much greater than in other countries. Moreover, this proportion is bound to become still more noticeable. At the time of the American Revolution, and even as late as the war of 1812, the number of physicians in this country was exceedingly small, and the medical colleges could be counted on one's fingers. During the long period of over sixty years from 1765 to 1826 only 12 medical colleges attained a permanent foothold in the United States; and the number of medical students was as small as the number of schools, in comparison with those of the present time. The medical school of the University of Pennsylvania was the first established in the United States-opened in 1765. The Harvard medical school followed in 1782, and Dartmouth in 1796. The twelve oldest medical colleges are as follows, the date being that of opening, not the date of the charter: 1. University of Pennsylvania, medical department. 1765 2. Harvard University medical school.. 1782 3. Dartmouth Medical College. 1796 4. College of Physicians and Surgeons, Columbia College, New York. 1807 9. University of Vermont, medical department 1823 10. National Medical College, Columbian University, Washington, D. C. 1824 11. University of Virginia, medical school... 1825 12. Jefferson Medical College of Philadelphia, Pa... 1826 While it took sixty years in those days for the establishment of 12 medical schools, half as many were established in one year, in 1893, namely: Council Bluffs Medical College, Iowa. Johns Hopkins University medical school. Tufts College medical school. North Carolina Medical College. University College of Medicine, Richmond, Va. Wisconsin College of Physicians and Surgeons, Milwaukee, Wis. The following statistics from Dr. William Pepper, of the University of Pennsylvania, show the ratio of physicians to population in various countries: It is said, too, that there are twice as many medical students in the United States as in France or Germany, and it is equally true that the number is still more striking when compared with the number in Mexico, Brazil, or China. In some portions of Africa there are some entitled to be called medical students; in Brazil, a larger number; in Italy still more; and in the United States, where the enlightenment of the masses of the people is highest and material prosperity greatest, is it surprising that the number of medical students is greater than in any other country? Instead of the relative number of physicians in the United States being the same as in Brazil, or Italy, or Spain, is it not a matter of congratulation that the people of this country are so well informed that they always endeavor to obtain a cure of disease, and that they are also so generally able and willing to give proper remuneration for medical services? Moreover, it is fortunate that in this country so many young men can secure the means necessary to obtain a full medical training, while in some other countries the conditions are so hard and exacting that it is with difficulty people can barely maintain a livelihood. Instead of deprecating the fact that there are so many more physicians in the United States than in Italy, we should point to this as evidence of greater prosperity. The people themselves are making no complaint that there are too many physicians; they content themselves with the thought that it is the same with physicians 1According to British Medical Register for 1896. The medical men as with any commodity-the greater the supply, the less the cost. themselves are the only ones who have reason to complain, and is it not probable that some of them are falling into the way of some trades unions in endeavoring to shut out accessions in order that they may enjoy exclusive possession-a monopoly? Not only are the people in this country better able to pay for the services of physicians than in other countries, and a larger number of young men able to bear the heavy expenses of securing a medical education, but the same conditions hold in regard to any of the higher pursuits. There is a larger number of lawyers than in other countries, a larger number of dentists. In whatever country the largest number of people can elevate themselves above the condition of day laborers, there will we find the largest number of doctors, lawyers, dentists, etc. Moreover, on account of their wide distribution the people of this country really need a much larger number of physicians than the crowded nations of Europe, just as the scattered agricultural population of a Western or Southern State will need three or more times as many physicians as the industrial population of some Eastern city, crowded together in adjoining houses. One physician can serve 2,000 people in a manufacturing town as easily as 3 physicians the same number of people in a scattered agricultural community. If the 3 homeopathic schools in the universities of Iowa, Michigan, and Minnesota are considered distinct schools, there are then 17 medical schools forming part of State universities, the faculty of physic of the University of Maryland also being included, although its connection with the State is only nominal, the university having only the professional schools, law, medicine, and dentistry. The departments in State universities are as follows: California, Colorado, Georgia, Iowa (regular and homeopathic), Louisiana, Maryland, Michigan (regular and homeopathic), Minnesota (regular and homeopathic), Missouri, North Carolina (preparatory medical), Oregon, Tennessee, Texas, and Virginia. With two or three exceptions, the annual charges for tuition are much lower than in other medical schools. The medical department of Texas University has the distinction of being the only medical school which makes no annual charge to resident students, and it has no diploma fee. Nonresident students must pay an annual fee of $50. Heretofore Colorado had no tuition fee, but after September, 1895, an annual fee of $35 will be charged. In Michigan University the fee is quite small, only $25 per annum; in Missouri it is only $20 the first year and $50 the second and third; in Iowa and Minnesota it is less than $50. Notwithstanding the large endowment funds of such institutions as Harvard, Yale, Columbia College, and the University of Pennsylvania, the annual charges to medical students are higher than in other schools. The tuition fee in the medical department of Harvard University is $200, and cost of the entire course about $714; in the College of Physicians and Surgeons, Columbia College, New York, tuition $200, entire cost about $850; in University of Pennsylvania, tuition $150, entire cost $612. In the collegiate departments, which receive the main benefit from the endowment funds, the charges to students are not apparently diminished. On the contrary, as the productive funds have increased, the costs to students have seemingly endeavored to keep pace with them. If one of these schools were now to receive a legacy of an additional million of dollars, it is quite probable that the charges to students would be increased. In justification of this it is said that the receipt of a large fund enables the institution to secure additional instructors of the highest attainments, to erect buildings specially adapted to the purposes intended, and to secure all necessary apparatus. Consequently, in consideration of the quality of instruction offered to students, the charges for tuition can not be considered unnecessarily high. Moreover, the attendance of a much larger number of students would diminish the possibility of the high quality of instruction which might otherwise be bestowed. On the contrary, it seems scarcely possible that an institution with no endowment fund and no assistance from State appropriations can be able to afford full and complete facilities for acquisition of medical knowledge, unless it has a large attendance of students who pay ample fees for laboratory, clinical, and other instruction. If such instruction is not given, and students are left to gather what information they can from lectures read by young men seeking a reputation as physicians or by old physicians struggling to retain one, the institution may, of course, be conducted with little cost, but the instruction given will be correspondingly meager. MEDICAL PRACTICE LAWS. Besides the District of Columbia and the Cherokee Nation of the Indian Territory, there are 21 states which require an examination of every candidate for a license to practice medicine. These states are Alabama, Delaware, Florida, Georgia, Louisiana, Maine, Maryland, Minnesota, Mississippi, Montana, New Jersey, New York, North Carolina, North Dakota, Oregon, Pennsylvania, South Carolina, Utah, Virginia, Washington, and West Virginia. It is noticeable that the South Atlantic States without a single exception require an examination, the District of Columbia also requiring an examination now accord ing to a late law of Congress. In fact, in every Southern State east of the Mississippi, except Kentucky and Tennessee, an examination is required, and two of these states, Virginia and North Carolina, were among the first to adopt restrictive medical regulations. The District of Columbia law was approved June 3, 1896. In Texas the medical law is interpreted differently in different parts of the State. A new law regulating the practice of medicine in Ohio was passed February 27, 1896, requiring a diploma from a reputable college. It is an auspicious promise of the further development and extension of restrictive measures that the two most influential States of the Union in wealth and population, New York and Pennsylvania, are among the strongest supporters of restrictive medical laws, and require of every candidate for a medical license that he shall first submit to a strict examination in order to determine whether he is qualified to take the health and lives of citizens in his hands. In the State of New York still other safeguards have been adopted in order to insure both general education and professional skill. While examinations are not required in the populous State of Illinois, other measures have been adopted and have hitherto been enforced with such rigid adherence by the State board of health that not many quacks and impostors could can find a resting place there. In fourteen States and Territories no one can practice medicine who is not a graduate of some medical school recognized as reputable by the State or Territorial board. Although examinations are not required in these States, in some of them the laws are so strictly enforced that only those who have received full and complete medical training are allowed to practice. In ten States and Territories the diploma of any chartered medical college gives the right to practice, and in one other State not even a diploma is required. In Massachusetts anyone with a diploma from a medical school in that State can practice medicine; all others must undergo an examination. uirements for the practice of medicine in the United States. Requirements. Examination by State or county board of medical examiners. Diploma of college in good standing, or examination by State or county Diploma of college in good standing. Do. Diploma of a college "recognized as reputable by one of the chartered medical societies of the State." Examination by one of the two State boards. Examination by one of the three boards. Examination by State or district board of medical examiners. Examination by one of the three State boards after showing diploma of a college requiring three years of six months. Diploma. Diploma of college in good standing. Diploma. Diploma of reputable college. Examination by one of the two State boards after showing diploma of college in good standing. Examination by State board of registration. Examination by one of the two State boards of examiners. Diploma of some medical college in the State, or examination by State board. Diploma. The words "in good standing" denote that the regulations of the college comply with the condi tions established by the State boards. 2 The law is interpreted differently in different parts of Texas, or rather is not enforced. MEDICAL BOARDS. Effort has been made to ascertain what States and Territories have separate boards for different schools of medicine, what States have mixed boards, number of members in each, and how appointed. Over one-half of the States with medical boards do not mention different schools of medicine at all. Seven States have special boards appointed by the Governor without regard to schools of medicine, viz, Arkansas, Maine, Massachusetts, Minnesota, Montana, Oregon, Washington. In 8 States the boards of health constitute the medical boards, viz, Illinois, Iowa, Kentucky, Mississippi, Missouri, Rhode Island, South Dakota, West Virginia. In 6 States and the District of Columbia there are three separate medical boards, regular, homeopathic, eclectic, viz, California, Connecticut, Georgia, New York, Pennsylvania, Vermont. In 3 States there are two boards, regular and homeopathic, viz, Delaware, Louisiana, and Maryland. Seven States have mixed boards, Colorado, Nebraska, New Jersey, |