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STATEMENT SHOWING EXPENSES OF ILLINOIS STATE BOARD OF HEALTH
FOR THE YEAR ENDING SEPTEMBER 30, 1880.
Total Balance remaining in State Treasury to the credit of the yellow fever or contingent appropriation
REPORT OF A. L. CLARK, TREASURER ILLINOIS STATE BOARD OF HEALTH,
FOR THE YEAR ENDING SEPTEMBER 30, 1880.
To the President and Members of the Ilinois State Board of Health :
Your Treasurer begs leave to present the following report of the receipts and expenditures of his office for the period commencing with the date of his last annual report, September 30, 1879, and ending September 30, 1880 :
51 00 19 00
Balance on hand to credit of general account at date of last report.
Dec., 1879. 31.
Jan., 1880. February 28
Feb., 1880. March
M'ch, 1880. April 30.
April, 1880. 31
May, 1880 June 30
June, 1880. July 31
July, 1880. August 31.
31 00 42 00 23 00 140 00 155 00 78 00 67 00 47 00 20 00 44 00
$1,290 34 There have been paid out by order of the Board the following sums:
$19 15 29 25 26 15 29 15 28 85 26 10 66 94 11 30 22 75 19 80 49 80 78 05 64 68 79 18 38 25 34 00 29 05 36 15 124 00 150 00 125 00 45 00 19 00
17 10 $1,161 68
170 13 $298 79
All of which is respectfully submitted.
A. L. CLARK,
STATE MEDICINE IN ILLINOIS.
By H. Wardner, M.D.
The subject of State medicine is, at the present time, attracting much attention from the medical profession and from the public.
For a long time the State has exercised certain functions that are now included in our definition of that term. In Illinois it has legislated against nuisances detrimental to health. It has conferred upon local health boards authority to establish and maintain quarantine, and in other ways it has done certain things which are included in our modern conception of the functions of State medicine.
These things, however, have been only the germs of a later growth. They have been the temporary expedients of immediate necessity, resorted to with no fixed and permanent purpose, and abandoned as soon as the pressure of the immediate necessity has been removed. State medicine has, indeed, grown out of these germs, but it differs from them as the tree differs from the seed from which it sprang. The modern system, so far as it has taken form, is a systematic effort to work certain reforms, protect the public against certain evil practices, and to accomplish certain ameliorations of the harsher conditions of modern life; it is an organized, consistent and persistent effort ; a permanent force, acting steadily toward the accomplishment of well defined ends. Upon the medical profession devolves, in a large measure, the duty of executing the will of the State in this matter. Upon the wisdom or the reverse, shown by physicians, will depend the efficiency of the work, and the escape of the system from public condemnation for failure to accomplish needed good upon the one hand, and unnecessary interference with the private rights of the citizen upon the other. If censure is incurred upon either hand, the system must suffer, and the beneficent work which it contemplates must be, in some measure at least, circumscribed. It is worth our while, therefore, while the system is still in its infancy, to consider with care its functions and limitations.
It should be borne in mind that the right of the State to interfere in this matter is derived from the duty of the State. The right is, therefore, sharply limited by the duty out of which it grows. In other words, the State cannot do more than it is in duty bound to do without transcending its right and trespassing upon the domain of private effort. Our whole American system of government, of life, of civilization, rests upon the principle of individuality. It is our wise custom to hold every man responsible for himself, and to permit every man to use his powers and opportunities in whatever manner he may prefer, with the single condition that, in the exercise of his own individual right, he shall not trespass upon that of another. It is the wise practice of our governments to refrain from doing for the individual anything which he can as well do for himself.
The natural tendency to forget this principle creates the greatest danger which State medicine has to encounter. In our eagerness to do all that lies before us, in our keen appreciation of the great desirability of accomplishing certain ends, we are in danger of losing sight of the distinction between things proper for State medical authority to do, and things which are desirable in themselves but belong properly in the domain of individual effort.
I dwell upon these fundamental principles because the future of State medicine, especially in a country governed, as ours is, by public opinion, will be determined by the degree of conscientious care exercised by its executive agents in confining themselves strictly within the limits of their proper functions.
It is inevitable that the enforcement of public right in these matters shall interfere somewhat with the interests and convenience of certain individuals, and the enmity of men thus interfered with, and that of their friends, must constitute a hostile agency, working constantly upon public opinion, alert to turn to account against the system whatever it can seize upon for such use. If the system is to be maintained, unembarrassed by effective criticism, it must be kept free from liability to just censure. It must look for justification to the public conviction that its work is not only beneficent, but necessary; that the functions conferred upon it are conferred in the public interests for a necessary public purpose, which could not be accomplished by private effort. It is important, therefore, that we shall, in the outset, draw the line very sharply between the respective domains of State and individual action; that we shall keep the distinctions thus made clearly in view, and that we shall, in this inquiry, keep strictly to the broad principle that governs the matter in order that there may be no possibility of stumbling, no occasion for defense.
The broad principle may be formulated thus: State medicine is charged with the protection of the health of the people from dangers which are beyond the control of private effort ; its just functions are derived from necessity, and the necessity constitutes their limit; in their exercise, every unnecessary invasion of private right, every unnecessary interference with the perfect freedom of personal action, is a usurpation of power, an unjustifiable trespass upon the liberty of the citizen.
With the limits thus set, there is much for State medical officers to do, and brief as the history of the system has been, it has already accomplished notable results.
Its work relates primarily and directly to three principal subjects. These are: first, medical education; second, sanitation; third, quarantine. Incidently and indirectly it has other functions not less important, namely, first, the education of the people in sanitary laws, and, second, the advancement of science. It is to the credit of the medical profession that, in invoking the authority of the State in behalf of the public health, and in exercising the powers granted the State Board, the first efforts have been directed to reforming the medical corps of the State by seeking to cast out ignorance, pretension, incompetence, and all manner of quackery.
Through the work of the Board, the profession has deliberately said to the people: "Your greatest danger is from ignorance and the iniquity of pretending physicians, and we have sought, and are seeking, to protect the people at this point, by subjecting the qualification of all persons desiring to practice medicine to reasonable and satisfactory tests."
The extent to which ignorance, incapacity and fraudulent pretense actually afflict the people is well illustrated by what has happened under the working of the “Act to regulate the practice of medicine in Illinois.
Briefly stated, its provisions with reference to physicians, required only that every physician should have his qualifications to treat disease subjected to a fair and reasonable scrutiny; that the result of such scrutiny should be officially recorded, and that men who should be insufficiently prepared for the proper discharge of their functions as physicians should fit themselves by further study, or should abandon practice in the State under penalty. In executing this law, the State Board of Health has taken pains to govern itself by the rule of great liberality in its tests. It has set up no arbitrary rule of exclusion. It has fully recognized not only the existence and the authority of what are called different schools of practice, but the right of private judgment and opinion also.
In the examinations held by the Board, respect has been paid to differences of opinion upon therapeutics, and theory and practice of medicine.
Diplomas have received from the Board so much respect as they were entitled to, and no more. That is to say, diplomas of those schools which are known to graduate students only when reasonably well educated, have been accepted as proof of the fitness of their possessors to treat disease; while diplomas which properly create no such presumption, have been held to be insufficient evidence of qualification.
On the other hand, practitioners who have no diplomas at all have not been excluded. All who have not been in practice in the State ten years previous to the act taking effect, have been required simply to submit to a reasonable examination of their acquaintance with the science of medicine. In a few words, the Board of Health in its enforcement of the law, has sought simply to ascertain, in each case, whether or not the person undertaking to treat disease was properly qualified to discharge his functions intelligently and with skill. Nevertheless, even under so liberal a system as this, one thousand seven hundred and fifty men who had been practicing medicine in Illinois, have been compelled, by their discovered ignorance and unfitness, to abandon practice or quit the State.
When the law went into effect, there were about 7,409 persons practicing medicine in the State, of whom 3,800 were non-graduates. There were 423 practicing under the pretended authority of spurious or fraudulent diplomas, and 67 under assumed names. There were 73 itinerants and 23 “cancer doctors."