The Dawn of Specialization

The concept of specialization is complex and makes it difficult to know exactly when it started. There is an old joke that says that soon after the world was created Cain became interested in agriculture and Abel in cattle raising. The world had only four inhabitants and two of them were specialists...

Regarding Medicine, we may quote Galen, who stated that specialization was common among Roman doctors. The modern medical specialities, however, evolved gradually during the 19th century.

I believe that specialization in Otolaryngology begin with Sir William Wilde, Oscar Wilde’s father.

Sir William Robert Wills Wilde was born in Ireland, in 1815, a son of a prominent medical practitioner. He called himself an “eye and ear surgeon.” And he was also an archaeologist. He graduated in Medicine in 1837 and became a knight in 1864 for his medical contributions, that included a successful cataract operation performed in the king of Sweden. King Karl XV of Sweden conferred on him a medal of the Order of the North Star.

Sir William Wilde

He also performed an operation on the father of another famous Irish author, George Bernard Shaw.

He had a successful medical practice and ran his own hospital, Saint Mark’s Hospital for Diseases of the Eye and Ear, in Dublin.

His main contribution to otology was the postauricular incision for acute subperiostal abscess, which was used for all operations on the temporal bone for a long period of time. In those days almost all of the attempts to operate on the mastoid resulted in the death of the patient from infection. Wilde’s incision was practically exempt of complications and saved lives.

I remember watching an old otolaryngologist perform Wilde’s incision in a young boy with acute mastoiditis, in a charity hospital. This happened in 1956, soon after I graduated from Medical School. A couple of years later I learned, from Dr. Julius Lempert, that Wilde’s incision saves lives, but the patient evolves to a chronic otitis media that may last for the rest of his life. This happened at my first American Academy Meeting, when I took one of the last instruction courses given by Dr. Lempert.

In this age of highly developed ear surgery techniques and antibiotics, therefore, there is no more use for Wilde’s incision. I must add that since the late 1920's there were otolaryngologists performing mastoid surgeries in São Paulo, but there were many that had not been trained to perform them. 

William Wilde’s son Oscar Wilde, born in 1854, became a famous writer and poet. His mother was a poet and was a powerful influence to her children.

During a medical meeting in the United States I had the pleasure of hearing an extraordinary otologist, Sir Terrence Cawthorne, talk about his research on Oscar Wilde’s death. One of these ironies of fate: the son of the man who saved so many lives with his postauricular incision died of a brain abscess caused by a cholesteatoma. At the time of his death he was considered demented. Cawthorne read all of his late writings and notes and reached  a very precise diagnosis of his condition. It was known that he had a drainage in his right ear, but its complication was not diagnosed and led to his early death in 1900.

Sir William Wilde, the first famous eye and ear surgeon, died in Ireland in 1876.