“When a true genius appears in the world, you may know him by this sign, that the dunces are all in confederacy against him.”
-Jonathon Swift, “Thoughts on Various Subjects, Moral and Diverting,” 1706
IT WAS DECEMBER 13, 1809, and Danville, Kentucky physician Dr. Ephriam McDowell finally arrived after a punishing 60-mile horseback ride at the Green County home of Jane Todd Crawford, who believed she was pregnant with twins but was far past her due date and deathly ill. Compounding her problems was that she was 47 years old, an almost certainly fatal age at that time to bear twins, and bearing many of the typical health frailties of middle-aged people living in such remote frontier conditions, exacerbated by isolation and poor food.
With the obviously pregnant and horribly sick woman lying on her straw tick, McDowell put his ear to her abdomen but heard nothing. Concerned, he palpated her, noticing her abdomen did not seem to have the consistency of most in such an advanced state of pregnancy. He also noted that she was oddly carrying more to one side than in the front, as was normal.
After further examinations, he announced his conclusion to her: she was not pregnant at all.
You too can become a doctor
The great-grandson of a Scotch-Irish immigrant and the son of Samuel McDowell, a widely-respected general who also served in the Virginia General Assembly, Ephriam McDowell was the ninth of twelve children born to Mary McClung McDowell in Rockbridge County, Virginia on November 11, 1771.
At the age of 20, while his siblings pursued careers in the military, the bookish Ephriam elected to instead go into medicine. Aware of a respectable program back in Virginia, McDowell traveled to Staunton to study under an esteemed physician, Dr. Alexander Humphreys, who had started a small school in 1787 in his office in the town’s wharf area after emigrating from Edinburgh, Scotland four years earlier. In addition to McDowell, Dr. Humphreys counted as students Andrew Kean, who became chief surgeon of the Eighth Regiment of the Virginia Militia in the War of 1812, and William Henry Harrison, who later became ninth President of the United States.
McDowell was astute to consider studying under Humphreys. After the Revolutionary War into the early 1800s, no laws regulated the practice of medicine, and the profession was filled with unscrupulous quacks (derived from the old Dutch term “quacksalver” or “kwakzalver,” meaning one who uses false cures or knowledge). Anyone could call themselves a doctor and free to practice their specialty with no accountability to any governing body. These early doctors were often revered more for their regal bearing and oratory eloquence than their medical successes; in fact, many patients may have survived not because of the doctor’s knowledge and procedures, but despite them.
Since medicine was so unregulated, small medical schools and apprenticeships under practicing physicians — some more reputable than others — sprang up around larger Southeastern cities in the years before the 1825 establishment of the first Eastern university-based medical school at the University of Virginia.
After two years in Staunton studying under Dr. Humphries, McDowell traveled overseas to continue his studies at Humphrey’s alma mater, the University of Edinburgh. McDowell remained there until 1795, also receiving private medical lessons from Dr. John Bell, a vascular surgeon. McDowell had to then regretfully return to Danville, Kentucky, without a medical degree, as the result of a common problem — he had run out of money.
Undaunted by the absence of a formal degree, McDowell still knew far more about medicine and surgery than anyone else in that remote, mountainous outpost, so he set up an exam room in his own home. Biographers recorded that McDowell was “compassionate, courageous, and completely devoted to serving the people” living within a roughly 100-mile radius around Danville. McDowell later met Sarah Shelby, the daughter of the first governor of Kentucky, Isaac Shelby, and they married in 1802. They had four daughters and two sons.
The problem with Jane Todd Crawford
After examining Mrs. Crawford, McDowell had some bad news for her. She was not pregnant, but saddled with an enormous tumor, most likely on one of her ovaries. He told her the tumor had to be removed, and informed her point-blank that no woman had ever survived this type of abdominal surgery, in that they always developed a bacterial infection or peritonitis and died. And also, she would have to ride a horse the 60 miles back to Danville for the surgery, which by the way, was to be performed with no anesthesia.
Crawford was resolute — she could not go on living in the “ceaseless agony” of her current condition and was willing to risk the operation.
According to “The biography of Ephraim McDowell: the father of ovariotomy,” written in 1894 by McDowell’s granddaughter, Mary T. Valentine, Mrs. Crawford was from a respectable Kentucky family, and her son went on to become the mayor of Louisville. “She was not a handsome woman,” Valentine critiques in florid prose, “her features being too prominent and large, and her lips too firmly set and curling.”
Finally arriving back at McDowell’s home office in Danville after a brutal horseback ride, the operation to remove the tumor from Crawford’s abdomen commenced on Christmas day, 1809.
Swift’s quote of genius confronted with a confederacy of dunces clarifies the first problem encountered by Dr. McDowell in this risky surgery. Regarding the procedure as radical and not in keeping with their peculiar brand of religious zealotry, a group of angry local men gathered outside his home, protesting this “butchering of a woman” and threatening to hang the only doctor in town if the surgery failed and Crawford died, adding a whole new layer of pressure to McDowell’s attempts just to help the woman. McDowell, however, was fully committed — he knew she would certainly die if he did nothing, even noticing the rope swung over a tree limb just outside his window, thrown there by the ugly crowd.
With Crawford lying on a simple table on a sheet, with no antiseptics, antibacterials, or anesthesia, and with only a cloth over her face, McDowell — assisted by his nephew James, who was also studying medicine –made a nine-inch-long incision into the left side of her abdomen. According to an 1857 report on ovariotomy to the Kentucky Medical Society, “As soon as the incision was made the intestines gushed out on the table, and so completely was the abdomen filled by the tumor that they could not be replaced during the operation.” After some effort, including continually bathing the exposed intestines in warm water, he removed over 22 pounds of “dirty, gelatinous” tumor wrapped in a sac from the woman’s abdomen in a twenty-five-minute procedure.
After surgery, Crawford was placed in a bed adjacent to the exam room. The grumbling crowd outside McDowell’s house dissipated.
McDowell noted that he visited the woman five days after the surgery to find her up and making her bed. Twenty days later, Crawford returned home and lived another 32 years to the then ripe old age of 79.
Surgeon to both presidents and slaves
Ephriam McDowell went on to perform other groundbreaking abdominal surgeries — always on a Sunday morning, to have “the prayers of the church” with him. In 1812 he was approached by a 17-year-old named Polk who complained of pervasive abdominal pain. Diagnosing him with a gall stone and a hernia, McDowell handily retrieved the stone and repaired the hernia, and following this early lithotomy, Polk was able to walk home carrying the bladder stone in his pocket to show off to his friends. In 1844, this same man, James K. Polk, was elected the eleventh U. S. President.
In 1813 and 1816 McDowell successfully performed ovariotomies on two slave women. Those surgeries drew harsh criticism from two fellow physicians, Auguste Nelaton and James Johnson, who debated McDowell’s intentions by claiming that he was only saving valuable assets rather than desiring to relieve human suffering.
McDowell also was harshly criticized for delaying describing these surgeries in writing. Not comfortable as a writer, McDowell finally published his results in an 1817 article titled “Three cases of extirpation of diseased ovaria” and in an 1819 article, “Observations on diseased ovaria.” It was also rumored for many years that Dr. McDowell performed the first successful Caesarian Section in America, but that distinction goes to an obstetrician named John Lambert, who performed the operation near Newtown Ohio in 1827.
Ephriam McDowell finally was awarded an honorary M.D. by the University of Maryland in 1825. He died in Danville on June 25, 1830, at age 59 of appendicitis.
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