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

First Impressions

Saturday 26 May 1855. On this date the S.S. Sierra Nevada arrived in San Francisco from San Juan del Sud, Nicaragua, bringing 664 passengers. Among them was a tall and sturdily built, black-bearded and somber-faced young man of 34 - Dr. Cooper of Peoria, Illinois. His bold and furtive plan to found a medical school in San Francisco had governed his every move for the past year, and was constantly in his thoughts during the long sea voyage. Now that he had at last reached his destination on the Pacific Coast, his whole concern was to take decisive steps toward his ultimate goal without delay.

He inquired aboard ship about a hotel in the city that would best serve as a temporary base of operations and was advised to try the new Rassette House. He went there directly from the pier as soon as the steamer had berthed. The choice could not have been more fortunate. The original Rassette House was a five-story frame structure that escaped the great fires of 1850 and 1851, but burned to the ground in 1853. It was then rebuilt on a grand scale at the same site on the corner of Bush and Sansome Streets. Situated in the heart of the commercial district, the new Rassette House was an impressive edifice and the largest private building in town devoted to a single business.^[1]

One block distant, on the corner of Bush and Battery Streets, was the fashionable Oriental Hotel where the Democratic Party was holding a political rally. Standing in front of the Rassette House on his first evening in San Francisco, Cooper witnessed a multitude of boisterous Democrats, numbering about 3000, milling around the Oriental and marching through the streets in torchlight procession, carrying banners and preceded by music. What he saw confirmed his belief that San Francisco was a up and coming city where he could realize his ambitions.^[2][3]

Sunday, 27 May 1855. This was Cooper's first morning in San Francisco. He left no account of the impressions and emotions that flooded his mind when he viewed the dazzling expanse of city and Bay from his window in the Rassette House. But we are not entirely at a loss to visualize the scene and fathom his thoughts on that occasion.

Four years later another perceptive traveler, Richard Henry Dana, gazed out on the same resplendent panorama from the nearby Oriental Hotel. We have previously told how he entered San Francisco Bay for the first time aboard the sailing ship Alert in 1835. Twenty-four years later Dana, now a Boston attorney, returned to the Bay on Saturday August 13th 1859 He arrived on this occasion aboard the superb steamship, Golden Gate, and engaged a room at the Oriental Hotel. The vista of San Francisco and the Bay from his hotel window on the following Sunday morning, and the emotions he felt, must have been much the same as those experienced by Cooper four years earlier on the Sunday morning of May 27th 1855. Dana described the scene in words that Cooper himself might well have chosen:^[4]

During the next few days Cooper explored his new surroundings eagerly and discovered a city unrivaled among the ports of the world for the grandeur of its prospect on rolling hills overlooking a majestic bay. The astounding prosperity of the Golden Era from 1849 to 1855 had brought incredible material progress to San Francisco. In the six-years following the Gold Rush of 1849, the city changed from a disorderly encampment of unsightly tents, shanties and rickety wooden shacks to a flourishing city of 50,000. Permanent buildings of wood, and over 600 of stone or brick, supplanted the former temporary structures that had been repeatedly consumed in devastating fires. By 1855 cobblestones were replacing planks on the main roads, and a gas works was in operation, furnishing lights for major streets. Omnibuses were running between key points in the city, steamboats plied the inland waterways tributary to the Golden Gate, and ferries made morning and evening runs to Oakland 10 miles across the Bay. At portside were a dry dock and a vast array of wharves and warehouses. Manufactories included foundries and boiler works; several oil, candle and soap works; four sawmills and eleven flour mills; a sugar refinery; distilleries and over a dozen breweries.^[5]

Downtown, only a few blocks distant from the port, there were some 160 hotels (including the Rassette House and the Oriental) and hostels, 60-odd restaurants, and ample bakeries and markets. Drinking and gaming were popular pastimes of the miners and footloose immigrants who flocked to the Gold Coast. Because of the prevalence of drunkenness, the Christian Advocate undertook in 1853 to determine the availability of strong drink. It was found by actual count that there were 527 places in the city where liquor was sold. Of these 83 were retail drinking saloons, 52 were wholesale stores, 144 were restaurants, 154 were groceries, 46 were gambling houses, and 48 were fancy and dance houses. In a word, alcohol was everywhere plentiful, and copiously imbibed. Gambling was a prominent feature of San Francisco night-life and one of the main branches of business. The gamblers had the best buildings and paid the highest rents. Their halls were on the level with the street and were crowded from dark till late at night. Orchestras and vocalists provided music, and the bar, liquor. At one time prior to 1855 a dozen large gambling houses were open, each with five to fifteen tables, making nearly a hundred tables in all - and the "take of the house" in gold and silver coin, and not infrequently nuggets and bags of gold dust, was prodigious.^[6]

Entertainment on a higher plane was provided by theaters and halls that commonly featured celebrated actors, actresses, singers and musicians from the East. Shakespeare was popular in San Francisco. The famous Edwin Booth played Hamlet, and toured the mining camps where the Bard's works were a rousing success. The Adelphi Theater was built in San Francisco in 1851, the Metropolitan in 1853. By 1855 the spacious Jenny Lind Theater had been converted to the City Hall. (Jenny Lind never came to California, but P. T. Barnum as her press agent made hers the most popular name in show business.^[7] There were also the American Theater (seating nearly 2000), the Union Theater and three Halls: San Francisco, Musical and Turn Verein. San Francisco was from its earliest days the cultural center of the West.

Nor was social development laggard in other respects. In addition to a dozen and a half primary, grammar and other public schools, there were two girls' schools, a Jesuit school, and the San Francisco College that aspired to the university grade. Churches were, as usual in frontier America, among the first institutions on the scene. By 1855 there were 32 congregations in San Francisco embracing eight Protestant denominations, and six Catholic and two Jewish bodies. There was also a convent. Some of the congregations worshipped in Halls, but most possessed their own buildings, the most imposing being the catholic cathedral. The number of women had greatly increased since '49 and their influence in fostering normal family life and religious observances, where they set the example, tempered the reckless and exuberant spirit of the mining era. In addition to the churches, many benevolent associations were established, such as a dozen military companies (with ornamental as well as useful aims); seventeen semi-heroic fire brigades, including three hook-and-ladder companies; Free Mason and Odd Fellows Lodges; and Temperance Societies. These various organizations served to elevate the moral tone of the city and changed it from a community of reveling adventurers to one of high average respectability and intelligence - for a city on the very rim of civilization, that is.

Finally, like churches, newspapers normally sprang to life early and helped to shape the character of new American settlements. By Cooper's day in San Francisco there were thirteen daily and as many weekly newspapers, in half a dozen languages. We shall soon see to what use he put them. Several hospitals were already flourishing when he arrived: The German Hospital; the French Hospital; the San Francisco City and County Hospital (supervised by the Sisters of Mercy); and the U.S. Marine Hospital, one of the most imposing structures in the city.^[8]

In his walks about the city, Cooper surveyed the streets and buildings with the shrewd judgement gained through real estate dealings in Peoria. Wherever he went he struck up a conversation with tradesmen who were eager to hear about conditions "back East," and to share with him their concern over the economic recession (California's first) that had devastated their business during the past year. The downturn had been precipitated by a sharp decline in the previous frantic pace of mining, commercial, and real estate activity. San Francisco's astounding prosperity during the period from the beginning of 1851 to the middle of 1853, with its spiraling prices and acute shortages of everything from shovels to rental property, was fueled by the surging growth of mining and gold production, accompanied by a massive influx of immigrants. This led to rampant overspeculation based on the belief that population, gold export, demand for commodities, and the value of real estate would continue to increase annually at the former rate. When this failed to occur, a severe panic seized the severely inflated banking, mercantile and real estate markets in early 1854. The failure in 1855 of Page, Bacon & Co., a major bank, and Adams & Co., the premier express company in California, wiped out thousands of investors and sent shock waves through San Francisco and the State. Cooper received this distressing news with quiet satisfaction. The depressed economic conditions played into his hands by reducing prices, and making it vastly easier and cheaper for him to find vacant property in a good location for his infirmary and clinic.^[9]

In his talks with the man in the street, Cooper learned of yet another threat to the community's welfare. While frontier conditions still prevailed at mining camps on the foothills and rocky slopes of the Sierra to the east, and in the small settlements in the sparsely populated inland valleys, San Francisco had in the half-dozen years of the Golden Era from 1848 to 1854 become the western metropolis and chief port of trade on the eastern shore of the Pacific. But the very conditions responsible for the city's remarkable development also attracted a rapacious and lawless element that preyed on society. Ruffians had so far controlled the streets and the courts in San Francisco in 1851 that the First Vigilance Committee was organized by Sam Brannan and other leading citizens who were outraged by the unbridled wave of crime. The Committee set up its own constabulary and courts and meted out a swift and stern "justice" that included the hanging of four and the deportation of many other vicious felons. The Committee's methods were denounced by the city's corrupt judiciary but firmly supported by the aroused populace. Within six months the Committee had intimidated the outlaws and rebuked the servile city courts. It then suspended its activities without ever formally disbanding. It stood ready for instant recall should circumstances warrant.^[10]

Although gun-toting desperadoes were less brazen, and law-abiding citizens somewhat less fearful of mugging on the streets of San Francisco when they ventured forth at night, crime in the city had not been greatly diminished. In the wake of the First Vigilance Committee professional scoundrels infiltrated the domain of politics where their control of city government by ruthless tactics went unchecked by the arm of the law. Finally, when James King of William, crusading editor of the San Francisco Evening Bulletin, was shot down in the street on 14 May 1856 by a ballot-box stuffing politician named James P. Casey, confidence in civil authority again collapsed and tolling of the bell at Monumental Engine House called the Second Vigilance Committee into action. We shall later return to the role in these events played by Cooper and the men associated with him in the founding of his medical school.^[11]

During the first months after his move to San Francisco, Cooper's decisions and maneuvers were so methodical, and pursued with such intensity, that there can be little doubt he followed a predetermined plan - a plan based on his Peoria experience and driven by a tireless zeal for surgery, anatomy, vivisection and teaching. He made haste to put in place the following main pillars of his strategy:

• Open an Infirmary and Clinic
• Advertise extensively
• Begin a Private Medical Teaching Program
• Acquire a large Surgical Practice
• Publish a Medical Journal
• Organize Medical Societies (Local and State)
• Found a Medical School.

It seems scarcely plausible that Cooper could have conceived such an audacious and comprehensive scheme, and had the ability and resolve to carry it out. Yet we know that he did, although the outcome of his venture hung often in the balance as we shall now learn by following his course stage by stage.

On 5 June 1855, just ten days after his arrival in San Francisco, Cooper rented a large house for his clinic and infirmary at 14 Sansome Street across from Rassette House, paying rent of one dollar a day.[12] One month later, on 7 July, he opened his Infirmary and announced its special services in newspaper ads similar to the following modest item in the Empire County Argus, published in Coloma where James Marshall had discovered gold in Sutter's millrace in 1848.^[13]

Six months later, in February 1856, Cooper moved his Infirmary and Clinic to a new location on the north side of Mission Street between Second and Third Streets, only three blocks from 14 Sansome. Various bills for repairs on the Mission Street house, sidewalk and sewer suggest that he eventually bought the building. In any case it became the permanent site for his medical activities, including teaching. A few years later he changed the title of his establishment to "Pacific Clinical Infirmary."^[14]

Within a month or so of Cooper's arrival in San Francisco, he invited Dr. Charles A Kirkpatrick to join him as an associate in practice. Our first inkling of their association is found in a bill dated 31 August 1855 addressed jointly to Cooper and Kirkpatrick by the Book and Job Printing Office for 5000 circulars and 500 cards.^[15] We know nothing more of the background of their association than can be inferred from a letter written by Captain James McDonald to Cooper from Sacramento dated 25 February in which McDonald refers to some of their fellow passengers on the S.S. Sierra Nevada and says "if Dr. Kirkpatrick is still with you, give him my best respects." The context of McDonald's comment makes it likely that Kirkpatrick was a shipmate aboard the Nevada and there made Cooper's acquaintance. Kirkpatrick followed Cooper into the medical societies that soon developed and its seems unlikely that he would have done so except under Cooper's wing. We learn from the Minutes of the San Francisco County Medico-Chirurgical Association for 24 October 1856 that Dr. Kirkpatrick moved to Sacramento at about that time and we can assume that he served as Cooper's associate until then.^[16]

Not content with simply announcing the opening of his facilities in July 1855, Cooper conducted over the following two years (until November 1857) an aggressive newspaper ad campaign throughout California, Oregon and beyond. During this period his ads appeared in 65 different news publications, usually for a run of 3 months at a time, with a later rerun in one or another of these papers on 46 occasions. Publications ranged from the Puget Sound Courier in the North to the Santa Barbara Gazette, San Diego Herald, and El Nicaragua in the South; from the Honolulu Polynesian in the West to the Downieville Sierra Citizen in the East. Cooper's expenditure for ads, cards and various circulars during the period of the ad campaign amounted to $ 1500, a major sum in those days.^[17]

After the move to Mission Street, Cooper's confidence soared and his impatience to build a surgical practice led him to have the following fulsome "puff" widely published as an ad in English, German, French, Spanish and probably Chinese-language newspapers.^[18][19]

The above ad consists of the verbatim quotation of a laudatory newspaper article printed in the San Francisco Alta California on 17 August 1855. It is impossible to believe that the editor of Alta California would have "found" the above flattering article about Dr. Cooper in the obscure Peoria News unless called to his attention by Cooper himself. Cooper must have known, and chose to ignore, that such self-serving manipulation of the lay press would be considered unethical and lead to his censure as an advertising quack by fellow physicians.

In addition to newspaper ads, Cooper had thousands of cards such as the following printed for distribution:^[20]

Cooper was fresh from the heated controversy and threat of expulsion from the Peoria and Illinois State Medical Societies caused by his advertising, yet we see that he proceeded to conduct an even more intensive newspaper ad campaign immediately upon his arrival in San Francisco. In Peoria he defended his advertising on the grounds that it was his right to acquaint the profession and public with the specialty services he had to offer, and we pointed out that he would not be condemned for doing so under today's ethical guidelines. In Peoria he had received absolution for his advertising only on the condition that he agree to stop it and abide by the stricter standards of the A.M.A. Code of Ethics. He was thus well aware that the Code did not admit of self-promoting practices, yet he began again to employ them vigorously as soon as he reached California.

Why Cooper now embarked on an advertising campaign of truly major proportions in spite of his previous experience in Illinois is an intriguing question. We know that he considered it grossly unfair to deny him the right to inform doctors and the public about the specialty services and facilities offered at his Infirmary. Furthermore, he thought (mistakenly) that the physicians of San Francisco were not yet sufficiently organized to take a firm stand on ethical questions of the day, and that it would thus be difficult for them to take concerted action against him. Cooper therefore felt secure in launching an ad campaign that would hasten the growth of his practice and attract candidates to his teaching program - crucial steps on the path to his goal. In the worst case, should he be seriously challenged by the profession, he could as he did in Peoria discontinue advertising "in deference to the respected opinion of his fellow physicians" and, presumably, be forgiven. By then, the ads would have had the desired effect.

In the light of the modern ethical standards to which we have previously referred, we may conclude that Cooper was a courageous rebel in the vanguard of the profession with respect to advertising. Unfortunately, he was too much in advance of some of his California colleagues and we shall see how far he miscalculated the ferocity of their adverse reaction to his industrious self-promotion.

Impatient to resume the teaching of anatomy and surgery as he had done in Peoria, Cooper announced a Course of Medical Instruction as soon as he had opened his Infirmary on Sansome Street. In addition to his obsessive devotion to self improvement, his motivation was also based on other considerations. He recalled that his exemplar, Daniel Brainard, had conducted a private school of anatomy while marking time in Chicago before he opened Rush Medical College. Furthermore, he knew from his own previous experience that teaching activities would enlarge the circle of his professional contacts, stimulate his surgical practice and elevate his standing in the community while his covert plan for a medical school matured.

He announced his Course by the mailing of 2000 Circulars which he had printed on 10 July 1855, just a month and a half after his arrival in California. He candidly stated that he would give the course free of charge to all who attend, the object being to make acquaintance with medical men of the Pacific coast. The following excerpt from the Circular includes the main points of his message to the physicians of the region:^[21]

As mentioned earlier, it was on this Circular that Cooper first appended the "A.M." degree to his title. But when we searched for evidence of his having been granted an A.M. degree by a college or university in the Northwest, we found none. Cooper's medical contemporary and bitter enemy in San Francisco, Dr. David Wooster, scoffed at the degree: "Where he got the A.M. he always appends to his name, we cannot imagine. It is inconceivable to those who know his literary attainments, what institution of learning in the civilized world could have conferred it. But, after all, it is a harmless affix, and perhaps the professor don't mean Master of Arts by it, but it may be a key to some family legend, for we understand he belongs to a 'very ancient family.'^[22]

As far as we can determine, neither Cooper nor anyone else ever specified the source of the A.M. degree. It is surprising that Cooper, if the degree was genuine, did not respond in some fashion to Wooster's implication that the degree was not authentic. There is the possibility, of course, that Cooper simply preferred not to dignify the insolence of his tormenter by a reply, or that the reply has been lost. It is also possible that other records and clues that would disclose the origin of his degree can simply no longer be found at this late date. As things stand, however, the absence of any evidence whatsoever that Cooper actually received an A.M. degree from an accredited institution makes it difficult to discount entirely Wooster's inference that the degree was "self-awarded."

Let us look back through the mists of time and try to imagine the state of Cooper's mind when he readied his Circular announcing the very advent of formal medical teaching on the Pacific Coast. Could he then have reasoned as follows? "How simple and uncontestable it will be, far from the scene of my previous life and from medical colleagues familiar with my every move, to adorn my signature with an A.M. degree. This modest and harmless symbol of scholarly achievement will significantly enhance my stature as a teacher and heighten the appeal of my present and future Courses of Medical Instruction." May not such dissembling thoughts as these, stirred by a feverish ambition, have been the genesis of the A.M. degree that appeared after Cooper's name so unaccountably on the occasion of his inaugural venture in medical education in the West?

This is the very suspicion the cunning Wooster sought to implant by his slashing attack on Cooper. But the unsupported insinuation of Cooper's implacable adversary must not be accepted in lieu of facts. Since no evidence has been found to prove that Cooper either did or did not receive an A.M. degree - and if such evidence ever existed, it may well have been lost - we must in fairness give him the benefit of the doubt. Therefore, because Cooper appended an A.M. degree to his name in July 1855 and continued to do so for the rest of his life, we shall perforce allow the possibility that an institution somewhere, somehow granted it to him.

As we follow Cooper's rising star, we shall hear much more of Dr. Wooster. This then will be a convenient point at which to sketch his background. He was born in Jasper, Steuben County, in western New York State, the son of the Reverend John Wooster and a remote descendant of the first Earl of Worcester, England. He was the great-grandnephew of the Revolutionary Major-General David Wooster (1711-1777) who graduated from Yale in 1738 and married Mary Clap, daughter of Yale's president, in 1746. General Wooster's record as a military leader was far from successful and congressional commissioners once reported him unfit to command. But he was well-liked by his troops and died in action while rallying them during a brief engagement with the British near Danville, Connecticut, on 27 April 1777.

Seventy years later Dr. Wooster, like his namesake General Wooster, entered military service. Before graduating in medicine, he served as Acting Assistant Surgeon in the U.S. Army during the Mexican War (1846-48), being stationed at La Puebla near Mexico City. In 1849 he received an MD degree from the Cleveland Medical College (organized in 1843 and now known as Case Western Reserve University School of Medicine), and in the same year began the practice of medicine at Adrian in southern Michigan. In 1850 he crossed the plains to California where he mined for gold and practiced medicine on the Yuba River in the northern sector of the Mother Lode until 1856 when he established himself in San Francisco.

Soon after his arrival in the city he attended some of Cooper's anatomical lectures and dissections and they became friends. Cooper attended Wooster's small son who was critically ill with croup and narrowly escaped tracheostomy. Cooper also assisted Wooster in building his practice in San Francisco and was prepared to provide the funds that he needed in 1858 to begin publishing the Pacific Medical and Surgical Journal which had the longest life of any of the early medical journals published in California. Following an incredibly acrimonious disagreement between them, to which we shall later refer, Wooster spitefully disclaimed Cooper's generous offer of financial assistance and went on to found the Journal under other auspices and to use its pages for virulent attacks on Cooper. Wooster edited or co-edited the publication for almost 4 years until he relinquished the post in 1861 during the Civil War in order to rejoin the U.S. Army, "hoping to be of real service in the present melancholy condition of our once glorious country."^[23][24][25]

Cooper's first Course of Medical Instruction, advertised in July 1855, was convened in October of that year, only four months after his arrival in San Francisco. The Course was continued under the original plan until modified by the following Circular dated 10 December 1856 which announced a considerably expanded curriculum:^[26]

The expansive invitation in the above Circular is the last announcement we have of the private teaching program conducted by Cooper in his Infirmary. By all indications, the program was essentially in continuous session along these same lines. It was a natural bridge to and preparation for the medical school curriculum that eventually superseded it three years later in 1859. Records are not available to document the actual attendance at the course, but indications are that numerous physicians from San Francisco and the region were in attendance for brief periods, this being the only postgraduate program available in the area at the time. The teaching program served the purpose of attracting those medical men in the city who shared Cooper's interest in medical education while at the same time it aroused the hostility of others, such as San Francisco's pioneer physicians, who considered his claims as a teacher to be presumptuous.

Building a large practice was to Cooper an urgent necessity for this was his only means of garnering the money, patients and especially the recognition that his scheme to found a medical school required. He was confident that his anatomical knowledge and technical skill were unsurpassed by any of the local practitioners. What he needed to attract patients and especially referrals was an opportunity to demonstrate his surgical virtuosity. Surgery is a performing art and preeminence is most rapidly acquired by the safe execution of hazardous, difficult and well-publicized procedures. As a bold, deft and experienced operator, Cooper was well aware of this formula for success and welcomed opportunities to perform "capital" operations.

It was customary at the time for surgeons to invite medical colleagues to be present as observers during operations in order to have their advice and moral support, and to cultivate their referral of patients. Cooper's purpose in opening an Infirmary as soon as possible was to enable him from an early date to perform surgery in his own premises and be host - and instructor - to local and regional doctors. Aseptic techniques were unknown, of course, and there was no bar to the presence of even a considerable group, such as up to ten or twenty observers, crowding close around the operating table in their street clothes. Afterwards they discussed the operation freely outside among the profession in general, especially if there were some special features. Daily papers were always on the lookout for a good story and the surgeon's guests at the operation commonly provided explicit details to reporters. When report of an unusual operation appeared in the press, as it often did, the surgeon could righteously disavow responsibility for a gratuitous "puff" to his reputation if the case were successful. On the other hand, if the outcome was unfavorable, the surgeon could expect a scathing critique of his judgement and technique.

Operating before an audience lent itself to the dissemination not only of complimentary information but also of distortions and malicious gossip, as Cooper was to learn from the following case that occurred six months after his arrival in San Francisco.

Cooper not only hosted practitioners at operations in his own Infirmary, but also attended the operating rooms of other surgeons at their invitation in order to broaden his clinical knowledge and to evaluate surgical practice in the community. It was on such a courtesy call that he by chance became involved in the Travers case. ^[27]

A man named Frank Travers was stabbed in the upper thigh (left or right not specified). His femoral artery was lacerated, resulting in repeated severe hemorrhages and development of a femoral artery aneurysm. Treatment of such a condition would require ligating the external iliac artery in the lower abdomen to control the flow of blood to the femoral artery - a difficult and truly "capital" operation at the time. According to Cooper:^[28]

Cooper was delighted with this unexpected opportunity, only six months after his arrival in San Francisco, to demonstrate his superior anatomical knowledge and surgical skill before a group of about twenty of the town's physicians. He recognized that his situation was similar to that of Brainard who, seventeen years before in Chicago, performed a difficult amputation on a canal worker's leg in the presence of many of the local doctors - with great benefit to his reputation.

Travers was anesthetized with chloroform by one of the doctors. Cooper, as well as the crowd of spectators, were all in ordinary street dress, although Cooper and his assistant did roll up their sleeves and don aprons to protect their clothes. Speed and dexterity being the hallmark of the master surgeon, he rapidly made an incision in the lateral aspect of the lower abdomen with a scalpel that he took from the instrument case he always carried with him. Pushing the superficial tissues aside in a swift and nearly bloodless maneuver, he reached the fibrous layer of the abdominal wall known as the "transversalis fascia" which is the last barrier covering the extraperitoneal space between the peritoneal membrane medially and the pelvic wall laterally. Within this space the iliac artery and vein course side-by-side to the lower limb where they become the femoral artery and vein.^[29]

The peritoneal membrane was markedly thickened and adherent to the side wall of the pelvis, effectively sealing off the space occupied by the iliac artery and vein which are normally easily exposed by detaching the peritoneum from the pelvic sidewall with the finger. While Cooper was carefully separating these thickened and adherent surfaces, the large and thin-walled iliac vein accompanying the artery was torn and dark blood gushed up in a torrent from deep in the pelvis. Dr. Sawyer, Cooper's panic-stricken assistant, froze and the horrified onlookers who now moved in close for a better view of the operative field, sensed that death from uncontrollable hemorrhage was imminent.

In the hands of any surgeon on the Pacific Coast except Cooper, a tragic outcome may well have been inevitable. No operator in the region aside from Cooper was so disciplined by countless hours of anatomical dissection and surgical procedures assiduously practiced in the animal laboratory, that equanimity and technical virtuosity were normal responses in an emergency. He knew that false or frantic moves would worsen bleeding or do irreparable damage to vital structures. While the observers watched in breathless anxiety, Cooper arrested the hemorrhage by calmly directing his assistant to press down a sea sponge firmly on the bleeding point in the pelvis while he coolly and adroitly enlarged the wound, exposed the iliac vessels, tied the vein above and below the tear and then ligated the artery. It was an impressive feat of damage control.

The patient made a rapid recovery, without a single untoward symptom. To Cooper, this favorable course was not only a source of gratification, but it also raised the physiological question of whether tying both the iliac artery and the vein at the same time, a procedure thought to be hazardous, was as harmful as generally believed. He knew that when the vein alone is tied and the artery remains open, congestion of the venous system often results and swelling of the limb, even clotting of the blood in the engorged veins may occur. When the artery alone is tied and venous return continues unimpeded, the limb is deprived of blood and may be cold and its sensation impaired.

Perhaps in Travers's case the tying of both vessels resulted in the retention of a more natural amount of blood in the extremity. Did this account for the good result? As was his custom, Cooper tried the experiment:^[30]

According to the above experiment, the answer to the question posed by Cooper and his medical friends is probably "Yes, tying both iliac artery and vein at the same time did result in a more normal balance in the circulation of the extremity."

While it is clear that Cooper exhibited superior technical skill in controlling hemorrhage under difficult conditions, the most significant feature of the Travers episode is not in Cooper's surgical coup, but in his turning to the laboratory for an explanation of the clinical outcome of the case. Indeed it was Cooper's devotion to research and teaching that set him apart from his peers in San Francisco where, from the outset, he conducted programs to teach anatomy (the basic surgical science of his day) and to investigate clinical surgical problems in the animal laboratory. He is the first surgeon in the region to heed the admonition of John Hunter (1728-1793), founder of surgery as a science: "Why not try the experiment?" Cooper's experimental ligation of the iliac vessels, simplistic as it seems today, was evidence of a commitment to academic pursuits that earned him the respect and loyalty of a small coterie who later joined him in founding a medical school.^[31]

But there is more to the Travers story. As usual in such cases, there was free discussion of the operation among the doctors, and sidewalk progress reports kept all informed. Interest on the street was particularly keen in this instance because Travers was a well-known figure in the downtown area, being the cabman on the corner of Broadway and Kearney. As we have seen, the operation was well attended. The many eye-witness accounts of the procedure generally varied only in the superlatives used to describe the surgeon's skill and poise. All of this was very gratifying to Cooper until the day when word reached him that a prominent physician, Dr. H.M. Gray who had been present at the operation, pronounced it the botched job of an inept surgeon - or words to that effect.

Although Cooper was not personally acquainted with Dr. Gray, he knew that criticism by him was a serious matter because Gray's arrival in San Francisco during the Gold Rush period conferred upon him and other doctors of this vintage a distinctly honorific status as "pioneers" within the medical profession of the city.

Henry M. Gray (1821-1863) was born in New York City, son of the Reverend William Gray, a Scotch Presbyterian clergyman. Soon after his birth his family moved to Seneca Falls in northeastern New York State where he spent his youth and early manhood. His medical education consisted of an apprenticeship with a private physician in nearby Almyra and graduation in 1842 from Geneva Medical College, a "country medical school" that was moved to Syracuse, New York, and became the Medical Department of Syracuse University in 1872.^[32]

To commence the practice of medicine he moved back to New York City where his bright mind, pleasing frankness of manner and gratuitous practice among the poor soon won him a secure professional and enviable social position. Although he was assured of speedy eminence as a New York physician, his love of adventure and the excitement of the California gold discovery led him to close his office and organize an immigrant party of ten congenial spirits - college mates, friends and associates. They purchased the bark Hope and set sail in July 1849 on the six-months' voyage around Cape Horn to the gold fields of California, he acting as the surgeon of the expedition. Touching en route at Rio de Janiero, they reached San Francisco in December. Some of the party, including Dr. Gray, visited the mining regions, but he returned to San Francisco in a few months where he immediately commenced the practice of medicine, to which he thenceforth devoted himself.

His practice, at first limited, grew to be among the most extensive in San Francisco, and so lucrative that in a few years he acquired a considerable fortune that enabled him to support not only his expensive habits but to make liberal contributions to the many charities that appealed to him for aid. As in New York, he was generous in his services to needy patients so that his kind offices were legendary in the community. He was a member of the San Francisco Medical Society and San Francisco Pathological Society, associations that were initiated by the pioneer group of physicians.

Just as with Dr. John D. Arnold, Cooper's adversary in Peoria, Dr. Gray had a decided interest in political affairs. He identified himself with the Whig Party in California and was Secretary of the Whig State Central Committee and Chairman of the Whig General Committee. His popularity was such that the Whig Nominating Committee considered (but did not choose) him as the Party's candidate for Mayor of San Francisco in 1852. His talents as an orator were greatly admired and hearers were impressed by his polished eloquence and unstudied gracefulness of delivery. He was a devoted member of the Masonic Order and on many special occasions addressed its members in the fervent rhetoric for which he was distinguished. However, the genial disposition and collegial temperament attributed to him by biographers were apparently not evident to Dr. Cooper in his relations with Dr. Gray.

Dr. Gray died at the age of 42 after a lingering period of broken health. He was unmarried and the Society of California Pioneers received his body in their hall where it lay in state before the funeral.

With respect to Dr. Gray's surgical knowledge and skills, we are unable to find any writings by him or statements by contemporaries that would enlighten us in this regard. The only reference to his proficiency in a natural science is ambiguous: "He had a genuine appreciation of the grandeur and beauty of nature, and the correctness of an anatomist in the choice of fine horses, of which he was particularly fond."^[33][34]

The barbs of Dr. Gray, a well-established and respected figure in San Francisco, were potentially ruinous when leveled at a newcomer such as Cooper who was beginning to annoy the old guard as an offensive upstart. Since coming to San Francisco, Cooper had indeed been "riding high." His whirlwind of activity (of which we have so far referred to only a small part) had gained him many friends and he had made great progress in implementing his long range plan. He had so far not been challenged for his extravagant advertising. Occupancy of his Infirmary and attendance at his Clinic on Sansome Street had grown so rapidly that he was arranging to move to more spacious quarters on near-by Mission Street. Students had been recruited for his Medical Course on Anatomy and Vivisection that had now been in session for several months. Therefore, the report that the silver-tongued Dr. Gray was slandering him to an ever-widening circle of practitioners and laymen who respected the 49er's judgement came as a shock and outrage to the sensitive Cooper.

As to Gray's criticisms of Cooper's surgical technique, they were in fact meaningless quibbles. Therefore, considering the distinction of the source, and counting on the generally favorable opinion of his operation to offset Gray's comments, Cooper took a cautious approach. He waited three months for the gossip to subside. But Gray's libel continued unabated and, inexplicably, there was a sinister persistence in his attack on Cooper's reputation. Finally, barely containing his anger, Cooper addressed the following letter to Dr. Gray:^[35]

To Cooper's increasing indignation, there was no reply or conciliatory gesture in response to his letter of 10 April; and Gray continued during the following weeks to make contemptuous allusions to the Travers operation and Cooper's alleged technical incompetence. Having previously been the victim of medical intrigues in Illinois, Cooper might be excused for his suspicion that the relentless Gray was the agent of a cabal determined to discredit him. Lesser provocations often led to lethal duels in mid-century America, but Cooper chose instead to engage in verbal combat. He wrote the following letter to the Editor of a San Francisco paper:^[36]

We have no record of a response by Gray to Cooper's sarcastic questioning of his motives and of his competence to judge the Travers operation, but we shall learn that the Cooper's seething resentment later erupted into a altercation with Gray who escaped physical harm only through the intervention of their medical colleagues. It is also of more than passing interest that the five doctors who signed the Testimonial were all co-founding members with Cooper of the San Francisco County Medico-Chirurgical Association, a society whose early history we shall shortly address.

The Gray episode was Cooper's first confrontation with San Francisco's medical "establishment" and we shall see to what lengths they will go in their intrigues to bring him down.

No medical journal had ever been published in California when Cooper arrived and he was well aware of the importance of such a publication both as an outlet for his medical articles and as a vehicle for informing and unifying the profession. As a model he had in mind the North-Western Medical and Surgical Journal published in Chicago as a continuation of the Illinois Medical and Surgical Journal which was founded in 1844. He noted that this journal had always been edited by a member of the Rush medical faculty and, in addition to scientific writings, regularly provided information about Rush Medical School, medical education and medical societies The very presence of such a journal in the Old Northwest stimulated the pursuit and publication of new knowledge, served as a major source of continuing education for practitioners, and by its editorial pages molded opinion and championed worthy medical causes - particularly the Rush Medical School itself.

Small wonder then that Cooper wished to found a journal along the same lines as soon as possible in order to confer these benefits on the rapidly developing West and, of course, enable him to be the principal spokesman for the cause to which he was devoted - medical education.

Therefore, when after six months his medical practice and medical course were well in hand, Cooper sent a prospectus for a medical journal to Dr. Alexander Josephus Spencer (1811-1885), a New Yorker who came to San Jose in 1852 and attained some prominence in medicine and community affairs (and was later a Cooper-colleague in the California State Medical Society). Cooper was under the impression that Dr. Spencer had the resources and sufficient interest in the subject to consider publishing a medical journal. In the following otherwise thoughtful reply, Spencer referred to the North-Western Medical and Surgical Journal of Chicago in terms that seem unduly critical.^[38][39]

Cooper did not at the time persist in the effort to establish a medical journal because a few months later in 1856 Dr. John F. Morse of Sacramento founded the California State Medical Journal (fully endorsed by Cooper) which sadly, after only four issues, was discontinued in 1857 for lack of funds. We have already alluded to Cooper's spurned offer to provide start-up support for the Pacific Medical and Surgical Journal which began publication in January 1858. Cooper ultimately achieved the goal of publishing his own medical journal when, in January 1860, there appeared the first issue of the San Francisco Medical Press, edited by E.S. Cooper, A.M., MD

Among Cooper's personal papers we find the following somewhat euphoric, but prophetic expression of San Francisco's prospects as he viewed them at the end of 1855:^[40]

In the following brief sketch, also written by Cooper at the end of 1855, he reviews his own accomplishments with pride but speaks ominously of "bitter enemies," while quaintly referring to himself in the third person:^[41]

We can but agree with Cooper that he made remarkable progress in his first six months in San Francisco and have described five crucial initiatives that he took during that period. We shall now turn to an account of the sixth facet of his plan - the founding of medical societies - with its historic significance for the organization of medicine on the Pacific Coast.

1. Frank Soulé , John H. Gihon and James Nesbet , eds., Annals of San Francisco (New York: D. Appleton and Co., 1855), p. 448
2. Dorothy H. Huggins, compiler, Continuation of the Annals of San Francisco, Part 1, From June 1, 1854, to December 31, 1855 (San Francisco: California Historical Society, 1939), pp. 44-45
3. Ludwig A. Emge, introduction to Elias Samuel Cooper, 1822-1862: notice of the death of Dr. E.S. Cooper, with a biographical sketch, by L. C. Lane (Stanford Medical School, 1965). (Reprint of L. C. Lane, "On the 13th of October, at 20 minutes before 9 o'clock, A.M., expired, Dr E.S. Cooper....," San Francisco Medical Press 3, no. 3 (Oct 1862): 226-243.) Library Catalog Record
4. Richard Henry Dana , Two Years before the Mast (New York: Bantam Books, 1959), p. 295
5. Hubert H. Bancroft , History of California, vol. 6, 1848-1859, The Works of Hubert Howe Bancroft, vol. 23 (San Francisco: The History Company, Publishers, 1888), p. 786. We have previously commented on the impossibility of obtaining reliable census data on early California. The San Francisco Directory for 1857-58 gives the city's population as 60,000. Alta California for 3 November 1855 claimed at least 60,000; whereas the Sacramento Union on 29 August 1855 reduced the figure to 40,000. We have used 50,000 as a reasonable estimate of San Francisco's permanent population in 1855
6. John S. Hittell , A History of San Francisco and Incidentally of California (San Francisco: A.L. Bancroft and Co., 1978), pp. 235-237 Library Catalog Record
7. Samuel Dickson , Tales of San Francisco (Stanford: Stanford University Press, 1957), p. 296 Library Catalog Record
8. Hubert H. Bancroft , History of California, vol. 6, 1848-1859, The Works of Hubert Howe Bancroft, vol. 23 (San Francisco: The History Company, Publishers, 1888), pp. 780-786 and p. 794
9. John S. Hittell , A History of San Francisco and Incidentally of California (San Francisco: A.L. Bancroft and Co., 1978), pp. 226-233 Library Catalog Record
10. John S. Hittell, A History of San Francisco and Incidentally of California (San Francisco: A.L. Bancroft and Co., 1978), pp. 172-178 Library Catalog Record
11. John S. Hittell , A History of San Francisco and Incidentally of California (San Francisco: A.L. Bancroft and Co., 1978), pp. 243-247 Library Catalog Record
12. Emge Research Materials-Typewritten copies of Cooper Correspondence - Box 3, Folder 16, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
13. Emge Research Materials-Correspondence, 1930-1978 - Box 3, Folder 14, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
14. Emge Research Materials-Typewritten copies of Cooper Correspondence - Box 3, Folder 16, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
15. Item 18[C], Emge Research Materials-Correspondence, 1930-1978 - Box 3, Folder 14, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
16. Item 18, Correspondence, 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
17. Emge Research Materials-Correspondence, 1930-1978 - Box 3, Folder 14, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
18. David Wooster , "Editor's Table. University of the Pacific," Pacific Medical and Surgical Journal 2, no. 12 (Dec 1859): 497-498 Library Catalog Record
19. Emge Research Materials-Typewritten copies of Cooper Correspondence - Box 3, Folder 16, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library. See transcription of an article from Alta Californian for 17 August 1855. The format of the ad as published in our text is a composite of information from Dr. Wooster's caustic article in the Pacific Medical and Surgical Journal (December 1859) and a transcription of the news story as it appeared in Alta California on 17 August 1855
20. Ephemera - Box 1, Folder 6, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
21. Circular printed for Cooper in July 1855 announcing the offering of a Course of Medical Instruction as soon a sufficient number of pupils were engaged to attend. Printed Materials - Box 1, Folder 7, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
22. David Wooster , "Editor's Table: University of the Pacific," Pacific Medical and Surgical Journal 2, no. 12 (Dec 1859): 496 Library Catalog Record
23. R. French Stone , ed., Biography of Eminent American Physicians and Surgeons (Indianapolis: Carlon and Hollenbeck, Publishers, 1894), s.v. "Wooster, David," p. 705 Library Catalog Record
24. Dumas Malone , ed., Dictionary of American Biography, Vol. 20 (New York: Charles Scribner's Sons, 1943), s.v., "Wooster, David," pp. 524-525 Library Catalog Record
25. David Wooster , "To the Readers of the Pacific Medical and Surgical Journal," Pacific Medical and Surgical Journal 4 (1861): 368 Library Catalog Record
26. Printed Materials - Box 1, Folder 7, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
27. Correspondence, n.d. - Box 1, Folder 5, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library. Ephemera - Box 1, Folder 6, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
28. Elias S. Cooper , "On ligating the satellite veins in connexion with arteries which they accompany: Operation of ligating the external iliac artery and vein: Rapid recovery of the patient," California State Medical Journal 2, no. 2 (Apr 1857): 441 Library Catalog Record
29. Elias S. Cooper , "On ligating the satellite veins in connexion with arteries which they accompany: Operation of ligating the external iliac artery and vein: Rapid recovery of the patient," California State Medical Journal 2, no. 2 (Apr 1857) Library Catalog Record
30. Elias S. Cooper , "On ligating the satellite veins in connexion with arteries which they accompany: Operation of ligating the external iliac artery and vein: Rapid recovery of the patient," California State Medical Journal 2, no. 2 (Apr 1857): 443-445 Library Catalog Record
31. Ralph H. Major , "Life of John Hunter (1728-1793)" , in A History of Medicine, vol. 2 (Springfield, Illinois: Charles C. Thomas, Publisher, 1954), pp. 601-606
32. William F. Norwood , Medical Education in the United States before the Civil War (Philadelphia: University of Pennsylvania Press, 1944), pp. 155-159 Library Catalog Record
33. Oscar T. Shuck , ed., Representative and Leading Men of the Pacific (San Francisco: Bacon and Company, 1870), pp. 479-493 Library Catalog Record
34. Editorial, "Obituary of H. M. Gray, M.D." , Pacific Medical and Surgical Journal vol. 6 (1863): pp.302-303 Library Catalog Record
35. Correspondence, n.d. - Box 1, Folder 5, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library. Ephemera - Box 1, Folder 6, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
36. Correspondence, n.d. - Box 1, Folder 5, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library.Ephemera - Box 1, Folder 6, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library. Among E.S. Cooper's papers is an undated draft of a letter to "Mr. Editor," regarding the Travers Case, probably written in May 1856. It is in the hand of Cooper with several missing pages, and there are multiple versions of short segments of the statement. These materials have been arranged in a logical sequence to reconstruct the letter. The date and name of the newspaper (presumably a S.F. publication) to which the letter was sent have not been located, nor has a clipping been found
37. Joseph Pancoast , A Treatise on Operative Surgery (Philadelphia: Cary and Hart, 1844), p. 56 Library Catalog Record
38. Correspondence, 1855 - Box 1, Folder 2, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
39. File of Alexander Josephus Spencer - Box 3.29, John L. Wilson Papers - MSS 39, Lane Medical Archives, Stanford
40. Autobiography - Box 1, Folder 8, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
41. Autobiography - Box 1, Folder 8, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library