ASSH History

By William L. Newmeyer, III, MD, FACS

“It falls to few men to originate a surgical specialty."  Sterling Bunnell, MD (1882-1957) did just that for surgery of the hand.  He was a general surgeon in the true meaning of the word, and believed that surgery of the hand was a “composite problem requiring the correlation of the various specialties–orthopaedics, plastic and neurologic surgery–the knowledge of any one of which alone is inadequate for repairing the hand.”

From July 1936 until January 1941, Norman T. Kirk, MD, one of the first US army surgeons specializing in orthopaedics, served as Chief of Surgical Service at Letterman General Hospital in San Francisco, California, where Dr. Bunnell had a thriving practice. In 1943, Dr. Kirk was appointed the Surgeon General of the US Army.  Realizing that a large group of patients in need of reconstructive surgery required specialized care, he asked his friend, Dr. Bunnell – a general surgeon with an overwhelming interest in hand surgery -- to organize nine regional hand centers at Army Hospitals in the United States.  This Bunnell did, and between November 1944 and February 1947 he visited these centers eight times teaching the proper care of patients with hand injuries and organizing the surgical treatment.  Dr. Bunnell’s monumental book, Surgery of the Hand (JB Lippincott, 1944), became the bible for hand surgeons and remained so for about 25 years.

As World War II drew to a close, Dr. Bunnell started to talk about forming an organization to continue to foster interest in problems of the hand.  Several hand surgeons, especially Joseph H. Boyes, MD, picked up on this idea, and 35 hand surgeons, mostly but not exclusively those who had worked in one of the nine hand centers, were designated as Founding Members of the American Society for Surgery of the Hand (ASSH).  The first meeting, held in Chicago in January 1946, was timed to precede the Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The early format of the meetings was to have a half-day meeting for members only, followed by a one-day meeting opened to any physician interested in surgery of the hand.  In the late 1940’s, the Journal of Bone and Joint Surgery (JBJS) became the de facto journal of the ASSH.

 

The inital meeting of the American Society for Surgery of the Hand, held at the Blackstone Hotel in Chicago in January 1946 was attended by 26 of the 35 designated founders. A portion of that group is pictured above.

Left to right: Darrel T. Shaw, Joseph H. Boyes, Lot D. Howard, S. Benjamin Fowler, Sterling Bunnell, Arthur Barsky, Donald D. Slocum, Walter C. Graham, J. William Littler, William Metcalf, Richard H. Mellen, Gilbert Hyroop, Donald R. Pratt, William F. Frackelton, Robert L. Payne, Jr.

Not pictured: Harvey S. Allen, Hugh Auchincloss, Julian M. Brunner, Condict W. Cutler, Homer D. Dudley, Alfred W. Farmer, Gerald Gill, Edward Hamlin, Deryl Hart, Sumner L. Koch, William M. Krigsten, Clarence A. Luckey, Henry C. Marble, Michael L. Mason, Joseph I. McDonald, James T. Mills, George S. Phalen, William H. Requarth, Thomas W. Stevenson, George V. Webster

Early on, Bunnell insisted that handling the complete care of the upper extremity required a multidisciplinary approach. At its founding and since, the ASSH has welcomed and admitted for membership orthopaedic, plastic and general surgeons. However, over the years, its membership has been predominantly composed of orthopaedic surgeons.

ASSH remained a small society for 25 years. Except for the founding members and the 22 members admitted in 1948, no more than 11 members were admitted in any year. However, the interest in hand surgery was growing rapidly and fellowships based mostly on a preceptor model further encouraged this interest.  By the late 1960's, many well-qualified surgeons were clamoring for admission.

Two things happened in response. In 1970, the American Association for Hand Surgery (AAHS) was established, predominated by plastic surgeons. Second, ASSH began to admit more members.  In 1971, 41 new members were admitted and this number has continued to grow over the years.

ASSH members have always been keenly interested in educating physicians at all levels of expertise about the care and treatment of hand problems. Starting in the late 60's and early 70's, seminars were frequently given throughout the United States.  Because JBJS did not have space to publish the large number of written and presented papers, the ASSH found the need for a new avenue for publication. During his presidency (1975-1976), Adrian E. Flatt, MD and the ASSH Council, after considerable discussion, founded the Journal of Hand Surgery. Dr. Boyes was named its first editor.

The logistics of meeting in conjunction with the AAOS became strained as other organizations developed similar relationship with the AAOS and the numbers of persons attending the meetings grew.  ASSH leadership decided in the mid 1980's that ASSH had reached a stand-alone status. The last meeting to be held in conjunction with the AAOS was in New Orleans in February 1986.  The time of the ASSH Annual Meeting was then changed to the early fall and the first solo meeting was held in San Antonio, TX in September 1987.  Meeting attendance remained steady and even grew.

Also in the year 1987, the American Foundation for Surgery of the Hand (AFSH) was founded. This 501(c) 3 organization (a federal tax designation) allows for the collection of funds with a tax deduction to the donor.  Since its inception, AFSH has granted over $2.4 million in hand-related research and education.

Because of the tri-specialty nature of hand surgery, there developed a perceived need for a common credential to establish the specialty of hand surgery.  This effort was spearheaded by George E. Omer, MD, an orthopaedist and ASSH president in 1978-79.  By using a great deal of persuasive diplomacy with the American Board of Surgery, American Board of Orthopaedic Surgery, and American Board of Plastic Surgery, Dr. Omer established a certificate of added qualification (CAQ) in hand surgery.  The first qualifying exam was given in 1989 (there was no grandfathering).  The physician’s parent board issues the certificate after the candidate passes the examination and meets certain qualifying criteria.  It is good for 10 years.  A CAQ -- now called the Subspecialty Certificate in Surgery of the Hand --  is necessary for Active Membership in ASSH.

The ASSH has continued to mature and thrive in the 21st century.  In 1983, a Residents and Fellows Conference preceding the main ASSH Annual Meeting was started. Candidate Membership, established to foster an interest in hand surgery during residency and fellowship training, was begun in 1999.  Completion of an accredited fellowship in hand surgery, a minimum number of years in practice, and significant evidence of hand-related experience is now essential for the completion of a Subspecialty Certificate in Surgery of the Hand and application for ASSH membership.  As a plethora of hand clubs, hand societies and hand-related research organizations have sprung up around the world, the influence of the ASSH has grown. The Society continues to be active in continuing medical education and because of the changing nature of American medicine has had to address various sociological, economic and political issues.

The Society now has over 3,500 members from around the world, including orthopaedic, plastic and general surgeons, as well as various allied health care professionals.

For a comprehensive review of the history of the ASSH, consult  The First 50 Years available for purchase from the ASSH. E-mail info@assh.org.

Last updated February 2013