This article appears in the August 2011 issue of LouisvilleMagazine. To subscribe, please visit loumag.com.
It was a bright June day on Abraham Flexner Way, the narrow two-block-and-change street that runs through the heart of the downtown medical center and seems like some weird cross between alley and vortex. White-coated residents hurried past. Med students on the way to class talked on their phones. Nurses and orderlies took cigarette breaks. A family from Paducah sat on a wall, waiting while their infant daughter received a blood treatment at Kosair Children’s Hospital.
I was down there to ask these people on the street named after Flexner — one of Louisville’s most accomplished natives, whose family once lived near that very spot — if they knew who he was.
“I need to plead the Fifth on that one,” a young paper salesman said with a laugh.
“They told me he was a doctor,” said an orderly at Jewish Hospital.
A 25-year-old medical student came closest. “I knew that he was an educator — he was very involved with the medical school and helped develop the education curriculum for the medical school. I think he’s national.”
National indeed. The New York Times editorialized upon Flexner’s death in 1959, “No other American of his time has contributed more to the welfare of his country and of humanity in general.”
Flexner was not a doctor, but his 1910 report for the Carnegie Foundation on the country’s system of medical education created a sensation and catalyzed the reforms that gave us the kind of medical schools (and thereby, doctors) we now have. He was a major figure in American philanthropy, fund-raising and directing hundreds of millions of dollars toward worthy causes. (He was so effective at coaxing money from wealthy donors that the New Yorker called its profile of him “Robin Hood, 1930.”) And for a final act, he established and was the first director of the groundbreaking think tank the Institute for Advanced Study in Princeton, N.J.
His life intersected with some of the great figures of the 20th century — as a peer. In 1928, when Flexner visited Oxford to deliver the Rhodes Trust lectures, he found himself at lunch with Chancellor of the Exchequer Winston Churchill. Churchill asked him what he thought ailed England. “It’s governed by amateurs,” Flexner replied, bringing down the house. In 1933, when Flexner was head of the Institute, he declined an invitation for faculty member Albert Einstein to have lunch with President Roosevelt — without ever running it by Einstein, who was furious when he heard. (Flexner wasn’t only being high-handed — he was concerned that public appearances risked the safety of a man who’d become an international symbol of resistance to Hitler.)
Of course, Flexner was the reason why Roosevelt’s request could be made in the first place: He was the one who had brought Einstein to America.
That accomplished life is what the Times obituary was talking about, and why Flexner ranked with Muhammad Ali as one of the only two Louisvillians on Life magazine’s 1990 list of the 100 most influential Americans of the century.
While no one would ever say Flexner floated like a butterfly — his gift was for slugging his way through large amounts of data, like an intellectual Joe Frazier — he moved almost as fast as Ali. He took the job to write the medical-school report in November 1908. By April 1910 he had visited every medical school in the United States and Canada. There were 155. And this should give a sense of how difficult traveling must have been — the first Ford Model T was introduced in October 1908, and dirt and crushed stone were the only road surfaces available.
No question, Flexner could sting like a bee. One reason the 346-page Flexner Report (originally titled Medical Education in the United States and Canada) made such a sensation was the author’s scathing reviews of subpar schools. Imagine fashion’s Mr. Blackwell (of the “Worst-Dressed List”) turning his tongue to something of importance. Flexner could tear into a whole city as if it wore an off-the-rack dress to the Oscars. An example: “The city of Chicago is in respect to medical education the plague spot of the country.”
Flexner’s rise from lower-class Louisville roots “is an example that education is the great democratizing and civilizing influence,” says Edward Halperin, dean of the U of L medical school. Born in 1866, the sixth of nine children of Jewish German immigrants who lost their economic footing in the Panic of 1873, Flexner became a star student at Male High, president of its debating society, and talked his way into an after-school job at the Louisville Library, then a private institution.
The two years he spent there, Flexner wrote in his autobiography, I Remember, were “a highly important period in my intellectual development.” He would do his schoolwork, then read on the job until about 5:30, then again from 6:30 or 7 until closing. But that hour or so that interrupted his reading might have made the greatest impression. A group of local notables came in to read newspapers and magazines such as The Nation and Saturday Review and discuss “politics, literature, religion, and to some extent… music and art.” The library space was small enough that Flexner could follow their conversation.
“From my 15th year I was continuously in contact with mature persons who were my superiors,” Flexner wrote. “I met men and women who would even today be considered very unusual in point of scholarship and culture” — chief among them, refugees from the German revolutions of 1848 who, he believed, gave the city “a cosmopolitan air.” In particular, he mentioned the lawyer Lewis Dembitz and Dembitz’s cousins the Brandeises. (It’s unlikely that future Supreme Court Justice Louis Brandeis would have been among their number — 10 years older than Flexner to the day, by 1881 he was already practicing law in Boston.)
It’s hard not to note that the comparatively small community of Louisville’s German Jews — in 1880 there were 2,500 Jews in the city, according to the Encyclopedia of Louisville — produced a number of people who would make a national impact, including Flexner’s brothers Simon and Bernard, the former as director of the Rockefeller Institute for Medical Research for 34 years and the latter as a leading New York attorney and an original member of the prestigious Council on Foreign Relations.
Lee Shai Weissbach, a professor of history at the University of Louisville who has studied Jewish life in America, says that in the middle of the 19th century Louisville was, for Jews, “a kind of magnet… certainly among the top 10 Jewish communities in the country. It’s not terribly surprising that in a community like this you get some people who emerge to become nationally prominent.”
Halperin calls attention to a practice within the Flexner family itself that gave Abraham his intellectual break. Older brother Jacob, who initially had to forgo a full medical education because of family financial woes and instead became a pharmacist, was able to save enough money from his pharmacy to send Abraham to the recently founded Johns Hopkins University in Baltimore. But it was only enough to pay for two years’ tuition. The young man’s solution was to finish in two years by scheduling two or even three classes at the same hour, then alternating his attendance between them. “Rushing from class to class, he barely had time to catch his breath,” writes Thomas Bonner in Iconoclast: Abraham Flexner and a Life in Learning, the definitive 2002 biography. (Years later, Abraham would reciprocate, paying for Jacob’s graduate medical studies.)
Flexner returned to Louisville and took a position at Male, teaching Greek, Latin, algebra and other subjects. In his second semester, he flunked an entire Greek class — an unprecedented move that made the newspapers. Flexner was called before the school board, which supported him.
He continued at Male for three more years, working on the side as a tutor. But he was growing restless. Then a wealthy lawyer whose son had been expelled from an Eastern prep school asked Flexner if he could prepare the son to be accepted at Princeton. Flexner agreed, if the lawyer could round up enough other students so that Flexner could start a school.
“Mr. Flexner’s School” was, he wrote, “a strange kind of school.”
The school operated without rules, without examinations, without records, and without reports. I relied upon other things: first, enthusiasm; second, cleverness in outwitting students who tried to dodge their responsibilities; third, good humor; and finally, emulation and competition. I pushed those who showed aptitude for a given subject and was patient where no aptitude existed.
And he made a success of the school. By 1905, its last year, there were 100 students. The revenues allowed Flexner to pay for his siblings’ education, as Jacob had for him. (He also employed his sisters Mary and Gertrude.)
Flexner attracted the attention of Charles W. Eliot, the president of Harvard, who noticed, according to Flexner, “that boys from my school were coming to Harvard younger and graduating in a shorter period of time than students from any other school.”
The most significant pupil, however, was the first girl he admitted, Anne Crawford. Three years after graduating from Vassar College in 1895, she became his wife. That didn’t halt her playwriting aspirations, and in 1903 she wrote the stage adaptation of fellow Louisvillian Alice Hegan Rice’s novel Mrs. Wiggs of the Cabbage Patch. It became the most successful play of its time, and brought in considerable royalties.
The money freed the Flexners. Abraham had once more become dissatisfied with his lot. As he recalled it, “I had begun to feel that in a remote town like Louisville and under the limiting conditions of a school preoccupied with admission to college, I had done all that I could hope to accomplish.” His brother Simon wrote in a letter that Abraham seemed to feel he was the only member of the family “without hopeful or congenial occupation.”
So Flexner sold his school in 1905, spent a year in graduate school at Harvard and went to Germany to study the German university system. And as far as Louisville was concerned, that was pretty much it. “He leaves and he’s gone — he becomes a New Yorker,” says Halperin (although the Flexners are buried in Cave Hill Cemetery).
The book Flexner wrote upon returning from Germany, The American College, was an attack on the incoherence of America’s system of higher education. Initially, it seemed like a failure — neither sold nor reviewed widely, while at the same time it antagonized such leading figures as Columbia University president Nicholas Murray Butler. But one of its readers was Henry S. Pritchett, president of the Carnegie Foundation for the Advancement of Teaching, who asked Flexner to write a report for the foundation on the nation’s medical schools. Flexner asked Pritchett if he wasn’t mistaking him for Simon, the Flexner with medical expertise. Pritchett said no, he wanted an educator, not a doctor.
Reading about medical education before Flexner’s assessment makes you think you’re hearing about a country a thousand, not a hundred, years ago. Medical schools taught almost exclusively via lectures — and the second year of a course was often just a repeat of the first. Laboratory facilities were small or non-existent. States didn’t regulate the awarding of medical degrees. Most amazing of all: Schools didn’t require even a high school diploma, much less a college one. Most schools were proprietary — commercial ventures with few incentives to improve the quality of their education, and woefully underfunded.
What Upton Sinclair’s The Jungle did for the meatpacking industry, the Flexner Report did for the American medical school. Not that the two enterprises were always distinguishable: One of the more famous passages in the report described the dissecting room of a Topeka, Kan., school as “indescribably filthy; it contained, in addition to necessary tables, a single, badly hacked cadaver, and was simultaneously used as a chicken yard” by a faculty member studying embryology.
Flexner was pretty rough on his hometown and state, too. While Indiana University was taking a leading role in its state, he wrote, “educational ineptitude” prevented the University of Kentucky from playing a similar part. As for U of L,
From the existing so-called academic department of the University of Louisville neither aid nor ideals can come. It is quite without resources. We have indeed progressed too far in our social and educational development to use the word ‘university’ for an enterprise of this kind.
“One can imagine being a dean in 1910 and opening up your mail and taking this report out and reading about your school,” says U of L’s Halperin. “Those guys must have fallen off their chairs.” Many may have felt duped — they had probably opened their doors to a Carnegie researcher hoping that Carnegie money would follow. Flexner was threatened, and sued for libel.
The reviews are the fun stuff, the material that got Flexner’s name and picture in hundreds of newspapers and magazines and made the report a cause célèbre. But the report’s first section laid out a model for medical schools remarkably similar to the one still in place today: The school would be attached to both a university and a hospital, with students’ curriculum comprising basic science, research in a laboratory and hands-on clinical experience. Admission standards would be raised.
Flexner’s presentation of the case for reform was stronger than anyone could have anticipated. And it retains its potency. Local cardiologist Dr. M. Saleem Seyal, who is something of a Flexner buff, recalls reading the report for pleasure on breaks during his residency at a Chicago hospital.
As Halperin argues in the Flexner Centenary issue of the journal Academic Medicine, the report arrived at the right moment — at what Harvard physiologist Lawrence J. Henderson described as “a Great Divide,” when, “for the first time in human history, a random patient with a random disease consulting a doctor chosen at random stands a better than 50/50 chance of benefiting from the encounter.”
Flexner followed up the medical-school report with three more — on European medical schools, on prostitution in Europe and on Johns Hopkins’ medical school. Then he took a position with the General Education Board of the Rockefeller Foundation — the position that would earn him the New Yorker’s “Robin Hood” moniker.
Halperin believes that this phase of Flexner’s career played an essential role in assuring the report’s legacy. “Maybe the reason we’re still talking about the 1910 report is, not only did he write it but he devoted about 15 years to seeing if his ideas could come to fruition. . . . Not a lot of people in life get that chance. A lot of people write reports and give opinions, but nobody puts the Rockefeller money at their (disposal).”
Internal foundation politics eventually forced Flexner to resign from the Rockefeller organization in 1928, aged 62. That year he gave the Rhodes lectures, which he then collected in a book called Universities: American, English, German. In it he described his idea for what he called “a university in the post-graduate sense of the word. . . . a free society of scholars — free, because mature persons, animated by intellectual purposes, must be left to pursue their own purposes in their own way.” He believed it would attract “the ablest scholars and scientists,” and though small, “its propulsive power would be out of proportion to its size.”
It would be, in essence, a Mr. Flexner’s School for some of the leading thinkers in the world.
While he was writing the book, Flexner was approached by lawyers for the Bamberger family, which had sold its department stores to Macy’s and had a large fortune to dispose of. The Bambergers had the idea of starting a Jewish medical school in Newark, and wanted Flexner’s advice. He didn’t think it was a good idea. Then, according to Bonner’s account, he asked them, “Have you ever dreamed a dream?” and described his idea for a post-graduate university devoted to research and learning.
Within a few months, Flexner was drawing up plans for what would become the Institute for Advanced Study, which ended up being located not in Newark but Princeton. Flexner became its director. The first school that opened was mathematics; its faculty included not only Einstein but Kurt Gödel, John von Neumann and Paul Dirac.
After his directorship ended in 1939, he wrote four books in the two decades left to him — his autobiography (revised in 1959); biographies of two mentors, Pritchett of the Carnegie Foundation and Daniel Coit Gilman, president of Johns Hopkins; and Funds and Foundations, about the philanthropic world in which he’d been so influential. He died September 21, 1959.
So, to circle back: What should those people on Abraham Flexner Way know about its namesake? Certainly the medical report, and the reform movement it both galvanized and came to stand for, had something to do with every endeavor going on there. Here’s another angle that Halperin pointed out to me: In the wake of the Flexner Report, the supply of doctors decreased, and in the most predictable of economic reactions, their compensation rose. The repercussions of that, for everything from tee times at Valhalla to the cost of a hip replacement, are vast.
It’s also cool to know that he sponsored Einstein, sassed Churchill and got to know the streetwalkers of Paris. But it might be the truest tribute to Flexner to view him as someone who made the most of the intellectual opportunities available to him, whether it was double-booking his schedule at Hopkins or snookering millionaires into funding the kind of post-graduate academic institution he’d dreamed of.
There’s something lovely about the fact that at age 81, with virtually all of his accomplishments behind him, his siblings dead and his wife in the grips of dementia, Flexner began to take classes at Columbia to keep his mind occupied and fight his loneliness. Regardless of where you rank him on some arbitrary list, that questing intelligence is a model everyone on Abraham Flexner Way and beyond could profit by emulating.
Photo courtesy of: The Shelby White and Leon Levy Archives Center, Institite for Advanced Study, Princeton, NJ