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portance demands, and make suitable provision therefor, in order that Missouri may stand on the same high plane in sanitary affairs as that now occupied by so many of its neighbors.

A noteworthy illustration of the progress that has been made during the last few years in co-operative work between States for the protection of public health is had in the Quarantine Conference which was convened by the Governor of Alabama at Montgomery early last March, the special object being to devise, consider and adopt measures for the prevention of yellow fever the present summer in the Southern States.

The joint and mutual agreement to that end reached by the participating States has been carried out with assurances that the country will be spared a repetition of the pestilential occurrences of last year in Florida.

At the instance of Governor Francis and the Merchants' Exchange of St. Louis, I attended the Conference as the representative of this Board and State, and upon my return made a report thereon to the Governor and to the Exchange, a copy of which is herewith submitted for your information.

An important matter that very closely concerns the public health is the transportation by common carriers of the bodies of persons dead of communicable diseases; and it is gratifying to be able to state that this subject has received the attention of the general baggage agents of the principal railway lines in this country at their annual meeting, and blank forms and regulations have been prepared for a uniform system of safeguards in this respect in the interest of the protection from diseases of railway employes and the public as well.

I submit for your consideration and approval such forms of this kind as have been sent to me for that purpose.

MEDICAL PRACTICE.-During the first six months of the present year certificates based upon diplomas of recognized schools have been issued to 252 physicians, and similarly, licenses have been granted to sixteen midwives, a total issued of 278.

During the four years ended on the 2d instant that I have served in my present position 1,141 licenses have been granted to graduated physicians, and 154 to midwives, a total of 1,295.

This source of revenue, small and uncertain as it is, has been the only finanacial income accruing to the board by means of which the necessary expenses of conducting its business could be met for the three and one-half years ending December 31st, 1888. All the additional outlay not covered by this insignificant source has been supplied by the members.

The meagre and insufficient appropriations for the Board made by the General Assembly at the late session afford no reasonable hope that this body will be able to do its appointed work in a proper manner during the next eighteen months, and in accordance with the just expectation of the public and the demands of progress and intelligence.

What shall be undertaken in this direction under existing cireumstances is a subject for consideration and determination by the Board.

A considerable number of cases arising under the "Practice Act" upon applications for registration await your hearing and decision, a majority of them being instances where I have declined to assume the responsibility of granting license, and referred the applicants to the Board for a hearing as provided by law.

The duties and powers of a state board of health, charged with the execution of laws relating to medical practice, have been made additionally clear by a decision of the Supreme Court of the United States, rendered the present year, in a case appealed to that tribunal from West Virginia, a copy of which I herewith submit.

The decision is of greater interest to us by reason of the fact that the medical practice act of West Virginia is almost identical with that of Missouri.

The decision in question sustains the view held by this Board that the regulation of medical practice falls within the general police power of the State, and that boards constituted for the purpose of enforcing laws to that end have the right to exact evidence satisfactory to them not only as to the sufficiency of an applicant's medical qualifications, but to guard the people against the consequences of deception and fraud on the part of practitioners of medicine.

In several of our neighboring States, having state boards of health, action has been officially taken notifying medical schools that after the session of 1890-91 the diplomas of no college will be recognized that does not require as a condition of graduation a medical course of four years with attendance at three regular courses of lectures; a school failing such requirements to be held as not being in good standing under the law.

The question of the advisability of this Board taking some action looking in the same direction is respectfully submitted for your consideration.

A considerable number of applications for registration by nongraduated practitioners exempt under the law have been declined under the option of the Board and in accordance with the rule to govern such cases adopted four years ago.

In several instances fraudulent diplomas have been presented and false affidavits made. These cases have been uniformly referred to the prosecuting attorney of the county from which the application was made.

There has been a considerable degree of activity shown in enforcing the practice act in different parts of the State during the last six months; in several instances this being undertaken by local medical societies acting in the interest of decency and honest dealing toward the public by practitioners, both licensed and unlicensed, with the general effect of purifying the professional atmosphere to some extent, educating public opinion in favor of thelaw and discouraging resort to unprofessional or dishonorable conduct in practice.

A number of applicants have made known their wish to appear for examination before the Board. Due notice has been sent to these as to the time and place of the meeting, with the blank forms of application required to be filled in and presented in such cases.

Inasmuch as it appears from information received from the Secretary of State that no changes were made in the laws relating to public health and medical practice during the late session of the legislature, there seems no necessity apparent for any radical departure from the course pursued by the Board, beneficially, it is believed, during the last four years.

So far as I have been able to learn, no provision has been made or steps taken looking to the publication of the annual report of 1888. The demands for such publication are frequent, copies are due to other States which send their official publications regularly to this office, and some means should be devised to secure as early as possible the appearance of the report in printed form.

The recent death of Dr. G. M. Cox creates a vacancy in the Board and deprives the Homeopathic school of present representation in this organization. Dr. Cox was the senior member of the Board in point of service, and to the extent the condition of his health permitted, was an active member.

On motion the report was received, considered and adopted.

A letter from the Governor relating to Board matters was read and on motion filed.

The hour of 3 o'clock having arrived on motion the Board gave a hearing to certain physicians, all of Buchanan county, and applicants for certificates who had been notified by the Secretary to appear before the Board on charges of unprofessional or dishonorable conduct in accordance with section 8 of the Medical Practice Act.

All the accused were present in person, and were represented by legal counsel.

The information and evidence collected and on file relating to the cases in the form of written and printed documents and matter were read by the Secretary and considered by the Board.

The accused were heard severally in their own defense, and the Board listened to the arguments of counsel at length.

Pending consideration of the matter at six o'clock the cases of two of the applicants were laid over until the following day.

On motion of Dr. Merrell, seconded by Dr. Griffith, the Secretary was directed to issue a certificate to Dr. R. W. Fisk.

The Governor entered and was received by the Board. He extended an invitation to hold future sessions at the Capitol, and promised the advice of the Attorney-General on any legal points arising in the transaction of its business upon which such advice was desired.

The courteous invitation and offer of the Governor was accepted with thanks.

The Board, on motion, at 6:30 p. m. adjourned until 8:30 a. m. the following day.

SECOND SESSION.

The Board met pursuant to adjournment with the same members present, except Dr. Griffith.

The approval of the minutes of the January meeting being in order, Dr. Homan moved a reconsideration of the vote by which the resolution in the Oregon county case was adopted. Carried. Dr. Homan then moved as an amendment that the following be added to said resolution: "provided, That this resolution shall not apply to the holders of licenses granted by county examining boards." Carried.

The minutes were then adopted as amended.

A communication from J. C. Nicholas was read submitting the regulations, forms, etc., to govern transportation of bodies of persons dead of communicable diseases adopted by the National Association of General Baggage Agents, and requesting their favorable consideration by the Board.

After the reading and discussion of the proposed rules, on motion of Dr. Goben, they were approved.

At 9 o'clock, on motion of the Secretary, counsel was again heard in support of the applications for certificates of the physicians from Buchanan county, he admitting that they were responsible for the character of the advertisements complained of appearing in the St. Joseph public press.

At the conclusion of the attorney's remarks the matter was taken under advisement, and the session of the Board transferred to the Capitol.

Advice concerning the proper construction of section eight of the Medical Practice Act and the bearing of a decision of the Supreme Court thereon, and in regard to the duty and powers of the Board in cases where unprofessional or dishonorable conduct was charged against those seeking registration, was had of Mr. Robb, representing the Attorney-General.

After due deliberation and upon full consideration of the matter the Board by unanimous vote refused certificates to the two applicants for unprofessional or dishonorable conduct, consisting in the publication by them of advertisements in the public press of St. Joseph, Mo., during the present year; said advertisements, in the opinion of the Board, being of a character that tended to mislead and deceive the public, to impose on the fears, weakness or ignorance of the sick or credulous, and to defraud the people by false and impossible claims in regard to the treatment of disease.

An application for registration from Douglas county, with accompanying papers, was submitted by the Secretary, who stated that the affidavit presented by the applicant was based on a license granted by a county examining board in Texas, such a license not being entitled under the law to recognition in Missouri, in the opinion of the Attorney-General. `

On motion the action of the Secretary in withholding a certificate thereon was approved and registration on said document refused.

The applications for registration of two physicians, both of Jackson county and recent graduates of a Kansas City college, action on which was deferred by the Secretary pending determination by the Board of the recognition of that college as being in good standing, were submitted and considered. The Secretary stated that the reputed Dean of the school had been duly notified of the time and place of this meeting and was invited to be present, as the matter of the standing of the college would be considered.

After due consideration, on motion it was decided to withhold certificates to the applicants until the proper authorities of the school had filed an affidavit with the Secretary to the effect that the minimum. requirements, adopted by the Board as a standard of recognition, had been enforced by the faculty during the session of 1888-89.

The action of the Secretary in withholding certificates on applications for registration made by a number of individuals in different. parts of the State, until satisfactory evidence of good professional standing was severally furnished, was, on motion, approved.

The action of the Secretary in refusing license to an applicant living in Jackson county on the diploma of a fraudulent school was. approved.

The application for registration of another physician of Jackson county was laid before the Board and considered. The Secretary stated that a certificate was withheld and the matter referred to the Board on account of alleged unprofessional or dishonorable conduct; the applicant had been notified to be present, and acknowledgment of receipt of the notice sent was submitted.

The action of the Secretary was approved, but no final action. taken, the matter being reserved for further consideration.

In the case of an applicant from the City of St. Louis, the application for registration was submitted and considered by the Board. The Secretary stated that the applicant had been duly notified as to time and place of meeting, the responsibility of granting license having been declined in the case for the reason of the possession and public distribution by applicant of printed matter admitted by him to be

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