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The Carnegie Foundation has issued a bulletin on medical education in America, which is likely to do good service in attracting attention to the low standards and inadequate endowment of many of the medical schools of the United States. On behalf of the foundation, Mr. Abraham Flexner has visited every one of the 155 medical schools, and gives a brief description of each. The conditions in each state are summarized, and plans are proposed for their improvement. This detailed report is preceded by an introduction by President Pritchett and by fourteen chapters by Mr. Flexner on the whole subject of medical education in this country, beginning with a historical sketch and ending with the education of the negro. The bulletin, which extends to 347 pages, may be obtained by sending seventeen cents for postage to the foundation.

The conditions of medical education in the United States have been investigated with equal thoroughness by the council on education of the American Medical Association, and are well understood by experts. There are too many inadequately trained physicians in the country, and one of the principal difficulties is the existence of proprietary schools dependent on the fees of students. Physicians are ready to be professors in medical schools for the title and connections. When the school depends for its support on the fees, low standards are likely to be adopted in order to attract students. It was at one time possible to conduct a proprietary school with tolerable efficiency, as can now be done in the case of law, but with the development of laboratory and clinical methods, the cost of a satisfactory medical education can not be met by fees. It is certainly a scandal that one third of our medical schools have incomes below $10,000, all from fees, that in some cases there are as many professors as students, and that many students do not have even a high school education. One school actually exists with twentysix professors and a total income of $1,060.

But while every one knows and admits the evils, the remedy is not clear. Though Dr. Pritchett and Mr. Flexner have obtained their medical education by a short course, they have had expert advice and their general point of view is sound. We need several university schools of medicine emphasizing research and demanding long preliminary preparation, the schools for the training of the great mass of practising physicians should require a training in science and the languages equal to two years of college, the schools in the south can not at present reach this standard, but should require a preparation equal to a four-year high school course. Each school should have adequate laboratories for anatomy, physiology, chemistry and pathology under the charge of professors and instructors who give their whole time to the work of teaching and research. The clinical departments should be under the charge of professors whose practise does not interfere with their teaching, and there should be a suitable hospital and dispensary controlled by every school.

But how are we to reach these standards? We are slowly approaching them. When the Johns Hopkins Medical School was opened seventeen years ago, it was the only well-organized department of medicine in the country. With Harvard it still maintains preeminence; but there are now some thirty schools which give adequate training for the medical profession. The commercial schools are closing and being merged every year, for by the nature of things they can not last when they do not pay. When good schools are adequately endowed in all sections of the country, students will naturally frequent them. The states can accomplish more for the profession of medicine and the people by