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

By participating in the founding of the San Francisco County Medico-Chirurgical Association Cooper secured a base of operations from which to organize a State Medical Society. Because of the parochial outlook and instability of the early city and county societies in California, there was no leadership at the state level until Cooper seized the initiative and supplied it. We now have sufficient information about the local societies to enable us to undertake a chronological account of the organization of the State Society.

The San Francisco Medico-Chirurgical Association had been in existence for less than a month when Corresponding Secretary E. S. Cooper requested authorization to address the following historic letter to Dr. Thomas Logan, his counterpart in the Sacramento Medical Society:^[1]

After a delay of three months, Dr. Logan of the Sacramento Medical Society responded to Cooper as follows:^[2]

Cooper, eager to keep negotiations regarding a State Society moving briskly, responded to Logan's encouraging letter of 29 November by dispatching to him the following letter on the very next day.^[3]

Two long months now passed before the impatient Cooper was rewarded with the following assurance from Logan of "unanimity of feeling and concurrence of action" with respect to the founding of a State Society:^[4]

Logan and his colleagues, by proposing in his letter of 3 February that a convention meet in Sacramento on 12 March 1856 to organize a State Medical Society, acutely accelerated the planning process. Less than six weeks remained for completion of all arrangements.

It was, of course, imperative to inform the State's physicians of the objectives of the Convention as soon as possible, and to assure a substantial attendance that included leaders of the profession. With these requirements in mind, Cooper responded immediately to Logan proposing the following Preamble and Resolution to be printed in a Circular and sent to all physicians:^[5]

Cooper also provided Logan with the following list of leading California physicians with the suggestion that they be invited to join in the call for the Convention:

In accordance with the foregoing Preamble and Resolution the undersigned do hereby call a convention to meet in Sacramento on the 2nd Wednesday of March 1856:

Doctors	Location	Doctors	Location
Cory	San Jose	- Baldwin	Shasta
Spencer	San Jose	Hon. Dr. Keen	Placerville
Bell	San Jose	H. J. Hammond	San Diego
J. Crane	San Jose	J. S. Griffin	Los Angeles
A. N. Sasee	Santa Clara	-..Walland	Santa Barbara
A. B. Caldwell	Santa Clara	- Ayer	Stockton
W. Warburton	Santa Clara	- Kerr	Stockton
B. R. Mitchell	Vallejo	- Screvens	Mariposa
J. N. Rice	Marysville	- Carman	Nevada
J. T. McLane	Marysville	D. Austin	Nevada
R. McDaniels	Marysville	R.C. Wyatte	Cherokee
J. Prisson	Marysville	T. Kendall	Sonora
J. T. Finch	Marysville	J. Walker	Sonora
- McKee	Monterey	- George	?

We do not know whether any of the above physicians actually joined officially in the call for the Convention as proposed by Cooper for we have no copy of the Circular announcing the Convention. However, Cooper's strategy to solicit their support was sound and consistent with his other diligent efforts to arouse interest in forming local medical societies as well as a State Society. With these objectives in mind, he wrote numerous letters such as the following one to Dr. McLane of Marysville:^[6]

It was now just one month before the Convention and much remained to be done to assure efficient transaction of the complex business of organizing a State Society. The urgency is reflected in Logan's next letter to Cooper that addressed politically-sensitive issues:^[7]

Imagine Cooper's chagrin at having the name of Dr. Gray so innocently brought forward by Logan for first President of the State Society. Cooper held his tongue and ignored Logan's question, but vented his annoyance by crossing out the Postscript on Logan's original letter with a sweep of his well-inked pen. There was also another cause for concern in Logan's letter. He asked Cooper to convey his special regards to Dr. Toland. Logan could not know that Toland, like Gray, was counted by Cooper as among his detractors. Now for the first time Cooper began to be apprehensive about the leadership that might emerge to dominate the State Society in which he had invested so much of his own effort.

A week later Cooper heard again from Logan, this time with the good news about arrangements for advertising the Convention.^[8]

It was clear from Logan's letter of February twenty-first that preparations for the Convention were reaching their final phase. Whether Cooper went to Sacramento for a pre-Convention conference with Logan and Morse, we do not know. That the Sacramento group were considering "a Medical School" must have aroused his concern, but we have no evidence that they made a serious move in that direction.

For his part, Cooper had been busy developing an appropriate response to Logan's magnanimous suggestion in his letter of February thirteenth that the San Francisco delegation to the Convention agree in advance to nominate one of their number as the first President of the State Society, with the assurance that the candidate would receive the support of the Sacramento Society. Given the strained relations among San Francisco's three medical societies, Cooper was faced with a delicate task. In a letter to Logan dated February twenty-third, he proposed a solution that took the high ground for the Medico-Chirurgical Association, showed deference to the "seniority" of the San Francisco Medical Society, and at the same time took a supercilious dig at the Society. The letter, Cooper-style, is fraught with pious resolutions:^[9]

In accordance with the final resolution, Cooper sent a copy of his letter of February twenty-third to Dr. W. P. Gibbons, Henry Gibbons' brother and Corresponding Secretary of the San Francisco Medical Society, with the following covering note:^[10]

In view of the tone of Cooper's letters to Logan and Gibbons, one would not expect a cordial response from the San Francisco Medical Society. As far as we can determine there was no formal response at all, and the selection of the first President of the State Medical Society took place appropriately on the floor of the Convention, where we will now join Cooper, Logan et al.^[11]

The Convention called to form the first State Medical Society in California assembled in Pioneer Hall in Sacramento on Wednesday, 12 March 1856, at three P.M. Seventy-six medical men were present, representing 16 Counties.

The largest delegation, twenty-eight in all, came from Sacramento, prominent among them being Drs. Logan and Morse. There were thirteen delegates from San Francisco including Drs. Bowie, Cole, Cooper, Henry Gibbons, Gray and Stout.

The Convention was called to order by Dr. Houghton, President of the Sacramento Medical Society and Dr. Morse was, on nomination, promptly elected temporary Chairman of the Convention. With Dr. Morse presiding, permanent officers of the Convention were nominated by a committee composed of one member from each County delegation. Dr. Benjamin F. Keene of Placerville in El Dorado County was elected President. Dr. Keene, a dignified and highly respected physician from the heart of the gold country was an admirable choice for the presidency, at one stroke gaining a universally acceptable presiding officer and avoiding the political issues surrounding the selection of a candidate from San Francisco. Dr. Keene appointed Dr. Gibbons Chairman of a Committee on Constitution and By-Laws and the Convention adjourned for the day.

The following morning Dr. Gibbons for his Committee submitted a draft Constitution and By-Laws for government of the California State Medical Society, the draft being based on principles and procedures recommended by the American Medical Association. After some minor amendments, the Constitution, By-Laws and Code of Ethics were adopted as a whole.

Selection of officers for the ensuing year now being in order, the following were duly elected:

• B.F. Keene, El Dorado President
• E.S. Cooper, San Francisco First Vice President
• T.S. Logan, Sacramento Corresponding Secretary

As the second day of the Convention drew to a close, Dr. Augustus J. Spencer of San Jose rose to offer the following resolution:

Notwithstanding that advertising was strongly condemned as "derogatory to the dignity of the profession" by the Code of Ethics of the American Medical Association just adopted by the State Society, disapproval of the practice was sufficiently intense among the delegates that Spencer's additional resolution was adopted unanimously. Cooper was yet to realize the implications for him of this evidence of the delegates' uncompromising position on the subject.

The third and final day of the Convention was devoted to various items, among which the following are the most noteworthy.

Dr. Logan reported the recommendation of the Committee on a Medical Journal that the State Medical Society support the publication of a medical journal to be edited by Dr. Morse. The recommendation was approved and Dr. Morse became editor of the California State Medical Journal which he agreed to publish as a quarterly provided two hundred subscribers could be obtained at the rate of five dollars each per annum. The first issue of the Journal was for the month of July 1856 and included the Minutes and Proceedings of the Convention and First Meeting of the Medical Society of the State of California. However, Morse was able to publish only three more issues (October 1856, January 1857 and April 1857) and was then forced by lack of funds from subscribers to discontinue this valuable journal.

As he previously had done at the Illinois State Medical Society, Cooper seized the opportunity once more to call for liberalization of laws regarding anatomical dissection. He introduced the following preamble and resolutions that were referred to the Committee on Legislation (where they died):

On motion of Dr. Dustin, the delegate from Nevada County, Cooper was invited to deliver the only scientific paper of the meeting. He chose to report the following experiments on ligation of the abdominal aorta in dogs.

As already mentioned, ligation of major vessels, usually for aneurysm or trauma, was among the "capital" operations of the day. The aorta, being the largest vessel of all, was the Mount Everest of vascular surgery. No patient had ever survived ligation of the abdominal aorta. Three such cases were described by Pancoast in his Treatise on Operative Surgery^[12]. The causes of death were not specified, but it had always been assumed (but not proven) that the most likely complications of aortic ligation would be gangrene of the lower extremities, peritonitis and hemorrhage.

After the attention of the profession was called to this subject, more than forty patients were reported to have survived gradual obliteration of the abdominal aorta by tumor or other cause. Survival in these cases was thought to be due to maintenance of circulation through development of collateral vessels that carried blood around the point of obstruction.

In December 1855 Cooper began a series of experiments on dogs to determine the cause of death in acute occlusion of the abdominal aorta and to devise a method to prevent it. Cooper's animals all died shortly after ligation of the vessel. By post mortem examination he determined for the first time that the cause of death in dogs under these circumstances was intense engorgement of the proximal arterial circulation above the ligation as well as the heart. This he attributed to cutting off nearly one half the vascular system, thus confining the arterial blood to a markedly reduced circulation.

He then decided to induce slow obliteration of the aorta, as occurred in the surviving human cases, so that collateral circulation would have time to develop. He invented an instrument that encircled the aorta and came out through the wound. The instrument could then be tightened from the outside so as to obstruct the aorta by degrees rather than acutely. By this procedure, he diminished the circulation in the vessel about one-half immediately, and on the seventh day obstructed it completely. The animal lived for four days with the aorta completely closed before dying from hemorrhage during the fourth night, presumably from having violently displaced the instrument with its teeth. Such an accident would not occur in a human patient. Post mortem examination showed that collateral circulation had already begun to develop around the dog's obstructed aorta and would apparently have sustained a permanent recovery had not the hemorrhage supervened.^[13]

Cooper's animal studies demonstrated uncommon initiative and indicated that he was making productive use of the surgical laboratory he had established. He was an enthusiastic teacher, normally involving others in his projects. For example, Drs. Beverly Cole and C. A. Kirkpatrick, among others, assisted Cooper in the aortic ligation experiments. Cooper never attempted to ligate the abdominal aorta in a patient but his experiments suggested a method of accomplishing the feat with survival. For years to come no other surgeon on the Pacific Coast was to address surgical questions in the laboratory with the combined objective of research and education. Meanwhile Cooper was developing a small but loyal group of physicians who recognized in him the genuine devotion to teaching and investigation that distinguished him from the critics who ridiculed his efforts.

Cooper's paper was very well received by the members of the State Society who voted to request him to report further on his experiments at the next meeting.

When the Convention and first meeting of the State Medical Society adjourned on 14 March 1856, all concerned had reason to be gratified. From Cooper's original letter to Logan on 27 August 1855 proposing organization of a State Society to the opening of the Convention in Sacramento on 12 March 1856, only six and a half months had elapsed. Cooper and the San Francisco County Medico-Chirurgical Association initiated and aroused wide professional interest in the proposal, while Logan and the Sacramento Medical Society sponsored and organized the Convention with consummate finesse. When the delegates assembled in Sacramento, the order of business was so well managed by the host Society that by the end of the second day the California State Medical Society had been founded, Constitution and By-Laws adopted, and officers for the ensuing year elected.

Cooper's contribution to the process was appropriately recognized by his election as First Vice President. Nevertheless, he felt a tinge of disappointment at not being named President. Among his papers there is the undated draft of an address obviously prepared for delivery when taking high office in the State Society. In the draft, Cooper states the objects and advantages of the new Society and includes the following high-minded advice to his enemies from San Francisco whom he suspected would try to infiltrate the organization.^[14]

The Minutes of the first meeting of the State Society contain not the slightest hint that the proceedings were marred by contention of any kind. However, Cooper was uneasy to find that Dr. Gray, with whom he was at odds over the Travers case, and Dr. Stout, Gray's fellow member from the despised Pathological Society, were both present and taking an active part in the parliamentary maneuvering. Also present was a third member of the Pathological Society, Dr. J. P. Whitney, whom Cooper was later to accuse of making slanderous remarks about him. Imagine Cooper's annoyance when Drs. Gray, Stout and Whitney were all three elected to the seven-member Board of Censors of the State Society for the ensuing year.

Could this mean that members of the Pathological Society, who prior to the Convention had shown no interest in a State Society, were now positioning themselves to control the new organization in order to attack him in the state-wide forum he had worked so hard to create? The following incident during the Convention led Cooper to believe that such an intrigue was indeed afoot. When his name was proposed for some inferior office in the State Society, Stout rose to move a change in the mode of procedure, urging as the reason that otherwise "some member from San Francisco might obtain office who was not qualified." To the suspicious Cooper, that "some member from San Francisco" could be none other than himself. His suspicion was justified for Stout later confirmed that he had attempted to discredit Cooper at the first meeting of the State Society.^[15]

With the relations between Cooper and the Pathological Society in a delicate state at the end of the Convention, it is necessary temporarily to leave the field of petty medical skirmishing and take note of the more lethal conflict about to erupt in the public sector - the murder of James King of William and revival of the Vigilance Committee.

1. Correspondence 1855 - Box 1, Folder 2, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
2. Correspondence 1855 - Box 1, Folder 2, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
3. Correspondence 1855 - Box 1, Folder 2, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
4. Correspondence 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
5. Correspondence 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library. The Preamble and Resolution and a mailing list of prominent physicians, in Cooper's handwriting, were found among his papers. Although no letter of transmission from Cooper to Logan was present, Logan's letter to Cooper of 13 February 1856 acknowledges that he received and concurred with Cooper's Preamble
6. Correspondence 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
7. Correspondence 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
8. Correspondence 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
9. Folder: Correspondence 1856 (CHSL Box #1. Folder #3), File of California Historical Society Library, E. S. Cooper Collection, Lane Medical Archives, Stanford
10. Correspondence 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
11. Arthur B. Stout et al, Committee on Publications, "Minutes and Proceedings of the Convention and of the Medical Society of the State of California, Held in Sacramento, March, 1856," California State Medical Journal 1 (Jul 1856): 4-34 Lane Library catalog record
12. Joseph Pancoast , A Treatise on Operative Surgery (Philadelphia: A. Hart, late Cary and Hart, 1852), pp. 68-69 Lane Library catalog record
13. Elias S. Cooper , "Remarks upon the practicability of obliterating the abdominal aorta by gradual pressure, illustrated by vivisections," California State Medical Journal (Jul 1856): 69-72 Lane Library catalog record
14. Correspondence, 1856 - Box 1, Folder 3, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library
15. Correspondence - No Date, Elias Samuel Cooper Papers – MS 458, California Historical Society, North Baker Research Library