The history of otolaryngology in Canada: University of Alberta

In 1905, the province of Alberta was delineated from the North West Territory (originally a vast area encompassing what is now Northern Quebec, Northern Ontario, Manitoba, Saskatchewan, Alberta, and the present Northwest Territories) and joined the Dominion of Canada. In the same year, Edmonton became a city (population 6000), but the settlement south of the North Saskatchewan River, Strathcona, did not amalgamate with the City of Edmonton until 1913. In 1906, during the inaugural session of the Legislative Assembly of the Province of Alberta, the Hon. A.C. Rutherford, the first premier of the province, introduced a bill authorizing the establishment of a provincial university, the University of Alberta (U of A), in Edmonton. Progress was rapid. Classes started in September 1908 with a faculty of 5 and 45 students, and the first degrees were conferred on the graduating class in 1912. In 1913, the Faculty of Medicine was established as the fourth faculty in the university, with 26 students enrolled in the first class. At that time, only the first 3 years of a 5-year medical course were offered at U of A, the last 2 years of study being completed at either McGill University or the University of Toronto. In 1920, the Medical Building was completed on campus and the entire 5-year medical course was then made available at U of A. The first class graduated in 1925.

In the early part of this century, there were four hospitals in Edmonton: The Edmonton General Hospital and the Misercordia Hospital (1906) were both run by Roman Catholic orders of nuns, the Royal Alexandra Hospital (1912) was run by the City of Edmonton, and the Strathcona Hospital (1906), which became the U of A Hospital (The University Hospital) in 1922.

In 1902, a medical society was formed in Edmonton to discuss medical subjects, provide social contacts, and protect the business and professional interests of its members. At that time, there were 900 doctors pracrising throughout the area, which is now Alberta, Saskatchewan, and the Northwest Territories.

Until well after World War II (WWII), ophthalmology and otolaryngology were practised as a combined specialty (EENT). Prior to World War I (WWI) there were two EENT luminaries practising in Edmonton: Drs. Norman Allin and R.B. Wells. Dr. Allin, with his brother, Dr. Edgar Allin, a surgeon, came to Edmonton in the early 1900s and eventually established the Allin Clinic, a large multidisciplinary clinic that still functions in Edmonton. Dr. R.B. Wells was practising in Edmonton in 1910, and in 1913, when the Medical Faculty was established, he was appointed the first director of the Division of EENT, Department of Surgery, U of A. He continued in this position until 1940. Dr Wells was a patron of the arts and was involved in the early formation of the Edmonton Academy of Medicine: while he was its president, it became known as the Central Alberta Medical Association. He was an impressive figure who was driven by a chauffeur and made grand entrances wearing a cape rather than a topcoat. A satellite building at the University Hospital-the Wells Pavilion-was named in his honour by his successor and partner Dr. Marshall in a somewhat unorthodox fashion: it is recorded that Dr.

Marshall had a sign painted "Wells Pavilion" and put it up himself. Whether this is true or not, the addition was known as the Wells Pavilion even though there's no record of the Hospital Board ever approving the name. The pavilion was demolished in the 1980s when the University Hospital was replaced by the Walter MacKenzie Health Science Centre.

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In the early 1920s, Dr. C.V. Jamieson established an EENT practice in Edmonton. He was born in Almont, Ontario, in 1881, graduated in medicine from the University of Toronto in 1907, and did postgraduate EENT training in London, England, following WWI. He came west and initially practised EENT in Red Deer and Rocky Mountain House, Alberta, prior to moving to Edmonton to practise as a partner of Dr. Wells; however, this relationship ended in the early 1930s. He was a lecturer at the U of A. In 1932, he had a heart attack after which he stopped performing surgery but continued to practise ophthalmology until well after WWII. He died at the age of 81. His brother Heber Jamieson, Head of Therapeutics, U of A, was interested in the history of medicine in the Edmonton area and, in the early 1930s, began to produce a medical history that was presented to the Edmonton Academy of Medicine.

Dr. Mark R. Marshall, whose original surname was Levey, began practising EENT in Edmonton as a junior partner of Drs. Wells and Jamieson. He succeeded Dr. Wells as director of the Division of EENT, Department of Surgery, U of A, in 1940, and following the separation of the Division in 1960, he continued to practise ophthalmology until the early 1980s. He lived into his 90s. Dr. Marshall had a unique career. Before WWI, he came from Austria to Montreal where he was befriended by a family named Marshall, whose name he adopted later as a sign of gratitude, but only after he made good under his own name of Levey. He was at McGill University when WWI broke out, and he went overseas with the artillary and devised routines that were taken up by the army for targeting heavy guns.

He graduated in Medicine from McGill University following WWI and, along the way, showed his powers of persuasion by being elected President of the Students' Union. He planned a postgraduate program for himself and arrived in Edmonton following clinical experience in England and Europe. Dr. Marshall was always progressive and had a feel for the trend to specialization. So when postgraduate training programs were developed in Edmonton following WWII, he was put in charge of professional staff development, and the so-called Marshall Plan evolved in the surgical department. This program gave Alberta something only Montreal and Toronto had before: a broader training of its professional staff. Dr. Marshall had a knack for getting things done, and he directed the professional development of many of the key surgical specialists at the U of A.

Dr. Harold Brown practised EENT in Edmonton following WWI. He was active in the Edmonton Academy of Medicine during the 1930s, and an ardent golferthe Brown Cup, which is awarded to the Edmonton Academy of Medicine's best golfer, is named after him.

Dr. W.J. Armstrong, whose father was an early postmaster in Edmonton, practised EENT with Drs. Wells, Jamieson, and Marshall. While he practised the combined specialties, he focused on otolaryngology while the others practised ophthalmology. He continued to practise both specialties into the 1960s. He then restricted himself to ophthalmology, which he practised till his early 80s in the 1970s in Edmonton. Dr. Armstrong was indeed a luminary in EENT in Edmonton, affectionately known as "Pappy Armstrong" to his patients and colleagues. He was the father-in-law of Dr. Richard Mallen, a subsequent divisional director of otolaryngology, U of A, and encouraged him to pursue otolaryngology as a career. Other EENT physicians practising in Edmonton prior to WWII include Dr. Talbot, Dr. Wannop, who had practised in China, Dr. Fuchs, who had immigrated from Austria to escape political prosecution; and Dr. James G. Young, a graduate from Queen's University. During WWII, a Dr. Williamson worked with the Department of Veteran Affairs in Edmonton. He came from Calgary and had trained at the Mayo Clinic.

Immediately following WWII, most of the EENT specialists mentioned were limiting their practice to ophthalmology or had retired, and the major portion of otolaryngology fell onto the shoulders of Dr. Armstrong. Throughout the 1950s, otolaryngology continued as a combined division of EENT with Dr. Marshall as its director. During this decade, there was an influx of specialists into Edmonton who limited their practices to otolaryngology: namely Drs. K.A.C. Clarke, T.C. Wilson, P. Quinlan, and McDonald.

Dr. Kenneth A.C. Clarke was born in Saskatoon, Saskatchewan, in 1914 and graduated in Medicine from the U of A in 1940. During WWII, he served as a Medical Officer in the Canadian Army and, following his discharge, trained in otolaryngology at the University of Toronto under Dr. Percy Ireland (1946-1949). He practised otolaryngology at the U of A (19491976) and was the first director of the Division of Otolaryngology, Department of Surgery, U of A, and was instrumental in the development of the postgraduate otolaryngology training program in the late 1960s. He was the president of the Canadian Otolaryngological Society in 1966. Dr. Thomas C. Wilson graduated in Medicine from Queens University in 1937, served as a Medical Officer in WWII, and following discharge, trained in otolaryngology at the Montreal General Hospital under Dr. George Hodge. He practised otolaryngology at the U of A (1948-1975) and is currently retired and living in Edmonton.

Dr. Peter Quinlan joined the U of A in the late 1950s. During WWII, he served with the British Army in Burma and, following his discharge, trained in otolaryngology, with an emphasis on otology, in Manchester, England. When he first came to Edmonton, he practised at the Misercordia Hospital and then practised solely at the University Hospital. He introduced modern otology to the U of A, performed stapedectomies, and was Edmonton's first microsurgeon. Dr. Quinlan established a temporal bone laboratory at the U of A and, for many years, was a major contributor to residency training. He died suddenly from ischemic heart disease on the eve of his planned retirement to Quadra Island, B.C.

Dr. McDonald, who trained in England, was on staff at the Charles Camsell Hospital, which is devoted to the care of native and northern people. His surgical career was limited, as he developed diabetic retinopathy, but he did continue to function in the otolaryngology clinic at the Charles Camsell Hospital into the 1970s.

In 1960, ophthalmology and otolaryngology were made separate divisions of the Department of Surgery at U of A, and Dr. K.A.C. Clarke was appointed as the director of the Division of Otolaryngology. In the same year, a new clinical service wing was opened at the University Hospital in which outpatient and inpatient otolaryngology facilities and supporting services were located. In time, an audiology unit was established, followed by a vestibular laboratory, a pre-school deafness clinic in conjunction with paediatrics, and a cleft palate clinic with the Division of Plastic Surgery. By the late 1960s, it was thought that the division had matured enough to offer postgraduate training in otolaryngology. This started as a Royal College of Physicians and Surgeons of Canada approved course of 1 year in general surgery followed by 1 year in otolaryngology, with completion of the residency to take place at the University of Toronto or elsewhere. Dr. Marvin Starko, who still practises in Edmonton, and Dr. Delvaille, who recently retired from practice in Lethbridge, Alberta, completed their training this way in Toronto. Dr. Harry Afaghanis, who is semiretired in Lethbridge, completed his training in Boston. Eventually, full training was approved at the U of A. The first residents to complete all of their training in the division were Dr. Louis Ahfat, who practised in Timmons, Ontario, and Dr. Nanjundan, who practised in New Brunswick. They were followed in 1972 by Dr. Upendra Vyas, Dr. Eldon Sunderland in 1973, and Dr. William Kudryk; who completed his residency training in 1974 and is currently on the faculty of the division.

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During Dr. Clarke's tenure (1960-1976), the principal members of his faculty were Drs. Wilson, Quinlan, Mallen, and Lupin, and residency training was done at the University Hospital, the Charles Camsell Hospital, and for a time at the Royal Alexandra Hospital.

In the early 1960s, plans for a new hospital to replace the University Hospital were under consideration, and a great deal of effort was made concerning its design from various departments and divisions.When the proposed "Centennial Hospital" was dropped from the agenda, there was a great deal of disappointment, but all this was dispelled when a new concept-The Walter C. MacKenzie Health Centre-was proposed and ultimately completed and opened in 1986. This new complex houses all undergraduate and graduate medical teaching, along with a new hospital with outpatient, day surgery, and emergency service facilities. Along with all the other departments and divisions, otolaryngology was provided with its own ward, OR rooms, examining rooms, and full-time office facilities.

In 1966, the division was enhanced by the appointment of Dr. Richard Mallen, who was born in Edmonton in 1936, graduated in Medicine from the U of A in 1959, and trained in otolaryngology under Dr. Joseph Ogura at Washington University, St. Louis, Missouri (1960-1964). From 1964 to 1966, Dr Mallen was on the attending staff at Barnes Hospital, the V.A. Hospital, and City Hospital, St. Louis, and on the faculty of Washington University. He was then invited to join the Division of Otolaryngology, U of A. He was an outstanding surgeon and teacher who made significant contributions to the division: his expertise in head and neck surgery was evident, and he developed a head and neck oncology program in conjunction with the W.W. Cross Cancer Hospital in Edmonton. He was involved in the early development of voice-preserving laryngectomy techniques. Among his interests was aboriginal chronic ear disease, and he became involved in the otology service at the Charles Camsell Hospital and at Inuvik, N.W.T. He was the president of the Alberta Otolaryngology Society and, on the national scene, an examiner in otolaryngology for the Royal College. When Dr. Clarke stepped down as director of the Division in 1976, Dr. Mallen succeeded him. Unfortunately, Dr. Mallen developed a health problem, and he stepped down as director of the Division in 1978. In 1979, he moved to Calgary where he continued to practise until his untimely death in 1988.

In 1969, Dr. Allan Lupin was recruited by Dr. Mallen to assist him in head and neck surgery and general otolaryngology. He graduated in Medicine from Oxford, England, did family practice for 1 year in Nova Scotia and then trained in otolaryngology in Cincinnati, Ohio, under Dr. Donald Shumrick. He became heavily involved in the Northern Health Services and, in 1979, moved to the Charles Camsell Hospital where he practised until his retirement in the early 1990s. Other otolaryngologists who came to Edmonton in the 1960s and who were involved in the teaching program to a lesser extent were Drs. Stan Warshawski, John Keohane Sr., Lawrence Diduch, Orest Bykowski, Joseph Kostiuk, Marvin Starko, and Alvin Backstrom. Drs. Warshawski, Diduch, Bykowski, Kostiuk, and Starko trained in otolaryngology at the University of Toronto; Dr. Keohane graduated in Medicine in Ireland and returned to Ireland to train in otolaryngology after practising in Stettier, Alberta, as a family physician. His son, Dr. John Keohane Jr., is currently on the faculty of the division. Dr. Backstrom trained in otolaryngology at McGill University after practising in B.C. as a family physician.

In 1979 Dr. Derald J. Oldring was appointed director of the Division. He was born in Alix, Alberta, and graduated in Medicine from the U of A in 1967. Following an internship at the Holy Cross Hospital, Calgary, he did family practice for 41/2 years in Dawson Creek, B.C. He finished training in otolaryngology at U of A in 1976, having done 1 year of off-service rotation at the University of Auckland, New Zealand. He then furthered his training with a fellowship in otology and skull-base surgery at the University of Zurich, Switzerland, under Professor Ugo Fisch. During his tenure to date, Dr. Oldring has fostered development of subspecialization within the division and has been active on the national scene: he was president of the CSO-H&NS in 1991. Among his appointments to the division are Drs. G. Misko, J. Cuyler, C. Elliott, J. Keohane Jr., H. Seikaly, C.S. Carter, and J. Ditoppa.

Dr. G. Misko trained in otolaryngology at U of A and then did a fellowship in head and neck oncology at Stanford University under Dr. Richard Goode. He moved to Duke University in North Carolina in 1993. Dr. James Cuyler trained in otolaryngology at U of A and then did fellowships in paediatric otolaryngology at the University of Pittsburgh under Dr. Charles Bluestone and in Sydney, Australia, under Dr. Bruce Benjamin. He moved to Portland, Oregon, in 1989. Dr. Clark Elliott graduated in Medicine from the University of Manitoba and trained in otolaryngology at both the University of Ottawa and the University of Washington. Dr. John Keohane Jr. graduated in Medicine from U of A and trained in otolaryngology at the University of Western Ontario. He then furthered his training in reconstructive and cosmetic surgery at the University of Toronto under Dr. David Ellis. Dr. Hadi Seikaly graduated in Medicine from the University of Toronto, trained in otolaryngology at U of A, and then completed a 2-year fellowship in head and neck oncology and reconstructive surgery in Galveston, Texas, under Dr. Byron Bailey. Drs. Clifford S. Carter and John Ditoppa took their core training in otolaryngology at U of A.

Since the mid-1960s, the division has been involved providing services to Northern peoples in the Northwest Territories through the Charles Camsell Hospital, Edmonton, Yellowknife, and Inuvik, N.W.T. In the early 1990s, U of A trained two otolaryngologists, Drs. David Cooke and Donald Giovanetto, who are located in Yellowknife and now carry on this program locally.

Undergraduate and Graduate Teaching in Otolaryngology

Prior to WWI, there was no graduate teaching in otolaryngology at U of A: teaching was limited to undergraduate lectures and clinics. These lectures were given in the medical building on campus, clinics at the bedside in the hospitals, and in an outpatient clinic situated in an old brick house in the centre of Edmonton. In the immediate post-WWII period, there was little change, except that a 1-month elective was offered in otolaryngology to interns during their rotation. In 1960, otolaryngology became a division of the Department of Surgery, and in the late 1960s, partial otolaryngology resident training (1 year surgery, 1 year otolaryngology) was approved by the Royal College, to be followed in the early 1970s by full approval (2 years surgery, 3 years otolaryngology). The program was accredited for two candidates each year (currently funded for 1 year), and to date, over 40 otolaryngologists have been trained. The program, based at the Walter C. MacKenzie Health Centre, offers excellent exposure for training in general otolaryngologyhead and neck surgery. In addition, the residents have exposure to the surgical subspecialties and rotate or have significant exposure to paediatric otolaryngology, head and neck oncology, skull-base and neurotology, and cosmetic/facial plastic surgery. Recently, a rotation to the University of Calgary has been formalized.

Recently, enormous changes have occurred in health care delivery in Alberta, with emphasis to community health centres and a downsizing of inpatient beds, necessitating changes in the way teaching programs function. The residency training committee, currently chaired by Dr. C.S. Carter, is confident that any changes required will be instituted without any significant changes in the quality of teaching and experience the residents obtain.

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References

Sources of Information

References

1. Archives, Division of Otolaryngology, Department of Surgery, University of Alberta.

2. History of the Edmonton Academy of Medicine by Dr.

Harry Letts, Edmonton Academy of Medicine. 3. Vant RJ, Cashman T. More than a Hospital, Vant & Cashman, University of Alberta Hospitals, 1906-1986. 4. Dr. K.A.C. Clarke-personal communication. 5. Dr. C.S. Carter-personal communication.