The origins of The Midland Institute of Otology date back to 11th February 1947 when William Stirk Adams (Queen Elizabeth Hospital, Birmingham) wrote to twelve consultant colleagues from within the Midlands, viz: J B Cavanagh (Worcester), D J Evans (Birmingham and Midland Ear & Throat Hospital), F B Gilhespy (E & T Hosp.), B G Goodwin (Kidderminster), W W Hallchurch (Wolverhampton), DAP Macalister (Warwick), A J Moffatt (General Hospital, Birmingham), R S Strang (QEH), C Naylor Strong (E & T Hosp.), W L Thomas (Wolverhampton), C L Walker (E & T Hosp,) and E M Woodman (QEH), suggesting the establishment "in association with the University of Birmingham of an Otological Institute for teaching and research in the subjects of our specialty". His idea had developed as a result of a meeting attended by him as Council Member of the British Association of Otolaryngologists when it was announced that Lady Ludlow had bequeathed £100 for the promotion of research and treatment of blindness and deafness in Great Britain and the British Empire. Stirk Adams perceived the Institute as having a team of research workers who might be supported by a grant from the Trustees of the estate. As the result of a positive response, a meeting was held at the Medical Institute, 154 Great Charles Street, Birmingham on "St. George's Day", 23rd April 1947, attended by eight of the recipients, apologies being received from Messrs. Evans, Hallchurch and Thomas. It was agreed to form "The Midland Institute of Otology" with the objects of "1. The promotion and encouragement of study and research in otology, rhinology and laryngology, 2. The promotion of postgraduate teaching in these subjects, both clinical and academic, 3. To obtain the power to establish and confer a Diploma in Otological Nursing".
At a second meeting on 9th May 1947 a draft constitution was produced and at a meeting at 257 Hagley Road, Birmingham on 11th July 1947 Stirk Adams was elected as Chairman for the ensuing year and also agreed to act as Secretary in the interim. It was agreed that the Treasurer should be a layman and that a number of other "prominent laymen" should be elected to the Council. Lay representation on the Council did, however, cease after a few years. The first General Meeting, open also to Specialists from Cheltenham, Coventry, Derby, Gloucester, Leicester, Northampton, Rugby, Stafford, Shrewsbury, Stoke on Trent and Warwick, was held at the Birmingham Medical Institute on 12th December 1947 and attended by 17 individuals with apologies from a further 7. The Constitution was adopted and the first Officers elected, including W H Lomas, House Governor at The Ear and Throat Hospital as Honorary Treasurer. Since that time the Institute's affairs have been managed by the Officers and Council who have met up to four times annually, initially at Mr Stirk Adams' home and subsequently at the Queen Elizabeth Hospital, Birmingham. Secretarial assistance was provided until 1969 by Miss Margery Barclay, secretary to Mr Stirk Adams, and since then by Mrs Valerie Coombes, formerly secretary to Mr G A Dalton.
Full Membership of the Institute is now offered to all ENT Consultants within the wider Midlands region and to interested ex-trainees from the region who become Consultants elsewhere. All trainees within the region become non-subscribing Associate Members.
The Annual General Meetings from 1948 have been held in October and in conjunction with a formal Dinner. The first venue for these meeting was the Edgbaston Golf Club and this has continued except for the year 1957 when it was held at the Queen Elizabeth Hospital and from 1963 - 1966 at the University of Birmingham Staff House. Since 1949 the Institute has held Clinical Meetings twice annually; a Winter Meeting hosted by one of the departments in Birmingham and a Spring Meeting usually by a department elsewhere in the Midlands, although in 1977 the hosts were the RAF Hospital, Wegberg, Germany and in 1987 the Free University, Amsterdam, where the meeting was joint with the South Western Laryngological Association, whilst in 1991 the meeting was joint with the West Midlands Surgical Society and held in Florence, Italy. Many of these meetings have included lectures by experts of both national and international standing, the most prestigious being the Annual Lecture at the Winter Clinical Meeting, this being instituted in 1971 and since 1980 being dedicated to the memory of W Stirk Adams.
In addition to local lectures the Institute has also since 1973 helped to sponsor the Toynbee Memorial Lecture held at the Royal College of Surgeons of England and more recently at the Royal Society of Medicine. This sponsorship continues to at least the year 2000.
In view of the fact that Stirk Adams' hope of obtaining large trust monies at the time of the establishment of the Institute did not materialise, the Institute's funds in its early years were limited and permitted little support of academic activity beyond clinical meetings and lectures. The relatively small income from subscriptions (3 guineas per annum in 1947, increased
to £5 in 1971) was supplemented by occasional donations of up to £100 from charitable trusts and from Mr Stirk Adams himself. However, the major bequest received from the will of its Founder President in 1978 allowed the Institute to extend considerably its funding of a wider range of activity. In recent years it has supported numerous research projects by consultants and trainees, provided expenses for members chairing sessions or presenting papers at meetings abroad, and supported the establishment of a Chair in Otolaryngology at the University of Nottingham. In addition, since 1984 a Bursary has been awarded to enable a Midlands trainee to attend the Advanced Otology Course in Nijmegen; in 1984 and 1985 the Institute joined with the TWJ Foundation to fund Fellowships open to national competition to enable a senior trainee to work in Toronto; and Fellowships have been awarded to enable trainees from Eastern Europe to attend the British Academic Conferences in Glasgow and Dublin.
In concert with Stirk Adams' initial vision, the Institute has a long history of supporting nurses in the specialty of otolaryngology. This began with the establishment in 1951 of a Diploma examination for State Registered Nurses and was followed in 1952 by the formation of the Midland Nursing Association of Otology for nurses successful in the examination and in 1961 by a Proficiency Certificate for State Enrolled Nurses. Despite many attempts over the years the Institute has been unable to obtain official recognition by the nursing authorities of the Diploma and Certificate but nevertheless, they are recognised unofficially within the specialty nationwide and continue to be a focus for postgraduate nurses. Mr Stirk Adams was the Founder President of the Nursing Association and close links between the Institute and the Association persist.
Having recognised a need, the Institute was instrumental in establishing in 1967, with the support of the West Midlands Regional Hospital Board, a Training Course for Audiology Technicians, this being later taken over by appropriate authorities as training in the subject developed.
From the earliest days the idea of finding permanent physical accommodation for the Institute existed, but this has never materialised. The earliest suggestion was for three rooms, including one equipped with six journals, at the Recovery Home of the Ear and Throat Hospital at 257 Hagley Road, but this was reduced to one room on the grounds of cost and this in turn was no longer available following the institution of the National Health Service in 1948. A subsequent search for suitable affordable accommodation was not successful and the idea was abandoned until, following the death of Mr Stirk Adams, his house was bequeathed to the Institute. This building was, however, considered unsuitable and following its sale it was considered more appropriate to use the funds for other purposes, the Institute's by now extensive library having already been installed in 1968 within the University of Birmingham Medical School Library. The library continues to expand within this accommodation and is now one of the most comprehensive ENT specialist libraries in the country.
Until recent years the Annual Dinner, held in conjunction with Annual General Meeting, was for members only, but wives and friends have long been catered for by programmes of general interest run in parallel with the Clinical Meetings and have also attended informal dinners held on the evenings of the Winter Clinical Meetings. Also from 1973 until 1989, when reducing interest led to a change in policy, an annual social meeting in November incorporated a dinner followed by a lecture, the Second Yearly Lecture, on a topic of general interest.
The records of the Institute are detailed and indicate that many of the problems of fifty-three years ago are not unlike those of the present day. Thus, for example, limited funding meant that the Institute was unable to establish a physical base and attempts to strengthen academic links with the University were frustrated, viz: "Mr Stirk Adams rejected the opportunity of a lectureship 'as the status was not defined and inadequate'". (20th April 1948)
However they also indicate dramatically how clinical practice has changed. Thus a number of early meetings discussed such topics as the problems of a survey of a Poloiomyelitis Epidemic, while the following quotations are also of interest:
"The Chairman brought to the notice of members the method of treatment of Tonsillitis suppositories of Bismuth following the work of Aristides Monteiro. A supply of suppositories available at Messrs. Philip Harris, Edmund Street, Birmingham, containing 20mg Bismuth Tartrate, a soluble salt of Bismuth as suggested by Prof. K D Wilkinson. The suggested dose is one suppository though rarely a second suppository may be required after 24 hours. It was suggested that practitioners should be invited by members of the Institute to carry out a clinical trial, keeping following records: 1. Age and sex of patient. 2. Whether first or a later attack of tonsillitis. 3. 1 elapsed in hours since the onset of malaise when suppository was inserted. 4. Results of treatment (11th July 1947)
"The Chairman reported that the Radium Commission had refused a request for 50m Radium for Nasopharyngeal Applicators which had been requested by Birmingham and two other centres". (17th September 1947)
"The President outlined a proposal that members of the Institute should co-operate with Medical Research Council in a clinical trial of the method of treatment of persistent Eustachian obstruction by the insertion Radium carrying applicators through the nasal passages to nasopharyngeal orifice of the Eustachian tubes". (12th December 1947)
"The President stated that a clinic for the treatment of established deafness was about to be formed (at the Childrens' Hospital.) He had seen 18 patients with established deafness and they were undergoing full investigation. These children were mostly found to have tonsils and adenoids not operated on. He proposes to start Radium applicators on these children as soon as they arrive. 20C of Radium were available from the Radium Commission and the MRC would give four applicators use among hospitals in the Midland area". (29th April 1948)
"The President reported that the MRC had arranged for two applicators with platin containers to be sent to the QEH and he hoped they would arrive in about ten days. It was proposed that these applicators should be stored at the QEH in the Radium Department and issued to outlying clinics by arrangement when required". (21st January 1949)
"The question of safety in transport was raised by the President. It was stated that the containers gave only one third protection and there was distinct danger of radiation to any person carrying this Radium about. Most of the Radium was in the Childrens' Hospital and was brought by car to the QEH. The President mentioned that the anaesthetic used was a quarter of the normal average dose, the patient's hands were tied, no cocaine was used in the nose and the applicators were placed in position and maintained for 13 minutes. The dosage was 500 R at 0.5cm. The Radium should be stored in a lead lined safe, the position of the safe should be such that no-one was constantly within 6 feet of it. The President said he would continue discussions with the physicist about travelling facilities, especially to Worcester and Derby. The only railway company who would carry it was GWR. The President also said that 150mg of Radium belonging to the Ear and Throat Hospital was stored at the QEH and not used at present; he hopes it will be possible to obtain more containers so that this Radium could be used as exposure was only 6 minutes". (29th April 1949)
"The President raised the question of follow-up which appeared to be necessary in the cases of deafness which had been
treated over the past two years at the Childrens' Hospital. He considered that it would require the appointment of a special officer to review the cases and deal with them wherever they might be. The Council considered that review was going to be a problem and Mr Stirk Adams thought that he should first approach the Board of the Childrens' Hospital to discuss ways in which the follow-up could be achieved". (19th April 1950)