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

Chapter 13. Conspiracy and Betrayal

A New Medical Journal

With respect to medical literature, the most significant event in California at the beginning of 1858 was the publication of Vol. 1, No. 1 of the monthly Pacific Medical and Surgical Journal edited by Drs. John Trask and David Wooster. At the time of its publication the Journal was the only medical periodical in California. Before this, only two other medical journals had been published in the State and both were short-lived. The first of these was the San Francisco Medical Journal of which only one issue (Vol. 1, No. 1 for January 1856) was published. We previously noted that the Proceedings of the San Francisco County Medico-Chirurgical Association for October and November 1855 were included in that issue. The second journal to be published in the state was the quarterly California State Journal of Medicine, born during the Convention of the State Medical Society and designated the official organ of the Society with Dr. John F. Morse as the editor. This excellent journal lasted just ten months. With publication in April 1857 of its fourth and last number, it expired for lack of sufficient paid subscriptions.[1][2][3]

From 1858 to 1860, except for the sporadic publication of the provincial Marysville Medical and Surgical Reporter, the Pacific Medical and Surgical Journal was the sole local medium for the publishing of scientific papers and editorial commentary on medical affairs. This virtual monopoly on medical communications by the PMSJ could, in partisan hands, be used with devastating effect. However, such thoughts never occurred to Cooper when the first issue of the journal appeared in January 1858.

As already mentioned, while attending to Mrs. Hodges during the final months of 1857 Cooper discussed the founding of a medical journal with Wooster and agreed to provide start-up funds, which presumably he did. Thus It was late in 1857 that arrangements for publishing the Journal were completed and the make-up of the January issue was decided. The January number included an article by Toland "On the reproduction of bones" and an article on a similar subject by Cooper entitled: "On exsection of bones - Reproduction of parts, etc."[4][5]

The January issue also included, in the section devoted to editorial comment and referred to as "Editors' Table," the following item:[6]

Surgery in San Francisco. Dr. E. S. Cooper, of this city has recently ligated the primitive carotid artery in two cases, the external iliac in one, the axillary in one, removed a large fibro-cartilaginous tumour from the uterus; made the Caesarean section in one; exsected parts of three ribs and removed a foreign body from beneath the heart; exsected the sternal extremity of the clavicle and a portion of the summit of the sternum; together with the exsection of nearly all the joints, in different cases, all successfully.

This embraces a list of formidable operations, which, being attended with favorable results, are worthy of note. The uniform success in operation of such magnitude, must, in part, be attributed to the effects of our climate, which, for the recovery of patients after receiving serious injuries, is, at least, unsurpassed in any part of the world. . . .

Singling out Cooper, in the first issue of the Journal, for a laudatory editorial that listed his operations and characterized them as "formidable" and "worthy of note" was bound to strike the uncharitable reader as bordering on puffery. It might even raise the suspicion of collusion between the editor and Cooper, which indeed there was, if we are to believe the later claim of Wooster that, except for the last sentence, Cooper himself wrote the above two paragraphs and submitted them to Wooster for publication.[7]

The purpose of citing the above editorial is to show: first, that during the preparation of the first issue of the Pacific Medical and Surgical Journal in December 1857, Cooper was on good terms with Wooster who was presumably obligated to him at the time for providing financial backing for the Journal; and, second, that Cooper continued to be insatiable in his desire to publicize his practice.

Betrayal by Wooster

In view of his good relations with Wooster during the recovery of Mrs. Hodges and Dr. Wooster's friendly attitude as shown by his publication of the above editorial, Cooper was shocked to receive the following letter dated 23 January 1858 from the editors of the Journal:[8]

San Francisco
January 23, 1858
Dr. E. S. Cooper

Dear Sir,
We would respectfully invite your attention to an article which appeared in the San Francisco Daily Times, of the 22nd of January. If you wish to avail yourself of the pages of the Pacific Medical and Surgical Journal for the publication of your cases, we shall require you to free yourself of complicity in that species of Quackery. We shall await your answer till Monday the 25th of January, 8 o'clock, P. M.

Very respectfully, etc.,
John B. Trask and David Wooster,
Editors

The pompous editors gave Cooper just two days to respond to their ultimatum. He immediately denied all responsibility for publication of the article in the Daily Times and, on the following day (24 January), submitted the issue for adjudication to the recently organized Pacific Medical and Surgical Association of which both he and Wooster were members. Cooper was promptly acquitted of "complicity in quackery" by a unanimous vote of the Association.[9]

Furthermore, on the 28th of January Cooper obtained the following affidavit from H. DeGroot, Editor of the San Francisco Daily Times, and submitted it to Trask and Wooster:[10]

I am Editor of the "San Francisco Times," and wrote the article in regard to Dr. Cooper's operations on the ankle joint, which appeared in that paper on the 22d of January, unsolicited by the Doctor or anyone else. l had frequently seen the patient previously, and being convinced that the case was a great triumph in surgery, voluntarily recorded it as such. Dr. Cooper requested me, a few days afterwards, not to publish anything more of the kind.

Subscribed and sworn to before me this 28th day of January, A. D. 1858
Wm. L. Higgins,
Notary Public

Keep in mind that the newspapers of California frequently published reports of medical cases, with and without the encouragement of the physician involved, and were fully as likely to pillory the doctor as to praise him. Under the circumstances, then, it seemed to Cooper that by the end of January he had convincingly refuted the charge of complicity with the editor of the Daily Times in "puffing" a case of ankle surgery - a relatively unimpressive operation by Cooper's standards. He was, however, particularly troubled and mystified by the apparent turnabout in Wooster's attitude toward him. Had not Wooster on the night of December thirteenth, only six weeks previously, summoned him urgently to the bedside of his own child who was near suffocation from respiratory infection and laryngeal edema and might require tracheostomy? Did not Wooster say then that Cooper was the most skillful surgeon on the Pacific Coast? And were not Wooster and his wife supremely grateful that both Cooper and Dr. Rowell came to the Wooster home and stayed until it was determined that tracheostomy was unnecessary?[11]

Although Trask was the senior editor of the Journal, he was hardly known to Cooper who therefore spoke personally with Wooster about the Daily Times episode and confirmed that he, not Trask, was behind the peremptory charge of puffery. But it was not until he received the February 1858 issue of the Journal that Cooper was fully convinced that Wooster had betrayed his trust in their friendship and revoked their understanding with respect to the financing of the Journal. The lead original article in the February issue was the report by Cooper of a rare and hazardous operation to remove an extensive osteosarcoma involving the clavicle, sternum and adjacent musculature, and also adherent to the innominate vein in the mediastinum. The operation was witnessed by a numerous assemblage of observers including Drs. Isaac Rowell, Washington Ayer and others. The procedure was done on 3 December 1857, the patient did well and Cooper submitted the manuscript to Wooster in mid-January 1858 for publication. It was the last paper ever published by Cooper in the Journal he had helped to found. The type for the osteosarcoma article had already been set up by the printer before Wooster's decision to anathematize Cooper, otherwise Wooster would have prevented its publication, as he later declared.[12]

There were four other items in the February issue of the Journal with special implications for Cooper. Two of these items were articles by H. H. Toland , one reporting a right thyroid lobectomy for goiter and the other a resection of the elbow joint for infected gunshot wound. Two papers by Toland in the same issue suggested to Cooper's suspicious mind that Toland had replaced him as financial backer of the Journal, a not unlikely possibility.

The third item was the following threatening editorial:[13]

With regret, not on our own, but on his account, we are compelled to announce that no more of Dr. E. S. Cooper's communications, will appear in this Journal. We have long been on terms of friendship with him, have repeatedly defended him, against even just censure, in reference to his allowing himself to be puffed to repletion in the newpapers. On 22 January 1858 an article appeared in one of the dailies of this city, purporting to be editorial, redolent with the most noisome flattery, such as no wise man could tolerate to be said concerning himself without disgust. It was not the matter so much as the manner and the medium (both notoriously unprofessional) and the author. We asked Dr. C. to deny his complicity in its publication, or allow us to forego his literary aid in future. He called and requested us not to publish the communication which appears in this number under his signature (the "Case of osteo-sarcomatous affection, etc."). It had already been struck off, and we could not comply with his request. We do not believe he intended to injure the Journal, but still, it would not have been a difficult matter for him, to have ignored the fulsome quackish article to which we have alluded. (The curious will find it in the Daily Times of the 22nd of January.)

We have not the least personal feeling in this matter, and if the profession which we desire faithfully to represent, will hereafter accept his apologies, the Journal will again receive his contributions.

The above editorial appeared in the Journal after Wooster had already received the affidavit from the editor of the Daily Times exonerating Cooper; and after the Pacific Medical and Surgical Association had unanimously cleared him of collusion in the affair. Bitter thoughts crowded Cooper's mind and led to but one conclusion: Wooster - his erstwhile friend - had become an agent of that clique of malignant medical men who were always "like a pack of bloodhounds on his track;" and, furthermore, Wooster was now the hireling of a new financial backer of the Journal, H. H. Toland.. . .

Finally, the last item in the February issue of the Journal with sinister connotations for Cooper was an editorial on the subject of professional ethics. This sanctimonious piece is, in the light of later developments, highly suggestive that Trask and Wooster, the editors, had both joined the cabal of San Francisco physicians who were conspiring to attack Cooper during the forthcoming meeting of the State Medical Society and expel him from the organization. The following is an excerpt from the editorial in question.[14]

The Faculty of the State will not forget that on February 10th, 1858, the State Medical Society is to meet in this city. It is most desirable that high ground be taken, in reference to professional ethics. No man should be admitted to any sect, club or circle of society, who will not conform to the usages thereof. It is correct enough, abstractly, for one to read a newspaper, but exceedingly impolite for one to read a newspaper in church during service, and the church officers would lead such an ill-bred man out by the collar, and would serve him right to kick him out of the portico of the temple. So in our venerable circle of society, we have a code as old as Hippocrates, and everyone who comes into our order swears tacitly to conform to immemorial usage. . . If it were possible for a low blackguard to be at the same time an excellent scholar, and a skilful physician or surgeon, we would not, because of the qualities of his head, ignore the unpardonable vices of his heart, and admit him to the intimacy and equality of our social life. We are all liable, to commit some discourtesy which we shall have to regret, and which our brethren are ever ready, like true gentlemen to forget and forgive; but those who wantonly, and defiantly, persist in notorious professional impropriety, without manifesting either regret, or a disposition to amend, should be cut off from all intercourse with that profession whose dignity they insult, and whose honor they would sully by their pen, their words and their daily actions.

The accusatory tone of the above editorial leaves no doubt that its author (surely Wooster) is censuring the unethical behavior of some specific member of the State Society. Cooper had no difficulty in recognizing that he was himself the "low blackguard" referred to in the editorial malediction.

As we shall soon see, the defection of Wooster, the hostile editorial policy of the Journal, and the harsh indictment of Cooper for unethical conduct by the editors of the Journal were the carefully orchestrated prelude to a concerted attack upon him at the impending meeting of the California State Medical Society. Therefore, let us now turn our attention to an account of that meeting.[15]

Third Annual Session of the Medical Society of the State of California San Francisco, 10-13 February 1858

Before discussing the events of the third annual meeting of the State Medical Society we should again take note of the practice of early California medical societies to omit reference in their minutes to controversial matters. Although the 1858 session was the stormiest in the Society's history, the official minutes of the session provide hardly a clue to the dissension involving Cooper that erupted during the meeting. The chief source of information on this subject is contemporary newspaper articles in the San Francisco Daily Evening Bulletin.[16] Enlightening references to the 1858 session are also found in the transcript of Cooper's trial for malpractice in the cesarean case to which we have already referred.[17]

The first and second annual sessions of the State Society met in Sacramento, which was neutral ground as far as Cooper was concerned. On the other hand, the holding of the third session of the Society in San Francisco made it convenient for the physicians of that city to attend and Cooper had long feared that, under such circumstances, his enemies would turn out in force. He also suspected that they would seek election as officers of the Society in order to gain control over its proceedings.

Day 1. Wednesday,10 February

President Henry Gibbons called the third session of the Society to order at 11:30 A. M. in the chamber of the U.S. District Court at the Merchants Exchange in downtown San Francisco. No official roster of attendees is available, but a count of members named in the minutes indicates that about sixty physicians were present during the session.

The first item of business was the report of the Committee of Arrangements which, according to the Society's constitution, had the following responsibilities:

The Committee on Arrangements shall, if no sufficient reason prevent, be mainly composed of members residing in the place at which the Society is to hold its next annual meeting, and shall be required to provide suitable accommodations for the meeting, to report on the credentials of membership, and to receive and announce all voluntary communications made to the Society.

All the members of the Committee on Arrangements were from San Francisco and its membership included Dr. H. M. Gray. As soon as the Committee's report (of which we have no copy) was read, Dr. Gray moved that the report be referred to the Society's Board of Censors. Whereupon, according to the Daily Bulletin:

A bitter debate immediately occurred. Some of the delegates deplored that private and personal difficulties in the profession of this city, should so soon be lugged in to distract and disturb the harmony of the Convention. A sort of guerrilla warfare, consisting of stray shots from various parts of the room, took place for an hour or two and finally, after considerable trouble and disorder, discussions of the constitution and making allusions and innuendoes, the Arrangements Committee's report was referred to the Censors.

Unfortunately, we know nothing of the subject of the bitter debate, referred to above, that disturbed the harmony of the Society for an hour or two after introduction of the Arrangements Committee's report. We can, however, reasonably deduce that the heated exchange was precipitated by an attack by Dr. H. M. Gray on the credentials of Dr. Cooper. Future events tend to support this conclusion.

There is no mention of this episode in the minutes of the Society which state simply that, after a brief recess, the Board of Censors reported their approval of all delegates and members proposed by the Arrangements Committee. In an unprecedented action, the Censors also granted delegate status to three members of the San Francisco City and County Hospital Staff, a status restricted by the Society's constitution to members of "permanently organized local medical societies." The three new delegates thus admitted to voting membership in the State Society were Drs. J. M. McNulty, William Hammond and Charles Bertody - all of whom Cooper considered to be ill-disposed toward him.

The next order of business was the election of officers of the Society for the ensuing year. In accordance with the Constitution, the President and other newly-elected officers take office immediately after the election and are responsible to conduct the remainder of the program of the session. Dr. A. B. Stout of San Francisco was unanimously elected President. Dr. H. M. Gray was elected Chairman of the nine-member Board of Censors. In addition to Dr. Gray, there were three other Board members from San Francisco - Drs. A. J. Bowie, J. M. McNulty and S. R. Gerry.

Cooper was not among the Society's elected officers. President Stout appointed the Standing Committees and excluded Cooper from all nine of these bodies. The San Francisco contingent achieved their aim They shut him out from participation in the direction of the Society.

Dr. Stout, on taking the chair as President, addressed the Society. In these inaugural remarks, presumably meant to define the goals of his presidency, Dr. Stout chose to emphasize his determination to maintain, as far as possible, the code of ethics and to be governed by it and the Society's Constitution, which he held as inviolable as the Constitution of the United States. As far as we are able to learn from the available record, he expressed little or no concern for the Society's role in advancing the science of medicine, the public health and the enlightenment and comity of the profession.

Day 2. Thursday, 11 February

The main event of the second morning of the session was the valedictory address of the retiring President, Dr. Henry Gibbons. In his quite lengthy remarks, Dr. Gibbons, like the kindly but exasperated father of a large family, deplored the sad state of the medical profession in general and of the California branch in particular. The following excerpts impart the gist of his remarks:[18]

We are a heterogeneous mass - an army of incompatibles. No country in the world is supplied with physicians so diverse in character. We have all the peculiarities of all the schools in the world, coupled with all the peculiarities of all the nations in the world. The physicians of California know less of each other than the physicians of any other land; and they care less for each other. There is no fraternity. Every man is for himself, and thinks the best way to raise himself is by treading down others. All through the country, in every town and village, there can be but one doctor in the same field. We live in continual war with each other - an internecine war, murderous and suicidal. It is so elsewhere, but more so in California. . .

Perhaps my brethren will object to this picture of the profession in California as overdrawn. Happy should I be to think so, but I fear there is no room for such consolation. To detect jealousies, and contentions and bickerings, and tale-bearing, in shameful and ruinous abundance, requires no great skill in diagnosis. I am afraid the case is beyond my range of therapeutics. One thing, however, is palpable, that no remedy can be so effectual as the organizing and cherishing of medical associations in every possible locality. This is one of the main purposes of the State Society. . .

Private and exclusive medical organizations have shown themselves capable of doing much mischief in the profession, out of their own limits. . . My own conviction is, that medical societies should be founded on a broad, catholic basis, and should be open to all worthy members, and that they cannot work well in the dark for the good of the entire profession. The tendency of private and exclusive associations is to establish cliques, and create jealousies and suspicions. Besides they are apt to degenerate into drinking clubs. . .

The temptation to advertise is sometimes strong enough to induce physicians to disregard our code of ethics, and to bring themselves to notice through the newspapers. To what extent a physician may advertise with propriety, is a difficult matter for settlement. . . . Thus, in Philadelphia, it is enough to place the name and profession on a small sign-board; and any addition, such as "surgeon" or "accoucheur," savors of charlatanism. There, one is scarcely suffered to publish his card in a newspaper. In New York, where things are done on a larger scale, the sign may be as large as that of an eating house, and may contain a little information. In Boston, specialties are advertised extensively. The practice of medicine, and of surgery, and of obstetrics, being separate in some countries, it is necessary to modify the sign accordingly. In California we have neither rule nor custom. Physicians have brought their customs and their signs from elsewhere, and we have a variety. . . .

In my strictures on professional character, all I ask is for credit for honesty and for freedom from personal motives. My personal relations with my brethren are, happily, such as to preclude suspicion in this respect. It is quite possible that I have trodden hardest on the toes of my best friends. And if any such should be conscious of the fact, I hope they will consider it a proof of the high regard I feel for them. . .

Gibbons' earnest call for improved relations among local physicians and his emphasis on the importance of the State Medical Society in achieving this goal were timely but, as he feared, too late. The divisive forces within the Society, united by their common resentment of Cooper's aggressive advertising of his surgical practice and his presuming to teach anatomy and surgery, had already chosen this third annual session of the Society for a concerted attack on the crass interloper from Peoria.

The wise words of Dr. Gibbons were followed by a lengthy report on meteorological observations in California by Dr. Logan. After other assorted business and a recess of half an hour, the Society reconvened at 2:30 P. M.

President Stout resumed the chair and called upon Dr. H. M. Gray, Chairman of the Board of Censors, to report the names of new members whose applications for permanent membership in the Society had been approved by the Board. it is of interest that the list of new members included both Drs. John Trask and David Wooster, editors of the Pacific Medical and Surgical Journal. In spite of the fact that they had been just admitted to the Society, they were well prepared to play significant roles in its proceedings.

In an unusual departure from the pre-arranged agenda, President Stout asked the indulgence of the Society to read the following Article from the Code of Ethics:[19]

Chapter II, Art. 1, Sec. 3. It is derogatory to the dignity of the profession, to resort to public advertisements or private cards or hand bills, inviting the attention of individuals affected with particular diseases - publicly offering advice and medicine to the poor gratis, or promising radical cures; or to publish cases and operations in the daily prints, or suffer such publications to be made; to invite laymen to be present at operations - to boast of cures and remedies - to adduce certificates of skill and success, or to perform any other similar acts. These are the ordinary practices of empirics, and are highly reprehensible in a regular physician.

The reason for President Stout's digression from the regular order of business and his invocation of the above Article of the Code of ethics now became clear. He proceeded without explanation to read an anonymous communication that had been laid on his table, requesting that the Report of the Committee on Surgery (prepared by Dr. Cooper) and the Report of the Committee on Obstetrics (prepared by Dr. Cole) not be received for the time being, and virtually charging Drs. Cooper and Cole with violating the Code of Ethics by getting newspaper notoriety.

The anonymous communication was handwritten and unsigned except by the words "Many Members." It would be disingenuous to believe that there had not been collusion between Stout and the authors of the anonymous letter in order for an irregular and provocative communication to be thrust before the assembly in such an arbitrary manner. Perhaps Stout and the other planners of this stratagem thought that sufficient members of the Society would be sympathetic to their initiative so that they could move at once to expel Cooper and, for good measure, impeach the troublesome Cole. In this expectation the plotters were mistaken.

A delegate from Yuba immediately objected, and said that the communication should not be received unless signed by real names. Dr. Cooper demanded to know the names of those who charged him with violating the Code of Ethics. Dr. Cole said that he considered that a personal attack was being made upon him. Dr. Gibbons, in an effort to calm the waters, suggested that President Stout had paid more attention to the matter than it deserved. Finally, after considerable heated discussion and several lost motions, Dr. Williamson moved that "the Society refuse to entertain the communication." His motion was carried and a recess was called, but emotions continued to run high.

During the recess brisk discussion of the anonymous letter continued as the members gathered in small groups to exchange views. Cooper was moving about among them when he chanced to encounter H. M. Gray. Tempers flared and harsh words were exchanged. Then, according to Cooper's friend Washington Ayer who was present, Gray suddenly found himself throttled by Cooper's powerful hand that seized his necktie with such force as to threaten suffocation, while a clasp on his shoulder fixed him as in a vice. Members intervened and Cooper released his grip on the helpless victim. Gray, a member of the Pathological Society, was in the company of the Society's President, Dr. A. J. Bowie, when the clash occurred. As a polished Southern gentleman and firm believer in the "code of honor," Bowie did his best to arrange a duel, offering Gray his services as a second so that the insult might be wiped out. When Gray declined to challenge Cooper, the disillusioned Bowie changed sides and became a fast friend of Cooper. Indeed Bowie later became a member of the faculty of the Medical Department of the University of the Pacific and, when Cooper died, he succeeded him as Professor and Chairman of Surgery.[20][21]

The above anecdote as told by Dr. Rixford, for which no source is cited, is presumably from the frequently unreliable oral tradition of events in the life of Elias Cooper. It is undoubtedly a garbled rendering of the encounter between Cooper and H. M. Gray during the 1858 meeting of the California State Medical Society which we have described. There are the following discrepancies in Dr. Rixford's version of events. (1) Dr. Cooper was persona non grata to the San Francisco Pathological Society and it is most unlikely that he would have ever attended one of its meetings. In any case there is no evidence that he ever did. (2) The President of the Pathological Society throughout the period in question was Dr. A. J. Bowie himself, making his role in the affair as described by Dr. Rixford implausible.

Bowie was a friend of Gray and the record (Daily Evening Bulletin, February 12 and 13, 1858) shows that he was with Gray when he was accosted by Cooper during the 1858 meeting of the State Society. Bowie was therefore in a position to propose a duel between Gray and Cooper, and to offer his services to Gray as a second. This would have been a perfectly credible thing for him to do. Therefore, we have taken the liberty of preserving this feature of Dr. Rixford's colorful anecdote in our description of the Cooper-Gray scuffle at the 1858 meeting of the State Society.

Immediately upon the reconvening of the Society, Dr. Mackintosh of San Francisco rose and stated that a disgraceful scene had been enacted in the convention during the recess. He called for an investigation into the matter and demanded that the conduct of Dr. Cooper in grossly insulting Dr. Gray be examined by the Board of Censors. Dr. Gibbons, ever the peace-maker, hoped that the matter would be allowed to drop. Another member said there was a question as to who had struck the first blow. He thought that Dr. Cooper had been attacked first. Another complained that the Society was becoming ridiculous, and that remarks were made on the streets that "the doctors ought to carry buckets with them to the hall of the Convention to catch the blood to be spilled." Dr. Logan called for an explanation of Dr. Cooper's expulsion from the San Francisco County Medico-Chirurgical Society, and said that he would not belong to a Society when there was a doubt hanging over the honor of any member, and moved that the matter of Cooper's expulsion should also be referred to the Board of Censors.

Finally, after a great deal of heated, disorganized and unprofitable discussion, pursued intermittently into the third day of the meeting, the question of Dr. Cooper's having insulted a member of the Society was referred to the Board of Censors for adjudication. After a recess of fifteen minutes the Board returned to report that Dr. Cooper had presented a written apology for his conduct following reading of the anonymous communication. The Board recommended that Dr. Cooper's apology be deemed satisfactory and the recommendation was approved by a vote of the Society.

This decision then touched off another debate on the subject of the anonymous letter. Some members considered the issue closed, others called for an apology from Dr. Stout, the President, for having read the unsigned communication to the Society, thus precipitating the unfortunate events which followed. After considerable rancorous discussion, Dr. Stout acknowledged that he had erred in reading the communication, but said that he had been deceived in regard to its character. Thus the clumsy attempt to indict Cooper and Cole for unprofessional conduct on the basis of unsubstantiated charges in an anonymous letter failed. But the reputation and morale of the State Society, to which Cooper had devoted so much effort, suffered grievously from the dissension and polarization fomented by the plotters of the anonymous letter fiasco.[22]

Cooper on the Anonymous Letter

Before continuing with our report on the 1858 meeting of the State Society, it will be instructive to interpolate Cooper's personal opinion of the anonymous letter affair. The following is from a handwritten statement prepared by him a few months after the event. It was found among his personal papers as the very rough draft of a Circular intended for distributions to physicians. There is no evidence that the Circular was ever distributed but the draft is a pungent commentary and our only source of his views on the episode.[23] He entitled the statement:

Vindication

(The Circular "To the Medical Profession" which I prepared on 10 February 1858) was only distributed among a few members of the profession. I wanted to see if the Editors of the Pacific Med and Surg Journal would not voluntarily make amends for the gross injustice they had done me.

Having, however, given them several months in which to do this I am now fully satisfied that these gentlemen intended to publish a false and defamatory accusation against me without the least apology for the same.

The statement of the Editors of the Pacific Medical and Surgical Journal or anyone else that I have ever been in the habit of resorting to the newspapers to publish my surgical operations is an unmitigated falsehood. It is true that some of my surgical cases have been noticed in the daily papers but they were such operations as have been and are still noticed in every city in the civilized globe, in nonprofessional publications. They were generally sought by the reporters of the papers and (were sometimes) items given by the different medical men who were present at the operations. The cures resulting from these operations have been truly miraculous, not that I claim any great skill in their performance because any other surgeon might have done as well in this climate, but I mention this fact to show that it is not strange they should have been sought for as interesting items for our daily papers.

In fact these cures have been made the basis of several newspaper articles, the design of which was to encourage emigration to California by showing the results of our unparalleled climate. But this was a public matter with which I had nothing to do, even if so disposed, and those who know how many scurrilous articles touching myself have been published in our inferior public prints in this city and have passed unnoticed by me will readily see that I would have little disposition to spend my time in attempting to regulate the tone of the public press whether favorable to myself or otherwise. There are medical men in this city who never do anything very creditable, and who at the same time seek every possible opportunity of getting noticed in our daily papers but yet who are constantly complaining of others securing public attention in that way.

This is not however the only calumny I have been slow in contradicting. I have permitted to pass unnoticed the grossest defamation of character which malice and envy could suggest. I exercised much forbearance in this as in many other cases from the fact of having early seen that dissension would rend the profession to atoms in this city unless a compromising spirit were shown by all who had its elevation in view.

Recent insults and outrages require that I should expose not only the course of the Editors of the Pacific Medical and Surgical Journal but that of other medical men in this city who use these individuals for the purpose of defaming me.

There is a combination of medical men in this city most of whom belong to the pseudo medical association called the Pathological Society who meet in drinking saloons and other public places and traduce my professional character in the presence of ignorant persons.

These medical men of whom Gray, Stout, Bertody and Hammond stand at the head are constantly alleging professional crimes against me but they are low and cowardly in their attacks and never dare to face their charges but endeavor to use low and despicable men such as Wooster and Trask.

As an example I might mention that attack made in the State Medical Society last February (1858) when they attempted to accomplish their object by an anonymous communication accusing myself and others of non-professional conduct.

This communication was recommended by the (weak) but willing Chairman, Dr. Stout, to be at once acted upon as a charge indicating clearly that the Code of Ethics had been grossly violated although he dared not even mention the name of the individual who made the charge or the nature of the professional crime of which we were accused. He however said of the one who made the charge that he "was a very respectable person."

The penmanship afterwards being recognized as that of Dr. Trask, he confessed to having written (the anonymous letter) and gave as his apology for the disturbance he caused the Society that he found the paper on the table but the penmanship being scarcely legible thought best to copy it.

I am tired of these indiscriminate condemnations made by persons who condemn without knowing me and hence I make this exposition. (These outrages accumulated to such an extent that in two instances in an unguarded moment I resorted to personal violence for redress but my men in each case displayed so much ill-timed prudence that they restrained me.) I hope by this means to avoid the necessity of a repetition of the scene which occurred in the State Medical Society last February (1858). I never again wish to have the Society disturbed as in that case by the unhealthy noise which this class of excessively prudent individuals make when called upon somewhat briskly to account for falsehoods and defamations of character of which they have been the perpetrators.

But as an apology for having surrendered the dignity of the profession by having ever resorted to personal violence which I abhor for the purpose of redress, I would say that for 2 1/2 years I have borne abuse such as no one possessed of an honorable (character) could bear longer without resorting to the only means that brings to their senses those persons who are destitute of that courage which makes a man a gentleman to respect the rights of others.

In conclusion, I may state that I challenge any medical man on this coast to say truthfully that I have not treated him kindly whenever opportunity has afforded. I challenge anyone to say in truth that I have not spent my entire time in efforts to cultivate and advance the medical profession or that I have not constantly assisted others in doing the same.

So far as newspaper notoriety is concerned all I have to say is that as a surgeon my professional course becomes public property subject to praise or censure according to the prejudice, form or information of parties concerned and that I shall spend no time which should be directed to the cultivation of my profession in attempting to regulate the tone of the press either the one way or the other unless I am outraged as in this case until silence becomes a tacit confession of the justice of my accusers.

Day 3. Friday, 12 February; and Day 4. Saturday, 13 February

We now return to the proceedings of the final two days the 1858 Session of the State Medical Society and have selected for review only those items of business that are of special interest to us. Because of their long range effects on the course of events, we have chosen the Reports of two of the Standing Committees of the Society: the Committee on Obstetrics (Beverly Cole reporting) and the Committee on Surgery (Elias Cooper reporting).

Report of the Committee on Obstetrics[24]

The Report of the Obstetrics Committee was read by Dr. Cole who was known to be at times impulsive, flamboyant and outspoken in his comments. This tendency to colorful speech was common in the West but, when Cole indulged in loose and florid language in the Obstetrics Report which dealt with delicate issues, he offended the sensibilities not only of many members of the Society but also the public.

When he read the Report before the Society, Cole began by saying that, since other members of the Obstetrics Committee had not responded to his request for contributions to the Report, he had "consequently during the past twenty-four hours thrown together some few facts and reflections in an exceedingly rude shape." The following are a few of Cole's offhand "reflections" which were deemed outrageous and an insult to California womanhood.

Now let us inquire into the general character of the female immigration to this country; we find them for the most part young, inexperienced women, and more properly girls, who at the most critical period of their lives, and dangerous to their chastity and virtue - when the bud is about bursting into the rose - when is just developed and released from the thraldom of girlhood, the woman, with her passions, alike to the smothered ember, requiring but a breath to fan it into a consuming flame. At this period they are removed from the proper guardianship and healthful advice of their mothers, their minds being not yet fully matured and consequently prepared to resist temptation, they yield to the solicitations of the opposite sex and seductive allurements of dissipation, and find themselves in a short time the prey of disease. This applies equally to the married and unmarried - and so general is it that I believe I am correct when I estimate two in every three females, who have reached the age of fifteen, to be victims of this dissipation and fashionable life.

At this very period when a girl most requires the advice of a mother based upon experience and observation, she herself either assumes the duties of a parent or gives herself up (being relieved of restraint) to every species of immorality; she occupies her leisure hours with the reading of exciting novels, and as a patient told me ten days since, she passed most of the night in the reading of such trash, and never slept but through the influence of laudanum or ether, which had been recommended by a girl somewhat more mature in years, and who had been in the habit of resorting to the use of these agents for an indefinite period. The only exercise of these girls is of that character which, so far from being attended with benefit, only serves to hasten the dire disease that is destined to speedily destroy their happiness and greatly shorten their lives.

Cole's Report elicited no unfavorable comment when delivered before the Society. It was approved by the Publications Committee and duly published in the Transactions of the Society. The Report was then available to the press which had a field day with the subject matter, especially the highlighted portions of the above paragraphs. Dr. Stout, President of the Society, was deluged with complaints not only from citizens, but also from members of the Society who demanded prompt action against Cole. We shall return to the subject of Dr. Cole's rash commentary on the depraved state of California womanhood when we discuss the Fourth Annual Session of the Society convened in Sacramento in 1859.

Report of the Committee on Surgery[25]

We will now conclude our consideration of the Third Session of the Society in 1858 with a review of Cooper's Report of the Committee on Surgery delivered on the third day of the meeting.

Cooper thought that the plans of his enemies to malign him consisted solely of the failed anonymous letter gambit of the previous day. Therefore, he was relaxed when he took the rostrum to make his presentation. He was confident that his Report entitled "The Results of Important Surgical Operations in California" (most of which he had performed himself) would add substantially to his reputation as one of the State's premier surgeons. The Report included accounts of some operations already familiar to us such as the exsection of bones, osteosarcoma of clavicle and sternum, removal of a foreign body from behind the heart, and the cesarean section on Mrs. Hodges. The description of the cesarean case was necessarily sketchy for lack of time. The diagnosis of narrowed birth canal was given as the reason for the failure of normal delivery and the necessity for cesarean section. The erroneous diagnosis of twins was not mentioned.

To Cooper's utter surprise, when he had completed his presentation David Wooster took the floor to present a paper giving his version of the cesarean case. He ridiculed Cooper, saying that the operation was unnecessary and needlessly endangered the life of the patient. He charged that Cooper falsely stated that the operation was undertaken because of a diagnosis of narrowed birth canal when in fact it was their wrong diagnosis of twins that led them to perform the procedure. Using vituperative language and caustic humor, Wooster denigrated Cooper's surgical ability and ethical standing, and accused him of lying about the reason for the operation in order to cover up the error of diagnosing twins, and to bolster his surgical reputation.

That evening, on the street outside the assembly hall, in an ostentatious display of malice and bravado, Wooster was heard to say that Cooper should be sued for malpractice in the cesarean case and that, if Cooper tried to attack him, he would shoot him down like a dog.[26]

On the following day, the fourth and last of the meeting, the presumptuous Wooster (he and Trask had been admitted to membership in the Society only two days before) had the audacity to move that the portion of Cooper's Surgical Report dealing with the cesarean section be expunged from the record, but that the Wooster paper on the subject be included in the Transactions. After heated discussion, the following Resolution was adopted:[27]

That the Society instruct the Committee of Publication to suppress from the Report of its Annual Transactions all reference to a certain Cesarean Operation, appearing in the report . . . of the Committee on Surgery; and also all reference to the same subject in a communication of Dr. Wooster, and that Dr. Wooster be allowed to withdraw his communication.

Although Cooper voted for the Resolution and tried to downplay its implications, it was a severe blow to his pride and credibility. Throughout the Third Annual Meeting of the State Society he had been on the defensive. The experience left him embittered and certain now that the conspiratorial clique had co-opted Wooster and Trask, thus bringing them and the Pacific Medical and Surgical Journal into the service of the conspirators. At this point the prospect of Cooper's reputation surviving the assaults of the malicious and powerful coalition arrayed against him seemed dim. Nevertheless, it would be wrong to assume that because of these reverses Cooper would alter his plans for a medical school or fail vigorously to counter the attacks of his enemies.

As a result of the above Resolution banning their publication, there is no record in the Society's Transactions of either Cooper's or Wooster's paper on the cesarean section. However, Wooster lost no time in placing his version of the case and his charges against Cooper before the medical profession at large. The March 1858 issue of the Pacific Medical and Surgical Journal contained an article by Wooster entitled: "Cesarean Operation-Case - False Diagnosis - Recovery of the Woman."[28]

In this self-serving article Wooster summarized the general indications for cesarean section, traced the historical background of the procedure, and quoted the dismal contemporary mortality rates. He then described Mrs. Hodges' labor, the decision to operate, the operation itself, and the postoperative course and recovery.

In his discussion of the diagnosis of twins and the operative procedure, Wooster made no reference to his failure to catheterize the patient or to his reporting of fetal heart sounds in a non-existent second infant - when these were in fact the key determinants of Cooper's decision to operate. Furthermore, according to Cooper's unpublished notes:[29]

(When Wooster and I discussed the case after the cesarean), we both agreed that notwithstanding the incorrect diagnosis that it was well for the patient that the cesarean operation had been adopted because the child was exceedingly large (nearly 12 pounds, I believe) and an effort to take it away through the vagina by instruments, adopt what method we might, would under the false impression that the bladder was empty, have resulted in the wounding of that organ. Its enormous distension was such as to have rendered it impossible to have avoided this, and any person who might have seen it would have said so at the time.

Nor did Wooster mention that Cooper had previously operated upon the patient for vaginal stenosis and that, according to Cooper, the fetal head was so densely impacted in the lower strait as to preclude safe use of forceps, crotchet, perforator or craniotomy forceps.

Wooster concluded the article with a lengthy condemnation of Cooper from which the following is an excerpt:

There is no doubt but that an immense mistake was made in this case. There is now no doubt in the mind of any one, with the facts before him, that the operation should not have been performed. It was plainly a mistake of diagnosis which any one might commit. Well knowing these facts, the principal in this operation being determined at all hazards to make reputation out of it, now denies that he ever diagnosed twins, but says that we operated, or that he did, because of malformation. Now fortunately for truth, and unfortunately for prevarication, malformation of the organs concerned, is not a matter upon which there can be different opinions; it is not a matter of argument, but of simple observation. . . So to lay down such a reason to cover up an error of diagnosis, or for any other cause, is beneath criminality. It does not suppose the penetration and intellect necessary to criminality, but indicates simple stolidity. . . .

[Note. - With a view of ascertaining the propriety of allowing the pregnancy to reach term, Dr. C. examined this case at the seventh month, and assured the woman she had nothing to fear from malformation of bones. Five months after he asserts in the presence of 150 medical gentlemen, that we operated on the same case, in consequence of Malformation of Bones, &c. The patient is still alive, and in good health, and I hope she will yet live many years, to benefit all her acquaintances with the excellent qualities of her head and heart.]

As far as we can determine Cooper never published a rebuttal to Wooster's accusations. However, his unpublished notes describe in detail the labor, cesarean delivery, and postoperative course of Mrs. Hodges, including Wooster's participation in her care. In these notes Cooper gives the following reasons for not mentioning the erroneous diagnosis of twins.[30]

First, (because of the limited time available; and )

Second, (because) an immense blunder (in diagnosis) had been committed prior to the operation in consequence of false statement(s) made to me by another medical man (Wooster) between whom and myself confidence existed at the time of the occurrence and which (could) not have been explained and justice done to myself without being injurious to him and, whatever change may have taken place since in our feelings towards each other, it did not, could not, obliterate the sacred obligation of confidence once reposed.

Thus Cooper claims that he did not refer to the misdiagnosis of twins in his Report on Surgery because he felt duty-bound not to expose Wooster's deception regarding catheterization and his error regarding fetal heart sounds of a second baby. Although Cooper later openly labeled Wooster a "Professional Traitor" and a "Medical Judas," he was true to his "sacred obligation of confidence" until legal considerations forced him to make public disclosure of Wooster's deceit with respect to the patient's urinary retention, the simple relief of which by catheter would have avoided the cesarean section.

Endnotes

  1. Emmet Rixford , "Early California Medical Journals," California and Western Medicine 23, no. 5 (May 1925): 604-607 Lane Library catalog record
  2. Henry Harris , California's Medical Story (San Francisco: Grabborn Press for J. W. Stacey, Inc., 1932), pp. 144-147 Lane Library catalog record
  3. Frances T. Gardner , "Early California Medical Journals," Annals of Medical History Third Series, Vol. 1, no. 4 (Jul 1939): 325-342 Lane Library catalog record
  4. Elias S. Cooper , "On exsection of bones - reproduction of parts, etc," Pacific Medical and Surgical Journal 1, no. 1 (Jan 1858): 9-13 Lane Library catalog record
  5. Hugh H. Toland , "On the reproduction of bones," Pacific Medical and Surgical Journal 1, no. 1 (Jan 1858): 6-9 Lane Library catalog record
  6. David Wooster , ed., "Editors' Table: Surgery in San Francisco," Pacific Medical and Surgical Journal 1, no. 1 (Jan 1858): 43 Lane Library catalog record
  7. 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. 41-42
  8. 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. 39
  9. 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. 40-42
  10. Printed Materials - Box 1, Folder 7, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  11. 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. 42-43
  12. Elias S. Cooper , "Case of osteo-sarcomatous affection, embracing the left clavicle, the sternum, sterno-cleido-mastoid, and scalenus anticus muscles, and adherent to the vena innominata, the 1st intercostal muscle, etc.," Pacific Medical and Surgical Journal 1, no. 2 (Feb 1858): 49-52.Lane Library catalog record
  13. David Wooster , ed., "Editors' Table. We are compelled to announce that no more of Dr. E. S. Cooper's communications will appear in this Journal," Pacific Medical and Surgical Journal 1, no. 2 (Feb 1858): 83.Lane Library catalog record
  14. Editors' Table (untitled editorial), Pacific Medical and Surgical Journal 1, no. 2 (Feb 1858): 75.Lane Library catalog record
  15. Transactions of the Third Session of the Medical Society of the State of California Convened at San Francisco, February, 1858 (Sacramento: James Anthony and Company, Printers, 1858) 168 pp.
  16. San Francisco Daily Evening Bulletin, February 10, 11, 12, 13, and 16, 1858.
  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), 256 pp.
  18. Transactions of the Third Session of the Medical Society of the State of California Convened at San Francisco, February, 1858 (Sacramento: James Anthony and Company, Printers, 1858), pp. 23-30.
  19. "Minutes of the Proceedings of the Convention and of the Medical Society of the State of California, held in Sacramento, March 1856," California State Medical Journal 1, no. 1 (Jul 1856): 29-30 Lane Library catalog record
  20. Washington Ayer , "Reminiscences of the life and labors of Elias Samuel Cooper," Occidental Medical Times 7, no. 11 (Nov 1893): 602. Dr. Ayer witnessed the confrontation between Drs. Cooper and Gray during the 1858 meeting of the California State Medical Society. Our description of Cooper's behavior is based on his observations. Lane Library catalog record
  21. Emmet Rixford , "Early history of medical education in California," Annals of Surgery 88, no. 3 (Sep 1928): 323. In this paper, Rixford describes an episode said by him to have occurred at a meeting of the San Francisco Pathological Society during which the Society President criticised Cooper severely for advertising. "Cooper who was present then strode to the chair, shook his fist in the President's face and threatened to thrash him if he uttered another word against him. Dr. A. J. Bowie, a scholar and polished gentleman, a southerner who believed in the code, did his best to arrange a duel, offering the President his services as a second so that the insult might be wiped out, but the President's valor oozed out in the drink emporium nearby, whereupon Dr. Bowie changed sides and became a fast friend of Doctor Cooper. Not long after Cooper started his medical school Bowie became Professor of Clinical Medicine. Lane Library catalog record
  22. San Francisco Daily Evening Bulletin, February 12 and 13, 1858.
  23. Correspondence 1857-1862 - Box 1, Folder 4, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library.
  24. R. Beverly Cole, M. D. , "Report on Obstetrics and Diseases of " in Transactions of the Third Session of the Medical Society of the State of California Convened at San Francisco, February, 1858 (Sacramento: James Anthony and Company, Printers, 1858), pp. 133-140
  25. E. S. Cooper, M.D. , "Results of Surgical Operations in " in Transactions of the Third Session of the Medical Society of the State of California Convened at San Francisco, February, 1858 (Sacramento: James Anthony and Company, Printers, 1858), pp. 110-132
  26. 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. 46
  27. Transactions of the Third Session of the Medical Society of the State of California Convened at San Francisco, February, 1858 (Sacramento: James Anthony and Company, Printers, 1858), p. 21
  28. David Wooster , "Cesarian operation-case - false diagnosis - recovery of the woman," Pacific Medical and Surgical Journal 1, no. 3 (Mar 1858): 89-96 Lane Library catalog record
  29. Cooper-Hoges Malpractice Suit, Cooper's notes - Box 2, Folder 13, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
  30. Cooper-Hoges Malpractice Suit, Cooper's notes - Box 2, Folder 13, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
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