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).

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What do you do when you’re sick?

I like to ask my students this question at the beginning of the term to help them get a mindset of what disease and illness was like in the early modern period and medieval ages. When confronted with the inevitable reality of disease, how did people of the Middle Ages react? Of the different forms of healing available, what factors determined which ones they turned to? Availability was one such factor, but we must also consider other factors such as the cost of services and treatment, the healer’s reputation, their suitability to treating the disease as well as explaining its underlying causation, as well as the past experience of the sick themselves, their family, and friends. More importantly, reliability was an ideal attribute to be found in practitioners.

Patients consulted astrologers, empirics, wise-women, midwives, nuns or priests known for their magical or miraculous healing powers, knowledgeable friends, as well as physicians or surgeons. They sought out healers and choose the one that most pleased them.

Physicians were, of course, expensive—but money was not the only consideration. Medical decision-making was a complex process. Medieval and early Renaissance patients were medically promiscuous. They often and perhaps even always consulted several different types of practitioners at the same time, or one after the other. This was true of both the rich and poor; the rich did not rely exclusively on physicians. To a large extent, patients perceived no firm cultural barrier between different medical practitioners, and behaved accordingly.

Moreover, as Gianna Pomata writes in Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (1998), the transaction between healer and patient was regulated by a business-like arrangement, known as the healing contract that dates back to the thirteenth century. Here’s an example of a contract from Bologna outlined in Pomata’s book, undersigned in 1244 by Rogerio de Bruch of Bergamo and Bosco the wool carder in Genoa:

          “In the name of the Lord, amen.

I, Rogerio de Bruch of Bergamo, promise and agree with you, Bosco the wool carder, to return you to health and to make you improve from the illness that you have in your person, that is in your hand, foot, and mouth, in good faith, with the help of God, within the next month and a half, in such a way that you will be able to feed yourself with your hand and cut bread and wear shoes and walk and speak much better than you do now. I shall take care of all the expenses that will be necessary for this; and at the time, you shall pay me seven Genoese lire; and you shall not eat any fruit, beef, pasta—whether boiled or dry—or cabbage. If I do not keep my promises to you, you will not have to give me anything. And I, the aforementioned Bosco, promise to you, Rogerio, to pay you seven Genoese lire within three days after my recovery and improvement.”

The promise of a cure is obviously a key feature in the agreement between healer and patient. To the patient, it was valuable because it outlined exactly what was to be expected from the healer and that payment was to be dismissed if cure was not provided—it was a legal binding document that could protect him from fraud as well. To the healer, it served to win the trust of potential clients, to showcase his learned medicine and prognosis. In addition, to those patients seeking out self-help, practitioners would actually build their authority on the difficulty of treatment and the dangers of treating selves without proper medical knowledge.

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.

A Brief History of the Eustachian Tube

The Eustachian tube is a passageway that lies between the middle ear and the pharynx, the upper part of the mouth located just below the top of the nose. One of the primary functions of the tube is to equalize ear pressure between the middle ear and the atmosphere; most of the time the tube is closed, but it can open to let in a small amount of air to prevent damage to the ear. Early mentions of the tube dates back to Alcmaeon of Sparta around 500B.C., who constructed a basis for understanding medicine via dissection, and thought the tube enabled goats to breathe through their ears as well as noses.[1] Other Greek philosophers, including Aristotle and Celsus, also vaguely referred to the tube’s existence, but did not elaborate on its function or purpose.

The Eustachian Tube
(from University of Maryland Medical Center)

The surge of Italian anatomists during the Renaissance period and their emphasis on dissection brought forth new understandings of the body and its parts. Andreas Vesalius (1514-1564), Professor of Anatomy of Padua, provided detailed descriptions of two of the tiny bones in the middle ear (the malleus and incus), but although he was aware of the existence of the Eustachian tube, he does not comment on its role in hearing. His contemporary, Bartholomeus Eustachius (1510-1574) who held the Chair of Anatomy at Rome, published the first detailed anatomical description of the tube in his 1562 Epistola de auditus organis (Examination of the Organ of Hearing), possibly the first treatise on the ear:

It originates at the anterior course of the base of the skull, and takes an anterior course toward the pterygoid process of the sphenoid bone. It consists of two parts: the first solidly connected with the temporal bone, close to the tympanic cavity; the second soft, partly ligamentous, partly cartilaginous, directed towards the nasopharyx. Cross sections of the tube are not perfectly round and the inner part is twice as wide as the outer.[2]

Bartholomeus Eustachius

Comparing the tube to a quill pen, Eustachius provided precise descriptions of its structure and position in the face, but he made no mention of its function:

Comparing to a Quill pen
(Wellcome Library Images)

Nor did he publish an engraving of the tube as part of the external auditory system in his 1651 Tabuli Anatomiceu, which also contained detailed figures of the ear ossicles and the tympanum membrane in man and dog.[3] It is likely that Eustachius held the long-standing belief that the Eustachian tube functioned as (another) avenue for breathing, since he postulated that other parts of the ear, especially the ossicles and tympanum, were involved in the mechanism of sound transduction. Not until 1683, with the work of French anatomist Guichard Joseph DuVerney (1648-1730) was this belief corrected. In Traité de l’organe de l’ouie, DuVerney described the Eustachian tube as a means for renewing air within the tympanum and for equalizing air pressure, believing that the tube was always open and it was the eardrum that maintained the flow of air.

Anatomy of the Human ear (1686); Steven Blankaart & Guichard Joseph Duverney
(Wellcome Library Images)

Descriptions of the Eustachian tube contained more than just anatomy: they highlighted the physiological and therapeutic importance of diagnosing and treating ear diseases confined to the Eustachian tube or tympanum. Antoine Maria Valsalva (1666-1732) is historically credited for giving the tube its eponymous name in honor of Eustachius, whose work set the foundation for understanding the anatomy and physiology of the ear. Valsalva, a pupil of the famed physician Marcello Malpighi (1628-1694), was appointed Professor of Anatomy at the University of Bologna in 1705, where his main interests were on anatomy and the function of the middle and internal ear.

Antonio Maria Valsalva. Line engraving by R. Ceracchi.
(Wellcome Library Images)

In 1705, Valsalva published De aure humana tractatus, which followed years of intense observations, animal experiments, and numerous dissections; the treatise included enhanced descriptions of the physiology and pathology of the ear, even demonstrating communication between the mastoid cells and the tympanic cavity. Valsalva also outlined the function of the Eustachian tube and its diagnostic use; the tube, he claimed, worked alongside the pharyngeal muscles of the ear. Believing that Eustachian tube blockages were among the main causes of deafness, in De aure, Valsalva also outlined his “Valsalvian maneuver,” a method consisting of the forced expiration of air through the Eustachian tube with the mouth and nostrils closed, thus resulting in increased pressure to the tympanic membrane. The procedure dates back to Arab physicians in the 11th century and was used as a remedy for cleansing the middle ear from pus, and hence, unblocking the ear and restoring hearing.[4]


NOTES

[1] Charles D. Bluestone, Eustachian Tube: Structure, Function, and Role in Otitis Media, Vol.2 (PMPH-USA, 2005), 4.

[2] Translated & quoted in Bluestone, Eustachian Tube, 5.

[3] Most of Eustachius’ works were not published during his lifetime or simply lost. His copper plates of anatomical engravings were discovered early in the eighteenth century and presented by Pope Clement XI to his physician Lanncisi (1655-1720), who then published the plates in 1712. Unlike Vesalius, Eustachius’ plates represented dead, not living anatomy.

[4] Steven H. Yale, “Antonio Maria Valsalva (1666-1723), Clinical Medical & Research 3: 35-38. The Valsalva maneuver remains a staple in modern medicine, having been adapted as a diagnostic procedure in modern cardiology for assessing heart murmurs and heart failure.

Monday Series: Constructing the (Naked) Social Body II

THE HISTORY OF THE BODY

Before continuing with my examination of the ideology of Nacktkultur and its respective relationships with the social body, I will first briefly outline what constitutes as a history of the body. Scholarship based upon the works of Foucault has emphasized the role of the body as a vehicle of social inquiry. According to Foucault, the historical specificity of the body and its history can only be learned through the notion that individual bodies are not separate entities, but rather products of construction existing in relation to a conceptual system. For Foucault, these complicated conceptual (and political) systems resided within clinics, jails, and asylums. The birth of the clinic, for example, seized the body with a medial gaze that penetrated inquisitively into the body, turning it to a discrete object of medicine. Reduced to its medical and biological realms, the body was expelled from history; it could only be understood within the social systems that govern it.

Arguably, the body then can only be understood as a socially constructed object for discourse. Building upon Foucault, historians have examined the diverse cultural variations of the body’s manifestation and attributions: sleep, food, sexuality, disease, age, and death, have all become topics of discourse.[1]  Discussing the role of the social body for historical analysis, Catherine Burroughs and Jeffery Ehrenreich question the historical ramifications for the body becoming socially constructed: “For if a body can be reshaped to accommodate a particular society, it can also be partly wrestled from that society’s control by an individual who has achieved enough power to redesign it according to his own desires.”[2] The symbolic body, as an object of historical discourse, literally embodies the values, prejudices, beliefs, and ideologies of its societies; additionally, it shifts, transforms, and mutates in reflection to the social and cultural meanings of historical periods.[3] The cult of Nacktkultur exemplifies this statement; viewed as a means to reconstruct the weakened German bodies, its power as a life reform movement transformed during the 1920s.

The body is thus overburdened with meanings. As a “source of amazement and pride, a symbol of human strength, ability and endurance,”[4] it embodies the hopes, fears, and expectations of its society. In its natural state, it serves as an antidote to problems of urbanization and industrial modernity.[5] Despite the Judeo-Christian tradition of associating nakedness with shame, Nacktkultur placed nakedness as an effort to recreate an Edenic state within the thrust of modern civilization.[6] The naked German body of the 1920s was a social body, with intense political significances, carrying multiple dimensions of identity and construction. Nakedness was not viewed as a separate force from the civilization, some form of savageness or incivility, but rather as a means for recovering one’s humanity lost within the symptoms of decay and cultural pessimism of postwar Germany. To most nudist Germans, the naked body became subjugated as a metaphor for reform, although as Heikki Lempa explains, “[t]here is no universal history of the body, no codification of science and practices that were applied to and applicable to each and everyone equally. The body is that of an individual who is a member of a social class, and that body is the carrier of the signifiers of that class.”[7]

While Lempa’s statement is true in the sense that the Germans did not view a single, universal history of the body, nudists aimed to construct a universal history, one which would represent the struggles between individual and state. In doing so, they aimed to reform society by first removing signifiers of social distinctions and reforming their bodies and disillusioned minds.  Nudists argued stripping their layers of clothing would reveal the universal and naked humanity underneath, which would cultivate an attitude towards equality that was absent in a society marked with social distinctions of class and wealth. By erasing titles and other forms of social distinctions, Nacktkultur suspended class inequalities as both the educated middle class and members of the working class would realize that material possessions were important. Nudity would be seen as a “certificate of authenticity,” as Germans “would not be reminded anymore of their own poverty and would forget the sorrows of everyday life. Envy based on social distinctions would vanish, and the German people would be welded into a “brotherly whole.””[8] Even the health of the proletariat—whose only real capital was their bodies—could raise consciousness for need for social equality.[9] 

Additionally, Nacktkultur presented an alternative view of the history of the body, one which celebrated nakedness as the highest and purest manifestation of German culture and beauty.[10]  From the late eighteenth-century onwards, life reformers emphasized the importance of a form of health and beauty that rejected the luxuries and refinements of the wealthy classes and stressed a return to the aesthetics of nature. For these life reformers, this return meant an expression of aesthetic ideals based on bodily norms of Greek antiquity. The history of the German body in this sense is traced to the representations of the ideal Hercules and Venus that embodied masculine and feminine ideals of strength, beauty, and perfection of the race. As Hau explains, “through the control of their bodies, [the life reformers] hoped to regain the fitness that would enable them to succeed again in the perceived struggle for survival,”[11] counteracting against images of the fat and bloated “beer philistine” which represented the weak and decaying bodies of the German race. Any deviance from the “timeless aesthetic norms of Greek antiquity” exposed signs of degeneracy of bodies, which in turn threatened the survival of the German race and manifested itself in serious diseases. Since beauty was accepted as an organic expression of a healthy and harmonious relationship of body, spirit and mind, life reformers urged for a body-consciousness that implemented aestheticized concepts of health.[12] “Normalcy was the precondition for beauty,” Hau explains, “while ugliness was the most important signs of degeneracy, a warning sign by nature which conveyed the message: ‘Do not love this person, because united with her you will worsen the race.’”[13]

The history of Nacktkultur is then the history of the German (naked) body. Disillusioned with social and political uncertainty, and faced with a strong perception of crisis, turn-of-the-century nudists found themselves politically charged and anxious for social reform. The perceptions of Nacktkultur were shot with political ideologies, and as Williams outlines, the more controversial ideologies of Nacktkultur spilled over to the social body, sparking loud debates and moral panics.[14] In the next section, I will narrate the origins of Nacktkultur and its ideologies. I will then discuss how, as a symbol of society, the naked body was able to penetrate and transform the ideologies of the social body.

NOTES


[1] U. LInke, German Bodies: Race and Representation After Hitler (New York: Routledge, 1999), 3.

[2] C. Burroughs and J.D. Ehrenreich, Reading the Social Body (Iowa City: University of Iowa Press, 1993), 4.

[3] C. Ross, Naked Germany: Health, Race, and the Nation (Oxford: Berg Publishers, 2005), 4.

[4] Ross, Naked Germany, 5.

[5] Williams, Turning to Nature, 3.

[6] A. Masquelier, Dirt, Undress, and Difference: Critical Perspectives on the Body’s Surface (Bloomington: Indiana University Press, 2000), 2.

[7] H. Lempa, Beyond the Gymnasium: Educating the Middle-Class Bodies in Classical Germany (London: Lexington Books, 2007), 6.

[8] Hau, The Cult of Health and Beauty, 196.

[9] Williams, Turning to Nature, 24. See also, G. Stollberg, “Health and Illness in German Workers’ Autobiographies from the Nineteenth and Early Twentieth Centuries,” Social History of Medicine 6.2 (1993): 261-276.

[10] Ross, Building a Better Body, 13.

[11] Hau, The Cult of Health and Beauty, 15.

[12] Hau, The Cult of Health and Beauty, 33.

[13] M. Hau, “Gender and Aesthetic Norms in Popular Hygienic Culture in Germany from 1900 to 1914,” Social History of Medicine 12.2 (1999): 275.

[14] Williams, Turning to Nature, 2.