History of the Highest Order

In the first decade of the 20th century, a man was called upon to write a report that would revolutionize the way medicine was taught and practiced.

The Flexner Report would be called “eminently fair and just” by some, and characterized as “impertinent meddling” by others. In the 98 years since it was published, though, every medical school, doctor, and patient in the United States has felt its positive impact. Perhaps especially so in Rochester, New York.

The report’s author, Abraham Flexner, did not consider himself an expert on medicine. He was, however, one of the world’s leading experts on education. He was born the child of poor Jewish immigrants, and worked to receive his A.B. degree from Johns Hopkins. He then started his own high school, challenging himself to learn firsthand how people learned most effectively.

In 1905, he went on to pursue graduate work at Harvard, then he traveled through Europe to study their educational systems. He later worked for the Carnegie Foundation and, in his later years, was the man responsible for bringing Albert Einstein to Princeton.

It was his report on the state of medical education, though, that brought Flexner notoriety. Andrew Pritchett, then President of the Carnegie Foundation, asked Flexner to explore the state of medical education in the U.S. No one knows exactly how Pritchett picked Flexner—Flexner himself later wondered if it had been a case of mistaken identity. Still, Pritchett could not have made a better choice, for Flexner undertook the task with zeal: First giving himself a crash course in medical education, and then spending a year visiting all 155 medical schools in the United States and Canada.

Flexner’s report was published in 1910. It created a sensation, not just among doctors, educators and politicians, but among lay people, too. The report’s findings were picked up by national newspapers, and they were sobering, to say the least. In the words of author Kenneth Ludmerer, Flexner’s report showed

The country boasted some of the best physicians in the world; it also suffered some of the very worst. The medical schools also ranged in quality from world class to abominable.

The report spared few details. It described the dissecting room at one medical school in this way: It “did duty incidentally as a chicken yard: corn was scattered over the floor—along with other things—and poultry fed placidly in the long intervals before instruction in anatomy began.”

The public was shocked by Flexner’s findings, and many politicians and reformers agreed with his recommendation: To close the vast majority of medical schools in the country—the ones known as “proprietary schools”, run as businesses to profit stockholders—and embark on a new model of medical education.

Flexner believed that with proper guidance, some of the sub-par medical schools in the country could be fixed. He was convinced that in many cases, though, the best course of action would be to start a medical school from scratch, by finding an exceptional university and creating a brand new school of medicine within it. He found that opportunity at the University of Rochester.

“Flexner thought Rochester would be a good choice,” says Chris Hoolihan, Rare Books and Manuscripts Librarian at the Edward G. Miner Library of the University of Rochester Medical Center. “The University of Rochester had an excellent reputation.”

Benjamin Rush Rhees was the president of the University of Rochester at the time, so Flexner traveled to Rochester in 1920 to meet with him. Flexner proposed the idea of establishing a medical school at the university, telling Rhees that Rochester was an ideal place for “a medical school of the highest order.”

Rhees liked the idea, but only if it was to be first class in every respect. Flexner, of course, agreed. Within weeks, the two men were presenting the idea to George Eastman, the founder of Eastman Kodak.

Eastman was also receptive, but only with the same condition that Rhees had imposed: It must be a school of the highest order. He pledged two and a half million dollars to the cause. Flexner promptly convinced him to double that, to five million. The Rockefeller Institute would put up another five million.

All three men knew that the task ahead of them was a monumental one. While medical schools had been started from nothing before, this would be the first to be founded in the wake of Flexner’s groundbreaking report. This medical center would be measured by an entirely new set of standards.

Rhees wasted no time getting to work. “Rhees approached William Henry Welch,” says Hoolihan. “He was a renowned pathologist, and ran a model department at Hopkins. He asked Welch who would be a first-rate person to develop the school. And Welch told him that the best person would be George Hoyt Whipple.”

Whipple was the director of the Hooper Foundation—a medical research institute—and the dean of the School of Medicine at the University of California. Rhees contacted Whipple, and was turned down flat. But Rhees persisted,

“Rhees told Whipple of the tremendous opportunity this represented,” says Hoolihan. “He told Whipple that he would have carte blanche, to design everything, to bring in whoever he wanted.”

In the end, it was one additional element that caused Whipple to relent: Rhees informed Whipple that the daughters of Henry Alva Strong, George Eastman’s deceased business partner, had made an additional contribution of one million dollars. Their donation would be used to start a world-class hospital to serve the Rochester area and beyond.

Whipple agreed to be the new school’s dean and moved to Rochester in 1921. He went to work designing the entire complex for the new school and hospital. In 1922, he began hiring faculty.

“It was largely young faculty, from Hopkins, Harvard and Yale,” Hoolihan relates. Their passion and new ideas would help the fledgling school and hospital to truly embark on a new age in medical education and clinical care.

In many ways, though, Whipple’s largest contribution was the model he himself set for the medical center. This would be a place of education, of clinical care, and of research, and Whipple embodied all three.

“He was a research scientist,” says Hoolihan. “Pathology was his passion, and he won a Nobel prize for that in 1934. He was also an educator who had a great feel for the way students should be brought along. And he realized the importance of first-rate hospital.”

With leadership of Whipple, and the vision of Flexner, Rhees and Eastman, the school and hospital thrived. Strong Memorial Hospital treated its first patient in 1926, and the University of Rochester School of Medicine and Dentistry graduated its first class in 1929. Over the course of the next eight decades, the University of Rochester Medical Center would live up to the great ideals that these men placed before it—providing world-class medical care to untold thousands, discovering cures for once incurable diseases, and educating the best and the brightest.

Each day, people feel the results of the visionary leadership provided by a few men in the early 1900s—and of the inspired work provided by thousands of doctors, nurses, researchers, faculty and staff at the medical center today: A broken bone mended. A diseased heart replaced. A cancer overcome. A mind enriched. A cure discovered.

Today, the medical center embarks on its greatest expansion since it’s founding in 1921. It is one of only twelve institutions in the country to be awarded a grant for medical translational research that will help expedite new discoveries from the lab to the bedside. A new facility is nearing completion to house the university’s Wilmot Cancer Center, which is already recognized for its world-leading research. The $260 million investment in the PRISM project is the largest in the medical center’s history. And its Orthopedics Department continues to lead the entire nation in federal funding.

All of this came to pass because a few people believed it was possible to create something very special, and quite extraordinary: A place that would provide medicine of the highest order.