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

The Planning Process

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

President Pritchett's response:

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

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

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

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

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

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

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

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

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

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

The Western Medical Schools 1909 ^[40]

Census Division	Number of Physicians	Population Per Physician	Total Population	Medical Current	Schools Plan
Mountain States
Montana	417	584	243,528	-	-
Idaho	343	472	161,896	-	-
Wyoming	202	458	92,516	-	-
Colorado	1,600	319	510,400	3	1
New Mexico	367	532	195,244	-	-
Arizona	246	500	123,000	-	-
Utah	359	771	276,789	½	1
Nevada	177	239	136,467	-	-
Pacific States
Washington	1,404	369	518,076	-	1
Oregon	782	529	413,678	2	-
California	4,313	344	1,483,672	9 1/2	1 1/2
Regional Total	10,210	407	4,155,266	15	4 1/2
MD's Required @ 1: 1500 Population	2,770	1,500	4,155,266
National Total	133,487	569*	75,954,103

*176 MD/100,000 population.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medical Department University of the Pacific

Year	Graduates
1859	2
1860	1
1861	5
1862	5
1863	8
1864	7
1865 - 1869 Suspension
1870	8
1871	8
Total	44

Medical College of the Pacific

Year	Graduates
1872	10
1873	14
1874	8
1875	13
1876	22
1877	13
1878	26
1879	15
1880	7
1881	9
Total	137

Cooper Medical College

Year	Graduates
1882	12
1883	13
1884	16
1885	19
1886	11
1887	28
1888	14
1889	41
1890	18
1891	29
1892	38
1893	42
1894	73
1895	64
1896	37
1897	45
1898	47
1899	44
1900	38
1901	27
1902	25
1903	45
1904	44
1905	38
1906	31
1907	29
1908	27
1909	19
1910	17
1911	23
1912	36
Total	990

Total Graduates of the Predecessor Schools: 1171

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