• • •
Mütter was the first professor to introduce this informal style of teaching—referred to in Europe as the Edinburgh “quizzing” system—into the United States. While the other professors at Jefferson Medical College continued to give lectures traditionally—a one-way conversation with the students—Mütter’s method was to actively engage with them. Instead of simply telling the students what he knew and leaving it at that, he engaged in an almost Socratic dialogue with them, challenging them with questions designed to tap into their instincts—and sometimes their biases—before telling them, or often demonstrating for them, the correct line of thinking. And then afterward, he would “quiz” them again to make sure they absorbed the lesson. It was something American students had never encountered before, and it proved extremely effective.
“I can well remember him in my student days, as he stood in yonder amphitheatre, beloved, nay almost worshipped, by his class,” a former Jefferson student would later recall of Mütter. “His observation was quick, and he never failed to note at a glance the effect of his words, even upon the dullest listener . . . he always strove to lecture up to his highest mark, for he was conscious of his powers, and fond of that public approbation which their exertion invariably brought him.”
Mütter’s reputation as riveting lecturer also partly owed to his habit of bringing specimens to class, those he kept safely stored at the school’s anatomical museum as well as those from his personal collection. And to his students, the volume of diagrams, models, and specimens collected from around the world seemed nearly limitless. There didn’t seem to be an injury, disease, malady, or treatment for which Mütter couldn’t seem to produce a relevant sample, and he would weave these specimens into his lectures masterfully, “so as to impress yet not confuse.”
This was, perhaps, the great hallmark of Mütter’s vision of what it meant to be a teacher. While many of his peers on the faculty adored the distance and superiority they felt as professors—that powerful chasm that separates the learned from the learners—Mütter was devoted to shrinking that very same gap. He was fiercely invested in presenting lectures that engaged with students, but his command of his subject matter also allowed him to change his lectures on the spot, if doing so would better follow the interests of his class.
“[Mütter’s] kindness and enthusiastic devotion to the interests of the student, his brilliant eloquence, his finished and clear style, and polished, gentlemanly manners, gained for him the love, admiration and respect of the class,” another former Jefferson student would write. “It has been frequently the case that medical teachers . . . have a distaste for the slow inculcating of elementary matters or principles, but delight to revel before the bewildered [student] about some of the latest theories, or expatiate at length upon other complexities which are to him incomprehensible. With Dr. Mütter, the solid groundwork of the great superstructure was laid before the student in such a plain and impressive manner, as to be clearly understood by him, before he was led up to its more complex and ornate developments.”
But if Mütter’s warm treatment of students—bright young men who paid for the privilege to be taught by him—seemed alarmingly odd to some of his peers, they would be even more ill-prepared for how he would treat his own patients.
CHAPTER NINE
THE RIGHT ARM OF THE COLLEGE
“The Pit”
George McClellan founded Jefferson Medical College with the insistence that it include the country’s first collegiate clinic, a medical facility where students could watch as their professors treated actual patients. The clinic—which accepted patients in need of both medical and surgical care—was a prominent feature in the weekly curriculum.
The people who came to the Jefferson Medical College clinic to seek treatment were mostly those who were too poor to pay for it elsewhere, but a significant number were members of the working and middle class whose complicated cases required a professor’s skill. But there were no restrictions on who could add their name to the list of potential patients for use as teaching examples. And what started off as a strange idea to both the medical community and the pool of potential patients was soon embraced by both.
Within months, patients were eagerly lining up for the opportunity to receive effective treatments (even if they did have to receive those treatments in front of a room full of strangers dutifully taking notes), and the American medical community would embrace Jefferson Medical College’s teaching clinic as an important and necessary advancement in the education of physicians of every stripe.
The clinic had already become an emblematic “stamp” of the school by the time Mütter first stepped into its operating room. It was often referred to as the right arm of the college, and the board that hired Mütter felt his charismatic and ambitious surgical lectures would only serve to bring the clinic to new heights.
“Brilliant as Dr. Mütter was in his didactic teachings,” one of his students later wrote, “he surpassed himself in the clinical arena.”
And yet almost immediately upon first stepping into that arena, Mütter saw things he wanted to change . . . and it didn’t take him very long to begin taking steps to change them.
• • •
Mütter had already developed a healthy medical practice of his own by the time he became a professor at Jefferson Medical College. His reputation, his charm with his patients, and his undeniable skill had attracted a large following of his fellow Philadelphians—citizens of every class who sought out his talent and his help. But it was more than just his quick fingers and attentive eyes that drew people to him.
Mütter’s methodical nature and utter focus before, during, and after the surgery was unprecedented—as was the amount of empathy and kindness he displayed for those under his care.
Many nineteenth-century physicians considered it a necessary part of their job to keep their patients in the dark about what exactly would be done to them during treatment. Surgeons especially felt that once the patient had agreed to an operation, it was their responsibility to the patient to proceed with the operation no matter what . . . no matter how loud the patient might scream in protest throughout the procedure, or how violently he or she struggled or resisted, verbally or physically.
Mütter, on the other hand, believed in transparency. Inspired by his own experiences on the other side of the doctor-patient relationship, Mütter faithfully explained to patients about their medical circumstances, and gave them their options plainly and clearly. He did not downplay the risks they might be taking, or the pain they would likely be tasked to endure.
While other members of the medical community—including some among his school’s own faculty—assumed that patients would be scared away by this sort of frank dialogue, Mütter saw firsthand that his patients were grateful for it.
Furthermore, Mütter was known for putting “considerable emphasis” on the care and attention he paid to patients prior to performing the operation. He would not only develop a bond with the patient via gentle, consistent communication, but would also physically as well as mentally prepare them. He showed them the tools he would use, and he began to get the body parts slated for surgery “accustomed to manipulation,” by massaging each by hand and touching the most sensitive areas with clean surgical instruments or fingers for several days prior to the operation. It was a unique approach to medicine, one that Mütter seemed to have invented out of whole cloth.
Professional distance was the standard in American medicine and elsewhere. Even the French surgeons Mütter held up as heroes were famous for the callous manner in which they treated their patients. Guillaume Dupuytren—the French surgeon whom Mütter admired most, and whose technique he studied extensively during his time as an interne in Paris—was accused of treating his patients worse than one would treat livestock when it came to presenting them before his students.
“If his orders are not immediately obeyed, [Dupuyt
ren] thinks nothing of striking his patient or abusing him most harshly,” remembered an American medical student studying in Paris. “A very favorite practice of his during his consultation is to make a handle of the noses of his patients. Whenever a man enters with any disease of the head, he is immediately seized by the nose and pulled down onto his knees where he remains half in sorrow and half in anger at the treatment until he is allowed to rise and describe his disease.”
But it wasn’t just preparing for his surgery in which Mütter invested his time. He also believed strongly in aftercare, ensuring that the difficult work he did as a surgeon would not be undone later by simple infection, the tearing of delicate stitches from careless movement, or any other preventable calamity. He examined his patients several times a day after surgery, checking and cleaning their wounds, deciding new treatment strategies and even strictly monitoring what the patient ate or drank—not just the types of foods and beverages, but their volume and frequency as well.
Because of this care, Mütter’s work and reputation rose above that of his contemporaries. He took on the abysmal realities of nineteenth-century medicine—the need to perform incredibly complex surgeries on patients who were wide-awake, in unsterilized environments that were lit only by candle, lamp, or daylight—yet he was still able to heal the sick and restore the wasted and withered to strength and health. And when it came to his plastic surgery, he could transform the deformed to wholeness.
Jefferson Medical College’s surgical clinic was housed in a beautiful amphitheater. It was a large, well-lit space with a sizable surgical table in its center. Students sat in rows of wooden benches, which encircled the main “stage” in increasing heights to ensure everyone had a good view. The dark wood was kept cleaned and polished. Numerous lamps cast a golden glow over the room and its tense occupants. The clinic was a pride of the school, a true jewel in Jefferson’s crown.
Jefferson Medical College’s Operating Table and Surgeon’s Amputation Kit
Mütter saw it as incredibly lacking.
It wasn’t the surgical amphitheater itself that drew his ire. Of course, he felt honored to be performing his craft in a space that was so beautiful, so cared for, and so well lit. Rather, he disliked the implication that the surgical experience was limited to just that one room—the operating room. It seemed to utterly ignore the important and various facets of surgical treatment that Mütter deeply valued and which took place outside of the room’s narrow confines.
Mütter was appalled to learn that after patients underwent operations before the students in the amphitheater of the college, they were sent immediately home in a carriage. There were no recovery beds—let alone recovery rooms—where patients who had just endured painful surgeries could rest and receive further care and observation.
It didn’t matter if the surgery was simple or complex, if the wound was tightly sown or strained and weeping, or if the patient felt well or disoriented. Regardless of their condition, they would be put into a rarely cleaned carriage whose wooden wheels would clatter and jump against Philadelphia’s uneven cobblestone streets for as long as it took to reach their destination.
Mütter could hardly imagine a more cruel follow-up to the emotional and physical trauma of surgery.
It was enough that patients had to endure the operation itself; to then subject them to the risk of infection, injury, and completely unnecessary pain by transporting them home without rest seemed needlessly brutal, in addition to being completely and medically unhelpful.
To Mütter, the solution seemed obvious. Jefferson Medical College should build its own hospital—a teaching hospital that could be the first of its kind in the country. But since that would take some time, a temporary solution would be to rent some rooms in the area to serve as the recovery rooms that were so desperately needed.
He shared his idea with his colleague, Dr. John Kearsley Mitchell, the chair of medicine, whom he thought might be a friendly ear. Mitchell was eighteen years older than Mütter, but they were both native Virginians who shared a Scottish ancestry.
John Kearsley Mitchell
Mitchell—a handsome man, tall and portly, with a gentle, polished bearing—was born into a family of doctors. Not only were his father and grandfather doctors, he would have a son and grandson who would become physicians too.
But he was far from conventional. He wore his brown hair severely combed from left to right, which gave the unfortunate impression that he was trying to cover up a bald spot. He often wore a scarab ring on his left middle finger, a souvenir from his “oriental travels,” and relished how people would “imagine the thrilled mystery centered about this ring.” Indeed, Mitchell had spent several globe-trotting years on a merchant ship bound to Calcutta and Canton, before settling in Philadelphia as a practitioner.
Mütter liked how much Mitchell was invested in the lives of his students, how they often considered him their friend and not just their professor.
“In sickness and trouble, they turned to him, and they never sought his aid in vain,” it would later be written of Mitchell. “Many a poor young fellow, struggling in the vortex of a great city’s temptation, has he sustained by his wise counsel and kindly sympathy. Many a needy student has he helped from his own purse, and none the wiser.”
Mitchell was more than just a kind teacher; he was a thoughtful and pragmatic physician. He was also among the first advocates of the germ theory of disease, the idea that some diseases were caused by organisms too small to see with the human eye which invaded humans, animals, and other living hosts, and it was the growth and reproduction of these organisms that caused disease.
This theory flew in the face of the common prevailing thoughts on the subject—especially the long-standing miasma theory, which pinned the cause of many diseases on “bad air” the infected person had breathed. When epidemics broke out, doctors did not think diseases spread because the infection was passed from person to person. Rather, it was broadly assumed that all parties infected had breathed the same poisonous vapor or mist, and doctors claimed this bad air was incredibly easy to identify—and thus avoid—because of its foul smell.
Mütter believed that Mitchell’s forward-thinking philosophies might make him a fantastic ally in convincing the board to expand its one-room clinic into a decent hospital, where the patients could be protected and cared for properly . . . and Mütter was right.
Together, Mütter and Mitchell worked toward their now shared vision. Between the two of them, they were able to find a building with grounds close to the college that could easily be repurposed for a hospital and that was available for purchase at minimal cost. Mütter was elated at this development and immediately put forth a petition that the Jefferson Medical College board move forward with the plan as soon as possible.
But the petition was summarily rejected. The board felt that building a collegiate hospital was simply unnecessary, and no amount of persuasive argument from Mitchell or Mütter could change their minds. It was a crushing blow, especially to Mütter, who could not hide his frustration with the decision.
“Mütter, he of the musical voice and charming personality, Mütter, the debonair, the eloquent, the enthusiastic, the beloved of the class,” a Jefferson Medical College alumnus would later write, “had wished the institution to build a hospital in 1841, but was defeated by the stupidity against which . . . even the gods fight in vain. . . .
“But that didn’t diminish his love of Jefferson,” he added, “and the potential he saw.”
“In his love for the Jefferson College, in his pride in its present, in his faith in its future, [Mütter] was second to none,” another former student wrote. “He believed that the Institution was second to none. He believed that the Institution was entering a great era.”
Unable to teach the way he wanted to in Jefferson’s legendary surgical clinic, Mütter simply decided to perform surgeries elsewhere.
&nbs
p; He knew Jefferson Medical College had a relationship with the Pennsylvania Hospital and so he would take whole classes to witness surgical lectures in a space that he thought was better suited for it.
The classes at Jefferson Medical College were large; Mütter needed an equally large way to transport them. His solution was to rent the biggest omnibus he could find—pulled by three horses with seating on top as well as inside of the vehicle. Nonetheless, students often had to crowd in to ensure that everyone could fit. The sight of so many students piled into one vehicle, bustling and shouting as they made their way across the cobblestone streets, proved to be more comical than academic. “This disorderly transportation was an event of great delight to all small urchins on route,” one student later recalled, “and afforded in winter, as I well recollect, inestimable chances for snowballing and boyish sharp-shooting.”
Mütter’s care, attentiveness, and willingness to engage made him a favorite with his students and his patients, but he was also earning the respect of some of his peers on the faculty, especially Joseph Pancoast—whose position as chair of surgery Mütter had usurped.
At first glance, Pancoast was an intimidating sight. A large man in both height and weight, his face was obscured by his thick wavy hair, which curled at his temples. His eyes were overwhelmed by heavy eyebrows, his cheeks and chin were obscured by a variety of unkempt beard and mustache combinations that he audaciously trotted out. Being an active surgeon and anatomist, Pancoast always chose to dress for ease of movement, not for style. In fact, even formal portraits of him often show his tie and clothing askew.
But while the sharply dressed, cleanly shaven Mütter and the hirsute, slovenly Pancoast may have differed in their approaches to fashion, they found ample common ground in their philosophies about teaching medicine.
Like Mütter, Pancoast took great pains to teach the very complicated subject of anatomy in a way that allowed his lessons to be absorbed easily and quickly.
Dr. Mutter's Marvels Page 9