Up From Bleed, Blister and Purge

Frontier Medicine
By David Dary
(Knopf, 381 pages, $30)

To think that I wince when I get a needle; reading just the review is ... er, incredible? Awe-inspiring? Gruesome?

In December 1809, Jane Crawford, 45 years old and living in a small log cabin in backwoods Kentucky, thought she was pregnant. Her belly was so enlarged that local doctors agreed that she was set to deliver her long-overdue twins. These physicians enlisted the aid of Ephraim McDowell, a highly regarded general practitioner from nearby Danville, who determined that Crawford was not pregnant but suffering from a massive ovarian tumor. "I gave to the unhappy woman information of her dangerous situation," McDowell would later write. "She'd appeared willing to undergo an experiment."

1809. Imagine how primitive medicine was then; I know that in the Civil War, a half century later, it was rudimentary.

Up until that point in medical history, before anesthesia or antisepsis, a fatality was the most likely outcome of abdominal surgery. McDowell knew as much, but insisted that the procedure was essential for Jane Crawford's survival.

No anesthesia for surgery. I get anesthesia for dental work.

McDowell made a nine-inch vertical cut into his patient's abdomen. For 25 minutes, Crawford endured unbearable pain while singing hymns and repeating Psalms. First, McDowell scooped out 15 pounds of a "dirty, gelatinous looking substance," then he excised 7.5 pounds of actual tumor, including the ovary and a portion of the Fallopian tube. Once all the tumorous material had been removed, McDowell turned his patient on her left side to allow the accumulated blood to escape, then he carefully replaced Crawford's intestines, which had spilled out during the operation, and finally closed the incision with sutures and adhesive plaster.

Oy.

As Ms. Dary explains, the surgery itself was unremarkable in its simplicity but memorable for what happened afterward. Crawford received no pain medicines, no antibiotics, no intravenous fluids, no formal post-operative care, but she rode her horse home after three weeks and suffered no complications. She lived to age 78, the world's first known survivor of an elective exploration of the abdomen and removal of an ovary.

Amazing.

Mr. Dary is masterly in his telling of the Crawford-McDowell tale, but he shows less facility when he discusses how this triumph fits into the larger universe of 19th-century medicine. In a recurring pattern, Mr. Dary uses his excellent research for compelling dramatic effect, as when he describes how Dr. William Beaumont, treating a Michigan fur trapper who had been shot in the abdomen in 1822, was unable to close the wound entirely. The doctor, afforded this window on the man's stomach, went on to make groundbreaking observations about the digestive process. With the Beaumont story, as with many others, Mr. Dary shows his customary brio but then seems to lose interest – as did this reader – when he ponders the meaning of it all.

Resourcefulness on the part of Dr. Beaumont, indeed. As for Mr. Dary, it seems that great research and narrative are not accompanied by equally gifted analysis.

Occasional inaccuracies, however, do not discredit the overall thrust of "Frontier Medicine" or the depth of Mr. Dary's research. He does an admirable job of pulling together stories about health care as practiced by Native Americans, Lewis and Clark, Civil War doctors and even 20th-century quacks. Moving briskly from one episode to the next, Mr. Dary is particularly effective at showing us the strengths and foibles of early American doctors, an often suspect class of professionals who now and again did more harm than healing. It is entertaining, enlightening material, but more analysis – of how these unrelated medical vignettes contributed to the process of professionalization that affected the education, training and personal lives of physicians – would have greatly enhanced "Frontier Medicine." History, medical or otherwise, is most useful when it strives to be more than a chronicle of tales – however diverting they might be – spun by a seasoned raconteur.