History of the Society of Surgical Oncology

Although Memorial Hospital in New York City was established in 1884 as a haven for patients with advanced cancer, its evolution in advancing cancer research, education, and patient care began in 1912 when Dr. James Ewing was appointed Pathologist of the Hospital. The institution became formally focused in 1931 with Ewing’s appointment as Director of the Hospital.

Memorial was one of the first institutions to recognize the potential of Madame Curie’s discovery of radium by using low-voltage x-ray machines as early as 1902 and radium in 1903. James Douglas’ donation of 375 grams of radium in 1917 gave Memorial one of the largest amounts available anywhere in the world.

Dr. Ewing, always alert to treatment modalities, recognized the enormous potential benefits of radiation therapy and was instrumental in initiating residency and fellowship training programs in the discipline in 1926. With the involvement of Dr. Gioacchino Failla (in about 1917) and other physicists, radiation therapy was nurtured, and over the years, it matured from a cottage industry into a scientific discipline.

Dr. Ewing recruited, acquired, and motivated surgeons, internists, pathologists and house staff. He insisted that surgeons be versed in the use of radium, radon, and those primitive machines that emitted gamma radiation beams. The staff was also subjected to extensive involvement in gross and histologic pathology. Truly, James Ewing should be considered the father of the multidisciplinary approach to the treatment of cancer.

By 1931, James Douglas’ administrative proposals to Cornell University Medical School and Memorial (backed by sizeable financial incentives) were accepted, and Memorial Hospital and its attending staff affiliated with Cornell University School of Medicine.

Time Magazine cover with Dr. James Ewing on the cover

The January 12th, 1931, issue of Time magazine devoted its front cover to “Cancer Man Ewing.” The three dense pages of text describe the then-current status of cancer and the national and international scientists who were considered the experts, with the focus on James Ewing. It is a fascinating historical document.

Dr. Ewing devoted most of his time and efforts to reorganizing the staff and expanding the clinical, educational, and research programs, along with planning the design and building of a new hospital.

Continuing a practice begun a decade earlier, some of the house staff during the ’30s were appointed to the attending staff. But most left, and soon became established as “cancer specialists” in medical schools, clinics, and private practice throughout the United States and in many foreign countries. These physicians’ multidisciplinary training, nurtured by Dr. Ewing’s tenets, became an asset, for they had learned that there was more than one way to treat patients with cancer. Thus, by the eve of World War II, Memorial Hospital had a sizeable cadre of house staff alumni, most of who returned periodically to Memorial to both renew old acquaintances and observe medical changes as practiced at Memorial.

During the summer of 1939, Memorial Hospital moved its Central Park West location to a new and larger facility constructed on East 68th Street. Dr. Ewing’s dreams became reality: a new hospital adjacent to Cornell Medical Center and Rockefeller Institute, and the recognition of Memorial Hospital staff members as international authorities in the cancer field. The Fellowship Program was expanded, resulting in more and more graduates carrying their professional expertise to many parts of the world. By 1940, the idea of a Memorial Alumni Society became a reality.

In the mid-1930s, Dr. Hayes Martin and Mr. George Holmes (the Superintendent of Memorial Hospital) had taken the initial steps to develop an alumni association for those physicians who trained at Memorial. Nothing concrete happened until November 1939 at a meeting held at the old Memorial Hospital on Central Park West; it was here that the formation of an alumni association was formally considered. Hayes Martin, Bill MacComb, Al Hocker, John Wirth, Sam Binkley, Gordon McNeer, and John Blady agreed to serve on a committee to ascertain the feasibility of creating such an organization.

On June 10, 1940, the Memorial alumni met at the Lexington Hotel in New York City and appointed William MacComb as temporary Chairman. The committee’s report on the feasibility of forming an alumni association was discussed and approved. Bill MacComb was designated as the spokesman to obtain Dr. Ewing’s approval to name the alumni society The James Ewing Society, in his honor. This was accomplished shortly thereafter, but with some reluctance on the part of “the Chief.” The positions of president, vice-president, and secretary-treasurer were established. A committee was appointed to draw up a constitution and a set of bylaws. A date, time, and place were set for the next meeting.

The second annual meeting of the James Ewing Society was held during the 1941 American Radium Society Annual Meeting on June 12th, 1941, in Cleveland. Hayes Martin, William MacComb, Al Hocker, Harry Houser, and Betty Howe were among those present. The Constitution and Bylaws were presented and accepted, and it was suggested that an education committee be appointed.

The third annual meeting, held on January 9th, 1942, in Atlantic City, New Jersey, was affected by the December 7th attack on Pearl Harbor and the mobilization for war. Only ten members were present. New officers were elected; the first Executive Council was appointed. The new president, Dr. George Sharpe, served until the next meeting could be held on June 10th, 1947.

The 1947 meeting established an expanded membership eligibility requirement to include all assistant residents, residents, fellows, and special fellows trained at Memorial regardless of time spent in training. It was also decided to make every effort possible to help in establishing a subspecialty Board of Oncology of the American Board of Surgery. The Society was more successful in its plans to initiate scientific programs on an annual or semi-annual basis.

The first James Ewing Society’s Cancer Symposium was held at Memorial Hospital on January 16th and 17th, 1948. It consisted of scientific sessions, clinical demonstrations, and displays in the Sloan-Kettering Institute. The business end of the Symposium established the basic standing committees and refined the Society’s purpose: to further the knowledge of cancer and to associate in membership all those who have received training at Memorial Hospital.

During the next decade and more, the Society, despite its lofty goals, functioned more as an alumni group than a professional organization. However, membership grew, its administrative structure improved, and its scientific meetings were more extensive. The decisions to expand membership eligibility to include cancer specialists not trained at Memorial and to hold annual meetings away from Memorial caused a storm of controversy.

But this was nothing compared with the uproar caused by the suggestion to change the organization’s name to The Society of Surgical Oncology. The changes, however, were necessary for the Society to realize its stated goals and to attain national recognition by the American Medical Association and other national medical organizations. At the 1975 annual meeting, upon recommendation of the Executive Council, the membership voted to change the name to “The Society of Surgical Oncology, Inc. (founded as The James Ewing Society).” The Constitution and Bylaws did not change appreciably at that time.

Since then, the Standing Committees on Training, Education, and Clinical Research have expanded programs. A Committee on Government Relations was formed, and an Ad Hoc Committee to the American Board of Surgery was established. Representatives were appointed to the Board of Governors of the American College of Surgeons, the National Cancer Advisory Board, and the Commission on Cancer of the American College of Surgeons. A review of the status of surgical oncology was completed at Roswell Park Memorial Institute. This report served the membership and many others in charting the Society’s goals for the 1980s and beyond.

Joint meetings with the Society of Head and Neck Surgeons expanded the scope of scientific programs and have improved attendance at the annual meetings. When Dr. Robert V.P. Hutter was President in 1975-1976, a joint meeting was held in London with the British Association of Surgical Oncology and the British Society of Head and Neck Surgeons.

The Society adopted a logotype in a roundabout way. Dr. A. Hamblin Letton, at the request of Dr. T.S. Davidson, the former President of the American Thyroid Association, designed a logo for their use using a picture of Dr. Graves. When Dr. Ted Winship (as a member of the Goiter Society) saw it, he fashioned a logo for the James Ewing Society by replacing Graves’ picture with one of Dr. Ewing around which he added “James Ewing Society.” Beneath the picture were inscribed the years of Dr. Ewing’s birth and death and the statement, “Established in 1940 to Further the Knowledge of Cancer.” When the name was changed in 1975, the original logo was retained.

The years between 1949 and 1970 were a time of development and expansion. The Officers, Committee Members, and Council Members built an organization that served as the foundation for the expansion of the Society’s activities during the ’70s and beyond.

The growth due to planning, developing, and implementing programs basic to the Society’s charter resulted in expanding the meaning and impact of the Society. Committee Members have been productively active in the areas of education, clinical research, training, and liaison. The officers and Executive Council recognized the efforts and professionalism of the newer and younger members and appointed many to positions of greater responsibility, thus ensuring future leadership for the organization and continuity of commitment to the Society’s objectives.

James Ewing, born in Pittsburgh, Pennsylvania, on Christmas Day, 1866, was the son of Thomas Ewing, the resident judge of Allegheny County (Pittsburgh) and Julia R. (Hufnagel) Ewing. Mrs. Ewing was a school teacher who came from Stockbridge, Massachusetts, and an early graduate of Holyoke College. Perhaps it was her influence that led her son to Amherst College, from which he graduated cum laude in 1888 with a Phi Beta Kappa key.

James Ewing received his degree of Doctor of Medicine from the College of Physicians and Surgeons of Columbia University in 1891. Following graduation, he had a short, interim surgical internship at the Western Pennsylvania Hospital of Pittsburgh before his regular internship at the Roosevelt Hospital in New York City. Here his interests in laboratory subjects surfaced, and during that service he published his first paper, “A Study of the Leukocytosis of Lobar Pneumonia.” Further expanding his interest in the pathology of blood was the publication in 1901 of his first book, Clinical Pathology of the Blood.

Immediately after graduation from medical school, Dr. Ewing tried the practice of medicine with an associate, Dr. William S. Stone. Because his medical practice was not very active, Dr. Ewing continued his work in the laboratory and became an Assistant in Histology at Columbia. This led to his appointment in 1899 as Professor of Pathology at Cornell University Medical School, where, at age 33, he was the only full-time Professor. A career of teaching and research developed, and his lectures were enthusiastically received by the medical students.

About this time he married Catherine Crane Halsted, a beautiful and charming woman, who was a descendent of a prominent New York family. The young couple moved gaily in the socially fashionable world of the gaslight era of the turn of the century, and the birth of their first child, named James Halsted Ewing, was a great joy to them. All this happiness soon shattered, however, when Catherine Ewing died in the third year of their marriage from toxemia in her second pregnancy. This emotional shock completely changed James Ewing’s character. He became a scientific recluse, devoting all his time to teaching and to his laboratory studies.

Dr. Ewing’s personal life was further complicated by chronic osteomyelitis of the femur, which he had developed when he was 14 years old. The condition left him with a permanent limp. He also suffered from intractable trigeminal neuralgia from which he had no relief. An operation in 1926 by Harvey Cushing left him with a disabling facial anesthesia and a corneal disturbance. In Ewing’s later years, urinary calculosis contributed still further to his physical impairment.

After his wife’s death, he became obsessed with studying toxemia of pregnancy. A concurrent interest, however, eventually developed that would consume all his attention and energies.

In 1902, the Collis P. Huntington Fund for Cancer Research was established, with the stipulations that the income from the Fund would support cancer research at Cornell University School of Medicine’s Loomis Laboratory and that it should be under the direction of Dr. Ewing.

The year 1910 became a moment of decision for James Ewing. After publishing nearly 50 papers from the laboratory, he concluded that the best hope for controlling cancer was to study the disease in man. One proposal he had, to establish a commission to study human cancer at the New York Hospital, did not materialize. Coincidentally, however, James Douglas, a wealthy mining engineer whose daughter had died of cancer, became interested in financially supporting clinical cancer research. He was referred to James Ewing, and the two of them concluded that these studies should be carried out in a special hospital.

The Memorial Hospital for Cancer and Allied Diseases was selected for their project. Originally the institution had been named the New York Cancer Hospital, established through the influence of the great gynecologist from South Carolina, James Marion Sims. The financial support provided for Memorial Hospital in 1912 by Douglas carried two provisions: (1) that Memorial once again engage exclusively in the diagnosis, treatment, and study of cancer; and (2) that Dr. Ewing be appointed Pathologist of the Hospital. Although he supervised Memorial’s clinical and laboratory programs –and taught at Cornell– Dr. Ewing did not become Director of the Hospital until 1931, at which time he retired from Cornell University School of Medicine and affiliated with the Hospital.

James Ewing plunged into a turmoil of clinical and pathological study of human cancer. He experimented with immunotherapy and chemotherapy of cancer. The potential value of treating cancer with x-rays and radium received his particular attention. Contrary to a common misconception, Dr. Ewing was not opposed to the surgical treatment of cancer. Although he did oppose surgical heroics that contributed nothing to the survival of the patient, he wanted surgeons to recognize that there were other methods of treating the disease and to understand the natural history of cancer.

For ten years he concentrated his time and efforts in the preparation of his greatest work, Neoplastic Diseases. first published in 1919. Additional editions appeared, and the book became a standard of reference of the pathology of cancer throughout the world. Other activities involved him in the organization of the American Association for Cancer Research; he was also one of the founders of the American Society for the Control of Cancer (later renamed the American Cancer Society), and served on the editorial board of the Journal of Cancer Research.

In 1922 James Ewing was made an Honorary Member of the American Radium Society, and in 1933 he delivered the first Janeway lecture of that same organization.

Privately, James Ewing followed a spartan life, living in a cheap, shabby mid-Manhattan hotel room. He saved old envelopes, using the blank side for note paper. His one automobile, a Wills St. Claire-resplendent with vases and draw curtains in the back compartment –lasted him from 1921 until his death in 1943. He indulged himself by spending some time at his home in Westhampton, Long Island, where he was regarded with great respect by the community.

His thrifty control of hospital expenditures did not affect his generosity to persons who were in financial need. Money in itself was not important to him–his financial resources were extensive. When someone needed help, he would give a signed check, telling the person to fill in the amount needed.

James Ewing has been characterized as eccentric, cynical, blunt, and openly contemptuous of pretension. One of his colleagues described him as limping along the corridors of Memorial Hospital with his frayed white gown flapping loosely on his frail figure like a cornfield scarecrow. His thin, hawk-like face and his eyes behind horn-rimmed glasses showed the strain of years of peering through a microscope, always a singular ocular model.

By contrast, among the people close to him, Ewing was warm, witty, loyal, and inspiring. As a dedicated teacher and scientist there are many who highly respect him for his intellectual and personal qualities.

Many national and international academic and scientific honors were conferred upon James Ewing. An event of great gratification for him was the transfer of Memorial Hospital in 1938 from Manhattan’s west side to a new facility on the upper east side, located near the Cornell Medical Center and the Rockefeller Institute. This was the beginning of the present Memorial-Sloan Kettering Cancer Center. A year later, in 1939, at the age of 73, he retired.

Almost everyone who personally knew James Ewing has an anecdote to tell about him. Ironically, in the spring of 1943, he made the microscopic diagnosis of his own incurable bladder cancer. It is told that in his terminal illness he apparently suffered cardiac arrest. Resuscitative efforts, including intracardiac injection of adrenaline, brought him around, whereupon it’s alleged that he demanded, “What the hell did you do that for? Now I’ll have to go through all of this again in a few days! And when I do, just leave me alone.”

Several days later when he lapsed into a coma he was allowed to die peacefully.

When in the future there occurs the final solution of the cancer problem, present at the same time will be the long, lingering shadow of James Ewing.

75th Anniversary: 1940 – 2015

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