Illllllllillllll il I ll III I III llllli HX64096556 R154.M14 R43 1894 The biography of Eph RECAP R i5^ ,n H Cdumbta 58ntt)em'tp College of ^fi^iiitiani anb ^urgeonsf Hitirarp Digitized by tine Internet Arciiive in 2010 with funding from Open Knowledge Commons http://www.arGhive.org/details/biographyofephra1894ride '(/ J THE BIOGRAPHY EPHRAiM McDowell, m.d THE FATHER OF OVARIOTOMY." KY HIS GRANDDAUGHTER, MRS. MARY T. VALENTINE, (MARY YOUNG RIDHNBAUGH.) TOGETHER WITH VALUABLE SCIENTIFIC TREATISES AND ARTICLES RELATING TO OVARIOTOMY, AND SKETCHES OF LIVES OF EMINENT MEMBERS OF THE MEDICAL PROFESSION IN AMERICA. ^ SECOND EDITION, REVISED. OLrfl EMOR . '"JU^, ERSITY % "^ THE A. W. CALHOUN MEDICAL LIBRARY ^ * PUBLISHED BY THE AUTHOR. "^ ^ Post Oppick Box 92, Philaoklphia, Pa. ^^ 1894, % ^ 7? |5"zf,M/^ Entered, according to Act of Congress, in the year 1894, By MRS. MARY T. VALENTINE, (MARY YOUNG RIDENBAUGH,) In the Office of the Librarian of Congress, at Washington, D. C. ^ JT'li.^t'^'-^^-^^- ^i^/i f- /Ff^ TO THE MEDICAL PROFESSION AND TO THE EARNEST WORKERS IN THE FIELD OF SURGERY WHO REVERE THE MEMORY OP EPHRAiM Mcdowell, m.d. 'S^is ^S'Otf: i$ Affecttottttfcft) 3»n5crt6cb, BY HIS GRANDDALGHTER, MARY YOUNG RIDENBAUGH. NOTE. Occasional repetition of facts recorded in medical works will be found in this book. This is owing to the articles containing these repetitions having been written by eminent surgeons who were not aware of what had already been contributed, and to the fact that a portion of the work had been electrotyped previous to the reception of these articles. PREFACE. Dr. Ephraim McDowell, the subject of this memoir, has rested from his earthly labors sixty years, and the reader will naturally wonder why so great a length of time should have elapsed before his biography had been written. Although notices of his wonderful career as a surgeon have appeared from time to time, notably one written by the late Professor S. D. Gross, yet no detailed account of his private life has heretofore been given to the public. At the present time laparotomy is appreciated and practised by the entire surgical world, and countless thousands are yearly being saved by McDowell's operation, ovariotomy. Each year the desire and interest becoming greater to know who this man was, and what prompted him first to insert the knife into the abdomen, led to a determination on the part of several of the most prominent surgeons of America to request some one of his de- scendants to give to the world all the facts of interest that could be gathered relating to the life of this daring surgeon. Hence the Author of this work, by request, has prepared The Biography of Ephraim J\fc Doiae/l, M.D., trusting that her labors will be appreciated, and the work prove a fitting tribute to the memory of one whose entire life was devoted to the cause of suffering humanity. We are largely indebted to Col. Thomas Marshall Green, of Maysville, Kentucky, for a correct and gra])hic history of the antecedents of Dr. McDowell, the persecutions of (v) VJ PREFACE. the family, and the flight of its members from their native country, together with an account of their success and progress after settlement in America. We understand that Col. Green has searched diligently the family records to obtain everything of interest connected with our subject, hence we are secure in quoting from his work, entitled Historic Families of Kentiuky, in following the ancestral line of Dr. Ephraim McDowell. Professor Eugene Cordell, of Baltimore, Md., after great difficulty and delay, kindly procured a copy of the original diploma awarded to Dr. McDowell in the year 1825. We are indebted to Col. J. McD. Alexander, of Virginia, for three very interesting letters, one, bearing date of 1792, written to the grandfather of Col. Alexander, and two, in 1793, to Ephraim McDowell, while he attended the lectures in Edinburgh, Scotland. Dr. Edwin A. Peaslee, of New York City, kindly loaned us the use of the fine steel-plate of Dr. McDowell, which likeness he had engraved from a daguerrotype furnished by the late Mrs. McDowell, forming the frontispiece of this work. Dr. Coleman Rogers, of Louisville, Ky., also kindly presented us with several copiesof the " memorial services," "held in Danville, Ky., at the dedication of the monument erected to the memory of Dr. Ephraim McDowell by the Kentucky State Medical Society, May 14, 1879. As addenda to this life of Dr. McDowell, there will be found contributions from some of the leading ovariotomists of America and Europe, which, when considered in com- bination, will be found possessed of the value of a complete text-book on the subject. In these articles is considered everything that relates to the matter in its most advanced development. Also every incident of interest connected with the private life of this remarkable man will be found in this work. Dr. Nathan Bozeman, of New York City, has given us an ably-written article comprising many points of deep PREFACE. vii interest to the medical profession. He has prepared his article especially for the Biography of Ephraim McDowell, M.D., and has spared no pains in its preparation. Through the kindness of Dr. John H. Mclntyre, of St. Louis, Mo., we have been furnished with a detailed description of the operation of ovariotomy, giving the reader an opportunity of comparing the present mode of operating with that first given to the profession by Dr. McDowell, in the year 1809. We were desirous of obtain- ing an article descriptive of ovariotomy from the able writer, Dr. William Goodell, of Philadelphia, Pa. ; but, on his careful reading of Dr. Mclntyre's paper, Dr. Goodell remarked, "The article from Dr. Mclntyre covers the entire ground of ovariotomy, and I could not add to or take from it one word. I think it admirable." To Professor William Tod Helmuth, of New York City, we extend our heartfelt thanks for his valuable article, pro- nouncing Dr. Ephraim McDowell "the father of ovari- otomy" flie world over, and for many other kindnesses received at his hands. Dr. Lewis S. McMurtry, of Kentucky, will please accept thanks for the sketch of Dr. Ephraim McDowell, by the late Dr. John D. Jackson, of Danville, Ky. We are also under obligations to Dr. W. W. Dawson, of Cincinnati, O., Prof. D. W. Yandell, of Louisville, Ky., and Prof. Walter Coles, of St. Louis, Mo., for valuable articles. We are pleased to refer to the late Dr. Washington L. Atlee, of Philadelphia, who did so much toward reestablish- ing " ovariotomy." His work entitled Ovarian Tumors, IS dedicated in part " to the memory of Ephraim McDowell, M.D., of Kentucky, the founder of ovariotorny in 1809." Drs. W. Gill Wylie and Augustin H. Goelet, of New York City, and Dr. Richard J. Levis, of Philadelphia, Pa., kindly contributed to this work. It also gives us pleasure to acknowledge our full appre- ciation of all favors extended to us during the preparation Vlll PREFACE. of this work, by Drs. Lewis A. Sayre, George F. Shrady, Fordyce Barker, T. Gaillard Tliomas, and William M. Polk, of New York City ; Drs. D. Hayes Agnew, A. R. Thomas, and Joseph Price, of Philadelphia, Pa. ; Drs. Oliver Wendell Holmes and Henry J. Bigelow, of Boston, Mass. ; Drs. Charles T. Parkesand E. C. Dudley, of Chicago, 111.; Dr. Dudley S. Reynolds, of Louisville, Ky. ; Dr. Dowling Benjamin, of Camden, N. J. ; and our many medical friends in St. Louis, Mo., and elsewhere, who are too numerous to individualize. Sir T. Spencer Wells and Dr. George Granville Bantock, London, England; Professor A. R. Simpson and Willoughby Walling, U. S. Consul, Edinburgh, Scotland; Charles William McDowell, Esq., of Otter Holt, Carlow, Ireland; M. Starkloff, U. S. Consul, Bremen, Germany; and many other eminent surgeons abroad have expressed their appreciation of Dr. Ephraim McDowell, and his won- derful achievements in surgery, by eulogistic letters and valuable articles, some of which will be found in this work. Professor James E. Garretson was kind enough to lend the value of the literary experience of "John Darby" to the Author in a reading and revision of her book as it went through the press, a favor more than duly appreciated and valued. Where remaining faults are noticed, blame belongs alone to her. Were we to attempt to enumerate the courtesies and kindnesses extended us by the medical profession, a detailed account would fill a volume. We can only say that their words of encouragement, and full appreciation of our labors, have urged us on to the completion of this book, and engraven upon our heart a feeling of friendship that the blighting hand of time cannot obliterate, and it will be a link to the memory of Dr. Ephraim McDowell. The several medical journals which have so kindly noticed our work in advance of its publication are most gratefully remembered by The Author, CONTENTS. PAGE I. Introduction This Work Contains all that has yet been Discovered in the Field of Ovariotomy 2 Circumstances that Prompted McDowell to Perform the First Operation 2 Material for the Work Collected by the Granddaughter of McDowell .... 3 Action Taken in Commemoration of McDowell, by the American Medical Association, held at Louisville, Ky., May 4-7, 1875 4 Earnest Efforts of Drs. John D. Jackson and Lewis A. Sayre, to have a Monument Erected to the Memory of McDowell 10 Dr. McMurtry Subsequently Engaged in Completing this Under- taking , II Characteristics of Mr. John Bell, Preceptor of McDowell, in Edinburgh, Scotland 12 II. Ancestral Line of Dr. Ephraim McDowell. Origin of the Name of McDowell 15 McDowell of the Race Known as the Scotch- Irish ...... 16 Arrival of McDowell's Ancestors in Pennsylvania, Sept. 4, 1729 19 Samuel McDowell, Father of Dr. McDowell, Born Oct. 29, 1735 28 Dr. Ephraim McDowell, Born in Rockbridge County, Virginia, November 11, 1771 . . 33 III. E.arly Life of Ephr.aim McDowell and His Educational Advantages. Dr. McDowell's Removal to Kentucky when Thirteen Years Old 34 Description of McDowell at the Age of Manhood 37 McDowell Attended Lectures at the University of Edmburgh, Scotland, in 1793-4 38 Interesting Letters to McDowell from his F.ither, in 1793 . . 40 IV. Return from Edinburgh. McDowell's Return to Danville, Kentucky, in 1795 .... 51 Marriage of McDowell in 1802 55 (ix) CONTENTS. PAGE An Incident Connected with jMcDowell's Study of Biology . . 58 McDowell's Characteristics 59 Record of McDowell's Children 60 Historical Account of Gov. Shelby, of " Kings Mountain " Fame 62 Indian Legend Connected v/ith the Naming of McDowell's Homestead— ''Cambiskenneth" 65 McDowell as a Slave Owner 66 Prayer of McDowell Previous to His First Ovariotomy ... 68 V. The First Case of Ovariotomy. First Operation was Performed on Mrs. Crawford, December 13,1809 70 Nature and Hazard of this First Operation 71 Personal Description of the Heroic Mrs. Crawford ..... 73 ■ Acknowledgment of McDowell's Daring Skill, by the Medical Society of Philadelphia, in 1817 74 Copy of Diploma Awarded to McDowell in 1825 75 Operation on James K. Polk by McDowell, with Letter of Appre- ciation from Patient ^^ McDowell's Crossing the Ocean on Three Occasions to do the Cassarean Section 7^ One Instance of McDowell's Charity in Undertaking a Perilous Journey of Over One Hundred Miles to Gratuitously Perform Ovariotomy ....«...•■••• °3 VI. Persecutions. "A Great Theory Never Accepted without Opposition" ... 85 Dr. Hunn's Misrepresentations and Scandalous Allegations . . 86 Negroes Regarding McDowell with Suspicion and Horror . . 88 McDowell made a Target by an Envious Pretender— Dr. Hunn 89 Interesting Article Contributed by Prof. William Tod Helmuth 90 VII. Death of Dr. Ephraim McDowell. Dr. McDowell Passed from His Earthly Labors, June 20, 1830 100 Dr, McDowell's Virtues, and His Abiding Faith in His Creator 102 Pecuniary Circumstances of the Deceased Surgeon 104 Desolation and Death of Mrs. Dr. McDowell 105 Removal of Dr. and Mrs. McDowell's Remains to Danville, Ky., in 1879 ^°^ VIII. Criticisms AND Comments. Dr. Fzra Michener's Sarcastic Allusions to McDowell .... 108 Dr. Washington L. Atlee's Early Persecutions 109 CONTENTS. xi PAGF Mr. Lawson Taifs Comments 115 Reply to Mr. Tait by the Authoress 118 Statistics and Remarks Regarding Ovariotomy in Various Countries, by Dr. E. Randolph Peablee 120 Tables of Completed Ovariotomy in the United States, Great Britain, France, and Germany up to 1872 136 IX. Comments upon Ovariotomy. Dr. Washington L. Atlee's " Diagnosis of Ovarian Tumors " . 142 Dr. Peaslee publishes, in 1872, Facts establishing Dr. McDowell's Priority as an Ovariotomist 152 Prof. W. Gill Wylie's Report on 110 Cases of Laparotomy . . 154 Dr. Augustin H. Goelet in Favor of Electricity 155 X. Joseph Nashe McDowell, M.D. The "McDowell Medical College," in St. Louis, Mo., Founded by Dr. J. N. McDowell 158 The Doctor's Peculiarities in Treating Patients 160 His Emaciated Form Suggests the Pseudonym of " Sawbones " 162 Cause of Alienation Between Dr. J. N. McDowell and His Uncle, Dr. Ephraim McDowell 163 Meeting of the Authoress with Dr. J. N. McDowell, at a Dread- ful Collision Between Two Trains of Union and Confeder- ate Wounded Soldiers and Refugees 16'S Wreck of the McDowell Medical College, and its Restoration 167 The Doctor's Crank Idea in Setting Apart and Designatmg One Room as " Hell " 169 Ek;centricities of the Doctor 171 Death of Dr. Joseph Nashe McDowell, October 3, 1S68 . . . 176 Father De Smit's Conversion of Dr. J. N'. McDowell to the Roman Catholic Faith 178 The Doctor's Idiosyncrasy Regarding the Burial of His Infant Children 178 Biographical Sketch of the Late Col. Basil Duke (a Relative of Joseph Nashe McDowell, M.D.) States the Fact that a Few Years .Ago Europe Erected a Suitable National Monument to the Memory of Dr. Ephraim McDowell iSo XI. Biographical Sketch of Ephraim McDowell, M.D., BY the Late Dk. John I). J.\ckson. Dr. Jackson's Great Veneration for McDowell 181 McDowell Performed Every Surgical Operation then Known to Science 182 Xll CONTENTS. PAGE Dr. James Johnson Asks Pardon of God and of Dr. Ephraim McDowell, for His Uncharitableness Toward the Doctor . 183 McDowell's Reply to His Critics, and Ardent Wish that the Operation of Laparotomy may not be Abused 184 Liberality of Mr. Overton, of Tennessee 185 McDowell Remarkable for His Strength and Agility .... 191 McDowell's Method of Treating Fever 193 McDowell's Coolness and De.xterity as an Operator .... 195 All Women Should Bless the Name of Ephraim McDowell . . 197 United States of America Should Erect a Fitting Monument to His Memory 198 Bronze Statue of Dr. Ephraim McDowell Should be Erected Solely from Voluntary Contributions made by those Women who Owe their Lives to Ovariotomy 199 XII. Sketch by W. W. Dawson, INI.D. Address Delivered Before the " American Medical Association,'' at Newport, R. L, in 1889, by W. W. Dawson, M.D. . . 201 Statistics of the First Medical Schools Formed in America . . 202 XIII. Description of One of the Methods of Per- forming Ovariotomy, by Dr. John H. McIntyre, of St. Louis, Mo. " McDowell Cut Away the Abdominal Barriers, and the Sur- geons Walked In and Reaped the Harvest of his Daring Surgical Adventure " 210 Sir James Paget stated — "This Operation is One of the Greatest Achievements of Surgery '' 213 Lord Selborne regarded Ovariotomy as " One of the Most Splendid Triumphs of Modern Surgical Art " 215 Dr. John H. Mclntyre's Method of Performing the Operation 216 XIV. McDo\vell's Operation of Ovariotomy by the Long Incision during the First Thirty- three Years of its Employ.ment. With Com- ments. By Nathan Bozeman, M.D., of New York City. introduction. McDowell's Operation of Ovariotomy. His Cases and Success. Their Influence on the World . . ,, 228 CONTENTS. Xiii PAGE Names Made to Precede McDowell's in Tables of Statistics . . 231 McDowell's Name Placed by Mr. Benjamin Phillips, of England, in his Statistics at the Head of the List of Operators . . 232 McDowell's Claims Accorded by Prof, Samuel D. Gross . . . 233 Acknowledged as the Founder of Ovariotomy by Dr. Atlee . . 234 Statistics by Surgeons at Large Regarding JIcDoweli's Priority 235 The Long Incision 236 Le Dran's Observations and Experiences, 1736 to 1746 . . . 238 Delaporte's Operation 239 Incisionism and the Drainage Tube 240 L'Aumonier's Operation, 1782 242 McDowell and Incisionism 243 The Long Incision of McDowell 244 McDowell's Advance on Incisionism 245 Error of McDowell's Followers 245 Failure of the Short Incision 247 Long and Short Incision Compared 248 Typical Case Showing Advantages of the Long Incision . . . 249 How this Operation has been Studied and its Advantages Brought Out 253 Immediate Followers of McDowell in the United States . . . 253 Attention Directed to Growth of Interest 256 SECTION I. — OVARIOTOMY IN THE UNITED STATES. Account of Three Cases of Extirpation of Diseased Ovaries by Dr. McDowell 259 Dr. Ezra Michener of Philadelphia Criticises the Operation . . 262 Dr. Henderson as a Defender of McDowell 264 Observations on Diseased Ovaria by Dr. McDowell .... 267 Comments by Writer 273 Thirteen Performances of the Operation by McDowell . . . 277 Ovarian Operation by Dr. Nathan Smith of Connecticut . . . 284 Comments on Smith's Operation by Drs. Nathan R. Smith and E. R. Peaslee 286 Comments by Writer 288 Alban G. Smith's Case of Ovariotomy 294 R. D. Mussey's Case of Ovariotomy 298 Comments by Writer 300 David L. Rogers's Case of Ovariotomy 300 Comments by Writer 302 Distinctions in Ovarian Tumors by Dr. J. C. Warren .... 303 Comments by Writer 304 Dr. Bellinger's Case of Ovarian Tumor Complicated with Hydrops Uteri 305 Conclusion of Comments by Writer, and Summary .... 305 Xiv CONTENTS. SECTION II.— OVARIOTOMY IN FRANCE. History in France of Tapping and Incisionism 307 Lisfranc's Clinical Report 308 Delaporte and Extirpation of the Ovary 310 Old Procedures Practised in France 311 Le Dran and Morand, Memoires Royal Academy 312 Encysted Dropsy Treated by Le Dran 313 Nuck's Case of Abdominal Tumor 314 Le Dran's Second Case 316 Cases Treated by M. De La Chaud and Montaulieu .... 318 First Proposal of Extirpation of a Dropsical Ovary .... 320 Comments on Case by M. Morand 321 Extirpation of Ovary Suggested by Delaporle, 1753 .... 323 Neglect of Subject from 1807 to 1837 329 Establishment of Drainage by M. Recamier 331 No Operation for Extirpation of Ovary Performed in France up to 1839 331 Comments by Writer 333 Theden's Scheme for Extirpating Ovary 342 L'Aumonier and his Operation 343 Conclusion of Comments by Writer 350 SECTION III— OVARIOTOMY IN GERMANY. Dzondi, of Halle, Association of his Name with Ovariotomy . 351 Results obtained by Chrysmar, Dieffenbach and Others . . . 353 Dr. Chrysmar the First to Perform McDowell's Operation in Germany 354 Three Cases of Ovariotomy by Chrysmar 355 Dr. Ehrhartstein. Synopsis of a Case 357 On the Puncture and Extirpation of Tumefied Ovaries . . . 358 Comments on Case by Dr. Dolhoff 361 Summary of Cases in Germany 365 Comments by Writer 365 SECTION IV.— OVARIOTOMY IN GREA T BRITAIN. Antiquity of the Tapping Operation 377 Encysted Dropsy Recognized 378 Houston and his Original Procedure by Incision 379 Incisionism and Incisionists . 379 Claims Affecting McDowell 380 Alice's Table of Ovariotomists, 1701 to 1851 381 Dr. Houston's Case of Dropsy of the Left Ovary 381 Influence of Houston on the Profession in France ..... 386 CONTENTS. XV PAGE Hunter's Criticism regarding Origin of Dropsical Ovaries . . 387 Credit due Dr. Hunter 390 Influence of the Incisionists on Hunter ........ 392 Lizars's Observations on Extirpation of the Ovaries .... 395 False Diagnosis and Unjustifiable Operation 399 Instruction of Lizars by McDowell's Manuscript 401 Report of Three Cases by Mr. Lizars 401 Criticism of Dr. McDowell by Dr. Johnson 403 Augustus Bozzi(Dr. A. B. Granville). His Operations in London 408 Mr. R. C. King, of Suffolk. His Operations 410 Mr. JeafFreson and his Views 413 Mr. W. J. West, of Tunbridge Wells, and his Cases .... 418 Hargrave's Case 421 Guy's Hospital Case 421 Mr. Crisp's Case 423 Mr. Benjamin Phillips's Case 423 Summary of Cases and Results in Great Britain 425 Comments of Writer on British Ovariotomy and Ovariotomists 425 General Summary of Cases and Results in the United States and Europe 444 XV. Eulogistic Letters, etc. Letter from Sir T. Spencer Wells, London, England, Dated July 2, 1887, Enclosing Remarks Relating to Ephraim McDowell, M.D., made at the " College of Surgeons " in 1878 . . . 445 The Remarks of Sir T. Spencer Wells 446 Letter from Dr. George Granville Bantock, London, England, Expressing the Wish that a Grand Success will Crown the Efforts of the Authoress . 449 Letter from Prof. A. R. Simpson, Edinburgh, Scotland, Dated October 20, 1887, to Dr. Willoughby Walling, United States Consul 450 Letter from Dr. Willoughby Walling, Edinburgh, Scotland, Dated October 20, 1887, to the Authoress, Enclosing Letter to Him from Prof. A. R. Simpson 451 Letter from Prof. A. R. Simpson, Dated December 6, 1887, En- closing Copy of the Lecture Delivered by Him at the Uni- versity of Edinburgh, Scotland, October 19, 1887 .... 452 The Lecture Delivered by Prof. Alexander Russell Simpson . . 452 Tribute to Dr. Ephraim McDowell by Prof. D. W. Yandell, Delivered at a Complimentary Dinner Given to Prof. Samuel D. Gross, at Philadelphia, P.i 460 Letter from Prof. Walter Coles, St. Louis, Mo., Dated May, 1889, Eulogizing Dr. Ephraim McDowell 463 xvi CONTENTS. XVI. Memorial Services at the Unveiling of the McDowell Monument, at Danville, Ky., May 14, 1879. PAGP Preface, by the Committee of Publication 467 Letter from Dr. Coleman Rogers, Louisville, Ky., Chairman, Committee of Publication 471 Letter from Dr. L. S. McMurtry, Danville, Ky., Chairman McDowell Monument Committee 471 Dedicatory Address, by Professor Samuel D. Gross, M.D. 472 Address of Professor Lewis A. Sayre, New York City .... 537 Letter from Dr. J. M. Toner, Washington, D. C 541 Letter from Dr. Theophilus Parvin, Indianapolis, Ind. . . . 544 Letter from Dr. T. G. Richardson, New Orleans, La 545 Letter from Sir T. Spencer Wells, London, England .... 547 Letter from Dr. Oliver Wendell Holmes, Boston, Mass. . . . 548 Letter from Dr. T. Gaillard Thomas, New York City .... 551 Presentation Address — Remarks by Prof. Richard O. Cowling, M.D., of Louisville, Ky., in Presenting the Door-knocker of Dr. McDowell to Professor Samuel D. Gross, M.D. . . . 553 Reply of Dr. Gross 557 ADDENDA. Portraits and Sketches of the Lives of Prof. T. G. Richardson, M.D., New Orleans, La 561 Joseph Eastman, M.D., LL.D., Indianapolis, Ind 569 Albert Vander Veer, M.D., A.M., Ph.D., Albany, N. Y. . . . 572 J. Henry Carstens, M.D., Detroit, Mich 576 Henry O. Marcy, A.M., M.D., LL.D., Boston, Mass. ... 580 Walker Gill Wylie, M.D., New York, N. Y 582 Egbert Guernsey, M.D., New York, N. Y 585 Cornelius Kollock, M.D., Cheraw, S. C 588 Jacob Geiger, M.D., St. Joseph, Mo 590 John Hoge Mclntyre, A.M., M.D., St. Louis, Mo 591 Augustus Palmer Dudley, M.D., New York, N. Y 594 Theodore Gaillard Thomas, M.D., New York, N. Y 597 Augustin H. Goelet, M D., New York, N. Y 599 Hermann J. Boldt, M.D., New York, N. Y 602 W. E. B. Davis, M.D., Birmingham, Ala 605 George Tucker Harrison, M.D., New York, N. Y 608 Alexander J. C. Skene, M.D., Brooklyn, N. Y 611 Joseph Edward Janvrin, M.D., New York, N. Y 617 Malcolm McLean, M.D. , New York, N. Y 620 CHAPTER I. INTRODUCTION, In the work now about to be put before the public, it is proposed to give a history of the late Dr. Ephraim McDowell, with a sketch of his antecedents, a description of his surround- ings, a review of the times in v/hich he lived, together with a treatise on ovariotomy, com- paring the present mode of operating with that of eighty years ago, besides some interest- ing accounts of results that have sprung from the daring experiments of the frontier doctor, who, without anaesthetics, with inadequate in- struments and unskilled assistants, conferred upon woman the greatest boon that surgery has ever given the sex. The work also contains letters and papers from some of the foremost American and Eng- lish surgeons testifying to the high place that Dr. McDowell holds in the history of surgery, and making clear his right to be called "The Father of Ovariotomy." These papers are not in I 2 INTRODUCTION. only eulogistic, but coming from the highest sources are equally instructive. The work contains all that has yet been dis- covered in the field of ovariotomy, besides giving the general reader an interestingr narrative of the life and times of one of the most remarka- ble men of early Kentucky. The causes which have led to a great and unexpected scientific achievement, the conditions under which It was performed, and the character of the man to whom it is due, must always be of interest to those concerned in the world's progress. Therefore it will be of peculiar interest to note the circumstances under which McDowell performed his first ovarian operation, as well as to discover just what manner of man was he whom his contemporaries denounced as little better than a murderer, and who yet had the temerity to insert the knife into the abdo- men of a woman, and to do this again and again. In order that his surroundings may be fully depicted, the author has carefully gathered all that has been written about him, and noted the conditions of society at this early date in Kentucky. Dr. McDowell married the daughter of Isaac INTR OD UC TION. « Shelby, Kentucky's first Governor, and this circumstance enables the writer to bring before her reader some most interestingf reminiscences of the early politics of the State, in which McDowell played no part, but which have a direct interest as showing the state of the times. The material for the work has been collected by a granddaughter of Dr. McDowell (Mrs. Ridenbaugh), who, being a descendant of these two eminent men, Ephraim ?yIcDowell and Isaac Shelby, unusual facilities have been offered her for making the required investigations. She has received the assistance of several eminent physicians and surgeons, the members of the fraternity displaying warm interest and zeal in aiding the production of a fitting memento of her grandfather. The great surgeon was born in Virginia, but was brought by his parents to Kentucky when Daniel Boone was still fiofhtino- the Indians on "the dark and bloody ground" of Kentucky, which State was literally a wilderness. Long afterward it was admitted to the Union. It is not to be supposed that it was in the wilds of the frontier that young McDowell learned to use the knife so skilfully and boldly. 4 INTR ODUC TION. Perhaps It was the pioneer spirit which gave him courage to make the experiment ; at a period, too, when it was difficult to obtain pro- fessional consultation, as then we had not en- tered the progressive age, the age of won- drously rapid development, when efforts to eirdle this microcosm of ours have been sue- cessfully accomplished in sixty-two days and six hours. Dr. McDowell planned and put into execu- tion an operation which, though successful, brought him, at the hands of the medical pro- fession, vituperation and violent opposition, posing him before the world as a heartless "woman-butcher." Quoting the words of the late Dr. W. L. Atlee, "he had little else than the book of nature before him, and the con- sciousness of rig^ht to sustain him." The twenty-sixth annual meeting of the American Medical Association was held in Public Library Hall, Louisville, Kentucky, on May 4, 5,6, and 7, 1875. The Association was called to order by Dr. Edward Richardson, of Louisville, chairman of the committee of ar- ranofements. The meeting was honored by the presence of many distinguished gentlemen from distant JNTR OD UCTION. e regions ; surgeons and physicians met for the advancement of medical science and for the promotion of high interests both as regards the profession and the community. Dr. Richardson, in his address of welcome on this interesting occasion, made the following allusion to some of Kentucky's noblest sur- geons who have done honor to the profession : "It is to us, Mr. President, assembled as we are, in the presence of so many eminent mem- bers of the profession, a source of congratula- tion that our State is not unknown to medical annals, and that she may justly assert the dis- tinction of beinof the first to introduce into sue- cessful practice several of the most important and beneficent operations of surgery, perform- ances now widely known and appreciated, both here and in foreign lands. "The names of McDowell, of Bradshear, of Briggs, of Dudley, have, with those of others, been placed high upon the roll of fame as original and independent thinkers and workers — men who have deserved well of their com- peers in the healing art ; and it is, Mr. Presi- dent, a grateful, if it l)e even but a fond im- agination, that their revered shades are now present with us, to do honor to this occasion 5 INTRODUCTION. and to enlarge our welcome by the addition of their own. Nor would it be improper, Mr. President, if our State should institute also a claim, or a part at least, to more than one of the distinguished gentlemen who are now en- rolled as Eastern members of the American Medical Association. "It is probable, however, Mr. President, that the larger portion of the membership of the Association have now, for the first time, visited our State. Allow me to say to these that it Is for the stranger that Kentucky ever accords a peculiar welcome, and that it is In 'her old Ken- tucky home' that she loves to dispense the grateful tribute due to the eminent in science and to public benefactors of society who honor her with their presence." After various papers had been read, the res- olutions relating to the business of the Asso- ciation were then taken up and acted upon. Dr. J, Marlon Sims, of New York, read the report of the committee on the "McDowell Memorial Fund," which, on motion, was re- ceived, and the resolutions were unanimously adopted. These resolutions were as follows : Resolved, Whereas, It Is universally acknowl- edged that the late Ephralm McDowell, of INTR OD UC TION. j Danville, Kentucky, was the orig-inator of the operation of Ovariotomy ; and ]Vhcreas, We believe that proper measures should be instituted to commemorate this oreat achievement, and do appropriate honor to its author ; therefore Resolved, That this Association recommends to each of its members, and to the profession generally, that contributions be made annually of such sums as may be thought proper until the amount of ten thousand dollars shall be accumulated, which money shall be known as the "McDowell Memorial Fund," the interest of it to be devoted to payment of prizes for the best essays relating to the diseases and surgery of the ovaries. Resolved, That this fund shall be invested by trustees to be appointed by the Association, and be subject to such regulations as it may devise. Resolved, That this Association shall elect a board of three trustees, whose duty it shall be to carry out the object of these resolutions, and whose term of office shall continue five years. Resolved, That this Association will leave to the State of Kentucky the grateful privilege of 8 INTR OD UC TION. providing a local memorial to the memory' of Dr. Ephraim McDowell. Respectfully submitted, J. Marion Sims, New York. Washington L. Atlee, Penna. W. H. Byford. Illinois. J. M. Keller, Kentucky. On motion of Dr. J. Morris, of Maryland, the following gentlemen were appointed trustees of the McDowell Memorial Fund : Drs. Wash- ington L. Atlee, Pennsylvania; W. H. Byford, Illinois; J. M. Keller and John D. Jackson, Kentucky ; and J. Marion Sims, New York. The following relates to the first series of essays pertaining to the McDowell Fund, and is to have its relevancy understood later. Dr. L. P. Yandell, chairman of Committee on Prize Essays, reported as follows : The Committee on Prize Essays beg leave to report that they have received a number of essays, carefully written and marked by various degrees of merit. But after as careful an ex- amination of them as the Committee have had time to make, they are not prepared to recom- mend any as worthy of the prize offered by the Association. One of the papers submitted INTRODUCTION. q to your Committee is a work of vast dimen- sions. It makes four volumes, and an aesfre- gate of more than twelve hundred pages. The Committee have found it utterly imprac- ticable in the time at their disposal to look through this elaborate paper. It treats of "Excision of the Larger Joints," and strikes the Committee as worthy of a careful examination. They would, therefore, recommend that it be submitted to a committee of experts, to be reported upon at the next meeting of the Association. Respectfully submitted, L. P. Yandell, Chairman. The report was received and the recommen- dation adopted. Drs. S. Ashhurst, S. D. Gross, and D. Hayes Agnew, of Pennsylva- nia, were appointed as the committee. Committee on Prize Essays : Drs. Samuel D. Gross, F. G. Smith, Alfred Stille, EUerslie Wallace, and H. C. Wood, of Pennsylvania. Dr. John I). Jackson, of Danville, Kentucky, as we see, was afterward appointed as one of the trustees of the McDowell Memorial Fund. He attended the meeting of the American Medical Association at Detroit, Michigan, in 1874, and upon that occasion he tried to im- lO INTRODUCTION. press upon the members of the Association the duty of the medical profession generally to erect a monument, as a fitting tribute of respect to the illustrious subject of our memoir, and giving to him the honor to which he is justly entitled, as the originator of Ovariotomy. As early as 1872, Dr. Jackson consulted with the distinguished Dr. Lewis A. Sayre, of New York, as to the propriety of erecting a monu- ment to the memory of the late Dr. Ephraim McDowell. Dr. Sayre urged him to push the matter, and said " undoubtedly a monument worthy so great a man should be erected, and that he (Dr. Sayre) then and there would contribute liberally to such a worthy cause." After several conversations with him upon the subject. Dr. Jackson returned to Kentucky fully determined in his own mind to leave no effort unmade to put into execution, at no dis- tant day, the result of his plans and of conver- sations with Dr. Sayre ; for after having met him he was still more strongly impressed that a monument should be erected. About the time that Dr. Jackson thought all the necessary arrangements perfected to carry out his purpose (and really the cherished object of his heart), he was stricken with a IXTRODUCTIOX. j j disease that has seldom yielded to man's skill (consumption), and in a brief period passed from his earthly labors, leaving unfinished, and to the hands of others, the work in which he was so much interested. Dr. McMurtry, a promising young surgeon at that time, also of Danville, eno-agfed at once in the same laudable undertaking begun by Drs. Jackson and Sayre, and in a few years thereafter the shaft was completed and stood ready to be unveiled; which occasion we will refer to in the closing chapter of this work. Great credit is due Dr. McMurtry for his perseverance and energy in this matter. The late Dr. Jackson, in his remarks relative to Dr. McDowell, seems to have been im- pressed with the idea that McDowell's first conceptions, his first promptings to make the experiment upon Mrs. Crawford, were but the teachings in embryo state of Mr. Bell — brought out and materialized, as it were, by McDowell. With all due deference to the lamented Jack- son, and to his earnest convictions, we must differ with him in his views ; for we are thor- oughly convinced that the idea of ovariotomy originated in the fertile brain of Dr. McDowell, although the words of Mr. Bell made a lasting 12 INTRODUCTION. impression upon him; but he, McDowell, lived in an atmosphere replete with brilliant achieve- ments, generating and putting into execution some of the most remarkable surgical discov- eries and operations of any age — amongst men whose works are blended with historical events and reported in our American medical histories. It is not surprising, however, that Dr. Mc- Dowell, under the immediate influence and dis- cipline of such an intellect as was possessed by Mr. Bell, should have unconsciously imbibed the spirit of his thoughts and suggestions ; for certainly the preceptor was a remarkable man, and, at the time, in his glory. Ephraim Mc- Dowell studied under him in 1 793 and 1 794. John Bell was tall and commanding in ap- pearance, his movements were quick, and his speech the essence of eloquence. He was nervously excitable, and often allowed his feel- ings to carry him further than he wished. Those familiar with his habits say that they have often seen him so absorbed in his own ardent decla- mations as to deviate from the subject upon which he would be lecturing. He would speak of some foreign subject until his hour had expired, then looking at his watch, and realizing- how ridiculous he must INTR OD UCTION. I ^ have appeared to the Hsteners would burst into tears. He was an experienced, bold operator, and understood the anatomy of the human body thoroughly. He excelled all other surgeons in his day, in easy flow of language and animated thought. His power of description was so great that even to the unprofessional person the reading of his Anatomy was pleasing and without fatigue ; and his surgery only added interest and recrea- tion. He gave himself great distinction by his studies in pathology of the arteries and by his ingenious treatment of arterial injuries. He devised many new and critical operations, and took a keen interest in removing the superflui- ties of the old surgery, not at all times sparing the new. Bound in the volume with the Life of Dr. McDowell is a complete copy of the memorial oration delivered by the late S. D. Gross, M.D., LL.D., D.C.L. Oxon., at Danville, Ken- tucky, on the occasion of the unveiling of the monument erected to the memory of Dr. Mc- Dowell, by the Kentucky State Medical Society, May 14, 1879, together with the proceedings of I^ INTRODUCTION. the Society relative to the erection of the mon- ument, and papers read on that occasion. The biography of Ephraim McDowell will interest every one who takes a pride in Ameri- can thinking, energy, and daring ; especially will it appeal to scientists — more than all, to every surgeon and every physician. Although the name of "the father of ovariotomy" is familiar to all surgeons, yet this fact cannot lessen an interest that must be felt in the life of Ephraim McDowell. CHAPTER II. ANCESTRAL LINE OF DR. EPHRAIM MCDOWELL. "Of all the fierce and warlike cepts that ranged themselves beside the Campbells, under the leadership of the chiefs of that name, in the struggle so replete with deeds of crime and heroism, of oppression and stubborn resistance which had their fruit in the overthrow of the right line of the Stuarts, there were none more respectable, nor none that more perfectly illus- trated the best qualities of their race than the sons of Dowall. Sprung from Dougal, the son of Ronald, the son of the great and famous Somerled, they had, from the misty ages, marched and fought under the cloud- berry bush, as the badge of their clan, and had marshalled under the banner of the ancient Lords of Lorn, the chiefs of their race. The form of McDowell was adopted by those of the McDougal clan who held lands in Gallo- way, to which they, the Black Gaels, had given its name. (15) 1 6 ANCESTRY. "The latter branch became allied by blood and intermarriage with the Campbells. Pres- byterians of the strictest sect, and deeply imbued with that love of civil and religious freedom which has ever characterized the fol- lowers of John Knox, they found their natural leaders in the house of Argyle. In what deeree related to the chiefs of the name was the McDowell who left behind him the hills of his native Argyleshire, to settle with others of his name and kindred and religion in the north of Ireland during the protectorate of Cromwell, cannot be actually stated ; he was, so far as can be gleaned from vague traditions, one of the most reputable of the colonists who there founded the race known as the 'Scotch-Irish,' the characteristics of which have since been so splendidly attested by its heroes, scholars, orators, theologians, and statesmen all over the world. "This Scotch colonist, McDowell, had among other children a son named Ephraim, which of itself indicates that he was a child of the Cove- nant. It was fitting that Ephraim McDowell should become at the early age of sixteen years one of the ' Scotch-Irish ' Presbyterians who flew to the defence of heroic Londonderry on ANCESTRY. ^1 the approach of McDonnell, of Antrim, on the 9th of December, 1688, and that he should be one of the band who closed the gates against the native Irishry intent on blood and rapine. During the long siege that followed, the memory of which will ever bid defiance to the effacing hand of time, and in which the devoted preacher George Walker and the brave Murray at the head of their undisciplined fellow-citizens — farmers, shopkeepers, mechanics, and ap- prentices — but Protestants, Presbyterians, suc- cessfully repelled the assaults of Rosen, Mar- mont, Persignan, and Hamilton, the McDowell was conspicuous for endurance and braver)^ in a land where all were brave as the most heroic Greek who fell at Thermopylae. "The maiden name of the woman who be- came the worthy helpmate of the Londonderr)^ soldier-boy was Margaret Irvine, his own full cousin. She was a member of an honorable Scotch family who settled in Ireland at the same time as their kinspeople, the McDowells. The names of Irvin, Irvine, Irving, Irwin, and Er- win are identical — those bearing the name thus variously spelled being branches from the same tree. The name was and is one of note in Scotland, where those who bore it had inter- l8 ANCESTRY. married with the most prominent families of the kingdom, breeding races of soldiers, states- men, orators, and divines. "Ephraim McDowell who fought at Boyne River, as well as at Londonderry, was already an elderly man when, with his two sons John and James, his daughters Mary and Margaret, and numerous kinsmen and co-religionists, he emigrated to America to build for himself and his a new home. In his interestinof Sketches of Virginia, Foote states that he was accom- panied to Virginia by his wife, and that his son John was a widower when he left Ireland ; but, as in the deposition of Mrs. Mary E, Green- lee, the daughter of Ephraim, her father, her brother John, her husband, and herself are designated as composing the party emigrating to Virginia from Pennsylvania, and no mention is anywhere made of her mother, Mr. Foote is probably in error, and the uniform tradition of the family is more Hkely to be correct — that the wife of Ephraim McDowell died in Ireland, and that John McDowell had never been mar- ried until he came to America. "The exact date of his arrival in Pennsyl- vania is not known. The journal of Charles Clinton — the founder of the historic family of ANCESTRY. I^ that name in New York — gives an account of his voyage from the county Longford, in the good ship 'George and Ann,' in company with the 'John of Dubhn,' having many McDowells aboard as his fellow-passengers. The ' George and Ann' set sail on the 9th of May, 1729. On the 8th of June a child of James McDowell died, and was thrown overboard ; several other children of the same family afterward died ; also a John McDowell, and the sister, brother, and wife of Andrew McDowell. The ship reached land on the coast of Pennsylvania on the 4th day of September, 1729. Whether or not the conjecture that Ephraim McDowell was a passenger with his kindred on board this ship at that time is correct, it is certain that about the same time he and his family and numerous other McDowells, Irvings, Camp- bells, McElroys, and Mitchells, came over together and settled in the same Pennsylvania county. "In Pennsylvania Ephraim McDowell re- mained several years. There his son John was married to Magdelena Wood, whose mother was a Campbell, and, as tradition has it, of the noble family of Argyle. There Samuel (the father of Dr. Fpliraim McDowell the subject 20 ANCESTR Y. of this work) the eldest son of John and Mag- dalena McDowell, was born in 1735. There too, probably, Mary, the daughter of Ephraim, met, was beloved by, and married James Greenlee, a Presbyterian Irishman, of English descent, and said to have been remotely de- scended from the Argyle-Campbells. "Some years before, a near relative of Eph- raim McDowell, by name John Lewis, had left Ireland a fugitive. Sir Mungo Campbell, an oppressive landlord, had attempted in a lawless and brutal manner to evict him from premises of which he had a freehold lease, had slain before his eyes an invalid brother, and with one of his cruel henchmen had died the death of the unrighteous beneath the strong hand of Lewis. First seeking refuge in Portugal, where lived a brother of his wife, he was by him advised to find a safer asylum in the great cen- tral valley of Pennsylvania, whither were then flocking many of the Protestants of Ulster. His first resting-place was at Lancaster, where he was in time joined by his sons Samuel, Tho- mas, and Andrew, and by his noble wife Mar- garet Lynn. The latter was a native of Ire- land. Her ancestors, the chiefs of their clan, derived their patronymic from the beautiful ANCESTRY. 21 loch on whose banks in Scotland nestled their homes, and in the mountains, reflected by the translucent waters of which, they hunted. He landed in Pennsylvania the same year that brought the McDowells to America — 1729. That John Lewis and Ephraim McDowell were related and had been friends in Ireland, ap- pears from the deposition of Mrs. Mar}'- Greenlee, the daughter of the latter, in 1806 in the suit of Joseph Burden vs. Alex. Cueton and others. The degree of the kinship is not stated ; but from the similarity of Christian names in the two families, and other circum- stances, it is believed their mothers were sisters. "James McDowell, the second son of the Londonderry soldier, had planted corn and made a settlement on the South River, in the Beverly Manor, in the spring of 1737 ; and thither the remaining members of the family determined to proceed and pitch their tents. Accordingly, in the fall of the year, Ephraim and John McDowell and James and Mary Greenlee left Pennsylvania, traversed the lower valley of the Shenandoah, intending to locate not far from John Lewis, and had reached Sewell's creek, where they went into camp. 22 ANCESTRY. The fires were lighted and arrangements made for the evening meal, when a weary stranger coming up solicited their hospitality. It was Ben- jamin Burden (or Borden as the name is spelt by those of the family who clung to New Jersey, and gave its designation to Bordentown), an Englishman who had recently come over as the agent of Lord Fairfax, the proprietor of the Northern Neck. Meeting at Williams- town with John Lewis in 1736, he had accepted the cordial invitation of the latter to visit him at Bellefonte, Pennsylvania, had chased the roaming buffalo with the hos- pitable Irishman and his stalwart sons, and with their assistance had taken a buffalo calf, which, carrying as a trophy to Williams- burg, he presented to Governor Gooch. Pleased with what was then a curiosity in tide- water Virginia, and anxious, besides, to pro- mote the extension of the frontier and the settlement of hardy pioneers, as a means of protection and defence to the more populous lower country, Sir William issued to Burden a patent for 500,000 acres of land or any less quantity, situated on the Shenandoah or James River, not interfering with previous grants, on condition that, within ten years, he should set- ANCESTRY. 23 tie on the lands so located not less than one hundred families ; one thousand acres for every family settled or cabin built, with the privilege of purchasing an additional adjacent one thou- sand acres, at one shilling per acre. Making himself known to the McDowells, and produc- ing the patents as proof of his rights, he in- formed them that he had located ten thousand acres in the forks of the James River, to which he could not find his way, and stated he would give one thousand acres to any one who would pilot him to his possessions. "John McDowell was a man of education, and a practical and skilful surveyor. He accepted Burden's proposition ; writings were entered into to complete the agreement, and finally the party agreed to settle in ' Burden's Grant ' and to assist him in conforming to its conditions. The next day proceeding to John Lewis' and remaining there a few days until all the stipulations of the contract could be reduced to writing, they went on until coming to the lands upon which Burden had the privi- lege to enter, building their cabins in what is now Rockbridge County, not far from the pres- ent town of Lexington — Ephraim and John 24 ANCESTR V. McDowell and James Greenlee, the first three settlers in all that region. "Complying- with their agreement with Bur- den, they immediately entered into communi- cation and opened negotiations with their kindred friends, and co-religionists in Pennsyl- vania, Ireland, and Scotland ; soon drawing around them other Scotch and Scotch-Irish families — McClungs, McCues, McCowns, Mc- Elroys, McKees, McCampbells, McPheeters, Campbells, Stuarts, Paxtons, Syles, Irvines, Caldwells, Calhouns, Alexanders, Cloyds — names which since have gloriously illustrated every page of Western and Southern history. In the field, at the bar, in the pulpit, in the Senate, on the bench, on the hustings, every- where by their courage, eloquence, learning, and patriotism, they have made themselves conspicuous ; making famous their own names, and building up the country with whose history and growth they are inseparably identified. "Burden lived on the grant until near the time of his death in 1742. Having, through the McDowells, fulfilled the conditions of the 'grant,' Burden induced his son-in-law, James Patton, to seek an increase of fortune in the new world. ANCESTRY. 25 "Remarkable in many ways, other than the great age of more than a century to which he lived, the span of Ephraim McDowell's life covered the overthrow of the Stuarts, the rise oi the House of Hanover, the establishment of the Empire of Britain in India and over the seas, the wresting of New York from the Dutch, and the expulsion of the French from North America ; the erection of the electorate of Brandenburg into the kingdom of Prussia ; the victories of Marlborougr-h and Eugfene, of the great Frederick, the consolidation of the Russian Empire under Peter and his succes- sors, the opening of the great West by the daring pioneers, and the growth of liberalism in Great Britain, France, and America. "Foremost by reason of influence and energy of the virtuous and hardy community, he and his associates erected school-houses and churches in the valley even before they constructed forts. Eminently useful and prac- tical in the character of his mind and the man- ner of his life, Howe records the fact that he built the first road across the Blue Ridge, to connect the valley with the tidewater country, at once affording a mode of egress for the production of the former, and facilities for 26 ANCESTRY. receivinof from the merchants of the latter the manufactures of the old world. Religious, moral, intelligent, and shrewd, the singular and beneficent influence he acquired among the independent and intrepid spirits by whom he was surrounded, was a natural tribute to his virtue and sagacity, and to the unflinching devotion to the cause of civil and religious liberty he had all his life upheld. "It is scarcely necessary to state of such a man, at once hospitable and provident, that he failed not to use the opportunities with which, fair and generous nature had surrounded him to reap and store a fortune considered very large in those days. Retaining full possession of all his faculties to the very last, he died not until the outbreak of the Revolutionary war, and not until he had heard praises bestowed on his grandchildren for good conduct shown at the battle of Point Pleasant."' John McDowell, the father of Samuel Mc- Dowell, fell in battle with the Indians, In the year 1 743. He commanded a company of brave men, who fought the savages desperately, but were compelled to retreat, when the Indians ^ Historic Families of Kentucky. ANCESTR V. 27 massacred the leader and eight of his men. The survivors, being completely routed, escaped as best they could. Rev. W. W. Foote, in his interesting- Sketches of Virginia, says : "The burial place of these men, the first perhaps of Saxon race ever committed to the dust in Rockbridge County, you may find in a brick enclosure on the west side of the road from Staunton to Lexington, near the red house or 'Maryland Tavern,' formerly the resi- dence of John McDowell. Entering the iron gate and inclining to the left about fifteen paces, you will find a low, unhewn limestone tomb, about two feet in height, on which, in rude letters, by an unknown, unpractised hand, is the following crude inscription : Heer lyes the boddy of John Mack Dowell. died. December — 1743. " John McDowell left three children, Samuel, James, and Sarah. James remained in Virginia, consequently inheriting a handsome estate. He married Miss Sarah Preston, whose family were closely identified with the interests of 28 ANCESTR Y. Virginia. Three children were born to them. The second daughter married Col. Thomas H. Benton, a once prominent politician. He was several times United States Senator, and was for many years identified with Missouri's inter- ests and politics. Samuel McDowell, the first-born of John (and grandson of old Ephraim, of London- derry), and the father of Dr. Ephraim Mc- Dowell, the subject of this work, was born in the colony of Pennsylvania, October 29, 1735. On the 17th day of January, 1754, in Rock- bridge County, Virginia, at the age of eighteen years, he was married to Miss Mary McClung, daughter of John McClung and Elizabeth Alex- ander, the lady being born in Ireland, October 28, 1735, and being by one day the senior of her husband. She, Elizabeth Alexander, was the daughter of Archibald Alexander and Mar- aaret Parks, and was born at "Manor Cunninof- ham," Scotland, and was married in Ireland, December 31, 1734. Samuel McDowell and his wife Mary had eleven children born to them, and Ephraim was the ninth child. For many years Judge Samuel McDowell was engaged in public life, and held many high positions of trust. He ANCESTRY. 20 served six different times as chairman of the State Convention before the election of a Gov- ernor. He was a member of the legislature several terms. He was colonel of a regiment in the battle of Guildeford, North Carolina. He was the first United States judge for Kentucky, and was president of the convention which framed the constitution of that State in 1792. When Spain opened negotiations with Ken- tucky to have that State declare its indepen- dence, he was an active worker and prominent politician. In the year 17S2 he was appointed by the Virginia Assembly a land commissioner. In 1784, many flattering inducements being offered him, he removed with his family to what is now known as Mercer County, Ken- tucky; and in 1786 he was one of the presiding judges at the first county court held in that State, the Kentucky District. From that date he was given the title of Judge, and was always known afterward as Judge Samuel McDowell. In the year 1785 he was chosen to preside over the convention which met in the rural village of Danville, then the county seat of Mer- cer County, Kentucky ; he was likewise chosen to preside over all the subsequent conven- tions which assembled to discuss the means of 20 ANCESTRY. attaining an end so commonly desired. His irreproachable character, his judicial temper, his solid attainments, and matured convictions possessed him of the universal confidence. He was admirably qualified for the position that his destiny allotted him to fill, and it was by the patient discretion and calm, considerate judg- ment of the presiding officer, and the deter- mined, cool patriotism of others like himself, that the difficulties of a separation from Vir- ginia were peacefully and legally overcome, and the numerous advantages commercially — the unobstructed and free navigation of the Mississippi — eventually and satisfactorily reached. In the unsettled and perilous times connected with the early history of the West, and especially with pioneer life in the State of Kentucky, he was the " central figure of an historical group of men conspicuous, like him- self, for courage, intelligence, fortitude, endur- ance, dignity of character, and mental poise. All were representative men, were types of a cultivated class and of a vigorous, aggressive, and enduring; race."^ Judge McDowell was appointed aid-de-camp by old "King's Mountain" Shelby, by whose ^ Vide The Genesis of a Pioneer Commonwealth. ANCESTR Y. 31 side he had fought at Point Pleasant. He was also commissioned by General Washington, under whose eye he had served in the campaign on the Monongahela in 1755, and who well knew his worth. In every position he honorably acquitted himself. Years afterward a singular coincidence occurred in his family — the marriage of his son Ephr-aim to the daughter of "King's Mountain" Shelby. The official records also show that Judge McDowell commanded a com- pany of scouts, that he was a gallant and brave officer, and that he did valuable service during that memorable campaign in which the power of the Shawanese was broken. After many years of useful service to his country, an honored and respected citizen, es- teemed for his strong sense, for an integrity that never succumbed, for an unassailable pri- vate as well as public life, he lived beyond his three score years and ten ; lived to serve and bless the God of his creation ; and as he lived a Christian life, so he died triumphant in his faith, expecting to receive the inheritance promised through the Holy Prophets. He calmly and peacefully passed away September 25, 18 17, at the ripe age of eighty-two years, at the residence of his son, Colonel Joseph 32 ANCESTR V. McDowell, whose home was near Danville, Kentucky. We herewith note the children of this re- markable pioneer : Their first-born "Magdaline McDowell,'' was the twin to Sarah McDowell. The children were born October 9, 1755. Magdaline was married to Andrew Reid, and vSarah married Caleb Wallace. John McDowell was born December 8, 1757. He married his cousin, Sarah McDowell. He was an officer in the Revolutionary war, James McDowell was born April 29, 1760, and married Mary Lee, of Virginia. He also served in the Revolutionary war, and was colonel in the war of 18 12. He fouo-ht in o various Indian conflicts and wars of Gov- ernor Scott's and Hopkin's campaign. William McDowell was born March 19, 1762. He married Margaret Madison, a cou- sin of President Madison, and sister of Gover- nor Madison. Samuel McDowell was born March 8, 1764. Married Annie Irvine. He filled with honor the position as first United States Marshal in the State of Kentucky. Martha McDowell was born June 26, 1766. ANCESTRY. 33 She married Colonel Abram Buford, a daring, courageous Revolutionary officer. Joseph McDowell was born September 13, 1768. He was an officer in the war of 1812, and Adjutant-General in Governor Isaac Shel- by's army in Canada. Ephraim McDowell, justly entitled "the father of ovariotomy," was born November 1 1, 1 77 1. He married Sarah Shelby, the daughter of Governor Isaac Shelby, of whom we will speak more hereafter. Mary McDowell was born January 11, 1774. Her marvellous beauty gave her great reputa- tion ; her gentle, amiable manners won her hosts of friends ; and her Christian character illumined her pathway of life. She married Alexander Keith Marshall, brother to John Marshall, Chief Justice of the United States. Caleb McDowell, the youngest child, was born April 17, 1776. He married his relative, Betsy McDowell, daughter of Major Joseph McDowell, of North Carolina. CHAPTER III. EARLY LIFE OF EPHRAIM McDOWELL AND HIS EDUCATIONAL ADVANTAGES. When Ephraim McDowell was only thirteen years of age, he came with his father from Rockbridge County, Virginia (the place of his nativity), to Danville, Kentucky. The party experienced many long days of perilous travel, and were subjected to privations that the youth of the present period would shrink from encountering ; but this brave and courageous boy kept a stout heart and not a murmur es- caped his lips. He had unbounded confidence in his father's judgment, and felt that whatever modification of his life was to come out of the change being made must result in his good and aggrandizement. Even at that tender age he displayed both unusual judgment and wonderful reasoning power. His youthful mind contrasted in its development favorably with those of much greater maturity. He was thoughtful and (34) EARL y LIFE. 35 Studious, and it was frequently remarked by members of his family, and those interested in his welfare, that when his schoolmates and associates would call for him to accompany them to their playground, he would frequently decline, resisting their persuasions and return- ing to his books and studies — displaying at once that indomitable will over the desire of the heart : for what boy is there that does not enjoy the freedom from school halls and per- plexing studies ? He realized, even at this early age, that he had a higher purpose in life than personal pleasure, that he had a mind to store with well-trained thoughts, and that the body was simply the servant to the will. He early received a religious training, and as soon as he could lisp the name of God was taught to reverence the word, and never to use it idly or in vain. Hence, with such parents to mould his character, to bend the twig as it should be bent, to guide his footsteps through life's thorny pathway, cold and perverse would have been his heart had it denied such holy impressions or not have been influenced and elevated by them. After traversing the vast wilderness, with here and there occasionally a hewn-log cabin 36 EARL Y LIFE. seen peering above the heavy undergrowth, nothing of interest occurring to dispel the lone- Hness of the soHtary journey, they reached, in due course of time, the small villaee of Dan- ville, at that time the seat of the most refined and cultured society in that far western land. The surrounding country presented an inviting appearance. The soil was loamy and friable. Clear and rippling brooks meandered through the timbers, making a natural irrigation that offered fine inducements to the agriculturist, who saw the advantages immediately derived from such soil, and grasped the opportunity of cultivating the same by permanently locating with their families in such a country. After Samuel McDowell settled with his family in Danville, he induced many of his friends to leave Virginia and come to Ken- tucky. Even before the sturdy citizens engaged in business or farming, they organized to establish schools and churches, that their chil- dren might not waste their precious time. They formed resolutions among themselves to this effect: "Many of us, and our forefathers left our native land and explored this once savage wilderness, to enjoy the free exercise of the rio-hts of conscience and of human na- O EARL V LIFE. ■^y ture. These rights we are fully resolved, with our lives and our fortunes, inviolably to pre- serve. Nor will we surrender such estimable blessings, the purchase of toil and danger, to any ministry, to any parliament, or any other body of men upon earth, by whom we are not represented, and in whose decision we have no voice." Such resolutions our forefathers framed, and strictly adhering to them, made for themselves happy homes and a prosperous country^ Ephraim McDowell developed early into a tall, erect, and commanding figure. He was considered strikingly handsome, having lustrous black eyes that seemed to penetrate into the very thoughts of those who looked into them. His refinement and intellectual powers were of the highest type, and his friends predicted for him a brilliant career in whatever profession he chose to follow. Young as he was, he had an inquisitive mind, searching for new truths ; and to attain these he was a constant reader. He seemed possessed with wonderful magnetism, and his ardent temperament won him some lasting friends, which he retained to the time of his death. He was a fine conver- sationalist, and his ready wit was most pleasing. ^8 EARL V LIFE. He enjoyed a good joke, and took great pleas- ure in perpetrating innocent pranks upon his friends. The profession of medicine was his own choice, and he was especially fond of the literature pertaining to surgery. He received his early education at the classi- cal seminary of Messrs. Worley and James, who first taught at Georgetown, Kentucky, and afterward at Bardstown in the same State. He then went to Virgfinia and entered the office of Dr. Humphrey, of Staunton, as a medical stu- dent, where he remained for two or three years, closely applying himself to his studies. We know but little of this Dr. Humphrey, save that he was a graduate of the University of Edinburgh, and in his day enjoyed a consid- erable local reputation and an extensive prac- tice in Staunton and its vicinity. The fact of his being a good instructor is highly probable. Another of his pupils. Dr. Samuel Brown, was one of the founders and one of the first corps of lecturers of the medical department of "Transylvania University" of Lexington, Ken- tucky, and rose to high distinction. In the years 1793 and 1794, Ephraim at- tended lectures at the University of Edinburgh, Scotland, contemporaneously with his country- EARL Y LIFE. ,q men, Drs. Samuel Brown (before alluded to), Hosack, and Davadge, of New York, also Dr. Brackenborough, of Virginia, all of whom sub- sequendy attained eminence in the profession. While in attendance on the course of the University, he also took the private course of John Bell, who at that time was not a member of the faculty, and it would appear that the bril- liant prelections of this most able, eloquent, and gifted of the Scotch surgeons of that day must have impressed him profoundly. That portion of his course in which he lectured on the diseases of the ovaries, dwelling on the inevit- able death to which the victims were doomed, and merely suggesting the possibility of suc- cess attending any operation that might be at- tempted for removal of the organs, was certainly never forgotten by his auditor, for he carefully stored in his mind the principles and sugges- tions at this time enunciated by the Master, together with other impressions, which sixteen years later determined him to attempt his first ovariotomy, which operation has immortalized him, and opened to the broad field of surgery the abdominal operations ; and from that distant day (now eighty years ago) to the present time, countless thousands can testify to their being 40 EARL Y LIFE. relieved and saved by the bold and daring ope- ration which he grave to the medical world. Through the kindness of Col. J. McD. Alex- ander, of Virginia, we have been furnished with and are indebted to him for the following in- teresting letters, not interesting for their anti- quity alone, but as conveying an idea of the political condition of the country at that early period when our forefathers were struggling for their rights. These letters were addressed to Ephraim McDowell during the time that he attended lectures at Edinburgh, and were writ- ten to him by his father and by Mr. Reid, his brother-in-law. Mercer County, State of Kentucky, February lo, 1793. Dear Ephraim : I have not heard from you since you left Rockbridge, and am very anxious to hear of your safe arrival in Scotland. I can with pleasure inform you that myself and all your friends in Kentucky are well, for which we have reason to be thankful to the great Author of our Being. We have not anything worth communicating since I wrote you last, when you were in Rockbridge. Our new gov- ernment seems to go on middling well, but our legislature seems very parsimonious. They EARL Y LIFE. 41 have given our government ;^300 a year, and the judges of the Court of Appeals ^200. The secretary ^100 and the auditor ^100. The treasurer ^100, and the judges of the court of Oyer and Terminer ^30, but it is supposed that they will increase the salaries at their next meeting; but I rather think they will not, as it [is] popularity the most of the members are seeking, and not to do right if they even knew it. The seat of government is fixed at Frank- fort, Kentucky, on the Kentucky River, where I have (jot a lot or two, one of which is for you, if you live to return, and choose to come to Kentucky, which I wish you to do. I would be glad to hear how you like your situation there, and how long you think it will be necessary for you to stay, for I assure you it will be very hard for me to send you a supply of money. But I will endeavor to sup- port you if in my power, and to enable you to bring with )'ou some books, and a quantity of medicine to serve you some time, and to set up a decent shop. But I fear I will not be able to send you money sufficient. But if you had it in your power to get credit for some of which you might think would be necessar)^ I will, I hope, be able in a short time after your return, EARL Y LIFE. 42 to make a remittance to pay for the medicine. Is there no person trading to Scotland to whom you could apply ? But I need say no more on the subject for it is not to be expected that any person there could place so much confidence in you as to give you credit for one hundred pounds worth of books and medicine, and you must try to do the best you can, and steward well the little money you took with you. I may be able to send you some, which may be about fifty pounds. I will send you more if you need it, and it will be in my power. Give my best compliments to Mr. Brown and Mr. Watkins. Tell Mr. Brown his brother James is well ; also tell Mr. Watkins I saw his father not long since, who was well and had got a letter from him. Your mother seems to think much and longs to see you once more in Kentucky. You know of my small misfortune in my speaking. I am almost now persuaded that what Dr. Humphreys said is the case (to-wit), a swelling in the glands about the root of the tongue, as sometimes, especially in the morning, you would not observe it to hurt my speaking and I feel no difficulty, and after some time in the day It grows worse. Try and EARL Y LIFE. 40 find out if any such case happens in the course of your business that you may help me. Let it be the swelling of the glands, or what I sus- pected, a touch of the palsy, I only add my best wishes for your happiness, and believe me to be your affectionate father, Samuel McDowell. N. B. — Your mother sends her blessines to you and hopes you will not forget your duty to God, who has always been so kind to you. Direction : Mr. Ephraim McDowell, Student, Edinburgh, Scotland, Care of Col. Gamble, Richmond. Letter to Ephraim McDowell from his brother-in-law, A. Reid, of Rockbridge County, Virginia. Note the length of time it required for letters to reach America a century ago, when they were written from Europe ; Ephraim McDowell's letter bearing date of March 4, 1793, and the reply being written immediately upon receipt of Ephraim's letter, August 25, 1793- 44 EARL V LIFE. Rockbridge, Virginia, August 25, 1793. Dear Ephraim : I have just received yours dated March 4th last, by which I was agreeably informed of your safe arrival at Edinburgh. The opportunity you had of seeing so much of that old and well-cultivated country, must have been very agreeable. I hope it has and will ease your mind on that score until you com- plete your studies. I hope you will not take it amiss of a friend, to repeat the necessity of your diligence. Your father has, I expect, written you that he means to furnish you with ^300, including what you took with you from home ; which, from the statement in your letter of the neces- sary expenses, I am afraid will scarcely be suf- ficient without very great economy. I have had letters from Kentucky lately; your friends are all well there. Indians are still very troublesome on the frontiers from North to South. A treaty has been proposed by the government, I suppose more with a view of quieting the minds of members who are averse to the war, than an expectation oi peace. By every act the Indians refuse treating on any other terms than making the Ohio River the EARL V LIFE. 45 line, which never will be complied with by the Government. The President' has called on the State of Kentucky for fifteen hundred vol- unteers. It is said they (with a considerable addition) will march about the first of next month. Report says that the commissioners who were sent to treat with the Indians are made prisoners and not permitted to return. We have agreeable news from France lately. It is said they have beat the combined armies, both by sea and land, and I hope will continue to do so until their freedom is established ; should the reverse take place the consequences might be of a serious nature to America. There is scarcely a doubt that the combined powers would attempt to suppress republican- ism here. Your brother Caleb came in about the first of March ; he will stay with me perhaps three years or better to learn the business of the office. When you return will expect you to take Rockbridge in your road to Kentucky. Dr. Falconer left Lexington in the spring and returned to the State of New Jersey. He sold out his shop of medicine to Dr. Campbell, who ^ General Washington. 46 EARL V LIFE. succeeded him in the practice and is in pretty good esteem. Dr. Falconer is expected every day to return. He intended settHng in Buck- ingham County on the James River. In addition to the medical faculty at Staunton, there is a Dr. Mcintosh, who by a pompous advertisement, offers his services, and in order to introduce himself he says he studied at Edinburgfh and attended the lectures of Mr. Monroe. Your sister, Caleb, Sallie, and the rest of the family join me in compliments to you. I am, dear Ephraim, respectively your friend and brother, A. Reid. Ephraim McDowell, Edinburgh, Scotland, 1793, A. D. The following letter was written by Judge Samuel McDowell (father of Ephraim) to his son-in-law, Mr. Andrew Reid, of Virginia: Mercer County, July 11, 1792. Dear Sir : I have nothing worth notice to tell you, only that it gives us sorrow to part with Sally, but as you expressed a desire that she should come home, Joseph thought as Ephraim was amind to go to Europe next fall, he might as well go now and see him before he went way. I had it not in my power to do EARL V LIFE. 47 anything with the sheriff about your fees. I have talked to them, and none of them have collected them ; they say the people against whom they are cannot pay as they are mostly very poor. Whenever the courts begin to do business, I will move against all the sheriffs who have any of them, but I really fear little of them will ever be collected. Benton declares he will pay off the balance that he owes by Christmas next, he has paid me about £60 ; very little of it in money, some cows, pork, and orders on other people who have not yet paid. I think the whole I have paid you is ^30. A civil list warrant by Joseph, fifteen pounds to Ligert, by your order, and six pounds for the land war- rants. I sent you in all ^51. I expect to set- tle with Benton before long and know the exact amount he has paid, and will then let you know how much is in my hands, and in the meantime if you get any money from Evens or Fritte make use of it till I send you Benton's whole money or state his account to you. Joseph can tell you some of the proceedings of our Assembly. The revenue law taxes land at two shillings the hundred acres, and all people claiming land here must make return of 48 EARL Y LIFE. it to the commissioner by February 9, 1795, or loose the land. I have not seen any of their laws — they are not printed, but Joseph can tell you something of several of them. I have not as much money as I intended to send by Eph- raim when he goes ; but perhaps he may have enough 'till I can send him a supply again ; he will perhaps have upwards of ^200, and I wished him to have ^250. But I think he had not better carry it in money, as there may be danger of losing it, but take a bill on some good man in Edinborough or Glascow ; but if that should be protested it would be bad for Eph- raim. I can say nothing on the subject, you and him must do as you find it best. I leave the whole direction to you, and I hope he will act prudently. If you have any doubt of his economy or prudence pray let me know, for I would not be for his groinor to Scotland, if he was of an im- prudent behavior in any respect whatever. I could wish to establish some way of sending him any little supplys from Richmond ; you and Joseph may lay some plan perhaps. Mr. Sin- clair can give you some assistance in fixing the matter. If Colonel Gamble lives in Richmond perhaps he may be a friend in the matter. But EARL V LIFE. ^g I am too far from the scene of action to o-ive any direction in the matter. I could wish you were here this fall, as there will be a number of clerks places to fill, and I believe you could get the first clerkship in the county, that ts to the Court of Appeals. But I would not wish to advise you to anything of that kind, least you should be disappointed. But I am fully of opinion it might be better for your prosperity that you were living here. Are the people in and about Lexington as religious as they were some time ago ? My dear sir, religion is a most excellent thing, and that we should be all earnest to obtain, but the zeal of some of the Lexingtonians goes wild or carries them to extravagances and folly ; that is, in my opinion, very foreign to ^rtie religion ; and will have a tendency to make them people very proud and unsocial, looking upon all who are acting like rational creatures to be the wicked ones on earth, and look down on them with contempt. I am persuaded that the way them people (or some of them) are acting, will inevitably lead to a savage or superstitious state in the course of one or two hundred years — perhaps in much less time. Those good people will not associate with the 4 50 . » '^^ EARL Y LIFE. wicked (as they call them) but meet only for religious worship or socially with their religious friends. Had that been the case formerly we had yet been in ignorance, but mankind mixing in assemblys for innocent amusement, culti- vates friendship and civilizes the world. It makes their manners more mild and friendly and removes that sourness that superstition and bigotry leaves on the mind. May you and me, my dear sir, be earnest to live in this world as not to give offense to any one, and still act like rational creatures ; for I am persuaded that the Divine Being cannot delight to see his creatures, that he has endowed with rational power, lay aside their reasoning powers and give themselves up to superstition. Give my love to Magdaline and your dear little family, and believe me to be with extreme affection, dear sir, Your affectionate father, Samuel McDowell. Mr. A. Reid, ■ Rockbridge, Va., 1792, A. D. ^I^Or^ CHAPTER IV. RETURN FROM EDINBURGH. Upon his return to Danville, in the year 1795, McDowell entered at once on the prac- tice of his profession. Commencing as he did with the eclat of an attendance upon the then most famous medical school of the world (for at that time Edinburgh held the position since occupied by Paris, and more recently by Vienna, as the centre of medical science), he soon as- sumed the first professional position in the community in which he lived, not uninterfered with, however, by envy and jealousy. His fel- low professors of medicine and surgery, aspiring, with himself, to fame and distinction, regarded McDowell's superior medical advantages with a jealous eye, as was proven by many acts and words of covert nature. Dr. McDowell made a speedy advance, his reputation extending, within a few years, throughout the entire Western and Southern country, all this wide region accepting him as ( 5') c 2 RE TURN FR OM EDINB UR GH. the first and leading surgeon west of Philadel- phia. Of Kentucky citizens of the preceding gen- eration, many obtained distinction in their respective pursuits, but it is doubtful if any of them builded so deeply the foundation of an enduring fame as did Ephraim McDowell, of Danville. While others wielded great powers, and rendered various services in their day and generation, Dr. McDowell inaugurated a work which continues to live and grow after the originator has passed from the scenes of his labors. By his originality, skill, and courage, he opened up a new departure in the science and practice of surgery which has advanced until now accepted as being not wide of the crowning glory of this great and beneficent art. Through this departure thousands of women have been rescued from certain and painful death. By his own hand he demonstrated the practicability of the new work his genius had devised, and he published the results of his labors. The crea- tion was complete in execution as well as in priority. He is recognized throughout the civ- ilized world as the originator of a great depart- ment of surgical practice and as a benefactor RE TURN FR OM EDINB UR GH. 5 3 to his race. His name is familiar to the stu- dents of medical science in every land and clime, forming, in the language of Fitz-Greene Halleck, one of the few, the immortal names that were not born to die. In every land the practitioner of surgery is utilizing amid the brilliant achievements of his art, and his efforts toward the restoration of life and health, the results of McDowell's work. In the rapid pro- gress of science, other hands and minds have now widened the scope and extended the appli- cation of his great operation, yet this but adds to the grandeur of the original step, and lends additional lustre to the fame of him who led the way. With the exception of J. Marion Sims, a native of South Carolina, no physician on this continent has contributed such far-reaching and potential influence toward advancing and enriching the resources of surgical science. Indeed these two oreat American surcjeons founded the modern science of gynecology, which has brought to American medicine and American physicians so much of the renown and esteem in which they are regarded in all foreign countries. Since the early Jiistory of the commonwealth, c 4 JiE TURN FR OM EDINB UR GH. the medical profession of Kentucky has ranked alongfside the most advanced of the entire country, and within her borders was estab- lished one of the oldest and most renowned of America's medical schools. But great discov- eries springing from that wonderful creative faculty which utilizes all previous research in conception, and combines skill, courage, and intelligent penetration of undiscovered lines of thought in execution, are uncommon in all branches of learninor. fo rend the veil which conceals the mysteries of science is allowed to comparatively few, but such privilege fell to the lot of Ephraim McDowell,' As has been previously stated, McDowell came fresh from the University of Edinburgh, and selected as his future home Danville, Ken- tucky, a small rural village composed of an aristocratic little colony, where he soon dis- played such talent as a surgeon and physi- cian, that it was not longf before he divided honors with the great men of the State, espe- cially those of Lexington City ; and while, at the latter point, the enterprising founders of what was soon to be the first great medical school ^ See Butler's History of Kentucky, written in the year 1834. RE TURN FR OM EDINB UR GH. 5 5 of the West were busying themselves with schemes for the permanent estabHshment of Transylvania University, Ephraim McDowell, at Danville, laid the foundation for a great revolution in the "ars chirurgriae." While measures were being consummated for laying a surgical foundation that would not crumble and fall by Time's blighting hand, plans for future personal comfort and happi- ness were also beincr weig^hed and stored in his well-balanced mind. He was thoroughly domestic in his habits and tastes, and admired the pure and ennobling characteristics of a good and elevated woman. At the age of thirty- one years he decided to select a suitable help- mate and companion for life. Having met Miss Sarah Shelby, the daughter of his father's tried and trusted friend (Gover- nor Isaac Shelby), his heart quickly became deeply interested in her, while his attentions, marked from the first, soon culminated in vows of love, which love, happily for him, was ar- dently reciprocated. In the year 1802 the two were married at the home of the bride's parents a few miles distant from Danville. Miss Shelby was the highest type of a noble Christian woman, and certainly a most 56 RETURN FROM EDINBURGH. suitable person to be the wife of Ephraim Mc- Dowell. She was remarkable for her intelli- gence and keen perceptive powers. Her strength of character, sound common sense and domestic qualities, combined with a lovable disposition, won for her the admiration and encomiums of those who were fortunate enough to know her. She was also gifted as a writer, and many beautiful and original thoughts emanated from her well-stored mind. She could never be induced, however, to give to the public any of her writings, though numerous pages of manuscript were stored away ; her most choice and original pages being carried to the garret, to moulder, and finally pass out of existence. In appearance Miss Shelby was graceful and of commanding height. She was digfnified and reserved in manner, althouo^h her brilliant flashes of wit and innocent double entendre were not unfreely furnished the social circle in which she moved. Her tastes were of that elevated, refined nature that makes woman most attractive. Although but eighteen years of age at the time of her marriage, she pos- sessed a mind matured and observingr to a degree that reflected large credit on her mater- nal rearinor. She was a devoted member of the RETURN FROM EDINBURGH. 57 Episcopal Church, and, believing that a true Christian should rise above the petty annoy- ances incident to the daily life of all, she verified her faith by acts of devotion. Her influence over her husband was so great that shortly after marriage he connected himself with the church, remaining a faithful and zealous member until the time of his death. The present site upon which Christ Church in Danville stands, was a donation from him. He was also an especial friend to "Centre Col- lege," cooperating largely toward its founda- tion both by his influence and liberal donations of money. He was, indeed, one of its original corporators and curators. This, too, although its government was by the Presbyterian Church. He was a man of liberal views, neither bigoted nor sectarian. He saw and appreciated the enjoyment and happiness derived from leading a religious life. He was fond of books, and at the time of his death possessed an excellent library for the period in which he lived. He constantly made additions to his medical works, and whenever a new book of merit was issued he would invariably purchase it. The iron grasp of progress had a firm hold on him and would e 3 RE TURN FR OM EDINB UR GH. not relax its grip until he had arrived at the pinnacle of fame and achieved the earnest desire of his heart. He had a fair knowledge of the classics, yet he gave most of his leisure time to belles-lettres and history, both of which he was very fond of studying. He also gave much and earnest at- tention to biology. . When leisure hours allowed opportunity he would take long strolls through beautiiul wood- lands convenient to his home. In one of these walks accompanied by his wife, he discovered lying upon the sand, bordering a clear stream of water which meandered through his farm, a number of small pale blue eggs, resembling those of some diminutive bird. The two gath- ered these and supposing them to be bird's eggs, carried them to their home, placing them in a saucer in a warm, dark closet. Hav- ing occasion to punish one of his grandsons, he could think of nothino^ more severe for the disobedient little fellow than to lock him up in this closet for a little time. The boy had not been confined in his prison but a few moments, when he screamed dreadfully, at the same time frantically calling out, "Oh! let me out, grandpa ; there is something crawl- RE TURN FR OM EDINB UR GH. 5 ^ ing all over me ; please let me out, I will be good." The doting grandparent could not resist the entreaties of the terrified child, and on unlocking^ the door, Imag-ine his horror and surprise to find the closet swarming with young snakes, every ^^^ having hatched out. Fortu- nately, nothing worse came of the incident than the sad fright experienced by the child. The grandfather never again, however, attempted to punish his little grandson. Dr. McDowell was a man of the tenderest emotions and sympathies. His manner was plain and unassuming. He invariably dressed in black, adhering closely to the silk stock and ruffled linen. He was scrupulously neat in his person. He did not use tobacco in any form, and often expressed himself as having a disgust for a man that chewed. Although strictly temper- ate, he would occasionally take a small drink of whiskey or cherry bounce (the latter his favor- ite beverage) when he had experienced any unusual exposure. He always kept the finest drinks upon his sideboard for the pleasure of his guests and friends. He employed an overseer to manage his farm, and taking a deep interest in raising fine 6o ^^ TURN FR OM EDINB UR GH. horses and swine, he closely observed the man- ner of rearing and fattening them. It was from a familiar process in this connection that he gathered important facts, which resulted in his experiment upon Mrs, Crawford. Being of Scotch extraction, it would naturally be inferred that the gifted Burns was a favorite with him, and from his familiarity with the Scot- tish dialect, acquired while in Edinburgh, his readings and quotations were given with idiom as perfect as if he had been a native of old "KeeKee." Six children were born to Ephraim and Sarah McDowell. Their first-born, "Shelby," was a bright and promising boy ; unfortunately, in the absence of his father, he inhaled a wheat spear into his windpipe, and expired before medical aid could reach him. The second son, "Wallace," a gentle, quiet, and greatly beloved son, lived to attain man- hood and married Miss Mary Hall. For several years he was engaged in mercantile pursuits, and was esteemed an upright and conscien- tious business man. A singular fact worthy to be noticed, was that Wallace McDowell could not look at the blood of any animal without fainting. It was evident that he was not born RETURN FROM EDINBURGH. 5i to be a surgeon. He lived to rear a family of children, dying only a few years back in Mis- souri. Susan McDowell, the eldest daughter, mar- ried Colonel David Irvine, of Richmond, Ken- tucky. She died leaving four children. Mary their second dauofhter, married her cousin once removed, George Young, a wealthy and pros- perous farmer of Shelby County, Kentucky. Mary McDowell, not unlike her aunt, and bearing the same name, was a marvellously handsome woman ; indeed, her blended beauty of face, form, and character, gave her both enviable reputation and celebrity. The sweet and fascinating expression of her face was but the reflection of a mind stored with choice knowledge, while her character was resplend- ent with deeds of mercy, love, and charity. The poor idolized her, for during her brief ex- istence (having died at thirty years of age) she had proved herself a friend to them by her many acts of benevolence. She left four small children ; they never knew the depth of such a mother's love. Adaline McDowell, the third daughter, mar- ried a prominent politician. Judge James Deade- rick, of Tennessee. She was an unusually ^2 RE' TURN FR OM EDINB UR GH. bright and clever woman, kind and lovely In disposition. She still survives. Catharine, the fourth and youngest child, married Colonel A. A. Andison, of Tennessee. She also survives her parents, and has lived to see her children grown. The father of Mrs. McDowell, Governor Isaac Shelby, of "King's Mountain" fame, was one of the most prominent and influential citi- zens In the State of Kentucky. Emigrating at an early day to that vast wilderness and be- coming closely Identified with the interests of the country, by the provisions of the Constitu- tional Convention at Danville, Kentucky, on the fourth day of June, 1792, he was chosen Governor of the State ; on the sixth day of the succeeding May he met in person and addressed the Lemslature after the custom of the British monarchs, which custom was Imitated by many Governors and by President Washington.' He served in the Revolutionary war with honor and distinction. He planned and was second In command at the battle of "King's Mountain," where one thousand British prisoners were cap- tured, and for his chivalry and daring deeds he was awarded by the Congress of the United ^ See History of Kentucky, RE TURN FR OM EDINB UR GH. 6 -> States a handsome gold medal, now in the pos- session of the State of Kentucky, and cared for at Frankfort, the Capitol. His son presented this medal to the State as a relic of meritorious antiquity. His election to the chief magistracy was an act of wisdom on the part of the common- wealth, then in its infancy. As an individual he sympathized with the project of opening the Mississippi River to free navigation, yet he held himself ready, not only to enforce the laws of Kentucky, but to perform whatever was constitutionally required of him, as Governor, by the President of the United States. His letter to General Washington is admirable in its tone, and exhibits more submission to the Federal authority than would now be shown b)' most Governors. His clear, far-seeing judg- ment predicted the downfall of slavery, and that a civil war would be inevitable to accom- plish that end. Shortly after the close of the Revolutionary war he removed to Kentucky from Virginia, and preempted large tracts of land in the rich- est and most fertile portions of the State. He erected a substantial residence built entirely of gray granite. He soon had the forest cleared 6^ RETURN FR OM EDINB UR GH. of its heavy undergrowth, and to make the sur- roundings of his home more attractive he spared from the axe an avenue of stately forest trees to pfuide the visitor to "Traveller's Rest," — an original name given by him to his homestead, a name suesfestive of comfort and of rest to the weary pioneer, for at "Travellers' Rest" such were sure to find a welcome and a haven from the perils and dangers incident to the life of a frontiersman. The present generation can never fully realize the privations which our forefathers endured in order to civilize this glor- ious land — a country, as it has now become, that compares favorably with any other in surgery, science, and literature. It was at this historic homestead that the wise men of the land met and held counsel to devise means for the rapid civilizing of the country which was to be their future home. In recently viewing the broad fields of golden grain, the new-cut grass, the orchards of ripen- ing fruit, they all were suggestive of the pros- perity and cultivation of one of Kentucky's most famous farms — "Travellers' Rest," which is still in the possession of the Shelby family. The old rock house has stood the storms of more than a century, but the fierceness of RETURN FROM EDINBURGH. 65 Nature's devastating touch Is not without its signs upon the vine-clad walls. It was at this home that Dr. Ephraim Mc- Dowell met, won, and wedded his wife, and it is in the family burying ground belonging to "Travellers' Rest" that both were interred. Several years previous to his death Dr. McDowell purchased a highly improved tract of land, with a modern-built, commodious dwelling upon it, situated about three miles from Danville. Here he removed with his family with a view to spending the remainder of his life in quiet, yet with no intention of giving up his lucrative practice, which had grown to be very extensive. The yearning of his heart, however, was for a quiet rural home, where he and his family and friends might enjoy the comforts to be found in country living. When the footprints of civilization were un- known in Kentucky, and only savage war whoops resounded through the depths of the forest, there lived a brave Indian chief called "Cambiskenneth." Dr. McDowell was so much pleased with some of the noble traits of char- acter possessed by this person that in honor of him he called his country seat "Cambisken- neth." A leofend runs thus: Cambiskenneth 66 RETURN FROM EDINBURGH. was the chief of a tribe of savages that had committed many outrages on the early set- tlers. In their perambulations they captured a fair young maiden who had ventured too far from home, and bore her away to their village (a circumstance not at all unusual in those days). When they arrived at their destination, a violent controversy arose between the war- riors as to who was entitled to have the maiden for his wife. In the midst of their discussion the commanding form of Cambiskenneth ap- peared on the scene. He silenced them, by saying they had stolen the girl away without his approbation or knowledge, and against his avowed principles, and commanded them to take her immediately home. Well they knew that when their chieftain gave an order it was to be obeyed. For this act of mercy the In- dian was ever afterward treated with the great- est kindness and consideration by the settlers. Travellers in passing over "Muldrow's Hill" pause to look at a mound of considerable height bordered by a crude granite slab that marks the last resting-place of the brave and noble Cam- biskenneth. Although Dr. McDowell was a slave-owner, he recognized the negro as belonging to the RETURN FROM EDINBURGH. ^7 human race. His own slaves were treated with the utmost kindness and considera- tion by himself, and as well by his entire family. He was never known to traffic in slaves, but would frequently purchase a man or a woman if one had fancied and married a servant belonging to himself. He would never under any consideration separate families. He evidently had a more tender feeling for the negro than had the renowned Dr. Johnson, who is reported as saying that a negress could "bear cuttinor about as well as could a doof or a rabbit." Dr. McDowell was a prayerful man, as an evidence of which we have the following- invoca- tion offered up by him to the Divine Master a few hours before the appointed time to make the firsi " ovariotomy." He realized that his feeble hand, without the strengthening power of the Almighty Father, would prove futile in the try- ing experiment he was about to make. It was an event that was to render his name immortal, and be the means of saving countless numbers of lives ; otherwise, in case of failure of the operation, was to prove his destruction. It was truly a trying hour with him, and it was well that he sought his closet and in ear- 68 ^E' TURN FR OM EDINB UR GH. nest prayer made an appeal to God to be with and help him. His abiding faith in the efficacy of prayer was beautiful, and no doubt his re- markable success in the field of surgery can be largely attributed to his strong convictions and unwavering faith in the Great Jehovah. Remembering the prayer and writing it down with his own fingers he placed it in his pocket, thinking some day that his faithful wife might accidentally find it — perhaps after his death, for threatening clouds were gathering about him as the time drew near for him to perform the operation upon Mrs. Crawford. THE PRAYER. "Almighty God be with me I humbly be- seech Thee, in this attendance in Thy holy hour ; give me becoming awe of Thy presence, grant me Thy direction and aid, I beseech Thee, that in confessing I may be humble and truly penitent in prayer, serious and devout in praises, grateful and sincere, and in hearing Thy w^ord attentive, and willing and desirous to be instructed. Direct me, oh! God, in per- forming this operation, for I am but an instru- ment in Thy hands, and am but Thy servant, and if it is Thy will, oh ! spare this poor afflicted RETURN FROM EDINBURGH. 69 woman. Oh! give me true faith in the atone- ment of Thy Son, Jesus Christ, or a love suffi- cient to procure Thy favor and blessing; that worshipping Thee in spirit and in truth my services may be accepted through his all-suffi- cient merit. Amen." CHAPTER V. THE FIRST CASE OF OVARIOTOMY. It was on the thirteenth day of December, 1809, when Dr, McDowell had been practis- ing his profession fourteen years, that he was sent for to see Mrs. Crawford, residing in Green County, Kentucky, some sixty miles from Danville, who was thought by her physicians to have gone long beyond her time in preg- nancy, and to be the subject of extra-uterine foetation. McDowell found her trouble to be an ovarian tumor, rapidly hastening to a fatal termination. To quote the graphic description of Dr. Gro^s: "After a most thorough and critical examination. Dr. McDowell informed his patient, a woman of unusual courage and strength of mind, that the only chance for relief was the removal of the diseased mass. He explained to her with great clearness and fidelity, the nature and hazard of the operation. He told her that he had never performed it, but that he was ready, if she were willing, to (70) FIRST CASE OF OVARIOTOMY. yi undertake it, and to risk his reputation on the issue, adding that it was an experiment, but one well worthy of trial." Mrs. Crawford listened to the surg-eon with great patience and coolness, and at the close of the interview promptly assured him that she was not only willing, but ready to submit to his decision, asserting that any performance which held out even the most remote prospect of relief was preferable to the ceaseless agony she suf- fered. The result has long been before the profes- sion. McDowell was conscious at the time he was doing the operation, that an angry and excited crowd of men were collected in the street awaiting the result of his experiment of "butchering a woman," as they expressed it. Had she died under the operation, there was no law in those primitive days sufficiently strong to have protected him from the people who were clamorinof for his life — determined men who would have shown no mercy, for they regarded it a (/u/jy to avenge the wrong inflicted on Mrs. Crawford. Indeed his life huncr on the recovery of the heroic woman. What nerve, what confidence in God and in his own ability, must J 2 FIRST CASE OF OVARIOTOMY. the surgeon have possessed to venture the per- formance of an operation of the magnitude of ovariotomy under sucJi circumstances. No soothing balm to quiet the nerves of his patient; only a covering thrown over her pallid face to shut out from her view the flashing of the few instruments that he used. This sio^nal event in the life of the illustrious surgeon cannot fail to impress a reader with the remarkable firmness of nerve and, as well, the surgical genius possessed by Dr. Mc- Dowell. It portrays strength in his character worthy of much more than a passing notice, and proves conclusively that the operative germ slumbered in his mind, waiting a proper subject. This subject came in the person of Mrs. Crawford. Dr. McDowell's close observation of manip- ulations practised on certain of the lower ani- mals, together with lasting impressions received from his old preceptor, generated, no doubt, the thought of his operation of ovariotomy, while consciousness of skill, and of dexterity in handling the scalpel, gave him confidence and courage in his own ability. With these was combined a firm conviction in the efficacy of prayer. FIRST CASE OF OVARIOTOMY. y-y As one of Chicago's most prominent sur- geons remarked in speaking of the operation, "Your orrandfather was the instrument and God the great surgeon that did the work." It really seems that there is much truth in these words, and, rememberino; all the attending- circum- stances under which it was performed, that McDowell was inspired to do the operation — one hitherto unknown to the zuorld. We regret our inability to furnish a life picture of Mrs. Crawford, owing to her never having had one taken. This heroic woman, whose courage gave Dr. McDowell an oppor- tunity to win immortal fame, survived the operation thirty-two years in good health. She was of a highly respectable Kentucky family and bore a son, who, at one time, was Mayor of Louisville, Kentucky. She was above the medium height and weighed, before her afflic- tion, one hundred and sixty-five pounds. Her form was good, and her face represented char- acter and determination of spirit. Her eyes were of that full, gray kind which indicate firmness. Her forehead was overhunor with clusters of wavy brown hair. She was not a handsome woman, her features being too prominent and large, and her lips too 74 FIRST CASE OF OVARIOTOMY. firmly set and curling. For some years after the operation was performed upon her, she re- mained at her old home in Green County, Kentucky, but finally moved with her family to Indiana, where she lived until her death. So far as we have been able to ascertain, the degree of M.D. was not possessed by him until the year 1825, when, entirely unsolicited on his part, the University of Maryland honored itself by conferring upon him its honorary diploma. The Medical Society of Philadel- phia, at that time the oldest and most distin- guished of the kind in this country, had sent him its acknowledgment in the year 181 7. The followinof names are identical with those at- tached to the diploma presented him In 1825^ by the University of Maryland: John P. Davidge, A.M., M.D., Professor of Anatomy. Nathaniel Potter, M.D., Prufessor of Theory and Practice of Medicine, Elisha DeButts, M.D., Professor of Chemistry, Samuel Baker, M.D,, Professor of Materia Medica. Richard Wilmot Hall, M.D., Professor of Obstetrics. Maxwell McDowell, M.D., Professor of Institutes of Medicine. Granville Sharp Pattison, Professor of Surgery. James Kemp, D.D., Praefectus. Johannes Allen, Professor of Mathematics. FIRST CASE OF OVARIOTOMY. 75 Copy of the diploma awarded to Ephraim McDowell, by the University of Maryland, in the year 1825 : Academia Terras Mariae Omnibus ad quos hae literae per- venerint Salutem. Cum mos sit antiquus et laudabilis ut qui multolabore studioque assiduo literis operam navaverint ii insigni aliquo honoris titulo condecorentur cumque nobis compertum sit Dominum E. M. rerum Medicinalium et Phil- osophicarum scientia et usuperitissimum et omnino talem esse quem summi in Medicina honores deceant potius ultro ambiant ; Nos eundem doctissimum virum E. M. summo quo potuimus honore prosequi volentes Medicinae Doctorem rite et legitime creavimus, renuntiavimus, eique tanquam vere idoneo et optima merito omnia Jura, Honores et Privilegia contulimus quaj Medicinae Doctori legibus aut consuetudine conceditribuique solent. In quorum fidem literis hisce sigillo Academiae communi munitis nomina nostra subscripsimus. Datum Urbe Baltimoriensi Mensis. Aprilis die quarto Anno Domini MDCCCXXV. Jas. Kemp, D.D., Praefectus. Joannes B. Davidge, A.M., M.D., Art. Incid. Prof. Nath'l Potter, M.D.. Theoret. Med. et Prax. Prof. Elisha DeButts, M.D., Chem. Prof. Samuel Baker, M.D., Mat. Med. Prof. Rich'd Wilmot Hall, M.D., Obstetri. Prof. Ma.xwell McDowell, M.D., Inst. Med. Prof. Granville Sharp Pattison, Chir. Prof Dr. McDowell certainly stood in his own light out of failure to report the numerous and skilful operations he performed, but at the same time many excuses are to be made for -5 FIRST CASE OF OVARIOTOMY. him. The condition of the country, the times in which he Hved, and his great aversion to writing, palHate the seeming neglect of what appears to have been his duty. He was so neghgent as to corresponding that when absent from home he would seldom send a letter to his immediate family, unless emergency demanded it. From the fact of his not re- porting his minor operations they are lost to his credit. A prominent Brooklyn surgeon said that he knew from good authority that Dr. McDowell was the first to perform the Csesarean section in this country successfully, the operation being done in New York City. No report of the case was made. He was remarkably successful in general surgical work, and we have ascertained from authentic sources that he was the first to venture upon a partial excision of the inferior maxillary bone. Afterward Dr. Wood, of New York, perfected the operation and obtained the honor. Dr. McDowell was really the origina- tor of the performance, though, as usual, he made no public account of it. One of his (Dr. McDowell) most interesting cases, in consequence of the exalted position afterward attained by the patient, was that of FIRST CASE OF OVARIOTOMY. yy James K. Polk, President of the United States. This gentleman had suffered for years from symptoms of vesical calculus, and in 1812, when in his seventeenth year, he was induced to consult Dr. McDowell, at Danville. He carried the stone home with him, not in his bladder, but in his pocket, to show to his friends and neighbors. In a letter dated Maury County, West Tennessee, December 3d (which letter we have been unable to procure), he in- formed Dr. McDowell of the progress of his cure, and feelingly expressed his gratitude for the services which he had received from him. The bad orthography and worse grammar con- tained in this letter, could but be contrasted with the contents of one which he wrote to Dr. McDowell fourteen years afterward, when he represented Tennessee in the Congress of the United States. This second was written with accuracy and even eloquence. Mr. Polk says : "My Dear Dr.: I have been enabled to ob- tain an education, study the profession of law, and embark successfully in the practice ; have married a wife and permanently settled in Tennessee, and now occupy the station in which the good wishes of fellow citizens have 78 FIRST CASE OF OVARIOTOMY. placed me. When I reflect, the contrast is imposing indeed, between the boy, the meagre boy, with pallid cheeks, oppressed and worn down with disease, when he first presented himself to your kind notice in Danville, nearly fourteen years ago, and the man of to-day in the full enjoyment of perfect health." And this greatest boon, "perfect health," which he was enjoying, he owed to Dr. Mc- Dowell. President Polk early in life was per- manently cured of a hernia by him. It is evident that Dr. McDowell was an ex- ceedingly cautious practitioner, always looking to the preparation of the patient's system before going into an operation. His anatomi- cal knowledge, dexterity, and his courage were sufficient to enable him to execute any manipu- lation that might have been required within the circle of his extensive practice. He took espe- cial pains in aiding his pupils to acquire a knowledge of the human structure. Upon three occasions, while in Europe, he did the Caesarean section, and with the first two cases both mother and child lived. He never reported these operations, and the mem- bers of his family were the only persons that preserved a record of the fact. FIRST CASE OF OVARIOTOMY. yg He seemed in his surgical ambition, as he increased in years and confidence, to become lost in all-absorbing thought as to how to help suffering humanity. Some writer has wisely remarked, in vindica- tion of surgeons and men of the healing art who have borne the semblance of having- been remiss in their reports of important cases or discoveries, that "in former times before the organization of the numerous medical vehicles and medical colleges and societies w^hich now exist throughout the civilized land, and when a medical journal was almost unknown, there was an excuse for failure to bring one's original work and discoveries promptly before the medi- cal profession, as was the case with Ephraim Mc- Dowell, but nozu the facilities for communicat- ing being so general no excuse is to be made for the delinquent pioneer, for such are not with- out opportunities to inform the profession as to what they have done or are doing. Indeed they are even urged and importuned to do so by the enterprise of medical journalists, and the officers of medical societies. One who in this day locks up in his own bosom, and for years, the knowledge of a valuable discovery may well be asked if he has not forfeited all 3o FIRST CASE OF OVARIOTOMY. claims under a statute of limitation, by reason of his neglect or of a desire to conceal." The reader must bear in mind that at the time McDowell lived and practised his pro- fession, there were even no stage coaches in use ; the only mode of transportation being by horseback, and journeys were often attended with great danger and much privation to the traveller. Fifty or one hundred miles was con- sidered no uncommon distance for a physician to be called to see a patient. Dr. McDowell was frequently so sent for, and it became necessary for him to take such long journeys, carrying his medicines and surgical instruments in "saddlebags," a manner of practice unknown to physicians of the present day. His earthly mission was, indeed, to relieve the sufferings of his fellow beings. On one occasion he was called to see a patient who lived over a hundred miles distant from his home. It was an important surgical operation that was required and which de- manded speedy attention, and although it was in a season of the year when the streams and brooks throughout the entire country were swollen beyond their utmost capacity, when little rivulets had become rushing creeks, and FIRST CASE OF OVARIOTOMY. 8 1 small brooks wide-spreading rivers, causing peril and danger to the traveller, he ven- tured upon his journey. His devoted wife entreated him not to oro — not to risk his life. o But duty called him, and that summons must be obeyed. She hastily prepared the necessary articles for the trip, and with many misgiv- ings bade him farewell. He mounted his faith- ful horse that had borne him in safety on many a similar errand, and soon was lost to sight in the distance. After having ridden some forty miles he came to a stream of water overflowing its banks. For a moment he viewed the swollen current, meditating on what course to pursue, for the driftwood was dash- ing and driving with such force that he feared (should he attempt to cross) collision with it. There was no alternative, however, but to let his horse have the rein and swim the angry torrent, that seemed bidding defiance to the doctor and to his mission of mercy. He realized his danger in attempting to cross, but the beautiful Christian faith mani- fested itself to him, and a still, small voice whispered "Fear nothing, for I am with thee," and the next moment he threw the bridle over his horse's head, and with charac- 6 82 FIRST CASE OF OVARIOTOMY. teristic instinct the animal plunged into the surofinof water. At times the doctor stood in his stirrups trying to escape the debris that threatened destruction to both horse and rider. Finally a heavy saw-log came in contact with the horse, almost causinof the strug-o-linpf animal to drown, but with herculean strength he over- came the dangerous situation, and raising his head in the air and blowing the muddy water from his distended nostrils, swam with a des- perate effort safely to shore. The doctor arrived at his destination, performed the critical work successfully, and returned to his home thankful and happy. Our forefathers who selected the profession of medicine, certainly practised it under great difficulties. Is the restless spirit of man in this progres- sive age as content and happy, surrounded with all the modern luxuries, as were our fore- fathers in their primitive homes, free from ambitious pride and desire to excel their neighbors ? We think that we can answer this question through the peaceful family circle of Dr. McDowell. He could say as did the Apos- tle Paul : "I have learned in whatsoever state I am, therewith to be content," and therein lies the true state of happiness. This is to a great FIRST CASE OF OVARIOTOMY. 83 degree the secret of Dr. McDowell's mighty faith, and it is a secret all would do well to learn. His hospitality w^as proverbially known, and it was seldom that "Cambiskenneth" was with- out visitors. Mrs. McDowell beingr a model housewife, order and method prevailed. Her domestic discipline was perfect, and had, blended with it, kindness and consideration. It was a pleasure to be a guest in such a well-reofulated household. Dr. McDowell's great benevolence was one of the marked characteristics of his nature, and much of his daily practice was gratis. The writer had the pleasure of meeting several ver}' aged persons who remembered vividly the many cases which he had operated upon, without in a single instance making any charge. A poor woman from the mountains of Tennessee hear- ing of the doctor's wonderful skill, and feeling convinced that some dreadful affliction had be- fallen her, wrote him soliciting advice as to what to do. He repHed, asking after symp- toms and everything connected with her case. She sent the required word, and he was con- vinced that she had an ovarian tumor ; not beine satisfied with a seemincr neo^lect to mve her the 84 FIRST CASE OF OVARIOTOMY. required professional assistance, he made a journey to see her. Her condition was found deplorable, as she was suffering' from the disease inferred. He operated successfully upon her, making no charge; his remuneration were these words : "God will bless you, doctor, for having saved my life." CHAPTER VI. PERSECUTIONS. As Dr. McDowell ascended the ladder of fame persecutions went with him ; men in the profession, be it told to their dishonor, resorted to unprofessional acts to traduce and injure the high standing and irreproachable character of the dauntless suro-eon. Providence had, how- ever, spared the life of brave Mrs. Crawford, and by so doing ovariotomy was founded. It is a noted fact, and undisputed experience shows it, that the man of genius, the man destined to rise, must traverse the rank and foulsome sloughs of envious persecution, until victory carries him out of them. Wisely said Professor Tyndale recently in speaking of the discouragements men of genius had to contend against: "A great theory has never been ac- cepted without opposition. Such must always be the course of things so long as men are endowed with different degrees of insight : where the mind of genius discerns the distant (85) 86 PERSECUTIONS. truth which it pursues, the mind not so gifted often sees nothing but the extravagance which it avoids," As an instance of a spirit of jealousy on the part of a member of the medical profession the followinor is to be noted. Durine one of the occasional absences from home of Dr. Mc- Dowell, his wife had a slight indisposition. Dr. Hunn, a self-important, opinionated and aristo- cratic old man, living in Danville and not far from the residence of McDowell, was called in to see her. He diagnosed the case, and with characteristic malevolence, to be appreciated in the reading of a succeeding paragraph, at once declared her to be dangerously poisoned, but said that if the family would have a cow driven into the yard, so that he might have fresh milk whenever called for, he could save her. All was arranged as he directed, and in due course of time Mrs. McDowell recovered. Nature was the successful physician. It seems to be a false dignity, a mistaken notion of elevated character, that prompts the worthy and skilful physician to stand idly by and see the substantial rewards of his labor appropriated by shameless pretenders. There is such a sympathy between this class of indi- PERSECUTIONS. 87 viduals and the people generally, that it would be but a just retribution should scientific physi- "cians abandon the field, and leave the public entirely in the hands of the nostrum-venders and advertising charlatans, — at least for a gen- eration or two, or until men shall have learned to appreciate the true physician and his scien- tific acquirements. The Dr. Hunn alluded to above, in order to injure the social standing of McDowell, fabri- cated a wicked falsehood, reporting that Mrs. McDowell had been poisoned by a young medical student at that time in the office of her husband, and that this pale, interesting man of medicine was none other than a young lady dressed in mans clothing. The assertion, malevolent lie as it was, found acceptance by some of the credulous, and not until after the marriage of the student, and he or she becom- ing a father, were their minds disabused of this wicked impression. We relate the incident as showing one of the many annoyances to which Dr. McDowell was subjected. It was only, however, when enemies assailed his pri- vate character that his indiofnation was aroused. He was a brave man, but one of such decision of character as to be master of his passions 88 PERSECUTIONS. and will. He usually armed himself when called at night to visit a patient, especially in the country. He only feared the assassin, who "loves darkness rather than light." His persecutions were very annoying, and his own profession denounced him as a cruel, wicked person, who had no sympathy for man or woman — that he gloried in cutting open the belly of a woman. His most intimate profes- sional friends avoided him, and the prejudice was carried so far that he was socially shunned by many. The negroes of the village and the surrounding country being naturally ignorant and superstitious, whenever they spied Dr. McDowell walking in the distance, would rush into the nearest building, fearing that he might waylay and maltreat them. They feared him as they would some beast of prey. Indeed they could scarcely be induced to venture out after twilight, unless McDowell was absent from home. For this fear, their masters were, of course, responsible. But he had his sport out of them. One after- noon as he was wending his way homeward, he met, in a solitary part of the road, a burly negro face to face. The man looked an instant at the doctor, and then attempted to run, but being PERSECUTIONS. 3q ordered, halted. With wild, staring eyes, and terrified face, the negro gave one unearthly groan and falling upon his knees offered up an appeal to God that would have touched a heart of stone. When he stopped praying, the doc- tor talked with him, trying to make the man understand his foolishness. The neero stated that he had heard his old master say, "That Dr. McDowell was next to the devil — that he went about cutting people open and killing them." To the time of his death, the ignorant residents, both white and black, held such ideas of him, and no argument could disabuse their minds of the uncanny impressions. Though his trials were many, they were dis- pelled by his abiding faith and by happy influ- ences related with his family circle. He taught his children, when engaged in sport, to regard him as one of themselves, dispossessing himself of that forbidding awe with which parents too frequently wean off their offspring. It is a remarkable fact that a man so true and sincere in his nature, as was Dr. McDowell, should have been a target for an envious pre- tender to hurl his venomous darts against. In reading the medical literature of the present QO PERSECUTIONS. age, we were chagrined at the unfairness meted out to Dr. McDowell by Mr. Lizars, who should have risen above such (to say the least of it) an unprofessional as well as dishonorable act, if the act were not due to negligence. True, Mr. Lizars is now numbered with the dead, and the thought may occur, let the faults of the dead be buried with them. Very well and just, but the deeply wronged McDowell likewise sleeps with the dead, and the injustice done him cries to be righted, and it is our privilege and duty to gather all the facts relating to him and his works. Our object is to place the illus- trious surgeon where he should be, and to state truths regarding him. Professor William Tod Helmuth, a renowned surgeon, says that the national pride of every American physician is to find gratification "in pronouncing Ephraim McDowell 'The father of ovariotomy,' not of American ovariotomy, but of ovariotomy the world over, and especially of ovariotomy in Great Britain. I am urged to this decisive pronunciation, because the endeavor has constantly been made in England to deprive the American people of the honor which belongs to them in this regard." Then he says further, that in 1817, Dr. McDowell prepared a report of PERSECUTIONS. 91 his cases, and with justifiable pride sent a copy to his friend and former preceptor Mr. Bell, whose health had failed, and who was then travellinof on the Continent. Mr. Lizars had charge of Bell's correspondence and practice, and failed to transmit the report to him. Seven years later Mr, Lizars brought them to light (Dr. Peaslee says they slumbered for seven years for some cause then unknown), and when he did so, they appeared as an appendix to a paper recording a case of his own, which proved to be not ovariotomy, but one simply of an accumulation oi fat. Mr. Christopher Heath thus spoke to his class : "Although ovariotomy was first performed by Dr. Ephraim McDowell, of Danville, Ken- tucky, who was a pupil of John Bell, the opera- tion of modern times has been entirely of Brit- ish cultivation. Mr. Lizars, of Edinburgh, was the first to attempt ovariotomy in this country, and by the long incision, /. c, from the umbili- cus to the pubes ; his example was followed by a few other surcreons and from time to time a o success was obtained." Mr. Heath allowed himself to overlook, ignorantly or wittingly, Dr. McDowell's eight successful cases attend- ing thirteen operations. p2 PERSECUTIONS. The facts are that had Mr. Lizars not read and studied Dr. McDowell's report he would never have attempted the operation, and when he did make such attempt he mistook a lump of fat for an enlarged ovary ; examination showing both organs to be healthy. Notwith- standing this humiliating fact, Mr. Lizars again attempted the performance, but in two cases was unable to remove the tumors, and in the third case mistook a sub-peritoneal uterine fibroid for a cystoma ovaria. The learned professor of surgery goes on to say: "These facts are very well known to every gynecologist, and though still of interest to the general practitioner, would not have been mentioned here had it not been that effort has recently been made in England by one high in authority, to give priority in the performance of ovariotomy to a certain Robert Houstoun, of Glascow. In Mr. Lawson Tait's latest work, 1883, the en- deavor of the author to procure for Great Bri- tain precedence in the performance of this operation is so apparent and indeed so over- drawn that the animus is plainly perceptible." We find the case of Mr. Houstoun which Mr. Tait refers to, in the Philosophical Trans- PERSECUTIONS. q3 actions: (From the year 1719 to the year ^12)Z)' Abridged and Disposed under General Heads, Vol. vii., pp. 541-546. published in 1834. We refer the reader to Case XXVIII. therein reported, being that of Margaret Millar : "In Aug. 1701. Margaret Millar, living not far from Glascow, informed me, that her Midwife, in her last Lying-in, at 45 years old, having violently pulled away the Burthen, she was so very sensibly affected by a Pain, which then seized her in the left Side, between the Umbilicus and Groin, that she scarce ever had been free from it after, but that it had troubled her more, or less, dur- ing 1 3 Years together ; that for two Years past she had been extremely uneasy, her Belly grew very large, and a Difficulty of breathing in- creased continually upon her ; insomuch, that for the last six Months, she had breathed with the utmost Difficulty. That in all that Space of Time, she had scarce eat so much as would nourish a sucking Child ; and that for three Months together she had now been forced to lie constantly on her Back, not daring to move at all, to one side or other. This tumour was trrown to so monstrous a Bulk, that it enofrossed p4 PERSECUTIONS. the whole left Side, from the Umbilicus to the Pubes, and stretched the Abdominal Muscles to so unequal a Degree, that I do not remember to have ever seen the like in the whole Course of my» Practice. It drew towards a point. Her being so long confined to lie continually on her Back, having grievously excoriated her, added much to her Sufferings, which, with want of Rest and Appetite, had greatly wasted her. " I told her, that in order to effectually relieve her, I must lay open great part of her Belly, and remove the Cause of all that Swelling: She seemed not frightened, but heard me without Disorder, and pressed me to the Operation. I drew (I must confess) almost all my Confidence from her unexpected Resolution, so that with- out loss of Time I prepared what the Place would allow, and with an Imposthume Lancet, laid open about an inch; but finding nothing issue, I enlarged it two Inches, and even then nothing came forth but a little thin yellowish Serum ; so I ventured to lay it open two Inches more. I was not a little startled, after so large an Aperture, to find it stopped only by a glu- tinous Substance. All my Difficulty was to remove it ; I tried my Probe, I endeavoured with my Fingers, but all was in vain ; it was so PERSECUTIONS. 95 slipper)^ that it eluded every Touch and the stronofest Hold I could take.- "I wanted in this Place almost everything necessary, but bethought myself of a very odd Instrument, yet as good as the best, because it answered the End proposed. I took a strong Firr-splinter, wrapped some loose Lint about the End of it, and thrust it into the Wound, and by turning and winding it, I drew out above two Yards in Length of a Substance thicker than any Gelly, or rather like Glue that is fresh made and hung out to dry ; the Breadth of it was above ten Inches : This was followed by nine full Quarts of such Matter, as I have met with in Steatomatous and Atheromatous tumours, with several Hydatides of various Sizes, all con- taining a yellowish Seriini, the least of them bigger than an Orange, with several large Pieces of Membranes, which seemed to be Parts of the distended Ovary. Then I squeezed out all I could, and stitched up the Wound in three Places, almost equi-distant : " I was obliged to make use of Liicatellus s Balsam, which was made by her Lady for the Use of the Poor ; with this Balsam I covered a Pled ■y that not a single member of the Obstetrical Society of London has raised an objection to the principle of ovariotomy, though several of them were for years opposed to it (among them Dr. Hall Davis, Dr. West, Dr. Savage, and Dr. W. Tyler Smith), until they became acquainted with the facts.' "In contrast with their French confreres, the English provincial surgeons early accepted the operation of ovariotomy, as we have seen ; though those of the metropolis generally re- mained Indifferent, rather than decidedly op- posed to It " It Is not surprising that the wholesale de- nunciations of ovariotomy, which I have quoted from the highest and most influential medical tribunal in France, should have checked its pro- gress ; and thus we find that for the next five years, or up to the commencement of 1862, only three more attempts at ovariotomy were made in that country. These were by Hergott, and Michel, in November, 1858;'' Boinet, In February, 1859;^ and Richard, in April, 1861.'* All of these were fatal cases ' Monograph, j). 45, ' Gazette Medicale de Strasbourg, 1859. ' Gazette des Hopitaux, 1859, p. 571. * Gazette Hebdoniadaire, 1862, p. 531. 134 CRITICISMS AND COMMENTS. "In i860 the memoir of M.Jules Worms, 'Sur I'Extirpation des Tumeurs cystiques de rOvaire,' appeared in the Gazette Hebdoina- daire de Medecine et de Chirurgie,^ Being equally familiar with the French, German, and English languages, a good observer, and a highly educated physician, M. Worms con- scientiously applied himself to the inquiry re- specting the actual results which had been achieved by ovariotomy, especially in England; and after much labor he arrived at the conclu- sion that ovariotomy is a valuable surgical re- source, and that it would doubtless, at some day, save many lives in France." . . . [See table page 137.] In Germany: "Whether the report of Dr. Ephraim McDowell's first three cases of ovari- otomy, published in 181 7, as we have seen, had been read by any of our German cojifi'eres, does not appear ; but it is certain that, in less than two years thereafter (in May, 1S19), Dr. Chrysmar, of Isny, Wiirtemburg, performed this operation for the first time, in Europe,^ and ' Pp. 642, 658, 690, 741, and 804. ' The first three operations of Dr. Chrysmar were reported by Dr. Hopfer, of Biberbach, in Journal fiir Chirurgie und Augenheilkunde. Herausgegeben von Dr. Von Grafs, und Dr. P. F. Von Walther. Zwolfter Band Erstes. Heft. pp. 60-87. Ibid., pp. 85-87. CRITICISMS AND COMMENTS. 135 six years before the first attempt of Mr. Lizars, Dr. Chrysmar, also, repeated the operation twice more before the end of the year 1820. The first operation was unsuccessful. The second in 1820, was performed in fifteen min- utes ; the patient recovered, and two years afterward had a child at full term. The third case. was unsuccessful.' .... " The operation of ovariotomy was attempted by Dieffenbach, of Berlin, in 1828, but not finished.^ His patient, however, recovered. . . " The first who boldly defended ovariotomy in Germany, was Biihring, of Berlin. He at- tempted to obtain a footing for it, as the only radical cure in all forms of ovarian dropsy. His monograph, entitled, Die Heilu7ig der £zers/ock£-esc/zwi(/s^e, \v3iS puhVished m 1848. . . " Dutoit^ remarks, that the history of ovari- otomy in Germany presents only a series of membra disjecta, rendering it very difficult to give an exact account of its development in that country [See table page 138.] ' Bulletin de Ferussac, tome xviii., p. 86, und Journal fiir Chirurgie und Augenheilkunde, B. xii., p. 62. * Rust's Magazin, B. xxv., p. 349. ' Die Ovariotomie und England, Deutschland, und Frank- reisch, Wurzburg, 1864, pp. 45. 136 CRITICISMS AND COMMENTS. Ovariotomy in the United States. (From 1853 to 1864.) Years. Cases. Cured. Died. Years. Cases. Cured. Died. 1853 • • • 8 7 I 1859 • ■ 7 4 3 1854 . . . II 8 3 i860 . . 3 3 IBS5 • • ■ 21 6 15 1861 . . 3 2 I 1856 . . . II 8 3 1862 . . 4 2 2 1857 . . . 5 4 I 1863 . . 3 2 I 1858 . . . 5 3 2 The total of the reported cases, up to 1864, is 117; of which 68, or 58.12 per cent, recovered, and 49 died. (From January i, 1864, to October 10, 1871.) Operators. 1 Cases. Cured. Died. Per cent, of recoveries. Atlee, W. L. . . 246 172 74 70.00 Kimball, G. ( Lowell, Mass.) . 121 80 41 66.11 Dunlap, A. (Ohio) 60 48 12 80.00 Peaslee, E. R. 28 19 9 67.85 White 25 17 8 68.00 McRuer (Maine) . 22 16 6 72.72 Thomas 27 18 9 66.66 Bradford, J. P. (Kentucky) . 30 27 3 90.00 Emmet 17 8 9 47-05 Sims, J. Marion 12 10 2 83-33 Miner 9 4 5 44.44 Axford 9 6 3 66.65 Crosby 5 2 3 40.00 Bennett, Ezra P. (Connecticut) 4 3 I 75.00 Green 8 S 3 62.50 Tewksbury (Portland) . 7 3 4 42.86 Beebe (Chicago) . 6 4 2 66.66 Hill (Augusta, Maine) . 6 3 3 50.00 Noeggerath . . .• . 6 I 5 16.66 Smith, A. G S 3 2 60.00 Jackson (Chicago) . 4 3 I 7500 "Mussey, R. D. (Cuicinnati) . 3 I 2 33-33 Total 660 453 207 68.63 Deduct cases previous to 1864 ) 38 included in above table J Total 622 since J anuary i, 1864. The total 7-cported cases up to January i, 1864, is Add total number of cases since January i, 1864 117 622 Total number of cases reported up to October 10, 1871 739 For the particulars respecting the ovariotomies reported in this country, from 1853 to 1863 inclusive, reference is made to the work of Dutoit. 1 For names and reports of cases of ovariotomists previous to 1864, see Dr. Peaslee's work, pp. 238-267. CRITICISMS AND COMMENTS. 137 Ovariotomy in Great Britain. (Up to January i, 1871-72.) Operators. Wells, T. Spencer . Clay, Charles . . . Keith, Thomas (end of 1871 Brown, I. Baker (to 1870)' Bryant, Thomas (to 1870)' Smith, W. Tyler (to 1870)1 Willett (to 1870)1 Total Cases. Cured. Died. Per cent, of recoveries. 440 328 JI2 74-54 250 182 68 72.80 136 III 25 81.61 120 84 36 70.00 28 17 II 60.71 20 16 4 80.00 12 4 8 33-33 1006 742 264 73-75 Note. — As this table is made up of operations, performed by the most experienced ovariotomists in Great Britain at that date (1872), and does not include isolated cases of other practitioners who were not as success- ful, the percentage of recoveries, of course, is greater than if the table in- cluded a// operations up to that date. — M. Y. R. Ovariotomy in France. (Up to March 31, 1S67. Made up from Boinet's Table. 2) Operators. Kceberle . Boinet Maisonneuve . Demarquay Nelaton Pean Richards, A. Gosselin . Le Croix (de Bcziersj Desgranges Serre (d'Alais) . Laumonier (1781) Woyerkowsky (1844) Rigaud (1844) Vaullegeard (1847) Other operators who had each per- formed one ovariotomy up to March 31, 1867, Total in Boinet's table Other cases not reported . Add cases classed by lioinet as not published, including 12 of Nelaton =:l Rejecting, as we should, Laumonier's"] case, Rigaud's case (unfinished), I Boinet's first case (degenerated | fibroid), K Gr ■^ Boinet's Maladies des Ovaries, 1867. 138 CRITICISMS AND COMMENTS. Ovariotomy in Germany. (Up to January i, 1870.) Dr. Peaslee states : " The whole number of ovariotomies in Germany, up to the commencement of 1870, is 180, of which 75 resulted in a cure, and 105 were fatal. The recoveries are, therefore, only 41.66 per cent.'' "Including only the operations of the three most experienced opera- tors, the following is the result : Operators. Cases. Cured. Died. Per cent, of lecoveries. Nussbaum .... Stilling Spiegelberg .... 34 17 14 18 16 8 9 8 6 52-94 47.06 57-14 Total 65 34 31 52.30 Dutoit's Table. (Up to November 30, 1863.) "This table is intended to include all cases of completed ovariotomy in the United States, Great Britain, France and Germany, up to November 30, 1863. In all respects it is prepared with the utmost care." Countries. Cases. Cured. Died. Per cent, of recoveries. United States .... Great Britain .... France Germany .... 117 379 26 55 68 230 12 15 49 149 14 40 58.12 60.68 46.15 27-27 Total 577 325 252 56.32 Summary of Cases of Completed Ovariotomy in the United States, Great Britain, France, and Germany. (Up to 1870-71-) Countries. Cases. Cured. Died. Per cent, of recoveries United States (to 1870-71), (739 cases to Oct. 10, 1871) Great Britain (to 1870-71) . France (to March 31, 1867) . Germany (to January i, 1870) 660 1006 116 180 453 742 47 75 207 264 69 105 68.63 73-75 40.51 41.66 Total 1962 1317 64s 67.13 Showing an increase of 11. 13 per cent, of recoveries during the years from November 30, 1863, to 1871. Since that date the percentage of re- coveries in ovariotomy has been greatly increased, until now it is one of the most successful of difficult surgical operations performed. CRITICISMS AND COMMENTS. j ^q Dr. Peaslee goes on to say: "Ovariotomy has very recently been performed for the first time, if at all, in most of the countries on the Continent which have not yet been mentioned in the preceding historical sketch. The scattered facts which have been accessible to me will be here stated." .... In Austria: "Ovariotomy had never been performed before 1866, and but twelve times since. Of these twelve cases only one re- covered Ovariotomy must, however, soon be generally accepted in this country also; as the following extract from the Surgical Reminiscences of Professor Billroth, of Vienna, now being published,' demonstrates: 'Up to the present time, I am tolerably contented with my results Hitherto, I have performed ovariotomy nine times, and of these patients only two have died ; giving, therefore, only a mortality of 22.2 per cent. The first four cases recovered, one after another, then the fatal cases occurred ; to be followed again by three recov- eries. The first case is related in my Zurich Chirurgische Klinik, and the second, third, and fourth cases in the Chirurgische K/inik, pub- lished at Vienna, in 1868.'" .... ' In the Wiener med. Wochenschrift, 1871. 140 CRITICISMS AND COMMENTS. In Spain: " Ovariotomy was first performed in this country, and unsuccessfully, by Dr. F. Rubio, of Seville.'" In Italy: "It is asserted by Fehr,^ that the first operation of ovariotomy, in Europe, was performed by an Italian physician, Dr. Emiliani, of Faenza, in 181 5, this being four years in ad- vance of the operation by Chrysmar, of Isny." In Sweden ; "Two successful operations were performed by Mesterton, at Upsala, in 1862." In Finland: "Haartman, of Helsingfors, ope- rated in February, 1849. The patient died in two days, of peritonitis." In Poland: "In i860, Bryk operated in Cra- cow; the patient dying four clays afterward." In Switzerland: "Breslau, of Zurich, operated unsuccessfully, in October, 1862, and afterward three times successfully. Dr. Montel, of Vevay, had a successful operation in 1865. It was a case of large polycyst."^ In Belgium: "Dr. Boddaut was the first Belgian surgeon who successfully practised ovariotomy." In Russia: "Ovariotomy was first successfully ^ The Lancet, 1863, vol. ii., p. 636. ^ Die Ovariotomie, p. 6. ^Gazette Hebdomadaire, March 7, 1865. CRITICISMS AND COMMENTS. j . j performed in Russia, December 23, 1862, by Dr. A. Krassovsky, at St. Petersburg."' In India : " Ovariotomy was twice successfully performed by Dr. J. M. Joseph, surgeon of the Civil Hospital, Combaconum.^ In 1869, it had been performed three times by a native surgeon, Dr. Mootoosawny Moodelly, of Manargudi, Tanjore District."^ .... In Ceylon : "Ovariotomy has been performed by Dr. P. D. Anthonisy."* In New Zealand: "Ovariotomy has been successfully performed by Dr. R. Tassel, of Auckland. "5 In Australia: "Dr. Tracy, of Melbourne, was the first to perform ovariotomy, and he saved ten out of his first thirteen patients."^ Note. — The limits of this work will not admit of our including in the foregoing article the records of many distinguished ovariotomists, as our design is simply to give a brief sketch of ovariotomy in its infancy, but we refer the reader to the statistics which will be found in the valuable treatise from which these excerpts and tables are mostly taken, and, also, to other articles in this book. — M. Y. R. ' Petersburger Medicin Zeitschrift, 1863. * Indian Annals of Medical Science, January, 1858, ' Reported in the Obstetrical Trans., 1869, vol. x., p. 1 19. *The Lancet, 1864, vol, ii., p. 728. ' Ibid., 1870, vol. ii., p. 507. • Ibid., 187 I, vol. ii., p. 517. CHAPTER IX. COMMENTS UPON OVARIOTOMY. Dr. Washington L. Atlee, in his valuable work entitled Diagnosis of Ovarian Tumors, writes as follows : "A patient seldom has any direct evidence of the existence of an ovarian tumor until she can feel it above the brim of the pelvis, or until some enlargement of the abdomen has occurred ; and as she does not usually seek the opinion of a surgeon before one or the other takes place, I shall confine my remarks on diagnosis to tumors after they have invaded the cavity of the abdomen. This is especially appropriate, as the subject will be discussed in reference to the question of ova- riotomy — an operation unlikely to be performed before the tumor has been elevated above the brim of the pelvis." He cites an interesting case (XIV.) entitled as follows: ''An ovarian cyst tapped twice ; subsequently a communication established with tJie bozvel, by means of which the contents of the cyst zvere evacuated and flatus entered the cyst. ( 142 ) COMMENTS UPON OVARIOTOMY. j^^ "On September i, 1869, I visited Princeton, New Jersey, for the purpose of operating on Miss E. B. R., daughter of a clergyman of that city, and a patient of Dr. J. A. Wikoff "In his letter requesting my attendance. Dr. Wikoff wrote : ' She is a young lady of about twenty-five, has recently come under my care, and is suffering from an ovarian tumor. Three years ago she was living near New York, and was under the care of Drs. Dela- field and Alarkoe, who twice tapped her pre- paratory to ovariotomy. Her health, however, failing, they deemed it prudent not to operate; but just as they imagined she was about to die, nature interfered and relieved her in a most remarkable way. To within a few months she has been in comparatively good health, but now the tumor, which, I think, is- composite in its nature, is increasincf and her health is sufferinor.' o "The following intelligent history of the case was written by the father of the lady: 'The first symptoms of this disease were noticed by her mother and herself in April, 1865, there beinof a hardness of the bowels, attributed bv them to dyspepsia, which was accompanied by paleness and want of appetite. 144 COMMENTS UPON OVARIOTOMY. " 'She paid a visit of six weeks at this time to some friends in Camden and Philadelphia, and when she returned in June there was a mani- fest enlargement of the stomach and waist, which alarmed us, when we called a physician, who pronounced it di^opsy and gave, without benefit, the ordinary remedies for that disease. Her strength being reduced (under the treat- ment for two weeks) very much, and violent pains increasing, we took her to New York, and placed her under the care of Drs. Dela- field and Markoe, who, after treatment of a week, pronounced it ovarian dropsy. They then prescribed iron, with careful diet and ex- ercise, and a return to the country. In Sep- tember, iodine was substituted for iron, together with palliatives. " 'She continued to increase in size through the winter, until she was enormously swollen, the fluid rising very high, even displacing the heart, so that it seemed to beat under the shoulder. " 'Her flesh had been very much reduced, yet she was strong enough to go up and down the stairs and ride out, although very heavy upon her feet. She ate moderately of anything she fancied with tolerable comfort. COMMENTS UPON OVARIOTOMY. 145 " 'In February, 1866, she was taken to New York to be tapped, not suffering- from the trip.- My wife says that more than two pails of fluid, or fifty-two pounds, were evacuated, o'f the appearance and consistency of stale lees or porter (perhaps a little thicker). She was very weak after tapping, but soon rallied, and in a little more than a week was walking about the house, and then visited with comfort some friends in the city. She soon began to fill again, although it did not show for a month. " 'She regained strength and flesh rapidly, and seemed well notwithstanding the gradual increase in size until July, when her health be- gan to suffer. " ' In the latter part of August there seemed to be a regular recurrence of fever at night, which Dr. M. thought to be independent of the dis- ease, and for which he prescribed (although he did not see her) without effect. During the intense heat of that season, nervous symptoms of an alarming character set in with the nightly fever. "'On Friday night they intensified, and the next day continued so that the family physician said that her brain was affected. " 'Saturday night she had a spasm, accompa- 1^6 COMMENTS UPON OVARIOTOMY. nied and followed by violent demonstrations, screaming, gritting the teeth, and terror,* like delu'umi tremens. "'Between two o'clock, a.m., Saturday, and two o'clock, P.M., Sunday, she had six spasms. At the latter hour (Dr. Markoe arriving from Long Branch) she was persuaded to be tapped, and remained calm during the operation, about three-quarters of an hour. '"Three-fourths of a pailful oi gelatinous fluid was drawn away, with sensible relief, although the excitement (which Dr. Markoe pronounced hysterics) subsided but little. She seemed strong, and could not be kept quiet through the night, but the next morning was very much exhausted, so that we used brandy and hot bricks at the feet to restore her. "'She gradually, however, increased in strength and erew a little more calm after a week, 'but was far from being like herself. "'It was evident that she was slowly filling again, but her habits were so whimsical and secretive that we could not inform ourselves particularly. " ' During this time she went up and down in the house and out of doors as she pleased, but would not see any one, even the members of COMMENTS UPON OVARIOTOMY. j^j the family more than could be avoided ; went to the table after meals, and helped herself, as she would not be waited on. " 'About the last of September, 1866, we no- ticed a manifest diminution, accompanied by- violent diarj^hcea, for two weeks or more, end- ing in entire relief, both of body and mind, as she became calm and natural just in propor- tion as the fluid passed away, " 'In two or three weeks she had regained both strength and flesh, and seemed like herself She spent several weeks in Camden and Phila- delphia, enjoying herself, during this winter as much as ever before. " ' In the summer of 1867 she noticed a lump as large as a walnut (she thinks on the right side), which gradually increased during the summer to the size of an oranofe, and in the fall seemed to flatten and slowly to spread laterally. But from the time she noticed it first, in 1867, until in 1868, it seemed to be hard over the stomach. She could push it with ease (as she expressed it) from one side of the stomach to the other, and, after it became larger, could lift up the sides of it with her hands under the skin. September, 1868, she noticed a ten- dency to increase, but it gave her no incon- 1^8 COMMENTS UPON OVARIOTOMY. venience until within two months, when Dr. Wikoff became cognizant of the case, to whom I refer you for further details.' "Two or three days before visiting the pa- tient for the purpose of performing ovariotomy, she was taken suddenly with diarrhoea, accom- panied with copious, watery and dark-colored discharges, affording her considerable relief, and causing some subsidence of the abdominal enlargement. Still she was as large as a woman at full period of gestation. *• When lying on her back the percussion sound was resonant over the whole abdomen in front, and dull below and along the sides, just as is found in ascites. "In an upright position, resonance existed over the epigastrium ; and when lying on either side it was noticed in the opposite side. A large cyst, with multilocular deposits in its walls, could be detected, occupying the whole cavity of the abdomen, containing both liquid and air — some of the liquid, no doubt, having escaped into the bowel, and flatus from the canal having found its way into the cyst. This was made still more evident by succussion. " The body of the uterus was wholly buried in a mass occupying the superior strait of the pel- COMMENTS UPON OVARIOTOMY. 149 vis, and was immovable. The os tincae could scarcely be detected on the left side of the pelvis. The sound entered the uterus two inches. " Under these circumstances I declined to operate, as the opening in the bowel was calcu- lated to cause a fatal result. Besides, nature itself was making an attempt to relieve the patient. ''September 30, 1869, Dr. W. wrote : ' Miss R. Is gradually improving. The cyst has com- pletely emptied itself, and she Is no larger than natural. The discharges kept up for about three weeks from twenty-four to ten a day.'" Nature in this peculiar case was the success- ful physician. " Percussion and palpation become very im- portant aids in detecting the existence and location of ovarian and other abdominal tumors. A patient should be examined with the abdo- men uncovered, and first in the sitting posture. The whole surface of the region should then be explored by palpation, varying the pressure. "By this means we are all able, through the sense of touch alone, to detect the presence of peritoneal fluid between the surface of the tumor and the walls of the abdomen ; to decide I50 COMMENTS UPON OVARIOTOMY. on the character of the tumor ; to detect the existence of smaller bodies in the walls of a large cyst, and frequently to trace the outlines of several cysts, by the sulci which divides a polycystic mass. During this examination the eye of the surgeon should follow all the motions of the hand — the general contour of the abdomen, as well as the form of the several parts, being worthy of the closest observation. " Different inferences would be drawn ac- cording to the impression imparted to the hand and the shape of the abdomen. " The patient being still in a sitting posture, percussion should next be practised by placing the palmar surface of the finger of one hand upon the abdomen and striking it with the ends of the fingers of the other hand, and noticing closely the sounds elicited. " It is well known that when percussion is made over any part containing air there will be a reverberation of sound, which is denominated resonance, while over a liquid or a solid 2l flat or dnll sound is returned. Therefore an ova- rian or other solid tumor, located anterior to the viscera, must give off a dull percussion sound over the anterior part of the abdomen, and indeed over the whole space occupied by COMMENTS UPON OVARIOTOMY. 151 it ; whereas the intestines, which always con- tain more or less air, must return a resonant percussion sound, and are usually thus traced, occupying- the lumbar, hypochondriac, and epi- gastric regions, being crowded beyond the borders of the tumor. A patient, therefore, having an ovarian tumor filling the abdominal cavity and crowding closely upon the viscera, will almost universally be free from a resonant percussion sound over every part of the abdo- men except in the regions above stated, and not unfrequently this sound is absent in one or more of these localities." In illustrating a peculiar condition to which Dr. Atlee was anxious to call the attention of the profession, viz., the cJiai'actcr of the fluid removed by tapping, and the value of this opera- tion as a means of diagnosis, he writes as fol- lows : "We have seen that even Mr. Spencer Wells, whom we all delight to honor as the highest authority in ovariotomy, was corrected in his diagnosis of a case only by the charac- ter of the fluid, so exactly did it resemble, in every feature, an ovarian tumor. This circum- stance, instead of disparaging our great master in England, adds to his character, by proving 1^2 COMMENTS UPON OVARIOTOMY. how closely observant he is of every phase of differential diagnosis, and should warn others, of less experience, not to be too sanguine in expressing an opinion until they have adopted every possible means of examination." Dr. Edmund Randolph Peaslee, in his work on Ovarian Tumors, published in 1872, sets forth the facts establishing the claim of Dr. Ephraim McDowell to priority as an ovarioto- mist, and gives a history of the four cases of Mr. Lizars, from which the following excerpts are taken : "From 1786, when John Hunter published an opinion I have already quoted (p. 235), that hydatid ovarian cysts may be extirpated when they first begin to grow, I do not find the extir- pation of ovarian tumors considered by any writer in Great Britain till the year 1824. Dr. McDowell's report of his first three cases, in- tended for Mr. Bell, had slumbered in Mr. Lizars's possession for more than seven years, and was now to see the light. While I do not explain the former fact, Mr. Lizars had himself now to publish a case of attempted ovariotomy, and Dr. McDowell's report was appended. ''The patient had been believed by Mr. Lizars, and 'all other eminent surgeons who had COMMENTS UPOX OVARIOTOMY. 153 seen the case,' to have had an ovarian cyst. She had been tapped, though it is not stated whether any fluid was obtained. Making an incision 'parallel with and to the left side of the linea alba about two inches from the ensiform carti- lage to the crista of the os pubis,' he found no tumor at all ; that both ovaries were healthy ; and that the supposed ovarian tumor was merely an accumulation of fat under the skin of the abdomen, and of gas in the intestines. In such circumstances. Dr. McDowell's report of three cases afforded a precedent for his opera- tion, if it did not indorse his diagnosis "The next year, 1825, Mr. Lizars attempted ovariotomy three times in three successive months, February 27th, March 2 2d, and April 24th. The results, however, were not flattering. All three were believed to be cases of ovarian tumor, at the time of the operations ; but two of the tumors were not removed on account of adhesions " Mr. Liston remarks of Mr. Lizars's first case, that he had himself treated this patient for lumbar abscess with disease of the spine. She recovered from the former, but the bones had grown together, and her stature had mucli diminished. She was now a puffy, podgy, little 154 COMMENTS UPON OVARIOTOMY. woman, with an exceedingly prominent belly. She begged Mr. Liston to perform the opera- tion, but he endeavored to persuade her not to submit to it. Alluding to Mr. Lizars's other operations in private practice, he adds, as if he had assumed the control of both the operator and the operation, 'For I took care to prevent him from cutting open women's bellies in the hospital after he became attached to it.'"' Prof.W. Gill Wylie, of New York, reports one hundred and ten laparotomies — sixty-one con- secutive operations without a death. "^ He very judiciously says: "A number of cases were sent to me for operation where the patients gave all the subjective symptoms of serious func- tional disturbance, if not of actual disease of the appendages ; but, on account of absence of any positive objective signs of actual enlarge- ment or disease, I refused to operate. There certainly are a number of cases where both local and general treatment fails to give relief from pain, and where complete loss of health is due, apparently, to disease or to a faulty action of the ""enerative orcrans, and where, on examination, all we can find is an Imperfectly developed, anteflexed uterus with a prolapsed ^ The Lancet, February 8, 1845. ^ Annals of Gynecology, December, 1887. COMMEXTS UPON O VARIO TO MY. \ 5 5 left ovary and a general condition of hyperses- thesia on both sides. The question is, in such cases, when all other means fail to give relief, are we justified in removing the tubes and ovaries to put a stop to functional activity ? Next, does the operation really cure such cases ?" Taking a view of laparotomy on the other side, are all the unsuccessful cases truthfully reported ? And is an estimate of the deaths caused from the operation announced? Surgery has its fashions in laparotomy, and when such is the case the operation is likely to be carried to excess, and the rash and incom- petent make mistakes, causing condemnation to rest upon what is good. Dr. Au<:fustin H. Goelet, of New York, who is strongly in favor of electricity as a substitute for laparotomy, and who advances some good ideas, says: " When we take into consideration the risk involved, coupled with the fact that the ulti- mate result is not always what is desired, laparotomy can by no means be considered successful or satisfactory when done for the uterine appendages. Unless it affords positive relief of the symptoms wliich caused the pres- 1^6 COMMENTS UPON OVARIOTOMY. ence of the disease to be detected, it cannot be considered ev^en a justifiable operation. If pain, the main symptom which drove the pa- tient to seek reHef, persists after the opera- tion, what has been gained beyond permanent steriHty ? " The recovery of the patient from a danger- ous operation often serves to ecHpse the purpose for which it was intended, and is mistaken for success, adding to the record of the successful operator, but in no way benefiting the patient. The mental impression produced upon her may serve to satisfy her for a time, until, when this subsides, she awakens to the truth that she is no better than before. "The proof of this assertion is to be found in the fact that a successful laparotomist has published an elaborate paper upon the cause of pain following laparotomy. Also in substan- tiation is the fact that operators declare that temporary improvement frequently follows laparotomy when the abdomen is only opened, inspected, and immediately closed, the condi- tion found being unfavorable. "The patient is often so overwhelmed by the magnitude of the disclosure, as well as by the long list of successful operations of the man COMMENTS UPON OVARIOTOMY. 157 who advises her, that she does not think to question the ultimate results of these perform- ances, but consents with a sort of resignation to a fate from which she is given no choice. Nothing else having been suggested by her adviser, she argues that there is no alternative, for the principle of the laparotomist is, ' If an eye offend thee, pluck it out.' If the tubes and ovaries are diseased, take them away. Do not try to cure them. Get clear of them. " It has been said, and with some degree of truth, that there are more healthy ovaries re- moved than diseased ones. Hence the term normal ovariotomy, which is a blot upon the escutcheon of the profession. "We might enumerate many surgeons who are opposed to promiscuous laparotomy and strongly in favor of ovariotomy — the latter the only remedy for ovarian tumor; but we have not space to devote to this very interest- ing subject." CHAPTER X. JOSEPH NASHE McDOWELL, M.D. As we have referred to several of the rela- tives of Dr. Ephraim McDowell in this work, we are not to lose sight of his nephew, Dr. Joseph Nashe McDowell, whose eminence as a surgeon and a man of brilliant intellect was acknowledged throuorhout the southern and western countries. He founded the " McDowell Medical Col- lege " in St. Louis, and that city owes to him the establishment of its most thorough and prosperous medical school. A few years after the death of its founder, for some reason unknown to the writer, St. Louis, the city of his adoption, changed the name of the "McDowell Medical College" to that of the "Missouri Medical College," which name it bears at the present time. The college is in a prosperous condition, and the faculty is composed of the most prominent physicians of the city. Many students from (158) JOSEPH NASHE MCDOWELL. 159 the South patronize the school, there being usually about three hundred in attendance. Although Dr. J. Nashe McDowell was born and reared in Lexington, Kentucky, his inte- rests and local attachments were closely iden- tified with those of St. Louis, Mo. He had many enthusiastic friends there and in the South, who warmly espoused his cause, and the medical profession in St. Louis recog- nized that fact. Col. Thomas Marshall Green, an exceedingly gifted and fluent writer, speaks of him in the following language : "It was not solely as a lecturer in medicine and surgery that the ora- torical gifts of Dr. Joseph Nashe McDowell shone conspicuously ; of varied and extensive culture, his gifts made him the delight of lite- rary circles, and the West contained no more eloquent speaker on political topics than was this able and learned teacher of the healing art. "He abandoned the rigid Calvinism of the McDowell without adopting the gentler tenets of Arminianism; discarding their Federalism, his devotion to the * lost cause ' made him an exile from his home and country. " Thus died a man whose learning, genius, l6o JOSEPH NASHE MCDOWELL. and enthusiasm, had his life been guided by the principles and religion of his fathers, would have placed him at the very head of his profes- sion, and have made him eminent in any walk of life and in any country." Col, Green con- tinues: "From Dr. Samuel Gross, with whom he frequently came in angry collision, his genius and superior talents extorted the admis- sion that Dr. McDowell was an eloquent and enthusiastic teacher of anatomy, who had a re- markable gift of speech, and who could enter- tain and amuse a class in a wonderful way." In a recent conversation with Dr. John H. Tate, of Cincinnati, Ohio, that gentleman re- marked " that he considered Dr. Joseph Nashe McDowell the finest demonstrator of anatomy in the whole country." In 1838 he delivered so able a lecture before the students in the Ohio Medical College as to give him great celebrity as a lecturer and teacher. As a surgeon he performed more general operations, and amputated more arms and legs than any practitioner in the city of St. Louis. He was a very profane man, using oaths freely. On an occasion he was hurriedly called in to amputate the limb of a poor unfortu- JOSEPH NASHE MCDOWELL. jgl nate laboring man, who had accidentally had his leg terribly crushed in some machinery' con- nected with a saw mill. Dr. JNIcDowell went as soon as possible to the relief of the sufferer, and as he entered the threshold of the door com- menced swearing at a dreadful rate, saying, "Where is the d — n rascal? I have come to cut him to pieces, d — n his trifling soul! Why did he not keep away from the d — d machinery? and other such vituperative expressions con- tinued to pour from his lips until he reached the bedside of his patient. He turned to the man, who was writhing in agony, and said : " Sir, I have come to cut you up, d — n you ! The instruments are all ready," displaying, with the remark, the glistening instruments that were to do the work. The poor sufferer, paralyzed and dazed, real- . ized how completely he was in the power of the Doctor. " Now, sir, hold still and I will make (}uick work of it ;" and in a very short time the Doctor amputated the limb, dressed the wound, and had the man made as comfortable as possible. When the operation was over he asked the patient how he felt. The man replied, " Doctor, you frightened me so badly I did not feel you l62 JOSEPH NASHE MCDOWELL. cut my leg off." The Doctor then explained to him that he had taken this mode to lessen his pain, adding, " My poor unfortunate, I felt all your pain for you." The man soon recovered ; and frequently expatiated on his operation, telling his friends how Dr. McDowell had cut his leof off, and what a great man he was. Apparently the brusque, off-handed manner of the Doctor caused many persons to judge him wrongfully, and to believe him void of that tender sympathy which it is so necessary for a physician to possess. Such was not the case ; on the contrary, a warm and generous heart beat within his bosom, and he was unusually kind and considerate with the poor. Much of his practice was gratuitous. His appearance attracted general attention. He was above the medium height, and from his boyhood had been remarkably tJiin and angular, having sharp-cut features and small, penetrating eyes that seemed to look into the very recesses of one's soul. This emaciated appearance suggested to the medical students the pseudo- nym of " Sawbones," a name he was well known by, not only among the young men but among his friends. JOSEPH NASHE MCD WELL. 1 63 When he was a youth much of his time was spent in the family of his uncle, Dr. Ephraim McDowell, and it was there that he formed an ardent attachment for his cousin, Mary McDowell, whose beauty has been alluded to. When he made his vows expressing more than cousiJily affection for her, she, with a sin- cerity and frankness that characterize a genuine noble-hearted girl, candidly told him that she could only regard him in the light of a relative, never in that of love, desiring him earnestly to banish from his mind such a thought as making her his wife. She confided to her father, as became a daughter, what she had heard from her cousin. Dr. McDowell immediately sought his nephew, and with kind, but decisive, manner empha- sized her decision and request. The nephew became angry and reflected on his uncle, charging him with influencing his daughter against him, an inference in which he un- doubtedly was mistaken. From that time a coolness existed between the two, the nephew leaving his uncle's house and never returning, nor did he ever forgive him. He sought new fields of friendship, and in course of time a new field of love. 164 JOSEPH NASHE MCDOWELL. The two never met again. The younger carried with him to the grave his feehng of hatred toward the elder, and never would listen to any eulogy bestowed on him for his grand surgical achievements. Shortly after this occur- rence he removed to Cincinnati, Ohio, and commenced the practice of medicine. Surgery was his specialty. He was con- sidered a bold operator. Dr. Daniel Drake, then the leading physician in Cincinnati, be- came devotedly attached to the young man, seeing in him the promise of an able practi- tioner. This friendship was later cemented after another manner. Dr. McDowell wooed and won the sister of his patron. After his marriage to Miss Drake he removed to St. Louis, and it was there that he built for himself a reputation for skilful surgery and remarkable determination of character, that not even time's destructive touch has taken from him. Attached to the college was one of the most complete museums to be found at that time in the land. It contained an attractive and ex- tensive collection of specimens relating to surgery, rare and ancient warlike weapons, birds, statuary, and many things of interest. The Doctor was fond of displaying his curiosi- JOSEPH NASHE MCDOWELL. 165 ties to visitors, and no one thoucrht of croinof to St. Louis without seeing the McDowell Mu- seum. The eccentricities and the erratic manner and habits of Dr Mc Dowell invited many com- ments and severe criticisms. It was never questioned, however, that he was a man of pronounced learning, and as well a genius in his profession. When the o-uns of Fort Sumter sounded a knell of war that was to wreck so many happy and prosperous families both in the north and in the south : when the echoes resounded throughout the length and breadth of the land, calling men to arms — brother against brother, and father against son, men hastily responded to the call, and went forth to battle, many, alas, to fall within the gates of their own homes. Dr. ^McDowell, inspired by that spirit of chivalry which characterizes the American peo- ple, offered at once to the Confederates his ser- vices as a surgeon. Bidding adieu to his family and friends in St. Louis, he was assigned duty in Mississippi, where he immediately entered on active work. Many wounded and gallant soldiers were l66 JOSEPH NASHE MCDOWELL. restored by his skilful operations ; his efforts to relieve the sick and wounded were unparalleled. He was out night and day on his mission of mercy, always responding punctually to the call of duty. The writer being banished from New Or- leans by General Benjamin F. Butler, when he occupied that city during the late civil war, had the pleasure of meeting Dr. McDowell on several important occasions. The one in which he was most prominent and took a very conspicuous part, was where a dreadful collision occurred between two trains freighted with many people. One of these cars was packed with wounded soldiers, fresh from the memorable sieo^e of Atlanta, the other coach contained refugee ladies with their help- less children fleeino- from an advancing^ foe. On board the soldiers' train there were many wounded federal soldiers who had been taken prisoners. Immediately after the accident (the scene of which beggared description) surgeons from every rank, and ladies by the hundred, flocked to the scene of distress, with lint, bandages, coffee, camphor, and cologne, all of them ready and willing to relieve the suffering and soothe JOSEPH NASHE MCDOWELL. i^j the dying in their last struggles. The blue and the gray uniforms mingled together upon their beds of anguish, and Dr. McDowell, in his kind, benign spirit, administered alike to both as did also the Southern ladies. Many a Northern soldier owed his life to Dr. McDowell and to Southern women on that occasion. The question was not then asked, "What side is he on?" Gentle and tender hands administered to all alike. On another occasion the writer met Dr. McDowell under different circumstances, when, his feelings being greatly outraged toward the North, and especially toward its then chief magistrate, Abraham Lincoln, he remarked that " to ////// was due all the terrible sacrifice of life. That to ///;;/ was due this civil war." At the close of this unfortunate conflict he returned to St. Louis an embittered man. His college was a wreck ; his handsome museum, in which he had taken so much pride, and had expended so much money, 2vas gone, not a vestige of anything being left to mark the spot where once were crowded so many things of interest to him. He then sought his once extensive library. Alas ! oiih- to find the empty shelves standing out in bold relief, as if 1 68 JOSEPH NA SHE MCDO WEL L . in defiance. Not a book was to be found. The bare walls of the once famous " McDowell College" were left standing as if in mockery. He peered through the broken panes of glass (for there was scarcely a whole one left in the building), and looking out into what was once a beautiful garden of flowers, tufted with grass, he saw filthy debris of every description, to- gether with the remnant of a gallows. (The authorities had used the building as a prison, and the once cultivated yard had been made the hangman's ground ; several men had there expiated their crime upon the gallows.) The Doctor, in despair and gloom, turned from these harrowing scenes, his mind quite unset- tled as to what was best to be done. The ground on which the college walls were left standing still belonged to him, but as his fi- nances were running low, and it certainly would be necessary to expend a great deal of money upon the building before it could be made habitable, he was truly at a loss as to how he should proceed. He sought the advice of some of his old and trusted friends in St. Louis, whom he knew had his interest at heart, and they advised that he return to his college, and with the JOSEPH NASHE MCDOWELL. i6q pecuniary assistance they were willing to give, that he put things in readiness to recommence his work. This generous offer was accepted, and in a short time the old college building put on a 71 ew dress. The Doctor had a crank idea that in that commodious building^ one room should be set apart and designated as ''Hell,'' in commemo- ration of Abraham Lincoln, who, although long since dead, held a bitter place in the heart of the eccentric old doctor. It was my pleasure to visit my relative (Dr. McDowell) soon after he refitted up his college and residence ; and after his congratulations of meeting were over, he re- marked that he wanted to take me to '■'■Hell!' Not comprehending his meaning, I replied: 'T hope I shall never be so unfortunate as to see h— 1. " He immediately caught me by the arm, and leading me through several narrow hallways, we finally halted in front of a heavy double door, when drawing a large brass key from his pocket and placing it in the lock, the door soon yielded and swung wide open. I noticed as I passed into this strange room that the word " Hell," in gilt letters, stood out I -^O JOSEPH NA SHE MC D O IV EL L . in bold relief over the entrance. The room was very long and narrow, and lacked carpet or other furniture. On entering this Dantean abode, the first salutation that greeted me was the venomous hissing of an unusually large rattlesnake that was to be seen darting out its fiery tongue be- tween the bars of its cage. To the left a huge crocodile was noticed, such as crowd the southern sloughs and bayous, and dot the lowlands and canebrakes of the tropical country. The hideous reptile crept slothfully through his pool of tepid water, now and then swinging his immense jaws as though he would like to make a meal of us ; but he too was con- fined within his own limits, and there was no danger. Becominof interested in this weird and un- natural place I followed the Doctor, not unwill- ingly and certainly with a much aroused curi- osity, deeper into the mysteries of his ''Hell!' Glancing to our right, we saw the bird of ill omen perched upon his pole, seemingly oblivious of us or of its surrounding ; occasionally it would grit its bill together, causing a peculiarly unwelcome sound. Alongside the bird was a lizard, singing its unvaried song. JOSEPH NASHE MCDOWELL. i -j j At the extreme end of a narrow hall-like room a gallows had been erected, suspended from which was an effigy of ex-President Abra- ham Lincoln. For a moment (the scene was so life-like) I was shocked and startled. There were several other images, one in par- ticular representing Lucifer and his imps. It was indeed a novel sieht to witness. Dr. McDowell took a lively interest in everything connected with this particular apartment. Before the late civil war, in the ante-bellum days, when the " McDowell Medical College" was at its height of prosperity, and several hundred students were in attendance, upon one occasion a very distinguished surgeon and phy- sician from a distance was to lecture, not only before the students, but others. Dr. McDowell, being at that time the Dean of the faculty, had sent out quite a number of invitations to members of the medical pro- fession and their families. At the appointed hour for the lecture to begin the spacious hall was filled with many of the most prominent ladies and gentlemen in the city.. The students had the front seats reserved especially for them, in order that they might hear more distinctly what the professor said. 1/2 JOSEPH NASHE MCDOWELL. When the lecturer was nearly half through, Dr. McDowell, who was seated upon the plat- form close beside the speaker, arose to his feet, and in the most quiet manner possible passed from the stage up the aisle to where one of his students was sitting, laughing and talking with a young lady. He (Dr. McDowell) took him quietly by the ear, and led him down to the front seats that had been reserved for students, and placed him in front of the speaker. Dur- ing the proceedings not a word was spoken by anyone. After the student had been seated, McDowell took his same place near the pro- fessor. During this singular performance he did not change a muscle of his face ; of course, the audience was convulsed with laugh- ter, but all understood zuhy the young man had received such a public chastisement from his preceptor — he zoas not hi his place. The eccentricities of Dr. McDowell were so great that had he lived in the present time his warmest friends would have been constrained to classify him with the legion of " cranks." His many peculiar acts and idiosyncrasies would certainly have justified such placing. Although never really acknowledging his belief in spiritualism, yet when any noted lee- JOSEPH NASHE MCDOWELL. 173 turer on that subject was in the city the doctor was always found among the audience. Dr. Tuckett, an intimate friend, relates the following conversation had with him : '• I see that you listen to the spirits some- times." "Yes," was the reply, "there is agreat deal more in the matter than a man can ex- press without being thought a d — n fool." " You are right," was added. " But have you ever had an experience or seen any manifesta- tions ?" " Yes ; a confounded sight more than I tell people. However, I will tell you," he continued, "what I know, and how I was saved by my mother's spirit." " A German girl died with a very unusual disease, and we were determined to get her body for dissection. We got it and laid it in the college. The secret leaked out, and the Germans got their backs up and made things lively for us. It was planned by them to come one nicrht and hunt over the collecre to see if the body was there to be dissected. " I received a note at my house at 9 o'clock of an evening warning me that the visit was to be that niofht. " I went down to the college about 1 1 o'clock, thinking to hide the corpse. When I got there 174 JOSEPH A'ASHE MCDOWELL. all was quiet. I went through the dissecting room, with a small lantern in my hand, in the direction of the body. I picked the cadaver up and threw it over my shoulder to carry It to the top loft to conceal it between the rafters, or place it in a cedar chest that had stood in a closet for years. "I had ascended one flight of stairs, when out went my lamp. I laid down the corpse and re-struck a light. I then picked up the body, when out went my light again. I felt for another match in my pocket, when I dis- tinctly saw my dear, old mother standing a little distance off, beckoning to me. "In the middle of the passage was a window ; I saw her rise in front of it. I walked along close to the wall, with the corpse over my shoulder, and went to the top loft and hid it. I came down in the dark, for I knew the way well : as I reached the window in the passage, there were two Germans talking, one had a shotgun, the other a revolver. I kept close to the wall and slid down the stairs. When I got to the dissecting-room door, I looked down the stairs into the hallway: there I saw five or six men lighting a lamp. I hesitated a moment as to what I should do, as I had left my pistols JOSEPH NASHE MCDOWELL. 173 in my pocket in the dissecting-room where I took the body. I looked in the room, as it was my only chance to get away, when I saw my spirit mother standing near the table from which I had just taken the corpse. I had no light, but the halo that surrounded my mother was sufficient to enable me to see the table quite plainly, " I heard the men coming up the stairs. I laid down whence I had taken the body and pulled a cloth over my face to hide it. The men came in, all of them beingf armed, to look at the dead. They uncovered one body — it was that of a man, the next a man ; then they came to two women with black hair — the girl they were looking for had light flaxen hair. Then they passed me ; one German said : 'Here is a fellow who died in his boots; I ofuess he is a fresh one.' " I laid like marble. I thought I would jump up and frighten tliem, but I heard a voice, soft and low, close to my ear, say, ' Be still, be still.' The men went over the building and finally down stairs. I waited awhile, then slipped out. At the corner of Gratiot Street, I heard three men talking German ; they took n(j notice of me, and I went home. 176 JOSEPH NA SHE MCDOWELL. " Early in the morning I went to the college and found everything all right. We dissected the body, buried the fragments and had no fur- ther trouble. " " Then, Doctor, you feel satisfied that the spirit of your mother saved you from that trouble ? "I know it," he replied. "I often feel as though my mother is near me when I have a difficult case of surgery. I am always success- ful when I feel this influence. Well, let me stop here. I have a boy to attend to with a broken leg, so good-bye." And with his char- acteristic manner of always being in a great hurry, he glided out the door and into his buggy. He was very fond of the violin, and played many of the old popular airs. It was his cus- tom to amuse his friends when they would call upon him socially, by playing familiar tunes for them. His death occurred October 3, 1868. Three sons survived him. He was singularly unlike any of his McDowell kindred. Two of his sons, Drs. Drake and John McDowell, arrived at considerable eminence in the medical profession ; both filled chairs in JOSEPH NASHE MC D O WELL. ^17 anatomy and obstetrics. Indeed, John Mc- Dowell was considered equal to his father in difficult operations. He had a lucrative prac- tice. All three of the sons are dead. The peculiarities of the father seem to have been inherited, to a certain extent, by his son John. On one occasion he drove up to his relative's house in St. Louis to make a social call. On entering the parlors he found quite a number of ladies and gentlemen there spending the evenine. When tea was announced he arose to take his departure, excusing himself to his hostess, but she would not permit him to go. After all the guests had entered the dining- room Dr. McDowell detected that there were twelve at the table, and that Jiis presence made the thirteenth. He refused to be seated ; his relative bantered him with being superstitious, when he replied: "Well, my cousin, in honor to you I will take my seat, but as my presence makes the thirteenth /will be the first one from this fatal number who will pass away." He ate sparingly and the thought certainly took possession of his mind, for he alluded to the circumstance repeatedly, and, true to his predictions, in a few weeks thereafter he died. 178 JOSEPH NASHE MCDOJVELL. A few years before his death Dr. Joseph Nashe McDowell married again : but the alli- ance did not prove a happy one ; his children wandered from home, and the old doctor soup-ht comfort and solace in the Roman Catholic reliction. When the iron grasp of death was upon him, claiming him as its victim, he calmly closed his eyes, passing thus to the great hereafter, bearinof with him the lovin;^ benediction of his faithful friend and spiritual adviser. Father De Smit. From the early experience of his Romanistic convictions, this Father De Smit was his re- ligious adviser and companion. Dr. McDowell reverenced him for his piety, admired him for his intellect, and regarded him as the soul- healer and spiritual comforter of those op- pressed by sin and wickedness. Before we close this brief memoir of a gifted and remarkable man, we may relate another circumstance pointing to his peculiar nature and eccentricities. The idiosyncrasy relates to his unnatural and unheard-of mode of interring his infant children. After death had claimed them, and they were robed in their burial dress and ready for the burial rites, he would order JOSEPH NASHE MCDOWELL. ^j^ the casket, which he had prepared expressly for the solemn occasion. This casket was made of heavy glass, and filled with alcohol ; the body of the infant was placed within the case con- taining the liquid, and the coffin securely cemented. Only the undertaker and the nearest kindred followed the remains to an island (several miles distant from the city) in the Mississippi River, where the grave had been prepared, and there the casket was lowered into the earth. After the death of the Doctor his surviving sons had the infantile remains removed to the family lot in Bellfontaine Cemetery and placed beside those of the father, where their little graves could not be disturbed by rises in the river. A singular coincidence : three surgeons be- longing to the same family, each having achieved professional honors and having risen to eminence in the medical world, now resting side by side in the beautiful "Bellfontaine" burying ground. We can only say, " Peace be to their ashes!' In reading a biographical sketch of the late Col. Basil Duke, whose mother was Martha McDowell, a member of the Virginia family of 1 80 JOSEPH NASHE MCDOWELL. McDowells, we find the fact established that more than forty years after the death of Dr. Ephraim McDowell, the European people awakened to the fact that Dr. McDowell was justly entitled to be called the " Father of ovari- otomy," and acting on such conviction erected a suitable monument to his memory. Can this be repeated of America, the land of his birth ? Has a national monument been erected to him who was truly woman's bene- factor ? The late Dr. Jackson, in appropriate re- marks, seemed fully to appreciate the fact that America had failed to do her duty toward this worthy son of her land. America, the country that pays tribute to merit and genius — that so fully appreciates intellect, seems here to have shrunk from her duty; yet the memory of Dr. McDowell is as fresh in the hearts of the people to-day as when he braved his own life for humanity's sake. CHAPTER XI. BIOGRAPHICAL SKETCH BY THE LATE ' DR. JOHN D. JACKSON. Through the kindness of Dr. Lewis S. McMurtry, we have been furnished a full ac- count of the character and services of Dr. Ephraim McDowell, prepared and written by the late Dr. John D. Jackson, of Danville, Kentucky, a gentleman who devoted much time during the latter days of his life in gather- ing facts relative to Dr. McDowell, for whose character and works he had great veneration. Dr. Jackson says : For a quarter of a century, or indeed until Dr. Benjamin W. Dudley, of Lexington, Ken- tucky, came upon the field as a lecturer upon surgery. Dr. McDowell yearly came before large classes of young men assembled at the medical department of Transylvania University from all portions of the Ohio and Mississippi valleys, thus possessing opportunity for extend- ing a reputation such as no man in the West ever had before him. \Vc may say that he ( '8' ) J 32 SKE TCH B Y DR. JO HAT D. J A CKSON. Stood " facile princeps " in surgery west of the Alleghenies. During this time McDowell's practice ex- tended in every direction, persons came to him for treatment from all the neighboring States, and he frequently took horseback journeys for hundreds of miles. He is to be accepted as being in the habit of performing every surgical operation then taught in the science. In lithotomy he was extremely successful. Up to 1828 he was known to have operated twenty-two times without a death. For strangulated hernia he also operated in a large number of cases, and there is good authority for stating that he successfully extirpated the parotid gland long before McClellan or any other American surgeon had attempted the procedure. Indeed there was scarcely any operation, from a simple amputation to tracheotomy, which was to be done, but that Dr. McDowell was sent for to perform it. The brevity and rather loose manner in which his first cases were recorded, exposed him to criticism, and Dr. Henderson and Dr. Michener, of Philadelphia, in articles in the SKE TCH B V DR. JOHN D. J A CKSON. j 3 j Repei'tory, reviewed him rather sarcastically and doubtingly ; while Dr. James Johnson, the caustic editor of the London Medico- Chirurgical Review, did not hesitate to take advantage of the opportunity and declare out- riofht his total disbelief as to Dr. McDowell's statements. A few years thereafter, when accuracy of the reports had been fully con- firmed, he however acknowledged his previous error, though in a flippant and very ungraci- ous manner; saying: "A back settlement of America — Kentucky — has beaten the mother country, nay Europe itself, with all the boasted suro^eons thereof, in the fearful and formidable operation of gastrotomy with extraction of the diseased ovaria There were circum- stances in the narratives of some of the first three cases that raised misgivings in our minds, for which uncharitableness we ask pardon of God, and of Dr. Macdowal, of Danville." In the Philadelphia Eclectic Repei'-toj-y for October, 1819, Dr. McDowell reported two more cases, and ia connection with them alluded incidentally to his critics and their criticism to this effect : "I thought my statement sufficiently explicit to warrant any surgeon performing the opera- 1 84 SKE TCH B Y DR. JOHN D. J A CKSON. tion, when necessary, without hazarding- the odium of making an experiment; and I think my description of the mode of operating, and of the anatomy of the parts concerned, clear enough to enable any good anatomist, possess- ing the judgment requisite for a surgeon, to operate with safety. I hope no operator of any other description may ever attempt it. It is my most ardent wish that this operation may remain to the mechanical surgeon for- ever incomprehensible. Such have been the bane of the science ; intruding themselves into the ranks of the profession with no other qualification but boldness in undertaking, ignorance of their responsibility, and indiffer- ence to the lives of their patients ; proceeding according to the special dictates of some author as mechanical as themselves, they cut and tear with fearless indifference, utterly in- capable of exercising any judgment of their own in cases of emergency, and sometimes without possessing even the slightest knowl- edge of the anatomy of the parts concerned. The preposterous and impious attempts of such pretenders can seldom fail to prove destructive to the patient and disgraceful to the science. It is by such this noble science SKE TCH B Y DK JOI/X D. J A CKSOX. i 8 5 has been degraded, in the minds of many, to the rank of an art." Dr. Jackson goes on to relate : In the summer of 1822, McDowell made a horseback journey of some hundreds of miles into middle Tennessee, and performed ovari- otomy in his usual way, with success, upon a Mrs. Overton, who resided near the "Hermit- age," the residence of the late President Jackson. Mrs. Overton was enormously obese, and he had to cut through four inches of fat upon the abdomen. The only assistance he had in the operation, as we have been informed, was from General Jackson and a Mrs. Priestly. General Jackson seems to have been greatly impressed with Dr. McDowell, and had him go to his house and remove a large tumor growing from the neck and shoulders of one of his men. Dr. McDowell charged for his operation upon Mrs. Overton $500, but the husband, with a commendable generosity, gave a check upon one of the Nashville banks for $1500, which, upon the doctor presenting for payment, and discovering the presumed error for the first time, sent a messenger back to Mr. Overton to have it corrected, but that gentleman re- 1 86 ^^^ TCH B Y DR. JOHN D. J A CKSON. plied that, far from a mistake, he felt that he had not even then made a full compensation for the great services which Dr. McDowell had rendered. How many times during his career he had occasion to perform ovariotomy is not now cer- tainly known. He seems to have been fonder of the scalpel than of the pen — indeed, to have been of that class of mankind (of which we have all seen specimens, even among the ablest and most cultivated) who have a natural antipathy to writing. He is said to have kept no notes of his cases, and with the exception of the communications quoted, we know alone of a card published in 1826, when an effort was made to wrest his honors from him ; this he addressed especially to the medical faculty and class at Lexington, defending his veracity and claiming to have been the first^ to perform and establish the feasibility of the removal of diseased ovaries. However, his nephew, Dr. William A. Mc- Dowell, who was for five years his pupil and two years his partner, tells us that up to 1820 his uncle had seven cases, six of which he wit- nessed, and that six of the seven were success- ful. SKE TCH B Y DR. JOHN D. J A CKSON. j 87 After Dr. William A. McDowell removed from Kentucky to Fincastle, Virginia, Dr. Albafi G. Smith succeeded to his position as partner of Dr. Ephraim McDowell, and while with him Dr. Smith twice performed ovariotomy. The younger McDowell stated that he had reliable testimony of his uncle having per- formed ovariotomy during his .life at least thirteen times, exclusive of the two cases Dr. Smith operated upon when they were in part- nership, and that of the cases treated by his uncle, subsequent to his retiring from partner- ship, he had personal knowledge of the recovery of two ; this would make a total of thirteen cases with eitjht recoveries. Dr. Ephraim McDowell seems to have been very careless either of an immediate present . or posthumous fame, and to have originally drawn up the report of his cases at the re- peated solicitation of his nephew, Dr. James McDowell, who, up to the time of his prema- ture death, had been a partner of his uncle, as his cousin William, to whom we have alluded, afterward was. The idea that his success would be pleasing to his former preceptor, John Bell, to whom he felt he owed his determination to |)erforni the 1 88 ^"^KE TCH B V DR. JOHN D. J A CKSON. operation, according to his nephew, seemed riiore than all else to have induced him to put his cases before the professional world. Long after all dispute as to the authenticity of Dr. McDowell's cases had ceased, the medical literature of the past was ransacked to find some one who had preceded him in the operation. Indeed, until the critical examination made by Dr. Gross, it was believed that L'Aumonier, Dzonde, Galenzowski, had all preceded him by having each done a single ovariotomy. Going to the original records of these gentlemen, it was found, however, that the first had only punctured an abscess of the ovary, that Dzonde's case was simply one of gastrotomy upon a boy who had a pelvic tumor, and that Galenzowski's case, while really an im- perfect ovariotomy, was not done until 1827, eighteen years after the first operation by McDowell. When McDowell performed his first opera- tion he had never heard, as he said in the publi- cation made of it, of an attempt at or a success attending any operation such as this required. At present we are not aware that even the most persevering antiquarian research has been able to find undoubted ovariotomy before the SKE TCH B V DR. JOHN D. J A CKSON. j gg time of McDowell, for althouQrh we observe that Mr. Spencer Wells, in his recently pub- lished History of the Origm and Progress of Ovariotomy, says, on the authority of Dr. Wash- ington Atlee, "Dr. Robert Houstoun operated near Glasgow in 1701, and that from this case it will appear that ovariotomy originated with British surgery, on British ground." Yet a reference to the original record shows ver)^ plainly that Dr. Houstoun was never really an ovariotomist in the sense of havino- removed an ovary ; his operation, like L'Aumonier's, consisting in laying open the diseased ovary and evacuating a large quantity of gelatinous fluid, when as he says. " I squeezed out all I could and stitched up the wound in three places almost equidistant." We observe that Dr. Atlee, in his volume on Ovarian Titmors, dedicates the book to his brother. Dr. John L. Atlee, and to the memory of Dr. Ephraim McDowell, "The Father of Ovariotomy." Even had the operation been done many times before, or been forgotten or unnoticed, as the cases lay among the dead records of the past, it should not, and it would not, derogate at all from the glory of Dr. Mc- Dowell, who never had heard of any attempt I no SKE TCH B Y DR. JOHX D. J A CKSON. to perform it, and who, after his performance of it, first succeeded in estabhshing it as a legitimate operation in the medical world. When we think of one living on the border of Western civilization, in a little town of be- tween three and four hundred inhabitants, far removed from the opportunity of consultation with any one whose opinions might, be of value to him in such a case, and nearly a thous- and miles from the nearest hospital or col- lege dissecting-room at which he might have had an opportunity of studying and practising upon some body who had perished of the dis- ease, before performing upon the living a new and untried operation of such fearful magni- tude ; and learn of his having pondered over and contemplated all the difficulties, when with a full sense of the dangers liable to environ him in the attempt, without ether or chloro- form, assisted by probably only one fully skilled physician or assistant, with one or two medical students — see him attempt and success- fully perform the first ovariotomy — our admi- ration for Dr. Ephraim McDowell's courage and skill rises to its full height, and we feel that he is justly entitled to have applied to him Horace's words, describinor the stoutness SKE TCH B Y DR. JOHX D. J A CKSOX. \ 9 1 of the heart of the first mariner who had bold- ness to go down to the sea In ships : lUi robur et aes triplex Circa pectus erat, qui fragilem truci Commisit pelago ratem Primus. Dr. Ephraim McDowell was always remark- able for his strength and agility, and while at Edinburgh was pronounced the swiftest foot- * racer of the whole University. He was one of the kindest-hearted and most amiable of men, overflowing with cheerfulness and good humor. He seemed totally devoid of all austerity, a tinge of which is generally characteristic of the scholar and professional man, and never ap- peared to assume that there was any difference between the plane of his vocation and that of the humblest, unlettered artisan. This seemed instinctively to strike all who came In contact with him, and an easiness amounting almost to familiarity existed be- tween him and his fellow-citizens. So true was this with the masses, that probably because of such fact he was not generally appreciated for his true worth. A man arro<^atintr to himself In manner nothing above the populace, would not, as may 1 g 2 SICE TCH B Y DR. JOHN D. J A CKSON. readily be believed, be acknowledged to be superior to his sphere, save by those gifted above common penetration. Never, however, was this air of familiarity in the slightest degree tinctured with professional demagoguery. His bitterest enemies did not once accuse him of this. By a gentleman of keen perception, yet living, whose father's family physician he was, we are told that never was there a man whose life was freer from the acts of the charlatan, or more entirely devoid of all the petty "tricks of trade" which too frequently disgrace the medical profession. While in the sick-room, though fond of gos- siping about local matters and events of the day, he habitually refrained from discussing things medical, or any of the affairs of his rivals, with some of whom he was known to be on anything but good terms. While in daily competition with certain mem- bers of the profession whose chief strength lay in the application of such arts, they and their artifices were held in supreme contempt by him. From what we can learn, one of the endeavors of these gentlemen, who knew they never could approach McDowell by fair com- SKE TCH B Y DR. JOHN 1). J A CKS ON. \ g 3 petition, was to impress the community with the idea that there was a sort of essential in- compatibiHty between surgery and medicine ; that in proportion as a man is superior in sur- gical knowledge and dexterity, that by just so much is he inferior in the intricacies of the practice of medicine, whose arcana were not so appreciably evident to the public as the more demonstrable work of the surgeon ; or, as they were in the habit of putting it : " That while McDowell was a bold surgeon, he was but a poor fever doctor." So far from this last being the case, however, he kept himself fully abreast of the progress of medicine by reading all that was new on the subject, and was probably really as far in ad- vance of his competitors in physic as in sur- gery. Certainly we now know that in the treat- ment of fever he was in some respects ahead of his time, though at variance with the gener- ally accepted doctrine of his day and the pre- vailing customs of the physicians of his section. At that time it was customary to give more or less mercury in the treatment of every fever, while to allow a patient cold water after a dose of calomel or blue mass was thought to be 1 94 SKE TCH B Y DR. JOHN D. J A CKSON. recklessly dangerous. The standard treat- ment of the country was to let a patient have no drink but what had been warmed ; and this usually consisted of water in which a piece of burnt bread-crust or warm toast had been soaked. On the contrary, Dr. McDowell used to tell his patients that there was no danger in cold water while the skin was hot ; and while such was the case he allowed them to use it ad libitum. I have heard an old gentleman, who lived in an adjoining county, tell how, when he was a boy, and one of his brothers lay very ill with a fever, Dr. McDowell was sent for; and of the anxious fears of the family while obeying the directions of the doctor, who had the patient laid naked upon the floor, and bucketful upon bucketful of cold water poured over him to his great relief and ultimate recovery. Dr. McDowell looked on Sydenham and Cullen as the master minds in medicine, and set their works above all others in practice. To the system of over-drugging, then so common, he was an enemy ; believing that drugs as then given by the mass of the profes- sion, without discrimination, were producing in the aggregate more harm than good. Though SKE TCH BY DR. JOHN D. J A CKSON. j g, 5 practising medicine with more than ordinary ability, yet his inclinations were always espe- cially toward surgery ; and it was his custom, when practicable, to throw as far as possible the medical practice into the hands of his partner. He was a most accomplished anatomist, and used every winter, in conjunction with his office students, of whom he generally had two or three, to dissect in the upper story of an old abandoned building, which had for years been the county jail ; and in his office, in the course of time, quite a number of anatomical prepa- rations, the work of his own hands, were deposited. When having determined upon the perform- ance of any capital operation, his custom was to drill thoroughly beforehand the students who were to assist him. Not only this, but he com- pelled each one to give a succinct history of the nature of the difficulty requiring the opera- tion, the anatomy of the parts involved, and the tissues to be divided, and then would, himself, rehearse the different steps of the operation. It was the invariable opinion of all compe- tent judges that for coolness and dexterity as an operator they had never seen Dr. McDowell's I q6 SKE TCH B Y dr. JOHN D. J A CKSON. equal. From the moment he took the knife in hand preparatory to operating, he seemed to become enthused, and to the bystanders looked quite a different person. When we consider the results to mankind of the labors of this surgeon, we do not hesitate to rank him with the great benefactors of the race. Before the nineteenth century, not one of the most astute or boldest of the healing profession could promise anything hopeful to women af- flicted with ovarian dropsy. The doctor when called to such a case, could only say, "Two years of life filled with gradually increasing misery is the full compass of the days allotted to a woman who may find that she has an ova- rian tumor, and unless God works a miracle in your case, this is your fate." But now, since the establishment of ovari- otomy by Ephraim McDowell, the matter stands quite differently, for the physician of our era says, 'Tt is true that without an opera- tion you are inevitably doomed to death after a few years of miserable suffering, but by ovari- otomy you have seventy chances or even more out of a hundred (much better than one under- going the amputation of a thigh), not only of recovery, but of a full restoration to health." SKE TCH B V DR. JOHX D. J A CKSOX. 1 97 Dr. Peaslee has made a calculation based on the known law of the length of life of a woman who has an ovarian tumor uninterfered with, and the average age of all the recorded cases of ovariotomy up to 1870, and the proba- bilities of longevity of healthy women of that age according to the most approved tables of life insurance, and has shown that in the " United States and Great Britain ovariotomy has, within the last thirty years, directly con- tributed more than thirty thousand years of active life to woman, all of which would have been lost, had ovariotomy never been per- formed" — to say nothing of saving her more than a thousand years of untold suffering. With these facts before us, most devoutly indeed should all women bless the name of Ephraim McDowell. To one living in Athens in the days of the glory of ancient Greece and conferring such a boon on the human race as ovariotomy, rank among the demigods, with a temple and an altar, would have been accorded by acclama- tion of the people. Had he lived in the palmy days of the Roman Republic, the highest civic honors, a medal, and a statue, if not a shrine in the temple, I gS -S^^ TCfi B y DR. JOHN D. J A CKSON. would have been his by a decree of the Senate; and had Ephraim McDowell been born and had he flourished in any one of the principalities of Europe instead of the United States, long since would the government, proud of such a son, have conferred titles of distinction upon him and his children while living, and erected a fitting monument to his memory when dead. But it seems that to us, of the boasted Great Republic of the Western World, the prover- bial charge regarding the ingratitude of repub- lics is literally applicable in the case of the sub- ject of our sketch. Such were the thoughts which crowded upon us when recently we made a pilgrimage to the burial ground of the Shelby family at "Travel- lers' Rest," and after climbing the stone-wall enclosure finally succeeded in making our way throuo-h brambles and wild flowers to a lichen- covered sandstone slab which simply bore the name of Ephraim McDowell, and which covers the remains of one to whom the whole world should feel deeply grateful, and of whom Kentucky and the American Republic may always be justly proud. While Kentucky and nearly every State of the Republic has, at different times, voted SKE TCH B Y DR. JOHN D. J A CKSON. i qq monuments, statues, or paintings to one and another political favorite, or military idol of the day, the worthiness of the commemoration of none of whom is to be compared to that of McDowell ; and while if our State (Kentucky) should erect the tallest shaft in all the land to mark his resting-place she would but justly honor the worthiest of all her children ; yet does his fame not rest with us alone, nor is the benefi- cence of ovariotomy confined alone to our part of the globe. Like Jenner, McDowell has been a benefactor for the generations of all time and all countries, and as a few years ago the world at large contributed to the statue of the former, now erected in Hyde Park, London, so do we think it most fitting that all nations should be allowed to contribute to a suitable statue to Ephraim McDowell, to be erected at Danville, the scene of the first ovariotomy. But since Dr. McDowell has been woman's special benefactor, we think it would be emi- nently appropriate that the gratitude of this sex of all nations should be allowed to dis- play itself in the erection of a fitting memorial to its friend. Indeed, that a bronze statue of life size should be erected solely from voluntary contributions made by those women throughout :jY 200 ^f^E. TCH B Y DR. JOHN D. J A CKSON. the world who owe their Hves to the opera- tion of ovariotomy. The following inscription might be placed upon the memorial rock : Many women throughout the world who, by ovariotomy, have been rescued from otherwise inevitable death, have, by their combined contributions, erected this statue in grateful commemoration of Dr. Ephraim McDowell, who, A. D. 1809, first removed an ovarian tumor and established the Operation of Ovariotomy, Ephraim McDowell, M.D. CHAPTER XII. SKETCH BY W. W. DAWSON, M.D. EXCERPT FROM ADDRESS BY RICHARD J. LEVIS. M.D. In an address delivered before the Ameri- can Medical Association, at Newport, R. I., in 1889, by W. W. Dawson, M.D., then Presi- dent of the Association, and one of the most prominent and successful surgeons of America, occurs the followinof: "A brief review of medical teaching in this country will be pardoned — it may be profitable — it will certainly illume the present, and may be somewhat of interest to the future. "The first medical lectures were delivered by Dr. John Morgan and William Shippen in 1767, in Philadelphia. Dr. Rush and Dr. Physick soon after participated, and in 1768 the Medical Department of the University of Pennsylvania was organized ; that great school which is steadily advancing to the highest station. "Philadelphia was a small, a provincial, city at that time ; now she is only second to the great metropolis in numerical strength, but second ( 201 ) 202 SKETCH BY DR. W. W. DAWSON. to none in the thorough equipment of her medical schools. "Contemporaneous with Philadelphia an or- ganization was projected for medical instruc- tion in New York. "In 1767 the first steps were taken which resulted in the school ever since known as the * College of Physicians and Surgeons,' one which challenges the confidence of all. " The medical colleges of New York, en- dowed not by government but by her public- spirited citizens, have won the honors which they wear so well. "In 1785 the first school was organized in Boston. The chairs were four, and the ses- sions four months. Harvard is the outQfrowth of this humble beginning of that provincial faculty. "In 1800 the first medical instruction was given in Baltimore ; since then the schools of Maryland have occupied a deservedly high posi- tion. Recently one of her citizens made an endowment by which the 'Johns Hopkins University' will be equipped for the most thorough work, experimental work, laboratory studies, a range and grade of investigation en rapport with the spirit of the times. This great SKETCH BY DR. W. VV. DAWSON. 203 benefactor has also given to Baltimore one of the most completely endowed hospitals to be found on this earth. "The great" Mississippi valley was yet un- known, but soon after the close of the Revolu- tion emigration began, and as early as 1799 Dr. Samuel Brown organized the medical department of Transylvania University. "Dr. Benjamin Dudley effected a re-organiza- tion in 1 8 19. "This school, after many prosperous years, having graduated men who acquired distinc- tion at home and abroad, was transferred, or rather most of the faculty removed, to Louis- ville, when and where the University of Louis- ville was founded. *' During the early part of the century medi- cal schools were org-anized in several of the Eastern States, usually under State or church patronage. Most of them exist to-day. Some of the most distinguished men in our profession have been associated with these institutions. " As the West and South were peopled, medical schools were established in cities and promising towns. As early as 18 19 Dr. Daniel Drake secured the charter of the Medical College of Ohio, and had it legally 204 SKETCH BY DR. W. W. DAWSON. connected with the City Hospital. The faculty constituted the hospital staff, the members of which were required to give clinical lectures — the first forward step on the continent in blend- ing didactic with clinical instruction. "The physicians in South Carolina began medical teaching in 1823, and those of Louisi- ana in 1835. ^^ both of these States schools of high character have been maintained." Dr. Dawson further said: "The advance in medical education is a gain most distinctly pro- nounced by a remark made by one of our dis- tinguished fellows, an American-bred physician, of whose fame we are all justly proud. " In conversation Dr. Battey said : ' When I began practice thirty years ago there was scarcely a graduate within fifty miles of my residence ; now, however, there is hardly a practitioner in the same territory who is not a graduate, and year after year a portion of our young men leave home to avail themselves of clinical advantages to attend post-graduate instruction.' " Could anything show more forcibly the con- servative and steady growth of medical culture ? " In our own country, as well as elsewhere, great achievements have often been made in SKETCH BY DR. W. W. DAWSON. 205 the provinces and not always under the shadow of the universities. " One of the greatest operations' waited for years for a metropolitan disciple — one to take it up ; and that too, long after the provinces at home and abroad had demonstrated its vital utility, its claim upon the scientific and skilful surgeon. " Some of the classical schools of Oxford and Cambridge were organized as early as the thirteenth century, but the systematic scientific study of medicine and surgery came long sub- sequently, not for four hundred years later — about the middle of the eighteenth century. " It was first projected in Great Britain, and soon after in our Atlantic cities. Unlike the old world, our fathers had a wilderness to con- quer before progress could be made. " When the pilgrim fathers left England, read- ing and writing were rare accomplishments, chimneys in that country had just been in- vented, and flock beds were luxuries. "The adventurers — the emigrants to these shores from that ancient and imperfect civiliza- tion — had much to learn, but in the midst of their pitiable ignorance, facing great hardships ' Ovariotomy. 2o6 SKETCH BY DR. W. W. DAWSON. and pressing wants, they were quick to pro- vide educational opportunities for all. "The results of their efforts are apparent — they are before us. Could more have been accomplished in one century? "Had Sidney Smith been a physician and given to reading, he would not, even in 1850, have asked the questions : Who reads an American book? What does the world owe to American physicians and surgeons ? This reverend gentleman, this famous critic, could not have heard of Ephraim McDowell, whose brief paper, detailing his first three cases of ovariotomy, published in the Philadelphia Eclec- tic Repei^tory, in 18 17, was of more value, did more for the conservation of human life than a score of ordinary publications, "Our first half century may be poor in books, but it abounded in strong, devoted, conscien- tious, and brave men, men who with the most limited resources accomplished the grandest results. "They compelled success, because they de- served it. The ink was hardly dry upon that cynical pen when anaesthesia was presented by the profession, so poor, as he supposed, in valuable works. SKETCH BY DR. U'. W. DAWSON. 207 "But what country or age can match in great contributions to the rehef of the suffering, McDowell, Sims, Bigelow, Sayre, Battey, and Emmet, and that trinity of men, Wells, Mor- ton, and Jackson, who gave anaesthesia to the world. The heart of every American physician is filled with thankfulness when he remembers that in the providence of God this great boon to humanity was vouchsafed to this country. The very ground upon which stands the Massa- chusetts General Hospital is sacred to us all. "Associated with the discoverers must ever be the name of Dr. Hayward, who performed the first operation under the strange Letheon. Previous to this, operative surgery was slow, tedious, and almost cruel. Contrast it to-day with what it was previous to 1847, what grand strides it has made under the direct support of anaesthesia, and its almost equal co-laborer antisepsis. The great cavities are invaded, and invaded safely ; the abdomen has become a familiar field. "The story of Ephraim McDowell, though so often repeated, humanity never tires of hearing. "To us he belongs, and to us only ; we can- not share his fame with another, we would not if we could. Who can measure the relief which 208 ADDRESS B Y DR. R. J. LE VIS. his operation has bestowed upon suffering woman ? — not only woman, for his was the genius which opened the way to laparotomy in both sexes." Dr. Richard J. Levis, in an address at the thirty-ninth annual session of the Medical Society of the State of Pennsylvania, alluded to Dr. McDowell as follows : "The records of the experience of individual practitioners of intelligent and trained minds would be a gain to surgical progress, and tend to avoid the transmission of traditional errors. " From practitioners in regions far away from medical centres, in such locations as are abroad styled provincial, have originated some of the most valuable practical discoveries and ad- vances. "There may be instanced the discovery of vaccination in rural England, by Jenner ; the origin of ovariotomy by McDowell, in what was then a frontier region of Kentucky ; and the very beginning of practical gynecology, by Marion Sims, in the obscurity of Northern Alabama. "It is said that the ploughman, tilling the fields of the western slope of our continent, who keeps his eyes intently on the furrow, may SKETCH BY DR. IV. W.DAIVSON. 2O9 occasionally find nuggets of gold ; and so the faithful toiler amidst human ills is liable to unearth jewels of fact, which, garnered and recorded, will add to the wealth of suro-ical o knowledo-e." 14 CHAPTER XIII. DESCRIPTION OF ONE OF THE METHODS OF PERFORMING OVARIOTOMY. Dr. John H. McIntyre, of St. Louis, Mo., a very successful ovariotomist, has, by request, kindly furnished us with a detailed account of the present mode of doing the operation of ovariotomy, in order that the reader may be able to contrast the performance of these times with that of its first accomplishment in the history of the medical world, by Ephraim McDowell, eighty years ago. The abdominal cavity was up to that time, unexplored ; and as a very prominent and successful practitioner of Chicago, Illinois, crudely said : " McDowell cut away the abdominal barriers, and the surgeons walked in and reaped the harvest of his daring surgical adventure." So long as Dr. McDowell lived, it certainly was his earnest desire that the operation ovariotomy shoitld not be abused by the medical profession ; as the reader will (2IO) OVARIOTOMY. 211 perceive in his (Dr. McDowell's) reply to criti- cisms published in vindication of th'e opera- tion. Hence he urged surgeons to be guarded, and not abuse it in a reckless way ; that, with judicious caution, ovariotomy would prove woman's benefactor, but abused, /icr ciwse. Dr. Mclntyre says : I may remark that it gives me pleasure to speak of the present status of this operation as compared to the opposition which it met in its earlier days, as it is to-day one of the most successful and brilliant of any of the major operations, adding thousands of years to the life of woman ; and smiles and happiness to households which would have been left gloomy and desolate by the loss of her who was its centre and its sunshine. For many years the opposition to this operation was most bitter and revengeful. Gentlemen occupying high posi- tions in the profession stigmatized it in most unmeasured terms. Well do I remember the denunciations hurled upon its justifiableness by the elder Meigs, in a lecture before a class of the Jefferson Medical College of Philadelphia ; and, student as I was at that time, I saw that his judgment was biassed, and I resolved then and there, that when the proper time arrived / 212 OVARIOTOMY. would do the operation. In a review of Mr. Clay's work in the British and Foi^eigji Medical Review, of 1843, vol. xvi. p. 402, this passage is found: "To our thinkingf, the facts need no comment. We earnestly hope that they will prevent the younger members of the profession from being dazzled by the alleged success of this operation." A fundamental principle of medical morality which we conceive is outraged whenever an operation, so fearful in its nature, often so immediately fatal in its results as gas- trotomy, is performed for the removal of a dis- ease, of the very existence of which the sur- geon is not always sure ; of the curability of which, by his interference, he must be in the highest degree uncertain. At a meeting of the Royal Medico-Chirur- gical Society (England), November 12, 1850, no less a man than Lawrence said: " I have no experience of ovariotomy. I have not per- formed it, and unless my view of the matter should be essentially altered, I never shall." And he further asked the question, "Can this operation be encouraged, and continued with- out danger to the character of the profession?" In one of my conversations with Keith (then ':>{ Edinburgh), in 1879, while complimenting OVARIOTOMY. 213 him on the brilliant results of his work, and the esteem and admiration in which he was held by the profession in America, he replied : " It was not always so pleasant. Not long after I began to do ovariotomies, one of the heads of the profession here — one of the best and most honest of men — indeed, he was my old teacher, and one to whom I looked up to as my profes- sional father — said to me : ' Fellows like you should simply be handed over to Mr. Lothian.' Now Mr. Lothian was the public prosecutor, and you can easily see what that meant." In contradistinction to the above, a few years later, Sir James Paget stated : " This operation is one of the greatest achievements of surgery in this century, and the gain is not limited to ovariotomy alone ; the success of this operation has led to an extension of the whole domain of peritoneal surgery. Surgeons act more boldly than before in operations involving the perito- neum, and the influence for good is not limited by the increased success of ovariotomy, but extends through many departments of opera- tive surgery, and will always continue to be felt in the whole practice of surgery." Peaslee, in the beginning of iy the ovary ? ' ' (The writer's italics. ) M. Morand makes comments upon the fore- going cases somewhat in this manner: He recognizes the two forms of general and en- cysted dropsies, and states that the latter is much more common than is generally believed. He refers to an unique case of it published in the Royal Academy of Sciences, in 1718, and says that " the cyst, with very delicate^ walls, ^22 MCDOIVELVS OPERATION. was found floating- free in the peritoneal cavity" ; but that there was a different variety, not uncommon, such as the one described by M. Delaporte. He states that the tunics or coats of the ovary constituted the walls of the cyst, and that the latter admitted of prodigious dilatation. The cavities of these cysts were frequently the seat of "scirrhous masses," lining the walls more or less extensively, and the growth of the cyst was influenced largely by the presence of these. He says that the encysted dropsy of the ovaries may be distin- guished from general dropsy by its occurring' In one or the other of the hypogastric regions ; and that it is only when the growth has attained sufficient size to fill the abdomen that the diag- nosis is obscure. He recog-nizes the coexist- ence of pregnancy as a complication of en- cysted dropsy, and refers to a case where the ofeneral health underwent but little chano-e dur- ing three terms of pregnancy, the patient suffering very little from the complication until the third, when it failed to reach full term. Tapping in this case was made at the end of the fourth year, and twenty-five pints of fluid drawn off He points out the difference in the quality, of the fluid found in the two forms of IN FRANCE. 223 dropsy, and lays great stress upon the consist- ency or thickness of the fluid in encysted dropsy of the ovary, which he assigns as a rea- son for the indistinctness of fluctuation fre- quently met with, and the consequent failure to detect it in many instances. As to the mode of treating encysted dropsy, he concludes his comments in the following words : " It is a question if the proper treatment of these cases is not the free incision of the cysts. M. Le Dran is per- fectly right in counselHng the operation before the tumor has reached any great size. M. Delaporte operated too late, and rather with a view to improve the patient than to cure her. " The incision is not as useful in cases of ovarian dropsy complicated by scirrhous tumors within the sac ; the rea- sons for this are obvious. "M. Delaporte ought to be praised for first enunciating the idea of removing the ovary at the same time the fluid is removed. It is true, it would not be an easy operation when the cyst has formed many adhesions, but it ought to be attempted early." Soon after the period (1753) Delaporte suggested extirpation of the ovary, for the cure of encysted dropsy of the organ, Theden pro- posed a method of operating that bears his name, and which we find described in the Encyclopedic dcs Sciences IMedicales,^ as follows : ' 3 Division Chirurgie Medecine Operatoire, par Malle, 1S41, t. ly, p. 919. ■324 xMCDOWELVS OPERATION , " He commences by making an incision in the inguinal region, extending it through the skin and muscles down to the cyst, which, according to his idea, is outside of the peritoneum. He then dilates the wound with the fingers, taking care to control the bleeding vessels. This being done, he separates the edges of the wound from the cyst, and by an incision into the latter gives vent to the con- tained fluid. He finishes this step by detaching and draw- ing out the emptied sac. Next, with a long silk thread, with the ends to project beyond the wound, he surrounds the sac with a loop, and passes it down to the ovary. In case the ovary resists the traction upon it, he ties and strangles the parts in the loop of the ligature. If the ovary is found to be hard he endeavors to extract it with the fingers; and if this cannot be done, he immediately puts on the ligature to cause its destruction. According to circumstances he tightens the ligature, and he says that what is best to be done to prevent accident is to amputate the ovary. If this can be accomplished without danger it should be attempted by all means. Once the sac is re- moved the only thing remaining is to close the wound." In the regular order of our study of the history in France of incisionism for the treat- ment of encysted dropsy of the ovary, we come to the consideration of another classic case re- ported under the title : " Observation sur un depot de la trompe, et sur I'extirpation de Tovarie," par M. L'Aumonier, Chirurgien en chef du grand hopital a Rouen, et Corres- pondant de la Societe.' The patient, Marie Louise Lagrange, aged twenty-one, entered the Hotel-Dieu, January 5, 1782, under the care 1 Histoire de la Societe Royale de Medecine, 1782-83, p. 296. IX FRANCE. 325 of INI. L'Aumonier, feeble, emaciated, and having a low fever and diarrhoea, with general distention, tenderness and pain of the entire abdomen, together with a purulent vaginal discharge, following her confinement six or seven weeks previously. M. L'Aumonier, upon a careful exami- nation of her case, discovered a hard, round tumor in the hypogastric region, resisting and painful under pressure. Firm pressure upon this tumor was attended by a sudden purulent discharge from the vulva, of which he assured him- self positively by two or three similar investigations. By the touch he was able to determine that the external os uteri was in a normal state. L'Aumonier says : ''The situation of the tumor, its connection with the matter in the uterus, the occurrence of an accouchement six or seven weeks previously, and the empty and flaccid state of the mammae, all pointed to a milk abscess (depot laiteux) situated in the ovary and Fallopian tube." ''It was already late, and the strength of the patient seemed too feeble to attempt a decisive operation; but, according to the maxim melius anceps quam nullum, I de- termined to make an incision through the integument, muscles, and aponeuroses. It was made in the direction of the inferior plane of the external oblique muscle, com- mencing three fingers' breadth below the imaginary line between the umbilical and hypogastric regions. It was four inches in length, and made as carefully as possible in order to spare the subjacent parts. (Side not mentioned.) "The peritoneal cavity opened, I perceived a round tumor, of a bluish color, adherent below to the part of the peritoneum covering the inguinal ring, and free above, where it was surmounted, in the direction of the umbilicus. 326 MCDOIVELL'S OPERATION by another oval-shaped tumor, the size of an egg, having a scirrhous solidity. The bluish part of the tumor was elas- tic, but fluctuation was distinct, and I could again, by compressing it, cause immediately to flow from the vulva a small quantity of pus. *' Notwithstanding the size and considerable number of bloodvessels which ramified upon this tumor, I did not hesitate to plunge the bistoury into its cavity. In directing this incision from the part of the ovary having scirrhous hardness to the point where the Fallopian tube unites with the side of the uterus, the opening made gave issue to a pint at least of blackish pus of an odor the most infectious and penetrating I have ever smelled. "The pus being evacuated, I passed my finger as far as it would reach into the interior of this cavity, and in carry- ing the finger to the superior part of it I felt an excavation in the body of the ovary, the edges of which were of con- siderable hardness, and which obliged me to examine more carefully the part that I had previously regarded as scir- rhous. I tried to detach this part from the Fallopian tube,' being sure now that the adherence was only the product of inflammation. Their separation was effected without dif- ficulty, and the point of adherence was found to be formed by the fixation of the fimbriated extremity of the F'allopian tube upon the body of the ovary, an occurrence which results from any stimulation whatsoever of the latter. The parts being separated, the ovary seemed to be sufficiently isolated, and could be seized without much difficulty for extirpation, it now being certain that the disorganization was irreparable. "The operation was simple, and included the applica- tion of a tenaculum to the upper part of the tumor (the hardened ovary), which fixed it, and facilitated the entire dissection without injury to the surrounding parts. " From a branch of the spermatic artery there was a little hemorrhage immediately after the extirpation, but it seemed to me of no great moment. A small bit of dry IN FRANCE. -.^j charpie, secured with a thread, as well as balls of the same, with which I filled the sac of the Fallopian tube, after hav- ing saturated them with the yellow of an tgg, one-third honey, were all that was necessary for the internal treat- ment. Emollient embrocations to the abdomen, covered with lint, over all of which poultices were applied, con- stituted the external treatment. ' ' The morning after the operation the patient was very weak, answering questions only by "yes and no," but to use M. L'Aumonier's own words, " the purulent discharge from the vulv^a was absolutely dried up." On the third dav he made the followino- ob- servations regarding the internal treatment of the abscess that was indicated : "I learned why the intestines do not present at the opening, as often happens in large incisions penetrating the abdomen. I readily discovered the causes of this — they are adhesions, resulting from inflammation between the circumference of the tumor and the peritoneum, which I have wished to overcome in order to avoid the pain they often occasion, from traction upon them, after the cure of the disease giving rise to them. I felt too great a resist- ance, and the patient too much pain, to push further the slight attempts that I made. I contented myself with treating the bottom of the ulcer with the small balls of chari)ie and the lint over the abdomen, medicated as pre- viously described." The progress of the improvement was unin- terrupted until the sixteenth day after the operation, when the patient was seized with 328 MC D O WEL L'S OPERA TION an hysterical convulsion which lasted several hours, though she appeared to come out of it all right. This was followed by the catamenia. On the second day of the flow the discharge from the wound was tino-ed with blood, the explanation of which M. L'Aumonier was not able to give — that is, as to whether it was men- strual or came from the sides of the granulating wound. He recognized, however, that the tinge gradually ceased with the menstrual flow. "At this stage the cavity of the Fallopian tube was reduced to about the size of an ^'gg!' The wound completely cicatrized without any fistula remaining, and the patient was discharged cured, February 20, 1782. Mr. L'Aumonier concludes the report of his case in these words : " This example and that of total amputation of the uterus and vagina performed with success, justify the conclusion that, with a thorough knowledge of anatomy, there are but few organs upon which one may not perform with advan- tage the different operations of surgery. " About twenty-five years after the report of L'Aumonier's case was published (i 782-1807), the Inaugural Thesis of M. d'Ischier, at Mont- pellier, appeared in defence of the success of this operation as one of real extirpation of the ovary, coupled with the success of a similar ly FRANCE. 2Q operation in a case by M. Kapeler ; but, accord- ing to Velpeau, as has been shown, the efforts of the author failed to impress the profession with the importance he attached to these cases and their results. In this connection Velpeau does not even so much as quote the publication of L'Aumonier, or allude in the slightest way to any of the circumstances attending the operation he performed, thus leaving the reader wholly in doubt as to the source of M. d'Ischier's information upon the subject. This brings us to a still longer lapse (1807- 1837) of almost total neglect, in France, of the treatment of ovarian dropsy, as the history of the subject would seem to prove. Notwith- standing the inauguration and recognized suc- cess by the McDowell procedure during this period in other countries, the first evidence we have of the revival of interest in the subject in France Is found in the proposal of M. Mon- teggia. The evidence regarding Monteggia is based upon the high authority of Professor Malgaigne,' who regards his proposal as only a sliHit modification of that described in the o report of a case by William Jeaffreson, Esq., of ' Manuel de Medecine Op6ratoire. Trans, by Dr. Frederick Brittan, 1846. 0^0 MCDOVVELVS OPERATION England. The following is a description of Monteggla's proposal, as given by Professor Malgaigne : " This surgeon objects principally to the large incisions of the abdomen. He advises puncturing the tumor with a large trocar, and extracting the liquid ; and then, after having somewhat enlarged the opening, if necessary, intro- ducing long-branched forceps, like those of Hunter for the extraction of calculi from the urethra. By means of these forceps he forcibly seizes the sac, thus emptied, draws it outside, and then excises it near its base ; apply- ing to its pedicle a ligature, the two ends of which are brought out of the wound so as to be withdrawn when the remainder of the sac is completely detached and removed." Tn connection with the above proposal of Monteggia, M, Malgaigne describes the mode of treating encysted dropsy by incisionism asso- ciated with the name of Le Dran (i 736-1 746), and later with that of Galenzowski (1827) ; and of treating hernia of the ovary by excision, as coupled with the name of Deneux. He also describes the proposal of Theden for extirpa- tion of the ovary, and the actual operation of McDowell for the same purpose, but cites no instance in which either had ever been em- ployed in France. In the latter connection he says : "We find traces of this operation in divers authors; but the first who framed an operative proceeding that he in- IN FRANCE. , ■. J tended adopting was Theden (between 1750 and 1760I, and the first who performed it seems to have been Mc- Dowell (1809)." As to the further history of the treatment of ovarian dropsy in France, I must again refer to Professor Velpeau' as the best authority. For an explanation of the character of this treatment it is only necessary to state that an attempt was made in a case by M. Recamier to establish drainao^e with a seton throuo-h the vagina ; and in another case, by M. Marjolin, with an injection of honeyed barley water (eau d'orge meillee), both in the year 1839, and both terminated fatally. From all that has been said thus far upon the history of extirpation of the ovary for the cure of ovarian dropsy, in France, it appears that not a single operation up to this date was performed there according to the teachings of McDowell. As proof upon this point I would refer to the communication entitled " Quelques notes relatives a Pexcision des tumeurs ova- riques," Par Achille Chereau, D.M.P." This writer, in his remarks introductory to his Table of Statistics, speaks as follows : ' Op. cit. ' Journal des Connaissances Medico-Chirurg^cales, 1844, t, i. p. 228. 222 MCDOWELVS OPERATION " I will say at the outset that one need not expect to find in the following lines an apology for, nor a criticism upon, the operation forming the subject of this article. They are simply notes from extracts that I have read of the estimate of it in French publications, and from which it is my sole aim to briefly show the present state of the science relative to the excision of tumors of the ovaries. According to my knowledge, the attempts which have been made up to the present time to remove, in totality, tumors situated in the ovaries, amount to sixty-five, of which cases the appended Table shows the circumstances." The writer excludes from this Table the case of L'Aumonler, and assigns his reason for it in these words : " In that number I do not include the case reported by L'Aumonier, as has been done erroneously, in my opinion, by all the authors who have written upon this subject. If that surgeon did perform the ablation of one of the ovaries, it was performed in a fortuitous manner, as It were, and on account of the disorganization of that organ." Even at the date of the publication of this Table of Statistics, by M. Chereau (1844), two years after the revival of the operation of Mc- Dowell in England, he does not include a case operated upon in France by this procedure. Of the sixty-five cases given we find the follow- ing distribution of them, as to the countries in which these operations were performed : Great Britain, 'i,'] cases; Germany 15 cases; United States, 8 cases ; anonymous, 5 cases. IN FRANCE. -i-i-y Comments. — The points brought out in our study of the early history of ovarian dropsy in France show a wide range of in- vestiofation with regard to the nature, oriein, diagnosis, prognosis, and treatment of this disease by the incisionist ; and are of far ofreater interest than would seem from a cursory glance at the subject. Le Dran, as we have seen, during the few years (1736-46) that he devoted to the study and investigation of these several aspects of the subject, accom- plished much that was of real value toward advancing the prevailing knowledge at that period. The disease was then called scirrhus by all writers, and Le Dran so described it, believing the origin and seat of it to be inside of the sac, at or near its base, the attachment of the ovary to the uterus, or in one or both iliac fossce ; also, that the growth of the disease depended upon the gradual enlargement up- ward of a single cyst. The growth of the dis- ease he also knew to be confined at first to one side, and that as the growth gradually extended it occupied both sides, thus showing by these observations accuracy in differential diagnosis, and the importance he attached practically to being always able to determine the side on 334 MCDOWELL'S OPERATLON which the disease was seated. For the ordinary operation of tapping he was influenced by these considerations, and in the advance from this practice to that of incisionism he adhered even more strictly to the observance of the same ofeneral rule. From the known result in nearly, if not all, cases in which tapping- was performed, he saw that the sac would refill sooner or later (in from a few weeks to several months), necessitating a repetition of the operation in order to relieve the distressed breathino- and the embarrassed o functions of the body generally, and by which alone death could be averted for a time. With this knowledge of the nature, seat, growth, and consequences of such tumors, he dared to make incisions below the umbilicus, by which the peritoneal cavity was laid open in its lower division ; to carry the finger or the hand, as the case might be, into the abdomen and pelvis in search of disease ; and to leave the cavity open for the employment of drainage and injections, by tent and tubes, as has been shown. In this way he actually cured, to all intents and purposes, one case that he operated upon, the patient remaining in a fair state of health, with only a fistulous opening, for four IN FRANCE. ^ , c years ; and in another he completed the cure without a remaining fistula. In the first case he made a small incision in the right side, four inches in length, admitting about two fingers for exploration, using afterward drainage-tubes and injections ; but after six months, finding an increased growth of the tumor, he made across the lower part of the abdomen an incision six or seven inches in lenorth, admitting the whole hand for exploration, and allowing of the same general after-treatment by tent, drainage-tube, and injections. In the second case he found the enlargement of two years' standing, occupy- ing both sides of the abdomen, and he tapped it. When the fluid was drawn off he discovered a scirrhous tumor, the size of a "melon," on the left side, and at the end of three weeks the abdominal distention was as great as ever ; whereupon, he decided to lay the abdomen and tumor open. This time he selected the linea alba below the umbilicus for his incision, ex- tending it to the pubes, with the intention, as he tells us, that the opening in the abdominal wall should not close up promptly, in order that the cyst itself might have time to contract, and the lower angle of the opening made in it be kept always near the angle of the external wound 226 MCDOWELL'S OPERATLON and the bottom of the sac, the scirrhous seat of the disease. In this way he was better enabled to employ his drainage-tube and injections to favor inflammation and suppuration of the walls of the cyst. Le Dran's theory of the treatment employed in the above two cases was based upon former observations and experience, and his logical explanation of it, before he undertook the ope- rations in question, accorded most fully with the results which he achieved. The final result in the second case, as we have seen, was a complete triumph for the method of'incisionism, without a remaining fis- tula. Had the tumor in the case not been a multilocular cyst, and complicated with adhe- sions, as was probably the case, Le Dran, with the incision he made, might have had a very different termination of the primary operation, to wit: the result of a spontaneous protrusion of the collapsed cyst through the abdominal opening, and a division by him of the pedicle, thus giving to the world an operation of com- plete extirpation of a dropsical ovary — the achievement left to McDowell just sixty-three years later (1809). Le Dran, although anticipated over a third of a century in the employment of incisionism by IN FRANCE. ^27 Houston, may properly be regarded as the first to fully comprehend and master the principle of the procedure, and thus to be able to secure its fullest fruition. For this the profession in his own country, and in all others as well, owe him more credit for the really scientific work he did, and for the triumph which he secured from it, than it is believed he has ever received. The four cases followinof Le Dran's are all of interest, as we have seen, illustrating, as they do, important points in regard to the origin and seat of encysted dropsies, and especially the first one (that of M. INIouton), in which the accumulation of fluid took place between the peritoneum and abdominal muscles, attaining enormous dimensions, and causing the death of the patient, while on her knees, the only posi- tion in which she had been able to breathe for two or three weeks previously. In another case (that of M. De La Chaud), the fluid forming the tumor was found between the folds of the peri- toneum. Next we have the case of M. Montau- Heu, in which the tumor was of a " cauliflower form," being, probably, of papillomatous origin ; and, lastly, that of M. Malaval, in which both ovaries were involved, and a correct diagnosis made, as was proved afterward by the autopsy. 238 MCDOIVELVS OrERATION Next is the important case of M. Delaporte, from the pecuharities of which, as we have seen, he was led, after his attempt at removal by in- cision simply, to inquire, for the first time in the history of the treatment of ovarian dropsy: Would it not be possible "to remove the focus of the disease — namely, the tumor formed by the ovary ?" In this instance Delaporte encountered a semi-solid tumor, no doubt multilocular in character, of enormous dimensions, and with no recognized features to indicate which ovary was involved. The greater prominence, how- ever, of the enlargement of the left side no doubt influenced him to make his incision here, and it was commenced just above the anterior superior spine of the ilium and extended up- ward and inward the length of five fingers' breadth. There is no evidence that Delaporte at any time introduced his finger or fingers through the opening for the purpose of explor- ing the interior of the tumor ; and the reason for this, no doubt, was that the gelatinous fluid it contained poured out in such continuous quantities that there was no opportunity to do it. He contented himself with simply looking on and noting the enormous discharge from LV FRANCE. ^^g day to day, until the thirteenth, when the patient expired, the wound having given issue to sixty- seven pounds of fluid. At the autopsy Dela- porte found that the tumor involved the rio-ht ovary, instead of the left, where the incision was made — precisely the same obstacle to success by incision that Le Dran encountered in his first operation. The latter mistake in diagnosis, and consequently the error in puncturing the abdomen in the wrong place, was made by the physician previously in charge. This error of diagnosis and the unguided puncture on the right side gave rise, no doubt, in Le Dran's second operation in the same case, to the long transverse incision he was forced to make, ex- tending from the point of this puncture to the left side, the actual seat of the tumor. Had the diagnosis of the seat of the disease been correct in Delaporte's case, and the incision made into the tumor on the right side, instead of the left, near its base, the probability is that all of the fluid would have escaped in a far shorter time. Thus would the chances of saving the life of his patient have been increased to a certain extent ; and by enlarging his incision to admit the hand into the interior of the tumor for breaking up the partitions between the o^O MCDOWELL'S OPERATLON minor cysts, as Le Dran did for diagnostic pur- poses in his second operation, he would hav^e increased his chances still more, probably to the extent of removing the entire diseased mass at the time of his operation. But, after all, it was no doubt his error of diagnosis as to the ovary Involved, and the great disadvantage ex- perienced from making the incision so far from the base of the tumor, that led Delaporte after- ward to institute the inquiry he did as to the preferableness of the incision being made over the focus of the disease, and of the removal of the affected organ in totality. Of the originality of the proposal of Dela- porte there seems to be no question. Certainly there is no evidence accessible to show that he was acquainted with the Eastern custom of re- moving normal ovaries in women mentioned by Lisfranc ; or that he was influenced by the well-known expedient of removing the ovaries in the female of quadrupeds which has come down to us from former centuries ; nor is there any reason to believe that he was at all familiar with the discussions upon the same subject by Schlenker, Willius, Peyer, and Targioni, claimed by Velpeau to have taken place during the thirty years previously (i 722-1 752). IX FRANCE. 241 Delaporte jnakes no mention of the work of Le Dran, as appears from the history of his case and operation ; but no one can fail to see that he was a strict follower of the latter as regards the procedure of incisionism. A fact deserving emphasis in this connection is that the four incisions made in the three cases of Le Dran and Delaporte, distinctive of the old method of incisionism, were restricted to the lower division of the abdomen alone (a line extending across the longitudinal axis of the body, at the umbilicus, being the limit), and were of variable length. These incisions for convenience in description may be divided into the short and the medium. One of them on the right side was four inches long ; one of them on the left was made four inches at first, and then extended somewhat into the medium, one reaching from four to six inches in the linea alba up to the umbilicus, and another medium or long, reaching transversely from the right to the left side and six or seven inches in extent. These incisions, all in the lower division of the abdomen, as stated, and made without refer- ence to the axis of the body, except in one in- stance, constitute the most important feature of the old method of incisionism. The one of ,^2 MCDOWELL'S OPERATLON Le Dran, however, which extended transversely across the body, without regard to the direction of muscles or the course of large bloodvessels, was made in a most unjustifiable way. Theden's scheme of extirpating a dropsical ovary, an extension of incisionism, was unques- tionably the outcome of Delaporte's proposal. It was characterized by a short incision four inches long in the inguinal region, as he sup- posed the diseased ovary to be outside the peritoneum. After exposing the organ and giving vent to the contained fluid he would draw the cyst out, put a ligature on its point of attachment, and cut it away. The tumor on being found hard, and not susceptible of being drawn out and excised, was to be seized with the fingers and forcibly brought out. Suffice it to say that this was merely a theory as to what the author thought an operation ought to be for the purpose indicated. It is, however, of interest here to refer to it, for the reason that it excited no little attention in France at the time of its proposal, was extolled by Mo- rand, and by two English surgeons, Power and Darwin, and was even favorably commented upon by Malgaigne, as late as 1842, as the first scheme proposed for extirpation of the IN FRANCE. -i^A-i ovary, while McDowell's procedure was the completion of it. L'Aumonier performed his operation from thirty to forty years (1782) after the proposal of extirpation of the ovary by Delaporte, and the plan of executing it as formulated by The- den. L'Aumonier's operation forms an im- portant era in the history of incisionism in France, as we have seen, and requires more than a passing notice. It was performed upon a young woman, aged twenty-one, six or seven weeks after an attack of puerperal peritonitis, resulting as the facts show, in a pelvic abscess which opened from Douglas's pouch into the vagina, the most favorable of the four common outlets of such purulent accumulations. L'Au- monier, finding a tumor of considerable hard- ness in the hypogastric region, and perceiving that pressure upon this region caused sudden and repeated gushes of matter from the vulva, concluded erroneously that an abscess of the ovary existed, which had opened into the cor- responding Fallopian tube, whence the pus escaped through the uterus and vagina. The external uterine orifice, he averred, from a digi- tal examination, to be in a normal state. His operation, based upon this theory of the ^44 MCDOWELL'S OPERATLON enlargement he found in the hypogastric re- gion, consisted, as we have seen, in making an incision over the prominent part of the dis- tended region (tumor) four inches in length, running obliquely across the linea alba, the side of the affected ovary not being mentioned. The bluish fluctuating tumor found at the bot- tom of his incision, after dilatation with the fingers, he says, was attached below, over the inguinal ring of the affected side, and floating above, while it was surmounted by another little tumor the size of an ^gg, having a hard feeling {tuineur skiri'-heuse). Below this latter point he plunged his bistoury (this being the second step of the procedure), extending the division of the structures down to the angle formed by the Fallopian tube of the corresponding side with the uterus, and thus gave vent to a pint of blackish and most offensive purulent fluid. His next step was the introducdon of his finger, to its full length, into the wound, and this re- sulted in the discovery, as he says, in the upper side of the cavity of "an excavation in the body of the ovary of which the borders were of con- siderable hardness," corresponding in situation almost precisely with the hard-feeling little tumor surmounting the bluish tumor, as de- IN FRANCE. 245 scribed. The small opening through which his finger passed to reach this point led him to reconsider his first opinion regarding this hard- feeling little tumor. The result was, he dis- covered, as he states, that the small opening mentioned, with "hardened borders," was the outlet of an abscess in the ovary, and that the " organ was disorganized beyond reparation. But in this reinvestigation of the parts involved he overlooked the fact that the fluctuatincr little bluish tumor, fixed below, floating above, and surmounted by the hard-feeling little tumor, still remained unexplained. The seizing of the disorganized ovary, with "hardened borders," with a tenaculum, tlie removal of it entire by dissection without injury to the surrounding parts, and with a loss of only a few drops of blood, all tend to prove the operation to have been not only complex and unique, but of a character bordering- on the marvellous. Such a procedure, without any explanation of the character of the specimen so removed, cannot, however, be accepted as justifying the import- ance given to it by L'Aumonier, to say nothing of the inconsistency of his statements regarding the anatomical and pathological structures in- volved, and their relations one with another. 046 MCDOWELL'S OPERATION The claim, therefore, of an abscess of the ovary- emptying into the corresponding Fallopian tube, and of the extirpation of the diseased organ, it must be said, is not only opposed by the vague pathological description of the struct- ures implicated, but by sound principles of surgery. It is clear enough, from what we have read of L'Aumonier's description, and the analysis here made of the different steps of his operation, that the true explanation is that given in the outset, viz. : that the enlargement found in the hypogastric region was nothing more or less than a pelvic abscess in Douglas's space, result- ing from jDuerperal peritonitis, with rupture of the pouch, and discharge through the vagina. The proof of the above explanation is, on the one hand, the impossibility of L'Aumonier's forcing out in sudden and repeated gushes a purulent fluid through the Fallopian tube, the uterus, and its external orifice, in a normal state, as he describes ; and, on the other hand, of the entire practicability of his being able to do this easily by the same manipulation with the open- ing that existed between the bottom of Dou- glas's pouch and the vagina. Besides, the extirpation of the hard-feeling little tumor sur- IN FRANCE. 347 mounting the large bluish tumor actually con- taining the purulent fluid, without reference to the walls of the tumor, would have been impos- sible, as described, and his claim of successful removal of a disorganized ovary is therefore clearly absurd. As another proof of the absurdity of L'Au- monier's having even discovered, to say nothing of his removing, a disorganized ovary indepen- dent of the walls of the sac containing the pus, it is only necessary to assume (which is in strict accordance with his description) that the upper part of the large cavity was bounded by the broad ligament and the fundus of the uterus, the latter being drawn over to the affected side by adhesions. This being understood, it is easy to see that the hardened substance finally recognized in the sac, claimed by him to have been seized with the tenaculum and removed, was not the disorganized ovary at all, l^ut the fundus of the uterus. Whether he dissected out this "without injury to the surrounding parts" remains, in my opinion, an open question. From this it follows that the small opening admitting L'Aumonier's finger was nothing more or less than the point of communication between two parts of the large bluish tumor 248 MCDOWELL'S OPERATLON actually containing the pus, one being on the affected side of the uterus, and the other in Douglas's pouch ; and that when he passed his finger through the small opening into the cavity of the ovary, as he supposed, he simply passed it under the fundus of the uterus into Douglas's pouch, thus showing the continuity of the two portions of this cavity, viz. : the bluish-looking tumor, or pus sac, which he had cut down upon In the outset of his operation and punctured. By so doing he gave vent to the pint of con- tained pus, and caused the " drying up " the day afterward of the purulent vaginal discharge, as he describes. In justice to L'Aumonier, however. It is proper to state that the incision made by him for the relief and cure of his case of pelvic abscess was simply an extension of the principle of incisionism as employed by Houston and Le Dran, especially in the first case of the lat- ter, nearly fifty years previously. In the result thus achieved by him of completely emptying Douglas's pouch by the procedure described, and thus curing his patient. Is to be found his triumph, which was truly brilliant for his day, and would even do credit to the most advanced laparotomist of the present time. IN FRANCE. ^.r. J 49 In this connection it is also proper to state that in the various references made by subse- quent writers to L'Aumonier's case there has been an extraordinary reticence, and conse- quently a misunderstanding regarding its diag- nosis, and the precise character of the operation he performed. Hence the non-appreciation of the operation as to its true merits, not as a procedure of extirpation of the ovary, so erro- neously claimed for him, but as a practical extension of the procedure of incisionism to the relief and cure of pelvic abscesses, and a de- monstration of its availability in other serious conditions, such as tubal pregnancy, pyosal- pinx, etc., to the value of which the attention of the profession has only been pointedly directed within the last decade. Again, as we have seen, twenty-five years after the publication of L'Aumonier's case, the claim of successful extirpation of the ovary by the latter was revived, in the Inaugural Thesis of M. d'Ischier, in connection with the success of Kapeler's case, and the fact that the date of this thesis was only two years before that of McDowell's first operation also proved preju- dicial to the recosfnition of TVIcDowell's claims, from the constant references made to the sub- ^co MCDOWELL'S OPERATION' ject at that time, and the want of knowledge of the real facts of the case — M. d'Ischier, instead of L'Aumonier, being usually referred to by authors. This was done even by Velpeau himself. Of all the French writers that have been con- sulted in connection with this subject only one has been found (M. Chereau) who quotes directly from the publication of L'Aumonier's case, as recorded in the Histoire de la Societe Royale de Aledecine, i'/S2-8j. In concluding these comments, I would state that during all these years of the history of McDowell's operation (the period of our present study of the subject, 1809-42) not a single report of an operation according to this procedure has been found in the medical litera- ture of France. The question may well be asked: What was the cause of this seeming neglect of the procedure ? Could it have been from dissatisfaction with the character and results of the few operations performed during the period of the old procedure by incisionism ; or did it result from the failure of surgeons, for all these years, to regain sufficient confidence to make the trial of a different and more pro- mising operation ? A\' GERMANY. ■> - £ SECTION III, Germany. A GREAT deal has been said of Professor Dzondi, of Halle, and the association of his name with ovariotomy. In the United States Dr. Nathan Smith, in the report of his success- ful case of ovariotomy (1822), refers to Dzondi's practice of incision and drainage ; and, evidently impressed with the importance of his views upon the subject, disclaims any knowledge of them prior to the date of his operation. Dr. W. L. Atlee places his name in his "Table of Statistics" (1851), before that of McDowell as a successful ovariotomist. In England Mr. John Lizars, in his paper entitled " Observations on the Extirpation of the Ovaria, with Cases," published in 1824, speaks of Dzondi's successful treatment of dropsical ovaries. Velpeau, at a still later date, mentions the plan of treatment ascribed to Dzondi by Mr. Lizars, but calls attention to the contradictory statement upon the subject by Dr. Dolhoff, of Magdeburg, Prussia, a pupil of Dzondi. As to the real facts relating to the credit attributed to Dzondi in the United States and ,e2 MCDOWELVS OPERATION in England, as above shown, a reference to his pubHshed work, entitled : Beitraege ziir Ver- volkommung dei^- Heilkimde (1816), an Eng- lish review' of which I have consulted, shows that the practice attributed to Dzondi did not relate to the treatment of dropsical ovaries at all, but to that of encysted dropsy ("hydrops succatus peritonei ") in the case of a boy, Christopher Shultz, twelve years of age. The operation he performed was simply a puncture with a trocar of the distended abdomen, which was made in the presence of Dr. Funke, May 24, 181 4. After the fluid was drawn off he en- larged the trocar puncture by incision, and " introduced into the orifice a large linen tent dipped in oil, and secured it externally by ad- hesive plaster." The tent was removed every other day, the size being gradually increased until the twenty-sixth day after the operation, when a ragged point of the cyst wall showed itself at the fistulous orifice, and was seized with a pair of forceps and entirely drawn out, piece by piece. The patient recovered. The reviewer of Professor Dzondi's work says of die principle of the treatment employed in the above case, that it "might be resorted to ^ Am. Med. Recorder, 1820, vol. iii., p. 57. IX GERMANY. y-y with equal success in ovarian dropsy, as soon as the sack Hes between the peritoneum and the external covering' (muscular wall), as is generally the case, and if the ovary itself has not yet entered into an ulcerated and scirrhous state." This theory of the ovaries being out- side of the peritoneum will be recognized as the same taught by Theden in France, 1 753-1 760. Thus is made clear what was actually pro- posed and accomplished by Dzondi in a case of encysted dropsy in a boy ; but it is also evident, from the presentation of the subject of incision- ism in France, where it was practised nearly three-quarters of a century earlier, that Dzondi had profited from the teachings of the incision- ists there, and, consequently, was entitled to no claim of originality of the employment of the principle further than as regards its extension by applying it to the successful treatment of encysted dropsy other than ovarian. Let us next see with what success McDow- ell's operation of ovariotomy by his long inci- sion was first employed by German surgeons, from the results as set forth in the recorded cases of Chrysmar, Martini, Dieffenbach, Ehr- hartstein, Quittenbaum, Dolhoff, Groth, Chriss- man, Ritter and Stilling. 23 354 MCDOIVELVS OPERATION To Dr. Chrysmar, of Isny, in Wurtemberg, is justly due the credit of having been the first in Europe to perform McDowell's operation, although he is credited by Dr. Hopfer, of Biber- bach, with having been the first anywhere to perform extirpation of a dropsical ovary, since no mention is made by him of the American operation. The facts are, that Chrysmar's first case, reported by Dr. Hopfer, bears the date of May 1 6, 1819 — nearly ten years after McDow- ell's first operation, and more than two years after the publication of his first three cases (181 7). Beside this, Chrysmar's first recorded cases bear the ear-marks of the long peritoneal incision, the full exposure of the peritoneal cavity, and the bringing out in the lower angle of the wound the ends of the lio^ature on the pedicle, which are themselves enough to prove beyond the shadow of a doubt the priority of the American operation, independent of Dr. Hopfer's statements, dates, or publications. Dr. Hopfer, in his report of Chrysmar's three cases, entitled : " On Extirpation of Diseased Ovaria,"' states the circumstances under which he became acquainted with Dr. Chrysmar and ^ Monthly Journ. of Foreign Med., 1829, vol iii., p. 440; trans- lated from Medicinische-chirurgische Zeitung, Feb., 1827. /X GERMANY. 255 the results of his operations. In 1819, as Medi- cal Superintendent, he went to Allgau, in the district of Swabia, where Chrjsmar enjoyed a wide reputation, and had already, as he learned, performed two operations, one of which was successful, Hopfer says that during his three years' residence in Swabia Dr. Chrysmar per- formed three operations for extirpation of dis- eased ovaria, two of which he witnessed, and the third of which was a case of his own (Hopfer's). Case I. — Mrs. Leupalz, aged forty-seven, presented her- self to Dr. Chrysmar with a hard tumor in her left side, about the size of a child's head, complicated with ascites. The operation was performed May 16, 18 19. The long incision of McDowell was adopted, extending in the linea alba from the ensiform cartilage to the pubes, with full exposure of the abdominal cavity. Extensive adhesions were found between the tumor and the arch of the de- scending and transverse colon, as well as the great arch of the stomach. The ligature was brought out at the lower angle of the wound. Patient expired thirty-six hours after the operation. The diseased ovarium weighed seven and a half pounds. Its surface was irregular and knotty, and upon section its structure was of a cartilaginous and fibrous character, with small "intervening cavities, filled with greenish offensive sanies." Case II. — A. B., aged forty, presented herself with a tumor, the size of a child's head, in the left side, with dis- tinct fluctuation, and anasarca of the lower extremities. In June, 1820, Dr. Chrysmar performed the operation in the presence of Dr. Bawnwarth and three other surgeons. The long incision was employed, as in the preceding case. 356 MC D O WEL US OPERA TION with full exposure of the abdominal cavity. No adhesions. Wound closed with sutures, and the ends of the ligature on the pedicle brought out at the lower angle of the wound. The tumor weighed eight pounds. Patient returned home well at the end of six weeks. Case III. — A single woman, of Bavaria, named Schei- deck, aged thirty-eight, with abdominal tumor, spinal curvature, and deformed pelvis, applied to Dr. Hopfer in 1820 for treatment, but he advised her to consult Dr. Chrysmar. The latter decided to make the operation for removal of the tumor, which he did in the presence of Dr. Hopfer and three assistants. The long incision was made, with full exposure of the abdominal cavity. There were slight adhesions, but the pedicle was found to be short and four inches thick. It was tied with a double ligature, wound closed with sutures, and ligature brought out at the lower angle of the wound. Death, preceded by convul- sions, took place at the end of thirty-six hours. "Tumor weighed six pounds and a half, and, on being divided, pre- sented a lardaceous texture, with numerous fibrous cysts, filled with a brownish stuff, like size." Next follow two cases operated upon, respec tively, by Dr. E. Martini and Prof. Dieffenbach. Case IV. — Woman, aged twenty-four, with enlarge- ment of her left side, believed by her former physician 10 be due to an ovarian tumor, consulted Dr. Martini in April, 1827'. She had previously been tapped four times, the last time only a month before her admission, at which date the cavity of the cyst was injected with water and alcohol in the proportion of 8 : i. Dr. Martini, at a fifth tapping, made two punctures at the same sitting to relieve distention ; after which he decided to make an incision in the linea alba three inches below the umbilicus. This incision was then enlarged above and below to the extent of nine inches (McDowell's incision). The tumor was the IN GERMANY. 25/ size of a man's head, round, smooth, and of a '' cartilagi- nous consistence," and it seemed solidly fixed in the brim of the pelvis. He could not find the pedicle. In the upper part of the tumor there was a large cyst which was punctured and evacuated, the canula being left in it to insure drainage. Wound closed with sutures, the canula projecting from the line of union. Case terminated fatally seventy-two hours after the operation. Disease was found seated in the left ovary, as diagnosticated. Case V. — A Polish woman, aged forty, after having been examined by a number of surgeons, finally consulted Prof. Dieffenbach in regard to a large tumor in the abdo- men, which she believed resulted from a blow received ten or twelve years previously. Prof. Dieffenbach decided to operate, and made the long incision, extending along the linea alba to the pubes (McDowell's incision). The lower part of the tumor, and its relations to the uterus and bladder could not be made out — it having a broad base and seeming to be attached to the vertebral column. It was somewhat round, of a bluish color, and of almost cartilaginous hardness, and contained large bloodvessels. The puncture in* the tumor was followed by profuse bleeding, which could be controlled only by com- pression. It was deemed proper not to attempt a removal of the tumor. Wound closed by sutures. Patient re- covered.^ The following is a short abstract of a case reported by Dr. Ehrhartstein,^ translated from the Med. Jahr. des Oester Staats : Case VI. — Mrs. A. D., aged thirty-one, in her fifth pregnancy showed enormous abdominal distention, which was l)ut little diminished after her delivery. The cause of this was soon after discovered to be enlargement of the * Archives Generales de Modecine, 1829, t. 20. ' Mcdico-Chirurg. Rev., July, 1833, vol. xix. 358 MCDOWELL'S OPERATION right ovary ; the case thus illustrating the possibility of such tumors becoming complicated with pregnancy. The cyst was partially relieved by puncture with the trocar and the abstraction of fourteen pounds of fluid ; where- upon another similar cyst was discovered, and a second puncture made, giving vent to twelve pounds more of fluid ; thus proving the tumor to be multilocular. The operation w'as performed eighteen weeks after delivery. The length of the incision is not stated, but presumably the long incision was employed, from the facility with which the existing adhesions were overcome and the opera- tion completed — only fifteen minutes being required for the purpose. Ligatures were applied to three bleeding vessels, but special treatment of the pedicle is not men- tioned. It is to be inferred, however, that the ligatures were brought out at the lower angle of the wound, since it is stated that the threatening febrile symptoms intervened, which were only relieved on the eighth day by a discharge from the wound, "of bloody serum and gas." The emptied tumor weighed twelve pounds, and was found to be composed of numerous cavities. The patient was dis- charged cured at the end of nine weeks. Case VII. — All the details of the case of Dr. Quitten- baum, next in order, are not accessible, but the writer has been able to ascertain that he performed the operation November i8, 1834, and that his incision was four inches in length. The cyst was successfully removed, and the patient made a complete recovery. Dr. Dolhoff,' of Magdeburg, Prussia, in a communication entitled "On the Puncture and Extirpation of Tumefied Ovaries," makes two divisions of ovarian cysts, requiring two differ- ' L'Experience, 1837-38, t. i. p. 625; from Rust's Magazin, 1838, 1st series, vol. li. IN GERMANY. 35^ ent plans of treatment, viz. : first, unilocular cyst, with puncture by trocar, incision, tent and injections (incisionism) ; and, second, multiloc- ular cyst, with incision and extirpation. He encountered two cases of the first variety, which were treated by incisionism with injec- tions of red wine, a weak solution of nitrate of mercury, etc., and both of which terminated fatally . (1829-33). Of the second variety (multilocular) he relates three cases. In the outset he speaks of the difficulty of diagnosis and the justifiability of the operation in this class of cases. He refers to Prof Dieften- bach's case,' in which there was a mistake in the diagnosis, and, consequently, failure to remove the existing tumor. In two of Uol- hoff's cases the tumor was removed, and in the third no tumor was found. Case VIII. — Maria Bock, aged twenty-three, after an attack of tertian intermittent fever, in 1832, first noticed a swelling in the left side. Little by little this tumor in- creased in size until the spring of 1833, when, after receiv- ing various opinions upon her case, she applied to Dr. Dolhofif, and was admitted to the hospital at Magdeburg. The girth of the abdomen was then fifty-three inches, and the condition was attended by great embarrassment in breathing. The tumor was irregular, and hard under pressure, fluctuation being very obscure. Dr. Dolhoff called for a consultation with his colleagues upon the case, ' Rust's Magazin, vol. xxv. 36o MCDOWELL'S OPERATION. and there was great diversity of opinion as to the true character of the tumor. He himself believed the disease to be ovarian. It was agreed by all that the tumor should be punctured, as it was thought that this would throw more light upon the diagnosis. Dr. Dolhoff found, however, that the abdominal wall was so thick everywhere except in the lower part, where there was risk of wounding the bladder from puncture with a trocar, that he decided to first make an incision into the peritoneal cavity, and then puncture the cyst. The point of election was to the left of the umbilicus, where the surface was more elevated than else- where, and here a perpendicular incision, two inches in length, was made through the muscular wall. (Sept. 27, 1833.) After a considerable quantity of ascitic fluid had escaped through the wound a puncture was made in the tumor, but only a little dark, thick fluid escaped ; where- upon the abdominal wound was enlarged, and an incision made into the cyst wall, found to be about an inch thick, and the contained fluid, of a gelatinous character, evacu- ated. The hand was next introduced, and the contents broken up and removed as far as possible. A large portion of the posterior cyst wall (about the size of a man's hand) was seized with forceps, drawn out, and cut off. It still being found that the tumor could not be removed from the abdominal cavity, the external incision was enlarged to the extent of seven or eight inches (McDowell's long incision), when the diseased mass became more movable, and was readily lifted out through the wound, there being no adhe- sions. The pedicle was found to be the size of the little finger, and was included in a strong ligature. After cut- ting away the tumor Dr. Dolhoff discovered the orifices of two arteries in the end of the divided pedicle, about the size of a crow's quill, and, fearing that his ligature might slip off, he tied each artery separately, and removed the ligature, including the pedicle in mass, thus guarding more effectually, as he believed, against secondary hemorrhage. He does not so state, but it is to be inferred, that he cut the lA- GERMANY. 361 ligatures off close to the knots, as the irritation likely to result from the ends of the ligatures would be an additional reason for his change in the mode of treating the pedicle. The wound was closed with sutures, and the patient died sixty hours after the operation from extensive peritonitis, as was found at the autopsy ; though the symptoms up to the time of death did not indicate this lesion, a circum- stance thought to be very extraordinary by Dr. Dolhoff and his colleagues. The tumor and its contents weighed forty-six and one-half pounds. Case IX. — Emilie Rcettcher, aged twenty-seven, ad- mitted to the hospital at Magdeburg, September 28, 1833, with a tumor in the left side of the abdomen, felt by the patient to be movable from side to side, and believed by her to have resulted from a blow. Dr. Dolhoff made an examination, and found the tumor to be a little larger than a child's head, of globular form, and pushed toward the right side. Operation October 21, 1833. A medium incision was made in the linea alba, from the umbilicus to the pubes, but this being found too small, it was extended two inches above the former. (McDowell's long incision.) This brought to view a hard tumor, covered above by the omentum, and containing bloodvessels enormously en- larged, and numerous little growths of a whitish and bluish- red color, while below it was solidly fixed in the pelvis, rendering introduction of the hand impossible. From the condition thus revealed an attempt at removal was deemed unjustifiable, and the wound was closed in the usual way with sutures, etc. The patient died eight hours afterward. At the autopsy the tumor was found to fill the pelvis, and to be firmly united by adhesions to the pelvis, uterus, bladder, rectum, and both ovaries, and it was not possible to determine in which of these organs the growth had originated. Dr. Dolhoff, in commenting upon the above case, says that, although the growth of the ,52 MCDOWELL'S OPERATION tumor was of short duration, and the sensation of the tumor, as described by the patient, was as if it fell from side to side, the diagrnosis as regards its mobility proved to be wholly faulty, and the removal of the tumor practically impossible. In the introduction to his third case of peri- toneal section Dr. Dolhoff, in a most commend- able way, states that it illustrates a grave error in diagnosis, and the unjustifiability of the ope- ration he performed. He says he delayed for some time before reporting the case, thinking it would be ridiculed. But, conscientiously believing it to be the duty of every surgeon to report his mistakes as well as his triumphs, he could not in this instance depart from the rule, consoling- himself with the knowledge that he was not alone in the world in his particular, since a celebrated surgeon had already pub- lished a similar experience. (His reference here being to the unfortunate case, in Great Britain, of Mr. John Lizars.) Case X. — Friederike Gollner, aged twenty-three, un- married, after an obstinate attack of tertian intermittent fever in 1835, of which she was cured by large doses of quinine, suffered from retention of urine (with varying quantities of mucous and purulent deposits in the urine drawn off), requiring the use of the catheter three or four IN GERMAXY. 363 times a day. There was also obstinate constipation of the bowels, for the relief of which, at times, three drops of croton oil would be used. Following this condition of things the patient, after several months, began to have tenderness in the lower part of the abdomen. This ten- derness was soon succeeded by distention of the abdomen, gradually extending itself to and above the umbilicus, which would alternately become more or less effaced and then salient. With the increase of the vesical trouble and the abdominal tenderness and distention, a hard rounded body, seemingly the size of a foetus, was discovered occu- pying principally the epigastric region. Dr. Dolhoff, after consultation with his colleagues, all of whom agreed that the enlargement was due to the presence of ovarian disease, decided to remove the tumor. He performed the opera- tion September 29, 1836, making a medium incision in the linea alba, from the umbilicus to the pubes. On intro- ducing his hand into the abdomen and carefully searching, however, he could not, to his own astonishment and that of his colleagues, discover any tumor. The wound was closed with sutures in the usual way, and the patient made a speedy recovery. In commenting upon the result of his first case, Dr. Dolhoff congratulates himself upon applying his ligatures separately to the two arteries found in the pedicle, thus guarding his patient against the additional danger of hemor- rhage by the ligature slipping off the pedicle. He calls the attention of the profession to this method of treating the pedicle, and in this con- nection refers to the history of an operation performed by Dr. Groth, whose name appears 364 MCDOWELL'S OPERATION in several of the statistical tables published, thouo-h without comments. t> Case XI. — A woman named Waswo, of Schonmoor, consulted Dr. Groth in regard to an enlargement on the left side of the abdomen, which he attributed to a dropsical condition of the left ovary. He recommended the extir- pation of the diseased organ, and to this the patient readily consented. The operation was performed in 1S33, but the kind of incision is not mentioned in the account of his operation, though it is believed to have been the long. The pedicle was encircled with a ligature in the usual way, and the tumor removed. The patient died six hours after the operation from secondary hemorrhage, which is be- lieved by Dr. Dolhoff to have been caused by the slipping of the ligature from the pedicle. Case XII. — Of the case of Dr. Ritter (1833), which is referred to by statistical writers, the details are not accessi- ble, and all that is known in regard to it is that he em- ployed the long McDowell incision, and successfully removed a fluid cyst, with no adhesions, and weighing twelve pounds. Case XIII. — This is Dr. Stilling' s case,* and here again there is a lack of details. We learn, however, from the Statistical Table of Mr. Phillips, that an incision (medium) was made six inches in length, that no adhesions were found, and that the patient died from hemorrhage. Case XIV. — The case of Dr. Chrissman is included in the Tabular Statement of Mr. Benjamin Phillips (1844), but the date of his operation is not given, though it is placed, chronologically, before that of Mr. Jeaffreson (1836), in England. Of the character of his operation it may be stated that he employed McDowell's long incision, found no adhesions, removed a tumor weighing twenty-two and a half pounds, and cured his patient. * Holcher's Hanoversche Annalen, 1841, Heft 3. IN GERMANY. 365 Summary' of cases and results in Germany, including- the two of Dr. Chrysmar referred to by Dr. Hopfer, but not reported : 1 2 completed operations with 5 cures and 7 deaths ; 3 unfin- ished operations with i recovery and 2 deaths ; I unjustified operation with recovery. Mortal- ity of complete operations 58.33 per cent. Comments. — This completes the history, as far as it can be ascertained, of McDowell's operation in Germany as regards its initiatory trial in sixteen cases (1819-1841). Two cases of Dr. Chrysmar, in addition to his three re- ported cases, are included in my summary upon the authority of Dr. Hopfer, who states that one of them was cured and one terminated fatally, making in all for Dr. Chrysmar five cases, with two successes and three deaths. It is proper to mention that McDowell's work is not alluded to in connection with a sino-le one of these sixteen cases, so far as I have been able to learn, and that the only way by which I have been enabled to trace the influence of his teachings upon the surgeons performing these operations has been through careful study of his long incision, and the extension of the short or medium incision into the long, together with another distinctive feature of his procedure ; ^56 MCDOWELL'S OPERATION that of bringing out both ends of the ligature on the pedicle in the lower angle of the wound. Just how Dr. Chrysmar, in the little town of Isny, in the Kingdom of Wurtemberg (1819), obtained his first information regarding the reports of McDowell's first three cases, two years after their publication in the Philadelphia Eclectic Rcpej^tory (181 7), it would be difficult to say ; when in the United States Dr. Nathan Smith, Professor of Surgery in Yale Medical College, at New Haven (a little over one hundred and fifty miles from Philadelphia, and in close connection with the latter), had not apparently read or heard of McDowell's bril- liant operations at the time when he (Smith) performed his first operation of extirpation of an ovary two years later (1821). And yet the facts clearly show that Dr. Chrysmar had not only obtained this information in the face of the many obstacles then existing to inter- communication between foreign countries ; but, on the authority of Dr. Hopfer, Medical Super- intendent at Allgau, in 1819, he had even then already performed two operations, one with success ; making, as stated, with the three other reported cases after this date (18 19-1820), five cases, precisely the same number that McDow- IX GERMANY. 367 ell had reported in his two papers embracing the period between 1809 and 1819. Dr. Chrys- mar's results in these five cases (two cures out of the five), though far short of those achieved by McDowell (three cures out of five cases) in the far off little village of Danville, in the back- woods of Kentucky, certainly show a very fair average of success. If nothing more, they in- dicate an earnest and determined effort on his part to rescue a large class of women from a disease nearly always fatal, and hitherto left to the chances of incisionism, which then only was practised, and that only to a limited extent, in England and France. To Chrysmar, therefore, honor is due next to McDowell, and a position assignable to no other surgeon in Germany or any other country outside of the United States, and even here outside of the State of Kentucky, since to Chrysmar properly belongs the credit of having been the first to catch the inspiration of the " Father of Ovariotomy " and to place his convictions of the soundness of the princi- ples of the operation before the eyes of the profession of his own country, which, as the history of the subject shows, was not done by any one else there until seven years later (1827). Such boldness and daring as were ,68 MC DO WELL'S OPERATLON displayed by Chrysmar in these first trials of ovariotomy, under the circumstances stated, are deserving" of the highest acknowledgment — yea, of a monument to perpetuate the nobleness of his example and the influence of it on his kind. May we not hope yet to see the high apprecia- tion of the deeds of this truly great surgeon and their value commemorated by the liberality of the profession of Germany ? A monument has been erected at Danville to the name and honor of the " Father of Ovariotomy " by the grateful profession of his own State, Kentucky, and one now erected to the memory of Chrysmar, the first to appreciate and perform ovariotomy any- where outside the State of Kentucky, would not only be a praiseworthy act on the part of the profession of his own country, but it would show a just appreciation of the claim properly belonging to the little town of Isny, near the border of Bavaria, and one of the free cities of Germany from 1365 to 1803, in which this historic achievement took place. To the other operations performed in Ger- many there is no special interest attached, except in the cases of Drs. Ehrhartstein and Dolhoff. The case of the former, it will be remembered, was the one in which the compli- IN GERMANY. ^ ^5g cation of pregnancy occurred, giving rise to enormous distention of the abdomen. Soon after labor, in which there is no special men- tion of difficulty, tapping was performed and two distinct cysts evacuated ; the fluid from one weighing twelve, and from the other fourteen pounds. From the circumstances there might have been inferred implication of both ovaries, the possibility of which had been shown in France some two-thirds of a century previously by an autopsy made by M. Malaval. Here there was likewise large and uniform disten- tion of the abdomen, resulting from ascitic effusion into the peritoneal cavity surrounding the two separate ovaries. This pair of ovaries weighed, respectively, twelve and fifteen pounds — figures corresponding almost precisely with those given by Dr. Ehrhartstein, and making a very extraordinary coincidence. About, or soon after, the period referred to in France (1753), Morand, in commenting upon dropsical ovaries and the several varieties then known to exist, speaks of the complication, sometimes, of the disease with pregnancy. He even cites a case in which the complication took place three times without any impairment of the general health, though the third gesta- 24 ,^0 MCDOWELL'S OPERATIOX tlon failed to reach its full term. After this (at the end of the fourth year) the patient was tapped and twenty-five pints of fluid drawn off. In this connection the writer recalls a case^ of complicating pregnancy he operated upon six or eight years ago, in which the long incision of McDowell again proved of inestimable value. Here the complication not only co-existed with- out impairment of the general health or diffi- culty in the labor, but the patient afterward nursed her child up to the time she applied for the removal of the tumor, five or six 'weeks after labor. She was then of the size of a woman at full term, and the result of the oper- ation was all that could have be-en wished con- sidering the existence of still another grave complication that was found seriously to inter- fere with the execution of the procedure. This second complication consisted of a calcareous deposit in the walls of the cyst, about one-third the size of the hand, to which was firmly adhe- rent a coil of small intestine. So firmly glued together were the peritoneal surfaces at this point that separation was found impossible. The difficulty, however, was overcome by spHt- ting the cyst wall, the scalpel being made to follow closely upon the external siirtace of the ^ Transactions Texas State Medical Association, for 1885. IN GERMANY. ,71 calcareous plate. In this way the correspond- ing part of the cyst wall was detached and left in its pathological relations with the intestine, to take care of itself afterward in the abdo- men ; which it did with no ulterior bad conse- quences, as proved by the final good result. Dr. Dolhoft' refers to five cases (two uniloc- ular and three multilocular), together with one of false diagnosis in which an operation was unwarrantably performed. The interesting point regarding the treatment of the first class of cases named is that he employed the old method of incisionism with drainage and injec- tions. In this connection he speaks of using injections of red wine and a weak solution of nitrate of mercury ; and both cases in which they were tried terminated fatally (1829-33). The general plan pursued by him differed but litde from that of Prof. Dzondi (18 16), he having been a pupil of the latter for several years, and, of course, familiar with his practice. It is in this connection that he avers most posi- tively that Prof. Dzondi entertained no special views upon the treatment of encysted dropsy of the ovaries, as claimed for him by Mr. John Lizars, and he expresses his surprise that the latter should ever have made a statement so erroneous. 272 MCDOWELL'S OPERATLON' In two of the three cases of multilocular cysts referred to by Dolhoff there are several Interesting points brought out. The first case presented a girth of fifty-three inches, and the tumor was uneven and more or less hard, with no distinct fluctuation at any point. From these and other peculiarities of the tumor and its surroundings, puncture of it with a trocar was deemed useless, and an exploratory inci- sion was consequently decided upon. For this the point of selection was to the left of the umbilicus, where a perpendicular opening two inches in length was made. The tumor was then punctured, but only a little dark fluid escaped from it. The incision was now ex- tended to a size sufficient to admit the hand into the tumor for the breaking up and removal of its contents as far as possible. At this stage of the operation (and this is an important point, showing the lack of appreciation of McDowell's long incision) a pair of forceps was introduced, and the posterior wall of the cyst (said to be an inch in thickness) was seized and drawn out, when a piece of it "the size of a man's hand" was cut off. With all this breaking up and excision of the cyst walls, the tumor still could not be drawn through the original opening. nv GERMANY. 373 Now it was thought advisable to extend the incision to seven or eight inches (jNIcDowell's long incision), when, to the astonishment of all, the tumor, which had a pedicle of the size of the little finger, at once became movable and could be lifted out of the abdomen. Next, a ligature was made to encircle the pedicle in mass ; but the operator, noting the large size of the divided arteries, afterward decided to re- move the first ligature put on and to tie each artery separately. To this mode of individu- ally tying the arteries he attached great value, and claimed originality for it. The case termi- nated fatally at the end of sixty hours. Now, considering the character of this tumor, its size (forty-six and a half pounds), the time taken up in the mutilation of its walls, and the delay in changing the ligatures, can anyone say that the long incision of McDowell, made at the outset, would not have been the proper thing to do ? Or, that the chances of saving the life of the patient would not thereby have been greatly increased ? Dr. Dolhoft", in his second case, made a medium incision, but, finding this insufficient, he at once extended it into the upper division of the abdomen, making it accord fully with Mc- ^74 MCDOWELL'S OPERATION Dowell's teachings. The removal of the tumor, however, could not be effected, and the case terminated fatally at the end of eight hours. Dr. Dolhoff, in his remarks upon the case of false diagnosis and the result of his operation, endeavored to explain the mistake as being mainly due to a spasmodic contraction of the abdominal muscles. He further remarks, strange as it may seem, that the patient was relieved in a great degree of all her old symp- toms, and remained so until the following April (1837), when they returned and became as troublesome as ever. After a long and inef- fectual trial of a seton in the abdominal wall, she was discharged unrelieved. Regarding the cystitis described in this case, whether or not it existed as cause or effect of the hysteria present, there was certainly a direct relationship between the two ; and this goes far to explain the cause of the error in diagnosis, and, consequently the uselessness of the operation that was performed. Dr. Dolhoff, in premising his report of this case, properly and justly remarks, that it is the duty of every surgeon to publish his mistakes as well as his triumphs, referring at the same time to the unfortunate operation performed IiV GERMANY. ^75 under like circumstances by an eminent British surgreon. In such a diseased state of the bladder as found in Dr. Dolhoff's case, ureteritis or pye- litis, on one or both sides, was to be expected as a direct sequence, and the symptoms charac- terizing either one of these affections are just such as would lead a patient suffering from them for a lono- time to imag-ine that she might have. a tumor in her abdomen, as he describes. As showing the wide range of bodily and mental sufferings (real and imaginary) closely related to some of the diseases of the genito- urinary organs, the writer has grouped the symptoms occurring in cases of this class according to the relation which cystitis bears to ureteritis and renal tenesmus, a relationship which he pointed out in a recent paper on the subject.' He has now the records of two cases in each of which incurable disease was declared to exist in both ovaries, by two eminent sur- geons, and they were respectively laparoto- mized successfully without the slightest benefit. ^ Renal Tenesmus : A Result of Chronic Cystitis and Ureter- itis ; Successful Treatment by Kolpo-uretero-cystotomy and Intravaginal Drainage, combined with Elevation and Support of the Uterus and Ovaries. The Medical Record, August 4, 1888. ^75 MCDOWELL'S OPERATLON Afterward, by means of kolpo-uretero-cys- totomy, the writer diagnosticated in one case grave disease in both kidneys, as shown by the purulent discharge present, and in the other cystitis with ureteritis and renal tenesmus of the left side. Both the cases terminated fatally, and in one the autopsy revealed pyelitis calculosa in both kidneys. In the other case there occurred melancholia and refusal to eat, which terminated in insanity with hallucinations of a state of pregnancy and impending parturi- tion, and finally in death from starvation. The melancholia resulted directly from the realiza- tion of her unnecessary mutilation in the sacrifice of her ovaries, of which she herself became convinced after she had been relieved of her vesical, ureteral, and renal complications by the kolpo-uretero-cystotomy and the subse- quent intravaginal drainage. Such is the writer's view and explanation of the complications presented in Dr. Dolhoff's case, and of the circumstances that led him into the mistake of performing the unjustified oper- ation he describes, which arose, not from an error of judgment at the period of its perform- ance (as should here be noted to his credit), but, from a want of appreciation in surgical IN GREAT BRITAIN. 277 science at that date of the true relationship between the diseases of the uterus and its appendages, on the one hand, and the diseases of the bladder, ureters, and kidneys on the other, such as has just been pointed out. SECTION IV. Great Britain. The operation of tapping for the relief and cure of general dropsy, as a cause of impair- ment of health and obstruction of respiration and other important functions of the body, dates back, there is reason to believe, to the time of the Greeks and Romans. From the lone-ac- cepted knowledge of the value of tapping for meeting the indications mentioned there is, also, reason to believe that encysted dropsy resulting from whatsoever cause, and in regard to the distinctive character of which no settled theory was held, was treated until within two or three centuries of our own time in the same way, and even cured, under favorable influences, now and then. But the precise period in the history of medicine at which the latter affection came to 278 MCDOWELL'S OPERATION be specially studied and differentiated from general dropsy, and treated with an appreciation . of its distinctive pathology, cannot now be satis- factorily determined. From all that I have been able to learn from my present investigation of the subject it is evident that this knowledge could not have existed long, if at all, prior to the beginning of the last century. There is reason to believe, however, that, independently of there not being any settled views among writers in resfard to the differences between general and encysted dropsy, the operation of tapping in both affections, previously to the period named, had been more or less extended and improved by enlarging the trocar puncture by incision, for the better escape of the varying fluids and the easier introduction of a tent for drainasfe, the latter beinor used either alone or in conjunction (especially in the encysted va- riety) with injections. Whether or not this conclusion be correct with regard to the con- joined use of the knife, prior to the early date of which I am speaking, the case of Dr. Robert Houston, of Glasgow, Scotland, establishes the fact, beyond any question, that in 1701 he not only recognized the distinct form of encysted dropsy as differing essentially from that of ^^^- IX GREAT BRITAIX. ^-rg eral dropsy, but suggested and executed an original pi^ocednre of iticision, with drainage by tent in the lower division of the abdomen, cu ring his patient by the plan in the course of three or four weeks. In order to render this practice more distinctive I have termed it incisionism, and the surgeons who employed it incisionists. This operation of Houston, so far as we know, inaugurated the practice of incision indepen- dently of tapping. I have previously referred to Houston's case in connection with several points in my study of encysted dropsy, and showed the influence of his method of incision- ism with drainage upon the practice of after years, especially in France, where the method was employed and enlarged upon by Le Dran, Delaporte, Theden, and L'Aumonier, up to the time that McDowell associated with it the ex- tirpation of the ovary by his long incision, embracing both the lower and upper divisions of the abdomen. From the importance of Houston's practice, and the credit due him for the advance he made upon the old operation of tapping, it is proper that the report of his case, with the description of his procedure and the result, should here be copied in full, this case marking the beginning -,3o MCDOWELL'S OPERATION of the treatment of a dropsical ovary by simply the short incision with drainage, without at- tempting removal of the diseased organ (i 701), and by the long incision with extirpation of the diseased organ (1809.) I may, perhaps, be excused for trespassing upon the time of the reader for this purpose, on the ground that the old and rare work in which this case is recorded is not readily accessible for reference except to a few physicians. In addi- tion to this, certain unwarranted comments, affecting the claims of McDowell, that have been made upon the case by various authors, demand attention, and they can be better and more fairly made with all the facts relating to the case pre- sented in the author's own words. For exam- ple, John Gorham, Esq., of England, in his efforts to give importance to the Hunterian short incision, couples the history in part of this case with the cases of Dr. Nathan Smith, and Messrs. jeaffreson. King, and West, in order to show that they were the first to com- prehend the true principles of the operation of extirpation of the ovary, forgetting that extirpa- tion of the organ, with extension of the practice of incisionism so as to include both the lower and upper divisions of the abdomen, were the IN GREA T BRITA IX. ^ 8 1 essential features of the operation, and that to McDowell alone belono-ed the credit for these innovations. The late Dr. W. L. Atlee, in the United States (1845), published his first "Tableof Sta- tistics upon Ovariotomy," without knowing about Houston's case, and introduced only the names of L'Aumonier, Dzondi, and Galenzowski, as preceding that of McDowell in point of priority. Discoverinof, however, from the London PJiilo- sophical Transactions, some four years later, his error in having omitted to place Houston's name in the list of previous operators, he ad- dressed a note to the late Dr. Isaac Hays, editor of the Ameincan yournal of the Medical Sciences, which was headed as follows : " Ova- rian Dropsy by the Long Abdominal Incision in 1 701, by Robert Houston.'" Accompanying it with a full copy of the report of the case, in quotation marks, under Houston's heading: "A Dropsy in the Left Ovary of a Woman, aged fifty-eight years. Cured by a Large Incision, Made in the Left Side of the Abdomen." In his corrected and enlarged table of cases of ovariotomy, published two years later,^ he adds ' Op. cit., 1849, vol. xvii., p. 534. ' Trans, of the Am. Med. Association, 1851. ^82 MCDOWELVS OPERATION Houston's name to the other three given, thus making the number of surgeons four who had preceded McDowell in the operation of ovari- otomy. His reprint of this publication bears the tide: "A Table of All the Known Opera- tions of Ovariotomy, from 1701 to 1851, Com- prising Two Hundred and Twenty-two Cases, Including their Synoptical History and Ana- lysis." Still again. Professor Mapother, in an intro- ductory address on ''Dublin Medical Schools," speaks at length of the " School of Surgery." In a published abstract of this address' I have found enumerated a great number of names of distinguished men connected with the history of this school, commencing with those of Mullen, the anatomist of the seventeenth century, and Proby, the first surgeon-general, and ending with those of Mr. Cusack, Professor Maccart- ney, Dr. Shekleton, and Dr. Houston. The writer, in concluding his notice of the last- named and his great work, the Catalogue of the JMuseiim, says : " To a namesake of Houston, and to a namesake of his contemporary, Ephraim McDowell, is assigned the first performance of ovariotomy. Professor Gross, in a memoir ' British Medical Journal, 1873, vol. ii., p. 634. IN GREAT BRITAIN. 383 of the great Kentuckian of the latter name, asserts that in 1809 he performed ovariotomy for the first time; but Dr. Mapother found, by the thirty-third volume of the Philo- sophical Transactions, that it was done successfully by a Dr. Houston in 1701." So much, then, for the injustice done Mc- Dowell's claim of originality in the first extirpa- tion of the ovary, and for the absurdity of any other claim for Houston than the important, and certainly the very creditable, one for his time of accomplishing the cure of his case by incisionism Vv^ith drainage in the lower division of the abdomen. This had nothing whatever to do with extirpation of the ovary by the long incision made in both the lower and upper divisions of the abdomen, the achievement ac- complished by McDowell a little over one hundred and eight years later. With these necessary preliminary statements I now introduce the report of Dr. Houston's case' as published by him : "A Dropsy in the Left Ovary Cured," by Dr. R. Hous- toun. In August, 1701, I was desired to visit one Margaret Millar, a poor woman of 58 years of age, who lived not far from Glasgow, and lay bedrid of an uncommon disease. She inform'd me that her midwife having violently pulled away the burthen in her last lying-in, at 45 years old, she • The Philosophical Transactions, N. 381, Jan., etc., 1724, p. 8. (From the year 1720 to the year 1732). Abridged and Disposed under General Heads, vol. vi., Part ii., ill., iv. 384 MCDOWELL'S OPERATLON . was very sensibly affected by a pain which then seized her in the left side between the umbilicus and groin, and had scarce ever been free from it after, it having troubled her more or less during 13 years together; that for two years past she had been extremely uneasy, her belly grew very large, and a difficulty of breathing increased con- tinually upon her ; insomuch that for the last six months she could scarce breathe at all without the utmost diffi- culty. That in all that space of time she had scarce eat so much as would nourish a suckling child, having quite lost her appetite, and that for the three last months she had been forc'd to lie constantly on her back, not daring to move at all to one side or other. This tumour drew towards a point, and was grown to so monstrous a bulk that it engross' d the whole left side from the umbilicus to the pubes, and stretch'd the abdominal muscles to so unequal a degree that I never saw the like. Her lying so continually on her back having greviously excoriated her, added much to her sufferings, which, with want of rest and appetite, had wasted her to skin and bone. I told her that in order effectually to relieve her, and remove the cause of the swelling, I must lay open a great part of her belly, but feared she would not be able to undergo such an operation : she seemed not at all fright- ened, but heard me without disorder, and, though scarce able to speak, urg'd me to perform it. I must confess I drew almost all my confidence from her unexpected resolu- tion, and without loss of time prepared what the place would allow, and with an imposthume lancet laid open about an inch ; but finding nothing issue I enlarged it two i-nches, and even then nothing came forth but a little thin yellowish serum ; so I ventured to lay it open about two inches more ; I was not a little startled to find only a glutinous substance stop up so large an aperture; but my great difficulty was to remove it; I tri'd my probe, I en- deavoured to do it with my finger, but all in vain ; it was so slippery that it eluded every touch and the strongest IN GREA T BRITAIN. 385 hold I could take. I wanted, in this place, alniost every- thing necessary, but bethought myself of a very odd instru- ment, yet as good as the best, because it answered the end. I took a strong fir splinter, and having wrapt some lint about the end of it, I thrust it into the wound, and by turning and winding it drew out above two yards length of a substance thicker than any gelly, or rather like glue that's fresh made and hung out to dry ; the breadth of it was about ten inches ; this was followed by nine full quarts of such matter as I have met with in steatomatous and ather- omatous tumours, with several hydatides of various sizes containing a yellowish serum, the least of them bigger than an orange, with several large pieces of membranes which seemed to be parts of the distended ovary. Having squeezed out all I could, I stitched up the wound in three places almost equidistant ; and, having no other but Lucatellus's balsam, with it I covered a pledget the whole length of the wound, and over that laid several compresses dipt in warm French brandy ; and because I judged that the parts might have lost their spring by so vast and so long a distention, I dipt in the same brandy a large napkin four times folded and applied it over all the dress- ings, and with a couple of strong towels, which were also dipt, I swathed her round the body, and then gave her about four ounces of this mixture : B, — Aq. menthas Ib.ss. Aq. cinnamomi fort .... Ib.iss. Syr. diacodii 5vi. — M, — ordering her also to take two or three spoonfuls of it four times a day. The cinamon water was drawn off from canary and the best cinnamon. Next morning I found her in a bathing sweat, and she informed me with great joy that she had not slept so much nor found herself so well refreshed at any time for three months past. I care- fully dressed her wound in the same manner as above once a day for about a week ; I kept in the lower part of the 25 386 MCDOWELUS OPERATION wound a small tent, which discharged some serosities at every dressing for four or five days. But, business calling me elsewhere, I instructed her daughters how to dress the wound, and told them what diet I thought most proper, which was chiefly strong broth made of an old cock, in each porringer whereof was one spoonful of cinnamon water ; this she repeated four times a day, and it gave her new life and spirits. After three weeks' absence I called at her house, and finding it shut up was a little surprised, but had not gone far before I was much more so, for I found her sitting wrapt up in blankets and giving direc- tions to some labourers who were cutting down her corn. She mended apace, and lived in perfect health from that time till October, 17 14, when she died after ten days' sickness. ' ' Having now shown the early labors of Dr. Houston by incisionism with drainage in the lower division of the abdomen, we are pre- pared better to appreciate the influence it had upon the profession, especially in France. Here, some thirty years later, it was taken up, as we have seen, by Le Dran (1736-46) and greatly improved upon by both him and Delaporte, the latter in 1753 making the first suggestion "to remove the focus of the disease, namely, the tumor formed by the ovary." Soon after Delaporte's important suggestion of the prefer- ableness of removing " the focus of the dis- ease" to that of simple incisionism in the lower division of the abdomen, Theden recommended a scheme of makinof a small incision in the in- IN GREA T BRITAIN. 28/ guinal region, somewhat as Le Dran had done in his first case, based upon the theory that the diseased ovary was always to be found outside of the peritoneum, in which situation it could be exposed, punctured, drawn out, and ligated, and thus be strangulated or amputated, as cir- cumstances called for. Theden proposed this procedure, as indicated, purely upon theoretical grounds, and there is no evidence to show that any one ever put it into practice, though it was highly commended by Morand, and somewhat enthusiastically endorsed at the time by Drs, Power and Darwin, in England. These points have been fully brought out in the French his- tory of the subject, and do not here call for further comment. With regard to the influence that Theden's theory of an operation for the removal of a dropsical ovary had upon the practice of Great Britain, at the period of which w^e are speaking, I am without the necessary data to speak posi- tively. Dr. William Hunter, in England, about the same period that Theden, in France, is credited with his proposal, called into question the views then entertained regarding the scirrhous origin of the dropsical ovaries, mainly brought out in ^88 MCDOWELL'S OPERATION the latter country, claiming that many little bags, or cysts, found one within another on the inside of a "dropsical ovarium" were not scir- rhous." He thus took the lead in advocating a more-advanced step regarding the pathology of the disease, and the basis of his views is found in a communication entitled "The History of an Emphysema," ' by William Hunter, M.D., read October 31, 1757, before a Society of physicians in London. Under this title he dis- cusses, in addition to emphysema, "the cellular membrane and some of its diseases," together with general and encysted dropsy of the ovarium, with attending anasarca. He states that he had seen a great many cases of " encysted dropsy of the ovarium," both in the living and in the dead, and that he had never seen one in which there was a perceptible diminution of the enlargement by any other plan of treatment than by the trocar. He thought that the ana- sarca of the lower extremities attending this disease was less amenable to relief by incisions than the same result attending general dropsy. He further held that encysted dropsy of the ovarium was incurable, remarking that "a patient will have the best chance of living ^ Med. Observations and Inquiries, London, 1762, vol. ii., p. 41. IN GREA T BRITAIN. 389 longest under it who does the least to get rid of it." Surgeons of the highest reputation, he adds, had proposed and advocated "a radical cure by incision and suppuration (incisionism), or by excision of the cyst," but the former prac- tice could only be pursued under particular cir- cumstances, and the latter hardly admitted of an attempt. Dr. Hunter's views with regard to the origin, growth, and complications of the disease, and his proposed plan of "excision of the cyst," which he thought might be employed under extreme circumstances, together with his ob- jections to the procedure by incisionism, are concisely stated in the following quotation : "I can hardly say that I have ever found any part of a dropsical ovarium in a truly scirrhous state. What at first view might seem such proved, upon cutting, to be a com- pact group of small bags, or a spongy substance filled with gelly. "Generally, before the patient dies of such a dropsy, some degree, both of leucophlegmatia and of ascites, is brought on, so that when such bodies are opened some water is found loose in the cavity of the belly, and some- times the cyst is found to have burst, and to have dis- charged its contents into that cavity. " Now, if the disease be nearly what I have stated, must not the wound made in the belly for the excision of the cyst or cysts always be large enough to admit the surgeon's whole hand ? Must it not be often a good deal larger, as when the tumor is large, and composed of a number of 5QO MCDOWELL'S OPERATION bags filled with gelly? Would not such a wound be attended with a good deal of danger from itself? Would it not be very difficult to cut the peduncle, or root of the tumor, with one hand only introduced ? Would it not be impossible to do this, where the adhesions proved to be considerable? Would there not be great danger of wound- ing the intestines? If any considerable branch of the spermatic artery should be opened, what could the surgeon do to stop the bleeding? If it be proposed, indeed, to make such a wound in the belly as will admit only two fingers, or so, and then tap the bag, and draw it out, so as to bring its root or peduncle close to the wound of the belly, that the surgeon may cut it without introducing his hand, surely in a case otherwise so desperate it might be advisable to do it, could we beforehand know that the cir- cumstances would admit of such treatment. "With regard to incision and suppuration, all that is proposed to be got by this painful operation is the change of the dropsy into an incurable fistula in the belly. For this the patient must not only undergo much pain, but likewise be exposed to great danger, particularly where the cyst happens not to adhere to the muscles at the part where the incision is made, or where there are a number of cysts. In the first case, the wound will be a large one, communi- cating with the cavity of the abdomen, and both the exter- nal air and the contents of the incised cyst, will be admitted into that cavity, so that we may expect very considerable inflammation. In the second case, where there are a num- ber of cysts, the inflammation and suppuration will either be too slight to discharge all of them, or too considerable to be supported with life." From this presentation of Dr. Hunter's views on the pathology of ovarian dropsy, together with his theoretical operation for the removal of this disease, it must be confessed that credit IN GREA T BRITAIN. -> q i Is due him for havincr attained a clearer insight into the nature of the disease and a more prac- tical comprehension of what sort of a procedure was called for for its removal than any one who had ever written upon the subject before. It was virtually an intelligent and practical re- sponse to the timid suggestion of Delaporte in France, after his disastrous failure by the old method of incisionism a few years previously, "to remove the focus of the disease — namely, the tumor formed by the ovary." With strong common sense he suggests that the opening in the abdomen should at least be laro-e enouorh to admit the surgeon's hand for the required manipulations of the tumor, and that even an opening of this size might not prove sufficient when adhesions and complications with neigh- boring viscera existed, with the danger of hem- orrhage that was liable to attend any effort to overcome such obstacles. In regard to a small opening by a short incision he had also a clear conception of just what was barely necessary to enable the surofeon under favorable circum- stances to expose the cyst, tap it, draw it out, and excise "its root or peduncle close to the wound of the belly." Whether or not he thought constriction of the pedicle before exci- ^Q2 MCDOWELL'S OPERATION sion necessary he does not state, but that he did may be inferred from his mention of the danger of wounding the spermatic artery In the operation. In his proposal of a short Incision Is seen the Influence exerted upon him by the previous teachings of the Inclslonlsts, requiring the open- ing to be made In the lower division of the abdomen, as limited by a transverse line at the umbilicus ; but the exact mode he describes of making the Incision of a certain length, admit- ting "two fingers or so," Is unquestionably original. There is nothing In the history of the subject to the date of McDowell's operation that approaches his proposed method for clear- ness of conception as to the kind of an opening In the abdomen necessary for the removal of a dropsical ovary composed of one, two, or three cysts. Appreciating the principle, as we do now, we cannot fail to wonder why there was no surgeon in Great Britain to profit by Hun- ter's teachings until after McDowell had led the way fifty-two years later, combining with a long incision the all-Important step of extir- pation of the ovary. Whether McDowell was familiar with his theory of an operation for ex- tirpation of the ovary there is nothing to show, IN GREAT BRITAIN. ^03 further than fhe fact that he was a medical stu- dent in the University of Edinburgh during the session of 1 793-94, and while there listened to the lectures of Mr. John Bell, one of the most eminent surgeons of that day. But whether or not while there he learned anything definite regarding the theoretical views of either Theden or Hunter (and this is certainly a matter of great doubt, to say the least), is of no prac- tical Importance, since it was thirteen years after his return to the United States that he encountered in the backwoods of Kentucky, where he was thrown entirely upon his own resources, his first case of dropsical ovary. Un- der these circumstances, what mode of proce- dure do we find him following ? Was it by the old method of making a small opening in the lower division of the abdomen as formerly em- ployed by the old incisionists, notably by Hous- ton, Le Dran, and Delaporte, and as extended in theory by Theden and Hunter? No, It was by the long incision that properly bears his name, made (though outside of the rectus mus- cle) in both the lower and the upper divisions of the abdomen, from the margin of the ribs to the OS pubis ; thus affording opportunity for the fullest exposure of the tumor, the widest 394 MCDOWELL'S OPERATION possible range for the manipulation of the same, the discovery of complications, and the preven- tion of accidents. Dr. Nathan Smith, who, as we have seen, was the first surgeon in the United States to imitate McDowell in the extirpation of a drop- sical ovary (July 5, 1821), in his case followed almost precisely the theory of Dr. Hunter in puncturing and drawing out the collapsed cyst through a short incision. In fact the whole 'procedure was carried out by him on the theory of the cyst being small and simple, and on the line of old inclsionism in the lower division of the abdomen, but combined with the practical and essential features of extirpation of the ovary by the long incision, as previously taught by McDowell, the account of which original practice had then been published over five years, and was familiar to the profession at home and abroad. As the facts stand In medical history. Dr. Smith published his case, the year after the operation,' without mentioning McDowell's name or alluding to his operation in the slightest way. The result was that for a long time his publication, either by itself or in con- » Op. cit. IN GREAT BRITAIN. ^95 junction with those of I\Ir. John Lizars, of Edin- burgh, was frequently quoted by writers, who spoke of these operators, if not as originators of the procedure, certainly in such a way as to greatly disparage the claims of McDowell. With this review of incisionism for the treat- ment of a dropsical ovary and the relation of the practice to that of extirpation of the dis- eased organ, we come to the direct study of the influence of McDowell's completed operation of ovariotomy by the long incision upon British surgery from the date of the first employment of it by Mr. Lizars^ to the tifne of its revival in England, September, 1842, by Dr. Charles Clay. Mr. Lizars in his first communication, which is entitled " Observations on Extirpation of the Ovaria, with Cases," by John Lizars, F.R.S.E., F.R.C.S.E., and Lecturer on Anatomy and Physiology, Edinburgh, commences by quoting in French the concluding paragraph of the report of the case of supposed extirpation of the ovary by M. L'Aumonier, as quoted in the French history of the subject, of which the following is a translation : ' Edinburgh Medical and Surgical Journal, Oct. 1S24, vol. xxii. p. 247. 396 MCDOWELL'S OPERATION " This example and that of total amputation of the uterus and vagina, performed with success, justify the con- clusion that, with a thorough knowledge of anatomy, there are but few organs upon which one may not perform with advantage the different operations of surgery." After stating that Le Dran and Dzondi had each cured dropsy resulting from disease of the ovary by incision and tent (incisionism), the lat- ter removing the sloughing sac by the forceps, he quotes Morand regarding the removal of the healthy ovaries in quadrupeds, and Felix Plater and Diemerbroeck, to show that the practice in women was not chimerical, as proven by a cus- tom among the Lydians ; Paulus Barbette, to show he had opened the abdomen for disen- gaging a strangulated intestine ; Bonetus, as claiming that relief was afforded a lady in a similar condition by the same operation, performed by a military surgeon ; and Schacht, as having secured a similar satisfactory result by the same method. Furthermore, to prove the practicability and safety of abdominal sec- tion, he recalls the well-known practice of the Ca&sarean operation, and refers to the classic case in which the same operation was per- formed six times successfully. He then adds: " But the practicability of extirpating a diseased ovarium does not rest on theory. It has been proved by experi- IN GREA T BRITAIN. ^Q? ence. L'Aumonier, who was chief surgeon of the great hospital at Rouen about fifty years ago, extirpated the ovarium successfully ; and since his time an ovarium has been repeatedly removed, and sometimes with success, par- ticularly in France, Germany, and America. Dr. Smith, of Connecticut, lately extirpated an ovarium in a dropsical state successfully. Three very instructive cases occurred to Dr. Macdowal, of Kentucky, and the following history of them was sent, about seven years ago, to the late celebrated surgeon, Mr. John Bell, who was then on the Continent, and came into my hands as having the charge of his pa- tients and professional correspondence during his absence." Here follows the report of the three cases of McDowell, from the manuscript that had remained unacknowledged and unpublished, in his possession, for seven years, and he gives the narration of these important cases entirely with- out comment or remark, though making a few verbal corrections and transpositions in the text. This brings us to the report in detail of Mr. Lizars's case of false diagnosis and unjustifiable operation, in which the incision made was that of McDowell. He states that in the year 182 1 he w^as requested by his friend, Dr. Campbell, to examine a woman, aged twenty-seven, with an enlargement of the abdomen equal to that ordinarily met with in pregnancy, in full term. " On examination the tumor occupied the whole abdomi- nal cavity, and appeared to roll from side to side. The woman stated that the enlargement began six years pre- 398 MC D O WEL VS OPERA TION viously in the left side, and that she assigned the cause of it ' to several blows and kicks received from a brutal hus- band.' She further stated that some two years after it commenced she had noticed * a small movable swelling in her left groin, which she allowed to increase for twelve months, when she came to Edinburgh, and, on consulting a surgeon, he opened it with a lancet, and discharged a large quantity of thin matter.' This was thought to be a * lumbar abscess,' which she ascribed to a fall on her back three years previously." The patient, after consulting the "chief medi- cal gentlemen " of Edinburgh, many of whom pronounced her case one of pregnancy, and all of whom dissuaded her from an operation, finally came to Mr. Lizars for the removal of the supposed tumor. He, " convinced, from the history of the disease in the records of medicine, and from gastrotomy having been successfully performed for volvulus, and from the Csesarean section, that there was little to apprehend either from loss of blood or peritoneal inflammation," decided to make an effort to relieve her of her sufferings by an operation, choosing, as men- tioned above, the procedure of McDowell by the long incision. He, accordingly, performed the operation October 24, 1823. This was six years after he had received McDowell's manu- script containing the report of his first three cases, and one year after the publication of the report of Dr. Nathan Smith's operation. IN GREAT BRITAIN. -,^0 Suffice it to say that the diagnosis of Mr. Lizars in this case was not only proved by McDowell's long incision to be wholly false as to the existence of an abdominal tumor that "appeared to roll from side to side," but that by means of the incision it was possible to discover "a flattened tumor of no great magnitude, at the left sacro-iliac synchonchosis of the pelvis, lying beneath the division of the common iliac artery, into its external and internal branches." By this little pelvic investigation of Mr. Lizars he did more, though in an unconscious way (as implied by his general description) to prove the value of the long incision, embracing both the lower and upper divisions of the abdomen (as opposed to old incisionism), than McDowell had ever done in any one of his three cases. Such an investigation in the pelvis, resulting in such a diagnosis of the growth and its relations to the soft parts found to exist, would have been wholly impossible by the incision made in Dr. Smith's case. In which, in his history of the sub- ject, Mr. Lizars gives so marked a degree of prominence. Could Mr. Lizars only have ap- preciated this fact, and brought it fairly to the notice of the profession, this improved mode of EMORY UNIVERSITY me A, y», CALHOUN MEDICAL UBRARi .QQ MCDOWELVS OPERATION pelvic investigation would have gone far toward lessening the horror created on all sides and in all directions by his performance of such an un- necessary operation. But, as it was, he failed to do this in his report of the case, and by the minute description of certain details of his ope- ration which might just as well have been omitted, he, himself, unconsciously or ignorantly, largely contributed toward increasing the pre- judice at that time existing against the proce- jure, as will presently be shown. For example, there occurred (as in McDowell's first case) a protrusion of the intestines through the incision, and he descants upon this as follows : "When the intestines protruded, and baffled all the efforts of Dr. Campbell and the other gentlemen to con- fine them, I shall never forget the countenances of my pupils and the younger members of the profession. This fact of the intestines being forced out proves, along with others, that the lungs can be expanded although atmos- pheric air be admitted into the abdominal cavity; the diaphragm acted with great vigor and with powerful impetuosity." Fortunately for Mr. Lizars, however, the poor woman recovered from her operation in the course of three or four weeks. She after- ward resumed her work, " earning her liveli- hood as formerly, by binding shoes, but often severely tortured with pain." IN GREAT BRITAIN. ^01 In explanation of his mistake in diagnosis and his unjustifiable operation Mr. Lizars says : " The reason why all of us were deceived in this woman's case was the great obesity and distended fullness of the intestines, together with some protrusion pelvic of the spine at the lumbar vertebrae." Mr. Lizars, from what he had learned from the manuscript of McDowell and the result of his own case, came to the conclusion "that there is little danger to apprehend in laying open the abdominal cavity," and that the pro- cedure would have a wide range of applicability outside the employment indicated — viz., for extrauterine conception, for the prevention of embryulcia of the foetus in deformities of the pelvis, for aneurisms involving the iliac arteries and aorta, for removal of foreign bodies from the stomach, for volvulous, for internal hernia, and for cancer of the uterus. He considered the dangers resulting from delay under these circumstances greater than would result from the timely employment of such an operation as he had performed. The following year Mr. Lizars published three additional cases in a paper entitled "Ob- servafions on Extraction of Diseased Ovaria ; 26 402 MC D O WEL L ' S OPERA TION Illustrated by Plates Colored after Nature."' A brief summary of the cases is here given : Case II. — Patient, aged thirty-six, presented herself with a tumor in the left side, of six years' standing and the size of a foetus at full term. Operation February 27, 1825. McDowell's procedure ; full exposure of the peritoneal cavity ; ligatures on the pedicle brought out in lower angle of wound. Upon examination the other ovary (right) was found to be also diseased and about one-fourth the size of the one removed, but Mr. Lizars decided for some reason not to remove this, probably on the supposition of unwar- ranted risk. The wound was closed in the usual way and the patient recovered. Case III. — A cookmaid, aged twenty-five, presented herself to Mr. Lizars with an abdominal tumor of six years' standing. McDowell's operation, March 22, 1825. In this instance the incision was curvilinear through the broad muscles, tendons and peritoneum. Some parietal adhe- sions were found, but these were easily overcome by the fingers. The pedicle was the size of the little finger. It was encircled with a ligature and the tumor cut away. The wound was closed with sutures, and adhesive strips, with compress, and a shawl was made to serve as a binder. The ends of the ligatures were brought cut at the lower angle of the wound. Peritonitis supervened and the pa- tient died at the end of fifty-three hours. Case IV. — A cookmaid, aged thirty-four, presented her- self to Mr. Lizars with an abdominal tumor of six years' standing. McDowell's operation performed April 24, 1825. The tumor was found to be covered by the great omentum, in which numerous bloodvessels, varying from the size of the finger to that of a crow's quill, were seen to * Abstract of the same, Edinburgh Med. and Surg. Journ., July, 1825; also, Archieves Generale de Medecine, t. viii., P- 437- IN GREA T BRITAIX. 403 ramify. No attempt was made to dissect the omentum from the tumor, and further efforts to complete the opera- tion, other than to puncture the tumor in several places (from which only blood escaped), being deemed inadvisa- ble, the wound was closed and dressed as in the preceding cases. The patient recovered. It is proper here to note the effect which the publication by Mr. Lizars of McDowell's first three cases, and of his own of false diagnosis and unjustifiable operation, had upon the pro- fession, judging from the criticisms and ridicule found in the Medico-Chirurgical Review for January, 1825, and October, 1826, by its editor, Dr. James Johnson. Dr. Johnson, in his first remarks upon the subject, says that the exploits of surgery cannot always be accepted as real advances, and ex- presses surprise at the importance attached by Mr. Lizars to the operation of McDowell, to whom he refers slightingly as "Dr. Mac" and " Dr. Macdowal, of Kentucky." He then pro- ceeds to accentuate what he considers the im- probabilities of McDowell's statements, espe- cially as they related to his first case, that of Mrs. Crawford. Thus, the patient travelling sixty miles on horseback to receive the care and attention of Dr. McDowell at his own home in Danville, and having her abdomen laid 404 MCDO WELVS OPERA TION open to the extent of nine inches ; the protru- sion of her intestines for twenty-five minutes through the wound made in her abdomen ; the laying open of the tumor; the excision of it; and the patient's getting up on the fifth day to make her bed, when McDowell, from his report, appears to have made his first visit, were all extraordinary statements, and he was not a little surprised that Mr. Lizars " should put such implicit credence in them " ; adding, Credat yudcEus, non ego. He expresses the same incredulity in regard to McDowell's state- ment of the management of his second case of irremovable tumor (fibrous growth of the uterus, no doubt), in which, by way of experi- ment he " plunged the scalpel into the diseased part," and found "a quart or more of blood escaped into the abdomen." The great prejudice of Dr. Johnson against the operations and results described by Mc- Dowell is further illustrated by his even ignor- ing the successful case of Dr. Nathan Smith, the report of which appears in Mr. Lizars's first communication. Mr. Lizars's description of his own case, however, he thought was altogether different from McDowell's account of his cases, and the fact of the operation by Mr. Lizars IX GREA T BRITAIN. 405 being performed and no tumor found he recog- nized as a most fortunate circumstance, because his " patient would have had Httle chance of hfe." As it was, she recovered, "and lives to tell the tale." After quoting Mr. Lizars's ex- planation of the cause of his mistake in diag- nosis, he concludes : "Be that as it may, we do not think that the cases brought forward in this paper will have the effect of ren- dering surgeons more bold in operating for the removal of abdominal tumors, whether ovarian orof any other kind." Just after the publication of the first case of Mr. Lizars the able work of Professor James Blundell appeared, entitled : Researches, Physio- logical a7id Pathological : instituted prijicipally with a Vieio to the Improvement of Medical and Surgical Practice. Dr. Johnson, in a lengthy review of this book (April, 1825), just after his strictures upon McDowell's operations, takes occasion to criticise the words of Professor Blundell regarding the extirpation of dropsical ovaries : "And if British surgeons will not patronize and perform it, the French and American surgeons will ; " making use of the extraordinary statement : "In despite of all that has been written respecting this cruel operation, we entirely disbelieve that it has ever been performed with success — nor do we think it ever will." ^06 MCDOWELVS OPERATION A little over a year after the appearance of Mr. Lizars's second publication, in which his three additional cases are recorded (1825), four years after Dr. Nathan Smith's case was pub- lished (1822), and seven years after the publi- cation of McDowell's second paper (181 9), containing the report of his fourth and fifth cases, Dr. Johnson, in his second editorial (1826) seems for the first time to be aroused to the injury he had done McDowell and his operation, which resulted, as he indirectly ad- mits, more from the loose manner of the nar- ration of his cases than from the facts stated. Here, at this late day, he endeavors to make amends for his error, as shown in his opening remarks in the editorial referred to : "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 with extraction of the diseased ovaria." Here follows a brief notice of McDowell's fourth and fifth cases, special reference being made to the fourth, in which ligatures were "applied to several arteries individually," and also to the fact that both of these cases were in negresses. In the same communication he intro- duces a notice of Dr. Nathan Smith's case, the IN GREA T BRITAIN. 407 result in which he ignored in his first notice. He also mentions the successful operation in a negress by Dr. Alban G. Smith, at Danville, Kentucky, which he speaks of as " still the scene of operations." It is clear from reading Dr. Johnson's second review of McDowell's operations that he was finally forced to the acknowledgment of his error by the reply to his first remarks by Dr. Coates,' in which the latter upheld the just claims of McDowell, deduced from the actual facts of his five cases, four of which recovered. " For which uncharitableness we ask pardon of God and of Dr. Macdowal, of Danville," he exclaims ; but, notwithstanding this, he goes on to say that he was "in good company" with " Diemerbroeck and Sabatier, who believed the operation to be altogether impracticable." In the same connection mention should be made of his persistent ridicule of the large proportion of negresses among McDowell's cases. He says: " When we come to reflect, that all the women operated upon in Kentucky, except one, were negresses, and that these people will bear cutting with nearly, if not quite, as much impunity as dogs and rabbits, our wonder is lessened, and so is our hope of rivalling Dr. Macdowal on this side of the Atlantic." * North America Med. and Surg. Journ., 1826, vol. ill., p. 30. 4o8 MCDOWELVS OPERATION Next, in England, following in the footsteps of Mr. Lizars in the employment of McDowell's operation is an Italian physician living in Lon- don, by the name of Augustus Bozzi, but better known as Dr. A. B. Granville. He encountered two cases of ovarian dropsy in the Westminster General Dispensary, where he was one of the attending physicians. His first operation was an unfinished one, and the report is entitled : " Case in which an Attempt was made to Ex- tirpate Ovarian Tumors."' Case V. — Operation performed July i, 1826, in the presence of Mr. Benjamin Brodie, Mr. Keate, Mr. Earle, and several others. Mr. Brodie had previously seen this case in consultation with Dr. Granville and they both agreed that the case was not favorable for an operation ; but, nevertheless, it was deemed advisable under the cir- cumstances. The incision made was seven inches and a half in length, in the left side external to the rectus muscle, and made in accordance with the teachings of McDowell. Dr. Granville, in passing his hand into the peritoneal cavity, found several tumors having extensive and firm adhesions, and, therefore, he concluded (in which opinion he was supported by the surgeons present, who examined the condition of the parts) that an attempt at removal of the tumors was not warranted. The wound was closed with hare-lip pins, and the patient recovered. The report of the case concludes in these words : ^ London Medical aad Physical Journal, 1826, vol. Ivi., p. 141. IN GREA r BRITAIN. 409 "As far as it goes, this case adds another to the many instances on record of the impunity with which the cavity of the abdomen may be laid open, and is an encouraging step toward attempting, under proper circumstances, and after mature deliberation, an operation, which Mr. Lizars, of Edinburgh, has the merit of having revived on rational grounds." Case VI. — Entitled: "Extraordinary Surgical Opera- tion."^ The patient, aged forty, presented herself to Dr. Granville for treatment, suffering with an abdominal tumor the size of the human head. McDowell's long incision was employed, as in the preceding case, March 21, 1827, in the presence of Mr. Keate, Mr. Eade, Mr. Patterson, and several other physicians. The tumor weighed eight pounds and was removed entire. The patient died seventy- two hours after the operation from exhaustion due to ex- cessive loss of blood from venesection by an over-zealous student, who thought peritonitis was present. In connection with Dr. Granville's two opera- tions it is proper to state the fact that some fifteen years after the date of his second opera- tion he found himself compelled to defend his claims to having been the first in England to perform ovariotomy,'' This he did in answer to the statement made by Mr. D. Henry Walne^ that after Mr. Lizars the operation of ovariotomy sunk into a state of apathy, so to speak, and was not revived by any British sur- geon until within a few months previously, ' Literary Gazette, March 31, 1827. * London Medical Gazette, 1842-43, vol. xxxi. ^ Op. cit. 410 MCDOVVELVS OPERATION when Dr. Clay (September 12, 1842) per- formed an ovariotomy, followed by his (Walne's) a few months later (November 6). To this Dr. Granville replies : " Mr. Walne assumes the credit which belongs to another," and in support of his claim he adduces the facts as brougfht out in the above two cases. Of the various publications credited to Dr. Granville, from 181 9 to 1858, it is curious to note that not one is mentioned as bearing upon the operation of ovariotomy, nor is any refer- ence made to the two operations performed by him in London in The Roll of the Royal College of Physicians of London (of which College he was a member), which contains a biographical sketch of him. The next British surg-eon in order who was led to adopt the long incision of McDowell is Mr. R. C. King,^ of Saxmundham, Suffolk; England, as appears from his communication entitled : " New Operations for the Removal of Abdominal Tumors." His reasons given for reporting the appended cases are principally to show the safety of the operation, and to en- courage further efforts in the employment of it: ' Lancet, Jan. 7, 1837, vol. i., p. 586. IN GREA T BRITAIN. a j ^ Case VII. — This patient (the first) presented herself to Mr. King with a large and irregular tumor, with general distention of the abdomen and distinct fluctuation. After four tappings, from which relief always resulted, partially as to the embarrassed breathing, an operation for the re- moval of the tumor was decided upon. Dr. Field and several other physicians were present, and assisted in the operation. A long incision was made along the left linea semilunaris, through which a considerable quantity of ascitic fluid escaped, together with the omentum. Whilst he was endeavoring to return the omentum the patient "became discomposed, and expressed a wish that the attempt might be abandoned." Accordingly, as soon as the omentum was returned the wound was closed, and, although the patient recovered from the unfinished opera- tion, she died from exhaustion a few months afterward. Case VIII. — Mr. King's second case was Sophia Put- tock, aged forty, who presented a " movable abdominal tumor." It was in the right side, oval in form, and four or five inches in its longest diameter. Mr. William Jeaf- freson, of Framlingham, who was called in consultation to see the case, corroborated the diagnosis of Mr. King, and expressed the opinion that removal of the tumor was called for. Operation, March, 1834. Present, Mr. Jeaffreson, Mr. Lanchester, and five other physicians. An incision, seven or eight inches in length, was made along the right semilunaris. The tumor not being found through this incision, it was enlarged transversely toward the lumbar vertebrae. Further search for the tumor was made in the direction of the liver and right kidney, the latter being " handled and held up two inches," but nothing of a dis- eased character could be discovered. The peritoneal cavity, in this fruitless examination, was exposed about twenty minutes. The wound was closed with sutures, and the patient made a speedy recovery. Mr. Kinof states that in his abdominal search o 412 MCDOWELVS OPERATION for the tumor he neglected to elevate the hips of his patient, which might have caused the dis- lodgementof the tumor from the pelvis, where it was probably concealed, and suggests that this precaution might prove of advantage to other surgeons placed under like circumstances. Mr. King further states that at the end of two or three years, when he reported the case, notwith- standing the increase of the tumor from one- fourth to one-third beyond its former size, the patient was in better health, and suffered less, than at the time of his unfinished operation, a fact which he attributes to the relaxation of the abdominal wall on the right side, resulting from imperfect union of the edges of the wound, the cicatrix being formed simply by the integu- ments. Mr. King's third case will be presented further on, for the reason that the extirpation of the diseased ovary was effected by the short inci- sion. This was previously suggested, as has been shown, by Dr. William Hunter, as the outgrowth of the old method of incisionism. Mr. King, however, attributes the credit of the procedure to his friend, Mr. William Jeaffreson, stating that he had previously operated upon a case by the short incision, and that it was IN GREA T BRITAIN. 4 1 ^ upon the result of this that his case followed, as "a scion grafted upon the parent stock." Mr. Jeaffreson, in his report' of the case re- ferred to, entitled : " A Case of Ovarian Tumor Successfully Removed," states that in an expe- rience of thirty years he had met with about twenty cases of dropsical ovaries, and that the tendency of all of them was to a fatal termina- tion, after varying periods of protracted suffer- ing. The treatment employed, consisting prin- cipally of tapping, although affording temporary relief, w^as at best only a "forlorn hope," not- withstanding the contrary claims made by Sir Astley Cooper, Dr. Haighton, and a few others. He then states that he was cognizant of the fact that " Dr. Smith once performed this opera- tion with success," and goes on to say that " Mr. Lizars had published many interesting cases of extirpation of the ovary," thus show- ing that he must have been ignorant of Dr. McDowell's original operation, or that he con- siders its special features of no practical advan- tage. In giving his own views he says : "It has often occurred to my mind that the operation might be had recourse to so soon as the sac was sufficiently distended as to press firmly on the • Trans. Prov. Med. and Surg. Asso., 1837, vol. v., p. 239. .J. MCDOWELVS OPERATION parietes of the abdomen, and before adhesions had taken place." He states that he was led, in 1833, to this conviction from meeting with a case of ovarian dropsy, complicated with preg- nancy at full term, in which the descent of the tumor retarded the process of labor until he lifted it up with his finger, and thus overcame this grave obstacle to the passage of the child's head. This woman died a few days afterward, and as an illustration of the soundness of his convictions, just stated, he rehearsed at the autopsy the stages of an operation by which he believed the woman's life might have been saved. The plan indicated, and which he proposed- to follow when the opportunity again offered, embodied these features : First, to make an incision in the linea alba midway between the umbilicus and the pubes, about an inch in length ; second, to expose and puncture the cyst with a trocar ; third, during the flow of the fluid, to seize a portion of the cyst wall " in the grip of the forceps " ; fourth, the sac being emptied, to draw it gradually through the opening, puncturing any other cyst or cysts as they presented themselves ; fifth, to include the pedicle in a ligature, cutting the ends "off close IN GREA T BRITAIN. 4 1 5 to the knot" and dropping the pedicle "into the cavity of the abdomen " ; and, sixth, in the after-treatment to use large doses of opium with foxglove, " keeping a napkin wrung out of the coldest spring- water constantly applied over the whole of the abdomen," as first recom- mended by Mr. King, With these preliminary statements, he proceeds to narrate his case : Case IX. — In November, 1833, ^'^^- Jeaffreson was called to see Mrs. B. in her second confinement, and, by an extraordinary coincidence, he discovered the case to be similar to the one just referred to as terminating fatally. The same line of treatment was pursued with success, and the child delivered without difficulty. His friend, Mr. King, was called in consultation. Nearly three years afterward (March 4, 1836), Mr. Jeaffreson was again called in to attend Mrs. B. in her confinement, and the child was born without difficulty. But he was surprised to find afterward that the size of the abdomen was but slightly diminished, a circumstance due to the gradual augmentation of the dropsical ovary during the interval that had intervened between the two labors. After a lapse of two months, during which time all the ordinary reme- dies for promoting absorption of the fluid present, includ- ing veratria, so highly extolled by Dr. Turnbull, had been resorted to without permanent benefit, the patient decided to submit to an operation for removal of the tumor. Operation by Mr. Jeaffreson, May 8, 1836, assisted by Mr. King. The incision made was said to be "between ten and twelve lines." The different steps of the operation were carried out as in the plan previously described, and the wound closed, only two sutures being called for. The patient perfectly recovered. 41 6 MCDOWELL'S OPERATION Mr. Jeaffreson goes on to state that after the recovery of his patient he received a thesis written by Dr. Charles Frederick Quittenbaum, on the successful treatment of a case of drop- sical ovary operated upon November i8, 1834, but he (Jeaffreson) had the same objection to this operation that he had to those of Mr. Lizars, viz. : " The greater extent of the incision and consequent hazard to the patient," referring here, of course, to the McDowell incision. He then concludes the report of his case by saying that if he had met with extensive adhesions between the cyst and the surrounding viscera he would have established a communication between the former and the peritoneal cavity, thus leaving the diseased organ to be cured by peritoneal absorption. In this is seen the most pointed acknowledgment of the defectiveness of the Hunterian short incision he had just adopted in the face of a difficulty that would not have been of the slightest consequence in the employment of McDowell's long incision. The expedient here referred to, of establishing a communication between the cyst and the peritoneal cavity in cases otherwise irremedi- able by the short incision, was a proposal pre- viously made by Prof. Blundell. AV GREA T BRITAIX. a^j Mr. Jeaffreson here mentions the case of ^Nlr. R. C. King- previously referred to by the latter, as " a scion grafted on the parent stock," and which now follows in recfular order. Case X. — Mr. King's third case, entitled "Ovarian Dropsy ; Removal of the Cyst ; Employment of Cold and Foxglove after Operation."^ H. C, a teacher, aged thirty-seven, applied to Mr. King, in August, 1833. She presented an enlargement of the abdomen, with fluctua- tion. Mr. King says that, previous to seeing Mr. Jeaffre- son's case, he had decided to allow this patient to go on until she was incapacitated from her duties, and then tap her to obtain the usual temporary relief; but the result of Mr. Jeaffreson's case proving so satisfactory, he was led to perform the same operation without further delay. Oper- ation July 12, 1836, at which Mr. Jeaffreson was present and assisted. The operation was virtually the same as that of the latter, except that, after drawing off twenty-seven pints of gelatinous fluid, he had to enlarge his incision to three inches in order to extract the sac. It should also be stated that, after applying the ligature to the pedicle in mass, it slipped off and had to be reapplied, which was done on the arteries individually, one of which was the size of the ulnar artery. The three ligatures applied were cut off close to the knots, and the pedicle returned to the abdomen. The bleeding was slight. After the operation Mr. King gave two drachms of tincture of foxglove and one of laudanum ; and immediately after the operation began the application to the entire abdomen of thick cloths wrung out of ice-water, fref[uently renewed. Sec- ond day, little or no tenderness of the abdomen; pulse 60. At no time since the operation had the pulse exceeded 64. But little nausea or hiccough. On the third day condi- ^ Op. cit., January 7, 1837. 27 4i8 MCDOWELL'S OPERATION tion of patient normal, and from this time on convales- cence was as satisfactory as it was possible to be. Patient cured. Mr. King concludes the report of this case with the followinor remarks : "These cases will, I think, materially add to our confi- dence in the powers of the human frame to dispose of ligatures when left in cavities The applica- tion of the ice-water was continued incessantly to the abdomen ; it was injected into the rectum and colon in large quantities and frequently. Nutritious fluids of animal broth, milk, and gruel were likewise given through the same medium. Foxglove acted very favorably in overcoming the tendency to quickened circulation, and it was frequently repeated during the first fortnight, although chiefly through the medium of the bowels in consequence of the irritability of the stomach. It would be occupying too much of your publication to add my observations on the use of cold and foxglove to counteract inflammatory tendencies, either after operation or in idiopathic inflam- matory disease, but I think there will be little difficulty in showing that, when fully and assiduously used, they have most important and controlling powers in arresting the march of the destroying power of inflammatory disease, chronic or acute." Mr. W. J. West, of Tunbridge Wells, was the next to report a case of ovariotomy, and it was entitled, "Successful Operation for the Removal of an Ovarian Tumor." ' He pre- cedes the narration of his case by reference to ' Lancet, 1837-38, vol. i. p. 307. IX GREA T BRITA IN. * I q the two published reports of the cases of Messrs. Jeaffreson and King, and to the objec- tions that had been made to the report of the former by the London University Medical Society.' Case XI. — Mrs. H., aged forty-four, was attended by Mr. West in her third confinement, the pregnancy being complicated by a tumor in the abdomen of thirteen years' standing. Mr. West had previously examined the patient, and knew the character of the tumor. She had consulted several surgeons, and had been treated by a seton, as recommended by Dr. Barnard, and by various other remedies. Operation November 2, 1837, Mr. West being assisted by Dr. Scudamore and Mr. Hargraves, also of Tunbridge Wells. Incision in the linea alba below the umbilicus, two inches in length ; then the tumor was exposed and secured by a loop of cord fixed in the sub- stance of the wall, preparatory to puncturing the cyst with a trocar. Twenty pints of fluid were drawn off", when, by very little traction on the loop, the emptied cyst was extracted from the peritoneal cavity. A ligature was applied to the pedicle in mass, the ends cut off" close to the knot, and the tumor removed, the pedicle being returned to the abdominal cavity. Four sutures were used for closing the wound, which was also supported by strips of adhesive plaster. In the after-treatment <' cold spirituous lotions were constantly applied over the abdomen," and calomel with saline aperients were given for keeping the bowels open. Patient was discharged cured. In Mr, West's concludino- remarks he sum- o marizes the objections of the London University Medical Society referred to regarding Mr. Jeaf- ^ Lancet, January 7, 1837. ^20 MCDOWELL'S OPERATION freson's plan of operatinor. They were : First, inapplicability of the procedure when adhesions had formed; second, "the danger of perito- nitis" ; third, "when the cysts are numerous"; and fourth, " the disease being complicated with other tumors." Mr. West performed three other operations according to the suggestions of Mr. Jeaffreson, which are not reported in detail, but he fur- nished Mr. John Gorham, of Tunbridge, Kent, for publication, the essential points of his treat- ment and the results, which the latter recorded, together with the cases of Dr. Nathan Smith, Mr. Jeaffreson, Mr. Hargraves, and the case in Guy's Hospital, in an article entitled: "Obser- vations on the Propriety of Extirpating the Cyst in Some Cases of Ovarian Dropsy."' Case XII. — Mr. West's second case, Miss S., aged twenty- five, presented an abdominal tumor with distinct fluctua- tion. Short incision, exposure of the cyst, and emptying the sac (which contained twenty-four pints of fluid), car- ried out as in the preceding case. No unfavorable symp- toms attended the after-treatment. The patient was cured. Case XIII. — Mr. West's third case. Mrs. Tompkins, aged forty, had an abdominal tumor which had previously been tapped. Short incision. Adhesions found and no attempt made to remove tumor, which was probably mul- tilocular and, therefore, unsuitable for short incision. ^ Lancet, 1839-40, vol. i., p. 155. IN GREA T BRITAIX. a 2 1 Wound was closed and patient recovered. She was tapped seventeen times afterward. Case XIV. — Mr. West's fourth case. A. M., aged twenty-four. Similar case to his third, and short incision was made. " Sac contained eleven gallons and her con- stitution was much shattered." Mr. West's statements to Mr. Gorham regarding this case are vague, but enough is brought out to show that the tumor was multilocular in character, and, therefore, unsuited for removal by the short incision. Eight pints of fluid withdrawn. Tumor was not removed. "Tapped repeatedly before she sank." In this connection Mr. Gorham refers to two other cases, the details of which are unpub- lished : that of Mr. Hargraves, and the one in Guy's Hospital. Case XV. — The case of Mr. Hargraves, of Tunbridge Wells. A. B., aged forty. Fluctuation distinct in the abdomen. The solid portion of the tumor could be felt through the abdominal wall. Short incision made. Pres- ent Mr. Gorham. Tumor found with adhesions. Opera- tion abandoned and wound closed. Tumor was probably multilocular and, therefore, unsuited for removal by short incision. Case XVI. — Patient in Guy's Hospital. Operation (unfinished) was performed in 1839. Fluctuation of tumor distinct. Short incision as in the preceding cases. More extensive exploration, and greater traction made than was thought justifiable. The tumor being probably multilocular, the operation was unfinished. Patient died, and the autopsy showed but slight adhesions. Tumor un- suited for the short incision. Operator not named, but sup- posed to have been Mr. Morgan, and the case was the first one operated upon in any of the great hospitals of London, ,22 MCDOWELL'S OPERATION Mr. West exhibited at Guy's Hospital the specimen of the cyst removed in his first case in 1839, and there is con- siderable direct evidence that Mr. Morgan, who was at that time one of the surgeons at Guy's, performed the operation in question. After the publication of Mr. Gorham's ten cases, and his comments upon them and their results, accompanied by an allusion to the prior proposal of Dr. William Hunter in connection with the possible extirpation of dropsical ovaries by a short incision, Mr. Jeaffreson, feeling that these remarks reflected upon his originality, addressed a letter to the editor of the Lancet (November 2, 1839) upon the subject, in an- swer to Mr. Gorham, in which he says : "I beg to say that I was perfectly sincere in claiming the more simple mode of operating in these cases as a sug- gestion of my own mind, never having seen or heard of Dr. Hunter's paper on the subject. Indeed, I think that it is the deference which has been paid to the gigantic authority of John Hunter, more particularly to his theory of 'Continuous Sympathy,' which has kept abdominal surgery in comparative abeyance." Mr. Gorham,' in his rejoinder to Mr. Jeaffre- son, disclaims any intention of reflecting upon the merits of Mr. Jeaffreson's proposal of the short incision, and admits the looseness of his statements regarding the prior suggestions of ^ Lancet, Dec. 9, 1839. IN GREA T BRITAIN. 423 Dr. Hunter. This done, he expresses his ap- preciation of Mr. Jeaffreson's contribution to science in these words : "It does seem we are indebted not only for what we know of real utility and benefit, as regards this particular operation, but also for opening to us a new era in the surgery of the abdomen." In the letter of Mr. Jeaffreson's just referred to he alludes to a successful operation of " ex- tirpation of an ovarian cyst," by his friend, Mr. Crisp, of Harleston, Norfolk, and this is here introduced in its regular order. Case XVII. — This patient consulted Mr. Crisp in re- gard to an abdominal tumor of about twenty years' stand- ing, and for which she had submitted to two tappings. Length of incision supposed to be short. No adhesions found with surrounding viscera, or from previous tappings. Cyst punctured, and three gallons of fluid drawn off, after which the collapsed cyst was removed without difficulty. Perfect cure. Next follows Mr. Benjamin Phillips's case. His report is entitled : " Extraction of an Ova- rian Cyst."' Mr. Phillips in the prefatory remarks to the report of his case, deprecates in a commendable way the reprehensible ten- dency of surgeons to report only their suc- cessful cases, "as if any moral imputation could ' London Med. Gaz., 1840-41, vol. xxvii., p. 83. 424 MCDOVVELUS OPERATION attach to failure in cases where failures must often happen." He considered such a practice not only "immoral," but tending to retard the true and legitimate advance of the art of sur- gery. Without going into the history of the operation for extirpation of ovarian cyst, he says : " For all practical purposes it is sufificient to assume that to Mr. Jeaffreson (1836) belongs any merit which may- attach to the plan of treating these cysts, by extraction through a short incision in the abdominal parietes." Case XVIII. — A. D., aged twenty-one, with an abdomi- nal tumor, having previously consulted several surgeons in London, among whom were Mr. Liston and Dr. Hamilton Roe, finally came through the latter to Mr. Phillips. No question as to diagnosis. Operation by Mr. Phillips, Sep- tember 9, 1840, at which were present and assisted Drs. Roe, Clendening, Harrison, and Messrs. Prichard, Brown, and several others. Short incision below the umbilicus, an inch and a half in length. Cyst exposed, seized with forceps, punctured with trocar, and three hundred and thirty ounces of transparent, glairy fluid drawn off; no adhesions, but walls of cyst found thick, requiring the opening to be enlarged a little so as to facilitate extraction. Pedicle small, firmly tied with a ligature, ends cut off close to the knot, tumor removed, and the pedicle allowed to return to the abdominal cavity. Wound closed with sutures. After the operation the patient almost im- mediately began to complain of pain in the right iliac fossa. On the third day she was attacked with severe diarrhoea, a " choleriform affection," for which opium and astringents were freely given, and twelve leeches applied. Case terminated fatally at the end of one hundred and IN GREAT BRITAIN. 425 three hours. Autopsy showed the ligature of the pedicle to be in place, but eight ounces of blood in the peritoneal cavity. Summary of cases and results in Great Britain of extirpation of dropsical ovaries by McDowell's procedure, including alike those operated upon by the long and sho.rt incisions : 9 completed operations, with 6 cures and 3 deaths ; 8 unfinished operations, with 7 recov- eries and I death ; i unjustified operation, with recovery. Mortality of completed operations, Zl-17> per cent. Comments. — Encysted dropsy of the ovary as distinguished from general dropsy, or ascites, was, as we have seen, first recognized as such, and successfully treated by incision and drain- age, in a woman, Margaret Millar, aged fifty- eight, residing near Glasgow, Scotland, by Dr. Robert Houston, in August, 1701. To Great Britain, it is believed, is justly due the credit of first adopting the practice designated as inci- sionism, and the circumstances of Houston's operation, with the result noted, mark an im- portant era in the history of the subject, not only on account of its being the first case in which incisionism was employed, but from the influence it had upon the practice of other coun- 426 MCDOWELL'S OPERATLON tries, leading, as it did, to the proposal of ex- tirpation of the ovary nearly half a century later in France. In still another particular the case is important, as has been shown, viz., in its having been clairned by one writer over a hun- dred years later as a case of successful ovari- otomy by the long incision, and again by another only a few years ago, who made the same claim on the assumption that a namesake of this old Scotch physician had catalogued, in a most creditable way, the anatomical museum of a school of surgery. In the contribution of Dr. William Hunter, offering a more advanced explanation of the pathology of ovarian dropsy, with his sugges- tion of the possibility of extirpating a simple and small cyst through a short incision in the abdorhen, there is much of practical value to commend, and for this also Great Britain has a just claim of credit, his position being on the line of advancement through old incisionism, as inaugurated by Houston. This theoretical pro- position of Hunter, however, was not accepted by any surgeon of that country, nor was even a trial of it made there, until extirpation of drop- sical ovaries became a settled fact three-quarters of a century later. Nevertheless, it was a IN GREA T BRITAIN. 427 movement in the right direction, as proven by the readiness with which surgeons took up the short incision in the lower division of the abdo- men, as proposed by Hunter, after McDowell had demonstrated the practicability of his oper- ation by the long incision. How much Mc- Dowell profited by the teachings of Hunter it is difficult to say, but the boldness displayed by him in his first movement of securing the widest exposure of "the focus of the disease, namely, the tumor formed by the ovar}^"as suggested by Delaporte, shows conclusively that to master adhesions and to avoid injuries of the surround- ing organs were with him considerations of paramount importance, a conception of the operation far beyond the simple thought of a short incision involving all the dangers incident to tugging at and dragging through such an opening a tumor of unknown dimensions. Fur- ther proof that the conception of McDowell was independent of any ideas derived from Hunter is shown in the fact that he made an entrance into the abdomen above the tumor, so to speak, instead of below, as had been advocated by Hunter, and was always the practice of the inci- sionists. The final abandonment of the short incision of Hunter, in England, after a few years' 428 MCDOWELL'S OPERATION trial of it, and the return there to the long in- cision of McDowell, may be considered conclu- sive, it is thought, not only as to the originality of the procedure of the latter, but as to the correctness of the principles upon which it rested. Mr. Lizars deserves special mention, not only on account of his being the fifth surgeon to employ McDowell's operation of ovariotomy by the long incision, and of the results he se- cured from the procedure, but because of his unwarranted neglect for seven years to acknowl- edge his accidental possession of the report of McDowell's first three cases of extirpation of the ovary. His first case, the one of false diagnosis and unjustifiable operation, proved, of course, most unfortunate for the procedure, and threw a damper upon it in the estimation of the profession in Europe for many years. His second case (one of double ovarian dropsy), reported as being successful, was unsatisfactory, to say the least. One ovary, it is true, was removed, but the woman was left in a state of continual dread of having to go through with the same ordeal for removal of the other, and after a few years she finally died, from the re- maining disease, in this state of mind. Double /X GREA T BRITAIN. .20 ovarian disease was not unknown at the date of this operation by Mr. Lizars, though the facts show that this was the first time that tumors of both ovaries had been encountered in an opera- tion. As brought out in the French history, M. Malaval, in the early part of the last cen- tury, found in an autopsy both ovaries to be the seats of tumors, one weighing twelve pounds and the other fifteen pounds. Mr. Lizars, there- fore, acted without a precedent, and, although wrongly, did the best he knew how under the circumstances. He could have removed both ovaries just as well, with but little increase of risk, and it was the proper thing to have done. The case has an additional interest in beine the o first in Great Britain to recover from the opera- tion of extirpation of an ovary, and, in conse- quence of this fact, aside from the incomplete- ness of the result, it elicited a orood deal of attention there from the profession. It is said that the woman (whether at the instance of Mr. Lizars, I do not know) came from Edinburgh to London on a visit, and was there the subject of several examinations by prominent physicians, notably by Prof. Blundell, the greatest advo- cate of the operation that had been performed, and by Dr. James Johnson, the greatest critic 430 MCDOWELL'S OPERATION and denouncer of It at that date of its trial. The third case of Mr. Lizars was a completed operation, but it terminated fatally at the end of fifty-three hours. In his fourth case the opera- tion was unfinished, but the patient recovered. These three operations of Mr. Lizars, affording the occasion of his second paper, were all per- formed within two months (February 27, April 24, 1825), and the results attending them, together with that of his previous case of false diagnosis, show pretty conclusively, it would seem, why he cut short his experience in this kind of surgery — an experience not uncommon among operators in like cases from that day down to the present time. This experience of Mr. Lizars had a notable precedent, in the days of incisionism, in the operation of Delaporte, where, after opening the abdomen and the tumor, and thus giving vent to sixty-seven pounds of gelatinous fluid in the course of eleven days, when death put an end to the scene, he wisely suggested that instead of this kind of work, it would be preferable "to remove the focus of the disease, namely, the tumor formed by the ovary." As we have seen, he even advised that this improved operation should be performed in the early stage of the f.V GREA T BR ITALY. ^^ ^ disease, but on account of his past experience in operating he does not appear to have had any desire, himself, to engage in the practice suggested, and here ended, it seems, his mis- sion as an operator. So it was with Mr. Lizars. Such is the experience of operators still, in even less grave operations than those referred to, and so it may be expected to continue under like circumstances in the future. As regards the conduct of ?*Ir. Lizars toward Dr. McDowell, in withholding his manuscript, sent to Mr. Bell for publication, for seven years without acknowledgment, and then publishing it in connection with a case of false diao^nosis and unjustified operation, there is nothing that can be said in extenuation of such neglect of duty and injustice. The simple statement of the facts is all that is needed here. These carry their own condemnation. As to the unjust criticisms of the McDowell operation and the retraction of the same by Dr. Johnson, they speak for themselves, as wc have seen in connection with the two papers of Mr. Lizars and the results of his former opera- tions. As to the four operations following Mr. Lizars's, by Dr. Grajiville and Mr. King, in 432 MCDOWELL'S OPERATLON which the lone incision of McDowell was em- ployed, there is certainly but little to be said further than that they proved unsatisfactory: one terminating fatally, and three being left unfinished, though with recovery. The two operations of Dr. Granville are deserving of note as being the first performed in London, one July i, 1826, and the other early in 1827. In connection with Mr. King's second case, the fact is worthy of special mention that he em- ployed in the after-treatment large doses of opium with tincture of digitalis and cloths over the abdomen wrung out of cold spring-water, and finally ice-water — an addition to the anti- phlogistic practice then in vogue, both valuable and creditable to his judgment as a surgeon. This brines us to the case of Mr. William Jeaffreson, of Framlingham, who, influenced by the case of Dr. Nathan Smith in the United States, as we have seen, was the first to revive and make trial of the short incision in the lower division of the abdomen, as proposed by Dr. William Hunter on the line of the old incision- ism. The idea which Mr. Jeaffreson had in view in taking up this old method of incisionism was precisely the same that influenced the old IN GREA T BRITA IN. 4 ^ ^ incisionists, namely : to operate early, when the tumor was below the umbilicus, and situated more or less on one side or the other, and the quality of the fluid, as determined by tapping-, v/as such as to lead to the conclusion that the tumor was simple and uncomplicated. In the study and investigation of this class of cases, where the tumor was liable, at any stage of its development to the size when the opera- tion was called for, to become complicated with pregnancy, very close differentiation between the two kinds of enlaro^ement became neces- sary, and thus great advance had already been made when Mr. Jeaffreson came to recognize this complication in a case of the kind which he afterward operated upon. As has been men- tioned, M. Morand, about two-thirds of a cen- tury previously, had called attention to the possibility of such a complication ; citing, as he did at that early day, a case in which it occurred three times, little or no inconvenience being caused until the third time, when the pregnancy failed to reach full term. It will also be recalled that a case complicated with pregnancy came under the observation of Dr. Ehrhartstein, in Germany, and that he successfully performed McDowell's operation just after labor ; a trans- 28 A-jA MCDOWELL'S OPERATION lation from the German report of it appearing in the Medico-Chirurgical Revieiv, July, 1833, the same year Mr. Jeaffreson encountered his first case. The latter says that it had often occurred to him that the operation of extirpa- tion of a dropsical ovary ought to be attempted as soon^ as the tumor began to distend the abdominal wall, and before adhesions had taken place, points he insisted upon as being a sine qua non to success ; and that he was led to these conclusions from encountering a case in which the tumor proved an obstacle to the descent of the child's head (1833). The patient died a few days afterward, and, learning from the autopsy that no adhesions existed, he decided upon a plan of removing such a tumor by operation, as previously mentioned. Mr. Jeaffreson, it would seem from this, was familiar with the published case of Dr. Ehrhartstein, and was no doubt led into the same line of investi- gation thus foreshadowed. This point, I think, is made clear from the fact that, four months after the publication of Dr. Ehrhartstein's case in England (November, 1833), Mr. Jeaffreson was called to see Mrs. B. in her second labor, and found the co-existence of a small dropsical ovary, a condition of things similar to that IN GREAT BRI TA IN. . •, c found in the case previously cited. The tumor was pushed up out of the way, and the labor terminated satisfactorily. Again, on March 4, 1836, the third labor occurred, and terminated in a satisfactory way, without a recurrence of the former difficulty. About two months later, the patient having become anxious about the size the tumor had attained, and having been informed of the danger she was in, decided to submit to an operation for its removal, which Mr. Jeaffreson performed May 8, 1836. The result, as we have seen, proved completely successful. From these circumstances and dates it is fair to infer that Mr. Jeaffreson, in his investi- gation regarding the relative advantages of the short incision and McDowell's long incision, profited not only by the teachings of his coun- tryman. Dr. William Hunter, upon this point, but by the previous experience of Dr. Nathan Smith with the short incision, together with that of Dr. Ehrhartstein, as has been pointed out in relation to the complication of ovarian dropsy by pregnancy. When he made an in- cision midway between the navel and the pubes in the linea alba "between ten and twelve lines " in lencrth for the removal of a tumor o 4^6 MCDOWELVS OPERATION which he knew to be small, and probably with- out adhesions (practical information derived from nearly three years' observation of its growth and behavior through two pregnan- cies), he had only to seize it with a pair of forceps, puncture a cyst or two, and draw it through the incision, as one would remove a tent from a sinus. But if, contrary to expecta- tions, there had been found adhesions of the tumor to the surrounding parts, he would, as he takes the precaution to tell us, have established communication between the interior of the cyst and the peritoneal cavity, thus leaving the col- lapsed walls of the former to take care of themselves in a new relationship. This is an expedient previously suggested by Prof. Blun- dell in connection with the old method of incisionism. How different was the prospect before Dr. Ehrhartstein in the contingency of his meeting with such a complication in his case, possessing, as he did, the advantages afforded by the long incision of McDowell for discovering and successfully dealing with adhe- sions or any other existing complication. And where was the superiority of the short incision and the manipulation of the tumor employed by Mr. Jeaffreson, over the practice taught him IN GREAT BRITAIX. ^-.y seventy-four years previously by the publication of his own countryman, Dr. William Hunter, in the following words ? " If it is indeed proposed to make such a wound in the belly as will admit only two fingers or so, and then to tap the bag and draw it out so as to bring its root or peduncle close to the wound of the belly, that the surgeon may cut it without introducing his hand, surely, in a case otherwise so desperate, it might be advisable to do it, could we beforehand know that the circumstances would admit of such treatment." The favorable circumstances in Mr. Jeaffre- son's case were the previous complications of two pregnancies, and a fairly thorough under- standing, acquired on these occasions, of the simple and even the uncomplicated character of the "baof" of fluids co-existinor. But even in a case so simple as the one described by Mr. Jeaffreson, where the cyst can apparently be so easily removed through an opening in the lower division of the abdomen, the procedure adopted is liable to be followed by serious results, as we learn from Mr. Jeaffre- son himself On the fifth day after the opera- tion there appeared symptoms of very grave and threatening import, which he describes in his report of the case as follows : "I found her with incessant vomiting, hiccough, pulse scarcely to be felt, considerable griping pain in the .^g MCDOWELL'S OPERATION bowels, and an aching, shooting pain along the course of the anterior crural nerve." Here is a state of collapse resulting no doubt from injury, and perhaps slow hemorrhage. The attending peritonitis was held in check and finally controlled by large doses of opium with tincture of digitalis, and cloths wrung out of ice-water applied continuously over the abdo- men, as had been employed previously and recommended by his friend, Mr. King, of Sax- mundham. To this treatment was largely due, no doubt, the final good result. Mr. John Gorham,' some four years after the publication of Mr. Jeaffreson's case, in speaking of excision of the ovary by both the long and short incisions, made the same quotation from the publication of Dr. William Hunter I have given, and Mr. Jeaffreson took exception to this, publishing in the Lancet a communication in which occurs the following statement : " I beg to say that I was perfectly sincere in claiming the more simple mode of operating in these cases, as the st%- gestion of my own mind, never having seen or heard of Dr. Hunter's paper on the subject. Indeed, I think it is the deference which has heen paid to the gigantic authority of John Hunter, more particularly to his theory of ' Con- ^ Lancet, 1839-40., vol. i., p. 156. IN GREA T BRITAIN. 439 tinuous Sympathy,' which has kept abdominal surgery in comparative abeyance." I have thus given more attention to Mr. Jeaffreson's case of extirpation of a dropsical ovary by the Hunterian short incision than I otherwise would have done, because in it he claimed originality for the method, just as was done in the United States by Dr. Nathan Smith and his supporters ; and because the principles underlying the practice deserv^e here to be brought out anew in connection with the trial of the latter by the other English surgeons credited with .cases and operations, which finally resulted in the revival of the long incision of McDowell. Mr. King's first and only operation by the Hunterian short incision, so far as is known, was in an unmarried woman, aged thirty-seven, and, the character of the tumor being favorable for it, the case terminated in a complete cure under the employment of large doses of opium, ice-water to the abdomen, and in the rectum as wtll, with tincture of digitalis and nutritive enemata, Mr. West's case, in which the tumor had also been found complicated with a third pregnancy, was operated upon with complete success, the AAQ AICDOIVELVS OPERATION operation being performed and the after-treat- ment carried out in conformity with the rules laid down by Messrs. Jeaffreson and King. His second case had an equally favorable ending. His third case, Mrs. Tompkins, aged forty, had previously been tapped. Hunterian short inci- sion employed, as usual. Adhesions found and operation abandoned. Patient tapped seven- teen times before death terminated the case. Who can say that the long incision of McDowell might not have relieved this woman, and given her an additional quarter of a century of health and happiness ? Mr. West's fourth case was similar to the last, the Hunterian short incision being used with a like abandonment from adhe- sions. Afterward the patient was tapped re- peatedly. The same question here likewise applies. Mr. Hargraves's case, aged forty, presented a tumor with distinct fluctuation, but solid portions as well were felt through the walls of the ab- domen» Hunterian short incision. Adhesions found and the operation abandoned, with final recovery of patient. This case was wholly un- suited for the form of incision employed. The long incision of McDowell afforded the only chance for removal with certainty and safety ; IN GREAT BRITAIN: ^I and why was it not tried when it only needed the extension of the short incision in the lower division of the abdomen into the region above the umbilicus ? The case in Guy's Hospital, the first operated upon in any of the large London Hospitals, presented a- fluctuating tumor. The Hunterian short incision was employed, but the tumor could not be reduced in size and drawn through the opening. Operation abandoned. Patient died, and tumor was found to be multilocular, with but slight adhesions. Here, who could say that the long* incision of McDowell would not have given this poor woman the requisite chances for the preser- vation of her life ? Mr. Crisp's case was stated to be of twenty years' standing, and she had been tapped twice. Hunterian short incision. No adhe- sions found, cyst punctured, three gallons of fluid drawn off, and the sac removed Vv^ithout difficulty. Complete cure. Mr. Phillips's case was a young woman. The Hunterian short incision employed. No adhe- sions found, but the walls of the cyst said to be thick. Cyst punctured and drawn through the opening. After closure of the wound the 442 MCDOWELL'S OPERATLON patient began almost immediately to complain of pain in the right iliac fossa. On the third day she was attacked with severe diarrhoea, and on the fifth day she died. Autopsy showed ligature on pedicle all right, but eight ounces of blood in the peritoneal cavity. Here the long incision of McDowell would have permitted an easy exploration and removal of the cyst, and thus have prevented the injury of surround- ing structures, the cause, no doubt, of the hemorrhaofe. In these ten cases operated upon by the Hunterian short incision, all, of course, with a view to the more or less simple and fluid char- acter of the tumor, the latter was removed in six cases, with one death, and was not removed in four, with one death and three recoveries, the latter cases, however, all terminating fatally from the remaining disease, one after seventeen tappings, another after repeated tappings, and the last after a period not long. Thus is shown a success of 60 per cent, and failures in 40 per cent., with a mortality of 20 per cent., in cases adjudged suitable for the operation, and all by surgeons of recognized high ability. The question here naturally arose. Why should there be so large a proportion of oper- IN GREA T BRITAIN. 443 ations, in selected cases, unfinished or failures — four out of ten? The answer was that, despite the best diagnosis possible, the tumors found in the four unfinished cases proved too large and too much complicated by adhesions to be ex- amined, manipulated, and removed through the opening in the lower division uf the abdomen, then deemed sufficiently large. Dr. Charles Clay, in England, was the first to make this answer, and to rehabilitate, so to speak, the McDowell long incision, made in both the lower and upper divisions of the abdomen. This he did in a case operated upon successfully Sep- tember 12,1 842,^ and as a result of it took place the so-called revival of the loner incision of the " Father of Ovariotomy,." which followed a year later in the United States, in the hands of Dr. John L. Atlee, and soon after in the other two countries, France and Germany, where alike, as we have seen, his operation has been the subject of investigation and defence. Following is a general summary of cases and results in the United States, Germany, and Great Britain, there being no case of extirpation of a diseased ovary in France during the period under consideration. ' London Medical Gazette, 1842-43, vol. xxxi., p. 437. .^4 MCDOWELLS OPERATION. General Summary of Cases and Results in the United States, Germany, and Great Britain. UNITED states. 1 2 completed operations, with 9 cures and 3 deaths. 6 unfinished " " 6 recoveries. Mortality of completed operations, 25 per cent. GERMANY. 12 completed operations, with 5 cures and 7 deaths. 3 unfinished *' " i recovery and 2 " I unjustified operation, " i " Mortality of completed operations, 58.33 per cent. great BRITAIN. 9 completed operations, with 6 cures and 3 deaths. 8 unfinished " "7 recoveries and i death. I unjustified operation, " i recovery. Mortality of completed operations, 33.33 per cent. GRAND TOTAL. 33 completed operations, with 20 cures and 13 deaths. 17 unfinished " " 14 recoveries and 3 " 2 unjustified " " 2 " Mortality of completed operations, 39.39 per cent. CHAPTER XV. EULOGISTIC LETTERS, ETC. 3 Upper Grosve.vor Street, • London. W., 2d July, 1887. Mrs. Mary Y. Ridenbaugh: Dear Madam : In reply to your letter of the loth of June, I may say that I shall read with great interest any life of McDowell that you may publish, but I am sorry I cannot add to what I have said about him in my book on Diseases of the Ovaries In 1878 I delivered six lectures at our Col- legfe of Surgeons, and I concluded those lee- tures by some reference to McDowell. They were published in the British Medical Jownial, of July, 1S78 (p. 132), and as you may have some difficulty in finding them I enclose the remarks which I then made, and which I can still entirely confirm. I am sorry I cannot be of any further assist- ance to you. I remain, my dear madam. Faithfully yours, T. Spencer Wells. (445) 446 EULOGISTIC LETTERS, ETC. The Remarks of Sir T. Spencer Wells.^ The hour is nearly complete, but I cannot conclude the very hasty and imperfect review of the subject of abdominal tumors, which I have been able to condense in six lectures — the operation now accepted as the only effectual means of relief in cases of ovarian tumors, espe- cially — and of the results which have, been obtained in alleviating distress and prolonging valuable life, without some reference to the man who is justly looked upon as "the father of ovariotomy." McDowell was wise, practical, and prophetic. He care- fully studied the subject which filled his mind ; did with an enviable success what his opportunities permitted ; and looked with an anxious eye on the prospect opening up to his successors. We, more happy in our opportunities, have entered into full possession of what to him was little more than a promised land ; and, speaking personally, I feel it my greatest happiness to have been able, chiefly through the encouragement of professional brethren (which at one time I had little reason to anticipate), to reach the point at which McDowell aimed. I have not only attained the amount of operative suc- cess which he gave as the standard ; I have not only the almost daily gratification of seeing some living and endur- ing evidences that my labors have not been in vain ; but I have, for the rest of my days, the satisfaction of knowing that my example has emboldened others, and will be the means of still further extending to human suffering the con- solatory assurance of the prospect of relief, and insuring ^ Delivered at the close of a series of six lectures on the " Diagnosis and Surgical Treatment of Abdominal Tumors," at the Royal College of Surgeons of England, June 21, 1878. EULOGISTIC LETTERS, ETC. 447 the certainty of its realization by the many skilful hands which are now betaking themselves to the work. This is a lot which falls to but few innovators. It is not given to every one to see the fruit of his labors; but the surest way of gaining that end is by studying the words and following the counsel of wisdom. The wish to do well what others have done is not all that is wanted. Step by step their course must be followed, difficult still, but somewhat easier from the results of experience ; and, while I content myself with a warning to aspirants that a fancied inspiration will not alone carry them on to success, I feel that I cannot quit them and the subject better than by repeating the words of McDowell, who, though better known in the open, rugged field of practice than in the paths of literature, was a man of broad and elevated views, and thus expressed the advanced opinions he had already formed respecting the operation he had inaugurated after years of patient waiting and zealous preparation. He strove to make ovariotomy a boon to humanity. He had reason to believe it had proved so, but he foresaw the dangers of its abuse from rash and indiscriminate rivalry amongst his followers. Listen to his own words: "I think my description of the mode of operating, and of the anatomy of the parts concerned, clear enough to enable any good anatomist, possessing the judgment requisite for a surgeon, to operate with safety. I hope no operator of any other description may ever attempt it. It is my most ardent wish that this operation may remain to the mechan- ical surgeon forever incomprehensible. Such have been the bane of the science; intruding themselves into the ranks of the profession with no other qualification but boldness in undertaking ; ignorant of their responsibility, and indifferent to the lives of their patients, proceeding according to the special dictate of some author as mechan- ical as themselves, they cut and tear with fearless in- difference, utterly incapable of exercising any judgment of their own in cases of emergency, and sometimes 448 EULOGISTIC LETTERS, ETC. without possessing even the slightest knowledge of the anatomy of the parts concerned. The preposterous and impious attempts of such pretenders can seldom fail to prove destructive to the patient and disgraceful to the science. It is by such this noble science has been degraded, in the minds of many, to the rank of an art." In conclusion, allow me to read a sentence or two from one of those able reviews which make one regret that the day of the medical quarterlies is passed {^British and Foreign Medical Review, April, 1873): "All honor to McDowell, of Kentucky, who, to use the words of Hufeland, ' looked upon his profession as a high and holy office, who exercised it purely, not for his own advancement, not for his own honor, but for the glory of God and the good of his neigh- bor, and who, long since called to give an account of it, is, no doubt, reaping the reward of his faithful steward- ship.'" EULOGISTIC LETTERS, ETC. ^.g 12 Granville Place, Portmax 59, W. Mrs. M. Y. Ridenbaugh. .Dear Madam : I beg- to acknowledge the receipt of your valued letter of the 12th inst., asking me for a contribution to your proposed work. While I thank you for the compliment you have paid me, I feel that anything I could say would only burden your work, and could not add to the renown attaching to the name of Ephraim McDowell. I shall look forward with much anticipation to the reading of the biography of so remark- able a man, who was so far in advance of his age, whose originality and surgical skill are still so conspicuous, and whose name is insepar- ably linked with the greatest surgical achieve- ment of this or any other age. Hoping that a grand success will crown your noble efforts, I have the honor to be, dear madam. Yours very faithfully, George Granville Bantock. 29 450 EULOGISTIC LETTERS, ETC. Correspondence between Professor Alexander Russell Simpson, Dr. Willoughby Walling, AND THE Authoress, Relative to a Lecture delivered by Professor Simpson at the University of Edinburgh, Scotland, October 19, 1887.^ 52 Queen Street, Edinburgh, Scotland, October 20, 1887. Dr. Willoughby Walling. My dear Sir : My introductory lecture, which contains, I beHeve, everything that can be gleaned from reference to our University matriculation books regarding Ephraim Mc- Dowell, will be published soon in one of our medical journals,^ of which I shall be glad to send a copy to Mrs, Ridenbaugh. Yours very faithfully, A. R. Simpson. The above note was in reply to a letter to Professor Simpson from Dr. Willoughby Wall- ing, United States Consul for Leith, who writes from Edinburgh to the authoress of this work, as follows : ^ Part of an introductory lecture on the Ninth International Medical Congress and American Gynecology. ^ Published in the British Medical Journal, London, July 2, 1887, vol. ii. p. 977. EULO GIS TIC L E TTERS, E TC. 451 U. S. Consulate for Leith, Edinburgh, Oct. 20, 1887. Mrs. Ridenbaugh. Dear Madam : . . . . You will see from the enclosed card from Professor A. R. Simp- son that I am in a way to get what you want. I will, however, be compelled to wait until the publication of the lecture referred to in the communication of Professor Simpson. .... I want to suggest that if you have not gotten a speech made by Dr. R. O. Cowl- ing/ at Danville, Kentucky, about the year 1879, at the meeting of the Kentucky State Medical Society, the occasion being the presentation of the door-knocker of Dr. McDowell's old resi- dence to Dr. S. D. Gross, of Philadelphia, you should by all means have it. Dr. Cowling was an old friend of mine, a professor of surgery in the University of Louis- ville, Ky., and the speech referred to was one of the most eloquent I ever heard, and was equally laudatory of Dr. McDowell and Dr. Gross. So strong was it that when Dr. Gross arose to reply he was so overcome by emotion that he could not speak for some moments. . . . Very respectfully, WiLLOUGHBY WaLLING. 1 See page 553. AC 2 EULOGISTIC LETTERS, ETC. 52 Queen St., Edinburgh, Dec 6th, 1887. Mrs. Mary Y. Ridenbaugh. Dear Madam : At the commencement of our session I o-ave a brief sketch of the work of Dr. Ephraim McDowell. . . . I send you now along with this a separate copy of the lectures, as I have got some printed for distribution among the students. . . . McDowell was a hero of whom our profes- sion may well be proud, and a good biography of him will receive a wide welcome. . . . Believe me, Yours very faithfully, A. R. Simpson. PROFESSOR ALEXANDER RUSSELL SIMPSON'S LECTURE. I have said that the Transactions of the American Gynecological Association give evidence of the vast amount of earnest and faithful work that is wrought in our department by our trans-Atlantic confraternity. And I would add that the noble services they have rendered in the past are an inspiration and incentive to them and us to further achievement in the future. Have you ever thought how much obstetrics and gyne- cology owe to America? We sometimes hear half con- temptuous reference to the scream of the American eagle ; but, in our section of medicine, at least, she has established the strongest claims to let her voice be heard. EULO CIS TIC L E TTERS, ETC. 430 I cannot pretend just now even to give an inventory of the contributions that have travelled to us over the Atlantic waters, but let me indicate a few. Laparotomy. — First of all, we must acknowledge Amer- ica's just claim to be the birthplace of ovariotomy. The conception was not peculiarly American. It had been thought of elsewhere. It had been talked of and written about, but only to be talked down and written down. It had even been attempted, but usually only in a doubtful and tentative sort of way, in isolated and unsuccessful cases. In 1809, at Danville, in Kentucky, a practitioner who had already achieved a surgical reputation for success in lithotomy and hernia — numbering among his thirty-two lithotomies (all successful) an operation on young James K. Polk, who afterward became President of the United States — removed an ovarian cystoma. The patient recov- ered. Four years later he repeated the operation on an- other patient with successful result. After the lapse of two more years he for the third time saved a life by extir- pating an ovarian tumor. He did not publish his cases until 181 7, and then in a somewhat slipshod fashion in an American journal. He sent a copy of his paper to his old teacher, John Bell, of Edinburgh. John Bell was ill at the time, and away on on the Continent in quest of health. The paper fell into the hands of John Lizars, who was doing duty in the ab- sence of his friend. Stimulated by the perusal, Lizars opened an abdomen where he and some of the other Edinburgh surgeons and obstetricians believed the pa- tient to be the subject of an ovarian tumor. He seems to have supposed that the American's success was in some measure due to climatic conditions, from this sentence, "As inflammation appears to be generally in- duced by exposure to cold, and, as these cases succeeded so well in America, I desired the room to be heated to 80° F." The diagnosis proved to be wrong, but the ACA EULOGISTIC LETTERS, ETC. patient recovered, and Lizars republished in the Edinburgh Medical Journal, for October, 1824, the cases of the more- successful American surgeon, prefixing a brief historical notice of the operation, and appending the history of his own case. How this first public announcement of the splendid achievement was received in England let the editor of the London Medico- Chirurgical Review, writing a notice of Mr. Lizars's paper, reveal to us : " Passing over the records of surgery, all of which can- not be depended on, we shall come at once to the recent facts, or alleged facts, communicated in this paper by Mr. Lizars. Three cases of ovarian extirpation occurred, it would seem, some years ago in the practice of Dr. Mac- d.owal, of Kentucky, which were transmitted to the late John Bell, and fell into the hands of Mr. Lizars. We candidly confess that we are rather sceptical respecting these statements, and we are rather surprised that Mr. Lizars himself should put implicit confidence in them. A woman, supposed to be parturient, was visited by Dr. Macdowal at the instigation of two physicians who con- sidered her in the last stage of pregnancy. Dr. Macdowal found the uterus unimpregnated, but a large tumor in the abdomen movable from side to side. The woman travelled sixty miles on horseback to have an operation performed. Dr. Mac made an incision, nine inches in length, parallel with the rectus abdominis, and right into the abdominal cavity. The tumor appeared in view, but could not be removed. A ligature was thrown round the Fallopian tube, the tumor cut open (found to be the ovarium) and fifteen pints of dirty gelatinous stuff extracted, 'after which we cut through the Fallopian tube and extracted the sac, which weighed seven pounds and a half.' As soon as the external opening was made the intestines rushed out upon the table, and they could not be replaced till after the operation was performed, which lasted twenty-five minutes ! The wound was sewed up by means of the inter- E UL O GIS TIC L E TTERS, E TC. 45: rupted suture, assisted by means of adhesive plaster. Dr. Mac visited the patient at the end of five days, though she had come to his own residence to have the operation per- formed I ! He found her engaged in making her bed ! She soon returned to her native place quite well. Credat Judceus, non ego. "The second case is little less extraordinary, if not incredible. A negress had a hard, painful, fixed tumor in the abdomen. Dr. Mac placed her on a table, laid the abdomen open, inserted his hand, and found the ovaria very much enlarged, painful to the touch, and firmly ad- hering to the bladder and fundus uteri. To extract this (two ovaria) he thought would be instantly fatal ; ' but, by way of experiment,' says the doctor, 'I plunged the scalpel into the diseased part, when some gelatinous sub- stance, as in the above case, with a profusion of blood, rushed to the external opening, which I conveyed off by placing my hand under the tumor and suffering the dis- charge to run over it.' A quart or more of blood escaped into the abdomen. The same dressing and the same success as in the first case. We cannot bring ourselves to credit this statement." The same Review writer in April, 1825, has still, no doubt, the Kentucky operator (McDowell) in his mind when he falls foul of the great obstetrician. Dr. Blundell, for thinking that ovariotomy will ultimately come mto general use, and saying: "If the British surgeons will not patronize and perform it, the French and American surgeons will;" for he adds: "In despite of all that has been written respecting this cruel operation we entirely disbelieve that it has ever been performed with success — nor do we think it ever will." How hard it is to move a man who has committed him- self to the position of a sceptic may be seen from the manner in which this writer returns to the subject in Octo- ber, 1826, after the North American Medical and Surgi- cal JournalhdA come into his office to tell him that " Dr. Mar," as he . contemptuously called the ovariotomist, had 456 EULOGISTIC LETTERS, ETC. operated not only three but five times, and in four of the cases with success. " Extirpation of an Ovarium. — 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, with ex- traction of diseased ovaria. In the second volume of this series, page 216, we adverted to the cases of Dr. Macdowal, of Kentucky, published by Mr. Lizars, of Edinburgh, and expressed ourselves as sceptical respecting their authen- ticity. Dr. Coates, however, has novv given us much more cause for wonder at the success of Dr. Macdowal ; for it appears that out of five cases operated on in Kentucky by Dr. M., four recovered after the extraction, and only one died. There were circumstances in the narratives of some of the first three cases that raised misgivings in our minds, for which uncharitableness we ask pardon of God, and of Dr. Macdowal, of Danville. The two additional cases now republished (for it appears that the cases were pub- lished, though in a very unsatisfactory form, in the Ameri- can Eclectic Repertory) are equally wonderful as those with which our readers are already acquainted." And toward the close of the article he says : "It was this mode of narration that excited our scepticism, and we must con- fess it is not yet removed." Now the man whose splendid success in a new field was received with so much scorn and scepticism, not only on this side of the ocean but his own, was no haphazard adventurer out in the wild West. Born in Virginia in 1771, and moved with his father's household to Kentucky in 1782, where his father became judge of the district court, he seems to have had but an imperfect training in letters in a land that, during his childhood, was fighting its way to freedom. After leaving school he studied medicine with Dr. Humphreys, of Staun- ton, Virginia, a graduate of the University of Edinburgh. Philadelphia was then the only seat of medical education in the United States, and doubtless it was at the instance EULOGISTIC LETTERS, ETC. 4-7 of this Edinburgh alumnus, with whom he had been read- ing from two to three years, that the eager student crossed the deep, and came to enroll himself among the Gives Academiae Edinensis. In the roll of Session 1792-93 I find that Ephraim Mc- Dowell has inscribed his name as it is reproduced in the zincotype (see frontispiece). It was not then the custom for the entrant to give his place of birth and residence. So he has simply signed his name, and opposite the sig- nature the secretary has noted that he is entered to study chemistry. In that subject he would come under the inspiring in- fluence of Joseph Black, and, as he had no other university class that session, it was probably during it that he studied surgery with John Bell. In a biographical sketch of him by the late Professor Gross, of Philadelphia, it is stated very confidently that it was during his second year that he attended the lectures of that distinguished extra-mural teacher. But, when he matriculates for the second time, at the beginning of session 1793-94, he is entered for the classes of anatomy and surgery under the second Monro ; practice of medicine under James Gregory ; and botany under Daniel Rutherford ; besides the clinical prelections in the Royal Infirmary. With so much to do in his second session, and so little in the first within the university, it seems to me more probable that he had put himself under Bell's tuition dur- ing, his first session here. Our librarian has shown me the library day-book of the time, from which it appears that throughout he had been greatly interested in the study of chemistry. On February 25, 1793, he had out Hopson's Chcviistry ; on March nth, Hoffman's Practice of Medicine; March 25th, Chaptal's CJiemistry, April 8th, vol. ii. of the same work, and on April 27th, Hamilton on Female Complaints. During the summer he had ceased to borrow from the library, and he then may have been making the excursion through Scotland, described by Gross, in company with 458 EULOGISTIC LETTERS, ETC. two of his compatriots, one of whom had been his fellow- apprentice with Dr. Humphrys, of Staunton, and who enrolled himself in the same two sessions with McDowell as Sam Brown. On September 25th a friend, James Cairns, a matriculate of 1793-94, gets Fourcroy's Chemistry for him; on Octo- ber 3d he is at the library himself for Savary's Letters on Egypt ; on October 15 th he gets a volume of Chemical Theses and two volumes of Medical Commentaries, and the last entry is on October 29th, 1793, when his friend Cairns gets for him Cullen's Practice of Physic. Among the readers who must have rubbed shoulders with him at the librarian's table were Henry Brougham and Francis Horner ; among the students who sat in the same classes with him were Monro Tertius, (Sir) William New- bigging, and John Bell's youngest brother, (Sir) Charles. Members of the athletic club will be pleased to hear, from Dr. Gross, that he used often to narrate with special glee how, during his sojourn in Edinburgh, "a celebrated Irish foot-racer arrived, boasting that he could outrun, outhop, and outjump any man in the city, and bantered the whole medical class. McDowell was selected as their champion. The distance was sixty yards, and the stake ten guineas. The trial took place in the college grounds, and the Amer- ican allowed himself purposely to be the loser. A second race for one hundred guineas and at an increased distance came off soon afterward, and this time the Irishman, after much bullying, was badly beaten, much to his own chagrin and the gratification of the students." That by way of parenthesis to help you know the man. Gross is uncertain as to whether he graduated here or not. But clearly he had not taken out the requisite courses to qualify, and his name is not to be found in our roll of graduates. Doubtless his biographer is correct in thinking that the teacher from whom he learned the most was John Bell, whose " enthusiasm and ardor," says Gross, "were abso- lutely boundless." EULOGIS TIC L E TTERS, E TC. 459 It is difficult to conceive, at this distant day, the charm which this great teacher infused into his subjects and the ambition which he inspired in his pupils. All loved him ; many worshipped him ; not a few idolized him. Among the latter was the subject of this memoir. During his attendance upon his prelections the young American was enraptured by the eloquence of his teacher, and the lessons which he imbibed, while thus occupied, were not lost upon him after his return to his native country. Mr. Bell is said to have dwelt with peculiar force and pathos upon the organic diseases of the ovaries, speaking of their hopeless character, when left to themselves, and of the possibility, nay practicability, of removing them by operation. The instruction thus given made a powerful impression upon Dr. McDowell, which was not lost upon him after he took leave of the academic groves of Edin- burgh. What actual success McDowell on the whole achieved is not accurately known. It is said he operated thirteen times in all with eight recoveries. It would seem, there- fore, that he was not so happy in his later series of cases as he had been in his earlier. But, it was a splendid triumph, then, to have rescued eight women from inevitable death, and, whatever premonitions of it there may have been beforehand, America has the right to claim for Ephraim McDowell the foremost place among ovariotomists. As Prof. Parvin said : " The suggestions of Hunter and the instructions of Bell had an important influence upon McDowell's mind, but this detracts nothing from the glory of his achievement. The fame of Columbus is not dimmed by the fact that others before him, others in his time, be- lieved with him that by sailing westward a sea-way to the Indies would be found. No matter what surgeons may have believed and suggested as to removal of diseased ovaries, no matter though John Bell taught the mode of operating, their faith without works was utterly dead, and the new Columbus (McDowell) started upon his exploration without pilot or chart." 460 EULOGISTIC LETTERS, ETC. Response of Professor D. W. Yandell, OF Louisville, Ky., In behalf of the invited guests, at a Comphmentary Dinner to Professor Samuel D. Gross.^ Mr. Chairman : When the invitation came to unite in this offering, I was deeply touched. It revived memories of my student life, when, as a pupil of your guest, I came before him for examination for the doctorate, now thirty- three years — a generation — ago. The teachings of that period have remained a part of my life. The method, the system, which the great master observed, as in his earnest way he gradually unfolded to the minds of his hearers the grand truths which lie in the upper planes of surgery ; the painstaking, conscientious care with which he infused interest into the dry details of his subject, his fiery zeal, his never-flagging industry, and, better than all this, the solemnity with which he declared that to be a truly great physician it was essential to be at the same time a truly good man — all these are as fresh to me this evening as when I made one of his hearers, now so long ago. Mr. Chairman, I obeyed the summons to be here with alacrity. I came with pleasure. Nay, more, I came with feelings akin, I fancy, to those which animate the pilgrim as he turns his footsteps toward the tomb of the Prophet. With fitting reverence, sir, I stand in this august pres- ence. I come, sir, as the humble representative of a great people, the people of Kentucky, who send you greeting on this auspicious occasion. I come, empowered by them to lay at the feet of your illustrious guest the homage of that renowned commonwealth. I come to wish him yet many years upon the earth, and to say that, though his name and fame have become a common heritage, Ken- ^ Given by his medical friends in commemoration of his fifty-first year in the profession. April 10, 1879. EULOGISTIC LETTERS, ETC. ■ ^gi tucky still claims them as peculiarly her own, since it was in her borders that he laid the foundation of a reputation which has not only irradiated this continent, but has penetrated wherever civilization is known or surgery is cul- tivated as a science. I feel, Mr. Chairman, that it is an honor to be called on to speak on such an occasion and for such a people — a people that has given to statesmanship a Clay, a Lincoln, and a Breckenridge ; to arms a Johnston, a Preston, and a Buckner ; and to surgery a McDowell and a Dudley. A goodly company ! Stately names ! Would you think me as exceeding the limits of good taste if I added — and chief among all these is that of him who bears the mark of our guild — Ephraim McDowell ? For, sir, will not the labors of the statesman yield to the pitiless logic of events; the voice of the orator grow fainter in the coming ages ; and the deeds of the soldier eventually find place but in the libraries of the student of military campaigns; while the achievements of the village surgeon (McDowell) like the widening waves of the inviolate sea, shall reach the uttermost shores of time, hailed of all civilizations as having lessened the sufferings and length- ened the span of human life ? Again, would you think me very far wrong were I to couple the victorious issue of the late war, and the opera- tion of ovariotomy as, in different fields, the two most stupendous events of modern times ? Sir, both are to be credited to Kentuckians. Mr. Lin- coln effected the one. Dr. Ephraim McDowell accom- plished the other. Nor yet, in my opinion, do the two achievements admit of comparison. Powerful cabinets, far-seeing ministers, renowned captains, a daring and multitudinous soldiery, a rich, a steady, a united, and a persistent people contributed to the success of the former. Its glory was won amid the blare of trumpets, the groans of men, the shock of contend- ing armies. The glory of the other belongs to but one 462 EULOGISTIC LETTERS, ETC. man, is single and indivisible, was born under ihe eyes of fair women, and by the cunning of a single hand, which, amid supreme peril, plucked victory from an enemy that, before McDowell's time, had defied all that was subtlest in art, and repulsed every assault of science. But, sir, I fain must have done. I feel that it is good to have been here. I shall return to my people and recount to them what I have seen and what heard, and repeat to them what I now offer in their name : '•'To our guest, the illustrious son of Pennsylvania, the foster son of Kentucky, who, to the nimbus which ever encircles great deeds, has added the milk-white flower of a stainless life." E UL OGIS TIC LE TTERS, E TC. 463 St. Louis, Mo., May, 1889. Mrs Mary Y. Ridenbaugh. My dear Madam: I regret very much that unavoidable circumstances prevented me from calling upon you personally before you left the city, thus enabling me to form a more correct idea of the scope of the memoir which you are preparing of your distinguished ancestor, Dr. Ephraim McDowell. You request me to make some contribution to your work, forgetting, perhaps, that not knowing what others have written, I may follow too nearly in their footsteps to present anything worthy of being considered original or readable. For, I feel that I would be unable to add a single leaf to the garland of honor and glory which an enlightened and grateful profession have already woven around the name and memory of your distinguished grandfather. So lonof as the fame of Sir Isaac Newton is cherished among philosophers, or that of Chris- topher Columbus is held in reverence by navi- gators, will the lesson of the life and achieve- ments of McDowell receive respectful homage at the hands of surgeons throuHiout the entire world. And could the women ot the present 464 EULOGIS TIC L E TTERS, E TC. generation fully realize the blessings which have accrued to their sex through the seeds planted by the patient industry of this great physician, they would erect above his grave a monument far eclipsing the proudest of the Pyramids. But, it is not in the line of eulogy that I would speak of Dr. Ephraim McDowell, for he needs none. The practical lesson of his professional life is to me the chief object of interest and study, since it carries with it a moral of peculiar value to the younger members of the medical profes- sion. Although he had the best advantages of study which his times and generation afforded, yet his sources of information were limited as compared with the superior resources accessible to the student of the present day. He evidently possessed, however, a well- trained and analytical mind which enabled him to turn to the best account such opportunities as came in his way. He cultivated inde- pendence of thought and action. What he learned he learned well ; so well, that it proved a deep and abiding foundation upon which he could venture to build. To a natural courage was added that self-reliance which is born of mature knowledge and clear perception. He E UL OGIS TIC L E TTERS, E TC. 46 5 was evidently a close and practical student of those fundamental principles of medicine, anat- omy, physiology, and pathology. The surgical triumph which in due time rendered his name famous followed naturally. Galileo was not the first to su^grest the tele- scope, neither was McDowell the first to sug- gest ovariotomy, and yet their names will be handed down to future ages as indissolubly connected with two of the crowning triumphs of science. What the one did for astronomy the other accomplished for abdominal surgery. Each developed and crystallized into practical results what before were merely theories, or vaofue ideas. It is difficult for the layman, who is ignorant of the anatomical relations and pathological conditions peculiar to the several varieties of ovarian tumors, to fully appreciate the brill- iancy of McDowell's achievement. It is only the anatomist and the pathologist who, in the light of knowledge, can enter fully into the spirit which animated this bold pioneer as he ventured into a hitherto unexplored region ot surgery, with rude instruments and with no precedents to guide him. It is plain that he had pondered well over A^^ EULOGISTIC LETTERS, ETC. the prophetic suggestions of the great Hunter, and of his illustrious preceptor, John Bell, of Edinburgh. In this instance Hunter may have planted, and Bell watered, but it was McDowell whose intelligent and unerring hand plucked the practical fruit of victory. After careful dissections and patient investi- gation at the bed-side and in the dead house, he arrived at a matured and intelligent plan of procedure, which for the first time placed the operation of ovariotomy upon a scientific basis. However brilliant may have been the im- provements which have attended later efforts in this direction, it will be impossible to efface the debt of orratitude due to the couragfe and skill manifested in the conception and execution of Ephraim McDowell. Trusting that you may meet with success in your very laudable undertaking I am, with respect, Very truly yours, Walter Coles, M.D, McDowell Monumlnt. Danville, Kentucky. Erected in 1ST9. COPVBOMTtD 1879 BV t M FOX CHAPTER XVI. MEMORIAL SERVICES AT THE UNVEILING OF THE Mcdowell monument. This chapter is made up from a volume en- titled "Memorial Oration in Honor of Ephraim McDowell, the ' Father of Ovariotomy,'" pub- lished by the Kentucky State Medical Society, Louisville, 1879. That Dr. Ephraim McDowell, of Danville, Ky., was the first to perform the operation of ovariotomy, and by his successful cases make the extirpation of diseased ovaria a legitimate surgical procedure, has long been conceded both in this country and in Europe. To Dr. S. D. Gross, of Philadelphia, is due the credit of successfully establishing the claims of Mc- Dowell to priority in this important field of surgery. The idea of marking the last resting-place of the first ovariotomist with some memorial com- memorative of his great services to humanity originated with the late Dr. John D. Jackson, (467) .58 MEMORIAL SERVICES. of Danville, and was brought by him to the attention of the Kentucky State Medical Society, and from thence before the American Medical Association. Quite a number of sub- scriptions were made to this object by members of the National Association, but at the meeting in Louisville, in 1875, ^^ Association adopted a resolution creating a Prize-essay Fund for the perpetuation of McDowell's great achieve- ment. The resolution left to the profession of Kentucky the work of placing some local memorial over his grave. The death of Dr. Jackson occurring soon afterward, the Ken- tucky State Medical Society intrusted the work to Dr. Lewis S. McMurtry, of Danville, the pupil and friend of Dr. Jackson. To his energy and perseverance, under many dis- couraging circumstances, the complete and perfect success of the enterprise is attribut- able. In addition to those made by the mem- bers of the Kentucky State Medical Society subscriptions toward the erection of a monu- ment to McDowell were made by Dr. Lewis A. Sayre, of New York, Dr. Samuel D. Gross and the late Dr. Washington L. Atlee, of Philadel- phia, the late Dr. Edmund R. Peaslee, of New York, and Dr. J, A. Murphy, of Cincinnati. MEMORIAL SERVICES. .gg The monument is a handsome shaft made from Virginia granite. Midway on the shaft is a bronze medallion of McDowell, and be- neath the medallion his monosfram with the motto, " Honor to whom honor is due." Upon the front face of the monument is the following inscription, encircled with a laurel wreath : "A grateful profession reveres his memory and treasures his example." On the opposite side is inscribed, "Erected by the Kentucky State Medical Society, 1879." On the eastern face this inscription : " Beneath this shaft rests Ephraim McDowell, M.D., the 'Father of Ovariotomy,' who, by originating a great sur- gical operation, became a benefactor of his race, known and honored throughout the civilized world,'' The western face is devoted to the historic inscriptions as follows, being encircled with the ^sculapian serpent : "Born in Rockbridge County, Virginia, 1771 ; attended the University of Edinburgh, 1793; located in Danville, Ky,, 1795; performed the first ovari- otomy 1809; died 1830." The monument is beautifully located near the centre of the city of Danville, in a park of several acres, which, by subscription of the citizens of that place, has been beautified and made suitable lor the purpose. 470 MEMORIAL SERVICES. The dedication of the monument occurred on the 14th of May, during the session of the Kentucky State Medical Society at Danville. These services were unusually interesting and imposing. An immense audience composed of the members of the Society, and of ladies and gentlemen from all parts of the State, assembled to witness them, and to honor the memory of a great man. In addition to the members of the Society, the Governor, the Secretary of State, the speakers of the two houses, and other officials, the following well- known physicians and surgeons of other States occupied seats on the platform : Dr. Oilman Kimball, Lowell, Mass. (who has performed ovariotomy two hundred and thirty-nine times) ; Drs. Whittaker, Seely, Ayres, and Stevens, of Cincinnati ; and Dr. McDowell, of St. Louis, and Drs. V. P. Gibney and Lewis A. Sayre, of New York City. The committee regrets exceedingly that a letter addressed it by Dr. Fordyce Barker, President of the New York Academy of Medi- cine, failed to reach its destination. Coleman Rogers, Preston B. Scott, J. W. Holland, Committee of Publication. MEMORIAL SERVICES. 471 Louisville, Ky., May 17, 1879. Dr. L. S. ^NIcMurtry, Chairman McDowell Monument Committee, Danville. Dear Sir: In accordance with the resolution adopted by the Kentucky State Medical So- ciety qn the 15th of May, I would respectfully request you to forward me for publication the Proceedings of the McDowell Memorial Exer- cises, held in your city on the 14th instant. I am, very respectfully, Coleman Rogers, Chairman Committee of Publication. Danville, Ky., June 19, 1879. Dr. Coleman Rogers, Chairman of the Committee of Publication, I^ouisville. Dear Sir: I have the honor to send herewith the Proceedings connected with the Dedication of the McDowell Monument, as requested in your favor of the 17th instant. I am, yours, etc., L. S. McMurtry, Chairman McDowell Monument Committee. DEDICATORY ADDRESS. By prof. SAMUEL D. GROSS, M.D. Gentlemen of the Kentucky State Medi- cal Society, Ladies and Gentlemen: Nearly fifty years ago the citizens of Danville, then a small, obscure village, carried to its last resting-place all that was mortal of the man whose monument will henceforth mark an era in the history of the medical profession and of the people of Kentucky. The announce- ment of his death, after a brief illness, in the fifty-ninth year of his age, on the 20th of June, 1830, caused deep and wide-spread grief in the community in which he had so long lived, and of which he had been so conspicuous, honored, and beloved a member. By none was his loss more profoundly deplored than by the poor of Danville and its neighborhood, who had been so frequently benefited by his skill and so fre- quently the recipients of his bounty. Many a tear was shed as the body was tenderly laid in the earth, and many a sigh was heaved as the (472) DEDICA TOR Y ADDRESS. ^y -> reflection came that the mantle of such a man would be long in finding worthy shoulders. Of those who were present on that melancholy occasion, one after another has disappeared. New generations have sprung up, and a scene that wrapped a whole community in sorrow and caused general regret in the American medical profession is with most of the people of this section of Kentucky a mere tradition. The marble slab erected by the hand of affection over the mortal remains bears the simple but significant inscription, Ephraim McDowell. Who was this man, this Ephraim McDowell, in honor of whose memory we have assembled here this evening ? Was he a hero whose body was scarred as he was leading his armies in the defence of his country'? W^as he a great magis- trate, meting out justice to his fellow-citizens, protecting their rights, and wisely interpreting their laws ? Was he a legislator, devising means for the development of the resources of his state, and the promotion of the happiness of society ? Was he a great senator, like Clay, or Crittenden, or Webster, expounding the constitution and convulsing the American people by the power and majesty of his eloquence ? Ephraim McDowell was not any 474 MEMORIAL SERVICES. of these, and yet he was none the less a good and a wise man, nor is he any the less entitled to the world's gratitude. Following: the noble vocation of a practitioner of the healing art, liberally dispensing alike to poor and rich the blessings of his knowledge and of his skill, he silently pursued the even tenor of his way, a faithful servant of his profession, with no am- bition for meretricious distinction. It was here, on this very spot, that he achieved that renown which so justly entitles him to be ranked among the benefactors of his race. It was here, while engaged in the daily routine of his calling, that he performed an exploit which no one had ever achieved before, and which, although for a long time denounced and condemned by many other- wise enlightened surgeons and practitioners as an outrageous, if not murderous, innovation, is now universally admitted as one of the estab- lished procedures in surgery ; an operation which, in its aggregate results in the hands of different surgeons, has already added upwards of forty thousand years to woman's life, and which is destined, as time rolls on, to rescue thousands upon thousands of human beings from premature destruction. Ephraim McDowell will be regarded in all DEDICA TOR V ADDRESS. a-j - time to come as the " Father of Ovariotomy," and as one of the master spirits of his profes- sion. We are here this evening to place upon his tomb a wreath of immortelles expressive of our admiration and respect, and of the grati- tude of more than two thousand women rescued from an untimely grave by his operation. That his claims to this distinction are well founded the history of this operation abundantly attests. For a lonor time it was thouofht that other sur- geons had anticipated him in this undertaking, but all the doubt that had hung over the sub- ject was at length completely dispelled in 1852 in an address which I had the honor to read before the Kentucky State Medical Society at its annual meeting at Louisville, entitled "A Report on Kentucky Surgery." In the prose- cution of my inquiries I became deeply inte- rested in the subject of ovariotomy, and espe- cially in the claims of McDowell as its origi- nator. With this end in view I engaged in a long and laborious correspondence, in which I was kindly assisted by Professor Daniel Drake, Dr. William Gait, and Dr. William A. Mc- Dowell, a nephew and at one time a partner of the great surgeon. Letters were addressed to physicians in different parts of the State, and .y^ MEMORIAL SERVICES. also to the surviving members of Dr. Mc- Dowell's family, asking for information re- specting the number and results of his cases, as well as the names and residences of his patients, and any other intelligence calculated to throw light upon his life and character; matters concerning which, up to that period, hardly anything definite was known. These documents are still in my possession, and will probably at no distant day be given to the public. When this investigation was begun the origin of this operation was generally ascribed to a French surgeon, L'Aumonier, of Rouen, who, it was contended, had performed it in 1782, when McDowell was not eleven years old. More recently the honor has been claimed by our British brethren for Dr. Robert Hous- ton, of Glasgow, whose name appears in con- nection with an operation upon the ovary as early as 1701. The operation, however, has been found upon a careful examination of the history of the case to be entirely different from that of the Kentucky surgeon. The case was simply one of ovarian tumor, the contents of which were partially evacuated by an incision made through the abdomen, the cyst itself being left behind. DEDICA TOR Y ADDRESS. 477 These and other pretensions that have been set up by different nationahties are wholly un- supported by facts ; for a careful study of the cases which have been reported by their respec- tive operators will serve to convince any un- prejudiced mind that, so far from, being exam- ples of ovariotomy, they were simply instances of cystic tumors, similar to those already men- tioned in connection with the names of L' Aumo- nier and Houston. Indeed a considerable number of such operations were performed during the last century, chiefly by French, Ger- man, and English surgeons, or, as they would now call themselves, if living, gynecologists. The first actual case of ovariotomy of which there is any authentic account occurred in this town in December, 1809, in the hands of Dr. Ephraim McDowell, and to him and to him alone is due the credit of haviniz" devised and o first successfully executed the operation. All honor, then, we say, to the man who thus paved the way to a new path of humanity, since so nobly trodden by his successors ! All honor to the man who had the courage and skill to do that which no man had ever dared to do be- fore ! All honor, too, to the heroic woman who, with death literally staring her in the face, Ang MEMORIAL SERVICES. was the first to submit calmly and resignedly to what certainly was at the time a surgical ex- periment. To her, too, let a monument be erected, not by the Kentucky State Medical Society or by the citizens of Kentucky, but by suffering women who, with her example before them, have been the recipients of the inestimable boon of ovariotomy, with a new lease of their lives and with immunity from subsequent dis- comfort and distress. I know of no greater example in all history of heroism than that dis- played by this noble woman In submitting to an untried operation. McDowell himself must have been startled, if not absolutely abashed, when he found how willing she was, after he had depicted to her, in the most glowing colors and in the strongest and plainest language, the risks of the operation. When a surgeon, how- ever experienced or skilful, meets with a des- perate case, and finds that, after having in- formed his patient, that If an operation be performed, it will be likely to destroy him, he is willing and ready to Incur the risk, his heart often fails him and he deeply regrets that the poor sufferer ever fell into his hands. So, no doubt, McDowell felt upon this occasion. " Having never," he said, "seen so large a sub- DEDICA TOR Y ADDRESS. ^yg Stance extracted nor heard of an attempt or success attending any operation such as this required, I gave to the unhappy woman infor- mation of her dangerous situation. She seemed willing to undergo an experiment, which I promised to perform if she would come to Dan- ville, the town where I live, a distance of sixty miles." She did come, and the experiment, as McDowell very properly calls it, was, as already stated, performed. A rapid recovery ensued, and the patient, Mrs. Crawford, a Kentucky lady, survived the operation thirty-two years, enjoying for the most part excellent health, and dying at length in the seventy-ninth year of her age. Thus, it will be seen, this heroic and courageous woman owed nearly two-fifths of her life to the skill and care of her suro-eon. Our admiration of this noble woman is gready enhanced when we reflect that the operation was performed without the aid of anaesthetics, which were not introduced into practice until a third of a century afterward, as is our admira- tion of the surgeon when we recall the fact that he had no trained assistants to aid him in his work, executed despite the most strenuous and persistent efforts to dissuade him from under- taking it. ^So MEMORIAL SERVICES. It is not a little remarkable that no account, of this operation was published until eight years after it was performed. Whether this was due to inherent modesty on the part of McDowell, to indifference to fame, to sheer apathy, to an aversion to writing, or to fear of criticism, to which such an undertaking, without a precedent in the annals of surgery, would necessarily ex- pose him, it would be idle to conjecture. It is sufficient for my purpose to know that the first notice of it appeared, in 1817, in the Philadel- phia Eclectic Repcrto7y and Analytical Review. The communication, which covered not quite three octavo pages of printed matter, was en- titled " Three Cases of Extirpation of Diseased Ovaria," and was drawn up so loosely and care- lessly as to be well calculated to elicit adverse criticism, as indeed it speedily did both at home and abroad in a way not at all calculated to re- flect credit upon the author as a literary and scientific man. The details of the cases were singularly meagre ; there was nothing said re- specting their origin, progress, or diagnosis, and even the operations themselves were very imperfectly described. If such operations had been performed in our day the most minute circumstances would have speedily found their ^DEDICA TOR 1 ' ADDRESS. . g j way into print. The fact is, McDowell pos- sessed no facility as a writer, and he lacked that grace of diction and power of expression so well adapted to impart interest even to the driest details, and which can be acquired only by long practice. In a word, he was a stranger to the pen and had no fancy for its use. Writ- ing was a great bore to him ; a compulsory necessity. The report of his cases soon after its publication was severely criticised, and an attempt was made to discredit his statements, or, in other terms, to impugn his veracity. Had McDowell lived in our day, when intelli- gence flashes with lightning speed, not only from one section of the country to another but from continent to continent, such an occurrence would not have been possible. Dr. James Johnson, the very able and learned editor of the London Medico-Chirtu^gical Re- view, a journal widely circulated both in Great Britain and in the United States, was especially savage and satirical. He could not imagine it to be possible that an American surgeon, living in a small, obscure village in the wilds of Ken- tucky, or in the backwoods of America, as he expressed it, could perform such an operation, or become a 'pioneer in a new branch of sur- 482 MEMORIAL SERVICES. gery. In commenting upon McDowell's first case, especially upon the wonderfully rapid recovery of the patient, he exclaims apparently in holy horror and with uplifted hands, ''Credat yudcEus 11011 egoT In a subsequent article, published in 1826, Johnson again calls attention to McDowell's cases, adding that of five cases reported four had recovered and only one had died. "There were circumstances," remarks this Cerberus, " in the narratives of some of the first cases that raised misgivings in our minds, for which uncharitableness we ask par- don of God, and of Dr. Ephraim McDowell, of Danville." It is presumable that this frank and manly recantation on the part of a man who occupied so elevated and influential a position as the editorship of the most widely read medi- cal journal in the world had some effect in controlling professional sentiment and Inspiring confidence in the declarations of a surgeon Avhom he had only a few years before de- nounced as a backwoods operator unworthy of credence. Nevertheless Dr. McDowell had for a long time no imitators. Among those who, on this side of the Atlantic, had the courage to follow in his footsteps, were Nathan Smith, of New Haven, in 1821, Alban G. Smith, apart- DEDICA TOR V ADDRESS. ^ g ^ ner of McDowell, in 1823, and Dr. David L. Rogers, of New York, in 1829. All of the cases terminated favorably. McDowell him- self, as clearly as I could determine in prepar- ing my report on Kentucky Surgery, operated altogether thirteen times, with the result of eight cures, four deaths, and one failure, due to an inability to complete the operation on account of extensive adhesions of the tumor ; a deeree of success which, considering the fact that he had no precepts except his own experience to guide him, was eminently creditable to his judg- ment, care, and skill, and which, although ex- ceeded in recent times, was for a third of a century pretty much the average in the hands of his followers, both in America and in Europe. If we go to the other side of the Atlantic we shall find that the first attempt at ovariotomy in Great Britain occurred in the practice of Mr. John Lizars, of Edinburgh. This gentleman, in 1825, published a beautiful monograph upon the subject, in which he gave a detailed account of four cases, with two recoveries, one death, and one an utter and disgraceful failure, due to an erroneous diagnosis, both ovaries being per- fectly sound. Mr. Lizars, who was a surgeon of considerable note in his day, was led to turn .84 MEMORIAL SERVICES. his attention to this subject from having read an account of McDowell's operations, which had accidentally fallen into his hands during the absence of Mr. John Bell, McDowell's old pre- ceptor, upon the continent, from which he never returned. The brochure here referred to was, there Is reason to believe, of great service in calling to the subject the attention of European surgeons generally, the more especially as it embraced a full report of the Kentucky cases, which, up to that period, had lain, as it were, in a state of dormancy. Nothing, however, of any moment was done anywhere, either at home or abroad, until 1842, when ovariotomy received a new impulse at the hands of Dr. Charles Clay, of Manchester, England, followed shortly after by Dr. Frederick Bird, of London, and the two brothers Atlee, John and Washing- ton, of Pennsylvania, the first case of the for- mer having occurred in 1843 ^.nd that of the latter in 1844. To these gentlemen is unques- tionably due the great merit of reviving the operation and of placing it upon a firm and immutable basis as one of the established pro- cedures in surgery. Their attempts to gene- ralize the operation met everywhere with great opposition and even obloquy. Dr. Clay, who DEDICA TOR V .1 DBA' ESS. . g 5 introduced it into EnHand, in referring- to the subject, states that he had to wade through much vexatious opposition, great misapprehen- sions, and gross misunderstandings ; and the experience of Dr. Washington L. Atlee was still more tr)dng and annoying. In an address which he delivered in 1S72 before the Philadel- phia County Medical Society, entitled " A Retrospect of the Struggles and Triumphs of Ovariotomy in Philadelphia," he depicts in glowing language the obstacles which this ope- ration had to encounter in this country and in his own city. "Ovariotomy," he exclaims, " was everywhere derided. It was denounced by the general profession, in the medical socie- ties, in all the medical colleges, and even by the majority of my own colleagues. I was misrepresented before the medical public, and was pointed at as a dangerous man, and even as a murderer. The opposition went so far that a celebrated professor, a popular teacher, and captivating writer, in his public lectures, invoked the law to arrest me in the perform- ance of this operation." This rancorous oppo- sition, however, founded as it was upon ignor ance and prejudice, gradually wore away, and the men who were most clamorous in keeping .g5 MEMORIAL SERVICES. it Up either disappeared from the active scenes of life, or yielded gracefully to the light of reason and experience. Dr. Clay, writing in 1874, states that he had operated upon two hundred and seventy-six cases, while those of Dr. Atlee, at the time of his death, less than a year ago, amounted to three hundred and eighty-seven. Mr. T. Spencer Wells, of Lon- don, whose brilliant career as an ovariotomist began in 1858, wrote to me on the 29th of April, 1879, that he had just had his nine hun- dred and thirty-eighth case. Mr. Thomas Keith, of Edinburgh, whose career in this field of surgery is also wonderfully brilliant, informs me, in a letter written a short time previously to that of his English confrere, that he had ope- rated up to that date two hundred and eighty- four times. Dr. John L. Atlee has operated fifty-seven times ; Dr. Alexander Dunlap, of Ohio, one hundred and forty-three times ; Dr. Edmund R. Peaslee, seventy-seven times ; Dr. T. Gaillard Thomas, one hundred and twenty-six times, and Dr. Gilman Kimball, the oldest and most-renowned American ovarioto- mist since the death of Dr. Washinofton L. AtleCj two hundred and forty times. Professor Briggs, of Nashville, who has operated upwards DEDICA TOR V ADDRESS. 487 of fifty times, recently had three cases of ovari- otomy on the same day, the patients hving within a short distance of each other. It is an interesting fact with regard to the history of ovariotomy in this country that Dr. John L. Atlee's first operation, performed in 1843, was also the first operation in which both ovaries were removed. In the report of this remarkable case, an unusually elaborate one, in the American journal of the Medical Sciences for January, 1844, after instituting a compari- son between this and other capital operations. Dr. Atlee makes a strong appeal in favor of ovariotomy. " Let this operation," he says, "but be placed upon its legitimate basis, and let it receive that attention from the profession which has been devoted to other departments of surgery, and we shall soon arrive at such a knowledge of the proper time and manner of operating, and before those complications exist which render it impracticable, as will be the means of saving many unfortunate and hope- less victims." When this operation was per- formed Dr. Atlee was not aware of the cases that had occurred in England in the practice of Dr. Clay and Mr. Walne, and he informs me that he would never have performed it if he ^83 MEMORIAL SERVICES. had not studied with great care the report of McDowell's cases. The success of his opera- tion, one of the most brilliant on record, in- duced him and his brother to repeat it on the first favorable opportunity, despite the opposi- tion and clamor of their professional brethren. Up to 1850 only eighteen American surgeons, including the originator, had performed this operation. In 1855 ^^ received a new impulse from the publication of Dr. Washington L. Atlee's first thirty-five cases, and in the follow- ing year appeared the admirable prize-essay of Dr. George H. Lyman, of Boston, entitled "The History and Statistics of Ovariotomy," embracing a summary of three hundred cases, being all that were then known as having occurred in different parts of the world. On the continent of Europe ovariotomy made, until recently, very slow progress, although Chrysmar, of Germany, had performed it three times before the close of 1820, and conse- quently several years before it was attempted by Lizars, of Edinburgh. In France it was performed for the first time in 1847. In these countries, as in the United States and Great Britain, it was long denounced as an unsafe and improper operation, and that this should DEDIC.l TOR J ' ADDRESS. 489 have been the case is not surprising when we consider the enormous mortahty which attended it, even in the hands of many of the most accompHshed surgeons. The results of late years, however, have been more encouraging, and have been particularly flattering in the hands of Koeberle, of Strasbourg, Schroeder, of Berlin, and Skoeldberg, of Sweden, not to mention others. Ovariotomy is no longer on trial ; it has successfully passed that ordeal, and is now performed in every country of the earth where civilization has carried the bless- ings of scientific medicine. The frequency of ovarian diseases is appal- ling; far greater, indeed, than it is generally supposed to be. One surgeon alone. Dr. Clay, of England, declares that he had examined within a single decade eight hundred and fifty cases ! Who, in view of these occurrences, will deny the blessings of ovariotomy, espe- cially when we take into consideration the fact that few women laborinof under maladies of this kind live longer than about four years, unless relieved by surgical interference? The mortality of this operation is worthy ol brief notice in connection with Dr. McDowell's name and fame. His own cases — thirteen in .go MEMORIAL SERVICES. number, with eight cures, four deaths, and one faihire to complete the operation on account of extensive adhesions — show an astonishing degree of success when we recollect all the circumstances attending them, especially the operator's own inexperience, and the absence of any rules to guide him in his undertakings. For a number of years after McDowell's death the mortality in the hands of different surgeons exhibited but little improvement upon that in his own practice. Thus, of one thousand four hundred and eight cases collected by me in 1872, from various sources, native and foreign, four hundred and fifteen died, affording a mor- tality of twenty-four per cent., or one death in every three and two-fifths cases. That the results of the operation are materially influ- enced by the manner in which it is performed, and by the previous and subsequent treatment, is a fact long since fully established. Thus, if we take the statistics of one hundred cases in the hands of so many different surgeons, men who have no experience in such cases and who follow the ordinary method of operating, the mortality will be found to be enormous, just as it would be likely to be under similar circum- stances in any other grave operation, as lith- DEDICA TOR Y ADDRESS. ^n I otomy, the larger amputations, trephining of the skull, and the ligation of the larger arteries. No one will deny that experience is a most important factor In saving or destroying life in all the more serious, severe, or capital opera- tions. The results of ovariotomy in the hands of professed or skilled ovariotomists, men who make a specialty of abdominal surgery, are among the greatest triumphs of our art, en- titling them to be ranked among the noblest benefactors of the present day, or indeed of any day. The cases of Washington L. Atlee, Charles Clay, T. Spencer Wells, Thomas Keith, Oilman Kimball, Alexander Dunlap, T. Gaillard Thomas, and others, are counted, not by tens or twenties or thirties, but by hundreds. It is this enormous multiplication of cases that makes these men such experts and that gives them such a superiority over those whose practice is comparatively limited. One of the most grati- fying circumstances connected with this opera- tion is the gradually decreasing mortality even in the hands of the most successful surgeons. This is strikingly shown, to go no farther, by the statistics of Dr. Clay, of Manchester, who, as previously stated, introduced ovariotomy into England. Of the first twenty cases the 492 MEMORIAL SERVICES. death-rate was one in two and one-half; of the second twenty, one in three and one-third ; and of the last thirty-one, one in four. In Mr. Wells's cases the same gratifying results are apparent, and so also in those of Mr. Keith, of Edinburcrh. Who will dare to assert that these triumphs are not due to superior skill in operat- ing, and to increased care and experience, and not to the selection of the cases, although this will doubtless, now that the diagnosis between innocent and benio-n ovarian diseases is so well established, have its influence ? The attention bestowed upon the after-treat- ment must necessarily exert a powerful influ- ence upon the patient's fate. All the professed ovariotomists employ trained and experienced nurses and personally superintend their cases from first to last. Mr. Keith, in referring to this subject, says, " No one knows the anxiety that ovariotomy has given me, nor the time and thought and care I have bestowed on the pa- tients." There can be no doubt that the chances of recovery after the operation are greater when the patient is treated in a private hospital, situated upon airy ground, and pro- vided wdth all the means and appliances which such an institution ought to possess. This fact DEDICA TOR Y ADDRESS. ^g 3 has been strikingly exemplified in the practice of Mr. Keith, and also in that of Mr. Wells while he was in charge of the Samaritan Hos- pital, London. Leaving out of the question the results of less-experienced ovariotomists, what can be more wonderful than the results of Mr. Keith's cases — two hundred and eighty-four — with a mortality of only thirty-five, or one death in about eight operations ? Of the last one hun- dred and fifty-eight cases only twelve suc- cumbed ; of the last seventy-seven only thir- teen, and of the last forty-nine not one, thus verifying his assertion that "this long-despised operation is now the safest of all the great surgical operations, at least judging from these results." The statistics of the operations of Mr. Wells are equally astonishing. Both these surgeons are now making constant use of anti- septics, notwithstanding they obtained most brilliant results from the ordinary treatment, conducted with that care which their increasing experience had taught them to employ. Mr. Keith does not hesitate to ascribe much of his wonderful success in his late cases to the effi- cacy of antiseptics. Mr. Wells, in the letter previously referred to, says : T began the year .g. MEMORIAL SERVICES. 1878 with the eight hundred and eighty-eighth case, by adopting the antiseptic system of Lis- ter, and have kept it up ever since, the result of forty-five cases being forty recoveries and five deaths. The recoveries have taken place, as a rule, without fever." " I believe," he adds, *' that the antiseptic system will certainly reduce mortality and expedite convalescence." Of the thirty-eight cases of the ninth hundred, the number operated upon by Mr. Wells up to April 29, five, he informs me, have died, and thirty-three are well or convalescing. Of Mr. Clay's two hundred and seventy-six cases two hundred recovered and seventy-six died. Koeberle, during the last four years, operated one hundred times with eleven deaths. The mortality in Dr. Washington L. Atlee's three hundred and eighty-seven cases was, as I am informed by his son-in-law. Dr. Thomas M. Drysdale, about thirty per cent, which, consid- ering that he did not select his cases, and fre- quently had no opportunity of superintending the after-treatment, always a matter of such great moment in every severe operation, may be regarded as a fair average. Dr. John L. Atlee's fifty-seven cases show forty recoveries and twelv^e deaths, with five failures to complete DEDICA TOR Y ADDRESS. ^^^t^ the operation on account of extensive adhesions. Of Dr. Dunlap's one hundred and forty-three patients one hundred and twelve recovered and thirty-one died. Of Dr. Peaslee's seventy- seven operations the resuhs of twenty-eight only are positively known, and of these nine- teen recovered and nine perished. J. Taylor Bradford had thirty cases with three deaths. Professor T. Gaillard Thomas's one hundred and twenty-nine cases show ninety-six recov- eries and thirty-three deaths. The mortality of Dr. Kimball's cases is in the ratio of one to four ; of his last twenty-four cases twenty-one have recovered and three have died. It would be foreign to my purpose, in an address like this, and especially before such an audience, to speak of the causes which mainly influence the results of this operation ; but there is one circumstance to which I cannot forbear alluding. I refer to the importance of establishing in every case, before an operation is attempted, a correct diagnosis. Fortunately this can now be done, with proper care, almost in every instance, with the aid of the micro- scope. Dr. Thomas M. Drysdale, availing himself of the great opportunities afforded by Dr. Adee's operations, has, after numerous 4q6 memorial services. examinations, satisfied himself of the existence, in all innocent forms of ovarian cysts, of what he calls the "ovarian granule cells." These cells, which are very small and of a rounded or oval shape, are largely supplied with nuclei and nucleoli, and, as they are not present in any other affections or in dropsical fluids, they may be regarded as characteristic. More recently Dr. Foulis, of Edinburgh, and Dr. Knowsley Thornton, of London, have ascertained that malignant ovarian tumors can be distinguished from benign ovarian growths by the presence of groups of large, pear-shaped, round, or oval cells, occupied by granular material with nuclei, nucleoli, vacuoles, or transparent globules. The value of these researches, in which Dr. Drysdale has taken the lead, cannot, in a diagnostic point of view, be overestimated, for they clearly indicate the necessity, in every case of doubt, of making a thorough examina- tion of the contents of these classes of tumors before finally deciding upon the propriety of using the knife. The brilliant success which has attended ovariotomy both in America and in Europe has led to an extension of the whole domain of abdominal surgery, and has emboldened ope- DEDICA TOR V ADDRESS. .g- rators to invade other regions of the body until recently regarded as too sacred to be meddled with. Indeed, there would seem to be hardly any longer any forbidden territory. The uterus, the spleen, and the kidneys have of late years been the coveted objects of the surgeon's cupidity. Very lately the gall-bladder has not only been aspirated for the purpose of relieving it of distending fluids, but actually, in several instances, extirpated. Many years ao-o, during my residence in Kentucky, I received a telegram from a distinguished surgeon of Co- lumbus, Ohio, saying he had just excised the liver, and that as his patient was progressing favorably he indulged great hope of her re- covery. The woman, however, died the next morning, when it was discovered that, instead of the liver, only an ovary had been removed, thus depriving my friend of the glory of being a pioneer in hepatic surgery! Within the last ten years a number of cases of excision of the larynx have been reported, including, in some instances, portions of the tongue and of the oesophagus, and yet despite the mutilation some of the survivors, with the aid of an artificial substitute, articulated nearly as well, it would seem, as before the operation. Ihe entire 32 .g3 MEMORIAL SERVICES. tono-ue, too, has on a number of occasions — perhaps in not less than forty or fifty cases — been extirpated with, as is alleged, very little impairment of the patient's voice or power of speech. With such inroads, such innovations, on the part of surgery, we need not be sur- prised if, on waking some morning, we should find the papers filled with accounts of the suc- cessful amputation of the head without any serious detriment to the patient's mental faculties, despite the assertion of Mons. Blan- din, a French surgeon, that this portion of the body, which he invariably, designates as the encephalic extremity, cannot be removed dur- ing life without stopping respiration and caus- ing other inconveniences which, unhappily, render the operation inadmissible ! This lan- guage, however, it must not be forgotten, was uttered fifty years ago, when surgery was in a comparatively crude condition, and is therefore hardly applicable at the present day. But, pleasantry aside, as perhaps unbecoming the occasion, while I have always been a friend to progress, it is evident that there must be limits to the use of the knife. What the fate of some of these operations may be, whether any or all of them will be ultimately admitted into the DEDICA TOR Y ADDRESS. ^q^^ domain of legitimate surger)-, must for the present remain an open question. We are no more justified now in condemning what may seem to us to be an improper operation than physicians were in the days of McDowell in condemning ovariotomy. Experience alone can determine how far the knife shall go or shall not go. What has been called, perhaps oddly enough, normal ovariotomy, an operation first performed by Dr. Robert Battey, of Georgia, may be regarded as a natural outgrowth of McDowell's operation, or ordinary ovariotomy, rendered necessary, as is alleged, on account of organic or functional disorder of the ovaries, incurable by ordinary treatment. The results obtained thus far are not very satisfactory, and it is evi- dent that further light is required before we can determine its real merits. Different me- thods of reaching the faulty structures have been suo-orested, but there is not one that is wholly free from danger, while tliat originally practised by the courageous and ingenious in- ventor does not always afford sufficient space for the purpose. The statistics of this operation published in 1878 by Dr. George J. Engelmann, of St. coo MEMORIAL SERVICES. Louis, embracing forty-three cases, show that the risk is very considerably greater than in ordinary ovariotomy, fourteen of the cases ter- minating fatally, while of the twenty-nine sur- viving patients nine only, or thirty-one per cent., were cured, and eleven were more or less improved. Many of the operations were not completed on account of the impossibility of extracting the entire ovary. Dr. Battey, as he informed me only a few days ago, has performed this operation fifteen times with two deaths and thirteen recoveries. Of these thirteen cases four were promptly and entirely cured, nine were benefited, and of those not completely relieved every one had made notable progress during the last twelve months. In delineating the character of McDowell the question naturally arises, how was he led to perform for the first time in the history of sur- gery so dangerous an operation ? Was it his superior knowledge of abdominal and pelvic diseases, or had he made a special study of them, and thus qualified himself above all other men to become a pioneer in a branch of sur- gery whose territory had never before been invaded by the knife ? Or was it his superior DEDICA TOR Y ADDRESS. ;oi sagacity or his more profound penetration which led him to undertake it? Finally, had the lessons which as a student he imbibed in the lecture-room during his sojourn at Edin- burgh any agency in the matter ? It must not be forgotten, in discussing this subject, that long before McDowell launched into this then unex- plored field of surgery a number of distin- guished physicians, in view of the hopeless character of ovarian diseases, suo-o-ested their removal through an opening in the wall of the abdomen. Among others who seriously thought of the matter may be mentioned more especially the names of Schlenker, Willius, Preger, Cham- bon, and the celebrated William Hunter, the foremost obstetrician of his day in Great Britain. None of these men, however, had the courage to undertake such an operation. Prior to McDowell no surgeon had been so bold as to do more than to open occasionally an ova- rian cyst and to let out its contents. No one had dared to remove an ovarian tumor of any kind bodily. In reflecting upon this subject I have always thought that the instruction which McDowell had received while attending the lectures of the celebrated Mr. John Bell, of Edinburgh, had H02 MEMORIAL SERVICES. mainly paved the way to this undertaking. It is a well-known fact that the young Kentuckian was greatly impressed by the lectures of this great surgeon, who was a man of splendid genius, of high intellectual endowments, an eloquent teacher, and a bold, dashing operator, then in the zenith of his renown. We may well imagine with what pathos such a man, a man of the most ardent temperament and a most accomplished scholar, would describe abdominal surgery, and with what force and emphasis he would dwell upon the hopeless character of ovarian tumors. No man, perhaps, ever taught surgery to more admiring pupils, or more completely fascinated them by the power of his eloquence. There was, moreover, from all accounts, a wonderful magnetism about John Bell, which drew to him, as with an irre- sistible charm, every one who came within his presence. Listening to the lectures of such an enthusiast, a kind of Tom Marshall in his way, it is not probable that the young American sat listlessly with closed eyes and ears upon the hard bench of the amphitheatre. On the con- trary, his attention was all agog. We can see him even now, as it were, with open mouth and protruding head, with his chin resting upon his DEDICA TOR Y A D DRESS. ^ q ^ hands, eagerly drinking in every word as it fell from the lips of this divine son of ^sculapius. The sparks of genius which such a teacher emits kindle a flame in the minds of his pupils which the waters of all the rivers and seas of the earth cannot extinguish. That the pre- lections of this wonderful man exerted a powerful influence in moulding the character of McDowell and in inspiring him with boldness and confidence as an operator is unquestionable. How far they affected his career as an ovari- otomist is of course a mere matter of conjec- ture. The knowledore which he brought home with him, and his warm sympathy for suffering woman, no doubt exercised a powerful effect upon his future life. Besides, he was not un- aware of the fact that success had often attended the Caesarean section, and that persons not unfrequently recovered after severe wounds and other injuries of the abdominal and pelvic viscera. Moreover, it is not improbable that, in reflecting upon the subject, he came to the conclusion, long since universally recognized, that the peritoneum, when chronically diseased, is generally comparatively tolerant of the rudest manipulation, whereas the slightest ex- posure of, or interference with, the healthy C04 MEMORIAL SERVICES. membrane is sure to be promptly resented, almost invariably, indeed, at the expense of the patient's life. Finally, it must not be forgotten that McDowell was a bold surgeon, and a man of a broad, elevated mind, capable of taking a comprehensive view of anything that was pre- sented to him. With a heart as tender and gentle as that of a woman, he was not afraid of the sight of blood. For many years he had the field of surgery in Kentucky almost wholly in his own hands. He had not been home longr from his foreign residence before patients began to flock to him from all parts of the southwest, and he found himself immersed in a larofe sur- gical practice, demanding the performance not only of the more common but also of many of the more difThcult and severe operations. His first case of ovariotomy occurred when he had hardly been twelve years engaged in the prac- tice of his profession. He was about the same age as Valentine Mott when he performed his great feat of tying for the first time the innomi- nate artery ; an operation in comparison with that of McDowell of utter insignificance, for of the nineteen or twenty cases in which it has . been done only one life has been saved, whereas the other has already restored to health and comfort upwards of two thousand women. DEDICATORY ADDRESS. rg- The career of McDowell is so intimately bound up in the great operation already so fre- quently mentioned that one might suppose nothing of interest remained to be considered. This, however, is lar from being the case. In many respects, indeed, it is replete with inci- dents. Born in Rockbridge County, Virginia, in 1 77 1, he was brought, when thirteen years old, by his parents to Danville, at a time when Kentucky was literally a wilderness, re- sounding with the howl of the panther and ot the savaije and reekinor with the blood of its early settlers. The terrible battle fought near Blue Lick Springs, in which Daniel Boone played so conspicuous a part and lost a son, and which proved to be so disastrous to his followers and companions in arms, took place only a short time after this event, and filled the country with pain and sorrow. The frequent wars of which it was the theater gave it a pecu- liar claim to the title of the " Dark and Bloody Ground," from which it derived its name. At the period in question Kentucky was still a ter- ritory, and it was not until after repeated con- ventions, the last of which was held in this city, that it was finally, in June, 1792, admitted as a State into the Union. -q5 memorial services. McDowell was of Scotch-Irish parentage, and the ninth of twelve children. His great-grand- father, after whom he was named, was Ephraim McDowell, a brave and courageous man, who, after having done some fighting in the civil wars of Ireland, in the cause of the Covenanters, emigrated, after he was past middle life, to Pennsylvania, which he left in 1737 for Augusta County, Virginia, where he died at a very ad- vanced age shortly before the revolutionary war. From an elaborate genealogical article in the Cincinnati Commercial, January 14, 1879, under the nom de plnme of Keith, it appears that the descendants of the Scotch-Irish emi- grant have become almost as numerous as the sands upon the sea-shore, and that they repre- sent by their intermarriages many of the most respectable^and influential families in Maryland, Virginia, Kentucky, Ohio, Illinois, Indiana, Mis- souri, and indeed almost in the entire south- west. If called together they would form, at least numerically, a powerful clan. Besides the great surgeon, who has immortalized the family, many of these people have held important positions, as governors of different States, con- gressmen, lawyers, judges, divines, physicians, politicians, and army officers. Joseph Nashe DEDICA TOR Y ADDRESS. -n? McDowell, who died only a few years ago, was a nephew of Ephraim, a great teacher of anatomy and surger)-, and the founder of a medical school at St. Louis. Another nephew, the late Dr. William A. McDowell, of Louis- ville, occupied a high position as a sagacious and successful physician. The name of Gen. Irvine McDowell, United States Army, is familiar to every American citizen. The father of Ephraim was Samuel McDowell, an accom- plished gentleman, a member of the Legisla- ture of Virginia, and, after his removal to Danville, a judge of the district court, a posi- tion which he held until within a short time of his death. On his mother's side he was de- scended from the McClungs, a distinguished family of Virginia. The son's early education was obtained at a classical seminary at George- town, in his adopted State, under the super- vision of Messrs. Worley and James, two accomplished teachers. How long he remained here, or what progress he made in his studies, I am unable to say, but it is safe to affirm that, although he was fond in after life of literary reading, his primary education was sadly neg- lected, and that he never surmounted his early deficiepcies. He wrote, as has already been co8 MEMORIAL SERVICES. Stated, with great difficulty, and his only literary contributions are two short articles contained in the Philadelphia Eclectic Repertory and Analytical Revieiu for 1817 and 18 19. His medical education was commenced in the office of an eminent physician, Dr. Humphreys, of Staunton, Virginia, a graduate of the Univer- sity of Edinburgh. It was doubtless through the influence of his preceptor that the youth determined to go at once to the fountain-head of medical education and learning, as the Scotch metropolis was then very justly regarded. At all events there is no proof to show that he ever attended any lectures In Philadelphia, at that time the only place of resort for the medi- cal student in this country. The University of Edinburgh, of which he was a member in 1793— 4, enjoyed a world-wide reputation at this period on account of the learning and ability of its professors, among whom may be mentioned as especially worthy of notice the names of Cullen and Black, two great luminaries, whose fame added lustre to the school and attracted pupils from all parts of the civilized world. Not waiting to take a degree, he immediately, upon his return to America, settled at Danville, where, having brought with him the prestige of DEDICA TOR Y ADDRESS. -qq foreign study, he soon acquired the confidence of the pubHc and rapidly rose to distinction as a successful practitioner. He particularly distin- guished himself as a surgeon and as an expert operator, a position of which he retained undis- puted possession until the organization, iu 1819, of the medical school at Lexincrton, when he was gradually eclipsed by his young rival, Dr. Benjamin Winslow Dudley, a gentleman of highly fascinating manners, a popular teacher, and, as all the world knows, a great surgeon. It is not the desio^n of this address to enter into minute details respecting Dr. McDowell's more ordinary surgical achievements. It will subserve my purpose to state that he was an excellent lithotomist, and that he repeatedly performed many of the great operations of surgery. The subject of one of these opera- tions was James K. Polk, afterward President of the United States, at the time a thin, ema- ciated stripling, fourteen years of age, worn out by disease, uneducated, and without appa- rent promise of future usefulness or distinction. "As an operator," as Dr. Alban G. Smith, who late in life changed his name to Dr. Goldsmith, and who knew him well, having at one time been his partner, told me, "as an operator he CIO MEMORIAL SERVICES. was the best I ever saw in all cases in which he had a rule to guide him ;" no slight praise from a man who was himself an expert operator ; and yet Dr. Goldsmith seemed to forget that this man did certainly once operate in a case in which he had no rule to guide him, a case which was destined to confer immortality upon his name, McDowell was not only a good operator, but he possessed all the higher attributes which make up the character of a great surgeon, intense conscientiousness and a scrupulous regard for the welfare of his patients. He never operated merely for the sake of operat- ing. He had always an eye to consequences. For the mere mechanical surgeon he had an immitigable contempt. In speaking of ovari- otomy, in answer to some strictures pronounced upon his first three cases, he expresses the hope that no such surgeon will ever attempt it. *' It is," he adds, " my most ardent wish that this, operation may remain to the mechanical surgeon for ever incomprehensible," He con- sidered the profession of medicine as a high and holy office, and physicians as ministering angels, whose duty it is to relieve human suffer- ing and to glorify God. He had a warm and DEDICA TOR \ ' ADDRESS. - , , loving heart, in full sympathy with the world around him. To the sick poor he was particu- larly kind. He was a loyal and devoted hus- band, a tender and loving- father, an honest, high-toned citizen. In all the relations of life he w^as a model. Naturally of a lively, social disposition, he enjoyed a good joke or a spicy anecdote, and was the delight of every social entertainment which he honored with his pres- ence. Late in life he devoted much of his leisure to reading and meditation. His favorite medical authors were Sydenham and Cullen ; his favorite literary authors, Burns and Scott. During his sojourn In Scotland he passed seve- ral months of his vacation in ramblino- over the country trying to make himself familiar with the nature and habits of the peasantry. In these perambulations he had the society of two of his Kentucky friends, Drs. Brown and Speed, the former of whom became afterward Pro- fessor of Medicine in Transylvania University. When the trio reached home some one asked Brown, "What do you think of McDowell?" "Think of him? Why, he went abroad as a gosling and has come back as a goose." It would be well if our country had more of such birds ! He had litde confidence in the efficacy ri2 MEMORIAL SERVICES. of medicine, and constandy cautioned his stu- dents against the too free use of drugs, saying that they were more of a curse than a blessing. He considered surgery as the most certain branch of the heahng art, and spared no means to extend his knowledo-e of it. He was an excellent anatomist, and it is said that he never performed any serious operation without pre- viously recalling to his mind the structures involved in it. In 1817 the Medical Society of Philadelphia sent him its diploma of member- ship, and in 1825 the University of Maryland conferred on him the degree of Doctor of Medicine. At the age of thirty-one he married Sallie, daughter of Gov. Isaac Shelby, of Ken- tucky, by whom he had six children, two sons and four daughters, two of the latter of whom, Mrs. Deadrick, of Tennessee, and Mrs. Ander- son, of Paris, Missouri, are still living at an advanced age, the parents of large and highly respectable families. He was nearly six feet in height, with a florid complexion, black eyes, a commanding presence and remarkable mus- cular powers. As an illustration of his great physical strength, he used to tell with peculiar glee an anecdote of a circumstance which occurred while he attended medical lectures at DEDICA TOR 1 ' ADDRESS. - I -> Edinburgh. One day, as the story goes, a celebrated Irish foot-racer, a kind of Mike Fink, arrived, boasting that he could out-run, out-hop, and out-jump any man in the city, and bantered the whole medical class. McDowell was selected as their champion, the distance being sixty feet, the stake ten guineas. The backwoodsman purposely allowed himself to be beaten. A second race for one hundred guineas, at an increased distance, came off soon afterward, and this time the Irishman, after much bullying, was badly worsted, much to his own chacfrin and the deliofht of the students. Although McDowell's means were not large he was liberal in the bestowal of his charities, and generous to a fault in his dealings with his patients. In 1828, only two years before his death, he united himself with the Episcopal Church, of which he remained a zealous and consistent member. A vein of piety ran through his whole life. As a proof of this fact it may be stated that he always preferred to perform any great operation that he might have on hand on the Sai)bath, knowing, as he affirmed, that he would then have the prayers of the church with him. Trinity Church of Danville was the special object of his care ; r-,. MEMORIAL SERVICES. and as an evidence of the interest he felt in it I may mention, what does not seem to be gen- erally known even among your own citizens, that he gave it the lot upon which the present building is situated. Indeed McDowell, to use the language of one of your most noble and accomplished women, was the head and front of its vanguard, which embraced many dis- tinguished names in the past history of this portion of Kentucky. Of Center College he was one of the founders and original trustees. Such, fellow-citizens of Kentucky, was the character of Ephraim McDowell ; kind-hearted, benevolent, and just in all his dealings, an ex- cellent citizen, an original thinker, a bold, fear- less, but most judicious surgeon, and, above all, a Christian gentleman. Such, citizens of Dan- ville, was your former townsman, whose career has shed so much lustre upon his age and country, and who, if he could be in our midst this day, might justly echo the words of the Roman poet, '' Exegi monumentwn cci'e per en- nuis y The latter years of this good man's life were clouded by an attempt made, strange as it may appear, by one of his own nephews and private pupils, to deprive him of his claims as the origi- DEDICA TOR Y ADDRESS. - , - nator of the operation so frequently mentioned. This circumstance induced him. in 1S26, only a few years before his death, to address a printed circular to the physicians and surgeons of the West in vindication of his rights. Without entering into any particulars respecting this matter, I am satisfied, from a careful examina- tion of all the facts connected with it, that the pretensions set up by this gentleman, were, like the "baseless fabric of a vision," without the slightest foundation in truth. It was not given to McDowell to see the fruit of his labors beyond the limits of his own coun- try ; the seed which he sowed fell upon meagre soil, and was slow in germinating. Now and then, it is true, a blossom shot forth and shed its fragrance upon the air, but fully a quarter of a century elapsed before it ripened into vigorous fruit. No single age has ever wit- nessed the birth and the maturity of any branch of human knowledge. McDowell lived in ad- vance of his time and of his profession ; his boldness, as his contemporaries were inclined to view his conduct, took them by surprise, and shocked their sensibilities ; hence, instead of investigating the merits of his operation, as i-easonable men should and would have done, ci5 MEMORIAL SERVICES. they rejected it as the device of a crack-brained man, who deserved to be prosecuted for a vio- lation of the sixth commandment. It was un- fortunate for McDowell that he lived at a time when there were no societies for the diffusion of knowledge, and when the means of com- municating' intelligence were so scanty as they were in the early part of the present century. News at that period of our history, locked up as it always was in the mail-bags of the cumber- some four-wheeled stage-coach, was often stale before it reached its destination. In those days, as well as for a lone time afterward, there were no railroads, no steamships, no telegraphs. The world moved at a snail-like pace, or, as it were, upon the back of a tortoise, at the rate of six or eight miles an hour. To publish reports of medical cases or of surgical operations was then, as it is now, unprofessional. Besides, even if such a course had been permissible they would have found their way very tardily to the public. Journalism was at a low ebb; there were comparatively few newspapers, and news- paper reporters had no existence. Medical news travelled still more slowly than miscellan- eous. In 1817, when McDowell's first three cases were reported in the Philadelphia Medical DEDICA TOR J ' ADDRESS. - j j Repertory and Analytical Reviezu, there was, if I mistake not, only one other medical periodi- cal in the United States. Had ^^IcDowell's operation been performed in our day the news would have spread far and wide within the first twenty-four hours, and in an almost incredibly short time would have been carried to the ut- most limits of civilization. As it was, it was locked up first for eight years in the brain of its originator, and then in an obscure medical jour- nal, and when at length it reached the other side of the Atlantic it met only with ridicule and incredulity. An account of McDowell's first three cases was, it seems, sent to Dr. Physick, of Philadel- phia, but from some cause or other it failed to interest him or to attract his attention. He probably knew little or nothing of the back- woods surgeon, and therefore, it may be, looked upon him as an adventurer unworthy of notice. However this may be, it fared much better in the hands of Dr. James, the amiable Professor of Midwifery in the University of Pennsylvania, This gentleman, deeply impressed with the novelty and importance of the subject, and thoroughly acquainted with the hopeless char- acter of the ordinary treatment of ovarian dis- cj8 memorial services. eases, read an account of the cases before his class, and caused it shortly after to be published in the journal already several times referred to, and of which, in fact, he was one of the editors. He, however, failed to make any editorial com- ments upon the subject, or to defend the opera- tion when assailed by ignorant critics. Mc- Dowell also sent an abstract of his cases to his old master, Mr. John Bell, but as this gentleman had been for some time absent on the Continent, and not long afterward died at Rome, it never reached him. The paper, however, fell into the hands of one of his pupils, Mr. John Lizars, of Edinburgh, by whom it was published in the Edinburgh Medical and Sui'- gical yournal for 1824. Mr. Lizars, as before stated, was the first to perform McDowell's operation in Great Britain. In no pursuit of life does history repeat itself more frequently than in affairs relating to human progress, innovation, and discovery. From this occurrence our profession is not exempt. The history of the discovery of the circulation of the blood, one of the most brilliant achievements of the human intellect in the seventeenth century, is a striking instance in point. Of Harvey's contemporaries not one, it is said, over forty DEDICA TOR Y ADDRESS. c i o years of age accepted his teachings. Many- years elapsed before the value of vaccination was fully recognized, and even now an opera- tion which has saved millions of lives has its opponents not alone among the vulgar, but among otherwise highly enlightened people. The use of the stethoscope as a means of diag- nosis was long rejected by medical men, and the speculum, an instrument as old as Hercula- neum, reintroduced to the notice of the profes- sion less than fifty years ago by Recamier, of Paris, met with no better fate. Everybody knows with what suspicion many physicians regarded the employment of anaesthetics, and it is fair to say that much prejudice in regard to the use of this class of remedies still lincrers in the public mind. Ignorance, superstition, and prejudice have ever been giants in the path of progress. The idea of erectinof a monument to the memor)^ of Dr. McDowell originated with one of the citizens of Danville, the late lamented Dr. John D. Jackson, a gentleman whose death, a few years ago, in the prime of life, threw a whole community into mfuirning, and whose memory will long be cherished on account of his varied accomplishments as a physician, his roQ MEMORIAL SERVICES. lovable character as a man, and the many- amiable impulses of his great heart. This idea was in due time communicated to the Kentucky- State Medical Society, of which Dr. Jackson was a prominent member, and acted upon through a committee whose duty it became to collect the necessary funds for carrying out the noble design. This committee made known its wishes not only to the profession of this country, but to our brethren in Europe, and also, if I mistake not, to the women who had been the fortunate recipients of the fruits of Dr. McDowell's operation : Finally, in 1875, a stirring appeal was made to the American Medical Association at its annual meetino- at Louisville in May of that year. From none of these sources, however, was any substantial aid derived, and it devolved at last upon the society in which the design originated to furnish nearly the entire sum necessary to carry it into execu- tion.' ^ All, in fact, that the American Medical Association did was to pass an empty resolution, leaving, as the illustrious chairman, Dr. J. Marion Sims, expressed it, "to Kentucky the grateful privilege of providing a local monument to the memory of Dr. McDowell," and requesting the Association to contribute through its individual members the sum of ten thousand dollars as a fund, to be called the " McDowell Memorial DED ICA TOR Y A DDR ESS. r 2 1 While, therefore, the granite shaft which graces yonder cemetery is a just tribute to the memory of a great and good man, whose title to immortality is well founded, let us not forget .the part borne in its erection by the Kentucky Medical Society, which had the sagacity to per- ceive, and the liberality to execute, a design which reflects so much credit upon the medical profession and the State of Kentucky. I feel a just pride when I recall the fact that I was one of the founders of a society which now includes among its members nearly all the medical talent, culture, and refinement of the State, and which has established a reputation for ability, learning, and enterprise not ex- ceeded by any similar association in the United States. Dr. McDowell is not the only physi- cian of whom Kentucky has reason to be proud. She furnished the first case of hip-joint amputation on this continent in the hands of Dr. Walter Brashear, of Bardstown, of lithot- rity in the practice of Dr. Alban G. Smith, of Danville, and the most flattering results in Fund," to be devoted to the payment of prizes for the best essays relating to the diseases and surgery of the ovaries. This fund is still unborn, and it is not probable that it will receive any further attention from the Association. C22 MEMORIAL SERVICES. ovariotomy in the hands of Dr. J. Taylor Brad- ford, of Augusta. The triumphs of Dr. Benja- min W. Dudley in lithotomy established for him an unrivalled reputation in his day as a great operator in calculous affections. Her. medical teachers were for a long time, as they still are, amongr the foremost in the land, and it is but just to say that her practitioners have nowhere any superiors. Kentucky was the first State west of the Allegheny Mountains to establish a medical school and to send forth its first medical graduate in the West. If in state- manship she may boast of a Clay and of a " sil- ver-tongued" Crittenden, whose eloquence en- chained admiring audiences, and elicited the applause of the senate chamber ; if her bar was long known as one of the most elegant, astute, and learned in the land ; if her pulpit was dignified by the piety, erudition, and oratory of her Campbells and her Breckinridges, and is still adorned by her Humphreys, her Robin- sons, and other great divines, she has their counterparts in her Caldwell, her Drake, her Dudley, her Miller, her Rogers, her Yandell, her Bush, and other great physicians whose names stand high upon the roll of fame, and who, if they had directed their attention to DEDICA TOR V ADDRESS. -^2}, Other pursuits, would have been equally dis- tinguished. These men need no monuments to perpetuate their virtues or their services ; their names live in the esteem and affection of their fellow-citizens, engraved in good acts, de- signed to relieve human suffering and to exalt the dignity of human nature. I stop here for a moment to ask, What is the object of a monument? Is it to glorify the dead or to encourage the living? The boy, as he passes along Charles Street, Baltimore, under the shadow of the Washington monu- ment, pauses to read the inscription upon its entablature : " Erected by the State of Mary- land in grateful recognition of the virtues and services of the ' Father of his Country.' " He gazes at the august figure at the top, and dis- covers in it all the attributes of a great man ; he goes home and curiosity impels him to inquire into his character ; perhaps he consults his childish history, and there finds that Washing- ton, the grandest subject of all history, was the saviour of his country ; like himself, at one time, an obscure youth, but now, long after his death, the idol of the American people. He has learned an important lesson ; his ambition is roused ; his energies have received a new J. 2 A MEMORIAL SERVICES. Impulse ; in a word, new IKe has been infused into his soul, and that boy is already the com- ing man. The granite shaft which we have this day dedicated to the memory of McDowell is a living biography, designed not merely to com- memorate the virtues and services of a great and good man, but to excite the emulation of Kentucky's youths and to urge them on to deeds of valor and of humanity. A country without monuments is a country without civili- zation. I cannot forbear introducing here the appro- priate and beautiful remarks of an old and dis- tinguished pupil, Dr. David W. Yandell, made upon a recent festive occasion, when contrast- ing the fame of the statesmen, the orators, and the military men of Kentucky with that of McDowell. " Chief among all these,'' says my eloquent friend, "is he who bears the mark of our guild, Ephraim McDowell ; for the labors of the statesman will give way to the pitiless logic of events, the voice of the orator grow fainter in the coming- ages, and the deeds of the soldier eventually find place only in the library of the student of military compaigns ; while the achievements of the village surgeon, like the widening waves of the inviolate sea, DEDICA TOR Y ADDRESS. r 2 C shall reach the uttermost shores of time, hailed by all civilizations as having lessened the suffer- ing and lengthened the span of human life." In selecting Danville for the site of the " McDowell Monument" the Kentucky State Medical Society made a happy choice, for it was here that the Father of Ovariotomy encoun- tered and vanquished his early professional struggles; here that he performed his great achievements ; here that at the close of a well- spent life he was laid quietly in the grave. When McDowell, after his return from Europe, began the practice of medicine here, Danville contained a mere handful of inhabitants ; but he soon identified himself with its prosperity, watching its progress with a jealous eye, and contributing largely by his means and his good sense to make it what it now emphatically is, the Athens of the West, a distinction at one time so justly conceded to her near neighbor Lex- ington. Its institutions of learning have be- come the foremost in the State. Center Col- lege has educated many of Kentucky's greatest citizens. Its theological school has widely dis- seminated the lessons of Christianity. Its female seminaries have planted the seeds of virtue, piety, and learning in the hearts and C26 MEMORIAL SERVICES. minds of her young women. The institution for the education of deaf-mutes was the first of the kind established in the West. Founded in 1823, shortly after those at Hartford, Philadel- phia, and New York, it gradually, despite great obstacles, attained, under the wise man- agement and fostering care of the late Mr. John A. Jacobs, extending over a period of forty-four years, a degree of reputation not less creditable to the country at large than to his adopted State. His death in 1869 was a public loss, widely deplored. Nearly forty years have elapsed since I was called to the chair of surgery in the University of Louisville, and responded, along with Pro- fessor Drake, at the request of my colleagues, to an invitation issued by the late Dr. William L. Sutton, of Georgetown, to assist in forming a State medical society. The first attempt proved abortive, but another, made under more favorable auspices several years later, was suc- cessful, and the society soon assumed import- ant proportions. Of the original members, of whom Dr. Sutton was one of the most zealous and influential, few survive ; but it is gratifying to know that the work which they inaugurated has been so nobly pushed forward by their sue- DEDICA TOR Y A D DRESS. 527 cessors, not a few of whom have achieved a wide and enduring reputation as medical phi- losophers, clear thinkers, accurate observers, and accomplished and sagacious practitioners. If any evidence were needed of their zeal to advance the interests of medical science and of suffering humanity, it would be found, not in idle talk or vapid boasting, but in hard work and steady and persistent effort, as shown in the transactions of their society and in our periodical literature. Progress of the most laudable character is everywhere visible in its ranks. Since the period adverted to most of my earlier Kentucky friends in and out of the profession have passed away, while of my earlier colleagues in the University of Louis- ville not one remains. Drake and Caldwell and Short and Cobb and Miller and Yandell have gone to their last home, to that sleep which knows no waking. Palmer and Rogers, who entered ■ the school at a later day, have also been gathered to their fathers ; the one a bril- liant anatomical teacher and a genial and intel- ligent companion ; the other for upward of a third of a century Louisville's honored, be- loved, and favorite physician, with a heart gentle as a woman's and a countenance benig- C28 MEMORIAL SERVICES. nant as an angel's. Kentucky has a long list of deceased physicians, who have left behind them a rich legacy and an example worthy of the emulation of their successors, whose duty it should be to cherish their memories and to transmit to their descendants the history of their lives. It would be unjust alike to the occasion, as it would be to my own feelings if I failed to con- nect with each other and with the great ovari- otomist, as with an adamantine chain, the names of those of our surgeons, already seve- ral times mentioned, who have been instrumen- tal in reviving this operation in this country, and thus giving it a new impulse. The names which stand most conspicuously upon this honored list are those of the two brothers Atlee, John and Washington, J. Taylor Brad- ford, Edmund Randolph Peaslee, Oilman Kim- ball, and Alexander Dunlap. Of these six pioneers in this field of surgery three have passed away, while the other three, John L. Atlee, Oilman Kimball, and Alexander Dunlap, are still spared to us, in a ripe but vigorous old age, to battle with disease and death and to earn additional laurels for themselves and their country. DEDICA TOR Y ADDRESS. r 30 Of the early life of Dr. J. Taylor Bradford, who died a number of years ago in the prime and vigor of life, I know nothing, although our acquaintance extended over a period of twenty years. He received his medical degree from the University of Louisville during the early part of my connection with that institution, and, settling at Augusta immediately afterward, soon acquired a large and commanding practice, per- forming many important surgical operations, and earning an enviable reputation as a most successful ovariotomist. Had he reached the age usually allotted to man his cases would probably have been counted by the hundred. Dr. Washington L. Atlee, who died at his home in Philadelphia in September, 1878, was, as is his brother John, a native of Lancaster, Pennsylvania, where he was born in February, 1808. After having received an academic education he graduated at the Jefferson Medi- cal College in 1829. Having been fellow- students in the office of Professor George Mc- Clellan, the eminent suro-eon, and havinij met with him very frequently after my removal to Philadelphia in 1856, I had excellent opportuni- ties of forming a correct estimate of his charac- ter, which no one perhaps appreciated more 34 c^o MEMORIAL SERVICES. fully than myself. If this character was not perfect in the true sense of that term it was a model worthy of universal imitation. He had many striking traits of character, with a strong, vigorous mind incased in a strong body, and accomplished a vast deal of work. He per- formed a much greater number of professional journeys than ever fell to the lot of any Ameri- can physician. His visits extended into almost every State of the Union and even into a num- ber of our Territories. His power of endur- ance was ofigrantic. He often travelled thous- ands of miles without taking any rest except such as he found upon the swiftly-flying railway train. Not unfrequently he performed two ovariotomy operations on the same day. Such labor could not fail to make serious inroads upon the stoutest frame, and, although the day of reckoning was long put off, it was sure to come at leno^th. The early professional life of Atlee was spent in earnest practice, enlivened by the study of botany and other branches of natural science, for which he had a great fondness. Much of his leisure during the first few years was spent among the flowers and grasses of his native county. After his removal, in 1844, to Phila- DEDJCA TOR Y ADDRESS. r ^ i delphia he occupied for eight years the chair of chemistry in what was then known as the Pennsylvania Medical College. His career as an ovariotomist began, as already stated, in 1844 and terminated only with his life. His first case proved fatal. As an operator in his specialty he had no superior on this continent, if indeed anywhere. Despising display, always so well calculated to entrap the vulgar, he em- ployed the fewest possible instruments and Avent about his work calmly and deliberately, with the greatest care for the welfare of his patient, which, it is safe to say, no man had -ever more at heart. There was no hurry, no parade, no ostentation. I witnessed a number of his operations and was strongly impressed by the simplicity of his movements and the coolness of his manner. Such, in a few words, was his character as an operator. But it must not be inferred that Dr. Adee was a mere spe- cialist. For many years he enjoyed a large and lucrative general practice, although during the last quarter of a century of his life his busi- ness was mainly in the direction of abdominal surgery, in which he achieved an enduring reputation. He wrote largely for the medical press, and late in life published an able and c^2 MEMORIAL SERVICES. elaborate treatise on the Diagnosis of Ovarian Tuinoi'S, a subject which he invested with new light. His operation for the removal of fibroid o-rowths of the uterus constitutes a new era in surgery, precious alike to science and to hu- manity. Like McDowell's operation, Atlee's was received with distrust, and remained un- appreciated for upward of a quarter of a cen- tury. Time, however, which generally meas- ures thinofs accordinof to their real value, has made a strong verdict in its favor, and it is therefore not surprising that the gynecologists of America and Europe should unite in pro- claiming it as one of the greatest achievements of modern surgery. Atlee's own successes should have been quite sufficient to convince any unprejudiced mind of its great value. Atlee had a strong but tender, sympathizing heart, a well-regulated temper, a high sense of honor, and a clear and well-cultivated mind. Tall and erect in person, he had a commanding presence, blended with the air and graces of the well-bred gentleman. In the sick-room he was cheerful and winningr in his manners, with a heart full of kindly feeling for the sufferer. He was the idol of his family, a warm friend, a loyal citizen, a consistent Christian. His last DEDICA TOR V ADDRESS. illness, extending over a period of three months, was cruelly severe, but he bore his suffering, which was daily making sad inroads upon his previously robust frame, without a murmur of complaint or impatience. The gradual decay of his body did not impair his intellectual powers, and his mind remained clear to the last. No man, perhaps, ever set his house more perfectly in order than he did ; not even the most minute details were overlooked. Im- partial history will assign to Washington L. Atlee a high rank in the temple of fame as an original thinker, an accomplished surgeon and physician, and a benefactor of his race. Dr. Edmund Randolph Peaslee, whose name, as has been stated, is, like that of Atlee, so honorably associated with the progress of ovariotomy in this country, died in January, 1878, only about eight months before his dis- tinguished Philadelphia confrh'e. Born in New Hampshire in 1814, he was emphatically a many-sided man, of high culture, great refine- ment, vast industry, and extraordinary pro- fessional resources in cases of emergency. With the exception of Nathan Smith, of New Haven, a contemporary of McDowell. I have no recollection of any man who in recent times r-nA MEMORIAL SERVICES. lectured on so many branches of medical sci- ence or filled chairs in so many medical schools. Anatomy and physiology, general pathology, surgery, obstetrics, and gynecology were the diversified themes which from time to time engaged his facile brain as a public teacher. He was also an expert and cautious operator and a most accomplished physician, especially distinguished for his skill as a diagnostician. Besides numerous papers contributed to the periodical press, he was the author of several books ; among others an exhaustive treatise on Ovarian Tuniors, published in 1872, a pro- duction which, while it greatly enhanced his reputation at home, made his name widely known abroad. Of his operations I have already spoken. The private character of Dr. Peaslee may be best summed up in the beau- tiful words of his biographer, the Rev. Dr. Bartlett, President of Dartmouth College, who, having known him long and well, thus speaks of him: "His day," says this accomplished scholar, "is done; his sun is set. But from the scene of its setting there streams up a trail- ing brightness, as of some perpetual zodiacal light — the shining example of one who, while profound in science, wise in counsel, and ex- DEDICA TORY ADDRESS. -or cellent in skill, was also sincere in piety, blame less in manhood, true in friendship, genial in intercourse, and whose presence enters the sick-chamber like a sunbeam from heaven streaming into a darkened room. Its mild radiance lingers in hundreds of homes and thousands of hearts. It is a life profitable for young men to contemplate." Young men of the Kentucky State Medical Society, listen to the voice of one who has grown old in his profession, and who will prob- ably never address you again, as he utters a parting word of advice. The great question of the day is, not this operation or that, not ovari- otomy or lithotomy, or a hip-joint amputation, which have reflected so much glory on Ken- tucky medicine ; but it is preventive medicine, the hygiene of our persons, our dwellings, our streets ; in a word, our surroundings, whatever, and wherever they may be, whether in city, town, hamlet, or country, and the establishment of efficient town and State boards of health, through whose agency we shall be the better able to prevent the origin and fatal effects of what are known as the zymotic diseases, which carry so much woe and sorrow into our families, and which often sweep, lik'- a hurricane, over -^5 MEMORIAL SERVICES. the earth, destroying milHons of human Hves in an incredibly short time. The day has arrived when the people must be roused to a deeper and more earnest sense of the people's welfare, and when suitable measures must be adopted for their protection as well as for the better development of their physical, moral, and intel- lectual powers. This is the great problem of the day, the question which you, as representa- tives of the rising generation of physicians, should urge, in season and out of season, on the attention of your fellow-citizens ; the ques- tion which, above all and beyond all others, should engage your most serious thoughts and elicit your most earnest cooperation. When this great, this mighty object shall be attained ; when man shall be able to prevent disease and to reach with little or no sufferino- his three- o score years and ten, so graphically described by the Psalmist, then, but not till then, will the world be a paradise, with God, Almighty, All- wise, and All-merciful, in its midst, reflecting the glory of His majesty and power, and hold- ing sweet converse in a thousand tongues with the human family. ADDRESS OF PROFESSOR SAYRE. No word from me can add a single laurel to the crown of the immortal McDowell, whose history and services to mankind have been so beautifully and truthfully portrayed by the dis- tinguished orator of the evening, the Nestor of American surgery, Prof Gross. In fact, any remarks from me in my individual capacity would seem almost inappropriate, but in my official capacity as President of the American Medical Association it is my duty as well as my pleasure to bring to the monumental shrine the ovations of the entire medical profession of these United States. And, Sir, I venture here the prediction that in all time to come the intelligent surgeons, either in person or in thought, from every part of the civilized globe, will wander here to Danville to pay their respects and sense of obligation to the memory of Ephraim McDowell, who has contributed more to the alleviation of human suffering and the prolongation of human life than any other (537) -^g MEMORIAL SERVICES. member of the medical profession in the nine- teenth century. We can scarcely comprehend the greatness of this man's mind, and the truly wonderful genius of McDowell, until we stop to consider who he was, what he did, and when and where he did it. A village doctor in the backwoods frontier, surrounded by Indians and the buffalo, almost beyond the bounds of civili- zation, with no books to refer to, with no pre- cedent to guide, with no one to consult but his own unaided judgment, with no one to share the responsibility if unsuccessful, unaided and alone assumes the responsibility of removing a disease which up to that time had been con- sidered absolutely incurable. Think for a mo- ment whai would have been the result of failure — a coroner's jury, and a verdict of wilful mur- der, which at that time would have been pro- nounced correct by the entire medical profes- sion throughout the civilized globe. All this he dared and did assume, because his clear intellect had reasoned out his plan of proce- dure, and his careful dissections had pointed out to him the path to victory. And now every intelligent surgeon in the world is performing the operation as occasion requires, until at the present time, as Dr. Thomas has stated, forty ADDRESS OF PROFESSOR SA YRE. - ^n thousand years have already been added to the sum of human hfe by this one discovery of Ephraim McDowell. Another fact strikes me very forcibly, Mr. President, and that is, the heroic character of the woman who permitted this experimental operation to be perforn^ed upon her. The women of Kentucky in that period of her early history were heroic and courageous, accus- tomed to brave the dangers of the tomahawk and scalping-knife, and had more self-reliance and true heroism than is generally found in the more refined society of city life ; and hence the courage of Mrs. Crawford, who. conscious that death was inevitable from the disease with which she suffered, so soon as this village doc- tor explained to her his plan of affording her relief, and convinced her judgment that it was feasible, immediately replied, " Doctor, I am ready for the operation ; please proceed at once and perform it." All honor to Mrs. Crawford ! Let her name and that of Ephraim McDowell pass down in history together as the founders of ovariotomy. Kentucky has many things to boast of in climate, soil, and magnificent forests of oak carpeted with her native bluegrass, far surpass- c^Q MEMORIAL SERVICES. ing in beauty and grandeur the most elegantly cultivated parks of England. She is famed for her beautiful and accomplished women ; she is renowned for her statesmen, her orators, and her jurists ; her Clays, her Johnsons, her Wick- liffes, her Crittendens, her Marshalls, her Shelbys, her Prestons, her Breckinridges, and a host of others ; but no name will add more to the lustre of her fame than the one whose name we this day commemorate by erecting this monument to Ephraim McDowell, the ovariotomist. CORRESPONDENCE. LETTERS FROM DISTINGUISHED GENTLEMEN AND MEMBERS OF THE PROFESSION. L. S. McMuRTRY, M.D., Chairman McDowell Monument Committee. My dear Doctor : With eagerness I ac- cepted, a few weeks since, the invitation of your committee, and anticipated rare pleasure in meeting the many distinguished medical gentle- men whom the occasion and the exercises so wisely planned for the dedication of the monu- ment just erected at Danville to the memory of Ephraim McDowell would naturally bring together. The medical profession of the United States, under the auspices of the Kentucky State Medical Society, has honored itself in honoring, by this special mark of gratitude, Kentucky's most eminent surgeon. The purpose of the meeting — a public and emphatic indorsement by the profession of the country — affirming the claim of originality in the operation of ovariotomy to Dr. McDowell, and (541 ) r ^2 MEMORIAL SERVICES. showing a readiness to recognize and admire superior genius in our ranks, and hold it up for imitation and encouragement, will certainly meet the approbation of every lover of the science of medicine. For a number of years I enjoyed the rare privilege of an intimate friendship with Dr. John D. Jackson, of Danville, the originator of the project to have the medical profession of America erect a becoming monument to Ken- tucky's — yes, to America's great surgeon, Dr. Ephraim McDowell, of Danville, Kentucky, who had the genius to devise and the courage to execute, almost without assistance, the for- midable operation of ovariotomy in your town. Well do I remember the enthusiasm of Dr. Jackson when commenting upon this splendid operation, which has added greater security to the life of woman, rendered its originator's name imperishable, elevated the character of medicine everywhere, and given fame to Ame- rican surgery throughout the civilized world. Ovariotomy deserves to rank as one of the four greatest discoveries in the progess of medical science, alongr with the circulation of the blood, vaccination, and anaesthetics. Besides my enforced absence I have but one CORRESPOXDENCE. 543 regret, which I doubt not Is felt by all who may be present with you, which is that Dr. Jackson was not spared to take part in the dedication of this noble and appropriate memento to his townsman, to whose memory and achievements he was so ardently attached. The work in its consummation will, I am con- fident, as faithfully and imperishably perpetuate the fanle.of Jackson as it does the name of the noble McDowell, for whom it has been erected. Thanking you, gentlemen, for your courtesy, and regretting more than I can express my inability to be present to testify by my presence my appreciation of your commendable and so satisfactorily completed labors, and to have the pleasure of hearing the dedicatory address of the veteran American surgeon, Prof. S. D. Gross, as well as to meet old friends and par- take of your hospitality on this occasion, I am, with sentiments of regard, Very truly yours, J. M. Toner. M.D. Washington, May 13, 1879. rAA MEMORIAL SERVICES. L. S. McMuRTRY, M.D., Chairman McDowell Monument Committee. Dear Doctor: I have much pleasure in acknowledging- receipt of the invitation to attend the memorial occasion in honor of "the Father of Ovariotomy." Unfortunately for me some professional duties here, which cannot in any way be postponed, will compel my return home from Atlanta immediately after the ad- journment of the American Medical Associa- tion. It is well in the name of American surgery, and in the name of a common philanthropy, that this honor, though tardy, should be paid to the memory and fame of Ephraim McDowell. I cannot but think of the fact that the erec- tion of the monument is largely due to the original su^Sfestion and active efforts of one who recently passed away from earth before he had reached the noon of his power and repu- tation, one who was esteemed and admired by every physician North, South, East, and West. The monument will tell not only of " the Father of Ovariotomy," but also of John D. Jackson. I am, dear Sir, yours very truly, Theophilus Parvin. Indianapolis, Ind., May i, 1879. CORRESPONDENCE. - ^ - L. S. McMuRTRY, M.D., AND OTHERS, Of the McDowell Monument Committee. Gentlemen : Your kind invitation to attend the dedication of the McDowell monument is just received, for which I beg leave to return my thanks, and the assurance of my sincere regret that I shall be prevented from taking part in the interesting- ceremonies. The occasion is one of extraordinary import, in that it is the first and only instance in the history of the United States that such honors have been paid to the memory of a physician ; and secondly, that the virtues which it is pro- posed to perpetuate in the monument were consecrated to the saving of human life and the mitigation of human suffering. Of the man Ephraim McDowell we know comparatively little, but of the great original ovariotomist no one at all concerned in the progress of surgery can be igfnorant. As a Kentuckian no less than as a surgeon I have always felt the deepest interest in his history, and have sought in his life and surroundings to penetrate to the origin of the great thought, and still greater courage, that gave expression to the thought which, without the sanction of precedent, and unaided by the advice or sympathy of others, culminated 35 r^5 MEMORIAL SERVICES. in the institution of an operation by which thousands of women heretofore doomed to early death now live to bless his name. But who can discover and open the secret door which hides from profane view the sacred laboratory of genius? Or who can trace the footsteps of the inspired discoverer as he works his narrow way out to the confines of human experience, and with purged eye looks into the mysteries which lie beyond ? All that we can do is to cheer on with our words of encourage- ment, and, when the work is done, with willing hands distribute its benefits to those who are in need, never forgetting to pronounce a blessing upon the author. In this spirit of humble reverence I bow my bared head before him whom you this day exalt in the sight of the whole world as one of its greatest benefactors, and proclaim by your act that the highest and noblest ambition of the physician should be the saving of human life. Who is there, since the days of Jenner, who can in this respect compare with the "backwoods surgeon of Ken- tucky? " I would not derogate in the slightest degree from the deserved honor which belongs to many who have followed their profession with equal zeal and earnestness, and who have CORRESPONDENCE. ■A7 added largely to the resources of the healing- art, but in the inscrutable wisdom of the Creator of all things it has not been given to any other single laborer in the field of medicine and sur- gery upon this western hemisphere to confer so great a blessing upon the human race. All honor to the memory of Ephraim Mc- Dowell, the man of genius, the wise and heroic surgeon, the benefactor of his kind. When the granite shaft which you have erected to signalize what he was and what he did shall have fallen into decay, his name will still be perpetuated by the many lives saved through his instrumentality. I am, gentlemen, with great esteem, your obedient servant, T. G. Richardson, New Orleans, May 9, 1879. L. S. McMuRTRY, M.D., Chairman McDowell Monument Committee. Dear Sir : I thank you very much for your invitation to attend the meeting connected with the McDowell monument, and I deei)ly regret that I am unable to leave London at present. It would give me extreme pleasure to be present at so interesting a ceremony, to make CAg MEMORIAL SERVICES. the acquaintance of so many of my American professional brethren, and to show my respect to the memory of "the Father of Ovariotomy." I shall hope in some future year to visit your great country again, and to see the monument you have raised over the grave of McDowell. Very sincerely, T. Spencer Wells. 3 Upper Grosvenor Street, London W., April 24, 1879. L. S. McMuRTRY, M.D., Chairman McDowell Monument Committee. Dear Sir: I regret that it is not in my power to renew the pleasure of a former visit to Ken- tucky and take part in the exercises at the dedication of the McDowell monument, at least so far as to be a sympathetic listener to all the eloquence which the occasion will call forth. I feel a personal interest in the surgical con- quest which is to be commemorated in addition to that which all the world recognizes. Among the births of the century this is a twin with my- self Dr. McDowell's first operation dates from the same year as that in which I first inhaled the slow poison that envelops our planet, the effects of which I have so long survived. I CORRESPONDENCE. e ,^ 549 thank God that the other twin will lone outlive me and my memory, carrying the light of life into the shadows of impending doom, the message of hope into the dark realm of de- spair ; opening the prison to them that are bound and giving them beauty for ashes, the beauty of a new-born existence even, it may be, as I have but recently seen it, of youthful and happy maternity in place of the ashes for which the inevitable urn seemed already wait- ing. I am glad that this great achievement is to be thus publicly claimed for American surgery. Our trans-Atlantic cousins have a microphone which enables them to hear the lightest foot- steps of their own discoverers and inventors, but they need a telephone with an ear-trumpet at their end of it to make them hear anything of that sort from our side of the water. There is another kind of trumpet they do not always find themselves unprovided with, as those who remember Sir James Simpson's astonishing article, " Chloroform," in the eighth edition of the Encyclopedia Bi'itannica, decently omitted and ignored in the ninth edition of the same work, do not need tc be reminded. If there was any one who could dispute Dr. ccQ MEMORIAL SERVICES. McDowell's claim to be called " the Father of Ovariotomy" it would have been our own Dr. Nathan Smith — our own and your own too, for he also was born and lived and died on the sunset side of the Atlantic, and within the starry circle which holds us all. Dr. Smith performed the operation of ovariotomy with success early in the century, but unfortunately there is no record, so far as I know, of the exact date. I allude to this fact not to invali- date Dr. McDowell's claim, for an undated case cannot do it, but to couple with his name as at least next in priority that of another native American practitioner worthy of companionship with the greatest and the best. A single thought occurs to me which may help to give this occasion something more than professional significance. Although our politi- cal independence of the mother country has been long achieved, our scientific and literary independence has been of much slower growth. And as we read the inscription on this monu- ment, let us gratefully remember that every bold, forward stride like this grand triumph of American science, skill, and moral courage, tends to bring us out of the present period of tutelage and imitation into that brotherhood CORRESPONDENCE. e r j and self-reliance which should belong to a people no longer a colony or a province, but a mighty nation. I am, dear sir, Yours very truly, Oliver Wendell Holmes. Boston, May 9, 1879. L. S. McMuRTRY, M.D., Chairman McDowell Monument Committee. My dear Sir : It is with extreme regret that I find myself prevented from accepting your kind invitation to take part in the dedication of the monument to the " Father of Ovariotomy." Although absent in body let me assure you that I shall be present in spirit. Kentucky cherishes the memory of many noble sons, but nowhere in her annals can she point to a name more deserving of her pride than that which adorns the monument erected to commemorate McDowell's glory. Others have given her the proud records of the warrior, the statesman, the philosopher, and the philanthropist. McDowell, favored by God above other men, has already bestowed upon humanity more than forty thousand years of active life, and insured for the future results which will surely dwarf those of the past. CC2 MEMORIAL SERVICES. The noble tribute which you erect in his honor will last long, but it will crumble into dust and be scattered abroad by the winds, while his memory will continue to live green and vigorous in the hearts of a grateful pos- terity. With sentiments of sincere regard, I am, dear sir, Very truly yours, T. Gaillard Thomas. 294 Fifth Avenue, N. Y., May i, 1879. PRESENTATION ADDRESS. Remarks made by Prof. Richard O. Cowling, M.D., OF Louisville, in Presenting the Door-knocker OF Dr. McDowell's House to Dr. Gross. Dr. Gross, the Kentucky State Medical Society thanks you for the beautiful oration you have just delivered on Ephraim McDowell. Surely hereafter, when history shall recall his deeds and dwell upon his memory, it will relate how, when he was fifty years at rest, the great- est of living surgeons in America came upon a pilgrimage of a thousand miles to pronounce at his shrine the noble words you have spoken. The Society does not wish that you should return to your home without some memento of the occasion which brought you here, and which shall tell you also of the admiration, the respect, and the affection it ever bears for you. I have been appointed to deliver to you this simple gift, with the trust and the belief that it will always pleasandy recall this time and be a ( 553) rc4 MEMORIAL SERVICES. token of our feelings toward you. We wished to give you something directly connected with McDowell, and it occurred to us that this me- mento of the dead surgeon would be most appropriate. It is only the knocker which hung upon his door, but it carries much meaning with it. The sweetest memories of our lives are w^oven about our domestic emblems. The hearthstone around which we have gathered, the chair in which our loved ones have sat, the cup their lips have kissed, the lute their hands have swept — what jewels can replace their value? Do you remember the enchantment that Douglas Jerrold wove about a hat-peg? How at the christening of the child they gave it great gifts of diamonds and pearls and laces ; and when the fairy godmother came, and they expected that she would eclipse them all with the magnificence of her dowry, how she gave it simply a hat-peg ? They wondered what good could come of that. The boy grew to be a man. In wild pursuits his riches were wasted, and at. last he came home and hune his hat upon that peg. And while the goodman's hat was hanging there peace and plenty and order and affection sprang up in his home, and the hat-peg was indeed the talisman of his life. PRESENTA TION A DDR ESS. ^55 I would that the magician's wand were granted me a while to weave a fitting legend around this door-knocker, which comes from McDowell to you, Dr. Gross. There is much in the emblem. No one knows better than you how good and how great was the man of whom it speaks. It will tell of many a summons upon mercy's mission which did not sound in vain. Ofttimes has it roused to action one whose deeds have filled the world with fame. A sentinel, it stood at the doorway of a happy and an honorable home, whose master, as he had bravely answered its signals to duty here below, so when the greater summons came, as trust- fully answered that, and laid down a stainless life. It belongs by right to you, Dr. Gross. This household genius passes most fittingly from the dearest of Kentucky's dead surgeons to the most beloved of her living sons in medicine. She will ever claim you as her son, and will look with jealous eye upon those who would wean you from her dear affection. And as this emblem which now is given to you hangs no longer in a Kentucky doorway, by this token you shall know that all Kentucky doorways are open at your approach. By the rc6 MEMORIAL SERVICES. relief your skill has wrought ; by the griefs your great heart has healed ; by the sunshine you have thrown across her threshold ; by the honor your fame has brought her ; by the fountains of your wisdom at which your loving children within her borders have drunk, the people of Kentucky shall ever open to you their hearts and homes. DR. GROSS'S REPLY. I AM much overcome, gentlemen of the Ken- tucky State Medical Society, by this mark of your approbation. I am not the great man your speaker has declared me to be, but I gratefully appreciate the feelings that have prompted his words. I claim to be but an earnest follower of Surgery, who during a period which has now extended beyond half a century, has striven to the best of his ability to grasp its truths and to extend the beneficence of its offices. I am not to be placed by the side of McDowell, for what I may have done in our art ; but if this reward be a measure of the appreciation I hold of the good-will of the people in this Commonwealth, I may claim it for that. The years of my life which I passed in Ken- tucky represent the most important era in my career. They witnessed many of its struggles and much of the fruition of its hopes. To the warm hearts of the many friends it was my ( 557 ) erg MEMORIAL SERVICES. o-Qod fortune to secure within these borders do I owe it that those struggles were cheered and rewards beyond my deserts were secured. I take this emblem now offered me as the most valued gift of my life. It shall be received into my home as a household god, environed by all the memories of goodness and greatness to which your speaker has referred, and above all recalling this scene. Dying I shall bequeath it, among my most important possessions, to the family that I may leave, or in failure of that, to be preserved in the archives of some society. I thank you again, gentlemen, and I wish I were able to tell you better how much I thank you. ADDENDA The following- portraits and sketches of the lives of a few of the prominent members of the medical profession have been incorporated in this second edition in the hope that they will add greater interest to the work by giving to the world a brief history of some of those who have successfully followed in the footsteps of Ephraim McDowell, M.D., who perilled his life to give to the medical profession an opera- tion which has led to the development of pro- miscuous laparotomy by which millions of lives of suffering humanity have been saved. These sketches have been obtained by the solicitation of the author, who regrets that the limited time at her command did not enable her to communicate with many other promi- nent surgeons who. doubtless, would also have (559) 560 ADDENDA. contributed their sketches, had they been re- quested, and thus shown their appreciation of her efforts to give to the medical profession a lasting memorial to the immortal McDowell. The Author. #»■ X 1^ PROF. T. G. RICHARDSON, M.D., LATE DEAX OF THE TULAXE UNIVERSITY, NEW ORLEANS, LA. On May 26, 1892, at 8.30 p.m., the spirit of a revered teacher and valued citizen passed away to its rest. While his death was not a surprise to those who knew of his long and painful illness, still it came as a shock to the many who owed a large part of their medical training to Dr. Richardson. Dr. Richardson was born at Lexington, Ky., January 3, 1827, and was the son of William Richardson, for many years before his death cashier of the Northern Bank of Kentucky, Louisville. His mother was Synia Higgins, whose father was a contemporary and personal friend of Daniel Boone. In 1837 he removed with his parents to Louisville, and in 1845 matriculated in the Medical Department of the University of Louisville. The same year he entered the office of Professor S. D. Gross, M.D., as a private pupil, having as a companion Dr. Nathan Bozeman, now of New York, who was also his classmate at the University. In 1847 he was appointed resident student of the Louis- ville Marine Hospital. He graduated at the University in the spring of 1848, and immediately afterward was appointed by the Faculty demonstrator of anatomy, which position he filled for eight years. During a large portion of this period he was engaged in anatomical investigations, and in 1853 published a large volume, entitled Elements of Hianan Anatomy, besides occasional contributions to the Western Journal of Medicine. This medical periodical 36 ( 561 ) 562 DR. T. G. RICHARDSON. being suspended in 1855, he founded the Louisville Review in connection with Professor Gross, Resigning the position of demonstrator of anatomy at Louisville, in 1856, he was at once offered the chair of anatomy in the New York Medical College, that of surgery in the Kentucky School of Medicine, and that of anatomy in the Medical Department of the Pennsylvania College, at Philadelphia. He decided to accept the latter, and re- moved to Philadelphia in the fall of 1856. While there he established, in conjunction with Professor Gross, who had accepted the chair of surgery in the Jefferson Medical College, the North Atnerican Medico- Chirurgical Review, and continued to act as junior editor until its suspension, in 1862, although he had in the meantime removed to another field of duty. While at the Pennsylvania Medical College he was associated with Professors Alfred Stille, Francis Gurney Smith, and other gentlemen well known to the profession throughout the United States as teachers and authors. In 1858 he was invited to the chair of anatomy in the medical department of the University of Louisiana, to succeed Prof. Nott, and removed to New Orleans in the latter part of the year. This school was at that time one of the largest in the country, and, with such distinguished professors as the late Warren Stone, M.D., Thomas Hunt, M.D., and others of like distinction, attracted annually more than four hundred students. He was at the same time appointed one of the attending surgeons to the Charity Hospital, and lectured upon clinical surgery in addition to his didactic lectures upon anatomy in the medical college. He was the first to perform successfully the operation of vesico-vaginal fistula, after the method of Dr. Nathan Bozeman, which had then but recently been intro- duced to the profession. He soon became engaged in a large surgical practice, which was only interrupted by the outbreak of the civil war. DR. T. G. RICHARDSON. 0^ Leaving New Orleans before its capture by the Federal forces, in 1862, he joined the Confederate Army of Ten- nessee, of which he was made practically, although not nominally, assistant medical director, and subsequently medical inspector on the staff of Major General Braxton Bragg. He was present on the field at the battles of Murfreesboro, Chickamauga, and Missionary Ridge, in the second of which it became his melancholy duty to amputate the thigh of the gallant Major- General Hood. He accompanied General Bragg, after the retirement of that distinguished officer from the Army of Tennessee, to Richmond, where he continued his duties as medical in- spector during the summer of 1864, and by request of the surgeon in charge. Dr. Hancock, and the attending sur- geons, Drs. Cabell, Hoyt, Tom, and Wellford, he per- formed a large part of the capital operations at the immense hospital after the battles of Rapidan, Spottsylvania Court House, and Cold Harbor. He subsequently accompanied General Bragg to North Carolina as medical director of that department, and was present on the field at the battle of Averysboro, and also that of Bentonville, where a mere handful of Confederates, under General J. E Johnson, made their last unsuccessful fight. Still adhering to the fortunes of his friend and chief. General Bragg, he joined the retreating column of govern- ment officials, with President Davis at its head, and con- tinued with them until the formal dissolution of the Con- federate Cabinet, at Washington, Ga. , and the dispersion of its members. He returned to New Orleans in the succeeding fall, and resumed his position in the University of Louisiana, and was immediately chosen Dean of the Medical Faculty. In 1873, upon the resignation of Professor Warren Stone from the chair of surgery, he became his successor, and his ability as a director and teacher aided in elevating the college to its present high standing. 564 DR. T. G. RICHARDSON. In 1877 he was elected president of the American Medical Association, at its annual meeting in Chicago, and presided at the subsequent meeting in Buffalo, N. Y. For a number of years he devoted the summer months to travel. He travelled over all the ground usually cov- ered by tourists, and besides a large amount of territory not often visited by them. He crossed the Atlantic many times ; spent two summers in Mexico ; ascended the Ama- zon ; scaled the Andes ; visited the Sandwich Islands, and went up and down his own country until no place of im- portance had been left unseen. In all of his journeyings he was accompanied by his devoted wife ; she was one of the three ladies who first looked down into the crater of Popocatapetl. In addition to the literary productions mentioned, Dr. Richardson contributed a number of articles to the New Orleans Medical and Surgical Journal and the Medical News and Library of Philadelphia. He also wrote a life of the distinguished anatomist and naturalist, Professor John D. Godman. He was a corresponding member of the College of Physicians and Surgeons of Philadelphia and of the Academy of Natural Sciences, Philadelphia, and an active member of the Louisiana State and the Orleans Parish Medical Society (representative men of the South). For many years Professor Richardson was a member and elder of the First Presbyterian Church, counting its pastor, Dr. B. M. Palmer, among his most valued friends. Dr. Richardson was married twice. His first wife was the daughter of Professor Charles W. Short, M.D., of Kentucky. Three children blessed this marriage. A tragic fate overtook the mother and children. They were on a steamboat coming down the Mississippi to join him; the boat sank, and among the victims were Dr. Richardson's wife and children. DR. T. G. RICHARDSON. 565 His second wife was Miss Ida Slocomb, daughter of Mrs. Cora A. Slocomb, who survives him. As an administrator of the Tulane University, from its origin in 18S4, he was zealous in behalf of the Medical Department, and secured for it important benefits. He never failed to encourage and aid his successor in every- thing calculated to promote the welfare of the college ; and the very last official letter, written two years after his retirement from active service, to the Dean of the Medical Department, proved conclusively his unalterable devotion to his beloved college and his judicious and generous appre- ciation of its needs. In this memorable letter of March 3, 1 89 1, Dr. Richardson wrote : "I am authorized by Mrs. Richardson to place at your disposal $50,000 for the erec- tion of a building for laboratories of chemistry, physiology, pathological anatomy, microscopy, etc., and for suitable anatomical rooms, provided that for this purpose the Fac- ulty can obtain from the administrators of the Tulane University of Louisiana either of the two lots contiguous to the building of the Medical Department ; work upon the new building to be begun within a year of this date." The Medical Faculty replied, March 6, 1891, as fol- lows : "The generous and philanthropic offer of Mrs. Richardson to contribute $50,000 for the building of labor- atories, on which now depend the future progress and prosperity of the Medical Department, is most gratefully accepted. In addition to the respect, affection, and ad- miration that her gentle and noble character arouses in all who know her, Mrs. Richardson has by this act deserved the profound and lasting gratitude of all who have at heart the welfare of New Orleans, the relief of human suffering, and the gratitude especially of those on whom is imposed the duty of promoting the prosperity of the Medical Department. "Professor T. G. Richardson, M.D., for very many 566 DR. T. G. RICHARDSON. years our honored colleague and Dean, is earnestly solic- ited to become the chief counsellor and agent of the Fac- ulty in everything that may concern the expenditure of this gift, to the end that every dollar may be disbursed prudently and wisely for the greatest benefit of the Med- ical Department, of the public, and to the perfect satis- faction of the donor." Difficulties arose as to securing either of the lots con- tiguous to the old building ; the Faculty did not desire the responsibility of taking charge of the donation, and for other reasons a letter was addressed, May 9, 1891, to United States Senator R. L. Gibson, President of the Board of Administrators, signed " Ida A. Richardson, ap- proved T. G. Richardson," which was briefly as follows: "If the administrators will furnish a suitable site for a medical college I will contribute $100,000 toward the erection of the building, to be paid from time to time as the work progresses." The administrators accepted this donation, and provided, at an expense of $35,000, an admirable site. Such is a brief history of the inception of the new col- lege building, due to the conjoint liberality of T. G. Rich- ardson and his wife, Ida A. Slocomb. Their timely gift will prove an incalculable advantage to the college, to many generations of its students, and to the cause of med- ical education, on which depend those inestimable bless- ings to the people, the prevention and cure of disease. Radiating from our city, these blessings will be disseminated far and wide over our land, and will be shared by count- less sufferers — by the rich and the blest, and yet even more by the destitute and the wretched. Our new building will stand an enduring monument not only to the generosity and worth of the donors, but also to their exceptionally enlightened appreciation of the value of medical knowl- edge to the welfare of the people ; and this building will serve as a memorial to bind in lasting union two names DR. T. G. RICHARDSON. 567 which were united for nearly twenty-five years (November 12, 1868, to May 26, 1892,) in faithful and devoted love. Dr. Richardson's influence in behalf of the college did not end with his life. Through him exceptionally appre- ciating the needs of medical education, and in loving remembrance of him, Mrs. Ida A. Richardson has added very largely to the original gift in order that everything lacking and indispensable to insure the usefulness of the new building may be supplied. Dr. Richardson added honor to his profession by con- tributing liberally to every good cause, not only money, but also the great influence which high character and great ability gave him. He was one of the largest contributors toward building the monument erected at Danville, Ky., to the memory of Ephraim McDowell, M.D. Though racked by agonizing pain, and fully conscious that death was near at hand, the anti-lottery cause, involved in doubtful conflict, had no friend, in like pitiable condition, so resolute and so valuable, and none less bitter to opponents. Hand-in-hand with his beloved and honored wife, he crowned these numerous and invaluable services to his contemporaries, within and without the medical profession, by contributing with a liberality, unexampled in the South, to the progress of medical education, for the benefit of generations to live after him. Surely if any man, then this man "wrought his life in noble deeds"; the medical profession profited by his labors, and mankind is better for his living. He taught well by precept, yet better still by example, and he has strengthened many to serve profession and humanity less selfishly. During his professional life there have lived many thousands of physicians, and of all these thousands I know not one throughout the United States who better served, and not one throughout the extended length and 568 DR. T. G. RICHARDSON. breadth of the South who as well served the medical profession as did Dr. Richardson. He possessed superior characteristics, which, during the intimacy of long friendship, specially attracted and im- pressed me. He had a profound and active mind, eager to the last for new knowledge, and earnest in search of truth, however unpalatable it might prove. Hence he was always a student and in step with the onward march of medical science. He regarded every subject broadly and from every side, and often surprised me by his thorough knowledge and appreciation of the arguments of those whose conclusions he opposed. The breadth of his mind and the extent of his knowledge, both of science and of human nature, rendered him tolerant of opinions opposed to his own, and charitable to human frailties. He possessed pre-eminently one of the distinguishing marks of great ability, not only the mastery of many details, but a profound comprehension of the elementary principles which bind details together and on which these are founded. He was distinguished not only for physical, but also for great moral courage. Actuated by a high sense of duty, he more than fulfilled whatever he promised, and was exceptionally punctual and efficient. He never subordi- nated official duty to personal convenience or private obligations, and used office and its influence not for self, but for the general welfare. He abhorred hypocrisy, falsehood, prevarication, scan- dal, and gossip with a vehemence proportionate, as is usual, to nobility of soul. Profanity, obscenity, vulgar wit met with no assumption of " I am holier than thou," but were ignored as if unheard. Beneath a calm^ manner and habitual reserve in the expression of his emotions, there throbbed a loving and a loyal heart. In his friendships he manifested the unusual combination of saying little but doing much, so that his \^.im DR. JOSEPH EASTMAN. 569 deeds in behalf of friends who needed his services always surpassed their expectations, and the longer he was known the greater was the trust reposed in him and the higher the value attached to his friendship. [The foregoing sketch of Professor T. G. Richardson has, by permission, been made chiefly of extracts from the June, 1892, number of the New Orleans Medical and Surgical Journal, and from the Memorial Address on the professional services of T. G Richardson, M.D., delivered April 5. 1893, by Professor Stanford E. ChaiJle, A.M., M.D. , Dean of the Medical Department, Tulane University, New Orleans, La. — The Author.] JOSEPH EASTMAN, M.D., LL.D., PRESIDENT OF THE CENTRAL COLLEGE OF PHYSICIANS AND SURGEONS, INDIANAPOLIS, IND. Dr. Joseph Eastman, of Indianapolis, Ind., was born in the Bleecker Mountains in Fulton Co., N. Y., in 1842. He is the son of Rilus Eastman, who was born in Amherst, Mass., his ancestors being among the earliest settlers in New England. The Doctor's mother's name was Catherine Jipson. She was of German descent. Dr. Eastman's early education was confined to winter schools and night study ; on reaching the age of eighteen he became a proficient blacksmith, having worked three years at that trade. At the breaking out of the Civil War, early in 1861, he enlisted as a volunteer in the 77th X. Y.; went to the front and took part in four battles. After the battle of Williams- burg he became a victim of fever, and was sent to Mt. Pleasant Hospital, Washington, D. C. After his recovery. Dr. Charles A. McCall and Dr. Harrison Allen (both now in Philadelphia) placed him on medical duty in that hos- 570 DR. JOSEPH EASTMAN. pital, later having him discharged from his regiment and appointed Hospital Steward in the U. S. Army. Through the courtesy of these doctors he was permitted to attend three courses of medical lectures in the University of Georgetown, where he was graduated in 1865. He then passed the army examination and was commissioned Assistant Surgeon to the United States Volunteers, and served in that capacity until May, 1S66, when he was mustered out of service at Nashville, Tenn. On his way home from the army he stopped at Indian- apolis, and located in a country village a few miles west of the city, where he followed the general practice of medi- cine and surgery for a period of nine years. In 1868 he married a daughter of Thomas Barker, of Indianapolis. In 1870-71 he attended a course of lectures in the Bellevue Hospital Medical College, where he was again graduated in 1871. At the solicitation of Drs. Parvin and Walker he accepted the position of Demonstrator of Anatomy in the College of Physicians and Surgeons in Indianapolis, locating in that city in November, 1875. Soon after he was appointed Consulting Surgeon to the City Hospital, a position which he held for nine years, delivering lec- tures on Clinical Surgery during that time. During this same period he assisted Professor Parvin, now of Phila- delphia, in most of his gynecological operations. In 1879 Dr. Eastman was one of the organizers of the Central College of Physicians and Surgeons, of Indianapolis, ac- cepting the Chair of Anatomy and Clinical Surgery. After having taught anatomy in the two colleges for seven ses- sions a special chair was established in the last-named institution, that of Diseases of Women and Abdominal Surgery, which he has held ever since. For the last seven years he has been President of this college. Since 1886 Dr. Eastman has limited his practice abso- lutely to diseases of women and abdominal surgery. Dur- ing this period he has opened the abdominal cavity over DR. JOSEPH EASTMAN. -yi 500 times and performed hysterectomy, suprapubic and infrapubic, over 120 times. His Priva'e Sanatorium for Diseases of Women and Abdominal Surgery, five stories high, with an elevator and the most modern facilities of every kind to render his work successful, speaks plainly of what an indomitable energy in the surgical type of a man will accomplish. He is the second in the world, and the only American sur- geon who, in operating for extra-uterine pregnancy, has dissected out the entire sac which contained a living child, and saved the life of both mother and child (see Hirst's American Obstetrics, vol. ii. pp. 269, 270). While yet doing general surgery he exsected the knee-joint five times, with five recoveries and five useful limbs ; and performed lithotomy five times in the male, with five recoveries. At the beginning of his special work he visited the hospitals of London, Birmingham, Paris, Strassburg, Munich, Vienna, Leipsic, Dresden, Halle, and Berlin, critically examining the methods of the distinguished operators in the department of diseases of women and abdominal surgery. In 1 89 1, in recognition of his original professional work, the degree of LL.D. was conferred upon him by Wabash College, the first and only time in the history of this old institution that this honor has been given to a medical man. The Doctor has one daughter, Mary, and two sons, Thomas B. and Joseph R. Eastman, associated with their father in practice and teaching. Dr. Eastman is a member of the American Medical Association, and at their meeting last June in Milwaukee, was elected Chairman of the Section of Obstetrics and Diseases of Women. 572 DR. ALBERT VANDER VEER. ALBERT VANDER VEER, M.D., A.M., Ph.D., ALBANY, N. Y. Physicians are, without doubt, among the most impor- tant members of a community. From the very nature of their profession, they are thoughtful, sharp-sighted men, always abreast of the knowledge of the times, and ready to apply it as opportunity affords. In public life, when- ever the time or inclination for such labor exists, the physician is pre-eminently the man whose work will re- dound to the credit of the community in which it is done. Fortunate, indeed, is the city whose leading physicians find time to aid in the conduct of its affairs. The subject of this sketch, Dr. Albert Vander Veer, although scarcely of middle age, has attained a prominence in his profession which easily makes him its local head as well as places him far along in the ranks of its recognized leaders. He was born in the village of Leatherville, in the town of Root, Montgomery County, State of New York, on July lo, 1841. His father was an energetic and successful business man, whose tanneries gave the name to the place. His early education was received at the public school at Palatine and at the Canajoharie Academy. When eighteen years of age Albert Vander Veer began the study of medicine, for which he had a strong inclina- tion, with the late Dr. Simeon Snow, of Currytown, New York. After a year's work on the rudiments the young man came to Albany and entered the office of the late Dr. John Swinburne. During the years 1861 and 1862 he attended the lectures of the Albany Medical College, where so many physicians of prominence have been taught the elements of the profession. In the spring of 1862 the student, now thoroughly imbued with ardor for his profes- /^n^-i^^^ (/''K^^L^ ^^^-^-p~ i^-C-^^^-h DR. ALBERT VANDER VEER. 573 sion, became one of the original "One Hundred," was commissioned as a United States medical cadet, and ordered to report for duty at Columbia College Hospital at Washington, D. C. While at this post he attended a course of lectures at the National Medical College, from which institution he received the degree of doctor of medi- cine in December, 1862. After graduation Dr. Vander Veer was commissioned assistant surgeon of the Sixty-sixth Regiment, New York Volunteers, and in June, 1864, was raised to the grade of surgeon with the rank of major. He served with his regiment until the close of the war. Upon returning to New York he attended a full course of lectures at the College of Physicians and Surgeons, and in the spring of 1866 established himself in Albany as a general practitioner. In July, 1869, he was called to the chair of general and special anatomy in the Albany Med- ical College, where as a student he had received his first instruction and which had in 1869 conferred upon him the honorary title of M.D. In the same year he became attending surgeon to the Albany Hospital, and in 1874 was appointed attending surgeon to St. Peter's Hospital. In January, 1882, he was appointed professor of surgery in the Medical College, which position he holds at the present time, and in which he ever labors strenuously for the promotion of the interests of the institution and of the profession. In October, 1874, Dr. Vander Veer visited Europe, where he remained until the following April, occupying his time chiefly in professional study and visiting the great centres of medical instruction, where he watched with absorbing interest the brilliant operations of the renowned surgeons and specialists. The next len years of Dr. Vander Veer's life were years of unremitting labor in his chosen profession. But the labor brought its rewards. In 1882 Williams College con- ferred upon him the degree of A.M., and Union College, ry. DR. ALBERT VANDER VEER. as well as Hamilton, honored him with the degree of Ph.D. In 1884 Dr. Vander Veer again visited Europe^ this time accompanied by his wife, formerly Miss Margaret E. Snow, daughter of Dr. Simeon Snow, his old preceptor. During this sojourn he was entertained by Mr. Lawson Tait, whose fame as a surgical specialist is known all over the world. During the trip he also read a paper before the Copenhagen Medical Congress. Besides being ex-President and member of both the county and State medical societies, Dr. Vander Veer is also a member of the Boston Gynecological Society, the British Medical Association, the International Medical Congress, the British Gynecological Society, the American Surgical Association, the Holland Society of New York, of which he is the Vice-President of the Albany district, having had conferred upon him at the last Holland Society dinner in New York the order of " Oranje-Nassau " by the Queen of Holland. He is also one of the executive officers of the Pan- American Medical Congress, an active member of the Southern Surgical and Gynecological Association, Ameri- can Association of Obstetricians and Gynecologists, etc. To all these he gives some portion of his time, systemat- ically divided. In addition, he is busily at work at every available moment upon his college lectures or gathering in writing the results of his varied surgical experiences for the benefit of his professional brethren. Among the subjects upon which Dr. Vander Veer has lectured or written are: "The Operation for Stone, as Observed in some of the London Hospitals, together with a Report of Cases from Private Practice;" "Operation for Closure of Cleft of Hard and Soft Palate " (series of American Clinical Lectures) ; " Report of Three Cases of Excision of the Rectum;" "Report of Eight Cases of Uterine Fibroids; " " History of Abdominal Surgery in DR. ALBERT VANDER VEER. 575 Albany, with report of Seventy-five Cases;" "Reports of Ten Cases of Gastric Ulcer," etc., some of his earlier works. Of late Dr. Vander Veer has devoted much of his time to abdominal surgery at the Albany Hospital, and to a steadily increasing, extended consultation and operating practice outside of his own city. Among his later publications are to be found: "The Use of the Curette in Uterine Surgery;" "Uterine Hemorrhage, Puerperal and Non-puerperal ; " "The Man- agement of Cancer of the Uterus, Complicated by Preg- nancy, with Report of a Case;" " Hystero-epilepsy, with Report of Cases; " " Retro-peritoneal Tumors: their Anatomical Relations, Pathology, Diagnosis, and Treat- ment ; " " Tubercular Peritonitis ; " " Report of Cases of Cholecystotomy, with Special Reference to the Treatment of Calculus Lodging in the Common Duct ; " "The Re- lation of the Board of Health to the Public ; " "Appen- dicitis: the Relation of the Physician and the Surgeon in the Care of Cases ; " " Comparison between Perineal and Suprapubic Cystotomy;" "She Thought It was Her Change of Life ; " " The Medico-Legal Aspect of Abdom- inal Section;" "Extra-uterine Pregnancy;" "Con- cealed Pregnancy: its Relations to Abdominal Surgery ; " "The Relation of the Abdominal Surgeon to the Obstetri- cian and Gynecologist ; " " Intestinal Obstruction ; " " Report of Cases of Cceliotomy performed at the Albany Hospital from July to November, 1893, with Presentation of Pathological Specimens," etc. The pressure of increasing professional duties does not prevent Dr. Vander Veer from taking an active interest in municipal affairs, and the value of his services as a mem- ber of the Board of Health, the Historical Society, etc., are fully recognized. He is a member of the First Presby- terian Church, and was selected as a Commissioner to attend the meeting of the General Assembly at Omaha. Whatever of eminence he has attained has been secured 576 ^R- J- ^lENRY CARS TENS. by close application, unremitting labor, and a determined following of those inclinations which, in his youth, led him to choose for his own the responsibilities of the silent profession. Honored by his associates, loved and respected by his patients. Dr. Vander Veer's career may well be femulated by all young men who are ambitious to secure for themselves the approval of their fellows and the emolu- ments which come of necessity to the leader in any pro- fession. J. HENRY CARSTENS, M.D., DETROIT, MICH., Was born June 9, 1848, in the city of Kiel, in the Ger- man province of Schleswig-Holstein. His father, John Henry Carstens, a merchant tailor, was an ardent revolu- tionist, and participated in the various revolts in the memorable years of 1848-49. He had been captured and was in prison when his son was born ; after some months he was released and began attending to his business, but, fearing that he might be again imprisoned, he packed up a few goods and, with his family, left in the dead of the night for America. On his arrival he settled in Detroit, where he has since remained. One of his grandfathers was an architect and builder ; another a shipbuilder ; many of his uncles, with other relatives, were officers in the army and navy, and nearly all of them participated in the revolution and were forced to leave Germany and come to the United States. J. H. Carstens is the elder of two children. His earlier education was received in the public schools of Detroit, supplemented by six years' attendance at the German- American Seminary. While receiving instruction at the latter institution his parents lived on a farm four and a half miles from the city, which distance he was compelled DR. J. HENRY CARSTEXS. ^yj to walk twice a day. He evinced, even as a boy, an eager desire for intellectual work, excelled as a student, and took high rank in his studies, especially in those pertaining to natural sciences and mathematics. Before he had attained his fifteenth year he was compelled to engage in business, and, after some time devoted to lithography, he entered the drug store of William Thum, and afterward served in Dufifield's drug store and with B. E. Sickler. He became proficient in the various details of the business, served one year as prescription clerk in Stearns's drug store, and then began the study of medicine, his name being the first on the matriculation book of the Detroit Medical College. Even before graduation he had charge of the college dispensary, and after his graduation, in 1870, he was immediately put in charge of the college dispen- sary, and a few years later held the same position in St, Mary's Hospital Infirmary. He was appointed lecturer on minor surgery in the Detroit Medical College in 1871, and afterward lecturer on diseases of the skin and clinical medicine. He has lectured on almost every branch of medical science, the most important subjects so treated being dis- eases of women and children, diff"erential diagnosis, ner- vous diseases, physical diagnosis, pathology, chemistry, materia medica, and therapeutics. His taste and practice gradually tended to the diseases of women ; and, after holding the professorship of materia medica and therapeu- tics in the Detroit Medical College for some years, in 1881 he accepted the professorship of obstetrics and clinical gynecology, a position he has ever since held ; and on the consolidation with the Michigan College of Medicine he was appointed to the same position in the Detroit College of Medicine. As a lecturer on medical subjects he has performed most satisfactory labors, is thorough in his investigations and in the application of knowledge gained by practical experience and unremitting research. He is 37 eyg D^- /• HENRY CARSTENS. terse, clear, and practical, and easily wins the respect of those who come under his teaching. In view of the experiences of his father, it is but natural that Dr. Carstens should have a strong taste for politics. Ever since he has been old enough to understand the political situation in this country he has been a staunch Republican. Before his twentieth year he delivered polit- ical speeches, and this he continued for many years, speaking in either English or German in many parts of the State of Michigan. In 1876 he was elected chairman of the Republican City Committee, and at the same time was a member of the County Committee. During the year he held these positions he materially assisted in securing Republican control of the city and county. Both as an organizer and as an earnest and effective worker he has rendered valuable aid in gaining victories for his party, and has been often tendered party nominations. He has, however, thus far refused to become a candidate for office, with the exception of a nomination as member of the Board of Education, to which he was elected in 1875 and re-elected in 1879. ^"^ 1S77 he was appointed president of the Board of Health, and during his term of office ren- dered valuable assistance in checking the spread of small- pox, which was then prevalent. On the organization of the Michigan Republican Club he Avas elected a director. His rapidly increasing professional duties of late years have prevented active political work, and, with the excep- tion of an occasional speech, his whole time has been devoted to his profession. His contributions to medical literature have been various and extended. He has reported many clinical lectures and has trans- lated various articles from German and French medical journals. Among the more important of the articles written by him may be named : "Cleft-palate and Iodo- form;" " Medical Education ; " ''Embolism;" "Vac- cination;" "Household Remedies;" "Phantasia;" DR. J. HENRY CARS TENS. 5^79 "Clinical Lectures ; " "A Case of Obstetrics; " " Dysen- tery Cured without Opium;" "Strangulated Hernia;" "Hemorrhoids; " "Clinical Lectures on Gynecology; " "A Case of Epilepsy Caused by Uterine Stenosis;" "Three Cases of Battey's Operation;" "Uterine Can- cer;" "Menorrhagia and Metrorrhagia;" "Cancer;" " Ergot in Labor ; " " Mechanical Therapeutics of Amen- orrhoea;" "A Different Method of Treating a Case of Freshly Ruptured Perineum ; " " Fibroid Tumor Removed by Laparotomy; " " Vesico-vaginal Fistula; " " Loewen- thal Theory of Menstruation ; " "Mastitis;" "Laceration of the Cervix Uteri;" "Two Successful Porro-Csesarean Sections ; " " Laparotomy with and without Drainage ; " "Six Years' Work in Abdominal Surgery, Technique, Vaginal Hysterectomy, etc.;" and a small book on ' 'Amenorrhoea, Dysmenorrhoea, and Menorrhagia. ' ' Lately he has only written on questions of abdominal surgery, as he has for years given up general practice, and even obstetrics, to be able to give his whole time to gynecology and coeliotomy. He has made about five hundred abdom- inal sections, with a mortality varying from 7 to 15 per cent, (different years, etc.). Nearly all of his articles have been extensively copied by medical journals in this country, and some by European journals. He* holds the position of gynecologist to Harper Hos- pital, attending physician to the Woman's Hospital, and obstetrician to the House of Providence. He is a member of the American Medical Association and of the Michigan State Medical Society, of which he was vice-president in 18S5 ; president of the Detroit Medical and Library Society; a member of the Detroit Academy of Medicine and of the British Gynecological Society ; honorary member of the Owosso and Kalamazoo Academy of Medicine and the Northeastern District Medical Society ; vice-president of the American Association of Obstetricians and Gynecol- ogists ; ex-president of the Detroit Gynecological Society, etc. 58o DR. HEXRY O. MARCY. His advance as a physician has been steady and sure ; he has been a continuous student and a hard worker ; his practice has grown into an extensive and remunerative one, and he finds his time and hands fully occupied. He has given to certain diseases close and special attention, and has worked out for them peculiar, independent, and successful modes of treatment. Among his professional brethren he holds the place due to his talents and manly character, and is ever ready to aid any enterprise that may be originated for the good of the public. Although his professional duties are onerous, he finds time for general reading, and keeps well informed in a wide range of intel- lectual culture; is thorough and earnest in all that he undertakes ; and has the undivided good-will and respect of the community in which he dwells. He was married October i8, 1870, to Hattie Rohnert, who had for some time been a teacher in one of the public schools. HENRY O. MARCY, A.M., M.D., LL.D., BOSTON, MASS. Dr. Henry O. Marcy is of New England birth and an- cestry, and is a graduate of Harvard University. He was a surgeon and medical director in the late war between the States. He was "a special student in Europe in 1869 and 1870, and was the first American pupil to receive the instruction of Mr. Lister at Edinburgh. At this time he commenced original investigations upon the pathological conditions incident to surgery, especially the relation of bacteria to wounds and their role in infectious diseases, publishing from time to time his researches and discov- eries. For this purpose he equipped a bacteriological laboratory, and for several years employed Dr. Samuel N. DR. HENRY O. MARCY. 581 Nelson as assistant in this work. Dr. Marcy early became interested in abdominal surgery, and saw much of the pioneer work of Dr. H. R. Storer, of Boston, and of that of the late Dr. Gilman Kimball, of Lowell. In 18S0 he opened a private hospital for the special treatment of sur- gical diseases of women, which is continued at the present. Dr. Marcy is a most skilful operator, and he elaborated the method of the peritoneal covering of the stump, after the removal of ovarian and uterine tumors, for intra- abdominal treatment of the pedicle, and the closure of the abdominal wound without drainage, now so generally accepted and practised. The profession is indebted to his researches for the demonstration of the advantages derived from the use of buried animal sutures, closing, layer after layer, all aseptic wounds, even the major amputations, and hermetically sealing with iodoform-collodion without the use of the drainage-tube. The advantages to be derived from animal — especially tendon — sutures were demonstrated by a long series of comparative studies, which taught the replacement in large degree of the aseptic buried material by vitalized connective tissue. Dr. Marcy's methods for the reconstruction of the pelvic structures have been very generally adopted. His contributions to medical litera- ture have been very numerous and extend over a wide range of surgical subjects. He is, perhaps, best known to the profession by his writings upon hernia, his latest pub- lication upon the subject being "The Anatomy and Sur- gical Treatment of Hernia," a large, illustrated, quarto volume, published in 1892 by D. Appleton &: Co. Dr. Marcy is an active member of various societies, has been honored with the presidency of the American Academy of Medicine, and in 1892 was president of the American Medical Association. WALKER GILL WYLIE, M.D., NEW YORK, N. Y. The subject of this sketch, Walker Gill Wylie, M.D,, was born in Chester, S. C, September 2, 1848. His father, Alexander Pierson Wylie, was a surgeon and physi- cian of considerable note, and for more than forty years he practised medicine in Chester County. His antecedents were Scotch-Irish Protestants, from the North of Ireland, as were many of those who early emigrated to East Ten- nessee and the Carolinas. Dr. Alexander Pierson Wylie was a strong Union man, and opposed secession from a moral standpoint. For forty years, or more, the grand- father, Peter Kelsey Wylie, held the office of Probate Judge in his district. The nullification principles and measures of John C. Calhoun he bitterly opposed. The maiden name of the mother of Dr. W. Gill Wylie was Juliette Agnes Gill, whose father was Robert Walker Gill, a merchant of Lancaster. Her ancestors were English. Dr. Wylie's early educational advantages were confined to the village school, which was the only opportunity offered then of obtaining an education. When at the age of sixteen years, the war cry was pro- claimed calling men to arms, inspired by that Southern chivalry so characteristic of the youths of the ante-bellum days, he volunteered his youthful services to the Southern army as Lieutenant. At this tender age he commanded a company in front of General Sherman's army in its march from Savannah into North Carolina. When hostilities had ceased between the North and the South, he entered the University of South Carolina, previously known as the ii/:44MJi/^pLi DR. WALKER GILL WYLIE. 583 College of South Carolina. After an attendance of two years, he graduated from all the studies of the scientific course, and at twenty years of 'age (in 1S68) he entered Bellevue Hospital Medical College in New York city. In the year 1870, by competitive examination, he secured the position of "interne," or house surgeon. In 1871 he graduated, but still retained the position of house surgeon of the hospital for a year and a half. In 1872 he was appointed as "interne" of the New York Woman's Hos- pital. This position was also secured upon another competitive examination, which held for eighteen months. Dr. Wylie's progressive nature, and an ardent desire to obtain still greater knowledge relating to his chosen pro- fession, induced him to go to Europe and make an especial investigation and study of hospital nursing and systems of hospital management. Having obtained this desired knowledge, he presented at the Cooper Institute, before an audience composed entirely of ladies, a paper on "Training Schools for Nurses." At that time the subject was quite new, consequently the paper attracted much attention. Encouraging results came from this movement, and the consequence has been to revolutionize the system in the United States. The Bellevue Training School was organized twenty years ago, and Dr. Wylie has personally examined every graduate during that entire time. He was greatly inter- ested in hospital work, and cooperated with the State Charities' Aid Association in this matter. His private practice in New York city dates from 1873. In 1876 he issued a book upon Hospitals ; Their History, Organization, and Construction. This was the Boylston prize essay of Harvard University for 1S76. Dr. Wylie also studied hospital construction, and the sanitary arrangements in buildings won success and dis- tinguished him as a sanitary engineer. 584 DR. WALKER GILL WYLIE. But his remarkable skill in gynecology and great success in abdominal surgery soon made him very prominent in this especial line of surgery, and placed him among the most brilliant and successful operators. By his skilful operations cases heretofore considered incurable have been restored to health. No one surgeon has been more emi- nently successful in abdominal section or laparotomy. Indeed, his percentage of recoveries in this line of surgery- remains unprecedented. Much of his success must be attributed to sound judgment, extreme cleanliness, and a natural skill combined with a perfect knowledge of abdominal surgery. In 1882 he was appointed visiting gynecologist of Belle- vue Hospital. He still holds this position. In 1877 he became associated with the late Dr. J. Marion Sims. In 1878 Dr. Wylie established a private hospital, located at No. 215 West Forty-third street. New York city. Asso- ciated with him in his hospital and general practice is his brother, Dr. Robert H. Wylie, also a surgeon of consider- able prominence in all the essentials necessary to make a distinguished operator, and is only second to his renowned brother. Dr. W. Gill Wylie is associated with many societies and medical associations, such as the American Medical Asso- ciation, New York State and New York County Medical Societies, the New York and the Northwestern Society, the New York Pathological Society, the New York Academy of Medicine, the American Gynecological Society, the British Gynecological Society, and various others. He is Professor of Gynecology in the New York Poly- clinic Hospital, and is Consulting Surgeon of the Seney Hospital, Brooklyn, N. Y. He is the author of numerous treatises and papers relating to his specialty, gynecology. In June, 1877, Dr. Wylie was married to Miss Fannie H. Damon, a daughter of Edward A. Damon, a merchant engaged in business in St. Louis, Mo. Dr. and Mrs. Wylie ^S;t^^ A.^>/ '/"Ux^rt.^^ A DH. EGBERT GUEKXSEY. 585 have four very interesting and promising children — two sons and two daughters. The Doctor is full of energy, hale and vigorous, with a prospect of a long life before him. Much of his wonder- ful success may be attributed to his remarkable good health. May he long live to enjoy the fruits of his success, and continue in his earnest efforts to relieve the afflicted and suffering who throng his presence seeking relief. . EGBERT GUERNSEY, M.D., NEW YORK, X. Y. To Dr. Egbert Guernsey the new school of medicine owes much of its life and success. Grasping with his broad and liberal mind the truths of the dual action of drugs, he has ever been constant in advancing their prin- ciples, and it is greatly through his efforts that the two schools of medicine have come within touch of one another. He has ever been foremost in advocating a broad and unrestrained medical training, and his time and experience have always been at the call of younger and less experienced medical brethren. To the poor and needy his skill and purse are ever free, and well may Bret Harte say in The Alan Whose Yoke Was Not Easy, speaking of his friend and physician. Dr. Guernsey: " He handed me a note. It was from a cer- tain physician ; a man of broad culture and broader experience ; a man who had devoted a greater part of his life to the alleviation of sorrow and suffering ; a man who lived up to the vows of a noble profession ; a man who locked in his honorable breast the secrets of a hundred families ; whose face was kindly, whose touch was as gentle as the dying Narcissa ; a man who, through long contact with suffering, had acquired a universal tenderness and 586 DR. EGBERT GUERNSEY. breadth of kindly philosophy ; a man who, day or night, was at the beck and call of anguish ; a man who never asked the creed, belief, moral or worldly standing of the sufferer, or even his ability to pay the few coins that enabled him (the physician) to exist and practise his calling; in brief, a man who so nearly lived up to the example of the Great Master that it seems strange I am writing of him as a doctor of medicine and not of divinity." Descended on both sides from the best English and American ancestry. Dr. Guernsey was born in Litchfield, Conn., July 8, 1823. The name of his first American ancestor, John Guernsey, who is said to have emigrated from the Isle of Guernsey in 1638, appears among the 180 Puritans who established the New Haven Colony. The mother of Dr. Guernsey was Amanda Crosby, a direct descendant of Enoch Crosby. Dr. Guernsey's descent is through Joseph, the son of John, whose name appears in the records of Milford, Conn., in 1659 ; thence through Joseph. John removed to America, Dutchess County, N. Y., where his son Noah, the grandfather of Dr. Guernsey, was born. He removed to Litchfield, Conn., having previously married Miss Hol- lister, who was a direct descendant of William Clinton, the first Earl of Huntingdon, A. D. 1350, whose descen- dant in the eighth generation became Lord High Admiral of England, and in 15 71 was created Earl of Lincoln, the title being subsequently merged into that of the Duke of Newcastle. Dr. Guernsey prepared for college at Phillips's Acad- emy, Andover. Before completing his college course, determining on medicine as his future profession, he entered the office of Dr. Valentine Mott, and graduated in 1846 at the Medical Department of the University of the City of New York. Beginning the practice of his profession in Williams- DR. EGBERT GUERNSEY. 587 burg, now part of Brooklyn, he was soon after appointed City Physician. In 1850 he definitely determined upon New York City as his field of work. Up to this time he had followed the old-school practice. Careful investigation of homoeopathy impressed him with its im- proved methods. Using the best features of both systems, he has always been a liberal practitioner, and unquestion- ably to-day stands first and foremost in that large class of medical men who prefer to be allied to neither one nor the other system, but use both according to the exigencies of the moment. For six years Dr. Guernsey held the chair as professor, first of materia medica, and then of theory and practice, in the New York Homoeopathic Medical College. In 1870 he organized the Western Dispensary, since united with the Hahnemann Hospital, of which he was also one of the organizers. In 1877, mostly through his instrumentality, the Inebriate Asylum on Ward's Island was converted into a hospital and placed under the charge of a competent Board of Physicians, with Dr. Guernsey as president of the board. He was for nineteen years one of the trustees and for four years vice-president of the State Insane Asylum of the State of New York at Middletown. He has been president of the County and State Medical Societies, and was for a period, from 1864 to 1868, surgeon of the Sixth Regiment of the State National Guard of New York. Possessed of great activity, mentally as well as physi- cally, almost from the beginning he has given a certain portion of time to literary work. While still an under- graduate in the University the Doctor became city editor of the Evening Mirror, being thus associated with N. P. Willis and George P. Morris. This was in 1845. I" ^848 he started the Brooklyn Daily Times, and was its editor-in- chief. In 1S72 he was associated with Dr. A. Gerald Hull in editing Fahr' s Manual. In 1872 he started the New 588 DR. CORNELIUS KOLLOCK. York Medical Times, and has since continued as its editor. While a young physician he wrote a school history of the United States, which became generally used through- out the country. In 1855 he published Domestic Practice, which has since passed through eleven editions, was re- published in England, and translated into the French, German, Spanish and Danish languages. He has been at all times an extensive contributor to medical journals. He was married in 1S48 to Miss Sarah Lefferts Schenck, a descendant of one of the imperial seneschals to Charle- magne. Two children blessed this union, a daughter and a son. The death of his son (which occurred July 24, 1893), a promising young physician, has been one of the hardest blows which have fallen to Dr. Guernsey's lot. Most keenly he feels the loss of his son, who was endowed with a warm, sympathetic, and generous nature, ever ready with his medical skill and his purse to aid and give relief to the suffering, and there is no one who will not feel, as they read the lines which tell of his removal to another sphere, that the life which was so full of love and kindly deeds, now freed from the contamination of earth, will blossom in that other world, upon which he has opened his eyes, in immortal beauty and fragrance. Whether as professor, editor, author, or physician. Dr. Guernsey's strong personality has exercised a remarkable influence upon all with whom he has come in contact. CORNELIUS KOLLOCK, M.D., CHERAW, SOUTH CAROLINA. Dr. Cornelius Kollock was born near Cheraw, S. C, December 7, 1824. He received his early education at the Cheraw Academy, entered the sophomore class of CORNELIUS KOLLOCK. M. D. DR. CORNELIUS KOLLOCK. 589 Brown University in 1842, graduated in 1845, studied medicine three years, and took the degree of M.D. at the University of Pennsylvania in 1848. Afterward he spent eighteen months in Europe, principally in Paris, attending lectures and hospitals, and taking private lessons of Malgaigne and Cazeaux. Returning home, he engaged in general practice in Cheraw, giving special attention to surgery, gynecology, and obstetrics. He has done abdominal section quite a number of times for the removal of ovarian tumors and other pelvic growths, also for knife- and gunshot-wounds of the bowels. His success in operations for intestinal obstructions has been good. His cases of strangulated hernia (which were many) have all resulted in recoveries. He has removed the uterus twice, both times successfully ; has done Cse- sarean section once, after Sanger's improved method, saving mother and child. In the conservative treatment of pyosalpinx he has had good results, and of that treat- ment he is an earnest advocate, while he as earnestly opposes craniotomy on the living foetus. He is a Fellow of the American Academy of Medicine, and of the American Gynecological Society ; has been President of the South Carolina Medical Association ; was Vice-President of the American Gynecological Society in 1892 ; was Vice-President, the same year, of the Southern Surgical and Gynecological Association, and was elected its President at its late meeting in New Orleans. Dr. Kollock, as a practitioner of surgery, has secured to an unusual extent the confidence, gratitude, and esteem of his patients. He possesses in an eminent degree the special qualifications requisite to the surgeon. His gen- erous nature and his unselfish character have endeared many hearts to him, who will ever hold in grateful remem- brance his many noble acts of charity and fidelity to the duties of his profession. CQO DK. JACOB GEIGER. JACOB GEIGER, M.D., ST. JOSEPH, MO., Was born in Wurtemberg, Germany, July 25, 1848. His father, Anton Geiger, a classmate of Niemeyer in the University of Tiibingen, died in 1851. Two brothers having emigrated to America, the subject of our sketch, with his mother, followed them in the spring of 1856. Two years later Mrs. Geiger died, leaving the boy penni- less and an orphan in a strange country. With untiring energy and pluck he set about to acquire an- education, attending the district schools, and later attending Homer Seminary, and graduating from Bryant's Business College. Having read medicine with Galen E. Bishop, of St. Joseph, Mr. Geiger began the practice of medicine in that city prior to his twentieth birthday. In the spring of 1872 he received the degree of M.D., after pursuing a regular course in the University of Louis- ville, Ky. With characteristic energy the Doctor began his professional career by working heartily in the different medical societies and contributing valuable and original articles for their consideration. The Ensworth Medical College and Hospital and the colleges from which this college emanated owe their existence in a large degree to the wisdom and zeal of Dr. Geiger. While devoting his attention for the past three years almost entirely to surgery, the Doctor is possessed of a broad scholarship in all that pertains to his chosen profes- sion. One of the organizers of the Marion-Sims College of Medicine, St. Louis, he holds the chair of principles and practice of surgery and clinical surgery in that insti- tution, and holds the same chair in the Ensworth Medical College and Hospital, St. Joseph, Mo., and is one of the life a^^t^^ ^-VL 'JUJL DR. JOHX HOGE MC IN TYRE. t^gi trustees of the latter institution. He is a member of the following medical societies: American Medical Associa- tion ; Mississippi Valley Medical Society ; Missouri Valley Medical Society; Missouri State Medical Society ; North Kansas Medical Society : Western Association of Ob- stetricians and Gynecologists; Grand River Medical Society; St. Louis Medical Society; Buchanan County Medical Society ; and the District Medical Society of Northwestern Missouri, of which he ib president. Dr. Geiger's ability as a teacher, his expertness as a diagnostician, and his skill as a surgeon, coupled with a kind heart and a noble, generous disposition, have en- deared him to the community and State in which he dwells. Being still in the prime of life, possessed of in- domitable will and tireless energy, much may be expected of him in the future. Possessed of excellent business qualifications, the Doctor has accumulated a comfortable fortune. In 1887 he mar- ried Miss Louise Kollatz, a most estimable lady, of St. Joseph ; but leaves no one to bear his name, as no children have been born to them. The Doctor is a Master Mason and in religion is a Presbyterian, being a member of the First Presbyterian Church of his adopted city. JOHN HOGE McINTYRE, A.M., M.D., ST. LOUIS, MO. Dr. John Hooe McIntyre was born in Pulaski County, Virginia, November 24, 1833. By his progressiveness, skill, and remarkable success in abdominal surgery he has particularly distinguished him- self as a specialist in the departments of gynecology. He is a careful but bold operator. 502 •^^''- J'^^^ HOGE MC INTYRE. His father, Rev. Dugald Mclntyre, was a native of Argyleshire, Scotland. He emigrated to this country, and married Miss Rebecca Hoge, of Virginia. Six children were the fruits of this union, the subject of this sketch being the eldest. Dr. Mclntyre received a classical education, and ob- tained his medical degree from the Jefferson Medical College of Philadelphia, Pa. When the late civil war was proclaimed, and immediately after his graduation, he attached himself to the army, was on duty in surgical wards of large military hospitals, and did noble work until its close. Soon after leaving the military service, while on a trip to the East, a railroad accident occurring near Richmond, Indiana, caused him to lay over in that goodly little Quaker city. To while away the tedium of an afternoon, he called on Dr. Vaile, who had been a post-medical director at Nashville, Tenn., when he met Miss Nellie, the Doctor's beautiful and accomplished daughter. It was, indeed, a case of love at first sight, and so great was his fascination for her that he lingered day after day around the object of his admiration, when finally he located in Richmond, and in the following year he was married to Miss Nellie Vaile. During his residence in Indiana he was a member of the staff of Gov- ernor Williams with the rank of Major. He spent a part of the years of 1879 and 1880 in obser- vation in the large medical centres of Europe, being especially interested in the work of the masters of ovariot- omy, and was an enthusiastic admirer of the work of Thomas Keith, of Edinburgh; Sir T. Spencer Wells, and George Granville Bantock, of London, England. Upon his return from abroad he located in St. Louis, Missouri, and was immediately tendered the Professorship of Clinical Surgery in the St. Louis College of Physicians and Surgeons, which position he resigned at the end of the year, and accepted the chair of Professor of Surgical Dis- DR. JOHN HOGE MC IXTYRE. 503 eases of Women in the College for Medical Practitioners, this being better suited to his tastes, and decidedly more in harmony with the class of practice in which he was engaged. He now numbers his abdominal operations by the hundreds, having achieved a grade of success equal to that of any surgeon now living. It is not difficult to realize that his wonderful success can be attributed to his sound judgment, united with extreme care, and natural skill. He certainly possesses a genius for these delicate feats of surgery. It fell to his lot on the 7th of December, 1890, to break the record-, and successfully remove, in the space of fifty minutes, a solid abdominal tumor weighing 93^ pounds, which is by far the largest solid tumor yet reported. He is cool, collected, and exceedingly rapid in his opera- tive work, being scrupulously neat in all his laparotomies. He is cautious, and has frequently been heard to remark " that the justifiableness of any operative procedure consists in its necessity." The religious principles of the Doctor are unlike those of his Scotch ancestors, he being an Episcopalian. He is an enthusiastic Mason, being up to the 32d grade in the Scottish Rite, and is also a Knight Templar. He is consulting surgeon to several public institutions, and presides over a well-appointed establishment of his own. He received the degree of Master of Arts from the St. Louis University ; is a member of the St. Louis Medical Society, Missouri State Medical Association, and the American Medical Association, and being a forcible, fluent speaker, receives frequent invitations from various medical societies to address or read papers before them. It, there- fore, is not surprising that he has been made an honorary member of nine distinct societies. Although a busy man, devoted to his profession, he is a steady contributor to the medical journals. 3S 594 DR. AUGUSTUS PALMER DUDLEY. The Doctor is still hale and vigorous, and, doubtless, will add still greater laurels to his prominence, and be the means of relieving many suffering women who would otherwise fill untimely graves. AUGUSTUS PALMER DUDLEY, M.D., NEW YORK N. Y. In Phipsburg, Me., July 4, 1853, Augustus Palmer Dudley, the subject of this sketch, was born. He is the third son of Palmer Dudley, who married Frances Wyman, a daughter of Captain Francis Wyman, a native of Phips- burg, Me. On his mother's side, he is descended from the Percys of the North of England and the South of Scotland, whose lineage can be traced to the tenth century, and from the Wymans, of Wales. His maternal grandfather, Francis Wyman, also his paternal grandfather, Patrick Dudley, were soldiers and pensioners of the war of 181 2, being respectively Orderly, Sergeant, and Ensign of Com* pany F, South Militia, at Fort Hunnewell's Point. His paternal great-grandfather, William Oliver, and his maternal great grandfather, William Wyman, both served in the Revolutionary War. His father, Palmer Dudley, was for many years prominent in the affairs of his native town. On March 18, 1843, he was by Governor Kava- nagh commissioned Ensign of Company F, of Infantry, in the ist Regiment of the ist Brigade, and 4th Division of the militia of the State of Maine, which commission he held for seven years, and was honorably discharged on April 18, 1 85 1. Dr. Dudley received his preparatory education at the public schools and at the Portland Academy. Being studious and earnest in his endeavors to not only acquire Oi^yxC£^-}^.ui^^ ^d^T^^A^^ DR. AUGUSTUS PALMER DUDLEY. 595 knowledge, but to become a physician and surgeon, he entered the Medical Department of Bowdoin College at the age of twenty-four, and was graduated with high honors from Dartmouth Medical School in the year 1877. He commenced the practice of medicine in Portland, Me., but possessing natural surgical abilities he desired to seek a broader field, where his surgical advantages would be greater, and therefore removed to New York City in the year 1881, where he entered the Woman's Hospital as house surgeon, which position he filled for eighteen months. He then went to San Francisco, Cal., where he had charge of the California Woman's Hospital for one year. He re- turned to New York in 1884 and resumed his practice, and has been remarkably successful in his specialty — abdominal surgery. He was appointed Instructor in Diseases of Women at the Post- Graduate Medical School in the year 1887, and Visiting Gynecologist to the Randall's Island Hospital and Northeastern Dispensary. Dr. Dudley's success as a skilful operator has given him an honored reputation. During the past three years he has three times performed successfully the Csesarean sec- tion, in all three cases saving mother and child. In May, 1893, ^^ ^^ made Professor of Diseases of Women in the Post-Graduate Medical School to fill the vacancy caused by the death of Prof. Charles Carroll Lee. He has written numerous papers on his specialty, among which are: " Vaginal Hysterectomy in America," " Vari- cocele in the Female," "Surgical Treatment of Sub- involution," "A New Method of Surgical Treatment for Restoration ot Lacerated Perineum," " A New Method of Surgical Treatment for Certain Forms of Retro-displace- ment of the Uterus with Adhesions," etc. Dr. Dudley is a fluent writer, easy and progressive. He has written ex- tensively for various medical journals, some articles of which have been translated into French and other foreign 596 DR. AUGUSTUS PALMER DUDLEY. periodicals. He is a member of the New York Academy of Medicine, New York Obstetrical Society, American Gynecological Society, American Congress of Physicians and Surgeons, etc. He is a contributor to various medical journals and other medical literature. His great success in abdominal surgery can only be at- tributed to sound judgment, with a thorough knowledge of his business and the care necessary to obtain good results an critical operations. Although comparatively a young man, he has won for himself an envied name in the field of abdominal surgery. He is greatly interested in the Dudley genealogy, and in the summer of 1891 made a trip to Europe for the pur- pose of tracing back the lineage of his American ancestors. Through the courtesy of Sir Bernard Burke he was granted free access to the records of Dublin Castle, and, by the kindness of Dr. William E. Dudley, of Bath, England, he was enabled to secure a complete history of the Irish branch of the family, as above described. Dr. Dudley married, July 15, 1884, Susanna Stephens;^ daughter of Jesse Mason, of Victoria, B. C. She died July 30, 1888; aged twenty-six years, seven months, leav- ing no children. September 14, 1891, he married Cas- sandra H. Coon, daughter of W. J. Adams, of San Fran- cisco, Cal. By his second marriage he has two interesting little girls. Dr. Dudley is of a warm-hearted, sympathetic nature. May he be spared many years to enjoy, to the fullest extent, the fruits of an industrious, energetic life. DR. THEODORE GAILLARD THOMAS. 5^)7 THEODORE GAILLARD THOMAS, M.D. NEW YORK, N. Y. Dr. Theodore Gaillard Thomas was born on Edisto Island, South Carolina, on the 21st day of November, in the year 1831. He is descended, on the male side of his house, from Rev. Samuel Thomas, a missionary sent to America by the Church of England, in the year 1704, to establish the Episcopal Church in South Carolina. On his mother's side Dr. Thomas is a descendant of Joachim Gaillard, a Huguenot gentleman who left France at the revocation of the edict of Nantes, and settled in what is known as the Orange District, S. C. Many prom- inent families came with him to this country at the same time, among them the Hugers, the Ravenels, and many others. His early education was obtained in Charleston, S. C, and in 1852 he was graduated from the " Medical College " of that city. Shortly thereafter he came North and became Resident Physician in Bellevue Hospital, New York. After completing this course he located in the City of New York, where, with Dr. Donaghe, he established, in connection with the "University of New York," a "quiz" class, which attracted much attention and became very success- ful. He succeeded Dr. Bedford as lecturer in this insti- tution. After serving as Resident Physician in Bellevue and Ward's Island Hospitals, he went to Europe for study and to acquire more knowledge regarding gynecology and other branches of his profession. He remained in Europe nearly three years, returning to America with a mind well stoied with medical knowledge, and a full determination to make a success in his profession. 598 DR. THEODORE GAILLARD THOMAS. Many who admired Dr. Thomas for his brilliant oratory and wonderful ability as a lecturer, will be surprised to learn that his first lecture was considered a perfect failure by his friends. But it was his first and last failure, as we know, for since then none of his colleagues has addressed more delighted audiences, among which old visiting phy- sicians frequently, in their eagerness to hear and see the lecturer, crowded out those whose matriculation fee gave them the better right. Upon his return from Europe he entered into partnership with Dr. John T. Metcalfe, who, at this time, "had his finger upon the pulse of fashionable New York." He was associated with Dr. Metcalfe fifteen years or more. From this time henceforth his success was assured, and he rapidly rose to distinction and fame. His general practice became very large, but he devoted himself especially to obstetrics, and made a great reputation in this branch of medicine. He has been surgeon or physician to Bellevue, the Roose- velt, St. Luke's, the Stranger's, Blackwell's Island, and the Woman's Hospitals. He was appointed Professor of Obstetrics at the College of Physicians and Surgeons, and held that chair for many years, succeeding Professor Chanler R. Oilman. When the Professorship of Diseases of Women was established at the College of Physicians and Surgeons, he resigned the chair of Obstetrics and accepted this, Dr. J. H. McLane succeeding him in the former position. In the year 1863 he was appointed Physician to the Woman's Hospital, and four years later he became Con- sulting Physician, and in 1873 ^^ was appointed one of the attending surgeons to the same institution. He held this position until a few years ago, when he resigned, and was requested by the Board of Governors to name his suc- cessor. , As an obstetrician his name is especially identified with the operation of laparo»