WHILE we are gathered together from widely separated parts of the world in this fair city where so much that is of interest is now centered, I am not insensible to the honor you do me in pausing even for a few moments to listen to the thoughts I have to offer upon the general subject of “Specialties in Medicine.” Though the occasion is not one to warrant us in entering largely into details, both the time and subject are too important to permit superficial consideration.
Let us therefore, first inquire briefly how the thing which we now know as specialization was evolved. When we resolve all the multiform effort of the world into elementals, we find that the one thing in the world is life. The one thing we are trying to do is live. All the issue and ologies are only a part of it, or helps to it. The effort of all who think and work truly is to increase the value of life, not to make life, that were impossible, but to render life more complete, more perfect.
Broadly considered, human life can be perfect only when a power and faculty is fully developed in absolute harmony with every other. But, as it would be impossible to entrust to any one man or set women, the guidance of the race in all of its wonderful and bewildering individual capacities, man early came to be regarded as divided into three distinct entities, physical, intellectual and moral (or spiritual), and we have as a result three classes of men to when the world looks for its uplifting.
To physicians has been given the task of broadening and perfecting the physical life of the race. To the clergy the hardly more sacred work of enlarging the moral life and perfecting spiritual vision, and to the great army of teachers in every branch of science and art comes the glorious possibility of developing the intellect of man into something yet more godlike.
Medicine, theology, and philosophy, the first three specialities. .
But so complex and all comprehending a thing as intellectual life could never be brought within the bounds of one man’s power and knowledge, and so the educators have almost infinitely divided their work. Those to whom the care of souls was given soon discovered that no one expression of belief could be broad enough to provide scope for the infinitely out-stretching, constantly expanding individual spiritual life, and theology consequently divided and subdivided, and took to itself creeds.
While it is obvious how powerless my one man must be and must have been to cover with ever so great industry and genius the whole vast field of human possibilities, and while a division of labor was and is imperative, the greatest possible value can never be obtained by such division in any field without a right understanding on the part of those who undertake any branch of work of the economic reasons governing its divisions, and the great natural laws under which each man must work within his own lines.
The more deeply we think and study into the things of nature and of life, the more we become aware of a central unity running through all things; a fundamental law with which all other laws must co-operate, with which all truth falls in line, to which all logic finally points as the needle to the pole.
We are closely pressed in our industrial life in these days by failing to appreciate or to apply this law. The underlying principle of unity, in man as in nature, implies the most perfect harmony, the fullest co-operation, and at the same time, and only in consequence of this, the most perfect expression of individual life and liberty.
As the plant is dependent upon the sun and dew; as the tree is saved from death by the bird that lives upon the insect which would destroy it; as the tide answers to the noon and the world itself to the motion of the spheres, so must man recognize his unity with man and nature, acknowledge his constant mutual interdependence, must severe and be served, or lose his highest and most harmonious development.
The freest and most perfect expression of human power and life is possible, then, not by more and more separation, but by more and more unification; by a deeper and surer perception of the laws of the world, and a living in harmony with them. This does not preclude special work. It does not deny to any man the right to work out the best that is in him in his own way, to choose his work within very narrow lines if he will. But that he may attempt something like perfection in one direction, he must lay down as well as take up. Specialization means concentration. Emerson has somewhere said; “You must elect your work; you shall do what your brain can and drop all the rest. Concentration is the secret of strength.”
Some apprehension of this truth, however dimly conceived, lay at the foundation of the first conscious division of work into what we call specialties. But specialization means also renunciation. “Drop all the rest, lay down as well as take up.” Leave some work that one might do, that even might bring more generous results in its performance than the little bit that must be wrought at with such unflagging care to bring it to its fullest beauty and perfection.
One must leave to some one else the work that might have been his own; be must relinquish some part of his inheritance; and if he would secure a true value in his exchange, let him see to it that what he gets is something more than a mess of pottage. His work will be to him little more than this if it is undertaken from motives of self- aggrandizement. If his object is a mercenary one, he will doubtless make money, which means food and clothes, as a good as, or a little better than, his neighbor’s; a little power and splendor, and a residuum, after analysis, of dust and ashes.
His object has been separation, not unification; he has striven against, not with, his brothers; he has undertaken a special work, not that he might do a little more perfectly than he could do more and the thing that he has devoted his life to be, in consequence, on more value to the world, but that by doing some one thing better than any one else could do it, he might receive for himself more gain and glory. Both greatest good will, of a surely, be denied him if he is content to seize these apples of Sodom. His work, I do not hesitate to say it, will fall short of that which is best.
Therefore, the value, that is, the worth, the importance, the utility of specialities, in medicine as in anything else, depends less upon the thing specialized, or the necessity for its specialization, than upon the man who does it and the spirit he works in. In comparison with this, all other reasons and reasoning are vain.
It has been said, and not without reason, that narrowness is a result of specialization.
But a broad man, liberally educated, does not necessarily become narrow by devoting his best energies to some one thing that he feels he can develop more power in than he could attain in any other direction. He may give himself up so completely to his chosen work as to almost exclude the possibility of any extended reading, not to say research, in any other direction. His time may become so absorbed by the demand upon it in his limited field that he can rarely even meet with those whose work is carried on with larger lines. And yet, if he maintains his true relation to the world; if his mental attitude be a right one, I insist that he need not become narrow in the generally accepted sense of the term.
There will be much that he cannot know, that he must voluntarily relinquish the possibility of knowing, but he will be broadly interested in it all. He may renounce frequent fellowship, but if in his work and growth he is constantly and conscientiously one of the great human family, connected by the closest ties with every other, doing his part, however distinct it may be, not in isolation, not in the spirit of separation, but simply as his bit of the great whole, in all of which he has a personal interest, which is all his, and yet not his; which, but for the perfection of his, would be less perfect, which is never to be lost sight of in the exclusion of his own, -if, in a word, he need no lose materially, or beyond compensation, by his adoption of a specially.
He does not renounce the spirit of fellowship, he does not glorify his own work to the exclusion of any other, he does not fasten his eyes to exclusively upon that which is growing under his hand as to lose I power of seeing it in perspective.
For, to reiterate, the value of any special work depends, first and chiefly, upon the power of the man who does it, to look at it constantly in its relation to that whole of which it is a part. From a failure to do this arises all the question as to the value specialties.
Educators have recently been considering with much seriousness whether many of the most defective methods of our educational systems might not be directly traceable to the arbitrary division of that which was never intended to be divided-the life of man-into physical, mental, and spiritual, the result being unequal, and, consequently, unnatural development.
