History of Medicine

FROM GOLD MINER TO SURGERY PROFESSOR:

THE LIFE OF HUGH TOLAND

          Last month’s blog featured Transylvania University as the first medical school in the west. One of their graduates, it happens, went on to be the founder of the University of California San Francisco Medical School. His name was Hugh Huger Toland.

     Hugh Toland entered the world in Guilder’s Creek, South Carolina, in 1806. His father, a prosperous planter, noting Hugh’s early interest in natural history, arranged an apprenticeship with a local practitioner, after which Hugh enrolled in the Transylvania U. Medical School. After receiving his MD degree in 1828, graduating at the top of his class, Toland practiced in a small town in South Carolina. Bills were seldom paid, and to supplement his income he served as an itinerant healer, traveling to various rural areas. On these travels he taught himself French, meanwhile earning sufficient money to travel to Paris. There he studied

Hugh Huger Toland (Wikipedia)

medicine, and especially surgery, under luminaries such as Guillaume Dupuytren, Jacques Lisfranc, Velpeau, and others.

     Fortified with invaluable experience he returned after 2½ years, opened a practice in Columbia, S.C., and married. By 1852, with civil war brewing and attracted by California gold fever, he set out for California in a Conestoga wagon, accompanied by a second wife (his first wife died). He made it overland from Independence, MO in 76 days, said to be a record. Sadly, his second wife died of dysentery or cholera three days after arrival. He bought a mining claim at Mokelumne Hill, Calaveras County, and mined gold for a few months but decided that mining was not for him. Returning to San Francisco, he opened a practice, at first in a partnership, then solo. His practice prospered as he saw up to 100 patients a day, patients who took their prescriptions to the adjoining drugstore that he owned. He also carried on a mail order drug business with numerous miners who mailed in their symptoms. Wells Fargo agents collected the fees. His surgical training helped him to achieve a reputation as an excellent surgeon, aided no doubt by the recent introduction of anesthesia. He married a third time, saved money (he was generally frugal), bought considerable land, and grew wealthy.

     San Francisco in the 1850s was corrupt and violent. In 1856 a former banker turned newspaper editor, James King of William (there were three James Kings in town and this one was the son of William King) used his paper to expose James Casey, a former inmate of Sing Sing Prison who had been elected to the Board of Supervisors through a stuffed ballot box. Casey responded to the exposé by shooting King in the upper chest. Two young surgeons, one named R. Beverly Cole (mainly practicing OB-GYN), rushed to help. Thinking the subclavian artery had been severed they

R. Beverly Cole (from Physicians and

Surgeons of America, 1896)

inserted a sponge to stop the bleeding. Later other physicians,

including Toland, appeared. Cole soon felt that the sponge could be safely removed, to avoid suppuration. But Toland, 23 years older than Cole and now a respected, experienced surgeon, felt it should remain (as did others) because of an absent pulse in the adjacent arm, and remain it did. King died of sepsis about a week later. Casey, meanwhile, had been convicted and hung by a rapidly assembled Vigilance Committee.

     At autopsy the subclavian artery was found intact. During a State Medical Society meeting Cole labeled Toland’s retention of the sponge malpractice and made similar remarks at the trial of an accomplice of Casey. Toland’s decision was considered legitimate but, needless to say, Cole and Toland were not friends.

     Three years later Dr. Elias Samuel Cooper formed the Medical Department of the University of the Pacific, the first San Francisco medical school, naming Cole as professor of obstetrics. Cooper died in a few years (1862) and his nephew, Levi Cooper Lane, could not sustain the school. Toland, in 1864, flush with ample money from his practice, opened his own medical school, inviting the U of P faculty, except Cole, to join. The school, on

Stockton St. near Chestnut St, used the nearby City and County Hospital for teaching purposes. It grew rapidly, but when a new dean arrived the old U of P faculty and most of the students left t0 form another school, one that eventually became the Stanford University School of Medicine. Toland, needing help, bit his tongue and asked Cole, now a physician influential in City affairs, to assume deanship of the Toland School.

     In 1869 the new University of California opened its doors. Toland wanted an affiliation and Cole was instrumental in

Toland Hall, University of California Medical Department
(from Annual Announcement of Lectures at Toland Hall, 1875.
Internet Archives)

negotiations with the University. Though the school was a gift from Toland, he had to drop the Toland name in return for a lecture hall in his name and a professorship of surgery.

      Students rated Toland’s lectures and bedside rounds highly, and in 1877 the lectures were published. Of interest is that they do not mention Lister’s antiseptic approach, but a former student indicates that he “insisted on the importance of absolute cleanliness”. He was

Rhinoplasty, from Toland's Textbook of Surgery, 1877,
before and after pictures. (Hathi Trust)

particularly known for bone surgery. He also excelled in vascular surgery (mainly ligations), bladder stone removals, and he was familiar with flaps for facial plastic surgery. Usually he worked seven days a week, devoting little time to social activities.

     Toland continued in active practice until February 1880, when, as he was walking downstairs to go to work, he fainted, fell, struck his head, and expired shortly thereafter. Reflecting the large number of devoted patients he served, the funeral was said to be “the largest ever held in San Francisco.”

SOURCES:

Gilcreest, EL. “Hugh Huger Toland”. 1938; Calif and West Med 48 (4); 263-6 and (5): 350-3.

Gardner, FT. “The Little Acorn: Hugh Huger Toland, 1806-1880”. 1950; Bull Hist Med 24: 61-9.

Toland, HH. Lectures on Surgery. 1877; Lindsay and Blakiston, Philadelphia.

UCSF Library web site: https://history.library.ucsf.edu/toland.html

McLean, R. “Hugh Toland, 1806-1880.” Unpublished manuscript, Archives of UCSF Library.

Toland, HH. “Report of the Committee on Surgery”. Trans Med Soc State of Calif 1874-5; 5 (ns): 45-50.

Lyman, GD. “The Sponge” 1928; AnnMed Hist 10: 460-79.

Gardner, FT. “King Cole of California”. 1940; Ann Med Hist 2 (3^rd series): 245-58, 319-47, 432-42.