The Doctor Who Unmade Monsters

While today the term ‘plastic surgery’ conjures up images of perfect noses and tummy tucks, smoothed wrinkles and breast lifts, the beginning of plastic surgery wasn’t rooted in the desire to enhance beauty. It was a means to bring victims back from the brink.

That’s because the first patients of plastic surgery had birth defects or physical deformities so horrific, the people bearing them were considered monsters.

Think bulbous facial tumors. Burns that rendered the sufferer nearly unrecognizable. Cleft palate cases that left the lips and mouth raw and open, often with thick cords of spittle pouring from the opening.

These were people who wouldn’t have been accepted in polite society. People who were shamed, shunned, or feared.

In the United States in the early 19^th century, one physician emerged as the forerunner in what the French at the time were calling la chirurgie plastique. ‘Plastic’ seems a strange word here, but in French it translates to ‘easily shaped or molded.’ It was a descriptor of hope, one that promised that physical atrocities could be, with careful study, altered or removed with surgery.

Dr. Thomas Mutter in the 1840s.

The physician’s name was Dr. Thomas Mütter. Unfortunately, he’s been largely forgotten.

Mütter was a clever, forward-thinking young man. In 1831, after graduating with a medical degree at the age of 20, he went to Paris and trained under the best surgeons in a new field of radical surgery. Under the great Guillaume Depuytren and Jacques Lisfranc de St. Martin, Mütter watched in amazement as these skilled men performed innovative procedures done on patients who were born with or had developed physical deformities or were the victims of fierce battle or tragic accidents.

By the time he left Paris, Mütter knew what he wanted to specialize in: reconstructive surgery.

I happened upon Mütter’s fascinating story when I read Dr. Mütter’s Marvels by Cristin O’Keefe Aptowicz. It’s 300-plus pages of history that reads like a novel. I was fascinated with Mütter and the gothic elements that so dominated medicine at the time: operating theaters, the study of anatomy, preserved specimens in jars.

The school that Mütter graduated from in Philadelphia, the University of Pennsylvania School of Medicine, was the first medical school in the United States. It was founded in 1765, a decade older than the country itself. It would be another sixty years before Jefferson Medical College was established, and it was there that Mütter would change so many lives for the better.

In its first year, 1826, Jefferson enrolled an impressive 107 students—not bad for a school that, in its nascent years, had to rent a theatre for space in which to teach. Soon, due to its impressive faculty, innovative lecture courses, and an ever-increasing roster of students, it was a formidable rival of the University of Pennsylvania. Notably for the time, Jefferson promised the all-important cadaver to each student which was crucial in the study of the body.

Jefferson College in the early years at Tivoli Theatre

By 1841, the chairs of the various departments—including surgery, anatomy, obstetrics, and pharmacology (called materia medica)—were occupied by some of the most brilliant minds in medicine. Mütter, who was then 30 years of age and had only been practicing medicine for ten, was elected to the prized chair of surgery. He was the youngest among them. It’s clear the board saw something special in him from the start.

The doctor differentiated himself immediately. He was talkative and amiable at a time when teachers didn’t often interact with students in such a way. He was also a master lecturer who would call upon his students. He welcomed discussions and questions. He learned his students’ names (again, quite unusual).

His students loved him for it.

Mütter was also a bit of a showman. He was known to wear rather flamboyant dress in striking shades and go about town with his wife in a fancy carriage driven by a servant in livery. For a man who’d lost his parents and only sibling when he was very young and had been sickly for most of his adolescent years, perhaps this was a way to celebrate that he was alive and thriving.

And yet he wasn’t the least bit vain. He would demonstrate in his treatment of patients—whom he operated on in a surgical amphitheater before students—that he was exceedingly trustworthy and compassionate.

Before surgery, he informed each patient what to expect. While this practice is normal today, it was very unique back then. Mütter would explain the surgical risks—loss of blood and excruciating pain (anesthesia wasn't used yet), and what to expect in recovery. Infection was common, as germ theory was yet to be born.

It's important to note that by the time many of these unfortunates came to him, it was their last-ditch effort. They were prepared to suffer whatever it took to restore their lives, even if the surgery ultimately proved fatal. They’d been shunned too much, ostracized too long. Reconstructive surgery offered a chance at a new life and it was a risk worth taking.  

On patients with deformities such as cleft palate, tumors, and club foot, he would work the skin around the area to relax the tissue and muscle weeks before surgery. He also insisted, post surgery, each patient rest in the school’s clinic because—believe it or not—it was common practice to place patients in hackneys directly following surgery and send them home. It would be years before he was able to convince the college of the need for an overnight space to watch over patients who’d undergone the knife.

A burn victim's progressive surgical stages

Mütter was remarkably ambidextrous and known for speed during surgery, skills he honed to prevent as little suffering as possible. In fact, grain alcohol was the only relief offered to assuage pain until ether came along.

In the late 1840s, he was the first surgeon in Philadelphia to use it (on a man with a tumor of the cheek). At last there was a way to safely eliminate pain during surgery. Mütter enthusiastically incorporated the administration of ether into his surgical curriculum and he never operated without it again.

His surgical successes—his way of unmaking monsters—became so well known that word spread, and patients began to come from all over the United States. As long as they agreed to allow students to observe the surgery, Mütter operated free of charge. But it wasn’t only his surgeries that made him successful, it was his innovations.

For example, the Mütter flap—a skin grafting procedure used on burn victims—is still used today.

While Dr. Mütter was making strides in reconstructive surgery, he was also collecting what he called 'marvels.' Giant skeletons, tiny gall stones. Tissues and tumors. His finds ranged from authentic dry and wet specimens, to models created in wood, wax, and paper-mâché. His assortment included Madame Dimanche (a wax head reproduction of a woman with a horn growing out of her forehead), the Human Balloon (a man whose colon was the size of a cow), and Soap Lady (the body having turned to a waxlike substance that didn't decompose after death). His goal wasn’t to ridicule or exploit those who’d endured such things, but to show his students that these physical anomalies could be understood, explained, and in many cases, remedied.

He endeavored to show that, despite our differences, we all have a shared humanity.

Mütter regretfully stepped down from his position at Jefferson Medical College in 1856. Consumption (tuberculosis) had plagued him for years and his health was declining fast. As his condition worsened in the last years of his life, he wondered what would become of his marvels—some 2,000 specimens—he’d amassed over the years. He wanted them displayed in a museum for students and doctors.

The Mutter Museum circa 1880

Naturally, his first choice was Jefferson College, as the school’s anatomical museum had existed there for fifteen years. The issue was space. Eventually, the College of Physicians of Philadelphia (not a school but a professional organization) agreed to accept Mütter’s collection.

Tragically, Mütter died of consumption in 1859. He was only 48 years of age. Two years later, the College of Physicians started construction on the building that would become the Mütter Museum. It opened in 1863.

If you’d like to know more about Mütter’s collection, I highly recommend a visit to the Mütter Museum in Philadelphia. It still exists! It’s a fantastic portal into early medical history. Though it has changed locations a few times, the museum remains the repository of Mütter’s extensive collection. It also has more modern additions--like a slide of Albert Einstein's brain and an iron lung from the polio era.

The exterior of the Mutter Museum today

Both Mütter’s work and his collection remain

testaments to the human condition and what he tried so hard in life to achieve: the alleviation of human suffering.

 If you’re interested in a fictionalized tale of Dr. Mütter, Jefferson Medical College, and a mystery surrounding it when a young female artist comes to work for him, check out my latest novel, Needle and Bone.