charlatan, the faculties of a few of our low grade schools and the public press. We can trace the existence of statutes regulating medical practice from the thirteenth century; in the year 1237 licenses were only obtainable in Italy upon attendance at medical lectures for a period of five years, with preliminary entrance requirements demanding three years' work in philosophy.

The first degrees in medicine were evidently conferred in Italy in 1384. Laws regulating medical practice have existed in all civilized countries for many centuries. It is unfortunate that in this country the diploma has been given a legal interpretation; in foreign countries it is simply an evidence of scientific value. With the advent of statutes regulating medical practice, this custom upon the part of the courts is becoming abrogated. We can not but conclude that in the older countries we have a superior profession in point of intelligence, with a more desirable environment; while with us we have, as a whole, men somewhat inferior in their preliminary training, a number triple that of any other country and a professional environment most undesirable.

The essentials of efficient medical legislation will incorporate the following features:

1. The adoption of more rigid rules. governing the admission of students to medical schools.

2. The determination of the applicant's fitness to practice by an examination upon all the branches of medicine.

3. The right to refuse or revoke licenses for unprofessional or dishonorable conduct.

4. An adequate penalty for violation of the provisions of this variety of legis

tion.

5. The boards of examiners to be appointed by the Governor, with proportionate representation by different schools of practice. In support of demands for an adequate entrance requirement, it is conceded that medicine is now more nearly practiced from a scientific basis than at any time in its history. Without adequate preliminary fitness the broad field cannot be grasped nor

its practice entrusted to persons without well trained minds.

Persons contemplating medicine as an avocation should give the scientific branches particular attention in preparation. tion. A thorough course in the scientific department of our better equipped colleges or universities will permit of the successful accomplishment of the course now provided in the four years' curricula in a period of three years. I fully concur in the position taken by Professor Vaughan, however, in that the classical course does not prepare the student in the manner that he can safely abridge the work now required in the four years' curricula. The necessity of a thorough college training is more apparent now than at any previous time. While an immediate attempt, looking to the demand as above suggested, would probably meet with defeat, I am of the opinion, however, that by concert of action we can secure the adoption at this time of an elevation of the standard of fitness requiring a college or university matriculation, or its equivalent, of all students wishing to commence the study of medicine. If the student cannot furnish a matriculation ticket from a recognized college or university, he or she should be required to undergo an examination that would admit to such

course.

Under existing relations we cannot safely entrust this examination to the representatives of the teaching body. Except in a few of our high grade schools the entrance examination has been a farce as at present conducted. The factors leading to this condition are the same as outlined earlier in this paper. It is the result of college competition with an unnecessary multiplication, in recent years, of the number of teaching bodies. It is my judgment, based upon a somewhat varied and extended experience, that a majority of the schools in this country exist to serve the personal interests of the respective faculties rather than to serve the legitimate demands of the people. About twenty-five per cent. of our schools have a matriculation of less than sixty pupils.

The determination of the fitness of the student to commence the study of medicine should be placed in the hands of a body of men entirely disinterested. I know of no body better qualified to superintend the execution of this important trust than a State board of medical examiners. If not such a body, then a committee composed of members of a faculty of a college or university.

The minimum of entrance requirements should be uniformed between the different states. Under the operations of the New York law regulating the examination of students commencing the study of medicine, much good is being accomplished. I desire to urge upon the profession the necessity of provisions in future acts looking to a rigid protection of the gateway to the study of medicine.

Having submitted satisfactory evidence of preliminary fitness, only such persons should be admitted to undergo the professional test as have received their courses of professional education at schools of medicine whose curricula of requirements are acceptable to the respective boards. A minimum of requirements, both as to time and teaching facilities, are as essential in measuring professional fitness as it is for similar purposes in universities, colleges and our public school system. A school should not be recognized unless it is working under a minimum that will assure the graduation of a class of persons that can safely be entrusted with the care of the sick. In arriving at a conclusion upon this most important function I desire to particularly impress upon the members of these boards the fact that medicine as at present understood and practiced is radically different from that of a few years ago. To comprehend requires years of study and a training in laboratory methods and surgical technique that can only be grasped when afforded by a person trained in methods of medical pedagogy. The clinical and laboratory facilities of many of our schools are shamefully inadequate. Several colleges known to the writer having operated for years with substantially no assets. It is the duty

of each board to inquire fully into the facilities of each school represented by graduates who are applicants for de

Having determined upon the fitness. of the school to afford satisfactory courses of medical instruction, applicants holding degrees from such institutions should be admitted and a further test of fitness demanded by requiring an examination upon all the recognized branches of medicine. These examinations should be conducted by number, be scientific, and of sufficient severity to assure the public a thoroughly educated profession. Students from the respective schools of practice should undergo an examination upon the same questions, no necessity existing for questions not primary in character.

Licenses should not be refused or revoked for other than gross unprofessional or dishonorable conduct. In criminal cases it is not well to anticipate the processes of criminal law. The latter feature of our legislation has been instrumental in protecting the people from the professional charlatan in several States. Its provisions should be incorporated in all statutes regulating medical practice.

Owing to the difficulty in securing indictments and the consequent tardiness of legal processes the penalty for violations of the provisions of this form of legislation should be by penalties imposed by a justice or a municipal judge; the latter method has given satisfaction as far as I am aware. Reasonable efficiency upon the part of the officers of these boards have been awarded by a full compliance with the provisions of this form of statute in all instances. The Governor should have the appointing power, being responsible for the successful operations of the different State boards. Experience satisfies us that the so-called mixed boards are doing satisfactory work and operating in perfect harmony. Seemingly no excuse exists for the duplicate boards operating in a very few States. At present, approximately thirty States possess legislation regulating medical practice. Seventeen States have a form of statute that fails to recognize the diploma as evidence of

fitness to practice; consequently they may be classed with those States operating under efficient acts. In the latter class of States I particularly desire to call your attention to the results of work thus far accomplished. In a paper read before this learned body, at Detroit, Michigan, in 1892, I suggested the future influences of these boards as most important in shaping the future medical education in this country. I submit data at this time confirmatory of the position then taken and reaffirm my former suggestion that future legislation will in a great measure determine and govern the work of the teaching bodies of the country.

I am deeply indebted to the officers of the various boards for courtesies extended and regret that space forbids reference to many suggestions and conclusions arrived at in the work of the different boards.

Data have been obtained from the following named States: Alabama, Minnesota, Maryland, North Dakota, North Carolina, New York, New Jersey, Virginia and Washinton.

in operation five years, being supplanted by the present law. The present act requires an examination of all persons commencing the practice of medicine and as amended by the last legislature, the minimum of requirments is changed, demanding that all graduates of later date than 1898 furnish satisfactory evidence of having attended at least four courses of lectures in different years, of not less than six months' duration each.

We have in Minnesota a practical illustration of the position taken in my former paper: "that in medical legislation we have the only solution of the problem of higher medical education." Having drafted these bills and by force of circumstances been somewhat conspicuously aggressive in urging their enactment, I have, in consequence, witnessed their operations with some concern and interest. The result is all that the most sanguine could have anticipated. In a period of twelve years the proportion of physicians to the population in Minnesota has been reduced from one practitioner to every six hundred and

It will be observed that of four thousand six hundred and seventy persons examined but eighty-two and two-tenths per cent. were successful in securing a license. The nine hundred and thirty unsuccessful applicants have, we doubt not, principally located in States not protected by this form of legislation.

I am pleased to direct your attention to the good work of the Minnesota board. The first act regulating medical practice in this State became operative in March, 1883. It was the form of legislation at present in force in Illinois. It was

and in 1885. The State has been substantially rid of the traveling charlatan. The present able Sscretary, Dr. McDavitt, informs me that the medical census just completed is accurate and that the present operation of the law is quite faultless. We therefore conclude that in one State at least the number of physicians has been reduced to a number commensurate with the demands of the people.

The work of the New York board is attracting considerable attention. Notwithstanding pronounced opposition and many embarrassments the act is destined to strengthen the character of the profession in this State. From advance sheets kindly furnished for use in this paper, I observe the following verification of a position taken by the Secretary, James Russell Parsons, in his 1893 report. He reiterates that the records of the past year conclusively proves the position taken in his 1893 report, "That the new law proves a barrier to the ingress of the incompetent, has operated

to raise the standard of preliminary education, improve the methods of teaching and terms of study of the different schools of medicine."

The following resolution from the President and Secretary of the Board to the State Medical Society is significant and should meet the approval and support of every member of the profession of this great State: "Resolved, That in the opinion of this Board the best interests of the public and medical profession would be materially advanced by gradually increasing the minimum of requirements as to general preliminary education till no candidate be entitled to matriculate in 1897 at a degree granting medical schools in this State, that has not completed at least a full high school course."

I am pleased to note that this bill has already passed the Senate in New York and is in a fair way of becoming a law. If it becomes operative it will operate to improve the character of matriculates in New York schools and will be followed by similar legislation in other States. Greater coöperation is necessary between different State Boards, as it is essential that harmony of policy exist as far as practicable. As in foreign countries their relations to the profession and teaching bodies is most important, their functions being that of professional censors of the conduct of the members of the profession, and guarding at the same time the avenues of entrance to professional work. It being the duties of these boards to protect the people from professional incompetency and charlatanry the duties are briefly comprehended in the performance of the following duties: 1. In establishing a minimum curricu lum for all colleges whose alumni apply for a license to practice. 2. The individual examination of all persons wishiug to practice medicine in the commonwealth. 3. A professional censorship, granting the right to refuse or revoke a license for incompetency and gross unprofessional or dishonorable conduct.

As this form of legislation becomes more fully understood and appreciated by the better class of schools, it will be observed as one of the most certain

and reliable avenues of placing before the profession of the country the character of work being done in all colleges whose alumni apply for license. A school doing honest work has little to fear at the hands of these boards; upon the contrary, as suggested in my former paper, it will be found that the proportion of applicants able to pass successful examinations will be a certain index of the character of instruction afforded students in the respective schools.

While the proportion of applicants successful is only eighty-two per cent., it will be found that from the schools heretofore operating under a high grade of requirements that, thus far at least in the work of these Boards, nearly all graduates are successful in obtaining a license upon examination. In substantiation of this conclusion I again submit data, using therein the same schools as in my former paper.

The following table indicates the proportion of students successful on examiuation from alumni of schools heretofore operating under the three years' curricula :

I cannot but conclude, gentlemen, that efficient medical legislation will operate to bring about the following results, as applied to the profession and public.

1. It will protect the people by affording a profession of greater intelligence. 2. It will suppress charlatanry.

3. It will reduce the number of persons practicing medicine to a number commensurate with the demands of the people.

4. It will reduce the number of medical colleges, at present far above legitimate demands.

5. It will raise the general standard of professional fitness, assuring us a professional prestige in the future, be