From Part-Time to Full-Time: The Rise of Otolaryngology in 20th-Century American Medicine

I graduated from the University of Virginia with a Bachelor of Arts in history, and my thesis, the title of this article, examined how our specialty overcame challenges during the 20th century to become what it is today, one of the most competitive and fastest-growing specialties in medicine. When ENTtoday’s physician editor, Robin Lindsay, MD, MBA, asked me to start a History of Otolaryngology column for the magazine, I thought to myself, “I finally get to use my history degree!”

This is the first article for this twice-a-year column; subsequent writings will interview people who helped shape the specialty as we know it today. First, though, I will summarize the history of our specialty and discuss why understanding where we came from is such an important step toward continuing to advance our specialty. We are building and adding to the work of our predecessors, not starting from scratch. We must study and understand the past, however, to add to it in a productive manner.

The History of Otolaryngology

The disciplines of otology, rhinology, and laryngology came to the East Coast of the U.S. in the first half of the 19th century. Early in this century, Philadelphia, New York, and Boston became centers of specialization in U.S. medicine and offered ports where American laryngologists, rhinologists, and otologists could travel to Europe, especially Germany and Vienna, to receive specialized training. These major seaports also offered access points for European physicians to come to the U.S. and help develop medical specialties. In 1820, the New York Eye Infirmary was established, and by 1873, the institution included otology and laryngology departments (Neil Weir, Otolaryngology: An Illustrated History).

Otolaryngologist and historian Neil Weir concluded in his landmark publication of our specialty’s history that the “comparative isolation of specialists in America” encouraged them to form specialty societies earlier than their European counterparts. Paul Starr determined that early specialization in U.S. medicine created interdependence among physicians and helped relieve competition among them, thus allowing them to consolidate their authority (Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry).

The first journals and societies that included otology in their names began to form in the U.S. during the 1860s. In 1888, the American Medical Association established the Otology, Rhinology, and Laryngology section, and in 1896, specialists formed the American Academy of Ophthalmology and Otolaryngology. In 1924, practitioners established the American Board of Otolaryngology, the second specialty licensing board in the U.S. This licensing board was created in large part to distinguish licensed otolaryngologists from medical practitioners who were ill-trained at performing operations such as tonsillectomies and adenoidectomies (Rosemary A. Stevens, Medical Specialization as American Health Policy: Interweaving Public and Private Roles, History and Health Policy in the United States).