A well-known quote by British writer L.P. Hartley goes “The past is a foreign country: they do things differently there.” Nowhere is this more evident than in the field of medicine, where advances in technology and technique arrive at dizzying speed. Doctors make breakthroughs that ripple around the world, wiping out diseases and making the most challenging injuries easy to treat and cure on behalf of their patients. These ideas and procedures, such as sanitary instruments, a good bedside manner, anesthesia, and even a good bedside manner seem commonplace and unworthy of mention today.
It was not always so, of course. There was a time when surgery was done in an open room in front of an audience of medical students for their education. No electricity, sterile instruments, or even painkillers save a few cups of wire were available, and afterwards you were bundled up in your same dirty clothes and hustled into a carriage for a bumpy ride home. The surgeon in question would then turn to his next patient, using the same tools and wearing the same apron, and giving the terrified patient no idea of what the doctor was about to inflict on their body, no matter how they screamed or struggled. And if you were a pregnant woman, things were even worse.
Enter Dr. Thomas Dent Mütter, a young man who determined that the main goal of a man of medicine should be to treat people needing surgery as equals before, during, and after the procedure. He would calmly and gently explain to you what was to be done at least a week in advance, show the instruments to be used, and advise you what you could do to assist him. During the operation he would work quickly and efficiently, keeping eye contact with you whenever possible, and giving you a reassuring touch on the shoulder if needed. Afterwards he would direct you to a bed for rest and recovery, stopping in several times over the next few days to check up on your progress.
All of which was totally unknown to the practitioners of surgery at the time. Indeed, you could set out your shingle as a doctor without any medical training whatsoever, and medical science in America, as I have mentioned, was far behind the level we enjoy today. You didn’t even need a medical license in Philadelphia until the end of the 19th century. Infectious disease was disputed, medicines were not standardized, bleeding and leeches were heavily promoted, and treating a fever with a cold bath would have been seen as murder.
Mütter tried to change all of it. After studying in France, he arrived in the city of Brotherly Love determined to use what he had learned to become a surgeon, and most importantly to dedicate those skills to helping those considered monsters: people with deformities such as the Widow Sunday, a French woman who grew a long brown horn from her forehead to her chin, or people suffering from severe burns that rendered them incapable of moving their heads and fearful of the public. Mütter prided himself on doing his best to ensure that these individuals would live happier lives through the groundbreaking use of skin grafts and deft cutting; the more terrible the case the greater he dedicated himself to its resolution.
Not content with simply using his abilities to help others, Mütter became a teacher of surgery, instructing others in his methods of cleanliness, empathy and hard work. Where medical teachers of the time generally dictated their wisdom so that the listeners could write and repeat it verbatim, Mütter encouraged dialogue and the asking of questions by his students and offering cadavers and patients with lesser problems for their use in practice. It is to his credit that many of them went on to have prestigious medical careers, applying his ideas to their own fields and patients with great success.
When he felt death was near, Mütter set about ensuring that his vast collection of bodies, specimens and medical equipment would not be lost, but instead would be placed somewhere they could be used to educate and inform future generations as to both the strangeness of the human body and the need for empathy when faced with individuals burdened with those quirks and afflictions as well as hopefully a desire to treat them with the same kindness Mütter himself tried to instill in his students. (I am ashamed to admit that I assumed they were a collection for his personal amusement or a “conversation piece.”)
Cristin Aptowicz has done a stunning job in shining a light on the life and career of this unappreciated pioneer in surgery. Weaving together his life story, the state of medicine at the time and political and professional rivalries with his colleagues, Ms. Aptowicz has done more than simply writing a biography of a remarkable man or educating her readers about the giant strides Mütter made in his field. The crisp, clear words easily make the individuals described understandable and approachable, and the descriptions of the procedures and practices of the time are both vividly grotesque and enthralling.
The book is likewise peppered with portraits of the individuals mentioned in the story, diagrams of Mütters’ patients, and quotations from the good doctor himself, all of which add to the remarkable work that was done by both the subject and author.
After his death at the age of forty-seven from both inherited and chronic illnesses, Dr. L. Beecher Todd lamented the fact that the story of Mütters’ compassionate personality, remarkable skills, dedication to healing and admirable teaching methods might be lost to history if no “able hand” was there to write “the biography of this great and good man” so that his name might become a “household word of American Surgery.” Dr. Todd can rest easy in that regard; Ms. Aptowicz has done as amazing a job in chronicling the life and work of Mütter as the man himself did for his fortunate patients.
As with all of my other reviews, this one is also featured on Cannonball Read, a race to review a certain number of books in a year, all in a good cause. There’s a lot of other good stuff over there: please feel free to take a look.