Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  As he watched his final class of graduates march into the hall for their commencement ceremony, he tried his best to hide his grief under a trained smile. Among the 215 graduates that year were the sons of two Jefferson Medical College professors: Richard J. Dunglison, the beloved son of Robley Dunglison (who had hand-selected Mütter as chair of surgery so many years ago), and William Henry Pancoast, the only child of Mütter’s closest friend and steadfast colleague, Joseph Pancoast.

  Mütter had met these young men when they were but children, and had watched them grow for a decade and a half. And now, here they were: doctors.

  He looked at the eager faces of the graduating class. Mütter could have no idea what the future held for these man, or for the hundreds more who had also sat on wooden benches in Mütter’s lecture hall and learned what it meant to be a physician—a good physician—from him.

  • • •

  Among those men changed forever by their time with Mütter was Edward Robinson Squibb.

  Squibb, who as a student had been so critical of Mütter, grew more admiring of his old professor in the years since graduation. Watching Mütter work various astounding ether surgeries while struggling with the limitations and complications of working with the earliest incarnations of inhalation anesthesia, Squibb had been inspired to find a way to standardize ether. His vision was to provide doctors and surgeons with stable, constant chemicals for their work, and thereby make ether surgeries safer, more popular, and even more widely accepted . . . and thus also make easier the very difficult job of surgeons like Thomas Dent Mütter.

  Squibb would spend over a year developing, creating, and testing a new type of still that would provide a safer, more efficient alternative for distilling ether (which had previously been done over an open flame). After finally building a still that met his high standards, he began months of experimentation with it to determine how to produce the finest and most uniform ether possible, better than anything else on the market.

  His journals—which had once been filled with detailed descriptions of meals he ate and the conversations he tolerated with his dim-witted employers—were now filled with charts detailing temperatures, amounts, costs, and specific gravities of solutions. The breakthrough would happen when he struck upon the perfect way to resolve his still’s condenser issues and realized that he would be able to wash away most of the impurities that plagued the current market’s ether with a combination of potassium carbonate and redistillation.

  After years of work—largely in isolation—he had finally done it: He had designed what he considered to be the perfect ether apparatus. It was not only capable of producing “ether of uniform strength by using steam,” but also was created in such a way that “nothing short of the grossest carelessness or inattention can interfere with the uniformity of the product.”

  But Squibb’s next move proved to be the most surprising of all.

  Instead of rushing to patent either the process or the still—both of which were conceived, created, tested, and perfected by Squibb alone—he gave them to the world for free, publishing an article on his apparatus, including a detailed diagram of his design, in the American Journal of Pharmacy. He then began work on making what would become the first truly effective “ether mask” for use in surgery—relieving yet another aspect of ether surgery that vexed surgeons.

  It would not be long before Squibb—who made his living as an onshore assistant surgeon for the U.S. Navy—would be encouraged to go into private industry and would found the pharmaceutical company that in his lifetime would be known as E. R. Squibb & Sons (and would develop over the course of 150 years to become the pharmaceutical giant Bristol-Myers Squibb). Their motto was one that Mütter could have stood behind: “Reliability. Uniformity. Purity. Efficacy.”

  Through his company and through his personal work, Squibb would become an advocate for transparency between patient and health-care provider and between doctor and medicine supplier. He was instrumental in launching the movement that produced the first federal Pure Food and Drug Act in 1906, the first of a series of consumer protection laws that, among other things, required drugs to be labeled with their active ingredients and also to maintain recognized purity levels in order to be sold in the United States. This would in turn lead to the creation of the Food and Drug Administration, a national agency dedicated to protecting consumers and regulating the drugs and food they consume.

  Squibb never forgot his experiences at Jefferson Medical College. When it was explained to the seventy-seven-year-old Squibb that his hand would have to be amputated due to infection, he immediately set about outlining the exact operation he wanted, planning “the amputation the way he thought his old professors Mütter and Pancoast would have done it . . . with improvements by Squibb.” When it came to the surgery itself, he insisted on self-administering his own brand of ether . . . or at least for as long as he remained conscious.

  • • •

  Squibb was not the only one of Mütter’s students who later went on to transform the world of medicine both locally and worldwide.

  Like Squibb, Francis West Lewis decided to spend three years studying medicine at Jefferson Medical College, instead of just the required two. A “marked friendship” grew between Lewis and Mütter, so much so that after his graduation in 1846, Lewis was invited by Mütter to join him during one of his summer trips to Paris and London. Mütter showed the young doctor the innovations and institutions that defined European medicine, and introduced him to doctors and professors who would become Lewis’s lifelong friends.

  It was during a trip to Europe that Lewis first conceived the idea for what would be his life’s legacy. In London, he saw the busy Hospital for Sick Children located on Great Ormond Street. The idea of founding a similar hospital in Philadelphia—one that would focus solely on the treatment of children—was sparked.

  Lewis’s passion for this idea grew when he returned to the United States, and through his work at the Pennsylvania Hospital, where he saw the appallingly high mortality rate for infants and children treated there. Children were viewed simply as “little adults” and suffered terribly from cross infection, hospital-contracted diarrhea, and even neglect since so many of them were too young to feel comfortable communicating their needs—or were simply unable to—until it was too late.

  Finally, in November 1855, Lewis helped open the Children’s Hospital of Philadelphia, and what started out modestly as twelve little beds tucked into a small house on Blight Street would develop through rapidly growing stages into a large, well-ordered institution, one of the earliest of its kind in the country—and owing much to “the indefatigable watchfulness and care” of Dr. Lewis.

  “Scarcely a day passed, regardless of the weather . . . ,” a biographer wrote of Lewis, “that did not find Dr. Lewis at the hospital investigating the minutest detail of its management, planning additions and improvements, and looking after the welfare of his little friends, who upon his appearance in the wards welcomed him with shouts of joy.”

  Carlos Finlay

  The graduating class of 1855 would include the Cuban-born Carlos Juan Finlay—who was born Juan Carlos Finlay but, like Mütter before him, altered his name slightly after receiving his medical degree, as a form of reinvention. After spending two years studying medicine in Philadelphia, Finlay returned to Cuba with a then-rare microscope in hand, and started a practice in Havana. However, between seeing patients, Finlay made time for research and study—and became obsessed with yellow fever, a disease that plagued both Philadelphia and Havana with equally deadly results. Between 1865 and 1881, Finlay would write and publish ten papers on this devastating disease that no one knew how to prevent.

  His breakthrough would finally come in 1881, when he was able to determine that the Aedes aegypti mosquito was the agent responsible for transmitting yellow fever. Because of this groundbreaking discovery, yellow fever would be effectively eradicated
and Finlay would be responsible for saving countless lives throughout South America, the Caribbean, Africa, and the United States.

  In the words of General Leonard Wood, a physician and a military governor of Cuba, “The confirmation of Dr. Finlay’s [discovery] is the greatest step forward made in medical science since [the] discovery of vaccination.”

  • • •

  Looking into the future, the one thing that Mütter may have been able to predict was that the long-simmering hostilities between the American North and South would finally bubble over into war.

  John Brown’s ill-fated attack on Harpers Ferry would one day be heralded as the first shot of the American Civil War. Brown was hanged for his crimes on the second day of December 1859, and exactly three weeks later on December 23, 1859—which also happened to be the thirteenth anniversary of Mütter’s first ether surgery)—there was a secret exodus of more than two hundred Southern medical students from both Jefferson Medical College and the University of Pennsylvania. The students fled the city under the cover of night, afraid that if they didn’t at that moment, they might be trapped in the North if war broke out.

  When war did break out, many of Mütter’s own students would rush to volunteer, and eventually fight, on both sides of the country’s bloodiest war. Some of them would become legends.

  Jonathan Letterman, Army Medical Director (Eighth Figure from Left), Standing between General McClellan (Sixth Figure from Left; Son of Jefferson Medical College Founder George McClellan) and President Lincoln (Sixth Figure from Right) on the Battlefield of Antietam in 1862

  Jonathan Letterman, who graduated from Jefferson in 1848, earned the nickname “father of battlefield medicine,” thanks to the innovations he developed as a Civil War surgeon. Letterman was named medical director of the Army of the Potomac. The Union Army had entered the war with only ninety-eight medical officers; more than half of the army’s medical professionals had resigned to join the South after the start of the war—echoing nearly exactly what happened in Philadelphia that night of December 2, 1859. In an effort to help resolve some of the issues that came up because the Union Army’s medical teams were short-handed—supplies that were either almost exhausted or necessarily abandoned; hospital tents that had to be abandoned or were destroyed; medical officers either deficient in numbers or broken down by fatigue—Letterman began drawing up plans and instituting them immediately.

  He began introducing a revised concept of the Ambulance Corps—army-issued wagons and trains would be used exclusively for transporting the wounded and, in urgent cases, for transporting medical supplies. Prior to Letterman’s ambulance system, there were horrible examples of inefficiency and abuse by personnel tasked to transport the wounded. In one unsettling example, more than three thousand injured soldiers from both sides were left on the battlefield for three days because the civilians responsible for moving the wounded had instead picked their pockets, stolen alcohol from the medical supplies, and left the injured to die.

  Letterman also insisted that all surgeons in the Union Army would be tested on their knowledge and be assigned to duty that reflected their skill level. Those who could cut off a limb swiftly and cleanly were sent to the front line; those who could manage the long-term care of patients suffering various unimaginable injuries were kept to work in Northern hospitals.

  Last, and perhaps most important, he established field-dressing stations, where wounded soldiers were divided into categories according to the severity of their wounds. Letterman’s system of organizing patients into groups of those who would live regardless of their wounds and those who would surely die—known as triage—proved to be a revolutionary concept, one still used today.

  • • •

  Letterman was hardly the only student of Mütter’s to take on a major role in the war. When Robert T. Coleman and John H. Brinton graduated from Jefferson in 1852, after having spent dozens of months studying medicine together in the same room, they could have no idea their futures would see them spending years of their lives aiding two great military men on opposite sides of the Civil War.

  Virginia-born Coleman returned to his and Mütter’s home state three years after he graduated from Jefferson. When the war broke out, he was appointed surgeon in chief of Thomas Jonathan “Stonewall” Jackson’s legendary army unit, the Stonewall Brigade. His work would result in Coleman’s being continually promoted until he was the highest-ranking officer in the medical corps of the Confederacy.

  Philadelphia-born Brinton—who had been one of Mütter’s favorite students and, like Francis West Lewis, had been invited by his beloved professor on several trips to Europe—would be asked to serve as the personal physician to Ulysses S. Grant. Brinton had been given Mütter’s surgical tool kit, which became the tool kit he used to personally treat the wounds of countless soldiers on numerous blood-soaked battlefields, as well as the wounds of their grizzled leader.

  Andrew Jackson Foard, whom Mütter watched graduate in 1848, had been the pride of the Jefferson Medical College when he became the U.S. assistant surgeon general, a position he held for nine years prior to the Civil War. But once secession began, Foard, a Georgia native, immediately resigned his prestigious position and enlisted with the Confederacy. He was placed in charge of the medical services of General Braxton Bragg’s army and found himself in the middle of some of the most notorious engagements in the war, including the Battle of Shiloh, which killed more than three thousand men and wounded sixteen thousand more in just two days of fighting.

  John H. Brinton and his Certificate of Commission

  Jefferson Class of 1854 graduate Henry W. Willoughby made history not just for how he served, but also for whom. Willoughby was proud to be named the assistant surgeon to the 1st Infantry, United States Colored Troops—the first African American troop in U.S. history.

  Daniel Leasure, Class of 1846, made a name for himself in the Union Army—not as a doctor, but as a soldier. When he heard of the Confederate Army attack on Fort Sumter, Leasure decided it was his duty as an American to answer President Lincoln’s call for seventy-five thousand volunteers to put down the rebellion. Within hours, he had turned over his practice, bid farewell to his wife, and begun to form a regiment. The Union Army would induct him as a colonel and he would go on to lead the immensely popular and storied 100th Pennsylvania Volunteer Infantry, a Scotch-Irish regiment nicknamed the Roundheads who were celebrated for their bravery and for reenlisting—en masse—every year until they had won the war.

  Even as a soldier, Leasure still clearly took to heart Mütter’s oft-taught philosophy of cleanliness. He became famous for “instruct[ing] his unit in the art of war while keeping a physician’s keen eye on sanitation and hygiene.”

  Because illness and infection were so disproportionately low in Leasure’s regiment, his methods were adopted by other commanders. And he earned undying respect from soldiers and doctors alike when, after even the most brutal of battles, Leasure could be found in the hospital tents, assisting the surgeons in their desperate bid to save men’s lives.

  • • •

  For every man who took what he learned from Mütter and boldly moved into the annals of history, there were even more who earned their degrees and went back home to change the world in smaller but no less important ways.

  Robert Sanford Beazley graduated Jefferson Medical College in 1842, and took as his motto “While there is life, there is hope.” Having received his medical degree at twenty-five years of age, Beazley enjoyed an incredible sixty-four years of practice, most of which he spent making house calls on horseback. He was said to have “held on to his patients with a grip that seemed to challenge death, making his success in healing almost phenomenal” and he continued to make frequent visits to the sick well into his eighty-ninth year.

  John Martyn Harlow left bustling Philadelphia after graduating Jefferson in 1844 and set up a practice in rural Vermont, where the village
rs living along the Black River and under the shadow of Ascutney Mountain would “look upon the coming of his carriage, as he flew along the winding and wooded roads, as a harbinger of help to the suffering and of hope to the afflicted in their scattered homes.”

  Harlow would later have a burst of fame when he was the first doctor to attend Phineas Gage, a railroad worker who survived having a three-and-a-half-foot iron bar driven through his skull because of a workplace explosion. Even though the bar entered through Gage’s eye socket and fully exited through the back of his skull, Harlow was able to tend to the man’s unusual and extreme injuries with such skill that within three months, Gage was not only walking and talking but was put back to work. When Gage died years later, the family gave the skull and the iron bar to Harlow, who donated both to the Warren Anatomical Museum at Harvard Medical School. When asked to speak at Harvard about the incident, it was a testament to the humble modesty that Mütter taught physicians to have in the face of their more harrowing cases that Harlow ascribed Gage’s astonishing recovery not to his own efforts, but rather to the young man’s “extraordinary vitality and the unconquerable will.”

  William S. Forbes graduated from Jefferson Medical College in 1852 to begin a thrilling career in the military. He worked as a surgeon beside the trailblazing nurse Florence Nightingale during Great Britain’s Crimean War, served as an army surgeon under Grant during the Siege of Vicksburg, and was named medical director of the 13th Army Corps, before being contracted as a surgeon for the Summit House Hospital in Philadelphia. Once he concluded his military service, Forbes—having never forgotten the experience of watching Pancoast and Mütter working side by side in the Jefferson surgical clinic—began advocating passionately on the importance of dissection and the detailed study of anatomy. In 1866, he presented the Pennsylvania state legislature with his version of a law to provide bodies to medical schools in a fair and legal manner. Although it was dismissively referred to as the Ghastly Act, Forbes’s efforts ultimately proved successful, and a board was created to regulate the distribution of bodies to Pennsylvania schools. He returned to his alma mater and became the demonstrator of anatomy at Jefferson, serving in that role for seven years before being appointed professor of anatomy.