lived up to by the weak schools. Many examining boards refused to admit their graduates to the examinations and the schools fell by the wayside, with the result that while in 1905 there were 162 medical schools in the United States, there are but 84 now.

At the same time the number of students in attendance has been reduced from 28,142 to about half that number.

Before this audience it is unnecessary to say much regarding the present standards of medical education. You nearly all know that a preliminary education of four years in an acceptable high school and two years of special college work is required before entering a medical college. Then four full years in medicine in a school expensively equipped with laboratories, hospital and dispensary facilities and a considerable number of full-time, full-paid teachers, and then in a good many instances an additional year as interne in an acceptable hospital. This is as it should be. The standard of medical education should be high. But just now we are considering the Medical Examining Boards and there is no doubt they played a large part along with the Council and the Association of American Medical Colleges and others in bringing this about. So long as they worked by themselves they accomplished little, but by the general consent of the medical profession the boards have two functions and the various laws have been drawn with special reference thereto, one raising the standard of medical education, the other the protection of the public from being preyed upon by ignorant and unscrupulous persons. The latter is the lawful duty, the one thing making the laws under which they act constitutional. Before taking up the latter let us look for a moment at another phase of the former. Is the great reduction of medical schools and the consequent lessening of the number of graduates each year an unmixed blessing? A great number of class A schools have not room and facilities for any greater increase in the number of their students. My information is that over 400 qualified students were turned away last year from Johns Hopkins, the University of Maryland and the University of Pennsylvania. What became of them I do not know. Probably some gave it up and others went to less desirable schools—although the number attending these latter does not seem to have greatly increased. I do know that there is even now a scarcity of physicians in many rural districts and I believe this deficiency will increase. However, I read a paper on this subject before the American Academy of Medicine at a meeting in this city in 1910 and will not discuss it further here. It is however a subject which will have to be seriously considered in the near future.

Let us turn to the real business of the Examining Boards. They have unquestionably done much good, but have they accomplished what was hoped and expected of them by the medical profession in the way of pro

tecting the public? It must be remembered they are the creatures of the doctors and not of the public and that about 250 laws have been passed in the 48 States all through the influence of physicians, and that these physicians all believe that the public is not protected so long as it is not protected from the practice of all the cults and sects and healers of one sort or another.

Why is it that, after thirty years, the medical practice acts, about 250 of them including amendments intended to strengthen them, have accomplished so little? The blame, if blame there be, has been variously put upon the public, the law makers and the profession. We have never gotten the public with us and perhaps we have not looked at the matter from the right viewpoint. A license to practice medicine is in the same category as a license to do anything else. It has been compared to a license to run an automobile. Suppose the automobile owners should appear before the legislature year after year under the plea of protecting the public and ask that only the owners of certain kinds of automobiles should be permitted, and more particularly that all boards and administration officers in carrying out the regulations of automobiles should be in the hands of automobile owners, etc.,-what would we think of it? And yet is it not what we have been doing with nearly all the medical practice acts and amendments thereto which we have been fathering for more than thirty years?

In conclusion, having been honored by serving you for perhaps too many years as a member of the Board of Medical Examiners, having been a regular attendant at the annual conferences and congresses in Chicago for fifteen or sixteen years-having been an active participant in the formation of the present Federation of State Boards of 10 years ago and a regular attendant at its annual meetings since that time, a delegate from that body to the Council of Education of the A. M. A. as well as a member of the National Board of Medical Examiners since its foundation-I may be permitted without wearying you farther with the reasons therefor, to say that it is my individual opinion that the standard of medical education is sufficiently high for the present and the maintaining of that standard can be safely left in the hands of the Association of Medical Colleges and the Council on Education of the A. M. A., and that the Examining Boards should confine their activities to what is their legitimate function, viz., the protection of the public from being preyed upon by ignorant and unscrupulous persons, and their requirements and examinations should be of a character to guarantee this and this only.

Of course I must make it plain that I am making no criticisms of the Medical Boards themselves individually or collectively but rather of the legal method of doing certain things by means of the Boards.

There should be no difficulty in having suitable laws passed when it gradually gets into the heads of a large majority of the people that medical laws and medical examining boards are only for their protection and not to crush out the various cults for the selfish purposes of physicians; that medical men have no objections to Christian Scientists, osteopaths, chiropractors, physio-therapists and all the other faddists of this or the past or the next generation being allowed to practice and forsooth to heal in their own way, provided first that each one has demonstrated to some state officer or state board that he knows enough to be safe. If he knows diphtheria or scarlet fever or smallpox and refuses to report the same to the proper authorities on the ground that there is no such disease, that God is good and in His goodness never did or could afflict the mortal body with any such thing; or if he treats the peritonitis of a ruptured appendix by the orthodox osteopathic or chiropractic method, there is a ready remedy for the malpractice in the courts, but as a fact if the practitioners of any cult had a reasonable knowledge of medicine no such case would

occur.

And finally, though this may seem just now somewhat radical to most of you, I believe that all licensing with a view of protection of the public, whether it be to do sanitary plumbing, to run an automobile or to practice medicine, is a government function which should be financed by the State and managed by the State, of course with the expert help which might be needed in each case. In a modified way this is now being tried out in a few States, but with the political situation as at present I do not think the time for this has arrived in Maryland.

ON PRESENTATION OF PORTRAIT OF DR. NATHAN
RYNO GORTER

BY DR. HERBERT HARLAN

Mr. President and Members of the Medical and Chirurgical Faculty of Maryland:

I have always derived the greatest pleasure from the contemplation of the portraits and pictures both ancient and modern on the walls of this building. Most of those who were with us during the last forty years were my friends. The older ones have given pleasure by recalling the medical history of the city and of this Society, but there are none of them which will appeal to me in future as will that which is presented to us this evening -that of Dr. Nathan Ryno Gorter. He was a warm friend of mine since his boyhood. Although he was several years my junior, graduating when not yet nineteen, we entered the University of Maryland the same year

had adjoining seats in most of the lecture halls, and as house students were room mates for a year-and always close friends to the day of his death.

He was a namesake of Dr. Nathan Ryno Smith, one of our very greatest members, and he derived many advantages from being an office student of his son, Dr. Alan P. Smith. He became a most successful physician and surgeon and was greatly beloved by his patients.

Baltimore and the Draft. An historical record by the State of Maryland has this to say:

IN MEMORIAM

Dr. Nathan Ryno Gorter, Secretary of the District Board for Baltimore City, son of the late Goose Onno Gorter, died at his home, 1 West Biddle Street, Saturday, June 1, 1918.

Appointed by the Governor of the State one of the original members of the District Board for Baltimore City, Dr. Gorter entered upon his official duties with all the conscientious enthusiasm which characterized him in everything he undertook.

As the volume of work required of the members of the Draft Boards increased with the gravity of the war situation, Dr. Gorter, unmindful of self, devoted to his duties not only long hours of the day, but often the greater part of the night.

Not neglecting the many and varied calls of the medical profession, of which he was one of the best known and most beloved members, and spending himself in the long hours of tedious labor at the District Draft Board was an effort too great for even his robust constitution.

Contracting an illness from a patient, Dr. Gorter sank rapidly and died at his home, mourned by the city and State as one of their foremost citizens.

"Dr. Gorter was one of the personalities of Baltimore. He possessed a fine mind and a heart which quickly won him the esteem and affectionate regard of all who met him. Few men were so universally respected and trusted."

It may be said without exaggeration that Dr. Gorter died, soldier-like, in the service of his Country.

This portrait is presented to the Medical and Chirurgical Faculty by Mrs. Gorter. I shall ask you to express your appreciation of the gift by a rising vote of thanks.

TRIMBLE LECTURE

ON THE RELATION OF HEREDITY TO THE

OCCURRENCE OF CANCER

BY H. GIDEON WELLS, M.D.

University of Chicago

Until very recently it has not been possible to speak with much assurance concerning this topic, for the evidence at hand has been of such an unsatisfactory character that the validity of whatever conclusions were drawn was always open to question. Numerous attempts to secure information by studying general mortality statistics, hospital populations or isolated clinical observations, have led to contradictory results, as they were bound to do from the inherent errors in the data obtained from such sources. Furthermore, until within a comparatively short time, we had no definite knowledge of the principles of heredity itself, and this ignorance foredoomed to futility any speculations as to the influence of heredity upon cancer.

It so happens that the year 1900 saw the rebirth of two unrelated discoveries which, together, have led to an entirely new outlook on the problem, for they placed for the first time on an experimental basis the investigation of both heredity and cancer. In this year, independently, three botanists (de Vries, Correns and Tschermak) reported the rediscovery of the fundamental principles of heredity which the Austrian monk, Gregor Mendel, had worked out so accurately and described in 1866.

The same year witnessed the work by Leo Loeb in Chicago and Jensen in Copenhagen, demonstrating that sarcomas in rats and carcinomas in mice can be inoculated into other animals of the same species, for an indefinite number of generations-Jensen's mouse carcinoma is still being transplanted in many laboratories. This same fact had been demonstrated in 1889 by Hanau, and 1891 by Morau, but, like Mendel's discovery, its significance had not been appreciated at the time and it had not been followed up. Although we have since learned that the information to be obtained from transplanted tumors is limited, especially in respect to the influence of heredity, these observations placed cancer research for the first time on an experimental basis, and the recent rapid progress in our knowledge of cancer has been largely due to the stimulus to investigation given by tumor transplantation work.

During the twenty-two years that have passed since these rediscoveries were made, genetics has become one of the most active fields of biological

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