Inclusion Was Why the American Academy of Neurology Was Founded
This article is part of a history series marking the 75th anniversary of the AAN's founding.
The creation of the American Academy of Neurology in 1948 was one of the final salvos in a decades-long philosophical sparring over which medical specialty in the United States should be preeminent in treating disorders of the brain: neurosurgeons, psychiatrists, or clinical neurologists.
The work of pioneer brain surgeon Dr. Harvey Cushing and psychoanalyst Dr. Sigmund Freud fascinated a public keen on cures for the complicated vicissitudes of the human brain. Clinical neurologists, on the other hand, had little in the medicine cabinet for treatment and no one with similar public stature to champion their cause. Dr. Wilder Penfield, a disciple of Cushing, claimed that clinical neurologists would be supplanted by neurosurgeons and psychiatrists.
The American Neurological Association, ensconced in New York City since its founding in 1875, limited its membership to 250 and was heavily skewed toward East Coast academic neurologists and neurosurgeons.
However, the human carnage of World War II raised demand for more neurologists to treat the hundreds of thousands of injured veterans. Neurology residencies, curtailed during the war, began to expand.
“There’s nothing that you can really belong to”
Lt. Col. Joseph A. Resch, MD, returned from the war in 1946. The young Wisconsin doctor had served seven years in the US Army Air Force and managed the hospital services for a fighter wing in New Guinea. Now 32, he was a resident in neurology at the University of Minnesota under Abraham B. Baker, MD, FAAN, chair of the Neurology and Psychiatry Division. Resch had a young family and was eager to establish his career—as a neurologist.
“Now all of us neurologists, very honestly, we did psychiatry too,” Resch recalled in 2008. “We had six months of our three years [in training] with psychiatry and that was the trouble with the field. You got going with psychiatry [so that] you had a good income—goodbye neurology, or you did a little, but that wasn’t your main deal.
“I got in with Dr. Baker and [Joe] Brown, who were the best teachers in the world,” Resch continued. “They wanted to know how we were doing, and what do we think about things. That’s when I popped off, I guess, to the chief and said, ‘Well, neurology, in this situation, what do you do when you finish? There’s nothing that you can really belong to for a young neurologist.’ The American Neurological Association, a very old professional society, was really an organization for department heads or faculty people. They required to be a member you had to have your boards, you had to have a list of publications and write a thesis. That’s pretty well not available for the fellows or brand-new neurologists…. So, Dr. Baker said, ‘Relax, we’re doing it.’ And they did, and it was really something.”
Baker was sympathetic to Resch’s concerns. The times were changing. If neurology was to move from the shadow of psychiatry and stand as a distinct specialty of medicine, it must organize and grow.
Baker began developing the idea of a new organization, collaborating with Russell N. DeJong, MD, FAAN (University of Michigan); Francis M. Forster, MD, FAAN (then at Georgetown University); and Adolph L. Sahs, MD, FAAN (University of Iowa). He invited 52 key neurologists to become charter members and Fellows of the new American Academy of Neurology, and 50 accepted.
“Breaking with tradition”
“In planning the Academy, you must keep in mind that one was breaking with tradition,” Baker later recalled. “The American neurological tradition at that time was the American Neurological Association and to consider a new neurologic group on a broad democratic scale was not to be tolerated. Therefore, for two years, I spoke to many important leaders in the neurologic field trying to stimulate some support for this new idea. Therefore, it was fairly well known that such a society was being considered and I believe most people felt that no one would have the courage to start such a group.”
Future AAN President Joseph M. Foley, MD, FAAN, humorously recollected, “I was cool to the idea of joining an organization started by obviously paranoid Midwesterners. Unlike some of my fellow Bostonians, I knew at least Forster and [Pearce] Bailey and had some awareness that the founders probably did not have horns or cloven hooves, hay behind the ears, and the smell of hog on their sturdy boots. Many of my teachers in this, my native city of Boston, thought it improbable that anything of nobility was likely to emerge from the Midwest Plains or whatever they might have out there.… The most vicious attitude on the East Coast in those years was not hostility; it was disinterest and apathy. There was a kind of alternating annoyance and amusement at the impudence of the upstarts.”
Frank Forster saw it a little more sharply. “[In] the beginning there [was] some antipathy between the early members of the AAN and some members of the ANA. This … was due to the strong Eastern influence and the elitism of the latter…. The primary motivation of the AAN was not against the ANA but rather to create a more inclusive organization. This was sort of like the Rooseveltian New Deal. From the cradle to the grave became from first-year resident to emeritus! And not only inclusive in membership but with active interplay between members. Of course, this would appear as a direct challenge to the more senior members of the ANA.”
There were calls to discipline Baker. “Abe, Ady, Russ, and I were already members of the ANA, albeit rather recently so (Ady wondered privately to me if we might be expelled from the ANA for that venture!),” said Forster.
“Neurology needs a progressive middle class”
But there was a handful of key ANA members who supported Baker, according to Joe R. Brown, MD, FAAN, the Academy’s first secretary and eventual president.
“One of these, Robert Wartenberg of San Francisco, was an enthusiastic, outspoken, and vigorous supporter. He protected Abe Baker from disciplinary action. Frederic Lewey of Philadelphia, a quiet, dignified, scholarly gentleman who was highly respected, used his influence within the American Neurological Association to promote tolerance of the Academy. Paul Yakovlev of Boston and Johannes Nielsen of Los Angeles similarly gave their support. These four men were particularly instrumental in ensuring that the formation of the Academy could be accomplished without too much disruption in the neurologic community. Alphonse Vonderahe of Cincinnati and Houston Merritt of New York also were instrumental in pointing out the different roles of the two organizations and in easing an accommodation between the established Association and the fledgling Academy after it was established.”
Forster explained, “My mentor at the University of Cincinnati, Dr. Vonderahe, who would belong to the older group, had an uncanny ability to understand things. And he looked over the situation and said, ‘Frank, you know, this is like the United States government. The American Neurological is the Senate, and the American Academy of Neurology is the House of Representatives.’ And with that theme, we were able to convince pretty much everybody that there was nothing [wrong] with the Academy.”
Baker escaped disciplinary action, but competition between the two organizations existed well through the 1950s. Even in 1992, former ANA President Fred Plum noted the seismic shift in power from the East Coast Brahmins to the Young Turks of the Midwest with a touch of rue.
“The Academy made it clear that there were more young people than old people who were doing first-rate analyses in neurological medicine. That is all there was to it. The Academy was collecting numbers very much the way alleys collect trash in a wind storm and that is not a very good metaphor. We will put it more favorabl[y]: very much the way that apple pickers choose the fall… I think it started probably as a Midwest … intellectual rebellion against the ANA as being too slow, too old, too fixed, and so on. So the tables became turned and the leadership of the ANA realized that the Academy was where the action was and if they hoped to prevent obsolescence they had to change.”
In January 1951, AAN President Pearce Bailey, MD, FAAN [himself the son of a famed New York City neurologist] squarely framed the situation in the premiere issue of Neurology: “The scope of the Academy is nationwide and hence antagonistic to the geographic sectionalism which always has hemmed in the neurology of the past. It should be recalled that the early American neurologists were all aristocrats, originating for the most part from the northeastern section of the United States and guided by the principles of rugged individualism. There were no middle or lower classes in the neurology of the early days.... Neurology needs a progressive middle class and the Academy, by virtue of its organizational plan, is equipped to help develop such a group.”