Storied Past, Bright Future
A lot has changed since Bernard Marsh was a resident in Johns Hopkins’ Department of Otolaryngology/Head and Neck Surgery in the early 1960s. One minor example: air conditioning. Marsh and the other first-year otolaryngology residents—there were three then, compared to the 28 Hopkins Otolaryngology–Head and Neck Surgery residents now—shared an on-call room right beneath Johns Hopkins’ famed Dome, the only open room.
“There was no air conditioning there, and it was hotter than blazes in the summertime,” Marsh, who retired in 1998, remembers. “I talked with my department director about that, but received little sympathy. He said that when he was a resident, he roomed over top of the boiler room, so he had it even worse than we did.”
On the more significant side, the measures taken for patient safety and comfort have changed, too. Marsh, who was an officer in the U.S. Public Health Service when he joined the Johns Hopkins team, says that for procedures like bronchoscopy, laryngoscopy and esophagoscopy—in which a doctor peers into the lungs, throat or esophagus through an open tube—the majority of procedures were done under local anesthesia that he and his colleagues administered themselves. Unlike these procedures today, there was no anesthesiologist, often no IV delivering fluids and sedation, and frequently not even a blood pressure cuff.
“We simply didn’t have anything like the degree of monitoring that today is standard and expected,” Marsh says.
Marsh remembers completing a mastoidectomy—a type of ear surgery—using a mallet and chisel when there was a breakdown of the dental drill used then for that procedure, far more primitive tools than surgeons use today. For diagnosing tumors and planning operations to remove them, there were no MRIs or CT scans. There was also no genetic or molecular medical research—most research that Marsh and his resident colleagues did was on data collected from outcomes or what they could see with the naked eye in whole tissues or through microscopes.
Even so, they made tremendous advancements. In the 1970s, Marsh and Edwin Broyles, a longtime part-time faculty member in the department, made fiber optic illumination a standard part of endoscopic procedures. Before then, doctors used tiny light bulbs powered by a battery box that they manually adjusted. Too bright, and the fragile light bulb could burn out. Too dim, and the patient’s tissue would look yellow, and diseases were hard to spot.
After the introduction of the fiberscope for esophagoscopies, Marsh worked with colleagues in Japan to create smaller scopes and instruments for bronchoscopy, revolutionizing the types of procedures that could be done in the small spaces of the lungs.
Foreign-body removal using specialized tools allowed Marsh and his colleagues to perform delicate procedures, such as removing an intact crab claw from a child’s airway or a glass thermometer that had been bitten in half and become lodged within a lung.
As the department has grown and more and more medical advances take place at Johns Hopkins and within the specialty, Marsh can’t wait to see what the future holds. “I’ve been retired for 15 years, but what I see in the literature is exciting beyond belief,” he says. “The future is incredibly bright.”