Ovariotomy No. 1

At Danville last week members of the Kentucky State Medical Association dedicated a monument to a woman because she survived an operation. It is the only recorded tribute of its kind, commemorating as it does the first successful removal of an ovarian tumor. That operation in turn marked the real beginning of abdominal surgery in the U. S.

Late in 1809 Dr. Ephraim McDowell, 38, of Danville, best surgeon west of Philadelphia, received a call to Greentown, 60 miles across country, to deliver a Mrs. Jane Todd Crawford. Dr. McDowell, a big, vigorous man, rode over to Greentown. Two attending physicians assured him that Mrs. Crawford carried twins. He made an examination per vaginam, soon ascertained that she was not pregnant but had a large tumor in the abdomen which moved easily from side to side.

Said candid Dr. McDowell: "Madam, I can do you no good. Your situation is deplorable. John Bell, Hunter, Hey and A. Wood, four of the first and most eminent surgeons in England and Scotland, have uniformly declared in their lectures that such is the danger of peritoneal inflammation, that opening the abdomen to extract a tumor is inevitable death. Notwithstanding this, if you think yourself prepared to die, I will take the lump from you, if you can come to Danville."

Dr. McDowell thereupon rode back to his two-story wooden mansion at Danville, whither Mrs. Crawford soon followed, on horseback.

Dr. McDowell was a devout Episcopalian. He preferred to operate on Sundays so that the prayers of the patient and friends would guide his knives, forceps and needles. For extra heavenly help during the death-defying operation on Mrs. Crawford, he waited for Christmas Day which that year fell on Sunday.

The day was chilly. One of Dr. McDowell's Negro servants got up a roaring fire in the big downstairs room where he operated. Another put a mattress and a clean sheet on a long wooden table, a couple of wooden buckets alongside and on a side table a basin of warm water. Handy were the heavy knives and other instruments Dr. McDowell operated with, the bayonet-like needles, silver suture wire, waxed thread for ligatures. Nothing was sterilized, for Lister's and Pasteur's work was still 60-70 years in the future.

Mrs. Crawford entered, flipped up her skirt and petticoats, stretched out on the table. Two of Dr. McDowell's surgical assistants strapped her to the table, lest her painful writhings inconvenience the surgeon. (A generation was to pass before the coming of modern anesthetics.) Dr. McDowell's nephew William assisted by holding Mrs. Crawford's hands.* One of the doctors held her feet.

Dr. McDowell entered the operating room, threw his hat, cane and coat on a chair, rolled up his sleeves, prayed: "Direct me, Oh God, in performing this operation for I am but an instrument in Thy hands and am but Thy servant. If it is Thy will, spare this afflicted woman."

Thereupon Dr. McDowell cut into Mrs. Crawford's flinching side. Instantly her intestines poured through the opening, uncoiled on the table. Dr. McDowell attacked the tumorous ovary, cut it free, threw it into a bucket. It weighed, he later determined, 22 1/2 lb.

Thirty minutes elapsed before Dr. McDowell was ready to gather Mrs. Crawford's intestines together and replace them in her abdomen. By that time they had become so cold that he "thought proper to bathe them in tepid water previous to replacing them." He then deftly stitched up the wound. In 25 days the first woman ever to undergo an ovariotomy was "perfectly well." She lived 33 years thereafter, had a son who became Mayor of Louisville.

*Andrew Jackson similarly held the hands of a Mrs. Overton of Nashville while Dr. McDowell cut through four inches of abdominal tissues to remove her diseased ovaries. Dr. McDowell asked $500, got $1,500 and an "elegant carriage" with a span of Kentucky-blooded horses and two slaves, largest fee on record up to 1822. There is no public record of who held the hands of James K. Polk when Dr. McDowell repaired a rupture and removed a stone from the future President's bladder.

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