THE DOCTOR'S BAG
Dr Keith Souter aka Clay More
There are some names that stand out in the history of medicine. Hippocrates, the father of Medicine who gave us the Hippocratic oath practiced in Classical Greece in the fifth century BC. Dr William Harvey, who described the circulation of the blood in 1628, was 'Physician Extraordinary' to King James 1 of England. Sir James Simpson was the first physician to extol the wonders of chloroform in 1847. Lord Joseph Lister, promoted the concept of aseptic surgery in Glasgow, Scotland in the 1860s. All of them deserve their status and their place in history for their contributions to the relief of suffering.
But less people know the name of Dr Ephraim McDowell? And probably less will know that he was the first surgeon to successfully perform a laparotomy. For this he is known as the father of abdominal surgery. He did this not in a major teaching hospital but in the kitchen of his house in Danville, Kentucky in 1809 - without anaesthetic and decades before the Germ Theory and aseptic surgery.
[A laparotomy is a surgical operation to open up the abdominal cavity. It is major surgery]
The tale is worth telling. But first, let me introduce you to this pioneering surgeon.
The surgeon - Dr Ephraim McDowell
The son of Samuel, a colonel during the American Revolution, and Mary McDowell, he was born in Virginia in 1771. The family moved to Danville when Ephraim was thirteen years old, as his father was appointed as a judge.
He studied medicine in Virginia for three years as an apprentice and then went to Edinburgh in Scotland to study surgery for two years. He returned to Danville, but without any formal medical qualification, a common enough occurrence in those days. It would not be until 1825 that this would be rectified, when the University of Maryland conferred the honorary degree of MD upon him.
In Danville he was the only surgeon for hundreds of miles. Calls to see patients could be brought with danger.
Over the years he performed many operations and actually perfected the technique of removing urinary bladder stones. These were a source of excruciating pain, so his operation of lithotomy was a real boon to sufferers. Indeed, one of his patients was James K Polk, who would become the 11th President of the USA.
The patient - Mrs Jane Crawford
Born in Rockbridge County in 1763, not far from Ephraim McDowell's birthplace, Jane Todd Crawford, her husband and four children moved to Kentucky in 1805. They built a log cabin on the Blue Spring Branch of Caney Fork. There she had a fifth child.
In 1809, when she was 46 years old she thought that she was pregnant with a sixth child. Unfortunately, she went beyond her due date and on December 13 she experienced severe pains, which were attributed to the late stages of labour. Her local doctor thought she had an obstructed labour, again not uncommon in those days. Dr Ephraim McDowell was sent for and after a sixty mile journey he diagnosed that she was not pregnant, but had an extremely large ovarian cyst, which was causing a false pregnancy.
Such cases were not considered treatable, he told her. She pressed him and he agreed to do an experimental operation, making her quite aware of the likelihood of failure and fatality. Nevertheless, a few days later she travelled on horseback the sixty miles to Ephraim's house in Danville.
On Christmas morning, 1809, on the kitchen table Ephraim and his young assistant performed the first laparotomy through a nine inch incision. This was without anaesthetic. The whole complex operation was performed in twenty-five minutes.
Jane Todd Crawford (1763-1842)
I will spare the surgical details, other than to say that he removed an ovarian cyst weighing almost eight pounds, plus fifteen pounds of fluid. Five days post-op she was on her feet and much to Ephraim's astonishment, he found her making up her own bed. Less than four weeks after that, she made the return journey home on horseback.
In 1821 she and her family moved to Indiana, where she died at the age of 78 years. A remarkable, stoical lady, who also deserves her place in medical history.
The Father of Ovariotomy and the Father of Abdominal Surgery
One would have expected a surgeon who had just performed a pioneering operation to have immediately written up his case. Not so Dr Ephraim McDowell. A staunch presbyterian, who preferred to operate on Sundays, possibly when prayers could be said in advance of his work. He did not immediately publish, but performed more laparotomies and did not publish his study of three cases of ovarian cyst removals by laparotomy until 1817.
The case report was treated with scepticism by other surgeons. Indeed, a renowned surgeon wrote in the London Medical and Chirurgical Review expressed total disbelief. However, later when Ephraim McDowell published a further report, the surgeon withdrew his remarks and apologised, stating 'A back settlement of America - Kentucky - has beaten the mother country, nay Europe itself with all the boasted surgeons thereof.'
He ended by asking '....pray pardon of God and of Dr McDowell of Danville.'
Ephraim McDowell died in 1830 after a two week illness diagnosed as acute inflammation of the stomach. The bitter irony is that this may well have been from peritonitis following an acute appendicitis. A laparotomy may have saved his life.