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Dr. J. W. Halsted, Oculist

Dr. J. W. Halsted, Oculist

Residing at La Fayette, Stark County, Illinois, would respectfully announce to those afflicted with diseased eyes, whether of recent or long standing, that he is fully prepared to treat all such cases with the utmost care and attention. From his knowledge and success in the treatment of diseased eyes, he feels confident in thus offering himself to the public. He would further state for the benefit of those who may reside at a distance wishing to put themselves under his care, that he has provided suitable boarding accommodations where all such persons will be provided for in the best possible manner, and that no means will be spared to insure entire success.

Dr. Hall, who was the delegate of the Stark County Medical Society to the 1852 meeting of the State Society, called the State Society's attention to Halsted's notice, which was in some respects similar to the notice that Cooper was running in newspapers at the same time. Hall reported to the State Society that the Stark County Society found Halsted's notice to be a form of advertising and offensive to ethical practice. The Society demanded that he withdraw it. When he refused to do so, Halsted was expelled from the Stark County Medical Society which now wished the opinion of the State Society on the propriety of the action they had taken. After considerable discussion, the members of the State Society voted that "such advertisement is a sufficient ground for expulsion," and adopted the following resolution:

Resolved, That (Dr. Halsted's) advertisement, presented for the consideration of this Society by Dr. Hall, is unprofessional in its character, and contrary to the code of ethics of this Society.

Thus the ground was laid and the precedent established for a move to expel Cooper from the State Society for running a similar ad. What back-stage maneuvers took place at the State Society meeting in 1852 to censure Cooper, or to begin recruiting a consensus for such action, we do not know. However, later events suggest that the Halsted expulsion was a dress rehearsal for an attack on Cooper.

Cooper was aware of the implications for him of the action taken in the Halsted case; but he did not anticipate the circumstances under which open hostilities would break out. When the attack upon him came a year later on his home ground in Peoria, it took him by surprise. The circumstances were as follows. The Peoria County Medical Society met on 1 June 1853 in the office of Dr. Hamilton to transact routine business, including the election of delegates to the forthcoming meeting of the State Society to be held at Chicago 7-9 June 1853. The Minutes of the Peoria Society provide the following account: [48]

Peoria, 1 June 1853

The society then proceeded to the election of delegates to the state medical society. Dr. (John D.) Arnold was nominated and elected by a vote of 5 to 2. Dr. Cooper (was then) nominated. Dr. Arnold objected to the nomination on the grounds of alleged quack advertisement. After a long discussion Dr. Cooper withdrew has name as a candidate. Dr. Stewart then moved a reconsideration of the vote taken on Dr. Arnold's election and presented certain charges of unprofessional conduct against him. A discussion ensued but it growing very late, the society adjourned till tomorrow evening at same place.

Peoria, 2 June 1853

The society met pursuant to adjournment, president in the chair. Discussion concerning Dr. Arnold's case continued. At a late hour he resigned his delegation. The following preamble and resolution (were) then offered by Dr. Dickinson and passed.

Whereas a variety of breaches of professional etiquette have been charged against Dr. J. D. Arnold by various members of this Society some of which perhaps have been proved to the satisfaction of a majority of the gentlemen present, but in consideration of Dr. Arnold having expressed his regret at such breaches of etiquette and his determination that nothing of the kind shall occur in the future, therefore

Resolved that no further action be taken. . .

Dr. Hamilton, Sr., then offered the following resolutions which were passed:

Whereas the conduct of Dr. E. S. Cooper in advertising his eye infirmary and orthopaedic Institution in a very unprofessional manner has rendered himself obnoxious to the unqualified censure of the Society, therefore

Resolved that we do hereby express our entire disapprobation of the course pursued by him in this respect, and

Resolved that in consideration of the doctor's expressed readiness to conform to the opinion of the Society regarding this matter and in view of his perfectly honorable and dignified course otherwise, it is but due to him to overlook all past offences in view of his promise to offend no more, and

Resolved that a copy of these resolutions be sent to the State Medical Society.

When Cooper departed for the June 1853 meeting of the State Medical Society in Chicago, he was under the impression that his arraignment and acquittal before the Peoria Society only a few days previously had settled the advertising issue. In this assumption, he was sadly mistaken for he underestimated the vindictiveness of the clique determined to discredit and humiliate him.

Cooper was no stranger to conflict over his professional activities in Peoria where he had already faced down strident critics of his dissecting. But the coming challenge was far more serious for it threatened to undermine his professional "honor." The success of his Infirmary and surgical practice; his intense competitiveness tinged with a certain arrogance of opinion; and his flouting of conventional ethics by running newspaper notices regarding his Infirmary had provoked a malignant combination of jealousy and self-righteous zeal among a few of his erstwhile colleagues. He was soon to be introduced at the State level to the fratricidal infighting for which the medical profession of the day was notorious.

At this point we must call special attention to the fact that the Minutes of the June 1853 meeting of the State Medical Society do not so much as mention that charges of unethical behavior (advertising) were brought against Cooper during the meeting. Lack of record on this subject is not surprising since such information was commonly not included in medical society minutes unless some action was taken - and we assume that there was no formal indictment of Cooper's behavior by the State Society. Thus we have only Cooper's word that an attempt was made during the June 1853 meeting to expel him from the Society.

His version of the incident is detailed in the following lengthy and caustic letter to the President and Members of the State Society for consideration by the Society at its Fourth Annual Meeting to be held at Lasalle 6-7 June 1854. The letter reveals a determined and self-assured man (he was thirty-three), independent in thought, unafraid of controversy, and formidable in polemic. He claimed the right to inform the public directly about his Infirmary, based on the important specialized services it made available to the region; and he rejected the authority of a medical society to deny him that right.

The following letter from Cooper to the President and Members of Illinois State Medical Society, long and rambling though it may be, merits recording here in full for it reveals in Cooper's own emotional words his concept of specialization, the vexing realities of small-town specialty practice, and a combativeness to which we shall become more accustomed as we follow his career. [49]

Peoria, Illinois

Early 1854

Mr. President and Gentlemen (of the Illinois State Medical Society):

I am charged of non-professional conduct in advertising my Eye Infirmary and Orthopedic Institute of Peoria.

Before attempting to commence my own vindication in the affair permit me to say that I have always designed to let my course in this respect be shaped by the opinions of the profession. I would at first almost as soon have given up my Institution as to have had my course condemned by a respectable number of reputable physicians since nearly all the reputation I have acquired has been through my professional brotherhood. My plan was to pursue a course that could not be objected to by the most fastidious in orthodoxy.

That I had a right to announce my Institution I judged it but reasonable to suppose from the fact that all public institutions do the same. . .

There are hundreds of cases requiring the precise treatment that can be given at an institution prepared for the purpose and which could not be treated advantageously in another place. These patients are not being treated at all or are in the hands of the unskillful, such practitioners as take no medical journal, and consequently there is no means of reaching them but by circular. The very class of cases in fact that would benefit most from my institution are such as would hear of me last. A code of ethics therefore which curtails the sphere of usefulness of anyone is of doubtful propriety and should never be followed by those whose privileges are unjustly trampled upon. (Emphasis added.)

If the code of medical ethics of the State and of the National Medical Association is intended to imply that I shall not pursue whatever department of the profession I wish; and that I shall not have a private hospital in which to carry out my treatment; and that I shall not make the same known in any way best calculated to be most creditable to myself and beneficial to the community - all I have to say is that the code may go to thunder and so may those who thus construe it.

I have expended nearly five thousand dollars in preparing buildings, bedding and other appurtenances of a private hospital. I have devoted almost four years to private study and dissections which I might have devoted to the more lucrative employment of general practice. This sacrifice of time and money I made the better to qualify myself for the treatment of deformities for which I ever had a predilection. I have not lost sight of the many sacrifices thus made on account of my profession nor am I going to forget that my profession shall repay me. I have not forgotten the popular fury and the criminal prosecutions I had to defend myself against when, had I not been dissecting, I might have pursued the even tenor of my professional career, making money and friends where I was losing money and making enemies.

Who would be so unreasonable as to propose that in the opening of my institution after engaging a matron and nurses in advance, buying buildings which I could appropriate to no other purpose, that I should have had permission from the Illinois State Medical Society merely to insert my name in the Peoria papers as E.S. Cooper, M.D., Physician and Surgeon, without the privilege of making the slightest allusion to my institution or its designs, which would be the case if I am not permitted to advertise for the treatment of peculiar diseases.

If it is wrong for an individual to pursue a specialty, why should Philippe Ricord, famous French venereologist, be encouraged in Paris at the head of a venereal hospital or Doctor G. . . , at the head of an orthopedic institution, both of whom are distinguished medical men. In fact, we cannot look around us in want of examples in which individuals have had private hospitals for the treatment of special diseases. Only a few years ago Valentine Mott of New York (to whom we shall refer again later) opened an Orthopedic Institution and sent circulars all over the United States announcing the same. Such men have a decided fondness for the instigation of particular branches of the profession and the history of medicine in all ages proves that it is to these persons we owe our greatest improvements in both medicine and surgery because special devotion gives special proficiency.

Any Institution therefore that discourages the cultivation of particular parts of the profession should be condemned as obnoxious to improvement and incompatible with its interest; and an association does discourage such effort if it cuts off the only means by which an individual can make himself known to a certain portion of the population with which it is his interest to deal. Those physicians whose wish it is to practice medicine, generally feel very independent in regard to advertising when they know full well that the entire community in which they reside must soon hear of them by their own doings, and that they can immediately be appreciated according to their merits. But the case is very different with the practitioner who wishes to extend his practice only to one or two classes of cases in which if all that ever occur in his vicinity should fall under his treatment he would have but an inadequate business.

Another apology for my past course is that some practitioners are so illiberal as to endeavor to prevent patients going off to be treated but, in preference, abandon them to nature although perhaps readily treatable by those whose special province is to treat such.

For many months Dr. Thomas Hall, who has been a leader in bringing this charge against me for advertising my institution, kept a patient from coming to me who could neither walk nor even stand alone and whom he had long before abandoned as incurable or only curable by the process of nature, a process somewhat tedious to an individual who could not get one rod from his door for nearly three years without being carried. This patient was Charles Rood of Osceola, Stark County, Illinois. He stood alone on the fourth day after his admission into my institution and in 10 days walked 150 yards.

Dr. Arnold of Peoria, another leader in bringing the charge against me, kept a patient from coming to me long after he had abandoned the case to nature. This was Fenton Shipler who had been unable to stand alone for 12 months when he placed himself under my treatment, but who began to walk in a few days and to walk well in a few weeks.

I will have to confess that it looks unfair to bring up, in a controversy like this, cases occurring in private practice; but I am fully convinced that whatever errors I may have committed, the present complaint has originated alone among my enemies who have either ulterior motives or are prejudiced against me.

Let us take a retrospective glance and view this matter of opposition to my course from its origin. It assumes the appearance of a conspiracy under the influence of Drs. Arnold and Andrew of Peoria and Dr. Hall of Toulon. At the Second Annual Meeting of the Illinois State Medical Society held in Jacksonville in June 1852, Dr. Hall secretly agitated the affair by showing copies of my advertisement to different members of the Society after having conferred with Dr. Arnold in Peoria in regard to it. The encouragement to proceed openly at that time was not so flattering as to justify his trying it. However, when Dr. Hall returned to Peoria he tried to soothe his coagitator, Dr. Arnold, by stating that he thought I would slacken my will after that. This is Arnold's statement subsequently made before the Peoria City Medical Society in June 1853.

Between the meeting of the State Society in June 1852 and the meeting of the Peoria Society in June 1853, it was a common observation among the profession of Peoria that Drs. Hall and Arnold were arranging their plans for a systematic attack on me, and that Dr. Quigley of Pekin was likely to be added to the list of my accusers. On 1 June 1853, immediately before the Third Annual Meeting of the State Society in Chicago on 7 June 1853, Dr. Arnold introduced a charge against me before the Peoria City Medical Society for advertising my institution and read at the same time a letter from Dr. W.C. Quigley very abusive to myself.

This created a discussion in which all the members expressed their opinions freely. As my friends concurred in expressing the opinion that it was against the code of ethics to advertise for the treatment of special diseases, I agreed to be guided by the verdict of the members of that body and promised to advertise no more; to issue no more annual reports of my institution; and not to do anything that would publicly identify myself with any particular branch of the profession. In return, I should have permission to keep open my institution for the reception of patients in a perfectly normal way. To this agreement on my part I have adhered ever since. I agreed to this willingly because it appeared to be the wish of a majority of the members that I should do so. In fact, I personally drew up the resolution in which my mode of advertisement was pronounced censurable by the Peoria Society. I did this because I preferred suffering myself to having the harmony of the Society marred in the slightest on my account. But in what manner have my accusers replied?

Dr. Arnold concurred in the vote on the resolution by which my past course was condemned, and also in the vote by which I was exonerated from all blame in consideration of my expressed willingness to be guided by the opinions of the Society as soon as I had ascertained what those opinions were. Therefore, as far as the Peoria Society or any of its members were concerned the matter was of right put to rest unless necessarily revived by some subsequent delinquency on my part. But instead of acting as any gentleman of honorable principles would have acted, we find Arnold going immediately to the meeting of the State Medical Society on 7 June 1853 in Chicago with the plain object of agitating the matter there. This he did although freshly from the scene of his own disgrace before the Peoria Society where he was judged to have violated every high-toned principle of a professional gentleman by traducing the character of his professional brethren by false statements; by stopping messengers on their way to the prescription shops from the sick room of other physicians' patients; by examining the prescriptions and making remarks about them; and by making it an established custom to visit other physicians' patients without being called - behavior which a practitioner possessing a spark of honor would avoid as he would a loathsome thing. . .

Let me examine still further the course pursued by my enemies. Dr. Quigley, formerly of Pekin now of Chicago, is one of them and his conduct will compare favorably with that of Arnold. Not knowing how else to vent his spleen, and like Dr. Chambers (of Peoria) being anxious to do something, Quigley collected the medical men of Pekin together such as he could get to join him, and formed a Society of which he became president. A Delegate from Pekin was then appointed to the State Medical Society whose duty it was to bring forward this same affair with the view of having me expelled. What became of the delegate, I never heard.

This Pekin Medical Society of which Dr. Quigley was the President consisted of Drs. I and W. Mans, both of whom were druggists and industrious vendors of nostrums; Dr. Wright, a sort of one-horse druggist who kept hardly anything but patent nostrums and sold one of his own for ague called Wright's pill; and Dr. Hinsey, who is an avowed eclectic and advertises himself as such. Drs. Fitch, Roberts and Merrik, regular physicians, refused to have any connection with the Pekin Society at the time.

Dr. Elwood Andrew of Peoria, another of the clique, has been ignominiously expelled from the Masonic order for gross violations of morality and decency.

So it will be discovered that it is to those men generally, whose own course is justly obnoxious to censure, that I owe most of this opposition. Take the mote out of thine own eye and then see clearly that which is in thy brother's.

I have dealt in personalities to an extent scarcely justifiable were it not for the fact that the charge brought against me before the meeting of the State Medical Society at Chicago in June 1853 was the result of personal ill feeling alone. I know this to be the fact. Though Dr. Chambers came forth and appeared the champion of the cause, it is very easy to perceive that he is merely a tool of Arnold. . . . Whatever wrong I had committed had been atoned for to the Peoria City Medical Society if no subsequent cause of complaint should occur. All that I promised to the Peoria City Medical Society in June 1853 I would have been promised the year before in June 1852 to the State Medical Society had a single unprejudiced member expressed a desire to have it so because, as I said before, my desire was to pursue a course that could not be objected to. It was at the meeting of the State Society in Jacksonville in June 1852 that Dr. Hall tried initially to thrust me into the notice of the Society on the shoulders of one Dr. Halsted but, as Dr. Halsted had no institution to advertise, there could be no analogy between our advertisements.

In conclusion, I would state that whatever wrongs I have committed have certainly been committed under a very fair semblance of being right; that whether it is compatible with the dignity of the profession to follow special departments of Medicine and Surgery, I have the most illustrious examples set before me of those whose course I would be proud to pursue and whose expectation I would be proud to assimilate even in the slightest. . . . I have always said that I am willing to have my course in regard to the publicity of my institution guided by the views of the profession. . . . I feel no desire to violate my obligations to the Peoria City Medical Society made last year in June 1853, however unnecessarily binding these may have been because my friends there wished them so. Therefore, I consider that I have nothing more to do, that I have no concessions to make to those who brought up this charge to the State Society because it originated among my enemies who do not seek the good of the Society so much as they seek to injure me.

The active agent is Dr. Arnold who cares naught about the State Society unless to further his plans as his former course proves. He never left home to attend State Society meetings though to each he was made a delegate from the Peoria Society until the State Society meeting in June 1853 when his dishonorable conduct prevented his appointment as a delegate from the Peoria Society though there was a vacancy, and he expressed a wish to be appointed which was denied. He was determined to go anyhow, which he accordingly did. Who can doubt his object in attending the State Society under the circumstances?

Dr. Hall, who works with Arnold in this affair, has a motive very different from his. Dr. Hall is honest but prejudiced; and while Dr. Arnold wants to injure me in order to advance his own interests, Dr. Hall wants to injure me for the benefit of the Society. While one would wrong me by being unjust himself, the other would wrong me from being biased by prejudice. It is from these wrongs that I claim exemption of this Society. I claim it in full confidence because I have a right to claim it.

Here ends the controversy over Cooper's advertising of his Peoria hospital, as far as we can determine from existing records. In the absence of evidence that the State Medical Society took any action in the matter during either its June 1853 or its June 1854 meeting, we can assume that Cooper's cogent arguments and his vow to desist from further advertising were persuasive and led to a dropping of the complaint. Whether he learned from this experience that future advertising would likely again expose him to the censure of his medical colleagues is an interesting question. In the light of similar charges against him during the California phase of his career, we might be tempted to believe that the Peoria lesson was lost on him. On second thought, it seems more likely that the keenly perceptive and strong-willed Cooper simply meant it when he said:

. . . if the code of medical ethics . . .is intended to imply that I shall not pursue whatever department of the profession I wish; and that I shall not have a private hospital the latter to carry out my treatment; and that I shall not make the same known in any way best calculated to be most creditable to myself and beneficial to the community - all I have to say is that the code may go to thunder and so may those who thus construe it.

This Manifesto and defiant challenge of the established order has about it the ring of conviction and an uncanny prescience. Cooper was simply ahead of his time, as is clearly evident in these excerpts from the A.M.A. Code of Ethics, as interpreted in 1989 by its Council on Ethical and Judicial Affairs: [50]

A.M.A. Code of Ethics on Advertising, 1989

There are no restrictions on advertising by physicians except those that can be specifically justified to protect the public from deceptive practices. A physician may publicize himself as a physician through any commercial publicity or other form of public communication (including any newspaper, magazine, telephone directory, radio, television, direct mail or other advertising) provided that the communication shall not be misleading because of the omission of necessary material information, shall not contain any false or misleading statement or shall not otherwise operate to deceive. . .

Objective claims regarding experience, competence and the quality of the physician's services may be made if they are factually supportable. Similarly generalized statements of satisfaction with a physician's services may be made if they are representative of the experiences of that physician's patients. . . .

Statements that a physician has an exclusive or unique skill or remedy in a particular geographic area, if true,. . . are permissible. . . .

Cooper would have had no difficulty operating within modern guidelines. Today's ethical codes allow publication, freely through all media, of advertisements and other releases by physicians, hospitals and health service organizations provided they are not deceptive or contain false, misleading or confidential information.

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