Mutter+Museum

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 * Introduction - Purpose of Medical Museums **

The medical museums have been a visual display of knowledge and practicum for the medical field for centuries. They were first seen as prized possessions of the physicians in Renaissance Europe. Beginning as early as the first European Industrial Revolution, when doctors used to display their lengthy careers in at-home museums, to recent times, through the Body Worlds exhibit, the medical museum has been used to display tools, applications, specimens, and rare cases for the public and has served as an integral part of medical students education [7]. Over the years the displays in these museums have also been sources of inspiration for medical research and have sometimes even provided subjects for medical research. In the year 1894, one of the curators of the Mȕtter Museum even commented,“Many specimens are photographed in the museum for the illustration of new publications”, showing one of the many ways that medical museums were used as a tool of education and science. Medical Museums have served as both a mirror of the attitudes and the thoughts of medical practitioners and an instigator propelling medical practitioners to focus on certain areas of research and study. They have been both instructional and inspirational to medical students. With the coming of the 20th century and the emergence of laboratories and residency programs to give students clinical experience, the medical museums have still not diminished in their importance. At their founding they served as 3-D textbooks for students, then their purpose changed to place where technological breakthrough and new medical ideas were shared, now their purpose has become to serve as a window into medical history and to provide scientists with unsolved medical mysteries and puzzles [8].

 **Exhibit from the older medical museum (Mutter Museum) and the present day medical museums (Body Worlds)** In the early part of the 1800’s medical education’s pillar and most trusted source of knowledge were textbooks and medical journals written by fore-fathers in the field. Medical knowledge relied on textbooks. Hands-on learning was not even part of medical education. Medical students would learn anatomy and clinical practice from books. Towards the middle of the 1800’s with the outbreak of the American Civil War when successful application of anesthesia and antiseptics was responsible for saving many lives, the medical practitioners made the pivotal decision that textbook which at the time did not mention anesthesia or antiseptics were outdated and that it was pivotal that medical practitioners use clinical experience to increase their knowledge [4]. Hence hands on learning and clinical experience had to integrated into medical education [19]. This knowledge and experience needed to be displayed and shared with the inexperienced from the medical field (i.e. – Students). Students at that that time did not have access to clinical subjects or cadavers, so many pathological medical museums like the Mȕtter Museum were founded in the United States at this time to serve podium were students could gain some "clinical" experience [14].

In the 1800’s the Mȕtter Museum was primarily a subsidiary or a laboratory for medical students, researchers and physicians, who were affiliated with the College of Physicians. As such the curator’s of the museum at that time were primarily interested in displaying instructional exhibits such as the wall of Professor Hyrtl’s collection of skulls which taught students that each skull was unique and often a common injury could need different solutions for different patients; or Dr. Benjamin Rush’s tool kit which was used to teach students how to utilize different surgical instruments. With the passing of the 1800's, as the Mȕtter Museum became a place where medical ideas and technological ideas were exchanged and this was reflected in the displays of that time such as Marie Curie’s electrometer, Dr. Gibbon’s Heart and Lung machine[3].These displays often gave physicians as well as students ideas of where to go with their research or some researchers even become inspired to improve of the design of devices found in museum. With coming of the 21st century and curators like Gretchen Worden who wanted to increase the funds of the museum by popularizing among the lay people, the displays gain changed to reflect this [13]. Medical mysteries like Harry Eastlack’s convoluted skeleton were put up as prominent displays. These displays probed students as well as medical researchers to solve these medical mysteries. **Gretchen Worden, Curator of the Mȕtter Museum 1982-2004**

 **Founding of the Mȕtter Museum (1849-1863)**

The concept of the Mütter Museum was first conceived in June of 1849, when Dr. Isaac Parrish proposed to the College of Physicians that a new cabinet should be formed for the promotion of science and material to the profession [6]. The College of Physicians acted on the proposal and decided to elect a committee to find a way to greater promote this science and material. Shortly after, the committee decided that it will be beneficial for the College of Physicians to create a museum of pathological anatomy. Parrish believed that a museum of this nature could contribute to the profession.

"Whereas, the institution of a cabinet of pathological specimens, under the control of this college, would greatly facilitate the promotion of science and secure to the profession a valuable amount of material of this kind which would otherwise be lost; Resolved, that a committee be appointed to consider the means of erecting the object" (Parrish, 1949).

**Dr. Isaac Parish**  This started an interesting relationship, which existed between the College of Physicians of Philadelphia and the Mütter museum because the CPP was always an honorary society, never conceived as a training institution. The museums primary goal, in Parrish’s eyes and later Mütter’s eyes was to teach practicing physicians and promote science and medicine. This all took place before the time when medical collections and specimens were replaced by textbooks.

The museum did not come into its full fledged state until 1856, when Dr. Thomas Mütter wrote a letter to the College of Physicians stating, “With the view of rendering some return to my profession for the benefits derived from its prosecution for so many years and above all to serve, at once, the cause of science and of humanity. I have determined to found a Pathology museum...” (Mütter, 1856) Dr. Mütter wanted to continue his legacy through his collection that he amassed over the years of medical practice. He insisted that in its early years the museum remain free of charge. Dr. Mütter had been offered $20,000 dollars for his collection; that it had cost more money, besides his attention and labor during twenty four years; that, in his opinion, it is for illustrative purposes “almost unrivaled.” In addition to contributing his personal collection and $30,000 to museum, Mütter also gave a list of requests that he required from the College of Physicians in order for him to leave his collection under their guardianship, the most important being to find a fireproof location to hold the collection. After a few years of discussions and a hiatus, the Mütter Museum finally was founded in 1863 [15]. Dr. Mütter’s overarching purpose was to use his great collection amassed over years of medicine to establish a great “pathological museum,” in which his initial collection would serve as a base for. The CPP viewed Mütter’s gift not only as a gift to the College, but as a gift that the whole profession would benefit from. Mütter’s goal in donating his massive collection to the CPP was to serve this exact purpose.

=Serving as a Medical Textbook (1863 -1890)=

In 1866 Professor Joseph Hyrtl, of Vienna, offered to sell his collection of skulls to the Mȕtter Museum for a price of $750. [9] The majority of this collection consisted of 70 skulls from people throughout Central and Eastern Europe. ”The skulls are perfect, snowy-white, teeth complete, inferior maxilla movable, with elastic wires. Such a collection will never be brought together.” [1] The skulls came from Muslims, Jews, and various tribes from the Balkans. Between these skulls one could see similarities between geographic areas and common lineages as well as a large number of the anomalies that were possible in humans. [1] In addition to the skulls, Hyrtl also wanted to provide the museum with his collection of 105 samples of the labyrinths of the inner ear and a number of placentas that had been dried and featured physical anomalies. These collection though contained ears from humans as well as animals. Hyrtl wanted the collection to show the evolution of the inner ear. The committee of decision makers who met at least once a year to discuss displays in the museum, decided against displaying this collection. The curator was instructed to send a letter to Hyrtl asking if he would only donate the human part of the collection. Hytrl of course refused, because his collection was meant to show evolution of the inner ear which would be incomplete if only the collection was separated into just human ears [9]. This decision reflects the medical thought and knowledge of that time although evolution was widely discussed if was not yet widely accepted. This was a time when treatments were not first tested on laboratory animals, because in order to do this one needed to accept evolution as the truth and therefore the accept that laboratory animals and humans will have a similar response to a treatment. This was a time when treatment was directly tried on humans and evolution was not a big part of medical education. Therefore collections of the 1800s displayed in the Mȕtter Museum, offered a unique view of structures for students that were hardly seen and a variety that could be found nowhere else, and these displays also provided further understanding of human anomalies to fellow American physicians. In addition to these displays also provided students and visiting physicians a certain view of medicine that the physicians responsible for the displays in museum believed to be important or the truth. Therefore these displays reflect the thought process of the physicians at this time [6].
 * [[image:Hyrtlskull.jpg width="199" height="191"]]  A skull from Professor Hyrtl's collection [10] **

When Chang and Eng Bunker died in January of 1874, several members of the College of Physicians were allowed to perform the autopsy. [10] Although the bodies needed to be returned for burial after the autopsy, the Mȕtter Museum was permitted to keep the conjoined liver of the Siamese twin and a plaster cast of the torso and the connection between the two. This cast allowed studying physicians for years to study in detail an anatomical anomaly that was extremely rare and misunderstood at the time, and the preserved liver provided an even greater amount of informative detail. On many occasions throughout the twins’, visiting students and doctors examined them for a way to safely separate them. After their deaths, the plaster cast could be examined in more detail for a method that could separate two similarly attached individuals in the future with the least amount of permanent damage. This presented an opportunity that textbooks could not come close to offering, as the best they could provide was written descriptions and diagrams [6].

The Mȕtter Museum also became home to unheard of abnormalities. Again, the museum offered a better source of learning than a textbook for this subject. When dealing with an anomaly that has been little studied or seen, a textbook cannot do the subject justice, while the museum can offer a first-hand encounter with the case in question. An excellent example of this came in 1874 with Dr. Joseph Leidy’s petrified woman, popularly known as the “Soap Lady.” [10] In this rare occurrence, the fatty tissue of the woman had decomposed into a substance called adipocere. When the body was found an unknown number of years after burial, her entirety had become a substance similar to soap. This corpse has been a subject of study since the time of its addition to the museum to the present day, as debates about the reason and date of death are still on-going. [10] As such, it has been available for countless interested medical practitioners to study and learn from this nearly unheard of occurrence.

=Serving a Place for exchange of Research and Technology Ideas and Breakthroughs (1900s -1970s) =

Towards the end of the 18th century began a radical change in medical education. Research, laboratory experience, and expansion of knowledge became an essential part of medical education with the foundation of "modern" medical schools in the United States, like Johns Hopkins School of Medicine. In addition, internships and residency programs became a requirement in order for doctors to practice medicine. The first national scale internship program began in the year 1951 and this was followed by the establishment of the Liaison Committee on Medical Education and later the Accreditation Council for Graduate Medical Education with accredited medical education and residency programs. With the large number of residential programs and the establishment that residency was required for independent practice of medicine, the museum changed from a laboratory for medical students to an area were research and technological ideas were exchanged.

In addition to anomalies in medical cases, there were also revolutionary medical devices that were now being displayed in the museum which often changed the course of medical study and research. One such device is John H. Gibbon’s heart-lung machine, first successfully used on May 6, 1953 to sustain 18 year old Cecelia Bavolek during an operation. The device was the first machine that was capable of operating the vascular and cardiac systems of a patient during an open heart surgery. [5] A replica of this first device was put on display in the Mȕtter Museum, where it was available for professionals and students alike to view its functionality. The working of this could provide insights to students on the basics of both how the cardiovascular system functions, as well as a number of ways that cardiovascular diseases can be approached while looking for a cure. The preliminary design and functionality of the device could also be used as a launching point for devices of a similar nature in the future.  Following the development and use of Gibbon's heart-lung machine, it was noticed that the heart would often fail to resume adequate function after the patient was taken off of the machine. [3] It was determined that this was because the heart needed a more prolonged support following a surgery than the heart-lung machine provided. This discovery eventually led to the idea of assisted circulation so that patients would be able to have prolonged support of their heart for weeks, ensuring proper time for the heart to heal, which led to the invention of the ventricular assist device, or VAD. [3]

**Modern Heart Lung Machine Gibbon's initial Heart and Lung Machine** Pierre Curie and his brother invented a machine called the electrometer, which is a device capable of measuring electrical charge. Marie Curie used this device and found out that uranium rays caused air to conduct electricity around a sample. Curie took measurements of these electrical charges. She found out that the more uranium atoms there are, the more intense are the rays a substance gives off. Curious about her discoveries, she tested other elements as well, so she and her husband studied the mineral pitchblende. They then discovered the two radioactive elements polonium and radium. Robert Abbe, who was a New York surgeon, is best known for his work in spinal surgery and using radium to treat cancer. In 1911 he joined the College of Physicians as an associate fellow. Due to his interest in using radium to treat cancer, he was interested in the Curies' electrometer. Marie Curie agreed to donate the electrometer to the Mȕtter  Museum [20]. This initial exchange of ideas between Curie and Abbe can be traced as one of events that brought about the use of radiation and chemotherapy to treat cancer [21]. 
 * Drawing of Electrometer made by Marie Curie for the museum** **[21]**

=Providing Subjects for Medical Research and Inspiring Scientists (1970s and beyond)=

With the addition of residency to the medical school curriculum, the Mȕtter Museum audience changed from primarily medical students and physicians to medical researchers and common lay people. To cater to this audience medical mysteries and anomalies became the highlight of the Mȕtter Museum. One such anomaly is Harry Eastlack's skeleton. Harry Eastlack broke his left knee when he was only 5 years old. His knee never recovered from the injury and doctors were surprised to see extra bone growth on his muscles of the thigh. As time passed more and more bone growth appeared all over his body. When surgeons tried to cut the unnecessary bones away, only more bone grew back. The rare disease that Harry Eastlack had is called fibrodysplasia ossificans progressiva, where cuts and other injuries are repaired by cells that are meant for building bones. Harry Eastlack donated his skeleton for scientific research and to the Mȕtter Museum. Due to this donation, scientists became intrigued by Eastlack's condition and have now even found a treatment for this disease. If his body had not been but on display the likelihood of such a rare disease being studied would have been very small [22,23].

=Conclusion= In conclusion, as shown by these displays and incidents, with the changing times has changed the primary purpose of the Mȕtter museum and other such medical museums, but their importance in medical education and in the field of medical research has not diminished throughout these years.


 * References **

[1] 1873 Joseph Hyrtl Letter. College of Physicians Archives. [2] AMEDD Regiment. Web. 12 Feb. 2010. <http://ameddregiment.amedd.army.mil/museum2/ history.htm>. [3] DeBakey ME. Development of Mechanical Heart Devices. Ann Thorac Surg 2005. http://ats.ctsnetjournals.org/cgi/content/full/79/6/S2228 [4] Echols, Micheal. "American Medical Libraries in the Nineteenth Century ." //American Civil War Medical & Surgical Antiques//. 17 Feb 2010. Health Sciences Library, Web. 19 Feb 2010. <http://www.braceface.com/medical/Articles_on_books/American_Medical_Libraries_c.1800s.htm>. [5] "JEFFLINE: TJU Archives Exhibit - "10 Notable Jefferson Alumni, John H. Gibbon"." //JEFFLINE//. N.p., n.d. Web. 6 Mar. 2010. <http://jeffline.tju.edu/SML/archives/exhibits/notable_alumni/john_gibbon_jr.html>. [6] Jones, Nora L., //The Mütter Museum : the body as spectacle, specimen, and art//. Philadelphia: The Temple University Press, 2002. 13-47. Print. <span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt; line-height: 115%;">[7] Kavanagh, Gaynor. //Making Histories in Museums//. London: Leicester University Press, 2005. 15-29. Print. [8] Kirshenblatt-Gimblet, Barbara. "The museum as catalyst." //New York University.// 29 Sept. 2000. New York University, Web. 25 Jan 2010. <http://www.nyu.edu/classes/bkg/web /vadstena.pdf>. [9] Letter from Joseph Hyrtl. College of Physicians Archives. [10] Lindgren, Laura, and Gretchen Worden. Mütter Museum Historical Medical Photographs. New York : Blast Books, Inc., 2007. Print. [11] Mayhem and Medical Students: Image, Conduct, and Control in the Victorian and Edwardian London Teaching Hospital, //Social History of Medicine//, 2002; 15: 45–64 <span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt; line-height: 115%;">[12] Physicians of the twentieth century, primarily dependent upon their plethora of diagnostic instruments rather than their own five senses, would marvel at the accuracy and detail of, for example, William Wood Gerhard's intricate description of bronchitis in //Lectures on the Diagnosis, Pathology, and Treatment of the Diseases of the Chest// (Philadelphia: Haswell & Barrington, 1842). [13] Strausbaugh, John. "A Curator's Tastes Were All Too Human." //The// //New York Times// 11 Oct. 2005: Web. 25 Jan 2010. <http://www.nytimes.com/2005/10/11/arts/design/ 11mutt.html?_r=2>. [14] The Age of Museum Medicine: The Rise and Fall of the Medical Museum at Birmingham's School of Medicine, //Social History of Medicine//, 2005; 18(3): 419-437 [15] "The College of Physicians: The Mutter Museum." //Detailed Museum History//. 2005. The College of Physicians, Web. 25 Jan 2010. <http://www.collphyphil.org/mutter_hist.htm>. [16] Thistle on the Delaware: Edinburgh Medical Education and Philadelphia Practice, //Social History of Medicine,//1992; 5: 19-42 [17] "TJU Archives Exhibit - "10 Notable Jefferson Alumni, William Keen" JEFFLINE. Web. 12 Feb. 2010. <http://jeffline.jefferson.edu/SML/archives/exhibits/notable_alumni/ william_keen.html>. [18] Unearthing and Dissecting the Records of English Provincial Medical Education //c//. 1825–1948**, //Social History of Medicine,// 2008; 21: 381-392 <span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt; line-height: 115%;">[19] William Frederick Norwood, //Medical Education in the United States Before the Civil War// Philadelphia: University of Pennsylvania Press, 1944: 396-402. [20] Chodos, Alan. "December 1898: The Curies Discover Radium." //APS Physics//. American Physics Society, 2010. Web. 17 Mar 2010. <http://www.aps.org/publications/apsnews/200412/history.cfm [21] Marie Curie letter to Robert Abbe, College of Physicians Archives. [22] "Shark therapy for bizarre bone disease ." //BBC News// March 24 1999: Web. 17 Mar 2010. <http://news.bbc.co.uk/2/hi/health/302528.stm>. [23] Angier, Natalie. "Bone, a Masterpiece of Elastic Strength." //New york Times// April 27 2009: Web. 17 Mar 2010. <http://www.nytimes.com/2009/04/28/science/28angi.html>.