Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective
Part II. E.S. Cooper in San Francisco

Chapter 12. Second Annual Session of the State Medical Society and Some Notable Surgical Cases

Transactions of the State Medical Society, 1857

The Second Session of the Medical Society of the State of California met in Sacramento, 11-13 February 1857. This meeting marked the high point of Elias Cooper's success in the furtherance of organized medicine in California. We shall now see how the Society became the focal point of professional discord that made the next few years the most contentious in California's medical history.

The first President of the Society, Dr. B. F. Keene, died on 5 September 1856. Therefore, when some forty-five members of the Society convened in Pioneer Hall at noon on 11 February 1857 for its Second Session, Senior Vice President Elias Cooper, serving as acting president, took the chair and conducted the initial proceedings. Dr. Henry Gibbons was promptly elected next President of the Society and took office during the Session.

Dr. Cooper, as the outgoing acting president, delivered the Annual Presidential Address. He chose a topic on which he had spoken previously at the Illinois State Medical Society in 1854: "Deformities of the Locomotive Apparatus." In this presentation before the California Medical Society, he again described his orthopedic splints and ingenious spring boot for the treatment of deformities of the lower extremities, and once more demonstrated by case reports how walking can be made the primary element in the cure of certain locomotor disabilities.[1][2]

Consistent with his policy to contribute liberally to scientific programs at medical meetings, Cooper read a second paper in which he reported the case of Frank Travers whose external iliac artery and vein were ligated in December 1855 with successful outcome. We have already referred to this operation and to Dr. H. M. Gray's criticism of Cooper's operative technique. The animosity between Cooper and Gray over this case, which was by this time well-known among the profession, had continued to smoulder. By presenting the Travers case before the Society in convincing detail along with the animal experiments, Cooper succeeded in discrediting the petty views of Gray who was present in the audience. By thus demeaning Gray in a public forum, Cooper made an eventual open clash between them inevitable.[3]

The scientific papers so far published by Cooper, and those to follow during the next five years as listed in his bibliography, record his significant efforts to define basic surgical principles, particularly in vascular and orthopedic disorders These efforts, and his commitment to dissection, animal experimentation and teaching, served increasingly to set him apart from his California contemporaries.

Even more distinctive and visionary was Cooper's unwavering faith in the ultimate success of his covert plan to establish a medical school in spite of mounting odds. For example, the Committee on Medical Education, chaired by none other than the respected John F. Morse, delivered its first report during the Second Session of the California Medical Society. The conclusion was discouraging. In the view of the Committee, conditions in California were so unfavorable that the issue of medical education was essentially irrelevant:[4]

The subject of medical education is at all times a source of great interest and of infinite importance to the welfare of the profession, to the success of science, and to the protection of the highest objects of humanity. But still there are circumstances in which the discussion of the question becomes of subordinate importance, and by such circumstances we believe the subject is at present surrounded in this State.

We have no schools in which medical science is being taught, nor are there any immediate indications of the practicability of the founding or sustaining of such institutions.

When our county hospitals are elevated into institutions worthy of the name of public charities, when the munificent hand of support is so opened to them as to endow them with the means of establishing clinical schools for students and practitioners, then it would be consistent and natural to have an elaborate report upon the subject which you have referred to our consideration. Such, however, is not the condition of our hospitals, and we confess that in our opinion there is little more than a microscopic probability of their becoming so. . . (Therefore, until California provides adequate support for its public hospitals), it will be a useless thing to attempt the establishment of clinical schools of medicine. . . Hence the reason your Committee deemed it unnecessary to trouble you with a very lengthy report.

Although we have no record of Cooper's reaction to the above report, his future course showed that he ignored it. Perhaps he even welcomed the Medical Education Committee's firm stand against a medical school in California as a deterrent to some rash entrepreneur other than himself attempting to found one.

Administrative decisions by the Second Session which proved to be of significance during the Third Session of the Society in 1858 were the appointment of Dr. Cooper as a member of the Committee on Surgery and of Dr. Beverly Cole as chairman of the Committee on Obstetrics. Also of importance was the decision to hold the Third Session of the Society in San Francisco.

Surgeon General Cole's Report to the Society

When the Society convened in 1857 for its Second Session, only six months had passed since disbandment of the Vigilance Committee of 1856. The medical aspects of the Committee's operations were still a matter of lively debate among the physicians of the State. Anticipating their interest in the subject Dr. Cole, Surgeon General of the Vigilance Committee and delegate to the Second Session from the San Francisco County Medico-Chirurgical Association, read a paper entitled "Successful Ligation of the Common Carotid" in which he described the formidable procedure on Sterling Hopkins to which we have already referred.[5]

Eager for more details on related issues, the members of the Society, by unanimous vote on the final day of the meeting, requested that Cole report "all the facts and points within his knowledge" pertaining to the case of James King of William. The Minutes of the Society contain no mention of this request to Cole and no record of his response to it. This is not surprising for it was not unusual for medical society minutes to omit controversial material, which the remarks of Dr. Cole certainly were. Therefore, we must depend on reports published in the Sacramento and San Francisco press, as reviewed in the excellent articles by Gardner[6] and Lyman[7], for the following account of Cole's unsparing criticism of King's treatment as delivered extemporaneously before the Society.

Cole told members of the Session how he was among the first to attend to King. He described the injured man as having received a flesh wound that with ordinary care and judgement would not have been life-threatening. Cole further stated that leaving the sponge in the wound for six days was contributory to King's death and he did not hesitate to pronounce it a case of gross malpractice. Dr. William Hammond, King's chief physician, was present at the Session as a delegate from the San Francisco Pathological Society. Also present was one of the consultant's on the King case, Dr. H. M. Gray, who was serving as chairman of the Society's Committee on Surgery.

It is hardly surprising that Cole's charges against King's doctors created an uproar among the medical men present at the Session as well as clamor in the press. On 14 February 1857, the Sacramento State Journal appeared with these glaring headlines: "James Casey innocent of murder. Death of James King caused by doctors." Another paper quoted Cole as saying that King's doctors were ignorant and unprofessional practitioners and that King would have recovered if they had exercised ordinary skill and prudence.

According to Alta California for 5 March 1857, Cole received the following letter immediately upon his return to San Francisco from the Society meeting in Sacramento:

San Francisco, California, 2 March 1857
To Dr. R. Beverly Cole, Sir:

We understand that you related a history of the injury and last illness of the late Jas. King of Wm. before the State Medical Convention of California, at its last session, together with comments upon the treatment instituted in his case. Will you be kind enough to inform us upon what data, and from whence derived, you founded your knowledge of the case?

Respectfully,
Dr. Hammond Dr. Toland Dr. Bertody Dr. Gray

Cole replied as follows, not directly but through the columns of Alta California:

San Francisco, California, 4 March 1857

Gentlemen,
Yours of yesterday was received, and in reply I have only to say, that the information upon which was based the history of Mr. King's case, as given by me, without comment, before the State Medical Society, at their last meeting, in Sacramento, was acquired through personal observation and reliable sources.

Respectfully,
Beverly Cole, M.D.

To this brief note, Drs. Hammond et al issued a rebuttal in the press claiming that Cole never had an opportunity to make personal observations and that he was never for a single moment in charge of the patient either as an attendant or consultant, nor was there any possibility that he would have been allowed to participate in King's care because of his previous professional misconduct (The nature of Cole's alleged misconduct was not specified and the gratuitous slur was simply a clumsy attempt to discredit him.)

Cole terminated this acrimonious correspondence with a brusque retort, likewise in the press. The Gentlemen were wrong, he wrote, to say that he was not present at any of the examinations of the wound. In fact, he had arrived at the office of the Pacific Express Company only seven minutes after the shot was fired. Dr. Nuttall was the only medical man who preceded him and they were considerably in advance of all other physicians. He and Dr. Nuttall had thoroughly examined the wound digitally and visually, and Nuttall had felt a clot formed in the wound. As to Cole's presence at any subsequent examinations of the wound, he declared: "I should regret to acknowledge any participation in them."

The Trial of Edward McGowan

We are now to see how this dispute between Cole and King's doctors figured in the last act of the James King tragedy when it was finally staged in a Napa courtroom. We earlier called attention to the report of witnesses who saw Edward (Ned) McGowan, a judge of the Police Court and intimate of James Casey, running from the vicinity of the shooting of James King on the afternoon of 14 May 1856. McGowan was an unsavory character who arrived in California in 1849 from Pennsylvania where his alleged involvement in political scandals and bank robbery prepared him well for successful maneuvering within the San Francisco judicial system. His proximity to the scene of the King shooting, and his unseemly haste to depart, led to the suspicion that he was guilty of conspiracy for inciting the inflammable Casey to assassinate King. To escape capture and trial by the Vigilantes, which may well have been a lethal experience for McGowan, he immediately vanished from the city and only ventured back to the area a year later when he turned himself in to the Sheriff at Napa, just north of the Bay. He petitioned the State Legislature to change the venue of his trial for "conspiracy as an accessory to the murder of James King" from San Francisco to Napa. The trial opened on 29 May 1857 in Napa Courthouse, Judge E. W. McKinstry on the bench.

By the time of the trial, Cole's widely publicized statement that King had not been killed by Casey's bullet, but by the gross malpractice of his doctors, had drastically changed the issues before the court. If Cole was right, Casey was not a murderer, McGowan was not an accomplice, and the conspiracy charge against him was moot. Medical testimony had therefore now become the keystone of the case. Hugh Toland was called by the prosecution and Beverly Cole by the defense.

When he took the stand, the austere and imposing Toland described King's wound and its treatment with cold self-assurance and disarming candor. He admitted that the sponge was left in the wound because of fear that the subclavian artery was injured and might bleed if the sponge were removed. He reported that the autopsy showed no disruption of either the subclavian artery or the vein, but pointed out that King's lungs contained tuberculous masses and that he was not in good health. It must be conceded on this account, he declared, that King was unable to survive a wound which might not have been mortal in a robust man. Cole's allegations of malpractice were never once mentioned by Toland who delivered his testimony with such consummate restraint and authority that the jurors possibly did not perceive that he essentially concurred in Cole's sternly negative assessment of King's treatment.

When the volatile and now impatient Cole was finally called to testify, he was asked about Toland's standing in the community. He ungenerously replied that Dr. Toland's reputation in the community was one thing, and his standing among the medical profession was another - the implication being that Toland was in some way unethical in his practice. When asked about Hammond, Bertody and Gray, he referred to them as "careful practitioners" - adding scornfully that "it often happens that fatal errors are made by careful men." The next question came from Counsel for Defense, Colonel E. D. Baker, the most eloquent of all California attorneys: "Do you think Mr. King died of his wound or from the treatment he received?" This was the moment of truth for the prideful Cole, still seething with resentment over his rude dismissal from the bedside of his friend James King: "In my opinion," he said, "the wound was not a mortal one. The treatment was of such character as to cause death!"

Determined to drive home his point with the jury, Cole concluded his testimony by wheeling into the courtroom a cart bearing the shrouded and indifferently-preserved body of a prisoner executed the year before. As the fetid aroma from the cadaver permeated the warm summer air, Cole launched into a detailed anatomical lecture, illustrating on the subject as he went, the course of the bullet, the position of the wound, the effect of the sponge and other pertinent facts. The exhibition was too much for the spectators who quietly slipped away. Only the helpless jury and legal staffs remained in the courtroom for Cole's concluding flourish.

Bewildered by the medical and anatomical technicalities of the doctors' testimony, and swept up in the spell-binding rhetoric of Colonel Baker, the jury retired at ten minutes to twelve. Ten minutes later they were back with their verdict: They voted for acquittal. Sponge or no sponge, James King of William had died as a result of a bullet wound inflicted by one James Casey. There was no conspiracy. Ned McGowan walked from Napa Courthouse a free man.

As for the malpractice charge, the sheer weight of Toland's dignified bearing and impassive objectivity evenly countered the fervent advocacy of the younger man. Although Cole lost his case at the bar, the merit of his argument was widely recognized among his peers, and his resolute challenge of "the medical establishment" elevated his professional stature in the community. On the other hand, his zealous approach to the issues hinted at an impetuosity that detracted from his emerging genius for leadership. As might be expected, the relations between Cole and Toland were decidedly strained after King's death. They remained so until fourteen years later in 1870 when the dour Toland swallowed his pride and invited the irrepressible Cole to become Professor of Obstetrics and Dean of his struggling medical school - about which we shall hear much more in due course.

Let us now return to a consideration of the affairs of Dr. Cooper and two difficult surgical cases operated on by him in 1857: (1) Removal of a Foreign Body from beneath the Heart and (2) a Cesarean Section. Although these were the two most remarkable surgical cases in early California history, and their outcomes successful from the surgical viewpoint, they were followed by unexpected consequences that threatened to extinguish Cooper's budding career.

Removal of a Foreign Body from beneath the Heart

Cooper described this case as follows:[8][9]

Mr. B. T. Beal, aged twenty-five, of Springfield, Tuolumne County, California, with some other young men, in a frolicksome mood, resolved to burst an old gun, and accordingly loaded it with about eighteen inches of powder, to which they connected a slow match and then endeavored to seek security by flight. Unfortunately a brisk wind blew up the powder with great rapidity and the gun exploded before they reached far. A slug of iron had been driven into the gun as a temporary breach pin, which bursting out in the explosion struck Mr. Beal in the left side below the armpit, fracturing the sixth rib, entering the chest and lodging, as was afterwards found, beneath the heart upon the vertebral column, just to the right of the descending aorta where it had evidently remained from the period of the injury on January 26th, 1857, until it was removed April 9th, seventy-four days after. In a state of extreme prostration he was brought to the city, having had frequent discharges of several ounces of purulent matter at a time from the chest through the original wound.. . .

He came to my Infirmary on Mission Street on the 8th of April, and during the night following had alarming symptoms of suffocation, so much so that I entertained most serious apprehensions that he would not live till morning. So urgent had his symptoms become that after his arrival he was constantly in absolute danger of dying from suffocation, so that no time was to be lost, even for him to obtain rest from the fatigues of his journey. Under the greatest disadvantages, therefore, the operation had to be performed; otherwise he must be abandoned to his fate, which a surgeon feels but little inclined to do in case of such a brave patient who is willing to endure any operation however painful or hazardous to save life.

It is appropriate here to point out that removal of an iron foreign body measuring an inch long and three-quarters of an inch thick, lodged in the deepest recess of the chest bounded by heart, spine, aorta and diaphragm, and associated with extensive pleural infection, was one of the most formidable procedures to be successfully undertaken anywhere up to that time. X-rays had not yet been discovered so that localization of the foreign body in the chest was impossible and, as mentioned previously when describing other operations, aseptic surgery was unknown.

The Operation, 9 April 1857

A few details will suffice to depict the setting. Cooper regarded every operation as an opportunity for teaching and customarily invited interested colleagues to attend his operating sessions. On this occasion seventeen observers were present including Beverly Cole, Isaac Rowell and representatives from the State Medical Society, San Francisco Medical Society and, of course, the San Francisco County Medico-Chirurgical Association. The patient understood the ordeal he faced, yet insisted on being given the chance for survival. His condition was so precarious that no anesthetic was administered until the last stages of the tedious search of the left chest cavity when some chloroform was used. In the course of the exploration it was necessary to remove portions of the fifth, sixth and seventh ribs and drain multiple pockets of infection. After the foreign body was eventually discovered by extensive probing with a metal sound, beating of the overlying heart prevented a secure grip upon the elusive object. Finally Cooper succeeded in grasping it with an unusual pair of forceps that some strange intuition had led him to put in his pocket before the case. This incident was later referred to as follows by Levi C. Lane in Cooper's obituary:[10]

Concerning the operation just mentioned, (Elias Cooper) has often spoken to me - he did this but a few days before his death. In speaking of it, he has frequently said, that, in the selection of his instruments, preparatory to his commencing, he had certain impulses which were most extraordinary, and which would seem supernatural. He said that, after he had selected all the instruments which appeared requisite in the case, another one kept constantly suggesting itself to his mind, which he could see no propriety of taking - still the impression was so strong that he finally slipped it into his pocket; this was a pair of very awkward and ungainly appearing forceps. When, during the operation, after the chest was opened, and after an excessively long and tedious exploration, the foreign body was found, beneath and behind the heart, failing with every other instrument that he had selected to grasp it, he withdrew from his pocket the pair of forceps mentioned, and on trying them, they were exactly suited for extracting the piece of metal.

The boldness of this operation, together with the success attending it, was the keystone to his reputation on this Coast. It placed his name, at once, among the first medical men of this country. The great majority of the cases requiring capital surgical procedure came to him, so that there was opened, at once, for him, a wide-spread field for the employment of that varied store of surgical knowledge which he had been laying up for so many years.

The operation lasted an hour and a half. After a hectic postoperative course, complicated by lingering pleural sepsis and a bronchopleural fistula, the infection subsided, the wound healed and the patient returned to a normal life.

17 July 1857

On this date, the Second Annual Meeting of the San Francisco County Medico-Chirurgical Association was convened, fourteen members being present. The Minutes included two significant items. First, officers for the ensuing year were chosen. Beverly Cole was elected president and Cooper was re-elected Corresponding Secretary.

Second, Cooper brought his recovered patient, B. T. Beal, to the meeting and introduced him to the members of the Association. Some of them had attended his operation and could now hardly recognize him, so improved was his appearance. Dr. Rowell unhesitatingly pronounced Beal's operation to be without parallel in the annals of Surgery and challenged anyone to produce the history of another like it. He said that had the patient died under the knife the attempt to relieve him would have been justifiable because the patient could not have lived many days without an operation, but now was alive and well. Rowell declared that he was proud to have vindicated the operation even when it was expected that death would result. After some further remarks along the same lines, he proposed that Dr. Cooper be requested to prepare a report of the case and present the same to the Medico-Chirurgical Association for publication. The resolution was promptly adopted.

31 July 1857

Buoyed up by the warm reception his account of the Beal case had received, Cooper "donated to the Association the sum of $300 to be offered to competitors throughout the State as a prize for the best Essay based upon statistics and surgical facts showing that the climate of California is favorable to longevity and probably the best in the world for the recovery of patients after receiving severe injuries or undergoing formidable surgical operations." In response to the generous "prize donation" the Association at once went about setting up the necessary committees to administer the fund, advertise the "Prize Essay" and select the winner of the competition.

14 August 1857

At the regular meeting of the Association on this date, ten members were present. Dr. David Wooster, who had arrived in San Francisco the previous year and whose biography has already been briefly sketched, was elected to membership in the Association. Cooper then presented a full report of the case of Mr. Beal suitable for publication as previously requested. Two weeks later, Cooper received the following formal request from the Association:[11]

San Francisco, Sept. 1st, 1857
E. S. Cooper, M.D.,

Dear Sir,
At a meeting of the San Francisco County Medico Chirurgical Association, held on Friday Evening , Aug 21st, 1857, the undersigned were appointed a Committee to publish the case of Mr. Beal, by authority of the Association. For this object we have the honor to request a copy of your Report of said case at your earliest convenience. The Committee undertake the discharge of their duty in the premises with pleasure, the more so, since the successful result of the extraordinary operation upon Mr. Beal must, when fully known, be alike honorable to Surgery, and consoling to Humanity.

Very Respectfully,

  • M. B. Angle, M.D.,
  • J. P. Macauley, M.D.,
  • P. J. Reilly, M. D.,
  • R. Beverly Cole, M.D.,
  • David Wooster, M.D.
  • Committee

(Report of an Operation for Removing a Foreign Body from beneath the Heart. See Cooper Pamphlets, Vol. 10)

On the same day that he received the above letter from the Publications Committee, Cooper delivered to it the completed manuscript of the Beal paper entitled: "Report of an operation for removing a foreign body from beneath the heart by E. S. Cooper, A. M., M. D." On 12 September 1857, the Publications Committee submitted the manuscript to Whitton, Towne & Co., a San Francisco Printer, with instructions that the title page should state "Published by the San Francisco County Medico Chirurgical Association as an additional paper to its Transactions for the year 1857." An order was placed with the Printer to print and bind 500 copies of the Report.[12]

However, when the Publications Committee received the bill from the Printer it contained two items:

  • Printing and Binding 500 copies of the Report $ 30.00
  • Printing 5500 unbound copies of the Report $ 160.00

The Committee quickly determined that Cooper had ordered and paid for an additional 5500 unbound copies of the Report which, nonetheless, continued to bear the inscription: "Published by the San Francisco County Medico Chirurgical Association, etc. " The obvious conclusion was that Cooper planned personally to distribute thousands of copies of the Report around the country. Whether he realized it or not, the fact that the Report was published by the Association led the Committee to believe that Cooper's plan had the appearance of involving the Association in puffery on a grand scale. Given the prevailing sentiment among the profession against self-advertising, a strong adverse reaction was to be expected. We have commented previously on Cooper's insensitivity on the issue of advertising. Although he had so far been fairly successful in fending off criticism for his practices in this regard, he was about to encounter a devastating backlash on several fronts.

We now enter a period during which the Minutes of the Medico-Chirurgical Association become decidedly irregular. After the meeting of 2 October 1857, which was uneventful, many sections of the Minutes have been "expunged" by drawing a line through the text with revised versions pasted over them, and two pages of Minutes have been eliminated entirely by cutting pages out of the Register. Therefore, the following account of the dispute between the Association and Cooper over his printing 5500 additional copies of the Beal Report is uncertain as to some of the details, but nevertheless generally reliable. [13]

The first move toward clearing up the misunderstanding was made by the Publications Committee. They wrote to Cooper requesting him to provide the Association with a written explanation of his reason for ordering 5500 extra copies of the Report. Unfortunately, no copy of the Committee's letter or of Cooper's response to it can be found.

9 October 1857

A regular meeting of the Association was held on this date. Dr. Cooper did not attend. Eight members were present but the new President of the Association, Beverly Cole, was unaccountably absent. Nor was Dr. Cole present during any of the succeeding meetings that dealt with the Beal Report. After a reading of the minutes and the transaction of some unimportant business, the members got down immediately to a review of the above-mentioned Publications Committee letter, and Cooper's response which they found entirely unsatisfactory. In fact, they considered Cooper's language to be insulting, which led the group to appoint a Special Committee of four members who were charged to write again to the recalcitrant Cooper. Accordingly, on the next day they dispatched the following letter:[14]

San Francisco, 10 October 1857
Dr. E. S. Cooper

Dear Sir,
At a meeting of the San Francisco County Medico Chirurgical Association held Friday evening October 9th, the undersigned were appointed a Committee to whom was referred your Communication without date, a copy of which is herewith enclosed.

The Committee are authorized by the Association to request from you an explanation whether or not you intended in that Communication to offer disrespect and insult to the Association as a body.

Also, whether or not you intended through the Association to offer insult to any member or members thereof, and if so to whom.

Also, whether or not you intended to withdraw the "Prize Donation" from the control of the Association by depositing the same in the Banking House of Davidson and Co. subject only to the order of a part of the Committee appointed by the Association.

The committee are unwilling to believe that any insult or even disrespect was intended to be offered in your Communication, either to the Association as a whole or to any of the officers or members thereof, and therefore hope that you will disclaim if no such construction was intended to be conveyed.

Please answer at your earliest convenience and oblige,
Yours, etc.,

  • Drs. J. M. Tewksbury
  • J. M. Sharkey
  • M. B. Angle
  • J. M. Williamson

16 October 1857

A regular meeting of the Association was convened Twelve members including Drs. Cooper and Wooster were present. Cooper explained his position on the ordering of extra copies of the Beal Report (details of his statement unknown). There followed a brisk discussion during which the opinion was expressed that his explanation was unacceptable, whereupon Cooper abruptly rose to leave and, on departing, told the assembled members: "You may go to Hell!"

Deeply offended by Cooper's shocking behavior, there was an immediate consensus that the Association's response should be prompt and severe. In rapid succession the following resolutions were adopted:

That Dr. Cooper be expelled from the Association on account of disrespectful, profane and insulting language used toward the Association; that henceforth he is no longer entitled to the rights and privileges of membership thereof; that the Secretary be instructed to inform Dr. E. S. Cooper of his expulsion from this Association

That all references to the $300 for a Prize Essay offered by Dr. Cooper to the Association be expunged from the records of the Association; and that the Secretary be requested to inform the Awarding Committee that the prize donation is withdrawn.

That the communication received from Dr. Cooper preferring charges against Drs. H. H. Toland and Dr. William Hewer (details unknown) be returned to Dr. Cooper by the Secretary.

The signature of Dr. Cooper on the official membership roster of the Association appended to the Constitution was conspicuously crossed out and followed by the word "Expelled."

Official membership roster Medico-Chirurgical Association

With the departure of Cooper, the spark went out of the Medico-Chirurgical Association. At the meeting of 23 October 1857 several of the members got into a pointless wrangle over the accuracy of the Minutes of the previous meeting. The Secretary disputed the assertions of a member who stormed out of the meeting in such a rage at being contradicted as to cause another member to wonder whether he had gone out to "procure his pistols." Members then began to leave one by one until there remained only Dr. Macauley who, in disgust, "dowsed the glim and seized the candles."

Subsequent meetings were also disorganized with various members serving in turn as temporary chairman because President Cole was still in absentia. Resignations were submitted by a few and others simply ceased to attend the meetings so that the average attendance at meetings in November was only four. Toward the end of November Cole returned to chair the meetings which showed flickering signs of life for a few weeks but the Minute Book shows no more entries after 15 January 1858. The Association then entered a phase of suspended animation, its bright flame extinguished by Cooper's callous disregard for the ethical concerns of the members who had no recourse but to expel him for his intemperate behavior.

Among Cooper's papers we find evidence in a set of Minutes dated 31 July 1858 that the Association was revived, probably by his own efforts. The Minutes were written by Beverly Cole and stated that Elias Cooper "was in the chair." We know that the Association continued to be active, sponsored chiefly by Cooper and his friends, for many years thereafter. We shall refer later to the auspices under which the Association resumed regular meetings.

It is difficult to account for Cooper's self-destructive performance with respect to ordering 5500 extra copies of the Beal Report. His quixotic confrontation with highly supportive colleagues and friends in the Medico-Chirurgical Association was so unnecessary and counterproductive that one is inclined to wonder whether his chronic and progressive neurologic disorder contributed at that time to transient emotional instability under stress. The instability thesis is somewhat borne out by the following letter, found in draft form among Cooper's papers and dated a year after the incident. It was presumably intended for the Association:[15]

San Francisco
Cal. 2 November 1858

Honorable Sirs,
I acknowledge the justice of your censure. If in future an opportunity should ever occur which enables me to secure forgetfulness of what occurred at a period of worse than insanity, in view of my own interest and the character of that noble profession I so much love and admire, that shall be accomplished.

Yours respectfully,
E. S. Cooper

Cesarean Section

In 1857 the operation of cesarean section (that is, delivery of a baby through an abdominal incision) was generally looked upon as a procedure of last resort to be undertaken rarely and only when other measures were inappropriate or had failed. Although many such operations were performed in the major European centers, especially Paris, the maternal and fetal death rates were extremely high. Most American doctors considered the cesarean to be unduly hazardous and seldom, if ever, justified. Thus there were few reports of maternal survival after cesarean section in the American literature, and no case had been reported from the Far West. However, Cooper let it be known in conversation with Dr. Wooster and others that while in practice in Peoria he had performed a cesarean with success to both mother and child. The mother was a German woman who was still living in Illinois.[16][17] He was soon to have occasion to perform the procedure again in what proved to be the first successful cesarean section on the Pacific Coast. The circumstances that led him to the fateful decision to operate were these.

Dr. Martha Thurston, graduate of the New England Female Medical College in Boston, and certainly one of the earliest women to practice in San Francisco, had frequently consulted Cooper in whom she had great confidence. In December 1856 she sought has advice about a particularly delicate problem. The patient was Mrs. Mary Hodges, a thirty-five year-old school teacher, whose recent marriage had not been consummated because her vaginal orifice was firmly occluded except for an opening "the size of a quill." With Dr. Thurston as his assistant, Cooper operated on Mrs. Hodges and relieved the obstruction by removing considerable tissue "of ligamentous hardness," which was followed by two weeks of packing for dilatation. Cooper warned Mrs. Hodges that she would be uncomfortable after the operation. Nevertheless, during the early postoperative period a friend invited her and her husband to a party. which the poor woman attended and, so that no one would know or suspect that she had had an operation, danced the whole night until she fainted away in the arms of her husband. In his notes Cooper describes the operative findings and procedure in such a manner as to indicate that residual thickening or fibrosis in Mrs. Hodges' vaginal wall might later cause obstruction to normal obstetrical delivery.[18]

In view of the possibility of persistent narrowing of the vaginal canal, Dr. Thurston advised Mrs. Hodges against having children. It was therefore with some apprehension that Drs. Thurston and Cooper learned a few months after the operation that Mrs. Hodges was pregnant. Following a period of despondency and desire to have an abortion, Mrs. Hodges was reconciled to having a baby and returned to see Dr. Cooper who advised that she might have difficulty delivering a full-term infant and should have her delivery at seven months when the baby was small. After discussing the matter with her husband, who was fearful that early delivery might harm the baby, Mrs. Hodges returned to say that she was determined that the pregnancy should go to full term, and that Dr. Cooper should attend her at her confinement - there being no one else whom she could trust.

Mrs. Catherine Roper, Matron at Dr. Cooper's Pacific Clinical Infirmary, recalled the following exchanges which then took place between the Doctor and Mrs. Hodges:[19]

[Mrs. Hodges] was but just well from the first operation[for vaginal occlusion], when she came[to Dr. Cooper] and said that she was pregnant. She said she knew she could not be delivered without an important operation. She asked the Doctor if he would attend her at her confinement. The Doctor told her that that was impossible. He said: "Mrs. Hodges, the condition of my health is such - I have a paralysis in my head and face - and if I lose a night's rest, I have to keep my bed for some time, and cannot attend to my patients in the institution." He said: "I would not be justified in taking that kind of practice." She appeared to be even much distressed when the Doctor told her this. She said she had so much confidence in the Doctor's skill that she did not know what she would do if he did not take her. She said that there was not a man on this coast that she had the confidence, as a medical man and a surgeon, that she had in him. The Doctor said: "There are many skillful accoucheurs in this city," and the Doctor mentioned the names of many persons - half a dozen or more - whom he could and would recommend. She did not say whether she would take one of them or not. She seemed to be very much discouraged. She said she would tell her husband what the Doctor had said. The Doctor told her again that he could not possibly attend her. He said that if he lost a night's rest there was a spasm came over him. He said that he was afraid of the effects of his disease, if he did not take care of himself. She then said: "Certainly, I would not desire you under such circumstances." She said: "I will tell my husband what you have said, Dr." The next time I saw her, she said that her husband was very much disappointed... She said that she had told her husband, and that he was very much disappointed, and she said she wanted to know if the Doctor would promise not to leave the city, if she would let him know when she was taken with labor. The Doctor promised her that he would[not leave]. "Let me understand you rightly," she said - I give you her exact language now - "Let me understand you rightly; if it is necessary that an operation should be performed, you will come and perform it?" "I will," he says....

She said - and I give you her language - "I am as confident that there will have to be an operation performed, before I am delivered, as I am that I have got to die before I go to heaven" - that's exactly what she said....

She came again[to the Infirmary], and I had an interview with the Doctor, and he told her that he would advise her to have her labor brought on in seven months. He thought that a small child could be born alive, but that a large child could not. I told her she had better take the Doctor's advice, and have labor in seven months. She said that her husband was so anxious for the child that she did not know what to do - she would consult him. She came back again and said that her husband was anxious for her to go the full time[full term] and have the child. She said she was afraid, but she said that she felt that she was almost willing to be sacrificed if the child could be born alive....

[She came again] . . . about a week before the day on which I heard that she was[in labor] . . . "Well," she said, "if I could only have had you Dr. Cooper, I do believe I should be reconciled - I think I dream of it. It appears to me now, that if you would only say that you would come to me when I am taken in labor I would be reconciled and delivered." The Doctor told her that it was impossible for him to lose a night's rest. She said: "I know my age is against me, and that I must expect considerable suffering." She said, too: "Maybe you would not lose a night's rest." The Doctor said: "Mrs. Hodges, I cannot take your case. I have constantly to send such cases as yours to others." She seemed to me as though determined to make the Doctor take the case. The Doctor repeatedly told her that there were plenty of very skillful medical men, who would come and do as well for her, as an accoucheur, as he would....

When the Doctor said that, she said: "I doubt it." Finally she said: "Well, then, Doctor, this is the last time I expect to see you before[I go into labor]. Now, you promise me here, before Mrs. Roper, that you will not leave town, till you hear from me." Then she turned to me and said: "You will keep reminding the Doctor of his promise to me, not to leave the city, wont you, Mrs. Roper?" I said: "Don't be alarmed, Mrs. Hodges; I will remind the Doctor every morning." I knew that as he had so many patients and so much on his mind, the promise might slip, if it was not recalled. She said that she would depend upon me to keep fresh the Doctor's memory. The Doctor recommended a number of physicians - Dr. Rowell, Dr. Williamson, Dr. Sheldon and some others, whose names I do not now recollect.

Dr. Cooper next heard from Mrs. Hodges early on the morning of 8 November 1857. Now at full term, she informed him by messenger that she was in labor and wished to see him. When he arrived he found that she had not engaged an accoucheur as he had advised and that she wished him to take the responsibility for her delivery. Whatever Cooper's thoughts might have been at this turn of events, he agreed to be of assistance. As he had previously made clear, he would not manage her labor. Nevertheless, he set out to find someone who would attend upon her. According to his notes, he made the following arrangement:[20]

I then called upon Dr. Wooster, a medical man of more than ordinary medical reading, but a comparative stranger with a family and whom I was endeavoring to introduce into family practice. I requested him to take charge of the case at the same time giving him a history of the lady's pelvic examination and previous operation and expressed my apprehensions in regard to the possibility of delivery in the natural way. . . I advised him to wait patiently and let nature do her best seeing that the obstruction in the soft parts might yield to long continued pressure but at the same time stated by way of encouragement to him, as he appeared to falter slightly in view of the impending difficulties, that if it came to extreme measures not to fear the responsibility as I should be unwilling to place it upon him in that case and to send for me at any time when he gave up all hope of a natural delivery. I promised to call occasionally in the meantime which I did.

On the evening of November the 10th at 7, while Dr Cooper was having supper in the dining room at the Pacific Clinical Infirmary, Mr. Hodges came with a note from Dr. Wooster desiring Dr. Cooper to come in great haste, and requesting him to bring instruments as Mrs. Hodges was rapidly sinking. The Doctor left immediately with Mr. Hodges without finishing his meal.

On arrival at the Hodges' residence Cooper went at once to the small upstairs bedroom and examined the patient. She had then been in labor for sixty hours and now lay moaning, and semiconscious from intermittent inhalation of chloroform. Dr. Wooster reported that he had given her the maximum amount of ergot to stimulate uterine contractions. In spite of the ergot and prolonged labor, the head was tightly lodged at the vaginal level (in a rare occipito-posterior position), the baby was dead and the patient was exhausted. In this situation, the strongly-favored obstetrical approach would be to deliver the baby per vaginam by forceps. It might be necessary also to reduce the size of the head by opening the cranium with a hook-like instrument known as a "crotchet" and removing the cranial contents. Another possible option was to dismember the infant. When Cooper decided not to use these conventional measures but to resort to the drastic cesarean section instead, his judgement and motives were questioned and he was sued for malpractice by Mr. and Mrs. Hodges. In his personal notes on the case, he cited the following exceptional circumstances as justification for his decision to perform the controversial operation:[21]

Owing to the almost unparalleled rigidity of the vagina, I entertained most serious apprehensions that neither the forceps nor the crotchet could be used and was confirmed in that opinion on my arrival.

A portion of the scalp the diameter of nearly a dollar could be distinctly felt but it was utterly impossible to introduce the end of the finger between it and the walls of the vagina and no one could possibly form any opinion of the presentation. All parts of the vagina were equally unyielding so that it was plain to perceive that neither the forceps nor the crotchet could be used without first cutting through the walls of the vagina both posteriorly and anteriorly for the space of from one and a half to three inches and with very uncertain prospect of success (but with very real prospect of serious consequences such as producing a fistula between bladder or rectum and the vagina). To this I preferred the caesarean section and this operation appeared to become the more imperatively demanded since we had diagnosticated twins and Dr. Wooster assured me that a few minutes previously to my arrival he had distinctly heard the pulsation of the fetal heart.

I was (also) led to mistake the case for one of twins in consequence of Dr. Wooster permitting the urine to accumulate to the amount of more than a gallon while he assured me that it had been drawn a few moments prior to my arrival. The bladder had attained almost the hardness of a child and the major portion of the child being high up in the abdomen a deep depression was formed between the prominence formed by the bladder below and the child above.

I think we might possibly have tried the crotchet but for this mistake. We might have done so to have said that we tried the crotchet first as a matter of self protection against the accusations of a combination of medical men in this city who with a zeal and industry worthy of better causes had pursued and thrown obstacles in my professional path ever since my arrival in this city.

But under the impression that there were twins and one of these alive a moment before and possibly then in a state of suspended animation, I forget to think of the means of protecting my own reputation in view of my duty to the patient.

I considered it utterly impossible to dissect one child and bring it away without cutting or lacerating the woman and of course a second (child) would be (injured) much worse.

Dr. Wooster opposed the caesarian section at first while he admitted the impossibility of extracting two children through that passage and have the patient survive and said in the most emphatic manner that it would be better to let the woman die than for us to perform the caesarian section with the (small) chance of recovery and run the risks of censure should she die, referring at the same time to the combination of malignant medical men who he said "are always like a pack of bloodhounds on your track," or words to that effect.

He appeared alarmed beyond anything I had met with in view of the immense responsibility I had been the unintentional means of throwing upon him and from that moment I conceived a feeling of contempt for him which never could have been removed even had he remained my friend and an honorable man as I supposed him then to be.

Our consultation was hastily dissolved when I assured him that if that was the only reason why we should not operate I was going to proceed at once and thereby give this woman what I considered the only remaining chance of recovery and take all responsibility let the case result as it may.

Whereupon he agreed to the operation then and said, "I will defend it from the obloquy of the curious and the reprobation of the ignorant to the best of my poor ability."

The Operation, 10 November 1857

Cooper's decision to operate without delay was ultimately based on the diagnosis of twins which in turn rested on two critical observations. Although he and Wooster agreed that the baby in the birth canal was dead, Wooster was sure that he had heard the beating of a second fetal heart only moment's before Cooper's arrival. Furthermore, the patient's abdomen was markedly distended, far beyond that consistent with a single pregnancy, and Wooster assured him that he had emptied the bladder with a catheter only shortly before. At the time Cooper said, "If there are not twins, I don't know how to account for the shape of the abdomen." If twins were indeed present, the life of the second one could only be saved by prompt action such as an experienced and confident surgeon could take.[22][23][24][25]

The setting for the operation was stark. It was 10 P.M. and several candles shed an uncertain light on the bed where lay the restless and semi-stuperous patient. Preparation by Cooper and Wooster consisted of taking off their coats, rolling up their sleeves and laying out a few instruments from the small case Cooper always carried with him. The only other person present was Mrs. Kriemer, the grocer's wife who had ministered to Mrs. Hodges since her labor began. She was so aghast at the thought of an operation that she agreed to stay only if she might sit in a corner of the room and shut her eyes.

The surgeons faced each other across the bed for a few tense moments awaiting the deep narcosis of chloroform and then, said Wooster, "We operated, he using the knife." At the first stroke of the blade in making the incision a stream of fluid under pressure shot out eight or ten feet across the room striking Cooper in the face, blinding him, and forcing him to lay down the knife to wipe his eyes. Said he:

A considerable amount of fluid spouted out striking me about the mouth and nostrils imparting at once the taste and smell of urine. This surprised me very much and I hastened to finish the incision through the abdominal wall which being done, the bladder was exposed to view distended to its utmost capacity. Dr. Wooster now confessed having deceived me in regard to the condition of the bladder, said he had twice tried to introduce the catheter but could not and was ashamed to acknowledge to me that he failed in so simple an operation. I therefore concluded there must be some slight rent at that point in the bladder through which urine that I tasted had passed and might still escape slowly into the abdominal cavity so without losing any time I punctured the bladder at the usual point above the pubis and discharged the major portion of its contents by inclining its fundus forward over the loins after which the uterus was incised and the child extracted.

There was only one baby, weighing a hefty eleven and a half pounds, its head and face badly misshapen from being tightly impacted in the lower strait. The patient's unduly enlarged abdomen was caused by a bladder distended with several quarts of urine. So much for the diagnosis of twins. During the operation hemorrhage was profuse and the patient stopped breathing repeatedly, requiring heroic feats of hemostasis and resuscitation, problems Cooper managed with cool efficiency - and also requiring better light provided by the horrified Mrs. Kriemer who was routed from her corner to hold a candle over the bloody field. Innovative as always, Cooper defied contemporary obstetrical authorities by closing the uterus with sutures to control bleeding, citing as his reason the high incidence of post-cesarean death from hemorrhage following non-suture of the uterus.

Postoperative Recovery

Cooper summarized the postoperative course in a few words:

The patient remained feeble for many days but finally recovered rapidly and in three months was able to walk with ease from her residence north of Greenwich to Pacific Clinical Infirmary on Mission near 3rd, a distance of near two miles which she did of mornings occasionally before nine o'clock when she was engaged in teaching school. The puncture in the bladder as might be expected healed at once and gave not the least inconvenience.

During the postoperative period, Wooster and Cooper followed Mrs. Hodges together. Wooster was particularly attentive, taking great pride in her progress. Never once did Cooper bring up with him the subject of the misdiagnosis of twins and the reasons for it. On the contrary, he encouraged the continuance of the cordial relations they had enjoyed prior to the operation. During the several months of their joint attendance on the convalescing Mrs. Hodges they were on the best of terms. It was Wooster's ambition to found a medical journal and Cooper agreed to finance the venture.

The cesarean operation, being the first successful procedure of its kind in the city, was much discussed among the local profession. Although some were critical, the early reaction seemed generally favorable. Wooster relished having participated in the case and during the months of November and December 1857 stated frequently to physicians that "I and Dr. Cooper performed the operation;" that "it was advisable and necessary to perform it and that it was successful and a great triumph of surgery," or words to that effect.

Overview

Cooper could look back on the events of 1857 with mixed emotions. The State Medical Society had weathered its Second Annual Session and appeared to be gaining in acceptance, but Beverly Cole's outright denunciation of the surgical management of James King of William created the first open rift in the membership and thereafter the Society became increasingly an arena for factional conflict.

Cooper's behavior in the dispute with the Medico-Chirurgical Association over publication of his case report on removal of a foreign body from beneath the heart was so arrogant and out of character as to raise the question of his being emotionally disturbed at the time. His summary expulsion from the Association was a staggering blow to his prestige and to the collegial spirit he sought to promote. He appears, however, to have realized his error and taken prompt steps toward reconciliation.

With respect to the cesarean section, we shall soon learn how Cooper's failure to report fully on the circumstances leading to performance of the procedure enabled "a medical Judas and a conspiratorial clique" to put his motives and veracity on trial before the State Medical Society in February 1858, and in a court of law later that year.

With regard to the question of a "conspiratorial clique," Cooper was convinced that such a group existed and was plotting his downfall. The following are excerpts from a rambling, belligerent Circular on this subject which he probably composed in late 1857 but, as far as we know, never published. By reproducing portions of the Circular here, we can let Cooper identify some of his adversaries and convey his low opinion of them in his own words.

To the Medical Profession of California

It has doubtless been noticed by many members of the profession of the State that I (previously) commenced an exposition of the ignorance, perfidiousness and villainy of some of the medical men of San Francisco. This step may by those not knowing the circumstances be condemned as a suicidal act seeing that whatever detracts from the interests of the medical profession injures more or less every member of the same. This I know but, while I am in professional honor bound to respect and treat respectfully all worthy medical men, I am not compelled by any professional obligations to keep quiet while a set of medico-political wire pullers attempt to trample under foot all my rights as a medical man - rights which I will stand upon and defend regardless of the smiles or frowns of any person or combination of persons (and) without reference to the position or influence which an early residence here and a keen extra professional tact associated with an uncommonly fine personal address may have given them.

I state without fear of successful contradiction that, while there are some most worthy exceptions, for the most part the older medical men of San Francisco are unexampled as prominent medical men in a city of this size for their want of skill in practice, want of industry in the cultivation of medicine, want of moral principles and want of harmony among each other, and I wish to avow at once and forever my disapprobation of the course and example of these men. It is they who have succored quacks on the Pacific Coast by the discredit into which they have sunk the regular profession by their unskillful practice. I defy the world to produce more frightful examples of want of skill than has been displayed among regular practitioners and the would-be leaders of the regular profession of San Francisco both in our public hospitals and in private practice. . . .

Further, these men derogate from the good name of the regular profession of San Francisco by keeping up constant broils among the members and, as it has been one of the chief pleasures of my professional life to make every effort in my power to promote unanimity of feeling and concurrence of action among medical men, so I consider it a duty to expose those who delight in and do all in their power to sustain discord and strife among the same.

Again, such is the ingenuity and audacity with which some of these men have asserted positive falsehoods to calumniate my professional character that I consider it absolutely a duty to myself to use all proper efforts to disarm them of their weapons by which they could injure me. Because it mattered not to what extent my reputation had suffered by their statements or however false they were, all my kindliest efforts to obtain explanations only met with the rebuke of additional insult or silent contempt. I have therefore no apology to make to the profession of the state for the step taken, however extraordinary it may appear, because I honestly believe that nothing more has been done than making a justifiable effort to defend myself against one of the most villainous assaults upon professional character ever attempted to be perpetrated by any combination of medical men, and this combination is known as the "Pathological Clique."

Oh surgery, what cruel but fatal destiny of which the world knows little is wrapped in thy magic power! Oh fatal science, how many murders are committed in thy name! Oh shade of Hippocrates, what ignorance curses thy noble art and thy noble science in the middle of the 19th century! Look at this lengthened picture, you drunken libertines who lead the Pathological Clique!

Now it may be thought that these allusions which cannot be mistaken in their application are rather harsh. Possibly that may be the case but only think of the contemptible course of the individual (Dr. H. M. Gray) who complelled me to institute (my own self-defence) by his gaining access to a surgical operation through the means of bland smiles and assumptions of friendship and who afterwards under a pompous affectation of superiority would try to hold himself above an explanation, however false his statements in regard to the matter. For many months as is well known I heard his abuse without an unfriendly reply but when circumstances compel me I will speak out regardless of consequences. . .

You are the men who abused my friends and myself beyond measure for (our action in) originating and carrying through the call for a convention to organize a State Medical Society. You are the men who cannot comprehend a higher aim in associations of medical men than that of gaining strength to discuss more forcibly large measures of brandy and water. You are the men who treated with contempt the gentlemanly members of the Sacramento Medical Society because, for sooth, they did not ask you if they might concur in calling a convention of medical men to meet at that place. You are the men whose unblushing impudence made you declare but too publicly for your own good that you would control that convention or break it up. . . .

(Who are members of this Pathological Clique? They are Drs. Gray, Stout and Hammond.) What great injury have I done Dr. Gray that justified him in calling me a d-d son of a b- because I wrote him a friendly note demanding explanation in regard to the most false and malicious statements made by him touching on my professional character? I would ask what gives Dr. Stout the privilege of stating almost in so many words that I was unfit for an inferior office in the State Medical Society? (Why did that surgical imbecile, Dr. Hammond, deny me the right to examine James King?). . . .

The Reason. We have at last ascertained the reason why the Pathological Clique of medical men are making such herculean efforts to put Dr. Cooper down. (Whereas) these men spend all their leisure time in drunkeness and vice, Dr. Cooper is a normal man and a most devoted student. He had not been in San Francisco two weeks before commencing to lecture on Anatomy and Surgery and has from the periodof his arrival exerted his utmost energies to improve and elevate the medical profession and, in spite of the efforts of the Clique, ranks among his medical friends as all the more moral, studious and learned.

We would advise all medical men of this coast to call at their convenience at Doctor Cooper's Eye Infirmary. They will find his Institution between 2nd and 3rd on Mission Street (in San Francisco) and on visiting it they can judge for themselves whether he is not perfectly posted in Medicine and Surgery.

During the previous three years the uncompromising and nettlesome Cooper had vilified and by his aggressive tactics offended, some of the most influential members of the self-ordained elite of the San Francisco medical profession whom he denounced as, with intentional double entendre, the "Pathological Clique." Cooper scornfully challenged their principles and their competence. Hence they considered it their duty to bring him to book, which they now undertook in various devious ways to do.

Endnotes

  1. Elias S. Cooper , "Walking rendered the primary element in the cure of deformities of the lower extremities; its early adaptation to white swelling and coxalgia, with apparatus for carrying out the designs of the same," Transactions of the Illinois State Medical Society (June 6-7, 1854), pp. 39-54
  2. Elias S. Cooper , "Deformities of the locomotive apparatus. Annual Address of the President of the California State Medical Society delivered February 12th, 1857, by First Vice President E. S. Cooper, A.M. , M.D., of San Francisco," Transactions of the Second Session of the Medical Society of the State of California (February 11-13, 1857): pp. 17-22 Lane Library catalog record
  3. Elias S. Cooper , "On ligating the satellite veins in connexion with the arteries which they accompany: Operation of ligating the external iliac artery and vein: Rapid recovery of the patient," Transactions of the Second Session of the Medical Society of the State of California (February 11-13, 1857): pp. 29-33 Lane Library catalog record
  4. John F. Morse et al., "Report of Committee on Medical Education," Transactions of the Second Session of the Medical Society of the State of California (February 11-13, 1857): pp. 27-28 Lane Library catalog record
  5. R. Beverly Cole , "Successful ligation of the common carotid," Transactions of the Second Session of the Medical Society of the State of California (February 11-13, 1857): pp. 38-41 Lane Library catalog record
  6. Frances T. Gardner , "King Cole of California," Part 2, Annals of Medical History Third Series 2, no. 4 (Jul 1940): 330-334 Lane Library catalog record
  7. George D. Lyman , "The Sponge: Its effect on the martyrdom of James King of William, the formation of the San Francisco Vigilance Committee of 1856, the execution of Casey and Cora for murder and the trial of Edward McGowan for complicity," Annals of Medical History 10, no. 4 (Dec 1928): 474-479 Lane Library catalog record
  8. E.S. Cooper , "Report of an operation for removing a foreign body from beneath the heart," Transactions, San Francisco County Medico-Chirurgical Association, 1857 Published by the San Francisco County Medico-Chirurgical Association as an additional paper to its Transactions for the year 1857. (San Francisco: Whitton, Towne & Co., Printers and Publishers, 1857), 9 pp Lane Library catalog record
  9. E.S. Cooper , "Results of surgical operations in California: Injuries and operations on the chest," Transactions of the Third Session of the Medical Society of the State of California (February 10-12, 1858), pp. 120-125
  10. Levi C. Lane , "Editor's Table: Notice of the death of Dr. E. S. Cooper with a biographical sketch," San Francisco Medical Press 3, no. 3 (Oct 1862): 236-237 Lane Library catalog record
  11. E.S. Cooper , "Report of an operation for removing a foreign body from beneath the heart," Transactions, San Francisco County Medico-Chirurgical Association, 1857 Published by the San Francisco County Medico-Chirurgical Association as an additional paper to its Transactions for the year 1857. (San Francisco: Whitton, Towne & Co., Printers and Publishers, 1857), p.2. (Lane Medical Library H172.5H C77 1857; also Cooper Pamphlets Vol. 10 in LML) Lane Library catalog record
  12. Correspondence 1857-1862 - Box 1, Folder 4, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  13. Minutes and Early Meetings (1 Volume), San Francisco County Medico-Chirurgical Association - CHSL MS 3119, California Historical Society
  14. Holograph Letters, Elias Samuel Cooper Papers - MSS 10, Lane Medical Archives
  15. Correspondence 1957-1862 - Box 1, Folder 4, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  16. Levi C. Lane , "Editor's Table: Notice of the death of Dr. E. S. Cooper with a biographical sketch," San Francisco Medical Press 3, no. 3 (Oct 1862): 234 Lane Library catalog record
  17. Proceedings in the Case for Damages for Alleged Mal-Practice in the Performance of the Caesarian Operation: Elkanah H. Hodges and Mary E.P. Hodges, plffs., vs. E.S. Cooper, defendant, tried in the Fourth District Court, San Francisco, John S. Hager, judge, November, 1858, (San Francisco, 1859), p. 32
  18. Cooper-Hoges Malpractice Suit, Cooper's notes - Box 2, Folder 13, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  19. Proceedings in the Case for Damages for Alleged Mal-Practice in the Performance of the Caesarian Operation: Elkanah H. Hodges and Mary E.P. Hodges, plffs., vs. E.S. Cooper, defendant, tried in the Fourth District Court, San Francisco, John S. Hager, judge, November, 1858, (San Francisco, 1859), pp. 147-148
  20. Cooper-Hoges Malpractice Suit, Cooper's notes - Box 2, Folder 13, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  21. Cooper-Hoges Malpractice Suit, Cooper's notes - Box 2, Folder 13, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  22. Cooper-Hoges Malpractice Suit, Cooper's notes - Box 2, Folder 13, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  23. Proceedings in the Case for Damages for Alleged Mal-Practice in the Performance of the Caesarian Operation: Elkanah H. Hodges and Mary E.P. Hodges, plffs., vs. E.S. Cooper, defendant, tried in the Fourth District Court, San Francisco, John S. Hager, judge, November, 1858, (San Francisco, 1859), pp. 32-33
  24. David Wooster , "Cesarean operation - false diagnosis - recovery of woman," Pacific Medical and Surgical Journal 1, no. 3 (Mar 1858): 89-96 Lane Library catalog record
  25. Ludwig A. Emge , "San Francisco's first cesarean section. Division 1," Western Journal of Surgery, Obstetrics and Gynecology 46 no. 2 (Feb 1938): 106-108 Lane Library catalog record
  26. Folder: Correspondence, No Date - Box 1, Folders 5 and 6, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
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