An Experiment in Chloroform

Tinnitus.

A ringing, buzzing, singing, clicking, roaring, annoying sound. It can get so loud that every other sound in the vicinity is drowned out. It can last a few minutes, or hours, or even years. It can be divine retribution, the “Curse of Titus,” after an insect flew into Titus’ nose and picked his brain for seven years. Beethoven complained of the ringing. Charles Darwin recorded the amplitude and frequency of his tinnitus daily.

In the mid-1860s, the aural surgeon Joseph Toynbee (1815-1866) began experimenting for a cure for tinnitus. He was plagued with the malady for years and could sympathize with his patients who complained and clamoured for a cure. In Diseases of the Ear (1860), Toynbee described a few case studies in which he devised treatments that included leeching and syringing. None of the cases were successfully cured of tinnitus in the long run.

Wanting to help his patients as well as himself, Toynbee conceived an experiment that induced chloroform into the tympanic cavity through a Valsavian maneuver. Chloroform was discovered in the 1830s by three researchers working independently of each other: French scientist Eugène Soubeiran 1797-1859), American physician Samuel Guthrie (1782–1848), and German chemist Justus von Liebig (1803-1873). Shortly after, chloroform’s  properties as an anaesthetic was introduced by Scottish obstetrician Sir James Young Simpson (1811-1870) in 1847.

Glass ampoule of liquid chloroform, Paris, France, 1845-1945

Glass ampoule of liquid chloroform, Paris, France, 1845-1945

Chloroform is a clear, colorless liquid. Physicians, surgeons, or even dentists would drop liquid chloroform to a cloth and place it over a patient’s nose until they became unconscious. It could also be vaporized and inhaled through a face mask. It’s popularity owed to its effectiveness as pain relief, as an alternative to opium or alcohol, and especially more so when Queen Victoria insisted on using it when she gave birth to Prince Leopold in 1853.Chloroform was administered by physician John Snow (1813-1858), who would also administer it to Queen Victoria for the birth of Princess Beatrice in 1857.[1] As the Queen wrote in her diary upon the birth of Leopold,

Dr. Snow administered ‘that blessed Chloroform’ & the effect was soothing, quieting & delightful beyond measure.[2]

For Joseph Toynbee, his experiences with tinnitus as well as his clinical observations suggested that chloroform could aid in relieving the ringing. In the summer of 1866, he conducted an experiment with chloroform and hydrocyanic acid, using himself as the test subject. He hypothesized whether the inhalation of vapours could pass through the Eustachian tubes and reach the cavity of the tympanum, effectively treating the tinnitus.

On Saturday July 7, 1866, Toynbee’s servant George Power found his master in his office dead. A piece of cotton-wool was placed over Toynbee’s nose and mouth. The room smelt strongly of chloroform and on a chair besides the couch, there was a watch, empty bottles, and two papers with handwritten notes: “The effect of inhalation of the vapour of chloroform for singing in the ears, so as to be forced to the tympanum, either by being taken in by the breath through a towel or a sponge, producing a beneficial sensation or warmth,” and “The effect of chloroform combined with “hydocyanic acid.”” The combination of chloroform and acid proved fatal.[2]

A familiar scene.  Sir James Young Simpson found unconscious following an experiment with chloroform. Lithograph: Edwin Hodder, c.1880

A similar scene.
Sir James Young Simpson found unconscious following an experiment with chloroform. Lithograph: Edwin Hodder, c.1880

Friday Evening Discourse

18 Savile Row. Burlington Gardens. W | 10 Feb 1860

Dear Mr. Faraday,

Having been unsuccessful in my attempts to obtain a ticket for Mr. Huxley’s lecture* tonight I shall esteem it a favour if you can give me one.

Believe me yours sincerely & obliged,

Joseph Toynbee

*Thomas Henry Huxley’s Friday Evening Discourse of 10 February 1860

 

The Artificial Tympanum

Perforation of the eardrum (tympanic membrane or tympanum) is a very common injury to the ear, often resulting from ear infection, trauma (damn those Q-tips!), loud noise, or blockages in the Eustachian tubes. Most cases the damage is minor and the drum heals quickly on its own, but other cases bring about hearing loss, and consequently, the rupture requires intervention to correct the damage.

The German physician Marcus Banzer (1592-1664) provided the first recorded account of correcting perforation of the tympanic membrane. In 1640, he published Disputatio de auditione laesa (Dissertation on Deafness) in which he describes the use of a tube made of elk hoof and connected to a pig’s bladder, to be used as a prosthetic eardrum. This construction replaced the rupture and aimed to protect the middle parts by preventing the funneling of external air, leading to further damage. This way, the eardrum could resume its function: air on both sides of the drum regulating sound.*

By the nineteenth century, however, there were no effective surgical treatments for perforation of the eardrum or the hearing loss that accompanied it. But there were many, many remedies recommended by physicians and aural surgeons, all applying the idea that the rupture needed to be closed somehow, but still allow sound to funnel through the ear drum. Some measures included: India rubber, lint, tin or silver foil, the vitelline membrane of an egg. Adhesion of the apparatus to the ear were used with: saliva, water, petroleum jelly, or glycerine.

Oh, that’s all, you say? Nope—how about cotton-wool inserted into the ear? Or onions? Pieces of fat bacon toasted over a candle then inserted into the ear along with some wax drippings? Pour some oil into your ear! Or when all else fails, just create your own homemade artificial eardrum with elk’s claw, pig’s bladder, fish bone, gold beater’s skin, or even some court plaster.[1]

Here’s when it gets interesting. In 1841, the aural surgeon James Yearlsey—who had just enough of quackery in aural surgery, by the way, and was advocating medical and surgical reform—became acquainted with the idea of constructing a surgical apparatus to treat perforation of the ear drum, when a patient from New York came to London for a consultation. Seven years later, he published a paper in The Lancet describing his new artificial tympanum made with cotton balls applied to the end of extraction cords.

However, whatever revolutionary sentiments Yearsley hoped with his innovation, were squashed by Joseph Toynbee (1815-1866), the charming and popular aural surgeon who once worked with Richard Owen at the Hunterian Museum. Toynbee is also father to the famous philosopher and economist Arnold Toynbee (1852-1883).

L0011028 Joseph Toynbee

Toynbee presented a paper on his artificial tympanum—making no reference to Toynbee—at the 1850 Annual Meeting of the Provincial Medical Association. His innovation was composed of gutta percha (natural latex made from South Asian trees of the same name—a very popular 19C material that eventually collapsed from overuse)  or vulcanized rubber, attached to a silver wire stem about 3cm. Toynbee followed his presentation with a paper, “On the Use of an Artificial tympanic Membrane,” published in 1853, which earned him a medal from the Society of Arts. The guidewire was used to install the device into the tympanic cavity, adhering the rupture and still allowing sound to funnel through the fine tube.

As you can imagine, Yearsley was outraged. Aural surgery during the 1850s was overwhelmed with priority disagreements between Yearsley and Toynbee, and many other enthusiastic aural surgeons chimed in their two cents on the efficacy of each of these new devices. Further surgical advancements would later demonstrate that artificial tympanic membranes have little value, for over time, the eardrum just heals itself naturally, or else grafts are recommended in cases of serious ruptures.

 

* Many thanks to Dr. Albert Murdy for the clarification.


[1] Eugene A. Chu and Robert K. Jackler, “The Artificial Tympanic Membrane (1840-1910): From Brilliant Innovation to Quack Device,” Otology & Neurotology 24 (2003): 507-518.

Quack Curers for the Deaf

During the 1830s, Alexander Turnbull (c.1794-1881), advertised a remedy he conjured, which he professed was capable of curing any cases of deafness not arising from organic disease. In particular, he advocated the use of veratria, a poisonous alkaloid obtained from the hellebore root, as an ointment applied to the external ear; the same treatment, along with other alkaloids from the Ranunculaceæ were also amongst several of his treatment options for deafness, gout, dropsy, rheumatism, and affections of the heart.[1] Six pages of Turnbull’s 1837 A Treatise on Painful and Nervous Affections, and a New Mode of Treatment for Diseases of the Ear were devoted to the application of veratria to the external ear and parts joining the auricle. Terming his treatment as “electro-stimulation,” Turnbull claims

Feeling satisfied that I had in my possession means decidedly effective in promoting absorption through the medium of the nerves, and knowing that deafness often arose from the Eustachian tube being obstructed by enlarged tonsil glands, I applied veratria externally over these glands, and found it frequently succeed in removing their enlargement and restoring the hearing.[2]

Signing off with the initials “J.T.,” on 5 April 1839, Joseph Toynbee (1815-1866) wrote to the Lancet warning readers of “quack curers for the deaf” that were printed in London’s daily newspapers that week.[3] Toynbee’s issue with the advertisement was not whether Turnbull could differentiate between organic and non-organic causes of deafness—a claim that Toynbee doubted merited any truth—but rather, on Turnbull’s public declaration of his expertise through advertisement. “[H]e sends his advertisement to the public papers,” Toynbee wrote, “for an enormous payment gets it inserted as a paragraph…[and] by the aid of the circulation of this puff…deaf people consult Dr. Turnbull; he makes his application, and takes his fee.”[4] Toynbee insisted this was a disgraceful and underhanded maneuver directed towards drawing in patients, who were left vulnerable to potentially dangerous treatments: “Sir, almost every medical man must have heard of the most horrible effects sometimes produced by the application Dr. Turnbull uses…It must be apparent that Dr. Turnbull has no greater knowledge upon the diseases of the ear, than the ignorant whom I have before exposed by means of your pages.”[5]

Moreover, Toynbee argued if Turnbull was truly anxious with “relieving suffering humanity” as he professed in his advertisements, then why didn’t he “devote care, time, and trouble to the study of diseases of the ear? By this mean only can a man obtain information, and practising without that information must make a man appear, what he really is, a noxious hypocrite.”[6] By emphasizing a practitioner’s altruistic nature, advertisements proliferated by newspapers only disguised the skills of a practitioner, and in so doing, “tend to mislead and cheat the public;” thus,

as long as the public is as unwise as it now is, it is to be feared that there will be found Turnbulls, with applications; Cronins, Curtises, and hosts of others with ear drops; Blairs, with gout drops; Holloways, with double universal ointments; St. John Longs, with killing frictions; and all of them will gain their end by getting a living.[7]

NOTES


[1] Alexander Turnbull, On the Medical Properties of the Natural Order Ranunculaceæ: and more particularly on the uses of sabadilla seeds, delphinium staphisagria, and aconitum napellus, and their alcaloids veratria, sabadilline, delphinia, and aconitine (London: Longman, Rees, Orme, Brown, Greene, & Longman, 1835).

[2] Quoted in William Wilde, Practical Observations on Aural Surgery and the Nature and Treatment of Diseases of the Ear (London: John Churchill, 1853), 44.

[3] “Quack Curers for the Deaf,” The Lancet 32 (April 1839): 112-113.

[4] “Quack Curers for the Deaf,” The Lancet 32 (April 1839): 113.

[5] “Quack Curers for the Deaf,” The Lancet 32 (April 1839): 113.

[6] “Quack Curers for the Deaf,” The Lancet 32 (April 1839): 113.

[7] “Quack Curers for the Deaf,” The Lancet 32 (April 1839): 113.