Faith And Resolution
It was a move, predicted KU Chancellor Frank Strong, that would create “the best medical school between Chicago and San Francisco,” the “Johns Hopkins of the West.” Others were even more effusive, claiming this action had instantly brought “into existence one of the best medical colleges of the United States today,” one whose “prospects bid fair to make it one of the best in the world.”
These rose-colored references to the April 21, 1905, decision by the University of Kansas Board of Regents to authorize establishment of a four-year KU School of Medicine certainly reflected confidence and conviction. Unfortunately, they bore little resemblance to the reality at the time.
The new medical school that had come into being was the result of a hurried merger between the University’s existing two-year School of Medicine, based on Mount Oread, and three proprietary medical colleges in metropolitan Kansas City, two of which were on the Missouri side of the border.
The birthing process itself, however, had been long in coming and had taken place amid a contentious atmosphere of intrastate rivalries and legislative foot-dragging. It was accompanied by a promise about future funding requests from Chancellor Strong that he could not possibly expect to keep. And it was further complicated by legitimate concerns about locating a major state-supported educational institution virtually cheek-by-jowl with the Kansas-Missouri state line on acreage that was not easily accessible.
In the end, the initial offspring that resulted from this gestation was an awkward creature. It was split between KU’s main campus in Lawrence, where first- and second-year medical students would receive background scientific instruction, and various scattered sites in the environs of Kansas City, Kansas, where third- and fourth-years would take their hands-on clinical training.
Compounding these initial difficulties were innumerable administrative headaches, chronic faculty discontent, lackluster state financial support, and outright hostility from much of the Kansas medical community. Dr. George H. Hoxie, first dean of the Clinical Department, likened the School’s precarious early years to a “bad dream.” Decades later, an account of the Medical School’s origins echoed this assessment, noting, “A more inauspicious beginning could hardly be imagined.”
But begin it did. And considering that its creation had been imagined in one form or another for more than four decades previously, the Board of Regents’ 1905 establishment of KU’s four-year School of Medicine was indeed a major achievement. Tenuous as it may have been, it turned out to be tenacious as well. Over time, it built the organizational foundation for the subsequent development of the present-day KU Medical Center, which by many measures, has ultimately lived up to Chancellor Strong’s optimistic forecasts. It just took a while to get there.
The legislation chartering the University of Kansas, signed into law in 1864, contained a provision authorizing the creation of a “Medical Department.” As Kansas was still a frontier state at the time and the early KU was little more than a glorified high school, establishing a formal program of medical education was nowhere near the young University’s priorities or capabilities.
In the years that immediately followed, modest levels of state funding, corresponding budgetary constraints, and the lack of adequate hospital facilities in Lawrence – which was still a small town – combined to keep the contemplated “Medical Department” on the back burner.
But beginning in the 1880-81 school year, KU repackaged a passel of existing basic science courses as a one-year medical preparatory program. With offerings in anatomy, chemistry, zoology, and similar subjects, this rudimentary undertaking enabled aspiring physicians to obtain their first two semesters of medical education at KU, after which they would have to go elsewhere to complete an MD.
KU maintained this one-year preparatory program for 19 years. By the mid-1890s however, fewer and fewer full-fledged medical schools were agreeing to accept the KU transfer credits and as a result, enrollments were dwindling. The time had come either to expand the preparatory program and raise its standards or just abandon it altogether.
KU – as well as Lawrence, for that matter – still lacked the resources and infrastructure to launch a four-year medical college, which was becoming the national norm. But the University could do the next best thing.
In 1899, a two-year medical education program – presumptuously named the University of Kansas School of Medicine – came into being under the deanship of Dr. Samuel Wendell Williston, a KU professor of geology and paleontology with degrees from Kansas State and Yale. Based on Mount Oread, this nascent medical school offered four semesters of scientific study, but no clinical training, and no MD at the end. (Graduates were awarded a Bachelor of Science in Medicine degree.)
This expanded program began with some two-dozen medical students and its own dedicated building – a structure previously known as Chemical Hall and appropriately renamed Medical Hall – situated just to the southwest of the original Fraser Hall. (Designed by noted Kansas architect John G. Haskell, Medical Hall went on to live a third life as “The Shack” where KU journalism students put out the University Daily Kansan. The building was demolished in 1962.)
The Medical Hall curriculum included advanced classes in pharmacy, embryology, bacteriology, psychology and medical jurisprudence. And thanks to Dean Williston’s indefatigable lobbying, the students’ preliminary coursework was becoming increasingly accepted by various professional associations, state licensing boards and medical colleges nationwide. All this, however, could not disguise the fact that Medical School alumni would still have to leave KU for the clinical training needed to become bona fide physicians.
According to KU historian Clifford Griffin in The University of Kansas: A History, as the twentieth century dawned on Mount Oread, “All of professional education raised problems for the University’s leaders, but it was the School of Medicine that most tried their souls.” Perhaps most beleaguered was Chancellor Frank Strong, who had taken office in 1902.
In Strong’s view, KU’s continued inability – after almost 40 years of existence – to offer a complete and proper four-year medical education program was something of an embarrassment. It was damaging in terms of the University’s general scholastic reputation, and beyond that, was causing many of the brightest Kansas students to avoid Mount Oread altogether.
As Strong saw it, this sorry state of affairs was the natural consequence of a string of untaken and otherwise squandered opportunities. Foremost in the chancellor’s mind was a languishing proposal made eight years earlier by Dr. Simeon B. Bell, a wealthy Wyandotte County physician and real estate speculator.
Back in 1894, Bell had offered to give the University $25,000 worth of land (that it could then sell for cash) along with $50,000 in “nucleus” money to build a brand new medical college and teaching hospital. This $75,000 gesture, intended as a memorial to his late wife, Eleanor Taylor Bell, did admittedly come with strings attached.
Chief among these was that the clinical facilities had to be built on a piece of land Bell owned in his hometown of Rosedale, Kansas (now part of present-day KCK). This seven-acre promontory, just a stone’s throw from the Missouri state line, overlooked Southwest Boulevard and was commonly known as “Goat Hill.” (It earned this nickname either for the herd of goats that grazed at its base or, as some suggested in jest, for the fact that only these hardy creatures could climb its steep gradient.)
Goat Hill was far from an ideal location. Situated about 40 miles east of Lawrence, it was somewhat inaccessible and lacked room for serious future expansion. Additionally, building a hospital and clinical program there would necessitate dividing the KU School of Medicine between two locales, since the first two years of background science courses would remain on Mount Oread.
Nonetheless, Bell’s offer qualified as a “stupendous windfall,” as historian Griffin later characterized it. Downplaying the problems that a divided medical school might cause, University leaders such as then-Chancellor Francis Huntington Snow were eager for the Kansas legislature to accept Bell’s offer. Had the lawmakers done so, construction of the Rosedale hospital facilities could have begun immediately, putting KU on a fast track to having, a real, four-year, MD-granting medical school. This was not to be. In the state legislature’s 1894 session, Topeka balked at accepting the deal.
Spearheading the “anti” faction were the very people one might think would have been most in favor of the proposal – practicing members of the Kansas medical community. Part of their argument against the proposed project was geography-based. If a state-assisted KU hospital and clinical department were built in Rosedale, these physicians claimed, it was inevitable that the facilities would be staffed and controlled primarily by doctors from Kansas City, Missouri.
Additionally, charged these critics, the vast majority of patients receiving care would also be Missourians, not Kansans. As one Sunflower State physician rather indelicately put it, a hospital in Rosedale would become nothing more than an “asylum for harboring the paupers of Missouri and treating their ailments at the expense of the whole people of Kansas.”
Physicians based in Topeka were particularly vituperative in their opposition. Many had long desired a publicly funded medical school for the state’s capital city. Still other Topeka doctors sought to thwart the Rosedale proposal for more pecuniary reasons – they were associated with the proprietary Kansas Medical College (later affiliated with Washburn University), and resented any action that might result in “state-supported competition.”
Although influenced by these compelling arguments, state legislators were most concerned with the potential costs of the proposed facility. Dr. Bell had, to be sure, offered to provide the Goat Hill site free of charge. And furthermore, his $75,000 pledge would likely be enough to construct and equip the hospital, as well as some other buildings. Yet even so, estimates were that the legislature would still have to kick in an additional $10,000 a year to keep the Medical School’s clinical program operating on a “creditable basis.”
Annual expenditures of this magnitude would be difficult to justify for many legislators, especially given that Rosedale was located some 400 miles from the western border of Kansas. Any clinical facilities built there would be of little service to those living outside the state’s northeastern quadrant, even though all taxpaying Kansans were being asked to support the project.
For all of these reasons, the representatives’ reaction to Bell’s offer was essentially thanks, but no thanks. The proposal lingered in legislative limbo for the rest of the 1890s, which is where it remained in 1902 when Frank Strong assumed the University chancellorship. Determined to succeed where others had failed, Strong took on the unenviable task of overcoming the opposition that had thus far thwarted KU’s bid to establish a full-fledged medical school.
Strong rationalized his way into supporting the Rosedale plan, despite its assorted downsides, in part because many of the alternative locations were even worse. With a population of around 12,000, the city of Lawrence hardly had the potential patient base to support a substantial clinical teaching hospital. Topeka counted about 34,000 residents and may have barely sufficed, but as Griffin noted, Simeon Bell “would give not a cent or an acre for a hospital or school outside Rosedale.” Indeed, the Rosedale site’s location within the Kansas City metropolitan area – which boasted an overall population topping 300,000 – became, in Strong’s view, one of the proposal’s strengths because it would all but guarantee KU medical students a diverse and abundant supply of “clinical material.”
On top of that, the way the chancellor figured it, Bell’s money would cover all initial construction costs, eliminating the need for the legislature to appropriate any funds for capital expenditures. As such, Strong came to believe that the Bell offer and the contemplated Rosedale campus was the University’s best – perhaps even only – chance to establish a four-year school of medicine.
Yet if Strong was going to make this case convincingly, he had to do it fast. Bell had placed a 10-year time limit on his original 1894 offer, and time was literally running out. In 1904, the offer would be rendered void.
Strong was in close contact with Bell and agreed with the doctor that the gift “ought never to be allowed to escape.” The chancellor persuaded the would-be benefactor – now aged 84 and as frustrated as anyone by the legislature’s continued unwillingness to accept his gift and erect the hospital in memory of his wife – to extend the offer one more year. Additionally, Bell, his lawyer John Sullivan (a KU alumnus) and Strong, joined by members of the KU Board of Regents, agreed to launch a last-ditch, full-court legislative press.
The tactics they employed were neither original, nor particularly subtle. Basically Bell just sweetened the pot. In addition to the $75,000 cash-land package he’d already promised, in early 1905, the good doctor tossed in 500 acres of Missouri farmland he owned in Cass and Jackson counties. Worth an estimated $25,000, this raised the total value of his gift to $100,000 (approximately $2 million in early twenty-first century terms). This appears to have had a noticeable calming effect on cost-conscious members of the Kansas State Senate and House of Representatives.
What appears, though, to have ultimately secured bicameral acceptance and the support of Kansas Governor Edward Hoch, was a written pledge by Frank Strong vowing never to ask, ever again, for any more money. “I can say to you authoritatively,” he wrote, “that the Board of Regents and the present management of the University will not either now or hereafter call for appropriations from the legislature either for buildings or maintenance of the clinical school at Rosedale.” With that, the deal was sealed and on March 15, 1905, it became law.
But in the haste to get Bell’s offer accepted, apparently little thought was given, as Griffin has pointed out, to “planning for the future” and even less to “whether the University was ready for a four-year medical course.” As Strong himself later confessed, “The whole problem of the medical school came so suddenly that it was impossible for anyone to see in just what direction the development would have to take place.”
Describing this situation as a “problem” was apt indeed, for as Griffin also noted, “though it would take time to sell [Bell’s] land and build a hospital and other facilities,” Strong and the Regents, flush with victory, “were determined to open the [Rosedale] clinical department in the fall of 1905 – even if it had no hospital, no money, no assured future, and a sloppy organization.”
Construction began apace on the 35-bed Eleanor Taylor Bell Memorial Hospital. As per Dr. Bell’s wishes, the facility would be located atop Goat Hill in Rosedale and be ready for occupancy the following year. In the meantime, Chancellor Strong forged ahead, proceeding to give his plans a more corporeal existence.
Reformulating the existing two-year KU School of Medicine on Mount Oread into a four-semester Scientific Department proved no real problem. It would still be comprised of all the basic and advanced science courses that KU medical students had been taking since 1899. Williston had departed a few years earlier, so Dr. Mervin T. Sudler, an associate professor of anatomy at KU, became dean of this section of the Medical School.
However, in establishing the two-year Clinical Department at Rosedale, a far more complicated scenario was playing out. With fall semester 1905 classes set to begin September 6, and with Strong and the Regents still intent on beginning clinical instruction that day, no matter what, some major strategizing was in order.
Their two principal quandaries were, to say the least, rather serious ones. Put simply, this new upper branch of the KU School of Medicine only existed on paper. It possessed no clinical facilities and no faculty members.
To address both issues simultaneously, the approach KU quickly settled on was to contact a number of Kansas City-area proprietary medical colleges and ask them to consider an immediate merger. Positive responses came from the Kansas City Medical College and the Medico-Chirurgical College (both in Kansas City, Missouri) and the College of Physicians and Surgeons (based in Kansas City, Kansas.) These schools agreed to “give up their existence” and hitch their collective wagons to KU’s still somewhat nebulous medical star.
Brokered during the early spring of 1905, the merger came to fruition at the KU Board of Regents’ April 21 meeting. At this gathering, members drafted what has become known as the four-year School of Medicine’s “language of incorporation.” Under terms of the agreement, both the students and the faculties of these three proprietary institutions would immediately become part of the Medical School. And moreover, until Bell Memorial Hospital in Rosedale was completed, all Clinical Department classes would be held in the basement of the now-former College of Physicians and Surgeons building, located at the corner of Simpson and Central Avenues in KCK.
At this time, too, Strong and the Regents negotiated agreements with four Kansas City hospitals – three on the Missouri side plus St. Margaret’s in KCK. The deals would allow the KU School of Medicine to hold clinics in their facilities, thereby giving the University’s new medical students access to some 600 patient beds.
In addition, the Clinical Department took possession of the Medico-Chirurgical College’s building and began using it as a dispensary for indigents. Although it was located on Independence Avenue in Kansas City, Missouri, this educational expedient dubbed the “North-End Dispensary” enabled KU medical students to “see and treat, under the direction of the Faculty, thirty to forty patients daily.” A second dispensary was situated “near the packing-houses in Kansas City, Kansas” – considered valuable, as a report from the time noted, because it “affords many cases of accidental injury” and would permit these future doctors to “study disease in some of its worst forms.”
What this grand alliance meant in terms of actual Medical School enrollment was a more than five-fold instantaneous increase in the student body. Whereas during the 1904-05 academic year, the two-year program on Mount Oread counted only 30 medical students, by the time classes began on September 6, 1905, total student headcount had risen to 162. Even more considerable was the change in the faculty complement. Over the same period, the number of Medical School faculty members surged almost ten-fold, from 13 to a whopping 125 – an amazing 1.3 to 1 student-teacher ratio.
This was, however, a bit less remarkable than it might seem on its face. Of the group, only 12 were actually full-time salaried professors. The rest were mostly unsalaried private physicians teaching everything from surgery to obstetrics on a strictly volunteer basis, an arrangement that “enhanced a physician’s social prestige and often increased his consultative practice,” as Dr. Robert P. Hudson, a longtime chair of the Medical School’s History of Medicine Department, has explained.
While having its bottom-line advantages, this plethora of no-cost physician-educators also caused considerable discomfort, particularly for the Clinical Department’s first dean, Dr. George H. Hoxie, who was also a professor of internal medicine. “With the merger,” according to Hudson, “Hoxie found himself facing a situation that present students and teachers would see as utopian, but one [he] knew held all the delights of the sub-basement of Dante’s eighth circle [of Hell].” Apparently many faculty members, at least in Hoxie’s estimation, were “incompetent.” Their ranks, he thought, were in need of pruning.
In this endeavor, Dean Hoxie had an ally in Chancellor Strong. To address their surplus faculty problem, the two men devised a plan that, they believed, would accomplish the reduction without actually having to fire anybody. “Hoping things might solve themselves through some variant of the law that has the fittest surviving,” wrote Hudson, they “hit on the idea of having all courses elective.” The effect would be that “those professors the students neglected would gradually” – and hopefully without rancor – “fade away.” Technically the scheme worked. Within one year, the faculty had been slashed by almost 20 percent, from 125 to just over 100.
Not surprisingly, though, the downsized doctors left not with a whimper, but with a bang, venting their anger at the Medical School as a whole and at Dean Hoxie in particular. Indeed, for his part in these furtive firings, Hoxie became “the most hated physician in Kansas City.” His relations weren’t much better with those faculty members who avoided the ax. Many of them complained about Hoxie’s “dictatorial” manner and for fancying himself, in one colleague’s words, as “God almighty … without either the Lord’s omniscience or His mercy.” As if this wasn’t enough, Hoxie also found time to butt heads with Dr. Mervin Sudler, dean of the Med School’s Scientific Department in Lawrence. Eventually, Chancellor Strong had to give Hoxie a formal reprimand for persistently “meddling” in Sudler’s domain.
Thus it was in slightly exaggerated tones that Strong, in November 1906, reported to the Board of Regents that KU’s new School of Medicine was enjoying “abundant success.” Granted he did have some reasons to be enthusiastic.
That year saw completion of the Eleanor Taylor Bell Memorial Hospital, as well as a teaching and research laboratory and an outpatient clinic – all on the new Goat Hill campus in Rosedale. The inaugural 57-member Class of 1906 had just been graduated. Plans were being made to organize five distinct specialty fields. These included surgery; obstetrics and gynecology; clinical pathology and hygiene; and “special subjects” such as ophthalmology and dermatology. On top of all that, a training program for nurses had been established (an undertaking that would ultimately evolve into the present-day KU School of Nursing).
Additionally, ongoing faculty discontent notwithstanding, there were now solid indications that a significant number of the Med School’s inherited physician-educators were of exceptional quality.
Orthopedic surgeon Dr. Robert M. Schauffler, formerly of the Kansas City Medical College and an MD from Columbia, was also a founding physician of Kansas City’s Children’s Mercy Hospital. Another surgeon and Kansas City Medical College transfer, Dr. George Gray, had helped found St. Margaret’s Hospital and would even serve a short stint as mayor of KCK. University of Pennsylvania alum Dr. Franklin E. Murphy, yet a third KC Medical College veteran, would ultimately serve the KU School of Medicine for 28 years as professor of internal medicine and become a trusted advisor to University and Medical School administrators.
Prominent Kansas City surgeon Dr. Ernest F. Robinson, son of one of KU’s original three faculty members and another Penn medical school alum, lent his considerable prestige to the Clinical Department faculty. As did Dr. John F. Binnie, a native Scotsman who was fast gaining a national, even international, reputation for his influential textbooks on surgery. Meanwhile, back on Mount Oread in the Med School’s Scientific Department, bacteriology professor Marshall Barber had begun experimenting with a device of his own invention he called the micropipette that would provide conclusive proof of the germ theory of disease.
These promising prospects, however, were somewhat mitigated by consequence of the compromises and corner cutting that had attended the Medical School’s establishment. Of principal concern was the institution’s severe shortage of money. Having exhausted the Bell bequest, Strong and his fellow administrators were soon forced to go begging to the state legislature, despite the chancellor’s initial promise never to do so. The lawmakers proved kindly forgetful and agreed to help – but only with appropriations sufficient to keep the Med School on what amounted to life support.
Meanwhile, much of the Kansas medical community remained unrelenting in its antipathy toward the School. To a degree, this antagonism was wholly understandable, since it reflected irritation with the very outcome many Kansas physicians had feared. Owing to the slapdash organization of the KU School of Medicine, roughly three-quarters of its faculty were residents of Missouri.
Accordingly, numerous Sunflower State physicians were up in arms. A typical piece of advice came from one Kansas doctor who, in 1910, declared that if the Med School’s leaders wanted his colleagues’ backing, “They had better get rid of their Missouri men and get Kansas men.” “Surely it would take but a whiff and a blow,” added the Wyandotte County Medical Journal, “to make the institution a Missouri one entirely.”
Back in 1905, Chancellor Strong had hoped that, within a short time, KU would have “the best medical school between Chicago and San Francisco,” the “Johns Hopkins of the West.” Yet as it happened, the School’s fifth and tenth anniversaries passed with little likelihood of such lofty designations being bestowed anytime soon. In fact, mere survival for the Med School seemed by far the most sensible goal.
“Ultimately,” Griffin observed, “the University would get the money it needed to convert the School of Medicine into a first-rate institution. But for its first decade and more, it suffered from careless planning and no planning,” hamstrung by both “Simeon Bell’s egocentric philanthropy and Frank Strong’s eagerness to have an appendage called a Medical School, whatever its quality.” As historian Thomas N. Bonner put it, “Only faith and resolution sustained the Medical School in these [early] years.”
John H. McCool
Department of History
University of Kansas