1 of 2 Parts: Abraham and Simon Flexner: Medical Education Reformers.

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1 of 2 Parts:”Abraham and Simon Flexner: Medical Education Reformers:

An Interpretive Dialog between Betty J. and Franklin Parker,” bfparker@frontiernet.net

Betty: We review first Abraham Flexner, An Autobiography (NYC: Simon & Schuster, 1960). Frank, who were the Flexners?

Frank: The Flexners of Louisville, Ky., were a remarkable family, nine children of immigrant German-Jews, the father a peddler in the South. We focus on Abraham Flexner, then on Simon Flexner, each outstanding in medical education in the U.S. and beyond. We then tell how Abraham Flexner encouraged our own research 45 years ago on educational philanthropist George Peabody (1795-1869). Betty, briefly characterize Abraham Flexner.

Betty: Teacher, researcher, and philanthropic foundation executive, Abraham Flexner (1866-1959) won early attention for his private Flexner prep school in Louisville, successful in getting indulged and lazy wealthy boys into Ivy League colleges. His first critical book, American College (NYC: Century Co., 1908), prompted a Carnegie foundation executive to ask him in 1906 to examine medical schools in the U.S. and Canada. The 1910 Flexner Report created a revolution, remade medical education in the U.S. and beyond, highlighted medical quackery, made science, medicines, and supervised clinical training central in the professional preparation of physicians. He helped make medical doctors top professionals, highly esteemed, valued, and well paid. Frank?

Frank: Abraham Flexner was at the center of Carnegie, Rockefeller, and other multi-million dollar foundations that tackled difficult problems?educational, social, racial, health, and others–in the U.S. South, nationally, and internationally. He topped his career by creating (1930) the first U.S. think tank, the Institute for Advanced Study, Princeton, N.J. As its first director he brought from Hitler’s Germany Albert Einstein as mathematics professor. Einstein was named Time magazine’s “Man of the 20th Century.” We then tell of Abraham’s equally famous brother, Simon Flexner. But first, Betty, tell of their immigrant father, Morris Flexner.

Betty: The first Flexner in the U.S., Morris Flexner (1819-1882), grandson of the chief rabbi of Moravia and Bohemia, was born in Germany in an impoverished family. Because his parents had more children than they could feed, Morris was sent at age 13 to live with an uncle in Strasbourg, Alsace, on the French-German border. There he was a teacher for a time, very poor, hoping for a better life in the U.S. He spent 90 days in steerage on a sailing ship to NYC, worked there two years among French-speaking Jews, living from hand-to-mouth. Knowing of French-speaking Jewish countrymen in New Orleans, hoping to do better there, he arrived during a yellow fever epidemic, was stricken, and barely recovered at a charitable hospital run by Catholic nuns. An unknown French-speaking Samaritan fed him, heard him speak of a countryman living in Louisville, Ky., and paid his fare to Louisville. Frank?

Frank: He arrived in Louisville on crutches, recovered, and became like his friend a pack peddler, selling goods house to house, store to store. Adept at sharing news and gossip, jovial and likable, he won customers and friends in isolated farm homes, where he was often asked to stay for meals and for the night. He bought a crippled horse for $4, later another horse and a wagon, made a living, stopped frequently at a Jewish merchant’s house in Louisville, the Godshaw family, where he saw and was smitten by an immigrant French-speaking Jewish seamstress, Esther Abraham, whom he married. Betty, what of Esther Abraham?

Betty: Esther Abraham (1834-1905) was born in Germany near the French border. Her father, a dealer in cattle and other items, sent her to school to age 13. When she was 16, an aunt in Paris with a lingerie shop took in Esther and her sister and trained them as seamstresses. Their Uncle Godshaw, the Louisville, Ky., merchant, visited them several times in Paris and sent them tickets for passage to America. After nine weeks crossing the Atlantic the sisters were met in NYC in Sept. 1855 by a cousin and reached Louisville, where they lived with Uncle Godshaw’s family. They successfully made and sold women’s Paris fashions. Esther, popular socially, took to Morris Flexner. He at 34, married Esther, 22, Sept. 15, 1856. Frank?

Frank: A year later when the oldest of their nine children was born, Jacob, (1857), Morris Flexner went into business in Lawrenceburg, Ky., taking his family with him. But Civil War raiders made that town unsafe. After six years in Lawrenceburg (1857-63), the enlarged Flexner family returned to Louisville. Morris sold hats wholesale on the road, traveling in Tenn., Ala., Ga., Texas, elsewhere in the South. But the Panic of 1873 ruined him. From 1873 the family lived hand-to-mouth, dependent on first-born Jacob who, apprenticed to a druggist, had his own drugstore until the Panic of 1893 ruined him. The older children and later Abraham earned enough to pay the bills that kept the family together. oBetty, what of Abraham Flexner’s early life?

Betty: From ages 15 to 17, 1881-83, after Louisville High School hours, Abraham Flexner, worked in the private Louisville Library, six days a week, 2:30 p.m. to 10 p.m., checking and shelving books, eating a cold supper behind the card catalog, earning $16 a month. Besides charging and shelving books, he dipped into classical books and listened to adult conversations on politics, literature, religion, music, and art. “The decisive moment of my life came,” he later wrote “in 1884.” Oldest brother Jacob told Abraham, 17 and just graduated from high school: take this $1,000 I saved from my drugstore and go to college in Baltimore at Johns Hopkins University. Frank?

Frank: Why Johns Hopkins University? Jacob had heard of its high reputation from a Louisville friend, a view confirmed by the medical doctors who came to his drugstore. Philanthropist Johns Hopkins (1795-1873) was a Baltimore Quaker, bachelor, merchant, and the B&O RR’s largest stockholder. B&O RR Pres. John Work Garrett (1820-84), knowing that Johns Hopkins sought advice about his will, brought Hopkins together with visiting Mass.-born George Peabody (1795-1869), a former Baltimore merchant, then a London-based banker and a well-known philanthropist. George Peabody, when asked why and how he came to give away his millions, told Hopkins (condensed quote): “Like you, I wanted to be rich. I worked hard and succeeded. When age and illness came upon me, I wanted to make the best use of my money. I found trustees who carried out my wishes for U.S. libraries, museums, and a music conservatory to serve people; and for low-cost housing for London’s working poor (from 1862). Seeing the good my institutes did made me happy.” Johns Hopkins soon after recorded his will, leaving some $7 million to found Johns Hopkins University, Medical School, and Hospital. Betty?

Betty: Its first President Daniel Coit Gilman (1831-1908) made Johns Hopkins University the first graduate university in the U.S., based on the German university idea that a university creates new knowledge as well educates new generations. While Abraham Flexner learned the classics in Hopkins undergraduate program, such doctoral candidates as Woodrow Wilson were writing the books and experimenting in the labs that would make them future leaders. Frank?

Frank: Weak in Latin and Greek, Flexner asked his Greek prof. what to do. The prof. said: See me each day at 1 PM. I can only give you 5 minutes but I will tell you what to read and check to see what you have learned. Concerned because he had only enough money for two years’ tuition and board, he asked and was given permission to double up on classes. At final exam time, finding that two or more exams came at the same time, he explained his dilemma to Pres. Daniel Coit Gilman, who said: all we require is that you know the subjects. I will arrange to stagger your conflicting exams. oFlexner later remarked at the informality at Johns Hopkins, and at the understanding and help that enabled him to get a bachelor’s degree in two years. Betty?

Betty: Back in Louisville (1886), aged 20 to 22, Abraham taught for two years in the Louisville Male High School he had attended. In the late afternoons and evenings he tutored well-to-do boys whose parents anxiously wanted them to get into college. A prominent Louisville lawyer whose only son had been expelled from an eastern preparatory school asked Flexner to help get his son into Princeton. Flexner said: if you can get together from your friends five of their sons for tutoring at $500 a year each, I will prepare your son for Princeton. Thus began “Mr. Flexner’s School” which, for 15 years (1890-1905), won high praise locally and nationally. Harvard Pres. Charles W. Eliot (1834-1926) wrote to Flexner (condensed): “Boys from your school come to Harvard younger than most and graduate in a shorter time. How do you do it?” Frank? “

Frank: Abraham Flexner used every strategy on boys who had failed elsewhere: humor, encouragement, emulation, competition. He played able students against indolent ones, built on what each knew, patiently overcame their weaknesses. Flexner kept the school small, tuition high, and discipline strict. He drilled, joked, cajoled, used every means to get his boys into Harvard, Yale, Princeton, and elsewhere. In the early 1890s prominent Louisville businessman John M. Atherton asked Flexner to tutor his bright niece, Anne Crawford, for entrance to Vassar. He demurred at first but then thought it might be fun to teach a young woman. Betty?

Betty: Anne Laziere Crawford was born while her parents visited Ky. but she was raised in Ga. Her great grandfather, William Harris Crawford (1772-1834), was a U.S. senator from Ga., U.S. Minister to France, U.S. Secretary of War and of the Treasury, and unsuccessfully ran for the U.S. presidency in 1824. Her grandfather was a Methodist minister and president of Mercer College. Her father was impoverished by the Civil War when she went to live with her Louisville uncle. Frank?

Frank: Abraham Flexner did get Anne Crawford into Vassar, where she edited the college literary magazine. She returned to Louisville, taught in “Mr. Flexner’s School” two years, and published several stories. They went bicycling together and became engaged in 1896. But because Abraham, eight years older than Anne, was the Flexner family’s financial mainstay, they put off marriage for over two years. Anne went to NYC, reviewed Broadway plays for the Louisville Courier-Journal, studied writing at New York University, and began writing plays. Betty?

Betty: Anne returned to Louisville, married Abraham Flexner (June 1898), and while Abraham ran his school, she wrote plays, some for leading actress Minnie Maddern Fiske (1865-1932). Anne Flexner’s biggest dramatic success was Mrs. Wiggs of the Cabbage Patch, based on the best selling novel, which opened in NYC Sept. 3, 1904, ran for seven seasons, was played by three touring companies, and was presented in England, Australia, China, India and Korea. She wrote other plays but none as successful. Frank?

Frank: In 1904 Anne asked Abraham: If you had not married me, what would you have done by now? He answered: Quit teaching and gone to Europe. She said: Then that’s what we will do. The three Flexners (they had a six year old daughter) first went to Cambridge, Mass., where he studied at Harvard’s graduate school of education (1905-06). They then sailed for England and the Continent. With letters of introduction, Abraham attended lectures at Oxford and Cambridge universities, visited Rugby and Eton, and studied at the universities of Berlin and Heidelberg. In Europe, reflecting on his 16 teaching years, he wrote his first book, The American College (NY: Century Co., 1908). It criticized trends he had observed at Harvard and other colleges:
1-free electives which allowed unwise students foolishly to take only easy courses,
2-large classes which limited student interaction, and
3-overuse of teaching assistants, busy and harried as graduate students themselves and unprepared to teach effectively. Betty?

Betty: One of the few who read his critical book was Henry Smith Pritchett (1857-1939), president of the new Carnegie Foundation for the Advancement of Teaching. They met several times and Pritchett asked Flexner: Would you consider making a study of U.S. medical schools? Taken aback, Flexner said: You are confusing me with my medical doctor brother Simon Flexner. No, said Pritchett, I know Dr. Simon Flexner and I know that the American Medical Association has a committee examining medical schools. But medical doctors can’t or won’t criticize their colleagues. I want you because you are an educator and a critic. You can call the shots as you see them. Frank?

Frank: Henry S. Pritchett, graduate of a college which his father had started in Missouri, earned the Ph.D. in science at the University of Munich (1894); was an astronomer at the U.S. Naval Observatory; then taught astronomy at Washington University, St. Louis, Mo. (1883-97). He headed the U.S. Coast and Geodetic Survey (1897-1900) and became president of the Massachusetts Institute of Technology (1900-06). There he suggested to steel magnet Andrew Carnegie that he establish the Carnegie Foundation for the Advancement of Teaching, which Pritchett headed for 24 years (1906-30). Pritchett’s list of things to accomplish at the Carnegie Foundation included:
1-a national pension plan for teachers and professors (today’s TIAA),
2-a national standard for high school graduation (the Carnegie unit), and
3-studies to uncover weaknesses in and to professionalize schools of medicine, law, engineering, and others. Betty?

Betty: Reading the history of medical education in the U.S., Flexner found that in all there had been 457 medical schools in the U.S., some still-born, most short lived, 155 of which survived in 1907, all private, all to make money. Nearly all accepted any applicant who could pay, used as teachers local physicians who taught part time for extra money. There were no state licensing boards. Few medical schools were connected to a hospital or had clinics, research facilities, or good equipment. Medical students were still little more than apprentices. Frank?

Frank: Flexner soon saw that Johns Hopkins was the best of the medical schools, largely led by its first medical faculty: Drs. William Henry Welch (1850-1934), pathology; Howard Atwood Kelly (1858-1943), gynecology and obstetrics; William Stewart Halsted (1852-1922), surgery; and William Osler (1849-1919), medicine. Betty, why did Flexner pick Johns Hopkins Medical School as his model?

Betty: Entrance requirements were high and its medical faculty were highly trained, mostly in European universities. Medical students examined and studied patients in hospital wards under experienced physicians; discussed symptoms, findings, and lab tests results with experienced physicians; and consulted their superiors about the best course of treatment. Patients benefited and medical students became competent. Frank?
Frank: Visiting the 155 medical schools in the U.S. and Canada, Flexner looked for:
1-entrance requirements: what were they? Were they rigidly followed?
2-faculty: size, training, how many full time (few), part time (most)?
3-finance: what endowment, what fees, what financial stability?
4-laboratories and equipment: how many, what kind, what quality, how much used, and how often updated?
5-library: books, journals, quality, quantity, upkeep, budget?
6-Hospital access by medical faculty, by medical student; the amount of student supervision by experienced physicians? Betty?

Concluded in 2 of 2 Parts: “Abraham and Simon Flexner: Medical Education Reformers,” by Franklin and Betty J. Parker, bfparker@frontiernet.net

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