It was not uncommon for these patients to enter the surgical room fully prepared to die. Death was a risk they happily took for the chance to bring some level of peace and normality to their mangled faces or agonized bodies. The surgeries weren’t physically necessary to save their lives; rather, they were done so the patient might have the gift of living a better, normal life. That is what les opérations plastiques promised.
Plastique was a French adjective that translated to “easily shaped or molded.” That was the hope with this surgery: to reconstruct or repair parts of the body by primarily using materials from the patient’s own body, such as tissue, skin, or bone.
The surgeries, of course, were not always successful—if a patient’s problem had been so easy to fix, it would have been corrected by lesser doctors years ago. But other times—and these were the times the audience waited for, the ones that made Mutter’s hair stand on edge—the end result was nothing short of miraculous.
With a careful hand, a steady knife, and a piece of bone, a surgeon could reconstruct a man’s nose with a twisted portion of his own forehead. A burned woman’s eye could close for the first time in ten years, thanks to a surgeon’s knife cutting the binding scar tissue and replacing it with skin from her own cheek. Cleft palates were fused back together—trickier than it might seem, for the sensitivities when working on the roof of the mouth meant the patient was in constant threat of vomiting, which would tear open delicate sutures and ensure infection.
Mutter seized every opportunity to witness these plastic operations firsthand. He used his charms to become an interne at the hospital to which Dupuytren was attached so he could watch the great master at work. But he didn’t limit his focus to Dupuytren, and soon became so familiar with each surgeon—their style and flourishes, their weaknesses and strengths—that he began to view them as his friends, even though they never shared a single word. He took copious notes, drew detailed diagrams, and bought every relevant book he could find and afford. It became his happy obsession.
Mutter hadn’t been in Paris even a year when he realized his time was running out. His limited funds were being swiftly exhausted, and he still needed to fund his trip back home. His newly made friends in the Parisian medical society tried to dissuade him. They adored the dashing young doctor with the “quick, active, appropriative mind . . . readily imbued with the spirit of his distinguished [Parisian] teachers.” They implored him to stay, pointing out how much work a charming American doctor could get in a bustling city full of English-speaking tourists.
Mutter loved his time in Paris, but his desire to return to Philadelphia was even stronger. He was twenty-one years old and felt healthier than he ever had in his entire life. He felt like a new man. He had even given himself a new name. He was no longer Thom D. Mutter from Virginia.
He had reinvented himself as Thomas Dent Mütter—with a perfectly European umlaut over the u.
With the last of his money, he purchased a wax model from a shop that specialized in reproductions for doctors. It was the face of Madame Dimanche, the French washerwoman who grew a large, brown horn from the center of her forehead. At first, the old woman hadn’t known what to make of the strange brown nub that appeared like an ashy smudge in the center of her head, but she knew to hide it from view, starting a decade-long habit of avoiding eye contact. But the nub grew relentlessly, larger and larger, until it was as thick and dark as a tree branch.
When she finally allowed it to be examined, she followed a chain of doctors that ended with a surgeon who told her he could remove it if she would trust him. She did. And so it happened the surgeon—practiced in this new art of les opérations plastiques—who promised her relief was able to actually deliver it. How happy she was to walk down the streets, her head unhidden. How thrilling it was to feel the wind kiss her bare face.
Mütter purchased a replica of Madame Dimanche’s presurgery face, her long, thick horn still intact. And on the long journey back to America, he took it out often, the sea bucking the boat beneath him. He took out her face and stared into it. In it, he saw his future.
CHAPTER TWO
THE CITY OF BROTHERLY LOVE
THE PHYSICIAN SHOULD BE AN AMBITIOUS MAN
To say to a young man “be not ambitious,” is to say to him live the life of a drone.
If ambition were a sin, is it probable that a wise Creator would have endowed nine-tenths of his people with it?
The love of praise is so congenial to our nature, and so powerful a spur to every undertaking, that the moral world would be a chaos without its animating influences.
It is like the sun; it gives life and heat to all around.
THOMAS DENT MÜTTER
Philadelphia in the early 1800s was an easy place to die.
The simplest thing could end your life: a broken bone from a fall, a leg gouged by a loose nail, a hand burned by a pot of boiling soup. In a time before antibiotics, infections could ravage a body in days. You could die from allergies. You could die from asthma. You could die from a single rotten tooth.
The food you ate and the water you drank could kill you just as easily as the guns that were bought and sold without regulation. Of course, there was cancer and diabetes, gout and heart disease. There was murder and suicide and accidental drownings, as well as executions by city and state.
Infectious diseases ran rampant through populous cities like Philadelphia, wreaking havoc on everything they touched.
There was smallpox, spread simply by human interaction. It caused the body to burst into blisters, lesions, and scabs, affecting adults and children equally and brutally. If you were lucky enough to survive it, the scars left behind—including sterility—could haunt you the rest of your life.
There was yellow fever, which no one knew was spread by mosquitoes and which earned its name by turning its victims yellow, before forcing them to bleed from the eyes and mouth and erupt with the black vomit of partially digested blood.
In 1793, yellow fever struck a rain-soaked Philadelphia so hard that the entire government shut down. Once symptoms were seen, the infected person was all but abandoned by friends and family. To protect their own patients, the Pennsylvania Hospital and Almshouse refused to receive yellow fever victims, forcing ailing citizens to eventually die alone in the streets. It became such a problem that local authorities annexed a circus ground on the outskirts of the city as a “depository [for] victims of the plague who had nowhere to go and nobody to care for them.” The city’s most prominent physician, Dr. Benjamin Rush, advised that all his patients leave the city at once, and anyone forced to remain should immediately engage in “heroic bleeding and purging.” Rush’s advice only caused more death. By the end of the disease’s reign, more than one-tenth of the city’s entire population was dead.
There was cholera, spread through contaminated drinking water, which painfully dehydrated its victims, the affected bodies retching liter upon liter of a fluid that looked like rice water and smelled like fish.
In 1832, cholera spread across the East Coast, finally hitting Philadelphia in July. It became such an overwhelming problem that Philadelphia publishing house Carey, Lea & Blanchard (at the time, the country’s leading publisher of medical books) began publishing The Cholera Gazette, a weekly publication designed to inform the public of the progress and hopeful treatment of this terrible disease. It became wildly popular as the death toll from the disease caused Philadelphia to log in sixty to seventy deaths a day. It took nearly four months for the city to rid itself of the disease, and as testimony to the “heroic role of the medical profession in battling the infection,” the city council would eventually reward the physicians in charge of the hospitals during this time with silver pitchers of recognition.
There was also malaria and croup, diphtheria and dysentery, measles and whooping cough, consumption and scarlet fever. Even something as simple as the flu could kill hundreds in a city over one wi
nter.
The swiftness and brutality of disease and death in the nineteenth century was something with which Mütter was already intimately familiar. It was a lesson he’d been forced to learn at an early age.
Lucinda Mutter was nineteen years old and in love when she became pregnant with Thomas in the summer of 1810. She and her husband, John Mutter, had happily married on Christmas Eve three and a half years earlier, when she was fifteen and he was twenty-five.
The two could not have been more different.
Lucinda had been born into the established Gillies family, which was connected, via marriage and blood, to some of the most prestigious families in the South: the military elite Armisteads (five Armistead brothers would fight in the War of 1812, and the British bombardment of George Armistead’s fort would later serve as the inspiration for “The Star-Spangled Banner,” the future U.S. national anthem); the prominent political family of the Lees (whose family would include not only governors, business leaders, and two signers of the Declaration of Independence, but also General Robert E. Lee, the future leader of the Confederate Army); and the influential Carters (whose patriarch, Robert Carter, was so powerful that he earned the moniker King Carter and, when he died in his late sixties, left behind fifteen children, three thousand acres of farmland, and more than one thousand slaves).
Lucinda and John Mutter
At age fifteen, Lucinda was a young bride even for an ambitious era in which women were frequently married in their late teens. However, she was bright and proudly educated. Early in their marriage, when she and her husband decided to have their portraits painted, she insisted that she be painted with an open book in her hand. John Mutter, on the other hand, was a scrapper. He was a first-generation Scottish immigrant whose father endeared himself to his new countrymen by fighting alongside them in the Revolutionary War. John, like his father, was a hard worker. He was also smart, ambitious, and extremely handsome, and was known to be a good neighbor and a good citizen. By the time he and Lucinda were ready to start their family, John ran a healthy business as a factor and commission agent. To have success in that field, you needed to be both resourceful and multitalented, for these men not only aided farmers in selling their crops but also helped them purchase farming supplies, gave advice concerning the condition of the market or the advisability of selling or withholding a crop, and sometimes even orchestrated the sale or purchase of slaves for a client. Mutter had built his reputation on his charm and his work ethic.
Lucinda gave birth to their first child on March 9, 1811, in the bedroom of their newly purchased home at 5th and Franklin Streets in Richmond, Virginia. The baby was born healthy and pink, and Lucinda named him Thomas, after her husband’s late father.
It was a happy time for the young family, but a troubled time for the nation. When President James Madison declared war on Britain in June, the ensuing two bloody years of unpopular battles forced the fledgling American economy to its knees. Businesses in both the North and South suffered, but luckily for his young family, John Mutter’s success continued. His businesses flourished and, as was expected during this time, so did his family.
Lucinda was soon pregnant again, and a second son was born in May 1813. She named him James, after her own late father, a beloved doctor who had died almost a decade earlier.
For a year, they were a family of four: John and Tom and James and Lucinda, living in a sunny house in Richmond, Virginia, flush with money and all in good health. But in 1814, the family’s uninterrupted string of good luck began to run out.
First, baby James got sick and declined rapidly. Just thirteen days after they celebrated his first birthday, James died. He barely beat a grim statistic, which noted that one in every five children born during this period died before their first birthday. John and Lucinda buried his thin, illness-ravaged body in the cemetery of St. John’s Church in Richmond, Virginia.
The family grieved all in black during a long hot Virginia summer. When autumn finally came, John thought a trip might brighten his sorrow-struck wife’s spirits and improve her unstable health, but this proved to be a mistake. Lucinda only grew more ill and weak as the journey progressed, and her body finally gave out in a Maryland inn. When she died, she was only twenty-two. Her stunned husband buried her small body in Baltimore’s St. Paul’s Church before traveling home.
Within a five-month span, John Mutter had buried his beautiful wife and youngest son. He was now thirty-three, a widower, and a single father to Thomas, who was only three.
The year after Lucinda died, John bought a large house in Henrico County, Virginia—a gesture meant to confirm that he intended to marry again, and that his family would continue to grow. He called it Woodberry, and he tried his best to make it a home for his young son, whom he loved deeply and spoiled often. But the next few years proved to be a relentless boot on John’s neck: His business and health begin to fail at an alarming rate; he was forced to sell all the furniture he had bought for his and Lucinda’s first home at 5th and Franklin Streets in Richmond, Virginia, and then finally to sell that home itself. He was tired all the time and couldn’t shake a rattling cough that took up residence in his chest. Sometimes he would return home from a long day of work with a handkerchief full of his own blood.
If you fell ill in the northern half of the United States, it was popular advice to go south to restore your health: the heat, the fresh air, the clean water and sulphur springs.
But if you already lived in the humid South—and especially if you ran in moneyed circles—you were told to go to Europe.
And so, in 1818, John Mutter left his young son behind and sailed to Europe with the hope that their doctors, the climate, and their medicine could bring him back to his former self. John assured everyone that he would make a full recovery, and even brought with him both a secretary for his correspondence and a private physician who would ensure his well-being every leg of the journey. But perhaps even he knew the truth: Before he left America, he penned a detailed will.
John Mutter said good-bye to young Thomas, now seven, on an autumn day in Virginia, placing him in the care of Tom’s grandmother, Frances Gillies, his late wife’s widowed mother. The boy sobbed at his father’s waistcoat once the carriage had been loaded. With his usual charm and a reassuring smile, John promised his son that he would return to him as quickly as he could, before climbing into the carriage and being driven away.
Thomas would never see his father again.
Four months into this journey, on a winter’s passage of the Alps, John Mutter died.
It would, of course, take weeks for the news to make its way to America. In Thomas’s mind, his father was still very much alive when the first alarming symptoms of his grandmother’s illness began to show.
Frances had been a martyr for many years to gout, a cruel and painful disease that caused various joints on her body—her fingers, her toes, her elbows, her knees—to swell painfully. The affected parts would turn bright red and become hot to the touch. She could scarcely stand for Thomas to be in the room with her when it got really bad, as air whipped up by his energetic body felt like a thousand needles piercing her skin.
But his grandmother’s health now seemed worse. As her body grew weaker, the pain grew more oppressive. A doctor’s widow, Frances tried to self-treat her ailment with food, drink, and rest, but nothing was working. Doctors were eventually called, and young Thomas could do nothing but watch as his grandmother endured the same treatments he’d watched both his parents suffer through: Her arms were sliced with small razors to “bleed out” her bad blood; heated glass cups were applied to skin to force out more “bad humors”; and unknown purgatives were given to her in liquid and solid form, causing her to vomit and her bowels to loosen and empty violently.
It was a truth that everyone in that era knew: Oftentimes the treatment was even worse than suffering with the disease itself.
Frances
Gillies lived just long enough to hear the news of the passing of her son-in-law, and to share it with her devastated grandson. Then she passed away too.
Thomas Dent Mutter was just seven years old, and every person who had ever loved him was dead.
• • •
Thomas Dent Mütter’s story is not so surprising if you consider that a man did not need a medical degree to practice medicine in early nineteenth-century Philadelphia. In fact, he didn’t even need a license—a practice that Philadelphia would not embrace until the final decade of the nineteenth century.
Although the tide was changing, the clear truth was that anyone who wanted to put out a shingle and call himself a doctor could do just that.
Even those doctors who followed due process—apprenticed under local doctors, went to medical colleges and studied hard, practiced often and kept as up-to-date as possible with the latest innovations—still struggled with the medical limitations of the day.
Medicine was performed literally in the dark. Electricity was newfangled and unpopular. Almost every act a doctor performed—invasive examinations, elaborate surgeries, complicated births—had to be done by sun or lamplight.
Basics of modern medicine, such as the infectiousness of diseases, were still under heavy dispute. Causes of even common diseases were confusing to doctors. Benjamin Rush thought yellow fever came from bad coffee. Tetanus was widely thought to be a reflex irritation. Appendicitis was called peritonitis, and its victims were simply left to die.
The role that doctors—and their unwashed hands and tools—played in the spread of disease was not understood. “The grim spectre of sepsis” was ever present. It was absolutely expected that wounds would eventually fester with pus, so much so that classifications of pus were developed: A “yellow ooze” was seen as a good “laudable pus” while an “ichorous pus” (a thin pus teeming with shredded tissue) was viewed as “the stinking herald of cadaverous putrefaction.”
Dr. Mutter's Marvels Page 3