of moderate severity and the physician careful and observant, he will 

 soon note, symptoms which do not squ&re with the fevers which he has 

 been accustomed to see. He may then suspect that all is not right 

 and begin to think of the possibility of yellow fever. Immediately 

 the purely medical and scientific character of the case becomes 

 clouded by the material considerations involved. Is the diagnosis 

 positive? Shall the case be reported or not? From where could 

 the infection have come? This last question is always given undue 

 weight, with fatal results, because as a rule it is impossible to answer, 

 and its consideration leads to uncertainty and delay. But why 

 should we pause to answer ? Do we do so in a case of measles, scar- 

 latina, or smallpox ? Why not make the diagnosis on the symptoms 

 of the disease as presented to us and not bother at that critical mo- 

 ment with the abstruse study of its possible origin? That surely 

 would be the most rational and practical way to proceed. In any 

 case, it is indeed a heavy responsibility to satisfactorily answer these 

 questions under the conditions at present affecting our Southern 

 States or other localities similarly placed. The usual course of action 

 is as follows: The attending physician will consult with his con- 

 freres. Some will opine that it is, others that it is not, yellow fever. 

 One who has had some experience with the disease, a so-called 

 expert, is finally called in and, we will presume, verifies the diagnosis 

 of yellow fever. As an immediate result of this declaration, the 

 physicians of the place, and with them the public, divide into two 

 antagonistic camps, one maintaining that the disease is yellow fever, 

 the other that it is not. And thus, with much wrangling and dis- 

 order and under the most discouraging circumstances, the work 

 of preventing the spread of the disease is inaugurated. The effort 

 to stamp it out then becomes a veritable campaign, not only against 

 the mosquito, but against a usually small but determined party of 

 opposition among the people. Such a condition of affairs would 

 not exist if the diagnosis could be promptly established beyond ques- 

 tion or cavil. 



To attain this being impossible with the diagnostic means at 

 present at our command, I pass on to speak of what seems to me a 

 most important indirect prophylactic measure, one which may do 

 much to offset the results of our present inefficiency to promptly 

 establish an absolutely correct diagnosis — and that is education. 



EDUCATION AS A PEOPHYLAOTIO FACTOR. 



The people in general, and the medical profession as well, should 

 be taught the truth about yellow fever, its comparatively low. mor- 

 tality as treated at present, and the facility with which the disease may 

 be avoided and controlled. In a community which is well informed 



