The ear drill

You’ve heard of using a sledgehammer to crack a nut; but what about a drill (or rather two drills) to crack a cherry stone?

That is exactly what took place at the Hôtel-Dieu hospital in Paris in 1833. The surgeon responsible was the great Guillaume Dupuytren, and his unusual case was reported in the Bulletin General de Therapeutique a few months later:

intra-auricular lithotrity

The headline means ‘Intra-auricular lithotrity’ – a medical term which has probably never been used since. Indeed, a footnote states that ‘we use this term though it be improper, since it perfectly conveys the type of operation performed’. The phrase means ‘crushing a stone inside the ear canal’ – and it is indeed entirely apposite.

In the month of July last, a child aged seven years, in playing with other children, let fall a cherry stone into the passage of the ear. A month later the child was presented at M. Dupuytren’s consultation; exploration of the ear by daylight (at sunrise) and examination by catheter, proved the existence of a foreign body at the bottom of the meatus.

The meatus is the ear canal. I like the qualification ‘at sunrise’. It is easy to forget that before the advent of electric light, it could be fearsomely difficult to see inside the cavities and passages of the body. Nineteenth-century journals regularly published articles about new inventions intended to assist ear, nose and throat specialists in their work, using complicated systems of mirrors to project candle- or gaslight into the darkest of crevices. But until miniature lightbulbs came along towards the end of the century, nothing could beat good old-fashioned sunlight.

It may easily be conceived how important it was to extract the body in the shortest possible time, to prevent mortal suppurations within the cranium, and various other possible accidents.

Physicians already well understood the dangers of inner ear infections. Because the organ is so close to the brain, the risk of meningitis was very real.

The attempt was first made, but in vain, to extract the foreign substance with several kinds of forceps. These instruments could take no hold, in consequence of the close apposition of the foreign body with the undilatable sides of the canal.

M. Dupuytren’s instrument was caught – quite literally – between a rock and a hard place. The cherry stone was solid, and the walls of the bone-lined ear canal too firm to be moved aside.

M. Dupuytren then came to the conclusion that the stone must be broken previously to extraction. A kind of metallic drill, sheathed in a silver cannula, was made for this express purpose by Charrière.

Joseph-Frédéric-Benoît Charrière was the most celebrated surgical instrument maker in France. Dupuytren – as the country’s leading surgeon – was probably the only person in the world who could make Charrière drop everything and make a bespoke instrument at a moment’s notice.

This instrument is a true lithotrite, enclosed in a simple canula without forceps.

A ‘lithotrite’ is an instrument designed to crush a stone. It was invented as a new means of treating bladder stones: instead of opening up the patient and removing the stone by incision (a famously painful procedure), the surgeon would insert the lithotrite through the urethra and into the bladder and crush the stone into fragments, which would then be passed with the urine. It was still far from pleasant, but definitely preferable to being ‘cut for the stone’ as previously.

The head of the child having been inclined toward the opposite ear, and placed on a table, where several assistants retained it firmly, the instrument was introduced, closed, to the stone, then the sheath being withdrawn a little, the drill was made to act on the stone, with great caution, to avoid the neighbouring parts. After a few turns of the instrument the stone remained engaged at the end like a cork caught within a bottle; but it was impossible to withdraw it whole, for on the one hand the inflammation had diminished the calibre of the passage, and, on the other, the size of the stone itself had augmented since its introduction.

Cherry stones, although hard, are not entirely impermeable. This one had evidently absorbed some moisture, hence the difficulty in removing it.

The instrument was, therefore, removed, and a larger drill ordered, by the aid of which the stone was broken into several fragments; its extraction was then effected partly with the forceps, and partly by consecutive inflammation.

None of this sounds particularly pleasant for the poor child. The author does not mention his demeanour during these rather protracted proceedings; I like to think of the little chap enduring it with heroic stoicism.

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