1 00:00:02,450 --> 00:00:06,250 Speaker 1: Happy Saturday. One of our upcoming episodes talks about someone 2 00:00:06,280 --> 00:00:09,060 Speaker 1: who went to medical school at a time when medical 3 00:00:09,100 --> 00:00:11,580 Speaker 1: education in the U.S. could be all over the place. 4 00:00:12,180 --> 00:00:15,340 Speaker 1: So today's Saturday Classic is about that and about a 5 00:00:15,380 --> 00:00:18,060 Speaker 1: report that was part of a shift toward medical schools 6 00:00:18,400 --> 00:00:23,640 Speaker 1: that were more standardized and comprehensive. That was the Flexner Report, 7 00:00:23,800 --> 00:00:26,360 Speaker 1: and our episode on it and its author originally came 8 00:00:26,440 --> 00:00:32,669 Speaker 1: out on July 8th, 2020. Welcome to Stuff You Missed 9 00:00:32,729 --> 00:00:42,840 Speaker 1: in History Class, a production of iHeartRadio. Hello and welcome 10 00:00:42,860 --> 00:00:47,540 Speaker 1: to the podcast. I'm Holly Frey. And I'm Tracy V. Wilson. Tracy, 11 00:00:47,580 --> 00:00:49,280 Speaker 1: one of the topics that's come up a couple of 12 00:00:49,320 --> 00:00:51,400 Speaker 1: times for me in recent weeks as I've just been 13 00:00:51,440 --> 00:00:54,320 Speaker 1: doing my own reading related to racial injustice is the 14 00:00:54,360 --> 00:00:57,720 Speaker 1: Flexner Report. And this was a report that was issued 15 00:00:57,760 --> 00:01:01,000 Speaker 1: in the early 20th century. It is often credited with 16 00:01:01,080 --> 00:01:04,420 Speaker 1: changing the medical field and shaping what medical education looks today. 17 00:01:04,540 --> 00:01:06,399 Speaker 1: I also found one article that said it's the most 18 00:01:06,500 --> 00:01:10,130 Speaker 1: overrated document in medical history, which made me laugh a bit. Oh, goodness. 19 00:01:10,709 --> 00:01:13,430 Speaker 1: But there are also aspects of this document that really 20 00:01:13,490 --> 00:01:15,870 Speaker 1: need to be discussed in terms of how they impacted 21 00:01:15,910 --> 00:01:18,030 Speaker 1: the Black community. So we're going to talk about this 22 00:01:18,130 --> 00:01:20,910 Speaker 1: one in three parts. First, we're going to talk about 23 00:01:21,250 --> 00:01:24,040 Speaker 1: Abraham Flexner, for whom the report is named. and who 24 00:01:24,080 --> 00:01:26,240 Speaker 1: made the report. And then we're going to talk about 25 00:01:26,260 --> 00:01:29,780 Speaker 1: the general impact of the Flexner Report on medicine. And finally, 26 00:01:30,220 --> 00:01:33,580 Speaker 1: we will talk about how this affected Black medical schools specifically. 27 00:01:33,750 --> 00:01:35,830 Speaker 1: And it is a lot to unpack, and I hope 28 00:01:35,860 --> 00:01:39,230 Speaker 1: we manage to do it justice. As with anything related 29 00:01:39,250 --> 00:01:42,709 Speaker 1: to any of these topics, a person's biography, the history 30 00:01:42,750 --> 00:01:45,250 Speaker 1: of any given field, and the history of how things 31 00:01:45,910 --> 00:01:50,330 Speaker 1: impact racial injustice, there are always more nuances than we 32 00:01:50,370 --> 00:01:52,920 Speaker 1: could ever pack into an episode. But We're hoping we 33 00:01:52,970 --> 00:01:56,010 Speaker 1: hit all of the prominent and pertinent points. Yeah, if 34 00:01:56,050 --> 00:01:59,570 Speaker 1: you listen to the podcast Sawbones, they did an episode, 35 00:01:59,590 --> 00:02:00,970 Speaker 1: which I guess at this point will be a few 36 00:02:00,990 --> 00:02:05,410 Speaker 1: weeks ago, that was about racism in medicine. And it 37 00:02:05,470 --> 00:02:08,880 Speaker 1: alludes to this without going into much detail about it. 38 00:02:08,910 --> 00:02:11,250 Speaker 1: So if you listen to our show and that show, 39 00:02:11,830 --> 00:02:15,330 Speaker 1: these are sort of... They'll complement one another. They do. 40 00:02:15,669 --> 00:02:20,290 Speaker 1: They do. We didn't plan that. It just happened. So 41 00:02:20,530 --> 00:02:23,830 Speaker 1: this starts with Abraham Flexner, and Abraham Flexner was born 42 00:02:23,889 --> 00:02:29,400 Speaker 1: in Louisville, Kentucky on November 13th, 1866. His father, Moritz Flexner, 43 00:02:29,760 --> 00:02:34,520 Speaker 1: and his mother, Esther Abraham, were German Jewish immigrants. Moritz 44 00:02:34,540 --> 00:02:37,800 Speaker 1: had a hat business, and Esther worked as a seamstress. 45 00:02:38,320 --> 00:02:42,020 Speaker 1: The Flexner family was large. Abraham was their sixth child, 46 00:02:42,080 --> 00:02:45,519 Speaker 1: and they ultimately had nine. Moritz and Esther were able 47 00:02:45,580 --> 00:02:48,330 Speaker 1: to build up their finances and With the plan not 48 00:02:48,350 --> 00:02:50,530 Speaker 1: that they would live lavishly, but that every one of 49 00:02:50,570 --> 00:02:53,989 Speaker 1: their sons, and there were seven of them, would attend college. 50 00:02:54,510 --> 00:02:57,730 Speaker 1: But that plan fell apart when the 1873 panic hit 51 00:02:57,850 --> 00:03:01,790 Speaker 1: and they lost their savings. But Abraham did manage to 52 00:03:01,840 --> 00:03:05,580 Speaker 1: go to college. He attended Johns Hopkins University, and the 53 00:03:05,760 --> 00:03:09,360 Speaker 1: funds came from his brother Jacob. The span and the 54 00:03:09,500 --> 00:03:12,040 Speaker 1: ages of the Flexner children meant that Jacob was already 55 00:03:12,120 --> 00:03:15,579 Speaker 1: established by the time Abraham graduated from high school— And 56 00:03:15,620 --> 00:03:18,059 Speaker 1: the money he was making as a drugstore owner was 57 00:03:18,120 --> 00:03:24,660 Speaker 1: put toward Abraham's tuition. Yeah, they definitely always prioritized education 58 00:03:24,720 --> 00:03:28,070 Speaker 1: as where they put their money. Abraham earned his B.A. 59 00:03:28,150 --> 00:03:30,830 Speaker 1: in 1886, and his hope had been to go into 60 00:03:30,870 --> 00:03:34,230 Speaker 1: a postgraduate program. But there was not enough money for that. 61 00:03:34,450 --> 00:03:37,910 Speaker 1: And though he did try to secure a fellowship, none materialized. 62 00:03:38,510 --> 00:03:40,990 Speaker 1: So he went home to Louisville to start his career. 63 00:03:41,510 --> 00:03:44,130 Speaker 1: For the next four years, Flexner worked as a high 64 00:03:44,170 --> 00:03:47,100 Speaker 1: school teacher. heading up the Latin and Greek classes at 65 00:03:47,120 --> 00:03:50,260 Speaker 1: Louisville High School. But during that time, he was developing 66 00:03:50,340 --> 00:03:52,820 Speaker 1: another idea because he thought there was a better way 67 00:03:52,880 --> 00:03:57,910 Speaker 1: to structure education. And that idea manifested as an experimental school, 68 00:03:58,110 --> 00:04:01,490 Speaker 1: and Flexner founded that school in 1890. That school was 69 00:04:01,550 --> 00:04:05,050 Speaker 1: simply called Mr. Flexner School, and it was incredibly progressive. 70 00:04:05,690 --> 00:04:08,670 Speaker 1: The structure probably seemed like no structure at all to 71 00:04:08,730 --> 00:04:12,200 Speaker 1: traditional educators. Flexner did away with the idea of a 72 00:04:12,260 --> 00:04:15,540 Speaker 1: set curriculum. Students did not have exams and they did 73 00:04:15,560 --> 00:04:19,180 Speaker 1: not receive grades. The vision that Flexner had for this 74 00:04:19,220 --> 00:04:23,750 Speaker 1: school was custom-tailored education to prepare students for higher learning. 75 00:04:24,380 --> 00:04:26,880 Speaker 1: And a lot of his students got into very good schools, 76 00:04:26,940 --> 00:04:30,589 Speaker 1: so this was a very successful model. The Flexner family 77 00:04:30,670 --> 00:04:33,950 Speaker 1: continued to value education and help one another in that regard. 78 00:04:34,760 --> 00:04:38,150 Speaker 1: One of the personal benefits for Abraham Flexner in creating 79 00:04:38,210 --> 00:04:41,390 Speaker 1: his school was that he could enroll his brother Simon 80 00:04:41,430 --> 00:04:44,490 Speaker 1: there and get him into Johns Hopkins. He was also 81 00:04:44,570 --> 00:04:47,810 Speaker 1: able to pay for Simon's tuition. Abraham also helped his 82 00:04:47,850 --> 00:04:51,409 Speaker 1: sister Mary. He paid her way at Bryn Mawr. This 83 00:04:51,510 --> 00:04:54,150 Speaker 1: marks an expansion of the family's plan to not only 84 00:04:54,310 --> 00:04:56,810 Speaker 1: educate the men of the family, but also the women. 85 00:04:57,150 --> 00:05:00,210 Speaker 1: And education for women was something that Abraham supported throughout 86 00:05:00,250 --> 00:05:04,409 Speaker 1: his life. One of the former pupils in Flexner's preparatory school, 87 00:05:04,570 --> 00:05:07,849 Speaker 1: a young woman named Anne Crawford, also became an important 88 00:05:07,870 --> 00:05:12,419 Speaker 1: part of Abraham's life. After graduating, Anne had become a teacher. 89 00:05:12,839 --> 00:05:14,880 Speaker 1: She had attended Vassar, and when she finished those studies, 90 00:05:14,920 --> 00:05:17,800 Speaker 1: she started working there at the school. And she also 91 00:05:17,839 --> 00:05:21,040 Speaker 1: had started to pursue a career as a playwright. Abraham 92 00:05:21,080 --> 00:05:23,000 Speaker 1: and Anne fell in love, and they were married in 1898. 93 00:05:22,990 --> 00:05:28,430 Speaker 1: And they eventually had two daughters, Jean and Eleanor. In 1904, 94 00:05:28,430 --> 00:05:31,690 Speaker 1: Anne adapted the novel Mrs. Wiggs of the Cabbage Patch, 95 00:05:32,110 --> 00:05:35,270 Speaker 1: which is a comedic story about an impoverished Southern family, 96 00:05:35,700 --> 00:05:39,420 Speaker 1: into a Broadway play. Mrs. Wiggs ran from September 3rd, 97 00:05:39,420 --> 00:05:43,200 Speaker 1: 1904 through January 1905 at the Savoy Theater, and it 98 00:05:43,240 --> 00:05:46,240 Speaker 1: was a success. The income from Anne's work on the 99 00:05:46,279 --> 00:05:49,220 Speaker 1: show made it possible for Abraham to enroll at Harvard 100 00:05:49,300 --> 00:05:52,700 Speaker 1: to get his master's degree in psychology. He closed his 101 00:05:52,839 --> 00:05:55,690 Speaker 1: school to do that, He also spent a year in 102 00:05:55,810 --> 00:05:59,230 Speaker 1: Germany as part of his studies, again bankrolled through his 103 00:05:59,310 --> 00:06:02,650 Speaker 1: wife's success in the theater. That time spent in Germany 104 00:06:02,730 --> 00:06:05,450 Speaker 1: made Flexner deeply aware of what he saw as the 105 00:06:05,490 --> 00:06:09,289 Speaker 1: failings of the education system back home. And as a result, 106 00:06:09,430 --> 00:06:12,810 Speaker 1: in 1908, he researched and wrote an assessment of higher 107 00:06:12,870 --> 00:06:17,419 Speaker 1: education in the United States titled... The American College, A Criticism. 108 00:06:18,120 --> 00:06:22,120 Speaker 1: Based on his work examining colleges and identifying what he 109 00:06:22,160 --> 00:06:25,320 Speaker 1: saw as the problems at the single school level, as 110 00:06:25,380 --> 00:06:29,500 Speaker 1: well as systematically, Flexner was commissioned by the Carnegie Foundation 111 00:06:29,820 --> 00:06:32,589 Speaker 1: for a new project. He was asked by the president 112 00:06:32,650 --> 00:06:36,330 Speaker 1: of the Carnegie Foundation for the Advancement of Teaching, that 113 00:06:36,350 --> 00:06:40,050 Speaker 1: was Henry Smith Pritchett, to apply that same critical and 114 00:06:40,110 --> 00:06:43,950 Speaker 1: analytical eye to the medical institutions, specifically in the United 115 00:06:43,970 --> 00:06:50,339 Speaker 1: States and Canada. There were 155 medical schools in his survey. Yeah, 116 00:06:50,380 --> 00:06:53,060 Speaker 1: he took two years to basically travel around and visit 117 00:06:53,080 --> 00:06:56,419 Speaker 1: all these schools and do his assessment. And then in 1910, 118 00:06:56,420 --> 00:06:59,960 Speaker 1: Flexner completed his report, which was titled Medical Education in 119 00:06:59,980 --> 00:07:03,420 Speaker 1: the United States and Canada. And when this report came out, 120 00:07:03,520 --> 00:07:07,200 Speaker 1: it had a massive impact on medical education in North America. 121 00:07:07,220 --> 00:07:10,560 Speaker 1: A lot of the schools that Flexner had found lacking 122 00:07:10,870 --> 00:07:14,870 Speaker 1: closed as a consequence of its publication. Others were completely 123 00:07:14,990 --> 00:07:18,310 Speaker 1: overhauled and essentially rebuilt from the ground up. And we're 124 00:07:18,330 --> 00:07:20,210 Speaker 1: going to talk more about all of that in just 125 00:07:20,250 --> 00:07:24,110 Speaker 1: a moment. Following the medical school report, Flexner produced a 126 00:07:24,150 --> 00:07:27,720 Speaker 1: report at the behest of the Rockefeller Foundation examining the 127 00:07:27,820 --> 00:07:30,540 Speaker 1: sex work field in Europe and how it was regulated. 128 00:07:31,040 --> 00:07:34,140 Speaker 1: It was the first of many varied reports that Flexner 129 00:07:34,180 --> 00:07:37,140 Speaker 1: would compile for the foundation. But though he had moved 130 00:07:37,200 --> 00:07:39,860 Speaker 1: on to other projects like that, Flexner did not just 131 00:07:39,980 --> 00:07:42,620 Speaker 1: drop his medical report and then move on with his life. 132 00:07:43,220 --> 00:07:49,260 Speaker 1: He actually dedicated himself to improving medical education specifically. In 1913, 133 00:07:49,260 --> 00:07:53,120 Speaker 1: following his report on European sex work, Flexner became the 134 00:07:53,260 --> 00:07:58,450 Speaker 1: secretary to the Rockefeller Foundation's General Education Board. During this 135 00:07:58,550 --> 00:08:00,810 Speaker 1: time in his role, he worked on a number of 136 00:08:00,930 --> 00:08:03,770 Speaker 1: other research and reporting projects, as we mentioned, but he 137 00:08:03,890 --> 00:08:07,730 Speaker 1: also made sure that money from private donors was allocated 138 00:08:07,810 --> 00:08:10,760 Speaker 1: to medical education institutions. and improving some of the problems 139 00:08:10,800 --> 00:08:15,210 Speaker 1: he had discovered while working on his 1910 report. In 1921, 140 00:08:15,210 --> 00:08:18,670 Speaker 1: Abraham Flexner wrote a memo for the Rockefeller Foundation's board, 141 00:08:18,850 --> 00:08:22,770 Speaker 1: which was titled The Usefulness of Useless Knowledge. And this 142 00:08:22,920 --> 00:08:26,020 Speaker 1: memo evolved, and it became a lecture, and then 18 143 00:08:26,020 --> 00:08:28,560 Speaker 1: years after he initially wrote it, it was published in 144 00:08:28,620 --> 00:08:32,000 Speaker 1: Harper's Magazine. And that piece of writing opens with the 145 00:08:32,040 --> 00:08:36,380 Speaker 1: following paragraph. Quote, Is it not a curious fact that 146 00:08:36,420 --> 00:08:40,580 Speaker 1: in a world steeped in irrational hatreds which threaten civilization itself, 147 00:08:41,200 --> 00:08:45,000 Speaker 1: men and women, old and young, detach themselves wholly or 148 00:08:45,059 --> 00:08:48,300 Speaker 1: partly from the angry current of daily life to devote 149 00:08:48,340 --> 00:08:52,090 Speaker 1: themselves to the cultivation of beauty, to the extension of knowledge, 150 00:08:52,450 --> 00:08:55,829 Speaker 1: to the cure of disease, to the amelioration of suffering, 151 00:08:56,350 --> 00:09:01,270 Speaker 1: just as though fanatics were not simultaneously engaged in spreading pain, ugliness, 152 00:09:01,410 --> 00:09:05,150 Speaker 1: and suffering? The world has always been a sorry and 153 00:09:05,190 --> 00:09:09,110 Speaker 1: confused sort of place, yet poets and artists and scientists 154 00:09:09,170 --> 00:09:13,030 Speaker 1: have ignored the factors that would, if attended to, paralyze them. 155 00:09:13,809 --> 00:09:17,290 Speaker 1: From a practical point of view, intellectual and spiritual life is, 156 00:09:17,480 --> 00:09:20,500 Speaker 1: on the surface, a useless form of activity, in which 157 00:09:20,559 --> 00:09:24,600 Speaker 1: men indulge because they procure for themselves greater satisfactions than 158 00:09:24,640 --> 00:09:28,490 Speaker 1: are otherwise obtainable. In this paper, I shall concern myself 159 00:09:28,530 --> 00:09:30,849 Speaker 1: with the question of the extent to which the pursuit 160 00:09:30,929 --> 00:09:35,310 Speaker 1: of these useless satisfactions proves unexpectedly the source from which 161 00:09:35,530 --> 00:09:39,579 Speaker 1: undreamed-of utility is derived. One of the things that Flexner 162 00:09:39,600 --> 00:09:43,290 Speaker 1: touches on in this writing is the unintentional outcomes of 163 00:09:43,390 --> 00:09:47,559 Speaker 1: pursuits that were of pure intent. He specifically mentions how 164 00:09:47,620 --> 00:09:51,679 Speaker 1: the advancement of the cruelty of warfare was fueled by 165 00:09:51,780 --> 00:09:55,160 Speaker 1: scientists who were often working they thought for the betterment 166 00:09:55,220 --> 00:09:59,190 Speaker 1: of mankind. As the 1920s wore on, Abraham Flexner found 167 00:09:59,230 --> 00:10:02,160 Speaker 1: himself at odds. with other members of the education board 168 00:10:02,200 --> 00:10:05,620 Speaker 1: at the Rockefeller Foundation. And this led to him ultimately 169 00:10:05,660 --> 00:10:10,490 Speaker 1: being pushed out of the organization in 1928. In 1929, 170 00:10:10,490 --> 00:10:16,050 Speaker 1: Abraham Flexner was approached by philanthropist siblings Lewis and Caroline Bamberger, 171 00:10:16,660 --> 00:10:19,280 Speaker 1: The Bambergers thought they could use their wealth to establish 172 00:10:19,400 --> 00:10:22,350 Speaker 1: a new medical school in Newark, New Jersey, and they 173 00:10:22,380 --> 00:10:26,050 Speaker 1: wanted Flexner as an advisor on the project. But Flexner 174 00:10:26,090 --> 00:10:29,230 Speaker 1: pointed out that Newark had neither a teaching hospital nor 175 00:10:29,250 --> 00:10:32,430 Speaker 1: a top-notch university, both of which were vital to the 176 00:10:32,470 --> 00:10:36,069 Speaker 1: success of a medical school. And Abraham Flexner was really 177 00:10:36,130 --> 00:10:38,510 Speaker 1: thinking of a different sort of project, and he was 178 00:10:38,650 --> 00:10:41,710 Speaker 1: able to convince the Bambergers that they should instead invest 179 00:10:41,750 --> 00:10:44,630 Speaker 1: in his idea. And they did, with a gift of 180 00:10:44,630 --> 00:10:49,170 Speaker 1: $ 5 million. Flexner envisioned what he would later call an 181 00:10:49,330 --> 00:10:53,070 Speaker 1: educational utopia that offered the greatest minds a place where 182 00:10:53,110 --> 00:10:56,770 Speaker 1: they could be driven entirely by their curiosity. And so 183 00:10:56,900 --> 00:11:01,560 Speaker 1: in 1930, Flexner founded the Institute for Advanced Study in Princeton, 184 00:11:01,620 --> 00:11:05,850 Speaker 1: New Jersey, and served as director there until 1939. Its 185 00:11:05,970 --> 00:11:09,589 Speaker 1: mission stated, quote, The institute is pledged to assemble a 186 00:11:09,610 --> 00:11:13,250 Speaker 1: group of scientists and scholars who, with their pupils and assistants, 187 00:11:13,309 --> 00:11:16,080 Speaker 1: may devote themselves to the task of pushing beyond the 188 00:11:16,140 --> 00:11:19,280 Speaker 1: present limits of human knowledge and to training those who 189 00:11:19,300 --> 00:11:22,500 Speaker 1: may carry on in this sense. Flexner was able to 190 00:11:22,540 --> 00:11:25,620 Speaker 1: attract some of the biggest names to his institute, including 191 00:11:25,740 --> 00:11:29,870 Speaker 1: Albert Einstein, who joined in 1933. In the years since 192 00:11:29,910 --> 00:11:33,290 Speaker 1: its founding, the institute has had, as members or as faculty, 193 00:11:33,290 --> 00:11:39,660 Speaker 1: 34 Nobel laureates, 42 Fields Medalists, and 18 Able Prize Laureates. 194 00:11:40,340 --> 00:11:43,540 Speaker 1: In addition to Einstein, notable names on that list include 195 00:11:43,580 --> 00:11:47,679 Speaker 1: Robert Oppenheimer and previous podcast subject John von Neumann. We're 196 00:11:47,700 --> 00:11:49,860 Speaker 1: going to cover the end of Flexner's life and the 197 00:11:49,960 --> 00:11:53,179 Speaker 1: impact of his work on medical education, but we're due 198 00:11:53,220 --> 00:11:55,720 Speaker 1: for a quick break to have a word from our sponsors. 199 00:11:56,470 --> 00:12:08,230 Speaker 1: Music The same year that he opened his institute, Abraham 200 00:12:08,330 --> 00:12:12,010 Speaker 1: also published another book about education. This time, it was 201 00:12:12,050 --> 00:12:15,370 Speaker 1: a comparative review of how schools ran in different countries, 202 00:12:15,450 --> 00:12:21,329 Speaker 1: titled Universities, American, English, German. Flexner retired as director at 203 00:12:21,350 --> 00:12:25,429 Speaker 1: the institute in 1939 after an internal conflict in which 204 00:12:25,530 --> 00:12:29,709 Speaker 1: the school was accused of allowing an anti-Semitic climate at Princeton, 205 00:12:30,150 --> 00:12:33,300 Speaker 1: a school that they routinely worked with. They were allowing 206 00:12:33,340 --> 00:12:35,300 Speaker 1: that climate to hinder the work of a lot of 207 00:12:35,320 --> 00:12:39,960 Speaker 1: the professors. As tensions among the scholars and leadership wore on, 208 00:12:40,140 --> 00:12:43,940 Speaker 1: Flexner retired in the autumn of 1939. Although he was 209 00:12:43,980 --> 00:12:47,230 Speaker 1: in his 70s, he stayed very busy after leaving the Institute, 210 00:12:47,610 --> 00:12:52,130 Speaker 1: consulting on various projects and writing several books, including his autobiography. 211 00:12:52,670 --> 00:12:56,530 Speaker 1: During and after World War II, several of Abraham's siblings died. 212 00:12:57,160 --> 00:12:59,760 Speaker 1: By the end of the 1940s, only Abraham and his 213 00:12:59,800 --> 00:13:03,240 Speaker 1: sister Gertrude were still living out of the nine Flexner siblings. 214 00:13:04,120 --> 00:13:06,930 Speaker 1: At the same time, his wife Anne had gradually developed 215 00:13:06,970 --> 00:13:11,730 Speaker 1: vascular dementia. In 1947, Anne had declined so seriously that 216 00:13:11,770 --> 00:13:15,150 Speaker 1: she was taken to a Rhode Island sanitarium. Their two 217 00:13:15,190 --> 00:13:18,110 Speaker 1: daughters frequently visited her, and they updated their father, but 218 00:13:18,210 --> 00:13:21,750 Speaker 1: Abraham never saw Anne again. He had not coped with 219 00:13:21,790 --> 00:13:23,890 Speaker 1: her illness well and could not bear to have the 220 00:13:23,910 --> 00:13:26,689 Speaker 1: person that he had been so close to no longer 221 00:13:26,770 --> 00:13:30,070 Speaker 1: recognize him. He later told friends that he had actually 222 00:13:30,110 --> 00:13:33,469 Speaker 1: had a breakdown during this time. As he recovered from 223 00:13:33,510 --> 00:13:36,390 Speaker 1: this significant change in his life, Flexner moved to a 224 00:13:36,450 --> 00:13:39,670 Speaker 1: hotel near Central Park and enrolled in classes at Columbia. 225 00:13:39,690 --> 00:13:44,900 Speaker 1: He opted for classes in literature and history. In 1951, 226 00:13:44,900 --> 00:13:48,060 Speaker 1: the New York Times read an article about the 85-year-old Flexner, 227 00:13:48,420 --> 00:13:52,599 Speaker 1: educational reformer, taking classes alongside co-eds a quarter his age. 228 00:13:53,170 --> 00:13:56,850 Speaker 1: Anne died shortly before Abraham's 90th birthday, which once again 229 00:13:57,050 --> 00:13:59,850 Speaker 1: sent him into a dark period. And as he was 230 00:13:59,890 --> 00:14:02,970 Speaker 1: slowly returning to his old self, his daughter Jean convinced 231 00:14:02,990 --> 00:14:05,650 Speaker 1: him to leave New York and move to Falls Church, Virginia, 232 00:14:05,690 --> 00:14:07,630 Speaker 1: which is where she lived, so that he could be 233 00:14:07,670 --> 00:14:10,689 Speaker 1: near her. And he spent two years there enjoying a 234 00:14:10,730 --> 00:14:14,510 Speaker 1: very active social life and visiting the museums of nearby Washington, D.C. 235 00:14:14,590 --> 00:14:19,730 Speaker 1: regularly before his death on September 21, 1959. So moving 236 00:14:19,870 --> 00:14:22,630 Speaker 1: on to his report about medical schools, as we mentioned, 237 00:14:23,140 --> 00:14:27,560 Speaker 1: Flexner covered 155 schools in his 1910 report, and in 238 00:14:27,640 --> 00:14:30,720 Speaker 1: researching that report, he had visited each school and written 239 00:14:30,800 --> 00:14:36,540 Speaker 1: detailed and comprehensive notes about their entrance requirements, faculty funding, laboratories, 240 00:14:37,020 --> 00:14:40,960 Speaker 1: and connections with affiliated hospitals. In the five decades before 241 00:14:41,000 --> 00:14:45,080 Speaker 1: his research, massive advances in science and medicine had been made, 242 00:14:45,220 --> 00:14:48,480 Speaker 1: but because there was no comprehensive guidance for how medical 243 00:14:48,520 --> 00:14:52,500 Speaker 1: schools operated, a lot of them were still teaching out-of-date information. 244 00:14:53,050 --> 00:14:57,380 Speaker 1: basically telling future doctors stuff that wasn't believed to be 245 00:14:57,400 --> 00:15:00,840 Speaker 1: true anymore. This was in large part because the faculty 246 00:15:00,900 --> 00:15:04,520 Speaker 1: at many medical schools consisted largely of practicing physicians who 247 00:15:04,560 --> 00:15:08,530 Speaker 1: were teaching exactly as they had been taught without updating 248 00:15:08,570 --> 00:15:13,870 Speaker 1: that information with the changing times. Bacteriology, diagnostic developments, and 249 00:15:13,920 --> 00:15:17,770 Speaker 1: surgical techniques were all rapidly changing fields. And if a 250 00:15:17,830 --> 00:15:20,670 Speaker 1: school wasn't keeping up, the doctors they trained were in 251 00:15:20,690 --> 00:15:24,050 Speaker 1: danger of offering their patients poor or outdated care at 252 00:15:24,130 --> 00:15:28,750 Speaker 1: best and endangering their lives at worst. To compound that problem, 253 00:15:28,790 --> 00:15:31,310 Speaker 1: there were a lot of new medical schools opening with 254 00:15:31,590 --> 00:15:36,870 Speaker 1: totally varied standards for entry. When Flexner published his study, 74% 255 00:15:36,870 --> 00:15:40,720 Speaker 1: of the medical schools that were open required only a 256 00:15:40,800 --> 00:15:44,950 Speaker 1: high school education for admission. Some were willing to accept 257 00:15:45,000 --> 00:15:48,090 Speaker 1: high school equivalency certificates, which meant that there was really 258 00:15:48,150 --> 00:15:51,730 Speaker 1: no clear standard. Only a fifth of the schools required 259 00:15:51,810 --> 00:15:54,810 Speaker 1: two or more years of college prior to entry. Many 260 00:15:54,830 --> 00:16:00,710 Speaker 1: were essentially profit-driven businesses. Abraham Flexner was also very frank 261 00:16:00,750 --> 00:16:03,650 Speaker 1: in his report about how little the public really knew 262 00:16:03,730 --> 00:16:06,930 Speaker 1: about the workings of any given medical school. He wrote 263 00:16:06,990 --> 00:16:11,430 Speaker 1: in the introduction, quote, Educational institutions, particularly those which are 264 00:16:11,470 --> 00:16:15,250 Speaker 1: connected with a college or a university, are peculiarly sensitive 265 00:16:15,330 --> 00:16:19,150 Speaker 1: to outside criticism, and particularly to any statement of the 266 00:16:19,210 --> 00:16:22,760 Speaker 1: circumstances of their own conduct or equipment which seems to 267 00:16:22,800 --> 00:16:27,580 Speaker 1: them unfavorable in comparison with that of other institutions. As 268 00:16:27,640 --> 00:16:30,820 Speaker 1: a rule, the only knowledge which the public has concerning 269 00:16:30,900 --> 00:16:34,160 Speaker 1: an institution of learning is derived from the statements given 270 00:16:34,260 --> 00:16:38,360 Speaker 1: out by the institution itself. information which, even under the 271 00:16:38,400 --> 00:16:42,320 Speaker 1: best circumstances, is colored by local hopes, ambitions, and points 272 00:16:42,380 --> 00:16:45,700 Speaker 1: of view. Flexner felt that this work was vital and 273 00:16:45,740 --> 00:16:48,510 Speaker 1: important to be doing, writing that the information in it 274 00:16:48,570 --> 00:16:52,010 Speaker 1: was of importance not just to medical practitioners, but to, quote, 275 00:16:52,030 --> 00:16:54,050 Speaker 1: Abraham Flexner, building on standards that were already in place 276 00:16:54,110 --> 00:17:03,360 Speaker 1: in Germany. established standards of evaluation for the medical schools 277 00:17:03,390 --> 00:17:06,940 Speaker 1: in his study and then judged each one against those criteria. 278 00:17:07,520 --> 00:17:09,119 Speaker 1: And we should note that he was not the first 279 00:17:09,200 --> 00:17:12,060 Speaker 1: person to do this in the United States. The Association 280 00:17:12,119 --> 00:17:15,740 Speaker 1: of American Medical Colleges, founded in 1876 and consisting of 281 00:17:15,740 --> 00:17:20,369 Speaker 1: 22 member schools, had agreed on curriculum standards to provide 282 00:17:20,609 --> 00:17:24,730 Speaker 1: uniformity in medical education that had happened after an assessment 283 00:17:24,790 --> 00:17:28,760 Speaker 1: of the state of medical education. The AAMC continued to 284 00:17:28,820 --> 00:17:32,000 Speaker 1: grow and re-evaluate in the years between its founding and 285 00:17:32,040 --> 00:17:37,030 Speaker 1: Flexner's report. The American Medical Association had similarly started issuing 286 00:17:37,090 --> 00:17:41,870 Speaker 1: reports on the status of medical education as early as 1848, 287 00:17:41,869 --> 00:17:44,429 Speaker 1: and some of the criteria they used were present in 288 00:17:44,510 --> 00:17:48,710 Speaker 1: Flexner's evaluation system as well, but neither of these had 289 00:17:48,910 --> 00:17:53,080 Speaker 1: oversight over all medical schools. It was an opt-in on 290 00:17:53,100 --> 00:17:56,450 Speaker 1: a set of standards. All of Flexner's work was aimed 291 00:17:56,490 --> 00:18:00,130 Speaker 1: at determining, in his opinion, whether a school was able 292 00:18:00,230 --> 00:18:04,300 Speaker 1: to effectively teach its students modern medicine. The model that 293 00:18:04,340 --> 00:18:07,120 Speaker 1: he drew up for what this looked like included admittance 294 00:18:07,160 --> 00:18:12,619 Speaker 1: requirements of college-level biology, chemistry, and physics courses, a curriculum 295 00:18:12,660 --> 00:18:17,070 Speaker 1: with both lecture and lab teaching of anatomy, pathology, bacteriology, 296 00:18:17,119 --> 00:18:21,850 Speaker 1: and pharmacology, among other courses, access to teaching hospitals for 297 00:18:21,910 --> 00:18:27,170 Speaker 1: hands-on experience. Salaried faculty who were exclusively working in teaching 298 00:18:27,210 --> 00:18:30,909 Speaker 1: and research, not practicing doctors who just taught on the side. 299 00:18:31,470 --> 00:18:34,560 Speaker 1: Flexner laid out his findings state by state and school 300 00:18:34,580 --> 00:18:37,800 Speaker 1: by school. He was detailed, calling out if he had 301 00:18:37,840 --> 00:18:41,840 Speaker 1: found dirty labs or lax standards. He criticized the way 302 00:18:41,880 --> 00:18:45,160 Speaker 1: the days were scheduled at schools and how exhausted students 303 00:18:45,180 --> 00:18:48,930 Speaker 1: were often sitting through hours of dull lectures by part-time faculty. 304 00:18:49,730 --> 00:18:52,800 Speaker 1: Because he was an outsider, an education reformer, rather than 305 00:18:52,820 --> 00:18:55,960 Speaker 1: a member of the medical community, his assessment was without 306 00:18:56,020 --> 00:18:59,540 Speaker 1: preconception and it was brutally honest, offering the general public 307 00:18:59,619 --> 00:19:02,080 Speaker 1: a startling look at the way people who cared for 308 00:19:02,100 --> 00:19:06,379 Speaker 1: their health were being educated. Flexner advocated for state licensing 309 00:19:06,420 --> 00:19:09,670 Speaker 1: boards to take a more assertive role in modernizing medicine 310 00:19:10,030 --> 00:19:13,170 Speaker 1: by refusing to license graduates from schools that were not 311 00:19:13,250 --> 00:19:16,149 Speaker 1: up to standards. And he believed that a lot of 312 00:19:16,190 --> 00:19:19,379 Speaker 1: schools were not up to standards. In the end, he 313 00:19:19,440 --> 00:19:23,750 Speaker 1: recommended that 120 of the 155 he reviewed for the 314 00:19:23,810 --> 00:19:27,510 Speaker 1: report should be closed. That recommendation was based on his 315 00:19:27,570 --> 00:19:30,070 Speaker 1: assessments that their standards were very poor and that they 316 00:19:30,109 --> 00:19:33,629 Speaker 1: were not keeping up scientifically, and thus were creating poorly 317 00:19:33,710 --> 00:19:37,399 Speaker 1: educated doctors who lacked up-to-date knowledge in their field, which 318 00:19:37,440 --> 00:19:40,619 Speaker 1: was something he saw as a completely obvious danger to 319 00:19:40,660 --> 00:19:44,560 Speaker 1: public health. Canadian schools, we should mention, fared much better 320 00:19:44,600 --> 00:19:48,190 Speaker 1: than their U.S. counterparts overall. Only one school there made 321 00:19:48,230 --> 00:19:51,730 Speaker 1: Flexner's list of closing recommendations It was not closed, though 322 00:19:51,780 --> 00:19:54,760 Speaker 1: they did have a little bit of a review of 323 00:19:54,800 --> 00:19:57,120 Speaker 1: their curriculum and their standards and changed up a little. 324 00:19:57,800 --> 00:20:00,480 Speaker 1: Many of the schools in the U.S. that he recommended 325 00:20:00,680 --> 00:20:04,040 Speaker 1: be closed did close. Within a decade, there were only 326 00:20:04,200 --> 00:20:07,080 Speaker 1: half as many medical schools as there had been when 327 00:20:07,140 --> 00:20:11,350 Speaker 1: Flexner's report was published. Those that had remained had reformed 328 00:20:11,410 --> 00:20:14,149 Speaker 1: their standards and their courses, and their lab work and 329 00:20:14,190 --> 00:20:18,470 Speaker 1: clinical teaching had been significantly changed, and in most cases modernized. 330 00:20:19,070 --> 00:20:21,950 Speaker 1: For all of the change that was catalyzed by the report, 331 00:20:22,010 --> 00:20:25,780 Speaker 1: Flexner became famous as an educational reformer. We're going to 332 00:20:25,840 --> 00:20:29,060 Speaker 1: pause here before we dig into the ramifications of Flexner's 333 00:20:29,080 --> 00:20:33,360 Speaker 1: work for Black medical schools specifically. So here, in the meantime, 334 00:20:33,740 --> 00:20:35,520 Speaker 1: are some of the sponsors that keep Stuff You Missed 335 00:20:35,540 --> 00:20:46,810 Speaker 1: in History class going. Before we talk about the effects 336 00:20:46,930 --> 00:20:49,629 Speaker 1: of the Flexner Report on the Black population in the U.S. 337 00:20:49,830 --> 00:20:52,129 Speaker 1: and its medical schools, we should give a brief sense 338 00:20:52,590 --> 00:20:56,180 Speaker 1: of what was going on in that space prior to 1910. 339 00:20:56,180 --> 00:20:58,320 Speaker 1: The first Black man in the U.S. to receive a 340 00:20:58,340 --> 00:21:01,840 Speaker 1: medical degree was David J. Peck. He received a degree 341 00:21:01,920 --> 00:21:05,920 Speaker 1: from Rush Medical School in Chicago in 1847. As a note, 342 00:21:05,980 --> 00:21:08,840 Speaker 1: he was not the first Black doctor in the U.S. 343 00:21:08,960 --> 00:21:13,810 Speaker 1: That's usually cited as formerly enslaved James Durham, who was 344 00:21:13,850 --> 00:21:18,389 Speaker 1: born in 1762 and learned medicine through an apprenticeship. In 345 00:21:18,430 --> 00:21:21,840 Speaker 1: the 13 years after Peck's graduation, there were a handful 346 00:21:21,910 --> 00:21:25,080 Speaker 1: of other Black med students who graduated with degrees in 347 00:21:25,119 --> 00:21:28,860 Speaker 1: the U.S., Nine medical schools had established that they would 348 00:21:28,900 --> 00:21:32,899 Speaker 1: admit Black students by 1860, including the Medical School of 349 00:21:32,960 --> 00:21:37,840 Speaker 1: Harvard University, Bowdoin Medical School in Maine, and the Medical 350 00:21:37,880 --> 00:21:41,510 Speaker 1: School of the University of New York. In the late 1860s, 351 00:21:41,540 --> 00:21:44,369 Speaker 1: the first medical school for Black students opened. That was 352 00:21:44,440 --> 00:21:47,930 Speaker 1: Howard University Medical School in Washington, D.C., and it opened 353 00:21:47,970 --> 00:21:53,110 Speaker 1: in 1868. Eight years later, Meharry Medical College opened in Nashville, Tennessee. 354 00:21:54,040 --> 00:21:58,280 Speaker 1: From 1876 to 1904, another six Black medical schools opened, 355 00:21:58,420 --> 00:22:01,820 Speaker 1: including Leonard Medical School, which became Shaw University in Raleigh, 356 00:22:01,859 --> 00:22:07,590 Speaker 1: North Carolina, New Orleans University Medical College, Knoxville College Medical Department, 357 00:22:07,670 --> 00:22:12,189 Speaker 1: that became Knoxville Medical College, Chattanooga National Medical College, and 358 00:22:12,330 --> 00:22:16,530 Speaker 1: University of West Tennessee College of Physicians and Surgeons. The 359 00:22:16,590 --> 00:22:20,010 Speaker 1: schools listed there are ones that were open when Flexner 360 00:22:20,070 --> 00:22:23,000 Speaker 1: compiled the report. there had been others that had folded 361 00:22:23,100 --> 00:22:28,030 Speaker 1: before the 1908 research started. That included Lincoln University in Oxford, Pennsylvania, 362 00:22:28,270 --> 00:22:31,050 Speaker 1: which had opened in 1870 and closed four years later. 363 00:22:31,890 --> 00:22:36,310 Speaker 1: Strait University Medical Department was established in New Orleans in 1873, 364 00:22:36,310 --> 00:22:41,660 Speaker 1: but was disbanded in 1874. Hannibal Medical College of Memphis, Tennessee, 365 00:22:41,900 --> 00:22:46,359 Speaker 1: had opened in 1889, but closed in 1896. Louisville State's 366 00:22:46,440 --> 00:22:51,970 Speaker 1: University Medical Department ran from 1899 to 1903 and Chattanooga 367 00:22:52,010 --> 00:22:56,750 Speaker 1: National Medical College closed in 1904 after five years in operation. 368 00:22:57,250 --> 00:23:00,550 Speaker 1: The Medical Society of the District of Columbia was founded 369 00:23:00,590 --> 00:23:05,700 Speaker 1: in 1817. That society was for whites only. The American 370 00:23:05,740 --> 00:23:09,620 Speaker 1: Medical Association was founded in 1847, and though Black doctors 371 00:23:09,720 --> 00:23:12,899 Speaker 1: applied to become members, for years they were denied entry. 372 00:23:12,920 --> 00:23:14,910 Speaker 1: We're going to come back to the AMA in just 373 00:23:14,950 --> 00:23:19,020 Speaker 1: a bit. The Medico-Chirurgical Society was founded as a Black 374 00:23:19,060 --> 00:23:23,320 Speaker 1: medical society in 1884 because of the impossibility that Black 375 00:23:23,340 --> 00:23:27,659 Speaker 1: doctors faced gaining admittance to those established groups. The National 376 00:23:27,700 --> 00:23:31,340 Speaker 1: Medical Association was founded in 1895 for Black doctors for 377 00:23:31,380 --> 00:23:35,250 Speaker 1: the same reason. It was not until the 1950s that 378 00:23:35,290 --> 00:23:39,170 Speaker 1: Black doctors had gained admittance to medical societies in most states. 379 00:23:39,630 --> 00:23:42,950 Speaker 1: In the midst of this clear division and racism, the 380 00:23:43,010 --> 00:23:47,780 Speaker 1: Flexner Report was released. Flexner had often been lauded for 381 00:23:47,820 --> 00:23:50,920 Speaker 1: his role as a reformer, and as we've discussed, reform 382 00:23:50,940 --> 00:23:54,400 Speaker 1: did need to happen. He was obviously blunt and often 383 00:23:54,480 --> 00:23:57,940 Speaker 1: scathing in his critiques of individual schools. And the schools 384 00:23:58,000 --> 00:24:00,780 Speaker 1: for Black med students were no different. In his report, 385 00:24:00,820 --> 00:24:03,560 Speaker 1: he wrote, quote, of the seven medical schools for Negroes 386 00:24:03,619 --> 00:24:05,760 Speaker 1: in the United States, five are at this moment in 387 00:24:05,820 --> 00:24:09,379 Speaker 1: no position to make any contribution of value. While he 388 00:24:09,460 --> 00:24:13,390 Speaker 1: praised both Howard and Meharry as worth developing, the rest 389 00:24:13,430 --> 00:24:17,340 Speaker 1: were deemed basically useless. This assessment did not take into 390 00:24:17,400 --> 00:24:20,220 Speaker 1: account the fact that Black medical schools charged much lower 391 00:24:20,260 --> 00:24:24,120 Speaker 1: tuition than white schools, had fewer endowments, and were operating 392 00:24:24,180 --> 00:24:28,040 Speaker 1: on much narrower margins. In his assessment, he wrote, quote, 393 00:24:28,580 --> 00:24:32,219 Speaker 1: The Negro needs good schools rather than many schools. He 394 00:24:32,280 --> 00:24:35,050 Speaker 1: went on to elaborate that it was important for Black 395 00:24:35,090 --> 00:24:39,230 Speaker 1: doctors to be well-educated. He understood that Black doctors would 396 00:24:39,290 --> 00:24:41,810 Speaker 1: see to the health of the Black population, and since 397 00:24:41,850 --> 00:24:44,650 Speaker 1: the Black population was a part of the larger whole... 398 00:24:44,810 --> 00:24:48,580 Speaker 1: Their care was important. But the language that Flexner used 399 00:24:48,619 --> 00:24:50,780 Speaker 1: throughout this section where he talked about all of this 400 00:24:50,900 --> 00:24:54,800 Speaker 1: is a very mixed bag. He simultaneously speaks of the 401 00:24:54,859 --> 00:24:58,320 Speaker 1: rights and contributions of Black people, but also asserts that 402 00:24:58,340 --> 00:25:00,580 Speaker 1: it is best if Black doctors take care of their 403 00:25:00,700 --> 00:25:03,939 Speaker 1: own people and offers the teaching of hygiene as one 404 00:25:03,960 --> 00:25:06,830 Speaker 1: of the most important duties of Black doctors and nurses 405 00:25:07,330 --> 00:25:11,670 Speaker 1: rather than life-saving skills, which is just inherently racist. Every 406 00:25:11,710 --> 00:25:15,820 Speaker 1: Black medical college that Flexner called out as subpar closed. 407 00:25:16,340 --> 00:25:19,220 Speaker 1: The first four had shut their doors by 1914. A 408 00:25:19,560 --> 00:25:23,460 Speaker 1: fifth closed in 1915. The last from the last list, 409 00:25:23,520 --> 00:25:26,640 Speaker 1: the Medical Department of the University of West Tennessee, lasted 410 00:25:26,880 --> 00:25:32,250 Speaker 1: until 1923. Howard and Meharry remained, and they still do. 411 00:25:32,890 --> 00:25:35,649 Speaker 1: The Charles R. Drew Medical School in Los Angeles was 412 00:25:35,670 --> 00:25:38,530 Speaker 1: the next predominantly Black medical school to open. That didn't 413 00:25:38,550 --> 00:25:42,660 Speaker 1: happen until 1966. Listen to our episodes on Brown v. Board. Like, 414 00:25:43,119 --> 00:25:46,310 Speaker 1: that seems late in the creation of a medical school. 415 00:25:48,470 --> 00:25:51,649 Speaker 1: But that school was founded, like, specifically to respond to 416 00:25:52,650 --> 00:25:56,030 Speaker 1: medical access needs within the Black community. The next was 417 00:25:56,330 --> 00:25:59,949 Speaker 1: Morehouse School of Medicine in Atlanta in 1975. So the 418 00:25:59,990 --> 00:26:03,470 Speaker 1: narrowing of options for prospective Black doctors left a huge 419 00:26:03,590 --> 00:26:07,510 Speaker 1: care gap for the Black community. Many potential physicians were 420 00:26:07,550 --> 00:26:11,550 Speaker 1: excluded from educational opportunities due to location, which meant that 421 00:26:11,570 --> 00:26:13,860 Speaker 1: the care of Black patients was often doled out by 422 00:26:13,950 --> 00:26:17,380 Speaker 1: white doctors who, even in the best of circumstances, met 423 00:26:17,420 --> 00:26:20,739 Speaker 1: their duties with inherent racial bias. And as we have 424 00:26:20,780 --> 00:26:24,420 Speaker 1: discussed on the show before, there were definite racist abuses 425 00:26:24,480 --> 00:26:27,140 Speaker 1: of power in the medical system, and this has had 426 00:26:27,320 --> 00:26:31,990 Speaker 1: far-reaching and ongoing consequences. A panel was assembled by the 427 00:26:32,030 --> 00:26:36,899 Speaker 1: American Medical Association's Institute for Ethics in 2005. to examine 428 00:26:36,940 --> 00:26:40,240 Speaker 1: the history of racism in the medical profession. One of 429 00:26:40,280 --> 00:26:44,070 Speaker 1: their findings was that the Carnegie Foundation's project, for which 430 00:26:44,109 --> 00:26:47,590 Speaker 1: they hired Flexner, that had been sponsored by the AMA 431 00:26:47,650 --> 00:26:51,010 Speaker 1: as well, although that hadn't been disclosed at the time. 432 00:26:51,690 --> 00:26:55,109 Speaker 1: Flexner's line of good schools rather than many schools had 433 00:26:55,150 --> 00:26:58,859 Speaker 1: ensured that medicine stayed segregated and that communities who needed 434 00:26:58,920 --> 00:27:02,280 Speaker 1: doctors the most were just left without them. Yeah, there 435 00:27:02,340 --> 00:27:06,340 Speaker 1: are some question marks that continue about whether or not 436 00:27:06,680 --> 00:27:09,540 Speaker 1: someone associated with the AMA was actually with him on 437 00:27:09,600 --> 00:27:13,490 Speaker 1: some of those school visits. And at some points in history, 438 00:27:14,170 --> 00:27:16,010 Speaker 1: he said that that person was with him. And then 439 00:27:16,050 --> 00:27:17,530 Speaker 1: later on, he was like, no, no, no, no, no. 440 00:27:17,570 --> 00:27:20,090 Speaker 1: Like they met me there. Like it it shifted. So 441 00:27:20,109 --> 00:27:22,990 Speaker 1: we don't really know if there was even more hands 442 00:27:23,080 --> 00:27:25,420 Speaker 1: on direction of that report in that regard or not. 443 00:27:25,980 --> 00:27:28,940 Speaker 1: A lecture on the now-defunct black med schools by Dr. 444 00:27:29,040 --> 00:27:32,440 Speaker 1: Earl H. Harley of Washington, D.C., was published in the 445 00:27:32,480 --> 00:27:35,600 Speaker 1: Journal of the National Medical Association in September of 2006. 446 00:27:35,600 --> 00:27:39,740 Speaker 1: And in it, Dr. Harley summarized how black medical schools, 447 00:27:39,790 --> 00:27:42,609 Speaker 1: which have always been smaller, with a higher percentage of 448 00:27:42,650 --> 00:27:46,750 Speaker 1: graduates going into medicine for underserved communities, have continued to 449 00:27:46,790 --> 00:27:50,250 Speaker 1: face obstacles in the centuries since Flexner's report, writing, quote, 450 00:27:50,750 --> 00:27:53,609 Speaker 1: one of the greatest challenges of today's black medical schools 451 00:27:53,770 --> 00:27:57,270 Speaker 1: is economics. Black medical schools find it difficult to compete 452 00:27:57,330 --> 00:28:01,130 Speaker 1: with well-funded majority universities with a longstanding commitment to train 453 00:28:01,190 --> 00:28:05,310 Speaker 1: African Americans, such as the University of Michigan. The result 454 00:28:05,390 --> 00:28:09,430 Speaker 1: may be the siphoning of well-qualified, highly competitive African American 455 00:28:09,510 --> 00:28:13,820 Speaker 1: students who choose, quote, rich schools for pragmatic economic reasons. 456 00:28:14,540 --> 00:28:17,980 Speaker 1: This places an extra burden on today's Black medical schools 457 00:28:18,119 --> 00:28:21,200 Speaker 1: of appealing to a higher social calling as they seek 458 00:28:21,240 --> 00:28:24,810 Speaker 1: to fulfill their historic missions. While they search for greater 459 00:28:24,869 --> 00:28:28,670 Speaker 1: endowments to become more attractive, they must continue to position 460 00:28:28,710 --> 00:28:31,440 Speaker 1: themselves as the training grounds for those who will serve 461 00:28:31,500 --> 00:28:34,940 Speaker 1: the underserved. So this brings up a natural question. Did 462 00:28:35,580 --> 00:28:40,340 Speaker 1: Flexner realize the disproportionate impact of his report on Black 463 00:28:40,400 --> 00:28:43,920 Speaker 1: med students and doctors and patients? He spoke at length 464 00:28:44,000 --> 00:28:47,140 Speaker 1: about race throughout his life, but what were his intentions 465 00:28:47,160 --> 00:28:50,250 Speaker 1: with this 1910 report? And I mean, apart from his intentions, 466 00:28:51,050 --> 00:28:53,600 Speaker 1: the effects that we just mentioned. Yeah, but we don't 467 00:28:53,620 --> 00:28:56,580 Speaker 1: know what his mindset was. And there are different schools 468 00:28:56,640 --> 00:28:58,240 Speaker 1: of thought on it. You can talk to a lot 469 00:28:58,280 --> 00:29:00,320 Speaker 1: of people and they will give you completely different answers 470 00:29:00,380 --> 00:29:04,140 Speaker 1: for whether or not they thought that there was racism 471 00:29:04,160 --> 00:29:07,170 Speaker 1: in the mix or if Flexner really understood this. He 472 00:29:07,210 --> 00:29:10,230 Speaker 1: did know that he was limiting the scope of Black medicine. 473 00:29:10,310 --> 00:29:13,150 Speaker 1: He said so in his report, although it is part 474 00:29:13,190 --> 00:29:17,030 Speaker 1: of a rather idealist passage that reads, quote, the upbuilding 475 00:29:17,150 --> 00:29:19,910 Speaker 1: of Howard and Meharry will profit the nation much more 476 00:29:20,310 --> 00:29:23,230 Speaker 1: than the inadequate maintenance of a larger number of schools. 477 00:29:23,940 --> 00:29:26,940 Speaker 1: They are, of course, unequal to the need and opportunity, 478 00:29:27,460 --> 00:29:30,060 Speaker 1: but nothing will be gained by satisfying the need or 479 00:29:30,140 --> 00:29:33,120 Speaker 1: of rising to the opportunity through the survival of feeble, 480 00:29:33,590 --> 00:29:38,390 Speaker 1: ill-equipped institutions, quite regardless of the spirit which animates the promoters. 481 00:29:39,130 --> 00:29:42,310 Speaker 1: In 1933, Flexner wrote a letter to the trustees of 482 00:29:42,350 --> 00:29:47,470 Speaker 1: his Institute for Advanced Studies in which he advocated against discrimination. Quote, 483 00:29:47,930 --> 00:29:50,930 Speaker 1: It is fundamental in our purpose and our expressed desire 484 00:29:51,020 --> 00:29:53,520 Speaker 1: that in the appointments to the staff and faculty, as 485 00:29:53,560 --> 00:29:56,680 Speaker 1: well as in the admission of workers and students, no 486 00:29:56,740 --> 00:30:00,900 Speaker 1: account shall be taken of directly or indirectly, of race, religion, 487 00:30:01,080 --> 00:30:04,600 Speaker 1: or sex. We feel strongly that the spirit characteristic of 488 00:30:04,660 --> 00:30:08,070 Speaker 1: America at its noblest, above all the pursuit of higher learning, 489 00:30:08,420 --> 00:30:11,990 Speaker 1: cannot admit of any conditions as to personnel other than 490 00:30:12,030 --> 00:30:15,390 Speaker 1: those designated to promote the objects for which this institution 491 00:30:15,450 --> 00:30:19,860 Speaker 1: is established, and particularly with no regard, whatever, to accidents 492 00:30:19,900 --> 00:30:23,280 Speaker 1: of race, creed, or sex. It appears that Flexner's progressive 493 00:30:23,360 --> 00:30:27,620 Speaker 1: ideas about equality, particularly in relation to race, probably came 494 00:30:27,660 --> 00:30:31,420 Speaker 1: from his childhood in Louisville. One biographer who is very 495 00:30:31,460 --> 00:30:34,320 Speaker 1: sympathetic to Flexner, Thomas Neville Bonner, made the case in 496 00:30:34,380 --> 00:30:37,380 Speaker 1: his book about Flexner that when Abraham was growing up 497 00:30:37,440 --> 00:30:40,420 Speaker 1: in Louisville, Kentucky, it was a time when, while there 498 00:30:40,510 --> 00:30:44,630 Speaker 1: was certainly nothing akin to equality, there were more services 499 00:30:44,690 --> 00:30:47,170 Speaker 1: and opportunities for the city's Black community than in a 500 00:30:47,210 --> 00:30:50,130 Speaker 1: lot of other places. There were a dozen schools for 501 00:30:50,170 --> 00:30:53,590 Speaker 1: Black students there when Abraham was growing up, and professional 502 00:30:53,650 --> 00:30:56,729 Speaker 1: training schools in teaching medicine and law were available there. 503 00:30:57,560 --> 00:31:00,050 Speaker 1: to Black residents, and the Flexners, who were not wealthy, 504 00:31:00,240 --> 00:31:03,190 Speaker 1: lived in a neighborhood where they had Black neighbors. Abraham 505 00:31:03,250 --> 00:31:05,310 Speaker 1: noted later in his life that he and his siblings 506 00:31:05,830 --> 00:31:08,810 Speaker 1: often played with the Black children in their neighborhood. This 507 00:31:08,850 --> 00:31:12,210 Speaker 1: experience may have left Abraham Flexner a little idealistic about 508 00:31:12,250 --> 00:31:14,610 Speaker 1: the realities of life for the Black families that he 509 00:31:14,650 --> 00:31:17,890 Speaker 1: knew and socialized with. To him, it seemed obvious that 510 00:31:17,950 --> 00:31:19,710 Speaker 1: any of the kids he played with could grow up 511 00:31:19,730 --> 00:31:21,710 Speaker 1: to do the same kinds of jobs that he and 512 00:31:21,750 --> 00:31:24,360 Speaker 1: his siblings could do. But it seems that he didn't 513 00:31:24,480 --> 00:31:26,270 Speaker 1: really come to terms with the fact that there were 514 00:31:26,330 --> 00:31:29,370 Speaker 1: plenty of other people who didn't see things this way. 515 00:31:29,390 --> 00:31:32,870 Speaker 1: He acknowledged during his lifetime that he didn't realize that 516 00:31:32,910 --> 00:31:35,100 Speaker 1: the Black students he had known growing up were so 517 00:31:35,300 --> 00:31:38,380 Speaker 1: deeply disadvantaged until later in his life when he was 518 00:31:38,500 --> 00:31:43,910 Speaker 1: researching and analyzing educational institutions. After his retirement from the Institute, 519 00:31:43,990 --> 00:31:46,950 Speaker 1: both before and after World War II, Flexner was pretty 520 00:31:47,010 --> 00:31:50,790 Speaker 1: outspoken against prejudice. He made a radio broadcast in which 521 00:31:50,850 --> 00:31:54,390 Speaker 1: he stated his disappointment that democracy hadn't brought more equality 522 00:31:54,470 --> 00:31:57,980 Speaker 1: to the relationship between races. After the war, he spoke 523 00:31:58,020 --> 00:32:00,720 Speaker 1: about how far behind England the U.S. was in terms 524 00:32:00,760 --> 00:32:04,600 Speaker 1: of both religious and racial prejudice. But his feelings about 525 00:32:04,660 --> 00:32:10,890 Speaker 1: prejudice are complicated. I'll also say that... That's an interesting 526 00:32:10,950 --> 00:32:13,140 Speaker 1: note about England and the U S in terms of 527 00:32:13,300 --> 00:32:18,300 Speaker 1: religious and racial prejudice. I feel like Flexner always compared 528 00:32:18,340 --> 00:32:21,240 Speaker 1: the U S to European countries he had visited. And 529 00:32:21,280 --> 00:32:23,719 Speaker 1: he always found the U S lacking by comparison, but 530 00:32:23,780 --> 00:32:28,060 Speaker 1: some of that is definitely a rose colored glasses situation. Yeah. Yeah. Um, 531 00:32:28,900 --> 00:32:31,790 Speaker 1: I don't, I don't know when he made that statement. Um, 532 00:32:32,200 --> 00:32:34,630 Speaker 1: but something that's going to come up in an episode 533 00:32:34,650 --> 00:32:38,960 Speaker 1: we're going to record shortly is like about racism, uh, 534 00:32:39,380 --> 00:32:42,470 Speaker 1: and England specifically. Anyway, back to the subject at hand. 535 00:32:44,130 --> 00:32:47,390 Speaker 1: His feelings about prejudice are complicated. Although he had been 536 00:32:47,410 --> 00:32:50,510 Speaker 1: raised by devout Jewish parents, Abraham and his siblings all 537 00:32:50,530 --> 00:32:53,150 Speaker 1: drifted away from the Jewish faith, and they considered themselves 538 00:32:53,210 --> 00:32:58,150 Speaker 1: secular Jews. When he encountered antisemitism, he tended to presume 539 00:32:58,210 --> 00:33:01,380 Speaker 1: the person involved was ignorant instead of malicious, and he 540 00:33:01,410 --> 00:33:03,120 Speaker 1: just brushed it off and went on with his life. 541 00:33:04,050 --> 00:33:05,830 Speaker 1: But he was in a position to be able to 542 00:33:05,910 --> 00:33:10,030 Speaker 1: do that. Antisemitism doesn't seem to have materially impacted his 543 00:33:10,110 --> 00:33:12,610 Speaker 1: career or his life. Yeah, this is definitely one of 544 00:33:12,650 --> 00:33:17,830 Speaker 1: those cases where I think he doesn't realize that he was, 545 00:33:17,870 --> 00:33:19,950 Speaker 1: you know, enjoying a certain degree of privilege and being 546 00:33:19,990 --> 00:33:21,910 Speaker 1: able to be like, oh, you don't like me? Okay. 547 00:33:22,610 --> 00:33:24,870 Speaker 1: I still have plenty of opportunities, which is not how 548 00:33:24,930 --> 00:33:28,690 Speaker 1: it works for everybody. The true depth of racism against 549 00:33:28,730 --> 00:33:31,510 Speaker 1: the Black community was clearly a blind spot in his work, 550 00:33:31,610 --> 00:33:34,830 Speaker 1: and that left a lasting legacy on both Black physicians 551 00:33:34,910 --> 00:33:38,070 Speaker 1: and patients that is still felt. He just thought that 552 00:33:38,130 --> 00:33:40,890 Speaker 1: medical schools and other institutions of higher learning should be 553 00:33:40,930 --> 00:33:44,400 Speaker 1: admitting students regardless of their sex, color, or religion. But 554 00:33:44,420 --> 00:33:46,740 Speaker 1: he didn't seem to recognize that there was a whole 555 00:33:46,800 --> 00:33:48,940 Speaker 1: world of obstacles that had to be addressed to get 556 00:33:48,980 --> 00:33:51,480 Speaker 1: to the point where students who weren't white or weren't 557 00:33:51,520 --> 00:33:54,090 Speaker 1: male could even be applying to medical school, let alone 558 00:33:54,160 --> 00:33:59,310 Speaker 1: get through the admission process. And in a way, It 559 00:33:59,370 --> 00:34:01,430 Speaker 1: struck me while I was researching this that his own 560 00:34:01,570 --> 00:34:04,590 Speaker 1: idealism put him in this situation not dissimilar to the 561 00:34:04,630 --> 00:34:08,160 Speaker 1: scientists that he once wrote about who accidentally advanced the 562 00:34:08,200 --> 00:34:12,140 Speaker 1: technologies of warfare. In his work for school reform, the 563 00:34:12,260 --> 00:34:16,120 Speaker 1: already disadvantaged black schools simply could not keep pace with 564 00:34:16,160 --> 00:34:19,440 Speaker 1: standards that required money and resources they simply didn't have. 565 00:34:19,989 --> 00:34:23,489 Speaker 1: and white schools were still not often admitting Black medical students. 566 00:34:23,930 --> 00:34:28,230 Speaker 1: The debate over Flexner's intentions continues among medical historians, and 567 00:34:28,290 --> 00:34:30,610 Speaker 1: if you start digging, you'll find people who think of 568 00:34:30,660 --> 00:34:35,120 Speaker 1: him as everything from a benevolent paternalist, we've talked about 569 00:34:35,140 --> 00:34:37,780 Speaker 1: a lot of those on the show, to inherently racist. 570 00:34:38,420 --> 00:34:41,440 Speaker 1: We've talked about a lot of those, too. And this 571 00:34:41,540 --> 00:34:44,360 Speaker 1: latter part is due to the discussion of hygiene as 572 00:34:44,420 --> 00:34:48,060 Speaker 1: a primary focus for Black physicians. There are examples of 573 00:34:48,140 --> 00:34:52,000 Speaker 1: leaders from both Meharry and Howard using similar language regarding 574 00:34:52,020 --> 00:34:54,480 Speaker 1: the need for hygiene instruction as an important part of 575 00:34:54,520 --> 00:34:58,540 Speaker 1: the service of Black doctors. They predate Flexner's report by 576 00:34:58,560 --> 00:35:01,680 Speaker 1: a couple of years. And this is, on its surface, 577 00:35:01,800 --> 00:35:05,049 Speaker 1: inherently racist. Those leaders who also said that that was 578 00:35:05,070 --> 00:35:08,430 Speaker 1: an important part of a Black doctor's training were also white. 579 00:35:09,210 --> 00:35:11,910 Speaker 1: But it also suggests that Flexner's statements were echoes of 580 00:35:11,950 --> 00:35:15,590 Speaker 1: the school's stated missions rather than standalone judgments that he made. 581 00:35:16,239 --> 00:35:19,900 Speaker 1: And there is also an interesting possibility, as discussed in 582 00:35:19,940 --> 00:35:22,410 Speaker 1: a 2011 article in the Journal of the History of 583 00:35:22,469 --> 00:35:26,290 Speaker 1: Medicine and Allied Sciences by Lynn E. Miller and Richard M. Weiss, 584 00:35:26,810 --> 00:35:29,370 Speaker 1: that this language was actually part of carving out a 585 00:35:29,450 --> 00:35:32,830 Speaker 1: public health role for the physicians from these schools in 586 00:35:32,870 --> 00:35:36,529 Speaker 1: an effort to garner support for the schools across racial divides. 587 00:35:37,480 --> 00:35:40,320 Speaker 1: In the statements from Meharry and Howard in 1907 and 588 00:35:40,320 --> 00:35:44,219 Speaker 1: 1908 that we're talking about, those sentiments of hygiene being 589 00:35:44,260 --> 00:35:48,090 Speaker 1: the highest need are followed by mentions of how obvious 590 00:35:48,250 --> 00:35:51,930 Speaker 1: it is thus that these institutions should be supported. And 591 00:35:51,950 --> 00:35:54,490 Speaker 1: there are some indicators that a number of medical schools, 592 00:35:54,730 --> 00:35:58,360 Speaker 1: black and white, were already in an economic tailspin before 593 00:35:58,440 --> 00:36:01,819 Speaker 1: Flexner's report was released. Some of that was because there 594 00:36:01,860 --> 00:36:04,380 Speaker 1: were already efforts to try to meet the guidelines that 595 00:36:04,400 --> 00:36:07,120 Speaker 1: had been issued by the AMA, and the financial burdens 596 00:36:07,180 --> 00:36:09,259 Speaker 1: of doing that just proved to be too much to 597 00:36:09,300 --> 00:36:13,259 Speaker 1: allow for sustainability. While the discussion of Flexner's intentions and 598 00:36:13,280 --> 00:36:17,450 Speaker 1: the real ramifications of his work continues, the AMA, following 599 00:36:17,489 --> 00:36:20,270 Speaker 1: the findings of their ethics council, did issue a public 600 00:36:20,330 --> 00:36:24,170 Speaker 1: apology in 2008, quote, for its past history of racial 601 00:36:24,230 --> 00:36:28,719 Speaker 1: inequality toward African-American physicians. and shares its current effort to 602 00:36:28,760 --> 00:36:32,000 Speaker 1: increase the ranks of minority physicians and their participation in 603 00:36:32,040 --> 00:36:36,060 Speaker 1: the AMA. The organization also announced a number of programs 604 00:36:36,180 --> 00:36:40,080 Speaker 1: aimed at encouraging minorities to pursue careers in medicine. This 605 00:36:40,160 --> 00:36:42,720 Speaker 1: is one of those cases where we're still untangling all 606 00:36:42,739 --> 00:36:45,709 Speaker 1: the tendrils of all these influences on the medical field. 607 00:36:46,250 --> 00:36:49,149 Speaker 1: That will probably continue for years to come. I wanted 608 00:36:49,190 --> 00:36:52,850 Speaker 1: to close with another quote from Flexner's usefulness of useless knowledge. 609 00:36:53,650 --> 00:36:56,350 Speaker 1: I personally remain in a state of conflict about the 610 00:36:56,370 --> 00:36:59,300 Speaker 1: man and his work. It's like I want to support 611 00:36:59,360 --> 00:37:02,239 Speaker 1: an idealist who wants to make things better, but not 612 00:37:02,260 --> 00:37:04,420 Speaker 1: when that idealism blinds you so much that you end 613 00:37:04,480 --> 00:37:07,970 Speaker 1: up hurting people. But when I came across this passage 614 00:37:07,989 --> 00:37:10,430 Speaker 1: while I was researching, it really hit me in its 615 00:37:10,489 --> 00:37:14,160 Speaker 1: pertinence to our world today. And he wrote, quote, The 616 00:37:14,219 --> 00:37:17,140 Speaker 1: justified outcry of those who through no fault of their 617 00:37:17,219 --> 00:37:20,219 Speaker 1: own are deprived of opportunity and a fair share of 618 00:37:20,280 --> 00:37:24,239 Speaker 1: worldly goods, therefore diverts an increasing number of students from 619 00:37:24,280 --> 00:37:27,780 Speaker 1: the studies which their fathers pursued to the equally important 620 00:37:27,920 --> 00:37:32,299 Speaker 1: and no less urgent study of social, economic, and governmental problems. 621 00:37:32,980 --> 00:37:36,020 Speaker 1: I have no quarrel with this tendency. The world in 622 00:37:36,060 --> 00:37:38,319 Speaker 1: which we live is the only world about which our 623 00:37:38,360 --> 00:37:41,620 Speaker 1: senses can testify. Unless it is made a better world, 624 00:37:41,760 --> 00:37:44,730 Speaker 1: a fairer world, millions will continue to go to their 625 00:37:44,750 --> 00:37:51,310 Speaker 1: graves silent, saddened, and embittered. That is the complicated Flexner report. Yeah. 626 00:37:54,570 --> 00:37:57,510 Speaker 1: I think it's worth knowing that, like, there's a question 627 00:37:57,550 --> 00:38:00,850 Speaker 1: sometimes where it seems like people are kind of asking, 628 00:38:01,890 --> 00:38:05,810 Speaker 1: was he racist or was he operating from best intentions? 629 00:38:06,700 --> 00:38:09,859 Speaker 1: It can be both. Yeah, if he was operating from 630 00:38:09,980 --> 00:38:13,569 Speaker 1: his best intentions, like, still racist, though. Like, it's impossible 631 00:38:14,850 --> 00:38:19,509 Speaker 1: to grow up in a position of privilege in a 632 00:38:19,610 --> 00:38:23,140 Speaker 1: racist society that is threaded all through with many layers 633 00:38:23,200 --> 00:38:26,799 Speaker 1: of racist, of racism, and, like, to not be racist. Like, 634 00:38:26,840 --> 00:38:30,120 Speaker 1: it is a lifelong effort to undo all of those 635 00:38:30,160 --> 00:38:33,799 Speaker 1: thinking patterns, no matter how well-intended you are. Yeah, I mean, 636 00:38:34,040 --> 00:38:37,170 Speaker 1: it's one of those things when you read his writing, 637 00:38:37,230 --> 00:38:40,629 Speaker 1: he so clearly believes that, like, If we just shut 638 00:38:40,650 --> 00:38:43,270 Speaker 1: down all the bad black medical schools, these two good 639 00:38:43,450 --> 00:38:45,790 Speaker 1: ones are going to be so good that then we 640 00:38:45,830 --> 00:38:48,009 Speaker 1: can expand from there and everything will be great. And 641 00:38:48,070 --> 00:38:54,090 Speaker 1: it's like he's missing so much of the puzzle that like, again, 642 00:38:54,610 --> 00:39:01,500 Speaker 1: in an ideal world. Sure. But like, yeah, he's he's complicated. 643 00:39:01,520 --> 00:39:09,520 Speaker 1: I have complicated feelings about him. Thanks so much for 644 00:39:09,560 --> 00:39:12,370 Speaker 1: joining us on this Saturday. If you'd like to send 645 00:39:12,410 --> 00:39:17,010 Speaker 1: us a note, our email address is historypodcast at iheartradio.com. 646 00:39:17,710 --> 00:39:20,450 Speaker 1: And you can subscribe to the show on the iHeartRadio app, 647 00:39:20,640 --> 00:39:23,720 Speaker 1: Apple Podcasts, or wherever you listen to your favorite shows.