Historical Perspectives on the Semon Lecture

In producing the semonlectures.org website, we have had the opportunity to review published and unpublished materials related to the Semon lectures. Of these, the published versions of the lectures between 1913-1970 are particularly interesting, because they were generally published as long (and, we think, fairly lightly revised) versions of the presented lectures. In concert with the lack of constraints on the lecture topics, these works present a fascinating insight into the emergence of ENT surgery as a surgical speciality in the twentieth century.

The theme of professional development is mentioned by many of the lecturers. One striking example is the concern with the low comparative status of ENT. Many of the early lecturers commented on their personal experiences of the rapid increase in status that ENT underwent in the early twentieth century. Others – such as Capps 1957 – reported second-hand from their trainers. These include striking characterisation of ENT as a low-status speciality that was carried out by surgeons who “did not care about the specialty, [were] expected to treat patients whose disease he could not diagnose, and to teach students the use of instruments he could not use himself.”. Yet the esteem in which the profession was held, which was lifted by a raft of institutions that grew up around the end of the nineteenth centuries such as professional organisations, journals, and – yes – prestigious international prize lectures, rapidly improved. This was a highly international process – as shown by the affiliations of the 44 lecturers between 1913 and 1970. Of these, 25 were based in the UK, 13 European, and 6 North American. As well as the importance of international cooperation in developing the speciality, we conjecture that this demonstrated that the Semon lecturers were one important factor in moving the European centre of laryngeal excellence from its historical concentration in Vienna.

As the status of ENT grew, frequent negotiations about its boundaries occurred. While many of these boundary disputes are mentioned in passing in the lectures (including surgery of the lungs and of the oesophagus), one particularly well-developed (but good humoured) dispute is to be found in the lectures of Nager (1939), Hamberger (1962), and Angell James (1965), which all concerned the boundaries drawn between ENT and neurosurgery with particular reference to surgery of the pituitary.

Training too was important to the development of ENT surgery. Considering its age, Logan Turner’s 1923 lecture presents a shockingly contemporary account of how he thought teaching should be organised. This lecture took place from a backdrop of the contemporary introduction of compulsory ENT in medical school curricula. Teaching was itself thought to elevate the profession, as long as the teacher could strike a balance between enthusiasm and hyperbole. Logan Turner (himself a key trainer in the early twentieth century) put this dilemma in terms that many of us will find familiar: “The majority of teachers tend to overestimate the importance in the curriculum of the subject which they profess…” Important advice when – as Logan Turner firmly believed – all practitioners should teach.

While half of the lectures are primarily or exclusively clinical, laboratory research is a frequent theme. One highlight, important for our understanding of the changing nature of ENT as a profession during this period, is the 1938 lecture by Mollison that paid direct and thoughtful attention to the ways that research and clinical practice would be of value to each other, and set out a programme for the ways that clinical and research practices might be better integrated.

There are also topics which – because of the almost 60-year span of the lectures – only becomes apparent at this time scale.

One such example are the reversal and controversies about laryngectomy. From a position of profound scepticism found in the lectures in the early twentieth century, such as Semon’s opposition almost to the end of his life to open laryngectomy, opinion became more nuanced. For example, Colledge’s position in 1927 was not prohibition, but instead that “no larynx should be sacrificed unnecessarilyā€¯. For Colledge, this necessitated both judicious choice between, and careful planning of, surgical procedures. This careful pluralism evolves into the later lectures. For instance, Som (1969) commented that “It would perhaps be more fitting to have this presentation entitled – The Renaissance of Conservation Surgery”, or Lederman (in 1968) describing his approach to the use of radiotherapy and surgery together for laryngeal cancer. This remains a live issue into the contemporary lectures, as Gilbert’s (2017) discussion of long-term survival after laryngectomy demonstrates.

Finally, Sir Felix Semon features in many of the lectures. Two particularly noteworthy examples are McBride’s 1913 lecture, and Janet Wilson’s in 2016.