His friends in Paris had asked him to stay.
They assured him that the treatment he could receive with them was still much, much better than any he could receive in Philadelphia.
Here, in Paris, he could extend his life and do so in luxury: eating the best foods, enjoying Europe’s modern comforts, and conserving his energy—the same energy he had always devoted to fighting battles with willful Philadelphia doctors and teaching teeming waves of medical students—to, instead, heal himself.
• • •
His thoughts wandered back to the man who had so earned his admiration during his first trip to Paris: Baron Guillaume Dupuytren, the Emperor of Surgery.
Dupuytren had died just a few years after Mütter studied under him, marveling at Dupuytren’s singular skills, his hard-won knowledge, and his unusual collection of anatomical specimens that he used in his teaching, which inspired Mütter to start one of his own.
Before he died, Dupuytren had asked a former student, Mathieu Orfila, to help him create a permanent home for this strange collection he had built for decades. And so in 1835, the same year that Dupuytren died at the age of fifty-seven, the museum now known as Musée Dupuytren was opened as the Museum of Pathological Anatomy of the Medicine Faculty of the University of Paris.
The museum, located at what had been the old dining hall of the Cordeliers Convent, included almost one thousand hand-selected specimens donated by Dupuytren. Generations of students and doctors who missed the opportunity to study under the man himself could at least learn from the anatomical pathology materials Dupuytren had collected and had used to teach over his lifetime, now organized and displayed en masse.
Skeletons, wax castings, deformed or defective organs preserved in jars, and various other “monstrosities,” as well as an abundant supply of anatomical paintings, drawings, prints, and instruments.
In this way, Dupuytren ensured that his legacy would live beyond the surgeries he taught and performed. Here was a monument to a great man, the difficult work he did, and the challenging world in which he had lived.
Mütter wondered what sort of legacy he himself would leave behind.
• • •
His friends’ proposal to stay in Paris was extremely tempting.
Here, his work was respected; his style, appreciated; and his personality, celebrated. And it would not be difficult at all for Jefferson Medical College to find a replacement for him—the chair he was vacating was one of the most prestigious in the country; competition would inevitably be fierce—but even the best candidate would never truly fill the void created by Mütter’s absence. No one did the caliber of work Mütter did—let alone at the level and the volume he was able to do it.
Still, he wondered, what responsibility did he have to Philadelphia, or to Jefferson Medical College? Hadn’t he done enough? What could be worth returning for, if it would shorten his own life?
Mütter had already done so much. He had authored some of the country’s earliest articles on plastic surgery—surgeries for burns, for cleft palate, for clubfoot.
He had become one of the country’s leading masters of plastic surgery, helping hundreds and hundreds of people to live better, longer, more fulfilling lives.
He had brought about lasting changes for the treatment of his patients: recovery rooms, meticulously clean surgical areas, and twenty-four-hour care before and after surgery. He helped in the construction of Jefferson Medical College’s first small hospital, and performed the city’s first ether surgery within its walls.
He had taught more than one thousand young minds. Had he not earned the right to rest, especially now when his own health was failing him?
• • •
But there was still one concern that plagued Mütter as he wrestled with his impending mortality.
In the years that followed his discovery of ether, he had published very little. Excited by the potential of this new innovation, he had kept himself extraordinarily busy putting it to use at the surgical clinic at Jefferson Medical College. He had successfully fought to have the clinic be open year-round, though this had the unfortunate side effect of severely limiting his opportunity to share his knowledge beyond the Corinthian-columned lecture halls of Jefferson.
His earlier publications had been praised for their “very explicit descriptions, including drawings” and for giving “an accurate idea of what was involved from the surgeon’s point of view.” He had hoped to have an opportunity to do so again in the new surgical textbook he wanted so badly to write (but knew, with this latest diagnosis, he would surely be forced to abandon when his health hopelessly failed).
What would happen to the patients who filled his waiting rooms, these men, women, and children with burned bodies, or split faces, or deformities that were so grotesque he still caught his students listing their condition as “monster”—those people who felt that Mütter was their only hope?
With so much of his amassed knowledge still left to pass along, it begged the question of who would help them when he was gone.
Sitting among the silks and fine wines and golden lights of Paris, surrounded by people who loved him and wanted nothing more than to care for him, Mütter’s heart and conscience told him what he must do.
He would return to freezing Philadelphia and finish the work he was meant to do.
CHAPTER TWENTY-TWO
THE RICH FRUITS OF LIFE’S LABORS
Advertisement for Jefferson Medical College, 1855–1856 Session, Featuring “the Famous Faculty of ’41”
THE PHYSICIAN MUST POSSESS MORAL COURAGE
What profession, what art, what calling demands a courage so unyielding, so self-sacrificing as that of medicine?
He must be a brave man who can meet, without flinching, “the pestilence that walketh at noonday.”
He must be a brave man who can remain at his post, when the “plague-spot” breaks every link of affection . . .
Oh, tell me not of a warrior’s courage, brilliant though it may be. . . . He advances with hope, and is sustained, admired, and seconded by a whole army.
But what sustains the physician, in the stillness of night, in the chamber of pestilence, in the reeking hut of the sick beggar—in the cell of the maniac?
A moral courage, which bids him die rather than desert his charge—
a God, who tells him that
“a faithful shepherd must give his life for the flock!”
THOMAS DENT MÜTTER
When Mütter returned to Philadelphia, he saw it with different eyes. By the mid-1850s, the city had stretched its boundaries so far that there were complaints that “there would soon be no rural population left at all.” The city’s population clocked in at just over half a million, making it the fourth-largest city in the Western world, as well as second-largest in the United States.
London and Paris, from which Mütter had just returned, were much larger, of course (their populations at two and a half million each), and New York City could claim more than 800,000 citizens (provided you included Brooklyn’s 266,000). But Philadelphia was firmly in fourth place, the other cities in America not even close to its size. Philadelphia’s population had even surpassed such European capitals as Vienna and St. Petersburg and the somewhat similar industrial and commercial cities of Liverpool and Manchester.
When the United States first declared its independence, many of the men of the First Continental Congress thought Philadelphia was “too big and too urban.” They could never have imagined the Philadelphia of the mid-nineteenth century, “one of the first of the world’s truly big cities . . . an agglomeration of people that made inherited notions of ‘a community’ obsolete,” as the mass of people and crush of industry created a city “too populous and widespread to be truly a community.”
Yet Mütter still considered it home. He was heartened by the sight of its coughing smokestacks, its cr
oss-stitch of cobblestone streets, railroad tracks, and telegraph lines, and the large thrashing wheels of the Fairmount Dam and the Fairmount Water Works on the Schuylkill River.
When Mütter finally arrived home, he knew he had no time to waste. He immediately began to set his latest plan into action: to use his remaining time to ensure that all the things he valued in his life would live on after his death—his philosophies, his surgeries, and his collection of unusual specimens.
“Dr. Mütter raised his reputation to the highest pitch during his life,” his colleague Pancoast would later say. “It may not, however, be so enduring, or go down so far to posterity, as if the rich fruits of his life’s labors had been more fully spread in our journals, or been enshrined in books. This was a distinction too of which he was ambitious. He was desirous of extending his reputation beyond his lifetime along the records of science.
“Fortune had showered so many present favors upon him . . . ,” Pancoast said, “he wished for more.”
• • •
When Mütter finally returned to his familiar lecture hall at Jefferson Medical College, it was impossible not to see how illness had begun to ravage him: He was very thin and pale now, his hair was changing from premature gray to bright white, and his skin was sallow. But even terminal illness could not dull his bright spirit, and he greeted his students—old and new—in the same energetic and teasingly affectionate manner he always had. When he walked to the lectern to begin what he alone knew would be his final introductory speech, his students could not hide their adoration for him.
“What ardent greeting he received . . . ,” a former student would later recall, “after some of his many attacks of painful illness, the warm and often boisterous applause which burst and rang, heedless of his attempts to silence it, indicating a feeling for him not alone of respect and admiration, but of the warmest affection and tenderest sympathy for his suffering.”
Mütter attacked his lesson plan with a renewed spirit and vigor, determined to impart all he knew—clearly, completely, and definitively—to this final batch of students. But despite his best efforts to show a brave face, it was evident to his students and peers alike that his condition was not improving.
“During the last course of lectures which he delivered, an anxious, care-worn expression evinced that his natural great buoyancy of spirits and extraordinary mental activity were vainly struggling under the crushing burden of disease and suffering,” a student forlornly wrote.
Mütter reframed his current tortured state of being as, instead, a gift from God. No longer could he simply show his students the techniques, styles, and approaches he used to help heal the desperate people who sought his care. Now he had to trust them to take over the scalpel, the stitching needle, the clean rolls of cloth and lint.
It forced Mütter to be diligent in correcting his students about things that had come so naturally to him: the swift confidence of his accurate, thoughtful cuts; the methodical cleanliness of his surgical kit, operation room, and clothing; the gentle, even temper that he used to comfort and treat every patient who walked through his door.
Before, Mütter had felt it was his role to lead by example—to show his students the heights they should strive to reach, even though their own talents and abilities would likely never match his own.
But now, Mütter realized his task was to create doctors who could replace him.
He had always loved being seen as a singular wunderkind, an unmatched genius whose surgical work was so complex and idiosyncratic that he alone could perform it. But now, that same thought filled him with fear and dread. That his knowledge and methodology would die with him became his greatest fear.
Mütter wanted more than just the surgical techniques he pioneered to live on. He wanted his empathetic philosophies and his humanist approach to be immortal as well.
“[First-century Roman medical writer Aulus Cornelius] Celsus long since urged the possession of certain physical qualities as essential to the surgeon. He must be young, adroit, ambi-dextrous—and he adds a moral attribute, which I trust few of you possess—without pity,” Mütter explained to his students. “So far as the mere mechanical portion of our art is concerned, the views of Celsus may be considered as partially correct, but fortunately the absence of his ‘requisites,’ by no means forbids the acquisition of great surgical skill, as a mere operator. . . .
“However, his declaration, that a surgeon would be ‘without pity,’ is most fallacious,” he told them firmly, “for surely there is no profession, in the performance of the duties of which such frequent and urgent appeals are made to our sympathy, and he must be more than man—or worse than brute—who can contemplate unmoved, the agony and torture to which his patients are so often subjected.
“No, gentlemen, I would say to you, cultivate your sympathy, but learn to control it. . . . A calm, determined, yet gentle demeanor, is that which you should endeavor to acquire, and beneath it, the deepest and purest sympathy—a sympathy that forces you to spare nothing. . . .”
Mütter began to speak often and ardently about the values and principles he believed were most important to have “honorable success.”
He implored that each of his students ask themselves, “Am I to live as an influential, well-informed, and man-loving physician, blessing and benefiting those by whom I am surrounded; or shall I endeavor, in the vulgar phrase, to ‘enjoy life,’ caring nothing for my profession, or estimating it as a trade, make money the basis of all my aspirations, leaving honor and reputation to him who values them?
“If you have never asked yourselves these questions, the time has come when you must do so,” he told them. “Your first step must be directed towards either one or the other of these positions. May I not hope that all will select the better path, sterile and thorny though it may prove, and carefully shun the facile and flowery one, that too surely leads to dishonor and despair?”
Again, Mütter felt keenly aware of how he allowed—nay, actively developed—his being a singularly talented genius, blessed by God with gifts one simply could not learn in a classroom. While this vision of him had served for so many years to stoke his ego, he had come to realize its intrinsic harm. How often—too often—good, solid physicians were made to feel humble, discouraged, and hopeless, thinking they had no chance at greatness.
“I cannot admit the opinion of [the French philosopher] Helvétius, that every one is born with equal capacity,” he told them, “but I am very sure that nearly every human being possesses nature intellect sufficient, if properly nurtured, and trained, to enable him to become at least a useful member of society, if he does not ultimately reach distinction.
“Starting, then, with this position, it will be my task in the lecture to point out the mental and moral culture to which each one of you should from this day diligently subject himself,” he told his students. “To some, the task will be easy and delightful; to others, a warfare, in which indolence, perverseness, pride, ill-nature, and sensuality will present themselves as foes. But let those who may unfortunately belong to the latter class ‘strengthen their hearts’ with the truth, that all these natural enemies may, by proper strategy and courage, be certainly overthrown.”
If Mütter’s students needed an example of what might happen to them if they were not as vigilant as Mütter was in thinking through and then standing up for their own principles, values, and standards, they needed to look no further than the crumbling example of the life and career of Dr. Charles D. Meigs.
CHAPTER TWENTY-THREE
THE VOICES OF THE ILLUSTRIOUS DEAD
Union Flag Flown over Jefferson Medical College
A PHYSICIAN SHOULD BE A PATRIOT
I do not mean by this a patriot of the “mob’s decree,” but a good old-fashioned patriot.
A man of honest heart, of pure intentions, of firm and high resolves, of ardent love for his country, because it is his country;
>
A man who, if occasion demands, will not hesitate to shed his last drop of blood in her defense.
THOMAS DENT MÜTTER
Charles D. Meigs, twenty years older than Mütter, was still robust and vigorous as he entered his mid-sixties. When the two passed each other in the halls of Jefferson Medical College, Meigs’s effortless health served as a startling contrast to the increasingly frail Mütter. But the strength and health of their individual ideas and philosophies could not have been taking more dissimilar paths.
Mütter’s ideas—long shunned and mocked by many in the Philadelphia medical community—were slowly being proven correct, and his star was rising even as his health was failing.
The hale and hearty Meigs, however—in almost perfect contrast—was forced to watch as his opinions were disproved, his long-held theories were ridiculed, and his reputation made a staggering, stunning decline.
Meigs’s practices and guiding philosophies, which had been seen as so grounded and traditional in the previous decades, now seemed more than just out of fashion—they seemed dangerously out of touch.
And this was true even outside the world of medicine.
• • •
Like the rest of the country, Philadelphia was caught up in the fear that the nation was going to be “split asunder” by the age’s most pressing issue: slavery.
Philadelphia not only allowed slavery when the city was founded in 1682, it was also once one of the country’s largest hubs for the slave trade. But attitudes toward slavery gradually changed, and nearly a century later, in 1780, Pennsylvania became the first state in the Union to pass an abolition act to outlaw slavery in the state.
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