This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

Ephraim McDowell

Ephraim McDowell (1771- 1830). American surgeon, Ephraim McDowell was born in 1771 in the Augusta County of Virginia. His family moved to the “frontier”, which at that time was Kentucky, where his father was a judge. McDowell studied in Kentucky and returned to Virginia to serve as an apprentice to Dr. Alexander Humphreys. Following Dr. Humphrey’s advice McDowell went to Edinburgh to finish his formal medical training, which he did not finish, taking chemistry, anatomy, and then a private medical course with Dr. John Bell.

Returning to America, he settled in the Ohio River Valley, and had a successful practice as a frontier surgeon in the city of Danville, Kentucky.  This was before the advent of anesthesia and antisepsis.

On Christmas Day 1809, Dr. McDowell  performed the first recorded ovariotomy to drain a massive ovarian cyst from Mrs. Mary Jane Crawford, who had to ride a horse for sixty miles to get to Dr. McDowell’s office where he performed the ovariotomy without anesthesia. Mrs. Crawford had been diagnosed as “pregnant” by two other physicians. Dr. McDowell’s hand-written report states that he performed a nine-inch abdominal incision, the operation lasted about twenty five minutes, and they removed “fifteen pounds of a dirty gelatinous substance” and “extracted the sac, which weighed seven and a half pounds”. 

Mrs. Crawford survived the operation, was ambulatory in five days, and lived for 33 additional years, until she was 78 years old. Research has been made as to the reason for the survival at a time when the norm for an operation that penetrated the peritoneal cavity was death. Othersen (2004) states that his research indicated that Dr. McDowell was “meticulous, neat and scrupulously clean”.

Because of the times, and because Dr. McDowell was not into writing, the achievement was not known for many years, until 1817. Dr. McDowell later performed a lithotomy on James Polk, who would eventually become president of the United States. In 1825, his achievements were recognized and he received an honorary MD degree by the University of Maryland.

Dr. McDowell’s house in Danville, KY is today a museum, and his name is remembered by the “Ephraim McDowell Health System” a group of integrated healthcare based in the same city. For more information on Mary Jane Crawford, click here.

PERSONAL NOTE: On February 19, 2017 I was able to go visit this place. Click here for a series of articles and pictures of this visit. Dr. Miranda

Sources:
1. “Ephraim McDowell (1771-1830) Kentucky Surgeon” JAMA. 1963;186 (9):861-862
2. “Ephraim McDowell: The Qualities of a Good Surgeon” Othersen, HB Ann Surg. 2004; 239(5): 648–650
3. “Ephraim McDowell (1771-1830): pioneer of ovariotomy” Tan,SY & Wong, C. Singapore Med J 2005; 46(1) : 4
4. “Ephraim McDowell, the First Ovariotomy, and the Birth of Abdominal Surgery” Horn, L and Johnson, DH. J Clin Onco 2010: 28; 7 1262-1268
5. "Surgeon of the wilderness: Ephraim McDowell" Haggard, WD. Presidential Address, ACS 1933. FACS archives 1934, 58: 415-4198
Image in Public Domain. Courtesy of the National Library of Medicine.

Anteroinferior view of the liver and stomach

The [lesser omentum] is a double-layered peritoneal membrane found between the stomach and the first portion of the duodenum and the liver.

Between the two layers of the lesser omentum there is a small amount of fat, the coronary vein, the arteries of the lesser curvature vascular arcade, the gastroduodenal artery, and the structures of the portal triad: Portal vein, common bile duct, and proper hepatic artery.

The lesser omentum is divided into two subcomponents:

• 1. The gastrohepatic ligament, the larger component, found between the lesser curvature and the liver. It includes the pylorus.

• 2. The gastroduodenal ligament, the smaller component, found between the first portion of the duodenum (superior portion, duodenal ampulla) and the liver. The common bile duct is found between the layers of the omentum.

Image property of: CAA.Inc. Photographer:David M. Klein

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

William S. Halsted, MD

William S. Halsted, MD (1852 – 1922) American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at  www.nih.gov