would have to utilize their meetings in the interest of public hygiene and sanitation. However, with the enactment of our recent substantial public health laws and the granting of an increased appropriation the members of the Board of Health and of the Public Health Council have shown themselves more than willing to give their time to matters of public hygiene and sanitation. In fact, their eagerness and enthusiasm in this phase of their duties have been so great of late that it looked as if medical licensure was doomed to a place of very small importance in their estimation. This, howover, was only apparently so, as at recent meetings the Council has devoted very much time to a consideration of our needs in medical legislation about which I hope to tell you later. In view of this experience I am satisfied that the administration of the laws of medical licensure can well remain in the hands of the Public Health Council, thus helping our citizens to gain and maintain the view that medical legislation is part and parcel of our public health code; that it is simply one phase of public health affairs; that it is in the interest of the people in general and not of any class of it. There is another important reason why it is best that the administration of the medical laws should remain with the Public Health Council. I shall not dwell much upon this reason, for a hint to the wise should be enough. Just so soon as a special medical examining board is created, such boards will multiply with the number of irregular sects, leading to the usual dire consequences.

The Law of 1881.

It is claimed that West Virginia was the first State in the Union to enact a law regulating the practice of medicine. Be that as it may, the first law for this purpose in our State was enacted with the law creating a State Board of Health on March 8, 1881, and went into effect 90 days thereafter. Under this law persons permitted to practice medicine were required to obtain a certificate from the State Board of Health, which was granted on either of the following conditions: 1. Graduation from a reputable medical college. 2. Ten years of continuous practice in this State prior to the enactment of that law. 3. An examination by members of the Board for the Congressional district in which the applicant desired to practice. Some amendments to this law were passed the following year, but my understanding is that the law remained substantially the same for upwards of twenty years. The credit for the passage of this act belongs to the late Dr. J. E. Reeves, who seems to have placed medical West Virginia on the map of this country in more than one way. In a personal communication our highly esteemed contemporary, Dr. L. D. Wilson of Wheeling, writes me as follows: "The original act was passed almost entirely through the efforts and influence of Dr. Reeves of this city, and was drawn up by the late James H. Ferguson of Charleston. Of this I am personally cognizant." Historians should accept Dr. Wilson's testimony on this point as final. It is evident that the requirements were not very high, and it is more than probable that any one with a smattering knowledge of medicine of that day could obtain a State license, although it is a matter of common knowledge that some of the ablest men of the profession of the State have taken up their practice during that

period. However, it was a very much needed beginning and proved a substantial starting-point for all subsequent medical legislation.

The Law of 1895.

In the early nineties the profession all over the United States became aroused to the peril of the low grade commercial medical schools which were multiplying with great rapidity and became opprobricusly known as diploma mills. Some of our large cities could still boast of one or more schools of a high character. But for every one such there were many schools founded as a rule by men with scrdid motives and maintained wholly in the interest of advertising the members of their faculties to the ignorant public. The product which these diploma mills ground out became a serious menace to the people of this country and was covering the medical profession with disgrace. How to remedy this evil became a burning question in those days with the true leaders of our profession. All ideas to accomplish this by national legislation proved to be impracticable because of our form of government. It became evident that each state would have to act for itself in this matter through its police power; and so one State after another amended her medical laws so as to require a State examination as a condition to the granting of license to practice. In some states this condition was in addition to graduation from a repu table medical schocl, while in others it was the sole requirement. I am under the impression that New York State was the first one to enact this protective legislation. The State of West Virginia was among the very early ones to fall into line; and in 1895 our medical law was amended so as to require an examination by the whole Board of Health as the sole requirement to practice. Graduation from a medical school was not required. The subjects on which the applicants were to be examined were specified in the law and practically coveral all the branches of medicine. It is my understanding that the State Medical Society was responsible for the enactment of this amendment. This, however, is merely a formal and general statement. As is usual with the work of such organizations, achievement is traceable to some one or few persons. I am not sure whether I can state positively who all are to be credited with this improvement in the medical law, but I know that the late Dr. Daniel Mayer of Charleston, president of the State Medical Society at that time, had much to do with it.

sons.

The Law of 1907.

For awhile this amended law seemed to be a satisfactory improvement in the desired direction. Soon, however, the permission of undergradu. ates to take the examination proved very cbjectionable for two main rea1. While there always have been men of much ability and high ideals on the State Board of Health, because of politics the majority of them were not always thus equipped for their duties. As a result, many undergraduate's passed the Board's examinations largely through the cramming of compenās. While some of these licentiates have since justly at tained high standing in the profession, others remained without further self-improvement and swelled the number of our poorly equipped physi

cians to a very marked degree. As the neighboring States improved their medical laws and raised their requirements, our State became a veritable dumping-ground for the flunks of other States, except when in spite of politics fortune favored the Board with a majority of members of superior attainments and ideals. Thus, for instance, in the year 1906 the Board rejected no less than 42 per cent of all applicants, most of whom were undergraduates. 2. As stated, the turning out of so many incompetent physicians by the medical diploma mills led many States to attach little importance to the value of medical diplomas and instituted the requirement of a State examination. It soon became evident that, while such a requirement was proper, in fact under the circumstances unavoidable, as far as recent graduates were concerned, it was quite a hardship on the older practitioner when on account of ill health new family ties, or other reasons, he was compelled to take up his residence and practice in another State. After much agitation and study it was found that the only prac tical way of relieving this hardship was by a systematic exchange of courtesies between States to recognize one another's license in lieu of an examination. That is to say, registration by reciprocity. It is quite obvious that no State would recognize the license of another unless the legal requirements were at least as high as her own. The fact that West Virginia did not require graduation from a medical school as a condition of eligibility to take the examination of the State Board of Health soon became conspicuous and made it impossible for her practitioners to be permitted to practice in other States on the basis of reciprocity. Because of these two reasons the need of further amending our law became sorely felt by the profession of the State. It naturally became a frequent topic for discussion at the meetings of the State Medical Association. The Medical Association made several efforts with the Legislature before it finally succeeded. My personal knowledge of, as well as participation in these efforts, began with the year 1903, while I was serving as Secretary of the Association. In that year the matter was in the hands of Dr. W. S. Keever, of Parkersburg, as chairman of the Medical Association's committee on public policy and legislation. In his report at that year's meeting, which was held at Charleston, he attributed the failure of his committee's efforts to opposition from the State Board of Health. This I found to be correct. For years there existed between the State Medical Society and the State Board of Health a spirit of unfriendliness and even antagonism, which at times amounted to mutual contempt. On the part of the Medical Association this feeling was engendered by a belief that the appointments on the Board were inade solely on political grounds. It was said among its members that the qualifications of the appointees were judged by the services they rendered to the dominant party in the preceding election and not by their scientific and professional attainments, and in this way they explained the frequency among the members of the Board of men who served as chairman of political county committees. The fact that notwithstanding this method of appointment the Board often did have men who were unquestionably competent to discharge their duties as members of it was not given much consideration. The members of the State Board of Health naturally resented this opinion and were able

to retort in kind by pointing out that not infrequently the affairs of the Association were not free from objectionable political methods and unworthy personal motives. This will in a measure explain why it was that the Association's bill of 1903 contained a provision which virtually placed the appointments on the Board of Health in the hands of the Association, and why this bill, therefore, was particularly obnoxious to the. members of the Board, and why the meeting of 1903 was made memorable by the bitter denunciation in which the members of the Association freely indulged against the members of the Board. It became evident to me that, if we were to succeed in amending the medical law, the two crganizations must be brought together in co-operation. To this end I labored with the result that in the fall of 1904 a special meeting of the officers of the Association was held at Parkersburg, at which was present by invitation a delegate from the State Board of Health. A bill was drawn up providing for the requirement of a diploma from a reputable medical school as well as an examination by the State Board of Health as a condition for licensure, and for the establishment of reciprocity with other States. The former clause to take the power of appointment away from the Governor was not inserted. The bill was introduced in the Legislature of 1905, but failed to pass. This failure was due to opposition from two sources. First, from the osteopaths, who at that time were clamoring for legal recognition. Second, from the members of the Pharmaceutical Association of this State, who somehow erroneously got the impression that this bill contained something which was inimical to their interests. I was never able to learn just what that was and how it came about. It was evidently based upon misrepresentation, and I suspect was fabricated by some one for a purpose. In the fall of 1906, profiting by the experience of the past. we again held a special meeting at Parkersburg, to which 1 invited delegates from the State Pharmaceutical Association, as well as from the State Board of Health, and the Eclectic and Homeopathic State Medical Societies. With the exception of the Homeopathic, all these organizations were represented at our meeting. The bill of two years before was again adopted and all the delegates present promised the support of their respective organizations, which we received in due time. As its pres. ident at that time. I succeeded in getting from the Association ample latitude for the exercise of my judgment and efforts in the matter, as well as all necessary pecuniary aid. I appointed Dr. J. E. Robins, then, as now, a worthy member of the Board, chairman of the lobbying committee, and the bill was once more introduced in the Legislature at its session of 1907. After a troublesome experience with the osteopaths, who by very peculiar methods succeeded in getting on favorable terms with many of cur legislators, our bill passed, but not until we permitted a new irregular sect to be inflicted upon the State. Incidentally a rather important sec tion of the old law was smuggled out. I could write a very important. chapter about this and our general experience with the osteopaths at that time and since, but will let it wait for another occasion.

The Laws of 1915 and 1917.

The medical law as amended in 1907, therefore, required from one wishing to practice medicine in this State that he must be a graduate of a reputable medical school and pass a written examination before the Public Health Council. These requirements were very good as far as they went. They were fundamental. They have enabled us to enter into reciprocal relations with about cne-half of the States of the Union. However, they have gradually become inadequate. The demand for bet ter physicians has been steadily growing all over the country, so that the standard of requirements in many States has become higher. This has been accomplished in three ways. 1. By refusing to recognize medical schools of low rank. 2. By requiring a preliminary education of a standard high school or its equivalent, and at least one year's work in chemistry, physics and biology of a college grade. 3. By making all the requirements a matter of law and not a matter of mere regulations of the Examining Board. The necessity for further amending cur medical law has been very clear to many of us for some time. But owing to the crying need of improvement in our laws pertaining to public hygiene and sanitation, we directed nearly all our energy with the last two legislatures to this purpose. In the meantime the Public Health Council did what it could to remedy the deficiency in the medical law by certain regula. tions. For some of these regulations the power of the Council under the law is quite clear. For instance, ever since July, 1913, the Public Health Council has refused to recognize diplomas from medical schools designated by the American Medical Association as belong to Class C. The law says that the applicant must be a graduate of a reputable medical school so considered by the Public Health Council, which clearly gives the Council the power to discriminate. This is not clearly the case with a certain other regulation of the Council. I refer to the regulation requiring a preliminary education cf a high school or its equivalent. These two regulations have rendered great service. First, by reducing the number of licentiates, and, second, by furnishing the State with physicians of better education and training. As to numbers: Among the people there are some who believe that it is of benefit to have a larger number of physicians than is really necessary, on the assumption that the benefit of competition in general life applies to the practice of medicine. But we as medical men know better than this. We know that overcrowding of the profession has led to great harm both to the people and to the members of the profession. Overcrowding means poverty, and with that go many unfortunate things. It is the overcrowding of the profession in this State which has caused many members of it in the past to fall out of touch with the progress of medicine: and, therefore, many of them were not as useful as they might have been, and scme of them became downright incompetent. It takes money with which to buy books and appliances and enable one to revise his mental equipment by a post. graduate course of study every now and then. It is the overcrowding of the profession and the consequent meager rewards of its practice that have placed a stigma upon us in this State in recent years by driving two of our members, through the gateway of politics, into the penitentiary