Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  Mütter tackled the project with a dark glee, and between his full teaching load and his demanding surgical practice, he found time to add more than two hundred additional pages of anecdotes and opinion, and several fearsome illustrations, increasing the size of the book—much to the surprise of his publisher—by over half. The American edition, with Mütter’s additions, came out in 1846, two years after Liston published the original.

  The book would teach medical students the best ways to tackle the basics, such as incisions, hemorrhage, and the dressing and union of wounds. It covered injuries of the scalp, the cranium, and the brain, including the most effective trephining techniques—that is, the use of small circle-shaped saws to drill into the skull for eventual bone removal. Tumors of all kinds were discussed—tumors of the eye, tumors of the throat, tumors of the ear—including methods of swiftest and safest removal, since of course all patients would be awake during surgery. And Mütter was sure to extensively cover the burgeoning field of plastic surgery.

  Mütter made sure to push forward his theories on presurgical care—how hours, days, or even weeks spent working with the patient prior to a surgery could be instrumental in a successful outcome. While the speed of the surgeon’s hands was certainly helpful, Mütter strongly believed that working with the patient was equally important—a somewhat radical idea.

  In his preface, he proudly spoke about the book and about himself in the third person:

  In presenting to the profession in this country these lectures of Mr. Liston, I feel fully assured that no apology is necessary; like everything emanating from that excellent surgeon, they teem with practical and judicious advice, and their perusal will amply repay even the veterans of our art.

  It will be observed that this volume contains all the lectures published up to the present date, but does not conclude the course. It is simply a collection of much valuable matter, delivered in 1844 at the University College, London, and furnished the profession through the pages of the “London Lancet.” It must prove a most valuable addition to the other works of Mr. Liston, republished in this country, and which should be in the hands of every surgeon.

  The additional matter furnished by the editor is included within brackets [ ], and amounts to near two hundred and fifty pages, a much larger quantity than he at first expected to add, but he trusts it may not be without its advantages as illustrating some points of surgery but slightly or not at all referred to by the author. Another volume will be issued hereafter, should the publication of the lectures be continued.

  Mütter felt confident that the book would be a breakthrough for him. In preparation of this, he began to change his demeanor slightly, dulling his personality and downplaying the perceptions that people had of him, even with his own students.

  In fact, for the 1845–1846 semester, Mütter’s own introductory lecture began, “I fear that some among you will be disappointed at the turn I have given this discourse, but my aim, gentlemen, is to instruct, not to amuse.”

  That year, Jefferson Medical College could not only claim the largest enrollment of students in its entire history (469 students), but also the largest enrollment of students of any institution of its kind in the entire United States.

  The college celebrated by renovating its main lecture hall. The upper and lower lecture rooms were enlarged to seat 600 students (up from 450) and the upper lecture hall—known as the pit—was reserved for Mütter and was where he would perform all of his surgical lectures. Mütter insisted that a connection be made between the pit and the upper floors being rented as recovery rooms in the building next door. This “miniature hospital” would represent a precursor of Jefferson Medical College’s subsequent formal teaching hospital, which would be built nearly thirty years later.

  Even the exterior of the college changed. Now when the nearly five hundred students came pushing toward the building doors, they would climb a fine set of marble stairs and negotiate the six Corinthian columns that graced the facade, evoking the form of a Grecian temple.

  “In every respect, the comfort and advantage of the students have been consulted,” the college would later state in its annual report, “and the outward form has been devised and executed in a style, which, lest it does credit to the architect, is an ornament to the city. Nowhere, perhaps, at home or abroad is there an edifice more admirably adapted for its important objects—none where more facilities are offered for successful teaching.”

  • • •

  Mütter’s prestige, too, continued to blossom. Former U.S. vice president John C. Calhoun even brought in his own daughter to Mütter to see if he could help fix her various curious ailments.

  “[We] expected . . . to be back yesterday,” Calhoun wrote in a letter home, “but the Doctor spoke with such confidence of restoring her hearing & befitting her in relations to the curve of the spine, that she has been induced to remain some time longer.”

  (It was only a few months later that former president Andrew Jackson, under whom Calhoun had served as vice president, died, sending the whole country into deep mourning. In honor of “the irreparable loss our Nation has sustained by the death of the illustrious Andrew Jackson,” the entire faculty, staff, and board of Jefferson Medical College wore crepe on the left arm for sixty straight days, and the building itself was shrouded in black mourning bunting for six months.)

  Mütter’s reputation had grown enough that the medical community was slowly warming to him too. He held charming parties often at his own home, where his wife and their servants (five free men) lived. It was a large home, filled with elegant and expensive furniture (“Mütter has no children and makes a good income by his profession,” a peer would offer as an excuse for such opulence, though no reason was given—nor would one ever be—for why Mary and Mütter’s union remained a childless one).

  At Mütter’s parties, he attempted to blend all strata of people, though he still struggled with not offending others when he expressed what he considered to be obvious facts and theories about the future of medicine.

  When a visiting doctor came through Philadelphia, he was delighted to have received an invitation to one of Mütter’s famous dinners. When he arrived, he found a motley group called together to dine: local doctors, British consuls, University of Pennsylvania professors, ministers of France, a former Virginia governor, and the most recent mayor of Philadelphia, and of course Mütter himself, who left a memorable but unfortunately less than charming impression on the man.

  The doctor later wrote in his diary, “At so large a dinner conversation is never general, but the company collect in little sets. Everything was very handsome. [Mütter] is, however, a good deal of a humbug, and has to great excess the bad habit of puffing himself. To this, however, I imagine he chiefly owes his success.”

  Still, Mütter felt his life was now on the right track and that this book would only serve to fortify the obvious: that he was a major force in the future of American medicine and that his life as a surgeon was about to change.

  He was right on one count: His life as a surgeon was about to change, but not for the reasons he imagined.

  • • •

  On October 16, 1846, the same year that Mütter’s textbook was published, a dentist named William T. G. Morton and a professor of surgery named John Collins Warren stepped into a Harvard University lecture hall and gave a demonstration that would change the face of surgery forever . . . and render Mütter’s just-released textbook on surgery almost instantly obsolete.

  CHAPTER SIXTEEN

  GENTLEMEN, THIS IS NO HUMBUG

  William T. G. Morton, Administering Ether

  In 1844, a Connecticut dentist named Horace Wells came to Harvard to share an astonishing discovery: If a person inhales the right quantity of the chemical nitrous oxide, the result is that they will feel no pain during medical or surgical procedures. It was hard to believe—a game-changing discovery that could instantly and p
ermanently alter the practice of surgery.

  • • •

  And it was, as was made evident to the elite Harvard class, a total fraud.

  After all, when Wells proudly gave a demonstration of it in front of an eager class of Harvard Medical School students and faculty, the poor boy he selected as his patient continuously screamed out in wretched pain whenever Wells tried to extract his rotten tooth. They called Wells a swindler and said his discovery was a humbug. Wells was crushed, and his career never recovered.

  But as it turned out, Wells was not a fraud. It was an “incident of history gone awry.” The young man with the rotten tooth would later admit that he actually felt no pain and didn’t even know the extraction had happened until he saw the bloody tooth in the dentist’s hands. But as no one at the time knew, his screaming was simply one of the most common side effects of inhaling nitrous oxide gas. For reasons that were unknown, individuals who had recently inhaled nitrous oxide gas were known to scream, groan, or show agitated behavior—despite the fact that they were feeling absolutely no pain.

  Unfortunately for Wells, he was not aware of this side effect, and neither was his audience at Harvard. So it happened that a medical breakthrough was showcased at one of the country’s leading medical schools, and no one even knew it.

  And even stranger, this wasn’t the first time.

  • • •

  The pain-erasing effects of nitrous oxide were discovered almost a half century earlier by a chemist named Humphry Davy, who began his experiments with the chemical at England’s Pneumatic Institution. However, these experiments were largely performed on himself and sometimes his friends. He became so fixated on the high he felt when inhaling the gas—addicted, some would later say—that he risked his life more than once in his attempts to inhale larger and larger quantities, and even had a colleague build him a portable gas chamber so he could have access to the gas wherever and whenever he wanted.

  Although Davy was clearly very impressed with nitrous oxide’s ability to seemingly stop the body from feeling pain, it seems that he never thought to promote it as an anesthetic for surgery. Instead, he promoted it as a cure for hangovers, and proceeded to perform detailed experiments—on himself, of course—to see just how many bottles of wine he could drink in a night and still have the effects “erased.”

  But Davy was not alone in missing the enormous potential of nitrous oxide, despite frequent interaction with it. In the early 1830s, sulphuric ether and nitrous oxide were both used as recreational drugs. In America, the fashionable and the young found themselves at “laughing gas parties” or “ether frolics,” a popular traveling amusement.

  In the 1830s and 1840s, it was not uncommon for a showman claiming to be a “professor of chemistry” to set up shop in towns, villages, and cities throughout the United States with the express intent of showcasing these amazing gases and their “exhilarating features.” Of course, the most crowd-pleasing moments of the night were when the “professor” invited members of the audience to the stage to inhale the gases themselves. The sudden loss of equilibrium and inhibition would delight and shock the roaring crowds.

  It was at one of these “laughing gas” demonstrations in 1844 that dentist Horace Wells realized the potential of sulphuric ether and nitrous oxide. The morning after witnessing the spectacle, he convinced a colleague to extract one of his teeth after he himself had inhaled some nitrous oxide. After the tooth was successfully removed, an elated Wells shouted out, “It is the greatest discovery ever made! I didn’t feel as much as the prick of a pin!”

  But if Wells’s disastrous experience at Harvard had a bright spot, it was that he met John Collins Warren, the influential professor of surgery at the Massachusetts General Hospital.

  Warren was already familiar with the idea of using nitrous oxide as an anesthetic through his acquaintanceship with Charles Thomas Jackson, “one of the most eccentric and bizarre of all personalities connected with the discovery of surgical anesthesia.”

  Jackson, a graduate of Harvard Medical School, began inhaling nitrous in 1841, and by 1844, he had persuaded several local dentists that the gas could be helpful in relieving the pain of their patients’ toothaches. And it was Jackson who suggested in September 1846—nine months after Wells’s embarrassing incident at Harvard—that another Boston-area dentist, William T. G. Morton, use sulphuric ether mixed with air, believing it might prove to be an even better anesthetic than nitrous oxide. Morton tried it out and found the results astonishing. He then asked John Collins Warren if he might share this latest innovation with his class.

  And that is how on October 16, 1846, in the same surgical amphitheater as Wells’s fiasco, Warren and Morton gave the first-ever public demonstration of the effects of this “anonymous” liquid on a patient.

  It was an incredible sight.

  Morton served as the esthetician—who both prepared the anesthesia mixture and administered it by tipping the jug of gas into the patient’s face. The confident Morton looked out into the audience as the young patient slowly seemed to lose complete consciousness. Once the patient appeared fully out, Warren stepped in to skillfully remove a small tumor from the young man’s neck. The patient seemed peacefully asleep during the whole procedure, even as the scalpel sliced through his flesh and the suture needles repeatedly pierced his skin.

  After the surgery was over, the duo patiently waited for the grand finale. Finally, the patient appeared to wake up from this man-made slumber and told the slack-jawed audience that he felt no pain.

  It was then that Warren—who had not spoken during the entire surgery—finally uttered his iconic words about the dawn of a new era in surgery:

  “Gentlemen, this is no humbug.”

  CHAPTER SEVENTEEN

  ADVENT

  THE PHYSICIAN MUST BE A DETERMINED, PERSEVERING MAN; A MAN OF STEADY PURPOSE

  There is scarcely a quality which so much dignifies human nature as consistency of conduct—and no weakness more deplorable than that of instability.

  Examine, choose, compare, reject, but having once made your selection of profession, stand by your decision.

  Difficulties, and privations, and hardships, must be encountered; but determination will overcome them all.

  And not only sloth and folly, but even genius will be outdone by perseverance.

  It often is the case that he who can endure the most is in the end the most successful.

  THOMAS DENT MÜTTER

  The earliest demonstrations of ether anesthesia were performed during painful yet somewhat minor surgeries—tooth extractions and small tumors—but each one was an “unqualified triumph.” As people clamored to know more about this amazing new discovery, Morton realized that his unique combination of sulphuric ether and nitrous oxide could be a potential moneymaking opportunity. He not only refused to tell people the makeup of this transformative gas, but he also stopped all public trials of the anesthesia—which he called Letheon, after Lethe, Greek mythology’s mythical river of forgetfulness.

  But the medical community wouldn’t stand for it, and an enterprising young surgeon named Henry J. Bigelow specifically called out Morton to give a more ambitious demonstration. Bigelow explained that while toothaches and small tumor removals were all well and good, he wanted to know if this promising surgical tool would work in “capital” (or major) surgery.

  Bigelow—who already imagined that Letheon contained sulphuric ether—challenged Morton to use his “preparation” in a leg amputation he was slated to perform. The amputation was one of the most dangerous, deadly, and painful kinds of this type of surgery: full amputation at the thigh.

  This was a true test of the new anesthesia, and one that medical men were all familiar with: the image of the man held down on the table as the doctor approaches with his kit of amputation tools; the first jolt and yelp of pain as the long, curved blade of the amputation knife slashes the
man’s skin, ripping into it violently; as the saw makes its way through veins and arteries and on to muscle, everyone’s clothing becomes dark, wet, and heavy with sweat and the eruptive spurts of salty blood; as the doctor pauses to switch tools, the man might receive a surge of adrenaline like an electrical shock, and the men tasked with holding him down redouble their efforts as he bucks wildly, his skin now hard to grab because of the slick coating of his own blood; and then everyone hears it, the sound of the amputation saw’s blade hitting the bone; minutes pass as the room fills with the slow growl of the saw, the cracking of bone, and the screams of the poor man tasked to endure it all.

  Now imagine being the surgeons who had to face this scenario so often, and who—because of the calling of their profession—had to be the traumatizing source of so much agony, even as a deep desire to relieve the pain of others was the reason so many of them wanted to become physicians in the first place.

  It is no mystery why surgeons often prized the speed of a surgery over its precision. Warren himself described how difficult these types of surgeries were to perform in the early to middle nineteenth century, writing:

  It was the custom to bring the patient into the operation room and place him upon the table. The surgeon would stand with both hands behind his back and say to the patient,

  “Will you have your leg off, or will you not have it off?”

  If the patient lost courage and said, “No,” he had decided not to have the leg amputated, he was at once carried back to his bed in the ward.

  If, however, he said, “Yes,” he was immediately taken firmly in hand by a number of strong assistants and the operation went on regardless of whatever he might say thereafter.