Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective
Part IV: Cooper Medical college 1883-1912

The year 1901-1902 was not only the twentieth anniversary of the founding of Cooper Medical College, but it was also the eve of revolutionary reforms in American medical education. Thus it is an appropriate year in the life of the College to review its academic status. We shall begin by evaluating the educational program of the school in the light of national standards at the turn of the century.

In so far as national standards of medical education existed in 1901-1902, they were those promulgated by the Association of American Medical Colleges. The most controversial issues under consideration by the Association were: (1) requirements for admission to medical school and (2) duration and content of the annual lecture program. The Association met at San Francisco in 1894, and voted to amend their constitution to specify: (1) a high school diploma as the minimum requirement for admission to medical school and (2) four annual graded courses of lectures of not less than six months' duration each as a minimum requirement for graduation.^[1]

By 1901-1902 Cooper Medical College had met both these requirements. As we have already reported, in 1884 the Faculty of the College adopted the high school diploma as the minimum standard for admission, and on 1 January 1894 its three-year graded curriculum was replaced by a four-year graded program, each annual lecture series being of six months' duration.^[2][3]

As pointed out previously, the Cooper College Faculty weakened its academic program in 1895 by adopting several provisions for skipping the first year of the curriculum. One of these provisions was private study of first-year subjects followed by the passing of an examination by the Faculty. Another means of by-passing the first year was one year's pupilage with a physician approved by the Faculty. Effective in 1900, the Cooper College Faculty closed these two loopholes by the simple proscription: "Private study will not hereafter admit to advanced standing.^[4][5]

On 1 November 1898 the Faculty of Cooper Medical College issued a "Preliminary Announcement of Change of Course " which included the following revised Requirements for Admission to take effect on 15 August 1902:^[6]

The above version of admission requirements represents no substantial change from the policy adopted in 1884 to the effect that a high school education was sufficient preparation for admission to Cooper Medical College.

With respect to the critical issue of admission standards, which ultimately determine the quality of the profession, the Faculty was well aware that Presidents Eliot of Harvard, Gilman of Hopkins and Jordan of Stanford all advised that a bachelor's degree or its equivalent should ultimately be required for entrance to medical school. Nevertheless, the Faculty was unprepared to take such a step. Like other free-standing proprietary schools, Cooper College depended upon tuition for its support. High standards for admission would have resulted in a disastrous reduction in the student body and in tuition income. It was growing increasingly clear to the Directors and Faculty of the College that only financial underwriting by a parent body such as a university could provide for the higher admission standard called for by the presidential triumvirate.

Throughout the two decades prior to 1901-1902 the lecture program at Cooper College consisted of an optional Short (Intermediate) Course of three months (February 1 to April 30), and a required Long (Regular) Course of six months (June 1 to November 30). The annual total of instruction by lecture was nine months, only six months of which were required.

The "Preliminary Announcement of Change of Course," issued on 1 November 1898 and referred to above, announced the following major changes in the dates and duration of the lecture program.

In order to conform to the almost universal custom of colleges to begin courses in the fall and conclude them the following spring, the Faculty decided to eliminate the optional Short Course of lectures entirely. Instead it would give annually a single required Regular Course of eight months' duration to be held during the winter instead of the summer months.

This new arrangement was initiated in 1899 and phased in over a two-year period so that on 15 August 1900 a regular schedule was established to begin August 15th each year, and continue for eight months (i.e., to mid-April).

Henceforth, Requirements for Graduation at Cooper College included the satisfactory completion of a graded curriculum of four annual Regular Courses, each of eight months' duration.^[7]

In connection with its limited effort to evaluate American medical education, the Association of American Medical Colleges conducted a survey by questionnaire of sixty-six of the 160 medical schools in order to determine the number and length of their annual lecture courses The following results of the survey were reported at the 1904 meeting of the Association:^[8]

Length of Lecture Course

4 years of 6 months each	6 Schools
4 years of 7 months each	19 Schools
4 years of 7 1/2 months each	2 Schools
4 years of 8 months each	23 Schools
4 years of 8 1/2 months each	1 Schools
4 years at 9 months each	15 Schools
TOTAL SCHOOLS IN SURVEY	66

The above data showed that four annual courses of eight months each was the pattern most frequently chosen by the sixty-six medical schools surveyed. We have just seen that Cooper Medical College adopted that schedule in 1899, making it possible for us to conclude that the College was then following common practice with respect to the number and duration of its lecture courses. We also learned from the survey that 15 trend-setting medical schools had by 1904 already extended their annual courses to nine months, theoretically enhancing their programs over those of schools with a shorter curriculum.

At a meeting of the AAMC in Chicago on 10 April 1905, a new constitution was adopted that reaffirmed the minimum entrance requirement as "a diploma from an accredited high school." It was decided to increase the curriculum to "a four years' course of study in four calendar years, each annual course to have been not less than thirty teaching weeks (seven months)." This undemanding standard for the annual lecture course was less than that already adopted by forty-one (over half) of the sixty-six medical schools surveyed by the AAMC and reported in the above table. Nevertheless, the AAMC was reluctant to press for higher standards simply because it was assumed, no doubt correctly, that many schools would object and would refuse to participate in the Association.

In 1905 the halting efforts of the AAMC to set standards received welcome support from an important source. The National Confederation of Examining and Licensing Boards announced that it was adopting as its standard the AAMC's admission and curriculum requirements. Pursuant to this action by the National Confederation, the State of California decreed that the admission standards for medical schools in the State should in no particular be less than those established by the AAMC for that year. This California statute did not affect Cooper Medical College for it had already met (and exceeded ) the AAMC requirements. However, the policy of the National Confederation had a beneficial effect nationwide in that it denied registration to graduates of the many schools not meeting AAMC standards, thereby putting irresistible pressure on them to make some modest reforms.

The decision of the National Confederation to enforce the matriculation and curriculum guidelines of the Association of American Medical Colleges as a national standard can be seen as recognition of the Association's long struggle to induce medical colleges to adopt higher standards voluntarily. This action also called attention to the powerful leverage of the National Confederation of Licensing Boards on the medical schools. In spite of this helpful development, the AAMC was actually making little progress in reforming medical education and a more effective agency under the aegis of the AMA was needed to achieve better results.^[9][10][11]

In spite of its limited past success in the arena of medical education, the American Medical Association had continued its efforts, in parallel with those of the AAMC, to reform American medical schools. For example, at its annual meeting in 1900 the AMA revised its constitution to prescribe that no state society or other organization would be allowed representation at future AMA conventions if it admitted to membership anyone who received the MD degree in less than four years of graded instruction.^[12]

This move to put pressure on the many inferior medical schools in the country was followed in 1902 by the appointment of a new AMA Committee on Medical Education to survey the problem of medical education in the country and make recommendations concerning the role which the AMA should play in its improvement. On the advice of this committee the AMA voted at its annual meeting in 1904 to establish a permanent agency, the Council on Medical Education, for the purpose of inspecting, classifying and improving American medical schools.^[13][14]

On 20 April 1905 the Council on Medical Education hosted its first annual conference in Chicago. The objective was to enlist the cooperation of the state medical societies, the AAMC, the Southern Medical College Association and the federated licensing boards in a coordinated assault on the low standards in many of the nation's 160 medical schools. Through data collection and analysis, and leadership in promoting reform, the Council was destined to play a major role in the improvement of American medical education in the twentieth century. The original purpose of the American Medical Association when founded in 1847 was to elevate the standards of medical education in the country. In the Council on Medical Education the AMA had at last created an effective instrument for the task.^[15][16][17]

Early Council Method of Grading Medical Schools

We have seen that Cooper Medical College readily fulfilled the admission and curriculum requirements of the AAMC However, none of the AAMC efforts served to gauge the quality of the education provided by Cooper College relative to that of other schools.

In searching for some practical means of measuring quality, the Council on Medical Education recognized that the performance of medical school graduates on state licensure examinations was an elementary, yet reasonably objective, criterion of a medical school's capacity to educate. From the results of these licensure examinations, as published periodically in the JAMA, the Council divided medical schools into the following three classes based on the percentage of failure of their students on the licensure examination:^[18]

• Class 1, schools with less than 10 per cent of failures.
• Class 2, schools with 10 to 20 per cent failures.
• Class 3, schools with more than 20 per cent failures.

The following performance data on State Board Examinations are derived from a JAMA Table that included all physicians who graduated from American medical schools during the period from 1900 to 1904 inclusive, and who took the State Board Examination in 1904.^[19]

Results of State Board Examinations of Physicians Graduating 1900-1904, Inclusive

School	Passed	Failed	% Failed
Cooper Medical College	43	4	8.5 %
Univ Calif Medical Department	33	2	5.7 %
Dartmouth Medical College	11	1	8.3 %
Harvard University Medical School	155	1	0.6 % *
Yale University Medical Department	34	2	5.6 %
College, Physicians and Surgeons, NY	214	7	3.2 %
Univ Pennsylvania, Med Department	111	7	5.9 %
Rush Medical College	216	5	2.3 %

* 1904 only.

The above table shows that graduates of Cooper Medical College during the period from 1900 to 1904 had a failure rate on the State Board Examination of 8.5% (i.e., less than 10 per cent). The failure rates of graduates of seven other well-known medical schools are listed for comparison. On the basis of this very gross indicator of institutional performance, Cooper Medical College rated as a Class 1 school, as did the other schools listed in the table.

Later Council Method of Grading Medical Schools

It was clear to members of the Council on Medical Education that a more comprehensive procedure for classifying medical schools was essential, and that such a procedure must include on-site inspection of and extensive collection of data on each school. The Council then used the information collected on each school to assign it a grade.

Listed below are the ten categories of information selected by the Council as the basis for its grading system. Each category received a grade of 10 for full compliance with accepted standards. Full compliance in all ten categories would result in a grade of 100. We take this opportunity to evaluate Cooper Medical College by entering our own grade for the College in each of the categories with the following result:^[20][21]

Grading of Cooper Medical College

Categories of Information Selected by the Council	Cooper Grade
1. Showing of graduates before state boards.	( 9)
2. Requirements of preliminary education.	(10)
3. Character of medical curriculum.	(10)
4. Medical school plant.	(10)
5. Laboratory facilities and instruction.	( 5)
6. Dispensary facilities and instruction.	(10)
7. Hospital facilities and instruction.	(10)
8. Extent to which the first two years are offered by men devoting entire time to teaching and also evidence of original research.	( 2)
9. Extent to which the school is conducted for the profit of the faculty directly or indirectly, rather than for the teaching of medicine.	(10)
10. Libraries, museums, charts and teaching equipment.	(10)

Overall Grade of Cooper Medical College: 85

The above grades for Cooper Medical College are based on information to be found in the Annual Announcements of Cooper Medical College and in this and previous chapters. For example, with respect to Category 1, we have shown that over 90 % of Cooper graduates passed the State Board Examination. We therefore assign Category 1 a grade of 9.

Because Cooper College fulfilled the admission and curriculum requirements adopted by the AAMC in 1894, and these represented national standards at the time, we have assigned a grade of 10 to each of Categories 2 and 3.

Category 4 concerns medical school plant. There can be no doubt that the College and Lane Hospital buildings, planned and donated by Dr. Lane, warrant a grade of 10 based on standards of the day.

The chief deficiencies of the school are to be found in laboratory facilities and instruction (Category 5) and in full-time basic science faculty (Category 8), which received grades of 5 and 2, respectively. Category 9 concerns profit motive for conducting the school. Since all tuition income was allocated to support of the school, and the Faculty, with rare exception, receive no payment for teaching, a grade of 10 for Category 9 seems well justified.

In summary, the outcome of this hypothetical inspection process is an overall grade of 85 for Cooper Medical College, a very respectable showing, which we shall later have an opportunity to compare with that in the Flexner Report of 1910.^[22]

The Council for Medical Education began its inspection of the nations 160 medical schools in 1906. Each school was visited by some member of the Council or by the secretary, Dr. Colwell; in most instances by both. Each school was graded on its performance in each of the ten categories listed above. On the basis of their overall grades, the schools were then classified into three groups as follows:

• Class A, those graded above 70, the acceptable class (82 schools)
• Class B, those graded from 50 to 70, the doubtful class (46 schools)
• Class C, those graded below 50, the nonacceptable (32 schools)

These results were reported to the Council in 1907. Although the Council was very lenient in its grading, the above summary shows that only half of American medical schools (82 out of 160) were classified as "acceptable." Half (78 out of 160) of American schools were classified as doubtful or nonacceptable.^[23][24]

The above classification of the schools was not published, but each college was privately notified of the rating given to it. As a result of this first inspection by the Council, the first major wave of improvement swept over the medical schools of the country. Fifty schools improved their curricula. Consolidations occurred in many cities having several medical schools. A number of schools went out of business entirely because state boards refused to examine their graduates. It became evident that the 160 schools would in a short period be reduced to less than a hundred.^[25]

Even though the delinquent schools were not identified openly, the Council's report caused considerable resentment among the medical colleges. It occurred to the Council that resistance to an on-going evaluation of the schools could be most effectively minimized by its joining with a respected private organization in the further pursuit of reform.

By a fortunate coincidence the trustees of the Carnegie Foundation for the Advancement of Teaching at their meeting in November 1908 authorized a study and report on the schools of medicine in the United States and appropriated money for the project. At the New York meeting of the Council in December 1908, members of the Council expressed keen interest in cooperating with the Foundation in this study. As a result, an informal conference was held with Henry S. Pritchett, President of the Foundation, and Mr. Abraham Flexner who had been chosen by the Foundation to conduct the study. President Pritchett expressed himself as agreeably surprised not only at the efforts being made by the AMA to improve medical education but also at the enormous amount of information that had been collected by the Council.

In the course of further discussion, Mr. Pritchett agreed with the opinion previously expressed by the members of the Council that while the Foundation would be guided very largely by the Council's investigation, to avoid the usual claims of partiality no more mention would be made of the Council's report than of any other source of information. The Foundation report would therefore be, and have the weight of, an independent report of a disinterested body. It would then be published far and wide, and do much to develop public opinion.^[26][27]

As a result of understandings such as the above, the Council on Medical Education cooperated fully with Dr. Flexner during his studies of medical education which culminated in the provocative Flexner Report published in 1910. By that date, Cooper Medical College was well on its way to full integration with Stanford University..

The original Faculty of Cooper Medical College in 1882, as listed previously, was composed of 12 full professors, and 3 teaching assistants.

Twenty years later, in academic year 1901-1902, the Faculty as listed below consisted of 13 full professors, 2 emeritus professors and 2 acting professors - constituting a professorial staff of 17, augmented by 13 teaching assistants. Considering the programmatic change during the intervening years from three annual courses of identical lectures to a four-year graded curriculum, and the advent of new clinical and basic science disciplines, the growth of the Faculty over the twenty-year period was commensurate with the increase in their teaching responsibilities.

Faculty of Cooper Medical College in 1901-1902

• L. C. Lane, M. D., President
  Professor of Surgery
• C. N. Ellinwood, M. D.
  Professor of Physiology
• Adolph Barkan, M. D.
  Professor of Ophthalmology, Otology and Laryngology
• Henry Gibbons, Jr., M. D., Dean
  Professor of Obstetrics and Diseases of Women and Children
• Jos. O. Hirschfelder, M. D.
  Professor of Clinical Medicine
• A. M. Gardner, M. D.
  Professor of Legal Medicine, Mental and Nervous Diseases
• W. T. Wenzell, M. D., Ph. M.
  Professor of Chemistry
• Stanley Stillman, M. D.
  Professor of Surgery
• Emmet Rixford, M. D.
  Professor of Surgery
• William F. Cheney, M. D.
  Professor of Principles and Practice of Medicine, and Secretary
• Wm. Ophüls, M. D.
  Professor of Pathology
• Geo. F. Hanson, Ph. G., M. D.
  Professor of Materia Medica and Therapeutics
• Geo. B. Somers, M. D.
  Professor of Gynecology
• Clinton Cushing, M. D.
  Emeritus Professor of Gynecology
• Jos. H. Wythe, M. D.
  Emeritus Professor of Microscopy and Histology
• Walter E. Garrey, Ph. D.
  Acting Professor of Physiology
• Albert H. Taylor, M. D.
  Acting Professor of Anatomy

Teaching Assistants (13)

• Anatomy 5
• Histology 1
• Hygiene 1
• Materia Medica 1
• Medicine 2
• Obstetrics 1
• Pathology 1
• Surgery 1

With respect to the quality of teaching, we have referred previously to the excellence of such professors as Lane, Henry Gibbons, Sr. and Jr., Barkan, Hirschfelder, Stillman, Rixford and others, who were outstanding clinicians by regional standards. According to the testimony of graduates, they were also respected teachers. In brief, Cooper Medical College had a strong clinical program, an asset that was ably preserved during and after its transition from proprietary institution to university status. As we have frequently noted, the professors of the clinical departments received no income from the school and were self- supported by their medical practices. This would continue to be the case in these departments for many years to come.

On the other hand, as in the vast majority of American medical schools, the basic science curriculum at Cooper College was under-developed. In 1901-1902 at Cooper these subjects were in the main taught gratuitously by practicing physicians with special preparation and interest in the fields of Microscopy and Histology (Wythe); Chemistry (Wenzell); Pathology (Ophüls); Pharmacology (Hanson); Physiology (Garry); and Anatomy (Taylor). Of these professors, only Dr. Ophüls was salaried full time by the College, thus providing him alone with the support to conduct teaching and research at the university level.

We should add that American medical schools generally were unable to provide adequate support for basic science departments. Income from student fees upon which the schools relied for funds was insufficient to cover salaries and other costs incurred by teaching programs in these rapidly developing and now essential branches of medical education.

American medical schools, including Cooper Medical College, were faced with increasingly insistent pressure to undertake radical reform, and with the growing realization that they had neither the fiscal nor the intellectual resources for the task. Organic union with a university and transition to an authentic doctoral program within that context was being widely recognized as the course to be followed.

According to the "Ideal Standard" of the AMA Council on Medical Education as published in 1905, every medical graduate should have an internship of one year's duration to supplement the clinical experience gained as an undergraduate. Therefore, the availability of internships to Cooper graduates is among the valid indicators of the relative quality of the school's educational program.^[28]

The Annual Announcement of Cooper College for 1882 listed internships as available only at the San Francisco City and County Hospital. Significant progress was made during the following two decades. According to the Annual Announcement for the Session of 1901-1902 seventeen internships were available in that year to Cooper graduates These positions of one year each in the following eight San Francisco hospitals entitled their possessors to room and board free of expense, and afforded invaluable opportunity for obtaining practical knowledge and experience:^[29]

Lane Hospital	4
City and County Hospital	4
St. Luke's Hospital	1
German Hospital	2
Children's Hospital	2
California Women's Hospital	1
French Hospital	1
U. S. Marine Hospital	2

Total 17

In 1902 there were twenty-five graduates of Cooper Medical College whereas only seventeen internships were available according to the above tabulation. Thus Cooper College was eight internships short of meeting the "ideal standard" of the AMA Council on Medical Education, a serious deficiency. We should keep in mind, however, that the Medical Department of the University of California was also producing graduates in need of internships in San Francisco Hospitals. Under the circumstances a shortage of internships is not surprising. We shall later see how the successor to the Cooper school provided internships for its students.^[30]

We last discussed Student Fees in a previous chapter. There we noted that, when the curriculum was lengthened from a two-year program to a three-year program in 1879, the total student fees for the entire program were not increased but remained at $ 315. However, when the curriculum was lengthened from a three-year to a four-year program on 1 January 1894, the total student fees were increased to $ 445. Total student fees for academic year 1901-1902 remained essentially the same, as shown by the following table.^[31][32]

Student Fees in 1901-1902

Matriculation Fee	$ 5
Demonstrator's Fee, first year	$ 10
Demonstrator's Fee, second year	$ 10
Lecture Fee, first year	$ 100
Lecture Fee, second year	$ 100
Lecture Fee, third year	$ 100
Lecture Fee, fourth year	$ 100
Graduation Fee	$ 25
TOTAL FEES	$ 450

As we have previously indicated, the income of the medical school was practically all derived from student fees. It is apparent from the above list of student fees that each matriculant annually contributed about $ 100 to the school budget. From the data on Cooper matriculants to be found in the following table, it is possible to calculate the school's approximate annual income (number of matriculants x $ 100), and to appreciate the negative effect of reductions in class size on the finances of the school. (For example: Annual Cooper Income for 1902: 212 Matriculants x $100 = $ 21,200.)

Matriculants and Graduates of Cooper Medical College 1882 to 1902 and Graduates of Medical Department of University of California

Year	Matriculants CMC	Graduates CMC	Graduates MDUC
1882	0	12	13
1883	0	13	11
1884	0	16	14
1885	83	19	11
1886	89	11	11
1887	107	28	11
1888	104	14	6
1889	126	41	11
1890	129	18	16
1891	148	29	23
1892	176	38	0
1893	228	42	28
1894	230	73	18
1895	219	64	38
1896	204	37	47
1897	191	45	39
1898	187	47	39
1899	154	44	42
1900	161	38	41
1901	167	27	49
1902	212	25	45
Total Graduates, 1882-1902		681	513

The financial condition of the College in 1901-1902 and in previous years was very satisfactory as a result of the sustained high number of matriculants as shown in the above table. . The annual occupancy rate of Lane Hospital was consistently at such a level as to make that institution also self-supporting.

This brief evaluation of the status of Cooper Medical College in 1901-1902 includes various evidence to support the view that the school's program, faculty and facilities were above the average of American medical schools of the day. It is also clear from the data on annual number of graduates cited in the above table that the College was successful in the competition with the Medical Department of the University of California for students, a practical indicator of relative standing.

The President's Financial Report for 1902 to the Board of Directors of the College showed that the medical school and Lane Hospital were both financially self-supporting and unencumbered. Together they comprised a thriving medical center.^[33]

These favorable conditions, to which should be added the abiding loyalty of the Cooper Faculty, were a tribute to Levi Cooper Lane. His tireless efforts, selfless generosity, and far-sighted ideals of education and service to humanity were the source of a creative energy that fulfilled the aspirations of Elias Cooper and profoundly influenced the early course of medical education in the West.

In counterpoint to currently favorable conditions at Cooper Medical College, we have called attention to nationwide forces then increasingly at work to reform American medical schools. This movement was certain in due course to have a major effect on the College.

In respect to this reform movement, we have referred to the revival of interest at the American Medical Association in the restructuring of the medical schools; the creation of the Council on Medical Education as an agency for that purpose; and finally to the Council's agreement to cooperate with Abraham Flexner in his definitive study of American medical education under the auspices of the Carnegie Foundation.

We have already commented amply on the excessive number and sad state of American medical schools, and will now only briefly mention an important consequence of this condition, namely, the gross overproduction of ill-trained American doctors. In the early 1900's, the 160 American medical schools numbered as many as in Great Britain, France, Germany and Austria combined. Germany had one doctor for every 2000 souls, and one for every 1000 in the large cities. In this country there was an average of one doctor for every 570 persons; and frequently for every 400 or less in large cities. Many small towns with less than 200 inhabitants had two or three physicians. In general terms, the United States had about four times as many doctors per capita as Germany. Proprietors of low-grade medical schools were wont to advance the specious argument that their standards were low to enable economically disadvantaged students to attend medical school and serve their communities. Obviously, low standards and poor training were no longer needed in order to supply physicians, much less poor ones, to America.^[34][35]

This review of the status of medical education at Cooper Medical College and in the nation at large, will serve as background for our consideration of an impending crisis in the life of the Cooper school when : "The old order changeth, yielding place to new."^[36]

When Dr. Lane established Cooper Medical College in 1882 he deeded all its lands and premises to the Corporation of Cooper Medical College. We recall that in 1893 he encumbered the deed by affixing to it a pledge from the Board of Cooper Medical College and the Faculty that "the College shall never be affiliated with, or become the department of any other educational institution, but shall remain an independent school in which Medicine and its Kindred Sciences shall be taught."

By 1901, Dr. Lane began to recognize that the ultimate destiny of medical education in the United States, as in Europe, was to be under the control of universities. He also realized that the expenses of his College would increase enormously as it became necessary to appoint more salaried professors; that the practice income of Faculty and tuition of students could no longer be expected to pay the full cost of medical education; and, finally, that eventual union with a University was necessary to the survival of Cooper Medical College.^[37][38]

On at least one occasion, and possibly more, Dr. Lane discussed with President Jordan the feasibility of a merger with Stanford. Although Stanford's financial condition had begun to improve, President Jordan was cautious in his assessment of the University's ability to fund a medical school. On 30 October 1901 he wrote: "As to the possibilities of organic union, should this be considered desirable by the Cooper Medical College, I may say that we would strongly favor it if it were practicable. Our main difficulty is this: We are not now ready to incur the expense of a salaried faculty; we do not think it wise to begin without one."^[39][40]

In view of the advantages to Cooper College in a union with Stanford University now foreseen by Dr. Lane, he decided to rescind his restriction on such a transaction. In order to do so it was necessary for him to regain possession of the College property that he and Mrs. Lane had previously deeded to the Corporation, and then reconvey it to the Corporation devoid of the encumbrance he had placed upon it. To this end Dr. Lane, who was seriously ill and failing rapidly at the time, initiated a series of meetings of the Board of Directors of the College from the 15th through the 18th of January 1902.

In the course of these meetings, the Corporation and Dr. and Mrs. Lane took the necessary legal steps to convey the Cooper properties to the Lanes and on 17 January 1902 they deeded the property back to the Corporation free and clear of the aforementioned restriction. In consequence, from this date forward, the Directors of the Corporation were at liberty to negotiate with Stanford regarding a relationship that might include organic union with the University. Dr. Lane's decision, at the eleventh hour of life, to remove all barriers to such negotiation was an evidence of his vision and a measure of his greatness as the century's leading benefactor of medical education in the West.^[41]

In 1905 the newly established Council on Medical Education adopted the following statement regarding an "ideal standard" for American medical colleges based on the programs of the better schools in England, Germany and France:^[42]

• One of the chief functions of the American Medical Association should be the elevation of medical education in this country and it should be its avowed purpose to secure throughout this country, within a reasonable time, as high a standard as that of any country in the world.
• The elevation from present conditions to the highest standard desired must be gradually brought about in justice to all concerned and we would not at this time recommend too sweeping changes.
• The ideal standard to be aimed at from our present view-point should consist of:
  • Preliminary education sufficient to enable the candidate to enter our recognized universities, the passing upon such qualifications by the state authorities. (Note: This is equivalent to accepting a high school diploma as the minimum standard for admission to medical school.)
  • A five year medical course, the first year of which should be devoted to physics, chemistry and biology, and such arrangements should be made that this year could be taken either in a school of liberal arts or in the medical school. Of the four years in pure medical work, the first two should be spent in laboratories of anatomy, physiology, pathology, pharmacology, etc., and the last two in close contact with patients in dispensaries and hospitals in the study of medicine, surgery, obstetrics and the specialties.
  • A sixth year as an interne in a hospital or dispensary should then complete the medical course.

It is believed that it will require about two years to secure the general adoption of these requirements by state boards and medical schools; and we, therefore, recommend that the effort be made to make these requirements effective by 1 January 1908.

1. Dean F. Smiley , "History of the Association of American Medical Colleges, 1876-1956," Journal of Medical Education 32, no. 7 (July 1957): 516. Lane Library Catalog Record
2. Cooper Medical College Announcements, Annual Announcement for 1884, pp. 9-10. Lane Library Catalog Record
3. Cooper Medical College Announcements, Annual Announcement for 1893, pp. 2 and 7-12. Lane Library Catalog Record
4. Annual Announcement of Cooper Medical College, Session of 1895, p. 10. Lane Library Catalog Record
5. Insert in Annual Announcement of Cooper Medical College, Session of 1898. Lane Library Catalog Record
6. Insert in Annual Announcement of Cooper Medical College, Session of 1898. Lane Library Catalog Record
7. Insert in Annual Announcement of Cooper Medical College, Session of 1898. Lane Library Catalog Record
8. Dean F. Smiley , "History of the Association of American Medical Colleges, 1876-1956," Journal of Medical Education 32, no. 7 (July 1957): 518. Lane Library Catalog Record
9. Dean F. Smiley , "History of the Association of American Medical Colleges, 1876-1956," Journal of Medical Education 32, no. 7 (July 1957): 518. Lane Library Catalog Record
10. "Minutes of Meeting of Association of American Medical Colleges in Chicago on 10 April 1905," JAMA 44, no. 15 (Apr 15, 1905): 1218-1219. Lane Library Catalog Record
11. Walter L. Bierring , "Medical Licensure after Forty Years," Federation Bulletin 43, no. 4 (Apr 1956): 101-102.
12. "Association News: Annual Session of AMA, 5-8 June 1900; Report on Revision of Constitution," JAMA 34, no. 24 (Jun 16, 1900): 1559. Lane Library Catalog Record
13. Morris Fishbein , A History of the American Medical Association, 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), p. 891. Lane Library Catalog Record
14. "Annual Session of AMA, 7-10 June 1904: Report of Committee on Medical Education," JAMA 42, no. 24 (Jun 11, 1904): 1576. Lane Library Catalog Record
15. "Council on Medical Education of the AMA: First Annual Conference, held in Chicago, 20 April 1905," JAMA 44, no. 18 (May 6, 1905): 1470. Lane Library Catalog Record
16. Martin Kaufman , American Medical Education: The Formative Years, 1765-1910 (Westport, Connecticut: Greenwood Press, 1976), p. 159-160. Lane Library Catalog Record
17. Morris Fishbein , A History of the American Medical Association, 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), p. 891-893. Lane Library Catalog Record
18. Morris Fishbein , A History of the American Medical Association, 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), p. 895 Lane Library Catalog Record
19. "Council on Medical Education of the American Medical Association: First Annual Conference held in Chicago, April 20, 1905. Table C," JAMA 44, no. 18 (May 6, 1905): 1470-1475. Lane Library Catalog Record
20. "Third Annual Conference of Council on Medical Education, 29 April 1907," JAMA 48, no. 20 (May 18, 1907): 1702. Lane Library Catalog Record
21. Morris Fishbein , A History of the American Medical Association, 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), p. 896. Lane Library Catalog Record
22. Abraham Flexner , Medical Education in the United States and Canada (Boston: D. B. Updike, The Merrymount Press, 1910), p. 193-194. Lane Library Catalog Record
23. "Third Annual Conference of Council on Medical Education of the AMA, 29 April 1907," JAMA 48, no. 20 (May 18, 1907): 1701-1707. Lane Library Catalog Record
24. Morris Fishbein , A History of the American Medical Association, 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), p. 896. Lane Library Catalog Record
25. Morris Fishbein , A History of the American Medical Association, 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), p. 897. Lane Library Catalog Record
26. Abraham Flexner , Medical Education in the United States and Canada (Boston: D. B. Updike, The Merrymount Press, 1910), p. viii. Lane Library Catalog Record
27. Morris Fishbein , A History of the American Medical Association 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), p. 898. Lane Library Catalog Record
28. "Annual Session of AMA, 10-13 June 1904: Report of Committee on Medical Education," JAMA 45, no. 4 (Jul 22, 1905): 270. Lane Library Catalog Record
29. "Hospital Appointments," Annual Announcement of Cooper Medical College, Session of 1901-1902, p. 21-22. Lane Library Catalog Record
30. "Graduates of 1902," Annual Announcement of Cooper Medical College, Session of 1902-1903, p. 21. Lane Library Catalog Record
31. Annual Announcement of Cooper Medical College, Session for 1894, p. 20. Lane Library Catalog Record
32. Annual Announcement of Cooper Medical College, Session for 1901-1902, p. 21. Lane Library Catalog Record
33. President's Financial Report, Minutes of Cooper Medical College, 20 August 1902, vol. 2, p. 69-78, Cooper Medical College Collection of publications, Lane Medical Archives, Stanford. Lane Library Catalog Record
34. "Third Annual Conference of Council on Medical Education, 29 April 1907," JAMA 48, no. 20 (May 18, 1907): 1702. Lane Library Catalog Record
35. Abraham Flexner , Medical Education in the United States and Canada (Boston: D. B. Updike, The Merrymount Press, 1910), p. 14-15. Lane Library Catalog Record
36. Alfred, Lord Tension , "Morte D'Arthur," in Book of Living Verse, ed. Louis Untermeyer (New York: Harcourt, Brace and World, Inc, 1945), p. 354.
37. Edgar E. Robinson and Paul C. Edwards , eds., The Memoirs of Ray Lyman Wilbur (1875-1989) (Stanford, CA: Stanford University Press, 1960), p. 158. Lane Library Catalog Record
38. Emmet Rixford , A Brief Account of the History of the Lane Medical Library and of Cooper, Leland Stanford junior University Publications 1912, Trustees' Series, No. 2, pp.16-17.
39. David S. Jordan , The Days of a Man (Yonkers-on-Hudson, NY: World Book Co., 1922), 2:282. Lane Library Catalog Record
40. Orrin L. Elliott , Stanford University: The first Twenty-Five Years (Stanford, CA: Stanford University Press, 1937), p. 536. Lane Library Catalog Record
41. Minutes of Directors of Cooper Medical College for 15 through 18 January 1902, pp. 38-48, Minutes of Directors of Cooper Medical College, Vol. 2 - Box 5.2, Cooper Medical College Collection of publications, Lane Medical Archives, Stanford. Lane Library Catalog Record
42. "Annual Session of AMA, 10-13 June 1904. Report of Committee on Medical Education."