In 1809 he did his first ovariotomy. He believed the operation to be without precedent in the annals of surgery, yet he kept no note of it or of his subsequent work. He prepared no account of it until 1817. This appeared in the Eclectic Repertory. It was so meagre and so startling that surgeons hesitated to credit its truth. He had not mastered his mother tongue. The paper was thought to bear internal evidence of its author's having "relied upon his ledger for his dates and upon his memory for the facts." The critics from far and near fell upon him. The profession at home cast doubt upon the narrative. The profession abroad ridiculed it. For all that, McDowell kept his temper and his course, and when he finally laid down his knife he had a score of thirteen operations done for diseased ovaria, with eight recoveries, four deaths, and one failure to complete the operation because of adhesions.
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.