Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  Not to mention, the springs were big business. Enormously popular and well patronized, they were massively profitable, so the proprietors had a vested interest in maintaining the illusion that mineral springs could cure the sick.

  Mütter’s critical exposé earned him the displeasure of one specific spring owner by the name of William Burke. Burke was a physician—or at least happily claimed to be—and was less than enthusiastic about Mütter’s comments on the efficacy of springs. Burke’s reaction was to treat the article with scorn, and to attempt to publicly discredit Mütter.

  Since Mütter had chosen to introduce climate into the argument, Burke went on to give him a proper lesson on the subject in a short book titled The Mineral Springs of Western Virginia, with Remarks on Their Use and the Diseases to Which They Are Applicable, published shortly after Mütter’s findings went public.

  “It is well known,” Burke pointed out, “that an excess of oxygen in the air is detrimental to the consumptive who gains no benefit from ‘pure mountain air’ which actually counteracts the effects of mineral waters and other internal remedies.”

  This line of argument ignored the fact that many owner-proprietors bottled and sold mineral water to those unable to come to springs, and reaped considerable profits from them.

  “One need look no further for confirmation on this point than the advice of the celebrated Dr. Beddoes, so eminent in consumptive cases, who recommends to his patients, thus afflicted, to sleep over cow-houses, where the proportion of oxygen in the air is less, and that of azote [i.e., nitrogen] great,” Burke continued, using half-truths and quasi-science—including the above Dr. Beddoes, whose advice about the healing properties of sleeping in an unvented room above piles of fresh cow manure was apparently accepted as being medically sound—to build a public case against Mütter.

  Mütter stood by the conclusions he stated in The Salt Sulphur Springs, Monroe County, Va., but he also recognized the timing of this controversy was incredibly poor. His appointment to Jefferson Medical College was fresh, and he felt pressure to recant and head off any further criticism that could spring up in the face of the “overwhelming evidence” Burke provided.

  Begrudgingly, Mütter wrote a public semi-apology to Burke that was dated November 9, 1841—exactly three weeks before classes started under the Faculty of ’41 at Jefferson Medical College. In it, he wrote:

  I have said to many, as I would say to you or any well-informed physician, that the Red Sulphur never yet cured a case of tubercular consumption, and you know as well as I do that such is the fact, for there is no cure for the disease. But I have always said privately and publicly that the Red Sulphur was a most valuable water in many cases resembling consumption. Not only have I said this, but I have sent you many a patient, and hope to send you many more. Very truly your friend and well-wisher,

  THOS. D. MÜTTER

  Whether Burke ever realized Mütter’s sneaky double entendre in “well-wisher” remains unknown—but he made no mention of it when he would later publish the letter, in its entirety, in his own book on the subject. A book that, of course, praised the springs.

  • • •

  Still, Mütter must have been heartened that his second publication would follow so swiftly, and under far less duress. Publishing was an important step to establishing a doctor’s reputation in the mid-nineteenth century, and Mütter was extremely lacking in that area. Every other professor at Jefferson Medical College had either written or edited one or more textbooks, or had one on the way. Mütter had one highly controversial article . . . and a related public apology. This new publication of his lecture on surgery was exactly what he needed.

  The introductory lecture—one of three Mütter lecture-speeches that Jefferson Medical College would publish in his lifetime—gives compelling insight into what surgery was like at the time, and Mütter’s grandiose vision of it.

  “The renown of an art, the noblest of all,” Mütter theatrically wrote of his chosen field, “the first and last and only object of which is the alleviation of human suffering.”

  Still, Mütter seems self-conscious about his reputation as a doctor who was a little too eager to believe and share the latest medical advancements.

  “This has been called the age of progression—the age of advancement,” he begins, “and our profession, gentlemen, has partaken of the general excitement. It may with truth be said, that of late it has exhibited much of the ‘freshness and vigor of youth.’ . . . None can urge now as in former times, that we continue in a state of comparative apathy, and content ourselves with servilely following the dictates of our predecessors.

  “A contrary disposition, indeed, seems to prevail, we are too anxious to be known as active men, and hence crude theories, senseless innovations, and not seldom injurious practical measures, have been crowded into the science.”

  Mütter swiftly changes direction, chastising those who reject new ideas too easily, as well as those who are aggressively critical in the hopes that it will make them look more impressive—rather than taking the risk of being seen as open-minded to ideas that could radically change medicine for the better.

  “But it is a surprising as well as humiliating reflection, that even with all this energy and vigor, with all the lights of modern science to guide us, with all the accumulated facts, false as well as true, of the crowd of laborers in the field, there should exist such diversity of opinion on subjects of the most constant observation,” Mütter wrote. “No operation, no theoretical opinion, no mode of practice is broached, but there at once springs up a controversy attended, too often, with an acrimony and harshness disgraceful to all concerned.

  “And why does this obscurity arise? It may be traced, gentlemen, to our eagerness to become known as discoverers, as the inventors of something new, as the great lights of the age; in conclusion, ere the facts upon which these conclusions are based have been properly investigated. We have, in truth, ‘Rested contented in ideal knowledge’; we have received as perfect, theories idle as day-dreams, and the foundations of our art must crumble to the earth, unless we learn more discretion and better judgment in the selection of the materials of which they are to be constructed.”

  From this starting point, Mütter engages the class with a discussion of modern advancements in surgery—both European and American—but not before warning them that “the numerous operations to be discussed have been as indiscreetly puffed and eulogized, as they have been injudiciously and hastily condemned.” But thanks to “patient and unprejudiced investigation, aided by experience and reason,” wrote Mütter, they can now be placed “in their true light.”

  He then continues sharing his thoughts about the innovations of his age, including the use of microscopes (“a new field of investigation, besides throwing a flood of light upon a subject hitherto the most obscure”) and the ongoing mystery of cancer (“I fear much remains to be done ere we arrive at its true origin and proper treatment”). And he gives praise to unusual but seemingly successful surgeries, including those of French surgeon Jean Zuléma Amussat, whom he credits for inventing a “most ingenious operation in certain varieties of imperforate anus” (a sorrowful condition in which a person is born without an opening to their anus, and thus is unable to defecate), in which “he cut[s] through the barrier” between the rectum and the vagina to evacuate a “rectum distended with feces.”

  He concludes, “No operation of modern times is more deserving your admiration, as well as imitation under similar circumstances.”

  Mütter affirmed some of his most lasting and important philosophies of medicine. Though obviously he understood and respected the power and potential of surgery, he implored his students to exhaust all nonsurgical options first:

  “It is the boast of modern surgeons, and well may we boast, gentlemen, that a resort to painful and mutilating operations is now much less frequent than formerly,” he writes. “In other words, disease
s considered but a few years since as invariably indicating a resort to the knife, are now readily cured by constitutional treatment alone.”

  He praised the advancements without which “incurable deformity, permanent maiming by the knife of the surgeon, or the quiet of the grave, was the inevitable fate.”

  He also disparaged those who seek a career in medicine as a moneymaking scheme.

  “Allow not then the temptings of the demon of avarice to lead you astray,” he warns them, “the gains of the mercenary and hard hearted empiric though often alluring to the poor and diligent, but honest and honorable votary of his art, can in the end be productive of no comfort, no satisfaction.”

  He spoke with empathy about how frustrating and confusing medicine could be in a world where so much wrong information is accepted as truth, and quackery runs rampant.

  “The dark clouds of ignorance, and error, and presumption do indeed gather more and more around and above us, and often the true votaries of our noble art are bowed down with despair,” he wrote. “It comes not within my province to discuss the causes of this increase of the evil, but there is surely none more efficient than the facility with which a medical degree is usually obtained, and consequently the little value set upon its possession by the community at large. I trust, however, that a better state of things will sooner or later arise, and in the mean time should any among you be disheartened, let him not look to the boasted success of the lying and impudent quack, but to the brilliant examples of wisdom, and intellect, and honesty with which our profession is replete. In whatever direction we turn, the trophies of these great men are before us.”

  And finally and perhaps most importantly, after years of holding up European—and especially French—medicine as the pinnacle of medical achievement, he took pains to praise American innovation.

  “It must have been obvious to you that American surgeons have been no laggards in the mighty race for professional fame,” he wrote. “That they as well as their collaborators in Europe, have been steadily engaged in adding each a stone to the pyramid of modern surgery! The flame which burns so brilliantly abroad has thrown its rays across the wide Atlantic, and soon its genial warmth will be felt from one extremity of our country to the other.”

  He championed American doctors in Philadelphia, New York, and Boston, highlighting their recent accomplishments and even shining a spotlight specifically on an American doctor, a Professor Warren of Boston, whose surgeries he lauded for their “most daring courage, intrepid coolness, rigid anatomical knowledge, and practical experience.” In that moment, Mütter could not have imagined how, in only a few years, John Collins Warren would go on to change the art of surgery—as well as Mütter’s own life—forever.

  In the final moments of his lecture, Mütter challenged his young students to join him in making American doctors the new medical vanguards.

  “Shall [this progress] be permitted to subside?” he asked them. “Will you who are destined to be the pillars upon which the medical science of this country is to rest, fail to add fuel to this flame? Will you by slothful indulgence, wasteful sensual gratification, ignoble and puny contentedness which readily receives but never gives, let pass this golden era?

  “Will you not rather ‘gird up your loins’ to the toil—and by your diligence, morality and laudable ambition, wreathe a new chaplet of glory for the land of liberty and equal rights? Show to the world that if in politics, religious tolerance, and social virtue, America once stood and will stand again, the foremost of nations, she may also boast of her medical science.

  “There are many among you who are discouraged from entering with ardor upon the pursuit of the profession, from the supposition that nothing or next to nothing remains for them to discover,” he tells his students. “Let no such idea take possession of your minds; ours as I have already told you is a progressive science and very far from perfection. . . . Let me urge upon you constant, patient, unprejudiced investigation. The harvest is rich and he who boldly thrusts in his sickle will assuredly reap an abundant reward. . . .

  “Dwell not then upon what has been done,” he told them, “but what remains to do.”

  In the ensuing years, Mütter’s mettle would be tested on just that.

  CHAPTER ELEVEN

  THE ROOT OF THE TROUBLE

  Despite its being home to over a thousand medical students and a plethora of doctors, hospitals, and medical schools, Philadelphia was still a place of chaos: socially, politically, and medically.

  Crushing poverty had become an everyday fixture of Philadelphia life. One neighborhood (the relatively small area between 5th and 8th Streets, from Lombard to Fitzwater) had become so crammed with the city’s most degraded classes that it earned the nickname the Infected District.

  A reporter from The Evening Bulletin investigated the harrowing neighborhood and found conditions among the 4,000–5,000 people who lived there so wretched that he felt “incapable of reporting their full horrors to his readers.” This area of the city—less than a mile from where Jefferson Medical College held its classes—seemed like a different world from the rarefied circles in which the doctors of the city drank imported French wine while dining on oysters, terrapin, quail, and ice cream.

  In the Infected District, it was common practice for shops to charge a penny for a meal that was made up entirely of scraps begged at the back doors of the wealthy. It was a common custom for one enterprising individual unable to afford rent at even the lowliest of flophouses to secure a room at a boardinghouse for twelve and a half cents a day, and then sublet as many sleeping spaces as could fit at a bargain price of two cents a head.

  The police and fire department at the time were of little help. The police were known as watchmen because the uniformed men could—and often did—lock themselves in specially constructed “watch-boxes” to protect themselves from the same criminals from which they were supposed to be protecting the community. The watch-box method would be abandoned, however, when rioting mobs realized they could simply destroy the watch-boxes and kill the police officers.

  The fire department was equally troubled. The all-volunteer companies were neighborhood-based, and just like the neighborhoods they had sworn to protect, some “were very respectable” while others “were the reverse,” as one doctor later observed.

  “The more humble and gentle the name of the [firefighting] company, the more apt it was to be pugnacious,” he recalled. “For instance, ‘The Good Will’ would fight anything at any time.”

  A watcher in the State House tower was tasked to be on the lookout for fires. When one was spotted, he would then alert all the fire departments en masse via taps on a bell. The disorder and chaos that would follow those bell taps was legendary.

  “When there was a fire, hand engines and hose carriages were dragged by men, a shrieking crowd ran along the pavements, and quiet citizens got out of the way, as there was ‘often a fight which would have brought joy to the heart of a Comanche or Pawnee,’” a Philadelphian recalled in harrowing detail. “Great disorders and riotous demonstrations were frequent . . . the firemen fought citizens, policemen and other firemen with scrupulous impartiality. One summer, two rival fire companies fought each other instead of a fire in the neighborhood of Eighth and Fitzwater Streets and the battle lasted all day. Two weeks later, the carriage of the Franklin Hose was thrown into the Delaware by a rival company.”

  One of the major challenging issues of 1840s Philadelphia was alcoholism, and the violence and death that seemed always to accompany it. By 1841, there were more than nine hundred taverns within Philadelphia County. In the Infected District, rum was commonly sold for a penny a glass, which might explain why the phrase “Rum is at the root of the trouble” was so commonly used when discussing the city’s problems.

  The threat that alcoholism posed to Philadelphia was so real that, by the early 1840s, the county supported nineteen temperance societies, which pr
oudly claimed a total of seven thousand members. Total-abstinence societies—groups that forbade their members from consuming any alcohol whatsoever—topped them with more than ten thousand members.

  Still, rampant alcoholism was an issue. When it came to the lower classes, alcohol-related crimes, injuries, and deaths only served to feed the popular belief that the poor had earned their lot in life and thus deserved no charity.

  Some took this idea even further, espousing the notion that there were people who were simply born to be poor, and who were actually quite happy living as they did. “He that is down needs fear no fall,” one clergyman of the time helpfully offered to explain why he thought the lower classes should be “of good cheer.”

  But it wasn’t just the poor that suffered in this overflowing city. Philadelphia’s working classes were consistently brutalized under the yoke of the free market.

  Men of all ages and backgrounds arrived in Philadelphia daily—from Europe, Asia, and the American South—all looking for work. The population of the city exploded from less than 140,000 people in 1820 to more than 250,000 by 1842, and significant credit could be given to the city’s industrial output.

  Foundries, factories, and mills of all kinds could be found within the city’s borders. There were mills for spinning cotton and weaving wool. Factories that built locomotives, fire engines, and chandeliers. The factories of Philadelphia produced, at their height, nearly one-fourth of the nation’s steel, and the city’s twelve sugar refineries made it the country’s largest single supplier of commercial sugar.

  To keep this extraordinary confluence of businesses going, these factories, mills, and foundries needed workers, but the city’s exploding population always seemed to contain more eager workers than were needed. Philadelphians were often forced by circumstance to accept abysmal wages for what inevitably proved to be long hours of relentlessly grueling work.