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“Towards a History of Medical Higher Education in the American South: 

Southern Nationalism, Racial Ethos, and the Flexner Report of 1910” 

 

Tiffany Greer R. Eric Platt Shamekia Woods 

University of Southern Mississippi University of Memphis University of Southern Mississippi 

 

 

Abstract 

Despite some literature on medical higher 

education in the American South, there remains no 

overarching subject-specific text. As such, this 

article provides a narrative guided by literary 

premises, which, in addition to future archival 

research, has the potential to become an expansive 

regional history. Through an examination of 

relevant publications (dedicated to southern 

medical higher education or briefly acknowledging 

it), three themes emerged: southern nationalism, 

racial ethos, and the impact of the 1910 Flexner 

Report. 

 

Introduction 

Medical higher education in the United 

States has experienced dynamic changes over the 

last two-hundred years as scientific knowledge and 

illness diagnoses have expanded and improved. 

After the establishment of the College of 

Philadelphia Department of Medicine in 1765, the 

practice of training physicians slowly spread 

throughout the country. Due to the lack of 

academic regulation and the allure of lucrative 

medical training, however, various questionable 

medical colleges were founded in both the North 

and South. (Duffy 1984; Halperin, Perman & 

Wilson 2010; Ludmerer 2010). Following the 

American Civil War and the horrors of battlefield 

medical tents, academic leaders at institutions such 

as Harvard University, Yale University, and Johns  

 

Curriculum History 2018: 70-85. 

Hopkins University championed rigorous 

medical training coupled with quality clinical 

experiences and thorough student examinations. 

While other northern institutions took note and 

adapted, southern medical colleges lagged (Ebert 

1977; Slawson 2012).  

Due to the rich history of progressive 

medical education in the northern states, copious 

research and publications have been dedicated to 

institutions in Illinois, Michigan, Maryland, New 

York, Pennsylvania, etc. These texts do much to 

illustrate predominantly northern curricular trends 

while southern medical higher education is only 

briefly addressed (Rothstein 1987; Ludmerer 

1999; Solberg 2009; Grauer 2012; Aptowics 2015; 

Gotto & Moon 2016; Boster & Howell 2017). 

Though some research has been published 

regarding southern physician training, the extant 

literature is either concerned with solitary 

institutions or only briefly addresses singular 

issues within the larger region. To date there has 

been no expansive, overarching text published 

concerning regional trends like medical college 

founding, curricular development, and/or 

physician training in the southern states.  

As such, the purpose of this article is to 

provide an exploration of literary themes drawn 

from twentieth- and twenty-first-century 

publications. These themes, in turn, can provide a 

useful framework for future archival enquiries 

regarding southern medical higher education. 

Resulting from a careful analysis of existing 

literature, three themes were apparent as concerns 

the development of medical departments/colleges 



71 
 

in the American South: southern nationalism, 

racial ethos, and the influence of the 1910 Flexner 

Report. All of which directly impacted how 

physicians were trained in a region typified by 

slavery, sectionalism, and curricular intransigence.  

Despite the dearth of overarching southern-

specific literature, some regional institutions such 

as the Medical College of Louisiana, the Medical 

College of Georgia, and Morehouse School of 

Medicine have been examined in book-length 

detail, but with little consideration given as to how 

they correlate with peer colleges located in 

surrounding states (Duffy 1984; Spalding 2011; 

Gasman, Bush, & Sullivan 2012). In addition, 

there are a handful of journal articles that examine 

issue-specific subjects associated with individual 

southern medical colleges. Topics range from the 

investigation of period-specific medical journals, 

such as the Medical College of Georgia’s Southern 

Medical & Surgical Journal, to the use of enslaved 

persons as the subject of antebellum anatomical 

experiments (Savitt 1982; Worthington 1991; 

Stewart 2015). As well, some articles explore the 

influence of southern nationalism, racism, and 

sectionalist ideology on medical instruction and 

college development (Duffy 1957, 1968).  

In addition to racial ethos and southern 

nationalism, there are a handful of texts that 

chronicle the rise and fall of short-lived southern 

medical colleges that failed to adapt to radically 

changing instructional, clinical, and facility 

(laboratories, associated hospitals, etc.) 

expectations posed in Abraham Flexner’s 1910 

assessment, Medical Education in the United 

States and Canada: A Report to the Carnegie 

Foundation for the Advancement of Teaching 

(Mitchell 1944; Harley 2006; Rhodes 2007). Even 

so, in-depth historical analysis of defunct southern 

medical colleges is sparse as related primary 

documentation has been destroyed, misplaced, or 

scattered amongst other archival repositories.  

Regardless of this brief literature review, 

the South has yet to be examined as thoroughly as 

other areas of the country. As such, this article, 

“Towards a History of Medical Higher Education 

in the American South”, provides a genesis 

narrative that explores southern medical higher 

education development. In the sections that follow 

a synopsis of regional medical higher education is 

provided to contextualize the aforementioned 

literary themes. Next, each theme is explored as 

regards their geographic and temporal setting. 

Finally, considering both historic context and 

publication analysis, the authors assert the need for 

extensive southern medical higher education 

research guided by the realities of nineteenth-

century nationalism, racism, and academic 

legitimization. 

 

Overview 

Medical higher education in the United 

States was still in its early stages of development 

in the nineteenth century. Prior to 1800, there were 

only four medical colleges in the country, and 

physicians-to-be learned primarily through 

apprenticeships with practicing clinicians (Miller 

& Weiss 2008). As John Duffy (1984) notes, given 

the need for formal training opportunities, 

institutions with affiliated medical programs began 

to open, one of which was Maryland Medical 

College, founded in 1807. In the South, one of the 

earliest medical academies was the Medical 

College of Virginia, which was established in 1838 

(Bowman 2011). These emerging institutions, 

though varying in admission standards and courses 

of study, were popular in both the North and South 

for providing opportunities for middle-class males 

to acquire lucrative careers post-graduation.  

To garner additional monies, these early 

institutions, largely controlled by their faculty, 

sold public lecture tickets (Ebert 1977; Geiger 

2000; Slawson 2012). Examples of public lectures 



72 
 

include those of Dr. W. Byrd Powell and Dr. 

Edward H. Barton, both of the Medical College of 

Louisiana. In the late 1830s, Powell gave lectures 

on physiology and pathology both on campus and 

at his private offices. Likewise, Barton gave 

lectures on the influence of Louisiana’s quasi-

tropical climate on general health and endemic 

diseases at the medical college and in off-campus 

rented rooms (Fossier 1998). In addition to public 

faculty lectures, instructors at the Medical College 

of Louisiana developed the New Orleans Medical 

and Surgical Journal, which, for most of the 

nineteenth century, focused on illnesses that 

plagued south Louisiana (Duffy 1957). Similarly, 

the medical department at the Kentucky-based 

Transylvania University founded both the 

Transylvania Journal of Medicine and Associated 

Sciences in 1828, and, later in 1849, the 

Transylvania Medical Journal to disseminate 

region-specific healthcare information (Savitt 

1982). 

By 1850, fifty medical colleges had been 

established nationwide (Miller & Weiss 2008; 

Stowe 2004) but only five of said institutions were 

in the South (Mitchell 1944). These included the 

Transylvania Medical College in Lexington, 

Kentucky, Charleston’s Medical College of the 

State of South Carolina, the Medical College of 

Georgia in Augusta, the Medical College of 

Louisiana in New Orleans, and the Louisville 

Medical Institute in Louisville, Kentucky (Stowe 

2004). By the onset of the Civil War, there were 63 

US medical colleges, 16 of which were located in 

states that eventually seceded from the Union 

(Slawson 2011). Examples of these southern 

institutions include the Memphis Medical College, 

the Botanico-Medical College of Memphis, and 

the Alabama Medical College (Delaney 1981; 

Kirkland 2011). This rather quick establishment of 

southern physician training academies is largely 

 

Table 1: Medical Colleges in the American South Prior to the Civil War 

Founded Institution Location 

1824 Medical College of South Carolina Charleston, SC 

1825 University of Virginia Charlottesville, SC 

1826 Winchester Medical College Winchester, VA 

1831 Medical College of Georgia Augusta, GA 

1835 Medical College of Louisiana New Orleans, LA 

1846 Memphis Medical College Memphis, TN 

1846 Botanico-Medical College of Memphis Memphis, TN 

1850 University of Nashville Nashville, TN 

1852 Savannah Medical College Savannah, GA 

1854 Medical College of Virginia Richmond, VA 

1854 Reformed Medical College of Georgia Macon, GA 

1855 Atlanta Medical College Atlanta, GA 

1856 New Orleans School of Medicine New Orleans, LA 

1856 Oglethorpe Medical College Savannah, GA 

1858 Shelby Medical College Nashville, TN 

1860 Medical College of Alabama Mobile, AL 



73 
 

attributed to a rise in sectionalism and southern 

nationalism (Duffy 1957). However, with the 

coming of southern secession and war, the coming 

of southern secession and war, the majority of 

southern colleges closed due to both students and 

faculty enlisting in Confederate armies (Cohen 

2012).  By 1861, only one of the 16 Confederate 

state medical colleges, the Medical College of 

Virginia in Richmond, remained open (Slawson 

2011).  

In addition to these war-caused closures, 

battles associated with the sectionalist cause 

brought with them the horrifying reality that 

medical training, particularly in the American 

South, was far from adequate. Although the 

engineering science of warfare had advanced to 

include explosive mortar shells and flesh-tearing 

minié musket balls, medical science still consisted 

of only a limited array of curative strategies. 

Penicillin and effective anesthetics had yet to be 

discovered and amputation was an all too common 

occurrence that cast a dark shadow over army 

doctors’ tents. Infection was rampant sans 

antibiotics, and wounds excreting puss were 

inaccurately diagnosed as a positive sign of 

healing. Consequently, “the common soldier,” as 

Simon Winchester puts it, was “monstrously 

treated by all the new weaponry, and yet only 

moderately treated with all the old medicine” 

(2005, 52). Likewise, wartime disease was 

widespread. Soldiers regularly died of typhoid and 

pneumonia, which were “treated with the 

ignorance of the day, with little more than . . . 

opium or calomel, painkiller and purgative” 

(Winchester 2005, 66). If anything, the bodily 

damages of the Civil War taught medical 

practitioners and educators alike that medical 

science and instruction needed to advance. 

As Reconstruction medical science 

progressed with new surgical instruments and 

more advanced pharmaceutical applications, the 

number of medical colleges increased. In the 

century following the Civil War, 457 medical 

colleges opened in the United States and Canada, 

the majority being proprietary (Ebert 1977). By 

1900, enrollment in US medical higher education 

reached approximately 49,000 students (Burke 

1982). Even so, as historian Roger Gieger (2000) 

reports, of those attending medical colleges, only 

7.9% graduated and received a medical degree in 

1880, 9% in 1890, and 10.2% in 1900. Equally 

disappointing, a significant portion of these 

institutions, such as the Medical College of 

Alabama, closed prior to the mid-twentieth century 

(Brown 2018).  

In addition to poor graduation rates and 

short-lived institutions, clinical study in 

nineteenth-century proprietary medical programs 

was rare as very few were even affiliated with a 

university, let alone a hospital that could readily 

supply experiential student opportunities. 

Understanding the need to provide practical 

learning experiences, early medical colleges went 

to great lengths to deliver clinical opportunities. To 

offset this curricular deficit, medical doctors with 

preexisting hospital affiliations were often hired as 

instructors in lieu of those physicians who had no 

infirmary or sanitarium connections (Ebert 1977). 

While some institutions hired faculty affiliated 

with local hospitals, other colleges founded their 

own clinics or hospitals to provide needed 

practitioner encounters (Slawson 2012).   

Institutions that had clinical opportunities 

advertised their hospital connections to recruit new 

students. An example of this important affiliation 

can be seen in the case of Tulane University 

Medical Center, which was created in 1847, when 

the Medical College of Louisiana merged with 

then University of Louisiana (present-day Tulane 

University of Louisiana) (Mohr 2011). In his 1984 

history of Tulane University Medical Center, 

Duffy points out that the New Orleans-based 



74 
 

institution had a long-standing clinical, student-

training relationship with Charity Hospital—a 

colonial infirmary opened in 1736 that remained in 

existence until the devastation of Hurricane 

Katrina in 2005 (Duffy 1984; Salvaggio 1992). In 

fact, this all-important affiliation influenced 

Abraham Flexner, who would soon go on to cause 

enormous changes in the field of medical 

education. After visiting the New Orleans 

institution in January of 1909, Flexner declared 

Tulane University Medical Center as being “one of 

a very few existing southern schools that deserve 

development” (1910, 233).  

Prior to Flexner’s 1910 report, medical 

colleges, North and South, possessed curricular 

structures like those developed at early on at 

Harvard Medical School. Academic terms lasted 

approximately four or five months, depending on 

the institution. These lecture-based courses and 

associated anatomical laboratory experiences were 

then repeated for a second year. Medical students 

typically followed one of two curricular tracks. 

Students who desired employment as “surgeons” 

post-graduation were usually provided intensive 

clinical and/or laboratory experiences (human 

examination and, when possible, dissection) and 

apprenticeship/internship opportunities to perfect 

their skills at surgery, amputation, and bleedings 

(Wilder 2013).  

Students who wished to become “physicians,” on 

the other hand, spent more time in the classroom 

studying internal medicine, chemistry, and 

pharmaceutical application. Having completed this 

relatively brief retinue of courses, and with the 

payment of graduation fees (in addition to tuition 

costs), students were awarded a doctorate of 

medicine degree (Wilder 2013). As most states had 

licensure laws that granted practicing rights upon 

graduation, the proliferation of low rigor 

proprietary medical academies swelled. The 

widespread existence of such low rigor 

institutions, particularly in the South, led historian 

Colin B. Burke to note, “The body of formalized 

medical education [in the mid-nineteenth century] 

was inadequate, if not incorrect and dangerous . . . 

” (1982, 252). 

However, as both Johns Hopkins Medical 

School in Baltimore, Maryland and the Harvard 

School of Medicine began to modernize their 

curricular structures, hire more astute professors, 

and employ harsher student examination 

procedures, other period medical colleges, like 

those associated with Yale University or the 

University of Michigan, followed suit (Cremin 

1988; Geiger 2000). As Roger Geiger explains, 

“Not only had the requirements for a M.D. been 

greatly expanded, but the advantage to future 

practitioners shifted decisively away from cheap 

degrees in favor of rigorous preparation” (2000, 

273). Between the late 1800s and early 1900s, 

American medical higher education underwent a 

transition from practices solely based on theory to 

training based on scientifically supported 

treatments and diagnostic evaluations. Before this 

transition, medical education and practice was 

dictated by various conflicting theories that aimed 

to explain health and disease (Cardinal & Kaell 

2017). 

Before these late-nineteenth-century 

curricular revisions, the admission standards for 

most US medical colleges were slack and 

unregulated (Ludmerer 1999). It was not until 

1905 that a high school diploma became mandated 

nationwide as an admission standard for medical 

programs (Cardinal & Kaell 2017). Eventually, 

having a bachelor’s degree was required to enroll 

in medical study. The period between 1870 and 

1910 saw sweeping change in medical higher 

education but only in a handful of leading 

institutions. Despite advances in some northern 

medical colleges, southern medical higher 

education failed to improve instruction and 



75 
 

scientific considerations. It was this uneven 

trajectory of reform that ultimately led to the 

development of a mass medical training inspection 

that culminated in the Flexner Report of 1910 

(Cremin 1988), wherein southern institutions were 

harshly judged for delays in improvement. Even 

so, throughout the nineteenth century, southern 

medical higher education relied on a precedent of 

“exceptionalism” that painted regional medical 

needs as being unique to the quasi-tropical climate 

and racially bifurcated social strata once 

capitalized by radicalized slavery and later 

substantiated by sharecropping and Jim Crow law. 

Such, in the minds of southern intellectuals, set the 

South apart from the instructional and practitioner 

norms of the North.  

 

Southern Nationalism 

The idea of “southern medicine,” being 

inherently different from the medical practices of 

the North, exemplified the extent to which 

southern nationalism had permeated academia. 

There are numerous examples of authors 

establishing “southern medicine” as a unique 

phenomenon in the landscape of medical history 

(Mitchell 1944; Duffy 1957; O’Brien 2010), 

whether due to the climate and the resulting 

differences in prevalent diseases (Stewart 2015) or 

through the inherently racist views pertaining to 

physiological differences between white patients 

and the enslaved “negro” population (Duffy 1968; 

Kenny 2013 & 2016; Willoughby, C.D. 2017). 

This kind of sectionalism reinforced the 

ideological need to establish state medical colleges 

and attract those southern students who had, for the 

first half of the nineteenth century, attended 

northern physician training institutions.  

Duffy (1968) illustrates how southern 

nationalism manifested itself in period medical 

practices via the reliance on eighteenth-century 

medical treatises that described a variety of 

diseases that were linked to regional climate and 

topography. In the eighteenth and nineteenth 

centuries, burgeoning southern intellectuals 

reasoned that sicknesses present in the American 

South were inherently different from those in the 

North. Sectionalist medical professionals argued in 

editorials that students who received medical 

training in the North were unprepared to deal with 

illnesses brought on by the southern climate (Duffy 

1957; 1968). In one such editorial, physician James 

C. Billingslea declared that anyone with 

aspirations to practice medicine in the South 

should receive a southern education because 

medical practice in the humid, muggy, tropical-

fever-ridden region “is entirely different from that 

taught in northern institutions, and by northern 

writers” (1856, 215). As early as the 1830’s, before 

there were any established medical colleges in the 

South, there was a call by sectionalist medical 

professionals demanding that medical students 

study the peculiarities of southern diseases or 

obtain remediation after graduating from Northern 

medical colleges if they intended to practice in the 

South (Kilbride 1999; Stewart 2015).  

As late 1850s sectionalism intensified and 

the threat of disunion and civil war grew, the 

demand for southern medical colleges increased 

(Duffy, 1984). Due to intense southern nationalism 

and enhanced numbers of southern medical 

colleges, students who heralded from such states as 

Arkansas, Mississippi, and Tennessee returned in 

ever-increasing numbers to enroll in newly minted 

medically academies firmly affixed in their home 

states (Mitchell, 1944). This exodus of southern 

students from northern medical colleges 

culminated in December of 1859, when 

approximately 200 students withdrew from 

colleges in Philadelphia and transferred to 

southern institutions. The majority of these 

students enrolled at the Medical College of 

Virginia. This educational egress was celebrated in 



76 
 

a variety of southern newspapers published in 

cities such as New Orleans and Richmond 

(Mitchell 1944; Duffy 1957).  

As the exodus of southern students from 

northern medical colleges progressed, many 

southern academies relied on southern nationalist 

propaganda to recruit. Medical colleges like 

Virginia’s Hampden-Sydney College framed their 

clinical opportunities as uniquely southern in 

nature (Stewart 2015). Similar, the Medical 

College of Louisiana touted its expertise and 

proximity to yellow fever outbreaks and other 

tropical diseases to entice interested students 

(Duffy 1984). To a greater or lesser extent, all 

southern medical colleges, regardless of state 

association, relied on a careful mixture of regional 

pride and racist ideologies to lure southern students 

who were likewise supportive of segregation. 

Racial Ethos 

Southern nationalism went far to wed 

racism and slavery to regional medicine. As a 

result, physicians cataloged numerous 

physiological and mental conditions that applied to 

slaves (Wilder 2013). Southern doctors and 

medical educators, when espousing the 

exceptionality of their medical colleges, argued 

that the physiological differences between whites 

and the large enslaved population required 

scientific attention to address diseases that were 

relevant to each race. For example, it was 

commonly held that individuals of European 

descent were more susceptible to yellow fever than 

persons of African descent (Carrigan 2015; 

Willoughby C.D. 2017). It was also argued, largely 

due to the American eugenics movement and the 

marginalizing effects of pseudo-scientific 

phrenological claims, that there were significant 

intellectual disparities between individuals of 

European ancestry and those of African descent. 

Even more disturbing was the reliance on 

nineteenth-century medical practices (such as 

forced gynecological examinations) to determine 

which enslaved females should procreate with 

healthy slave males in order to produce new 

generations of forced labor (Smith 1998; Goodson 

2003; Winfield 2007; Tomlinson 2013; Kenny 

2013 & 2016; Sublette & Sublette 2016; Forret 

2016; Willoughby U.E. 2017).  

Indeed, southerners from all professions 

attempted to rationalize the institution of slavery 

by arguing that the anatomical differences between 

blacks and whites were so great as to warrant 

separate medical practices. Samuel Cartwright, a 

native of Virginia who had practiced medicine in 

both Mississippi and Louisiana, published 

profusely about the social requirement of 

segregated medical facilities and diagnostic 

sciences. He even went so far as to “discover” 

uniquely “negro” disorders, such as drapetomania, 

a mental illness that Cartwright asserted caused 

slaves to run away from their plantation masters 

(Duffy 1968). While not all physicians of the era 

were as outspoken as Cartwright, most of his 

contemporaries subscribed to an ideology that 

insisted on wholly different medical treatments for 

each race (Mitchell 1944). In 2017, historian 

Christopher D. Willoughby highlighted this 

phenomenon of period specific, race-based 

medical theories and practices after examining 

over 4,000 nineteenth-century medical students’ 

theses. In his research, Willoughby observed a 

distinct ideological shift toward racial medical 

differences in periods of increased sectionalism 

and southern nationalism (2017). 

In addition to the physiological differences 

highlighted by nineteenth-century medical 

professionals, southern medical academies made 

regular use of slave labor to perform tasks 

including, but not limited to, resurrection—the 

illegal exhumation of human remains for autopsy 

(Schultz 1992). Prior to emancipation, some 

medical colleges, such as the Medical College of 



77 
 

Georgia, used enslaved persons to procure corpses 

for instructional dissection and student surgical 

practice. Grandison Harris, a slave purchased for 

$700 by the faculty of the Georgia-based medical 

institution, not only dug up corpses and transported 

them to the college under cover of night, he was 

also forced to bury the dismembered remains in the 

college’s basement to conceal the illicitly procured 

bodies (Cohen 2012; Wilder 2013).  

As well as providing labor for unpleasant 

tasks such as the abovementioned, slaves were also 

exploited for clinical purposes and were easily-

acquired specimens for antebellum colleges. As 

described by historian Todd L. Savitt: “southern 

white medical educators and researchers relied 

greatly on the availability of negro patients for 

various purposes. Black bodies often found their 

way to dissecting tables, operating amphitheaters, 

classroom or bedside demonstrations, and 

experimental facilities. . . . blacks were particularly 

easy targets, given their positions as voiceless 

slaves or ‘free persons of color’ in a society 

sensitive to and separated by race. . . . Blacks were 

considered more available and more accessible in 

this white-dominated society: they were rendered 

physically visible by their skin color but were 

legally invisible because of their slave status” 

(1982, 331-332).  

A majority of southern medical education 

institutions engaged in slave examination and 

experimentation including, but not limited to, 

Transylvania University Medical Department in 

Kentucky, Louisville Medical Institute, Atlanta 

Medical College, and the Medical College of 

South Carolina. Faculty at the Medical College of 

South Carolina advertised in local newspapers 

requesting that plantation owners bring sick slaves 

to the institution for diagnosis, pharmaceutical 

treatment, or, in some cases, surgery (Savitt 1982). 

In short, slaves were exploited as medical 

specimens to both train students and attract 

potential enrollees. Medical colleges that 

advertised training with live humans (in addition to 

the dissection of corpses) were more likely to 

attract larger enrollments than those who could not 

provide human subjects, living or deceased, black, 

white, or otherwise.  

Knowledge of medical college slave abuse 

spread throughout the South and, as a result, 

enslaved persons were frightened by the notion 

that, after they or their loved ones passed away, 

their bodies would be used for medical student 

autopsies and discarded without proper burial. This 

fear spilled over into the Reconstruction era and 

spawned such nightmarish tales amongst black 

communities as “’night doctors’ who stole, killed, 

and then dissected black people (Savitt 1982, 340). 

These fears would become all too real in 1930s 

Alabama when members of the US Public Health 

Service, in conjunction with officials at Tuskegee 

University, performed unethical syphilis studies on 

hundreds of unknowing African American males 

(Jones 1993).  

These ties to the institution of slavery 

should come as no surprise given that, in the late 

eighteenth and early nineteenth centuries, founders 

of medical colleges in both the North and the South 

were entrenched in the tradition of purchasing and 

keeping human chattel. According to historian 

Craig Steven Wilder (2013), cofounders of the 

medical college in Philadelphia, John Morgan and 

William Shippen, Jr., both owned slaves and were 

wed to major slave holding families. Likewise, 

“New York surgeon John Bard, president of the 

local medical society, secured his family’s 

economic position by investing in land and slaves” 

(Wilder 2013, 228). 

During the antebellum era, plantations 

owners provided rudimentary health care for 

slaves. After emancipation, however, freedmen 

were devoid of basic medical attention. Even 

though the Freedman’s Bureau provided some 



78 
 

financial assistance for healthcare, most hospitals 

were predominantly white serving with little time 

or attention given to black patients. Prior to the 

Civil War, the need to provide physician training 

to African Americans was recognized by some 

northern medical colleges. As a result, some 

integrated. In 1848, Bowdoin Medical School in 

Maine conferred medical degrees to John V. De 

Grasse and Thomas J. White. Less than ten years 

later, Berkshire Medical School in Massachusetts 

graduated two African American in 1858. By 

1860, nine northern medical colleges in total had 

admitted black students (“Black History Month: A 

Medical Perspective, Education” 2018).  

On the contrary, in the South, per the 

steadfast precepts of late-nineteenth-century 

southern segregationists ideology, enhanced by the 

1896 “separate but equal” ruling in Plessy v. 

Ferguson and de jure Jim Crow law, separate 

educational institutions to train black doctors were 

founded. As a result, fourteen African American 

medical colleges, such as Flint Medical College in 

New Orleans and the Raleigh, North Carolina-

based Leonard Medical School, opened to provide 

training for black men who were expected to care 

for an expansive population bereft of medical  

attention (Rhodes 2007; Harley 2006). However, 

half of these institutions closed before the 

twentieth century, leaving only seven to educate 

black medical professionals. 

While Howard University College of 

Medicine and Meharry Medical College remain 

viable in the twenty-first century, the remaining 

five closed before the 1920s due to the crippling 

results of the 1910 Flexner Report, decreased 

student numbers, and loss of external funds. For 

example, Flint Medical College, (opened in 1889 

as a physician-training department associated with 

New Orleans University) was originally supported 

by the Freedman’s Aid Society, the Methodist 

Episcopal Church, and private citizens (Rhodes 

2007; Hart 2013).  However, during the early 

twentieth century enrollment steadily decreased as 

funding from the aforementioned religious, 

organizational, and private citizen sources waned. 

When the Flexner Report was published, damaging 

claims about the college’s inability to provide 

adequate training further dampened enrollments 

and the institution’s board of trustees decided to 

close the college in 1911 (Rhodes 2007). Per 

Flexner, “Flint Medical College is a hopeless 

affair, on which money and energy alike are 

wasted” (1910, 233). 

 

Table 2: Early-Twentieth-Century African American Medical Colleges 

Founded Institution Location 

1869 Howard University College of Medicine Washington, DC 

1873 Meharry Medical College Nashville, TN 

1882 Leonard Medical School Raleigh, NC 

1888 Louisville National Medical College Louisville, KY 

1889 Flint Medical College New Orleans, LA 

1900 Knoxville Medical College Knoxville, TN 

1900 University of West Tennessee Medical Department Memphis, TN 

 

 

 

 



79 
 

Impact of the Flexner Report 

As a step toward standardizing medical 

higher education, medical organizations such as 

the American Medical Association (founded in 

1847) pressed for curricular revisions in 

nineteenth-century medical colleges. Admission 

requirements also became a focus of these 

standardization efforts, and some colleges began to 

tighten their requirements in the mid-1800s, with 

the trend becoming more widespread following the 

Civil War (Miller & Weiss 2008). These reform 

efforts were often met with objections from faculty 

due to the limitations they would impose on the 

number of eligible students (Slawson 2012). 

Medical colleges in the South, even those with 

excellent reputations, were often unable to meet 

the American Medical Association’s standards, 

particularly with difficulties associated with 

reopening institutions temporally closed by the 

Civil War (Duffy 1984).  

As academic reform became commonplace 

in medical higher education, malpractice and low 

standards become evident at southern institutions. 

Though the requirement for potential students to 

possess bachelors’ degrees had become an 

accepted norm, it was reported that Tulane 

University Medical Center, in the early twentieth 

century, was still accepting students with no 

undergraduate degree whatsoever. Despite being 

one of the South’s “premier” medical colleges, the 

Louisiana institution had continued to rely on an 

age-old and outdated policy that applicants provide 

their high school diploma alone for program 

admittance (Platt 2014). It was amidst these early 

attempts at reform, and the resulting academic 

push back, that Abraham Flexner was 

commissioned by the Carnegie Foundation, with 

the approval of the American Medical Association, 

to determine deficiencies in US and Canadian 

medical instruction and make recommendations 

for the standardization of medical training 

practices (Halperin, Perman, & Wilson 2010; 

Ludmerer 2010; Leslie 2011).  

 Flexner spent the better part of a year 

touring each of the then existent 155 US and 

Canadian medical colleges before publishing his 

recommendations. The report laid out deficiencies 

noted at each medical college and included harsh 

recommendations for improvement. Flexner went 

so far as to call for the closure of 117 US 

institutions (Flexner 1910; Ebert 1977). 

Resultantly, deficiencies described in the report 

such as inadequate laboratories, poor equipment 

funding, unacceptable admission standards, etc. 

ultimately led to the closure of most US 

proprietary medical colleges (Miller & Weiss 

2008).  

The report was especially harsh concerning 

medical colleges in the South. Flexner grouped the 

institutions he visited into three divisions. The first 

division which listed sixteen institutions—none 

from the South—was dedicated to medical 

academies deemed worthy of operation and 

recognized as providing quality educational 

services to their home states (1910). The second 

division, containing fifty colleges, listed 

institutions that should be kept open, so long as 

they were significantly improved. Only one 

southern medical college, Tulane University 

Medical Center, was included in the second 

division of the Flexner Report, but not without 

criticism. The Louisiana medical college needed to 

enhance admission standards and increase 

academic rigor if it was to continue operation 

(Duffy 1984).  

Various northern institutions, as well as all 

other medical colleges in the American South, fell 

into Flexner’s third division. These academies 

were condemned for a variety of reasons including, 

but not limited to, extremely lax entrance 

requirements. Flexner explained that the majority 

of students attending these colleges were allowed 



80 
 

to enroll with the “equivalent of a high school 

education” or with educational certificates “from 

non-existent schools as well as from non-existent 

places” (1910, 36). It was discovered that 80% of 

the students enrolled at the Mississippi Medical 

College in Meridian had been admitted with only 

minimal education requirements. The Meridian 

institution was deemed “totally without merit” 

(250). Flexner went on to admonish those colleges 

that “apologize[d] for their wretchedness by 

alleging the shortcomings of the student body” 

(41). This, per Flexner, was not an acceptable 

excuse.  

In Flexner’s opinion, such weak medical 

colleges did nothing to improve academic merit in 

their home states and should be closed instead of 

allowing them to remain open and besmirch the 

public with inadequate instruction. Flexner was 

disappointed to report that most southern 

institutions insisted on maintaining lax admittance 

to warrant continued operation. Such defenses 

were, to Flexner, wholly inexcusable, as medical 

physicians and surgeons ought to be of the highest 

academic caliber in order to effectively treat 

disease and execute safe medical procedures. 

Flexner not only recommended that institutions 

improve or close, but he also maintained that there 

were far too many medical students relative to the 

US population. As Flexner explained, it was better 

to have an adequate number of well-trained doctors 

than a surplus of unqualified physicians (1910).  

African American-serving medical higher 

education was also addressed in the Flexner 

Report. Though Flexner indicated the importance 

of these institutions, he concluded that if African 

American medical academies, such as Knoxville 

Medical College and the Louisville National 

Medical College in Kentucky, were to persist, 

extreme measures had to be taken. Entire 

campuses needed refurbishment; new laboratories 

with up-to-date medical apparatuses were 

required; well-organized residency programs were 

mandatory; and sufficient endowment funds were 

needed to support organizational longevity. 

Though Flexner gave a crippling assessment of 

African American medical education, he 

emphasized that only two such training programs 

were worthy of retention: Meharry Medical 

College in Nashville, Tennessee and the medical 

department of Howard University in Washington 

DC (1910). 

Originally, Flexner championed the 

survival of the Nashville institution: “The urgent 

need in respect to the medical education of the 

negro is concentration of resources slender at best 

on a single southern institution.  Much the most 

favorable situated for this purpose is Meharry 

Medical College at Nashville” (1910, 233). 

However, he eventually advised that Howard 

University’s medical division alone was to be 

nurtured through the creation of a $500,000 

endowment due to the institution’s associated with 

the city’s Freedman’s Hospital. Even so, Meharry 

Medical College remained in existence. Per 

Flexner’s assessment, the other five African 

American medical colleges were ill equipped to 

provide adequate African American medical 

training and should be shuttered (Epps 1989; 

Thomas 2011; Miller & Weiss 2012).  

 

Conclusion 

 The results of the Flexner Report were slow 

to take effect nationwide but, by 1928, only 76 US 

institutions were open. Seven years later, that 

number had dropped to 66 (Beck 2004; Ludmerer 

2010). By, the start of the 1930s, approximately 

75% of southern medical colleges had closed. The 

rapid growth of medical higher education during 

the nineteenth century, the substantial scientific 

advancements made during the late 

nineteenth/early-twentieth century, and the 

South’s slow advancement of medical instruction 



81 
 

makes this region and era significant for historical 

research. Certainly, this period of southern medical 

higher education was heavily influenced by 

southern nationalism, slavery and racism, and the 

lasting impact of the Flexner Report. As a result, a 

more in-depth exploration of the region and its 

medical educational practices are warranted. To be 

sure, southern nationalism and increased 

sectionalism leading up to the Civil War led to a 

dramatic increase in the establishment of medical 

institutions in the South. This epoch of distinctly 

southern medical institutions was encouraged and 

touted by medical practitioners due to the 

promotion of “unique” regional diseases and 

racialized pseudoscientific medical claims (Duffy 

1968).  

During Reconstruction, efforts were being 

made nationwide to adopt more stringent standards 

for medical instruction. The lack of compliance 

with these reform efforts led directly to the 

creation of the Flexner Report of 1910, which 

exposed the deficiencies present in most US 

medical colleges—particularly those in the 

American South. Flexner, as explained above, was 

especially harsh in his assessment of southern 

medical higher education, to the degree that only 

three institutions were designated as worthy of 

continuance: Meharry Medical College, Howard 

University, and Tulane University Medical Center, 

two of which were black institutions (Flexner 

1910). Despite this literature-fueled narrative, 

there is a need to further explore the history of 

southern medical higher education through intense 

archival source analysis. By instituting a 

conceptual framework centered on southern 

nationalism, racial ethos, and the impact of the 

Flexner Report, greater care can be taken to 

produce a text rooted in significant primary data 

that inclusive of all southern medical academies, 

defunct or otherwise. Such a text will go far to 

enhance an understanding of higher education, 

medical training, and southern intellectualism in an 

era rife with sectionalism and segregation.  

 

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