the Board to revoke licenses has been tested in the courts, and so far has been sustained.

In view of all these facts it is quite evident, I think, that it is possible to regulate the practice of medicine and to vastly improve its condition, and that this can be done and probably best done by State Boards of Health.

In conclusion the writer begs leave to suggest that it is the duty of the State to protect its citizens from the injuries they may sustain from the practice of incompetent physicians and surgeons as well as from any other source of danger to public health. The mode in which this protection can be best extended is one upon which there may be differences of opinion; in fact there may be different modes equally efficient. But that adopted by the State of Illinois, if it could be carried still further and made more complete in this investigation of the status of every practitioner of medicine, would, as it seems to me, be amply sufficient. A diploma from any medical college ought not to be accepted of itself as the evidence of a qualification for the discharge of the duties of the profession. It is true a Board invested with the power of discriminating like that of this State perhaps may be trusted to determine what colleges do give to their graduates an education qualifying them for these responsibilities; but practically it is found very difficult to make such discrimination. An examination should be held of every practitioner of medicine; that examination, if successful, should entitle him to a license to practise. The colleges would then be relegated to their legitimate places as teaching bodies, and not as bodies empowered to give authority to practise. The colleges that have the best teachers, whose students are most successful in passing this examination, and which are therefore evidently rendering to the community the highest services, would become the most popular, and would justly receive at the hands of the public that recognition which they deserve.

But the consideration of this subject leads us beyond the scope and purview of this paper, which was simply to submit the results of the effort in the State of Illinois to regulate by law the practice of medicine.

STATE MEDICINE AND STATE MEDICAL SOCIETIES.

By STANFORD E. CHAILLÉ, A. M., M. D.,

NEW ORLEANS, LOUISIANA.

STUDY of the last ten volumes of the annual Transactions of this Association, and also of the constitutions and histories of the thirty-seven State Medical Societies in the present thirtyeight States, has inspired a strong conviction that there are two important questions which have not been sufficiently considered by this Association, and especially by the "Section of State Medicine and Public Hygiene." One of these questions is: What is State Medicine? The other is: What can be done by this Association to promote its practice?—for the art is now far behind the science of State Medicine, as is forcibly illustrated by the frequent prevalence of smallpox, notwithstanding the power given by vaccination to stamp it out. As to the latter question, it seems evident that the progress of State Medicine depends upon enlightenment of public opinion, that this must be promoted by an enlightened and organized medical profession, and that inasmuch as this Association since 1874 derives its power from, and depends for its life on, the State Medical Societies, with their auxiliary county and district societiesthis second question resolves itself, in large measure, into: What can this Association do to enlighten and more efficiently organize its own branches, the State Medical Societies? These questions, with some subjects incidental thereto, will now be considered.

WHAT IS STATE MEDICINE?

The adjective-noun being used generically, as in statecraft and statesmanship, State Medicine is the application by the State of medical knowledge to the common weal; and embraces every subject for the comprehension of which medical knowledge, and for the execution of which State authority, are indispensable.

Its bounds are necessarily as limited as may be the authority of the government; so that, in the United States, State Medicine is restricted by the Constitution, so far as the national government is concerned, within narrow bounds, within even narrower bounds than as to our county and municipal governments, while our State governments have ample and undisputed authority over each of its four chief subdivisions, viz.: Public Institutions for the Sick and the Infirm; Medical Education; Medical Jurisprudence, or Forensic Medicine; and Public Hygiene, or Preventive Medicine.

If the definition given be correct, then the titles of the 4th and 5th Sections of this Association, viz., "Medical Jurispru dence, Chemistry, and Psychology" for the former, and “State Medicine and Public Hygiene" for the latter, are due to a misconception of what State Medicine really is, and not only promote confusion of ideas in this Association, but also in all of its branches. Further, these titles contribute to strengthen the prevalent professional tendency, which I deem false and mischievous, to regard Public Hygiene, which is no more than the most important branch of State Medicine, as synonymous therewith.

To illustrate still farther the definition of State Medicine, it will be well to enumerate the most important subjects which belong to each of its four branches, and merit special attention because of the defects of our laws in regard to them.

PUBLIC INSTITUTIONS FOR THE SICK AND THE INFIRM.

The subjects appertaining to this branch are the organization and maintenance of hospitals, dispensaries, infirmaries, and sanitaria; of asylums for the insane and for inebriates; and of asylums, educational as well as medical, for idiots and feebleminded children, for mutes, and for the blind.

MEDICAL EDUCATION.

The subjects appertaining to this branch are the organization, maintenance, and governmental regulation of medical colleges; the promotion of means to facilitate the study of anatomy and clinical medicine, surgery, and obstetrics; the foundation and support of medical libraries, museums, laboratories, and of botanical and zoological conservatories; the encouragement of

original research; and the regulation of the legal qualifications requisite to practice medicine, surgery, midwifery, and dentistry -not only of those who have received no medical education, but also of those who are graduated doctors in medicine.

MEDICAL JURISPRUDENCE.

The subjects of present chief interest appertaining to this branch are the improvement of the laws relating to insanity, inebriety, poisoning, fœticide, malpractice, and to medical witnesses in four important particulars. These are, better provision for securing properly qualified physicians to serve as ordinary witnesses to medical facts, such facts as are derived from coroners' inquests, and from the observation and examination of those alleged to be insane; thoroughly competent medical experts as skilled witnesses to medical opinions, and better legal methods for the selecting of such experts, and the taking of their testimony; the adequate compensation of medical experts; and proper protection to prevent the disclosure, by force of law, of confidential communications made, and necessary to be made, by a patient to his physician.

PUBLIC HYGIENE.

Whenever civilization has so far advanced that social order has been, by law, firmly secured, then Public Hygiene, however much neglected, is the subject of greatest importance. As a science, it may be said to consist in the study of the avoidable causes of disease and death, their removal, extent, cost, and influence on morality and human progress. As an art, many subjects appertain to this branch of State medicine, and chief among these are: the establishment of efficient and central boards of health, with auxiliary local boards, and an efficient system for the registration, not only of marriages, births, and deaths, but also of prevailing diseases; the introduction into the public schools of instruction by competent teachers in the elements of hygiene; adequate provision for food neither adulterated nor diseased, for an abundant supply of uncontaminated water, and also of man's first and greatest need, pure air, which nature lavishly supplies and man recklessly poisons; the suppression of numerous sanitary nuisances, and the regulation of many insanitary occupations; the proper construction of healthy houses for schools and all other purposes; the drainage and irrigation

of the land for sanitary as well as for money-making ends; the topographical sanitary survey of every section of the countrysuch surveys as Massachusetts is said to have effected in 1849, and New York to have initiated in 1875; protection from contagious and infectious diseases, and the sweeping away of the removable causes of many other diseases; and the regulation of sexual intercourse, even to the extent of castration or spaying, to the end, not only that venereal diseases may be diminished, but also that a corrupt progeny may cease to curse humanity and burthen its progress. While this list embraces the chief subjects belonging to public hygiene, many unmentioned expedients are required to redress numerous insanitary evils, which have increased, and will increase in number and extent as population increases in density, and the arts of advancing civilization multiply. Hence the necessities for an efficient system of public hygiene are destined to increase year by year.

Of the various subjects of State medicine now enumerated there are at least a dozen which, before proceeding to consider the second part of this article, deserve brief notice. These subjects refer to inebriate asylums, and measures to control inebriates; the education of idiots and feeble-minded children; the regulation by law of the qualifications necessary to practice medicine; fœticide; malpractice; the compensation of medical experts; the protection of confidential communications; coroners; expert witnesses to medical opinions; introduction into public schools of a text-book on the elements of hygiene; boards of health; and the registration of vital statistics.

These subjects deserve farther notice because of the superior importance of some of them, and because they, although attracting in recent years professional attention, have failed to secure from the profession such treatment as is likely to promote their progress. For, to promote the practice of State medicine its subjects must be discussed from a legal as well as from a medical standpoint, must be rendered comprehensible to the public, and must be advocated by a united and organized profession. In matters of State medicine, physicians are prone to denounce evils, and to dwell upon the reasons why these evils should be corrected, but fail to teach how they can be corrected. Sufficient importance is rarely given to such important practical considerations, as that law breaking is as easy as law mak