Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  “He made anatomy so plain,” a peer once wrote of him, “that the dullest pupil, if at all attentive, could not fail to be enlightened.”

  As a physician and surgeon, it was said that Pancoast had one flaw—and it was perhaps this defect that kept him from retaining his position as Jefferson’s chair of surgery: He was a poor pathologist. That is, when he was presented with an ailing patient, one could not be assured his diagnosis of the problem would be correct. It was a poor weakness to have when a person’s life was at stake.

  Still, once a diagnosis was correctly made, Pancoast’s skills at surgically resolving the issue were nearly unrivaled.

  “Pancoast, the dexterous, the dramatic,” a former student gushingly wrote about watching his professor at work in the operating room, “with a hand as steady as a rock, but as light as a floating perfume; with a heart that was a stranger to fear, and with an eye as quick as a flashing sunbeam.”

  Joseph Pancoast

  As the only faculty member whose chair had been usurped—let alone usurped by the faculty’s youngest and most inexperienced member—it had been uncertain what relationship, if any, Pancoast and Mütter would have.

  But it turned out they were admirers of each other’s work and shared similar senses of humor, similar values, and similar aspirations for moving forward the art of surgery. Soon, they began to visit each other’s lectures and, perhaps most amazing of all, calling upon each other for assistance in the operating room. And Pancoast began to publicly appreciate Mütter’s unorthodox but crowd-pleasing style of teaching.

  “You have but just now listened to a lively and instructive lecture from my friend and colleague the Professor of Surgery,” Pancoast told a class of students still settling down from their latest lecture with Mütter, “and I trust you have been so well entertained and put in so good a humor as to listen at this late hour of the evening, with patience and with kindness, to that which I have now the honor to address to you.”

  While other doctors may have held a grudge or let awkward tension drive a wedge between them, Mütter and Pancoast chose to “work in seemingly perfect harmony” and a lifelong friendship was forged.

  “Mütter and Pancoast, Pancoast and Mütter,” a former student would write, “each striving to assist the other [in] the alleviation of human suffering, the welfare of the surgical clinic, and the advancement of the honor and renown of the Jefferson Medical College.”

  • • •

  However, not everyone in the medical community was so welcoming to the young, eccentric Mütter.

  Some felt that his type of clinical instruction should be denounced and “sneered at.” They accused it of being imperfect, insufficient, and unrealistic, and alleged that Mütter was conveying a false impression of what a doctor’s role should be. They criticized his lectures, saying that his lessons were designed to theatrically mislead rather than instruct.

  Some were openly disappointed in Jefferson Medical College for even hiring him, a neophyte who they felt was not the best surgeon, nor the best teacher, and whose contributions to surgical literature were completely lacking.

  His critics would rail that the adoration of his students had more to do with “his personal attractions, features, voice and bearing” than his skill or merit, and bitterly accused him of “playing for popularity” in his lectures.

  “In no period in our medical history was rivalry so marked with jealousy and unfairness,” a peer noted. “Medical lore and literature contain ample evidence of the personal abuse and criticism which medical men showered upon one another and of the acrimony which characterized the discussion and unwarranted jealousy that we have in America.”

  And as it turns out, one of Mütter’s biggest critics could be found among his fellow members of the Jefferson Medical College faculty.

  • • •

  Charles D. Meigs had waited his entire career to become the chair of obstetrics at a nationally renowned medical college. Twenty-five years after moving to Philadelphia as “a Varginny student”—what Philadelphians charmingly called any medical student whose accent gave away his Southern roots—he felt this appointment gave him the first opportunity of showing fully what was in him.

  Meigs’s original dream had been to return to the South after graduating, to serve as a glowing example of American medicine down there, but his wife, Mary, derailed those plans. Mary had always lived in what Meigs saw as the sheltered North, and she was horrified by some of the brutal scenes that were commonplace in slave states: public auctions where wailing mothers were torn from their children; freshly beaten slaves whose wounds leaked through their tattered clothing; an entire culture that was utterly comfortable in treating their fellow human beings like chattel. Unable to stomach it any longer, she insisted under no certain terms that they return to the North at once.

  Her ultimatum would prove fortuitous for Meigs. Once appointed to its influential faculty, he threw himself into being a Jefferson Medical College professor with the greatest ardor, studying all the literature he could about obstetrics and women’s health in all six languages that he spoke and read.

  “He took great pleasure in his lectures during the first years that he occupied the chair,” his son would later recall. “They were a constant and agreeable stimulus to his mind, and, being new ground for him, broke into the tedium of his daily routine work among the sick.

  “Being thoroughly versed in all his subjects, and having a most active mind and lively imagination, which readily felt the stimulus of large classes and a sympathetic audience, he was roused to efforts which this new field alone served to bring forth,” he continued, “and to show to himself and to others what latent powers he had.”

  But while Mütter and Meigs shared a passion for their new roles, their approaches to medicine and teaching could not have been more different. It didn’t take long for the simplest things to cause discord between them.

  While Mütter taught his students to spend days slowly desensitizing the parts of a patient’s body that would be subject to surgery, through gentle touch and massage, Meigs taught that one shouldn’t “bother too much” when it came to patients’ comfort, instructing them 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 [is] ready.”

  Though the concept of sepsis—the idea of diseases being spread by doctors through contaminated tools and unwashed hands—would not be widely accepted for four more decades, Mütter seemed to understand the dangers of doctors not keeping their hands, clothing, tools, and surgical areas clean.

  Though antisepsis was not a term or concept used at the time, Mütter was known to be very “clean” in his technique and worked under “as near an aseptic technique as was possible at the time.” His diligence continued after the surgery as well. At a time when the use of poultice—a moist, warm porridge of meal and seeds—to seal wounds was still very popular because doctors were unaware that they were providing a near-perfect breeding ground for bacteria, Mütter spoke out against this “filthy abomination.” Instead, he encouraged his students to use a “mild, clean, and simple warm water dressing” to aid in healing open surgical wounds.

  Charles D. Meigs did not share Mütter’s views on the subject of doctorly fastidiousness. At his popular obstetrics practice, Meigs saw numerous women throughout the day and thought nothing of examining each one using largely unwashed equipment, including his own unwashed hands. A simple rinse with water—if he believed it was needed—was sufficient for Meigs when it came to his hands, tools, and sponges. He wore a single work frock until the end of the day, regardless of how many patients he saw and no matter how stained it might become with blood, pus, or other fluids.

  He vigorously and publicly disagreed with those who believed that diseases were spread by doctors, and refused to give in to thos
e who insisted on aggressive washing of hands and tools. Meigs felt that doing so would imply that “doctors were not gentlemen” because “all gentlemen were clean men.”

  It seemed an odd stance to take in a city that had been—and continued to be—terrorized by infectious diseases. But Meigs had reason to feel confident in his opinions, considering his professional history. After all, when the cholera epidemic hit Philadelphia in 1832, Meigs was one of the handful of doctors to receive a silver pitcher of recognition from the city council for the “heroic role of the medical profession in battling the infection.”

  And he lived in a time when the concept of medical sterilization was so unrecognized that the appearance of pus in an infected postoperative wound was “welcomed as harbinger of a successful surgical outcome.”

  Soon the school seemed to be dividing into two: the partnership of Thomas Dent Mütter and Joseph Pancoast on one side, and Charles D. Meigs and his longtime friend and chair of chemistry Franklin Bache on the other.

  Still, that first year, Mütter and Meigs kept any disagreements private. Perhaps both of them wanted to make a good impression on the Jefferson Medical College board. If the board was so powerful it could fire George McClellan, the college’s own founder, perhaps it was wise to keep their conflicts to themselves.

  • • •

  Neither Mütter nor Meigs would have any idea during the 1841–1842 session that this would be only the first of fifteen years that they would teach side by side. And not just the two of them. The entire faculty—who’d earned the nickname the Faculty of ’41—would remain united in an unprecedented fifteen-year reign at Jefferson Medical College, and later would be called “one of the most illustrious faculties in the history of American medical education.”

  Nor could they have imagined that amid the chaos of the years to come—the infighting, the public battles, the private slights, the life-and-death issues that faced not only medicine but the entire country—that this community of doctors would usher in a period of remarkable prosperity and growth, a period of the true rise and healthy growth of the school, which later would be described as “the golden age of the second great School of Medicine in Philadelphia.”

  All Mütter knew was that he had survived his first year, and he wanted to at least celebrate that accomplishment.

  Perhaps he would host an extravagant dinner prepared by the city’s best French chef, the well-known M. Latouche, who was famous for pairing his cellar’s choicest wines with such decadent meals as oyster pies made with one hundred oysters, or eight quails roasted and larded to perfection, or even a whole hog’s head trimmed with jelly, which alone cost as much as an average Philadelphia weaver was paid for half a week’s work.

  Or perhaps Mütter would reward himself with several new silk suits—each in a brighter color than the last and trimmed in delicate ribbon.

  But he suddenly knew what he wanted: to commission a portrait of himself by famed Philadelphia painter Thomas Sully.

  A Sully portrait was practically a tradition among the Philadelphia elite, proof that you had made it. Despite Mütter’s new income and status as a Jefferson Medical College professor, he still struggled with what he believed was a lack of respect within the larger community. In many ways, he still felt like an outsider.

  “The mere acquisition of great wealth did not guarantee admission to the ranks of Philadelphia’s upper class,” a British writer traveling through Philadelphia observed. “The exclusive feature of American society is no where brought so broadly out as it is in the city of Philadelphia. It is, of course, readily discernible in Boston, New York, and Baltimore; but the line drawn in these places is not so distinctive or so difficult to transcend as it is in Philadelphia.”

  Still, Mütter felt the success of his first year was a step in the right direction, and he wanted Sully to capture that in a portrait that would be uniquely Mütter.

  Unlike the stern-faced portraits popular among doctors at that time, the small oval oil painting by Sully shows Mütter as an almost romantic vision. His thick dark hair tousled from his face in an unselfconscious pompadour. His pink cheeks are flushed, his eyes bright, his mouth curled up into a sly smile.

  Opting out of one of his bright-colored suits, Mütter instead wears a brown coat with high stiff white collar, black bengaline cravat tied in a flat bow in front, and a white pleated jabot. The glossy dark brown fur of his shawl collar pops against the pastel pink of the background.

  It was the portrait of a man who seemed certain of his bright future. He had no idea what was to come.

  THE PHYSICIAN SHOULD HAVE A REVERENCE FOR HIS ART

  In every village in our land, the parson, the lawyer, and the doctor are the “great men of the place,” and none stands higher than the doctor.

  Whose friendship is more highly prized;

  Whose name is so often coupled with expressions of gratitude, and love, and confidence;

  Whose visit is more anxiously expected or more warmly received; whose cheerful smiles and kindly expressions so readily banish gloom and sorrow;

  Whose hand is so eagerly grasped by the devoted wife when she thanks him for the care with which he has watched over her husband, herself, or her children;

  Into whose ear is the tale of private griefs, hidden sorrows, blighted hopes, and dreadful anticipations of the future, so readily poured forth!

  Be ye sure, gentlemen, that such a position is . . . an object worthy of the utmost desire, and is a reward more “precious than rubies,” for the fatigue, anxieties, and sorrows, with which the pursuit of his calling is almost necessarily attended.

  THOMAS DENT MÜTTER

  CHAPTER TEN

  DWELL NOT THEN UPON WHAT HAS BEEN DONE

  Thomas Dent Mütter, Portrait by Thomas Sully

  The letter arrived a few days after Mütter began his second year of teaching at Jefferson Medical College.

  Philadelphia, Nov 10, 1842

  To Professor Mütter.

  Dear Sir,

  At a meeting of the Class of Jefferson Medical College, held on Monday the 7th instant, Thomas K. Price, of Virginia, having been called to the chair, it was resolved, unanimously, to publish your very able and eloquent Introductory Lecture to the present Class. The undersigned being appointed a Committee to solicit a copy, do earnestly add their wishes to those of the Class, that you will comply with their request, which will ever be appreciated by them, and by us individually, as a source of the most grateful remembrances.

  The students closed their letter:

  We have the honor to subscribe ourselves,

  Your most obedient servants

  before signing their names.

  • • •

  It was a promising start for the new school year.

  Enrollment at Jefferson Medical College had increased by more than fifty percent between the Faculty of ’41’s first year and their second. In this watershed moment for the school, the board’s decision to take the college in a new direction two years earlier had now proven triumphant. The sounds of almost 350 students settling into their wooden benches on that first day served as a comforting anthem for the school, one that seemed to portend a bright future.

  Mütter, in particular, seemed to shine in this new spotlight.

  “No one who attended his lectures could deny their intrinsic excellence,” Joseph Pancoast would later write. “He sought diligently what was good and valuable, wherever it was to be found and, passing it through the alembic of his own mind, added to it, from his large experience, an amount of novelty which was by no means inconsiderable.”

  The affirming invitation from his new class of students to publish his introductory lecture was irresistible. Mütter replied to their request almost immediately.

  Philadelphia, Nov 12, 1842

  Gentlemen—Your note requesting a copy of my Introductory Lecture for publication, has just
been received, and it will afford me pleasure to comply with the wishes of the Class. Be pleased to accept my thanks for the flattering manner in which you have conveyed the sentiments of those whom you represent, and believe me to be

  VERY TRULY YOURS,

  THOS. D. MÜTTER

  The lecture, “a retrospective view of surgery for the last few years,” would be only Mütter’s second publication. His first, The Salt Sulphur Springs, Monroe County, Va., had been a disaster.

  • • •

  That first publication was inspired by Mütter’s 1834 visit to the Virginia spa. He had made the trip with the primary hope of restoring his health, but once there, he couldn’t resist slyly investigating the spa’s claims of having “healing waters”—a claim not uncommon among such retreats. His charm had earned him clientele among the spa’s visitors, providing him with an up-close view of the effects the salt sulphur springs were having on those who longed to be healed by them.

  His conclusions, meticulously detailed in his article, were not flattering. While he gave credit to the agreeable temperature and dry atmosphere of the springs, which he stated were an advantage for those seeking treatment for lung-related issues, he asserted quite emphatically that the waters themselves did not have any curative properties, and especially did not cure cases of consumption (now called tuberculosis), a power the owners of the springs boldly claimed they held.

  The article was published in 1840, six years after Mütter’s visit, and was swiftly regarded as heresy by defenders of the springs, both within and outside the medical community.

  A significant portion of the medical profession of that era recommended the therapeutic merits of such springs, and the general public had embraced them also. To take a public stand against the springs was to make all the people who believed in the springs, and the doctors who recommended them, appear foolish, uneducated, and gullible. It was not the best first impression for Mütter to make with his debut article.