Ephraim McDowell (1771–1830) and Jane Todd Crawford (1763–1842)

On 2 July 1864, the U.S. Congress enacted legislation allowing each state to display two statues in the Capitol (Figure 1). ¹ This legislation honoured citizens who were ‘illustrious for their historic renown or from distinguished civic or military services…’. ² In 1929, Kentucky donated the statue of Dr. Ephraim McDowell – the first surgeon to successfully remove an ovarian tumour and the ‘founder of abdominal surgery’. ¹

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Figure 1.

Dr. Ephraim McDowell's bronze statue in the Capitol Visitor Center in Washington, D.C. Designed by Charles H. Niehaus, commissioned by Isaac Wolfe Bernheim, and donated to the National Statuary Hall Collection in 1929. The inscribed platform in part reads ‘Eminent Physician and Surgeon’. Sitting in a bowl behind McDowell's left knee is a depiction of Jane Todd Crawford's ovarian tumour, which McDowell removed in 1809. Courtesy of the Architect of the Capitol.

McDowell was born on 11 November 1771 in Rockbridge County, Virginia, and began his medical apprenticeship in Staunton, Virginia.^3,4 McDowell then travelled to the University of Edinburgh Medical School in 1793, where he studied anatomy under Alexander Munro secundus (1733–1817) and surgery under John Bell (1763–1820).^5,6 Despite never receiving a medical diploma, McDowell occasionally signed his name as ‘Ephraim McDowell, M.D.’, leading critics to call him ‘a backwoodsman without a diploma to practice’.^5,7

In 1795, McDowell established his medical practice in Danville, Kentucky, where he journeyed on horseback to see patients within a 100-mile radius. ⁴ McDowell's most prominent patient was 17-year-old James K. Polk (1795–1849), who later became the 11th President of the United States. ⁶ Plagued by a recurring malady in 1812, Polk ventured over 200 miles to see McDowell, who performed a transperineal cystolithotomy and removed at least one urinary calculus.^8,9 Polk reportedly wrote two letters of gratitude to McDowell, stating that he was ‘in the full enjoyment of perfect health’. ³

However, it was McDowell's operation on a mother of four from rural Kentucky that led to international recognition. Jane Todd Crawford (1763–1842) was a 45-year-old woman who developed persistent abdominal distension in the spring of 1809. ⁴ Despite her age, she assumed it was a natural pregnancy with twins, as did her two local physicians who sent for Dr. McDowell to deliver her.^4,10 After a 60-mile journey, McDowell arrived at her residence in Green County, Kentucky, on 13 December 1809. ⁴ He diagnosed that she had an ovarian tumour, which carried a terminal prognosis. Refuting the conventional wisdom of his time, McDowell offered to remove her ovarian tumour as an ‘experiment’ if she was willing to return to his apothecary shop in Danville.^4,10 She arrived on 19 December 1809, and the operation began on Christmas morning. ⁵ In an operation that lasted 25 minutes, McDowell removed a 22.5-pound tumour without any anaesthesia. ¹⁰ While not the first to open the peritoneal cavity or have a patient survive, McDowell's operation marked the advent of abdominal surgery. ⁷

Dr. Ephraim McDowell died on 25 June 1830 at age 58 following a sudden bout of abdominal pain, presumed to be appendicitis. ³ Over his 35-year career, McDowell performed 13 ovariotomies, including eight cures and four deaths (31%). ¹¹ For his groundbreaking work, McDowell was described as ‘undisputedly the most eminent surgeon west of the Alleghanies’. ¹² Dr. James Johnson (1777–1845), Editor of the British and Foreign Medico-Chirurgical Review, later remarked: ‘A back settlement of America – Kentucky has beaten the Mother Country, nay Europe itself, with all the boasted surgeons thereof, in the fearful and formidable operation of gastrotomy [ovariotomy] with extraction of diseased ovaria…’ ¹³

As for Mrs. Crawford, she made a full recovery and lived an additional 32 years. ⁵