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]

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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.

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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.”

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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.

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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.

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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.

Ear-picks to Q-tips

Cotton-wool has long been a staple in households as well as in the aural surgeon’s tool kit. For ear ailments, cotton was used in all sorts of ways: soaked in olive oil and inserted into the ear, trimmed and soaked in medicaments to cover a perforated eardrum, and even inserted between rubber to serve as a hearing aid. These days, the extent of our relationships between cotton and the ear is Q-tips®–most of us use these cotton swabs to clean out ear wax, risking the tremendous pain of stabbing our eardrums each and every time. We’re not supposed to use cotton swabs anymore, medical professions say, but that doesn’t really stop us, does it?

Did you know Q-tips® were invented in 1923 by Polish-born American Leo Gerstenzang (1892-1973)? He was inspired after watching his wife attach pieces of cotton to short sticks of wood to clean out hard-to-reach places. Gerstenzang founded a company, the Leo Gerstenzang Infant Novelty Company, which marketed baby care accessories; his cotton product was originally called Baby Gays. Yes, Baby Gays. By 1926, he changed the name to Q-tips® Baby Gays to identify the “quality” of the product. Eventually he changed the name again.

But Q-tips® were not the first technological product designed for cleaning out ears. Earwax was, and is, an annoying problem for most people. Too much of it not only feels gross, but can hamper hearing. How did people deal with this? Basic procedures: using the finger or small stick to clean out ear. If the earwax build-up was bad enough, a medical practitioner would recommend syringing with water or medicaments to weaken and drain out the earwax.

Ear Scoops, or Ear-picks were used for cleaning out the ear canal. People from all levels of society used these tools which were made from different types of materials. Some versions, however, were costly status symbols made for higher, fashionable living; they were made of gold or silver and intricately detailed. Some ear scoops were double-ended, with the other side for cleaning nails; others were a part of the splendour of toiletry, with a space reserved in toilet kits.

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Bronze ladies’ toothpick/ear scoop, dating to c.1-3rd century Rome
Silver ear pick and nail parer, English c.1400-1500 (Victoria and Albert Museum)
Silver ear pick and nail parer, English c.1400-1500 (Victoria and Albert Museum)
Toilet case, 1750.  Kingwood parquetry box with combined silver ear pick & tongue scraper  (Victoria and Albert Museum)
Toilet case, 1750. Kingwood parquetry box with combined silver ear pick & tongue scraper (Victoria and Albert Museum)
Ear pick & spoon carved out of bone & used during American Civil War by Brigadier General Lewis Addison Grant (Minnesota Historical Society) 
Ear pick & spoon carved out of bone & used during American Civil War by Brigadier General Lewis Addison Grant (Minnesota Historical Society)
1898 cylindrical gold case with gold toothpick & earpick, French (British Museum)
1898 cylindrical gold case with gold toothpick & earpick, French (British Museum)

The British Museum has an amazing collection of ear picks. But really, anything–anything–was better than this:

Steam treatment? 17th century painting by G.M. Faenisch 
Steam treatment? 17th century painting by G.M. Faenisch 

 

The Surgeon’s Plan: Tympanic Membrane Perforation

By the nineteenth century, Sir Astley Paston Cooper (1768-1841), surgeon to Guy’s Hospital, outlined his observation that puncture of the tympanic membrane could be effective in draining out collections of fluid in the middle ear, and hence, improve a particular type of deafness.

Sir Astley Cooper

Cooper’s work was inspired in part by his friend Sir Everard Home (1756-1832), surgeon to St. George’s Hospital and son-in-law of surgeon John Hunter (1728-1793). On 7 November 1799, Home read a paper before the Royal Society describing how comparative anatomy led him to outline the radial fibres of the tympanic membrane, emphasizing how the “muscular action…may conduce to account for certain phanomena in the sense of hearing.”[1] In particular, Home emphasized that while it “is true that the membrane tympani is stretched and relaxed by the action of the muscles of the malleus…It is stretched, in order to bring the radiated muscle of the membrane itself into a state capable of acting, and of giving those different degrees of tension to the membrane” suitable for hearing.[2] In a letter to Home, read before the Royal Society, Cooper remarked on whether “the loss of power which the organ of hearing would sustain by perforating the membrane tympani,” of a human ear, as only dogs have previously been made the subject of these trials, as exemplified by the work of British physician Thomas Willis (1621-1675) and Valsalva. Observing the ear of two of his patients—a Mr. P., twenty year old medical student at St. Thomas’s Hospital, who had been subjected to vicious attacks of inflammation and suppuration in his left hear since childhood, and Mr. A., another gentleman professing similar complaints—Cooper contended that it “was evident from these experiments that the membrana tympani of each ear was incomplete, and that the air issued from the mouth, but the Eustachian tube, through an opening in that membrane, and escaped by the external meatus.”[3] Cooper’s observations claimed that in cases where the membrana tympani had been destroyed, air was still able to produce the necessary effect for perfect hearing.

The likelihood that tympanic membrane perforation did not necessarily result in a loss of hearing and immediate enthusiasm for the procedure led Cooper to deliver a second paper before the Royal Society, outlining a clear methodology for the procedure and describing its success.[4] Remarking on the “prejudice” against medical intervention, Cooper writes:

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 for the rest of their lives, who might have been restored to hearing, had proper assistance been easily applied. But this prejudice, it is hoped, will now be done away; since it appears, that part which had been thought most essential to hearing, viz., the membrana tympani may be injured by disease, or may be broken by violence, without a deprivation of the sense of hearing, and that, even when this membrane is entirely destroyed, another is found to perform its functions; so that the powers of the organ have still been, in a considerable degree, preserved.[5]

Cooper examined more than twenty cases of deafness coupled with damaged membrana tympani, which he insisted often arises from an obstruction in the Eustachian tube. The operation Cooper proposed to cure for this deafness consisted in puncturing the membrana tympani, which he documented in several cases: “The operation to remedy the species of deafness here described, consists in passing into the ear a canula, of the size of a common probe, in which a trocar is concealed; the canula is to rest upon the membrana tympani, and the trocar is then to be thrust through the membrane.”[6] The operation, however, was performed blind, as Cooper’s sole motives for implementing the procedure was based on Eustachian tube obstruction.[7] For his observations, in 1802 Cooper was bestowed the Copley medal by the Royal Society, and in 1805 was elected a Fellow.

The immediate response from Cooper’s papers led to tympanic membrane perforation becoming a popular procedure, used as a catch-all “cure” for all cases of deafness, despite Cooper’s claims that it should be carefully adhered to his strict selection criteria. Christian Michaelis, for instance, Professor of anatomy and surgery in Marburg, performed the operation on sixty-three patients in 1804 alone.[8] Many “non-medically trained” practitioners also promoted the use of the procedure for their patients, and its “injudicious overuse inevitably led to it falling from favour, as the majority of patients did not gain any benefit, and many presumably lost further hearing as a result of blind tympanic membrane perforation.”[9]


 NOTES

[1] Everard Home, “The Croonian Lecture: On the Structure and Uses of the Membrana Tympani of the Ear,” Philosophical Transactions of the Royal Society of London 90 (1800): 1-21; 1.

[2] Home, “On the Structure and Uses of the Membrana Tympani,” 11.

[3] Astley Cooper, “Observations on the Effects Which Take Place from the Destruction of the Membrana Tympani of the Ear,” Philosophical Transactions of the Royal Society of London, 90 (1800): 151-160; 153.

[4] Astley Cooper, “Farther Observations on the Effects Which Take Place from the Destruction of the Membrana Tympani of the Ear; With an Account of an Operation for the removal of a Particular Species of Deafness,” Philosophical Transactions of the Royal Society of London 91 (1801): 435-450.

[5] Cooper, “Farther Observations on the Effects,” 449.

[6] Cooper, “Farther Observations on the Effects,” 444.

[7] J. Rimmer, C.E.B. Giddings, and Neil Weir, “History of Myringotomy and Grommets,” The Journal of Laryngology & Otology 121 (2007): 911-916, 912.

[8] Rimmer, Giddings, and Weir, “History of Myringotomy and Grommets,” 912.

[9] Rimmer, Giddings, and Weir, “History of Myringotomy and Grommets,” 912.