Early Innovators (book excerpt: Frontier Medicine)

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In this first excerpt, Dary writes about the first ovariotomy in the United States.

In December 1809, Dr. [Ephraim] McDowell was asked to visit the log cabin home of Mrs. Jane Crawford in Green County, Kentucky. The request came from two physicians already caring for her who believed that she was struggling to deliver overdue twins. After a vaginal examination, McDowell concluded that she was not pregnant and that her distended belly was caused by an enlarged ovarian tumor. He realized that the only thing that could save her life was to remove the tumor, but he knew no such operation had ever been successful. In fact, abdominal surgery in general was positively taboo. Medical school professors were emphatic in warning students never to operate on the abdomen, pointing out that attempts at cesarean section had always been fatal. McDowell, however, had heard [his mentor Dr. Alexander] Humphreys describe a successful cesarean operation. Fifteen years earlier, Dr. Jesse Bennett, a graduate of the University of Pennsylvania, had performed a successful cesarean section on his own wife at Edom, in what is now West Virginia, in 1794. A few physicians in the area knew about the operation, but Bennett never reported it, because as a rule doctors did not operate on their own family members.

Dr. McDowell confronted Mrs. Crawford and frankly explained that she could stay home and die, or there was a chance she could live if she was willing to come to his home in Danville and let him operate. Her husband opposed the operation. McDowell again explained her chances. Finally, the Crawfords agreed. McDowell left for Danville to make preparations. A few days later Mrs. Crawford dressed warmly and mounted her horse, resting her distended stomach on the pommel of her saddle. With a neighbor's wife, she rode sixty miles in the winter cold to Danville. Once she was in the doctor's home, McDowell had her rest to regain her strength while he made plans for the operation. He decided to operate on Christmas Day 1809, saying, "God's beneficence will be at its highest." As was his custom before every operation, he wrote out a prayer: "Direct me, Oh! God in performing this operation for I am but an instrument in Thy hands. ... Oh! Spare this afflicted woman." With the assistance of his nephew James McDowell, who had studied medicine, and another physician, Dr. Alban Smith, McDowell began the operation.

Without sedating Mrs. Crawford, Dr. McDowell used a pen to mark the path of his incision. He then made a nine-inch cut into the abdominal cavity, exposing the large tumor. Mrs. Crawford endured the pain by reciting psalms and singing hymns even as her intestines rolled onto the wooden table beside her. The tumor was so large that McDowell could not remove it in one piece. So he cut it open and took out 15 pounds of a dirty, gelatinous-looking substance. He next removed the sack, which weighed 7½ pounds. He then rinsed Mrs. Crawford's intestines with warm water and replaced them. He then turned his patient on her side to allow the blood to drain from the abdominal cavity before he carefully sutured the edges of his incision together and apposed the edges with adhesives. The operation had taken twenty-five minutes.

Twenty-five days later Mrs. Crawford returned home in good health and lived to age seventy-eight. This was the world's first ovariotomy. McDowell waited seven years before submitting his report for publication, but it took many more years before the medical profession would admit that a small-town physician in Kentucky had the ability to make medical history.

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In this excerpt, a unique doctor-patient relationship allows for numerous discoveries about how the stomach works.

Between the early 1820s and 1840, most fur trappers and traders survived their rugged life. One Canadian trapper, Alexis St. Martin, made a significant contribution to medicine after he was accidentally shot in the stomach in 1822. Dr. William Beaumont, a U.S. Army surgeon at Fort Mackinac, Michigan, treated the wound but was repeatedly unable to close the two-and-a-half-inch hole in St. Martin's stomach. Beaumont put a tent compress and bandage over the hole to keep it closed. Since his patient was unable to return to his work as a trapper, Dr. Beaumont hired him as the family's live-in handyman in 1823. Eventually the doctor recognized the unique opportunity for medical research that St. Martin's condition afforded. Two years later, after being transferred to Fort Niagara, Beaumont began experiments with St. Martin, observing the digestion of food as it was occurring in his stomach. Dr. Beaumont discovered that gastric juice has solvent properties. The experiments continued until the fall of 1825, when the former trapper returned to Canada, married, and had children. After another two years, Beaumont and St. Martin met again at Fort Crawford in Prairie du Chien, Wisconsin, where St. Martin and his family now lived, and Beaumont began a new series of experiments on St. Martin to determine if there was any relationship between digestion and weather. By the spring of 1831, Dr. Beaumont concluded that dry weather increases stomach temperature, humid weather lowers it, and a healthy stomach is a hundred degrees. The doctor also learned gastric juice needed heat to digest, that vegetables are less digestible than other foods, and milk coagulates before the digestive process. Dr. Beaumont also learned that anger hinders a human's digestion. Late in 1832 Dr. Beaumont and St. Martin traveled to Washington, D.C., and conducted other experiments concluding that exercise helps the production and release of gastric juice.

In 1833, Dr. Beaumont's observations and experiments were published and became the greatest single contribution to the knowledge of gastric digestion up to that time, thanks in part to his patient. The Canadian trapper St. Martin died in Canada in 1880 at the age of eighty-six. His family believed he had suffered enough indignities in the name of science and let his body rot in the sun. His remains were then buried in an unmarked grave so no further experiments could be performed. Later a marker was placed near the grave in St. Thomas de Joliette, Canada, relating St. Martin's history and noting that "through his affliction he served all humanity." Dr. Beaumont, considered the "Father of Gastric Physiology," died twenty-seven years before St. Martin after falling on an icy step in St. Louis, Missouri. He is buried there in Bellefontaine Cemetery.

Excerpted from "Frontier Medicine" by David Dary. Copyright © 2008 by David Dary. Excerpted by permission of Knopf, a division of Random House Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. $30.