Institutes of the medical faculties of the German universities and the attendance of the

faculties.

Not including the salary of the six mechanicians to be added in 1894 but included in preceding column.

IV. THE INTEREST OF THE STATE.

The active reform in medical education began about 1880. In the early part of that year the American minister to Germany, Hon. Andrew D. White, addressed a letter to the honorable the Secretary of State, Mr. Evarts, by whom the letter was forwarded to this Department. Mr. White had been requested by the German authorities to give information respecting the diploma presented by a man named Volland, which had been granted him by the "American University of Philadelphia." Mr. White's letter is as follows:

After looking through the correspondence on record in this legation and seeking in vain for the name of the institution in the list of colleges and universities published by the Bureau of Education in the Department of the Interior at Washington, my answer was unfavorable to Volland's claim... That such cases as these have brought disgrace upon the American system of advanced education and upon the American name in general is certain. This has been recently revealed to me incidentally in a curious way. In a very successful play now running at the Royal Theater in this city (Berlin), a play written, strangely enough, by a judge of one of the highest tribunals in the Empire, one of the characters, in casting a reflection upon another, who is dignified with the title of doctor, declares a belief that the latter had simply bought his degree in America; and in a recent novel by a popular author here, the scoundrel of the book, having escaped justice in Germany, goes to America, and is, at last advices, very comfortably settled and practicing medicine with a sham diploma which he has bought for money.

Immediately the police powers of the States were invoked to remedy this evil, and since that date we have seen State after State create boards of medical examiners or

The

empowering boards of health to act as such. Law, too, has felt the swing of the movement in medicine. But both in the case of medicine and law there are difficulties to be encountered in practice that theory perhaps is too disinclined to see. principal of these are (1) the control of the States, making forty-five jurisdictions to be taken into consideration, and (2) the fear of creating a close corporation or monopoly. Perhaps by an arrangement among the medical and judicial authorities of the States uniformity might be introduced all over the Republic, while the State, retaining the administrative power in its own hands, might prevent there being a professional monopoly by legislating in such a way as to prevent the accomplishment of the purposes for which monopolies of a dangerous kind are formed. Great Britain, after whose early practice our own is formed, presents us with an example both for what is good and for what appears undesirable in legislating upon this subject.

The earliest effort of a State to regulate, or rather to coordinate institutions maintained and managed by private persons or corporations, is New York. That State, in 1781, created a board of regents of the University of New York, which is a State body, composed of the governor, the lieutenant-governor, the secretary of state, the state superintendent of public instruction, and nineteen members chosen by the State legislature. The duties of this board are to approve the incorporation of colleges and secondary schools, to visit and inspect such institutions, to examine into their condition and methods, and to grant honorary degrees above the degree of magister artium, and to establish examinations for the bestowal of a degree of any grade. From time to time since 1866 the board has also been called upon to examine candidates for the degree of doctor of medicine and of dentistry and to confer those degrees, to establish a standard of graduation from the secondary schools (which is also the entrance requirement to any college in the State), and, finally, to examine candidates for matriculation in a law or medical school or other place for the study of law or medicine, as to the literary qualifications of such candidates.

By a law passed June 26, 1895, the State of Pennsylvania instituted an official body, which has control of the incorporation and the course of study of all institutions empowered to confer degrees established after the date of the act. This official body is styled the College and University Council of the State of Pennsylvania, and its members are the governor of the State, the attorney-general, the superintendent of public instruction, and nine persons appointed by the governor, three of whom are presidents of undenominational colleges or universities of the State of Pennsylvania, three others are presidents of denominational colleges, and the remaining three members have some relationship to the common schools of the State. No new institution may be chartered by the College and University Council unless it has property amounting to $500,000 to be exclusively used in education, has a faculty of six or more regular professors who are to devote their entire time to instruction, and requires four years of study for a degree, the requisites for entrance upon each course of study leading to a degree being fixed by the College and University Council. But a university or a college empowered before the passage of the act creating the College and University Council to confer degrees may continue to do so provided, in the case of the university, it have $500,000 in property or capital, and in the case of the college, $100,000. The recent action of the State of Pennsylvania is the most decisive step taken in the United States for the regulation of granting degrees, which is the object of the law, for it states explicitly within itself that its provisions shall not apply to institutions possessing capital stock and established for purposes of private profit or gain. This law is too recently enacted to speak of its results.

In the United States the admission to the bar of persons who desire to practice in the Federal courts has been left by Congress in the hands of the Supreme Court of the United States. In the States, though invariably it is a court of law which licenses the applicant, much diversity exists in the manner of ascertaining his qualifi

cations. In some States the local courts decide upon this question; in others it is the supreme court of the state that establishes the rules by which the applicant's knowledge is tested. It is very generally the case, however, that the examination is made by a committee of the court. A notable innovation on this time-honored method is that of the State of West Virginia, which sends all applicants who desire to be admitted to the State bar to the faculty of law of the University of West Virginia. This body examines the applicants and certifies the result of its examination to the supreme court of the State, by which final action is taken.1

The licensing of persons who desire to practice medicine is entirely in the hands of the legislatures of the several States. These bodies have delegated their powers to certain boards of medicine, sometimes called a State Board of Health, sometimes a State Board of Examiners. The discretionary power of the majority of these boards is very large. There are now eighteen States having the rule to admit no one unless he has been examined by the board of that State. These States are thus treating not only each other, but all other sister States of the Union as though they were foreign countries. A very interesting question, indeed, is raised in this matter by a correspondent of the Bureau, in answer to a recent inquiry, who replies that "The law of his State does not permit reciprocity, which in his opinion is an error and unconstitutional."

In the tabulations which follow are given the answers concerning citizenship, the treatment of a diploma from a school in a sister State or in a foreign country, and admission of practitioners of a sister State or foreign country.

SUMMARY OF TABLE.

Medicine.

Showing the number of States (a) which will not accept a diploma from any school as an evidence of fitness to practice medicine; (b) those that do not make any distinction between a diploma from schools in their own State or those of another State of the Union and the diploma of a foreign school; and (c) those that will not accept a State certificate from the medical authority of a foreign government or of a sister State as prima facie evidence of fitness to practice medicine.

Class a: States that refuse to accept the diploma of any school-Connecticut, Maine, Massachusetts, New Hampshire, New Mexico (from foreign countries), North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Washington (?), and West Virginia.

Class b States that make no distinction between home and foreign diplomas-California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Montana, New Jersey, Nevada, New York, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, Vermont, Washington (?), Wisconsin, and Wyoming. Among these twenty-eight States are eight which require both a diploma and an examination. States thus admitting no one to examination unless he has a diploma are Florida, Georgia, Idaho, Louisiana, Minnesota, Montana, New Jersey, and South Carolina.

Class c: States that will not accept a State certificate from the medical authority of a foreign government or of a sister State-Connecticut, Delaware, Florida, Georgia, Idaho, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey (except in the case of certificates from the State board of New York or of Pennsylvania), North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania (certificates from New Jersey State board are accepted), Rhode Island, Tennessee, Utah, Washington, and West Virginia.

1 See page 1191.

Law.

Showing the number of States (a) which “consider” a diploma as an evidence of a fitness for admission to the bar and (b) those States whose authority will probably be strongly influenced in favor of a candidate who has a diploma from a foreign (state controlled) university if testifying that the holder is proficient in the civil law and the law of his own country.

Class a: States considering a diploma of a law school of the State or of a sister State as an evidence of fitness for admission to bar-Alabama, Arizona, Colorado, Delaware, Connecticut, Georgia, Idaho, Illinois, Indiana, Iowa, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New York, North Carolina, North Dakota, Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia, and Wisconsin. But thirteen of these States will only recognize the diplomas of State institutions or those incorporated under its laws.

Class b States which will give considerable weight to a proficiency in the civil law and the law of applicant's own country-Arizona, Colorado, Georgia, Indiana, Iowa, Louisiana, and North Carolina. Attention is also asked for replies of Maryland, Missouri, Nevada, Ohio, and Oklahoma.

MEDICINE.

During the month of August the president of the medical board or the secretary of state of each State of the Union was invited to answer, among others, these questious:

On granting a license to practice medicine in your State is any distinction made between applicants who hold a diploma from a medical institution, incorporated under your own State laws or the laws of another State of the Union, and appli. cants who hold a diploma from a foreign school of medicine?

(Should it happen that your State pays no attention to college diplomas of any kind, please state that fact.)

The answers are-

CALIFORNIA: No distinction is made

COLORADO: No....

CONNECTICUT: There was a distinction made in favor of some of the colleges of the United States, but under the law of 1897 no attention whatever is paid to college diplomas. DELAWARE: They must have a diploma, but [law] does not specify any particular college or colleges.

FLORIDA: Any holder of a diploma from a recog.

nized medical college is eligible for examination, a diploma being necessary.

GEORGIA: No distinction is made against any "regular" (allopathic) college requiring three courses of lectures.

KANSAS: No distinction is made..

What formalities, if any, do physicians who have been duly licensed by another State or by a foreign government have to undergo in order legally to practice their profession in your State?

The answers are

Applicant must present diploma, a letter of recom mendation from a regular practitioner of medi cine, an affidavit stating that he is the lawful possessor of said diploma; that he is the person named therein; that the diploma was procured in the regular course of medical instruction, etc. Those physicians presenting diplomas from recog nized reputable schools are registered upon their presenting it, or on presenting five affidavits from responsible persons setting forth that holder has practiced medicine for ten years continuously as a business.

They must pass an examination.

Examination. There is nothing in our law which allows reciprocity, which I think unconstitutional.

Pass an examination before one of the seven ev. amining boards of the State.

All are required to stand the examination before the board.

A diploma or a certificate of qualification from some State or county medical society.

MEDICINE- continued.

IDAHO: If the board find that his or her diploma has been issued by a reputable college of medicine the applicant is eligible for examination.(Law, March 12, 1897.)

All persons who have been licensed to practice medicine and surgery, or either, after examination by State boards of medical examiners or State boards of health of other States where the standard of examination is substantially the same as required by the provisions of this act, shall be, upon application, licensed without examination. (Law, March 12, 1897.)

ILLINOIS: Graduates of colleges in the United States recognized conditionally are required to supplement their diplomas with an examination in the four principal branches of medicine-practice, surgery, gynecology, and obstetrics. A percentage of 80 is required. Graduates of colleges in the United States that are not recognized by this board are required to pass an examination in all branches. Graduates of Canadian colleges and foreign colleges and universities are required to supplement their diplomas with an examination in practice, surgery, gynecology, and obstetrics unless they present evidence of their right to practice medicine and surgery in the province or country in which the college is located from which they receive their diploma. INDIANA: Must come in on diplomas from schools recognized by this board or satisfy this board that they maintain a course equal to our requirements.

IOWA: No; provided the college has been recognized by our State board of medical examiners as determined by its compliance with the provisions of the law.

LOUISIANA: No distinction between this State and any foreign country. The applicant must present a diploma from a reputable medical college requiring three courses of six months each in three different years.

MAINE: No distinction as to diploma. All persons presenting themselves for registration have to pass an examination.

MARYLAND: No; the law requires that the applicant shall be a graduate of some reputable medical school.

MASSACHUSETTS: No distinction made. College diplomas not a factor in testing an applicant's qualification for practice.

MICHIGAN: No; every graduate of any legally authorized medical college in this State or any one of the United States, or in any other country, shall be deemed qualified to practice medicine and surgery in all its departments after having registered. (Law, 1887.)

MINNESOTA: No; college diplomas are only recog nized as evidence of the prescribed course of study.

MISSOURI: No distinction is made

MONTANA: No; all applicants for certificate must pass the State examination and must possess a diploma from some school recognized by the board of examiners.

NEW HAMPSHIRE: Our State pays no attention to college diplomas, except Dartmouth College diplomas, for the next four years. After 1903 Dartmouth men will have to pass examination. ED 97-78

Come in on their diplomas filling the proper blanks and paying their fees.

If graduates, they fill out the application blank and send it to this office for verification, with the fee, $5, and diploma.

They must present their diplomas and stand a written examination before the board. Fee, $11. Seventy-five per cent required in order to pass.

Pass an examination before the board and be registered.

They have to fill out and swear to a printed application form, giving name, age, when and where graduated, etc., and then undergo a regu lar or special examination, as the board may deem best.

All applicants must pass a satisfactory examination.

File sworn statement with clerk of county.

Pass examination of State board of medical ex

aminers.

All physicians must register with the State board of health by making au affidavit that they are the lawful holders of the diploma which they present, and pay a fee of $1.

Pay fee of $15 and pass examination. If granted a license, the same to be recorded in the office of the clerk and recorder of the county in which holder intends to practice within sixty days. Pay annual fee of $20 to State.

Pass regent's examination-i. e., superintendent of education-but there is a "board of examiners."