Franklin Paine Mall
Author: Florence Rena Sabin
Franklin Mall perhaps contributed more than any of the other founding physicians of the Johns Hopkins Hospital to defining the course of medical education in the United States. In demonstrating Mall’s influence, the book argues that ‘the story of his life reveals how medical research was started in this country’, and it provided varied examples of how he ‘changed the type of anatomical teaching in every laboratory in the country’. Unlike his other Johns Hopkins colleagues whose impact on medical education was very visible, the author showed that Mall exerted his influence covertly through the ‘trenchant and stimulating quality of his thought‘, and by ‘the wisdom of his counsel‘. The book’s depiction of Mall as ‘modest and assuming‘, and as a doctor who ‘so thoroughly accepted as his own, the simple life of the scholar’, perhaps explains why very little was known about him publicly during and after his time. The author, Mall’s student and later colleague, was indeed best placed to explore his hidden personality traits, and to put his under-appreciated research and medical educational contributions in context (pages 1-2, 10 and 222).
The book’s portrayal of Mall’s personality was of a conflicted man who possessed a ‘most complex grouping of qualities which were diametrically opposite‘. On one hand, the author described him as ‘quiet, modest, original, enigmatic’, amusing, entertaining, and extraordinarily kindly’, and on the other hand, as ‘severe, critical, and caustic’. It was also paradoxical that whilst he helped to define the direction of teaching and research, the author remarked that he ‘had no ability as a lecturer‘, and ‘no gift of eloquence as a speaker‘. Equally incongruous was the picture the book painted of his ‘mild’ and ‘even unimpressive’ physical appearance and demeanour, which contrasts with his personality as ‘a man of power, who loved to fight for ideals‘, and who ‘made people go his way’ just by the ‘sheer force of his will power‘. And even as the author referred to him as the a loyal friend who had a ‘devoted group of followers’, she added that in the pursuit of his goals, he demonstrated ‘a certain ruthlessness‘ by which he was willing to sacrifice himself as others. But the character trait that perhaps underlined Mall’s success was his intellectual approach to matters, the author asserting that he was ‘a thinker‘ who ‘would think for hours before in order to plan the best possible way to do a thing’ (pages 59-60, 121, 174-176, 121, 141 and 59-60).
The most important theme of the book relates to Mall’s immense contribution to the much needed reform of medical education. The book set this narrative in the context of the wider role played by the Johns Hopkins in restructuring medical training and research in the United States. In achieving this objective, the author acknowledged that Mall worked collaboratively with his colleagues, remarking that they were all ‘destined to become distinguished in their fields’; she however maintained that it was Mall’s ‘daring and original‘ mind that was ‘the most potent force’ in that process. The author went further to assert that Mall was the leader because of ‘the extraordinary clarity of his views’, and because of ‘the strength and lasting quality of his determination to put through the changes in medical education which he saw were needed’. It was particularly cogent that the author portrayed Mall as ‘a leader who saw education on a broad basis‘, describing his vision as one that conceived of medical education as ‘an integral part of a university’, and one which encompassed all subjects, not just the one ‘in which his own interest lay’. It was also compelling that Mall’s vision transcended his own institution, the author arguing that ‘he was not working just for his own school, but was using his abilities to help the development of his subject in America‘. It is therefore understandable when the author said ‘probably no one in medical circles, except Dr. Welch, was so universally appealed to for advice on educational matters’ (pages 1, 113, 119-121, 129, 142-143 and 175).
The biography provided an exhaustive account of Mall’s own education in anatomy, and the author said this ‘can be summed up in one sentence: he met two great teachers‘. The first teacher was Wilhelm His, professor of anatomy at Leipzig, who the author referred to as ‘the outstanding embryologist of his time’. The author said His, impressed by Mall’s ability and work, guided and supported him, and made Mall to appreciate that ‘those master minds who had led biological thought throughout the nineteenth century…had taken their education into their own hands‘. This insight undoubtedly contributed to Mall’s own distant teaching approach in which he ‘made his students take their problems into their own hands and solve them’. Mall’s other influential German teacher was Carl Ludwig who the author portrayed variously as ‘the greatest teacher of physiology that ever lived’; as a man who was ‘wholly without selfishness‘; and as ‘the personification of the ideal professor‘. The author said it was from Ludwig that Mall appreciated ‘the meaning of the life of the scholar’, and from whom he fully understood how the German university system enabled ‘the pursuit of science for its own sake’, and gave ‘complete freedom for the teacher to express his own views’, and ‘the freedom of the student ‘to choose his teachers’ and ‘outline his own course’. Unlike His, the author said Ludwig took a more active interest in his students’ work, but both were impressed by Mall’s skills and the quality of his work, and they both developed very close and enduring friendships with him (pages 38-47, 52-63 and 153-155).
In placing Mall’s medical education reforms in context, the book first provided a background of the medical reform movement that preceded him. For example, the book traced the earliest reform efforts in America to Charles Eliot, the President of Harvard College who attempted to raise the admissions standards to ‘above the actual level of the ability to read and write’. As a prelude to the resistance that future reformers would face, the book described how Eliot’s recommendations were met with ‘vigorous opposition…due to a fear of depleting the medical schools by requirements so drastic‘. A less direct effect on medical reform that the book also noted was the speech delivered by Aldous Huxley at the opening of the Johns Hopkins University in which he recommended that its medical school applicants ‘should have a sound elementary instruction in physics, chemistry and in the elements of human physiology‘. But perhaps the most defining reform that preceded Mall was the ‘uncompromising‘ stance taken by the female benefactors of the Johns Hopkins on raising the entry requirements to its medical school, and on opening its doors to female students. It is on this background that the book narrated how Mall championed such reforms as the concentration system of teaching whereby medical educators must also be investigators; ‘the stress he laid on the training of students in research‘; and his push to rebalance the time spent in learning different subjects to correspond with advances in knowledge in each field. Alongside documenting his contributions to medical education, the author also put on record Mall’s output as a researcher, from his work on the brain, the heart and the liver, to his investigations of the embryo, the lymphatics, and the spleen. In all these, the author stressed that his methods ‘always involved the greatest amount of thinking and the least amount of repetition of work’ (pages 100-111, 166-172, 180-184, 213-214 and 196-200).
In her biographical sketch of Mall’s early life, the author traced his German ancestry and exhaustively charted his family tree, and in the process she extracted the key factors that fashioned his personality and enabled his success. For example, she noted that ‘none of the Malls had wealth, but…as a family they stood out in the community for honesty and idealism‘. The biography also covered his medical education from his enrolment to Michigan University in 1878, through to his appointment as the Fellow in Pathology at the Johns Hopkins Hospital, beating sixteen other candidates to the post. The narrative also followed his professional advancement as he attained ‘his full stature‘ to become assistant to William Welch, the Professor of Pathology, and as he struck a close and productive research relationship with the surgeon William Halsted. Within his specialty, the book noted such innovations he introduced as expanding its remit beyond gross anatomy; introducing ‘adequate dissection‘ and ‘extramural quizzes‘ to the curriculum; and making ‘his students interested in the structure of the body, not in memorizing facts about it’. The book also reviewed his leading roles in setting up a professional association of anatomists, in establishing an anatomy journal, and in setting up an embryological institute (pages 7, 21, 69-70, 75-76, 89-95, 101-109 and 121-125).
This detailed portrait of an under-rated leader of modern medical education is not only exhaustive, it also demonstrates the achievements that established his place as a founding physician of the Johns Hopkins Hospital. The biography details the influences that determined his career, from his family background to the guidance and mentorship of the most exemplary type. Whilst the biography highlights the sterling qualities of this visionary physician, it did not shy away from highlighting his shortcomings as a complex personality and a poor teacher. The author also managed to recreate the atmosphere of the time, setting Mall’s achievements within its historical context. The narrative was slightly disjointed, and some themes were unclear, but the biography nevertheless painted a vivid enough picture of its subject.
This biography documents the life and works of a central figure in modern medical education in America, a reform movement that flourished in one hospital and then diffused across the world. His understated personality comes through and explains why his contributions are little appreciated in medical circles. The book explores the exemplary lives of the teachers who influenced Mall’s career and guided his reforms, and this narrative is pregnant with lessons for all doctors. The book emphasises the fundamental place of educational reforms in sustaining good medical practice, and I recommend it to all doctors.
Publisher, Place, Year: The Johns Hopkins Press, Baltimore, 1934
Number of chapters: 11
Number of pages: 342
Star rating: 5