Cooper in Europe
The enterprising spirit, moral courage, stubborn individualism and surgical talent that Cooper demonstrated during his Peoria years were attributes that fitted him uniquely for his California venture. By the time he left Peoria he was a hardened veteran of professional competition and intrigue. In consequence, when he arrived in San Francisco in May 1855, he was prepared to embark with scarcely a day's delay upon the vigorous execution of his plan to found a medical school.
As we have seen, Cooper's plan had been quietly germinating throughout his sojourn in Peoria. By mid 1854 he was ready to carry out its first phase comprised of visits to medical centers in Britain and France - a pilgrimage that would not only expand his knowledge of medical education and surgery, but also enhance his stature in the profession.
Our first indication of his planned departure for Europe is found in four letters written by the highly respected Nathan S. Davis, MD, Founder of the A.M.A., Professor at Rush Medical College and Editor of the North-Western Medical and Surgical Journal. These letters, dated 1 and 21 September 1854, were addressed to prominent surgeons at the College of Physicians and Surgeons in New York and at New York Hospital. Davis's message to each of these surgeons was substantially as follows: "I write to introduce my friend, Dr. Cooper of Peoria, who will be traveling to Europe and wishes to stop over in New York for a few days to observe your work." This would be Cooper's first journey east of the Alleghenies. 
We have already referred to his transatlantic voyage on the Arabia from New York to Liverpool 4-14 October 1854. The only reliable information we have about Cooper's itinerary in Europe is found in the Diary of his younger brother Jacob who was at Edinburgh when Elias arrived in Britain. On 18 October Elias joined Jacob in Edinburgh for a joyous reunion. After three days in Edinburgh, Elias went down to London on 21 October where he spent nine days making contacts with eminent surgeons before crossing the Channel to Paris on 30 October. While in Paris, Elias became ill with "dyspepsia" which was of such concern to the tenderhearted Jacob that he went to Paris on 22 November to be with his ailing brother. A few days after Jacob's arrival in Paris, Elias received word from Peoria that his presence there was much needed to look after his business affairs. Although Jacob had planned to remain longer in Europe, Elias much desired his company on the voyage home and Jacob agreed. Thus Elias, after a month in Paris that was marred by persistent abdominal complaints, departed with Jacob for London on 30 November. During their stay in London from 1 to 7 December, Elias felt so much better that he again visited hospitals and principal medical gentlemen. Meanwhile Jacob went sightseeing until December 7th when he made the following entry in his Diary: "This day completed my twenty-fourth year! I can scarcely believe I am so old for I have done so little. . . Left London at 7 A. M. on the . . . Parliamentary train bound for Liverpool. The distance 200 miles. Arrived in Liverpool at 8 P.M." On December 9th he and Elias embarked on the S. S. America, a Cunard steamer bound for Boston where they arrived on 25 December 1854. 
During his European interlude of 57 days from October 14th to December 9th, 1954, Elias while in Edinburgh attended the Clinics of Symes and Miller. In Paris he observed the methods of Velpeau, Jobert, Nelaton and Ricord. The dexterity of the French surgeons impressed him, but he found deficiencies in their pre and postoperative care which in his view contributed to their less than optimum results. In London, he visited the surgical services of Fergusson and Erichsen. Even brief exposure to the practice of internationally recognized surgical authorities and the surroundings in which they worked would be of significant benefit to a keen observer like Elias who was already familiar with their contributions to the medical literature.  
The America docked at 10:30 A. M. on Christmas Day and at 1:30 P. M. Elias and Jacob were southbound on the Boston and New York Railroad. They changed trains in New York and headed west, arriving at the Cooper farm outside Somerville on 30 December 1854. On 9 January 1855 Elias took the train to Peoria, there to dispose of his hospital, close out his practice and prepare for the journey to California.
Cooper Invites Dr. Saul G. Armor to Accompany Him to California
Dr. Armor, born in Pennsylvania in 1819, was Cooper's contemporary. He received his MD degree in 1844 from Missouri Medical College where he was a pupil of the controversial Joseph McDowell. In 1849 he became Professor of Physiology, Pathology and Jurisprudence in the Medical Department of the University of Iowa at Keokuk. When Cooper was offered the professorship of Anatomy at Keokuk in 1851, Professors Armor and Hudson had the delicate task of withdrawing the offer because of an administrative technicality, as we have already related. Neither Armor nor Cooper was likely to forget that unpleasant incident.
In 1853 Armor won the prize offered by the State Medical Society of Ohio for the best paper on the subject: "Zymotic Theory of the Essential Fevers." This brought him to the attention of the trustees of the Medical College of Ohio who offered him the chair of Physiology and Pathology, which he accepted. This is how Armor chanced to be located in Cincinnati when Cooper returned from Europe and called on him there to discuss their joining forces and migrating together to San Francisco.
After their meeting in Cincinnati, there was the following exchange of letters. 
From Dr. Armor to Cooper:
Cincinnati, 28 January 1855
My dear Doctor:
Since my interview with you - and indeed for some time before - I have been strongly thinking of making a tour to the Pacific, and it is barely possible that I may conclude to go the coming Spring, after the close of our Session.
Are you making your calculations to (go) early in the Spring? At what time (will you) start, and what route will you take? Please write me on receipt of my letter. I have a brother - an only one - who recently talks of making his future home in California, and his decision may very much influence me as to my future.
It does appear to me to be a very desirable field for energetic young men; but, above all, I think I should like the climate.
Very truly yours,
Saul G. Armor
To which Cooper promptly replied:
Peoria, Ills., 9 Feb 1855
My plan of operation in San Francisco is this, viz., in connection with the private (medical) teaching of which I mentioned at our interview in Cincinnati. My design is to engage in active practice as soon as possible and, by economy, endeavor to make considerable instruments in real estate which must rise in value in San Francisco to an extent almost unprecedented. With this for a foundation I should be led to hope in a few years to possess not only the wealth but likewise the reputation to enable me to establish a medical college.
That San Francisco is destined to make one of the largest cities on this continent - perhaps in the world - wants but a glance at her position to decide. There is China with a population of 360 millions and materials of exportation equal to that of 1/3 of the entire commercial world besides; and San Francisco will be her chief place henceforth as can reasonably enough be inferred from what has occurred already. This of itself would make it a great city to say nothing of the trade with Sister States and the balance of the world, and the impulse given by the construction of the Pacific Railroad which no one doubts will be speedily accomplished.
Now, Sir, you are young, have talents, ambition and abiding faith in being adequate to accomplish an important destiny in life, and as our tastes leading us to pursue different branches of the profession would not only remove all difficulties in the way of permanent harmony, but we might be immensely advantageous to each other from the commencement of our career, more particularly as we should have the prudence to keep our mutual understanding and plans a matter of secrecy.
I design leaving here for San Francisco about the last of May or the first of June (1855) but cannot affix a definite time at present as I have some real estate to dispose of yet and business to settle - making it a point to hold on to a bird in the hand.
I have given you my plans without reserve and shall be pleased . . .
(The letter ends here abruptly at the bottom of a page, and all the rest has been lost.)
What a dazzling prospect with which to tempt an adventuresome spirit, but it did not attract the hesitant Armor for whom California's greatest appeal was its climate. It was fortunate for him that he did not join Cooper who, above all, saw California as the land of the future where great deeds were possible for those with an abiding faith in their destiny. Had Armor teamed with Cooper, he would have found himself in harness with a tiger. Better for his peace of mind that he should spend the rest of his days gliding from professorship to professorship in established medical schools in the East, which he did - joining the faculty of Missouri Medical College in 1858, moving to the University of Michigan in 1863, and finally to Long Island Medical College in Brooklyn in 1866 where he became Dean in 1868. He continued on the Long Island faculty until his death in 1885. 
Better, also, for Cooper that he should travel alone to California. His searing ambition and contemptuous disregard for the sensibilities of San Francisco's self-anointed medical elite would have strained relations with any partner except his devoted nephew, Levi Cooper Lane, whom Providence later sent at a crucial juncture to sustain him.
By early April 1855 Cooper had concluded his business affairs in Peoria and terminated his practice. Jacob, who was visiting Esaias in Henderson at the time, came over to Peoria by stagecoach on April 17th and was delighted to find Elias looking very well - indeed, he "never saw him better." But when Elias told him that he was on the eve of departing for San Francisco, Jacob was greatly distressed. On April 19th the sad and trying hour of their separation came and Jacob accompanied Elias to the railroad station. "I went with him into the car and there took my long - I greatly fear my last - farewell." Elias set out for New York quietly, leaving Peoria without even giving notice to friends, one of whom later wrote of his disappointment in finding Cooper no longer among them.
When Jacob returned to Somerville on May 10th he received news that must have eased his sadness over his brother's departure for the West. Awaiting him was a letter from Centre College in Danville, Kentucky, announcing his appointment as Professor of Greek in the College. Now that he had a good situation that would enable him to support a family, there was nothing in the way of his marriage to Caroline. They were wed on 31 May 1855.
To California by Sea via Nicaragua
On about 23 April 1855, Elias left New York on a steamer that carried him down the Atlantic Coast to Central America on the first stage of his journey to San Francisco. He chose the route that involved crossing the Isthmus through Nicaragua.
The discovery of gold in California on the American River in 1848 created the Gold Rush of 1849 and a massive wave of migration that Cooper now joined. There were three possible routes from the East to the Pacific Coast - by wagon train across the western plains and mountains; by sea around Cape Horn; and by sea to a crossing in Central America and thence again by sea to San Francisco. The route by way of Central American was the most rapid and convenient of the three, being the itinerary followed by an increasing proportion of passengers, mail and treasure from the gold fields. Until completion of the transcontinental railroad in 1869, the Central American route remained the preferred way for the ordinary person or message to travel between the Atlantic and Pacific Coasts.
At the time of Cooper's journey, Central America could be crossed either through Panama or Nicaragua. The southern crossing at the Isthmus of Panama was the shortest. The distance between the Atlantic and Pacific Oceans was only 47 miles, with less than 300 feet elevation at the highest point. Nevertheless the hardships and perils of crossing the Isthmus through malarious tropical swamps and rain forest by mule-back and shallow-draft boat made this route at first relatively unattractive. This changed when on 27 January 1855, after heroic exertions, the last track was laid on the Panama Railroad, and on the following day a locomotive passed over it from ocean to ocean. From that time forward, it was possible to cross the Isthmus in half a day in the comfort of a railroad car. This assured that the Panama crossing would eventually become more popular than the northern option through Nicaragua. Sixty years later the Panama Canal was excavated along the same route as the Panama Railroad. On 15 August 1914 the Canal was opened by the United States to the commercial vessels of all nations. Not only was the Canal the greatest construction project the world had ever seen, the practical eradication of malaria and yellow fever in Panama by controlling the mosquito vectors during building the canal was one of the greatest triumphs of sanitation in history.  
Cooper chose to book passage on a shipping line that used the northern route. He landed in Nicaragua at San Juan del Norte on the Atlantic Coast then traveled by boat up the San Juan River and across Lake Nicaragua to its far shore, beyond which there was an overland trek of only 18 miles to San Juan del Sur on the Pacific Coast. Although the distance between oceans at Nicaragua was 174 miles as compared with 47 miles at Panama, all but 18 miles of the Nicaragua passage could be covered by boat. Also the higher latitude of Nicaragua was thought to make the climate cooler and tropical fevers less prevalent. The most obvious advantage of the Nicaragua route lay in its shorter over-all distance. The journey from New York to San Francisco via Panama was 5,245 miles; whereas it was only 4,871 by way of Nicaragua, a difference of 374 miles in favor of the northern crossing. This small advantage, however, was later more than offset by the convenience of rapid rail transit across Panama when that service became well established. 
Competition between shipping lines carrying traffic on a fortnightly basis between New York and San Francisco was fierce, Bankruptcies, mergers and rate-wars were frequent. Passenger volume on the Panama and Nicaragua routes was closely watched. In 1855, 15,000 passengers traversed Panama and 11,000 crossed by way of Nicaragua. Fares fluctuated erratically according to the state of hostilities among the carriers so we are unable to determine with certainty what it cost Cooper to travel from New York to San Francisco. We do know that in June 1854 steamers via Nicaragua charged $ 225 for first cabin accommodations, $130 for second cabin and $ 75 in steerage. At that time the trip from New York to San Francisco required approximately 33 days (11 on the Atlantic and 22 on the Pacific leg). 
On 4 May 1855 Cooper boarded the S. S. Sierra Nevada at San Juan del Sur on the Pacific. After 22 days at sea, steaming north off the Mexican and California coasts, his ship docked at San Francisco on Saturday, May 26th.
The "Captain Jim Story"
Cooper had the happy faculty of making interesting friends while on sea voyages. We have previously referred to his correspondence with the Honorable Hugh Keenan, U.S. Consul to Cork, Ireland, whom he met aboard the S.S. Arabia when on his way to Europe in October of 1854. He had a similarly pleasant experience in May of 1855 on the S. S. Sierra Nevada where he encountered a congenial fellow passenger named Captain James M. McDonald whose friendship and generosity continued throughout Cooper's life, and beyond. As sometimes occurs when facts are few and memories dim, an intriguing myth arose that attributed to Captain McDonald a decisive influence on Cooper's career. Stanford's Professor Rixford, a principal biographer of Cooper, wrote the following:  
Dr. Cooper greatly admired (Daniel) Brainard, founder of Rush Medical College, and conceived the ambition of emulating him and founding a medical college on the Pacific Coast. He sailed for Portland, Oregon, but on the steamer met one Captain James M. McDonald who prevailed upon him to leave the ship at San Francisco. I mention "Captain Jim" as we afterward called him because, out of this friendship for Doctor Cooper and thirty years after Cooper's death, he gave to Cooper College the (two varas of) land on which Lane Hospital (was erected), as well as ($ 25,000 in money for college purposes).
Professor Rixford did extensive research on Cooper's life, but the Rixford papers contain no hint of the origin of the "Captain Jim" legend. It is possible that Cooper himself was inadvertently responsible for the birth of this romantic fiction regarding his decision to settle in San Francisco. We have seen from his letters to Keenan and Armor that he was secretive about his plan to found a medical school in the city by the Golden Gate. Obviously these letters never came to Professor Rixford's attention. We assume that it was Cooper's reticence to speak openly of his seemingly quixotic plan to found a medical school in San Francisco that led to the poetic conception that he was bound for Oregon and that Providence in the person of Captain Jim influenced his fateful decision to disembark at San Francisco. We know that the Captain was a great admirer of Cooper, lent him money on very favorable terms, and was later a generous donor to Cooper Medical College. 
In any case, the entire sequence of events somehow led to the fanciful "Captain Jim Story" that was reported in good faith by Professor Rixford. Under the circumstances, those who prefer to believe the appealing notion that it was Captain Jim who convinced Cooper to remain in San Francisco should feel free to do so - but should keep in mind that the now available evidence indicates that Cooper had long before made up his mind on his destination.
Intimations of Mortality
When Cooper visited Europe he was just 34 years of age but was already beset with early symptoms of the strange neurological and gastrointestinal disorder which was to bring his tempestuous career to a close in just 8 more years. Levi Cooper Lane made the following reference to the onset of Cooper's chronic and ultimately fatal disease in the Obituary he wrote in 1862: 
In 1854, (Cooper) visited Europe, and though in ill-health at the time, he made the acquaintance of most of the eminent medical men in Edinburgh, London and Paris; he also made many observations in respect to the institutions pertaining to Medicine located in these cities. Immediately after his return from Europe, in May, 1855, he came to California, and located in San Francisco. His purpose in coming here, was two-fold, first, the improvement of his health, which had been shattered by a too uninterrupted application to business, and, second, to find an ampler field for the exercise of his surgical talent, and besides, an ulterior object was, that, at no remote day, California would have, as one of her wants, the establishment of a medical school on the shores of the Pacific. . . .
Soon after coming to this coast, he was attacked with an obscure nervous affection, which manifested itself by an attack of left hemiplegic facial paralysis, and wandering neuralgic pains in the extremities, with indigestion.
There can be no doubt that facial palsy accompanied by recurrent neurologic and digestive symptoms would be a significant handicap to a young physician newly arrived in the maelstrom that was San Francisco in 1855. Political corruption and crime in the streets were rampant. There was a surplus of physicians, and an additional doctor was looked upon by those already present as an unwelcome intruder. This would be especially true in the case of a newcomer with the aggressiveness and pretensions of Elias Cooper. He indicates from time to time during the following years that he is unwell, but provides insufficient detail to allow us to hazard a diagnosis. Although we lack specifics, we should keep in mind when considering his behavior and achievements during his residence in San Francisco that he was burdened throughout by a serious and progressive chronic illness.