1674-6 Helen Muir 1 "it 1 il iffir
Abraham „ _ _�
-111
Flexner'siir -.
,.,',, .le".4
Medical Ica ..... _ . ,
.. , _ _ _.
ill
Bombshell ,., I. le• .........
•
by JAMES L. SLATTERY
and RICHARD GOSSWILLER # ( _
l r ' \ �. '
ON AN EVENING in April 1909, while touring 1, ••1` 1
the medical schools of the United States and `
;,
Canada, an educator named Abraham Flexner visited
the National Medical University in Chicago. He walked '-.•✓ ``'«
through dingy, dimly lit classrooms and unwept, ill- _. r - _
equipped laboratories until at last he stopped before a !
i door that his guide, walking ahead of him, had already k1
passed.
•"Just a minute," said Flexner. "What's in here?" i
"Oh, we don't use that room," was the reply. ' ',
He asked to see it anyway, and the door was reluc-
tantly opened. Before him on a table was "a putrid '
corpse, several of the members of which had been hacked '''""�— ,.,
off." Flexner backed out of the room quickly, but con- #t '1'
tinued his tour of the "university" with increasing in- `,
terest. In an attic "hospital" he found "two lonely ti"
patients" who appeared to be unattended and in dan-
ger of death.
Such was the manner in which the National Medical
University, the so-called medical school of the so-called
Chicago Night University carried on its program of .
medical education. The 150 men who attended the l
school might have been as well trained in medicine at r...• • { `-.
the Chicago stockyards a few miles south, except that ' ., ,T 1 r' t yi,•q
the stockyards would not have offered them "free trans- .... /1" ‘,� 4i/
portation from Chicago to Vienna by way of New York, `, t 4 , : . p
London, Paris" as a reward for paying "regular fees in '•,' /
cash" for three years or more—an offer advertised by the , j I ' \� ,• \,,
National Medical University. c. i V'.\i
The National Medical University was not unique for •
its day. Bennett Medical College, also located in Chica- , V «.— r; �� ''i
go, eagerly recruited all students who could afford its i ;__ ?4.� 1_ c.
tuition fees. It even paid a commission to anyone who ' ••
signed up full tuition students. (Continued on page 70) _ .- ;... ,`,,ll, ,.cls • x %
. r iii '~ ,i. �. i'
44 TODAY'S HEALTH/MAR. 1969 `�+
(Continued from page 68) • Henry S. Pritchett, president of the that characterized all his undertakings,
Arrive at the terminal early. This Carnegie Foundation, during a series of threw himself into his new project—one
allows you to double-check on seating, meetings with the AMA's Council on that, as he later recalled, carried with it .
board early,and make sure that.the`agent Medical Education, came to see the "a modest compensation but, fortunate-
wires ahead regarding your neecjs at your merit of their proposal. To execute the ly, an unlimited expense account." And
• destination point. Be sure you/get a lug- study he chose Abraham Flexner, Ph.D., a healthy expense account was essential.
gage tag for your wheelchaiOf you have whose reputation in education anti During 1909 and 1910 Flexner made per-
: _; a transfer point,check your/chair only to knowledge of medicine—including stud- sonal inspections of 155 different inedi-
' that point,and insist on ung it between ies in anatomy and physiology—made cal schools in the United States and
i:','-':,' fli flights to ensure it will not be lost. him a worthychoice.
` g Canada. Fortunately, Flexner had both
.•' ' i When you're approaching your desti- Abraham Flexner had been born in enormous physical stamina—and a strong
..''''7'''4::. nation remind ,the stewardess thatyou Louisville, Kentucky, in 1866, a member stomach.
- ' '
.; will need help deplaning and that your of a poor but extraordinary family. His /The strong stomach was needed to r
•',••:' wheelchair ii in the "belly" of the air- father, Moritz Flexner, died while Abra- withstand conditions he found in all
craft.She ill wire ahead. ham was still only 16, but a year later too many "medical schools" that were t
One al suggestion: Be considerate of Abraham's older brother, Jacob, gave simply business ventures. To today's
rs,,.- your low-passengers and the busy cabin him the thousand dollars he had man- American it may seem inconceivable
And thank the skilled Skycap with aged to save so that Abraham could go that in 1907 a few individuals could set t
a warm smile and a generous tip. END to college. This sacrifice, which was up and run—as a financial investment— 1
typical of the Flexners, turned out to be their own "medical school." But it was
----- — an unexpectedly wise investment. For possible because what few controls ex- f.
f.
Abraham was able, a few years later, to isted were inadequate or unenforced. d.
edical Bombshell finance Jacob's own higher education. State licensing boards often were un- t
(Continued from page 44) Jacob Flexner later became a prominent concerned—and sometimes corrupt.None t
St. Louis College of Physicians and Sur- physician. of the health-profession associations had 1
geons was an impressive name, but the Abraham made the money with which anything like the strength they later 1
school neglected to teach anatomy. As he helped his brother by founding at acquired. And the public's knowledge
for the "Western Eclectic College of the age of 24 a remarkable small private of health and medical subjects was just ,,
'' Medicine and Surgery" in Kansas City, school in Louisville. The school was about zero.
Flexner in his report for the Carnegie designed to prepare for entry into col- There were, of course, many ethical f
• ,.,t,Foundation had this to say of its "lab- lege academically borderline sons of doctors who loathed the diploma mills, t
_ • ''oratory facilities:" well-to-do fathers. But so skillful was but even many of them were inade-
.
"These comprise a few small, inde- young Flexner's teaching that his gradu- quately trained in the fundamentals of 4
scribably dirty and disorderly rooms ates were entering Harvard—and gradu- medicine and surgery. (Quite a similar •
-,containing three microscopes, a small ating from it—at a younger age than situation had existed—and still existed
•' amount of physiological apparatus,some were those from any other school. then in many parts of the' country-in• "..
bacteriological stains, a few filthy speci- "What are you doing?" asked President the law profession, which between 18204
mens, and meager equipment for ele- Eliot of Harvard in a letter to Flexner. and 1850 had been so extravagantly
mentary chemistry, but no running Eliot soon became one of Flexner's most "democratized" that many a man who ;
water." enthusiastic supporters—and support had never read any lawbook became not j
• Such diploma-mill medical schools from such a quarter was no handicap only a lawyer but also a judge!)
kept medical education in America early to a young teacher who wished to ad- In April 1910, Flexner's report ap-
in the 20th century far below the level vance himself in American education. geared under the formal title of "Medi-
of some European countries—a fact that When Henry Pritchett of the Carne- cal Education in the United States and
•
the nation's conscientious and profes- gie Foundation asked him in 1908 to Canada—A Report to the Carnegie
rY,V sional doctors were deeply concerned conduct an exhaustive study of medical Foundation for the Advancement of
about. So bad, in fact, was the average education in America, Flexner was both Teaching." This is the famous Bulle-
U.S. medical school that 72 percent of gratified and surprised. Investigate med- tin Number Four of that great Founda-
the 1512 medical-school graduates who ical education—when he himself had tion, known widely as the "Flexner
A applied to the U.S. Army Medical Corps never set foot inside a medical school? Report.",
from 1888 to 1909 failed to pass the Perhaps Pritchett had confused him Even before its formal publication,
Corps' medical-knowledge test. with his brother, Dr. Simon Flexiter? the Flexner Report caused a number
What was wrong with American medi- Simon was a distinguished pathologist, of the worst American medical schools
cal education? What could be done to later to become director of the Rocke- to collapse, like the pestilent pseudo-
improve it? These questions churned feller Institute. educational bubbles they actually had
disturbingly in the minds of Dr. Arthur But Pritchett answered, "I know your been. And after the report appeared, a
D. Bevan, president of the American brother, so that I am not laboring un- veritable shock wave went through the
Medical Association, and Dr. N.P. Col- der any confusion. This is a layman's whole of American higher education '
well, secretary of the AMA's Council on job, not a job for a medical man." He and through the American medical pro- .
Medical Education. They had made explained that the Carnegie Foundation fession. '
careful—though limited—studies of med- wanted Flexner to study not the prac- It was, after all, rather shattering to
ical education, and the results were Lice of medicine in America but the ad- read that the Epworth College of Medi-
alarming. They concluded that what ministration of medical education. And cine in Oklahoma City, supposedly the i'
was needed was a full-scale investigation Abraham Flexner had already proved medical department of a university, was
of medical education in America, and that he was expertly qualified to evalu- nothing more than a profitable stock
to that end they appealed to the hand- ate the administration of educational company for a few individuals. Given
somely endowed Carnegie Foundation programs. its aims as a profit-maker, it was only
for the Advancement of Teaching. So Abraham Flexner, with the vigor to be expected that—as Flexner said in i •
70 ---""'"""��� TODAY'S HEALTH/MAR. 1969
his report on it—its entrance require- "The new commonwealth of Okla- an adequate number of well-qualified
ments were "nominal" (an applicant homa may, if wise, avoid most of the doctors. He also recognized very clearly
needn't have gone to high school•at all, evils which this report has described; that to achieve this desirable arrange- ,
much less be a high-school graduate). for though they have already appeared, ment would entail finding genuinely
What became of the Epworth College they have not taken deep root. Immi- practicable solutions to a number of
of Medicine? In a footnote to his re- gration—of physicians, among others— very difficult and very complex problems.
4' K port on it, Flexner remarked 'that: "As has been so rapid that the state has eas- Although in his report Flexner was
this report goes to press, it is stated that ily three times as many doctors as it scathingly critical of those medical
''': this school has been consolidated with needs. They pour in from the schools schools which not only were inadequate
the medical department of the state uni- of St. Louis, Kansas City, and Chicago. but quite evidently didn't care about
versity . . .' If, however, the state wishes a high- professional ideals and ethics, he was
This was but one of a number of grade supply only, it must speedily de- sympathetic to those which he felt it
instances in which, in consequence of fine a standard such as will (I) suppress necessary to criticize but were at least
+'' •'` the publication of the Flexner Report, commercial schools—as, for .example, trying to do a good job. In repotting
independently operated medical schools that now nominally belonging to Ep- on the "Woman's Medical College of
were quickly absorbed into state or pri- worth University—and (2) by the same Baltimore,"he wrote: "Laboratory facili=
vate universities in their area. But many action exclude inferior doctors trained ties: Small laboratories, scrupulously
others simply folded up altogether—with elsewhere. Having done this, only an well kept, show a desire to do the best
no foss whatever to their communities institution with considerable resources, possible with meager resources: pathol-
or to the nation. derived either from taxes or endow- ogy, bacteriology,embryology,chemistry,
For as Flexner emphasized over and ment, will even attempt to conduct a and anatomy are thus taught."
over in his report, the United States medical school in the state: which is as Contrast that judgment with what
had become oversaturated with low- it should be." Flexner was moved to say about an-
quality medical men. For example, in Far earlier than most other persons, other institution in the same state, the
his summary of the condition of medi- Abraham Flexner clearly recognized that Maryland Medical College: "The school
cal education of Oklahoma in 1909, he what was really important was not sim= building,"he wrote,"is wretchedly dirty"
stated that: ply to have a lot of doctors but to have and the "so-called laboratories are of
the worst existing type: one.neglected
and filthy room is set aside for bacteri-
ology, pathology, and histology: a few '
^`• dirty test tubes stand around in pans
•;',•_,, ,-• • and old cigar boxes." We are hardly
t` ° surprised to hear that "the dissecting
s •
:%%+• v room is foul" and that "there is no mu-
scum or library and no teaching access
•vAy' sories of any sort whatsoever.
The fairness and accuracy of Flexner's
�,.. investigation and report made his find-
- l Q Ir..: ings all the more devastating. There
7r, I I ( �rll,� were shrieks of protest, naturally, from
some of the schools he had criticized
severely-but they were in vain. In his
_%i autobiography, Flexner mentions one of
/ 4/ 1ji. c_ these instances, which involved his ad-
' verse evaluation of the Medical School
• :� !� of Maine at Portland. He says:
"Later I met Dr. Edville G. Abbott,
sL
who was professor'of orthopedics in the
/ p )1% Portland school. He told me that when
my report was read to the faculty, one
W-,,3,r ,- - of the members remarked that I had
spent only one day looking at the school.
• - , �`� 1 That,' Doctor Abbott intervened, 'is
.11111)1111
where we were lucky!'"
Some protests were put in violent lan-
guage. From Chicago—which Flexner
1 r: had'called "the plague spot" of Ameri-
can medical education—there came anon-
-
ymous letters telling him that he would
—,�4' be shot if he dared ever.come to the
city again. Flexner immediately went
ti ( r there to make a speech before the Amer-
ican Medical Association's Council on
,i—+ .1 . Medical Education,'and returned home
?/1".....°(
FLc.l Q unharmed.
The publication in 1910 of the Flex-
ner report both instigated a huge refor-
"Did the photo of our car make today's paper?" mation of American medical education
TODAY'S HEALTH/MAR. 1969 71
and made Flexner himself internation- tinning activities in the accreditation of mass, and any nipple discharge. During
ally famous. But he was only about medical schools"—two of the measures the examination of a woman's vagina,
halfway along his road of distinguished by which "the medical profession of this the custom is to take a smear of cells for '"t..
achievement. Nation has played the leading role in the "Pap test." This Papanicolaou test `''?''
Having been the scourging critic of making medical education here the finest for cancer is saving the lives of many `t`t"` .
American medical education, he now in the world." women.
became its outstanding fund-raiser. Flex- There of course remain many prob- Both men and women can expect a ..a:i4''
ner persuaded John D. Rockefeller, Sr., lems—many large and difficult problems rectal examination.
*1,7
to make an initial gift of $50 million —in the path of medical progress. But The commonest laboratory tests of the • :;; 4'
to improve the teaching of medicine. those problems do not include the task urine are for sugar, which could point -`,;. 4i
And he went on, year after year, getting of getting rid of such pest-holes as the to diabetes, and for albumin, which 'y +, -
millions of dollars from other multi- National Medical University or the Chi- could mean kidney damage. For this 4;:>;,:',
millionaires who listened to Flexner's cago Night University, or the California reason, you should be prepared by not ,,
advice when planning their gifts—or Medical College, which Flexner de- urinating just before your first examina- < ` ,' ,
when making gifts they hadn't even scribed as "a disgrace to the state whose tion. :%.4. ;
planned to make until Flexner started laws permit its existence." Commonest blood tests rule out or de- •v., °•
talking CO them. Long gone are those old-time chain- tect syphilis, anemia, and several other
Two such wealthy individuals were ber-of-horrors "medical schools." The ailments. :' ;Y
Louis Bamberger, a Baltimore mer- cleansing light of the great Flexner Re- If your new doctor has a professional "ii:
}`
chant, and his sister, Mrs. Felix Fuld. port burned them away. END way of going about this routine health � ;.,>�� :;
To them Flexner brought an idea which examination, •this is another plus in his +.,;`4,a-;,.,,,..•a •
had come to him partlybecause of his "' r,,.
�---- _� favor. Should he then want to perform :is_.
intimate knowledge of the aims and some of the longer and more expensive
Before the Doctor
achievements of the Rockefeller Insti- tests, such as an ECG (electrocardio-
tute (which later became Rockefeller (Continued from page 55) gram) of the electrical activity of the -',,
•.
University) in advanced medical re- diseases, and the dates when you had heart, or the basal metabolism test, you • ,,,t
search. Flexner dreamed of a new non- any of these. You write down any al- can stop at this point and ask about his -.1-.:,
medical "advanced research institute" lergies or sensitivities to drugs of which reasons and his charges for a more ex-
for America—and the result was the you are aware—and this can be lifesav- tensive examination.
establishment of the great Princeton ing information. You note any times Having had your basic health exami-
Institute of Advanced Studies, which you went to the hospital and why, and nation, both you and your doctor are r .;I y ,
was launched with the $5 million that your illnesses at home. You can save prepared for faster, more effective treat ''t` ``7:-
Flexner persuaded Mr. Bamberger and your doctor time, and protect both of ment when you have the flu, a sore arm r •'
` Mrs. Fuld to 'donate. They gave it en- <'you,from overlooked items by keeping or a"pain which might be indigespon_ ','"'t1.:.-,
- 'thusiastically-and also insisted, over his this book lip to date, and showing it to .or which might be a heart attack :-.,.,
i", initial doubts and objections, that.Flex ;your doctor when he starts.to take your' Who, when, how often, and whyl Aso f 1
` • ner himself become the'new Institute's 'history. soon as a baby is born, he should be.41.f;tt
first director. 'It was in that capacity Take your record book along on any given a careful medical inspection.Ask: ''4,'*.'''
that Abraham Flexner managed to win hospital admissions. It can save you your doctor how often he wishes to see '
Albert Einstein to permanent residency from repeating your medical history to a well baby during the first year, includ- '
in the United States—and soon the peo- resident and intern doctors, and will ing his schedule of immunizations.
ple of Princeton, New Jersey, became help protect you against forgetting to against infectious diseases.
familiar with the figure of the greatest warn the hospital staff about any. sensi- The age of three is a good time to be `l,`"
theoretical physicist of modern times. tivity to food or medicine. sure your child's eyesight and hearing :N-
OnOn September 21, 1959, Dr. Abraham Your physical examination. Basic ex- are normal, not waiting for a school
Flexner—almost 93—died peacefully at i amination includes your temperature, teacher to discover a handicap which
his home at Falls Church, Virginia. In f pulse rate, blood pressure, and a look could have been cured with earlier
Europe, in Britain, in Canada, and in into the back of your eyes with an treatment.Ask your doctor how often he
the United States, newspaper editorials ophthalmoscope. Because no concealing wants to see your child if he apparently
loudly praised the achievements of a k skin covers the inside of your eyes, your is well.
man who had not merely lit.a candle i doctor can look directly at the blood Before school and before going away
in a dark world but. with intelligence, I,vessels. This gives him major clues about from home to camp are traditional
vigor, and generosity, turned great hope- ' your health or a possible change due to health-examination times. Adolescence
inspiring floodlights on. hardening of the arteries, diabetes, or is a period when an understanding fain-
At the Communications Institute ofeveral other conditions. ily doctor can be helpful, and you don't
the American Medical Association lastOn a first examination, your doctor want to neglect teen-age pimples, or
August, AMA President Dwight L. Wil- t robably will want you to undress and changes in eyesight or hearing.
bur cited the Flexner Report as one of ut on a white examination gown. This When you go into the military or on
the "three outstanding events or move- ives him the best opportunity for a to a new job, a compulsory health ex- ° •,:
ments in this century which have most head-to-toe look, not only at your ears, amination can be expected. Perhaps you
significantly influenced the field of med- mouth, throat,and hearing,but a chance want to go first to your own family
•
kine-as we practice it today." The Flex- with a stethoscope, thumping, and pres- doctor and be sure you are in the best -
ner Report, Doctor Wilbur pointed out, sure with his hands, to learn about your possible health. .
was of immense value in helping the heart, lungs, and body organs. With his Before marriage, the sensibly romantic
AMA push for the establishment of little rubber hammer he tests your re- couple will each have a health examina-
properly conducted state boards for li- flexes such as the familiar knee jerk. tion—they want to bring the best pos-
censing medical-school graduates to prac- Women particularly need a breast ex- sible health to their joint venture.
tice medicine, and also the AMA's "con-if amination for tenderness, any abnormal From age 35 upward, a yearly physical
92 *#0.- -- y,._ �,w�,,,T...-- " TODAY'S HEALTH/MAR. 1969