Chapter I. Introduction
The history of Stanford Medical School begins in 1858 with the founding in San Francisco by Dr. Elias Samuel Cooper of the first medical school on the Pacific Coast, known as the Medical Department of the University of the Pacific. Stanford's School of Medicine is the lineal descendant of this pioneer medical school. 
Dr. Cooper (1820-1862), founder of the new school, was a controversial but able surgeon in Peoria, Illinois, when in 1854 at the age of 34, and with premonitions of failing health, he abruptly gave up his flourishing practice to pursue postgraduate studies in Europe. Leaving New York on October 4, he arrived in Liverpool 10 days later on 14 October, and proceeded on to Edinburgh. There he joined his younger brother Jacob, who was engaged in religious studies at the University of Edinburgh.
After his arrival in Edinburgh, Dr. Cooper had time to reflect on his Atlantic crossing. It had been a memorable experience for him. He had never before traveled beyond the Middle West, and this was his first sea voyage. The Cunard Line's wooden steamship, S. S. Arabia, on which he embarked at New York was a 2400-ton side wheeler, said to be fitted with the largest and most powerful steam engines ever put into a vessel. Her accommodations for 180 passengers, all first-class, represented the height of Victorian comfort. Her length of 285 feet provided space below deck for two libraries; sumptuous, steam-heated cabins; a children's nursery; a dining saloon seating 160, and other amenities. The promenade deck extended from stem to stern. 
The Arabia was popular in the Atlantic trade because of her agreeable appointments, and these were doubtless favorable to the blooming of those pleasant shipboard friendships that not infrequently spring up naturally during the leisure and confinement of sea travel. Indeed, for Dr. Cooper the most gratifying aspect of the voyage was the companionship of a fellow passenger, Hugh Keenan, who was en route to his post as U.S. Consul in Cork, Ireland. Within a few days of his arrival in Edinburgh, Dr. Cooper addressed the following letter to Mr. Keenan:
Edinburgh, Scotland 18th October 1854
To the Honorable Hugh Keenan
There are circumstances that may cause emotions which we do not desire to express, and sentiments which not to disclose would do violence to our feelings. I speak of my own impressions just now. Whether it was owing in any degree to my own weakness and apparent dependence at the time, or altogether to your display of humanity and good sense during our voyage on the Arabia, I shall not puzzle myself to try to define. But certain it is I never before conceived such strong feelings of friendship for any stranger as for yourself, and consider that I have as yet expressed inadequately the obligations under which I feel you have placed me for the pleasure and benefit of your society and kindly attentions during that period. And though I shall not stop here to identify the various points of obligation under which you have placed me, I will state that it will be my own fault if I do not receive benefit by endeavoring to imitate your example of modesty. . .
As an evidence of the confidence I have in your prudence as well as friendly feelings toward myself, I will inform you of my purpose in visiting Europe. It is this: I desire to obtain information which may be available in carrying out my plans to establish a Medical College in San Francisco at as early a period as circumstances appear to be opportune - a plan from which its magnitude should it obtain publicity and then fail, would excite ridicule; and a plan which though successful, if known long beforehand, would meet with far more mature opposition.
Ever truly, your friend,
It was only recently that a copy of this letter to Keenan in Cooper's handwriting was discovered among miscellaneous correspondence in the Medical School Archives. We shall probably never learn why he chose to reveal to Keenan (and, as far as we know, only to Keenan) his closely-guarded plan to found a medical school in San Francisco. No doubt he meant the sharing of what had now become his life's purpose to be the ultimate expression of esteem for his new friend. And perhaps a homesick Cooper sought intuitively to lessen the lonely burden of his crucial decision by disclosing it to a sympathetic confidant.  
Years later Dr. Levi Cooper Lane, Cooper's nephew, wrote that Cooper had as early as 1851 spoken of his interest in establishing a medical school. It was later that Cooper decided on California as the site for his endeavors. It is said that this ambition was inspired in Cooper by the example of his friend and surgical colleague Dr. Daniel Brainard who eight years earlier, at the age of 31, had founded Rush Medical College in Chicago in 1843. Illinois was then on the rapidly advancing frontier of the country.  
By the early 1850s the frontier had moved to the Pacific Coast, and Cooper astutely concluded that San Francisco, burgeoning seaport and gateway to the gold fields, was a more promising site for a new medical school than the Middle West. Adventurous spirits, aspiring to perform great deeds, must often seek out a place where great deeds are possible. So it was with Cooper who, upon his return to Peoria from Europe and in accordance with his covert plan, joined the westward migration then at full flood. He arrived in San Francisco in 1855, traveling by the sea route from the East Coast via Nicaragua.
After reaching San Francisco, Cooper recalled his crucial decision to leave Illinois in search of his destiny in California, and these were his thoughts:
While some men are reared amidst circumstances calculated to develop them, others are compelled to wait until the time arrives in which they can place themselves in the midst of circumstances calculated to call forth their energies.... To illustrate, I left a home and friends in Illinois to which and to whom I was most devotedly attached to come among strangers, not that I ever expected to be treated better nor even for a long time as well, but simply because I was living in a small place in a bad climate for protracted mental and physical labor, and in an atmosphere that admitted of dissection at best no more than one half of the year, to come to a place where practical anatomy can be cultivated as well in June as in January; where animal life is developed in the highest degree of perfection; where there is flattering prospect of an immense city; and in the centre of what may soon be the world's greatest thoroughfare; and a region of country in which fancy might make the breezes of evening whisper as they pass by: "Great empire to build! Brilliant destiny in future!" 
In three years, and in spite of ridicule, professional misadventures and chronic illness, obstacles that would have defeated a lesser man, Cooper succeeded in 1858 in establishing the first medical school in the vast territory between Iowa and the Pacific.
Memorable achievements that determine the course of history are generally traceable to exceptional individuals such as Elias Cooper. Clearly the beginnings of medical education in California, and the existence of Stanford Medical School, are the legacy of Cooper's vision and determination. It will therefore be fitting, in recognition of biography as the essence of history, to begin this chronicle of the School with an account of Cooper's life and work. 
The history of Stanford Medical School and its antecedent institutions spans the years from 1858 to the present. During this interval, four distinct chronological periods in the annals of the School can be identified. Because of the length and complexity of the School's evolution, the following Synopsis is provided as an overview of the events to be discussed in subsequent chapters.