Hampden Sydney College - Kaleidoscope Yearbook (Hampden Sydney, VA)

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of silver sutures in vesicovaginal fistula. His reference to Mettauer, even in these cir- cumstances, is so slight that at first reading I overlooked it. He says in part, ln IS45 I conceived the idea of curing vesicovaginal fistula, etc. lVlettauer's first reference to the matter appeared in the Boston Medical and Surgical journal, vol. xxii. p. I54. twelve pears before Sims' communication, and it clearly outlines the operation which ought always to be associated with his name. ln the American journal of the Medical Sciences, new series, vol. xiv. p. ll7, five pears before Sims' communication, Nlettauer says, I am decidedly of the opinion that every case of vesicovaginal fistula can be cured, and my success justifies the statement. It seems almost marvellous that so little should be known of Mettauer, when we go on to say that his was clearly the earliest operation for cleft palate performed in the Western world the used for the work a novel instrument made for the purpose by himselfl, and that he was clearly among the first of American surgeons in adopting or adapting the best of the advance suggested by any other man. He was, also, the original suggester of the employment of iodine in the treatment of scrofula, and among the first in such major operations as amputation of the shoulder, ligation of the carotid, and resection of the superior maxilla. And last, but not least, it is by no means sure that, in the care and detail of his preparations, he may not be ranked as the American Lister, and it is certain that the excellence of his precaution seems almost, by a sort of invested inheritance, to have come to him from some ad- vanced man of our day. Dr. Mettauer was a man of striking appearance, tall, well-formed, and robust: his piercing black eyes were shadowed by a heavy fringe of brow, and above arose a fore- head high and of the most intellectual shape. He was seclusive in his habits, and few persons were admitted to any closeness of acquaintance, and very few to any sort of intimacy. ln fact, from the first dawn of manhood to his death he was busy. His practice with the patients who came to him in his office at home and that at Farmville, where he was to be found at certain hours every day, would have appalled the average worker: his medical school was, in the language of our streets, a good deal more than one man's job, and, in addition, he did an amount of writing which would have kept the ordinary scientific man engaged all of his time, and satisfied him wholly with himself. To this eternal business may be attributed much of Mettauer's failure in the social duties, and it is vain to inquire whether, in other circumstances, he might have been more ap- proachable. That he was master of some, at least, of the social charms is witnessed by the fact that he was four times married, and in each instance to a woman of attraction and excellent social connections. To an extent, which never failed to make his character of interest, but which never subjected him to ridicule, Mettauer was eccentric. There was, indeed, about him that which would have saved him from ridicule, even had he been far more eccentric than he was. I have referred to his invariable custom of wearing on all occasions and at all times a preposterously tall hat. One of his children, now surviving, has told me 23

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No characterization of Mettauer could be complete unless it took note of the practical common-sense which guided him in his work whenever there was no other guide to be found in his own experience or in that of other men. ln employing the methods suggested in the most advanced journals he was by no means sure to follow even remotely the details of an operation. An instinct enabled him to grasp the essential of the matter. and, this accomplished, he was rather more likely to improve and to shorten the details than to follow in the track laid down by him who first described some new method. ln exactly the same direction it mattered not seriously to Mettauer whether hc had an instrument of the make of the most celebrated shops or of his own fashioning, or none at all. To turn any sort of thing into a reasonably sufficient tool was a common trick of his, and hence we read of emergency catheters made out of pipe-stems and of every sort of employment of the commoner articles of daily use to serve some pro- fessional turn. When one calls an American country surgeon of the old day daring, he has in mind no trace of the fussy, vain desire for notoriety, which we sometimes now associate with the advertising surgeon, and which some writers have pretended to discover among some of the surgeons of France. Surgical daring is a matter of the when, not of the nvhat. The ancient poet gives oak and triple brass about the breast to him who first trusted his frail bark to the savage deep, and now the trackless highways of the ocean are safe as lighways of the land. In the sense that he was far ahead of his age, and only in that sense, was Dr. Mettauer a daring surgeon. Many of his operations would stamp him as a high leader in surgical advance, and on several of these the fame of an ordinary or even an ordinarily great man might securely rest. But lVlettauer's most brilliant work in the way of operations was his method of vesicovaginal fistula, and his successful em- ployment of wire sutures made of lead, in which he antedated by a good many years even Sims, whose name is generally associated with this operation. So successful was Mettauer that he declared his belief that every case of this sort was curable by his method, and, so far as his efforts were reported, I am not aware that he ever failed in one. Proper pride and regard for his own reputation in the coming years must make every surgeon careful to a degree in assigning credit for useful and honorable achieve- ments to those who have preceded him, and there is in the history of surgery no claim more clear and unmistakable than that of John Peter Mettauer to the honor of discovery in this case, and he is plainly entitled to rank in medical history and in the grateful memory of his successors in the same class with McDowell and Dudley and Sims and Mott. Strangely enough, Mettaueris isloated position and his little conspicuous way of life have barred him from well-earned fame, and he is not even mentioned in some such works as lVlumford's Narrative of Medicine and Park's History. Even where it would appear that circumstances demanded a thorough knowledge of Mettauer and of his work, the reference to him is so slight as to be slighting. In l858 Sims takes occasion to rebuke an old associate of his for the attempt to defraud him of the credit of the use 22

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that she never saw her father without his hat on. He never attended service in the churches, and the explanation was always assumed to lie in the unwillingness either to remove the covering from his head, or to attend church wearing his hat. He would decline to take off his hat in court on the occasions when his expert testimony was sought: and the sole occasion on which a judge seems to have insisted that the doctor should be uncov- ered brought from Mettauer the suggestion that if his evidence were essential to the case he would be pleased to give it with his hat on, and that if it were not so, he would be quite as well pleased to leave the court-room, meanwhile, of course, wearing his hat. With posthumous insistence, Dr. Mettauer left directions that he should be buried with his hat on, and a coffin a trifle over eight feet long was found necessary to contain his body with this favorite article of dress and the considerable number of instruments which, along with a parcel of letters from his first wife, he directed to be buried with him. It is really not likely that lVlettauer's absence from religious and social gatherings should be put down to oddity. There is far more probability that the same lack of time for anything other than the tasks he set himself, which marked him out as a man without a pastime, also prevented his attendance on any occasion where his professional service was not in demand. Dr. Mettauer formed for the community in which he was born an affection which was little short of passion. He had numerous opportunities to come out into the great world under the fairest auspices, but he found when he tried it that he dragged a length- ening chain wherever he roamed that anchored him back in Prince Edward again. He once made a settlement, which proved a brief one, in Norfolk. He tried life in Baltimore as professor of surgery in Washington University, but soon the longing for his native scenes swept over him, and he came home to stay. lVlettauer's versatility was so truly great that he might have resented an intimation which identified him with any particular branch of practice to the exclusion of the others. Pre-eminent as he was in surgery, he certainly did resent what he considered the invidious attempt of some of his brethren to classify him as a specialist in that direction, and, though he would have scorned a consideration which rested solely on his writings, these were, in magnitude and in force, enough to malce the magnum opus of another man. I have in my possession a very large number of manuscripts on various medical and even quasi medical topics. These were produced in his most active literary period, from l825 to l845. Among them are articles and essays on yellow fever, congestive fever, puerperal fever, Asiatic cholera, continued fever, remitting and intermitting fever, and a most interesting article on the prophylactic use of drastic purging in the early treatment of puerperal fever, etc. During these years he was a most voluminous and valued contributor to nearly every medical journal published in this country, and on my book-shelves are un- counted piles of the older journals containing contributions from Nlettauer, to which the editors well-nigh uniformly assign the place of honor in their magazines. 24