Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective
Part I. Background History & E.S. Cooper's Midwestern Years

Chapter 4. Elias Cooper & Medical Schools West of the Alleghenies

No sooner had the American frontier swept from the Alleghenies to the Mississippi following the Revolution, leaving permanent settlements in its wake in Kentucky and the Northwest, than medical colleges began to spring up. To establish a medical school in the hinterland appealed to the pioneer spirit and brought national recognition and personal satisfaction to the founder. Small wonder that Elias Cooper whose medical education, such as it was, took place in the setting of these nascent schools, should be attracted by the challenge of founding a school himself. Therefore, in addition to the following account of his formative years, we will also describe some of the regional schools that served as examples to him.

Early Life

From the outset, our review of the early life of Elias Samuel Cooper must also include that of his nephew, Levi Cooper Lane , whose name is inseparably linked with his in the history of Stanford Medical School. Elias was like an older brother to Levi who was eight years younger and the son of Elias's sister Hannah. Growing up on neighboring Ohio farms, they were boyhood companions and explored the still-wild countryside together. The bond of loyalty, developed between them during this period and strengthened by the Quaker traditions of their close-knit families, was crucial to the survival of the Medical School in San Francisco after the death of Elias in 1862.

The merging streams of Quakers, fleeing the spread of slavery in the South, brought the Cooper and Lane families together in Southwestern Ohio. The Lanes arrived from North Carolina in 1806, the Coopers from South Carolina in 1807. The Cooper farm lay just outside Somerville in Butler County, and the Lane farm only five miles distant in adjacent Preble County, close to the present town of West Elkton. Being Quakers, both families attended the Weekly Meeting in West Elkton, and there Jesse Lane's son Ira met Jacob Cooper's oldest daughter Hannah. Ira and Hannah were married on 7 June 1827 and remained in Preble County 13 years, during which five of their nine children were born. Their first child, born 9 May 1828, was named Levi Cooper Lane.[1]

Dr. Levi Cooper Lane, 1828-1902
Cousin, co-worker, and successor to E. S. Cooper in medical education

see larger image »

Photo of Dr. Levi Cooper Lane (1828-1902)

Elias Cooper left no personal account of his early life, education, and medical practice for the period prior to his move to Peoria, Illinois, in 1844. Until now, the only sources of information about these years have been the following two articles published by Dr. Levi Cooper Lane: (1) an obituary of Cooper in 1862[2] and (2) a biographical sketch of Cooper in 1870.[3]

All previous authors have relied on these two articles for facts regarding Cooper's youth and early manhood. They have thus perpetuated inaccuracies, particularly as to dates, contained in the articles. Recently an important new source of personal observations regarding both Elias Cooper and Levi Lane has been made available to us, i.e., the eight-volume Diary of Elias's brother, Professor Jacob Cooper (1830-1904), covering the years from 1847 to 1902.[4] Professor Cooper's meticulous Diary provides considerable additional information about the lives of Elias Cooper and Levi Lane and also allows us to correct certain misconceptions. For example, the date of Cooper's birth was reported in Lane's articles to be 1822. However, the well-kept family records found in Professor Jacob Cooper's Diary list the birth date of Elias as 25 November 1820. We believe this source to be more reliable than Dr. Lane's memory and therefore propose to designate 1820 as the correct year of Elias Cooper's birth. We should add that birth dates in Cooper's day were often inaccurate. In fact, the date of Dr. Lane's birth was uncertain according to Dr. Emmet Rixford, Stanford Professor of Surgery who, early in his career, was an assistant to Dr. Lane.[5][6]

Lane's misunderstanding as to Cooper's birth date led him to exaggerate the youthful precocity of his uncle who, irrespective of his actual age, was an uncommonly able and resolute young man. With this mild caveat we quote from Lane's warmly partisan memories of his Uncle Elias, written in 1870 in the florid style familiar to the time:[7]

From the example of an older brother (Esaias Samuel Cooper) who had entered the medical profession, in which he has won and now holds an enviable position, the younger brother was led naturally to embrace the same calling. The selection of this profession was his own choice, and having once chosen it, he gave himself to its study with all the passionate ardor of youthful enthusiasm. The leading textbooks - especially those upon Anatomy - he almost committed to memory; for this branch of medical science he early exhibited a strong predilection, and its almost endless details, which are tiresome and difficult of acquirement by most students, were mastered by him with that pleasure and eagerness which love for a science always lends to its study. A fondness for Human Anatomy can scarcely exist alone - it naturally leads to Comparative Anatomy, its kindred science; hence, we find our young student soon pushing his investigations in the latter quarter, and learning there those laws which, in the humbler grades of animated nature, do not differ from those existing in the "paragon of animals." With no other guide than his own original and all but intuitive genius, he instituted a series of most interesting and instructive experiments in the ligation of veins and arteries in reference to the mechanism and functions of the various valves; and the observations then made by him, he found subsequently of great value in operative surgery.

There is much more in the same elegiac mode, but this excerpt is sufficient to convey Lane's expansive view of Elias's intellectual promise, sterling character, and early vocation for medicine as his life's work.

We can find no specific information regarding Elias's early schooling. We assume that he attended one of the country schools in Butler County but where and for how long is unknown. Years later, in an Introductory Lecture to medical students, he stated that he taught school and at the same time pursued independent study including animal experimentation. It is probably to this interlude of independent study that Lane referred above in such glowing terms.

Apprenticeship

The next stage of Elias's preparation for a medical career would in his day have been an apprenticeship with a practicing physician. Although Elias never mentions having served an apprenticeship, Volume 1 of Jacob's Diary contains the following entry:

My brothers Esaias and Elias began their professional studies early; the former went to study with Dr. Waugh in 1835 and Elias in 1838.

On the basis of this information, it is reasonable to conclude that Elias began an apprenticeship in 1838 at the age of eighteen with a Dr. Waugh and probably served through 1839. We have been unable to find Dr. Waugh listed among the physicians practicing in southwestern Ohio. In view of the fact that both Esaias and Elias later began their practice of medicine in Indiana, it seems likely that Dr. Waugh practiced there and introduced them to the state.

As we shall later mention, it is probable that Elias also served as an apprentice or as a partner with Esaias in Greenville, Indiana, from 1840 to 1843 when Elias moved and began to practice independently.

Medical Department of St. Louis University

Lane was correct in stating that Elias received his medical degree from St. Louis University in St. Louis, Missouri. After considerable difficulty in deciphering the records of that school, due to the fact that Esaias was also a graduate of it, we have determined that Elias was awarded the degree of MD ad eundem by the Medical Department of St. Louis University in 1851.[8]

Esaias received a similar MD ad eundem degree in the previous year of 1850. Thus both Elias and Esaias received their MD degrees qualified by the suffix ad eundem. The literal English translation of this Latin phrase is "in or of the same rank".[9] When suffixed to an academic degree as, for example, in "M.D. ad eundem", it means that some or all of the work on the basis of which the degree was granted was done elsewhere, but was recognized as being of equivalent rank or quality to that provided by the degree-granting institution. Ad eundem medical degrees were introduced in colonial America and were awarded by American medical schools during the nineteenth century, but their use has been discontinued.[10]

Requirements for the degrees of MD and MD ad eundem, as published in the Annual Announcement of the Medical Department of St. Louis University for 1850-51, were:[11]

  • That the candidate be twenty-one years of age, of good moral character and have been engaged in the study of medicine for three years (courses of lectures included).
  • That he shall have attended two full courses of lectures in this Institution (duration of course, 4 1/2 months: 15 October through February). Attendance on a regular course in some respectable and generally accredited medical school, or four years of reputable practice will, however, be considered as equivalent to one of the courses above specified.
  • That he shall undergo a satisfactory examination on all the branches taught in this College, and write an acceptable Thesis, either in the English, Latin, French or German language, on some subject connected with medicine.
  • Candidates, applying for the degree ad eundem, must show written and satisfactory testimony that they are graduates of a generally acknowledged school of medicine - that they have been engaged in practice at least two years, without having followed, during that time, any other occupation.
  • Fees for the whole course amount to $105. The Matriculation ticket (paid but once) is $5; that of the Demonstrator, $10; the Hospital tickets are gratuitous; and the graduation fee is $20.

It is apparent from the above outline that, if the candidate received credit for "four years of reputable practice", it would be possible to qualify for an MD degree from St. Louis University in a period of four and a half months; that is, the length of one course of lectures. We assume that both Esaias and Elias exercised this option.

In summary, as far as we can determine, Elias Cooper's total medical college education consisted of only one series of lectures lasting four and a half months in the Medical Department of Saint Louis University in 1850-51. We should keep in mind that at mid-century many American practitioners of medicine had attended no medical school at all, receiving their training (if any) through apprenticeship. It was an objective of American Medical Societies, to which we will later refer, to exclude these "irregular" physicians from the practice of medicine.

These findings regarding Elias's limited medical education make his considerable accomplishments more noteworthy rather than otherwise, reflecting as they do his native ability, self discipline, and personal commitment to independent study. He was from the earliest stage of his career imbued with academic aspirations. He was no doubt well aware of the usefulness of "academic credentials" in the furtherance of his ambition, and felt keenly his lack of them.

Before leaving this subject we should take passing note of an instance in which Cooper's use of the M. D. degree was premature. Elias designated himself as an M. D. on the following article in a medical journal in 1849.

"Remarks on Congestive Fever by E.S. Cooper, M. D., of Peoria, Illinois". St. Louis Medical and Surgical Journal. 1849 Jan and Feb; 6 (4): 323-27.

This was the first medical paper ever published by Elias. We know that he did not hold an MD at the time. Therefore, we must conclude that the MD he used on the paper was "self awarded." Given the lax attitude toward such matters at the time, and the absence of legal requirement for a medical diploma in order to practice, it was not unusual for medical practitioners to put the MD after their name even though they had never attended a medical school.

The Illusory AM Degree of Elias Cooper

Unaccountably, Cooper began in 1855 to sign himself: "E. S. Cooper, A. M., M. D." This raises a further question with respect to his education. That is, when and where did he receive an AM degree?

On 10 July 1855, about six weeks after his arrival in San Francisco, he printed a circular entitled: Announcing a Course of Medical Instruction. He invited the Medical Profession of California and Oregon to attend a series of lectures and demonstrations on anatomy and surgery which he would provide. His name was printed on the circular as follows: "E. S. Cooper, A. M., M. D." As far as we can determine, this was the first time that he listed an AM degree after his name.

About a year after his arrival in California, Elias published the following article:

E.S. Cooper, A.M., M.D., of San Francisco. "Remarks upon the practicability of obliterating the abdominal aorta by gradual pressure, illustrated by vivisections." California State Medical Journal 1856 Jul 1 (1): 69-72.

The notable feature of this citation is the appending of "A.M." to his name for the first time on a scientific publication. From 1855 onward for the rest of his life, he continued to sign himself as "E.S. Cooper, A.M., M.D."

There is no information on the origin of this Master of Arts degree either among Elias's personal papers or in the various biographical commentaries that cover his professional career. Hoping to identify the institution that granted the Master of Arts degree, we contacted some likely prospects. in the Northwest including Knox College in Illinois; Hanover College in Indiana; Miami University in Ohio; and Union College in New York. None had a record of awarding an A.M. degree to Elias Cooper.

Thus, the source of Elias's A.M. degree remains a mystery. We have no documentary evidence that he ever earned such a degree. There is no other college in the Northwest that seems a likely prospect as grantor of the degree which he appended to his name beginning in 1855, and he certainly could not have received it from a school in California. Why Elias first added the A.M. to his signature in 1855 just after he arrived in San Francisco is puzzling. We shall return to this interesting question when we have followed him to California.

Now that we have provided all the information available on Elias Cooper's early life and education, it is an opportune point to become better acquainted with three devoted relatives to whom we shall later refer frequently. They are Elias's brothers Esaias and Jacob and his nephew Levi Cooper Lane, each of whom made a distinctive contribution to the favorable outcome of his efforts.

Esaias Samuel Cooper, MD (1819-1893)

Esaias Samuel Cooper, Elias's older brother, was also born near Somerville, Ohio, on the family farm where he worked during his youth. Otherwise we know little of his early years except that he was a diligent and precocious young man. It was said that he studied at Miami University in Oxford, Ohio, only six miles from his birthplace. However, the records of the University covering the period of 1809 to 1855 do not show a registration for Esaias or either of the other two Cooper brothers.[12][13]

We have already reported that Esaias left home in 1835 to begin his medical studies, presumably an apprenticeship, with a Dr. Waugh in Indiana. We have seen that he attended Ohio Medical College for two four-month terms, the first in 1838-39 and the second in 1839-40. Upon completion of his first term in 1839, at the age of twenty, he probably either resumed his apprenticeship or began the general practice of medicine in Greenfield, a small town in central Indiana about 20 miles east of Indianapolis. He had no medical degree at the time but, as we have noted, this was no bar to practicing medicine in those days.

In 1843 he married and moved from Greenfield, Indiana, to Henderson near Galesburg in Knox County, Illinois (just east of the Mississippi River). There he continued general practice and cultivated the scholarly interests he developed as a boy. These included botany (he was familiar with the name and properties of almost every plant in North America), and the sciences of mathematics and astronomy (he calculated all the eclipses of the century at the age of 17). He was deeply read in the holy scriptures and well versed in the Latin tongue.[14]

As a result of his industrious efforts, he was awarded an AM degree by Knox College in 1849 and in 1850 was granted additional academic honors: an MD degree ad eundem from the Medical Department of St. Louis University and an AM degree from Hanover College. Also in 1850 he received an honorary MD degree from Rush Medical College in Chicago.[15] Later, the Thirteenth Annual Catalogue of Rush Medical College carried the announcement that in 1855 "an excellent Thesis, written in Latin, was received from Dr. E. S. Cooper of Henderson, Illinois."

Both Elias and Levi Cooper Lane served medical apprenticeships with Esaias. He had seven children, three of whom became doctors and served apprenticeships with their father.[16]

Professor Jacob Cooper (1830-1904)

Jacob was the youngest of the Cooper brothers and, like his two older siblings, was noted for his devotion to hard work and intellectual pursuits. He too was born on the family farm near Somerville, Ohio. We may infer from the following comment on Jacob's preparation for Yale that conditions in the Cooper family were conducive to self-reliance and self-improvement.

With a BA Degree from Yale in 1852, Jacob was of delicate health during his childhood and early adolescent years. Instead of attending preparatory school as he had wished to do, he worked on the farm by day and studied at night. With increasing years his health grew more robust and in his sixteenth year he began the study of Latin, Greek and mathematics with first one and then another of the local clergymen. For some portion of the 1848-49 academic year he enrolled in Hanover College in nearby Hanover, Indiana, but received no degree.

Finally, in September 1850 at the age of twenty he was able to enter the Junior class at Yale where he graduated in July 1852, receiving the BA degree with the highest honors allowed to one who entered as late as the junior year. While at Yale he was a member of Phi Beta Kappa and other honor societies.

One of Jacob's classmates at Yale called him "an honor to the college, his class and his age", and added:

His coming among us made more stir in another direction than any other new comer did in our college days . . . He was made fun of to an extent that would rouse the ordinary recipient to wrath . . . It was his clothes . . . They were of wool raised on his father's farm, spun, dyed, loomed and tailored by his own family. . . Cooper's appearance should not have attracted unwelcome and derisive attentions but it made no difference to him. Unruffled, he calmly wore his genuine home made woolen suit.

Ordained as a Presbyterian Minister in 1853. During the year following his graduation from Yale, Jacob studied theology and philology at home and was licensed in the Presbyterian ministry. Like so many brought up in the Quaker faith, Jacob (and Esaias, Elias and Levi Cooper Lane as well) ultimately departed from a strict observance of Quaker discipline while continuing to be influenced by the imbedded moral precepts of their rigorous native religion.

MD Degree from Medical Department, Saint Louis University in 1853

We were unaware of Jacob having received an MD degree until we found a brief entry in his Diary made on 5 June 1855 clearly stating that he was "a regular M. D." Spurred by this notation in the handwriting of the unimpeachable Jacob, we searched the Annual Announcements of the Medical Department of Saint Louis University. In the Announcement for 1853-54 Jacob Cooper of Ohio is listed as being awarded an MD ad eundem degree on 1 March 1853. He is also listed in later rosters of alumni as an MD graduate of the Medical Department in 1853. We have no evidence that he ever practiced medicine. Instead, he pursued an academic career in classical languages and religion. For the record, however, we can report the interesting detail that each of the three Cooper brothers received an MD ad eundem from the Medical Department of Saint Louis University: Esaias in 1850, Elias in 1851 and Jacob in 1853.[17][18][19]

PhD Degree from Berlin University in 1854

Jacob entered the University of Berlin in 1853 and earned the degree of PhD in 1854. Also in 1853, he was elected to membership in the Philosophical Society of Berlin at the age of 23.

MA Degree from Yale In 1855

With the acquisition of a Master's degree from Yale, Jacob was at the age of twenty-five finally prepared for a promising future in academia.

Professorial Appointments

Jacob began his teaching career in April 1855 upon his election as Professor of Greek at Centre College, Danville, Kentucky. In 1866, he was appointed Professor of Greek at both Miami University in Oxford, Ohio, and at Rutgers College, New Brunswick, New Jersey. He chose to go to Rutgers where he held the Chair of Greek until 1893 when he became the Collegiate Church Professor of Logic and Mental Philosophy. He remained at Rutgers until his death in 1904. Because of his prodigious erudition and good works, he was memorialized at Rutgers in prizes, gifts, plaques and buildings.

Honorary Degrees awarded to Professor Cooper by other universities were:

  • Doctor of Civil Laws (F.C.L.) by University of Jena in 1873
  • Doctor of Laws (LLD) by Tulane University in 1895.

The Benign Intercessions of Jacob Cooper

Jacob was deeply attached to Elias to whom he wrote periodically with news of the family, always including encouraging words and expressions of affection for his brother such as these:[20]

My firmness is not enough to bear up when I recollect the dear days of childhood, the days when we were together on those quiet hills and sported with no care on our youthful hearts, happy in our dear sweet home and as yet having no experience of sorrow. And when we turned our feet homeward we found a house unstricken by the dread destroyer.

We shall later relate how Jacob, who was studying in Europe in 1854, was of great moral support and practical assistance to Elias when he arrived there to visit hospitals and observe the work of prominent surgeons.

Following their return together from Europe in December 1854, Jacob received his appointment to a professorship at Center College. This made it possible for him to marry his fiancée, Caroline Macdill of Oxford Ohio, on 31 May 1855. Elias brought her a beautiful wedding dress from Paris. There was a hint of shyness as well as pride in the warm letter she wrote to Elias to thank "my dear brother" for her wedding dress "pronounced by all to be the most splendid article that ever has been exhibited in the town."[21]

On 13 June 1857, Carrie gave birth to a daughter who was named Caroline. During that summer and fall Jacob took great satisfaction in his little family and his teaching at Centre College. The entry in his Diary for 24 November 1857 reads: "My dear Carrie (is) so well at this time and also the baby. . . Joy fills my household. Surely no one could be more happy in their life."

Four days later Carrie became ill with vomiting, fever and weakness. While her condition worsened, her doctor insisted that she was not sick but "that all these symptoms (are) occasioned by her constitutional make-up." The implication that Carrie was exaggerating her complaints disturbed Jacob immensely. He was convinced that she had typhoid fever. Devastated by the inability of her doctor to provide relief, Jacob filled page after tear-stained page of his Diary with words of helpless anguish and urgent prayers for divine intervention. At last, utterly depleted by overwhelming infection, Caroline died on the twenty-second day of her illness. At mid-century, sickness and death from infectious disease stalked young and old They could expect little help, and often suffered much harm, from their physicians - a subject to which we will shortly return.[22]

Jacob was no less attached to his nephew, Levi Cooper Lane, than to his brother Elias. In 1902, when Jacob was seventy-two, he reappeared on the scene at a crucial juncture in the affairs of Cooper Medical College. Dr. Lane had recently died and Mrs. Lane, who inherited a large estate from Dr. Lane, sought Professor Cooper's counsel on the terms of her own will. Through no fault of Professor Cooper, the episode that followed had appalling repercussions for the College.

Jacob outlived both his brothers, Esaias and Elias, and his nephew, Levi. In view of the educational and economic limitations of their parents, it is remarkable the degree to which these three brothers, and their nephew, each in his own way, had an exceptional commitment to learning. The following resume of the early stages of the career of the nephew, Levi Cooper Lane, will show that he shared their determination to approach the future with a prepared mind.

Levi Cooper Lane (1828-1902)

Having already referred to Levi Cooper Lane's birth to Quaker parents on a farm in southwestern Ohio, and to the early camaraderie with his Uncle Elias, we now turn to his education and other relevant activities during the period up to 1861 when he joined his uncle on the faculty of the new medical school in San Francisco.

Levi's first instruction came from his mother Hannah, and his Aunt Ruth Cooper. Both were sisters of his Uncle Elias. In 1840, when Levi was 12 years of age, his parents moved the family from Preble County, Ohio, to Wayne County in southeastern Indiana, where they bought a farm at Greens Fork near Richmond. By this time five of their nine children had been born. In 1853 they moved to Knox County in northwestern Illinois where his father purchased land near Henderson, the home of Dr. Esaias Cooper.

Farmers' College

The Lanes had few luxuries and little money, so Levi began teaching in rural schools when sixteen years of age to earn money for his college education, which he is said to have begun at the now extinct Farmers' College. In seeking to confirm his college attendance, we learned that a highly regarded preparatory school, located in Hamilton County about six miles north of Cincinnati and known as Pleasant Hill Academy, was founded in 1833. In February 1846, the Academy was chartered as Farmers' College, being then the only one of the 120 colleges and 42 seminaries in the United States organized especially for the sons of farmers. Catalogues of Farmers' College from 1847-48, its first year of instruction, through 1851-52, are held in the Archives of the Cincinnati Historical Society Library. The Farmers' College Catalogue for the academic year 1847-48 lists "L. Lane, Butler County, Ohio" as a student, and the listing occurs in no other year. We assume that this "L. Lane" is Levi Cooper Lane and that he is using his grandparents' address in Butler County. Thus we can only document Lane's attendance at Farmers' College during part of one academic year, 1847-48, and there is no record that he received a diploma from the school.[23][24]

Union College

Founded in 1795, Union College in Schenectady, New York, is the first and now the oldest non-denominational college in the United States. Levi Cooper Lane is said to have attended Union in the autumn and winter of 1849-50.[25] An archivist at Union College has found records showing that Levi Cooper Lane attended Union for only four months, from September through December, in 1849. He was a member of the Class of 1851 for that brief period but did not graduate. There is no evidence that he received either an A. B. or an A.M. degree (honorary or otherwise) from the school which did, however, award him an Honorary LL.D. degree in 1887.

Professor Emmet Rixford reported that Lane's Uncle Jacob was at Union College with him, and that they shared a room as well as a devotion to the classics. According to Rixford:[26]

They had an arrangement with each other that their daily conversation should be in Latin. Doctor Lane would tell with much gusto how one day, when approaching the building in which they lived, he saw his Uncle Esaias leaning out of the window in his shirt sleeves, wildly gesticulating and shouting at the top of his voice, "ignis, ignis." The building was on fire.

With regard to Jacob, if he was at Union College with Levi in 1849, as the above anecdote infers, he was not registered as a student. There is no record at the College that any of the Cooper brothers - Esaias, Elias or Jacob Cooper - ever attended the school.[27]

At best, Levi would appear to have had minimal formal education at the college level. Nevertheless, from his impressive command of Latin, Greek and other languages, and the breadth of his knowledge of classical literature and history, we can conclude that he acquired a remarkable liberal education, and largely through independent or tutorial study. Emmet Rixford (1865-1938), Professor of Surgery at Stanford, was Dr. Lane's assistant and knew him better than anyone e lse. He had this to say about Dr. Lane's intellectual attainments, and how he acquired them:[28]

Dr. Lane was a highly educated man. With a fair preliminary education, he continued to be a student throughout his long life. Never robust, it was by sheer force of will and self-discipline, and by dividing his sleep, that he formed the habit of using six or seven hours in the middle of the night for study. Six nights in the week he read medicine and did his writing, the seventh night he read in general literature. Thus he was widely read, especially in the literature of surgery in the nineteenth century. He was fond of the classics, read Greek and Latin, also French, German and Spanish. He translated Billroth's Surgical Pathology for his students, laboriously writing it out in longhand in blank books, finishing this or that chapter at three or four in the morning. He read Hippocrates once a year in the Greek.

Lane's massive compendium of 1180 pages entitled Surgery of the Head and Neck, published by him privately in 1896, was the first American textbook on the subject, and the culmination of a life devoted to the study of surgery and the classics. As an introduction to this impressive work, he wrote the following preface evocative of his classical perspective:[29]

It has been the custom of authors in separating from their books to say a parting word to them; this, by some, has been a dedication to a father, brother or friend, and in one case to the Author of Nature. Horace warns his of coming abuse and final neglect; Martial hints to his scroll that it may serve the base use of wrapping fish, or the worse one of becoming a flaming festoon to illuminate and torture the criminal; but Ovid, more ambitious and hopeful, announced in advance the salutations of immortality with which the coming years would greet his Metamorphoses; but the medical writer of today, warned by the fortune of his contemporaries, may prudently contract the horizon of his expectation, and reckon on but a brief life for his book. He who thinks otherwise, reckons ill with Futurity. Thus warned, with limited hope, should a few years of existence be granted to the following pages, the writer's expectations will be fully realized.

Time and the advance of science have indeed long ago made obsolete Lane's extensive treatise, but one cannot scan its contents without recognizing it as scholarly and comprehensive It was the author's definitive contribution to the field of surgery.

Apprenticeship

Returning to our chronological tracking of Lane's career, we next find him recorded as "L.C. Lane, Student" in the 30 October 1850 census of Hendersonville (later known as Henderson), Knox County, Illinois. Dr. Esaias Cooper is listed on the same page of the census document along with his wife and three children. Lane, who was 22 at the time, had doubtless come to Hendersonville to serve a medical apprenticeship with his Uncle Esaias.[30] Later, in 1853, Lane's family bought land near Henderson and moved there from Indiana. We do not know the duration of Lane's apprenticeship with his Uncle Esaias, which could have also included some time with his Uncle Elias who was then practicing in nearby Peoria. We believe that the apprenticeship encompassed an overall period of three years (possibly 1848 through 1850).

Jefferson Medical College

Levi Cooper Lane was awarded an MD degree by Jefferson Medical College at Philadelphia in 1851, the same year in which Elias Cooper received his MD from St. Louis University.

The Jefferson Medical College Student Register, a log book in which all students are registered in their own handwriting, includes this entry:

E. L. C. Lane, M.D., Henderson, Illinois, October 9, 1850

Attended Rush Medical College 1849-50

We believe that the above entry was made by Levi Cooper Lane. He registered as an "M.D.", a degree he did not then hold but probably used during apprenticeship with his Uncle Esaias in Henderson. In order to determine whether Lane did in fact attend Rush Medical College an archivist at Rush was consulted, but could find no evidence that Lane registered there as a student or received a degree. However, important Rush records from the period in question were destroyed when the School burned down in the great Chicago fire of 1871.

The Annual Announcement for Jefferson Medical College for the Session of 1850-51 gives the following requirements which were fairly standard for the MD degree in American medical schools at the time:

  • The Candidate must have attended two full courses of lectures in some respectable medical school, one of which shall have been in this college (duration of each lecture course, 4 months);
  • must have at least one course of clinical instruction;
  • must present to the Dean of the faculty a thesis of his own composition correctly written and in his own handwriting on some medical subject; and
  • must have studied medicine for not less than three years.

Authorities at Jefferson Medical College appear to have accepted Lane's claim of attendance at Rush Medical School in fulfillment of requirement (1) above. In fulfillment of requirement (3), Lane exhibited his classical learning by submitting the following thesis in Latin:[31]

"De Febribus Miasmaticus in Illinois Septentrionali (Of Miasmatic Fevers in Northern Illinois) "

Lane's apprenticeship with his Uncle Esaias satisfied requirement. (4).

Medical Practice in Henderson

Biographical sketches of Levi Cooper Lane frequently include a statement such as the following:[32][33][34][35]

He was graduated in medicine from Jefferson in 1851, and spent the following four years as interne and house officer at Ward's Island, New York.

However, we have determined that Instead of taking an internship at Ward's Island immediately after graduation from Jefferson in 1851, Lane went to Peoria where he entered practice, doubtless in association with his Uncle Elias. The evidence for this is found in Transactions of the Illinois State Medical Society, Minutes of the Second Annual Meeting, Jacksonville, Illinois, 1-3 June 1852.

In a paper on "Treatment of incomplete anchylosis of the knee joint" read before the Society on 2 June 1852, Elias Samuel Cooper describes a patient treated for anchylosis during the period from 26 January to 20 May 1852. In this paper he remarks that the progress and cure of the patient were "frequently noticed by Drs. John L. Hamilton, J.T. Stewart, W.R. Hamilton, and L.C. Lane of Peoria."

On the same day at the Society, Cooper read another paper entitled "Remarks on transforming lacerated and contused, into incised wounds" written by "L.C. Lane, M.D., of Peoria." Finally, L.C. Lane is listed in the Minutes of that meeting as elected to be a Permanent Member of the Society, proposed for membership by E.S. Cooper. Here Lane's address is given as "Henderson." From these citations, we can deduce that Lane practiced in Peoria from mid-1851 to mid-1852. As we shall later see, Lane refers in his obituary on Cooper to having personally witnessed his uncle's devotion to dissection and medical practice, thus confirming that he was associated with him in Peoria.[36]

In mid-1852 Lane moved from Peoria to Henderson (near Galesburg in Knox County, Illinois) where he resumed medical practice with his Uncle Esaias. We are confident of this because of the following information. On 26 June 1852 a group of Knox County physicians met at Galesburg, Illinois, for the purpose of organizing the Knox County Medical Society. The group chose E.S. Cooper, MD, from Saint Louis University, to serve as President and L.C. Lane, MD, from Jefferson Medical College to serve as Secretary.[37] The "E.S. Cooper" here named is undoubtedly Esaias Samuel Cooper who practiced in Henderson near Galesburg in Knox County and "L.C. Lane" is his nephew, Levi Cooper Lane.

Due to the fact that Elias Samuel Cooper was also known as "E.S. Cooper", some biographers have erroneously credited Elias, who practiced in neighboring Peoria County but never in Knox County, with being the founder of Knox County Medical Society. When Knox County Medical Society met at Henderson on 9 October 1853, Dr. Lane was still serving as Secretary.[38] When the Society met at Galesburg on 1 July 1854, Dr. Esaias Cooper was named a Censor, but Dr. Lane was no longer listed as Secretary, and there was no mention of him in the published proceedings. By this time Lane had left Henderson.[39]

From the above evidence, we conclude that Dr. Lane was engaged in medical practice in Peoria with his Uncle Elias for a year from mid-1851 to mid-1952; and that he practiced in Henderson with his Uncle Esaias for two years from 1852 to 1854.

Ward's Island

Tiring of the country practice in which he had been engaged in Peoria and Henderson for the previous three years, Lane moved to the East Coast in 1854 to become House Surgeon to the Lying-in Department of the New York Emigrant Hospital. The hospital was located on Ward's Island, New York City, and at the time contained never less than 3000 inmates. When Elias and Jacob Cooper stopped for a few days in New York on their return from Europe in 1854 they visited with Dr. Lane on 27 and 28 December before proceeding by rail to Somerville, Ohio.[40]

Surgeon on a Merchant Vessel

Lane served at Ward's Island until 24 March 1855 when he sailed for England as surgeon on a merchant vessel plying between New York and Liverpool. While his ship was lying in port at Liverpool, he went to London and Paris and was greatly delighted with his visit. Upon his return to New York he embarked on a second voyage in the same ship and returned to New York about 1 December.1855.[41]

Navy Surgeon

In December 1855 Lane applied for a commission in the United States Navy.[42] He was highly successful on the entrance examination, the Navy Examining Board awarding him the first place on the merit-roll, over the entire list of successful candidates. His record remained the highest in Navy Examinations for many years. It is said that he astounded the Board by submitting, as part of his examination, an essay on "External Urethrotomy" written in Latin. For a time after entering the Navy he was stationed at the great Naval Hospital at Quarantine, Staten Island, New York, where, he always said, he learned to know typhoid fever. In fact, he himself was desperately ill with it. Indeed, his sister Catherine and his mother both died of the disease in 1863.[43][44]

In due course, Lane was assigned to a navy ship. While on sea duty his ship was stationed for a time off the coast of Central America where he learned Spanish and, in 1859, performed a thyroidectomy for goiter on a Nicaraguan woman. He had never previously undertaken such an operation, recognized as requiring major technical skill even under the best of conditions. The procedure, done before the days of asepsis and the hemostatic forceps, is graphically described by Lane in his monograph on Surgery of the Head and Neck to which we previously referred:[45][46]

This operation was performed on a woman in Chinandega Nicaragua; and as aids were a German and an American physician, residents of that city. As it was thought possible that the woman might die during the operation, the priestly official with his tapers and other appanage in use there in the death ceremonial, stood near by to perform the last offices, should the knife render them necessary. The Patio of the Spanish house, and the street in front, were crowded with curious spectators of the bloody drama which was to be enacted: a scene in which the operator and patient played parts as interesting to that motley company of witnesses, as did the gladiators of old to the Roman corona, which once filled the Coliseum. The operation was a very bloody one, and midway in the work, the bleeding was so profuse that one of the assistants was seized with panic, and begged that the work should cease there. These remonstrances were not heeded; the patient could not have run more risk from concluding the work than from leaving the half-enucleated tumor in her neck. By the careful ligation of vessels, and dissection of the growth from the parts to which it was attached, the work of removal was brought to a fortunate issue. The patient soon recovered, and was amply repaid for the risk of submitting to an operation which had rarely been done, risks here augmented through submitting to a knife which had been disciplined by but little experience.

Incidentally, while Lane's ship was off the coast of Central America, it became the temporary refuge of members of the filibustering expedition of the infamous William Walker who sought to control Nicaragua and reintroduce slavery, the detestable institution which had already been outlawed by the Nicaraguan authorities for a generation. Walker's erratic and violent career in California and Central America, which attracted international attention at the time, was finally terminated by a Honduran firing squad.[47]

Shore Leave in San Francisco

Later in 1859 Lane was aboard the U.S. sloop-of-war Decatur when it steamed through the Golden Gate to anchor at the port of San Francisco. There was a joyous reunion with his Uncle Elias Cooper who had in the previous year fulfilled his dream of founding a medical school on the Pacific Coast. Cooper induced Lane to resign his commission in the Navy in 1859 with the offer of a Professorship of Physiology in the new school, and an association with him in surgical practice. In the San Francisco Medical Press, the journal established in January 1860 by Cooper as an outlet for his own viewpoint in a community hostile to the new school, he published editorials in 1860 and 1861 describing Lane as a gentleman of intelligence and suavity of manners who would work for the elevation of the profession, and be a valuable addition to the school's faculty - an understatement, as time would tell.[48]

European Study

Following his resignation from the Navy, and in order to prepare himself for professorial duties in the Medical Department of the University of the Pacific, Lane spent over a year in Europe. At the University of Göttingen in Germany he took a Special Course of Vivisections with Rudolph Wagner; and also a Practical Course of Physiological and Toxicological Chemistry in the Laboratory there, under the supervision of Professors Boedeker and Woehler. At Paris, besides attending some of the principal hospitals, he attended a Course of Vivisections with Flourens; and also a Course of Chemical Lectures by Fremy and Chevreul.[49]

Professor Lane

In the July 1861 issue of the San Francisco Medical Press Cooper wrote:

At a recent meeting of the Trustees of the University of the Pacific, at Santa Clara, Dr. L.C. Lane, late of the U.S. Navy, was appointed to the Chair of Professorship of Physiology, in the Medical Department that is located in San Francisco.

Upon taking up his position on the faculty, Lane immediately became a source of much needed relief and solace for his Uncle Elias who was then approaching complete exhaustion from failing health, worsened by the professional and medicolegal harassment he had endured since his move to San Francisco. In the months that followed, Lane found it necessary to assume increasing responsibility for his uncle's affairs, including acceptance of the editorship of the San Francisco Medical Press in July 1862. By this time Cooper's illness was terminal, and his death in October at the age of 41 signaled the impending close of the stormy fledgling era of the school. Had not Lane appeared on the scene when he did, there is little doubt that the school would never have recovered from the premature loss of its founder. In retrospect, there is something eerily providential about the impulse that prompted Lane, born and bred in the pacifist Quaker creed on a farm in Ohio, to join the Navy whose sloop-of-war, at a crucial stage of events, delivered him to the port of San Francisco for a fateful rendezvous with his Uncle Elias and his destiny.

In summary, let us again note that Elias Cooper's personal papers contain virtually no record of his early schooling, apprenticeship and medical education. Therefore, we have gleaned as many facts on this subject as possible from collateral sources and combined them with biographical sketches of the Cooper brothers and his nephew, Levi Cooper Lane. The purpose of this compilation is to provide background for the ensuing chronological account of Elias Cooper's medical career, including related developments in medical science and education. We shall rejoin him now as he begins a general medical practice.

Elias Cooper, Danville Surgeon

In 1843 Elias completed his apprenticeship with Esaias in Greenfield, Indiana, and moved to Carrol County in northwest Indiana. There he intended to enter the practice of medicine but was soon dissatisfied with the prospects and, within a few months, moved west to the town of Danville, Illinois, on the Illinois-Indiana state line.[50]

Elias met with remarkable success in Danville as a medical practitioner. He at once acquired a large practice, from the proceeds of which he realized near $800 per month, an amount which was enormous for a western country practice. It was the surgical cases that interested him most, and among them was a young man with a lesion that required the removal of a large portion of the lower jaw. Elias performed the operation with such poise and skill as to reveal to himself and others his talent, indeed his true vocation, as a surgeon.[51]

We have no details of this operation, but such a procedure, involving the complex and highly vascular terrain of the face and neck, would demand skill in dissection and experience in the control of bleeding. Strong assistants would be required to restrain the limbs and head of the patient, for anesthesia was still undiscovered. We need not dwell on the starkness of the room in the patient's house where the operation probably took place on an ordinary table with elementary, unsterilized instruments. Infection, its cause yet unknown, was inevitable. In such circumstances, a crowd often gathered outside to await the outcome of the operation, and the surgeon could never predict their mood in case of failure. We shall later further illustrate the status of surgery in the early 1800's by referring to an historic operation performed by Dr. Ephraim McDowell in a neighboring state, an operation that must certainly have kindled yearnings in Elias to become a surgeon.

At the time of the Danville procedure, Elias was 23 years of age and, as far as we can determine, almost entirely self-educated in anatomy and self-trained in surgery. He had never attended a medical school and was thus without formal medical education and credentials. He may have had some surgical experience during his apprenticeship but, if he did, there is not the slightest hint of it in the available records. His decision to undertake and his success in carrying out this difficult operation showed him to be unusually capable and self-assured, qualities he displayed throughout the remainder of his life. Encouraged by his accomplishments in Danville, and seeking a more promising field for the pursuit of his ambitions in surgery, Elias moved to Peoria, Illinois, in 1844 - a phase of his career to which we shall return after a consideration of medical education and practice in the region.

Medical Education West of the Alleghenies

We have now followed Esaias, Elias and Levi through their premedical and medical education and seen them all enter medical practice in their native Northwest. Preceding them in the region were pioneer physicians who recognized that there were only three medical schools in the entire United States when the Territory was opened to settlement in 1787, and all were east of the Alleghenies:

  • University of Pennsylvania Philadelphia 1765
  • College of Physicians and Surgeons New York 1767
  • Harvard Medical School Boston 1782

To found the first medical schools west of the mountains became an irresistible challenge and those who responded to it made medical history. We will now look to the origins of these new schools as a further means of tracing the evolution of medical education in America, and of defining the setting in which Elias's aspirations were awakened. But first an introduction to the outstanding medical figure in the Northwest during its pioneer era - Daniel Drake.

Daniel Drake (1785-1852), Medical Educator

Isaac Drake, the father of Daniel, served in the Revolutionary Army. After the war he returned home in 1781 to a devastated New Jersey countryside, and went to work in a grist mill on his father's farm located near Plainfield. In 1782 Isaac married Elizabeth Shotwell of a Quaker family who lived on a farm four miles from his father's place. As a Quaker, Elizabeth was "disowned" by the Society of Friends for marrying Isaac who was a Baptist and therefore "outside the faith." Isaac and Elizabeth moved to a log cabin close to the grist mill on Bound Brook. There Daniel was born on 20 October 1785, and a sister in due course thereafter.

Times were hard and prospects poor in New Jersey, but there were glowing accounts of cheap land and a promising future in Kentucky. And so, in the Spring of 1788, the two and a half year-old Daniel, his parents, baby sister, and unmarried Aunt Lydia Shotwell, with all their furniture and other possessions, set out for Kentucky in a two-horse wagon. The company of emigrants also included Isaac's two brothers; two of Elizabeth's cousins, David Morris and John Shotwell; and their families. After an exhausting and dangerous journey of 400 miles over rough roads across the Appalachians they reached the upper Ohio River. Here the Drake party joined up with other homeseekers and floated downstream on flatboats to Limestone (now Maysville), Kentucky., their horses and loaded wagons secured amidships. Among those aboard the flatboats was "Dr." William Goforth who, impressed by the sprightly two year old Daniel Drake, implanted in his parents' minds the thought that he should become a physician.

Isaac Drake sprained his ankle so severely during the journey down river that on arrival at Limestone on 10 June 1788 he had to be carried ashore. Daniel, in later years, wrote that his father "was not very heavy for he had in his pocket but one dollar and that was asked for a bushel of corn." From Limestone, Isaac took his family to Washington, Kentucky (four miles south of Limestone), where their first residence was a covered pen built for sheep. There they stayed while Isaac was negotiating for land in a frontier tract called Mayslick, 12 miles southwest of Limestone. He finally secured 38 acres in the tract, subsequently increased to 50, and built a rude log cabin. This was the family's home for the next six years until, in the autumn of 1794, Isaac purchased another farm of 200 acres in an unbroken forest that had to be cleared and a log cabin built. Daniel Drake, then a boy of nine with a father who was not in vigorous health, spent the remainder of his childhood years in the hard but unfettered life of a backwoods outpost. His early education was by itinerant teachers in a one-room school from November to March. During the remainder of the year he helped his father to clear and fence the farm, cultivate the land, and care for the livestock.[52][53]

Drake's parents were struggling settlers, "to fortune and to fame unknown, but they possessed the great merit of being industrious, honest, temperate and pious."[54] From them Drake acquired priceless intangible assets - natural endowments, moral precepts and example, the discipline of work, and a reassuring family life. Although he had only the barest of material advantages, he overcame this handicap, thus proving himself to be of the rugged species Homo americana, sprung from the "crucible of the frontier", now epitomized by Abraham Lincoln in American folk tradition. Drake's limited opportunities, contrasting with his exceptional later accomplishments, demonstrate the role of personal responsibility and effort in giving direction and meaning to life. The idealized view of our national antecedents as intrepid pioneers, self-taught and self-sufficient, is a source of American pride and identity as a nation. Although this perception is often exaggerated, history records that a host of such distinctive men and women did indeed exist in all walks of life - Drake was one, and Elias Cooper was another - and their image may be fairly invoked as an inspiration to contemporary society.

In 1800, at age 15, Drake moved to Cincinnati, then a town of about 600 inhabitants (exclusive of the garrison) founded on the banks of the Ohio in 1788 under the original name of "Losantiville". Drake's purpose in going to Cincinnati was to become an apprentice to the long-time family friend from flatboat days, "Dr." William Goforth (1766-1817), who was so pleased with Drake's progress that he made him his partner in practice in 1804., when Drake was just 19. He later issued to Drake the following "diploma":[55]

I do hereby certify that Mr. Daniel Drake has pursued under my direction for four years, the study of Physic, Surgery and Midwifery. From his good Abilities and marked Attention to the Prosecution of his studies, I am fully convinced that he is well qualified to practice in the above branches of his Profession.

Resurrectionists and the Doctors Mob

Although Goforth had served two successive apprenticeships with well- qualified practicing physicians, he did not attend medical school and hold a medical degree. He was a native of New York City where, according to Drake, he was engaged in medical studies in 1788 at the time of "The Doctors Mob." Because of life-threatening danger to physicians and medical students during this episode, Goforth fled to New Jersey where he decided to join his brother-in-law, John S. Gano, the Drakes and others of the party preparing to migrate to Kentucky.[56]

The Doctors Mob, one of the most violent outbreaks of civil unrest in early American history, was a furious response to the common practice of obtaining cadavers for anatomical dissection by robbing graves. This hazardous and loathsome business, made necessary by the gross inadequacy of legal provisions for obtaining cadavers for medical instruction, was carried out by a disparate group, generally referred to as "resurrectionists." Medical students and teachers of anatomy were frequently involved in grave robbing, and there was a more or less disreputable assortment of entrepreneurs who sold cadavers to medical schools or private teachers of anatomy.

Resurrectionists preferred to rob the graves of the poor, the unknown, and enslaved Blacks as least likely to be noticed and cause public outcry; but no graves were exempt unless there was some protection such as an iron coffin, a vault, or a watchman standing guard with a shotgun from dusk to dawn for two weeks, after which the corpse was so decomposed as to be of little use for dissection.

Grave robbing at its best was a complicated and dangerous undertaking that required careful planning to avoid detection, and considerable skill to complete the task with dispatch. Two strong men, two large canvas tarpaulins, digging tools, and a dark lantern to light the scene but invisible from a distance, were the essentials. Dirt was removed from only the head end of the coffin and placed on one of the tarpaulins. After silently breaking through the lid of the coffin, weakened by a row of holes bored across it, the corpse was hauled up by a hook inserted under the chin or, alternatively, by a rope attached to a ring on the back of a harness strapped under the arms. The body was then stripped of all clothing and wrapped in the other tarpaulin. The clothes were thrown back into the coffin, the excavated dirt returned to the grave, and its surface restored exactly to its prior appearance to disarm suspicion of tampering.

In the hands of experts, the over-all job required about an hour. The deceased, wrapped in the tarpaulin, was placed in a wagon, whose inconspicuous drive past the graveyard was carefully timed to coincide with the completion of the disinterment, and thence the cadaver was delivered to the medical school through a clandestine entrance. Bodies were usually procured during the cool season from November to February when anatomy courses were given, and were dissected immediately because embalming was not in use, putrefaction progressed rapidly, and discovery was always to be feared.[57][58]

Elias Cooper's obsessive commitment to anatomical dissection as the basis for his surgical teaching and research brought him repeatedly into conflict with the community over the issue of obtaining anatomical material. This exposed him to a degree of condemnation and personal risk that one can best understand in light of the riot, ambiguously referred to as "The Doctors Mob," that erupted in New York in 1788 in response to a grave robbing incident. Accounts of the tumultuous event vary, but the facts are probably about as follows.

In a building that was later to be used as the New York Hospital, there was a laboratory used by medical students and physicians for anatomical dissection. Here, at 3 o'clock on the afternoon of Sunday, 13 April 1788, several medical students or physicians with at least one instructor were dissecting a cadaver. Outside some small boys were playing and one of them, the son of a mason, placed a ladder laying nearby up to the window of the dissecting room and peered inside. Surprised and annoyed at the apparition in the window, one of the dissectors brandished a dismembered arm in the boy's face and told him that it was the arm of his mother. It so happened that the boy's mother had recently died, leading him to flee in terror to his father who was at work on masonry in the neighborhood. The enraged father quickly gathered his fellow workers and broke into the dissecting room where the finding of some partially dissected and some fresh bodies put them in a frenzy during which they wrecked the laboratory before carrying off the bodies in carts to be buried the same day.

A mob rapidly formed and reentered the premises bent on further destruction and determined to capture the physicians, all of whom escaped except for four whose lives were doubtless saved by the city officials who put them in jail for safe keeping. Over the next four days, rampaging mobs invaded and vandalized the homes of many local doctors who fled for their lives (as did the medical students, including Goforth); besieged the jail seeking to apprehend the dissectionists; and remained generally uncontrollable until sufficient militia could be mobilized to confront the rioters. Then, hard pressed and bombarded with rocks and paving stones by the surging rabble, the militia fired several volleys into the crowd, resulting in seven killed and eight injured, according to reports the accuracy of which cannot be verified. It is amazing that no doctors or medical students were killed or injured during the turmoil.[59][60]

Elias Cooper introduced resolutions before both the Illinois State Medical Society and the California State Medical Society calling for the legalization of dissection and of the procurement of bodies for that purpose, but favorable legislation in those states was not to be enacted until years after his death. Between 1765 and 1852 there were at least 13, and possibly more, anatomy riots in the United States, taking place in Illinois, Maryland, Massachusetts, New York, Ohio, Pennsylvania and Vermont. We shall have occasion to refer later to the riot in Illinois.[61]

Medical Practice without a Medical Degree

The practical effect on Dr. Goforth of his having been diverted by the Doctors Mob from his goal of obtaining a medical degree was not disastrous under the circumstances of the day. As already mentioned it was commonplace at the beginning of the nineteenth century in America to practice medicine with no other training than apprenticeships such as Goforth completed in New York before the riot, and as Drake completed under Goforth's preceptorship in 1804. In his comprehensive Contributions to the Annals of Medical Progress, J.B. Toner has the following commentary on medical practice at the time of the Revolution:[62]

It is probable that at the time of the Revolution there were not living in all the colonies 400 physicians who had received medical degrees; and yet .... there were presumed to be over 3,500 practitioners. The American colleges had up to 1776 in the aggregate issued but fifty-one degrees, including that of bachelor of medicine. At the close of the century, those who had received degrees from American institutions did not number 250, but probably five times this number had attended one course of lectures at the different colleges, and who were then in practice. ....(Up) to the beginning of the revolutionary war but two medical colleges had been organized in the United States. .... During the period from the close of the Revolution to (1800), .... there was a marked increase of medical students in the country, and no less than five additional colleges, or rather medical faculties, organized; but in 1800 we find only four of them still in existence, welcoming within them the medical students of America.

Drake, however, was not content to continue medical practice without formal medical studies and an MD degree. He traveled 18 days by horseback to Philadelphia to take the course of lectures at the University of Pennsylvania School of Medicine in 1805-1806 when Benjamin Rush was in his heyday. Drake returned to Philadelphia in the fall of 1815 for further study, and received his MD degree from the University in 1816 at the age of 30. By this time he had become well established in medical practice in Cincinnati and had written two books in 1810 on the Climate and Topography of Cincinnati and the Miami Country that earned him a national reputation as an author.

Drake at Transylvania Medical College

New horizons then beckoned Drake in academia. He was offered an appointment as Professor of Materia Medica and Medical Botany on the faculty of the Medical Department of Transylvania University in Lexington, Kentucky. This was the first medical school west of the Allegheny Mountains. It had been authorized by the Board of Trustees of Transylvania University in 1799, but regular instruction in the Medical Department did not begin until the fall of 1817. It was at this time that Drake took up his appointment. "Thus Drake, the first medical student of medicine in Cincinnati, the first Cincinnatian to receive a diploma in medicine, and the first medical author in the West, also became a member of the first accredited faculty of the first medical institution west of the Alleghenies."[63]

The 1817-18 session was the first recognized medical course conducted by the Transylvania Medical School, and 20 students were enrolled. Of this first class, there was only one successful candidate for the MD degree. Drake acquitted himself admirably of his teaching responsibilities, consisting almost entirely of lectures. An example of his earnest eloquence is to be found in his lecture to the departing class at the end of the year. In this final lecture he addressed the perennial theme of "medicine as a life-long study," and did so in the ornate language then much admired:[64]

When you leave the medical school, your studies are merely begun. The germ of your future professional knowledge is yet a tender seedling, which neglected by you must inevitably perish. Watch over it then unceasingly - foster it with tenderness - supply it with liberality, and you will elevate it in time to a magnificent tree. Its balmy exhortation will diffuse health and comfort among the wretched victims of disease; - the golden fruit of its wide spreading branches will supply your numerous wants, and in the shade of its ever green foliage you will glide serenely down the vale of declining life . . . . .

Dudley-Richardson Duel

When he joined the Transylvania faculty, Drake was unprepared for the academic polemics, and worse, that he encountered. But he later demonstrated a natural aptitude for the art of invective.

Dissension had erupted during the organizational meeting of the medical faculty at the beginning of the year, and continued throughout the session. Controversy was stirred when Benjamin Dudley, Professor of Anatomy and Surgery, objected to the presence on the faculty of William Richardson, Professor of Obstetrics, who held no degree in medicine. Tension remained high after the session ended in early March 1818 and a conflagration, to be ignited, needed only a spark.

This was provided by Drake's letter of resignation from the faculty in late March of 1818. Dudley openly accused Drake of breaking a promise to remain on the faculty two years, and of trying to destroy the Transylvania Medical College. In the ensuing correspondence with Drake, Dudley made insulting references to Richardson who became incensed when they came to his attention, and challenged Dudley to a duel. Although illegal in Kentucky, duels were still countenanced in defense of a "gentleman's honor", broadly construed. Dudley accepted the challenge and chose pistols as the weapons. To avoid intervention by the authorities, the duel took place in secrecy in the summer of 1818. Dudley's shot struck Richardson in the groin, lacerating a major artery, presumably the femoral. He would probably have bled to death from the wound had not Dudley rushed to his side and made pressure with his thumb on the artery proximally, thereby preventing further blood loss while Richardson's surgeon tied the vessel - without the benefit of either anesthesia or asepsis, both then unknown to medicine as we have already mentioned. All hail to the surgeon who performed this difficult operation on a patient stretched on the ground in a remote forest clearing.

Dudley recovered and, according to some versions of the affair, he and Richardson later became "fast friends." Although questionable, this outcome gains some credibility from the fact that they were both Past Masters of the Grand Lodge of the Fraternal Order of Masons in Kentucky. The Grand Lodge first suspended the duelists, and then reinstated them as a result of "the reconciliation which has happily taken place between said brothers."[65]

Dudley-Drake Confrontation

In his dispute with Dudley, Drake took a different approach from that of Richardson. He refuted Dudley's accusations against himself by publishing two pamphlets addressed to the citizens of Lexington that thoroughly demolished Dudley's arguments, and directed at him the following barbs:

How far the preceding facts are adequate to (prove all my conduct relative to the University to have been correct and honorable) is not for me to decide. But I may be permitted to remark, that in proportion as they establish my innocence, they inevitably demonstrate Dr. Dudley to be a base and unprincipled villain, who has wantonly and wickedly sought to destroy my reputation. For this outrage, my feelings require no other, and can have no higher satisfaction, than the favorable award of an impartial and intelligent public.

I have now finished a necessary but disgusting task, and shall with great difficulty be re-excited to another of the same kind. Although I cannot, like the Grecian Hercules, boast of having vanquished a monster, I may at least claim some praise for having ferreted out one of the vermin which infest our modern Attica.

In a final scornful thrust at his adversary, Drake let it be known publicly that if Dudley committed the further outrage of challenging him to a duel, he would accept it. Nothing more was heard from Dudley, and Drake departed the field of his first major academic encounter with a clear victory. He was not in future to fare so well.[66]

The unfortunate Richardson had in Drake at least one forthright and effective advocate. Recognizing the importance to Richardson of obtaining medical credentials if he was to survive in the academic arena, Drake on 31 December 1817 wrote to David Hosack, MD, at the College of Physicians and Surgeons in New York requesting that Richardson be given an honorary MD degree. The Honorary degree of Doctor of Medicine was awarded to Richardson on 6 April 1819, thus bespeaking Drake's already considerable stature in the medical profession at the age of 33. The cause of the delay in awarding the degree is unknown but was probably related to the complicated process by which such degrees were conferred, not by the College but by the Regents of the University of the State of New York.[67]

Drake's Contributions to Medical Education

The Cincinnati newspapers expressed regret that Kentucky was ahead of Ohio in establishing a medical school. In spite of his Transylvanian experience, Drake was eager to respond to the local desire not to be outdistanced by Kentucky in the field of medical education. The fruits, and disappointments, of his efforts to found a medical school in Cincinnati are relevant to our interest in identifying problems that Elias Cooper might encounter when starting a medical school.

The Medical College of Ohio was, on Drake's personal appeal, chartered by the Ohio General Assembly on 19 January 1819, naming him as President, and Professor of Institutes and Practice of Medicine. While it was the second medical college to be opened west of the Allegheny Mountains (the first being Transylvania in Lexington, Kentucky, in 1817), it was the first medical college to be founded in the Northwest Territory. Drake's early success with the Assembly was soon followed by a severe setback. Faculty disunity broke out even before the school opened, and he also had a Town-Gown problem. Local physicians, critical of the projected school, precipitated an incredibly rancorous clash with Drake during which he was convicted of assault on one of his critics, and a formerly close associate in practice challenged him to a duel (an invitation he declined). He was lampooned and christened "Dr. Pompous" in newspapers that became disgusted with the doctors' squabbles. Not unexpectedly, the first course of medical lectures, planned for the fall of 1819, had to be postponed for a year. To say the least, these were ominous signs. The first term finally opened in November 1820 with 24 students and ended with commencement exercises for seven students on 4 April 1821.

Although the surface was calm, faculty resentment against Drake was growing due, according to him, to their jealousy of his prominence and popularity in the city. At the second commencement on 4 March 1822, seven students graduated while the rival school in Lexington had 37 graduates in that year. Two days later, on 6 March, the climax occurred. Two of the school's five-member faculty resigned, leaving only two members in addition to Drake. When he convened them in a faculty meeting to transact some routine business, they both voted to dismiss him from the faculty. Thus President Drake was summarily deposed from the school that he had founded only two years before.[68]

That he was bitter over this turn of events can be easily understood. His only recourse, however, was to write a scathing satire of the whole affair entitled "Narrative of the Rise and Fall of the Medical College of Ohio" which he published himself and dedicated to the General Assembly of the State that had chartered the school. Regarding the manner of his expulsion and the reasons for the outrageous behavior of his erstwhile colleagues, he said:[69]

The faculty were . . . reduced to Dr. Smith, Mr. Slack and myself. . .We met according to a previous adjournment, and transacted some financial business. A profound silence ensued, our dim taper shed a blue light over the lurid faces of the plotters, and everything seemed ominous of an approaching revolution. On trying occasions, Doctor Smith is said to be subject to a disease not unlike Saint Vitus' Dance; and on this he did not wholly escape. Wan and trembling he raised himself (with the exception of his eyes) and in lugubrious accents said, "Mr. President - In the resolution I am about to offer, I am influenced by no private feelings, but solely by a reference to the public good." He then read as follows: "Voted that Daniel Drake, M.D., be dismissed from the Medical College of Ohio." The portentous stillness recurred, and was not interrupted till I reminded the gentlemen of their designs. Mr. Slack, who is blessed with stronger nerves than his master, then rose, and adjusting himself to a firmer balance, put on a proper sanctimony, and bewailingly ejaculated: "I second the motion." The crisis had now manifestly come; and, learning by inquiry that the gentlemen were ready to meet it, I put the question, which carried, in the classical language of Doctor Smith, "nemo contradicente." I could not do more than tender them a vote of thanks, nor less than withdraw, and, performing both, the doctor politely lit me downstairs. . . .

The real objects which the gentlemen proposed to themselves in my expulsion were: First - To drive me from Cincinnati and succeed to my professional business. Second - To reorganize the school in such a manner as would give it a new aspect, and dissolve, in the public mind, a connection it had with my name, so intimate as to be painful to them. The former would feed their avarice, the latter their vanity.

The community was outraged at the eviction of the founder of their medical school. Drake was immediately reinstated, and he as promptly resigned - refusing to be again associated with those who had subjected him to such an indignity. But he was still determined to put how own stamp on medical education in Cincinnati.[70]

Drake Plans a Medical Department for Miami University

The decade following his expulsion from the Medical College of Ohio in 1822 was a hectic period for Drake who continued to be involved in a wide range of activities related to medical education. He held professorships at Transylvania (1823-27) and Jefferson Medical College in Philadelphia (1830-31).[71]

By 1831 he was ready to challenge the Medical College of Ohio, still the object of his criticism as an inferior institution, his judgement in the matter being well justified. He proposed to the Trustees of Miami University of Oxford, Ohio, that the University establish a Medical Department in Cincinnati with Drake as Professor of Medicine and Dean. His proposal was promptly accepted by the Miami Trustees, and on 22 February 1831 Drake and other faculty members of his selection, including his brother-in-law Joseph N. McDowell, were appointed to the Miami Faculty.

The prospect of a rival medical school in Cincinnati threatened the very existence of the Medical College of Ohio whose Board of Trustees and Faculty rightly concluded that the College would be doomed by the competition of the superior Faculty organized by Drake. On the brink of success, however, Drake's well-laid plan was shrewdly frustrated by the Medical College of Ohio through a combination of delaying the opening of the new school by court action, and hiring away some of Drake's faculty by offering them appointments in a reorganized Medical College of Ohio. Before any students had been admitted to the Medical Department of Miami University, these maneuvers forced its consolidation with the Medical College of Ohio, thus eliminating the Medical Department of Miami University and saving the Medical College of Ohio from extinction. By 13 July 1831 the College faculty had been reorganized to incorporate some members from the now defunct Miami school, including Drake himself. Expecting to participate in reform of the Medical College by joining its faculty, Drake accepted an appointment as Professor of Clinical Medicine in the College.

Drake's expectations for improvement in the College, and a leadership role for himself in the process, were soon dashed. He learned that the chair of "Clinical Medicine" to which he was appointed had been stripped of the responsibilities he had wished it to entail. On 19 January 1832, six months after accepting the post, he resigned it. As on the occasion of his previous abrupt departure from the Medical College of Ohio, Drake stated his grievances. In a letter to the Board of Trustees of the College, couched in diplomatic but unmistakable terms, he implied that the Trustees had dealt with him in bad faith with respect to his professorship, and that the standards of the College were still deficient. He was promptly accused of attempting either to rule or ruin the College, his resignation setting off a chain reaction of spiteful reprisals and recriminations too convoluted for recounting here.[72]

Drake Founds the Medical Department of Cincinnati College

During the three years following his second resignation from the Medical College of Ohio in 1832, Drake busied himself very productively, enhancing his regional and national stature by medical and editorial activities in Cincinnati where he maintained his home base.

By 1835, he was ready to turn his attention again to medical education, drawn irresistibly by his abiding interest in the field, and his exasperation with the continuing mediocrity and discord at the Medical College of Ohio. His strategy was the same as before - to establish a rival medical school in Cincinnati, this time as the Medical Department of Cincinnati College. On 22 May 1835 the Trustees of Cincinnati College passed the following resolution:[73]

Whereas the recent attempt of the medical profession and the General Assembly of Ohio to reorganize and improve the conditions of the Medical College of Ohio, have, as we are informed been unsuccessful . . . and whereas there is the utmost danger that Ohio will lose the advantages of a Medical institution, unless immediate measures be taken to organize a substitute for said College, therefore be it

Resolved, that the Board will proceed forthright to establish a medical department of Cincinnati College.

The first session of the Medical Department of Cincinnati College opened in the fall of 1835. Drake's purpose was two-fold. First, he desired to found a medical college that would reflect the high educational standards to which he was devoted; and second, he wanted finally to drive out of existence the failing Medical College of Ohio whose faculty and program he ridiculed openly. Accomplishment of the latter goal would also avenge his summary dismissal from the College 13 years before. Since then, faculty dissension and inadequacy had thoroughly discredited the College, and embarrassed the Ohio Assembly that in 1825 had made it a state-supported institution.

For his new school Drake assembled a faculty comparable to that in the better American schools and distinctly superior in teaching and literary ability to their counterparts in the Medical College of Ohio. The following list of chairs and professors shows the range of subjects making up the curriculum:

  • Theory and Practice of Medicine: Daniel Drake, MD, Dean of the Medical Faculty of Cincinnati College
  • Special and Surgical Anatomy: Joseph N. McDowell, MD
  • General and Pathological Anatomy, Physiology and Medical Jurisprudence: Samuel D. Gross, MD
  • Surgery: Horatio G. Jamison, MD
  • Obstetrics and the Diseases of Women and Children: Landon C. Rives, MD
  • Chemistry and Pharmacy: James B. Rogers, MD
  • Materia Medica: John P. Harrison, MD
  • Adjunct Professor of Chemistry and Lecturer on Botany: John L. Riddell, MS

The school's progress during the first four years was remarkable as reflected in the annual enrollment of 66, 85, 125 and 112 students. As might be expected, certain local factions opposed the school from the outset, and rivalry with the Medical College of Ohio was bitter, even to the point of involving students of the two schools in fisticuffs. Unfortunately, lacking the facilities and support commanded by the Medical College of Ohio as a state school, the medical faculty of Cincinnati College were one by one lured away to better positions elsewhere. In 1839, after a brilliant four years, the Medical Department of Cincinnati College (the third medical school to be opened west of the Alleghenies) was forced to close.[74]

Drake's Valediction

The school had hardly disbanded when Drake received an invitation from the University of Louisville to become Professor of Clinical Medicine and Pathological Anatomy. He accepted the position and held it from 1839 until 1849 when he resigned. While at Louisville he completed his magnum opus, the medical classic for which he is best known, entitled: A Systematic Treatise on the Principal Diseases of the Interior Valley of North America.[75]

In 1849, nostalgic and still hopeful, Drake once again accepted a professorship in the Medical College of Ohio, the school that he had founded in 1819, thirty years before. To the students attending his Introductory Lecture at the Opening of the Thirtieth Session of the College, Delivered at the Request of the Faculty on 5 November 1849, he said:

(Over the past thirty years) my heart still fondly turned to my first love, your alma mater. Her image, glowing in the warm and radiant tints of earlier life, was ever in my view.

At the end of the year, again disillusioned by faculty intrigues and dissension, he resigned from the Ohio Medical College for the third time to resume a professorship at the University of Louisville.

Finally, in the spring of 1852 and toward the end of his life, Drake resigned his professorship at Louisville to again accept a position at the Medical College of Ohio. The Founding Father was united for the last time with the prodigal son. Just at the opening of the fall session on 5 November 1852 he died at the age of 67, full of renewed hope for the institution that had survived in spite of his determined efforts either to reform, or to destroy it. At the time of his death Drake was one of the most widely known and highly respected physicians in the United States.[76][77]

In 1832 in his Practical Essays on Medical Education and the Medical Profession, Drake spoke from the depth of his long experience and made the following prophetic statement:[78]

The establishment of medical schools is a prolific source of discord in the profession.

Medical Education in St. Louis

Both Esaias and Elias Cooper practiced medicine and appended "M. D." to their signatures for some years before acquiring their medical degrees from the Medical Department of St. Louis University in 1850 and 1851, respectively. . Hence our interest in the origin of the school that they attended.

Purchase of the Louisiana territory from the French for $15 million in 1803 during the administration of President Jefferson almost doubled the size of the United States by moving its western border from the Mississippi River to the Rocky Mountains. This acquisition, the greatest bargain in American history and basic to the rise of the new republic as a world power, brought vast western lands, including the present State of Missouri and the site of the city of St. Louis, under United States control. St. Louis was then an isolated French trading post located on the west bank of the Mississippi River, just across from Illinois country of the Northwest Territory. As center of the trans-Mississippi fur trade, the post had acquired a population of about 1000. The first steamboat to reach St. Louis, the paddle-wheeler Zebulon M. Pike, docked in 1817 to usher in an era of increasing commercial and passenger traffic on the river. In 1821, when Missouri was admitted to the Union as the 24th state, St. Louis was still only a town of 5, 600 inhabitants. During the next several decades, however, St. Louis came into its own as a vital way station between the Northwest and the advancing western frontier.[79]

As gateway to the Far West, St. Louis attracted settlers in increasing numbers, including a contingent of trained and untrained American doctors. Among them were those who foresaw the opportunity in a dynamic, evolving community to realize their professional ambitions. For a physician caught up in the general westward migration then in full swing, few goals could be higher than to found a medical school, and St. Louis was as inviting a location for that purpose in the 1830's, as was San Francisco to Elias Samuel Cooper two decades later.

Medical Department of Kemper College in St. Louis

When the Medical Department of Cincinnati College closed in 1839, Joseph Nash McDowell (1805-1868), Professor of Special and Surgical Anatomy, moved to St. Louis. Already an experienced teacher, he immediately set about organizing a medical faculty with four other St. Louis physicians. Under the authorization of an Episcopal institution known as Kemper College, he founded the Medical Department of Kemper College, the first medical school west of the Mississippi. The first course of medical lectures was presented during the winter of 1840-41. McDowell taught anatomy and divided the other subjects among his four associates. It was his flamboyant leadership that held the school together when failing financial support made necessary the transfer of its sponsorship from Kemper College to Missouri State University in 1847. The school then became the Medical Department of Missouri State University (also called Missouri Medical College) with faculty in 1847-48 of six professors: McDowell in anatomy and other chairs in medicine; physiology and materia medica; obstetrics and diseases of women and children; pathology and clinical medicine; and chemistry and pharmacy. So closely were these early medical schools identified in the public mind with McDowell as their founder and colorful advocate that they both were generally known as McDowell Medical College.[80]

Regarding McDowell's personality and ability, he may be charitably described as a brilliant eccentric. A native of Kentucky, he was married to the girl who had been his playmate when he was a young boy, Amanda Virginia Drake, the sister of Daniel Drake. After receiving his MD degree in1825 from Transylvania University in Lexington, Kentucky, he served as Professor of Anatomy at Transylvania and at Jefferson Medical College before joining the faculty of the Medical Department of Cincinnati College from 1835 to 1839.

As a lecturer in anatomy, he was truly gifted, with a marvelous power to entertain while driving home the subject. In the words of a student, he "made even the dry bones talk". He was wonderfully eloquent as a speaker, and a master of extemporaneous invective, abuse and vilification when his ire was aroused, which was easily done. While a member of the medical faculty of Cincinnati College during Drake's campaign against the Medical College of Ohio, McDowell enthusiastically joined the fray by attacking the professors of the Ohio College openly in offensive language, vowing that given a year's time he would blow the damned Ohio Medical College to hell. In St. Louis he used similar tactics and exhibited a fanatical streak as well in his opposition to a rival medical school as we will shortly relate. His objectionable traits were at least partially, if not fully, offset by his devotion to family, friends and patients; by his consistently effective leadership of the medical school he founded; by his democratic relationship with students (frowned upon by his peers as unseemly fraternization); and by his ability as a surgeon which was comparable to his proficiency in anatomy.[81]

Anecdotes of McDowell's unconventional attitudes and behavior abound. He was either genuinely superstitious or, more likely, pretended to be. As an anatomist he was often involved in the dangerous business of colluding with resurrectionists who provided his school with material for dissection. He told his cousin, the author Mary Ridenbaugh, of the following narrow escape which he ascribed to the intervention of his mother's spirit:[82]

Said Cousin Mary, "I see that you listen to the spirits sometimes." "Yes," was Dr. McDowell's reply, "there is a great deal more in the matter than a man can express without being thought a d--n fool"

"You are right," she added. "But have you ever had an experience or seen any manifestations?" "Yes; confounded sight more than I tell people" ."However," he continued, "I will tell you what I know, and how I was saved by my mother's spirit."

"A German girl died with a very unusual disease, and we were determined to get her body for dissection. We got it and laid it in the College. The secret leaked out, and the Germans got their backs up and made things lively for us. (There was a large community of Germans in St. Louis.) It was planned by them to come one night and hunt over the College to see if the body was there to be dissected. "I received a note at my house at 9 o'clock of an evening warning me that the visit was to be that night.

"I went down to the College about 11 o'clock, thinking to hide the corpse. When I got there all was quiet. I went through the dissecting room, with a small lantern in my hand, in the direction of the body. I picked the cadaver up and threw it over my shoulder to carry it to the top loft to conceal it between the rafters, or place it in a cedar chest that had stood in the closet for years.

"I had ascended one flight of stairs, when out went my lamp. I laid down the corpse and re-struck a light. I then picked up the body, when out went my light again. I felt for another match in my pocket, when I distinctly saw my dear, old mother standing a little distance off, beckoning to me.

"In the middle of the passage was a window; I saw her rise in front of it. I walked along close to the wall, with the corpse over my shoulder, and went to the top loft and hid it. I came down in the dark, for I knew the way well; as I reached the window in the passage, there were two Germans talking, one had a shotgun, the other a revolver. I kept close to the wall and slid down the stairs. When I got to the dissecting-room door, I looked down the stairs into the hallway; there I saw five or six men lighting a lamp. I hesitated a moment as to what I should do, as I had left my pistols in my pocket in the dissecting room where I took the body. I looked in the room, as it was my only chance to get away, when I saw my spirit mother standing near the table from which I had just taken the corpse. I had no light, but the halo that surrounded my mother was sufficient to enable me to see the table quite plainly.

"I heard the men coming up the stairs. I laid down whence I had taken the body and pulled a cloth over my face to hide it. The men came in all of them being armed, to look at the dead. They uncovered one body, it was that of a man, the next a man; then they came to two women with black hair - the girl they were looking for had light flaxen hair. Then they passed me; one German said: 'Here is a fellow who died in his boots; I guess he is a fresh one.'

"I laid like marble. I thought I would jump up and frighten them, but I heard a voice, soft and low, close to my ear, say, 'Be still, be still'. The men went over the building and finally down stairs. I waited awhile, then slipped out. At the corner of Gratial Street, I heard three men talking German; they took no notice of me, and I went home.

"Early in the morning I went to the College and found everything all right. We dissected the body, buried the fragments and had no further trouble."

"Then, Doctor, you feel satisfied that the spirit of your mother saved you from that trouble?

"I know it," he replied. "I often feel as though my mother is near me when I have a difficult case of surgery. I am always successful when I feel this influence. Well, let me stop here. I have a boy to attend to with a broken leg, so good-bye." And with his characteristic manner of always being in a great hurry, he glided out the door and into his buggy.

Joseph McDowell was the nephew of the celebrated Kentucky surgeon, Dr. Ephraim McDowell, a relationship which doubtless eased his early acceptance into the highest medical circles. He is said to have harbored a smoldering resentment against his uncle because of a misunderstanding that arose during his youth. Joseph spent much of his time in his Uncle Ephraim's home and there formed an ardent attachment for his cousin Mary McDowell, the daughter of his uncle. She informed Joseph that she did not share his more than cousinly affection and confided in her father who kindly but firmly emphasized to Joseph the finality of her decision. The nephew then charged his uncle, no doubt unjustly, with influencing his daughter against him, and left his uncle's house never to return, nor did he ever forgive him.[83] In later life he even sought to discredit his uncle's remarkable surgical achievement by charging that the operation of ovariotomy for which Ephraim McDowell won acclaim was actually performed by James McDowell, another nephew, who was fresh from medical school and actually only served as an assistant.[84]

Circumstances attending that famous operation by Ephraim McDowell shed much light on the realities of medical care in the early 1800's, and on the conditions under which Elias Cooper practiced surgery in Illinois a few decades later.[85]

Ephraim McDowell, Pioneer Surgeon

Dr. Ephraim McDowell of Danville, Kentucky, became in 1809 the first surgeon world-wide to successfully remove an ovarian tumor. It is difficult for us to understand that performance of an operation, done today routinely with minimum risk, was in 1809 a singular contribution to medical progress, but such was the case. Until then, ovarian tumor was an incurable and frequently fatal disease, and was thought to be unapproachable surgically. Indeed, opening the abdomen for treatment of any internal disorder was not considered feasible by the savants in European medical centers where medicine and surgery were the most advanced. As a result, the report by a backwoods American physician of the first ovariotomy was at first disparaged by disdainful British surgeons. Nevertheless, McDowell is now universally recognized as the first to demonstrate the feasibility of the operation and, being from the neighboring state of Kentucky, would surely have been among the pantheon of eminent surgeons who inspired the efforts of the young Dr. Elias Cooper in Illinois. This is an additional reason why Dr. McDowell deserves our respectful notice here.

Dr. Ephraim McDowell (1771-1830) served an apprenticeship in his native state of Virginia for about two years under Dr. Alexander Humphreys of Staunton who was an MD graduate of Edinburgh University. McDowell then spent two years (1783-85) at Edinburgh, but did not graduate; nor did he hold a medical degree from any institution until he was awarded an unsolicited Honorary MD degree by the University of Maryland in 1825. By 1809, in spite of his lack of medical credentials, he had become one of the most highly regarded surgeons west of the Allegheny Mountains.[86][87]

The patient from whom Dr. McDowell removed a huge ovarian tumor in 1809 was a courageous Kentucky woman of about 46 named Mrs. Jane Todd Crawford. He described her as a woman of small stature whose abdomen had become so pendulous with the tumor as to reach almost to her knees. During the few days before the operation she rode 60 miles by horseback, resting the tumor on the horn of the saddle, to reach Danville, then a frontier town of possibly a thousand.[88]

The procedure was carried out in Dr. McDowell's house. He was assisted in the operation by one of his nephews, Dr. James McDowell, who had graduated in Philadelphia a few months previously and who, from the time of Mrs. Crawford's arrival in Danville, made frequent attempts to persuade his uncle from operating on her. Several other attendants were present to observe the operation and to help restrain the patient who was operated on without anesthesia. In this pre-anesthesia era, an alcoholic or narcotic potion was commonly administered before an operation, yet the utmost fortitude was still required by the patient. Mrs. Crawford is said to have diverted her thoughts during the procedure by repeating the Psalms. Under such circumstances speed, deftness, self assurance and a precise knowledge of anatomy were essential qualities of a surgeon. Antisepsis and asepsis were unknown, and postoperative infection usually occurred.

In an otherwise bare room in McDowell's home in Danville, the patient was placed on an ordinary table. Equipment consisted of scalpel, scissors, forceps, needle holder, ligature passer, heavy thread and an assortment of household items such as basins, towels and other dry goods, all laid out on a small nearby stand. The following are the important features of the operation.

  • A long incision was made to the left of the midline, extending from the rib margin above to the pubis below.
  • The tumor then came into full view. It was freely movable with a pedicle of sufficient length so that a strong ligature could be tied around the fallopian tube and other tissues containing the tumor's blood supply.
  • The tumor, being so large that it could not be delivered from the abdomen, was then opened and its gelatinous contents were evacuated - whereupon the intestines rushed out of the abdomen and remained exposed until the remaining solid portion of the tumor was cut off from its pedicle and removed.
  • The patient was turned briefly onto her side to permit escape of accumulated blood from her abdomen.
  • The operation to this point had taken 25 minutes. Another five minutes were required to replace the intestines and close the abdomen with large interrupted sutures, the long ends of the ligature on the tumor pedicle being brought out through the lower end of the wound for later withdrawal from the abdomen after it had cut through the pedicle. Altogether the procedure took about a half an hour.
  • The tumor was partly cystic and partly solid, the cystic portion weighing 15 pounds and the solid portion weighing 7 1/2 pounds, a total of 22 1/2 pounds.
  • Postoperative course was exceptionally smooth. She did not develop either of the two most feared and frequent complications of abdominal operations - peritonitis and wound infection. In five days she was up and making her bed, and in 25 days she returned home. Mrs. Crawford was in apparently good health for the next 33 years until her death in 1842, outliving her surgeon by 12 years.[89][90]

Dr. McDowell told Mrs. Crawford that the operation he proposed to her would be "an experiment" - as indeed it was at the time. Recognizing that she had no other alternative if she wished to live, she promptly agreed. Before publishing the Crawford case in 1817, McDowell performed his "experimental operation" on two additional patients, both of whom survived the procedure and were included in his original report.[91] However, it was not until mid-century, and after the advent of anesthesia, that ovariotomy gained general acceptance in the higher echelons of British and French surgery. The prolonged delay in the adoption of this life-saving procedure in Europe led Schachner to attribute McDowell's earlier initiative and success to the spirit of independence nurtured by the American frontier, and to his freedom from the constraints of an entrenched professional elite such as existed in Europe.[92]

Ephraim McDowell's unprecedented operation demonstrated for the first time the curative potential of surgery in the previously hopeless condition of ovarian tumor. Equally important, it proved that the abdominal cavity, formerly off-limits to the surgeon, could be safely explored. By these memorable achievements, McDowell became not only "Father of Ovariotomy", but also "Founder of Abdominal Surgery".[93]

Medical Department of St. Louis University

Just as the Medical College of Ohio fought hard to prevent the opening of a rival school in Cincinnati in 1835 by Daniel Drake, so Joseph McDowell reacted furiously to a similar challenge to his medical college in St. Louis. As early as 1836, three years before McDowell's arrival in the city, St. Louis University, founded by the Jesuit Order of the Catholic Church in 1818, had adopted a plan to establish a Medical Department. For various reasons, steps to put the plan in operation were delayed until after McDowell had established his school. When the University finally enacted a constitution for its Medical Department on 14 October 1841, McDowell assailed the plan in vitriolic anti-Catholic speeches, specifically attacking the Jesuit Order. Nevertheless, a medical faculty was appointed by St. Louis University and lectures were begun a year later on 8 October 1842. The faculty consisted of a Dean and four associates. During the next seven years, in spite of McDowell's fulminations and the vigorous competition of his College, the Medical Department of St. Louis University prospered and capacious new quarters were constructed.[94]

In addition to Joseph McDowell's move to St. Louis, repercussions from the late Medical Department of Cincinnati College were felt in other ways on medical education in St. Louis. One of Dr. McDowell's able students at Cincinnati Medical College during 1837-38 was a young man from Huntsville, Alabama, by the name of Charles Alexander Pope (1818-1870) who transferred to the University of Pennsylvania Medical School in the following year and there earned his MD degree in 1839. After a Wanderjahr in Europe where he spent most of his time in Paris, but also visited other great medical centers on the continent and in Great Britain and Ireland, Dr. Pope returned to the United States to settle in St. Louis in 1841. He too was interested in starting a medical school in the rapidly growing city which now had a population of about 20,000. He took part in the organization in 1841 and activation in 1842 of the Medical Department of St. Louis University, in spite of the implacable opposition of his former teacher.[95]

In his pursuit of an academic career, Pope had a powerful advocate in Dr. Samuel Gross, Professor of General and Pathological Anatomy in the Medical Department of Cincinnati College where he had been a faculty colleague of Joseph McDowell. Gross considered McDowell to be an incomparable teacher of anatomy, but otherwise something of a crank. For McDowell's Uncle Ephraim, however, Gross had the utmost respect and was chosen to deliver the Memorial Oration at the dedication of a monument to the ovariotomist at Danville, Kentucky, in 1879.

After leaving Cincinnati, Gross rose to national prominence as a surgeon and served for 26 years (1856-1882) as Professor of Surgery at Jefferson Medical College. He well remembered Pope's studious habits and moral and intellectual attributes while a student at Cincinnati Medical College, and ever retained a kindly disposition toward him. It was upon Gross's strong recommendation that St Louis University chose Pope as Professor of Anatomy in 1843. Later, in recognition of his special interest and ability in the field of surgery, the University transferred Pope to the professorship of Surgery in 1847. He was given the additional appointment of Dean of the medical school in 1849, a position he filled with such distinction for the next 15 years that the Medical Department of St. Louis University was commonly referred to as "Pope's College". This was particularly galling to the head of "McDowell's College". Elias later referred gratefully to Dr. Pope as a benefactor during his student days.[96]

As for the controversial McDowell, he lives in memory as the most colorful character in the history of medical education in Saint Louis. He never lost his antipathy for the rival Jesuit school, or overlooked an opportunity to ridicule it. Medical students looked forward with relish to the commencement exercises of McDowell's College when he was sure to have something caustic and irreverent to say about Pope's College. On one such occasion McDowell, who was an avid amateur musician,

. . slowly sauntered down the aisle with violin and bow in his hand. Seeing so many students sitting sideways he commandingly said: "Gentlemen, I pray you, sit straight and face the music." After scraping off a few tunes he very gravely laid aside his violin and bow and said: "Gentlemen, we have now been together for five long months and we have passed many pleasant and delightful moments together, and doubtless some sad and perplexing ones, and now the saddest of all sad words are to be uttered, namely, "Farewell'. . .In after years one of your number will come back to the City of St. Louis, with the snow of many winters upon his hair, walking not on two legs, but on three, as Sphinx has it, and as he wanders here and there upon the thoroughfares of this great city, suddenly, gentlemen, it will occur to him to ask about Dr. McDowell. Then he will hail and ask one of the eager passersby: "Where is Dr. McDowell," he will say: "What Dr. McDowell." "Why, Dr. McDowell, the surgeon." He will tell him, gentlemen, that Dr. McDowell lies buried out at Bellefontaine. Slowly and painfully he will wend his way thither. There he will find amidst rank weeds and seeding grass a simple marble slab inscribed, "J.N. McDowell, Surgeon." As he stands there contemplating the rare virtues and eccentricities of this old man, suddenly, gentlemen, the spirit of Dr. McDowell will arise upon ethereal wings and bless him. Yes, thrice bless him. Then it will take a swoop, and when it passes this building, it will drop a parting tear, but, gentlemen, when it gets to Pope's College, it will expectorate."[97]

To the Medical Students, the sardonic humor of the irrepressible McDowell during commencement services was a welcome alternative to the weighty sermons usually delivered on such occasions.

During his final years this "erratic genius", estranged from his children because of a second marriage of which they disapproved, and in a state of utter bankruptcy, turned in the end to the Roman Catholic religion and received in death the blessing of his spiritual comforter and companion, a Jesuit priest.[98][99]This brief account of the birth of medical education west of the Mississippi, presaging as it does later San Francisco conflicts in which we have a special interest, lends support to Drakes' postulate that medical schools are a fertile source of discord within the profession.

Perspective

The historical roots of Stanford Medical School are deeply planted in American medicine of the 1800's. If we are to understand and appropriately evaluate the contributions of the men, women and institutions of these earlier days we must know the conditions under which they labored.

It is for this reason that we have referred in this and preceding Chapters to aspects of American society that affected the careers and achievements of Elias Samuel Cooper and Levi Cooper Lane. We have also attempted an overview of American medical education from its beginning in Philadelphia in 1765, through some pioneer schools west of the Alleghenies, to the advent of the modern era at Johns Hopkins. In the following Chapter we complete our "environmental impact study" by noticing the condition of medical science and practice in the 19th century as experienced by Cooper and Lane.

It is hoped that this approach will lead to broader insight, and a deeper appreciation of the challenges overcome by the Faculties of Stanford's predecessor institutions for, to paraphrase Macauley, Medical Schools that take pride in the achievements of remote antecedents are more likely to be remembered with pride by remote descendents.

Endnotes

  1. See Cooper-Lane genealogy - Box 1, Folder 18, Elias Samuel Cooper Papers - MSS 10, Lane Medical Archives.
  2. Lane, L. C. , "Editor's Table: Obituary of Elias Samuel Cooper, M.D.," San Francisco Medical Press 3, no. 12 (Oct 1862): 225-42 Lane Library catalog record
  3. L. Cooper Lane , "Elias S. Cooper" in Representative and Leading Men of the Pacific, ed. Shuck, O. T. (San Francisco: Bacon and Company, Printers and Publishers, 1870), pp. 237-47. Lane Library catalog record
  4. Diary of Professor Jacob Cooper (1830-1902) covering the period 1847 to 1902. This invaluable holograph document was generously made available to us as a reference by John R. McDonnell of Houston, Texas, a descendent of Professor Cooper.
  5. Speeches and Writings: Levi Cooper Lane, Biographical Sketch - Box 1.12, Emmet Rixford Papers - MSS 8, Lane Medical Archives, Stanford. Lane Library catalog record
  6. Rixford, E. , "Levi Cooper Lane, M.D. - The Lane Popular Lectures, Part I," California and Western Medicine 37, no. 6 (Dec 1932): 384. Lane Library catalog record
  7. L. Cooper Lane , "Elias S. Cooper" in Representative and Leading Men of the Pacific, ed. Shuck, O. T. (San Francisco: Bacon and Company, Printers and Publishers, 1870), pp. 237-39. Lane Library catalog record
  8. Cooper family genealogy, in the personal collection of Ruth Ragsdale, Genealogist, Galesburg, Illinois.
  9. Webster's Third International Dictionary of the English Language Unabridged, s.v. "ad eundem," (Springfield, Massachusetts: G. and C. Merriam Ce., Publishers, 1976). Lane Library catalog record
  10. Waite, F. C. , "Medical degrees conferred in the American colonies and in the United States in the eighteenth century," Annals Medical History 9, no. 4 (Jul 1937): 314-20.
  11. Cooper family genealogy, in the personal collection of Ruth Ragsdale, Genealogist, Galesburg, Illinois.
  12. Chapman, Charles C. , publisher, History of Knox County, Illinois (Chicago: Blakely, Brown and Marsh, Printers, 1878), p 667.
  13. Based on materials held at Miami University Library. Lane Library catalog record
  14. Chapman, Charles C. , publisher, History of Knox County, Illinois (Chicago: Blakely, Brown and Marsh, Printers, 1878), p 667.
  15. "Article III. Graduates in Rush Medical College: Session of 1849-50," North-Western Medical and Surgical Journal 3, no. 1 (May 1850): 86-7. Lane Library catalog record
  16. Cooper family genealogy, in the personal collection of Ruth Ragsdale, Genealogist, Galesburg, Illinois. Materials include newspaper clipping from Galesburg (Illinois) Daily Mail for 17 November 1893 reporting the Obituary of Esaias Samuel Cooper, M.D. who died 16 November 1893.
  17. Annual Announcements of the Medical Department of Saint Louis University, 1853-54, p. 20, Pamphlets Collected by E.S. Cooper, vol. 10, Lane Medical Library Special Collections, Stanford. Lane Library catalog record
  18. St. Louis University , Memorial volume of the diamond jubilee of St. Louis University, 1829-1904 [St. Louis, MO: Little & Becker Print. Co., 1904], pp. 185, 187 and 188.
  19. St. Louis Medical College , History of St. Louis Medical College (St. Louis: T. G. Waterman, 1899), p. 29.
  20. Letter Jacob to Elias dated 11 Feb 1856, Emge Research Materials-Correspondence, 1930-1978 - Box 3, Folder 14, Elias S. Cooper Papers - MS 458, California Historical Society, North Baker Research Library.
  21. Two letters from Caroline Cooper to Elias Cooper dated 20 August 1855 and 10 February 1856, and one letter from Jacob Cooper to Elias Cooper dated 11 February 1856.
  22. Diary of Jacob Cooper, notes on Volume 2 (1854-1857), in the personal collection of John McDonnell.
  23. Based on materials held at Cincinnati Historical Society Library.
  24. The Farmers' College Catalogue for 1847-48 also includes a list of students in attendance at Pleasant Hill Academy during the previous two years, and L. Lane is not among them. The Catalogues for 1852-53 and for 1854-55 list the alumni of Farmers' College, and L. Lane is not among them.
  25. Ellinwood, C. N. , "In Memory of Levi Cooper Lane," in Exercises in memory of Levi Cooper Lane held in Lane Hall of Cooper Medical College 9 March 1902 (San Francisco: Stanley-Taylor Company, 1902), p. 19. Lane Medical Archives H172.5H L26 1861-1902. Lane Library catalog record
  26. Rixford, E. , "Levi Cooper Lane, M.D. - The Lane Popular Lectures, Part 2," California and Western Medicine 38, no. 1 (Jan 1933): 37. Lane Library catalog record
  27. Based on materials held at Union College Library.
  28. Rixford, E. , "Levi Cooper Lane, M.D. - The Lane Popular Lectures, Part 1," California and Western Medicine 37, no. 6 (Dec 1932): 383-84. Lane Library catalog record
  29. Levi Cooper Lane , Surgery of the Head and Neck (Published by the Author, 1896). Lane Library catalog record
  30. Personal collection of Ruth Ragsdale, Genealogist, Galesburg, Illinois.
  31. Personal collection of Ruth Ragsdale, Genealogist, Galesburg, Illinois.
  32. Rixford, E. , "Early History of Medical Education in California," Annals of Surgery 88, no. 3 (Sep 1928): 329. Lane Library catalog record
  33. Barkan, H. , "Cooper Medical College, Founded by Levi Cooper Lane: An Historical Sketch," Stanford Medical Bulletin 12, no. 3 (Aug 1954): 153. Lane Library catalog record
  34. Kelly, H. A. Burrage, W. L. , American Medical Biographies (Baltimore: Norman Remington Company, 1920), pp. 678-79. Lane Library catalog record
  35. Malone, D. , ed. Dictionary of American Biography, vol. 10 (New York: Charles Scribner's Sons, 1943), pp. 580-81. Lane Library catalog record
  36. Transactions of Illinois State Medical Society for the Year 1852. Minutes of Second Annual Meeting,1-3 June 1852, p.39; pp. 45-6; p. 4.
  37. Editorial, "Knox County Medical Society," North-Western Medical and Surgical Journal 9 [New Series vol. 1], no. 3 (Jul 1852): 143-44. Lane Library catalog record
  38. Editorial, "Knox County Medical Society," North-Western Medical and Surgical Journal 11 [New Series vol. 3], no. 1 (Jun 1854): 45-6. Lane Library catalog record
  39. Editorial, "Knox County Medical Society," North-Western Medical and Surgical Journal 11 [New Series vol. 3], no. 9 (1854 Sep): 430-31. Lane Library catalog record
  40. Diary of Jacob Cooper, notes on Volume 2 (1854-1857), in the personal collection of John McDonnell.
  41. Letters Jacob Cooper to Elias Cooper dated 2 July 1855 and 21 August 1855, Emge Research Materials-Correspondence, 1930-1978 - Box 3, Folder 14, Elias S. Cooper Collection - M.S. 458, California Historical Society, North Baker Research Library.
  42. Letter Jacob Cooper to Elias Cooper dated 21 August 1855, Emge Research Materials-Correspondence, 1930-1978 - Box 3, Folder 14, Elias S. Cooper Collection - M.S. 458, California Historical Society, North Baker Research Library.
  43. Editorial, "Professorship of Physiology in the Medical Department of the University of the Pacific," San Francisco Medical Press 2, no. 7 (Jul 1861): 160-61. Lane Library catalog record
  44. Rixford, E. , "Early History of Medical Education in California," Annals of Surgery 88, no. 3 (1928 Sep): 329. Lane Library catalog record
  45. Lane, L. C. , Surgery of the Head and Neck, 2nd ed. (Philadelphia: P. Blakiston, Son and Company, 1898), pp. 842-843. Lane Library catalog record
  46. Bishop, W. J. , The Early History of Surgery (London: Robert Hale Limited, 1960), p. 174. Lane Library catalog record
  47. Hunt, R. D. , and Sanchez, N. G. A Short history of California (New York: Thomas Y. Crowell Co., 1929), pp. 487-90.
  48. Editorial, "Personal," San Francisco Medical Press 1, no. 2 (Apr 1860): 126. Lane Library catalog record
  49. Editorial, "Professorship of Physiology in the Medical Department of the University of the Pacific," San Francisco Medical Press 2, no. 7 (Jul 1861): pp. 190-61. Lane Library catalog record
  50. L. Cooper Lane , "Elias S. Cooper" in Representative and Leading Men of the Pacific, ed. Shuck, O. T. (San Francisco: Bacon and Company, Printers and Publishers, 1870), p. 239. Lane Library catalog record
  51. Levi C. Lane , "Editor's Table: Obituary of Elias Samuel Cooper, M. D." San Francisco Medical Press 3, no. 12 (Oct 1862): 227. Lane Library catalog record
  52. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 36-46. Lane Library catalog record
  53. Mansfield, E. D. , Memoirs of the Life and Services of Daniel Drake, M.D., Physician, Professor, and Author; with Notices of the Early Settlement of Cincinnati and Some of its Pioneer Citizens (Cincinnati: Published by Applegate and Co., 1860), pp. 14-43. Lane Library catalog record
  54. Gross, S. D. , Discourse on the Life, Character, and Services of Daniel Drake, M.D. (Louisville: Printed at the Office of the Louisville Journal, 1853), pp. 9-17. Lane Library catalog record
  55. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 73-78 and p. 79. Lane Library catalog record
  56. Drake, D. , Discourses Delivered by Appointment before the Cincinnati Medical Library Association, January 9th and 10th, 1852 (Cincinnati: Published for the Association by Moore and Anderson, 1852), p. 38. Lane Library catalog record
  57. Waite, F. C. , "Grave robbing in New England," Bulletin of the Medical Library Association 33, no. 3 (Jul 1945): 279-281. Lane Library catalog record
  58. Lassek, A. M. , Human Dissection: Its Drama and Struggle (Springfield, Illinois: Charles C. Thomas, Publisher, 1958), pp. 186-188. Lane Library catalog record
  59. Ladenheim, J. C. , "'The Doctors' Mob' of 1788," Journal of History of Medicine and Allied Sciences (New York) 5 (Winter 1950) : 23-43. Lane Library catalog record
  60. Ball, J. M. , The Sack-'Em-Up Men: An Account of the Rise and Fall of the Modern Resurrectionists (Edinburgh: Oliver and Boyd, 1928), pp. 201-3. Lane Library catalog record
  61. Lassek, A. M. , Human Dissection: Its Drama and Struggle (Springfield, Illinois: Charles C. Thomas, Publisher, 1958), p. 270. Lane Library catalog record
  62. Toner, J. M. , Contributions to the Annals of Medical Progress and Medical Education in the United States before and during the War of Independence (Washington: Government Printing Office, 1874), p. 108. Lane Library catalog record
  63. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 111-122 and p. 123. Lane Library catalog record
  64. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 125-26. Lane Library catalog record
  65. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), p. 130. Lane Library catalog record
  66. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 128-32. Lane Library catalog record
  67. Brodman, E. , "An unpublished letter of Daniel Drake to the College of Physicians and Surgeons in New York," Bulletin of the History of Medicine 18, no. 3 (Oct 1945): 338-348. Lane Library catalog record
  68. Norwood, F. W. , Medical Education in the United States before the Civil War (Philadelphia: University of Pennsylvania Press, 1944), pp. 304-308. Lane Library catalog record
  69. Juettner, O. , Daniel Drake and his Followers: Historical and Biographical Sketches (Cincinnati: Harvey Publishing Company, 1909), pp. 49-56 and pp. 121-124. Lane Library catalog record
  70. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 36-46 Lane Library catalog record
  71. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 184-253 Lane Library catalog record
  72. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 254-259 Lane Library catalog record
  73. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), p. 293 Lane Library catalog record
  74. Horine, E. F. , Daniel Drake (1785-1852): Pioneer Physician of the Midwest (Philadelphia: University of Pennsylvania Press, 1961), pp. 293-323 Lane Library catalog record
  75. Drake, D. , Systemic Treatise, Historical, Etiological, and Practical, on the Principal Diseases of the Interior Valley of North America (Cincinnati: Winthrop B. Smith and Co., Publishers, 1850), pp. 878.
  76. Drake, D. , Physician to the West: Selected Writings of Daniel Drake on Science and Society, ed. Shapiro, H. D. , and Miller, Z. L. (Lexington: University Press of Kentucky, 1970), pp. 315-316; p.327. Lane Library catalog record
  77. Gross SD , ed. Lives of Eminent American Physicians and Surgeons of the Nineteenth Century (Philadelphia: Lindsay and Blakiston, 1861), pp. 623-625. Lane Library catalog record
  78. Drake, D. , Practical Essays on Medical Education and the Medical Profession in the United States, 1832 (Baltimore: The Johns Hopkins Press, 1952), p. 98. Lane Library catalog record
  79. Encyclopedia Americana, International Edition, 1983 ed., s.v. "Louisiana," "Louisiana Purchase" and "St. Louis" Lane Library catalog record
  80. Norwood, F. W. , Medical Education in the United States before the Civil War (Philadelphia: University of Pennsylvania Press, 1944), pp. 353-355. Lane Library catalog record
  81. Juettner, O. , Daniel Drake and his Followers: Historical and Biographical Sketches (Cincinnati: Harvey Publishing Company, 1909), pp. 192-94. Lane Library catalog record
  82. Ridenbaugh, M. Y. , Biography of Ephraim McDowell: "The Father of Ovariotomy" (New York: Charles L. Webster and Company, 1890), pp. 173-76. This eulogistic memoir of Dr. McDowell, written by his granddaughter, includes glimpses of the McDowell family as well as a history of ovariotomy - all presented in a most engaging style.
  83. Ridenbaugh, M. Y. , Biography of Ephraim McDowell: "The Father of Ovariotomy" (New York: Charles L. Webster and Company, 1890), pp.163-64.
  84. McDowell, J. N. "Report on the improvements in the art and science of surgery in the last fifty years" , Transactions of the American Medical Association 13 (1860): 458. Lane Library catalog record
  85. Schachner, A. , Ephraim McDowell, "Father of Ovariotomy" and Founder of Abdominal Surgery (Philadelphia: J.D. Lippincott Company, 1921), 331 pages. Lane Library catalog record A well documented biography from the surgical standpoint with rebuttal of the critics of Dr. McDowell. Includes an Appendix on the patient, Jane Todd Crawford.
  86. Ridenbaugh, M. Y. , Biography of Ephraim McDowell: "The Father of Ovariotomy" (New York: Charles L. Webster and Company, 1890), pp. 74-75.
  87. Schachner, A. , Ephraim McDowell, "Father of Ovariotomy" and Founder of Abdominal Surgery (Philadelphia: J.D. Lippincott Company, 1921), pp. 18-21 and p. 57. Lane Library catalog record
  88. Schachner, A. , Ephraim McDowell, "Father of Ovariotomy" and Founder of Abdominal Surgery (Philadelphia: J.D. Lippincott Company, 1921), pp. 48-9. Lane Library catalog record
  89. Schachner, A. , Ephraim McDowell, "Father of Ovariotomy" and Founder of Abdominal Surgery (Philadelphia: J.D. Lippincott Company, 1921), pp. 61-70. Lane Library catalog record
  90. Ridenbaugh, M. Y. , Biography of Ephraim McDowell: "The Father of Ovariotomy" (New York: Charles L. Webster and Company, 1890), pp. 70-84.
  91. McDowell, E. , "Extirpation of Diseased Ovaria and Observations on Diseased Ovaria," in Surgery in America: From the Colonial Era to the Twentieth Century: Selected Writings, ed. A. Scott Earle, M.D. (Philadelphia: W.B. Saunders Company, 1965), pp. 60-70. Lane Library catalog record
  92. Schachner, A. , Ephraim McDowell, "Father of Ovariotomy" and Founder of Abdominal Surgery (Philadelphia: J.D. Lippincott Company, 1921), pp. 40-43; pp. 174-203. Lane Library catalog record
  93. Schachner, A. , Ephraim McDowell, "Father of Ovariotomy" and Founder of Abdominal Surgery (Philadelphia: J.D. Lippincott Company, 1921), p. 181. Lane Library catalog record
  94. Norwood, F. W. , Medical Education in the United States before the Civil War (Philadelphia: University of Pennsylvania Press, 1944), pp. 356-357. Lane Library catalog record
  95. Carmichael, E. M. "Charles Alexander Pope," Annals of Medical History, Third Series, 2, no. 5 (Sep 1940): 422-31. Lane Library catalog record
  96. Juettner, O. , Daniel Drake and his Followers: Historical and Biographical Sketches (Cincinnati: Harvey Publishing Company, 1909), pp. 188-92. Lane Library catalog record
  97. Kelly, H. A. , Cyclopedia of American Medical Biography Comprising the Lives of Eminent Deceased Physicians and Surgeons from 1610 to 1910, vol.2 (Philadelphia: W.B. Saunders Company, 1912), s.v. "Joseph Nashe McDowell." Lane Library catalog record
  98. Ridenbaugh, M. Y. , Biography of Ephraim McDowell: "The Father of Ovariotomy" (New York: Charles L. Webster and Company, 1890), p. 178.
  99. Gross, S. D. Autobiography of Samuel D. Gross, vol. 1 (Philadelphia: George Barrie, Publisher, 1887), p. 70. Lane Library catalog record
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