There may still be justification for innocent temporary deception and for professional reserve, but it certainly is true that the general tendency among physicians whose standing and practice are most assured is to speak frankly, to assume a modicum of common sense and general intelli gence on the part of patients who show these qualities in other relations of life, and to rely for public respect upon their real skill in diagnosis, their acquired judgment as to treatment and remedies, and their familiarity with the literature and with the unrecorded professional experience which together place, of course, an impassable gulf between the competent physician and his best generally informed patient.
A similar change may be expected in the attitude of the profession toward other groups of workers whose social aims are similar to the aims of public-spirited physicians who wish to reduce the death-rate and to lessen human suffering. There are many things which might be done by others than physicians if these others could be confident that in doing them they are moving in the right direction ; if physicians would offer them the necessary direction, encouragement, and support ; if their personal relations with physicans were sufficiently intimate to permit the correction of errors before they had become serious and before the workers in question had done something inad vertently to invite ridicule or contempt.
The county and state medical organizations afford, in part, the machinery through which such increased coopera tion might be secured. These organizations have rendered excellent service of a negative kind to the community in preventing loose and unsafe legislation, and have also participated in positive movements for social betterment. It may be that the trade-union element, the mutual bene fit element, the class-interest element, or whatever that element should be called which socialists are trying to develop among workingmen, and which is so conspicuous a feature of Wall Street, has been present also in these organizations. There is no special occasion for criticism if that is the case, and yet the ideal undoubtedly calls for the organization of the professions primarily not for self protection, but in order—that through such organization more effective cooperation with the best social tendencies z may be possible. It is a question only of the point of view. The test of whether it is worth while to belong to an organization is not what it contributes to one's income, but the, extent to which it increases one's power for use ful service to mankind.
The Rockefeller Institute in New York and the Chicago Institute for the Study of Infectious Diseases are made possible by special endowment. Both of them will natu rally find useful materials in the experiences of the chari table institutions, the settlements, the hospitals, and certain of the city and state departments ; and will in turn con tribute materials for the more fruitful prosecution of the work of these agencies. Those who favor a democratic organization of society, and who like to see workers get the maximum satisfaction from their daily work, might conceivably long for the time when special endowment or subsidies for such purpose would not be necessary; when each physician who has the capacity for research and the taste for it might afford to devote some time to it ; and when such special labors as require the prolonged and continuous attention of the investigator might still in some way result from the mutual sacrifices of the medical profession itself.
Those who are engaged in the relief of distress, unless they are mere automata, are inevitably led on to the consideration of preventive measures. Among all the causes of undeserved destitution, sickness is the most con spicuous. It is certainly most unsatisfactory to be taking part in the relief of families who are in distress because of illness, and at the same time to realize that forces are at work and conditions are present which are undermining the health of others, and leading inevitably to the situation in which relief will be required. The personal indignation which is aroused by the neglect of such forces and con ditions would be a valuable ally in securing the changes which physicians well know to be essential. The social force which might easily be developed among charitable visitors, professional and volunteer, among clergymen and church visitors, among trade-unionists and social reformers, can scarcely be exaggerated.
One of the diseases whose insidious and evil effects are most frequently encountered by those who are called upon to inquire why a family cannot be self-supporting is malaria. It not only increases the hardship of wage earners, causing irregularity of work and reducing physical energy, but it makes precisely the difference between self support and dependence for many of those who are already near this dreaded border line. It attacks adults as well as children, and its full effects upon the economic position of the family may not be obvious until many years after the fever has been acquired. Is it not then important, if we would lessen the burden of poverty and the need for charitable relief, to do everything that science has demon strated that it is possible to do to lessen the number of its victims? If it is true, to quote Dr. Howard's language, that perfectly satisfactory proof has been gained during the past few years that mosquitoes " are responsible for the transmission of the malarial germ from the malarial patient to healthy is it not incumbent upon us to utilize to the full every influence that will compel the adoption of the remedy which is thus indicated, viz., the extermination of the mosquito ? Is not the time already longer than should have elapsed between the demon stration and the public policies which are its logical result ? Should we not attack malaria in every community in precisely the spirit in which the military governor of Cuba acted upon the results of the experiments and demon strations at Havana ? The conquest of yellow fever as a result of demonstrations made at Columbia Barracks near Havana, in 1900-1901, that the disease is communicated through the medium of a certain species of mosquito, is one of the most brilliant achievements of medical science. The United States military government, during its brief existence in Cuba, not only freed the island of yellow fever, but also made great strides in the control of malaria and of tuberculosis. At the time of a visit by the author, in 1902, there were to be seen two interesting, tangible indications of these changes. In a corner of one of the general hospital wards there was a small enclosure the walls of which were wire screens. It was separated only 1 " Mosquitoes: How they Live ; How they carry Disease; How they are Classified ; How they may be Destroyed," L. 0. Howard.