First ACS President Lives Life as “Surgeon’s Surgeon”

My great grandfather, J. S. Houston of Alabama, was a physician in the late 19th century. Understandably, the rigor and excellence of today’s training and practice are very different from what my grandfather experienced 150 years ago. One of the catalysts for the evolution of medical education was John M. T. Finney, MD, FACS, who later became the first ACS President and was known as the “Surgeon’s Surgeon,” often consulting with many of his colleagues about their surgical issues.

Dated July 18, 1876, the first letter my great grandfather received from the Medical Department of the University of Louisville was written by Dr. J. W. Bodine, dean of the faculty. It informed my great grandfather that his examination at the completion of his studies was “satisfactory.”

The school was, of course, proprietary, and the nine members of the faculty depended on the fees for their livelihood. Most medical schools of that time only required the ability to read and write, and although the letter went on to say that my great grandfather would be “recommended as worthy” to receive an MD degree, it was likely that he had not seen any patients during the two 4-month series of lectures nor had he participated in any courses with the exception of anatomy.¹

My great grandfather received his second letter from Dr. Bodine on March 22, 1877, and it confirmed that his diploma was being sent in a “tin case” to avoid damage. Once his diploma was in hand, Dr. Houston was free to travel, largely on horseback, to see patients with a variety of ills and supported only by the few medicines in his bag and his own common sense. He didn’t know, of course, that just a few decades later, two individuals, Dr. Finney and Abraham Flexner, MD, and one institution, Johns Hopkins University, were about to come on the scene and completely change the standards for both medical education and surgery.

In 1876, Johns Hopkins University opened its doors, thanks to the beneficent gift of $7 million from its namesake. Johns Hopkins Hospital was founded just 13 years later in 1889, and the medical school followed in in 1893. Dr. Flexner was born in 1866, the sixth of nine children. He was unable, on his own, to afford college, but he was fortunate that his brother, Jacob, a pharmacist, gave him $1,000, which allowed him to enter Johns Hopkins University at the age of 17.² Realizing that his limited funds made a lengthy college education impossible, he vowed to finish the college requirements in 2 years. In his autobiography, Dr. Flexner wrote, “I did nothing in these 2 years in Baltimore but work, for the time was short.”

After graduation from Hopkins, Dr. Flexner started a college preparatory school in Louisville, Kentucky, in 1890, married a well-to-do actress, and wrote a scathing book about the inadequacies of American colleges.

This book came to the attention of Henry Pritchett of the Carnegie Foundation, and Pritchett asked Dr. Flexner “if he would like to make a study of medical schools.” Shortly thereafter, in 1908, with an answer in the affirmative, Dr. Flexner began a tedious, and at times, exhausting survey of the medical schools in Canada and the US.

Prior to starting this monumental task, he went to Baltimore and interviewed multiple members of the Hopkins faculty. The standards they espoused became the template for all of the medical schools that he visited.³ In his autobiography, Dr. Flexner stated, “In the course of a few hours, a reliable estimate could be made respecting the possibilities of teaching modern medicine in almost any one of the 155 schools that I visited in the United States and Canada.”

The culmination of his work, Medical Education in the United States and Canada Bulletin Number Four, became the intellectual scythe of medical education, and as Dr. Flexner wrote, “Schools collapsed to the right and left, usually without a murmur.” By 1930, only 66 medical schools in the US remained open.

Only 3 years before Dr. Flexner’s birth, in 1863, with the American Civil War raging a short distance from the Finney plantation, Dr. Finney was born near Natchez, Mississippi. The war was at its midpoint and gunfire could be heard just a short distance away. His mother died that same year, and thanks to the care of “four foster mothers,” he received the love and attention that he needed.⁴ One of his four foster mothers, Mrs. Turpin, insisted on taking baby Finney (5 months old) into her own home, and her care was so profound that Finney’s father added the “T” to his son’s name.

After the Civil War ended, young Finney had had a variety of homes due to the peripatetic nature of his clergyman father’s “calling.” With his grandfather and father having attended Princeton University (and his brother enrolled at the institution at that time), and thanks to the generosity of his fourth foster mother, he, too, attended Princeton.

Graduating in the class of 1884, he went on to Harvard Medical School, noting that his 3 years there were “among the most fruitful years of [his] life.” After his time at Harvard, Dr. Finney was selected as a Resident Surgical Staff member at Massachusetts General Hospital, and he completed 18 months in that institution. In 1889, he left Boston and went to Baltimore to work under William S. Halsted, MD, FACS(Hon), of Johns Hopkins.

About a year later, still not having operating privileges at Johns Hopkins, he opened a private practice at Union Protestant Hospital (now Union Memorial Hospital).⁵ However, when Dr. Halsted was away from Baltimore, Dr. Finney was often left in charge of the service. Gradually, Dr. Finney’s reputation grew.

In 1913, when the ACS was working to select its first president, the organization passed over more well-known names and chose Dr. Finney as its first president. As noted by John L. Cameron, MD, FACS, in his 2008 Presidential Address to the ACS, “Finney was chosen . . . because he was a sound surgeon with strong moral and ethical values, and an outstanding human being.”⁵

Dr. Finney went on to serve with the American Expeditionary Force in Europe for 2 years, and he served for 3 years as interim chair at Johns Hopkins after Dr. Halsted’s demise. He later served as president of the American Surgical Association and Southern Surgical Association before he died in 1942.

Dr. Thomas Dodson is a Professor Emeritus in the Department of Surgery at the Emory University School of Medicine in Atlanta, GA.

References

1. Ludmerer KM. Learning to Heal: The Development of American Medical Education. New York. Basic Books, Inc., 1985.
2. Flexner A. I Remember; The Autobiography of Abraham Flexner. New York. Simon and Schuster, 1940.
3. Duffy TP. The Flexner Report—100 years later. Yale J Biol Med. 2011;84(3):269-276.
4. Finney JMT. A Surgeon’s Life. New York. J. P. Putnam’s Sons. 1940.
5. Cameron J L. John Miller Turpin Finney: The First President of the American College of Surgeons. J Am Coll Surg. 2009;208(3):327-332.