Monday Series: An Inquest into a Surgical Procedure II

Charles Spradbrow also witnessed Joseph Hall in perfectly good health on Saturday June 22, having had seen him at Turnbull’s ten or twelve times on occasion to be treated for deafness, and was “always very anxious to use the instrument.” Several other individuals—as many as thirty, according to some reports—were also at Turnbull’s that Saturday, awaiting their turn to be treated for deafness. As Spradbrow testified, sometime around 10 o’clock, Hall filled up the air pump as full as possible, having become familiar with the set-up process from his previous visits. He also assisted Hall and Mr. Lyon, Turnbull’s surgical assistant, in setting up the instruments for catheterization, including connecting catheter to the pump. Spradbrow emphasized that both he and Hall were following the Lyon’s directions. Once the instruments were setup accordingly, Hall seated himself and Lyon inserted the catheter into Hall’s nostril and began to proceed with the process:

Continue reading Monday Series: An Inquest into a Surgical Procedure II

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Leigh’s New Picture of London

On the London Asylum for the Deaf and Dumb (est. 1792):

By this excellent institution, extensive and successful arrangements are made to teach even the deaf and dumb! So long ago as 1653, the celebrated Dr. Wallis first laid down the principles by which the deaf and dumb might be instructed, (Vide the Philosophical Transactions for 1666); and when it is considered how long the art of instructing these objects had been known, both upon the continent and in this country, it must excite astonishment that no effectual attempt was before made to extend the required assistance. It is painful to reflect, how many must have lived in misery, and died in ignorance, who might have been materially benefited, had there existed a charity of this character! The visitors of this institution will “find those who were once dumb and ignorant as the beasts of the field,” receiving a course of moral and religious instruction, and enabled to speak, read, write, cipher, and comprehend the meaning and grammatical arrangement of words. What will not perseverance accomplish,—what cannot science effect?

Leigh’s New Picture of London. Printed for Samuel Leigh, 18, Strand;
by W. Clowes, Northumberland Court. 1819

“that deaf stupid man!”

In 1839, a deaf man, G.H. Bosanquet, published a pamphlet entitled The Sorrows of Deafness, explaining in the preface that his aims for publication were derived from his “having suffered misery…from the privations of deafness.” Writing on behalf of his “fellow-sufferers,” Bosanquet remarks “[t]here is no class of sufferers whose feelings, as far as the results of my own bitter experience teach me, are so little understood as that of deaf patients.” He thus condemns those in society who pity “that deaf stupid man!” and especially those, who despite their charitable intentions and sympathy, misunderstand the experiences of thedeaf man and fail to bestow compassion towards him:

But, “the most unkindest cut of all” is, the wonder, the not concealed dislike of relations at your want of energy;–

“The pitying friend,

With shoulder shrugged and sorry.”

To hear them talk one would suppose deafness a possession to be coveted, as an excuse for idleness, instead of thegreatest source wherewitn the Almighty ever afflicted and tried the faith of an educated being.

Bosanquet’s pamphlet is reflective of relatively common perceptions of the deaf: they were  social outcasts deprived from communication and left as objects of charity.

A Patient Interaction

An aurist’s assertion of authority could at times be intimidating for deaf patients. An anecdote by a Reverend J. Richard about his “deaf and nervous friend” best demonstrates this intimidation. The friend was too timid to oppose or contradict an opponent, and said “yes” to everything or “no” everything, answering questions as he “conjectured the answer to be desired.” Hearing of John Harrison Curtis and the Royal Dispensary for Diseases of the Ear (RDDE), Richardson encouraged his friend to apply for a consultation. As Richardson narrates the story,

Mr. Curtis was a man who from long experience was able to form a correct idea of the character as well as the people who made applications for his service, and he soon discovered that the new applicant was not a very wise man. Mr. Curtis in his practice adopted rather the vigorous energy by which Dr. Radcliffe was distinguished than the persuasive lenity with which modern practitioners in nervous cases are accustomed to treat fine ladies and gentlemen [i.e. in reference to the list of questions]. He took patients by storm rather than by protracted advances, and in the case of my deaf and nervous acquaintance, he came in contract with the man who was of all others least calculated to withstand his robustness.[1]

The practice at the RDDE was to employ a rigid criteria for examining patients, a move that Curtis deemed would be beneficial for the aurist to properly diagnose an ailment and employ the most effective treatment. Examination began with a series of questions Curtis drew up in accordance with the plan of his friend Dr. Schmaltz of Dresden; he intended the questions to assist his correspondence with distance patients in order to possess a full and detailed history of their ailment, but as evident from Richardson’s anecdote, Curtis also used some aspects of the questions in his daily practice. Richardson describes the experience of his friend at the appointment, supposedly as retold by the friend:

[Curtis] seated the patient in a chair in which patients were placed during examination, and after various questions proceeded thus:–

‘You hear what I say to-day better than you did yesterday?’

‘Yes, sir.’

‘You hear what I say without difficulty; don’t you?’

‘Yes, sir.’

‘What’s your name?’

‘Yes, sir.’

‘How old are you?’

‘Yes, sir.’

The practitioner was growing irate, the patient was trembling with fear, he could hear nothing, but concluded that his safety depended on the acquiescence of his responses. The practitioner was resolved not to be so easily satisfied; he pulled out his watch, and held it to the ear of the patient.

‘Do you hear that watch tick?’

‘Yes, sir.’

‘That’s a d____d lie, for it doesn’t go.’

The patient, though he could not hear the words of Mr.  Curtis, was aware something was wrong. He got out of the chair and out of the house as fast as he could, and never troubled the owner of them again with his presence.”[2]


 NOTES

[1] J. Richardson, Recollections, Political, Literary, Dramatic, and Miscellaneous of the Last half-Century, Volume II (London: C. Mitchell, 1856), 290.

[2] Richardson, Recollections, 291-292.

Diagnostic Instruments & Surgical Authority

On 29 October 1839 the Bankruptcy Register listed John Harrison Curtis as a “bookseller.” By 1841, Curtis lost his patrons and his career was pretty much in shambles and his Dispensary was sold to the aurist William Harvey.

The invention of the cephaloscope and the publication of his treatise on the instrument were aimed as an approach for him to revive his career. In 1842, Curtis wrote a letter to Sir Robert Peel (1788-1850), a former patient of his who he appealed for assistance. In the letter, Curtis refers to his On the Cephaloscope (1842) as evidence enough for his merits for an appointment to Queen Victoria’s household as Surgeon-Aural surgeon-in-Ordinary.

But the treatise itself doesn’t spend much time discussing the merits of the instrument—most of the book is spent outlining the basic physiology and anatomy of the ear, the cranium, and the organs of the voice, explaining that the details are “absolutely necessary in order [for] the proper application of the instrument.”[i] In the chapter on the cephaloscope, Curtis spends little time actually discussing the merits of his instrument in practice, or providing extended cases studies of its application. But these details seem relevant, if not required, for Curtis to his credibility to other aurists. In particular, his long explanation of the augmentation of sound seems superfluous, but it appears to be central for his explanation of the design of his instruments.

The fact that Curtis used an instrument—as opposed to another “miraculous cure” or nostrum or surgical procedure—to extend his authority is noteworthy. It reveals much into the embodiment of medical and surgical authority within material objects and how instruments can be used as rhetorical devices. The cephaloscope, above all, was more of a symbol of orthodoxy for Curtis; as historian John Harley Warner points out, instruments that were presented as symbols of unity were means for preserving confidence at times of severe professional dislocation. Movements towards a more unified specialty based on Parisan pathological anatomy and diagnosis, became crucial epistemological and rhetorical shifts for aurists; by appealing to notions of “science” and “professional” they were in fact redefining the boundaries between the newer type of aurists like Toynbee, and those like Curtis who held on to their passive practices. Diagnostic instruments in aural surgery thus rested not on some abstract notions of what constituted as evidence for aurists, but rather on how authority could be asserted through material objects.[ii] These instruments served more than the mark of a surgeon. They were a symbol of the aurist’s skills and his judgment, considered to be more valuable to the public than a diploma or certificate, which could easily be forged.

The durability of any diagnostic instrument rested on a practitioners’ power to correlate what was heard or observed, with specific disease symptoms. The stethoscope for instance, not only unified the medical profession and transformed the patient-practitioner relationship, but it popularized a new skill for diagnosis—auscultation—which required the practitioner to make use of his auditory senses. Of course, the practitioner had to be trained for such a skill.[iii] Curtis hoped to do the same for aurists: since diagnostic instruments in aural surgery were long plagued with the problem of limited examination due to insufficient light source, he argued the cephaloscope could remedy this limitation by appealing to the aurist’s other sense. Sounds could convey images of internal anatomy, revealing damages to the structure of the ear, blockages in the ear or Eustachian tubes, or evidence of lesions brought by other diseases. Moreover, the cephaloscope was a far safer diagnostic tool than the speculum, forceps, or even Eustachian catheter, all of which, if improperly used, could cause pain and suffering in the patient. The reticent state of British aural surgery in the 1840s, however, made it difficult to construct a profession unified by a material expression of its authority. Nearly all aurists agreed diagnosis was the key to improving the state of aural surgery and securing their authority as specialists; more precise instruments would allow them to forge their skills as diagnosticians, and thus, prescribe more effective medical or surgical treatments. But some aurists, like Toynbee, concentrated on dissection in order to improve their clinical understanding of ear diseases; others, like Wright, recommended language training as alternatives to surgical treatments.


[i] Curtis, On the Cephaloscope, 1.

[ii] Jennifer Stanton, “Introduction: On Theory and Practice,” in Innovations in Health and Medicine: Diffusion and Resistance in the Twentieth Century, ed. Jennifer Stanton (London & New York: Routledge, 2002).

[iii] W.F. Bynum and Roy Porter (eds), Medicine and the Five Senses (Cambridge: Cambridge University Press, 1993).