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tions, he illustrated his meaning by grimaces and a variety of grotesque manipulations of his person which served to fix in the mind of the terrified student the truth that meddlesome midwifery must be bad. Such teachings bore their legitimate fruits. Operative interference in obstetric practice was a resort to which each practitioner was brought only after every prudent mean was exhausted, and the condition of the patient imperatively demanded assistance. The frequent employment of artificial aid in midwifery practice was an opprobrium under which no accoucheur would willingly rest. It was the pride of practitioners to report the number of cases which they attended annually without the use of forceps. Several of the oldest and most eminent obstetricians of this country can boast that they never had occasion to use the forceps more than once, twice, or thrice in their own practice; nor did they have a considerable annual mortality among their cases. Their records of practice, on the contrary, exhibit a per-centage of deaths too slight for criticism. But whoever is familiar with current medical literature must have become convinced that a new and powerful school of obstetrical practitioners and teachers is rising into importance, which has for its chief aim to popularize operative midwifery. With them the old text, "meddlesome midwifery is bad," passes for a prejudice of our forefathers. Brushing it away as the rubbish of the past,

they have laid as a foundation for the superstructure which they are building, the power and necessity of art to guide to successful issue the processes of nature. While science is leading physicians and surgeons to conservatism, its teachings have a contrary influence upon obstetricians. As the armamtarium chirurgicum diminishes, the armamentarium obstetricum increases. Twenty years ago few practitioners had obstetrical instruments, and these were carefully concealed; to-day they are a necessary part of the graduate's outfit, and occupy too frequently a conspicuous place in his office. The change in obstetrical practice which we have indicated as now in progress must be witnessed with alarm by every believer in conservatism in medicine. Already we witness the sad results which must inevitably follow the inculcation of an aggressive practice in midwifery. Many lying-in asylums give a far larger mortality of puerperal cases and of still-births at full term than formerly; and the history of these institutions shows that the number of instrumental cases is annually largely increasing. Private practice would, if honestly written, give similar results. The medical journals teem with the death-records of meddlesome midwifery; and it is surprising what senseless audacity is frequently exhibited by these progressive obstetricians in publishing to the world the records of their own shame. It was not long since that a

practitioner of this school gravely advocated version in natural labor, and reported a large number of cases in proof of its advantages, in several of which the arm or leg was fractured during the necessary manipulations. It would seem quite impossible that a school of practice, founded on such erroneous principles, and giving such disastrous results, could ever make proselytes. It requires, however, but a slight knowledge of human nature and the peculiar temperament of the present age, to discover that such a code of practice has many elements of popularity. The éclat of an operation is never lost sight of by the ambitious. If the license is given they will never fail to find the opportunity to impress the community with their skill and daring. The tedious waiting at the bedside may also be limited by interference, and the practitioner is liable to consult his convenience rather than the interests of the patient. In the earnest and eloquent words of a recent author, "it is time that plain language should be spoken on this subject: the spirit of conservative midwifery seems to have been lost in sleep; the ordinances of nature have been disregarded, and the accoucheur with instrument in hand, rampant in his desire for opportunity, rushes with good heart and unmeasured confidence to what he deems the scene of conquest, but too often, alas! it proves a scene of harrowing agony to the unhappy patient.”

XLV.

SPECIALISTS IN MEDICINE.

TH

HE tendency of the age is to the division of labor. We see it in all the mechanic arts and in every department of human service and thought. It grows out of the limited capacity of both the body and mind, and the constant expansion of every branch of science and of every department of industry. Not all minds can grasp the widely varying facts in any one of the generally recognized divisions of the sciences, much less become profoundly conversant with them. Neither can the artisan become proficient in many branches of the same business. He who is recognized as a "Jack at all trades" cannot excel in any one art, though he may be a most useful person by his general knowledge. Medicine, as a science and an art, has not escaped this tendency to the division of labor. The three grand divisions, practical medicine, surgery, and obstetrics, have long been recognized and adopted. They very naturally grow out of fundamental differences in methods of treatment of diseases. Surgical affections require, for the most part, entirely different remedial agents from medical diseases; and the prac

tice of obstetrics differs equally from both in the appliances of art. In the progress of the medical sciences many of the classes of maladies embraced in these several grand divisions have become objects of special study, as the diseases of the eye and ear in surgery, of the heart and lungs in medicine, and of the uterus in obstetrics. These divisions have gradually become more and more numerous, until surgery, medicine, and obstetrics are little else than an agglomeration of specialties. The necessity of pursuing the study and practice of a single branch in order to success, is beginning to possess the minds of young physicians. They are stimulated by the examples of men who have won reputation and fortune by devotion to a specialty. It is time that this subject was thoroughly discussed in all its bearings, that the younger members of the profession may have correct views of the advantages or disadvantages of such a course. The arguments geneerally brought forward by the advocates of specialties in medicine are, as we have already intimated, those which apply to a division of labor in any other department of business. And they have great plausibility. To surpass all contemporary laborers in any single pursuit requires the undivided efforts of every ordinary mind. But we are not prepared to accept this reasoning in an unqualified sense. As a general rule we must aver that the man whose knowledge

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