Iowa Heritage Illustrated

Swaim, Ginalie

Iowans Mourn Lincoln

English

Iowa Heritage Illustrated, vol.89 no.3, Fall 2008

Salmagundi

Hill, James

Students at Still College of Osteopathy observe a surgery, circa 1906. The medical school was on Locust Street in Des Moines.
Abraham Flexner 
and Medical Education in Iowa
by James Hill
was "a disgrace to the state" and Education in the United States and 
deserved to be "summarily sup- Canada: A Report to the Carnegie 
pressed." The schools' graduates, Foundation for the Advancement of 
in his judgment, were ill equipped Teaching, published in 1910. But he 
for their work and their numbers did not single out Iowa's schools
excessive for the population they as notably bad. They were a small 
served—three times as many as part of the 155 medical schools in
were needed in the state. the "Flexner Report" and were no
Such was Flexner's dim view worse than many of the others he
of medical education in Iowa, as had investigated. Together they 
it appeared in his report on the absorbed his public review of their
nation s medical schools, Medical shortcomings, and for many of the
A
braham Flexner
was not one to 
mince words—not 
when it came to 
education—and
the tone of his report was charac­
teristically sharp: The four Iowa 
medical schools he had visited in 
April 1909 were all unsatisfactory. 
One was too small in its clinical 
base, two were "well-intentioned 
but feeble institutions," and one
140 Iowa Heritage Illustrated
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lesser schools that unwanted scru­
tiny was the beginning of the end.
Within ten years of the report, 
a third of the schools written up 
by Flexner had closed or merged 
with other schools. Two of the four 
Iowa schools were among them, 
and the two that survived under­
went transformations, one far 
more than the other. But Flexner 
was not yet done with Iowa. Ten 
years after he had stirred things 
up as a critic, Flexner returned 
to Iowa as the agent of renewal 
in medical education and as an 
important benefactor to the state. 
For that, Iowa's debt to Flexner 
continues to this day.
F
lexner had arrived in
Iowa as the lone agent 
of the Carnegie Founda­
tion, but he symbolized 
a growing reform move­
ment in medical education. It had 
begun in the late 19th century as 
an effort to bring medical train­
ing and practice up to modern 
standards, and as the 20th century 
opened, its progressive voice de­
manded that more be done to pro­
tect the public from poorly trained 
doctors and the medical diploma 
mills that credentialed them.
Commercial medical schools 
were an attractive business ven­
ture in 19th-century America; all 
their backers needed were a few 
rooms where a handful of medical 
men could deliver lectures on a ro­
tating basis to students who could 
afford the fee. Across the country, 
such schools multiplied from 57 
in 1880 to 160 in 1900, and Iowans 
saw much of this expansion as its 
population surged and the de­
mand for doctors grew. Thirteen 
medical schools opened in Iowa in 
the last decades of the 19th cen­
tury, from Sioux City to Keokuk, 
and all but two were proprietary
enterprises, privately owned and 
profit oriented. The State Univer­
sity of Iowa College of Medicine 
opened in Iowa City in 1870 as the 
medical department of the state 
university; in 1877, it was joined 
by a second state-supported medi­
cal department, later known as the 
Homeopathic Medical College.
Medical training in Iowa 
varied along with competing 
sects and was largely unburdened 
by fixed standards for licensing. 
That changed in 1886, however, 
when Iowa legislators passed the 
Medical Practice Act to govern 
medical education and practice 
within the state. Under the law, a 
Board of Medical Examiners set 
standards for training and ruled 
on whether a medical school had 
met them; candidates for medical 
licensure would either present a 
license from a school approved 
by the board or pass a board 
examination.
Such efforts to regulate medi­
cal education in Iowa had the 
effect of putting a good many 
commercial schools out of busi­
ness. The King Eclectic Medical 
College in Des Moines closed in 
1889, the Council Bluffs Medical 
College in 1895, and the Sioux City 
College of Medicine in 1908. Thus, 
by the time of the Carnegie Foun­
dation's survey, only four medical 
schools remained in the state: two 
regular, one osteopathic, and one 
homeopathic.
Across the nation, other states 
passed their own medical licens­
ing acts, though the requirements 
for that licensing varied widely. 
More had to be done to elevate 
standards across the board. In 
1906, the American Medical As­
sociation responded by carrying 
out a critical survey of the nation's 
medical schools through its Coun­
cil on Medical Education. The 
findings of its investigation were
little noted, however, owing to a 
claim of bias: The AMA was seen 
as reluctant to criticize its own 
members. An unbiased outsider 
was needed for another national 
survey.
LIBRARY OF CONGRESS
r
Educator Abraham Flexner, circa 1900.
A
braham Flexner was
not an M.D., and he 
had no training in 
medicine. He was 
an educator with 
degrees from Johns Hopkins and 
Harvard whose book The American 
College had come to the attention 
of Henry Pritchett, president of 
the Carnegie Foundation. Pritchett 
was impressed by Flexner's criti­
cal ability and his forceful manner 
as a writer, and he felt that Flexner 
would be the ideal person for a 
new Carnegie project: a response 
to a request from the AMA to 
carry out a survey of the nation's 
medical schools.
What Flexner lacked in health 
care experience, he made up for
Fall 2008 141
e.
in his sound grasp of educational 
principles and his practical, clear- 
thinking, analytical mind. He also 
had the advantage of his employ­
er's august name as a calling card. 
Because Flexner represented the 
Carnegie Foundation in his cross­
country travels, he had doors 
opened to him by school officials 
who must have thought financial 
benefits would follow.
Before Flexner embarked on 
his travels, he had determined that 
the best medical education could 
be found at the Johns Hopkins 
Universitv medical school, which 
was based on European scientific 
and clinical models. The "proper 
basis" of medical education, in
his view, should be grounded in 
the pure and applied sciences and 
include laboratory work, thus 
preparing the medical student for 
the clinical part of training. His 
vision embraced higher admission 
standards for students, access to a 
variety of cases in a modern hospi­
tal, and liberal amounts of clinical 
instruction. It also included a med­
ical faculty who were full-time. 
Flexner knew that a survey of 
American medical schools would 
show that most fell well short of 
the high Johns Hopkins standard. 
A year of fieldwork followed.
In April 1909, Flexner visited 
schools in Iowa City and Des 
Moines. He arrived in Iowa City
in the afternoon, conducted a 
hurried tour of the university's 
College of Medicine in the com­
pany of school officials, and left 
the following day. At each school 
he visited, Flexner collected a half- 
dozen pieces of information, and 
usually he gathered them quickly: 
entrance requirements, student 
enrollments, teaching staff, re­
sources available for maintenance, 
laboratory facilities, and clinical 
(hospital) facilities.
As one might have expected, 
Iowa's schools did not measure up 
to the Johns Hopkins standard. 
The opportunities for clinical 
teaching at the Drake University 
College of Medicine were "in
SPECIAL COLLECTIONS UNIVERSITY OF IOWA UBRARIES. IOWA CITY. PHOTO CIRCA 1905-1910
A lecturer in the University of Iowa College of Medicine holds the attention of male and female students. On behalf of the 
Carnegie Foundation, Abraham Flexner visited Iowa’s four medical schools in I 909. None of the four met his high standards.
142 Ioiva Heritage Illustrated
Flexner inspected the College of Homeopathy in Iowa City and the Drake University College of Medicine in Des Moines.
every respect inadequate"; the 
laboratory facilities at the Still Col­
lege of Osteopathy in Des Moines 
had no laboratory equipment; the 
clinical facilities at the University 
of Iowa College of Homeopathic 
Medicine consisted of a 35-bed 
hospital, "quite inadequate to its 
purpose"; and several members of 
the teaching staff at the University 
of Iowa College of Medicine were 
non-resident, with the professor of 
surgery based in Sioux City and 
the professor of gynecology in 
Dubuque.
In sum, Flexner found the 
schools falling short in one way or 
another, and all hobbled by inad­
equate clinical facilities for teach- 
ing. Of the four medical schools 
in the state, none is at this time 
satisfactory," he wrote. Taking into 
account the state of medical educa­
tion and the oversupply of doctors, 
he recommended that the two Des 
Moines schools cease operations.
The osteopathic school, he wrote, 
should be "summarily suppressed," 
and the Drake University College of 
Medicine should "retire from a con­
test to which [it] is clearly unequal."
Hexner recommended that the 
homeopathic school in Iowa City,
with its low attendance and meager 
prospects for growth, be absorbed 
into the university's College of 
Medicine, and that one school serve 
the medical education needs of the 
entire state.
T
he experience of Iowa's
four medical schools 
was typical of those 
in other states where 
the scrappiest or the 
middling schools survived and 
the weak perished. The Drake 
University College of Medicine 
closed in 1913, and the University 
of Iowa's College of Homeopathy 
was absorbed by the College of 
Medicine in 1919. The Still College 
of Osteopathy survived, follow­
ing reorganization in 1911. Over 
the years, it underwent still more 
organizational change, and today 
its descendant is the College of 
Osteopathic Medicine and Surgery 
at Des Moines University.
Flexner's impact on medical 
schools in Iowa was dramatic, 
but his recommendations to the 
University of Iowa College of 
Medicine had the most far-reaching 
effect on medical education in the
state. He had listed shortcomings, 
notably the absence of a resident 
faculty at the college and a short­
age of clinical patients for teach­
ing—a problem in a rural state 
like Iowa—but he allowed that the 
college could be salvaged given 
a full commitment to his recom­
mended improvements and the 
right leadership.
This was done. Under the 
leadership of University of Iowa 
President George MacLean and 
William Boyd, chairman of the 
Finance Committee of the Iowa 
State Board of Education, the rescue 
of the College of Medicine began. 
With additional funding available 
for new hires, the college recruited 
an eminent physician from McGill 
University—answering Flexner's 
call for a "great clinician"—and over 
time succeeded in attracting other 
promising faculty to Iowa City.
State funds were appropriated to 
expand medical facilities west of the 
Iowa River—a children's hospital 
in 1919 and a psychiatric hospital in 
1920. And perhaps most important, 
state laws were passed that ensured 
the college would never again be 
short of clinical patients for teach­
ing. In 1915, the Iowa General As­
Fall 2008 143
LEFT SHSI (IOWA CITY) RIGHT: DRAKE UNIVERSITY YEARBOOK 1905
/
sembly passed the Perkins Law, and 
in 1919 the Haskell-Klaus Law—the 
"indigent care laws"—granting poor 
Iowans, both children and adults, 
care in the University of Iowa 
Hospitals at state expense, and thus 
generating a steady base of patients.
I
t was Iowa's good luck that 
after 1910 Flexner moved 
on from the Carnegie 
Foundation to a branch 
of the Rockefeller Foun­
dation, the General Education 
Board. As a board trustee for 
many years, Flexner had a say 
in the distribution of grants to 
colleges and universities, and he 
was able to contribute to the im­
provement of medical education 
through the provision of funds 
for the construction of modern 
medical facilities and the en­
dowment of full-time faculty 
positions. As Flexner recalled in 
his autobiography, "In less than 
ten years—between 1919 and 
1928—operating with something 
less than fifty million dollars, the 
General Education Board added 
half a billion dollars or more to 
the resources and endowments 
of American medical education."
One of those large gifts was 
made to the state of Iowa. In 1920, 
William Boyd and University 
of Iowa President Walter Jessup 
contacted Flexner with a request 
for a grant to help expand the 
university's medical facilities.
Flexner answered quickly and with 
encouragement. He and Boyd 
had developed a warm personal 
friendship over the years, and 
he was gratified that the univer­
sity had responded promptly 
to his earlier recommendations.
He advised the men to propose 
something on a large scale instead 
of the piecemeal plan they envi­
sioned for the medical campus. 
This they did.
When Flexner took the Iowa 
plan to the General Education 
Board, however, he met resistance. 
Board policy restricted funding 
to privately endowed schools; 
tax-supported state universities 
were not part of its philanthropy.
It wasn't until 1922, therefore, 
that the board and the Rockefeller 
Foundation were sufficiently 
moved by Flexner's patient argu­
ments to approve grants for $2.25 
million for the Iowa project. An 
equal amount was to come from 
the state of Iowa.
How had Flexner prevailed 
in the face of resistance from the 
General Education Board? He had 
convinced his fellow trustees that 
a "model" school in Iowa would 
compel other midwestern states to 
follow its example at their own ex­
pense, so as not to be left behind. 
As he later noted with satisfac­
tion, "Within a few years Mis­
souri, Michigan, Minnesota, and 
Wisconsin—all of which were far 
better than Iowa when our action 
was taken—entered into friendly
rivalry in order to create within 
their own states the facilities and 
opportunities which Iowa offered 
to its own youth in the field of 
medicine."
With the state portion of the 
$4.5 million approved in 1923, 
planning began, and in 1928, the 
new medical campus—including a 
new general hospital and medical 
laboratories facility—was com­
plete. It was a campus in which 
all Iowans could take pride. What 
had begun 18 years earlier as a 
desperate effort to save the Col­
lege of Medicine from collapse 
had succeeded beyond the wildest 
dreams of anyone. Over the next 
80 years, it grew out from that 
central core and today stands as 
a medical center with a national 
reputation in cutting-edge health 
care and research. For that remark­
able rise from the dismal pros­
pects of 1910, a nod of thanks is 
owed the man from the Carnegie 
Foundation who had stepped off 
a train in Iowa some years before 
and started a shake-up of medical 
education in the state. ❖
James Hill became acquainted with the 
Abraham 'Flexner story while research­
ing the history of the University of Iowa 
Hospitals ami Clinics for a book-length 
project. His interest in Flexner remained 
long after the project was completed, and 
this article is the result of his further 
research. Hill works at Pearson in Iowa 
City and lives in Coralville.
NOTE ON SOURCES
I would like to thank the staffs of the University of Iowa Archives and the State Historical Society of Iowa for their assistance with my research and for their helpful 
suggestions. Among the sources I used for this article are Lee Anderson. "A Great Victory: Abraham Flexner and the New Medical Campus at the University of 
Iowa.” Annals of Iowa. 5 1 (Winter 1992); Thomas Bonner, IconodastAbraham Flexner and a Life in Learning (Baltimore: Johns Hopkins University Press, 2002): Abraham 
Flexner, Abraham Flexner: An Autobiography (NewYork: Simon and Schuster I960); Abraham Flexner Medical Education in the United States and Canada:A Report to 
the Carnegie Foundation for the Advancement of Teaching. Bulletin No. 4 (New York: Carnegie Foundation for the Advancement of Teaching, 1910); John Gerber et 
al, A Pictorial History of the University of Iowa (Iowa City: University of Iowa Press. 1988); Mark Hiatt, “The Amazing Logistics of Flexner's Fieldwork," Medical Sentinel 
5:5 (2000); Susan Lawrence, “Iowa Physicians: Legitimacy. Institutions, and the Practice of Medicine,” Annals of Iowa 63 (Winter 2004); Samuel Levey, et al.. The Rise 
of a University Teaching Hospital, A Leadership Perspective: The University of Iowa Hospitals and Clinics (Chicago: Health Administration Press, 1997); Stow Persons. The 
University of Iowa in the Twentieth Century: An Institutional History (Iowa City: University of Iowa Press. 1990); Paul Starr The SodaI Transformation of American Medicine: 
The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books. 1982); and Steven Wheatley. The Politics of Philanthropy Abraham Flexner and 
Medical Education (Madison: University of Wisconsin Press, 1988).
Annotations to the original manuscript are in the Iowa Heritage Illustrated production files. State Historical Society of Iowa (Iowa City). _____
144 loica Heritage Illustrated


Abraham Flexner and Medical Education in Iowa

Beranek, Leo

Earning My Way in Iowa: Prologue to a Career in Sound

Iowa Heritage Illustrated, vol.89 no.1-2, Spring-Summer 2008

Veeder, Grant

Abraham Lincoln and the Hawkeye State

Yearly Index, Iowa Heritage Illustrated, v.89 2008

Iowa Heritage Illustrated, vol.89 no.4, Winter 2008

Grant, H Roger

The Chinese 
Come to Iowa
by H. Roger Grant
The vital role played by thousands of Chinese la- erans of the Central Pacific stayed with the company borers in building the Central Pacific Railroad, and remained in railroading, including building andwhich linked the east and west coasts at Promon- maintenance projects outside the West. Resistance to
tory, Utah Territory, is commonly known. Yet it is less these new Americans existed and grew. Beginning in
widely recognized that when the track was officially 1868, these strong feelings led to various pieces of fed-
completed on May 10, 1869, contractors selected an eral Chinese exclusion legislation and in the mid-1880s
eight-man Chinese crew to place the last section of prompted a bloody strike at coal mines operated by
iron rail, honoring the invaluable contributions made Union Pacific in Wyoming Territory. Euro-Americans
by these people from Asia. often did not take kindly to the "Heathen Chinese"
Chinese immigrants solved the critical shortage of who competed for good or scarce jobs, especially in
workers as the line took shape eastward from its west- the West.
ern terminal at the public wharf on the Sacramento Although a few Chinese drifted to Iowa and stayed,
River in Sacramento, California. Euro-American laborers newspaper reports, both national and local, made much
found more profitable and less back-breaking work in of a large party of Chinese passing through the Council
agriculture and mining and seemed content to allow Bluffs area months after completion of the transconti-
foreigners to build the Central Pacific. The Chinese nental rails. On January 22,1870, the widely circulated
willingly assumed the dangerous and difficult tasks of Harper's Weekly took notice of their activities in a brief,
blasting and picking out a right-of-way across the rug- illustrated article, "Coolies for Texas" (right). Reported
ged Sierra Nevada Mountains and endured the hard- the paper: "The Mongolian invasion has begun at last
ships of pushing track across the vast wastelands of in good earnest, and the advance-guard of the peace-
Nevada. ful army has already crossed the Missouri River. On
The opening of the Union Pacific-Central Pacific the 26th of December the first detachment of Chinese
rail artery not only strengthened the nation, but ben- laborers engaged to work on a railroad now building
efited Iowa. Not long after the driving of the ceremo- in Texas, numbering 250 men, arrived opposite Coun-
nial spikes at Promontory, three railroads—Chicago cil Bluffs."
& North Western; Chicago, Burlington & Quincy; and Perhaps the piece implied possible "yellow peril."
Chicago, Rock Island & Pacific—linked Chicago, the More likely, though, there existed an intrinsic interest
emerging railroad mecca of America, with Council in how these Chinese made their way from the Ne-
Bluffs, the eastern terminus of the Union Pacific. These braska to the Iowa side of the stream. "The river was
carriers handled the expanding "bridge" or inter- covered with a pack of broken ice sufficiently strong to
change traffic with the new transcontinental route. prevent the passage of boats. [The Union Pacific would
Although some Chinese returned to their home- not bridge the "Mighty Mo" until 1872.] A plank walk
land after the Central Pacific building period, others was laid across the uneven surface, on which the Celes-
remained in America. California became an important tials passed over to the eastern side of the river ... carry-
center for these former railroad workers who might ing their baggage on poles balanced over the shoulder,
earn their livelihoods in farming or in restaurant and in true Oriental fashion."
hand-laundry businesses. But some construction vet- The Council Bluffs Daily Nonpareil did not ignore
190 Iowa Heritage Illustrated
CHINESE .COOLIES CROSSING THE MISSOURI RIVER.—[ S k e t c h e d  u y  L e a v i t t  R c n s u v M . ]
the coming into the town's midst of several hundred Bugle, for one, called them "Johnny Chopstick," hardly
Chinese laborers. Under the headline "Chinamen Gone a term of endearment. But the Chinese "invasion" war-
South," a story on January 14 indicated that "three ranted no meaningful concerns.
hundred Chinamen came in over the Union Pacific While some of these experienced railroad work-
Railroad on Monday and left in the afternoon for Mem- ers may have headed to other work sites, including
phis by the St. Joseph and Council Bluffs Railroad." Augusta, a large contingent did go to Texas, where
Rather than suggesting that these men were bound for they labored under the supervision of General John G.
railroad construction in Texas, the account indicated Walker, a former Confederate officer, on a predeces-
that "they're destined for plantation work in the south. sor of the gestating and strategic Texas & Pacific (T&P)
More of them are coming." Railway. The T&P would take years to complete; not
Indeed, some Chinese laborers found employment until 1881 did its rails meet the Southern Pacific near El
in the Deep South, including Augusta, Georgia, where Paso, forging a second transcontinental rail route, 
they dug a canal that supplied power to mills from the As with their earlier involvement with the Central
waters of the Savannah River. However, another Coun- Pacific, these Chinese laborers helped to bind together
cil Bluffs paper, the Bugle, had announced somewhat the American nation-state with iron rails, making pos- 
earlier that the Chinese were headed to Memphis. "We sible the benefits of the long-lasting Railway Age. ♦> 
did not learn what business they care to follow when 
they arrive in Memphis but understand they have been 
brought here under the auspices of a society organized 
at that point for the purpose of introducing Chinese 
labor into that section."
Those Chinese who made the somewhat risky ____________________________________________
crossing of the ice-choked Missouri River did not re- j-j p0ger Crant is the Kathryn and Calhoun Lemon Professor
main in Iowa, perhaps a relief to its citizenry. After all, of History at Clemson University. His article "Iowa's Brightest
the local press used current anti-Chinese language. The Railway Project" appeared in a recent issue of this magazine.
i
Winter 2008 191


The Chinese Come to Iowa

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