Rockefeller philanthropy and the “Flexner Report” on medical education in the United States

International Journal of Sociology and Social Policy

Volumn 22, Issue 11-12, 2002, Pages 1-47

  Hewa, Soma ^a  

^a NONE   (Canada)

Author keywords

Medical; Philanthropy; USA

Indexed keywords

EID: 34247456906     PISSN: 0144333X     EISSN: 17586720     Source Type: Journal    
DOI: 10.1108/01443330210790184     Document Type: Article

References (72)

1. Abraham, Flexner, 1910 Medical Education in the United States and Canada. A Report to the Carnegie Foundation for the Advancement of Teaching, (New York, 437, Madison Avenue). The Flexner Report, as it is generally called, was the Bulletin Number Four of a series of studies sponsored by the Carnegie Foundation For the Advancement of Teaching. Flexner began his study in 1908, and visited 155 medical colleges in the United States and Canada. The study examined a wide range of issues pertaining to medical education, including entrance requirements, the number of students and professors, standards and conditions of laboratories, the clinical facilities, such as the availability of teaching hospitals, and the size of endowments or any other source of income besides the fees charged from students. Although it was well-known to those involved in educational matters that medical education in North America was substandard, the report documented, for the first time, in detail what Flexner described as “appalling conditions” in medical education. In most proprietary medical schools, the laboratories described in their catalogues were not there, or existed only as a collection of few test tubes packed away in a cigar box, libraries had no books, and instructors were nowhere to be found, as they were busy with their own practices. Owing to the commercial interest in medical education, a large number of the existing medical schools were ill-equipped, poorly staffed and produced too many uneducated doctors.
2. P. Frishauf, “The AAMC Story: The Rise to Power,” New Physician, 1974, Vol.23, pp. 36–39.
3. Daniel M. Fox, “Abraham Flexner's Unpublished Report: Foundations and medical education, 1909–1928,” Bulletin of the History of Medicine, 1980, Vol. 54, pp. 475–496.
4. Arnold Naimark, “Universities and Medical Schools: reflections on a half-century of Canadian medical education,” Canadian Medical Association Journal, 1993, Vol. 148, pp. 1538–1542.
5. Kenneth M. Ludmerer, 1999 Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (New York, Oxford University Press).
6. Fox, 475. However, contrary to these positive images of Flexner that have surfaced after the publication of the Report, one cannot ignore the fact that the impression of Flexner among his colleagues and friends at the time he was working on the Report was that he was “somewhat erratic,” and there was “doubt upon his judgement.” Concerned with Flexner's ability to complete the project, Henry S. Pritchett, the President of the Carnegie Foundation, made several inquiries about his previous record including the reasons for not completing a Master of Education degree that he had started at Harvard in 1905.
7. Howard S. Berliner, “New Light on the Flexner Report: Notes on the AMA-Carnegie Foundation Background,” Bulletin of the History of Medicine, 1977, Vol. 51, pp. 603–609.
8. E. V. Hollis, 1938 Philanthropic Foundations and Higher Education (New York, Columbia University Press), p. 27.
9. Max Weber, [1920] 1958 The Protestant Ethic and the Spirit of Capitalism (New York, Charles Scribner's Sons), p. 97.
10. Max Weber, [1922] 1978 Economy and Society, (eds.) Guenther Roth and Claus Wittich (Berkeley, University of California Press), Vol. I, p. 26.
11. Weber, [1922] 1978, Vol. I, p. 975.
12. For a detailed analysis of the relationship between Protestant teachings and philanthropy, see: Soma Hewa, “The Protestant Ethic and Rockefeller Benevolence: The Religious Impulse in American Philanthropy,” Journal For the Theory of Social Behaviour, 1997, Vol. 27, pp. 419–452.
13. Undoubtedly, it was this sense of burden that was described by Andrew Carnegie when he suggested, “The man who dies rich dies dis-graced….The day is not far distant when the man who dies leaving behind him millions of available wealth, which was free for him to administer during life, will pass away unwept, unhonored and unsung.” Andrew Carnegie, “Wealth,” North American Review, June 1889, p. 664. Gates made similar remarks when he wrote to Rockefeller in 1905 urging him to create a series of philanthropic foundations endowed with large sums of money. See Rockefeller Archive Center (hereafter RAC), Letter from Gates to Rockefeller, Gates Collection, June 30, 1905, Box 2, Folder 48.
14. Quoted by Thomas A. Bland, 1881 How to Grow Rich (Washington), p. 18.
15. Andrew Carnegie, 1889 “Wealth,” North American Review, No. CCCXCI, June, p. 659.
16. John D. Rockefeller, 1907 Cosmopolitan, XLIII, p. 369.
17. Russell H. Conwell, 1915 Acres of Diamonds (New York, Harper and Brothers), p. 30.
18. Rockefeller was humiliated by the media in 1905 when his gift of $100,000 to the American Congregational Board of Commissioners of Foreign Missions was turned down by a group of Congregational ministers arguing that the money had been earned improperly, and that if the gift was accepted it would constitute an acceptance of Rockefeller's business conduct. The issue led a newspaper sensation known as the “tainted money” controversy. Allan Nevins, 1940, John D. Rockefeller, The Heroic Age of American Enterprise (New York, Charles Scribner's Sons), pp. 534–554.
19. Conwell, pp. 18–19.
20. John T. Flynn, 1932 God's Gold: The Story of Rockefeller and His Times (New York, Harcourt Brace), p. 306.
21. Kenneth W. Rose, “Why Chicago and Not Cleveland? The Religious Imperative Behind John D. Rockefeller's Early Philanthropy, 1855–1900.” Unpublished Paper, 1995, p. 2.
22. Gates, p. 91.
23. One must observe caution here not to overemphasize the influence of Baptist education leaders because such an argument implies that Rockefeller was without his own particular world view and that he was dependent upon the opinions of his advisors. In Random Reminiscences, Rockefeller argued that “every right-minded man has a philosophy of life, whether he knows it or not. Hidden away in his mind are certain governing principles….Surely, his ideal ought to be to contribute all that he can, however little it may be, whether of money or service, to human progress.” Rockefeller, p. 104.
24. Gates, pp. 86–87.
25. Nevins, p. 210.
26. Gates, p. 159.
27. For a detailed analysis of Gates' role in organizing of Rockefeller philanthropy from the late nineteenth to the early twentieth centuries, see: Soma Hewa, “Toward the Well-Being of Mankind: Rockefeller Philanthropy and the Problem of Economic Research,” International Journal of Sociology and Social Policy, 1998, Vol. 18, pp. 85–129.
28. Gates, p. 162.
29. John Ettling, The Germ of Laziness (Cambridge, Harvard University Press), 1981, p.66.
30. Engel G. “The need for a new medical model: A challenge for biomedicine,” Science, 1977, Vol. 196, pp. 129–136.
31. Soma Hewa and Robert W. Hetherington, “Specialists without Spirit: Limitations of the Mechanistic Biomedical Model,” Theoretical Medicine, 1995, Vol. 16, pp. 129–139.
32. Kelvyn Jones and Graham Moon, 1987 Health Disease and Society (London, Routledge and Kegan Paul).
33. William Osler, one of the leading medical educators in the late nineteenth century, writes: “From the brilliant overthrow by Pasteur, in 1861, and by Koch and Cohn, in 1876, of the theory of spontaneous generation, we may date its modern growth. Wrapped up in this theory of spontaneous generation, upon which speculation raged centuries before the invention of microscope, lies the history of bacteriol-ogy….From that time onward innumerable workers have satisfied the critical scientific world as to the cause of pneumonia, diphtheria, tetanus, influenza, and bubonic plague, besides many diseases of cattle, horses, sheep, and other animals and insects.” Osler, 1932 Aequanimi-tas (Philadelphia, P. Blakiston's Son & Co.), pp. 227–229.
34. Simon Flexner and James Thomas Flexner, 1941 William Henry Welch and the Heroic Age of American Medicine, (New York, The Viking Press), p. 91.
35. RAC, Dr. Simon Flexner's Address to Honor the Memory of Frederick Taylor Gates, May 15th, 1929, p. 14. Gates Collection, Box 3, Folder 62. Flexner stated in his address: “Mr. Gates' desire, therefore, to see the establishment of an institution, the purpose of which was to be the study of the actual nature of disease, precisely as problems in chemistry and physics are studied, grew in part, out of this personal experience.”
36. Paul Starr, 1982 The Social Transformation of American Medicine (New York, Basic Books, Inc.), pp. 93–97.
37. Gates, p. 180.
38. This original memorandum has since been lost. However, Gates quotes the memorandum in its entirety in his autobiography. p. 182.
39. RAC, In Opposition to Endowment of Economic Research, Gates Collection, p.1. 1914, Box 2, Folder 24.
40. Gates, p. 182.
41. Nevins, Vol. 2, p. 470.
42. Quoted in Howard S. Berliner,1985 A System of Scientific Medicine, Philanthropic Foundations in the Flexner Era (New York, Tavis-tock Publications), p. 60.
43. Steven C. Wheatley, 1988 The Politics of Philanthropy, Abraham Flexner and Medical Education (Madison, The University of Wisconsin Press), p. 30.
44. Gates, p. 231.
45. There was also a personal dimension to Rockefeller's commitment to medicine. In 1901, the death of John Rockefeller McCormick (also known as Jackie McCormick), the first grandson of John D. Rockefeller, of scarlet fever at the age of four was a shock to the grandfather, who had offered to pay half a million dollars to a physician in New York if he could save the life of the child. Jackie's death strengthened Rockefeller's determination to create an institute of medical research. See, Ron Chernow, 1998 TITAN, The Life of John D. Rockefeller, Sr., (New York, Random House), pp. 417–418.
46. Gates, p. 193.
47. RAC, General Education Board, Purpose and Program, 2 (OMR), GEB, Box 15.
48. Raymond Fosdick, 1989 The Story of the Rockefeller Foundation (New Brunswick, Transaction Publications), p. 9.
49. Also, see Fosdick, 1962 Adventure in Giving: The Story of the General Education Board (New York, Harper and Brothers).
50. Gates, p. 218. I have discussed the role of the GEB in the development of a system of education in detail elsewhere
51. see Soma Hewa, “The Protestant Personality and Higher Education: American Philanthropy Beyond the Progressive Era,” Politics, Culture and Society, 1998, Vol. 12, pp. 135–163.
52. RAC, Letter from F. T. Gates to John D. Rockefeller, June, 6, 1905, (OMR), GEB, Box 18, p. 1.
53. J. Wall, 1970 Andrew Carnegie (New York, Oxford University Press).
54. RAC, Letter from F. T. Gates to John D. Rockefeller, April 18, 1905, (OMR), GEB, Box 18, pp. 1–2.
55. RAC, Letter from F. T. Gates to John D. Rockefeller, April 24, 1905, (OMR), GEB, Box 18, pp. 1–6.
56. RAC, Letter From John D. Rockefeller to F. T. Gates, June 24, 1905, General Education Board 2 (OMR), Box 18.
57. Gates, p. 218.
58. RAC, Some Reflections on Questions of Policy, Presented by F. T. Gates to the annual meeting of the General Education Board, January 23, 1906, 2 (OMR), GEB, Box 19, Folder 198.
59. RAC, Memorandum by Starr J. Murphy and Wallace Buttrick to the General Education Board, October 10, 1905, 2 (OMR), GEB, Box 15.
60. RAC, Memorandum by Starr J. Murphy to the General Education Board, September 24, 1906, 2 (OMR), GEB, Box 16.
61. RAC, Letter from William Osler to F. T. Gates, April 26, 1907, Gates Collection, Box 1, Folder 19.
62. Welch, p. 286.
63. RAC, Some Elements of an Effective System of Scientific Medicine in the United States. Gates Collection, Box 2, Item 44. P. 12.
64. Raymond B. Fosdick, 1962 Adventure In Giving: The Story of the General Education Board (New York, Harper and Row Publishers), p. 159.
65. Donald G. Tewksbury, 1932 The Founding of American Colleges and Universities Before the Civil War (New York, Bureau of Publications, Teachers College, Columbia University), p. 5.
66. Soma Hewa, “Physicians, The Medical Profession and Medical Practice,” in Health, Illness, and Health Care in Canada. Edited by B. Singh Bolaria and Harley D. Dickinson, Third Edition (Toronto, Nelson Thomson Learning), p. 63.
67. Charles W. Eliot, “The New Education. Its Organization,” Atlantic Monthly, 1869, Vol. XXIII, p. 203.
68. Starr, p. 114.
69. Hugh Hawkins, Pioneer: A History of the Johns Hopkins University, 1874–1889 (Ithaca, Cornell University Press).
70. RAC, F. T. Gates, Memorandum, August 1911, pp. 8–9, Gates Collection, Box 4, Folder 74.
71. According to Fosdick, from the beginning of Flexner's investigation, Carnegie “had no intention of making extensive benefactions” to educational reform. Flexner, as the Foundation's investigator, was compelled to inform every medical college he visited that there would be no money forthcoming from Carnegie. Fosdick, p. 153.
72. RAC, F. T. Gates, Memorandum, August 1911, pp. 8–9. Gates Collection, Box 4, Folder 74. This particular endowment was intended to provide financial support to place clinical teaching on a full-time basis at the Johns Hopkins Medical School. The GEB authorized $1.5 million to help reorganize both hospital and teaching staff in the three important clinical branches of medicine, surgery and pediatrics. RAC, RF History, Vol. 10, p. 2651.