Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  When the sea was calm and the sky bright and blue, he forced himself to stand on the ship’s deck and look toward what he hoped was Europe. He tried to enjoy these moments, but he didn’t know true relief until the crew pointed out birds appearing in the sky, a sign that they were approaching land, after more than a month at sea.

  • • •

  When Mutter finally arrived in Paris, it immediately reminded him of the ocean; it too was vast and wild and incredibly loud. Unlike at sea, however, in Paris he felt perfectly at home.

  Its streets were packed, people and buildings in every direction. His world was suddenly and delightfully filled with new sounds, new scents, new music. There were colorfully dressed women sweeping the streets, and strapping men carrying enormous bundles on their heads. There were strange-looking carriages that seemed like relics of a barbarous age, which were in turn being pulled by enormous and brash horses. Even the food being eaten at street-side cafes seemed strange and exotic to Mutter. The city avenue was a vast museum of wonderful new sights to gawk at, and it seemed that the French wanted it that way. They loved to look, and to be looked at. It was true what Mutter had heard: Those French who could spare the time would flamboyantly promenade every day. And on Sundays, absolutely everyone did.

  Once Mutter had secured modest student housing, he set out to promenade himself. He’d been sure to pack his finest clothes for the journey: suits cut close to his slim frame (his natural thinness being perhaps one of the only benefits he’d gained from the illnesses that had plagued him since childhood) and made from the most expensive fabrics he could afford in the brightest colors in stock. Years earlier, a schoolmaster once wrote to Colonel Carter, Mutter’s guardian, that his pupil’s “principal error is rather too much fondness for a style of dress not altogether proper for a boy his age.” Clearly, that schoolmaster had never been to Paris.

  Mutter enjoyed the moment, peacocking on Parisian streets for the first time, a master of his fate. The lines between Mutter’s starting points and his destination were not often straight, but he took pride and comfort in knowing that he always got there. And the next morning, he would begin the next phase of his mission, his true goal in Paris: to learn everything he could about modern medicine until his money, or his luck, ran out.

  • • •

  In 1831, over a half million people called Paris their home, and by royal decree, each French citizen was entitled to free medical treatment from any of the dozens of hospitals within the city limits. The hospitals were typically open to any visiting doctors, provided one could show them a medical degree and, when necessary, place the right amount of coins into the right hands.

  Studying medicine in Paris became so popular that guidebooks were written just for the visiting American doctors. Nowhere else in the world, one wrote, could “experience be acquired by the attentive student as in the French capital . . . where exists such a vast and inexhaustible field for observation . . .”

  Woman with Ulcer of the Face

  And it was true. Where else but Paris would there be not one but two hospitals devoted entirely to the treatment of syphilis? Afflicted women were sent to the Hôpital Lourcine, a hospital filled with the most frightful instances of venereal ravages. The men were sent to the Hôpital du Midi, which required that all patients be publicly whipped as punishment for contracting the disease, both before and after treatment.

  Hôpital des Enfants-Malades was a hospital for ill children, and was nearly always filled to capacity. It had a grim mortality rate—one in every four children who came for treatment died there—but the doctors on staff assured visiting scholars that this was because most of the patients came from the lowest classes of society and thus were frequently brought to the hospital already in a hopeless or dying condition.

  Doctors specializing in obstetrics could visit Hôpital de la Maternité. It served laboring women only, and averaged eleven births a day. Some days, however, the numbers rose to twenty-five or thirty women, each wailing in her own bed, as the doctors and midwives (called sages-femmes) rushed among them. New mothers were allowed to stay nine days after giving birth, and the hospital even supplied them with clothing and a small allowance, provided they were willing to take the child with them. Not all of the women were.

  So the Hôpital des Enfants-Trouvés for abandoned children was founded. Newborns arrived daily from Hôpital de la Maternité from women unable or unwilling to keep their children, as well as those infants whose mothers died while giving birth, as one in every fifty women who entered Hôpital de la Maternité did.

  The Hôpital des Enfants-Trouvés also allowed Parisian citizens to come directly to the hospital and hand over a child of any age. The hospital encouraged families to register and mark the children they were leaving so they might reclaim them at a later date, but the families who chose to do so were few. In fact, the vast majority of the children there had arrived via le tour.

  Le tour d’abandon (“the desertion tower”) was merely a box attached to the hospital, constructed with two sliding doors and a small, loud bell. An infant was unceremoniously placed in the box, the door firmly closed behind it, and the bell was rung. Upon hearing the bell, the nurses on duty would go to le tour to remove the infant, replace the box to its original position, and wait. Every night, a dozen or so infants were received in precisely this way.

  For a while, it had been in vogue for wealthy, childless individuals to adopt children from the Hôpital des Enfants-Trouvés to bring up as their own, but the practice had long since fallen out of fashion. At the time of Mutter’s visit, more than sixteen thousand children were considered wards of the Hôpital des Enfants-Trouvés, and of those, only twelve thousand would live to adulthood.

  There were hospitals for lunatic women and for idiot men, hospitals for the incurable, for the blind, for the deaf and dumb, and even for ailing elderly married couples who wished to die together—they could stay in the same large room provided that the furniture they used to furnish their room became the property of the hospice upon their deaths.

  And perhaps most astonishing to the visiting American doctors, Paris had the École Pratique d’Anatomie, which provided any doctor, for six dollars, access to his own cadaver for dissection. In America, cadaver dissection was largely illegal. Many doctors resorted to grave robbing to have the opportunity to examine the human body fully. In Paris, twenty doctors at a time would whittle a human body down to its bones—provided they could stand the smell and the ultimate method of disposal of the dissected corpses: At day’s end, the decimated remains were fed to a pack of snarling dogs kept tied up in the back.

  However, more than any single hospital, what most attracted Mutter to Paris were the surgeons: brilliant and daring men who were to him living gods, redefining medicine and at the zenith of their renown.

  • • •

  Mutter had always loved surgical lectures and made sure he secured seats as close to the front as possible. In Philadelphia, there were two great medical colleges—the University of Pennsylvania and Jefferson Medical College—and it was customary for the rival schools to hold surgical demonstrations so that prospective students could choose between them, a glorified public relations exercise. Mutter loved the daringness of the surgeries attempted during this time. The lectures were often packed, as eager established and prospective doctors thrilled at the city’s best surgeons attempting to outdo one another with their skill and showmanship. However, the combination of ambitious surgeries and unprepared young men sometimes proved disastrous. On one occasion, a Jefferson Medical College professor attempted a daring removal of a patient’s upper jaw, using marvelous speed to incise the face and rip out the bones with a huge forceps. But the surgery was perhaps too much for a public display. Doctors who were present would later recall the spectacle of it, how the partially conscious patient spat out blood, bones, and teeth, while unnerved students in the audience vomited and fainted i
n their seats.

  But regardless of how brutal or simple the case, all surgical lectures were a challenge to watch. The anxious patient would be publicly examined and forced to listen to his surgery loudly outlined to an audience of strangers. Next, the patient would nervously drink some wine with the hope that it would dull the nerves and lessen the pain. (In Paris, the need for medicinal wine was so great, the hospital system maintained its very own wine vaults, spending more than 600,000 francs a year on an extensive collection of red and white wine housed exclusively for its patients.)

  The patient was then instructed to lie on the surgical table, where he would be held down by the surgeon’s assistants and told to stay as still as possible. Everyone—the patient, the doctor, even the students in their seats—knew how impossible this command would be to follow.

  The first incision usually brought the patient’s first scream—the first scream of many. Soon came the blood, the struggle, the shock. The patient would beg the surgeon to stop, plead and shout, and yell to the students to come save him, his voice cracking, tears streaming down his face. The surgeon was expected to ignore it all, to move forward swiftly and surely, and to hope that his assistants were strong men with equal resolve. Every student had heard stories of patients who were able to struggle free, who leapt off the table and attacked their doctors—often with the surgeon’s own instruments!—before running out of the room, leaving a trail of their own blood behind them.

  Man with Tumor of the Jaw

  To Mutter, ignoring the patient was one of the most difficult parts of surgery. He struggled to develop the ability to temporarily see past the patient’s pain—their wide and desperate eyes—and focus solely on his goals as the surgeon.

  It had always been explained to him that the most important quality of a good surgeon is confidence, born of both education and experience. You needed to know you were right and that your actions were right, regardless of what was happening around you. Mutter understood this, but in the moment, it was often still a difficult instruction to follow.

  Of course, in spite of the skill and care of the surgeon, the patients often died. Sometimes they died in the middle of surgery, the trauma to their bodies becoming too much. Sometimes they would die after, because their wounds were unable to stop bleeding, or the unwashed tools of their own surgeon had given them a fevered infection that consumed their flesh from the inside out. Under the best circumstances, the patient not only lived but lived a better life.

  And it was this opportunity to improve a life that caused Mutter to be deeply attracted to studying surgery. Having spent so much time as a patient when he was a child—being bled by lancet or by leech, fed tinctures and bitter weeds, left to sweat it out alone in his bed or soaked in a special bath—he was perhaps too familiar with other, nonsurgical branches of medicine, where recovery was often a guessing game. Sometimes, the relief would be almost immediate once treatment had begun, but more often, the results were undefined, his chest rattling for weeks, his body left to grow gray and thin.

  Surgery, however, was not a guessing game; it was an art. People came in need of relief, and the surgeons used every ounce of their skill and knowledge to provide it.

  • • •

  There was one more reason Mutter revered surgery above all other medical pursuits. Surgeons, unlike other professionals of the medical field, were successes of their own creation. While other doctors found their patients—and their positions in society—based on the family they were lucky enough to be born into, surgeons earned their place through hard work, study, and skill. In fact, it seemed to Mutter that the best surgeons came from the lower or middle classes. It was a “natural consequence of this state of things,” one doctor from the era wrote, seeing that “very few persons entitled by birth or other advantageous circumstances . . . would condescend to study, much less engage in the practice of medicine,” thus “poor and ambitious young men from the provinces were induced to repair to Paris and enter upon the study of the only profession through which they could expect to obtain distinction and worldly prosperity.”

  It was well known that several of the best-respected surgeons and physicians in France had risen from the lowest castes of life and many from the uttermost depths of poverty. Even the acclaimed chief surgeon of Hôtel Dieu, Guillaume Dupuytren, who was often referred to as the Emperor of Surgery, had been born poor and had struggled. Furthermore, he was not ashamed of it, but rather credited his background with his success, telling his students that “had not Monsieur Dupuytren been compelled from poverty to trim his student’s lamp with oil from the dissecting-room, he never would have succeeded in becoming Monsieur le Baron Dupuytren.”

  • • •

  Mutter 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.

  Mutter 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 Mutter’s 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?

  Woman with Severe Burns of the Face

  Monsters. This is how the patients would have been categorized in America. Mutter 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, beco
ming 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 opérations plastiques.

  Was it quackery? Mutter 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, Mutter 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, Mutter 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.