Rethinking modern prostheses in Anglo-American commodity cultures, 1820–1939 9781526113535

Citation preview

i

RETHINKING MODERN PROSTHESES IN ANGLO-​A MERIC AN COMMODITY CULTURES, 1820–​1 939

ii

Series editors Dr Julie Anderson, Professor Walton O. Schalick, III This new series published by Manchester University Press responds to the growing interest in disability as a discipline worthy of historical research. The series has a broad international historical remit, encompassing issues that include class, race, gender, age, war, medical treatment, professionalisation, environments, work, institutions and cultural and social aspects of disablement including representations of disabled people in literature, film, art and the media.

Already published Deafness, community and culture in Britain: leisure and cohesion, 1945–​95 Martin Atherton Destigmatising mental illness? Professional politics and public education in Britain, 1870–​1970 Vicky Long Fools and idiots? Intellectual disability in the Middle Ages Irina Metzler Framing the moron: the social construction of feeble-​mindedness in the American eugenics era Gerald V. O’Brien Recycling the disabled: army, medicine, and modernity in WWI Germany Heather R. Perry Worth saving: disabled children during the Second World War Sue Wheatcroft

iii

RETHINKING MODERN PROSTHESES IN ANGLO-​AMERICAN COMMODITY CULTURES, 1820–​1939 Edited by Claire L. Jones

Manchester University Press

iv

Copyright © Manchester University Press 2017 While copyright in the volume as a whole is vested in Manchester University Press, copyright in individual chapters belongs to their respective authors, and no chapter may be reproduced wholly or in part without the express permission in writing of both author and publisher. Published by Manchester University Press Altrincham Street, Manchester M1 7JA www.manchesteruniversitypress.co.uk British Library Cataloguing-​in-​Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-​in-​Publication Data applied for ISBN 978 1 5261 0142 6 hardback First published 2017 The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-​party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Typeset by Out of House Publishing

v

This volume is dedicated with respect, love and affection to my grandparents, Fred and Louise Callon. They met at Anerley Deaf School, London in the 1930s and it is through them that I came to understand, appreciate and value Deaf/​deaf history and culture.

vi

vii

Contents List of illustrations Notes on contributors Series editors’ foreword Acknowledgements Introduction: modern prostheses in Anglo-​American commodity cultures Claire L. Jones

ix xi xv xvii 1

I  The commodification of hearing aids and aids to hearing

25

1 Purchase, use and adaptation: interpreting ‘patented’ aids to the deaf in Victorian Britain Graeme Gooday and Karen Sayer

27

2 Between cure and prosthesis: ‘good fit’ in artificial eardrums Jaipreet Virdi 3 Inventing amplified telephony: the co-​creation of aural technology and disability Coreen McGuire II  Th  e commodification of artificial limbs and associated appliances 4 ‘A hand for the one-​handed’: prosthesis user-​inventors and the market for assistive technologies in early nineteenth-​century Britain Laurel Daen 5 ‘Get the best article in the market’: prostheses for women in nineteenth-​century literature and commerce Ryan Sweet 6 Itinerant manipulators and public benefactors: artificial limb patents, medical professionalism and the moral economy in antebellum America Caroline Lieffers

48

70

91

93

114

137

vii

viii

Contents

7 Separating the surgical and commercial: space, prosthetics and the First World War Julie Anderson

158

Select bibliography Index

179 180

ix

Illustrations Figures 1.1 Hearing trumpet with ‘F. C. Rein & Son. Patentees, Sole Inventors & Only Makers, 108 Strand London’ engraved around outer rim. Source: Thackray ­Medical Museum, Object No. 1333.003. Image: K. Sayer 34 1.2 Arnold-​branded hearing horn in gunmetal with accompanying bag. Source: Thackray Medical Museum collection, Object No. 2005. 0338. Image: K. Sayer 40 2.1 A page from the 1917 edition of Fred Haslam & Co., Illustrated Catalogue of Surgical Instruments (Brooklyn, NY, Fred Haslam & Co., 1917), listing Toynbee’s artificial eardrum (top row, third from left) among other hearing instruments, indicating its classification as an acoustic aid. Image: Yale University, Cushing/​ Whitney Medical Library 54 3.1 The front page of the 1936 Post Office advertisement booklet ‘A ­Telephone for Deaf Subscribers’. Image: BT Archives 76 3.2 The Bristol engineers’ diagram of Harris’s amplifier. Image: BT Archives 79 3.3 The front page of the 1938 Post Office advertisement booklet ‘Telephone service for the Deaf ’. Image: BT Archives 85 4.1 Woodcut of Derenzy’s Ivory Vice. George Webb Derenzy, Enchiridion, Or, A Hand for the One-​Handed (London: T. and G. Underwood, 1822), 17. Image: New York Academy of Medicine Library 96 4.2 Woodcut of Derenzy’s Hat-​Stick. George Webb Derenzy, Enchiridion; or, A Hand for the One-​Handed (London: T. and G. Underwood, 1822), 40. Image: New York Academy of Medicine Library 96 5.1 An illustration of a male Marks-​type artificial leg user digging with a shovel. George E. Marks, A Treatise on Marks’ Patent Artificial Limbs with Rubber Hands and Feet (New York, NY: A. A. Marks, 1888), 346. Available at http://​hdl.handle.net/ ​2027/​loc.ark: /​13960/​t6h14501h?urlappend=%3Bseq=356 (accessed 6  May 2016). Courtesy of HathiTrust 119

x

x

Illustrations

5.2 An illustration of a female Marks-​type artificial-​leg user demonstrating the mimetic capacities of her prosthesis. George E. Marks, A Treatise on Marks’ Patent Artificial Limbs with Rubber Hands and Feet (New York, NY: A. A. Marks, 1888), 335. Available at http://​hdl.handle.net/​2027/​loc.ark:/​13960/​ t6h14501h?urlappend=%3Bseq=345 (accessed 6 May 2016). Courtesy of HathiTrust 6.1 Drawing from B. F. Palmer’s 1846 patent of his artificial leg, US Patent No. 4834. Image: United States Patent and Trademark Office

120 138

Tables 7.1 Recommended costs for artificial-​limb prostheses, 1915

166

xi

Contributors Julie Anderson is Reader in History at the University of Kent. She has published a number of articles on the intersection of the history of disability, mainly physical and sensory, and medicine, and she is the author of War, Disability and Rehabilitation: Soul of a Nation (2011). Her current work centres on histories of orthopaedics and ophthalmology, and her forthcoming book, The Science of Seeing: Vision and the Modern World in Britain, 1900–​1950, will be published by Manchester University Press in 2017. Laurel Daen is an adjunct lecturer of History at the College of William & Mary and the Lapidus Initiative Digital Communications Coordinator at the Omohundro Institute of Early American History and Culture. Her research focuses on the political, economic and cultural history of disability in early America. Her dissertation (William & Mary, 2016) explored the intertwined histories of disability and nation-​building in the early American republic. Her work is forthcoming in the Journal of the Early Republic and Early American Literature. Graeme Gooday is Professor of the History of Science and Technology at the University of Leeds. He has written on the socio-​cultural history of British technology in the late nineteenth and early twentieth centuries, focusing on themes of trust, gender and ambivalence in Domesticating Electricity: Technology, Uncertainty and Gender, 1880–​1914 (2008) and on the contentious history of patenting in early telecommunications and power in Patently Contestable: Electrical Technologies and Inventor Identities on Trial in Britain (2013); the latter volume, with Stathis Arapostathis, was awarded the Pickstone Prize by the British Society for History of Science in 2014. Gooday is currently supervising the AHRC collaborative Ph.D. project ‘Transforming Communications for the UK’s Hearing Loss Community’ with BT Archives and Action on Hearing Loss and is collaborating with Karen Sayer to complete Hard of Hearing: Managing the Experience of Auditory Loss in Britain, 1830–​1950. Claire L. Jones is Lecturer in the History of Medicine at the University of Kent and Deputy Director of the University’s Centre for the History of Medicine, Ethics and Medical Humanities. Her research centres on the cultural, economic and social history of medicine and health in Britain post-​1750, with particular emphases on the relationship between medicine and commerce and the multiple ways in which this relationship affects professional social structures, consumption and material culture. She has published numerous articles

xii

xii

Contributors

on this topic, and her first monograph on the development of medical industry in Britain, The Medical Trade Catalogue in Britain, 1870–​1914, was published in 2013. Caroline Lieffers is a Ph.D. student in the History of Science and Medicine at Yale University, where she focuses on the histories of disability, medical ethics and domestic life. Her research is supported by the Trudeau Foundation, the Social Sciences and Humanities Research Council of Canada, the Government of Alberta and Yale University. Coreen McGuire is a Ph.D. student in the School of Philosophy, Religion and History of Science at the University of Leeds. Her thesis is titled, ‘The “deaf subscriber” and the shaping of the British Post Office’s amplified telephones, 1911–​1939’. This is part of a larger AHRC-​funded project on communication with hearing loss and is a collaborative doctoral partnership with BT Archives. Coreen’s research focuses on technologies that were designed in the early twentieth century to help people with hearing loss. She has collaborated with the Thackray Medical Museum and the Legacies of War project and recently sat her Level 1 sign-​language exam. Karen Sayer is Professor of Social and Cultural History and a faculty member of the Leeds Centre for Victorian Studies at Leeds Trinity University and is a fellow of the Royal Historical Society. In 2012, she led the organisation of ‘Disability and the Victorians: Confronting Legacies’, an international conference in which Victorian and Disability Studies intersected, sponsored by the British Association for Victorian Studies, for the Leeds Centre for Victorian Studies. She has delivered papers at seminars and at international conference panels on the Victorian experience of hearing loss, and, with Professor Graeme Gooday, is contracted with Palgrave for a Palgrave Pivot volume addressing the pre-​NHS management and self-​management of hearing loss. Ryan Sweet completed an AHRC-​funded medical humanities Ph.D. in the Department of English at the University of Exeter in 2016. His thesis explored representations of prosthetic body parts in literature and culture from 1832 to 1908. Ryan has research published in Victorian Review, and he is a contributor to the online reader Victorian Disability: Culture and Contexts, funded by the Social Sciences and Humanities Research Council (www.nineteenthcenturydisability.org). Now Occasional Teacher at the University of Exeter and Associate Lecturer at Bath Spa University, Ryan is also the Managing Editor of the international academic journal Literature & History, which is published biannually by Sage Publications.

xii

Contributors

xiii

Jaipreet Virdi is a postdoctoral fellow at the Department of History at Brock University, Ontario, whose work intersects the history of medicine and disability studies. She is working on a project, ‘Objects of Disability’, funded by the Social Sciences and Humanities Research Council of Canada, investigating the material culture of disability in the Canadian experience. She is also working on her first book, Hearing Happiness: Fakes, Frauds and Fads in Deafness Cures.

xvi

xv

Series editors’ foreword You know a subject has achieved maturity when a book series is dedicated to it. In the case of disability, while it has coexisted with human beings for centuries, the study of disability’s history is still quite young. In setting up this series, we chose to encourage multi-​methodologic history rather than a purely traditional historical approach, as researchers in disability history come from a wide variety of disciplinary backgrounds. Equally, ‘disability’ history is a diverse topic that benefits from a variety of approaches in order to appreciate its multidimensional characteristics. A test for the team of authors and editors who bring you this series is typical of most series, but disability also brings other consequential challenges. At this time, disability is highly contested as a social category in both developing and developed contexts. Inclusion, philosophy, money, education, visibility, sexuality, identity and exclusion are but a handful of the social categories in play. With this degree of politicisation, language is necessarily a cardinal focus. In an effort to support the plurality of historical voices, the editors have elected to give fair rein to language. Language is historically contingent and can appear offensive to our contemporary sensitivities. The authors and editors believe that the use of terminology that accurately reflects the historical period of any book in the series will assist readers in their understanding of the history of disability in time and place. Finally, disability offers the cultural, social and intellectual historian a new ‘take’ on the world we know. We see disability history as one of a few nascent fields with the potential to reposition our understanding of the flow of cultures, society, institutions, ideas and lived experience. Conceptualisations of ‘society’ since the early modern period have heavily stressed principles of autonomy, rationality and the subjectivity of the individual agent. Consequently we are frequently oblivious to the historical contingency of the present with respect to those elements. Disability disturbs those foundational features of ‘the modern’. Studying disability history helps us resituate our policies, our beliefs and our experiences. Julie Anderson Walton O. Schalick III

xvi

xvi

newgenprepdf

Acknowledgements This volume arises out of an AHRC Research Network project ‘Rethinking Patent Cultures’, 2013–​14, and a project conference on commerce, patents and disability held at Leeds City Museum in September 2014. The editor would like to thank Manchester University Press, the AHRC and Leeds City Museum for their assistance and support and the authors of the chapters in this volume for all of their valuable contributions to this collection.

xvi

1

INTRODUCTION: MODERN PROSTHESES IN ANGLO-​A MERIC AN COMMODITY CULTURES Claire L. Jones

Commodification in contemporary perspective The present-​day relationship between disability, technology and commerce in the developed world is hugely intricate. While the medical-​industrial complex develops ever more innovative forms of myoelectric limb prostheses, cochlear ear implants and other devices designed to alleviate physical impairment, market responses to these technologies and the views these responses embody are diverse. For some, prosthetic technologies have certainly transformed lives, particularly those who have experienced impairment resulting from accidents, illness, trauma or war.1 Other prostheses users, however, remain increasingly frustrated over the affordability, the functionality and general restrictions to innovation as a result of growing corporate monopolies and call for more effective, cheaper and more easily available products enabled by greater state sponsorship, the greater separation of design from manufacturing and, perhaps most crucially of all, user-​generated platforms for open-​source designs.2 Yet, at the same time, it is well recognised that those who rely on prostheses to ‘fix’ their body and transform it to a state of ‘normalcy’ are not representative of all prosthetic technology users’ experiences. Scholars within the burgeoning academic fields of disability studies and disability history, along with many disability-​rights activists, have highlighted and sought to correct the impact of the ‘medical model of disability’, a conception of disability as a bodily defect that modern medical science and engineering are well equipped to correct. Indeed, it may well be suggested that the user experiences just outlined are underscored by the presupposition of the medical model. Since the late twentieth-​century growth of the modern disability-​rights movements in both Great Britain and the United States, the rejection of prosthetic technologies –​of cochlear ear implants among the Deaf community for ­example –​has

2

2

Introduction

often signalled attempts at forging identities that are not related to the m ­ edical ­profession’s view of disability but rather to forms of community-​building aimed at remedying the previous exclusion of impaired individuals from social, cultural, economic and political life.3 Concurrently, however, some who reject medical conceptions of disability may have an uncomfortable relationship with prostheses; they may use an assistive device to function where barriers to access still persist, on public-​transport systems, for example, and in such situations, their prosthesis conceals the social marker of impairment, allowing them to pass as ‘able-​bodied’. Other individuals subvert manufacturers’ intended use for the technology by using their prosthesis as a proud assertion of their non-​‘normal’ body, as artist Claire Cunningham does with the incorporation of her crutches into performance work.4 These diverse lived experiences of prosthetic technologies today represented through different interpretive frameworks are intricately tied to the past and to the study of the past. As scholars of disability know all too well, what constituted ‘disabled’ and ‘abled’ and the ways in which these two categories were viewed and constructed depends on temporal, social, geographical, cultural and economic contexts. This historical fluidity is also true for the relationship between innovation and commercialisation and between supply and demand, but our knowledge of the ways in which the changing status of prostheses and their markets relate to varying conceptions of disability is limited. Indeed, the ‘new disability history’, spurred by disability-​rights activism and patient-​centred narratives, has recently taken the lived experience of disability as its focus in order ‘to join the social-​constructionist insights and interdisciplinarity of cultural studies with solid empirical research’ and could be usefully supplemented by an exploration into how markets for prosthetic technologies shape those user experiences.5 ­Certainly, the general dearth in detailed market-​focused histories of prostheses may be partly due to the fact that they initially appear to be at odds with the new disability history’s efforts to emphasise the shortcomings of the medical model. Yet, as the diversity of experiences outlined above indicates, to neglect prostheses, how they came to be commodities and responses to them is to recount an incomplete lived reality of some individuals. Studying the commodification of prostheses may garner insight into how the medical model evolved, achieved its influence, and was institutionally realised. Understanding the ways in which such forces helped to develop and entrench the medical model may thus indeed serve those who seek to now limit its influence. It is the purpose of this collection to contribute new insights into the historical experiences of disability by uncovering more about the nineteenth-​and twentieth-​century foundations of modern prosthesis industries and their many complexities. While today’s high-​tech myoelectric limb prostheses and cochlear

3

Introduction

3

ear implants clearly differ from the relatively low-​tech artificial limbs and h­ earing trumpets of the nineteenth century, this collection outlines the remarkable similarities between the commercial processes involved in successfully getting these seemingly different products to market. Yet, by taking a commodification approach, this collection does not seek to privilege its significance over and above other interpretive frameworks, or to suggest that historians have neglected economic approaches to disability and prostheses altogether. Indeed, the collection is informed by materialist histories of disability, which have drawn on Marxist political economy in order highlight the importance of modern industrial capitalism in shaping disability and prosthesis use.6 Instead, its aim is to bring together a body of new scholarship from established historians and promising early careers researchers from a variety of historical sub-​disciplines to consider in more depth the commodification processes surrounding prosthetics and the involvement of companies, users and others in these processes. In particular, a little-​explored avenue in the history of disability, and of prostheses more specifically, is the significance of company investment in and their consideration of intellectual-​property protection. In the nineteenth and twentieth centuries, just as today, patenting and copyright enhanced product commercial viability, and yet we know very little about their effect on prostheses markets. In paying closer attention to commercial influences on prosthesis development and use, this volume not only outlines some of ways in which the expanding industries of prostheses and assistive devices of the nineteenth and twentieth centuries formed a precursor to those we recognise today but also proposes commodification as another useful analytical tool for the historian interested in disability. While materialist histories of disabilities have been criticised for emphasising the socio-​economic context of industrialisation over cultural factors and vice versa, the essays in this collection seek to align these elements through a culturally embedded history of the prosthesis as a commodity. As historian David M. Turner has recently argued, ‘an approach is required which simultaneously appreciates that disability is shaped by people’s particular social and cultural identities and their positions, while recognising that social and medical discourses, institutional practices and spatial environments also act to shape bodies and experiences’.7 By addressing the interrelation of these factors, a culturally informed commodification approach can inform ongoing efforts at reconceptualising disability. Prosthesis commodification since the nineteenth century As a descriptive term for an artificial body part, ‘prosthesis’ gained its modern meaning in the eighteenth century.8 While artificial body parts were

4

4

Introduction

certainly used prior to the eighteenth century, a growing body of scholarship has ­outlined how the rise of new pathological-​anatomical understandings of the body in late eighteenth-​century Western thought aligned with the beginnings of industrialisation that gave rise to the commercial production and promotion of new forms of prosthetic technologies.9 New understandings of the body, which provided a more clearly defined medical perspective of disability, resulted in the medical profession’s attempt to control the impaired body through new corrective procedures and was accompanied by a growing distaste for visible signs of physical impairment within ‘polite society’.10 In a new world oriented around the able-​bodied, a prosthesis became a device crucial for those with physical or sensory impairment to participate in society. Replacement body parts such as artificial limbs were far from the only assistive devices available. As recent studies by Liliane Hilaire-​Pérez and Christelle Rabier and by David Turner and Alun Withey have demonstrated, an increasing range of devices detached and detachable from the body, from rupture trusses, walking sticks and spectacles to elaborate machines, also become widely promoted from the late eighteenth century.11 Like replacement body parts, these devices ‘fashioned’ the body to both restore functional capability and to create the aesthetic of ‘normalcy’. Yet, while this array of devices was prominently promoted in the late eighteenth century, industrial structures and commercial markets for such products were relatively small and fragmented. It was from the nineteenth century, with the further advancement and alignment of medicine and modern industrial capitalism, that prosthetics flourished, in both scale of production and design innovation. Not only was the nineteenth century a moment of major redefinition in disability history, as various state-​sanctioned institutions brought disabled people under professional supervision, but definite shifts in the economy occurred too.12 As the UK established itself as the ‘the workshop of the world’, with the United States as its greatest English-​speaking global economic rival following closely behind, the manufactured prosthetic tool was transformed into a standardised commodity that reached large numbers of commercially literate consumers across the world. New modes of production both excluded those with physical impairments and facilitated the manufacture of technologically more complex prostheses. Although it never became a mass-​market good along the lines of a patent medicine, the prosthesis became a familiar piece of hardware that not only embodied economic value through market exchange but also standardised social and cultural meanings of disability as bodily impairments that required normalising.13 Prostheses were thus commodified as they circulated and as ownership of them transferred from buyer and producer to seller and user. Property relations of a different kind,

5

Introduction

5

in the form of intellectual property and patents, also became crucial from the ­nineteenth century as ownership of the individual body and rights over ‘correcting it’ became contested following revisions to patent laws. Centring their analysis on prosthesis commodification and commercialisation, this collection of essays therefore takes a more inclusive view of prostheses, one that recognises devices external to the body, such as specialist cutlery (discussed in Chapter 4 by Laurel Daen), hearing trumpets (discussed in Chapter 1 by Graeme Gooday and Karen Sayer) and amplified telephones (discussed in Chapter  3 by Coreen McGuire), as well as the replacement body parts discussed by Jaipreet Virdi, Ryan Sweet, Caroline Lieffers and Julie Anderson. Accordingly, the collection provides us with a more holistic and thus more meaningful analysis of the technologies that users incorporated into their daily lives in order to ‘correct’ or hide their bodily difference. At its most extreme definition, prostheses may incorporate any device that intervenes on human subjectivity, such as computers, even to the extent that they have the power to transform humans into cyborgs.14 While it is important to note that this book does not adopt a Foucauldian perspective on technologies of self-​ fashioning, it does view assistive technology as a mere variation of traditional prosthetics because both assist, and have long assisted, with independent living and access to life-​and work-​related activities. The two terms are therefore used more or less interchangeably. However, this collection does incorporate one crucial tenet of post-​modern critiques: prostheses are more than just hardware. Like other technologies, prostheses are and were ideological tools, and their widespread consumption is contingent on the economic, social and cultural contexts in which they are designed, produced and promoted. By addressing several commodification processes simultaneously, each chapter highlights the complex intertwined relationships between them. Processes divided into neat divisions were certainly not an industry feature. Nonetheless, these divisions according to invention, design and production; use, consumption and identity; and intellectual property and promotion aid reader orientation of this book. The themes also orient the collection towards recent scholarship in three main areas: disability and prosthetics history; history of science, technology and medicine (HSTM); and economic history. The chapters are influenced by scholarship in the ‘new disability history’, particularly around the historical construction of disabled identities, but they also contribute to a growing body of scholarship that increasing aligns HSTM and economic history. As historians increasingly recognise, the complexities and nuances involved in patterns of innovation and use analysed by historians of technology parallel the production–​consumption cycles commonly found in commercial and economic histories.15 Some essays also address the ways in

6

6

Introduction

which the new commercial approach informs scholarship in material culture studies and literary criticism. Before the remainder of this introductory essay addresses each commodification process in turn in order to contextualise the essays, it is important to reiterate the powerful influence of medicine and the market in shaping social and cultural meanings of disability in nineteenth-​and twentieth-​century Great Britain and the United States. Accordingly, the Anglo-​American medical establishment is a main focus of this collection. This focus is not an attempt to valorise medical conceptions of disability. Indeed, unpacking the significant historical legacy of the medical establishment’s involvement in shaping and controlling impairment is crucial to our understanding of prosthesis commodification today, despite how distasteful this might appear to those schooled in histories told from the bottom up and how uncomfortably it sits within current disability-​rights discourse. As Beth Linker has recently argued, the ways in which the disabled have interacted with health-​care institutions, caretakers and the medical establishment are too significant to be written out of disability history.16 This medical control, underpinned and reinforced by commercial and corporate interests is, in fact, so significant that it convinced generations of those with physical impairments that prostheses were required to fully participate in society, and is still successful in doing so. Recasting those with physical impairments as consumers and promoting a range of inventive prostheses to them provided these generations with an illusion of choice. It is questionable whether consumers in a society that converts impairments into disabilities could choose any alternative but to consume prostheses, although Jean Baudrillard’s influential sociological work on the structures of consumption makes us reconsider whether any type of consumer has ever had free choice over the commodities they consume.17 The historical medical control over impairment is also, of course, in no small part responsible for the subsequent rise of disability activism and of patient-​activism groups more broadly. By uncovering more about the medical practitioners who defined and aimed to shape disability through prosthetic commodities, the empirically grounded chapters make the case for a scholarly approach that sees economics, and commodification specifically, as part and parcel of the social, cultural and indeed medical milieu that historically defined disability. Invention, design and production As the first stage of the commercialisation process, the invention of a prosthesis, or adaptation of an existing prosthesis, involved a complex alignment of engineering, design and medicine. Individual prosthesis makers, large

7

Introduction

7

medical companies, surgeons and others worked collaboratively to ensure that each prosthesis was fit for its functional purpose, whether that be walking, hearing or something more intricate, such as eating and playing cards.18 Crucially, these decisions were not only steered by those within the industry but were also dictated by the sensibilities of users. As historians of technology and of commerce have long recognised, invention and innovation do not take place in a vacuum but are stimulated by the reciprocal relationship between supply and demand.19 With its foundations in the late eighteenth century, the stigmatisation of the physically impaired in nineteenth-​and twentieth-​ century polite society, which depicted disability in terms of personal tragedy, shame and loss, meant that affluent middle-​and upper-​class consumers not only demanded a prosthesis that was functional but also required one indistinguishable from a real body part. Such disguised prostheses provided users with the appearance of ‘normalcy’. The most expensive artificial limbs designed during this period mimicked human limbs in terms of shape and colour, while hearing aids made from fabric, silver and porcelain were disguised as everyday objects, including beards, fans, ornaments and hair accessories.20 Ferris & Co., artificial-​limb makers of London, stated in 1910: ‘We have taken Nature as our guide, imitating as closely as possible every action of the human leg.’21 The importance of invisibility in prosthesis design is a major theme within some of the chapters in this collection. Gooday and Sayer’s chapter (Chapter 1) extends existing research on disguised hearing aids; Virdi addresses the invisibility of hitherto-​neglected artificial tympanums (Chapter  2), and McGuire discusses the conspicuous design of amplified telephone (Chapter 3), while Sweet contributes to work in English literature on the disguised nature of limbs and other prostheses in Victorian marriage plots (Chapter  5), and Anderson focuses on the production of disguised designs for artificial limbs (Chapter 7). Functional and disguised designs were more likely to be commercially successful. Yet, as existing histories of prosthetics have argued, prosthetic innovation was limited until demand reached suitable levels in the mid nineteenth century. Rising numbers of amputees and those with hearing impairments –​ resulting from industrial accidents and as casualties of the American Civil War (32,000 amputees from the Union Army alone) –​often financially aided by the medical profession and the state, led to the emergence of many more designs of limbs and an assortment of hearing devices produced by growing number of specialist makers, all competing for custom.22 Prior to the mid nineteenth century, those with impairments more often designed and constructed their own apparatus, as Daen demonstrates for apparatus designed by Captain George Webb Derenzy in the 1820s.

8

8

Introduction

More often than not, commercial prosthesis makers, or mechanicians as they were sometimes known, were either surgeons themselves or worked closely with surgeons, albeit in demarcated physical spaces, as Anderson shows us through her detailed analysis of the nineteenth-​and early twentieth-century. artificial limb trade in Britain. Makers and surgeons worked together to combine technical ingenuity with new invasive surgical procedures considered too dangerous before the mid nineteenth-​century advent of anaesthesia, antisepsis and asepsis.23 Among the most significant innovations in artificial legs prior to the Civil War adhering to new methods of amputations was American physician Douglas Bly’s of 1858, which not only fitted better on a neater and less painful stump but also incorporated a ball and socket ankle mechanism users found helpful when walking up slopes and on uneven surfaces. B. Frank Palmer’s ‘American’ leg, an important precursor to Bly’s leg, was used by approximately 1,200 people in Britain, and permutations on the original remained in use until the First World War.24 Lieffers’ chapter (Chapter  6) expands our knowledge of the commercialisation of Palmer’s leg, while Sweet’s chapter locates Palmer’s leg in a wider context of Victorian fiction (Chapter 5). Similarly, a wider variety of designs for hearing trumpets gained popularity following news of Queen Victoria’s use of one alongside the development of new audiological innovations, such as the artificial tympanums addressed here by Virdi which corresponded with new invasive procedures of the inner ear. Growing prosthesis innovation was accompanied by increased prosthesis production. The increasing adoption of industrial methods, machinery and processes into prosthetic trades, particularly after the First World War, began to gradually transform production from small-​scale jobbing workshops to production-​line-​oriented units inspired by Henry Ford’s famous assembly-​line production of the Model T.25 Such a transformation broke down and standardised individual tasks. The desire for standardised prostheses was not only a result of mass-​production techniques but also paralleled a more homogenising view of the human body and its mechanisms under the medical gaze. Yet, while some elements of prosthesis manufacture began to m ­ irror larger-​scale production of mass-​consumer technologies, the trade also retained many of its craft-​based processes in order to ensure the continued production of bespoke products. Balancing the production of made-​ to-​order and increasingly standardised goods was no easy task, as Anderson and McGuire demonstrate (Chapter 7 and Chapter 3). Both Anderson and McGuire highlight the growing involvement of the British state in attempts to increase standardised twentieth-​century prosthesis production. Drawing on studies that depict the First World War as a crucial turning point for

9

Introduction

9

reconfiguring the spaces of prosthesis production, Anderson outlines the increasing involvement of the Ministry of Pensions in the production of artificial limbs in the 1910s and 1920s, while McGuire demonstrates how the British Post Office’s monopoly over amplified telephony in the inter-​war period allowed them to attempt to standardise the apparatus.26 Changes to production in artificial limbs and in amplified telephony resulted in significant cost implications for both private companies and the public sector, particularly as the British state’s involvement meant that some users did not pay for these prostheses in an age of growing welfare reform. Perhaps more crucially, however, attempts at standardisation created tensions with users because they sought to minimise accommodation for the requirements of the individual body. The wider effects of industrialisation also had an impact on prosthesis development. Scholars are paying increasing attention to the effects of modern capitalism on the ‘industrial body’ in various sites, including the South Wales coalfields and the factories of industrial Pittsburgh.27 The factory, the coalfield and urban working environments were a major cause of physical disablement in the nineteenth and twentieth centuries and led to the philanthropic intervention of local manufacturers, businessmen, medical-​aid societies and others who sought to conceal bodily damage through the increased provision of prostheses.28 Edward Slavishak’s recent study of industrial Pittsburgh demonstrates how prosthetic devices not only ‘normalised’ the worker’s impaired body but enhanced it by shaping it into a machine.29 Yet sites of labour simultaneously became increasingly important for the employment of physically impaired workers. Attempts by philanthropists, benevolent businessmen and others to find suitable work for impaired workers typically excluded from new modes of production represented another charitable attempt at ‘normalising’ individuals as workers in a capitalist economy and increasing national productivity. By analogising assembly-​line production to a prosthetic extension of the worker’s body, Henry Ford saw the modern factory as a way of extending the capacities of the physically impaired and non-​impaired alike.30 These two effects of modern capitalist economies and the resulting philanthropic interventions  –​the provision of prostheses to impaired workers and the inclusion of impaired workers in the labour market –​are an important part of prosthetics history. Lieffers addresses the second of these effects by expanding Lisa Herschbach’s study on ways in which artificial limb manufacturers in early nineteenth-​century America claimed to be dedicating themselves to benevolence (Chapter 6). She highlights the philanthropic motives of US artificial-​limb maker, B. F. Palmer, and his use of patents for limbs for this purpose.

10

10

Introduction

Prosthesis use, consumption and identity The sheer variety of prosthetic appliances on the market in the nineteenth and early twentieth centuries, as well as a plethora of designs for each type of appliance, reflects the assortment of users and their specific requirements. In some ways, the identities of the prosthesis users in this collection are obscured. As Katherine Ott has remarked, disabled individuals were ‘too busy living to be restrained by our post-​structuralist worries over the cultural contingencies of what they did or who they were’.31 Yet, the proliferation of hearing aids and artificial limbs with a ‘natural’ function and appearance in this period provide us with important clues as to how users saw themselves. Indeed, in contrast to late twentieth and early twenty-​first-​century disability-​rights activists, who have sought out a variety of identity forms not anchored to medical technology, the users uncovered in this collection did align at least one part of their identities with prostheses. The proliferation of disguised prostheses suggest that many physically impaired individuals consumed and used prostheses in order to be able to ‘pass’ as able-​bodied in society. Recent sociological work on the concept of disability ‘passing’ has highlighted the complex and diverse methods in which individuals concealed markers of impairment to avoid the stigma of disability and has outlined how these methods encompassed an imposed identity of others on these individuals.32 The use of disguised prostheses was one method of concealment, and the multifaceted ways in which this use shaped disabled identities and how it stimulated innovation and production are key themes of this collection. Indeed, as McGuire and as Gooday and Sayer highlight, users of the amplified telephone and of other hearing devices would not have recognised today’s self-​proclaimed cultural identity of the Deaf community or even a hard-​of-​hearing community, but would have simply used their technology to ‘pass’ as hearing individuals. It was those who experienced impairment later in life, in particular, who were heavily influenced by commerce and the medical profession’s intent to restore them to the ‘normal’ state of their former selves through prostheses: Colonel Derenzy, the protagonist of Daen’s chapter (Chapter 4), and the First World War soldiers discussed by Anderson (Chapter  7), for example, experienced physical impairment as a result of war. Similarly, Virdi (Chapter 2) outlines how intermediaries in the form of medical professionals could impose deaf and hard-​of-​hearing identities on the end-​users of artificial tympanums. She outlines how aural surgeons regulated their patients’ use of the device, thus taking away responsibility from the end-​user. McGuire’s chapter (Chapter  3) goes further by explicitly forcing us to consider the amplified telephone as the British Post Office’s tool for imposing its own categorisation

1

Introduction

11

of deafness on its amplified telephone users, while Gooday and Sayer (Chapter 1) demonstrate that the relationship between hearing-​aid users and designers was mutually beneficial precisely because it centred on issues of identity, trust and efficacy. Purchasing a prosthesis did not necessarily mean, however, that its owner passively accepted the technologies presented to them or used it in the manner for which the designer and manufacturer intended, if at all. Prosthesis users have always adapted devices to accommodate their needs, and these adaptations may have subverted the foreseen uses of the inventor and designer, as a number of the chapters here will outline. Beyond the use of prostheses as a way for individuals to ‘pass’ as able-​bodied, it is important to recognise that disability has never been a discrete identity category. Accordingly, identities of prosthesis consumers are further complicated by the intersection of other axes of social identity, including gender, class and occupation.33 Yet, while studies of artificial limbs have demonstrated the gendered and sometimes class-​based nature of prosthesis consumption, particularly as symbols of masculinity among Civil War and First World War soldiers, research on the complex intersectionalities surrounding prosthesis use is in its infancy.34 The authors in this volume expand on current thinking on the intersectional identities of prosthesis users. Extending a growing scholarship on female users of Victorian prostheses, Sweet demonstrates how the interchangeability of the content of works of fiction and trade literature sought to influence female readers to use disguised prostheses as an embodiment of femininity and in order to secure their social positions as wives and mothers.35 As Joanna Bourke has pointed out, artificial limbs were generally the reserve of those who could afford them until after the Second World War.36 Daen fruitfully expands on recent work on both masculinity related to artificial-​limb use and on the reception of tasteful yet functional assistive devices within polite society by uncovering how and why Derenzy’s apparatus for the one-​handed only appealed to male wealthy officers like himself in particular, despite his attempt to gain wider appeal.37 Complementing the growing scholarship on the body of the industrial worker, McGuire demonstrates that middle-​class businessmen like Raymond Harris could also be important hard-​of-​hearing consumers of the telephone. While prosthesis users implicitly or explicitly fed back their requirements to manufacturers, it is also clear that some prosthesis users contributed much more to the commercialisation of prosthetic devices than existing studies suggest.38 Numerous artificial-​limb makers and hearing-​aid manufacturers were prompted into the industry through their own experiences of impairment. For example, Marcel Desoutter, who after having his leg amputated after a flying accident, became an artificial-​limb maker along with his brother, Charles, in

12

12

Introduction

London in 1914. Desoutter Brothers Ltd became very successful, particularly during the First World War.39 User-​designers believed that their personal experience would provide them with a greater degree of understanding of the needs of others with limb loss or hearing impairment but their development of new prostheses was also a way of expressing their dissatisfaction with existing designs. Chapters in this volume therefore uncover more about user-​designer motivations:  Daen discusses Derenzy’s ambition to help fellow one-​handed users following his own limb loss; Lieffers explores Palmer’s voyage into the commercialisation of artificial limbs following his own limb loss; and McGuire outlines Raymond Harris’s own telephone design, which he proposed to give freely to other hard-​of-​hearing subscribers. While Palmer was the only one of these three users to form and operate a business in order to sell his designs, all three of these chapters do much to highlight the complexities in relationships between designers, users and user-​designers. Moreover, the fact that Derenzy and Harris were prepared to freely promote their designs to other users without any desire to make a profit from them has far-​reaching implications for how we view the relationship between prostheses and intellectual property. Intellectual property, patenting and promotion With the number of different designs for artificial limbs and hearing devices increasing in the nineteenth and twentieth centuries, protecting one’s intellectual property through the use of patents and other formal forms of protection became a growing concern for designers and user-​designers.40 The number of patents registered for such designs was certainly much smaller than for other types of invention, but, even prior to the inventive impetus first provided by the Civil War, the patent record is littered with designs for walking sticks, splints, hearing aids, artificial limbs, teeth, eyes and hair, and other assistive devices. According to the United States Patent and Trademark Office, 130 American patents were granted for artificial limbs between 1790 and 1873, and artificial limbs were the second-​highest category of all medical devices patented during the nineteenth century.41 B. F. Palmer, the US-​ based manufacturer-​user discussed by Lieffers, became a prolific patentee after first patenting his ‘American’ leg in 1846. Palmer was quickly followed by other US manufacturers, as well as those in Britain. There were six English patents issued just for ‘improvements in artificial legs’ alone in 1857, and in 1858, Douglas Bly patented his innovative lateral motive ankle joint for artificial legs. By 1895, the number of US artificial-​limb patents rose to 144, while approximately 5 per cent of the 14,000 patents filed in Britain annually were for prostheses and other assistive devices by the end of the decade.42

13

Introduction

13

An increasing number of patents were also registered for prostheses beyond limbs into the twentieth century as surgeons and appliance makers realised the commercial potential of such devices, including artificial breasts, as Kirsten Gardner has recently argued, and artificial tympanums, as outlined by Virdi in this collection.43 This proliferation of patenting activity was in part enabled by Acts of legislation. The Patent Act of 1790 in the US, its revision in 1836, and the Patent Law Amendment Act of 1852 in Britain created modern patent systems, the basis of which still operate today. The passing of these Acts meant that patents for designs of devices, as well as for processes, were easier and cheaper to obtain, while the liberal conditions in England in particular meant the country was a magnet for inventions. Prior to the 1790 Act, North America had followed its colonial rulers and used a patent system established centuries before in the reign of Elizabeth I. This outdated system, which expressed royal patronage rather than any meaningful legal protection, was long criticised for its ineffectiveness, its exclusivity and injustice. The American 1790 Act and British 1852 Act, along with subsequent legislation, provided each country with the framework to develop slightly different patent systems, but, despite their differences, patents remained attractive for individual inventors in both countries because they were a lawful acknowledgement of proprietary rights and created a monopoly over a particular design for a designated period of time. A patent was (and still is) a device to prevent the diffusion of new methods before the original inventor had recovered profit adequate to induce the requisite investment. At its most fundamental level then, a patent represented an important but largely overlooked form of commercial intent within the industry for prostheses, regardless of whether the commercial potential was realised or not. As Zorina Khan has noted in her study of late nineteenth-​century American household goods, the very attempt to obtain a patent signalled a commercial orientation, and multiple patents of one type of device supports the idea that markets were profitable.44 The patenting activity within the prosthesis industry thus highlights the belief in the commercial potential of their designs by a variety of inventors. Patents in both countries became statue-​based weapons of capitalist competition.45 While the prosthesis industry shared this view of the patent system with other industries, there were also important elements that made patenting activity within this industry unique. It was not unusual for patentees in the prosthesis industry and beyond to conceptualise a patent as a form of social contract with the public. As Lieffers in particular outlines, prosthesis patentees were awarded a temporary monopoly in return for disclosure of their secret. Yet what made this concept particular to the prosthesis industry were

14

14

Introduction

manufacturers’ claims that patents benefited those with impairments because their securement of knowledge rights would result in an improved standard of living through the development of assistive devices. As Lieffers informs us, Palmer asserted the benevolent nature of his patenting activity when applying for a patent extension for one of his artificial limbs in 1860. Moreover, the relationship between prostheses and patents was in fact closer than those within other industries because both concepts enshrined similar ideas over intellectual property and ownership. Statutes protecting intellectual property over prosthesis designs were introduced and revised at the same time as modern concepts of ownership and autonomy over one’s own body were emerging. Following the increasing emphasis on individual responsibility for health, the consumption of goods for bodily adornment or enhancement thus grew rapidly. Yet, despite the presence of dynamic patent cultures for prostheses, it is important to emphasise that the majority of prosthesis designs were not patented, and, accordingly, not all of the authors in this collection address prostheses that were officially patented. Even against the commercial backdrop of the era and the concomitant patenting of artificial limbs, certain hearing devices were not commonly patented. Consideration of the reasons for and consequences of not patenting are just as important, if not more so, for revealing crucial insights into prostheses as commodities. Certainly, ethics played a large role in decisions not to patent, particularly when medical professionals were involved in invention or design. As historians of medicine have recently discussed, formal and informal codes of medical ethics in both Britain and the United States prohibited medical professionals from any involvement in patenting appliances because it was seen as an ungentlemanly activity of tradesmen and as profiteering from the ill-​health of patients.46 While beyond the scope of their occupation, some appliance makers were also influenced by medical ethical codes and refrained from patenting to align themselves with codes of medical professionalism. Indeed, it is possible that heavy medical professional involvement in the development of new hearing-​aid designs prevented large-​scale patenting activity, as indeed it does today with regard to cochlear ear implants, although more research in this area is needed to further examine this. Both Lieffers and Virdi provide in-​depth analyses of the e­ thical complications of involving medical professionals in prosthesis patenting ­activity. While Lieffers emphasises the ways in which Palmer took the responsibility for patenting artificial limbs away from doctors and framed such activity in benevolent intentions, Virdi demonstrates that the patenting of artificial tympanums was not hindered by the involvement of aural surgeons but served to blur the boundaries between assistive technologies and curative ones.

15

Introduction

15

The patenting of prostheses was not only restricted by medical intervention, however. Modern patent systems in both Britain and America elicited debate over whether patenting restricted or encouraged a national culture of invention. Indeed, critics stated that one of the paradoxes of patenting systems was that in order to stimulate invention they inhibited diffusion.47 This lack of diffusion prevented other innovators from building on patented designs for as long as the patent was valid, and, thus, many inventors refrained from patenting in order to give their design freely to the nation and to other inventors. Such views on the restrictive nature of patenting made a significant impact in the prosthesis industry where philanthropy and benevolence played a prominent part, as the chapters here by Daen and McGuire demonstrate. Both Derenzy (discussed by Daen, Chapter 4) and Harris (discussed by McGuire, Chapter 3) neglected to patent their apparatus for the one-​handed and telephone for the hard-​of-​hearing respectively. Crucially, as prosthesis users themselves, Derenzy and Harris wished to make it easy for others not only to use their devices but to build on them. In the case of Harris, the lack of restriction on his design for a telephone for the hard-​of-​hearing meant that the Post Office was free to not only adopt his design but also to adapt it and commercialise it as they saw fit. Moreover, such was the commercial value of a patent that prosthesis manufacturers, along with producers of other medical goods, attempted to profit from them without filing for them. Some manufacturers instead made patents tools of advertising. Existing histories of prosthetics have emphasised that advertising was central to transforming prostheses into commodities, typically through perpetuating the stigmatising discourse of personal tragedy, shame and loss of disability within detailed and copiously illustrated trade catalogues and at visually impressive international exhibitions.48 In fact, Herschbach has called trade literature of the Civil War period itself prosthetic because it imaginatively repaired veteran’s damaged body while creating an ideal of the reconstructed veteran.49 Yet, even those who draw on a Marxist-​materialist framework have rarely mentioned the promotional value of prosthesis patents. As Gooday and Sayer’s chapter in particular shows, hearing-​aid manufacturers rarely patented their devices but nonetheless used the patent mark as an important advertising tool both on their devices and in their trade literature as a way of conveying product reliability and company trustworthiness. Functioning as promotional tools then, such patent markings are part of what historians of science Christine Macleod and Greg Radick have called ‘broad’ forms of intellectual property.50 The very use of patent (and indeed trademark) markings, alongside other ‘broad’ form of intellectual property, such as eponymy common to the medical profession, hinted at proprietary rights but still legally

16

16

Introduction

allowed other inventors and users to build on the designs. These markings were displayed on the promotional literature of other prosthesis manufacturers too, including US manufacturers John S.  Drake and A.  A. Marks (addressed by Sweet in this volume) and manufacturers based out of Roehampton Limb Fitting Hospital (addressed by Anderson). Sweet’s chapter also demonstrates the similarities between trade literature and works of fiction by highlighting how prosthesis manufacturers drew on literary sources that encapsulated disability stigma, while Anderson draws on patents within trade literature, as well as other features, to examine the effect of the First World War on the industry for artificial limbs. Even without the inclusion of patented discourse, print more generally did much intellectual-​property work for its authors. For prosthesis manufacturers and for Derenzy, publications ensured proprietary recognition for products and for ideas, although this was often contested. Not all commercial activity can be encapsulated in patenting activity, but prosthesis manufacturers’ use or non-​use of patents nonetheless formed a crucial but overlooked part of the commodification process. While this book does not cover all, or even many of, the motivations behind or implications of prosthetic patent cultures, it is clear that some designers were keen to protect their proprietary rights, and some desired to give their designs away freely to other inventors and to the public. Others valued patents as promotional tools. Indeed, the extended implications of patenting cultures of prostheses, as well as patentees’ motives, including profiteering from the sale of patent rights or licensing their use to others, require further study. Methods and sources This book’s focus on commodification, and on intellectual property in particular, extends the focus of recent historical work that has aimed to reinterpret source material as a way of recovering disability histories. Douglas C. Baynton’s 2001 assertion that ‘disability is everywhere in history, once you begin looking for it’ reminds us that, far from being a paucity in relevant sources, narratives of disability and the actors within these narratives have only ever been overlooked, ignored or silenced.51 Indeed, historical examination of disability previously solely based on medical pathology misinterprets or filters out a great deal of evidence. Some chapters within this volume therefore draw on sources scholars have highlighted as potentially fruitful for providing new insights into disability, including trade literature, fictional texts, periodicals and artefacts. Sweet, for example, draws on a growing literary tradition of using works of fiction to highlight contemporary social and cultural attitudes to prostheses and disability. While existing studies have highlighted Victorian

17

Introduction

17

and Edwardian perceptions of prostheses as an effective way to restore bodies to normalcy and economic productivity, Sweet demonstrates how we can also read Victorian fictional works as valuable indications of views on prostheses industries and the market forces that dictate them.52 Conversely, Gooday and Sayer draw on a range of neglected artefacts, while Anderson and Lieffers draw on an array of trade literature to uncover more about users and their consumption patterns. Through their focus on the meanings embedded in the material form of these artefacts and literature, which change across adaptations and editions, these chapters extend recent scholarly work on the history of print and material culture of medicine and disability. Such work is indebted to anthropological approaches, which frame objects in terms of their ‘biography’, ‘­trajectory’ or ‘life story’.53 In addition, some chapters examine sources on which disability scholars are yet to draw. Chapters by Gooday and Sayer, Lieffers, Anderson and Virdi in particular draw on patent specifications for designs of artificial limbs, hearing aids and tympanums. While economic historians have long used the patent record as evidence of inventive activity, they have been slow to recognise its usefulness in identifying processes of commercialisation and for connecting these processes to specific user groups.54 With intricate textual descriptions and illustrations, patent records not only contain detailed evidence of design, production and the extent of entrepreneurial creativity but can also reveal intentions over the pursuit of profit and a patentees’ potential for understanding of the needs of impaired users. Patents can also reveal much about inventors for whom no other evidence exist, particularly user-​designers and those whose attempts to commercialise their designs any further failed. In conjunction with other re-​examined sources then, patent records provide crucial insights into prosthesis commodification and the ways in which this commodification fed into the everyday experience of disability. Content and outline The chapters in this collection run chronologically and are thematically divided into two parts, the first focusing on prostheses for hearing impairment and the second on prostheses for limb loss. The collection’s focus on only two types of prosthesis is deliberate. The historiography of disablement and prosthetics has long emphasised the proliferation of both artificial limbs and hearing devices during this period, often to the exclusion of other devices, and it is precisely within this well-​established discourse that a case needs to be made for greater engagement with a commercial approach. By maintaining its focus on these two types of prosthesis, this book does not suggest that their function

18

18

Introduction

and availability, nor indeed the experiences of their users, were homogenous. Using a hearing trumpet to facilitate communication was categorically not the same as wearing an artificial limb, and it is the diversity of prosthetic technologies that provide further insights into the range of lived experiences of users. Yet, it was the medicalisation of hearing impairment and of limb loss and the resulting social exclusion of those with these physical impairments that subsequently produced the set of disability-​specific histories and ‘politics of identity’ with which we have all become familiar. Indeed, all groups experienced some form of discrimination, despite the fact that subsequent activism developed around and within disability-​specific groups, and thus deaf individuals and those with limb impairments marked parallel historical paths.55 This shared experience of discrimination and common political interests led in some cases to cross-​disability coalitions seeking to create ‘access for all’ and ‘equal access’. With commodification as the starting point, as opposed to distinct disability histories, it will therefore become clear that the two types of technology and their users have more in common than immediately appears. Medical and commercial enterprise sought to exploit these different types of users attempting to ‘pass’ in similar ways. The first two chapters by Gooday and Sayer and by Virdi assess the role of medical companies and practitioners producing hearing trumpets and artificial tympanums in the late nineteenth and early twentieth centuries, while the following paper by McGuire moves into the twentieth century to focus on the complicated relationship between the British state and the hard-​of-​hearing telephone-​user in the mid twentieth century. In the second section, the first chapter by Daen focuses on the role of the early nineteenth-​ century user-​inventor, while the following three chapters by Sweet, Lieffers and Anderson demonstrate the prevalence of disability commodity culture in works of Victorian fiction and the role of the medical profession, prosthesis manufacturers and the state in the production, promotion and patenting of artificial limbs and associated appliances. Yet, despite the commodification links between these chapters, it remains important to recognise the individual experiences of users, within these categories of ‘hearing impaired’ or ‘amputee’ and beyond. The collection’s focus on Great Britain and North America from the 1820s until the Second World War highlights the important concomitant developments in medicine and the market in shaping disability in this period and the transatlantic exchange of prostheses in similar types of commodity cultures. In addition, by situating their essays in the broader geographic context of the British Empire, Daen and Sweet provide some indication of what a global trade of prostheses in this period might have looked like. Nevertheless, commercial and medical involvement in prosthesis development is by no means

19

Introduction

19

exclusive to Anglo-​American history, and further studies in the burgeoning history of disability field are required to analyse the diversity of experiences of prosthesis development and use in different geographical contexts in this period and beyond. Moreover, while Sweet’s essay includes discussion of wigs and dentures, the collection’s overall focus on artificial limbs and hearing aids can be, and indeed should be, extended to include other forms of commodified prostheses, including breasts, dentures, ears, larynxes, noses and penises, wheelchairs and furniture. Such omissions mean that this collection certainly cannot claim to be comprehensive, and much more empirically grounded historical research drawing on ‘the new disability history’ needs to be conducted before simplistic ‘medical’ and ‘social’ models of disability are abandoned altogether. Studies of commodification and patent cultures on a global scale, of prosthetics and also of technologies more broadly, are in their infancy but form an exciting field that may further expand insights into disability experiences.56 Yet, historical and methodological gaps notwithstanding, the seven chapters here offer small glimpses into prosthesis commodification and, together, suggest new ways of thinking about disability’s pasts. Notes 1 In 2009, there were over 2  million amputees or people with limb absence in the United States. Many of these amputees were veterans of the Iraq and Afghanistan conflicts. Stories surrounding US and UK soldiers who successfully, even heroically, use prostheses as replacements for limbs lost in the recent wars are the subject of much recent discussion. See, for example, B. Bailey and R. H. Immerman (eds), Understanding the US Wars in Iraq and Afghanistan (New York, NY: New York University Press, 2015); T. Mills and M. Brotherton, As Tough as They Come (New York, NY: Convergent Books, 2015). For the medical-​industrial complex, see S. Blume, ‘Medicine, technology and industry’, in R. Cooter and J. Pickstone (eds), Companion Encyclopaedia of Medicine in the Twentieth Century (London and New York, NY: Routledge, 2003), 171–​86. 2 See, for example, the Open Prosthetics Group wiki, available at www.instructables. com/​group/​openprosthetics/​ (accessed 22 January 2015). 3 For Deaf responses to the cochlear ear implant, see S. Blume, The Artificial Ear: Cochlear Ear Implants and the Culture of Deafness (New Brunswick, NJ:  Rutgers ­University Press, 2010). 4 See http://​www.disabilityartsinternational.org/​artists/​profiles/​claire-​cunningham/​; http://​www.clairecunningham.co.uk/​ (accessed 18 January 2016). For a recent discussion on how the world of art has taken up prosthetics, see M. Smith and J. Mora (eds), The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future (­Cambridge, MA: MIT Press, 2005).

20

20

Introduction

5 P. K. Longmore and L. Umansky, ‘Introduction: Disability history –​from the margins to the mainstream’, in P. K. Longmore and L. Umansky (eds), The New Disability History: American Perspectives (New York, NY: New York University Press, 2001), 1–​33, at 15. See also L. J. Davis, The Disability Studies Reader, 4th edn (­London and New York, NY: Routledge, 2013); L. J. Davis, Enforcing Normalcy: Disability, Deafness and the Body (London: Verso Press, 1995); S. Birch and M. Rembis (eds), Disability Histories (Urbana, IL: University of Illinois Press, 2014). 6 See B. Gleeson, Geographies of Disability (London and New York, NY: Routledge, 1999), Chapter  6; M. Oliver, ‘Capitalism, disability and ideology:  a materialist critique of the Normalization principle’, in R. J. Flynn and R. A. Lemay (eds), A Quarter-​Century of Normalization and Social Role Valorization: Evolution and Impact (Ottawa: University of Ottawa Press, 1999), 163–​72. 7 D. M. Turner, ‘Introduction: approaching anomalous bodies’, in D. M. Turner and K. Stagg (eds), Social Histories of Disability and Deformity (London and New York, NY: Routledge, 2006), 1–​16, at 3. 8 S. S. Jain, ‘The prosthetic imagination: enabling and disabling the prosthesis trope’, Science, Technology, and Human Values, 24:1 (1999), 31–​54, at 31. 9 See, for example, I. Metzler, A Social History of Disability in the Middle Ages: Cultural Considerations of Physical Impairment (London and New York, NY: Routledge, 2013). 10 Turner, ‘Introduction’, 6. 11 L. Hilaire-​Pérez and C. Rabier, ‘Self-​machinery? Steel trusses and the management of ruptures in eighteenth-​century Europe’, Technology and Culture, 54:3 (2013), 460–​502; D. M. Turner and A. Withey, ‘Technologies of the body: polite consumption and the correction of deformity in eighteenth-​century England’, History, 99:338 (2014), 775–​96; A.  Withey, Transforming the Body:  Technology, Self-​Fashioning and Politeness in Eighteenth-​Century Britain: Refined Bodies (Basingstoke: Palgrave, 2015). 12 Longmore and Umanksy, ‘Introduction’, 22. 13 For a useful overview of the history of the cultural meaning of commodities, see A. Appadurai, ‘Introduction:  commodities and the politics of value’, in A. Appadurai (ed.), The Social Life of Things:  Commodities in Cultural Perspective (­Cambridge: Cambridge University Press, 2014), 3–​63. 14 For a post-​modern analysis on prosthetics, see, for example, D. Harraway, Simians, Cyborgs and Women: The Re-​invention of Nature (London and New York, NY: Routledge, 1991). 15 For example, R. Fox (ed.), Technological Change: Methods and Themes in the History of Technology (Amsterdam: Harwood Academic Publishers, 1996); T. Pinch and N. Oudshoorn (eds), How Users Matter:  The Co-​construction of Users and Technologies (Cambridge, MA: MIT Press, 2003); J. Brown and M. B. Rose (eds), Entrepreneurship, Networks and Modern Business (Manchester: Manchester University Press, 1993). 16 B. Linker, ‘On the borderland of medical and disability history:  a survey of the fields’, Bulletin of the History of Medicine, 87:4 (2013), 499–​535. See also B.  J. ­Gleeson, ‘Disability studies:  a historical materialist view’, Disability and Society, 12:2 (1997), 179–​202.

21

Introduction

21

1 7 J. Baudrillard, The System of Objects, trans. J. Benedict (London: Verso, 2005), 151. 18 See Chapter 5. 19 For example, W. E. Bijker, T. P. Hughes and T. J. Pinch (eds), The Social Construction of Technological Systems: New Directions in the Sociology and History of Technology (Cambridge, MA: MIT Press, 1987); Pinch and Oudshoorn, How Users Matter. 20 C. C. Sarli, R. M. Uchanski, A. Heidbreder, K. Readmond and B. Spehar, ‘19th-​ century camouflaged mechanical hearing devices’, Otology and Neurotology, 24:4 (2003), 691–​8. 21 J. Ferris and E. Ferris, From the Surgical to the Mechanical Art: A Treatise on the Manufacture of Artificial Limbs (n.p., 1910), 15. 22 For example, L. Herschbach, ‘Prosthetic reconstructions:  making the industry, re-​making the body, modelling the nation’, History Workshop Journal, 44 (1997), 22–​57; J. D. McDaid, ‘How a one-​legged rebel lives: confederate veterans and artificial limbs in Virginia’, in K. Ott, D. Serlin and S. Milm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 119–​43; J. Virdi-​Dhesi, ‘Curtis’s cephaloscope: deafness and the making of surgical authority in London, 1816–​1845’, Bulletin of the History of Medicine, 87:3 (2013), 347–​77. Without a comprehensive geographical survey, it is difficult to know the precise number of existing prosthesis makers. London trade directories for the late nineteenth century suggest that the city was home to at least twenty specialist prosthesis suppliers: Post Office London Directory for 1899 (HMSO, 1899). For a directory demonstrating the increase in medical companies generally in Britain in this period, see C. L. Jones, The Medical Trade Catalogue in Britain, 1870–​ 1914 (London: Pickering & Chatto, 2013), 161–​210. 23 For a medical perspective of amputation, see J. Kirkup, A History of Limb Amputation (London: Springer Verlag London Limited, 2007). 24 G. Philips, Best Foot Forward:  Chas. A.  Blatchford & Sons Ltd. (Artificial Limb ­Specialists) 1890–​1990 (Cambridge, MA: Granta Editions, 1990), 30. 25 Jain, ‘The prosthetic imagination’, 33–​9. 26 For the First World War as a stimulus in the prosthesis industry, see R. Cooter, ‘The disabled body’, in R. Cooter and J. Pickstone (eds), Companion Encyclopaedia of Medicine in the Twentieth Century (London and New York, NY: Routledge, 2003), 367–​84; S. Koven, ‘Remembering and dismemberment: crippled children, wounded soldiers and the Great War in Great Britain’, American Historical Review, 99:4 (1994), 1167–​202; M. Guyatt, ‘Better legs: artificial limbs for British veterans of the First World War’, Journal of Design History, 14:4 (2001), 307–​25. 27 Cooter, ‘The disabled body’, 373. 28 For the coalfield, see B. Curtis and S. Thompson, ‘“A plentiful crop of cripples made by all this progress”: disability, artificial limbs and working-​class mutualism in the South Wales coalfield, 1890–​1948’, Social History Medicine, 27:4 (2014), 708–​27. 29 E. Slavishak, Bodies of Work:  Civic Display and Labor in Industrial Pittsburgh (­Durham, NC: Duke University Press, 2008), particularly Chapter 6. 30 Jain, ‘The prosthetic imagination’, 34.

2

22

Introduction

31 K. Ott, ‘The sum of its parts: an introduction to modern histories of prosthetics’, in K. Ott, D. Serlin and S. Milm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 1–​44, at 5. 32 J. A. Brune and D. J. Wilson (eds), Disability and Passing: Blurring the Lines of Identity (Philadelphia, PA: Temple University Press, 2013). 33 S. Birch and M. Rembis, ‘Re-​membering the past: reflections on disability histories’, in S. Birch and M. Rembis (eds), Disability Histories (Urbana, IL: University of Illinois Press, 2014), 1–​13, at 2. 34 J. Bourke, Dismembering the Male: Men’s Bodies, Britain and the Great War (Chicago, IL: University of Chicago Press, 1996); Herschbach, ‘Prosthetic reconstructions’; E. O’Connor, ‘ “Fractions of men”: engendering amputation in Victorian culture’, Comparative Studies in Society and History, 39:4 (1997), 742–​77. 35 For example, see M. Smith, ‘The vulnerable articulate: James Gillingham, Aimee Mullins, and Matthew Barney’, in M. Smith and J. Morra (eds), The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future (Cambridge, MA: MIT Press, 2006); V. Warne, ‘“To invest a cripple with peculiar interest”: artificial legs and upper-​class amputees at mid-​century’, Victorian Review, 35:2 (2009), 83–​100. 36 Bourke, Dismembering the Male, 47. 37 Turner and Withey, ‘Technologies of the body’. 38 For consumers feeding back into product-​development processes, see C. L. Jones, ‘(Re-​)reading medical trade catalogs:  the use of professional advertising in British medical practice, 1870–​1914’, Bulletin of the History of Medicine, 86:3 (2012), 361–​93. 39 Desoutter Brothers, Progress (n.p., 1922); Guyatt, ‘Better legs’. 40 Intellectual property is, of course, a late twentieth-​century term that encompasses patenting, brand marks, trade names and other forms of formal protection. Certainly, our historical actors would not have used this term nor would they have banded them together under one descriptive category, partly because laws kept them distinct. Nonetheless, intellectual property is a useful term for our purposes. See C. MacLeod and G. Radick, ‘Claiming ownership in the technosciences: patents, priority and productivity’, Studies in History and Philosophy of Science, Part A, 44:2 (2013), 188–​201. 41 J. M. Edmonson, ‘United States patents for medical devices: patterns of inventive activity in the nineteenth century’, Congress of the European Association of Museums of History of Medical Sciences (7th); 1994, ‘Medical objects and their writings’ (Lyon: Fondation Mérieux, c. 1996), 45–​54, ill. 42 Edmonson, ‘United States patents’. With no comprehensive study, it is difficult to know exactly how many patents for prostheses were issued. Abridgements for Patents:  Medicine, Surgery and Dentistry (London:  HMSO, 1855–​66, 1880, 1893–​6, 1900, 1903) remain a useful source of reference. 43 K. E. Gardner, ‘From cotton to silicone: breast prostheses before 1950’, in K. Ott, D. Serlin and S. Milm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 102–​18. 44 B. Z. Khan, ‘“Not for ornament”: patenting activity by nineteenth-​century women inventors’, Journal of Interdisciplinary History, 33:2 (2000), 159–​95.

23

Introduction

23

45 C. Macleod, ‘The paradoxes of patenting: invention and its diffusion in eighteenth and nineteenth century Britain, France and North America’, Technology and C ­ ulture, 32:4 (1991), 885–​910, at 888. 46 J. M. Gabriel, Medical Monopoly: Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry (Chicago, IL: University of Chicago Press, 2014); Jones, The Medical Trade Catalogue, Chapter 6. 47 A useful summary remains F. Machlup and E. Penrose, ‘The patent controversy in the nineteenth century’, The Journal of Economic History, 10:1 (1950), 1–​20. See also Macleod, ‘The paradoxes of patenting’. 48 S. Mihm, ‘ “A limb which shall be presentable in polite society”: prosthetic technologies in the nineteenth century’, in K. Ott, D. Serlin and S. Milm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 282–​99. O’Connor, ‘ “Fractions of men” ’. 49 Herschbach, ‘Prosthetic reconstructions’, 50. 50 Macleod and Radick, ‘Claiming ownership in the technosciences’. 51 Douglas C.  Baynton, ‘Disability and the justification of inequality in American ­history’, in P. K. Longmore and L. Umansky (eds), The New Disability History: American Perspectives (New York, NY: New York University Press, 2001), 33–​57, at 52. 52 R. G. Thomson, Extraordinary Bodies:  Figuring Physical Disability in American Culture and Literature (New  York, NY:  Columbia University Press, 1997); M. S. Holmes, Fictions of Afflictions: Physical Disability in Victorian Culture (Ann Arbor, MI:  University of Michigan Press, 2004); J. Esmail, Reading Victorian Deafness: Signs and Sounds in Victorian Culture (Athens, OH: Ohio University Press/​ Swallow Press, 2013). 53 For example, Appardurai, The Social Life of Things; L. Daston, Things that Talk: Object Lessons from Art and Science (Cambridge, MA: MIT Press, 2004). 54 For example, K.  L. Sokoloff, ‘Inventive activity in early industrial America:  evidence from patent records, 1790–​1846’, UCLA Economics Working Papers 499 (Los Angeles, CA: UCLA Department of Economics, 1988). 55 Longmore and Umansky, ‘Introduction’, 4. 56 S. Wilf and G. J.  N. Gooday (eds), International Diversity in Patent Cultures:  A ­Historical Perspective (Cambridge:  Cambridge University Press, in preparation); J. F. Stark, ‘Owning health: medicine and Anglo-​American patent cultures’, British Journal for the History of Science, 49:4 (2016).

24

25

I THE COMMODIFIC ATION OF HEARING AIDS AND AIDS TO HEARING

26

27

1

PURCHASE, USE AND ADAPTATION: INTERPRETING ‘PATENTED’ AIDS TO THE DEAF IN VICTORIAN BRITAIN Graeme Gooday and Karen Sayer

Whether there was ever as much reluctance to acknowledge defective sight as there now is defective hearing, whether the mention of spectacles was ever as hateful as that of a trumpet, I do not know; but I was full as much grieved as amused lately at what was said to me in a shop where I went to try a new kind of trumpet: I assure you. ‘Ma’am,’ said the shopkeeper, ‘I dread to see a deaf person come into my shop. They all expect me to find them some little thing that they may put into their ears, that will make them hear everything, without anybody finding out what is the matter with them.’ Harriet Martineau, ‘Letter to the Deaf ’, Tait’s Edinburgh Magazine, April 1834

Hearing assistive devices were a more or less visible feature of middle-​class and aristocratic life throughout the nineteenth century. Since up to one-​sixth of the population has historically been affected by hearing loss at some stage of their lives, the ubiquity (and therefore effective mundanity) of hearing aids seems easily explicable. Yet the changing social status of hearing loss and the changing availability of such devices force us to consider carefully the implications of the commercial relationships involved. The famous ‘deaf ’ writer, Harriet Martineau (1802–​76) observed in her often republished ‘Letter to the Deaf ’ that purchasing a hearing aid was not always a well-​informed or prudent shop transaction. As is well known, she enjoined those embarrassed or distressed by their hearing loss to purchase a hearing trumpet –​both publicly to declare their ‘deafness’ and to ease communication with others. But, judging from her own anecdote above, not all needed such encouragement; the problem was rather that many assumed that they could buy an appropriate hearing aid as readily as a pair of spectacles without any professional advice on the circumstances of their particular form of hearing loss.1

28

28

Rethinking modern prostheses

We show that the often fraught experiences of acquiring and using a h­ earing aid necessitate a sensitively differentiated understanding of this apparently simple commercial transaction. Only some used hearing trumpets as openly and confidently as Martineau prescribed. Wealthy clientele wore expensive (upmarket, decorated or more than usually disguised) devices as a form of conspicuous consumption commensurate with their social position. Others were less confident: those of the professional classes who feared for their employability or marriageability could choose instead to wear disguised hearing assistance to ‘pass’ as fully hearing people.2 Then again, others who purchased such commodified devices might reject or abandon them in favour of other mechanisms (lip-​reading and/​or epistolary methods) of communication. If they subsequently kept an aid to hearing, they might adapt it with their own creative and craft skills, overriding any control over the transaction presumed by the patentee or vendor. Such are the issues that we explore later in this chapter. Despite the enormous number and variety of hearing devices sold in the nineteenth century, and currently displayed in a variety of museums across the UK and the United States, there has hitherto been no commercially focused study of the business of selling and making them.3 While this might be because remaining company records are very sparse, another key issue is that such technologies, unlike artificial limbs, do not fall obviously in the domain of disability, nor medicine or communications. Hence they have until recently been under-​represented in the historical studies of the Victorian period.4 We focus on the diverse lived experiences of hard-​of-​hearing people who did not necessarily identify as (partially) ‘deaf ’ but who were nevertheless treated normatively by hearing contemporaries as if relatively deaf. By engaging with their experience of hearing aids to either pass as ‘hearing’ or at least be visibly ‘hard-​ of-​hearing’, our study complements the recent work of Jaipreet Virdi on medical encounters with deaf subjects; of Jennifer Esmail on Deaf sign-​language culture, and of Mara Mills on USA hearing technologies in the twentieth century.5 We look at how a range of commercial techniques, including patenting, modulated the engagement between hard-​of-​hearing people and their assistive devices; we conclude by showing how users could draw upon older craft traditions to maintain their own creative culture of adapting personal property to make it their own. Deafness vs. hearing loss as interpretive themes The history of deafness in the UK has primarily been told by the Deaf community narrating the political repression of sign language from the 1880s–​90s

29

Interpreting ‘patented’ aids in Victorian Britain

29

when the Pure Oral (non-​signing) method began to dominate UK-​based ­discussions of communication with deafened people, and then the eventual re-​emergence of sign-​language communication in the late twentieth century.6 But this historical narrative increasingly encompasses a variety of experiences of ‘deafness’ that is mirrored in the historical evidence of a huge variety of hearing aids. For example, Jennifer Esmail has noted that while Queen V ­ ictoria insisted on signing directly with deaf subjects who used signed communication, later in later life she used a large and highly ornate aid for audiences with ‘hearing’ people.7 So what more generally can we say about how hard-​of-​ hearing people chose strategies –​and often devices –​for communication, and how far does this relate to the varieties of deaf identity? Esmail frames this discussion within a narrative of ‘disability’ by referring to hearing aids as a form of ‘prosthesis’, as a replacement body part akin to mechanical substitutes for amputated legs or withered arms. Certainly, as Claire L.  Jones’s introduction to this volume explains, it is conventional in historical disabilities literature to categorise such devices within present-​day taxonomies of ‘prostheses’. While hearing trumpets and other aids were not always necessarily useful prostheses for all deaf people (e.g., those who had lost all hearing or those whose hearing loss was not physiological in origin), these devices were prosthetic in the sense that for many hard-​of-​hearing people they could replace some degree of auditory loss –​depending on how these devices were chosen, fitted, used and maintained. Indeed, it is clear from traces of earwax and exteriors visibly worn from frequent handling on certain remaining examples that these devices were intimately connected with the wearer’s body.8 These devices were fully detachable and entirely discretionary in their contextual mobile usage, and wealthier owners might choose from a range of different assistive devices dependent on context. A visible hearing trumpet or speaking tube was a bodily accessory that was as detachable as a pair of spectacles or a watch, and portable in a purchased or user-​made case when not in use.9 For those seeking to pass as ‘hearing’, clothing and accessories could be purchased with discreetly installed amplification. For more sedentary settings, hearing assistance was designed into decorative objects such as domestic vases or public furnishings such as church pews. All facilitated the performance of normative ‘hearing’. Rather than taking the static identity of disability as our main theme in exploring the normative power of ‘hearing’, we interpret hearing loss in a diachronic vein. That is to say, we treat the experience of the ‘onset’ of deafness for those who identified themselves as ‘hearing’, directly in terms of a ‘loss’: a form of sensory and social bereavement, whether gradual or sudden.10 Ours is a story of how adults came to terms with the fading of a lifetime’s capacity to

30

30

Rethinking modern prostheses

hear and a loss which they had to learn –​to a greater or lesser extent –​to self-​ manage. Harriet Martineau is a key case of one who, as Esmail has shown, set a model –​albeit not fully consistently–​for hearing loss self-​managed by discretionary use of a trumpet. Various manufacturers made a multitude of hearing devices (some modelled on Martineau’s) so that hard-​of-​hearing people could enact their responsibility, as Martineau saw it, to adapt to hearing culture’s conversational norms, rather than vice versa.11 Eponymised versions of Harriet Martineau’s hearing trumpet can be seen in nineteenth-​century instrument catalogues and in NHS blueprints through to the late 1970s.12 Rather than representing disability, these hearing aids were devices aimed ostensibly at diminishing what their users felt to be the social awkwardness of differential hearing capacities. The many different understandings of ‘deafness’ paralleled the diverse, sometime multiple aetiologies of hearing loss that were researched in the nineteenth century. Hearing loss could arise as an anticipated family trait, as the result of disease or temporary illness, or through accidental injury at work or home. There were also differences in form and presentation, such as unique personal experiences of high or low frequency loss, sensory-​ neural, conductive, unilateral/​bilateral, which could also vary and multiply across an individual’s lifetime. All of these resulted in many different personal experiences and (self-​)representations of hearing loss over the life course. Yet the myriad of hard-​of-​hearing people in the Victorian period also shared the common experience of being pejoratively cast as ‘deaf ’ by institutions. These included charitable bodies, medical practitioners, teachers, journalistic commentators and legislators.13 Not least among these were hearing-​aid vendors who had a great financial interest in upholding normative expectations that hard-​of-​hearing people should purchase a commodified solution to ‘overcome’ their relative deafness. As Esmail, Mills and Virdi have noted (and as discussed further below), various British companies supplied these on the high street among other bodily accoutrements.14 There was also a welter of opportunist vendors not previously discussed by historians, who used newspaper mail-​order advertising or peripatetic direct sales. Later in the century these thrived on a climate of increasing and very real stigmatisation of hearing loss, notably in shifts in employment insurance legislation that motivated employers to hire only those with ‘normalised’ bodies.15 Furthermore, the advent of the telephone as an entirely aural system from the late 1870s increasingly excluded all unable to hear the scratchy-​sounding speech transmitted through the device without any visual cues for assistance.16 These trends all served to entrench a broader prejudice against hard-​of-​ hearing people as if they were the sole cause of any communication problems,

31

Interpreting ‘patented’ aids in Victorian Britain

31

thereby engendered in the broader phenomenon of deafness. This prejudice was embodied pragmatically by hearing companies as a financial strategy for increased sales and profit maximisation. In anticipation of a mass market for hearing devices engendered by widespread anxiety about hearing loss, some makers of such devices took out patents on their inventions. But how significant was patenting as a feature of nineteenth-​century hearing aids –​and what did it mean to the consumer to have a hearing aid that was patented? Hearing aids as patent ‘solutions’ for deafness The significance of patenting was a very widespread concern for purchasers of hearing aids since many of the devices that they encountered were at least purportedly patented or marked with the word ‘patent’ or naming the makers as ‘patentees’.17 But what did this status mean for a consumer? Were they meant to take this as a purely legal claim to inventors’ rights or as a legitimate statement of efficacy akin to the claims of patent medicine? For the former interpretation, truly innovative hearing devices could be used to secure a patent-​wrought monopoly and thus secure large-​scale profits as from steam engines, telephones and light bulbs. But, as Stathis Arapostathis and Graeme Gooday have recently argued, patenting was an expensive business even after the patent law reforms of 1852. There was only a prospect of return on the expense of innovation, regular Patent Office fees and lawyer’s charges if regular income could be secured through large-​scale sales during the fourteen-​year period of patent and if infringers could be litigated into retreat. Once a patent had expired, any other commercial producer could copy the design so the original patentee sometimes took out successor patents.18 We can thus understand at least some patented hearing aids in the nineteenth century. According to Berger, the earliest such patent in the UK was by the aurist Alphonsus William Webster:  ‘Apparatus to assist the organ of hearing’ (1836, No. 7033). This device was designed to imitate the cupped human hand and was apparently sold by the Rein company.19 In a more experimental vein, J. Marshall produced an ear trumpet that also served for remotely hearing ship signals, while Frederick Charles Rein patented a device that communicated sound from a pulpit through tubes to pews in a church (1867, No. 160). However, the absence of such devices in major museums or in private collections raises questions about whether they ever proved financially viable as mass products. The sheer cost and bureaucratic burden of securing a patent must have deterred many from the effort. Indeed, several attempts at hearing-​ aid patents were abandoned at an early stage: the surgical-​instrument maker, Edward Collier of Clerkenwell, only received provisional protection for his

32

32

Rethinking modern prostheses

invention of ear dilators ‘to expand in and open the ear’ in 1859. Collier may have simply dropped this patent on grounds of anticipated unprofitability or because a similar invention had been anticipated in the public domain.20 Taking out no more than a provisional patent specification was enough, however, for some to claim strategically that they had secured a ‘patent’ for their invention. Jaipreet Virdi has shown how James Yearsley, an aural surgeon in mid-​nineteenth-​century London, took out such a provisional patent for his ‘artificial tympanum’ in 1856 to establish priority in invention over his rival Joseph Toynbee. Although Yearsley did not then pursue his patent to a full specification, he did not scruple –​at some legal hazard –​to advertise his device in the Medical Times and Gazette of 14 November 1857 as one that was fully patented for the ‘relief ’ of deafness. For 2s 6d, his device could be obtained by post from the ‘Superintendent of the Patent’ (sic), Mr Charles Greene of King William Street in the Strand.21 While this patent-​based marketing did not in fact end Yearsley’s controversy, his so-​called ‘patent’ evidently upstaged his rival in the marketplace. Clearly, however, this strategic use of ‘patented’ status by hearing-​aid inventors –​or indeed any other inventors –​should not be taken at face value. This takes us to the second view of the significance of patented status, as exemplified in the case of Rein & Co., which adopted a more subtle strategy than Yearsley. If they had a device to promote but no legitimate patent for it, they would simply describe the company’s status as that of ‘patentees’, going so far as to inscribe this visibly on many of their products. This approach artfully –​ but entirely legally –​evaded the question of whether the company was patentee for the specific device in question or just holders of patents for some other devices. While the Rein Company’s earliest patent was for ear plugs to attenuate sound (1864, No. 3000) and a second, as mentioned above, in 1867 for a pulpit device, apparently unpatented ear trumpets of all varieties thereafter were inscribed with the words ‘F. C. Rein, Patentees’. However, the strategy behind the ‘Patent Aurolese’ devices dating from the 1820s discussed below was altogether less legally secure:  no Rein patent from that period can be found in the records, and, even if it had been, the patent would not have been valid beyond the mid-​1840s at the latest. The inference must be that these were to be understood as analogous to ‘patent medicines’ –​a vernacular term that referred to supposedly efficacious medical cures purchased on the high street from chemists. Just as many so-​called patent medicines were by no means actually patented, many hearing aids marked with claims to patent status were not the subject of a current patent. Defensive strategies used by other companies included trademarking or eponymous branding to maintain company identity while avoiding the

3

Interpreting ‘patented’ aids in Victorian Britain

33

comparatively great cost of taking out and maintaining a patent.22 As indicated above, the significance of patenting was a very widespread concern for purchasers of hearing aids since many of the devices that they encountered were at least purportedly patented or marked with the word ‘patent’ or naming the makers as ‘patentees’.23 This fraudulent claim of patent-​protected status for commercial products was illegal and punishable in the UK by substantial fines. So why did hearing-​aid makers (like other pseudo-​patentees) bother to take this risk? From the point of view of the consumer, patenting often signified some guarantee of reliability, of therapeutic efficacy. This drew both on the paradigm of patent medicines and also of patenting as a royal bequest, with the implication thereby of the royal touch –​traditionally a therapeutic route grounded in the divine right of monarchs.24 Allegedly patented status on aids to hearing stimulated trade/​sales via connotations of reliability, authenticity and trustworthiness as they had done for any British patented device since the late eighteenth century.25 In the next section we will see the diverse response of some British hearing-​aid manufacturers to the opportunities thereby presented. The hearing-​aid companies: Rein, Hawksley and Arnold Various companies involved in selling hearing aids used a range of strategies to advertise their wares. Whether using patents, trademarks or eponymous branding, each of the big London names –​Rein set up in 1800, Arnold in 1819, and Hawksley from 1869 –​highlighted their authenticity and legitimacy through their longevity of establishment and metropolitan location. Their manifold aids (hearing trumpets, hearing tubes, etc.) were shaped to amplify sound to varying degrees for different kinds and experiences of deafness and for use by different degrees of wealth, manufactured in a range of materials and deployed in various social and cultural contexts.26 Wealthier users may well have owned several aids for use in different social settings, for example, an India rubber speaking tube for everyday conversation at home and an ornate silver-​plated dome for use in the opera box.27 Many aids were quite straightforward, fixed, simple trumpets in gunmetal. The most ornate were made of polished brass, or sterling silver, decorative yet practical (e.g., collapsible), especially those made by Rein and Arnold (see Figure 1.1). Some of these aids would have been chosen by their users on the basis of cost in the widely distributed catalogues. Patented, disguised and the most highly ornate aids were always more expensive than simple fixed hearing horns made out of gunmetal, cardboard or tin. The Hawksley catalogue retailed the simplest devices from 7s 6d with more expensive devices with prices that reflected the exact design and size.28

34

34

Rethinking modern prostheses

Figure 1.1  Hearing trumpet with ‘F. C. Rein & Son. Patentees, Sole Inventors & Only Makers, 108 Strand London’ engraved around outer rim.

Acts of conspicuous consumption shaped the contours of many sales from the most famous of all the companies, Rein & Co.29 its high-​street emporium, Rein’s ‘Paradise for the Deaf ’, was located at 108, The Strand –​significantly central to the cultural life of the City. Its advertising claimed Rein to be ‘the only Makers of real Acoustic Instruments for extreme, and every other degree of Deafness’. Much of the credibility of Rein’s ‘Acoustic Repository’ was drawn from winning prize medals for its hearing aids at almost every single international exhibition since they began in London in 1851. Furthermore, testimonials as to ‘their efficacy’ were available from ‘one of Her late Majesty’s Judges’, who used a Rein appliance on the judicial bench.30 Evidently, for an upper-​ class audience, this was a more of a significant marker of trustworthiness than Rein’s status as a ‘patentee’. Nevertheless, for many customers, the language of patents was important. Rein had the advantage of a long pedigree. At its apparent centenary in 1900, the company’s advertising emphasised that Rein had a progressive succession of ten ‘Patent Aurolese’ devices as if this gave a longue durée guarantee of quality.31 But, at least one notion of ‘patent’ here was clearly not in the literal sense of being patented by the formal bureaucracy of the Patent Office. No patent

35

Interpreting ‘patented’ aids in Victorian Britain

35

numbers or years were specified; instead, the more generic phrase ‘Inventors and ­patentees’ was used.32 The absence of any patents can be inferred from warnings to consumers mistaking the Rein Company’s products for similar models made by others such as Hawksley. This does not refer to the infringement of patents as would surely have been the case had Rein held any current patent rights.33 Subtly diverting attention away from such formal legal matters, the Rein Company publicity represented its series of ‘Patent Aurolese’ devices as the ‘stepping stones to our present scientific results’ as embodied in the Rein hearing aids of 1900. The credibility of these was thus based on the authority of the laboratory as much as on the exhibition prize. Examples from Rein of other ‘invisible’ aids, such as the Aurolese –​made to fit in –​included fashionable accessories, many constructed to be inconspicuous in specific social contexts, such as aids for ladies in mourning which were lace-​covered and black.34 The evidence suggests that the purchasers could be very proud of these disguised and patented, pricey Rein aids.35 However, there were many (cheaper) alternatives. The Hawksley Company, for example, which, like Rein, also produced horns, tubes and shells designed to be visible luxury items, specialised in disguised devices sold with a different form of authority. According to its third Catalogue of Otoacoustical Instruments to Aid the Deaf in 1895, all devices were not only invented by Thomas Hawksley but were also made by him at 357 Oxford Street in central London. His credibility was based not on any claims to patents but on being ‘Acoustical Instrument Maker to the Principal Aurists in England, Scotland, and Ireland, France, Germany, India and the United States of America’ as well as three major London hospitals: Middlesex, Guy’s and St George’s. In contrast to the Rein Company’s use of establishment evidence in its advertising, the Hawksley Company therefore presented no direct personal testimonials to substantiate its claims to international sales. And, in further contrast to the Rein Company, Hawksley claimed no patents or patentee status as any kind of mark of originality or efficacy in alleviating hearing loss. The Hawksley approach was, instead, to borrow from the Martineau tropes of the exasperation that unalleviated deafness could cause the hearing unless the deafened person took the trouble to invest in a hearing device: ‘A deaf person is always more or less a tax upon the kindness and forbearance of friends. It becomes a duty, therefore, to use any aid which will improve the hearing and the enjoyment of the utterances of others without any murmuring about its size or appearance.’ Importantly, this company’s catalogue made a major concession to hard-​of-​ hearing people that the difficulties involved here were not entirely of their own making: ‘The deaf also have a just complaint against many of their friends and public speakers, who render their affliction apparently greater by an indistinct

36

36

Rethinking modern prostheses

and mumbling utterance.’ And, given this challenge, the issues of aesthetics also came to the fore in ways not raised by Martineau: The ingenuity and taste of the instrument maker are required to construct mechanical aids to hearing which shall combine gracefulness of form and appearance without detracting from their efficiency, for the burden of deafness is great and the sensitiveness of the sufferers should not be wounded by the necessity of announcing their affliction to the public by having to use instruments either unsightly in form or objectionable in colour or material.36

New forms of hearing assistance became available in the late nineteenth century, deriving from telephone amplifiers, and both Rein and Hawksley sold such devices alongside the older forms (which were retained especially for those wary of the dangers of electrical power). These new electrical devices needed careful trialling, and the pseudonymous Evan Yellon reported in his Surdus in Search of His Hearing in 1906 that the Hawksley Company was one of the few that could be trusted to show and explain their workings: ‘I believe that they can show every form of aid, electrical or otherwise; they will certainly offer sound advice.’37 The predatory hearing-​aid ‘patentees’ There were, however, two other particular constituencies of hearing-​aid vendor that did often claim to have devices with the efficacy of state-​sanctioned patenting:  these were the opportunist mail-​order company and/​or roving salesman. These were the subject of exposés by campaigning journalists such as Yellon from the hard-​of-​hearing community who sought to show from their own experiences how untrustworthy such vendors were, notwithstanding any expectations that patents might have induced. Yellon wrote in Surdus in Search of His Hearing of the many sellers of hearing aids by postal service that could not be trusted. One of these was ‘Professor Keith-​Harvey’ who sold his ‘aural batteries’ from his office at 49 Finsbury Pavement and then latterly 117 Holborn, London. Significantly, Keith-​Harvey advertised heavily in popular magazines and journals with information on purportedly successful cures of eminent patients. Yellon swiftly demolished this approach, showing that whatever personal details were submitted by letter, the same diagnosis was issued by return of post, and the same course of therapy using Keith-​Harvey’s ‘patented aural battery’. After analysing the hardware in question, donated by ‘the kindness of a Barnsley gentleman’, Yellon concluded that if any deaf person had experienced relief or cure by the Keith-​Harvey system, they could ‘safely assign such cure to Faith not Electricity’.38

37

Interpreting ‘patented’ aids in Victorian Britain

37

This reflected a broader trend of activist journalism in the pages of d­ edicated late nineteenth-​century newspapers such as the Deaf Chronicle. This claimed to represent all conditions of deafness, including the hard-​of-​ hearing and their travails with exploitative ‘cure’ merchants. This was the era of the new journalism in which writers for newspapers and magazines did not passively report on the world around them but sought actively to expose crime and fraud.39 In its Capanbells column, readers regularly saw its campaign against the ‘Quack Doctors who profess power to cure deafness’. The column warned readers not to believe newspaper advertisements declaring ‘Deafness Curable’ with new ear gadgets. To supplement this in 1892 it reproduced in its entirety a piece concerning ‘Swindles on Deaf People’ recently published in Tit-​Bits by a ‘partially deaf ’ journalist. This was evidently for the benefit of any reader of the Deaf Chronicle still tempted by such offers. The Tit-​Bits journalist reported a recent experience of replying to an advertisement from one such opportunist company, receiving from them a pamphlet for a patented ‘artificial ear drum’, which promised hearing restoration in every case or a full refund. Having filled in the patentee’s questionnaire about his degree of deafness, he soon received a letter advising that it was curable by a gold-​plated device at a cost of £2 11s 3d. Only half payment was required initially, but after trying it for three months the correspondent found it ineffective and asked to return the device for a refund. Despite the money-​back guarantee, the patentee’s company wrote back declining his ‘second-​hand’ goods and demanding instead full payment. When he refused to comply, a letter soon arrived from the vendor’s solicitor threatening a county-​court summons; he soon learned of two other cases in his neighbourhood with the same experience, but for each the vendor evidently gave up further legal attempts to secure the return of their gold-​plated device.40 This was just one of a series of episodes that the journalist recounted: ‘How it is I  don’t know’, but proprietors of other patents ‘have found out I  am deaf ’. Significantly, he found that he had often received pamphlets and letters ‘describing something fresh’. The obvious inference is that the companies involved in this enterprise shared with each other the names and addresses of those who wrote to them, confident in many cases that the unhappy affluent hard-​of-​hearing would keep spending money on ever new varieties of ineffective devices. The ever-​campaigning journalist did not stop there in his exposure of fraudsters. He also related a story of one pamphlet that announced the visit of a company agent to a large town with a new device to offer. After a few questions about his experience of hearing loss, an ear inspection and a check on whether he was in a position to pay £2 14s 6d, the agent inserted two instruments into

38

38

Rethinking modern prostheses

the journalist’s ears. Upon being told by the agent that he could thus now ‘hear better’, the journalist tried to put his pocket watch to his ear to test their efficacy –​implicitly implementing the standard clinical test for hearing a ‘ticking’ watch. However, the agent prevented him from doing so, asserting that one should not in fact expect to be able to hear this ticking through the new hearing aid. The journalist thus departed a ‘non-​purchaser’ more determined than ever not to part with ‘hard-​earned money’ on ineffective aids to hearing. Nevertheless, these merchants of mock cures were still advertising undeterred by the time that the Deaf Chronicle had evolved again, into the British Deaf-​Mute in late 1895. Such was the relentlessness of their advertising campaign that in 1895 the partially deaf house journalist George Frankland wrote an evaluative piece titled ‘Aids to deafness’. Comparing the many treatments of the quasi-​medical ‘Aurists’, the high-​street ‘Auricians’ and the newspaper-​ advertising ‘Quacks’ that he had experienced, Frankland reported: Aurists have syringed, painted, oiled, physicked, inflated and perforated me. Auricians have furnished me with diaphragms, trumpets, whispering tubes and noise machines. Quacks have sent me their works, exhibited their devices, and endeavoured to bleed me. So, by this time, I ought to be an authority on any subject. The general result of my experience has been to bias me in favour of the regular aurists and auricians.41

As Frankland explained further, the respectable aurists and auricians were to be trusted because they assiduously kept ‘abreast of the latest scientific discoveries’ and thus were more likely to know how to capitalise upon innovations than ‘untrained amateurs’ who had to advertise their devices. Indeed, as the regular practitioners were reputable enough not to need to ‘advertise very largely’, they could afford ‘to sell their goods at a moderate profit’ –​not at the exorbitant prices demanded by the ‘Quacks’ with regular advertising bills to pay.42 One ‘persistent’ advertiser that Frankland reported was as an individual fashioning himself as Dr J.  H. Nicholson. The ‘Ear Drums’ he advertised in his mail-​order pamphlets at two guineas were too costly for Frankland to warrant purchase, especially without a free trial. Receiving no response to the first pamphlet posted to him, Nicholson sent ‘another, and yet another’. For all Frankland knew or cared, Nicholson was probably still ‘bombarding my ancient residence with them to this day’. Eventually, at a surgical-​instrument shop, Frankland obtained a similar appliance  –​a rubber disc attached to a wire –​at a twentieth of Nicholson’s price. This Frankland wore ‘for a time to no purpose’, without therapeutic relief. Another energetic advertiser that Frankland encountered was a ‘plausible, bustling’ fellow who represented

39

Interpreting ‘patented’ aids in Victorian Britain

39

himself as the respectable-​sounding Revd Mr Silverton. Frankland had met him on various visits to Liverpool, Silverton having with him all manner of ‘shining and expensive serpent tubes and trumpets’, such as might be seen at any conventional ‘aural depot’. While Silverton inevitably alleged his devices to be ‘better’ than others, Frankland saw nothing to suit him as he had tried ‘like appliances’ before. Most suspect of all was Silverton’s lack of professional ethics in selling hearing aids, a conspicuous characteristic of all advertisers: ‘At a respectable aural establishment one can readily obtain them on trial, cash returned if useless; but this is not the practice of our advertising friends. Perchance it would not be profitable.’43 Columnists for the British Deaf-​Mute and its successor, the British Deaf Times, regularly warned its readers against opportunists such as Nicholson and Silverton. Such journals, did, however, welcome and endorse new electrical gadgets that came along at the turn of the century, based on the microphone amplification technologies of the telephone –​and later the amplifying valves of early wireless (radio) sets. Thus, for example, in 1911, the Globe Ear-​phone imported from the United States was the subject of a glowing review in the British Deaf Times, contrasted favourably with recent products by the American Miller Reece Hutchison (the ‘Akoulallion’ and patented ‘Acousticon’). The operations of this device were clearly explained in the accompanying literature, and trials at home with money-​back guarantee were offered: these two characteristics were soon to become standard features of the trust relationship between vendor and users of hearing aids. More than this, readers of the journal were asked to become active experimenters and commentators on the merits of these devices.44 Personalising hearing aids in use Finally we turn to the context of hearing aids in use, for at least some users were evidently satisfied enough with their purchases to deploy them regularly over long periods. Their independent views and creative activities in using hearing aids was a domain outside that of the commercial control of hearing-​aid makers and vendors, and they could make these devices their own by subtle processes of adaptation. More than just artefacts of patenting or prostheses, hearing aids were ‘things’ that circulated in everyday life and contributed to social status in ways well established within Victorian studies, subject to the characteristic forms of relationship between designers, users and user-​designers.45 Given the prevalence of so many kinds of vendors and devices with no extant records, it is impossible to reconstruct sales figures for Victorian hearing aids. In the absence of such data, a study of hearing aids in use

40

40

Rethinking modern prostheses

provides us with at least information about the shifting preferences, or successes of the market, the socio-​economic or gendered dynamics of those who could afford or who desired (patented or unpatented) aids and those who had to ‘make do’ with the rougher and readier constructions of the local tin merchant. Except for the transient cardboard models, the collections held by museums such as the Thackray Medical Museum in Leeds demonstrate that some hearing-​aid designs persisted over a long period of time. This persistent availability of some types of aid suggests that those types at least were functionally effective and desired. With a reputation for utility, some types therefore remained in demand, regardless of wider debates about or perceptions of deafness and hearing loss, or newly patented additions to the field; a case in point is the long-​lasting Martineau aid discussed above. Moreover, looking at the artefacts themselves, many of the hearing trumpets held by the Thackray Medical Museum are too delicate for display because of wear and tear, which in and of itself is evidence of their long-​term use and value to their users. A particularly fascinating example in the collection is an Arnold Hearing Horn (see Figure 1.2).46 It is made of nickel-​plated

Figure 1.2  Arnold-​branded hearing horn in gunmetal with accompanying bag.

41

Interpreting ‘patented’ aids in Victorian Britain

41

gunmetal and is unadorned bar the Arnold trademark. (It was not patented.) It is slightly dented, and, from this general wear and tear, we can infer that it was used frequently. Moreover, its (presumably) female user valued it enough to make or have made a drawstring bag to contain it: a personal adaptation, made of hand-​sewn modest (possibly curtain) fabric decoratively embossed with flowers. Unlike its Hawksley competitors, which could be bought with leather, silk-​lined carrying cases,47 Arnold’s London domes were not, as far as can be determined, normally purchased with bags. And this example is far from being the only aid to have been adapted its user. Another London dome, a brass example made in France by Audios c. 1890, is slightly dented and covered in a close-​fitting crochet cover (the cover being typical of ‘local peasant crochet work’). A conversation tube with an ivory horn, c. 1890, has had tape placed over the joins between tube and horn, and tube and earpiece, presumably to protect those joins from wear and tear or finger marks building up in use.48 Another example of adaptation to context is the Rein open-​pan model (c.1916; marked ‘Patentee and Inventors and from the new Rein premises in Charing Cross Road’). This was acquired by a First World War aeroplane pilot who lost significant use of his hearing in a combat crash. Although long thought in the family to be his own creation, the clear indications are that he acquired this Rein device and then adjusted it to be shorter than the original. He thereby established this device as his ‘own’ in just as significant a way as a patentee claiming proprietary rights over an invention.49 If we consider the users, through their production of alternative and alteration of existing designs, they overrode any control over the transaction presumed by the patentee or vendor. Each modification by a user, opting in or out of what was prescribed at the point of sale, tells us about time spent in the care of the object and adaptation for personal use. Victorian aids to hearing might involve dressing to hear but were also selected for purpose and had to be fit to use, maintained both as an aid and within the context of life as it was lived. Conclusion This chapter has focused on these ‘hard-​of-​hearing’ subjects from their own perspective, in relation to hearing aids within the domain of patenting. Considering its life cycle in design, patenting, manufacture and use, the interpretation of a hearing aid’s story cannot be abstracted from its social relations –​particularly the often complicated and sometimes distrustful relationship between hearing-​aid sellers and purchasers. Looking through the historical ‘lens’ of the

42

42

Rethinking modern prostheses

hearing aid we have explored the potential of many different reports, adaptations and perceptions of it, including its interpretation as a device fashioned pejoratively for the ‘afflicted’. From these we have shown how we can investigate the histories of the deafened and hard-​of-​hearing through the everyday material culture they accessed –​purportedly designed for (and occasionally by) them –​with all the complex, ambiguous and sometimes disingenuous use of patenting rhetoric.50 To put the whole commercial process of selling hearing aids into perspective, we can note that problems posed by opportunist advertisers of hearings aids lingered well into the twentieth century. It was only with the post-​First World War rise of the National Institute for the Deaf (NID) that a campaigning organisation was able to coordinate countrywide resistance to the fraudulent or disingenuous practices involved. As the NID announced in its Annual Report to members in 1929: Advertisements, encouraging the deafened, regardless of the nature or degree of their auditory defect, to expect the return of normal hearing, prey to-​day, more than ever before, upon their natural hope for relief; and large numbers of hearing aids are purchased only to be cast aside as useless. The refusal of certain dealers to allow an adequate trial of their instruments before purchase or to refund any part of the money paid if they do not help, results in disappointment and serious loss to the deafened. Certain advertisers should be compelled to adjust their misleading advertisements to the facts of deafness and the possible performance of their instruments and to amend their methods of business to ensure a fair deal to the deafened.51

In response to this, the NID indicated that no more should their members be left to judge the plausibility of hearing-​aid efficacy from advertised or patented status from companies that were only interested in ‘the extent of their sales’. They thus launched a register of firms and dealers who would make no unscheduled house calls, offer disinterested advice on the suitability of any electrical or mechanical device, and who would offer a full refund if any device proved unsatisfactory. ‘Deafened persons’ were strongly advised to deal only with those who met these conditions, and such people could receive a copy of this list from the NID simply by mailing the cost of return postage to the Institute. It was by such organisationally wrought approval by the broad deaf community, whether through monthly newspapers or activist institutions, that hearing aids were evaluated less by a purported ‘patented’ status and more by open accountability of vendors to demonstrate the technical efficacy of their products and the financial transparency of their sales operations.

43

Interpreting ‘patented’ aids in Victorian Britain

43

Notes 1 A. Broomfield and S. M. Prose (eds), Victorian Women: An Anthology (London and New  York, NY: Garland, 1996), 51, report that Martineau’s letter was often republished by charitable and cooperative organisations: H. Martineau, ‘Letter to the Deaf’, Miscellanies, vol. I (Boston, MA: Hilliard, Gray & Company, 1836), 248–​65. See extensive discussion of Martineau in J. Esmail, Reading Victorian Deafness: Signs and Sounds in Victorian Literature and Culture (Athens, OH: Ohio University Press/​Swallow Press, 2013), 169–​73. For a sympathetic discussion of Martineau’s deafness, see F. Fenwick Miller, Harriet Martineau (Boston, MA: Roberts Brothers, 1887), especially 32–​8. 2 The concept of ‘passing’ has been discussed with reference to contemporary disability in J. A. Brune and D. J. Wilson (eds), Disability and Passing: Blurring the Lines of Identity (Philadelphia, PA: Temple University Press, 2013). 3 Anonymous, Deafness in Disguise:  Concealed Hearing Devices of the 19th and 20th Centuries (St Louis, MO: Washington University School of Medicine, 2009), available at http://​beckerexhibits.wustl.edu/​did/​ (accessed 1 June 2016). 4 Whereas A. Briggs, Victorian Things (Harmondsworth: Penguin, 1990) focuses on the philosophy of the eye, there is minimal discussion of the process of hearing or of the ubiquity of hearing aids. J. Virdi-​Dhesi, ‘Curtis’s cephaloscope: deafness and the making of surgical authority in London, 1816–​1845’, Bulletin of the History of Medicine, 87:3 (2013), 347–​77; J. Virdi-​Dhesi, ‘From the hands of quacks:  aural surgery, deafness, and the making of a surgical specialty in 19th century London’, Ph.D. thesis, University of Toronto, 2014; M. Mills, ‘Hearing aids and the history of electronics miniaturization’, Annals of the History of Computing, IEEE, 33:2 (2011), 24–​45. Esmail, Reading Victorian Deafness. 5 Virdi-​Dhesi, ‘Curtis’s cephaloscope’; Virdi-​Dhesi, ‘From the hands of quacks’; Esmail, Reading Victorian Deafness; Mills, ‘Hearing aids and the history of electronics miniaturization’. 6 See J. Branson and D. Miller, Damned for Their Difference: The Cultural Construction of Deaf People as ‘Disabled’: A Sociological History (Washington, DC: Gallaudet University Press, 2003), 145. Deaf cultures thus do not see deafness as a disability but as an issue about communications. For the wider debates about the Deaf and communication, and the eventual dominance in Europe of Pure Oralism as the most ‘modern’ and ‘rational’ form of communication in the late nineteenth century, see I. Hutchinson, ‘Oralism: a sign of the times’, European Review of History, 14:4 (2007), 481–​501; C. Aicardi, ‘The analytic spirit and the Paris Institution for the Deaf-​ Mutes, 1760–​1830’, History of Science:  An Annual Review of Literature, Research and Teaching, 47:2 (2009), 175–​221; S. A. Rosenfeld, ‘The political uses of sign language:  the case of the French Revolution’, Sign Language Studies, 6:1 (2005), 17–​37; L. J. Davis, E ­ nforcing Normalcy: Disability, Deafness and the Body (New York, NY: Verso, 1995). 7 Esmail, Reading Victorian Deafness, 1–​2. Information on a model of Queen Victoria’s ornate Rein hearing horn from Alan Humphries, Thackray Medical Museum, Leeds.

4

44

Rethinking modern prostheses

8 This is in contrast to the kinds of medical and surgical devices and interventions supposed to ‘cure’ deafness, such as the artificial timpani discussed by J. Virdi-​ Dhesi, ‘Priority, piracy, and printed directions:  James Yearsley’s patenting of the artificial tympanum’, Technology and Innovation, 16:2 (2014), 144–​54. 9 As with other forms of bodily accessories, a display of wealth could be implicated as much by what was construed by the user to be successful disguise as by an ostentatious material display of chased silver. 10 Compare with D. Lodge, Deaf Sentence (London: Harvill Secker, 2008). 11 Advertisement, Review of Reviews, 41:246 (1910), 579; ‘The Stolz electrophone’, Review of Reviews, 50:300 (1914), 467: ‘It is exercise the deaf ear requires to bring it back to its original activity’. The converse was rarely the case since the hearing population did not generally take great effort to adjust speech to greater audibility; e.g., T. Morison, ‘New Ear Trumpet’, Blackwood’s Edinburgh Magazine, 14:79 (1823), 199. Available at www.search.proquest.com/​docview/​6526703?accountid=13651 (accessed 1 June 2016). 12 H. Martineau, ‘Letter to the Deaf’, Tait’s Edinburgh Magazine, 1 (1834), 174; Thackray Medical Museum (TMM), Leeds, 1333.022, Trumpet hearing aid, telescopic cone shape, black celluloid, ear piece: vulcanite, c. 1890s–​1900; National Health Service, Model OL370, blueprint for hearing apparatus, telescopic ear trumpet with bent end, celluloid, 1976; TMM 2007.0431, hearing apparatus, telescopic ear trumpet with bent end, celluloid. See also, The Surgical Manufacturing Company, Catalogue, 1930, 195, no. 1361, and similar to Arnold & Sons, Catalogue, 1904, 340, fig. 1156. 13 For many Victorians, a popular understanding of those Deaf/​deafened people who appeared unable (or unwilling) to find a way to adapt to the expectations of the hearing world, especially in the poorer community, was as ‘afflicted’/​unfortunate. For a sympathetic period example of the use of ‘afflicted’, see series of letters sent in reply to ‘Out in the Cold’, ‘Life and Work at Home’, The Woman at Home: Annie Swan’s Magazine, c.1895, 892. 14 See www.eartrumpets.co.uk/​history.php (accessed 1 June 2016). 15 P. Jackson, Britain’s Deaf Heritage (Edinburgh: Pentland Press, 1990). 16 See McGuire’s chapter in this volume, and Esmail, Reading Victorian Deafness, 188–​9. 17 The ambiguous status of objects marked as patented is touched upon in J. F. Stark and G. J. N. Gooday, ‘Patents and publics: engaging museum audiences with issues of ownership and invention’, Museum and Society, 12:2 (2014), 104–​17. See also resources at www.thackraymedicalmuseum.co.uk/​library-​resources/​collaborative-​ research/​recent-​projects (accessed 1 June 2016). 18 S. Arapostathis and G. J. N. Gooday, Patently Contestable: Electrical Technologies and Inventor Identities on Trial in Britain (Cambridge, MA: MIT Press, 2013). 19 Later patents in the UK came in the 1860s. The surgical-​instrument maker Joseph John Pratt produced a double ear trumpet (1860, No. 2990); John Henry Johnson patented an at-​ear sound deflector (1860, No. 3164), imported from Charles Grafton Page in the United States. Thanks to Ross Macfarlane at the Wellcome Trust Library for pointing us to this original patent specification and others of its

45

Interpreting ‘patented’ aids in Victorian Britain

45

sort in its comprehensive holding of medical patents. The Webster device is the earliest in this collection, and the priority of that patent in the UK is claimed by Kenneth Berger in K. Berger, The Hearing Aid: Its Operation and Development, rev. edn (Lavonia, MI: National Hearing Aid Society, 1974), 13. 20 E. Collier, ‘Ear dilators’, UK Patent specification no. 2145, 1859. 21 See Virdi-​Dhesi, ‘Priority, piracy, and printed directions’ and her chapter in this volume. 22 See C. L. Jones, The Medical Trade Catalogue in Britain, 1870–​1914 (London: Pickering & Chatto, 2013) and Jones’ editorial introduction to this volume. 23 Stark and Gooday, ‘Patents and publics’. See also resources at www.thackray medicalmuseum.co.uk/​library-​resources/​collaborative-​research/​recent-​projects (accessed 1 June 2016). 24 See A.  Mackintosh, ‘Potency of print:  selling patent medicines in late Georgian England’, Ph.D. thesis, University of Leeds, 2015; A. Mackintosh, ‘The patent medicines industry in late Georgian England: a respectable alternative to both regular ­medicine and irregular practice’, Social History of Medicine, www.shm.oxfordjournals. org/ ​ content/ ​ early/ ​ 2 016/ ​ 0 5/ ​ 2 7/ ​ s hm.hkw054.full.pdf ?keytype=ref&ijkey= L73YDHIPMOSIzm9 (accessed 2 June 2016). 25 H. Berry, ‘Polite consumption:  shopping in eighteenth-​century England’, Transactions of the Royal Historical Society, 6th Series, 12 (2002), 375–​94, at 383; C. Rabier, ‘Introduction:  expertise in historical perspectives’, in C. Rabier (ed.), Fields of Expertise: A Comparative History of Expert Procedures in Paris and London, 1600 to the Present (Newcastle:  Cambridge Scholars Publishing, 2007), 1–​34, ­especially 10, 12–​15. 26 Studying the material culture of devices makes us consider their composition. Some were made out of very simple materials, such as tin, or even cardboard (the latter are described in the Hawksley catalogues, though a surviving example has not yet been found). Others were fabricated from shell –​and later faux shell –​possibly because some of the earliest aids were actual shells, and through the material the association remained strong, as well as shell being decorative and reputedly low in vibration. J. Bell & Croyden, The Complete Hearing Service for the Deaf [pamphlet] (c. 1920–​30), 12. Available at:  http://​gateway.proquest.com/​openurl?url_​ver=Z39.88–​2004& res_​dat=xri:jjohnson:&rft_​dat=xri:jjohnson:rec:20080730103009mf (accessed 1 June 2016). 27 Myk Briggs, photographer and independent collector, email to Karen Sayer, 14 October 2013: ‘As for which to choose, it is a minefield of vendor opportunism … More work needs to be done if manufacturers’ sales/​distribution records can be located how many such devices were made and sold, and to whom, or indeed how many patented aids to hearing were sold in proportion to unpatented devices, and whether this changed over time/​as any patents were defended.’ 28 See Hawksley, Catalogue of Otacoustical Instruments, 6th edn (London: John Bales Sons & Danielsson, 1909), ‘Class B (series 1) Simple Rigid Cones, 26; also Arnolds, Catalogue, 341, fig 1161; Allen and Hanbury, Catalogue, 1923, 190, No. 21153.

46

46

Rethinking modern prostheses

29 A Rein notebook in the Thackray Museum’s collection shows some evidence of personalised home fitting service to the more famous seeking discretion (including William Ewart Gladstone). 30 F. C. Rein & Son, ‘The paradise for the Deaf ’, Centenary promotional pamphlet (1900). F. C. Rein, publicity pamphlet reproduced from M. L. Koelkebeck, D. Calvert and C. Detjen, Historic Devices for Hearing:  The CID-​Goldstein Collection (St Louis, MO: Central Institute for the Deaf, 1984). E. Bennion, Antique Hearing Devices (London and Brighton: Vernier Press, 1994). For more on Rein, see K. W. Berger, The Hearing Aid: Its Operation and Development. For a ‘flesh-​ coloured’ flexible hearing tube of the period, see http://​www.sciencemuseum. org.uk/ ​ b roughttolife/ ​ o bjects/ ​ d isplay?id=92088#wwKyg12c8I66y1fi.97 (accessed 11 October 2013); also ‘Deafness in Disguise’, curated by the Washington School of Medicine and Bernard Becker Medical Library, available at http://​beckerexhibits.wustl.edu/​did/​index.htm (accessed 11 October 2013). 31 Examples of these can be found on the site ‘Deafness in Disguise’, http:// beckerexhibits.wustl.edu/​did/​advert/​part2.htm (accessed 9 September 2015), and Bennion, Antique Hearing Devices. 32 Brand marking on acoustic pan produced by Rein company:  ‘F C Rein & Son. Inventors & Patentees, 35 Charing X Rd. London’. Note that no patent number or year is claimed. See final section for discussion of this device. 33 ‘Warning: any Shapes after the above must not be mistaken for our new POWERFUL PATENT AUROLESE INVISIBLE PHONES’. 34 The largest UK collection of these is held at the TMM; it is possible to see some of the collection in use on film via Pathe, Hearing Aid Museum (1967), Film ID 411.03, available at http://​www.britishpathe.com/​search/​query/​Search/​film_​id/​ 41103 (accessed 1 June 2016). 35 For example, ‘this ambrotype … suggests a proud owner’. Item history: date 1851–​ 1880; origin United Kingdom; specifications:  materials  –​leather, glass, gilt, velvet; weight –​(approximate) 70 grams; size –​(approximate) 110 × 60 × 5 mm. Physick Medical Antiques, ‘Ambrotype of man wearing ear trumpet’, available at: http:// phisick.com/​item/​ambrotype-​of-​man-​wearing-​ear-​trumpet/​ (accessed 30 November 2015). 36 T. Hawksley, Catalogue of Otacoustical Instruments to Aid the Deaf (n.p., 1883), preface. 37 E. Yellon, Surdus in Search of His Hearing: An Exposure of Aural Quacks and a Guide to Genuine Treatments and Remedies, Electrical Aids, Lip-​Reading and Employments for the Deaf, etc., etc. (London: Celtic Press, 1906). 38 Yellon, Surdus in Search of His Hearing 16–21. 39 G. Dawson, ‘The Review of Reviews and the new journalism in late Victorian Britain’, in G. Cantor and S. Shuttleworth (eds), Science in the Nineteenth-​Century Periodical: Reading the Magazine of Nature (Cambridge: Cambridge University Press, 2004), 172–​95. 40 ‘Tit-​bits’, The Deaf Chronicle (1892), 142–​3.

47

Interpreting ‘patented’ aids in Victorian Britain

47

4 1 ‘Aids to deafness’, British Deaf-​Mute, 5 (1895), 84. 42 ‘Aids to deafness’, 84. 43 ‘Aids to deafness’, 84. 44 ‘The Globe Ear-​phone’, British Deaf Times, 8 (1911), 127–​8. 45 See, for example, J. Sattaur, ‘Thinking objectively: an overview of “thing theory”’, Journal of Victorian Literature and Culture, 40 (2012), 347–​57; A. Owens, N. J­ effries, K. Wehner and R. Featherby, ‘Fragments of the modern city: material culture and the rhythms of everyday life in Victorian London’, Journal of Victorian Culture, 15:2 (2010), 212–​25; M. M. A. Hendriksen, ‘Consumer culture, self-​prescription, and status: nineteenth-​century medicine chests in the Royal Navy’, Journal of Victorian Culture, 20:2 (2015), 147–​67. 46 TMM, 2005.0338, Arnold-​branded hearing horn in gunmetal. 47 For an example, see A. Peck, Medical Antiques, ‘A late 19th century large London dome ear trumpet by Hawksley in its original leather and silk lined carrying case’, available at http://​phisick.com/​item/​london-​dome-​ear-​trumpet-​by-​hawksley (accessed 1 June 2016). 48 Myk Briggs, personal communication, 14 October 2013, re:  www.eartrumpets. co.uk/​pictures2.php?pageno=23&buyno=128 (accessed 14 October 2013): ‘It is French and I am told very typical of local peasant crochet work, so I believe it to be a home-​made addition’; ‘one of my conversation tubes (#171) has homemade sleeves at either end –​they are not as manufactured but definitely of the period –​I think to catch the finger traces off the user.’ See www.eartrumpets.co.uk/​trumpets5b. php?ref=194&picno=D3x6770.jpg&field=&fieldno=0&test=&sort=buyno (accessed 14 October 2013). 49 Rein model c.1916 from the private family memorabilia of Gavin Poole. 50 As Deaf comedian John Smith (aka Beautiful BSL) has stated, ‘hearing aids are for the hearing’ (performance for Disability and the Victorians conference, Leeds Trinity University, August 2012), available at www.beautifulbsl.co.uk (accessed 8 August 2014); see also The Destruction of Hearing Aids by J. Mercurio Hostile Deaf Community, illustration and caption from R. A. R. Edwards, ‘Sound and fury; or, much ado about nothing? Cochlear implants in historical perspective’, Journal of American History, 92:3 (2005), 892–​920. 51 ‘Aids to hearing’, National Institute for the Deaf Annual Report, 5th edn (­London: National Institute for the Deaf, 1929), 15–​16.

48

2

BETWEEN CURE AND PROSTHESIS: ‘GOOD FIT’ IN ARTIFICIAL EARDRUMS Jaipreet Virdi

A young girl, perhaps no more than six years of age, dressed in a striped outfit, her hair drawn back and tied in a low ponytail, stands and faces an old man. The man, clad in a black coat and hat, his bespectacled face weary and sporting a powerful moustache, looks at the girl’s face. Interrupted from his reading, a newspaper remains enclosed in his right hand and rests on his lap. They are in the middle of a conversation aided by a speaking tube: one part held into the man’s ear, the other end tightly held by the girl and brought near her mouth. The caption accompanying the advertisement lets us eavesdrop on their conversation: ‘Grandpa, why don’t you get a pair of Wilson’s Common Sense Ear Drums and throw that long tube away?’ Printed in Century Illustrated Magazine in 1900, the advertisement highlights the problematic features of popular nineteenth-​century aids to hearing: they were conspicuous, drew attention to the user, constructed an image of old age and infirmity and rendered conversational situations uncomfortable for hearing participants. Moreover, they were relics of the past:  ‘The use of trumpets, tubes, audiophones, and other cumbersome and obsolete devices to aid to the hearing is everywhere being abandoned.’1 Why purchase one of these bulky devices when there were newer, ‘Scientific Sound Conductors for DEAFNESS’ such as the artificial eardrum, a small prosthesis inserted into the ear that discreetly cured one’s deafness? The introduction of artificial eardrums in 1850s Britain was primarily an attempt by aural specialists to treat eardrum perforation in a simpler and safer manner than standard aural therapeutics such as syringing of the ear or catheterisation of the Eustachian tube.2 Constructed as a surgical prosthesis to patch, if not completely replace, a damaged tympanic membrane, the artificial eardrum was invisible within the body, rather than serving as an external extension of the ear.3 Requiring an examination and prescription from a

49

‘Good fit’ in artificial eardrums

49

qualified aurist, the device was strictly managed to secure its legitimacy as a surgical prosthesis, particularly important in a field regularly dismissed in the nineteenth century as charlatanry.4 Moreover, increasing stories of the success of artificial eardrums in improving, if not completely restoring, hearing in deaf or deafened patients, posed potential for dispelling medical and social pessimism of the curability of deafness. By the 1890s, despite aurists’ persistent claims the device was only beneficial in rare cases of deafness cause by perforation, the attractiveness of a permanent cure, especially one that was ‘invisible’, captured the imagination of British and American inventors and new manufacturing firms. Thereby, artificial eardrums ceased to be classified by aural surgeons as surgical prostheses and became reclassified as domestic medical products, enjoying their heyday before disappearing into obscurity by the 1930s as ‘trivial, worthless, and often dangerous’.5 Aggressively advertised and marketed with entrepreneurial flair, these variations targeted the desperate consumer by proclaiming they could cure all cases of deafness with minimal discomfort and relative ease. On both sides of the Atlantic, the refrain of ‘DEAFNESS IS MISERY’ marked deafness as a debilitating condition that isolated a deaf person from society, sending the message that purchasing an artificial eardrum could normalise them, or at least make them appear as ‘normal’, through opportunities to converse and mould their deafness towards the hearing culture.6 This chapter traces the shift of artificial eardrums from surgical prostheses to domestic devices over the course of the 1880s and 1900s. Focusing on the ways in which the concept of ‘good fit’ was imbedded in innovation and commercialisation, I use multiple sources, including surgical texts, clinical case studies, patent specifications and advertisements to outline how artificial eardrums are vexed devices straddling the line between ‘cure’ and ‘prosthesis’. As Katherine Ott has shown, the popularity of certain surgical procedures or theories could spur new designs and marketing of artificial devices, such as how enucleation brought new demands for good fit in artificial eyes.7 Good fit not only meant mimicking the (damaged) organ, but also ‘depended on the availability of materials as well as the interplay of cultural aesthetics and medical practices’.8 For aurists, good fit meant good design: on how well materials could incorporate theories of sound resonance and replicate the natural flexibility of the tympanic membrane. Manufacturers of domestic versions adopted similar parameters of ‘good fit’, but in marketing the device, good fit additionally referred to its inconspicuousness, to how well it could mask the ‘defect’ of deafness. Moreover, the vexed status of artificial eardrums raises broader questions about how we define the success of a ‘cure’ through prostheses and the implications such definitions can have on how we approach disability.

50

50

Rethinking modern prostheses

Designating a cure In Chapter 1, Graeme Gooday and Karen Sayer make the case for aids to hearing being classified as prostheses, given their intimate proximity in assisting a ‘defective’ sense.9 Though prostheses have commonly been considered as replacements for a damaged or missing body part rendered permanently inoperative or malfunctioning, Katherine Ott asserts that prostheses rather ‘fall within the broad category of assistive devices that people use to support what they want to do’, as much as they refer to implanted or integrated body parts.10 Artificial limbs, split-​hook hands, reconstructed bones and breast prostheses are designed to assist the user to gain or recreate full function of ‘normal’ body movements; and, as Gooday and Sayer argue, so are acoustic aids to hearing, for they allow the user to (to some extent) regain ‘normal’ range of sounds. Artificial eardrums are a more complicated case. British hearing-​aid maker Thomas Hawksley lists artificial tympanums (as they were known prior to the 1880s) within the class of devices ‘by which the hearing is improved by extending or expanding the auricle or dilating the auditory canal’.11 Historical surveys of hearing-​aid technologies similarly categorise artificial eardrums as ‘inserts’ or ‘invisibles’ designed to increase the sound-​conducting mechanisms of the ear, or as ‘simple devices’ placed with the same category as non-​electric hearing aids. Some users even referred to them as ‘machines’, and entrepreneurs frequently drew connections to the marvels of electricity and communication technologies: artificial eardrums were ‘telephones for the ear’, ‘sound discs’, ‘ear phones’ or even ‘tiny megaphones’.12 At the same time, artificial eardrums were designated as a cure for deafness since, in restoring hearing, they essentially eradicated the medical affliction of deafness, even temporarily. They thus provide us with an interesting study for examining the nature of medical prostheses and determining the parameters of their success, particularly devices that are surgically implanted or inserted inside the body and strip agency from the user. The hip joint, for instance, is implanted inside the body and serves as a prosthesis replacement. As Alex Faulkner argues, since the technology is only visualised through x-​rays and other imaging technologies, the ‘material properties of the devices are not part of the end-​users’ everyday social world’.13 They are controlled strictly by health professionals and do not necessarily impact users’ identities, especially if they restore a semblance of ‘normal’ function. So too are other medical objects such as artificial heart valves or cerebral spinal fluid shunts. These prostheses become integrated with the body, intertwining with biological systems and remaining invisible to both the user and the non-​medical observer.

51

‘Good fit’ in artificial eardrums

51

Though nineteenth-​century artificial eardrums were created under similar guises –​that is, being integrated with the user’s body and controlled by aural specialists –​users were actually more capable of enhancing their hearing with total autonomy over their prostheses. As consumers, deaf persons had choices over the crafting of their self-​image, including how to bring technologies ‘into better alignment with their readings of their own bodies’, as Stuart Blume asserts.14 Artificial eardrums allowed for the concealment of deafness: figuratively, by allowing users to effectively ‘pass’ as hearing, and literally, by masking the defective tympanum and normalising the defect. Users were more dexterous and more aware, so to speak, in the application of artificial eardrums to the correct place inside the ear canal, thereby guiding aural specialists in creating better, more comfortable modifications to designs. We can see similar arguments in the case of amputees and prosthetic limbs, for instance, especially when the subjective experience of users’ adjustment of their prostheses shapes clinical communication to improve proper fit and mobility.15 At the same time, by shifting from expert authority, artificial eardrums presented opportunities for deafened persons to mask their deafness and ‘pass’ as hearing, fitting into David Turner and Alun Withey’s concept of ‘technologies of the body’: the adoption of prostheses as a prescription for those who felt a duty to succeed in polite society.16 Furthermore, as David Yuan argues, concerns of the ‘defective body’ in Victorian Britain often led people to disguise deliberating social ills to mark themselves as ‘normal’ in polite society, by purchasing prostheses that did not require (or rely upon) medical surveillance.17 Indeed, for most prosthesis users, the success or failure of their artefact depended accordingly on the distinction between invisibility and visibility; success, in many instances, was defined in terms of not being able to see the technology or its consequences.18 Indeed, the growth of commercialised versions of artificial eardrums gives us insight into the ways that deaf users were encouraged to select among the multitude of ‘cures’ to reflect the vision of ‘normal’ citizens: godly, educated, civic-​minded and hearing.19 Design modifications Though the first recorded account of a prosthetic eardrum originates in 1640, it was not until the 1850s that the artificial eardrum (or artificial tympanum, as it was originally referred as), attained international acclaim.20 In 1848, British aurist James Yearsley (1805–​69) announced his glycerine-​soaked cotton-​wool pellet in The Lancet as a prosthesis for treating deafness caused by eardrum

52

52

Rethinking modern prostheses

perforation. Four years later, following a series of anatomical investigations into the tympanum, surgeon Joseph Toynbee (1815–​66) presented his intricate prosthesis design, an ‘artificial membrana tympani’ constructed of gutta percha with a silver wire stem. As the two practitioners battled over claims of priority, the concept of using a prosthesis to aid, if not amplify, hearing, resonated with aural practitioners.21 To avoid being labelled as another catch-​all cure, the artificial eardrum was carefully regulated by aural practitioners. Insisting the device should only be prescribed in cases where the integrity of the tympanic membrane was compromised, these practitioners reinforced the device’s status as a prosthesis. Only with proper diagnosis and examination could a patient obtain a prescription; even then, patients had to regularly visit the aurist for fittings and adjustment to ensure proper restoration of hearing. However, some aurists followed Yearsley and Toynbee’s lead that patients should be taught how to apply the device themselves. Given the complexity of the ear canal and the delicacy of the device’s materials, patients could actually be more dexterous in applying the artificial eardrum and better capable of adjusting for proper fit. Aurists even referred to the device as ‘ear spectacles’, drawing parallels to the fact that eyeglasses are not traditionally considered disabling.22 William Dalby (1840–​1910), for instance, observed that ‘After a few attempts the patient soon learns to adjust it, and, when he has had a little practice, can direct it to the exact spot requiring pressure far more readily than anyone else can do for him.’23 Some patients required a few lessons in application, while others remained beholden to the aurist. Between 1860 and 1900, the value of artificial eardrums (as well as tympanums and ‘drumheads’) were increasingly discussed in periodicals as aurists debated the merits of the prosthesis, locating the tympanum as a distinct object of study. For some patients, the device completely restored and normalised their hearing, while in others, it merely amplified sounds, sometimes as much as 20–​25 decibels.24 While results varied, patient testimonials drew aurists to some of the more problematic aspects of design, particularly pertaining to materials. In this sense, patients became participants in the designs of their own prostheses, often trying out different modifications or materials and advising aurists on the nature of sound resonance. Modifications focused on obtaining maximum benefits from the artificial eardrum, namely to heighten and improve its role as a prosthesis: to disappear within the ear once hearing was restored and, in so doing, effectively ‘cure’ patients. Once ‘cured’, patients no longer considered themselves as deaf or deafened but rather as citizens with normalised hearing, judging the success of the prosthesis by how well hearing was returned to ‘normal’.

53

‘Good fit’ in artificial eardrums

53

Designs modifying the original Yearsley or Toynbee prostheses reworked the concept of good fit accordingly to clinical research and patient testimonials. Of particular concern was Toynbee’s silver-​wire stem, which frequently produced a ‘very harassing noise in the ear’, especially when worn while eating. German aurist Anton von Tröltsch (1829–​90) advised his British colleagues to adopt J. C. August Lucae’s (1835–​1911) version that replaced the wire with a rubber tube for more comfortable fitting. Other designs substituted the gutta percha of Toynbee’s innovation, making use of different shapes and materials, including a disc of oil silk, a cylinder of gold, a plug of boracic acid powder and even a disc of sized paper.25 George P. Field, aural surgeon at St Mary’s Hospital in London, created a combined version of Yearsley and Toynbee’s artificial eardrum that included a cotton-​wool pellet sandwiched between two plates of silver and affixed with a thread for insertion. He explained the advantage of his device was that it did not irritate as Toynbee’s silver wire did, the cotton-​wool was extra absorbent, and easily used by patients; moreover, the ‘hearing distance is improved’.26 As well, solutions for soaking Yearsley’s cotton wool were changed, and the pellet was reshaped to a wick, arguably to better support the ossicles.27 Patient testimonials additionally provided an avenue for aurists to gauge the success of material designs. Empirical tests were used to objectively measure hearing amplification. Distance tests with ticking watches, tuning forks and even ear trumpets were employed to determine the verifiability of various artificial eardrums and to make modifications if required.28 As a surgical prosthesis regulated by aural practitioners, the artificial eardrum was only beneficial for patients whose deafness was caused by eardrum perforation, an exceedingly rare condition. Nevertheless, the attractiveness of the prosthesis as an inconspicuous device –​particularly in comparison to large and bulky acoustic aids –​and stories of successful hearing restoration, drew hearing-​impaired persons to request a prescription, even without a diagnosis of perforation (see Figure 2.1). Aural surgeons described turning patients away, arguing that such prescriptions would do little to enhance or even amplify hearing. Even Thomas Hawksley, a prominent hearing-​aid maker in London, cautioned his customers against purchasing artificial eardrums without proper inspection and prescription from qualified aurists. The company’s pamphlet Aids to the Deaf, for instance, opens with a declaration that ‘The deaf are especially warned against giving any consideration to advertisements of small or invisible aids for their infirmity.’29 Artificial eardrums, the passage continues, are only useful in certain cases of eardrum perforation, as aurists insisted. There is strong evidence that Hawksley compiled with aurists’ recommendations in promoting artificial eardrums only for perforations, for he often set up

54

Figure 2.1  A page from the 1917 edition of Fred Haslam & Co., Illustrated Catalogue of Surgical Instruments (Brooklyn, NY, Fred Haslam & Co., 1917), listing Toynbee’s artificial eardrum (top row, third from left) among other hearing instruments, indicating its classification as an acoustic aid.

5

‘Good fit’ in artificial eardrums

55

exhibits of his collection at meetings of the British Medical Association and invited practitioners to test out instruments at his shop on Oxford Street.30 Advertisements for domestic versions of artificial eardrums appeared with increasing frequency after the 1890s. Part of the broader patent medicine culture, these versions were directly marketed to the deaf customer, eradicating aurists’ requirements for diagnosis and prescription.31 Moreover, they were promoted as cure-​alls for all cases of perforation, proclaiming their product ‘superior’ in terms of fit and materials, proving problematic to aurists who strove to prevent misapplications of the prosthesis. While the domestic versions were dismissed by aurists as a form of quackery that threatened the legitimacy of the surgical prosthesis, many of these designs actually adopted the artificial eardrum designs of aural surgeons, especially Toynbee’s. Furthermore, they adhered to the notion of good fit by virtue of the device’s invisibility in the ear and added improvements in designs to strengthen its prosthetic features: tubes for insertion, changing the direction of the disc, substituting rubber for metal or supplementing with newer materials such as aluminium. With the exception of the Wilson Ear Drum Company, a company rooted in Louisville, Kentucky, and also advertising in Britain, manufacturers of artificial eardrums prior to the 1900s made no claims of original design. As Richard Ohmann points out, most innovations between 1890 and 1900 were new products, though advertisements were nearly silent on this feature.32 Records of domestic artificial eardrum innovators are scant. This is particularly the case for innovators who did not advertise their designs or who disappeared into obscurity. Some of these, however, filed for patent protections, either in Britain, the United States, or both. In rare instances, patent protection was also filed for other countries of the British Empire, including Canada and Australia, as was the case for J. H. Nicholson, an ‘aural specialist’ who relocated to London from New York in 1885 and who marketed artificial eardrums constructed of magnetised steel rod with soft rubber disc fixed with gold washers. In Britain, approximately twenty-​five patents were filed for artificial eardrums between 1880 and 1910; nearly thirty-​five were filed in the United States for the same period. Patent specifications reveal a significant aspect of artificial eardrum innovators: with the exception of British aural surgeons James Yearsley, John Ward Cousins (1864–​1921) and H. J. Dadysett of Bombay who studied medicine in Britain, nineteenth-​century aural practitioners did not file patent protection for their innovations. Accounts of patents filed by nineteenth-​century medical practitioners have thus been limited in historical scholarship, as notions of patents, monopoly or profits counteracted the altruistic and gentlemanly image associated with Victorian medicine. Those who filed for medical patents frequently were surgeons or from outside the

56

56

Rethinking modern prostheses

profession, placed on the ‘fringes of medical authority’ as Caroline Lieffers notes and categorised as ‘medical entrepreneurs’, to borrow Claire L.  Jones’ phrasing.33 Even medical discussions of patents and priority are noticeably absent from debates on patent laws and rights in Victorian England, as medical experiences of monopoly were vastly different from other professions. Where patents were discussed, ‘it tended to be with suspicion and disdain’, as Sally Frampton illustrates.34 However, Zorina Khan has argued that the very attempt to obtain patents is evidence of commercial orientation: patents can reveal not only evidence of commercialisation and entrepreneurial creativity but also the motives behind a medical practitioner’s decision to patent, particularly for reasons other than financial gain or monopoly.35 For instance, even if high costs associated with filing a British patent prior to the 1880s legislative amendments discouraged aural practitioners from patenting their innovations –​indeed, Yearsley was the only one who filed for a patent, though he only received a provisional patent and never filed for Letters Patent –​even the post-​ 1880s record of aurists filing patents for artificial eardrums is scant.36 There are two other British patent applications for artificial eardrums prior to 1880, but neither were filed by British surgeons. The first was an 1863 provisional patent protection for Parisian merchant L. J. H. Marville’s ‘flesh-​coloured coverings of the ear’, made of gutta percha and India rubber, and the second, an 1874 patent protection for one year to E. Giampietro of Naples for a rubber disc constructed with a silver-​wire rod and gold sprint for adjustment.37 As Joseph Gabriel argues, even if patents were considered as an ‘unethical form of monopoly within the medical community’ and threatened a practitioner’s reputation, a handful of practitioners considered patenting as a way to protect the integrity of their innovation(s).38 Yearsley’s motivations for filing patent protection have been discussed elsewhere.39 While Daydsett’s motives are unclear, Cousins’ position offers a revealing insight into the ethics of medical commercialisation and the challenges quackery presented to the credibility of deafness cures. For one thing, as president of the British Medical Association, surgeon at the Royal Portsmouth Hospital and co-​founder of the Portsmouth and South Hants Eye and Ear Infirmary, Cousins exerted tremendous influence. He even invented and patented several appliances for medical practice, especially in attempts to standardise aural surgical instruments and eliminate unsophisticated, if not unnecessary, tools that could be adopted by the quack aurist. While Cousins agreed it was important for the use of artificial eardrums to be restricted to cases of eardrum perforation, at the same time he insisted that a more general design was required, one that could assist in cases with abnormalities in the eardrum, including chronic middle-​ear disease brought upon by damage to the ossicles. Such a general design would also

57

‘Good fit’ in artificial eardrums

57

provide a safe alternative to the unverified and questionable variations listed in the advertising sections of periodicals; for, if frustrated patients were going to forgo expert advice and purchase their own prosthesis, the least aurists could do was ensure an affordable and vetted version was available. The peculiar shape of Cousins’ ‘Antiseptic Artificial Eardrum’ (which derived the moniker ‘hat-​shaped membrane’) was presented as advantageous over other domestic artificial eardrums since it was specifically created for self-​application to enclose the tympanic cavity, effectively acting as a protector against external force. Composed of compressed cotton fibre saturated with antiseptic oil and ether and with a rubber brim, the eardrum was manufactured in different sizes to suit the patient’s ear accordingly, indicating how good fit varied between patients. With its flesh colour and shape, it was practically invisible inside the user’s ear and commended by reviewers for its superior construction. The patent specifications of Cousins’ design additionally reveal how patentees ensured the integrity of their designs by exerting control over product manufacturing.40 Cousins collaborated with Messrs Burroughs, Wellcome & Co., to manufacture the eardrums and sell them in boxes of three dozen at 1s 6d per box. Special machinery was installed at the company’s Dartford factory to produce Cousins’ eardrums accordingly to the explicit details of manufacturing process he outlines in the patent specifications: the product should include macerating cotton wool in boracic acid solution, be left to dry, then saturated with a mixture of collodion, alcohol, ether and wax to create its antiseptic properties. While more work is required to reveal connections between manufacturers and surgeons, especially in the manufacturing stage and for tracing how many products were sold, there are indications that collaboration offered not only financial success but also professional esteem for practitioners who patented their innovations. Dadysett, for instance, collaborated with famed surgical-​instrument makers Arnold & Sons to manufacture his design, listing manufacturing guidelines in his patent specifications, including that the disc-​shaped portion should have extra India rubber so that aurists could readily cut it to fit into a patient’s ear canal. Non-​medical patentees of artificial eardrums provided manufacturing specifics as well: Ulrich Kleiner of Brookline, Massachusetts, lists in his 1902 patent details on cutting thin textile materials such as sheer silk, cutting sheets of absorbent cotton and combining the materials with mandrel and die (of ivory or bone) in conical shape, then dipped in wax, heated and left to cool.41 Patenting practice As amendments to the British Patent Acts made the process of obtaining patent protection simpler, easier and cheaper, from 1880 there was a steady

58

58

Rethinking modern prostheses

increase of patents filed for artificial eardrums of varying designs. Some were filed by importers of innovations created in the United States. Several were multiple patents for a single patentee. Homer P. K. Peck of Cincinnati, Ohio, for instance, was granted the first American patent for artificial eardrums in 1880 for his ‘metal collar’ cushioned with a disc of elastic materials.42 A year later, he received a British patent for the same device.43 Yet no advertisements for ‘Dr. Peck’s Artificial Eardrums’ in 1881 mention the patent, which suggests it was not perceived by Peck as a marketing necessity. Later adverts suggest the contrary. In 1885, Peck collaborated with Freeman Hiscox of Newark, New Jersey, to manufacture and market his innovation to British and American customers. Peck’s product was then rebranded and advertised as ‘Peck’s Patent Improved Cushion Eardrums’ and as ‘Peck–​Hiscox Patent Tubular Cushioned Eardrums’, indicating both Hiscox’s involvement and the emphasis on comfort as a key feature of the device.44 Though multiple post-​ 1900 artificial-​ eardrum manufacturers patented their innovations, the reasoning behind their patenting is unclear, particularly as they do not always mention their patented status in advertisements. Graeme Gooday and Stathis Araposthathis have shown how a device’s patented status could be used for validating a company’s business credibility and entrepreneurialism, or as a reflection of an innovator’s professional identity and business strategy.45 Company letterheads of the Wilson Eardrum Company, Way Ear Drum Company and J. H. Nicholson Company all contain illustrations of their respective designs and dates of patent grants. Yet in the majority of their advertisements the patent(s) are not referenced, suggesting that it was not predominantly perceived as an entrepreneurial strategy for increasing profits. Patenting practice additionally reveals how innovators were attuned to the needs of deaf customers and how these needs were reflected in good fit and good design. Francis M. Way (1861–​1931) provides a particularly interesting example of an innovator. Though the majority of patentees for artificial eardrums were male, patent applications allow us to trace the hidden histories of ‘ingenious women’, as Deborah Jaffé refers to women who were behind innovation, inventions and patents but who received little or no credit for their work.46 This is particularly the case in the United States, where in serving to promote invention and domestic ingenuity the American patent system made no demarcation as to social class and privilege of patent applicants during the late nineteenth century.47 Frances Way was regularly referred to as a prominent (male) ear specialist in advertisements for her husband George P. Way’s (1857–​1919) Detroit-​based Artificial Ear Drum Company, though her contemporaries considered her the real inventor behind the family business. Unlike Laura H. Vickers of West Philadelphia (b. 1873), who transferred her patent for the Morley

59

‘Good fit’ in artificial eardrums

59

Ear Phone to her husband George M. Vickers Jr. (b. 1872), Frances retained full control over the design and marketing of her innovation. A graduate of the Detroit Homeopathic College in 1902, Frances was among the first women to practise medicine in Michigan. Her contributions to the commercial success of the Way Company was largely overlooked until George’s sudden death in 1919. After she took the reins of the company, Detroit businessmen recognised and respected her entrepreneurial spirit, even applauding her when she received trademark registration for her patented design of the Way Eardrum, which was a superiorly modified version of George’s bell-​shaped artificial eardrum.48 Frances’s medical professionalism and expertise further outline the blurred boundaries of cure and prosthesis that frame the historical categorisation of artificial eardrums. In joining ranks with male aural surgeons to normalise the deaf patient, Frances approached the construction of artificial eardrums as a means for medically curing hearing loss, presumably while also applying principles of homoeopathy. In contrast to the single bulb of George’s bell-​shaped version, Frances’s patent specifications sketch ‘double-​purpose’ bulbs:  the larger serving as support for the ossicles with the end functioning as contact point to the inner ear, providing a chamber for supplying medicinal preparations. Flesh-​coloured and designed for better prosthetic support, Frances Way’s design was also a medical product, marketed as a ‘medicated ear drum’. For Frances Way, good design ensured good fit for amplifying the acoustics of the tympanic chamber, while using medicinal preparations to treat associated ear disorders. Patent specifications provide detailed evidence of how innovators perceived ‘good fit’ as ‘good design’ and decisions behind selection of materials. Vulcanised India rubber, for instance, was desirable for its ability to imitate the natural flexibility of the tympanic membranes.49 Springs feature in several designs. A. D. Munro’s 1889 design uses spring to add extra tension in application, whereas E. Giampietro’s (1874) uses spring to act as a clamp.50 Others followed Cousins’ method, saturating cotton fibres in solutions either for antiseptic properties or, arguably, for ensuring longevity of the device. R. C. Nutall’s 1902 design included a cotton cord dipped in wax and threaded through glycerine-​coated discs; his patent specifications emphasise replacing glycerine with ether or alcohol, depending on availability, would produce similar benefits.51 In other cases, materials such as gold were used for no other purpose than to justify the price or to market the artificial eardrum as a luxury good, as in the case of J. H. Nicholson who adopted A. M. Clarke’s 1885 patent outlining two parallel gold ‘rubber-​magnetised steel rods’.52 Another interesting feature in patent specifications is how innovators structured designs to maximise the acoustic properties of their creations. Notions

60

60

Rethinking modern prostheses

of ‘self-​ventilation’ appear in patent specification, referring to both the hygienic properties of the device and its ability to mimic the natural tympanic membrane’s ability to resonate sound vibrations. H. A. Wales’s design proclaimed it could be ‘inserted or withdrawn without difficultly and without the slightest pain to the wearer’.53 Further, Wales’s patent specifications declared, ‘The essential requirements of artificial eardrums are, that they shall be soft and flexible, easy to insert and withdraw, invisible, and that they shall have no metallic or rigid parts.’ Acoustic function, however, was not to be compromised at the expense of comfort. Indeed, innovators promised increased amplification and immense comfort, reflecting back to the prosthetic feature of the artificial eardrums. John B. Campbell’s 1906 megaphone design, for instance, incorporated several fibrous materials, including wood, silver, metal and rubber, to concentrate ‘sound vibrations’ centrally in the ear.54 He claimed the ‘megaphone’ could allow sound waves to pass directly through the opening on one side of the artificial eardrum towards the natural eardrum, allowing vibrations to resonate through. George H. Wilson (1886–​1949) of Louisville, Kentucky, perhaps the most successful domestic artificial eardrum manufacturer, promoted his ‘rimless [and] self-​ventilating’ ‘Common Sense Ear Drum’.55 Completely modifying the shape to resonate sound vibrations was another strategy by which innovators addressed the needs of consumers. E. J. Loosmore’s 1905 design reshaped Toynbee’s disc into an oval and rectangular shape to resemble an elastic cup, whereas Ashbury O. Leonard’s 1923 cone-​shape funnel was intended to resemble a trumpet.56 Though rubber remained a popular material for most artificial eardrums, not all agreed on its capacities as a sound conductor. Edward Baum’s 1912 patent specifications disclosed that despite the flexible properties of rubber, the material carried high risk of disintegration under the influence of body heat, thus proving dangerous to use.57 Drawing attention to the acoustic benefits of artificial eardrums in patent specifications and advertising served as a strategy to juxtapose the intricate designs against bulky and conspicuous mechanical hearing aids that appeared at the end of the nineteenth century. Adverts were accompanied by ‘scientific’ illustrations that included a cross-​section of the ear with artificial eardrums placed comfortably in the ear canal, reinforcing its position as a prosthesis, while copy taglines boldly declared ‘DEAFNESS CURED’. The Wilson Common Sense Ear Drum is so ‘small that no one can see it, but nevertheless, it collects all sound waves and diverts them against the drum head, causing you to hear perfectly’.58 The Way Ear Drum is ‘narrowed down to a small tube just where it strikes the natural eardrum’.59 The ‘flesh-​coloured’ and ‘invisible-​ shape’ of artificial eardrums were underlined. They were invisible to the external observer and to the user: tiny and hidden, the device was so comfortable

61

‘Good fit’ in artificial eardrums

61

that it would soon be forgotten. Such rhetoric was not restricted to advertisements for domestic artificial eardrums. Surgical-​instrument trade catalogues, for instance, used by medical practitioners for advertising and self-​promotion, included sections on acoustic aids, prominently displaying the delicate and inconspicuous features of artificial eardrums (mostly Toynbee’s version), against hearing trumpets, audiphones and all sorts of acoustic aids.60 Unseen comfort By virtue of its ‘invisibility’ in size and colour, the artificial eardrum reinforced the stigmatisation of deafness, with concealment often prioritised over acoustic function, as Mara Mills has shown.61 Advertisements particularly extolled design features of comfort in relation to invisibility. The advertisement for the Vickers’ Morley Ear Phone emphasised, ‘You can’t see ’em –​they’re invisible. I wouldn’t know that I had ’em in myself, only that I hear alright.’62 Another Morley advert used the tagline ‘Don’t Shout!’, stressing their design ‘makes use for the deficiencies of the impaired natural ear. [It is] entirely different from any other device. No drugs. No wire, rubber, metal nor glass. Invisible, comfortable, safe. Adjusted by any one’. The reference to comfort expressed the relative ease of communication: since the Morley Eardrum made it possible for even whispers to be heard, there was no longer any need for shouting, responding to the common perception that raising one’s voice was an appropriate solution to a conversation with a person with limited hearing. The Morley Ear Phone was not comfortable for the wearer, but it removed any uncomfortable and embarrassing conversational situations. The Way Company also mentioned about its devices that they ‘do not hurt, will not collapse in the ear and are so sensitive that they catch the faintest sounds’.63 Likewise, Asbury O. ­Leonard promised that his artificial eardrums would deliver ‘unseen comfort’ while restoring hearing. Even as the introduction of vacuum-​tube hearing aids in the 1920s drastically increased amplification, deaf users refused to visibly identify themselves as hearing impaired.64 As historians have shown, campaigns to assimilate and acculturate deaf people during the late nineteenth and early twentieth centuries were spearheaded by an oralist ideology that constructed perceptions of normality for deafness. By imposing the ‘normalising’ process of speech (over sign language) and forging alliances with medical practitioners, oralists defined deafness as a correctable defect:  being able to ‘hear’ essentially meant being able to ‘converse’. While none of the manufacturers of artificial eardrums made grandiose claims for enabling deaf users to speak, they promised nothing less than perfectly restored hearing –​which would thus render

62

62

Rethinking modern prostheses

the deafness indiscernible and speech sufficiently restored. Some adverts even insisted that their artificial eardrum was superiorly manufactured so that even when ‘­hidden’ in the ear it would stay in position, preventing any embarrassing situations where the device could fall out and expose the user. Users could thus comfortably and confidently hear even the ‘faintest whispers’ to reduce the burden on their hearing counterparts and limit their dependency on the kindness of others. Both British and American advertisements for artificial eardrums made bold declarations of ‘hope for the deaf ’. Garmore’s Artificial Ear Drums could ‘perfectly restore the hearing and perform the work of the Natural Drum’, so users could then hear all conversations and whispers distinctly. Peck’s Patent Improved Cushion Ear Drums promised the same, having proved successful even in cases previously deemed incurable. As a marketing technique, the rhetoric of ‘hope’ emphasised the importance of hearing and the ability of artificial eardrums to cure deafness. The concept of good fit was particularly employed:  manufacturers of domestic versions advised customers to assess their own hearing loss and need for aid, arguing that users were more capable than aurists in determining the degree and severity of their deafness. Further, self-​diagnosing (as guided by manufacturer’s pamphlets), ensured that customers could prevent exposing themselves, especially if they were embarrassed or striving to conceal their hearing loss. Good fit assured user autonomy. While most artificial-​eardrum manufacturers did not make any demarcation between degrees of hearing loss (or even cared to), their advertisements and pamphlets used scores of testimonials to demonstrate how users were dexterous and better able to adjust their devices to increase hearing amplification. Laura Vickers’ 1900 patent specifications, for instance, described the Morley Ear Phone as superior to others on the market, for it was durable, inexpensive and could be ‘inserted into the ear without the use of forceps or wires … which are not only dangerous in inexperienced hands, but do not insure proper insertion’.65 Again, good fit essentially meant full, or at least improved, restoration of hearing loss. At the same time, advertisements that highlighted ‘hope’ pushed the view that deafness demanded to be cured. Deaf persons could prevent themselves from becoming ‘oral failures’, individuals who failed to restore their hearing, and thus speech –​or, becoming in the extreme, ‘defective, deviant, and even un-​American’, as Susan Burch writes.66 A 1905 advertisement for the Way Ear Drum asked customers: ‘Do You want to Hear … the conversations of your friends –​music –​singing? Are you “hard of hearing” and denied these pleasures? If you are not totally deaf –​nor born deaf –​your hopes may revive, because relief is at hand.’67 The Douret Institute in London, which sold J. H. Nicholson’s artificial eardrums in the late 1890s, took out a full-​page advertisement in the

63

‘Good fit’ in artificial eardrums

63

Illustrated London News to discuss the ‘Curse of Deafness’ and how it could be treated.68 In fulfilling this promise for a ‘relief ’, artificial eardrums offered a chance for users to appear ‘normal’ to polite society, reinforcing the stigmatisation of deafness by underlining that it was the ‘duty’ of the deaf to lessen the burden on their hearing counterparts by adopting technologies to better manage their self-​presentation.69 Success stories of good fit and successful hearing restoration further propelled the notion of ‘hope’. Some innovators advertised their domestic artificial eardrums by marketing their (alleged) stories of hearing loss and ‘suffering’ to resonate with customers. George P. Way included narrative advertisements describing how he lost then regained his hearing. One 1905 advert in Cosmopolitan Magazine tells the story of Way as an electrical engineer who ‘was so deaf that he could scarcely hear the roaring of his own engines and dynamos’.70 Following an attack of typhoid fever, he barely noticed his hearing was declining, but after twenty-​five years of aural deterioration despite therapeutic and technological assistance, he found his own solution: the Way Ear Drum. The advert then requested interested customers to ‘Write a frank statement of how you became deaf, how long your hearing has been defective and how much trouble you have with your ears.’ The Wilson Eardrum frequently included photos of a man, believed to be the graphic artist who illustrated the advertisements, in different layouts: one copy had a photo of the morose man, his face turned away from the camera, cupping his hand and straining to hear; the other depicted the man staring straight ahead, hand only slightly cupping his ear. If placed together, these two photos appear as a remarkable before-​and-​ after transformational success. Conclusion Through artificial eardrums, we have an index of activity to trace innovation and commercialisation as well as how perspectives of deafness as ‘hopeless’ were diffused among social norms. The commercialisation of this now-​ neglected technology gives us insight into the way deaf users selected among a multitude of ‘cures’ and how the vexed status of the device owed to its blurred boundary between prosthesis and cure. Although initially constructed as a surgical prosthesis requiring examination and prescription from a qualified aurist, once redesigned by British and American innovators, the device shifted away from its status as a regulated surgical technology towards classification as a domestic medical good. Yet the prosthetic status of the device was never really altered: even in highlighting designs of ‘good fit’, comfort and invisibility, innovators reinforced the construction of the artificial eardrum as a prosthesis.

64

64

Rethinking modern prostheses

It fit so easily and readily into the ear canal, integrated with the user’s body to the point that the user themselves would become unaware of the device’s presence. Artificial eardrums thus played a small but important role in shaping late nineteenth-​and early twentieth-​century meanings of deafness. Acknowledgements Special thanks are owed to Carl Erickson for kindly sharing materials of his family’s history (George and Francis Way), M.  Donald Blaufox for details about the Wilson’s Eardrum in his Museum of Historical Medical Artifacts collection (MoHMA.org) and the archivists at the Detroit Public Library and the Detroit Historical Association for their generous research assistance. I am indebted to Katherine Ott for her sage advice and to Claire L. Jones for her careful editorial remarks. Notes 1 Advertisement for Wilson’s Common Sense Ear Drums, Century Magazine (1900). 2 The membrane tympanum, also called the tympanic membrane or eardrum, is a thin, oval membrane separating the tympanic cavity (the middle ear) from the external auditory meatus. It also protects the tympanum, the bony cavity on the inner side of the tympanic membrane, where the malleus, incus and stapes bones (­collectively the ossicles) are housed, and where the passageway of the Eustachian tube terminates. Perforation of the eardrum is a common ear injury, often resulting from infection, trauma, loud noises or blockages in the Eustachian tubes. In most cases, the damage is minor, and the perforation heals quickly on its own. Severe cases are accompanied by blood and/​or pus discharge and may induce hearing loss, serious infections in the middle ear or extreme tinnitus. Consequently, the rupture requires surgical intervention to correct the damage. 3 Even telephony, which emphasises the mechanistic properties of hearing, can serve as an extension of the ear. See McGuire, Chapter 3. 4 A note on terminology: the word ‘aurist’ was used by nineteenth-​century medical practitioners to refer to an ear specialist. It was also used as a term of abuse against a ‘quack’ practitioner. ‘Aurist’ and ‘aural surgeon’ were frequently used interchangeably with no demarcation in expertise and skill. On the relationship between aural surgery and quackery, see J. Virdi-​Dhesi, ‘Curtis’s cephaloscope:  deafness and the making of surgical authority in London, 1816–​1845’, Bulletin of the History of ­Medicine, 87:3 (2013), 347–​77; L. Ross, P. Lyon and C. Cathcart, ‘Pills, potions, and devices:  treatments for hearing loss advertised in mid-​nineteenth century British newspapers’, Social History of Medicine, 27:3 (2014), 530–​56. 5 A. J. Cramp, Nostrums and Quackery, vol. II (Chicago, IL: American Medical Association, 1921), 109.

65

‘Good fit’ in artificial eardrums

65

6 J. Esmail, Reading Victorian Deafness: Signs and Sounds in Victorian Literature and Culture (Athens, OH: University of Ohio Press, 2013). 7 K. Ott, ‘Hard wear and soft tissue: craft and commerce in artificial eyes’, in K. Ott, D. Serlin and S. Mihm (eds), Artificial Parts, Practical Lives:  Modern Histories of ­Prosthetics (New York, NY: New York University Press, 2002), 147–​70. 8 Ott, ‘Hard wear and soft tissue’, 151. 9 See Gooday and Sayer, Chapter 2. 10 K. Ott, ‘Prosthetics’, in B. Reiss and D. Serlin (eds), Keywords for Disability Studies (New York, NY: New York University Press, 2015), 140. 11 T. Hawksley, Catalogue of Acoustical Instruments to Aid the Deaf (London: Creswick & Co., 1883), reproduced in M. L. Koelkebeck, C. Detjen and D. R. Calvert (eds), Historic Devices for Hearing:  The CID-​Goldstein Collection (St Louis, MO:  The ­Central Institute for the Deaf, 1984). 12 American Medical Association (AMA), Chicago, Bureau of Investigation, Deafness Cures, various letters from deaf persons addressed to the AMA, 1900–​25. For an overview of how artificial eardrums (and other acoustic devices) incorporated the language of communication technologies, see M. Mills, ‘When mobile communication technologies were new’, Endeavour, 33:4 (2009), 140–​6; K. W. Berger, The Hearing Aid:  Its Operation and Development (Detroit, MI:  National Hearing Aid Society, 1970). 13 A. Faulkner, ‘Casing the joint:  the material development of artificial hips’, in K. Ott, D. Serlin and S. Mihm (eds), Artificial Parts, Practical Lives: Modern Histories of ­Prosthetics (New York, NY: New York University Press, 2002), 199–​226. 14 S. Blume, The Artificial Ear:  Cochlear Implants and the Culture of Deafness (New Brunswick, NJ: Rutgers University Press, 2009), 13. 15 S. Kruzman, ‘ “There’s no language for this:” communication and alignment in contemporary prosthetics’, in K. Ott, D. Serlin and S. Mihm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 227–​46; V. Warne, ‘“To invest a cripple with peculiar interest”: artificial legs and upper-​class amputees at mid-​century’, Victorian Review, 35:2 (2009), 83–​100. 16 D. M. Turner and A. Withey, ‘Technologies of the body: polite consumption and the correction of deformity in eighteenth-​century England’, History, 99:338 (2014), 775–​96. On the concept of ‘passing’, see J. A. Brune and D. J. Wilson (eds), Disability and Passing: Blurring the Lines of Identity (Philadelphia, PA: Temple U ­ niversity Press, 2013). 17 D. Yuan, ‘Disfigurement and reconstruction in Oliver Wendell Holmes, “The Human Wheel, its Stokes and Felloes”’, in D. T. Mitchell and S. L. Synder (eds), The Body and Physical Difference: Discourses of Disability (Ann Arbor, MI: University of Michigan Press, 1997), 71–​88. See also M. Seltzer, Bodies and Machines (London and New York, NY: Routledge, 1992). 18 M. Smith, ‘The vulnerable articulate: James Gillingham, Aimee Mullins, and Matthew Barney’, in M. Smith and J. Morra (eds), The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future (Cambridge, MA: MIT Press, 2006), 43–​72.

6

66

Rethinking modern prostheses

19 R. A.  R. Edwards, Words Made Flesh:  Nineteenth-​Century Deaf Education and the Growth of Deaf Culture (New  York, NY:  New  York University Press, 2012); K. E. Nielsen, A Disability History of the United States (Boston, MA:  Beacon Press, 2012). 20 German physician Marcus Banzer (1592–​1664) outlines a tube made of elk hoof, wrapped in a pig’s bladder and inserted into the ear for temporary treatment of eardrum perforation in Disputatio II de auditione laesa (Wittenberg, 1640). 21 E. A. Chu and R. K. Jackler, ‘The artificial tympanic membrane (1840–​1910): from brilliant innovation to quack device’, Otology and Neurotology, 24:3 (2003), 507–​18. 22 W. Kramer, The Aural Surgery of the Present Day, trans. H. Power (London: The New Sydenham Society, 1863), 74. The earliest reference of ‘ear spectacles’ for an acoustic device is in F. Bacon, Sylva sylvarum (Frankfurt: Schonwetteri, 1665). 23 W. B. Dalby, Lectures on Diseases and Injuries of the Ear (London: J. & A. Churchill, 1885), 150. 24 Berger, The Hearing Aid, 17. 25 J. W. Cousins, ‘New antiseptic artificial membrana tympani, with some remarks on the perforation and other disorders of the middle ear’, British Medical Journal, 2:1500 (1889), 712–​15. 26 G. P. Field, Aural Surgery:  A  Treatise on the Curable Forms of Ear Disease (­London: Henry Renshaw, 1876). 27 T. M. Hovell, A Treatise on the Diseases of the Ear Including the Anatomy and Physiology of the Organ (London:  J & A  Churchill, 1894); U. Pritchard, Handbook of Diseases of the Ear for the Use of Students and Practitioners, 2nd edn (London: H. K. Lewis, 1891). 28 H. Knapp, ‘The cotton-​pellet as an artificial drum-​head’, Archives of Otology, 10 (March 1881), 60–​9. 29 T. Hawksley, Ltd., Aids for the Deaf (351 Oxford Street, n.d.). 30 ‘Fifty-​Fourth Annual Meeting of the British Medical Association’, British Medical Journal, 2:1340 (1886), 453–​62, at 458. 31 Indeed, the history of medicine is rife with cases of patients turning to alternative sources of treatment, including patent medicines, upon being discouraged or disappointed with the medical profession. See M. S. R. Jenner and P. Wallis, Medicine and the Market in England and its Colonies, c.1450–​1850 (New York, NY: Palgrave Macmillan, 2007); E. W. Boyle, Quack Medicine: A History of Combating Health Fraud in Twentieth-​Century America (Santa Barbara, CA: Praeger, 2013). 32 R. Ohmann, Selling Culture: Magazine, Markets, and Class at the Turn of the Century (New York, NY: Verso Books, 1996). 33 See Lieffers, Chapter 6, and Jones, Introduction. 34 S. Frampton, ‘Patents, priority disputes, and the value of credit: towards a history (and pre-​history) of intellectual property in medicine’, Medical History, 55 (2011), 319–​24. 35 B. Z. Khan, The Democratization of Invention: Patents and Copyright in American Economic Development, 1790–​1920 (Cambridge: Cambridge University Press, 2005).

67

‘Good fit’ in artificial eardrums

67

36 J. Yearsley, ‘Artificial tympanums for the ear’, UK Patent No. 316, filed 19 November 1856. 37 L. J. H. Marville, ‘Artificial eardrum’, UK Patent No. 316, issued 4 February 1863; E. Giampietro, ‘Artificial eardrum’, UK Patent No. 1,010, issued 23 March 1874. 38 J. M. Gabriel, Medical Monopoly:  Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry (Chicago, IL:  University of Chicago Press, 2014), 81. 39 J. Virdi-​Dhesi, ‘Priority, piracy, and printed directions: James Yearsley’s patenting of the artificial tympanum’, Technology and Innovation: Proceedings of the National Academy of Inventors, 16:2 (2014), 145–​54. 40 J. W. Cousins, ‘Artificial ear drum’, US Patent No. 419,420, filed 2 November 1889, issued 14 January 1890. 41 U. Kleiner, ‘Artificial ear-​drum’, US Patent No. 702,800, filed 6 August 1901, issued 17 June 1902. 42 H. Peck, ‘Artificial ear-​drum’, US Patent No. 235,566, filed 7 October 1880, issued 14 December 1880. 43 H. Peck, ‘Artificial ear-​drum’, UK Patent 5453, issued 28 December 1881. 44 The extent of Hiscox’s involvement in the business is additionally supported by the fact that, in 1886, Peck assigned his second US patent for improvements on the original design, to Hiscox. While little is known of Hiscox, British patent records indicate he was an assignee for other artificial eardrum patents around the same period, although he never filed any under his own name. For instance, H. J. Allison received a UK 1886 patent for his artificial eardrum with an expanding applicator and transferred it to Hiscox. Likewise, H. H. Lake did the same for his version constructed of a rubber disc and silver tube with a ring at the end, granted patent protection in 1887. H. J. Allison, ‘Artificial ear-​drum’, UK Patent No. 13,681, issued 26 October 1886; H. H. Lake, ‘Artificial ear-​drum’, UK Patent No. 3,684, issued 10 March 1887; H. Peck, ‘Artificial ear-​drum’, US Patent No. 351,398, filed 20 November 1885, issued 26 October 1886. 45 G. J. N. Gooday and S. Araposthathis, Patently Contestable: Electrical Technologies and Inventor Identities on Trial in Britain (Cambridge, MA: MIT Press, 2013). 46 D. Jaffé, Ingenious Women: From Tincture of Saffron to Flying Machines (Stroud: Sutton, 2003). Technologically creative women engaged in entrepreneurial behaviour and even requested patent protection for their products of innovation. For health goods, only 6 per cent of all patents filed between 1790 and 1895 were by women, predominantly for useful and/​or improved products in the household sector. See:  B. Z. Khan, ‘“Not for ornament:” patenting activity by nineteenth-​century women inventors’, Journal of Interdisciplinary History, 31:2 (2000), 159–​95. 47 Khan, The Democratization of Invention; R. Oldenziel, ‘Man the maker, woman the consumer: the consumption junction revisited’, in A. N. H. Creager, E. Lunbeck and L. L. Schiebinger (eds), Feminism in Twentieth-​Century Science, Technology, and Medicine (Chicago, IL:  University of Chicago Press, 2001), 128–​48; A. Stanley,

68

68

Rethinking modern prostheses

Mothers and Daughters of Invention: Notes for a Revised History of Technology (New Brunswick, NJ: Rutgers University Press, 1995). 48 The patent for the Way Company’s artificial eardrum was first granted to George in 1899 and was jointly assigned to William H. Seldon Jr., presumably a business partner. In 1906, George received another patent for improvements on his original design, changing the specifics to include details on the device’s benefits on perforation and changing the contour of the device’s wall for safer insertion into the ear. G. P. Way and W. H. Seldon Jr., ‘Ear-​drum’, US Patent No. 628,051, filed 21 May 1898, issued 4 July 1899; G. P. Way, ‘Ear-​drum’, US Patent No. 831,125, filed 27 March 1905, issued 18 September 1906; F. M. Way, ‘Invisible ear-​drum’, US Patent No. 902,785, filed 6 April 1908, issued 3 November 1908. 49 L. Herschbach, ‘Prosthetic reconstruction:  making the industry, re-​making the body, modelling the nation’, History Workshop Journal, 44 (1997), 22–​57, at 42–​3. 50 A. D. Munro, ‘Artificial eardrum’, UK Patent No. 3,374, issued 24 February 1889. 51 R. C. Nutall, ‘Artificial eardrum’, UK Patent No. 3,150, issued 7 February 1902. 52 A. M. Clarke, ‘Artificial eardrum’, UK Patent No. 1,290, issued 29 January 1885; J. H. Nicholson, ‘Artificial eardrum’, US Patent No. 312,577, filed 11 April 1884, issued 17 February 1885. 53 H. A. Wales, ‘Artificial ear-​drum’, US Patent No. 335,660, filed 11 May 1885, issued 9 February 1886. 54 J. B. Campbell, ‘Artificial ear-​drum’, US Patent No. 834,259, filed 7 December 1905, issued 30 October 1906. 55 G. H. Wilson, ‘Artificial ear-​drum’, US Patent No. 476,853, filed 3 May 1892, issued 14 June 1892. 56 E. J. Loosmore, ‘Artificial ear-​drum’, UK Patent No. 19,360, issued 15 September 1908; A. O. Leonard, ‘Eardrum’, US Patent No. 1,446,257, filed 7 December 1921, issued 20 February 1923. 57 E. Baum, ‘Artificial ear-​drum’, US Patent No. 1,207,704, filed 26 October 1912, issued 12 December 1912. 58 ‘Deafness cured’, New York Observer and Chronicle, 5 March 1903, 318. 59 ‘The deaf engineer of Detroit’, The Cosmopolitan: A Monthly Illustrated Magazine, October 1905, 721. 60 On surgical trade catalogues, see C. L. Jones, ‘(Re-​)reading medical trade catalogs: the uses of professional advertising in British medical practice, 1870–​1914’, Bulletin of the History of Medicine, 86:3 (2012), 361–​93. 61 Mills, ‘When mobile communication technologies were new’. 62 AMA, Bureau of Investigation, Deafness Cures, Advertisement for Morley’s Ear Phones. 63 AMA Bureau of Investigation, Deafness Cures, Advertisement for Way Eardrum Co. 64 M. Mills, ‘Hearing aids and the history of electronics miniaturization’, IEEE Annals of the History of Computing, 11:2 (2011), 24–​44; C. C. Sarli, R. M. Uchanksi, A. Heidbreder, K. Readmond and B. Spehar, ‘19th-​Century camouflaged mechanical hearing devices’, Otology and Neurotology, 24:4 (2003), 691–​8.

69

‘Good fit’ in artificial eardrums

69

65 L. H. Vickers, ‘Artificial ear-​drum’, US Patent No. 652,202, filed 11 January 1900, issued 19 June 1900. 66 S. Burch, Signs of Resistance: American Deaf Cultural History, 1900 to World War II (New York, NY: New York University Press, 2004), 31. 67 AMA Bureau of Investigation, Deafness Cures, Advertisement for Way Eardrum Co. 68 ‘The curse of deafness’, Illustrated London News, 14 April 1900, 522. 69 Sarli et al., ‘19th-​Century camouflaged mechanical hearing devices’, 692. 70 Advertisement for Way’s Ear Drum, Cosmopolitan Magazine, 1905.

70

3

INVENTING AMPLIFIED TELEPHONY: THE CO-​C REATION OF AURAL TECHNOLOGY AND DISABILITY Coreen McGuire

Telephony and wireless have revolutionised life. Both are now indispensable to business and social happiness. In a moment, they overcome distance and unite friends separated by oceans and continents. It is, therefore, a greater misfortune to be deaf today than ever before. What has been described as the ‘mental blindness’ of deafness has become far more serious in its effects in social and working life since the losses of the closed ear grow greater as the discovery of acoustic sciences proceed. Can any of these discoveries be made serviceable in enabling the deafened to regain, even if only in measure, their contact with speech? Report of the Executive Committee to the Council of the National Institute for the Deaf, 1933.

The telephone was originally designed for people with unproblematic hearing to communicate with each other. As the above report shows, it was thus a purely aural device –​like radio –​that served to further isolate hard-​of-​hearing people from key areas of everyday life. Yet a subsequent cross-​fertilisation between telephony and hearing assistive technology embedded the connection between hearing loss and telephony in devices such as electronic hearing aids and amplified telephones. My chapter explores how amplified telephony was introduced by the UK’s General Post Office in an attempt to provide ‘hard-​ of-​hearing’ individuals access to telephone communications in the 1920s and 1930s. In its failure to supply a telephone to those with hearing loss too great for its device, however, the Post Office redefined the thresholds of ‘deafness’.1 Here, I explore how, during the inter-​war years, the state of being deaf or hard-​ of-​hearing became defined through the ability, or otherwise, to use certain kinds of telephone –​both literally in the form of the audiometer and socially through the ability to engage with the telephone. Linkage between telephony and hearing loss has long been noted by historians of sound and historians of science, with many noting the involvement of

71

Co-creation of aural technology and disability

71

Alexander Graham Bell, who cited his work with the deaf and with the human ear as the inspiration behind his invention of the telephone in the 1870s. Yet, beyond Bell, little is known about the later development of amplified telephony nor its relation to hearing loss.2 In this chapter, the amplified telephone is defined as a prosthetic device in the sense that it was an assistive technology to those with hearing loss and was designed to enable users to cope with the loss of physical abilities. Crucially, the amplified telephone enabled those using it to ‘pass’ as hearing over the telephone during a period when the stigmatisation of being hearing impaired remained.3 Indeed, while Anthony Enns has considered telephony as working like a prosthesis to become a technological extension of the senses in the Victorian era that emphasised the mechanistic properties of aural perception, the amplified telephone of the twentieth century could be considered as an ideal prosthesis because it promised to solve issues of both audibility and stigmatisation without being apparent to the caller on the other side of the line.4 Although the amplifying apparatus used in the design of the modified telephone was bulky and visible to its user, its invisibility to the caller on the other end of the line allowed the user to blend in with other non-​hearing impaired telephone users. Like the users of hearing aids addressed by Jennifer Esmail in Reading Victorian Deafness and Graeme Gooday and Karen Sayer’s chapter in this volume, and the users of artificial eardrums discussed by Jaipreet Virdi, the kind of people the Post Office was targeting with its amplified telephones would not have necessarily identified as deaf and may have passed as hearing in all other aspects of their lives.5 In order to retain their hearing identity and not be categorised as deaf –​with the corresponding stigma that invoked –​people with hearing loss engaged with amplified telephones. Those who desired access to telephony in the inter-​war years would almost certainly not have recognised the Deaf community and its cultures of the late twentieth century, but less scholarly attention has been paid to those who became hard-​of-​hearing later in life and did not affiliate themselves with the Deaf community. This is in part because there is not an identified community of people with hearing loss and in part because the stigma surrounding deafness has led those with hearing loss to identify with the hearing and to minimise the significance of their hearing loss. In modern Deaf culture, hearing loss is not regarded as disabling; rather, the Deaf regard themselves as being defined not by their medical status but through their social and political status.6 In the context of the medical model of disability, technology is often described as apparatus that can be used to fix the problems associated with non-​standard bodies, but late twentieth-​and early twenty-​first-​century developments in telecommunication technology revolutionised the ways in which

72

72

Rethinking modern prostheses

the Deaf communicated; the rise of text messaging and social media in particular empowered Deaf technology users and allowed them to use a form of technology that had previously relied on audibility.7 The cultural distinction between hearing loss and Deafness has recently been further challenged by the ambiguities around cochlear implants and the contested identity of their users. In this chapter I show how, in the inter-​war years, amplified telephone technology posed a similar challenge to deaf and Deaf identity. The telephone already was used as a way to extend normal hearing and so by amplifying the telephone the category of those with ‘normal hearing’ could be widened. The amplified telephone became a device to categorise hearing in increasingly mechanistic terms. Viewing the amplified telephone as a prosthesis then brings new analysis to bear on an understudied technology and highlights the tensions between product categorisation and personal identity in the complex user–​producer relationship. It also provides a new perspective on invisibility in relation to hearing loss and stigma because the British Post Office used the stigma attached to hearing to promote amplified telephony, emphasising the social embarrassment caused by having to use one’s family members to conduct phone conversations. Drawing on social construction of technology approaches (SCOT) and on Nelly Oudshoorn and Trevor Pinch’s pioneering How Users Matter in particular, this chapter also highlights the active role of innovative users with hearing loss in early twentieth-​century amplified telephony and their influence on Post Office designs. Indeed, beyond Alexander Graham Bell’s experience of deafness and telephony, we lack an understanding of how producers and everyday users tinkered with their telephone devices to improve their audibility. Yet the development of amplified telephony by the Post Office was particularly marked by user innovation. User engagement with the amplified telephone was characterised by users bringing their own embodied knowledge about hearing to improve the telephones. Study of this interplay between producer and user can reveal new insights about innovation, use and disability. These themes are most strongly reflected in the 1936 case of Raymond J. Harris, a businessman with hearing loss, who wrote to the British Post Office to demand a telephone suitable for his level of hearing. Through focusing on a case study of the individual experiences of one amplified-​telephone user, we can see the direct impact that hard-​of-​hearing telephone users had on the development of the British Post Office’s amplified-​telephone sets during the inter-​war years and, accordingly, how users could be primary agents of technological change to amplified telephony. The influence of hard-​of-​hearing individuals on the telephone system beyond Alexander Graham Bell becomes more apparent than has hitherto been recognised.

73

Co-creation of aural technology and disability

73

Controversies and co-​construction: the disputes surrounding the design of amplified telephony The amplified telephone was co-​constructed by the Post Office and its users in an ongoing process of user inputs and corresponding design modifications. This design process was marked by the Post Office’s powerful position as the sole authority over telephone communication in Britain and its relationship with the wider government. The 1869 Telegraph Act had granted this monopoly over communications, and it was confirmed in 1880 that it included telephony even though the telephone had not been invented when the Act was first conceived.8 The Post Office had legalised control over the telephone service in Britain, and it was illegal for private companies or individuals to modify or tamper with its apparatus, which meant commercial companies could not offer specialised telephones for those who struggled to hear on the telephone. The Post Office was challenged by such users to provide telephones that could be used by people with less than perfect hearing, and this led to its initial provision of a ‘telephone for deaf subscribers’.9 Throughout the 1930s there was increasing tension within the Post Office institution over how its apparent state responsibilities to provide a ‘telephone for deaf subscribers’ conflicted with its need to function as a profitable business enterprise. The Post Office’s duty to provide this must be considered in the context of inter-​war welfare developments. The Post Office was a state office of the government, and its increased involvement in the welfare of its citizens had been marked through legislation such as the National Health Insurance Act (1911) and the creation of the Ministry of Pensions (1916) and the Ministry of Health (1919). The First World War had further increased the newly enfranchised public’s expectations that the government was responsible for citizen welfare. Therefore, the provision of universally accessible telephones was perceived by the public to be part of state duty. However, designing these telephones was not profitable for the Post Office because there was not a large market for their use. Motivation for their construction was primarily a result of state duty and activism from individuals with hearing loss. This meant that the Post Office’s involvement in telecommunications for hearing loss was marked by a conflict between duty and profit and its use of the term ‘deaf subscriber’ did not reflect the needs or the identity of its clientele. The construction and use of the term ‘deaf subscriber’ was itself contrived by the Post Office as an artificial label, created in order that the Post Office could conveniently group people with hearing loss together, without considering the wide spectrum of hearing abilities or the stigma attached to the term. Accordingly, telephone users, such as those with greater hearing loss, different

74

74

Rethinking modern prostheses

frequency needs or bone-​conductive hearing losses, were unhappy with their telephone provision and demanded that the institution fulfil its duty to provide telephone access to all citizens. The first telephone designed to aid ­people with hearing loss was designed by the Post Office in 1922 at the request of wealthy London oil-​distilling businessmen, who insisted on an improved telephone service at any cost. The Post Office subsequently provided an amplified telephone service to its subscribers at an increased rental price. This was an extra cost to an already expensive service and so, between 1928 and 1934, Mr Howard Buckley, a war veteran, continually demanded a cheaper amplified telephone for those who had lost their hearing in the First World War and could not afford high telephone rental on a meagre war pension (which was just under half of that accorded to those who had lost their sight).10 The improved telephone designed after Buckley’s intervention was known as the Repeater 17A and was advertised in the booklet that came to the attention of Harris, whose actions are the main focus of this chapter. Claire L. Jones has demonstrated similar processes of user feedback through analysis of the design process of medical trade catalogues in which medical practitioners would contribute to design and content.11 Practitioners also engaged with the catalogue in ways that the catalogue manufacturers did not anticipate, for example by adapting them to better suit their own needs and tearing out illustrations rather than using the reference numbers provided. However, the manufacturers, in turn, responded better to direct user input than to subversive practices and modifications. The Post Office also reacted negatively to Harris’s subversive modification of the telephone, but it did have a positive effect in that it forced the Post Office to take action and respond to his design and improve what they termed the ‘telephone for deaf subscribers’. For a business man to have to rely upon a member of his staff to conduct his telephone conversations is a disability which must be irritating both to himself and, which is probably more important, to his correspondents. He cannot really afford to take this risk yet he may think he has no alternative. To be dependent upon his wife or servants to answer his friends’ telephone calls is equally unpleasant in his social relationships. Many tolerate this condition while, fortunately, it is entirely unnecessary.12

The above advertisement shows the way in which the Post Office marketed the amplified telephone service as a device that could ease fraught social relationships and promote independence from familial care.13 It stigmatised hearing loss in order to market its products, as private companies did in their advertisements for the hearing aids and artificial tympanums discussed in Chapters 1 and 2. Yet it is clear that this promise was not fulfilled in practice

75

Co-creation of aural technology and disability

75

when Harris initially wrote to the Post Office to try the newly advertised ­amplified telephone, which had been designed in conjunction with another telephone user with hearing loss. The pattern of such collaborations indicates that the Post Office was heavily influenced by the specific needs of certain hard-​of-​hearing subscribers. Harris stipulated regarding his new amplified telephone that ‘unless it was much better than the previous one I had tried I did not want it’.14 After he had previously tried the 1922 Repeater 9A and found it to be unsatisfactory, Harris had instead designed and built his own personal amplifying apparatus which he used in conjunction with the Post Office telephone and which he insisted was far superior to even the most recently advertised equipment. This led to a protracted struggle between Harris, who believed that the Post Office should have been able to provide apparatus at least as good as his own for anyone suffering from hearing loss, and the Post Office, who did not want private apparatus used on its lines but who simultaneously did not want to waste money designing specialised apparatus for a single customer. Although the Post Office was advertising to people that it termed in its marketing as ‘deaf subscribers’, who paid increased rent for the amplified telephones, it did not believe it needed to improve the apparatus aimed at them. Harris was able to successfully modify his telephone because he was a wealthy and successful large business owner whose wealth had been partially built on his company’s technical improvements to refrigeration techniques. Harris had the wealth, technological facilities and expertise necessary to create an apparatus that other users needed but had neither the skills not resources to construct. Although telephony was still a luxury item for most households in 1930s Britain, it was an essential and necessary business tool for Harris. The first communication between Harris and the Post Office was through his mother, Mrs J. Mitchell Harris, as she telephoned to rent the amplified telephone on behalf of her son.15 Harris, a businessman forced to use his mother to conduct his telephone business, was the exact type of customer the Post Office was targeting, as its advertisement emphasised that it was particularly problematic for businessmen to use unsuitable people as mediators in private transactions because of their hearing loss. After Harris made it clear that he was not satisfied with the new telephone, the Post Office reacted by visiting his home. This allowed the Post Office to ascertain that the equipment was working but that the newly advertised instrument was not supported in his service area.16 The sectional engineer’s visit was crucial, however, because it allowed him to closely examine Harris’s personal amplifying device and send a diagram outlining its design to the engineer-​in-​chief. Harris’s apparatus was described by the engineers as a microphone that other members of the household could use, in the dining room for instance.17 It is unclear whether this was

76

76

Rethinking modern prostheses

Figure 3.1  The front page of the 1936 Post Office advertisement booklet ‘A T ­ elephone for Deaf Subscribers’.

used like a hearing aid for conversations or solely as a device to be used with the telephone. The reason that it could be used in both capacities was because Harris used the older style of candlestick telephone, with a separate receiver and transmitter (see Figure  3.1). He would place his amplifier beside the receiver and then plug in headphones to hear the amplified sound. By doing this, he amplified the sound after it had passed through the telephone rather than increasing the signal strength the way a Post Office telephone repeater would have done. Similar instances of unanticipated appropriation of candlestick-​ style telephones were evident in cases of people with bone-​conductive hearing loss, who would hold the receiver to their mastoid bone rather than to their ear and still be able to comfortably talk into the transmitter (mouthpiece).18 Such

7

Co-creation of aural technology and disability

77

usage only became apparent to the Post Office as the candlestick telephones were phased out and replaced with standard integrated headsets. This led to an unexpected surge of complaints from telephone users with bone-​conductive hearing loss and was another factor that motivated the Post Office to improve its amplified telephone service. Development of amplified telephony was marked by tensions between the Post Office’s monopoly of telephony and its duty to provide a service to citizens with varying hearing needs. The diverse needs of telephone users was not encapsulated in the technology provided for an imagined standard ‘deaf subscriber’ and so improvements to amplified telephony were affected by the complexities of matching individual user needs with the Post Office institutional set-​up. Individuals lived experience of hearing loss came into conflict not only with the dynamics of supply and demand within the Post Office but also with its desire to base production on standardised mechanisation. The quest for standardisation: embodied knowledge immersed into measurement The disparity between the Post Office’s measured approach to the amplified telephone and Harris’s personally embodied design was at the heart of the tensions that developed in this case. Although his modified device was perfect for him, it was not accepted by the Post Office because it was not standardised and could not be measured by their equipment or engineers. Harris’s correspondence with the Post Office is especially revealing of such inconsistencies between institutional expectations of hearing and user expectations of amplification as well as incongruities inherent to Post Office policies regarding its deaf subscribers. Furthermore, his case highlights how users drew upon personal experience and bodily knowledge to improve the telephones in ways that the Post Office could not. Through the increased use of machines such as the audiometer that marginalised the human element, devices such as Harris’s personally developed apparatus for his individual hearing needs were increasingly in conflict with such methods of measurement and design. Anderson’s chapter in this volume (Chapter 7) highlights a similar tension between the desire to mass produce standardised prostheses and the need to design each one for the individual customer’s body. Moreover, Harris’s invention could not be measured, tested or trusted by the Post Office engineers. Ideas of trust being invoked by a particular instrument or measurement have been explored by Gooday in the context of electricity and measurement in the late nineteenth century. Trust in instrumental measurement was also contrasted with distrust in the body.19 In the

78

78

Rethinking modern prostheses

context of Harris’s innovation, his body was problematised as a reliable source of knowledge because it could only be measured in individualistic terms. Yet it was his personal insight that allowed the Post Office to improve its amplified telephone service. The Post Office profited from his bodily knowledge by turning his insight into a commodity that could be exploited for commercial gain. Mara Mills has pointed out that disability can be used in this way to provide a source of technical innovation but that in the case of telephony and hearing loss this connection is far deeper and more complicated than simple appropriation.20 Indeed, the kind of technical insights that Harris could provide were not welcomed by the Post Office telecommunication department, who were trying to provide a standard telephone for the deaf that could be used by a typical ‘deaf subscriber’. As a government department, standardisation was integral to the Post Office’s wider ethos regarding its customers at this time, as giving the same service to all was integral to its democratic position. Standardisation was a built-​in component of the telephone network and was partially stimulated by technical necessity. In the United States, though the telephone network AT&T did not have a government-​mandated monopoly, it still dominated the lines of communication, and this standardisation was reflected in the AT&T slogan that demanded, ‘One policy, One system, Universal service’.21 Yet although it was created for an individual need, we can see by comparing the technologies (Figure 3.2) that Harris’s device was superior to the Post Office’s device in providing greater amplification as well as being uniquely suitable for his exact level of hearing. The Repeater 9A, the only amplified telephone that could be used in Harris’s area, utilised just one single thermionic valve and one dry battery, whereas Harris’s circuit created greatly increased amplification because it used a triode valve and a pentode valve. The resulting amplification was so great that Post Office engineers reported it could not be tolerated by a person with normal hearing and that they could not risk putting on the headphones to test it.22 The level of amplification was perfect for Harris, however, and this particular aspect of his invention can be usefully considered as a form of embodied knowledge, a type of knowledge intimately linked a person’s specific nature.23 Knowledge of the degree of amplification and tone control needed in order for Harris to hear on the telephone was something that only he could gauge. His body and his hearing allowed him to mediate the level of amplification in a way that the Post Office engineers physically could not. However, the fact that the Post Office reproduced his amplifier instead of allowing him to use his own indicates that the kind of embodied knowledge gained through (dis)ability was not considered legitimate by the institution. Indeed, the decision to move away from equipment designed using personal, embodied knowledge of sound through individual sensory judgement was

79

Co-creation of aural technology and disability

Figure 3.2  The Bristol engineers’ diagram of Harris’s amplifier.

79

80

80

Rethinking modern prostheses

reflected in larger movements towards standardised measurements of sound in the 1920s and 1930s. The move towards standardisation manifested in the increased use of the audiometer, an example of the telephone being used literally to measure ­levels of hearing loss. By the 1920s, the telephone had also been adapted as an audiometer that could be used to measure noise levels through quantifying sensation units, which an engineer could do by increasing the audiometer’s tone in his ear until it was loud enough to mask external noise.24 Of course, this method did not take into account the wide spectrum of hearing ability even among those considered to hear ‘normally’. Therefore, this kind of individual subjective measurement was superseded with the rise of decibel measurement from 1923. Increased standardisation and the decibel were also used in hearing testing during the 1930s. This decade was marked by the culmination of a drive for standardisation of sound that was expressed, for example, in the introduction of the decibel as a fixed term and the standardised of concert pitch. Methods of testing hearing were still relatively flexible in 1931, however, as a report on standard tests of hearing for speech compiled by the National Institute for the Deaf Medical Sub-​committee made clear. This report shows that the Institute desired that hearing no longer be tested through the unreliable medium of an individual examiner’s voice:  ‘Inasmuch as the decibel index of speech sounds by telephone has been adopted by international agreement between the various telephone services, the committee recommend that this index should be the basis of measurement and description of standard speech intensities used for testing hearing for speech.’25 The above quote also shows that hearing testing was actively influenced by developments in telephony and exemplifies the complexity of the connections between telephony and the classification of hearing loss. Moreover, it indicates that the shift towards greater standardisation affected not only hearing measurement and testing but also the telephone system. Such technocratic approaches represented a developing dichotomy between the divergent needs of users with hearing loss and the decibel-​based standards of the Post Office. Although the Post Office admitted that Harris’s device provided greater amplification, this dichotomy proscribed Harris’s embodied invention as an unmeasurable, untrusted and unpatented device. The relationship between patents and community inventions The relationship of patents to identity and community becomes clear when considering why Harris did not patent his invention. The ethical conflicts

81

Co-creation of aural technology and disability

81

related to medical invention and patents have recently been explored in ­relation to hearing loss because of André Djourno’s decision not to patent any of his inventions related to electrical auditory prosthetics that stimulated the development of the cochlear implant. He believed his work should be open science, used in the public realm for the public good.26 Such an attitude problematises patents as counter to the unfettered development of important medical devices. By prioritising free access to invention, Harris allowed the Post Office to produce his device for others without due credit. His involvement was also restricted, as the quotation below demonstrates, For his private use the subscriber has an amplifier with associated microphone giving an output much in excess of our instrument. I have called for a special report on this private apparatus and may be able to adapt our amplifier to work in conjunction with it. No mention of this has of course been made to the subscriber.27

The Post Office explicitly decided not to inform Harris that it had compiled a special report on his apparatus as this, alongside the absence of patent protection, allowed its engineers to reproduce his design without his knowledge or consent. There was precedent within the Post Office of appropriating designs in this way, as can be seen in the case of the deaf electrical engineer Oliver Heaviside and his interactions with the Post Office in the late nineteenth century.28 Like Harris, Heaviside had hearing loss, worked on improvements to telephony (long-​distance telephony) and did not protect his inventions because of his altruistic principles. Heaviside also had an acrimonious relationship with the Post Office, and his ‘open approach to “do good to my fellow creatures” was in part a reaction against attempts by William Preece, the chief electrician at the UK Post Office, to suppress his theories of long-​distance telephony’.29 Because Heaviside did not patent his innovation and took the same moral stance as Harris regarding the need to share inventions, the Post Office was able to adopt his invention without according Heaviside any recognition.30 Like Heaviside, Harris was an innovator, but he was also first, and perhaps foremost, a user. Harris’s design was clearly very personal and was tailored to his individual body and needs and yet was still commodified by the Post Office for national use. Like Derenzy, the one-​handed inventor discussed in Chapter 4 by L ­ aurel Daen, Harris used his own experience of physical impairment to create a product that he chose to publish and not patent out of a philanthropic desire to help others.31 However, this impulse is contrasted in Chapter 6 by Caroline Lieffers’ exploration of Palmer, who improved on existing prostheses to create a product he could use but then used the patenting system to ensure that he profited from his innovation.32

82

82

Rethinking modern prostheses

The Post Office was protected from accusations of piracy because its work was under crown copyright, which gave greater protection and secrecy than a patent. Established in 1911, this protected any works created under any government department.33 However, although neither the Post Office nor Harris patented their amplified telephones, there were thirteen amplified telephony patents taken out by private entrepreneurs between 1921 and 1935 despite the fact that it would have been illegal to use them.34 Clearly, the problem of hearing over the phone was widespread, and there was a felt need for it to be addressed. Private hearing-​aid companies, including Amplivox, Multitone and Ossicaide, all invented systems of listening to the telephone via a hearing aid through induced currents.35 The Post Office viewed private hearing-​aid firms offering telephonic assistance as a threat to its control and refused to sanction the use of such hearing-​aid couplers with its telephones.36 Indeed, it was concerned to such an extent that it advocated completely prohibiting private hearing aids with couplers as illegal infringements, as it had done with Harris’s equipment. However, as these devices did not have a physical attachment to the telephones, the Post Office could not ban their use, although it could refuse to sanction their use. Initially, a special report considered whether it would be viable to combine Harris’s device with the Post Office’s own amplifier set. However, this idea was rejected by the engineering department because of concerns about overheating on adjacent lines and, more importantly, the aberration from its standardised service.37 The subject is not merely hard of hearing but is extremely deaf […] It will probably be agreed that too much nonstandard apparatus on P.O. lines is not wholly desirable […] the better plan would be to consider the matter from the point of view of economic value than the desire to please one subscriber in particular.38

However, the Post Office did continue to engage with Harris to develop a more suitable instrument despite the fact that there was evidently no economic value in doing so. The instrument that the engineering department eventually developed was offered to Harris in order that he could try it out at home, subject to a trial fee. Harris strongly objected to this plan, however, and pointed out, in his typically eloquent manner that, It seems to me a somewhat unusual method of selling to charge £1 for testing the apparatus in order to test whether your claims that it is suitable for the purpose are true. Seeing that the P. Office will not allow private enterprise to supply efficient amplifiers so that deaf people can use them in connection with the National Telephones, I maintain the P.O. should be in a position to supply good apparatus themselves.39

83

Co-creation of aural technology and disability

83

In the above quotation, we see again the comparison of the Post Office efficacy with that of private companies, and Harris’s point does seem to have influenced the Post Office to increase its efforts to develop an equally effective device. The Post Office then tried to persuade Harris to bring his personal apparatus to its research station in Dollis Hill, London. However, this request was rather impractical, and Harris stated, ‘I should be willing to visit the P.O. Engineering Research Station when I am in London but I am sorry I cannot undertake to carry my amplifier with me, it is not made to be transported and in any case I seldom carry anything of this description.’40 He added that, ‘My instrument can be seen and tested at my office, Bowyers Wiltshire. I am not taking all this trouble in order to get an instrument for myself but because other deaf people also require an efficient instrument.’41 His final comment on the benefit of his instruments for other hard-​of-​ hearing users suggests why Harris did not protect his invention through the patent system. If he was only concerned with his own telephone service and his amplifier worked perfectly well, then he did not really need to complain to the Post Office. There was no need for him to engage with the Post Office for his own sake and by doing so he was putting his modified device at risk of confiscation. Although direct evidence is wanting, it is likely then that he contacted the Post Office in order that it could adapt his invention to benefit others with hearing loss. He allowed the Post Office free access to his design and encouraged it to develop a similar device without seeking any recognition or monetary gain for his invention. It is likely that he was acting with an awareness of an imagined community of other people with hearing loss like his own and their need to use the telephone. I  extend the use of Benedict Anderson’s term ‘imagined community’ in relation to nationalism in order to explain Harris’s feeling of belonging to a wider community of hard-​of-​hearing people.42 This extension of imagined communities includes communities associated by empathy, explaining how Harris could have felt affinity and duty to other people with hearing loss. One of the reasons why the hard-​of-​hearing did not form social groups was that many people with hearing loss would have ‘passed’ as hearing, perhaps with aids. I use the concept of ‘passing’ here as defined by Michael Rembis: ‘in the disabled context, passing traditionally has been seen as the ability to conceal one’s identity or to mask or cover impairment’.43 Harris was also acting to fulfil the principle that the government, and, by extension, the Post Office, was responsible for citizens with hearing loss. Although the hard-​of-​hearing did not form a cohesive group that identified with each other as having similar interests during the 1930s, it nonetheless seems that Harris was working altruistically for the benefit of an imagined

84

84

Rethinking modern prostheses

community of people with hearing loss like his own. Harris’s unpatented invention was a way of reaching out to people otherwise being denied such relationships. Therefore he was primarily motivated by his desire to make amplified telephony more successful, and he succeeded in his goal as the Post Office accelerated the development of its telephone for ‘deaf subscribers’ so a device with greater amplification could be used in all areas. This became known as the Repeater 17b and was 13.5 decibels louder than the 17a and included a tone control button. The Post Office advertised the new phone in its 1938 booklet (Figure 3.3), and this chapter has shown that Harris’s design was a clear influence on that model. Harris’s decision not to patent his design allowed the Post Office to appropriate it without acknowledgement, and the Post Office incorporated important elements of his design into its improved telephone repeater.44 By doing so, the Post Office used its telephone monopoly and crown copyright as a form of patent protection to commodify Harris’s specific hearing ability and embodied knowledge in order to gain profit and positive publicity for their office and the government. Harris was able to use this new telephone despite the fact that, according to the Post Office, he was ‘extremely deaf ’. Categorical terminology like this is a recurring difficulty in such cases, revealing tensions regarding how best to decide who was ‘too deaf ’ to use the telephone, who was simply hard-​of-​ hearing and what to call these two groups. The Post Office described those who could use the telephone with extra amplification as ‘hard-​of-​hearing’ and those who could not as ‘deaf ’ or ‘extremely deaf ’. Categorising deafness in this way meant that the condition of hearing or deafness changed with the improvement of technology rather than through any change in bodily physiology. When Harris was able to use the more powerful telephone, he was recategorised as hard-​of-​hearing rather than ‘extremely deaf ’, although his medical level of hearing was unchanged. Histories of technology by Langdon Winner and Mara Mills that view the design and production of technologies as intrinsically political relate to the fact that the amplified telephone was used by the Post Office to categorise their users’ identity as either hearing (could use the standard telephone model), hard-​of-​hearing (could use the telephone when amplified) or deaf (could not use the telephone even when amplified).45 As Jones has highlighted in the introduction to this collection, the categorisation of disability and ability has historically been constructed according to diverse ‘temporal, social, geographical, cultural and economic contexts’.46 The case of Harris has demonstrated that technology and improvements to technology have also been used to constitute these categories. For the Post Office, categorisation depended on the efficacy of the technology rather than on the telephone user’s level of hearing.

85

Co-creation of aural technology and disability

Figure 3.3  The front page of the 1938 Post Office advertisement booklet ‘Telephone service for the Deaf ’.

85

86

86

Rethinking modern prostheses

Conclusion The relationship between hearing loss, technology and who controls these two things are more nuanced than existing studies have recognised. The telephone is a powerful symbol of the way in which technology can augment disability. While technologies such as telephony are more often characterised as a way to ‘fix’ disability, in this case it was Harris’s hearing (dis)ability that allowed him to design specialised, superior equipment to fix his telephone. In profiting from Harris’s personal creation by turning it into a commercial device, the Post Office turned his hearing loss into a state commodity. It is clear that the Post Office commodified Harris’s invention and profited from it. The experiments carried out to improve the telephone experience for Harris led to an awareness that frequency and tone were problems for hard-​of-​hearing subscribers equal to the problem of volume and the realisation that amplification was not the only component implicated in problems of audibility. Therefore, the Repeater 17b signalled increased awareness of the diversity of problems of audibility and hearing experience that were not encompassed by the all-​inclusive term ‘deaf subscriber’. This analysis builds on recognitions of the fluidity of deaf identity that have been identified by Gooday and Sayer and shows the incompatibility of such diversity with increasingly standardised technology. While Anthony Enns has noted the relationship between the desire for mechanisation and early developments in telephony, this chapter has extended this argument to show how these priorities affected the ongoing development of telephony for those with hearing loss. When hearing and hearing loss are considered to be on a spectrum, it becomes clear that the desire for objective measurement was in conflict with the body, as Gooday has explored in the context of nineteenth-​ century electrical measurements.47 The interventions of Harris had a potent effect on directing the development of the Post Office’s amplified telephones. Indeed, the telephone that he (at least) inspired and (more likely) designed was to remain in use until transistor technology started to supersede valve amplification in the late 1950s. To publicise its new transistorised telephone, the Post Office commissioned an article on the history of amplified telephony, which was disseminated in 1961.48 In this article, the Post Office rewrote the history of amplified telephone development in order to place the transistor-​based design in a narrative that celebrated institutional innovation and inclusiveness. It implied that invention of these telephones was motivated by the Post Office’s special awareness of the problems that those using the telephone with hearing loss were faced with. ‘Have you ever considered the difficulties encountered by those

87

Co-creation of aural technology and disability

87

with impaired hearing or speech, and imagined how you would deal with the problems involved if you were similarly handicapped?’ This official history records a company-​led, progressive technical narrative of amplified telephony, which is in fact a story of individual innovation and ingenuity working against institutional discrimination. Thus we can see how politics have been embedded in the amplified telephone similar to the way Mills considers the politics of cochlear implants. This narrative was to continue beyond the inter-​war years. Even as late as 1970 the Post Office was still affecting the provision of Deaf telephony because of its insistence on standardisation. American advocates of TTY technology were especially in conflict with the Post Office over their desire to help set up a TTY network in England, which the Post Office saw as undercutting their provision of amplified telephony and (by this time) teletypewriter exchange services.49 Richard Murphy, a deaf engineer who challenged the Post Office on the TTY issue, summarised the situation in both 1970 and in 1937 most succinctly when he explained, ‘I am afraid it will be most difficult for me or anyone else to start the Phonetype system here … The P.O. authorities can do much as they like –​in fact they are a law unto themselves.’50 However, the Post Office’s expertise in amplification technology did enable it to create a further legacy in the form of state provision of hearing aids, when the Post Office collaborated with the Medical Research Council after the Second World War to design a national hearing aid known as the Medresco.51 This large-​scale state intervention in hearing loss was built into the National Health Service, and yet amplified telephones were never similarly considered as medical devices, and customers still had to pay a surfeit charge to access telephony. This charge was justified through the categorisation of amplified telephony as a non-​medical device. Such categorisation of telephony was a key issue as it related to whether or not amplified telephone devices counted as a medical item, a prosthesis, or simply a telecommunication apparatus. This chapter has shown that drawing such dichotomies between perceived polarities such as deaf or hard-​of-​hearing does not reflect the true diversity of hearing experience. If we, as historians, are to truly profit from Harris’s invention, then we should consider challenging the construction of such categorisation. Notes 1 For a comprehensive discussion of multiple aetiologies of hearing loss, see Gooday and Sayer, Chapter 2. 2 See R. V. Bruce, Alexander Graham Bell and the Conquest of Solitude (Boston, MA: Little, Brown & Company, 1973); O. Sacks, Seeing Voices (Berkeley, CA:

8

88

Rethinking modern prostheses

University of California Press, 1989); C. Padden and T.  Humphries, Inside Deaf Culture (Cambridge, MA: Harvard University Press, 2009); A. Enns, ‘The human telephone: physiology, neurology and sound technology’, in D. Morat (ed.), Sounds of Modern History: Auditory Cultures in 19th and 20th century Europe (New York, NY, and Oxford: Berghahn Books, 2014); J. Esmail, Reading Victorian Deafness: Signs and Sounds in Victorian Literature and Culture (Athens, OH: Ohio University Press and Swallow Press, 2013). 3 For a consideration of disability and passing, see A. Brune and D. J. Wilson, Disability and Passing (Philadelphia, PA: Temple University Press, 2013). 4 See M. McLuhan, Understanding Media:  The Extensions of Man (New  York, NY: McGraw Hill, 1964), 293; Enns, ‘The human telephone’. 5 Virdi, Chapter 3; Gooday and Sayer, Chapter 2; Esmail, Reading Victorian Deafness. 6 L. J. Davis, Enforcing Normalcy:  Disability, Deafness and the Body (London and New York, NY: Verso, 1995), 15. 7 For example, see G. F. Pick and E. F. Evans, ‘Strategies for high-​technology aids to compensate for hearing impairment of cochlear origin’, in W. J. Perkins (ed.), High Technology Aids for the Disabled (London: Butterworth & Co, 1983), 99–​106. For a discussion of the history of the medical and social model of disability, see T. Shakespeare, ‘The social model of disability’, in L. J. Davis (ed.), The Disability Studies Reader (London and New York, NY: Routledge, 2013), 214–​21. For a discussion of the problems of the social model for historians, see J. Anderson, War, Disability and Rehabilitation in Britain (Manchester: Manchester University Press, 2011), 5–​6. For more information on current issues with hearing loss and telephony, see H. G. Lang, A Phone of Our Own: The Deaf Insurrection against Ma Bell (Washington, DC: Gallaudet University Press, 2000). 8 D. Campbell-​Smith, Masters of the Post:  The Authorised History of the Royal Mail (London: Penguin, 2011), 193. 9 British Telecom Archives (BTA), London, TCB 318/​PH 632 Post Office Booklet, ‘A Telephone for Deaf Subscribers’, 1936. 10 Hansard, 6 March 1917, vol. 91, cols. 241–​354, line 251. 11 C. L. Jones, ‘(Re-​)reading medical trade catalogs: the uses of professional advertising in British medical practice, 1870–​1914’, Bulletin of the History of Medicine, 86:3 (2012), 361–​93, at 367. 12 BTA, POST 33/​1491C, Proof draft of the 1935 advertisement, A Telephone for Deaf Subscribers, Repeater 17A, ‘Telephone apparatus:  special apparatus fitted on telephone exchange lines rented by deaf subscriber. Valve amplifiers’, 19 October 1935. 13 See the related discussion of masculinity and independence in Sweet, Chapter 6; and Daen, Chapter 5. 14 BTA, POST 33/​1491C, Letter to the sectional engineer, Bristol, from Raymond J. Harris, Calne, Chilvester Lodge, 1 July 1936. 15 BTA, POST 33/​ 1491C, The telecommunication department to the district ­manager ‘Harris, Chilvester Lodge Calne’, 21 November 1936.

89

Co-creation of aural technology and disability

89

16 It could be used in CB (central battery working) and automatic areas but not in the Magneto and CBS (central battery signalling) areas. At this time, the telephone service was divided into service areas which were abbreviated according to the system they used. They were either CB, CBS Magneto (using crank generators) or the automatic exchanges which were becoming more common after 1920. CBS and Magneto were old and outdated systems by the 1930s, which explains why the newer amplified telephones did not work in areas using these systems. They also had batteries at their end rather than at the exchange, which would have further complicated adding extra apparatus. 17 BTA, POST 33/​1491C, letter from A. C. Belgrave to the district manager, ‘Valve amplifiers for deaf subscribers’, 12 September 1934. 18 For more on unintended user appropriation, see N. Oudshoorn and T. Pinch (eds), How Users Matter: The Co-​construction of Users and Technology (Cambridge, MA:  MIT Press, 2005); and R. Oldenziel and M. Hard, Consumers, Tinkerers, Rebels: The People Who Shaped Europe (Basingstoke: Palgrave Macmillan, 2013). 19 S. Arapostathis and G. J. N. Gooday, Patently Contestable: Electrical Technologies and Inventor Identities on Trial in Britain (Cambridge, MA: MIT Press, 2013), 33. 20 Mara Mills, quoted from D. Mulvin, ‘Talking it out: an interview with Mara Mills’, Seachange Journal, 57 (2012), 52–​65; M. Mills, ‘Deafening: noise and the engineering of communication in the telephone system’, Grey Room, 43 (2011), 118–​43. 21 B. Sterling, ‘The hacker crackdown: evolution of the US telephone network’, in N. Heap, R. Thomas, G. Einon, R. Mason and H. Mackay (eds), Information Technology and Society (London: Sage, 1995), 33–​40, at 37. 22 BTA, POST 33/​1491C, letter from W. G. Lucton, sectional engineer, to the Bristol district manager, 5 August 1936. 23 M. Fourcade, ‘The problem of embodiment in the sociology of knowledge: afterword to the special issue on knowledge in practice’, Qualitative Sociology, 33:4 (2010), 569–​74. 24 E. Thompson, The Soundscape of Modernity (Cambridge, MA: MIT Press, 2002), 148. 25 Action on Hearing Loss Library, UCL London, ‘Meeting of the Medical Committee of the National Institute for the Deaf ’, 6 March 1931. 26 P. R. Seitz, ‘French origins of the cochlear implant’, Cochlear Implants International, 3:2 (2002), 77–​86, at 82–​3. 27 BTA, POST 33/​1491C, letter from W. G. Luxton, Bristol sectional engineer to the chief engineer, 5 August 1936. 28 Arapostathis and Gooday, Patently Contestable, 106–​10. 29 Arapostathis and Gooday, Patently Contestable, 107. 30 Arapostathis and Gooday, Patently Contestable, 110. 31 L. Daen ‘A hand for the one-​handed’ (Chapter 4, this volume). 32 Lieffers, Chapter 7. 33 Crown Copyright in the Information Age, Section 2.5, 1998, available at www.opsi. gov.uk/​advice/​crown-​copyright/​crown-​copyright-​in-​the-​information-​age.pdf (accessed 29 April 2015).

90

90

Rethinking modern prostheses

34 Directory of European patents, available at http://​worldwide.espacenet.com/​ mydocumentslist?submitted=true&locale=en_​EP (accessed 29 April 2015). 35 BTA, TCB 2/​171-​2/​172, letter from Edwin Stevens, Amplivox, to the chief engineer, 7 July 1938. 36 BTA, TCB 2/​171-​2/​172, Memo, ‘Private hearing aid couplers’, 3 August 1938. 37 BTA, POST 33/​1491C, letter from Mr Jones, engineer, to W.  G. Luxton, 18 August 1936. 38 BTA, POST 33/​1491C, letter from Mr Jones, 18 August 1936. 39 BTA, POST 33/​1491C, letter from Raymond Harris to the Bristol district manager, 12 January 1937. 40 BTA, POST 33/​1491C, letter from Raymond Harris, 12 January 1937. 41 BTA, POST 33/​1491C, letter from Raymond Harris, 12 January 1937. 42 B. Anderson, Imagined Communities (London and New  York, NY: Verso Books, 2006). 43 M. A. Rembis, ‘Athlete first: a note on passing, disability and sport’, in A. Brune and D. J. Wilson, Disability and Passing (Philadelphia, PA: Temple University Press, 2013), 111–​41. 44 See also discussion of the use of the party line in rural America in R. Kline, ‘Resisting consumer technology in rural America: the telephone and electrification’, in N. Oudshoorn and T. Pinch (eds), How Users Matter: The Co-​construction of Users and Technology (Cambridge, MA: MIT Press, 2005), 51–​66, at 58. 45 See L. Winner, ‘Upon opening the black box and finding it empty: social constructivism and the philosophy of technology’, Science, Technology and Human Values, 18:3 (1993), 362–​78; L. Winner, ‘Do artifacts have politics’, in D. Mackenzie and J. Wajcman (eds), The Social Shaping of Technology (Buckingham: Open University Press, 1999). Mills has recently used Winner’s approach to argue that early users of cochlear implants have left ‘traces’ of their identity in the hardware as well as the software of the devices. M. Mills, ‘Do signals have politics: inscribing abilities in cochlear implants’, in T. Pinch and K. Bijsterveld (eds), The Oxford Handbook of Sound Studies (Oxford: Oxford University Press, 2011), 320–​46. 46 Jones, Introduction. 47 Graeme J.  N. Gooday, The Morals of Measurement:  Accuracy, Irony, and Trust in Late Victorian Electrical Practice (Cambridge:  Cambridge University Press, 2004). 48 BTA, Disability folder, Post Office Magazine, from an original held at the BT Museum, July 1961. 49 TTY is a type of telecommunications for the hard-​of-​hearing which uses a telecommunications relay service. Lang, A Phone of Our Own, 197. 50 Lang, A Phone of Our Own, 131. 51 See Sean McNally’s forthcoming Ph.D.  thesis for fuller discussion of the Medresco: ‘Medresco: the history of state-​sponsored auditory assistance’, University of Leeds.

91

II THE COMMODIFIC ATION OF ARTIFICIAL LIMBS AND ASSOCIATED APPLIANCES

92

93

4

‘A HAND FOR THE ONE-​H ANDED’: PROSTHESIS USER-​I NVENTORS AND THE MARKET FOR ASSISTIVE TECHNOLOGIES IN EARLY NINETEENTH-​C ENTURY BRITAIN Laurel Daen After George Webb Derenzy, Captain of the 82nd Regiment in the British Army, lost his right arm at the battle of Vitoria in 1813, he experienced physical challenges returning to his home in London and resuming his everyday activities. ‘I found myself continually exposed to … inconveniences’, he later wrote, ‘a thousand painful instances of daily and inevitable occurrence’ that ‘made [me] sensible’ of the loss of my arm and ‘the full use [I]‌had for two’.1 To ease his daily routines of washing, eating, writing and socialising, Derenzy began inventing contraptions –​at first simple tools made from household items and later more elaborate appliances which he partnered with local artisans to produce. For instance, when Derenzy found it challenging to eat an egg from an egg cup because the whites continually turned round, he invented a modified egg cup that could be tilted in any direction and fastened to the table. Similarly, when he experienced discomfort asking a companion to hold his cards during a card game, he devised a card-​holder that folded up, fanned out and could easily be transported to any party. Nine years after Derenzy’s injury, in 1822, he published twenty of his most useful inventions in a slender volume titled Enchiridion; or, A Hand for the One-​ Handed. Chock-​full of textual descriptions and blueprints of his devices, along with strategies for accommodating limb loss at home, Derenzy’s publication soon circulated widely throughout Europe, North America and the British Empire. Copies appeared in private and institutional libraries in New York and Toronto, medical collections in Copenhagen and Berlin and a garrison reading room in Gibraltar.2 Booksellers from Edinburgh to Philadelphia advertised the sale of the volume, and newspapers from Paris to Calcutta printed reviews.3 The Enchiridion’s geographic range was only equalled by its broad topical appeal. It was discussed in military magazines, literary weeklies, medical

94

94

Rethinking modern prostheses

journals, mechanical periodicals and general-​interest publications, such as The Gentleman’s Magazine, and Historical Chronicle.4 Within one year, Derenzy’s instruments had been illustrated in their entirety in the Transactions of the Society for the Encouragement of Arts, Manufactures, and Commerce in London.5 Within five years, the volume was owned by such a prominent individual as Prince Frederick, the Duke of York and Albany.6 As noted by Claire L. Jones in the introduction to this volume, scholarship on historical prosthetics could benefit from more research on user-​inventors –​ individuals who drew on their personal experiences with impairment to design prosthetic technologies  –​a lacuna that chapters in this volume, especially those by McGuire (Chapter  3) and Lieffers (Chapter  6), begin to address. In addition, building on scholarship by Liliane Hilaire-​Pérez and Christelle Rabier and by David Turner and Alun Withey, more research is needed on the development and use of prostheses prior to the mid nineteenth century, when industrialisation and medical professionalisation not only increased the visibility and stigma of impairment but also drastically altered the modes of manufacturing and marketing such items.7 Derenzy’s Enchiridion –​along with the nearly fifty newspaper and magazine reviews it inspired around the globe –​ provides the exciting opportunity to explore the technological productions, entrepreneurial strategies and personal experiences of one prosthesis user-​ inventor in early nineteenth-​century Britain. In addition, attending to the gendered and class-​based assumptions embedded in Derenzy’s text contributes to historical understandings of the relationships between disability and masculinity, discussed by Ryan Sweet in Chapter 5, and between disability and social respectability, considered by Sweet and in Chapter 2 by Jaipreet Virdi. This chapter begins by examining Derenzy’s motivations for publishing the Enchiridion and then turns to the responses he received from readers and the presuppositions about gender and class that ultimately constrained his consumer appeal and commercial profit. Like Raymond J.  Harris, described in Chapter 3 by Coreen McGuire, Derenzy did not patent his inventions due to his charitable desires to share them with others with similar impairments. Less interested in protecting his methods of production than patenting them, he printed textual and visual depictions of his devices in the Enchiridion to enable readers to construct these appliances for themselves or to arrange for their manufacture with a local artisan. Readers were overwhelmingly complimentary of Derenzy’s inventions and publication, and many made or purchased his designs. Nevertheless, as some pointed out, and as a close reading of the Enchiridion reveals, his contraptions were integrally informed by the expectations and responsibilities of his gender and class, which rendered them largely impractical and inaccessible to consumers from different backgrounds. As a

95

Prosthesis user-inventors

95

descendant of a landed Irish family and a British military hero, Derenzy developed his devices to reclaim and reassert his masculinity, respectability and, ultimately, a measure of his former able-​bodiedness.8 His fixation of securing his social privileges through prosthesis production, however, alienated poor, middling and female consumers and contradicted his benevolent motives, limiting his success as both an entrepreneur and a philanthropist. Perhaps due to these marketing missteps, over the course of his lifetime Derenzy experienced the plight of many people with physical impairments during the period; unable to profitably labour, he and his family sustained a steady and continual descent into poverty. The publication of polite prostheses Derenzy devotes the majority of his Enchiridion to detailed descriptions and illustrations of twenty of his contraptions, which he collectively refers to as the ‘One-​Handed Apparatus’. Structured as if readers were embarking on a new day, Derenzy first introduces objects that facilitate what he terms ‘the affairs of the toilette’ and continues with those that aid the act of dressing, eating breakfast, writing letters, socialising, eating dinner and, finally, the best means for one-​handed persons to snuff their candle and wind their watch before bed.9 The backbone of his inventions is the ivory vice (see Figure 4.1). More ‘substantial’ than those of ‘the common kind’, Derenzy equips his vice with a universal joint, or ball and socket, to which he attaches various appendages.10 The vice secures his egg cup and card-​holder, as mentioned previously. It also holds his ‘wash-​hand tray’ for cleansing, his lather box for shaving, his syringe, his quill-​holder and his hat-​stick (see Figure 4.2).11 ‘There is then scarcely any part of the day in which [the vice’s] utility is not called into action in some way or other’, Derenzy explains to the reader.12 To facilitate easy attachment and removal of fixtures, he locates a spring on the vice’s outer edge that, when lightly pressed, releases unneeded appliances and secures their replacements. Some of Derenzy’s inventions do not use the vice and are instead intended to be portable. He introduces a ‘pen-​knife’, for example, which is used to sharpen quills and features a spring that makes it safer and easier for use by persons with one hand.13 As he notes, the pen-​knife could also double as a comb, turn screw and ruler and be stored in a pocket for maximum accessibility. In addition, Derenzy provides readers with a modified version of the popular ‘Lord Nelson knife’, a combined knife and fork originally produced by Vice Admiral Horatio Nelson after losing his arm at the battle of Santa Cruz de Tenerife in 1797.14 Derenzy equips his variation with three blades and a button, located on the handle, by which the blades could be released and exchanged.

96

Figure 4.1  Woodcut of Derenzy’s Ivory Vice. George Webb Derenzy, Enchiridion, Or, A Hand for the One-​Handed (London: T. and G. Underwood, 1822), 17.

Figure 4.2  Woodcut of Derenzy’s Hat-​Stick. George Webb Derenzy, Enchiridion; or, A Hand for the One-​Handed (London: T. and G. Underwood, 1822), 40.

97

Prosthesis user-inventors

97

Derenzy instructs his readers to have such portable devices with them at all times in order to prevent potential discomfort and embarrassment. He even provides a strategy for these articles’ transportation. ‘A small loop of ribbon … strongly fastened to the cuff of the sleeve on the defective side, and appended to one of the buttons of the breast of the coat’, he declares, ‘will convert the sleeve itself into a safe and convenient pocket, wherein … the knife and fork, or any other small articles may be easily carried.’15 The Enchiridion concludes with numerous recommendations for readers who are living with lost limbs. Most focus on personal hygiene, cleanliness and dress. Derenzy discusses, for example, multiple methods of stropping a razor with one hand and the best means for washing and drying the hand, which he states is by sitting down and drawing a towel across the knees. For clothes, he asserts that ‘wherever strings [and buckles] can be done without, they ought to be avoided’ and offers detailed instructions for tying a cravat, a fashionable men’s necktie of the period.16 Also in this section, Derenzy presents readers with new uses for appliances that they might already have at home. A pair of snuffers, he notes, can easily be used upside down by persons with only a left hand. The final page of the volume provides a list of Derenzy’s inventions and their prices as manufactured by John Millikin, a prominent surgical-​instrument maker in London.17 According to the chart, Millikin sold the entire One-​Handed Apparatus, along with a ‘neat Mahogany Case’, for £10 4s and produced individual and specialty items for separate sale.18 As will be discussed further, Millikin’s prices were extremely expensive for the average consumer, rendering Derenzy’s devices largely inaccessible to those in poor or middling circumstances. Emphasis on autonomy and physical appearance pervades the Enchiridion. As Derenzy declares in the introduction, he invented his contraptions to facilitate his independence and fulfilment of the polite standards of bodily comportment and form. He writes, I have been induced to devote a considerable portion of my time and thoughts to the contriving and perfecting of a set of instruments, which shall enable the possessor of them to dispense with the attendance of a servant, or that attention from a friend, which would otherwise be absolutely necessary, to supply to him those minute arrangements of neatness and economy, which the modes and refinement of social life render indispensable to personal comfort and appearance.19

Derenzy intended for his appliances to reduce his reliance on friends and aides and to facilitate his valued cleansing, grooming and dressing routines. This focus on self-​sufficiency and bodily presentation continues through

98

98

Rethinking modern prostheses

the volume. Derenzy notes that his ‘wash-​hand tray’ provides him with the ­capacity ‘to wash that which remains, far better than any other person could do it for him’.20 Similarly, when instructing readers in how to tie a cravat, he states that the method enables him to tie his own ‘as neatly and as expeditiously as the most accomplished valet could do it for him’.21 For Derenzy, autonomy and accordance with the corporeal standards of politeness were the primary values that his impairments threatened, and he constructed his devices to reassert and re-​establish these priorities in his life. Derenzy’s focus on independence and physical propriety aligns with early nineteenth-​century notions of masculinity and respectability. According to John Tosh, self-​reliance or ‘the capacity to make one’s own way in the world and to be one’s own master’ was the ‘public face’ of manliness during the period, and such priorities only gained in importance over the course of the nineteenth century with growing self-​consciousness about occupation, work ethic and ‘maintaining the means of independence at a time when the free play of the market was more unpredictable than ever’.22 Kathleen Brown has also demonstrated the centrality of bodily sanitation and presentation to the eighteenth-​and early nineteenth-​century ‘genteel aesthetic’ whereby ‘gentlemen and gentlewomen expressed gentility through their grooming, manners, and criticism of others … for a lack of fastidiousness’.23 Lawrence Klein has emphasised that these gendered and class-​based ideals and aspirations extended beyond the elite. ‘Politeness was roughly correlated with wealth and status’, he writes, but ‘it is helpful to think of polite society not as a certain segment of society but rather as the entirety of contemporary society insofar as it was influenced by politeness’.24 Conceptions of gentility, respectability and manly independence, then, saturated early nineteenth-​century British culture and deeply informed Derenzy’s notions of self and society. With his considerable and visible physical impairments and his position as an elite Irishman in London, Derenzy was likely continually reminded of the aspects of his body and self that failed to achieve these cultural standards. In this context, he designed his instruments to exhibit and assert his social status. Derenzy’s use of prostheses to reclaim his manliness and politeness also reflects broader trends in prosthesis culture and consumption. As discussed in the chapter by Virdi, according to Turner and Withey, in the seventeenth and early eighteenth centuries, many Britons condemned the use of prosthetic technologies as deceitful, prideful and impious.25 Although most would not have criticised functional items that facilitated economic productivity, such as wooden legs, contraptions designed to improve physical appearance were believed to cultivate and evidence dishonesty and immodesty. Early modern

9

Prosthesis user-inventors

99

Britons also claimed that it was sinful to change or alleviate corporeal conditions that God had willed. In 1744, for example, The Afflicted Man’s Companion advised readers to ‘be not anxious for Recovery to Health, but leave the Issue of the present Sickness to the Will and Pleasure of the infinitely wise God’.26 Towards the late eighteenth century, however, Turner and Withey explain that Britons became increasingly receptive to prostheses with developing notions of politeness. ‘Visible “deformity” made others uneasy’, late eighteenth-​century individuals argued, ‘and threatened the virtuous social interaction or “conversation” that lay at the core of notions of politeness’.27 In this context, the use of products to correct physical defects and shape the body according to social ideals and expectations became not only acceptable but morally and socially necessary. Such beliefs about technology and the body clearly informed Derenzy’s desire for and construction of his instruments. After his injury in 1813, he entered a world that not only welcomed the use of prosthetic devices but required them for personal decency and social respectability. Empathy and sympathy are also prominent themes in the Enchiridion. As Derenzy declares in the introduction, he decided to publish textual and visual depictions of his inventions in order to share them with others with physical impairments. He writes, If I should be fortunate enough … to afford a hint to a single individual, which may enable him to pass his solitary hours with somewhat more of pleasure to himself, or to join the social circle, unchecked by the fear of being obliged to tax the kindly feelings of some benevolent person in the party, for those attentions which his own helplessness compels him to owe in general to the politeness of others … fully shall I be repaid.28

Derenzy invented his appliances for himself but he published the Enchiridion for the benefit of others. These empathetic and philanthropic feelings shaped the content and construction of his volume. First, they encouraged Derenzy to acknowledge and accommodate readers with diverse bodily incapacities. He comments on the many causes of debility and declares his products suitable for all those ‘who are subjected by the chance of war, the hazards of machinery, the effects of accidents, disease, or malconformation, to a loss of power on one side’.29 In addition, Derenzy often notes when certain instruments or modifications might meet readers’ unique corporeal needs. When describing his ‘pen-​nibber’, for example, he asserts that it ‘will be found as useful for persons of imperfect sight as for the One-​Handed’.30 Like Harris in McGuire’s chapter and Palmer in Lieffers’ chapter, then, Derenzy’s personal experiences with impairment motivated him to use his inventions and publication for the benefit of others with similar conditions. Even more, it facilitated his ability to

10

100

Rethinking modern prostheses

think broadly about physical impairment and to recognise and accommodate its various causes and manifestations. Derenzy’s charitable aims further compelled him to share his production methods with his readers, rather than patenting and producing his appliances for his own gain. No evidence suggests that Derenzy pursued the patent application process. Perhaps he was deterred by high fees, which often amounted to over £100, and complex administrative procedures. As Zorina Khan has demonstrated, patent applications during the period ‘had to pass through seven offices, from the Home Secretary to the Lord Chancellor, and twice required the signature of the Sovereign’.31 Considering Derenzy’s physical limitations as well as his familial responsibilities –​by 1830 he was married with a growing family –​such a time-​and labour-​intensive endeavour may have been impracticable.32 At the same time, his detailed technological descriptions and blueprints in the Enchiridion suggest another motivation. Inspired by feelings of empathy and charity, Derenzy may have felt conflicted about patenting and profiting from technologies designed to improve the lives of those with physical impairments, especially incapacities that he experienced personally. Derenzy’s commitment to publicising his inventions in print then, in turn, may have made patenting unnecessary. The Enchiridion already documented the originality of his designs, their forms and functions, thus securing him a degree of proprietary recognition outside of the patent system.33 By publishing his prosthetic technologies, Derenzy intended to fulfil his philanthropic intentions and demonstrate the authenticity of his innovations. Praise from respectable readers Derenzy wrote the Enchiridion for others with physical impairments, and many such people purchased and perused the volume, although their responses often went undocumented and unarchived. Reviewers regularly recommended the text to those with lost limbs. ‘A Constant Reader’, writing into The Cottager’s Monthly Visitor, for example, suggested the Enchiridion to a contributor named ‘Benevolus’ who requested employment advice for ‘a little girl of nearly twelve years of age who has had her right arm amputated at the shoulder’.34 Magazine and newspaper editors also advised impaired readers to consult the volume. As the editors of the Literary Chronicle declared, ‘we devoutly wish that we may not have a single reader that may require the assistance of this ingenious work. Should, however, any of them have suffered a similar misfortune with the author’ they should purchase the book ‘without delay’.35 In addition, reviewers noted that many people with lost limbs had already read and benefited from the Enchiridion. In 1834, the editors of the Mechanics’ Magazine contended

10

Prosthesis user-inventors

101

that there were ‘few one-​handed persons in the higher walks of life who have not already availed themselves of its valuable assistance’.36 Nearly seventy years later, in 1901, the editors of Chambers’s Journal mentioned Derenzy’s products, particularly his combined knife and fork, among those that had frequently been employed by wounded soldiers.37 Derenzy published the Enchiridion for the benefit of people with physical impairments, and, although their direct reactions and evaluations have largely been lost, reviews of the publication suggest that they comprised a central component of his audience. The vast majority of the Enchiridion’s readers, however, had comparatively intact and able bodies. In letters and reviews, many asserted that the text was as interesting and appealing to those with physical impairments as to those without. Able-​bodied patrons often read and recommended the Enchiridion for its curious and entertaining content. As the editors of the London Weekly Gazette claimed, Derenzy’s inventions were ‘minutiae so admirable, and therefore so difficult to expect, as to deserve the highest praise’.38 The Morning Post similarly called his appliances ‘really surprising’ and concluded that ‘the pleasure which he affords the Reader, on so limited a subject, is a proof that it is not necessary we should be fellow-​sufferers in order to take an interest in this valuable little performance’.39 Non-​impaired readers also enjoyed and applauded the Enchiridion for its demonstrations of intelligence and benevolence. ‘What an admirable instance have we here of the ascendancy of mind! Of its creative energy and almost boundless resources!’ the Mechanics’ Magazine declared.40 The editors of the Asiatic Journal and Monthly Register for British India and its Dependencies concurred, writing that Derenzy brought his instruments ‘into perfection and use … with the greatest ingenuity’.41 Henry Colburn of the New Monthly Magazine meanwhile commended Derenzy’s generosity and goodwill. ‘The thanks of society … are surely due to him’, Colburn stated, ‘who has proved himself equally zealous in the active service of his country abroad, and in the promoting the comfort of his fellow-​sufferers at home’.42 Derenzy targeted his publication towards readers with impairments, but those without such incapacities soon became his largest audience and most vocal supporters. Non-​impaired readers were especially complimentary of Derenzy’s use of his appliances to reclaim the aspects of his masculinity and respectability that his limb loss seemed to threaten. Many reviewers commented on his admirable efforts to regain self-​sufficiency. ‘It is delightful to see an active minded man like this’, the editors of the London St James Chronicle and Evening Post wrote, ‘not only disdaining to appeal to our sympathy for one of the misfortunes incident to his profession, but claiming and deserving our respect and admiration for the ingenuity and perseverance by which he has rendered himself independent of casual aid’.43 Sylvanus Urban, editor of the Gentleman’s Magazine, similarly

102

102

Rethinking modern prostheses

asserted that Derenzy had ‘bless[ed] social and domestic life’ by designing ‘several instruments by which he was enabled to do all for himself ’.44 Readers also praised Derenzy’s accordance with the polite standards of bodily form and behaviour. ‘Instead of sitting down and contenting himself with repining at the calamity’, the editors of the Ladies’ Monthly Museum stated, Derenzy ‘devoted no inconsiderable portion of his time in contriving, and then bringing to perfection’ technologies that allowed him ‘to enjoy all the refinements of social life with ease and independence’.45 The Morning Post likewise praised Derenzy for ‘perform[ing] most of the offices essential for dress and personal comfort’ despite ‘the inconvenience occasioned by [his] loss’.46 Across Europe, North America and the British Empire, then, individuals of diverse backgrounds and bodily forms bought and perused the Enchiridion. The majority of readers, however, had comparatively able bodies and consulted the text not for its designs and suggestions regarding impairment but rather for its compelling displays of ingenuity, charity, manliness and politeness. European and American physicians were particularly prominent among Derenzy’s readership. These men were attracted to the volume because of the potential medical usefulness of Derenzy’s devices and because they viewed them as evidence of the advantages of intervening in cases of physical debility. Doctors recommended the text to both patients and practitioners. ‘No man who is maimed in the manner in question’, the Medico-​Chirurgical Review proclaimed, ‘should hesitate to convince himself, by an inspection of the apparatus or a perusal of the work, whether or not … [it] will prove an invaluable convenience and comfort’.47 The London Medical and Surgical Journal also suggested the volume to ‘all surgeons in large cities and manufacturing towns, but especially to those of the army and navy’.48 In addition, doctors used the Enchiridion to demonstrate the advantages of treating and curing physical impairments. As Michael Ryan, a member of the Royal College of Physicians, explained, Every part of the body may be defective or absent at birth … Though the greater number of these deformities are incurable, we ought to supply the want of organs when possible. Thus we see persons with an artificial eye of glass, an ear or a nose of silver, a steel substitute for a hand. Captain Derenzy has described a variety of instruments for persons who have lost one hand, in his work entitled “Enchiridion …” This is a vast improvement. It is deplorable to witness a fine, athletic man hobbling his weary way, whose health is injured and whose life is shortened … [in] cases that admit of relief.49

To physicians, Derenzy’s inventions and publication showed that corporeal incapacities should be cured and remedied when possible, a contention that aligned with contemporary philosophies and practices of heroic medicine and was only

103

Prosthesis user-inventors

103

increasingly gaining acceptance among the general public with advances in ­medical professionalisation. With the potential utility of Derenzy’s designs and his depiction of the value of cure, then, the Enchiridion received much attention from European and American medical writers and practitioners. Derenzy’s text was also widely discussed in scientific circles, largely because readers believed that it held implications for contemporary conversations about the differences between humans and animals. Citing Greek philosophers and physicians from Anaxagoras to Galen, many gentlemanly scholars of science and physiology during the period argued that the primary physical feature that made humans distinct from and superior to animals was the hands.50 Derenzy’s inventiveness and intelligence despite his loss of a hand seemed to challenge this notion or at least render it less convincing. Readers often discussed the consequences of Derenzy’s text for this debate. Some claimed that his contraptions showed that humanity was distinguished by the brain, not the hands. As the editors of the Mechanics’ Magazine wrote, One of the hands of which so much has been said is wanting and the mind engages to supply its place. When could as much be said for the hands as regards the brains? Did ever hand[s]‌yet offer to supply ‘wit for the hand-​witted’ or ‘brains for the brainless’?51

Other readers simply modified their original understanding of the association between hands and humanity. Sylvanus Urban of the Gentleman’s Magazine, for example, asserted that Derenzy’s volume showed that it was the number, not the presence, of hands that made humans unique. Others, as perversely desirous of degrading their species, have asserted that monkies [sic] are destined for the upright posture. But this attitude they cannot maintain long, and, in fact, they are not biped or quadruped, but four-​handed animals … The work before us shows the wisdom of providence, in providing us with the exact number of two hands, for one would be insufficient, and more would be in the way.52

With such implications about the meanings and marks of humanity, the Enchiridion was read and discussed by scholars of science as well as religious thinkers, philosophers and general readers engaged by such debates. Exclusions of class and gender Although most reviewers enjoyed and praised the Enchiridion, some voiced criticisms or at least areas for the text’s extension and improvement. These

104

104

Rethinking modern prostheses

critiques primarily concerned questions of class, with some readers claiming that Derenzy overlooked the needs of working-​class people with physical incapacities. A review by the editors of the Mechanics’ Magazine in 1834 provides an example.53 Their article begins by commending Derenzy’s ingenuity and generosity but goes on to explain that his ‘contrivances are mostly of a description suited to the wants of persons in the author’s own condition of life’.54 To complete his One-​Handed Apparatus, the editors declared, ‘some valuable additions’ were needed from their ‘clever mechanical readers’.55 As they wrote, The peculiar wants of the one-​handed among the manufacturing and trading classes must doubtless have given rise to contrivances different from any here recorded; and it seems reasonable to hope that the excellent example which Captain Derenzy has set of publishing the results of his personal experience, for the benefit of all similarly circumstanced, will not be left without numerous imitators.56

According to Mechanics’ Magazine’s editors, then, Derenzy’s apparatus failed to meet the needs of the artisans, mechanics and other labourers who had lost limbs and thus required relevant additions and adaptations. One week later, the editors were delighted that they had ‘already a striking proof of the truth’ of their appeal for more prosthetic devices.57 A recent article in the Transactions of the Society for the Encouragement of Arts, Manufactures, and Commerce, they noted, had discussed a modified telescope-​holder that was ‘not only advantageous to one-​handed persons, for whose use it was specially designed, but to all who do not possess that perfect steadiness requisite for making telescopic observations with accuracy’.58 For the editors, this telescope-​holder was just the beginning of the additions that were needed to complete Derenzy’s apparatus. Acknowledging his elite bias, they called for an expansion of his work in ways that better accommodated the working class. As the editors of the Mechanics’ Magazine recognised, Derenzy’s instruments and publication were specifically designed for elite male consumers and thus were largely impractical for most women who had lost limbs as well as those in poor and middling circumstances. In many ways, Derenzy cannot be faulted for such omissions and exclusions. By basing the Enchiridion on his personal inventions and experiences, he inevitably prioritised appliances that facilitated his daily routines and responsibilities and that fulfilled his desires to reclaim and reassert his masculinity and respectability. Nevertheless, Derenzy’s failure to modify and supplement his apparatus with devices that appealed to a broader clientele constrained the marketability and profitability of his products and publication. Even more, such gendered and

105

Prosthesis user-inventors

105

class-​based exclusions reveal the limits and, perhaps, the hollowness of his professed charitable aims. Derenzy published the Enchiridion to assist others with impairments, but the vast majority of such individuals were unable to benefit from his contraptions or even obtain them through production or purchase. Ultimately, such exclusions constrained Derenzy’s success as a businessman and a philanthropist and may have contributed to his increasing impoverishment. Derenzy’s intended elite male audience is apparent in the variety of prostheses that he constructed and his descriptions of them in the Enchiridion. By concentrating on instruments that facilitated his washing, grooming and dressing routines, he alienated poor and middling male consumers who did not prioritise such practices or who performed different procedures, along with women from all classes whose gender necessitated alternative rituals of sanitation and presentation. Poor and middling men, for example, may have had little use for Derenzy’s portable nail file; women would not have needed his instructions for tying a cravat; and both would likely have preferred other appliances and suggestions that better suited their needs. Derenzy also reveals his targeted audience in his textual descriptions of devices. Frequently throughout the Enchiridion he addresses the type of reader that he presumes to be perusing the work. When discussing his nail file, for example, he explains that it ‘will always enable a gentleman to shape his nails, and keep them clean … and will be found to take up very little room in the waistcoat pocket’.59 Similarly, when describing his egg cup, he notes that it will fit into ‘the pocket of a traveler [sic] under the circumstances of those to whom I am addressing myself ’.60 Designed to assist and accommodate elite male patrons, Derenzy’s inventions and publication failed to meet the needs and desires of the many potential consumers outside of these bounds. The production and sale of Derenzy’s instruments even more clearly demonstrates his gendered and class-​based biases. To create his devices, Derenzy partnered with premier artisans and mechanics in London and Edinburgh. George Palmer, who made Derenzy’s boot hooks, and Nicholas Middleton, who manufactured his combined knife and fork, had both received royal patronage.61 In addition, William Dobson, who constructed Derenzy’s wash-​hand tray, and Joseph Brasbridge, who developed his egg cup, maintained their successful hardware and silversmith businesses for over fifty years. These prominent producers all fashioned Derenzy’s instruments from luxury materials, such as ivory, silver and mahogany, and sold them at high prices. According to Gregory Clark, in 1820, two years before the Enchiridion was printed, the average male farm worker earned 20d per day, the average male building labourer earned 27d per day, and the average male coal miner earned

106

106

Rethinking modern prostheses

32d per day.62 Women’s wages were about half that of men’s, and the average household could expect an annual income of approximately £31. Millikin, the surgical-​instrument maker who publicised the sale of Derenzy’s devices in the Enchiridion, sold his apparatus for £10 4s, about one-​third of the average family’s annual earnings.63 While appliances could be purchased more economically individually (the lead cushion cost 1s 6d, for example), most remained expensive and required the additional purchase of the ivory vice, which cost £1 4s. Even a copy of the Enchiridion itself was 5s, about three days’ wages for the average male farm worker. By pricing his products and publication out of reach of most people, Derenzy limited his consumer base and exposed the falsity or at least the futility of his charitable aims. Despite the significant ways in which Derenzy’s prosthetic technologies and text excluded female users and readers, no reviews criticised his exclusively male focus and called for an expansion of his apparatus in ways that better accommodated impaired women. Some readers did note that Derenzy’s appliances were primarily suitable for men. The London British Neptune, for example, recommended the text to ‘any gentleman who may have been deprived, by war or paralysis, of a hand’.64 However, no surviving reviews questioned Derenzy’s gendered biases or requested gender-​appropriate additions or modifications, as the editors of the Mechanics’ Magazine did in regards to class. This lack of critique can be partly explained by contemporary associations between masculinity, impairment and disability. According to Turner, men who experienced bodily incapacities on account of work or military service occupied more visible positions in early nineteenth-​century British society than did women with comparable conditions, reinforcing connections between maleness and disablement.65 In addition, during the period, disability was a distinctly gendered concept that was highly correlated with men and their expected social roles.66 Women of the period were often deemed to be inevitably incapacitated due to their ‘defective’ bodies and social and political limitations, such as coverture.67 Their impairments and disabilities, however, were rarely described as such because they were considered to be natural. Only men, who were expected to earn a living and actively participate in society, were recognised as debilitated and disabled, simply because it was possible for them to be regarded as able-​bodied, healthy, competent and capable in comparison. With these associations between masculinity, impairment and disability, then, reviewers of the Enchiridion failed to critique Derenzy’s gendered biases as they did his assumptions about class. Nevertheless, preconceptions and exclusions based on both gender and class profoundly shaped Derenzy’s products, publication and, ultimately, his entrepreneurial and philanthropic success.

107

Prosthesis user-inventors

107

Conclusion By all accounts, Derenzy was a remarkable inventor, writer, mechanic, businessman and philanthropist in early nineteenth-​century Britain. At a time when people with physical impairments experienced considerable social, economic and political challenges and constraints, he took advantage of the privileges of his class and gender to create technologies that were specifically designed for an impaired population. Even more, inspired by feelings of empathy and charity, he chose to publish, not patent, his inventions in a volume intended for readers with various incapacities, which provided them with concrete strategies and tools for accommodating their corporeal conditions and improving their domestic lives. Long before disability became a political category uniting individuals with atypical bodily forms and behaviours upon a shared history of marginalisation and exclusion, Derenzy espoused a capacious and inclusive understanding of impairment and, through print, drew together a community of readers who otherwise may not have considered their various conditions or experiences in common. In addition, he projected a positive image of impairment to readers with comparatively able bodies and showed that physical difference did not compromise intelligence, inventiveness, masculinity, respectability and humanity. Derenzy’s inventions and publication were remarkable achievements in early nineteenth-​century Britain and, for this, he should be acknowledged. Nevertheless, Derenzy’s shortcomings are as significant to his story as his successes. His technologies and text were designed for an elite male audience, which constrained his charitable possibilities and consumer base. These marketing missteps may also have created financial challenges for Derenzy. In 1847, when he attempted to publish another volume on the military achievements of the Duke of Wellington, a celebrated British soldier and statesman who commanded the Peninsular Campaign in which Derenzy had fought and become injured, the editors of the Court, Lady’s Magazine, Monthly Critic and Museum printed an article about his situation and whereabouts. As they declared, Derenzy ‘is now in his sixty-​first year; and, with a large family and domestic affliction of a peculiarly severe and expensive description, is a barrack-​ master with the paltry allowance of five shillings a day!’68 Although these daily earnings still doubled that of the average building labourer and tripled that of the average farm worker, according to the editors, Derenzy’s familial expenses and corporeal limitations had caused financial challenges.69 Serving as a barrack-​master in the army, his daily wages now equalled the price of just one copy of the Enchiridion. It is possible that Derenzy might have improved

108

108

Rethinking modern prostheses

his economic situation by more carefully tailoring his prostheses and publication to the needs and desires of the majority of impaired consumers. Perhaps by constructing items that were useful to more people and by disseminating his designs in an economical and accessible volume he would have not only advanced his philanthropic aims but also enhanced his consumer appeal and financial prospects. Perhaps. What is clear is that Derenzy’s products and publication, while impressive and important, reached a limited number of users and readers with impairments. For scholars, Derenzy’s Enchiridion provides valuable insights into the experiences and conceptions of physical debility, and limb loss in particular, in early nineteenth-​century Britain and into the tools that some prosthesis user-​inventors made and sold to accommodate their corporeal conditions. The text reveals some of the domestic difficulties of living with physical impairments. Derenzy not only struggled to complete minor, everyday tasks, such as filing his nails, but he also faced greater, personal challenges, such as the perceived loss of his masculinity and respectability. As he makes clear in the volume, these trials were intimately intertwined. By taking control of his everyday routines, Derenzy also claimed ownership of the management and direction of his life. His increasing poverty, however, demonstrates some of the limits of this control and the considerable financial challenges that many early nineteenth-​century people with impairments faced. In addition, the Enchiridion displays some of the technologies that impaired people invented and used to alleviate their domestic difficulties. From card-​holders to hat-​ sticks, Derenzy modified existing appliances and constructed new ones according to his needs. He rendered his inventions visible in his publication, but many more individuals during the period likely developed similar, if less complex, prosthetic devices and adaptations that have escaped attention and documentation. Third, Derenzy’s text indicates that sentiments of charity and philanthropy inspired some inventors to publish their designs rather than patent and manufacture them for their own gain. Publication allowed Derenzy to both share his instruments with those in similar situations and to document these items’ originality. Perhaps other producers, particularly those who experienced and created technologies for impairment, pursued similar strategies. Finally, the Enchiridion exposes the deep intersections between notions of disability, class and gender in early nineteenth-​century Britain. Although Derenzy envisioned a broad readership of people with various ailments and incapacities for his volume, his ideas about impairment remained fundamentally constrained by his assumptions about class and gender, factors that ultimately limited his philanthropic and technological influence and commercial success.

109

Prosthesis user-inventors

109

Notes 1 G. Webb Derenzy, Enchiridion; or, A  Hand for the One-​Handed (London:  T.  and G. Underwood, 1822), iv, 10. 2 Catalogue of the New-​York State Library (Albany, NY:  Charles van Benthuysen, 1856), 214; Catalogue de la Bibliothèque du Parlement (Toronto: John Lovell, 1857), 940; A.  C. P. Callisen, Medicinisches Schriftsteller-​Lexicon der jetzt lebenden Aerzte, Wundarzte, Geburtshelfer, Apotheker, und Naturforscher aller gebildeten Volker (Copenhagen: A. C. P. Callisen, 1834), 448; J. G. Bernstein, Medicinisch-​Chirurgische Bibliothek oder Verzeichniss der medicinisch-​chirurgischen Schriften (Frankfurt: Andreäische Buchhandlung, 1829), 29; A Catalogue of the Books in the Gibraltar Garrison Library (Gibraltar: Gibraltar Library Press, 1837), 124. 3 ‘Monthly list of new publications, Aug. 1821’, Blackwood’s Edinburgh Magazine, vol. IX: April–​August 1821 (Edinburgh: William Blackwood, 1821), 580; S. Emlen and W. Price, ‘Quarterly list of new foreign medical publications’, Journal of Foreign Medical Science and Literature, vol. II: 1822 (Philadelphia, PA: E. Littell, 1822), 717; Revue Encyclopedique (Paris: Au Bureau Central de la Revue Encyclopedique et Chez Arthus Bertrand, 1821), 575; ‘Enchiridion, or a hand for the one-​handed’, Asiatic Journal and Monthly Register for British India and Its Dependencies, vol. XIII, January to June, 1822 (London: Kingsbury, Parbury, & Allen, 1822), 469–​70. 4 ‘Military review of troops, men, books, and things: inventions and improvements of Captain Derenzy’, Military Register (11 October 1815, 436–​7; 18 October 1815, 466–​7; and 13 December 1815, 712–​13); ‘Enchiridion’, Literary Chronicle and Weekly Review, for 1821 (London: Davidson, 1821), 472; J. Copland (ed.), ‘Monthly medical bibliography’, London Medical Repository, Monthly Journal, and Review, vol. XVII (London: T. & G. Underwood, 1822), 525; ‘Derenzy’s Hand for the One-​Handed’, Mechanics’ Magazine, Museum, Register, Journal, and Gazette, October 5, 1833–​March 29, 1834, vol. XX (London: M. Salmon, 1834), 322–​5; S. Urban (ed.), ‘Enchiridion; or a Hand for the one-​handed’, The Gentleman’s Magazine, and Historical Chronicle, vol. CII: July–​December 1832 (London: J. B. Nichols and Son, 1832), 450–​1. 5 Derenzy presented a complete set of his one-​handed apparatus to the Royal Society for the Encouragement of Arts, Manufactures and Commerce; see George Webb Derenzy to Arthur Aiken, Esq., Secretary of the Society of Arts, April 11, 1821, Royal Society of Arts Archive (London, England). ‘Appendix, No. 1’, Transactions of the Society, Instituted at London for the Encouragement of Arts, Manufactures, and Commerce, vol. XXXIX (London: Royal Society for the Encouragement of Arts, Manufactures, and Commerce, 1821), 241–​58. 6 ‘Sixth day’s sale’, Catalogue of the Extensive and Valuable Library of His Royal Highness the Duke of York, Deceased (London: Compton & Ritchie, 1827), 52. 7 L. Hilaire-​Pérez and C. Rabier, ‘Self-​machinery? Steel trusses and the management of ruptures in eighteenth-​century Europe’, Technology and Culture, 54:3 (2013), 460–​502; D. M. Turner and A. Withey, ‘Technologies of the body: polite consumption and the correction of deformity in eighteenth-​century England’, History, 99:338 (2014), 777–​81.

10

110

Rethinking modern prostheses

8 Derenzy was born in Clonegal, Co. Carlow, Ireland, in 1786; see ‘George W. ­Derenzy’, Census Returns of England and Wales, 1861 (Kew:  The National Archives of the UK [TNA]: Public Record Office [PRO], 1861), Class RG, Piece 1387, Folio 90, Page 2, GSU Roll 542805. 9 Derenzy, Enchiridion, 13, italics are original. 10 Derenzy, Enchiridion, 17. 11 Derenzy, Enchiridion, 14. 12 Derenzy, Enchiridion, 18. 13 Derenzy, Enchiridion, 34. 14 Lord Nelson’s knife points to a longer history of military and naval men producing prostheses. For other examples during the period, see Captain G.  Fitzgerald Stack, ‘No. XXI Apparatus for those who have lost an arm’, Transactions of the Society Instituted at London for the Encouragement of Arts, Manufactures, and Commerce, vol. XXXVIII (1821), 121–​4, Plate 21; ‘No. X Telescope Holder. The Large Silver Medal was voted to Lord John Hay, Capt. R. N., for a Telescope-​Holder’, Transactions of the Society Instituted at London for the Encouragement of Arts, Manufactures, and Commerce for the Session 1831–​32; being Part I of Vol. XLIX (London: The Society, 1832), 138–​9. For more on Lord Nelson’s knife, see ‘Admiral Horatio Nelson’s combined knife and fork’, Bulletin of the New York Academy of Medicine, 47:8 (1971), 1025–​7. 15 Derenzy, Enchiridion, 42, 53. 16 Derenzy, Enchiridion, 49. 17 Millikin ran a successful surgical instrument store at 301 Strand. Following his death in 1833, his wife, Martha, and son, John, took over the business. John continued the shop’s success in part by forming partnerships with physicians at nearby Guy’s and St Thomas’s Hospitals; see ‘John Millikin, 301 Strand’, UK, Poll Books and Electoral Registers, 1538–​1893 (London: London Metropolitan Archives and Guildhall Library, 1820); ‘John Millikin, Strand’, Board of Guardian Records, 1834–​ 1906 and Church of England Parish Registers, 1813–​1906 (London: London Metropolitan Archives), 28 April 1833; ‘Martha Millikin, surgical instrument maker’, Census Returns of England and Wales, 1841 (Kew: TNA PRO, 1841), Class HO107, Piece 731, Book 2; St Clement Danes, Middlesex, Enumeration District 4, folio 40, page 20, line 15, GSU Roll 438833; ‘John Millikin … surgical instrument maker to Guy’s and St. Thomas’s Hospitals’, Lancet, 82:2086 (1863); C. L. Jones, ‘Instruments of medical information:  the rise of the medical trade catalog in Britain, 1750–​1914’, Technology and Culture, 54:3 (2013), 563–​99, at 574–​6. 18 Derenzy, Enchiridion, 59, 60. 19 Derenzy, Enchiridion, 11. 20 Derenzy, Enchiridion, 16. 21 Derenzy, Enchiridion, 52. 22 J. Tosh, ‘Masculinities in an industrializing society: Britain, 1800–​1914’, Journal of British Studies, 44:2 (2005), 330–​42, at 335. 23 K. M. Brown, Foul Bodies:  Cleanliness in Early America (New Haven, CT:  Yale ­University Press, 2009), 120–​1.

1

Prosthesis user-inventors

111

24 L. E. Klein, ‘Politeness and the interpretation of the British eighteenth century’, The Historical Journal, 45:4 (2002), 869–​98, at 897. 25 Turner and Withey, ‘Technologies of the Body’, 777–​81. 26 J. Willison, The Afflicted Man’s Companion; or, A Directory for Families and Persons Afflicted with Sickness or Any Other Distress (Belfast:  Samuel Wilson and James Magee, 1744), 18. 27 Turner and Withey, ‘Technologies of the Body’, 779. 28 Derenzy, Enchiridion, 12. 29 Derenzy, Enchiridion, 13. 30 Derenzy, Enchiridion, 37. 31 B. Z. Khan, ‘An economic history of patent institutions’, Economic History Association Encyclopedia of Economic and Business History, available at https://​eh.net/​ encyclopedia/​an-​economic-​history-​of-​patent-​institutions (accessed 1 June 2016). For more on the British patent system during the period, see C. Macleod, Inventing the Industrial Revolution (Cambridge:  Cambridge University Press, 1988); H. I. Dutton, The Patent System and Inventive Activity during the Industrial Revolution, 1750–​1852 (Manchester: Manchester University Press, 1984). 32 ‘Poetical illustrations of the military and other achievements of the Duke of Wellington and his illustrious companions in arms’, The Court, Lady’s Magazine, Monthly Critic and Museum (London: Dobbs & Co., 1847), 27. 33 For publication as an alternative to patenting, see C. L. Jones, The Medical Trade Catalogue in Britain, 1870–​1914 (London: Pickering & Chatto, 2013), Chapter 6. 34 ‘Employment for the maimed’, The Cottager’s Monthly Visitor, vol. XX (London: J. G. F. & J. Rivington, 1840), 418–​19, italics are original. 35 ‘Enchiridion’, Literary Chronicle and Weekly Review, 472. 36 ‘Derenzy’s Hand for the One-​Handed’, 322. 37 ‘New limbs for old ones’, Chambers’s Journal, Sixth Series, vol. V (London and ­Edinburgh: W. & R. Chambers, Ltd., 1902), 691–​4. 38 ‘Enchiridion’, London Weekly Gazette, 20 March 1822, clipping in Derenzy, Enchiridion, Widener Library, Harvard University, Cambridge, MA, USA. 39 ‘Enchiridion’, Morning Post (London), 2 August 1821, 2. 40 ‘Derenzy’s Hand for the One-​Handed’, 322. 41 ‘Enchiridion, or a Hand for the One-​Handed’, 469–​70. 42 H. Colburn, New Monthly Magazine and Literary Journal, vol. III: Historical Register (London: Henry Colburn & Co., 1821), 403. 43 ‘M. Angelo Maio’, London St. James Chronicle and Evening Post, 31 July 1821, 2. 44 Urban, ‘Enchiridion; or a Hand for the one-​handed’, 450–​1. 45 ‘Enchiridion’, The Ladies’ Monthly Museum, vol. XIV (London: Dean & Munday, 1821), 151–​2. 46 ‘Enchiridion’, Morning Post (2 August 1821), 2. 47 ‘The bibliographical records, or books received for review since the last quarter’, The Medico-​Chirurgical Review and Journal of Medical Science (London: G. Hayden, 1823–​4), 481.

12

112

Rethinking modern prostheses

48 M. Ryan (ed.), London Medical and Surgical Journal, vol. IV (London: Henry Renshaw, 1834), 224. 49 Lectures on the physical education and diseases of infants, from birth to puberty, by Dr.  Ryan, delivered at the Medical School, Westminster Dispensary, Gerrard Street, Soho’, in M. Ryan (ed.), London Medical and Surgical Journal, vol. VII (London: G. Henderson, 1835), 76–​81. 50 See citations in ‘Derenzy’s Hand for the One-​Handed’, 322–​5; S. Urban (ed.), ‘Enchiridion; or a Hand for the one-​handed’, The Gentleman’s Magazine, and Historical Chronicle, vol. XCII:  January–​June 1822 (London:  J. B.  Nichols and Son, 1822), 623–​4. 51 ‘Derenzy’s Hand for the One-​Handed’, 322. 52 Urban, ‘Enchiridion; or a Hand for the one-​handed’, 623–​4. 53 The Mechanics’ Magazine, Museum, Register, Journal, and Gazette was formed in 1823 to, as the editors declared in the first issue’s preface, ‘invite, encourage, and stimulate inquiry and communication among the working classes … including all who are manually employed in our different trades and manufactures’. It is thus unsurprising that they were among the most vocal critics of Derenzy’s class-​ based biases. ‘Preface’, Mechanics’ Magazine, Museum, Register, Journal, and Gazette (­London: Knight & Lacey, 1823), iii–​iv. 54 ‘Derenzy’s Hand for the One-​Handed’, 322. 55 ‘Derenzy’s Hand for the One-​Handed’, 325. 56 ‘Derenzy’s Hand for the One-​Handed’, 325. 57 ‘Telescope-​holder for one-​handed persons’, Mechanics’ Magazine, Museum, Register, Journal, and Gazette, 20 (1834), 351. 58 ‘Telescope-​holder for one-​handed persons’, 351; see also ‘Telescope-​Holder … Lord John Hay’, Transactions of the Society for the Encouragement of Arts, Manufactures, and Commerce, Part I of Vol. XLIV (London: Royal Society for the Encouragement of Arts, Manufactures, and Commerce, 1832), 138–​9. 59 Derenzy, Enchiridion, 26. 60 Derenzy, Enchiridion, 33. 61 A review in the Military Register discusses the artisans who produced and sold Derenzy’s inventions. ‘Military review of troops’, 436–​37, 466–​67, 712–​13; Holden’s Annual London and Country Directory, of the United Kingdoms, and Wales, in Three Volumes, for the Year 1811, 3 vols. (London: W. Holden, 1811). 62 G. Clark, ‘Average earnings and retail prices, UK, 1209–​2010’, The Annual RPI and Average Earnings for Britain, 1209 to Present, available at www.measuringworth. com/​ukearncpi (accessed 1 June 2016); L. Levi, Wages and Earnings of the Working Classes (London: John Murray, 1867), 53. 63 Clark, ‘Average earnings and retail prices’; Levi, Wages and Earnings of the Working Classes, 53; Derenzy, Enchiridion, 59–​60. 64 ‘Enchiridion; or, A  Hand for the One-​Handed’, London British Neptune, or Naval ­Military and Fashionable Adviser, 5 August 1821, 3. 65 Turner, Disability in Eighteenth-​Century England, 9.

13

Prosthesis user-inventors

113

66 For more on gender and disability during the period, see D. M. Turner, Disability in Eighteenth-​Century England: Imagining Physical Impairment (London and New  York, NY:  Routledge, 2012); see also R. Garland-​Thomson, ‘Integrating disability, transforming feminist theory’, National Women’s Studies Association Journal, 14:3 (2002), 1–​32; R. Garland-​Thomson, Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature (New York, NY: Columbia University Press, 1997), especially Chapter 2; B. G. Smith and B. Hutchinson (eds), Gendering Disability (New Brunswick, NJ:  Rutgers University Press, 2004). 67 Garland-​Thomson, Extraordinary Bodies, Chapter 2. 68 ‘Poetical illustrations of the military’, 27, punctuation is original. 69 Clark, ‘Average earnings and retail prices’. See also ‘George W.  Derenzy’, Census Returns of England and Wales, 1861, and ‘George W.  Derenzy’, Census Returns of England and Wales, 1871 (Kew: TNA PRO, 1871), Class RG 10, Piece 43, Folio 71, Page 12, GSU Roll 824566.

14

5

‘GET THE BEST ARTICLE IN THE MARKET’: PROSTHESES FOR WOMEN IN NINETEENTH-​C ENTURY LITERATURE AND COMMERCE Ryan Sweet Published during the aftermath of the American Civil War, Alonzo Hill’s John Smith’s Funny Adventures on a Crutch (1869) was a novel that provided a conspicuously gendered role model for maimed American veterans in the form of its eponymous protagonist. ‘[B]‌ear[ing] his mark with a patriotic sense of humor, and thereby scorn[ing] those who ignore his manly vigor’, the narrator-​ protagonist of Hill’s novel praises the work of prosthetist B. Frank Palmer, one of the men contracted by the US government to supply artificial limbs to the nation’s amputee veterans –​whose patenting of his devices is explored in depth in Chapter 6 by Caroline Lieffers.1 Smith describes how one amputee walked ‘splendidly on his “Palmer leg” ’ and later he refers to Palmer himself as ‘the great manufacturer of artificial limbs’.2 Hill was not the only literary figure to recommend Palmer’s artificial legs in this period. Famous poet and physician Oliver Wendell Holmes describes how he was ‘completely taken in … by the contrivance of the ingenious Surgeon-​Artist’ in his 1864 essay ‘The Human Wheel, Its Spokes and Felloes’.3 While Hill’s novel and Holmes’s essay provided ringing endorsements of Palmer’s artificial limbs, which were specifically designed to, in the words of Erin O’Connor, ‘remasculinise’ the male amputee, a radically different but equally commercially engaged literary connection with prostheses pervaded narratives concerning female prosthesis users.4 A  number of prosthesis narratives, more often than not marriage plots, coexisted that showed women exactly which prosthetic devices they should avoid using. These stories provided an important commentary on the kinds of artificial body parts that were deemed acceptable or lamentable for females to use in this period. Certain marriages plots, including Thomas Hood’s satirical poem Miss Kilmansegg and Her Precious Leg (1840–​41), were so popular that international prosthesis makers, such as John S. Drake and A. A. Marks, drew on them for commercial

15

Prostheses for women in literature and commerce

115

gain and included extracts in their treatises. Furthermore, other makers of ­artificial body parts, such as Thomas Elliott and Professor Brown, drew upon the public penchant for prosthesis narratives by including poems about their products in advertisements. The relationship between literature and the prosthesis industry was therefore more fluid and complex than historians and literature scholars have recognised. Writers used fiction as a means through which to critique poorly performing prostheses, while prosthesis makers sought to exploit the contemporary interest in fictional prostheses to their advantage. This chapter explores the reciprocal relationship between fictional texts and the prosthesis industry in this period. I demonstrate that fictional writing was a key component of nineteenth-​century prosthesis discourse, a constituent that provided practical advice for its readers on the kinds of prostheses that should be avoided for both social and functional purposes. Popular literary sources provided kinds of advertisement not for but against certain prostheses. Meanwhile, both entire fictional works and particular representational strategies were used by contemporary prosthetists interchangeably as means through which to subtly disparage the devices of opposing makers, reinforce the proprietary ownership of particular designs or promote the concealing abilities of particular devices to female users. In terms of both the literary and commercial history of prosthetics, gender is a major factor. Perhaps unsurprisingly when one considers the historical figures that we so often associate with artificial body parts  –​pirates, veterans and maimed industrial workers –​much recent critical attention on nineteenth-​century prostheses has tended to focus on male users. Studies by Lisa Herschbach, Erin O’Connor and Steven Mihm, for example, demonstrate the importance of such devices in terms of masculinity.5 O’Connor’s work in particular is important from a gender perspective as it reveals that prostheses were perceived as restorative devices that could reinstate a male amputee’s supposedly lost sense of masculinity by making him ‘whole’ and allowing him to work once more.6 Yet, like depictions of disabled characters in nineteenth-​century literature, the prevalence of disabled females is receiving a growing amount of scholarly attention. Between them, Kirsten E. Gardner, Marquard Smith, Vanessa Warne and Galia Ofek investigate a wide range of prostheses for women (including artificial legs, breast implants and wigs).7 Warne shows how financial networks are tied to artificial legs in two Victorian marriage plots. Smith explores what he calls ‘technofetishism’ in the commercial photography of nineteenth-​ century Chard-​based limb maker James Gillingham, arguing that the exposure of a prosthesis for a woman in this period equated to an ‘assault to modesty’, bringing to the fore ‘the pivot between invisibility and visibility, hiding and

16

116

Rethinking modern prostheses

revealing, concealment and revelation’.8 Gardner draws attention to ‘the ­creation of appendages that enhance the realistic nature of the part’ in her discussion of breast prostheses before 1950.9 Ofek, on the other hand, describes how, despite its popularity at the mid-​century, women’s use of artificial hair was often treated with distrust in literary and cultural sources.10 Further exploring the conceptual ties that Smith and Gardner draw between invisibility and the female body, re-​examining the links between marriage, money and prostheses that Warne brings our attention to, and extending analysis of the suspicion that Ofek observes regarding artificial hair to other types of prosthesis, this chapter demonstrates how a particular branch of Victorian marriage plots commented upon the kinds of prostheses that were deemed suitable (and regrettable) for women in this period. Commenting on the pervasiveness of disabled women in Victorian literature, Cindy LaCom argues that such a trend ‘signaled very real cultural fears about women, female sexuality, and the maternal’.11 Along similar lines, Martha Stoddard Holmes’s work builds on Rosemarie Garland-​Thomson’s thesis to demonstrate that the female and the disabled have long been entangled in patriarchal thought.12 Stoddard Holmes highlights the transgressive allure of disabled women, arguing that ‘As potential signs of both disease and sexuality, disabled women characters functioned not only in parallel ways to “fallen” women in Victorian literature and culture –​as containers for the most dangerous qualities associated with all women –​but even as stand-​ins for fallen women.’13 This chapter furthers the work of the feminist disability scholars listed above. It shows that prosthesis-​using women, in addition to disabled ones, were a common motif in marriage plots. In addition to the recent work on disabled women and prostheses for female users, this chapter is also informed by current disability ​studies research into the social practice of ‘passing’  –​a term that for the most part ‘refers to the way people conceal social markers of impairment to avoid the stigma of disability and pass as “normal” ’.14 Jeffrey A. Brune and Daniel J. Wilson explain how passing is a contested practice in disability studies since it ‘can take a psychological toll [on those who attempt to “pass”] and can also reinforce –​or, at least, fail to challenge –​the stigma of disability’. They also, however, note that ‘Even when passing seems to reinforce the stigma of disability, it is more productive, and more just, to challenge the ableism that compels people to pass rather than blame the individuals who choose to do so.’15 This chapter follows in the footsteps of David Linton, who explores the curious history of how women have had to ‘deny their membership’ as menstruators in order to avoid ‘shame, embarrassment, and ostracism’, as it shows how in the nineteenth century physically ‘incomplete’ women were, more so than men, pressured into and provided advice how to ‘pass’ by commercially resonant literary texts.16

17

Prostheses for women in literature and commerce

117

To appreciate why women felt under such pressure to disguise physical losses in the nineteenth century, it is worth bearing in mind the specific stigma that was attached to disabled or otherwise physically ‘incomplete’ women –​ those missing an eye, teeth or hair, for instance. First, disabled women were often viewed as unfit mothers. Motherhood was widely perceived as the primary function of women  –​a sentiment that Sally Shuttleworth and Mary Poovey have shown was buttressed by medical opinion.17 Such a devastating estimation therefore rendered females considered physically ‘incomplete’, for many, unmarriageable. As physical aberrance came to be seen in wider society as increasingly unfavourable –​as Lennard J. Davis has identified, in part, due to the emergence of the concept of ‘normalcy’ –​medical attention was drawn to heredity.18 ‘As a Victorian cultural sign, disability pointed not only backward, to parental transgression and defect, but even more urgently forward, to future generations.’19 Much attention on physical and mental inheritance resulted in an increased focus on mothers as sources of congenital defects. Furthermore, wholeness came to be seen as the fundamental hallmark of health, meaning that those who had lost body parts, however minor, were seen as less desirable partners.20 Since beauty had long been held as an essential trait of womanhood and was ‘legitimised’ as such by scientific papers written by Alexander Walker (1836) and later Havelock Ellis (1904) and Carl Heinrich Stratz (1903), women were judged more harshly than men for having perceivable physical losses.21 Prostheses held both the capacity to aid and betray their users as pressures to erase visible marks of physical imperfection proliferated. A convincing prosthesis might allay any suspicions of physical incompleteness; an unconvincing one might not only reveal the user as a ‘defective’ but would draw attention to her supposedly fraudulent attempt at hiding a physical loss. Such a conundrum provided ample material for a number of marriage plots, which served as indexes for the kinds of prostheses that should be avoided. This chapter begins by juxtaposing images of male and female prosthesis users in an 1888 trade catalogue of successful American artificial-​limb maker A. A. Marks in order to display the differing ways in which artificial body parts were marketed to men and women in the nineteenth century. Building upon the conceptual ties between female prosthesis use and invisibility that Marks’s treatise makes manifest, the chapter then turns to fictional responses to female prosthesis users in contemporary literary marriage plots. These stories provide the reader with specific guidance on devices to avoid –​noisy and showy devices –​buttressing the necessity for female prostheses to be unnoticeable. Finally, the chapter highlights the way in which such literary stories and representational strategies were utilised to the advantage of various prosthetists, underlining the surprising intersections of fiction and commerce in Victorian

18

118

Rethinking modern prostheses

prosthesis discourse. These latter sections of the chapter consider false teeth, wigs and artificial eyes alongside prosthetic limbs. False teeth and wigs are not often seen as prostheses in the traditional sense, yet, as I show, these technologies were often considered alongside other forms of prosthesis as devices of concealment in the nineteenth century. I analyse false teeth and wigs alongside limbs to verify the importance of gender in the relationship between commerce and literature. Indefatigability and invisibility: A. A. Marks’s legs for men and women Figure 5.1, from American prosthesis franchise A. A. Marks’s 1888 A Treatise on Marks’ Patent Artificial Limbs with Rubber Hands and Feet (authored by George E. Marks), is one of many examples that could be used to reveal the way in which artificial limbs were advertised to men as devices that could, first and foremost, enable them to return to work. The illustration shows a male artificial-​leg user digging using a shovel. In the testimonial that accompanies the images, the man depicted lauds the functional and enabling capacities of his prosthesis.22 For instance, he boasts, ‘I have used your make of legs at nearly all kinds of work, such as plowing, spading, hauling logs, and other work. I have walked twenty-​five miles in a single day.’23 Also significant in this image is the fact that the artificiality of the user’s false limb is conspicuous: it is uncovered, foregrounded, and the limb closest to us as viewers. Curiously, the testimonial fails to mention the aesthetics of the prosthesis. Several similar illustrations of and endorsements from working men appear in the A. A. Marks catalogue marking the practical capabilities of the limbs as a major selling point to male amputees. The firm A. A. Marks was keen to draw attention to the fact that its devices were patented (as foregrounded in the title of its catalogue), and there are clear links in the 1888 catalogue between the foregrounding of patenting and the gendered advertising rhetoric of the piece as a whole. Aligning with James F.  Stark’s observations about the commercial uses of patents in the medical marketplace, Marks’s use of patents served to legitimise the promises made about the restorative capacities of the firm’s prostheses for male users –​the patented parts of Marks’s products being the rubber hands and feet, aspects introduced primarily to enhance function rather than aesthetic.24 In contrast to Figure 5.1, Figure 5.2 is one of only two illustrations of women that appear in the A. A. Marks treatise. The focus of this illustration is less on function and durability and more on appearance and concealment –​the latter also being an important feature in the history of artificial eardrums as revealed

19

Prostheses for women in literature and commerce

119

Figure 5.1  An illustration of a male Marks-​type artificial leg user digging with a shovel. George E. Marks, A Treatise on Marks’ Patent Artificial Limbs with Rubber Hands and Feet (New York, NY: A. A. Marks, 1888), 346. Available at http://​hdl. handle.net/​2027/​loc.ark:/​13960/​t6h14501h?urlappend=%3Bseq=356 (accessed 6 May 2016).

120

120

Rethinking modern prostheses

Figure 5.2  An illustration of a female Marks-​type artificial-​leg user demonstrating the mimetic capacities of her prosthesis. George E. Marks, A Treatise on Marks’ Patent Artificial Limbs with Rubber Hands and Feet (New York, NY: A. A. Marks, 1888), 335. Available at http://​hdl.handle.net/​2027/​loc.ark:/​13960/​ t6h14501h?urlappend=%3Bseq=345 (accessed 6 May 2016).

by Jaipreet Virdi in Chapter  2. Indeed, in this image, the Marks-​type leg is imperceptible, virtually invisible. In fact, if it were not for the ‘before’ image on the left-​hand side of Figure 5.2 –​showing the female user holding her artificial leg in her hand –​and the explanatory written material surrounding the illustration, one would hardly know that the illustration depicted a prosthesis user. The invisibility of a prosthesis in this image –​aided in part by the way in which it can be easily hidden under clothing –​is of course precisely the point. As George E. Marks explains, ‘It is very well understood that young ladies wearing artificial limbs are not over-​desirous of having it publicly known.’25 Whereas

12

Prostheses for women in literature and commerce

121

the men depicted in the image discussed above is named –​Lewis C. Cox –​ the female subject of the only other image of an adult female prosthesis user that appeared in Marks’s catalogue wished to remain anonymous. This wish for anonymity –​in addition the images, which highlight how A. A. Marks’s devices could supposedly mask physical loss –​shows that it was less favourable for a woman to be perceived as physically incomplete. George E. Marks thus markets his firm’s devices as ones that can enable women, such as the amputee on the right of Figure 5.2, to look physically complete and thereby able to pass. The fact that only two images of women appear in Marks’s treatise is also telling of the gendered consumer culture surrounding these products  –​a theme also taken up by Laurel Daen in Chapter 4. Such suggests that men were the main consumers of artificial limbs in the 1880s –​unsurprising considering the number of surviving Civil War amputees who still occupied a significant place in the cultural consciousness during this decade.26 Fitting the economic situation of the time, the lack of illustrations depicting female consumers also suggests that men were the ones with the capital available to purchase such devices, which were relatively expensive.27 Marks’s treatise is aimed primarily at respectable working-​class men (including farmers, skilled workers and clerks), middle-​and upper-​class men and veterans (in particular those provided with a US government subsidy for an artificial limb). In other words, the prostheses were marketed at the men who could afford them. Men were also responsible for purchasing artificial limbs for their wives and daughters. One Wilbur S. Studwell wrote to A. A. Marks in 1887 to thank the limb maker for the artificial leg that he had bought for his wife. To Studwell’s delight, his wife’s prosthesis did an excellent job at disguising her physical loss: ‘strangers, even experienced doctors, seeing her walking, or at work, can never detect that she is wearing a false limb’.28 Studwell’s quote shows that the promise of invisibility was as much an assurance to the husband of a female amputee as it was to the amputee herself. We must of course consider axes of representation, such as social class, as significant factors in the marketing materials just discussed, but these images show how the aspects of artificial limb design that were considered most important depended, in part, on the gender of the amputee subject –​the mimetic capacity of artificial body parts was also important for middle-​and upper-​class gentlemen because of the stigma attached to bodily loss.29 Since marriage and motherhood were both ideologically and economically considered the best routes for women in life, and because such virulent prejudices stood in the way of both spinsterhood and physically ‘incomplete’ females marrying, women were forced, by necessity, to mask their physical imperfections in order to give themselves the best chance possible to find an eligible partner and get married.

12

122

Rethinking modern prostheses

An 1882 article for the New  York Sun reflected that ‘the young woman will dance all night with that substitute leg without her partner suspecting its existence’, highlighting the impressive verisimilitude of contemporary prostheses while gesturing towards prejudices against limbless women.30 Similarly, affirming the importance of a good-​quality prosthesis that will not give itself away to a potential partner, and forming the title for this chapter, William Chambers’ 1877 Chambers’s Journal article ‘The Wooden Leg’ advises its female readers to not compromise when it comes to selecting a prosthesis: ‘A keen regard for economy in a matter of this kind is poor policy. I should say if you want an artificial leg that will look and act as nearly as possible like a real one, do not grudge the money. Get the best article in the market’ (emphasis added).31 For women already married, however, the functionality of prosthetic body parts was also important. Concealing their physical loss as much as possible from their husbands and, more importantly, from friends, acquaintances and the general public (to protect the reputations of their spouses) was important for such women, but it was also essential for them to be able to continue their domestic duties. The Marks artificial-​leg user Mrs S. E. Silley wrote a poem to A. A. Marks, included in the firm’s 1888 treatise, which reveals both the value of artificial legs that can enable one to perform household chores and the close link between literary texts and commercial works in this period. The poem included the following lines: I now could walk around the room, Then o’er the house about my home; Could cook and wash and iron too, And do all the work that others do.32 This poem shows us that functionality was also important for women who had domestic duties to perform. The concept that prostheses could enable physically ‘incomplete’ women –​ including not just those who had had limbs amputated but also those who lacked hair, were missing teeth or who had lost eyes –​to appear ‘whole’ to eligible men proved a point of contention for some. Indeed, William Blanchard Jerrold famously debated the virtues and vices of prostheses –​including artificial limbs, eye, teeth and hair –​identifying that some saw artificial body parts as ‘emblem[s]‌of deceit’, ‘device[s] of ingenious vanity’ or items that ‘cover[ed] the wearer with gross and unpardonable deceit’.33 An 1861 Chambers’s Journal fictional text purporting to be an article drew from such claims, suggesting that women, in particular single ones looking for partners, had less of a right than men to use prostheses:

123

Prostheses for women in literature and commerce

123

I admit, if the lady I pay my addresses to has the misfortune to have one of her legs made of cork, I should prefer to be apprised of the fact before I put up the bans, rather than after the marriage-​ceremony. Perhaps she, too, has some claim to be made acquainted with the circumstance, that my prepossessingly natural appearance is not altogether free from a certain alloy of unreality. But we will let that pass.34

This quotation draws our attention to the seemingly impossible position faced by a single woman who had lost a body part. ‘For her own sake’, and her family’s, an ‘incomplete’ woman would mostly likely face significant pressure to use a prosthesis and try as hard as possible to mask her loss in order to attract a future husband. However, the implication in the passage above is that she should not try to deceive potential suitors. This assertion is troubling when one considers the stigma that accompanied physical loss in this period. Men were encouraged to avoid copulating with physically aberrant women. Thus ‘incomplete’ women faced a conundrum:  did they use a prosthesis and risk discovery? Or did they give up on the possibility of marriage altogether and face an also-​stigmatised life of spinsterhood? Such a situation reveals that life-​ shaping decisions like this were informed less by impairment itself than by the social conditions that prohibited intermarriage with physically aberrant women. The next section of this chapter draws from this context as we turn our attention to the discourse surrounding a different type of prosthesis that women were advised to select with care: false teeth. Fiction and falsehood: literary guides for selecting false teeth and artificial legs One might assume that the reception of nineteenth-​century female artificial-​ leg and false-​teeth users was radically different, but both types of prosthesis user was subject to similar stigma regarding either (or both) sexual unattraction and/​or duplicitousness depending on the mimetic capacity of the user’s device. Many writers, including Jerrold and Chambers, considered such devices alongside one another as concealers of physical disfigurement, ignoring issues of impairment versus aesthetic preference. Like wooden legs, false teeth were also seen as fair game for comic stories by fiction writers. Though historian John Woodforde suggests that references to false teeth are virtually absent in Victorian novels, the periodical press reveals several marriage plots in which female false-​teeth users are brutally exposed –​usually resulting in the withdrawal of a marriage proposal.35 Such stories include ‘Too Hard upon My Aunt’ (1863), A.M’.s ‘Was She False?’ (1875) and ‘Kitty

124

124

Rethinking modern prostheses

the Careless’ (1883), to mention but a handful. Woodforde is right about the lack of false-​teeth references in canonical novels, but the relative popularity of them in periodical sources, such as the All the Year Round, The London Reader and Judy (in which ‘Too Hard upon My Aunt’, ‘Was She False?’ and ‘Kitty the Careless’ appeared respectively), draws our attention to their status as popular motifs in light-​hearted stories designed to elicit mild shock and comic revulsion. It is true that these prostheses served a primarily comic function. However, such representations not only reinforced prejudices against those missing teeth but also provided a reminder to readers of devices to be avoided: namely, dentures prone to malfunction or those that appear overly striking. Like the Tit-​Bits journalist described by Graeme Gooday and Karen Sayer in Chapter 1, who critiqued poorly performing artificial eardrums and their sometimes disreputable sellers, literary texts provided advertisements against certain prosthesis types. Since together All the Year Round, The London Reader and Judy covered a wide readership, it seems that readers from the literate working class upwards were exposed to similar directives concerning prostheses for women. The rest of this section will show how two of these stories, ‘Kitty the Careless’ and ‘Was She False?’ provided particular advice to women regarding two kinds of false teeth to avoid: partial plates and overly white dentures. ‘Kitty the Careless’, which appeared as the sixth part of a series called ‘The Misses Lovibond’s Refusals’ in the London-​based comic journal Judy, provides a comic example of how young women should not act while also highlighting a kind of dental prosthesis they should avoid –​in this case, a partial dental plate. In this sketch we are told of the careless habits of an otherwise very attractive young woman called Kitty. Having lost her three front teeth after trying to slide down a bannister (an action that the sketch chastises as ‘unladylike’), she is fitted with three false ones, it would appear, as part of what was known as a partial set –​an upper or lower plate, usually by this time made of vulcanised rubber but occasionally celluloid, gold or ivory, with false teeth, often porcelain but occasionally human teeth, positioned only in place of the missing teeth.36 When a childhood lover, who since he last met Kitty has earned his fortune in the colonies, returns to renew his devotion to her, the careless girl drops her false teeth out of her mouth, frightening her devotee into making an abrupt exit. We learn from Woodforde’s work that such malfunctions were not uncommon in prostheses of this design.37 Indeed, springless plates had been around since the eighteenth century, but they remained often ineffective throughout the nineteenth century  –​in part because few makers or users understood how atmospheric pressure worked.38 Stories of false teeth being swallowed or fired out were common in surgical and dental journals, as well as in periodicals directed at untrained readers. R. H. Rozenzweig, for instance, wrote

125

Prostheses for women in literature and commerce

125

in the British Medical Journal in 1891 of a patient who swallowed and then excruciatingly passed a golden false-​teeth plate.39 Ever the source of cruel jokes about prostheses, Fun jested, ‘The poor lady who was found suffocated in bed the other morning through swallowing her false teeth ought to be a warning to others, by gum!’40 Kitty evidently experiences difficulties keeping her false teeth in. But her appearance is described as deceptively flawless: ‘Those who gazed with rapture at her ruby lips, which as they parted displayed a row of pearly teeth, were far from suspecting the truth.’41 Thus, while this story does not attack the aesthetics of partial dental plates, which, it suggests, could be alluring to look at, it does scrutinise the reliability of such devices. By the time that ‘Kitty the Careless’ was published, partial plates were a fairly outdated mode of replacing lost teeth on a low scale, explaining, in part, their critique in this instance. Following the inventions of safe dental cement (an oxyphosphate of zinc) in 1869 and the foot-​operated dentist drill in 1871, fixed replacements, such as crowns and bridges, took preference over partial dentures. The implementation of such fixed replacements became known as ‘American dentistry’ in Britain, reflecting the superiority of American dental expertise in the second half of the century. Crowns and bridges were more expensive than partial plates in the 1880s but were generally preferred to artificial teeth since they carried less stigma and were less prone to falling out.42 ‘Kitty the Careless’ uses a comical mode to warn women against making the ‘careless’ mistake that Kitty does –​that is, using a partial plate –​as it subtly endorses ‘American dentistry’. The Judy sketch reflects the aspirational interests of the journal’s lower-​ middle-​class readership as it attacks what was by the 1880s an inexpensive, yet unfashionable and outdated, mode of fixing teeth, thereby providing implicit support for ‘American dentistry’, which was, for dentists, a more profitable and, for the public, a more respectable method for replacing lost teeth.43 Overly showy prostheses also received scrutiny in Victorian marriage plots. Such devices were feared to draw too much attention and scrutiny to the appearance of the female user, thereby risking discovery. A  story that reveals the possible consequences of using a device that looks better than the real thing, which also concerns false teeth, is the 1875 London Reader short story ‘Was She False?’ In this tale, a man called Mr Mortimer breaks his engagement after it is revealed to him that his betrothed, Miss Hopkins, wears false teeth. The reader’s suspicions are alerted about the questionable authenticity of Miss Hopkins’ teeth (if not by the title of the story!) when her looks are eulogised over in larger-​than-​life terms: ‘Eyes deep blue, like midsummer sky –​hair lustrous as flaxen gold –​teeth like twin rows of pearls.’ The description of her teeth as akin to ‘pearls’ highlights their preciousness, suggesting that they are assets that alone make their owner worthy of marriage. Their

126

126

Rethinking modern prostheses

appearance also communicates in coded terms that they may not be human. Miss Hopkins’ deceptively youthful appearance also raises suspicions: she is ‘five-​and-​thirty, but … has the complexion of eighteen’. Our inkling about her potentially augmented physical appearance is vocalised by Mr Mortimer’s handsome nephew, Harry, who postulates his fear that the ‘desperate old maid that Uncle Mortimer is going to marry is painted like a Jezebel’. The reader’s suspicions shift to an impending sense of marital catastrophe as we learn that Mr Mortimer is, typically, strongly opposed to artificiality: ‘one don’t want to look as if one were varnished all over or dipped in a jar of boiling oil, like the forty thieves in the Arabian Nights’. This discriminatory attitude is soon put to practice: Harry discovers a box of false teeth with Miss Hopkins’ name on it at the dentist’s and mischievously arranges for the teeth to be delivered to her lover –​who, of course, is unaware of her ‘falseness’. Mr Mortimer then seeks confirmation from Miss Hopkins’ servant that his lover uses false teeth and breaks his engagement immediately. He angrily asserts, ‘She’s treacherous! I have been deceived all through. I daresay the rest of her is as false as her –​ but no matter! I am disenchanted at last. I have bidden her an eternal adiou!’44 Here, then, it is the fact that Mortimer feels ‘deceived’, the shock of discovery and the fear that ‘the rest of her is … false’ that drives him to end the relationship. Her actual ‘defects’, while one would imagine still important, are a secondary concern. In this case, the fraudulent capacity of the woman’s prosthesis, its very success in masking physical loss, is what makes it, in the male suitor’s eyes, so deplorable. Echoing Jerrold’s earlier fears, that prostheses are ‘device[s]‌of ingenious vanity’ that obscure dominant physiognomic means of judging people, ‘Was She False?’ comes to the problematic conclusion that those who conceal their physical ‘defects’ are more likely to have other secrets that they wish to conceal.45 Above all, though, this story demonstrates that overly white and straight, ‘pearly’, false teeth can arouse suspicions and, in the case of female users, result in tragic consequences: discovery. Marriage plots such as ‘Kitty the Careless’ and ‘Was She False?’ provided advice for female readers about what kinds of prostheses should be avoided. Literature, however, was also used in a similarly rhetorical but even more commercially driven way by contemporary prosthetists. Lumbering legs and wonderful wigs: commercial literature and fiction In terms of showy prostheses, artificial body parts do not come more ostentatious than the golden artificial leg that is used by the eponymous protagonist of Thomas Hood’s Miss Kilmansegg and Her Precious Leg, a poetic parable that

127

Prostheses for women in literature and commerce

127

was popular and well remembered throughout the nineteenth century.46 The resounding message in Hood’s poem, like the previously mentioned London Reader story, is that eye-​catching prostheses, and pretentiousness in general, should be avoided by women. Hood’s poem comically portrays a pompous countess, who, after losing a leg in a riding accident, demands to be adorned with an artificial leg made of solid gold. The eponymous protagonist later marries an in-​debt Italian count who demands that she sells her leg to pay off his gambling debts. After she refuses, he bludgeons her to death using the very leg that he so wishes to sell. Hood’s poem is certainly a parable that warns against materialistic avarice –​as Warne notes, ‘Hood’s heavy-​handed moral is clear: the love of gold costs Miss Kilmansegg both life and limb.’47 However, the poem also provides a commentary on a kind of prosthesis that women should avoid using: showy, impractical devices that attract unnecessary attention. Though the leg is visually impressive –​‘’Twas a splendid, brilliant, beautiful Leg’ –​it draws considerably more attention, good and bad, than any other kind of prosthesis imaginable: while money-​driven suitors are transfixed by it, others are outraged by its obnoxiousness –​‘The jeers it had met, –​the shouts! the scoff! /​ The cutting advice to “take itself off,” /​For sounding but half so heavy.’48 The criticism that Hood’s poem levied towards Miss Kilmansegg’s noisy leg was such a lasting concern that it was invoked on a couple of occasions several decades later by American artificial-​limb makers. Such highlights the transatlantic appeal of Hood’s poem, the longevity of its engagement with topics pertinent to prosthesis marketing, the international nature of prosthesis discourse and the important role that literature played more widely in prosthesis commerce. Hood’s golden leg was cited in the commercial texts of American prosthetists John S. Drake and A. A. Marks as an example of bad prosthesis. In praise of Drake’s artificial legs, an article in the Boston Evening Gazette in 1859, quoted by Drake in his manual of the same year, noted that: Instead of the cumbrous and clattering pedals which, like Miss Kilmansegg’s wonderful leg, go ‘clump, clump, clump, like the ghost in Don Giovanno’, Dr. Drake has made a delicate and ingenious machine, that bends naturally with the motion of the body, provided with springs that answer the purpose of muscles and sinews.49

Similarly, George E. Marks also commented on Miss Kilmansegg’s noisy gait in his 1888 treatise on artificial limbs, describing her leg as a ‘fascinating perambulator’.50 The mutual concern that Hood’s text, the Boston Evening Gazette journalist and George E.  Marks all have regarding the weightiness of prosthesis brings to our attention the widely held view that prostheses, especially those used by women, should be as silent (both literally and figuratively) as

128

128

Rethinking modern prostheses

possible –​a logical extension one might say to the Victorian ideal of women as muted and passive. The reuse of the golden leg as a comical example of a poorly designed prosthesis reveals the enduring concerns that prosthetists had regarding the weight of their devices throughout the century. In terms of the commercial use of such a text, we see the prosthesis narrative serve as a kind of anti-​advertisement used for particular marketing ends. In the Drake example in particular, Miss Kilmansegg’s leg is a referent used in a simile that disparages the ‘cumbrous and clattering’ artificial legs of rival limb makers. The use of a comical literary referent, in combination with the fact the words are quoted from a newspaper  –​therefore distancing them slightly from the prosthesis maker –​softens the tone of what is otherwise a denigrating remark about artificial limbs that are not made by Drake. The reference to Miss Kilmansegg’s leg in nineteenth-​century discourse relating to real-​life prosthetics highlights not only the popularity of Hood’s poem but also the way in which fictional texts were understood to inform or educate people’s views on new or existing technologies. George E. Marks included not just an allusion to Miss Kilmansegg but a whole section on ‘Literary Amenities on Artificial Limbs’, including a full transcript and comment on the popular song ‘The Cork Leg’, in his 1888 treatise on prostheses, in part to dismiss popular misconceptions regarding his devices. Like Miss Kilmansegg and Her Precious Leg, ‘The Cork Leg’ was another British text thus attesting to the transatlantic exchange of prosthesis discourse in this period. Not only did the firm A. A. Marks include British literature in its treatises but it also sold artificial limbs to British amputees via its popular mailing system. In his 1886 catalogue, A. A. Marks included a section called ‘Our Foreign Trade’ featuring a testimony from Frank Mills of Bath.51 A. A. Marks included instructions and prices for overseas orders from its 1888 catalogue onwards: $1.50 for orders to Liverpool and $1.75 for orders to London.52 In its 1908 Manual of Artificial Limbs (authored by James Law), A. A. Marks included no fewer than nine testimonials from English amputees. For A. A. Marks and others on both sides of the Atlantic who saw Hood’s poem as a comment on unsuitable false limbs and artificiality, literature was seen as a powerful means of shaping people’s views concerning prostheses. A. A. Marks’s inclusion of internationally popular pieces of literature such as Hood’s poem in its prosthesis treatises reveals an intriguing marketing strategy. By evoking these popular narratives, prosthetists such as A. A. Marks and Drake hoped to conjure an association between popular pieces of literature about prostheses and their firms’ artificial limbs. These limb makers literalise Hood’s representation of an artificial leg but do so in an attempt to implant their prostheses in the popular imagination as real-​life solutions to the issues

129

Prostheses for women in literature and commerce

129

that Miss Kilmansegg encounters in Hood’s poem. A.  A. Marks and Drake hoped that amputees would think of their artificial limbs when reading, or ­listening to, popular pieces of verse, such as Miss Kilmansegg and Her Precious Leg and ‘The Cork Leg’. Implicit in the use of such texts, this kind of literary engagement also bolstered the intellectual-​property protection of Marks’s prostheses, which were already protected by a patent. Medical historian Claire L. Jones has shown us how eponymously named devices were deployed by medical men in trade catalogues as an informal and respectable means of enforcing intellectual property protection.53 Neither Miss Kilmansegg nor ‘The Cork Leg’ directly mention Marks’s patented artificial legs with rubber feet in order to further enforce the proprietary ownership of Marks’s design, but the incorporation of these stories in Marks’s advertising texts implanted into the imagination of the reader a negative image of an artificial leg against which the maker’s ‘superior’ leg could stand. In other ‘Literary Amenities’ appended in Marks’s treatise, however, more direct reference is made to the firm’s artificial legs. For instance, in the poem by Mrs S. E. Silley mentioned above, the speaker references Marks directly and draws attention to his devices’ patented aspect: ‘I tried it on; it fitted neat, /​With rubber foot and straps complete.’54 Elsewhere, a humorous (though problematic) literary sketch called ‘A Part of Stewart’s Body’ was printed in full, which, like Silley’s poem, praised the capacities of Marks’s rubber-​footed artificial legs. The sketch once again draws our attention to the conspicuously gendered discourse of Marks’s treatise. The firm’s rubber feet enable the protagonist Stewart to ‘run, skate, play billiards, drink … and spend money as well as any of the boys’.55 Specially crafted literary texts were therefore included in Marks’s trade catalogues as endorsements for, and reminders of, the manufacturer’s patented features. Meanwhile, internationally recognised literary depictions of suspect prostheses were included to contrast Marks’s limbs and therefore emphasise the ingenuity of the firm’s products. The American artificial-​limb makers were not the only ones to utilise literature in the nineteenth century. Indeed, from the mid-​century, when the fashion for artificial hair was at its height, British wig makers such as Thomas Elliott and ‘Professor Brown’ used poetry for advertising purposes.56 On one of Elliott’s circa-​1860 posters, he included a ballad entitled ‘The Baffler of Time’, which pondered ’Tis rueful when we think how Time pursues his reckless way, In hast’ning Locks on youthful heads to premature decay; And as for older heads, not he would let a hair remain, If Art or Science could not check his too encroaching reign.57

130

130

Rethinking modern prostheses

On his 1863 poster, on the other hand, ‘Professor Brown’ used a poem written ‘In something like a measur’d verse’ to assure readers that ‘Hereafter you’ll patronize no one but Brown, /​And soon have fine Tresses of Hair’ (1863). This poem capitalised on the anxieties of ‘incomplete’ women evoked by contemporary marriage plots, such as ‘Kitty the Careless’ or ‘Was She False?’, while also using such stories as familiar and popular frameworks for expressing more commercially driven messages about prostheses. These literary components of nineteenth-​century prosthesis advertising promised female users restored youthfulness, beauty and the ability to go unnoticed as ‘incomplete’ women. Such poems used witty verse to make the eponymous devices of wig makers memorable while emphasising the link between women and the necessity to erase visible physical ‘defects’. Corresponding with the increase in medical trade catalogues towards the end of the nineteenth century identified by Jones, other literature to do with prosthetics responded directly to such commercial messages and the commodification of artificial body parts. Such sources can be read in context with the ethical resistance to medical advertising described by Anne Digby and Jones.58 The 1881 Punch poem ‘To Lydia’s Glass Eye’, for instance, includes an epigraph quoted from The Times that explains, ‘From particulars supplied to the reporter of a Chicago paper by a dealer in glass eyes in that city, it appears that there are as many as a thousand wearers of these eyes in Chicago.’59 The subsequent poem purports to be a poetic advertisement for a Chicago ocularist and draws from both contemporary marriage plots that include prosthesis users and the commercial poetry published by prosthesis makers as it comically portrays a glass-​eye-​using speaker addressing his lover, who also wears a glass eye. The poem evokes an ironic degree of tenderness centring on the speaker and subject’s mutual use of glass eyes –​‘Wink at me only with glass eye, /​And I respond with mine’ –​which it rebuts with grotesque imagery intended to draw the reader’s attention to the unnaturalness of artifice: ‘smile not when the harmless fly /​Goes crawling over thine.’ The poem also mocks the commercial rhetoric of contemporary prosthesis manufacturers as the speaker tells his lover, I sent thee late a new glass eye, Impervious to the tear, Tinged with some new aesthetic dye, And quite ‘too utter’ dear.60 Here the poem directly evokes contemporary ocularists, who, like artificial limb, teeth and hair makers made bold claims about the abilities of their devices to mimic nature, function correctly and resist wear and tear. Indeed, in the 1850s and 1860s, French artificial-​eye maker Auguste Boissonneau, who

13

Prostheses for women in literature and commerce

131

was very much a market leader in Europe at the time, described in his 1854 British patent specification an important innovation that made his artificial eyes, to use the words of the Punch poem, ‘impervious to the tear’: ‘[by means of a notch or aperture] on any point of the inferior palpebral section of the artificial eye[,]‌… communication is established between the internal and external parts of the artificial eye which prevents the stagnation and decomposition of the tears in the concavity of the eye’.61 In less technical terms, Boissonneau’s 1864 Saturday Review of Politics, Literature, Science and Art advertisement posited ‘the unpleasant, dirty appearance of a glass eye’ against his superior enamel artificial eyes.62 It seems to be such bold claims and the use of jargon seen in contemporary advertisements that make the prosthesis market the target of Punch’s humour in ‘To Lydia’s Glass Eye’. However, in spite of its satirising of the contemporary prosthesis market, ‘To Lydia’s Glass Eye’ supports the status quo expressed in contemporary marriage plots regarding female prosthesis visibility. The final lines of this poem use an absurd image to mock the sexual allure of female prosthesis users, thus reminding the reader of the importance of imperceptible prostheses: You’ll wear it, won’t you, when you think How faithful it must be, For it is warranted to wink At nobody but me?63 By drawing ironic attention to the possible unfaithfulness of the speaker’s glass-​eyed lover, mischievously hinting that the woman might be the subject of other men’s winks, the reader is subconsciously reminded of the imperative for prostheses, in particular for female users, to enable wearers to defy detection as individuals who are physically ‘incomplete’. Conclusion As we can see from the range of fictional texts explored in this chapter, literature intersected with the contemporary prosthesis market in a number of ways: it echoed and cashed in on messages directed at women in commercial texts that advised that more silent/​indivisible prostheses were superior; it suggested that women should avoid outdated and frankly dangerous devices, such as partial dental plates, as well as ostentatious prostheses, such as overly white false teeth, which could jeopardise their anonymity as invisible prosthesis users; it provided catchy lyrics, memorable images and endorsements of devices when commissioned for advertising purposes or when hijacked for similar commercial endeavours; it provided a critique of the contemporary prosthesis market,

132

132

Rethinking modern prostheses

which was seen by some as hyperbolic in the claims that it made regarding the reparative capacities of devices and by others as an industry that dubiously thrived through encouraging fraudulence and deception. Though the relationship between literature and the prosthesis market was certainly complex, literature provided a conflicting but nonetheless socially informed guide for selecting prostheses in nineteenth-​century Britain and America. Above all, literary texts and the prosthesis market together propounded the troubling ableist message that women who could best conceal their physical imperfections were better off in the world than those that could not convincingly hide their physical losses. The representation of female prosthesis users in popular culture continues today but with more mixed perspectives. Films such as De rouille et d’os (Rust and Bone, 2012, dir. Jacques Audiard) strip away the problematic prosthesis mandate for concealment. Audiard’s film documents the day-​to-​day struggles that the former orca trainer Stephanie (played by Marion Cotillard) has with her two artificial legs, while showing how an acceptance of her physically altered state, something facilitated by her relationship with street fighter Ali (played by Matthias Schoenaerts), brings her happiness and contentment. De rouille et d’os also eroticises the amputee, shifting and intensifying the kind of fascination displayed towards disabled women in earlier narratives. The film resists a technophilic narrative of passing as it suggests that human relationships and acceptance are the most effective prostheses for limb loss. Meanwhile, representations such as Jaime Sommers, in Kenneth Johnson’s 2007 revamped NBC version of The Bionic Woman, endorse a lingering desire for prostheses to eradicate the appearance of physical loss. In this television series, Sommers (played by Michelle Ryan) is ‘rebuilt’ following a life-​ threatening car accident using state-​of-​the-​art prostheses and implants. This use of technology not only makes her physical capabilities magnificent but also renders her injuries invisible. Representations like this –​though progressive from one perspective since they endorse a robust form of femininity –​validate attempts to eradicate disability via a medical model, which sees physical loss as a potentially fixable issue. In this sense, then, the troubling conceptual tie between female prosthesis users and attempts to render physical loss invisible lingers in the twenty-​first century. Acknowledgements I am very grateful to the editor and anonymous peer-​reviewers of this book whose suggestions helped to shape the chapter into the piece that it is today.

13

Prostheses for women in literature and commerce

133

Notes 1 K. Twelbeck, ‘The nurse, the veteran, and the female scientist:  dependency and separation’, European Journal of American Studies, 10:1 (2015), 2–​15, at 10. 2 A. Hill, John Smith’s Funny Adventures on a Crutch (Philadelphia, PA: J. E. Potter, 1869), 20, 173. 3 O. Wendell Holmes, ‘The human wheel, its spokes and felloes’, in Sounds from the Atlantic (Boston, MA: Ticknor & Fields, 1864), 318. 4 E. O’Connor, Raw Material:  Producing Pathology in Victorian Culture (Durham, NC: Duke University Press, 2000), 124. 5 See L. Herschbach, ‘Prosthetic reconstruction:  making the industry, re-​making the body, modelling the nation’, History Workshop Journal, 44 (1997), 23–​57; O’Connor, Raw Material; S. Mihm, ‘A limb which shall be presentable in polite society:  prosthetic technologies in the nineteenth century’, in K. Ott, D. Serlin and S. Mihm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 282–​99. 6 O’Connor, Raw Material, 117–​43. 7 See K. E. Gardner, ‘From cotton to silicone: breast prosthesis before 1950’, in K. Ott, D. Serlin and S. Mihm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 102–​18; M. Smith, ‘The vulnerable articulate:  James Gillingham, Aimee Mullins, and Matthew Barney’, in M. Smith and J. Morra (eds), The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future (Cambridge, MA: MIT Press, 2006), 43–​73; V. Warne, ‘“To invest a cripple with peculiar interest”: artificial legs and upper-​class amputees at mid-​century’, Victorian Review, 35:2 (2009), 83–​100; G. Ofek, Representations of Hair in Victorian Literature and Culture (Farnham: Ashgate, 2009). 8 Smith, ‘The vulnerable articulate’, 54. 9 Gardner, ‘From cotton to silicone’, 116. 10 Ofek, Representations of Hair, 9–​16, 118–​30 and 202–​7. 11 C. LaCom, ‘“Is it more than lame?” Female disability, sexuality, and the maternal in the nineteenth-​century novel’, in S. L. Snyder and D. T. Mitchell (eds), The Body and Physical Difference: Discourses of Disability (Ann Arbor, MI: University of Michigan Press, 1997), 189–​201, at 190. 12 See R. Garland-​Thomson, Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature (New York, NY: Columbia University Press, 1997), 27. 13 M. Stoddard Holmes, Fictions of Affliction: Physical Disability in Victorian Culture (Ann Arbor, MI: University of Michigan Press, 2004), 69. 14 J. A. Brune and D. J. Wilson (eds), Disability and Passing: Blurring the Lines of Identity (Philadelphia, PA: Temple University Press, 2013), 1. 15 Brune and Wilson, Disability and Passing, 4–​5. 16 D. Linton, ‘The menstrual masquerade’, in J. A. Brune and D. J. Wilson (eds), ­Disability and Passing:  Blurring the Lines of Identity (Philadelphia, PA:  Temple ­University Press, 2013), 58–​70, at 58.

134

134

Rethinking modern prostheses

17 See M. Poovey, Uneven Developments: The Ideological Work of Gender in Mid-​Victorian England (Chicago, IL: University of Chicago Press, 1988); S. Shuttleworth, Charlotte Bronte and Victorian Psychology (Cambridge: Cambridge University Press, 1996). 18 See L. J. Davis, Enforcing Normalcy:  Disability, Deafness, and the Body (London: Verso, 1995). 19 Stoddard Holmes, Fictions of Affliction, 68. 20 See B. Haley, The Healthy Body and Victorian Culture (Cambridge, MA: Harvard University Press, 1978), 4; O’Connor, Raw Material, 103–​5. 21 See A. Walker, Beauty: Illustrated Chiefly by an Analysis and Classification of Beauty in Woman (London: Effingham Wilson, 1836); H. Ellis, Man and Woman: A Study of Human Secondary Sexual Characters (London: Walter Scott, 1904); C. Heinirch Stratz, Die Schönheit des weiblichen Körpers, 14th edn (Stuttgart: F. Enke, 1903). 22 The penchant for emphasising functionality in the marketing of artificial limbs in the nineteenth and twentieth centuries is explored in depth by Julie Anderson in Chapter 8 in this collection. 23 Quoted in G. E. Marks, A Treatise on Marks’ Patent Artificial Limbs with Rubber Hands and Feet (New York, NY: A. A. Marks, 1888), 346. 24 See J. F. Stark, ‘Recharge my exhausted batteries:  Overbeck’s Rejuvenator, patenting, and public medical consumers, 1924–​37’, Medical History, 58:4 (2014), 498–​518. 25 Marks, A Treatise, 111. 26 See J.  Olsen Padilla, ‘Army of “cripples”:  Northern Civil War amputees, disability, and manhood in Victorian America’, Ph.D.  dissertation, University of Delaware, 2007. 27 In 1888, Marks’s top-​of-​the-​range devices could be purchased for between $65 and $100. According to measuringworth.com, $100 for a commodity in 1888 is relative to the ‘real price’ of $2,570 in 2014. See www.measuringworth.com/​uscompare (accessed 6 May 2016). 28 Quoted in Marks, A Treatise, 312. 29 See Mihm, ‘A limb which shall be presentable’; K.  Ott, ‘Hard wear and soft tissue:  craft and commerce in artificial eyes’, in K. Ott, D. Serlin and S. Mihm (eds), Artificial Parts, Practical Lives:  Modern Histories of Prosthetics (New  York, NY: New York University Press, 2002), 147–​70. 30 Quoted in Marks, A Treatise, 155. 31 W. Chambers, ‘The wooden leg’, Chambers’s Journal of Popular Literature, Science and Arts, 685 (1877), 81–​2, at 82. 32 Quoted in Marks, A Treatise, 287. 33 W. Blanchard Jerrold, ‘Eyes made to order’, Household Words, 4:81 (1851), 64–​6, at 64. 34 ‘The false hair’, Chambers’s Journal of Popular Literature, Science and Arts, 396 (1861), 65–​7, at 65. 35 J. Woodforde, The Strange Story of False Teeth (London: Routledge & Kegan Paul, 1968), 3.

135

Prostheses for women in literature and commerce

135

3 6 ‘Kitty the Careless’, Judy (1 August 1883), 50. 37 Woodforde, The Strange Story, 69–​74, 77. 38 Woodforde, The Strange Story, 69–​75. 39 R. H. Rozenzweig, ‘False teeth swallowed’, British Medical Journal, 2:1614 (1891), 1204. 40 ‘Curt comments’, Fun, 835 (1881), 187. 41 ‘Kitty the Careless’, 50. 42 Woodforde, The Strange Story, 77–​8. 43 For more Judy’s readership, see J. Don Vann, ‘Comic periodicals’, in J. Don Vann and R. T. VanArsdel (eds), Victorian Periodicals and Victorian Society (Toronto:  University of Toronto Press, 1994), 285; H. Hansson, ‘Punch, Fun, Judy and the polar hero:  comedy, gender and the British Arctic Expedition 1875–​76’, in C. DeVine and M. Ann Wilson (eds), North and South:  Essays on Gender, Race and Region (Newcastle:  Cambridge Scholars Publishing, 2014), 67. Partial plates could be purchased for as little as 2s 6d per tooth in 1883. According to www.measuringworth.com/​ukcompare, such a price for a commodity in 1883 is relative to the ‘real price’ of £11.24 in 2014 (accessed 6 May 2016). The price for ‘American dentistry’, by contrast, was seldom advertised, reflecting, perhaps, not only its bespoke form but also its higher cost. For example, see advertisement for Mr. Hogg, consulting dentist, Sheffield and Rotherham Independent, 1 January 1883, 1. 44 A. M., ‘Was She False?’, London Reader of Literature, Science, Art and General Information, 26:656 (1875), 75–​6. 45 Jerrold, ‘Eyes made to order’, 64. 46 For more on Miss Kilmansegg’s popularity, see Warne, ‘ “To invest a cripple” ’, 95–​6. 47 Warne, ‘ “To invest a cripple” ’, 89. 48 T. Hood, ‘Miss Kilmansegg and Her Precious Leg’, in J. Clubbe (ed.), Selected Poems of Thomas Hood (Cambridge, MA: Harvard University Press, 1970), l. 817, 1167–​9. 49 Quoted in J. S. Drake, Drake’s Patent Artificial Legs, Hands, Arms, &c. (Boston, MA: J. Drake, 1859), 45. 50 Marks, A Treatise, 8. 51 A. A. Marks, Marks’ Patent Artificial Limbs with Rubber Hands and Feet (New York, NY: A. A. Marks, 1886), 27. 52 Marks, A Treatise, 397. 53 C. L. Jones, The Medical Trade Catalogue, 1870–​1914 (London: Pickering & Chatto, 2013), 146–​50. 54 Quoted in Marks, A Treatise, 287. 55 Quoted in Marks, A Treatise, 169. 56 Ofek, Representations of Hair, 37–​8. 57 Wellcome Library, London, EPH 160 B, Hair care box 9, poster, T.  Elliott, ‘The Baffler of Time’, c.1860. 58 A. Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720–​1911 (Cambridge:  Cambridge University Press, 2002), 39–​68; Jones, Medical Trade Catalogue.

136

136

Rethinking modern prostheses

5 9 ‘Glass Eyes’, The Times, 13 April 1881, p. 11. 60 ‘To Lydia’s glass eye’, Punch, 30 April 1881, 193. 61 A. Boissonneau, ‘Artificial eyes’, UK Patent No. 1,715, issued 1855. 62 ‘A . Boissonneau’s artificial eyes’, Saturday Review of Politics, Literature, Science and Art, 18:462 (1864), 314. 63 ‘To Lydia’s glass eye’, 193.

137

6

ITINERANT MANIPULATORS AND PUBLIC BENEFACTORS: ARTIFICIAL LIMB PATENTS, MEDIC AL PROFESSIONALISM AND THE MORAL ECONOMY IN ANTEBELLUM AMERIC A Caroline Lieffers ‘The legal right is, of course, not disputed; the moral right is by no means so clear.’ So wrote Robert Arthur, a professor at the Philadelphia College of Dental Surgery, in 1853.1 Arthur was referring to the practice of patenting, which was at the centre of contentious debates to define ethics and etiquette in a variety of health professions in nineteenth-​century America. The legal right was in black and white in the US Constitution, which empowered Congress to establish patent laws in order to ‘promote the Progress of Science and useful Arts’; the country passed its first Patent Act in 1790.2 The 1847 code of ethics of the American Medical Association (AMA), however, deemed it ‘derogatory to professional character … for a physician to hold a patent for any surgical instrument, or medicine’.3 This clause was intended to assert the authority and integrity of America’s orthodox physicians in contrast to the perceived secrecy, monopoly and profiteering of their assorted rivals, but it also articulated a clear –​though not unchallenged –​point of professional reference for other players in the chaotic marketplace of nineteenth-​century American health and medicine.4 This chapter examines how one such player, B.  Frank Palmer, balanced these two injunctions –​progress and professionalism –​by asserting his patent’s unique moral position.5 Palmer, who lost a leg in a childhood accident, received the first patent for an artificial limb in the United States in November 1846 (Figure 6.1) and was one of the most celebrated manufacturers of prostheses in antebellum America. While Ryan Sweet’s chapter examines prostheses such as Palmer’s through a literary and cultural lens, the inventor’s entrepreneurial strategies take centre stage here. Though he had no formal medical training, Palmer, as the first part of this chapter demonstrates, owed much of his success to his ability to cast himself in the role of ‘surgeon-​artist’,

138

138

Rethinking modern prostheses

Figure 6.1  Drawing from B. F. Palmer’s 1846 patent of his artificial leg, US Patent No. 4834.

139

Patents, professionalism and the moral economy

139

a craftsman-​cum-​medical professional who worked in partnership with the operating surgeon. This ambiguous position was also an advantageous one. By situating himself in a field inflected but not wholly defined by medical expertise, Palmer could simultaneously demonstrate inventive know-​how and surgical and scientific knowledge in a society that privileged and remunerated both. He built a business of remedying physical impairments on the monopoly assured by his patent, while avoiding the ethical encumbrances that dogged physicians who might attempt to do the same. Palmer’s ambiguous position, making prosthetic devices at the fringes of medical authority, also puts him at a significant historiographical crossroads. Disability history and the history of medicine emerged from distinct political and academic traditions, particularly as disability activists rejected a model that privileged medicine’s attempts to correct impairments in favour of one that understood disability as a matter of social barriers.6 Certainly Palmer’s desire for medical approval calls up medicine’s often-​maligned historical power to define and intervene upon people with disabilities. Yet, as the second part of this chapter demonstrates, Palmer ultimately sought a professionalism in parallel with the medical establishment that reified his unique expertise and compassion, and he testified to the importance of the patent as an institution for asserting this professionalism and relieving amputation’s attendant problems of poverty and suffering. ‘Beyond the question of whether medicine and the medical model is bad or good, lies a long historical, dynamic and multifaceted moral terrain’, writes Julie Livingston, and Claire L.  Jones’s introduction to this volume clearly convinces us of the value of mapping it.7 Palmer supported his aspirations to professional stature through appeals to the moral economies of medicine and patenting alike, and his case allows us to historicise the medical model’s versatility and complexity, as well as its now-​notorious strength. Historians and sociologists have frequently used the concept of moral economy, adapted from E. P. Thompson’s analysis of eighteenth-​century food riots, in their examinations of the scientific community’s shared expectations, assumptions and obligations, which cannot be adequately explained by market exchange, ideology or political interests.8 Similarly, the history of medicine captures practitioners’ ongoing struggles to find the moral balance between ‘medicine as an art in service of humanity, and medicine as a commercial endeavour, engaged in primarily for the profit of its practitioners’, as Robert Baker puts it.9 This tension between collective and individual interests is particularly salient in matters of intellectual property. Katherine J.  Strandburg demonstrates how physicians often looked to alternative systems of credit and reward, preferring to think of their profession as adhering to a ‘sharing norm’.10

140

140

Rethinking modern prostheses

Jaipreet Virdi, moreover, shows how appliances and their patents could serve strategic functions for medical professionals, helping them assert priority and take credit for inventions, control procedures and even legitimate their surgical specialties.11 Physicians and other researchers might also consent to have their patents managed by institutions in order to serve the greater public good, as was the case with insulin.12 Palmer’s patent represents more than a new disciplinary twist in this longer history. By drawing on a unique source –​patent extension files –​this chapter demonstrates more specifically how an ambitious entrepreneur might use the ideals and protection of the patent system to claim his own brand of professional authority. The US 1836 Patent Act specified that the term of a patent was fourteen years, with the possibility of an additional seven-​year extension. Extension came down to a matter of judgement: with ‘due regard to the public interest’, if the patentee ‘without neglect or fault on his part, [had] failed to obtain, from the use and sale of his invention, a reasonable remuneration for the time, ingenuity, and expense bestowed upon the same, and the introduction thereof into use, it shall be the duty of the Commissioner to renew and extend the patent’.13 Patent extension files can thus offer rare assessments of whether the patent was serving its public purpose, how that purpose was defined and what constituted fair reward; in short, they hint at the patent system’s economic –​and moral economic –​ underpinnings.14 In requesting an extension in 1860, Palmer and his attorney mounted a sophisticated argument that used the patent as a kind of social contract to assert the surgeon-​artist’s exclusive, expert and philanthropic character, supporting a benevolent professionalism in close parallel with that of the AMA. The institution of the patent was thus pressed to serve Palmer’s claims to medical and social authority, working as a national currency of credibility and moral legitimacy. Yet Palmer’s patent extension application also strategically acknowledged the limb’s monetary service to American society, casting the moral work of resolving impairment into the fiscal terms most legible to the Commissioner of Patents. This chapter concludes by reflecting on how the patent was presented as serving the public interest not only in lofty rhetoric but also hard budgetary assessment, operating within both the moral and monetary economies of debility. Palmer’s model was medical, offering a material solution to the perceived problem of impairment, and it also appealed to larger social calculations. The surgeon-​artist’s professionalism depended on an ethic of beneficent contribution to the public good, underwritten by the authority of medicine, protected by the patent and measured against the costs of charity.

14

Patents, professionalism and the moral economy

141

The ‘surgeon-​artist’: a productive hybridity The aptly named Benjamin Franklin Palmer embodied nineteenth-​century American virtues of inventiveness and self-​sufficiency. An 1854 profile in the Scalpel declared that he was born some thirty years earlier in New Hampshire to ‘excellent but poor parents’. Undaunted by his childhood injury, the biographer explained, Palmer’s ‘abhorrence of pity, and self-​reliance’ determined his fate.15 Dissatisfied with the best available artificial limbs, he made his own, carving a leg out of willow and installing internal bolts, springs and tendons so that the knee and foot would move in synchronisation. He took his invention to the National Fair for the Exhibition of American Manufactures in Washington, DC, in May 1846 and returned home to establish a small shop, which he later relocated to Springfield, MA. By the 1850s, he was manager of Palmer & Co.’s central office in Philadelphia, while Erasmus Darwin Hudson, a surgeon, headed a New York City location and another partner took charge of the Massachusetts branch, which soon moved to Boston. Earlier artificial-​leg makers were often trained as carpenters, metalworkers or boot makers, and, though the Scalpel lauded Palmer’s work, it classed him undeniably as an artisan, calling his limb ‘a triumph of mechanical skill of which our country may be proud’.16 Between 1846 and 1873, Palmer would file six patents for artificial legs and arms, cementing his commitment to an American ideal of mechanical progress.17 Indeed, with a streamlined bureaucracy and low financial barriers, the American patent system, as Zorina Khan convincingly contends, was ‘motivated by the democratic belief that everyone, regardless of social status or economic standing, could make a valuable contribution to social welfare’ through invention.18 Yet Palmer was also an aggressive publicist and self-​promoter, skilled at controlling his public image through a blend of sentimental prose and scientific posturing. He could call up his own injury to emphasise his strength of character, empathy or impressive appearance of ‘wholeness’, but from the outset of his career he also hastened to define himself as something akin to a medical professional. In contrast to the ‘itinerant Manipulator … standing at the Railroad-​crossing waiting for a victim’, Palmer called himself a ‘surgeon-​artist’, a step above the already-​established ‘surgical mechanician’, an expert who applied devices such as trusses and braces.19 Though both appellations emphasised the hybridity of artisanal and medical skills, ‘surgeon-​artist’ seemed to share the surgeon’s status and evoked ancient characterisations of medicine and surgery as ‘arts’. Medical trade catalogues, as Jones has noted, frequently imitated medical reference books, and Palmer similarly produced a series of advertising

142

142

Rethinking modern prostheses

pamphlets under the guise of medical journals to gain purchase with both medical colleagues and the public.20 Palmer’s Artificial Leg Reporter and Surgical Adjuvant, the Bane and Antidote (a reference to amputation –​‘the bane of an eminent and humane profession’ –​and the artificial limb) and the Orthopedic or Artificial Leg Reporter were filled with ‘scientific documents’, as Palmer labelled them, which endorsed both his product and his expertise.21 Framing his craft as a systematic ‘science’ mirrored the medical profession’s rhetorical appeal to this term as ‘a code-​word for a methodology, a designation for specialised expertise, and a vehicle for social mobility’, as S. E. D. Shortt puts it.22 In an essay entitled ‘Compensatory Art’, Palmer asserted the importance of similar scientific professionalism in the field of artificial limbs: To imitate successfully a human member (so beautiful in its external form and complex in its internal mechanism) with inanimate bones, muscles, tendons, and cuticles, requires no small degree of anatomical, surgical, and artistic knowledge. For this knowledge we have been studying and laboring with the hope, by the aid of efficient colleagues, of ultimately placing the Profession on a level with the highest –​a position to which its importance entitles it. The Scientific Surgeon who skillfully removes the obnoxious limb, and the competent Surgeon-​ Artist who successfully replaces the same, should be regarded as filling offices of coördinate importance, and each should be the colleague of the other.23

Palmer explicitly termed his work a ‘Profession’, recalling the traditional learned professions of law, medicine and the clergy. As Bruce A.  Kimball observes, the popular American Panorama of Professions and Trades (1837), which included nearly 100 vocations, ‘applied the term “profession” only to ministers, lawyers, and doctors, denominating the rest as “trade,” “art,” “employment,” or “business” ’.24 Though the word was occasionally used more broadly, Palmer’s choice to capitalise it suggests a self-​conscious attempt to align his work with that of his surgical counterparts. Conspicuous allusions to the history of surgery, contemporary medical literature and Latinate anatomical terms throughout his so-​called ‘journals’ further secured his association with arcane and expert knowledge, gained through study rather than simply empirical observation and trial. Palmer also employed the title ‘doctor’ consistently after receiving an honorary doctor of laws from the Western University of Pennsylvania in 1864.25 As he carved out a reputation for his new profession, Palmer was especially proud of his artificial leg’s influence on surgical practice. He distributed his brochures freely, was invited to numerous college clinics and hospitals, and was delighted when major figures such Thomas Mütter and Joseph Pancoast displayed his models and endorsed his invention in their classes at Jefferson

143

Patents, professionalism and the moral economy

143

Medical College in Philadelphia, often in conjunction with their lectures on amputation.26 Earlier surgeons had often amputated higher on the limb to facilitate the fitting of a peg leg, but Palmer recommended leaving, in most cases, as much of the limb intact as possible, in keeping with a trend towards more conservative surgery. His medical colleague Hudson likely helped him devise ideal ‘places of election’, which the men published in almost every promotional brochure; Palmer contended that these rules were ‘generally adopted by the Medical Faculty’.27 Working with surgeons at Jefferson College, his firm even helped counsel patients to undergo elective amputations or re-​amputations to facilitate the fitting of artificial limbs. Palmer and Hudson also engaged explicitly with the latest medical news so that they might refine their expertise. After reading that the Scottish surgeon James Syme was performing a new amputation at the ankle joint, for example, Palmer expressed his wish that a surgeon who had performed the operation might furnish the firm with a patient so that they could report on their limb’s compatibility with the technique.28 Palmer’s association with medical authority soon led to conflation. In a review of the Bane and Antidote published in the Boston Medical and Surgical Journal in 1855, Palmer was listed as the Bane and Antidote’s sole author, and long passages likely informed by Hudson’s surgical expertise were attributed to him alone.29 Palmer further secured his connection with the medical profession by showing his appliance at dozens of fairs and exhibitions, and he quoted reports from the juries –​usually made up of noted physicians and surgeons –​in his journals and pamphlets. At the Great Exhibition in London in 1851, for example, Palmer won a coveted prize medal granted by a panel that included William Lawrence, former president of the Royal College of Surgeons and Surgeon to St Bartholomew’s Hospital, and Philibert Joseph Roux, surgeon-​in-​chief at the Hôtel-​Dieu in Paris. Such accolades helped secure the limb’s reputation in the United States, where elite surgeons such as Henry J. Bigelow had already endorsed it, and Palmer also liaised with the Marquis of Anglesey, wooed the elite British medical community and was even invited to a conversazione at the Royal College of Surgeons.30 These personal connections meant more business and publicity: Palmer met The Lancet editor Thomas Wakley, for example, and an article in that journal soon followed.31 Palmer could multiply the effect by reprinting such puff pieces in his own publications under the banner of medical authority. Surgeons, for their part, had much to gain from working with the artificial-​ limb purveyor. Their reputations as humane healers rested not simply on the patient’s survival but also on the quality of their experience, particularly as the profession moved towards a more cautious and sympathetic style of practice.32 Palmer was well aware of this shift. He commented that ‘[we] recognize in the sensitive Surgeon the deepest and purest sentiment of beneficence; and we

14

144

Rethinking modern prostheses

have no higher earthly aspirations than to earn an honorable reputation among the devotees of this pre-​eminent Profession’.33 This lofty language ingratiated him towards the men who provided him with patients, but, by flattering surgeons’ awareness of their own progress, Palmer could also elevate his work to the same plane as theirs. He wrote, ‘A glance at the achievements in operative and mechanical surgery may, at this time, gratify the humane Surgeon who is seeking such truth in a collateral science as is essential to his own reputation, and indispensable to the welfare of his Patient.’34 The surgeon and the surgeon-​ artist shared progressive, idealistic views as well as practical cooperation, and their efforts were mutually dependent. Palmer also added his own rhetoric of civilisation’s advancement: ‘In this age of progress’, he began, when art is becoming more and more the hand-​maid of nature and subservient to the comfort, interest, and happiness of mankind, … the surgeon embracing intelligence and humanity, will have a single and well directed eye to the highest usefulness of his patient, when called to amputate a limb, by enabling art to perform her perfect work, in restoring nature’s loss so far as possible.35

If not wholly medical, Palmer’s art and science were crucial complements to a surgical art and science whose reputation had been similarly enhanced by the achievements of another inventor at the fringes of the profession, the dentist William Morton. In association with Charles Jackson, Morton received a patent for ether inhalation only a week after Palmer’s artificial limb.36 Palmer deemed Morton ‘the glorious synonym of humanity’ and emphasised their shared roles in bringing surgery to its highest development.37 The surgeon-​ artist’s work was an extension of a larger endeavour: the benevolent alleviation of suffering. The ether patent, however, was not without controversy, as it represented an attempt to monopolise a valuable medical discovery.38 Physicians, dentists and artificial-​limb manufacturers alike had to find the line between the legal and the moral right. Was patenting’s financial incentive necessary for progress? Did patents unjustly limit access to important discoveries? In the 1850s, the stance of the AMA was firm, as it further resolved that no state or local society would be entitled to representation in the AMA unless they adopted its code of ethics –​including the notorious patent clause.39 The AMA’s code of ethics was undoubtedly intended to secure professional exclusivity, but it strove to protect the public interest too.40 Insistence on regular education, for example, was ostensibly meant to protect both patients and professionals from what the AMA deemed to be unprincipled quacks and sectarians. And, while the code encouraged uniform fees, the notion of physicians’ philanthropic service, one of the oldest qualities of a professional, continued to hold firm: ‘Poverty’, the

145

Patents, professionalism and the moral economy

145

code declared, ‘should always be recognised as presenting valid claims for gratuitous services … [which] should always be cheerfully and freely accorded.’41 The prohibition on patents, in this reading, was a similar effort to correct or even extract medicine from a marketplace in which both parties might exploit and be exploited, moving it away from a monetary economy and towards a moral one. Yet these rules met  almost immediately with violation, opposition and denial, not least in the artificial-​limb business. Douglas Bly, a physician from Rochester, New York, for example, patented his first artificial leg in 1857, with a number of variations thereafter.42 Hudson, who managed Palmer’s New York office, left the partnership in 1860 but continued to sell patented Palmer legs, along with some of his own modifications. In May 1862, the American Medical Times mentioned both doctors in an editorial; the journal’s editor and likely author of the piece, Stephen Smith, was a noted surgeon at New York’s Bellevue Hospital. While he deemed the application of mechanical devices to be ‘a legitimate branch of the healing art’, he added that Rationally, the Mechanical Surgeon, or the ‘Surgeon Artist’, to use an elegant phrase, must be a thoroughly educated physician as well as an inventive genius. … The medical profession have too long regarded mechanical surgery as the legitimate field of non-​medical men, or medical speculators in patents. … But medical men of real merit have begun to enter this field of improvement, and already the ripe fruits of skilled labor begin to appear.43

The author cited Bly’s and Hudson’s achievements, while encouraging the profession to condemn ‘the uneducated pretenders in this department of surgery, who throng our cities, and trumpet their wares in every market’.44 But this emphasis on medical education left Palmer in uncertain territory. The term ‘Surgeon Artist’ was lifted directly from the young inventor, and Smith’s endorsement of ‘Messrs. Palmer & Co’.s Artificial Limbs’ appeared regularly in Palmer’s advertisements and brochures.45 But while the product he endorsed was Palmer’s, as assured by the patent, Smith was based in New York: the work he endorsed was probably Hudson’s.46 The article’s position on patents was even more ambiguous. ‘If the profession recognise the claims of this branch of the healing art, and take under its protection those who devote themselves to it, there will be no need of patents to insure to an inventor the honest proceeds of his labor and study.’47 The patent was an ethical inconvenience that could be obviated by the medical community’s support, particularly if these devices stayed in the hands of fellow physicians and surgeons. While Hudson held only one patent (for an apparatus for exsections, not granted until 1865), the writer evidently overlooked

146

146

Rethinking modern prostheses

Bly’s offence of filing multiple patents.48 He was not alone. Although the Medical Society of the State of New York adopted the same ban on patents as the AMA, Bly was Monroe County’s delegate to both the state society and the AMA in 1862, and the state society published his article on amputation sites.49 Other physicians and surgeons were less concerned about the surgeon-​ artist’s level of medical training, perhaps because his appliance was so clearly mechanical. Palmer received endorsements from D. Humphreys Storer, Samuel Gross, Charles A. Pope and Alden March, each of whom served as president of the AMA. Others cheered the inventor’s pioneering spirit, and his convenient position just outside the AMA’s bailiwick absolved them of any requirement to condemn his patent. But Smith’s fear of ‘uneducated pretenders’ was not idle, and Palmer himself veered well beyond the bounds of gentlemanly and professional propriety by reproaching competitors and violators of his patent. Richard Clement, a close associate who in fact stood as a witness for Palmer’s 1846 patent, set up his own business with the claim that he had personally manufactured the Palmer limb that won the prize medal at the Great Exhibition in London in 1851.50 Palmer responded obliquely to this assertion by republishing an 1846 commendation of his limb, ‘before he had any associates in the business’, in his advertising material. He noted, ‘It is indeed gratifying to the Inventor, at this time, when for the first instance his ability to construct his own Patent is called into question by mountebanks and piratical copyists, to fall back upon the old record.’51 Palmer’s greatest rivals were perhaps his former workmen Benjamin Jewett and Darwin DeForrest Douglass, who now sought their own shares of the market. Jewett received his patent in 1857, with explicit notes on how his model differed from his former supervisor’s.52 Palmer, however, believed Jewett’s product to be pirated and tried to sue him, even travelling to Chicago in the summer of 1859 to bring his opponent to court, but Jewett had already left the city. Palmer later claimed that Jewett was ‘under heavy bonds’ for violation of his patent, but the pirate evidently escaped serious prosecution and in the 1860s claimed cheekily that inferior, weaker products were being ‘palmed’ among amputee soldiers.53 Douglass set up in Springfield, and he and Palmer were involved in a row in the Boston Medical and Surgical Journal in 1859. A letter supporting Palmer asserted that the Douglass leg was nothing more than a copy and claimed (wrongly) that it would probably never be granted a patent. The public, it declared, should not be deceived by such ‘charlatans and pretenders’.54 While hurling accusations and cautioning rivals to ‘stand upon their own legs’ was probably unbecoming of a quasi-​medical professional, Palmer was quick to explain why the patent was so in need of protection.55 In a long

147

Patents, professionalism and the moral economy

147

essay cautioning against infringements, which featured prominently and repeatedly in his advertising brochures in the 1850s, he stated that violators, particularly his former and inferior workmen, not only damaged his reputation and exploited his investments of ‘toil and study’ but also committed an injustice against those most in need of good care.56 These manufacturers’ only goal, he claimed, was ‘pecuniary gain’, although this was a somewhat specious insult from an inventor who also averred that his patents ‘have cost too much and are too valuable to admit of such practice’.57 But Palmer insisted that his infringers’ flaws were most evident in how they treated their own work and the complementary field of surgery. When their factitious inventions were excluded or overlooked by expert judges at major competitions and exhibitions, ‘failing of encouragement in the only circles where success can be reliably established, [they] go out into the highways for patients, and make rude remarks about scientific men, who, knowing their duty as impartial jurors and the incompetency of these mechanics, speak of their work and themselves as they deserve’.58 The approval of the medical faculty, as well as behaviour in keeping with its standards of professional conduct, was the best testament to a surgeon-​artist’s work. Indeed, as the next section will attest, Palmer was able to assert this expertise and professionalism not in spite of his patent, but because of it. Patents, professionalism and moral economy When it came to conduct, endorsements and partnerships, Palmer sought validation from the established medical profession. The patent was clearly a departure, grounded in his extra-​medical position. As the end of its fourteen-​ year term in November 1860 drew near, the inventor hired the noted Washington patent attorney Charles F. Stansbury (who had also helped manage the American display at the Great Exhibition) to plead his case for a seven-​year extension. Patents were a simple institution with the complex task of ensuring the greater social welfare: inventors had to be induced to develop new contributions, but the system must not hinder their diffusion or other innovation. Patent rights ideally ensured both progress and the public good. The patent extension process was an opportunity to evaluate their success, and a close reading of Palmer’s extension application suggests that the patent was not simply a symptom of a mechanical, inventive and business-​minded orientation. Rather, like the code of ethics, the patent could be called upon to serve as a form of social contract, ensuring the best interests of the practitioner and, at least rhetorically, of patients and the public as a whole. Through patenting, Palmer might align with both medicine’s moral economy and the broader

148

148

Rethinking modern prostheses

ethic of American society, securing traction in the elite medical model without ­foreclosing commercial opportunities. In addition to hundreds of pages of supporting testimony and documents, Stansbury supplied a long written argument that attested to the invention’s adherence to the patent system’s ideals. His plea began with a nod to the fundamental aims of patent legislation, noting confidently to the commissioner that it must indeed be a pleasure to grant an extension of a patent in a case where, in addition to a full compliance with the legal requirements on which the right is founded, you discover that the object of the invention is purely beneficent, and that its proprietor has so administered his property in it as to contribute, in the most efficient manner, to the production of the largest amount of good at the least possible expense to the public.59

He also strategically addressed each point of patent law, easily affirming that the invention was novel and useful and that Palmer had shown due diligence in introducing it into public use. The next issues were more complex, as Stansbury established the invention’s value to the public. His argument rested on the assumption that the collective good was patent protection’s most fundamental moral and social purpose, and in addition to testimony from satisfied customers he drew special attention to eminent surgeons’ endorsements. Palmer’s invention was a boon to patients, medical professionals and the nation as a whole. Testimony from acclaimed physicians and surgeons such as D. Meredith Reese, Stansbury noted, carried particular weight, especially given ‘the reserve which gentlemen of the faculty are accustomed to maintain, especially on subjects of this character’.60 The attorney, moreover, argued that the AMA’s patent prohibition only affirmed the rarity and significance of such plaudits. ‘The most distinguished American surgeons have not hesitated’, he observed, ‘notwithstanding the somewhat stringent ethics of the American Medical Association on the subject of patents, to respond to the application of Mr. Palmer, and give their testimony to the value of his invention’.61 This phrasing conveniently avoided the fact that Palmer was not technically subject to the code, subtly suggesting that he was already part of the fold. Even more importantly, the extension application emphasised Palmer’s skill and training. The patent was a monopoly, but it ensured that Palmer’s patients received a product of consistently high quality, made and fitted by someone whose expertise and experience were unparalleled. Stansbury declared that if the bid for extension failed, and the patent of Mr. Palmer were made public, many persons, tempted alone by the desire of gain, would at once begin the manufacture of his limb. Destitute

149

Patents, professionalism and the moral economy

149

of capital, experience, or anatomical and surgical knowledge, and strangers to those just and elevated views which Mr. Palmer has always held, of the character of the trust which the possession of such a property implies, they would produce an article vastly inferior in material and workmanship, fail in the nice adaptation of the limb to the peculiarities of each case, cut down the price to a standard which would render the highest excellence impossible, and thus ruin the reputation of the limb, destroy the public confidence in it, and leave the unfortunates who need such an appliance, to the tender mercies of pegs and crutches, or the more doubtful consolations offered by other inventors.62

Artificial limbs, he observed, required great ‘surgical skill’ to produce and fit, and the patent acted as a form of control on production and quality.63 The patent, in this reading, was as much a moral as a material monopoly, playing both to a medical ethic of expertise and to the nation’s best interests. Testimonials from Palmer’s workmen, patients and surgeons confirmed the difficulty of making and fitting a high-​quality limb, and Palmer was known to discard nearly finished products that did not meet his standards. The patent acted as a kind of medical licensure and regulation in a field threateningly bereft of both. Stansbury concluded: The public confidence in the invention will be maintained and strengthened, and the mutilated will have the satisfaction of knowing that their losses can be supplied by a reliable substitute, in every respect of the very best quality. The reverse of all this would be true, were the invention to be made public property.64

For a surgeon-​artist working at the fringes of medicine, the patent –​at least rhetorically  –​offered the same guarantees of professional expertise, quality and exclusivity as the AMA’s code of ethics. Professional ethics and patenting were not in moral conflict when the artificial limb and its manufacturer worked in the public’s best interests. Palmer’s patent extension application, moreover, highlighted the most essential criterion of professionalism:  philanthropy. G.  R. Searle argues that ‘self-​ serving though their behaviour and rhetoric might sometimes be, members of professions were able to make a powerful claim to being animated by a desire for service rather than profit’.65 Just as the AMA’s code of ethics was meant to draw a symbolic line between professional medicine and capitalistic indignity, so too did the patent apparently allow Palmer to practise his work for the philanthropic benefit of patients. With competition curtailed, Palmer could, according to his argument, supply consistently excellent products while still giving substantial price reductions to the indigent. The limbs typically sold for around $150, but Palmer testified that fewer than one in five of his patients paid full cost, ‘while one half of the others have paid a profit of less than 25 per cent, and all of the

150

150

Rethinking modern prostheses

remaining portion have paid no more, on the average, than the first cost of the mechanism’, which was about $75.66 Other manufacturers, seeking only ‘pecuniary gain’, could not be counted on to be so generous. Beneficence was fundamental to the liberal professions, originating in religious service and charity to the poor. This profound philanthropy supposedly ensured that Palmer’s societal contribution well outstripped his profit and signalled the need for a continued monopoly. Reese, a former vice-​president of the AMA, summarised the justification for Palmer’s patent extension: [T]‌he invention and improvements of Dr. Palmer … constitute him a public benefactor, and entitled to all the rewards of his ingenuity and skill which the laws of his country have provided in such cases. And believing that he has not been adequately rewarded for his great labor and expense in bringing his invention to perfection, and making it known for the public benefit, the undersigned regards it as a professional duty to science and humanity to add, that the continued protection from trespassers upon his rights, by an extension of his Patent, would be no more than a just remuneration for the service he has rendered to the profession and the public.67

Keeping the patent in Palmer’s hands ensured that his product would be used only munificently and for the public good rather than for personal profit –​a point that appealed to the principles of patent legislation and emphasised the nobility of the surgeon-​artist’s vocation. The patent could be co-​opted to serve the same purposes as a code of ethics. As Baker explains of physicians, ‘In their minds, public, private, and professional goods were one: they understood and forthrightly professed that by acting in the public’s interest, they were also acting in their own.’68 Palmer and his supporters, too, could balance principles with pragmatics. They saw the patent as demonstrating professional disconnect from venal interests while simultaneously providing the inventor with just compensation –​a continued monopoly on his product and protection for his business –​for his admirable and selfless service to the nation. Palmer’s patent, in this construction, was a triumph of a moral economy first envisioned in the US Constitution, in which inventions and monopolies might serve the national good. But this selfless service and guarantee of expertise also mirrored the moral economy of medicine. The combination of the two secured the surgeon-​artist’s professional status and business success. Palmer’s application for patent extension, with its rhetorical flourish and copious supporting materials, pressed patent legislation to its loftiest moral potential. But the extension rested ultimately on whether the inventor’s remuneration was proportional to the invention’s value to the public. ‘It has been well observed’, Stansbury agued, ‘that it is the ratio between the amount of

15

Patents, professionalism and the moral economy

151

compensation received by the inventor, and the ascertained value of the invention, which is the true test of the propriety of granting an extension.’69 Palmer’s profit, calculated at $30,507 and largely reinvested in his business, was only marginally more than the estimated $2,000 per annum he might have made had he pursued ‘the exercise of his talents and enterprize in any of the professions, (for any one of which his education and ability would have made him a proper candidate)’.70 Palmer’s work, Stansbury subtly implied, should be viewed as commensurate with that of the learned professions. In determining the patent’s worth, moreover, the attorney sentimentally acknowledged that ‘We can never reduce the value of an invention like this, to exact pecuniary statement, until we learn to measure human sensibilities with a rule, and weigh human joys and sorrows in a balance.’71 The limb’s chief value might have been a moral one –​ resolving men’s ‘mortified and wounded sensibilities’ as well as their ‘cruel [physical] sufferings’ and reduction to ‘beggary’ –​but he complemented this sentiment with hard numbers.72 Stansbury argued that the limb had rescued at least 500 men from utter dependence on charity, who would have otherwise cost American society at least $500 each per year. Putting this population alone back to productive work had saved an estimated $3.5 million over the patent’s fourteen-​year life, making it of significant worth to the nation.73 Though these fiscal calculations were only one element of the attorney’s beguiling argument, they were the focus of the commissioner of patents’ final decision. Philip F. Thomas did not comment on Stansbury’s arguments about quality control. Instead, he commended the limb’s utility as evidenced by the ‘testimony of very many distinguished surgeons in this and foreign countries, and of a large number of unfortunate persons’. Such reports confirmed ‘that it does possess a very large pecuniary value to the public’, which he pegged at a somewhat lower estimate of $1.5 to 2  million.74 Palmer, quite simply, had not been remunerated for his invention’s ‘public value’. Even as it carried a heavy moral load, the patent system reduced matters of disability, professionalism and the public interest to a balance sheet of social costs and personal rewards. Thus the moral economies in which Palmer so enthusiastically operated were also, in the end, monetary economies. The work of alleviating suffering and obviating impairment was as much a fiscal priority as a sentimental one for the American government, and Palmer benefited financially from the quasi-​professional status that his philanthropic monopoly afforded. The inventor’s advertising repeatedly asserted that the patented product assured his unique skill and service, and in 1862 he even reissued some of his patent extension materials, presumably for promotional purposes.75 With the term ‘patent leg’ standing frequently as a synonym for ‘artificial leg’ in testimonials,

152

152

Rethinking modern prostheses

exhibition reports and advertising prose, Palmer’s limbs were the embodiment of a social contract for the moral and monetary good of patients, practitioner and public. Each, in fact, was required by law to be physically marked as ‘patented’.76 For Palmer, the patent and the authority of professionalism were one and the same. In the late 1860s, after briefly selling his business to the American Artificial Limb Company  –​largely to manage the demand and profit from injured Civil War soldiers –​he repurchased his patents and stock. He declared, ‘The work is again placed upon a truly Professional basis; augmented to a grand scale by great expenditure and effort, and will thus be continued by the original Inventor.’77 Palmer recognised a market for his own version of the medical model’s powerful expertise, and, in an ironic departure from the AMA’s code of ethics, to control the patent was to control the profession –​ and its profits. The legal and the moral right, Palmer proved, need not be in opposition. Exclusive, expert and philanthropic, his work was undoubtedly a professional complement to medicine and surgery. As the New York State Agricultural Society declared after his success in London, Palmer exposed –​alongside the liberal and beneficent medical profession –​‘another class of men alive to human woe, whose skill in mechanism entitles them to rank among the benefactors of their race’.78 In this depiction, the surgeon and the surgeon-​artist stood in parallel roles of trust and authority, each supported by his own form of social contract. Even as he contravened the AMA’s code, Palmer ensured that he contributed to the patent system’s most moralistic ideal, through which he could gain professional credibility by contributing to a larger humanity. But he also appealed to his country’s most reductive concerns about the monetary costs of impairment and unemployment. Artificial limbs exemplify a patent system whose moral uses and interpretations entwined with the balance sheets of social value and a culture of disability positioned between mechanical invention, medical professionalism and monetary calculation. Notes 1 R. Arthur, An Argument against Professional Patents (Baltimore, MD: John W. Woods, 1853), 4. 2 US Constitution, Article I, §8, clause 8; Patent Act of 1790, Chapter  7, 1 Statute 109–​12 (10 April 1790). 3 American Medical Association, Code of Ethics of the American Medical Association, Adopted May 1847 (Philadelphia, PA: T. K. Collins and P. G. Collins, 1848), Chapter 2, Article 1, Section 4.

153

Patents, professionalism and the moral economy

153

4 See J. S. Haller Jr., American Medicine in Transition, 1840–​1910 (Urbana, IL: University of Illinois Press, 1981), 240–​2; J. M. Gabriel, ‘A thing patented is a thing divulged:  Francis E.  Stewart, George S.  Davis, and the legitimization of intellectual property rights in pharmaceutical manufacturing, 1879–​1911’, Journal of the History of Medicine and Allied Sciences, 64:2 (2009), 135–​72; J. M. Gabriel, Medical Monopoly: Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry (Chicago, IL: University of Chicago Press, 2014). 5 Another version of this argument was published as C. Lieffers, ‘Patents, profit and the public good: the case of a 19th-​century artificial limb manufacturer’, Canadian Medical Association Journal, 188:11 (2016): 824–​5. 6 For a recent survey, see B. Linker, ‘On the borderland of medical and disability history: a survey of the fields’, Bulletin of the History of Medicine, 87:4 (2013), 499–​535. 7 J. Livingston, ‘Comment:  on the borderland of medical and disability history’, ­Bulletin of the History of Medicine, 87:4 (2013), 560–​4, at 564. 8 E. P. Thompson, ‘The moral economy of the English crowd in the eighteenth century’, Past & Present, 50 (1971), 76–​136. For moral economy in science, see, among many others, R. E. Kohler, Lords of the Fly: Drosophilia Genetics and the Experimental Life (Chicago, IL: University of Chicago Press, 1994); and L. Daston, ‘The moral economy of science’, Osiris, 10 (1995), 2–​24. 9 R. Baker, ‘Medical propriety and impropriety in the English-​speaking world prior to the formalization of medical ethics: introduction’, in R. Baker, D. Porter and R. Porter (eds), The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Western Medical Morality in the Eighteenth and Nineteenth Centuries, vol. I: Medical Ethics and Etiquette in the Eighteenth Century (Dordrecht: Kluwer, 1993), 16. C. L. Jones similarly engages with this issue in ‘A barrier to medical treatment? British medical practitioners, medical appliances and the patent controversy, 1870–​1920’, British Journal for the History of Science, 49:4: 601–25 (2016). 10 K. J. Strandburg, ‘Derogatory to professional character? Physician innovation and patents as boundary-​spanning mechanisms’, New York University Law and Economics Working Papers, paper 357 (2013), available at http://​lsr.nellco.org/​nyu_​lewp/​ 357 (accessed 1 June 2016). 11 J. Virdi-​Dhesi, ‘Curtis’s cephaloscope:  deafness and the making of surgical authority in London, 1816–​1845’, Bulletin of the History of Medicine, 87:3 (2013), 347–​77; and J. Virdi-​Dhesi, ‘Priority, piracy, and printed directions:  James Yearsley’s patenting of the artificial tympanum’, Technology and Innovation, 16:2 (2014), 145–​54. 12 M. Cassier and C. Sinding, ‘“Patenting in the public interest:” administration of insulin patents by the University of Toronto’, History and Technology, 24:2 (2008), 153–​71. 13 Patent Act of 1836, Chapter 357, 5 Statute 117 (4 July 1836), Section 18. 14 Other scholars have also discussed the relationship between intellectual property and moral economy. See, for example, S. Arapostathis and G. J. N. Gooday,

154

154

Rethinking modern prostheses

Patently Contestable:  Electrical Technologies and Inventor Identities on Trial in Britain (­Cambridge, MA: MIT Press, 2013); B. Charnley, ‘Seeds without patents: science and morality in British plant breeding in the long nineteenth-​century’, Revue économique, 64:1 (2013), 69–​87; and C. L. Fisk, ‘Working knowledge:  trade secrets, restrictive covenants in employment, and the rise of corporate intellectual property, 1800–​1920’, Hastings Law Journal, 52 (2001), 441–​535. 15 ‘B. Frank Palmer’s portrait’, Scalpel, 6:3 (1854), 448–​9, at 448. 16 ‘Palmer & Co’.s artificial leg, Springfield, Massachusetts’, Scalpel, 5:1 (1852), 56–​7, at 57. 17 B. F. Palmer, ‘Artificial Leg’, US Patent No. 4,834, issued 4 November 1846; ‘Artificial Leg’, US Patent No. 6,122, issued 20 February 1849; ‘Artificial Leg’, US Patent No. 9,200, issued 17 August 1852; ‘Artificial Forearm’, US Patent No. 22,575, issued 11 January 1859; ‘Artificial Arm and Hand’, US Patent No. 22,576, issued 11 January 1859; ‘Improvement in Artificial Legs’, US Patent No. 137,711, issued 8 April 1873. 18 B. Z. Khan, The Democratization of Invention:  Patents and Copyrights in American Economic Development, 1790–​1920 (Cambridge:  Cambridge University Press, 2005), 18–​19. 19 B. Frank Palmer, ‘Amputations, and fugitive thoughts connected’, Palmer’s Artificial Leg Reporter and Surgical Adjuvant, 4 (1852), 1–​3, at 2. 20 C. L. Jones, The Medical Trade Catalogue in Britain, 1870–​1914 (London: Pickering & Chatto, 2013). 21 [B. F. Palmer], ‘The bane’, Bane and Antidote, 6 (1854), 3–​5, at 3; [B. F. Palmer], ‘Compensatory art’, Bane and Antidote, 8 (1859), 11–​14, at 11. 22 S. E.  D. Shortt, ‘Physicians, science, and status:  issues in the professionalization of Anglo-​American medicine in the nineteenth century’, Medical History, 27:1 (1983), 51–​68, at 64. 23 [Palmer], ‘Compensatory art’, 12. 24 B. A. Kimball, The ‘True Professional Ideal’ in America: A History (Oxford: Blackwell, 1992), 137. Kimball references E. Hazen, The Panorama of Professions and Trades; or, Every Man’s Book (Philadelphia, PA: Uriah Hunt, 1837). 25 ‘Medical intelligence’, Boston Medical and Surgical Journal, 71:1 (1864), 47–​8, at 48. 26 [B. F. Palmer], ‘Glances at operative surgery and subsidiary science’, Bane and ­Antidote, 7 (1855), 1–​4, at 2–​3. 27 [Palmer], ‘Compensatory art’, 14. 28 J. Harden, ‘Amputation at the Jefferson College, Philada. for an anchylosed knee’, Bane and Antidote, 7 (1855), 30; [B. F. Palmer], ‘Amputations, as affecting the ulterior happiness of the patient’, Bane and Antidote, 7 (1855), 4–​9, at 7–​8. 29 ‘Review:  Bane and Antidote (1855)’, Boston Medical and Surgical Journal, 52:24 (1855), 482–​3. 30 B. F. Palmer, ‘Palmer’s artificial leg in London’, Boston Medical and Surgical Journal, 45:1 (1851): 18–​22. 31 ‘New inventions in aid of the practice of medicine and surgery’, Lancet, 59:1479 (1852), 14–​15.

15

Patents, professionalism and the moral economy

155

32 See M. S. Pernick, A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth-​Century America (New York, NY: Columbia University Press, 1985). 33 [Palmer], ‘Glances’, 2, italics in original. 34 [Palmer], ‘Glances’, 1. 35 [B. F. Palmer], ‘On amputations’, Orthopedic or Artificial Leg Reporter, and Surgical Adjuvant, 5 (1852), 1–​2, at 1. 36 C. T. Jackson and W. T. G. Morton, ‘Improvement in surgical operations’, US Patent No. 4,848, issued 12 November 1846. 37 [Palmer], ‘Glances’, 4, italics in original. 38 For a recent analysis, see S. P. Browner, Profound Science and Elegant Literature: Imagining Doctors in Nineteenth-​Century America (Philadelphia, PA: University of Pennsylvania Press, 2005), 15–​38. 39 See Gabriel, Medical Monopoly, 58–​9; R. Baker, Before Bioethics:  A  History of American Medical Ethics from the Colonial Period to the Bioethics Revolution (Oxford: Oxford University Press, 2013), 183. 40 R. B. Baker, ‘The American medical ethics revolution’, in R. B. Baker, A. L. Caplan, L. L. Emanuel and S. R. Latham (eds), The American Medical Ethics Revolution: How the AMA’s Code of Ethics Has Transformed Physicians’ Relationships to Patients, ­Professionals, and Society (Baltimore, MD: Johns Hopkins University Press, 1999), 41–​8. 41 American Medical Association, Code of Ethics, Chapter 3, Article 1, Section 3. 42 R. H.  Nicholas and D.  Bly, ‘Artificial Leg’, US Patent No. 17,888, issued 28 July 1857; Bly, ‘Artificial Leg’, US Patent No. 23,656, issued 19 April 1859; ‘Artificial Leg’, US Patent No. 24,002, issued 17 May 1859; ‘Artificial Leg’, US Patent No. 25,238, issued 30 August 1859; ‘Artificial Leg’, US Patent No. 31,438, issued 19 February 1861; ‘Improvement in Artificial Legs’, US Patent No. 38,549, issued 19 May 1863; ‘Improvement in Artificial Legs’, US Patent No. 38,550, 19 May 1863; ‘Improvement in Artificial Legs’, US Patent No. 57,666, 4 September 1866; ‘Improved Artificial Leg’, US Patent No. 87,624, 9 March 1869. 43 [S. Smith?], ‘Claims of mechanical surgery’, American Medical Times, 4 (1862), 266–​7, at 266. 44 [Smith?], ‘Claims of mechanical surgery’, 267. 45 Another antebellum manufacturer also used the term, but it was almost certainly lifted from Palmer. See J. S. Drake, Drake’s Patent Artificial Legs, Hands, Arms, &c. (Boston, MA, n.p., [1859]), 11. 46 Compare S. Smith’s letter (17 March 1859), in C. F. Stansbury (ed.), Testimony in Behalf of the Extension of the Patent of B. Frank Palmer (n.p., 1860), 68; and letter from S. Smith to E. D. Hudson, 25 August 1865, in E. D. Hudson (ed.), Mechanical Surgery (New York, NY: Baker & Godwin, [1867]), 35–​6. 47 [Smith?], ‘Claims of mechanical surgery’, 267. 48 Hudson, ‘Improvement in surgical apparatus for exsections’, US Patent No. 50,128, issued 26 September 1865. 49 ‘List of officers of county medical societies, 1862’, Transactions of the Medical Society of the State of New York (1862), 513–​27, at 521–​2; D. Bly, ‘The points of election

156

156

Rethinking modern prostheses

and kind of operation for the amputation of the lower extremities, with reference to the use of artificial limbs’, Transactions of the Medical Society of the State of New York (1862), 295–​9. 50 R. Clement, The Clement Patent Improved Artificial Leg (Philadelphia, PA: Samuel Loag, 1868), 2. 51 B. F. Palmer, The Patent Palmer Arm and Leg: Adopted for the US Army and Navy and Worn by Ten Thousand Officers, Soldiers, and Civilians (Philadelphia, PA: American Artificial Limb Company, 1866), 15, italics in original. 52 B. W.  Jewett, ‘Artificial Leg’, US Patent No. 16,360, issued 6 January 1857. He received another three years later. See B. W. Jewett, ‘Artificial Leg’, US Patent No. 29,494, issued 7 August 1860. 53 E. Osborne deposition (10 September 1860), in Stansbury, Testimony, 11; The Palmer Arm and Leg: Correspondence with the Surgeon-​General USA (Philadelphia, PA: C. Sherman & Son, 1862), 46; B. W. Jewett, Jewett’s Patent Artificial Leg Company (Washington, DC: McGill & Witherow, 1865), 4, italics in original. See also G. R. Hasegawa, Mending Broken Soldiers:  The Union and Confederate Programs to Supply Artificial Limbs (Carbondale, IL:  Southern Illinois University Press, 2012), 17. 54 ‘Palmer’s artificial leg’, Boston Medical and Surgical Journal, 60:1 (1859), 26–​7, at 27; D. D. Douglass, ‘Artificial Leg’, US Patent No. 26,753, issued 10 January 1860. See also letter from D. D. Douglass, Boston Medical and Surgical Journal, 60:3 (1859), 67–​8; Palmer & Co., ‘Palmer’s artificial leg’, Boston Medical and Surgical Journal, 60:6 (1859), 126–​7. The row actually began with a notice about Douglass’s limbs in another journal; see ‘Artificial substitutes for lost legs’, College Journal of Medical Science, 4:1 (1859), 48. 55 [B. F. Palmer], ‘Palmer’s patent’, Orthopedic or Artificial Leg Reporter, and Surgical Adjuvant, 5 (1852), rear cover. 56 [B. F. Palmer], ‘Infringements –​caution’, Bane and Antidote, 8 (1859), 15–​17, at 15. 57 [Palmer], ‘Infringements’, 15, italics in original; [Palmer], ‘Compensatory art’, 13. 58 [Palmer], ‘Infringements’, 16, italics in original. Some inventors complained that juries were wrongly excluding their limbs from competition because they believed them to be copies of Palmer’s work; such judgments, these inventors argued, should be left to the courts. Palmer countered that juries were right to exercise such discretion as the awards were to be given for what men produced, not simply what they presented. 59 C. F. Stansbury, Argument in Behalf of the Extension of the Patent of B. Frank Palmer, for an Improvement in Artificial Legs (Baltimore: Murphy & Co., 1860), 1. 60 Stansbury, Argument, 16. The AMA Code prohibited physicians from ‘adduc[ing] certificates of skill and success’; it also discouraged advertising (Chapter  2, Article 1, Section 3). Palmer, however, had no qualms about either of these activities, and physicians evidently did not object to their statements being published in Palmer’s brochures. Advertising was in fact essential for patent extensions as it demonstrated that the applicant had done everything possible to promote and profit from his invention.

157

Patents, professionalism and the moral economy

157

6 1 Stansbury, Argument, 14. 62 Stansbury, Argument, 17. 63 Stansbury, Argument, 20. 64 Stansbury, Argument, 20–​1. Bigelow made a similar point about Morton’s ether. See H. J. Bigelow, ‘Insensibility during surgical operations produced by inhalation’, ­Boston Medical and Surgical Journal, 35:16 (1846), 309–​17, at 316. 65 G. R. Searle, Morality and the Market in Victorian Britain (Oxford: Clarendon Press, 1998), 132. 66 National Archives and Records Administration, College Park, MD, RG 241, Extension Case Files 1836–​75, Box 215, B.  F. Palmer, ‘Explanatory statement’, 15 August 1860, 4–​5. L. Hilaire-​Pérez and C. Rabier observe similar claims from an eighteenth-​century truss maker in ‘Self-​machinery? Steel trusses and the management of ruptures in eighteenth-​century Europe’, Technology and Culture, 54:3 (2013), 460–​502, at 486. 67 D. M. Reese deposition, 18 September 1860, in Stansbury, Testimony, 31. 68 R. Baker, ‘Introduction’, in R. Baker (ed.), The Codification of Medical Morality, vol. II: Anglo-​American Medical Ethics and Medical Jurisprudence in the Nineteenth ­Century (Dordrecht: Kluwer Academic Publishers, 1995), 1–​22, at 17. 69 Stansbury, Argument, 10. 70 Stansbury, Argument, 7. 71 Stansbury, Argument, 10. 72 Stansbury, Argument, 10–​11. 73 Stansbury, Argument, 12. 74 P. S. [sic] Thomas, ‘Decision of the commissioner of patents, extending the patent’, 3 November 1860, in Testimony in the Matter of the Application of B. Frank Palmer for an Extension of His Patent for an Artificial Leg (Philadelphia, PA: C. Sherman & Son, 1862), 16. 75 Testimony in the Matter of the Application of B. Frank Palmer. 76 See ‘Stamping patented articles’, Scientific American, 9:40 (1854), 317. 77 [B. F. Palmer], Report of the Great National Benefaction (Philadelphia, PA: C. Sherman & Son 1868), inside rear cover. 78 J. Delafield, ‘New  York State Agricultural Society:  address on presenting the medals of the Society to its members who received awards at the Great Exhibition in London’, Orthopedic or Artificial Leg Reporter and Surgical Adjuvant, 5 (1852), 8.

158

7

SEPARATING THE SURGIC AL AND COMMERCIAL: SPACE, PROSTHETICS AND THE FIRST WORLD WAR Julie Anderson

On 24 February 1920, King George V and Queen Mary attended the British Industrial Fair at Crystal Palace in London. From contemporaneous newspaper reports, it is clear that the king in particular was interested in the artificial limbs on display. The royal couple and other attendees marvelled at the demonstration by a one-​armed man who manipulated a 14-​pound sledgehammer and took a cigarette from a packet, lit it with a match and, as it was reported, ‘threw the match away with an ease one would associate with a person not suffering from any disability’.1 To the audience, this veteran epitomised the restoration of function that was brought about by innovations in prosthetics during the First World War. There is no doubt that a significant number of British soldiers and sailors who experienced amputation in the First World War had an improved life experience owing to the provision of prostheses. More than 40,000 men suffered some form of limb loss.2 It is this scale of amputation that led some historians to argue that the First World War altered the process of artificial-​limb making and fitting.3 In line with historians who view the First World War as a catalyst for change in the pace and scale of technological developments, in surgery, wound case and trauma, for example, a book published in 1936 by limb manufacturer J.  E Hanger noted that, ‘The experience from the many thousands of amputations of limbs due to the Great War has led to a marked advance in surgical technique, and remarkable improvements in the design and mechanical efficiency of artificial limbs’.4 The Ministry of Pensions confidently asserted, ‘Prior to the Great War, the supply of artificial limbs … had been a comparatively small matter, and such organisations as existed for the purpose were therefore not very numerous or extensive, nor were the limbs supplied very satisfactory.’5 Yet, prior to the war, there was a well-​developed market for artificial limbs, and the technological advances evident in the few

159

Space, prosthetics and the First World War

159

catalogues, treatises and advertisements produced in the nineteenth century demonstrate that artificial-​limb making was a highly skilled practice with an established market for provision and repair. Furthermore, it can be reasoned that without the established market and expertise available in Britain before the First World War that technical developments and innovations in design would not have progressed during and after it. Roger Cooter has convincingly argued that ‘crucial to the wartime making of modern orthopaedics was the negotiation and occupation of a political space in medicine for reorganising medical work and power relations generally’.6 This paper contends that, in addition to medical space, that physical space was of particular importance to changes in the organisation of the process and provision of artificial limbs during the First World War. Moreover, wartime necessity also created specialised spaces, augmenting the hospital, where these groups established dialogues and working relationships, albeit with a certain level of suspicion, particularly on the surgeons’ behalf. The medical profession and the commercial companies that manufactured artificial limbs worked in specialist limb-​fitting centres, and the process of design, fitting and rehabilitation became organised under the authority of surgeons. While medical historians have explored technological innovations in the nineteenth century, they have focused principally on those relating to the laboratory and the hospital, commercial markets have yet to be explored.7 This chapter argues that the creation of spaces and new working relationships was also important to the production and innovation of prostheses during the First World War. Demarcated spaces: limb-​fitting in the nineteenth century In the nineteenth century, the limb fitter’s shop was the space for refashioning the body after amputation. After the surgeon completed the removal of the diseased or damaged limb in the medical space, the patient attended commercial premises to purchase a prosthesis, should they be able to afford it. The limb maker’s function was to recreate a body part, thereby refashioning the customer’s aesthetic body. While the hospital was the locus of pain and loss, the limb fitter’s shop was a space devoted to the resumption of a bodily vision and reassured the customer of the potential to return to aesthetic and functional normality. In order to fulfil the desire of customers who wished to purchase a refashioned body after amputation, limb fitters reworked designs and experimented with new materials, which they often advertised in newspapers. Before the First World War, surgeons and limb fitters occupied highly specialised spaces. Surgeons did not consult in the commercial premises of the manufacturer of artificial limbs. Doctors worked in the highly specialised surgical

160

160

Rethinking modern prostheses

and medical realm, not the commercial space of the maker. In their consulting rooms or even the hospital, doctors worked with flesh, blood and bones. The commercial concerns regarding the manufacture of replacement body parts to make a profit was of less interest to surgeons who were principally concerned with healing and creating, in the case of amputations, a suitable stump. Nineteenth-​century artificial-​limb design and production was a craft-​based industry, as care and time were taken over the creation and production of each prosthesis. In the majority of cases, a single prosthesis often took longer than six weeks to produce, and each one was specially made for its wearer. As images in nineteenth-​century catalogues illustrate, artificial limbs were complex constructions of wood, leather and fabric. Newspaper advertising was an important method of communicating these innovations in materials, designs and services to potential customers. From Gloucester to Burnley, the local press carried a significant number of advertisements for artificial limbs. It is evident from the sheer quantity of advertisements appearing on a daily basis in local and national newspapers that the public were the main consumers and selected their own artificial limbs from individual manufacturers. Newspapers were the means by which the public were presented with commercial choices, recommending certain types of innovation in prosthetics. The relationship between the supplier and the customer was largely commercially dependent on direct advertising. Furthermore, Claire L. Jones has noted that there were few medical trade catalogues produced by artificial-​limb manufacturers, who also manufactured orthopaedic appliances.8 She suggests that one company, J. & A. Carter of London, targeted the public in its trade literature.9 Consumers were presented with a range of choices in their purchase of an artificial limb. Owing to cost, several different levels of quality were offered to potential buyers. A catalogue from Salt & Son from Birmingham showed an artificial leg with tendon action cost £21, and one of ‘second quality’ cost £15 15s. An above-​elbow arm prosthesis with ‘perfectly articulated hands, palm socket and implements and latest improvements’ also cost £21.10 The manufacturer had to demonstrate the benefits of these expensive prostheses in order to persuade each level of customer that they were getting a range of innovations for their money. Manufacturers sought endorsements from users who wrote letters to companies stressing the comfort and utility of their prostheses. It was hoped that recommendations would produce a steady flow of customers. Factors stressed by wearers, in the many letters published in the treatises for artificial legs, were the ability to regain their proficiency in activities such as cycling and being able to camouflage any noticeable difference from others. One recipient noted, ‘I can ride and walk with perfect ease, and have often been complimented by my

16

Space, prosthetics and the First World War

161

friends upon my appearance, and have been told by them that they can scarcely distinguish the one from the other.’11 Although manufacturers were not prepared to overly extoll the virtues of their artificial arms, as they were complicated and difficult to fit, customers wrote letters to manufacturers declaring their satisfaction with their new arm prostheses. One customer wrote, ‘my friends are delighted that I have procured such a serviceable article, and seem surprised when they saw me write, and take up or drop the pen and pencil’.12 Newspaper advertising and personal endorsements were not the only methods employed to entice customers in to these commercial spaces. Trade also came from passers-​by. Although many limbs were individually manufactured, a few companies operated an over-​the-​counter service, where a prosthesis could be purchased and taken away at the same time.13 Prosthetic manufacturers conducted their business in person and also by mail order. There was a range of consultation methods, but many encounters between limb maker and customer were a combination of discussions by letter, and more intimate personal meetings were conducted in person. Constant consultation with the wearer was important for a good fit. In one pamphlet, it was noted that three interviews with the limb maker were required, one for taking casts and details, one for a preliminary fit and a third when the limb was complete.14 Yet this communication varied and was controlled by the wishes of the customer, not the manufacturer. Indeed, those who wished to have an artificial leg made and sent to them were instructed to send the most basic of information including measurements such as the circumference of the stump at certain points, a boot and a pencil tracing of the wearers foot and whether a right or left leg was required.15 The limb fitter’s shop was a space specifically devoted to the relationship between customer and manufacturer. For the most part, the medical profession in Britain distanced itself from the design, provision and, more importantly, the profit from artificial limbs; it continued to be the preserve of the limb makers and fitters, who took out some patents on components and developed new technology to improve artificial limbs’ function.16 Doctors and surgeons avoided the commercial arena, and each profession’s expertise and practices were contained in the employment-​specific spaces of the hospital and the shop respectively. The only cooperation between limb fitter and surgeon was the practice of a patient obtaining a certificate from a surgeon on a limb’s suitability once it was manufactured and fitted by the limb maker.17 Other than that, consultation was not formally undertaken by surgeons and limb fitters, although it probably did occur. Although design, utility and camouflage were all part of the remit of the limb fitter, skilled surgical technique was also vital to the success of a prosthetic

162

162

Rethinking modern prostheses

limb. By the middle of the nineteenth century, new types of amputation techniques were developed. These included James Syme’s amputation of the foot and Stephen Smith’s amputation at the knee.18 No matter how proficient the limb maker, without a functioning stump an artificial limb was useless. If there was significant pain from nerves that had not been removed successfully, or indeed an insufficient cushion of muscle and skin, an artificial limb was more a hindrance than an aid.19 There was discussion in medical pamphlets and journals, discussing the ideal location for an amputation, in order to provide function and comfort. Surgeons were not the only group interested, nor indeed the only group with an opinion, in the construction of a healthy, functioning stump. Artificial limb makers vocalised their interest in the creation of the best stumps. Nineteenth-​century manufacturers’ catalogues show that manufacturers provided information for surgeons as to the best site to amputate. It would appear that the advice of limb fitters was not taken seriously, as some manufacturers criticised surgeons’ preference for saving as much of the stump as possible. In one treatise, Automatic Mechanism as Applied to the Construction of Artificial Limbs, Frederick Gray, a limb fitter from London, whose company produced the Anglesey artificial limb, articulated his preferences for certain types of stump. He noted that he was in consultation with a Mr Stanley of Bartholomew’s Hospital in London about the best prostheses. Gray demonstrated some medical knowledge:  he suggested that for amputations above the knee he preferred the flap operation and below the knee the circular to the flap.20 According to his book, Gray was encouraged by surgeons to consult with other surgeons; he noted that he was ‘gratified in seeing that my advice has been acted upon to the great advantage of patients’.21 Furthermore, Gray thanked Sir Benjamin Brodie who was surgeon to Queen Victoria and Prince Albert, thereby hinting at a possible royal connection. In the foreword to the book, Gray wrote, ‘I take this opportunity of expressing my obligation for the confidence which has induced you to entrust so many cases to my care.’22 Despite a normally limited relationship, some artificial-​limb makers benefited from their connections with surgeons, which also provided a potential commercial advantage. Surgeons supplied patients with the names of prosthesis manufacturers so there was some level of communication between doctors and artificial-​limb makers. Some catalogues, such as one produced by Down Brothers in London, made special reference to their connections with hospitals, noting that its premises were opposite Guy’s Hospital.23 So there was some communication and a tenuous, often private, endorsement between the majority of surgeons and manufacturers. From complaints levelled by manufacturers, Mr Gray’s positive experience and relationship with the medical profession was uncommon. The medical

163

Space, prosthetics and the First World War

163

profession argued against limb fitters’ claims at the problems encountered through the practice of limb saving. Charles W. Cathcart argued in the Edinburgh Medical Journal that, in the case of the foot, ‘there was every reason why surgeons should save as much of the natural parts as the nature of the case permitted’.24 Although consultations between limb fitters and surgeons did take place, it seemed that the commercial premises of the limb fitter and the surgeon’s consulting room were not places for the meeting of minds. This physical demarcation of the control of space was clear, yet each group was aware of practices and innovations that occurred within their separate spheres. Doctors and surgeons were kept apprised through their own medical networks and publications. In 1862, sThe Lancet detailed some of the innovative technical developments in British artificial limbs on display at the Great International Exhibition.25 Surgical technique was important to the surgeons, but the manufacture and fitting of the artificial limb was the preserve of the limb maker, although it is evident that surgeons needed to know about innovations in technology in order to make recommendations to patients. Spaces of knowledge and expertise were clearly delineated, and surgeons thwarted attempts by limb fitters to offer advice or influence in what was their preserve. The potential for prosthesis manufacturers to profit from war with the cooperation of the state occurred in the latter part of the nineteenth century. Changes to military regulations meant that soldiers who suffered amputation were entitled to state support. Newspapers, both local and national, announced that the Regulations for Army Medical Service had changed; those who had served and had a limb amputated would be provided with an artificial limb at a cost to the state.26 Amputees were given a £15 allowance to purchase an artificial limb, which meant that amputee war veterans rapidly became one of the principal clients of prosthesis manufacturers. Refashioning the ex-​serviceman’s body became a regular and profitable enterprise. Indeed, contemporary newspapers noted that artificial-​limb makers were busy as a result of the South African War.27 There was an increased awareness centred around ex-​servicemen’s amputation and limb provision; even royalty also took an interest –​Queen Victoria visited Netley Hospital in 1898, where she inspected the artificial limbs provided to soldiers.28 The provision of artificial limbs as recompense for injury during military service began to be entrenched in the mind of the public. Amputation and prostheses in the First World War The scale of the number of wounded returned to Britain from the battles of the First World War was unprecedented. Many hundreds of thousands suffered

164

164

Rethinking modern prostheses

some type of wound, and, within that number, over 41,000 suffered some type of limb amputation.29 The War Office had difficulty managing the number of wounded, and the Ministry of Pensions, which was responsible for the needs of those ex-​servicemen permanently affected, was only established at the end of 1916. Historians such as Mary Guyatt and Meghan Kowalsky have undertaken interesting work on the provision of prostheses in the First World War. Kowalsky’s analysis focuses on the development of limbs and the cultural resonance of the heroic amputee through their portrayal in limb catalogues and other instruction books such as Handbook for the Limbless. Guyatt’s work places the adoption of the aluminium artificial leg at the centre of developments in prosthesis design and standardisation. She argues that, as an established reward for service and owing to the significant number of newly created amputees, prosthesis production became more central to the responsibility taken up by the state.30 Owing to the sheer number of prostheses required, both large and small companies that specialised in artificial-​limb making and fitting expanded rapidly during the war. Initially, the greatest concentration of limb fitters worked at the Roehampton Limb Fitting Hospital, just outside London, which opened in 1915, and whose basement soon became a bustling centre of prosthesis making and fitting. Mary Eleanor Gwynne Holford enlisted the help of Viscountess Falmouth and Sir Charles Kenderdine to raise funds by press and public appeal for the establishment of a specialist limb-​fitting hospital, after she came in contact with a soldier when she was visiting Millbank Military Hospital in January 1915, ‘with a look of unutterable hopelessness and sadness on his face, a man who had lost both arms’.31 The soldier had been sent his standard Chelsea Hospital Pattern artificial arms and attended a local fitting agent who was supposed to adjust them, following common practice in 1915. Gwynne Holford vowed to address this lack of support, and the Queen Mary Convalescent Auxiliary Hospital, as it became known, was founded later in 1915. The Queen and Princess Alexandra were installed as patrons. Roehampton House, which had already been requisitioned by the War Office, was chosen. Similar to other owners of stately homes during the war, the owner, Kenneth Wilson provided it without any cost to the state.32 In 1915, the War Office contracted twenty-​two manufacturers to attend Roehampton in order to judge their skills and expertise. In July 1915, an exhibition of limbs and a conference was held at Roehampton, and twenty-​four firms, including American, British and Scandinavian, were present.33 The seven judges were all surgeons and included the well-​known and highly respected orthopaedic surgeon Robert Jones. One of the reasons for this exhibition was

165

Space, prosthetics and the First World War

165

the sheer number of prostheses that needed to be manufactured to supply the significant numbers of men who had undergone amputation, even as early as 1915. There was no interest in the manufacture of standardised limbs. In a letter to the secretary of the War Office, the honorary secretary and treasurer at Roehampton noted: They are very alive to the fact that artificial limbmakers are fully employed in peace time, and are very overworked at the present moment. It must follow, therefore, that the supply of artificial limbs to meet the present extraordinary demand, is totally inadequate unless the services of many limbmakers are utilised, and unless considerable latitude is allowed to each individual limbmaker. The limbmakers must be allowed to manufacture the particular mechanism with which they are familiar, otherwise the manufacture will be slow and the supply will be considerably curtailed.34

In order that supply was maintained, a number of well-​known firms were called on to provide artificial limbs for the war wounded. British firms included W. R. Grossmith, Masters & Son, Anderson & Whitelaw, Chas Blatchford & Sons, F. G. Ernst and Mayer & Meltzer, all well-​established makers of a wide range of medical devices. Later, Desoutter Bros, joined the increasing ranks of limb makers required to keep pace with the numbers of limbs required. Expansion was slow. At the start of the war, larger firms such as Grossmith and Blatchfords only employed about forty to fifty men, and it took time for new ones to be trained.35 American companies were also invited to produce prostheses, partly due to the necessity of employing a large number of manufacturers to maintain supply, but also to take advantage of American expertise. Between 1860 and 1870, Britain’s expertise in the design and manufacture of artificial limbs had been challenged by the United States. Owing to the severity of the fighting and the number of limbs requiring amputation during the American Civil War, the concentration and improved expertise in artificial limb making shifted to the United States.36 Manufacturers included J. E. Hanger and Rowley & Co. in Chicago and the Carnes Artificial Limb Co. in Kansas. At Roehampton, the surgeons took control of the process, in establishing themselves as judges of the quality of limb makers and also by setting the prices that the War Office, and later the Ministry of Pensions, paid the limb maker for prostheses. In comparison with the nineteenth-​century prices quoted above, the prices were significantly lower than limb manufacturers usually charged. In addition to the limbs judged as standard by the surgeons, manufacturers were allowed to maintain themselves as specialists in certain areas of manufacture. The surgeons recommended that a consulting surgeon had ‘the power to recommend special appliances for special occasions’.37 They cited the American

16

166

Rethinking modern prostheses

Table 7.1  Recommended costs for artificial limb prostheses. Location of amputation

Price recommended by the Committee

Ankle joint Below the knee Thigh, knee joint or upper third of the thigh Hip joint Below the elbow Above the elbow

£6 £11–​15(according to type of prosthesis) £15 £18 £6 £8 8s or more

Source:  compiled from data in Queen Mary Roehampton Trust archive, HO2/​QM/​A/​2/​1, ­London Metropolitan Archives.

Carnes Arm as an example. It was considered the best artificial arm available, but cost £40, which was a significant increase on the basic prices they had recommended (see Table 7.1).38 Yet the Carnes Arm was provided in cases where it was deemed suitable to maintain the best function. Despite this concentration of British and American manufacturers in centres such as Roehampton, and the increase in limb-​fitting centres around the country, demand quickly outstripped supply, and many designs from larger companies were provided to small-​scale manufacturers; some were even outsourced to blacksmiths. Smaller manufacturers used their own established designs, which they sold before the war, to provide limbs to the patients in their local hospitals. From 1915, James Gillingham, who had manufactured and designed artificial arms and legs for a number of years, made limbs to his own design and fitted them to amputees in the local Voluntary Aid Detachment hospital, Monmouth House, in Chard, Somerset.39 Despite the establishment of specialist limb-​fitting centres such as Roehampton, hospital space was at a premium, and many men were returned to their homes following surgery and before they were fitted with an artificial limb. They did not benefit from staying in a hospital, with experts to aid them with using their new appliance. Further problems were created for the ex-​serviceman, as they had to travel to a limb fitter that might be some distance from their home. After adjustments were made by the local limb fitter, the limb was posted to the patient, in the same way as nineteenth-​century limbs were sent to customers. As a Ministry of Pensions publication noted, ‘Under this arrangement misfits were fairly common and, in the absence of any efficient machinery for effecting alterations and adjustments, and for training the man in the use of his limb, it frequently occurred that the man discarded the limb and reverted to the use of crutches.’40

167

Space, prosthetics and the First World War

167

Despite the assertions that design and comfort of artificial limbs had significantly improved during the war, artificial limbs were not always worn, or were not worn continuously. Heather Perry has argued that German artificial limbs were often discarded by soldiers or were used only for special occasions when the limb was required for aesthetic purposes.41 A stay at a limb-​fitting hospital such as Roehampton ensured that a soldier or sailor could be trained in the prosthesis’s use, and the fit was adjusted as soon as a problem was noted. Although some men did not stay in hospital, many others did, and their time there was taken up with learning to use their artificial limbs. Roehampton and other limb-​fitting centres dramatically expanded the number of beds to increase the number of men who benefited from training. Soldiers and sailors were transferred to these centres only when their stumps had healed sufficiently to withstand the fitting of a prosthesis.42 The establishment of such centres as Roehampton brought together significant numbers of amputees and created an unprecedented boon to orthopaedic surgeons’ skills. Orthopaedic surgeons at these centres improved their surgical expertise and their knowledge of stump rehabilitation. This was partly owing to the number of patients available to operate on and the ability of them to be monitored as the limb was fitted. It was also a means to judge the efficacy of and to improve surgical techniques. Roger Cooter notes that civilian surgeons had little experience in amputation; he cites figures from St Thomas’s in 1913, which showed only thirty-​four amputations out of 5,483 procedures.43 Wounded men often required re-​amputation, sometimes as many as five, in order to ensure a comfortable stump. The stump became the focus of surgeons and limb fitters as they became increasingly aware of the importance of the body–​prosthesis nexus. The functional value of the stump was determined by its efficiency when fitted with a prosthesis. These included factors such as the condition of the stump, the state of the patient and the nature of the orthopaedic appliance.44 A period of adjustment was important as the stump could swell or shrink depending on the climate or indeed the health of the amputee. ‘It takes from six months to two years for stumps, following amputation, to fully shrink.’45 It was agreed by limb manufacturers and surgeons that the condition of the stump was fundamental to the fitting of the prosthesis. One book noted, ‘Orthopaedic treatment of the stumps is of a very recent date. It was entirely disregarded up till 1915; before that time the only treatment of the stump consisted of operations of very small value.’46 The other issue was the patient’s mental health. One book noted, ‘The psychology of the amputee is an important factor in limb-​ fitting. The condition of the stump and the psychological factor are much more important than the nature of the prosthesis.’47 Doctors were convinced that a poorly fitting prosthesis had a deleterious effect on the health of an amputee.48

168

168

Rethinking modern prostheses

Surgeons took a lead role at the hospitals and highlighted the importance of their role, in amputation and the maintenance of the mental health of the patient in the process of rehabilitation, thereby limiting the manufacturer’s input to the production of the prosthesis. Mary Guyatt argues that the First World War was a catalyst for change in the production and standardisation of artificial limbs. She focuses on the standardisation of the metal limb and the dominance of one manufacturer in its production, citing a new interest in Taylorism and mass-​production principles. Moreover, there was competition between the companies. Designs, methods of attachment and intricate internal machinery were patented, and that created further complications for standardisation. However, a type of standardisation was attempted in the later stages of the war as the need for appliances grew. Instead of an individual design and fit, which was more common in the nineteenth century, parts of the prosthesis were mass-​produced in order to provide limbs rapidly for the growing number of amputee soldiers. Methods of mass production and standardisation used in industry were employed to fulfil the requirements of returning amputees.49 Nowhere was this more evident than in Scotland, where the engineering and shipbuilding industries took over some of the manufacture of artificial limbs. Shipbuilding firms on the Clyde used their expertise to make artificial limbs at cost, refusing to profit from their manufacture.50 The Hospital for the Limbless was opened in Erskine specifically for the Scottish amputee servicemen. They were told ‘it would be impossible for us in Scotland to get artificial limbs unless we employed alien limb makers who were already at work in this country’.51 In order to address these issues, shipbuilders who had made Dreadnoughts were drafted in to make artificial limbs, which was apparently a ‘recreative diversion’ for them.52 The mass-​production principles that were intrinsic to manufacturing became more closely allied to the individualised experience of losing a limb as the war progressed. Despite this movement towards mass production in components, some parts of the limb still had to be manufactured individually. For instance, standardisation of the bucket, which housed the leg stump, was impossible.53 Artificial arms were also not standardised. In 1918, at the Inter-​Allied Conference, it was noted that artificial limbs had approached a certain level of standardisation. Apparently the War Office had examined all of the components of the artificial-​leg prosthesis from a range of manufacturers and had assembled the best ones.54 While this was not standardisation in the accepted sense, the best-​functioning components were put together in an effort to secure the best performance from the artificial limb. It was not clear to what extent this recommendation from the War Office was followed in limb-​fitting hospitals.

169

Space, prosthetics and the First World War

169

While there was competition between the main limb manufacturers, any outward controversy over patenting between the companies at Roehampton was not evident. Nevertheless, Mary Guyatt noted that Chas A.  Blatchford registered 250 patents in 1915–​19. In contrast, between 1898 and 1914 the company registered only eighteen patents.55 The First World War provided the means for businesses to protect intellectual property, the causes of which may have been a reaction to the international aspects of prosthesis manufacture and the physical environment of hospitals such as Roehampton where a number of competing companies worked in close proximity. Competition took on a nationalist tone. Concerns were expressed about British artificial-​limb manufacturers’ ability to maintain their level of innovation during the war. Further anxieties were expressed by artificial-​limb makers as early as 1915, that the government had lost faith in British manufacturers. At the Allied Exhibition of Orthopaedic Work at Central Hall, Westminster, the Belgians, Italians and French exhibited their artificial limbs. Apparently British manufacturers did not have pamphlets and other information that demonstrated their advances in the field of artificial-​limb production. The booklet Help for Wounded Heroes: The Legless argued that English limb makers were producing items of quality and that the industry was well established before the war. The author of this book does grudgingly admit that there were advances on the part of the French, Belgians and Italians in the construction of prostheses for the maimed in war, but Britain was still a world leader, and that it was part of British ‘reserve’ that meant that they had been ‘silent on this matter’.56 There may have been strategic reasons for this. In Germany, it became an offence to release any details of artificial limbs to other countries as they were fearful of other warring nations adopting new developments.57 By the end of the war, limb manufacturers were still divided along national boundaries. The British Artificial Limb Makers Association was founded by a number of artificial-​limb manufacturers, mainly from London. They produced a journal called Surgical Appliances, which kept readers up to date with advances in limb construction. Improvements in manufacture and a concentration on the wearer’s comfort meant that the prosthesis became fundamental to the amputee’s identity, including that of family member and wage earner. As the amputee veterans became more dependent on improved limbs for their mobility, or their capacity to work, numbers of artificial limbs required for soldiers and sailors had to increase. From October 1919, each man was provided with one limb and a spare so that when a prosthesis was sent for repair it did not cause inconvenience to the wearer.58 It meant that the Ministry of Pensions could legitimately argue that as well as a requisite number of prostheses for

170

170

Rethinking modern prostheses

every amputee soldier and sailor, there needed to be further limb-​fitting centres under medical supervision.59 The prosthesis became further legitimised as compensation for the loss of a limb in war. Furthermore, the state was charged with ensuring that an amputee was never without his aid. Artificial limbs were fundamental to the service offered to the amputee veteran by the Ministry of Pensions, and several reports were commissioned and published –​including the Departmental Committee on Artificial Limbs in 1919, the Departmental Committee of Inquiry on Artificial Limbs, 1921, and the Committee of Inquiry on Metal Artificial Limbs in 1925 –​that demonstrate the Ministry of Pension’s interest in the provision of artificial limbs. The reconfiguration of spaces Hospital spaces have altered throughout the centuries. Dana Arnold has argued that the military hospital was conceived of as a small city in the eighteenth century, but in the nineteenth and early twentieth centuries the hospital evolved further.60 Hospital spaces were fluid; they expanded to encompass new technological developments. For instance, space was needed for the laboratory in hospitals in the nineteenth century. Internal spaces within hospitals shifted, owing to the innovation of improved systems of lighting, the operating theatre migrated from the roof space of the hospital to lower floors or the basement. Office space had to be found for the hospital’s increasing bureaucratic function, and, as more specialties were developed, departments were organised, thus requiring more diversification of space. It was the exigencies of the First World War that significantly contributed to the redefinition of spaces for medical care. Some of these changes were transient and had little long-​term impact after the war was over. Nevertheless, the way that hospital spaces changed during the war, in their scope and population, provides insight into the impact of war on medical care. Thousands of stately homes, schools and other public and private buildings were used to provide spaces for the seriously wounded, the convalescing and those permanently affected by the war. Roehampton was just one of many stately homes used for this purpose. Large-​scale military hospitals that treated the same types of injury were established in a number of locations around Britain. Jeffrey Reznick has analysed the role of Shepherd’s Bush Hospital, a specialist centre for orthopaedics.61 Where possible and expedient, Dominion and colonial troops were housed and cared for in hospitals established specifically for them. Initially, the Brighton Pavilion was used as a hospital to treat colonial Indian troops as it was felt that they would feel at home with the familiar type of architecture.62

17

Space, prosthetics and the First World War

171

Owing to the significant numbers of amputations that resulted from the war, the number of limb-​fitting centres increased throughout Britain. These included Edenhall Hostel, Musselburgh; the Princess Louise Hospital for Limbless Sailors and Soldiers at Erskine House in Scotland; the Duke of Connaught Hospital, Bray, in Ireland; the Ulster Volunteer Hospital in Belfast; and the Prince of Wales Hospital in Cardiff. By 1917, more capacity was required as the numbers of amputees increased. Special centres in military hospitals were opened in major cities such as Liverpool, Manchester, Leeds and Birmingham. Centres in Charterhouse and Paddington Military Hospitals in London were also established, and workshops for repairs were opened at Putney, Park Lane and Queen’s Gate.63 Yet it was not merely the scale and number of hospitals and specialist medical facilities that were altered by the First World War. Within hospitals, there was a fundamental shift and reconfiguration of space that allowed non-​medically trained individuals and groups to use hospitals for a wide range of purposes. Scientists were allowed access to patients in hospitals. Steve Sturdy’s article on experimentation in war demonstrates that some scientists, including physiologists, such as J. S. Haldane, were invited to hospitals to examine servicemen affected by gas.64 The military hospital in particular became a locus of scientific experiments, not solely a space where the wounded were cared for. Other groups of experts gained admittance to hospitals. Artists located themselves in specialist facial units. Marjorie Gerhardt explores the role of artists such as Francis Derwent Wood, Henry Tonks, Kathleen Scott and Horace Nicholls and the work they undertook in hospitals for the facially wounded.65 Indeed, many individuals, mainly women, who visited hospitals or took up posts as Voluntary Aid Detachments altered the sheer number of non-​professional medical employees in hospitals and impacted on the organisation and routine of them. Crucially, the First World War renegotiated the boundaries of the hospital and loosened the demarcation between the medical and the types of practices that went on inside them and the number of individuals in them at any given time. In 1915, an invitation for commercial companies to work on site at ­Roehampton Hospital further expanded the diversity of groups that were given permission to work inside hospitals. As we saw in the first section, surgeons and limb fitters occupied specific spaces prior to the First World War, the surgeon his consulting rooms and the hospital and the limb fitter in his commercial premises. While there was communication between the two groups prior to the war, the war and specialist medical institutions further loosened the physical boundaries between the medical and the medical-​commercial practices that existed previously. This demarcation between the two groups was reconfigured at Roehampton and, by 1915, profit-​making manufacturing

172

172

Rethinking modern prostheses

companies were located within the hospital space. Gwynne Holford, who was instrumental in the establishment of Roehampton, noted in 1918, It was soon found that it was necessary to have workshops on the premises where limbs could be made and fitted for the men, and in 1915 these were instituted. This, however, was not nearly sufficient and in 1917, more were added and the work in this respect has increased by leaps and bounds, the output of artificial limbs being now over 150 a week.66

At Roehampton, doctors and commercial limb fitters worked in relatively close proximity for the first time. The proposed reassignment of control was unprecedented, because surgeons engaged with the fitting of the prosthesis and took charge of it. Instead of being responsible merely for the production of the amputated limb, surgeons were placed in charge of the process of limb amputation, the fitting of the artificial limb and the management of rehabilitation. The reduction in the physical distance between the two distinct groups provided a model for more effective communication and cooperation. It was argued by state agencies that this proximity ensured that surgeons maintained dominance over the process of limb-​fitting. It is important to reiterate that, early in the war, patients were admitted to Roehampton to be fitted with a prosthesis when their stump had healed. Many consultant surgeons at Roehampton had beds in London hospitals and operated on patients there. Control was exercised. Indeed, a publication from the Ministry of Pensions noted, ‘both the selection and fitting of the limb, and the training of the man in its use, must be carried out under the personal supervision of the competent surgeon’.67 At the Inter-​Allied Conference for the Study of Professional Re-​education, which took place in Paris in May 1917, the fitting of artificial limbs was discussed. It was restated that qualified doctors make a decision on the patient’s needs. The reasons given were that amputees were often given unsuitable prostheses by overzealous limb fitters and that ‘badly constructed apparatus, so far from helping the wounded, are injurious and hinder technical re-​education’.68 Despite the directives from surgeons, which were supported by the War Office and the Ministry of Pensions, doctors at Roehampton did not feel that they were in charge. Proximity did not always create cordial relationships between surgeons and limb fitters. A letter sent from the honorary secretary of the Medical Board to Roehampton Hospital in 1916 noted that the ‘consulting surgeons were in some doubt as to what voice they actually have in the selection of limb makers’.69 Indeed, by 1917, the consulting surgeons at Roehampton expressed concern that the companies working at the hospital were too interested in the profits they made from the manufacture of limbs, and the concentration of supply was within ‘the hands of four or five private

173

Space, prosthetics and the First World War

173

firms’.70 Furthermore, surgeons suggested that limb manufacture be shifted to state control, pointing out that Britain was the only country that did not produce and supply artificial limbs through a state factory.71 One of the reasons why the consulting surgeons at Roehampton felt that the limb makers were in control was the manufacturers’ relative and regular proximity to patients. Jonathan Reinarz noted in his explanation of Thomas Cresswell’s definition of place as ‘space with meaning’ that ‘individuals endow a space with meaning’.72 As the control of spaces are often imbued with power and influence, surgeons were obviously worried that they were not able to control the limb-​fitting process, as set out by the War Office, Ministry of Pensions and Medical Board. The continuity of the limb fitters’ presence in the hospital ensured they spent more time with the men undergoing rehabilitation and performed the often intimate process of measuring and fitting an artificial limb. Consulting surgeons connected to Roehampton were occupied with operating on a significant number of patients at the London hospitals, and many of them only spent a few hours at the hospital, often in the evenings or when they were able to conduct a visit.73 By 1917, it was agreed that a surgeon would attend Roehampton ‘to attend daily at fixed hours both morning and afternoon’.74 This maintenance of control through regular visiting was fundamental for the surgeons to demonstrate their dominance in the hospital space. The Ministry of Pensions relied on the cooperation of doctors and limbs fitters to ensure that amputee soldiers and sailors were fitted with a suitable prosthesis. The manufacturer and surgeon worked more closely than they had previously, and, while problematic, this cooperation between the medical profession, particularly surgeons and limb fitters, was established as a result of the First World War. Conclusion Historians have argued that the First World War altered the provision of artificial limbs in Britain. The amputee soldier and sailor were rewarded with the best artificial limb that manufacturers, sponsored by the War Office and the Ministry of Pensions, could provide. While there was no denying that the material used to construct artificial limbs improved and numbers manufactured increased exponentially, there appeared to be little in the actual design of the prosthesis that differed from those constructed in the latter stages of the nineteenth century, although there were some small improvements in joint function and materials, particularly the increased use of aluminium to decrease the weight of the prosthesis. Designs of artificial limbs were more sophisticated in the nineteenth and early twentieth century than previously thought, with innovations including joints, movement and materials.

174

174

Rethinking modern prostheses

Furthermore, there was a well-​established commercial limb-​fitting industry in existence in the nineteenth and early twentieth centuries that demonstrates a level of innovation in designs and technological advances prior to the First World War. The war affected the scale of production, and a degree of standardisation was attempted, but not achieved. This chapter contends that one of the biggest changes was the proximity of the medical profession and the limb manufacturer, and it was the relationship between the surgeon and the limb maker that significantly altered. Although there had been some linkages between the two in the past, the manufacturer and the surgeon’s closer working relationship had a fundamental impact on the experience of the amputee during and after the First World War. The artificial-​limb maker’s craft did not change –​prostheses were still made in a similar fashion to the way in which they had been manufactured in previous centuries. Surgeons still amputated and created functioning stumps. Both the medical profession and artificial-​ limb manufacturers remained concerned with the sites of amputation and the functionality of the remaining stump. While both the medical profession and the limb manufacturer were interested in the body–​prosthesis nexus, the medical profession endeavoured to maintain its dominance in the selection and fitting of the artificial limb and maintained the demarcation of the hospital space as its own during and after the First World War. This chapter focuses on the relationships between surgeons and manufacturers and explores the continuities and changes within them in the nineteenth and early twentieth centuries. Essentially, the focus is medical and takes a top-​ down approach to disability. This chapter reflects attitudes to disabled people in the early part of the twentieth century, as we do not hear the voices of the soldier and sailor amputees. Part of the reason for this might be unique to war, as can be seen by much of the provision of limbs as the war progressed, the creation of thousands of amputees and the standardisation of provision that occurred. That does not mean, however, that these soldiers’ and sailors’ experiences were standardised. Some may have had a positive life experience, while the life experiences of others might have been negative. The nuance of experience of these individuals, not just those that in many ways controlled their future, must be investigated as fully as possible in order for new perspectives to appear, and hopefully other individuals will be interested enough to take up this challenge. Notes 1 ‘The King’s interest in orthopaedics’, The Orthopaedist, 1:3 (March 1920), 1. 2 The numbers of amputees were: regular soldiers, 28,000 legs and 11,000 arms; and officers, 1,400 legs and 600 arms. Ministry of Pensions, Report of the Departmental

175

Space, prosthetics and the First World War

175

Committee of Inquiry into the Machinery of Administration of the Ministry of Pensions (London: HMSO, 1921), 110. 3 See M. Guyatt, ‘Better legs: artificial limbs for British veterans of the First World War’, Journal of Design History, 14:4 (2001), 307–​25; M. M. M. Kowalsky, ‘Enabling the Great War: ex-​servicemen, the mixed economy of welfare and the social construction of disability, 1899–​1930’, Ph.D. dissertation, University of Leeds, 2007. 4 J. E. Hanger, Solvitur Ambulando:  A  Symposium on Prosthetic Achievement (London:  J. E.  Hanger & Co., 1936), 3. Knowledge of psychiatric conditions such as shell shock were advanced by the war, although it has been argued that progress in treatment regimens did not keep pace with knowledge. See T. Loughran, ‘Shell-​ shock and psychological medicine in First World War Britain’, Social History of Medicine, 22:1 (2009), 79–​95; P. Leese, Shellshock: Traumatic Neurosis and the British Soldiers of the First World War (Basingstoke: Palgrave, 2002); F. Reed, Broken Men: Shellshock, Treatment and Recovery in Britain, 1914–​1930 (London: Continuum, 2010). In medical history, discussion has centred on the way certain aspects of surgery, wound care and trauma were affected by the conflict. See M. Harrison, The Medical War: British Military Medicine in the First World War (Oxford: Oxford University Press, 2010); A. Carden-​Coyne, The Politics of Wounds: Military Patients and Medical Power in the First World War (Oxford: Oxford University Press, 2014). 5 Ministry of Pensions, Artificial Limbs and Their Relations to Amputations (­London: HMSO, 1939), 9. 6 R. Cooter, Surgery in Society in Peace and War: Orthopaedics and the Organization of Modern Medicine (Basingstoke: Macmillan, 1993), 108. 7 See C. Timmermann and J. Anderson (eds), Devices and Designs: Medical Technologies in Historical Perspective (Basingstoke: Palgrave, 2006); S. J. Reiser, Medicine and the Reign of Technology (Cambridge: Cambridge University Press, 1978). 8 C. L. Jones, The Medical Trade Catalogue in Britain, 1870–​1914 (London: Pickering & Chatto, 2013), 49. 9 Jones, Medical Trade Catalogue, 50. 10 Salt & Son, Drawings and Testimonials of Artificial Limbs Manufactured by Salt & Son (n.p., 1896). 11 F. Gray, Automatic Mechanism as Applied in the Construction of Artificial Limbs in Cases of Amputation (London: H. Renshaw, 1855), 209. 12 J. Ferris and E. Ferris, From the Surgical to the Mechanical Art: A Treatise on the Manufacture of Artificial Limbs (n.p., 1910), 22. 13 D. W. Warren, James Gillingham: Surgical Mechanist and Manufacturer of Artificial Limbs (Chard: Somerset Industrial Archaeological Society, 2001), 94. 14 Salt & Son, Drawings and Testimonials of Artificial Limbs. 15 J. Gardiner & Sons, Artificial Limbs (n.p., 1900). 16 Caroline Lieffers’ chapter in this volume outlines some of the surgeons willing to participate in commercial activities regarding artificial limbs in mid-​nineteenth-​ century America. 17 Report of the Departmental Committee on Artificial Limbs (London: HMSO, 1919).

176

176

Rethinking modern prostheses

18 James Syme, an Edinburgh surgeon, developed his partial foot amputation in 1829. Stephen Smith was an American surgeon in the Civil War who published an article in 1870 on the knee amputation that bears his name. 19 For an article on the stump in the First World War, see J. Anderson, ‘“Jumpy stump”: amputation and trauma during the First World War’, Journal of First World War Studies, 6:1 (2015), 9–​20. 20 Gray, Automatic, 12–​13. 21 Gray, Automatic, 14. 22 Gray, Automatic, vi. 23 Down Brothers, A Catalogue of Surgical Instruments and Appliances (n.p., 1906). 24 C. W. Cathcart, ‘Sites of amputation in the lower limb in relation to artificial substitutes’, Edinburgh Medical Journal, 34:2 (1889), 819–​29, at 819. 25 ‘The Great International Exhibition: xvii. Report on surgical instruments’, Lancet, 80:2044 (1 November 1862), 489–​91. 26 ‘Artificial limbs for soldiers’, Dover Express, 19 August 1898. 27 ‘Soldiers used to buy their own’, Dundee Evening Post, 5 May 1900. 28 ‘The Queen presents to Netley Hospital’, London Evening Standard, 1 April 1898. 29 See J. Bourke, Dismembering the Male: Men’s Bodies, Britain and the Great War (London: Reaktion, 1996). 30 See Guyatt, ‘Better legs’, 307–​25. 31 London Metropolitan Archives (LMA), H2/​QM/​YO5/​02, Scrapbook, M.  E. G.  Holford, Report for the War Museum on the Roehampton Hospital for Limbless Sailors and Soldiers. 32 For a history of Roehampton, see H. Alper, A History of Queen Mary’s University Hospital Roehampton (Roehampton:  Richmond, Twickenham and Roehampton Healthcare NHS Trust, 1997). 33 ‘Conference on Artificial Limbs for Disabled Servicemen’, British Medical Journal, 31 July 1915, 190. 34 LMA, HO2/​QM/​A/​2/​1, Executive Committee Meeting Minutes, Letter from T. Openshaw to the Secretary, War Office, 28 July 1915. 35 Warren, James Gillingham, 69. 36 See C. G. Boggs, ‘The Civil War’s “empty sleeve” and the cultural production of disabled Americans’, The Journal of Nineteenth-​Century Americanists, 3:1 (2015), 41–​65; J. Davis McDaid, ‘ “How a one-​legged rebel lives”: Confederate veterans and artificial limbs in Virginia’, in K. Ott, D. Serlin and S. Milm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 119–​46; L. Herschbach, ‘Prosthetic reconstructions: making the industry, re-​making the body, modelling the nation’, History Workshop Journal, 44 (1997), 20–​57. 37 LMA, HO2/​QM/​A/​2/​1, Executive Committee meeting minutes, letter to the Secretary, War Office, from T. H. Openshaw, 28 July 1915. 38 Letter to the Secretary, War Office, from Openshaw, 28 July 1915. 39 Warren, James Gillingham, 70.

17

Space, prosthetics and the First World War

177

4 0 Ministry of Pensions, Artificial Limbs, 9. 41 H. Perry, ‘Re-​arming the disabled veteran: artificially rebuilding state and society in World War One Germany’, in K. Ott, D. Serlin and S. Milm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 75–​101, at 96. 42 Ministry of Pensions, Artificial Limbs, 9. 43 Cooter, Surgery and Society in Peace and War, 105. 44 Martin, Artificial Limbs, 11. 45 Thomas, Help for Wounded Heroes, 24 46 Martin, Artificial Limbs, 15. 47 Martin, Artificial Limbs, 12. 48 Hanger, Solvitur Ambulando, 14. 49 See Guyatt, ‘Better legs’, 307–​25. 50 Wellcome Library London, 33737i, photograph album, Princess Louise Scottish Hospitals for Limbless Sailors and Soldiers, 1917. 51 W. MacEwan, ‘On the limbless’, The Inter-​Allied Conference on the After-​Care of Disabled Men, Second Annual Meeting, 20–​25 May 1918, London (London:  HMSO, 1918), 367–​75, at 373. 52 W. MacEwan, ‘On the limbless’, 373. 53 T. H. Openshaw, ‘Paper on fitting and adjustment of artificial limbs’, The Inter-​Allied Conference on the After-​Care of Disabled Men, Second Annual Meeting, 20–​25 May 1918, London (London: HMSO, 1918), 356–​66, at 356. 54 Openshaw, ‘Paper on fitting and adjustment of artificial limbs’, 357. 55 Guyatt, ‘Better legs’, 322, footnote 20. 56 Thomas, Help for Wounded Heroes, 3. 57 J. Anderson and H. Perry, ‘Rehabilitation and restoration: orthopaedics and disabled soldiers in Germany and Britain in the First World War’, Medicine, Conflict and Survival, 30:4 (2014), 227–​51, at 245. 58 Ministry of Pensions, Report of the Departmental Committee of Inquiry, 110. 59 Ministry of Pensions, Report of the Departmental Committee of Inquiry, 111. 60 D. Arnold, The Spaces of the Hospital: Spatiality and Urban Change in London 1680–​ 1820 (London and New York, NY: Routledge, 2013), 7. 61 J. S. Reznick, ‘Work therapy and the disabled British soldier in Great Britain in the First World War: the case of Shepherd’s Bush military hospital, London’, in David Gerber (ed.), Disabled Veterans in History (Ann Arbor, MI: University of Michigan Press, 2012), 185–​203. 62 See S. Hyson and A. Lester, ‘“British India on trial”:  Brighton military hospitals and the politics of empire in World War I’, Journal of Historical Geography, 38:1 (2012), 18–​34. 63 Ministry of Pensions, Artificial Limbs, 10. 64 See S. Sturdy, ‘War as experiment, psychology, innovation and administration in Britain, 1914–​1918: the case of chemical warfare’, in R. Cooter, M. Harrison and S. Study (eds), War, Medicine and Modernity (Stroud: Sutton Publishing, 1998), 65–​84.

178

178

Rethinking modern prostheses

6 5 See M. Gehrhardt, The Men with Broken Faces (Bern: Peter Lang, 2015). 66 LMA, H2/​QM/​YO5/​02, scrapbook; Holford, Report for the War Museum on the Roehampton Hospital for Limbless Sailors and Soldiers. 67 Ministry of Pensions, Artificial Limbs, 9. 68 A. Griffith Boscawen, Report on the Inter-​Allied Conference for the Study of Professional Re-​education and Other Questions of Interest to the Soldiers and Sailors Disabled by the War, Paris, May 1917 (London: HMSO, 1917), 33. 69 LMA, HO2/​QM/​A/​2/​1, Executive Committee meeting minutes, letter from A. S. Bankart to G. H. Kenderdine, 16 May 1916. 70 LMA, HO2/​QM/​A/​2/​1, Executive Committee meeting minutes, letter from A. S. Bankart to G. H. Kenderdine, 20 June 1917, 1. 71 Letter from Bankart to Kenderdine, 20 June 1917, 3. 72 J. Reinarz, ‘Putting medicine in its place: the importance of historical geography to the history of health care’, in E. Dyck and C. Fletcher (eds), Locating Health (London: Pickering & Chatto, 2011), 29–​43, at 29. 73 LMA, HO2/​QM/​A/​2/​1/​Executive Committee meetings minutes, meeting of the subcommittee and consulting surgeons, Roehampton, 18 May 1916. 74 LMA, HO2/​QM/​A/​2/​1/​Executive Committee meetings minutes, letter from Francis Lloyd to the Medical Board, Headquarters, London District, 13 January 1917.

179

Select bibliography Appadurai, A. (ed.), The Social Life of Things:  Commodities in Cultural Perspective (­Cambridge: Cambridge University Press, 2014). Berger, K., The Hearing Aid:  Its Operation and Development, rev. edn (Lavonia, MI: National Hearing Aid Society, 1974). Brune, J. A. and D. J. Wilson (eds), Disability and Passing: Blurring the Lines of Identity (Philadelphia, PA: Temple University Press, 2013). Esmail, J., Reading Victorian Deafness:  Signs and Sounds in Victorian Culture (Athens, OH: Ohio University Press and Swallow Press, 2013). Garland-​Thomson, R., Extraordinary Bodies:  Figuring Physical Disability in American Culture and Literature (New York, NY: Columbia University Press, 1997). Gooday, G. J. N. and S. Araposthathis, Patently Contestable: Electrical Technologies and Inventor Identities on Trial in Britain (Cambridge, MA: MIT Press, 2013). Guyatt, M., ‘Better legs:  artificial limbs for British veterans of the First World War’, ­Journal of Design History, 14:4 (2001), 307–​25. Herschbach, L., ‘Prosthetic reconstructions: making the industry, re-​making the body, modelling the nation’, History Workshop Journal, 44 (1997), 22–​57. Holmes, M. S., Fictions of Afflictions: Physical Disability in Victorian Culture (Ann Arbor, MI: University of Michigan Press, 2004). Jones, C. L., The Medical Trade Catalogue in Britain, 1870–​1914 (London: Pickering & Chatto, 2013). Khan, B. Z., The Democratization of Invention: Patents and Copyright in American Economic Development, 1790–​1920 (Cambridge: Cambridge University Press, 2005). Linker, B., ‘On the borderland of medical and disability history: a survey of the fields’, Bulletin of the History of Medicine, 87:4 (2013), 499–​535. Longmore, P. K. and L. Umansky (eds), The New Disability History: American Perspectives (New York, NY: New York University Press, 2001). Ott, K., D. Serlin and S. Milm (eds), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York, NY: New York University Press, 2002), 119–​43. Pinch, T. and N. Oudshoorn (eds), How Users Matter: The Co-​construction of Users and Technologies (Cambridge, MA: MIT Press, 2003). Thomson, R. G., Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature (New York, NY: Columbia University Press, 1997). Virdi-​Dhesi, J., ‘Curtis’s cephaloscope: deafness and the making of surgical authority in London, 1816–​1845’, Bulletin of the History of Medicine, 87:3 (2013), 347–​77. Warne, V., ‘“To invest a cripple with peculiar interest”: artificial legs and upper-​class amputees at mid-​century’, Victorian Review, 35:2 (2009), 83–​100.

180

Index able-bodied 2, 4, 10, 11, 95, 101, 106 pass as 2, 10, 18, 116, 121, 132 see also body accident 1, 30, 99 car 132 childhood 137 flying 11 industrial 7 riding 127 adaptation of devices 11 of prostheses 6, 17, 104, 108, 149 of hearing aids 27, 39, 41–2 advertising 15–2, 34–5, 38–9, 55, 60–1, 75, 129–31, 146–7, 156n.60, 160–1 bills 38 mail-order see catalogue medical 130 newspaper 38, 160 see also newspaper patents as tools of 15, 22n.38 see also patent periodical 57 rhetoric 118 trade catalogue see catalogue see also marketing; promotion aesthetics 36, 49, 118, 125 see also design Allied Exhibition of Orthopaedic Work see exhibitions aluminium 55, 164, 173 American Civil War 7–8, 11–12, 15, 114, 121, 134n.26, 165, 176n.18, 176n.36 amputee 7, 114, 121, 146 soldier 152 see also war American Leg see leg; Palmer, B. Frank American Medical Association Code of Ethics (1847) 137, 144, 147–9, 152n.3, 155n.40 see also ethics

American Medical Times see publications amplified telephony 9, 70–3, 75, 77, 82, 84, 86–7 see also telephony amputation 8, 21n.23, 22n.34, 139, 142–3, 146, 154n.19, 154n.28, 155n.35, 156n.49, 158–60, 163–74, 174n.5, 175n.11, 176n.18, 176n.19, 176n.24 above the knee 162 at the ankle joint 143 Smith’s 162 Syme’s 162, 176n.18 amputee 7, 18–19, 22n.35, 51, 65n.15, 114–15, 118, 121, 128–9, 132, 133n.7, 134n.26, 163–4, 166–74 see also American Civil War Anderson, Julie 5, 7–10, 16–18, 77, 88n.7, 134n.22, 158, 175n.7, 176n.17, 177n.55 Anglesey, Marquis of (Field Marshal Henry William Paget) 143 artificial limb 162 see also limb apparatus 7, 9, 71, 172 amplifying 71, 73, 75, 77, 81–3, 87, 88n.12, 89n.16 hearing 31, 44n.21, one-handed 11, 15, 95, 97, 102, 104, 106, 109n.5, 110n.14 see also Derenzy surgical 145, 155n.48 see also appliance; device; hardware; instrument; technology appliance 14, 18, 38–9, 56, 93–5, 97, 99–101, 104–6, 140, 143, 146, 149, 153n.9, 165–6, 168, 176n.23 Derenzy’s 106, 108 see also apparatus – one-handed; device – Derenzy’s; instrument – Derenzy’s; invention – Derenzy’s; product – Derenzy’s

18

INDEX

orthopaedic 160, 167 prosthetic 10 maker 13–14 Rein 34 see also companies surgical 169 see also apparatus; device; hardware; instrument; technology arm 29, 93, 95, 100, 158, 164 artificial 135n.49, 141, 154n.17, 161, 164, 166, 168 prosthesis 160–1 see also hands Arnold & Sons see companies artefact 16–17, 39–40, 51 see also material culture; object Artificial Ear Drum Company see companies Artificial Leg Reporter see publications Artist see surgeon-artist Asiatic Review and Monthly Register for British India see publications AT&T 78 aurician 38 see also aurist; specialist – aural, ear; surgeon – aural aurist 31, 35, 38, 49, 51–3, 55–7, 62–3, 64n.4 see also aurician; specialist – aural, ear; surgeon – aural Aurolese see Patent – Aurolese audiometer 70, 75, 77, 80 authority, medical see medical battery, aural 36 Baudrillard, Jean 6, 21n.17 Bell, Alexander Graham 71–2, 87n.2 Belle-Vue Hospital see hospitals benevolence 9, 14–15, 95, 99, 101, 140, 144 see also charity; philanthropy Berger, Kenneth 31, 45n.19, 46n.30, 65n.12, 66n.24 Blatchford, Chas A. see companies Blume, Stuart 19n.1, 19n.3, 51, 65n.14 Bly, Douglas 8, 12, 145–6, 155n.42, 155n.49 see also leg

181

body 1–2, 4, 5, 8–9, 14, 20n.5, 21n.22, 29, 43n.6, 48, 50–1, 60, 64, 65n.17, 68n.49, 77–8, 81, 86, 88n.6, 98–9, 102, 126, 129, 133n.5, 133n.11, 134n.18, 134n.20, 159, 167, 174, 176n.36 damaged 15, 50 defective 51, 106 disabled 21n.26–7 ex-serviceman 163 see also ex-serviceman; veteran female 116 industrial 9 impairment 4, 9 see also disability new understandings of 4 non-normal 2 normal 2, 50 normalised 30 part 3–5, 7, 29, 50, 114–15, 117, 121–3, 126, 130, 159–60 artificial 2, 3, 114–15, 117, 121–2, 126, 130 prosthetic 122 technology of the see technology worker 9 see also able-bodied; norm; normal; normalcy Boissonneau, Auguste 130–1, 136n.61–2 Boston Evening Gazette see publications Boston Medical and Surgical Journal see publications breast artificial 13, 115 implants 115 British Artificial Limb Makers Association 169 British Deaf-Mute see publications British Deaf Times see publications British Empire 18, 55, 93, 102 British Medical Association 55–6 British Medical Journal see publications Brune, Jeffrey A. 22n.32, 43n.2, 88n.3, 90n.43, 116, 133n.14–16 Burroughs Wellcome & Co. see companies buyer 4, 160 see also consumer; customer; purchaser

182

182

INDEX

capitalism and competition 13 and disability 3, 20n.6 industrial 4, 9 and medicine see medicine catalogue 33, 35, 44n.12, 159–60, 162, 164 Down Brothers 162, 176n.23 Haslam 54 Hawksley 45n.26, 45n.28, 46n.36, 65n.11 see also companies – Hawksley, Thomas & Co. instrument 30 manufacturer 74, 162 Marks, A. A. 118, 121, 128–30 see also companies – Marks, A. A. medical trade 22n.38, 74, 130, 141, 160 Salt & Son 160 trade 15, 21n.22, 30, 61, 68n.60, 74, 117, 129, 141, 160 see also advertising; literature; marketing; promotion Century Illustrated Magazine see publications Chambers, William 122–3, 134n.31 see also publications – Chambers’ Journal charity 100, 102, 107, 108, 140, 150–1 see also benevolence; philanthropy charlatanry 49 see also quackery Chelsea Hospital see hospitals class see social class coal field 9, 21n.28 coal miner 105 cochlear ear implants 1, 2, 19n.3, 47n.50, 65n.14, 72, 81, 87, 89n.26, 90n.45 see also hearing aid Code of Ethics (1847) see American Medical Association; ethics Collier, Edward see companies commerce 1, 7, 10, 94, 104, 109n.5, 110n.14, 112n.58, 114, 117–18, 127

and artificial eyes 65n.7, 134n.29 history of see history commercial enterprise see enterprise commercialisation 2, 5, 8, 11, 12, 17, 49, 56, 63 process 3, 6, 42 see also commodification Commissioner of Patents 140, 148, 151, 157n.74 commodification 1–2, 5, 18 approach 3 of artificial body parts 130 process 3, 5–6, 16 see also commercialisation commodity 78, 86, 134n.27, 135n.43 culture 18 prosthesis as 3, 6 standardised 4 see also standardisation see also good; product communication 18, 27–31, 43n.6, 61, 65n.15, 73, 78, 89n.20, 112n.53, 126, 131, 160–2, 171–2 clinical 51, 162 sign language as 28–9, 43n.6, 61 telecommunication 70, 73, 78, 87, 88n.15, 90n.49 telephone 70, 73, 89n.20 technologies see technologies companies American Artificial Limb Company 152, 156n.51 Arnold & Sons 33, 40–1, 44n.12, 45n.28, 47n.46, 57 Artificial Ear Drum Company 58 Audios 41 Blatchford, Chas A. 21n.24, 165, 169 Burroughs Wellcome & Co. 57 Collier, Edward 31–2, 45n.20 Desoutter Brothers (Marcel and Charles) 11–12, 22n.39, 165 Down Brothers 162, 176n.23 Drake, John S. 16, 114, 127–9, 135n.49, 155n.45 Ferris & Co. 7, 21n.21, 175n.12 Gillingham, James 22n.35, 65n.18, 133n.7, 166, 175n.13, 176n.35, 176n.39

183

INDEX

Gray, Frederick 162, 175n.11 Grossmith, W. R. 165 Hanger, J. E. 158, 165, 175n.4 Hawksley, Thomas & Co. 28, 33, 35–6, 41, 45n.26, 45n.28, 46n.36, 47n.47, 50, 53, 65n.11, 66n.29 see also catalogue Marks, A. A. (George E.) 16, 25, 114, 117–22, 127–9, 134n.23, 134n.25, 134n.27–8, 134n.30, 134n.32, 135n.50–2, 135n.54–5 see also catalogue Palmer & Co. (B. Frank) 8–9, 12, 14, 81, 99, 114, 137–57, 141–52, 154n.16 see also leg Rein, & Son/Rein and Co. (Frederick Charles) 31–6, 41, 43n.7, 46n.29–34, 47n.49 Way Ear Drum Company 58–9, 61, 63–4, 68n.48 Wilson Ear Drum Company 55, 58 company 3, 15, 28, 32, 36–7, 58, 75, 87, 169 British 30 commercial 73, 159, 171 hearing-aid 31, 33, 82 medical 7, 18, 21n.22 see also maker; manufacturer; producer consumer 4, 6, 7, 8, 11, 22n.38, 31, 33, 35, 47n.45, 49, 51, 60, 67n.47, 89n.19, 90n.44, 94–5, 97, 104–8, 121, 134n.24, 160 see also buyer; customer; purchaser consumption 5, 10–11, 14, 20n.11, 45n.25, 65n.16, 67n.47, 98, 109n.7 conspicuous 28, 34 cycles 5 patterns 17 structures of 6 see also Baudrillard control, medical see medical Cooter, Roger 19n.1, 21n.26–7, 159, 167, 175n.6, 177n.43, 177n.64 copyright 3, 66n.35, 154n.18 crown 82, 84, 89n.33

183

see also eponymy; intellectual property; trademarks; patent cork leg see leg Cousins, John Ward 55–7, 59, 66n.25, 67n.40, cure 36–8, 44n.8, 49–52, 56, 59–60, 62–3, 65n.12, 68n.58, 68n.62–3, 69n.67, 102–3 all 55 medical 32 customer 34, 53, 62–3, 75, 77–8, 87, 148, 159–61, 166 American 58 British 58 deaf 55, 58 see also buyer; consumer; purchaser Dadysett, H. J. 55, 57 Daen, Laurel 5, 7, 10–12, 15, 18, 81, 88n.13, 89n.31, 121 Davis, Lennard J. 20n.5, 43n.6, 88n.6–7, 117, 134n.18 Deaf 19n.3, 34, 43n.6, 44n.13, 44n.15, 47n.50, 49, 71–2, 88n.7 Chronicle see publications community 1, 10, 28, 71 culture 43n.6, 66n.19, 69n.66, 71, 88n.2 see also communication – sign language; deaf; deafness; deafened; hard-of-hearing; hearing; hearing-aid; hearing loss; National Institute for the Deaf deaf 18, 27, 29–30, 35–8, 42, 43n.1, 44n.10–12, 45n.26, 46n.30, 46n.36–7, 47n.51–3, 55, 58–9, 61–3, 65n.1–11, 66n.19, 66n.29, 68n.59, 68n.62–3, 69n.67, 70–2, 78, 80–5, 87 identities 10, 29, 72, 86 subscriber 73–8, 84, 86, 88n.9, 88n.12, 89n.17 see also communication – sign language; Deaf; deafness; deafened; hard-of-hearing; hearing-aid; hearing loss; National Institute for the Deaf

184

184

INDEX

deafened 29, 35, 42, 44n.13, 49, 51–2, 70 see also communication – sign language; Deaf; deaf; deafness; hard-of-hearing; hearing; hearing-aid; hearing loss; National Institute for the Deaf deafness 11, 20n.5, 21n.22, 23n.52, 27–38, 40, 43n.1, 43n.3–7, 44n.8, 44n.16, 46n.30–1, 47n.41–3, 48–51, 53, 56, 60–4, 64n.4, 65n.6, 65n.12, 65n.14, 68n.58, 69n.68, 70–2, 84, 88n.3, 88n.5–6, 134n.18, 153n.11 see also communication – sign language; deaf; deafness; deafness; hard-of-hearing; hearing; hearing-aid; hearing loss; National Institute for the Deaf defect 1, 49, 51, 61, 117, 126 auditory 42 physical 99 defective 50, 62–3, 97, 102, 106, 117 hearing 27 sight 27 tympanum 51 see also body demand 2, 7, 37–8, 40, 49, 62, 72, 74, 77–8, 127, 152, 165–6 see also supply dentist 125–6, 135n.43, 144 dentistry 22n.42 American 125, 135n.43 Derenzy, George Webb, 7, 10, 11–12, 15–16, 81, 93–113 see also apparatus; appliance; device; instrument; publications – Derenzy’s Enchiridion design 1, 5–8, 10, 12–17, 29, 31, 33, 35, 40–2, 49–53, 55–63, 67n.44, 68n.48, 70–8, 81, 83–7, 94, 98, 100, 102–5, 107–8, 114–15, 121, 124, 129, 158–61, 164–8, 173–4 disguised 7 functional 7 innovation 4, 159 open-source 1 prosthesis 7, 14, 52, 128, 164

designer 11–12, 16, 39 user-designer see user-designer see also innovator; inventor Desoutter Brothers (Marcel and Charles) see companies Detroit 58–9, 64, 68n.59 device 1, 5, 11, 13, 15, 28–34, 45n.19, 45n.26–7, 70, 72, 74–8, 80–4, 86–7, 93–5, 97, 114, 117, 121–5, 127–32, 134n.27, 141, 145 artificial 49 assistive 2–4, 11–12, 14, 27–9, 31–6, 50 see also prostheses aural 70 Derenzy’s 97–8, 102, 105 see also apparatus – one-handed; appliance – Derenzy’s; instrument – Derenzy’s; invention – Derenzy’s; product – Derenzy’s hearing 7, 10, 12, 17, 21n.20, 27–8, 30–9, 41–3, 43n.3, 46n.30–2, 48–53, 55, 58–64, 64n.4, 65n.11–12, 66n.21–2, 68n.48, 68n.64, 69n.69, 90n.45 see also hearing aids medical 12, 22n.41, 81, 87, 165 prosthetic 9, 11, 71, 99, 104–6, 108, 114–15, 118, 126, 139 quack 66n.21 see also appliance; apparatus; hardware; instrument; technology disability 1–2, 4, 6–7, 11, 15–17, 20n.6–9, 20n.16, 23n.52, 28–30, 43n.6, 49, 65n.17, 72, 74, 78, 84, 86, 94, 106–8, 117, 152, 158, 174 and class 11, 21n.28, 27–8, 34, 58, 65n.15, 94, 98, 103–8, 112n.53, 112n.62–3, 121, 124–5, 133n.7 see also social-class economic approaches to 3 and femininity 11, 116, 132, 133n.11 and gender 11, 22n.34, 31, 40, 94, 98, 103–8, 113n.66, 114–15, 118, 121, 129 history see history

185

INDEX

and masculinity 11, 94–5, 98, 101, 104, 106–8, 114–15, 134n.26 medical model of 1, 2, 4, 19, 71, 132, 139, 148, 152 and passing 10–11, 22n.32, 43n.2, 88n.3, 90n.43, 116, 133n.16 rights 1–2, 6, 10, 18, 139 social model of 19, 88n.7, 175n.3 studies 1, 20n.16, 65n.10, 116 see also body – impaired; impairment disablement 9, 17, 106 doctor 14, 102, 121, 142, 145, 159–63, 167, 172–3 see also practitioner; surgeon Down Brothers see companies Drake, John S. see companies Duke of Connaught Hospital see hospital ear 8, 27, 29, 32, 37–8, 41, 44n.11–12, 44n.19, 45n.20, 48, 50–3, 55–7, 59–64, 64n.2–4, 66n.20, 66n.22–3, 66n.25, 66n.27, 67n.36, 68n.48, 70–1, 76, 80 artificial 19n.3 specialist see specialist see also surgeon; aurist; aurician trumpet 31–2, 44n.11–12, 44n.14, 44n.19, 46n.35, 47n.47–8 see also hearing trumpet; Patent – Aurolese eardrum artificial 37, 48–69, 71, 118, 124 manufacturer see manufacturer prosthetic 51, 55, 59–60 economy 3, 4, 97, 122, 145, 175n.3 capitalist 9 moral 139, 147, 150, 153n.8, 153n.14 Edenhall Hospital see hospitals Edinburgh 93, 105, 176n.18 Edinburgh Medical Journal see publications empire see British Empire Enchiridion see Derenzy; publications – Derenzy’s Enchiridion endorsement 114, 118, 129, 131, 145–8, 160–2

185

engineering 1, 6, 82–3, 168 enterprise 18, 37, 73, 82, 151, 163 entrepreneur 50, 56, 58–9, 82, 94–5, 106, 137, 140 medical 56 eponymy 15, 30, 32–3, 114, 126–7, 129–30 see also copyright; intellectual property; patent; trademark Erskine House see hospitals Esmail, Jennifer 23n.52, 28–30, 43n.1, 43n.4–5, 43n.7, 44n.16, 65n.6, 71, 88n.2, 88n.5 establishment, medical 4, 6, 139 ether 51, 57, 59, 144, 157n.64 ethics code of 150 Code of (1847) see American Medical Association Code of Ethics medical 14, 149 professional 39, 56, 137, 149 reasons not to patent 14 Europe 93, 102–3, 131 exclusion, social 2, 18, 103–7 exhibition 143, 147, 152, 164 Allied Exhibition of Orthopaedic Work (1915) 169 of American Manufactures, Washington DC (1846) 141 and fair 141, 143, 158 Great International, London (1851) 143, 146–7, 157n.78, 163, 176n.25 international 15, 34 prize 35 expertise, medical 139 ex-serviceman 163–4, 166, 175n.3 see also body; veteran extension of the ear 48, 64n.3 of the senses 71 patent see patent prosthetic see prosthetic eye 43n.4, 117, 122, 125–7, 130–1, 144 artificial 12, 49, 102, 118, 122, 130–1, 134n.29, 136n.61–2 glass 130, 136n.60–1, 136n.63 glasses 52

186

186

INDEX

factory 9, 57, 173 fair see exhibition Ferris & Co. see companies fiction, Victorian 8, 17–18, 116, 123 see also literature firm, hearing aid 82 see also company; companies First World War 8, 11–12, 16, 21n.26, 41–2, 73–4, 158–9, 163–4, 168–71, 173–5, 175n.4, 176n.19, 177n.57, 177n.61 see also Great War; war Ford, Henry 8–9 Frankland, George 38–9 Gardner, Kirsten E. 13, 22n.43, 115–16, 133n.7 Garland-Thomson, Rosemarie 113n.66–7, 116, 133n.12 gender see disability – gender Gentleman’s Magazine and Historical Chronicle see publications George V, King 158 Gillingham, James see companies Globe Ear-phone 39, 47n.44 good, medical 15, 63 see also commodity; product Gooday, Graeme 5, 7, 10–11, 15, 17–18, 23n.56, 27, 31, 44n.17–18, 45n.23, 50, 58, 65n.9, 67n.45, 71, 77, 86, 87n.1, 88n.5, 89n.19, 89n.28–30, 90n.47, 124, 153n.14 Gray, Frederick see companies Great International Exhibition (1851) see exhibition Great War 21n.26, 22n.34, 158, 175n.3, 176n.29 see also First World War; war Grossmith, W. R. see companies Guyatt, Mary 21n.26, 22n.39,164, 168–9, 175n.3, 176n.30, 177n.49, 177n.55 Guy’s Hospital, London see hospitals hair artificial 12, 116, 122, 129, 130 false 134n.34 see also wig

hands, artificial 135n.49, 154n.17 see also arm Hanger, J. E. see companies hard-of-hearing 10, 15, 28–30, 35–7, 41–2, 70–2, 83–4, 87, 90n.49 consumer 11 identities 10 subscriber 12, 75, 86 telephone-user 18, 72, 83 see also deaf; Deaf; hearing hardware 4, 5, 36, 90n.45, 105 see also appliance; apparatus; device; instrument; technology Harris, Raymond J. 11–12, 15, 72, 74–90, 94, 99 see also invention – Harris’s Hawksley, Thomas & Co. see companies; catalogue health 14, 23n.56, 66n.31, 67n.46, 102, 117, 137, 167 care institutions see institutions ill 14 mental 167–8 professionals 50 professions 137 healthy 106, 134n.20, 162 hearing 7, 27–9, 35–8, 41–2, 43n.4, 45n.26–7, 46n.30, 46n.37, 49–53, 61–3, 64n.3, 70–3, 77, 80, 82, 84, 86–7 aid 7, 10, 12, 17, 19, 27–34, 36, 38–9, 41–2, 43n.4–5, 44n.12, 45n.19, 46n.30, 46n.34, 47n.50–1, 48, 50, 60–1, 65n.11–12, 68n.64, 70, 74, 76, 82, 87 company see company; companies design 14, 40 firm see firm inventor see inventor maker see maker manufacturer see manufacturer patent see patent user see user vendor see vendor Victorian 39, 41 device see device horn 33, 40, 43n.7 impairment see impairment

187

INDEX

instrument see instrument loss 27, 29–31, 35, 37, 40, 59, 62–3, 64n.2, 64n.4, 70–8, 80–1, 83–4, 86–7, 88n.7 normal 42, 72, 78 pass as 18, 28–9, 51, 71, 83 trumpet 3, 5, 8, 18, 28–9, 33–4, 40, 47n.46, 61 see also ear see also hard-of-hearing; deaf; Deaf heart valves, artificial 50 Herschbach, Lisa 9, 15, 21n.22, 22n.34, 23n.49, 68n.49, 115, 133n.5, 176n.36 history of commerce 5, 7, 115 of disability 1–5, 16, 18–19, 66n.19, 139 new disability history 2, 5, 16, 18–19, 20n.5, 22n.33, 23n.51 of economics 5, 17, 111n.31, 139 Marxist/materialist history of disability 3, 15, 20n.5, 20n.16 of medicine 14, 20n.16, 129, 158–9 of prostheses/prosthetics 5, 7, 9, 15, 94, 115, 164, 173 of science 15, 70 of science, technology and medicine 5 of technology 5, 7, 72, 90n.44–5 Holmes, Oliver Wendell 65n.17, 114, 133n.3 hospital 142, 159–62, 166–74, 177n.60 specialist limb-fitting 164, 167–73 see also hospitals hospitals Belle-Vue 145 Chelsea 164 Duke of Connaught 171 Erskine House 168 Guy’s 110n.17, 162 Middlesex Hospital, London 35 Millbank Military 164 Netley 163, 176n.28, Prince of Wales 171 Princess Louise 171, 177n.50 Queen Mary Convalescent Auxiliary 164

187

Roehampton Limb Fitting 16, 164, 167, 169–73, 176n.31–2, 178n.66 Royal Portsmouth 56 Shepherd’s Bush, London 170, 177n.61 St Bartholomew’s, London 143, 162 St George’s, London 36 St Mary’s, London 53 St Thomas’, London 110n.17 Ulster Volunteer 171 Voluntary Aid-Detachment 166 see also infirmary Hudson, Erasmus Darwin 141, 143, 145, 155n.46, 155n.48 Hutchison, Miller Reese 39 identity 2, 5, 10, 11, 32, 50, 72–3, 80 amputee 169 cultural 10 deaf 29, 84, 86, 90n.45 and Deaf community 10, 72 and disability 5, 10, 29 hard-of-hearing 10, 72, 84 hearing 71 and passing 22n.32, 43n.2, 83 politics of 18 professional 58 and prosthesis users 10, 11 social 11 social and cultural 2, 3 illness 1, 30 impaired see body; consumer; hearing; worker impairment 6, 10–11, 14, 94, 98–102, 105–8, 123, 139–40, 151–2 and concealment 10, 83 hearing 7, 12, 17–18, 53, 61, 71, 88n.7 limb 18 and passing 2 physical 1, 4, 6, 10, 18, 81, 95, 98–102, 107–8, 133n.66, 139 sensory 4 social marker of 2, 116 see also disability independence 74 and masculinity 97–8, 102

18

188

INDEX

industrial 21n.29, 23n.54 accident see accident body see body capitalism see capitalism fair see exhibition medical-industrial complex see medical methods 8 structures 4 worker see worker industrialisation 3–4, 9, 94 and masculinity 110n.22 industry 5, 7, 11, 13, 15–16, 19n.1, 21n.22, 21n.26, 23n.46, 45n.24, 115, 132, 160, 168–9, 174 prosthesis 2, 13, 15, 21n.26, 115 Infirmary Portsmouth and South Hants Eye and Ear 56 see also hospital; hospitals innovation 1–2, 4–5, 7–8, 10, 31, 38, 49, 53, 55–9, 63, 66n.21, 67n.46, 72, 78, 81, 86–7, 100, 131, 147, 153n.10, 158–60, 163, 169–70, 173–4, 177n.64 in design see design; invention prosthesis 7–8 user 72, 81, 100 innovator 15, 55, 58–60, 63, 81 see also designer; inventor institution 2–3, 30, 42, 43n.6, 73–4, 77–8, 86–7, 93, 111n.31 health-care 6, 140 medical 171 patent as see patent Post Office see Post Office state-sanctioned 4 instrument 36–7, 42, 55, 75, 77, 81–3, 94, 98–9 acoustic 34, 35 catalogue see catalogue Derenzy’s 97–9, 101–2, 104–5, 108 see also apparatus – one-handed; appliance– Derenzy’s; device – Derenzy’s; invention – Derenzy’s; product – Derenzy’s hearing 54

maker see maker otoacoustical 26n.36, 35, 45n.28 surgical 31, 38, 54, 56, 61, 97, 106, 110n.17, 137, 176n.25 see also maker see also appliance; apparatus; device; hardware; technology intellectual property 5, 12, 14–16, 22n.40, 23n.46, 66n.34, 139, 153n.4, 153n.14, 169 and ownership 14 and patents 5 protection 3, 129 see also copyright; eponymy; patents; trademarks intervention, medical 15 interwar 9, 70–90 invention 5–7, 12–15, 23n.45, 31–2, 41, 44n.17, 58, 66n.35, 68n.47, 71, 125, 140–2, 147–8, 154n.31 Derenzy’s 93–5, 97, 99, 101–2, 104–5, 107–8, 109n.4, 112n.61 see also appliance– one-handed; apparatus – Derenzy’s; Derenzy; device – Derenzy’s; instrument – Derenzy’s; product – Derenzy’s Harris’s 77–8, 80–1, 83–4, 86–7 see also Harris, Raymond J. national culture of 15 Palmer’s 147–52, 156n.60 see also leg – Palmer’s; companies – Palmer & Co. (B. Frank); product – Palmer’s see also design; innovation; inventor inventor 11, 13, 15–17, 22n.44, 31–2, 44n.18, 49, 58, 67n.39, 67n.45, 107–8, 137, 144–7, 149–52, 156n.56 hearing-aid 32 one-handed 81 see also Derenzy and patentee 34–5, 41, 46n.32 user-inventor see user-inventor see also designer; invention invisibility 7, 51, 55, 61, 63, 71–2, 115–8, 120–1 see also visibility

189

INDEX

Jerrold, William Blanchard 122–3, 126, 134n.33, 135n.45 Jones, Claire L. 21n.22, 22n.38, 29, 56, 64, 74, 84, 94, 110n.17, 129–30, 139, 141, 153n.9, 160 journal, medical 142 see also publications Judy see publications Khan, Zorina 13, 22n.44, 56, 66n.35, 67n.46–7, 100, 141, 154n.18 knowledge 78, 81 artistic 142 bodily 77–8 expert 142 medical 162 scientific 139 of sound 78 of stump rehabilitation 167 surgical 149 LaCom, Cindy 116, 133n.11 Ladies’ Monthly Museum see publications Lancet, The see publications law 13, 22n.40, 32, 35, 37, 73, 87, 142, 144, 150, 152 patent see patent see also legislation Lawrence, William 143 leg 7, 11, 29, 118, 122–3, 127–8, 135n.48, 137, 141, 143, 146, 161, 168–9, 174n.2, 176n.36 American 8, 12 see also Bly, Douglas; companies – Palmer & Co. (B. Frank) artificial 8, 12, 22n.35, 114–15, 119–23, 126–9, 132, 133n.7, 135n.49, 138, 141–2, 145, 151, 154n.16, 154n.17, 154n.19, 154n.30, 155n.35, 155n.42, 156n.50, 156n.52–3, 160–1, 164, 166, 168 see also Bly, Douglas; companies – Palmer & Co. (B. Frank) Bly’s 8, 12, 145 see also Bly, Douglas cork 123, 128–9

189

Palmer’s 8, 114, 145 see also companies – Palmer & Co. (B. Frank); invention – Palmer’s; product – Palmer’s patent 151 wooden 98, 122–3, 134n.31 see also arm; hands; limb legislation 13, 30, 56, 73 patent see patent see also law Letters Patent 56 see also patent Lieffers, Caroline 5, 8, 9, 12–14, 17–18, 56, 81, 94, 99, 114, 153n.5 limb artificial 3, 4, 7, 9–12, 14, 16–19, 21n.21–2, 21n.24, 21n.26, 21n.28, 28, 50, 65n.15, 114, 118–22, 128–9, 134n.22–3, 135n.51, 137, 142–4, 149, 152, 156n.49, 158–70, 172–3, 175n.3, 175n.5, 175n.10–17, 176n.26, 176n.33, 176n.36, 176n.46–7, 177n.40–2, 177n.44, 177n.53–4, 177n.63, 178n.68 false 118, 121, 128 fitters 163, 167 loss 12, 17–18, 93, 101–2, 108, 132, 158, 170 maker see maker manufacturer see manufacturer prosthetic 51, 118 standardised 165, 168 trade 8 see also arm; hands; leg Linker, Beth 6, 20n.16 literary Chronicle see publications criticism 6 guides 123 lens 137 marriage plots 117 see also Victorian – marriage plots sources 16, 115–16 texts 117, 122, 124, 129–30, 132 weeklies 93 see also literature

190

190

INDEX

literature 17, 29, 39, 113n.66, 115, 118, 126–8, 130–2 British 128 English 7 medical 141–2, 162 see also publications nineteenth-century 115, 129 promotional 16 trade 11, 15–17, 160 see also catalogue Victorian 65n.6, 116 see also literary London 7, 12, 21n.22, 32–6, 41, 43n.4, 46n.32, 47n.45, 47n.47, 53, 55, 62, 74, 83, 93–4, 97, 105, 124–5, 127–8, 143, 146, 152, 158, 160, 162, 164, 169, 171–3, 177n.53, 177n.60–1 British Neptune see publications Illustrated News see publications Medical and Surgical Journal see publications Reader see publications St James Chronicle and Evening Post see publications Weekly Gazette see publications McGuire, Coreen 7–11, 15, 18, 94, 99 maker 8, 31–4, 67n.47, 115, 124, 129, 160, 165 appliance see appliance hearing-aid 33, 39, 50, 53 instrument 31, 34, 36, 44n.19, 57, 97, 106 limb 7, 9, 11, 117, 127, 129, 130, 156n.54, 156n.59, 157n.74, 158–9, 162–5, 169, 174 English 169 prosthesis 6, 8, 128 specialist 7 surgical instrument 31, 38, 44n.19, 57, 97, 106, 110n.17 wig 129–30 see also company; companies; manufacturer; producer manufacturer 2, 9, 11, 14–15, 30, 49, 55, 57, 74, 129, 147, 149–50, 160–2, 164–5, 173–4

American 12, 16, 165–6 artificial eardrum 55, 58, 60–2 British 33, 166, 169 catalogue see catalogue hearing-aid 11, 15, 33, 45n.27 limb 9, 144, 153n.5, 160, 162, 165, 169, 174 prosthesis 15–16, 18, 130, 137 user see user-manufacturer see also company; companies; maker; producer Martineau, Harriet 27–8, 30, 35–6, 40, 43n.1, 44n.12 market 2–4, 6, 10, 13, 17–18, 32, 40, 62, 66n.31–2, 73, 98, 118, 122, 131–2, 135n.58, 137, 145–6, 152, 157n.65, 158–9 commercial 4, 159 exchange 4, 139 labour 9 medical 118 responses 1 marketing 32, 49, 55, 58–9, 62–3, 74–5, 94–5, 104, 107, 117, 121, 127–8, 134n.22 see also advertising; promotion Marks, A. A. (George E.) see companies Marquis of Anglesey see Anglesey Marxist/materialist history of disability see history Mary, Queen 158, 164 masculinity 11, 95, 98, 101, 104, 106–8, 115 and disability see disability mass-market 4, 31 see also market mass-production 8, 168 see also production material culture 42, 45n.26, 47n.45 of medicine and disability 17 studies 6 see also artefact; object mechanic 104–5, 147 mechanician 8, 141 Mechanics Magazine see publications mechanism 28, 50, 142, 150, 152, 153n.10, 162, 165, 175n.11 ball and socket ankle 8, 12

19

INDEX

medical 38, 49, 174 advertising see advertising authority 56, 139–40, 143 care 170 companies see companies control 4, 6, 50–1, 140 device see apparatus; appliance; device; instrument; technology entrepreneur see entrepreneur establishment see establishment ethics see ethics expertise see expertise good see commodity; good; product history see history – of medicine industrial complex 1, 19n.1 institution see institution intervention see intervention knowledge see knowledge literature see literature market see market model of disability see disability monopoly 23n.46, 56, 137 patent see patent practice 49, 56, 171 practitioner 6, 30, 55, 61, 74, 103, 129, 145 see also medical – professional product see product profession 2, 4, 7, 10, 14–15, 18, 142–3, 145, 147, 152, 159, 161–3, 173–4 professional 139–41, 146, 148, 171 see also medical – practitioner professionalisation 103 professionalism 59, 152 surveillance 51, 170 technology see technology Times and Gazette see publications trade catalogue see catalogue training 137, 146 medicalisation 18 medicine and capitalism 4 Victorian 55 Medico-Chirurgical Review see publications Middlesex Hospital, London see hospitals

191

Mihm, Steven 23n.48, 65n.7, 65n.13, 115, 133n.5, 133n.7, 134n.29 Millbank Military Hospital see hospitals Mills, Mara 28, 30, 43n.4–5, 61, 65n.12, 68n.61, 68n.64, 78, 84, 87, 89n.20, 90n.45 Ministry of Health 73 Ministry of Pensions 9, 73, 158, 164–6, 169–70, 172–3, 174n.2, 175n.5, 177n.58–9 monopoly 13, 31, 55–6, 73, 78, 139, 148–51 medical see medical – monopoly; patent Post Office 9, 77, 84 moral economy see economy Morley Ear Phone see Vickers’ Morley Ear Phone Morning Post see publications Morton, William 144, 155n.36, 157n.64 National Health Insurance Act (1911) 73 National Health Service (NHS) 30, 44n.12, 87 National Institute for the Deaf (NID) 42, 47n.51, 70, 80, 89n.25 see also communication – sign language; Deaf; deaf; deafness; deafened; hard-of-hearing; hearing; hearing-aid; hearing – loss Netley Hospital see hospitals new disability history see history – of disability newspaper 30, 37, 38, 42, 48, 64n.4, 93–4, 100, 128, 158–63 New York 55, 93, 141, 145–6 New York Sun see publications Nicholson, J.H. 38–9, 55, 58–9, 62, 68n.52 norm, social/cultural 30, 139 normal 9–10, 63 see also body; hearing normalcy 1, 4, 7, 17, 117 see also body North America 13, 18, 93, 102 see also the United States

192

192

INDEX

O’Connor, Erin 22n.34, 114–15, 133n.4 object 7, 17, 21n.17, 22n.41, 23n.53, 29, 34, 40–1, 44n.17, 50, 95 see also artefact; material culture occupation 11, 14, 98, 159 one-handed apparatus see apparatus open-source design see design oral method 29 oralism 43n.6, 61 oralist 61 orthopaedic appliance see appliance surgeon see surgeon orthopaedics 159, 169–70, 174n.1, 175n.6, 177n.57 otoacoustical instrument see instrument Ott, Katherine 10, 21n.22, 22n.31, 22n.43, 23n.48, 49–50, 64, 65n.7–8, 65n.10, 65n.13, 65n.15, 133n.5, 133n.7, 134n.29, 176n.36, 177n.41 owner 11, 29, 46n.35, 75, 125, 164 ownership 4, 5, 108 and intellectual property 14, 22n.40, 44n.17, 115, 129 Palmer & Co. (B. Frank) see companies; leg Palmer’s Artificial Leg Reporter and Surgical Adjuvant see publications Palmer’s Bane and Antidote see publications Palmer’s Orthopaedic or Artificial Leg Reporter see publications passing see able-bodied; disability; hearing patent Act (1790) 13, 137 Act (1836) 140, 153n.13 American 12, 58, 141 for apparatus 15, 17 for appliance 56 application 58, 100 for artificial eardrums 37, 57–62, 67n.36–48, 68n.50–7, 69n.65 for artificial eyes 136n.61 for artificial limbs 9, 14, 17–18, 118–20, 129, 134n.23, 135n.49– 52, 137–9, 141–7, 154n.17,

155n.42, 155n.45, 156n.50–8, 157n.74, 161, 169 for artificial tympanums 14, 44n.8 Aurolese 32, 34–5, 46n.33 British 33, 56, 58, 111n.31, 131 and community 80–4, 94, 107 cultures 14, 16, 19, 23n.56 English 12 extension 14, 140, 149–50 for hearing aids 17, 31–5, 44n.19, 45n.27 and intellectual property 5, 12–14, 17, 22n.40–2, 22n.44–7, 28–35, 37–42, 44n.17–19, 55–6, 66n.34–5, 67n.36–40, 67n.45–8, 80–2, 89n.19, 100, 129, 137–40, 145–51 law 5, 31, 56, 137, 148 Law Amendment Act (1852) 13, 31, 57 leg see leg legislation 148, 150 mark 15–16, 31–5, 44n.17 medical 45n.19, 55 medicine 4, 31–3, 45n.24, 55, 66n.31 monopoly 13, 31, 55–6, 139, 148–51 and moral economy 137–52, 152n.1, 153n.5, 153n.9, 153n.12 Office 31 for prostheses 15 provisional 32, 56 as record 16, 17, 23n.54, 55, 140 right 16, 56 as social contract 13, 140 specifications 17, 32, 49, 57–62, 131 for surgical instruments 137 system 13, 15, 58, 81–3, 100, 140, 151 as tools of advertising 15–16, 28, 32, 58, 118–20, 134n.24, 150 see also copyright; eponymy; intellectual property; trademarks patentee (and pseudo-patentee) 12–13, 16, 28, 31–7, 41, 46n.32, 57–8, 140 patenting activity 13–14, 16 practice 58, 137 patient 2, 6, 10, 36, 49, 52–3, 57, 59, 66n.31, 102, 125, 135n.58,

193

INDEX

143–4, 147–9, 152, 159, 161–3, 166–8, 171–3, 175n.4 Peck, Homer P. K. 58, 62, 67n.42–4 periodicals 16, 39n.46, 52, 57, 94, 124, 135n.43 see also publications Perry, Heather 167, 177n.41, 177n.57 Philadelphia 93, 141, 143 College of Dental Surgery 137 West 58 philanthropy 15, 81, 108, 149–50 see also benevolence; charity physician 8, 102–3, 110n.17, 114, 137, 139, 143–8, 150, 153n.10, 154n.24, 155n.40, 156n.60 see also practitioner; surgeon politeness 20n.11, 98–9, 102, 111n.24 polite society 4, 7, 11, 23n.48, 51, 63, 98, 133n.5 Poovey, Mary 117, 134n.17 Post Office 10, 15, 70–8, 81–8 monopoly see monopoly poverty 95, 108, 139, 144 practitioner aural 52–3, 55–6 medical 6, 18, 30, 38, 55–7, 61, 64n.4, 74, 102–3, 139, 152, 153n.9 see also physician; surgeon Prince of Wales Hospital see hospitals Princess Louise Hospital see hospitals producer 4, 72, 105, 108 commercial 31 of medical goods 15 user see user-producer see also company; companies; maker; manufacturer product 1, 3–4, 15–16, 32–5, 42, 55, 57–8, 67n.46, 72, 74, 81, 99, 115, 146 Derenzy’s 101, 104, 106, 108 see also apparatus – one-handed; appliance– Derenzy’s; device – Derenzy’s; instrument – Derenzy’s; invention – Derenzy’s Palmer’s 142, 145, 148–51 see also companies – Palmer & Co. (B. Frank); invention – Palmer’s; leg – Palmer’s

193

patented 151 mass 31 medical 49, 59 see also commodity; good production 4, 5, 7, 10, 17–18, 41, 105, 148, 168 mode of 4, 8–9, 77, 94, 100 prosthesis 8–9, 95, 149, 159, 160, 164, 168–9, 172 scale of 4, 8, 174 standardised 8 of technologies 84, 94 production-consumption cycles 5 profession see medical – profession professionalism see medical – professionalism promotion 4, 5, 12, 15–16, 18, 61, 143, 151 see also advertising; marketing proprietary rights 13, 15–16, 41, 100, 115, 129 see also monopoly prosthesis as camouflage 21n.20, 68n.64, 69n.69, 160–1 and comfort 58, 60–1, 63, 97, 101–2, 144, 160, 162, 167, 169 design see design and discomfort 49, 93, 97 history see history development 3, 9, 19 industry see industry innovation see innovation invisible 35, 46n.33, 48–50, 53, 57, 60–1, 68n.48, 120, 131–2 maker see maker manufacturer see manufacturer myoelectric limb 1–2 patent see patent production see production standardised 8, 77 surgical 48–9, 53, 55, 63 telephony as 71, 87 trade see trade use see use user see user see also device; hardware; instrument; technology

194

194

INDEX

prosthetic 3–5, 17, 19, 19n.2, 19n.4, 20n.8, 21n.22, 22n.31, 22n.35, 23n.48, 29, 63, 65n.7, 65n.10, 65n.13, 65n.15, 65n.18, 81, 128, 130, 158–74 appliance see appliance device see device eardrum see eardrum limb see limb technology see technology tool 4 publication 16, 94, 108, 143, 163, 166, 172 as alternative to patenting 111n.33 publications American Medical Times 145, 155n.43 Asiatic Review and Monthly Register for British India 101, 109n.3 Boston Evening Gazette 127 Boston Medical and Surgical Journal 143, 146, 154n.25, 154n.29–30, 156n.54, 157n.64 British Deaf-Mute 38–9, 47n.41 British Deaf Times 39, 47n.44 British Medical Journal 66n.25, 66n.30, 125, 135n.39, 176n.33 Century Illustrated Magazine 48 Chambers’ Journal 101, 111n.36, 122, 134n.31, 134n.34 Deaf Chronicle 38 Derenzy’s Enchiridion: Or, A Hand for the One-Handed 93–7, 99–112 Edinburgh Medical Journal 163, 176n.24 Gentleman’s Magazine and Historical Chronicle 94, 101, 103, 112n.50, 190n.4 Judy 124–5, 135n.36, 135n.43 Ladies’ Monthly Museum 102, 111n.45 Lancet, The 51, 110n.17, 143, 154n.31, 163, 176n.25 Literary Chronicle 100, 109n.4, 111n.35 London British Neptune 106, 112n.64

London Illustrated News 63, 69n.68 London Medical and Surgical Journal 102, 112n.48–9 London Reader 124 London St James Chronicle and Evening Post 101, 111n.43 London Weekly Gazette 101, 111n.38 Mechanics Magazine 100–1, 103–4, 106, 109n.4, 112n.53 Medical Times and Gazette 32 Medico-Chirurgical Review 102, 111n.47 Morning Post 101–2, 111n.39, 111n.46 New York Sun 122 Palmer’s Artificial Leg Reporter and Surgical Adjuvant 142–3, 154n.19 Palmer’s Bane and Antidote 142–3 Palmer’s Orthopaedic or Artificial Leg Reporter 142–3, 155n.35, 156n.55, 157n.78 Punch 130–1, 135n.43, 136n.60 Scalpel 141, 154n.15–16 Surgical Appliances 169 Tait’s Edinburgh Magazine 27, 44n.12 Times, The 130, 136n.59 Tit-bits 37, 46n.40, 124 Transactions of the Society for the Encouragement of Arts, Manufacture and Commerce 94, 104, 109n.5, 110n.14, 112n.58 Punch see publications purchase 27–35, 38–41, 48, 57, 94, 100, 105–6, 121, 134n.27, 135n.43, 142, 152, 159–61, 163 purchaser 31, 33, 35, 38, 41–2 see also buyer; consumer; customer quack 144 aural 38, 43n.4–5, 46n.37, 56, 64n.4 device see device doctor 37 quackery 55–6, 64n.5 see also charlatanry Queen Mary Convalescent Auxiliary Hospital see hospitals see also Mary, Queen

195

INDEX

reader 37, 39, 94–5, 97–108, 115, 117, 124–6, 129–31, 135n.43, 169 female 11, 122, 124–6 rehabilitation 88n.7, 159, 167–8, 172–3, 177n.57 Rein, Frederick Charles (and Son/Rein and Co.) see companies see also Patent – Aurolese respectability 94–5, 98–101, 104, 107–8 Roehampton Limb Fitting Hospital see hospitals Royal College of Physicians 102 Royal College of Surgeons 143 Royal Portsmouth Hospital see hospitals royalty 8, 13, 29, 43n.7, 158, 162–3, 176n.28 St Bartholomew’s Hospital, London see hospitals St George’s Hospital, London see hospitals St Mary’s Hospital, London see hospitals St Thomas’ Hospital, London see hospitals Sayer, Karen 5, 7, 10–11, 15, 17, 18, 27, 34, 40, 45n.27, 50, 71, 86, 124 Scalpel see publications science 81, 103, 129, 131, 137, 142, 144, 150 acoustic 70 history see history – of science Scotland 35, 168, 171 Second World War 11, 18, 87 see also war seller 4, 36, 41, 93, 124 see also vendor Shepherd’s Bush 170, 177n.61 shipbuilding 168 Shuttleworth, Sally 46n.39, 117, 134n.17 sign language see communication Slavishak, Edward 9, 21n.29 Smith, Marquard 19n.4, 22n.35, 115–16 Smith, Stephen 145–6, 155n.43–4, 155n.46–7, 162, 176n.18 social class 11, 21n.28, 22n.35, 27, 34, 58, 66n.32, 94, 98, 103–8, 121, 124–5

195

contract, patent as see patent exclusion see exclusion identity see identity model of disability 19, 88n.7 see also medical – model of disability soldier 10–11, 19n.1, 21n.26, 101, 107, 146, 152, 156n.51, 156n.53, 158, 163–4, 167–71, 173–4, 175n.4, 176n.25–7, 176n.31, 177n.50, 177n.57, 177n.61, 178n.66, 178n.68 South African War (Boer War) 63 speaking tube 29, 33, 48 specialist 165 aural 48, 51, 55 ear 58, 64n.4 maker see maker see also aurician; aurist; surgeon standardisation 9, 56, 78, 80, 82, 86–7, 164, 168, 174 Stark, James F. 23n.56, 44n.17, 45n.23, 118, 134n.24 state, the 7, 18, 87–6, 177n.41 British 8, 9, 18, 163–4, 170, 173 sponsorship 1, 4, 36, 90n.51 stigma 10, 16, 71–2, 116–17, 121–5 stigmatisation 7 of hearing loss/deafness 30, 61, 63, 71–4 of physical impairment 94, 121–5 Stoddard Holmes, Martha 116 stump 8, 160–2, 167–8, 172, 174, 176n.19 supply 2, 7, 59, 70, 77, 82, 97, 102–3, 114, 149, 156n.53, 158, 165–6, 172–3 see also demand Surdus see Yellon, Evan surgeon 7–8, 13, 52, 55–7, 102, 139, 141–6, 148–52, 159–68, 171–4, 175n.16, 176n.18, 178n.73 aural 10, 14, 32, 49, 53, 55, 59, 64n.4 orthopaedic 164, 167 surgeon-artist 114, 137, 140–2, 145–7, 149–50

196

196

INDEX

surgery 137, 141–5, 147, 152, 154n.26, 154n.31, 155n.43–47, 158, 166, 175n.4, 176n.6 aural 43n.4, 64n.4, 66n.22, 66n.26 surgical appliance see appliance instrument see instrument instrument maker see maker procedure 8 prosthesis see prosthesis Surgical Appliances see publications technique 158–9, 161, 163, 167 Sweet, Ryan 5, 7, 8, 11, 16–19, 88n.13, 94, 114, 137 Syme, James 143, 162, 176n.18 Tait’s Edinburgh Magazine see publications technology 1–2, 10, 18, 19n.1, 50–1, 77, 132, 161, 163 assistive 5, 70–1 aural 70–89 communication 65n.12, 68n.61, 71, 84–7 hearing 50–63, 72, 84–7, 88n.7 history of see history medical 10, 175n.7 of the body 4, 20n.11, 22n.37, 51, 65n.16, 99, 109n.7, 111n.25, 111n.27 prosthetic 1 surgical 63 see also apparatus; appliance; device; hardware; instrument teeth artificial 12, 118, 122, 125, 130 false 118, 123–6, 131, 134n.35, 135n.39 telecommunication see communication Telegraph Act (1869) 73 telephony 70–1, 75, 77–8, 80–1, 86–7, 88n.7 see also amplified telephony Thackray Medical Museum 34, 40, 43n.7, 44n.12, 44n.17, 45n.23, 46n.29 Times, The see publications Tit-bits see publications Toynbee, Joseph 32, 52–5, 60–1

trade catalogues see advertising; catalogue; literature literature see advertising; literature prosthesis 8, 18, 33, 128 trademark 15, 32–3, 41, 59 see also copyright; eponymy; intellectual property; patent tradesmen 14 Transactions of the Society for the Encouragement of Arts, Manufacture and Commerce see publications trauma 1, 64n.2, 158, 175n.4, 176n.19 Turner, David M. 2–4, 20n.7, 20n.11, 51, 65n.16, 94, 98–9, 106, 109n.7, 113n.66 tympanums, artificial 7, 8, 10, 13, 14, 18, 32, 44n.8, 50, 51, 66n.21, 66n.25, 67n.36–37, 67n.39, 74, 153n.11 see also eardrums Ulster Volunteer Hospital see hospitals United States, the 1, 4, 6, 14, 19n.1, 28, 35, 39, 44n.19, 55, 58, 66n.19, 78, 137, 143, 165 see also North America United States Patent and Trademark Office 12, 138 user prostheses 1–15, 17–18, 20n.15, 28, 30, 39–42, 44n.9, 47n.48, 48, 50–3, 56–64, 70–87, 89n.18, 94, 114–32, 148, 156n.50, 160, 167 user-designer 12, 17, 39 user-inventor 18, 94–109 user-manufacturer 12, 29 vendor, hearing-aid 28, 30, 36–7, 39, 41–2, 45n.27 see also seller veteran 15, 19n.1, 21n.22, 21n.26, 74, 114–15, 121, 133n.1, 158, 163, 169–70, 175n.3, 176n.36, 177n.41, 177n.61 see also ex-serviceman

197

INDEX

Vickers Jnr, George M. 59 Vickers, Laura H. 58, 62, 69n.65 Vickers’ Morley Ear Phone 58–9, 61–2 Victoria, Queen 8, 29, 43n.7, 162–3, 176n.28 Victorian marriage plots 7, 115–16, 125 see also literary – marriage plots studies 39 Virdi, Jaipreet 5, 7–8, 10, 13–14, 17–18, 21n.22, 28, 30, 32, 43n.4–5, 44n.8, 45n.21, 64n.4, 67n.39, 71, 88n.5, 94, 98, 120, 140, 153n.11 visibility 51, 94, 115, 131 see also invisibility Voluntary Aid-Detachment Hospital see hospitals Wakley, Thomas 143 war 1, 10, 19n.1, 74, 106, 158, 163, 165–74 American Civil War see American Civil War First World War see First World War Office 164–5, 168, 173 pension 74 Second World War see Second World War

197

South African War (Boer War) see South African War Warne, Vanessa 22n.35, 65n.15, 115–16, 127, 133n.7 Way Ear Drum Company (Francis M. and George P.) see companies welfare 9, 73, 141, 147, 175n.3 wig 115, 118 see also hair Wilson, Daniel J. 22n.32, 43n.2, 65n.16, 90n.43, 116, 133n.14–16 Wilson Ear Drum Company see companies Withey, Alun 4, 20n.11, 22n.37, 51, 65n.16, 94, 98–9, 109n.7, 111n.25, 111n.27 Woodforde, John 123–4, 134n.35, 135n.37–8, 135n.42 worker 121 farm 105–7 impaired 9 industrial 9, 11, 115 World War One see First World War World War Two see Second World War Yearsley, James 32, 44n.8, 51–3, 55–6, 67n.36, 67n.39, 153n.11 Yellon, Evan 36, 46n.37–8