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Rh it can, but does not; in a third it neither does nor can. Six boards have announced the requirement of one or more years of college work preliminary to medical schooling as the basis of practice in their respective states; but seventy-six remain to be converted. Their conversion, with the necessary changes in the state laws, must precede the actual elevation of the entire medical profession. For though agreed elevation of standard by individual schools improves their own product and indirectly leavens the mass, it does not stop the making of low-grade doctors. Temporarily it even assists the low-grade school. The ultimate improvement of the entire mass will come from control of all schools through the state boards, and not merely from voluntary action on the part of the more self-respecting institutions. The middle west seems likely, the osteopaths permitting—first to realize this condition; for the states will surely not leave the practice of medicine within their borders open to strangers on terms denied to their own sons.

Whether or not it will be left for the osteopaths to say, depends just now on making the public appreciate the fact that the point at issue is not a matter of business. A clever hue and cry has been raised to give the controversy the appearance of a competition between rival claimants for business patronage. The instinct for fair play, opposition to exclusive or aristocratic privileges, have thus won for the sectarian a chance on his own terms. Unfortunately, this leaves the sick man wholly out of account. Medicine, curative and preventive, has indeed no analogy with business. Like the army, the police, or the social worker, the medical profession is supported for a benign, not a selfish, for a protective, not an exploiting, purpose. The knell of the exploiting doctor has been sounded, just as the day of the freebooter and the soldier of fortune has passed away.

Despite imperfect and discordant laws and inadequate resources, the state board has abundantly justified itself. It is indeed hardly more than quarter of a century old; yet, in summing up the forces that have within that period made for improved conditions, the state boards must be prominently mentioned. Their rôle is likely to be increasingly important. They have developed considerable esprit de corps. Their power of combined action on broad lines has distinctly increased even in the last few years. Reciprocity between states whose laws are measurably concordant and whose ideals are taking similar shape tends to demonstrate the fundamental sameness of the problems requiring solution. Out of these first coöperative efforts, a model law will emerge; federated action may become possible. Perhaps the entire country may some day be covered by a national organization engaged in protecting the public health against the formidable combination made by ignorance, incompetency, commercialism, and disease.