first examination may have a second trial within six months, without paying an additional fee.

The Commissioner of Education may at his discretion, upon the approval of the Regents, endorse the license or diploma of a physician from another state provided the applicant has met all the preliminary and professional qualifications for earning a license in this state, has been in reputable practice for a period of ten years, and has reached a position of conceded eminence or authority in the profession.

Before beginning to practice, the holder of a license shall have the same registered in the office of the clerk of the county where such practice is to be carried on, producing proper evidence that he is the person to whom the license has been issued and that he has complied with all the requirements of the laws governing the practice of medicine, that no money except the regular fees has been paid for such license, and that he has not been guilty of any fraud or misrepresentation in securing his credentials. He shall receive a certificate of such registration, for which he shall pay a fee of one dollar.

A license to practice medicine may be revoked if it is found that the practitioner has been guilty of any fraud or deceit in securing his credentials; if he is an habitual drunkard or addicted to the use of morphine, opium or cocaine; if he violates any of the laws governing the practice of medicine.

Nothing in the law shall be so construed as to affect commissioned medical officers serving in the army, the navy or the marine hospital service, while so commissioned, or any one while serving on the medical staff of a legally incorporated hospital.

The law of 1912 for the state of Pennsylvania is very similar to the law of New York. The Bureau of Medical Education and Licensure is under the jurisdiction of the Superintendent of Public Instruction. This Bureau prepares annually a list of medical colleges and schools which are satisfactory to the department, and which require of applicants for a medical degree a satisfactory high-school education, together with one or more years of work in chemistry, biology and physics in an approved college, and maintain graded medical and surgical courses of four years, of not less than thirty-two weks each of not less than thirty-five hours of work, in didactic, laboratory and clinical studies.

Applicants for the medical examination must furnish satisfactory proof of being twenty-one years of age, of good moral character, not addicted to the intemperate use of alcoholics or narcotic drugs, and that they have complied with the requirements as to preliminary education and attendance upon a duly authorized and approved medical school, have successfully passed each of the courses prescribed by such school and served as an interne for one year at a hospital having, at least, twenty-five beds for each interne.

The medical examination shall be in writing, but may be supplemented by oral examinations, by laboratory tests or by bedside examinations. The examinations shall be conducted at such times and places as may be designated by the Bureau, and specially qualified assistants may be called in to assist in conducting the examinations.

The subjects of the examination shall include: anatomy, physiology, chemistry as applied to medicine, pathology, bacteriology, symptomatology, diagnosis,

surgery, gynecology and obstetrics. The examination in therapeutics and materia medica is to be conducted by members of the Bureau who are of the same school of medicine as the candidate. The law also provides for partial examinations at the end of the second year of medical study, exempting the applicant who passes any subjects at this examination from further examination upon those subjects at the final examinations.

From a table published in the Journal of the American Medical Association in its annual state board issue it appears that from 1912 to 1916 inclusive 545 of the 4283 graduates who appeared before the state boards for examination failed. During those same years none failed in Idaho, Iowa, Minnesota, Nebraska, New Hampshire, Utah, Vermont, Washington, and Idaho. During the same years, 36 per cent. of the applicants were rejected in Mississippi; 20 per cent. in New York; 20 per cent. in South Carolina; 30 per cent. in Oregon. It appears that in those states reporting large percentages of failures the proportion of failures was greater among the applicants who were graduated from colleges outside of those states than from graduates from colleges in the respective states which seems to indicate that a student is more likely to fulfill all the requirements of a state board in a particular state if he has been graduated from a college located in that state.

The lack of uniformity of standards is also indicated by the variation of the number of failures by the graduates of the same institutions in different years. Of one leading institution 10 per cent. of the graduates were rejected by the state boards in the years from 1912 to 1916 inclusive and only 5 per cent. in the latter year; of another large college 6 per cent. failed in the former

period and none in the latter. For all the colleges the percentage of failures was 20 per cent. in 1912 as against 15 per cent. in 1916. This improved result undoubtedly indicates that standards are becoming more uniform.

The lack of uniformity of standards has resulted in a movement for the establishment of a federal board for granting licenses which are to be good for the entire country. Such a board has been constituted but at present it has no official status but it is believed that the several state boards will take steps to validate the licenses issued by this national board.

The medical laws do not regulate the conduct of a physician after he secures his license to practice, but if it can be proven that he has failed to exercise due diligence and care in his duties to his patients he may be held for damages for malpractice. While it is difficult for a patient to establish before a court claims for damages, suits of this kind are so injurious to a physician that every precaution must be taken to forestall them. There are insurance companies which undertake for an annual fee to afford to practitioners protection against suits of this kind by supplying to their clients at the expense of the company, attorneys for their defense and by paying damages in cases which result unfavorably to the defendant.

A summary of the medical laws of the several states will be found in the Appendix.

CHAPTER XXIX.

THE CODE OF MEDICAL ETHICS.

As a final indication of the peculiar position of the physician we give in this closing chapter a summary of professional ethics as set forth in the Hippocratic Oath, which has been subscribed to by physicians for over two thousand years, and as embodied in one of the several approved modern statements of the code of medical ethics.

The Hippocratic Oath.

I swear by Apollo, the physician, and Esculapius, and Health and All Heal and all the Gods and Goddesses, that according to my ability and judgment, I will keep this oath and this stipulation; to reckon him who taught me this art equally dear to me as my parents; to share my substance with him and relieve his necessities if required; to look upon his offspring on the same footing as my own brothers and to teach them this art if they shall wish to learn it, without fee or stipulation, and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons and those of my teachers, and to disciples bound by a stipulation and oath, according to the law of medicine but to none others; I will follow the system of regimen which according to my ability and judgment, I consider for the benefit of my patients, and abstaining from whatever is deleterious and mischievous,