meaning, but cunning, powerful, and closely aligned with selfish and harmful political interests. In a few instances, that stand out, the boards are vigorous, intelligent, and public spirited,—notably in Colorado, Michigan, and Minnesota.
In the matter of organization they are decidedly defective. The whole weight rests usually upon a single executive officer, the secretary, whose sole staff consists of a stenographer, if that. As long as everything depends on the personality of a single individual, administration will be liable to marked fluctuations. There can be neither security nor continuity. For enlightened public opinion and accepted ideals have not as yet established definite and correct policy. Organization would within limits be independent of individuals; for it embodies a routine that fortifies every gain won, and makes possible the division of labor that is indispensable to system and thoroughness.
A bureau properly organized cannot live on small fees. It requires liberal support; for it must be in position to take trouble to secure information and to defend its rights. The power that validates the diploma with its license must have the strength to protect its issues against either debasement or infringement. The physician, like the lawyer, is an agent of the state. If he proves unworthy, the same board that vouched for him must have power to recall its act; and its function must extend to the prosecution of fraudulent or unwarranted attempts to practise without its official sanction. Any effort to exercise powers of recall or restraint will of course be resisted. The state must therefore provide funds that will enable the board to defend its action in the courts.
A model state board law must therefore guard the following points: the membership of the board must be drawn from the best elements of the profession, including—not, as now, prohibiting—those engaged in teaching; the board must be armed with the authority and machinery to institute practical examinations, to refuse recognition to unfit schools, and to insist upon such preliminary educational standards as the state's own educational system warrants; finally, it must be provided either by appropriation or by greatly increased fees with funds adequate to perform efficiently the functions for which it was created. The additional powers needed in order to deal as effectively with the practice of medicine, lie outside the present discussion.
Far-reaching legislative changes would be required in most states before the state boards could play the part here assigned to them. Yet for it they are clearly destined. As a matter of fact, recent legislation has been self-contradictory. The boards have been strengthened, their powers more satisfactorily defined; and thereupon the end thus sought has been partially defeated by the creation of sectarian boards with lower standards and looser ideas. Minnesota, for example, obtained an excellent law, consolidated the medical schools of the state, established a high standard, and quarantined against invasion by a low-grade product from without; and then, having fairly secured for the people of the state the best attainable conditions in the matter of protecting the public health, it proceeded partly to undo the good work by es-
