The making of a career: Joseph Toynbee's first steps in otology

Abstract

Joseph Toynbee (1815-1866) is considered one of the fathers of modern otology. He spent his whole life in London, studying and describing the anatomy and pathology of the main diseases of the ear. This paper presents some of the motivations behind Toynbee's decision to specialise in otology, by examining several of his letters published under the signature 'J. T.' in The Lancet between 1838 and 1839. Frustrated by the weakened state of aural surgery in Britain, and by the popularity of several 'quacks aurists' (including John Harrison Curtis, William Wright and Alexander Turnbull), Toynbee insisted that the study of the ear needed to distance itself from quackery and rebuild itself upon a scientific foundation. This paper evaluates several exchanges between Toynbee and Curtis, Wright and Turnbull.

Shedding light on the tympanic membrane: a brief history of the description and understanding of its anatomy

“…anonymously published letters in The Lancet challenging those he called quack aurists. 26 His approach was based on methodical and accurate observation of his patients, combined with meticulous specimen dissection, drawing, for the first time, pathology and treatment inferences from tympanic membrane anatomy. 27 Toynbee described the tympanic membrane as consisting of five superimposed layers (from outside to inside: 'the epidermis, the dermoid layer, the radiate fibrous layer, the circular fibrous layer and the mucous layer, with its epithelium'), and identified the cutaneous nature of the external layers: 'Between the epidermoid and radiating fibrous layers of the membrana tympani, there is a distinct and completed lamina of membrane which is continuous with the dermoid layer of the meatus'.…”

“…28 These observations led him to propose an ingenious way to restore hearing in tympanic membrane perforation cases, using an Indian rubber disc which would be placed on the eardrum and was removable thanks to an attached silver wire. 26 In the late nineteenth century, progress shifted back to the European continent with Alexander Prussak and the great Adam Politzer (Figure 6). Politzer (1835Politzer ( -1920) synthesised knowledge about the tympanic membrane.…”

How advances in light technology have shaped ENT

“…Upon embarking on his career as an otologist in 1839, Toynbee commented on the ‘degraded state of aural surgery’, 12 referencing the lack of rigorous scientific endeavour in otology in Britain in the early nineteenth century. Better illumination of the tympanic membrane, and the ability to visualise it outside of daylight hours, led to significant advancements by the latter half of the nineteenth century.…”

Hearing loss and dementia, vestibular neuronitis, salivary carcinoma, and the history of tympanic membrane anatomy

“…10 They take us on a fascinating voyage through the history of knowledge of this structure, from Hippocrates ('a dry thinspun web'), through to Fallopius and Vesalius (who both used the term 'tympanum'), then the great leaps in knowledge in the latter part of the renaissance and nineteenth century that occurred in parallel with technical advances which allowed dissection then microscopy. The story reads like a 'who's who' of otology, with giants such as Toynbee, 11 Prussak, Politzer 12 and Shrapnell. This paper makes fascinating bedtime reading for anyone interested in the ear.…”