At the time of the 1910 publication of the report Medical Education in the United States and Canada, known informally as the Flexner Report, the Medical College of the State of South Carolina had been in existence for 86 years. Significant for being the first medical school in the Deep South, the Medical College had flourished in its first 37 years until the outbreak of the Civil War forced the college to close for four years. After the war ended and the school reopened in 1865, the faculty and board of trustees struggled to keep its doors open. For the next 48 years the Medical College continued educating men to be physicians however by the early twentieth century the school was compelled to reevaluate its existence.