Medical Licensing in America, 1650–1965

patients had been created, and a number of eminent foreign visitors had toured the hospital. The unfortunate Millingen, who succeeded Ellis, did not stay long, and in 1839 Conolly was appointed. He remained five years as resident physician; it was this five-year experience on which he was to base his major writings, of which The Construction and Government ofLunatic Asylums is perhaps his best. It is a lucid exposition of all those matters concerned with the administration of a mental hospital, and even if it is perhaps a little too full of loving kindness, that may be excused as Victorian sentimentality. The organizational system which was to persist in mental hospitals for over a century in England owes much to Conolly, and if today we are in revolt against it, this is not to say that it did not fulfil a very useful and necessary purpose. Hunter and MacAlpine, as we have come to expect of them, have unearthed a good deal of new material for their introduction, which helps to set the scene for the book itself. The book is impeccably produced-the lucky possessors of the original edition will want to put this present reprint side by side with it. This is an interesting account of the struggle to establish a system of licensing that would limit practice to those proved fit to protect the public while maintaining the ethical standards of the profession. Already in 1649 a Massachusetts Act had urged regulation on English models. Hope of success came in John Morgan's foundation of the first medical school at Philadelphia in 1765, but by 1780 there was no virtual control over practice, generally of poor quality. By the mid-nineteenth century, however, there was a pride in American medicine, fostered by public support for the demand of medical societies for reform in education. Such pride proved ill-founded. Quarrels over ends and means, over prestige of early schools that, like professors, conferred too many licences, and the growth of sectarian schools, many of them confined to homeopathy and botanic medicine, brought chaos until in 1870 there was pressure for the British principle of searching written as well as oral examinations. The first registration system was set up by the Legislature in 1881, and in 1896 the National Confederation of State Medical Examining and Licensing Boards urged that graduation from high school must be the minimum standard for entrance to a …