Imagine lying on a gurney waiting for surgery, nicely sedated with Valium, knowing that the outcome will be as good as medical science, training, and technology can provide these days, and that your pain will be, if not minimal, at least dealt with by strong drugs.
Now imagine you’re on a hard chair. Three men stand behind you, ready to hold your head and the rest of you in vise-like grips while you scream that you’ve changed your mind. Afterward, you’ll be bundled up with bandages that are most likely dirty, sent home, and good luck to you.
Welcome to mid-19th-century surgery ― specifically the decades between 1831 and 1859, when Thomas Dent Mütter taught and performed surgery at Philadelphia’s famed Jefferson Medical College.
Well known as a poet, Cristin O’Keefe Aptowicz’s new book Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine, is compelling and fascinating. The deceptively simple pen-and-ink, before-and-after drawings of frightful medical conditions will grab you before you’ve even started reading, no matter how un-squeamish you might think you are.
This isn’t a book aimed to shock, however, although at times it does. The years Aptowicz put into writing it show in her deft mixture of well-researched history, biography, and social commentary. Although Aptowicz doesn’t insert herself into the writing, she does give a glimpse of how people thought over a century and a half ago, which makes for some memorable reading and more than a little amazement.
Dr. Mütter’s Marvels begins in the 1830s with Mütter earning his medical degree at age 20 and moving to Paris for further training. It ends with Mütter’s untimely death at age 49, shortly before the beginning of the Civil War in 1860. The state of medical knowledge was appallingly scant at that time, although of course physicians then were as “modern” as anyone. There were no anesthetics until 1846, and even then there wasn’t general agreement that they were safe or even moral to use. There was no clear idea of germs, no agreement among doctors that cleanliness had anything to do with the terrible death rates from infection.
The hallmark of a skilled surgeon in the 1840s was, Aptowicz writes, like a British surgeon of the time, Dr. Robert Liston: “the fastest knife in the West End [of London].” That, and sufficiently strong men to hold the patient down, was as good as it got. For pain relief ― a swallow or two of wine and water.
Mütter, young and eager to advance medical science, was going against the tide of popular practice. Resistance to change, as in every age, was powerful. For example, when in 1846 a successful demonstration of the pain-killing qualities of ether led some, Mütter prominently among them, to promote and use the anesthetic from then on, rather than it bringing an end to nightmarish surgeries, the old guard stood firm against it. Aptowicz writes: “the medical community’s opposition to ether anesthesia was immediate and widespread, especially in Philadelphia.” In the poetically named chapter, “All the Fair Daughters of Eve,” an especially outspoken opponent of Dr. Mütter, Charles D. Meigs, would ask surgeons if they planned to use anesthetic that day, and when answered in the affirmative, he said, “Then, by god, I hope you kill your patient!”
Attitudes about women in general, and specifically as patients, is something that Aptowicz covers in detail, as well. Meigs, a prominent Philadelphian gynecologist and obstetrician, held a particularly dim view of women, especially their intellect — or lack of. During a gynecological exam in front of a hall full of male medical students, he referred to the patient’s private parts as “a vile lump of animal texture.” He went on to say “[women’s] intellectual force is different from that of her lord and master. …She has a head too small for intellect.” It makes one’s hair stand up on one’s head. It’s evident that Aptowicz takes a dim view of such male attitudes.
The “marvels” of the title refer to the 1,700 medical oddities that Mütter collected during his short lifetime and willed to the College of Physicians in Philadelphia. The Mütter Museum stands today and has a collection of 25,000 specimens. But Dr. Mütter’s Marvels is more about one man’s crusade to modernize medicine. His gift to the world, described eloquently by Aptowicz, was his ability to see his patients’ sufferings and determine to alleviate them.