The History Of Otorhinolaryngology At Mayo Clinic
HISTORICAL VIGNETTEThe History of Otorhinolaryngology atMayo ClinicMatthew L. Carlson, MD, and Kerry D. Olsen, MDThe sum-total of medical knowledge is nowso great and wide-spreading that it wouldbe futile for one man to attempt to acquire,or for any one man to assume that he has,even a good working knowledge of anylarge part of the whole. The very necessitiesof the case are driving practitioners intocoöperation. The best interest of the patientis the only interest to be considered, and inorder that the sick may have the benefit ofadvancing knowledge, union of forces isnecessary.William J. Mayo1The following historical account waswritten after the 100th anniversary ofthe Department of Otorhinolaryngology to document the development of thespecialty at Mayo Clinic in Rochester, Minnesota. This article serves to commemorate thosebefore us, ensuring that the details of thisformative time are not forgotten. It also celebrates more than 150 years of otology, rhinology, and laryngology practice at Mayo Clinic.This report was compiled from multiple sources including the annual reports to the MayoClinic Board of Governors, the Mayovox(Mayo Voice) newsletter, the illustration archives of the Mayo Clinic Division of CreativeMedia, staff biographies, curriculum vitae,memoirs, personal interviews, full-text journalarticles, and book publications including TheDoctors Mayo, Mayo Roots: Profiling the Originsof Mayo Clinic, Early Days in the Mayo Clinic,and Sketch of the History of the Mayo Clinicand the Mayo Foundation. The core informationfor this report was abstracted from the annualreport documents submitted to the MayoClinic Board of Governors every year by thesection or department chair that detailedroutine departmental business and any notableactivities from the preceding year. The articleis organized into 4 distinct historical eras: (1)the early years, (2) the establishment of thespecialty, (3) adversity, transformation, andexpansion, and (4) the modern era.From the Department ofOtorhinolaryngology,Mayo Clinic, Rochester,MN.The Early YearsAs with all specialties at Mayo Clinic, the genealogy of the Department of Otorhinolaryngologybegins with Dr William Worrall Mayo. DrW.W. Mayo immigrated to the United Statesfrom England in 1845, and received his medicaltraining in La Porte, Indiana, and St. Louis, Missouri. Shortly after beginning his medical practice, Dr W.W. Mayo contracted malaria andelected to leave Lafayette, Indiana, and traveledto Minnesota in 1856 in search of a more healthful climate. Dr W. W. Mayo and his family journeyed to several cities in Minnesota beforeultimately settling in Rochester after Dr Mayowas appointed by President Abraham Lincolnto serve as the examining physician for drafteesin southern Minnesota during the Civil War.During these years, his 2 sons were bornd“Will”on June 29, 1861, and “Charlie” on July 19,1865. Even early on, Dr W. W. Mayo involvedhis sons in the care of his patients; they wouldfrequently attend country rounds and weresometimes permitted to observe “kitchen tableoperations” at the Carpenter House or participate in autopsies (Figure 1).2 These early decisiveexperiences led the brothers to pursue formalsurgical training and return to Rochester tojoin their father’s practicedDr William JamesMayo after obtaining his medical degree in1883 from the University of Michigan at Ann Arbor and Dr Charles Horace Mayo after receivinghis medical doctorate at Northwestern University, Chicago, Illinois, in 1888. Notably, Dr W.J. Mayo received much of his training in Michigan under Dr George E. Frothingham, Professorof Ophthalmology and Otology.3,4 Additionally,shortly after graduating, Dr C. H. Mayo traveledto Europe for 6 months, where he spent much ofMayo Clin Proc. n February 2017;92(2):e25-e45 n mayoclinicproceedings.org n ª 2016 Mayo Foundation for Medical Education and Researche25
MAYO CLINIC PROCEEDINGSFIGURE 1. The Carpenter House, located at621 North Broadway in Rochester, Minnesota,was used by Dr William Worrall Mayo foroutpatient surgical procedures before the construction of Saint Marys Hospital wascompleted in 1889. Reproduced with permission of the W. Bruce Fye Center for the Historyof Medicine, Mayo Clinic, Rochester, Minnesota.his time observing treatment of eye, ear, nose,and throat conditions, and he assumed responsibility for most of this work after returning toRochester.4It is notable that the brothers received theireducation at a time of great discovery in Western medicine and surgery. In 1864, Dr JosephLister, disheartened by the formidable rate ofinfection and the constant stench of hospitalwards, began using carbolic acid (phenol) asan antiseptic in solutions for hand washing, instrument cleaning, dressing application, andeven steam spray atomization.5 It was also atthis time that several signficant surgical advances in the field of head and neck surgerywere made, including Dr Emil Theodor Kocher’s goiter excision in 1872, Dr Christian AlbertTheodor Billroth’s first description of total laryngectomy in 1873, Dr William S. Halsted’sbeginning use of cocaine as a topical vasoconstrictant and anesthetic in 1885, and the introduction of rubber gloves in 1889.6 It was saidregarding this era, “Probably the most interesting period of medicine has been that of thelast few decades. So rapid has been thisadvance, as new knowledge developed, thatthe truth of each year was necessarily modifiedby new evidence, making the truth an everchanging factor.”7The early success of the Mayos was propelled by their exemplary surgical outcomese26Mayo Clin Proc.nduring a time when laboratory medicine, surgical pathology, asepsis, anesthesia, andexploratory surgery were in their infancy.6,8In these years, a surgeon operated on all areasof the body, and a notable part of their practice dealt with the treatment of head andneck ailments. In Dr W. W. Mayo’s seventhbibliography entry of 13 publications, he reports on the surgical management of a lingualepithelioma, a carcinoma of the tongue, in the1885 Transactions of the Minnesota State Medical Society.9,10 In this report, the patient wasplaced in a reclined position, a chloroformanesthetic was administered, the tumor wasresected using a “dulled scissors” and a “sharpscoop,” and the area was subsequently cauterized with a hot iron.9Central to the history of the Mayo Clinicand the establishment of the Department ofOtorhinolaryngology was the construction ofSaint Marys Hospital after a series of tornadosdevastated the local region in August 1883.2Saint Marys Hospital was finally operationalon October 1, 1889, with the 3 Mayos and 5of the Sisters of Saint Francis comprising themedical and executive staff. The hospital andclinic buildings relevant to the history ofotorhinolaryngology at the Mayo Clinic arepresented in Figures 2 through 8.3The completion of the 27-bed hospitalwelcomed the first major growth period inthe history of Mayo Clinic, between 1889and 1906.2 During this time, a total of 21 staffFIGURE 2. Saint Marys Hospital was completedin 1889 and was the primary site where DrCharles H. Mayo performed hundreds of operations of the head and neck before work wasdelegated to the specialty sections. Reproducedwith permission of the W. Bruce Fye Center forthe History of Medicine, Mayo Clinic, Rochester,Minnesota.February ocp.2016.11.010www.mayoclinicproceedings.org
HISTORY OF OTORHINOLARYNGOLOGY AT MAYO CLINICFIGURE 3. Constructed in 1900 on the northwest corner of what is now First Avenue andSecond Street SW in Rochester, Minnesota, thefirst floor of the Masonic Temple was used bythe Section of Otolaryngology and Rhinologyfor examinations, diagnostic work, and minorsurgical procedures from 1901 to 1914.Reproduced with permission of the W. BruceFye Center for the History of Medicine, MayoClinic, Rochester, Minnesota.were added, including 13 permanent memberphysicians, 6 interns, and 2 laboratory assistants.6 Specific to the field of otolaryngology,Dr Justus Matthews was hired on May 2,1906, as the section head of laryngology andrhinology, and Dr Gordon B. New was hiredFIGURE 4. The 1914 buildingdthe originalbuilding called “Mayo Clinic”drepresented thefirst fully integrated multispecialty group practiceof medicine. Following construction, the Sectionof Otolaryngology and Rhinology was transferred to the north wing of the second floor ofthe Clinic. The building was located on thecorner of First Street and Second Avenue SWin Rochester, Minnesota, now the site of theSiebens Building. Reproduced with permissionof the W. Bruce Fye Center for the History ofMedicine, Mayo Clinic, Rochester, Minnesota.Mayo Clin Proc. n February GURE 5. The major operative work of theSection of Otolaryngology and Rhinology wastransferred to the Worrall Hospital, located at215 Third Street SW in Rochester, Minnesota,after its opening in January 1919; however, minor surgical procedures were still performed onthe second floor of the 1914 building. Reproduced with permission of the W. Bruce FyeCenter for the History of Medicine, Mayo Clinic,Rochester, Minnesota.on May 20, 1910.10 Dr Matthews learned histrade under the instruction of Dr C. H.Mayo. Also relevant were the additions of DrGertrude Booker Granger in 1898, who wasthe first woman physician to join the Mayopractice and was an assistant to Dr C. H.Mayo in the treatment of diseases of the ears,nose, throat, and eyes10; Dr Carl Fisher in1909 as the section head of ophthalmologyand otology, predominantly managing onlyconditions of the eye10; Dr Henry S. Plummerin 1901 as the chief of medicine, who had akeen interest in upper aerodigestive endoscopy and the treatment of thyroid disease10;Dr E. Starr Judd in 1902 as head of one ofthe sections in surgery and later as chief ofthe surgical staff, whose major interest wasthe treatment of cancers and tumors of thehead and neck10; and Dr Walter E. Sistrunkin 1911 as head of one of the sections in surgery, whose primary interest was the treatmentof head and neck tumors and who developedthe definitive surgical treatment of thyroglossalduct tract anomalies (Figure 9).6,10-12 From1893 to 1906, the annual surgical caseloadincreased 12-fold, from 406 to 4770, withmore than 100 thyroid operations performedannually in the 2 operating rooms at SaintMarys Hospital.6 Notably, the Upper Midwestwas considered the “goiter belt” because of thelow iodine content in the water, and operations of the thyroid gland comprised approximately 10% of the surgical volume in the 016.11.010e27
MAYO CLINIC PROCEEDINGSFIGURE 7. On June 19, 1954, the clinical workof otolaryngology moved to the West 5 desk ofthe new Mayo Building, which included 26 patient examination rooms and separate facilitiesfor audiometric and vestibular testing. Reproduced with permission of the W. Bruce FyeCenter for the History of Medicine, Mayo Clinic,Rochester, Minnesota.FIGURE 6. In 1929, all office work of the Sectionof Otolaryngology and Rhinology was transferredto Desk N-6 of the new Mayo Clinic buildingdnow called the Plummer Buildingdand the entirecorridor was assigned to the section. The spaceincluded 15 examination rooms and 1 room forvestibular testing in addition to separate staff officespace. The new office was equipped with space forholding and storing medical records as well as apneumatic tube system and vertical carrier forefficient transport of clinical records. At the timethe Plummer Building was completed in 1928, itwas the tallest building in Minnesota. Reproducedwith permission of the W. Bruce Fye Center for theHistory of Medicine, Mayo Clinic, Rochester,Minnesota.Even in the early years of practice, thespecialization of surgery had begun. TheMayo brothers saw the importance of dividingsurgical fields between them to best meet thepatients’ needs and manage their large casevolume.2,3 As Dr C. H. Mayo put it best,“The definition of a specialist as one who‘knows more and more about less and less’ isgood and true. Its truth makes essential thatthe specialist, to do efficient work, musthave some association with others who, takenaltogether, represent the whole of which thespecialty is only a part.”13At this time, Dr W. J. Mayo was primarilyinvested in gynecologic and visceral surgery,e28Mayo Clin Proc.nwhile his brother Dr C. H. Mayo began pioneering several surgical specialties includinghead and neck surgery, neurologic surgery,and orthopedic surgery.2,3 In this regard, DrC. H. Mayo was the first otorhinolaryngologyspecialist at the Mayo Clinic. In a 1905FIGURE 8. Most recently, the Department ofOtorhinolaryngology moved from the MayoBuilding to the Gonda Building on December14, 2009. The new space includes 32 patientexamination rooms, 13 double-walled soundbooths for audiological testing, and 8 roomsdedicated to vestibular testing in addition toseveral procedure rooms, conference rooms,and separate office space. The Gonda Buildingcan be seen between the Mayo Building on theright and Methodist Hospital on the left.Reproduced with permission of the W. BruceFye Center for the History of Medicine, MayoClinic, Rochester, Minnesota.February ocp.2016.11.010www.mayoclinicproceedings.org
HISTORY OF OTORHINOLARYNGOLOGY AT MAYO CLINICFIGURE 10. Charles Horace Mayo (left)standing next to his older brother, WilliamJames Mayo (right) in the first operative theaterat Saint Marys Hospital (photograph taken in1904). Reproduced with permission of theW. Bruce Fye Center for the History of Medicine, Mayo Clinic, Rochester, Minnesota.FIGURE 9. Walter Ellis Sistrunk of Mayo Clinicfirst described the importance of removing thecentral portion of the hyoid bone in addition tothe tract of tissue extending to the base oftongue and foramen cecum to prevent recurrence of thyroglossal duct cysts, which was animprovement of Schlange’s 1893 description ofremoving the central portion of the hyoid bonealone. Reproduced with permission of the W.Bruce Fye Center for the History of Medicine,Mayo Clinic, Rochester, Minnesota.publication, Dr C. H. Mayo remarked on thetechnical details of head and neck cancer surgery, an area at which he excelled, stating,“This is to me a most interesting region forsurgical work. A large part of abdominalwork is recreation as compared with thebulk of what might be called the heavy surgeryof the neck.”14 He was known for his unusualsurgical dexterity, and Dr W. J. Mayo referredto his brother on several occasions as thegreatest living surgeon (Figure 10).2A review of the 1904 surgical log revealsthat 3131 operations were performed by thebrothers and their assistants that year.3 Duringthis time, they would perform up to 20 operations in a day, operating 6 days a week.2Among these operations, Dr C. H. Mayo hadperformed 215 operations of the face and135 of the neck.3 The 413 scientific articlesthat Dr C. H. Mayo authored included suchMayo Clin Proc. n February pics as surgical treatment of thyroid andparathyroid disease, tuberculous adenitis ofthe neck, foreign bodies of the trachea andesophagus, surgical management of esophageal diverticula, the relationship betweenmouth conditions and general health, removalof sinonasal malignancies, and many others.10The Establishment of the SpecialtyThe growth and work completed by 1917 ushered in a new era for Mayo Clinic.6 At thistime, the staff had enlarged to a critical number,allowing the clinical work to become increasingly divided by sections. The early sections atthe Mayo Clinic that comprise the modern practice of otolaryngologyehead and neck surgeryincluded the sections of surgery, with treatmentof thyroid and parathyroid disease and care ofcertain head and neck cancers (Figure 11); theSection of Ophthalmology and Otology established in 1909 with Dr Carl Fisher as head, whichprimarily dealt with conditions of the eye; the Division of Medicine with Dr Henry Plummer andhis interests in aerodigestive endoscopy; and theSection of Laryngology and Rhinology established in 1906, with Dr Justus Matthews servingas section head, which was subsequentlydivided in 1917 into the Section of Laryngology,Oral and Plastic Surgery and the Section ofOtolaryngology and Rhinology (Figure e29
MAYO CLINIC PROCEEDINGSFIGURE 11. Early surgical illustration depictingenucleation of a malignant tumor of the parotidgland in order to reduce the risk of facial paralysis. Reproduced with permission of theW. Bruce Fye Center for the History of Medicine, Mayo Clinic, Rochester, Minnesota.Given the fragmented, overlapping, andoften shifting nature of many early surgicalsections that comprise the modern practiceof otolaryngologyehead and neck surgery,the exact start date of the Mayo ClinicFIGURE 12. Illustration of a surgical specimenwith an infiltrating left vocal cord epithelioma, orsquamous cell carcinoma. Reproduced withpermission of the W. Bruce Fye Center for theHistory of Medicine, Mayo Clinic, Rochester,Minnesota.e30Mayo Clin Proc.nFIGURE 13. Harold “Pete” Lillie was the firsthead of the Section of Otolaryngology andRhinology at Mayo Clinic, holding this appointment from 1917 to 1951. Reproduced withpermission of the W. Bruce Fye Center for theHistory of Medicine, Mayo Clinic, Rochester,Minnesota.Department of Otorhinolaryngology initiallymay seem somewhat obscure. However, acareful review of publication history and surgical case logs of this time reveals that the officialfounding date of the department should beMay 2, 1906, with the establishment of theSection of Laryngology and Rhinology. Subsequently, the department’s history predominantly continues through the Section ofOtolaryngology and Rhinology. Because the1917 section transformation played a pivotalrole in the history of the department, this transition is reviewed in greater detail. On April 1,1917, 2 years after the official establishment ofthe Mayo School of Graduate Medical Education, Dr Harold I. Lillie joined Drs Matthewsand New as a specialist in diseases of thenose and throat (Figure 13; Tables 1 and 2).Three months later, on July 1, 1917, the Section of Otolaryngology and Rhinology wasestablished at Mayo Clinic, and Dr. H. I. Lilliewas appointed chief, a position he held untilOctober 1, 1951.3 The formal appointmentof Dr H. I. Lillie to section head upset Dr Matthews, who resigned that same year. It is saidFebruary ocp.2016.11.010www.mayoclinicproceedings.org
HISTORY OF OTORHINOLARYNGOLOGY AT MAYO CLINICTABLE 1. Chairs of the Section/Department ofOtorhinolaryngology, Mayo Clinic, Rochester,MinnesotaDepartment chairChair yearsConsultantyearsJustus MatthewsHarold I. LillieHenry L. WilliamsKinsey M. SimontonD. Thane R. CodyH. Bryan Neel IIIThomas J. McDonaldCharles W. BeattyColin L. W. -20071982-Present2002-Presentthat during this time, Dr New persuaded Dr H.I. Lillie to divest himself from several areas ofthe specialty to allow Dr New to form theseparate section of Laryngology, Oral and Plastic Surgery (Thomas J. McDonald, MD, writtencommunication, 2002). Dr New was originallyan assistant to Dr Matthews in 1910 and had abackground in dental surgery, head and necktrauma surgery, and ablative head and neckoncologic surgery. In contrast, during theseyears, most of Dr H. I. Lillie’s time and interests involved the surgical treatment of suppurative disease and its related complications. Hecould not foresee the substantial changes tothe field that would occur with the introduction of antibiotics, and thus this division of labor seemed both equitable and natural.Although not evident at the time, the departure of laryngology, oncologic surgery, andplastic surgery was a major strategic error onDr H. I. Lillie’s part because it set in motionmajor obstacles that the section would needto address more than 50 years later. Despitethe seeming overlap of laryngology betweenthe 2 sections, the appointments of 1917 stipulated that two-thirds of the laryngology casesgo to the Section of Laryngology, Oral andPlastic Surgery and a third to the Section ofOtolaryngology and Rhinology; however, inpractice, laryngological surgery largelyremained under the jurisdiction of theformer.15Dr H. I. Lillie’s background is particularlyinteresting because he was the first physicianin the field of otolaryngology at Mayo Clinicto receive training from someone other thanDr C. H. Mayo.4 Dr H. I. Lillie was born inGrand Haven, Michigan, on May 6, 1888,Mayo Clin Proc. n February d received his Doctor of Medicine degree atthe University of Michigan in 1912.10,16 Hesubsequently received his graduate clinicaltraining from 1912 to 1913 under the supervision of Dr Roy Bishop Canfield, the firstClinical Professor of Otolaryngology at the University of Michigan. Between 1913 and 1917,Dr H. I. Lillie worked as an instructor and assistant in otolaryngology at the University ofMichigan Medical School and subsequently atRush Medical College in Chicago. It wasrumored that unfairness in referral apportionat his Chicago practice led him to search forother job opportunities, and the open land ofRochester was particularly appealing to himwith his equestrian background.4During his 36 years of service, Dr H. I. Lillieorganized and directed the graduate educationprogram in otolaryngology and rhinology atMayo Clinic, authored nearly 100 articles inleading medical journals, was the President ofthe American Laryngological, Rhinological andOtological Society in 1939, the President ofthe American Laryngological Society in 1945and 1946, and the President of the AmericanBoard of Otolaryngology in 1949, while servingas a member between 1942 and 1953.10,16 During Dr H. I. Lillie’s time of leadership, the section grew from 4 to 9 staff physicians, andacademic productivity increased markedly.During these years, each staff surgeon publishedan average of 8 journal articles annually andgave dozens of lectures nationally and internationally. “The Chief,” as many affectionatelyaddressed him, was a master clinician and surgeon.16 He frequently emphasized that understanding a patient’s entire clinical conditionwas required for correct diagnosis and treatment of local disease. As an accomplished surgeon, his operative skill was characterized by a“minimum of wasted motion.”16 A respectedcolleague from Rochester, New York, Dr C.Stewart Nash wrote, “Pete was a man whopossessed the ruggedness of a lumberjack, thepower of a football player, the expertness of ahorseman, the skill of a famous physician andsurgeon, the strictness of a disciplinarian andthe renown of a teacher.”16By the early 1900s, the focal infection theory had grown popular in Western medicineand strongly influenced medical and surgicalpractice.17-20 This theory held that a primarysilent or unrecognized focus of 1.010e31
MAYO CLINIC PROCEEDINGSTABLE 2. Physician and Doctorate Staff of theSection/Department of Otorhinolaryngology, MayoClinic, Rochester, MinnesotaStaff memberYearsEmeritus/active (MD)Justus MatthewsGordon B. NewHarold I. LillieBert E. HempsteadW. Berkeley StarkCarl M. AndersonHenry L. WilliamsKinsey M. SimontonO. Erik HallbergHenry A. BrownClifford F. LakeJames B. McBeanD. Thane R. CodyJack L. PulecKenneth D. DevineJohn C. LillieLawrence W. DeSantoGeorge W. FacerEugene B. KernThomas J. McDonaldStephen G. HarnerBruce W. PearsonH. Bryan Neel IIINicolas E. MaragosKu Won SuhWilliam J. O’RourkeMitchell S. MarionThomas V. McCaffreyJack L. ClarkKerry D. OlsenCharles W. BeattyRay O. GustafsonDavid A. SherrisTom D. WangJan L. KasperbauerEvan L. NelsonLaura J. OrvidasSharon E. LibiNorval E. BernhardtScott E. StromeDana M. ThompsonLuis A. GarciaColin L. W. DriscollHarvey M. FreedmanAlain N. SabriJens U. PonikauEric J. MooreOren Present1996-2002; 2016-Present1997-19991998-20041999-2006; 01-20052001-Present2003-2010Continued on next columne32Mayo Clin Proc.nTABLE 2. ContinuedStaff memberEmeritus/active (MD), continuedJohn F. PallanchDaniel J. BlumBrian A. NeffDale C. EkbomJohn H. ShelbyShelagh A. CoferDaniel L. PriceAnn F. BellGrant S. Hamilton IIIMatthew L. CarlsonErin K. O’BrienJeffrey R. JanusKarthik BalakrishnanSerban San MarinaKathryn M. Van AbelJanalee K. StokkenLisa A. SchimmentiEmeritus/active (PhD)LeRoy D. HedgecockJack F. UttingLawrence W. KeatingDarrell E. RoseWayne O. OlsenChristopher D. BauchMartin S. RobinetteDavid CyrRobert H. BreyDavid A. FabryJon K. ShallopJodi A. CookDiana M. OrbeloRené H. GiffordNeil T. ShepardCynthia A. HoganDouglas P. SladenGayla L. 014-Present2014-Present(research Present2015-PresentaAt Mayo Clinic since 1947At Mayo Clinic since 1952cFamily practice, serving as medical otorhinolaryngologist.dAt Mayo Clinic until 2001eMedical genetics.bexisted and could result in secondary infections at sites susceptible to circulating toxinsor microbiological spread. It was believedthat by removing the primary nidus, manychronic ailments could be prevented or cured.Numerous anatomic sites were implicated ascommon foci, but the oral cavity and pharynxFebruary ocp.2016.11.010www.mayoclinicproceedings.org
HISTORY OF OTORHINOLARYNGOLOGY AT MAYO CLINICwere the most well recognized. As a result,tooth extraction and tonsillectomy werefrequently performed even in the absence oflocal symptoms, leaving many patients edentulous (Figure 14). Influenced by Dr EdwardC. Rosenow, who was recruited from Chicagoto Mayo Clinic to assist in laboratory diagnostic testing and basic science research, DrC. H. Mayo published in support of the focalinfection theory.2,19,21 As a result, in the1920s more than 80% of the operations performed within the Section of Otolaryngologyand Rhinology involved tonsillectomy. Between 1920 and 1930, 2000 to 3000 tonsillectomies were performed annually, comparedwith fewer than 1000 in the 1930s aftergrowing skepticism regarding the merits ofthis theory surfaced.17In the early years, the Section of Otolaryngology and Rhinology at Mayo Clinic wasprimarily engaged in the treatment of conditions affecting the sinuses, pharynx, andearsddiseases of the head and neck behindthe “mucocutaneous margin.” Beyond pharyngeal procedures for tonsillitis and treatment ofsystemic chronic disease, the otolaryngologistwas preoccupied with the management of acutesuppurative otomastoiditis and infections ofthe paranasal sinuses to the point that otherconditions of the head and neck were forfeitedto other sections. Although it is difficult toconceive today, in the preantibiotic era lifethreateningintracranialcomplicationsincluding septic dural sinus thrombosis, meningitis, abscess, and empyema were commonsources of severe morbidity and mortality andrequired surgical intervention to halt progression, often resulting in disfiguring defects. During this era, radical mastoidectomy andexternal approaches to the paranasal sinuses,such as the Lynch, Denker, or Caldwell-Lucprocedures, were common (Figure 15).17The introduction of antibiotics in the 1930sand 1940s radically altered the landscape of thespecialty. The first time sulfanilamide and itsderivatives were mentioned within the section’shistorical archives was in 1939. Subsequently,penicillin was first referenced in 1942 andstreptomycin in 1945.15,17 Because penicillinwas not widely available until after WorldWar II, Dr Dorothy Heilman at Institute Hills,a local private Mayo Cliniceaffiliated laboratory, developed the first supply for clinicalMayo Clin Proc. n February GURE 14. Surgical illustration of left palatinetonsillectomy using a “scoop method,” whichwas efficient but imprecise and bloody. Duringthe early 1900s, tonsillectomy was rampantbecause of concern over the “focus of infection.” Reproduced with permission of theW. Bruce Fye Center for the History ofMedicine, Mayo Clinic, Rochester, Minnesota.use at Mayo Clinic. Purportedly, the first patient treated with penicillin in the Section ofOtolaryngology and Rhinology was a terminally ill woman with severe leukopenia whohad extensive cellulitis of the face.4 Afterreceiving a substantial dose of 60,000 U ofpenicillin per day via continuous intravenousinfusion, the patient experienced complete recovery in only 3 days, and her urine wascollected to extract any precious remainingantibiotic. In the 1930s, there was a markedtransition to primary medical management ofmany cases of acute infection, and it was generally only cases of chronic infection that ultimately required surgical intervention.15The success of antibiotic therapy permittedotolaryngologists to shift their focus from prevention and treatment of life-threatening infections to functional surgery and furtheradvancements in pharmacological therapy.This trend was most evident in the early 0e33
of the Sisters of Saint Francis comprising the medical and executive staff. The hospital and clinic buildings relevant to the history of otorhinolaryngology at the Mayo Clinic are presented in Figures 2 through 8.3 The completion of the 27-bed hospital welcomed the first major growth period in the history of Mayo Clinic, between 1889
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