Journal of Pediatric Surgery 49 (2014) 251–257
Contents lists available at ScienceDirect
Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg
BAPS 60th Anniversary Historical Review
From where did the BAPS emerge? Daniel G. Young ✠,⁎ a r t i c l e
i n f o
Article history: Received 30 October 2013 Accepted 9 November 2013 Key words: Medical societies History British Association of Paediatric Surgeons
a b s t r a c t This is a personal account of the emergence of the British Association of Paediatric Surgeons (BAPS), one of the oldest of the specialty associations. It was formed in 1953 by like-minded professionals from around the UK, and its first meeting was held in and around the Hospital for Sick Children, London, in the summer of 1954. It included many surgeons from around the world eager to share experience of the challenges of this new surgical discipline. The BAPS had four aims: the advancement of the study, practice, and research in paediatric surgery, the promotion of the teaching of paediatric surgery, both under-graduate and post-graduate, and advice on the training of paediatric surgeons, advice on matters concerning the paediatric surgical services in the British Isles, and fourthly, the promotion of friendship with paediatric surgeons overseas.
The Scientific American for 2nd November 1909 recorded that “the automobile has practically reached the limit of its development is suggested by the fact that during the last year no improvements of a radical nature have been introduced” [1]. This bold statement, with the passage of time, has been proven to be quite inaccurate. Similar misconceptions have occurred in many medical situations and this paper is an attempt to clarify the evolution of the British Association of Paediatric Surgeons (BAPS). It was a challenge, writing on its 60th anniversary, to try and find actual facts on the genesis of the BAPS. Sir David Innes Williams commented in our 50th anniversary supplement that “personal recollections are notoriously fallible” [2]. An account of the origin of the BAPS has been subject to various inaccuracies, as suggested by Sir David, and the content of Peter Paul Rickham’s paper [3] as presented in Japan may have contributed a little to that. His paper contains a magnificent collection of photographs of the paediatric surgeons of the time and he reports that “David Waterston, Bob Zachary, Denis Browne and himself were responsible for the foundation of BAPS”. This seems at variance with the facts which had been published by Innes Williams who had been appointed a year earlier as Twistington Higgin’s successor at Hospital for Sick Children, Great Ormond Street (London). He was certainly in a position to know much of the detailed background for the establishment of the BAPS. 1. Before “Paediatric Surgery” Paediatrics as a term had arrived from the continent in the second half of the 19th century. Before that the preferred term was “the surgery of children or childhood”. The first English treatise was written ⁎ Corresponding author at: Robert Carachi, Surgical Paediatrics, Royal Hospital for Sick Children, Dalnair Street Yorkhill, G3 8SJ Glasgow, UK. E-mail address: [email protected] (R. Carachi). ✠ Deceased. 0022-3468/$ – see front matter http://dx.doi.org/10.1016/j.jpedsurg.2013.11.032
by J Cooper Forster, in 1860 in which he recorded lengthy details of the surgery of children [4]. These were based on his extensive experience at Guy’s Hospital and the Royal Waterloo clinic and were a historical record that has rarely been given credit. Johnston from Great Ormond Street also published a series of three papers in the British Medical Journal of 1860 on the “Surgery of Childhood” [5]. Surgeons were a little slow to change to the new terminology and many did not do so until well into the 20th century.
1.1. The First Wave Edinburgh has always had an international reputation in the medical world. There had been extensive communication between Scots-trained doctors and the main centres on the continent. Paediatrics as a specialty spread across Europe in the 19th century with the development of children’s hospitals in Paris, Vienna and others. The first wave of surgeons specialising in the surgery of children emerged early in the 20th century. In Scotland, these were individuals such as Hector MacLennan, Matthew White, Miss Gertrude Herzfeld and John Fraser. The latter published two volumes on the “Surgery of Childhood” in 1926 [6]. White and Mason Brown, each early paediatric surgeons, were offered posts as chief in their adult teaching hospitals in the 1930s but preferred to stay with paediatric surgery rather than move to a general surgery unit. In London, Thomas Twistington Higgins [7] was appointed as a junior surgeon to the HSC in 1912 and then to the staff in 1919. He faithfully served this hospital for many decades and was the senior surgeon from 1944 until his retirement in 1952. After he retired from his appointment to the Royal Northern Hospital and any adult commitments in 1930 [8] as his obituary puts it he became “the first paediatric surgeon in England”. Together with D I Williams and DF Ellison Nash he produced one of the seminal books on paediatric urology — “The Urology of Childhood” in 1951 [9].
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D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
The Edinburgh graduate Sir Lancelot Barrington-Ward [10] also went to HSC in 1914 before the First World War after holding junior appointments in the north. He subsequently published a book on the “Abdominal Surgery of Children” in 1928. In the preface he made the oft-repeated point that “the adult may be safely treated as a child but the converse can lead to disaster” [11]. This comment was repeated twenty years later by William Ladd in the foreword to Orvar Swenson’s “Pediatric Surgery” textbook. Both Twistington Higgins and Barrington Ward were highly respected surgeons but their personalities were very different from the man who became their colleague — Denis Browne. He was to become a major player in the development of paediatric surgery as a specialty in the London scene. At that time individuals such as William E Ladd, Herbert Coe and Oswald Wyatt were developing the specialty in the United States as later re-told by O’Neil and Fonkalsrud [12]. But, for most surgeons at that time there was no specialisation and the paediatric component of their work accounted for something like 10% of their case load.
1.2. The Second Wave The second group of paediatric surgeons included Denis Browne, the Australian who had settled in London [13]. “DB” as he was known was described by James Crooks, his closest colleague, thus: “He quite rightly deemed himself greatly wronged by lack of recognition of the work which, he knew was true and of basic importance, and it was probably an essential defect in the character of someone like him that he gave not an inch in discussion, and rode high over many of his colleagues, making enemies of them as he went. With a more gentle manner and modest approach he might have had an easy life with his genius acclaimed by everyone, rather than a life of struggle against ignorance and prejudice which, all the same, he greatly enjoyed” [14]. James Mason Brown in Edinburgh and Wallace Denison in Glasgow became influential in Scotland. Around about the time of the Second World War, Robert Gross, Orvar Swenson, Chick EverettKoop and later Hardy Hendren continued the development of the specialty in North America. Denis Browne had a particularly hard time in London — his chosen branch of medicine was one where financial return was relatively small and general surgeons were not keen to pass on cases, either because of the financial loss, non-acceptance of someone else having specialised ability, or because they and their nursing staff simply liked having children around. In this interface between the second and third waves of paediatric surgery, George MacNab was an outstanding example. He concentrated on the relatively unrewarding task of ameliorating the problems of the hydrocephalic [15] and spina bifida children and was responsible for the development of the Society for Research into Hydrocephalus and Spina Bifida.
1.3. The Third Wave David Innes Williams also mentions a third wave of paediatric surgeons. These were surgeons who came into practice after the Second World War and the introduction of the National Health Service (NHS) in Britain. The senior registrar grade was then being introduced as the ultimate training grade and the first two senior registrars at the HSC in London were Harold Nixon and Peter Paul Rickham. Nixon remained in London and Rickham moved to Liverpool to the service established by Isabella Forshall [16], becoming a consultant there in 1952. The list David iIinnes Wiliams published also included Barry O’Donnell in Dublin who was early on the scene when the Association was established, John Atwell and the author. These three may be surviving but were not intimate to the development of BAPS.
2. Early Paediatric Surgical Societies It was interesting that the Scottish Surgical Paediatric Club (later called Society), and the Surgical Section of the American Academy of Pediatrics were established in the same year five years before the BAPS was founded. The Scots group applied to the Board of Governors of the HSC in 1951 for permission to hold their winter meeting at Great Ormond Street. The Board approved of this visit. What is not clear is who the instigator of this meeting was although from memory Twistington Higgins had a significant part. He, then the senior surgeon at the HSC, was described as a perfect gentleman and maintained good relationships with his colleagues not something that could be applied to Sir Denis Browne [13]. Higgins also figures strongly at the second Meeting of BAPS in Glasgow and is mentioned below. 3. Towards BAPS This Scottish visit occurred but the record of those attending is not unfortunately available. All the early documents of the Scottish Paediatric club were lost in the early 70s and no details are given in the HSC minutes. By 1952 Denis Browne had become the senior surgeon and he with some other UK paediatric surgeons attended the Surgical Section of the American Association of Paediatrics (AAP) meeting that autumn. There was discussion of the formation of an association. The group included David Vervat from Holland who was also visiting Britain and America at the time. Rickham with his dynamic approach did much to further the development of the BAPS. Initially he was the Treasurer but then took over from David Waterston the additional duties of Secretary and later was the President. Part of the lack of clarity on the genesis of the BAPS is that the original secretary was described by the first President as a brilliant surgeon and a delightful man but a poor secretary! 4. British Association of Paediatric Surgeons The Foundation Members are shown in Table 1. The late Valentine Swain, a surgeon at the Queen Elizabeth Hospital, Hackney (London), wrote a booklet for publication, the cost of which was supported by some instrument firms (personal communication V Swain 1981). This “Genesis of the British Association of Paediatric Surgeons” does record that in November 1953 at a special meeting in GOS agreement on the formation of the association was approved with the initial committee of the BAPS formed in 1953. The Foundation Members included two ladies, Miss Isabella Forshall who had built up the Liverpool Paediatric Surgery Centre and to which Peter Rickham had been appointed in 1952 as a consultant [16] and Miss Rosie MacKay from Edinburgh. The appointments made were that Denis Browne would be the President, with an Executive Committee of Mason Brown, Nixon, Waterston and Rickham. The Honorary Secretary was to be Waterston and the Honorary Treasurer Rickham. A view put forward by David Vervat and supported by Peter Rickham was that the association would be an international one as individuals in many countries had no significant support. There was support for this to be a meeting place
Table 1 Foundation members of BAPS, 1953. J Aitken D Browne J J Mason Brown S L Davidson W M Dennison Miss I Forshall A Jolleys
Miss R M Mackay A P Laird H H Nixon P P Rickham F H Robarts D Waterston R B Zachary
D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
for paediatric surgeons where their mutual or separate problems could be discussed. This international aspect expanded very quickly, and a parochial outlook avoided, unlike that of their medical paediatric colleagues for instance. The objects of the newly formed BAPS were: 1. The advancement of the study, practice and research in paediatric surgery. 2. The promotion of the teaching of paediatric surgery, both under-graduate and post-graduate and advice on the training of paediatric surgeons.
253
3. Advice on matters concerning the paediatric surgical services in the British Isles. 4. The promotion of friendship with paediatric surgeons overseas.
4.1. First Meeting The inaugural meeting was held in the Royal College of Surgeons of England and at the HSC, Great Ormond Street (Fig. 1A–D) in 1953. There was a full range of topics as expected with lectures on hiatus hernia, neonatal bowel obstruction and talipes but it also included a
Fig. 1. (A–D) Programme and arrangements for the inaugural meeting of BAPS in London, 1954.
254
D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
live televisual presentation from the operating theatre! It also attracted impressive speakers from outside the community; the programme includes Prof. Ian Aird who had been appointed as the first academic surgical professor at the Hammersmith Hospital, London in 1946. He addressed the meeting and presented a film on “Surgery of Conjoined Twins” — a subject famous in Britain at the time as the twins (Boko and Tomo) were the first to be separated in this country. The meeting did have a very strong international aspect as can be seen from the program with Thomas Ehrenpreis from Stockholm lecturing on Hirschsprung’s disease for instance. This aspect expanded and in the 1990s in Jersey at the 15th BAPS meeting over twice as many registrants were from overseas as from the UK. At that time many brought with them family as there was a strong social as well as a scientific aspect. 4.2. Second Meeting The second meeting was to be held in Scotland and Mason Brown and Dennison arranged for Glasgow to be the venue at a time in the summer when Denis Browne had already made plans to be out of the country! DB was the President of the Association and had offered his support in organising the meeting but was evidently not required. Matthew White who retired in 1954 after being at the Royal Hospital for Sick Children, Glasgow from 1919 was listed as the president. In fact it was planned for him to be Chairman for the Glasgow meeting but it was unfortunate that ill health kept him away from most of the proceedings. It was also interesting that Twistington Higgins was invited as a special guest to this meeting and made a poetic speech at the annual dinner (Fig. 2). This poetic approach was more than matched by Wallace Dennison in his reply (Fig. 2). 4.3. Third Meeting
Fig. 1 (continued).
This was to be the first meeting of the combined groups from BAPS and the Surgical Section of the American Academy of Pediatrics meeting in 1956. The international contributions indicate how quickly
Fig. 2. After-dinner speeches at the 2nd BAPS in Glasgow, 1955 (Left by Twistington Higgins, right by Dennison).
D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
255
Fig. 3. (A–C) Programme and arrangements for 3rd meeting of BAPS and Surgical section of AAP in London, 1956.
the BAPS had filled an important area in which paediatric problems could be freely discussed. William Mustard (Toronto, Canada) presented the Simpson Smith Lecture (still extant) on the surgery of Total Anomalous Pulmonary Venous Drainage; Fritz Rehbein (Bremen, West Germany) presented a short paper on Funnel Chest and M Sulaama from Helskini (Finland) showed a film on surgical correction of ectopic cordis (Fig. 3A–C). Not all the communications were serious and certain individuals became known and appreciated over the years for their standard of public disagreement. Harvey Beardmore and Mark Ravitch for
example stimulated considerable laughter but also were thought provoking individuals who enlivened discussions. 4.4. Subsequent Meetings A decade later in 1965 a second combined meeting was held in Edinburgh following the death of Mason Brown. He was President of BAPS and also the President of the Royal College of Surgeons of Edinburgh. Wallace Dennison was elected to fill the vacancy in BAPS. This meeting with Larry Pickett as the Chairman of the American
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Fig. 3 (continued).
Surgical Section was a particularly eventful Meeting. Steve Gans, at the Council meeting, proposed the establishment of the Journal of Pediatric Surgery and sought backing from the BAPS Council. This he obtained subject to the Surgical Section of the AAP also agreeing to support the Journal at their autumn meeting. Steve had arranged for Chick Koop to be the Editor-in-Chief as he needed support from the east side of the USA to satisfy the publishers. The Journal of Pediatric Surgery has been a huge success and Steve Gans has been followed after his untimely death by Jay Grosfeld. Jay seems to have been able to find 30 hours in each day!! The Journal appeared in 1966 and took over publishing proceedings of BAPS annual meetings from the Archives of Diseases of Children. Koop was a firm supporter of the BAPS and attended regularly until health reasons and political
appointment made travel difficult. He was appointed by Ronald Reagan as the Surgeon General in the USA and was clearly the most outstanding and productive Surgeon General they had ever had. Fig. 4 illustrates the council members of BAPS from 1975. 4.5. BAPS Crest There seems to be a fixation in the minds of some paediatric surgeons on conjoined twins and at the time it certainly captured the general public’s interest. The first of the many excellent illustrations Peter Rickham had in his 2002 paper [3] was that of Johannes Fatio who was said to be the first to separate conjoined twins in the 17th century [17]. Rickham recalls that in about 1955 it
Fig. 4. Undated photograph from a BAPS Council but includes 10 who have been presidents (1975).
D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
was agreed a crest should be established. Initially he came up with a design related to this first surgeon to separate conjoined twins. Wallace Dennison took this to a crest designer friend and had it refined to the current design.
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My thanks are also due to Wallace M Dennison who was my mentor and who introduced me to so many senior participants in paediatric surgery giving me a wide knowledge of their background. References
5. Conclusions Paediatric surgery evolved over a century and the last 60 years were an opportune time for the development of the BAPS. The international character of the society was an outstanding success and key characteristic and many surgeons from around the world have contributed to its success. The future poses many fresh challenges. Increasing political regulatory forces have been inflicted on the profession and require professional responses. Rather naive measures of assessment have become a major challenge as are some of the controls to which trainees are subjected. A balance between adequate service provision and the development of ultra-specialist skills which require constant practice and full exposure needs resolving. Acknowledgments I would like to acknowledge Robert Carachi especially in the final presentation of this text. My thanks to him and his family and to my colleagues for their extensive support over many years especially in these sad times.
[1] Scientific American. The automobile; Nov. 1909. [2] Williams DI. In the beginning. J Pediatr Surg 2003;38(Suppl 1):6–9. [3] Rickham PP. The dawn of modern paediatric surgery and the man who made it possible. J Jpn Soc Pediater Surg 2002;38:1–13. [4] Cooper Forster J. The surgical diseases of children; 1860. [5] Johnston A. Surgery of childhood. Br Med J 1861(i):1–14 [41–47 and 61–63]. [6] Fraser J. Surgery of childhood, vol I And vol II. London: Edward Arnold & Co.; 1926. [7] Anon. Obituary of TH Twistington Higgins. Br Med J 1966(ii):177–8. [8] Anon. Obituary of TH Twistington Higgins. Ann R Coll Surg Engl 1966;39:260–2. [9] Twistington Higgins T, Williams DI, Nash DFE. The urology of childhood. London: Butterworth; 1951. [10] Anon. Obituary of Sir Launcelot Barrington Ward. Br Med J 28th Nov. 1953:1221 [VOL]. [11] Barrington Ward LE. Abdominal surgery of children. Oxford University Press; 1928 vii [11]. [12] O’Neil JR, Fonkalsrud EW. A history of surgical paediatrics. In: Carachi R, Young DG, Buyukunal C, editors. New Jersey & London: World Scientific; 2009. p. 507–17. [13] Smith ED. A history of surgical paediatrics. In: Carachi R, Young DG, Buyukunal C, editors. New Jersey, London: World Scientific; 2009. p. 525–6. [14] Crooks J. Selected writings of Sir Denis BrowneIn: Nixon H, Waterston D, Wink AS, editors. 1983. p. 1. [15] Macnab GH. Hydrocephalus of infancy. British Surgical Practice, 5. Surgical progress; 1961. p. 98–128. [16] Madhotra D, Makura Z, Clarke R. British society for the history of ENT; history of Alder Hey hospital. J Laryngol Otol 2004;116:406. [17] Rickham PP. The history of pediatric surgery: Johannes Fatio (1649–1691)—his life, his work and his horrible end. Prog Pediatr Surg 1986;20:94–105.
Contents lists available at ScienceDirect
Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg
BAPS 60th Anniversary Historical Review
From where did the BAPS emerge? Daniel G. Young ✠,⁎ a r t i c l e
i n f o
Article history: Received 30 October 2013 Accepted 9 November 2013 Key words: Medical societies History British Association of Paediatric Surgeons
a b s t r a c t This is a personal account of the emergence of the British Association of Paediatric Surgeons (BAPS), one of the oldest of the specialty associations. It was formed in 1953 by like-minded professionals from around the UK, and its first meeting was held in and around the Hospital for Sick Children, London, in the summer of 1954. It included many surgeons from around the world eager to share experience of the challenges of this new surgical discipline. The BAPS had four aims: the advancement of the study, practice, and research in paediatric surgery, the promotion of the teaching of paediatric surgery, both under-graduate and post-graduate, and advice on the training of paediatric surgeons, advice on matters concerning the paediatric surgical services in the British Isles, and fourthly, the promotion of friendship with paediatric surgeons overseas.
The Scientific American for 2nd November 1909 recorded that “the automobile has practically reached the limit of its development is suggested by the fact that during the last year no improvements of a radical nature have been introduced” [1]. This bold statement, with the passage of time, has been proven to be quite inaccurate. Similar misconceptions have occurred in many medical situations and this paper is an attempt to clarify the evolution of the British Association of Paediatric Surgeons (BAPS). It was a challenge, writing on its 60th anniversary, to try and find actual facts on the genesis of the BAPS. Sir David Innes Williams commented in our 50th anniversary supplement that “personal recollections are notoriously fallible” [2]. An account of the origin of the BAPS has been subject to various inaccuracies, as suggested by Sir David, and the content of Peter Paul Rickham’s paper [3] as presented in Japan may have contributed a little to that. His paper contains a magnificent collection of photographs of the paediatric surgeons of the time and he reports that “David Waterston, Bob Zachary, Denis Browne and himself were responsible for the foundation of BAPS”. This seems at variance with the facts which had been published by Innes Williams who had been appointed a year earlier as Twistington Higgin’s successor at Hospital for Sick Children, Great Ormond Street (London). He was certainly in a position to know much of the detailed background for the establishment of the BAPS. 1. Before “Paediatric Surgery” Paediatrics as a term had arrived from the continent in the second half of the 19th century. Before that the preferred term was “the surgery of children or childhood”. The first English treatise was written ⁎ Corresponding author at: Robert Carachi, Surgical Paediatrics, Royal Hospital for Sick Children, Dalnair Street Yorkhill, G3 8SJ Glasgow, UK. E-mail address: [email protected] (R. Carachi). ✠ Deceased. 0022-3468/$ – see front matter http://dx.doi.org/10.1016/j.jpedsurg.2013.11.032
by J Cooper Forster, in 1860 in which he recorded lengthy details of the surgery of children [4]. These were based on his extensive experience at Guy’s Hospital and the Royal Waterloo clinic and were a historical record that has rarely been given credit. Johnston from Great Ormond Street also published a series of three papers in the British Medical Journal of 1860 on the “Surgery of Childhood” [5]. Surgeons were a little slow to change to the new terminology and many did not do so until well into the 20th century.
1.1. The First Wave Edinburgh has always had an international reputation in the medical world. There had been extensive communication between Scots-trained doctors and the main centres on the continent. Paediatrics as a specialty spread across Europe in the 19th century with the development of children’s hospitals in Paris, Vienna and others. The first wave of surgeons specialising in the surgery of children emerged early in the 20th century. In Scotland, these were individuals such as Hector MacLennan, Matthew White, Miss Gertrude Herzfeld and John Fraser. The latter published two volumes on the “Surgery of Childhood” in 1926 [6]. White and Mason Brown, each early paediatric surgeons, were offered posts as chief in their adult teaching hospitals in the 1930s but preferred to stay with paediatric surgery rather than move to a general surgery unit. In London, Thomas Twistington Higgins [7] was appointed as a junior surgeon to the HSC in 1912 and then to the staff in 1919. He faithfully served this hospital for many decades and was the senior surgeon from 1944 until his retirement in 1952. After he retired from his appointment to the Royal Northern Hospital and any adult commitments in 1930 [8] as his obituary puts it he became “the first paediatric surgeon in England”. Together with D I Williams and DF Ellison Nash he produced one of the seminal books on paediatric urology — “The Urology of Childhood” in 1951 [9].
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D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
The Edinburgh graduate Sir Lancelot Barrington-Ward [10] also went to HSC in 1914 before the First World War after holding junior appointments in the north. He subsequently published a book on the “Abdominal Surgery of Children” in 1928. In the preface he made the oft-repeated point that “the adult may be safely treated as a child but the converse can lead to disaster” [11]. This comment was repeated twenty years later by William Ladd in the foreword to Orvar Swenson’s “Pediatric Surgery” textbook. Both Twistington Higgins and Barrington Ward were highly respected surgeons but their personalities were very different from the man who became their colleague — Denis Browne. He was to become a major player in the development of paediatric surgery as a specialty in the London scene. At that time individuals such as William E Ladd, Herbert Coe and Oswald Wyatt were developing the specialty in the United States as later re-told by O’Neil and Fonkalsrud [12]. But, for most surgeons at that time there was no specialisation and the paediatric component of their work accounted for something like 10% of their case load.
1.2. The Second Wave The second group of paediatric surgeons included Denis Browne, the Australian who had settled in London [13]. “DB” as he was known was described by James Crooks, his closest colleague, thus: “He quite rightly deemed himself greatly wronged by lack of recognition of the work which, he knew was true and of basic importance, and it was probably an essential defect in the character of someone like him that he gave not an inch in discussion, and rode high over many of his colleagues, making enemies of them as he went. With a more gentle manner and modest approach he might have had an easy life with his genius acclaimed by everyone, rather than a life of struggle against ignorance and prejudice which, all the same, he greatly enjoyed” [14]. James Mason Brown in Edinburgh and Wallace Denison in Glasgow became influential in Scotland. Around about the time of the Second World War, Robert Gross, Orvar Swenson, Chick EverettKoop and later Hardy Hendren continued the development of the specialty in North America. Denis Browne had a particularly hard time in London — his chosen branch of medicine was one where financial return was relatively small and general surgeons were not keen to pass on cases, either because of the financial loss, non-acceptance of someone else having specialised ability, or because they and their nursing staff simply liked having children around. In this interface between the second and third waves of paediatric surgery, George MacNab was an outstanding example. He concentrated on the relatively unrewarding task of ameliorating the problems of the hydrocephalic [15] and spina bifida children and was responsible for the development of the Society for Research into Hydrocephalus and Spina Bifida.
1.3. The Third Wave David Innes Williams also mentions a third wave of paediatric surgeons. These were surgeons who came into practice after the Second World War and the introduction of the National Health Service (NHS) in Britain. The senior registrar grade was then being introduced as the ultimate training grade and the first two senior registrars at the HSC in London were Harold Nixon and Peter Paul Rickham. Nixon remained in London and Rickham moved to Liverpool to the service established by Isabella Forshall [16], becoming a consultant there in 1952. The list David iIinnes Wiliams published also included Barry O’Donnell in Dublin who was early on the scene when the Association was established, John Atwell and the author. These three may be surviving but were not intimate to the development of BAPS.
2. Early Paediatric Surgical Societies It was interesting that the Scottish Surgical Paediatric Club (later called Society), and the Surgical Section of the American Academy of Pediatrics were established in the same year five years before the BAPS was founded. The Scots group applied to the Board of Governors of the HSC in 1951 for permission to hold their winter meeting at Great Ormond Street. The Board approved of this visit. What is not clear is who the instigator of this meeting was although from memory Twistington Higgins had a significant part. He, then the senior surgeon at the HSC, was described as a perfect gentleman and maintained good relationships with his colleagues not something that could be applied to Sir Denis Browne [13]. Higgins also figures strongly at the second Meeting of BAPS in Glasgow and is mentioned below. 3. Towards BAPS This Scottish visit occurred but the record of those attending is not unfortunately available. All the early documents of the Scottish Paediatric club were lost in the early 70s and no details are given in the HSC minutes. By 1952 Denis Browne had become the senior surgeon and he with some other UK paediatric surgeons attended the Surgical Section of the American Association of Paediatrics (AAP) meeting that autumn. There was discussion of the formation of an association. The group included David Vervat from Holland who was also visiting Britain and America at the time. Rickham with his dynamic approach did much to further the development of the BAPS. Initially he was the Treasurer but then took over from David Waterston the additional duties of Secretary and later was the President. Part of the lack of clarity on the genesis of the BAPS is that the original secretary was described by the first President as a brilliant surgeon and a delightful man but a poor secretary! 4. British Association of Paediatric Surgeons The Foundation Members are shown in Table 1. The late Valentine Swain, a surgeon at the Queen Elizabeth Hospital, Hackney (London), wrote a booklet for publication, the cost of which was supported by some instrument firms (personal communication V Swain 1981). This “Genesis of the British Association of Paediatric Surgeons” does record that in November 1953 at a special meeting in GOS agreement on the formation of the association was approved with the initial committee of the BAPS formed in 1953. The Foundation Members included two ladies, Miss Isabella Forshall who had built up the Liverpool Paediatric Surgery Centre and to which Peter Rickham had been appointed in 1952 as a consultant [16] and Miss Rosie MacKay from Edinburgh. The appointments made were that Denis Browne would be the President, with an Executive Committee of Mason Brown, Nixon, Waterston and Rickham. The Honorary Secretary was to be Waterston and the Honorary Treasurer Rickham. A view put forward by David Vervat and supported by Peter Rickham was that the association would be an international one as individuals in many countries had no significant support. There was support for this to be a meeting place
Table 1 Foundation members of BAPS, 1953. J Aitken D Browne J J Mason Brown S L Davidson W M Dennison Miss I Forshall A Jolleys
Miss R M Mackay A P Laird H H Nixon P P Rickham F H Robarts D Waterston R B Zachary
D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
for paediatric surgeons where their mutual or separate problems could be discussed. This international aspect expanded very quickly, and a parochial outlook avoided, unlike that of their medical paediatric colleagues for instance. The objects of the newly formed BAPS were: 1. The advancement of the study, practice and research in paediatric surgery. 2. The promotion of the teaching of paediatric surgery, both under-graduate and post-graduate and advice on the training of paediatric surgeons.
253
3. Advice on matters concerning the paediatric surgical services in the British Isles. 4. The promotion of friendship with paediatric surgeons overseas.
4.1. First Meeting The inaugural meeting was held in the Royal College of Surgeons of England and at the HSC, Great Ormond Street (Fig. 1A–D) in 1953. There was a full range of topics as expected with lectures on hiatus hernia, neonatal bowel obstruction and talipes but it also included a
Fig. 1. (A–D) Programme and arrangements for the inaugural meeting of BAPS in London, 1954.
254
D.G. Young / Journal of Pediatric Surgery 49 (2014) 251–257
live televisual presentation from the operating theatre! It also attracted impressive speakers from outside the community; the programme includes Prof. Ian Aird who had been appointed as the first academic surgical professor at the Hammersmith Hospital, London in 1946. He addressed the meeting and presented a film on “Surgery of Conjoined Twins” — a subject famous in Britain at the time as the twins (Boko and Tomo) were the first to be separated in this country. The meeting did have a very strong international aspect as can be seen from the program with Thomas Ehrenpreis from Stockholm lecturing on Hirschsprung’s disease for instance. This aspect expanded and in the 1990s in Jersey at the 15th BAPS meeting over twice as many registrants were from overseas as from the UK. At that time many brought with them family as there was a strong social as well as a scientific aspect. 4.2. Second Meeting The second meeting was to be held in Scotland and Mason Brown and Dennison arranged for Glasgow to be the venue at a time in the summer when Denis Browne had already made plans to be out of the country! DB was the President of the Association and had offered his support in organising the meeting but was evidently not required. Matthew White who retired in 1954 after being at the Royal Hospital for Sick Children, Glasgow from 1919 was listed as the president. In fact it was planned for him to be Chairman for the Glasgow meeting but it was unfortunate that ill health kept him away from most of the proceedings. It was also interesting that Twistington Higgins was invited as a special guest to this meeting and made a poetic speech at the annual dinner (Fig. 2). This poetic approach was more than matched by Wallace Dennison in his reply (Fig. 2). 4.3. Third Meeting
Fig. 1 (continued).
This was to be the first meeting of the combined groups from BAPS and the Surgical Section of the American Academy of Pediatrics meeting in 1956. The international contributions indicate how quickly
Fig. 2. After-dinner speeches at the 2nd BAPS in Glasgow, 1955 (Left by Twistington Higgins, right by Dennison).
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Fig. 3. (A–C) Programme and arrangements for 3rd meeting of BAPS and Surgical section of AAP in London, 1956.
the BAPS had filled an important area in which paediatric problems could be freely discussed. William Mustard (Toronto, Canada) presented the Simpson Smith Lecture (still extant) on the surgery of Total Anomalous Pulmonary Venous Drainage; Fritz Rehbein (Bremen, West Germany) presented a short paper on Funnel Chest and M Sulaama from Helskini (Finland) showed a film on surgical correction of ectopic cordis (Fig. 3A–C). Not all the communications were serious and certain individuals became known and appreciated over the years for their standard of public disagreement. Harvey Beardmore and Mark Ravitch for
example stimulated considerable laughter but also were thought provoking individuals who enlivened discussions. 4.4. Subsequent Meetings A decade later in 1965 a second combined meeting was held in Edinburgh following the death of Mason Brown. He was President of BAPS and also the President of the Royal College of Surgeons of Edinburgh. Wallace Dennison was elected to fill the vacancy in BAPS. This meeting with Larry Pickett as the Chairman of the American
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Fig. 3 (continued).
Surgical Section was a particularly eventful Meeting. Steve Gans, at the Council meeting, proposed the establishment of the Journal of Pediatric Surgery and sought backing from the BAPS Council. This he obtained subject to the Surgical Section of the AAP also agreeing to support the Journal at their autumn meeting. Steve had arranged for Chick Koop to be the Editor-in-Chief as he needed support from the east side of the USA to satisfy the publishers. The Journal of Pediatric Surgery has been a huge success and Steve Gans has been followed after his untimely death by Jay Grosfeld. Jay seems to have been able to find 30 hours in each day!! The Journal appeared in 1966 and took over publishing proceedings of BAPS annual meetings from the Archives of Diseases of Children. Koop was a firm supporter of the BAPS and attended regularly until health reasons and political
appointment made travel difficult. He was appointed by Ronald Reagan as the Surgeon General in the USA and was clearly the most outstanding and productive Surgeon General they had ever had. Fig. 4 illustrates the council members of BAPS from 1975. 4.5. BAPS Crest There seems to be a fixation in the minds of some paediatric surgeons on conjoined twins and at the time it certainly captured the general public’s interest. The first of the many excellent illustrations Peter Rickham had in his 2002 paper [3] was that of Johannes Fatio who was said to be the first to separate conjoined twins in the 17th century [17]. Rickham recalls that in about 1955 it
Fig. 4. Undated photograph from a BAPS Council but includes 10 who have been presidents (1975).
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was agreed a crest should be established. Initially he came up with a design related to this first surgeon to separate conjoined twins. Wallace Dennison took this to a crest designer friend and had it refined to the current design.
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My thanks are also due to Wallace M Dennison who was my mentor and who introduced me to so many senior participants in paediatric surgery giving me a wide knowledge of their background. References
5. Conclusions Paediatric surgery evolved over a century and the last 60 years were an opportune time for the development of the BAPS. The international character of the society was an outstanding success and key characteristic and many surgeons from around the world have contributed to its success. The future poses many fresh challenges. Increasing political regulatory forces have been inflicted on the profession and require professional responses. Rather naive measures of assessment have become a major challenge as are some of the controls to which trainees are subjected. A balance between adequate service provision and the development of ultra-specialist skills which require constant practice and full exposure needs resolving. Acknowledgments I would like to acknowledge Robert Carachi especially in the final presentation of this text. My thanks to him and his family and to my colleagues for their extensive support over many years especially in these sad times.
[1] Scientific American. The automobile; Nov. 1909. [2] Williams DI. In the beginning. J Pediatr Surg 2003;38(Suppl 1):6–9. [3] Rickham PP. The dawn of modern paediatric surgery and the man who made it possible. J Jpn Soc Pediater Surg 2002;38:1–13. [4] Cooper Forster J. The surgical diseases of children; 1860. [5] Johnston A. Surgery of childhood. Br Med J 1861(i):1–14 [41–47 and 61–63]. [6] Fraser J. Surgery of childhood, vol I And vol II. London: Edward Arnold & Co.; 1926. [7] Anon. Obituary of TH Twistington Higgins. Br Med J 1966(ii):177–8. [8] Anon. Obituary of TH Twistington Higgins. Ann R Coll Surg Engl 1966;39:260–2. [9] Twistington Higgins T, Williams DI, Nash DFE. The urology of childhood. London: Butterworth; 1951. [10] Anon. Obituary of Sir Launcelot Barrington Ward. Br Med J 28th Nov. 1953:1221 [VOL]. [11] Barrington Ward LE. Abdominal surgery of children. Oxford University Press; 1928 vii [11]. [12] O’Neil JR, Fonkalsrud EW. A history of surgical paediatrics. In: Carachi R, Young DG, Buyukunal C, editors. New Jersey & London: World Scientific; 2009. p. 507–17. [13] Smith ED. A history of surgical paediatrics. In: Carachi R, Young DG, Buyukunal C, editors. New Jersey, London: World Scientific; 2009. p. 525–6. [14] Crooks J. Selected writings of Sir Denis BrowneIn: Nixon H, Waterston D, Wink AS, editors. 1983. p. 1. [15] Macnab GH. Hydrocephalus of infancy. British Surgical Practice, 5. Surgical progress; 1961. p. 98–128. [16] Madhotra D, Makura Z, Clarke R. British society for the history of ENT; history of Alder Hey hospital. J Laryngol Otol 2004;116:406. [17] Rickham PP. The history of pediatric surgery: Johannes Fatio (1649–1691)—his life, his work and his horrible end. Prog Pediatr Surg 1986;20:94–105.
