Friday, July 10, 2009

Forbidden Abdominal Surgery

By Shawn Vuong

In this editorial Dr. Holm brings up a little history of a group of operations so common now, we actually take it for granted. Back in a time before anesthesia and sterile technique, abdominal surgery led to almost certain death. Today, great advances in anesthesia and surgical technique make this type of surgery routine. As we look into the future of surgery with advances in robotic and minimally invasive techniques surgeons and patients are seeing better outcomes and shorter hospital stays than any other point in history. By looking at the history of surgery we can really appreciate the modern miracle of abdominal surgery.


By Richard P. Holm MD

Abdominal surgery was absolutely fatal until the time of Ephraim McDowell.

In the early 1800s medical school professors from every country in the world taught that cutting into the abdominal cavity would always result in infection and death. It was forbidden territory for surgeons.

People settling this new American country were less bound by rules and regulations however, and there was rumor of a West Virginia surgeon who had, a few years earlier, saved his wife and baby with what we now call a cesarean section. But, it could have been just rumor.

Ephraim McDowell was a young doctor from Danville, Kentucky, who had been educated mostly by following and assisting another doctor. Although he had one year of med-school training in the late 1700s, McDowell had never received a formal degree. Despite this, he earned a superb reputation as a neat and meticulous surgeon.

It was in 1809 that Jane Crawford’s lower abdomen began to swell. Her local doctors had made the mistaken diagnosis that she was over-due with twin babies, and called McDowell for guidance. After examining her he knew this was not a pregnancy. He explained to the desperate patient that it was an ovarian tumor, and the only possible cure could be surgery – which had never been done before.

Anesthesia was not to be discovered until the 1840s, and aseptic or sterile technique not to be popularized until the1870s. Despite all convention against doing abdominal surgery in 1809, McDowell knew the woman was doomed without it.

Mrs. Crawford pleaded for him to try, and so he had her come to his office some 60 miles away. While she sang hymns, Ephraim McDowell surgically removed the twenty-two pound tumor. Twenty-five days later Mrs. Crawford returned home in good health and lived for thirty-two more years.

It was quite a while later before the medical profession would admit that a small-town physician from Kentucky had opened the door to the life-saving possibilities of abdominal surgery.

No comments: