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Obstetric cases. 5 schools offer their students no opportunity to attend obstetric cases before graduation; 28 give students opportunity to attend personally from one to three cases; 7 from three to five cases; 6 from 5 to Io cases; 7 OVCT I O CaSeS. Clinical cases yearly available. 3 schools furnish no evidence of having even one patient to present to their students before graduation; 4 have less than 500 patients all told from which to select clinical cases; 4 have less than Iooo; 5 between IOOO and 2000; 9 between 3000 and 5000; 8 between 5000 and 10,000; 6 between 10,000 and 20,000; 6 between 20,000 and 40,000; 3 between 40,000 and 100,000. Minimum number of hours of clinical attendance by each student. 6 schools offer less than 300 hours of clinical work in four years; 6 give only from 300 to 400 hours; 7 from 400 to 500 hours; 19 from 500 to 800 hours; 14 from 8oo to 1200 hours; 4 give over 1200 hours. Didactic work. 2 schools give less than 1000 hours in four years; 7 from Iooo to 1500 hours; 22 from 1500 to 2OOO hours; 13 from 2000 to 2500 hours; 4 from 25oo to 3000 hours; 8 give over 3000 hours. Total number of hours' work demanded of medical students. 3 schools demand less than 2000 hours; 2 from 2000 to 2500; I I from 2500 to 3ooo; 7 from 3000 to 35oo; 7 from 3500 to 4000; 26 over 4000 hours. The committee recommended a change in the constitution and by-laws of the association by the adoption of the following: I After July 1, 1900, and till more stringent rules be adopted, students beginning the study of medicine must possess a diploma from a high school giving a thorough preliminary education, or must pass a thorough examination in all the branches usually taught in such schools. This examination is to be conducted by a state superintendent of public instruction or some one delegated by him, or by members of the faculty of a university or college, who are not connected with the medical faculty of the school the student wishes to enter, or by such a body as the regents of the University of the State of New York. 2 Before a student can enter an advanced class he must present certificates from a school whose requirements fully equal those of this association of having successfully passed the examinations in at least three fifths of the branches embraced in the curriculum of the previous years of the school he desires to enter or he must pass examinations on the same; on the remaining branches he may be conditioned, but these conditions must be removed by taking the work, providing it has not already been taken, and by passing examinations before he can pass on to the succeeding class (that is a man shall not carry conditions for more than one year), providing, however, that this shall not prevent schools from allowing students who have earned the B. A. or B. S. degree and who have had an adequate course in science, or graduates in dentistry or pharmacy, who possess the proper preliminary education, to enter the sophomore class. 3 Before a student can be eligible for the degree of doctor of medicine he must have attended in a well-equipped medical school, four courses of lectures of at least six months each. These courses must embrace at least 3300 hours' actual work in the school, including besides didactic lectures and recitations, a 500 hours of laboratory work; b 150 hours of practical work; c One or more obstetric cases personally attended by each student; d 750 hours of clinical teaching. At least 45 months must intervene between a student's matriculation and the date of his graduation. All of the work should be fairly apportioned throughout the four years. 4. No school can be considered capable of giving the requisite instruction that can not command each year at least 3ooo hospital or dispensary patients for presentation to its classes.
Medical sects — As commonly understood, regular physicians have no distinctive theory or practice; homeopaths treat diseases with drugs that excite in healthy persons symptoms similar to the morbid condition treated; eclectics make use of what they regard as specific remedies, chiefly botanical; physiomedicalists use only botanical remedies, discarding those which are poisonous. In practice these distinctions are not always observed.
In addition to the medical sects to which detailed reference is made in this work a number of pathies flourish in many states unmolested under such names as osteopath, vitapath, electropath, hydropath, divine healer, magnetic healer, Christian scientist, faith curist, mind curist, sun curist, etc. Men and women without preliminary or professional training treat diseases under these or similar systems to such an extent that the health of the people is endangered. These so-called systems are followed with impunity in many states in what seems to be open violation of laws restricting the practice of medicine. This is due largely to the fact that so many statutes lack specific definitions as to what constitutes the practice of medicine, and without these definitions the conviction of such practitioners can not be secured through the courts."
Osteopathy was “discovered" in 1874. It is based on the theory that “a natural flow of blood is health" and that the bones may be “used as levers to relieve pressure on nerves, veins and arteries.” Osteopathy is now recognized by law in Iowa, Michigan, Missouri, North and South Dakota, Tennessee and Vermont. Practice of “the system, method or
* In Illinois the medical practice act provides special state examinations in obstetrics for midwives, and in anatomy, physiology, physiologic chemistry, histology and pathology and hygiene for those desiring to practise systems of treating human ailments in which medicines are not used internally or externally and operative surgery is not followed. The act does not apply, however, to any person who “treats the sick or suffering by mental or spiritual means, without the use of any drug or material remedy.” It is encouraging to note that notwithstanding this broad exemption Justice Everett of Chicago ruled against “divine healing" in August 1899. If his opinion is sustained in the higher court the “Zion curers" can no longer practise the “laying on of hands.”
science of osteopathy" is restricted to licensed physicians and to graduates of “a legally chartered and regularly conducted school of osteopathy." The use of drugs and operations in “major or operative surgery" are not permitted in the practice of osteopathy. In Georgia, Kentucky, Nebraska, New Jersey, New Mexico, Montana, Ohio' and West Virginia there are stringent laws against non-medical practitioners. In some other states, like Illinois, they receive such legal protection that any person may treat “the sick or suffering by mental or spiritual means, without the use of any drug or material remedy." Under these conditions any person in Connecticut, Maine, Massachusetts and New Hampshire is free to practise “the sun cure, mind cure, hypnotism, magnetic healing, Christian science, etc.” The greater part of New England’ seems to be on about the same footing in this respect with the Cherokee nation, Indian territory, where entire liberty is given to “enchantments in any form.” In striking contrast Hawaii inflicts heavy fines on any person convicted of an attempt to cure “another by practice of sorcery, witchcraft, anaana, hoopiopio, hoounauna, hoomanamana, etc."
*In spite of this the court (6 Ohio Dec. 296) held in January 1897 that an osteopath was not practising medicine by kneading and manipulations, using only his hands and no medicines. In Kentucky and West Virginia, however, the courts have upheld the statutes which provide that manipulations or other expedient shall constitute the act of practising medicine. In Nebraska the court (40 Neb. 158) ruled in 1894 that the “object of the statute is to protect the afflicted from the pretensions of the ignorant and avaricious, and its provisions are not limited to those who attempt to follow beaten paths and established usages.” In Americus, Georgia in 1899 six prominent citizens, Christian scientists, were sentenced to fines and imprisonment for refusing to submit to vaccination.
* In Customs and fashions in old Wew England Alice Morse Earle tells us that in “1631, one Nicholas Knapp was fined and whipped for pretending ‘to cure the scurvey by a water of noe worth nor value which he sold at a very deare rate.'" One is almost tempted to suspect that this whipping took as much out of the New England officials as it did out of Mr Nicholas Knapp, for since that remote date scarcely a rumor has reached us of any equally vigorous remonstrance with unqualified practitioners. As a result New England has been a specially promising field for quacks, not many of whom were considerate enough to follow the example of the celebrated “rain water doctor." Of this worthy it is recorded that he “worked wondrous miracles and did a vast and lucrative business" till he opportunely ended his career by tumbling into a hogshead of his own medicine.
There is much misunderstanding in this country regarding the duty of the state in relation to the health of the people. It does not consist in discriminating between schools or systems of medicine, but in requiring without prejudice or partiality of all who seek a license to practise for gain on the lives of fellow beings a minimum preliminary and professional training.'
Midwifery—Special tests for certificates of registration as midwives are required in :
Arizona Illinois Louisiana Puerto Rico
In the following political divisions the provisions of the medical practice acts do not apply to women engaged in the practice of midwifery:
Alabama Kentucky New Mexico Texas Arkansas Maine North Carolina Vermont" Florida Maryland Rhode Island Virginia Georgia Mississippi South Carolina Washington Idaho Montana Tennessee West Virginia
In other political divisions, though there are some special provisions for certain localities, the general acts regulating the practice of medicine make no reference whatever to the practice of midwifery by women. It would seem, therefore, that these laws restrict the practice of midwifery to
"In the November 1898 Medical record, W. A. Purrington of New York asks if we are to punish the physician who fails to report contagious diseases and allow a person who boasts his ignorance of medical and sanitary science to treat and conceal such cases. Medical laws provide only, at most, that no person shall practise medicine who has not studied medicine; a licentiate may practise as he pleases. But there is no reason why unqualified persons should be allowed to pretend to cure disease, by their pretenses deprive the sick of the benefits of science, and yet escape the just consequences of their imposture. * Either examination or approval of diploma. * Those practising midwifery without a certificate can not enforce collection of fee, but this does not apply to the practice of midwifery by women in the town or locality in which they reside. * In Nebraska, North and South Dakota the practice of “medicine, surgery or obstetrics” without a license is prohibited.