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Ann Surg. Jun 2004; 239(6): 808–817.
PMCID: PMC1356289


The Other Flexner

Moritz (Morris) Flexner immigrated to the United States from Europe in the middle of the 19th century. Although born in Neumark, Bohemia, Moritz lived in Strasbourg, France, for several years before coming to the United States. Therefore, after landing in New York in 1851, he headed for New Orleans to make his way among the French population there. He contracted yellow fever, was nursed to health in Charity Hospital, and eventually came by river to Louisville because of a family he had known in Europe. When Moritz came to Louisville, he was a peddler in the finest sense of the word. He wore a pack on his back as he went from house to house selling wares probably mostly dry goods. He eventually purchased a cart and a horse with a stiff leg for 4 dollars. This increased the amount of merchandise he could sell on his journeys around the Commonwealth of Kentucky. He eventually had a small “rural shop” to store his goods.

Esther Abraham was born in Roden, Germany, and as a teenager was urged by her uncle who lived in Louisville to come to the New World. She did so with her older sister in the summer of 1855, finally arriving in Louisville in October 1855. Meanwhile, Morris's business was steadily improving. Esther and Moritz met, courted, and married September 13, 1856. Jacob Aaron Flexner, whom I have designated the Other Flexner, was born in 1857, the eldest son in a family that would eventually number 9 children: 7 boys and 2 girls. Five boys, Henry, Isadore, Simon (1863), Bernard, and Abraham (1866) arrived over the next decade. Then a boy, named Washington “in gratitude for American bounty”1 was born in 1869 followed by the birth of 2 girls, Mary and Gertrude.

During these years, Morris, ever the salesman, decided that he and his family should live close to the business. At that time he couldn't afford to make such an arrangement in Louisville. He and his growing family moved to nearby Lawrenceburg with the family living over the store. Lawrenceburg was the site of a profitable distillery, and his customers often paid for the wares they purchased from Morris with kegs of whiskey. This allowed Morris to continue his traveling salesman type habit of drinking, but it also gave him another profitable line since the kegs were quite salable. During the Civil War, his store was raided but not destroyed, and he eventually sold out to his partner and returned to Louisville in 1862. Because of limited means, the family was forced to live in a “shabby part of town,”1 but an exciting prospect came when Morris was asked to join an acquaintance, Emmanuel Hirsch, in the hat business. Hirsch and Flexner became a most successful venture, and the Flexner family was able to move to more commodious housing.

They don't all agree on some points, but a picture does emerge to support the theory that Jacob Flexner played a pivotal role in the lives of his better-known brothers, Abraham and Simon.

As a child it became obvious that Jacob was bright and assertive. In the words of James Thomas Flexner, Simon's son, who wrote Simon's biography: “Morris seemed blessed with the ideal eldest son: Jacob was precocity incarnate. Morris had happily destined him for medicine.”1 Jacob himself had discussed this ambition with his father who readily agreed. His father had already decided that he would send Jacob (Fig. 1) to the Jefferson Medical School in Philadelphia and then to Paris for further study. However, the panic of 1873 intervened and sidetracked Jacob's ambition for some time. The panic forced Hirsch and Flexner to liquidate. The family subsisted on what Morris could bring in from part time work as a salesman. In true Flexner family unity, the children who had paying jobs contributed their share to the family finances.

figure 8FF1
FIGURE 1. Jacob about the time of the panic of 1873.

Jacob, in an article written in 1931 for the Atlantic Monthly, described the situation after the panic as follows:

“One of the saddest memories of my life is the walk I took with him [his father] on Christmas day of that year. The pavements were encrusted with ice, so we plodded down the middle of the street and had gone for some distance in silence when, suddenly, my father stopped and told me he was a ruined man. It would be impossible, he said, for me to go on with my schooling; instead I should naturally want to assist him in supporting and educating my younger brothers and sisters, of whom there were eight. He told me that since my hopes were set upon medicine, my only chance to realize them would now be to enter the profession by way of a drug store.”2

In those days a pharmacist was the closest professional person to a doctor, and the pharmacists who worked in those drug stores used elemental materials to compound physician's prescriptions. The store itself hardly resembled the present day drug store, with its magazine racks, cosmetic displays, greeting cards for all occasions, and multiple over-the-counter drugs. The background of the pharmacist of that day was in chemistry and material medica; some pharmacists even held a medical degree. As Jacob put it: “The druggist of my day was the right-hand man of the physician, and it was natural that the two professions should stand in a very close relationship to each other.”2

He first worked in a drug store owned by a Dr. Thomas E. Jenkins, a man who possessed a medical degree and who had been educated in chemistry. Jacob lived in the basement of the store, which had a good library that Jacob often visited. He started by washing windows and bottles, but was soon promoted to the prescription counter where he was an assistant pharmacist. He then moved to another drug store and a more generous salary, but for the first time came into contact with what he termed manufactured drugs, basically medicines produced in bulk by pharmaceutical companies. His third drug store job brought him back to the more traditional pharmacy of the times where pharmacists were skilled at fashioning pills or fluids as directed by doctor's prescriptions. During his various employments, Jacob, who had a “passion for reading and retaining what he read,”1 continually pored over medical texts that were available. He also sat in on discussions by physicians who often visited the drug store to pick the brains of the pharmacist on how to treat one of their patients. As will be shown, all of this proved to be very influential in Jacob's future endeavors.

While thus employed, not all his adventures were classically educational. For example, he was given to experimentation:

“When I first heard of the Aspinwall explosion of nitroglycerin I determined to try to produce some myself I got my materials together and, following the proper directions, mixed them in a thin glass beaker. To await the subsidence of the reaction I stood the glass on a slab of granite in the back-yard behind the store and proceeded with my other work. Hardly had I got inside the building when a heavy cart, rumbling along the street gave the glass a jar and it let go with a roar that shook the neighborhood.”2

Apparently there were no untoward consequences from that explosion, so Jacob prepared a similar concoction and put it outside for the reaction to subside. The resulting explosion made a doctor whose office was close by come rushing out:

‘“Son, what are you going to do next?', he shouted at me. I explained to him that I had done no harm, whereupon he replied laughingly, ‘No, nothing but good. I was just talking to Mr. Richardson, who has had rheumatism for months. He came in on crutches, but when your thunderous detonation went off almost under him he leaped up and ran off as fast as his legs could carry him. His crutches are still in my office.”'2

He once accompanied a doctor from one of the Louisville medical schools on a body-snatching expedition. Two bodies were taken from their resting place in a nearby cemetery and placed in casks on a wagon. Because of the presence of 2 detectives on the ferry they had taken to cross the river, they tossed the casks over the side. They were let go by the detectives for lack of evidence, but the casks were later retrieved from the river, and the bodies eventually found their way to the medical school's anatomy laboratory. Another episode recounted by Jacob took place during his service at the third drug store. He had become very friendly with the professor of anatomy at one of the medical schools. They studied anatomy at night. During the course of study it was necessary for Jacob to perform a dissection on a human body. He managed to obtain a cadaver from the anatomy department and kept it wrapped up under his bed in his room at the drug store. When another employee discovered the body, Jacob had to return it to the medical school immediately.

All his studying at night and his friendship and adventures with various physicians enabled him to take an accelerated course and graduate from the Louisville College of Pharmacy in 1878 (Fig. 2). He was clearly the brightest in his class. However, because of his argumentative nature, he was not very popular, which may have cost him the opportunity to be awarded the gold medal as the top student upon graduation. Nevertheless, once he had his degree he was able to consider the possibility of owning a drug store.

figure 8FF2
FIGURE 2. Pharmacy degree Jacob was awarded in 1878.

Shortly before this, Morris had secured a permanent position as a salesman. His more substantial income supplemented by earnings from Jacob and some of the older brothers enabled the family to move into a larger home in a newer section of town. Across the alley at the back of the house stood the newly constructed Temple Adas Israel. In one part of that structure lived the sexton who had a lovely daughter named Rosa Maas. Jacob fell in love with her and married her in 1877. It was a fortuitous union in more ways than one. Jacob's in-laws provided the funds that allowed him to purchase his very own drug store; Rosa and her mother-in-law, Esther, became fast friends; in times of future stress, these two women were the bulwarks for the family.

The drug store, which Jacob acquired in 1878, are well depicted in the biography of Simon:

“Jacob featured toilet articles; ‘soda water and its appurtenances;’ shelves of standard drugs that the Flexner brothers had made up in quantity and bottled; local remedies, which had often been mixed in the drugstore, bearing the names of the quacks who promoted them. Behind the counter were blankly labeled nostrums for venereal diseases and male impotence. However, the heart of the business was filling prescriptions drawn up by physicians whom Jacob encouraged to frequent the store.”1

Jacob's drug store was strategically situated between the wholesale and retail districts of the city so that their commerce grew enormously. The store became quite profitable. The combination of a flourishing business and frequent up-to-date medical discussions often led by Jacob and his brother, Simon, were to prove significant in the eventual attainments of both Abraham and Simon, who because of their more notable careers in education and medicine are well-known to most physicians. So exactly how did Jacob influence his 2 younger brothers?

During the early years of the drug store's existence, Abraham was completing his high school education at Male High School in Louisville. Then in Abraham's own words:

“The decisive moment of my life came in 1884 when, at the age of seventeen, I was sent by my oldest brother, Jacob, to the Johns Hopkins University. He had shortly before that opened a drug store of his own, and practically the first money he saved was given to me for my college education, one thousand dollars in all, if I remember correctly. The sum was small, but this step marked a turning point in the history of our family. We can never be sufficiently grateful to the memory of our oldest brother for the sacrifice he made in behalf of an ideal at a time when his own needs were pressing; but he was throughout his life a person of quick and remarkable intelligence, and he must have realized that we were all destined to humble careers unless at the first opportunity a break was made.”3

Why did Jacob choose Johns Hopkins for his youngest brother? An acquaintance of Jacob's, a lawyer named Lee Sale, had obtained his bachelor's degree from Johns Hopkins University and convinced Jacob about the premier education he received there. In his characteristically decisive manner, Jacob decided that Abraham should go there. In his autobiography, Abraham said: “Upon that choice my whole subsequent career and those of others of our family have depended.”3 After 2 years (1884–1886) Abraham acquired his degree and returned to Louisville to open Mr. Flexner's School. This school was started to help the son of a prominent Louisville resident who was having difficulty in high school. Soon the school was giving a basic education in reading, composition, mathematics, science and the classics (Latin and Greek) to a small number of troubled students. Eventually, students from Mr. Flexner's School were accepted in the finest colleges of the day and often excelled over others who had been educated in well-known preparatory schools. This fact came to the attention of a number of educators including Charles W. Eliot, then president of Harvard University, who suggested that Abraham Flexner be given the task of reviewing medical education for the Carnegie Foundation.

When he was approached about taking on this task, Abraham's first reaction was that as a neophyte in medicine he might not be able to succeed in the venture. On second thought, he had proven himself as an educator, and this was essentially an educational matter. In typical Abraham Flexner style he read everything he could that dealt with the history of medical education in America and Europe. He found that “the most important and stimulating volume was Billroth's Lehren und Lemen der medizinischen Wissenschajten….”3 He went to Chicago to consult with several men at the American Medical Association and read the reports of the Council on Medical Education of that organization. He stopped at Johns Hopkins where because of his Hopkins degree he had an entree to interview the leading lights of the medical school, Drs. Welch, Halsted, Mall, Abel, and Howell. He next visited the 155 “medical schools” then extant and found that almost all of them could not be regarded as educational institutions. The result of these efforts was published in 1910 as “Bulletin Number Four” of the Carnegie Foundation for the Advancement of Teaching. In the Bulletin he wrote: “The schools were essentially private ventures, money-making in spirit and object. A school that began in October would graduate a class the next spring. …”3 The report showed 2 maps with suggested reduction by at least 120 of the 155 institutions he visited and amalgamation of others so that there would be a satisfactory regional coverage of the country by proper medical schools.

Shortly after the publication of Bulletin Number Four, Abraham Flexner joined the staff of the General Education Board (GEB). He used the considerable Rockefeller money, which funded the activities of the GEB, to support those medical schools that were willing to go to the full-time academic system he had promulgated in Bulletin Number Four. He had a remarkable talent to persuade wealthy and influential community leaders to join with medical school administrators to raise money to support development of a university-based medical school. Thus he was able to influence Iowa, Yale, Vanderbilt, Chicago, Cornell, and Rochester to become medical schools with a scientific foundation following the standard established by the Johns Hopkins Medical School.

Abraham Flexner's other notable accomplishment was the establishment of the Institute for Advanced Study at Princeton, NJ. As a member of the staff of the General Education Board Abraham Flexner came to know the Rockefeller Institute for Medical Research (RIMR) very well. The RIMR had been founded in 1903 and was funded by Rockefeller money for most of its initial years of existence. When he conceived the idea of a group of advanced scholars in a single field working in a favorable atmosphere, he decided to pattern it after the RIMR. He was also guided by the dictum of “brains, not bricks and mortar”3 often preached by Daniel Coit Gilman, first president of the Johns Hopkins University. At this time it happened that there were 2 wealthy residents of the State of New Jersey who wanted to donate some funds to an educational project. That fact and the welcoming attitude of the administration at Princeton University made Princeton, NJ, the ideal site for the new institute. Flexner, having decided that mathematics should be first field to be emphasized, went after Albert Einstein and convinced him to come to Princeton. The Institute opened in 1931 with one building and a group of trustees who dealt with finances and space while the scholars were left alone in keeping with what one scientist had told him as the institute was beginning:

“Academic democracy means letting men of brains alone and this can be achieved only if the head (president, director, or whatever he be called) has tact and good sense enough to confer with the proper people and dispose of current affairs in the general interest. He will be called an autocrat, but how can he be if individuals are free to follow their own bent and are not distracted by the routine of “talk fests,” such as committee and faculty meetings inevitably become.”3

What about Simon Flexner? Most biologic scientists and many physicians, particularly pathologists, know of Simon Flexner, 6 years younger than Jacob, the Other Flexner. In the biography of Simon there are 2 chapters, one of which is entitled: “Simon Flexner, Delinquent” and the other: “Simon Flexner, Unemployable.”1 From subsequent events, it would seem that Simon Flexner would be classified in this day and age a late bloomer. When he was 16, he contracted a serious bout of typhoid fever from which he almost died and during which he was nursed back to health by the ministrations of the family stalwarts, Esther and Rosa Flexner. Upon complete recovery, his previously hidden mental capacities were awakened. He entered and was graduated from the Louisville College of Pharmacy in 1881 first in his class for which he received the coveted gold medal. The father, Morris, having reverted to his younger salesman days of excessive drinking and smoking many cigars, had to be informed of this event literally on his deathbed. Morris died early in 1882.

Now that Simon possessed his pharmacy degree, it seemed only logical that he should work in Jacob's drug store. The brothers worked side by side for 8 years. Although they had strikingly different temperaments, they worked without serious conflicts during that time. It is likely that Jacob probably continued his hegemony over Simon whenever he could, and this surely contributed to Simon's desire to excel. As an example, Simon's biographer recounts the following: “Thus, his [Simon's] annoyance because Jacob, preferring to talk, left most of the prescription work to him, was tempered by the realization of how much more quickly and efficiently he could put up a prescription than Jacob could.”1 Moreover, Jacob's drug store was the medical meeting place of Louisville:

“Jacob's overaggressiveness had been somewhat tamed by the years, and thus his conversational gifts, his passion for reading and retaining what he read, enabled him to preside over a kind of medical salon. Practitioners would drop in at the store during their round of house calls, find colleagues there, exchange gossip, and talk over their problems. When not otherwise engaged, Simon sat in on the discussions, and when Jacob was absent he took over as best he could his brother's role. He found he could do so with increasing effect.”

“Learning through endless conversations the methods and results of the leading doctors—no others were welcomed into the informal fraternity—the Flexner brothers became a clearinghouse for such information. Furthermore, by subscribing to several periodicals, the brothers kept up ‘in a small way’ with German and American medical literature.”1

In addition to being able to hobnob with the best physicians in Louisville, Simon had access to a microscope. It had been made by Zenmeyer of Philadelphia and was used for urinalyses. Simon, however, used the microscope to examine tissues, first of animals and then of humans from specimens given to him by his physician acquaintances. According to his biographer Simon: “taught himself histology (the study of normal organs and tissues) and moved on to pathology (the study of structures distorted by disease).”1 About this time he read John Tyndall's book Floating Matter in the Air and learned of Pasteur, bacteriology, and the possibility of doing research in this area. This, of course, became his life's work. With such extensive exposure to medicine and by doing more study, Simon was able to obtain his medical degree from the Louisville Medical College in 1889.

This degree was only the beginning of Simon's education. He wanted to do postgraduate work and was thinking seriously of going to Pennsylvania, which at this time had a fine reputation in the field of pathology. However, Jacob intervened and insisted that Simon go to the Johns Hopkins Medical School. In September 1890, Simon went to Baltimore to begin study at the Pathologic, the name given to Dr. William H. Welch's domain, at the Johns Hopkins Medical School. Simon immersed himself in pathology and bacteriology. After mastering these 2 closely related fields and contributing new knowledge to them, he was made an assistant in pathology. Thus, less than 2 years after obtaining his medical degree, he was now a member of the medical faculty at the Johns Hopkins Medical School and perhaps more importantly, Welch's protege. After making a number of significant medical discoveries and publishing extensively, Simon Flexner was enticed by the University of Pennsylvania to become the professor of pathology at their renowned medical school. In the fall of 1899 he assumed that position, then purported to be the most prestigious pathology situation in the United States.

Simon Flexner began to assemble a pathology department, which resembled in many ways the Pathologic at the Johns Hopkins Medical School, though not without some opposition and even threats of mutiny among some faculty members. He became well known for his organizational skills, administrative talents, and continuing abiding interest in basic medical research. From 1900 to 1902 as the concept of an institute for medical research was being discussed at the General Education Board, Simon Flexner's name surfaced as a candidate for the first director of such an institute. There was much private discussion and negotiation. Then, without any official word from the parties involved, the New York Times in its February 12, 1903, edition ran an announcement of Dr. Simon Flexner's appointment as the first director of the RIMR. The article described him as “… a comparatively young man [who] has already achieved an international reputation as a pathologist and investigator.”1 At the conclusion of the 1903 academic year, Flexner became director of the Rockefeller Institute for Medical Research, a position he held until his retirement in 1935.

Jacob's influence on his 2 brothers can be summarized as follows: Jacob and Abraham had very similar personalities. They loved to argue and debate with each other, but both developed respect for each other. When Abraham was ready to go to college, Jacob was in a fiscal position that allowed him to finance his higher education and also to steer him to Johns Hopkins. In Abraham's own words at the conclusion of his autobiography, he wrote: “My brother Jacob - keen, ambitious, quick to perceive - was the first stimulating influence in my life.”3 On the other hand, Jacob and Simon were vastly different in personality and approach, but Jacob was always a domineering brother. Jacob stimulated Simon to prove himself, and he steered him to Johns Hopkins and Dr. Welch, clearly a decisive event in Simon's life. Perhaps these differing relationships among the 3 brothers account for the sometimes-conflicting image of Jacob given in the first and third references.

By early 1893, both Abraham and Simon seemed well on their way to successful careers. But how did the Other Flexner, Jacob, fare over the next years? Jacob's fortunes were in the ascendancy at this time. The drug store was doing well, so well that Jacob's business stationary declared him to be a “manufacturing pharmacist.” He and Rosa now had 5 children, and they had moved into more spacious quarters. Unfortunately, financial storm clouds were gathering during that year and became the full-blown panic of 1894:

“But Jacob began to show distressing symptoms. He smoked cigar after cigar in a frenzy; he drank heavily. The family came to suspect that he was helping himself to the narcotics on his drugstore shelves. And then the awful truth came out. He was heavily in debt and had reached the end of his ability to borrow. The drugstore was on the edge of bankruptcy. Forced, for the first time in his life, to doubt his own powers, Jacob sank into a nervous collapse.”1

Most likely, Jacob and some of his friends were probably abusing cocaine and other drugs since the addicting nature of those drugs was not known at that time (shades of William Stuart Halsted). Abraham provided the financial rescue. He maneuvered the debts and properties together so as to produce more reasonable payments over time and to make the ultimate bankruptcy not as severe as it might have been for Jacob and some of the other brothers. Jacob slowly recovered from his addiction and depression probably with the help of his wife and his mother; as he did so, he revived his ambition to become a doctor. Jacob, who was now in his late thirties, had continued studying anatomy at the medical school. He became a full-fledged student and earned his medical degree from the University of Louisville Medical College, one of the many medical schools that would be doomed by Abraham's Bulletin Number Four (Fig. 3).

figure 8FF3
FIGURE 3. Medical degree awarded to Jacob. This degree is dated 1902, but the archives at the University of Louisville School of Medicine note that 2 degrees had been awarded to a J. A. Flexner, one, an M.D. HCM in 1895 and another, an M.D. in 1902.

Abraham, who by now was becoming the dominant figure in the family particularly in matters educational, decided that Jacob should go to the Hopkins for some polishing. At Hopkins, Simon felt obliged to invite his older brother to lunch at the “hospital high table.”1 Jacob had regained some of his old ways and tried to take over the conversation in a manner that was extremely embarrassing to Simon. When Simon lectured him, Jacob complained to Abraham. This interesting paragraph appears in the biography about Simon:

“Abraham reminded Simon that it was hard on Jacob to have himself and his family, after all his work, dependent on others. He must be encouraged not discouraged. Of course, a few months could not make Jake a doctor in the Hopkins manner, but there was no need to admit this to the world. Simon should remember that the issue was not scientific but economic. It was essential that Jake should make his living, and he would be competing not with Hopkins graduates but Louisville practitioners. Obviously, he could not start as an experienced physician. However, the ability to present an impressive front was almost as important as knowledge, and Jake had a gift in that direction. Abraham then pointed to his own situation. As a scholar he would be laughed at by university professors, yet ‘tact and management’ had carried him ahead. Jake would have to get his knowledge in the same way Simon had got much of his: through experience rather than prior instruction.”1

After his stint at Hopkins, Jacob went to New York City and served as an intern from January 16th to March 11th 1897 at the Mothers’ and Babies’ Hospital. He received a certificate from that institution indicating “he has acquired such practical and theoretical training in obstetrics as entitles him to this official endorsement.” (Fig. 4). Of course, this hardly made him an accomplished obstetrician, but the experience probably stood him in good stead when he did enter the practice of medicine.

figure 8FF4
FIGURE 4. The certificate Jacob earned from the Mothers’ and Babies’ Hospital in 1897.

Shortly after his return to New York, Jacob opened his office in Louisville. Although he struggled at first, he finally succeeded in having a successful and up-to-date practice of medicine. As Simon remembered it: “The struggle was sharp and strong.  . Mother and Rosa (Jake's wife) held together like twins.”1 In the end Simon admitted that Jacob became “one of the most trusted physicians in the city.”1

This was an exciting time in medicine. Many of the previously fatal infectious diseases were being conquered by the use of serum. Simon performed many experiments on what we now know are autolytic enzymes. After reasoning that active inflammatory cells had some ingredient in them that could break down cell walls, he produced a serum that proved to be effective in treating individual cases and terminating epidemics of cerebrospinal meningitis. Jacob happened to be treating a case of meningitis in 1917 with the serum. When he ran out of the serum, he contacted Simon and procured some additional serum, which he gave not only intravenously but “intraspinous” as suggested by Simon. The patient had a fairly strong reaction to the treatment, but from that time on began to improve. When Jacob wrote a letter to Simon describing the situation, the patient was approaching discharge from the hospital (Fig. 5).

figure 8FF5
FIGURE 5. The letter from Jacob to Simon written in 1918 about the use of serum for a patient with cerebrospinal meningitis.

Jacob was the first physician in Louisville to use diphtheria antitoxin to treat successfully a young female patient. He was also actively practicing when the exciting discovery of insulin was made. Insulin for treating diabetes was in very short supply at first. Jacob had a patient who was dying of hyperglycemic ketoacidosis. He probably called on Simon for assistance in obtaining some insulin and was the first physician in Louisville to use insulin therapy. Clearly he had retained his passion for reading and keeping up with the literature.

Each of the 5 children of Jacob and Rosa attained some prominence in their own respect. Jennie, the eldest, never married but for many years was the head of the Reader's Advisory of the New York Public Library. Hortense, the next daughter, was a poet, playwright, and writer of children's books. She and her husband, Wyncie King, a political cartoonist, vacationed on Sutton's Island in Maine. It was there that she composed many of her poems and earned the title la grand poetess du Maine. Alice, the next child, lived many years in Toronto, but was also a research worker for the New York Welfare Council. Their youngest, Carolin, was an aide to a New York lieutenant governor and senator and special assistant on headquarters staff of the United Nations Relief and Rehabilitation Administration.

Their fourth child and only boy, Morris, followed in his father's footsteps. He obtained his medical degree from Johns Hopkins and undertook a year of postgraduate work in pediatrics at Johns Hopkins followed by a year with Dr. George Dock in St. Louis. He was then drafted in the army during World War I and ran a bacteriology laboratory. When he was discharged from military service, he joined his father in the practice of medicine in Louisville and became a highly respected clinician. Morris had a son, John M. Flexner, who obtained his medical degree from Johns Hopkins and is a professor of internal medicine at Vanderbilt University Medical Center. Jacob's great grandson, Charles, who is John's son, is a professor of pharmacology and infectious diseases at the Johns Hopkins Medical School, where he also acquired his medical degree.

Despite serious heart disease, Jacob continued to practice well into the 1920s. In 1931, the Atlantic Monthly published his article about pharmacy as a vanishing profession. In addition to the stories recounted earlier, that article includes a tale about an adventure he had when he worked in his third drug store. Sometime after midnight on a Monday morning, there was a knock on the drug store door. Jacob, who lived in the store, answered it immediately and was forced inside by 2 intruders. He was taken into the bedroom, where his hands were tied behind his back. He had the key to the safe in his pocket, and in the safe were a thousand dollars and some valuables belonging to the pharmacist and his wife. He wriggled his hands free and hid the key. When the robbers returned to him, they asked for the key. Jacob told them that the proprietor had taken it home with him. That explanation was accepted, and the criminals went back to helping themselves to whiskey and cigars. They left, and when the detectives came, Jacob told them what had happened. The detective looked at the rope used to tie Jacob's hands and recognized the knot as “Red Leary's knot.” Red Leary was a notorious criminal, who had been a member of Quantrell's gang, the group that produced the James brothers. The very next night Leary killed a gatekeeper at a toll road, and as Jacob related it, he didn't relax until he heard of Leary's death several years later.

Another story that did not appear in the article but was related to me by his grandson, John, had to do with a man from Atlanta who entered Jacob's drug store one afternoon. He was peddling Coca Cola as a family drink and offering to put it in the fountain at the store with inducements such as stock in the company. When Jacob asked why it was named Coca Cola, the salesman admitted that the formula called for some crushed coca leaves. Jacob, knowing that the active ingredient in coca leaves was cocaine, threw the man out of the store and told him that the company would probably go bankrupt in 3 months. Perhaps had he not been so outraged at this company trying to sell a family drink containing a narcotic, Jacob might have become the financial wizard he always wanted to be and had a career as notable as his two brothers (personal communication; JM Flexner, 2003).

Jacob was in failing health by the middle of the 1920s, and his grandson, John M. Flexner, can remember his grandfather living with them in their Louisville home. Five years after giving up the practice of medicine, Jacob A. Flexner died in 1934 at the age of 77. Loquacious, assertive, but smart, in his early years, he was the archetype for the Flexner family especially after his father's fortunes fell. The author hopes that this story of Jacob and his influence on his family members will lead to his deserved recognition for the role he played in the lives of his two famous brothers.


Reprints: Ward O. Griffen, Jr., MD, PhD, 4140 Peninsula Drive, Frankfort, MI 49635. E-mail: ten.knilsoc@gowspop.


1. Flexner JT. An American Saga. Boston/Toronto: Little, Brown and Company; 1984.
2. Flexner JA. A vanishing profession. Atlantic Monthly. 1931;98:16–25.
3. Flexner A. Abraham Flexner: An Autobiography. New York: Simon and Schuster; 1960.

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