Interview with Philip Eskew

CAROLYN CRABTREE: This is Carolyn Crabtree. I'm at the McDowell House and Apothecary in Danville, Kentucky, interviewing Dr. Philip Eskew, who is from North Webster, Indiana. Dr. Eskew, tell us a little bit about yourself.

PHILLIP ESKEW: Well, I'm an obstetrician and gynecologist. I practiced obstetrics and gynecology for thirty-three years at St. Vincent Hospital in Indianapolis. Started solo practice many years ago, formed a group, and then after twenty years became the Residency Director to teach residents in obstetrics and gynecology. I've been very involved politically with the American 1:00College of Obstetricians and Gynecology, being an Indiana section chair, a district chair, and a national vice president of ACOG.

CRABTREE: Now you do a presentation of Dr. Ephraim McDowell. Would you tell us how you got started doing that?

ESKEW: Well, I was district chair from 1991-1993. Every three years we'd go out of the district for a meeting someplace. It so happened that in 1992 we had our district meeting in London and then an extension of that trip to Edinburgh, Scotland. Since we were going to be in Edinburgh in 1992, it coincided with exactly two-hundred years since Dr. McDowell had attended the University of Edinburgh to study medicine. So I thought in one of the lectures that we were giving at the University of Edinburgh that I should give a history telling the story of the operation and a little bit about Dr. McDowell. But I also thought 2:00that history lectures are pretty boring, so I decided that I would give the first person. So prior to the lecture I acted like I got sick, I left the room, I put on my costume and makeup, and the moderator said, "Dr. Eskew's sick. He cannot give his lecture, but we have somebody that is going to take his place, and may I present to you Dr. Ephraim McDowell." And so then I gave the lecture as if I had come back from the dead and been given a special dispensation. I have given the lecture all over the United States. I have felt a very strong attachment to Dr. McDowell, and as such have served on the board as the one non-resident member of Kentucky that serves on the board of managers for the 3:00McDowell House.

C: You have done this presentation many times and many places. Have you done it overseas in other countries besides Edinburgh, Scotland?

E: No, Edinburgh, Scotland was the only time, and when we went there we really tried to get them to recognize him as the Father of Abdominal Surgery. They consented to allowing us to put a little silver metal plaque in their library at the University of Edinburgh recognizing the fact that he performed a successful abdominal operation on Christmas Day, 1809, but they will not call him the Father of Abdominal Surgery. If you look at the research, if you really study what they said in Europe, you will find out that in the 1700s several different doctors performed what is called incisionism. Incisionism means that if a lady 4:00has a very large ovarian tumor, they stick a knife through the skin, through the abdomen into the ovarian cyst and let it drain. And that's all they do, and then they say, "Well, we've taken out the ovarian cyst." Nobody had ever done an operation like Dr. McDowell, so they practiced incisionism for all of the 1700s, and it wasn't until after Dr. McDowell performed this that some other surgeons in Europe also performed an abdominal surgery. Without question Dr. McDowell was the first and is the Father of Abdominal Surgery, but the people in Europe cannot accept the fact that somebody from Danville, Kentucky, was the Father of Abdominal Surgery.

C: You said Danville was called the "Athens of the West" because it was such a 5:00cultured community during that time. Why do you think Danville was so different from other communities?

E: Well I think this is where a lot of the leaders of the state resided. Certainly this city was founded early; it was a good location for people to settle in because of the roads, because of the climate, it wasn't along the river. There were several prominent people who lived here and had their homes here on the hills around Danville, and I just think it was a place where very outstanding people from the state of Kentucky resided. Yes, there was a state capital but--in other cities, but Danville just had a lot of wonderful 6:00attributes, and, of course, Dr. McDowell lived here and was recognized throughout the Midwest as an excellent physician and surgeon.

C: You did your research for your talk yourself, I'm assuming?

E: Yes I did, and that was reading Dr. Laman Gray's book, reading many, many articles that had been written about this. I really would like to write a story from the perspective of Jane Todd Crawford that we could have somebody portray Mrs. Crawford and tell her story, because I think there's a real story involved in the courage that it took for her to submit to this type of surgery. Haven't done it yet, but I'm working on it.

C: There is a woman in Green Country, Suzanne Bennett, who does a wonderful 7:00presentation of Mrs. Crawford. Have you been aware of her?

E: No, I was not.

C: --or seen her presentation?

E: No. So maybe I don't need to do it.

C: Hers is very inspiring and she says that the woman still inspires her today with her courage and her faith.

E: Well, you know there's so many different things about Dr. McDowell, and there were things written about him saying that there were angry people outside the house, which is really been proven to not be true, and a lot of the rumors were dispelled. People ask me when I give this talk, "Well I heard that he was threatened with death" and all this, but if you really talk to the people that know a lot about Dr. McDowell, he was so well-respected that this did not happen. And for somebody to decide that they're going to make a nine-inch 8:00incision on somebody's abdomen, that's really pretty amazing. Now people say, "Well how can he do this? She didn't have any anesthetic." Well first of all her abdomen had to be quite large from the distension from this ovarian tumor, and what that means is that once this tumor or twenty-two pounds of tumor were removed the skin was so, and the abdomen/abdominal muscles were so stretched that probably it was easy to get the bowel to go back into this incision. And doing this without anesthetic, you've also got to remember that she was in a lot of pain. Well if you could all of a sudden relieve this pain by making this incision or allowing this tumor to suddenly burst forth and remove that, that had to provide a tremendous amount of relief for her, which would mean that she 9:00really wouldn't have as much pain for that. So relieving the distension, relieving the pain, having the distended abdominal muscles to put the bowel back inside were all issues that allowed her to recover completely. There weren't as many bugs or bacteria in those days. My guess is that they probably at least washed her abdomen, but you don't know that. Certainly he probably washed his hands, only because, you know, this was the type, it was a pseudomucinous cyst adenoma that really, it's a very, very ugly ovarian tumor that's full of a jelly-like material and a lot of corroded things, so there had to be some washing of things to clean this area up once they got the tumor out, and I think 10:00that contributed to her recovery.

C: I'm going to get a little personal here. I had the very same type of surgery when I was twenty years old, and instead of just draining the tumors they actually removed my ovaries. Now why do you think that Dr. McDowell did not do that?

E: Dr. McDowell did remove the ovary. He put a--

C: Oh he did?

E: He put a ligature around a pedicle, and coming off the horn of a uterus, which looks like a pear, there is a fallopian tube and ovary on a very thin pedicle, about the size of your finger. And so the ovarian cyst was twenty-two pounds, which probably meant that it was in the neighborhood of fifteen to 11:00twenty inches. And so if I can get that tumor out and then tie a very tight leather ligature around that pedicle that's only the size of a finger, the ovary's removed and so's the fallopian tube. So she still had her other ovary, but that ovary was completely removed, and so that's why it's called an ovariotomy.

C: All right, I did not understand that before. Another person that I interviewed for this said that they thought she had children after her surgery. Is that true or do you know?

E: That's not true. Her children were already born at that time, and she was forty-six years of age when she had this done, so it's highly likely in that era that she was clear into menopause and incapable of having children. It'd be very unusual for a woman forty-six to have a child, and it would be unheard of in the 1800s.

C: Now when did you first become interested in Dr. McDowell?

E: Well, I've been involved with the American College of OB/GYNs since 1972, and I was involved politically with the District Five of the American College of Obstetricians and Gynecologists. I was a Junior Fellow. Junior Fellows are those that are residents, and I actually was the national chair or the National President of the Junior Fellow Organization. As such, I was a member of the District Five District Advisory Council. Well the District Advisory Council meets throughout the district of Indiana, Kentucky, Ohio, Michigan, and Ontario, and since the early '70s, District Five has contributed a thousand, now it's two or three thousand, and in the past we've given several thousand dollars to the 13:00McDowell House. So every year it came up, should we continue to give this donation to the McDowell House, and we all said, "Absolutely. He's the father of OB/GYN, and therefore we need to continue to contribute." So as I rose from a junior fellow to a fellow and as an officer I really always was aware of the McDowell House. I had visited it when we had district meetings in Lexington, and so I've been aware of this since '72, and I was fortunate enough many years ago to be placed on the executive, not the executive but the Board of Managers of the McDowell House and have served, so--it's a love.

C: How do you get younger physicians interested in the McDowell House and keep the McDowell House going?

E: Well, I think people really need to pay attention to this. One of the things that I have seen in the various medical schools is some people will do a history of obstetrics and gynecology, and they'll always talk about Dr. McDowell. I have given this talk as a Grand Round speaker at three or four different universities. So certainly in this area of the Midwest, there's a lot of people that are aware of this. You just have to find that special physician/surgeon who's interested in medical history. But it really should be a part of all education for all OB/GYN residents. We certainly have a historical part of our annual programs that talks about various things dealing with the history of 15:00OB/GYN. So there's no other way to do that other than to just make people aware of it.

C: Do you find it harder and harder to do?

E: Yes, without question it's harder to get younger people involved in the history of medicine simply because they just don't have an appreciation for how they got there, what they learned, who taught you. Certainly I revere my physicians/colleagues that taught me, and you know as you get further along, forty years later these people won't even remember those people who taught them, and they have no idea how basic medicine was. When I started practicing medicine 16:00in '74 we didn't have ultrasound machines, so we didn't have any way of knowing whether it was a boy or girl. Then we had a very crude ultrasound machine that would tell us whether it was head-first or a breach. During my residency was when we first saw a laparoscope, and that was in '72, and now almost all procedures are done through some type of a scope or even using robots. So medicine has changed and people don't see the value of what happened many, many years ago.

C: In your role as Dr. McDowell, do you ever imagine what he might think of the medical procedures today?

E: I don't think that surgeons or physicians from the 1800s could even 17:00comprehend the advances that have been made in medicine. They made their decisions based on symptoms that people had. Somebody had written about that same symptom in a book, and then, therefore, they knew what to do. So if somebody had a bad cough, and if it was productive, they thought they had a pneumonia. Well, all they could do was make them comfortable and hope that it didn't kill them, because they didn't have antibiotics. If somebody had a tumor they couldn't operate on them. And so for people to even imagine that they could perform surgeries and stop people from bleeding, they had afflictions just like we do now, but certainly they could do very little to help them. Dr. McDowell 18:00died from an appendicitis attack, and they called it a colic of some type of the abdomen. But fever, nausea, vomiting? I mean, it's so typical of appendicitis, and nobody was able to go in and remove his appendix. So I don't think they even thought about surgeries. I don't think they thought about medicines that were available. They just made people comfortable and hoped that they recovered. I mean even in the early 1900s when we had the huge influenza scare that was happening, there were so many people that died because they just simply had a pneumonia that didn't get better, and they got weak.

C: Medicine has become, it seems, so diversified now. I mean, you're either a 19:00surgeon, you're a gp, you're a pharmacist. Dr. McDowell was all of those things, right?

E: Well, you've got to remember that in the 1700s, early 1800s, there wasn't much to learn. I mean, you just learned how to listen to a patient, how to listen to their complaints, and how to make a diagnosis, and the medicine could be written in three or four books. Yes, there was anatomy, so you knew the anatomy that they did from working on cadavers, but certainly there was just not that much medicine that made any sense whatsoever. I've got medical books from the late 1800s, and it's one book of medicine. But you've got to remember we didn't have radiology. We didn't have anybody doing bone surgery other than 20:00fixing a splint. You didn't go in and operate on people to replace hips, knees, or whatever. And so it's--medicine was so simple in those days; it was just really making people comfortable, or people had to learn to live with an affliction. Ear, nose, and throat surgery--nobody removed tonsils, nobody did any surgery on their eyes or their ears. I mean, all those things were gone. Thoracic surgeons, cardiology--all we knew about the heart was what could we do to help you. Well, we couldn't do anything about congestive heart failure or heart attacks, even until we got into the '60s and '70s.

C: You mentioned that there weren't as many bugs, bacteria back then. What do you think has made the difference? We have Staph infections--

E: Well I think a lot of bacteria have mutated and I think the organisms have 21:00split and formed other things that are more virulent. I just think that there's more things that have been stirred up that have contributed to the number of bacteria and things that make medicine so complicated. Viruses. Very few viruses that affected, and viruses mutate so commonly. So there's just been a lot of advancement of the bacteria, of the organisms since early times.

C: Would Jane Todd Crawford have survived her surgery probably today?

E: Without question. It would have been a very easy operation--

C: Really?

E:--easy operation for her to survive. She'd have probably been more comfortable, but without question we--that was an enormous tumor, and it 22:00probably would have been diagnosed much earlier, not allowing it to get as large as it did. And she wouldn't have been misdiagnosed; I mean, that's a very simple operation.

C: Have you seen anything like that in your career?

E: Many times.

C: That large?

E: I've removed a lot of tumors, a lot of uteruses that were much larger than that.

C: Really?

E: Uteruses that were clear above the so that somebody looked like they were six months pregnant, and it was just a large fibroid tumor. So we've all seen things that were pretty large; many of those were early in my training before people started getting preventative care, when they started coming in for annual exams, when you would pick up on something like this at an early stage of the disease rather than waiting and somebody not going to see a doctor for five or ten years 23:00when a tumor could grow that large.

C: Do you have anything else you would like to tell us about this, your history, anything? Before we stop?

E: You know, I just think that Dr. McDowell was such a pioneer. I just--and it's so, to me, ironic that he comes from Danville, Kentucky. And here was a man that had great parents, he had great mentors, he had great teachers. He had a lot of confidence; he had a lot of courage. I think he was skilled in communication, which is so important for a surgeon to have the ability to communicate to a 24:00patient who's suffering so that they understand what the problem is and they understand what they can do for that patient. I think he was committed to providing care; he was very confident in his abilities, and I just think that he really was a very special person in medical history that was so careful, so prepared, and had the courage to try something to try and relieve somebody's pain and suffering. So Dr. McDowell was not only a pioneer, but he was a hero in medical history.

C: I will ask one other question. He seems to be -- to have been very modest 25:00about this entire thing. He did not tell other people about it.

E: That doesn't surprise me because you have to understand that he had been told by a lot of people that if you open the abdomen the patient will die. If you expose the bowel to the air, then they'll get peritonitis and they will die. And everybody had that had tried at that time, and I think the fact that he was successful--he was not a boastful man, and he wrote something of this, but it really wasn't published until years later. I just think he was very cautious; he was not looking for an award or any type of accolade for doing this type of surgery. He was just providing care, and I think he was just being as modest as he possibly could. And he did a lot of these; he did several other operations. 26:00He did a lot of bladder surgery and things like that, so word spread but he was really not one of those people that published his own works for other people, and he relied on other people to tell his story.

C: Why do you believe he did not become a teacher at Transylvania or Louisville or somewhere?

E: I think he was very happy to be practicing medicine. I think he probably had several apprentices that came and studied under him, but my assumption would be that he really was not interested in just lecturing. He wanted to care for people; he wanted to take care of people and make them well. So I, you know he practiced medicine a long time, and when he got back here, I mean, he got married at the age of 31 and he died at the age of 59, so he was, had a fairly 27:00lengthy career of practicing medicine. In those days it wasn't somebody who traveled the country and lectured; you just didn't do that. You just stayed in a locale and practiced medicine. I think he was very happy; he had a family, and he had no desire to go and just go into a laboratory and teach.

C: My last question: what role do you feel that his faith in God played in all of this?

E: There's no question that anybody that operates on a patient has to have faith in not only their abilities but in those abilities that have been given to you by a Higher Being. There's no doubt in my mind that he had a very, very strong faith. Number one: he wanted to operate on a Sunday. Number two: he read a 28:00prayer before he operated. I think he had a deep faith which gave him calmness, gave him confidence, gave him courage. And, you know, he felt like he was working with the hands of God.

C: I certainly thank you for doing this interview for me and for the McDowell House. I appreciate your time very much.

E: You're quite welcome.