Mütter was told to be patient and to keep working hard, but it only served to make him more frustrated. Especially when he took into account how Charles D. Meigs was treated.
• • •
Meigs had not been born into the Philadelphia elite. Far from it, in fact. He was born on the island of St. George’s in Bermuda, but his father Josiah’s legendary temper forced them to leave. It was an unfortunate trend, and the family found themselves relocating across the United States—first in New England, then in the South—for much of Meigs’s early life.
The vagabond life was not easy for the large and growing family. Meigs’s parents already had four children when Meigs was born—Henry, Clara, and Samuel, who were still living, and little Julia, who died when she was just over six months old—and continued to have children despite the family’s habit of packing up and moving on. Juliana, Ezra Stiles, and John Benjamin were born after Meigs and lived, but a little brother died shortly after his birth on a ship while the family was traveling from Bermuda back to the mainland. They named the infant Sea, and then buried him there.
It must have been a relief to Meigs’s mother, Clara, when the family decided to settle permanently in Georgia, in a little frontier town whose population numbered “only two hundred and seventy souls.” Josiah was hired to be president of a new school currently being built there, and felt secure that his family could finally lay down some real roots in this semi-wild, sparsely inhabited country surrounded on all sides by a great forest.
The American frontier was an ever-shifting landscape at the time, and the land within twenty-eight miles of young Meigs’s front door was still occupied by Native Americans—the various tribes of the Cherokee, Creek, Choctaw, and Chickasaw. It was also a short distance from Hiwassee, Tennessee, where Meigs’s uncle, Colonel Return J. Meigs—his father’s elder and best-beloved brother—lived.
Colonel Meigs was a legend in the family. He had fought so bravely all through the Revolutionary War that the United States Congress itself gave him a sword for gallant conduct. Now he served as the government’s Indian agent in Tennessee, overseeing numerous tribes in the area. Over six feet tall and as “erect as a tree,” he commanded the respect of all around him. So much so that the Native Americans in his area referred to him as the White Chief.
It was in this land “of law and lawlessness, of wild nature and of cultivated humanity, of education and refinement, of ignorance and downright barbarism” that Charles D. Meigs spent his formative years.
“Here was a spot, a climate—forest and stream, hill and dale—well calculated to tempt a hardy, active and most restless child to the pursuits best fitted to develop a strong and vigorous body,” Meigs’s son would later write of his father’s childhood. “Not only so, but the basis of that decision of character, which, under the various terms of courage, pluck, grit, endurance, constitutes, it seems to me, the chiefest element in the mental constitution of most of our ablest and most successful men—that predominance of will which comes of a sound, robust body, and which we ought all to endeavor to evolve in our children—must have here been laid in my father, broad and deep.”
The combination of the wilderness of this area surrounding his home and the refinement of the college being built proved to be the defining element of Meigs’s childhood. His father made sure that all of his boys were highly educated: multilingual and well-versed in a variety of subjects. But living in the frontier country meant that young Meigs couldn’t help but also become familiar with what it meant to live “a truly savage life.”
“He had made the acquaintance of a certain Jim Vann, a well-known and conspicuous Indian of the Cherokee tribe, who had a store on the frontier,” his son would write. “On one occasion, when on his way down to the coast, Vann said to my father: Now, Charlie, if your mother will let you, I will take you back to the Indian country when I return, where you can see how we live, and I will give you the finest Indian (Injin) pony in the country.”
While Meigs thrilled at the offer, it wasn’t easy to convince his family to allow the young Meigs to take this trip. While many knew Vann to be a generous and kind man, no one could escape the fact that when he was in his moods, he became “a most violent and brutal fellow.”
And indeed, Meigs’s mother at first flatly “and with high indignation” refused even to listen to such a project. But Meigs persisted and “never ceased to beg and entreat and knock, until finally, in a very despair of escape from his knockings, she yielded.”
Having received his mother’s blessing, he waited for Vann’s return. And waited. And waited. And just when all hope was about to die, Vann arrived, riding a powerful black stallion, looking the very picture of adventure. Meigs climbed on the back of the horse and off they went. Meigs would live “in the Nation” for over a month. He was twelve years old.
Meigs spoke often of this time in his life, and especially of Vann’s savagery and wildness.
“As I grew older, I came to think that some of his stories about that time have been exaggerations,” Meigs’s son would later confess, “but when I found my grandfather writing to his brother, the government agent to the very tribe to which Vann belonged . . . I can well believe that all my father’s stories may have been quite within the truth.”
The letter, written just four years after Meigs’s extended trip with Vann, reads: “Poor Vann has ceased from troubling, and the circumstances must be pleasing to you, for his death was a public blessing.”
So how was it that Meigs, who was so brutish in his interactions with people and had such an unconventional past, could be accepted into Philadelphia’s highest social strata while Mütter still struggled to be seen and heard?
• • •
By the mid-1840s, Meigs was wildly popular in Philadelphia medical circles, a man of great versatility and personal magnetism, and he was an extremely rapid writer.
Meigs was swiftly creating an extensive literary work, starting with his translation in 1831 of Velpeau’s Traité Élémentaire de l’Art des Accouchemens, ou Principes de Tokologie et d’Embryologie, under the title, An Elementary Treatise on Midwifery, or Principles of Tokology and Embryology. For the next thirty years, one book after another flowed in rapid succession from his hand. He prepared many of his books within a few months, and even composed one of his bestselling textbooks, Females and Their Diseases, a Series of Letters to His Class, in the interval between two teaching sessions. Meigs’s 1838 textbook, The Philadelphia Practice of Midwifery, was so hugely popular that a second edition was already necessary by 1842. This despite the fact that critics had called it “a meager book,” noting that the author had not only made no attempt to classify the several varieties of deformities in his chapter on deformed pelvises, but actually stated that “the task would be useless.” They also criticized him for his views on embryology—which they called “very misty” and confusingly lost in “a haze of words”—and for his strongly held belief, which was incorrect, that the placenta was entirely fetal in origin and that no vascular connections existed between it and the uterine wall.
But students and readers in the medical community loved his textbooks, which were theatrically written and often studded with harrowing dialogue-filled scenes between doctor and patient. In the chapter about the muscular structure of the womb, he wrote about a physician who, upon introducing his hand to remove a retained placenta, “found his arm so firmly grasped by the cervix that he was unable to withdraw it until the spasm had relaxed by copious bloodletting.”
Bloodletting and leeching were commonly prescribed forms of treatment by Meigs, who was an eloquent advocate of the use of the lancet in a variety of circumstances, including the threat of miscarriage, to overcome the rigidity of the birth canal, and as his cure of eclampsia (a sometimes fatal condition caused by dangerously high blood pressure found in laboring women).
• • •
Even Mütter had agreed that M
eigs was an engaging and highly readable author with the enviable ability to vividly impress into the minds of his readers whatever views he wanted to promote. Unfortunately, Mütter disagreed with many of those views. He found many of Meigs’s ideas lazy, others inaccurate, and some to be outright harmful, especially his tendency not only to positively deny the contagious nature of diseases he came across in his practice (such as childbed fever), but to take a step further and ridicule anyone who opposed with him.
It was this bravado and colorful showmanship that earned him a devoted following within the Jefferson Medical College student body, including the future Class of 1845 graduate Edward Robinson Squibb.
Edward Robinson Squibb
Squibb was a local boy, born on the Fourth of July of 1819, whose attraction to medicine seemed eerily similar to Mütter’s. At age twelve, Squibb watched his mother and all three of his sisters die within a year of each other. His father suffered a stroke soon after, and though the elder Squibb survived, he was an “ineffectual invalid for the rest of his days.” And being from poorer circumstances than his classmates, Squibb paid his tuition at Jefferson Medical College by working as an apprentice for a Philadelphia pharmacist—where he learned the art of grinding crude drugs, mixing elixirs, and compounding powders—and then by working at the pharmaceutical house of J. H. Sprague, between attending classes full-time.
But of all the members of the Jefferson faculty, it was Drs. Meigs and Bache who were Squibb’s “unqualified favorites.”
“Dr. Bache, with his patriarchal white beard and distinguished lineage,” Squibb wrote in the journal he kept his entire life, “with his clear, playing, logical and unforgettable definition of chemistry, is the most forcible teacher I have ever known. . . . He contrasts strongly with some of the rest.”
Meanwhile, Squibb described “the clean-shaven, dramatic, Bermuda born” Meigs as having “the originality of idea, and erratic, familiar manner, curious postures and gestures which would not fit well elsewhere.
“He and Bache are wildly different as good and bad,” Squibb said appraisingly. “And yet both are capital teachers.”
While he admired both men, Squibb’s praise for Meigs echoed over more pages. Squibb saw Meigs as “a striking figure as he stood before his class, his sharp features animated, his long dark hair brushed back over his ears, his spectacles pushed up on his high forehead,” noting his skill and knowledge of obstetrics, and how unafraid he was to use humor in his lectures.
For instance, a charmed Squibb wrote about how one day in class—to illustrate how little women knew about the realities of childbirth—Meigs recounted his experience of aiding a young French woman in the birth of her child. Peals of laughter filled the lecture hall as Meigs described the doleful expression on the young woman’s face as he attempted to examine her post-labor, and through her shock she could only tell him, “Ah, mon pauvre docteur, c’est tout gâté pour jamais!” (“Ah, my dear doctor, it’s all spoiled forever!”).
Squibb’s opinions of the other faculty members, especially Mütter and Pancoast, were not as favorable.
Squibb wrote about watching the duo—with an admiring but not uncritical eye—during a public exhibition of plastic surgery. While he gave credit to the “small, blue-eyed Mütter with his dark curly hair graying prematurely, and his finely chiseled features” for explaining every move in his clear, musical voice, he was critical of the “round faced Pancoast, bald except for a monastic fringe, a spot of his full red lower lip showing below the twists of his sandy handlebar mustache,” who throughout the delicate surgery could be seen wiping his bloody fingers on his pocket handkerchief and his instruments “on whatever was handy.”
Squibb was an outspoken student and did not hide his opinions of his professors, even openly discussed his differences with them. They, in turn, would invite him to sit in the best seats in the amphitheater for their lectures, and he earned invitation to parties at the professors’ homes. Bache invited Squibb to his “medical-club meeting,” where, ironically, strictly professional conversation was prohibited by rule, and Squibb even went to back-to-back student parties held by Pancoast and Meigs. The menus at both parties—chicken salad and ice cream at Pancoast’s; chicken salad, oysters, and ice cream at Meigs’s—resulted in the young medical student finding himself and his fellows students in a tavern at night’s end, where they collectively hoped that a little brandy would “keep down the rebellion in [their] stomachs.”
But Mütter was absent from many of these festivities, and the reason his time was so fully occupied during this period could be traced back to Europe.
• • •
While Mütter often felt misunderstood and dismissed in America, he remained a darling of Europe. In July 1844, The British and Foreign Medical Review published a rapturous write-up of Mütter’s surgeries, especially those on the severely burned—a population that many had been led to believe was “beyond any real medical help.”
They wrote:
There are few, if any, deformities consequent on accident, short of the irreparable loss of limbs, which have so successfully set at defiance the art of surgery for their removal, as those occasioned by burns; indeed the surgeon has felt that, in the production of the deformity which he could fully anticipate and had ample leisure to watch, nature’s antagonising powers have overmatched him. . . .
We, therefore, hail with satisfaction any attempt to remedy evils which have been either from neglect or unavoidably produced; and we cordially congratulate Dr. Mütter on the success which seems to have attended his operations. . . .
We shall have great pleasure in resuming a more intimate acquaintance with Dr. Mütter’s present productions; and shall be pleased, as we have reason to expect, if they lead to an introduction to some more comprehensive work, by which we may judge of the present state of transatlantic surgery.
Mütter eventually caught the attention of a British publishing house, which was releasing what they hoped would be the definitive surgical textbook of the famous British surgeon Robert Liston, known as the fastest knife in the West End.
Liston, like Mütter, was a colorful figure in surgery. He was tall, ambitious, and charismatic, often yelling, “Time me, gentlemen, time me!” to his students before beginning his amputations.
Although Liston was renowned for his success stories—such as the removal of a forty-five-pound scrotal tumor in four minutes; prior to the operation, the poor patient had been forced to carry his scrotum around in a wheelbarrow—he also developed a reputation for the flamboyancy of his surgical failures. For instance, his joy at amputating a patient’s leg at the thigh in less than three minutes was hindered greatly when he realized he had also inadvertently sawed off the patient’s testicles.
And perhaps, most famously, another leg amputation performed in less than three minutes had the unfortunate result of killing three people: the patient (who survived the surgery but died of gangrene several days later); his young assistant (whose fingers he accidentally sawed off during surgery and who would also later succumb to gangrene); and “a distinguished surgical spectator” whose coattails Liston also slashed. The man, who found himself surrounded by geysers of blood, was so convinced that the knife had pierced his vitals that he immediately “dropped dead from fright.” It was later described as “the only operation in history with a 300 percent mortality [rate].”
But those luckless cases were, of course, rare for Liston.
And if anything, Liston was far more likely to enrage and alienate the medical community with his thoughts on surgical hygiene than with tales of his darkly comical surgical mishaps.
Like Mütter, Liston inherently understood that there was a connection between the cleanliness of a doctor and the rate of infection among his patients. It was an unpopular line of thinking during a time when “surgeons operated in blood-stiffened frock coats” and “the stiffer the coat, the prouder the busy surgeon.
”
“There was no object in being clean,” a medical historian would later note of this era in surgery. “Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head.”
Liston was unafraid to challenge the thoughts of the day, which he considered fundamentally wrong. It was even written that his suggestions for hygiene improvement to reduce obstetric infections and mortality from puerperal fever had crossed the ocean and “outraged obstetricians, particularly in Philadelphia.”
But despite his “abrupt, abrasive, argumentative” nature, he was also known as a man who was “charitable to the poor and tender to the sick.”
“He relished operating successfully in the reeking tenements of [Edinburgh, Scotland’s] Grassmarket and Lawnmarket on patients [whom his peers] had discharged as hopelessly incurable,” a historian later wrote. “They conspired to bar him from the wards, banished him south, where he became professor of surgery at University College Hospital in London and made a fortune.”
To the publisher, it seemed a perfect pairing to combine these two controversial, rising stars of surgery, and create a textbook that would bridge the gap between Europe and America.
Mütter was invited to edit an American edition of Liston’s textbook, the lengthily titled Lectures on the Operations of Surgery, and on Diseases and Accidents Requiring Operations.
All Mütter was tasked to do was to read the tome and then add his own thoughts and ideas to the material. To be clear, the text of Liston’s book would not and could not be largely changed, but Mütter would be free to clarify points for an American audience of readers and add his own anecdotes and illustrations as needed.
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