A trip to the doctor is a common enough practice. You feel a twinge here, an ache there, and off you pop to consult the local quack, who following careful examination will dutifully dispense practiced wisdom and efficacious treatments. All of which will be promptly ignored when that little problem you had just ‘goes away’. Because you know better than that know-it-all physician, right?
It’s a different matter entirely when you live on the frontiers of society, where amenities such as a nearby saloon are hard enough to come by, let alone desperately needed medical attention.
For one hardy frontierswoman in 1809 by the name of Mrs Jane Todd Crawford, the need for attention was extremely pertinent, and her condition dire. Yet, this unfathomably brave lady was not going to let anything get in the way of proper treatment, not the 60-odd miles to the doctors office, nor the 22-pound tumor that ailed her…
On a chilly December morning in Green County, Kentucky, at the closing of the year 1809, Dr. Ephraim McDowell was called to the house of what seemed to be a desperate case. Mrs Jane Todd Crawford, 46 years old and mother of 4, appeared to be suffering from an extremely painful and long overdue pregnancy of twins. Her stomach, swollen and distended, caused continual pain and she was unable to move. Her doctors had called for assistance in what was assumed to be a problematic delivery. However upon arrival, Dr McDowell quickly understood the problem that Crawford’s other physicians had somehow been unable to deduce.
Following a swift examination per vaginam, McDowell discovered a distinct lack of baby, either twins or otherwise. It was instead, he correctly diagnosed, an enormously enlarged ovarian growth, given that it freely moved beneath her stomach.
Extraction of such a large tumor had never before been attempted. Certainly, antiseptics and anaesthetics were not yet conceived and abdominal surgery, although not completely untried, would almost undoubtedly result in an excruciating demise. Dr. McDowell communicated this to his stalwart patient, who rather surprisingly and bravely agreed to whatever procedure the doctor deemed appropriate, desirous of preventing ‘a slow and painful death’. Even so, matters were not simple. Upon leaving, Dr. McDowell insisted that he would only perform the procedure:
“…if she would come to Danville, (the town where I live) a distance of sixty miles from her place of residence. This appeared almost impracticable by any, even the most favourable conveyance…”
The doctor had clearly underestimated the fortitude of this singular woman. To his superlative surprise, a week later, he found Mrs Crawford standing at his door. Unbelievably, in her invalid state, despite agonizing pain caused by the pestiferous tumor, she had traveled a distance of 60 miles over several days, fording rivers and streams, crossing largely uninhabited territory to undergo a procedure that would almost certainly kill her. It was a journey that stood as testimony to not only the rugged hardiness of the frontier people at the time, but also to Mrs. Crawford’s personal courage and determination.
On December 25th, with the aid of his nephew James McDowell, M.D., being the only actually officially qualified doctor between the two (no annoying mandatory diplomas needed in those days), Dr. Ephraim McDowell performed his procedure – without anaesthetic. His lateral incision into her abdominal muscles was 9 inches long and cut through to the tumor, revealed to be an enlarged ovarium and fallopian tube and shown to be contused (heavily bruised) from the resting of the mass on the saddle horn during her arduous journey.
It could not be removed in one go:
“…we then cut open the tumor… [and] took out fifteen pounds of a dirty, gelatinous looking substance. After which we cut through the fallopian tube, and extracted the sack, which weighed seven pounds and one half.”
So large was the tumor that upon making the external cut:
“…the intestines rushed out upon the table and could not be replaced during the operation…”
Mrs Crawford recited psalms and sang hymns throughout, exhibiting self control one can scarcely imagine. Had it been me, as spiritually uninclined as I might be, I too would have been calling upon a higher power – had I been able to verbalize anything through the screaming.
The procedure took a scant 25 minutes, and Dr. McDowell swiftly stitched her up and put her to bed. Did she survive? Given this woman’s herculean constitution, it should come as no surprise that she did indeed. Even the doctor was surprised, once again underestimating her resilience:
“In five days I visited her, and much to my astonishment found her engaged in making up her bed.”
Mrs. Crawford was apparently ready to go home. Well, farms in the middle of rural Kentucky don’t run themselves, do they Dr. McDowell?
Dr. McDowell, although not publishing his work until 1817, went on to perform 9 further ovariotomies, as well as other surgeries on such celebrities as the future President of the United States, James Polk, and his work gave birth to the hitherto unexplored field of abdominal surgery. Ironically, the doctor himself died in 1830 of a ruptured appendix. As for the indestructible Jane Crawford, she lived to the ripe age of 78, the procedure having been a total success.
The patients of lauded and famous doctors are frequently relegated to the footnotes of history, with true accolades so often failing to be attributed to the true heroes – the proverbial guinea pigs who offer themselves up on the altar – better yet – the operating table of progress. While Dr. Ephraim’s contribution to science is without doubt monumental, it is clear that Jane Todd Crawford should receive copious adulation, as without her courage and strength, we might be a step further away from confidently performing surgery on this most tricky location of the body – and importantly, having the patients survive.