Anyone who complains about modern day medicine and its practitioners ought to examine this history of American medical education. In the good old (pre-1900) days, the standard medical school program took eight months of lectures, students often graduated without having examined a patient, and entrance requirements were based more on an ability to pay than an ability to think. One Harvard faculty member opined in 1870 that more than half the medical school students could not write; a survey in 1890 showed only 8 percent of US medical students had undergraduate degrees. In painstaking detail, Ludmerer traces the growth of American medical education from the days when medical schools were owned by professors who taught as a side business to the medical-university-industry complexes of today. He looks at how the unique American system evolved thanks to French and German influences in the mid-1800's and, in part, to a pair of non-doctors in the late 1800's and early 1900's. One was Charles W. Eliot, president of Harvard University, who brought Harvard's Medical School under university control and instituted many curriculum changes--setting the tone for a national trend. The other was Abraham Flexner, a Carnegie Foundation staff member whose famous 1910 report was a catalyst for many reforms in medical education. Ludmerer chronicles the debates among medical faculties over changing curricula, reviews historical problems of financing medical education, and looks into the development of medical practice regulations by both government and professional associations. Only in the final chapter does he assess current problems and trends, warn about bureaucratization of medical training, and worry that medical schools' growing emphasis on research is detracting from the seeking and proper compensation of good teachers. The book's major strength is also its biggest weakness; the attention to detail is extensive but often excessive. There are too many facts and figures crammed into the pages for the lay reader; the author's points can be made with far fewer examples. This will appeal more to the physician and the historian--but the author's extensive research makes the book an interesting reference work.