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

Transactions of the State Medical Society, 1857

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Operation, 9 April 1857

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

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

17 July 1857

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

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

31 July 1857

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

14 August 1857

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

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

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

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

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

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

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

9 October 1857

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

16 October 1857

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cooper summarized the postoperative course in a few words:

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

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

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

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

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

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

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

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

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