given authority to determine by suitable tests the good standing of medical colleges, the genuineness of diplomas presented, to make inquiry concerning the moral character and professional standing of applicants for license to practice, and to grant certificates to those found possessing the requisite qualifications. Provision is made also for the revocation of licenses for unprofessional or dishonorable conduct, and power is given to refuse their issue for like cause.

JUDICIAL DECISIONS.- During the present year the constitutionality of the medical practice laws of Illinois and Iowa has been affirmed by the Supreme Courts of those States, and a case appealed to the United States Supreme Court from West Virginia, in which the constitutionality of the Act of that State was involved, was affirmatively decided last January.

The West Virginia State Board of Health had refused to recognize the diploma of an applicant for registration for the reason that it emanated from a school not in good standing; the holder having been engaged in practice in the State for some years and declining an examination by the board had recourse to the courts, which action resulted adversely to him. The following occurs in the opinion of the Court, which comprehensively discusses the right of a State to enact such a law:

* *

It is undoubtedly the right of every citizen of the United States to follow any lawful calling, business, or profession he may choose, subject only to such restrictions as are imposed upon all persons of like age, sex and condition. The interest, or, as it is sometimes termed, the estate acquired in them, that is, the right to continue their prosecution, is often of great value to the possessors, and cannot be arbitrarily taken from them, any more than their real or personal property can be thus taken. But there is no arbitrary deprivation of such right where its exercise is not permitted because of a failure to comply with conditions imposed by the State for the protection of society. The power of the State to provide for the general welfare of its people authorizes it to prescribe all such regulations as, in its judgment, will secure or tend to secure them against the consequences of ignorance and incapacity as well as of deception and fraud. As one means to this end it has been the practice of different States from time immemorial, to exact in many pursuits a certain degree of skill and learning upon which the community may confidently rely, their possession being generally ascertained upon an examination of parties by competent persons, or inferred from a certificate to them in the form of a diploma or license from an institution established for instruction on the subjects, scientific or otherwise, with which such pursuits have to deal. The nature and extent of the qualifications required must depend primarily upon the judgment of the State as to their necessity. If they are appropriate to the calling or profession,

and attainable by reasonable study or application, no objection to their validity can be raised because of their stringency or difficulty. It is only when they have no relation to such calling or profession, or are unattainable by such reasonable study and application, that they can operate to deprive one of his right to pursue a lawful vocation.

Few professions require more careful preparation by one who seeks to enter it than that of medicine. It has to deal with all those subtile and mysterious influences upon which health and life depend, and requires not only a knowledge of the properties of vegetable and mineral substances, but of the human body in all its complicated parts, and their relation to each other, as well as their influence upon the mind. The physicians must be able to detect readily the presence of the disease, and prescribe appropriate remedies for its removal. Every one may have occasion to consult him, but comparatively few can judge of the qualifications of learning and skill which he possesses. Reliance must be placed upon the assurance given by his license, issued by an authority competent to judge in that respect, that he possesses the requisite qualifications. Due consideration, therefore, for the protection of society may well induce the State to exclude from practice those who have not such license, or who are found upon examination not to be fully qualified. The same reasons which control in imposing conditions, upon compliance with which the physician is allowed to practice in the first instance, may call for further conditions as new modes of treating disease are discovered, or a more through acquaintance is obtained of the remedial properties of vegetable and mineral substances, or a more accurate knowledge is acquired of the human system and of the agencies by which it is affected. It would not be deemed a matter for serious discussion that a knowledge of the new acquisitions of the profession, as it from time to time advances in its attainments for the relief of the sick and suffering, should be required for continuance in its practice, but for the earnestness with which the plaintiff in error insists that, by being compelled to obtain the certificate required, and prevented from continuing in his practice without it, he is deprived of his right and estate in his profession without due process of law. We perceive nothing in the statute which indicates an intention of the legislature to deprive one of any of his rights. No one has a right to practice medicine without having the necessary qualifications of learning and skill and the statute only requires that whoever assumes, by offering to the community his services as a physician, that he possesses such learning and skill, shall present evidence of it by a certificate or license from a body designated by the State as competent to judge of his qualifications.”

:

UNPROFESSIONAL OR DISHONORABLE CONDUCT. The question of the legal authority of a medical board created for the purpose of passing upon questions of professional morality openly affecting the public and administering the laws relating to medical practice in England,

F

4

has received the attention of the supreme court of judicature of that country, the Court of Appeal, during the year.

The license of a registered practitioner was revoked after a hearing for conduct deemed sufficient by the Medical Council, the powers and functions of which body correspond closely to those of a board of health under our practice law. The charge against the accused was the publication and sale for general circulation of a pamphlet to the detriment of public morals, and constituting infamous conduct in a professional sense.

The court held that the Council was the sole judge of what properly constituted conduct of the kind indicated in a physician, that the decision of the Council would not be reviewed or disturbed, and that the publication of the fact that the defendant's name had been stricken from the register for cause was privileged, and not a libel, but was proper for the information of the public.

From these decisions it would appear that the practice laws of the States above named are based on sound principles, and that in their operation they tend to the benefit of the public and the medical profession by discouraging and repressing questionable methods and dishonest practices on the part of physicians.

MEDICAL LAWS IN CERTAIN OTHER STATES. --In Minnesota, Virginia, and North Carolina a legislative departure has been made from the usage required under the Missouri law in regard to medical colleges.

In these States no diploma is recognized as entitling the owner to practice, this right can only be acquired by an examination conducted by the State board.

This plan obviates the necessity of making any requirements of medical schools, and takes no cognizance of their standing as determined by length of terms of study, facilities of instruction, thoroughness of teaching, conditions of graduation, etc., etc.

STANDARD OF REQUIREMENTS.-The administration of the law in this State makes necessary some standard by which thoroughness of instruction in any given school may be measurably determined, and this has been done by prescribing for the schools a schedule of minimum requirements to which they must conform in order to have their diplomas recognized by the Board-compliance with such schedule being the accepted evidence of their good standing.

Heretofore attendance at only two full courses of lectures at such a school, as a prerequisite to the graduation of students, has been required, but the States of Illinois and Iowa have decided that after the close of the next collegiate year (1890-91), the future diplomas of no

school will be accepted that does not require attendance at three such terms as a condition of graduation.

PROPOSED REQUIREMENT OF THREE TERMS. Under these circumstances, and in view of such action by our near neighbors on such an important matter, it is obvious that this subject must of necessity have engaged the attention of the Board, and it has been discussed and held under advisement throughout the year, decisive action being delayed only by reason of the Board membership not being full,— it being thought best that such an important step should not be taken until all the interests, provided by law to be represented in the Board, could be heard and, if possible, unanimity of views and action secured.

The wishes of the schools in this State in regard to the matter have not been ascertained, but probably few of them would oppose the change.

AN ELEMENT OF WEAKNESS IN THE PRESENT LAW. The administration of the Practice law takes up much of the time that the members feel should be devoted to sanitary affairs, the concurrent opinion held being that properly the Board is an organization formed for the advancement of public health, and on this account release from other duties, which often prove embarrassing and thankless, would be welcomed.

Furthermore, a criticism that may with justice be made by medical men concerning a Board created and constituted as is this and similar bodies, is that the appointing power, although acting in the best attainable light and with the very best intentions, may yet fail to make selections for such positions that are truly representative and acceptable to the body of the profession; and, hence, lukewarmness on their part in the support accorded to such an official body, or positive hostility, may result.

This objection may be raised against any method devised for the appointment and confirmation of an official body, created for the purpose of administering laws designed to regulate medical practice, into which any political considerations may enter; the consequence may be that the result reached will not be a true reflex of the will of the profession concerned.

As a means of

INCORPORATION OF THE MEDICAL PROFESSION. avoiding this objection, and relieving the Board of all duties save those of a purely sanitary nature, and as a measure of justice to physicians, it is suggested that the entire matter of regulating medical practice and education in this State be placed exclusively in the hands of the medical profession.

20

REPORT OF THE STATE BOARD OF HEALTH.

This may be done by the enactment of a law authorizing the incorporation of the medical profession, including every legally qualified member in the State, with the right and duty to elect, under suitable regulations, a governing body out of their own membership, securing to all shades of medical opinion the right of proportional representation, and to which body would be referred for consideration and decision all questions relating to the regulation of practice, the requirements and standard of medical education, standing of schools, discip line of offenders, etc., etc.

This course would lodge responsibility for the honor, advancement and attainments of the medical profession in the hands of physicians themselves; and however high or low these respective standards might rise or fall they would correctly mirror the condition and truly represent the will of the profession, and all the consequent merit or demerit would attach solely to medical men.

PRINTING OF REPORTS. The printing and publication of the annual reports of the Board for several years past, as authorized by the General Assembly, has not yet been completed and is a cause of regret and inconvenience.

The complete register of physicians should be published by the State, as being due to the law-abiding members of the profession, and for the information of county clerks and other officials concerned, but the Board has no means at its disposal to meet the expense of such publication.

In conclusion the members of the Board beg to tender to you their sincere thanks for the interest shown and Executive encouragement and support extended during the year; and to express their hope for a continued prosperous and successful administration of the important interests and affairs committed to your hands.

All of which is respectfully submitted.

WM. GENTRY,

ALBERT MERRELL,
GEO. HOMAN,

J. D. GRIFFITH,

G. A. GOBEN,

J. B. PRATHER.

DECEMBER 31st, 1889.