The College of Physicians of Philadelphia Digital Library

"Nothing More Disgraceful Calling Itself a Medical School Can Be Found Anywhere"

Abraham Flexner

Photo of Abraham Flexner from 1910.

At the beginning of the 20th century, the United States suffered from an over-abundance of physicians.  On average, there was one doctor for every 568 people in the U.S.  Compare this to Germany, known at the time for the quality of its medical education, where there was one doctor for every 2,000 people.

This “reckless over-production of cheap doctors” was the result of 19th century commercialization of medical education, as well as a lack of standards for entry to medical school.  Didactic teaching methods popular in the 19th century made medical education profitable.  Students read texts, listened to lectures, but often had little hands-on experience in laboratory or clinical settings, which allowed schools to save by not investing in equipment, libraries or cadavers.  Programs of lectures often lasted no more than 28 weeks a year for two years, with “graduates” having never attended the bedside of a patient.

Students could attend medical school lacking proof that they had graduated from high school.  Of the 148 medical schools in the United States in 1910, only 15 required at least two years of college-level class work prior to admission.

In 1908, Abraham Flexner, a prominent reformer of education, was commissioned by the Carnegie Foundation to survey the state of American medical education.  Flexner’s report, published in 1910, advocated for fewer medical schools; fewer, but better trained, physicians; a minimum of two years of college-level classes prior to admission; and four years of medical training.

Flexner’s comments regarding the teaching of anatomy were frequently harsh.  Lab facilities at one school in Philadelphia were “utterly wretched…an intolerably foul dissecting-room [was located] in a dark building, once a stable.”

Flexner stressed the importance of active learning through laboratory and clinical settings.  He acknowledged that the study of the human body required both gross anatomy and the “microscopic structure of tissues and organs” which could only be learned through histology, embryology and pathology.