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state boards are the instruments through which the reconstruction of medical education will be largely effected. To them the graduate in medicine applies for the license to practise. Their power can be both indirectly and directly exerted. They may after examination reject an applicant,—an indirect method of discrediting the school which has vouched for him by conferring its M.D. degree. A small percentage of failures the doctrine of chance would lead one to expect; an increasing proportion must cast increasingly serious doubt on any institution. A more direct and therefore more salutary method is needed, however, in dealing with schools bad beyond a reasonable doubt. In such instances the board should summarily refuse to entertain the applicant's petition because his medical education rests upon no proper preliminary training or was received under conditions that forbade thorough or conscientious instruction : the full weight of its refusal would fall with crushing effect upon the school which sent him forth. No institution can long survive the day upon which it is thus publicly branded as feeble, unfit, or disreputable. For the purpose, however, of saving the victims whose cruel disappointment will in time destroy these schools, the arm of the state boards should for the present go beyond the rejection of individuals to the actual closing up of notoriously incompetent institutions. The law that protects the public against the unfit doctor should in fairness protect the student against the unfit school.

With the manifold duties and responsibilities of the state boards we cannot here fully deal. Our attention is necessarily confined to their educational function. They examine candidates for license; but admission to examination should be granted only after a fair presumption of intellectual fitness in favor of the applicant has been established by the record of his preliminary education, and a fair presumption of sufficient professional training by his graduation from a recognized or reputable medical school. Neither of these points can for the present be overlooked. So long as the medical school has as such no determinate position in the school system, the public health authorities must be empowered to fix at least the lowest point to which it can safely be permitted to fall; moreover, so long as any group of physicians may in most states incorporate a medical school under general laws that offer no safeguard at all, and license examinations are not yet deliberately constructed to frustrate their activity, summary protective power against mercenary and incompetent faculties must be lodged somewhere. The boards therefore touch at three points the problems with which this report has dealt: for they deal (1) with the preliminary educational requirement, (2) with the facilities of medical schools, (3) with examinations for licensure.

In all these respects, the scope of the state board is of course determined by statute. Let us consider briefly what powers in respect to each are needed if the boards are