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viii maintenance. For the past two decades there has been a marked tendency to set up some connection between universities and detached medical schools, but under the very loose construction just referred to.

Meanwhile the requirements of medical education have enormously increased. The fundamental sciences upon which medicine depends have been greatly extended. The laboratory has come to furnish alike to the physician and to the surgeon a new means for diagnosing and combating disease. The education of the medical practitioner under these changed conditions makes entirely different demands in respect to both preliminary and professional training.

Under these conditions and in the face of the advancing standards of the best medical schools it was clear that the time had come when the relation of professional education in medicine to the general system of education should be clearly defined. The first step towards such a clear understanding was to ascertain the facts concerning medical education and the medical schools themselves at the present time. In accordance, therefore, with the recommendation of the president and the executive committee, the trustees of the Carnegie Foundation at their meeting in November, 1908, authorized a study and report upon the schools of medicine and law in the United States and appropriated the money necessary for this undertaking. The present report upon medical education, prepared, under the direction of the Foundation, by Mr. Abraham Flexner, is the first result of that action.

No effort has been spared to procure accurate and detailed information as to the facilities, resources, and methods of instruction of the medical schools. They have not only been separately visited, but every statement made in regard to each detail has been carefully checked with the data in possession of the American Medical Association, likewise obtained by personal inspection, and with the records of the Association of American Medical Colleges, so far as its membership extends. The details as stated go forth with the sanction of at least two, and frequently more, independent observers.

In making this study the schools of all medical sects have been included. It is clear that so long as a man is to practise medicine, the public is equally concerned in his right preparation for that profession, whatever he call himself,—allopath, homeopath, eclectic, osteopath, or whatnot. It is equally clear that he should be grounded in the fundamental sciences upon which medicine rests, whether he practises under one name or under another.

It will be readily understood that the labor involved in visiting 150 such schools is great, and that in the immense number of details dealt with it is altogether impossible to be sure that every minute fact concerning these institutions has been ascertained and set down. While the Foundation cannot hope to obtain in so great an undertaking absolute completeness in every particular, such care has been exercised, and the work has been so thoroughly reviewed by independent authorities, that the statements which are given here may be confidently accepted as setting