what I'm working on
Excerpts from a letter written by Mutter in 1841 (bolding mine)
In the month of January, 1841, I was requested to attend Miss A. T. of Chesterfield township, New Jersey, who for twenty-three years endured much mental as well as physical inconvenience from the effects of a burn which occurred when she was five years old and involved the face, throat and upper part of the thorax in front… [she] was unable to throw her head to the left side or backwards, or to close her mouth for more than a few seconds a time for 23 years. Her right eye was also drawn down some distance below the other…
After carefully examining the case, and fully explaining to the patient and her friends the inutility of any of the usual operations for such deformities, I proposed to them one entirely different in its principle, which although severe, as well as somewhat hazardous, promised partial, if not entire relief. To this my patient readily assented, declaring that death were preferable to a life of such misery as hers...
Seating myself in front, I began the operation by making an incision which commenced on the outside of the cicatrix in sound skin on the opposite side… I exposed the sterno-cleidomastoid mucle of the right side, and passing a director under it, as low down as possible, divided both its attachments. This enabled me to raise the head an inch or two; but finding that it was still kept down by the sterno-cleidomastoid of the left side, I divided the sternal attachment of this muscle, and was much gratified to find that head could at once be placed in its proper position, the clavicular attachment of the muscle offering little or no resistance. A most shocking wound six inches in length by five and half in width was thus made, and yet there was scarcely an hemorrhage
The next step of the operation consisted in the detachment of a flap of sound skin with which this chiasm could be filled… To obtain this flap, I commenced at the terminal extremity of the incision, and carrying the scapel downwards and outwards over the deltoid, dissected up an oval piece of integument six inches and a half in length, leaving it attached at the upper part of the neck... This dissection was painful but not bloody, not one small vessel being opened. The flap thus detached was next brought round by making a half-turn in its pedicle, placed in the gap it was destined to full, and carefully attached by several twisted sutures to the edge of the wound...
…. the fortitude with which this truly severe surgery was born excited the admiration of all present. Scarcely a groan escaped the patient, nor was it necessary to give her more than a mouthful of wine and water during the whole period of its duration. *
Rest and quietude were enjoyed and the patient prohibited from taking any kind of nourishment, in order that adhesion or union by the first intention might be accomplished.
It will be sufficient to state that no unfavorable symptom made its appearance… The following extract is from a letter received some time since. “The comfort and satisfaction I feel, cannot be expressed; your exertions in my behalf have been blessed far beyond my most sanguine expectations.”
The whole appearance of the patience [was] so much altered that persons who saw her before the operation, scarcely recognized her as the same individual.
* - because she was, you know, AWAKE the whole time the surgery was happening. In another letter I found, some spoke highly of Dr. Pancoast (Mutter's friend and colleague) as being a kind gentleman doctor who did a wonderful job HOLDING HERE LEGS DOWN THE WHOLE SURGERY. GAH.... Lucky, anesthesia was on the horizon, which Mutter being the first surgeon to use it in Philly, but I'm not quite there yet.
Alright, back to the books.
In the month of January, 1841, I was requested to attend Miss A. T. of Chesterfield township, New Jersey, who for twenty-three years endured much mental as well as physical inconvenience from the effects of a burn which occurred when she was five years old and involved the face, throat and upper part of the thorax in front… [she] was unable to throw her head to the left side or backwards, or to close her mouth for more than a few seconds a time for 23 years. Her right eye was also drawn down some distance below the other…
After carefully examining the case, and fully explaining to the patient and her friends the inutility of any of the usual operations for such deformities, I proposed to them one entirely different in its principle, which although severe, as well as somewhat hazardous, promised partial, if not entire relief. To this my patient readily assented, declaring that death were preferable to a life of such misery as hers...
Seating myself in front, I began the operation by making an incision which commenced on the outside of the cicatrix in sound skin on the opposite side… I exposed the sterno-cleidomastoid mucle of the right side, and passing a director under it, as low down as possible, divided both its attachments. This enabled me to raise the head an inch or two; but finding that it was still kept down by the sterno-cleidomastoid of the left side, I divided the sternal attachment of this muscle, and was much gratified to find that head could at once be placed in its proper position, the clavicular attachment of the muscle offering little or no resistance. A most shocking wound six inches in length by five and half in width was thus made, and yet there was scarcely an hemorrhage
The next step of the operation consisted in the detachment of a flap of sound skin with which this chiasm could be filled… To obtain this flap, I commenced at the terminal extremity of the incision, and carrying the scapel downwards and outwards over the deltoid, dissected up an oval piece of integument six inches and a half in length, leaving it attached at the upper part of the neck... This dissection was painful but not bloody, not one small vessel being opened. The flap thus detached was next brought round by making a half-turn in its pedicle, placed in the gap it was destined to full, and carefully attached by several twisted sutures to the edge of the wound...
…. the fortitude with which this truly severe surgery was born excited the admiration of all present. Scarcely a groan escaped the patient, nor was it necessary to give her more than a mouthful of wine and water during the whole period of its duration. *
Rest and quietude were enjoyed and the patient prohibited from taking any kind of nourishment, in order that adhesion or union by the first intention might be accomplished.
It will be sufficient to state that no unfavorable symptom made its appearance… The following extract is from a letter received some time since. “The comfort and satisfaction I feel, cannot be expressed; your exertions in my behalf have been blessed far beyond my most sanguine expectations.”
The whole appearance of the patience [was] so much altered that persons who saw her before the operation, scarcely recognized her as the same individual.
* - because she was, you know, AWAKE the whole time the surgery was happening. In another letter I found, some spoke highly of Dr. Pancoast (Mutter's friend and colleague) as being a kind gentleman doctor who did a wonderful job HOLDING HERE LEGS DOWN THE WHOLE SURGERY. GAH.... Lucky, anesthesia was on the horizon, which Mutter being the first surgeon to use it in Philly, but I'm not quite there yet.
Alright, back to the books.