diagnosis of acute fevers. If there is an acute suppurative process going on in the ethmoid cells it is recognized by the fever and localized pain. By prompt treatment you can prevent destructive changes and the chronic suppurative condition which follows after the acute stage is passed. As very little has been given to the profession along this line, and those of us who are doing special work in the nasal cavities see these cases only after a destruction of the bones has set in or a chronic inflammation produced, I thought it would be well to bring this important subject to the attention of the profession in general, in order that future trouble which may last for years may be prevented. If the disease is recognized within the first 48 hours after the onset, abortive treatment may be instituted which will be successful.

CHAPTER IX

Natural Selection as Applied to Medicine and Medical Specialism

By CHARLES H. HIGGINS, A. M., M. D., Sonora

To some it may seem a little trite to announce a paper on the subject of evolution; yet to medical men and men whose minds have a scientific turn it must be noted that the mental renaissance inaugurated by such minds as Lamarck, Kant and Darwin is only beginning to bear fruit. Great as was the revolution in thought inaugurated by the fearless minds of the Reformation, a calm and sober judgment must realize that it was only an example of evolution by elimination of the unfit. It is true that in pre-Christian Greece, Arabia and Egypt we find evidence of a progress in pure science which seems marvelous, considering the abyss into which it had fallen during the Middle Ages, and many of us will fail to find in the change from paganism to popery very much of a victory for evolution; yet in the reformation of the sixteenth century only those most deeply prejudiced can fail to see a marked gain. We go back thus far only to remark that all advancement is gained by battling with error, and though error held the reins throughout the greater part of the Middle Ages, it was doomed to fall, as error must always fall, when truth breaks through the mist of mysticism and error sees her faults.

The history of the art of healing, though crude and sustained by credulity, is contemporaneous with the history of man; but the history of scientific medicine is of much more recent origin. Empiricism is contemporaneous with the earliest trustworthy historic records. Rational medicine is yet in its infancy, but the parental relationship of empiricism

to modern rational medicine can not be questioned. Though shorn of so many of the features of its ancestors as to be scarcely recognizable, it still possesses sufficient atavistic properties to leave no missing link in the chain of its evolution.

Our modern perfected methods represent the results of natural selection, or as Mr Herbert Spencer more concisely put it, “the survival of the fittest." By the retention of those methods which were found to be of use in a profession that is perpetually advancing and the discarding of the useless and unfit, we have reached a plane far higher than that of even a decade ago; so that the physician of today who draws his fund of knowledge from text-books must read them before they become shelf-worn, or he will fall behind in the modern march of medicine.

The evolution of an ideal form from a biologic point of view requires the most careful selection, even when the assistance of human agencies is invoked. Great time is required, and even when the desired object seems to be reached, a freak of nature or an atavistic accident frequently occurs which for the time may give us doubt as to the universality of our creed of natural selection. Leave the selection to nature alone, and the struggle for existence of the best may sometimes seem almost a hopeless task; but as nature has decreed that the feeble, the undesirable, must lose in the war of evolutionary succession, there is no appeal from the final judgment of annihilation, save traces here and there upon the shifting sands, which Eternity's ocean soon sweeps away. Equally slow is the evolution of an ideal form from a psychologic point of view-the ideal idea. The acme of mental activity is reached only by a succession of step-ladder advances.

The history of the Alexandrian School of Physicians gives us the first authentic account of an attempt at ideal medicine an attempt to free medicine from mysticism and make it rational-as well as rational views in the other fields of scientific research. It was here that the propelling power of

skepticism was most adequately demonstrated; and it was here that many great discoveries were made that were forgotten in the later strifes between rationalism and fanaticism. In the Alexandrian Museum there was an anatomic room for the dissection not only of the dead, but of the living who had been condemned for crimes. Is it not probable that the circulation of the blood was demonstrated at such a period of investigation? But with the intellectual dormancy of the thousand years from the fourth to the sixteenth centuries all was forgotten, and medicine, as well as mathematics and physics, had to be born again.

We have no means of estimating the loss that the art of healing suffered during these dark ages; but could we estimate it by the progress of the past century we would be safe in assuming that it would have attained as near the ideal as human wisdom can reach. It was during these dark centuries that the attempt at rational medicine of the Alexandrian School was supplanted by the mystic knowledge of the priesthood, and natural selection, which is always progressive when not interfered with, was supplanted by artificial selection, which often enough is in error, and instead of the mind being allowed to work out its problems in a natural way, the injection of false teachings and a subordination of the thinking individual to the unthinking state, so imprisoned human reason that there could be no advancement. Superstition and medicine became united, and the baneful effects of such marriage may be seen even now, every day, by the busy physician, especially if there is a large tincturing of rural patients in his clientele. Still in the past quarter-century the survival of the fittest from a medical point of view, not only among physicians' ideas of medicine, but in the medical ideas of the lay mind, has been most pronounced, and bids fair to eliminate the unfit entirely, if medical organization keeps up the crusade of education and a determined effort not only to educate the people, but to eliminate the unfit from our profession.

With the elimination of the unfit must go the freaks of

nature and the atavistic accidents in medicine-the pseudophysicians, and pseudospecialists, and pseudoschools of medicine. The disappearance of certain organs, as the eyes of subterranean animals, can be compared to the disappearance of certain methods of treatment and schools of medicine because of their uselessness. It is the specialist who sifts out the useful from the useless, the wheat from the chaff. As with the disappearance of the useless eyes we find an abnormal growth of the useful antennæ, so with the disappearance of useless systems we get an increased growth of the useful.

The evolution of specialism is a result of the action of an unchangeable law. As referring to some special adaptability of the individual to his environment, it is as much an example of natural selection as the establishment and maintenance of some special organic change in our anatomic and physiologic makeup. The breeder of fine sheep or cattle thoroughly understands this law, though he may never have read, or even heard of Darwin, Draper or Haeckel. He selects as the heads of his flocks those animals possessing characteristics especially suitable to his farm or his section of the country. He is only imitating nature, however, in so doing. While nature is abundantly capable of reaching this desired end, her workings are slow, and she accomplishes only in ages, without man's aid, what she may accomplish by human aid in the course of a few decades. Yet, after all, man's work is only fleeting, like an opiate for a pain. His influence upon nature is soon dissipated when his agency ceases. He acts only through human life, or more properly through the geologic age of man, while nature acts through all geologic ages, and though her actions are influenced to some extent by man, she keeps the even tenor of her way and in the end is victor over all. Few, feeble and fleeting are the monuments man will erect when compared with the handiwork with which Nature decorates her walls.

Natural selection does not effect variations which would be neither useful nor injurious. It implies the "preservation