knowledge of the truth. Medical genius frequently leads to medical hobbyism, and a hobby-horse is like another horseit must be curbed and guided to make it useful, but having been once trained it serves a very useful purpose. The moving spirits of the past were no doubt hobbyists; their enthusiasm often brought condemnation upon them; yet the works of Nestor, of Averroez, of Keppler, Kant, LaPlace, Darwin and the living Haeckel are monuments to these master minds more enduring than shafts of marble. Genius manifests itself in a special adaptability in some particular line, in medicine as well as in music and art; but as music is an instrument with a thousand strings, and each string has its specialist, likewise is it with art, with literature and with medicine. The law of natural selection is as infallible in medicine as in the other departments of human occupation, but the general practician is as necessary to the maintenance of medical science as the general farmer is to the maintenance of the science of agriculture. The demand for exact knowledge that has arisen within the past century has acted as an incentive for men to enter the specialties, for it is there only that the truth is likely to be found. Democratus asserted that the final result of human inquiry is the discovery that man is incapable of absolute knowledge; that even if the truth be in his possession he cannot be certain of it. But since the days of Democratus we believe we are getting pretty nearly the truth in some lines of medical inquiry. Modern medicine attempts to find natural causes for all diseases, and long since threw off the yoke of medieval supernaturalism. It looks not to the stars nor to the wrath of God, but finds in Mother Earth and her products enough of cause. The specialists of today are not fully satisfied that they have arrived at the truth. They have produced disease to demonstrate the action of bacteria, and they have killed the germs to demonstrate the usefulness of their antiseptics. The truth is beyond our reach, possibly beyond our conception, but the search for it has stimulated investigation in special lines to such an extent as to render what little knowledge we have more nearly exact. It has taught us that there is a cause to be found somewhere in nature for all our physical ills. It has invented the microscope to study pathology and physiology; and by the discovery of causes, it has watched the action of therapeutic agents. It has added new and potent remedies to combat disease and has eliminated the useless and unfit. This dissatisfaction with one's environment, which is characteristic of all nature, is equally patent in the medical profession, and leads to two note-worthy results: A weeding-out of the incompetent, and a better equipment of those capable of withstanding the struggle for existence. It weeds out the incompetent, because no competent man will be content to stand still; and the practician of medicine who stands still, whose books are the shelf-worn tomes of his preceptor, is a contradiction of the law of evolution, which we have assumed to be so comprehensive that no progressive physician will raise a question as to its infallibility. It leads to a better equipment of the competent, for he is the first to note his own imperfections, and is the first to profit by his errors. An English rhymester once wrote that a little learning is a dangerous thing, and advised that one drink deep of the fountain of knowledge, or taste it not. The appetite for knowledge, like the appetite for artificial stimulants, grows greater and greater, but unlike in the case of stimulants man never becomes full. Every physician here has experienced the difficulty of prescribing for and carrying treatment to a successful termination in a man whose knowledge of physiology was gained at a temperance lecture or from reading a patent-medicine circular. Physiology of all subjects pertaining to medicine is the most in the dark. Nature throws a veil over her workings, and permits us to see only her grosser actions through its meshes. Yet the ignoramus who has possibly seen the blood current in the webb of a frog's foot through the microscope or has probably vivisected a halfyear old bull-calf, answers the question of an examiner, made one by his political "pull,” and receives a certificate to teach physiology to our children from a text-book that receives the sanction of the W. C. T. U., and the effect is just what Pope deprecated. The failure of an unqualified man to attain renown as a specialist often drives the would-be specialist to newspaper specialism. He succeeds, after a manner, in pulling the wool over the peoples' eyes (and the majority of the people are very susceptible to such wool-pulling). He gains the confidence of a clientele sufficient, though not of a desirable quality, to make him a fair income; or, failing in this, he travels over the country, and using the newspapers as a herald, rakes in the golden sheckles of his dupes until found out, when he strikes out for pastures new and patients more green. The law of the survival of the fittest works doubly in this case; for with his patients only the strongest can recover, and these are less likely to consult the next quack, and thus he too is the remainder in the division of labor. In general medicine the elimination of the unfit is a much slower process. He will long be with us. Ten-year practice acts and lax medical examining boards and supreme courts and Christian Science legislators will long make it possible for men to become legally qualified who are not educationally qualified. But with the more liberal education of the masses, this class of practicians will yield to nature's unrelenting law, and be lost in the struggle for existence. With him must also go the legalized, but unqualified specialist. Nearly every city of a few hundred population has its catarrh specialist, its genitourinary and lost-manhood specialist, legalized though he may be; yet he is a money-sucking leech, a stigma upon the escutcheon of scientific medicine. He is likewise the friend of the pure quack and the unethical portion of our regular profession. He exists like his friend the quack, through the sympathy of tender-hearted physicians and his blackmailing influence upon the ward politician. Together with the pure quack, this class of specialists seems doomed by our natural law. The Roman Horace wrote wisely of his art, but assumed too much of the divine when he said "Poeta Nascitur, non fit." The world is beginning to realize that the grand, the sublime, the nigh-perfection is reached only by a gradual pro cess. The one rosebush that blossoms after frost is a freak, yet the seed from that rose is more likely to stand the bitings of Jack Frost than those from the next bush, and thus by selection the gardener may finally get a rose whose bloom will grace the lapel of the well-dressed specialist throughout the coldest winter. As the poet shows the refinement of soul of one in love with nature, and thus separates himself from the common herd of humanity; so the specialist in medicine, deeply in love with that branch of his art in which he feels his greatest competency, delves deeper into its depths and becomes more closely in touch with its intricacies than the man who attempts to cover the whole field of medicine. But can we say of the specialist "Nascitur non fit?" Many of the laity seem to have the notion that there is something akin to the supernatural in medical specialism. This idea is of course, the child of charlatanism and the Weltmeristic advertisement. Doctors, be they specialists or not, are not born under any special dispensation of Providence, and they are not able to keep diseases from themselves by any mysticism. They have no secrets save the closeted skeletons of their patients. |