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Stanford School of Nursing

We referred earlier to the important contribution of the Stanford Nursing School to the operation of Lane Hospital, and we specifically cited the recommendation in 1912 of Physician Superintendent George E. Somers that there was an urgent need for a building large enough to accommodate one hundred nurses. [18]

In the following year, 1913, the Board of Trustees decided to construct a nurses' home, a decision attributable to the influence of Dean Wilbur - and another example of his successful efforts to improve the facilities available to the Medical School. [19]

However, the promised new nurses' home was slow to materialize for financial reasons, and the following related events transpired during the long delay.

In 1915 the nurses' alumnae offered to raise five thousand dollars to support the construction of a nurses' home, provided that they be given the privileges of a hospital bed for sick alumnae. This offer was accepted by the Board of Trustees and put on hold. From another source, one thousand dollars was paid in, so that the nurses considered that a building fund was at least started. [20]

In 1916 the old nurses' home was wrecked in preparing for construction of Stanford University Hospital. No one regretted demolition of the old building, but it was then necessary to house the nurses in four residences immediately adjacent to the Hospital, in addition to the residence on Clay Street previously occupied by Dr. and Mrs. Lane. While the nurses were now very comfortable and enjoyed their new quarters, still the scattering of nurses in five different houses added considerably to the responsibility of the management and was attended by many inconveniences. [21]

By 1917 the nurses had increased in number and were housed in seven residences in the neighborhood, and soon an eighth would be necessary. The scattering of the nurses in these various locations was not only expensive, but rendered the problem of supervision and discipline very difficult. The construction of a suitable nurses' home was now an urgent necessity and some funds for that purpose were raised by subscriptions from several friends of the training school. [22]

In 1918 the number of residences in the neighborhood of Lane Hospital occupied by nurses had increased to nine. A tenth house was used for the accommodation of male employees. Meanwhile the standards and methods of teaching nurses had increased remarkably since the decision in 1913 to build a new nurses home. The University in supporting the School for Nurses was now by this time merely extending the educational program of and providing the opportunity for its women graduates to supplement college training with practical work, not alone in nursing but in hospital teaching and administration, in social service and public health work. As courses along these and related lines gradually became incorporated into the training of nurses, the nursing school developed, almost without realization, into a separate institution with separate organization and demanding separate consideration.

In view of these facts, therefore, the Clinical Committee, which had jurisdiction over the nursing program, found itself dealing with the affairs of the School for Nurses as with a separate educational institution. One important consequence of this was that, in planning for the future housing of the school, it was necessary to provide classrooms, laboratories and such other accommodations as were needed for teaching purposes.

The decade of delay in construction of the nurses' home was fortunate in that, as a result, the final plans for it could and did include provision for the developing educational as well as the housing needs of the nurses. In keeping with this revised concept, instead of "Nurses Home" the new building was to be known as "The Stanford School of Nursing." Construction began in 1920, was completed in 1922, and the School was formally opened on March 31st of that year. [23] [24] [25]

On the afternoon of March 31, 1922, with impressive ceremony, the Trustees of Stanford University presented the new building to President Wilbur who, while serving as Dean in 1913, had been responsible for gaining approval for its construction. In his acceptance remarks, he graciously acknowledged his honor and satisfaction that Stanford University now possessed a suitable facility for the further development of this important professional school. Mrs. Helen Hoy Greeley of Washington D. C., through whose efforts "Rank for Nurses" had been enacted by Congress, gave the address of the afternoon, after which the School was open to the inspection of invited guests.

In the evening the graduates and students of the Stanford School of Nursing entertained with a reception and dance. On that day about 1,000 guests passed through the Home - all enthusiastic and admiring. [26]

The following description is from the Nursing School's Annual Announcement for 1925-26: [27] [28]

The School of Nursing was established in 1895 as the Lane Hospital Training School for Nurses. After Cooper Medical College became Stanford School of Medicine, the name was changed to Stanford School for Nurses, later to become the Stanford School of Nursing.

Five hundred and twenty-eight nurses had been graduated. by the 1925-26 school year.

The Stanford School of Nursing of the Stanford University School of Medicine was directed by the Clinical Committee of the Medical School Faculty (chaired by Dean Wilbur until 1916), which was also in charge of the University Hospitals.

The School's Combined Nursing Course consisted of a Pre-Nursing Course given at Stanford University. This covered a period of three years and was supplemented by a two years' Course in Nursing given at Stanford School of Nursing. At the end of the five years, the student received an A. B. degree from the University and a diploma in Nursing from the School of Nursing.

The Course was designed primarily for those who wished to prepare themselves for administrative and teaching positions, social service or public health work.

The Stanford School of Nursing was situated in an educational and residential building located at 2340 Clay Street, directly opposite the University Hospitals and connected with them by a tunnel under the street. It was erected by Stanford University at a cost of $ 425,000. It was built of reinforced concrete, seven stories high, and accommodated 200 nurses. Besides bedrooms, there were large and beautifully furnished reception rooms, a music room, a library of 1,000 books for general reading, and the current magazines. There was an auditorium with seating capacity for 450, which could be used for lectures, dancing, or private theatricals. Housemothers had charge of the home and carefully looked after the comfort of the nurses and acted as chaperones.

The educational department consisted of classrooms, a demonstration room, and laboratories for Chemistry, Bacteriology, and Dietetics.

On the seventh floor of the building was the Nurses' Infirmary, where student nurses, taken ill in the line of duty, were cared for and treated gratuitously. The Infirmary was equipped as a small hospital and was in charge of a woman physician as Medical Director. [29] photo of Stanford University School of Nursing, building opened in 1922 [30]

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Organization of the Medical Faculty and Attempt to Install the Clinical Full-time System

As noted in Chapter 31, a Plan for Organization of the Faculty of the Medical Department of Stanford University was adopted in 1909. At that time the titles and functions of the full-time faculty were broadly defined as follows: [31]

Professors and Associate Professors are to be those members of the Medical Faculty who are under full salary and who give the main part of their time to the work in their respective departments.

This ambiguous definition applied primarily to the Professors and Associate Professors in the basic science departments who were indeed employed and paid on a full-time basis, and received no outside income from medical practice. However, with the exception of Professor Ophüls of the Pathology Department who was paid a "full salary" and was denied the privilege of private practice for personal gain, other professorial faculty of clinical departments were paid a negotiated "full salary," which was often nominal, but were permitted to supplement their incomes by private medical practice.

This plan of organization, that is the paying of less than full-time salaries to professors in the clinical departments but allowing them to enhance their incomes by private practice, is referred to as the geographic full-time system. which we have discussed at some length in the previous Chapter.

The topic of faculty organization was further addressed at a meeting of the Executive Committee of the Medical Faculty on 29 December 1910. Those present were Doctors John Stillman, Henry Gibbons, Jr., Emmet Rixford, William Snow, William Ophüls and Ray L. Wilbur. The minutes of the meeting state: [32]

it was moved and seconded that it was the sense of the Executive Committee that future appointments in the Medical (School) of heads of divisions and subdivisions should be on an academic basis, at least on the salary of an instructor - it being understood that this recommendation is not intended to interfere in any way with the appointment of such paid and unpaid clinical staff as may be required. Motion carried unanimously.

This resolution, in its reference to placing heads of divisions and subdivisions on an "academic basis" would seem to be committing the Medical Department, in principle, to the "clinical full-time system " as described by Dr. Lewellys Barker in 1902 and adopted by Johns Hopkins faculty in 1914. However, the statement that heads of divisions and subdivisions should be on an academic basis "at least on the salary of an instructor" is contradictory. It indicates that a strictly full-time salary would not be paid to professorial faculty as is required under the definition of the clinical full-time system, which also disallows private practice as a means of supplementing an inadequate university salary.

Grant Application to General Education Board Proposed

Obviously, the deterrent to adoption of the clinical full-time system at Stanford in 1910 was not lack of motivation but insufficient money. It was clear to Dean Wilbur that the system could not be implemented without a major increase in the endowment of the University to cover the added cost of paying actual full-time salaries to heads of clinical divisions and subdivisions. Therefore, as soon as the controversy with President Branner over the future of the medical school had been decided, the Dean addressed the following letter to him asking his help in raising the funds required to establish the true clinical full-time system. The Dean proposed applying for a grant to the General Education Board of the Rockefeller Foundation, an agency with which whose sponsorship of the clinical full-time system we are already familiar. [33]

July 22, 1914

President. J. C. Branner

Stanford University

Dear President Branner:

Now that the position of the Medical School is assured and the lines of action proposed therefor have met with the approval of such an eminent authority as Dr. Vaughan, it would seem to me desirable to urge upon the General Education Board that they enlarge the field of their efforts to improve medical education in America by assisting Stanford to improve conditions on the Pacific Coast. With some assistance Stanford can readily set an example not only for the first-class schools of Medicine that will soon develop in Portland, Vancouver and Los Angeles and in association with the University of California but also for medical education in general. As Dr. Vaughan has pointed out the development of the Stanford Medical School will be both a stimulus and a protection to the University of California in their medical work. Just as the foundation of Stanford University led to the remarkable development of the University of California, so will proper growth of the Stanford Medical School lead to the State with its unsurpassed resources pushing forward rapidly its Medical School.

The Dean outlined for President Branner Stanford's current "geographic full-time plan" of paying nominal salaries to professors in the clinical divisions and subdivisions and allowing them to make additions to their income through private practice.

He then pointed out to the President that if Stanford's investment in the School of Medicine could be increased by $750,000, that is to say $35,000 per year, Stanford's geographic plan could be converted to a clinical full-time plan by allocating the money as follows:

Division Annual Allocation
Surgery $7,500
Pediatrics $6,000
Neurology $5,000
Genito-Urinary Surgery $4,000
Eye $4,000
Ear, Nose and Throat $4,000
Medicine at San Francisco Hospital, etc. $4,500
Total $35,000

The Dean omitted Medicine at Stanford from this budget because he considered that subdivision to be already operating on a clinical full-time basis.

The Dean concluded his letter to President Branner with the following remarks:

In addition to the Basic Science Divisions, Stanford now has the Clinical Divisions of Medicine, part of Surgery, including the Subdivisions of Orthopedic Surgery, Obstetrics and Gynecology, on an academic (i. e., full-time salaried) basis Stanford is probably the first institution to put the various subspecialties on a full-time basis.

Anything that can be done to bring the possibilities of our Medical School before those interested may prove helpful.

Very truly yours,

(Signed) R. L. Wilbur.

The following Inclusions to accompany the above letter are abstracts of the grants already approved by the General Education Board:

JOHNS HOPKINS MEDICAL SCHOOL

William H. Welch Foundation $1,500,000

To provide for full time clinical teachers with sufficient assistants in Medicine, Surgery, and Pediatrics. Salaries thought to be about $ 10, 000 each. The professors are allowed to practice Medicine as they please but all fees are to be collected and retained by the hospital. Since Johns Hopkins Hospital contains many private rooms the medical care of patients occupying these rooms will be something of a problem and will probably lead to the superintendent of the hospital urging the care of such patients upon the paid staff since thereby the earnings of the institution will be greatly increased. This will make it difficult for the teacher to refuse and also to control his own time. It will also prevent him from having that sense of responsibility to the individual and to the community that is most important in the development of the real physician.

YALE UNIVERSITY MEDICAL SCHOOL

Gift of $750,000.

Contingent upon obtaining full control over the New Haven Hospital and additional endowment between $ 1,000,000 and $1,500,000 to put Medicine, Surgery and Pediatrics on an academic basis. Yale has not yet obtained the full amount but seems likely to reach the amount required soon.

WASHINGTON UNIVERSITY MEDICAL SCHOOL, St. Louis

Gift of $750,000.

Contingent upon a similar amount being raised by the institution. Aimed to put at least Medicine, Surgery and Pediatrics on a basis similar to that of Johns Hopkins but not so restricted as to plan. Details not worked out yet.

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