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Choosing the Student Body: Masculinity, Culture, and the Crisis of Medical School Admissions, 1920–1950

Published online by Cambridge University Press:  24 February 2017

Charlotte G. Borst
Charlotte G. Borst*
Affiliation:
Union College, Schenectady, New York
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Extract

“Is it possible to select medical students scientifically?” asked Mary D. Salter in a 1942 journal article that examined the Medical College Aptitude Test (MCAT). Salter, a Lecturer in Psychology at the Faculty of Medicine at the University of Toronto answered affirmatively, pointing out that “scientific selection of students would greatly reduce the wastage of time, money, and effort involved when students fail.”

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Articles
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History of Education Quarterly , Volume 42 , Issue 2 , Summer 2002 , pp. 181 - 214
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Copyright © 2002 by the History of Education Society 

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References

1 Salter, Mary D. “A Method of Selection of Medical Students Based on Previous Academic Grades and Medical Aptitude Scores,“ Journal of the Association of American Medical Colleges [hereafter JAAMC] 17 (1942): 300.Google Scholar

2 Lemann's, Nicholas important work on the Scholastic Aptitude Test makes this claim for the SAT. However, as he admits, this test was not widely used until World War II, when Harvard's Henry Chauncey moved to the Educational Testing Service and took over the development and dissemination of the SAT as one of the two most widely used standardized admissions’ tests for higher education. The Big Test: The Secret History of the American Meritocracy (New York: Farrar, Straus, and Giroux, 1999).Google Scholar

3 “Resolution on Entrance Requirements to Medical Courses of Educational Institutions,” Journal of the American Medical Association [hereafter JAMA], 106 (1936): 1823. The AMA's Committee on Medical Education and Hospitals was one of two important national groups that oversaw medical education in the United States. (The other group was the Association of American Medical Colleges). Both of these groups vied for supremacy in this task, but the AMA committee had the power to determine that a medical school admissions and curricular requirements did not meet requirements appropriate for licensure. This ability gave this group particular power in medical education circles.Google Scholar

4 As we shall see, that test was administered throughout the 1930s and into the 1940s. However, the key is whether the medical schools were really using it. As this paper will make clear, they were not. The Executive Council of the AAMC, which was responsible for the test, voted to discontinue its work on August 31 of 1946. [JAAMC 21 (1946)]Google Scholar

5 Starr, Paul The Social Transformation of American Medicine (New York: Basic Books, 1982), 5.Google Scholar

6 As David O. Levine notes in The American College and the Culture of Aspiration, 1915–1940 (Ithaca: Cornell University Press, 1986), 43: “Between the two world wars, for the first time in American history, a college education became an essential part of the success strategy of those who sought fortune or prestige in the United States.”Google Scholar

7 Scott's, Joan Wallach “Gender: A Useful Category of Historical Analysis,“ is the most cited essay on this topic [first published in the American Historical Review, 91 (December 1986).]Google Scholar

8 Morantz-Sanchez, Regina Sympathy and Science: Women Physicians in American Medicine (New York: Oxford University Press, 1985). Mary Roth Walsh's Doctors Wanted: No Women Need Apply (New Haven: Yale University Press, 1977) documents this well. See especially chapter 6, “Moving Backward,” 178–206. See also Ellen More, Restoring the Balance: Women Physicians and the Profession of Medicine, 1850–1995 (Cambridge: Harvard University Press, 1999), 96–99. More argues that the ascendency of private practice that replaced enthusiasm for “maternalist” medicine in the Progressive Era eliminated the special place that women physicians had been able to carve out for themselves.Google Scholar

9 In 1910 and in 1920, there were 59 women doctors to every 1000 male doctors, but by 1930, this ratio had dropped to 52:1000. Various explanations were offered during this time period, but prejudice and other opportunities are compelling explanations. Chase Going Woodhouse, “Opportunities for Women in the Medical Profession,” in Bulletin of the Women's Medical College of Pennsylvania 88 (May 1938): 9–11.Google Scholar

10 Bacon, Emily P. “Qualifications for Success in Medicine,“ Bulletin of the Women's Medical College of Pennsylvania 88 (May 1938: 14–15.Google Scholar

11 See Chapter 1 of Gail Bederman, Manliness and Civilization: A Cultural History of Gender and Race in the United States, 1880–1917 (Chicago: University of Chicago Press, 1996), especially pp. 28, 36.Google Scholar

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13 Jacobson, Whiteness of a Different Color, 5–7.Google Scholar

14 Brodkin, How Jews Became White Folks, 23.Google Scholar

15 Rotondo, E. Anthony American Manhood: Transformations in Masculinity from the Revolution to the Modern Era (New York: Basic Books, 1993), especially Chapter 10, 222–246; Kimmel, Michael Manhood in America: A Cultural History (New York: The Free Press, 1997), 90.Google Scholar

16 Bederman, Manliness and Civilization, 1–31 has a nice summary of these issues.Google Scholar

17 Since overall birth and death registration data for the whole United States did not exist in a reliable form until the second decade of the twentieth century, historical demographers have had to rely on individual city mortality data. In general, all of this data shows a decline from the late nineteenth to the early twentieth centuries. In Philadelphia, for example, the expectation of life at birth in 1870 was 39.6, by 1910, this figure had risen to 49.6, and by 1930, it was 57.9. Infant mortality showed some of the sharpest declines: in 1870, 175 of every 1000 children died before their first birthday; by 1930, this figure was 75 of every 1000 children. Whether particular laboratory scientific investigations led to this decline in mortality is debated among scholars; however, it is clear that the public saw “science” as the reason. Gretchen A. Condran, Henry Williams, and Rose A. Cheney, “The Decline of Mortality in Philadelphia from 1870 to 1930: The Role of Municipal Services,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, 2nd ed. revised (Madison: University of Wisconsin Press, 1985), 423, Table 1.Google Scholar

18 For example, see Robert H. Wiebe, The Search for Order, 1817–1920 (New York: Hill and Wang, 1967).Google Scholar

19 Reuben, Julie A. The Making of the Modern University: Intellectual Transformation and the Marginalization of Morality (Chicago: University of Chicago Press, 1996), 5–6.Google Scholar

20 More, “Empathy Enters the Profession of Medicine,“ in Ellen S. More and Maureen A. Mulligan, eds. The Empathetic Practitioner: Empathy, Gender, and Medicine (New Brunswick: Rutgers University Press, 1994), 23–25.Google Scholar

21 Charles, E. Rosenberg's classic article “The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America,” in The Therapeutic Revolution: Essays in the Social History of American Medicine, Morris J. Vogel and Charles E. Rosenberg, eds. (Philadelphia: University of Pennsylvania Press, 1979), 3–25 discusses the relationship of therapeutics with the need for the physician to understand the social context of the patient. My own work explores this relationship specifically with regard to obstetrics. Charlotte G. Borst, Catching Babies: The Professionalization of Childbirth, 1870–1920 (Cambridge: Harvard University Press, 1995).Google Scholar

22 Wright, Louis T. “I Remember“ typescript autobiography, folder 12, Box 130–1 family and personal papers, 17; 30 Louis T. Wright papers, Moorland Spingarn Archives, Howard University, Washington, D.C.Google Scholar

23 Ibid., 9. Wright later did his residency in surgery at Freedman's Hospital in Washington, D.C. Wright clearly understood the racial issues at Harvard, and he understood that white supremacy was linked to issues of gender. “I Remember” has a long section detailing Wright's own memories of the infamous Atlanta 1907 race riot. For a lengthier discussion of the context of this issue, see Glenda Elizabeth Gilmore's brilliant book, Gender and Jim Crow: Women and the Politics of White Supremacy in North Carolina, 1896–1920 (Chapel Hill: University of North Carolina Press, 1996).Google Scholar

24 I am not the first historian to suggest that laboratory medicine eliminated the places for women and ethnic physicians. Regina Morantz-Sanchez examines the impact on women doctors in Sympathy and Science: Women Physicians in American Medicine (New York: Oxford University Press, 1985). Gerald E. Markowitz and David Karl Rosner have made this argument for working-class men (who were often immigrants) in “Doctors in Crisis: A Study of the Use of Medical Education Reform to Establish Modern Professional Elitism in Medicine,” American Quarterly 25 (March 1973): 83–107. I am indebted as well to the analyses of science by feminist philosophers and historians of science. See for example, Ruth Hubbard, “Science, Facts, and Feminism,” and Evelyn Fox Keller, “The Gender/Science System: or, Is Sex to Gender as Nature is to Science?,” both in Feminism and Science, Nancy Tuana, ed. (Bloomington: Indiana University Press, 1989) and the essays in Sandra Harding's edited collection, The Racial Economy of Science: Toward a Democratic Future (Bloomington: Indiana University Press, 1993). It is noteworthy, however, that most of these accounts focus on science as constructed and practiced before the twentieth century. I believe that the introduction of the laboratory paradigm in the late nineteenth century was the crucial period when women and ethnic men are displaced. Sinclair Lewis's novel Arrowsmith (1925) gives one of the best contemporary examples of this cultural shift. Martin Arrowsmith, the book's hero, rejects first clinical medicine, then the model of public health, for the science emblematic of the laboratory. Charles Rosenberg's essay, “Martin Arrowsmith: The Scientist as Hero,” in Rosenberg, No Other Gods: On Science and Social Thought (Baltimore: Johns Hopkins University Press, 1976), 123–131 analyzes the writing of this novel and its assumptions of science in twentieth-century culture. It does not, however, examine the gender possibilities.Google Scholar

25 Wright described the Harvard Dean as “a bigoted, prejudiced man” who barred Negroes from medical school over a period of years after Wright had graduated‥ [“I Remember,” 54]. Note: Kenneth Ludmerer's otherwise carefully written book, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (New York: Oxford University Press, 1999), 63 is in error in noting that Harvard had not admitted any black students in this time period.Google Scholar

26 Reitzes, Dietrich C. Negroes and Medicine (Cambridge: Harvard University Press for the Commonwealth Fund, 1958), p. 5, Table 1; p. 7, Table 4.Google Scholar

27 Ibid, xxi., xxii.Google Scholar

28 All these figures were compiled by Martha Tracy, Dean of Women's Medical College of Pennsylvania, for a report she wrote in 1938 “Report of a Conference on Opportunities for Women in the Medical Profession and the Selection of Medical Students.” “Facts on Medical Women, 1938,” in Martha Tracy Papers, Box 5, folder 42, Dean's Office (Rebuilding) Women's Medical College Archives, MCP-Hahnemann Archives, Philadelphia, PA.Google Scholar

29 Flexner, Abraham Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching Bulletin No. 4 (New York: Carnegie Foundation, 1910); reprint (New York: Classics of Medicine Library, 1990), 53.Google Scholar

30 Thorpe, Edward S. “Qualifications for Success in Medicine,“ in Bulletin of the Women's Medical College of Pennsylvania 38 (May 1938: 16.Google Scholar

31 By World War I, most states required two years of college work before going to medical school as a part of the requirements for licensure; medical schools adopted this policy as a minimum requirement. Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), 252.Google Scholar

32 Ludmerer, (ibid., 115) argues that the imposition of these languages was part of medical educators’ view of “entrance requirements” as “science.” Ludmerer argues that they required German and French so that students could keep up with the current scientific literature. While this need may have played a role in some medical educators’ advocacy of languages, it was clear from Hugh Cabot's correspondence that he regarded language requirements at Michigan as elevating the culture of the students.Google Scholar

33 Wiebe, Search for Order, 121.Google Scholar

34 Markowitz, Gerald E. and David Karl Rosner argued that the entire issue of professionalization and reform of medical education was tied to elite doctors’ attempts to make medicine more homogeneous in terms of class and ethnicity. (“Doctors in Crisis”).Google Scholar

35 There were 13,052 students in medical schools in 1919. By 1923, the number had reached 17,432. Council on Medical Education and Hospitals, American Medical Association, “Medical Education in the United States: Annual Presentation of Education Data for 1923,” JAMA 81 (August 18, 1923): Table 4, 549.Google Scholar

36 This was the assumption also made by undergraduate institutions in their relationships with prep schools and some public high schools that served as “feeder schools” for these institutions. See Harold S. Wechsler, The Qualified Student: A History of Selective College Admission in America (New York: John Wiley & Sons, 1977), 131–133.Google Scholar

37 A survey by Hugh Cabot in 1928 of his medical school dean friends revealed a wide variety of practices regarding admissions. But the example of the Dean at the University of Pennsylvania was fairly typical. Dean Pepper wrote Cabot that though there was a Committee on Admissions, “the selection of the class, however, is entirely in my hands” letter “To the Dean and Faculty of the Medical School of the University of Michigan” May 12, 1928, in Dean's Files, Box 37, Folder 1928 AA,” University of Michigan Medical School Dean's Records, Bentley Library, University of Michigan.Google Scholar

38 Myers, Burton D. “Report on Applications for Matriculation in Schools of Medicine of the United States and Canada, 1929–1930,“ JAAMC 5 (1930): 65.Google Scholar

39 Moss, F.A. “Scholastic Aptitude Tests for Medical Students,“ JAAMC, 5 (1930): 90; Editorial, “Endorsement of Aptitude Tests,” JAAMC 6 (1931): 47.Google Scholar

40 Myers, “Report on Applications for Matriculants,“ 65; this rate persisted, with minor blips, into the early 1930s. See Fred C. Zapffe, “Study of Applicants for Admission to the 1935 Freshmen Class in Seventy-nine Medical Schools,” JAAMC 11 (1936): Table 1, p.186.Google Scholar

41 Morantz-Sanchez, Sympathy and Science, Table 9.3, p. 249; also Council on Medical Education and Hospitals, American Medical Association, “Medical Education in the United States and Canada: Annual Presentation of Educational Data for the Academic Year 1934–1935,” JAMA 105 (August 31, 1935): Table 9, p. 68. African-American medical students were confined almost exclusively to Meharry and Howard University Schools of Medicine, which were historically black institutions.Google Scholar

42 Levine, American College and the Culture of Aspiration, 14 68.Google Scholar

43 MacCracken, W.H. “Discussion,“ for Burton D. Myers, “Report on Applications for Matriculation in Schools of Medicine of the United States and Canada,” JAAMC 4 (1929) 107.Google Scholar

44 These details were released in a letter written by a committee at the University of Michigan that surveyed medical schools throughout the country on their admissions processes. “To the Dean and Faculty of the Medical School of the University of Michigan” May 12, 1928, in Dean's Files, Box 37, Folder 1928 “A” University of Michigan Medical School Dean's Records, Bentley Library, University of Michigan, 2–3.Google Scholar

45 An entire issue of JAAMC in 1930 was devoted to the question of the “multiple applicant”: Adam Miller, “Academic Achievements of Multiple Applicants,” (pp. 9–12); Begg, Alexander S. “The Scholastic Achievement of Multiple Applicants,“ (pp. 13–15); and Schwitallla, Alphonse M. “The Scholastic Achievements of Multi-Applicants,“ (pp. 15–26) all in Vol. 5, January 1930). All of these articles reflected the great anxiety over the “multi-applicant” who was generally a man from a northeastern or large mid-western city. Despite all their attempts to find that these applicants were academically weak, the data presented by these authors showed that they were very strong students. But the tone of the articles made it clear that the deans generally disliked these applicants.Google Scholar

46 Correspondence with Hugh Cabot, Folder “Commission on Med Education” Box 36, University of Michigan Medical School Dean's Records, Bentley Library, University of Michigan, Ann Arbor, Michigan.Google Scholar

47 Correspondence with Hugh Cabot, Folder 1926 AA”, Dean's Correspondence, University of Michigan Medical School Dean's Records, Bentley Library, Ann Arbor, Michigan.Google Scholar

48 Davison, Wilbert C. “The Significance of Present Entrance Requirements,“ JAMA 96 (April 25, 1931): 1369.Google Scholar

49 This was found in a 1926 letter to Jeanette Noble (who wrote on behalf of Cabot) from W.C. Hunt (the Bureau of the Census) telling her that it is impossible to provide statistics regarding the Jewish population for the United States or for states or cities. Hunt did go on to provide information regarding mother tongue, and estimated the Jewish pop at 3.3 million in 1917. Hugh Cabot Correspondence, University of Michigan Medical School Deans’ Correspondence, 1926, Folder “I-J,” Bentley Library, Ann Arbor, Michigan.Google Scholar

50 Synott, Marcia Graham “Anti-Semitism and American Universities: Did Quotas follow the Jews?“ in Anti-Semitism in American History, David A. Gerber, ed. (Urbana: University of Illinois Press, 1986): 252–258. Ludmerer, Time to Heal, devotes only a few pages to this whole issue. He quotes a dean at Harvard who also spoke out on this issue, though in a less overtly racist manner. Nonetheless, Harvard's dean, like every other dean, wished to limit the number of Jewish medical students there (p. 64).Google Scholar

51 In addition to the transcript and the “confidential letters from teachers”, Columbia University Medical School by 1928 interviewed 95 percent of their applicants. “Letter to the Dean and Faculty of the Medical School of the University of Michigan” 2–3, in Medical School Dean's Correspondence, Box 37, Folder 1928 “A”, Bentley Library, University of Michigan.Google Scholar

52 Description of both Johns Hopkins and the University of Michigan's decisions are found in a report made by a committee appointed by Dean Hugh Cabot, in “Letter to the Dean and Faculty of the University of Michigan,” in Dean's Files, University of Michigan Medical School, Box 37, Folder 1928 AA”, in Bentley Library, University of Michigan, Ann Arbor, MI.Google Scholar

53 Kimmel, Manhood in America, 191–221 examines the general concept of masculinity after World War I. That “race” was part of this process is made clear in the University of Michigan Dean's correspondence after that school established the personal interview. Students were interviewed both in Ann Arbor and in New York City, and the Dean preferred that a psychiatrist do the off-campus interviews. In a series of letters from 1928 between Cabot and Dr. Frankwood E. Williams, New York City physician who was a member of the National Committee for Mental Hygiene, Williams reported on a group he had interviewed for Michigan from New York City: “Those on Wednesday and Friday were mostly from New York City and were most unpromising. They were mostly Jewish and not representative by a good deal of the best of their race.” Letter from Frankwood E. Williams to Hugh Cabot, June 22, 1928, Medical School Dean's Records, Folder 1928 “A”, Box 37, Bentley Library, University of Michigan, Ann Arbor, MI.Google Scholar

54 Levine, American College and the Culture of Aspiration, 146–158.Google Scholar

55 “Personal Interview Reduces Applicants,” JAMA 90 (1928): 1957. The dean of the University of Michigan Medical School reported that in the year before the imposition of the requirement, almost 1000 students had applied to the school. In the year after this required was implemented, however, only 400 students applied for the 200 spaces available.Google Scholar

56 Synnott, “Anti-Semitism and American Universities,“ 251–252.Google Scholar

57 Levine, American College and the Culture of Aspiration, 148 estimated that “less than 50 percent of students at New York University were Jewish in 1919,” a far higher percentage of Jewish students than at any other university in the area.Google Scholar

58 MacTavish, William C. and Mullowney, J.J. “Discussion of Papers of Drs. Miller, Begg and Schwitallla,“ JAAMC 5 (1930): 23–25.Google Scholar

59 Though their private correspondence revealed outright racism, it is clear from reading the transactions of AAMC meetings that the medical school deans were very uncomfortable with public discussions of race. The discussion noted in the preceding paragraph was the only extended discussion I could find in the JAAMC, which recorded the AAMC meetings, where race was discussed so openly. As will become apparent, the deans preferred more subtle, coded discussions.Google Scholar

60 Reed, James “Robert M. Yerkes and the Mental Testing Movement,“ in Psychological Testing and American Society, 1890–1930,” Sokal, Michael M. ed. (New Brunswick: Rutgers University Press, 1987), 75–94; quoted by Hanson, F. Allan Testing, Testing: Social Consequences of the Examined Life (Berkeley: University of California Press, 1993), 212. There is a substantial amount of scholarship dealing with the testing movement. Stephen Jay Gould's The Mismeasure of Man (New York: Norton, 1981) is often cited.Google Scholar

61 Hanson, Testing, Testing, 212.Google Scholar

62 Ibid., 212–216; also Wechsler, The Qualified Student, 158–161.Google Scholar

63 Hawkes, Herbert to Wilson, E.B. June 16, 1922, Columbia University Files, Herbert Hawkes File, quoted by Wechsler, The Qualified Student, 160–161. Nicholas Lemann, The Big Test, 30 notes that Thorndike's test, developed as an intelligence test, was used at Columbia University and it was adopted by the University of Pennsylvania.Google Scholar

64 Moss, F.A. “Scholastic Aptitude Tests for Medical Students,“ JAAMC 6 (1931): 13–14.Google Scholar

65 Lemann, The Big Test, 17–26 has a brief description of the various factions in the 1920s who were working on educational testing. Interestingly, he does not cite Hanson or Wechsler's work.Google Scholar

66 University of Michigan Medical School Archives, Dean's Records, Box 37, Folder 1928 “A”, Bentley Historical Library, University of Michigan.Google Scholar

67 Letter from C.S. Yoakam to Frankwood E. Williams, March 10, 1928, in University of Michigan Medical School Dean's Files, Box 37, Folder 1928 “A”, Bentley Library, University of Michigan. Williams was a New York City physician who interviewed prospective Michigan candidates in New York City. Yoakam was a faculty member at the University of Michigan who had worked evidently with the Carnegie Tech group.Google Scholar

68 There was a further problem with these tests. Though it was not acknowledged in the Michigan dean's correspondence, the Iowa tests were developed by a psychologist who wished to use these psychological tests to widen the possible net of qualified applicants, not restrict it. E.F. Lindquist, an educational psychologist at the University of Iowa, developed the Iowa “Every Pupil Testing Program” as a means of identifying talented public school children. Achievement tests were given to every public school child. Indeed, in 1936, he decried the use of the tests to identify only gifted students, arguing that the tests were meant to screen out the few students who would not benefit from a college education. See Lemann, The Big Test, 24–25.Google Scholar

69 Moss, F.A. “Scholastic Aptitude Tests for Medical Students,“ JAAMC 5 (1930):90.Google Scholar

70 Robertson, David Allen “Educational Relations of the Professions,“ JAMA 92 (April 27, 1929): 1403–1404. The use of the word “aptitude” in this description of the test for medical school carried a specific meaning. Those who developed many of the IQ tests of the war years and into the 1920s believed that tests needed to discover “aptitude” that was somehow independent of “achievement.” Aptitude was believed to be the essence of native intelligence, and of course, the fact that native-born elites had done well on these intelligence tests vindicated their further use. Achievement tests, on the other hand, measured something that anyone who studied very hard would do well on. Lemann finds that the college SAT test was deliberately developed as an “aptitude test”, not an achievement test. See Lemann, The Big Test, 38. The very name of the Moss test, the Medical “Aptitude Test” explains this test's rationale.Google Scholar

71 Moss, “Scholastic Aptitude Tests,“ (1930): 90–110.CrossRefGoogle Scholar

72 “Endorsement of Aptitude Tests,” JAAMC 6 (1931): 47.Google Scholar

73 At the Women's Medical College of Pennsylvania (WMCP), for example, Dean Martha Tracy had access to the actual scores for each WMCP student. It appears that she did the correlations with the grades, and then reported to the faculty whether students had scores in various quartiles. In a meeting in 1933, faculty got to see the actual test, but not student scores. It is hard to gauge whether Dean Tracy's method was followed by all medical school deans, but the results were certainly closely guarded. Faculty minutes, April 21, 1933, in bound volume, Women's Medical College of Pennsylvania Archives, WMCP-Hahnemann, Philadelphia, PA.Google Scholar

74 The first substantial discussion of this test at WMCP was in March of 1931, when the faculty reviewed the results from two years of testing together with students’ actual grades. Faculty minutes, March 6, 1931, WMCP Archives. Dean Tracy at the Women's Medical College appears to have been an eager proponent of this test: faculty minutes in 1929 reported her great enthusiasm for the development of this test and the reports at the AAMC meeting. Faculty minutes, December 13, 1929, WMCP Archives. The results at Michigan were summarized in a report bound in the faculty minutes for 1930. Executive Committee Minutes, University of Michigan Medical School, Dean's Records, Bentley Library.Google Scholar

75 Executive Committee Minutes, December 8, 1930 and January 5, 1931. University of Michigan Medical School, Dean's Records, Bentley Library. It is unclear why the faculty Executive Committee, which was running the medical school in the absence of a Dean, was unwilling to require the test. President Ruthven, however, was an eager proponent of the test, and he entered directly into negotiations with the AAMC's group that had arranged to conduct the February 1931 testing of undergraduates.Google Scholar

76 Moss, F.A. “Report of the Committee on Aptitude Tests for Medical Students,“ JAAMC 7 (1932): 129–141. The reason for the confidentiality of the test results may have been a fear that students would sue. See W.C. MacTavish, “Discussion,” of F.A. Moss, “Report on the Committee on Aptitude Tests for Medical Students,” JAAMC 7 (1932): 143. MacTavish, of NYU, did note that students complained about this.Google Scholar

77 Moss, “Scholastic Aptitude Tests,“ (1931): 15.Google Scholar

78 Moursund, Walter H. “Premedical Qualifications in Relation to Achievement in Medical School,“ JAAMC 7 (1932): 149–157. This paper followed Moss's report on the aptitude test, and it is noteworthy that Moursund, the Dean of the Baylor School of Medicine, used the opportunity to criticize the subjectivity of the personal interview.Google Scholar

79 Executive Committee Minutes, March 10, 1930, in bound volume, Box 6, University of Michigan Medical School, Dean's files, Bentley Library, University of Michigan, Ann Arbor, Michigan. The President's support for the Medical Aptitude Test was reiterated in a meeting on March 24, 1930, in which the committee discussed faculty desires to keep using their own test as well as the Moss test. The meeting was in the President's office, and perhaps this venue was one reason the President's wishes were followed. No motion was taken on this proposal. All the committee members did agree, however, that they disliked the personal interview. (Executive Committee minutes, March 24, 1930).Google Scholar

80 Moss, F.A. “Report of the Committee on Aptitude Tests for Medical Schools,“ JAAMC 14 (1939): 250.Google Scholar

81 Moss, F.A. “Scholastic Aptitude Tests for Medical Students: Report for 1932,“ JAAMC 8 (1933): 1–27. It is apparent that the dean of the medical school at George Washington University (GWU) when Moss had originally developed the test, Dean Borden, had been supportive of the exam and its predictive value. The very negative report was written by a new dean, Earl B. McKinley. Academic politics appears to have been at work to some degree—the President of GWU was involved in separate meetings with McKinley and Moss, and it was the President's decision to call in a neutral statistician. Moss's co-creator in 1927, O.B. Hunter, the Assistant Dean of GWU's Medical School, remained loyal to Moss.Google Scholar

82 Kingdon, “Discrimination in Medical Colleges,“ 396.Google Scholar

83 Cooley, Thoms B. “Our Changing Profession,” Annals of Internal Medicine 2 (1929): 685–688.Google Scholar

84 Wechsler, The Qualified Student, 131–185 deals with this issue.Google Scholar

85 Frederick, T van Beuren, “Correlation of Grades in Medical and Premedical Work with Personality,” JAAMC 4 (1920): 199–201.Google Scholar

86 Cabot, Hugh “Discussion of Frederick T. van Buren, ‘Correlation of Grades,'“ 203–204.Google Scholar

87 An editorial in the establishment New York Herald Tribune of 1929 (later reprinted in the Harvard Crimson) noted that “Membership in the varsity football team represents the peak of undergraduate attainment.” Scholastic excellence, it noted sardonically, was at the bottom of the scale of values. Harvard Crimson, October 14, 1929, quoted by Levine, American College and the Culture of Aspiration, 120. Intercollegiate athletics could provide a means for a young man of lower class status to go to college, and Levine notes that a number of elite schools did beef up their programs by offering athletic scholarships to poor but athletically gifted students. This was also the period when university administrators first began to realize the value of intercollegiate athletics as a part of stimulating alumni giving. Medical students at Saint Louis University (SLU) played varsity basketball and football throughout at least the 1920s, and one junior medical student was even captain of the basketball team in 1920. See copies of the SLU yearbook, The Archive, kept in the Saint Louis Room, Pius Library, Saint Louis University.Google Scholar

88 An analysis of the applications for the 1934 classes at American medical schools showed an increase of 5.5 percent over the 1933 rate, but the number actually accepted dropped by 2 percent. 57.9 percent of applicants were accepted. Fred C. Zapffe, “Study of Applicants for Admission to the 1934 Freshmen Class of Seventy-Nine Medical Schools,” JAAMC 10 (1935): 201–217. Enrollment in undergraduate colleges fell in the period between 1929 and 1934. Universities lost about 6 percent and liberal arts schools about 3 percent of their enrollments. Levine, The American College, 189.Google Scholar

89 Rappleye, Willard C. “Relation of the Number of Medical Graduates to the Public Need,“ JAAMC 9 (1934): 1–8.Google Scholar

90 Cutter, William D. “Relation of the Number of Medical Graduates to the Public Need,“ JAAMC 9 (1934): 8–11.Google Scholar

91 Synnott, “Anti-Semitism and American Universities,“ Table 2, p. 253.Google Scholar

92 “Resolution on Entrance Requirements to Medical Course of Educational Institutions,” JAMA 106 (May 23, 1936): 1823.Google Scholar

93 Lape, Esther Everett “Medical Education as Discussed in American Medicine,” JAAMC 12 (1937): 363.Google Scholar

94 Lape, “Medical Education,“ 367 369.Google Scholar

95 Ibid., 368.Google Scholar

96 “Report of the Executive Council,” in Association of American Medical Colleges, Minutes of the Proceedings of the Forty-Fifth Annual Meeting, Nashville, TN, October, 1934, 14–17. President Patterson noted that there were a “number of criticisms presented to the Council in various ways with regard to the aptitude test.” In the discussion that followed, the University of Minnesota's dean was the most vocal proponent of the test, and his spirited defense helped to sway other members.Google Scholar

97 Lape, “Medical Education,“ 370.Google Scholar

98 Moss, F.A. “Report of the Committee on Aptitude Tests for Medical Schools,“ JAAMC 16 (1941): 236.Google Scholar

99 Letter and enclosure from F.A. Moss to Members of the Executive Committee of the AAMC, April 11, 1941. This was the Aptitude test given on May 1, 1941. Program Files, MCAT, Box 1, Association of American Medical College Archives, Washington, DC. My thanks to Professor Thomas Curran at Saint Louis University for suggesting how this map played into the cultural “memory” of the Civil War among certain groups of Americans and not others.Google Scholar

100 Ibid. Quote is from Moss's letter to the Executive Committee.Google Scholar

101 The AAMC Executive Council, which was responsible for the test, voted to discontinue the AAMC's involvement with the test on August 31, 1946. JAAMC 21 (1946).Google Scholar

102 By 1941, Moss reported, somewhat querulously, that he had added questions relating to general cultural questions, but that these had “exceedingly low predictive value.” That he was under attack for this test is evident from the multiple reports from “experts in psychology” that were incorporated in his report. Moss, “Report,” (1941): 239.Google Scholar

103 Kingdon's report of 1945 noted the drop in Jewish medical students between 1937 and 1940. His data, based on a survey of medical schools in 1945, showed that the largest number of Catholic medical students were enrolled at Catholic universities. Not surprisingly, these schools also had the largest number of “Italians” as well. Schools in the South, such as Bowman Gray and the University of Virginia, had the fewest students in this group. Kingdon, “Discrimination in Medical Colleges,” 396–397.Google Scholar

104 Brodkin, How Jews Became White Folks, 138–174; quote is from p. 140; Jacobson, Whiteness of a Different Color, 246. Brodkin also points out that the construction of Jews as “white” was also highly gendered.Google Scholar

105 “Medical Aptitude Test,” JAAMC 23 (1948):271.Google Scholar

106 The test brochure also noted that the test consisted of “tests of general scholastic ability, a test of the candidate's understanding of modern society, and an achievement test in science.” Educational Testing Service, “Medical College Admission Test: Bulletin of Information, 1956,” copy in the AAMC Archives, AMCAT”, Box 6, MS C 267, History of Medicine Division, National Library of Medicine, Bethesda, MD. Quote is from page 3.Google Scholar

107 Reitzes, Negroes and Medicine, xxi., xxii.Google Scholar

108 Lemann, The Big Test, 155–165 points out that the question of scores by African Americans on standardized tests became an important and hotly argued question during the debate over the Civil Rights Act of 1964. With the passage of the act, the Office of Education conducted a study to determine the causes of the poor performance by African Americans on standardized tests. The Educational Testing Service received the contract to do the study.Google Scholar

109 Executive Committee Minutes, February 12, 1948, Medical School Dean's files, Bentley Library, University of Michigan. The Executive Committee minutes make it clear that the issue of race had not gone away at Michigan, but that it did transform from concern about Jews and others to a concern about African-American applicants. As late as 1951, the Executive Committee refused to eliminate race and religion from the admissions blank, citing its “high purpose in choosing physicians responsible for the health of the communities of this state and that in such a high responsibility no information about an individual is irrelevant. The Executive Committee of the Medical School believes further that uncritical adoption of recommendations of minority groups is likely to result in the very undemocratic situation of discrimination against the majority.” Minutes, February 1, 1951. That this was related to black applicants is demonstrated by the constant references to black students at Meharry and Howard, and pride that Michigan had more black students than many other historically white schools.Google Scholar

110 Anders, James A. “Research Method of Teaching Science,“ General Magazine and Historical Chronicle 31 (1929): 484; quoted by Reuben, Making of the Modern University, 204.Google Scholar

111 Interestingly, the number of female medical students did not change from the 1920s through the beginning of World War II. The number remained at about 5 percent. See Note 24.Google Scholar

112 The 1970 class-action suit by the Women's Equity Action League, in conjunction with the federal government's requirements for affirmative action led directly to an increase in the number of female medical students. Until 1970–71, the number of female medical students never exceeded 9 percent of all medical students. By the 1975–76 school year, the number had reached 20.5 percent. Walsh, “Doctors Wanted: No Women Need Apply,” 268–269. The number of minority medical students remained very low until the 1980s. In 1968, over 75 percent of the 266 first-year African-American medical students attended the historically black Howard or Meharry Medical schools. Black first-year medical students constituted 2.7 percent of all medical students. The number of black medical students peaked at 7.5 percent in the mid-1970s, but declined in the mid-1980s, and with recent decisions in California and in Texas to ban affirmative action in higher education admissions decisions, the number of minority students has declined even further. The AAMC's attempt “Project 3000 by 2000” which would raise minority admissions, is unlikely to succeed under these legal proscriptions. In 1995, minority first-year medical students constituted 12.4 percent of all first-year students. Minorities & Women in the Health Fields (DHHS Publication No. (HRSA) HRS-DV 84–5 (Division of Health Professions Analysis, U.S. Dept. Of Health and Human Services, 1984), 25–28; also “Minority Enrollments Drop at Medical Schools,” Chronicle of Higher Education (Jan. 10, 1997), p. A49.Google Scholar

113 In the fall of 1997, the state of California had received the go-ahead to begin enforcing a ban on the use of racial or gender preferences by state and local agencies, including public colleges and universities. This decision mirrored a similar one in Texas, the Hopwood decision, which also banned similar preferences. When a New Jersey case headed to the Supreme Court that directly challenged affirmative action, many higher education groups joined with the Clinton administration to urge the Supreme Court not to dismantle affirmative action in higher education. The American Association of Medical College was among these organizations, and their leader, Dr. Jordan Cohen, has continued to be very vocal in his support of racial and gender diversity in medical school education. “College Groups Urge Supreme Court to Preserve Affirmative Action,” and “Legal Barriers Removed to California's Ban on Racial Preferences,” Chronicle of Higher Education (September 5, 1997), A46, A47; on the AAMC, see “Minority Enrollments Drop at Medical School,” Chronicle of Higher Education (January 10, 1997), p. A49. By the fall of 2000, most universities had dropped overt affirmative action policies for admissions, and minority applications to medical schools have declined by 12 percent since 1996. AAAMC News Room, Issue Summaries, ‘Diversity.'” December 7, 1999.Google Scholar