Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective
Part III. Founding of First Medical School and Successions 1858-

The Way Prepared

For Elias Samuel Cooper the year of 1858 was truly the worst of times. We have already seen the misfortunes he endured in that year. He narrowly escaped expulsion from the State Society by a hostile clique of San Francisco physicians. Furthermore, these same forces of conspiracy and betrayal later instigated the Hodges' malpractice suit as a more certain means whereby to administer a coup de grâce to the "presumptuous" Cooper.

Adversities such as these, augmented as they were by failing health, could scarcely fail to break the spirit of a man. Yet even in the shadow of such threatening conditions, Cooper's master plan continued to unfold and in 1858 his ultimate goal was achieved. He founded a medical school. In the light of this achievement, the year of 1858 was also for him the best of times.

Over the previous three years Cooper had developed his Pacific Clinical Infirmary, a capacious building of several stories in downtown San Francisco on Mission Street between Second and Third Streets, into a mini-medical center. Facilities comprised an ambulatory clinic, hospital beds, an operating room, anatomy and animal surgery laboratories and, on the top floor, a large room for lectures and demonstrations. There were doctors' offices, living quarters for the matron, and doubtless for himself as well. Not only did Cooper encourage the attendance of local and visiting doctors at his clinics and operations in the Infirmary for teaching purposes, but he also conducted there an ongoing series of formal courses of anatomical and surgical lectures and demonstrations. These he had initiated and advertised widely within a few months of his arrival on the Coast in 1855.

As participants in his clinical and laboratory teaching exercises, he co-opted a select-few able physicians who shared his interests in medical education and enthusiastically participated in his programs. Among these were Dr. Beverly Cole who lectured at the Infirmary and Dr. James Morison who rented an office in the Building. Both later became professors in the new school To complete the small inner circle of confidants to be included in his plan to found a medical school, Cooper chose Dr. Isaac Rowell. During the summer of 1858, in the lull between the State Society meeting in February and the malpractice trial in November, Cooper and his three colleagues, their confidence in him unshaken, defined their strategy for implementing the plan. They agreed to act on it promptly without awaiting the outcome of the Hodges suit.

The first objective was to conclude an affiliation with a college or university authorized to award the MD degree. Dr. Cole acted as the representative of the group. With discretion to avoid rumors that would frustrate his efforts, he approached various members of the Board of Trustees of the University of the Pacific. As previously noted, the University was established by the Methodist Church and chartered by the State of California in 1851. It was the first college in California to receive a charter from the State and was empowered to grant degrees. The institution was located in the town of Santa Clara, 48 miles south of San Francisco, but has since been moved to Stockton. At about the time of Cole's negotiations there was a faculty of six dedicated men, four of whom held A. M. degrees and four were protestant ministers. The school offered a two-year (high school) preparatory program, and a four-year college curriculum leading to the Baccalaureate degree. The school's catalogue for 1859-60 lists 82 students in the Preparatory Department and 26 in the College for a total of 111 students. For the time and place, the University of the Pacific was a substantial institution.^[1][2][3]

The trustees whom he consulted advised Cole to submit a proposal from the Cooper group to the University of the Pacific for creation of a Medical Department, with appointment of the group as its faculty. With this encouragement, Cole dispatched the following letter to the Board of Trustees:^[4]

Minutes of the Board, 16 September 1858. "Rev. E. Thomas presented a proposition from R. Beverly Cole in reference to a medical department of the U. of the P. Moved it be referred to a committee of three to take the matter under consideration."

Minutes of the Board, 22 September 1858. The Board met on this date and approved Cole's Proposition in accordance with a Resolution which is quoted in full in the following cordial letter to Cooper and associates.^[5][6]

The above anxiously-awaited letter was received with jubilation by the Cole, and deep satisfaction by Cooper whose vision of a medical school was beginning to materialize. Now he was determined to sustain the momentum by promptly organizing the faculty and inaugurating the teaching program before his predators recovered from their surprise and their preoccupation with the looming Hodges case. To this end Cooper promptly called together the Professors of the Medical Department to establish the Faculty as a self-governing body and to adopt the instruments of governance.

Minutes of First Faculty Meeting, 31 October 1858 ^[7]

Minutes of Second Faculty Meeting, 7 November 1858 ^[8]

As the year of 1858 drew to a close, Dean Cole addressed a progress report to the Board of Trustees. He included in the report a recommendation for appointment of two additional Professors, B. R. Carman and George Barstow, and for redistribution of the subjects to be taught by the faculty.^[9]

On this occasion the Board of Trustees lost no time in responding to a communication from the San Francisco doctors. The following reply to Cole's letter of December 6th was dispatched by the Secretary of the Board on December 8th:^[10]

The formal negotiations to found the first medical school on the Pacific Coast were completed in less than three months. By this time prospective students for the first teaching session of the Medical Department were already receiving lectures at the Pacific Clinical Infirmary. Relations between the Department and the University were harmonious from the beginning and remained so throughout their affiliation. We should note in passing that Cooper's group had a trusted friend, Dr. Henry Gibbons, on the Board of Trustees when the Proposal for a Medical Department was originally submitted to it. Dr. Gibbons became a member of the Board in 1855 and was serving on the Board when the Medical Department was established.^[11]

Planning for faculty, courses and graduation requirements in the new Department, or "medical school" as we shall now call it, was a comparatively easy task for the following reason. All American medical schools, of which there were 42 in operation in 1859, were structured along quite similar lines. The curriculum consisted primarily of an Annual Course of Lectures, usually of four months' duration. In designing the program, Cooper simply adopted the generally accepted principles or "formula" followed by existing schools as published in their Annual Announcements, of which Cooper had numerous copies among his personal papers. In addition to these useful documents, the Proceedings of the National Medical Conventions of 1846 and 1847 that founded the American Medical Association were available to him, as were the subsequent Reports of the A. M. A. Standing Committee on Medical Education.

The following is the standard format of American medical education on which Cooper based his program:^{[12][13][14][15]}

Professors: 7 (i. e., one for each of the following subjects)

Lecture Subjects (Number of Lectures in each subject per Annual Course):

• Theory and Practice of Medicine (100)
• Anatomy and Physiology (100)
• Materia Medica and Therapeutics (75)
• Medical Chemistry and Toxicology (75)
• Surgery (75)
• Obstetrics and Diseases of Women and Children (75)
• Medical Jurisprudence (40)

Annual Course of Lectures:

• Duration of the Annual Lecture Course - usually 18 weeks (4 months)
• Frequency of Lectures. - 5-6 one-hour lectures or demonstrations were delivered daily on 5-6 days of each week.
• Number of lectures delivered by an individual Professor during a Course varied from 50 to 110.
• Total lectures during a Course ranged from 400 to 550, depending upon the school.
• The same lectures were delivered in every Annual Course (i. e., students who took two Annual Courses heard the same lectures twice).
• A concurrent special course of Clinical lectures and bedside teaching in a well-regulated hospital was considered essential. Such a course was actually provided by only about half the medical schools due to lack of suitable hospital facilities.
• A Preliminary Course of free lectures was commonly given during the month preceding the Annual Course.

The Candidate must:

• Be a man of good moral character and at least 21 years of age
• Complete two Annual Lecture Courses, one of which must be in the school awarding the degree
• Have studied medicine for three years (including the time in lecture courses) with a respectable practitioner
• Submit an acceptable Medical Thesis of his own composition
• Pass an examination
• Pay the following fees

Fees:

• Each Annual Course of Lectures $105
• Matriculation Fee (paid only once) 5
• Annual Fee for Instruction by Demonstrator 5
• Graduation Fee 30

American medical schools in the 19th century were normally self-supporting and self-governing. Arrangements with universities and state legislatures were mainly for the purpose of acquiring authority to award the MD degree. Formal authorization as a "state school" was often sought for the additional purpose of obtaining state funds for operational support and building programs. In any case, medical schools were essentially autonomous from the programmatic standpoint and therefore highly resistant to educational reform. They derived their support primarily from Lecture and Graduation Fees which were commonly divided among the Professors after the modest cost of operating the school was deducted. This method of allocating funds encouraged large classes. In the larger schools, student fees were the source of considerable income, and medical education was profitable to the faculty. As an example, the following are 1859 data from Jefferson Medical College of Philadelphia (the nation's largest medical school at the time):^[16]

Students	Lecture Fee	Graduation Fee	Income
570	$105		$59,850
256 graduates		$30	7,680

Annual Receipts from Lecture and Graduation Fees = $ 67,530

(If $ 10, 000 were allocated annually for operational expense, the seven Professors would earn $8,000 each, a handsome return considering the purchasing power of the dollar in Philadelphia in 1859.)

It is not difficult to identify serious deficiencies in the education provided by American medical schools in Cooper's day. Modest changes such as the following were recommended by the A. M. A. Standing Committee on Medical Education, with little early success:

• Make prior collegiate studies a requirement for admission
• Lengthen the Annual Lecture Course to six months
• Provide for substantial clinical experience in a hospital

The Standing Committee compared European and American medical education and found the American far less rigorous than the European schools. For example, the University of Edinburgh program had the following characteristics:^[17]

• Admission requirement: A certificate of premedical studies plus an examination in Latin
• 13 Professors and 13 subjects
• Each Professor delivered 180 lectures annually
• 4 years of study required including a total of 8 courses (2 courses annually, one of 6 and one of 3 months).

During the eighty-odd years between Morgan's founding of the first medical school in 1765 and the mid-1800's, would-be reformers like Daniel Drake decried the low standard of American medical education and made valiant but futile efforts to improve it. Despite the discouraging prospect, Dr. Nathan S. Davis, a country practitioner of Binghamton, New York, initiated a reform movement in 1845 that was the major positive influence on medical schools during the years prior to the genuine revolution in medical education sparked by the Flexner Report of 1910.

At the annual meeting of the New York State Medical Society in 1845, Dr. Davis rose to submit the following resolution:^[18]

The proposed National Medical Convention met in New York on 5-6 May 1846 and a committee chaired by Dr. Davis submitted a series of memorable resolutions which were adopted. Pursuant to the first and second of these resolutions the Convention was reconvened in Philadelphia on 5-7 May 1847 for the purpose of founding a National Medical Association which was named the "American Medical Association." We will again mention that Dr. Davis, for his role in this transaction, is often referred to as the "Father of the A. M. A."

At the New York session of the National Medical Convention in May 1846, the Davis Committee also submitted the two other resolutions with major significance for the future of American medical education. These were approved as follows:^[19]

In response to these two resolutions of the Davis Committee, the newly-established American Medical Association appointed a Standing Committee on Medical Education. During the remainder of the century, the A. M. A. continued through this Committee to strive diligently to improve medical education but, unfortunately, with limited success. Dr. Davis was the "untiring, irrepressible, uncompromising and incorruptible" leader of the Association's campaign to raise standards. However, since the A. M. A. could do no more than exhort, the medical schools had little incentive to change. Few schools were willing to increase standards when this would result in the loss of many students (and significant income) to the schools that refused to reform. Therefore, medical schools in the United States remained distinctly inferior to European institutions and, as a result, American students flocked to Europe for the education necessary to fulfill their professional aspirations. Upon returning home, many served to revitalize their native institutions.

The Civil War years of 1861 to 1864 were as disastrous for progress in medical education as they were for the nation as a whole. In the decades that followed, however, the insistence of the A. M. A. on increasing premedical requirements, lengthening the curriculum, and strengthening the examinations began to have an effect. Finally, at the turn of the century, Johns Hopkins provided the definitive model and Abraham Flexner the stern indictment that led at last to fundamental and widespread reform.^[20][21][22]

As the figure most responsible for the constant prodding that led to such reform in medical education as occurred in the 19th century, and as a benefactor of Elias Cooper, Nathan Smith Davis (1817-1904) deserves our further consideration. He was another of those remarkable sons of the American frontier whose native ability and devotion to independent study overcame the handicap of limited opportunity. Born in the log house built by his pioneer father on a homestead in Chinango County, south-central New York State, he was the youngest of seven children and his mother died when he was only seven. He spent the first sixteen years of his life on the farm, and in 1833-34 attended a single six-month term at Cazenovia Seminary where he studied English grammar, chemistry, natural philosophy, algebra and Latin.

The following summer, at the age of seventeen, he began the study of medicine as an apprentice to a local doctor who provided room and board for his help in the office, caring for the horses and doing the chores. While continuing apprenticeship with another physician in the village of Binghamton, New York, not far from his birthplace, he attended three courses of lectures at a country medical school known as the College of Physicians and Surgeons of the Western District of the State of New York. The school was commonly referred to as Fairfield Medical College and ceased operation in 1840. Dr. Davis received his MD degree from Fairfield in 1837 at the age of twenty and the same year began practice in Binghamton. He remained in practice there for nine years and from the outset was active in the County Medical Society. He soon became Secretary of the Society and was the Society's delegate to the New York State Medical Society at its meeting in 1845 where he introduced the resolution to which we have referred.^[23][24]

In 1849, Dr. Davis accepted the Chair of Physiology and Pathology at Rush Medical College and there made the acquaintance of Elias Cooper, probably during the Anatomy Concours in 1850. As one of the organizers of the Illinois State Medical Society, Davis certainly crossed paths with Cooper at Society meetings. As we have seen, he thought well enough of the Peoria Surgeon to recommend him to prominent surgeons in New York in 1854.

Davis was no armchair medical philosopher. While Dean Daniel Brainard was on a trip to Europe in 1858, Davis persuaded the Rush Faculty to adopt the A. M. A. recommendations for preliminary education and a longer, graded curriculum. When Brainard returned from abroad, he vetoed the reforms approved in his absence. Whereupon Davis and several other faculty members resigned from Rush to found the Medical Department of Lind University in Chicago in 1859. The new school, which became in 1862 the Chicago Medical College and in 1892 the Northwestern University Medical School, from its inception "boldly adopted and enforced" all of the A. M. A.'s recommendations, except those concerning preliminary education. By 1862 when the new school became known as the Chicago Medical College, the entrance requirements had been raised (candidates were required to be a college graduate or pass an examination) and the course lengthened to three years with a "graded curriculum," i. e., primary subjects were given to entering students while advanced subjects were taught to separate classes of students who had satisfactorily passed the primary courses.^[25]

These elementary reforms, implemented for the first time by the Chicago Medical School, were rejected by other schools who were firmly committed to the traditional curriculum, and for the following reasons. It required minimal resources. As befitted a frontier democracy, it was applicable to very large classes of students who commonly had negligible premedical preparation. Faculties were self-appointed and content to allocate more than two-thirds of the period of "medical study" to an apprenticeship which, depending on the preceptor, varied from excellent to worthless. Last and not least, the system was unreservedly laissez faire and normally capable of generating ample income from student fees. With such lenient requisites, small wonder that a plethora of medical schools sprang up in the 19th century, some of them founded by men like Drake, Brainard, McDowell and Cooper who were impelled by a combination of ambition and idealism "to impart this Art by precept, by lecture and by every mode of teaching."

But for the intervention of President Eliot of Harvard, the lonely example of reform at Chicago Medical College would have had little influence on a national pattern of medical teaching that had resisted change for a century. When Charles Eliot assumed the presidency of Harvard College in 1870, Harvard Medical School was a proprietary school of the primeval sort with a faculty of seven lecturing professors that included such medical legends as Henry J. Bigelow (Professor of Surgery) and Oliver Wendell Holmes (Professor of Anatomy and Physiology). The curriculum consisted of four months of identical lectures during each of two years. There were so many semi-literate students in the classes that written examinations were impracticable.

President Eliot first attempted to persuade the faculty to raise the standard of the Harvard medical program, but was vehemently opposed by a group led by Professor Bigelow who was particularly caustic and overbearing. The following year, in 1871, finding it impossible to gain a faculty consensus, President Eliot with the backing of the Harvard Corporation installed a program similar to that of Chicago Medical College. At the same time Harvard Medical School was brought under the firm control of Harvard University.

Chastened by his defeat, Professor Bigelow backed down completely and made the following conciliatory remarks in an address before the Massachusetts Medical Society on 7 June 1871: "I heartily join with my associates in hoping that these carefully considered measures will accomplish the special purpose for which they were adopted, which is the raising of the standard of medical education in this country." And such was indeed the result. Harvard's example broke the national logjam on reform. Pennsylvania, Syracuse, Michigan and gradually other enlightened medical schools adopted the A. M. A. agenda. After twenty-five years the efforts of Nathan Smith Davis were finally being rewarded.^[26][27]

During the month of December 1859 the Faculty prepared the customary Announcement which included a listing of the Professors and of the subjects taught, and a summary of the requirements for graduation. The school's program was in all respects consistent with the standard formula followed by other American medical colleges. The preface to the Announcement began as follows:^[28]

The regular Annual Course of Lectures in this Institution will commence on the first Monday in May, 1859, and be continued for eighteen weeks.

The Medical Faculty of the University of the Pacific, in announcing this, the first course of medical instruction ever given upon this coast, feel warranted in claiming for San Francisco a superiority in climate over either of the Eastern cities; which will render the otherwise arduous labors of the student comparatively easy and agreeable on the one hand, and facilitate the study of practical Anatomy irrespective of season on the other.

There were six Professors:

• J. Morison, MD
  Professor of the Principles and Practice of Medicine and Pathology
• Isaac Rowell, MD
  Professor of Chemistry
• R. Beverly Cole, MD, Dean
  Professor of Obstetrics and Diseases of Women and Children , and Physiology.
• E. S. Cooper, MD
  Professor of Anatomy and Surgery
• B. R. Carman, MD
  Professor of Materia Medica
• Hon. George Barstow
  Professor of Medical Jurisprudence

Elias Cooper, as Professor of both Anatomy and Surgery, was in his element. Exceptionally well-versed in these subjects, he had established anatomy and animal laboratories in the Infirmary and for over three years had been engaged in dissection, experimental surgery, scientific publication and postgraduate teaching. No one in the West had comparable "academic" credentials. His extensive surgical practice included many "capital" operations which he duly reported in national journals. As a surgeon he displayed a surgical virtuosity and self-assurance that impressed and enlightened a host of physician observers. He was, in short, an experienced and committed teacher in the laboratory and clinical arenas. On the other hand:^[29]

In contrast to Cooper, Beverly Cole was fluent and embellished his sometimes rambling lectures with a wealth of anecdote based on personal experience. Never at a loss for words, he was an eloquent extemporaneous speaker with a tendency to be unduly expansive in his "off-hand" remarks. We recall that in February 1858 he made an ill-considered Report on Obstetrics to the State Medical Society. Even as the new school was being organized in the fall of 1858, a storm was brewing over the Report and, as we have seen, he narrowly escaped expulsion from the Society in February 1859. The experience seems not to have quenched his spirit. After all, Cole's reputation throughout the West as the dashing Surgeon General of the Vigilantes and fiery critic in the King case was far too lustrous to be dimmed by a semantical row among the local doctors.

As out-going in manner as Cooper was reserved, Cole proved invaluable as the school's representative and Dean. He and Cooper were second to none in California as anatomists and as clinicians in their respective fields. Happily, instead of the rivalry so prevalent among San Francisco physicians, there was mutual respect between them from their first acquaintance in 1855.

Cooper conceived the school, organized its curriculum and selected its faculty. He was its inner strength and zealous defender against incredible odds. Cole was the chief executive officer whose dynamic style and gregarious nature invigorated the faculty and helped disarm the critics who assailed Cooper. They were a well-matched pair with a fortunate combination of complementary traits.

Isaac Rowell, Professor of Chemistry, was born in New Hampshire in 1818. He was descended from Pilgrim ancestors, and educated in the arts, sciences and medicine at Dartmouth where he received an MD degree in 1849.^[30] We have little additional information regarding his early years in New England except that he was in medical practice in Gardiner, Maine, at the time of the discovery of gold in California.

In 1849, at the age of thirty-one, he joined the "innumerable caravan" bound for a new life in the farthest West, arriving in San Francisco by way of Cape Horn on the 16th of June. He made no detour through the gold fields, but at once entered medical practice and was soon popular and successful. Although his credentials as a "Forty-niner" were impeccable, he was never associated with the snobbish clique of the Pathological Society.

In addition to his local distinction as an able practitioner generous in his care of the poor, Dr. Rowell was universally respected as a resolute man of action in military and public affairs. In 1852 he organized the first cavalry company on the Pacific Coast, the Eureka Light-Horse Guards. This unit under Captain Rowell later became the First Light Dragoons, and eventually combined with other companies to form the First California Mounted Battalion. At the first meeting of the Battalion, every member voted for Dr. Rowell as commander. We have already referred to the crucial decision of Major Isaac Rowell, MD, when serving as commanding officer of the San Francisco militia at the outbreak of civil unrest in 1856. Upon being ordered by the government to restore order and guard the jail, he disbanded his forces and went over with them to the Vigilantes. This bold and controversial defection by Major Rowell and his troops enabled the Vigilance Committee of 1856 to prevail at a critical stage of its revival.

Dr. Rowell's qualifications to serve as Professor of Chemistry are unknown except that the science was doubtless included in his liberal education at Dartmouth. Whatever his background, his Introductory Lecture on 12 May 1859 defined the subject and objectives of the Chemistry Course in vivid terms that appealed to the impressionable students:^[31]

It was customary in medical schools of the day for students to request permission from the Professor to publish a lecture of which they highly approved. The Introductory Address on Chemistry was the first to be chosen for publication by the students of the new school.

Professor Rowell's son Charles, age 34 and born in New Hampshire, was among the students in the first class to be matriculated. His signature is the first to appear on the Student Roster of the new school. He served a three-year apprenticeship under his father in San Francisco and received his MD degree from the Medical Department in 1861. Chester Rowell, another New Hampshire-born son of Professor Rowell, also served an apprenticeship with his father. Chester graduated from the Medical Department in 1870.^[32][33]

While the Cooper's infant medical school struggled for recognition and survival, the nation was being impelled inexorably toward civil war by the unyielding demands of southern states for extension of slavery into the western territories and California. Rowell was among the California's most vocal and determined opponents of slavery. He temporarily suspended his practice in order to traverse the State at his own expense, appealing for preservation of the Union and strict enforcement of California's laws excluding slavery.^[34][35]

Professor James Morison (whose date and place of birth are unknown) began the study of medicine in 1838, presumably as an apprentice, and graduated from the University of Maryland Medical School in 1846. After serving four years as resident physician at Baltimore Infirmary, he succumbed to the lure of the West and migrated to San Francisco in 1850.

He immediately entered practice and became active in medical affairs. He joined the short-lived First San Francisco Medical Society. Founded in June 1850, the Society dissolved four months later in October due to a controversy over the setting of physicians' fees. Dr. Morison was a member of the group that organized the Second San Francisco Medical Society in 1853 and was named Treasurer. The Second Society was only slightly more robust than its predecessor and accomplished little. After a few years it ceased to be active. Meanwhile in 1854 Dr. Morison departed for a period of study at European hospitals in Edinburgh, Dublin, London and Paris.^[36][37]

Upon his return from Europe he resumed practice and in 1856 joined the San Francisco County Medico-Chirurgical Association. There he met Elias Cooper for the first time and was an active member of the Association at the time of Cooper's expulsion in October 1857. We next meet Dr. Morison in February1858 at the stormy third session of the California State Medical Society where Cooper came under attack. At that time, Morison was serving as a delegate to the Society from the newly established Pacific Medical and Surgical Association which, as we have learned, exonerated Cooper from Wooster's charge of advertising. During the 1858 meeting of the State Society, Morison's regional stature in the medical community was recognized by his election as one of the five Vice Presidents for the coming year, and by his appointment to the Committee on Publications. We know little else of Dr. Morison's professional life except for these medical society affiliations.^[38]

We can at least be sure that he was well acquainted with Cooper and his problems. Notwithstanding, it is obvious that Morison had confidence in him for he rented an office in the Pacific Clinical Infirmary on the 20th of July 1858. It is also evident that Morison's confidence was reciprocated by Cooper who had him called as a witness in the Hodges Trial. On the witness stand Morison asserted, citing the famous Baudeloque of France as his authority, that cesarean section is a safer operation than the craniotomy procedure being touted by the plaintiff's witnesses. In response to their claim as to the extreme difficulty and deadly risk of the cesarean operation, Morison said that the dangers of the procedure are much exaggerated and that he looked upon it as one of the most easy to perform. On the whole Morison's testimony was notable for its candor and prudence. Unable to discredit the witness, as was the usual strategy, the frustrated attorney for the plaintiff finally concluded his lengthy interrogation with a sarcastic: "That will do Professor Morison."^[39]

These generalities are all we have been able to learn about Dr. Morison's career. Certainly he was an experienced and respected professional. In the Annual Announcements of the University of the Pacific for 1859-60 he is listed as a member of the University's Board of Trustees, presumably as a replacement for Dr. Henry Gibbons.

Benjamin R. Carman was, like Isaac Rowell, a bona fide "forty-niner," a distinction of some importance in the medical hierarchy of early California. As we have seen, he was warmly endorsed for the Chair of Materia Medica by Dr. Cole who wrote to the Board of Trustees, with characteristic hyperbole, that he had known Dr. Carman personally for the past twenty years. If true, Cole would have been about nine years old when first they met.

Carman (whose date and place of birth we do not know) and Cole probably met in Philadelphia where Cole received his MD from Jefferson Medical College in1849. Carman graduated from the University of Pennsylvania in the same city, possibly at about the same time, although the date of his graduation is unknown.^[40] We know nothing further of his career in the East, nor do not we know how or when he reached California. Our next information about Dr. Carman comes from newspaper notices which place him in Sacramento on 8 December 1849 engaged in closing a deal to purchase an interest in Sutter's Fort Hospital. It was also in December 1849 that J. D. B. Stillman and John F. Morse were building a hospital in Sacramento which they opened on Christmas Day.

We again lose track of Dr. Carman. There is no record of his having been a member of either the Sacramento Medico-Chirurgical Association or the Sacramento Medical Association. At some time between 1849 and 1858 he moved from Sacramento to Marysville in Yuba County (about 40 miles north of Sacramento) for his name appears on the roster of the Marysville Medical Society. He seems not to have been active in regional medical affairs for he is not mentioned in the Transactions of the California State Medical Society for the sessions held in 1856, 1857 and 1858.

We assume that at some point he moved from Marysville to Nevada City for Cole informed the Board of Trustees in his letter of 6 December 1858 that Carman "was formerly from Nevada," no doubt meaning Nevada City located 50 miles northeast of Sacramento.^[41][42]

Under the circumstances, we are forced to acknowledge that we know little about Dr. Carman's life and professional qualifications.

Five physicians and George Barstow made up the first faculty of the Medical Department of the University of the Pacific. Their ages were Cooper, 38; Cole, 29; Rowell, 40; and Barstow, 33. The ages of Carman and Morison are unknown. Most, if not all, of the faculty were relatively young men. Their indispensable attribute was loyalty to each other and to the school in the face of vicious opposition soon to come.

The following information on the Curriculum and Requirements of the Medical Department of the University of the Pacific is excerpted from the first Annual Announcement of the School published in 1859.

The following standard courses comprised the Annual Lecture Series of the curriculum:

• Pathology and Principles and Practice of Medicine
• Chemistry and Toxicology
• Physiology
• Anatomy (fully illustrated by preparations and the cadaver)
• Surgery
• Obstetrics and Diseases of Women and Children
• Materia Medica and Pharmacy
• Medical Jurisprudence

The Announcement also included a brief description of the content of each of the courses of which the following are interesting examples:

In keeping with common practice in other American medical Schools, a Preliminary Lecture Course upon subjects of importance was offered without charge to the student during the month immediately preceding the regular annual series.

As we have already noted, during the 1850s about half the medical colleges failed to provide clinical instruction in a well-managed hospital. They instead relied on private clinics conducted by the Professors, a situation criticized by the A. M. A. as quite unsatisfactory.

Lacking a hospital affiliation, and well aware of this important deficiency, the faculty organized teaching clinics at the Pacific Clinical Infirmary The Medical Clinic was under the direction of Professor Morison, the Surgical Clinic under Professor Cooper and the Obstetrical Clinic (including Diseases of Women and Children) under Dr. Cole. In addition, as was the common practice in medical colleges nationally, each of the Professors served as Preceptor to one or more students who saw patients with him in his private office.

These Requirements are similar to those listed above for the average American medical school.

This concludes our summary of information from the first Annual Announcement of the Medical Department.

Present: Professors Barstow, Cole, Cooper, Morison and Rowell.

The faculty had already begun to discuss the possibility of constructing a medical school building, and Sam Brannon had made a proposition to Professor Rowell in reference to a plot of ground. To look into this matter, Professor Rowell was appointed chairman of a Building Committee.

In order to settle once and for all the troublesome issue of admitting women to the new medical school, "Professor Rowell moved that such females as may desire to attend the lectures and graduate be accepted." As foreordained, the motion was lost unanimously. Thus the Medical Department of the University of the Pacific took the precaution in advance of its first Annual Session to slam the door on women applicants. With rare exception, the exclusion of women was standing policy in all other American medical schools at the time.

The Medical Department of Geneva College, a country medical school in Geneva, New York, was such an exception. This school accepted the 26 year-old Miss Elizabeth Blackwell for the fall term in 1847. In 1849 she completed the two-year course with honors and became the first woman to graduate in medicine in the United States. Miss Blackwell, a dedicated and courageous woman, had been previously refused admission to the medical colleges in both Philadelphia and New York. When the Dean and trustees of Geneva Medical College were unable to decide whether to accept her application in 1847, the faculty referred the question to the medical students. They graciously replied "that the application of Elizabeth Blackwell to become a member of our class meets our entire approbation; and in extending our unanimous invitation we pledge ourselves that no conduct of ours shall cause her to regret her attendance at this institution."

Dr. Blackwell's graduation from Geneva encouraged many other women to apply to medical colleges only to experience almost universal rejection. In response to the pressure from women and the stubborn refusal of medical schools to admit them, the first Female Medical College was chartered in Philadelphia in 1850. This school, precursor to the Medical College of Pennsylvania, admitted forty women to its first class in the fall of 1850 and graduated eight of them at its first commencement in 1851. However, it was not until after the close of the Civil War in 1865 that American medical schools, other than the four women's medical colleges that existed by that time, began gradually to open their doors to women.^[43]

Present: Professors Barstow, Carman, Cole, Cooper and Rowell.

The Building Committee was granted more time to negotiate with Sam Brannon.

A Room Committee to be chaired by Professor Rowell was appointed to secure a room for the regular lecture course.

A Memorial Committee, chaired by Professor Barstow, was directed to draft a bill for presentation to the California Legislature asking an endowment for the Medical Department of the University of the Pacific.

Professor Barstow was appointed to deliver the Introductory Lecture at the Opening Ceremony of the school to be held on 5 May 1859.

Present: Professors Barstow, Carman, Cole, Cooper and Rowell.

Professor Rowell's Building Committee reported progress and was granted additional time; the Room Committee similarly;

Professor Bastow, chairman of Memorial Committee, read a bill requesting endowment from the Legislature. Professor Carman read a testimonial to accompany the bill (Copies of the bill and testimonial have not been found.)

"On motion, adjourned to Thursday evening the 4th inst."

(Note: There is no record of a Faculty Meeting being held on 4 February, 1859.)

Present: Barstow, Carman, Cole, Cooper and Rowell.

The object of the meeting was to consider appointing a Committee to visit Sacramento for the purpose of presenting a Memorial and bill to the Legislature asking an appropriation to the Medical Department of the University of the Pacific.

On motion of Professor Cole, Professors Cooper and Rowell were appointed said Committee.

(Note: The bill was duly conveyed to the California Assembly of 1859. The Assembly took no action but referred the bill to the Committee on State Hospitals. There it failed, this negative decision being consistent with the Legislature's reluctance to support schools of higher education.)^[44]

This concludes our selected excerpts from Minutes of Faculty meetings held during the period prior to the formal Opening of the Medical Department. As we see from the Minutes, Cooper organized the professors with dispatch and finesse, and they began at once to address practical issues facing new medical schools - such as space and money. In the short term Cooper would provide space for the teaching program in the Pacific Clinical Infirmary, and the school would be self-supporting. In reality, the founding of a medical school on the American plan was not a complex or expensive undertaking. That, in large part, accounted for the plethora of them.

From time to time we must interrupt our account of the evolution of the new school to touch on the concurrent vicissitudes of Dr. Cooper. The favorable outcome of the Hodges malpractice trial in early December 1858 did not moderate the Pathological Society's campaign of vilification. The dissemination by the clique of false and defamatory rumors about Cooper continued unabated. As an example of this pernicious behavior, we must now introduce Dr. J. P Whitney, a rather loquacious member of the Society. He testified during the trial that he graduated from the Jefferson Medical School and that he could think of nothing that would justify the performance of a cesarean section on Mrs. Hodges. At some time around the termination of the trial, in the presence of attorneys from the trial and various bystanders, Dr. Whitney initiated a sidewalk gossip-fest during which he made untrue and derogatory comments about Cooper, who curtly demanded an explanation:^[45]

As time passed Cooper was increasingly embittered by the unremitting hostility of an intransigent element within the medical profession in San Francisco, leading him on 20 October 1859 to inscribe the following comment as a footnote on his file copy of the above letter:

In due course Cooper's steadfastness, and vigorous rejoinders to his critics, were rewarded by defection to his Faculty of Dr. A. J. Bowie, the first President of the Pathological Society, and also of Dr. J. P. Whitney who later developed a personal interest in the new school.

Whereas the Third Annual Session of the State Society had been the occasion for a concerted assault on Elias Cooper in an unsuccessful effort to expel him from the Society, the principal business of the Fourth Annual Session was the attempt to censure Beverly Cole and terminate his membership in the Society because of the Obstetrics Report.^[46]

On the first day of the Fourth Session, President Stout in the chair, Dr. Bertody took the floor to offer the following Resolution:

There was a determined effort (supported by President Stout) to pass immediate summary judgement on Dr. Cole by trying his case before a Committee of the Whole of the Society. After extended debate, it was decided that a Select Committee of Five should be established to investigate the charges against Dr. Cole and to prepare a report and recommendations to be voted on by the thirty-nine members then in attendance. Thirty-four members were absent, making a total of seventy-three members enrolled in the Society at the time of the Fourth Annual Session. Henry Gibbons was appointed chairman of the Select Committee of Five which included the respected Thomas Logan among its members.

In the usual order of business, Dr. R. B. Ellis of Sacramento was elected President of the Society to replace Stout. According to normal procedure, the incoming President of the Society should assume the post immediately upon election and serve until new elections at the next Annual Session. In a highly irregular move, Stout attempted to delay Dr. Ellis's assumption of the Presidency until after the report of the Select Committee so that he, Stout, could preside over the debate on the report. When Stout was challenged and defeated on this underhanded maneuver, he teamed with Bertody to seek passage of a motion to require the Select Committee to report their findings without further delay. At this point Gibbons, master parliamentarian, blocked the move and secured deferral of the Committee's report until the evening of the second day of the meeting when all witnesses and Dr. Cole had received a proper hearing. The following report was then submitted:

The careful wording and moderate tone of the report reflect the fine hand and impartial spirit of Henry Gibbons. After a lengthy discussion and the defeat of several contrary motions, the question of the adoption of the report of the Select Committe of Five was finally put to the vote. The Report was adopted by a majority of 22 to 8. Although Cole was properly chastised by the Committee for his unwarranted and offensive "reflections," he was not censured or expelled, thanks in large part to the involvement of Gibbons in the proceedings.

Among those voting "aye" on the Committee Report was Elias Cooper who maintained a low profile during the meeting. Uncharacteristically, he did not submit a single proposal from the floor. No doubt he was still smarting from the criticism he endured at the Third Annual Session of the Society the previous year.

Among those voting "no" on adoption of the Report were C. A. Bertody, H.M. Gray, A. B. Stout and J. P. Whitney - all allied with the faction of San Francisco physicians that Cooper dubbed the "Pathogical Clique," who were almost as hostile to Cole as they were to Cooper.

The reputation of the State Society and its usefulness as a forum for professional discourse were further diminished by the dissension over the Cole case. Before the Fourth Annual Session ended on 11 February 1859, eleven disgruntled members (i. e. , fifteen percent of membership) had resigned from the Society. Eight were from San Francisco, most of them identified with the Pathological Clique: (Bertody, Gerry, Gray, Sharkey, Stout, Trask, Whitney and Wooster). Stout chose to show his displeasure at the outcome of the Cole case by refusing to deliver his valedictory address as the outgoing President. Instead, he took the podium to blast Cole, to preen himself on his zeal in promoting the welfare of the Society, and to announce his resignation from it.

The other three members who resigned were from Sacramento. They were Fourgeaud, Hatch and, alas, Thomas M. Logan, collaborator with Cooper in founding the Society. He was perhaps the most highly regarded of all its members. The loss of his participation was a near fatal blow to the organization.

The further dissolution and ultimate demise of the Society were now only a matter of time. Ironically, it was the ill-considered actions of Cooper and Cole that set the State Society on a downhill course at the very time when they were laying the foundation for another worthy enterprise, a medical school in San Francisco.

1. Rockwell D. Hunt , History of the College of the Pacific: 1851-1951 (Stockton, California: Published by The College of the Pacific, 1951), pp. 6-10 and 210-213
2. American Universities and Colleges, 13th ed. (New York: Walter de Gruyter, 1987), p. 277 Lane Library catalog record
3. Announcement of the Medical Department of the University of the Pacific (California, 1859) Lane Library catalog record
4. Holograph Letter to Board of Trustees, University of the Pacific, undated (c. 10 September 1858), Box 1.1, Medical Department of the University of the Pacific Collection of publications, Lane Medical Archives, Stanford Lane Library catalog record
5. Minutes: material held at University of Pacific Library
6. For Letter of Acceptance see: Founding documents for Medical Dept., University of Pacific, 1858 - Box 1.2, Medical Department of the University of the Pacific Collection of publications, Lane Medical Archives, Stanford Lane Library catalog record
7. Constitution, Bylaws and Minutes of Faculty Meetings of Medical Department, University of the Pacific, 1858 - Box 1.3, Medical Department of the University of the Pacific Collection of publications, Lane Medical Archives, Stanford Lane Library catalog record
8. Constitution, Bylaws and Minutes of Faculty Meetings of Medical Department, University of the Pacific, 1858 - Box 1.3, Medical Department of the University of the Pacific Collection of publications, Lane Medical Archives, Stanford Lane Library catalog record
9. Holograph Letters to Board of Trustees, University of the Pacific, 6 December 1858, Medical Department of the University of the Pacific Collection of publications, Lane Medical Archives, Stanford Lane Library catalog record
10. Holograph Letters from Board of Trustees, University of the Pacific, Medical Department of the University of the Pacific Collection of publications, Lane Medical Archives, Stanford Lane Library catalog record
11. Communication from Donald Walker, Archivist, Library of University of the Pacific
12. Pamphlets collected by E.S. Cooper, vol. 3, 8, 9, 10, Lane Medical Library Special Collections, Stanford Lane Library catalog record
13. Miscellaneous Communications, "Statistics of medical colleges for the Session 1858-59," Chicago Medical Journal 2, no. 4 (Apr 1859): 256-257 Lane Library catalog record
14. Proceedings of the National Medical Conventions in New York 1846 and Philadelphia 1847 (Philadelphia: Printed for American Medical Association, 1847), pp. 63-77; 79-82 Lane Library catalog record
15. "Report of the Committee on Medical Education," Transactions of American Medical Association (Philadelphia) 2 (1849): 257-311 Lane Library catalog record
16. "Miscellaneous Communications: Statistics of medical colleges for the Session 1858-59," Chicago Medical Journal 2, no. 4 (Apr 1859): 256-257 Lane Library catalog record
17. "Report of the Committee on Medical Education," Transactions of American Medical Association (Philadelphia) Vol. 2 (1849): 280 Lane Library catalog record
18. Nathan Smith Davis , History of Medical Education and Institutions in the United States (Chicago: S. C. Griggs and Company, Publishers, 1851), p. 124Lane Library catalog record
19. Proceedings of the National Medical Conventions in New York 1846 and Philadelphia 1847 (Philadelphia: Printed for American Medical Association, 1847), pp. 16-17; 55-82
20. Proceedings of the National Medical Conventions in New York 1846 and Philadelphia 1847 (Philadelphia: Printed for American Medical Association, 1847), pp. 50-51
21. Morris Fishbein , A History of the American Medical Association 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), 3-16 Lane Library catalog record
22. Martin Kaufman , American Medical Education: The Formative Years, 1765-1910 (Westport, Connecticut: Greenwood Press, 1941), pp. 93-163 Lane Library catalog record
23. George H. Weaver , Beginnings of Medical Education in and Near Chicago: The Institutions and the Men (Reprinted from the Proceedings of the Institute of Medicine of Chicago, 1925, Vol. 5, and The Bulletin of the Society of Medical History of Chicago, 1925, Vol. 3), pp. 54-55 Lane Library catalog record
24. Morris Fishbein , A History of the American Medical Association 1847 to 1947 (Philadelphia: W. B. Saunders Company, 1947), pp. 9-10 Lane Library catalog record
25. Martin Kaufman , American Medical Education: The Formative Years, 1765-1910 (Westport, Connecticut: Greenwood Press, 1941), pp. 127-130 Lane Library catalog record
26. Henry K. Beecher and Mark D. Altschule , Medicine at Harvard: The First Three Hundred Years (Hanover, New Hampshire, University Press of New England, 1977), pp. 87-94 Lane Library catalog record
27. Henry J. Bigelow , "Medical Education in America. The Annual Address read before the Massachusetts Medical Society, June 7, 1871," in Surgical Anesthesia: Addresses and Other Papers (Boston: Little, Brown, and Company, 1900), p. 340
28. University of the Pacific: Medical Department; Announcement of Lectures, Session of 1859 (San Francisco: Towne and Bacon, 1859), p. 7
29. Levi C. Lane , "Editor's Table: Obituary of Dr. E. S. Cooper," San Francisco Medical Press 3, no. 12 (Oct 1862): 234 Lane Library catalog record
30. Editors' Table, "Medical Register of the State of California (Revised)," Pacific Medical and Surgical Journal 1, no. 12 (Dec 1858): 498 Lane Library catalog record
31. Isaac Rowell , Introductory Address (on Chemistry), 12 May 1859 (San Francisco: O'Meara and Painter, 1859), p. 5
32. University of the Pacific Medical Dept., Record of Students and Instructors, April 1859-Jan 1883 - Box 1.7, Medical Department of the University of the Pacific Collection of publications, Lane Medical Archives, Stanford Lane Library catalog record
33. Annual announcement (University of the Pacific Medical Department) Lane Library catalog record
34. Oscar T. Schuck , ed., Representative and Leading Men of the Pacific (San Francisco: Bacon and Company, Printers and Publishers, 1870), pp. 539-543. (Portrait referred to on p. 543 but not found in this rebound copy of Schuck's book. Check Green Library for another edition which may contain portraits. Many fine engravings of leading men are found in Schuck's volume of biographies.) Lane Library catalog record
35. George D. Lyman , The Scalpel Under Three Flags in California (San Francisco: California Historical Society, 1925), p. 55 Lane Library catalog record
36. 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. 202
37. J. Marion Read and Mary E. Mathes , History of the San Francisco Medical Society, Vol. 1, 1850 to 1900 (San Francisco: Published by the San Francisco Medical Society, 1958), pp. 12, 13 and 17 Lane Library catalog record
38. Transaction of the Third Session of the Medical Society of the State of California; Convened at San Francisco, February, 1858 (Sacramento: James Anthony and Co., 1858), pp. 3-21
39. "Trial," in Transaction of the Third Session of the Medical Society of the State of California; Convened at San Francisco, February, 1858 (Sacramento: James Anthony and Co., 1858), pp. 202-07
40. J. Roy Jones , Memories, Men and Medicine: A History of Medicine in Sacramento, California (Sacramento: Published by the Sacramento Society for Medical Improvement, 1950), pp. 4, 5 and 11 Lane Library catalog record
41. J. Roy Jones , Memories, Men and Medicine: A History of Medicine in Sacramento, California (Sacramento: Published by the Sacramento Society for Medical Improvement, 1950), pp. 22-23 and pp. 29-32 Lane Library catalog record
42. Editors' Table, "Medical Register of the State of California (Revised)," Pacific Medical and Surgical Journal 1, no. 12 (1858 Dec): 499 Lane Library catalog record
43. William Frederick Norwood , Medical Education in the United States before the Civil War (Philadelphia: University of Pennsylvania Press, 1944), pp. 407-415 Lane Library catalog record
44. Henry Harris , California's Medical Story (San Francisco: Printed by Grabborn Press for J. S. Stacey, Inc., 1932), p. 132 Lane Library catalog record
45. Correspondence 1857-1862 - Box 1, Folder 4, Item 15, Elias Samuel Cooper Papers - MS 458, California Historical Society, North Baker Research Library
46. Sacramento Daily Union, "State Medical Convention: Fourth Annual Meeting," Vol. 16, Issues of 10, 11 and 12 February 1859. The Transactions of the Fourth Annual Meeting of the State Society were not published. A full account of the three daily meetings is found in the Union