Dr. Mütter's Marvels: intrigue and innovation at the dawn of modern medicine

Specializing in performing reconstructive surgery on the severely deformed in a time before anesthesia, Thomas Dent Mütter was one of the first American pioneers of plastic surgery. In the new book, Dr Mütter's Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine, author Cristin O'Keefe Aptowicz explores the life and times of this idiosyncratic doctor and American original.

11.1.Mutter.Sully
Best known today for his namesake museum, Philadelphia's (in)famous Mütter Museum, 19th century doctor Thomas Dent Mütter first made a name for himself as a young surgical wunderkind. Specializing in performing reconstructive surgery on the severely deformed in a time before anesthesia, Mütter was one of the first American pioneers of plastic surgery.

In the new book, Dr Mütter's Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine (Gotham Books, 2014), author Cristin O'Keefe Aptowicz explores the life and times of this idiosyncratic doctor and American original.

15.1.BurnSurgery1
In a time when they wore constrictive clothing and cooked in front of open flames, it was not uncommon for women to become severely deformed due to burns that had occurred in the home. Shame often kept these women from seeking medical treatment. However, Mütter invented a new type of treatment, which he called the Mütter Flap Surgery, which revolutionized the treatment of burn deformities. Severely burned women (and men) came from all over the country to be treated by him, despite the fact the lengthy, painful surgeries would be performed while the patient was still awake. An early form of skin grafting, the Mütter Flap Surgery is still used today, over 150 years after Mütter's death.

25.1.OldMeigs
During his career, Dr. Charles D. Meigs (1792-1869) was one of the most prominent and influential doctors in America, as well as a colleague and peer of Dr. Thomas Dent Mütter (1811-1859). The two men were both faculty members of Philadelphia's Jefferson Medical College, and clashed often because of their radically opposing philosophies towards medicine. For instance, while Mütter (a surgeon) taught his students to spend days slowly desensitizing the parts of a patient’s body through gentle touch and massage, Meigs (an obstetrician) did not believe in pain management for laboring women. Standing behind the bible verse which stated that "In sorrow thou shall bring forth children," Meigs instructed his students to absolutely avoid “fussing about” for example when their female patients were in labor. He encouraged students to follow his lead and simply “read and write in another room until the delivery was ready.”

06.1.GYNexamposition
Dr. Charles D. Meigs (1792-1869) was famously brutish with his female patients, but this came from his strong belief that the field of gynecology and obstetrics was handicapped by the prejudices and false modesties practiced by women. How were doctors like Meigs supposed to treat women effectively when, in many localities, an obstetrician could examine the abdomen of a pregnant woman only through blankets? Having little patience for women whose bodily shyness proved a barrier to him, Meigs believed and preached passionately that treatment others might view as curt and brutish was often the quickest route between a foolish patient and the treatment the doctor knew was needed.

28.2.OldPancoastAnother colleague of Thomas Dent Mütter (1811-1859) and Charle D. Meigs (1792-1869) was Dr. Joseph Pancoast (1805-1882), who was a surgeon as well as the Chair of Anatomy of Jefferson Medical College, the school where all three taught. Like Mütter, much of Pancoast's early career as a surgeon took place in a time before anesthesia, so his patients were awake during the procedures. During one public surgery, Pancoast attempted a daring removal of a patient’s upper jaw, using "marvelous speed" to rip out the bones with a huge forceps. But the surgery was perhaps too much for a public display. A student who was present would later recall how the partially conscious patient spat out blood, bones, and teeth, while unnerved students in the audience vomited and fainted in their seats.

16.1.MutterTicketPink
At Jefferson Medical College, where Dr Thomas Dent Mütter (1811-1859) served as the wildly popular Chair of Surgery, annual admission tickets were given to enrolled students. Medical students were required to attend two years of lectures and pass a test before given their medical degree. While the majority of the admission tickets were printed on light brown or gray paper, the flamboyant Mütter's admission tickets were often printed on hot pink paper.

16.2.Squibb
The years that Mütter served as the Chair of Surgery were a transformative time in medicine, and a significant amount of students who learned from him would go on to help revolutionize American medicine. One such student was Edward R. Squibb, who was deeply impressed by the ether surgeries that Mütter performed (Mütter performed the first ever ether surgery in Philadelphia on December 23, 1846), but shared Mütter's frustrations about the lack consistency and quality of ether in a time before standardized medicine. Squibb's passion for creating standardized and pure forms of medication, including ether, helped him form the medical supply company which would eventually evolve into the modern pharmaceutical giant, Bristol Myers Squibb.

21.1.GoutyHands
Mütter was forced to end his surgical career early because of constant, painful and crippling flare-ups of gout, a medical condition he inherited from his grandmother. As a surgeon, Mütter’s hands were one of his most valuable tools. Swift and nimble, quick and precise, Mütter was also ambidextrous, and was equally skilled with both hands. (“Few can boast of [being ambidextrous]... and often, many who can have in fact only two left hands,” a fellow doctor once quipped).

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During his lifetime, Mütter amassed a large collection of pathological marvels, many extremely unusual. There were “the usual osseous, nervous, vascular, muscular, ligamentotaxis, and other preparations for anatomical demonstration,” but his collection also contained a large number of wet preparations (specimens in jars); diseased bones and calculi; an extensive series of paintings and engravings, representing healthy and morbid parts, fractures, dislocations, tumors… and the surgical operations that are necessary for their relief; as well as graphic models of medical conditions in wood, plaster and wax. When Mütter realized that his life was coming to a premature end because of his lifelong struggles with health, he became fixated on finding a proper home for his collection, which he considered "the chief object of my professional life.” He struck a deal with the College of Physicians of Philadelphia, who opened the Mütter Museum in 1862--three years after Mütter's death.

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Philadelphia's Mütter Museum is one of the country's most popular science museums. There—for the modest price of admission—you can stand in front of a giant’s skeleton. Or marvel at a colon the size of cow, extracted from a man known only as the Human Balloon. Or, of course, peer into the face of Madame Dimanche, that French widow who one day began to grow a horn from her forehead, and whose wax model had so bewitched Mütter, he had carried it with him across an ocean. There, you will also find a woman dubbed the Soap Lady, her body having turned into a waxy soaplike substance after her death, freezing her small face in what looks like a perpetual scream. In the century and a half since Mütter's death, the museum’s collection has grown to include tumors cut from presidents, the jarred brains of madmen and geniuses, deformed skeletons displayed in delicate glass cases, Civil War surgical tools still caked in dried blood, and even the death cast of Chang and Eng Bunker, the famous sideshow act, a pair of conjoined brothers who inspired the term Siamese twins. All of this and more can be found under one roof, and all of it is watched over by the dashing portrait of one man: Thomas Dent Mütter. “Thus, in dying,” his old friend Dr. Joseph Pancoast (1805-1882) would say of the museum, “has he left a precious heritage to the profession.” mutter-cover
Excerpt from Dr. Mütter's Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine By Cristin O’Keefe Aptowicz

CHAPTER ONE: MONSTERS

Mütter knew that surgery was his calling, and raced through the streets of Paris to study the work of its greatest practitioners. He was aggressive in his pursuits, pushing through crowds to secure the best seats at the surgical lectures, or firmly staying as close as possible to the lecturing doctors as they made their rounds in hospital, no matter how much the other students pushed. Meals of spiced mutton and fresh bread went half-finished as he plotted the next week’s schedule. Bowls of café au lait were abandoned so he could make an early start every morning, eager to begin his day.

He had come to Paris assuming it would be the doctors themselves who would have the greatest influence on him, these men who were legends in their own time. Chief among them was Guillaume Dupuytren, who ruled over the Hôtel-Dieu, the city’s largest hospital, and single- handedly changed how surgery was done. An immensely brilliant operator, exhibiting marvelous dexterity, proceeding with almost inconceivable speed, his boorish arrogance became as famous as his accomplishments in the surgical room. Jacques Lisfranc de St. Martin was head of the Hôpital de la Pitié, the city’s second-largest hospital. He was Dupuytren’s greatest friend turned into his most bitter rival, and spent most of his life trying to escape Dupuytren’s shadow. Lisfranc was known to refer to Dupuytren as “the bandit of the river bank,” while Dupuytren frequently called Lisfranc “that man with the face of an ape and the heart of a crouching dog.” There was Philibert Joseph Roux — who so dazzled his classes with his graceful and brilliant work that it was said “his operations were the poetry of surgery,” but who had also earned Dupuytren’s scorn years earlier by winning the hand of the woman they both loved. And Alfred-Armand-Louis-Marie Velpeau, whose textbook on obstetrics was so influential, it had been translated into English by one of America’s most respected obstetricians: Philadelphia’s own Charles D. Meigs.

Mütter was deeply impressed with the audacity of each of these surgeons’ talents and their seemingly inexhaustible work ethic. However, it was not any single man who ended up changing the course of Mütter life but, rather, a new field of surgery freshly emerging in Paris, which even the French referred to as la chirurgie radicale.

Who sought out this radical surgery?

Monsters. This is how the patients would have been categorized in America. Mütter was used to seeing them replicated in wax for classroom display, or hidden in back rooms away from the public eye. He had seen them in jars, fetuses expelled from their mothers, irreparably damaged. monster, the label would read.

Some of these monsters were born that way: a cleft palate so severe the face looked to have been split in two with an ax. Hardly able to eat or drink, spit collected in pools on the child’s clothing as his tongue lolled around the open hole of his mouth, awkward and exposed.

Others were born “normal,” but their bodies would slowly turn them into monsters, as tumors laid siege to their torsos or limbs, swelling their legs like soaked wood, their eyes strained and nearly popping.

Other times, the monsters were man-made: men whose noses were cut off in battle, or as punishment, or for revenge, the centers of their faces evolving into a large weeping sore; women whose dresses caught fire, becoming houses of flames from which their owners couldn’t escape, the skin on their faces turned into melted wax, their mouths permanently frozen in screams.

Monsters. This is what they were called, and this was how they were treated. For such tortured people, death was often seen as a blessing.

In Paris, however, the surgeons had a solution. They called it les operations plastiques.

Was it quackery? Mütter wondered when he first heard about it. Was it a trick? Would these unfortunates be presented like a sideshow? Were the doctors in the audience there to learn or to gape? What could surgeons possibly do to help such hopeless cases?

At the very first lecture, Mütter began to understand the difference between regular surgery and les opérations plastiques.

The patient, often greeted with gasps of horror and pity, stood stock-still and unafraid as the surgeon made his examination. These regrettables didn’t show the unease normal patients did; their eyes didn’t wander back to the door from which they entered and through which they could also escape. Gradually, Mütter grew to understand why.

In regular surgical lectures, patients rarely understood the trouble they were in. When the knife first pierced the skin, they could come to the sudden realization that a life without this surgery might still be a happy one. Thus, escape was the best possible solution and a choice they wanted to exercise right away.

Patients of les opérations plastiques, however, were often too aware of their lot in life: that of a monster. It was inescapable. They hid their faces when walking down the street. They took cover in back rooms, excused themselves when there were knocks at the door. They saw how children howled at the sight of them. They understood the half a life they were condemned to live and the envy they couldn’t help but feel toward others — whole people who didn’t realize how lucky they were to wear the label human.

It was not uncommon for these patients to enter the surgical room fully prepared to die. Death was a risk they happily took for the chance to bring some level of peace and normality to their mangled faces or agonized bodies. The surgeries weren’t physically necessary to save their lives; rather, they were done so the patient might have the gift of living a better, normal life. That is what les opérations plastiques promised.

Plastique was a French adjective that translated to “easily shaped or molded.” That was the hope with this surgery: to reconstruct or repair parts of the body by primarily using materials from the patient’s own body, such as tissue, skin, or bone.

The surgeries, of course, were not always successful — if a patient’s problem had been so easy to fix, it would have been corrected by lesser doctors years ago. But other times — and these were the times the audience waited for, the ones that made Mütter’s hair stand on edge — the end result was nothing short of miraculous.

Published 4:00 am Thu, Sep 4, 2014

About the Author

Cristin O'Keefe Aptowicz is author of the forthcoming nonfiction book, Dr Mutter's Marvels: A True Story Of Intrigue And Innovation At The Dawn Of Modern Medicine. She is also the author of six books of poetry -- The Year Of No Mistakes (2013), Everything Is Everything (2010), Oh Terrible Youth (2007), Working Class Represent (2004), Hot Teen Slut (2001), and Dear Future Boyfriend (2000), as well as second book of nonfiction: Words In Your Face: Twenty Years Of The New York City Poetry Slam.

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