Dr. Mutter's Marvels
Page 7
Surgery on Nathaniel Dickey
If Mütter had chosen to look at them, he would have noticed their faces: mouths pursed, eyebrows gathered in concentration, eyes narrowed in half disbelief. Each one wanted to ask Mütter to stop, to slow down. Mütter’s ambidextrousness meant that he could do twice the work in half the time. The doctors grew dizzy and overwhelmed, unsure of which hand to follow, unsure how they would be able to replicate the surgery themselves when it seemed like quick, efficient chaos.
But Mütter paid them no heed. The only thing that could distract him from his work was the face of Nathaniel, which he monitored as a mother would—tracking each wince, each moan, each muffled cry. When Nathaniel’s body would quake uncontrollably under Mütter’s hand, he would remove all instruments and look into Nathaniel’s eyes. With Mütter’s hand gently placed in Nathaniel’s damp hair, he would feed him a small glass of cold water. Nathaniel gargled it, and spat. The pan turned red as it grew slick with blood.
And when Nathaniel was ready, Mütter returned to his work, his face calm and focused, clear and bright, almost happy.
After just twenty-five minutes, it was done. Nathaniel’s face, which just a moment earlier had been an open wound—bleeding, raw, and split—now was tenderly united, the silk thread straining at the incision sites, but holding. Nathaniel, exhausted and drenched in sweat, relaxed into the chair as Mütter walked backward, wiping his hands on a fresh towel.
The doctors were silent, still trying to process what they had just seen. The students sat back in their seats, their journals open and empty on their laps. What notes could they take that could capture what they had just witnessed? It felt as if perhaps they had been given a glimpse of the future, a sign that things were about to change.
But Mütter noticed none of it. Instead, he remained focused on Nathaniel. He stepped again toward the trembling young man, a small sponge in hand. He softly blotted the last remnants of blood from his newly reunited mouth, his hand firm and proud on Nathaniel’s shoulder. Where others once saw a monster, Mütter thought, he had revealed the man. And from under the handkerchief on the surgical table, he pulled one more hidden item: a small mirror, clean and shining. With one tender hand cupping the back of his exhausted patient’s head, he held the mirror in front of Nathaniel’s new and handsome face. Mütter smiled.
And Nathaniel Dickey, disobeying doctor’s orders this one time, smiled back.
CHAPTER SIX
CE QUE FEMME VEUT, DIEU LE VEUT AUSSI!
Woman Posed for Gynecological Examination
THE PHYSICIAN SHOULD ALSO BE A GENTLEMAN
The Dictionary tells us that a gentleman is one raised by birth, office, fortune, or education, above the vulgar. But surely such a definition is far from the truth.
To be a gentleman, something more is necessary than to have had a grandfather.
If fortune was the key to the sanctum of the gentleman, how many a knave, how many a swindler, how many an ignoramus, would find admittance and how many a true gentleman be excluded!
Nor does education alone make the gentleman, without being combined with good-breeding and good morals.
Perhaps I cannot better define the characteristic of gentleman than has been done by a most distinguished writer of our own country—Bishop [G. W.] Doane.
“A gentleman,” says he, “is but a gentle man—no more, no less: a diamond polished that was a diamond in the rough; a gentleman is gentle; a gentleman is modest; a gentleman is courteous; a gentleman is generous; a gentleman is slow to take offence, as being one that never gives it; a gentleman is slow to surmise evil, as being one that never thinks it; a gentleman goes armed only by a consciousness of right; a gentleman subjects his appetites; a gentleman refines his tastes; a gentleman subdues his feelings; a gentleman controls his speech; and finally, a gentleman deems every other better than himself.”
Of such, doctors should be made.
THOMAS DENT MÜTTER
The woman grimaced, her sex opened to the classroom full of young men.
“See this unobvious, apparently vile lump of animal texture?” Dr. Charles D. Meigs asked his collection of students, gesturing to the woman’s genitals. “Here, in the inner court of the temple of the body? How can you study this subject sufficiently?
“Women possess a peculiar trait—it is modesty,” he continued, as he walked over and firmly placed another pillow between the woman’s legs. “It is one of their most charming attributes.
“But scan her position in civilization, and it is easy to perceive that her intellectual force is different from that of her master and lord. I say her master and lord; and it is true to say so,” he continued as he casually repositioned the woman for the maximum exposure: moving her buttocks to the edge of the table, pushing her thighs at right angles to her quaking trunk.
“The great administrative faculties are not hers,” he continued. “She plans no sublime campaigns, nor leads armies to battle, or fleets to victory. In society, she is still in bonds, manacled by custom and politics. She composes no Iliad, no Aeneid. Do you think that a woman could have developed, in the tender soil of her intellect, the strong idea of a Hamlet, or a Macbeth? No.”
Meigs walked to the table, which displayed the tools of his trade: speculums and scalpels, tinctures and powders, a stack of handkerchiefs, and a large jar of properly starved leeches. He dipped his fingers in a bowl of olive oil and rubbed them slowly together as he looked back at the woman.
“Such is not woman’s province, nature, power, nor mission. She reigns in the heart; her seat and throne are by the hearth-stone. The household altar is her place of worship and service,” he said, walking toward her. She was staring at the wall in front of her, her hands balled on the thin cotton sheet.
“She has a head too small for intellect,” he said, stroking her hair but looking to his audience, “but it is just big enough for love.”
• • •
Dr. Meigs felt he knew what he was talking about.
He was the father of ten children, all with the same devoted wife, Mary. She not only survived each of the ten births but nursed all the children herself, and was so faithful to them throughout that, though several had most violent and prolonged attacks of illness during infancy and childhood, only one died. Her fourth son, William Montgomery, passed away at four and a half. The couple’s sixth son (and seventh child) would be named William Montgomery as well, in honor of the late child, a custom of the time.
Charles D. Meigs himself was the fifth of nine children and had received his unusual middle name, Delucena, from a Spanish gentleman to whom his maternal grandfather had become strongly attached during the Revolutionary War. Meigs’s own father had been the thirteenth and final child of his mother, Jane, who gave birth to him when she was forty-nine years old.
It came as no surprise that the Meigs men felt they knew a little something about women and birth, and Charles D. Meigs, in particular, felt it was his duty to share this knowledge with the world. It was his extraordinary gift to the world.
Meigs was an enormously popular and respected figure in women’s health during the mid-nineteenth century. Though he had lost the coveted position of chair of obstetrics at the University of Pennsylvania to Hugh Lenox Hodge (a talented doctor whose failing eyesight forced him out of surgery but for some reason seemed to pose no problem when it came to obstetrics and gynecology!), Meigs was still regarded as one of the leading voices in obstetrics.
Meigs believed that the field of gynecology and obstetrics was handicapped by the prejudices and false modesties practiced by women and encouraged by many religious leaders of the time. How were doctors 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 passi
onately that treatment others might view as curt and brutish—but he saw as efficient and gentlemanly—was often the quickest route between a foolish patient and the treatment the doctor knew was needed.
Charles Delucena Meigs
In his lectures, he would act out scenes for his students, illustrating brief exchanges he had had with his patients. In one exchange he recounted in his own textbook, a frightened patient told Meigs she’d “rather die” than be subjected to a manual gynecological examination by him. His response was simply to shout at her in French, “Ce que femme veut, Dieu le veut aussi!” The translation: “What a woman wants, God wants too!”
If Mütter represented a new, more empathetic vision of how doctors could treat patients, then Meigs was a perfect symbol of the dominant—and dominating—establishment. And these men had no reason to believe that their careers would be so intimately tied to each other. Until, of course, they were.
CHAPTER SEVEN
THE GREAT THAW
In Philadelphia, the year 1841 was born in ice. The last days of 1840 were spent in a torrent of hail, rain, and snow, and when dawn cracked against the cobblestone streets of Philadelphia on January 1, 1841, the city was frozen solid.
“It will, perhaps, long be remembered by the present generation,” wrote a historian of the time, “that in the year 1841, there was . . . no spring. Winter commenced on the 15th of November and continued until the 15th of May.”
It was during these relentlessly frozen months that the fate of Jefferson Medical College would be decided.
• • •
The problems plaguing Jefferson Medical College reached a tipping point in the late 1830s. McClellan, the mad genius who founded Jefferson Medical College a decade earlier, would face yet another battle—this time with his own school.
While his students, who warmly called him Mac, still adored him, the board of trustees of Jefferson Medical had grown tired of his antics. Unquestionably a brilliant visionary, McClellan still lacked two important requisites of great surgeons and great professors: judgment and patience. The casual frequency with which he jumped to conclusions, both personally and professionally, coupled with his uncontained temper and unmanageable tongue, led to frequent clashes inside and outside his own college.
The board had other concerns as well. Most recent years of the Jefferson Medical College were plagued with financial problems and it still suffered from continued harassment by the University of Pennsylvania. The board had also created problems for itself by hiring new faculty members who were just as eager to brawl as McClellan, including John Revere (the unruly son of patriot Paul Revere), Granville Sharp Pattison (whose nickname was the Turbulent Scot), and William Barton, whose open hostility toward other members of the faculty was expressed loudly and often through his legendary “Navy vocabulary.”
“[Dr. Barton]’s favorite epithet, almost constantly applied when speaking of one of the trustees, was so profane and abusive, that from regard to the highly respectable family of this trustee, I shall not mention it,” a shaken faculty member would later write in his memoir.
Jefferson Medical College had hired its faculty precisely because it wanted to be seen as embracing the “spirit of independent thinking,” but it did not foresee how this would translate into constant challenges between board and faculty, as well as near-constant clashes among faculty members themselves. When the board decided it had had enough and suggested that a major change must be made, McClellan aggressively resisted. He called the board “a parcel of politicians” and a “blackguard Board of Trustees,” before publicly announcing that Jefferson was “rotten and going to the dogs.”
But in his rashness, he failed to reckon with the power and stability of the board of trustees.
In 1838, the Jefferson Medical College board decided that the only course to take was to vacate all the chairs and to elect new professors. Current faculty members who still wanted to be a part of Jefferson Medical College were, of course, invited to place their names on the ballot for consideration. McClellan placed his name on the ballot to retain his position as founding chair of surgery, but when the final votes were tallied in July 1839, he didn’t make the cut. McClellan’s connection with the school he had fought so hard to found had come to an unceremonious end.
Even with the dismissal of McClellan and several other members of the faculty, the college continued to struggle. Two years later, when two faculty members decided to leave and one passed away suddenly, the board decided once again to take drastic measures and vacate all the positions for a second time.
The Jefferson Medical College board knew its institution was at a crossroads. The school, which was born from innovation and blazed a new path in medical education, had been slowly strangled by the same faculty who had once brought it such pride. They knew they needed to hire new faculty, but this time, they tasked one of their best remaining faculty members, Robley Dunglison, to scout out the best candidates.
Dunglison had earned his nickname, the Great Peacemaker, by holding the college together in spite of all the explosive personalities who were happily tearing it apart, and he was tasked with rebuilding the school’s lineup yet again. It was not easy. The city was teeming with talented doctors eager to live and work in the prestigious spotlight that a faculty position at Jefferson Medical College afforded, but more than just their skills would need to be considered this time around. Dunglison was asked not only to bring together the most innovative minds in medicine, but also to ensure that the gentlemen hired could form a harmonious family of professors. Nonetheless, the whole city of physicians wanted to be considered, and rumor had it that among those jockeying for a spot were the stalwart Charles D. Meigs and a newcomer by the name of Thomas Dent Mütter.
• • •
By the end of an ice-covered March, Dunglison had come up with his list, which he hoped would mark the dawn of a new era at Jefferson Medical College. He offered the list up to the Jefferson Medical College board for their ultimate vote on April 2. On the list were some of the city’s best-known doctors.
For some chairs, the decision about who should fill them was easy. Dunglison was able to present the one name he considered the best, and the board unanimously agreed with his choice. But for other chairs, like those for surgery, anatomy, and chemistry, there was serious competition.
It came as little surprise that Charles Meigs would be nominated for the chair of obstetrics. He spoke six languages, had a popular practice in Philadelphia, and was already the author of two wildly acclaimed books on women’s medicine. His first, a bestselling translation of An Elementary Treatise on Midwifery by the famous French anatomist and surgeon Alfred-Armand-Louis-Marie Velpeau, proved so successful that a second edition was issued just in time for Meigs to publish his first independent work, The Philadelphia Practice of Midwifery, which also became a big seller. In print and in practice, Meigs was swiftly becoming his country’s leading authority on women’s health. As a lecturer, he earned even more raves.
“Meigs possessed all the requisites for success upon the stage—remarkable powers of mimicry, great enthusiasm, and a strong perception of the ludicrous. In the lecture-room, he was the best actor I have ever seen,” a contemporary once wrote of him, “and it is deeply to be regretted that there are not more of such teachers in the amphitheatre, especially in the afternoon, when the student, exhausted by the fatigues of the day, finds it difficult to keep awake.”
Of course, what student could sleep when being lectured on such topics as the difference in appearance between genitals of virgins and those who had given birth (Meigs described the labia of virgins as being plump, with a “rose tint,” while those who had borne children have labia “bluish” and “shriveled or collapsed in appearance, except with fat persons”), as well as the proper treatment of abscesses on the labia (Meigs strongly recommended bleeding the woman from the arms, using small sharp razors, before applying leeches d
irectly onto her genitals).
The board of Jefferson Medical College elected him as chair of obstetrics unanimously.
Joining him would be Dunglison himself, since he had forwarded his name for the chair of Jefferson’s Institutes of Medicine and Medical Jurisprudence. This was not an act of hubris. The British-born Dunglison made his name in the 1820s and 1830s, when his seminal medical texts established him as the “father of American physiology,” and his long residence in the South had enabled him to act as the personal physician for both Thomas Jefferson and James Madison. The Jefferson chair was created specifically for him, in what would prove to be a successful attempt to lure him north. It would be a position he would hold for over a third of a century, and he would be so dedicated to it that he wouldn’t return home to his native England for thirty years. When he finally did, his elderly mother—“still a fine-looking old lady, dressed in the old style, wearing a turban” though now suffering from dementia—could not remember him.
“This, it need not be said, was a great disappointment to Dr. Dunglison,” a former student would later recall, “but he showed much equanimity and delighted to talk with her by the hour of by-gone days . . . she would generally conclude [their conversation] by saying to him, ‘So you have seen Robley? He was the best boy that ever was . . . ,’” as her afflicted mind was unable to marry the memories of her young son with the old man who sat before her.