Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  It was not uncommon for Meigs to use his position as a doctor as a sort of pulpit from which he could condemn anyone he thought was being disobedient.

  “I love my profession as a ministry, not as a trade,” he would later be quoted as saying. “Can any human avocation have a stronger tendency to elevate and purify the mind than the physician’s? What other? In what light shall he see the nature of man so clearly and so plainly?”

  • • •

  When Chauncey was later found guilty, it proved to be a watershed moment. In the twelve years after his sentencing, the courts of Pennsylvania issued some of the strictest laws against abortion in the entire United States, expressly prohibiting the procedure no matter what stage of pregnancy a woman found herself in.

  Life had been hard for women in America up until then, and it was about to get even harder.

  But for one segment of women—a desperate population kept largely hidden from view—there was a growing reason to hope that their lives could one day improve. And that hope came in the form of Thomas Dent Mütter.

  CHAPTER THIRTEEN

  THE WOMEN WHO WERE SWALLOWED BY FIRE

  THE PHYSICIAN MUST BE A MAN OF STRICT INTEGRITY AND VIRTUE

  It is with much gratification I can assert that no profession, not even that of our holy religion, boasts a higher code of morality than ours.

  How edifying, and how eminently calculated to direct the thoughts of the medical man into the noblest channel, are the daily instances with which he meets, of exalting and touching fortitude, of sublime patience, of heavenly faith.

  Yes, yours is truly a moral, yea, a religious profession.

  And be assured that when, with tottering step and sinking frame, you grope through the “valley of the shadow of death,” His rod and His staff shall support you; and at the last, when the frail barrier which separates our fleeting world from that whose duration is eternity is passed, you will be greeted with cheering welcome:

  “Well done, thou good and faithful servant;

  I was sick, and ye comforted me.”

  THOMAS DENT MÜTTER

  Many of the women who came to Mütter were monsters.

  That is how they were seen on the streets, how strangers would describe them, and how they saw themselves when they were confronted with the horror of their own reflections.

  In the nineteenth century, women were largely dependent on men. While there were always exceptions to this rule, for the most part, to have a roof over her head, food in her stomach, or a life worth living, a woman needed a man to provide it—in one way or another. And for a woman to find a husband and leave her father’s house, it was said she needed to be beautiful and pure, modest and obedient.

  So what could the future hold for a woman whom the world saw as a monster?

  • • •

  To understand how these “monsters” were created, it is important to understand how women were forced to dress at this time: an imposed modesty that could literally kill them. Every morning, women began the process of dressing themselves for the day in the era’s notoriously restrictive clothing. Layer upon layers of cotton, wool, and silk, and these pieces of clothing held snugly to the body with tightly bound ribbons and laces. When this routine was finally complete, her movement was, of course, severely limited.

  The way women walked, moved, or even stood up in the 1800s was dictated in part by these restrictive layers of clothing. And yet, household chores—cooking, cleaning, minding children—were expected to be performed while wearing these restraining frocks.

  Now imagine the typical nineteenth-century kitchen, where cooking was often still done over an open flame. Pans were placed on grates, and pots hung from swinging arms that could be pulled out of and pushed into the fire.

  It was in this horrible concurrence of troubles—a veritable death trap of early domesticity—that these monsters were born.

  • • •

  How easily it could happen—a piece of hot ember loosens itself from its pack and rolls to the floor, its orange flame licking the fine lace of a petticoat; or a splatter of hot oil hops from a swinging pot and leaps—flame-touched—onto a woolen apron; or even something as basic as a child running toward his mother to hug her legs and accidentally pushing her into the flames. Once started, these types of fires were devastatingly difficult to stop.

  Within moments, more of the woman’s clothing would begin to catch fire, layer after layer, building intensity. Restricted in her movements and impeded by that easy flammability of the natural fibers, she would helplessly flail, trying to reach the flame and beat it out.

  However, the air would only serve to fan the flames, making them grow larger, stronger, and more powerful. And in her bending over, the fire would often hit the neck of the dress, a virtual powder keg in its combination of air, restrictive dense fabrics, and light airy layers of decorative cloth.

  And this is where the real damage was done. The woman’s face would soon be consumed with flame—burning, blistering, turning skin to liquid, and tearing flesh from bone. It was said the lucky ones died. The ones who did survive were cursed to live half a life, as monsters.

  • • •

  Of course, Mütter knew of these women. Survivors of such horrible burns often sought the help of plastic surgeons, hoping there was something that could be done. Those who had been burned as children had never known a normal life.

  Very little could be done. Typically, years would have passed, and the scar tissue would have grown painfully tight around the women’s faces. Some of the skin was thick and tough; other parts were stretched impossibly thin. The landscape covered by the disfigurement was often large: Horrific scarring commonly reached from the woman’s chest up to her eyes. Because of the alarming aftermath of their gruesome burns, these women—hidden from society by their shame-filled families—frequently couldn’t close their mouths, blink their eyes, or turn their heads.

  The older they got, the more they realized their already small world was only going to shrink: Who would take care of them once their siblings left the family home to start their own lives, and their parents grew old and thin from age and failing health?

  Too often, death by their own hands seemed their only solution. And by the time they grew desperate enough to find their way into Mütter’s office, they would tell him that is exactly what they would be prepared to do if he did not help them.

  • • •

  The most obvious solution—to cut away the damaged skin and replace it with healthy skin from another person or even another area of the victim’s own body—was assumed to be impossible. In fact, experiments in this area had halted progress in plastic surgery for centuries.

  “It is now generally admitted that ‘plastic surgery’ originated in India,” Mütter would tell his class. Earlier in the millennium, Indian criminals earned “peculiar punishments” for their crimes—noses sliced off, ears, lips, limbs. The natural result of this practice was the creation of a black market for doctors who claimed to be able to replace missing body parts.

  “And what the knife of the executioner called forth in India,” Mütter would tell them, “disease and accident have excited in Europe and America.”

  Mütter continued his far-reaching investigation of the genesis of plastic surgery, telling the story of Gaspar Taliacotius of Bologna, whose fame depended on his having practiced the art of restoring lost parts of the body by grafting and who tried but ultimately abandoned attempts to make noses from the skins of other people.

  Mütter told how Taliacotius attempted to transplant the skin from the arm of a porter onto the noseless face of his patient.

  “All went well for the space of thirteen months,” he explained, “but at the end of that period the borrowed organ gradually lost its temperature, and in a few days became gangrenous; upon inquiring, it was found that at the self same period the original ow
ner of the nose had died!”

  The students would laugh at this obvious tall tale, but Mütter continued.

  “The sympathy between the nose and its parent was indeed most extraordinary,” Mütter told them. “Not only did the former die with the latter, but during life it was effected by the pains of the original proprietor.” He then told them another artful story about “three Spaniards, whose noses were all cut from [the skin of] the same porter” and who were shocked to discover their noses swelling enormously in size. In an effort to get to the source of the problem, the Spaniards tried to locate the porter, only to hear that he was bruised and swollen himself, and recovering in bed after being severely kicked by a horse. The Spaniards, in retaliation, went and kicked the horse!

  The students would again laugh, as Mütter smiled and rolled his eyes. But his expression turned stern when he brought home his point: As preposterous as these stories were, the chief consequence of this ridicule was that there was “no attempt to perform these operations made after this period until the latter end of the last century.”

  The fear of being seen as foolish had prevented progress; “an art nearly lost, yet of the greatest value to mankind” was a grim consequence indeed.

  “Even now plastic surgery must be considered in its infancy, for although much has been done, much remains to do, in order that the true value of the principle may be fully established,” he told his students.

  And Mütter was now attempting to put into action what he had been teaching his students: He was going to move the science and art of plastic surgery forward.

  Man with Nose Being Reconstructed from Forehead

  • • •

  It was a known fact that transplanting a piece of skin—from either the same person or a different one—would result in the body’s rejecting it. What might at first seem pink and hopeful would slowly turn yellow, then green, then black, as the skin flaked off what inevitably was, at this point, a festering pus-filled wound.

  However, the French doctors popularizing plastic surgery in Paris introduced Mütter to what was, for him, a revolutionary concept. While moving the skin completely from one area to another did not seem possible at that time, surgeons realized that if one section of a patient’s skin remained attached to the body, and that skin was simply twisted over an open wound, it had a higher probability of attaching, slowly grafting itself onto the new area, becoming healthy and growing as if it had always been there. It was how French surgeons were able to construct a whole nose from the twisted skin of a person’s forehead.

  It was this new approach to plastic surgery that inspired Mütter to try and help these women. His vision was ambitious in its scope. Any woman who agreed to it would have to endure a long, painful operation while wide awake, followed by a lengthy recovery time. But it promised a miracle: It promised to unmake the monster.

  Mütter had no idea that the surgery he was planning would one day carry his name—the Mütter flap—and that it was so visionary and ahead of his time that it would still be performed more than a century and a half after his death.

  All he knew in that moment was that he had formulated a plan to help these tragic, fate-struck women, and now he needed to see if it would work.

  • • •

  When the trembling woman entered his office, Mütter greeted her severely deformed face with the same warmth with which he greeted friends on the street; his glittering blue eyes locked directly onto her misshapen ones.

  It was disarming to the twenty-eight-year-old woman, who—in the twenty-three years since she received her life-changing injuries—had grown used to people avoiding eye contact with her, often even turning away from her in revulsion. She, in turn, was used to avoiding eye contact as well.

  Even though Mütter positioned himself directly in front of her, the woman kept lowering her head out of his eye line, from pure habit. But Mütter persisted, dipping his head down to maintain their connection and smiling confidently. It was important that she trust him, and vital that he ascertain the task that lay ahead of him, not unlike a general surveying a battlefield before planning his maneuvers.

  “I received a burn when five years old by my clothes taking fire,” she told him, her words slurred and slow. “My grandmother being a great doctress nursed me. . . . As they wished me to remain in as comfortable a position as possible, my life being entirely despaired of by the family, medical aid was not called. . . .”

  As she spoke, Mütter let his eyes wander over her. Her lower eyelids were drawn down by her shocking scars. It made it difficult for her to blink, and her face grew wet with the persistent flow of tears.

  “Dr. Burns, a neighboring physician, hearing of my circumstances, could not refrain from calling to see me,” she continued. “He called twice as a friend, and was then forbidden to come again until sent for, which was never done.”

  The angles of her lower jaw were completely altered by the burns, so much so that her teeth were nearly horizontal. Her tongue, with no barrier to press against, developed chronic hypertrophy (swelling to abnormal proportions) and she was unable to close her mouth for more than a few seconds at a time.

  “When I was eleven years of age, an attempt was made by Dr. Cook, of Bordentown, to afford some relief,” she told him. “Being young, I was much alarmed, and opposed him. My near relations, being unwilling to see me suffer, united with me; and he was obliged to desist before completing his design. I therefore did not experience any relief.”

  The clavicle on her right side was also so completely embedded in scar tissue and thickened skin that it could scarcely be felt, and there was no external indication of its location. Her chin was drawn down to within an inch and a half of the top of her sternum, making her unable to turn her head left or backward. There was so much thick roping scar tissue covering her from chin to chest that she appeared not to have any neck at all.

  “My condition has been most humiliating and made my life a burden,” she whispered to him. “Death is preferable to a life of such misery as mine.”

  Mütter took in what she said and nodded, before giving her a brief, steady smile.

  “Do I have your permission to examine your back?” he asked. She looked at him strangely, but nodded her assent and began to undress.

  When finally she was able to lower the fabric from her shoulder, Mütter saw her back for the first time: It was perfect. Healthy, pink, and free of the burn scars to which the front of her body was yoked. He broke into a wide bright grin, almost laughing with joy. She, of course, would have no idea, but this sorrowful woman was indeed a perfect candidate for his new surgery.

  Once she had re-dressed, he invited her family to join them in the room. He fully explained to them what he had learned from his examination. He told them what other surgeons would likely suggest, and how futile any of the usual operations for such deformities would be. Instead, he asked if he could perform a surgery on her that was entirely different from any previously conducted.

  “Although [the surgery would be] severe, as well as somewhat hazardous,” he explained, “[it] promised partial, if not entire relief.”

  It was an enormous promise to make. The woman agreed, and Mütter immediately placed her in “preparatory treatment.”

  CHAPTER FOURTEEN

  TO UNMAKE MONSTERS

  Mütter had to wait until his patient was ready. It was going to be a long, multistage surgery, and once the procedure had started, there was no turning back. If Mütter wasn’t allowed to perform his envisioned operations—swiftly and fully—there was a strong possibility that the patient would bleed out on the table. Mütter had walked the young woman through every step of the surgery, being clear and frank about what was to come and what was expected of her despite the pain she would feel. Once Mütter felt she was sufficiently prepared, mentally and physically, he scheduled the surgery. In the room would be six other men—two doctors whom Mü
tter had asked to assist him and four medical students who had begged to witness the procedure.

  Mütter sat the young woman down on a low chair and placed her in the strongest light possible. He asked her to throw her head back as far as she could, farther than was likely comfortable for her. She strained her neck, wincing, as one of the doctors stood behind, holding her head firmly and gently to maintain this difficult angle.

  Mütter sat himself in front of her and washed her neck one last time, feeling through the cloth the rough landscape of scars that had become so familiar to him. He asked the young woman if she was ready. She nodded, her body already restrained by another doctor’s arms. Mütter took a final look at this woman, trembling and vulnerable before him, her neck bared for his knife. He took a deep breath, and began.

  • • •

  The first incision was a long one. It began in the “sound” unscarred skin, outside of the most heavily scarred area on one side of her throat, and continued until it passed into sound skin on its opposite side. His goal was to cut through the dead center of the most scarred area of her throat—“the most vital part of the neck.”

  Mütter was sure to handle the scalpel lightly but firmly, the scalpel cutting uniformly through the skin, deep enough to get through the heavy scar tissue, but light enough to, hopefully, avoid the delicate muscles of the neck and the heavily trafficked arteries and veins. It seemed to work. There was blood, but it was not much.

  He kept cutting through the skin—swiftly and confidently but deeper and deeper—as he moved strips of the scarred skin from her neck and placed them in a basin out of her field of vision. When he thought he had cleared all the scarred skin he could afford, he told the assisting doctor holding her head to help to raise it into its proper position.