Evan O’Neill Kane

Evan O'Neill Kane (1861-1932) portrait

Evan O’Neill Kane (1861-1932) was an American general surgeon

Kane was the archetypal American “country surgeon” who turned a rural Pennsylvania hospital into a high-throughput trauma-and-general-surgery service for the industrial age. Based in Kane, he spent decades as chief surgeon at Kane Summit Hospital (an outgrowth of the cottage hospital founded by his mother, Elizabeth Wood Kane) and became closely identified with the demands of lumber and railroad communities where injuries were frequent and time mattered.

Kane became internationally famous in 1921 when he performed an auto-appendicectomy to demonstrate both the feasibility of appendicectomy under local infiltration and the patient experience of the operation. In his own report he describes rigging his position on the table (feet braced, table raised, pillows, head pushed forward) to obtain “a fairly good view,” then infiltrating “cocain and adrenalin” before opening the abdomen and completing the key steps of the procedure.

A major strand of his career was railway surgery. Kane was retained by multiple railroads and wrote from hard-won experience about shock, field improvisation, and the realities of accident medicine. In this setting he strongly favoured techniques that reduced physiological stress and sped recovery, helping explain his long-running advocacy for local anaesthesia for operations many contemporaries still did under ether.

Kane designed or promoted practical solutions for austere environments such as rapid hypodermoclysis for shock, fire-proof asbestos dressings, an acetylene headlight for night operations, and even mica as a transparent cranial “window”). He also embraced comfort innovations such as use of the phonograph in the operating-room.

Biographical Timeline
  • Born on April 6, 1861 in Darby, Pennsylvania (USA) son of American Civil War Major General Thomas L. Kane, the founder of the town Kane, Pennsylvania
  • 1884 – Graduated Jefferson Medical College (Philadelphia) (MD).
  • 1887 – With his mother (Elizabeth Dennistoun Wood Kane) and brother, helped found Woodside Cottage Hospital in Kane, Pennsylvania (later Kane Summit Hospital).
  • 1892 – Hospital moved to a larger site and became known as Kane Summit Hospital.
  • Late 19th–early 20th century – Served as chief surgeon at Kane Summit Hospital and worked as a railway surgeon for multiple railroads
  • 1921 (15 Feb) – Performed a highly publicised self-appendicectomy under local anaesthesia, later publishing the case as “Autoappendectomy: a case history”
  • 7 Jan 1932 – Performed self-inguinal hernia repair under local anaesthesia
  • Died on April 1, 1932 in Kane, Pennsylvania, aged 70.
Key Medical Contributions
Auto-appendicectomy (February 15, 1921)

Kane published his own case report, and it reads like a deliberate proof-of-concept for major abdominal surgery under local anaesthesia. He describes chronic appendicitis, minimal prep (“one day’s starvation” and oil), walking to hospital, premedication with morphine, then announcing (to everyone’s alarm) that he would perform the operation himself. He positioned himself semi-sitting with the table head raised, pillows under his shoulders, a foot brace to flex hips/knees, and had the anaesthetist push his head forward so he could see the field.

Technique details from the primary report:

  • Incision planning: mapped the site “one inch below McBurney’s point,” planned a 3.5 inch diagonal incision (larger than he preferred in routine cases because he “did not know what to expect” in himself).
  • Local anaesthesia: infiltrated locally with “cocain and adrenalin” (not novocaine as frequently quoted) into skin and deeper abdominal wall. Kane noted the striking the peritoneum produced a “sharp prick” sensation. He then waited ~4 minutes before incision.
  • Finding the appendix: Kane reports no adhesions and lifting the caecum exposed the appendix. It appeared enlarged/injected with concretions. He then had an assistant hold it up under tension while he ligated in the usual way.
  • Closure: Kane states he left wound closure to his assistants

Kane explicitly framed the self-operation as evidence that local anaesthesia could be tolerated for “major operation” and therefore might spare patients in whom general anaesthesia was risky.

1921 Kane self-operation or auto-appendicectomy
Self-operation or auto-appendectomy. Kane, 1921
Historical inconsistencies of the 1921 operation and re-telling

Local anaesthetic used (cocaine vs novocaine/procaine)
Kane’s own case report states he injected “cocain and adrenalin” locally (after a pre-op morphine injection). Many secondary retellings substitute novocaine/procaine, often implying it was chosen as a “safer” agent—worth flagging unless a source explicitly quotes Kane using novocaine.

How he could see what he was doing (mirrors vs positioning)
In the primary description, Kane does not mention mirrors; instead he describes positioning (cross-brace for feet, table adjustments, pillows, “doubling” himself up) and instructing the anaesthetist to push his head forward to get “a fairly good view.” The common “used mirrors” line appears to be a later embellishment unless you can find “mirror(s)” elsewhere in the original report.

“Painless” vs candid discomfort
Kane is explicit that the procedure was not uniformly painless: he reports “some discomfort” when tightening the mesenteric ligature (because he didn’t wait for anaesthetic effect) and pain with some peritoneal and some skin stitches outside the anaesthetised field. Secondary summaries often flatten this into “painless” or “bearable throughout,” losing his qualifiers.

Duration and pace of the operation
Kane remarks he worked “comparatively rapidly” and notes “less than half an hour in my whole undertaking.” Popular accounts quote longer operating times.

Auto-hernia repair (January 7, 1932) — the second public “self-operation”

Kane operated on himself again for an inguinal hernia on January 7, 1932, following a horseback riding injury. Contemporary press descriptions emphasised his composure as he “smiled throughout,” and “joked with the nurses”.

The operation was performed at Kane Summit Hospital under local anaesthesia, with press present, and was regarded as riskier than the appendectomy because of potential vascular damage. The operation reportedly took as 1 hour 55 minutes and Kane “back operating” 2 days later.

Key medical contributions (beyond the self-surgery headlines)

Railway surgery innovations (shock and austere operating). Kane devised equipment and methods intended for emergency/field conditions including rapid hypodermoclysis concepts and other practical aids emerging from railway trauma work. Accounts of his innovations highlight materials and practicality such as:

  • Fire-proof asbestos surgical dressings that could be rapidly sterilised over open flame (in the era before sealed sterile packs).
  • Acetylene headlight for night operating and field illumination.

Early patient-centred workflow ideas. In the hospital setting he proposed

Major Publications
References

Eponym

the person behind the name

more eponyms…

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | On Call: Principles and Protocol 4e| Eponyms | Books |

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