ‘ 
WM. WOOD & CO., 27 GREAT JONES STREET. 
1876. BY THE SAME AUTHOR. 
The American Journal of Syphilography and 
Dermatology. Devoted to the consideration and treat- 
ment of all Venereal and Skin Diseases, including their lesions. 
5 volumes. From January, 1870, to January, 1875. 
The Treatment of Venereal Diseases: A Monograph 
on the method pursued in the Vienna Hospital. 1 vol. 1872. 
On the Indications for Operative Interference in 
Cases of Phimosis. Pamphlet. 1870. 
On Amputation of Redundant Scrotum in the 
treatment of Varicocele. Illustrated with a new 
instrument. Pamphlet. 1871. 
Clinical Observations on the Dementia and the 
Hemiplegia of Syphilis. Pamphlet. 1872. 
Clinical Contributions: Three cases of Induration of the 
Os and Cervix Uteri, the result of Syphilis. Two cases of 
Syphilitic Insanity. Four cases of Anomalous Localities of 
Chancres—extra genital—with remarks. Pamphlet. 1874. 
Account of a New Instrument to facilitate the 
removal of the Prepuce in cases of Phimo- 
sis, Pamphlet. 1874. 
Etc., Etc., Etc. Specialists and Specialties 
IN 
MEDICINE. 
ADDRESS DELIVERED BEFORE THE ALUMNI ASSOCIATION OF 
THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF 
VERMONT, BURLINGTON, JUNE 27, 1876. 
By M. H. HENRY, M.A., M.D., 
BURGEON-IN-CHIEF TO THE STATE EMIGRANT HOSPITALS, WARD’S ISLAND, NEW 
YORK ; PRESIDENT OF THE ALUMNI ASSOCIATION OF THE MEDICAL 
DEPARTMENT OF THE UNIVERSITY OF VERMONT; FELLOW OF THE 
NEW YORK ACADEMY OF MEDICINE; MEMBER OF THE 
MEDICAL SOCIETY OF THE COUNTY 
OF NEW YORK, ETC., ETC. 
NEW YORK: 
WM. WOOD & CO., 27 GREAT JONES STREET. 
1876. PREFACE. 
This address is published in its present form at the 
request of the Alumni Association, before whom it was 
delivered, as well as other members of the profession who 
coincide with me in the views I have expressed on the 
nature and treatment of Specialists and Specialties in 
Medicine. 
I have only to add that if the plea I have made in the 
cause of a higher standard of education and culture in medi- 
cine is maintained in the smallest degree, I shall be perfectly 
satisfied. 
157 West Thirty-Fourth Street, 
New York, July, 1876. SPECIALISTS AND SPECIALTIES 
IN 
MEDICINE. 
one in this audience could, I think, appreciate 
the honor which I feel has been conferred, in se- 
L»jay.t3| lecting me to deliver the address before the Alumni 
of this Association, more than I do; nor could any one feel 
more sensitively the difficulties surrounding and associated 
with the task. The more I have thought of it, the more I 
have realized the .exactions demanded of those who deliver 
addresses on these occasions. 
It is exceedingly difficult to select a subject that will be 
of equal interest to the professional and non-professional 
friends of the favored Alumni who gather around, and lend 
interest, by their presence, to these annual festivals. 
I purpose calling your attention, to-day, to a subject that 
is of vast importance to the physician, and of no less interest 
to the public. I allude to specialists and specialties in 
medicine. Many of you will doubtless think that I am 
treading on very delicate ground in discussing the medical 6 
fashions of the day. I can only say that I conscientiously 
believe that the present fashions in medicine are working 
harm, and are subversive of true scientific progress. Need 
I offer any better reason for devoting the little time at our 
disposal to the consideration of so important a subject. I 
purpose directing your attention to specialties in medicine, 
and their relation to science and the public good. I may as 
well state here that I believe in specialists and specialties, 
under certain conditions. I believe in the specialist who 
HAS WON DISTINCTION BY RIPE CLINICAL OBSERVATION, A 
GOOD KNOWLEDGE OF PATHOLOGY, HISTOLOGY, MICROSCOPY, 
AND PRACTICAL EXPERIENCE ; AND WHO, AFTER A GOOD 
CAREER IN THE GENERAL PRACTICE OF HIS ART, FINALLY 
DECIDES TO TREAT ONLY A CERTAIN CLASS OF DISEASES. 
The practice of any specialty, followed without good natural 
qualifications, without previous and constant study, special 
observation and thought, and a thorough groundwork in 
pathology and general medicine, is, in my judgment, unde- 
serving the confidence of the profession or the patronage of 
the public. 
I have no inclination—even if time permitted—to dwell 
on the wrongs to the public, and the injuries to the profes- 
sion, committed by ill-cultured and irresponsible specialists 
within our own ranks. I think that I may fairly claim that 
the wane of public confidence in the regular practitioner—a 
fact beyond doubt or dispute—may justly be attributed to 
the subdivision of labor, and the want of unity and harmony 
in practice. Experience has forced me to believe 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- 7 
fully and successfully treated, in the early part of this cen- 
tury, 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. It is useless to deny the success attending, 
at times, the efforts of these impostors. Many of them are 
wise in the ways and personnel of the world. They listen 
attentively to the course of treatment that has been pursued, 
and they discover previous excessive and meddlesome inter- 
ference as the cause of the failures. May not some of the 
successes claimed by the followers of the mock science of 
homoeopathy (in cases that have previously been under the 
care of so-called better educated practitioners) be attributed 
to this cause, and a nice appreciation of what not to do 
under certain circumstances ? I speak of homoeopathy as 
a mock science—for “ homoeopathy, mesmerism, and phre- 
nology have now been before the world a sufficient time to be 
fairly and fully examined by competent judges ; and as they 
have not stood the test of impartial scientific investigation, 
and therefore have not established themselves in profes- 
sional opinion, they may be safely, on this ground alone, set 
down under the head of mock sciences ; though, as in the 
case of alchemy, the researches to which they give rise, and 
the new hypotheses which they promulgate, may assist in pro- 
moting genuine science.”* In illustration of this last propo- 
sition, let me remind you of the fable which Lord Bacon 
applies to the alchemists : An old man told his sons, on 
dying, that a treasure was concealed in his vineyard, but he 
* An Essay on the influence of authority in matters of opinion. By 
George Gornewall Lewis, Esq. Second Edition, 1875* 8 
had forgotten the place ; whereupon they fell to digging the 
ground in all directions and found no gold, but improved 
the cultivation of the vines. 
The evils of this unscientific and unnatural division of 
labor may, in my judgment, be accounted for in the 
following manner :— 
Firstly. Admitting uneducated and improper persons to 
the study of medicine. 
Secondly. The absence of any preliminary test of qualifi- 
cation or fitness to pursue the study. 
Thirdly. The recognition of all sorts of specialties in the 
medical schools. 
Fourthly. The patent of fitness conferred by the colleges 
on illy qualified specialists. 
Fifthly. The establishment and support of special rings 
and cliques for the purpose of worldly gain, to the utter and 
entire exclusion of all measures of a scientific or progressive 
character. 
Sixthly. The excess of Medical Journals; and the wretched 
character of, at least, two-thirds of the contributions that 
monopolize the pages of too many of them. 
There are, of course, many other minor causes that assist 
in sustaining and supporting the evils of which I complain. 
Remove the greater, and the lesser will follow as a natural 
sequence. The question is now—how shall they be re- 
moved ? 
Firstly. No one, in my judgment, should be permitted 
to matriculate in any medical college who has not shown by 
academic diploma, or certificate, or by special examination 
that he is sufficiently educated and prepared to understand 
and appreciate the highest order of medical teachers. 9 
Secondly. Maintain and insist on proper qualification be- 
fore matriculation. I firmly believe that the only way in 
which quackery and imposition, in the practice of medicine, 
can be fairly crushed out of the stronghold which it has 
established amongst persons of average intelligence—is by 
educating the alumni of our own schools so thoroughly, that 
when they enter the world for the purpose of practising their 
profession, the public will have no difficulty in discovering 
the well-qualified and intelligent practitioner from the ignorant 
and suave pretender. Until this is accomplished, the public 
will follow their false prophets to the exclusion and disgust 
of your own alumni. 
Thirdly. For the purpose of leading the mass of the pro- 
fession and the public into the belief that the schools are 
progressive, too many of the “faculties” have yielded to the 
fashionable spasm of the day, and appointed persons to deliver 
special courses of lectures. With some few exceptions, these 
special lecturers are scarcely up to the standard which might 
fairly be asked in so-called specialists. The fact is, the ap- 
pointments are too frequently bestowed in reward for services 
of a private nature ; or for considerations which, perhaps, it 
would not be well to indicate at this time, or on such an 
occasion. I can assure you 1 speak with a full knowledge 
of the subject, and I challenge contradiction. 
Fourthly. The title of Professor does, doubtless, carry with 
it a certain prestige of skill, or respectability, or both, when 
associated with a chair in a medical college of good repute. 
The public is led to believe that “the Professor” is better 
qualified to treat disease than his neighbor “the Doctor.” 
The falsity of this assumption is illustrated every hour of the 
day at the cost of the public, and to the discredit of the 10 
colleges whose chairs are filled by second-rate or incompetent 
teachers. 
Fifthly. The struggle for professional preferment—owing 
to the large numbers who are annually graduated from our 
schools—has led to the formation of special rings and cliques, 
that have done infinite and irretrievable harm to the status 
of the profession. Self-gain and aggrandizement have been 
the sole watchwords of these bunches of little men. From 
their narrow and morbid conceptions have been born only 
their own dishonor and a wide-spread lack of faith in the 
unsullied masses of the profession. 
Sixthly. I sincerely believe—from a somewhat large ex- 
perience in Journalism—that if four-fifths of the Medical 
Journals of the day could be “in the deep bosom of the 
ocean buried,” it would prove a source of new and better 
life in medicine. It would be the means of affording a health- 
ful support to the really good Journals and well-qualified 
Journalists, and a corresponding boon to the students of cur- 
rent medical literature. The standard text-books of authors 
whose veracity and capacity are beyond dispute might then 
find more readers;—can any one question the good effects 
that would result from such a course ? 
I have sketched, thus far, the existence of and the remedy 
for the evils which have resulted from the tolerance of 
specialties pursued by incompetent persons. I shall now 
endeavor to show that scientific success in the practice of 
general medicine or a specialty, depends on natural quali- 
fications and fitness, and ripe clinical observation and 
experience. By experience, I mean general familiarity with 
and knowledge of disease—not the mere act of visiting a 
large number of patients and affixing a signature to a large 11 
number of formulae. I have known not a few gentlemen of 
large practice and handsome income, who were literally igno- 
rant of the first as well as all other elements of medicine,— 
but the world regarded them as men of large experience. 
The world is too apt to regard quantity rather than quality 
in most affairs of life. In medicine, success is too often 
measured by the numbers seen in the ante-room, rather than 
the results that take place at the bedside. Nine-tenths of all 
special practice is congregated in the ante-room. The public 
mainly takes cognizance of the numbers. The infection is 
soon spread, and each and every one who has waited for one 
or more hours for his favorite “ ologist ” infects his whole 
circle of friends with his disease. It would be useless to talk 
of the unity of medicine to this class of persons. Their con- 
ception of the scientific or intellectual attainments of their 
favorite special advisers is about as feeble as their notions of 
pre-historic ages, or the spiritual conditions of a future exist- 
ence. But the censure should not be attached to the public 
on this account. It belongs to what are termed the “Facul- 
ties,”—they who nurse and accept the “royalties” and 
moneyed rewards of this patent practice. The unity of medi- 
cine depends on harmony ; the want of this unity—the viola- 
tion of this unity is the great obstruction to progress, both in 
the science and the art which we practise. Deprive medicine 
of the science, and nothing more is produced; deprive it of 
the art, and there is no further development. 
The same principles apply in music, painting, sculpture, 
architecture ; and, in fact, in all branches of aesthetics, indus- 
try, and intellectual development, which mark the periods of 
the highest civilization. The great masters in music display 
in their compositions profound knowledge in all that pertains 12 
to a great musician—poetry, melody, composition, harmony, 
thorough bass, and power and capacity of instrumentation 
Those who have excelled in painting display their intimate 
knowledge of nature in all its forms, with the keenest sense 
and appreciation of all changes and mutations of organic and 
inorganic life. The same principles apply to sculpture. No 
one ever excelled as a sculptor, who did not combine a good 
knowledge of mathematics, anatomy, physiology, and psychol- 
ogy, with a finely cultivated imagination, and appreciation of 
all that was grand and ennobling in nature. Those only who 
have been fortunate enough to view the grand structures of 
the older European capitals, can form an estimate of the 
capacity and attainments of the architects who have added 
such lustre to the ages in which they lived. The success of, 
and interest manifested in the three great novelists of the 
day—Thackeray, Balzac, and Dickens—is due to their 
extraordinary knowledge of human nature, and their wonder- 
ful word-pictures of all phases of human character. I might 
dwell more on this, perhaps, digression, in illustration of 
the necessity of more perfect culture and experience than 
is now regarded as essential in the practice of specialties. 
But time will not permit. 
The necessity of a full and good knowledge of all branches 
of general practice in the successful pursuit of a specialty, is 
well illustrated in the account of the following failures : 
Only recently, in the New York Pathological Society, a 
teacher of the practice of medicine mentioned some cases 
of aneurism of the aorta that had been for some months under 
the care of some “ throat doctors,” who were making almost 
daily topical applications to the larynx and vocal cords, for the 
cure of the aphonia incidental to aneurism in this locality. A 13 
few years’ practice, and a fair average knowledge of general 
disease on the part of the laryngologists, would have pre- 
vented the possibility of such unpardonable errors. The laryn- 
gologists have not, as far as I am aware, mentioned these 
cases in the transactions of their special society. 
Again, a gentleman who had been for a long time under 
the care of a great experimental physiologist (who devoted 
himself to nervous diseases), asked me to give him a letter 
of introduction to an oculist. He mentioned that his physi- 
cian was treating him for softening of the brain—he was 
then absent from the city—and, as his vision was becoming 
impaired, he‘desired to consult an oculist. I gave him a 
letter of introduction to an ophthalmologist of deservedly 
great repute—one who is highly cultivated in the general 
science and art of medicine, and its literature. An examina- 
tion with the ophthalmoscope displayed beyond any doubt 
that the so-called softening of the brain was—Bright’s dis- 
ease in an advanced stage. The attention of the pure 
“nerve doctor” was subsequently called to the case, and 
he gracefully admitted his error. Now, was such an error 
of diagnosis pardonable in one who claims a very exalted po- 
sition, and who charges correspondingly large fees for his valu- 
able services ! A few years judiciously spent in the practice 
of general medicine would enable any one of average intelli- 
gence to differentiate between a case of softening of the 
brain and Bright’s disease. 
Thirdly. A well-known New York gynaecologist a few 
years ago, relying too unwittingly on the statements of his 
patient, performed the preliminary steps of an ovariotomy, 
which was subsequently terminated in what is known as 
Caesarian section. I am inclined to think that a really 14 
good obstetrician would scarcely have been led into such a 
serious blunder. 
Fourthly. An account was published in the Medical 
Record, a few months ago, of a poor gentleman, who, having 
suffered for a long time in the hands of a specialist, was sub- 
sequently, by his advice, and with the assistance of three 
friends, subjected to the operation of lithotomy. There was 
no calculus found. The specialist then decided that the 
sufferer was the victim of reflex spinal irritation, and it was 
thought that would account for all the symptoms of disease 
under which he suffered. It is possible that reflex spinal 
irritation may simulate somewhat the symptoms of vesical 
calculus ; but the performance of a capital operation, without 
having first ascertained beyond question the presence of the 
stone, is, to my way of thinking, a most unpardonable piece 
of malpractice. I am inclined to think that such a mistake 
could never have occurred to such men as Civiale, Sir 
Henry Thompson, or to any of our own surgeons of large 
culture and experience. 
The advantages of dividing the practice of medicine from 
that of surgery is now generally conceded in all countries, 
and in all localities where the demand for professional ser- 
vices is sufficient to admit of the distinction. There are 
many obvious advantages in this separation. It tends to 
develop the special acquirements of each practitioner in the 
line in which he is best fitted to excel. It must not be for- 
gotten, however, that success in surgery frequently depends 
on acquirements in medicine, and success in the practice of 
medicine is only obtained by a thorough knowledge of the 
same branches that secures success in surgery. In his essay 
on Barere, Macaulay aptly says :—“ Practice contributes 15 
more than books. Books are indeed useful to the politician, 
as they are useful to the navigator and to the surgeon. But 
the real navigator is formed on the waves; the real surgeon 
is formed at the bedsides.” 
There is no branch of medicine that requires more exact 
knowledge than that of ophthalmology. It deals with the 
most important and delicate structures. On the skill of the 
oculist thousands daily place their faith, and his judgment 
and skill determine whether those who submit themselves to 
his care shall enjoy God’s greatest gift—sight; or whether 
they shall sutler the doom of darkness in all their future days 
on earth. I would ask you to pronounce the judgment 
deserved by those who venture to practice ophthalmology 
without thorough and complete preparation. I can assure 
you, from a survey of the literature of this subject, no one has 
ever attained real distinction in this department of surgery 
who was not a proficient in general medicine and in all the 
exact branches that bear on the treatment of eye-diseases. 
Von Graefe, of Berlin, displayed beyond any doubt the 
greatest talent as a clinical observer. No one excelled him 
in his profound knowledge of anatomy, physiology, pathology, 
optics, and mathematics. Von Arlt, of Vienna, was the 
author of one of the first and best text-books based on a 
thorough knowledge of pathological anatomy. Horner, of 
Zurich, was a great anatomist and clinical teacher. In 
London, there is Bowman, the eminent anatomist and phy- 
siologist, and author of the Encyclopaedia bearing his name. 
Critchett, the general surgeon of wide local reputation, and 
author of many valuable treatises on the Eye and its diseases, 
including many anatomical and pathological essays. There 
is also Hulke and Bader, both excellent pathological ana- 16 
tomists. In France the late Dr. Sichel won great repute. 
He was a brilliant anatomist. Holland is justly proud of 
Bonders, a distinguished anatomist and physiologist, and one 
of the first authorities of the Century on optics. Warlomont, 
of Belgium, is also distinguished as an anatomist. In this 
country we have Knapp, Coring, Althof, Noyes, Norris, 
Joy Jeffries, Williams, and many others who have fairly 
won distinction in the profession, and the esteem of the public. 
Among the aurists of deserved repute, Von Troeltsch, 
Schalbe, Politzer, Toynbee, and Roosa stand in the first 
rank. As anatomists and clinical observers they have no 
superiors. There are many others working their way to dis- 
tinction, through a course of studious observation of diseases 
of the ear. 
Diseases of the mind have for some years been under the 
special care and protection of what are termed alienists. The 
disparity in that which has been accomplished and what is 
now claimed by this class of practitioners, in this country, is 
daily manifested in our courts of law, to the discredit of our 
profession. In the words of the immortal bard: 
“ What done—brief told. 
What not done—Volumes.” 
Blandford, one of the best English authors of the day, 
says :—“ If there be one branch of the great study of medi- 
cine which more than another deserves to be called an art 
and a mystery, it is the treatment and investigation of in- 
sanity.” Maudsley, another English authority, whose works 
are familiar to you, aims, in his Treatise on the Mind, “ to 
deal with mental phenomena from a physiological rather than 17 
a metaphysical point of view; and secondly, to bring the 
manifold instructive instances presented by the unsound 
mind to bear upon the interpretation of the obscure prob- 
lems of mental science.” 
You can doubtless picture to yourselves the amount of 
study, observation, practical experience, and power of gen- 
eralization involved in the accomplishment of a work of this 
character. Many, endowed with the peculiar temperament 
for the study and observation of disease, and fitted by culture 
and experience, have failed to accomplish much in this 
department of medicine in this country. If we except the writ- 
ings of Ray, Gray, Ordronaux, Weir Mitchell, and a few 
others, but little advancement has been made in the litera- 
ture or jurisprudence of brain diseases since the days of Beck. 
He was undoubtedly a master of his art. He was not a spe- 
cialist, nor did he claim to be an alienist; but he excelled all 
others in this country in his contributions. It is now more 
than fifty years since he published his Elements of Medical 
Jurisprudence. On looking over some early numbers of the 
Lancet, I find a review that must certainly have been gratifying 
to the distinguished author. The reviewer concludes by say- 
ing : “ By no analysis that we can give of Dr. Beck’s perform- 
ance, can our readers appreciate its proper merit and value. 
The present work is remarkable for the extent of research it 
displays, the minuteness of detail, and the luminous arrange- 
ment of facts and observations which are to be found on 
every page. It reflects the highest honor on its author. . . . 
The work before us possesses decidedly sterling merit, and 
ought to find its way into the library of every medical prac- 
titioner in the kingdom. The notes of the editor are fre- 
quently curious and valuable, and the whole production is, 18 
in our opinion, decidedly superior to any other that has yet 
appeared on the subject of medical jurisprudence.” At the 
time this review appeared, the Lancet was regarded as the 
most critical and severe on all questions submitted for its judg- 
ment. I will now ask you to devote, at some future time, a 
little leisure to the works of the so-called alienists of our own 
day, and satisfy yourselves whether there is any one among us 
that possesses the ability, or frame of mind, capable of pro- 
ducing a work comparable to that of Dr. Beck. Large 
octavos, said to contain wonderful discoveries on all sorts of 
brain and nervous diseases, including hydrophobia, are con- 
stantly advertised. The value of the claims of many of 
these authors will depend on the experience of other ob- 
servers. “If you regard not the opinion of Pericles, yet 
wait at least for the advice of time, which is the best of all 
counsellors.” 
Another favorite specialty of the day is devotion to the 
peculiar ailments of the gentler sex. With all deference to 
their judgment and good taste, I am led to think that, in a 
large proportion of cases, the special medication to which 
they are subjected has been productive of more harm than 
good. No less an authority than Dr. Graily Hewitt, 
ridicules the idea of the subdivision of organs into special- 
ties. He certainly is privileged to speak authoritatively on 
this subject. Dr. Fordyce Barker, the distinguished gynae- 
cologist, could not possibly have expressed more clearly his 
dissent from attempts to practice his own favorite branch 
without full and ample general experience, than he has already 
done in the preface to his admirable work on “Puerperal Dis- 
eases.” He says :—“ At the present day, for the first time in 
the history of the world, the obstetric department seems to 19 
be assuming its proper position as the highest branch of 
medicine, if its rank be graded by its importance to society, 
or by the intellectual culture and ability required, as com- 
pared with that demanded of the physician or surgeon. A 
man may become eminent as a physician, and yet know 
very little of obstetrics ; or he may be a successful and dis- 
tinguished surgeon, and be quite ignorant of even the rudi- 
ments of obstetrics. But no one can be a really able obste- 
trician, unless he be both physician and surgeon.” Now, as 
obstetrics is only part of the duties of the specialist who de- 
votes himself exclusively to the diseases of women, is it not 
absurd for any one to attempt to practice or to claim atten- 
tion as a specialist in this department, unless he is well quali- 
fied in general medicine and surgery ? There is not, as far 
as I am able to learn, a single exception in the long list of 
great obstetricians and gynaecologists who have not been 
good general practitioners 'ere they attained distinction in 
the branch to which they subsequently devoted their time 
and attention. 
I was led some twelve years ago to pay some special atten- 
tion to diseases of the skin, mainly at that time for the 
purpose of differential diagnosis in certain diseases in which 
cutaneous lesions formed a prominent part. The interest 
which I felt in this class of affections was shortly after in- 
creased by my appointment to the class of Skin Diseases, in 
one of the largest New York dispensaries. At this time, with a 
few exceptions, there were really no physicians who held 
professorships of Dermatology, and none who, so far as I can 
learn, paid exclusive attention to skin diseases. I am satis- 
fied that the well-educated physicians of that day understood 
and treated skin affections far more successfully than they 20 
are now treated by the newly-fledged dermatologists of the 
present hour. 
In speaking of the decay of the University of Vienna, Dr. 
Jacobi says :—“Their great merit is to teach some young for- 
eigners who go to Vienna for the purpose of “ brushing up,” 
as the phrase goes, or of returning, after a few months’ drill- 
ing, as eminent specialists in some ‘ ology.’ ” The fact is, it is 
useless for any one to think of or to attempt to become a 
successful dermatologist unless he be a proficient in the prin- 
ciples of general medicine. The successful study of skin 
disease necessitates a knowledge on the part of the student, 
whoever he may be, of diseases in general; and he alone 
can treat cutaneous ailments satisfactorily who is master of 
the details of general therapeutics. If any of my hearers 
want any additional evidence of the truthfulness of my re- 
marks concerning this branch of medicine I will only ask 
them to devote an hour to the published discussions of the 
New York Dermatological Society, where all knowledge of the 
co-relation of other branches of medicine seems to be stud- 
iously—maybe innocently—ignored. 
The same arguments apply, and the same requisites are es- 
sential in the pursuit of syphilodology, laryngoscopy, neurolo- 
gy, tumorology, electrology, and that other specialty which 
has recently, according to its advocate, been the means of ex- 
posing the wretched pretensions of the Creator in the struc- 
ture of his favorite image ! These faulty conditions are said 
to be only overcome by the specialist who submits all his 
patients to operations in utter violation of all anatomical or 
pathological considerations. Sir Henry Thompson, who 
is, beyond question, the best living authority in this depart- 
ment of surgery, says :—“ Now, I don’t know that this fashion 21 
has as yet been adopted here, but I do know that it exists 
elsewhere, and I raise my earnest protest against it.” I 
mention this to-day, because I believe it to be one of the 
evils of the hour that should be denounced in every quarter 
where the infection might by any possibility be conveyed. 
It may perhaps not be out of place to mention that in 
France, Germany, Holland, and Switzerland no one is per- 
mitted to practice a “ specialty” without having first passed 
through a state-examination, which embraces the theory and 
the practice of all branches of medicine and surgery, natural 
sciences, and chemistry, botany, etc. In the United King- 
dom of Great Britain the course is a severe one. No one 
can matriculate in medicine who has not been graduated in 
arts, or passed a satisfactory preliminary examination which 
is an equivalent. 
Without any desire or intention of offering compliments 
to your own University, I am, in justice, bound to say that I 
know of no Medical School that numbers so large a propor- 
tion of Alumni who have been previously graduated in arts. 
It speaks well for this Medical School. It affords the best 
evidence of the appreciation of your faculty by the best 
cultivated class of students. Indeed experience has shown 
that those graduated from this college have maintained the 
best credit in all competitive examinations in which they 
have taken part. 
Now, one word for myself. I feel that I have detained you 
longer than I ought to have done on such an occasion, but 
the subject is one fraught with so much interest and import- 
ance that I know you will pardon the detention. I have 
explained, as far as time would permit, the nature and the 
remedy for the evils which are working such injury in our 22 
profession. Let the Alumni of this University strike the blow 
for reform—let them show in their own attainments the 
strength and advantages of sound and thorough knowledge 
and culture, and wherever they may go or wherever they 
may practise, I can assure them they will meet with a good 
and substantial reward.