As Ross well says, "Not only our comfort, but our security depends upon the measures we adopt against these insects"- the mosquitoes which indeed are the true sources of danger in the transmission of malarial fevers. The recent work in prevention of the disease is designed to get rid of the mosquito which transmits it, and the thorough organization of brigades for this purposes promises more effective results than other methods. The work accomplished in Cuba in overcoming the spread of yellow fever by annihilating its medium of transmission, that variety of mosquito, the, culex has given a practical and lasting impression of the power for good to be had in thorough organization for hygienic purposes. It pays to be clean, both morally and financially, and it would seem that the problem of malarial fevers is resolving itself into one of public hygiene. This season has witnessed an unusual prevalence of the pest, mosquitoes, due largely to the excess of rain, with high water which has left many breeding places for the mosquitoes. We can expect, therefore, an unusual prevalence of malarial fevers during the late summer and early fall. Physicians familiar with early history of his part of the country, and especially with prairie regions, know that malarial fevers are decidedly less prevalent now than formerly, and due to the extensive drainage introduced in the development of farm lands. Drainage here is a practical demonstration of the facts deduced by the observations made by Koch, Ross and others, where they reduced the possible breeding places of the mosquito, and by so doing reduced the prevalence of the disease. The mosquito-theory has become the mosquito-fact of etiology of malarial fever and every physician should well consider the work of Howard in this country, that of Ross, Manson Koch and other European observers, and endeavor to profit by these intensely interesting scientific advancements. F. P. N.

ONE of the most trying experiences of the practitioner is to formulate a prognosis. To the young man just entering practice there is perhaps

The Question of Prognosis.

nothing so overwhelming as the question of prognosis; to him diagnosis and prognosis represent the Scylla and Charybdis of practice and call upon him to command all of his skill, tact and good common sense in order to steer successfully through these difficult and trying ordeals to be confronted in every serious case.

The following helpful editorial (Medical Record, August 16, 1902) is full of consolation and good advice, and should be read by every earnest worker in clinical medicine. It was written by one, evidently, who with accumulated experience, views every case as one worthy of study and thoughtful consideration from every view which clincal knowledge can suggest:

'Every physician who has inadvertently committed himself to a positive opinion regarding the outcome of a case under his care, learns by bitter experience and becoming chagrin how difficult-in fact, impossibleit is to be absolutely sure of his ground. There are in the vast majority of instances so many incidental circumstances to be considered in forming

conclusions that he is never safe in trusting to a possible chance. The verdict, whether pro or con, always determined by time, is sure to settle the question for or against him beyond the chance of explanation for his demonstrated mistake. Thus the wise man always qualifies and inserts the "if" in all his prognostications. In this, avoiding conclusions which are obviously beyond his control, he is willing to venture in a purely suggestive way, as to probabilities, rather than actualities. His reasons for such a course are well-founded and beyond the range of ordinary argument.

"He is not long in practice before he becomes aware of the fact that the most unexpected things happen; the most trivial diseases in apparently strong patients end disastrously, while the severe ones, generally looked upon as hopeless, recover. Oftentimes also death occurs as suddenly and unexpectedly as with a stroke of lightning from a clear sky. No one of the signs of dissolution are absolute. Even the hippocratic face sometimes survives to smile at the would-be prophet. The old physician who said he never acknowledged that a patient was caught. Even when at his wits ends to account for the result, he found it safer to accept the explanations of the patient's friends than to offer any himself. It was in one way the cultivation of the faculty of never being surprised at anything, but quietly expecting everything. Ordinarily there are difficulties enough in trying to guide the ship without attempting to govern the storm or the fog. The only cheerful thing to say is that the vessel will eventually reach the port if there be no accident--and death is always the accident. We are told by the highest authorities that the sudden deaths give no preliminary sign. Before an attack of apoplexy, the stroke of which is so often given during sleep, the patient often says on retiring, that he never felt in better physical condition. With heart disease, the victim often passes away with an unfinished sentence on his willing lips. Death simply touches the pendulum, and he stops like a clock. The wasting consumptive, wearily awaiting the messenger, asks that his head be raised-and the last gasp is given. The fatal coma of uremia often comes on as suddenly as the blowing out of a light. So far as human prediction is concerned, the exact time depends upon a mere whim of the wasting destroyer; and yet the physician is expected to explain the when and the how.

"In his contemplation of conditions controlling the outcome of disease he must take many-sided views as to correctness of the diagnosis and treatment, the often uncertain action of remedies, the variable vitality of the patient, and reconcile all to the reactionary tendencies of the particular case in hand. While it is always necessary and proper to be optimistic to the patient, it is never safe to say he is absolutely beyond danger. This would obviously apply with more particular force to the patient's friends, who are not supposed to communicate suspicions to the one most particularly interested. 'May he die suddenly?' 'I hope not, although sudden deaths are not common in this disease.

"When we sum up the situation on the question of the always unknown quantity-the vitality of the particular individual-what more can be said, and what more can be expected?"

Fortnightlettes

THE Frisco Railway Hospital, at Springfield, Mo., is to be enlarged to double its present size.

DR. A. P. OHLMACHER has been appointed superintendent of the Ohio Hospital for Epileptics, at Gallipolis, to succeed Dr. Coleman, resigned. Dr. Richard F. O'Connell has been appointed assistant.

THE INDIANA STATE MEDICAL SOCIETY.-The officers for the coming year are as follows: President, Dr. J. B. Berteling, South Bend; vicepresident, Dr. Will. H. Gilbert, Evansville; secretary, Dr. F. C. Heath, Indianapolis; assistant secretary, Dr. J. H. Grant, Richmond; treasurer, Dr. A. E. Bulson, Indianapolis..

A SHIPMENT OF PREPARED OPIUM, worth more than $500,000, arrived at San Francisco from Macao, China, July 5, on the Steamer Doric. The opium consists of 810 cases, or 33,210 pounds, upon which the duty is $199,260, making the commercial value $531,000. It is the largest shipment of opium that ever reached that city.-Meyer Bros. Druggist.

AMERICAN ORTHOPEDIC ASSOCIATION.-At the sixteenth annual meeting, held in Philadelphia, the following officers were elected for the ensuing year: President, Dr. L. A. Weigel, Rochester, N. Y, Vice-presidents, Drs. R. H. Sayre, New York, and R. T. Tayor, Baltimore, Secretary, Dr. John Ridlon, Chicago, Treasurer, Dr. E. G. Brackett, Boston.

COLLEGE WILL NOT REOPEN.-The faculty of the Cincinnati College of Medicine and Surgery decided, August 8, not to reopen for the coming fall session. The reason for this closure is the falling off in attendance, which has become so marked in all institutions of medical teaching throughout the State since the entrance requirements have become so rigid.

WORLD'S TOBACCO USERS.-According to recent statistics, the average consumption of tobacco by each person in the various countries of the world is as follows: Netherlands, 3, 400 grams; United States, 2,110; Belgium, 1,552; Germany, 1,485; Australia, 1,400; Austria and Hungary, 1,350; Norway, 1,335; Denmark, 1,125; Canada, 1,050; Sweden, 940; France, 933; Russia, 910; Portugal, 850; England, 680; Italy, 635; Switzerland, 610, and Spain, 550.--Med. Record.

A CRYING NEED.-The last census contained several surprises, but the one shown in the table below would indicate that physicians looking for a location need not long hesitate in a choice between Missouri's three largest cities. St. Joseph'sphysicians must be overworked:

Society Proceedings.

PRELIMINARY PROGRAM OF THE MISSISSIPPI VALLEY MEDICAL ASSOCIATION.

The following is a preliminary program of the twenty-eighth annual meeting of the Mississippi Valley Medical Association to be held at Kansas City, Mo., October 15, 16 and 17, 1902:

Address in Medicine, by Dr. Hugh T. Patrick,. Chicago, Ill.

Address in Surgery, by Dr. Geo. W. Crile, Cleveland, O.

1. Oil of Erigeron, its Use in Hemorrhages and Uterine Congestions, by J. M. Postle, Hinckley, Ill.

2. The Criminal Responsibility of the Epileptic, by John Punton, Kansas City, Mo.

3. Isolated Thrombosis of the Jugular Bulb, its Diagnosis and Surgical Treatment, by Norval H. Pierce, Chicago, Ill.

4. The Surgical Treatment of Trigeminal Neuralgia, by Truman W. Brophy, Chicago, Ill.

5. Drainage in Surgery, by J. Lively Johnson, Louisville, Ky.

6. Smallpox, by J. M. Batten, Downingstown, Pa. Discussion opened by Clinton E. Sapp, Omaha, Neb.

7. Syphilis in the Negro, by Francis D. Kendall, Columbia, S. C. 8. Extrinsic Traumatisms of the Spine, their Diagnosis, Pathology and Treatment, by Thos. H. Manley, N. Y.

9. The General Consideration of Surgical Patients, by A. J. Ochsner, Chicago, Ill.

10. The Treatment of Extensive Rectal Strictures, by Emil Ries, Chicago, Ill.

11. Cancer, by L. H. Warner, New York City.

12 Plaster of Paris the Best Dressing for Injuries to and after Operations on the Extremities, Chest and Head, by A. C. Bernays, St. Louis, Mo.

13. Tubercular Peritonitis, by A. M. Pond, Webster City, Ia.

14. The Value of Ureteral Catheterization in the Male and Female, with Presentation of an Original Uretero-Cystoscope for Effecting that Procedure, by Bransford Lewis, St. Louis, Mo.

15. Antistreptococcic Therapy in Septic Conditions, by C. E. Ruth, Keokuk, Ia.

16. What Class of Pulmonary Cases do Well in Colorado? by W. A. Campbell, Colorado Springs, Col.

17. Medical Gynecology, by John H. Fuller, Wichita, Kas.

18. Diagnostic Points of Difference between Spermatorrhea and Seminal Pollutions, by F. R. Sturgis, New York City.

19. Some Developments in the Therapy of Iodoform, by J. J. Gaines, Excelsior Springs, Mo.

20. The Treatment of Tuberculosis, by Thos. Bassett Keyes, Chicago, Ill. 21. Preventive Medicine, by C. E. Crawford, Rockford, Ill.

22. A Severe Case of Purpura Hemorrhagica, Recovery, by B. F. Campbell, Burlington, Ia.

23. The Nature and Treatmnet of Tuberculosis, by Adam E. Ford, Denver, Col.

24. Renal Calculi or Gall Stones; Differential Diagnosis, Report of a Case, by Chas. E. Barnett, Fort Wayne, Ind.

25. Radical Treatment of Mastoiditis, with Report of Cases, by Robert Everett Moss, San Aetonio, Texas.

26. Exophthalmic Goitre, by Eliza H. Root, Chicago, Ill.

27. The Treatment of Typhoid Fever with Castor Oil, by C. C. Bass, Columbia, Miss.

28. The Mechanics of Intubation, by B. F. Gillmor, Creston, Ia.

29. Myomatous Tumors of the Uterus, by Leora G. Bowers, Richmond, Ind.

30. Relation of Gonorrhea to Tuberculosis of the Genito-Urinary Tract, by Daniel N. Eisendrath, Chicago, Ill.

31 Climate and Electric Peculiarities of Colorado Favoring recovery in Pulmonary and Intestinal Diseases and from Surgical Operations, by J. E. MacNeill, Denver, Col.

32. Chronic Nasal Catarrh, Medical and Surgical Treatment, by T. E. Speed, Jefferson, Texas.

33. Neurasthenia, its Etiological Relation to the Other Neuroses, by J. C. Gebhart, Dallas, Texas.

34. Vaccine Virus and Vaccination, by Hugh A. Cowing, Muncie, Ind. 35. Operation for Cancer of the Rectum, by Emerson M. Sutton, Peoria, Ill.

36. A List of the Medical Plants Indigenous to Southeast Kansas, by W. S. Newlon, Oswego, Kas.

37. The Care and Treatment of Girl and Woman, by Walker B. Gossett, Louisville, Ky.

38. Retarded Development of the Fetus and Prolonged Gestation, by W. D. Carter, Nashville, Ill.

39. Spinal Injuries, by Carl E. Black and Frank Parsons Norbury, Jacksonville, Ill.

40. The Present Status of the Treatment of Mastoiditis, by Geo. F. Keiper, Lafayette, Ind.

41. Through-and-through Intestinal Suture, with the Report of Additional Cases, by F. Gregory Connell, Leadville, Col.

42. Rheumatic Neuritis, Neurasthenia, Report of Cases, by John J. Taylor, Streator, Ill.