Local history, national leadership and the ‘St. Louis mafia’

A prominent historian once said, ‘Corporations are not necessarily soulless, and of all corporations universities are the most likely to have, if not souls, at least personalities’ (Becker, 1943, p. 193). For corporations, including universities, ‘personalities’ can be defined as enduring traditions of characteristic behaviours that are carried over time through many individuals. In fact, the same idea can be applied to professions. In neurosurgery, it is still possible to trace the existence and influences of distinct ‘schools’ within the larger profession (Laws, 1997). Among those discernible entities, neurosurgery (and all of the neurosciences) at Washington University in St. Louis (not to be confused with the University of Washington, Seattle) has been ‘a powerful force in academic neurosurgery in the United States’ (Laws, 1997, p. 523). Thus, Robert Grubb’s extensive history of his own department and institution can be reviewed from a national perspective, despite the ostensibly local focus of the book. From the outset, it is obvious that ‘leadership’, in all of its professional and scientific meanings, has always been an essential part of the soul of Neurosurgery at Washington University. Because of its location at the confluence of tributaries to the Mississippi River, the area that is now St. Louis, Missouri, was explored quite early in American history. The city dates its formal founding by French explorers to 1764. By the mid-19th century, St. Louis was thriving and it had two medical schools. In the later 19th century they amalgamated and became the Medical Department of Washington University in 1899—more than a decade before publication of the Flexner Report (1910), which transformed American medical education. When Abraham Flexner (1866–1959) gave the school a disparaging assessment, the University’s far-sighted (and wealthy) leadership had already started on a path towards scientific reform. The medical school was to be …