The Evolution of
Carl H. Hauber, J.D., C.A.E., Chris A. Philips
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The evolution of organized neurosurgery in the United States is of great interest from the historical standpoint. The most curious thing is how the original exclusionary societies all led to the development of other societies that became more and more inclusive and more effective as time went by and the number of neurosurgeons grew large enough to require some sort of unified voice. As interesting as the history of neurosurgical organizations is, speculation about the future is even more interesting. Surely, socioeconomic issues have come to play a more and more dominant role in our organizations, occasionally superseding their traditional educational functions. The development of technology and the freedom to develop innovative procedures have led to neurosurgery becoming a high profile superspecialty that is viewed by some people as a cause for the high cost of medical care. It seems important to me that we maintain our professional status in the deepest sense of the word. It is most important that neurosurgeons be recognized as caring physicians who place the importance of the patient ahead of their own interests. If we as neurosurgeons remember this, and if our neurosurgical organizations can spread that message and help to educate young neurosurgeons and keep them at the forefront of clinical neuroscience, the organizations will continue to fulfill their major obligation.
Edward R. Laws, Jr.
As Historian of the Society of Neurological Surgeons for more than a decade, I have had the privilege of going over the old records of the Society and have just completed a "Perspectives" for the 75th Anniversary Volume for the 1995 meeting in Boston in May. The material in many ways reflects some of the material that is evident in the article by Hauber and Philips. The Society of Neurological Surgeons in its early years was an informal and intimate organization. Very few people were entering the field of neurosurgery, and there were very few applications from any of the beginners in neurosurgery, such as Dr. Cushing, Dr. Sachs, Dr. Frazier, or Dr Elsberg. They formed what really would be called a "Travel Club," although travel at that time was altogether by train or automobile, and they met twice a year for 10 years. The neurosurgeons were mostly young and wanted to learn from one another, and their impression at that time was that they should remain small.
The Society of Neurological Surgeons (The Senior Society) and the specialty of neurosurgery matured slowly. It was more than 40 years after the formation of the Society, in 1963, that the President, Bronson Ray, asked the Secretary, Guy Odom, for space on the program to give a Presidential Address. But neurosurgery was taking advantage of the great advancement in medicine (as well as in technology, transportation, and communication), so there was an increasingly manifest ability to do something genuinely useful for patients.
Each of the Societies that formed after that were created to give the younger members a chance to have a forum and to have the intimate and informal association with other neurosurgeons that the Society enjoyed. It was only when the Congress of Neurological Surgeons was formed that a society decided to accept all neurosurgeons. Eventually, the Harvey Cushing Society enlarged to its present size, but it required Board certification.
In the early 1960s and 1970s, The Society of Neurological Surgeons began to realize its original intent as an academic society and began to include within its membership and within its discussions all of those in the academic field in the United States and Canada. This was concomitant with the great increase in teaching, research, and patient care in medical schools and in academic medical centers.
I was Treasurer of The Harvey Cushing Society when Hank Svein was Secretary, and I was Secretary of The Cushing Society when Barnes Woodhall was President, and also President of Duke University. He had received an inquiry from someone high in government asking who spoke for neurosurgery, and he simply said that he didn't know. He asked that question of various people, including Frank Mayfield. Consequently, there was a lot of restless activity among those of us who were active in The Harvey Cushing Society, looking to the unification of the specialty.
Frank Mayfield's leadership was essential, and the name change from the Harvey Cushing Society to the American Association of Neurological Surgeons came about because there were a number of small societies named for eminent surgeons. These societies had very little recognition over the country, because not all surgeons in that field were trained by those particular individuals. Consequently, the name The American Association of Neurological Surgeons was chosen because it appeared early in the alphabetic listings of organizations and achieved more prominence in their listings. It was a suitable name for this all-inclusive society.
When I was President of The Harvey Cushing Society, I made the effort to foster the unification of neurosurgery by inviting, at least twice, the Presidents and Secretaries of the other societies for weekend meetings, during which all of these things were discussed. This was a very essential matter, because there was a good deal of discomfiture by the membership of other societies that they might be giving up something. The field of neurosurgery was fortunate in having not only Frank Mayfield as a genuinely great leader but also many other people who contributed their time, their efforts, and their talents to the present status of neurosurgery.
Whether the Congress of Neurological Surgeons and the AANS should become one or change in some other way seems superfluous now, because there really is a need for two large meetings every year. Most of the rank and file of neurosurgeons are concerned about having a good meeting at which they can learn a great deal and see excellent exhibits as well as commercial products, and they are not nearly so interested in how the organization is governed and whether they are well represented.
This article by Hauber and Philips presents a viewpoint by those who are not personally, professionally involved but are deeply involved with the organizations they have discussed. Undoubtedly, many will find areas of disagreement in reading the text, but the authors have presented this in a concise and dispassionate manner.
Eben Alexander, Jr.
The authors have compiled an accurate and thoughtful, but brief, history, covering a span of almost 75 years, of the creation and evolution of the five major national neurosurgical organizations in the United States. Insight into many of the specialty's current problems with communication and representation can be gained by recognizing the messages underlying the formation of each new organization and thereby understanding both the successes and the failures of these organizations and their leaders. The basic human desires for social interchange, for peer approval, to be important, and to belong to or be a part of something worthwhile are not often openly mentioned as the raison d'être for joining professional societies but, for many, are probably of equal importance to the proclaimed purposes of improving skills, increasing knowledge, and advancing the specialty. As the five organizations have matured, one has elected to become a forum and unified voice for the neurosurgical professors and residency program directors, and two have chosen to remain limited in size and selective in membership. For these, "networking" among the members, both during and between the annual meetings, has become as important as the presentations during the meetings. It is unlikely that there will be any significant changes in the structures or the goals of these organizations during the next several decades. There are also several highly regarded regional neurosurgical societies, not mentioned in this article, but probably not seeking a national status.
Thus, what remains is the AANS and the Congress, two behemoths encircling each other while engaged in a fragile embrace of the Joint Officers, with each half still subservient to the final decision of the respective governing boards. Perhaps at this time it would be wise for both organizations to provide open and careful scrutiny of the concept of unification such as is being currently embraced nationally by other surgical subspecialty organizations. Nothing of value would have to change; the two journals of the respective societies serve quite different roles and member needs, as do the distinctly different semiannual sessions, a spring assembly for new science, technology, and original papers, a fall Congress for Honored Guest(s) presentations, the didactic sessions, and the targeted continuing education for residents and younger neurosurgeons. Current leaders of both organizations may wish to merge into transitional entities of governance, electing officers for the respective semiannual sessions who could continue as long as desirable. This would not save any money during the early years, but the myriad of benefits over the long term should be obvious to all.
Byron Cone Pevehouse
Hauber and Philips have nicely outlined the evolution of five neurosurgical organizations in the United States over the last 75 years. There are several more they could include.
The Society of University Neurosurgeons, for example, was founded in 1965 and has as its goal the preservation of youth in its members, a dedication to academic work, and little formal organizational structure. The Research Society of Neurosurgeons is even more antiorganizational. Its origins are lost, but it re-emerges each year at one of its members' institutions to talk about neurosurgical research, and it does this without officers, boards of directors, or any other paraphernalia. The Canadian Neurosurgical Society participates in the annual Canadian Congress of Neurological Sciences, which combines many disciplines in its annual meeting.
The proliferation of these groups is problematic for anyone with a need for parsimony and neat organization. Yet, there is something refreshingly American in them. We live in a pluralistic society, one that recognizes and supports diverse points of view and encourages people to associate with those whom they wish.
What may be disturbing to some neurosurgeons is the initiative of Frank Mayfield in the self-proclaimed role for the AANS as the spokesman for neurosurgery. It would be difficult for any one group to serve as the spokesperson for all neurosurgery. The joint Washington committee between the AANS and the CNS serves as the lobbying group for neurosurgery in Washington, for example. The Resident Review committee and the American Board of Neurological Surgery serve to regulate residency education. The various joint sections strive for up-to-date scientific and editoral exchanges.
History suggests that neurosurgeons may not want one spokesperson; they may wish to fumble along with several organizations that provide social and intellectual stimulation for small groups of people. The economic and potential realities of our present time may force significant changes and lead to increasing unification; however, only time will tell.