Review: Dr Mütter’s Marvels, Cristin O’Keefe Aptowicz (2014)

When you think of plastic surgery an image may spring to mind—of heavily botoxed celebrities, or subway commercials for breast enlargements, or Rachel Green pre and post nose job. But Cristin O’Keefe Aptowicz’s engrossing biography of nineteenth-century surgeon, and a plastic surgery pioneer, Thomas Dent Mütter may make you think of the practice entirely differently.

Cristin O’Keefe Aptowicz (1978-)

Mütter (1811-1859) lived in a time when those with ‘deformities’ were outcasts, when birth defects that are fixable today (e.g. cleft palates) determined the course of your entire life, when burns victims were ‘monsters’, kept hidden away from the world by their ashamed families, when terrible conditions in match factories led to ‘phossy jaw’—working class women suffering from painful abscesses, potential brain damage and, ultimately, if left untreated, death.

And he brought them comfort. Mütter’s skill and surgical innovations transformed and saved the lives of many. He removed horns and unsightly tumours. He let burns victims turn their heads (and face society) again. He developed so-called Mütter flap surgery, a technique that survives until today, where flaps of skin remain partially attached to one area, while being grafted onto another, ensuring the body does not reject them.

How Mütter transformed the lives of burns victims

Aptowicz gives us Mütter the ambidextrous maverick, Mütter the innovator, who had the foresight to believe in the importance of hygiene in the surgery room and the crucial nature of patient pre- and post-operative care, and Mütter the teacher—he was the Chair of Surgery at Philadelphia’s Jefferson Medical College (now Thomas Jefferson University) from 1841 until 1856, when poor health expiated his retirement.

But she also gives us Mütter the orphan, who made his way to Paris with very little money to learn from the century’s best physicians, Mütter the dandy, who always had a weakness for extravagant dress, and Mütter the collector, whose lifetime’s store of specimens and oddities went on to form the basis of the museum that now bears his name.

A woman suffering from 'phossy jaw'

Mütter’s story, and the history of medicine more generally, is revealing of many aspects of nineteenth-century American culture. There is, of course, the backdrop of racial tensions and impending civil war (his students would go on to be physicians on the battlefield on both sides of the conflict). There are the attitudes towards women—excluded from the medical establishment, while obstetrics is one of its most important branches, due to the high levels of maternal, and even higher levels of infant, mortality at the time. There’s a particularly gruelling section dealing with the realities of nineteenth-century abortion, and the case of Eliza Sowers, which would go on to have huge ramifications for the legal debate around termination and the ‘personhood’ of the foetus.

To contrast with Mütter, Aptowicz spends a lot of time delving into the life and opinions of his fellow lecturer Charles D. Meigs, Chair of Obstetrics at Jefferson College, who was staunchly conservative in his views. Unlike Mütter, Meigs refused to recognise the role doctors might play in contagion, even as his patients were dying from outbreaks of puerperal fever and his industry peers started to posit theories that would be proven by the advent of microbiology. Meigs also opposed the use of ether, the first anaesthetic (while Mütter was the first to use it for an operation in Philadelphia). He preferred to operate on his patients without any form of pain relief and delivered babies without it, even as women begged for relieving gas, as he saw labouring pains as a God-given trial for his female patients.

Thomas Dent Mütter

Aptowicz’s biography could have come off as macabre and voyeuristic, the literary equivalent of a nineteenth-century freak show, but throughout she remains true to the humanity of her subjects, using the same care with which Mütter treated his samples, which he often ‘saved’ from being seen as horrors to form part of his educational collection. But it’s a shame she hasn’t more information to delve into about Mütter’s personal life. While his views on medicine, and his personality as a teacher, come alive throughout, his relationships, especially with his wife Mary, are still shrouded in obscurity.

Mütter died when he was forty-seven but his life had a profound effect on the medical establishment, his patients, his students and Philadelphia. ‘Ambition…is like the sun,’ he wrote. ‘It gives life and heat to all around.’ Aptowicz’s work shows us just how far ambition (if you were an educated white man) could take you in nineteenth-century America, in spite of poverty, ill health and bad luck, and how much we owe to pioneering doctors like Mütter in medical practice today.

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