In 1809, Dr. McDowell was called to see Jane Todd Crawford in Green County, Kentucky, 60 miles from Danville. Her doctors believed she was beyond term for pregnancy, but McDowell diagnosed her with an ovarian tumor. Crawford pleaded for a solution to save her from a painful death. Understanding the risks, the surgeon decided to proceed with the surgery.
On Christmas morning, McDowell operated without anesthesia or antiseptics, neither of which was then known to the medical profession. The tumor weighed 22.5 pounds (10.2 kg). Unable to completely remove it, he tied a ligature around the fallopian tube and opened the tumor. The whole procedure took 25 minutes, and Crawford made a smooth recovery, returning home 25 days later. She lived for another 32 years, marking this as the first successful removal of an ovarian tumor in history.