By the turn of the twentieth century, the drive to make medicine more scientific and comprehensive and to limit its ranks to the well prepared had had a profound effect on student populations. Almost universally, students were now older, better educated, more schooled in science, less rowdy, and able to spend larger amounts of time and money in study than their counterparts in 1850 had been. Their ranks, now including a growing number of women, were also likely to include fewer representatives of working- and lower-middle-class families, especially in Britain and America, than a half-century before. Nations still differed, sometimes sharply, in their openness to students from different social classes. The relative openness of the German universities to the broad middle classes, as well as their inclusion of a small representation of “peasantry and artisans,” wrote Lord Bryce in 1885, was a sharp contrast with “the English failure to reach and serve all classes.” The burgeoning German enrollments, he noted, were owing to “a growing disposition on the part of mercantile men, and what may be called the lower professional class, to give their sons a university education.” More students by far from the farm and working classes of Germany, which accounted for nearly 14 percent of medical enrollment, he observed, were able to get an advanced education than were such students in England. A historic transformation in the social makeup of universities, according to historian Konrad Jarausch—from “traditional elite” to a “modern middle-class system”—was taking place in the latter nineteenth century. In France, rising standards in education, together with the abolition of the rank of officiers de santé—which for a century had opened medical training to the less affluent—were forcing medical education into a middle- class mold. In the United States, the steeply rising requirements in medicine, along with the closing of the least expensive schools, narrowed the social differences among medical students and brought sharp complaints from the less advantaged. The costs of medical education in some countries threatened to drive all but the most thriving of the middle classes from a chance to learn medicine.