the history of otorhinolaryngology at mayo clinic · doctors mayo, mayo roots: proﬁling the...

HISTORICAL VIGNETTE

The History of Otorhinolaryngology atMayo Clinic
Matthew L. Carlson, MD, and Kerry D. Olsen, MD
From the Department ofOtorhinolaryngology,Mayo Clinic, Rochester,MN.

Mayww

The 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. Mayo1

T he following historical account waswritten after the 100th anniversary ofthe Department of Otorhinolaryn-

gology to document the development of thespecialty at Mayo Clinic in Rochester, Minne-sota. This article serves to commemorate thosebefore us, ensuring that the details of thisformative time are not forgotten. It also cele-brates more than 150 years of otology, rhinol-ogy, and laryngology practice at Mayo Clinic.This report was compiled from multiple sour-ces including the annual reports to the MayoClinic Board of Governors, the Mayovox(Mayo Voice) newsletter, the illustration ar-chives 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)

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the early years, (2) the establishment of thespecialty, (3) adversity, transformation, andexpansion, and (4) the modern era.

The Early YearsAs with all specialties at Mayo Clinic, the geneal-ogy 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, Mis-souri. Shortly after beginning his medical prac-tice, Dr W.W. Mayo contracted malaria andelected to leave Lafayette, Indiana, and traveledtoMinnesota in 1856 in search of a more health-ful climate. Dr W.W. Mayo and his family jour-neyed 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 sonswere 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 partici-pate in autopsies (Figure1).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 ofMichigan at Ann Ar-bor and Dr Charles Horace Mayo after receivinghis medical doctorate at Northwestern Univer-sity, Chicago, Illinois, in 1888. Notably, Dr W.J. Mayo received much of his training in Michi-gan under Dr George E. Frothingham, Professorof Ophthalmology andOtology.3,4 Additionally,shortly after graduating, Dr C. H. Mayo traveledto Europe for 6months, where he spentmuch of

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FIGURE 1. The Carpenter House, located at621 North Broadway in Rochester, Minnesota,was used by Dr William Worrall Mayo foroutpatient surgical procedures before the con-struction of Saint Marys Hospital wascompleted in 1889. Reproduced with permis-sion of the W. Bruce Fye Center for the Historyof Medicine, Mayo Clinic, Rochester, Minnesota.

FIGURE 2. Saint Marys Hospital was completedin 1889 and was the primary site where DrCharles H. Mayo performed hundreds of op-erations 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.

MAYO CLINIC PROCEEDINGS

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his time observing treatment of eye, ear, nose,and throat conditions, and he assumed responsi-bility for most of this work after returning toRochester.4

It is notable that the brothers received theireducation at a time of great discovery in West-ern 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, in-strument cleaning, dressing application, andeven steam spray atomization.5 It was also atthis time that several signficant surgical ad-vances in the field of head and neck surgerywere made, including Dr Emil Theodor Koch-er’s goiter excision in 1872, Dr Christian AlbertTheodor Billroth’s first description of total lar-yngectomy in 1873, Dr William S. Halsted’sbeginning use of cocaine as a topical vasocon-strictant and anesthetic in 1885, and the intro-duction of rubber gloves in 1889.6 It was saidregarding this era, “Probably the most inter-esting 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 ever-changing factor.”7

The early success of the Mayos was pro-pelled by their exemplary surgical outcomes

Mayo Clin Proc. n February 2017

during a time when laboratory medicine, sur-gical pathology, asepsis, anesthesia, andexploratory surgery were in their infancy.6,8

In these years, a surgeon operated on all areasof the body, and a notable part of their prac-tice dealt with the treatment of head andneck ailments. In Dr W. W. Mayo’s seventhbibliography entry of 13 publications, he re-ports on the surgical management of a lingualepithelioma, a carcinoma of the tongue, in the1885 Transactions of the Minnesota State Medi-cal 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 cauter-ized with a hot iron.9

Central 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 1883.2

Saint 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 8.3

The 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 staff

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FIGURE 3. Constructed in 1900 on the north-west 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.

FIGURE 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, mi-nor surgical procedures were still performed onthe second floor of the 1914 building. Repro-duced with permission of the W. Bruce FyeCenter for the History of Medicine, Mayo Clinic,Rochester, Minnesota.

HISTORY OF OTORHINOLARYNGOLOGY AT MAYO CLINIC

were added, including 13 permanent memberphysicians, 6 interns, and 2 laboratory assis-tants.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 hired

FIGURE 4. The 1914 buildingdthe originalbuilding called “Mayo Clinic”drepresented thefirst fully integrated multispecialty group practiceof medicine. Following construction, the Sectionof Otolaryngology and Rhinology was trans-ferred 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.

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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 endos-copy 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 sur-gery, 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 opera-tions of the thyroid gland comprised approxi-mately 10% of the surgical volume in the early1900s.3,4

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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 newofficewas equippedwith 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 permissionof theW.Bruce FyeCenter for theHistory of Medicine, Mayo Clinic, Rochester,Minnesota.

FIGURE 7. On June 19, 1954, the clinical workof otolaryngology moved to the West 5 desk ofthe new Mayo Building, which included 26 pa-tient examination rooms and separate facilitiesfor audiometric and vestibular testing. Repro-duced with permission of the W. Bruce FyeCenter for the History of Medicine, Mayo Clinic,Rochester, Minnesota.

FIGURE 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.


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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.”13

At this time, Dr W. J. Mayo was primarilyinvested in gynecologic and visceral surgery,


while his brother Dr C. H. Mayo began pio-neering 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 1905




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 recur-rence 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.

FIGURE 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 Medi-cine, Mayo Clinic, Rochester, Minnesota.


publication, Dr C. H. Mayo remarked on thetechnical details of head and neck cancer sur-gery, 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).2

A 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 oper-ations in a day, operating 6 days a week.2

Among 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 such


topics as surgical treatment of thyroid andparathyroid disease, tuberculous adenitis ofthe neck, foreign bodies of the trachea andesophagus, surgical management of esopha-geal diverticula, the relationship betweenmouth conditions and general health, removalof sinonasal malignancies, and many others.10

The Establishment of the SpecialtyThe growth and work completed by 1917 ush-ered in a new era for Mayo Clinic.6 At thistime, the staff had enlarged to a critical number,allowing the clinical work to become increas-ingly divided by sections. The early sections atthe Mayo Clinic that comprise the modern prac-tice 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 estab-lished in1909withDrCarl Fisher ashead,whichprimarily dealt with conditions of the eye; theDi-vision of Medicine with Dr Henry Plummer andhis interests in aerodigestive endoscopy; and theSection of Laryngology and Rhinology estab-lished 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 12).

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FIGURE 11. Early surgical illustration depictingenucleation of a malignant tumor of the parotidgland in order to reduce the risk of facial pa-ralysis. Reproduced with permission of theW. Bruce Fye Center for the History of Medi-cine, Mayo Clinic, Rochester, Minnesota.

FIGURE 13. Harold “Pete” Lillie was the firsthead of the Section of Otolaryngology andRhinology at Mayo Clinic, holding this appoint-ment from 1917 to 1951. Reproduced withpermission of the W. Bruce Fye Center for theHistory of Medicine, Mayo Clinic, Rochester,Minnesota.


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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 Clinic

FIGURE 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.


Department of Otorhinolaryngology initiallymay seem somewhat obscure. However, acareful review of publication history and surgi-cal 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. Subse-quently, the department’s history predomi-nantly continues through the Section ofOtolaryngology and Rhinology. Because the1917 section transformation played a pivotalrole in the history of the department, this tran-sition is reviewed in greater detail. On April 1,1917, 2 years after the official establishment ofthe Mayo School of Graduate Medical Educa-tion, 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 Sec-tion 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 Mat-thews, who resigned that same year. It is said




TABLE 1. Chairs of the Section/Department ofOtorhinolaryngology, Mayo Clinic, Rochester,Minnesota

Department chair Chair yearsConsultant

years

Justus Matthews 1906-1917 1906-1917Harold I. Lillie 1917-1951 1917-1953Henry L. Williams 1951-1958 1934-1963Kinsey M. Simonton 1958-1967 1937-1970D. Thane R. Cody 1968-1982 1963-1987H. Bryan Neel III 1982-1990 1974-2005Thomas J. McDonald 1990-2003 1972-2007Charles W. Beatty 2003-2011 1982-PresentColin L. W. Driscoll 2011-Present 2002-Present


that 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 Plas-tic 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 inter-ests involved the surgical treatment of suppu-rative disease and its related complications. Hecould not foresee the substantial changes tothe field that would occur with the introduc-tion of antibiotics, and thus this division of la-bor seemed both equitable and natural.Although not evident at the time, the depar-ture 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 stip-ulated 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.15

Dr 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,


and 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 supervi-sion of Dr Roy Bishop Canfield, the firstClinical Professor of Otolaryngology at the Uni-versity of Michigan. Between 1913 and 1917,Dr H. I. Lillie worked as an instructor and assis-tant 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.4

During 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 Dur-ing Dr H. I. Lillie’s time of leadership, the sec-tion 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 interna-tionally. “The Chief,” as many affectionatelyaddressed him, was a master clinician and sur-geon.16 He frequently emphasized that under-standing a patient’s entire clinical conditionwas required for correct diagnosis and treat-ment of local disease. As an accomplished sur-geon, 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.”16

By the early 1900s, the focal infection the-ory had grown popular in Western medicineand strongly influenced medical and surgicalpractice.17-20 This theory held that a primarysilent or unrecognized focus of infection

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TABLE 2. Physician and Doctorate Staff of theSection/Department of Otorhinolaryngology, MayoClinic, Rochester, Minnesota

Staff member Years

Emeritus/active (MD)Justus Matthews 1906-1917Gordon B. New 1911-1950Harold I. Lillie 1917-1953Bert E. Hempstead 1921-1950W. Berkeley Stark 1925-1934Carl M. Anderson 1925-1937Henry L. Williams 1934-1963Kinsey M. Simonton 1937-1970O. Erik Hallberg 1942-1970Henry A. Brown 1942-1974Clifford F. Lake 1944-1979James B. McBean 1945-1978D. Thane R. Cody 1963-1987Jack L. Pulec 1963-1969Kenneth D. Devine 1968-1979a

John C. Lillie 1968-1976b

Lawrence W. DeSanto 1968-1997George W. Facer 1970-2000Eugene B. Kern 1970-2001Thomas J. McDonald 1972-2007Stephen G. Harner 1973-2003Bruce W. Pearson 1973-2004H. Bryan Neel III 1974-2005Nicolas E. Maragos 1977-2010Ku Won Suh 1977-1982William J. O’Rourke 1978-1996c

Mitchell S. Marion 1986-1989d

Thomas V. McCaffrey 1980-1998Jack L. Clark 1979-1981Kerry D. Olsen 1981-PresentCharles W. Beatty 1982-PresentRay O. Gustafson 1982-2015David A. Sherris 1984-2003Tom D. Wang 1987-1993Jan L. Kasperbauer 1989-PresentEvan L. Nelson 1990-2009Laura J. Orvidas 1995-PresentSharon E. Libi 1996-2002; 2016-PresentNorval E. Bernhardt 1997-1999Scott E. Strome 1998-2004Dana M. Thompson 1999-2006; 2008-2013Luis A. Garcia 1999-2009Colin L. W. Driscoll 1999-PresentHarvey M. Freedman 2000-2009Alain N. Sabri 2001-2004Jens U. Ponikau 2001-2005Eric J. Moore 2001-PresentOren Friedman 2003-2010

Continued on next column

TABLE 2. Continued

Staff member Years

Emeritus/active (MD), continuedJohn F. Pallanch 2004-2016Daniel J. Blum 2005-2015Brian A. Neff 2005-PresentDale C. Ekbom 2007-PresentJohn H. Shelby 2007-PresentShelagh A. Cofer 2008-PresentDaniel L. Price 2008-PresentAnn F. Bell 2010-PresentGrant S. Hamilton III 2011-PresentMatthew L. Carlson 2012-PresentErin K. O’Brien 2012-PresentJeffrey R. Janus 2013-PresentKarthik Balakrishnan 2014-PresentSerban San Marina 2014-Present

(research associate)Kathryn M. Van Abel 2015-PresentJanalee K. Stokken 2015-PresentLisa A. Schimmenti 2015-Presente

Emeritus/active (PhD)LeRoy D. Hedgecock 1949-1978Jack F. Utting 1969Lawrence W. Keating 1970-1977Darrell E. Rose 1970-1996Wayne O. Olsen 1974-1996Christopher D. Bauch 1978-2014Martin S. Robinette 1985-1998David Cyr 1989-1990Robert H. Brey 1990-2007David A. Fabry 1990-2002Jon K. Shallop 1998-2008Jodi A. Cook 2002-2006Diana M. Orbelo 2006-PresentRené H. Gifford 2006-2010Neil T. Shepard 2007-PresentCynthia A. Hogan 2008-PresentDouglas P. Sladen 2011-PresentGayla L. Poling 2015-Present

aAt Mayo Clinic since 1947bAt Mayo Clinic since 1952cFamily practice, serving as medical otorhinolaryngologist.dAt Mayo Clinic until 2001eMedical genetics.


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existed and could result in secondary infec-tions 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 pharynx




FIGURE 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 infec-tion.” Reproduced with permission of theW. Bruce Fye Center for the History ofMedicine, Mayo Clinic, Rochester, Minnesota.


were the most well recognized. As a result,tooth extraction and tonsillectomy werefrequently performed even in the absence oflocal symptoms, leaving many patients eden-tulous (Figure 14). Influenced by Dr EdwardC. Rosenow, who was recruited from Chicagoto Mayo Clinic to assist in laboratory diag-nostic 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 per-formed within the Section of Otolaryngologyand Rhinology involved tonsillectomy. Be-tween 1920 and 1930, 2000 to 3000 tonsillec-tomies were performed annually, comparedwith fewer than 1000 in the 1930s aftergrowing skepticism regarding the merits ofthis theory surfaced.17

In the early years, the Section of Otolaryn-gology and Rhinology at Mayo Clinic wasprimarily engaged in the treatment of condi-tions affecting the sinuses, pharynx, andearsddiseases of the head and neck behindthe “mucocutaneous margin.” Beyond pharyn-geal 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 life-threatening intracranial complicationsincluding septic dural sinus thrombosis, men-ingitis, abscess, and empyema were commonsources of severe morbidity and mortality andrequired surgical intervention to halt progres-sion, often resulting in disfiguring defects. Dur-ing this era, radical mastoidectomy andexternal approaches to the paranasal sinuses,such as the Lynch, Denker, or Caldwell-Lucprocedures, were common (Figure 15).17

The 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 labora-tory, developed the first supply for clinical


use at Mayo Clinic. Purportedly, the first pa-tient treated with penicillin in the Section ofOtolaryngology and Rhinology was a termi-nally 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 re-covery 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 gener-ally only cases of chronic infection that ulti-mately required surgical intervention.15

The success of antibiotic therapy permittedotolaryngologists to shift their focus from pre-vention and treatment of life-threatening infec-tions to functional surgery and furtheradvancements in pharmacological therapy.This trend was most evident in the early years

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FIGURE 15. Surgical technique of mastoidectomy for treatment of acute otomastoiditis used before thewidespread adoption of the otologic drill. A, A Wilde (postauricular) incision is made, and the mastoidcortex is exposed. B, The dense cortical bone is removed with a mallet and chisel. C and D, The less-dense pneumatized bone is curetted away. Additional mastoid cortex is removed with a rongeur toexpose the sigmoid sinus (E) and temporal lobe dura (F) when indicated. Reproduced with permission ofthe W. Bruce Fye Center for the History of Medicine, Mayo Clinic, Rochester, Minnesota.


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of modern otology with the treatment ofotosclerosis and Ménière’s disease. At theturn of the 20th century, the practice of stapesfootplate surgery was condemned given therisk of ascending meningitis and sensorineuralhearing loss.22 As an alternative to stapes foot-plate mobilization, pioneering aural surgeonsincluding Dr Julius Lempert in New Yorkturned to labyrinthine fenestration for treat-ment of otosclerosis.22,23 In 1943, Dr HenryL. Williams visited Dr Lempert for 5 weeksin New York and returned to Mayo Clinicwith great enthusiasm for performing single-stage lateral canal fenestration operations.15

With the availability of this procedure,numerous patients with otosclerosis-type deaf-ness came to Mayo seeking treatment. By1945, 164 fenestration operations were per-formed, accounting for half of all mastoid


procedures for that year, and this trendcontinued for many more years.15

Along with medical antimicrobial therapy,beginning in the 1930s there was growing in-terest in the study of allergic disease at MayoClinic. In many cases, striking results wereachieved when an allergen could be found.Dr Bayard T. Horton and others recognizedthat groups of patients responded remarkablywell to the desensitization of histamine.17 In1945, Dr Williams authored an article on theuse of diphenhydramine (Benadryl) in the“syndrome of physical allergy of the head,” 3years after its discovery and the same year itbecame approved for use by the US Foodand Drug Administration.24 Finally, in 1950,the same year that Mayo Clinic researchersreceived the Nobel Prize for the developmentof cortisone, Drs Williams and Clifford F.





Lake reported on the effects of cortisone onbronchial asthma and hay fever.15 At thistime, there grew an untempered enthusiasmfor developing medical treatmentsdthe possi-bilities for medical cure were endless. The mo-mentum of success from advancing medicaltherapies even raised questions regarding thefuture need for oncologic surgery: “If somemedicament is developed which will controlcancer, general surgical procedures will like-wise be reduced. Recent reports in the medicalliterature indicate that such a medicament iswithin the range of probability.”15 By theend of the “Lillie era,” the institution as awhole was flourishing, and the staff of MayoClinic numbered 851, 302 of whom weremembers of the permanent staff.6

Coinciding with the early developmentand evolution of the specialty was the birthand expansion of the Mayo School of GraduateMedical Education and the Mayo Clinic otolar-yngology residency training program in 1915.During this year, the Mayo brothers estab-lished the Mayo Foundation for MedicalEducation and Research in association withthe University of Minnesota, providing aninitial endowment of $1.5 million dollars.2,25

The development and maintenance of theotolaryngology graduate education programrequired much of the section’s time and re-sources. During the early to mid 1900s, theeducational term of an otolaryngology residentcommonly ranged between 2 and 4 years. In1915, the annual salary of fellows was $600the first year, $750 the second, and $1000the third year.26 In 1950, the pay scaleincreased to a starting annual salary ofbetween $9000 and $15,000.15 First appliedby the chairman of the residency graduatecommittee Dr Emil H. Beckman, the termfellow was used in the same way most pro-grams label resident todaydreminiscent ofthe graduate students in Oxford, UnitedKingdom.11,26 Dr H. I. Lillie helped developand strongly supported the apprenticeshipmodel of teaching in which student andinstructor worked in close cooperation in thecare of patients, and the student was grantedincreasing responsibility and autonomy as heor she developed skill and experience in thefield. In the operating theater, early on thefellow acted as first assistant, but throughthe course of training was granted a graduated


number of operations to perform under thewatchful supervision of the staff surgeon.4

Believing in a practical education, Dr H. I.Lillie taught that “suggestions which causehim [the fellow] to think rather than toremember are more productive.”17 In the earlyyears of the section, there was no organized di-dactic teaching.4 The apprenticeship model ofresidency teaching still continues today, andthe designation of fellow remained until after1970, when it was changed to resident. Symbol-izing the Mayo brothers’ progressivism towardequality of sex and race, the first graduate inotolaryngology at the Mayo Clinic was awoman, Dr Margaret I. Smith (Table 3).11

Between 1917 and 1940, there was a sur-plus of able candidates applying for graduatemedical education training in the Section ofOtolaryngology and Rhinology, and manywell-qualified applicants were turned down.17

This scenario paralleled the general popularityof Mayo Clinic as a whole. Early on, MayoClinic established itself as a premier center forsurgical training. In the 1920s, more than1000 candidates sought graduate training op-portunities annually, and by the 1940s, nearly10% of all graduate medical school traineeshad completed their residency or fellowshipat Mayo Clinic.27 In 1928, it was noted, “TheMayo Clinic is looked upon by otolaryngolo-gists as an excellent place for post-graduatework in the specialty. Many men of standinghave suggested to younger men that theycome here for their training.”17 Subsequently,in 1929, Dr H. I. Lillie remarked that therewere 15 applications for fellowship in thepast year; however, only 3 could beaccommodated.17

Adversity, Transformation, and ExpansionBeginning in 1940 with the first peacetimeconscription in the United States, the numberof prospective fellowship applicants declined,and the candidate pool included a greater frac-tion of those who were excluded from thearmy for technical reasons.15 It was also dur-ing this time that many other training pro-grams were becoming established and wouldcommonly offer a combined eye, ear, nose,and throat experience, which was appealingto applicants who were pursuing communitypositions.

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TABLE 3. Otorhinolaryngology Residents andFellows, Mayo Clinic, Rochester, Minnesota

1911-1920Margaret I. Smith 1908-1911Roy W. Porteus 1914-1915E. Frank Chase 1915-1917Charles M. Clark 1917-1920

1921Floyd M. Allen 1919-1921James C. Braswell, Jr. 1919-1921

1922Herrmann E. Bozer 1919-1922Roll O. Grigsby 1920-1922Malcolm C. Pfunder 1920-1922John L. Sanders 1920-1922

1923French K. Hansel 1919-1923Horace R. Lyons 1917-1923Donald C. Rockwell 1920-1923

1924William J. Greenfield 1918-1924Albert B. Murphy 1921-1924Max E. Settelen 1923-1924William B. Stark 1922-1924

1925Carl M. Anderson 1921-1925Guy E. Burman 1924-1925Fred A. Figi 1918-1925Joseph B. Stevens 1922-1925

1927-1928Dewey R. Heetderks 1923-1927Henry P. Johnson 1924-1927Victor R. Lapp 1923-1927Henry F. Wilkinson 1924-1927Fred Z. Havens 1926-1928

1930Walter J. Decker 1924-1930Nicholas E. Lacy 1927-1930Walter M. Paton 1926-1930George C. Saunders 1928-1930Donald E. Tinkess 1926-1930Henry L. Williams 1925-1930

1931John H. Childrey 1928-1931Leo P. Coakley 1927-1931Joel A. Peterson 1927-1931Ehrhardt Ruedemann 1927-1931

1932William H. Craddock 1930-1932S. Frank Hazen 1929-1932

1933Norman C. Cook 1930-1933Hugh H. Johnston 1930-1933Walter Kirch 1932-1933George L. Pattee 1930-1933


TABLE 3. Continued

1935-1936Clyde M. Cabot 1931-1935William M. Youngerman 1931-1935Wilson J. Troup 1933-1936

1937Henry A. Brown 1936-1937Buford L. O’Neal 1934-1937Kinsey M. Simonton 1934-1937

1939-1941Delmar F. Weaver, Jr. 1936-1939Robert D. Ralph 1937-1940William H. Wilson 1938-1941

1942-1943Christopher R. Dix 1937-1942Olav E. Hallberg 1937-1942Pietro N. Pastore 1936-1942Walter D. Stevenson, Jr. 1938-1942Bernard P. Cunningham 1939-1943

1944Donald G. Albers 1940-1944Clifford F. Lake 1939-1944William C. Thornell 1940-1944Robert J. D. Williamson 1941-1944

1945-1948Hans V. von Leden 1943-1945Theodore J. Hughes 1946-1947Stefan J. Olafsson 1944-1947Robert E. Ryan, Sr. 1944-1947Arthur A. Spar 1943-1948

1949Eugene L. Bauer 1946-1949James O. Gooch 1946-1949Miles L. Lewis, Jr. 1948-1949Joseph X. Medwick 1946-1949Charles B. Porter 1947-1949

1950Neil D. Adams 1947-1950Wilford W. Beck, Jr. 1947-1950Walter E. Heck 1947-1950

1951Walter P. Anthony 1948-1951Joseph W. Begley 1948-1951Lee G. Eby 1948-1951William C. Hugenberg 1948-1951

1952Clyde B. Lamp, Jr. 1949-1952John C. Lillie 1949-1952Ivan M. Spear 1949-1952

1953Robert H. Freedman 1950-1953Raul I. Lessa 1951-1953

1955Robert S. Hendrick 1951-1955Quentin D. Jacks 1952-1955Paul W. Lapp 1951-1955

Continued on next page


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TABLE 3. Continued

1956Dean C. Elliott 1953-1956Arthur J. Kuhn 1951-1956Jack L. Mahoney 1953-1956

1957-1959Paschal A. Sciarra 1954-1957Louis M. Lehoux 1954-1958Richard L. Dobbs 1957-1959Maurice C. Gyde 1956-1959

1960Darius K. Shahrokh 1957-1960Joseph W. Teynor 1957-1960

1962D. Thane R. Cody 1958-1962Paul L. Goethals 1960-1962Marton Majoros 1959-1962Jack L. Pulec 1959-1962John T. Rulon 1959-1962A. Leonard Zimmerman 1959-1962

1963-1965James Parker Cross, Jr. 1960-1963Berkley S. Eichel 1962-1965Trevor E. Mabery 1961-1965Claude Nadeau 1961-1965Rollie E. Rhodes, Jr. 1961-1965

1966A. Munson Fuller 1963-1966Nathan A. Geurkink 1962-1966Evan L. Nelson, Jr. 1962-1966Raymond H. Stecker 1962-1966Donald P. Vrabec 1962-1966

1967Fernando B. Bersalona 1963-1967Lawrence W. DeSanto 1961-1967Daniel L. Dewerd 1961-1967George M. Hall 1965-1967

1968Kenneth H. Brookler 1964-1968George W. Facer 1964-1968Eugene B. Kern 1964-1968

1969Richard E. Cottrell 1965-1969Peter R. DeMarco 1965-1969Robert J. Dunn 1967-1969John W. Miller 1963-1969Nicholas P. Redfield 1963-1969Carl E. Reiner 1965-1969

1970Philip J. Furman 1966-1970Frederick W. Hahn, Jr. 1966-1970George L. Kullman 1966-1970David F. Wilson 1964-1970

1971Richard A. McKinne 1967-1971Gary L. Townsend 1968-1971


TABLE 3. Continued

1972George A. Carder 1968-1972Harvey M. Freedman 1968-1972Thomas J. McDonald 1968-1972Allen M. Morimoto 1968-1972

1973Richard D. Anderson 1969-1973Judd H. Chidlow 1969-1973Kenneth H. Farrell 1968-1973Charles E. Heinberg 1969-1973

1974Mohsen Djalilian 1967-1974H. Bryan Neel III 1970-1974James H. Whicker 1970-1974Richard D. Zujko 1970-1974

1975-1976Norman A. Fordyce 1971-1975James A. Greer, Jr. 1970-1975Ronald R. Henrickson 1971-1975John W. Wyllie 1972-1976

1977George E. Breadon 1972-1977Harvey L. C. Coates 1973-1977Nicolas E. Maragos 1973-1977Ku Won Suh 1971-1977

1978Barry L. Brown 1974-1978Robert J. Carpenter 1974-1978Jack L. Clark 1975-1978Aryeh Gorenstein 1974-1978Robert E. Ryan, Jr. 1974-1978

1979David M. Barrs 1974-1979Winston M. Campbell 1975-1979

1980Thomas V. McCaffrey 1975-1980Gregory D. Mathew 1975-1980Robert D. Woods II 1975-1980

1981Antonio C. Andrade 1977-1981James J. Holt 1976-1981Kerry D. Olsen 1976-1981

1982Charles W. Beatty 1977-1982Ray O. Gustafson 1977-1982John R. Salassa 1978-1982

1983Janet S. Mertz 1978-1983Michael F. Miltich 1978-1983John F. Pallanch 1979-1983William H. Wilder 1978-1983

1984Daniel J. Blum 1980-1984Peter S. Dumich 1979-1984Frank J. Laird 1979-1984Robert P. Schefter 1980-1984



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TABLE 3. Continued

1985Howard J. Beck 1981-1985Eaton Chen 1982-1985John C. Ellis 1981-1985Kevin K. McVey 1980-1985

1986Joseph W. Bremer 1982-1986Steven D. Spotts 1981-1986Arthur P. Wood 1981-1986

1987Stephen F. Bansberg 1983-1987Jeffrey C. Manlove 1982-1987James B. Miettunen 1982-1987Nila M. Novotny 1983-1987

1988Ronald D. Hanson 1983-1988Craig P. Hedges 1983-1988Gregory C. Jones 1983-1988Robert J. Stanley 1982-1988

1989Nicholas J. Berg 1983-1989Jonathan L. Ferguson 1984-1989Jan L. Kasperbauer 1984-1989Gregory V. Osetinsky 1985-1989

1990Jeffrey M. Bartynski 1985-1990James D. Green, Jr. 1985-1990Richard J. Lipton 1985-1990

1991Robert K. Gaughan 1986-1991Gerard L. O’Halloran 1987-1991P. Perry Phillips 1986-1991David H. Slavit 1986-1991

1992Michael C. Bard 1987-1992William J. Kane 1987-1992David M. Nienhuis 1987-1992Michael R. Nordstrom 1988-1992

1993John V. Cichon 1988-1993Michael L. Hinni 1988-1993Eric M. Tallan 1988-1993Jon V. Thomas 1988-1993

1994Kenneth V. Hughes III 1989-1994Joost L. Knops 1989-1994Paul A. Reder 1989-1994James M. Yohanan 1989-1994

1995Finn R. Amble 1990-1995Josef E. Gurian 1991-1995Willard S. Noyes 1990-1995Laura J. Orvidas 1990-1995


TABLE 3. Continued

1996Douglas T. Cody II 1991-1996Judith M. Czaja 1992-1996Sharon E. Libi 1993-1996Dana M. Thompson 1991-1996

1997Michelle R. Aust 1992-1997Steven P. Davison 1992-1997Colin L. W. Driscoll 1992-1997Eric J. Moore 1992-1997

1998Scott M. Gayner 1993-1998David S. Kaba 1993-1998Christine M. Puig 1993-1998Mark C. Witte 1993-1998

1999David C. Pearson 1994-1999William J. Remington 1994-1999Jordan S. Weiner 1994-1999

2000Shawn S. Nasseri 1995-2000Douglas L. Schulte 1995-2000Patrick A. Shinners 1995-2000Michael R. Shohet 1997-2000

2001Anthony E. Brissett 1996-2001Matthew A. Kienstra 1996-2001A. Daniel Pinheiro 1996-2001Julie L. Wei 1996-2001

2002David J. Congdon 1997-2002Michelle L. Facer 1998-2002Nissim Khabie 1999-2002Matthew J. Taylor 1997-2002

2003Larry K. Burton, Jr. 1998-2003Stacey A. F. Hudson 1998-2003Tamekia L. Wakefield 1999-2003Eric C. Weinman 1998-2003

2004Kofi D.O. Boahene 1999-2004Angela D. Martin 1999-2004Scott A. McLean 1999-2004Ronald G. Shashy 1999-2004

2005Eileen H. Dauer 2000-2005Lance A. Manning 2000-2005Matthew S. Pogodzinski 2000-2005Robert J. Tibesar 2000-2005

2006Holger G. Gassner 2001-2006Michael B. Gluth 2001-2006Jonathan H. Lee 2001-2006Shepherd G. Pryor 2001-2006



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TABLE 3. Continued

2007Jason P. Haack 2002-2007Laura M. Iuga 2002-2007Daniel L. Price 2002-2007

2008John B. Bitner 2003-2008Darren R. McDonald 2003-2008Abraham J. Sorom 2003-2008

2009Eran E. Alon 2004-2009Douglas K. Henstrom 2004-2009Patrick D. Munson 2004-2009Geoffrey J. Service 2005-2009Christian J. Wold 2004-2009

2010Jaspreet K. Dhaliwal 2005-2010Anthony F. Fama 2005-2010Jonathan W. Hafner 2008-2010Michelle M. Roeser 2005-2010

2011David J. Archibald 2006-2011Sivakumar Chinnadurai 2006-2011Rajanya S. Petersson 2006-2011Benjamin D. Powell 2006-2011

2012Matthew L. Carlson 2007-2012Cody A. Koch 2007-2012Steven M. Olsen 2007-2012Amy M. Saleh 2007-2012

2013Amy C. Dearking 2008-2013Jeffrey R. Janus 2008-2013William R. Schmitt 2008-2013

2014Joseph T. Breen 2009-2014Brian C. Gross 2009-2014Ashley G. O’Reilly 2009-2014Joshua J. Thom 2009-2014

2015Ian J. Lalich 2010-2015Jonathan J. Romak 2010-2015David G. Stoddard 2010-2015Kathryn M. Van Abel 2010-2015

2016Cara C. Cockerill 2011-2016Christopher D. Frisch 2011-2016James R. White, Jr 2011-2016Stephanie C. Contag 2011-2016


In earlier years, positions in Mayo’s otolar-yngology fellowship training program werehighly sought because of the Clinic’s earlyrecognition of the importance of treatinghead and neck cancer and laryngological dis-orders. Despite a division of labor betweensections, for over 20 years fellows of the


Section of Otolaryngology and Rhinology atMayo Clinic received training across severalsections, including 1 year of training withthe Section of Laryngology, Oral and PlasticSurgery. Under the leadership of Dr New,the latter had expanded to include severalother notable figures including Dr FrederickA. Figi and Dr John B Erich, who both servedas fellows in otolaryngology and rhinologybefore their appointment as staff in the Sectionof Laryngology, Oral and Plastic Surgery.However, as founding members of the Amer-ican Board of Plastic Surgery, Drs New andErich developed a separate fellowship programin plastic surgery at the Clinic. The establish-ment of this program resulted in less collabo-ration between training programs and areduction in time and educational prospectsin laryngology, head and neck cancer surgeryand plastic surgery by the otolaryngology fel-lows.15 After several negotiations, temporaryagreements occurred to improve training op-portunities between the sections; however,these arrangements were largely ineffectivebecause of the fundamental problem of spe-cialty jurisdiction.

The timing of the change in the structure ofthe otolaryngology residency program wasincredibly inopportune because other reputabletraining programs across the country wereexpanding to encompass skull base surgery,head and neck surgical oncology, maxillofacialtrauma, and later, facial plastic and reconstruc-tive surgery. As the specialty expanded, turf bat-tles ensued at many institutions. Most academiccenters recognized the expanding domain of oto-laryngologyehead and neck surgery and adapt-ed to the growth; however, the Section ofOtolaryngology and Rhinology at Mayo Clinicwas slow to evolve (H. Bryan Neel III, MD,PhD, written communication, October 22,2015).4,15 Further, coinciding with growing in-ternal pressures, the American Board of Otolar-yngology placed additional requirements oneducation in the basic sciences and expandedclinical specialties. The state of affairs was sum-marized well by an internal publication draftedby the Section of Otolaryngology and Rhinologyin 1949:

A decreasing number of suitable men areapplying for training in ear, nose andthroat. In discussing this situation with

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physicians conducting other similarteaching services it is the consensusthat a serious situation may develop.More training services have been devel-oped throughout the country becauseof the influence of the American Exami-nation Board and thus has made avail-able opportunities for training moremen in the field. The decrease in inci-dence of surgical mastoiditis due to theeffect of treatment of ear infection withsulfonamides and antibiotics has beena deterrent for physicians entering thefield. Actually in the past the field waslargely surgical. At present, patients pre-sent more medical problems than surgi-cal. The work is not so spectacular but iseven more important to the patients. Inthe future the outstanding men in thefield will need to have broad generalmedical background training and theborderline surgical fields will beincluded in the scope of the specialty..When the special surgical field is arbi-trarily confined, by the desire and occa-sionally by the dictum of generalsurgeons, to structures within the muco-cutaneous margin of the involvedanatomic structures, it would seem atonce too arbitrary and actually a veryshort-sighted and silly position to take.The same medical education andtraining are demanded of the specialsurgeon as of the general surgeon.15

Although many solutions were considered,including the establishment of a joint programwith the University of Minnesota and theconsolidation of training between sister surgi-cal specialties, the single otolaryngologytraining program endured.15,17 Despite thetrend for many centers to combine eye andotolaryngology training, the departments ofophthalmology and otolaryngology at MayoClinic agreed that the lifestyle, hazards of sur-gery, and clinical skill set of these 2 specialtieswere too divergent, stating that “it is felt gener-ally that one is either an ‘eye man’ or a ‘noseand throat man.’”15

During this time of adversity, there was acritical need for the establishment of a fellow-ship program director. In 1942, Dr Williamswas appointed by Dr H. I. Lillie to manage the


fellowship program.15 After Dr Williams wasselected as head of the section in 1951, theseduties were transferred to Dr Kinsey M. Simon-ton. Dr Simonton saw to the development of amore organized curriculum, expanding beyonddirect patient consultations to include formaleducation in anatomy, pathology, audiology,vestibular medicine, and endoscopy.15 Didacticeducation was provided by designated mem-bers of the section, consultants in related fields,and anatomic demonstrations by Dr W. HenryHollinshead, a prominent anatomist of thetime and author of the definitive 3-volume text-book Anatomy for Surgeons.15 In order toaugment surgical training, fresh cadaveric headscould be obtained from the State Hospital fortrainees to dissect after hours.15

In the 1940s and 1950s, reflecting on theconsiderable changes that had occurred overthe preceding 4 decades of the specialty’s his-tory, it was clear that the staff surgeons sensedthat the Section of Otolaryngology and Rhi-nology was at a tipping point: the dwindlingpopularity of the field among prospectivemedical school graduates and a shift from sur-gical to medical management for many of theconditions that once defined the specialtydemanded reinvention if the specialty was tosubsist and succeed.15

The Section of Otolaryngology and Rhi-nology sought to expand the specialty’s scopeto include common conditions of the headand neck that were lost to other specialtiesduring the section’s historical preoccupationwith surgical treatment of inflammatory dis-eases. It was proposed that rhinoplasty andoperative laryngological procedures bereturned to the otolaryngology and rhinologysection.15 This step was argued to be a logicaland beneficial change because patients oftenrequire intranasal and extranasal proceduresfor relief of nasal symptoms. Similarly, a casewas made that the Section of Laryngology,Oral and Plastic Surgery should be satisfiedwith the management of “neoplastic and plas-tic services” alone, and the field of laryngologysurgery should be reallocated to the section ofotolaryngology and rhinology under the su-pervision of Drs O. Erik Hallberg and JohnC. Lillie, who had general surgical training.The precedent for this change existed becausethe original division of sections in 1917 calledfor a minimum of a third of the laryngology




FIGURE 16. D. Thane Cody, MD, PhD, played apivotal role in transforming and expanding theSection of Otolaryngology and Rhinology intoan influential department, leading in clinical care,resident education, and research. Reproducedwith permission of the W. Bruce Fye Center forthe History of Medicine, Mayo Clinic, Rochester,Minnesota.


cases to be managed by the ear, nose, andthroat section.15 Notably, Dr J. C. Lillie wasthe son of Dr. H. I. Lillie and received hisresidency training at Mayo Clinic in the Sec-tion of Otolaryngology and Rhinology.

The period of great transformation andgrowth for the Section of Otolaryngology andRhinology occurred under the chairmanshipof Dr D. Thane R. Cody (Figure 16). Dr Codyreceived his Doctor of Medicine degree atDalhousie University Faculty of Medicine inHalifax, Nova Scotia, Canada, and accepted afellowship position in surgery at the MayoFoundation in 1958.28 One quarter after begin-ning his training, Dr Cody transferred to theSection of Otolaryngology and Rhinology,where he remained for his entire career.4 DrCody was the first physician in the Section ofOtolaryngology and Rhinology to receive pro-tected research time of 2 days a week, duringwhich he could spend time in the physiologylaboratory to conduct basic science researchwithin the field of immunology. Over time, DrCody earned a national reputation as an innova-tive otologic surgeon, prolific writer and pre-senter, and basic science researcher. Amongmany other topics, Dr Cody authored seminalwork on the use of corticosteroids for sensori-neural hearing loss; cortical audiometry; andconcentrations of parenteral antibiotics in theblood, cerebrospinal fluid, and inner ear withimplications for streptomycin ototoxicity.4 Healso developed a novel surgical treatment forMénière’s diseasedthe “tack procedure”dinwhich a stainless steel tack prosthesis wasplaced into the vestibule through the stapesfootplate via a transcanal stapedectomyapproach. The sharp tack prosthesis wouldthen perform repeated decompression of thesaccule during hydropic episodes.29

Dr Cody was a servant of the department,institution, and specialty. Under his leadership,the Section of Otolaryngology and Rhinologygraduated from a section to a department, theinternal committees of education, clinical prac-tice, and research were initiated, an obligatory6-month or 1-year basic science laboratoryterm for fellows was begun, and the develop-ment of the chief year, as it is commonly knowntoday, occurred in 1968.15 However, perhapsthe greatest of Dr Cody’s accomplishments re-mains unknown to most. When Dr Cody beganas section chief in 1968, he received a letter


from the American Board of Otolaryngologyon January 10, 1968, stating that “on June 30,1968, theDepartmentwillmove fromprobationto a status where it would close downcompletely” (T. J. McDonald, MD, writtencommunication, June 17, 2002). It seemedthat for 5 years, the knowledge that the trainingprogram was under probation had never beenshared by the previous section head of otolaryn-gology. Dr Cody called for an urgent meetingand received permission from the personnelcommittee to move several key staff from theSection of Laryngology, Oral Surgery and PlasticSurgery to the Section of Otolaryngology andRhinology, including Dr Kenneth D. DevineandDr J. C. Lillie. Interestingly, bothDrsDevineand J. C. Lillie had already been certified by theAmerican Board of Otolaryngology in the 1950sin order to legitimize their prior involvementin the training of otolaryngology fellows.4

Following this meeting, Dr Cody wrote to theAmerican Board of Otolaryngology describinghis plan, and on May 29, 1968, the probationstatus of the training program was lifted (T. J.

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McDonald, MD, written communication, June17, 2002).4 This action marked the first majorstep forward in a long-term struggle to expandthe clinical realm of the section.

Realizing the critical and timely need foradditional surgical personnel with diversetalents, Dr Cody aggressively recruited newfaculty to develop several expanding areas ofpractice and research: otology and neurotologywith Dr GeorgeW. Facer in 1970, Dr Thomas J.McDonald in 1972, and Dr Stephen G. Harnerin 1973; head and neck surgery with Dr Law-rence W. DeSanto in 1968 and Dr Bruce W.Pearson in 1973; head and neck surgery andrhinology with Dr H. Bryan Neel III in 1974;rhinology with Dr Eugene B. Kern in 1970;laryngology with Dr Nicolas E. Maragos in1977; general otolaryngology with Dr ThomasV. McCaffrey in 1980, Dr Charles W. Beattyin 1982, and Dr Ray O. Gustafson in 1982;and general otolaryngology and facial plasticsurgery with Dr Kerry D. Olsen in 1981. In or-der to further broaden the training experience,Dr Cody arranged for resident rotations in theDivision of Thoracic Diseases for bronchoeso-phagoscopy experience and at HennepinCounty General Hospital in Minneapolis, Min-nesota, for maxillofacial trauma (H. B. Neel III,MD, written communication, October 22,2015). During his term, the first medical otolar-yngologist, Dr William J. O’Rourke who wasboard-certified in family practice, was hired in1978, and the first physician assistant atMayo, Carroll F. Poppen, PA, was hired in1971 (H. B. Neel III, MD, written communica-tion).30 These advancements brought the resi-dency training program and department outof a 20-year downturn and reinstituted thedepartment’s national reputation in research,education, and clinical care.

Notably, Dr DeSanto was the first otolaryn-gology resident who received further trainingoutside Mayo Clinic in head and neck surgicaloncology. Between 1966 and 1967, Dr DeSantoreceived additional experience in head andneck surgery at Case Western Reserve Univer-sity in Cleveland, Ohio.4 With his return toMayo Clinic in 1968, he was the first physicianin the department to perform neck dissectionsfor treatment of head and neck cancer, andhis practice was critically observed by some ofhis colleagues in general surgery. Dr DeSanto’sperseverance and favorable clinical outcomes,


combined with the existing practices of DrsDevine and Pearson, firmly established headand neck surgery as a major component ofthe Department of Otorhinolaryngology.

In 1982, Dr Neel succeeded Dr Cody aschair of the Department of Otorhinolaryn-gology, serving until 1990. Dr Neel continuedthe momentum initiated by Dr Cody, furtherimproving the reputation of the departmentand supporting advancement of the specialtyat Mayo Clinic and nationally. Instrumental tonegotiations regarding official acknowledg-ment of the expanding and capable head andneck surgical domain of the otolaryngologistat Mayo Clinic was a written report on headand neck surgery (unpublished data, 1988).This 27-page report, submitted to the membersof the Board of Governors, sought to “finallyend a long cycle of divisiveness among a fewand lead to clear recognition that Otorhinolar-yngology was the only department at Mayowhich practiced the entire scope of head andneck surgery and indeed cared for the vast ma-jority of patients in this specialty.” From thispoint forward, the department began to usethe term otolaryngologyehead and neck surgeryto more accurately portray the breadth of thespecialty.

The Modern EraThe modern era marks a period of stabilityand achievement for the Department ofOtorhinolaryngology. Mayo Clinic, includingthe specialty of otorhinolaryngology, hasexpanded to incorporate campuses in Jackson-ville, Florida, and Scottsdale, Arizona, in 1986and 1987, respectively. Additionally, the MayoClinic Health System was initiated in 1992, anetwork of clinics and hospitals now servingmore than 70 communities in Minnesota, Wis-consin, and Iowa. Most recently, Mayo Clinicwas ranked first by the U.S. News & World Re-port’s Best Hospitals rating in 2016, and thedepartment was ranked first in specialty in2014. Never before has the Department ofOtorhinolaryngology more fully realized ac-complishments in the areas represented bythe 3 shields of the Mayo Clinicdpatientcare, education, and research, as summarizedbelow.

Patient Care, the First Shield. From a clinicalpractice perspective, the modern period is





defined by the subspecialist. Historically, all resi-dent graduates would start their career as a gen-eral otolaryngologist until interests and talentsmatured toward one particular area. In the1980s, it was normal for a surgeon to performstapedectomy, glossectomy with neck dissec-tion, and rhinoplasty on any given operativeday. Although there are exceptions to this prac-tice, since 1998 nearly all hired staff in thedepartment have received additional subspe-cialty training following a minimum of a 5-yeargeneral otolaryngology residency. The increasingvolume of medical knowledge and technicalskills required to care for patients with complexotolaryngological disease has led to the develop-ment of subspecialty training in areas includingotology, neurotology and skull base surgery,head and neck surgical oncology, facial plasticand reconstructive surgery, rhinology, sinusand allergy, pediatric otolaryngology, laryn-gology, and sleep medicine and surgery. Evenwithin the past 3 years, the department hasseen a net growth of 6 subspecialty-trained sur-geons in the fields of neurotology, head and neckoncologic surgery, pediatric otolaryngology, si-nus surgery, and sleep surgery, as well as theaddition of a medical geneticist specializing inhead and neck and audiovestibular disorders.Although a comprehensive summary of thecurrent clinical activity of the department isbeyond the scope of this report, several notablehighlights warrant mention, including thedevelopment and expansion of the cochlearimplant program, the application of the da Vincisurgical system to augment minimally invasivetransoral surgery, and the growth and expansionof endoscopic sinus and anterior skull basesurgery.31

Today the Department of Otorhinolaryn-gology enjoys a highly collaborative relation-ship among subspecialists within thedepartment and among specialties. The intro-ductory quote by Dr W. J. Mayo rings moretrue today than everdthe field of medicineand surgery has required increasing specializa-tion, which in turn has required greater collab-oration with other specialists to providecomplete care to the patient. As an example,the multidisciplinary model of care is exempli-fied by the daily collaboration for treatment ofcomplex skull base disorders seen amongotolaryngology, neurosurgery, radiationoncology, medical oncology, neuroradiology,


medical genetics, and speech pathology.Patients are evaluated in a multidisciplinaryclinic according to their individual needs,and complex cases are presented at a regularlyscheduled skull base tumor conference. TheMayo Clinic model of equal salary within adepartment is unique in contrast to anincentive-based practice, which is commonnationally. Physicians are free to provide carewithout financial pressures, which fosterscollaboration, reduces unnecessary proceduresor tests, and ultimately benefits the patient.

Education, the Second Shield. For the past 30years, the otolaryngology residency program hasconsistently held a competitive position, prizedfor early autonomy, high surgical volume, andbroad case diversity. From more than 300 appli-cants, 32 candidates are offered interviews, andonly 5 residents are selected each year. TheMayo Clinic residency program continues tofollow the apprenticeship model, which remainsunique among programs. Additionally, the 6months of dedicated research time and semiau-tonomous chief year, originally established byDr Cody, remain protected attributes of the pro-gram. Every year, graduates of the programsecure positions in competitive fellowshiptraining programs, with approximately halfobtaining academic appointments followingtraining. A fellowship in advanced head andneck oncologic surgery andmicrovascular recon-struction, initiated in July 2011, has attractednational and international candidates. Addition-ally, the department has applied for a fellowshipprogram in neurotology and lateral skull basesurgery, with an anticipated start date of July2018.

Research, the Third Shield. The Departmentof Otorhinolaryngology remains active in basicscience and clinical research, and a monthlyresearch symposium is held to facilitate intra-departmental and interdepartmental collabora-tion. Areas of particular interest includeregenerative medicine, whole-exomesequencing for biomarker discovery andanalysis of genotype-phenotype correlations,and quality of life outcome analysis in skullbase surgery, to name a few. Overall, depart-mental academic productivity remains highwith approximately 100 articles published inpeer-reviewed journals and an equal number

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of presentations at national and internationalconferences each year.

ConclusionIn closing, it is fitting to review a timelessreflection by Dr C. H. Mayo, published in1928 in the Annals of Otology and Laryngology,in which he spoke of his place in medicineand the future of the profession: “How fortu-nate we have been who have lived during thisgreat period of medical progress of say, 30years, yet I have heard my father say thesame, many years ago. The textbooks of thedays of his youth, when the microscope wasrevealing only the most obvious things andbefore the germ theory of disease was put for-ward, show in a most startling way how falsetheir ideas of disease were. Their clinical obser-vations were often strikingly accurate, butsometimes unaccountably faulty.. Yet theycalled themselves modern and looked back attheir predecessors with a patronizing sort ofpity from the pinnacles of scientific success towhich they had attained. In spite of the sound-ness of our present theories and the exactingproof to which all our beliefs are put, I cannotalways be sure that a century from now some-body will not be saying the same sort of thingsabout us. It may be that we are sojourning inthe wilderness, that such discipline is necessaryfor the children of Medicine, and that we havenot yet so much as seen the promised land.. Ibelieve we are traveling the road to the elucida-tion of all disease, but the journey’s end may bea long way off. Each day is a step, and there isalways a milestone just around the corner; thatis good enough”.32

ACKNOWLEDGMENTSWe thank Ms Nicole M. Tombers in theDepartment of Otorhinolaryngology for hervaluable assistance in retrieving and organizinghistorical records, Ms Nicole L. Babcock andthe W. Bruce Fye Center for the History ofMedicine, Mayo Clinic, Rochester, Minnesota,for providing the historical documents relevantto this work, Ms Brenda S. Lindsay in the Di-vision of Creative Media for her assistance inacquiring historical illustrations and manu-script art, and Mr Michael Hohberger in theSection of Scientific Publications for editorialassistance.


Correspondence: Address to Matthew L. Carlson, MD,Department of Otorhinolaryngology, Mayo Clinic, 200 FirstSt SW, Rochester, MN 55905 ([email protected]).

REFERENCES1. Mayo WJ. The necessity of cooperation in medicine: an address

delivered at the Rush Medical College commencement, June15, 1910, and originally published in the Collected Papers bythe staff of Saint Marys Hospital, Mayo Clinic, 1910;2:557-566; reprinted in Mayo Clin Proc. 2000;75(6):553-556.

2. Braasch WF. Early Days in the Mayo Clinic. Springfield, IL: CharlesC. Thomas; 1969.

3. Mayo Clinic. Sketch of the History of the Mayo Clinic and theMayo Foundation. Philadelphia, PA: WB Saunders Co; 1926.

4. Mayo Historical Unit. MHU 0670: General and Staff MemoirCollection. Box 13; Folder 243. W. Bruce Fye Center for theHistory of Medicine. Mayo Clinic, Rochester, MN.

5. Lister J. On the effects of the antiseptic system of treatmentupon the salubrity of a surgical hospital. Lancet. 1870;95(2418):4-6.

6. Mayo Historical Unit. MHU-0777: William Carpenter MacCartyPapers. Box 05; Series 03; Folder 08. W. Bruce Fye Center forthe History of Medicine. Mayo Clinic, Rochester, MN.

7. Mayo CH. Philosophic considerations of the gall-bladder. AnnSurg. 1930;92(4):640-643.

8. Clapesattle H. The Doctors Mayo. Rochester, MN: Mayo Foun-dation for Medical Education and Research; 1969.

9. Mayo WW, Mayo WJ. Lingual epithelioma. Transactions MinnState Med Soc. 1885:49-50.

10. Mayo Clinic. Physicians of the Mayo Clinic and the Mayo Founda-tion. Minneapolis, MN: The University of Minnesota Press; 1937.

11. Nelson CW. Mayo Roots: Profiling the Origins of Mayo Clinic.Rochester, MN: Mayo Foundation for Medical Education andResearch; 1990.

12. Sistrunk WE. The surgical treatment of cysts of the thyroglossaltract. Ann Surg. 1920;71(2):121-122.2.

13. Mayo CH. Surgery’s problems as they affect the hospital. ModHosp. 1938;51:68-69.

14. Crile GW. On the surgical treatment of cancer of the head andneck: with a summary of one hundred and twenty one opera-tions performed upon one hundred and five patients. TransSouth Surg Gynecol Assoc. 1905;18:108-127.

15. Mayo Historical Unit. MHU-0002: Board of Governors Re-cords. Box 073; Subgroup 02; Series 03, Subseries 07; Folders016-048. W. Bruce Fye Center for the History of Medicine.Mayo Clinic, Rochester, MN.

16. Mayo Historical Unit. MHU-0675: People Files Collection.Folder title: Harold I. Lillie, M.D. W. Bruce Fye Center for theHistory of Medicine. Mayo Clinic, Rochester, MN.


18. Pallasch TJ, Wahl MJ. The focal infection theory: appraisal andreappraisal. J Calif Dent Assoc. 2000;28(3):194-200.

19. Mayo CH. Mouth infection as a source of systemic disease.JAMA. 1914;63(23):2025-2026.

20. Rosenow EC. Mouth infection as a source of systemic disease.JAMA. 1914;63(23):2026-2027.

21. Mayo CH. Focal infection of dental origin. Dental Cosmos. 1922;64:1206-1208.

22. Shea JJ Jr. A personal history of stapedectomy. Am J Otol. 1998;19(5 suppl):S2-S12.

23. Shambaugh GE Jr. Julius Lempert and the fenestration opera-tion. Am J Otol. 1995;16(2):247-252.

24. Williams HL. Use of benadryl in the syndrome of physical al-lergy of the head: a preliminary report. Proc Staff Meet MayoClin. 1945;20:434-436.


mailto:[email protected]




25. Willius FA, ed. Aphorisms: Dr Charles Horace Mayo 1865-1939,Dr William James Mayo 1861-1939. Rochester, MN: MayoFoundation for Medical Education and Research; 2008.

26. Boes CJ, Long TR, Rose SH, Fye WB. The founding of the MayoSchool of Graduate Medical Education. Mayo Clin Proc. 2015;90(2):252-263.

27. Mayo School of Graduate Medical Education: history. MayoClinic website. http://www.mayo.edu/msgme/about/history.Published August 1, 2014. Accessed July 22, 2016.

28. Mayo Historical Unit. MHU-0675: People Files Collection.Folder title: D. Thane Cody, MD. W. Bruce Fye Center forthe History of Medicine. Mayo Clinic, Rochester, MN.


29. Cody DT. The tack operation. Arch Otolaryngol. 1973;97(2):109-111.


31. Luckstein K. Mayo Clinic celebrates 1,000th patient to getcochlear implant [news release]. Mayo Clinic website. http://inthenews.mayoclinic.org/2013/09/. Published September 20,2013. Accessed July 21, 2016.

32. Mayo CH. Medicine in retrospect. Ann Otol Rhinol Laryngol.1928;37(1):206-208.

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http://www.mayo.edu/msgme/about/history

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http://inthenews.mayoclinic.org/2013/09/



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