Chapter XXIII. Educational Reform at Medical College of the Pacific 1872-1882
Educational Reform at Medical College of the Pacific 1872-1882
The foregoing summary of the disappointing national effort to reform medical education nationally will serve as background for the following account of the evolution of medical standards at the Medical College of the Pacific.
Under the policy adopted originally by Elias Cooper et al when the Medical Department of the University of the Pacific was founded in 1859, responsibility for taking the minutes at Faculty meetings was assigned to the Dean. In the early days, when Dean Cole kept the minutes, they were brief, often scarcely legible, and frequently on mere scraps of paper. As a result, information regarding Faculty deliberations and curricular matters during his era is scanty. In contrast, the minutes beginning in 1870, written in the fine hand of young Dean Henry Gibbons, Jr., are clear and concise. He meticulously recorded in laconic style an impressive succession of astute actions that portray the Cooper loyalists who revived the school in 1870 as experienced and committed professionals.
Graduation Requirements at Medical College of the Pacific in 1872
The Annual Session for 1872, extending over the five months' period from June 3rd to November 3rd, was the first Session of the newly established Medical College of the Pacific (MCP). The only major change in the requirements for graduation in the Cooper schools between 1859 and 1872 was an increase in the duration of the Annual Course of Medical Lectures from four months to five months, beginning with the Session for 1870. Otherwise the following requirements for graduation in 1872 were the same as when the school opened in 1859:  
The candidate must be 21 years of age.
Must have attended two identical Annual Courses of Medical Lectures, each of five months' duration, one of which must have been delivered in this institution.
Must have studied Medicine for three years (the terms of the Lectures included) under the direction of a respectable practitioner, i. e., serve an Apprenticeship.
Must write a Medical Thesis and pass examinations.
Annual Lecture Course at MCP in 1872
Although requirements for graduation had changed little since 1859, the range of subjects taught in the Annual Course of Lectures was increased significantly upon revival of the school in 1870. Thereafter, the Lectures included new subjects related to the developing medical sciences and clinical specialties. This important trend is illustrated by the following list of subjects taught in 1872: 
Principles and Practice of Medicine
Clinical Medicine and Diagnosis
Surgery and Surgical Anatomy
Clinical and Operative Surgery
Pathology (with practical illustrations)
Obstetrics and Diseases of Women and Children
Clinical Ophthalmology and Otology
Materia Medica and Therapeutics
Hygiene and Insanity
Physical Diagnosis (Auscultation, Percussion, etc.)
Histology and Diseases of the Nervous System
Descriptive and Microscopic Anatomy
Theoretical and Practical Physiology
Ophthalmology and Otology;
Inorganic and Organic Chemistry
Analytical Chemistry and Toxicology;
New (Additional) Subjects:
The Annual Lecture Course was now beginning to reflect the contributions of Pasteur, Lister, Koch and other European investigators, to whom we have previously referred. Similarly, new clinical specialties were being introduced into the curriculum and reinforced by clinical instruction in the school's affiliated hospitals and clinics. The modern era of medical education and practice was beginning to emerge.
Free Preliminary Lecture Course
Prior to suspension of the Medical Department of the University of the Pacific in 1864, a Preliminary Course of only one month duration was provided. At the Faculty meeting on 15 December 1870, shortly after successful completion of the first Session of the revived Medical Department, it was decided to augment the curriculum by lengthening the Preliminary Course of Lectures from one to four months. Attendance was optional and there was no examination or grade. As an inducement to attend the Course, there was no charge to the students who matriculated for the Regular (or Annual) Course.
For example, in 1872 the Preliminary Lecture Course was given over a four month period from February to May, and was followed by the five month Regular Course from June to November. Here is the description of the Preliminary Course from the Annual Announcement for 1872:  
Aware of the impossibility of treating fully in the Regular Course all the branches with which it is well for the Student to become acquainted, the Faculty instituted, in January 1872, an Extra Course of Lectures, which is now in operation, and is free to all Matriculants for the Regular Course. Eight Lectures a week are now being delivered on Insanity and Medical Jurisprudence, the Special Surgery of the Head, Special Anatomy, Operative Surgery and Pathology, Diseases of Children, Diseases of the Skin, the Thermometer in Diagnosis, Methods of Physical Diagnosis (Auscultation, Percussion, etc.), and on Practical and Analytical Chemistry and Toxicology. Besides this, Clinical Instruction is given three times a week at the College; and Surgical and Medical Clinics twice a week at the City and County Hospital. The Dissecting Room is open the year round for the use of Students.
The Preliminary Lecture Course (renamed "Intermediate Course" in 1878), required considerable additional unrequited effort by the Faculty. For those students who voluntarily took the Course, it had the effect of extending the annual term of instruction to nine months. This substantial offering by the Faculty was evidence of their determination to improve the educational program, but they were not yet prepared to adopt a three-year graded curriculum.
Clinical Instruction in 1872
We learn from the minutes of 28 June 1870 that Dr. Gibbons, Sr., was directed to secure hospital privileges for teaching purposes at the San Francisco City and County Hospital. The minutes of 1 April 1871 record that equal clinical privileges with the Toland School had now been granted at the Hospital. The County Hospital was the most important clinical teaching facility in the city and so promptly to obtain equal access with the Toland School, which might have shut them out, was a major coup for the revived Cooper school.
As an additional resource for clinical teaching, the Faculty decided on 9 July 1870 to establish a Free Public Clinic (to be located at the University College Building) in accordance with the following generous plan: 
Plan of Organization of the Public Dispensary and Clinique
1st. The Faculty to have the entire control and management as in other College matters; to designate from time to time, who may perform the service in order to make it most available for clinical instruction.
2nd. The Dispensary to be established and continued as a public charity, for the benefit of the poor, supplying medicines and advice gratuitously.
3rd. Any expenses incurred for the Dispensary and Clinique shall be incurred and paid as are the College expenses.
4th. The Dispensary shall be continued during the year in and out of the College Term and always open to the students of the College without charge.
The following excerpt from the Annual Announcement for the Session of 1872 outlines the overall provisions for Clinical Instruction made by the Faculty. 
Ample facilities for Clinical Instruction at the City and County Hospital having been obtained, Students will have the best opportunities for perfecting themselves in the practical branches. This Hospital contains over four hundred beds and from three hundred and fifty to four hundred patients, and furnishes examples of a large number of diseases. The greatest advantages for obtaining a knowledge of Venereal Diseases are afforded here, and Clinical Instruction will be regularly given on such affections and other Surgical Diseases including Diseases of the Eye and Ear, and of the Skin; on Diseases of Women, and on Diseases in general. Clinics are also occasionally given at some of the private hospitals.
Although the advantages thus offered are of much value, the Faculty desires to call special attention to the Public Dispensary established nearly two years ago, at the College building. New arrangements have just been completed, which will make the Clinic given here, a very efficient aid to Students in the study of disease, as material is abundant and of great variety and frequently furnishes operations. On three days of the week, patients are examined and prescribed for in the presence of the Students. Such a Clinic is of special value as enabling them to gain practical experience in the diagnosis and treatment of the Diseases of Children which cannot be obtained elsewhere.
In 1877 the U. S. Marine Hospital with 120 beds and 1000 patients annually, and St. Mary's Hospital were listed as also available for clinical teaching. 
It can be seen from the preceding review that the educational program of the MCP in 1872 was considerably improved over that in 1859, but the curriculum (like that in most other American medical colleges) was still quite deficient due to antiquated Requirements for Graduation.
In 1882 a formal program of postdoctoral training, available to a limited number of students, was announced. 
Students, immediately upon graduating, are eligible for appointment as Interns for one year at the City and County Hospital. The position entitles its possessor to room and board free of expense, and affords an invaluable opportunity for obtaining practical knowledge and experience.
This modest offering represents the first of a considerable number of internships and residency positions later to be made available by the hospitals of San Francisco.