Other attributes were determined from his description of the initial consultation with Mrs. Crawford. Dr. McDowell had been asked by her 2 attending physicians to help with a difficult delivery, but he made the diagnosis of ovarian tumor after a careful history and physical examination. Even though his teachers and surgeons of his time felt that abdominal exploration resulted in peritonitis and death, he had enough confidence in his knowledge of anatomy and his skill as a surgeon that he was willing to attempt the “experiment,” as he called it. He listened with compassion to the pleas of his patient as she asked him to keep her from a slow and painful death. Dr. McDowell then described to the patient, in great detail, her condition and the fact that operation for cure had never been performed. He also stated that the best surgeons in the world had believed successful operation to be impossible. When Mrs. Crawford said that she understood the risks and was willing to proceed, he committed himself to perform the operation if she could travel the 60 miles to Danville. Dr. McDowell described a process of truly informed consent.

In his own words, he described the details of the ovarian tumor removal and included his concerns with keeping the intestines warm, draining the excess blood from the peritoneal cavity, and careful apposition of the skin edges.

Following is a list of Dr. Ephraim McDowell's personal qualities described as “C” words along with evidence corroborating each of the characteristics.

Courageous. When he agreed to attempt an operation that his teachers had stated was doomed to result in death, he, as well as his patient, showed great courage.

Compassionate. He was concerned for his patient and responded to Mrs. Crawford's pleas for help.

Communicative. He explained to his patient the details of her condition and her chances of survival so that she could make an informed choice.

Committed. He promised his patient that if she traveled to Danville, he would do the operation. He made a commitment to her care.

Confident. He assured the patient that he would do his best, and she expressed confidence in him by traveling 60 miles by horseback to his home.

Competent. Although lacking a formal medical degree, he had served an apprenticeship in medicine for 2 years in Staunton, Virginia, and he had spent 2 years in the study of medicine at the University of Edinburgh, an excellent medical school. In addition, he had taken private lessons from John Bell, one of the best surgeons in Europe. By 1809 he was an experienced surgeon.

Careful. Despite the fact that 2 physicians had pronounced Mrs. Crawford as pregnant, he did a careful physical examination and diagnosed that she was not pregnant but had an ovarian tumor. He also carefully planned each operative procedure with a review of the pertinent anatomic details. As a devout Presbyterian, he wrote special prayers for especially difficult cases and performed many of these operations on Sundays.

The above characteristics are desired traits in surgeons today, even with our advanced technology.

There is one final trait, which is helpful to surgeons, that Dr. McDowell possessed. This attribute is directly addressed in descriptions of him.⁴

Courteous. He was humble and courteous in his dealings with others. Even when he was publicly and privately criticized after the publication of his case reports, he did not react with vitriol.