Although the hyperbole and dramatics painted a nastier picture of surgery than he saw, it was true that Mütter shared some of the sentiments of those who criticized “radical surgery.”
Many of the surgeries he performed—especially the ones he did on the severely deformed—would most definitely fall under the category of radical, but Mütter had long preached that surgical intervention wasn’t needed for all cases that came to his doorstep.
This was a sentiment he felt especially strongly when it came to women, who—because of the enforced modesty of the time period—were more likely to come to doctors after it was already too late for treatment to be helpful.
In fact, Mütter was criticized for being cruel and inhumane for his opinion on the treatment of breast tumors, which he firmly believed should not be operated on, except in very specific circumstances. He simply didn’t believe there were nearly enough benefits to the surgical removal of a breast to outweigh the enormous negatives: the wretched pain of surgery and recovery; the inevitable infection that would turn the woman’s chest into a painful, throbbing wound leaking with foul pus; the days, weeks, months that the woman would be unable to leave her bed, to hug her children, or to sleep, eat, or love without searing, ceaseless pain.
But a woman is seeking your help, his critics would say. How merciless and cold must you be to refuse to aid her?
“To answer this question in a satisfactory manner,” he would reply, “it is necessary to investigate, first, the results of the disease when left to itself; and secondly, the benefits likely to accrue from the performance of an operation, its effects upon the progress of the disease, and its dangers. It is a melancholy truth that when left to itself this disease usually advances steadily, but with an unequal pace in different cases.”
He would then explain how, often by the time a lump in a woman’s breast has become so large, troubling, and painful that she would show it to her doctor, the cancer in the breast has likely progressed to all adjacent tissues, and—regardless of whether the tumor itself is surgically removed—would ultimately end in the death of the patient, who likely would see death at this point as “a welcome messenger,” having been for months of her brutal recovery “a martyr to unspeakable sufferings, and a loathsome object to her friends.”
“It is true, that some of the French, who adopt the view that cancer is invariably in its commencement a local disease, operate in cases where the English and American surgeons would hesitate to use the knife,” he would tell them, “but, as a general rule, they advise an early operation, before the system becomes involved, or none at all.”
But while this philosophy was grounded in rational and logical thought, even Mütter could not escape how difficult this decision inevitably is when faced with the distressed and frantic face of a woman who doesn’t know she will be dead soon anyway.
“It is urged by some, that we are justified [in performing surgery on] desperate cases, [to] escape the horrors of ulcerated or open cancer,” he said. “This is certainly a humane motive . . . where the patient is young, or has some especial reason for wishing the nature of her disease concealed, and is willing to take all the responsibility of the result upon herself, after having been made aware of the almost certain failure of the operation . . . and that she must die in a few months. . . .
“But, gentlemen,” he confessed to them, “whenever I have done so, it has been with an aching heart, and a most fervent wish that my patient had spared her surgeon and herself the terrible ordeal to which she is voluntarily subjected.”
To those who thought Mütter was of the camp that believed a surgeon’s knife could solve every problem, his opinion came as a surprise.
But Mütter’s students knew the truth. He had always taught them that “the knife promises nothing” and should be used only if the disease is caught early enough or if “it will serve to satisfy the patient in part, and prevent, to a certain degree, that terrible sickness of heart that overwhelms a poor sufferer when utterly abandoned by the surgeon.”
He shared the opinion of John Watson, an influential New York City surgeon who simply said: “Surgery . . . is a good thing, a useful thing, an excellent thing in its way; but too much of it is a great evil. And the sooner you find this out for yourselves, the better for your patients.”
• • •
The early years of the 1850s were a transformative time in Philadelphia—for its people, for its industry, and for its politics.
For Mütter, it was a time when, in so many respects, he was at the height of his power: a decade into his chair at one of the most prestigious medical colleges in the country; peerless in his ability to perform complex and visionary new surgeries; and an emerging yet powerful voice within the community whose opinions—though maybe not embraced by those around him—were at least heard.
But there was another side to this life, a painful truth Mütter could not escape: the increasing failure of his own body.
“The old axiom, mens sana in corpore sano (‘a healthy mind in a healthy body’) is full of wisdom,” he had told a class during a period of good health in the late 1840s, “and if there is one among you so unfortunate as to possess a feeble constitution, let me counsel him—as one who has dearly proven the misery of such a possession—to abandon the study of medicine at once, or at least until vigor and tone have been imparted to his frame.
“Without health,” he said bluntly, “the professional life of a man is one, long dreary night of suffering and disappointment.”
For the past year, Mütter had felt trapped in that “long dreary night.” There were more bad days now than good. He began to worry about how strained his body was becoming. His frame felt constantly fatigued. When his joints weren’t swollen with gout, they were stiff and painful to bend. In surgeries, his hands struggled to do what they once did so easily; movements that had been swift and light were now uncertain and laborious.
Mütter had trouble sleeping, trouble breathing, trouble putting on weight. His pale skin grew sallow, and his hair began to gray prematurely. He was spending a fortune on handkerchiefs because he had to constantly replace the ones that became irreparably stained by the blood he so frequently coughed up.
Mütter knew what he had to do: Go to Europe.
Throughout his career, Mütter had made professional visits to Europe—mostly to Paris and London, where he spent time with “numerous eminent friends.” It was his way of “rubbing up” on the latest medical innovations. He would visit hospitals, sit in on surgeries, and study and observe all he joyfully could. Mütter sometimes brought former students with him on these trips, allowing those young men he saw as being the most industrious and the most forward thinking to benefit from his reputation and stature.
One student who accompanied him on a European visit was amazed at how many doors were opened to him by Mütter, how he “was greeted warmly by the most eminent medical men of London and Paris, often meeting them socially, and attending, by invitation, their operations and consultations.”
To the European medical societies, Mütter was a bit of a celebrity: a dashing, outspoken, idiosyncratic American visionary. Even established American doctors would ask Mütter to be “favored by him with letters of introduction to distinguished medical men” and, after receiving such letters, “found them passports at once to the society and attentions of the recipients.”
And when in residence in a foreign city, his presence seemed “at once known among the numerous American health or pleasure seekers in Paris.” So though he was thousands of miles from his home, there were still throngs of people who both sought his company socially as well as wanted to be consulted by him professionally.
But Mütter knew this trip would have to be different. He had begun to feel a creeping fear about what was happening with his body. He wanted to address it—fully, boldly, and transparently—before it was too late and the damage became permanent. Or, wors
e—a thought he strove to chase from his troubled mind and from his devoted wife’s frightened lips—before it killed him.
This time, Mütter would arrive in Europe largely unannounced, and endeavor only to be among his most “distinguished and attentive friends,” esteemed doctors whom he trusted the most. In the confidence of their small offices, he would share with them the extent of the damage caused by the severe attacks of his “frequently recurring malady.” He would ask them for their advice, for their guidance, and, most importantly, for the truth.
• • •
Still, it was difficult for him to leave Philadelphia and the clinic he cherished so much.
He worried about the patients he wouldn’t be able to see, and whether, in his absence, their painful infirmities would be properly treated. He worried about his students, and whether their skills would slack or regress without his watchful eye. And he worried that the influence of doctors like Meigs might strengthen in his absence, stifling progress he had worked so hard to achieve.
While the sharply dressed yet ailing Mütter was tireless in his efforts to inspire Jefferson Medical College students, encouraging them to push further, dream larger, and move the profession forward, the grimly dressed yet robustly healthy Meigs would lecture them to instead stay “in the middle.”
In the speech he gave to the 1852 graduating class, Meigs proffered the following advice:
“You ought to conceive, therefore, of the tenor of a medical life as one subdued, and brought into conformity . . . ,” he told them. “I am far from recommending . . . habits of moping and dullness, but would have you shun all trifling and all frivolities, incommensurate with the dignity of your station, and the gravity of your concerns.
“You must go, in and out, before the people, daily; the boisterous laugh, the stormy carouse, and the discreditable spree are but evil antecedents of that visit . . . ,” he explained. “There is a just medium,” he flatly added, “and he is safest who touches neither extreme in anything.
“Therefore, we charge you: be good men, and learned men; join yourselves to every good work and purpose: oppose all evil; let your examples shine before all worthy men to encourage them,” he said, before adding this threatening conclusion: “Check and reprove whatsoever tends to the subversion of religion, of morals, of the public welfare in short.”
• • •
But what Meigs said or did didn’t matter—it couldn’t. Mütter felt he had no choice; he knew what he had to do. And shortly after graduation, he quietly left for Europe because he saw it as his “only means of securing relaxation and escaping the incessant calls for his services at home” and “his only hope for healing the same painful infirmities which always oppressed him.”
He was determined, now more than ever, to return a healthier, stronger man and continue the work he needed to do.
CHAPTER TWENTY-ONE
THAT BOURNE FROM WHICH NO TRAVELER RETURNS
Mütter, after Illness Had Set In
THE PHYSICIAN SHOULD BE AN HONEST MAN
Much injury is inflicted upon the profession by its members claiming too much for its power in controlling disease; we have taught the public to look upon medicine with a feeling near akin to superstition and awe; to rely upon our dicta as infallible, to suppose us in some way the positive arbiters of their fate; the dispensers of health and vigor, and even life itself. . . .
Let us hasten to disabuse them of this error.
Let us tell them candidly that, although our resources are in reality great, and that often, by their proper administration, dangers are diminished; yet without the help and blessing of Him who gives knowledge to the physician, and health to the sick, these resources are feeble and powerless!
How modest, and yet how true, was the reply of good old Ambrose Paré when complimented upon his skill in curing the Duke de Guise of his terrific wound:
“I dressed him, but God healed him.”
THOMAS DENT MÜTTER
When Mütter had first arrived in Paris twenty years earlier, he was wet and hungry and dashing about the streets madly trying to absorb all he could in the limited time he had. Now here he was returning again in his mid-forties, and he couldn’t help but reflect on how much things had changed—how much he had changed.
Thankfully, he no longer had to charm his way into naval ships to afford to visit Europe. There had been considerable improvement in ocean travel in recent decades, and Mütter now preferred to travel on luxurious ships managed by the Collins Line, which in 1850 began offering the country’s first transatlantic expeditions, connecting ports directly between the British Isles and the United States. The Collins Line could also boast that their ships were the biggest and fastest steamers afloat. But this luxury didn’t come cheap. A solo trip cost Mütter a thousand dollars, and that number would be bumped up to three thousand dollars if he needed accommodation for both himself and his wife.
The sea was now a comforting place to Mütter. The fresh, salty ocean air made his breathing easier and his joints feel more relaxed. Though his body still felt weakened and “at the point of breaking down completely,” his mind remained bright and alert and his ambition remained strong.
He had already decided on his next great project: “a full and systematic work on surgery.” This time, he would be the book’s sole author, and it would contain everything he had learned in his long career, as well as all the new innovations that had come to light in the years since he published his textbook with Robert Liston.
As soon as his health issues were resolved, he would spend the additional time in Paris gathering and arranging material for his new book. He felt buoyed just by the idea of it, and looked forward to the energizing beauty and sweet joie de vivre to be found only in the bustling streets of Paris.
• • •
Like Mütter himself, Paris had changed over the last two decades. It still filled him with the same awe, but he was reminded of how much those early experiences in Paris had formed him.
“Merely to have breathed a concentrated scientific atmosphere like that of Paris,” a peer of Mütter’s once wrote, “must have an effect on anyone who has lived where stupidity is tolerated, where mediocrity is applauded and where excellence is defied.”
It was a different Paris now, of course. Many of the physicians he’d seen as absolute masters had died, and his opinions of them—now seasoned with his own experiences as a doctor and a surgeon—had changed.
He was grateful for the sparks of inspiration these men had struck within him and for blazing the innovative paths that allowed him to do so much of the work on which he had built his whole career. But he was now harshly critical of how often these same visionaries seemed to treat their patients as cases instead of human beings. How they seemed to spend more time thrilling at conquering a difficult case or a particular ravaging condition than they did considering the impact—both emotional and physical—their treatments would have on their patients.
Mütter was eager to meet up with the circle of friends and doctors he had cultivated in the years since his first trip: smart, clear-eyed men who shared his compassion-based vision for transparency in medicine. It was such a relief to finally be back in their company, and he was hoping the advice he received from these men would help speed his recovery and get him back in solid health in time for the fall term at Jefferson Medical College.
But it didn’t take long to see that his ambitious hopes for the summer would not come to fruition.
He could see it in their faces—their expressions becoming more tense and concerned as the examinations continued. He tried his best to lighten the mood—cracking jokes and smiling through what was obviously painful. But it was no good.
He knew how difficult it was for them to tell him the news. He had been in their shoes many times, and always tried to remember what he had learned from his maternal grandfather’s friends in Alexandria: that a
bove all else, truth is what the patient needs to hear . . . no matter how difficult it is to be the one who must say it.
“Be honest at the bedside . . . In cases of great danger, when life is really at stake, unless some cogent reason forbids, it is the duty of the medical attendant to deal candidly and honestly with the friends of the patient or the patient himself,” Mütter would tell his students frankly. “Each one of us has some preparation to make, some kind word to utter, some fond embrace to exchange, ere he quits this ‘earthly tabernacle,’ and passes to that ‘bourne from which no traveler returns.’
“If the physician fails under these circumstances to discharge his duty, painful and heart-rending though it may be,” he explained to them, “the worldly affairs of his patient may, by his negligence, be left in irretrievable confusion; the happiness of a whole community may be destroyed; but, above all, he may become the direct agent by which an immortal soul is lost.”
Mütter taught that lesson so easily and often, without ever realizing just how soon he would be on the receiving end of it.
His physician friends told him what perhaps in his heart he already knew—his face thinning in the mirror before him, his hair slowly turning white, his once graceful hands now becoming gnarled and bent with disease, his lungs raw and rattling.
Mütter was dying.
Regardless of the pedigree or background of the doctors he saw, or how dutiful he was in following their optimistic treatments to the letter, or how many humble prayers he offered up in church, his body would still decline.
Death, it was explained to him, wasn’t a far-off if; it was a humbling and inevitable when.
• • •
Paris was still beautiful, despite the crushing news he had just received. It was still bustling and lively and loud. Its brilliant splendor didn’t dim at all in the heavy shadow of Mütter’s diagnosis. In fact, it seemed even more beautiful: the enormous stained-glass windows of the impossibly old cathedrals; the exquisite women of all ages glittering in new dresses as they glided along the promenade; the singular taste of a freshly made café au lait; the cleansing smell of summer rain hitting a sweltering street; the sight of young lovers, their whole future ahead of them, kissing hard in dark corners where they were sure no one could see them.
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