The University of Michigan, an encyclopedic survey ... Wilfred B. Shaw, editor.

THE DEPARTMENT OF OTOLARYNGOLOGY

THE Department of Otolaryngology originated as a distinct and separate entity in the Medical School in 1904 under the direction and leadership of Roy Bishop Canfield ('97, '99m). At the age of twenty-nine he began his first year of service in the University as Clinical Professor of the Diseases of the Ear, Nose, and Throat, and one year later, in 1905, he was promoted to the rank of Professor of Otolaryngology. Although Dr. Canfield was preceded by such eminent men as Dr. George Edward Frothingham, Professor of Materia Medica and Ophthalmology, 1872-89, and Dr. Flemming Carrow (George Washington '70, M.D. ibid. '74, A.M. hon. Michigan '03), Professor of Ophthalmic and Aural Surgery, Laryngology, and Clinical Ophthalmology, 1889-1904, the functions and activities of these men were varied and pertained more significantly to ophthalmology than to the field of the ears, nose, and throat. Consequently, the appointment in 1904 of Dr. Canfield marked the separation of ophthalmology from otolaryngology and laid the foundation for the subsequent growth and development of otolaryngology in the Medical School.

Animated by a passion for the study of his specialty and familiar with the latest developments and surgical techniques, Dr. Canfield plunged vigorously into his assignment, organized a modern curriculum, and brought early recognition to the Medical School through distinguished achievements in the field of otolaryngological surgery. He was a pioneer of modern otolaryngology in the Middle West. Local anesthesia was successfully attained by his skillful methods, innovations in throat surgery were instituted, and his operations upon the nasal septum and complete procedures upon the nasal accessory sinuses were brilliantly performed. His astute knowledge of diseases of the temporal bone and his amazing dexterity in surgical approaches to this structure soon brought him wide recognition in the field of otology. It may be said of Dr. Canfield that he was the founder and one of the chief builders of modern otolaryngology in Michigan from the point of view of pedagogy and practice.

During his first five years at the University Dr. Canfield made important additions to his surgical armamentarium in spite of inadequate facilities. He established his operating room in the basement of the surgical wing of the old hospital, built in 1889-91, beneath the stairway leading to the main surgical amphitheater, and began to practice the procedures which he had learned through a rich experience in the Massachusetts Eye and Ear Infirmary in Boston and in clinics abroad. It has often been said that the operating room space allotted Dr. Canfield barely admitted the patient, the doctor, and the anesthetist, thus making it necessary for the surgical nurse to take her position in the corridor and hand instruments to Dr. Canfield through the open door. But it was under such conditions, with poor facilities and meager equipment, that the young otolaryngologist achieved an international reputation through some of the most noteworthy surgical successes of his life. When one considers what Dr. Canfield accomplished in those early years, admiration for his courage and invention is exceeded only by the widespread acknowledgment of the tremendous influence he exerted in the field of otolaryngology and in the progress of medicine.

Dr. Canfield's achievements were in keeping with the excellent training he had received in the field of otolaryngology. After his graduation from the Medical School in 1899, he was appointed assistant to Dr. Carrow, but resigned the post to become house surgeon at the Massachusetts Charitable Eye and Ear Infirmary in Boston. Later, he engaged in clinical work at the New York Eye and Ear Infirmary in New York City. During this early period he was inspired by the teaching of such eminent otolaryngologists as Dr. Clarence John Blake, of Harvard, Dr. Fred L. Jack, of Tufts Medical School, and Dr. Cornelius Godfrey Coakley, of Bellevue Medical School. Upon the completion of Dr. Canfield's services in Boston and New York, he went abroad for two and one-half years, where he devoted himself to studies under the leadership of some of the most distinguished physicians and teachers in Europe. He came under the influence of such men as Fraenkel, Jansen, Halle, Krause, and Friedlaender, of Berlin; Schwartze, of Halle; and Killian, of Freiburg. Thus, he had obtained a thorough and comprehensive training under the direction of many of the great academicians of the period. Upon his return to the United States, Canfield received the appointments of attending laryngologist to the New York City Clinic for Communicable Pulmonary Diseases and assistant aural surgeon to the Manhattan Eye and Ear Hospital. In June, 1904, he was elected to membership in the American Laryngological, Rhinological, and Otological Society, Inc., and in October of the same year, he became a fellow of the New York Academy of Medicine.

Upon assuming his professorship at Michigan in 1904, Dr. Canfield set about organizing undergraduate and graduate education in his department. Classes in applied anatomy of the ear, nose, and throat were instituted for the junior students, and clinical instruction of a genuinely practical nature was given the members of the senior class. On every occasion he emphasized the importance of paring subjects down to their essentials and presenting only those studies in the specialties that would be of subsequent value to the general physician. This point of view he retained all his life. His didactic lectures and clinical presentations always reflected most convincingly his determination to assist the student in preparing himself for the general practice of medicine.

Dr. Canfield never failed to display a keen interest in graduate medical education. As early as 1906, in co-operation with other members of the clinical faculty, he organized a plan of graduate training which has developed into one of the most adequate and creditable systems found anywhere in this country today. Under this plan the young doctor joined the hospital staff as an intern and served in this capacity for a period of one year, with maintenance in the hospital. In the second year he was appointed demonstrator at a small salary sufficient to cover the cost of a meager livelihood, and in the third year under the rotation system became an instructor with a somewhat larger stipend. At this stage in his education he was charged with important responsibilities of an academic and clinical nature. Thus, the young physician studied the basic principles of otolaryngology and progressed through a comprehensive curriculum of training until in the third and final year, he was given the title of instructor on the medical faculty and vested with the duties and responsibilities of teaching medical students and of treating the sick. The young man upon completion of such a service had acquired the fundamentals of his specialty and was thoroughly competent to practice otolaryngology in all

its medical and surgical aspects. The fact that every man now living who has finished such a training at the University of Michigan is one of the outstanding otolaryngologists in his community and a much respected member of the profession is proof of the thorough manner in which this subject was taught him during his service on the otolaryngological staff. The early services were for a period of three years, but the time was later lengthened to four and finally to five years. The four- and five-year services included a general rotation internship immediately upon graduation from the Medical School, although such a requirement was not maintained in the early years when the three-year plan was in operation. Every clinical service in the University Hospital at the present time conducts its graduate training upon this program, and the teaching and clinical services rendered by the various departments in the Hospital are made possible by this system of staff rotation.

In September, 1907, Canfield appealed to the medical faculty and thence to the Board of Regents for a special appropriation sufficient to construct "a proper building for eye, ear, nose and throat cases." No official action was taken on the matter until November 30, 1908, when De Nancrède moved "that the Faculty of the Department of Medicine and Surgery request the Honorable Board of Regents to erect a building for the accommodations of eye, ear, nose and throat cases to cost $60,000."

In March, 1909, the drawings for the new Eye, Ear, Nose, and Throat Ward were completed and submitted for bids. The building, to be erected at a cost of $25,000, was to consist of three stories and a basement; the basement was to be given over to a waiting room, offices, laboratories, staff rooms, and cubicles for the examination of patients; the first floor, to contain the operating units, several two-bed rooms, and a large ward for patients; the second floor, to be devoted entirely to patient accommodations; and the north end of the third story, to furnish quarters for the interns of the two departments, Ophthalmology and Otolaryngology. The southern extremity of the third story was to be a contagious unit to be occupied by otolaryngological patients afflicted with communicable diseases. The plans met with the approval of the Regents, and in the summer of 1909 construction of the new building was begun. It was situated on the brow of the hill north of the surgical building and connected with the latter by means of a one-story corridor. As pointed out by Dr. Canfield in one of his letters to the contractor: "The site to the north of the present hospital will present several advantages; there is plenty of room here, it is the quietest part of the hill, there will be fine light for the operating rooms, the Contagious Unit is at a distance from all other buildings and it is convenient to the administrative offices."

The new building furnished accommodations for fifty-three patients. In the spring of 1910, in addition to the regular hospital furnishings, the equipment included such modern apparatus as an S. S. White surgical engine and drills for bone surgery, material and supplies essential to the complete outfitting of a "laboratory worthy of the name," an ear operating table especially designed and built by the Scanlan Morse Company, a Rauch gastroscope purchased from Louis and H. Loewenstein, Berlin, Germany, and a balopticon used for projection purposes in the teaching of medical students.

The duties and obligations of the department were varied. Craniotomies were performed, and the Hudson drill was frequently used in making initial openings into the skull. The successful

use of the bronchoscope for the removal of foreign bodies in the bronchi brought early recognition to the department, and the gastroscope, the employment of which has undergone a recent revival and which has become a popular instrument of precision in the diagnosis of lesions of the stomach, was first used by Dr. Canfield in the University Hospital in 1910. Operations upon the throat, nose, and sinuses, and complicated procedures in the ear and mastoid had become routine experiences by this time.

Further evidence of Dr. Canfield's varied interests and his alertness in seizing upon recent scientific discoveries, is contained in a letter that he wrote to Simon Flexner, of the Rockefeller Institute, on October 3, 1910: "Have been much interested in reading of the work being done with Ehrlich's 606 and would appreciate it very much if you would send to the clinic of Otolaryngology some of this preparation. I shall be pleased to keep you informed of what success we have with it." This drug was subsequently administered in the Department of Otolaryngology for the treatment of syphilis until Dr. Udo J. Wile's appointment to the Department of Dermatology and Syphilology in 1914, when the treatment of this disease was relinquished to his supervision.

As early as 1907 Dr. Canfield was performing complete operations upon the nasal accessory sinuses and instituting those principles of sinus surgery which are now recognized as the accepted ones. The technique which he advocated called for the complete eradication of all diseased processes, the meticulous removal of the lining mucous membrane of the sinus, whether it was the maxillary, ethmoid, frontal, or sphenoidal sinuses, and the ablation or maintenance of permanent drainage of the sinus cavity. Modern surgery is making more skillful approaches to the sinuses, reducing deformities to a minimum, and embellishing the techniques in some of their minor aspects. In 1907, nevertheless, the fundamental principles of sinus surgery were as well recognized and executed by Dr. Canfield as they are by the surgeons of today.

It would appear from our records that the first successful operation for the total extirpation of the larynx for carcinoma was performed in the department in 1911. A number of unsuccessful attempts at laryngectomy followed; the operative mortality remained so high that the operation was finally considered futile and for a period of twelve years was abandoned. It was not until 1923 when the epoch-making technique of Dr. George MacKenty was put into effect at Michigan, that the laryngectomy ceased to be a hazardous operation and became the accepted procedure in the University Hospital for extensive carcinoma of the larynx. This was followed by the laryngofissure or hemilaryngectomy, a procedure now used when practicable and gaining popularity because of its splendid results in early laryngeal cancer, with the minimum cost to the voice. Laryngectomy has become less popular at Michigan because of the good results obtained by fractionated doses of X ray in far advanced carcinoma of the larynx.

The Department of Otolaryngology had only one professor for the first thirteen years of its existence. In 1917 Dr. Albert Carl Furstenberg ('14, '15m) was appointed Acting Assistant Professor and in 1919 was given the title of Assistant Professor of Otolaryngology. In March, 1927, Dr. Furstenberg was promoted to the rank of Associate Professor of Otolaryngology, which position he held for the succeeding five years.

On May 12, 1932, the tragic death of Dr. Canfield in an automobile accident brought to a close the colorful and extraordinary career of a great savant of

medical science. At the June meeting of the Board of Regents in the same year, Dr. Furstenberg was made Professor of Otolaryngology and succeeded Canfield as head of the Department of Otolaryngology, which position he still retains.

After the completion of University Hospital in 1925 the Department of Otolaryngology was transferred to the new building, and the adequate and improved facilities for the handling of patients brought a corresponding increase in the number of clinic patients seeking otolaryngological consultations. This Hospital met a very urgent departmental need. The otolaryngological service immediately acquired a larger personnel, and the physical handicaps and mechanical difficulties in the old building which had seriously impaired the growth of the department were rapidly eliminated. In 1933 James Hoyt Maxwell ('24, '27m) was appointed Assistant Professor in Otolaryngology. Dr. Maxwell had grown up in the service of the Hospital, having completed his rotation internship in 1928. He became Associate Professor in 1940. His splendid attainments in clinical medicine, his conscientious devotion to the Medical School, and his accomplishments in pedagogy and research brought him rapid promotion to the position of responsibility which he now holds in the Department of Otolaryngology.

In 1932 the University was the recipient of the Roy Bishop Canfield Memorial Fellowship in Otolaryngology, established by Mrs. Leila M. Canfield in memory of her husband. The munificent benefaction, amounting to the sum of thirty-five thousand dollars, was established as an endowment, "the interest therefrom [to] be awarded to young men, physically and mentally equipped, but perhaps financially unable, to carry on, with honor, work in this special field." It was further specified that appointees to this fellowship must be "young men, not only of ability, but of such sincerity of purpose, and of effort, that they will uphold the high standards to which Dr. Canfield pledged himself" (R.P., 1932-36, p. 34).

Since 1930 the department has actively furthered postgraduate instruction. An annual course is conducted for physicians from various parts of the country. The postgraduate curriculum is not designed for the purpose of training doctors in this special field; it merely aims to refresh the specialist by bringing to him each year some of the newer studies and techniques. This instruction, given in conjunction with the Department of Ophthalmology, has been enthusiastically received by the members of the various classes, and each year requests for registrations exceed the capacity for instruction in this feature of the academic program. In addition to a brief and rapid review of new achievements in the field, the student engages in anatomical studies and serial courses in pathology, all designed to equip him with a working knowledge of these important basic sciences and to furnish him with current clinical information.

A. C. Furstenberg

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Annual Report of the University Hospital of the University of Michigan Calendar "The Department of Otolaryngology." Catalogue …

"Roy Bishop Canfield, '97, '99m." "Minutes of the Medical Faculty" "The New Eye and Ear Ward." President's Report Proceedings of the Board of Regents … "Two New Deans Are Appointed,"