Disorder by Peter A. Swenson

Author:Peter A. Swenson
Language: eng
Format: epub
Publisher: Yale University Press
Published: 2021-06-15T00:00:00+00:00

AFTERMATH

Arthur Bevan’s negative publicity strategy worked. In the case of Washington University in St. Louis, even the mere threat of bad publicity did the job. Flexner’s draft of an entry about the university’s medical department for his forthcoming report was shown to philanthropist Robert S. Brookings, the university’s president and biggest endower. Brookings, who was proud of the university he had helped develop into a prestigious institution, was appalled that the world would hear that its medical school was “absolutely inadequate in every respect” and only “a little better than the worst.” When he protested, Flexner returned to give him an eye-opening personal tour. In short order, Brookings initiated a radical reorganization of the school, backed by a huge new endowment of $1.5 million—just in time for Flexner to praise the school in his report for its current reorganization “on modern lines.”40

After his report appeared, according to Flexner, “schools collapsed right and left, usually without a murmur.” In September 1911 he told a meeting of the American Hospital Association that 20 schools had folded in the last year. He attributed the closing of some “mercenary” schools “that trade on ignorance and disease” to their being boycotted by hospitals after it was made known to the public that they allowed professors from inferior schools to give instruction in their wards. By 1915 there were only 95 schools left due to closings and mergers among the approximately 130 that had existed around 1910. The shuttered schools were mostly the rotten, low-hanging fruit needing impossibly large investments to make the grade; others merged with viable schools. Another 10 schools disappeared by 1920, leaving only 85. Small proprietary schools unattached to universities were heading into extinction. Other major casualties were sectarian schools, most of them having exceedingly low entry standards and paltry resources.41

The numbers did not say everything, according to Pritchett in 1912. The “internal improvements” were “more remarkable and significant” than just reduction in numbers. One quantifiable indicator was the rise in the number of schools requiring two years of collegiate premedical training. In 1914, the AMA journal noted that state licensing boards, emboldened by the Flexner report, were using their authority to discriminate against inferior medical colleges by using the AMA’s class A as a quasi-official accreditation. Thus, for example, the Missouri State Board of Health finally got around in 1912 to rejecting graduates of the ill-reputed St. Louis College of Physicians and Surgeons. In 1917, the federal government stepped in to enhance the power of the post-Flexner state authorities. On an order from President Woodrow Wilson, the surgeon general gave young men an exemption from the draft if they were admitted to schools recognized by at least 50 percent of the states’ licensing boards. By 1918, thirty-two state boards were recognizing only colleges adhering to the CME’s two-year, A-level standard for premedical training. By 1922, diplomas granted by some medical schools were not recognized in as many as forty-six states. Pressure from the state boards taking their cues from the CME

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