The 1922 Harold Lloyd silent film Dr. Jack the phrase "a four-flusher" is used to describe the doctor in charge of "The Sick-Little-Well-Girl" in the city.
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Metro Pictures released a comedy titled The Four-Flusher in 1919,.
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In National Lampoon's Christmas Vacation, Clark refers to his boss as "four flushing" in his tirade over his corporate Christmas present; in Home Alone 2: Lost in New York it's used by the mafia boss Johnny in the fictional film Angels with Even Filthier Souls; and in Uncle Buck, Pooter the Clown calls Buck a four flusher, which results in Buck punching the clown right in the face.