Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  A Single Clothing Bill for a Sixteen-Year-Old Mütter

  But there was something within Thomas that compelled him to want to see the world outside of Virginia. He even convinced the initially reticent Colonel Carter to support his decision to spend a semester at Yale, a college of growing reputation located in the northern city of New Haven, Connecticut. But this adventure proved to be disastrous as Thomas’s weakened health came into immediate odds with the frigid northern winter. He was eventually sent home when none of the Connecticut doctors could stop him from coughing up blood—but not before he ran up outstanding bills with a tailor and a shoemaker, which Colonel Carter would again be contacted to pay.

  Thomas risked Colonel Carter’s ire one last time when, instead of returning to college after leaving Yale, he decided to spend time in Fredericksburg and Alexandria, places where his family once lived, again without Colonel Carter’s permission. But it turned out to be a wise choice.

  Thomas’s family still had connections in that area. He was able to meet with knowledgeable and helpful doctors who agreed to help the troubled seventeen-year-old, the grandson of their long-dead friend, Dr. James Gillies. The news from these consultations was not reassuring—Thomas would be too ill to return to college anytime soon, they advised, and this unsettling condition would likely plague him for the rest of his life.

  Thomas took the news with fortitude and equanimity, impressed with and grateful for the doctors who analyzed his situation with speed, and gave him advice with honesty and clarity.

  It proved to be a watershed moment for Thomas. He suddenly realized what he wanted to do with his life: to study medicine and become a compassionate, trustworthy, and humanistic doctor like these men were.

  Though he knew that Colonel Carter was upset with him and his erratic behavior, he felt compelled to write him immediately with the news:

  My dear Sir

  Owing to your short stay in the District, I was unable to have any conversation with you concerning my future course of studies. My present ill health will I am afraid prevent my returning to College, at all events for some time. I have therefore with the advice of several of my friends determined to study Medicine, which course I hope will meet with your approbation. I propose studying with Dr. Semmes of Alexandria. I feel I had best study here as my expenses would be much less than in any other place. You will perhaps say that study is study in whatever way one may pursue it, but you must recollect that there is a very great difference between a college life, which requires you to be up both late and early, and the life of a student of medicine. I should like therefore to commence as soon as I am a little better for my time is very precious and I wish to be able to commence practice by the time I am twenty-one. And I do assure you if you will give your consent to this plan and assist me with your counsel and friendship you shall have no cause to repent; and although you have been led to think rather too harshly of me, yet, I hope it is all forgotten and that you will be to me, as I have every reason to suppose you were before, my sincere friend.

  THOMAS D. MUTTER

  • • •

  Colonel Carter gave his support, and nearly a decade later—after graduating from the best and oldest medical school in the country, and after much studying under the most impressive doctors in the United States and Europe—Thomas Dent Mütter became a doctor. One who was now floundering in his always empty office in Philadelphia.

  Colonel Carter supported his dream of being a doctor, just as seventeen-year-old Thomas had hoped. It was a dream to which Mütter had been so enthusiastically and devotedly focused that every financial request he made of Colonel Carter was met with generous response, as the guardian grew more and more impressed with the actions of his young ward.

  But now that Mütter’s extensive schooling was over and he had officially “come of age,” Colonel Carter felt it was time for his generosity to be withdrawn and for Thomas to stand on his own. With that news, Mütter knew the safety net that Carter’s resources and name provided was vanishing. And Mütter’s own already strained funds were swiftly being depleted by the incredible upkeep of his office and lifestyle.

  Mütter felt he could do nothing but sit frustrated in his empty office and watch as other doctors in the city used the currency of their well-known and well-connected family names to secure their first patients. From the beginning, Mütter knew his success would have to depend on his own efforts alone, but even he was not prepared for how difficult it would truly be. How was it possible that he was able to endear himself to respectable figures in France, where haughtiness and disdain were almost an art form, and yet it was such a struggle here?

  When 1834 arrived in typical frigid Philadelphia fashion, Mütter found himself in feeble health. Worried his condition would deteriorate in Philadelphia’s cruel winter, he decided the best course of action would be to temporarily close his practice and make an extended visit to one of Virginia’s famed health spas. There he could do some thinking about what he should do about his situation.

  Mütter chose a spa in Monroe County (in what would later become West Virginia) and was drawn in by the promise of warm weather and familiar foods. But he was also more than a little curious about the spa’s claims for the healing qualities of their saltwater springs. While most doctors agreed that the warm humid air of the South encouraged the body to heal itself quicker—especially when it came to ailments of the lungs—than the dry and bitterly cold air of the wintry North, many spas took it one step further and claimed that dipping in their saltwater or sulphur springs could cure a person of disease. Mütter was eager to investigate.

  In a fateful twist, Mütter was also able to make some extra money in the weeks he spent at the spa, by using his charm to develop a sizable practice among the spa’s clientele. While his own besieged body slowly healed, Mütter was able to slightly rebuild his beleaguered finances and collect material for what he hoped would be an insightful article on “watering spas” and whether they deserved the considerable confidence certain segments of the medical profession (and larger segments of the greater population) had in their healing properties.

  • • •

  However, when Mütter returned to Philadelphia, he realized he had more pressing issues than writing the article. He had spent a year trying to establish himself as a reputable doctor in the City of Brotherly Love, with very little to show for it. Mütter saw only one solution: He would shutter his practice, leave Philadelphia for good, and return to Paris, where he felt he would have excellent prospects of success.

  While he had been studying there, he had noticed there was not a single English or American physician actively working, despite the constant influx of American and English-speaking visitors. And Mütter thought that, because he had formed such associations and acquired such favorable influences during his residence in Paris, and was proficient in both French and German, he could likely anticipate receiving the patronage of the English, American, and German tourist as he developed his reputation with the French. Considering all of this, Mütter began to feel foolish for even considering staying in Philadelphia.

  A doctor whom Mütter had first met at the University of Pennsylvania, Samuel Jackson, asked him to wait. Jackson was an assistant to one of the medical college’s best-known professors and had met Mütter when he was a bright, eager but puckish student (the subject of Mütter’s doctoral thesis was “Chronic Inflammation of the Testis”). Even then, Jackson believed that Mütter had extraordinary potential.

  Jackson asked that Mütter give Philadelphia one more year.

  “If at the end of that time the prospect should then seem no brighter,” he offered, “return for a permanent residence in Paris.”

  However, this additional year would be different. Instead of attempting to establish himself by starting his own practice, Mütter would agree to work as an assistant to the popular, and increasingly sickly, Dr. Thomas Harris. Harris was a teachin
g surgeon at the summer school of medicine, the Medical Institute, and Jackson sensed that Mütter might have a chance of establishing his reputation in Philadelphia if he aligned himself in this way—not just as a surgeon, but as a teacher too.

  It wasn’t clear if that was the path Mütter wanted to take, but he decided to accept the challenge Jackson offered.

  And with this decision, Mütter’s fate became forever entwined with the chaotic, turbulent, and cutting-edge history of Philadelphia’s medical schools.

  CHAPTER FOUR

  THE MEDICAL ATHENS OF AMERICA

  The Medical School of the University of Pennsylvania

  THE PHYSICIAN SHOULD POSSESS SELF-RESPECT

  In no profession, probably, does a man more need the possession of this truly honorable attribute.

  The very nature of his avocation, which places him at the beck and call of every one, tends to diminish his self-respect; and the desire to please all drags him still lower.

  Bear always in mind who you are and what your office is, and determine never to add another to the disgraceful herd.

  THOMAS DENT MÜTTER

  It could rightfully be said that medical education in America was born in Philadelphia.

  The University of Pennsylvania School of Medicine became the first and only medical school in the thirteen American colonies in the fall of 1765, making the school more than a decade older than the country in which it was founded.

  Prior to its existence, all serious American aspirants toward the medical profession were compelled to go to Europe to complete their education.

  But the medical school at Benjamin Franklin’s own University of Pennsylvania made it possible for American students to study “anatomical lectures” and “the theory and practice of physik.”

  To earn a medical degree in these early years, a student had to: attend at least one course of lectures in anatomy, materia medica (now known as pharmacology), chemistry, and the theory and practice of physik (the art of healing, or medicine); attend at least one course of clinical lectures; study for one year under the doctors working at the Pennsylvania Hospital; be examined privately by medical trustees and professors; and, finally, be examined publicly.

  It should go without saying that in addition to being at least twenty-four years of age, the student would also need to be both white and male. Being white and male, of course, were the two main prerequisites for successfully undertaking most any profession at this time.

  But even from the beginning, the Philadelphia school earned a reputation for attracting the brilliant and the strange. Dr. John Morgan, who founded the medical school at the University of Pennsylvania in 1765, was regarded as “something extra among the people,” and was seen as possessing “some of the eccentricities of genius.” He was known in the city for being the first male public figure who ventured to carry a silk umbrella in Philadelphia (then “a scouted effeminacy”), but he was also credited with being the first doctor to send his patients to an apothecary—a person whose profession was the preparation and selling of medicine—instead of feeling responsible for creating and distributing the various herbs, tinctures, and salves himself.

  In his first public address about his vision for the school, Morgan said, “Perhaps this Medical Institution (the first of its kind in America), though small in its beginning, may receive a constant accession of strength and annually exert new vigor. It may collect a number of young men of more than ordinary abilities, and so improve their knowledge as to spread its reputation to distant parts, and, by duly-qualified alumni, may give birth to other institutions of a similar nature.”

  This statement proved prophetic. For sixty years, the University of Pennsylvania was the defining medical institution for Philadelphia. By 1825, Philadelphia’s population had exploded to over 138,000 people; more than 1,000 of these citizens were medical students. Not all of these students attended the University of Pennsylvania, where the total medical school population of closer to 500 packed into the undersize classrooms and lecture halls, to the students’ growing discomfort. Every physician had private students who apprenticed under him, and this tradition continued even after other schools opened. But what the students learned through these apprenticeships was not standardized. Students who came to Philadelphia because of its reputation as America’s medical center could not be guaranteed a slot in a medical school, nor could they be assured that the doctor under whom they studied was teaching them information that was up-to-date, or even correct.

  Additionally, many in the community began to be more critical of how the University of Pennsylvania was being run. There was criticism of its cramped classrooms and overstuffed student rolls; accusations of favoritism in filling its department chairs and teaching positions; criticism of the faculty’s recent duplicitous practice of operating private schools that would then feed into the university’s medical school, ensuring that they could collect double the fees for teaching their classes; and most damning, an air of infallibility when it came to their opinions, which was not at all in keeping with scientific progress.

  It became obvious to some in the community that “for Philadelphia to retain her position as the medical Athens of America,” another major medical school in the city was needed.

  Philadelphia at that time could have supported several colleges with the medical talent within its city limits. Several physicians in the city were popular enough to necessitate the building of personal lecture rooms connected to their offices. But the University of Pennsylvania—not wanting any competition to their obvious monopoly—was always quick to downplay such claims. And as the call for more medical schools grew louder, the University of Pennsylvania would use its political power to thwart any attempt to start a new school and, furthermore, would ostracize any doctor who didn’t share its belief that Penn should be the only medical school in Philadelphia.

  Several efforts to establish a second medical school were made in the 1810s and early 1820s, but all efforts to obtain a charter from the state legislature were unsuccessful.

  This would all change in 1824, when the irascible Dr. George McClellan’s ongoing quarrels with the University of Pennsylvania’s Medical Department resulted in his leaving to found his own school: Jefferson Medical College.

  George McClellan had received his medical degree from the University of Pennsylvania in 1819 and yearned to be one of the “duly-qualified alumni [who] may give birth to other institutions of a similar nature,” of whom the medical school’s founder John Morgan had spoken fifty years earlier.

  McClellan was a brilliant physician, a true natural who saved a man’s life before he even entered the medical school by fully amputating a leg that was almost completely severed, “swiftly stopping the hemorrhage” and instinctively leaving enough skin to make flaps for the stump. As a teacher, he was popular, a persuasive and forceful speaker with “a resounding voice that bespoke authority.” His ability to attract all kinds of people to his lectures—students, practitioners, and laymen—led him to be one of those Philadelphia doctors who needed their own lecture hall.

  But he was also extremely erratic and temperamental.

  “Some of his best friends indeed would say that [McClellan] was impolitic, and unwise, and, at times, even inconsiderate and imprudent,” a peer would later write.

  He thought of himself as an excellent judge of character and wasn’t shy in expressing those opinions. A bombastic figure, he was even known to heckle other surgeons while they were performing surgical lectures. His friends attempted to explain his galling behavior as simply the “sans ceremonie and en avant spirit” of his “sleepless genius.”

  George McClellan

  “In public, he was inconsiderate and irregular,” his friend explained, because “alone, he was the grave, profound Philosopher.”

  When McClellan’s repeated attempts to obtain a charter for a second school failed, the sly McClellan
channeled his rage toward simply circumventing the issue. Instead of wasting time and energy fighting the city for the permission to found a brand-new school, he instead coordinated with Jefferson College in Canonsburg, Pennsylvania, to simply establish a medical department of that college in Philadelphia.

  Canonsburg’s Jefferson College was founded a half century earlier and had earned a prominent place as a literary institution. It proudly laid claim to “a respectable contingent of educated intellect to our country . . . spread all over this land, engaged in the various departments of trade and manufactures, in agriculture, statesmanship, in the professions of law, medicine, and theology, and in establishing and conducting other seminaries of learning.”

  McClellan knew that while the University of Pennsylvania might find it easy to squash the ambitions of one man, it would be tougher to deny such a respectable and established institution—which prided itself “in extending the benign influences of sound learning and an elevating morality”—from the same opportunity.

  And it worked.

  Much to the chagrin of the University of Pennsylvania—which had remained unrivaled in the city for well more than a half century—Jefferson Medical College became the city’s second such institution in 1824.

  But getting the school started was a tricky endeavor. While Jefferson had been able to secure a talented faculty, they did not have an endowment or any buildings in which to teach. McClellan rented the Tivoli Theater on the south side of Prune Street and remodeled it as best he could to fit a college setting. He also had the school’s top three professors—including himself—give public demonstrations and lectures every day and night until the school opened, to help advertise the merits of the new school to the medical students arriving in the city every week.

  It proved a successful gambit. The first class numbered an impressive 107, with 20 graduating at the end. The faculty and founders were highly satisfied with its first session, which they had considered to be only “an experiment.”