Medical Specialisation 1830 – Becoming an Expert Amid Endless Complexity

Biochemist and author Isaac Asimov wrote: “I believe that our process of learning about science, and what we learn, have fractal properties: however much we learn, whatever remains, however small, is as infinitely complex as it was at the beginning.”

The development of medical knowledge, practice and technology creates a need for specialised fields within medical practice and training.

Medical historian George Weisz suggests that medical specialisation began on a large scale in the major hospitals of Paris in the 1830s, driven by the search for new medical knowledge, advances in education, new treatments and the spread of information. It subsequently expanded rapidly in Vienna in the 1850s. 

In the United States, it began after the Civil War with the growth of major cities, the interests of American doctors returning from European training, and new knowledge gained from experiences during the war.

Today there are many medical specialties and subspecialties. For example, a doctor may specialise in anaesthesia, with subspecialties in cardiothoracic or paediatric anaesthesia.

Examples of specialties in Turkey include:

1. Emergency Medicine
2. Forensic Medicine
3. Oral and Maxillofacial Surgery
4. Family Medicine
5. Algology (Pain Medicine)
6. Anaesthesiology and Reanimation
7. Paediatric Surgery
8. Paediatric Endocrinology
9. Paediatric Infectious Diseases
10. Paediatric Gastroenterology
11. Paediatric Haematology
12. Paediatric Immunology
13. Paediatric Nephrology
14. Paediatric Neurology
15. Paediatric Oncology
16. Child Psychiatry
17. Paediatrics
18. Paediatric Urology
19. Dermatology
20. Endocrinology and Metabolic Diseases
21. Infectious Diseases
22. Physical Medicine and Rehabilitation
23. Gastroenterology
24. General Surgery
25. Thoracic Surgery
26. Respiratory Medicine
27. Ophthalmology
28. Haematology
29. Internal Medicine
30. Obstetrics and Gynaecology
31. Cardiovascular Surgery
32. Cardiology
33. Clinical Microbiology
34. Otorhinolaryngology
35. Nephrology
36. Neurology
37. Neurosurgery (Brain and Nerve Surgery)
38. Orthopaedics and Traumatology
39. Pathology
40. Pedagogy (Child and Adolescent Mental Health and Disorders)
41. Plastic, Reconstructive and Aesthetic Surgery
42. Psychiatry
43. Radiation Oncology
44. Radiology
45. Rheumatology...

There are more than 150 specialties and subspecialties not included in this list, each divided into various further branches.

Description of the article image: Medical specialisation began on a large scale in the major hospitals of Paris in the 1830s. The image shows Jean-Martin Charcot (1825-1893), one of the founders of modern neurology, with a “hysterical” patient at Pitié-Salpêtrière Hospital, in an 1887 painting by Pierre-André Brouille (1857-1914).

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