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).


Popular Remedies for Deafness

The aurist William Wright (1773-1860) published a journal in 1825, The Aurist. In the third volume, 31 May 1825, he prints the first of series of articles to be devoted to discussing the merits of some popular remedies advertised and recommended by aurists and “quacks” in London. Unfortunately, the third volume was the last one, but we are left with some interesting insights into how Wright assesses some of these “popular” remedies.

On insects being inserted into the ear:

We do not believe that these insects or eggs, ever assisted to relieve one case of deafness, but we do believe that some simple cases may have been benefited by the application of the oil [of earthworms] alone, which is directed to be used in the preparation of these other remedies.

For instance, ants, when boiled or distilled, give off formic acid, which can be used to drain out wax from the ear.

On the use of Nitrone Oxide Gas:

As experimented with some professionals for deafness, we think, if administered with due caution, it is worthy the experiment, because as it does stimulate the muscular powers so forcibly, without leaving any of that debility, which is the usual consequence of all other stimuli; in moderate but frequent doses, and under proper management, it might permanently increase the tone of the organ of hearing.”

The gas was often used by aurists for Eustachian tube catheterization.

Also used for catheterization, Aether:

We are trying the effects of the vapour of aether in a few cases to which every other method of treatment has previously been applied, and failed of affording relief. The patients who are having it applied, are persons of an extreme nervous temperament, and they are satisfied that they have already desired benefit from the application. At present we do not think the fact is sufficiently established, to enable us to speak decidedly upon the subject, but we hope to be able to do so in the course of the succeeding numbers, when we shall explain the manner of using the ether.

As discussed earlier with the case of Joseph Hall, catheterization with an air douche can be dangerous, and even more so when applied with aether; it was thus recommended by many aurists only the skilled and well-trained of the brethren should apply it on patients.

William Wright & Miss Hannah Thatcher

William Wright (1773-1860), whose professional career began in Bristol, England in 1796, moved to London and acquired a large practice in aural surgery that included the Duke of Wellington and other members of the nobility as patients. Eventually he became one of John Harrison Curtis’ fiercest and most outspoken rivals, rallying against the prevalence of quackery in aural surgery. Part of his early career included teaching deaf-mutes the elements of speech, an approach that was scarcely offered by other aurists of the day.

Continue reading William Wright & Miss Hannah Thatcher

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.

On Pretended and Itinerant Aurists

As focused as I’ve been on John Harrison Curtis, my current research focus has branched out, exploring a seeming network of aurists that also practiced in London during Curtis’ time.

William Wright (1773-1860), as I’ve mentioned previously, was one of Curtis’ contemporaries, and perhaps his most fierce and prominent competitor. Wright had a very long career–nearly 50 years–and published as many treatises on deafness and ear diseases as Curtis did. While his early work concentrated on warning the public against the dangers of using mercury as a treatment for deafness, much of his later work commented on various types of treatments described by other aurists at his time.

In fact, Wright’s writing actually serves as a commentary on the state of aural surgery during the early 19th century: his early publications remarks on the lack of expertise in the field, then he writes about the various treatments offered by aurists of his day, and during the latter part of his career, he scorns the level of quackery in the field and commends the newer generation of anatomists (like Joseph Toynbee) for taking a more “scientific” interest in the field. Pretty much every aurist during the period is mentioned in one or more of Wright’s publications!

I’ll write a longer essay in the near future examining the evolution or transformation of Wright’s perceptions of aural surgery. In the meantime, here’s one of Wright’s comments on “pretended and itinerant aurists”:

It is high time that some legislative enactment should put a stop to these nefarious practices, and to the evils which these impostors inflict through want of skill, upon many families among the poor. But it is almost hopeless to expect any change, whilst government receive so much from the advertisements issued by these empirics, and whilst the country newspapers are so materially benefited from the same source. Even Royalty itself has been imposed upon more than once, and made a medium for promulgating the names of some of the most notorious quacks to the world; which circumstances must be fresh in the recollection of the public.

Wright, Plain Advice for all classes of Deaf Persons, the Deaf and Dumb, and those having Diseases of the Ears (London, 1826)