Dr. Wilbur addressed the following letter to Mr. Timothy Hopkins and included in it a copy of the above letter to President Branner. [34]
| San Francisco, July 22, 1914
Mr. Timothy Hopkins Dear Mr. Hopkins: Your efforts to increase the endowment of the Lane Medical Library and the Medical School lead me to call your attention to the very favorable opportunity open for the further development of the Stanford Medical School from additional endowment. From an endowment equal to about the amount spent by Stanford in remodeling the Clinical and Laboratory Building and to be spent on the new hospital an income sufficient to practically place the whole institution on an academic basis could be derived. Evidently the limitations of the income of the University necessitate that certain lines must await outside help before proper teaching arrangements can be made. In short if Stanford could have an addition of $35,000 to its (annual) budget for the following specific purposes it could put the whole Medical School on an academic basis.
Very truly yours, (Signed) R. L. Wilbur |
Mr. Timothy Hopkins, President of the Stanford Board of Trustees responded as follows to the above letter from Dr. Wilbur dated July 22, 1914:
|
Holland House, New York City Doctor. Ray L. Wilbur Dear Doctor Wilbur: I have had a long talk this morning with Doctor Flexner and Doctor Buttrick. Doctor Flexner is quite willing to take our proposition before the (General Education) Board at its meeting in the latter part of January (1915), providing it is modified to meet the purposes of the Board. It appears that they wish to try an experiment in three or four different places, and this experiment they do not wish to modify. An application from Harvard, something like ours, was turned down. The plan is to provide clinical professors who shall devote their whole time to the interests of the university, not taking any paid practice outside, although of course free to write and lecture and to do anything except to practice medicine. There are some cases where medical advice must be paid for, else it would appear that they were undercutting the regular practitioners. In case fees were received for such practice, they should be turned over to the Medical School, but it is not expected that they should try to make money for the Medical School by practice. If we are to receive help, we shall have to modify our Stanford plans somewhat. We shall have to pay professors higher salaries than $4,000, but young men can be had who would rather have $4,000 or $5,000 and be free to study and teach, rather than to go into practice for the larger sums which might be obtained. Knowing it must be on these terms that we get any help from the Education Board, we could, perhaps, with the $35,000, employ one less man than you suggest, and I certainly think the experiment is worth trying if we can get the $750,000 for which we have asked. Thus far the three institutions chosen for these experiments are John Hopkins, Yale and Washington. I have tried to show them that in the half of this old country which lies west of St. Louis there is no adequate Medical School excepting our own, and I think I convinced them that we were the ones on which they should try their experiment. They want you to write out quite fully what we are actually doing in medicine; what professors are already paid; and the amounts including assistant professorships; the salaries of each; a statement as to the ordinary charges and management of the institution; the reasons why we would like to enter into this experiment and to try it under the new conditions of this coast - quite different from those surrounding any of the three already chosen - also the reason why Stanford University is to be chosen. My general impression is that if we will meet their requirements by cutting off all profit for these new professorships and letting the fee that they must charge go into the general fund, but neither expecting nor requiring any money in this way, they will look with a good deal of favor on us. I think it best to put all this in form and get Doctor Branner as President, and perhaps Mr. Newhall (who succeeded Mr. Hopkins as President of the Stanford Board of Trustees) to sign it. The whole matter is practically in the hands of Doctor Flexner. I found both these men very friendly, and perhaps the omens are good for our success. Some of the documents I had with me are available for your report, as I return them. Doctor Flexner implied that they would rather have a somewhat long report anyhow; we will try it. I remain, (Timothy Hopkins) |
As advised by Mr. Hopkins, the following covering letter was dispatched on December 11, 1914 as a grant application to the General Education Board. This covering letter was accompanied by supportive documentation prepared by Dr. Wilbur.
|
December 11, 1914 Gentlemen: On behalf of the Leland Stanford Junior University we request the assistance of your honorable board to the extent of $750,000 as a special endowment for our medical school. A detailed statement of the history, present condition, and future plans of the medical school, by the dean, Dr. R. L. Wilbur, together with copies of publications relative to it, accompany this application. The following conditions are suggested as applicable to the gift, if made: 1. That the income of the fund shall be used for payment of salaries of full-time clinical professors, preferably in the divisions of medicine, of obstetrics and gynecology, and in pediatrics; and for salaries of assistant and associate professors either in these same divisions or preferably, in the clinics devoted to genito-urinary surgery, neurology, ophthalmology, otology, rhinology, and laryngology. 2. That the holders of these professorships shall be expected to devote their time to teaching, to research, and to the care of patients; that they shall have the privilege of delivering lectures and of being of general public service, also to care for private patients, at their discretion, in the hospital or through consultation, all fees for such attendance to be collected by the medical school and to become a part of its funds. Respectfully submitted, (William Mayo Newhall) (John C. Branner) |
Dean Wilbur discussed the grant application with officers of the General Education Board in New York in January 1915 and reported the discussion to President Branner in the following letter.
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January 11, 1915 I beg leave to report that I have returned from the East this morning. . . . In New York I took up with Mr. Flexner and Mr. Buttrick of the General Education Board the details of the desired endowment for the Medical School, and think that I was able to get the proposition concretely and definitely before them for discussion. Their attitude was most friendly and favorable, as we had been led to expect by the way they had taken the problem up with Dr. Jordan. Mr. Flexner particularly desired information along certain lines and certain comparisons between our institution and the others already endowed by them, and I think that the way the proposition was presented by us will be in our favor. He was particularly impressed by the unanimous action of the Medical Faculty requesting that the endowment be sought along the lines adopted by the Board. In all the other medical schools there has been some more or less definite opposition to the plan of the General Education Board. . . Very sincerely yours, R. L. Wilbur |
The General Education Board denies approval of Stanford's grant application President Branner received the following terse letter: [35]
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New York City President John C. Branner Dear Dr. Branner: The application that was made by you on behalf of Leland Stanford Jr. University for assistance toward a special endowment for your Medical School was submitted to our Board for its consideration at a meeting held on January 28, 1915. I am instructed to inform you that the Board did not find it practicable to grant the request which was made. Very truly yours, E. C. Sage |
Reasons for the decision not to approve the Stanford application were not forthcoming from the GEB.. Immaturity of the school, which had been in existence for less than a decade at the time of the application may have been a negative factor. when to a visionary this could have been seen as an asset. The criticism of the Stanford program published in the Flexner Report only a few years previously in 1910, and Stanford's refusal to merge with the University of California, may also have inclined Flexner and other members of the GEB to reject the application. The fact that Stanford was a "divided" school with the clinical departments and hospital at a distance from the University was contrary to one of the Flexnerian imperatives, and doubtless made Stanford Medical School sub optimal as a site for the GEB's experiment with the clinical full-time system.
Geographic Full-time System continues at Stanford. In view of Dean Wilbur's efforts to obtain funding to establish the clinical full-time system, and of the medical faculty's unanimous concurrence with these efforts, it is reasonable to conclude that only the lack of funds prevented early introduction at Stanford of the clinical full-time system (Hopkins model) and led ultimately, as in so many other medical schools, to continuation of the geographic system as a practical expedient. Years later the adoption of the clinical full-time system became a major issue at Stanford, a subject to which we will in due course return.
Dean Wilbur was highly effective in developing the faculty and promoting research during his five-year tenure as Dean from academic year 1910-11 to 1915-16. He presided over expansion of the medical faculty from 20 to 62 as shown by the following table based on Annual Announcements of the School of Medicine for those years: [36] [37]
Faculty of Stanford School of Medicine
|
Titles |
1910-11 |
1915-16 |
Increase |
|
Professor |
11 |
14 |
3 |
|
Clinical Professor |
2 |
8 |
6 |
|
Associate Professor |
3 |
3 |
- |
|
Associate Clinical Professor |
- |
2 |
2 |
|
Assistant Professor |
4 |
9 |
5 |
|
Assistant Clinical Professor |
- |
5 |
5 |
|
Instructors |
- |
5 |
5 |
|
Clinical Instructors |
- |
16 |
16 |
|
Total |
20 |
62 |
42 |
In 1915-16 32 "Assistants" were also listed with the Faculty.
With respect to faculty research during Dr. Wilbur's deanship and afterward, we refer to the Medical Bulletin of Stanford University School of Medicine. Volume 8 was the final issue of the Bulletin. It covers the three-year period from 1924 to 1927 and contains 93 reprints. In an Appendix are listed an additional 594 articles making an estimated total of approximately 700 articles published by the Faculty during that period.
These data suggest that the number of journal articles published by the Faculty increased 10-fold during the decade and a half from 1910-13 to 1924-27, and that Dr. Wilbur's early efforts to create On 4 May 1912 the Faculty of the Medical Department decided to collect and bind the reprints of all medical journal articles published by the Faculty. The objective was to document their research activities and make them more widely available for study. Since it was soon learned that it was not possible to obtain reprints of all articles, a list of those reprints not bound in the Bulletin was included as an Appendix in all except the first two volumes.
Volume 1 of the Bulletin covers the three-year period from the beginning of the Department in 1910 to 1913 and contains 35 reprints. Assuming that reprints of only half of the articles were submitted for binding, we can estimate that about 70 articles were published by the Faculty during that period.
Volume momentum for research in the new school was highly successful. [38]
In a previous Chapter we discussed President Branner's strong objection to funds being made available to the Medical Department by the Trustees in excess of prior agreement. These were the funds invested by Dean Wilbur in construction of the new and improved medical facilities we have described earlier in this Chapter, and in support of the additional faculty tabulated above. The Trustees' generous allocation of funds to the Medical School, so outrageous to President Branner, paid off handsomely by rapidly upgrading the School's facilities and faculty in both preclinical and clinical departments. These important initiatives by Wilbur no doubt contributed to Dr. Vaughan's favorable impression of the Stanford medical program in June 1914.