Specialties in Medical Practice.
Selected writings of A. Jackson Howe.
"Man proposes and God disposes." In the midst of life we are near to death. The last sentence of this selection show's how little one can bank upon heredity and how unexpectedly the fell destroyer may come upon us. "The lion in the path of the ambitious is that I am in the enjoyment of robust health and my ancestors have been afflicted with longevity" writes Professor Howe He could not foresee, nor little did his readers expect, that before this paragraph would be read Professor Howe would have passed the portals of life unto death. Even as his great heart was stilled his teachings went on, and to this day their influence is widely felt in Eclecticism. Professor Howe believed in specialties in medicine, but not to the extent that they are carried at the present time To those whose mad desire is to rush at once into a specialty his words concerning fitness and preparation should prove profitable Much that is now claimed by the specialist can be successfully and legitimately done by the general practitioner, and much that some general practitioners attempt should be referred to the competent specialist The latter is especially true of surgery, which ought to be done chiefly by surgeons, and in places of surgical safety and not in the dangerously unsafe offices of most general practitioners nor in the surgically unprepared homes of the sufferers The specialist should also have several years of general practice to fit him for special work—Ed Gleaner.
SPECIALTIES IN MEDICAL PRACTICE —Although much fault has been found with specialties in medicine they seem to go on and flourish. The alienist gives his time and attention to mental disorders; the oculist attends to defects of vision; the aurist confines his studies to the ear; the rhinologist restricts his professional labors to the nose; the pulmonist treats consumption and cardiac troubles; the gynecologist spends his energies upon diseases of women; and the obstetrician engages in parturition; while the surgeon gives most of his time and attention to operative measures —to cutting disease from the human organism. But the most busy of all is the family physician. He works night and day in taking care of the little things as well as the great. He medicates febrile disorders; he manages "colds" and coughs; he prescribes for unaccountable aches and pains; he has to prescribe for senile asthma, paralysis, cystitis, insomnia, boils, corns, chilblains, and every sort and kind of ailment. And to do this successfully and satisfactorily he must be at home (or about home) all the time. He can not recreate in summer, nor deer hunt in winter—he is a fixture, or his practice will decline and eventually vanish.
The same necessity governs the obstetrician. If he would take engagements and keep them; if he would attain eminence in the art and science of obstetricy, he can not be away from home when the parturient women call for professional help. If the obstetrician would be an operative gynecologist, responding to calls from a distance, he can not sustain a large obstetrical practice. While he is executing hysterectomy away from home his lying-in patients will have to seek professional aid elsewhere. Once I attended twenty or thirty obstetrical cases in a year, but now I have only accidental or consultation cases. The word is that "the doctor may be away from home, on some surgical tour, just when I may want him."
The ambitious practitioner may cater for all kinds of practice— aim to be oculist, dermatologist, surgeon, obstetrician, gynecologist, and to do the duties of a general practitioner; but trying to cover everything he will fail in many ways—will prove a failure in all of the specialties. One specialty is enough for any practitioner to pursue. Besides, the nature of the doctor's education and general make-up will have much to do with success in any branch of practice. All are not fitted to be oculists, obstetricians, and surgeons. A good knowledge of anatomy is essential to surgical success; and the contingencies of abdominotomy are such that only the coolest and most courageous can overcome a set of unexpected contingencies. The timid will close the "exploratory" incision, and lose an opportunity to gain experience and reputation. To fight out of a complex abdominal difficulty requires the highest order of heroism. Furthermore, it requires many years of professional life to acquire a reputation which shall command a paying patronage. Unless a physician be well fitted physically, mentally, educationally, and ethically for a surgical career, to enter upon the course leading in that direction will prove unprofitable. I am led to make these remarks by several physicans, who, under the impression that I might be on the point of retiring from active practice, were desirous of entering upon a course that might lead to successorship. The lion in the path of the ambitious is that I am in the enjoyment of robust health, and my ancestors have been afflicted with longevity.—HOWE, Eclectic Medical Journal, 1892.