SYMHC Classics: Flexner Report

This 2020 episode covers the Flexner Report, which is often credited with changing the medical field and shaping what medical education looks like today. But this document negatively impacted medicine in the Black community. 

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Episode Transcript

Speaker 1 (00:02):
Happy Saturday. One of our upcoming episodes talks about someone
who went to medical school at a time when medical
education in the U.S. could be all over the place.
So today's Saturday Classic is about that and about a
report that was part of a shift toward medical schools
that were more standardized and comprehensive. That was the Flexner Report,

(00:23):
and our episode on it and its author originally came
out on July 8th, 2020. Welcome to Stuff You Missed
in History Class, a production of iHeartRadio. Hello and welcome
to the podcast. I'm Holly Frey. And I'm Tracy V. Wilson. Tracy,

(00:47):
one of the topics that's come up a couple of
times for me in recent weeks as I've just been
doing my own reading related to racial injustice is the
Flexner Report. And this was a report that was issued
in the early 20th century. It is often credited with
changing the medical field and shaping what medical education looks today.
I also found one article that said it's the most
overrated document in medical history, which made me laugh a bit. Oh, goodness.

(01:10):
But there are also aspects of this document that really
need to be discussed in terms of how they impacted
the Black community. So we're going to talk about this
one in three parts. First, we're going to talk about
Abraham Flexner, for whom the report is named. and who
made the report. And then we're going to talk about
the general impact of the Flexner Report on medicine. And finally,
we will talk about how this affected Black medical schools specifically.

(01:33):
And it is a lot to unpack, and I hope
we manage to do it justice. As with anything related
to any of these topics, a person's biography, the history
of any given field, and the history of how things
impact racial injustice, there are always more nuances than we
could ever pack into an episode. But We're hoping we
hit all of the prominent and pertinent points. Yeah, if

(01:56):
you listen to the podcast Sawbones, they did an episode,
which I guess at this point will be a few
weeks ago, that was about racism in medicine. And it
alludes to this without going into much detail about it.
So if you listen to our show and that show,
these are sort of... They'll complement one another. They do.
They do. We didn't plan that. It just happened. So

(02:20):
this starts with Abraham Flexner, and Abraham Flexner was born
in Louisville, Kentucky on November 13th, 1866. His father, Moritz Flexner,
and his mother, Esther Abraham, were German Jewish immigrants. Moritz
had a hat business, and Esther worked as a seamstress.
The Flexner family was large. Abraham was their sixth child,

(02:42):
and they ultimately had nine. Moritz and Esther were able
to build up their finances and With the plan not
that they would live lavishly, but that every one of
their sons, and there were seven of them, would attend college.
But that plan fell apart when the 1873 panic hit
and they lost their savings. But Abraham did manage to
go to college. He attended Johns Hopkins University, and the

(03:05):
funds came from his brother Jacob. The span and the
ages of the Flexner children meant that Jacob was already
established by the time Abraham graduated from high school— And
the money he was making as a drugstore owner was
put toward Abraham's tuition. Yeah, they definitely always prioritized education
as where they put their money. Abraham earned his B.A.

(03:28):
in 1886, and his hope had been to go into
a postgraduate program. But there was not enough money for that.
And though he did try to secure a fellowship, none materialized.
So he went home to Louisville to start his career.
For the next four years, Flexner worked as a high
school teacher. heading up the Latin and Greek classes at
Louisville High School. But during that time, he was developing

(03:50):
another idea because he thought there was a better way
to structure education. And that idea manifested as an experimental school,
and Flexner founded that school in 1890. That school was
simply called Mr. Flexner School, and it was incredibly progressive.
The structure probably seemed like no structure at all to
traditional educators. Flexner did away with the idea of a

(04:12):
set curriculum. Students did not have exams and they did
not receive grades. The vision that Flexner had for this
school was custom-tailored education to prepare students for higher learning.
And a lot of his students got into very good schools,
so this was a very successful model. The Flexner family
continued to value education and help one another in that regard.

(04:34):
One of the personal benefits for Abraham Flexner in creating
his school was that he could enroll his brother Simon
there and get him into Johns Hopkins. He was also
able to pay for Simon's tuition. Abraham also helped his
sister Mary. He paid her way at Bryn Mawr. This
marks an expansion of the family's plan to not only
educate the men of the family, but also the women.

(04:57):
And education for women was something that Abraham supported throughout
his life. One of the former pupils in Flexner's preparatory school,
a young woman named Anne Crawford, also became an important
part of Abraham's life. After graduating, Anne had become a teacher.
She had attended Vassar, and when she finished those studies,
she started working there at the school. And she also

(05:17):
had started to pursue a career as a playwright. Abraham
and Anne fell in love, and they were married in 1898.
And they eventually had two daughters, Jean and Eleanor. In 1904,
Anne adapted the novel Mrs. Wiggs of the Cabbage Patch,
which is a comedic story about an impoverished Southern family,
into a Broadway play. Mrs. Wiggs ran from September 3rd,

(05:39):
1904 through January 1905 at the Savoy Theater, and it
was a success. The income from Anne's work on the
show made it possible for Abraham to enroll at Harvard
to get his master's degree in psychology. He closed his
school to do that, He also spent a year in
Germany as part of his studies, again bankrolled through his
wife's success in the theater. That time spent in Germany

(06:02):
made Flexner deeply aware of what he saw as the
failings of the education system back home. And as a result,
in 1908, he researched and wrote an assessment of higher
education in the United States titled... The American College, A Criticism.
Based on his work examining colleges and identifying what he
saw as the problems at the single school level, as

(06:25):
well as systematically, Flexner was commissioned by the Carnegie Foundation
for a new project. He was asked by the president
of the Carnegie Foundation for the Advancement of Teaching, that
was Henry Smith Pritchett, to apply that same critical and
analytical eye to the medical institutions, specifically in the United
States and Canada. There were 155 medical schools in his survey. Yeah,

(06:50):
he took two years to basically travel around and visit
all these schools and do his assessment. And then in 1910,
Flexner completed his report, which was titled Medical Education in
the United States and Canada. And when this report came out,
it had a massive impact on medical education in North America.
A lot of the schools that Flexner had found lacking

(07:10):
closed as a consequence of its publication. Others were completely
overhauled and essentially rebuilt from the ground up. And we're
going to talk more about all of that in just
a moment. Following the medical school report, Flexner produced a
report at the behest of the Rockefeller Foundation examining the
sex work field in Europe and how it was regulated.

(07:31):
It was the first of many varied reports that Flexner
would compile for the foundation. But though he had moved
on to other projects like that, Flexner did not just
drop his medical report and then move on with his life.
He actually dedicated himself to improving medical education specifically. In 1913,
following his report on European sex work, Flexner became the

(07:53):
secretary to the Rockefeller Foundation's General Education Board. During this
time in his role, he worked on a number of
other research and reporting projects, as we mentioned, but he
also made sure that money from private donors was allocated
to medical education institutions. and improving some of the problems
he had discovered while working on his 1910 report. In 1921,

(08:15):
Abraham Flexner wrote a memo for the Rockefeller Foundation's board,
which was titled The Usefulness of Useless Knowledge. And this
memo evolved, and it became a lecture, and then 18
years after he initially wrote it, it was published in
Harper's Magazine. And that piece of writing opens with the
following paragraph. Quote, Is it not a curious fact that

(08:36):
in a world steeped in irrational hatreds which threaten civilization itself,
men and women, old and young, detach themselves wholly or
partly from the angry current of daily life to devote
themselves to the cultivation of beauty, to the extension of knowledge,
to the cure of disease, to the amelioration of suffering,
just as though fanatics were not simultaneously engaged in spreading pain, ugliness,

(09:01):
and suffering? The world has always been a sorry and
confused sort of place, yet poets and artists and scientists
have ignored the factors that would, if attended to, paralyze them.
From a practical point of view, intellectual and spiritual life is,
on the surface, a useless form of activity, in which
men indulge because they procure for themselves greater satisfactions than

(09:24):
are otherwise obtainable. In this paper, I shall concern myself
with the question of the extent to which the pursuit
of these useless satisfactions proves unexpectedly the source from which
undreamed-of utility is derived. One of the things that Flexner
touches on in this writing is the unintentional outcomes of
pursuits that were of pure intent. He specifically mentions how

(09:47):
the advancement of the cruelty of warfare was fueled by
scientists who were often working they thought for the betterment
of mankind. As the 1920s wore on, Abraham Flexner found
himself at odds. with other members of the education board
at the Rockefeller Foundation. And this led to him ultimately
being pushed out of the organization in 1928. In 1929,

(10:10):
Abraham Flexner was approached by philanthropist siblings Lewis and Caroline Bamberger,
The Bambergers thought they could use their wealth to establish
a new medical school in Newark, New Jersey, and they
wanted Flexner as an advisor on the project. But Flexner
pointed out that Newark had neither a teaching hospital nor
a top-notch university, both of which were vital to the

(10:32):
success of a medical school. And Abraham Flexner was really
thinking of a different sort of project, and he was
able to convince the Bambergers that they should instead invest
in his idea. And they did, with a gift of
$ 5 million. Flexner envisioned what he would later call an
educational utopia that offered the greatest minds a place where

(10:53):
they could be driven entirely by their curiosity. And so
in 1930, Flexner founded the Institute for Advanced Study in Princeton,
New Jersey, and served as director there until 1939. Its
mission stated, quote, The institute is pledged to assemble a
group of scientists and scholars who, with their pupils and assistants,

(11:13):
may devote themselves to the task of pushing beyond the
present limits of human knowledge and to training those who
may carry on in this sense. Flexner was able to
attract some of the biggest names to his institute, including
Albert Einstein, who joined in 1933. In the years since
its founding, the institute has had, as members or as faculty,
34 Nobel laureates, 42 Fields Medalists, and 18 Able Prize Laureates.

(11:40):
In addition to Einstein, notable names on that list include
Robert Oppenheimer and previous podcast subject John von Neumann. We're
going to cover the end of Flexner's life and the
impact of his work on medical education, but we're due
for a quick break to have a word from our sponsors.
Music The same year that he opened his institute, Abraham

(12:08):
also published another book about education. This time, it was
a comparative review of how schools ran in different countries,
titled Universities, American, English, German. Flexner retired as director at
the institute in 1939 after an internal conflict in which
the school was accused of allowing an anti-Semitic climate at Princeton,

(12:30):
a school that they routinely worked with. They were allowing
that climate to hinder the work of a lot of
the professors. As tensions among the scholars and leadership wore on,
Flexner retired in the autumn of 1939. Although he was
in his 70s, he stayed very busy after leaving the Institute,
consulting on various projects and writing several books, including his autobiography.

(12:52):
During and after World War II, several of Abraham's siblings died.
By the end of the 1940s, only Abraham and his
sister Gertrude were still living out of the nine Flexner siblings.
At the same time, his wife Anne had gradually developed
vascular dementia. In 1947, Anne had declined so seriously that
she was taken to a Rhode Island sanitarium. Their two

(13:15):
daughters frequently visited her, and they updated their father, but
Abraham never saw Anne again. He had not coped with
her illness well and could not bear to have the
person that he had been so close to no longer
recognize him. He later told friends that he had actually
had a breakdown during this time. As he recovered from
this significant change in his life, Flexner moved to a

(13:36):
hotel near Central Park and enrolled in classes at Columbia.
He opted for classes in literature and history. In 1951,
the New York Times read an article about the 85-year-old Flexner,
educational reformer, taking classes alongside co-eds a quarter his age.
Anne died shortly before Abraham's 90th birthday, which once again

(13:57):
sent him into a dark period. And as he was
slowly returning to his old self, his daughter Jean convinced
him to leave New York and move to Falls Church, Virginia,
which is where she lived, so that he could be
near her. And he spent two years there enjoying a
very active social life and visiting the museums of nearby Washington, D.C.
regularly before his death on September 21, 1959. So moving

(14:19):
on to his report about medical schools, as we mentioned,
Flexner covered 155 schools in his 1910 report, and in
researching that report, he had visited each school and written
detailed and comprehensive notes about their entrance requirements, faculty funding, laboratories,
and connections with affiliated hospitals. In the five decades before

(14:41):
his research, massive advances in science and medicine had been made,
but because there was no comprehensive guidance for how medical
schools operated, a lot of them were still teaching out-of-date information.
basically telling future doctors stuff that wasn't believed to be
true anymore. This was in large part because the faculty
at many medical schools consisted largely of practicing physicians who

(15:04):
were teaching exactly as they had been taught without updating
that information with the changing times. Bacteriology, diagnostic developments, and
surgical techniques were all rapidly changing fields. And if a
school wasn't keeping up, the doctors they trained were in
danger of offering their patients poor or outdated care at
best and endangering their lives at worst. To compound that problem,

(15:28):
there were a lot of new medical schools opening with
totally varied standards for entry. When Flexner published his study, 74%
of the medical schools that were open required only a
high school education for admission. Some were willing to accept
high school equivalency certificates, which meant that there was really
no clear standard. Only a fifth of the schools required

(15:51):
two or more years of college prior to entry. Many
were essentially profit-driven businesses. Abraham Flexner was also very frank
in his report about how little the public really knew
about the workings of any given medical school. He wrote
in the introduction, quote, Educational institutions, particularly those which are
connected with a college or a university, are peculiarly sensitive

(16:15):
to outside criticism, and particularly to any statement of the
circumstances of their own conduct or equipment which seems to
them unfavorable in comparison with that of other institutions. As
a rule, the only knowledge which the public has concerning
an institution of learning is derived from the statements given
out by the institution itself. information which, even under the

(16:38):
best circumstances, is colored by local hopes, ambitions, and points
of view. Flexner felt that this work was vital and
important to be doing, writing that the information in it
was of importance not just to medical practitioners, but to, quote,
Abraham Flexner, building on standards that were already in place
in Germany. established standards of evaluation for the medical schools

(17:03):
in his study and then judged each one against those criteria.
And we should note that he was not the first
person to do this in the United States. The Association
of American Medical Colleges, founded in 1876 and consisting of
22 member schools, had agreed on curriculum standards to provide
uniformity in medical education that had happened after an assessment

(17:24):
of the state of medical education. The AAMC continued to
grow and re-evaluate in the years between its founding and
Flexner's report. The American Medical Association had similarly started issuing
reports on the status of medical education as early as 1848,
and some of the criteria they used were present in
Flexner's evaluation system as well, but neither of these had

(17:48):
oversight over all medical schools. It was an opt-in on
a set of standards. All of Flexner's work was aimed
at determining, in his opinion, whether a school was able
to effectively teach its students modern medicine. The model that
he drew up for what this looked like included admittance
requirements of college-level biology, chemistry, and physics courses, a curriculum

(18:12):
with both lecture and lab teaching of anatomy, pathology, bacteriology,
and pharmacology, among other courses, access to teaching hospitals for
hands-on experience. Salaried faculty who were exclusively working in teaching
and research, not practicing doctors who just taught on the side.
Flexner laid out his findings state by state and school

(18:34):
by school. He was detailed, calling out if he had
found dirty labs or lax standards. He criticized the way
the days were scheduled at schools and how exhausted students
were often sitting through hours of dull lectures by part-time faculty.
Because he was an outsider, an education reformer, rather than
a member of the medical community, his assessment was without

(18:56):
preconception and it was brutally honest, offering the general public
a startling look at the way people who cared for
their health were being educated. Flexner advocated for state licensing
boards to take a more assertive role in modernizing medicine
by refusing to license graduates from schools that were not
up to standards. And he believed that a lot of

(19:16):
schools were not up to standards. In the end, he
recommended that 120 of the 155 he reviewed for the
report should be closed. That recommendation was based on his
assessments that their standards were very poor and that they
were not keeping up scientifically, and thus were creating poorly
educated doctors who lacked up-to-date knowledge in their field, which

(19:37):
was something he saw as a completely obvious danger to
public health. Canadian schools, we should mention, fared much better
than their U.S. counterparts overall. Only one school there made
Flexner's list of closing recommendations It was not closed, though
they did have a little bit of a review of
their curriculum and their standards and changed up a little.

(19:57):
Many of the schools in the U.S. that he recommended
be closed did close. Within a decade, there were only
half as many medical schools as there had been when
Flexner's report was published. Those that had remained had reformed
their standards and their courses, and their lab work and
clinical teaching had been significantly changed, and in most cases modernized.

(20:19):
For all of the change that was catalyzed by the report,
Flexner became famous as an educational reformer. We're going to
pause here before we dig into the ramifications of Flexner's
work for Black medical schools specifically. So here, in the meantime,
are some of the sponsors that keep Stuff You Missed
in History class going. Before we talk about the effects

(20:46):
of the Flexner Report on the Black population in the U.S.
and its medical schools, we should give a brief sense
of what was going on in that space prior to 1910.
The first Black man in the U.S. to receive a
medical degree was David J. Peck. He received a degree
from Rush Medical School in Chicago in 1847. As a note,
he was not the first Black doctor in the U.S.

(21:08):
That's usually cited as formerly enslaved James Durham, who was
born in 1762 and learned medicine through an apprenticeship. In
the 13 years after Peck's graduation, there were a handful
of other Black med students who graduated with degrees in
the U.S., Nine medical schools had established that they would
admit Black students by 1860, including the Medical School of

(21:32):
Harvard University, Bowdoin Medical School in Maine, and the Medical
School of the University of New York. In the late 1860s,
the first medical school for Black students opened. That was
Howard University Medical School in Washington, D.C., and it opened
in 1868. Eight years later, Meharry Medical College opened in Nashville, Tennessee.

(21:54):
From 1876 to 1904, another six Black medical schools opened,
including Leonard Medical School, which became Shaw University in Raleigh,
North Carolina, New Orleans University Medical College, Knoxville College Medical Department,
that became Knoxville Medical College, Chattanooga National Medical College, and
University of West Tennessee College of Physicians and Surgeons. The

(22:16):
schools listed there are ones that were open when Flexner
compiled the report. there had been others that had folded
before the 1908 research started. That included Lincoln University in Oxford, Pennsylvania,
which had opened in 1870 and closed four years later.
Strait University Medical Department was established in New Orleans in 1873,
but was disbanded in 1874. Hannibal Medical College of Memphis, Tennessee,

(22:41):
had opened in 1889, but closed in 1896. Louisville State's
University Medical Department ran from 1899 to 1903 and Chattanooga
National Medical College closed in 1904 after five years in operation.
The Medical Society of the District of Columbia was founded
in 1817. That society was for whites only. The American

(23:05):
Medical Association was founded in 1847, and though Black doctors
applied to become members, for years they were denied entry.
We're going to come back to the AMA in just
a bit. The Medico-Chirurgical Society was founded as a Black
medical society in 1884 because of the impossibility that Black
doctors faced gaining admittance to those established groups. The National

(23:27):
Medical Association was founded in 1895 for Black doctors for
the same reason. It was not until the 1950s that
Black doctors had gained admittance to medical societies in most states.
In the midst of this clear division and racism, the
Flexner Report was released. Flexner had often been lauded for

(23:47):
his role as a reformer, and as we've discussed, reform
did need to happen. He was obviously blunt and often
scathing in his critiques of individual schools. And the schools
for Black med students were no different. In his report,
he wrote, quote, of the seven medical schools for Negroes
in the United States, five are at this moment in
no position to make any contribution of value. While he

(24:09):
praised both Howard and Meharry as worth developing, the rest
were deemed basically useless. This assessment did not take into
account the fact that Black medical schools charged much lower
tuition than white schools, had fewer endowments, and were operating
on much narrower margins. In his assessment, he wrote, quote,
The Negro needs good schools rather than many schools. He

(24:32):
went on to elaborate that it was important for Black
doctors to be well-educated. He understood that Black doctors would
see to the health of the Black population, and since
the Black population was a part of the larger whole...
Their care was important. But the language that Flexner used
throughout this section where he talked about all of this
is a very mixed bag. He simultaneously speaks of the

(24:54):
rights and contributions of Black people, but also asserts that
it is best if Black doctors take care of their
own people and offers the teaching of hygiene as one
of the most important duties of Black doctors and nurses
rather than life-saving skills, which is just inherently racist. Every
Black medical college that Flexner called out as subpar closed.

(25:16):
The first four had shut their doors by 1914. A
fifth closed in 1915. The last from the last list,
the Medical Department of the University of West Tennessee, lasted
until 1923. Howard and Meharry remained, and they still do.
The Charles R. Drew Medical School in Los Angeles was
the next predominantly Black medical school to open. That didn't

(25:38):
happen until 1966. Listen to our episodes on Brown v. Board. Like,
that seems late in the creation of a medical school.
But that school was founded, like, specifically to respond to
medical access needs within the Black community. The next was
Morehouse School of Medicine in Atlanta in 1975. So the

(25:59):
narrowing of options for prospective Black doctors left a huge
care gap for the Black community. Many potential physicians were
excluded from educational opportunities due to location, which meant that
the care of Black patients was often doled out by
white doctors who, even in the best of circumstances, met
their duties with inherent racial bias. And as we have

(26:20):
discussed on the show before, there were definite racist abuses
of power in the medical system, and this has had
far-reaching and ongoing consequences. A panel was assembled by the
American Medical Association's Institute for Ethics in 2005. to examine
the history of racism in the medical profession. One of
their findings was that the Carnegie Foundation's project, for which

(26:44):
they hired Flexner, that had been sponsored by the AMA
as well, although that hadn't been disclosed at the time.
Flexner's line of good schools rather than many schools had
ensured that medicine stayed segregated and that communities who needed
doctors the most were just left without them. Yeah, there
are some question marks that continue about whether or not

(27:06):
someone associated with the AMA was actually with him on
some of those school visits. And at some points in history,
he said that that person was with him. And then
later on, he was like, no, no, no, no, no.
Like they met me there. Like it it shifted. So
we don't really know if there was even more hands
on direction of that report in that regard or not.
A lecture on the now-defunct black med schools by Dr.

(27:29):
Earl H. Harley of Washington, D.C., was published in the
Journal of the National Medical Association in September of 2006.
And in it, Dr. Harley summarized how black medical schools,
which have always been smaller, with a higher percentage of
graduates going into medicine for underserved communities, have continued to
face obstacles in the centuries since Flexner's report, writing, quote,

(27:50):
one of the greatest challenges of today's black medical schools
is economics. Black medical schools find it difficult to compete
with well-funded majority universities with a longstanding commitment to train
African Americans, such as the University of Michigan. The result
may be the siphoning of well-qualified, highly competitive African American
students who choose, quote, rich schools for pragmatic economic reasons.

(28:14):
This places an extra burden on today's Black medical schools
of appealing to a higher social calling as they seek
to fulfill their historic missions. While they search for greater
endowments to become more attractive, they must continue to position
themselves as the training grounds for those who will serve
the underserved. So this brings up a natural question. Did

(28:35):
Flexner realize the disproportionate impact of his report on Black
med students and doctors and patients? He spoke at length
about race throughout his life, but what were his intentions
with this 1910 report? And I mean, apart from his intentions,
the effects that we just mentioned. Yeah, but we don't
know what his mindset was. And there are different schools

(28:56):
of thought on it. You can talk to a lot
of people and they will give you completely different answers
for whether or not they thought that there was racism
in the mix or if Flexner really understood this. He
did know that he was limiting the scope of Black medicine.
He said so in his report, although it is part
of a rather idealist passage that reads, quote, the upbuilding

(29:17):
of Howard and Meharry will profit the nation much more
than the inadequate maintenance of a larger number of schools.
They are, of course, unequal to the need and opportunity,
but nothing will be gained by satisfying the need or
of rising to the opportunity through the survival of feeble,
ill-equipped institutions, quite regardless of the spirit which animates the promoters.

(29:39):
In 1933, Flexner wrote a letter to the trustees of
his Institute for Advanced Studies in which he advocated against discrimination. Quote,
It is fundamental in our purpose and our expressed desire
that in the appointments to the staff and faculty, as
well as in the admission of workers and students, no
account shall be taken of directly or indirectly, of race, religion,

(30:01):
or sex. We feel strongly that the spirit characteristic of
America at its noblest, above all the pursuit of higher learning,
cannot admit of any conditions as to personnel other than
those designated to promote the objects for which this institution
is established, and particularly with no regard, whatever, to accidents
of race, creed, or sex. It appears that Flexner's progressive

(30:23):
ideas about equality, particularly in relation to race, probably came
from his childhood in Louisville. One biographer who is very
sympathetic to Flexner, Thomas Neville Bonner, made the case in
his book about Flexner that when Abraham was growing up
in Louisville, Kentucky, it was a time when, while there
was certainly nothing akin to equality, there were more services

(30:44):
and opportunities for the city's Black community than in a
lot of other places. There were a dozen schools for
Black students there when Abraham was growing up, and professional
training schools in teaching medicine and law were available there.
to Black residents, and the Flexners, who were not wealthy,
lived in a neighborhood where they had Black neighbors. Abraham
noted later in his life that he and his siblings

(31:05):
often played with the Black children in their neighborhood. This
experience may have left Abraham Flexner a little idealistic about
the realities of life for the Black families that he
knew and socialized with. To him, it seemed obvious that
any of the kids he played with could grow up
to do the same kinds of jobs that he and
his siblings could do. But it seems that he didn't
really come to terms with the fact that there were

(31:26):
plenty of other people who didn't see things this way.
He acknowledged during his lifetime that he didn't realize that
the Black students he had known growing up were so
deeply disadvantaged until later in his life when he was
researching and analyzing educational institutions. After his retirement from the Institute,
both before and after World War II, Flexner was pretty

(31:47):
outspoken against prejudice. He made a radio broadcast in which
he stated his disappointment that democracy hadn't brought more equality
to the relationship between races. After the war, he spoke
about how far behind England the U.S. was in terms
of both religious and racial prejudice. But his feelings about
prejudice are complicated. I'll also say that... That's an interesting

(32:10):
note about England and the U S in terms of
religious and racial prejudice. I feel like Flexner always compared
the U S to European countries he had visited. And
he always found the U S lacking by comparison, but
some of that is definitely a rose colored glasses situation. Yeah. Yeah. Um,
I don't, I don't know when he made that statement. Um,

(32:32):
but something that's going to come up in an episode
we're going to record shortly is like about racism, uh,
and England specifically. Anyway, back to the subject at hand.
His feelings about prejudice are complicated. Although he had been
raised by devout Jewish parents, Abraham and his siblings all
drifted away from the Jewish faith, and they considered themselves

(32:53):
secular Jews. When he encountered antisemitism, he tended to presume
the person involved was ignorant instead of malicious, and he
just brushed it off and went on with his life.
But he was in a position to be able to
do that. Antisemitism doesn't seem to have materially impacted his
career or his life. Yeah, this is definitely one of
those cases where I think he doesn't realize that he was,

(33:17):
you know, enjoying a certain degree of privilege and being
able to be like, oh, you don't like me? Okay.
I still have plenty of opportunities, which is not how
it works for everybody. The true depth of racism against
the Black community was clearly a blind spot in his work,
and that left a lasting legacy on both Black physicians
and patients that is still felt. He just thought that

(33:38):
medical schools and other institutions of higher learning should be
admitting students regardless of their sex, color, or religion. But
he didn't seem to recognize that there was a whole
world of obstacles that had to be addressed to get
to the point where students who weren't white or weren't
male could even be applying to medical school, let alone
get through the admission process. And in a way, It

(33:59):
struck me while I was researching this that his own
idealism put him in this situation not dissimilar to the
scientists that he once wrote about who accidentally advanced the
technologies of warfare. In his work for school reform, the
already disadvantaged black schools simply could not keep pace with
standards that required money and resources they simply didn't have.

(34:19):
and white schools were still not often admitting Black medical students.
The debate over Flexner's intentions continues among medical historians, and
if you start digging, you'll find people who think of
him as everything from a benevolent paternalist, we've talked about
a lot of those on the show, to inherently racist.
We've talked about a lot of those, too. And this

(34:41):
latter part is due to the discussion of hygiene as
a primary focus for Black physicians. There are examples of
leaders from both Meharry and Howard using similar language regarding
the need for hygiene instruction as an important part of
the service of Black doctors. They predate Flexner's report by
a couple of years. And this is, on its surface,

(35:01):
inherently racist. Those leaders who also said that that was
an important part of a Black doctor's training were also white.
But it also suggests that Flexner's statements were echoes of
the school's stated missions rather than standalone judgments that he made.
And there is also an interesting possibility, as discussed in
a 2011 article in the Journal of the History of

(35:22):
Medicine and Allied Sciences by Lynn E. Miller and Richard M. Weiss,
that this language was actually part of carving out a
public health role for the physicians from these schools in
an effort to garner support for the schools across racial divides.
In the statements from Meharry and Howard in 1907 and
1908 that we're talking about, those sentiments of hygiene being

(35:44):
the highest need are followed by mentions of how obvious
it is thus that these institutions should be supported. And
there are some indicators that a number of medical schools,
black and white, were already in an economic tailspin before
Flexner's report was released. Some of that was because there
were already efforts to try to meet the guidelines that

(36:04):
had been issued by the AMA, and the financial burdens
of doing that just proved to be too much to
allow for sustainability. While the discussion of Flexner's intentions and
the real ramifications of his work continues, the AMA, following
the findings of their ethics council, did issue a public
apology in 2008, quote, for its past history of racial
inequality toward African-American physicians. and shares its current effort to

(36:28):
increase the ranks of minority physicians and their participation in
the AMA. The organization also announced a number of programs
aimed at encouraging minorities to pursue careers in medicine. This
is one of those cases where we're still untangling all
the tendrils of all these influences on the medical field.
That will probably continue for years to come. I wanted

(36:49):
to close with another quote from Flexner's usefulness of useless knowledge.
I personally remain in a state of conflict about the
man and his work. It's like I want to support
an idealist who wants to make things better, but not
when that idealism blinds you so much that you end
up hurting people. But when I came across this passage
while I was researching, it really hit me in its

(37:10):
pertinence to our world today. And he wrote, quote, The
justified outcry of those who through no fault of their
own are deprived of opportunity and a fair share of
worldly goods, therefore diverts an increasing number of students from
the studies which their fathers pursued to the equally important
and no less urgent study of social, economic, and governmental problems.

(37:32):
I have no quarrel with this tendency. The world in
which we live is the only world about which our
senses can testify. Unless it is made a better world,
a fairer world, millions will continue to go to their
graves silent, saddened, and embittered. That is the complicated Flexner report. Yeah.

(37:54):
I think it's worth knowing that, like, there's a question
sometimes where it seems like people are kind of asking,
was he racist or was he operating from best intentions?
It can be both. Yeah, if he was operating from
his best intentions, like, still racist, though. Like, it's impossible

(38:14):
to grow up in a position of privilege in a
racist society that is threaded all through with many layers
of racist, of racism, and, like, to not be racist. Like,
it is a lifelong effort to undo all of those
thinking patterns, no matter how well-intended you are. Yeah, I mean,
it's one of those things when you read his writing,

(38:37):
he so clearly believes that, like, If we just shut
down all the bad black medical schools, these two good
ones are going to be so good that then we
can expand from there and everything will be great. And
it's like he's missing so much of the puzzle that like, again,
in an ideal world. Sure. But like, yeah, he's he's complicated.

(39:01):
I have complicated feelings about him. Thanks so much for
joining us on this Saturday. If you'd like to send
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