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Humanist Hero: A Medical Pioneer Healed Deformities and Innovated Plastic Surgery

Dr. Thomas Dent Mütter (1811-1859) was a pioneering physician who helped modernize surgical practice and innovate plastic surgery in the US. Here we interview Cristin O’Keefe Aptowicz, author of a new book about him, Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. Click below to hear the whole interview, or read on for an edited excerpt. (See more images from Mütter's collections on our Tumblr)

Sound Medicine: When Dr. Mütter started doing plastic surgeries in the early 1800s, why was it uncommon for people with deformities or serious injuries to seek treatment?

Cristin O’Keefe Aptowicz: In Mütter’s time you didn’t need a license or degree to practice medicine. You could just say you were a doctor and begin treating people. And medicine was not regulated yet either. People did not seek treatment often because it was a game of roulette whether your doctor was going to treat you in way that was helpful or if the treatment was going to be worse than your actual illness. And because of that, people who suffered from disfigurements or deformities from injury or accidents rarely sought treatment. Back then “monster” was a medical term... You would have people who were so deformed, they could not walk the streets and they couldn’t have a livelihood. This particularly affected women who were obviously extremely dependent on men in the 19th century. They couldn’t have homes; they couldn’t have jobs that would pay any sort of wage that you could live off.  So to be extremely deformed and a women was a double negative... I found letter after letter [from patients], which said “I would rather die on your surgical table than continue looking as I do.” These were the people who came to Mütter and these were the people he helped.

SM: And you’ve said he got the reputation as the one to go to for the most severe or odd deformities?

CO: Absolutely. Mütter specialized in a humanist version of surgery that welcomed people who thought they had no other option. One of the surgery techniques that he invented, the Mütter Flap Surgery, was for a very [common] type of deformity which was burned women. In that time period women wore a lot of restrictive clothing; it was corseted and tightly knotted and very flammable fabric and they worked in kitchens with open fires. It did not take that long for something to kick under their petticoats and light them ablaze and they would be trapped in a chimney of flames and their faces and necks would become horribly deformed. Frequently they were just hidden from society. They wouldn't even see a doctor even for that initial treatment and that became a population that came out in droves to be healed by Mütter. He figured out before anyone else essentially early skin grafting to rebuild their faces. Mütter thought this was his calling...He loved being seen as this person who could help this population that was hugely underrepresented.

SM: What are some of the other innovative ways he thought about medicine and modernized the practice of surgery?

CO: He believed that medicine was about alleviating human suffering. He had a humanist philosophy towards medicine that was decades ahead of his time. This was a time before anesthesia, so all of the surgeries were performed on patients who were awake. They had men who were actually paid to hold the patients down so they wouldn’t thrash and destroy the work the surgeon was doing. You have to imagine the 19th century mindset: When you're performing surgeries on people who are awake you don't typically empathize with that person. They're screaming and wailing and begging you to stop but you know you have to continue the surgery in order to help them. But Mütter was painfully sympathetic to his patients. And because of that, he created many surgical innovations that were ahead of their time that kept the patient in mind.

He believed strongly in preoperative care. He spent a lot of time massaging and working with and desensitizing his patients so surgery was less painful for them.  And [he believed in] postoperative care which back then was really not heard of—they didn't have recovery rooms. So after surgeries were done they would put you in an unsanitized carriage and send you across the cobblestone streets with all of the delicate stitches tearing apart. He insisted that they build recovery rooms at the college he taught at. They refused and he just rented out rooms above a restaurant so that his patients could be under his care until he believed they were fully enough healed to go home. And again these were all revolutionary things.

SM: And what about anesthesia?

CO: He was a huge proponent of ether anesthesia. During his career anesthesia surgery was invented. He was the first surgeon in Philadelphia to perform it on December 23, 1846 and it was hugely  successful. Within months it was banned from hospitals. They thought it was a Satanic influence that “robbed men of their will of reason” And he had to fight extremely hard to have people take it seriously. Mütter fought hard to have the basic tenets of what we see as modern medicine: cleaning your hands and tools, patient care and anesthesia surgery.

SM: Mütter is known for the Museum of Medical Oddities that bears his name in Philadelphia and that grew out of his personal collection. Why were these specimens collected? 

CO: They did not have photography [in Mütter’s time] and it was actually extremely rare for medical schools to use live patients in their teachings. So how would you teach medical students about the wide variety of medical cases they could come up against in the length of their career? And the answer was you would have these unusual specimens in jars, dried, infused with wax; and you'd have wax models and really gory illustrations. And you'd save them so you could show students--if you ever come across conjoined twins at birth, or a giant colon. And in fact they do have a mega colon in the Mütter museum that was nine feet long. It was removed from a man known as the human balloon.

SM: Does Mütter’s legacy live on, beyond the oddities in the museum?

That entire time period was such a revolutionary time in medicine. They had the tools in front of them to have modern medicine, but they just couldn’t put all the pieces together, like having ether anesthesia, but not knowing about germ theory. Mütter’s curiosity and his interest in his patients fueled this path that opened up medicine for generations of doctors. He died very young at the age of 47, but his influence lives on, not just in the museum that bears his name, but also in the surgical innovations that are still being used today and the institutions and discoveries that were created by his students. It's an amazing story.