Historical Introduction to

Notes on the History of the Founding of the Harvey Cushing Society

Samuel H. Greenblatt, AANS Historian

     The ‘gestational' period of modern neurosurgery can be dated from 1879 to 1920. The earlier date corresponds to the first modern neurosurgical operations by William Macewen of Glasgow, Scotland, who was the first to utilize the combined technologies of anesthesia, antisepsis/asepsis, and cerebral localization. The later date corresponds to the founding of the world's first neurosurgical society, the Society of Neurological Surgeons, by Harvey Cushing and Ernest Sachs. Before Cushing's work in 1901-1910, neurosurgical operations were feasible, as shown by Macewen, Bennett, and Godlee (1884), Horsley (1886), and a few others, but the reported mortality rates were daunting - often 50% or more. Cushing showed that neurosurgical operations could be successful by reducing the rate to 10-15% in tumor cases in large part because he understood and controlled intracranial pressure (ICP).

     In the early 20th century, the number of surgeons who were willing to face the myriad problems of the intracranial space was very small. Consultations among them about problems of diagnosis, surgical techniques, and postoperative management were carried out on an individual-to-individual basis. However, by the time of World War I (1917-1919 for the United States) the numbers of dedicated practitioners had grown to a few dozen. Many of them had been trained by Cushing. He and others felt the need for a semi-formal group that would meet regularly to discuss their shared problems and this became the Society of Neurological Surgeons (SNS). Cushing modeled the SNS on his earlier experience with the Society of Clinical Surgery, which was a group of young turks in general surgery. Since 1905 Cushing had been pleading for the medical profession's specific recognition of the ‘special field' of neurological surgery. With the founding of the SNS, he and his colleagues answered their own plea. In the 1920s, the total membership of the SNS was limited to 45 by statute, partly because the original founders could not conceive that North America would support any more. In 1931, the SNS had only 29 members.

     Despite the limitations of the SNS, in 1930 the specialty was actually growing apace. Its younger practitioners were often well trained by Cushing and others. Being largely excluded from the SNS, they felt the need for another group with a similar purpose, i.e., to be a forum for discussing the problems that they all faced, and they hoped with collegiality similar to the SNS. Thus was born in 1931 the Harvey Cushing Society (HCS) known since 1967 as the American Association of Neurological Surgeons (AANS).  The same pattern of young insurgents starting their own organizations was to repeat itself three times more in the history of American Neurosurgery

     In Chapter 1 of the Notes on the History of the Founding of the Harvey Cushing Society, the first letter (Van Wagenen to Spurling, August 18, 1930) set the course that was ultimately followed. Although there appears to have been a ten month interval before Spurling answered Van Wagenen on June 24, 1931, we don't know what other communication may have passed between the two men. In any case, Spurling's reply set the ball rolling, because the initial organizational meeting of the four founders took place at the Raleigh Hotel in Washington, DC, on October 10 of the same year. With regard to the letter from Van Wagenen to Spurling, dated September 30, 1933, the contents indicate that it was written on that day in 1931 - a typo! Indeed, the contents of that letter are characteristic of much of the founders' correspondence, involving problems such as Putnam's initial reluctance and other peoples' views of Fay. In any case, it is clear that the real founder was William Van Wagenen, followed by Glen Spurling, Eustace Semmes, and Temple Fay completing the foursome. The last letter in this chapter (Spurling to Van Wagenen, October 17, 1931) is appropriately concerned with arrangements for the first scientific meeting of the still-nameless group.

     Among the items of interest in these letters are some ideas that did not come to fruition. The founders originally expected to have some members who were not neurosurgeons, such as the neurophysiologist John Fulton of Yale. He did become a member and second President (1933-34), but early on there were only a few others who were not neurosurgeons. In some of the letters there are remarks about trying to include ‘organic neurology' (e.g., in Van Wagenen's ‘Record' of the organizational meeting of October 10, 1931). This is a reference to the fact that a lot of American ‘neurology' at the time was actually Freudian neuropsychiatry which was of little help to surgeons. Many other fascinating threads of professional and personal interactions can also be traced in this wealth of correspondence.

Outline of chapters for Notes on the History of the Founding of the Harvey Cushing Society by Dr. WM. P. Van Wagenen, Dr. R. Glen Spurling, Dr. Eustace Semmes, Dr. Temple Fay, 2 volumes,1930-1931 and 1932-1933. Unpublished manuscript in the Archives of the American Association of Neurological Surgeons, Rolling Meadows, Illinois.

These Notes were given to the Yale Medical Library by the founder of the HCS, William Van Wagenen, on his retirement. After enduring some decades in dusty oblivion, the Notes were located by Yale in 1992 and forwarded to the archives of the AANS, then headquartered in Park Ridge, Illinois.

Chapter 1
concept/correspondence/minutes/potential member lists.  This chapter ends with the organizational meeting of the four founders at the Hotel Raleigh, Washington, DC, October 10, 1931.
Chapter 2
concept development and invitations to first scientific meeting
Chapter 3
invitation acceptances, program development, first meeting program, minutes, bylaws draft
Chapter 4
preparations for second scientific meeting

Brief Biographies of the Four Founders

Temple Fay (1895-1963) was 36 years of age when the HCS/AANS was founded in 1931. He was the sixth President in 1937-38.  Fay was born in Seattle, Washington – his ancestors arrived in Massachusetts in 1656. After undergraduate studies at the University of Washington, Fay attended the University of Pennsylvania medical school, attracted there by the fame of Penn's pioneer neurosurgeon, Charles Harrison Frazier. Once at Penn, Fay was also attracted to the premier neurologists Charles K. Mills and William Spiller. Thus he was formally trained (for the time) in neurology and neurosurgery. In 1929 he was appointed Professor and Head of the Department of Neurosurgery at Temple University, which was his position when he co-founded the HCS. Later in his life he experimented on hypothermia in tissues and in people. He left Temple University in 1943 and devoted much effort to the so-called Doman-Delacato ‘patterning' exercises for impaired children, which had been based partly on some of his earlier experimental work. This latter did not redound to his credit.   

Raphael Eustace (‘Pappy') Semmes (1885-1982) was born in Memphis and was 46 when he attended the first  organizational meeting of the HCS. He served as eighth President in 1939-40.  At the University of Missouri he was a classmate of Walter Dandy, and they both attended the Johns Hopkins medical school. As a third year student, Semmes took Cushing's course in operative (animal) surgery. Upon graduation in 1910, Semmes accepted an internship at Hopkins, which included a rotation (plus extra time) on Cushing's neurosurgical service. After a year of training at the Women's Hospital in New York, he returned to Memphis and started a general surgical and obstetrical practice. However, his reputation as a neurological surgeon spread widely. During World War I, Semmes was one of 10 surgeons who were sent to Charles Elsberg in New York for a 3 month, crash course in neurosurgery. When he returned to Memphis in 1919, Semmes devoted himself to neurosurgery full time. He was appointed Professor of Surgery (Neurosurgery) at the University of Tennessee in 1932, when he also co-founded the Semmes-Murphy Clinic.

Roy Glenwood Spurling (1894-1968) was 37 at the time of the HCS founding in 1931, and he served as the third President in 1934-1935. He was born in Centralia, Missouri. In 1920 Spurling received a B.A. at the University of Missouri, and in 1923 he took his M.D. at Harvard. Although he served two years as an intern/resident at the Brigham Hospital, he had only limited contact with Cushing. During (not after) another year as a surgical resident at the Louisville (Kentucky) General Hospital, he was appointed Neurosurgical Consultant, and in 1926 he established a neurosurgical service at the University of Louisville Medical School. He remained in charge of neurosurgery there until his retirement in 1960. In the early years, he paid frequent visits to Cushing at the Brigham. During World War II he served in many capacities, including that of leading consultant in the case of General George S. Patton III, who died from a C3-4 fracture. For most of his career, Spurling's main interest was in spinal problems.

William Perrine Van Wagenen (1897-1961), at 34, was the youngest member of the founding foursome, but he was clearly the leader of the group, since he was its first President in 1932-1933. He grew up on a farm in central New York State and graduated from Cornell in 1918. In 1922 he received his M.D. at Harvard. Internships and residencies were served at Memorial Hospital in New York and the Brigham. In 1924-1925 Van Wagenen was Assistant Resident to Cushing. Thus, he was the only one of the four founders who was actually trained by Cushing in the full sense of the term. After his year with Cushing, Van Wagenen was a surgical resident at the Rochester General Hospital. In 1928 he was appointed Assistant Professor in Neurosurgery and Chief of the Neurosurgical Service at the recently opened medical school of the University of Rochester. In Van Wagenen's "Record" of the organizational meeting of October 10, 1931, he remarked that he had proposed the idea of a brain tumor registry to Cushing, but the older man was not then in favor of the it. In 1939, Van Wagenen and a colleague began the world's first series of corpus callosotomies in epileptic patients, though he later expressed some regret about that undertaking. He retired at age 57 and enjoyed life until his early death at 64.


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Chapter 1 - The Idea