A Chamber of the Stillness of Death: Phyllis M.T. Kerridge’s Experiments in the Silence Room

I’m beginning a new project on the historical contributions of women to otology, many of whom have been overlooked in scholarship. My current article investigates the physiological work of Dr. Phyllis Margaret Tookey Kerridge, who died on June 22, 1940, the only daughter of Mr. William Alfred Tookey of Bromley, Kent. She was educated at the City of London School of Girls and at University College London; her graduate studies commenced at the latter institution, first in chemistry and then physiology, where she was also appointed as lecturer. She also held posts in the London School of Hygiene and Tropical Medicine, the Marine Biological Association Laboratory at Plymouth, the Carlsberg Laboratories at Copenhagen, and at London Hospital. She received her M.D. from University College Hospital, in 1933 and became member of the Royal College of Physicians in 1937.[1]

During the 1930s, Kerridge conducted experiments to measure the residual hearing capacity of children in London County Council schools, as well as experiments in teaching with electronic hearing aids. Much of her research was on patients at the Royal Ear Hospital, who were tested in the hospital’s “Silence Room:” a 3,500 cubic room in the basement of the hospital’s new building on Huntley Street, with

“walls impenetrable to extraneous noises and which will never reflect, deflect nor refract sounds—a chamber of the stillness of death, where absolute accuracy and complete consistency in results will be obtained.”

The room was built so exact tests to measure degrees of deafness can be made in ideal and constant conditions. Such stillness in this room apparently allowed people to hear heartbeats and the “flick” of their eyelids! A small table and two chairs were placed in the room. There was a bell to call the Porter’s room and an electric fan affixed there as well.

The Committee of the Royal Ear Hospital occasionally granted permission to medical practitioners to use the Silence Room for their own research purposes. For instance, in 1929, they granted the otologist Dr. Charles Skinner Hallpike (1900-1979), a research scholar from Middlesex Hospital, to use the room free of charge. Hallpike is particularly known for his ground-breaking work on the causes of Meniere’s disease (a disorder that causes episodes of vertigo) and for the Dix-Hallpike test for diagnosing benign positional vertigo (sensation when everything is spinning around you).

The Western Electric 1-A Audiometer in clinical use at the Central Institute for the Deaf in St. Louis, c.1920s. Western Electric produced only about 25 of these audiometers, which retailed at about $1,500 in 1923. (Central Institute for the Deaf Collection)
The Western Electric 1-A Audiometer in clinical use at the Central Institute for the Deaf in St. Louis, c.1920s. Western Electric produced only about 25 of these audiometers, which retailed at about $1,500 in 1923. (Central Institute for the Deaf Collection)

The hospital’s 1938 Annual Reports reveals that Kerridge was appointed to research at the Silence Room, then renamed as the “Hearing Aid Clinic,” working alongside Mr. Myles Formby to conduct hearing test on the hospital’s patients. Though the Clinic was initially started on a 6-month trial period, Kerriddge’s work was so beneficial that the hospital Committee decided to let her continue her research work and audiometer tests, extending care to private patients as well. They provided her with two more rooms in the basement, one as a waiting room and the other as an office, as well as the services of Miss W.J. Waddge as an assistant. In 1939, Kerridge viewed 170 cases, and according to the reports, her work among deaf patients was successful in helping many of them to be fitted properly for hearing aids.

Wartime of course, changed the course of things. The clinic was abandoned during World War II, but the hospital still provided hearing tests with the audiometer to test the hearing of patients suffering from “bomb blast.”

NOTES

[1] Nature 146 (august 3, 1940).

Inside an Operating Theatre of the 1900s: A Review of Cinemax’s “The Knick”

This post includes a review of Cinemax’s The Knick and contains minor spoilers.

On arriving to Bellevue Hospital in New York in the 1880s, American surgeon Robert Morris (1857-1945) commented on the new surgical operating rooms at the institution:

[T]he operating room was similar to that of other large general hospitals. The set-up consisted of a plain wooden table to carry instruments, lint or oakum dressing, unbleached muslin bandages (we had no absorbent gauze or cotton), and a large tin basin of tap water. Sometimes plaster of paris and other splint outfit was added.[1]

image
Dr. William Williams Keen conducts a surgical clinic in the Jefferson Medical College Hospital amphitheater, c.1890s.
Archives & Special Collections, Thomas Jefferson University, Philadelphia.

I’m utterly fascinated with the surgical operating theater and how it evolved from a simple room with minor equipment to a packed theatre stage, and eventually to the sterile and spacious environment of modern operating rooms. The transformation of the operating theatre mirrors many tremendous advancements in the surgery during the twentieth century, as surgeons became more skilled and innovative as they mastered complicated and dangerous procedures. It’s no surprise then that I was completely riveted by Cinemax’s new television series, The Knick, directed by Steven Soderbergh, written  by Jack Amiel and Michael Begler, and starting Clive Owen.

image

The show takes place in turn-of-the-century New York City, with Owen playing the anti-hero Dr. John Thackray, surgeon at the Knickerbocker Hospital. The pilot episode, “Method and Madness” brilliantly captures the dual nature of medicine: we see Thackray begging his nurse (Eve Hewson) to inject him with 22cc of cocaine, and a short time later, watch him order her to prepare a 2% solution as an innovative spinal anaesthetic to inject a patient on the operating table.

The show’s opening scene in the operating room is, in a word, gory, illustrating the difficulty of procedures that are considered as routine today. Bareknuckle surgery. 100 seconds to perform a caesarean section on a patient with haemorrhage in the womb. Brass hand cranks for suction. White aprons and rolled-up sleeves of street clothes. The rubber apron of Dr. Jules Christiansen (Matt Frewer), which could barely camouflage the surgeon’s hopelessness and despair over 12 unsuccessful caesarean operations. When the patient and baby die on the operating table, Christiansen turns to his audience and reminds them that surgery is about advancement: “It seems…it seems we are still lacking. I hope, if nothing else…this has been instructive for you all.”

image

During the early 19th century, operative surgery was limited to breakages, fractures, and amputations. Experimental operations to save the life of a patient were incredibly painful, gruesome, and, in many instances, unsuccessful. Two major advances during the mid-19th century would establish a foundation for surgeons to innovate new life-saving operations with greater confidence: the discovery of anaesthetics and the introduction of antiseptics. Analgesics were always made use of in medicine, as medical practitioners were aware of certain natural substances contained properties for relieving pain, such as opium or alcohol. During the 1790s, experiments of the effects of inhaling various gases and vapours first initiated the possibility pain relief could be achieved by inhalation of some suitable vapour or gas. Humphrey Davy (1778-1829) experimented with nitrous oxide (laughing gas), but other medical practitioners did not pay attention to his developments. The 1840s introduced ether as a more satisfactory anaesthetic, though chloroform anaesthesia became widespread as well after 1847 when James Young Simpson (1811-1870) first used it to relieve a patient’s difficult childbirth pains.

image
Dr. William Halstead is the inspiration for Clive Owen's character.

However, post-operative sepsis infection accounted for the majority patient deaths after major surgery. Antiseptics and antiseptic surgical methods became widespread with Joseph Lister’s (1828-1912) introduction of carbolic acid (phenol) as a method for eliminating bacteria on skin and on surface objects. The development of anaesthetics and antiseptics spearheaded the notion of a painless surgical operation. In the 1870s, towns with 10,000 residents had only 100 hospitals within their limits or nearby; by 1910, the number of hospitals increased to over 4,000, as new, innovative surgical procedures were became more successful.[2]

Even with anaesthetics and antiseptics, surgery was an incredible gruesome practice. Operations were performed either in patient wards, a small operating room, or in front of hundreds of students in the ordinary lecture theatre. We see this in The Knick, which surely benefited from the medical, historical and technical advice of Dr. Stanley Burns and the Burns Archive.

image

The scenes in the operating theatre appear to jump out of the incredible photographic collections housed at the Burns Archives. I found it difficult to get emotionally connected to characters, though the pilot episode did set up a solid foundation to explore their developments as well as the broader cultural strokes of America in the 1900s. Midwifery and “Stretcher Men;” divisions of the rich and poor; hospital administration; and of course, new technological developments like electricity being fitted in the Knick as it undergoes renovation. Dr. Algernon Edwards (Andre Holland) the “Negro” surgeon, gives us an interesting insight into America racial tensions, but I was more captivated with the scenes of the squalor and poverty of immigrants. The New York Public Health Board’s inspections of tuberculosis cases and their forced removal of sick persons, for instance, shows us how medicine was enforced in the legislative level, as laws outlined demands to enforce structural changes in housing to eradicate breeding grounds for disease. These scenes are a reminder of the terrifying cloud of disease and death.

You can watch the first episode here: http://youtu.be/ItBAXOEE8Vk

 

NOTES

[1] Quoted in Roy Porter, Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton & Company, 1997), 374.

[2] Morris J. Vogel, “Managing Medicine: Creating a Profession of Hospital Administration in the United States, 1895-1915,” in Lindsay Granshaw and Roy Porter (Eds.), The Hospital in History (New York: Routledge, 1989).

Surgeons & Surgical Kits

There’s always a scene in any movie or television show depicting a surgical operation: a nurse or assistant clad in scrubs, enters the room pushing a cart. On the cart lies several delicate instruments, their hard steel glistening under the harsh lights of the theatre. None of the instruments touch each other, and they are placed in a carefully organized order.

Then we see the scene after the operation: the once pristine instruments stained with the bright red of blood, and discarded into a bowl. They have fulfilled their purposes, the dangers embodied in their construction has diminished and they are to retire until they are called for again.

I love those scenes. The instruments play as much of a role in surgical operations as the nurse, the lights, the antiseptics anesthetics and of course, the surgeon. But without the instruments there really is no operation. Without the instruments is a surgeon even a surgeon?

The 10th century Arabic scholar and physician, Abu al-Quasim ibn al-Abbas al-Zahrawi (936-1013) introduced many notable surgical instruments in his eponymous Kitab al-Tasrif ( Method of Medicine), a thirty volume encyclopedia on the anatomy and practise of medicine. Al-Zahrawi, also known by his Latinized name Albucasis, details over 200 instruments, many of which he devised himself, combining ideas from ancient Greek and Roman physicians with his own observations and experiences as a surgeon.

A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)
A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)

Al-Zahrawi stressed a skilled surgeon would not only know the uses and benefits of numerous types of instruments, but will apply the knowledge to make sure an instrument was used properly and carefully to prevent excessive pain to the patient. Other medieval surgeons also stressed the importance of instruments–the surgeon’s kit–as an essential part of the surgeon’s practice.

Before the operating theatre had instruments nicely laid out on a cart, surgeons often carried their own instruments in a box or bag, taking with them as they attended to patients. Some were of simple designs, while others were more elaborate, with ivory, gold, or silver detailing.

An ivory surgical presentation set, c.1868. It contains  a full complement of scalpels, bistouries, needle threaders and tenaculum hooks.  The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps. This was the Governor's Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)
An ivory surgical presentation set, c.1868. It contains a full complement of scalpels, bistouries, needle threaders and tenaculum hooks. The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps.
This was the Governor’s Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)

These kits consisted of knives, razors, and lancet for making incisions; cattery irons grasping tools, probes, suture scissors, saws, needles, cannulae, pads, bandages, and in some instances, even tools for trepanation. Some kits also contained analgesics such as opium or hashish as pain relievers, or plasters for treating wounds.

A 19th century 14-piece surgical instrument kit (Barcelona)
A 19th century 14-piece surgical instrument kit (Barcelona)
A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder,  toothed forceps and two plain forceps. (Phisick Medical Antiques)
A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder, toothed forceps and two plain forceps. (Phisick Medical Antiques)

Pre-anesthetic surgery was crude, gruesome, and horrifying. Operations were limited to amputations, suturing, and bone-setting. And because it was preferable patients remained awake during the operation (as it was easier to deduct whether there was serious danger), speed was a crucial factor for ensuring a higher degree of success. Instruments were used over and over, frequently without being cleaned, and without being disinfected–antiseptics wouldn’t arrive until the second half of the nineteenth century.

Five surgeons participating in the amputation of a man's leg while another oversees them.  Coloured Aquatint by Thomas Rowlandson, 1793.
Five surgeons participating in the amputation of a man’s leg while another oversees them.
Coloured Aquatint by Thomas Rowlandson, 1793.

Dieting Deafness Away

I’m sure some of you have heard of London-based undertaker William Banting (1797-1878), who was the first to popularize a low-carb diet that formed the basis of modern-day diets (think Atkins). Banting was an upper middle-class funeral director whose family held the Royal Warrant for burials for five generations, until 1928; George III, George IV, Prince Albert, and Queen Victoria were buried by the Banting family.

William Banting. (Wikipedia)
William Banting. (Wikipedia)

There’s plenty of commentaries on Banting’s diet floating around the Internet. A retired widower, he was obese, 5’5 and 202lbs at age 66, his heaviest weight. He wore a truss to hold in place an umbilical rupture. His weight—and the associated complications—was so bad he could not stop to tie his shoe, and had to go down the stairs backwards to limit the pain of weight on his knees and ankles. He tried various attempts to drop some pounds: “sea air and bathing in various localities, with much walking exercise; taken gallons of physic and liquor potassae, advisedly and abundantly; riding on horseback; the waters and climate of Leamington many times, as well as those of Cheltenham and Harrogate frequently…”[1] All of these were in vain.

In 1862, after finding his eyesight failing and his hearing greatly impaired, Banting consulted an aural surgeon, but was disappointed with the surgeon’s medical approach: He “made light of the case, looked into my ears, sponged them internally, and blistered the outside, without the slightest benefit, neither inquiring into any of my bodily ailments, which he probably thought unnecessary, nor affording me time to name them.”[2] After the surgeon went on holiday, Banting sought other assistance to relieve him from his ailments. He likely visited the Royal Dispensary for Diseases of the Ear (est. 1816), which in 1862, was directed by the aural surgeon William Harvey (1805/6-1876/9).

Harvey was a well-known aurist in London and had a steady career as a surgeon. He was educated at Guy’s Hospital and practiced general surgery for a few years before establishing himself as an aural specialist and publishing The Ear in Health and Disease in 1854. In addition to his post at the Royal Dispensary, Harvey was also aural surgeon to the Freemason’s Asylum for Female Children and the Great Northern Hospital. As he repeated often, he bore no relation to the physician William Harvey who experimented with blood circulation.

Upon examining Banting’s ears and assessing his obese stature, Harvey explained that the deafness was symptom of fat deposits in the Eustachian tubes. He advised Banting to overhaul his diet to lose weight, explaining that as the pounds came off, his hearing would be improved. Banting was advised to abstain from bread, butter, milk, sugar, beer, and potatoes, which had “been the main…elements of [his] existence.”[3] Instead, he was to eat four meals a day composed of meat, greens, fruit, and dry wine. The diet worked: Banting lost 46 pounds in a few months. He was so astounded by the results he gave Harvey an extra £50 to his usual fees, to be distributed amongst his favourite hospitals. In addition, Banting published a pamphlet in the form of an open testimonial, Letter on Corpulence, Addressed to the Public (1863).

Photo: University of Buffalo Libraries
Photo: University of Buffalo Libraries

The first edition was self-published at his own expense, but became so popular that he sold it; later editions were published by Harrison, London. The pamphlet and Banting’s dietary success became so well-known that “Do you bant?” became a referred to fashionable way of asking whether people were trying to drop a few pound.

Where did an aurist get the idea for dietary management as a way to improve hearing? According to Harvey, in 1856, while he was out for a walk in Paris, he came across an announcement for a lecture by Claude Bernard at the Paris School of Medicine. Through Bernard’s lectures, Harvey learned how starch could affect the body negatively and played a role in the production of insulin. Diabetics management in particular, could be handled with a proper diet—and of course, assist in losing weight.

Unfortunately for Harvey, false rumours spread in London that the diet had ruined Banting’s health, and that Harvey was to blame. Furthermore, his practice suffered as he was constantly ridiculed for being unable to explain why the diet worked; medical practitioners criticized the diet as “unscientific” and Harvey’s application of diet management as a process that could not be replicated under similar variables.

6779312-M

In 1872, Harvey published his own account of the diet, On Corpulence in Relation to Disease as a way to address some of the critique against him. In particular, he outlined how his treatment was misapplied in many cases, applied rashly and indiscreetly without proper medical advice. And of course, he points out, it “was…natural to expect that a pamphlet on a dietary for the cure of Corpulence, coming from a lay source, would not have found much favour with the profession, and that it would receive some severe criticism.”[4]The book is technically detailed, with information on the physiology and anatomy of the body, how fat deposits affect tissues and muscles, and symptoms of illness that arise from obesity. He also provides an explanation of how fatty deposits can enter the Eustachian tubes and result in temporary deafness through the mucus membranes.

 

NOTES:

[1] William Banting, Letter on Corpulence, Addressed to the Public (1863), 12.

[2] Ibid, 16.

[3] Ibid, 17.

[4] William Harvey, On Corpulence in Relation to Disease (1872), vi.

The Time-Travelling, Vote-Gathering, Miraculous Acousticon

An 1922 advertisement in The Illustrated London News caught my eye:

deaf

Look at the flapper! Is she being coy? Ignoring the gentleman who’s obviously flirting with her? Or is she deaf to his fancy words?

This was the first half of an advert for the “Acoustion,” which claimed it could restore hearing in deaf individuals and improve their lot in hearing culture:

Why…should you be debarred from the pleasures of attending church, theatre, concert or conference? Why, when there is an instrument that will neutralise your deafness, should you be prevented from entering into conversation without difficulty, and listening to music without effort?

The Acousticon was one of the first portable electric hearing aids, the invention of American engineer Miller Reese Hutchison (1876-1944).

Acous_Hutchinson

He invented the first electrical hearing aid around 1895, called the “Akoulallion” (Greek for “to hear” and “to speak”), a table instrument that was connected to a carbon microphone and earphones—essentially, a “microtelephone.” The device was sold in limited quantities for $400 out of The Akouphone Company, which was established by Hutchinson and James H. Wilson in Mobile, Alabama in 1898/9. In 1901, the Akoulallion is redesigned and sold as the “Akouphone,” at a retail price of $60. The bulky nature of these devices made them unpopular and thus did not sell well. For instance, in the 1902 The Silent Worker, the popular newsletter for deaf individuals, Alexander L. Pach wrote:

Some question has been raised as to Mr. Hutchinson’s sincerity and belief in the efficacy of his machine [the Akoulallion]. There should not be any. Mr. Hutchinson was sincerity itself. He believed what many deaf people told him, and it’s a surprising fact that many of us who are deaf were fooled by that they experienced. I had intelligent deaf people tell me that they heard, where they only felt the vibrations, and these vibrations needed no machine to bring them out. Such a great number of the deaf are unable to distinguish between hearing and feeling that they were the means of deceiving the inventor, and some of our expert teachers, hearing ones, who stood by were fooled, too.

In 1901, Hutchison moved to New York and continued inventing new devices through his new company, the Hutchison Acoustic Co., operated along with Willard S. Mears. The “Acousticon” was shortly introduced, a more portable version of the Akouphone and powered by batteries; it had three components, cost 10 guineas, and the batteries lasted from a few hours up to a week. It was deemed a miraculous invention and adverts asserted the deaf that it was recommended, if not favoured, by many aural specialists.

Surdus in search of his hearing
The Acousticon. From: Evan Yellon, Surdus in search of his hearing (1906)

A patent was granted on August 25 1903 (U.S. Patent 737,242). The specifications outline that:

This invention is a portable telephonic apparatus intended to be used by persons with impaired hearing…[It can be] adapted to be used in a room or hall to enable partially-deaf persons to hear speech, music, or other sounds which are ordinarily heard by persons with normal hearing powers.

HutchinsonPatent1

Hutchison was prominent in publicizing his invention, even exhibiting it at the Louisiana Purchase Exposition. Queen Alexandra of Denmark counted herself as a grateful customer.

The virtues of the Acousitcon were tested by selected deaf and partially-deaf individuals in New York, who offered their professional opinions of the instrument. R.E. Maynard tested the device and notified readers of The Silent Worker that

the result was exactly the same—something that approximated sound was sent through the ear, which was rather more a sense of feeling, than of real hearing. It was so faint that no distinction could be made without the inventor first teaching the difference of sounds in the words “papa,” mamma,” “hello.” The notes from the piano and banjo could be differentiated, while the finer and shriller notes of the guitar and cornet could not, although the sound was thrown into the ear by some powerful current. It is probable the same difference in sounds could be distinguished by a deaf person holding in his hands an empty cigar box. While it was shown that bona fide deaf-mutes have little hope of making practical use of the Acousticon, it was clearly demonstrated that the device will prove highly helpful to the hard of hearing, and for that purpose is probably a great success (1903).

Hard-of-hearing Lucy Taylor was delighted at the benefits of the instrument. In 1913, she wrote to the Silent Worker:

It gave me the first ray of hope I have had in many years, for surely Mr. Hutchison knows what he is talking about. I have long felt, that if someone who understood, cared enough to really try, something might be invented, that would do for the partially deaf what glasses do for the partially blind.

The Acousiton’s advertisements were spectacular, quite eye-catching, even used during elections and maybe the device was even used by time-travellers!* Adverts highlighted the numerous satisfied customers across North America and Europe–this ad in particular indicates that there was a Toronto office branch.

acousticon1916

He also invented another variation of the Acousticon, the “Massacon,” which converted audio into vibrations.

photo 1
From: Evan Yellon, Surdus in search of his hearing (1906)

This variation was for those with more profound hearing loss, but the price was high: 12 guineas up to 23 pounds when sold in England through the company Acoustic Patents, Limited. A table version was also adopted in schools for the deaf, particularly in Chicago and San Francisco as a teaching tool to teach deaf pupils speech.

From: Evan Yellon, Surdus in search of his hearing (1906)
From: Evan Yellon, Surdus in search of his hearing (1906)

By 1905, Hutchison sold his company and the rights to Kelley Monroe Turner (1859-1927) who would introduce various types of the Acousticon, some with volume control.

*The idea of a time traveller with a bulky hearing aid (or cellphone) struck me as really funny–imagine all the hijinks! No? Okay…