It would be neither fitting nor becoming on this occasion, and in this presence, to speak in detail of the technic observed by McDowell in his work. That has long since passed into history. I may, however, be permitted the remark that the procedure, in many of its features, is necessarily that of to-day. The incision was longer than that now usually made, and the ends of the pedicle ligature were left hanging from the lower angle of the wound. But the pedicle itself was dropped back into the abdomen. The patient was turned on her side to allow the blood and other fluids to drain away. The wound was closed with interrupted sutures. This marvel of work was done without the help of anesthetics or trained assistants, or the many improved instruments of to-day, which have done so much to simplify and make the operation easy. McDowell had never heard of antisepsis, nor dreamed of germicides or germs; but water, distilled from nature's unpolluted cisterns by the sun, and dropped from heaven's condensers in the clean blue sky, with air winnowed through the leaves of the primeval forest which deepened into a wilderness about him on every hand, gave him and his patients aseptic facility and environment which the most favored living laparotomist well might envy. These served him well, and six out of seven of his first cases recovered. He removed the first tumor in twenty-five minutes, a time not since much shortened by the average operator.
It was not alone, however, in this hitherto unexplored field of surgery that McDowell showed himself a master. His skill was exhibited equally in other capital operations. He acquired at an early day distinction as a lithotomist, which brought to him patients from other States. He operated by the lateral method, and for many years used the gorget in opening the bladder. At a later period he employed the scalpel throughout. He performed lithotomy thirty-two times without a death. Among those who came to him to be cut for stone was a pale, slender boy, who had traveled all the way from North Carolina. This youth proved to be McDowell's most noted patient. He was James K. Polk, afterward President of the United States.
Dr. McDowell's "heart was fully open to the lesson of charity, which more than all men we should feel," and he dispensed it with constant remembrance of the sacred trust imposed upon us. Yet he had a proper appreciation of what was due his guild from those whose means allowed them to make remuneration for professional services. He charged $500 for an ovariotomy that he went to Nashville, Tenn., to do. The husband of the patient gave him a check, as he supposed, for that sum. On presenting it, the doctor discovered that it was drawn for $1,500 instead of $500, whereupon he returned the check, thinking a mistake had been made. The grateful gentleman replied that it was correct, and added that the services much outweighed the sum paid. When the fact is borne in mind that the purchasable value of money was much greater in the first than in this the last decade of the century, it will be seen that the "father of ovariotomy," at least, set his successors in the field a good example. This is made conspicuous by the fact that Sir Spencer Wells has seldom charged a larger sum, and has declared £100 to be a sufficient fee for the operation.
In person Dr. McDowell was commanding. He was tall, broad-shouldered, stout-limbed. His head was large, his nose prominent and full of character, his chin broad, his lips full and expressive of determination, his complexion florid, his eyes dark-black. His voice was clear and manly; he often exercised it in recitations from Scotch dialogues, when he would roll the Scotch idiom upon his tongue with the readiness of a native. He was fond of music, especially comic pieces, which he sang with fine effect, accompanying his voice sometimes with the violin.
He was a man of the times, taking an active interest in the affairs of the community in which he lived. He had many books for that day. Cullen and Sydenham were his chief authorities in medicine; Burns and Scott in literature. He was fond of reading, yet he was inclined to action rather than study.
He placed great reliance on surgery and its possibilities; he placed little trust in drugs. He counselled against their too liberal use. In truth, he did not like the practice of medicine, and turned over most of his non-surgical cases to his associate in business. In manner he was courteous, frank, considerate, and natural. He was a simple, ingenuous man. His great deeds had given him no arrogance. His was a clean, strong, vigorous life. His spirit remained sweet and true and modest to the last. He lived a God-fearing man, and died on June 25, 1830, in the communion of the Episcopal Church.
1813. While McDowell was so busily engaged in his special line of surgery, his colaborers elsewhere in the State were not idle. Four years after his first ovariotomy, the first complete extirpation of the clavicle ever done was accomplished by Dr. Charles McCreary, living in Hartford, Ohio County, Ky., two hundred miles, as the crow would fly, farther into the wilderness. The patient was a lad named Irvin. The disease for which the operation was done was said to be scrofulous. Recovery was slow but complete. The use of the arm remained unimpaired, and the patient lived, in good health, to be forty-nine years old.
In 1829, sixteen years after the back-woods surgeon had achieved his success, Professor Mott repeated the operation, also on a youth, with a like fortunate result, and, believing he was first in the field, claimed the honor of the procedure for the United States, for New York, and for himself. He termed it his "Waterloo operation," not, however, because it surpassed, as he declared, in tediousness, difficulty, and danger any thing he had ever witnessed or performed, but because, as it appears, it fell on the 18th of June, the anniversary of the battle of Waterloo.
Mott's operation required nearly four hours for its execution, and the tying of forty vessels; but after all it proved to be not a complete extirpation; for the autopsy, made many years later, showed three quarters of an inch of the bone at the acromial end still in its place. Yet the case passed quickly into the annals of surgery and added much to the already great renown of the operator. To this day it is referred to by surgical writers as "Mott's celebrated case," and the description of his procedure is often given in his own words.
McCreary removed the entire collar bone, and that while a young practitioner, living in a village composed of a few scattering houses, situated in a new and sparsely settled country, where opportunities for cultivating surgical science were necessarily rare, and the means for acquiring anatomical knowledge necessarily small.