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Tex Heart Inst J. 2000; 27(4): 386–389.
PMCID: PMC101108

Austin Flint: Clinician, Teacher, and Visionary

Not one of you who takes a stethoscope into his hand but is a debtor to Dr. Flint for simplifying much that was complicated in the auscultation of the heart and lung. 1

—Dr. William Osler to his students

Dr. Austin Flint, Sr. (1812–1886), holds a special place in the history of medicine in America. Gifted teacher, founder of 2 and professor in 6 medical schools, prolific writer and outstanding clinician, he continued and further refined the classic art of physical diagnosis initiated earlier in Europe by Leopold Auenbrugger and René Laennec. More than a century after his death, Flint's contributions to medicine, and to cardiology in particular, remain impressive.

Dedicated Clinician and Teacher

Austin Flint was born on 20 October 1812 in Petersham, Massachusetts, into a family claiming a number of physicians in its lineage, including his father and grandfather. The Flint heritage in America goes back to 1638, when the 1st family member settled in Concord, Massachusetts. The 1st Flint to practice medicine was Edward Flint (1733–1818), Austin Flint's great-grandfather.

Austin Flint, Sr., attended Amherst College and Harvard Medical School. He studied as a private pupil of James Jackson, an early advocate in America of the use of the stethoscope. 2 On graduation from Harvard in 1833 at the age of 21, Flint entered into medical practice in Northampton and Boston. In 1835, he married Anne Skillings; their son, Austin Flint, Jr., was born in 1836. That same year, Dr. Flint moved to Buffalo, where he spent most of the next 24 years. In 1844, Flint accepted a position at Rush Medical School in Chicago as Professor of Medical Theory and Practice, but after only 1 year, he returned to Buffalo. On his return in 1845, he helped to found the Buffalo Medical Journal, which he edited for 10 years. In 1847, he and 2 colleagues established the Buffalo Medical School, and he became the 1st Professor of the Theory and Practice of Medicine at that institution. At a time when medical education was largely didactic and theoretical, Flint's innovative method of teaching required students to conduct an independent, thorough, and systematic study of cases.

In 1852, Flint went to the University of Louisville as a Professor of Medical Theory and Practice. While there, he introduced innovations in the teaching of physical diagnosis, emphasizing the relationship between the anatomy and physical diagnosis. 3 Austin Flint returned to Buffalo in 1856. From that year until 1860, he was on faculty at 3 different institutions: During the summer, he worked in Buffalo; during the winter, he taught at the New Orleans Medical College as Professor of Clinical Medicine, and he served as a visiting physician at Charity Hospital, a position he held until 1861. 4

In 1860, at the age of 48, Dr. Flint—by now an eminent and widely published physician—accepted the position of Professor of Pathology and Practical Medicine at the Long Island College Hospital in Brooklyn. In 1861, he again helped to found a medical school, this time the Bellevue Hospital and Medical School, where he became the 1st Professor of the Principles and Practice of Medicine. He taught at Bellevue in the fall and at Long Island in the spring. In 1863, Flint's son, Austin Flint, Jr., joined the faculty of the Long Island College Hospital as Professor of Physiology. Austin Flint, Sr., resigned from his position at the Long Island College Hospital in 1868 but continued to teach at the Bellevue Hospital and Medical School until his death.

In New York, Flint gave up the general practice of medicine in order to devote his time and energy to educational pursuits. In 1872, he was elected president of the New York Academy of Medicine and served for 3 years. He was instrumental in organizing the New York County Medical Association and the New York State Medical Association. By the time of his death from cerebral apoplexy in 1886, Flint had achieved both national and international recognition. He received an honorary degree from Yale, he was made a corresponding member of the Academy of Medical Sciences, Palermo, and, in 1884, he was elected president of the American Medical Association. He was the principal orator at the International Congresses of Medicine held in Philadelphia in 1876, London in 1881, and Copenhagen in 1884. He was scheduled to give the presidential address at the International Congress in Washington, D.C., in 1887, and he had been invited to address the British Medical Association in 1886, the first American to be so honored, 3 but his death prevented him from fulfilling these engagements. His address to the British Medical Association was read posthumously by his son.

Prolific Writer

Austin Flint's contributions to American medicine are recorded in his voluminous writings. Throughout his career, he kept meticulous notes on his cases, eventually filling some 16,922 folio pages. He wrote and rewrote several books and published over 240 articles on almost every possible aspect of internal medicine. 4 Most of Flint's works were reprinted in Great Britain, which served to increase his reputation in both countries. His obituary noted: “The London Lancet, in compliment to his graceful diction as a writer, styles him the Watson of America; many of his friends here delight to mention him with Syndenham whom, in philosophical statement, he more fully resembles.” 5

Many of Flint's early writings dealt with fevers and contagious diseases. His first published paper, a description of 24 cases of rubeola, appeared in the Boston Medical and Surgical Journal in 1840. 4 As a young health officer, he investigated an outbreak of epidemic fever in North Boston, Erie County, New York. He identified the disease as typhoid fever and pointed out its contagious aspects. 6 An 1850 article on pericarditis complicating pleuropneumonitis signaled the beginning of his greater interest in the physical diagnosis of diseases of the chest.

Flint's writings won recognition early in his career. He won the 1st prizes of the American Medical Association for 2 essays, “The Variation of Pitch in Percussion and Respiratory Sounds” (1852), and “The Clinical Study of the Heart Sounds in Health and Disease” (1859). During this period, as previously mentioned, Flint also served as editor of (and frequent contributor to) the Buffalo Medical Journal. In 1866, Flint published 1 of the great textbooks of medicine of its time, A Treatise on the Principles and Practice of Medicine. This work went through 6 editions, and over 40,000 copies were published.

Visionary Thinker

Dr. Flint repeatedly showed himself to be a progressive thinker whose theories and methods were far ahead of his time. He emphasized reasoning by exclusion and careful physical examination in the process of arriving at a differential diagnosis; 3 he cautioned against the excessive use of mercury and rarely advised bleeding, which was a popular medical practice of his era. He was among the 1st American physicians to advocate the “germ theory” in the 1880s. In his paper “Medicine of the Future,” which was presented posthumously by his son at the meeting of the British Medical Association, Flint foresaw the development of immunology, microbiology, and even molecular biology, as well as the teaching techniques used in cardiology today. 7

One notable example of his prescience can be found in a lecture he delivered at the beginning of his professorship at the Long Island College Hospital in September 1860. 8 His subject was anemia. In discussing cases of Addisonian “idiopathic anemia,” he hypothesized about the importance of the gastric glands, saying that “the fatal anemia [may] follow an amount of degenerative disease, reducing the amount of gastric juice so far that the assimilation of food is rendered wholly inadequate to the wants of the body.” He continued, “I shall be ready to claim the merit of this idea when the difficult and laborious researches of someone have shown it to be correct.” Nearly 70 years later, Dr. William B. Castle of Harvard, in his report “Observations on the Etiology, Relationships of Achylia gastrica to Pernicious Anemia,” confirmed Flint's prediction that the explanation was in the gastric mucosa. 9

Forerunner of Cardiology

Modern-day cardiologists may be surprised to learn that Flint advocated exercise for many cardiac disorders. In his book, A Practical Treatise on the Diagnosis, Pathology and Treatment of Diseases of the Heart (1859), he stated his belief that “indolence or inaction” could lead to weakness of the heart and fatty degeneration of the heart muscle. He advocated a “healthy” diet and advised that patients with fatty degeneration avoid “fatty substances and those readily converted in to fat.” 10

Flint's interest in the heart may have been encouraged by his association with Dr. Joseph Rouanet at Charity Hospital in New Orleans. 3 Rouanet had been a student of the great French cardiologist Jean-Nicholas Corvisant who, in 1832, suggested that heart sounds were of valvular origin and not of muscular origin as previously believed. In any event, it was during his tenure at Charity Hospital that Flint first identified the murmur that bears his name. His description, first published in his treatise, “On Cardiac Murmurs,” in the American Journal of Medical Sciences in 1862, 11 is as follows:

In some cases in which free aortic regurgitation exists, the left ventricle becoming filled before the auricles contract, the mitral curtains are floated out and the valve closed when the mitral current takes place, and, under the circumstance, this murmur may be produced by the current just named, although no mitral lesion exists.

In addition to the eponymous murmur, Flint's name has also been attached to his observation on the importance of pitch. Known as Flint's law, it states that “an elevation of pitch always accompanies diminution of resonance in consequence of pulmonary consolidation. In other words, dullness of resonance is never present without the pitch being raised.” 4 Ironically, Flint was a critic of associating physical signs with the name of the original describer. He once stated, “So long as signs are determined from fancied analogies, and named from these or after the person who describes them, there cannot but be obscurity and confusion.” 12

A Legacy of Achievement

After the death of Austin Flint, Sr., in 1886, the Flint family tradition of medicine was carried on by 5th and 6th generation physicians—by his son, who was a Professor of Physiology at Long Island College Hospital, Bellevue Hospital Medical College, and Cornell University Medical College, and by his grandson, who was a Professor of Obstetrics and Gynecology at New York University until his death in 1955. Thus, the legacy of Austin Flint extended well into the 20th century.

Dr. Samuel D. Gross, a longtime friend of Austin Flint's, paid tribute to the life and work of Dr. Flint as follows:

Tall, handsome and of manly form, with well-modulated voice of great compass, he is as a lecturer at once clear, distinct, and inspiring…. He ranks especially high as a clinical instructor. As a diagnostician in diseases of the chest he has few equals. Nor is this fact at all surprising when we bear in mind the time and the immense labor which, from an early period of his professional life, he has devoted to their investigation. I know of no one who is so well entitled as Austin Flint, Sr., to be regarded as the American Laennec. 13

Footnotes

Address for reprints: Ijaz A. Khan, MD, Creighton University Cardiac Center, 3006 Webster Street, Omaha, NE 68131-2044

References

1. Osler W. Remarks to the class in clinical medicine, University of Pennsylvania. Canada Med Surg J 1886;14:571–574, p.572.
2. Thorn GW. Austin Flint: A biographical study of a founding member. Trans Am Clin Climatol Assoc 1959;71:li,liv,lxii.
3. Berman P. Austin Flint—America's Laennec revisited. Arch Intern Med 1988;148:2053–6. [PubMed]
4. Evans AS. Austin Flint and his contributions to medicine. Bull Hist Med 1958;32:224–41. [PubMed]
5. Obituary Notice. Medical Register New York, New Jersey, and Connecticut.1886–87:244–8.
6. Flint A. Account of an epidemic fever which occurred at North Boston, Erie County, N.Y., during the months of October and November 1843. Am J Med Sci 1845;10:21–35.
7. Flint A. A medicine of the future: An address prepared for the annual meeting of the British Medical Association in 1886. New York: Appleton, 1886.
8. Flint A. A clinical lecture on anemia. Delivered at the Long Island College Hospital. American Medical Times 15 Sept 1860:181.
9. Curran JA. The tradition of Austin Flint and Alexander Skene at “Long Island.” Minnesota Medicine Dec 1965;1719–22. [PubMed]
10. Flint A. A practical treatise on the diagnosis, pathology and treatment of diseases of the heart. Philadelphia: Blanchard & Lea, 1859.
11. Flint A. On cardiac murmurs. Am J Med Sci 1862;44:29–54.
12. Landis HRM. Austin Flint: his contributions to the art of physical diagnosis and the study of tuberculosis. Bull Johns Hopkins Hosp 1912;23:182–186.
13. Gross SW, Gross AH, editors. Autobiography of Samuel D. Gross, M.D. 2 vols. Philadelphia: George Barrie, 1887;2:161.

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