Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  If his courage failed him after this crucial moment, it was too late and no attention was paid to his cries of protest.

  It was found to be the only practicable method by which an operation could be performed under the gruesome conditions which prevailed before the advent of anesthesia.

  Having been publicly called out, Morton felt forced to accept the challenge. In front of Bigelow’s watchful eyes, Morton was able to render the patient “unconscious and insensitive to pain.” And the amputation surgery was a complete success. Not only that, but Bigelow was able to convince Morton to share his recipe of how to create Letheon simply and cheaply and to give authorization to Bigelow to write the first truly detailed public announcement of his discovery. The Bigelow-penned paper would be read before the Boston Society for Medical Improvement in early November and published as a report in The Boston Medical and Surgical Journal a week later.

  Though all would agree that Bigelow’s actions represent the first formal announcement of the discovery of surgical anesthesia to the medical profession, there was considerable controversy at the time about whether Morton should be credited with the first use of ether anesthesia.

  As it turned out, a rural physician named Dr. Crawford W. Long, who ran a practice in Jefferson, Georgia, had been using ether anesthesia for minor procedures as early as 1842. But unlike Morton and Wells, Long did not share the news of this breakthrough, and therefore, his works on his own history with ether anesthesia were not published until well after Morton’s demonstrations.

  • • •

  Regardless of the long and crooked road it took, when news of ether anesthesia reached Thomas Dent Mütter, he immediately saw its vast potential and knew he had to try it for himself.

  Not everyone in the community shared Mütter’s enthusiasm for the potential of ether anesthesia, and some even advised him not to do the surgery, but he was determined.

  Two days before Christmas in 1846—just two months after Morton and Warren performed the first public ether anesthesia demonstration—Mütter brought a young man with a large cheek tumor into the pit of Jefferson Medical College. Having read everything he could on the subject, Mütter carefully administered the anesthesia himself and performed the surgery.

  It was . . . effortless.

  Mütter—about whom it was said that he “appeared often at operations to be painfully sympathetic with the suffering of the patient”—became the first surgeon in Philadelphia to administer anesthesia and soon became consumed with the idea of harnessing its incredible promise . . . never imagining the resistance he would face.

  CHAPTER EIGHTEEN

  ALL THE FAIR DAUGHTERS OF EVE

  Early Tools and Texts on Anesthesia

  Much to Mütter’s shock, the medical community’s opposition to ether anesthesia was immediate and widespread, especially in Philadelphia.

  “We are persuaded that the surgeons of Philadelphia will not be seduced from the high professional path of duty into the quagmire of quackery by this will-o’-the-wisp,” the editor of the powerful Medical Examiner noted when speaking about the subject of anesthesia. “We . . . regret that the eminent men of . . . Boston should have . . . set so bad an example to their younger brethren.”

  In their defense, when “inhalation anesthesia” was introduced into the medical community, not all the surgeries were successful. As doctors and dentists began their own experiments with the imperfect chemicals and dosages, there was a great number of deaths. Many in the community would begin to see ether anesthesia as no more than a passing fad, yet another dangerous medical novelty in a century that seemed rife with them.

  “The last special wonder has already arrived at the natural term of its existence, and the interest created by its first advent has in a great measure subsided,” the New York City medical journal The Annalist wrote in January 1847—just three months after ether anesthesia made its Harvard debut. “It has descended to the bottom of that great abyss which has already engulfed so many of its predecessor novelties.”

  And Philadelphia—“the medical Athens of America”—was perhaps the most resistant to the idea of it. The first medical textbook to mention anesthesia was On Bandaging and Other Operations of Minor Surgery, written by a Philadelphia surgeon named Fitzwilliam Sargent, and in it he wrote:

  These agents have been employed to relieve pain in all sorts of operations . . . they have been administered by the ignorant as well as by the learned, and without any discrimination of cases.

  It is not at all surprising, therefore, that in many instances injurious, and sometimes fatal, consequences have ensued. . . .

  It should be recollected that the mere performance of an operation, with comparative freedom from suffering to the patient and with satisfaction to the surgeon, is but one step towards the cure of the affection for which the operation is performed: the treatment of the patient subsequently is a matter of equal importance; and with reference to this part of the surgeon’s duty, any cause which disturbs the healthy play of important functions, whether it be the impression of too intense pain, or of too powerful narcotic agents, is to be regarded as an evil.

  Mütter was dismayed that something he considered a gift from God could be seen as an evil by his peers and contemporaries. The strong feelings against the use of anesthesia went much deeper than just a gentleman’s disagreement about its use. Institutions began to take public stances against it. The board of Philadelphia’s Pennsylvania Hospital—the main hospital with which Jefferson Medical College had a working relationship— successfully voted to ban all use of the surgical anesthesia for seven years.

  Even worse for Mütter, one of anesthesia’s most outspoken critics would emerge among his own faculty: Charles D. Meigs.

  • • •

  In his 1846 introductory lecture, Meigs explained to a packed lecture hall what he perceived to be his responsibilities as both a professor and a physician.

  “I acknowledge that I am an enthusiastic admirer of my profession. My speech declares it, and my whole past life is perpetual proof of it. But I love that profession as a ministry, not as a trade . . . ,” he told them. “In what light shall he see the nature of man so clearly and so plainly?”

  Meigs truly saw his role as God-given, and thus his opinions as actual absolutes.

  “He taught in his lectures not only the absolute duty of the student to be always a student, in order that he might personally command the use of all that the observation and experience of the world were constantly discovering in the way of remedies and cures . . . ,” his own son would later write of him, “but he also ever taught that there was in medicine a moral element, which did not enter so deeply into any other human vocation except that of the preacher.

  “He always held that there was in the practice of medicine what he sometimes called a missionary element, a high flavor of charity,” he continued, “which no man could, and no good man would, desire to escape from.”

  After examining what he saw as the facts of this new discovery, Meigs believed it was his responsibility to take “great pains to demonstrate the dangers of ether inhalation.” It should come as no surprise that Meigs, a professor who was not afraid to be theatrical in his lessons, would take this particular lesson to the extreme.

  And what could be more effective in showing how easily a life might be destroyed by this, in his opinion, “dangerous agent” than by etherizing a sheep to death in the classroom?

  Sometimes it would be just one sheep; other times, Meigs would bring up to four—forcing the class to watch each one die in succession in order to afford his students, as he alleged, “a practical illustration of its dangers.”

  “Prejudice was an element deeply rooted in his character,” his future colleague Samuel D. Gross later wrote of Meigs. “His opposition to [anesthesia] was founded, not upon personal experiences, but upon the reports of medical journalists, who inconsiderably
exaggerated its evil effects.”

  Meigs didn’t care if the lesson he was teaching was in direct opposition to the work and passions of peers such as Mütter. In fact, he seemed to delight in being their foil, so certain was he of himself.

  One professor recalled how Meigs even got into the habit of interrogating other surgeons as to whether or not they were planning to use anesthesia during their next clinic day.

  “Certainly, my dear friend” was the invariable answer.

  “Then, by God, I hope you will kill your patient!” was the invariable rejoinder, the professor remembered.

  Once this same professor grew so upset that Meigs would say such a thing that he shouted at Meigs, “You will find it hard when you die to pass the gates of St. Peter, opposed as you will be by the vast flocks of sheep, the family, friends, and descendants of those you so unceremoniously and unkindly immolated upon the altar of science.”

  Meigs simply responded with a hearty laugh.

  • • •

  However, Meigs wasn’t always triumphant with his rabid evangelism against ether. A favorite story shared by those who resented his disdainful position on anesthesia was about one of the days when he brought a sheep into the amphitheater to be “heroically etherized” to death.

  In every way, it was the standard demonstration he loved to give. The animal, ears nervously flitting, was dragged into the center of the lecture as hundreds of students looked on.

  Ellerslie Wallace, Meigs and Mütter’s former student, now serving as Meigs’s dutiful assistant, poured the freshly prepared ether from a demijohn as Meigs gave his speech.

  “Pain,” Meigs began, “what is pain? Is pain something temporary? Is pain something necessary? What is pain worth?”

  With a nod from Meigs, the fat sheep was hefted onto the examination table. Meigs lowered his glasses and read the directions clearly and loudly. Wallace, following the instruction as best he could, began the sloppy process of etherizing the sheep, tilting the heavy jug of ether into the hastily constructed mask held firmly on the animal’s face. The sheep bucked and struggled against its handler as its feet flailed on the wooden surface. The poor animal’s plaintive bleating sounded not unlike the shrieks of a woman as it echoed against the lecture walls.

  Meigs stepped away from the table, pushed his glasses onto his forehead, and looked out into the sea of students as the ether took effect and the sheep’s body relaxed. Its breathing slowed. With another gesture from Meigs, the assistant removed the mask. The sheep remained motionless. Meigs placed his ear on the sheep’s body and listened.

  “Genesis 3:16,” Meigs finally said, straightening up, “In sorrow thou shalt bring forth children.”

  This was a lecture Meigs loved to give: Pain, and what we can learn from it. Pain, and how it was sometimes necessary. And, with this cherry-picked Bible quote: Pain, and how it was something women must endure, how it was God’s will that they should suffer in labor for all time as penance for original sin.

  Other obstetricians had begun to use ether in labor, Meigs explained, and word was spreading. Now women had begun to ask for it, to beg for it, this gas that promised to take all the pain away. There were stories of women so desperate for relief that they clawed at the eyes of the doctors who tried to remove the ether-soaked sponge from their faces. Meigs recounted to his students how his own laboring patients now pleaded with him for ether, and how they wept and tore at their clothes when he refused—which he did every single time.

  The sheep had been lying on the table for about twenty minutes and it was then that Meigs called forward one of the nearly five hundred students who were packed into the lecture hall and asked him to come to the center of the room and inspect the etherized sheep. The student complied and gingerly began examining the animal, gently at first, and then more and more roughly.

  Finally, the student said what Meigs already knew: “The animal is dead, sir.”

  Meigs’s assistant carefully examined the sheep and confirmed the diagnosis.

  “The animal is dead,” Meigs repeated. “Healthy when he entered. Given ether, exactly—exactly—as directed, and now, as a result, it is dead. Dead.”

  Meigs instructed Wallace to remove the sheep, and the students watched as the animal was dragged by its feet to the lying-in room at the back of the amphitheater. Meigs noticed how their eyes trailed the animal.

  “Imagine if that was your patient,” he said, without turning his eyes away from his audience.

  “What is death?” he asked after a pause. “Should it be natural, or unnatural? What should we fear more of, pain or death? What should we try to prevent, pain or death?

  “My long and extensive practice of midwifery has rendered me a familiar witness of pain and its various forms,” Meigs continued. “And now, I have grown accustomed to looking upon labor pain as a most desirable, salutary, and conservative manifestation of life force. And I have found that women, provided they were sustained by cheering counsel and promises, are freed from terror and able to endure without great complaint, those labor pains which the friends of the anesthesia desire so earnestly to abolish and nullify for all the fair daughters of Eve.

  “Perhaps, I am cruel in taking so dispassionate a view of the case,” Meigs confessed. “I know what you have heard. That a hundred thousand have taken it without accident! I am a witness that it is attended,” Meigs insisted, gesturing to the sheep, “with alarming accidents, however rarely.

  “So I ask you? Should I exhibit a remedy for pain to a thousand patients in labor—merely to prevent the physiological pain and for no other motive—and risk destroying one of them? Is relief from natural pain, decreed pain, for even a thousand patients worth the risk of killing one woman?

  “My God,” he whispered, “if that were to happen, I ask that you clothe me in sack-cloth. I ask that you cast ashes on my head for the remainder of my days. What motive could I have had to risk the life or the death of one in a thousand? What motive should any of us?”

  Meigs rapped his thin knuckles on the wooden railing that separated the students from the lecture floor. Meigs’s style of lecturing was described by a colleague as being “conversational, not at all rhetorical. His habit was to walk around the arena of the amphitheatre, when he was not engaged in demonstrating, with one hand in his pocket and the other on the railing, earnestly talking as it were to the group of young men immediately before him, apparently forgetting that he was in the presence of anybody else.”

  Some of his critics had written that Meigs’s lectures were often too melodramatic, or too conversational for a scholarly audience. A fellow professor even wrote that in the lecture room, Meigs was the best actor he had ever seen, for he “possessed all the requisites for success upon the stage—remarkable powers of mimicry, great enthusiasm, and a strong perception of the ludicrous.”

  But Meigs paid them no mind. He knew his lectures were persuasive and effective, and that he got his point across. And as he looked into the faces of his students and saw them enraptured, he felt the power of his position—a position he deserved and had earned.

  And it was in that moment that it happened: a slight moan, barely audible, rose from the back of the amphitheater. It was low and almost human.

  Meigs froze as he tried to place the sound and trace it to its origin. The only movements in the room were Meigs’s eyebrows slowly gathering at the center of his face.

  The sound filled the lecture hall again, grew louder, gained clarity.

  Baaaa . . .

  The collective eyes of his students immediately found the source: the once-dead sheep was now rising, groggy and confused.

  The students paused in their note-taking. Pens wet with ink dried in the air. Meigs stood silent and stiff before them, refusing to turn.

  The sheep announced itself once more—Baaa!—before it attempted to stumble to its feet. It promptly fell over, a loud c
latter in the suddenly uncomfortably quiet room. Soon after, the students couldn’t help but erupt in deafening laughter as the sheep stumbled inelegantly out of the room, taking Meigs’s boastful dignity with it.

  CHAPTER NINETEEN

  IF I MAY BUT TOUCH HIS GARMENT, I SHALL BE WHOLE

  THE PHYSICIAN SHOULD BE A DISCREET MAN

  It seems scarcely possible that one possessed of the ordinary attributes of a gentleman could ever forget the sacred character of confidence . . .

  “Whoso keepeth his mouth and his tongue,

  keepeth his soul from troubles.”

  THOMAS DENT MÜTTER

  Mütter’s fight for anesthesia to be widely accepted—to be adopted by doctors and surgeons as swiftly as possible in order to end what he saw as unnecessary human suffering—proved to be a turning point in his career. Those who had trouble taking the young, boastful doctor seriously were now finding themselves watching him carefully. Those who once gossiped about his method of getting out of an overlong Mass—by having his students rush into church and falsely claim there was an emergency—were the same doctors who now doggedly tracked his surgeries, praised his successes, and even adopted his positions, becoming his ally.

  Among the former critics who looked at Mütter with fresh eyes was Edward Robinson Squibb. The Jefferson Medical College alumnus, after spending several years as a naval surgeon, decided to return to his old school to “rub up” on the latest medical developments.

  Squibb was deeply impressed with the Mütter flap surgery and wrote about watching Pancoast and Mütter perform together on a young man whose entire neck and chin were heavily scarred.

  “The operation was an extensive one,” he noted in his journal. “Pancoast assisted Mütter throughout . . . and it was independently remarked by the gentlemen who sat on either side of me that it was a beautiful sight to see two great surgeons working so amicably and so harmoniously together, without any exhibition of envy or rivalry. . . . Whether as an exhibition of perfect good feeling, or of self-control, or a mixture of the two as is most probable, I must tell them of this circumstance, for such things have good effect.”