privilege of selecting men of special training and ability in particular lines of work for the purpose of investigating matters peculiarly difficult and with which none but specialists can successfully cope-such specialists to be paid for the work done and to be regularly employed as other work may arise and demand their services. The chief of the bureau should also have authority to select representatives of the bureau in various parts of the United States, who shall represent the bureau in their particular locality, and, if necessary, shall maintain an office for the transaction of such matters as may be necessary. This should be done especially in districts infected with contagious diseases or districts subject to malarial, typhoid or other fevers. Such local representatives should be especially instructed as to the gathering of information about the conditions in their particular locality, with the idea of determining, if possible, the causes of the local disease and the suggestions of remedies therefor. A State Sub-Bureau should be established and maintained in every state which signifies its desire that such bureau should be so established and which shall agree to co-operate with such bureau and with the officers of the Federal Government in carrying out the ends undertaken by the bureau. The entire influence and strength of the bureau should be available by any state desiring its assistance in the investigation of any matters concerning diseases within the state. In addition to the investigation of local contagious diseases, or diseases confined to localities, and the suggestion of the proper treatment, the bureau should investigate the sanitary conditions as they exist in the cities of the United States, the sewerage and particularly the water supply, and the sanitary laws of the cities. Reports should be made showing the quality of water used by the various cities, the presence in the water of diesase germs, or its freedom therefrom; likewise the methods of sewerage and drainage, so far as these matters bear upon the subject of health, should be fully reported and in case any city or state shall offer to co-operate with the bureau in any special investigation of the sanitary or health conditions or in obtaining a remedy, then the bureau should make such special investigation, either as to sanitary matters or as to diseases as the situation may warrant.

The bureau should investigate, so far as is not already done, the food and drink supply of the United States, so far as these things have a bearing upon health and disease. Special attention should be paid to those products with which the people are not sufficiently acquainted to enable them to judge. All

artificially prepared foods-oleomargarine, canned meats and prepared foods-should receive special consideration, and such attention should be given to the purity and healthfulness of public drinks, as well as the sanitary condition of public drinking places, as the circumstances will permit, such investigation to be conducted through the local bureaus or by special investigation.

All the local branches of the bureau should make regular reports to the head of the bureau at the Department of the Interior at Washington, and at such intervals as may be expedient. The Chief of the Bureau should make such reports and issue such circulars of information as he may deem proper, and at least once a year the chief should issue a general report of the work of the bureau, showing the investigations made and offering such suggestions as shall naturally grow out of the work in hand. Such reports to be distributed throughout the United States at the expense of the government.

The duties of the bureau so far referred to cover the first point of the general plan of elevating the profession, namely, the investigation of the health and diseased conditions and the reporting of those investigations for the purpose of bettering the condition of the whole people. This is the great work which I have suggested to you to be the best means of raising the medical profession to a dignified place in the estimation of the people. It is placing the medical profession back of a great and much-needed movement, not only to study and understand the condition from a scientific standpoint and to know the causes of disease in various localities and to suggest as far as may be possible remedies therefor, but to investigate more fully and more honestly than has ever been done before the sanitary conditions of our cities and the wholesomeness of the water used by the people and to take more intelligent steps than have as a rule been taken to insure that the food and drink that is offered to the people is wholesome and healthful. This work, honestly taken up and sincerely carried out, emanating, as it should, from the medical profession, can and will educate the people in all these great and vital matters and cannot fail to inspire confidence and respect for the medical profession of this country that no other means could possibly achieve.

The other branch of the work that has been suggested, namely, the bettering of the medical profession itself, will go hand in hand with the investigation and reports which the

bureau is supposed to make upon the matters which we have mentioned. This bureau should investigate the condition of the medical profession in the various states of the Union, should' classify the profession so far as possible with reference to determining the relative proficiency and efficiency of the physicians in various states; should likewise investigate the laws regarding the licensing of physicians and the laws providing for the revocation of licenses, the grounds therefor, and the proceedings nec essary to be taken in order to revoke licenses; the intellectual and moral standards required in the various states of physicians; and generally to make a report in the regular annual report of the bureau, and full and complete investigation of the medical laws in the United States, with such recommendations as the bureau shall deem wise, such suggestions to be placed in the form of proposed legislative enactments, to be passed in full by such states as may agree to adopt the suggestions. As soon as practicable, and as soon as such investigations can be made as will warrant the step, the bureau shall prescribe a full and complete set of laws, rules and regulations for the admission of physicians to the practice of medicine, for the controlling of physicians in the practice of medicine and for the entire government of the profession in the various states, such legislation to be adopted by such states as may care to adopt it. Of course, the proposed legislation should embody such standards and such regulations as shall tend to uplift the profession and place it upon the high plane to which it aspires, and the regulations should be such as not to be irksome, but sufficient to prevent abuse and so planned as to give the greatest freedom of movement of physicians from one part of the country to another and to insure the greatest possible encouragement to those proposing to enter the profession upon legitimate lines.

As a part of this work of establishing and maintaining standards and regulations for the upbuilding of the profession, the bureau should investigate and report on the subject of medical education as it exists in the United States to-day, classifying the schools and colleges with reference to their comparative efficiency, investigating the methods of any institution upon which there may rest any doubt as to its method or purpose, and to make such suggestions to the schools and colleges teaching medicine as shall be, in the opinion of the chief of the bureau, beneficial, and as shall tend to bring medical education in this country upon the highest plane of excellency. The bureau

should also suggest and by every means possible aid and promote the establisment of schools, or branches of existing schools, for post-graduate instruction in sanitary science, as recommended by Dr. William P. Munn in his Presidential Address at the recent meeting of the Colorado State Medical Association; the men educated in these schools to be fitted for such public service as may be demanded of city boards of health, or state or county officers, having to do with matters of sanitation, water supply, food supply or in any matter having a bearing upon the health of the people. In addition to the duties which we have enumerated, either in carrying out the idea of benefitting the people of the United States by the establishment of this health bureau, or in the duties and work to be performed by this bureau in discovering the abuses and undesirable elements now existing in the medical profession, and the suggesting of remedies therefor, the bureau may be relied upon to take up any new work that the conditions of civilization or new methods of life may render expedient. This work may after awhile be lessened by reason of the establishment of smoothly working sanitary laws and conditions throughout the country. Its supervision over the medical profession, so far as it may be best for it to exercise a supervision, may in time pass away. The states having once taken the suggestions of the bureau and after establishing uniform laws, will realize the benefits of the improved condition and will no longer hesitate to co-operate in all matters tending to the good of the profession as well as the good of the people. But there may be in the growing conditions of medicine elements that will require the maintenance of such a bureau permanently.

I have now laid before you in this crude and imperfect way suggestions which may be of some benefit when properly enlarged and applied-ideas which as I have said and which I repeat, would tend to put the medical profession in this country on a higher plane, because it would tend to establish among the people a confidence and respect for the profession born of the experience that the profession is fervently at heart in sympathy with the masses of the people, and which will at the same time insure through the force of sound suggestions and unanswerable logic the adoption by every state in the union of laws that will define the medical profession in such terms that it cannot long be questioned that it is one of the learned professions of the world, and shall so hedge about the practice of medicine