Women’s role in otolaryngologic medicine

Otolaryngology may be among the oldest surgical specialties, and many of its practitioners have been revered for thousands of years. However, surgeons and other physicians may be unaware of the contributions women have made to this specialty.

Brief history of otolaryngology

Otolaryngology has an extensive history that spans nearly five millennia; in fact, the world’s first known physician, Sekhet’enanch, may be considered a rhinologist. As the “[healer of] the king’s nostrils,” he is believed to have served as personal physician to Pharaoh Sahura in approximately 3500 BC.1 Indeed, detailed otolaryngological knowledge shared by generations of ancient Egyptian physicians has been unearthed, specifically in the Edwin Smith papyrus dating to approximately 1600 BC and in the Ebers papyrus, a document littered with surgical cases written in hieroglyphics in approximately 1500 BC.2,3

Further roots of otolaryngology have been uncovered in the well-known Grecian schools of the fourth and fifth centuries BC, where Hippocrates outlined multiple otologic etiologies and treatments. Centuries later, noted Arab physicians such as Abu al-Qasim Khalaf ibn “Abbas al-Zahrawi” (known in the West as Albucasis) performed and detailed multiple otolaryngological techniques, including tracheotomy, tonsillectomy, and nasal polyp removal.4

Moshe ben Maimon, also known as Moses Maimonides, a Jewish scholar and physician in the 12th century AD, wrote extensively on proper management of various pathologies that affect the ear, nose, and throat, ranging from peritonsillar abscesses, to vertigo and beyond.5 Advancements in otolaryngology continued throughout the Renaissance, in the late 1300s through the scientific revolution in Europe between the 16th and 18th centuries, and into the modern era with novel ideas proposed by individuals such as Heinrich Adolf Rinne, Robert Barany, Manuel Garcia, Graeme Clark, and others whose influence has proven to be invaluable to the field.6 Nonetheless, discussions of the history of otolaryngology often glaringly overlook the contributions of many woman physicians who, alongside their male counterparts, have helped to shape the specialty. This article summarizes the contributions of a handful of influential women otolaryngologists who have served as pioneers in the field.

Women as specialty physicians

Multiple medical schools in ancient Egypt and Greece, including, perhaps, the most famous institution at Heliopolis on the northeast edge of modern-day Cairo, trained women students as early as 1500 BC. 7 Although medical historians acknowledge that specialty physicians practiced medicine during this era, evidence speaking to the degree of specialization of the two most prominent women physicians of ancient Egypt, Peseshet and Tawe, has yet to be discovered.8 Similarly, while research suggests that Antiochis—a famous and well-respected woman physician in Tlos, Greece, in the first century AD—was accomplished in areas pertaining to rhinology, particularly nasal hemorrhage, no proof has emerged documenting medical or surgical treatment provided by Antiochis in the field of otolaryngology. 9 Regardless of whether these women performed otolaryngologic procedures, their involvement in the medical profession paved the way for future women physicians and surgeons.

Despite the increasing role of women physicians during the first century, the rise of the Catholic Church, beginning in the middle of the first millennium AD, significantly challenged women seeking to practice medicine. Patriarchy dominated the sciences, and medical education for women was outlawed throughout Europe. Moreover, the lack of a formal educational system and the increasing illiteracy among women in the Middle Ages precluded self-tutelage from the wide array of surgical and medical texts that existed in this era.10 Interestingly, medieval literature often fails to assign women who practiced medicine the title of physician (fisica) or surgeon (cirurgica).11 Multiple census data derived via household taxes from the late 13th through 15th centuries AD reveal that across Europe, fewer than 2 percent of medical professionals were women.12

Notably, some women superseded all of these obstacles to become well-known, highly proficient surgeons. For example, Cleopatra Metrodora, a Greek physician, perfected her practice in obstetrics and gynecology before branching out into other medical specialties and performing novel facial reconstructions, likely in the seventh century AD.13

Later, a clandestine Frau von Tesingen contributed various medicinal treatments for auricular pathologies to a German text published in the 13th century.14 Further contributions were made by Benvinguda Mallnovell of Spain, who used herbal preparations to treat diseases affecting the throat in both pediatric and adult populations.15

Although important rays of light in otolaryngologic medical history, these few examples likely represent a small portion of women’s contributions to this speciality during this era. It is important to note that treatment of otolaryngologic disease by women medical practitioners during medieval times likely has been overlooked due to a lack of documentation.

Pioneers in the field

The greatest advancement of women in otolaryngology has occurred within the last 200 years. The development of multiple medical schools for women such as The Women’s Medical College of New York and the Woman’s Medical College of Pennsylvania (WMCP), Philadelphia, later renamed The Medical College of Pennsylvania, in the mid-19th century provided opportunities for women to continue to breach the boundaries of the medical profession. The WMCP, for example, offered lectures in otology, laryngology, and rhinology during third-year coursework, providing women with the background necessary to enter otolaryngology.16

Dr. Butler

Dr. Butler

Margaret F. Butler, MD, a graduate of the WMCP program in 1894, was appointed chief of the nose and throat department of the WMCP in 1906. Many female physicians of her time chose to specialize in women’s health, but Dr. Butler was adamant about pursuing otolaryngology, not solely to satisfy her own interests but also to form a path for future female surgeons to follow. She stated, “While I enjoy obstetrics and gynecology, I feel a woman is needed in nose and throat work, and I have decided to work in that field.”17 In accordance with this sentiment, Dr. Butler spent many hours in the operating room performing multiple procedures, including biopsy and removal of malignancy of the paranasal sinuses, tonsillectomy, and middle turbinate resection.18,19 With a knack for innovation, she went on to design multiple instruments used in otolaryngologic operations, such as the Butler tonsil snare and a nasal septum splint used following submucosal resection of the turbinates. 20 Dr. Butler proved influential in guiding her students toward a career in otolaryngology. In her address to the freshman class of 1913, she said, “Women physicians are being sought as assistants to busy specialists in ophthalmology, laryngology, and otology. Such positions are particularly desirable for the young physician, for she has an opportunity to learn and at the same time to build up a practice [for] herself.”21 She mentored many female students, including Louise Mason Ingersoll, a 1914 graduate of WMCP who used the otolaryngological knowledge she acquired from Dr. Butler to perform mission work in Shanghai, China, related specifically to the treatment of ear, nose, and throat pathologies.22 As a respected, highly competent otolaryngologist and an ambassador of the specialty, Dr. Butler provided a blueprint for generations of future female otolaryngologists.

Succeeding in a male-dominated field

Dr. Van Loon

Dr. Van Loon

Emily Lois Van Loon, MD, succeeded Dr. Butler as the head of the department of otolaryngology at WMCP. A practicing otolaryngologist and an inventor within the field, Dr. Van Loon, along with Chevalier Jackson, MD, is credited with the development of the bronchoscope and bronchoscopic removal of foreign bodies.23 Notably, due to her treatment of police officers and firefighters in her otolaryngology clinic in Philadelphia, coupled with her groundbreaking presence as a woman in the field, Dr. Van Loon received the Elizabeth Blackwell Award from the New York Infirmary. This award is presented annually to a woman physician who shares two main qualities with Elizabeth Blackwell, namely “conspicuous professional achievement in a previously male-dominated occupation” and “achieve[ment] and serv[ice].”24 Dr. Van Loon achieved great success within the field of otolaryngology and provided a model for women otolaryngologists today.

Eleanor Maxine Bennett, MD, similarly defied the odds to become a well-accomplished otolaryngologist. After graduating as one of only four women in her medical school class at the Medical School at the University of Nebraska, Omaha, in 1942, Dr. Bennett served as professor and chair of otolaryngology at the University of Wisconsin (UW), Madison, in 1963. She is considered to be the first woman chairperson in any department among all major medical schools within the U.S, and she earned the prestigious distinction of being the first woman member of the American Laryngological, Rhinological, and Otological (Triological) Society.25 Akin to Dr. Butler’s quest to provide future generations of women the opportunity to practice otolaryngology, Dr. Bennett established an otolaryngology residency at UW that today continues to train approximately 15 residents annually.26 A woman of many firsts, Dr. Bennett continually broke free of limiting expectations ascribed to women within otolaryngology in the mid-20th century.

Decades later, Jeanne Vedder, MD, entered into two male-dominated fields at the same time: otolaryngology and the military. In 1976, the U.S. Air Force (USAF) began equally enlisting males and females for active duty. As the first woman otolaryngologist in the USAF, Dr. Vedder was responsible for treating patients, mentoring residents, and acting as department chair at the David Grant USAF Medical Center at Travis Air Force Base, Fairfield, CA.27 She helped lead the way for the women who have subsequently served as otolaryngologists in the USAF and for the approximately 60,000 women in the USAF today.

In 2010, three women otolaryngologists successfully realized their plan to establish a division of Women in Otolaryngology (WIO) Section within the American Academy of Otolaryngology–Head and Neck Surgery. The WIO Section is tailored specifically to the advancement of women otolaryngologists. Linda S. Brodsky, MD; Pell Ann Wardrop, MD; and Sujana Chandrasekhar, MD, FACS, founded the WIO to “provide the Academy a dynamic professional community of women and men who seek gender equality in the specialty.”28 Additionally, a WIO Section endowment has been funded to offer women otolaryngologists the financial backing needed to excel both in academic and private practice.29

A path forward

Despite the best efforts and notable accomplishments of women in otolaryngology over the last 5,000 years, women otolaryngologists continue to encounter a glass ceiling at all levels of training and practice. Unquestionably, otolaryngology has experienced growth in the number of women who are in the field since the middle of the 20th century. In 1963, only 0.3 percent of otolaryngologists were women, whereas in 2014 14.5 percent of the otolaryngologists in the U.S. were women.30 Nonetheless, the number of women in otolaryngology lags far behind the national average of 32.6 percent women across all specialties in 2014.31

Gender inequities also exist in academic advancement and in National Institutes of Health (NIH) grant funding within the specialty. A 2014 study by Eloy and colleagues demonstrated that men disproportionately attained higher academic ranks in otolaryngology when compared with their women counterparts.32 Regardless, women in otolaryngology have continued to increase scholarly productivity within the academic arena, with authorship increasing from 14.5 percent to 22.5 percent between 1998 and 2008, all while receiving nearly $100,000 less in individual NIH grant funding than their male colleagues.33

The reduction and ultimate elimination of gender inequality is an issue that extends beyond the scope of otolaryngology. However, steps can be taken to ensure that more women may overcome the barriers within our specialty. To level the field’s gender gap, today’s otolaryngologists will do well to follow the example of the women surgeons identified in this article, who constantly sought to encourage young women medical students to enter the field. This effort may be complemented by an exploration of the reasons behind the paucity of female otolaryngologists. If implicit and explicit biases toward women in otolaryngology exist, they must be exposed through objective research. Such studies may highlight possible inequities in areas including, but not limited to, the following: otolaryngology residency positions, evaluation of surgical skill, salary considerations, research funding, and consideration for promotion.

The onus lies on the entire otolaryngology community—men and women alike—to ensure equality for future generations of women otolaryngologists.

References

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