Drake's Contributions to Medical Education
The Cincinnati newspapers expressed regret that Kentucky was ahead of Ohio in establishing a medical school. In spite of his Transylvanian experience, Drake was eager to respond to the local desire not to be outdistanced by Kentucky in the field of medical education. The fruits, and disappointments, of his efforts to found a medical school in Cincinnati are relevant to our interest in identifying problems that Elias Cooper might encounter when starting a medical school.
The Medical College of Ohio was, on Drake's personal appeal, chartered by the Ohio General Assembly on 19 January 1819, naming him as President, and Professor of Institutes and Practice of Medicine. While it was the second medical college to be opened west of the Allegheny Mountains (the first being Transylvania in Lexington, Kentucky, in 1817), it was the first medical college to be founded in the Northwest Territory. Drake's early success with the Assembly was soon followed by a severe setback. Faculty disunity broke out even before the school opened, and he also had a Town-Gown problem. Local physicians, critical of the projected school, precipitated an incredibly rancorous clash with Drake during which he was convicted of assault on one of his critics, and a formerly close associate in practice challenged him to a duel (an invitation he declined). He was lampooned and christened "Dr. Pompous" in newspapers that became disgusted with the doctors' squabbles. Not unexpectedly, the first course of medical lectures, planned for the fall of 1819, had to be postponed for a year. To say the least, these were ominous signs. The first term finally opened in November 1820 with 24 students and ended with commencement exercises for seven students on 4 April 1821.
Although the surface was calm, faculty resentment against Drake was growing due, according to him, to their jealousy of his prominence and popularity in the city. At the second commencement on 4 March 1822, seven students graduated while the rival school in Lexington had 37 graduates in that year. Two days later, on 6 March, the climax occurred. Two of the school's five-member faculty resigned, leaving only two members in addition to Drake. When he convened them in a faculty meeting to transact some routine business, they both voted to dismiss him from the faculty. Thus President Drake was summarily deposed from the school that he had founded only two years before. 
That he was bitter over this turn of events can be easily understood. His only recourse, however, was to write a scathing satire of the whole affair entitled "Narrative of the Rise and Fall of the Medical College of Ohio" which he published himself and dedicated to the General Assembly of the State that had chartered the school. Regarding the manner of his expulsion and the reasons for the outrageous behavior of his erstwhile colleagues, he said: 
The faculty were . . . reduced to Dr. Smith, Mr. Slack and myself. . .We met according to a previous adjournment, and transacted some financial business. A profound silence ensued, our dim taper shed a blue light over the lurid faces of the plotters, and everything seemed ominous of an approaching revolution. On trying occasions, Doctor Smith is said to be subject to a disease not unlike Saint Vitus' Dance; and on this he did not wholly escape. Wan and trembling he raised himself (with the exception of his eyes) and in lugubrious accents said, "Mr. President - In the resolution I am about to offer, I am influenced by no private feelings, but solely by a reference to the public good." He then read as follows: "Voted that Daniel Drake, M.D., be dismissed from the Medical College of Ohio." The portentous stillness recurred, and was not interrupted till I reminded the gentlemen of their designs. Mr. Slack, who is blessed with stronger nerves than his master, then rose, and adjusting himself to a firmer balance, put on a proper sanctimony, and bewailingly ejaculated: "I second the motion." The crisis had now manifestly come; and, learning by inquiry that the gentlemen were ready to meet it, I put the question, which carried, in the classical language of Doctor Smith, "nemo contradicente." I could not do more than tender them a vote of thanks, nor less than withdraw, and, performing both, the doctor politely lit me downstairs. . . .
The real objects which the gentlemen proposed to themselves in my expulsion were: First - To drive me from Cincinnati and succeed to my professional business. Second - To reorganize the school in such a manner as would give it a new aspect, and dissolve, in the public mind, a connection it had with my name, so intimate as to be painful to them. The former would feed their avarice, the latter their vanity.
The community was outraged at the eviction of the founder of their medical school. Drake was immediately reinstated, and he as promptly resigned - refusing to be again associated with those who had subjected him to such an indignity. But he was still determined to put how own stamp on medical education in Cincinnati. 
Drake Plans a Medical Department for Miami University
The decade following his expulsion from the Medical College of Ohio in 1822 was a hectic period for Drake who continued to be involved in a wide range of activities related to medical education. He held professorships at Transylvania (1823-27) and Jefferson Medical College in Philadelphia (1830-31). 
By 1831 he was ready to challenge the Medical College of Ohio, still the object of his criticism as an inferior institution, his judgement in the matter being well justified. He proposed to the Trustees of Miami University of Oxford, Ohio, that the University establish a Medical Department in Cincinnati with Drake as Professor of Medicine and Dean. His proposal was promptly accepted by the Miami Trustees, and on 22 February 1831 Drake and other faculty members of his selection, including his brother-in-law Joseph N. McDowell, were appointed to the Miami Faculty.
The prospect of a rival medical school in Cincinnati threatened the very existence of the Medical College of Ohio whose Board of Trustees and Faculty rightly concluded that the College would be doomed by the competition of the superior Faculty organized by Drake. On the brink of success, however, Drake's well-laid plan was shrewdly frustrated by the Medical College of Ohio through a combination of delaying the opening of the new school by court action, and hiring away some of Drake's faculty by offering them appointments in a reorganized Medical College of Ohio. Before any students had been admitted to the Medical Department of Miami University, these maneuvers forced its consolidation with the Medical College of Ohio, thus eliminating the Medical Department of Miami University and saving the Medical College of Ohio from extinction. By 13 July 1831 the College faculty had been reorganized to incorporate some members from the now defunct Miami school, including Drake himself. Expecting to participate in reform of the Medical College by joining its faculty, Drake accepted an appointment as Professor of Clinical Medicine in the College.
Drake's expectations for improvement in the College, and a leadership role for himself in the process, were soon dashed. He learned that the chair of "Clinical Medicine" to which he was appointed had been stripped of the responsibilities he had wished it to entail. On 19 January 1832, six months after accepting the post, he resigned it. As on the occasion of his previous abrupt departure from the Medical College of Ohio, Drake stated his grievances. In a letter to the Board of Trustees of the College, couched in diplomatic but unmistakable terms, he implied that the Trustees had dealt with him in bad faith with respect to his professorship, and that the standards of the College were still deficient. He was promptly accused of attempting either to rule or ruin the College, his resignation setting off a chain reaction of spiteful reprisals and recriminations too convoluted for recounting here. 
Drake Founds the Medical Department of Cincinnati College
During the three years following his second resignation from the Medical College of Ohio in 1832, Drake busied himself very productively, enhancing his regional and national stature by medical and editorial activities in Cincinnati where he maintained his home base.
By 1835, he was ready to turn his attention again to medical education, drawn irresistibly by his abiding interest in the field, and his exasperation with the continuing mediocrity and discord at the Medical College of Ohio. His strategy was the same as before - to establish a rival medical school in Cincinnati, this time as the Medical Department of Cincinnati College. On 22 May 1835 the Trustees of Cincinnati College passed the following resolution: 
Whereas the recent attempt of the medical profession and the General Assembly of Ohio to reorganize and improve the conditions of the Medical College of Ohio, have, as we are informed been unsuccessful . . . and whereas there is the utmost danger that Ohio will lose the advantages of a Medical institution, unless immediate measures be taken to organize a substitute for said College, therefore be it
Resolved, that the Board will proceed forthright to establish a medical department of Cincinnati College.
The first session of the Medical Department of Cincinnati College opened in the fall of 1835. Drake's purpose was two-fold. First, he desired to found a medical college that would reflect the high educational standards to which he was devoted; and second, he wanted finally to drive out of existence the failing Medical College of Ohio whose faculty and program he ridiculed openly. Accomplishment of the latter goal would also avenge his summary dismissal from the College 13 years before. Since then, faculty dissension and inadequacy had thoroughly discredited the College, and embarrassed the Ohio Assembly that in 1825 had made it a state-supported institution.
For his new school Drake assembled a faculty comparable to that in the better American schools and distinctly superior in teaching and literary ability to their counterparts in the Medical College of Ohio. The following list of chairs and professors shows the range of subjects making up the curriculum:
Theory and Practice of Medicine
Daniel Drake, MD, Dean of the Medical Faculty of Cincinnati College
Special and Surgical Anatomy
Joseph N. McDowell, MD
General and Pathological Anatomy, Physiology and Medical Jurisprudence
Samuel D. Gross, MD
Horatio G. Jamison, MD
Obstetrics and the Diseases of Women and Children
Landon C. Rives, MD
Chemistry and Pharmacy
James B. Rogers, MD
John P. Harrison, MD
Adjunct Professor of Chemistry and Lecturer on Botany
John L. Riddell, MS
The school's progress during the first four years was remarkable as reflected in the annual enrollment of 66, 85, 125 and 112 students. As might be expected, certain local factions opposed the school from the outset, and rivalry with the Medical College of Ohio was bitter, even to the point of involving students of the two schools in fisticuffs. Unfortunately, lacking the facilities and support commanded by the Medical College of Ohio as a state school, the medical faculty of Cincinnati College were one by one lured away to better positions elsewhere. In 1839, after a brilliant four years, the Medical Department of Cincinnati College (the third medical school to be opened west of the Alleghenies) was forced to close. 
The school had hardly disbanded when Drake received an invitation from the University of Louisville to become Professor of Clinical Medicine and Pathological Anatomy. He accepted the position and held it from 1839 until 1849 when he resigned. While at Louisville he completed his magnum opus, the medical classic for which he is best known, entitled: A Systematic Treatise on the Principal Diseases of the Interior Valley of North America. 
In 1849, nostalgic and still hopeful, Drake once again accepted a professorship in the Medical College of Ohio, the school that he had founded in 1819, thirty years before. To the students attending his Introductory Lecture at the Opening of the Thirtieth Session of the College, Delivered at the Request of the Faculty on 5 November 1849, he said:
(Over the past thirty years) my heart still fondly turned to my first love, your alma mater. Her image, glowing in the warm and radiant tints of earlier life, was ever in my view.
At the end of the year, again disillusioned by faculty intrigues and dissension, he resigned from the Ohio Medical College for the third time to resume a professorship at the University of Louisville.
Finally, in the spring of 1852 and toward the end of his life, Drake resigned his professorship at Louisville to again accept a position at the Medical College of Ohio. The Founding Father was united for the last time with the prodigal son. Just at the opening of the fall session on 5 November 1852 he died at the age of 67, full of renewed hope for the institution that had survived in spite of his determined efforts either to reform, or to destroy it. At the time of his death Drake was one of the most widely known and highly respected physicians in the United States.  
In 1832 in his Practical Essays on Medical Education and the Medical Profession, Drake spoke from the depth of his long experience and made the following prophetic statement: 
The establishment of medical schools is a prolific source of discord in the profession.
Medical Education in St. Louis
Both Esaias and Elias Cooper practiced medicine and appended "M. D." to their signatures for some years before acquiring their medical degrees from the Medical Department of St. Louis University in 1850 and 1851, respectively. . Hence our interest in the origin of the school that they attended.
Purchase of the Louisiana territory from the French for $15 million in 1803 during the administration of President Jefferson almost doubled the size of the United States by moving its western border from the Mississippi River to the Rocky Mountains. This acquisition, the greatest bargain in American history and basic to the rise of the new republic as a world power, brought vast western lands, including the present State of Missouri and the site of the city of St. Louis, under United States control. St. Louis was then an isolated French trading post located on the west bank of the Mississippi River, just across from Illinois country of the Northwest Territory. As center of the trans-Mississippi fur trade, the post had acquired a population of about 1000. The first steamboat to reach St. Louis, the paddle-wheeler Zebulon M. Pike, docked in 1817 to usher in an era of increasing commercial and passenger traffic on the river. In 1821, when Missouri was admitted to the Union as the 24th state, St. Louis was still only a town of 5, 600 inhabitants. During the next several decades, however, St. Louis came into its own as a vital way station between the Northwest and the advancing western frontier. 
As gateway to the Far West, St. Louis attracted settlers in increasing numbers, including a contingent of trained and untrained American doctors. Among them were those who foresaw the opportunity in a dynamic, evolving community to realize their professional ambitions. For a physician caught up in the general westward migration then in full swing, few goals could be higher than to found a medical school, and St. Louis was as inviting a location for that purpose in the 1830's, as was San Francisco to Elias Samuel Cooper two decades later.
Medical Department of Kemper College in St. Louis
When the Medical Department of Cincinnati College closed in 1839, Joseph Nash McDowell (1805-1868), Professor of Special and Surgical Anatomy, moved to St. Louis. Already an experienced teacher, he immediately set about organizing a medical faculty with four other St. Louis physicians. Under the authorization of an Episcopal institution known as Kemper College, he founded the Medical Department of Kemper College, the first medical school west of the Mississippi. The first course of medical lectures was presented during the winter of 1840-41. McDowell taught anatomy and divided the other subjects among his four associates. It was his flamboyant leadership that held the school together when failing financial support made necessary the transfer of its sponsorship from Kemper College to Missouri State University in 1847. The school then became the Medical Department of Missouri State University (also called Missouri Medical College) with faculty in 1847-48 of six professors: McDowell in anatomy and other chairs in medicine; physiology and materia medica; obstetrics and diseases of women and children; pathology and clinical medicine; and chemistry and pharmacy. So closely were these early medical schools identified in the public mind with McDowell as their founder and colorful advocate that they both were generally known as McDowell Medical College. 
Regarding McDowell's personality and ability, he may be charitably described as a brilliant eccentric. A native of Kentucky, he was married to the girl who had been his playmate when he was a young boy, Amanda Virginia Drake, the sister of Daniel Drake. After receiving his MD degree in1825 from Transylvania University in Lexington, Kentucky, he served as Professor of Anatomy at Transylvania and at Jefferson Medical College before joining the faculty of the Medical Department of Cincinnati College from 1835 to 1839.
As a lecturer in anatomy, he was truly gifted, with a marvelous power to entertain while driving home the subject. In the words of a student, he "made even the dry bones talk". He was wonderfully eloquent as a speaker, and a master of extemporaneous invective, abuse and vilification when his ire was aroused, which was easily done. While a member of the medical faculty of Cincinnati College during Drake's campaign against the Medical College of Ohio, McDowell enthusiastically joined the fray by attacking the professors of the Ohio College openly in offensive language, vowing that given a year's time he would blow the damned Ohio Medical College to hell. In St. Louis he used similar tactics and exhibited a fanatical streak as well in his opposition to a rival medical school as we will shortly relate. His objectionable traits were at least partially, if not fully, offset by his devotion to family, friends and patients; by his consistently effective leadership of the medical school he founded; by his democratic relationship with students (frowned upon by his peers as unseemly fraternization); and by his ability as a surgeon which was comparable to his proficiency in anatomy. 
Anecdotes of McDowell's unconventional attitudes and behavior abound. He was either genuinely superstitious or, more likely, pretended to be. As an anatomist he was often involved in the dangerous business of colluding with resurrectionists who provided his school with material for dissection. He told his cousin, the author Mary Ridenbaugh, of the following narrow escape which he ascribed to the intervention of his mother's spirit: 
Said Cousin Mary, "I see that you listen to the spirits sometimes." "Yes," was Dr. McDowell's reply, "there is a great deal more in the matter than a man can express without being thought a d--n fool"
"You are right," she added. "But have you ever had an experience or seen any manifestations?" "Yes; confounded sight more than I tell people" ."However," he continued, "I will tell you what I know, and how I was saved by my mother's spirit."
"A German girl died with a very unusual disease, and we were determined to get her body for dissection. We got it and laid it in the College. The secret leaked out, and the Germans got their backs up and made things lively for us. (There was a large community of Germans in St. Louis.) It was planned by them to come one night and hunt over the College to see if the body was there to be dissected. "I received a note at my house at 9 o'clock of an evening warning me that the visit was to be that night.
"I went down to the College about 11 o'clock, thinking to hide the corpse. When I got there all was quiet. I went through the dissecting room, with a small lantern in my hand, in the direction of the body. I picked the cadaver up and threw it over my shoulder to carry it to the top loft to conceal it between the rafters, or place it in a cedar chest that had stood in the closet for years.
"I had ascended one flight of stairs, when out went my lamp. I laid down the corpse and re-struck a light. I then picked up the body, when out went my light again. I felt for another match in my pocket, when I distinctly saw my dear, old mother standing a little distance off, beckoning to me.
"In the middle of the passage was a window; I saw her rise in front of it. I walked along close to the wall, with the corpse over my shoulder, and went to the top loft and hid it. I came down in the dark, for I knew the way well; as I reached the window in the passage, there were two Germans talking, one had a shotgun, the other a revolver. I kept close to the wall and slid down the stairs. When I got to the dissecting-room door, I looked down the stairs into the hallway; there I saw five or six men lighting a lamp. I hesitated a moment as to what I should do, as I had left my pistols in my pocket in the dissecting room where I took the body. I looked in the room, as it was my only chance to get away, when I saw my spirit mother standing near the table from which I had just taken the corpse. I had no light, but the halo that surrounded my mother was sufficient to enable me to see the table quite plainly.
"I heard the men coming up the stairs. I laid down whence I had taken the body and pulled a cloth over my face to hide it. The men came in all of them being armed, to look at the dead. They uncovered one body, it was that of a man, the next a man; then they came to two women with black hair - the girl they were looking for had light flaxen hair. Then they passed me; one German said: 'Here is a fellow who died in his boots; I guess he is a fresh one.'
"I laid like marble. I thought I would jump up and frighten them, but I heard a voice, soft and low, close to my ear, say, 'Be still, be still'. The men went over the building and finally down stairs. I waited awhile, then slipped out. At the corner of Gratial Street, I heard three men talking German; they took no notice of me, and I went home.
"Early in the morning I went to the College and found everything all right. We dissected the body, buried the fragments and had no further trouble."
"Then, Doctor, you feel satisfied that the spirit of your mother saved you from that trouble?
"I know it," he replied. "I often feel as though my mother is near me when I have a difficult case of surgery. I am always successful when I feel this influence. Well, let me stop here. I have a boy to attend to with a broken leg, so good-bye." And with his characteristic manner of always being in a great hurry, he glided out the door and into his buggy.
Joseph McDowell was the nephew of the celebrated Kentucky surgeon, Dr. Ephraim McDowell, a relationship which doubtless eased his early acceptance into the highest medical circles. He is said to have harbored a smoldering resentment against his uncle because of a misunderstanding that arose during his youth. Joseph spent much of his time in his Uncle Ephraim's home and there formed an ardent attachment for his cousin Mary McDowell, the daughter of his uncle. She informed Joseph that she did not share his more than cousinly affection and confided in her father who kindly but firmly emphasized to Joseph the finality of her decision. The nephew then charged his uncle, no doubt unjustly, with influencing his daughter against him, and left his uncle's house never to return, nor did he ever forgive him.  In later life he even sought to discredit his uncle's remarkable surgical achievement by charging that the operation of ovariotomy for which Ephraim McDowell won acclaim was actually performed by James McDowell, another nephew, who was fresh from medical school and actually only served as an assistant. 
Circumstances attending that famous operation by Ephraim McDowell shed much light on the realities of medical care in the early 1800's, and on the conditions under which Elias Cooper practiced surgery in Illinois a few decades later.