A Word, Aurist.

The word—or rather, the identity of—“aurist” has an incomplete history. Even right now, as I typed the word, Microsoft Word automatically corrected it to “aorist,” as if questioning my word choice. A quick dictionary search turns up a definition of “an ear specialist” or even “former name for audiologist.” The former is true. The latter false. An audiologist studies hearing (or lack of) and measures degree of hearing losses, and the tem did not emerge until the late 1940s. An otologist, however—or the more modern otolaryngologists, or Ear/Nose/Throat doctors—studies the normal and pathological anatomy and physiology of the ear, as well as diseases, diagnosis, and treatment of various defects in the ear.

Let me inspect your ears... From: David Hayes Agnew, The principles and practice of surgery : being a treatise on surgical diseases and injuries (Philadelphia: J.B. Lippincott & co., 1878-83)
Let me inspect your ears…
From: David Hayes Agnew, The principles and practice of surgery : being a treatise on surgical diseases and injuries (Philadelphia: J.B. Lippincott & co., 1878-83)

“Aurist” is more fitting as an ancestor of “otology,” but the transformation of usage and identity formation was not an easy one. In my dissertation on nineteenth century British aural surgery, one of the major themes I address is the making of a speciality: how did practitioners of ear diseases, who chose to specialize and claim legitimacy for their field, identify themselves as specialists? The ways in which “aurist” or “aural surgeon” suggests the very ambiguous characterization of the word, even by those who asserted themselves as ear specialists. Looking through newspapers, correspondences, and publications, it’s clear that “aurist” was a panoramic term used to describe all practitioners who provided treatments for aural diseases, especially during the first half of the nineteenth-century. The earliest reference to “aurist” I found dates to a practitioner’s newspaper advert in 1775 and there’s a remarkable jump in the word’s usage starting in the nineteenth-century.

But the word was more than a reference to a practitioner treating the ear. It was a term of abuse against proprietors of such medical nostrums as “Dr. Taylor’s Celebrated Remedy,” “Dr. Dunbar’s Bonatical Snuff,” or “Collin’s Coridial Cephalic Snuff,” who boasted their potions could cure incurable deafness. It was a word to condemn the nefarious itinerant whose fallacious promises could scarcely cloak his sheer quackery. These were the men (and yes, they were all men), who, as The Gentleman’s Magazine reported in 1828, were “bad, dangerous, and ignorant practitioner[s].”

At the same time, “aurist” was used to refer to a distinctive surgical identity, the specialist practitioner who also called himself an “aural surgeon,” whose knowledge of physiology and diseases of the ear enabled him to develop newer techniques for diagnosis and treatment. These were the practitioners who crafted their surgical authority by publishing widely on the anatomy, physiology, and diseases of the ear. They also called themselves “surgeon-aurists.” To use the word “surgeon” as part of a self-imposed identity was clearly to construct (in)visible ties to the tripartite hierarchy of elite medicine in nineteenth century Britain, which was composed of physicians, surgeons and apothecaries aligned in degrees of authority, while at the same time, distinguishing the specialist.

Yet, much to this historian’s confusion, these practitioners also used the word “aurist” and “aural surgeon” interchangeably, dismissing the notion that the former was strictly an idiom of abuse. And even more confusingly—all practitioners of aural surgery were at one time or another, or even in the entire duration of their career, denounced as quacks, from John Harrison Curtis the “nefarious” aurist who attended to the royal family, to Joseph Toynbee, the pathologist who was the first to be appointed as Aural Surgeon at St. Mary’s Hospital. The whole story is so complicated that even at nearly 300 pages, I’m still not finished writing this story of the aurists and on aural surgery.

So when did “aurist” fade away? It’s hard to determine, but words don’t really drop out of fashion all of a sudden. William Wright published a journal called The Aurist in 1825, but this was short lived, with a print run of only 3 issues.  “Otology” started showing up in the second half of the nineteenth century. The German journal Archiv für Ohrenheilkunde (Archives of Otolarynology) was established in 1864 by Anton von Tröltsch (1829-1890), Hermann Schwartze (1837-1900) and Adam Politzer (1835-1920), with print runs in both German and English. The first British journal of otology, the Journal of Larynology and Otology founded in 1887 by Morel Mackenzie and Norris Wolfden—it was originally the Journal of Larynology and Rhinology and Otology was later added in 1892 after changes in editorship.

Thanks to H.Stiles for the scan!
Thanks to H.Stiles for the scan!

In 1868, the American Otological Society was established, with no doubt due to Politzer’s influence, as evident from an 1879 letter from his student Clarence Blake (1843-1919):

We have every reason to be encouraged as to the standing of otology in America in the future and the cordial good feeling which exists among aurists in this country will do much to advance our branch of science. The aurists here seem always ready to acknowledge each others good work and to help each other in study and in experiment…” (quoted in Weir, p.184). 

Blake held the first Professorship at Harvard in 1870 and was also appointed Lecturer in Otology and Aural Surgeon to the Massachusetts Eye and Ear infirmary, clearing showing that “otologist” did not immediately replace “aurist” or “aural surgeon.” In England, Urban Pritchard (1856-1926) founded the department of aural surgery at King’s College Hospital in 1876 and was created Professor of Aural Surgery in 1886—the only chair of its kind in all of England. Pritchard was also the British representative on the committee of organization for the International Congress of Otology, which held its first meeting in 1876; he would become president of the society in 1899. The Germans did not establish a society for otology until 1881, the British in 1900 with the Otological Section of the United Kingdom; seven years later the society would become the Section of Otology of Royal Society of Medicine.

There’s still more work to be done, of course. This is but the beginning!

For an overview of the history of otolaryngology, see: Neil Weir, Otolaryngology: An Illustrated History (London: Butterworths, 1990).

61 Questions

In Advice to the Deaf: The Present State of Aural Surgery (1840), John Harrison Curtis addressed to deaf individuals the importance of seeking out an aurist to receive a through examination of the ear. Acknowledging that some of his distant patients might be unable to find a skilled aurist in the countryside, Curtis describes how he put together a list of 61 questions to better serve distant patients and be able to diagnose them from their answers.

As seen below, the questions were developed in accordance with Curtis’ friend, Dr. Schmaltz of Dresden–but as I’ve discussed before, these questions were also used in Curtis’ practice at the Royal Dispensary. Some of the sources I’ve come across strongly suggest that the answers to these questions would determine the outcome of a deaf patient’s treatment. How overwhelming and terrifying it must have been!

P.s. Sorry for the poor quality of the photos–I really should invest in a scanner instead of relying on my iPad camera…

photo 1

photo 2photo 3photo 4

The Royal Dispensary: Motivations and Prejudices

I’ll be presenting at the Deaf World/Hearing World: Spaces, Techniques, and Things in Culture and History Conference on December 10-11 in Berlin and as I write my presentation, I’ve been thinking a lot about how motives and intentions guide history. I also just wrapped up a semester of teaching Medicine from Antiquity to the Renaissance at Ryerson University (which explains the lack of posts, sorry Dear Reader!), and many students have remarked how marveled they were at learning about some of the (sinister) motives and biases behind Western medicine. So as you can figure, the topic was very much on my mind, and in my own research it pops up over and over again…

Traditional histories of hospitals assumed that dispensaries were designed simply to advance the interests of “outsiders” in the market for health, or founded because hospitals were unable to meet the needs of the sick poor. Recent scholarship, however, has argued that these histories are incomplete, for they do not explain the success of a dispensary or the motivations of benefactors without being conflated with the needs of the sick poor (see Granshaw & Porter, The Hospital in History, for instance). Specialist hospitals, for instance, were founded on humanitarian reasons and conditioned by Christian individualism that promoted a sense of duty and philanthropy as the most effective remedy for social ills; but these hospitals were also a natural response to the need for accurate and specialized medicine. The spotlight has thus been turned towards examining the history of hospitals and dispensaries beyond the mere act of lay philanthropy, and revealing insight into the motivators of benefactors, the characteristics of patients, and the features of social control embedded within these institutions.

One of my dissertation chapters aims to anchor within this historiography of hospitals and dispensaries by exploring the early years of the Royal Dispensary for Diseases of the Ear. Curtis founded the Dispensary in 1816 and stories of success in restoring hearing in his deaf patients quickly spread throughout the metropolis. Although Curtis initially established the Dispensary to propel his career, within wider dimensions of historical experience, his motivations can tell us much about broader cultural and social attitudes towards the deaf. The Dispensary was more than just an institution from which Curtis could employ his theories about treatments for deafness or experiment with new treatment techniques—it was a place that provided an alternative framework for dealing with the “problem of deafness” by undermining the monopoly of educational asylums for the deaf. In so doing, the Dispensary advocated the notion that deafness could be cured, that aural surgery was deserving of attention, of transformation, and of respectability.

In 1816, Curtis apparently gave a lecture outlining that the ultimate agenda of the Dispensary was to defeat the rhetoric of “popular prejudice” that was advocated largely by educational asylums for the deaf. The prejudice insisted that deafness was incurable and thus it was futile to subject patients to medical and surgical intervention. As Curtis explains,

This popular prejudice, I am endeavouring to combat, may be considered as one cause that impedes the progress of medicine, for it prevents patients from applying to the practitioner on the commencement of a malady,—the idea of nature curing disease in general, through proper to be entertained to a certain length by a professional character, should be opposed as a general opinion, from conveying a want of confidence in a science, which is justly considered as the most useful.

The problem with the “popular prejudice” was not just that it prevented aurists from experimenting with newer treatment methods—especially on pupils at educational asylums for the deaf—but that it increased the likelihood that deaf children with structural defects in their ear or easily curable ear ailments were forced into isolation and “doomed to perpetual science and hopeless despair.” To Curtis, the Dispensary provided a platform for exerting efforts to remove “the prejudices unhappily entertaining in respect to this class of diseases being incurable.” Curing a large number of cases would not only be sufficient for demonstrating the utility of a specialized field of medicine but will also provide credence to the notion that many cases of deafness were simply misdiagnosed.

The 1816 lecture also indicated two objectives for the Dispensary. First, it was to provide charitable care for the “relief of the industrious poor from a class of diseases to the last degree painful and inconvenient, and often neglected, if not generally misunderstood.” The Dispensary was not the first institution in England providing medical and surgical treatment for deafness—John Cunningham Saunders, for instance, managed the London Dispensary for the Relief of the Poor Afflicted with Eye and Ear Disease from 1805 to 1809—but it was the first to be devoted solely to treating ear diseases. As such, its charitable endeavors earned the institution an eminent reputation on a national scale. The second objective was to

show that diseases of the ear, like diseases of other organs, if properly studied and judiciously treated, are by no means of so incurable or manageable a nature as it has been too much the custom to suppose—an opinion, the prevalence of which has been productive of considerable mischief.

Early nineteenth-century aural surgery could hardly be called a cohesive and unified field. Without any direct or clearly observable cause for deafness, aurists found it difficult to diagnose a cause in order to prescribe an appropriate course of treatment; in many cases, treatments were not only ineffective, but provoked further damage to the ear. Consequently, Curtis intended to construct the Dispensary as an institution for clinical study as well as for experimentation and advancement with treatments for aural diseases; as evident from Curtis’ series of introductory lectures, he did use the Dispensary as a practical school during the founding years of the institution, but there is little evidence to support that the practice of teaching continued after 1820 when the Dispensary was relocated to larger grounds.

Aurists’ Treatments for Eustachian Tube Obstruction

In 1834, the aurist William Wright published a treatise addressed to the Honorable Members of the Committee of Inquiry into the State of the Medical Profession. The treatise, The Present State of Aural Surgery; or, Methods of Treating Deafness, Diseases of the Ears, and the Deaf and Dumb (London: T. Hurst, 1834), attempted to assess the various types of cures and practices offered by (mostly) London-based aurists in order to assess the “scientific merits” of aural surgery.

Wright actually ends up spending much of the treatise devoted to outlining various treatments for dealing Eustachian Tube obstruction, and the resulting symptoms of deafness following an obstruction, in order to criticize how aurists proceeded with treatment:

  • Mr. Cleland, Mr. Douglas, and Mr. Wathen in 1755 proposed cleansing the guttural passage of the ear by introducing a tube through the nose—a method Wright also employed in 1818.
  • Nicolas Deleau: “introduces a flexible tube through the ear, which is connected o a large vessel containing condensed air, which upon turning a stop clock, rushes air into the Tube.” The douches d’air.
  • Mr. Tod: “passes an instrument through the nose to the Tube and to its termination in the cavity beneath the drum of the ear.”
  • Mr. Mason: iodine in various modifications used to relieve deafness by thickening the membraneous lining of the tube
  • John Stevenson: touching the tonsils and adjacent parts with either a solution of lunar caustic or some stimulating application
  • John Harrison Curtis: removing  obstructions by stopping the external auditory passage with cerate—using the same principles of sound effects produced by a diving bell.
  • John Cunningham Saunders: mercury applied on the auditory passages of the Ear.

The “Popular Prejudice”

Throughout my research of nineteenth century works on aural surgery, as well as works on deafness and education for the deaf, I’ve come across the phrase “popular prejudice” often enough to warrant some analysis. The phrase reflects two crucial aspects of how deafness was perceived as a social image:

Firstly, deaf-mutes were constructed as social tragedies, isolated from society by their dumbness and denied the word of God by their deafness. The prejudice in this sense refers to the isolation, which could be helped only through benevolent charity and religious endeavors to release deaf-mutes form their “mental and moral imprisonment.” Seclusion in educational asylums that provided sign-language and speech instruction were deemed the best means for defeating this prejudice.

Secondly, and partly as a consequence of the first aspect, deafness was subjected to a prejudice regarding the medical and surgical impracticability of curing aural diseases. As Sir Astley Cooper (1768-1851) explained in 1801, following the success of his procedure of tympanic membrane perforation, “[a] prejudice has prevailed, that the ear is too delicate an organ to be operated upon, or, as it is commonly expressed, tampered with; and thousands have thus remained deaf…who might have been restored to hearing, had proper assistance been easily applied.”[1] Likewise, John Harrison Curtis wrote in his An Essay on the Deaf and Dumb (1829):

Though in very old cases cures may be performed, yet it is to recent ones chiefly that the aurist is to look for success; but, owing to popular prejudice, the malady is too often slighted or temporized with; and hence it is generally in confirmed cases on that he is consulted; for, in the early period of the disease when relief may be obtained, it is commonly neglected, until, tired out with the fruitless expectation of nature curing herself, the patient has at last recourse to advice.

I don’t yet have a solid historical analysis of this phrase, but I believe it’s worth emphasizing the value of it as a means for understanding the tensions between educators of asylums for the deaf and medical practitioners edging for patients. I’ll report more as I figure this out; in the meantime, your thoughts, Dear Reader, are more than welcome.

[1] Astley Cooper, “Farther Observations on the Effects which take place from the destruction of the membrana tympani of the ear,” Philosophical Transactions of the Royal Society in London 91 (1801): 35-450; 449.