The short life of Doctor Mütter illustrated

the most remarkable mental abilities

and the gentlest qualities of heart.

Dr. Richard Levis (1859)

The Mütter Museum of the College of Physicians of Philadelphia houses one of the most significant collections of anatomical and pathological specimens, medical curiosities, instruments and photographs in the world. Exhibits include specimens from President Grover Cleveland, the famous conjoined twins Chang and Eng Bunker, and presidential assassins—John Wilkes Booth and Charles Guiteau—as well as many examples of deformity and disfigurement that go back to the challenging days of medicine before germ theory and the advent of anesthesia.

The museum was founded for medical education and research by Dr. Thomas Dent Mütter (1811-1859), an innovative surgeon and acclaimed professor of medicine committed to alleviating human suffering.

Until recently, there was no comprehensive biography of the groundbreaking Dr. Mütter. Award-winning writer Cristin O’Keefe Aptowicz corrected this omission with her book Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Medicine (Avery).

In her biography, Ms. Aptowicz recounts Mütter’s early fascination with medicine; his determination to treat the most disfigured people (who were labeled, medically, as “monsters”); his pioneering use of anesthesia; his insistence on sterile surgical practices; and his compassionate approach to helping even the most hopeless patients. She also details his flamboyance and eccentricities as well as his humane treatment of students and patients alike, and his devotion to preserving his vision by assuring that his immense collection of medical artifacts would find a home. As the book reveals, Dr. Mütter was far ahead of his time as many of his contemporaries eschewed sanitation, kindness and compassion, treating patients as clinical problems, not as individual human beings.

Dr. Mütter’s Marvels has been widely acclaimed for its original research, remarkable detail, vivid evocation of the historical period and the state of medicine, and sympathetic approach to Mütter and his patients. The book earned starred reviews inPublishers Weekly,Library Journal,School Library Journal, and Kirkus Reviews, and debuted at number seven on The New York Times Bestseller List for Books about Health. In his review of the book in the Wall Street Journal, author and physician Dr. John J. Ross commented: “Ms. Aptowicz rescues Mütter the man from undeserved obscurity, recreating his short life and hard times with wit, energy, and gusto. Her book, like the Mütter Museum, is a reminder that the course of human suffering and the progress of medical science are often messy, complex, and stranger than can be imagined.”

And author and historian Wendy Moore wrote: “Cristin O’Keefe Aptowicz immerses us in the strange world of Dr. Thomas Mütter and unfolds the tale of his pioneering approach to surgery with verve, wit, and sensitivity. We are all of us the richer for Dr. Mütter’s visionary work and the legacy he left us in the shape of one of the world’s most beguiling museums.”

Cristin O’Keefe Aptowicz is a bestselling nonfiction writer and poet. She is the author of six books of poetry (including Dear Future Boyfriend,Hot Teen Slut,Working Class Represent,Oh, Terrible Youth and Everything is Everything), as well as the nonfiction book Words In Your Face: A Guided Tour Through Twenty Years of the New York City Poetry Slam. Her sixth book of poetry, The Year of No Mistakes, won the Writers’ League of Texas Book of the Year Award for Poetry (2013-2014).

Ms. Aptowicz’s screenplay Mütter, based on the life of Dr. Mütter, won the 2003 "Set in Philadelphia" Screenwriting Award at the Philadelphia Film Festival, and a Sloan Foundation Fellowship at the 2004 Hampton International Film Festival. A film short based on her feature-length script was created as a part of the Philadelphia Film Festival prize. In writing Dr. Mütter’s Marvels, she had full access to the archives and other materials of the Mütter Museum.

For further information, contact Ms. Aptowicz at www.aptowicz.com or the museum at www.muttermuseum.org.

Ms. Aptowicz recently talked about her Mütter biography and her research at a restaurant in the University District in Seattle.

Thomas Dent Mutter Portrait by Thomas Sully (Thomas Jefferson University, Philadelphia).

Robin Lindley: How did you come to write a biography of Dr. Thomas Dent Mütter? I read that you visited his museum of medicine in Philadelphia when you were in grade school.

Cristin O’Keefe Aptowicz: I grew up in Philly and it was a rite of passage to visit the Mütter Museum when you’re a kid. My older siblings told me that I’d see a woman with a horn growing from her head and babies in jars and diseased limbs and giant skeletons. I was terrified but that’s how you knew you were a big kid— you could go to the museum.

I was in the fourth grade and the nuns took us. Some of the girls said they’d pass out but for me, it was the first time that I had actual scientific curiosity. Your mother might say at the grocery store, “Don’t look at that woman with a horn in her head.” But at the Mütter Museum they said, “Here’s the stuff you’ll never get to look at your entire life. Get close and look at it. Ask questions. How did this happen? Could it happen today? How would we treat it? How was it treated back then? Walk around and let yourself be drawn to whatever you’re drawn to.”

Up to that time, science was a bunch of facts that other people had figured out long before I was born and my job was to memorize them and understand their place in the history of science. But science wasn’t something strange and mysterious and complicated.

Some people ask me why we don’t still see some of the deformities and disfigurements from the Mütter Museum. Some of it is because our relationship with doctors is very different and we have early intervention and we can stop things before they get worse unlike doctors in the nineteenth century. We’ve been able to understand the role of nutrition and sanitation so that doesn’t occur. And some of it was labor law. Much of the horrible disfigurement in the nineteenth century was because we didn’t have labor laws and child labor was legal. Also, deformity was more common then.

All of this was interesting as a kid. You mean that laws to protect workers prevent us from having exposed jawbones that glow in the dark?

Woman with Cheek Ulcer [from Phossy Jaw](from Lectures on the Operations of Surgery by Robert Liston with additions by Thomas Mutter—from Collection of Cristin O’Keefe Aptowicz)

Robin Lindley: You vividly describe that dreadful condition—“phossy jaw” that afflicted women who made matches and suffered terrible, disfiguring reactions to phosphorus that destroyed their jaws.

Cristin O’Keefe Aptowicz: Yes, and they’d glow in the dark.

It wasn’t until I went to NYU that I realized that not everyone had been to the Mütter Museum. People would ask, “What is it with that museum? Why does it exist?” I realized that I didn’t know if Mütter was a man or a family or an acronym. I looked it up on the Internet, but found nothing in the early days of the Internet.

At the same time, the Alfred P. Sloan Foundation offered a fellowship for the best screenplay or play on the life of a scientist or on a scientific discovery. I said I could do that and it would be a small pool and I just needed a scientific story that hadn’t been told. And I thought maybe there was a story with the Mütter Museum.

I went to the museum archives and asked permission to go in and discover the story of the museum.

Robin Lindley: To go back a bit, were there a couple of Mütter Museum exhibits that stood out to you or that you tended to remember?

Cristin O’Keefe Aptowicz: There was the Soap Lady. She was buried in a shallow grave and the minerals of the area mixed with the fat of her skin and transformed it into a soap-like substance. I wondered how that was possible.

There was also the display of Chang and Eng, the conjoined brothers who supplied the term “Siamese twins.” They had their death casts and their conjoined liver in a jar, and I saw that they were connected by a thin band. As a kid, I just wanted to snip it and it was difficult to imagine there was no surgery to help them. They went on to have 21 children between them. They married sisters in the South and owned a farm. They spent half a week in one house and the other half a week in the other. They followed each other’s rules. One was a loud drunkard and a gambler, and the other was quiet. How does that work?

So I recalled that kind of [display]—anything that came with a story that was impossible for me to wrap my head around.

Robin Lindley: So you got access to the museum archives to do research and then wrote a prize-winning play about Dr. Mütter. When was that?

Cristin O’Keefe Aptowicz: Fifteen years ago. The screenplay got to Hollywood and they met with me—but it was a very expensive period piece about a doctor people largely didn’t know.

I thought this would be a great book, but thought I wasn’t the person who got to write this kind of book. I was 23 and had an undergraduate degree in screenwriting and was making a name for myself in performance poetry, and it didn’t seem that’s what [historians] David McCullough or Erik Larsen did.

It wasn’t until I finished my history of the poetry slam movement [Words in Your Face] that I said I can do a history and could tell this story.

I went about trying to fund a history of the museum and I got the [University of Pennsylvania] residency. And my background in poetry helped. The UPenn people were interested in working with a poet and college-aged kids like slam poetry. And the NEA fellowship that I won to work on this book was for poetry and the Amy Clampitt House residency that I won was for poetry.

This weird art form that people may consider antiquated or not valued by today’s society was a key for me in writing this book.

Robin Lindley: How do you think poetry influenced your writing of this biography?

Cristin O’Keefe Aptowicz: I think it’s twofold. Slam poetry is competitive. It’s a lively crowd and a community representing itself. With poetry slams, you see people from all different socioeconomic classes, different races, different sexual orientations. They talk about what’s important to them today, about their own lives, about what’s happening in their community, in the world. It’s made me think about how important representation is and how a diversity of stories adds to our understanding of the world.

From that perspective, it was very important for me in the Mütter book to include the full spectrum of people living in the nineteenth century. You get to see what the patients’ lives were like, what the working class lives were like, what women’s lives were like, what life was like for people of color, in a way that adds to understanding of the world. I want you to understand that Mütter, who suffered greatly in his life, did not have it the worst. Being a rich white man in that time was not as bad as being a slave! Or a woman.

I wanted to add this context and, my background with the poetry slams with representation of diversity as a benefit, not as tokenism, guided my research.

In writing nonfiction, I was interested in the work of Erik Larsen, author of The Devil in the White City. He is clearly in love with his research the way I’m in love with my research. At a reading, I asked him, “With your love of research, how do you know what to include and what not to include, when you find everything really interesting?” The answer was: “You’ll want to include everything, but the key is the telling detail—the one detail, the quality or action of a person that unlocks the character for the rest of the book. You never have to worry that the reader will lose track with that one telling detail.”

That was instrumental for me in approaching Mütter. And also, my poetry aims to make a larger meaning from a moment or a detail. That is what poetry is about. You unlock that detail and marry it to the narrative.

Robin Lindley: Those telling details bring the story to life. Dr. Mütter isn’t known to most people. What are a few things you’d say to introduce him to readers?

Cristin O’Keefe Aptowicz: It’s interesting why he isn’t a household name. First, he didn’t have children who kept his name alive. Many of the memoirs of doctors that I read were written by their sons. You also had letters and journals that were passed on and archived, and that didn’t happen with Mütter. Second, he died fairly young (at age 48 in 1859). The old guard wasn’t interested in him. The younger generation of students may have [admired him], but with the Civil War, he was forgotten in the rush of history. Lastly, he devoted the last years of his life to teaching the surgical techniques to treat deformed people because he didn’t want this population that he devoted his life to helping to have nobody to turn to. In that way, other parts of his life were lost.

In introducing Mütter, I’d lead with that fact that he was a humanist. He really cared about people and their suffering as human beings—not problems to be solved.

He was also scrappy. Mütter knew about society’s expectations and found ways to pivot around them. He had many obstacles but gamed the system and pursued the goals he wished.

Also, he was arrogant, vain and flamboyant. He was a risk taker in ways that may not have helped his career, but he moved forward with a passion for what he saw as right.

Robin Lindley: I’m struck by his compassionate for patients and even colleagues, and he was incredibly ahead of his time on patient care and sanitary surgical techniques at a time before germ theory and before anesthesia. And he was drawn to treating the most terribly deformed or disfigured people who were then called “monsters.”

Cristin O’Keefe Aptowicz: He was especially compassionate because he was also a patient all of his life and knew the difference between being treated as a human being and being seen as a problem that needed to be solved—the usual approach of nineteenth century medicine.

Robin Lindley: Do you think Mütter’s illnesses brought him to medicine?

Cristin O’Keefe Aptowicz: Yes. He always remembered the doctors who treated him compassionately in Atlanta and he set out to be that kind of doctor.

When it came to plastic surgery, he chose to treat “monsters,” which was a medical term then like “idiot” was a medical term. And this was a time when people rarely sought surgery and wouldn’t agree to it unless their life was at risk.

When you were designated a “monster,” it meant were so deformed that there was no treatment for you. There was not a field dedicated to doing surgery on people while they were awake that was “cosmetic.” Who would voluntarily be experimented upon in the way you’d need to treat [deformities]?

Mütter was attracted to plastic surgery because it was a new field that he felt he would be good at. He was bright, innovative, quick and clean, and he knew when he found solutions, he could execute them exactly as he saw them in his mind.

He also realized he had a kinship with these patients and he wanted to see them treated respectfully as he was in his childhood. He did not want them to feel ignored and not seen. Being seen is so important as a human being, and for Mütter to look at an ignored patient and say I can help was meaningful for both parties.

I have a theory about why he dressed so flamboyantly. The patients had operations in theaters with all these strange men staring at them and it must have been terrifying. It must have comfort if Mütter said, “They’re not looking at you. They’re looking at me because I wore this new suit.” It’s like he shared some of the eyes and the judgment.

Robin Lindley: And Mütter’s surgery was a gift for disfigured people because those who once had hid themselves could again function in public.

Cristin O’Keefe Aptowicz: Absolutely. It literally brought back their humanity from that category of “monster.”

Robin Lindley: It seems you found the perfect foil for Mütter in his colleague at Jefferson Medical College, Dr. Charles Delucena Meigs, who eschewed cleanliness and kindness and objectified patients, especially women.

Cristin O’Keefe Aptowicz: Yes, he was the chair of obstetrics and gynecology. In a speech, he said that women’s skulls were too small for intellect but just the right size for love. His philosophy was much different than Mütter. He didn’t believe in pain management for women in labor and cited the Bible, “In sorrow thou shalt bring forth children.” We’ve come a long way since then, but some debates about women’s health are still vital today.

Robin Lindley: You vividly describe the ordeal of patients as well as the plight of poor people and women then.

Cristin O’Keefe Aptowicz: It was important to portray an accurate version of the time. And with women, half the population was cut out of decision-making process by a society that set expectations. The society said you’re not allowed to show your body to anyone but your husband, and that affected when women would feel comfortable seeking treatment. It highlights how amazing Mütter must have been to have women come out of hiding to seek treatment.

The brutality of the time is also important. I told the story of the women with “phossy jaw” in detail and I wondered who I would have been if I’d been alive then. The story of working-class women and girls is not often told, and then I came across that story on something so horrific and so common that it had a nickname. There’s no sugarcoating that, nor should there be. In writing history, I want to make sure that the stories that are powerful are shared.

Robin Lindley: You see Mütter as compassionate and caring and innovative, and it seems Dr. Meigs was at the opposite pole. Was Meigs more representative of the physicians at that time?

Cristin O’Keefe Aptowicz: Yes. It turned out that Mütter was such a modernist. Of course anesthesia should be used. Of course wash your hands and tools. Of course have a recovery room. But I wondered how to explain the triumph.

I read Devil in the White City by Erik Larsen about H. H. Holmes, a serial killer who struck during the Columbus Exposition (in Chicago). Larsen did a brilliant job of explaining how the innovations and progress in America on the verge of the twentieth century were opening all of these new doors. Innovation was exploding, but for every beautiful thing the fair promised to showcase, you had this guy who exploited the weakness in what you saw.

So Larsen presented progress but also had this counterbalance. I realized that I could alternate Mütter and Meigs, and have Meigs represent the culture, which he did, then you could see how frustrating the ladder was that Mütter had to climb. So I’m grateful for Meigs who was the perfect foil, the opposite of Mütter. Meigs was robust, healthy, with tons of kids, and stubborn opinions. And Mütter was slight, frail, childless and died young.

Robin Lindley: And you mentioned Erik Larsen. Are there other writers or historians who influenced your work?

Cristin O’Keefe Aptowicz: Yes. Erik Larsen was a big one. Another was David McCullough with The Greater Journey on nineteenth-century Paris and I loved John Adams and how he humanized figures and established the time period in fresh ways. John Adams helped me a lot. I love the work of Sarah Vowell and she wrote about the Mütter Museum in Assassination Vacation.

So I read nonfiction books, but I also read The Great Gatsby for how to describe an enigmatic, dazzling person who seems both in the world and out of the world, moving with the community yet beyond the day to day. And I read the author and my friend who later became my fiancé, Ernest Cline, with Ready Player One, a huge page-turner. I wanted to have that energy, and to capture how I was voraciously researching my book and loving it.

And my mom was a lifelong lover of nonfiction. When I was little, she read to us in the car. She’d read a book or article that was gory or shocking and say, “Can you believe that this is true?” I wanted to make sure that I included surprising moments like that in my book. With fossy jaw, I pictured my mom and reading that story to us and asking, “Can you believe that happened here in Philly?”

Jefferson Medical College After Renovations (Thomas Jefferson University, Philadelphia).

Robin Lindley: You’ve said you don’t have any medical background. Were you assisted by medical professionals on the draft of your book?

Cristin O’Keefe Aptowicz: Yes. I was assisted by archivists who are champions of knowledge. They would help me with follow up information if I didn’t understand something. I had the archivist for the Mütter Museum read the manuscript before publication to assure it read well. And I looked at the history of medicine and how the practices of the time of Mütter reflected society.

Robin Lindley: What struck you about Mütter’s legacy and the people he inspired?

Cristin O’Keefe Aptowicz: In my research, I found a list of every student who had graduated under Mütter in his 15 years at Jefferson. I researched each one of them name by name and tried to find what happened to these students and how many embraced the ideals Mütter had taught.

Edward Robinson Squibb was lovely to have. He preferred the style of Meigs, but after his practical experience as a naval surgeon, he realized how right Mütter was. And he remembered the problems Mütter had in popularizing anesthesia in surgery, and he realized that the problem was lack of stability in the drugs themselves. Squibb thought if he could stabilize the drugs it would move the dial to use in surgery. The company he founded became Bristol-Myers Squibb, the pharmaceutical giant today.

Another part of the Mütter legacy is the Children’s Hospital of Philadelphia, where my nephews go when they’re sick. And it’s interesting to see how much of his influence remains with the museum.

His former student Richard J. Levis wrote about how he feared Mütter would be forgotten and how he hoped “abler pens” would write Mütter’s story to make Mütter a “deathless name . . . forever blended with the history of American surgery.” And now that’s me. It’s very humbling. I can’t believe the story hadn’t been told before I came along.

Robin Lindley: What inspired Mütter to create a museum of medical artifacts?

Cristin O’Keefe Aptowicz: In that time before photography, it was a way of showing students what unusual cases looked like. Pathological specimens became very important. You’d have wax replicas or models or dry or wet specimens in jars. Mütter collected these things. He was one of only three plastic surgeons in the country and by far the one who did the most radical surgery on the most damaged population. He sought unusual specimens to challenge himself and ask: if this person came to me, how would I help? He rescued the samples from hospitals and other doctors as well as barrooms and sideshows. And he wanted to make sure they but would be respected as medical teaching tools and he wanted to keep them together.

That became the basis of the Mütter Museum, and then it became a place where other doctors could find a place for their collections. The Hyrtl Skull Collection was donated by Dr. Hyrtl who used all of these skulls mostly for phrenology. And then you have Chevalier Jackson who collected and cataloged things that were trapped in people’s throats, as recounted in Mary Cappello’s book Swallow. It was interesting to see that doctors found a place for the objects of their passion at the Mütter Museum.

Some of the best-known objects in the museum were donated after Mütter’s death: the Hyrtl skulls, the Soap Lady, the man whose muscle turned to bone, Chang and Eng, the Mütter Giant. But he created a home for these pieces.

At readings, people think the title of the book Dr. Mütter’s Marvels refers to oddities in the museum, but it’s much more than that. It’s about his surgery and the marvels of his teaching and his life.

The museum wasn’t open to the public until Gretchen Worden became director. She made the museum her life’s mission and she believed it should be open to everyone to bring the museum to greater prominence. And I was one of the beneficiaries of that largesse as a child in Philly; I was part of the generation that grew up with the museum. That wasn’t true of my mother’s generation in Philadelphia.

Robin Lindley: Is there anything you’d like to add about the book?

Cristin O’Keefe Aptowicz: I’m thrilled that it’s had a connection with people. I’m fascinated by the man and by the time period and I hope that translates to a mainstream audience. I had no expectations. I knew the people in Philly would be interested but I didn’t realize it would reach beyond.

Robin Lindley: The reviews are glowing.

Cristin O’Keefe Aptowicz: Yes, it’s exceeded my expectations of what I thought was possible. I’m glad it’s reached a broad audience and it’s really meaningful to me that it’s connected with doctors. It’s used in medical schools to talk about Mütter. The doctors of this generation come from science backgrounds and have very analytical minds but see patients as a series of templates to determine what’s wrong and checklists to fix what’s wrong. The story of Mütter’s human touch is very important now for students to learn.

The thing that stays with me is Mütter’s words to his students. He tells them “place no dependence on your genius, even if you possess it. If you have great talents, industry will improve them; if you have moderate talents, industry will supply their deficiency—nothing is denied to well directed labor; nothing is obtained without it.”

I admire that philosophy. He must have been seen as a genius by the population he talked to. He was careful not to intimidate his students out of thinking they can’t do it.

For me, Mütter was saying you don’t have to be a genius to write the book. All you have to do is the work. Nothing is denied without hard work.

Robin Lindley: Thank you for your insights Cristin and congratulations on your new book.