DARWIN H. STAPLETON
Abraham Flexner, Rockefeller
Philanthropy, and the Western
Reserve
School of Medicine
In September 1914 the president of
Western Reserve University in
Cleveland, Charles F. Thwing, addressed
a friendly letter to an important
ally of the university's medical school:
I am glad to say to you that your
Western Reserve Medical School is opening to-
morrow in excellent form ... The
students seem to be overflowing. We have a lit-
tle larger first-year class than we
ought to receive. We, Faculty and Trustees of
both Lakeside [hospital] and the
University, are now considering, with utmost care,
the question of [future] location.
The correspondent to whom Thwing wrote
so intimately was neither one
of the great contributors to the
university nor one of the important lead-
ers of the medical school. Rather it was
Abraham Flexner, an officer of
the Rockefeller-funded General Education
Board in New York.
Thwing was neither flippant nor
overgenerous when he told Flexner that
the Western Reserve University School of
Medicine was "his," and there-
by hangs the tale of this essay.2 Beginning
in 1910, a few years before
Thwing's letter, and at a crucial point
in the school's evolution, Flexner
and Rockefeller funding had become
important actors, and for at least two
decades remained highly influential. It
was precisely during those years,
1910 to about 1930, that the school was
transformed from a regionally-
Darwin H. Stapleton is the Director of
the Rockefeller Archive Center, North Tarrytown,
New York. An earlier version of this
paper was read as the 1990 Anton and Rose Sverina Lec-
ture for the Historical Division of the Cleveland
Medical Library Association, Cleveland,
Ohio. Both versions have drawn on
research in the Case Western Reserve University
Archives by Bari 0. Stith.
1. Charles F. Thwing to Abraham Flexner,
30 September 1914, f. 7283, box 709, Gener-
al Education Board archives (hereafter
GEB), Rockefeller Archive Center (hereafter RAC),
North Tarrytown, New York.
2. The name of the Medical Department of
Western Reserve University was changed to
the School of Medicine in 1912. I shall
use the latter name throughout this paper. Frederick
C. Waite, Western Reserve University
Centennial History of the School of Medicine (Cleve-
land, 1946), 422.
Western Reserve School of Medicine 101 |
|
known institution in downtown Cleveland into a nationally-important in- stitution with a unified medical center in University Circle.3 Existing histories of the School of Medicine do not elaborate on the effect of Flexner and Rockefeller philanthropy, in part because the pri- mary sources for exploring the relationship were not consulted. The Rockefeller Archive Center, which houses 50 million documents deal- ing with the Rockefeller family and its philanthropies, was not opened until 1975, and scholars are only beginning to tap it to explore the im- portant role of the Cleveland-based Rockefeller fortune in a wide range of American institutions.4 Abraham Flexner is certainly one of the figures who plays dramatical- ly across the stage of Rockefeller philanthropy. Born to a Jewish immi-
3. Centennial History, esp. chs. 15-17; Clarence L. Cramer, Case Western Reserve: A His- tory of the University, 1826-1976 (Boston, 1976), 295-304; and David D. Van Tassel and John J. Grabowski, eds., Encyclopedia of Cleveland History (Bloomington, IN., 1987), 157- 59,672-74,837, 1000-02. 4. For example: John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Pub- lic Health in the New South (Cambridge, MA., 1981); Gerald Jonas, The Circuit Riders: Rock- efeller Money and the Rise of Modern Science (New York, 1989); Martin Bulmer, The Chicago School of Sociology: Institutionalization, Diversity, and the Rise of Sociological |
102 OHIO HISTORY
grant family in Louisville, Kentucky,
Flexner attended and graduated from
Johns Hopkins University in the 1880s
with a degree in the classics. He
returned to Louisville for more than
fifteen years of high school teaching
and private tutoring, then went to
Harvard to study psychology. Disap-
pointed with his graduate program there,
he went to Europe for a sabbat-
ical and wrote a book critical of American
higher education.5
On his return to the United States
Flexner sought a position with the
Carnegie Foundation for the Advancement
of Teaching, a new philan-
thropy established by Andrew Carnegie.
Flexner may have been advised
and aided in his approach to the
foundation by his brother Simon Flexner,
a leading American medical researcher
who had a few years earlier become
the first director of the Rockefeller
Institute in New York, the first
biomedical research center in the United
States.
As it turned out, the President of the
Carnegie foundation was inter-
ested in commissioning a survey of
American medical education, and in
Abraham Flexner he found the
intelligent, critical, informed, but disin-
terested point of view that he wanted.
After clearing the project with the
American Medical Association, Flexner
was sent out on a whirlwind tour
of over 150 medical schools in the
United States and Canada in 1909 and
early 1910.
Flexner set his task as investigating
and assessing the entrance re-
quirements, faculties, and clinical and
research facilities of each school.
He believed that he could do so rapidly,
and often needed less than a day
to review admission records, interview
faculty, and tour facilities at a sin-
gle institution. Within a year he
produced a monumentally influential
work, Medical Education in the United
States and Canada, that was high-
ly critical of much of what passed for
medical education in America.6
Flexner's findings are not complex to
relate. He wanted to reduce the
number of medical schools from about 150
to 30, because he thought that
only one-fifth had rigorous admission
standards, well-trained faculties,
and excellent laboratories and clinical
facilities. He also argued in favor
of professors being full-time, that is
without any commitment to private
medical practice, so that their
loyalties and time would be committed to
Research (Chicago, 1984).
5. For my view of Flexner and other
general material on the Flexner report and the Gen-
eral Education Board I have relied
heavily on Steven C. Wheatley's The Politics of Philan-
thropy: Abraham Flexner and Medical
Education (Madison, Wis., 1988). See
also Howard
S. Berliner, A System of Scientific
Medicine: Philanthropic Foundations in the Flexner Era
(New York, 1985) and E. Richard Brown, Rockefeller
Medicine Men: Medicine & Capital-
ism in America (Berkeley, Cal., 1979); s.v., "Flexner,
Abraham," in Who's Who in America,
1934-35 (Chicago, 1934).
6. Abraham Flexner, Medical Education
in the United States and Canada: A Report to
the Carnegie Foundationfor the
Advancement of Teaching. Bulletin no.
4. (New York, 1910);
Berliner, A System of Scientific Medicine,
108-10.
Western Reserve School of
Medicine 103
education and research. In general these
criticisms and ideas had been
around for some years, as Flexner
acknowledged, but the time was ripe for
a forceful and authoritative advocate of
reform, and he filled that role ex-
tremely well.
The effect of the Flexner report was in
some instances very dramatic.
Robert Brookings, the benefactor of the
medical school at Washington
University in St. Louis, read a
preliminary version of the report and im-
mediately asked Flexner to visit the
school with him to point out its defi-
ciencies. Within two days Brookings
pushed through the board of trustees
reforms on the lines Flexner had
suggested.
The Flexner report was extremely
favorable to Western Reserve Uni-
versity's school of medicine. The school
had ten years earlier adopted the
stiffest level of entrance standards in
the United States-three years of col-
lege preparation-and had for several
years had its laboratory courses
taught by full-time professors, with
excellent facilities provided for them.
Flexner had high regard for the school's
affiliation with Lakeside Hospi-
tal, and throughout his report cited it
as a model for clinical relationships.
For more than a decade the university
had nominated the staff of the hos-
pital and had exclusive teaching
privileges there.7
The general impact of the Flexner report
on American medical educa-
tion was slight at first because its
recommendations were not adopted for-
mally by state medical boards or by
medical associations. However, it had
enormous impact over the next decade and
beyond, and the Flexner report
became the bible of the Rockefeller
philanthropies that massively sup-
ported American medical schools: it has
been estimated that they provided
60 percent of the foundation aid to
medical education from about 1910-
1930. Their promotion of medical
research and full-time faculties trans-
formed medical education into its modern
form in the United States.8
Flexner's influence became very strong
when in 1912 he accepted a per-
manent position with the General
Education Board, a philanthropic foun-
dation created in 1902 by John D.
Rockefeller to support the orderly
growth of higher education and the
reform of public school education in
the American South. Rockefeller
eventually gave the board $129 million
for its endowment.9 This
organization should not be confused with the
Rockefeller Foundation, established by
John D. Rockefeller in 1913 as the
largest general-purpose foundation
created in the first half of the twenti-
7. Flexner, Medical Education, esp.
106, 285-86; Waite, Centennial History, 249. See also
B.L. Millikin to S.T. Murphy [sic], 15
March 1905, f. 6637, box 631, GEB.
8. Wheatley, Politics of
Philanthropy, 112.
9. The General Education Board: An
Account of its Activities, 1902-1914 (New
York,
1930), 3-9; John Ensor Harr and Peter J.
Johnson, The Rockefeller Century (New York, 1988),
70-81,562.
104 OHIO HISTORY
eth century. During the period covered
here, 1910-1930, it was the Gen-
eral Education Board, Flexner's
organization, not the Rockefeller Foun-
dation, that was the major actor in
American medical education.
Now that the outside actors have been
described, let us see how the his-
tory of the medical school was
influenced by Abraham Flexner and Rock-
efeller philanthropy.
The Western Reserve University school of
medicine was founded in
Cleveland in 1843, and operated as a
rather autonomous unit until 1893
when growth in the school's endowment
permitted the creation of full-time
professorships in the laboratory
departments. Thereafter the university had
increasing financial oversight of the
school, and the school turned in the
direction of scientific medicine. A
physiological laboratory was erected
in 1898, and the Cushing Laboratory of
Experimental Medicine was
opened in 1908 as a result of the gifts
of Cleveland industrialists Howard
M. Hanna and Oliver H. Payne. The
laboratory scientists at the school
quickly compiled an enviable record of
publications in nationally-promi-
nent journals, including the Journal
of Experimental Medicine, which had
been founded at Johns Hopkins in 1896
and transferred to the Rockefeller
Institute in 1905.10 The clinicians at
the school were outstanding as well.
George W. Crile, for example, was known
for his highly successful sur-
gical technique, and for his important
and respected publications.
When Rockefeller philanthropy entered
this situation it was largely in
an attempt to preserve and expand the
strong teaching environment that
already had been created. John D.
Rockefeller, who had grown up in Cleve-
land and had founded his fortune on his
business activities there, was aware
of the growth of higher education in
Cleveland and had long been inter-
ested in Cleveland medicine. His
benefactions ranged from contributions
to the association that bought the land
for the adjoining Western Reserve-
Case campuses, to the construction of
the Mather dormitory for the Col-
lege for Women, the funding of the
physics building for Case, and to the
Cleveland Medical Library Association.
Having a homeopathic orienta-
tion, in the 1880s and 1890s Rockefeller
supported the Cleveland Home-
opathic Medical College through his
personal physician, Hamilton F. Big-
gar. (There is not space to discuss here
the role of Rockefeller philanthropy
10. Millikin to Murphy, 15 March 1905,
loc. cit.; George W. Corner, A History of The
Rockefeller Institute, 1901-1953:
Origins and Growth (New York, 1964),
62-63; H.M. Han-
na to E.F. Cushing, 14 November 1906,
extract, box 18, Charles F. Thwing Office Files (here-
after TOF), Case Western Reserve
University Archives (hereafter CWRU Archives), Cleve-
land, Ohio.
Western Reserve School of Medicine 105 |
|
in practically every area of Cleveland's educational, cultural, and educa- tional institutions.)11 As the twentieth century dawned, however, Rockefeller's son, John D. Rockefeller, Jr., and his philanthropic advisor Frederick Gates persuaded Rockefeller that modern medical research and allopathic medicine held the greatest promise for alleviating or eradicating the endemic and epi- demic diseases that were, according to reformers of the era, the causes of much social misery and vice. Rockefeller founded the Rockefeller Insti- tute for Medical Research in New York in 1901, the first American med- ical research institution devoted solely to research into human physiolo- gy and the fundamental causes of illness, and the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease, established in 1909 to work in the American South. Rockefeller's interest was first drawn to the Western Reserve Univer- sity School of Medicine when Starr J. Murphy, his financial advisor and a trustee of the General Education Board, visited Cleveland in 1905 to ex- amine Rockefeller philanthropic commitments. He wrote a 30-page report to Rockefeller describing Western Reserve University, and especially its medical school, concluding that "This is the best Medical School I have
11. The author's A History of University Circle: Community, Philanthropy and Planning in Cleveland, 1800-1985 will be published by Ohio State University Press. |
106 OHIO HISTORY
seen except Harvard and Johns Hopkins.
The professors and instructors
are in the main from those institutions
and have brought with them the tra-
ditions and practices of those
institutions."12
It was four years later, just before
Abraham Flexner came to survey the
school for his famous report, that
President Thwing made an appeal to the
General Education Board. He asked for
$250,000 toward a proposed
$1 million endowment for the school of
medicine. Howard Hanna, a lead-
ing Cleveland industrialist, had given
$250,000 a year before, but the
endowment campaign had stalled. Thwing
played on the known prejudices
of the Rockefeller philanthropies by
emphasizing the school's high ad-
mission standards and its commitment to
laboratory science. He was able
to point to the recent creation of the
Cushing Laboratory as an example
of what he called "this
indispensable association" of "laboratory and clin-
ical research" which have
"continually ... become closer."13
The General Education Board asked Simon
Flexner, director of the
Rockefeller Institute and co-editor of
the Journal of Experimental
Medicine, to review Thwing's proposal, and he replied favorably
with-
out hesitation.
I believe that the Medical Department of
Western Reserve University is one of the
most modern and progressive faculties in
the country. The scientific chairs in the
Institute have now for several years
been on a university basis, and have been filled
with men of distinction. The
Laboratories have devoted for many years a consid-
erable part of their energies to
research and have been productive in a highly com-
mendable degree ... In other words, I
have a high opinion of the Medical Depart-
ment of Western Reserve University and
believe that it is moving in the right
direction ....14
The General Education Board's secretary,
Wallace Buttrick, presented
Thwing's request to the board's trustees
favorably, but they decided that
they were already overcommitted to
undergraduate colleges and were not
prepared to support professional
schools. Frederick Gates, however, rec-
ommended that the $250,000 be given by
Rockefeller personally, and the
request was passed along through Starr
Murphy and John D. Rockefeller,
Jr. 15 Rockefeller apparently
replied favorably, but suggested that a con-
12. Starr J. Murphy to John D.
Rockefeller, 27 April 1905, "Western Reserve Universi-
ty" file, box 121, Education
series, RG 2, Rockefeller Family archives, RAC.
13. Charles F. Thwing to General
Education Board, 14 October 1909, f. 6637, box 631,
GEB; Waite, Centennial History, 382.
14. Simon Flexner to Starr J. Murphy, 21
March 1910, "Western Reserve University" file,
box 121, Education series, RG 2.
15. Starr J. Murphy to Wallace Buttrick,
29 March 1910, f. 7283, box 709, GEB; Starr J.
Murphy to John D. Rockefeller, Jr., 18
April 1910, "Western Reserve University" file, box
121, Education series, RG 2.
Western Reserve School of
Medicine 107
dition of the gift be that the school be
required to teach homeopathy. Starr
Murphy replied firmly that "to
prescribe that a given theory of medicine,
or a given school of practice, must be
taught would go counter to our best
modern tendencies, and would involve
grave danger that the fund might
become wholly useless and even
pernicious."16
A few months later Rockefeller decided
to make the $250,000 contri-
bution without any reference to
homeopathy, and gave the university from
October 1910 until the end of December
1911 to raise a matching
$750,000.17 During the next year Thwing
worked assiduously to reach the
required sum, and by the end of 1911
reached the $1 million goal with
gifts of $100,000 each from Samuel
Mather and Oliver Payne, and twen-
ty-eight gifts of $50,000 or less from
other Cleveland business and phi-
lanthropic leaders.18
The success of Rockefeller's gift to the
school seems to have been an
important stage in the association of
Rockefeller philanthropy and med-
ical schools. Never previously had John
D. Rockefeller or his philan-
thropies given to the endowment of a
medical school, but the gift to West-
ern Reserve University-a challenge grant
to an institution committed to
scientific research and full-time
professorships--became the model. As
so often happened in Rockefeller
philanthropy, John D. Rockefeller's pri-
vate action (and later that of his son,
John D. Rockefeller, Jr.) pioneered
a policy that was carried out globally
or nationally by one of his philan-
thropic organizations.
In this case, the General Education
Board up to 1910 had been focused
on the improvement of secondary school
education in the South, higher
education for blacks, and developing the
endowment of a few leading col-
leges. But what happened with Western
Reserve University, and the con-
tinuing flow of millions from
Rockefeller, provided the impetus to broad-
en the board's agenda. When the board
hired Flexner late in 1912 they
knew he was bringing a strong vision of
how to improve medical educa-
tion through philanthropy.19
Flexner began to assert his new role in
the spring of 1913 when he was
appointed to a General Education Board
committee that was "to make a
16. Starr J. Murphy to John D.
Rockefeller, Jr., 2 May 1910, "Western Reserve Univer-
sity" file, box 121, Education
series, RG 2. Rockefeller had several years earlier shown his
concern regarding homeopathic
instruction in the controversy regarding the affiliation of
Rush Medical College with the University
of Chicago: Berliner, A System of Scientific
Medicine, 39-41.
17. Starr J. Murphy to Charles F.
Thwing, 4 October 1910, "Western Reserve Universi-
ty" file, box 121, Education
series, RG 2.
18. Charles F. Thwing to Starr J.
Murphy, 11 January 1912, "Western Reserve Univer-
sity" file, box 121, Education
series, RG 2.
19. Raymond B. Fosdick, Adventures in
Giving: The Story of the General Education Board
108 OHIO HISTORY
careful study of clinical instruction in
medical schools."20 Although ap-
parently the committee planned to visit
only Harvard and Johns Hopkins,
the word of its mission seems to have
leaked to Cleveland, for in Septem-
ber George Crile, a member of Reserve's
faculty and, perhaps, Cleveland's
most eminent physician, invited Flexner
to "run out here to look over our
medical college and Lakeside Hospital
situation to give your advice
about the size of classes."21
Flexner came with Wallace Buttrick, presi-
dent of the General Education Board, and
addressed a planning meeting,
probably the medical school's committee
on the future location of the
school and Lakeside Hospital. Afterward
Thwing thanked him for estab-
lishing the "general
principles" for their plans.22
Flexner's advice was sought, first,
because Thwing and others had high
hopes for further Rockefeller support of
the School of Medicine and, sec-
ond, because Flexner's insistence on the
importance of consolidation of
medical schools with clinical facilities
corresponded well with the goals
of Cleveland's medical and business
leaders who wanted to associate more
closely the school of medicine, Lakeside
Hospital and possibly other
Cleveland hospitals.
Plans for an organic association of
these bodies had become serious two
years before when Thwing and Samuel
Mather, as president of the trustees
of Lakeside Hospital, had agreed to plan
the future of their institutions to-
gether.23 To Cleveland
philanthropists this seemed the only route to effi-
ciency and excellence of service. As
Howard Hanna put it: " A Medical
School cannot reach, or maintain, a high
standard, without a close affili-
ation with an up-to-date Hospital.
Without that affiliation accomplished
between the ... Medical school, and the
Lakeside Hospital, my interest and
support of the Medical School would
cease."24 With this kind of support
the affiliation was a fait accompli: in
1913 the University Medical Group
was formed consisting of the School of
Medicine, Lakeside, and the Ba-
bies and Childrens' Hospital.25 But
plans for a new downtown complex
of buildings for these institutions
foundered. Early in 1914 Samuel Math-
er raised serious questions about its
location.26 As he explained it a year
later in his report to the Lakeside
trustees:
(New York, 1962), 150-60; 25 October
1912, trustees' minutes, GEB.
20.23 May 1913, trustees' minutes, GEB.
21. George W. Crile to Abraham Flexner,
[September 19131, f. 7283, box 709, GEB.
22. "Report of the Faculty
Committee on the location of the Medical School and Hospi-
tals," 22 September 1913, box 18
TOF; Charles F. Thwing to Abraham Flexner, 16 December
1913, box 18 TOF; Abraham Flexner to
Edwin P. Carter, 9 June 1914. f. 7283, box 709, GEB.
23. Howard M. Hanna to Charles F.
Thwing, 5 December 1911, box 18, TOF.
24. Howard M. Hanna to Charles F.
Thwing, 12 December 1911, box 18, TOF.
25. Van Tassel and Grabowski, eds., Encyclopedia
of Cleveland History, 1001.
26. 30 January 1914, minutes, joint
committee on hospital and medical school buildings,
box 18, TOF.
Western Reserve School of
Medicine 109
A year ago we were confidently planning
the establishment of a large Hospital-
Medical group in our present [downtown]
location ... The unexpected discovery,
however, that in connection with the
proposed new Union Depot, the railroads were
planning to very largely multiply their railroad tracks
in front of the Hospital, and
also to elevate them sixteen feet above
their present level, aroused in the minds
of all ... an apprehension [regarding]
... the resulting increase in noise and smoke
from the increased number of tracks and
trains passing between our building and
the lake ...27
A substantial debate over the new
location ensued that had an unex-
pected relationship to the full-time
issue for the clinicians. Some profes-
sors and trustees argued that only a
downtown site would be accessible for
a substantial number of patients and
convenient to professors with private
practices: some of the clinical
professors feared that a site on the periph-
ery of the city would make it impossible
to serve their clientele and would
certainly reduce their incomes. They
were probably right. A few years lat-
er Harvey Cushing, a leading Boston
surgeon who had become a full-time
professor at Harvard, stated that
"Happy full-time people are either bach-
elors or people of independent means ..
.I suppose my take-in is about one-
fifth of what what it would be if I
wanted to go out for the full emoluments
which my special training would
bring."28
Throughout the deliberations on the site
and "full-time," Thwing,
Mather, and Crile kept Flexner informed.
When the process seemed stale-
mated in the spring of 1914 they invited
him to Cleveland to address the
concerned parties, and particularly to
deal with the concerns of the med-
ical school faculty. Flexner came armed
with a thorough knowledge of the
debate through documents sent to him.29
His talk emphasized the impor-
tance of full-time instruction and urged
Western Reserve to follow the re-
forms recently initiated at Johns
Hopkins, Yale, and Washington Uni-
versity with the aid of General
Education Board grants. Although his talk
was eloquent about the great
possibilities for reform in medical education,
Flexner was also frank. He said:
"Certain practical questions arise in con-
nection with the full-time scheme. You
may be interested in the details of
their tentative solution. The full-time
clinician will practically live in the
hospital laboratories and the
wards."30
Afterward Professor David Marine, a
pathologist at the school of
medicine and a graduate of Johns
Hopkins, told Flexner that he had done
27. Samuel Mather, "Report of the
President of Lakeside Hospital to the Annual Meet-
ing of the Corporation, 1915,"
University Hospitals archives, Cleveland, Ohio.
28. Harvey Cushing to Richard M. Pearce,
1 May 1920, f. 11, box 2, series 906, RG 3,
Rockefeller Foundation archives, RAC.
29. David Marine to Abraham Flexner, 13
June 1914, f. 7283, box 709, GEB; George W.
Crile to Abraham Flexner, 13 June 1914,
ibid.
30. Abraham Flexner, [after-dinner
address], [c. 18 June 1914], f. 7283, box 709, GEB.
110 OHIO HISTORY
"a great service" to "the
cause of higher medical education in Cleveland."
Specifically, Marine said, "as a
result of your presence here, men who a
few months ago were anxiously looking
about for avenues of escape are
now enthusiastic, encouraged, and glad
to be in a position to render ser-
vices towards obtaining a better Medical
School."31 But the situation was
not so easily resolved, because the medical
school faculty and the Lake-
side trustees could not agree on a new
site for the combined institutions.
In October 1914 Samuel Mather wrote
urgently to Flexner asking him to
return again to "give us the aid of
your experienced judgment."32 Flexner
instead invited Mather to visit him in
New York, and over the next few
months he also had visits from Crile and
Thwing.33
The full-time issue for clinical
professorships was resolved diplomat-
ically, as Thwing informed Flexner, by
creating full-time positions for new
appointments forjunior faculty beginning
in 1916, but retaining part-time
teaching positions for current faculty.
This avoided the problems experi-
enced at Johns Hopkins and other
institutions where venerable clinicians
were forced to make a painful choice
between private practice and full-
time teaching.34
Along with this compromise came
agreement to build the new medical
center on a site adjacent to the Western
Reserve University campus.
Flexner now became a consultant on the
architectural plans for the com-
plex. He returned to Cleveland once more
in June 1916 to go over the de-
sign with Howard Hanna, and again gave a
luncheon address on the de-
velopment of the full-time plan.35 Flexner
avoided making any
commitment to financial support of the
venture, but assured Mather that
the General Education Board regarded the
school "as one of the most hope-
ful spots in the country from the
standpoint of medical education."36
Interestingly enough, Charles A.
Coolidge of Boston, the architect who
had drawn the plans for the Medical
School and for Lakeside Hospital that
Flexner was called on to review, had
earlier designed the buildings of the
Rockefeller Institute in New York, and
had just been commissioned to de-
sign the Rockefeller-financed Peking
Union Medical College in China.
31. David Marine to Abraham Flexner, 19
June 1914, f. 7283, box 709, GEB.
32. Samuel Mather to Abraham Flexner, 7
October 1914, f. 7283, box 709, GEB.
33. Abraham Flexner to Samuel Mather, 17
October 1914; George W. Crile to Abraham
Flexner, 31 December 1914; and Charles
F. Thwing to Abraham Flexner, 25 May 1915, all
in f. 7283, box 709, GEB.
34. Charles F. Thwing to Abraham
Flexner, 25 May 1916, f. 7283, box 709, GEB; Waite,
Centennial History, 402; Wheatley, Politics of Philanthropy, 67-68,
97-98; Berliner, Sys-
tem of Scientific Medicine, 150-61.
35. Charles F. Thwing to Abraham
Flexner, 24 June 1916 and 12 October 1916, f. 7283,
box 709, GEB; Samuel Mather to Abraham
Flexner, 14 July 1916, f. 7283, box 709, GEB.
36. Abraham Flexner to Samuel Mather, 17
July 1916, f. 7283, box 709, GEB.
Western Reserve School of
Medicine 111
Coolidge was known to Clevelanders for
his design of the largest office
building in the city, the New England
Building, and already had a repu-
tation as an architect of academic
buildings, but his close connection with
Rockefeller interests could have
influenced the decision to employ him.37
This is not the place to follow in
detail the progress, or lack thereof, of
the medical center idea over the years
from 1916 to 1922. But quite sim-
ply, although the trustees of the
University and the hospitals elaborated
and refined the plans for the complex,
the price tag of some ten to fifteen
million dollars daunted them, especially
during the war years and post-
war recession. Samuel Mather made an
initial gift of $300,000 to the pro-
ject in 1917, and Thwing hoped, with
Flexner's support, to get a large sum
from the Rockefeller or the Carnegie
philanthropies to make the total
achievable.38 But neither made
a contribution to the endowment, despite
the pleas of Thwing and, after his
retirement in 1921, the new university
president Robert E. Vinson.
Instead it was Samuel Mather' s decision
to make a personal commitment
to the construction of the medical
school building in 1922 that put the
wheels in motion. The Medical School
building opened in 1924 at a cost
of $2.5 million, and the Babies and
Childrens and Maternity Hospitals were
completed a year later. Lakeside Hospital
opened in 1931. These achieve-
ments were entirely the result of
contributions from Clevelanders.39
Vinson was finally able to obtain
General Education Board participa-
tion in the medical center by convincing
Flexner to support the universi-
ty's request for $750,000 for the
construction of the Institute of Patholo-
gy building, which opened in 1928.
Almost as important, in 1927 the board
began to give the medical school a grant
for operating expenses, begin-
ning with three annual appropriations of
$75,000. Vinson had told the
board in 1925 that the medical school
had expenditures of about $300,000
but an income of only $175,000. The
endowment of the medical school
had grown only slightly since the $1
million campaign of 1910-11 to which
John D. Rockefeller had personally
contributed.40
In all, however, by 1929 the medical
school and the associated medi-
cal institutions had come a remarkable
distance since Thwing had asked
37. Corner, Rockefeller Institute, 55;
Mary E. Ferguson, China Medical Board and Peking
Union Medical College (New York, 1970), 30-32; Henry F. Withey, Biographical
Dictio-
nary of American Architects
(Deceased) (Los Angeles, 1970),
136-37.
38. Charles F. Thwing to Jeptha H. Wade
II, 1 February 1917; Charles F. Thwing to Samuel
Mather, 23 July 1918; Samuel Mather to
Charles F. Thwing, 31 July 1919, all in box 18, TOF.
39. Waite, Centennial History, 421-22,426.
40.3 December 1925 and 4 February 1926,
Richard M. Pearce diary, RG 12, Rockefeller
Foundation archives, RAC; Robert E.
Vinson to Abraham Flexner, 2 December 1925; Robert
E. Vinson to Abraham Flexner, 4 October
1926; W.W. Brierley to Robert E. Vinson, 22
112 OHIO HISTORY |
|
for General Education Board support in 1909. On a visit to Cleveland ear- ly in October 1929, Dr. R.A. Lambert, an officer of the General Educa- tion Board, examined the medical school in order to consider whether to recommend it for a continuation of its annual operating grants. On virtu- ally every score he found it a model of the kind of medical education the board wanted to promote. Extracts from his assessment are a neat and glowing summary of the accomplishments at the medical school over the previous twenty years:
The laboratories of the Medical School are not merely ample; they are splendid- ly organized and equipped ... The new Institute of Pathology indeed surpasses in completeness any other in the United States ... The Medical Faculty is unusually strong. With a few exceptions the heads of departments are leaders in their re- spective fields ... [the school] is setting the pace in academic salaries ...
The community support of the Medical School and University as judged by gifts in the past five years, has hardly a parallel in the United States ... The new Med-
November 1926; Robert E. Vinson to W.W. Brierley, 24 November 1926; Robert E. Vin- cent to Abraham Flexner, I April 1927, all in f. 7284, box 709, GEB. |
Western Reserve School of
Medicine 113
ical Center is made up of a group of
well-planned, well-organized, well-equipped
institutions located in the center of
the University campus."41
This assessment must have mightily
pleased the General Education
Board and especially Abraham Flexner,
who had just retired.
***
Flexner's role in the development of the
school of medicine suggests
the importance of ideas in history. Even
though the school had established
its own commitment to the scientific
direction of modern medicine, its
leaders found it very important to call
on Flexner to articulate the call to
full-time professorships and to the
importance of an integrated medical
complex in a university setting. What
Flexner brought to Western Reserve
was a connection with the broader
currents of medical education in the
United States, and nurturance of the
faith that Clevelanders had progres-
sive-minded colleagues who shared their
goals. These ideas, which Flexn-
er presented authoritatively, were
critical to moving the discussions and
the decision-making process forward.
In a similar way, Rockefeller's personal
act of philanthropy in 1910
demonstrates the power of money when
used as a lever. We do not know
the extent to which Rockefeller was
apprised of the school of medicine's
inability to develop support for its
million-dollar endowment campaign,
but his "challenge grant" (as
we would call it today) was an effective cat-
alyst and put the whole process of
creating the University Hospitals
Group onto a new footing. It is clear
that philanthropy, often regarded as
either simple charity or as
self-aggrandizement, can also be a tool for in-
stitutional change and development. In
the case of the relocation and ex-
pansion of Western Reserve University's
school of Medicine, Rockefeller
philanthropy had a vital role in the
conception and planning of a model
medical complex.
41. R.A. Lambert, "Western Reserve
Medical School," 24 October 1929, f. 7284, box 709,
GEB.
DARWIN H. STAPLETON
Abraham Flexner, Rockefeller
Philanthropy, and the Western
Reserve
School of Medicine
In September 1914 the president of
Western Reserve University in
Cleveland, Charles F. Thwing, addressed
a friendly letter to an important
ally of the university's medical school:
I am glad to say to you that your
Western Reserve Medical School is opening to-
morrow in excellent form ... The
students seem to be overflowing. We have a lit-
tle larger first-year class than we
ought to receive. We, Faculty and Trustees of
both Lakeside [hospital] and the
University, are now considering, with utmost care,
the question of [future] location.
The correspondent to whom Thwing wrote
so intimately was neither one
of the great contributors to the
university nor one of the important lead-
ers of the medical school. Rather it was
Abraham Flexner, an officer of
the Rockefeller-funded General Education
Board in New York.
Thwing was neither flippant nor
overgenerous when he told Flexner that
the Western Reserve University School of
Medicine was "his," and there-
by hangs the tale of this essay.2 Beginning
in 1910, a few years before
Thwing's letter, and at a crucial point
in the school's evolution, Flexner
and Rockefeller funding had become
important actors, and for at least two
decades remained highly influential. It
was precisely during those years,
1910 to about 1930, that the school was
transformed from a regionally-
Darwin H. Stapleton is the Director of
the Rockefeller Archive Center, North Tarrytown,
New York. An earlier version of this
paper was read as the 1990 Anton and Rose Sverina Lec-
ture for the Historical Division of the Cleveland
Medical Library Association, Cleveland,
Ohio. Both versions have drawn on
research in the Case Western Reserve University
Archives by Bari 0. Stith.
1. Charles F. Thwing to Abraham Flexner,
30 September 1914, f. 7283, box 709, Gener-
al Education Board archives (hereafter
GEB), Rockefeller Archive Center (hereafter RAC),
North Tarrytown, New York.
2. The name of the Medical Department of
Western Reserve University was changed to
the School of Medicine in 1912. I shall
use the latter name throughout this paper. Frederick
C. Waite, Western Reserve University
Centennial History of the School of Medicine (Cleve-
land, 1946), 422.