THE 
REGULATION OF MEDICAL PRACTICE BY 
STATE BOARDS OF HEALTH, 
AS 
EXEMPLIFIED BY THE EXECUTION OF THE LAW IN ILLINOIS. 
BY / 
n. A- m.d., 
ILLINOIS. 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
' 187 9. THE 
REGULATION OF MEDICAL PRACTICE BY 
STATE BOARDS OF HEALTH, 
AS 
EXEMPLIFIED BY THE EXECUTION OF THE LAW IN ILLINOIS. 
BY z 
IL A. JOHNSON, M.D., 
ILLINOIS. 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
187 9. THE REGULATION OF MEDICAL PRACTICE BY STATE BOARDS 
OF HEALTH, AS EXEMPLIFIED BY THE EXECUTION OF THE 
LAW IN ILLINOIS. 
The Legislature of Illinois, at its session of 1877, passed a 
bill creating a State Board of Health, and at the same session 
an Act to regulate the practice of medicine in the State of 
Illinois. The duty of carrying into execution this last law was 
committed to the State Board of Health. The bill provides 
that every person practising medicine in any of its departments 
shall possess the qualifications required by this Act. If a 
graduate of medicine, he shall present his diploma to the State 
Board of Health. If the diploma is found genuine, and if the 
person named therein be the person claiming and presenting 
the same, the State Board of Health shall issue a certificate to 
that effect, and such diploma and certificate shall be conclusive 
as to the right of the lawful holder of the same to practise 
medicine in this State. If not a graduate, he shall present him- 
self before said Board and submit himself to such examination 
as the Board shall require, and if the examination be satisfac- 
tory the said Board shall issue its certificate in accordance with 
the facts, and the lawful holder of the certificate shall be en- 
titled to all the rights and privileges herein mentioned; the 
lawful holder of a diploma shall be required to make an affi- 
davit that he is the legal possessor of the same; and that he is 
the person therein named. These certificates, whether issued to 
graduates, or upon examination, shall be recorded in the office 
of the clerk of the county in which the holder resides. The 
register of the county clerk shall be open to public inspection. 
The examination of those not graduates may be wholly or 
partly in writing, and sufficiently strict to test the qualifications 
of the candidate as a practitioner. The Board has power to re- 4 
REGULATION OF MEDICAL PRACTICE. 
fuse certificates for unprofessional or dishonorable conduct and 
to revoke certificates for like cause. The law requires the 
Board to grant certificates to the holders of diplomas from 
legally chartered medical institutions in good standing, giving 
to the Board the power to determine what colleges are in good 
standing. It also defines a practitioner of medicine to be one 
who shall profess publicly to be a physician and to prescribe 
for the sick, or who shall append to his name the letters 
" M. D." Itinerant vendors of any drug, or application for the 
treatment of the sick, or cure of disease, are required to pay a 
license of $100 per month. The punishment for any violation 
of the Act is a fine of not less than $50 nor more than $500, 
or by imprisonment in the county jail for not less than one 
month or more than one year, or both. The provisions of the 
Act do not apply to persons who have been in the practice of 
medicine in the State of Illinois ten years or more. 
This law went into effect July 1, 1877. The Board organized 
and soon after July began its work. Its utility was a matter 
upon which the profession was by no means a unit. By very 
many physicians it was thought inexpedient and perhaps im- 
possible to carry out its provisions so as to better to any appre- 
ciable degree the condition and qualifications of those engaged 
in practice. The greatest difficulty was apprehended from the 
apparently conflicting schools of medicine. It was thought im- 
possible to form a Board that should work well together and 
which should have the confidence of those holding these widely 
different theories/ upon therapeutics. For these reasons the 
formation of the Board and its action was on the part of very 
many waited for with indifference or distrust. The Governor, 
in making the appointments, recognizing the existing facts, ap- 
pointed three physicians called "regular," for the want of a 
better term, one homoeopath, one eclectic, and two who were not 
physicians but who were men deservedly held in high esteem as 
thoroughly accomplished and scientific gentlemen, both of them 
at the head of prominent institutions of learning. It was thus 
made a mixed Board. In the prosecution of the work-the 
regulation of the practice of medicine-there were found to be 
seven, classes or grades of doctors. 
1st. Those who hold diplomas from legally organized medical 
colleges in good standing, that is, having the confidence of the 
profession at large. REGULATION OF MEDICAL PRACTICE. 
5 
2d. Those holding diplomas from colleges not recognized as 
in good standing, either for the reason that the curriculum is 
too short, too narrow, and the work of teaching too carelessly 
or imperfectly done, or because they are not teaching bodies at 
all, though chartered schools, their function being the sale of 
diplomas. As medical colleges they are myths, as business 
organizations they have only an indifferent success. 
3d. Midwives-women engaged in that special department 
of practice. 
4th. Those holding diplomas that do not belong to them, ob- 
tained by inheritance, by borrowing, or by theft. Among this 
class some change the name of the diploma, while others, sa- 
credly respecting the venerable document, issued perhaps before 
they were born, only clumsily mutilate its date and change 
their own name so as to accommodate the holder to the diploma. 
Forty-one practitioners were found under assumed names. 
5th. Non-holders of diplomas who had been in practice ten 
years or more in Illinois. 
6th. Non-holders of diplomas who had not been in practice 
ten years in Illinois. 
7th. A class of itinerants going from town to town adver- 
tising in advance that they will work their wonders at such a 
place, on such days of such month, etc. 
The work of the Board had to do with this heterogeneous 
mass. It commenced first by inviting physicians holding di- 
plomas to present them for verification; second, by holding 
sessions at different points in the State where those not gradu- 
ates could present themselves for examination. These exami- 
nations have been conducted in writing by different members 
of the Board, and from the papers seen by the writer are judged 
to have been practical and thorough. The fact that not one- 
half of those presenting themselves passed justifies the belief 
that in this respect the Board has done its duty. 
The report of the Board presented to the Governor in De- 
cember, 1878, gives in detail the results of this work up to that 
date, and I beg leave to present a few abstracts which may be 
of interest to the Section. There have been issued, to holders 
of diplomas from schools deemed by the Board in good stand- 
ing, 3858 certificates; upon examination of non-graduates of 
less than ten years' standing, 150; upon affidavits from non- 
graduates of more than ten years' practice, 942; being a total 6 
REGULATION OF MEDICAL PRACTICE. 
of 4950. Certificates were also issued to 420 midwives; mak- 
ing a grand total of certificates of 5370. It is well known that 
in our large cities there are quite a number of women engaged 
in this special work. Examinations were held, and the qualifi- 
cations of this class of practitioners determined. In addition 
to all these holders of certificates, there are quite a number who 
do not come within the requirements of the law on account of 
time in practice. The Board estimated that there were in the 
city when the Act went into effect, July, 1877, about 3600 
practitioners of medicine not graduates from any medical col- 
lege. Of these only 371 have presented themselves for exami- 
nation, of whom 150 only have passed successfully that ordeal. 
950 had been in practice ten years or more, and were conse- 
quently not required to present themselves for such examination ; 
about 450 have graduated from medical schools; the cases of 
about 400 are still undetermined by the Board, while 150 are 
evading the provisions of the law by every possible means, and 
1400 have left the State. 
The effect of this law and its execution has, I think, been 
much more satisfactory both to the profession and the public 
than its most ardent supporters dared to hope. The attention 
of the non professional public has been called to the importance 
of knowledge as a qualification for practice. A general interest 
has been awakened upon this subject which in its influence will 
lead to a more just estimate of the physician and a better un- 
derstanding of the responsibilities of his office. 
The Board is invested with authority to determine what con- 
stitutes a medical college in good standing. At a meeting held 
in Cairo, November 5, 1877, the following resolutions were 
adopted:- 
" Resolved, That on and after July I, 1878, the Board will not 
consider any school in good standing which holds two gradu- 
ating courses in one year. 
" Resolved, That on and after July 1,1878, the Board will not 
recognize the diplomas of any medical school which does not 
require of its candidates for graduation the actual attendance 
on at least two full courses of lectures with an interval of six 
months or more between each course." 
These resolutions make it impossible for the graduates of 
schools which give two graduating courses in each year, or 
which do not require an interval of at least six months between REGUL A'1'ION OF MEDICAL PRACTICE. 
7 
each course, to practise medicine in any of its departments in 
the State of Illinois. This action has led to the extension of 
the lecture term and the abandonment of the two-term system 
in one of the medical colleges of Chicago-the " eclectic." It is 
believed that this action has had some influence on medical 
colleges outside of the State. In other words the action of the 
Board under the law has been the means of bettering a certain 
class of medical institutions, whose status in the estimation of 
the profession was somewhat equivocal. The execution of the 
law has also given encouragement to the legally qualified phy- 
sicians. It has secured for them more honorable association, and 
has given to them the means of certifying to the public their 
own claims to the confidence of the people. 
Fears have been entertained that a law, such as that placed 
upon the statutes of Illinois, could not be executed; that it 
must remain a dead letter; that it would be impossible to hunt 
up and investigate and determine the status of the thousands 
of practitioners scattered from the lake to the river. This task 
is no doubt a difficult one, and would be still more so but for 
the existence of the State Board of Health and the provisions 
of the organic law requiring the registration of practitioners as 
a part of the machinery necessary for securing the vital statistics 
of the State. The State Board requires a registration in the 
office of the county clerk of each county of every person prac- 
tising medicine or midwifery. The neglect of such registration 
subjects the person so neglecting to the penalty for the violation 
of the law regulating the practice of medicine. It will be easily 
seen that if a few only of the practitioners become registered it 
will be for their interest to determine the fact that all others 
are also registered. In this way every practitioner who has 
complied with the law is made an aid to the State Board in the 
execution of its provisions. It has been found to be practically 
the fact that in many counties not a single person is engaged in 
the practice of medicine who has not complied with the law, 
and this not so much through the immediate intervention of 
the State Board as through the action of the local physicians. 
A suspicion that a neighboring or competing practitioner has 
not complied with this law, or that he is disqualified by law, 
leads at once to an investigation, and, in case of the neglect or 
refusal to comply or qualify, to prosecution. The authority of 8 
REGULATION OF MEDICAL PRACTICE. 
the Board to revoke licenses has been tested in the courts, and 
so far has been sustained. 
In view of all these facts it is quite evident, I think, that it is 
possible to regulate the practice of medicine and to vastly im- 
prove its condition, and that this can be done and probably best 
done by State Boards of Health. 
In conclusion the writer begs leave to suggest that it is the 
duty of the State to protect its citizens from the injuries they 
may sustain from the practice of incompetent physicians and 
surgeons as well as from any other source of danger to public 
health. The mode in which this protection can be best extended 
is one upon which there may be differences of opinion ; in fact 
there may be different modes equally efficient. But that adopted 
by the State of Illinois, if it could be carried still further and 
made more complete in this investigation of the status of every 
practitioner of medicine, would, as it seems to me, be amply 
sufficient. A diploma from any medical college ought not to 
be accepted of itself as the evidence of a qualification for the 
discharge of the duties of the profession. It is true a Board in- 
vested with the power of discriminating like that of this State 
perhaps may be trusted to determine what colleges do give to 
their graduates an education qualifying them for these respon- 
sibilities ; but practically it is found very difficult to make such 
discrimination. An examination should be held of every prac- 
titioner of medicine; that examination, if successful, should 
entitle him to a license to practise. The colleges would then be 
relegated to their legitimate places as teaching bodies, and not 
as bodies empowered to give authority to practise. The colleges 
that have the best teachers, whose students are most successful 
in passing this examination, and which are therefore evidently 
rendering to the community the highest services, would become 
the most popular, and would justly receive at the hands of the 
public that recognition which they deserve. 
But the consideration of this subject leads us beyond the 
scope and purview of this paper, which was simply to submit 
the results of the effort in the State of Illinois to regulate by 
law the practice of medicine.