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

Chapter 34: Dean Wilbur's Administration
1911 - 1915

Dr. Wilbur noted in his Memoirs that the first important decision he had to make when he assumed the deanship of the Stanford Medical Department on 1 January 1911 was whether to abandon the Cooper College buildings and move to the campus. The availability of patients for teaching and research was the crucial issue. San Francisco was at the time still recuperating and rebuilding from the great earthquake and fire of 1906 and Dr. Wilbur took many long walks through the neighborhoods between Cooper College and the downtown area in order to assess the emerging patterns of urban recovery. It was clear to him that, with the streetcar systems extending as they were, and with the wooden housing to the east, the College would be adjacent to deteriorating neighborhoods which would be a source of abundant "clinical material." Therefore, it seemed to me," he wrote, "that we could get ahead faster by developing the medical school on the Cooper Medical College site. If, in the course of years, San Francisco eliminated the slum areas, the medical school could be transferred to a new site, perhaps to the University campus." But now," he wisely concluded, "such a move would be premature."

He further observed that the campus seemed destined to be the ultimate home for any medical school connected with Stanford University - a prediction fulfilled 48 years later when, in 1959, the school moved to a new Medical Center on the Stanford Campus. [1]

In addition to the availability of teaching patients, Dean Wilbur could have mentioned two other prime assets of the San Francisco location - the substantial Cooper Medical College facilities, and the loyal private physicians willing and able to continue serving as clinical faculty at no cost to the University.

New and Improved Facilities

With these valuable resources in hand Dean Wilbur set about energetically upgrading the Medical Department to a university standard.

As we have seen, the process had already been initiated in 1909-10 by Professor John Maxson Stillman, Wilbur's predecessor as Executive of the Department. Professor Stillman appointed five basic scientists:

  • (1) Dr. Hans Zinsser, Associate Professor of Bacteriology
  • (2) Dr. Albert C. Crawford, Professor of Pharmacology
  • (3) Dr. Ernest C. Dickson, Assistant Professor of Pathology
  • (4) Dr. Frank T. Blaisdell, Assistant Professor of Applied Anatomy
  • (5) Mr. R. M. Llamon, Instructor in Anatomy

and began construction of lab space in the old Museum buildings on the campus [2]

Construction of laboratories for the work in Bacteriology, Pharmacology, and Anatomy in the old Museum buildings on the campus was completed in 1910-11 and the labs were well equipped. The pathology work in San Francisco was carried on with the apparatus and laboratory formerly used by Cooper Medical College. The physiology laboratory in the College building was arranged to serve as a laboratory for medical research. [3] [4]

In 1912-13 the Division of Pharmacology was transferred from the campus to the fifth floor of the Clinical and Laboratory Building in San Francisco, occupying a new laboratory in the rooms formerly used for topographical anatomy, which was moved to the campus. [5]

Also during 1912-13 the Lane Medical Library was opened. Books, journals and other holdings of the Lane collection were transferred to the new Library from the Clinical and Laboratory Building which was then extensively remodeled, the first two floors being devoted entirely to clinics and the upper three floors to laboratories. This rearrangement, together with the conversion of Lane Hall to an amphitheater, was very satisfactory and provided facilities for handling the rapidly growing clinic where there was a record 70,000 visits in the year ending 30 June 1913. [6]

The new faculty appointments and space allocations outlined above laid a firm foundation for preclinical instruction upon a true University basis. Dean Wilbur's further objective was to create academic and physical conditions in the clinical divisions similar to those evolving in the professorships and laboratories of the basic sciences.

San Francisco City and County Hospital

The teaching services at San Francisco City and County Hospital, shared to an equal extent with the Medical Department of the University of California, were a major component of the Stanford clinical program. However, the Hospital, hopelessly outmoded, was closed in 1910 and construction of its modern replacement begun. It was not until five years later that Dr. Wilbur, now President of the University, could issue the following announcement of its re-opening: [7] [8]

The new City and County Hospital of San Francisco, erected at a cost of two million dollars, was occupied on 1 May 1915. It is one of the most beautiful and complete structures of its kind in America. The Medical School controls one hundred beds averaging about a thousand patients per year. Stanford University was assigned two excellent wards (Wards C and D on the upper floors of one of the ward buildings), and there has been an increase in the house staff on the Stanford service to five interns and one house officer appointed by the School. With increased interns, and with the splendid facilities offered by this large institution, a great advantage has been obtained for the medical faculty and students. [9]

Lane Hospital

During the year ending 31 July 1915 extensive structural and equipment improvements were completed that increased the efficiency and scope of service in Lane Hospital. For example, a new power plant and new circulating refrigeration system were installed; the entire fourth floor, on which was situated the kitchen and dining rooms, was reconstructed and the hospital was renovated throughout. As a result, Hospital admissions and Clinic visits were increased, and the Annual Report of the Hospital for the year ending July 31, 1915 portrayed Lane Hospital as a dynamic institution, intensively utilized and taking steps to maintain and improve services and standards. [10] [11]

Stanford University Hospital

With the change of Lane Hospital and the Medical School to a university basis, the teaching uses of Lane Hospital rapidly expanded. The increased number of clinic patients and the demands for space for student uses crowded the Lane accommodations to such a degree that other provisions had to be made for private patients.

In a resounding vote of confidence in Dean Wilbur and the Medical Department during the tense period of financial uncertainty to which we have already referred, the Board of Trustees of Stanford University approved planning and construction of the Stanford University Hospital. It was intended especially for the care and comfort of private patients, so that Lane Hospital could be conducted as a staff and clinic hospital for teaching purposes.

In the spring of 1914 the Clinical Committee began to work steadily with the architects in preparing plans for Stanford University Hospital. On 24 June 1916 excavation was started for the foundation of the new hospital to be located on Clay Street immediately adjacent to Lane Hospital. Plans called for about 45 private rooms and 125 ward beds. The appropriation of $ 500,000 for the new construction included funds for two clinical laboratories and a new power plant to serve all the Medical Department buildings. [12] [13]

On 22 December 1917 Stanford University Hospital was opened for inspection, and was ready for patients on 26 December 1917. The expectations of the Faculty as to the outcome of the plans for the institution were more than realized, as testified by its immediate popularity with both patients and physicians.

The Clinical Committee in charge of Planning the new hospital consisted of Dean Wilbur, Chairman; Dr. George B. Somers, Secretary; and Doctors William Ophüls, A. B. Spalding and Stanley Stillman. The features planned by the committee included operating rooms; hydrotherapeutic, electrotherapeutic and X-ray departments; numerous solaria and balconies connected with the private rooms; ample size and complete equipment of service kitchens, utility and supply rooms; and generous accommodations for special nurses in the line of dressing rooms, rest rooms, locker rooms, baths, etc. [14] [15]

During the year September 1 1918 to September 1, 1919 Stanford University Hospital was improved by the addition of 26 more rooms. Two floors of the new hospital had been left unfinished until such time as demands for accommodations should warrant their completion. The original plan was to use the uncompleted space for ward beds, but experience showed that private rooms were in much greater demand than wards, and the plans were changed accordingly. The new rooms filled up at once and proved very popular, as they were large and quiet. [16]

In the President's Report of 1917-18, Dr. Wilbur commented on the important programmatic contribution of Stanford University Hospital and the other facilities planned during his deanship: [17]

The Stanford Hospital in San Francisco has been in operation since December 26, 1917. It is undoubtedly one of the best institutions of its kind. It is now possible for the members of the medical staff to have available under one roof practically everything needed for the care of patients, instruction of students and research work. The combination of the Lane Medical Library, the laboratories of the Medical School and hospital, the public clinics, the clinical wards of Lane Hospital, the private rooms and the consultation rooms of the Stanford Hospital, has met the problem of the medical teacher in a most satisfactory way. The arrangement is also most economical from the standpoint of time and the distribution of all overhead expenses between the Medical School, private rooms and clinical wards.

Stanford School of Nursing

We referred earlier to the important contribution of the Stanford Nursing School to the operation of Lane Hospital, and we specifically cited the recommendation in 1912 of Physician Superintendent George E. Somers that there was an urgent need for a building large enough to accommodate one hundred nurses. [18]

In the following year, 1913, the Board of Trustees decided to construct a nurses' home, a decision attributable to the influence of Dean Wilbur - and another example of his successful efforts to improve the facilities available to the Medical School. [19]

However, the promised new nurses' home was slow to materialize for financial reasons, and the following related events transpired during the long delay.

In 1915 the nurses' alumnae offered to raise five thousand dollars to support the construction of a nurses' home, provided that they be given the privileges of a hospital bed for sick alumnae. This offer was accepted by the Board of Trustees and put on hold. From another source, one thousand dollars was paid in, so that the nurses considered that a building fund was at least started. [20]

In 1916 the old nurses' home was wrecked in preparing for construction of Stanford University Hospital. No one regretted demolition of the old building, but it was then necessary to house the nurses in four residences immediately adjacent to the Hospital, in addition to the residence on Clay Street previously occupied by Dr. and Mrs. Lane. While the nurses were now very comfortable and enjoyed their new quarters, still the scattering of nurses in five different houses added considerably to the responsibility of the management and was attended by many inconveniences. [21]

By 1917 the nurses had increased in number and were housed in seven residences in the neighborhood, and soon an eighth would be necessary. The scattering of the nurses in these various locations was not only expensive, but rendered the problem of supervision and discipline very difficult. The construction of a suitable nurses' home was now an urgent necessity and some funds for that purpose were raised by subscriptions from several friends of the training school. [22]

In 1918 the number of residences in the neighborhood of Lane Hospital occupied by nurses had increased to nine. A tenth house was used for the accommodation of male employees. Meanwhile the standards and methods of teaching nurses had increased remarkably since the decision in 1913 to build a new nurses home. The University in supporting the School for Nurses was now by this time merely extending the educational program of and providing the opportunity for its women graduates to supplement college training with practical work, not alone in nursing but in hospital teaching and administration, in social service and public health work. As courses along these and related lines gradually became incorporated into the training of nurses, the nursing school developed, almost without realization, into a separate institution with separate organization and demanding separate consideration.

In view of these facts, therefore, the Clinical Committee, which had jurisdiction over the nursing program, found itself dealing with the affairs of the School for Nurses as with a separate educational institution. One important consequence of this was that, in planning for the future housing of the school, it was necessary to provide classrooms, laboratories and such other accommodations as were needed for teaching purposes.

The decade of delay in construction of the nurses' home was fortunate in that, as a result, the final plans for it could and did include provision for the developing educational as well as the housing needs of the nurses. In keeping with this revised concept, instead of "Nurses Home" the new building was to be known as "The Stanford School of Nursing." Construction began in 1920, was completed in 1922, and the School was formally opened on March 31st of that year. [23] [24] [25]

On the afternoon of March 31, 1922, with impressive ceremony, the Trustees of Stanford University presented the new building to President Wilbur who, while serving as Dean in 1913, had been responsible for gaining approval for its construction. In his acceptance remarks, he graciously acknowledged his honor and satisfaction that Stanford University now possessed a suitable facility for the further development of this important professional school. Mrs. Helen Hoy Greeley of Washington D. C., through whose efforts "Rank for Nurses" had been enacted by Congress, gave the address of the afternoon, after which the School was open to the inspection of invited guests.

In the evening the graduates and students of the Stanford School of Nursing entertained with a reception and dance. On that day about 1,000 guests passed through the Home - all enthusiastic and admiring. [26]

The following description is from the Nursing School's Annual Announcement for 1925-26: [27] [28]

The School of Nursing was established in 1895 as the Lane Hospital Training School for Nurses. After Cooper Medical College became Stanford School of Medicine, the name was changed to Stanford School for Nurses, later to become the Stanford School of Nursing.

Five hundred and twenty-eight nurses had been graduated. by the 1925-26 school year.

The Stanford School of Nursing of the Stanford University School of Medicine was directed by the Clinical Committee of the Medical School Faculty (chaired by Dean Wilbur until 1916), which was also in charge of the University Hospitals.

The School's Combined Nursing Course consisted of a Pre-Nursing Course given at Stanford University. This covered a period of three years and was supplemented by a two years' Course in Nursing given at Stanford School of Nursing. At the end of the five years, the student received an A. B. degree from the University and a diploma in Nursing from the School of Nursing.

The Course was designed primarily for those who wished to prepare themselves for administrative and teaching positions, social service or public health work.

The Stanford School of Nursing was situated in an educational and residential building located at 2340 Clay Street, directly opposite the University Hospitals and connected with them by a tunnel under the street. It was erected by Stanford University at a cost of $ 425,000. It was built of reinforced concrete, seven stories high, and accommodated 200 nurses. Besides bedrooms, there were large and beautifully furnished reception rooms, a music room, a library of 1,000 books for general reading, and the current magazines. There was an auditorium with seating capacity for 450, which could be used for lectures, dancing, or private theatricals. Housemothers had charge of the home and carefully looked after the comfort of the nurses and acted as chaperones.

The educational department consisted of classrooms, a demonstration room, and laboratories for Chemistry, Bacteriology, and Dietetics.

On the seventh floor of the building was the Nurses' Infirmary, where student nurses, taken ill in the line of duty, were cared for and treated gratuitously. The Infirmary was equipped as a small hospital and was in charge of a woman physician as Medical Director. [29] [30]

Organization of the Medical Faculty and Attempt to Install the Clinical Full-time System

As noted in Chapter 31, a Plan for Organization of the Faculty of the Medical Department of Stanford University was adopted in 1909. At that time the titles and functions of the full-time faculty were broadly defined as follows: [31]

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.

This ambiguous definition applied primarily to the Professors and Associate Professors in the basic science departments who were indeed employed and paid on a full-time basis, and received no outside income from medical practice. However, with the exception of Professor Ophüls of the Pathology Department who was paid a "full salary" and was denied the privilege of private practice for personal gain, other professorial faculty of clinical departments were paid a negotiated "full salary," which was often nominal, but were permitted to supplement their incomes by private medical practice.

This plan of organization, that is the paying of less than full-time salaries to professors in the clinical departments but allowing them to enhance their incomes by private practice, is referred to as the geographic full-time system. which we have discussed at some length in the previous Chapter.

The topic of faculty organization was further addressed at a meeting of the Executive Committee of the Medical Faculty on 29 December 1910. Those present were Doctors John Stillman, Henry Gibbons, Jr., Emmet Rixford, William Snow, William Ophüls and Ray L. Wilbur. The minutes of the meeting state: [32]

it was moved and seconded that it was the sense of the Executive Committee that future appointments in the Medical (School) of heads of divisions and subdivisions should be on an academic basis, at least on the salary of an instructor - it being understood that this recommendation is not intended to interfere in any way with the appointment of such paid and unpaid clinical staff as may be required. Motion carried unanimously.

This resolution, in its reference to placing heads of divisions and subdivisions on an "academic basis" would seem to be committing the Medical Department, in principle, to the "clinical full-time system " as described by Dr. Lewellys Barker in 1902 and adopted by Johns Hopkins faculty in 1914. However, the statement that heads of divisions and subdivisions should be on an academic basis "at least on the salary of an instructor" is contradictory. It indicates that a strictly full-time salary would not be paid to professorial faculty as is required under the definition of the clinical full-time system, which also disallows private practice as a means of supplementing an inadequate university salary.

Grant Application to General Education Board Proposed

Obviously, the deterrent to adoption of the clinical full-time system at Stanford in 1910 was not lack of motivation but insufficient money. It was clear to Dean Wilbur that the system could not be implemented without a major increase in the endowment of the University to cover the added cost of paying actual full-time salaries to heads of clinical divisions and subdivisions. Therefore, as soon as the controversy with President Branner over the future of the medical school had been decided, the Dean addressed the following letter to him asking his help in raising the funds required to establish the true clinical full-time system. The Dean proposed applying for a grant to the General Education Board of the Rockefeller Foundation, an agency with which whose sponsorship of the clinical full-time system we are already familiar. [33]

July 22, 1914
President. J. C. Branner
Stanford University

Dear President Branner:
Now that the position of the Medical School is assured and the lines of action proposed therefor have met with the approval of such an eminent authority as Dr. Vaughan, it would seem to me desirable to urge upon the General Education Board that they enlarge the field of their efforts to improve medical education in America by assisting Stanford to improve conditions on the Pacific Coast. With some assistance Stanford can readily set an example not only for the first-class schools of Medicine that will soon develop in Portland, Vancouver and Los Angeles and in association with the University of California but also for medical education in general. As Dr. Vaughan has pointed out the development of the Stanford Medical School will be both a stimulus and a protection to the University of California in their medical work. Just as the foundation of Stanford University led to the remarkable development of the University of California, so will proper growth of the Stanford Medical School lead to the State with its unsurpassed resources pushing forward rapidly its Medical School.

The Dean outlined for President Branner Stanford's current "geographic full-time plan" of paying nominal salaries to professors in the clinical divisions and subdivisions and allowing them to make additions to their income through private practice.

He then pointed out to the President that if Stanford's investment in the School of Medicine could be increased by $750,000, that is to say $35,000 per year, Stanford's geographic plan could be converted to a clinical full-time plan by allocating the money as follows:

DivisionAnnual Allocation
Genito-Urinary Surgery$4,000
Ear, Nose and Throat$4,000
Medicine at San Francisco Hospital, etc.$4,500

The Dean omitted Medicine at Stanford from this budget because he considered that subdivision to be already operating on a clinical full-time basis.

The Dean concluded his letter to President Branner with the following remarks:

In addition to the Basic Science Divisions, Stanford now has the Clinical Divisions of Medicine, part of Surgery, including the Subdivisions of Orthopedic Surgery, Obstetrics and Gynecology, on an academic (i. e., full-time salaried) basis Stanford is probably the first institution to put the various subspecialties on a full-time basis.

Anything that can be done to bring the possibilities of our Medical School before those interested may prove helpful.

Very truly yours,

(Signed) R. L. Wilbur.

The following Inclusions to accompany the above letter are abstracts of the grants already approved by the General Education Board:


William H. Welch Foundation $1,500,000

To provide for full time clinical teachers with sufficient assistants in Medicine, Surgery, and Pediatrics. Salaries thought to be about $ 10, 000 each. The professors are allowed to practice Medicine as they please but all fees are to be collected and retained by the hospital. Since Johns Hopkins Hospital contains many private rooms the medical care of patients occupying these rooms will be something of a problem and will probably lead to the superintendent of the hospital urging the care of such patients upon the paid staff since thereby the earnings of the institution will be greatly increased. This will make it difficult for the teacher to refuse and also to control his own time. It will also prevent him from having that sense of responsibility to the individual and to the community that is most important in the development of the real physician.


Gift of $750,000.

Contingent upon obtaining full control over the New Haven Hospital and additional endowment between $ 1,000,000 and $1,500,000 to put Medicine, Surgery and Pediatrics on an academic basis. Yale has not yet obtained the full amount but seems likely to reach the amount required soon.


Gift of $750,000.

Contingent upon a similar amount being raised by the institution. Aimed to put at least Medicine, Surgery and Pediatrics on a basis similar to that of Johns Hopkins but not so restricted as to plan. Details not worked out yet.

Dean Wilbur consults Trustee Timothy Hopkins

Dr. Wilbur addressed the following letter to Mr. Timothy Hopkins and included in it a copy of the above letter to President Branner. [34]

San Francisco, July 22, 1914
Mr. Timothy Hopkins
President, Board of Trustees, Stanford University
510 Nevada Bank Building
San Francisco

Dear Mr. Hopkins:
Your efforts to increase the endowment of the Lane Medical Library and the Medical School lead me to call your attention to the very favorable opportunity open for the further development of the Stanford Medical School from additional endowment. From an endowment equal to about the amount spent by Stanford in remodeling the Clinical and Laboratory Building and to be spent on the new hospital an income sufficient to practically place the whole institution on an academic basis could be derived. Evidently the limitations of the income of the University necessitate that certain lines must await outside help before proper teaching arrangements can be made.

In short if Stanford could have an addition of $35,000 to its (annual) budget for the following specific purposes it could put the whole Medical School on an academic basis.

Genito-Urinary Surgery4,000
Ear, Nose and Throat4,000
Medicine at San Francisco Hosp., etc.4,500

Very truly yours,
(Signed) R. L. Wilbur

Mr. Timothy Hopkins, President of the Stanford Board of Trustees responded as follows to the above letter from Dr. Wilbur dated July 22, 1914:

Holland House, New York City
November 16th, 1914
Doctor. Ray L. Wilbur
Palo Alto, California

Dear Doctor Wilbur:
I have had a long talk this morning with Doctor Flexner and Doctor Buttrick. Doctor Flexner is quite willing to take our proposition before the (General Education) Board at its meeting in the latter part of January (1915), providing it is modified to meet the purposes of the Board.

It appears that they wish to try an experiment in three or four different places, and this experiment they do not wish to modify. An application from Harvard, something like ours, was turned down.

The plan is to provide clinical professors who shall devote their whole time to the interests of the university, not taking any paid practice outside, although of course free to write and lecture and to do anything except to practice medicine. There are some cases where medical advice must be paid for, else it would appear that they were undercutting the regular practitioners. In case fees were received for such practice, they should be turned over to the Medical School, but it is not expected that they should try to make money for the Medical School by practice.

If we are to receive help, we shall have to modify our Stanford plans somewhat. We shall have to pay professors higher salaries than $4,000, but young men can be had who would rather have $4,000 or $5,000 and be free to study and teach, rather than to go into practice for the larger sums which might be obtained.

Knowing it must be on these terms that we get any help from the Education Board, we could, perhaps, with the $35,000, employ one less man than you suggest, and I certainly think the experiment is worth trying if we can get the $750,000 for which we have asked.

Thus far the three institutions chosen for these experiments are John Hopkins, Yale and Washington.

I have tried to show them that in the half of this old country which lies west of St. Louis there is no adequate Medical School excepting our own, and I think I convinced them that we were the ones on which they should try their experiment. They want you to write out quite fully what we are actually doing in medicine; what professors are already paid; and the amounts including assistant professorships; the salaries of each; a statement as to the ordinary charges and management of the institution; the reasons why we would like to enter into this experiment and to try it under the new conditions of this coast - quite different from those surrounding any of the three already chosen - also the reason why Stanford University is to be chosen.

My general impression is that if we will meet their requirements by cutting off all profit for these new professorships and letting the fee that they must charge go into the general fund, but neither expecting nor requiring any money in this way, they will look with a good deal of favor on us. I think it best to put all this in form and get Doctor Branner as President, and perhaps Mr. Newhall (who succeeded Mr. Hopkins as President of the Stanford Board of Trustees) to sign it.

The whole matter is practically in the hands of Doctor Flexner. I found both these men very friendly, and perhaps the omens are good for our success.

Some of the documents I had with me are available for your report, as I return them. Doctor Flexner implied that they would rather have a somewhat long report anyhow; we will try it.

I remain,
(Timothy Hopkins)

As advised by Mr. Hopkins, the following covering letter was dispatched on December 11, 1914 as a grant application to the General Education Board. This covering letter was accompanied by supportive documentation prepared by Dr. Wilbur.

December 11, 1914
The General Education Board
17 Battery Place
New York City

On behalf of the Leland Stanford Junior University we request the assistance of your honorable board to the extent of $750,000 as a special endowment for our medical school.

A detailed statement of the history, present condition, and future plans of the medical school, by the dean, Dr. R. L. Wilbur, together with copies of publications relative to it, accompany this application. The following conditions are suggested as applicable to the gift, if made:

1. That the income of the fund shall be used for payment of salaries of full-time clinical professors, preferably in the divisions of medicine, of obstetrics and gynecology, and in pediatrics; and for salaries of assistant and associate professors either in these same divisions or preferably, in the clinics devoted to genito-urinary surgery, neurology, ophthalmology, otology, rhinology, and laryngology.

2. That the holders of these professorships shall be expected to devote their time to teaching, to research, and to the care of patients; that they shall have the privilege of delivering lectures and of being of general public service, also to care for private patients, at their discretion, in the hospital or through consultation, all fees for such attendance to be collected by the medical school and to become a part of its funds.

Respectfully submitted,
(William Mayo Newhall)
President, Board of Trustees
(John C. Branner)
President of the University

Dean Wilbur discussed the grant application with officers of the General Education Board in New York in January 1915 and reported the discussion to President Branner in the following letter.

January 11, 1915

Dear President Branner:
I beg leave to report that I have returned from the East this morning. . . . In New York I took up with Mr. Flexner and Mr. Buttrick of the General Education Board the details of the desired endowment for the Medical School, and think that I was able to get the proposition concretely and definitely before them for discussion.

Their attitude was most friendly and favorable, as we had been led to expect by the way they had taken the problem up with Dr. Jordan. Mr. Flexner particularly desired information along certain lines and certain comparisons between our institution and the others already endowed by them, and I think that the way the proposition was presented by us will be in our favor. He was particularly impressed by the unanimous action of the Medical Faculty requesting that the endowment be sought along the lines adopted by the Board. In all the other medical schools there has been some more or less definite opposition to the plan of the General Education Board. . .

Very sincerely yours,
R. L. Wilbur

The General Education Board denies approval of Stanford's grant application President Branner received the following terse letter: [35]

New York City
Feb. 8, 1915
President John C. Branner
Leland Stanford Jr. University
Stanford University, California

Dear Dr. Branner:
The application that was made by you on behalf of Leland Stanford Jr. University for assistance toward a special endowment for your Medical School was submitted to our Board for its consideration at a meeting held on January 28, 1915. I am instructed to inform you that the Board did not find it practicable to grant the request which was made.

Very truly yours,
E. C. Sage

Reasons for the decision not to approve the Stanford application were not forthcoming from the GEB.. Immaturity of the school, which had been in existence for less than a decade at the time of the application may have been a negative factor. when to a visionary this could have been seen as an asset. The criticism of the Stanford program published in the Flexner Report only a few years previously in 1910, and Stanford's refusal to merge with the University of California, may also have inclined Flexner and other members of the GEB to reject the application. The fact that Stanford was a "divided" school with the clinical departments and hospital at a distance from the University was contrary to one of the Flexnerian imperatives, and doubtless made Stanford Medical School sub optimal as a site for the GEB's experiment with the clinical full-time system.

Geographic Full-time System continues at Stanford

In view of Dean Wilbur's efforts to obtain funding to establish the clinical full-time system, and of the medical faculty's unanimous concurrence with these efforts, it is reasonable to conclude that only the lack of funds prevented early introduction at Stanford of the clinical full-time system (Hopkins model) and led ultimately, as in so many other medical schools, to continuation of the geographic system as a practical expedient. Years later the adoption of the clinical full-time system became a major issue at Stanford, a subject to which we will in due course return.

Dean Wilbur was highly effective in developing the faculty and promoting research during his five-year tenure as Dean from academic year 1910-11 to 1915-16. He presided over expansion of the medical faculty from 20 to 62 as shown by the following table based on Annual Announcements of the School of Medicine for those years: [36] [37]

Faculty of Stanford School of Medicine
Clinical Professor286
Associate Professor33-
Associate Clinical Professor-22
Assistant Professor495
Assistant Clinical Professor-55
Clinical Instructors-1616

In 1915-16 32 "Assistants" were also listed with the Faculty.

With respect to faculty research during Dr. Wilbur's deanship and afterward, we refer to the Medical Bulletin of Stanford University School of Medicine. Volume 8 was the final issue of the Bulletin. It covers the three-year period from 1924 to 1927 and contains 93 reprints. In an Appendix are listed an additional 594 articles making an estimated total of approximately 700 articles published by the Faculty during that period.

These data suggest that the number of journal articles published by the Faculty increased 10-fold during the decade and a half from 1910-13 to 1924-27, and that Dr. Wilbur's early efforts to create On 4 May 1912 the Faculty of the Medical Department decided to collect and bind the reprints of all medical journal articles published by the Faculty. The objective was to document their research activities and make them more widely available for study. Since it was soon learned that it was not possible to obtain reprints of all articles, a list of those reprints not bound in the Bulletin was included as an Appendix in all except the first two volumes.

Volume 1 of the Bulletin covers the three-year period from the beginning of the Department in 1910 to 1913 and contains 35 reprints. Assuming that reprints of only half of the articles were submitted for binding, we can estimate that about 70 articles were published by the Faculty during that period.

Volume momentum for research in the new school was highly successful. [38]

In a previous Chapter we discussed President Branner's strong objection to funds being made available to the Medical Department by the Trustees in excess of prior agreement. These were the funds invested by Dean Wilbur in construction of the new and improved medical facilities we have described earlier in this Chapter, and in support of the additional faculty tabulated above. The Trustees' generous allocation of funds to the Medical School, so outrageous to President Branner, paid off handsomely by rapidly upgrading the School's facilities and faculty in both preclinical and clinical departments. These important initiatives by Wilbur no doubt contributed to Dr. Vaughan's favorable impression of the Stanford medical program in June 1914.

Dean Wilbur Elected President of Stanford University

In view of the considerable effort by President Branner to expel the Medical School from the University, it is of special interest to note that, on 13 October 1915, after many months of debate and negotiation, the Board of Trustees chose Dean Wilbur to replace him as President of Stanford University, effective 1 January 1916. On that date Professor Branner became President Emeritus.

Also on 1 January 1916 Professor Ophüls was named Acting Dean of the School of Medicine to replace Dr. Wilbur. Professor Ophüls was appointed as Dean on 1 August 1916.

When Professor Branner accepted the presidency of the University in 1913 he concluded his inaugural address by saying: [39]

Here and now I beg to remind you that I shall be sixty-five years of age in July 1915, and I recommend that I be retired at the end of that academic year.

We also recall that Trustee Herbert Hoover, at the time of Dr. Branner's appointment as President, proposed to the Board of Trustees that Dr. Wilbur be Dr. Branner's successor as President of the University. In view of Hoover's confrontation with Branner over funding of the Medical School, it is not surprising that he looked forward to the termination of Branner's appointment as President.

Meanwhile, World War I began in Europe in August 1914 and Hoover, then residing with his family in London, soon became involved in humanitarian work - first the repatriation of Americans stranded in Europe. Soon afterward he organized and became head of the Commission on Relief in Belgium (CRB) devoted to the prevention of famine in that beleaguered country by importing food. In spite of this pressing commitment, Hoover continued to serve as a Stanford trustee and maintained a keen interest in university affairs. Hoover took particular notice that by late in 1914 President Branner's anticipated term of office would be more than half over, and he was increasingly anxious to find a proper successor for him.

On 25 October 1914, only three days after formally launching the CRB, Hoover took the time to write a four-page letter about the university presidency to his friend, Timothy Hopkins, who was still chairman of the Board of Trustees. It was a matter, Hoover said, "very near to my heart."

The appointment of a successor to Dr. Branner was also a matter of great consequence to the Medical School. It is for that reason that we include here a full account of the lengthy and involved appointment process as reported by George H. Nash, author of the definitive Hoover biography: [40]

Hoover's opinion on (the presidency of Stanford ) was emphatic. Stanford, he declared, was "essentially a Western institution, with ideals entirely different from those which obtain on the Atlantic seaboard." Its development policies of the previous two years (policies largely conceived by himself, he might have added) were "practically unique." Indeed, the university's "whole internal academic structure" was "essentially different from that of any other institution." To Hoover it was therefore evident that Stanford's next president should be "a Western man," and "a man from the present university body." He would also be pre-eminently an administrator. "The old-line President who was able to preside at Sunday School Conventions and make choicely classical orations on public occasions is not the type of man that Stanford needs," he argued. "Nothing would be more disastrous than to choose some classical Professor from the East." For Hoover only one man fit his criteria: the current dean of Stanford's medical school, Ray Lyman Wilbur.

Hoover's reasoning was extremely revealing of his educational philosophy and self-image. He wanted Stanford to be led by a Westerner, not an Easterner; an executive, not an orator, a man of practical education, not a classically trained academic. A man, in short, like himself. If Wilbur was "deficient on the side of flowered and classical oratory," he remarked crisply, that deficiency could be supplied by Chancellor David Starr Jordan. Hoover also admired Wilbur's aggressiveness on behalf of his department. If Stanford had "another ten Wilburs" in its other departments, he argued, "they would have been much further forward than they are today." Hoover's choice was significant for another reason. Ray Lyman Wilbur was one of his oldest and closest friends.

Having circulated his views to key trustees, Hoover now awaited developments. At the beginning of 1915 President Branner duly announced his intention to retire on August 1, and the search for his successor began in earnest. It quickly developed that opposition to Hoover's candidate was strong. During 1914 Wilbur had been embroiled in the bitter battle over the future status of his San Francisco-based department, a battle that he had won and Branner had lost. Apparently embittered by his defeat, Branner seemed determined not to let Wilbur succeed him. He was not alone in his opposition. Many members of the Stanford faculty feared that Wilbur, as president, would place the interests of the medical school ahead of those of other departments.

Well aware of these sentiments, Hoover tried to neutralize them by proposing to his fellow trustees that his friend be appointed acting president for a trial period of one year. Hoover was certain that Wilbur would introduce so much administrative "steam and push" to the campus that he would "galvanize the whole place within twelve months." But if he should not meet expectations, he could then return "with dignity" to the medical school and another person could be chosen president. It would be far better to handle matters in this way, Hoover thought, than to embark on what he called the "experiment " of hiring an educator from the East.

Hoover's suggestion went nowhere. It soon transpired that the faculty's apprehensions about Wilbur were shared by certain trustees, some of whom, including W. Mayo Newhall and J. Leroy Nickel, wished to look outside the faculty - to the East, in fact - for a successor. Hoover, in London, was angry at this turn of events. "I am . . .appalled at the idea of Nickel and Newhall dominating the appointment of a President for Stanford University," he told a friend. "Neither of these men has the university instinct, nor have they the remotest idea as to what constitutes such an institution."

Meanwhile Stanford's newest trustee, Ralph Arnold, was pursuing an idea of his own. A petroleum geologist and businessman (as well as Ray Lyman Wilbur's second cousin), Arnold had known the Hoover brothers for years. In January 1915 he asked Hoover whether he would accept an offer of the Stanford presidency. Arnold was convinced that the university would be "making no mistake" if it installed Hoover as president for a long enough term to "thoroughly organize the faculty" and establish "a definite policy of administration."

Hoover's reply was swift and clear: Ray Lyman Wilbur, he said, should be chosen. But then he added:

"If it was not for the intervention of all these international troubles, I would have been quite prepared to take on the job for a couple of years, simply as acting president or acting trustee in charge of the University, in order to hold the position open for Ray. I have no intention to become a University President as a permanent occupation."

Hoover pointed out he could not "desert the Belgians until peace has been signed" and that he would then need three or four months to arrange his "private affairs" before he could "take on the job." How soon he might even be available was therefore impossible to determine. Nevertheless, he seemed willing, at least in principle, to accept the position if offered it.

Arnold was extremely pleased. He immediately replied that if certain circumstances materialized, he would nominate Hoover as a compromise candidate for acting president or acting trustee in charge of the university. Hoover, significantly, did not object.

Then, in the winter of 1915, an unexpected event threw the selection process into turmoil. David Starr Jordan, who as chancellor had been attending trustees' meetings, announced publicly that Wilbur would probably be selected as president. Not long afterward Jordan, a strong advocate of Wilbur, compounded his indiscretion by practically demanding that the board come to a decision in April (1915) - a move interpreted by some as an attempt to stampede the board toward Wilbur. Jordan's behavior incensed the trustees, fortified the anti-Wilbur faction among them, and obliged the rest to defer a choice for some time. As a result, the spring of 1915 passed without result, and Branner was induced to remain as president for as much as another year.

Reporting all this to London, Ralph Arnold again expressed his wish that Hoover could step in for two or three years as president and reorganize the entire university. Not only would the institution benefit, he argued; the interim period would enable Wilbur to solidify his credentials as Hoover's successor. Arnold yearned for Hoover's presence at the showdown meeting of the trustees; at such a meeting, he knew, Hoover's influence would be "dominant."

Far from the environs of Stanford, Hoover was disgusted at the course events were taking. He told Arnold that it was a source of "humour" to think that "a narrow-minded farmer like Newell (Newhall) or an extremely avricious (sic), egotistical banker like (trustee Frank B.) Anderson are either one or the other at all capable in choosing a President for Stanford." As for Branner, who was about to head east on a search for candidates:

"You and I have known for years that Branner is capable of the most violent and consistent prejudices and that with all his admirable qualities these prejudices absolutely blind him to the merits or demerits of individuals. I should consider that he above all men associated with Stanford University is the least qualified to nominate a new President, but when I think of Jordan's judgment I am equally appalled. As to myself, if it does not work out in the next six month that Ray is possible, until the above gentlemen have been completely removed from the scenery and their influence entirely excised, I might manage to take the job and hold it for two or three years, provided I had a clear six months to get prepared. Much depends upon how long this War lasts and a hundred other contingencies, but rather than see some loudmouthed Princetown (sic) professor put in the position, I would be willing to take three years out of my life and throw them away."

Hoover's worries about a "loudmouthed Princetown professor" proved apposite. After a trip east late in the spring to investigate presidential possibilities, Branner and Newhall returned with an enthusiastic endorsement of Edwin Capps, professor of classics at Princeton - the very epitome of all that Hoover found objectionable. Thoroughly alarmed, Arnold cabled London that Wilbur's "only chance" depended on Hoover's attending the next trustees' meeting. Only Hoover, he said, could win over Trustee Anderson and sufficiently isolate the opposition to prevail. Once again Arnold held out the prospect of Hoover's becoming president if Wilbur's bid should fail, and he disclosed that two other trustees seemed amenable to this possibility.

Hoover's reaction to the Capps candidacy was scorching, The Princeton professor, he cabled, was a "social fop" and "sycophant to (the) Wall street bunch." He was the "absolute negation of (the) type required for president." but for all his vehemence, Hoover had to record that he had "no Hope" of visiting California until the war was over. Millions of people were dependent on his venture in humanitarian relief. The CRB, he said, would collapse into "absolute Chaos" without him.

By now (mid-1915) the Stanford Board of trustees was deeply divided between the Pro- and anti-Wilbur factions. Chancellor Jordan agreed with Arnold that only Hoover, appearing in person, could persuade the board to select his nominee. To Jordan, (Hoover wrote that) Leland Stanford would "turn over in his grave" if he knew that "a Professor of classics from the most reactionary university in America" were to become president. Alas, the one man who seemed capable of resolving the impasse in Wilbur's favor was thousands of miles away.

At its meeting (in August 1915) the Board of Trustees decided to interview several candidates; clearly a decision was some time away. Arnold immediately informed Hoover that he might yet be "the victim of circumstances" if Wilbur were blocked and the "(trustees) Hopkins and Eells are strong for you in case Wilbur cannot get it." Lou Henry Hoover, cabling to her husband from California, was more succinct. "Presidential campaign at deadlock, " she said. "May insist on you."

Immersed in Belgian relief problems six thousand miles away, Hoover could do little to influence the outcome. As it turned out, his personal presence was not required. During the autumn, a majority of the trustees voted for Wilbur, the minority acquiesced, and the board tendered its offer. Wilbur accepted - in order that (he later wrote) "medicine would not be destroyed as a part of the University." To Wilbur the time had arrived for Stanford to fulfill its early promise and become in full measure a university, not simply a small college with a large endowment. The acquisition of the medical school, in his view, was the first great step in this transition. In all these aspirations his friend Herbert Hoover agreed with him. Now thanks in considerable part to Hoover's own "steam and push," Wilbur was to have his opportunity.

Shortly after the board made its decision, Hoover sent the president-elect a seven-page letter of advice and felicitation. For "the first time in its history," he predicted, Stanford University under Wilbur would "take absolutely first rank." Hoover urged Wilbur to reorganize Stanford's system of "faculty control" in order that the "leaders of the University" might emerge instead of "secondary men." Specifically, Hoover suggested that Wilbur bring related faculty departments together into "groups," administered by committees of department heads, who in turn would elect representatives to a small "legislative body" to be known as the University Executive Committee or University Senate. In this way, he argued, the "best brains" could prevail in university governance, and the influence of assistant professors and instructors could be reduced. With such a body drawn from the "pre-eminent professors," Wilbur might even be able to abolish "the well-known Debating Society called the "Academic Council' " Returning to a theme he had expounded often before the war, Hoover also advocated that Stanford hire more "illustrious men." These select few were the key, he asserted, to the university's success and to its standing in the academic world.

Hoover offered his friend one other self-revealing suggestion:

"There is one bit of advice that I will hazard you on the whole question of administration of any institution and that is never to be afraid of the ability of one's lieutenants but to bear in mind that the more able the men with whom one surrounds oneself the more certainty one has of ultimate success."

Dean Wilbur's Recollections of the Deanship

For an overview of Dr. Wilbur's five productive years as Dean we turn now to excerpts from his Memoirs. [41]

As it was obvious that the Stanford Medical School which Dr. Jordan had asked me to head would develop slowly and the classes would be small, Marguerite (Mrs. Wilbur) and I decided that it would be better to live in Palo Alto than in San Francisco. We purchased a house in Palo Alto at 1201 Bryant Street. (The house was torn down and replaced in 1966. ) We knew by experience that I could make five times my academic salary if I went back into medical practice. I still had my reputation as a teacher in medicine and my administrative way to make. Plenty of observers at Stanford and in San Francisco and Berkeley were in opposition to the medical school The whole idea of medicine taught by men on academic salaries was a subject of day-to-day discussion in medical and university circles. It was a period when Cooper Medical College was letting go and Stanford taking hold more each year. . . .

The succeeding years until I was elected president of the University were used for the development of a program for the new medical school. My whole attention was centered on making it of as high quality as possible. . . .

This was a period of considerable conflict. I found it not the easiest thing in the world to push overboard some of the members of the Cooper Medical Faculty who had given me training and to bring others forward in the new school. What I did was done in an atmosphere of opposition, not only from the University of California Medical School but also from members of the Stanford faculty, some of whom thought the University should not take on such a new responsibility. . . .

The medical faculty of Cooper (Medical College) had been made up largely of volunteers who were leaders in the practice of medicine and who gave a portion of their time to the care of patients and to teaching students for the medical school. There had to be a reorganization of titles and new adjustment of departments, and many disappointments, so that my first years as dean were busy ones . . . .

It is given to few men to see the beginnings of a great university, such as I had seen in my Stanford student days; fewer still have had, in addition to that, the unique opportunity that I now had to pioneer in the organization of a new medical institution. It was a stimulating experience. I was on my mettle, too, because the acceptance of the Cooper Medical College property by Stanford University was at first a subject of some debate. The agitation died down as the Stanford Medical School became renowned for its research in various fields of medicine and soon had as many medical students as it could accommodate with its existing facilities.

This was a time of revolutionary change in the medical schools of the United States. They were discontinuing their old lecture system with staffs made up of part-time clinical professors. Many of the schools were appointing academic professors to the various medical chairs on academic salaries, with the idea that they could engage in teaching and research, assist in the clinical work, and do a certain amount of consultation work if it could be done without harm to their teaching programs.

It all meant that medical education had become more expensive, requiring more men of long and expensive training to work in its departments, and that true university status should be maintained in all of its departments. It also meant two kinds of instructors in the medical schools: (1) those with clinical appointments on a nominal salary who, as a side line to their own medical practice, worked in the clinics doing a certain amount of teaching, and (2) the so-called full-time academic professors, some in clinical positions in addition to their regular teaching, on academic salaries. . . .

Our first Stanford class in San Francisco was small but our students were well trained. The courses by Professors A. W. Meyer in anatomy, Hans Zinsser in bacteriology, A. C. Crawford in pharmacology, and Robert E. Swain in chemistry were done as well as anywhere in the country.. . .

Dr. William Ophüls was a constant source of scientific strength. Dr. George E. Somers took on the management of the hospitals and clinics. While we had insufficient funds to go on a full academic basis, we did appoint a few full-time younger men on academic salaries, such as Dr. Thomas Addis in medicine, Dr. James Eaves in surgery, and Dr. Harold K. Faber in pediatrics. We were fortunate, too, to get Dr. Albert B. Spalding (A. B. Stanford, 1896; M. D. Columbia, 1900), who had taken a thorough training in obstetrics and gynecology in New York, to head that department.

From the first we considered research as one of the most important functions of the medical school. In transmitting to the student the medical knowledge gathered in the past the work of the medical school is only half done. So long as there is even one disease left in the world for which we have no cure, research must go on. Students and faculty members must have thorough training in gathering facts first hand and in working out new procedures to meet new conditions. In doing so, full use must be made of the laboratories and clinical material in our medical schools and hospitals. Today, that is a generally accepted program; but when we organized our new Stanford Medical School with a definite provision for research programs it was looked upon as something of an innovation. . .

I tried to stimulate the men who were working with me to take up special fields of medicine. For example, Bright's disease seemed to be one of the most promising fields and, as it was one in which the kind of mind that Dr. Thomas Addis had would be most apt to be useful, I encouraged him to take up the studies on the kidney which he subsequently carried out with great success. Addis came to us as a young doctor, in 1911, from the University of Edinburgh, highly recommended to me by Sir Clifford Allbutt, of Cambridge, as one of the most promising of the younger British trained men.

We had a series of botulism cases on the University campus that we were able to trace to their source, which turned out to be home-canned string beans. Dr. Thomas M. Williams who was practicing medicine in Palo Alto, was called in to see some of the girls who had become acutely ill after attending a dinner party at one of the sorority houses on the campus. He brought me into consultation. Botulism is now well known; but at that time it was a rare disease, not well understood and seldom diagnosed. . . That botulism outbreak led to a general public attack on the commercial canning of food, so that it was very important when we were able to show that only those who had eaten the home-canned string beans were affected.. . .Out of this experience grants of money were made to the Stanford Medical School for Assistant Professor Ernest Charles Dickson (who became professor of public health and preventive medicine in 1926) to make a careful study of the conditions which brought about the development of botulism and to work out methods of destroying the poison through boiling. . .(Dr. Dickson later took up the laboratory side of coccidioides and made important observations.).

We worked in an atmosphere of young men and enthusiasts, friendly critics and congenial associates. (Here Dr. Wilbur well describes the collegial atmosphere that characterized faculty relationships at Stanford Medical School in San Francisco from 1909 to 1959.)

Frankly, I took the Stanford presidency so that medicine would not be destroyed as a part of the University. [42]

President Branner saw the medical school as a menace to the future of Stanford University with its limited endowment, while I saw it as the first great gift for a Stanford that was to be one of the great universities of the world. It had started that way in the mind of Senator Stanford, as embodied in the

Founding Grant of Stanford University

"The Trustees shall have the power, and it shall be their duty:

"4. To establish and have given by the University, by its ablest professors, courses of lectures upon the Science of Government, and upon Law, Medicine, Mechanics, and the other Arts, and Sciences." [43]

Medicine, as a crown on biology and as of service to man seemed to me to have its natural home in the University. I agreed with the original statement of the Stanfords (in the Founding Grant) on having medicine as a part of the University and as I became more involved in medicine at Stanford and in the United States I found myself a part of the movement to advance the requirements for premedical and medical education and to bring medicine into the universities of the country. . . So much so that when the presidency of the University was offered to me, I decided to accept.


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  3. Illustration of Campus Labs
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  31. Annual Report of the President for the Year ending July 31,1909 (Stanford University, CA: Published by the University, 1909), p. 66.Lane Library catalog record
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  38. Stanford University School of Medicine, Medical Bulletin, vols. 1-8.Lane Library catalog record
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