It would seem as if the division were an imperative antecedent on progress, the mistake being that in the division of work each worker should look upon his part as a whole in itself. he then might and did isolate it and himself from those to whom the work of perfecting the other parts had fallen, and the morbid conditions thus created have spread into every branch of study and of practice, and have worked endless disintegration where wholeness should have been.
You will bear with me if I seem to be dealing too long with abstractions. In the daily routine which absorbs our every faculty as physicians into one tremendous effort to restore and preserve such physical perfection as is possible to suffering humanity, we have little time or opportunity to think of that which it were worth our while not to forget, -which is not alien to the practical side of our work, but an integral part of it,- the fact that even before we are physicians we are men, and that the highest physical life is at its best but an expression of the intellectual and spiritual life.
We who have chosen for our calling the physical redemption of man cannot look too broadly upon our work, and that will not be lost time which we spend in getting it so in focus that we can have indelibly printed upon our mental negative a picture of what we are doing, and the relation our work sustains to the moral and intellectual life of our race. Still more is this necessary if we have taken but a small part of the medical practice for our field. The same laws hold good here as those that work throughout the whole wide range of human experience. Unity is strength, life; division is disintegration, death.
No one part of the human economy can be disturbed without affecting in some degree every other part; and it would be at variance with every law that we know in nature or in life to believe that in studying thoroughly one branch of medicine, one might, without more than a very superficial knowledge of anything else, treat successfully the one part two which faithful attention has been given.
In the practice of a specialty one may not do any work outside of certain lines, but one must do a vast amount of study and investigation outside of those lines, and the work within must be constantly connected and fitted into that which lies without. One must work steadfastly in a restricted field, yet with constant reference to the whole; must be able to work alone, yet in a spirit of fellowship, to work in accordance with the great world-law of unification, and not against it.
When this become not only possible, but habitual, then and then only is one in a position to understand and to prove the great value of specialization, by the concentration of force in one direction.
The concentration of force develops power in two ways. It makes possible a more profound intellectual grasp of the subject specialized, and if it be in the line of technical work, it given tactile fineness and manual skill to a degree impossible to derive from general work.
The devoting of much time to one thing renders the research and the acquisition of facts in regard to it so complete as to often outrun all previous knowledge, and lead to discoveries and inventions, to new refinements of diagnosis, added instruments of precision, and to scientific methods of investigation and practice that seem little short of marvelous; and it is a wonderful power of eye and hand, a wonderful acuteness of sight and touch, that are developed by doing intelligently one thing over and over again.
The value of this knowledge and technique is three-fold. First, to the specialist himself, since knowledge is power, and “All power,” as Emerson says, “is a sharing of the nature of the world.” Second (second only in order of sequence, not in importance) is the value to the large number of those whose increased soundness, and therefore increased power, is the direct result of the physician’s dealing with the things that make strength. And third (in order of sequence) is the value to the world at large; for all increase of knowledge and power and strength becomes a part of the world’s inheritance, and this is perhaps the widest and most positive value of all.
We see, then, the specialist taking his little bit out of the work that lies waiting for who can and will do it, giving to it the best of his time, his strength, his intellect, perfecting it more and more until he returns it to the world again, as a sculptor might the stone into which he has wrought his brain, his heart, his life, and which has become, in the process, of a value immeasurable.
The practical proof of the value of specialization in medicine lies, of course, in what has been accomplished through specialties that would not have been possible under the time and opportunities afforded by general medicine.
This is somewhat difficult to specify with exactness; but it is safe to say that the enormous results that have recently been obtained in surgery, gynecology, obstetrics, neurology, and ophthalmology could not have been reached but by that deliberate concentration which is indeed the “secret of strength.” I need not dwell upon the work that has been done by the men in each of these different fields, although it would be pleasant to do so, for with much of it you are familiar, and to begin would make my task an endless one. But of the results of special work in bacteriology-a comparatively new field for specialization-I wish to speak a little more at length.
Whatever a man’s work may be, whether generalist or specialist, whether Old School or New, bond or free, if he is a physician at all, one thing he must be familiar with, so far as study and investigation can make him so, and that is the nature of disease. This, I think, will be admitted without question, and no further argument will be necessary when it is remembered that no less a subject than that-the nature of disease-has come to be entirely reconsidered in consequence of the light thrown upon it by the investigations and discoveries of bacteriologists during the last few years.
I have somewhere read that the “new” opinion which now obtains was held by some several centuries before Christ, and has found credence in every age since, but it eluded proof, and consequently could not gain general acceptance until the specialization of bacteriology has brought knowledge on these lines to such a point of perfection as to establish as a fact what more than eighteen previous countries filled to render more than “probable.”.
The contest between the bacterium and the phagocyte has added a new factor to our study of disease, and has made necessary a statement of every pathological equation. It has robbed tuberculosis of half its terrors by localizing its origin and making large possible its prevention. It has lowered the mortality in surgery a phenomenal degree. It has demonstrated the source of typhoid fever and diphtheria, and it has proven the germicidal character of cholera and enabled us to keep it at bay. It has elevated sensation to a position of first rank, and makes it possible for us to deal more intelligently with matters of dietetics and hygiene.
Not all our problems are yet solved, but we may now deal with them in a more direct and scientific way, and are much further advanced toward their correct solution by reason of the data put into our hands through bacteriological research.
As brilliant and important as have been the additions to our medical equipment through the medium of specialism in the past, I cannot but believe that greater things are in store for us when we have learned more practically that specialization does not mean separation, and when specialists work more constantly in unison.
And now let us hear the conclusion of the whole matter, in words more strong and beautiful than I would hope to equal, words taken from the “Ethics of the Dust,” by John Ruskin:.
“The highest and first law of the Universe, and the other name of life, is ‘help.’ The other name of death is ‘separation.’ Government and co-operation are, in all things and eternally, the laws of life; anarchy and competition, eternally and in all things, the laws of death.
“Exclusive of animal decay, we can hardly arrive at a more absolute type of impurity than the mud or slime of a damp or overtrodden path in the outskirts of a manufacturing town. That slime we shall find in most cases composed of clay (or brick- dust, which is burnt day), mixed with soot, a little sand, and water.
“All these elements are at helpless war with each other, and destroy reciprocally each other’s nature and power; competing and fighting for place at every tread of your foot; sand squeezing out of clay, and clay squeezing out water, and soot meddling everywhere and defiling the whole. Let us suppose that this ounce of mud is left in perfect rest and that its elements gather together, like to like, so that their atoms may get into the closest relations possible.
“Let the clay begin. Ridding itself of all foreign substances, it gradually becomes a white earth, already very beautiful, and fit, with the help of congealing fire, to be made into finest porcelain, and, painted on, can be kept in king’s palaces. But such artificial consistence is not its best. Leave it still quiet, to follow its own instinct of unity, and it becomes not only white but clear; not only clear but hard, but so set that it can deal with light in a wonderful way, and gather out of it the blue rays only, refusing the rest. We call it then a sapphire.
