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.

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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.