Jane Todd Crawford thought she was 9 months pregnant when she was visited by Ephraim McDowell in 1809. She lived near the frontier outside of Danville, Kentucky. He was practicing medicine and had been trained by the famous physician John Bell in Edinburgh, Scotland.
Jane had requested his services to deliver her over-due baby but when McDowell examined her, he determined that she was not pregnant. She had a huge ovarian mass making her only appear to be nine months pregnant.
At this time an Ovariotomy (surgery of the abdomen, specifically on an ovary) had never before been successfully performed. But McDowell offered the surgery to Jane and explained the risks. As he noted in his journal, “She appeared willing to undergo the experiment.” She rode a mule sixty miles to Danville for the procedure.
It was a 25 minute surgery performed in the front room of McDowell’s home on Christmas morning 1809, without anesthesia. He removed a twenty-two pound tumor from the conscious patient. The mass involved the left ovary and the Fallopian tube. The tumor itself was 7 pounds and surrounded by 15 pounds of a “gelatinous material”.
Mrs. Todd sang hymns to “dull the pain” during the surgery, survived the “experiment” and lived another thirty-two years. This was the first successful removal of an ovarian cyst in the world. She stayed at McDowell’s home for 25 days to recover. When he visited her five days after she returned home he was stunned to find her doing housework.
McDowell did not report the success of the operation right away because he was sure it would be doubted. He successfully performed two more Ovariotomies before publishing his achievement in Eclectic Repertory and Analytical Review in Philadelphia in 1817.
He then forwarded the story to his revered teacher in Scotland. He was certain John Bell would inform the European surgical profession. Unfortunately, Bell became ill and died shortly after receiving the letter from McDowell. Bell’s assistant didn’t accept the greatness of McDowell’s success and only passively quoted the letter in his own publication in 1825. Even then, McDowell’s achievement was disputed and doubted.
One reason other physicians were skeptical of McDowell’s success was because of the statistics of deaths from abdominal surgeries – 100%. In the years following the 1809 operation more physicians had begun to experiment with this procedure but the mortality rate still exceeded 25% and was almost always, remarkably, from infection, sepsis or peritonitis and not from the surgery itself.
McDowell was known for being “scrupulously clean” and “neat and orderly” in his preparation. During surgery he bathed the intestine in warm water and carefully cleaned the peritoneal cavity before closing it with sutures. His preparation and cleanliness is now considered the reason for his success in performing these difficult procedures.
McDowell continued to do more successful Ovariotomies, then published another report in 1826 citing the details of twelve successful cases. It astonished the medical world. Today he is acknowledged as the “Father of abdominal surgery.”
This surgery was performed many times in the 19th century without anesthesia and without post-operative antibiotics. The death rate slowly dropped as cleanliness and hygienic practices became an important part of surgery. Fortunately in the 21st century we have sterile procedure, anesthesia and scopes for non-invasive Oopherectomies (the contemporary name for removal of the ovaries).
But the first successful removal of an ovarian cyst in history was performed by the fearless Ephraim McDowell who saved the life of the courageous Jane Todd Crawford.