For more than 150 years the Mutter Museum of the College of Physicians of Philadelphia has housed a collection of medical and anatomical oddities, such as the complete skeleton of a man who suffered from fibrodysplasia ossificans progressive disease, which caused his muscles and tendons to ossify, Albert Einstein's brain, and 139 human skulls. It's one of the world's more impressive medical museums, but it's namesake doesn't even have a Wikipedia page.
Poet and writer Cristin O'Keefe Aptowicz grew up in Philadelphia hearing about and going to the museum without ever knowing who this Mütter was. She spent nearly 15 years finding out, resulting in last year's Dr. Mütter's Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine, a biography of the fascinating life of Thomas Dent Mütter, who in his 48 years rose from being a tubercular orphan to one of the most celebrated surgeons of his era, whose empathy for the people he operated on spurred new ideas in patient care. Aptowicz stops by Barnes & Noble Johns Hopkins University Tuesday, Sept. 15, for a reading and book signing.
Though Aptowicz knew fellow Philadelphians might be curious about the man behind the museum, she had no idea Mütter's story would be embraced so strongly. "You know, my mom knows a lot of people, so they might buy the book," she says with a laugh during a recent phone interview, before adding that Dr. Mütter's Marvels went on to be a New York Times best-seller, in addition to generous reviews from NPR, The Onion's AV Club, and the Los Angeles Review of Books. "I'm so grateful that the things I found so powerful about Mütter and his life seem to have been embraced by all different types of people."
The Hub caught up with Aptowicz to talk about what a poet can bring to medical history, Mütter's medical innovations, and what surgery was like before germ theory and anesthesia.
I read that you first visited the museum in fourth grade, wrote a biographical screenplay about him, and then spent a great deal of time researching his life and work for the book. Could you tell me what about him grabs your attention—how do you go from being fascinated by the "marvels" of the collection to wanting to know more about Thomas Dent Mütter himself?
I grew up in Philly, so the Mütter Museum was always a part of my childhood. And even before you visited it, you heard rumors about it from the older kids in your school and visiting it was a rite of passage. And it wasn't until I went to college at NYU that I began to get questions about why it existed. People had heard about it but never visited. And I realized that as much as I'd gone there I did not know really who Mütter was—Was it a man? Was it a family? Was it an acronym? I had no idea.
I was also paying my own way through college so I was always on the lookout for scholarships and fellowships. And my senior year, the Alfred P. Sloan Foundation offered a fellowship for the best screenplay or play written about the life of a scientist or scientific discovery. I'm a nerd, I figured this is the first year they're putting it out, the pool of applicants will be very small, even if I just research and write something over a few months, I bet it would have a chance. I just need to have a scientific story that maybe no one has heard before—and that's when I thought about Mütter.
It was the early days of the Internet, and I looked up the story behind the museum and there was nothing there. To this day, he doesn't have a Wikipedia page. So I wrote the then director of the Mütter Museum, the fabulous Gretchen Worden, who passed in 2004, and I said, "I know I'm an unlikely person to allow access to your medical archives—I'm a screenwriting student, I run a poetry slam out of the basement of CBGB's—but I'm a native Philadelphian and I'm interested in this story and I just want to see if there's anything there." And in the spirit of the Mütter Museum, which is very open and accepting and wants people to be curious and seek them out, she said, "Of course, you can have total access to anything you from the museum and its library." That was December 1999.
And for me, the first time I began researching him and realized what a fantastic and curious person he was, the idea that his story was not known became a real itch for me that I wanted to scratch. For a long time I didn't think that I would be the person who would get to write this story. I'm a nontraditional historian. I'm a poet. My previous book was a history of the poetry slam movement. And I didn't think a person like me would be allowed to write a story like his. But I realized that was all me—the medical community welcomed me. The museum and archives all opened their doors to me. And it wasn't until I finished the poetry slam history, called Words in Your Face, that I realized I could do this. And the museum said, "We would love to help you in any way." So we began jointly applying for grants and fellowships, and it was in 2010 that I got the University of Pennsylvania writing residency and got a year to focus on the writing, which was the beginning of what would eventually become the book.
Mütter's name is associated with the museum's collection, but as you write about, he was a pioneering surgeon renowned for his work on people with so-called deformities. What drew him to this specialty—the surgical challenge, the people who were living with these conditions, or a combination of the two?
He was a really interesting guy. His parents both died, and then his brother died, then his grandmother died. He was an orphan, alone at a young age. But even at a young age he was always trying to stand out. He charged his school for fanciful clothing and then earned academic scholarships to offset his clothing bills, but he always wanted to be noticed. And when he was in his late teens, he realized he wanted to be a doctor and that was the way he was going to stand out in the world. But in that time period in America, the only way to be in the wealthier, established ranks of a doctor was to be born into that class—you're taking very personal histories and examining people and you want to know the person who is doing it. The only medical career where you could rise based solely on your talent was surgery at that time period. This was before anesthesia, and as I like to say when I give talks, if you're getting your leg cut off you don't care if the guy knows your dad. You care that it's done quickly, safely, and that you survive the surgery.
So Mütter realized that if he was going to be a renowned doctor, it was going to be as a surgeon. When he went to study surgery in Paris he fell in love with opérations plastique, plastic surgery, though we would probably see his work as reconstructive surgery. The population that this area served was largely ignored by medicine because who would volunteer to have surgery if you didn't need it, if you're going to be awake during it. And frequently the surgeries as delicate as Mütter performed, you couldn't drink wine or any alcohol whatsoever because the amount of blood you were going to be shedding during the surgeries, it couldn't be thinned out by alcohol. So you were going to be stone cold sober for a very long surgery. So I think it was a very dramatic challenge, something no one else was doing. He was one of three best known plastic surgeons in America and the one that did the most radical work.
So I think he both saw it as an opportunity to make himself stand out but he was an enormous humanist. Having been ill throughout his entire childhood, he was described as being painfully sympathetic with his patients. I think he understood what it was like to have your life be out of control because of health conditions that you could not have helped. And I think that he loved that these people came out of the darkness, came out of hiding, and sought him, and that he could help them. In addition to the standard work he did, he created innovative surgeries, some of which are still used today, the Mütter flap surgery perhaps being the way most surgeons know the name Mütter. So I think it was a combination of the instinct of wanting to stand out and then the relationship he got to have with these people that I think he felt a kinship to. When you are orphaned the way he was and shuttled around, you feel like a monster yourself, a freak that no one else can see. I think that's perhaps one of the reasons he dressed so flamboyantly, to match the sort of outlier feeling he had about himself. But I think he really fell in love with the population he helped. And certainly toward the last years of his life it became his mission to almost dissolve his legacy as this brilliant, idiosyncratic surgeon because he didn't want that population to be left without treatment. If people thought only he could perform these surgeries, then they would be without help. So he became a wünderkind and then told everyone that's not true–anyone can do this. That's one of the reasons I think he's not better remembered today.
And his innovations were not just in the operating suite, right?—he was the surgeon who introduced the post-operative recovery room?
Absolutely—again, you have to remember these are doctors of the 19th century. You didn't really have standardized painkillers. You didn't have medical schools, medical degrees. You could just call yourself a doctor, hang a shingle outside, and just start sticking leeches on people. That was perfectly legal and acceptable. And a lot of times people did not want to go to doctors, so they sought one only when already in extreme conditions. And though doctors knew what needed to be done, they also knew people were going to fight it—especially surgeons. Nobody is agreeing to have their leg cut off and then halfway through thinking, "This is still a great idea." The stories of people getting super human strength from the adrenaline and pushing surgeons and stabbing the doctor with his own tools—they paid men to hold people down during surgeries.
So there was a natural rift between patient and doctors. Doctors had to have a disconnect from the emotions of their patients. Mütter, a humanist who had an empathetic vision of medicine, was so different from that. And I think because of that he was able to create innovations in both pre-operative and post-operative care that weren't really being done before. Pre-operatively, before anesthesia was discovered, he spent days, if not weeks, desensitizing his patients for the use of his tools for surgeries. He did a lot of cleft palate surgeries, so you can imagine having tools work in the top of your mouth and back of your throat that may cause you to purge, as they said in the 19th century, which would be ruinous in terms of open wounds and infections. So he would desensitize them so they would no long have that gag reflex for weeks prior to having the surgery.
And then post-operatively, in his operating theater at his college, once they were done with their surgeries they would stick the person in an un-sanitized wagon, because the germ theory was not proven yet, and then ship them home over the cobblestone streets of Philadelphia. Now, you're in Baltimore so you've driven over a cobblestone street or two—not a pleasant experience in a rubber tire filled with air, let alone a wooden wagon wheel. Imagine having your skin being delicately stitched together with horsehair.
Mütter insisted that the college create recovery rooms so that these patients he was doing these delicate surgeries on would have time to recover prior to being sent home. And the college refused, didn't see the reason for it, so Mütter himself rented floors above a nearby restaurant and began stashing his patients up there, and his students would go through rotations and help take care and learn post-operative care, which is a brand new concept. But it was one of the reasons Mütter's surgeries were so successful. Again, in a time before germ theory, doctors did not know to sterile their hands or tools, so Mütter being so fastidiously clean and really taking care of his patients caused him to have survival rates which hugely outpaced his contemporaries at that time period.
You used his notes and lectures as part of your research. As a writer and poet, what did you learn about the man from his writing? I mean, we reveal ourselves in our writing sometimes far more than we realize.
And a lot of it was very coded. At that time you had doctors who really flung mud at each other. They would heckle each other in surgeries and fistfight each other at faculty meetings. So once you learned what the disagreements were about, when you read these lectures and speeches you kind of saw the subtle digs and sometimes not-so-subtle digs that people were taking at each other. But certainly the evolution of Mütter and his vision of himself is seen very clearly in these lectures. He was the youngest member of the staff of 1841, the famous faculty of '41 at Jefferson [Medical College], at 31 [years old], and so he was very self-conscious in his earlier writing. He leaned a lot on references and old guard thinking. As his career went on, his own philosophies emerged, especially his philosophies of being respectful toward patients, essentially palliative care. Mütter took a lot of positions that said, "OK, you are going to die, let's make that as comfortable for you as possible"—which was totally not what the 19th century was about at that time, especially for a high-ranking medical professor.
He spent his entire life swanning through the medical society, wanting to be seen, and then his speeches and writings in his later years were all about dissolving that. The end of the book has one of my favorite speeches that he ever gave, where he talked about "do not place dependence on your own genius even if you have some, nothing can be denied to well directed labor and nothing can be obtained without it." That to me spoke so strongly—especially as a nontraditional historian going into these medical libraries. I'd see other professionals and doctors and PhDs and here I am with my background of poetry slams and just a love of this work. And I began to think, "Am I a fraud?" And to have Mütter speak to me through the ages and say, "Hey, it's about the work. Nothing will be denied if you work hard enough," really helped orient me, as it should anyone, to what you should be focusing on.
Though this book is a biography it's also very much a history of medicine of a certain time and place, and—as you've mentioned as few times—you're not a so-called trained medical historian. And I can't remember what film director it was who said he liked to use cinematographers from other countries because they see his country with new eyes. And as somebody who has in recent years begun reading a fair bit of medical history because of my job, what I'm enjoying about Dr. Mütter's Marvels is seeing a sliver of medical history told through new eyes—and I mean history in the explicit sense, as you're very rigorous with your sourcing and documentation. What do you think as a poet you were able to bring to the study and telling of this story, this history—either through what was of interest to you or the questions you wanted answered? I ask not because I want you to defend your work, but I think that the practice of any variety of history in general constantly asks itself how it is producing and telling the stories of our past.
First of all, I am a lifelong lover of nonfiction, and I think it's natural that you want to see yourself in that time period. One of the things I found frustrating as a young working-class girl is to realize when you read these biographies of great men, whether it be the Kennedys or John Adams, that people like me are rarely talked about. The poetry slam community, that's all about representation and identity. You get to see people tell their own stories in their own voice from their own perspective in front of diverse people. That's what I found so attractive about it. And I think that it also made me feel really moved and passionate about making sure that when I communicate histories, it examines the whole world that event or person was moving through.
So one of the things that spoke to me about Dr. Mütter was that he, even though he came from a privileged background—he lost it as an orphan, and even though his guardian was very wealthy, his support was very erratic and he had to, as anyone from a background of unstable finances knows, do a lot of songs and dances to cover his bases all the time. That really resonated with me.