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Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective
Part I. Background History & E.S. Cooper's Midwestern Years

Chapter 3. Quaker Heritage of Elias Samuel Cooper

Elias Samuel Cooper was descended from early American colonists of English background. The first of the Cooper family line to come to America were William Cooper (1649-1709) and his wife Thomasin Porter. They were married in about 1672, had eight children and lived in High Ellington, Yorkshire, England.

William and his family were members of the Society of Friends (also known as "Quakers"), a religious group then subject to harsh repression in England. Hoping to find religious toleration and a better life in America, they joined one of the expeditions organized by the Quaker William Penn to colonize the Province of Pennsylvania. The Cooper family, including their eight children, sailed for the American colonies from Liverpool aboard the Britannia in 1699, and on their arrival went directly to Bucks County just north of Philadelphia where they settled. The Coopers were soon active in their religious community in the New World. According to family records, the first Quaker meeting in Bucks County was held in their home in 1700.[1][2]

It is generally agreed that the positive influence of Quakers on British and American society has in past generations far exceeded their relatively small proportion in the population. In this regard, it is of interest to note that four physicians of Quaker background (Drs. Elias Cooper, Levi Lane, and Henry Gibbons Senior and Junior) at different periods during the half century from 1858 to 1908 played key roles in founding the first medical school on the Pacific Coast and in assuring its survival. Their success in creating and preserving the institution, under the difficult circumstances of the times, can best be attributed to the shared idealism of their common religious heritage.[3][4]

Such a premise is supported by Dr. Lane's tributes to the Society of Friends in his eulogies of Drs. Cooper and Gibbons, Senior. Of Elias Cooper, Lane wrote that he requested during the last days of his life in 1864 that his obituary consist of only a single brief sentence stating the day of his death; "so, also, in regard to his last resting place, he requested that the simplicity of the Quaker faith, in the principles of which he had been instructed in his youth, and for the tenets of which he ever cherished the warmest admiration, should characterize it ... (and) that the spot should remain without grave-stone or epitaph".[5] In a Memorial Tribute to Dr. Henry Gibbons, Sr., after his death in 1884, Lane spoke in detail of the Quaker movement in England and of William Penn's Pennsylvania Colony where the forebears of the Gibbonses, as did those of the Coopers, found refuge from religious persecution, and freedom to live by the unpretentious and disciplined Quaker creed which they imparted to their descendants.[6]

Kinship is another tacit yet enduring bond that was crucial to the outcome of the precarious enterprise in which these physicians were engaged. There is no doubt that the medical school, founded in 1858 by Elias Cooper, would not have survived his death in 1862 were it not for the loyalty of both his nephew, Dr. Lane, and the highly respected Dr. Gibbons, Senior, who together revived the School after its suspension for a period of six years (1864-1870). Their stewardship was soon augmented by the appointment as Dean in 1870 of Dr. Gibbons, Junior, who was one of the earliest graduates of the School. Dean Gibbons served in that office for 41 years as a benign and stabilizing presence until his death in 1911. By that time the bond with Stanford had been sealed.

Pragmatic idealism and strong family ties, as exemplified in the lives of these early leaders of the school, are hallmarks of the Quaker faith. An ultimate embodiment of these values is to be found in the construction by Dr. Lane, at his own expense, of a splendid new medical school building in 1882, and its dedication as Cooper Medical College in memory of his uncle Elias.

Ideals and motivation are among the most potent determinants of outcome in human affairs. Thus we cannot avoid the conclusion that the Quaker heritage of our protagonists, with its undoubted influence on their goals and values, had a decisive bearing on the advent of medical education in the West. We have already described how the westward movement of the national frontier created external conditions full of challenge and opportunity to which Cooper and his closest associates responded with a vision and resolve that were vital to the success of their efforts. Now It seems reasonable to propose that their Quaker faith and ties of kinship were the inner resources responsible for their mutual trust and lasting commitment to the new medical school.

The importance of religion and the role of the Society of Friends in early American history lend support to this thesis, and make relevant the following discussion of religion in America and the contribution of Quakers to American medical education from colonial times to 1900.

Religion in America

Religion was a dominant feature of life in colonial and frontier America. After 1800 the frontier moved rapidly westward from the Atlantic seaboard. Ordained ministers and itinerant preachers of many different sects accompanied the migration, establishing churches, schools and colleges with a missionary zeal that assured the early presence of congregations and educational institutions wherever settlements occurred. In a process repeated over and over during the development of the country, these varied social ingredients were united within a uniquely American frame of government to produce dynamic communities where religion was often an agent of progress. For instance, from 1858 to 1882, the medical school founded by Cooper was the medical department of a sectarian institution - first the University of the Pacific founded by the Methodists, and later the University (City) College established by the Presbyterians. A striking example from modern times of constructive social change fostered by a religious group is the leadership of African American churches and their ministers in the movement for desegregation and equal opportunity.

In contrast to the strife created in Europe by restrictions on religious worship during the Reformation (1500-1700), religious free enterprise in the United States after the founding of the Republic in 1778 led to vigorous competition among the many religious groups with relatively little sectarian conflict. The First Amendment of the Constitution (1791) is responsible for this tolerable state of affairs. Although the Amendment has not entirely eliminated either religious discrimination or political intervention by religious partisans, it has controlled them, and has been an effective bulwark against the harsher forms of religious repression which drove many of America's most resourceful immigrants from the Old World to the New in colonial times.

The spectacle of bloody religious conflict during the European Reformation convinced the framers of our Constitution that government dominated by religion is incompatible with a free society - a principle still widely ignored among nations in today's world. James Madison (1751-1836), in A Memorial and Remonstrance, which he addressed to the General Assembly of Virginia in 1785, made an historic plea for separation of religion and government. He referred to the Reformation era in these words: "Torrents of blood have been spilt in the old world, by vain attempts of the secular arm, to extinguish Religious discord, by proscribing all difference in Religious opinion."[7]

Madison recognized that the question of church-state relationships was one of the most crucial and potentially disruptive issues facing the First Congress of the new American Republic. Resolution of the question was urgent for the reason that, after the War of Independence (1775-1783), establishments of religion had been promptly authorized by six of the original 13 states (New Hampshire, Massachusetts, Connecticut, Maryland, South Carolina and Georgia); and also by Vermont which was admitted to the Union in 1791 as the 14th state. An "establishment of religion" meant that taxes were collectible in each of these states to provide for the public support of one or another Protestant sect chosen in accordance with state law. These arrangements were already in sharp contention among competing religious groups, and European experience during the Reformation foretold divisive escalation of the controversy.

Fortunately for future generations of Americans, and as an example to the world, the First Congress of the United States in 1789 took an unprecedented and definitive step. It mandated separation of church and state by adopting the First Amendment to the Constitution, proposed by Representative James Madison of Virginia. The Amendment reads (in part) "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof... ."

This statute has been of immeasurable benefit to American society by guaranteeing freedom of religion and erecting a "wall of separation between Church and State". In spite of persistent efforts to breach the wall, the Amendment has served its purpose well. (The first ten Amendments to the Constitution, known as the Bill of Rights, were ratified in 1791).[8]

In spite of the First Amendment, the Americans were incorrigibly religious. Alexis de Tocqueville, an observant young Frenchman who visited America in 1831, wrote: "On my arrival in the United States the religious aspect of the country was the first thing that struck my attention." He also observed: "Religion in America takes no direct part in the government of society, but it must be regarded as the first of their political institutions....".[9]

For another keen observer's view of religion in America at the same period, one may turn to Domestic Manners of the Americans by Mrs. Frances Trollope, British gentlewoman, member of the Church of England and mother of the novelist Anthony Trollope. Her unsuccessful commercial venture in the department store business in Cincinnati in the late 1820's brought her within 35 miles of Elias Cooper, living then as a boy of ten on his family's farm near Somerville, Ohio. The "gossipy pages" of Mrs. Trollope's chapter on Religion are unsparingly critical of the coarseness and arrogance of the society she encountered in the raw New World of the Andrew Jackson era: She wrote:[10]

I had often heard it observed before I visited America, that one of the great blessings of its constitution was the absence of a national religion, the country being thus exonerated from all obligation of supporting the clergy; those only contributing to do so whose principles led them to it. My residence in the country has shown me that a religious tyranny may be exerted very effectually without the aid of the government, in a way much more oppressive than the paying of tithe, and without obtaining any of the salutary decorum, which I presume no one will deny is the result of an established mode of worship....

The whole people appear to be divided into an almost endless variety of religious factions, and I was told, that to be well received in society, it was necessary to declare yourself as belonging to some one of these. Let your acknowledged belief be what it may, you are said to be not a Christian, unless you attach yourself to a particular congregation. Besides the broad and well known distinctions of Episcopalian, Catholic, Presbyterian, Calvinist, Baptist, Quaker, Swedenborgian, Universalist, Dunker, etc., etc., etc.; there are innumerable others springing out of these, each of which assumes a church government of its own; of this, the most intriguing and factious individual is invariably the head; and in order, as it should seem, to show a reason for this separation, each congregation invests itself with some queer variety of external observance that has the melancholy effect of exposing all religious ceremonies to contempt.

It is impossible, in witnessing all these unseemly vagaries, not to recognize the advantages of an established church as a sort of headquarters for quiet unpresuming Christians, who are contented to serve faithfully, without insisting upon having each a little separate banner, embroidered with a device of their own imagining....

I believe I am sufficiently tolerant; but this does not prevent my seeing that the object of all religious observances is better obtained, when the government of the church is confided to the wisdom and experience of the most venerated among the people, than when it is placed in the hands of every tinker and tailor who chooses to claim a share in it.

Mrs. Trollope's caricature of the uncouth and egalitarian Americans resonated well with public opinion in Victorian England, and it scandalized the Americans. This assured a good market for her book on both sides of the Atlantic, compensating her financially for the bankruptcy of the exotic bazaar she unaccountably built in the riverboat town of Cincinnati. As to her caustic views on religion among the provincials, she clearly did not share their distrust of state religion. For their part, the pragmatic Americans created a religious Babel which served to prevent any sect from gaining undue influence over government or from enforcing conformity.

The influence of religion on community life in America was more pervasive in the day of de Toqueville and Mrs. Trollope than at present. And it remained so until after the publication of Darwin's On the Origin of Species in 1859 when it began to diminish. Darwin's research was an historic turning point for it materially loosened the hold of religious dogma on the mind of western man, and "pricked the great bubble of belief in which the world of 1859 had its being".[11] He injected a rational view of man, based for the first time on credible scientific observation, into the main stream of secular discourse, and since then religion has been increasingly demythologized. On 12 February 1909, fifty years after publication of Origin of Species, David Starr Jordan, distinguished zoologist and President of Stanford, gave a resumé of the work and influence of Darwin at a symposium in San Francisco honoring the hundredth anniversary of the birth of two of the greatest men of the nineteenth century - Charles Darwin and Abraham Lincoln. Of Darwin he said: "The chief and essential contention of Darwin, that species are formed by natural processes, is now absolutely established. That animals and plants today, man included, are descended from the animals and plants of earlier periods by natural lines of descent with modification, is one of the certainties of modern science".[12]

In the fall of this same year (1909) the first students entered the newly established Medical Department of Stanford University, made possible by the advocacy of President Jordan. We will continue now to pursue the objective of placing the West's pioneer medical school, the precursor of Stanford's Medical Department, within the context of American history of which it is a memorable chapter. We have already told how the westward movement of the frontier swept Cooper and Lane to a fateful rendezvous in San Francisco. We shall next endeavor to throw more light on the religious milieu and Quaker heritage that we have identified as the source of the common ideals that united them and the Doctors Gibbons.

In the above discussion we have referred to religion as a pervasive feature of American life in the colonial and succeeding period, and have alluded to the determining influence of Quakers on the early history of Stanford medical school. For a perspective on these subjects we will now consider the European roots of religion in America, and the English origin of the Society of Friends.

The Reformation in Europe (1500-1700)

In 1517 Martin Luther, a German Catholic priest at the University of Wittenberg, appealed to the Pope to correct abuses in the Roman Catholic Church, about which there was already widespread concern within the church and among the laity. When reforms were not forthcoming, and Luther was excommunicated by the Pope for insubordination, religious dissension and wars erupted in Europe, and continued intermittently for the next 200 years. When, ultimately, a religious "balance of power" emerged, the political face of the continent had been changed.

Historians now refer to these events, in retrospect, as the Reformation. During this period the Catholic Church was reformed and reorganized, and numerous "protestant" sects were separately established. These included Lutheran, Anglican and Calvinist denominations. The Protestants were later subdivided by doctrinal differences into a bewildering number of sects known as Congregationalists, Baptists, Methodists, Presbyterians, Puritans, Quakers and so on. In keeping with the long tradition of deep involvement of the church in political affairs, European states, large and small, adopted either a Protestant sect or Catholicism as the state religion in accordance with the ruler's religious preference (cuius regio eius religio, "whose the region, his the religion").

When each ruler attempted to enforce religious conformity within his domain, religious intolerance, already the norm, was intensified. Special police and courts were set up to investigate and penalize non-conformity. Expulsion, imprisonment, torture, the death penalty, mass executions and massacres were tools of religious repression applied by both Catholics and Protestants. To these afflictions of European society, already inured to centuries of judicial cruelty, were added the destruction and demoralization of the protracted religious wars.

Why was the struggle so bitter, long and deadly? Because the Protestant movement, as it evolved, sought not merely to reform the Catholic Church; it aimed to replace it with a church based on the Protestant interpretation of the Bible, shorn of traditional Catholic sacraments, ritual and ecclesiastical hierarchy for which the Protestants could find no scriptural justification. At stake was the immense and pervasive spiritual and temporal power of the medieval Catholic Church. Finally, after 200 years, either Catholicism or Protestantism had achieved dominance in each European state. Religious strife then gradually waned. However, a state policy of religious toleration was rarely adopted until much later. Catholics and Protestants simply became reconciled to a wary coexistence.

The Catholic Church retained its ascendancy in Spain, Portugal, France, Ireland, and in southern and eastern Europe. Protestant denominations prevailed in central and northern Germany, Holland, the Scandinavian countries and in England and Scotland. Meanwhile, major political realignments and consolidations occurred within the nations of Europe, leading to establishment of strong secular states that progressively reduced the influence of religion in government.[13]

The Reformation in England

With the above outline of the Reformation in Europe as a whole in mind, we can more readily understand how England was affected.

The English Reformation began in 1534 when King Henry VIII (1509-1547) despaired of obtaining a male heir to succeed him on the throne from his existing wife, Catherine of Aragon. Therefore, he requested Pope Clement VII to annul his marriage to Catherine. Since Catherine objected and was, furthermore, the aunt of the Holy Roman Emperor Charles V, the Pope hesitated. Impatient with the delay, Henry acted by repudiating Papal authority and setting up the Anglican Church as the State Church of England with the King as "Protector and Only Supreme Head of the Church and Clergy of England". At the time, Henry did not intend to create a Protestant church along the lines evolving on the continent under the influence of the moderate German, Martin Luther, or more radical reformers such as the Frenchman, John Calvin. He only wanted to be the supreme head of an English Catholic Church.

Nevertheless, Protestant ideas infiltrated England and Scotland, and Protestant churches were organized, thus setting the stage for 150 years of religious conflict between Catholics and Protestants, and between subsets of the Protestants. The details are tiresome, but tragic and of great import to the future American colonies.

Scottish Presbyterian congregations were led by the Calvinist John Knox in the 1550s. About the same time the Puritan movement, also Calvinist in origin, came to notice in England as the result of insistence by Queen Elizabeth I (1558-1603), who was head of the Church of England, on the enforcement of uniformity in the dress of the clergy. Because the Calvinists objected to the prescribed vestments as a remnant of popery, they were called "Puritans". This was the beginning of a long and bitter confrontation between the Puritans and the English monarchs, with the Puritans continuing to press for reforms of the Church of England along Calvinist lines. They had no quarrel with official Anglican doctrine, but they wished to do away with all clergy above the rank of parish priest; abolish set prayers and elaborate rituals; and reorganize the Church as either a hierarchy of councils (Presbyterianism) or a federation of independent parishes (Congregationalism) free from state control.

Throughout the 1600s English monarchs, except for two brief, bloody and unsuccessful attempts to restore Catholicism, sought primarily to assure the supremacy of the State Church of England by enforcing conformity with Anglican doctrine and practice. At the same time, they were engaged in ominous confrontations with a Parliament that increasingly challenged the right of the King to make laws, decide legal cases, enforce religious conformity and levy taxes. Charles I, who reigned from 1625 to 1649, confronted a Parliament in 1640 which by that time had come under the control of the Puritans in spite of his efforts to suppress them.

In the ensuing Civil War Oliver Cromwell, a devout Puritan, emerged as the military leader of the Parliament's army, and Puritan soldiers proved to be the most effective of the military forces. Gradually the royalist followers of Charles I were defeated by the Parliamentary forces, called Roundheads from the close haircuts favored by the Puritans. In 1649 King Charles I was tried and condemned to death by a Parliament which in the course of the Civil War had been reduced to subservience to Cromwell and his Puritan army. The King was beheaded on 30 January 1649.

There followed a turbulent decade of autocratic rule of England, Scotland and Ireland by Cromwell during which the British Isles were declared a Republic. It was known as the "Commonwealth," and Cromwell assumed the title of Lord Protector. Ultimately, the people and the army became disillusioned with the puritanical restrictions and political dictatorship of Cromwell's regime. After he died in 1658, his son proved unable to maintain the Protectorate. As a result, the monarchy, the Church of England and the Parliament were restored in 1660, and with almost universal approval.

These changes inaugurated the period in English history known as the Restoration (1660-1688). The Puritans, while in control of the Parliament, had abolished bishops and otherwise reorganized the Anglican Church. In order to secure the support of the Scottish army, Parliament had agreed to make Presbyterianism the legal state religion of England, Scotland and Ireland. Now these "reforms" were reversed and Charles II (1660-1685), son of the executed Charles I, was proclaimed King. Legally, government and religion supposedly reverted to the status they held in 1640.

Charles II, an Anglican with Catholic leanings, died in 1685 and was succeeded on the English throne by his Catholic brother, James II (1685-1688). When a son was born to James in June 1688 and baptized into the Catholic faith, it foreshadowed a line of Catholic monarchs for England. This being unacceptable to the political leaders of England, they abandoned James and offered the throne to his grown daughter, Mary, a Protestant married to the Dutch William of Orange. James lost the ensuing military struggle and in December 1688 fled to France and the protection of Louis XIV. The English refer to this episode as the Glorious Revolution of 1688.

William of Orange became William III (1689-1702). He and his wife Mary (1689-1694) were offered the crown of England jointly and assumed the throne in 1689, but not until they had acceded to the demand of Parliament for an historic Bill of Rights that assured the preeminence of Parliament over the king in government. The Bill asserted the "true, ancient, and indubitable rights of the people"; and declared that no Roman Catholic could wear the crown. Parliament also passed the Toleration Act in 1689 which legalized Protestant dissent and defined the rights of Nonconformists such as the Quakers, but still excluded them from political activity and public service.

The threat of Counter Reformation through a Catholic monarchy had been kept alive in England for 150 years by French and Spanish intrigue, and by hereditary accession to the throne of two Catholic sovereigns, Mary I (1553-1558) and James II (1685-1688). When Mary I, daughter of Henry VIII and Catherine of Aragon and older half-sister to Elizabeth I, became Queen she restored the Catholic creed and the laws against heresy. Because of her relentless pursuit of heretics, many of whom were hanged and some 300 burned at the stake, she has gone down in English history as "Bloody Mary." Fortunately her reign was short. With the coming of William and Mary, the threat of deadly persecution was virtually eliminated by Parliament, and the Toleration Act greatly reduced the grounds for religious dissent and repression. The Protestant Reformation in England and Scotland was coming to a close.[14][15]

With this essential background, we can now turn to consideration of how religious conflict during the English Reformation spawned the Quaker movement; and how the desire to escape religious repression led to the founding of six of the original 13 English Colonies in North America, including the Quaker state of Pennsylvania.

Six American Colonies Founded for Religious Motives

Five Colonies were established by Puritans in New England: Plymouth (1620); Massachusetts Bay (1630); New Haven (1638); Connecticut (1639); and Rhode Island (1644). In 1662, Connecticut received a charter from the Crown that included in its boundaries the New Haven Colony, which thereafter became part of Connecticut and ceased to exist as a separate Colony. The other two Colonies founded on a religious basis were Maryland (1633) and Pennsylvania (1682).

Plymouth Colony, 1620

The first to emigrate for religious reasons were Puritan Separatists (known to history as the "Pilgrims") who established Plymouth Colony in 1620.

During the reign of Elizabeth I, certain English Puritan groups called Separatists, despairing of reform and unwilling to compromise, formed voluntary congregations. They broke with the Church of England, chose their own pastors by common consent, and lived as religious communities in accordance with their conception of the original church described in the Bible. They were savagely repressed by Elizabeth. Two laymen were hanged in 1583 for selling Separatist tracts; and three Separatists clerics were hanged in 1593. Severe pressure on these groups continued under her successor, James I (1603-1625), who had the Bible translated into the "Authorized King James Version", and swore that he would "harry the Puritans out of the land".

Seeking to escape persecution and the worldly excesses of English society, a small Separatist congregation from the area of Scrooby, England, fled to Holland in 1607. They lived first in Amsterdam and later moved to Leyden where they formed an English Congregational Church. After 13 years of exile in Holland, they decided to emigrate to America and returned to England in July 1620 to make final preparations for the voyage. They sailed from Plymouth on 6 September 1620 aboard the Mayflower with a company of 102 men, women and children to establish the Plymouth Colony.

Two months later, on 11 November 1620, these Pilgrims disembarked on the shore of Cape Cod Bay. After prospecting the coast for the best place to settle permanently, they chose the site of the present city of Plymouth, Massachusetts. Committed as they were to facing all hardships together, they drew up the historic Mayflower Compact, signed by the forty-one adult males of the company, by which they agreed to the principle of self-government by the majority. They were ill-prepared to face the wilderness and the rigors of the New England winter. By the following spring, half the company had died, yet when the Mayflower set sail for England on 5 April 1621, not one of the survivors elected to return in her.[16][17][18]

Massachusetts Bay Colony, 1630

Under King Charles I (1625-1649) pressure for religious conformity worsened, even for English Puritans who were not Separatists and had remained nominally in the Church of England. When the restrictions became intolerable, a company of 900 to 1000 Puritans decided to emigrate. They sailed in 17 ships to new England in 1630 to establish Massachusetts Bay Colony, a "Godly Commonwealth" based on Puritan doctrine. The Colony included Boston and six or seven nearby towns. Because the Massachusetts Bay Charter was transferred to America with the colonists, the Colony became practically independent of England and was thus able to develop a distinctively American form of representative government. Colonial New England was set on a course significantly influenced by Puritan values which included piety, hard work and learning.

Harvard College and Medical School

More than 100 graduates of Oxford and Cambridge came to Massachusetts in this Puritan migration. Among them was John Harvard (1607-1638) who received an A. B.. degree in 1631 and an M. A.. degree in 1635 from the Puritan Emanuel College of Cambridge University and shortly after his graduation was ordained as a dissenting minister. He arrived in the Massachusetts Bay Colony in 1637 and settled in Charlestown where he occasionally served as a minister. In poor health from tuberculosis, he made his will in 1636 two years before his death and bequeathed half his small estate of 1,700 pounds, and his well-chosen library of 260 volumes, to a new school founded on 28 October 1636 in Newtown (Cambridge), by the General Court of Massachusetts.

A contemporary of John Harvard among the colonists described how this new school received the name of Harvard College:

After God had carried us safe to New England, and wee had builded our houses, provided necessaries for our livelihood, rear'd convenient places for God's worship and setled the civill Government: One of the next things wee longed for and looked after was to advance Learning, and perpetuate it to Posterity; dreading to leave an illiterate Ministry to the Churches, when our present Ministers shall lie in the Dust. And as we were thinking and consulting how to effect this great Work it pleased God to stir up the heart of Mr. Harvard (a godly Gentleman and a lover of Learning, there living amongst us) to give the one halfe of his Estate .... towards the erecting of a Colledge, and all his Library; after him another gave 300 pounds. Others after them cast in more, and the publique land of the State added the rest; the College was, by common consent, appointed to be at Cambridge (a place very pleasant and accommodate) and is called (according to the name of the first founder) Harvard College.[19]

In 1782, the Harvard Corporation voted to establish a Medical School. Dr. John Warren was asked to draw up a plan for medical studies and was elected Professor of Anatomy and Surgery. By this action, Harvard founded the third American medical school. The second medical school was the Medical Department of King's College in New York, opened in 1767, later to become the College of Physicians and Surgeons of Columbia University. Drs. William Shippen, Jr. and Benjamin Rush (faculty members from America's first medical school established in 1765 by the College of Philadelphia) assisted Dr. Warren in the work of organization.[20]

Society of Friends and Pennsylvania Colony, 1682

The Society of Friends (or Quakers as they are more often called) is a protestant religious sect. It emerged out of English Puritanism in the mid seventeenth century as a radical reform movement under the leadership of George Fox (1624-1691). This was a time of intense religious agitation in England caused by the government's attempt to enforce universal acceptance of the Church of England. The people responded with a proliferation of dissenting groups, foremost of which were the Puritans.

George Fox, the first Quaker, was the son of a weaver in Leicestershire. Although he was raised in a Puritan family, he early became dissatisfied with Puritan ways and beliefs, finding them unfaithful to the tenets of the original Christian church as described in the Bible. Therefore in 1644, when he was only 20 years of age, he founded the Society of Friends for the purpose of reviving primitive Christianity as a way of life.[21]

The distinctive teachings of Fox tended to make the Quakers "a people apart." His cardinal doctrine was that religious authority dwells neither in the Bible nor in a "hireling clergy" but in the mystical "Inner Light" of God which is present in the soul of every person, and is the ultimate source of Truth, Guidance and Comfort. Early Friends worshipped together without preachers or formal church buildings. The worshipers sat in silence unless a member of the congregation felt moved by the Inner Light to pray or testify. During the initial evangelical period of the movement, worshipers would sometimes physically quiver and shake, overwhelmed with emotion as they struggled with self-judgment under the Inner Light. Hence the name of "Quakers."

Early Friends tried, literally, to live by the precepts of Jesus, hoping thus to inaugurate the reign of Christ on earth. They wore simple, drab clothing as a rejection of pride and waste, and used the familiar "thee" and "thou" in speaking and writing. This manner of address was normally reserved for God, familiars and inferiors, and was often considered offensive, particularly by the upper classes.

Consistent with their advocacy of a primal form of Christianity, Friends vigorously opposed the creeds, rituals and hierarchies of the established churches of the day, including the Puritan. They also refused to pay the state-required tithes for the support of the Church of England; to take oaths (because of the biblical injunction that all swearing is evil); to fight in wars ("Thou shalt not kill."); to take off their hats (i.e., to pay "hat-honor") to anyone but God; or to forsake their convictions in spite of repression. These idiosyncrasies were intolerable challenges to church and state at that time and the authorities reacted harshly.

Friends also developed a unique organizational structure for the Society. The Weekly Meeting was primarily devoted to worship and was the basic unit of Quaker Fellowship. Monthly Meetings were made up of the members of the Weekly Meetings within a specific, contiguous area. The Monthly Meetings certified the eligibility of members within the district (i.e., "within the bounds of the Monthly Meeting") for membership in the Society and for marriage; maintained membership records; held title to the funds and property of the Society; and disbursed funds for aid to the poor and other purposes. Several Monthly Meetings were combined to form a Quarterly Meeting; and Quarterly Meetings were in turn combined to form a Yearly Meeting that served all the subsidiary meetings in a wide geographic area, providing advice and assistance on weighty matters of principle and practice. It is from the records of the Monthly Meetings that information can best be obtained about the lives of individual Quakers and their families.

Among the early Quakers there were zealous missionaries who spread out over the British Isles, Europe and the American colonies, making many converts. In the period between 1650 and 1690 the Quakers were a very dynamic sect, likened to a spiritual explosion by Quaker historian, D. Elton Trueblood (Chaplain and Professor of Philosophy of Religion at Stanford in the 1940s). He pointed out that "Quakerism was, for a while, the fastest growing movement of the Western world".[22]

In an era of extreme religious intolerance, the impassioned approach of Quaker missionaries was at times provocative and their suffering severe--witness the execution of four Quaker missionaries by the Puritans of Massachusetts Bay Colony in 1659-60. The Puritan values of the Massachusetts Bay Colonists did not include religious freedom or even toleration. They brought with them to New England a full measure of the religious bigotry and superstition that was nearly universal in the Reformation society from which they sought refuge in America. This was reflected in verdicts handed down in their judicial system. The Colony Court invoked the death penalty against four Quaker missionaries who returned for the third time to preach in the Colony where they denounced the Puritan church and accused the Puritan pastors of being "hirelings of Satan." Two Quaker men and one woman were hanged in 1659, and one Quaker man was hanged in 1660. (King Charles II later issued an order to the Bay Colony forbidding them to put Quakers to death.) The Salem witchcraft trials are a further example of lethal religious fanaticism in the Massachusetts Bay Colony. In 1691 and 1692 a Special Court of the Colony conducted these infamous trials in which 19 persons, including a Congregational clergyman and 14 women, were found guilty and hanged; and one man was pressed to death. During this era in New England, religious toleration existed only in Rhode Island, a colony founded by Puritan dissenters.[23][24]

In England, Quakers in general faced repression. The death of Cromwell and failure of his Puritan Commonwealth was followed in 1660 by restoration of the monarchy and the rule of Charles II (1660-1685) and James II (1685-88). During their reigns, Quakers were persecuted simply because of their form of worship and their refusal to accept Anglican doctrine. At that time there were about 50,000 Quakers in England. It is estimated that as many as 5,000 of them went to prison where almost 500 died.

After Parliament under William and Mary passed the Toleration Act of 1689, Quakers were permitted relative freedom of worship. The manner in which they had shown resistance in previous years gained them many followers, as recorded by Richard Baxter, a famous Puritan preacher who was no friend of the Quakers:[25]

The fanatiks called Quakers ... were so resolute and gloried in their constancy and sufferings that they assembled openly - and were dragged away daily to the Common Gaol, and yet desisted not, but came next day nevertheless, so that the Gaol at Newgate was filled with them. Abundance of them died in prison and yet many continued their assemblies still - yea, many turned Quakers because the Quakers kept their meetings openly and went to prison for it cheerfully. . .

In the course of four decades of repression, Quakers gradually adjusted to the realities of English society. They also achieved social acceptance and even prosperity in the process. Their high ethical standards, self sufficiency, hard work, business acumen and emphasis on family life earned them respect and eventual toleration. Until the nineteenth century they were barred from universities and public office but directed their talents with success in other channels including science, commerce, banking and industry. Later, as eccentric customs of dress and speech lost meaning, their usage was laid aside; and Quaker worship and organization began in some ways to resemble that of Protestant sects such as Baptist, Methodist or Presbyterian.[26]

Pacifism has, in particular, remained a pillar of the Quaker Faith, as originally expressed in their Peace Testimony of 1660:[27]

The Spirit of God by which we are guided is not changeable; the Spirit of Christ, which leads us into all Truth, will never move us to fight and war against men with outward weapons.

Nevertheless, many Quakers have joined the armed forces of their native countries in time of national need. Another distinctive feature of modern Quakerism is the special emphasis on programs of social welfare, international relief, and peaceful resolution of international conflict. The exceptional achievements of Friends through these philanthropic endeavors are widely recognized, and gratefully acknowledged around the world.

Let us digress here briefly to cite a notable example of the Quaker humanitarian ethos in the person of Stanford alumnus and former President of the United States, Herbert Clark Hoover (1874 - 1964). He descended from a long line of Friends and epitomizes the Quaker ideal of service.

When Stanford opened on 1 October 1891, Hoover was a member of the first or "Pioneer Class" of 559 students to enter the University. He majored in Geology and Mining and graduated with an A. B.. degree in 1895. Ray Lyman Wilbur, first Dean of Stanford Medical School and later President of the University, entered Stanford one year after Hoover. As we shall later see, their lasting friendship, struck up during student days at Stanford, had important consequences for the Medical School and the University.

David Starr Jordan, first President of the University, remembered Hoover as a student and in 1922 wrote:[28]

Added to the unflinching idealism already foreshadowed in his youth, Hoover has shown in mature years a degree of administrative capacity never surpassed; no other man, moreover, has so broad an outlook on world political and economic relations. The highest motive of his life, withal, is a spirit of helpfulness, and millions now speak his name with gratitude!.

President Jordan was referring to the unprecedented scale of humanitarian relief work that Hoover accomplished during and after World War I (1914-1918). Examples of his remarkable efforts include the following. He served as Head of the Commission for Relief in Belgium and Northern France that fed and cared for some 10 million civilians during the War. After the Armistice of 11 November 1918, the Allied Leaders appointed him Director of relief and rehabilitation in Europe with the result that the organizations under his direction had fed and clothed over 200 million people by 1920. During the famine in the Ukraine from 1921 to 1923, the American Relief Administration, originally established by Hoover for the purpose of feeding the millions of children left undernourished and diseased by the War, also fed millions of Russians, adults as well as children.[29]

Hoover went on to be elected as the 31st President of the United States (1929-1933) in a landslide victory. Unfortunately, the Great Depression, which began with the stock market crash on 29 October 1929, cast a pall over his presidency that often obscures the many constructive policies adopted during his administration. However, nothing can overshadow his peerless record of practical idealism in the public arena where he continued to be active until his death in 1964 at 90 years of age.[30][31][32][33]

We shall have occasion to comment later on Hoover's relationship to Stanford University as a trustee and benefactor; how his personal intervention at critical junctures saved the Medical School when its very survival was threatened; and how he influenced the choice of Ray Lyman Wilbur for President of the University.

Now that we have some understanding of the origin and beliefs of the Quakers, we can introduce William Penn (1644-1718) who founded the Colony of Pennsylvania. Born to all the advantages of the landed aristocracy of England, he was sent to the finest English schools and on a grand tour of the continent by his father, Admiral Sir William Penn, conqueror of Jamaica. While living on his family's estate in Ireland in 1667, Penn was converted at the age of 23 to the persecuted Quaker faith, and this gave new meaning and direction to the remaining 51 years of his life. His father at first disowned him, but later relented and left him a considerable fortune. Penn's outspoken support of Quakerism and opposition to the Church of England led to his imprisonment in the Tower of London in 1668-69, and twice in Newgate (in 1670 and 1671). Next to George Fox, the founder of Quakerism, Penn was the most prolific of the early Quaker writers.

Penn wanted to found an American colony that would be a refuge for the persecuted of every race and religion. The circumstances that made this possible must have seemed truly providential at the time. The Duke of York, who held a large grant of land in North America, had received a loan of 16,000 pounds from the now deceased Admiral Penn. When the Duke was gently reminded that the loan was as yet unpaid, he settled the account by transferring a generous portion of the grant to William Penn, and insisted that the territory be named for Penn's father, the Admiral. The Duke's brother, King Charles II, then implemented the grant by issuing a Charter to Penn in 1681 for a proprietary province to be known as Pennsylvania.

Settlement of the Pennsylvania Colony, that Penn called his "Holy Experiment", began without delay in 1682 at the present site of Philadelphia, an admirable location. Generous terms for land, religious toleration, and a sound frame of government were included in Penn's careful and pragmatic plan for colonization. As early colonists he mainly attracted "middling" class English, Welsh and Irish Quakers, and other groups seeking freedom of worship. They were mostly farmers, artisans and small merchants who generally came with their families. In many cases whole communities emigrated together. Penn was correct in judging that settlers such as these had the necessary motivation and practical skills to successfully develop the Colony. The Quaker ancestors of Drs. Cooper, Lane and Gibbons were among the early settlers.[34][35]

Medical School of the College of Philadelphia

We should call attention to the career of Dr. John Morgan (1735-1789) (MD Edinburgh 1763) who, although not a practicing Quaker himself, was descended from early Quaker immigrants. Even before the arrival of William Penn in the Colonies, Dr. Morgan's maternal great grandparents, William and Joan Biles, were prominent Quakers in Bucks County where they owned large estates in 1679. It is said that the first known meeting of the Quakers in Bucks County was held in their home on 2 May 1683 which, if true, would have preceded the meeting in 1700 at the Cooper residence referred to previously.[36]

The achievements of Dr. Morgan were undoubtedly well known to Elias Cooper who must have admired and envied his success in founding the Colonies' first medical school in 1765, the Medical School of the College of Philadelphia. This College and its Medical School have survived as the University of Pennsylvania which is recognized as having the oldest medical school in the United States.

Morgan, as did Cooper nearly a century later, aspired to establish a medical school and planned ahead for it. By the time he undertook the project, Morgan's qualifications for the task were outstanding. In 1750 at the age of fifteen he became the medical apprentice of the European-trained and highly respected Dr. John Redmond of Philadelphia. He continued with Dr. Redmond for six years during which he also attended the College of Philadelphia in 1754, '55 and '56 and was granted a B. A. degree. In 1756 he joined the Pennsylvania Provincial troops as a regimental surgeon. The French and Indian War (1754-1763) was in progress and Morgan was a member of the militarily crucial expedition under the British General Forbes who, with George Washington as his aide, drove the French from Fort Duquesne at the forks of the Ohio River in 1758, renaming the site Pittsburgh after the great British war minister, William Pitt.

In 1760 the American phase of the war was over and the Provincial Forces were disbanded. Morgan then resigned his commission and returned to Philadelphia. While in the army he met British surgeons who impressed him with their ability, and convinced him that only in Europe could he acquire the training that would make him a leader in his profession. On 1 May 1760 his College honored him with a Master of Arts degree, and later that month he sailed for England. Morgan spent the next five years abroad, taking his MD. degree from Edinburgh in 1763, and also studying diligently in well-known centers of medical learning on the continent.

While growing up in Philadelphia, Morgan was a neighbor of Benjamin Franklin who thought highly of the young man. When Morgan arrived in England in 1760 to begin his medical studies, Dr. Franklin was an agent of the Colonies in London and was helpful to him with wise counsel and warm letters of reference to prominent people. He commended him especially to his friend and personal physician, Dr. John Fothergill (1712-1780), a scholarly gentleman and leading Quaker with one of the largest practices in London. This made for an auspicious beginning to Morgan's European sojourn.

It was while a medical student in Britain that he and William Shippen, Jr., a fellow student from Philadelphia, conceived the idea of together founding a medical school in Philadelphia. In 1765, soon after his return from Europe, Morgan independently and without consulting Shippen presented a proposal for a Medical School to the Trustees of his alma mater, the College of Philadelphia which had been established in 1749 in accordance with a plan drawn up by Benjamin Franklin. On 3 May 1765 the Trustees unanimously approved Morgan's recommendation to establish the Medical School of the College of Philadelphia; unanimously elected him Professor of the Theory and Practice of Physic; and authorized him to proceed with organizing the School. Thus was medical education inaugurated in the Colonies.

Later that same month Morgan delivered his landmark Discourse upon the Institution of Medical Schools in America at the Anniversary Commencement held at the College of Philadelphia. In this address he laid out his plan for the new Medical School and made the radical proposal that the teaching and practice of medicine should be conducted by those who specialize in and confine their efforts to only one of three fields that he broadly designated as Medicine, Surgery and Pharmacy. Although the concept of specialization was valid and appealing in principle, it was ahead of its time. It drew criticism as being premature and impractical, as Morgan himself later discovered in his own practice. For many decades to come, the great majority of American physicians carried on a general practice as well as preparing and furnishing the medicines they prescribed. Nevertheless, Morgan is the best known early American advocate of the advantages of specialization and is well remembered for it. In his Discourse Morgan called for high academic standards which his School sought to maintain in the years to follow.

Later in 1765, Professor Morgan was joined on the Medical School faculty by his contemporary and fellow Philadelphian, Dr. William Shippen, Jr. (1736-1808) (MD Edinburgh 1761), who was appointed Professor of Anatomy and Surgery. In 1768 Dr. Adam Kuhn (1741-1817) (MD Edinburgh 1767) was appointed Professor of Botany and Materia Medica; and in 1769 Dr. Benjamin Rush (1745-1813) (MD Edinburgh 1768) was made Professor of Chemistry. Dr. Rush, later a member of the Continental Congress and a signatory to the Declaration of Independence, is the most widely known of this original group of four professors, all of whom were Edinburgh graduates. Small wonder that the new Medical School in Philadelphia was modeled as far as local conditions would permit after the Medical School of Edinburgh University, making it therefore reasonable to regard that great University in Scotland as the father of American medical education.[37][38][39][40]

As we have already noted, Morgan established the new Medical School without including Shippen as co-founder in spite of what Shippen believed was an understanding between them that they would cooperate on the project. In order to understand Shippen's viewpoint on the matter, we must mention some relevant events occurring prior to founding the School and involving Dr. John Fothergill of London, the eminent physician and respected man of science to whom we have already referred. Dr. Fothergill was a prestigious Quaker and as such had significant influence on medical developments in Philadelphia. He was deeply concerned for the success of Penn's Holy Experiment. As young colonials from Pennsylvania, Shippen and Morgan were assured of Fothergill's hospitality and guidance. He invited them to his home and took an interest in their careers, advising them to seek clinical experience and tutelage from his friend Dr. William Hunter (ablest and most famous of the private teachers of anatomy) in London, but to go to Edinburgh for their medical degrees - counsel that they sensibly heeded. It was with Fothergill that Shippen and Morgan, who were in England at the same time during a portion of their medical studies, discussed their dream of co-founding a medical school on their return to Philadelphia.

Fothergill gave them carefully tempered encouragement and when Shippen returned home in the spring of 1762, he brought with him a set of eighteen beautifully executed anatomical drawings of dissections of the human body by Riemsdyk as a gift from Fothergill to the Pennsylvania Hospital. This hospital, precursor of the present University of Pennsylvania Hospital, was the first in the British colonies intended solely for the care of the sick and wounded. It opened in Philadelphia in 1752 as a direct result of the planning and fund-raising efforts of Dr. Thomas Bond and Benjamin Franklin. They were abetted in the project by Fothergill who was a personal friend of both. Fothergill had known Bond since the latter's student days in Europe, and had edited and written the introduction to Franklin's important pamphlet on electricity published in England in 1751.[41] Fothergill maintained an interest in the Pennsylvania Hospital for the rest of his life and, anticipating the needs of America in the future, looked forward to the eventual development of a medical school in connection with it. In a letter accompanying the Riemsdyk drawings, Fothergill wrote to James Pemberton, one of Pennsylvania Hospital's managers, as follows:

In the want of real Subjects, these (drawings) will have their Use and I recommended to Dr. Shippen to give a Course of Anatomical Lectures to such as may attend. He is very well qualified for the subject and will soon be followed by an able Assistant Dr. Morgan, both of whom I apprehend will not only be useful to the Province in their Employments, but if suitably countenanced by the Legislature will be able to erect a School for Physic amongst you that may draw Students from various parts of America and the West Indies and at least furnish them with a better Idea of the Rudiments of their Profession than they have at present the Means of acquiring on your Side of the Water.

After his return to Philadelphia Shippen organized a course in anatomy based on the Riemsdyk drawings. He opened the course with some fanfare by a public lecture in the State House on 16 November 1762. Shippen maintained that this lecture (there is no surviving copy of it) included a plan for establishing a medical school in Philadelphia to which the course in anatomy would serve as the introduction. He continued to offer lectures and demonstrations on anatomy at the Pennsylvania Hospital, utilizing the Riemsdyk drawings, so that when Morgan arrived from Europe in 1765 Shippen had already been teaching anatomy for three years, thinking that he was laying the groundwork for the new medical school which they had agreed to collaborate in founding. Imagine his chagrin when Morgan stole a march and obtained the approval of the College of Philadelphia for a Medical School in 1765 without sharing with him either the planning or the glory. Morgan's apparent duplicity was deeply resented by Shippen who nevertheless decided to join the faculty of the new school and bide his time.

For a period of two years after inauguration in 1765 of the Medical School by the Board of Trustees of the College of Philadelphia, and the appointment of Morgan and Shippen as Professors, Morgan delivered an annual series of lectures on Materia Medica and Shippen an annual series on Anatomy under the auspices of the College. Their lectures included a broad range of other medical subjects, and in 1766 Dr. Thomas Bond, still one of the physicians at Pennsylvania Hospital, commenced an annual course of Clinical Lectures in that institution, the first such lectures in an American Hospital. Since Bond was a trustee of the College of Philadelphia, it was considered unethical to give him an appointment to the faculty of the Medical School in spite of his significant contribution to its teaching program.[42][43]

By 1767 it was time to adopt a more thorough organization of the Medical School. Accordingly, the following code of rules was approved by the Board of Trustees of the College on 12 May 1767, and published in the Pennsylvania Gazette:[44]

At a meeting of the Trustees, held the 12th of May last, it being moved to the Board that conferring the usual degrees in Physic on deserving students will tend to put the Practice of Physic on a more respectable footing in America; the motion was unanimously agreed to; and the following Course of Studies and Qualifications, after mature deliberation, was fixed on and enacted as requisite to entitle physical students to their different degrees.

For the Bachelor's Degree in Physic:

  • It is required that such students as have not taken a Degree in any College shall, before admission to a degree in Physic, satisfy the Trustees and Professors of the College concerning their knowledge in the Latin tongue, and in such branches of Mathematics, Natural and Experimental Philosophy as shall be judged requisite to a medical education.
  • Each student shall attend at least one course of lectures in Anatomy, Materia Medica, Chemistry, and the Theory and Practice of Physic, and one course of Clynical (sic) Lectures, and shall attend the Practice of the Pennsylvania Hospital for one year, and may then be admitted to a Public Examination for a Bachelor's Degree, provided that on previous examination by the Medical Trustees and Professors, and such other Trustees and Professors as choose to attend, such Students shall be judged fit to undergo a public examination without attending any more courses in the Medical School.
  • It is further required that each student, previous to the Bachelor's Degree, shall have served a sufficient apprenticeship to some reputable Practitioner in Physic, and be able to make it appear that he has a general knowledge in Pharmacy.

Qualifications for a Doctor's Degree in Physic:

It is required for this Degree that at least three years have intervened from the time of taking the Bachelor's Degree, and that the Candidate be full 24 years of age, and that he shall write and defend a Thesis publicly in the College, unless he should be beyond seas, or so remote on the continent of America as not to be able to attend without manifest inconvenience; in which case, on sending a written thesis, such as shall be approved of by the College, the candidate may receive the Doctor's Degree, but his thesis shall be printed and published at his own expense.

This scheme of a medical education is proposed to be on as extensive and liberal a plan as in the most respectable European Seminaries, and the utmost provision is made for rendering a Degree a real mark of Honor, the reward only of distinguished learning and abilities. As it is calculated to promote the Benefit of Mankind by the improvement of the beneficent Art of Healing and to afford an opportunity to students of acquiring a regular medical education in America, it is hoped it will meet with public encouragement, more especially as the central situation of this city, the established character of the Medical Professors, the advantages of the College and of the public Hospital, all conspire to promise success to the Design.

The courses of lectures were advertised to last for a period of six months, beginning on the first Monday of November and finishing around the first of May. Few candidates returned to take the Doctor's Degree in Physic (the MD degree) so that ultimately the Bachelor's Degree was discontinued and the M. D.. degree substituted for it, as is now the normal practice in American medical schools. At the first Commencement of the new School on 21 June 1768 the Bachelor's Degree in Physic was awarded to ten graduates. The secretary of the board wrote in his minutes that "This day may be considered the Birth-day of Medical Honors in America." The second Commencement was held on 30 June 1769 and the Bachelor's Degree was conferred on eight candidates.[45]

The life of the Medical School of Philadelphia College was hectic during its first few decades, including as they did the American Revolution (1775-1783) and the founding and early years of the Republic. Much of this historic conflict and lawmaking took place in and around Philadelphia. The Medical School suspended operation during the Revolution, and it was in this period of great national stress that Morgan, Shippen and Rush became involved in a personal vendetta that sorely tried the patience of General Washington, Morgan's former comrade-in-arms, and the United States Congress.

The rift between Morgan and Shippen over Morgan's failure to include Shippen in the founding of the Medical School never healed and was doubtless an underlying factor in their bitter legal confrontation on the national stage. The events leading up to the dispute were as follows. On 17 October 1775 Morgan was appointed Director-General of the General Hospital and Chief Physician of the Revolutionary Army to replace Dr. Benjamin Church of Boston who was discovered in treasonable correspondence with the British. Shippen was appointed to Morgan's staff. When Morgan was summarily relieved of his post in 1776 without formal charge or opportunity to defend himself, and Shippen was appointed in January 1777 to replace him as Director-General, Morgan suspected that machinations of Shippen were the cause of his dismissal. Morgan appealed to Congress for redress. Finally, after a delay of three years, Morgan received a perfunctory communication from Congress on 12 June 1779 absolving him of any wrong-doing.

Three days later, on 15 June 1779, Morgan counterattacked. In a formal statement to Congress, he charged Shippen with "Malpractice and Misconduct" in the Office of Director-General. Furthermore, Morgan offered to be a prosecution witness in Shippen's Court Martial. Benjamin Rush was Morgan's principal witness against Shippen whom they described as a "monster of public iniquity," cowardly, treacherous and false. They characterized a Shippen aide as "one of those insects who have been hatched in the sunshine of his corrupt administration." Shippen replied with similar invective to complete a thoroughly unseemly performance all around. Shippen escaped conviction, and then resigned the post of Director-General on 3 January 1781, without doubt to the great relief of Congress. But the Morgan-Shippen feud continued for years to disturb the tranquility of the faculty of the Medical School.[46][47]

In regard to the offensive tone of the public debate in the court martial of Dr. Shippen, it should be remembered that the exchange of scathing epithets between adversaries was common in those days, and we shall learn that Elias Cooper was himself formidable in waging war with words. Cooper subscribed to Morgan's views on specialization, generally limiting his practice to surgery and fiercely defending his right to inform the profession and the community through the public press that he offered specialized services - for which he was accused of "advertising" and severely castigated by his professional colleagues. But more of this later.

Unfortunately, most American medical schools in the nineteenth century failed to sustain the commitment to high academic standards implicit in the College of Philadelphia's original "code of rules." By the end of the century, large numbers of doctors were being graduated annually, but overall quality was at a low ebb, brought down by the proliferation of inferior proprietary schools. All this was convincingly documented in the Flexner Report of 1910.[48]

This is an appropriate juncture to consider the medical renaissance initiated by Johns Hopkins Medical School, founded in Baltimore in 1893. We shall introduce the subject with some remarks on the Colony of Maryland and the Quaker family of Johns Hopkins.

Colony of Maryland, 1633

Baron Baltimore, a Catholic, received a charter for the Colony of Maryland in 1632 from Charles I, and settlement began in 1633. Although the colony was named for the Virgin Mary, and was intended as a refuge for English and Irish Roman Catholics, Maryland was never predominantly Catholic.

Gerard Hopkins, of English background and member of the Church of England, was among the early colonists. Between imprisonments in England George Fox, founder of the Society of Friends and great preacher, came to America in 1671 on a mission to spread the Quaker doctrine. While in the Colonies he visited Maryland where he converted many to his belief including Gerard Hopkins. In due course Gerard married Margaret Johns, also of the Quaker persuasion, and they became the great grandparents of the wealthy Baltimore merchant and banker, Johns Hopkins (1795-1873), who endowed the Johns Hopkins University, Hospital and Medical School.

Johns was one of eleven children. There were six sons, of whom he was the second, and five daughters. The family lived comfortably on a tobacco plantation operated by slave labor until the local Quaker Meeting declared that slavery was unacceptable to their creed. Whereupon in 1807, when Johns was 12 years of age, his father freed all their slaves while continuing to provide for those who were young or old and still dependent. Life changed drastically for the Hopkins family, parents and children alike, all of whom now took up the considerable manual labor and other homely tasks required to tend the farm and make themselves completely self sufficient. This change brought to Johns and the other children the blessings of a disciplined life of hard work, frugality and sharing, with parents who imparted an uplifting faith and a love of learning. We may be sure that Johns's attitudes and ideals were influenced by the experiences of his youth. "Just as the twig is bent, the tree's inclined."

When Johns Hopkins' uncle would not give his daughter permission to marry Johns because of Quaker disapproval of consanguineous marriage, they both remained single. Later in life the childless Johns Hopkins, who was highly successful in business in Baltimore, looked upon his wealth as a trust and began to consider how he could best dispose of it for the benefit of humanity. After much thought and consultation he "was given to see", as the Quakers say, the course that he should follow: found a University, a Hospital and a Medical School in Baltimore. The Johns Hopkins University was opened in September 1876; the Johns Hopkins Hospital on 7 May 1889; and the Johns Hopkins University School of Medicine in October 1893. When Hopkins named the twelve-member Board of Trustees of the Hospital in 1867, he appointed his personal friend and fellow Quaker, Francis T. King, as President of the Board. Quite a few other members were also of the Society of Friends so that Quaker influence permeated the Board.[49]

In his Address at the opening ceremonies of the Hospital in 1889, Francis King had this to say about Johns Hopkins:[50]

What were the motives that led him to found his two great trusts (for the University and the Hospital), each with an endowment of nearly three million and a half dollars? Was it the act of a man of great wealth without children, who near the close of life wished to build a monument to his memory? No, not at all; it was done conscientiously, with all the deliberation, judgment and grasp of subjects which characterized him through life, first as a successful merchant, then as a banker.

l remember, many years ago, while spending an evening at Clifton (the country home of Johns Hopkins), I heard (him) say, in reply to a question put to him by an intimate friend of his own age, why he had never made a will, that he looked upon his wealth as a gift, for which he was accountable; that it grew and piled up from a small beginning, he hardly knew how; but he was sure it was given to him for a purpose, and he did not believe he would die before he was given to see how he should dispose of his estate. "This wealth," he repeated, "is my stewardship."

During the same period another prominent financier, Leland Stanford, and his wife were led by a personal tragedy, the death of their only child, also to devote their fortune and the remainder of their lives to the founding of a university on the other side of the continent from Maryland. Leland Stanford, Jr., died in Florence, Italy, from typhoid fever on 13 March 1884, a few weeks before his sixteenth birthday. "In the shadow of a great sorrow" Mr. Stanford, one of the builders of the first transcontinental railroad and former Governor of California, and Mrs. Stanford were guided by deep religious and humanitarian sentiments in their resolve that, in memory of their son, "the children of California shall be our children." The cornerstone of Leland Stanford Junior University was laid on the outskirts of Palo Alto, California, on 14 May 1887, the nineteenth anniversary of Leland Junior's birth. Opening exercises of the new University took place on 1 October 1891. Seventeen years later, in 1908, the University acquired the medical college founded by Elias Cooper.[51][52][53]

Johns Hopkins Medical School

The Medical School of Johns Hopkins University was the harbinger of change in many important respects. It was the first American medical school to require a bachelor's degree for admission and the first to be of the "university type" on the German model, as opposed to the clinically oriented schools and the large number of inferior proprietary establishments that characterized nineteenth century medical education in the United States. As late as 1871 Henry J. Bigelow, the influential Professor of Surgery at Harvard, referring to the commercialization of medical schools in order to maximize income from student fees, wrote: "It is safe to say that no successful school has thought proper to risk large existing classes and large receipts in attempting a thorough education". The Hopkins school was prepared to take the risk.[54]

Johns Hopkins was a medical school, albeit on a small scale, with something approaching an adequate endowment; it had well equipped laboratories conducted by modern teachers committed equally to medical investigation and instruction; and it had its own hospital where clinical research and teaching were combined with patient care. It is true that Harvard, Pennsylvania and a few other schools were evolving along similar lines but Hopkins made the first definitive move and became the national paradigm. It was held up as an example for emulation by Abraham Flexner whose critiques of medical education in 1910 and 1925 are the most influential writings on the subject ever published in the United States, and are justly credited with spurring much needed reforms.[55][56]

The fact is that the innovations at Johns Hopkins Medical School, which were the original manifestation of the so-called Flexnerian reforms, placed it in the forefront of medical education at the time. Similar developments were also in progress at Harvard and some other institutions, but to a lesser extent. Far from deterring students, Hopkins' high admission and other standards brought them flocking. The School's program was initiated under the guidance of Johns Hopkins University's first President, Daniel Coit Gilman (who resigned as President of University of California, Berkeley, to take the post), and William Welch, first Dean and Professor of Pathology. In addition to Dr. Welch, 34 years of age at the time of his appointment, the original Hopkins faculty included a stellar group of relatively young professors whose names are inscribed in the annals of American Medicine: Anatomy (Franklin Mall, aged 31); Pharmacology (John Abel, 36); Physiology (William Howell, 33); Gynecology (Howard Kelly, 31); Medicine (William Osler, 40); and Surgery (William Halsted, 37).[57]

The issue of full-time appointment of faculty in Clinical Departments arose early in the life of the new medical school. Here, as in numerous other aspects of medical education, Hopkins set an important precedent. Full-time appointment meant that the faculty member was employed full-time by the University and was not permitted to hold any outside paid position or, in the case of a physician, to engage in private medical practice for personal gain. The purpose of the full-time system is, of course, to encourage the faculty member to devote full effort to teaching, research and related activities, and to prevent diversion from these pursuits by outside commitments and the prospect of additional income from private practice.

Full-time appointment of basic science faculty was the policy at Johns Hopkins Medical School from its inception because basic science departments were analogous in function to the academic departments of the University at large where full-time appointments were already the norm.

However, full-time appointments did not exist in the Clinical Departments at Hopkins or, on an organized basis, in any of the other American medical schools at the time. The professors in Clinical Departments in these schools and at Hopkins were free to engage in private practice and keep the income, thereby earning some or all of their salaries and relieving the School of a major expense. In fact, few if any American medical schools in the late nineteenth century could have existed without freedom of the professors in the Clinical Departments to support themselves by private practice.

Nevertheless, the Hopkins faculty concluded, with the urging of Flexner, that earnings from medical practice by members of Clinical Departments, as well as the demands of patient care, represented a potential distraction from their responsibilities in teaching and research.

As a result, Hopkins furthered the revolution in medical education by becoming the first American medical school to effectively introduce a full-time system in the Clinical Departments. That is, the professors and their staffs in these departments received a regular salary in full payment for their services. They held their posts on the condition that, while employed by the university and hospital, they would be free to engage in any medical practice required by humanity or science; but that the fees for these services would not be collected by the faculty member but by the medical school which would use them as it saw fit in support of the school's program.[58]

Installation of the full-time system for appointments in Clinical Departments was the most controversial feature of the Hopkins program. In 1911 Welch wrote: "I am sorry to say that Dr. Osler is strongly opposed to the plan, going so far in a letter received today as to say that it will wreck the hospital if we attempt it, at least on the basis of $7500 salaries for the chief physicians and surgeons. I am myself equally strong on the other side of the question....".[59] (Some years later Sir William Osler changed his view of the full-time system and supported the concept in principle.) Many voices within the medical profession, including the American Medical Association, were also critical. They predicted that the very physicians, surgeons and specialists best qualified by motivation and experience to teach clinical subjects in a medical school could not be adequately supported by the school on a full-time basis; that these practitioners would be reluctant to forego the income associated with private practice; and that full-time faculty would tend to give insufficient priority to patient care and clinical problems. These same caveats regarding the full-time system are not without substance and they are still heard today. As we shall see, the full-time question was warmly debated and proved to be a divisive issue when the Clinical Departments of Stanford Medical School were moved from San Francisco to the Campus and the full-time system was adopted in 1959.

Indeed, Hopkins had considerable difficulty in recruiting for the first full-time professorship in the Department of Medicine. The circumstances were these. Dr. Lewellys F. Barker, in a notable address in 1902, was the first American physician to make the case for full-time appointments in the Clinical Departments of medical schools.[60] In 1905, when William Osler departed for Oxford to become the Regius Professor of Medicine, he was replaced as Professor of Medicine at Hopkins by none other than Dr. Barker, an early exponent of the full-time system. However, in 1913, when Barker was invited to become the first full-time Professor of Medicine, he declined the offer and stepped aside to become a Professor of Clinical Medicine (which allowed him to continue in private practice and retain the fees) because he believed that he could not make adequate provisions for his family on the income from the full-time appointment. The next in line at Hopkins, William Thayer, then a clinical professor of medicine, also refused the full-time professorship and it became necessary to seek an outside candidate for the post. An intensive recruiting effort finally culminated in the appointment in on 1 July 1914 of Theodore Janeway from the Columbia University College of Physicians and Surgeons in New York as the first full-time Professor of Medicine at Hopkins.[61][62]

Implementation of the full-time system at Hopkins was made possible (1) by a grant on 23 October 1913 of $1.5 million from the General Education Board (established in 1903 by John D. Rockefeller, Sr.) from which funds were obtained to support full-time salaried "University" appointments in Clinical Departments; and (2) by the decision to augment the full-time staff by offering unpaid "clinical" appointments (e.g., Professor of Clinical Medicine, etc.) to professors who chose to remain in private practice and donate their services as teachers. The full-time system was thus finally installed in 1914 with the following as the first group of full-time faculty in Clinical Departments: Professor of Medicine Theodore Janeway; Professor of Pediatrics John Howland; and Professor of Surgery William Halsted. The importance of some full-time appointments in Clinical Departments is now well recognized, and such appointments are a normal component of American medical faculties. However, many medical schools (Stanford included) find it necessary to continue experimenting with various titles and financial and procedural arrangements in an effort to maintain, in the face of changing conditions, an appropriate balance of "University" and "clinical" appointments. We shall return to this subject when discussing Stanford's faculty policy.[63]

We are also indebted to the Hopkins faculty for other innovations that have since become standard components of undergraduate and graduate medical education. These now-familiar features are the clinical clerkship for medical students and residency training for graduate physicians.

The father of the clinical clerkship is William Osler, world-renowned physician and medical educator, author of The Principles and Practice of Medicine (first edition, 1892), the most respected medical textbook of his day. It was in the autumn of 1896 that he brought fourth year medical students into the wards, outpatient department and clinical laboratory of the Johns Hopkins Hospital to take histories, examine the patients, and participate in their diagnosis and treatment. He did so with many misgivings at the time for he feared that there would be a hostile reaction. On the contrary, under his auspices the experiment was a resounding success, and the clinical clerkship is now an essential ingredient of medical education. Indeed, introduction of medical students into the wards and outpatient clinics as an integral part of a hospital's machinery for the care of patients is considered by some to be Osler's most lasting contribution to medicine. The overall reform in clinical teaching for medical students introduced at Hopkins consisted mainly in the reduction or abandonment of didactic lectures as the principle mode of instruction in clinical subjects, and the substitution of practical, supervised training experiences such as the clinical clerkship. Involvement of students in research was an additional invigorating aspect of the Hopkins teaching program. By 1896 senior medical students all had a research project of one kind or another which overlapped or supplemented their work in the clinic and laboratory. The students presented their findings in papers read at Hopkins' meetings, and many notable contributions by medical students were published in the Johns Hopkins Hospital Bulletin.[64][65][66]

For a personal reminiscence of Sir William Osler (who was created a Baronet in 1911), and a nostalgic commentary on the inauguration of the clinical clerkship at Hopkins, we are indebted to a distinguished Stanford alumnus, Dr. Emile Holman (1890-1977), Stanford A. B.. 1911, who was Professor and Executive Head of the Department of Surgery at Stanford from 1926 to 1955. As a young man, Holman entered Oxford University on a Rhodes Scholarship in 1911 where for three years he studied medicine and came to greatly admire Dr. Osler, the Regius Professor. After returning to America Holman received an MD in 1918 from Hopkins. He continued there for five more years as a surgical resident under Dr. Halsted before completing his surgical training with a year at Harvard in the Peter Bent Brigham Hospital under Dr. Harvey Cushing (who had himself spent fourteen years at Hopkins). It is not surprising that the Hopkins educational ideals accompanied Dr. Holman when he finally returned to his alma mater in 1925 as a member of the Stanford medical faculty. In 1964 Dr. Holman wrote as follows of Dr. Osler and the clinical clerkship:[67][68][69]

The claim of Sir William Osler to enduring fame may well rest on one simple fact: Said he, "I hope my gravestone will bear only the statement: 'He brought medical students into the wards for bedside teaching' ". As early as 1896, students at Johns Hopkins Hospital were assigned the duties of recording the patient's past medical history and present illness, of making a complete physical examination, and of doing the simpler laboratory examinations. To us, now, all this seems quite commonplace, but at that time it took vision, courage, and faith to assign such important tasks to "mere" students. As Iris Noble reports, Osler himself was beset by the haunting fear that these radical innovations would be fought by the public and spurned by the medical profession. To his genuine relief, their acceptance was immediate and general, and they survive today as important keystones in medical education.

The claim of Sir William Osler to enduring fame may well rest on one simple fact: Said he, "I hope my gravestone will bear only the statement: 'He brought medical students into the wards for bedside teaching' ". As early as 1896, students at Johns Hopkins Hospital were assigned the duties of recording the patient's past medical history and present illness, of making a complete physical examination, and of doing the simpler laboratory examinations. To us, now, all this seems quite commonplace, but at that time it took vision, courage, and faith to assign such important tasks to "mere" students. As Iris Noble reports, Osler himself was beset by the haunting fear that these radical innovations would be fought by the public and spurned by the medical profession. To his genuine relief, their acceptance was immediate and general, and they survive today as important keystones in medical education.

Residency training, in a modern sense, was introduced at Hopkins. Simply stated, this type of training is a supervised program of study and experience, usually in a hospital, for a physician who has already graduated from medical school. It should be pointed out that hospital training for doctors wishing further experience after graduation has a diverse history extending back over many centuries in Europe, and since colonial times in America. Various arrangements evolved whereby the doctor seeking additional training before entering practice or other medical work served in a hospital under such titles as dresser, walker, intern, resident, house pupil, house physician, Assistant to the Professor (in Germany), etc. On the American scene in the 1800s, hospital-based training during the first year or two after graduation from medical school was usually known as an "internship", and generally amounted to an inpatient apprenticeship. The growing need in American medicine for advanced training beyond the internship, leading to maturity and clinical specialization grounded in medical science, was first met in a systematic fashion by the Hopkins residency training program.

In its original form the Hopkins program began after the internship and consisted of an indefinite number of years (reduced in modern times to an average of three or four) of hospital-based clinical and scientific work in a specific field, such as medicine or surgery, during which an optimum balance of supervision, responsibility, service and education was achieved. The Johns Hopkins Hospital was completed in 1889 and a resident staff in medicine and surgery could begin their work in the next year because John Shaw Billings who planned the hospital had, with keen foresight, included a unique facility: ample living quarters for a resident staff in a dignified setting in the front building of the hospital. These accommodations made it possible for a relatively large number of carefully selected medical graduates to live in the hospital and obtain long periods of training under professorial guidance, bringing them to levels of competence rarely attainable under other conditions. Osler in Medicine and Halsted in Surgery, influenced by their knowledge of the German Assistantships, designed and in 1890 installed training programs that presaged present-day residencies, and prepared an unparalleled number of academic and scientific leaders in their respective fields. The joint statement of residency training objectives by Osler and Halsted was brief and to the point: "Clinical training, to be truly graduate training, should discipline the resident in scientific attitudes toward health and disease, and should enable the graduate to begin the practice of a clinical specialty in a scientific manner without supervision." Dr. Welch was later to say that the residency training system introduced into American Medicine by the Johns Hopkins Hospital was "the most important contribution which Johns Hopkins made to medical education".[70][71][72]

Graduates from Johns Hopkins Medical School and physicians who had served in the Hopkins residency training program went forth in unprecedented numbers to become influential faculty members in medical schools across the country.

The following Hopkins graduates held full professorships at Stanford Medical School:

  • Arthur Meyer, MD (JHMS 1905) Professor of Anatomy
  • Wilfred Manwaring, MD (JHMS 1904) Professor of Bacteriology
  • Edward Schultz, MD (JHMS 1917) Professor of Bacteriology
  • Albion W. Hewlett, MD (JHMS 1900) Professor of Medicine
  • Arthur Bloomfield, MD (JHMS 1911) Professor of Medicine
  • John Luetscher, Jr. MD (JHMS 1937) Professor of Medicine
  • Ernest Martin, PhD (JHU 1904) Professor of Physiology
  • Emile Holman, MD (JHMS 1918) Professor of Surgery
  • Frederick Reichert, MD (JHMS 1920) Professor of Surgery

Other Stanford professors who had Hopkins experience include Dr. Emmet Rixford, Professor of Surgery from 1898 to 1930, who worked in Welch's laboratory during the summer of 1892, a year before admission of the first class of students to the Hopkins medical school. There was Dr. Ernest Dickson who served as an Assistant Resident Physician at Johns Hopkins Hospital from 1907 until 1908 when he became a Fellow in Pathology with Dr. Welch. Soon after beginning his fellowship Dr. Welch called him into his office to tell him that Dr. William Ophüls, Professor of Pathology at Cooper Medical College and a brilliant young German-trained pathologist whom Dr. Welch held in high regard, needed an assistant. With Dr. Welch's blessing, Dickson was accepted by Dr. Ophüls and in 1908 moved to San Francisco to take up his new post. Dr. Dickson continued on the faculty when Stanford took over Cooper Medical College, and from 1926 until his death in 1939 he was Professor and Chairman of the Stanford Department of Public health and Preventive Medicine. For his outstanding research on botulism he earned worldwide recognition. Dr. Windsor Cutting (Stanford AB,'28; MD, '32), after two years as a Fellow in Pharmacology and Medicine at Hopkins from 1936 to 1938, joined the Stanford faculty in 1938 where he rose to the rank of Professor of Pharmacology in 1950, and was Dean of the School of Medicine from 1953 to 1957.[73][74]

We have seen how the program of the nation's oldest medical school, founded in Philadelphia in 1765, was based on the Edinburgh model. Similarly, the evolution of medical education at Stanford strongly reflects the influence of Johns Hopkins. And in the early history of all three of these important American schools, we can discern a relationship to the Society of Friends.


When casting about for an explanation of the tenacity with which the first medical school on the Pacific Coast clung to life against the odds, it seemed obvious that the legacy of Elias Cooper, significant as it was, could not account for the school's survival. Social conditions were unsettled in San Francisco, as we have seen, and far from ripe for medical education. The faculty of his new school were innocent of academic credentials, and their pretensions were resented and ridiculed by the old guard of physicians. To make matters worse, Cooper himself was the focal point of one controversy after another, as we later describe. Finally, the most devastating blow to the school's prospects was Cooper's untimely death from a lingering illness at the age of 41, only four years after his founding of the school. As a counterpoise to these unfavorable circumstances, there must have been factors intrinsic to the project that saved it from extinction.

All quests for sustaining factors indispensable to the life of the school have led invariably to the same conclusion: the school owed its survival, during the half-century from its founding in 1858 to its adoption by Stanford in 1908, to the commitment to learning and to each other shared by Elias Cooper, Levi Lane and the Doctors Gibbons. Their unwavering personal loyalty, and devotion to an institution that epitomized their common purpose, seem best explained by the bonds of kinship and the unifying source of values we have broadly referred to as their "Quaker heritage."

Lest it seem unwarranted to attribute decisive influence on the destiny of the school to ephemeral considerations such as these, we have sought to define the singular nature of the Society of Friends by following a meandering course through religious history from the time of the Reformation. This has given us the opportunity to place the origin and beliefs of the Society in perspective, and to cite the substantial Quaker influence on the inauguration of American medical education in colonial times, and on its renaissance at the close of the nineteenth century. In the process we have broadly sketched the religious aspects of the historical matrix within which Cooper's school was founded and evolved.

It should be added that the special interest here shown in the Quakers is occasioned only by the accident of history that brought a few of them together in San Francisco, thus making the Society of Friends directly relevant to a sequence of events that might well have featured some other sect, or none at all, had chance so decreed. Yet we should pause to reflect, as we leave this subject, what would have been the consequences for medical education at Stanford and in the West but for the power of the Quaker faith as a "tie that binds".


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