Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective
Part V. The Stanford Era 1909-

Chapter 31.Transition to University Department 1908-1912

The Planning Process

As soon as the transfer of Cooper Medical College properties to Stanford was decided upon in 1908, but before the actual transfer was completed in 1909, President Jordan began to pursue intensively the important work of converting Cooper Medical College to a University Medical Department. As the first step in the process he appointed a Committee of Three to consider the organization and entrance requirements of the Medical Department, and adaptation of the medical course to related work in the existing departments of the University.

This original committee, consisting of Stanford Professors O. P. Jenkins, C. D. Marx and John Maxson Stillman (Chairman), after consulting many individuals within and without the University, recommended entrance requirements later adopted by the Academic Council, and a plan for organization of the Medical Faculty which was approved by the President and Advisory Board and adopted by the Trustees. Details of these entrance requirements for students and plan of organization of the Faculty are included in the text at a later stage of this discussion. [1] [2]

The Academic Council referred to above is the chief governing body of the Faculty and is composed entirely of members of the University Faculty. It was established by the Board of Trustees in 1904 when the Board first adopted a formal plan of organization of the University Faculty. The Advisory Board is a subcommittee of the Academic Council. [3]

The Committee of Three also recommended appointment by the President of a larger committee composed of those members of the Cooper Medical College Faculty and the Stanford Faculty who would doubtless be engaged in the future work of the Medical Department. This committee had no official authority, but was to serve as a Provisional Medical Faculty and advisory committee to the President with special reference to instruction in the Medical Department at the University and in San Francisco.

It was decided that the first year of medical instruction would begin in August 1909, students entering then to receive their M. D. degree in 1913. To this end, on 30 October 1908 the President appointed the following twelve professors and three associate professors to serve as the Provisional Medical Faculty. Those not already members of the University Faculty were later elected to the Stanford Medical Department: [4] [5]

Provisional Medical Faculty

  • Adolph Barkan, Professor of Structure and Diseases of the Eye, Ear, and Larynx.
  • Henry Gibbons, Jr., Professor of Obstetrics.
  • Joseph O. Hirschfelder, Professor of Clinical Medicine.
  • Stanley Stillman, Professor of Surgery.
  • Emmet Rixford, Professor of Surgery.
  • William Ophüls, Professor of Pathology.
  • Ray Lyman Wilbur, Professor of Clinical Medicine (on leave of absence in 1909-1910)
  • William F. Cheney, Clinical Professor of Diseases of the Digestive System.
  • Arthur W. Meyer, Professor of Human Anatomy.

The following members of the then current Stanford Faculty were to be associated with the above in medical instruction and were therefore included in the Provisional Medical Faculty:

  • John M. Stillman, Professor of Chemistry (Chairman)
  • Oliver P. Jenkins, Professor of Physiology.
  • Frank M. MacFarland, Professor of Histology.
  • George C. Price, Associate Professor of Embryology.
  • Robert I. Swain, Associate Professor of Physiological Chemistry and Bacteriology.

During the year ending 31 July 1909 the Provisional Medical Faculty held regular sessions to consider the problems and immediate needs of the Medical Department. They elected a special committee, consisting of Professors Barkan, Ophüls, Rixford, Snow and Wilbur (Chairman), whose specific task it was to develop the plan for internal organization of the Medical Department. This plan, as approved by the President and eventually adopted by the Board of Trustees, was as follows: [6] [7]

Plan for the Organization of the Medical Department

The teaching body of the Medical Department of Leland Stanford Junior University shall consist of:

a

  • Professors
  • Clinical Professors
  • Associate Professors
  • Associate Clinical Professors

b

  • Assistant Professors
  • Assistant Clinical Professors

c

  • Lecturers
  • Instructors
  • Assistants

"Professors and Associate Professors" are to be those members of the Medical Faculty who are under full salary and who give the main part of their time to the work in their respective departments.

"Clinical Professors and Associate Clinical Professors," are to be of equal rank with Professors and Associate Professors, respectively, in the Medical Faculty, but to be men engaged in practice.

The following shall be the Officers of the Medical Department Faculty:

(Note: The Officers and Standing Committee members named below are those holding appointment in 1912-13 as listed in the Annual Announcement of the Medical Department for the Year 1912-13) :

1. The Executive Head of the Department, appointed annually by the President, shall act as presiding officer (Ray Lyman Wilbur).

2. A Secretary, who shall also act as Assistant Registrar for the work in San Francisco, under the Registrar of the University (William Ophüls).

3. Standing Committees of the Faculty (among others):

An Executive Committee of five members, appointed by the President of the University, to have general administrative functions for the Medical Faculty and to perform such other duties as may be assigned to it by the Medical Faculty. (Ray Lyman Wilbur, Chairman, John Maxson Stillman, William Ophüls, Emmet Rixford, Hans Zinsser.

A Committee on Academic Matters , of three members, to be elected by the Medical Faculty from those members of the Medical Faculty belonging to the Academic Council. (Oliver Peebles Jenkins, Chairman, Frank Mace McFarland, Arthur William Meyer).

A Clinical Committee, of five members, to take the initiative in arranging clinical material for purposes of instruction and to control the Lane Hospital, to be appointed by the President of the University. (Ray Lyman Wilbur, Chairman, Stanley Stillman, William Ophüls, Alfred Baker Spalding, Adolph Barkan)

The term of service of all officers and of all committees shall be one year, or until their successors are chosen.

The Medical Faculty shall meet monthly in term-time and otherwise at the call of the presiding officer or of five members.

Administrative Divisions. For purposes of administration the Medical Department shall be divided into the following divisions with Divisional Executives:

(Note: The Divisional Executives named below are those holding appointment in 1912-13 as listed in the Annual Announcement of the Medical Department for the Year 1912-13)

  • 1. Anatomy (Arthur William Meyer)
  • 2. Physiology (Oliver Peebles Jenkins)
  • 3. Chemistry (John Maxson Stillman)
  • 4. Pharmacology (to be appointed)
  • 5. Pathology, including Bacteriology, Legal Medicine (William Ophüls)
  • 6. Medicine - Subdivisions: Pediatrics; Neurology, Psychiatry and Psychotherapy; Electrotherapy; Dietetics; Tropical Medicine (Ray Lyman Wilbur)
  • 7. Surgery - Subdivisions: Ophthalmology, Otology, Laryngology; Genito-Urinary Surgery; Gynecology; Dermatology; X-Ray (Stanley Stillman)
  • 8. Obstetrics (Henry Gibbons, Jr.)
  • 9. Hygiene and Public Health (William Freeman Snow)

Requirements for Admission

In 1908 the original Committee of Three, consisting of Professors O. P. Jenkins, C. D. Marx and J. M. Stillman (Chairman), proposed the following requirements for admission to the Medical Department which were later adopted by the Academic Council of the University: and published in the Announcements for 1909 and 1910-1911. [8] [9]

Requirements for Admission. Three years of collegiate work in Stanford University (approximately ninety unit-hours), or its equivalent as accepted by the Committee on Advanced Standing, will be required for admission to the Department of Medicine. This preparatory training must include one year of Physics with laboratory work, one year of Chemistry with laboratory work including Qualitative Analysis, one year of Physiology or Biology with laboratory work, and French or German (such a reading knowledge as shall be acceptable to the Department of Medicine). . . .

The State law governing the practice of Medicine in California requires that every person before practicing medicine or surgery must produce satisfactory testimonials of good moral character and a diploma, issued by some legally chartered medical school, the requirements of which shall have been at the time of granting such diploma in no particular less than those prescribed by the Association of American Medical Colleges for the year. For the year 1908 the Association of American Medical Colleges prescribed that every medical student must be registered in a medical college or department for four years and that his preparatory course shall have included two years of Latin, two years of Mathematics, two years of English, one year of History, two years of laboratory science, and six years of further credits in languages, literature, history, or science.

Men and women are admitted to the Department of Medicine on equal terms.

Clearly the AAMC, in cooperation with state licensing boards, was now moving decisively to enforce higher standards for admission to American medical schools.

Dean Wilbur later observed that "Our unusually high admission standards for those days aided in attracting students of exceptional quality. Setting the bars so high meant a considerable loss of students, which at first caused some unfavorable criticism, but by 1912-13 the general attitude was one of 'pointing with pride'." [10]

The Curriculum in Medicine

The original period of study required for the degree of Doctor of Medicine as announced in 1909 was four years (eight semesters). The duration of each semester was approximately 4 months, and there were two semesters in each academic year: September to December and January to May.

The work of the first three semesters is given in Palo Alto and is devoted mainly to laboratory studies, with lectures and demonstrations in anatomy, physiology, histology, neurology, embryology, chemistry, pharmacology, and bacteriology. The work of the last five semesters will be given in San Francisco and will be devoted mainly to work in the pathological and clinical laboratories and in the hospital wards and dispensary. [11]

A Thesis based as much as feasible upon research work will be required of each student, as originally announced in 1911. Four curriculum hours of the seventh and eighth semesters shall be devoted to its preparation under the supervision of one of the Divisions. (The thesis requirement was discontinued in 1931.) [12] [13]

Required Hours Reduced

The year 1912-13 was the first in which the complete curriculum leading to the degree of Doctor of Medicine was given by the Medical Department. Seven men were granted that degree in May 1913.

During the year the medical faculty modified the curriculum for the four years in Medicine, reducing the number of required hours and increasing the number of optional subjects, particularly in the senior year. [14]

The Combined Seven Years' Curriculum at Stanford, announced in 1913, consisted of three years of college work (the premedical program) and four years in medicine; and it led to the degrees of Bachelor of Arts and Doctor of Medicine. [15]

Required Intern Year

Beginning with the class entering the Medical Department in September 1914, all students were required to take a fifth practical year in Medicine before receiving the degree of Doctor of Medicine. Arrangements were made so that the fifth year may be spent as intern in a hospital or in part as worker in a laboratory. [16]

The Combined Eight Years' Curriculum, announced in 1915, consisted of three years of college work (the premedical program) and five years of medicine (including the internship); and it led to the degrees of Bachelor of Arts and Doctor of Medicine. [17]

Fee Schedule

The tuition fees of the Medical Department, as announced in 1910, were $150 per annum (being the same as currently charged in Cooper Medical College and in the Medical Department of the University of California). Tuition fees were payable in installments of $75 each semester; $5 per semester for the first four semesters, covering charges for anatomical material; and such other deposits to cover breakage or loss of apparatus or materials as may be required in any department or division, these deposits being returnable, less charges for breakage, loss, or wear and tear of apparatus or materials used. The total deposits for this purpose might vary from $10 to $20 per annum. [18]

Requirements for Graduation

The candidate for the degree of Doctor of Medicine must have attained the age of twenty-one years, must be of good moral character and have shown exemplary conduct while a student in this department. He must have been enrolled in a medical college of recognized standing for four years, the last of which must have been in this department. He must have satisfactorily completed the required curriculum, passed all examinations, and paid in full the required fees.

The above Faculty organization and requirements for premedical and medical studies show that the Stanford program was significantly greater in duration and depth than the Cooper Medical College course that it replaced - and therefore inherently more expensive. Nevertheless the Stanford schedule of tuition and student fees was little changed from that of the Cooper School. As a result, the Department of Medicine, in contrast to Cooper Medical College which was essentially self-supporting, would need a substantial infusion of University funds from the outset. Under these circumstances, it is not surprising that the need of the Medical Department for considerable financial support from the University was destined to be a controversial issue. Especially so since President Jordan insisted on an early investment in additional medical faculty and facilities.

Early Additions to the Faculty

The following report in 1909-10 of President Jordan's additions to the basic science faculty, and construction of laboratory facilities for support of their work, is evidence of his determined effort to strengthen the medical faculty. [19]

The teaching staff has been augmented by the appointment of Dr. Hans Zinsser as Associate Professor of Bacteriology, Dr. Albert C. Crawford as Professor of Pharmacology, Dr. Frank T. Blaisdell as Assistant Professor of Applied Anatomy, Dr. Ernest C. Dickson as Assistant Professor of Pathology, and Mr. R. M. Lhamon as Instructor in Anatomy. The duties of Professor Zinsser, Professor Crawford and Instructor Llamon began with the opening of the current year, 1910-11, while the duties of Professor Blaisdell and Professor Dickson will begin with the second semester of the year.

The equipment for the work in Anatomy, Pharmacology and Bacteriology has been provided for by continuation of the reconstruction of the rear line of the old museum buildings on the Stanford campus. This work is not yet quite completed, but when finished will furnish efficient and convenient laboratories and equipment for those divisions of the work.

In May, 1910, Bacteriology was, by action of the Board of Trustees, made a separate division, and Professor Zinsser was appointed executive while Professor Ophüls remained as executive of the Pathology and Legal Medicine.

Inauguration of Stanford Department of Medicine

During the consolidation negotiations it was decided that the last class of Cooper Medical College would be admitted on 17 August 1908 and would graduate on 9 May 1912; and that the first class of Stanford University's Department of Medicine would begin on 8 September 1909 and graduate on 19 May 1913. [20]

In accordance with this schedule, the Department of Medicine was formally inaugurated on 8 September 1909 by a University Assembly on campus at which an introductory address was delivered by President Jordan. Dr. Henry Gibbons, Jr., Dean of Cooper Medical College and Professor of Obstetrics in the Stanford Department of Medicine, spoke on the history of medical education on the Pacific coast and the development of Cooper College. The principal address was delivered by Dr. Henry Christian, Dean of the Harvard Medical School.

Enrollment

Professor John Maxson Stillman served as Acting Executive of the Department of Medicine during 1909-10, the first year of its operation. In his "Annual Report on the Medical Department to President Jordan" for the year ending 31 July 1910, Professor Stillman reported that 15 students were enrolled in the first-year class of the Department in 1909 The first year class in 1910 numbered only 10, but by 1912 the first year class had reached 21. [21] [22]

The first to receive the M. D. degree from the Stanford Medical Department were the 7 students in the Class of 1913 who graduated on 13 May 1913. Among them was George De Forest Barnett, the first Stanford medical graduate to receive an appointment to the medical faculty.

Dr. Barnett was appointed as an Instructor in Medicine in 1915, and retired as a highly respected Professor of Medicine Emeritus in 1949. [23]

Dr. George De Forest Barnett, one of the first graduates from Stanford Department of Medicine. He received an immediate appointment to the faculty

see larger image »

A photo of Dr. George De Forest Barnett, one of the first graduates
									from Stanford Department of Medicine.

As mentioned above, the Medical Department's more stringent admission and performance standards initially resulted in fewer applicants for admission than Cooper Medical College normally received Nevertheless, within six years there were so many applicants that it was necessary to adopt the following policy: [24]

Limitation of the Number of Students

The accommodations of the Medical School at San Francisco render it inadvisable to admit more than 25 students to each class. It will therefore be necessary, beginning in 1915, to restrict the number of students to 25 in each class, commencing with the fourth semester. There are no restrictions in regard to entrance to the first three semesters in medicine at Stanford University, but all students entering the medical classes at Stanford University cannot be assured that they will be able to continue their medical studies at the University for more than three semesters.

The fifth class, graduating on 21 May 1917, numbered 26. One month earlier, on 6 April 1917, President Woodrow Wilson had declared war against the German Empire, and the United States entered World War I. So many students joined the armed services that the graduating class of 1918 was reduced to 5. The Faculty was also severely depleted. Fortunately, the war ended on 11 November 1918 and the full program was rapidly restored by returning students and Faculty. [25] [26]

Financial Concerns

Returning to Professor Stillman's "Annual Report on the Medical Department" to President Jordan for the year ending 31 July 1910, we note that Professor Stillman saw fit to comment as follows in that report on the financial uncertainties still facing the Medical Department. He was correct in anticipating that the high cost of bringing up the medical program to University standards would soon become a serious problem. [27]

I may be permitted to recall that, as a member of a special committee appointed by the Board of Trustees in 1906 to consider the cost of a medical program, I commented as follows in a letter to the chairman of the committee on 17 October 1906:

"I do not at present have an adequate idea of the cost of maintenance of a first-class medical department, but from what I know thus far I should consider that the President's estimate of $100,000 per annum within a few years is conservative. . . .

"It is a matter of the utmost importance to the future of the Medical School, therefore, that endowments should be secured which shall materially increase the present income of the Medical Department..."

Dr. Wilbur, Executive Head, Department of Medicine

On 1 January 1911, in accordance with prior arrangement, Dr. Wilbur returned from leave of absence abroad to replace Professor John Maxson Stillman as Executive Head of the Department of Medicine. Except for some consultations Dr. Wilbur gave up his medical practice and devoted his time to building up the medical school as rapidly as possible. [28]

Dr. Wilbur's first "Annual Report to President Jordan" as Executive Head of the Department of Medicine was for the year ending 31 July 1911. In his report Dr. Wilbur referred both to the impending termination of Cooper Medical College on 1 July 1912 and to the challenges facing its successor, the Department of Medicine of Stanford University: [29]

"Next year on 9 May 1912," he said, "Cooper Medical College will graduate its last class and, on 1 July 1912, Stanford will come into complete control of Cooper Medical School buildings and Lane Hospital. In September of 1912 Stanford's Department of Medicine will for the first time have a full quota of four medical school classes and will, on 19 May 1913, award M. D. degrees to its first class of medical graduates." He then added:

A good foundation for sound medical instruction upon a true University basis has been laid. The aim of the future should be to create conditions for the clinical years similar to those now prevailing for the first two years of the medical course. This will mean additional expense for laboratories and professorships. As soon as possible after the Lane Hospital comes under the control of Stanford, it should be converted into a University hospital. The proposed construction of the new Lane Library building upon the lot across the street from the Medical Building in San Francisco, assured by an additional gift of $20,000 from the directors of Cooper Medical College, will add greatly to the efficiency of the institution. With the hospital, library, laboratories, clinics and lecture rooms all so well concentrated and arranged, the appropriation of an adequate amount for salaries and running expenses will permit of the best grade of medical work for the moderately sized classes that are to be expected for some years.

This prospectus, so confidently outlined by the new Executive of the still controversial Department of Medicine, was alarming to those in the University professorate who had predicted exorbitant demands upon the University budget by a medical department if ever established. Now the camel's nose was under the tent and further intrusion certain, but we must leave this subject temporarily while we attend to:

The Final Years of Cooper Medical College

During the period from 1908, when Cooper Medical College and Stanford reached general agreement to consolidate, to 1 July 1912 when the two institutions were completely integrated, President Jordan continued to be uncertain of the advisability of the union. His doubts on this score were encouraged by Henry S. Pritchett, President of the Carnegie Foundation for the Advancement of Teaching. Before publication of the Flexner Report by the Foundation in 1910, President Pritchett had written to Dr. Jordan and President Wheeler of the University of California remonstrating against the action of Stanford in taking over Cooper Medical College and that of the State University in adopting the moribund clinical department of the Los Angeles branch of the University of California. President Pritchett concluded: "These actions seem to me to make the existence of a first class modern medical school in San Francisco practically impossible unless one or the other of these institutions is prepared to spend millions on a medical school and hospital." [30]

When, in 1911, the University of California received an unexpected gift of $750,000 for medical education, President Wheeler asked President Pritchett for suggestions on the planning of their Medical Department in San Francisco. Dr. Pritchett immediately took up with Presidents Wheeler and Jordan the question of a union between the clinical departments of the two schools. An interchange of letters between Presidents Wheeler and Jordan led to the suggestion by President Wheeler that a conference be held between Dr. Jordan and two Stanford Trustees with himself and two Regents of the State University.

Following this conference, and seeking to close the issue of union between Stanford and UC Medical Departments, Dr. Jordan wrote as follows to President. Pritchett on 26 July 1911: "We had a joint meeting with the Regents the other day. It appeared in brief from this that the University of California virtually had two alternatives - one, to leave the clinical work in our hands on some terms of mutual agreement, the other, to withdraw to Berkeley and to develop a clinic there. . . The only hope I see for medical education on this Coast is for us to go straight ahead with or without the cooperation of the University of California." [31]

The minutes of the California Board of Regents dated August 8, 1911, contain the following statement on union with Stanford: "President Wheeler presented, as the result of a recent conference with Stanford University in reference to the merging of the medical schools of each institution, the following letter from President David Starr Jordan as representing President Jordan's suggestion . . . It was the sense of the Board that the suggested arrangements referred to in President Jordan's letter are not deemed wise. Such was the order of the Board." One might think that this definitive ruling of the University of California Board of Regents against merging their medical school with Stanford's would permanently settle the question. But, as we shall see, it did not. The publication of the Flexner Report in 1910 served to reopen the tiresome issue. [32]

The Flexner Report of 1910

We have referred previously to the national survey of medical schools by Dr. Abraham Flexner under the auspices of the Carnegie Foundation for the Advancement of Teaching. Dr. Flexner and associates visited the 10 medical schools in California in May of 1909 and published the following general information about them in the Flexner Report of 1910: [33]

California

Population, 1,729, 543. Number of physicians (exclusive of osteopaths), 4313. Ratio of physicians to population, 1:401(optimum ratio: 1:1500). Number of medical schools, 10.

Los Angeles

(1) College of Physicians an Surgeons.. Established 1903.
Entrance Requirement: High School. Attendance 32.

(2) University of California: Clinical Department.
Reorganization in Progress. Affiliated with UCSF.

(3) California Medical College. Eclectic. Established 1879.
Entrance Requirement: Nominal. Attendance 9.

(4) Los Angeles College of Osteopathy. Stock Company Emigrated from Iowa, 1905. Entrance Requirement: Less than Grammar School. Attendance: "more than 250."

(5) Pacific College of Osteopathy. Stock Company. Established 1896. Entrance Requirement: High School or Less. Attendance: 85

Oakland

(6) College of Medicine and Surgery. Stock Company. Established 1902. Entrance Requirement: High School. Attendance: 17

San Francisco

(7) University of California Medical Department. Established 1872
Entrance Requirement: 2 Years College. Attendance: 86.

(8) Leland Stanford Junior University School of Medicine, on the Cooper Medical College Foundation. Until 1908, the Cooper Medical College offered a four-year course based on high school graduation. Its property has now been deeded to Stanford University, its buildings being the seat of the clinical department of Stanford University School of Medicine, the instruction of the last five semesters being given in Cooper Hall and Lane Hospital. That of the first three semesters is given in Palo Alto. As its present classes graduate, the Cooper Medical College passes out of existence and its faculty disbands.

Entrance Requirement: Three years college work. Attendance: 16 in first year (fourth collegiate year). No other year's work has yet been given.

Clinical Facilities: Clinical work on the part of Stanford University is not yet begun. The university now owns the Lane Hospital of 125 beds, which has hitherto been conducted as a pay institution. Patients paying $10 a week are used for clinical teaching; seventy-odd beds are thus available, part of these being temporarily supported by the city. The hospital is now under temporary control of Cooper Medical College until needed by the university. Its organization at present, from the teaching point of view, is seriously defective. Records are meager; no surgical rounds are made in the wards; obstetrical work exists only in the form of an outpatient department; post-mortems are scarce. No hospital report is obtainable. The catalogue statement that the hospital is a teaching hospital is hardly sustained by the facts.

The dispensary in the college building adjoining had in 1907 an attendance of 20,000, including both old and new cases. But the material, though adequate in amount, was not thoroughly used by the Cooper Medical College.

(9) College of Physicians and Surgeons. Established 1896. An independent school. Entrance Requirement: High School. Attendance: 70.

(10).Hahnemann Medical College of the Pacific. Homeopathic. Established: 1881. Entrance Requirement: High School. Attendance: 23

General Considerations

Consideration of medical education in California may well start from the fact that, without taking into account the osteopaths - who abound - the state has now one physician to every 401 inhabitants, that is, in round numbers, about four times as many doctors as it needs or can properly support. Such an enormous disproportion can hardly be rectified within less than a generation; it makes radical measures in the interest of sound medical education not only immediately feasible, but urgently necessary.

Legal enactment fixing a sound basis for future practitioners, of whatever school, the grant of authority to the state board to close schools flagrantly defective in either laboratory or clinical facilities, or the institution of practical examinations for license, - any one of these measures would at once wipe out at least seven of the ten existing schools, with distinct advantage to the public health of the state. As none of these schools has the resources indispensable to meet the rising tide in medical education, this outcome is in any case inevitable; legal regulation of the type indicated would merely hasten the day. . . .

(The University of California in Berkeley has undertaken to dominate two detached clinical departments, manned by local practitioners - one in San Francisco and one in Los Angeles.) There is nothing in the present status of detached clinical departments of this type to encourage confidence in the outcome. Before too far committing itself to this policy, it is at least worth inquiring into the advisability of concentrating its medical instruction across the bay (in San Francisco), where a population of over two hundred thousand affords sufficient clinical material, and where a compact, effective, and organically whole university department of medicine, with a faculty, laboratory and clinical, selected on educational principles, could be readily developed.

These considerations apply in some respects with equal force to the action of Stanford University in taking over the Cooper Medical College at San Francisco. It was well enough to offer the laboratory sciences at Palo Alto, where the resources and ideals of the university insure high-grade instruction; but the entrance of the university into the San Francisco field in all probability portends the division and restriction of whatever opportunities the city may hereafter create. Lane Hospital can be developed into a teaching hospital of adequate size only if very large sums are available for the purpose; its organization and conduct have been in the past pedagogically very defective; and the clinical professors so far appointed have been taken with one exception from the former Cooper faculty. With one university medical school already on the ground, a second - and a divided school at that - is therefore a decidedly questionable undertaking. There is no need of it from the standpoint of the public; it must, if adequately developed, become a serious burden upon the finances of Stanford University. If the experience of other schools and cities is to be heeded, the question arises whether Stanford would not do well to content itself with the work of the first two years in Palo Alto, and to cooperate with the state university in all that pertains to the clinical end.

The situation just presented deserves to be studied carefully by all interested in medical education. What has happened in California is likely to happen elsewhere. Scores of schools are beginning a desperate struggle for existence. Their first impulse is to throw themselves into the lap of some prosperous university. The universities, not as yet themselves realizing that medical education is no longer either profitable or self-supporting, are prone to complete themselves by accepting a medical department as an apparent gift. From the standpoint of the university this blunder will soon prove a serious drain, as increased expenditure on instruction and reduced income from fees reveal the actual state of affairs. From the standpoint of medical education and practice, the tendency in question is still more deplorable. The curse of medical education is the excessive number of schools. The situation can improve only as weaker and superfluous schools are extinguished.

Findings of Flexner Report Contested

In May 1909 when Flexner surveyed the Leland Stanford Junior University School of Medicine, Cooper Medical College was being phased out and the Stanford program had not begun. Thus the weight of the Flexner Report's stern criticism of the medical program fell on the Cooper College Faculty. The Report was brought to the attention of the Faculty on 20 June 1910 and Dr. Ophüls was appointed to prepare a statement for President Pritchett of the Carnegie Foundation to be submitted to him by the Dean.

In a firm but courteous letter to President Pritchett Dean Henry Gibbons, on behalf of the Faculty, took exception to certain of the Report's findings. President Pritchett then tartly defended the Report, and concluded with familiar advice on the future of medical education in San Francisco. First the letter from Dean Gibbons to President Pritchett: [34] [35]

Henry Gibbons, Jr., M D. , Dean
Cooper Medical College
San Francisco
25 July 1910
Henry Pritchett, President
Carnegie Foundation for the Advancement of Teaching
New York, NY

Gentlemen:
We are in receipt of your Report on Medical Education in the United States and Canada. While in a general way we fully agree with your conclusions and while we expect that your report will accomplish much towards improving Medical Instruction in our country, still we feel bound in justice to ourselves to correct a few errors which have crept into the report so far as our College is concerned. We are aware of the fact that such mistakes may occur taking into account the vast territory covered but we presume that you will gladly receive such corrections as are necessary for your own information.

Your statement in regard to Lane Hospital, that "it has hitherto been conducted as a pay institution" conveys an erroneous idea. It is true that the larger number of patients at the Hospital so far have been private patients, but whatever surplus the Hospital has received from them has always been used for necessary improvements of the Hospital or Medical College, with the particular view of improving the teaching and scientific work in both. Since the establishment of the College no money has every been distributed in the form of dividends to anyone connected with the institution.

We acknowledge that the organization of the Lane Hospital from the teaching point of view is seriously defective. This is easily accounted for in a Hospital where much private work must be done to keep the Institution going. Your report says "The catalogue statement that the Hospital is a teaching Hospital, is hardly sustained by the facts." What this catalogue really says is this (Page 17) "Lane Hospital was designed as a teaching Hospital. It has seventy-five teaching beds which number it is hoped to increase in the near future." We have never claimed it to be a teaching Hospital but have always relied upon the City & County Hospital which was not even mentioned in the Report, as our chief source of clinical instruction.

The statement "records are meager" is not borne out by the facts. There are several teaching services from the College represented in the clinical wards of Lane Hospital. The histories naturally vary a little with the different men, but they are all quite full and complete, stenographers being employed by some clinicians. There is no foundation for the assertion that no surgical rounds are made in the wards.

It is also said that obstetrical work exists only in the form of an out patient department, whereas a small but fully equipped obstetrical ward of six beds for teaching purposes was opened at Lane Hospital on 2 July 1908. In addition there are two free obstetrical beds in Lane Hospital which were given to the Fruit & Flower Mission with the understanding that the patients could be used for teaching purposes. In parts of 1907 and 1908, 194 cases were confined in Lane Hospital. In 1909 there were 167 clinical confinements, in 1910 to July 1, 83. The out patient obstetrical clinic was somewhat small (67 cases in 1909) but well organized. Students are always accompanied by a competent instructor and have ample instruction in external clinic examination. None of our students sees less than six confinements and some many times that number.

You go on to say: "Post mortems are scarce" and in another part of your volume you refer to the inadequacy of the autopsy material at Cooper Medical College. It is true that the number of autopsies at Lane Hospital is comparatively small, but it should have been stated that the College controls good autopsy material at the City and County Hospital. Our Pathological Department has averaged from 199 to 150 autopsies a year for many years and the material has been supplemented from other services at the City & County Hospital and by material obtained at the German and St Luke's Hospitals. We believe that our Pathological Department is especially well equipped for teaching and research.

It should also have been stated in your Report that the Medical Colleges in San Francisco are in an exceptionally fortunate position in controlling the clinical material at the City and County Hospital almost absolutely. The service at this Institution averaging annually over 500 cases, is divided between the Medical Teaching Institutions of San Francisco; and the various colleges appoint the physicians in charge. The main clinical autopsy service of our College has always been at the City & County Hospital where conditions were very satisfactory from a teaching point of view, until it became necessary to remove the old Hospital buildings. While the new $2,000,000 Hospital is being constructed the patients are partly kept in the Hospitals in the City where medical teaching is carried on, and partly in Ingleside Camp Hospital where we now control 100 beds and use them for teaching purposes although with some difficulty on account of the distance and lack of facilities. In the same catalogue that your informant refers to it is stated on page 10: "At the City and County Hospital in San Francisco the College controls 100 beds, averaging about one thousand patients per year. The Hospital facilities will be greatly improved with the erection of the new City and County Hospital which the City of San Francisco is building at an expense of two million dollars."

Referring to our Dispensary, upon which the College has always looked as one of its best assets, you say, "but the material, though adequate in amount, was not thoroughly used by Cooper Medical College" and underneath, "Date of visit, May 1909." The latter seems to explain the former and also why it is said, "no surgical rounds are made in the wards of the Hospital." Instruction to the students in the Dispensary stops at the end of April, our commencement being in the beginning of May. It was impossible therefore for our visitor by personal inspection to ascertain how the clinical material in the dispensary was used for teaching purposes. We do not wish to imply that improvement could not be made in our dispensary service, we are far from assuming such an attitude, but we are positive that good scientific records are kept in all departments of the dispensary, that the heads and assistants are competent teachers, and that the students have been given full opportunity to avail themselves of the clinical material as well by didactic clinics as by work in small sections in actual contact with the patients as is shown by the enclosed schedule which was rigorously adhered to.

Thus not only has our chief source of clinical material and post mortems been ignored, and the fact that the College was not in session when the visit was made been overlooked, but Cooper Medical College with its Faculty numbering fifty-six of whom twelve were full Professors; its eighty students; its many well supplied laboratories whose apparatus is inventoried at $15,000 although worth more; its several salaried Professors and Instructors who receive $10,000 per annum; and its yearly expenditure of $25,000 for educational purposes is scarcely given credit in the Report for existence.

Copies of this letter have been sent to the Board of Trustees of Leland Stanford, Jr. University; to Pres. D. S. Jordan; to the California State Medical Society; to the American Medical Association; to the Association of American Medical Colleges; and to Mr. Abraham Flexner of Carnegie Foundation for the Advancement of Teaching.

By order of the Faculty of
COOPER MEDICAL COLLEGE
Henry Gibbons, Jr., Dean

President Pritchett's response:

Henry Pritchett
Teignmouth, England
29 August, 1910
Henry Gibbons, Jr., Dean
Cooper Medical College
San Francisco.

My dear Sir:
Let me acknowledge your courteous letter of the twenty-fifth of July written on behalf of the faculty of the Cooper Medical College, in which you object to certain expressions in the description of that school as it appeared in the recent Report on Medical Education in the United States and Canada, issued by the Carnegie Foundation. The Foundation is desirous of securing in its reports as great accuracy as possible and welcomes any such courteous statement as that which you and your colleagues have sent. Let me endeavor in the same spirit to point out a little more clearly the standpoint from which the Report was prepared and to give the reasons which make us feel that the report represented the essential facts concerning the school.

Your letter seems to me to some extent to be founded upon a misconception; for the Report does not profess to deal with the Cooper Medical College now passing out of existence, but only to deal with it in so far as it is taken over by Leland Stanford Junior University. This is made clear on page 193 where the institution is described not as "Cooper Medical College" but as "Leland Stanford Junior University School of Medicine on the Cooper Medical College Foundation."

The account of the school which had been prepared was therefore sent to President Jordan some months before its publication for such criticism as he and the officers of the medical department of the university desired to make. He returned it with a few suggestions, all of which were incorporated in the Report as published. After sending the Report in advance to the authorities of the university, we were justified in feeling that they concurred in the statements which were made.

With regard to the detailed statements with which you deal, I venture to make the following replies:

You contend that in describing the Lane Hospital as a pay hospital the report conveys an erroneous impression. I think you have again misunderstood the meaning of the report. It was intended to show that Lane Hospital, just taken over as the main reliance of a university clinical department, could not support that role because, being without adequate endowment, it had to earn its way. Educationally it is immaterial where the profits go; in describing it as a "pay hospital" it was not intended to imply that the profits went into anyone's pockets, but it was simply meant to indicate that the patients could not be used for teaching purposes as they paid for their care. This situation is, as I understood from your letter, the situation as it stands today: and the term "pay hospital" meant nothing more than this.

You object in the second place to our statement: "The catalogue statement that the Lane Hospital is a teaching hospital is hardly sustained by the facts" because, as you say, the catalogue does not say that it is a teaching hospital but only that it was designed as a teaching hospital. I am not clear that I entirely understand this argument. The language of the catalogue would unquestionably create in the mind of a prospective student, as it did in ours, the impression that Cooper Medical College had in Lane Hospital a hospital that was the best sort of teaching hospital because it had been designed as such. To argue now that the catalogue description meant only that the school is connected with the Lane Hospital, designed but not used as a teaching hospital, is an argument that I do not entirely understand; and I am inclined to feel that the argument is not exactly that which you had in mind. Certainly the men employed in the Cooper school emphasized strongly the fact that the Lane Hospital belonged to the school, implying at once its teaching value.

With regard to your objection to the statement that the hospital records are meager and uneven, one can only say that this is a question of individual judgment and standards. It still seems to us, from our knowledge of the best institutions in this country, that our description was quite fair; and the information which we had in respect to the school did not depend upon a single visit nor upon the observation of one person alone.

The statement made in the report with regard to post mortems is correct, as it seems to us, so far as present conditions are concerned; and it was only with these that the report undertook to deal, as was made clear in the introduction, page xvi. The same remark applies also to clinical facilities. No reference is made to the old City and County Hospital, for it no longer exists, nor to the new hospital now building, for it is not yet a factor in the situation. The report mentions Lane Hospital only for that is practically all the school now has. The best evidence of the correctness of these statements is furnished by the schedule which you kindly enclosed since this shows that all the clinical and pathological work offered outside amounts to three hours a week, one hour in medicine, one hour in surgery, and one hour in pathology.,

The opinion expressed in the Report concerning the dispensary was based on an examination of the records, equipment, and so forth, and upon inquiries as to how it was used in teaching. The conclusions expressed were endorsed by at least one or two men connected with the school.

With regard to the facilities in obstetrics, I am unable at a distance from the office to make a definite reply. The information was procured from those in the Lane Hospital itself.

Let me say again in conclusion that I appreciate the kindly spirit in which your letter is written; but I am still persuaded, in view of the care which was taken in the preparation of the Report, that the differences to which you call attention are differences rather in point of view than differences in the actual facts. The financial statement which you made at the end of your letter is itself quite full proof that the Cooper Medical College is being maintained on a scale entirely inadequate to the demands of modern medicine. I am quite aware that in this institution and in many similar ones a large measure of devotion has been given which cannot be represented in the income account of the school. Such devotion is sometimes wise, sometimes unwise. But in any case, it is clear that a university school of medicine cannot be sustained upon any such basis as that which you describe.

In view of the kindly letter which you and your colleagues have sent, I cannot close this reply without reference to one other matter which seems to me of supreme importance to medical education in San Francisco, and that is to the regrettable competition brought about by the effort to conduct two medical schools in that city. It will be difficult enough to build up in San Francisco a single school, maintained and conducted upon modern ideals. The effort to conduct two makes the whole future doubtful. Is it not possible for those interested in medical education in San Francisco to come together in one effort worthy of modern medicine and of your great city?

Very sincerely yours,
(Signed: Henry Pritchett.)

We find no reference to President Pritchett's letter in the minutes of the Directors or those of the Faculty of Cooper Medical College, or in the Annual Reports of the President of the University. No doubt, from their viewpoint, there was little more to be said on the subject for, by that time, consolidation was assured. Years later, in his Memoirs, Dr. Ray Lyman Wilbur recalled the correspondence between Dean Gibbons and President Pritchett: [36]

The survey of medical education in the Unites States, inaugurated by Dr. George H. Simmons of the American Medical Association and its Council on Medical Education, and carried out by Abraham Flexner through the backing of the Carnegie Foundation for the Advancement of Teaching, began the revolution in medical education which is still going on. The report by Flexner on the Cooper Medical College was harsh and in part unjust, but it served to stimulate changes and to further the efforts of those who held that medicine should be a part of the work of a university.

A letter of protest which Dr. Henry Gibbons, Jr., sent to the Carnegie Foundation at the time gives a picture of how the medical education looked to a fine, sympathetic, and honorable dean who was a leader in medical service and in medical education throughout most of his career.

President Pritchett's letter mainly served to expose the wide gulf then existing between the standards of an above-average proprietary institution such as Cooper Medical College, and those required of a modern medical school. President Pritchett also took the opportunity in his letter to reinforce what he considered the "supreme importance" of his agenda for medical education in San Francisco. That is, Stanford should "content itself with the work of the first two years in Palo Alto and cooperate with the state university in all that pertains to the clinical end."

Flexner's Master Plan for American Medical Education

Based on studies of the physician/population ratio in Germany, to which we have previously referred, Flexner estimated that one doctor for every 1500 persons was an appropriate ratio to be used in determining the number of physicians actually required to provide medical care for the population of the United States. (This would be equivalent to a ratio of 67 physicians to every 100,000 population,)

He further decided that "we may in general figure on one more physician for every gain of 1500 in total population. We are not arguing that a ratio of 1:1500 is correct; we are under no necessity of proving that. Our contention is simply that, starting with our present overcrowded condition, production henceforth at the ratio of one physician to every increase of 1500 in population will prevent a shortage for the next generation at least." [37]

Having adopted the above premise, Flexner's analysis of the information acquired by his survey of American medical schools, and by his study of population density and trends in the various regions of the country, led him to the following conclusion: [38]

(The 155 American medical schools now existing should be reduced to) 31 medical schools with a present annual output of about 2000 physicians, i.e., an average class of about 70 each. (The 31 schools being recommended for retention are capable of producing 3500 graduates annually should that become necessary.). All schools to be retained are university departments, busy in advancing knowledge as well as in training doctors. Nineteen are situated in large cities with the universities of which they are organic parts; four are in small towns with their universities; eight are located in large towns always close by the partner institution. Divided and far distant departments are altogether avoided. . . .

Reduction of our 155 medical schools to 31 (with the elimination of 124 schools) would deprive of a medical school no section of the country that is now capable of maintaining one. It would threaten no scarcity of physicians until the country's development actually required more that 3500 physicians annually, that is to say, for a generation or two, at least. Meanwhile , the outline proposed involves no artificial standardization; it concedes a different standard to the south as long as local needs require; it concedes the small town university type where it is clearly of advantage to adhere to it; it varies the general ratio in thinly settled regions; and, finally, it provides a system capable without overstraining of producing twice as many doctors as we suppose the country now to need. In other words, we may be wholly mistaken in our figures without in the least impairing the feasibility of the kind of renovation that has been outlined; and every institution arranged for can be expected to make some useful contribution to knowledge and progress.

The Flexner Report includes two maps of the United States on one of which is shown the location of each of the 155 existing American medical schools. On the other map the site of each of the 31 medical schools to be preserved or established is indicated. [39]

The Western Medical Schools

The following Table lists the 8 Mountain and 3 Pacific States that constitute the Western Region of the country in which we are primarily interested.

The Table also gives the location of each of the 15 medical schools then existing in the Region, and each of the 4 1/2 schools to be retained or established there under the terms of the Flexner plan. To be specific, Flexner recommended that the number of medical schools in the Western Region be reduced from 15 to the following 4 1/2: 1 in Colorado; 1 in Utah; 1 in Washington; and 1 1/2 in San Francisco. In his Report, Flexner has few kind words and many severe criticisms for the Region's 15 medical schools. He found not one of them to be up to modern standards, Johns Hopkins being the model of a modern school.

The physician/population ratios in the Western Region, calculated for each of the eleven States in the Region and included in the Table, show there to be two to six times as many physicians per State as required under the Flexner plan which called for only one physician for every 1500 population. The Region as a whole, with a population of 4.2 million, had 10, 210 doctors (407 persons per physician), approximately 4 times as many physicians as required by the Flexnerian norm of 1500 persons per physician.

These data support Flexner's conclusion that there were too many doctors in the Western Region in 1909, and that the plethora of physicians justified his plan for allocating only 4 1/2 medical schools to the entire Region. .In brief, the issues facing medical education in the West were the same as those affecting the nation at large - too many inferior medical schools and a gross oversupply of poorly trained physicians - with the sovereign remedy being elimination of surplus schools.

The Western Medical Schools 1909 [40]
Census DivisionNumber of PhysiciansPopulation Per PhysicianTotal PopulationMedical CurrentSchools Plan
Mountain States
Montana417584243,528--
Idaho343472161,896--
Wyoming20245892,516--
Colorado1,600319510,40031
New Mexico367532195,244--
Arizona246500123,000--
Utah359771276,789 ½ 1
Nevada177239136,467--
Pacific States
Washington1,404369518,076-1
Oregon782529413,6782-
California4,3133441,483,6729 1/21 1/2
Regional Total10,2104074,155,266154 1/2
MD's Required @ 1: 1500 Population2,7701,5004,155,266
National Total133,487569*75,954,103

*176 MD/100,000 population.

The Flexner master plan envisaged a total of 2 1/2 medical schools for the entire Pacific tier of Western States - Washington, Oregon and California - one school to be developed by the University of Washington and 1 1/2 medical schools to be maintained in the San Francisco area as follows:

  • One full four-year medical program conducted by the Medical Department of the University of California in San Francisco.
  • A "1/2 program" conducted by Stanford consisting of two preclinical years at the University in Palo Alto.
  • Upon completion of the two preclinical years, the Stanford students would transfer to the Medical Department of the University of California in San Francisco for completion of two clinical years and receipt of the M. D. degree from the University of California.

Both Pritchett and Flexner insisted upon this arrangement on the grounds that conduct of clinical teaching programs by two medical schools in San Francisco would have dire consequences for medical education in California. In vigorous support of this idea, Pritchett lobbied the administration of both universities with near success, advancing the dubious concept of hegemony over medical education in California by the State University as a desirable goal.

It goes without saying that the Flexner proposal was entirely unacceptable to Stanford which had just completed a consolidation agreement with Cooper Medical College based on the commitment by Stanford to conduct a full four-year medical program leading to the granting of the M. D. degree.

There is no indication that either Pritchett or Flexner gave serious consideration to the historic implications for medical education and science of a commitment to these fields by Stanford, the leading private University in the West. Their vision was clouded by devotion to their mission. They were on a crusade to extinguish the nations' weaker and superfluous medical schools. Their error was to overlook the potential of a Department of Medicine at Stanford University and to reckon such a Department as inevitably weak and superfluous. Now, in the mid 90's of the twentieth century, with the perspective of eighty years, we can see what an incalculable loss it would have been had their views prevailed.

We recognize the general validity of Flexner's reservations about "divided and far distant departments" Stanford was establishing a "divided department" and therefore did not meet the strict Flexnerian standard. Over the next fifty years the inexorable logic of the Flexner position had its effect. In 1959 the clinical branch of Stanford Medical School, located in San Francisco, was united with the basic science departments in a new Academic Medical Center on the campus of the University. No longer "divided," the school entered a new era of growth and creativity.

On the whole, the Flexner Report of 1910 was of immense benefit. It provided the most thorough documentation and analysis of the malaise of American medical education yet available. It laid out and effectively advocated a rigorous national plan for its reconstruction by extinction of weak and superfluous schools, and establishment in the remaining schools of academic programs in accordance with high standards such as those prevailing at Johns Hopkins. In effect, the Flexner Report served as an aggressive adjunct to the continuing work of the AMA's Council on Medical Education, the Association of American Medical Colleges, and the various state medical examining boards. The standards of these agencies lagged behind those considered optimal by Flexner and the Carnegie Foundation because of resistance by inferior schools.

The combined effect of these agencies and the Flexner Report is registered on the accompanying chart which shows the number of medical graduates each year during the fifty-year period from 1880 to 1930. The peak output of physicians from American medical schools during that period was in 1904 when there were 5750 graduates from some 155 medical schools. As the graph shows, there was a 50 % drop in the annual number of medical graduates between 1904 and 1922 when there were 2500 graduates from 81 medical schools. The rate of physicians per 100,000 population nationally fell to about 130 - equivalent to 769 persons per physician. [41] [42]

Flexner's goal of only 31 medical schools nationwide was never achieved and he doubtless did not expected such an outcome. Nevertheless, reduction of American medical schools and medical graduates annually by about one half over the 18 year period from 1904 to 1922 was a remarkable achievement. Thereafter, the number of American medical schools reached the low point of 76 in 1929. The number of schools then lingered around 77 until 1950 when it began a steady climb to a peak of 124 in 1990. At that point, annual physician output leveled off at around 15,000. [43] [44] [45]

After the Flexner Report in 1910, oversupply of physicians in the United States did not threaten again until the 1970's when data began to indicate that the supply of doctors was outpacing the growth of the population. Barring drastic changes this trend is expected to continue for another 20 years (that is, into the second decade of the 21st century).

In 1992 there were 15, 243 graduates from 120 medical schools. At that time the supply of physicians (about 200 physicians per 100,000 population , or 1 for every 500 persons) was generally agreed to be excessive.

Coincident with the progressive increase in the supply of physicians since the 1970's there has been a significant change in medical practice from mainly fee-for-service medical care to systems increasingly dominated by managed care and HMO's (Health Maintenance Organizations). Under these types of practice, staffing requirements are only about 150 physicians per 100,000 population (667 persons per M. D.). There is also a reduced requirement for specialists who in 1992 represented 65% of practicing physicians whereas the need is probably best met by a combination of 50 % generalists and 50% specialists. In view of these developments, most analysts of the medical work force believe that "the underemployment or unemployment of specialist physicians in the early 21st century is a distinct possibility in the United States, as is already the case in several European countries." [46]

Thus, for American medical education, the twentieth century will close as it began - face to face with the complex problem of too many medical schools and too many doctors.

Henry Gibbons, Jr. (1840-1911)

Dr. Gibbons, Jr., was confined to his bed with "rapidly advancing arteriosclerosis" in the late summer of 1911, and died on 27 September. He had continued his active work in teaching and practice until a few weeks before he passed away. At the time of his death he held the academic titles of Professor of Obstetrics and Diseases of Women and Children and Dean in Cooper Medical College. He had also been appointed Professor of Obstetrics Emeritus in the Medical Department of Stanford University.

Dr. Gibbons was born in Wilmington, Delaware, on 24 December 1840. He came to California in 1851 when his father, Dr. Henry Gibbons, Sr., brought the family to San Francisco. He graduated from San Francisco High School in 1856 at the age of sixteen years. He then taught school for a time before entering the Medical Department of the University of the Pacific where he graduated on 12 March 1863. While a medical student he was closely associated with Dr. E. S. Cooper, receiving in consequence an exceptional training in surgery. This training stood him in good stead when, immediately upon graduation, he went east to join the United States Army in Washington D. C. as an assistant surgeon. This was followed by the Civil War experience to which we have previously referred.

When he returned to San Francisco he was associated with his father in medical practice, in the editorship of the Pacific Medical Journal, and in the revival of the Medical Department of the University of the Pacific of which he was named the Dean in 1871 - a position he held continuously in the successor schools for the next forty years. [47]

It was to celebrate these forty years of devoted service, which we have amply described in the foregoing chapters, that special exercises were held at Lane Hall of Cooper Medical College on the eighth day of December, 1911. A large assemblage of persons gathered in the Hall for doing honor to his memory, Dr. Edward R. Taylor, President of the College, presiding.

Doctor William Fitch Cheney, Secretary of the Faculty, spoke of Dean Gibbons' compassionate character: [48]

He was loved by all this Faculty as one of its officers; he was loved by all the young students who had known him as their teacher; he was loved by thousands of people whom he served as their physician, and by all into whose lives he came he was loved as a man. . . His attitude was ever that of trustfulness, and he gave every man credit for the same high sense of honor as his own. Therefore one of the greatest sorrows that ever came into his life was the discovery some few years ago that a man (C. N. Ellinwood), given every confidence by him and by others in authority, could be guilty of what seemed to him a deliberate violation of a moral trust. To Dr. Gibbons honesty was all his life a sacred thing, and in all the years of his stewardship not one word or question ever arose about the moneys entrusted to his care, any more than about the performance of any other duty he had assumed, either inside or outside the college.

Doctor Gibbons was also highly regarded by the officers of Stanford University. During the negotiations leading to consolidation, he dealt with them as Treasurer of Cooper Medical College as well as its Dean. Professor Orrin Elliott, Registrar of the University, recalled their relationship: [49]

During these last years, indeed, Doctor Gibbons has been a member of the Stanford Faculty, and a colleague. His work, however, remained in the city and his connection with those of us at the University was naturally slight. But though slight, it was not nominal. He made it real by his identification with us, by the pains he took to respond to those formal occasions when the Faculty stands together in its relation to the whole university and the larger community outside. His confidence in us and his fellow-feeling won recognition and respect. And in behalf of the Faculty of Stanford University I may be permitted to voice our appreciation of the perfect modesty and courtesy with which he entered into this new relation and took his place among us.

The Honorable Horace Davis, a member of the Board of Trustees of the Leland Stanford Junior University, then spoke as follows: [50]

We are gathered today to honor the memory of a man whose whole life was a benediction. Born of old-fashioned Quaker stock, he carried out in his daily life their best traditions, "Peace on earth, good will to men.". . . .He was a man of high principle, even stern in his integrity, but with a large, open heart. . .Such men are the salt of the earth. Quiet, retiring, indifferent to fame, realizing the golden rule: "Do unto others as you would they would do unto you". The world rarely appraises such a man at his true value until he is gone. Then we wonder how great a place he filled and so quietly. Thus we shall think of Dr. Gibbons as the years roll by. As for me, personally, so long as I live I shall hold him in tender, affectionate memory.

Then, Doctor Edward Robeson Taylor, President of Cooper College, rendered the final words of eulogy: [51]

A noble soul, a model of all the virtues has fallen; a friend of humanity, a helper of the suffering, a resolute, indomitable soul.. . . His was a life of service from the time of his early years when, during the Civil War, he labored day and night in the hospitals at Washington among the mangled human creatures coming in day by day, in hundreds and thousands from the awful fields of war

It is indeed a wonder that his life went beyond the psalmist's three-score and ten, his labors were so great and incessant. For consider, that in addition to his large and strenuous medical practice and his pedagogical labors, he has always been Dean of Cooper Medical College, and of late years President of its Faculty, and a member of its directorate, while he was also its treasurer, through whose hands passed all of its moneys and by whom its accounts and books were personally kept. Yet he never once complained; he never dreamed of flagging but willingly and cheerfully bore every burden put upon his shoulders. His religion was that of service - the one true religion that all can subscribe to of whatsoever creed or race.

Where he was but yesterday, as it were, there remains a great void, not to be filled in this life of ours. Yet, he is not dead, he lives. He lives to us in soul-enriching memories that time can never take away; his example blazes as an oriflamme to lead us to a life as greatly honorable as was his; he lives in his deeds that are imperishable. And so we leave him now to time and memory, with wreath of unfading laurel on his brow, and with countless affections hallowing his name.

Something further remains to be said in praise of the worthy Henry Gibbons, Jr. He was the last of the honorable triumvir - Henry Gibbons Senior and Junior and the indomitable Levi Cooper Lane - who traced their inspiration for medical education on the Pacific slope directly to Elias Samuel Cooper. The unselfish and lifelong commitment of these three was responsible for assuring the survival of Cooper's vision of a medical school until its long-range future could finally be secured through union with Stanford University. In a more fundamental sense, we can attribute the ultimately favorable outcome of Cooper's venture to the ideals of loyalty, learning and humanitarian service imparted to Cooper and his partisans by the Quaker faith during their formative years.

Last Days of Cooper Medical College

Anticipating the final transfer of all properties and programs of Cooper Medical College to Stanford University on 1 July 1912, the Directors and Faculty took various steps to complete the business of the College and effect the merger.

Transfer of Medical Clinic to Stanford

The first class of Stanford students having now advanced to the clinical stage of their studies, the Directors voted on 11 May 1911 to turn over the Medical Clinic to Stanford. on 1 July. [52]

Bust of Doctor Lane Cast in Bronze

In memory of the benefactor, the Directors voted on 2 June 1911 to have the marble bust of Dr. Lane cast in bronze. The original elegant sculpture itself remains in the Lane Library building in San Francisco, and the bronze replica now graces the entryway to the Lane Library at Stanford University Medical Center. [53]

Contribution to Construction of Lane Medical Library

As we shall later discuss, the Trustees of Stanford University agreed to construct a Lane Medical Library building. When the cost of construction was found to exceed the funds available, the Trustees requested the Board of Directors of Cooper Medical College to contribute $20,000. The Directors responded as follows to Timothy Hopkins, President of the Stanford Board of Trustees: [54]

2 June 1911

Dear Sir:
We, the Directors of Cooper Medical College, understand that your Board is unwilling by reason of the extra expense necessarily to be incurred therein, to erect the contemplated Lane Medical Library Building at the corner of the lot which was purchased for that purpose; and that in order to erect a suitable library building at said corner you will need twenty thousand dollars in addition to the amount which your Board has set aside for the purpose of erecting the library building.

Cooper Medical College is prepared to turn over to you at once the needed twenty thousand dollars . . . on the assurance that no demand will be made on Cooper Medical College for a specific amount for the maintenance of free beds.. . .(Upon receiving such an assurance ) the College will turn over to you on demand, twenty thousand dollars, said sum to be used in a Library Building to be erected at the corner of said library lot so as to make it a corner building.

The decisive action of the Cooper Directors in thus making funds available for construction of the library assured that the vital project designed to memorialize Dr. Lane could proceed without further delay.

The last recorded meeting of the Directors of Cooper Medical College was held on 16 August 1911, and their last recorded action as governors of the College was to authorize payment to the Stanford Trustees of the last installment on the $20,000 they had agreed to provide. for the Lane Library building.

Election of a New Dean and Other Officers

In the interval between the death of Dr. Gibbons on 27 September 1911 and the memorial service on 8 December 1911, the College Faculty convened on 16 October and elected George B. Somers, Professor of Gynecology, as Dean. Professor Adolph Barkan was elected as President and Professor Ophüls as Vice President of the Faculty. Their terms of service were to end on 1 July 1912 when the last of Cooper properties came under Stanford control.

Final Commencement of Cooper Medical College

On Thursday evening at eight o'clock, May ninth 1912, the thirty-first and final Commencement Exercises of Cooper Medical College were held in the College Auditorium. President Edward R. Taylor conferred degrees on 31 graduates. He also gave an address of which we have no record. This is unfortunate for the occasion called for such oratorical heights as only President Taylor could have attained. . Appropriately, the orchestra concluded the Exercises with a spirited rendition of the march entitled "Flag of Victory."

Final Transfer of Cooper Properties to Stanford

President Jordan, in his Annual Report to the Stanford Trustees for the year ending July 31, 1913, described the final stage of transfer of the Cooper properties: [55]

The final transfer of the Cooper Medical College and Lane Hospital properties, which constituted then the Medical Department of the University, was accomplished and reported to the Board of Trustees on August 1, 1912. In recognition of the admirable spirit in which the directors and faculty of the College have conducted the negotiations leading to this transfer, and in recognition of their efforts to raise and maintain the standards of medical education on the Pacific Coast, the following resolutions were adopted by the Board, which should be here recorded:

Whereas, On the first day of July, 1912, Cooper Medical College and Lane Hospital, did, by agreements previously made, pass from the control of the Directors of Cooper Medical College to the Trustees of Stanford University; and

Whereas, All the negotiations between the Trustees and the Directors attending the transfer of the properties and the assumption by the Trustees of the obligations belonging thereto have been most harmonious and satisfactory; and

Whereas, The Directors have shown the utmost reliance on the good faith of the Trustees;

Now, therefore, be it resolved, that this Board desires to express to the former Directors of Cooper Medical College its appreciation of their broad-minded action in all the transactions between the two bodies; and

Be it further resolved, that the Secretary of the Board be instructed to transmit to the Directors a copy of this minute and resolution.

In the same Annual Report, President Jordan followed the above resolution with an important announcement: "At a special meeting of the Board of Trustees, on November 29, 1912, Mr. Herbert Clark Hoover, an alumnus of the University , Class of 1895, was elected to fill the vacancy in the Board created by the death of Hon. Whitelaw Reid."

Supplement to Chapter 31
Medical Graduates of the Predecessor Schools

The number of medical graduates annually from each of the Predecessor Schools is provided below:

Medical Department University of the Pacific
YearGraduates
18592
18601
18615
18625
18638
18647
1865 - 1869
Suspension
18708
18718
Total44
Medical College of the Pacific
YearGraduates
187210
187314
18748
187513
187622
187713
187826
187915
18807
18819
Total137
Cooper Medical College
YearGraduates
188212
188313
188416
188519
188611
188728
188814
188941
189018
189129
189238
189342
189473
189564
189637
189745
189847
189944
190038
190127
190225
190345
190444
190538
190631
190729
190827
190919
191017
191123
191236
Total990

Total Graduates of the Predecessor Schools: 1171

Endnotes

  1. Fifth Annual Report of the President of the University for the Year Ending July 31, 1908 (Stanford University, CA: Published by the University, 1908). pp. 17-23.Lane Library catalog record
  2. Sixth Annual Report of the President of the University for the Year Ending July 31, 1909 (Stanford University, CA: Published by the University, 1909). pp. 65-67.Lane Library catalog record
  3. Orrin Leslie Elliott , Stanford University: The First Twenty-Five Years (Stanford University, California: Stanford University Press), pp. 466-473.Lane Library catalog record
  4. Fifth Annual Report of the President of the University for the Year Ending July 31, 1908 (Stanford University, CA: Published by the University, 1908). pp. 17-23.Lane Library catalog record
  5. Sixth Annual Report of the President of the University for the Year Ending July 31, 1909 (Stanford University, CA: Published by the University, 1909). pp. 65-67.Lane Library catalog record
  6. Fifth Annual Report of the President of the University for the Year Ending July 31, 1908 (Stanford University, CA: Published by the University, 1908). p.18.Lane Library catalog record
  7. Sixth Annual Report of the President of the University for the Year Ending July 31, 1909 (Stanford University, CA: Published by the University, 1909). pp.65-68.Lane Library catalog record
  8. Fifth Annual Report of the President of the University for the Year Ending July 31, 1908 (Stanford University, CA: Published by the University, 1908). p.19.Lane Library catalog record
  9. Leland Stanford Junior University Department of Medicine, Annual Announcement 1910-1911, pp. 10-11.Lane Library catalog record
  10. Edgar E. Robinson and Paul C. Edwards , editors, The Memoirs of Ray Lyman Wilbur: 1875-1949 (Stanford, California: Stanford University Press, 1960) p.167.Lane Library catalog record
  11. Leland Stanford Junior University Bulletin: Department of Medicine, Annual Announcement 1910-11, pp.11-12.Lane Library catalog record
  12. Leland Stanford Junior University Bulletin: Department of Medicine, Annual Announcement; 1911-12, p.15.Lane Library catalog record
  13. Leland Stanford Junior University Bulletin: Department of Medicine, Annual Announcement; 1931-32, 1932-33.Lane Library catalog record
  14. Annual Report of the President of the University for the Year Ending July 31, 1913 (Stanford University, CA: Published by the University, 1913). pp.54-55.Lane Library catalog record
  15. Leland Stanford Junior University Bulletin: Department of Medicine, Annual Announcement 1913-14, p.27.Lane Library catalog record
  16. Leland Stanford Junior University Bulletin: Department of Medicine, Annual Announcement, 1913-14, p.32.Lane Library catalog record
  17. Leland Stanford Junior University Bulletin: Department of Medicine, Annual Announcement 1915-16, p.36.Lane Library catalog record
  18. Leland Stanford Junior University Bulletin: Department of Medicine, Annual Announcement 1910-11, pp.13-14.Lane Library catalog record
  19. Seventh Annual Report of the President of the University for the Year Ending July 31, 1910 (Stanford University, CA: Published by the University, 1910), p.60.Lane Library catalog record
  20. Seventh Annual Report of the President of the University for the Year Ending July 31, 1910 (Stanford University, CA: Published by the University, 1910), pp.59-60.Lane Library catalog record
  21. Seventh Annual Report of the President of the University for the Year Ending July 31, 1910 (Stanford University, CA: Published by the University, 1910), p.59.Lane Library catalog record
  22. Leland Stanford Junior University: Department of Medicine, Annual Announcements for 1910-11, p. 26; for 1911-12, p. 31; for 1913-14, p. 64.Lane Library catalog record
  23. Annual Report of the President of the University for the Twenty-second Academic Year Ending July 31, 1913 (Stanford University, CA: Published by the University, 1913), p.54.Lane Library catalog record
  24. Leland Stanford Junior University School of Medicine: Annual Announcement 1915-16, p.36.Lane Library catalog record
  25. Leland Stanford Junior University School of Medicine: Annual Announcement 1918-19, p.105.Lane Library catalog record
  26. Annual Report of the President of the University for the Year Ending August 31, 1918 (Stanford University, CA: Published by the University, 191), p.76.Lane Library catalog record
  27. Annual Report of the President of the University for the Year Ending July 31, 1910 (Stanford University, CA: Published by the University, 1910), p.59.Lane Library catalog record
  28. Edgar E. Robinson and Paul C. Edwards , eds., The Memoirs of Ray Lyman Wilbur 1875-1949 (Stanford, California; Stanford University Press: 1960), p.172.Lane Library catalog record
  29. Eighth Annual Report of the President of the University for the Year Ending July 31, 1911 (Stanford University, CA: Published by the University, 1911), pp.64-66.Lane Library catalog record
  30. Elliott, Orrin Leslie , Stanford University: The First Twenty-Five years (Stanford University: Stanford University Press, 1937), p.543.Lane Library catalog record
  31. Elliott, Orrin Leslie , Stanford University: The First Twenty-Five years (Stanford University: Stanford University Press, 1937), p.544.Lane Library catalog record
  32. Elliott, Orrin Leslie , Stanford University: The First Twenty-Five years (Stanford University: Stanford University Press, 1937), p.545.Lane Library catalog record
  33. Flexner, Abraham , Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching (Boston: Merrymount Press, 1910), pp.188-196.Lane Library catalog record
  34. Letter, Henry Gibbons, Jr., to Henry Pritchett, 25 July 1910, Board of Trustees Board meeting supporting documents, 1905-1975 - SC 027, University Archives, Stanford University Libraries.
  35. Letter, Henry Pritchett to Henry Gibbons Jr., 29 August 1910, Board meeting supporting documents, 1905-1975 - SC 027, University Archives, Stanford University Libraries.
  36. Edgar E. Robinson and Paul C. Edwards , eds., The Memoirs of Ray Lyman Wilbur (Stanford, CA: Stanford University Press, 1960), p.81.Lane Library catalog record
  37. Flexner, Abraham , Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching (Boston: Merrymount Press, 1910), pp.14-17.Lane Library catalog record
  38. Flexner, Abraham , Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching (Boston: Merrymount Press, 1910), pp. 151 and 154.Lane Library catalog record
  39. Flexner, Abraham , Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching (Boston: Merrymount Press, 1910), pp. 152-153.Lane Library catalog record
  40. R. G. Leland , Distribution of Physicians in the United States (Chicago: American Medical Association, 1935), pp. 2, 8, 9.Lane Library catalog record
  41. R. G. Leland , Distribution of Physicians in the United States (Chicago: American Medical Association, 1935), p. 13, Chart No. 3.Lane Library catalog record
  42. R. G. Leland , Distribution of Physicians in the United States (Chicago: American Medical Association, 1935) p. 13, Chart 3.Lane Library catalog record Number graduating in medicine each year; actual numbers of years.
  43. U. S. Bureau of the Census , Historical Statistics of the United States, Colonial Times to 1970, Bicentennial Edition, Part 1 (Washington, D. C. , 1975) Series B 275-290, p.76.Lane Library catalog record
  44. U. S. Bureau of the Census , Statistical Abstract of the United States: 1975, 9th ed. (Washington, D. C. , 1975), No. 238, p.141.
  45. U. S. Bureau of the Census , Statistical Abstract of the United States: 1995, 115th ed. (Washington, D. C. , 1995), No. 302, p.192.
  46. Marc L. Rico and David A Kindig , "A Report Card on the Physician Work Force in the United States," New England Journal of Medicine 334, no. 14 (April 4, 1996): 894.Lane Library catalog record
  47. Exercises Held at Lane Hall of Cooper Medical College in Memory of Doctor Henry Gibbons, Junior, on Sunday the Eighth Day of December 1911 (Printed by Order of the Directors and Faculty of Cooper Medical College, 1911), pp.1-3.Lane Library catalog record
  48. Exercises Held at Lane Hall of Cooper Medical College in Memory of Doctor Henry Gibbons, Junior, on Sunday the Eighth Day of December 1911 (Printed by Order of the Directors and Faculty of Cooper Medical College, 1911), pp.4-9.Lane Library catalog record
  49. Exercises Held at Lane Hall of Cooper Medical College in Memory of Doctor Henry Gibbons, Junior, on Sunday the Eighth Day of December 1911 (Printed by Order of the Directors and Faculty of Cooper Medical College, 1911), pp.10-11.Lane Library catalog record
  50. Exercises Held at Lane Hall of Cooper Medical College in Memory of Doctor Henry Gibbons, Junior, on Sunday the Eighth Day of December 1911 (Printed by Order of the Directors and Faculty of Cooper Medical College, 1911), pp.13-15.Lane Library catalog record
  51. Exercises Held at Lane Hall of Cooper Medical College in Memory of Doctor Henry Gibbons, Junior, on Sunday the Eighth Day of December 1911 (Printed by Order of the Directors and Faculty of Cooper Medical College, 1911), pp.15-18.Lane Library catalog record
  52. Minutes of Cooper Medical College, v. 3, p.159, Cooper Medical College Collection of publications, Lane Medical Archives, Stanford.Lane Library catalog record
  53. Minutes of Cooper Medical College, v. 3, p.161, Cooper Medical College Collection of publications, Lane Medical Archives, Stanford.Lane Library catalog record
  54. Minutes of Cooper Medical College, v. 3, p.163, Cooper Medical College Collection of publications, Lane Medical Archives, Stanford.Lane Library catalog record
  55. David S. Jordan , Annual Report of the President of the University for the Twenty-second Academic Year Ending July 31, 1913 (Stanford University, California: Published by the University, 1913), p. 8.Lane Library catalog record
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