These things give rise to many perplexing questions which must be solved before the subject of quarantine can be regarded as properly settled. The end to be sought, of course, is the exclusion of disease germs from uninfected regions with the least possible interruption of the ordinary freedom of intercourse between different parts of the country. The creation of a National Board of Health was an effort to solve this problem, and it has, without doubt, accomplished something in that direction. It has power to supply the defects of State jurisdiction where territorial boundaries create embarrassments. By undertaking to give timely warning in every case of danger it deprives local greed and jealousy of opportunities to pervert quarantine to trade purposes, and it also obviates another difficulty, namely, the concealment of the truth, frequently practiced in infected cities to prevent the injury to their trade which the knowledge of the existence of infection there would work. The capacity of the National Board of Health to accomplish much needed good in these ways is very great, and there is reason to hope for such an organization of the National Board's work as will make it a highly efficient supplemental agency. As yet, however, there exist occasions for conflicts of authority between the National and the local boards, which must be adjusted upon some mutually acceptable basis before the two systems, working together, will become capable of their highest usefulness.

The other matter-that which concerns methods of quarantine protection and sanitary improvement-is even more important as a subject of investigation and wise experiment. We know really so little respecting the laws that govern the propagation of disease by infection and contagion, that more than half of what we do by way of protection is done in the dark, and much of it, no doubt, done wrong. There can be little question that in our ignorance we sometimes impose burdensome restrictions upon the freedom of inter course, which might be dispensed with if our knowledge of the laws with which we deal were greater than it is, and, on the other hand, it is certain that, in spite of our best endeavors, the infection sometimes eludes our vigilance and finds entrance through some aperture which might easily have been closed if our knowledge of the subtle nature of the disease, and the occult method of its transmission were profounder than it is. We can and do restrict the area of epidemics by our existing methods; but we do this imperfectly for want of knowledge, and in doing it we are compelled, for want of exact information, to interfere with commercial and social intercourse to a greater extent than need be.

It is not too much to say, therefore, that so far as quarantine and sanitary functions are concerned, one of the most important things that the men charged with the administration of State medicine have to do is to learn. Quarantine, more or less effective, could be maintained by municipal or even private effort. As a matter of fact, it has been more than once maintained by purely individual effort, plus a shot-gun. But a systematic sanitary organization, under State law, opens a field of investigation and improvement in quarantine methods which is wholly closed to local efforts. It systematizes the work over large areas; it collects together in a single body of facts all the results of personal and local observation; it frees

the body of facts thus gained from all uncertainty with respect to conditions fulfilled or neglected, and thus enables us to make inductions with precision and safety from a sufficiently broad foundation of accurately made and correctly recorded observations. In fine, a system of State medicine organizes the investigation of the laws of disease transmission, and gives that investigation its opportunity. Under this system, what has hitherto been an incoherent mass of loosely observed facts, lacking significance for want of analysis and comparison, lacking even such value as individual observations, because the carefulness and skill of their making have been insufficiently attested,-this loose and nearly valueless mass of observations becomes a highly significant body of facts upon which we may rest conclusions with entire safety. Such a body of facts, studied in the collated form and interpreted authoritatively, must point the way to the rapid and certain improvement of our quarantine and sani tary methods. Under a system of this sort we have already gained much, and we shall gain greatly more. We shall learn how to exclude infection and to remove local causes of diseases with far greater precision and certainty than are now possible, and we shall learn also how to accomplish these ends at smaller cost and with less interference with travel and business than now.

With respect to the indirect functions of State medicine-namely, the advancement of science and the education of the public in sanitary laws-it may be said, briefly, that these things flow as the necessary results of the direct action of the system.

The exclusion of ignorant and fraudulent pretenders from the profession, the pressure brought to bear upon the colleges in behalf of better education, the systematic study of the principles of sanitation and quarantine-all these things must advance science, whether that end is contemplated or not. The other object referred to, namely, the education of the people in health laws, follows quite as inevitably from the direct operations of the work. The discovery of a source of typhus or typhoid in a badly-constructed drain, when made by constituted and recognized authority, sets everybody thinking on the subject of domestic drainage, and is in itself an effective lesson in the laws of health preservation.

These indirect benefits, though worthy ends to be sought, are rather results than purposes of the system.

In running thus rapidly over the field, I have mentioned only the chief objects to be kept in view. The minds of all physicians are awake already to these matters, and there is greater necessity just now to keep in mind the dangers that attend the development of the system, and to observe very strictly the limitations that should govern us, than to exalt the work to be done. It is in human nature to exceed bounds where the importance and desirability of the ends sought are keenly realized.

We need to remember, therefore, that we have enemies to confront and dangers to avoid upon every hand. Every quack whose profits are cut off by the interference of health officers is an active enemy of the system from which he suffers. Every selfish property owner who is compelled to make costly improvements in his houses and tenements in the interest of public health, becomes a hostile

influence. Still worse, perhaps still more difficult to combat, is the inertia of mere conservatism. How solidly this force can stand in resistance to anything which savors of change, merely because it is change, every one of us knows, and no one can adequately tell.

In the face of such obstacles, a strict adherence to principle-a rigid refusal to step beyond the assigned limits of function-is the necessary condition of success in the work.

MEDICAL EDUCATION.

Report of Committee of the Illinois State Board of Health.

Your undersigned committee, appointed to report requirements of "good standing" for medical colleges, respectfully submit that the committee addressed to many leading members of the medical profession, and to the medical colleges of the Union, a circular making the following

INQUIRIES:

I. In the present state of medical science and education in this country, what preparation is and ought to be required for admission to the lectures of a medical college, to entitle it to "good standing?" II. On what branches of medical and cognate science ought courses of lectures to be provided, and what length of course each to entitle the college to "good standing?"

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III. What requirements as to full attendance, reading and quizzes, or other examinations, occasional or final, ought to be maintained in such colleges?

IV. What attendance on lectures, as to time, number of terms, or courses and intervals between courses, are and ought to be required by such colleges as conditions of graduations?

V. What other conditions of graduation, such as hospital practice, or practice under preceptors, attendance on clinics, and dissections, are and ought to be required for graduation?

To this circular eighty-seven replies were received from officials of medical colleges and medical societies, and from eminent physicians. The medical colleges also promptly sent their annual announcements or circulars, and many other documents were furnished the committee touching the matters involved in their questions.

The letters, which are herewith presented to the Board, express much interest in the subject under discussion, and evince deep and general desire for improvement in medical education in this country. It is evident that the members of the medical profession are ready to welcome and sustain all wise efforts to advance the standards and increase the thoroughness of medical instruction. The committee regret that the proper limits of their report will not permit them to quote at length from the letters received.

The annexed tabular statement, drawn from their annual announcements, will show the present usages of the medical colleges in the several respects involved in our inquiries. The letters accompanying the announcements often express a desire and purpose to

introduce reforms as soon as the concurrence of other colleges will permit. This is especially true in regard to the preparatory studies to be required of candidates for admission to the lecture courses. The failure to require adequate preparation before entering upon professional studies is doubtless one of the most serious and even fatal defects in American medical education. As students usually begin their studies with private preceptors, the remedy lies first with those who consent to act as such preceptors. Let them strenuously advise all candidates to make a liberal and thorough scholastic preparation, and refuse to receive any who are destitute of such preparation, and the reform would be well begun. But the failure of private preceptors to perform this obvious duty cannot exonerate medical colleges from the responsibilities which, by implication, they voluntarily assume. The committee are glad to report that so many of the leading medical colleges have now announced preliminary examinations as conditions of admission, in accordance with the vote of the American Medical College Association, that we are justified in including such examinations in our requirements or marks of "good standing."

After a careful comparison of the usages of the colleges, and of the opinions of the profession, the committee offer the following scheme of requirements, and recommend its formal adoption by the Board as its definition of the colleges whose diploma shall be hereafter accepted by it:

MINIMUM REQUIREMENTS FOR A MEDICAL COLLEGE TO BE HELD IN "GOOD

I. Conditions of Admission to Lecture Courses.

1. Credible certificates of good moral character.

2. Diploma of graduation from a good literary and scientific college, or high school. Or, lacking this,

3. A thorough examination in the branches of a good English education, including mathematics, English composition, and elementary physics or natural philosophy. This provision will not be required before the close of the lecture sessions of 1882-1883.

II. Branches of Medical Science to be included in the Courses of Instruction.

1, Anatomy. 2, Physiology. 3, Chemistry. 4, Materia Medical and Therapeutics. 5, Theory and Practice of Medicine. 6, Surgery. 7, Obstetrics and Gynecology. 8, Hygiene and Sanitation. 9, Medical Jurisprudence.

III. Length of Regular or Graduating Courses.

1. The time occupied in the regular courses or sessions from which students are graduated shall not be less than five months, or twenty weeks each.

2. Two full courses of lectures, not within one and the same year of time, shall be required for graduation with the degree of Doctor of Medicine.