REPORT OF THE SECRETARY.

(1.) — The registration of physicians in 1889 conducted in accordance with the rules of previous years numbered 347, all these being graduates, or holding the educational equivalent of a diploma, as a license granted upon examination by a legally qualified body; the numerical total of such registration since the law took effect being 4,037.

Forty-two certificates were given to graduated midwives, making the total number of original certificates issued to physicians and midwives, during the year, 389.

Two applications from exempt non-graduate midwives were declined, and likewise seven similar applications from physicians.

Eight applications were declined and referred to the Board on account of the fraudulent or otherwise unsatisfactory character of the diplomas presented, or the evidence being insufficient to warrant registration.. Eight duplicate certificates were issued upon sufficient proof of loss of originals, and two certificates were refused applicants by the Board after a hearing, for unprofessional or dishonorable conduct. Information in regard to this action will be found in the abstract of proceedings of the Board, but as indicating the position taken in such cases the following letter is here given:

Major Wm. Gentry,

Prest. State Board of Health,

Dear Sir,

"ST. LOUIS, Aug. 29th, 1889.

Sedalia, Mo.

Your favor of 26th instant, with communication from Mr. J. T. C. of 20th instant enclosed, was duly received and both have been carefully considered by Dr. Merrell and myself.

I think I have furnished you copies of all correspondence from this office, relating to Mr. C.'s clients, so that as a member of the Executive Committee you are fairly well advised concerning the present status of the matter which was referred to us.

I do not think that the Board or any member of it can in fairness be held responsible for the "impression" or " or "understanding claimed by Mr. C. regarding the granting of certificates to Drs. B. and H. certainly both Dr. Merrell and I must disclaim the imputed assurance he sets out.

As we view it there is one position for the Board to take in such a matter and only one, and this is that the law since it took effect has always been in force with suitable machinery in existence for its execution, as we fully know, and that the plain unmistakeable letter and spirit of that law must be obeyed by those who seek the benefits and privileges it confers.

But the clients of Mr. C., while pleading ignorance that the law was in effect — in spite of the fact of their having been shown the contrary to be true-practically say to the Board, "We will continue to violate the law until you see fit to give us the legal right to practice."

They alone are responsible for delay in the issuance of the desired certificates, for it would clearly be a violation of the obligations of the Board as State officers to take favorable action in the face of such a defiant attitude.

On this point we have the opinion of the Attorney-General given in connection with these cases as follows:

"Under the provisions of Section 9, of the Act regulating the practice of medicine in this State, any one who professes publicly to be a physician and to prescribe for the sick, is regarded as practicing medicine within the meaning of the Act, and unless such person had a certificate from the State Board authorizing him to practice, he would thereby violate the law.”

Being thus advised and with our obligation faithfully to enforce the law resting upon us, how can we do otherwise than insist that these gentlemen shall first respect the law, yield obedience to its plain requirements, and cease deliberately and knowingly to violate its provisions?

This is the first necessary step and attitude on their part; and they must surely perceive that no other course promises to secure to them the ends desired.

If such steps be taken by them then, on our part, so soon as assurance has been given that they have ceased violating the law, have stopped advertising themselves as physicians, and say when licensed that their future advertisements shall contain nothing that might tend to deceive an unenlightened public, I would favor the immediate issuance of certificates on their renewed application therefor.

As I take it, this is a sound and tenable position, within the law and just powers of the Board, and recent decisions of the higher courts support this view.

On June 15th, last, the Supreme Court of Illinois affirmed the constitutionality of the Medical Practice Act of that State, which law is very similar to our own.

On July 6th, last, the Court of Appeal, the highest law court in England, in deciding a case before it declared that the "General

Medical Council

whose powers and duties under the Act of Parliament are similar to those of our Board under the Practice Act were the sole judges of what constitutes right and proper professional conduct in a physician; the plaintiff's name having been stricken from the register for cause deemed sufficient by the Council; he claiming that there had been no sufficient inquiry in the matter by that body and, further, that he had been libelled by the publication in their minutes of the fact that his name had been stricken from the roll, on both of which points the Council was sustained. The Court thus concludes :

"This action is, in truth, an attempt to have the decision of the Council reviewed by another tribunal. We express no opinion on that decision. It cannot be reviewed directly and this attempt to review it indirectly cannot succeed."

Our own Supreme Court says:

* *

*

"The Board of Health, in the discharge of duties in reference to the issuance of certificates, is engaged in the performance of those things which essentially partake of a judicial nature, requiring the examination of evidence and passing upon its probate force and effect, requiring the exercise of judgment, and the employment of discretion. * After the discretion has been exercised, no matter in what way, the mandatory authority to compel the doing of the particular act prayed for is at an end. And whenever an element, shred or degree of discretion enters into the duty to be performed, the functions of mandatory authority are shorn of their customary potency and become powerless to dictate terms to that discretion. Were the rule otherwise, instead of officers discharging their duties in accordance with their own official discretion, that of a court would be substituted therefor * * * palpably usurping functions conferred exclusively by the law upon others."

The Court cites authorities to support the position that discretionary powers are not revisable, and states further that the creation of such a board as this one with powers such as have been described, is within the powers of the legislature and does not transcend constitutional limits.

The powers and duties thus conferred and imposed are comprehensive and weighty but their very extent with the accompanying sense of responsibility imposes the obligation of caution and wise judgment in their exercise and performance, and I am confident that it is the earnest desire of every member of this Board to avoid everything that would even appear to be an abuse of the powers given by which any one would be wrongfully deprived of any desired benefit or privilege. Dr. Merrell fully approves the view above set forth.

Very respectfully yours,

GEO. HOMAN,

Secretary."

(2.) As tending to show the state of feeling in the profession of the State toward the Board the following preambles and reso

lutions were unanimously adopted by a rising vote at the meeting of the District Medical Society of Northwest Missouri (a society embracing within its territory nineteen counties) held in the City of St. Joseph, on July 11th:

"WHEREAS, In the judgment of this Society the State Board of Health is an institution important and necessary to the sanitary interests of the State at large; and

WHEREAS, The members of the State Board of Health of this State have not only devoted their time and energies to the promotion of its objects without proper pecuniary compensation, but at a great personal sacrifice of time and money in order faithfully and conscientiously to perform the duties imposed upon them by the Legislature; therefore be it

Resolved, That we, the members of the District Medical Society of Northwest Missouri, hereby extend to the said members of the Board our cordial encouragement, and promise our co-operation in any way that it may be possible for us to aid them in the performance of their duties.

Resolved, That the Corresponding Secretary be instructed to forward a copy of these resolutions to His Excellency, Governor Francis, and to the Secretary of the State Board of Health. THOMAS H. DOYLE, M. D.,

(Signed)

DANIEL MORTON,

Secretary.

President."

On January 29th ultimo, the St. Louis Medico-Chirurgical Society passed the following resolutions:

Resolved, That this Society approve the course pursued by the State Board of Health in endeavoring to the extent of their ability to maintain and enforce the laws relating to the sanitary interests of the State, and those of the medical profession.

2. That we deprecate the indifferent or unfriendly spirit seemingly present with some members of the legislature evidenced by the suggestion that these laws should be repealed and the Board abolished.

3. That we earnestly urge that financial provision be made for the support of the Board, commensurate with the importance of the work committed to it, and in amount corresponding with that given in neighboring States for similar purposes.

4. That copies of these resolutions be sent by the Secretary to our representatives in the General Assembly.

The Missouri State Medical Association at the meeting in Springfield in May, appointed a special committee on the State Board of Health with the view to advance the interests committed to that

body, and to secure, if possible, favorable action by the General Assembly.

(3.) In the case of one physician who received a certificate from the Board and who presented it to be recorded to the clerk of the county court of the county in which he resided in accordance with Section 6875, Revised Statutes of 1889, the clerk refused to make such record on the ground that in order to do so he would be compelled to provide the necessary blank book for such purpose at his own expense, he alleging that the court refused to authorize its purchase.

The facts of the case were laid before the Governor for such action as might be deemed appropriate and necessary.

In the case of a physician prosecuted during the month of December in the St. Louis Court of Criminal Correction for practicing under a name other than his own the Court held that the requirement in the section named that a practitioner removing from one county to another shall have the fact of such removal indorsed on his certificate by the county clerk was not of binding force, the act of placing · it on record in the county to which removal is made being deemed sufficient.

(4.) The information elicited in the course of correspondence relating to the collection of poor house statistics showed that as a class these dependents are the most deplorably wretched of all the dependents on public charity; and it is urged that in this direction lies a most important work of administrative reform, either on the part of county or State authorities, or both.

A system might be devised by which an oversight of county indigents could be secured somewhat on the plan pursued in regard to the inmates of insane asylums.

(5.) It is a pleasure to be able to say that the harmony and good will which marked the conduct and proceedings of the members of the present Board in former years has continued throughout the present year; and that the most cordial and hearty support has always been accorded the Secretary in the performance of the duties entrusted to him the proper execution of which was often beset with difficulties growing out of the straitened circumstances of the Board from lack of proper provision being made for its financial support. My thanks are hereby respectfully extended to each member for the confidence and support always so uniformly shown me.

GEO. HOMAN.

Secretary.