Lane LibraryChapter VII. A Long Farewell to Peoria
A Long Farewell to Peoria
Peoria was the "crucible" and proving ground where Elias Cooper gained professional experience and maturity. During the decade from 1844 to 1855 he worked tirelessly to improve his knowledge of anatomy and his mastery of surgery. Literally, there was "no day without a line." Like Daniel Drake and many other leaders of American Medicine in his day, he overcame formidable educational and other handicaps by relentless personal effort. With Drake he shared the firm belief that "labor omnia vincit" and, in later years, he made this the theme of his exhortation to medical students in California.
Peoria's historians write of Cooper as the leading surgeon of the city. "Large, powerful, earnest, vigorous and sensitive, he thought, talked and wrote only of surgery, begrudging even the few hours he slept daily as time lost from his work". [1]
By all accounts he was single-minded and dedicated. He demonstrated uncommon enterprise and courage by conducting Anatomy Courses regardless of public censure in Peoria from 1848 to 1855. He competed creditably against considerable odds in the Anatomy Concours at Rush in June 1850. He attended a 4 1/2 month course of medical lectures in 1850-51 at St. Louis University where he finally received an MD degree in March 1851. And he founded Peoria's first hospital entirely at his own expense in September 1851. Meanwhile he developed an extensive surgical practice where he introduced innovative and advanced procedures to which we shall later refer. In his eagerness to expand his specialty practice and attract patients with eye and orthopedic disorders to his hospital, he advertised his services and the hospital in newspapers in the region. For this, his medical society colleagues accused him of unethical conduct, a subject to which we shall shortly return.
Cooper recognized the significance of the National Medical Conventions of 1846 and 1847 that founded the American Medical Association and stimulated the formation of state and local medical societies throughout the country. He had an abiding faith that such organizations were the best hope for raising medical standards and improving relations among physicians. This conviction led him to participate zealously in the founding of medical societies in Illinois and California. Understandably, he was dismayed when fellow society members, first in Illinois and later in California, accused him of unethical conduct for "advertising" his hospital and specialty practice. Throughout his career Cooper's medical ethics were questioned on one pretext or another by detractors whose often-spurious charges cast a still-lingering shadow over his reputation. Recently, however, we have discovered transcripts in his own hand that explain his actions and respond vehemently to his critics. When in the course of our continuing narrative the question of ethics arises, as it frequently will, these new findings should help us to understand, and possibly even accept, his point of view.
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Advertisement for Cooper's Hospital
We cannot be certain when Cooper began to place advertisements for his hospital in regional newspapers but can assume from subsequent events that it was probably in the fall of 1851, shortly after the opening of his institution. The following advertisement, published in the Peoria Weekly Republican on 23 July 1852, is the earliest copy of the ad available. [2]
PEORIA EYE INFIRMARY
and Orthopedic Establishment
The undersigned having purchased and enlarged the house known as the English cottage on Monson and Sanford's Addition to the City of Peoria, designs it as a permanent place for the treatment of all persons afflicted with Eye Diseases, and those desirous of undergoing examinations for the cure of all deformities such as long standing dislocations, club foot, immobility of the lower jaw, etc.
The building is in a healthy and beautiful location where patients can be accommodated with comfortable rooms, boarding and nursing such as corresponds with the desires of each case. Every instrument is provided, and in the Orthopaedic department, several entirely original ones are used, some of which in the club feet of young children, frequently obviates the necessity of operating with the knife. For further information address
E.S. Cooper, M.D.
Peoria, Ill.
References
Hon. S. A. Douglas, Chicago
Hon. A. Lincoln, Springfield, Ill.
(and names of 25 other persons).
Not reticent to claim the support of prominent citizens for his institution, Cooper appended a list of 27 References to his advertisement. The list included many high officials in Illinois State government as well as other notables from Ohio to Iowa. Most memorable of the references are Stephen A. Douglas, U.S. Senator from Illinois at the time, and Abraham Lincoln, an attorney at Springfield, who had served as an Illinois Representative to the U.S. Congress from 1847 to 1849. Lincoln had been elected to Congress as a member of the Whig Party which was superseded by the new Republican Party organized in 1854 to oppose the extension of slavery. Lincoln joined the Republican Party and became its successful candidate for the U.S. Presidency in 1860. There is no evidence among Cooper's papers to prove that he was acquainted with Abraham Lincoln or any of the other political figures listed as references. On the other hand, it is doubtful that even the brash Cooper would have used their names in a published advertisement without some personal link with them. It could be that Cooper was much more active in State and regional politics than we are aware. We have only one tantalizing clue. A simple notice was published in the Peoria Weekly Republican for 7 May 1852. It read: "(Dr. Elias Cooper was) at Whig meeting." Why should Cooper's presence at a meeting of the Whig political party be newsworthy? We must add this to the many unanswered questions about his personal life. [3]
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A.M.A. Code of Ethics on Advertising, 1847
In the mid 1800s medical ethics was a highly sensitive issue among physicians. Since the self-confident and aggressive Cooper was destined frequently to test the boundaries of ethical practice, and provoke harsh criticism for his temerity, it will be useful for us to consider the status of American medicine and the attitude of the profession toward medical ethics in his day.
When the second session of the National Medical Convention convened in Philadelphia in 1847 it not only founded the American Medical Association but also passed a number of important resolutions. The Fourth Resolution stated: "That it is desirable that a uniform and elevated standard of requirements for the degree of M.D. should be adopted by the Medical Schools of the United States." This resolution was the basis for the A.M.A.'s continuous struggle to induce American medical schools to raise their standards, an effort frustrated over the next 60 years by the self-serving intransigence of the majority of the schools. General reform in medical education did not finally occur until after Flexner's fearless critique of 1910, to the preparation of which the A.M.A. lent its valuable support. [4] [5] [6]
When the Fourth Resolution was framed in 1847, the parlous state of the medical profession was much on the minds of the delegates: [7]
The very large number of physicians in the United States, a number far larger in proportion to its population than in any other country perhaps of which we have a correct knowledge, has frequently been the subject of remark. To relieve the diseases of something more than twenty millions of people, we have an army of Doctors amounting by a recent computation to forty thousand, which allows one to about every five hundred inhabitants. And if we add to the 40,000 the long list of irregular practitioners who swarm like locusts in every part of the country, the proportion of patients will be still further reduced. No wonder, then, that the profession of medicine has measurably ceased to occupy the elevated position which once it did; no wonder that the merest pittance in the way of remuneration is scantily doled out even to the most industrious in our ranks, - and no wonder that the intention, at one time correct and honest, will occasionally succumb to the cravings of a hard necessity. The evil must be corrected. With a government like ours, to diminish the number of medical schools is not to be expected; and the corrective can alone be found in the adoption of such a standard of requirement. . . as will place the diploma beyond the reach of those who seek to wear its honours without deserving them.
The National Convention's Sixth Resolution, also relevant to Cooper's future, asserted: "That it is expedient that the Medical Profession in the United States should be governed by the same code of Medical Ethics." [8] Convinced that high ethical standards were vital to improvement of medical practice and the status of medicine, the National Convention drew up a comprehensive ethical code for the A.M.A. and, in due course, each state and local medical society adopted a code of ethics comparable to it. The Illinois State Medical Society of which Cooper was a founding member was organized at a Medical Convention in Springfield in 1850. On that occasion the Convention accepted the A.M.A. code with slight modification of the section on advertising. The following is the Illinois version of the section on advertising which Cooper was accused of transgressing: [9]
It is derogatory to the dignity of the profession, to resort to public advertisements or private cards or handbills, inviting the attention of individuals affected with peculiar diseases - publicly offering advice and medicine to the poor gratis, or promising radical cures; or to publish cases and operations in the daily prints, or favor or encourage such publications, except in approved medical prints; to invite laymen to be present at operations,- to boast of cures and remedies, - to adduce certificates of skill and success, or to perform any other similar acts. These are the ordinary practices of empirics, and are highly reprehensible in a regular physician.
During the Colonial period and throughout the 19th century American physicians were on the defensive against irregular practitioners who indeed swarmed "like locusts, " especially in newly settled regions of the country such as the Old Northwest. The irregulars were, to say the least, unconstrained by any ethical principles. Government regulations and licensure requirements were either non-existent or unavailing. On the other hand, the medical profession itself took no substantial steps toward self-improvement because the majority of medical schools were unwilling to raise their standards. As a result, public opinion was ambivalent regarding even regular medical practitioners in the mid 1800s. Another reason for the public's disaffection was that physicians often had little more to offer than did the botanics, sectarians, cultists, eclectics, electric healers, mesmerizers, hydropaths and other quacks. In fact, the punishing regimes that at mid century still often included bleeding, purging and calomel led many patients to believe that they were unsafe in the hands of the regular physician. [10]
Under these circumstances, one of the profession's most effective means for distinguishing the regular from the irregular practitioner was the ban on advertising, and medical societies were committed to its strict enforcement. Given the contentious spirit latent in the medical fraternity, abundant manifestations of which we have already seen, it is not surprising that there was self-righteous vindictiveness in the persistence with which Cooper's enemies in the Peoria and Illinois State Medical Societies pressed a case against him for "advertising" his hospital.
The following chronological account of Cooper's role in these Societies will bring to light important features of his career in Peoria not yet addressed, and will provide background for our consideration of the dispute over ethics in which he became embroiled.
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Founding of Peoria Medical Society
19 April 1848
Peoria doctors were among the first, if not the first, in Illinois to organize a stable and continuing local medical association. They formed a medical society in 1846, reorganized it in 1847 and finally established a permanent society on 19 April 1848. It was on the evening of this latter date in the office of Dr. Frye - a dingy little room with a pine floor and three or four stuffed wooden chairs - that the following six physicians met by candlelight to found an association known originally as the Peoria Medical District Society: [11] [12]
- Elwood Andrew
- J.C. Frye
- John D. Arnold
- F.A. McNeill
- Edward Dickinson, Chairman
- J. Murphy, Secretary
Dr. Zeuch, historian of the early days of medical practice in Illinois, writes that "seven men met to organize the first medical society in Peoria County" and he names Cooper as the seventh man. Nevertheless, the account of the organizational meeting of 19 April 1848, recorded longhand in the Minute Book of Peoria Medical Society, states that the founding group consisted of only the six physicians named above - and Cooper was not among them. [13]
Although it appears that Cooper may not have been a founding member of Peoria District Medical Society, we do find him present only seven weeks later on 6 June 1848 when 30 members convened at Peoria in the First Annual Meeting of the Society. During that meeting Cooper was appointed to membership on the Standing Committee on Medical Statistics. It was on this occasion that Cooper was initiated into the mysteries of medical society organization which remained a fatal attraction for him the rest of his life. In this particular aspect of professional affairs, he was ever after intensely involved. [14]
This leads us here to the further observation that Cooper was never married and his records contain little information about his social life, apart from interaction with his own family and his ardent participation in medical societies.
There were several features of the First Annual Meeting of the Peoria Society that attest to the alertness of its members and the extensive region of the country over which they were scattered: (1) E.M. Colburn of Bloomington (40 miles southeast of Peoria) made a report on the use of ether in obstetrics practice (only a year and a half after its introduction as an anesthetic), and was elected President of the Society for the ensuing year; (2) the Society adopted the Code of Ethics of the American Medical Association which had been formulated only a year previously at the National Convention in Philadelphia. Among those present at the meeting were the men who later charged Cooper with unethical practice: Drs. John D. Arnold of Peoria and Dr. Thomas Hall of Toulon (30 miles northwest of Peoria). This is an opportune moment to introduce them and through their lives gain some additional insight into medical practice in Illinois at mid-century.
John D. Arnold, MD (1820-1863)
Sketches of Doctor Arnold's early life by historians of Peoria County are contradictory and create uncertainty as to the facts. He was born 8 June 1820 in the small town of Collins, Erie County, New York, 15 miles south of Buffalo. He probably began the study of medicine in 1840 as an apprentice to a practitioner in Buffalo. According to the annual Buffalo City Directory, Arnold was a "Medical Student" with M.W. Hill, a "Botanical Doctor," in 1840 and 1841. He attended Allegheny College in Meadville, Pennsylvania, as a Preparatory Student for one year in 1842. He was enrolled as a first year college student for part of 1843 before dropping out. He appears only once more in the Buffalo City Directory in 1844 when he is listed simply as a "Medical Student." [15] [16]
If and where he received an MD degree are unclear. The History of Peoria County records that he "attended for a considerable time the New York College of Surgeons;" that "he commenced the practice of Medicine at Springville, New York, with Dr. Emmons;" and that "in the Spring of 1847 he emigrated to Galveston, Texas, remaining there but one year, when he removed to Peoria and resumed the practice of medicine. . . "
The actual date of Arnold's arrival in Peoria is unknown although it was obviously prior to April 1848 because he was sufficiently established in practice by that time to be included among the six physicians who organized the Peoria District Medical Society. He was not a founding member of the Illinois State Medical Society that first met in Springfield in 1850, but he became a member of that Society when it convened in Peoria in 1851 for its First Annual Meeting. On that occasion he was listed as a delegate from the Peoria Medical Society.
Presumably he was primarily engaged in general practice as were virtually all physicians in Peoria, but it is evident from his appointment to the State Society's Committee on Surgery in 1853 that he also did some operating. This would have put him into competition with the hard-driving Cooper who considered himself a specialist in surgery and scorned dilettantes in his field, as he would have deemed Arnold to be.
A tall, slender man of a lively social turn of mind, Arnold is said to have enjoyed the esteem and confidence of all with whom he came in contact, and was rewarded by a flourishing practice. He had a delicate constitution and throughout his adult life suffered from what would now be termed latent tuberculosis. His tastes ran more to political affairs than to the intricacies of medical science, and this was reflected in his approach to professional matters. In fact, as his career unfolded, his interest and forte proved to be not medicine, but politics. He was a Whig and, when the Party dissolved, he cast his fortune with the Republicans. He campaigned for public office and in 1854 was elected to the Illinois State Senate where he served four years. In 1859 he was elected mayor of Peoria and served one year. During the 1840s and 1850s Abraham Lincoln emerged as the "wheelhorse" of the Whig and Republican Parties in Central Illinois and Arnold became his personal friend. This led in 1861 to Arnold's appointment by President Lincoln as Consul to St. Petersburg, Russia. Arnold left Peoria for his foreign post in May 1861. When the rigors of the Russian winter proved too severe for his fragile health, he was forced to return to Peoria in the spring of 1862. There, after a protracted illness, the Honorable John D. Arnold died of consumption in April 1863 at the age of 43. [17] [18] [19] [20]
Thomas Hall, MD, (1805-1876)
According to a schoolteacher who was raised on a small farm north of Peoria, the country around the homestead where her family settled in 1838 was a wasteland broken only by distant groves of trees. She recalled that: [21]
In the early '40s, the roads by which the settlers occasionally passed from one grove to another were faint trails, sometimes almost overgrown and hidden by the luxuriant grass of the prairie. And the sloughs, as the feeble watercourses were called, were unbridged, so that in spring season or time of heavy rains many of them were impassable.
The nearest physician lived . . . 18 miles away in the village of Osceola. He was an Englishman. . . No man ever more adorned the profession of healing. He rode in what he called his "pill-cart," night and day, in all weathers, from hamlet to hamlet, prescribing for the sick, supplying them medicines, setting broken limbs, and delivering pregnant women. His patients paid when they could, and how they could. A load of hay, or corn, or firewood, or a quarter of venison, or a horse to supply the wear and waste of his stable. He never considered the question of gain, and I doubt if he ever sent a bill to a single patient.. . . He died a poor man, followed to his grave by the tears and affectionate remembrances of three generations. His name was Thomas Hall.
According to local tradition, one of the first settlers on Spoon River in what is now Stark County was a very religious man. He had great faith in the power of prayer, but he was also a practical man and never asked God to do the impossible. Among his petitions to the Almighty was the fervent request that a doctor be sent to the settlement where he and his family lived; that the doctor would be devoted to his work and labor for the benefit of the people; and that he would be accompanied by a well-educated wife who would be interested in the wives and daughters of the settlers. When in 1837 Dr. Thomas Hall arrived on the Illinois frontier, bringing with him his wife and family from England, it was regarded as undeniably an answer to the old settler's prayer. [22]
Doctor Hall was born on 12 March 1805 near Hulland in Derbyshire, England, where he attended a local grammar school. Following apprenticeship under a practitioner in neighboring Stafford County, he studied at the Royal College of Surgeons in London, graduating as a doctor of medicine and surgery in 1828. His diploma bore the names of Sir Astley Cooper and Dr. John Abernethy, two of the best known medical men in England at the time. "When the young Dr. Hall was leaving home to begin life and practice for himself, his good mother followed him to the gate, and laying her hands lovingly on his shoulder said to him 'Tom, do your duty by all, but especially remember the poor'." [23]
After nearly ten years of active and successful practice in his native county of Derbyshire, Dr. Hall had a wife and four children, and a desire to seek a new home for them on the American frontier in Illinois where two brothers and a sister had settled the year before. In 1837 he embarked for America, the land of promise, accompanied by his own family, his father and mother, and his sister, her husband and their five children. Overcome by sea sickness on the Atlantic, his mother died a few days before the ship reached New York and was buried at sea. An exhausting and hazardous journey inland still lay ahead for the sorrowing party of five adults and nine children. They traveled northwest by boat up the Hudson River; by way of the Erie Canal, and Lake Erie to Cleveland, Ohio; thence by boat on a canal to the Ohio River; and, from there, down the Ohio, and up the Mississippi and Illinois Rivers to Peoria, then only a hamlet on the west bank of the Illinois River where it widens to form Lake Peoria. The final stage of the odyssey, by horse and ox-drawn wagons, brought them to a happy reunion with Dr. Hall's brothers and sister at the frontier settlement of Osceola, 35 miles north of Peoria. The settlement was in open country later to become Stark County.
Assisted by his brothers and his father, Hall built a log cabin for his family including an office for himself. At the age of 32, and having "brought with him a library of choice medical works and surgical instruments of the most approved pattern then known to meet every emergency," he began the practice of his profession without delay. In 1842 he moved with his family ten miles south to the village of Toulon which had become the county seat, and from there he continued his peripatetic practice. We have already learned of the respect and affection in which he was held by his patients. He continued to serve them until incapacitated by the infirmities of age. Only a few days before his death he remarked to some of his friends, "I am not afraid to meet my mother, for she knows that I have done as she told me." Here was a man whose criticism Cooper was bound to respect. [24]
Cooper's First Scientific Paper
Cooper found in the Peoria and the State Medical Societies a welcome forum for the scientific papers that he now began to produce regularly. His entire bibliography will be found in Appendix 2.
We have already mentioned the first publication of his career, a paper entitled "Remarks on Congestive Fever" printed in 1849, on which paper he prematurely listed himself as "E.S. Cooper, M.D.," two years before he actually received a medical degree from St. Louis University in 1851. He presented a second paper, entitled simply "Congestive Fever," at the Peoria Medical Society and published it in 1850. Since both these papers were reviewed at the First Annual Meeting of the Illinois State Medical Society in 1851, we shall defer comment on them until we take up Cooper's participation in that meeting.
We learn from the Minutes of the Peoria Society that Cooper was a frequent contributor to their scientific program. His topics were: [25]
- 1850 -Congestive Fever
- 5 Dec 1852 - Diseases of the Eye
- 7 Jan 1853 - New Operation for Congenital Scrotal Hernia
- 20 Feb 1853 - Treatment of Vaginal Ulceration
- 5 Mar 1853 - Surgery of Oceanea as Practiced by Natives
- 16 Jul 1853 - Surgery of the South Sea Islands
- 1 Apr 1854 - Treatment of Diseases of Hip Joint
As far as we can determine none of these presentations, except for that on "Congestive Fever," was ever published. They are listed here primarily to illustrate the range of his interests at the time and the fact that he enthusiastically supported the educational efforts of the new Society. We shall return to consider the disciplinary action taken against him by the Peoria Medical Society after we have reviewed his substantial contributions to the early history of the State Society, beginning with the Medical Convention at which the Society was founded.