The Retrospectompe

The H d s P. Mosher A w h A Legacy of Excellence

he phrase "larger than life" can be applied to only a few individuals in each field of medi- T cine. It is the usual pattern for these special

figures to be highly productive, creative, immensely talented, and extremely committed to their profes- sion. But to put it bluntly, it is not always a pleasant experience to be in their company as a colleague or a student, at least that would seem to be the case with "The Chief," as Harris Mosher was known.

Harris Mosher had close ties to The LARYNGO- SCOPE and to the Triological Society. In 1920 he presided at the 26th Annual Meeting of the Society in Boston and used the occasion to reflect upon his experience and observations while working with physicians who designated themselves as "special- ists in otolaryngology" during World War I. It seems from his written remarks that he was very con- cerned that there was a great need for higher stan- dards in training programs in otolaryngology. To- day it is difficult for us to imagine the system of graduate medical education that existed in the Unit- ed States at that point with fewer than 10 faculty in our specialty who held paid full-time positions.

Before delivering his President's Address1 on the anatomy and pathology of the esophagus, Mosher chose to express these views:

The war is behind us. It has left a mark that many of us will never lose. It took us out of our routine, gave us a new start and a new perspective, and sent us back home with new k d s and new thoughts. We met better men than ourselves and learned from them. Some have found the old kids too confiied and have broadened their work or radically altered it. Our sense of values has changed, Our patients notice a new vigor about us and

comment approvingly. Our offices have been brought up to date and there is more SMP in our hospital work, and the words "command and obey" mean more than they ever did before.

It has been much heralded that the specialist in ote laryngology was shown by the war not to be always up to requirements, and those interested in the improve- ment of the education of the specialist, and I take the lib- erty of putting myself in that group, have used the fact as the central point in their propaganda. They are welcome to make all the use they please of it, but an accompany- ing word of explanation would be generous. The aspi- rant in otolaryngology was one of the earliest of the spe- cialists to be rated. The Department of Otelaryngology in the Surgeon General's office established one of the first schools for sorting and training of its men and their figures were the first available. Our men were no worse than those who were enrolled in the other specialties of medicine and surgery.

The war gave new life to a nearly moribund effort that had been languishing for some five years to formu- late and get into operation a plan by which the education of the specialist could be standiudized. The war also has crowded our Post Graduate schools, and many men are turning to our specialty. The six weeks' course has be- come an abhorred thing. Every medical faculty has seen the light at once, and an air of holiness is broadcast. These words may sound like scoffing but they are not meant in that vein. I congratulate the young man who en- ters the specialty of oto-laryngology today. In at least two places can he obtain a two-years' course with a degree at the end, and in at least one other institution he can get a systematic course of the same length without a degree.

Money and teachers are needed to put the two years' course into effect in more of the fvst class medid schools. Those of us in the East envy the resources of the state endowed universities of the West and Middle West. Give them the clinics of the East and the East would have nothing left but its tradition.

Speaking of teachers, those of us in active hospital work and in teaching are becoming increasingly anxious about the supply. Young men who can afford to do sci-

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entiftc and school work not coming forward. A few make abortive attempts, but their laboratory desks soon become vacant. We hear the older men say, "When we were young, things were different," and I rather think that they were. There has been a change in the attitude of the younger men, and the change must be met. I sympa- thize with the younger man. He has a right to the full Me, even if he wants it a bit earlier than his father did. The best solution of the problem that I can give is the estab- lishment of the paid hospital position and the full time service. Pay a salary commensurate with the amount of time given and allow the hospital men to see their private patients in the hospital. This is being done, fully or in part, in a few places. A plan of this kind would enable the young man to live from the start and it would make a hospital p i t i o n , not an incident in a medical man's life, but a career.

First and foremost, Mosher was a teacher. It was the passion of his professional life and he believed that it would be his greatest legacy.

At a Triological Society dinner at the Fairmont Hotel in San Francisco in May 1950, Dr. Mosher shared some personal sentiments and his views on clinical teaching. The following excerpts from that address reveal much about the man whom many regard as the "gold standard" for teachers in our specialty:

On looking at the members of the Association be- fore me, it is easy to see three or four faces whose looks speak louder than words, and say, "Will he never quit and give us a chance?" The October issue of the Satu&y E m t n g h r of last year carried the sentence, "The late Dr. Harris P. Mosher." This should give these men hope; but I find it a queer sensation to be both dead and alive.

The psychiatrists say that confessions are the catharsis of the soul, so I have a few to make. My fvst is that I shun the word "old." To speak it brings crashing down upon me the heavy weight of the accumulated years, and I find that I am becoming as sensitive about telling my age as a woman over twenty.

Second, you can date me by the following incident. At a neighboring hospital where I recently had a check- up, the nurse who prepared me for a chest X-ray and a day or two in the hospital was heard to say, "Think of it, I have just found a man who still wears garters."

Third, show me the photographs of your children once but, please, not every time we meet. Be merciful, as I have no children. Remember that I, too, was a beautiful golden-haired baby; at least my mother had to say so, in order to keep up with all the other mothers.

Fourth, my bluff, staccato manner is deliberately put on. When I was in flower, so to speak, people came to me because they wanted something, and this manner

brought them at once to the point. I found it very useful, and survived in spite of it. From the fust I have been con- scious that neither Chesterfield nor his successor, Emily Post, nor Dale Camegie, would recommend it.

So much by way of introduction. My topic tonight is "Teaching." All that I have to say is reminiscent of my post graduate courses. All that I know about teaching I learned in them. Half or more of what I have to say is in a light vein; the rest, at least to me, is serious.

My courses featured applied anatomy. I held that it was only if you knew your anatomy were you ready for surgery. The parts of my post graduate course which I hoped to be of the most lasting value were: First, a com- prehensive series of drawings of picked anatomical and surgical specimens. A drawing was always started in the tncing box, and then finished according to the student's native skill in drawing, and with what help I could give him as he went along. Second: A series of casts to supple- ment the drawings was made from master casts or from the cadaver. The casts, unlike the drawings, were in three dimensions and constituted an anatomical and surgical library which ranked next to the cadaver for study, and was always available.

I have always liked to work with my hands. To mea- sure a significant anatomical or surgical specimen, to draw it, or to reproduce it in permanent form was an in- born and always an increasing and lasting pleasure.

Now, a word more about teaching.-It is becoming increasingly hard to get young men in our locality to give up time from their practice for teaching. AU teaching should be paid for. The amount depends upon the bud- get of the department. In my beginning days, we were supposed to do anything we were capable of doing for the older men, for nothing. Happily, those days are over. Getting a practice is harder than it used to be, especially in a large city, and raising a family today is more costly. I feel that I have led a sheltered medical life because, thanks to my father, and later to Mrs. Mosher, I had a small private income from the stsut.

Speaking generally, when you try for a reason why a man should take up teaching, the fm one which comes to mind is that he does it to make a living, and does it in spite of the fact that the living proves to be a modest, if not a meager one. The crudest explanation of all, one which is only a poor wise crack, is that, if mar- ried, he cannot be boss at home, but hopes he can in the school room.

When you are honest with yourself, you realize that one of your most constant dreams is to leave something behind to be remembered by, and you hope that some- thing in your teaching may do this. One remark of mine, perhaps, may do this for me, namely: "Respect the virgin- ity of the nasoh ta l duct, or take the consequences."

I cannot help feeling that in teaching there is an in- born element of the urge to lead and direct, as in the leader ofthe herd or the mob; but it is hard to believe that

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those teachers who live in ivory towers, snug, warm and protected, like a human caterpillar in a cocoon, have this feeling for leadership.

In closing, allow me a general remark or two about teaching. In speaking, a teacher should radiate enough strength to command attention, and, if possible, respect. A weak voice and manner have no place in a class toom at any grade. More than once I have said to my students that they should feel that what they were saying in their assigned talks was the most important thing being said in the world at that moment. Without being brazen, they were to put some strength into their voice and manner.

A few teachers help to make their points as much by their mannerisms as by what they say. I am not advo- cating clowning, but action is life and life is contagious.

As I see it, the fundamental fact about teaching is that the teacher’s personality is what makes him success- ful or a failure. To attempt to defme personality would soon put me over my head in metaphysics, and at once put you listeners to sleep. One set of thinkers hold that God has no personality; fortunately, we as humans have. Philapophers often I;mk personality as the basic, divine spark in a human being. There is truth in this, even if it does sound like tall talk.

One thing about teaching seems clear, at least to me, and this is that every teacher, consciously or uncon- sciously, has the instinct of a showman and, at his best, is a showman. I refrain from naming present-day examples.2

Upon his death in 1954, Mosher’s obituary in The LARYNCOSCOPE was written by Gordon Hoople, MD, of Syracuse, New York, who observed:

It is given to few men to attain the leadership in their chosen field such as Dr. Harris P. Mosher achieved in his. By universal acclaim he was known as “The Chief,” Some used this form of address as a friendly salu- tation, others in awe or respect; but everyone included in its use a feeling of reverence. His death brings to an end an era in otolaryngology the like of which will not be seen again.

No memorial can detail all of Dr. Mosher’s achieve- ments so no attempt will be made to do so here. Out- standing among them, however, is the fact that not only was he a member of all of the national otolaryngologic sodetles but he, in turn, served as president of each of them. When the American Board of Otolaryngology was formed he was chosen as its president and served in that capacity for 25 years. While others worked hard for its position of excellence in the kld of medicine, it was his driving zeal and high ideals which were responsible for the major share of its accomplishments. He was the re- cipient of many honors, among them several honorary degrees fm leading American Universities and the Se- men Medal from the Royal Society of Medicine of Lon- don, England. In 1931 Dr. Mosher was awarded the Gold Medal of the American Laryngologid Association, and

in 1939 a similar medal was awarded to him by the h e r - ican Academy of Ophthalmology and Otolaryngology.

He will be remembered best, however as a teacher of his specialty at Harvard University, his Alma Mater, the Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary. He added fame to these illustrious institutions as citadels of learning. Testimony to his ex- ceptional skill as a teacher is the number of his “boys” who have become chairmen of their departments in many schools and hospitals. He inspired more men to such attainments than any other teacher of his time, and scores of men who did not seek such positions owe their otolaryngologic successes to him.

He was an “inventor” as well as a doctor. He de- signed several instruments which added much to the sur- gical armamentarium of his day. In addition, he outlined several surgical procedures which remain as standards to the present. Among the most notable, being his tech- nique in the ethmoid labyrinth and his method for the re- moval of safety pins swallowed by babies, for which he was given a Citation by the American College of Sur- geons, in 1934. He was not a surgeon, with emphasis on fme detail as would suit the present era of fenestration surgery, but rather he was bold and brave, eminently fit- ted to attack the ravages of infection.

In 1905 Dr. Mosher became a collaborator on the staff of The LARYNGOSCOPE and his guiding counsel throughout these many years has been instrumental in attaining the enviable position this journal now holds in otolaryngologic literature.

Harris P. Mosher was an artist. This helped him im- mensely in his teaching endeavors, fmding expression in telling illustrations. Many pictures of merit came from his pen or brush. He was an artist with a camera, and color photography furnished for him one of his great plea-

No memorial to Dr. Mosher would be complete without reference to his ability to find an appropriate word for a particular occasion. He was a past-master at repartee. The use of this gift enlivened many a national meeting when he rose to discuss a paper. His thinking was incisive, so he was quick to discuss a presentation if he thought it was lacking in merit; yet he was equally willing to give praise if it was deserved. At the last nation- al meeting he attended, he went out of his way to praise a young man who had made his first national presenta- tion. He lent rich color to all our gatherings.

There were many who thought Dr. Mosher was a rough, gruff man. This was because they did not know him, for he used an apparent austerity to cover one of the kindest and softest hearts we shall ever know. Many re- cipients of his graciousness and kindness teshfy to this. The number of young men to whom Dr. Mosher gave a friendly helping hand is legion.

Above all, he was loyal. Certainly he was loyal to the institutions he served. He was more than loyal to his %oys.” His devotion to his wife, Helen, was magnificent.

sures.

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Finally, he was loyal beyond words to his chosen work; he gave his life for it, and its present enviable status is in no small measure due to his efforts.3

Frederick Hill, MD, of Waterville, Me., was cho- sen by Kenneth Day, MD, the Triological Society president, to provide a eulogy for Dr. Mosher. Hill's remarks followed a close association for 40 years, beginning as a medical student, then as a resident, and finally as a close friend. His tribute, "To The Chief," included these remarks:

Dr. Mosher possessed a most dynamic personality. To those who really knew him, he was not only an out- standing otolaryngologist, skilled both in clinical practice and in research, and a teacher par excellence, but also a sincere, generous, lovable person, with a great deal of sentiment in his make-up which he always tried desper- ately to conceal. No one will ever know of the many per- sons he helped, both in obtaining an education, training in our specialty, or in meeting economic problems at home. To those who knew him less well, or not at all, he often was an enigma; but none who had ever been in at- tendance at a meeting with him could ever forget him. His own presentations, as well as his contributions to the literature, were masterpieces, scientifically accurate and always meticulously prepared. He had the inquiring mind of the me scientist and was indefatigable in what- ever he was doing.

In discussions he had an uncanny ability to get at the gist of anything. He was honest to the core, and this, combined with frankness and courage, sometimes made him caustic in his remarks. He had an inborn trait that im- pelled him to speak out against anything he felt was in-

his own regret and due, as he confessed to me, actually to diffidence on his part; but he had the courage always to speak the truth as he saw it.

What a master he was at conducting a meeting! I never will forget the occasion when I became a member of this Society, just 35 years ago. Dr. Mosher was presi- dent at that time, and the sessions were held at one of the amphitheaters of the Harvard Medical School. Readers of papers were kept strictly within their allotted time, and discussions were to the point. It was a Mosher meeting.

Despite a seemingly bluff exterior he was generous and kind-hearted, and would go out of his way to bestow praise when warranted, or to defend a person unjustly at- tacked, as many of us can testify. He had understandable pride in his own accomplishments but never tried to keep them to himself. He always expected his men to do everydung he could do.

He was a wonderful teacher, with a flair for the dra- matic which he used to good advantage. His background in ART, with his proficiency in all media, enabled him to give courses which were unique, in that the students

correct or misleading. At times he might wax sarcastl 'c, to

were taught anatomy by making drawings and plastic casts of specimens and dissections. His residency pm- gram at the Massachusetts Eye and Ear I n f i i r y was the goal of aspiring otolaryngologists from all over the world. He once said that his greatest professional satis- faction was in the vicarious fatherhood of some 500 men who had taken his courses.

In a letter to me, shortly before his death, he had a bit of poetry, "imperfect lines" he called them, which had occurred to him that morning.

"The hunger to be remembered Ends only with Life's last breath And a cold death notice Of a line or two marks the hunger's end."

I think he foresaw what was approaching. I know his last wish was to be remembered, and I feel certain that this wish will be granted him, that he will live forever in the memories of his friends.4

At the meeting of the Triological Society Coun- cil in January 1955, President Day proposed that a memorial lecture be established and bear Dr. Mosh- er's name in remembrance of his contributions to the specialty. After some discussion, an alternative proposal was introduced suggesting that the top ranking thesis be selected to receive the "Mosher Award." There was initially a sentiment expressed that the Mosher Award cany a fiscal honorarium as well, but this concept was discarded on the basis that it would put "the whole thing on a vulgar ba- sis." The proposal was tabled for reconsideration at the 1956 Annual Meeting.

The minutes of the January 1955 Midwinter Meeting of the Triological Society Council report the following:

New Business-Doctor Day said he would like to see the Triologid Society inaugurate a memorial lecture to perpetuate the name of Doctor Harris P. Mosher. Doc- tors Lierle and Nash talked to the point, agreeing that it was a splendid idea but suggesting that a great deal of care should be used in the selection of speakers, mem- bers or non-members, and that the subject was one upon which the Council needed to give serious thought. Other members concurred, and Doctor M a l l MOVED that the matter be referred to the Executive Committee and that they be given authority to make decisions in the choice of speakers. Doctor Marcotte seconded the motion and it was Camed.

From the next meeting of the Council in March 1955, the minutes state:

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Then in January 1956, the deliberations began to move forward as reflected in the Council minutes:

Unfinished Business-Masher Memotiul Lecture. This matter was again reviewed and discussed and Doc- tor Nash MOVED that the matter of the Mosher Memorial Leaure be placed in the hands of a special committee headed by Doctor Lou Morrison (Fig. 1); that the consen- sus of the Council was that some means should be worked out to honor Doctor Mosher and also honor some designated candidate whose paper had been grad- ed "excellent." The motion was seconded by Doctor Day and carried. The fust Mosher Memorial Thesis will be so earmarked in 1957."

Fig. 1. Dr.LouMonisonandI)r.Mosher(right)relaxingaftertheABO exemsin1953.

Memorial Lechl-Doctor Mosher. Doctor Day stated that the Executive Committee had no report to make at this time, but that he would like to see one item on the annual program each year which would perpetu- ate the name of Doctor Masher and might be called the Mosher Memorial Lecture, with or without an honorari- um. Inasmuch as the President and Secretary make up the Annual Program, Doctor Day felt that the selection of the speaker could be left in the hands of the Executive Committee.

Doctor Morrison suggested that perhaps the Thesis which ranked No. 1 in the opinion of the Thesis Commit- tee might be presented as the Mosher Memorial Thesis- in honor of the man who spent most of his life teaching others.

Doctor Lierle agreed with Doctor Morrison's sug- gestion but said he would not like to see any stipend at- tached to the honor.

Doctor Nash also felt that any monetary considera- tion put the whole idea on a vulgar basis.

Doctor Schall believed the idea of recognizing an outstanding thesis to be a good one and might ease the task of finding someone to give the memorial lecture.

No action was taken by the Council and the whole matter was laid on the table until the next Council Meeting.

Dean M. Lierle, MD, of Iowa City presided at the 60th Annual Meeting of the Triological Society in Montreal in 1956. It was at this meeting that the Council authorized that there be established a form of recognition for "the most outstanding thesis."

The minutes of the Council meeting report: Report of Commi-Masher Memorial Lecture.

Doctor Morrison, Chairman presented a rough draft of recommendations for Council approval. It was suggested the Harris P. Mosher award be reserved for the candidate who presented the most outstanding thesis. This would mean that the award would be made to one of the younger men, a course Doctor Mosher would heartily approve. The Committee recommended that there should be no medal accompanying the award and no monetary consideration.

In addition to the notification that he had been se- lected for the Mosher Award, the honor candidate should receive: (3) A suitable certificate, (2) One hundred com- plimentary reprints of the published article, 0) Perma- nent listing in the roster of names of the individuals se- lected to receive the Harris P. Mosher Memorial Award (published in the annual program and Transactions).

Doctor Walsh moved that the Council accept the Report of this Committee and that the Committee be giv- en full power to put the plan into operation at the next Annual Meeting (which would be in 1958 inasmuch as there will be no meeting in 1957). The motion was sec- onded by Dr. LeJeune and carried.

It was decided that the first winner would be selected the following year (1957) even though there would not be an Annual Meeting of the Trio- logical Society due to the Sixth International Con- gress of Otolaryngology which was held in Wash- ington, D.C.

The first recipient of the Mosher Award was Harold G. Tabb, MD, of New Orleans. His thesis en-

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titled, “Carcinoma of the Antrum: An Analysis of 60 Cases with Special Reference to Primary Surgical Extirpation” was published in The LARYNGOSCOPE~ and in the Trunsacffons of the Triological Society.6

Harris Mosher was a prolific medical writer. His subjects covered a broad range of basic science and clinical topics and many were illustrated with excel- lent artwork from his own hand. Frank Ritter, MD, of Ann Arbor, Mich., himself a Mosher Award win- ner, has provided one of the best contemporary bio- graphic sketches of Dr. Mosher.’ From Ritter’s arti- cle we get an excellent sample of Mosher’s belief system by virtue of his “Medical Creed”:

If medicine is not your greatest fun, you are at the wrong job. Watch the clock and you will often miss the train. Overtime is opportunity. The cases from which you learn the most come on Sundays and holidays. The great- est satisfaction of a medical career is the acquaintance of the men who are doing things and being counted by them, “one of the gang.” Meet the busy men and take their overflow jobs-scientific jobs, I mean. Join a med- ical society of national scope and go to its meetings. Get a hospital connection. Never resign. Work to the age lim- it. It will come quickly enough. To spend a medical life doing nothing but private practice numbs the soul and kills the imagination. Set aside a stated t i m e 1 take an evening a week-for scientific medicine. Spend it in your library, the hospital library or in a laboratory. Come to an understanding with the family about it, peacefully if you can, by force if necessary. Read regularly something

worthwhile besides medicine. Often, in such reading, words, phrases or even ideas which can be used in medi- cine will literally jump out at you. Make yourself better than the men of your community in at least one thing. What this medical thing &notice I say medical-t- ters but little.-Harris P. Mosher, M.D. 1948.

None of us can know to a certainty the sub- stance and nature of our legacy. As we go about our daily lives, we would do well to remember that each personal encounter, each friendship, and each helping hand is a piece of that legacy. Perhaps, it is truly the small acts of kindness and the gentle words of encouragement we have to offer that mean the most to those around us.

BIBLIOGRAPHY 1. Mosher HP. President’s address. Transactions of the American Law-

gologid, Rhinological and Otological Society, Inc., 1-3,1920. 2. Mosher HP. Memories of post graduate teaching. Transactions of the

American Iaryngological, Rhinological and Otological Society, Inc., 29307,1950.

3. Hoople GD. In memoriam: Harris Peyton Mwher, MD, 1867-1954.

4. Hill FT. To the chief. Transactions of the American Laryngological, Rhinological and Otological Society, Inc., 511-515,1955,

5. Tabb HG. Carcinoma of the antrum. An analysis of 60 cases with special reference to primary surgical extirpation. ~RYNGOSCOPE. 195767269-341.

6. Tabb HG. Carcinoma of the antrum. An analysis of 60 cases with special reference to primary surgical extirpation (candidate’s thesis). Transactions of the American Laryngological, Rhinologi- cal and Otological Society, Inc., 47446,1957.

7. Ritter FN. Presidential Address: Harris Mosher, MD-Outstanding

mcosco~e. 1954;64:1035-1039.

OtOhryngologiSt. ~ Y N G O S C O P E . 1993;103:1192-1194.

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