The Case for Western Reserve: Medical Education Reform in the Midwest, 1900–1920

Western Reserve University expands our understanding of the reform processes of early twentieth-century medical education in the United States. The institutional powerhouses of the East Coast dominate historical accounts, but change may have occurred differently and more slowly in medical schools of the Midwest and West. Western Reserve University (WRU), although midwestern and supported by meager endowments, ranked among the best medical schools in the early 1900s.¹ It is clear that medical education reform leaders were not limited to the Northeast because, as Kenneth Ludmerer states, “improvements at these schools [in the Midwest] occurred quietly, almost without notice.”² Western Reserve University’s Medical Department warrants historical attention because of how its socially progressive policies and ambitious professional efforts placed the department at the forefront of medical education.

There are three qualities in particular that make the Western Reserve University (WRU) Department of Medicine stand out. First, WRU was in Cleveland, Ohio, an area of the country often overlooked in medical education literature. Popular histories of medical education primarily focus on the large northeastern schools, while state historians or historians associated with the schools themselves tend to focus on midwestern institutions.³ It is unclear why WRU is neglected in the literature. Around the turn of the twentieth century, Cleveland, a booming industrial city, had no medical school competition within hundreds of miles. Placing the high standards originating in a rising Ohio medical school in dialogue with the extensive narratives compiled regarding East Coast schools can better illuminate the successes and struggles of both. Second, because Abraham Flexner’s report positioned WRU alongside the ranks of medical schools like Johns Hopkins, there needs to be more emphasis on the excellence originating within the WRU Medical Department.⁴ Western Reserve University modeled academic program design, land acquisition, and building design and construction of Northeastern institutions with abundant endowments. Third, WRU’s socially progressive policies allowed for a socially diverse population. WRU remained competitive by eagerly following Northeastern schools’ examples and reflecting larger trends of the profession and society.

Former Western Reserve University president, Louis Toepfer (1970–71), said that “this university has more opportunities than most to celebrate its history.”⁵ The medical school has a well-rounded, notable history that includes graduating women with medical doctorates in the 1850s and revolutionizing medical curriculum again in the 1950s.⁶ In the one hundred years spanning the two largest and most widely circulated accomplishments of the WRU Medical Department, medical education constantly redefined itself through structural changes influenced by the professionalization and scientific advancement of medicine.⁷ WRU was competitive but earned little historical exposure. It is clear that WRU, a midwestern institution, was capable of competing against the northeastern powerhouses, and the significance of such accomplishments should be recorded. Vice president emeritus of Case Western Reserve University, Richard E. Baznik, said that a “study of that history [of the university] provides a prospective on the development of universities more generally, and on the emergence of key concepts in institutional leadership.”⁸ It is with the same intent that I aim to explore Western Reserve University’s Medical Department.

Women and the profession

Before the Civil War, American medicine was a poorly regulated open market where anyone who decided to call themselves “Doctor” participated. A diverse population of these “doctors” flooded the market: “regular” doctors, who believed they were followers of Greco—Roman traditions, and homeopathic and eclectic doctors, who dominated the opposition.⁹ Physicians responded anxiously to the rise in transportation, urbanization, industrialization, immigration, and corporations of the late nineteenth century, as well as to the diversification of medical thought. Regular doctors, those who most advocated hard science in medicine, pushed for professionalization, hoping to secure their dominance over homeopaths and eclectics.

In 1893, the Cleveland Medical Gazette reported that physicians should be concerned with the education of their peers because “if his competitors are of little education and culture, his own standing as a physician is lowered.”¹⁰ Physicians rallied together to tighten the ranks and limit the flow of new doctors into...