Stanford University School of Medicine and the Predecessor Schools:
An Historical Perspective
Part III. Founding of First Medical
School and Successions 1858-
Chapter 22.Medical College of the Pacific Established in 1872 and National Efforts to Reform Medical Education
During the critical decade from 1864 to 1873, the Cooper school was suspended and revived; the Toland school was founded and its adoption by the University of California finally arranged. Having completed a summary of these events, we can now relate how the revived Cooper school became the Medical College of the Pacific in 1872, and retained that name until it was succeeded by the Cooper Medical College in 1882. It was during the tenure of the Medical College of the Pacific that reform of American medical education became increasingly an issue of national concern to the medical profession.
Affiliation with University (City) College
Renting of Facilities
At the meeting in Dr. Gibbons' office on 23 May 1870, convened for the purpose of reviving the Medical Department of the University of the Pacific, Dr. Cole remarked that to compete with the Toland School it was necessary to have comparable facilities. It would scarcely do, he said, to have the lecture room in one part of the city, the dissecting room in another and the clinic in a third. The three should be concentrated in the same vicinity.
It was pointed out that the Chapel and adjacent College building of University (City) College, a Presbyterian school founded in 1860, were ideally suited to the needs of the Medical Department. They were located in the center of San Francisco at the corner of Stockton and Geary Streets, opposite Union Square which is still a well-known landmark in the city. Furthermore, the science laboratory of the College, under the charge of Professor Price, was near the College building and could be used to demonstrate the principles discussed in the chemical lectures.[1]
Fortunately, Professor Price, Chairman of the Faculty's Committee on Rooms, was able to report to the Faculty on June 6th that the College Chapel had been engaged so that the Annual Lecture Course for the Session of 1870 could begin in the Chapel on July 5th as scheduled.
Prior to the next Session, that of 1871, rooms in the College Building were rented for the Lectures and for the purpose of establishing a Dispensary. In order to accommodate these activities, the Faculty paid for the necessary remodeling of the College building, the first of many renovations to be subsidized by the Faculty in the years ahead.[2][3][4]
Medical College of the Pacific Established in 1872
Renting and renovating the College building, combined with access to the adjoining science laboratory of Professor Price, provided the medical school with centralized and very serviceable quarters. In the course of making these arrangements, a cordial relationship developed between the Trustees of University (City) College and the Faculty of the Medical Department of the University of the Pacific, facilitated by the fact that Professor Price was a member of the Faculties of both. During the Session for 1871 the College facilities proved so convenient and the Trustees so cooperative that the Medical Faculty on 25 January 1872 designated Professors Price, Lane and Gibbons, Sr., as a committee to explore with the Trustees the possibility of transferring the Medical Department to University (City) College. The response from the Trustees being prompt and favorable, the Faculty voted unanimously on 2 March 1872 to complete forthwith all necessary procedures whereby they would withdraw from the University of the Pacific and be constituted thereafter as the "Medical College of the Pacific, being the Medical Department of University College."[5]
Total Graduates: Medical Department, University of the Pacific. During the existence of the Medical Department of the University of the Pacific from 1859 through 1871, the number of graduates was as follows:[6]
| 1859 | 2 |
| 1860 | 1 |
| 1861 | 5 |
| 1862 | 5 |
| 1863 | 8 |
| 1864 | 7 |
| 1870 | 8 |
| 1871 | 8 |
| Total: | 44 |
The Annual Announcement for the Session of 1872 carried the following explanation of the change in title and sponsorship of the school:[7]
The Faculty of the Medical Department of the University of the Pacific take pleasure in announcing that they have formed a connection with University (City) College of San Francisco, and that their school will henceforth be known as The Medical College of the Pacific.
The reasons for this change have been entirely satisfactory to all parties concerned. The connection of the School with the University of the Pacific, the oldest Collegiate Institution on this Coast, has always been a source of pride and gratification to the Faculty, and has also been esteemed a high honor; and the connection would not have been severed without the consent of the University, and without important advantages to be gained by the change. The most important of these is the securing of a permanent building and location, in the most convenient and eligible situation in San Francisco. The location is in the heart of the city, central to travel and to business, and almost directly opposite to Union Square. The grounds, which are the same as occupied by University College, are forever dedicated to educational purposes. Without this fortunate affiliation, the Faculty would have been under the necessity of erecting buildings somewhere on the outskirts, much less acceptable to students.
University College, which has been in existence thirteen years, is one of the most flourishing educational institutions on the Pacific Coast. Besides the Buildings and Schools at the corner of Stockton and Geary Streets, it owns a valuable property at University Mound, five miles from the center of the city, on which it has erected extensive buildings, and established a Preparatory School which is in a prosperous condition.
The Trustees. . . are among our best and most influential citizens (and include Henry H. Haight, Esq., Governor of California 1867-1871).[8] These gentlemen are not trustees in name only but they are active and zealous in the performance of their duties, and exhibit a deep personal interest in every department of the Institution under their charge. Their object is to build up a University in every sense of the word, with all the departments proper to such an establishment, and to place it in the van of the educational institutions of the Pacific Coast. Under these auspicious circumstances the permanence and success of the Medical College of the Pacific are insured.
The school, which now takes the title of the Medical College of the Pacific, was organized in 1858, and is consequently by far the oldest Medical School on the Western Coast of America. Most of the Professors are experienced and successful teachers, whose devotion to the cause of medical education is attested by the arduous and unrequited labor which was required to build up a College from the scanty materials of a newly settled country. The Faculty refer with pride to the professional careers of its Graduates, who have uniformly reflected credit on the Institution, and on the profession.
Reform of Medical Education
The preeminent issue facing the Medical College of the Pacific in 1872, and American medical schools generally, was the reform of medical education. We shall therefore mention some of the factors contributing to the persistence of low standards, and then discuss efforts to improve them.
Medical Schools Resist Reform
The organizational structure of American medical colleges was the major impediment to raising standards. Curriculum, graduation requirements and dependence on student fees for financing had changed little since the founding of the nation's earliest schools in Philadelphia, New York and Boston a century earlier. Educational programs were stagnant, and were widely criticized within and without the profession.
Virtually all American medical schools in 1872 were "proprietary." That is, they were privately owned and operated by the Faculty. Schools acquired the capacity to award the M. D. degree either by charter from the state, or by affiliation with a college or university. In either case the Faculty was essentially autonomous. The Medical College of the Pacific was a typical example of a medical school affiliated with a college. Only the Board of Trustees of the parent institution (University[City] College), had the authority to appoint professors and award M. D. degrees. However, in affiliations such as this, recommendations by the Medical Faculty were normally approved without question. Compliant Trustees rarely exercised their latent jurisdiction over the standards of medical education. The College assumed no fiscal responsibility for, and had no financial leverage over, the medical school which was completely self-supporting, mainly by student fees.
Such marriage of convenience between an American College and a medical school was a widely adopted and mutually agreeable arrangement because the medical school acquired the mantle of an institution of higher learning and was spared the necessity to obtain a charter from the State to award the M. D. degree. The College enjoyed the prestige of alliance with a professional school. Under these circumstances, and also in the case of medical schools chartered by the State, the net result was that Medical Faculties were insulated from pressure to raise standards. Since they depended on student fees for survival, they were actually deterred from adopting reforms by the assumption that schools that raised standards would lose students to those that did not.
Contribution of Universities to Reform.
It is important to point out that there were some notable exceptions to the prevalent stagnation of American medical schools, but in 1872 the Medical College of the Pacific was not among them. There is no indication that the Trustees of University (City) College, when they adopted the Cooper school, showed any interest in the standards of medical education. They were doubtless unaware that in 1871 President Charles Eliot of Harvard, with the support of his Board of Trustees (Harvard Corporation), had shocked the Harvard Medical Faculty by instituting basic reforms over vehement faculty objection. The reforms required candidates for admission to show evidence of prior educational achievement; the annual session was increased from four to nine months; and a three-year curriculum of progressively advanced courses was instituted, each year being concluded with a written examination. President Eliot's initiatives at Harvard, to which we referred briefly in a previous chapter, had the effect of reinforcing nation-wide the influence of similar changes introduced at the less-prestigious Chicago Medical School by Dr. Nathan Davis in 1862, and of reforms more recently adopted by the Female Medical Colleges in Philadelphia and New York. In due course, the Universities of Pennsylvania, Syracuse, and Michigan followed suit, but progress among the great majority of medical colleges was impeded by the fear that raising standards would result in decreased enrollment and income.[9][10][11]
Professor Oliver Wendell Holmes of Harvard commented that "Our new President, Eliot, has turned the whole University over like a flapjack. There never was such a bouleversement as that in our medical faculty."[12] It was too much to expect that many other colleges and universities would soon move, like Eliot's Harvard, to demand sweeping reforms from the Faculties of their affiliated medical schools, or that State Legislatures would be interested to joust over standards with the self-sufficient and hypersensitive Faculties of their chartered medical colleges.
In 1876 the vital contribution of Universities to the comprehensive reform of American medical education was again foreshadowed. The occasion was the inaugural address of Daniel C. Gilman, first President of Johns Hopkins University. During Dr. Gilman's brief and stormy tenure (1872-1874) as first President of the University of California, he was exposed to the unpleasant bickering of two rival medical schools. That experience acquainted him with their admission requirements and their teaching programs, leading him to include the following declaration in his inaugural address at Hopkins on 22 February 1876:[13]
When we turn to the existing provisions for medical instruction in this land and compare them with those of European universities; when we see what inadequate endowments have been provided for our medical schools, and to what abuses the system of fees for tuition has led; when we see that in some of our very best colleges the degree of Doctor of Medicine can be obtained in half the time required to win the degree of Bachelor of Arts; when we see the disposition of the laymen at home and the profession abroad to treat diplomas as blank paper; and the prevalence of the quackery vaunting its diplomas; when we read the reports of the medical faculty in their own professional journals; and when we see the difficulties that have been encountered in late attempts to reorganize the existing medical schools, it is clear that something should be done. . .
When the medical department (of Johns Hopkins University) is organized it should be independent of the income derived from student fees, so that there may not be the slightest temptation to bestow the diploma on an unworthy candidate; or rather let me say, so that the Johns Hopkins diploma will be worth its face in the currency in the world.
President Gilman was particularly concerned with the lax admission standards of American medical schools. He did not allow the matter of providing intensive preparation for the study of medicine to wait until the Hopkins School of Medicine opened in 1893. Instead, during 1876-77, the first year of teaching at Johns Hopkins University, he planned a preliminary course of three years' duration designed "to impart that knowledge and skill which will be subservient to future professional work, and, at the same time, to develop the intellectual powers, upon a liberal and comprehensive plan." The course was inaugurated in 1867-78. According to the announcement of the course, published in the Johns Hopkins University Circular in 1877, "Physics, Chemistry and Biology, with Latin, German, French and English, form the principal elements of this course, with opportunities for the study of Psychology, Logic, History, and other branches of knowledge, according to the requirements of the scholar."
The Hopkins "preliminary course" set the standard for American premedical education in the decades ahead and was the first step toward the eventual common practice of requiring a bachelor's degree for admission to medical school. We have referred elsewhere to the Johns Hopkins Medical School as also a fertile source of innovation in medical education at the doctoral and postdoctoral levels.[14][15]
Before further consideration of the standards of American medical education, we should comment on a major internal deterrent to reform, i. e. , the faculties of the medical schools. Many, probably most, medical professors were of the opinion that existing admission and program requirements were well suited to conditions in America, and were reluctant to see them made more demanding. .
Dr. Henry J. Bigelow, Professor of Surgery at Harvard, was an extreme but interesting example of faculty resistance to change. He was the most vehement critic of President Eliot's reforms at Harvard. He was also a presumptuous man with low regard for professional amenities, as indicated by the following incident.
Dr. Bigelow was a mere bystander in the operating room when his colleague, Dr. John Collins Warren, also a Professor of Surgery at Harvard, successfully carried out the first public demonstration of ether anesthesia at the Massachusetts General Hospital on the 16th of October in 1846 to which we have previously referred.
On 3 November 1846, recognizing the immense significance of this event and determined to identify himself with it, Dr. Bigelow read before the American Academy of Arts and Sciences the abstract of a paper entitled: "Insensibility During Surgical Operations Produced by Inhalation. The First Public Announcement of the Discovery of Surgical Anesthesia."
On 9 November 1846, Dr. Bigelow read the full text of the above paper before the Boston Society for Medical Improvement.
Finally, on 18 November 1846, he published the full text of the article in the Boston Medical and Surgical Journal.[16] This hasty flurry of presentations by Bigelow was designed to give the impression that he was prime mover and patron of the demonstration. In making the precipitous "first public announcement of the discovery of surgical anesthesia," Dr. Bigelow's sole acknowledgment of the role of the responsible surgeon was the statement: "The present operation was performed by Dr. Warren."
On 9 December 1846 in the Boston Medical and Surgical Journal, Dr. John C. Warren published a carefully considered and definitive report of this historic case in a paper entitled "Inhalation of Ethereal Vapor for the Prevention of Pain in Surgical Operations, " being an account of the partial ligation of a cavernous hemangioma in the left neck of a man, aged 20, named Gilbert Abbott under ether anesthesia on 16 October 1846.
Dr. Warren included in his report the description of several subsequent cases successfully anesthetized by Dr. Morton and operated by surgical colleagues at the Massachusetts General Hospital He concluded the article by generously "congratulating my professional brethren on the acquisition of a mode of mitigating human suffering which may become a valuable agent, in the hands of careful and well-instructed practitioners, even if it should not prove of such general application as the imagination of sanguine persons would lead them to anticipate.[17][18]
In 1869, near a quarter century later, President Eliot was to collide head-on with Professor Bigelow whose imperious and self-serving manner had not been softened by the intervening years. Their first difference was over admission standards. Eliot proposed that candidates for admission to Harvard Medical School be required to show evidence of academic achievement. Bigelow retorted that this criterion was arbitrary, and might exclude a genius who had not conformed to the approved academic pattern. Moreover, Bigelow claimed that academic performance was irrelevant, since physicians and surgeons are born and not made. Furthermore, great medical discoveries are not born in the academic environment of university laboratories. (Here he doubtless had in mind the discovery of ether anesthesia, the credit for which he unscrupulously maneuvered to share.)
When Bigelow learned that Eliot had submitted the recommendation for revised entrance requirements to the Harvard Corporation for approval, he was outraged. "Does the Corporation hold opinions on medical education? Who are the Corporation? Does Mr. Lowell know anything about medical education? or Reverend Putnam? or Judge Bigelow? Why Mr. Crowninshield carries a horse-chestnut in his pocket to keep off rheumatism! Is the new medical education to be best directed by a man who carries horse-chestnuts in his pocket to cure rheumatism?"[19]
Fortunately for Harvard, and for American medical education, President Eliot had strong allies on the faculty. He survived the contemptuous criticism of Bigelow; precedent-setting reforms were adopted; and Harvard Medical School came firmly under the control of the University.
The conservative viewpoint that American Medical Education required no major reformation was eloquently expressed by Henry Gibbons, Sr., in his address to the California State Medical Society in October 1872 at the expiration of his term as second President of the revived Society:[20]
There has been much lachrymation of late over the low standard of medical education in America. There are too many schools, and the schools make too many doctors. The complaint may be true, but then one gets sick of the everlasting whine. It is perfectly natural that persons accustomed to the long and laborious education of the old world, should deem it quick work to make a doctor out of new material in less than the standard European time for the preliminary drill. But the circumstances of the two worlds are widely different, and they create necessities of their own. There, you behold forty millions of souls concentrated upon a spot that is covered with the end of your finger on the map. Here, the forty millions are scattered over a continent reaching from ocean to ocean, and from the Arctic circle to Cancer. There, in the climacteric of the nations, wealth, leisure and luxury abound. Here, in our obstreperous boyhood, there is no capital to be spared from physical development, no time to be spared from art and trade. There, the population is compact and fixed, and a doctor's patients are near his door. Here, except in a few ancient centres, they are widely scattered, and a resistless centrifugal force adds every year immensely to the range of practice and the demand for practitioners.
It is folly to talk of supplying this illimitable field with physicians who have invested five years of their life and five thousand dollars in an education. Such men do not like to ride from five to fifty miles to visit a patient, and run the risk of starving unless they have learned, in addition to medical science, the art of raising cabbages. The practice of medicine in the rural districts of America demands an adaptation, a fertility of resource, a tact, not acquired in the schools. The high-bred graduate, with the Bodleian library and all the medical lore of Vienna and Berlin in his head, would stumble on the problem of Nicodemus, and find a new departure necessary to qualify him for his new field of labor.
Notwithstanding the easy path to the doctorate furnished by the half-hundred rival schools of America, the path is still too difficult for many of the aspirants. In the absence of candidates possessed of wealth and pursuing knowledge for its own sake, the classes are composed mainly of students of moderate or slender means, in search of a living in a profession chosen by themselves and not by their parents. Ambition and perseverance are required to enable them to struggle through their difficulties. How many of our best practitioners, the most capable and the most honorable, have trod this thorny path! How many have been compelled to teach school or to perform some other service during their term of study, in order to obtain the means of education! How many have been forced by misfortune, or necessity in some form, to abandon the college before reaching the goal!
In a new country like ours, there is some propriety in conferring degrees in certain cases where the required curriculum of studies has not been completed. If an individual who has practiced without a diploma and established an honorable reputation, and who may be unable to leave his home to complete the formulated course of study, should be able to pass a satisfactory examination in the several branches, what reasonable objection can be urged against admitting him to the doctorate? His fidelity has been proved, and his past life is a guaranty that the profession will suffer no discredit or disgrace from his membership. There can be no such assurance in the case of young men who pass through the complete curriculum, without having had an opportunity of resisting the temptation to play the charlatan. A diploma, be it ever so well earned, will not deter a man devoid of principle from abandoning the path of honor and wallowing in the filth of quackery. Of this we have frequent illustrations in British and European graduates, who are often the most villainous of advertising charlatans in this country.
Dr. Gibbons' nostalgic soliloquy was an elegy for the status quo, and a memorial to the self-reliant men of his generation who, like Elias Cooper (he surely had him in mind), "trod a thorny path" before ultimate acceptance into the profession. Nevertheless, in spite of his fondness for the traditional program, when Dr. Gibbons learned of President Eliot's installation of higher admission standards, a three-year graded curriculum, and other reforms at Harvard, he observed, "We may expect before many years to see this system, or a modification of it, adopted universally." We shall soon see that the Medical College of the Pacific had already begun taking prudent steps to strengthen its program.[21]
The American Medical Association Defines National Standards
Harvard, Hopkins and a few other progressive institutions introduced comprehensive medical reform in their own medical schools which then served as models. Unfortunately, adoption of these prototypes by other schools was initially slow and limited. It was clear that general acceptance of higher and more costly standards by a majority of the independent and highly competitive American medical schools would require consensus among them on standards, and an effective means of gaining voluntary compliance.
It was generally agreed that government intervention was not a practical solution to the problem, and that medical associations would be the most effective agents in defining standards and inducing the medical schools to accept them.
We have already noted that the American Medical Association was founded in 1847 under the leadership of Dr. Nathan Davis, and that he influenced the Association to make reform of medical education one of its primary goals. At the National Medical Convention in 1846 that preceded the meeting in 1847 when the A. M. A. was organized, Dr. Davis proposed the following Resolution which was adopted:[22]
That it is desirable that a uniform and elevated standard of requirements for the degree of M. D. should be adopted by all the Medical Schools of the United States.
To implement this resolution, the A. M. A. established a Standing Committee on Medical Education in 1847 with which Dr. Davis was associated. Unfortunately, progress on medical education was interrupted by the Civil War (1861-1864).
When, after the war, the A. M. A. returned to the subject at its annual meeting in Baltimore in 1866, Dr. Davis was appointed to chair a Committee Appointed to Call a Convention of Delegates from the Several Medical Colleges in the United States. The Convention was charged with the task "of thoroughly revising the present system of medical college instruction." Pursuant to this mandate, a Convention of Teachers of the Medical Colleges was convened in Cincinnati on 3 May 1867, just prior to the Annual Meeting of the A. M. A. in the same city on May 7 to 10. Twenty-four delegates from nineteen colleges were in attendance at the Convention. Among those present were several familiar luminaries: Dr. Nathan Davis from Chicago Medical College; Dr. Samuel Gross from Jefferson Medical College; Dr. Joseph McDowell from Missouri Medical College; and Dr. Thomas Logan representing Toland Medical College. The Medical Department of the University of the Pacific was in suspension at the time.
The Cincinnati Convention prepared an historic document known as "Report of the Committee of Medical Teachers" which was submitted by Dr. Davis to the A.M.A. at its Annual Meeting a few days later. The Association unanimously approved the Resolutions contained in the Report and urged their adoption "by all the medical colleges in our country." The object of the Resolutions was to establish national standards for medical education. The following is a summary of the proposed requirements:[23]
Resolved 1st, That every student applying for matriculation in a medical college, shall be required to show, either by satisfactory certificate, or by direct examination by a Committee of the Faculty, that he possesses a thorough knowledge of the common English branches of education.
2d. That every medical student be required to study four full years, including three regular annual courses of medical college instruction, before being admitted to an examination for the degree of Doctor of Medicine.
3rd. That the minimum duration of a regular annual lecture term, or course of medical college instruction, shall be six calendar months.
4th. That every medical college shall embrace in its curriculum the following branches, to be taught by not less than nine Professors, namely: Descriptive Anatomy, including Dissections; Inorganic Chemistry, Materia Medica, Organic Chemistry and Toxicology; General Pathology, Therapeutics, Pathological Anatomy and Public Hygiene; Surgical Anatomy and Operations of Surgery; Medical Jurisprudence and Medical Ethics; Practice of Medicine, Practice of Surgery, Obstetrics, and Diseases of Women and Children; Clinical Medicine and Clinical Surgery. And that these several branches shall be divided into three groups or series, corresponding with the three courses of medical college instruction required, as follows:
The first or Freshman Series shall embrace Anatomy, etc.
The second or Junior Series shall embrace Chemistry, etc.
The third, or Senior Series shall embrace Practical Medicine, etc.
The instruction in the three series is to be given simultaneously and to continue throughout the whole of each annual college term; each student attending the lectures on such branches as belong to his period of progress in study, in the same manner as the Sophomore, Junior, and Senior Classes, each pursue their respective studies simultaneously throughout the college year, in all our literary colleges
At the close of each series the student shall submit to a thorough examination, by the proper members of the Faculty, and receive a certificate indicating the degree of his progress.
5th. That every medical college should immediately adopt some effectual method of ascertaining the actual attendance of students, upon its lectures and other exercises, and at the close of each session, of the attendance of the student a certificate, specifying the time and the course of instruction actually attended, should be given, and such certificate only should be received by other colleges as evidence of such attendance.
6th. That a Committee of Five be appointed by the President (of the Convention), whose duty it shall be to present the several propositions adopted by the Convention, to the Trustees and Faculties of all the Medical Colleges in this country, and solicit their definite action thereon, with a view to the early and simultaneous practical adoption of the same throughout the whole country. And that the same Committee be authorized to call another Convention whenever deemed advisable.
In submitting the above recommendations to the A. M. A., Dr. Davis extolled the benefits that would accrue to American medical education if the above reforms were adopted. He pointed out that "the plan proposed requires no legislative aid, and no exterior influences, but simply the cooperative action of all the principal medical colleges in the country. It is simply their voluntary co-operative action that gives to the present system all its binding force, and their voluntary action in the adoption of the revised plan would make it equally the practical law of the profession throughout the whole country."[24]
What were the prospects for "cooperative action of all the principal medical colleges of the country?" For an early answer to the question we turn to the Minutes of the next meeting of the A. M. A. held in Washington in May 1868. Dr. A. B. Palmer of Michigan, Chairman of the Committee on Medical Education, submitted a discouraging report:[25]
The Committee on Medical Education regret to report that the various questions respecting this subject, which for so long a period have demanded the attention of the American profession, have not yet received a practical solution. . . The plan of reform (approved at the A. M. A. meeting in 1867), though containing many excellent features, must be conceived as a rather hastily conceived ideal decidedly in advance of realization. . . Some of the changes the plan proposes, and generally regarded as desirable, are believed to be too great to be soon accomplished; and besides other defects, no provision is made in the plan for a repetition of the lectures to the same students. . .
Dr. Davis, who was not a member of the Palmer committee, requested the floor to counter the negative report. He stated that several schools had endorsed the reform plan adopted at the meeting in 1867 and that evident progress was being made. The following resolution was then proposed and adopted:[26]
Resolved, That the American Medical Association refers the whole subject of medical education to the faculties of the regular medical colleges of the nation, pledging itself to adopt and enforce any system or plan that may be agreed upon by two-thirds of all recognized medical colleges.
Resolved, That the resolution be referred to the Committee already acting in this matter (A. M. A. Committee on Medical Education), and they are requested to report within two years from this session.
When the next Annual Meeting of the A.M.A. convened in May 1869 at New Orleans, medical education was again a major issue. Dr. Baldwin, President of the Association, devoted his lengthy Presidential Address to the subject. He stated that he concurred fully with the sentiments on medical education expressed in the following excerpt from a letter he had recently received from "a gentleman who is one of the most distinguished surgeons of the age" (undoubtedly Samuel Gross):[27]
The future holds no promise of amendment. We shall go on from bad to worse until the people can stand it no longer, and then we may hope to be able to effect some reform by our efforts as a great national association. The medical schools are getting worse every year, belowering the standard of education, and opening their doors more widely by the reduction of their fees. The time is near at hand when honorable men will cease to take any interest in medical teaching"
Dr. Baldwin then continued his Address by expressing his equally despairing view of the standards enacted at the Annual Meeting in 1967:[28]
The plan of action you have adopted, that of endeavoring to induce forty or fifty medical colleges, with conflicting interests, to agree voluntarily upon a "uniform and elevated standard of requirements for the degree of M. D.," and adopt it in good faith, has become almost a Utopian idea, a forlorn hope. Though urged with all the force that truth could impart, and enforced with all the appealing earnestness that the gravity of the subject could inspire, yet (the) views and wishes (of the A. M. A.) have not impressed themselves on the schools to such an extent as to change their course of action. It seems to me that all hope of reform through this means must be abandoned.
President Baldwin concluded his Address by saying that he could see no mode by which reform of medical education could be accomplished, except through enforcement by "Federal Legislation" and the founding of "one or more National Medical Schools" that would serve as national standards.
At the same meeting, the Annual Report of the Committee on Medical Education also deplored the condition into which the profession had fallen and the lack of progress toward reform. Furthermore, the decision at the previous A. M. A. meeting "to refer the whole subject of medical education to the faculties of the regular medical colleges of the nation," was sharply criticized. The Committee stated:[29]
In this connection, we cannot refrain from most respectfully but most earnestly enquiring what the medical colleges of the nation have done in the past to entitle them to the confidence of the profession in this matter for the future. . . For twenty years it has been in their hands or entirely at their command. . . Any five years of that time would have sufficed for every change to have been made, had the schools, as a body, so willed it. . . There cannot be found then, in the opinion of your Committee, anything in the past action of the schools which warranted this Association in again committing the subject to their keeping. . .
In spite of failure to date, the Committee on Medical Education had not lost faith in the ultimate success of continuing pressure on the medical schools by the A. M. A. They recommended the following prescription:
The agencies by which reforms will be effected and advances made, we believe, will be chiefly these:
- a more general formation of active medical societies that act harmoniously with the A. M. A.
- the influence of high-toned and independent medical journals
- but above and beyond all other influences we would place the action of the A. M. A. If it will act in this matter firmly, consistently, steadily progressive, it will in due time effect every desirable change, and the profession will rapidly rise in the respect and confidence of the public.
These disparate views reflected the confusion and frustration within the A. M. A. in 1869 . Obviously it had failed to induce a significant change in the inferior programs of the majority of the fifty-odd "regular" medical schools then existing (as distinguished from homeopathic, eclectic and other formula schools). As the premier medical organization in the nation, the A. M. A. faced a crucial dilemma over the course it should follow in overcoming the intransigence of the medical schools, the very institutions that were undermining public confidence in the profession.
The debate on reform of medical education during the 1869 meeting of the A. M. A. finally concluded with the Report of the Ad Hoc Committee on Various Propositions and Communications from Medical Societies, etc. chaired by the tenacious Dr. Davis. The following observations and recommendations by the Committee were approved:[30]
Whereas, The results of all the efforts made during the last twenty-five years to elevate the standard of medical education, through concert of action among the numerous medical colleges of this country, have proved with equal clearness that such concert of action in an efficient manner is unattainable; therefore,
Resolved, That whatever is done to establish and maintain a just and fair standard of medical education throughout our whole country must be done by the profession itself, through its own voluntary organizations, in the same manner that it now establishes and enforces its Code of Ethics. . .
Resolved, That this Association earnestly requests each State medical society to appoint annually one or more boards of examiners, composed of five thoroughly qualified members, whose duty it shall be to meet at suitable times and places for the examination of all persons, whether graduates of colleges or not, who propose to enter upon the practice of medicine in their respective States, except as have been previously examined and licensed by a similar board in some other State. . .
Resolved, That each State medical society be requested to require its examining board to exact of every applicant for examination. . . proof of having had a proper general education and of having completed a full course of medical studies in a regularly organized and recognized medical school.)
The objectives of the above resolutions as set forth by Dr. Davis were met in California when the State Legislature enacted a law in 1876 to regulate the practice of medicine. As a result of this statute, which we shall later discuss, State Boards of Medical Examiners under the aegis of State Medical Societies were established in California. Other states also passed medical licensing laws whose chief objective was to disbar unlicensed practitioners. We shall see how the Boards ultimately contributed to the reform of medical education.
Assessment of A. M. A. Efforts to Reform Medical Education
In spite of continuing efforts by the A. M. A. and dedicated physicians such as Nathan Davis to achieve an acceptable standard of medical education in every regular medical school in the country, reform was essentially stalled in 1869. Relatively few schools followed the lead of Harvard et al in revising their entrance and graduation requirements. In fact, the overall status of medical education grew worse during the final decades of the century. This was due to the proliferation of inferior schools that were unable or unwilling to incorporate into their programs the information stemming from the scientific revolution in medical and basic sciences then in progress. The number of medical schools increased from fifty in 1870 to 162 in 1906[31][32]
| Year | Medical Colleges |
|---|---|
| 1870 | 50 |
| 1880 | 100 |
| 1890 | 133 |
| 1900 | 160 |
| 1906 | 162 |
The increase of 112 new medical schools, mostly of inferior grade, over a period of thirty-six years was not related to the health needs of the people but to professional vanity and the amplitude of student fees. As a result there was still a crisis in American medical education at the turn of the century.
We should not leave the subject of the A. M. A. without recalling that from its very inception the Association was committed to the improvement of medical education. Furthermore, one cannot follow the transactions of the organization without being impressed by the time and earnest consideration devoted to the subject, and without recognizing the impediments to success imposed by the self-serving and reactionary outlook of physicians at the time.
Medical Colleges Organize to Reform
Officers of the A. M. A. had little confidence in the ability of the medical colleges to reform themselves. Nevertheless, it could be anticipated that they would at some point, in view of the stalemate in the A. M. A., make renewed efforts to do so. This is an opportune juncture to summarize these efforts which were not initiated until 1876.
With the laudable goal of reform in mind, Dr. J. B. Biddle of Jefferson Medical College and five other professors, all of whom were from the Middle West or South, sent an invitation to all medical schools to send representatives to a convention in Philadelphia on 2 June 1876. The purpose of the convention was "to consider all matters relating to reform in medical college work." Representatives of twenty-two medical schools attended the convention which proceeded to form a "Provisional Association of American Medical Colleges" and pass a few resolutions one of which "recommended that all medical colleges offer three courses of lectures (presumably of at least five months each)." Dr. Biddle was elected President of the Association.[33]
A second meeting of the new Association was convened at Chicago in June 1877 in response to the call of President Biddle. Twenty-six colleges were represented. A constitution, bylaws and Articles of Confederation were adopted including the name of "American Medical College Association" and the statement that "The objects of the Association shall be the advancement of medical education in the United States and the establishment of a common policy among medical colleges in the more important matters of college management." The medical curriculum proposed at this meeting was hardly revolutionary. It consisted of the traditional three-year apprenticeship during which the student must attend two regular courses of identical lectures. This was a long step backward from the national standards adopted by the A. M. A. in Cincinnati in 1867. Dr. Biddle was elected President of the American Medical College Association and Dr. Nathan Davis was chosen Vice-President.
Meetings of the Association were held in Buffalo in 1878 (15 colleges represented); in Atlanta in 1879; in New York in 1880 (25 colleges represented); in Richmond in 1881 (18 colleges represented); in Cincinnati in 1882 (11 colleges represented). Little was accomplished by the Association. After it decided in 1880 to recommend three courses of lectures instead of two, twelve medical colleges withdrew from the Association. They feared loss of revenues if they adopted the lengthened curriculum. Their withdrawal was a fatal blow to the Association. Among the defectors were such well-known institutions as the New York College of Physicians and Surgeons, Jefferson Medical College, Rush Medical College, and Dartmouth Medical College.
The Association died. It had tried to raise standards too rapidly. No annual meeting was held during the years 1883 through 1889. There could be no better demonstration of the tenacity with which the majority of American medical schools clung to the traditional two courses of identical lectures as the major feature of the curriculum, and to lecture fees paid by students to the professors as the main source of support.
In March 1890 the five medical colleges in Baltimore and the staff of the Johns Hopkins University invited representatives from each of the 133 then-existing medical schools in the United States to convene at Nashville in May 1890 "for the consideration of reforms urgently needed in the system of medical education hitherto in operation in this country." The invitation made clear that the agenda would include discussion of
- Three years Course of Six-Months Sessions
- Graded Curriculum
- Written and Oral examinations
- Preliminary examination in English
- Laboratory Instruction in Chemistry, Histology and Pathology
By this time resistance to reform had decreased and some seventy medical colleges, a majority of the 133 existing schools, sent representatives to the Nashville meeting. The original American Medical College Association was reorganized under the new name of "Association of American Medical Colleges" - a title that it retains to the present day. Dr. Nathan Davis served as President of the A. A. M. C. from 1891 through 1894 while the organization shepherded American medical colleges toward acceptance of the national standards he had called for in 1846 and defined in 1867.
State Licensing Boards Spur Reform
In 1891 the National Confederation of State Licensing Boards voted to require a minimum of three years of medical training. This decision to deny licensure to laggard schools was critical. It initiated at last an appreciable nationwide movement toward reform. By 1893, 96 percent of schools required at least three years of study, and when the A. A. M. C. met in San Francisco in 1894, twenty-one of the seventy-one members voted to require a four-year course to be effective for the graduating class of 1899. Cooper Medical College had already implemented such a requirement. In the Annual Announcement for 1893, the Faculty announced "the adoption of a four years' curriculum to take effect January 1st, 1894, for all students matriculating after that date."[34]
But much further progress was still needed, particularly in the content and methods of medical education nationally. In his Report on Medical Education in the United States and Canada to the Carnegie Foundation in 1910, Abraham Flexner mercilessly exposed the gross deficiencies still existing in the programs of the generality of American medical schools, a subject to which have already briefly referred and will later return.[35]
Revival of Medical Societies in California
We turn now to the role of the San Francisco Medical Society and the California State Medical Society in the general movement to reform medical education and drive out "irregular" practitioners (i. e., those without a legitimate M. D. degree).
We have seen that frustration over failure to reform medical schools led the A. M. A. in 1869 to call upon State Societies to establish Boards of Medical Examiners. It was recommended that applicants for a license to practice medicine be required by the Boards to submit proof of having had a proper general education, and of having completed a full course of medical studies in a "recognized school." It was hoped that the Boards would force medical schools to reform by recognizing only schools with high standards. The Boards would at the same time serve the purpose of weeding out "irregular" practitioners.
This leads us to a consideration of the revival of the San Francisco Medical Society and the California State Medical Society, both of which were in suspension during the early 1860's; and the extent to which these Societies contributed to the eventual establishment of Boards of Medical Examiners in the State.
Third San Francisco Medical Society, 1868
We have already mentioned that the First and Second versions of the San Francisco Medical Society, like other California medical societies in the Gold Rush era, failed to survive the intense medical competition, personal rivalries and social upheaval of the period. Prior to its complete disappearance in the late 1850's, the Second San Francisco Medical Society had a period of mild florescence during the presidency of Henry Gibbons, Sr. He never ceased to express regret, through editorials in the Pacific Medical and Surgical Journal, over the demise of medical societies in California, and he was a persistent advocate of their revival as a requisite for professional amity and advancement in the State.[36]
It is not surprising then to find Dr. Gibbons playing a major role in restoration of both the San Francisco and the California State Medical Societies. Although Dr. Gibbons never claimed the distinction, it was undoubtedly he who, in early January 1868, "invited to his residence several members of the profession, to consider the propriety of organizing a Medical Society".[37] After two or three more preliminary sessions to frame the Constitution and Bylaws, the first meeting of the Third San Francisco Medical Society was held on 4 February 1868. It was at this meeting that the officers and standing committees of the Society were selected.
Familiar names among the revived Society's new officers and committee members were J. P. Whitney, President; Henry Gibbons, Jr., Recording Secretary; Thomas M. Logan, Corresponding Secretary; Henry Gibbons, Sr., Admissions Committee; and John F. Morse, Ethics Committee.[38]
Henry Gibbons, Sr., greeted the new Society with an editorial in the Pacific Medical and Surgical Journal of which he was Senior Editor:[39]
We are highly gratified to be able to announce the birth of (the San Francisco Medical Society), the need of which has been seriously felt by the members of the profession in San Francisco for a number of years. It opens on a liberal basis, ignoring all personal considerations, and all cliques and coteries. . . We have not a doubt of the success of the present movement. We know that the profession in this city contains the elements of a large, useful and flourishing association.
The first scientific meeting of the reborn Society was convened on 24 March 1868 in San Francisco's imposing City Hall.[40] In honor of the occasion, the newly elected president, Dr. J. P. Whitney, delivered an inaugural address which was ironically, in view of subsequent developments, mainly concerned with drawing the distinction between "regular" and "irregular" doctors in San Francisco.[41]
By 1868 San Francisco had become a more hospitable environment for medical societies and medical schools than previously. When gold was discovered in 1848 the population of San Francisco was less than 1,000. By the end of 1849, the Gold Rush had swelled the former bayside outpost to a chaotic city of 30,000. A decade later, in 1859, the population had more than doubled to a total of 70,000. By mid 1868, it had doubled again, reaching 147, 950.[42][43]
General conditions gradually improved as the population matured. By 1868, the motley assemblage of tents and shanties, argonauts and adventurers of '49 had given way to a stable and flourishing society. Schools, churches, business enterprises and family life contributed to an atmosphere of civility, culture and progress. It was a season of economic prosperity. There were good rains and bumper crops. Downtown consisted of substantial buildings, many of stone or brick. Comfortable middle class homes adorned the surrounding hills. Optimism was in the air as day-by-day, the gap narrowed between the eastern and western ends of the transcontinental railroad that would in another year link coast to coast.[44]
Dr. Gibbons was elated with the prompt and favorable response of the profession in San Francisco to the call for reinstatement of a medical organization in the city. In an editorial in the Pacific Medical and Surgical Journal in May 1868, he confidently predicted a bright future for this third San Francisco Medical Society.[45]
The Medical Society of San Francisco is now fully established, and in good working order. Its meetings are held on the evenings of the second and fourth Tuesdays of every month. . . in the City Hall. Already the good results of such organizations are rendered palpable by the development of professional activity and energy in the form of discussions and written communications. We expect the association soon to gain such a position as a school of medicine, that no practitioner can afford to do with out it.
Dr. Gibbons was prophetic. The Third San Francisco Medical Society has endured to the present day.
A. M. A. Invited to meet in San Francisco
The year of 1870 was a busy one for Dr. Gibbons. Most importantly, he masterminded the revival of the Medical Department of the University of the Pacific, as we have seen. He also undertook other important tasks.
In April 1870 the State Legislature established a State Board of Health, the second in the nation and, in May, Dr. Gibbons was elected as the first President and Dr. Thomas Logan as the Secretary of the State Board.[46][47]
During 1870, Dr. Gibbons served both as President of the San Francisco Medical Society and Vice President of the American Medical Association. In that dual role he presided over arrangements for the A. M. A. to hold its Annual Meeting in San Francisco in 1871.
As a result of previous groundwork by Dr. Thomas Logan, the A. M. A. let it be known that an invitation to hold its 1871 meeting in San Francisco would be welcome. In response to this encouragement, the San Francisco Medical Society appointed Dr. Joseph C. Tucker, director of the local U. S. Marine Hospital and a member of the A. M. A., to serve as a delegate from the San Francisco Medical Society to the Annual Meeting of the Association held at Washington, D. C., in May 1870. Dr. Tucker was the only delegate from California at the Washington meeting where he extended a formal invitation to hold the next Annual Meeting in San Francisco. The invitation was accepted, and at the end of the Washington meeting the "Association adjourned to meet at San Francisco on the first Tuesday in May, 1871." It would be the first meeting of the A. M. A. in the Far West.[48][49]
San Francisco was a popular choice because of the recent availability of a convenient means of travel, and the prospect of viewing the legendary region west of the Mississippi from the comfort of the transcontinental railway now in service. In an all-out construction race, the Central Pacific Railroad laid track from the west and the Union Pacific from the east until they met near Ogden, Utah. On 10 May 1869. with an engine from the west drawn up cowcatcher to cowcatcher with an engine from the east, Leland Stanford of the Central Pacific took up a position on the north side of the track and Thomas Durant of the Union Pacific on the south. Then each drove a spike that joined the rails, and inaugurated travel by train from the Atlantic to the Pacific. The ceremonies that followed celebrated an historic engineering achievement and marked the beginning of a new era. The festivities included an address by Professor Morse and, in honor of the occasion, Bret Harte was inspired to contribute the following deathless poetry:[50]
What was it the engines said,
Pilots touching - head to
head ?
----------------------------
Said the engine
from the west;
"I am from Sierra's crest,
and if
altitude's the test,
Well, I reckon, it's confessed,
That I've done my level best."
Said the engine from the
east:
"Those who work best talk the least.". . .
Certainly there could have been few inducements other than tourism for the A. M. A. to hold its Annual Meeting in San Francisco in 1871. The city by the Golden Gate had a national reputation for factional infighting among its doctors and between its medical schools. Organized medicine in the city was currently represented by only a recently-resurrected local medical society of uncertain viability, and it was well-known that the California State Medical Society had expired of acute and chronic dissension in 1861.
It was soon evident that the contentious spirit of earlier days had not been extinguished. When the testy Dr. Stillman, Editor of the California Gazette, heard that the A. M. A. had been invited to meet in San Francisco he hastened to issue the following bull in June 1870:[51]
We give the following report of the proceedings of the National Medical Association, held in May 1870, at the National Capitol, as given in the New York Medical Gazette:
"To those who have read the published reports of the proceedings of the late session of the American Medical Association, no words of ours could more vividly picture the degrading position in which that body has placed our profession before the eyes of the community. We would fain, if it were possible, keep the shame a secret; but the busy tongues of the daily press have babbled it verbatim by the column, to the thousand-eared public, and it is well that those who know our disgrace should know, also, that there are some among us who blush for it."
(Now Stillman adds his caustic personal views.:) Twenty-one years ago this Association was organized with the best wishes and highest hopes of the medical profession. What has it done in all that time? Year by year it has dwindled until the hopes of its founders have ended in shame and humiliation. No subject of higher consideration than the fee that should be charged for examination for life insurance companies, or the color of the skin requisite to membership in medical societies was definitely settled.
The proceedings upon the whole would do credit to some Trades' Union Convention, and its objects seem to have been no higher. If the profession at large has been deteriorating as fast as this national association during the same time, may God have mercy on us!
The Association did agree upon one other thing which fills us with apprehension. It resolved, upon the solicitation of some physician, who was at Washington on some lobby business connected with a hospital contract, who it seems had credentials sent to him by the so-called San Francisco Medical Society, to invite them to meet next year in this city.
We shall be glad to see them; we will show them the Seal Rock, Woodward's Gardens, our magnificent and unique City and County Hospital, and do the best we can to make their stay as pleasant as possible. The President of the San Francisco Medical Society, will be delighted to take them to Yosemite Valley; his overflowing wine cellars will make their hearts glad; but we hope the "nigger question" will not be raised here for we are not all white. Some Caucasian physicians too, do attend African patients, and the question might be raised - but we will not borrow trouble, "sufficient for the day is the evil thereof."
Editor Stillman's tirade merely confirmed the existing impression in the east that the professional environment in San Francisco was uncommonly rancorous. His sanctimonious criticism of the Association's handling of a membership issue involving race was uncalled-for. The National Medical Society in the District of Columbia, organized by African-American physicians, accepted members who were not licensed to practice medicine. Solely on that account the Ethics Committee, chaired by the meticulous Dr. Nathan S. Davis, ruled that members of the National Medical Society were ineligible to serve as Delegates to the Annual Meeting at Washington in May 1870. The decision was warmly contested at the meeting but finally sustained by a large majority, "inasmuch as it has been distinctly stated and proved that the consideration of race and color has had nothing whatsoever to do with the decision." The episode does serve to point up again the divisiveness of the question of "irregular" physicians.[52]
In rebuttal to Dr. Stillman, Henry Gibbons only published a quite civil letter from Dr. Tucker who mildly rebuked the personal slanders and bad manners of the Editor of the Gazette.[53] Dr. Gibbons himself stayed out of the dispute for he was at this time engaged in fending off Stillman's vicious editorial attack on the Faculty of the Medical Department of the University of the Pacific for their letter to the Regents of the State University. In that communication the Faculty urged the Regents to organize the medical department of the University distinct from any medical school, and to appoint an impartial Board of Examiners for conferring degrees.
Revival of California State Medical Society
As President of the San Francisco Medical Society, Dr. Gibbon's attention was now drawn urgently to a vital issue. The existence of a State Medical Society was an essential prerequisite to the hosting of the A. M. A. in May 1871. This meant that only eight months remained in which to revive and reorganize the defunct State Society. To expedite the process, Drs. Gibbons and Logan, acting in their capacities as President and Secretary of the State Board of Health respectively, published the following notice in the issue of Pacific Medical and Surgical Journal for September 1870:[54]
State Medical Society
State Medical Society
In compliance with the request of a number of physicians in different parts of the State, and in view of the meeting of the National Society to be held in San Francisco in May 1871, the State Board of Health, as the only organization representing in any degree the profession in the State, hereby invite all regular practitioners in California to meet in San Francisco on
Wednesday, October 19th
for the purpose of reorganizing the State Medical Society. Local Societies and Medical organizations of all kinds are request to send delegates.
H. Gibbons, President
T. M. Logan, Secretary.
Pursuant to the above call from the State Board of Health, the meeting to reorganize the State Medical Society of California convened in the hall of the Young Men's Christian Association in San Francisco on the 19th and 20th of October 1870. At the request of Dr. Gibbons, Dr. Logan delivered the address of welcome:[55]
Gentlemen: In consequence of the part I have taken, as the executive of the only organization representing, in any degree, the profession of the State, in calling you together, it becomes my privilege, as well as my duty, to thank you sincerely for this your cordial response. Fourteen years ago, in association with the lamented Cooper, who was the leading spirit of the occasion, I officially signed the call, as Corresponding Secretary of the Medical Society of Sacramento, for a Convention in that city, to inaugurate the scheme which we are now assembled to resuscitate. The objects for which the State Medical Society was formed did then, as they do now enlist my warmest interest and command my active cooperation; and, judging from the intelligent - many of them old familiar - faces around me, I have reason to believe that I entertain these views and professions only in common with you all. . .
Upon conclusion of Dr. Logan's address, Dr. A. B. Stout, who played such a prominent role in the extinction of the former State Society, came forward with the motion "that this Convention organize itself into a State Medical Society." The motion was immediately approved and the original Society was thus reborn at the behest of its former despoiler, and without a whisper of dissent.
Drs. Logan of Sacramento, Gibbons of San Francisco and Shurtleff of Stockton were appointed as a committee to draft a constitution, an assignment they promptly discharged by recommending that the Constitution of the old Society be adopted. Their recommendation was approved unanimously.
Dr. Logan was then unanimously elected President. Dr. Stout was elected as Treasurer, and Drs. Nixon of Sacramento and Gibbons, Jr., of San Francisco as Secretaries.
Throughout the proceedings, emphasis was on the amicable and brisk conduct of business. When Dr. Hoffman of San Diego offered the following resolution, controversy over "the woman question" was avoided through a parliamentary maneuver by Dr. Stout:[56]
Resolved, That all persons, of either sex, who possess the qualifications prescribed by the Constitution may become members of this society.
On a motion by Dr. Stout, the motion was laid on the table, indefinitely.
When a member from the interior, in the course of remarks, referred to the profession in San Francisco as bearing the reputation of being divided into hostile cliques, Dr. H. Gibbons, Sr., requested the privilege of correcting the error. He argued that the great body of physicians of the city were in perfect harmony. He added, no doubt with Dr. Stillman in mind, that as a matter of course, among so many there are bound to be a few growlers who take pleasure in giving a bad name to medical organizations.
Dr. Gibbons pronounced the meeting for reorganizing the State Society to be a complete success. He characterized the proceedings as entirely harmonious and marked by a high degree of professional spirit. About eighty doctors were enrolled as members. Many others who were not able to attend signified their wish to become members. Therefore, the meeting was adjourned until 1 May 1871, the day before convening of the San Francisco Meeting of the American Medical Association, at which time they had an opportunity to join the State Society.
A. M. A. Meeting in San Francisco, 2-5 May 1871
In the opinion of Dr. Gibbons, the atmosphere of the meeting was distinguished by the gracious hospitality extended by the San Francisco hosts to their visiting brethren from the east. As predicted by Dr. Stillman, there was a busy schedule of sight-seeing for the guests including visits to medical and cultural institutions, and views of the awesome scenery of San Francisco Bay during a lengthy excursion aboard the steamer Antelope.
When officers of the Association for the ensuing year (1872) were selected, Dr. Thomas. Logan was chosen First Vice President. This placed him in the line of succession so that at the Annual Meeting for 1872, he was elected President of the A. M. A. for 1873.
Topics on the agenda of the San Francisco meeting ranged from medical education to ethical matters, including quackery and abortion, but no significant issues were settled.
Unfortunately, the President of the A. M. A., Dr. Alfred Stillé (1813-1900), Professor of the Theory and Practice of Medicine at the University of Pennsylvania, chose an unfortunate theme for his Annual Address. According to Dr. Gibbons' sarcastic resumé of the President's remarks:[57][58]
Dr. Stillé canvassed pretty fully the question of Women Doctors, and administered to the sex a merciless castigation for their attempts to rise to a level with man in intellectual pursuits. He proved conclusively that the female mind was vastly inferior to that of man, and that women are incapable of studying and practicing medicine with success, or of attaining to distinction in any pursuit which requires mental force. His strictures on this topic were highly relished by a portion of the audience, while others were perplexed to comprehend how such an inferior animal could be the mother of man.
We include the following excerpts from President Stillé's comments in order to reinforce the point that it was not unusual for arrogant men in the highest echelons of the profession to deride the endowments of women:[59]
In every department of active life man excels woman, excels her even in things for which she is esteemed most fit. In the arts of design, in painting and sculpture, no woman, albeit the artist's career has always been open to her, has ever risen far above mediocrity; while men have excelled women in not a few employments which are regarded as essentially feminine. In the art of cookery, for example, no woman ever occupied the first rank; and in more than one capital, male hairdressers and dressmakers set the fashions in which court ladies and city dames contend for the palm of beauty. . . .
Women may possibly become persuasive preachers, or even safe practitioners of domestic medicine; but learned and subtle divines, great lawyers, scientific physicians - never. To reach such eminence, a knowledge of principles is necessary, a power of eliminating the essential from the accidental, of distinguishing plausible falsehood from genuine truth, and that power has been denied them. It seems very probable that if woman could be made fully to comprehend the difficulties of a professional career, and the vastness and complexity of medical science and art, she would be less eager to become a physician. . . .
If, then, woman is unfitted by nature to become a physician, we should, when we oppose her pretensions, be acquitted of any malicious or even unkindly spirit. . .
After Dr. Stillé's Address, a controversial amendment to the Association's Constitution, proposed by Dr. Hartshorne of Pennsylvania at the previous Annual Meeting, was called up for consideration:[60]
Resolved, That nothing in this Constitution shall be so construed as to prevent delegates from colleges in which women are taught and graduated in medicine, and hospitals in which medical women graduates in medicine attend, from being received as members of this Association.
Dr. Nathan Davis, the chief parliamentarian of the meeting, pointed out that the net result of this amendment would be to admit delegates from female colleges, whether male or female, to the meetings of the Association. It would, in essence, legitimize the admission of qualified women to the A. M. A. on an equal basis with men - and Dr. Davis was firmly opposed to this eventuality.
In the heated debate which followed, Dr. Gibbons' response to the demurrer of Dr. Davis is memorable:[61]
I am surprised at so good a logician as Dr. Davis resorting to the ad captandum bugbear of female suffrage. The question is not, Shall women study and practice medicine? We can not settle that question. They are doing it in spite of us, and the more we oppose them, the greater their determination and their success, and the stronger the public sympathy for them. The question is, When a woman has had a regular medical education, and has received a well-earned diploma, shall we treat her with the same courtesy as a man, or shall we trample her under foot merely because she is a woman? I don't understand why the idea of a female delegate in this body is so terrifying. We have ladies here now, as spectators, by special invitation, and the members appear satisfied. This is the first time I ever spoke publicly on this question. But standing here on the verge of the continent, outside of the vortex of excitement, and surveying dispassionately the course of events in America and in Europe, I am satisfied that, in our opposition to female doctors, we are only damming up the stream to increase its power. Public sentiment is more and more against us. Our best policy is to accept the situation. In view of the future, I wish to place myself on the record in favor of the amendment. Let women study and practice medicine if they will. It is a matter of taste. We can not help it. . .If a woman is smart enough to compete with me in practice, let her do it. I will show her fair play, just as I do a man.
After an animated discussion of about two hours, a motion to postpone indefinitely was carried: yeas, 85; nays, 25.
In concluding our reference to the first meeting of the A. M. A. on the Pacific Coast, we must reluctantly report that some of the medical profession in San Francisco misbehaved during the meeting, thus preserving the city's reputation for divisive "cliques and coteries." Dr. Gibbons' mail from delegates to the recent meeting contained references to "disorder and want of harmony as a feature of the sessions of the Association lately held in San Francisco."
Dr. Gibbons, as usual, rose to the defense of the local profession, insisting that although some of the doctors refused to participate in the reception of the visitors, the welcome was on the whole extremely cordial. He maintained that "the physicians of the city and State vied with each other in perfect harmony of feeling and action, for the purpose of honoring and entertaining their guests."
Dr. Gibbons conceded that a disreputable publication did appear during the meeting, denouncing the Association and falsely asserting that a large number of the most eminent medical men in town were hostile to it - statements which our faithful apologist dismissed as false, mendacious and malignant.
In spite of Dr. Gibbons' impression that perturbations in the San Francisco medical community during the A. M. A. meeting were minor and inconsequential - one might say within the normal range for the universe in question - they were sufficient to evoke from President Stillé the following rather stern letter to Dr. Gibbons:[62]
I sincerely trust that the late meeting may have some influence in promoting union among the members of the Profession in your city, and at the same time in showing those of them who kept aloof that their conduct has done more to lower them in the opinion of their visitors than they can readily estimate. The people of San Francisco have lived so isolated a life until the railroad was opened, that some of them seem to have forgotten that they belong to the family of civilized man, and are expected to conform to the usages and courtesies of older communities.
Evolution of the California State Board of Medical Examiners
Our ultimate objective in tracing the revival of the San Francisco and State Medical Societies is to provide background for an assessment of their role in the establishment of a State Board of Medical Examiners in California, as urged by the American Medical Association.
It is surprising to learn that Dr. Gibbons actually had little interest in this issue. In January 1870 he wrote an editorial in the PMSJ entitled "Legislation against Quackery:"[63]
A bill has been introduced in the California Legislature by Mr. Naphtaly, similar to the law of Ohio, Minnesota and some other states, prohibiting persons from practising medicine without the diploma of a medical College, or a license from a State Board of Examiners. . . The subject is a fit one for legislation, provided legislation can be made effectual. It is well, however, that the movement is not made by physicians.
Also in January 1870, Dr. Stillman disavowed interest in Mr. Naphthaly's bill before the Legislature. Unaccountably, in view of his contempt for the organization, Stillman assigned to the American Medical Association the task of determining standards and, through subordinate associations in each State, conferring the medical diploma. He addressed the topic in his usual incisive manner:[64]
A Bill is before the State Legislature which has for its object the regulation of the practice of medicine. Its details are unknown to us, nor do we care to know them. . .
The American Medical Association has for more than twenty years been laboring to. ..raise the standard of medical education, but without success. . . When the Association addresses itself to the work of establishing its own standard of medical qualifications, and shall confer its own title upon its members, with subordinate associations in each State, then it will have taken the only available road out of the wilderness. . .
Then the A. M. A. may ask for legislative protection only to punish all such as assume its title without its authority. This, it seems to us, is all the legislation that should ever be asked for by the medical profession.
Meeting of State Medical Society, April 1873
As indicated by the above editorials, an antiquackery law had already been under consideration in the California Legislature for several years when the Third Annual Meeting of the California State Medical Society convened in April 1873. It was at this meeting that Professor John F. Morse introduced the following Resolution, the only proposal regarding a Board of Medical Examiners to be considered by either the San Francisco and or the State Medical Society until the 1875 meeting of the State Medical Society:[65]
Resolved, That the State Medical Society of California, desiring to see some system adopted by which a high and liberal standard of medical education and graduation may be secured, have heard with great pleasure that our State University contemplates the organization of an independent Board of Medical Examiners, and we do hereby express the hope that such a Board may be appointed, on a foundation so independent, that, upon their certificate of graduation, a diploma of the University will be granted and conferred , irrespective of the school or source of instruction in which the applicant has been educated.
This resolution was similar to the proposal to establish a Board of Medical Examiners made to the Board of Regents of the University of California by the Faculty of the Medical Department of the University of the Pacific in 1870. As we have already noted, when the proposal was adopted temporarily by the Regents in c. April 1873, it caused much confusion and ill-will.
Approval of Dr. Morse's Resolution by the State Medical Society would keep open the question of a State Board of Medical Examiners appointed by the Regents of the University of California with the sole power in the State to conduct final examinations and award the M. D. degree. If such a Board were established, both Dean Cole's Medical Department and the Medical College of the Pacific would thereby be divested of important prerogatives.
It is important to note that the State Board of Medical Examiners as proposed by Dr. Morse did not address the issue of licensure of all physicians in the State. That being the case, his Resolution failed to deal with the major problem agitating the public and physicians in California, i. e., "irregular" doctors and quackery.
After a lengthy discussion, the State Society declined to approve the Resolution, deeming it "premature." It was, therefore, on motion, laid upon the table for one year.
Meeting of San Francisco Medical Society, c. June 1873
A few months later at the meeting of the San Francisco Medical Society, Dr. Morse again campaigned for his version of a State Board of Medical Examiners. He made the argument that control of examinations and graduation by an independent Board of Examiners would raise the standard of medical education and enhance the value of the M. D. degree. He concluded by introducing the following Resolution which was similar to that tabled at the State Society meeting:[66]
Resolved, That in the opinion of the San Francisco Medical Society, there should be a competent, independent State Board of Medical Examiners, whose duty it should be to carefully examine all persons who claim the proper qualifications, and who desire to obtain a diploma of regular medicine; and that to such applicants as pass this examination and receive the endorsement of the aforesaid Board of Examiners, there should issue a diploma from the highest possible State authorities, irrespective of any conditions except the thorough qualification of the applicant, as attested by the Board of Examiners.
After discussion, the San Francisco Medical Society adopted the Resolution and commended it to the consideration of the several medical associations throughout the State.
Meeting of State Medical Society, April 1874
Encouraged by the support of the San Francisco Society, Dr. Morse reintroduced his Resolution a year later on 16 April 1874 at the Fourth Annual Meeting of the State Society, again recommending the institution of a State Board of Examiners not connected with any medical school, which should have the exclusive authority to conduct final examinations and confer degrees.[67][68]
This was the third time within a year that Dr. Morse had proposed his Resolution to a medical society. Dr. Beverly Cole saw plainly that implementation of the proposal would significantly limit his authority as Dean of the Medical Department of the University of California, and would be a coup for the Medical College of the Pacific whose Faculty had originally proposed the measure to the Board of Regents of the University. Thoroughly incensed at the repeated introduction of this threatening Resolution, Cole attacked it with great severity, declaring it to be impracticable and preposterous. He also reflected harshly on Dr. Morse, personally.
Dr. Morse responded in his usual earnest and persuasive manner and it was evident from the frequent applause which he elicited that he had with him the sympathies of the audience.
But when Dr. Gibbons saw that Dr. Cole's intemperate language was becoming a needless embarrassment to the Society, he adopted a standard stratagem for controlling unruly debates. He offered a substitute Resolution calling for further study of the issue:
Resolved, That it is desirable that there should be a uniform system of examinations for the Degree of Doctor of Medicine, apart from the institution of teaching, so that the Diploma shall be awarded to all competent candidates, and that the profession and society at large shall be secured against the possibility of the degree of Doctor of Medicine being conferred upon unworthy or incompetent individuals.
Resolved, That a committee of five be appointed by the Chair, to prepare and present at the next meeting of the society some plan by which the said object can be accomplished.
Dr. Morse accepted the substitute, and it was adopted unanimously. The committee of five was appointed to included Drs. Morse, Gibbons and Logan. There the matter rested. The committee never reported.
Separation of teaching from qualifying examinations and credentialing was a lost cause. It was an abortive attempt to plant a British tradition in stony ground. Dr. Cole was correct. The proposal was impracticable and not in his interest - nor in that of the Medical College of the Pacific. Had the proposal been implemented, medical education in California would have been politicized, as was the administration of the University of California itself after the departure of President Gilman.[69]
Dr. Morse's Resolution would not have received so many hearings but for the wide personal influence of Dr. Morse. He doubtless would have continued to press for its adoption had he not become seriously ill during the fall of 1874. He died on 31 December. It was his last crusade.
Meeting of the State Medical Society, April 1875
Dr. Thomas Logan, Secretary of the State Board of Health, was also Chairman of the Society's Committee on State Medicine and Public Hygiene in California. In his Committee Report, Dr. Logan referred to the Society's past failure to adopt the Resolution of Dr. Morse, and pointedly refrained from proposing further consideration of it.
He further reported that he had been called upon by the California Legislature, as the Chief Sanitary Officer of the State, to prepare a bill for presentation to the next Legislature, looking specifically to the prevention of the practice of medicine and surgery by unqualified persons.
In response to these instructions, Dr. Logan drafted a statute for establishment of a State Board of Medical Examiners with the responsibility to determine the validity of the Medical Degree of every physician practicing medicine or surgery in California. In preparing the statute, he drew upon the text of measures being enacted by other States for the same purpose, including Nevada and New York.
Dr. Logan concluded his Committee Report by appending a copy of his proposed bill bearing the following title:[70]
An Act For the Better Protection of the Sanitary Interests of the People against Fraud and Imposture in the Practice of Medicine land Surgery.
After a free discussion of the Act and related issues, the Society appointed a three-member Committee on Legislation which drafted a bill that was laid before the Legislature. Members of the Committee lobbied for adoption of its provisions, some but not all of which were included in the final version of the legislation.[71][72]
Final Bill to Regulate Medical Practice in California, April 1876
A bill to regulate medical practice was finally approved by the Legislature on 3 April 1876. The following is a summary of its main provisions:[73][74]
The Act to Regulate the Practice of Medicine in the State of California
The Act to Regulate the Practice of Medicine in the State of California
The Act requires that each State Medical Society incorporated and in active existence on 10 March 1876, whose members are required to possess diplomas or licenses from some legally chartered medical institution in good standing, shall appoint annually, a Board of Examiners consisting of seven members; who shall hold their office for one year, and until their successors shall be chosen.
The Act further provides that every medical graduate practicing medicine in the State shall present his diploma to the Board of Examiners for verification as to its genuineness. If the diploma is found genuine, the Board shall issue its certificate to that effect. A diploma and certificate are required for the lawful practice of medicine in the State.
If not a medical graduate, the person practicing medicine in the State shall present himself before the Board, and submit himself to such examinations as the Board shall require; and if the examination be satisfactory to the examiners, the Board shall issue its certificate in accordance with the facts, and the lawful holder of such certificate shall be entitled to all the rights and privileges mentioned in the Act. But no examination into the qualifications of persons not holding diplomas or licenses shall be made after 31 December 1876. After this date no certificates shall be granted by the Board except to persons presenting diplomas or licenses from legally chartered medical institutions in good standing.
(This provision for certification by examination was inserted to provide a strictly limited period during which "old-timers," who held no diploma but had proven competent in practice, might obtain a certificate if able to pass examination by the Board.)
Any person practicing medicine or surgery in this State without complying with the provisions of this Act, shall be punished by a fine of not less thant fifty dollars ($ 50) nor more than five hundred dollars ($ 500), or by imprisonment in the County Jail for a period of not less than thirty days nor more than three hundred and sixty-five days, or by both such fine and imprisonment, for each and every offense.
(This original Medical Practice Act, with minor revisions made in 1878, remained in effect and unchanged in form until 1901.)
Nothing in the Act prevented Homeopathic physicians and Eclectic physicians from organizing State Societies and appointing Boards of Examiners in like manner to the California State Medical Society for "regular physicians." This option was initially considered by regular physicians to be an objectionable feature of the Act, but when the Homeopathic and Eclectic Boards proved diligent in rooting out the blatant quacks in their own ranks, the regular physicians were mollified.
The above Act as finally adopted was the result of five years of study and debate in the Legislature, involving many individuals and organizations, including Dr. Logan and the State Medical Society who, as we have seen, were late in taking an active interest in the formulation of the bill. It is sad to report that Dr. Logan, the leading medical statesman of California in his era, was not to be rewarded by seeing the approved version of the legislation. He died on 13 February 1876. At the time of his death he held the chair of Hygiene in the Medical Department of the University of California.[75]
Meeting of the State Medical Society, April 1876
The Sixth Annual Meeting of the State Medical Society met on April 19th and 20th in San Francisco. We take special note of the following two significant actions of the Society.
First, the Society voted to admit women holding valid medical diplomas to the State Society on the same basis as men. Five women were duly elected to membership (three from San Francisco, one from Oakland and one from San Jose). A male member of the Society wrote a strong letter of objection to the Editor of the PMSJ. To which Dr. Gibbons replied:[76][77]
As for the argument of our correspondent against admitting females to membership, we will leave it to have its full weight with the reader, simply remarking that if women "cannot" practice medicine, the sooner they are allowed to try it, the sooner the question will be settled, and the sooner they will retire from the field. They are determined on the trial and we cannot prevent it. Let them show their incapacity if they are incompetent, and then we shall be done with female doctors. If they cannot stride a mustang or mend bullet holes, so much the better for enterprising and skillful practitioners of the sterner sex.
Seven weeks later, on 6 June 1876 at the Annual Meeting of the A. M. A in Philadelphia, Dr. Sarah Hackett Stevenson, delegate from the Illinois State Medical Society, became the first woman member of the A. M. A.
Second, the California State Society elected the seven members of the first Board of Examiners of the Medical Society of the State of California. Dr. Gibbons was among them. The Board was officially organized on 1 June 1876. It was announced in the PMSJ that the first meeting for examinations would be held in San Francisco on June 29th; and that meetings for the same purpose would be held subsequently at Sacramento, Chico, and Los Angeles.[78]
Dr. Gibbons, who was 68 years of age, was forced to resign from the Board of Examiners on 19 September 1876 because of illness. It was an ominous sign that his health had begun to fail. From that period until the time of his death on 5 November 1884, he was frequently unwell.[79][80]
State Licensing Boards Spur Reform
We now recall the Resolutions proposed by Dr. Nathan Davis and endorsed by the A. M. A. in 1869 calling upon the State medical societies of the country to establish State Boards of Medical Examiners in the hope that they would promote the reform of medical education. Eventually, this approach had the desired effect.
On 4 January 1888 the California Board of Medical Examiners took a firm step in the hoped-for direction of mandating educational reform by adopting the following resolution:[81]
Whereas, the law to regulate the practice of medicine in the State of California, provides, that the Board of Examiners in the discharge of its official duties shall determine what colleges are in good standing, whose diplomas may be presented by applicants for certificates under the law;
And, Whereas, it is apparent that the protection of the public and the best interests of the profession require a higher standard of medical education than that which is now adopted by many Colleges,
Therefore, Resolved, that on and after April 1, 1891, the Board of Examiners of the Medical Society of the State of California will not grant certificates to practise medicine on diplomas issued after that date by Colleges which do not require that all candidates for graduation shall have studied medicine not less than three full years, and shall have attended not less than three full regular courses of lectures delivered during three separate yearts.
In 1891 the National Confederation of State Licensing Boards voted to require a minimum of three years of medical training. This decision to deny licensure to laggard schools was critical. It initiated at last an appreciable nationwide movement toward reform. By 1893, 96 percent of schools required at least three years of study, and when the A. A. M. C. met in San Francisco in 1894, twenty-one of the seventy-one members voted to require a four-year medical program to be effective for the graduating class of 1899.[82]
Cooper Medical College had already implemented such a program. In the Annual Announcement for 1893, the Faculty announced "the adoption of a four years' curriculum to take effect January 1st, 1894, for all students matriculating after that date."
But much further progress nationally was still needed, particularly with respect to premedical studies and the content and methods of medical education. In his Report on Medical Education in the United States and Canada to the Carnegie Foundation in 1910, Abraham Flexner mercilessly exposed the deficiencies still existing in the programs of the generality of American medical schools, a subject to which have already briefly referred and will later return.[83]
Endnotes
- Illustrations: 1. Chapel and College Building of University City College, Pacific Expositor, July 1861; 2. Original College Building after removal to 129 Haight Street in 1876. Drury , William Anderson Scott, No Ordinary Man, p. 320.[See Files on University (City) College and Illustrations.]Lane Library catalog record
- Faculty Minutes for 23 May 1870, Minutes of Meetings of Faculty of Medical Department of Pacific, 23 May 1870 to 24 May 1874, Box 1.18 vol. 1, Medical College of the Pacific Medical Department, University College, San Francisco, Lane Medical Archives, Stanford Lane Library catalog record
- Annual Announcement of the Medical Department, University of the Pacific, Session of 1871, pp. 6-7 Lane Library catalog record
- See also page 6, and Note 10 in Chapter 1
- Faculty Minutes for 25 January to 2 March 1872, Minutes of Meetings of Faculty of Medical Department of Pacific, 23 May 1870 to 24 May 1874, Box 1.18, vol. 1, Medical College of the Pacific Medical Department, University College, San Francisco, Lane Medical Archives, Stanford Lane Library catalog record
- Ninth Annual Announcement of Medical Department of University of the Pacific, Session of 1871 (Insert) Lane Library catalog record
- Annual announcement of the Medical College of the Pacific, Session of 1872, pp. 5-6 Lane Library catalog record
- Oscar T. Shuck , ed., "Henry Huntly Haight," in Representative and Leading Men of the Pacific (San Francisco: Bacon and Company, 1870), pp. 663-666 Lane Library catalog record
- Henry K. Beecher and Mark D. Altshcule , Medicine at Harvard: The First Three Hundred Years (Hanover, New Hampshire: University Press of New England, 1977), pp. 87-90 Lane Library catalog record
- Martin Kaufman , American Medical Education: The Formative Years, 1765-1910 (Westport, Connecticut: Greenwood Press, 1976), pp. 109-110, 127-130 Lane Library catalog record
- Henry Gibbons, Sr. , "Gradation of Studies in Medical School," Pacific Medical and Surgical Journal 14, no. 50 (1871 July): 79 Lane Library catalog record
- Henry K. Beecher and Mark D. Altschule , Medicine at Harvard: The First Three Hundred Years (Hanover, New Hampshire: University Press of New England, 1977), pp. 88 Lane Library catalog record
- Alan M. Chesney , The Johns Hopkins Hospital and the Johns Hopkins University School of Medicine: A Chronicle, Vol. 1, Early Years 1867-1893 (Baltimore: The Johns Hopkins Press, 1943), pp. 39-43 Lane Library catalog record
- Alan M. Chesney , The Johns Hopkins Hospital and the Johns Hopkins University School of Medicine: A Chronicle, Vol. 1, Early Years 1867-1893 (Baltimore: The Johns Hopkins Press, 1943), pp. 44-45 Lane Library catalog record
- Johns Hopkins University , Official Circulars, (Baltimore), No. 11, (June, 1877)
- Henry J. Bigelow , "Insensibility During Surgical Operations Produced by Inhalation: The First Public Announcement of the Discovery of Surgical Anesthesia," Boston Medical and Surgical Journal 35, no. 16 (Nov 18, 1846): 309-317 Lane Library catalog record
- John C. Warren , "Inhalation of Ethereal Vapor for the Prevention of Pain in Surgical Operations," Boston Medical and Surgical Journal 35, no. 19 (Dec 9, 1846): 375-379 Lane Library catalog record
- Washington Ayer , "The Discovery of Anesthesia by Ether: With an Account of the First Operation performed under its influence at the Massachusetts General Hospital, and an extract from the Record-Book of the Hospital," Occidental Medical Times 10, no. 3 (Mar 1896): 121-129 Lane Library catalog record
- Henry K. Beecher and Mark D. Altschule , Medicine at Harvard: The First Three Hundred Years (Hanover , NH: The University Press of New England, 1977), pp. 87-90 Lane Library catalog record
- Henry Gibbons , "Address at the expiration of his term of office as President of the California State Medical Society, 9 October 1872," Pacific Medical and Surgical Journal 15, no. 6 (Nov 1872): 271-273 Lane Library catalog record
- Henry Gibbons, Sr. , "Gradation of Studies in Medical School," Pacific Medical and Surgical Journal 14, no. 50 (July 1871): 79 Lane Library catalog record
- Proceedings of the National Medical Conventions in New York 1846 and Philadelphia 1847 (Philadelphia: Printed for American Medical Association, 1847), p. 17 Lane Library catalog record
- "Minutes of the Eighteenth Annual Meeting of the American Medical Association, Cincinnati, 7-10 May 1867," Transactions of the American Medical Association 13 (May 1867): 27-28, 363-384 Lane Library catalog record
- "Minutes of the Eighteenth Annual Meeting of the American Medical Association, Cincinnati, 7-10 May 1867," Transactions of the American Medical Association 18 (May 1867): 384 Lane Library catalog record
- "Minutes of the Nineteenth Annual Meeting of the American Medical Association, Washington, 5-8 May 1868," Transactions of the American Medical Association 19 (1868 May): 105-117 Lane Library catalog record
- "Minutes of the Nineteenth Annual Meeting of the American Medical Association, Washington, 5-8 May 1868," Transactions of the American Medical Association 19 (May 1868): 27-28: 32-33 Lane Library catalog record
- "Presidential Address of William O. Baldwin," Transactions of the American Medical Association 20 (May 1869): 76 Lane Library catalog record
- "Presidential Address of William O. Baldwin," Transactions of the American Medical Association 20 (May 1869): 77 Lane Library catalog record
- "Report of the Committee on Medical Education," Transactions of the American Medical Association 20 (May 1869): 129-130, 153-154 Lane Library catalog record
- "Minutes of the Twentieth Annual Meeting," Transactions of the American Medical Association 20 (May 1869): 34-35 Lane Library catalog record
- Martin Kaufman , American Medical Education: The Formative Years, 1765-1910 (Westport, Connecticut: Greenwood Press, 1976), p. 120 Lane Library catalog record
- Commission on Medical Education, A. A. M. C. , Final Report of the Commission on Medical Education (New York: Office of the Director of the Study, 1932), Table 104. (Data from Council on Medical Education and Hospitals of the American Medical Association.) Lane Library catalog record
- Dean F. Smiley , "History of the Association of American Medical Colleges, 1876-1956," Journal of Medical Education 32, no. 7 (Jul 1957): 512-525. The section on the organization of medical colleges draws freely from this concise history by Dr. Smiley. Lane Library catalog record
- Martin Kaufman , American Medical Education: The Formative years, 1765-1910 (Westport, Conn.: Greenwood Press, 1967). pp. 155-156 Lane Library catalog record
- Abraham Flexner , Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (Boston: D. R. Updike, the Merrymount Press, 1910), 346 pp Lane Library catalog record
- Henry Gibbons, Sr. , "Editor's Table: Something Wrong," San Francisco Medical Press 6, no. 20 (Jan 1865): 188-189 Lane Library catalog record
- J. P. Whitney , "Inaugural Address to the San Francisco Medical Society," Pacific Medical and Surgical Journal 11, no. 13 (Jun 1868): 24 Lane Library catalog record
- J. Marion Read and Mary E. Mathes , History of the San Francisco Medical Society, vol. 1, 1850-1900 (San Francisco: Pub. by San Francisco Medical Society, 1958), pp. 25 and 32 Lane Library catalog record
- Henry Gibbons, Sr. , "San Francisco Medical Society," Pacific Medical and Surgical Journal 10, no. 9 (Feb 1868): 417 Lane Library catalog record
- J. Marion Read and Mary E. Mathes , History of the San Francisco Medical Society, vol. 1, 1850-1900 (San Francisco: Pub. by San Francisco Medical Society, 1958), p. 38 Lane Library catalog record
- J. P. Whitney , "Inaugural Address to the San Francisco Medical Society," Pacific Medical and Surgical Journal 11, no. 13 (Jun 1868): 22-25 Lane Library catalog record
- The State Register and Year Book of Facts for the Year 1859 (San Francisco: Henry G. Langley and Samuel A. Morison, 1859), p. 375 Lane Library catalog record
- Thomas M. Logan , "Medical History of the Year 1868 in California," Pacific Medical and Surgical Journal 11, no. 23 (Apr 1869): 499 Lane Library catalog record
- J. Marion Read and Mary E. Mathes , History of the San Francisco Medical Society, vol. 1, 1850-1900 (San Francisco: Pub. by San Francisco Medical Society, 1958), pp. 25 and 50 Lane Library catalog record
- Henry Gibbons, Sr. , "The Medical Society of San Francisco," Pacific Medical and Surgical Journal 10, no. 12 (May 1868): 562 Lane Library catalog record
- Henry Gibbons, Sr. , "Items of News," Pacific Medical and Surgical Journal 12, no. 36 (May 1870): 575-576 Lane Library catalog record
- J. Marion Read and Mary E. Mathes , History of the San Francisco Medical Society, vol. 1, 1850-1900 (San Francisco: Published by San Francisco Medical Society, 1958), p. 57 Lane Library catalog record
- J. Roy Jones , Memories, Men and Medicine: A History of Medicine in Sacramento, California (Sacramento: Sacramento Society for Medical Improvement, 1950), pp. 77-78 Lane Library catalog record
- J. Marion Read and Mary E. Mathes , History of the San Francisco Medical Society, vol. 1, 1850-1900 (San Francisco: Pub. by San Francisco Medical Society, 1958), pp. 56-57 Lane Library catalog record
- Norman E. Tutorow , Leland Stanford: Man of Many Careers (Menlo Park, California: Pacific Coast Publishers), p. 90 Lane Library catalog record
- J. D. B. Stillman , "Editorial. American Medical Association," California Gazette 2 (Jun 1870): 219 Lane Library catalog record
- Nathan. S. Davis , "Report of Ethics Committee," Transactions of the American Medical Association, vol. 21 (Philadelphia: Printed for the Association by Collins, Printer, 1870), pp. 53-55 and 65-67 Lane Library catalog record
- Henry Gibbons, Sr. , "Discourtesy Rebuked," Pacific Medical and Surgical Journal 13, no. 39 (Aug 1870): 132-133 Lane Library catalog record
- Henry Gibbons, Sr. , and Thomas M. Logan , "State Medical Society," Pacific Medical and Surgical Journal 13, no. 40 (Sep 1870): 192 Lane Library catalog record
- "Minutes of the Meeting to Reorganize the State Medical Society, 19-20 October 1870," Transactions of the Medical Society of the State of California, 1870-1871 (Sacramento: Russell and Winterburn, Book and Job Printers, 1872), pp. 1-12 Lane Library catalog record
- "Minutes of the Meeting to Reorganize the State Medical Society, 19-20 October 1870," Transactions of the Medical Society of the State of California, 1870-1871 (Sacramento: Russell and Winterburn, Book and Job Printers, 1872), p. 12 Lane Library catalog record
- Henry Gibbons , "Annual Meeting of the American Medical Association," Pacific Medical and Surgical Journal 14, no. 49 (Jun 1871): 19 Lane Library catalog record
- Morris Fishbein , A History of the American Medical Association, 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1847), pp. 82-83, 617-618 Lane Library catalog record
- Alfred Stillé , "Address of Alfred Stillé, M. D., President of the Association," Transactions of the American Medical Association 22 (May 1871): 92-94 Lane Library catalog record
- H Hartshorne , "Amendment to the Constitution," Transactions of the American Medical Association 22 (May 1871): 32 Lane Library catalog record
- Henry Gibbons , "Annual Meeting of the American Medical Association," Pacific Medical and Surgical Journal 14, no. 49 (1871 Jun): 30 Lane Library catalog record
- Henry Gibbons , "Editorial: The Late Meeting of the National Association," Pacific Medical and Surgical Journal 14, no. 50 (Jul 1871): 75-76 Lane Library catalog record
- Henry Gibbons , "Editorial: Legislation against Quackery," Pacific Medical and Surgical Journal 12, no. 32 (Jan 1870): 369-370 Lane Library catalog record
- J. D. B. Stillman , "Medical Legislation," California Medical Gazette 2 (January 1870): 107-108 Lane Library catalog record
- John F. Morse , "Resolution for an Independent State Board of Medical Examiners," in Transactions of Third Annual Meeting of Medical Society of California, 9-10 April 1873, pp. 10-1
- Henry Gibbons , "Proposed Standard for the Doctorate," Pacific Medical and Surgical Journal 16, no. 3 (Aug 1873): 135-136 Lane Library catalog record
- Henry Gibbons, Sr. , ed., "Proceedings of the California State Medical Society," Pacific Medical and Surgical Journal 16, no. 12 (May 1874): 616 Lane Library catalog record
- John F. Morse , "Resolution for an Independent State Board of Medical Examiners," Transactions of Fourth Annual Meeting of Medical Society of California, April 15-16, 1874, pp. 12-13
- William C. Jones , Illustrated History of the University of California (San Francisco: Frank H. Dukesmith, Publisher, 1895), pp. 123-137 Lane Library catalog record
- Thomas M. Logan , "Report of the Committee on State Medicine and Public Hygiene in California," Transactions of Fifth Annual Meeting of Medical Society of California, April 21-22, 1875, pp. 95-102 Lane Library catalog record
- "Proceedings of the State Medical Society, 21-22 April 1875," Pacific Medical and Surgical Journal 17, no. 12 (May 1875): 605 Lane Library catalog record
- Henry Gibbons , "History of the Medical Law of California," Pacific Medical and Surgical Journal
- 26, no. 5 (Nov 1883): 193-199 Lane Library catalog record
- Henry Gibbons , ed., "The Anti-Quackery Law," Pacific Medical and Surgical Journal 18, no. 11 (Apr 1876): 521-524 Lane Library catalog record
- W. A. Grover, Compiler, Catalogue of Physicians and Surgeons Licensed by Board of Examiners of the Medical Society of the State of California (San Francisco: A. L. Bancroft and Co, Printers, 1877), pp. 5-6
- Henry Gibbons , "Death of Dr. Logan," Pacific Medical and Surgical Journal 18, no. 10 (Mar 1876): 491-493 Lane Library catalog record
- "Minutes of the Sixth Annual Meeting of the California State Medical Society," Transactions of the Medical Society of the State of California, April 19-20, 1876, pp. 6-8 and 15 Lane Library catalog record
- Henry Gibbons , "Protest Against Receiving Females as Members of the State Medical Society," Pacific Medical and Surgical Journal 19, no. 1 (June 1876): 23-25 Lane Library catalog record
- Henry Gibbons , "Editorial: Organization of the Board of Examiners," Pacific Medical and Surgical Journal 19, no. 1 (June 1876): 37 Lane Library catalog record
- W. A. Grover, Compiler, Catalogue of Physicians and Surgeons Licensed by Board of Examiners of the Medical Society of the State of California (San Francisco: A. L. Bancroft and Co, Printers, 1877), p. 7
- Levi C. Lane , Dr. Henry Gibbons, In Memoriam: A Lane Lecture (San Francisco: Howard and Pariser, Printers and Publishers, 1885), p. 21 Lane Library catalog record
- Official Register of Physicians and Surgeons in the State of California, 4th ed., March 31st, 1889 (San Francisco: Revised and Published by the Board, 1889) p. 6 Lane Library catalog record
- Martin Kaufman , American Medical Education: The Formative years, 1765-1910 (Westport, Conn.: Greenwood Press, 1967). pp. 155-156 Lane Library catalog record
- Abraham Flexner , Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (Boston: D. R. Updike, the Merrymount Press, 1910), 346 pp Lane Library catalog record