by Bill Carey

The impact of Abraham Flexner on the School of Medicine cannot be overstated. In fact, the school as we now know it is as much the creation of Flexner as anyone else; his effect on the institution is so dramatic that author Timothy Jacobson's 1987 history of the School of Medicine is rightfully titled Making Medical Doctors: Science and Medicine at Vanderbilt since Flexner.

So who was Abraham Flexner? He was a native of Louisville, Ky., who attended Johns Hopkins University in Baltimore, Md. After graduation, he moved back to Louisville and taught public school. For many years, it appeared as if Flexner was destined to live out a life of obscurity as an eccentric and demanding schoolteacher. But in 1905, he and his wife decided to leave Louisville to study at Harvard and then in Germany.

Along the way, Flexner wrote a book called The American College that was highly critical of the college system employed in most parts of the United States, and of what he saw as the American educational system's tolerance of mediocrity. "I had noticed all too frequently that the boys whom I had sent to Eastern colleges lost rather than gained enthusiasm for scholarship in the course of their college careers," Flexner later wrote in his 1940 autobiography I Remember.

The American College did not sell many copies. But it was read by a man named Henry Pritchett, the head of the Carnegie Foundation for the Advancement of Teaching. Pritchett was impressed by Flexner's outlook and asked Flexner if he would make a detailed study of American medical schools. Flexner agreed, and in December 1908, he began his tour of 155 medical colleges in the United States.

Flexner's report was published in 1910 and is now regarded as one of the most important exposés in the history of medicine. Known as the Carnegie Foundation's "Bulletin Number Four," it was a complete indictment of the American system of producing physicians. Flexner argued that most medical schools weren't set up to train new doctors, but to give existing physicians a supplemental source of income. He pointed out that Germany, which had far better medical care than America, actually had far fewer doctors per citizen. In Flexner's opinion, there were too many doctors in America and too many medical schools. Most of the medical schools had few, if any, admission standards and not enough equipment.

Flexner was not a man for subtlety, and his report was full of vivid and uncomplimentary details about individual medical schools. He said that the California Medical College was a "disgrace to the state." The Baylor University College of Medicine had a "bare" laboratory. The Birmingham Medical College was "given over largely to surgical patients with gun-shot and other wounds." The Washington University Medical School in St. Louis "must be either abolished or reorganized." And as for the state of Tennessee, it contained "more low-grade medical schools than any other Southern state," including small medical schools in Knoxville and Chattanooga that Flexner described as "utterly wretched."

The School of Medicine, then housed in a group of buildings on the south campus, didn't fare much better than most schools in Flexner's report. For example, Flexner said that the School of Medicine's entrance requirement was "less than high school graduation" and that the the school had no full-time faculty. However, Flexner said that of Tennessee's nine medical schools, Vanderbilt's alone should be continued because it was "the only institution in position at this juncture to deal with the subject effectively."

Today, it is hard to know exactly why Flexner came to that conclusion. However, it should be pointed out that Flexner had been a lifelong friend of Vanderbilt Chancellor James H. Kirkland; in fact, the two had neighboring summer homes in Canada. Flexner thought very highly of Kirkland and described him as a "great man" in his autobiography.

"I think the personal relationship between Kirkland and Flexner cannot be overemphasized," said Mary Teloh, a librarian at the Eskind Biomedical Library who has done considerable research into the Medical Center's history. Teloh also believes that Vanderbilt might have been more prepared for Flexner's inspection than other schools because of Kirkland's relationship with Flexner.

One person with first-hand knowledge of Flexner's relationship to Kirkland is Flexner's great-nephew Dr. John Flexner.

"They were friends, neighbors and fishing buddies," said John Flexner, now a professor of medicine in the Vanderbilt School of Medicine's Division of Hematology. Flexner tells numerous anecdotes that illustrate how much of a perfectionist his great-uncle was.

"He used to return all the letters that I would send him with all the grammatical mistakes corrected in the margin," he said.

Whatever the cause for Flexner's conclusion, the impact of his report on medical schools in Tennessee cannot be overemphasized. Within years of the Flexner report, most of the medical schools in Tennessee, including the University of Tennessee's Medical School in Nashville, were shut down (the U.T. Medical School was later moved to Memphis). In 1913, largely as a result of Flexner's conclusions about the future of medical education in Tennessee, the Carnegie Foundation gave $1 million to Vanderbilt's medical school to recruit full-time professors, equip laboratories and raise its standards. This took place at about the same time that Nashville's Methodist community was raising money for a new hospital building to be built on Vanderbilt's south campus. Galloway Memorial Hospital, named for a Methodist bishop, was begun in 1916.

On the eve of World War I, the future of the School of Medicine appeared to be good, and it appeared to be permanently linked with several structures on the University's south campus.

Part II: Why Vanderbilt moved its medical school across town.

Bill Carey is a Vanderbilt alumnus, a writer for the Nashville Scene and author of Fortunes, Fiddles and Fried Chicken: A Nashville Business History.

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