Iconoclast: Abraham Flexner and a Life in Learning
by Thomas Neville Bonner
Johns Hopkins University Press, 2002
309 pp., $36
Unless you’ve been to medical school, you’ve probably never heard of Abraham Flexner (1866-1959). In an age when big money was first poured into philanthropy, Flexner was among the few who had a significant effect on how that money was spent. Between the turn of the twentieth century and his death, Flexner worked with four great philanthropists—George Eastman, Paul Mellon, John D. Rockefeller Jr., and Julius Rosenwald—to transform American medical schools and to found Princeton’s Institute for Advanced Study. He was also an energetic writer whose work attracted national attention.
Though Flexner wrote an autobiography, until now we have had no comprehensive biography. Fortunately, Thomas Bonner has filled that gap with Iconoclast: Abraham Flexner and a Life in Learning. As a former university president with significant experience working with donors, Bonner is well qualified to understand his subject.
Abraham Flexner was born in Louisville, Kentucky, in 1866, the son of merchant Moritz Flexner. The elder Flexner was an Orthodox Jew who saw education as the key to climbing the social ladder. To teach his children the importance of school, Moritz Flexner took them on a field trip to the city jail, warning that if they failed to work hard in the classroom, they would become criminals. The Flexner children became excellent students.
Though his family was poor, Abraham Flexner managed to finance his way through Johns Hopkins, though soon after graduation he had to return to Louisville to help run the family store. Eventually, after reducing his debts, Flexner opened a private K-12 school. He adopted some of the progressive tenets of the day, such as giving students more say in what courses they took, and he began writing on education. His work found its way into several national publications, including the Atlantic Monthly and Popular Science.
At age 40, it seemed Flexner would live the balance of his life in Louisville. But Flexner’s wife, Anne, was a talented playwright who penned the comedy Mrs. Wiggs of the Cabbage Patch. The play’s royalties gave the family financial independence and enabled Abraham Flexner to write his first book, The American College. Published in 1908, it included five favorable references to Henry S. Pritchett, president of the Carnegie Foundation for the Advancement of Teaching. Pritchett was impressed by the work and promptly hired Flexner to produce a survey of medical schools. Bonner observes that this hiring was “one of the strangest in philanthropic history,” since Flexner was neither a doctor nor the recipient of a graduate degree. In fact, he hadn’t even been to graduate school.
His shortcomings in credentials didn’t deter Flexner from engaging the assignment with a great deal of energy. He inspected 174 medical schools in 98 cities and found most of them shoddy, unsanitary places, with out-of-date equipment and inadequately trained professors. Because no standards for medical education existed at the time, patients had no idea whether their doctors had the skills to heal them.
Flexner published his findings in 1910 in a report titled Medical Education in the United States and Canada. It remains a landmark in the history of medical education. Flexner’s forceful prose and keen eye (the anatomy room at Kansas Medical College consisted of “a single badly hacked cadaver”) caused his report to be read. Flexner’s recommendations—close bad schools, consolidate others, and insist that all medical schools have an affiliation with a teaching hospital—began to be carried out.
The work changed American medical education and Flexner’s life as well. His report attracted the attention of John D. Rockefeller’s philanthropic advisor, Frederick T. Gates. Gates had a deep interest in medicine, which had led, in 1902, to the creation of the Rockefeller Institute of Medical Research, now called Rockefeller University. [For the early history of Rockefeller University, see Philanthropy, “The Donors Are In“] In 1913, the Rockefeller-funded General Education Board hired Flexner full time to oversee the board’s medical education programs. Flexner spent the next 15 years reforming medical schools in America and Canada. During this period, the board spent $80 million on medical schools. An imposing amount given that the total annual budget of all U.S. medical schools in 1920 was $12 million.
Rockefeller’s grant money came with substantial strings. Schools accepting Rockefeller money had to affiliate with teaching hospitals. Further, their professors had to work full time and could not accept fees for seeing patients in their spare time. Faced with smaller (if steadier) incomes, doctors kicked and screamed about these restrictions. Still, the reforms were implemented.
By the mid-1920s, internal feuds at the Rockefeller Foundation made Flexner’s position unstable, as old allies retired and younger program officers sought to redirect the foundation’s wealth away from medical schools toward new projects. In 1928, all the Rockefeller philanthropies were merged into the Rockefeller Foundation, and as part of the reorganization, Flexner’s position was abolished. He was offered, and declined, a job on John D. Rockefeller Jr.’s personal staff.
Rockefeller was not the only philanthropist Flexner corralled into his medical education project. He persuaded Julius Rosenwald to help fund medical schools in the Chicago area. And in February 1920, he gained the ear of Kodak founder George Eastman. Eastman was the major patron of the University of Rochester, and Flexner hoped the camera tycoon would aid that university’s medical school.
Eastman, Flexner wrote his wife, was a “sweet-faced, gentle man with thin hair covered by a skull cap, who puffed continually on a cigarette.” He initially offered to donate $2.5 million to the university’s medical school. Flexner refused. The next day, Eastman said he would raise his donation to $3.5 million. Flexner declined a second time. Only after a few weeks of negotiations did Eastman raise his offer again, this time to $5 million. Flexner finally accepted.
After leaving the Rockefeller Foundation, Flexner spent a year lecturing at Oxford University. Then in 1929 he began his last great philanthropic project. Louis Bamberger, who had sold his department store chain to Macy’s and wanted to spend his wealth on charity, contacted Flexner that year. Flexner persuaded Bamberger to share what had long been Flexner’s dream—creating a university dedicated exclusively to research. Bamberger liked the idea and funded the Institute for Advanced Study at Princeton University. For the next decade, Flexner alternated between attracting great scientists (most notably Albert Einstein) to Princeton and persuading his donor to be less parsimonious with his gifts.
In 1939, Flexner finally retired, but chose not to rest. He wrote four books, including his autobiography, as well as biographies of Henry S. Pritchett and Daniel Coit Gilman, the first president of Johns Hopkins. Flexner also began to advise Paul Mellon on his giving. As late as 1957, when Flexner was 91, the education visionary dreamed of heading an institute on the humanities that Mellon was thinking of starting (but ultimately decided not to create).
Flexner’s impact on an emerging American philanthropy is striking. From setting the standards for the nation’s medical education to establishing the Institute for Advanced Study at Princeton, Flexner played a pivotal role in shaping the work of many great philanthropists, demonstrating both the creativity of the private sector and its capacity to reform its own institutions.
Contributing editor Martin Morse Wooster is the author of The Foundation Builders: Brief Biographies of Twelve Great Philanthropists, published by The Philanthropy Roundtable.