John Bell (1763-1820) was a famous Edinburgh anatomist and surgeon, and one of the founders of vascular surgery, a field in which Dr. Cooper had a special interest. Bell introduced his classical monograph on The Principles of Surgery in 1801 with the following reflections on the evaluation of surgeons: [1]
| In every profession, the daily and common duties are most useful; and in ours, the man who is capable of the great operations rises into public esteem, only because it is presumed, that he who is most capable in the higher departments of his profession will best perform all its ordinary duties. . .(Accordingly), operations have come at last to represent as it were the whole science; and a Surgeon, far from being valued according to his sense, abilities and general knowledge, is esteemed excellent only in proportion as he operates with skill. |
We shall in due course show that Cooper was not only "capable of the great operations," but that he also drew upon his extensive surgical experience and laboratory experiments to make significant observations. It is these distinctive contributions that qualify him to be regarded as a "University Surgeon" in the modern sense, and set him apart from all other surgeons on the Pacific coast in his era.
Before proceeding with our evaluation, we should point out that Cooper's numerous publications in the medical literature are our major source of information on his achievements as a surgeon. Since a list of his papers had never been assembled, we searched the journals of his day and compiled a Bibliography of 139 original articles and commentaries (Appendix 4). From these we will now draw some conclusions as to the significance of his surgical work, keeping in mind of course the state of the art at the time.
Many of Cooper's articles were accepted for publication in such well-known journals in the east as the American Journal of Medical Sciences (Philadelphia), Medical and Surgical Reporter (Philadelphia), American Medical Gazette (New York, American Medical Times (New York), Cincinnati Lancet and Observer, St. Louis Medical and Surgical Journal, Chicago Medical Journal and North-Western Medical and Surgical Journal (Chicago). Not only did this general acceptance of his papers indicate an interest at the national level in his case reports and ideas, but also assured them of wide dissemination. The recognition thus gained by Cooper was especially galling to the venomous Wooster who had unwittingly impelled him onto the national stage of medical literature by denying him access to the Pacific Medical and Surgical Journal. In the following editorial in the June 1861 issue of the Journal, Wooster sought to discredit Cooper with the editor of the American Medical Times, hoping that he and other eastern editors could be induced to refuse Cooper's manuscripts. [2]
| The American Medical Times must have an intense desire to gratify its readers with original matter from remote sources. We are led to give this hint at seeing a California communication in the number of May 25th 1861, and also one in that of June 1st. The status of the author is so low here, socially and professionally, that we cannot imagine how the editor of the Times will lend himself to bolster up such an advertising pretender. Medical journals cannot ignore this allusion, for we definitely proved it to the profession some two years since. ( Pacific Medical and Surgical Journal 1859 Dec; 2 (12): 495-499) |
The editor of the Times ignored the Wooster libel and continued to publish papers submitted by Cooper, as did other eastern editors.
We shall begin our assessment of Cooper's professional stature by calling attention to his technical proficiency and follow with comment on the exceptional range and complexity of the operations that brought him the "public esteem" to which John Bell referred. We shall then mention some of his noteworthy experiments in the animal laboratory before, finally, identifying certain surgical principles that he derived from personal experience, and for which he claimed priority.
Master Surgeon
There can be no doubt from the operations we have already described and the regional acclaim to which we have previously alluded, that Cooper was a fearless and skillful surgeon, with a self-assurance born of natural aptitude and intensive anatomical study. Incredibly, he was almost entirely self-taught. Levi Cooper Lane, a not impartial witness, assisted his uncle during many operations and was in awe of his surgical prowess: [3]
| As an operator, he manifested, in a pre-eminent degree, that cool daring, that deliberate self-possession, - which the most untoward circumstance, so far from disturbing, seemed only to increase, - that instant comprehension of the difficulties which happen to arise during an operation, and that intuitive readiness to surmount them, which are the essential elements of great and original surgical genius. Not only was he self-possessed himself, but his manner was such as to thoroughly inspire his patient with the most perfect confidence that he was wholly secure in his hands; and of his spectator, no one who saw with what perfect ease the chisel and drill moved in his hand during his exsections, and the use of the silver ligature for ununited fractures, or with what rapidity, at one bold sweep, he deeply divided the structures of those regions of the body which most surgeons approach with caution, but who, in the one case, were thoroughly impressed with the superiority of his mechanical talent, and in the other, that his daring celerity could only be founded upon that accuracy of anatomical knowledge, which rendered the tissues, as it were, transparent under his eye. I think that no one, who ever stood by his side at such a time, feared for a moment, that the operation would not end successfully. |
Such a paean from an experienced observer, albeit a biased one, leads us to conclude that Cooper was indeed an accomplished surgeon. For him, surgery was a true vocation. He was undaunted by the stress and complexity of difficult operations and he had the rare gift of responding to technical challenges by improvised measures. According to Dr. Lane, Cooper once remarked that at no time had he been happier than when, during an operation, some grave unforeseen complication arose which threw his mind wholly on its own resources, and for surmounting the difficulty compelled him to rely upon the suggestions of the moment. [4] We recall, for example, his remarkable extraction of a slug of iron from behind the heart of B. T. Beal with a special instrument; the control of major hemorrhage by ligating both iliac artery and vein in Frank Travers; and suture of the uterus to control bleeding during Mary Hodges' cesarean section. In all these operations Cooper made innovations, and they were life-saving.