the corner." And yet it is no unusual thing for these same men to declaim against our lack of liberality in refusing to consult with Homeœpathists, or Eclectics.

We could justify a Christian clergyman in refusing to hold a private consultation with a Mormon or a Mahometan priest over the case of a dying man, in which the two were to decide how to save his soul; but it is another thing when he refuses to preach in a building not consecrated.

Our code does not teach or intimate, that I may not tie an artery or give my medical or surgical opinions in a charlatan's house or hospital.

Dr. Warren. Permit me to ask one more question. If we need in this country a medical code of ethics, why it is not needed also in Europe and other counties?

Dr. Putnam. That is a very pertinent question, and one which perhaps naturally suggests itself to every medical man not born and educated under our peculiar republican system,a system which differs in many essential points from even the republican systems of other countries. It is a system of States within a State; each State has a limited, not absolute

autonomy, so also have counties and municipalities. There is in reference to most matters no such thing as national centralization of authority; and to this peculiar feature of our political institution must be traced many of our social institutions, including many of the restraints which we voluntarily continue to impose upon ourselves, and without which, experience has taught us, there would grow up gradually the rankest social evils. What government cannot do, or has not done, for us, because of its lack of centralization, and perhaps partly because of its intensely democratic tendencies, we combine to do for ourselves. We do, I repeat, by association what law cannot or does not do for us. But I must beg you to permit me to defer a more full reply to this question to another occasion.

FOURTH CONVERSATION.

Why we need a Code, continued-Low standard of Education required by our medical colleges-National legislation impracticable; State legislation inefficient-The medical associations unable to regulate medical education-Our medical colleges are private enterprises-" Color" line.

Dr. Warren. Just before we parted the other day, you began to answer my question, "Why, if we stand so much in need of a code of ethics, is it not needed also in Europe?" Medical men in all other civilized countries seem to get along very well without well without any written code. You began to say something about the social and political peculiarities of this country, when, for some reason, our conversation was interrupted.

Dr. Putnam. Yes, and I think this is the very point which those intelligent foreign physicians who have within the last few years come among us-for I ought to say that the earlier importations were very bad—have found it most difficult to understand.

The answer is, in brief, that in this country medical men have to supplement the duties of the State It is the plain duty of the State to regulate the standard of medical education, or to declare what qualifications are necessary to enable a man to practice medicine intelligently and safely. It is so understood in Europe; and their several governments have done their duty so well in this regard as to leave little or nothing to be desired.

It is very different here. Our Government is less centralized, and the matter of education is one of those subjects which the general government has always thought it best to relegate to the State Governments. We have at Washington a "Bureau of Education," but it has no duty to perform, except to gather statistics and other facts relating to matters of education, and to disseminate this information, accompanied, perhaps, with suggestions, among the people.

It is well that the power of regulating the amount and character of medical education is not assumed by the Federal Government, since it could not be exercised satisfactorily to the people, unless all classes of medical opinions were represented in the central board.

The States have always claimed and exercised this power, and have, through their representatives in Congress, shown great jealousy whenever any attempt or proposition was made in Congress to take it from them. How the States have exercised this power you need not be told. Our present system (!) of medical education is the product of State legislation. In some

States there were until recently no laws regulating the practice of medicine. In no two States are they probably exactly alike; and in all of the States they are subject to radical changes from year to year. The experience of the past, therefore, would seem to show that, if the standard of qualifications to be demanded for graduation in medicine is ever materially raised in this country, it must be done by the efforts of medical men and by the medical colleges, and not by State legislation.

Dr. Warren. Excuse me, Doctor, but I would like to interrupt you for a moment at this point, and to ask, if, as I assume you are intending, to attribute the necessity for a code wholly to the low standard required for graduation in medicine in this country, and that practically the only remedy for this lies in the hands of the medical profession itself, why, then, does

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