enforcement on the state board of health.1 Up to that time the most ignorant and untrained charlatans could practise in any part of the United States without fear of the law, but by the persistent and untiring energy of Dr John H. Rauch, secretary of the Illinois board of health, the law was carried into effect, and as a result "out of 3600 non-graduates who were practising medicine in the state when the act went into effect, about 1400 left the state, or ceased to practise."2 These irregular practitioners settled in other states for the transaction of their business, wherever a credulous public was willing to tolerate their presence.

This action on the part of Illinois resulted almost immediately in the attempt of many other states to take similar measures for their own protection, and in several instances, mostly in the new states, similar laws were enacted with but little opposition, while in some of the older states it was only after several years of persistent and long-continued effort, chiefly on the part of the medical profession, that legislation was finally secured. The chief points in these laws consist: 1) In the registration of all practising physicians.

2) In the examination of candidates for license to practise. The first of these, registration, is a feature of all the laws, while examination of candidates is not required in all the states. In some of them the presentation of a diploma from some reputable medical college is the essential feature, and the examination of candidates is not required. Dr McIntire classifies the states in 4 groups, according to their several requirements, and his classification has been followed in preparing the following list, and also chart No. 6, in which the facts shown in the list are graphically presented.3

The following summary presents the results of examinations

1) Laws had existed in some states for nearly a century restricting medical practice, but they had either become inoperative, or had been repealed. For a full discussion of this subject, see annual address by Dr R. H. Fitz in Transactions of Massachusetts medical society. v. 16, 1894. p. 275.

3) American academy of medicine. Bulletin. February 1897. p. 700. For details of this classification, see appendix 1.

REGISTRATION OF PHYSICIANS

made in 1898 in those states from which accurate returns could be obtained.1

Total number examined 2890; number accepted 2328; rejected 562.

1) American academy of medicine. Bulletin. February 1899. p. 691.

There is very little uniformity in the details of the laws, but they can all be classed under 4 general divisions, as follows:1 A) Examination required.

B) Certain diplomas are accepted; all other applicants must be examined.

C) Only a diploma is required.

D) The laws practically impose no restriction.

INQUEST SYSTEMS OF THE UNITED STATES

The method of procedure employed in most of the United States for the investigation of the cause of death in cases occurring from violent, sudden, or suspicious causes is the coroner system, a method which had its origin in England at least 7 or 8 centuries ago, but is unknown either in Scotland or on the continent of Europe. For the efficient operation of this system several officials are usually employed, a coroner, a coroner's physician, a jury of 6 men or more, and an officer who is employed to summon the jury. The coroner usually makes a view or a superficial examination of the body, and if in his opinion the cause of death was of a violent or criminal character, he causes a jury to be summoned, and if a more thorough investigation is required, in order to reveal the cause of death, he directs a medical man to make an autopsy.

Following the example of some of the principal continental countries some of the states have introduced a new and more direct method for the investigation of this class of deaths, namely, the medical examiner system, the principal features of which are the following: the abolition of the jury and the substitution in place of the coroner (an official supposed to combine the incongruous functions of law and medicine) of a medical examiner to determine the cause of death, and the reference of all legal questions to a district judge. In those states where this plan has been adopted its operation has been

1) American academy of medicine. Bulletin. February 1897; February 1898; February 1899. Articles entitled "State requirements for the practice of medicine," by Charles McIntire, A.M., M.D., Easton, Pa.