"The complete school in touch with the rest of the university represents the normal and correct form. The study of medicine must center around disease in concrete, individual forms. The ease with which the clinic and the laboratories may there illuminate each other is an incontestable advantage to both." Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (Boston: The Merrymount Press, D. R. Updike, 1910) p. 72.
As the Great War ended and the nation passed into a prosperous new decade, the single most important issue for the UC Medical School continued to be the problem of the split campus. In the wake of the 1906 earthquake, the displacement of the sciences from San Francisco to Berkeley was viewed as a temporary measure. With science instruction ensconced in teaching laboratories at Berkeley while clinical training was centered at the SF County Hospital and Parnassus Heights in San Francisco, students were forced to function in two very different environments. Despite much rhetoric about consolidation of the campuses and frequent pronouncements of plans for change, the rift would continue to plague the medical school and the university until well after the Second World War.
As early as 1911, Dean D'ancona identified the split as a serious mistake, echoing the judgment of the Flexner report that elaborated on the dangers involved in a geographically divided medical curriculum where "busy physicians...[do] not breathe the bracing atmosphere of adjacent laboratories." The UC Regents were aware of the need for consolidation, but preferred San Francisco as the location for the medical school, and in April of 1912, they resolved that the medical school should be reunited in San Francisco as soon as possible. In 1916 they commissioned Dean Herbert Moffitt to study medical education around the county and draw up a plan for future development of the Medical School at Parnassus. Moffitt's ambitious plan, drafted while the new UC Hospital was under construction, recommended that new buildings to house anatomy and pathology be built in back of the new hospital at a cost of $150,000. To house physiology and biochemistry and the requisite student labs, he urged that the old Medical School building be refitted for laboratory instruction and that the outpatient facilities located in the basement be removed to a new building to be erected for this purpose in front of the UC hospital on Parnassus Avenue. With the exception of the nurses' dorm built across the street from the hospital in 1921, little of Moffitt's plan ever came to pass, but it identified and foreshadowed the pressing needs of the Parnassus campus for the next forty years.
World War One's distractions prevented implementation of the Moffitt reconsolidation plan, but in 1920 university and medical school officials again turned their full attention to the problem of the split medical school. Their interest was prompted by rumors that the General Education Board, an organization backed by Rockefeller philanthropy and committed to rebuilding American medical education, wished to endow a third school of public hygiene at Berkeley, on par with those already created and endowed at Johns Hopkins and Harvard. As part of this plan, they indicated that they would financially assist the UC Medical School in upgrading instruction and reconsolidation. The main requirement of the Rockefeller donors, however, was that the UC Medical school be relocated at Berkeley in close proximity to established academic programs in anatomy, bacteriology, immunology, and biochemistry.
In 1920, University President David P. Barrows, who was anxious to meet the criteria for this potential multi-million dollar donation, traveled east to speak with the Rockefeller board members in person. In consultation with Abraham Flexner himself, President Barrows was succinctly reminded of the current reforms deemed necessary in medical education. This was a time in American medicine when substandard schools identified in the Flexner report were rapidly being closed and the remaining institutions were realigning themselves according to Flexner's blueprint for reform. The UC Medical School's plight was not unique--the report indicated that of twenty-five top university-affiliated institutions, five (Rush Medical College, California, Nebraska, Kansas, and Stanford) had similarly separated instructional programs. Flexnerian reforms mandated the implementation of salaried full-time positions for both scientists and clinicians, consolidation of science and clinical instruction in one geographical location near a major university, and designation of a large teaching hospital completely dedicated to clinical training. In response to these requirements, President Barrows drafted a plan for bringing full-time "vocational" professors to the medical school, consolidation of instruction in one place, and reconfiguration and expansion of the UC Hospital teaching bed capacity along with plans for a school of public health. He then asked the Regents to develop a budget corresponding to these reforms, hoping that in so doing he would secure "the generous participation" of the General Education Board.
As he managed these negotiations, President Barrows was well aware of the local political obstacles to relocating the school at Berkeley. By the early 1920s there were substantial reasons for keeping the medical school in San Francisco, especially in terms of the city's potential as an inexhaustible source of talented practitioners and needy patients. Moreover, the medical school's major endowments of the late nineteenth and early twentieth centuries dictated a commitment to the Parnassus site. Sutro's donation of land for the Affiliated Colleges in 1895 was contingent on the use of the site expressly for professional medical education, and the Hooper Foundation specified that Hooper-funded research be conducted in San Francisco. Then in 1916, the new UC Hospital was built with $600,000 of private subscriptions from a supportive San Francisco community. President Barrows hoped that the regents might solve the problem and bend to the wishes of the General Education Board, or conversely that the General Education Board might be flexible on the issue of the school's actual location.
On March 12, 1921, in a move reflecting local politics and the lobbying influence of San Francisco clinicians, the UC Regents voted to reaffirm their 1912 decision, stating flatly that "as a prudential measure. . . . it shall be the policy of the Board to consolidate the medical department in San Francisco." That summer the General Education Board received the UC proposal for consolidation at San Francisco and never replied. It was clear that consolidation of the medical school would have to take place at the university campus in Berkeley in order to merit further endowment.
This was a major loss for California higher education: Rockefeller money was transforming the national landscape of medical education in the interwar years and would eventually provide over $50 million to sixteen medical schools. Philanthropy came from other sources as well. Between 1910 and 1932 foundations would pour a total of $150 million into the reform of American medical education. The regents' stubborn adherence to the San Francisco location prevented UC School of Medicine from obtaining any national philanthropic financial support during this time of flush private endowments.
As negotiations with the Rockefeller boards fell silent in the wake of the regents' decision, Berkeley scholars began to leave for more promising teaching posts, and plans for a great new school of public health on the west coast were dropped. George Whipple left the Hooper Institute to take a leadership position at Rochester, a new school developed with a GEB grant of $4 million. Whipple persuaded Walter Bloor from the Biochemistry Department at Berkeley to lead a new Biochemistry Department at Rochester. Dr. Robert Gesell, who had been recruited to UC in 1920 to strengthen the Berkeley Physiology Department, left abruptly to be professor of Physiology at Michigan. Finally, Frederick P. Gay, a nationally known Berkeley expert in immunology and bacteriology, left California to teach at Columbia.
The matter of Rockefeller endowment surfaced yet again in 1923, when the incumbent UC president, astronomer William W. Campbell, made a last forceful attempt to resolve the medical school situation, which he regarded as "the University's largest and most difficult problem." Like Barrows before him, President Campbell traveled east to confer directly with Abraham Flexner and the Rockefeller board, and discovered that, although the donors' offer of endowing a third great school of public health at Berkeley was still on the table, they would not assist the medical school if it remained in San Francisco. On the other hand, if the Medical Department was consolidated at Berkeley it was clear that the Rockefeller interests would be "instantly and tremendously interested in its financial problems." President Campbell delivered an ultimatum to the regents in 1924, arguing that "the Berkeley location of the medical school would tend to make it a statewide institution, in greater degree than it is today, and it would bring many millions of help from outside the State." He emphatically pointed out that "if the location is to remain in San Francisco, then I respectfully represent, the regents should be prepared to find in San Francisco or elsewhere, very soon, many millions of dollars for the consolidation expansion and maintenance of the Medical School and Hospitals." Once again, the regents stood firm for the Parnassus location, sealing the fate of the UC Medical School for the next three decades. Despite their stubborn rejection of an all-Berkeley medical campus, the regents responded to President Campbell's call for dramatic reform at the medical school and joined him in mobilizing state resources to accomplish the task.
In their disillusionment following the loss of Rockefeller funding, several key science faculty left Berkeley, but the void was soon filled with more local talent. Biochemist Carl L. A. Schmidt was made chair of Biochemistry and began his research into the chemistry of amino acids and proteins. With the loss, first of Jacques Loeb, and then Robert Gesell, the Physiology Department went into a period of decline. In contrast, the Department of Anatomy at Berkeley flourished under the leadership of young California-born Johns Hopkins graduate Herbert M. Evans. Evans had studied anatomy under Franklin Mall at Hopkins and before returning west had already published his first work on the embryology of the vascular system. In 1915 he was recruited to chair the Department of Anatomy at Berkeley. There he consistently championed basic research turning to the study of endocrinology using microscopic anatomy to study hypophyseal hormones, and utilizing vital dyes to differentiate tissues during different stages of the estrous cycle. Throughout the next three decades, Evans taught an entire generation of first-year medical students the rigors of bench research. He disdained the more applied nature of gross anatomy, and, when clinicians traveled from San Francisco to teach the necessary skills to medical students, he referred to them derisively as "the hat-rack boys." In 1930, when the Depression reached California, effectively halting any plans to construct research labs at San Francisco, a 375,000 square foot Life Sciences Building was erected on the Berkeley campus, funded by a state bond issue and a WPA appropriation. This building, for its time one of the largest academic structures in the nation, provided labs and classroom space for anatomy, physiology, biochemistry, botany, and zoology, and stood as an important architectural symbol for basic biological research and instruction on the Berkeley campus.
In addition to Evans' work at Berkeley, significant research was being done in San Francisco in connection with the Hooper Foundation. Karl F. Meyer replaced George Whipple as director in 1922 and his reputation soon equaled that of his eminent predecessor. Trained as a veterinarian, Meyer was a gifted investigator and under his direction the Hooper's research moved into the epidemiology of infectious disease and large-scale studies of animal infections in man. Given its location at Parnassus, the Hooper's relationship was "closely correlated" with the Medical School and researchers were given free access to university hospital wards. The Hooper Foundation also made research fellowships available to a handful of medical students who desired careers in research medicine.
Full-time research was a highly unusual career choice for UC medical students of the interwar years, for it was the clinical work at San Francisco that became the mainstay of the school's reputation during this time. Once the 220-bed UC Hospital was up and running, clinical instruction was divided into four main departments: Medicine, Surgery, OB/GYN, and Pediatrics, with full-time professors occupying the latter two chairs. Additional clinical training was available in 100 UC-controlled teaching beds at the county hospital, 70 beds at the Children's Hospital, and training opportunities at the Laguna Honda Home, Mt. Zion Hospital, and Letterman Hospital in the Presidio. The medical school also supported special tuberculosis clinics at the County Hospital and an endowed Cancer Ward at Parnassus. Throughout the 1920s and 1930s internship and residency positions were steadily increasing at the UC and the County Hospital, and a growing privately endowed scholarship and fellowship fund provided assistance to needy students. The UC Hospital was assisted by a social service department that provided nurses and social workers devoted to infant welfare, and a course for social service workers was offered at Parnassus under the auspices of the UCB Department of Social Economics. The medical curriculum was supported by an Anatomical-Pathological Museum of teaching and demonstration specimens and a library of journals, books and monographs in French, English and German.